On World No Tobacco Day, the Royal College of Physicians (RCP) has renewed its call for opt-out tobacco dependency treatment to be introduced across every NHS setting, warning that without urgent action, smoking will continue to cost thousands of lives and billions of pounds to the UK economy every year.
World No Tobacco Day (31 May) is an initiative set up by the World Health Organization to draw global attention to the preventable death and disease caused by smoking.
The RCP's recent report, Smoking, health and social justice, set out the cost and inequality of smoking - nearly £9 billion a year in productivity losses and smoking rates in the most deprived communities running almost five times higher than in the most affluent areas.
Data from the Global Burden Study of Disease 2023 said tobacco is the cause of 12.4% of deaths in the UK each year.
The RCP is calling for opt-out tobacco dependency treatment to be introduced across every NHS setting including emergency departments, primary care, outpatient services and neighbourhood health services. Under this model, everyone who smokes and has contact with the NHS would be automatically referred to quit support unless they choose not to participate.
Evidence from existing NHS opt-out inpatient programmes already shows that when barriers to access are removed, the greatest number of successful quit attempts come from the least advantaged communities delivering both health and economic benefits, and reaching the people the current system fails.
A 2025 survey of UK clinically active RCP members revealed 53% of respondents said at least half of their average caseload consisted of patients whose conditions had been caused or worsened by smoking - a stark reminder of the pressure tobacco places on clinicians and services every single day.
Professor Sanjay Agrawal, RCP special adviser on tobacco and lead author of Smoking, health and social justice, said: 'On World No Tobacco Day, the message is simple: we have to eradicate tobacco use. The intensive care unit I work in and the lung cancer clinics I run are full of people who have come to harm from a lifetime of smoking.
'Smoking's health harms are increasingly concentrated among people already living in poverty, poor health and social exclusion. The health and economic costs fall most heavily on the communities who can least afford them. This reinforces cycles of disadvantage and addressing it is a matter of public and economic urgency.
'Quitting is one of the most transformative things a person can do for their health and finances. But people need to be supported to do this. The around six million smokers in the UK today need opt-out smoking cessation pathways that evidence shows reach the people our current system consistently fails. Every missed opportunity to treat tobacco dependence is a missed chance to save a life.’