A smoker trying to quit in south-east London can access a well-resourced NHS Stop Smoking Service with weekly one-to-one support and free nicotine replacement therapy. A smoker a few miles away in south-west London may find a service running on a fraction of the budget. This is not a hypothetical: it is the documented reality of how stop-smoking support is funded across the capital, and it sits at the centre of the wider determinants of health that the original 2014 "Better Health for London" review identified as central to the city’s prevention agenda.
Stop-smoking services in London are commissioned and funded by individual local authorities through the Public Health grant, not delivered as a single citywide NHS programme. That structure was designed to let boroughs tailor support to local need. In practice, it has produced wide and persistent variation in what a smoker actually receives depending on where they live.
The Borough-by-Borough Patchwork
An analysis by the campaign group Action on Smoking and Health (ASH) found stark differences in per-smoker spending between neighbouring Integrated Care Board areas. NHS South East London allocated £32.11 per smoker in 2025-26, while NHS South West London spent just £1.44 per smoker in the same year, despite South West London recording a higher smoking prevalence. Coverage of the disparity in the BMJ has described the pattern as a "postcode lottery" in cessation support — funding levels that do not track the level of need they are meant to address.
This matters because stop-smoking services are one of the most cost-effective interventions available to public health teams, and because smoking prevalence itself is unevenly distributed across London’s boroughs, tracking closely with the same deprivation patterns that drive differences in respiratory and cardiovascular disease.
What a Well-Resourced Service Actually Offers
Where investment is strongest, the service model looks markedly different from a leaflet and a helpline number. Camden and Islington jointly commission "Breathe — It’s About Living," built on a three-tier structure that follows an established behavioural-support framework for treating tobacco dependence:
| Tier | What it provides | Who it is for |
|---|---|---|
| Tier 1 | Self-support: phone apps, online resources, printed information | Smokers who want to quit independently |
| Tier 2 | Brief clinical support: a minimum of two sessions with a trained professional | Smokers who want light-touch professional input |
| Tier 3 | Intensive one-to-one behavioural support over at least six weeks | Highly tobacco-dependent smokers, repeated failed quit attempts, or complex needs |
Other boroughs have built their own variants of the same idea. Ealing’s Smokefree Service offers weekly sessions with specialists and a full range of nicotine replacement therapy, delivered face-to-face, by phone, or through participating pharmacies. Hammersmith & Fulham runs a free Stop Smoking and Wellbeing Service open to anyone who lives, works, or studies in the borough, with a dedicated pathway for 12–18 year olds and targeted support for pregnant smokers, people with mental health conditions, and people in contact with drug, alcohol, or criminal justice services. Across north-east London, individual boroughs run their own branded services under one ICB umbrella: Smokefree City & Hackney provides twelve weeks of support with a dedicated advisor, while Quit Well Newham offers up to twelve weeks of support and NRT delivered in multiple community languages, including Bengali, Urdu, Gujarati, and Lithuanian, alongside British Sign Language.
The common thread across every well-run service is the same: sustained contact with a trained advisor over weeks, not a single conversation, plus free or subsidised access to nicotine replacement therapy or vapes as a substitute product during the quit attempt.
A National Law Is About to Reshape Local Responsibility
The picture is about to shift, driven not by borough policy but by Westminster. The Tobacco and Vapes Bill has received Royal Assent and introduces what has been called a "smokefree generation" policy: it will become illegal to sell tobacco products to anyone born on or after 1 January 2009, with the effective age of sale rising by a year, every year, from 2027 onwards.
Enforcement of that law falls to local authorities, the same bodies already commissioning stop-smoking support. Council trading standards officers gain the power to issue on-the-spot fines of £100 to retailers caught selling tobacco or vapes to underage customers, on top of the existing maximum £2,500 penalty. The Bill also restricts sales of e-cigarettes, non-nicotine vapes, and other consumer nicotine products to under-18s, and gives ministers powers to introduce registration and licensing schemes for tobacco and vaping retailers — a meaningful expansion of what a borough’s trading standards and public health teams are expected to police.
New Money Against an Old Shortfall
Alongside the enforcement duties comes new funding: the government has committed an additional £70 million per year from 2025-26 to local authority-led stop-smoking services, described as more than doubling existing funding, allocated according to each area’s proportion of smokers so that higher-prevalence boroughs receive a larger share.
That investment arrives after a long period of decline. Public Health grant funding to local authorities in England fell by 26% per person in real terms between 2015/16 and 2023/24, and smoking cessation services specifically absorbed a 45% real-terms cut over the same period. The new money is a partial reversal, not a full one, and whether it becomes a recurring commitment rather than a one-off boost will determine whether boroughs like South West London can close the gap with better-funded neighbours.
The stakes for getting this right are substantial. Smoking is estimated to cost the NHS and social care system around £3.5 billion a year, with a further £21.3 billion lost annually to reduced productivity across England. National modelling behind the smokefree generation policy projects that it could prevent 1.7 million people from taking up smoking by 2075 and avoid 115,000 cases of serious illness — but only if the local infrastructure to support quitting is funded consistently enough to reach every borough, not just the ones that already spend the most.
Conclusion
The 2014 "Better Health for London" review argued that prevention and the wider determinants of health — not just hospital beds — would decide the capital’s long-term health outcomes. A decade on, stop-smoking services are a clear test case: the tools that work are well understood and consistently documented across boroughs, but a smoker’s chance of receiving them still depends heavily on which local authority they happen to live in. New national law will tighten enforcement and add funding, but closing London’s stop-smoking postcode lottery will still come down to whether that money reaches the boroughs currently spending £1.44 per smoker as reliably as it reaches the ones spending £32.11.