Two Decades on the Frontline: A Personal Reflection on 25 Years of Stop Smoking Services
I’m Joanna Feeney and I’m the Stop Smoking Strategic Manager at Fresh.
In nearly 20 years, smoking rates in the North East have seen one of the biggest falls in the country. In that time the landscape around the awareness of the risks – and the support available – have been transformed.
Looking back, my first day on the frontline of supporting smokers to stop in January 2007 feels like a world away. My own father had died from lung cancer – a motivation in itself at the waste of life.
As a Pregnancy Specialist Advisor in Easington, I was confronted with a daunting reality: more than one in three pregnant women were smoking at the time of delivery. I was based in some of the first Sure Start centres, delivering weekly clinics alongside midwives and working face-to-face to support expectant parents in some of our most deprived communities. That was the beginning of a remarkable nearly 20-year journey, and a testament to the extraordinary evolution of stop smoking services.
Back then, Stop Smoking Services were commissioned through Primary Care Trusts, and our work focused on large-scale community clinics, drop-ins, and group support. But services – and the world around them – were changing. When County Durham’s services merged into a single unified Stop Smoking Service, I was part of that transition, adapting delivery and embracing new guidance that shaped our approach.
One of the most impactful moments in my career was the implementation of NICE PH10 Smoking in Pregnancy guidance, and helping to lead the phase one launch of the regional BabyClear approach. We worked closely with County Durham & Darlington Foundation Trust maternity services, and in 2012, we expanded this work and trained all Maternity Support Workers to deliver stop smoking support directly as part of their roles. This was pioneering at the time – embedding tobacco dependency treatment into maternity care.
This initial work on the ground laid the foundation for bigger, more systemic changes. In 2013, we broke further ground by providing in-reach support to patients at University Hospital North Durham. Whilst this service was specifically aimed at supporting Respiratory, Cardiology and Surgical patients – it wasn’t just about offering help; it was about starting a cultural change that would, nearly a decade later, see the full embedding of tobacco dependency treatment in secondary care.
The following year, I moved into a leadership role as Stop Smoking Service Manager for South Tees. I championed a new nurse-led model and worked across Primary Care, training providers in GP surgeries and community pharmacies to increase accessibility.
We continued to expand our reach through bespoke training and referral pathways with maternity, health visiting, family support, pre-assessment, neo-natal and contraception services. To reach populations with high smoking rates who weren’t accessing our universal services, we developed bespoke solutions, including training substance misuse services to deliver their own support.
Times were still changing and we moved from paper-based systems to a new digital data system, allowing us to utilise data for service improvement and re-engage clients who had dropped out or relapsed through automated texts. As the service grew we needed to adapt to ensure that all stop smoking medications were accessible to all regardless of where the accessed support so we established a community pharmacy PGD for varenicline.
In 2018, I was seconded to Fresh to lead on the ambitious drive for a Smokefree NHS. Working alongside a dedicated clinical lead and our newly formed regional Smokefree NHS Taskforce, we gained the endorsement of all 10 Foundation Trusts in the North East for the Smokefree NHS Pledge – a testament to regional collaboration and commitment.
After the publication of the NHS Long Term Plan, I joined the national Public Health England (PHE) Tobacco team, supporting the North East and Yorkshire region to implement its bold commitments. Through the transition to the Office for Health Improvement and Disparities (OHID) and working with the North East & Yorkshire NHSE regional team, I supported our region to become the first in the country with fully established Tobacco Dependency Treatment Services in every Trust. Support was now available in both community and hospital across the region.
In 2024, I returned to Fresh as the Stop Smoking Systems Strategic Manager – continuing the work towards our ambitious goal under the Declaration for a Smokefree Future.
Looking back, I’ve seen the prevalence of smoking fall from 27% in 2000 to just 11% last year—an extraordinary achievement. When services first launched 25 years ago, the North East had the highest smoking prevalence in the country, and we were supporting tens of thousands of people each year in large-scale community clinics. This peaked around 60,000 accessing Stop Smoking Services in the North East in 2010/11 and 2011/12. Today, with smoking prevalence much lower, our work is more targeted and nuanced, focusing on the people most affected by inequality. We now direct our efforts toward those in our most deprived communities, routine and manual workers, people living in social housing, those with mental health conditions, and people using drugs and alcohol.
It’s been inspiring to see how services have adapted over the years with both established and innovative ways of increasing reach and effectiveness:
- Enhanced flexible support with structured “cut down to quit” services.
- Provision of vapes as standard, recognising them as one of the most effective stop smoking aids.
- Use of financial incentive schemes to help maintain engagement for key cohorts.
- Evidence-based digital interventions like the Smoke Free app.
- Collaboration across the system between Local Authority Stop Smoking Services, NHS Tobacco Dependency Treatment Services, pharmacies, and others.
My personal connection to this work, driven by the loss of my father to lung cancer, is as strong today as it was on my first day. This personal loss continues to fuel my passion we continue to strive to achieve the national 5% by 2030 ambition. Modelling shows this is within reach if we increase the proportion of people who smoke making a quit attempt every year to 46%, and improve overall quit success rates to 29%. But ultimately, 5% is still far too many of our friends and family smoking, across the region our goal is for a smokefree future, one where no family is torn apart by tobacco
The past 25 years have shown that with bold action, compassion, and unwavering commitment, progress is not just possible – it’s an extraordinary reality. But the story doesn’t end here. The next chapter is about going further, faster, and ensuring that no community is left behind. We have a once-in-a-generation opportunity to make smoking history and protect future generations from the harm caused by tobacco. Achieving a Smokefree Future will take all of us – professionals, partners, communities, and individuals – working together with the same determination that has brought us this far. It’s been a privilege to play my part in this journey, and I invite you to join me in shaping the next 25 years. Together, we can turn ambition into action and realise a future where smoking is no longer the norm, and no family has to experience the pain of losing a loved one to tobacco.