Contracting for smoking and pregnancy interventions: current practice across England

In order to understand the commissioning of smoking and pregnancy intervent ions across England prior to the implementation of the Government's nationa l strategy, Smoking Kills: A White Paper on Tobacco in 1998, a postal surve y was undertaken amongst all 96 Health Authorities (purchasers) and 207 Mat ernity Service Provider Units (providers) in England. The main outcome meas ures included the type and duration of contract agreements/service specific ations, the level and nature of smoking and pregnancy interventions, barrie rs to commissioning smoking and pregnancy interventions, data collection an d monitoring of activity and duality. A quarter of health authorities were encouraging smoking cessation through contract agreements. The level and complexity of contract agreements and se rvice specifications varied tremendously. Existing smoking and pregnancy in terventions were diverse and ad hoc. Data collection and monitoring were ha phazard and inconsistent making crosscountry comparisons difficult. The commissioning of smoking and pregnancy interventions across England dur ing 1997 and 1998 appeared to be inadequately prioritised. These findings o ffer a benchmark for observing changes in practice following the recent cha nge of government policy.