Contracting for smoking and pregnancy interventions: current practice across England.

In order to understand the commissioning of smoking and pregnancy interventions across England prior to the implementation of the Government's national strategy, "Smoking Kills: A White Paper on Tobacco" in 1998, a postal survey was undertaken amongst all 96 Health Authorities (purchasers) and 207 Maternity Service Provider Units (providers) in England. The main outcome measures included the type and duration of contract agreements/service specifications, the level and nature of smoking and pregnancy interventions, barriers to commissioning smoking and pregnancy interventions, data collection and monitoring of activity and quality. A quarter of health authorities were encouraging smoking cessation through contract agreements. The level and complexity of contract agreements and service specifications varied tremendously. Existing smoking and pregnancy interventions were diverse and ad hoc. Data collection and monitoring were haphazard and inconsistent making cross-country comparisons difficult. The commissioning of smoking and pregnancy interventions across England during 1997 and 1998 appeared to be inadequately prioritised. These findings offer a benchmark for observing changes in practice following the recent change of government policy.