Smoke Free Homes
Creating a healthy, smoke-free environment in the earliest years of life is fundamental to giving every child the best possible start. Smoking in pregnancy, postnatal relapse, and exposure to second-hand smoke remain significant and preventable contributors to poor maternal and child health outcomes, particularly in areas experiencing entrenched inequalities. In the South West, rates of smoking at the time of delivery remain above national targets, reinforcing the need for system-wide, evidence-based action.
Led by the South West Association of Directors of Public Health and the Office for Health Improvement and Disparities and developed collaboratively with local authorities, NHS colleagues, maternity services, health visiting teams and smoking cessation specialists, a Sector Led Improvement (SLI) project was developed to strengthen regional approaches to supporting smoke-free homes in the postnatal period. This work aimed to identify variation, share best practice and develop practical guidance that can be adapted locally.
The project focused on the critical transition from maternity to health visiting services, recognising this as a key opportunity to sustain smoking cessation, prevent relapse and reduce infant exposure to second-hand smoke. Through benchmarking, practitioner insight and alignment with national guidance, the work highlighted areas for improvement including communication and handover processes, carbon monoxide monitoring, workforce training, referral pathways, resources, and data collection.
The resulting guidance provides a clear and pragmatic framework to support local areas in strengthening their health visiting pathways and developing standard operating procedures for smoke-free homes. It is intended as a supportive tool rather than a prescriptive model, enabling systems across the South West to continue to learn from one another and make measurable improvements for babies, parents and families.
Evaluation and Learning
To understand how the guidance was being received and implemented across the South West, an evaluation survey was undertaken in late 2024 as a follow‑up to the original practice improvement work. The survey sought feedback from health visitors, service leads, commissioners and public health practitioners on awareness, usefulness and local embedding of the Guidance for Delivering Smoke‑Free Homes.
The findings provide valuable insight into how the guidance has been used in practice, highlighting areas of progress alongside ongoing challenges. While awareness and use at a strategic level were generally strong, the evaluation identified variation in frontline awareness and implementation, particularly relating to communication and handover between maternity and health visiting services, capacity, training, access to carbon monoxide monitoring, and data systems.
Importantly, the evaluation also captured examples of positive local practice, strong partnership working and emerging improvements, helping to inform next steps at both regional and local levels. The learning from this work is being used to shape further activity, strengthen system leadership, and inform future iterations of guidance and support.
The evaluation work was also showcased by Russ Moody – Health & Wellbeing Programme Lead OHID via a mini oral presentation at the South West Public Health Scientific Conference on the 18th March 2026.