Smokers huddled outside hospital doors are a common sight since smoking indoors was banned.
Many are sick or caring for others and deserve our greatest compassion, yet continuing to normalise smoking in hospital settings is damaging the health of not just those that our doctors and nurses are trying to help, but of future generations too.
We know that the best way to reduce the devastating impact that smoking continues to have on our population is to make smoking less affordable, less accessible and less acceptable.
The NHS brand is one of the most recognised and trusted in the UK and is a powerful symbol of health and wellbeing.
Just as schools should be free of unhealthy fast foods, there is no place for smoking in the NHS. Banning smoking inside hospitals was an important step, but we must do more.
That is why I wrote to the chief executive of every NHS Trust in England last week, calling for their personal commitment to work with PHE towards a truly tobacco-free NHS.
Although smoking is declining, over 7 million adults in England still smoke and tobacco use remains the largest cause of premature death.
It also accounts for half of the health gap between the poorest and most affluent communities. Smoking causes 96,000 deaths a year in the UK, and for every death caused by smoking, approximately 20 smokers are suffering from a smoking-related disease.
The burden of smoking on the NHS is massive: in 2014-15, around 475,000 hospital admissions in England were attributable to smoking and the total annual cost is estimated at £2bn, with a further £1.1bn in social care costs.
We can reach some of those 7 million smokers through health services; they are in hospital waiting rooms, consulting rooms and beds, and many are NHS staff. As many as 25% of patients in our acute hospital beds are smokers.
A tobacco-free NHS means:
- No smoking anywhere in NHS buildings or grounds
- Stop smoking support offered on site or referrals to local services
- Every frontline professional discussing smoking with their patients
As health professionals, we also have a moral imperative to do all we can to help people give up smoking and increase their chance of living longer, healthier lives.
I believe we can make the NHS a place that provides a supportive tobacco-free environment for patients, staff and visitors, and in which the treatment of tobacco dependence is fully integrated into clinical pathways.
Putting ambition into action
The NHS delivers a fantastic service, day in and day out. However, we know that we need to invest in prevention now in order to avoid stacking up problems for later.
Interventions to support smokers to quit save money – smokers that manage to give up reduce their lifetime cost to the NHS and social care by almost 50%.
Action is already underway to support trusts to become truly tobacco-free:
First, PHE’s Menu of Preventative Interventions for local sustainability and transformation plans recommends evidence-based interventions on smoking that will secure savings and improve the health of local populations.
Second, from next year, all patients coming in for a hospital stay will be asked if they smoke, and if the answer is yes, referred to advice and support on quitting. PHE has commissioned online training on delivering brief advice on smoking from the National Centre for Smoking Cessation and Training and this will be available for all health care professionals.
And third, the British Thoracic Society (BTS) will soon be publishing the first ever comprehensive audit of smoking cessation activity in the NHS. I had a preview of the results and there is a long way to go, but this will provide a benchmark for trusts to measure future progress.
Progress is also variable on implementing the 2013 NICE recommendations for smokefree NHS buildings and grounds and evidence-based quitting support for all patients who smoke, although it is encouraging to see mental health trusts leading the way.
Of course, with e-cigarette use continuing to rise, organisations and employers will also want to update their policies to cover these new products, and PHE has published five principles to use as a guide.
The evidence shows that smoking and vaping are not the same: unlike cigarette smoke, there is no evidence so far that exposure to secondhand vapour is harmful. Furthermore half of vapers in the UK have stopped smoking and around a third of the remainder are using them as part of a quit attempt.
I know that some trusts are already well ahead on tobacco control, and sharing best practice will be important.
Tackling the devastating harm of tobacco is a national priority and the NHS must be front and centre for us to secure a tobacco free generation in England.