Over recent months we’ve been speaking to NHS trusts at different stages of the journey to becoming tobacco-free.
Implementing smokefree grounds is something that some have struggled with, but there are useful learnings out there too.
A tobacco-free NHS is about creating a ‘new normal’. Since 2007, people haven’t been able to smoke inside any hospital building, and don’t expect to be able to.
Now we need to get them accustomed to not expecting to smoke anywhere on NHS premises.
Hospitals are health promoting environments for all and cannot be a place for a behaviour that leads to the illness and death of so many. Implementing smokefree sites will present differing challenges to different hospital trusts, however the experience of the early adopters shows it can be done.
The reasons for going tobacco free – and the potential outcomes for individuals and families, for patients and for NHS staff – should be compelling for anyone working to improve health and deliver care.
Smoking remains the leading cause of premature death in the UK and is responsible for half of the health gap between the poorest and most affluent communities. We can reach millions of smokers with stop smoking support through our health services – a quarter of all patients occupying beds in acute hospitals smoke.
This is an opportunity that we must embrace and act upon, not only to reduce the huge burden of smoking on the NHS, but to reduce health inequalities and save lives.
Drawing on the national guidance and what we know has worked at local level; here we’ve addressed some of the key questions trusts may have:
How can we enforce a no smoking policy across the grounds?
The easier you make compliance, the less you depend on enforcement.
Staff, patients and visitors should be given sufficient advance warning and clear information so they know what to expect.
Many smokers find e-cigarettes helpful for quitting and staying smokefree and they carry a fraction of the risk of cigarettes. Allowing vaping in all or part of the hospital grounds can support compliance with the smokefree policy.
Making sure a choice of fast acting nicotine replacement therapy is available over the counter from the hospital shop can also help by providing effective treatment of withdrawal.
Obviously, good signage is essential and trusts could consider following the example of Medway NHS Foundation Trust, which created a team of volunteer ‘smokefree champions’ to support smokefree grounds.
The champions are trained to offer practical advice on stopping smoking and can signpost people to quitting support.
What about the costs involved?
Going tobacco-free is about much more than requiring smokers to stand on the other side of the fence to smoke - it is primarily about helping patients and staff who smoke to quit.
There will be initial set-up costs, including new signage, possibly the removal or “repurposing” of existing smoking shelters, creation of communications resources and so on.
Investment may also be needed to put in place improved access to quitting support.
However with fewer hospital admissions, shorter inpatient stays and reduced staff sickness absence, the net financial gains to individual trusts and the NHS overall over the medium and longer term will be substantial.
Hospital patients and their families are going through stressful times – won’t we be seen as lacking compassion?
The key here is changing expectations. At the moment, hospital trusts have differing policies on smoking and this leads to confusion.
With a consistent approach across the NHS, everyone will understand that smoking can’t be allowed or facilitated in a place where they, or their loved ones, have come to get well.
Alongside this, it needs to be made easier for people to comply with the smokefree policy.
Should they need it, hospital inpatients should be provided with immediate support for temporary abstinence, and all patients and staff who smoke should have access to quitting advice and support, including the option of referral for specialist help.
A policy that allows vaping in areas where smoking is not allowed also supports smokers to stay smokefree while on site. NICE has provided guidance on how to use nicotine replacement therapy to support “temporary abstinence” from smoking.
Won’t having to leave the grounds mean staff take longer breaks to smoke?
A tobacco-free trust should be doing all it can to help its staff who smoke to quit or, for those who aren’t ready to stop in one step, to reduce the harm from smoking.
Over time, it can be expected that the number of people requesting smoking breaks will reduce.
Policies that make it a more convenient choice to vape than to smoke can support staff in staying smokefree and help keep them onsite during working hours.
What if having people smoking outside the hospital perimeter brings its own problems?
Some hospitals may encounter issues such as nuisance to neighbouring residential or business premises from cigarette litter.
If the right building blocks are in place for the trust’s tobacco-free policy, the number of people standing smoking outside the hospital gates will be minimised. This includes:
- Clear communications, so that patients and visitors know in advance of coming to the hospital that they won’t be able to smoke onsite
- Onsite quitting advice and support for all patients and staff who smoke
- A vaping policy that makes it an easier and more convenient choice to vape than to smoke. Our advice on e-cigarette use in public places provides organisations with some key evidence-based principles to follow.
Whatever the challenges in implementing smokefree sites and ultimately a tobacco-free NHS, the bottom line is clear: it should never be the job of the NHS to support smokers to smoke.