Complete NHS smoking ban offers model for employers
Official guidance on making the National Health Service smoke-free by 2006 could provide a model for action by private sector employers.
Learning points NHS hospitals are set to become completely smoke-free by the end of 2006.
Guidance on achieving this has recently been produced, and presents a useful policy template for all employers.
A survey undertaken by the Health Development Agency suggests that many trusts have some way to go in becoming smoke-free; most still have smoking rooms within the hospital.
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The NHS will be smoke-free in less than two years if the government achieves its objectives for public health, recently set out in its Choosing Health white paper1.
But what does "smoke-free" mean, and will parts of the NHS be able to opt out of banning the weed? Not according to official guidance2 for hospital trusts recently published by the Health Development Agency (HDA).
No blanket exemptions
The HDA says that "smoke-free" means that smoking will not be permitted anywhere in hospital buildings, hospital grounds or vehicles.
There will be no exceptions for staff or visitors. Nor will blanket exemptions be allowed for particular categories of patients, as has been the practice. Exceptions may be made on a case-by-case basis for long-stay mental health patients in an acute psychiatric state, or for those who are terminally ill.
Where exceptions are made, every effort should be made to minimise the exposure of staff and other patients to the smoke: "Smoking in these circumstances should occur out of sight of other patients, staff and visitors, and there should be an agreed protocol for risk management."
Ban it in the grounds
The government believes that extending the ban to hospital grounds is "the ultimate standard to which all trusts might aspire to in the near future".
It points out that smoking just outside the entrance to hospital buildings can give a very poor impression, as well as creating a cloud of smoke for patients, staff and visitors to walk through on their way to hospital.
The guidance presents a separate annex setting out the rationale for including grounds in a smoking policy, focusing on the fact that smoke travels into buildings, and that patients "dislike the smell of cigarette smoke on staff if employee smoking is allowed on site".
Some hospitals have built shelters in the grounds where staff, patients and visitors are allowed to smoke, costing an alleged £60,000 in the case of one trust.
The guidance argues these structures are unsightly and undermine policies designed to protect health: "Rather than spend budgets on building shelters, it is much more preferable to invest in advice and support for smokers." A policy template forming part of the guidance suggests that the work areas included in the ban extend to cars leased from the trust during business usage, but not to "the interior of cars owned privately and not being used for business purposes or during business hours".
The guidance also suggests that individual trusts can extend policies to "protect staff from exposure to smoke when making home visits", although no suggestions for how this might work in practice are provided.
The guidance presents five steps to making NHS trusts smoke-free:
gain commitment to the policy: including identifying a champion who will be responsible for implementation (the guidance suggests a clinician, as this group is often difficult to involve in this kind of policy area), and considering the pros and cons of including hospital grounds as well as buildings;
create the policy: including anticipating and dealing with common challenges, such as previous exemptions for particular categories of patients and staff;
ensure cessation support is widely available and accessible: including ensuring smoking cessation medications are held in the hospital;
communicate the policy: including advertising the start date and informing ancillary services including ambulance workers and volunteer car drivers; and
consolidate the policy: including dealing with violent or abusive patients or visitors who refuse to comply.
Findings from an HDA survey of 80 hospital trusts at the end of 2003 suggest that ensuring that the NHS becomes smoke-free within two years will present a challenge for many trusts.
Most permit smoking in some parts of the hospital site, most frequently in a smoking room, outdoor shelter or outside the hospital entrance.
Overall, 70% of hospitals in the snapshot survey carried out before the public health white paper's publication in autumn 2004 thought the NHS should be totally smoke-free, but only 11% thought this a very realistic prospect.
1See Investors in People to incorporate workers' health
2"Guidance for Smokefree Hospital Trust", Health Development Agency, 2005, www.hda.nhs.uk.
This article was written by Sarah Silcox, a freelance writer and trainer on employee health issues, sarahsilcox@waitrose.com.