NHS hospitals must become completely smoke free, says NICEBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7105 (Published 27 November 2013) Cite this as: BMJ 2013;347:f7105
NHS hospitals and clinics must do more to help patients to give up smoking, and this includes making their premises, including grounds, smoke free, the UK National Institute for Health and Care Excellence has said.
On Wednesday 27 November NICE published guidance on smoking cessation in secondary care: acute, maternity, and mental health services. The guidance includes a range of recommendations on effective actions that secondary care services can take, such as promoting smoking cessation in advance of planned admissions of patients, immediate provision of smoking cessation drugs and behavioural support after admission, and making all secondary care settings smoke free.1
Smoking related diseases put a huge burden on the NHS and are responsible for over 460 000 hospital admissions in England each year, NICE said.
John Britton, chairman of the NICE guidance development group and director of the UK Centre for Tobacco and Alcohol Studies at the University of Nottingham, told a press briefing on Tuesday, “It makes no sense at all for that [burden] to continue and for the NHS not to be dealing with it.
“We need to prevent disease by preventing the smoking rather than just tidying up after the event. This means helping all smokers who use NHS secondary care services to stop smoking, at the very least while they are using the NHS services, but ideally for good. That should be a priority for the NHS—and should have been for years perhaps and certainly needs to be now.”
Britton added, “It is about a change of culture in the NHS, moving from an organisation that has passively tolerated smoking for many years to an organisation that is absolutely smoke free—for its patients, its visitors, its staff, everybody.”
Smoke free policies and the provision of smoking cessation support for patients and staff should be led from the top of the organisation by a clinical or medical director, the guidance says. Smoke free plans should include the removal of smoking shelters and a ban on staff smoking in working hours, while in uniform, or while on hospital business.
Sale of tobacco products should be banned in secondary care settings, while nicotine replacement therapy should be available to visitors to buy. In addition, staff should not help patients go outside to smoke and should encourage compliance with the smoke free policy and report any breaches.
Mike Kelly, director of NICE’s Centre for Public Health, said that managers in NHS secondary care organisations had “to make it as clear as possible that an NHS environment should be an example to us all in terms of the healthiest way to live our lives.
“Probably the most important thing to do in that respect is to make the non-smoking site a reality, rather than merely a symbol of an aspiration that is lost in its delivery.”
Asked what sanctions hospital trusts could use against staff, patients, or visitors who refused to obey the policy, Kelly said, “Obviously, the rules and regulations that each individual trust will have would prescribe and proscribe certain things.”
Ultimately breaches could be dealt with through employment contracts, bye-laws, and even prosecutions, but he emphasised that prosecutions would be a last resort. “The emphasis here is not about looking at a set of regulations that penalise people but rather trying to provide a culture that is supportive of not smoking and makes not smoking the norm,” he said.
The guidance says that patients should be given written and oral information about the hospital’s smoke free policy before their appointment, procedure, or stay in hospital. The information should detail the short and long term benefits of stopping smoking and how patients could get support to help them stop smoking before, during, and after their hospital stay.
Staff should be offered support to help them stop smoking, and all healthcare professionals should be trained to identify smokers and direct them to smoking cessation services to receive specialist support. In the case of patients, that support should be intensive and immediate and include access to nicotine replacement therapy or other pharmacotherapy and carbon monoxide measurement at each contact with smoking cessation services.
Cite this as: BMJ 2013;347:f7105