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Public Health doctor argues for a smoke-free NHS

Smoking on NHS premises is ‘collusion’

Jo Carlowe

Thursday, 02 February 2017

The NHS is not yet smoke free, but it’s time that it was.

This is the message of a senior public health doctor, writing in The BMJ* today. 

Dr Mary Black at Public Health England argues that tolerating tobacco smoking on NHS premises is a form of collusion. 

Staff who smoke in NHS uniforms are sending a very clear pro-tobacco signal, she writes. Health staff who smoke with patients are empathising in a harmful way, while colleagues who smoke “deserve all our support to kick the habit at work.”

She recalls how her doctor father, born in 1924, started smoking cigarettes as a teenager and died of a smoking-related cancer in 2003. 

“When my father practised medicine, doctors used to prescribe cigarettes, and doctors and nurses were used in tobacco advertising campaigns. You could smoke in the Department of Health, smoke in hospital corridors, and ward coffee rooms - you could even smoke on NHS hospital wards.”

Although this would all be unthinkable now, “a kind of misguided sympathy keeps the last vestiges of tobacco acceptability alive in the NHS,” she writes.

“We falter before ill patients in pyjamas dragging their IV fluid stands out onto the winter street in front of a hospital to have a fag, we pass with no comment past colleagues clustered around the emergency department exit having a communal smoke - some staff even smoke with patients at the exits of mental health units or in the last few remaining smoking shelters.” 

Dr Black herself recalls “wheeling ill folks out on hospital balconies so that they could have a fag.” But she believes now that staff should focus their efforts on making sure every smoker (one in six people admitted to the NHS and half of all admitted to mental health facilities) gets nicotine replacement therapy and stop smoking advice in the first critical hours. 

“By actually doing this, I have seen many recalcitrant older smokers stop,” she says.

“None of my justifications for colluding with tobacco use still hold water,” she concludes. “The NHS is not yet smoke free. But it’s time that it was.”

Public Health England is currently campaigning for a completely tobacco-free NHS, with Chief Executive Duncan Selbie writing to all NHS trusts in November to help make this happen.


 * Black ME. A smoke-free NHS. BMJ 2017;356:j500. DOI: 10.1136/bmj.j500  

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