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Impose total smoking ban in hospitals, NHS told

Ban extends to staff, visitors and volunteers; medical/clinical director should lead on policy

Caroline White

Wednesday, 27 November 2013

All hospitals should ban smoking completely in a bid to help smokers stub out their habit during treatment—and preferably for good—says the National Institute for Health and Care Excellence (NICE) in new public health guidance published today.

This includes patients who have mental health problems. Whilst 1 in 5 of the general population smokes, the figure rises to 1 in 3 among those with longstanding mental illness. And up to 70% of people in psychiatric units smoke.

Most of the reduction in life expectancy among people with serious mental illness is attributable to smoking, which increases the dose requirements of psychotropic drugs and therefore the costs by an estimated £40 million a year across the UK, says NICE. 

The guidance will also apply to staff, visitors and volunteers.

The NICE guidance makes a range of recommendations. These include promoting cessation in advance of planned admissions, and providing relatives, carers, friends and other visitors with information about the risks of smoking and second-hand smoke; immediate provision of smoking cessation drugs; and intensive behavioural support after admission, for patients in receipt of acute, maternity and mental health services, as well as a total ban on smoking in all NHS secondary care facilities.

Smoking costs the NHS and wider society billions of pounds each year and is responsible for over 460,000 hospital admissions in England each year.  

Professor Mike Kelly, Director of the NICE Centre for Public Health commented: “Smoking is the most important health problem facing the NHS. It’s the leading cause of premature death in England – nearly 80,000 lives are lost each year due to smoking. Treating smoking-related illnesses costs the NHS around £2.7bn each year, and costs society an estimated £13.7bn a year. So it’s a no brainer: we must deal with the problems caused by smoking.” 

He added: “NHS hospitals and staff have a duty of care to protect the health of people who use or work in their services. The guidance is clear that this responsibility should cover routinely giving stop smoking support to all patients and staff who smoke, as part of providing advice on how to improve health.

"Importantly, this includes mental health patients who too often don’t get help to stop smoking when attending clinics or hospitals, despite their smoking rate being over 50% higher than the general population.”

He said that the NHS needed to “end the terrible spectacle of people on drips in hospital gowns smoking outside hospital entrances.” Making hospitals smoke free would help to make NHS secondary care an exemplar for promoting healthy behaviour.

The guidance says that staff will need to explain to visitors that smoking is not allowed on the premises, and direct them to places on site or in the hospital where they can buy nicotine replacement therapies.

It suggests that a clinical or medical director should be assigned to lead on the smoke-free policy for the organisation and its staff, including a ban on staff smoking breaks; the removal of shelters or other designated outdoor smoking areas; and ensuing that staff, contractors or volunteers are not allowed to smoke during working hours or when in uniform or on hospital business.

Professor John Britton, Chair of the NICE guidance development group and Director, UK Centre for Tobacco and Alcohol Studies, at the University of Nottingham said: “Doctors, nurses and other health staff are accustomed to detecting and treating other life-threatening problems such as diabetes and high blood pressure, but helping people to stop smoking is one of the most cost-effective things that the medical profession can do. We want to see a change of culture in NHS secondary care settings, to make smoking history.”

Professor Sue Bailey, President of the Royal College of Psychiatrists, said that some mental health professionals mistakenly believed that it’s alright for patients in their care to smoke. “This is wrong. Patients with mental health problems are far more likely to smoke than the general population, they suffer disproportionately higher rates of physical illnesses, and they die earlier. It’s a disgrace that this section of our NHS patient population is left to suffer the consequences of smoking.”

Speaking on behalf of the BMA, Dr Vivienne Nathanson added: "Whilst we sympathise with patients with long-term conditions or relatives, who may find comfort in smoking, it continues to be the lead cause of preventable death and hospital admissions and is therefore more important than ever that the NHS sets the example."

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