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It’s time for a truly smokefree NHS

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Unique ID: FRAM510 Caption: A sign indicating the hospital building and grounds are smoke-free. No smoking. Smoke Free Site. Restrictions: NHS Photo Library - for use in NHS, local authority Social Care services and Department of Health material only Copyright: ©Crown Copyright

Smokers huddled outside hospital doors are a common sight since smoking indoors was banned.

Many are sick or caring for others and deserve our greatest compassion, yet continuing to normalise smoking in hospital settings is damaging the health of not just those that our doctors and nurses are trying to help, but of future generations too.

We know that the best way to reduce the devastating impact that smoking continues to have on our population is to make smoking less affordable, less accessible and less acceptable.

The NHS brand is one of the most recognised and trusted in the UK and is a powerful symbol of health and wellbeing.

Just as schools should be free of unhealthy fast foods, there is no place for smoking in the NHS. Banning smoking inside hospitals was an important step, but we must do more.

That is why I wrote to the chief executive of every NHS Trust in England, calling for their personal commitment to work with PHE towards a truly smokefree NHS.

Although smoking is declining, over 7 million adults in England still smoke and tobacco use remains the largest cause of premature death.

It also accounts for half of the health gap between the poorest and most affluent communities. Smoking causes 96,000 deaths a year in the UK, and for every death caused by smoking, approximately 20 smokers are suffering from a smoking-related disease.

The burden of smoking on the NHS is massive: in 2014-15, around 475,000 hospital admissions in England were attributable to smoking and the total annual cost is estimated at £2bn, with a further £1.1bn in social care costs.

We can reach some of those 7 million smokers through health services; they are in hospital waiting rooms, consulting rooms and beds, and many are NHS staff. As many as 25% of patients in our acute hospital beds are smokers.

A smokfree NHS means:

  • No smoking anywhere in NHS buildings or grounds
  • Stop smoking support offered on site or referrals to local services
  • Every frontline professional discussing smoking with their patients

As health professionals, we also have a moral imperative to do all we can to help people give up smoking and increase their chance of living longer, healthier lives.

I believe we can make the NHS a place that provides a supportive tobacco-free environment for patients, staff and visitors, and in which the treatment of tobacco dependence is fully integrated into clinical pathways.

Putting ambition into action

The NHS delivers a fantastic service, day in and day out. However, we know that we need to invest in prevention now in order to avoid stacking up problems for later.

Interventions to support smokers to quit save money – smokers that manage to give up reduce their lifetime cost to the NHS and social care by almost 50%.

Action is already underway to support trusts to become truly tobacco-free:

First, PHE’s Menu of Preventative Interventions for local sustainability and transformation plans recommends evidence-based interventions on smoking that will secure savings and improve the health of local populations.

Second, from 2017, all patients coming in for a hospital stay will be asked if they smoke, and if the answer is yes, referred to advice and support on quitting. PHE has commissioned online training on delivering brief advice on smoking from the National Centre for Smoking Cessation and Training and this will be available for all health care professionals.

And third, the British Thoracic Society (BTS) will soon be publishing the first ever comprehensive audit of smoking cessation activity in the NHS. I had a preview of the results and there is a long way to go, but this will provide a benchmark for trusts to measure future progress.

Progress is also variable on implementing the 2013 NICE recommendations for smokefree NHS buildings and grounds and evidence-based quitting support for all patients who smoke, although it is encouraging to see mental health trusts leading the way.

Of course, with e-cigarette use continuing to rise, organisations and employers will also want to update their policies to cover these new products, and PHE has published five principles to use as a guide.

The evidence shows that smoking and vaping are not the same: unlike cigarette smoke, there is no evidence so far that exposure to secondhand vapour is harmful. Furthermore half of vapers in the UK have stopped smoking and around a third of the remainder are using them as part of a quit attempt.

I know that some trusts are already well ahead on tobacco control, and sharing best practice will be important.

Tackling the devastating harm of tobacco is a national priority and the NHS must be front and centre for us to secure a smokfree generation in England.

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  1. Comment by Alex Bratton posted on

    a very nice article, glad to go through this, got a lot information, thanks

  2. Comment by lungs sleep posted on

    Really this blog means alot to public for their health.amazing blog you shared.

  3. Comment by neil posted on

    how much money from tax do the government get each year from tobacco products?
    In Harrogate you have to phone up York to get an appointment with a stop smoking clinic in Harrogate,this was thought to be the best way to get people to stop now try and get an answer from the clinic in York to see someone 4 or 6 weeks later,Now my own doctors used to do all of this but its a joke now

  4. Comment by neil posted on

    When you can get the staff at our local hospital to stop smoking in the grounds of hdh,then maybe the general public will stop,its hardly a good advert when you see staff smoking hiding around corners

  5. Comment by John posted on

    Lets be honest - you're a smoker and just been given bad news - the first thing you want to do is to light up.
    I am lucky in that I gave up the evil weed years ago, but I sympathise with people who smoke. Try telling ayoung Mum who has just lost her child 'sorry you cant smoke here'
    Duncan how many people have you told outside a hospital 'you can't smoke here' I somehow doubt that between getting out of your chauffer / taxi car that you would sayanything. Now if you want to talk about a greater evil - lets talk about diesels

  6. Comment by uudbhdhkdj posted on

    Stop manufacturing tobacco

  7. Comment by Ena Bowles posted on

    I find it admirable to be concerned about the smokers habit. However, I was diagnose over twenty tears ago with Multiple Chemical Allergies. That includes Nicotine. Having been forced to tailor my own lifestyle because of that allergy in order to avoid contact with the nicotine smoke, has not been easy and I missed out on lots of mixing with family and social life in general. Now in addition, I separately have a long term serious lung illness.
    On my most recent visit to my local hospital and feeling very poorly I had to wait outside for a taxi I had ordered. I am aged 85 but as three benches in the seating area (ALL MARKED NO SMOKING) were all occupied by smokers I had to stay standing elsewhere hoping the taxi driver could find me. In your article I would have liked to see at least some recognition of the effect on people who may have never chosen to smoke themselves.

    • Replies to Ena Bowles>

      Comment by Gail posted on

      Bless you. I'm in the same boat, I have brittle asthma, I am allergic to tobacco particles. I have died twice as result of idiots smoking, in illegal places, i.e a public lift, and on my doorstep, a man banged my door for directions, I opened the front door he blew smoke straight at me; I have a note on my door, please do not smoke on my property, you may kill me.

      I no longer walk my dog, as I do my best to avoid smoke, but smokers run up to me to stroke my dog, causing a massive attack, no one cares, people light up in places that are prohibited. All people like us get is abuse.

      I have never smoked, but 18 months ago I developed brittle asthma.
      through no fault of my own, I was a marathon runner.

      No I cannot just move away, if the place is a no smoking place please respect that. We are idiots or nuisances. This allergy is not a choice. It is ruining my life, yet we are treated with utter contempt by smokers, the general public and the government.

      We are not a joke or a nuisance, we have rights too!

      I keep myself to myself, why can't smokers do the same?

  8. Comment by Brian Finney posted on

    I speak as a lifelong NON-smoker.
    This is another example of the NHS attempting to control people – just about sick of it.

    We had the same with the breast screening propaganda, now amended to some limited extent, bowel cancer screening with only 14% of expected right side cancers detected the list is endless yet it is propagandised.

    Then we have the DH Medical Director, ‘ every time you have a drink alcohol think of cancer.’ It really is time she and PHE got out more into the real world.

    From your figures the costs can hardly be described as massive (sic) as you do - £2 billion is less than 2% of NHS budget and there is no saying you would save all of it; dying usually costs money no matter how we do it.

    Time for PHE to butt out - you simply don’t have the competence to prevent disease at an individual level, and it is only the individual level that matters to the individual. The research around the contrived condition of pre-diabetes also shows this.

    I won’t accept second hand smoke in my breathing zone BUT I see the need for people with the addiction to smoke particularly at times of stress.

  9. Comment by RAS posted on

    When are the government going to enforce the rule and make it an offence to smoke outside hospitals

    • Replies to RAS>

      Comment by Gail posted on

      Never, they don't enforce any of the non-smoking legislation. Smokers smoke wherever they like. The government don't care, they want people to die sooner

  10. Comment by Nomatter Hands posted on

    Yes I agree legislations should be put in place. All smokers please think of other people around you before lighting a cigg. Passive smoking kills.

  11. Comment by Ena Bowles posted on

    I agree with Gail (3rd October) that the answer to Ras (7th September) is probably never, unless the law is extended to include places which the general public are permitted to use. Further to my complaint in June this year I did approach the police to ask why they did nothing about what I presumed was breaking the law to allow smoking in the designated sitting and waiting area within the grounds of our local large hospital.
    The answer was that it is private property. The hospital does nothing about flagrant flouting of the No Smoking signs. Pubs and eating places are private properties where smoking is banned so how does that work? Now I believe the law should be reworded to make it an offence to smoke where ever "The Public" in general can be sharing the space. Would hospitals then be forced to police their own properties or would the police be given powers to police private/public areas?