NHS 'should not facilitate smokers'
NHS hospitals should ban smoking on their premises and staff should be told not to help patients who want to smoke, according to new guidance.
Measures are needed to help patients stop smoking while they receive care and "preferably help them to stop for good", the National Institute for Health and Care Excellence (Nice) said.
While individual NHS trusts will have the final say, staff and people using NHS services, including clinics, should be told not to smoke on the hospital grounds, Nice said.
All hospitals should have an on-site stop-smoking service and staff will be told not to help or "facilitate" patients who want to smoke.
Trusts should ensure "there are no designated smoking areas, no exceptions for particular groups and no staff-supervised or staff-facilitated smoking breaks for people using secondary care services".
Patients should be encouraged to stop smoking before planned admissions to hospital, while stop-smoking drugs should be on hand immediately to help people stop.
Relatives, carers, friends and other visitors will also be given information on smoking and told not to smoke near patients.
Professor Mike Kelly, director of the Centre for Public Health Excellence at Nice, said: "The idea behind this is not to create a penal culture but it is about a culture shift. It's clearly absurd that the most lethal set of toxins to the human body are being passively encouraged in hospitals.
"We've known since the 1950s that smoking kills you and 61 years have passed and we're now tackling the problem in hospitals. That's too long.
"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 £2.7 billion each year, and costs society an estimated £13.7 billion a year. So it's a no-brainer, we must deal with the problems caused by smoking."
Prof Kelly said support should be given to all patients and staff who smoke, as part of providing advice on how to improve health.
"We need to end the terrible spectacle of people on drips in hospital gowns smoking outside hospital entrances. This guidance can help make that contradiction a thing of the past by supporting hospital smoke-free policies to make NHS secondary care an exemplar for promoting healthy behaviour."
Professor John Britton, chair of the Nice guidance group and director of the UK Centre for Tobacco Control Studies at the University of Nottingham, said: "We have to recognise that, for many people, smoking is a very powerful addiction and whenever the opportunity comes up to help we should be taking it. Admission to hospital is a key opportunity.
"Most smokers do not want to smoke and most smokers are well aware that if they are smoking when they come into hospital, they are much more likely to pick up an infection and will be slower to heal. It's therefore in their interests to go without smoking when they are in hospital."
Smoking is responsible for around 460,000 hospital admissions in England each year, according to Nice.
Failure to quit in pregnancy causes up to 5,000 miscarriages and stillbirths each year, and increases the risk of premature birth and low birth-weight babies.
In children, second-hand smoke is linked to cot death and middle ear disease, and makes asthma worse.
Smoking is especially common among people with poor mental health. While one in five of the general population smoke, the figure rises to one in three among people with long-standing mental illness.
Some 70% of people in psychiatric units also smoke.
Professor Sue Bailey, president of the Royal College of Psychiatrists, said: "There is a common but mistaken belief among some mental health professionals that it's all right 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."
Dr Keith McNeil, chief executive of Cambridge University Hospitals NHS Foundation Trust, said smoking will not be allowed anywhere on its campus from the New Year.
"I have spent a large part of my professional life dealing with the terrible effects of smoking: deaths from cancer, emphysema and lung transplantation. As well as this, smoking costs the NHS and society billions of pounds each year.
"As a leading healthcare organisation we should be encouraging a healthy lifestyle, and smoking is not part of that. I know how hard it is to quit and I want to do everything I can do to support staff and patients to give up.
"It's only right and proper that we lead by example, and make Cambridge University Hospitals a smoke-free campus."
Simon Clark, director of smokers' lobby group Forest, said: "NHS staff have a duty of care to protect people's health but that doesn't include the right to nag, cajole or bully smokers to quit.
"Many smokers are in hospital for reasons that have nothing to do with smoking. Why should they be told they can't nip outside and have a cigarette in the open air?
"Tobacco is a legal product and a lot of people smoke to relieve stress. A cigarette break at work or while they are in hospital is something they look forward to.
"It's not only heartless and inhumane to ban patients from smoking outside hospitals and clinics, it's almost impossible to enforce without installing CCTV cameras and employing wardens to monitor the grounds.
"Apart from the Big Brother connotations, it doesn't strike us as a sensible way to spend taxpayers' money."
Peter Carter, chief executive of the Royal College of Nursing, said: "The RCN supports efforts to reduce smoking, which must include support services and guidance for both patients and staff to help them to stop smoking.
"Although nursing staff should not be expected to enforce non-smoking policies, they continue to play a vital role in reducing smoking by offering advice and support to patients."