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All inpatients should be encouraged to stop smoking, states NICE

Ill smokers should be given nicotine patches or gum the moment they arrive in hospital in a bid to help them curb the habit, according to the National Institute for Health and Care Excellence.

Hospitals should provide all smokers “immediate access” to smoking cessation products to help them stop or temporarily abstain from smoking, said NICE.

In new draft recommendations, the health guidance body also calls on all hospitals to implement smoke-free policies in their grounds.

In some trusts around the country, patients can be seen smoking outside buildings wearing hospital gowns and slippers. While other hospitals have zero tolerance policies on smoking in their grounds.

In the new guidance, which is now open for consultation, NICE says that such a policy should be implemented across England.

It is also calling on trusts to give all patients information about their smoke-free rules and support to help smokers kick the habit.

Professor Mike Kelly, director of NICE’s Centre for Public Health, said: “The benefits of stopping smoking are well known, and people are already required by law not to smoke inside enclosed or mostly enclosed buildings.

“This draft guidance sets out proposals on supporting people in a hospital environment not to smoke, as well as supporting the smoke-free policies in hospitals.

“Secondary care providers have a responsibility to protect the health of people who use or work in their services.

“The draft recommendations propose that this duty of care should also routinely cover providing advice on how to improve health, including stop smoking interventions.

“Some people do not want to give up smoking completely, so one of the draft recommendations advises they should be helped to abstain from smoking during their stay.

“It adds that they should be given advice on using nicotine replacement therapies (such as patches or gum) to help with any cravings. We want to hear people’s views of these proposals.”

Treating smoking-related illness costs the NHS £2.7bn every year.


Sign our Speak Out Safely petition to support a transparent and open NHS. We are calling on the government to implement recommendations from the Francis report that will increase protection for staff who raise concerns about patient care.

Readers' comments (26)

  • I think patients should be banned from leaving the ward inless accompanied by relatives. All too often patients leave the ward and not always telling the staff. Some then collapse outside which causes more stress and anguish to the nurse in charge as they are responsible for bringing them back to the ward safely which then puts other patients at risk while a nurse goes out to retrieve them.

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  • I work in a North East and until fairly recently we had access to in house smoking cessation services if a patient requested referral for support.
    This has now stopped due to costs of running the service, now we simply have to advise patients to either seek help from GP or call at a local pharmacy for a NHS quit kit.

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  • Makes you wonder. The costs of running a cessation service vs costs of long term complications from smoking. Easy to guess which one is less and better value for money.

    How many patients (some with drips running, some on crutches or wheelchairs) + relatives still smoking just outside hospital entrances, whilst still on hospital grounds? Never ceased to be amazed what some people do for a smoke while very ill + likely contributor to them being admitted. Carbon monoxide binds stronger than oxygen to red blood cells. So patients are more likely to be bit more breathless when coming back to their bed, assuming they make it and others know which ward they've come from.
    Thought it was completely no smoking on site. Due to chimney effect, from height of the buildings, smoke + traffic pollution are drawn into the building from surrounding area to affect those inside (especially those nearer the main entrances + outside windows).

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  • you would need to "encourage" all of the staff to stop first. Practice what you preach! How many at NICE smoke?

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  • In NHS Greater Glasgow & Clyde, they are introducing a much more robust approach. Red grid lines being painted all over the ground around all hospital entrances with STRICTLY NO SMOKING in red. Wardens patrolling in pairs to challenge anyone (staff, patients, visitors, etc) caught smoking in contravention of the policy.

    NRT and smoking cessation support have been freely on offer for years to staff and patients. The health board decided that a zero-tolerance approach must be adopted. I will be interested to see how this is received and if it will be effective.

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  • mags | 6-Apr-2013 11:58 am

    that really seems to be going to extremes and what about civil liberties?

    on the other hand, please could you send them over to Europe? Getting on and off trains you have to choke and peer your way through a thick smoke screen as so many get off the train for a quick smoke. Those on the train often already have an unlit cigarette in their hand at the ready.

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  • Tiger Girl

    Smoking is an addiction though, isn't it ?

    Trying to get politicians to be less deliberately deceptive in their utterances would be nice, as well - but probably not achievable !

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  • Anonymous | 6-Apr-2013 1:17 pm

    I don't think the wardens are going to be armed. At least, I hope they won't be!

    With regard to civil liberties, it is illegal (Smoking Health and Social Care (Scotland) Act 2005) for anyone to smoke within hospital environs, so smokers are breaking the law.

    This crackdown is in response to a substantial amount of complaints from patients, staff and visitors who are fed up with running the 'smoke' gauntlet on their way into hospital buildings. So there is a lot of support for it.

    The wardens will apparently be approaching smokers to offer advice, support, etc, whilst pointing out the policy. It will hopefully get rid of smoking from hospital grounds once and for all.

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  • mags | 6-Apr-2013 4:50 pm

    from Anonymous | 6-Apr-2013 1:17 pm

    good scheme. hope it is successful.

    like i said if they get dispirited or bored send them off to the European railway stations - apart from the thick smoke screens on the platforms they can get away to the lakes and mountains on their days off for plenty of fresh air and sunshine! pay is probably pretty good too. their only job requirement would be to bring cans of red paint with them and knowledge of a European language might be useful for their survival.

    I see in England smoking is banned in all parts of the railway stations. In Europe unfortunately passive smoking is still endemic everywhere except on public transport and most cafés and sadly very common among doctors and nurses!

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  • Surely anything which helps people to stop, or kick starts an effort to stop has to be worth doing?

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  • Had it in our trust for years, completely unworkable!
    Wonder how long it'll take for one of those wardens to be given a 'Glasgae kiss' from someone with a few bottles of buckie in it! As for being 'illegal' to smoke in hospital grounds in Scotland, will they be emptying Barlinnie of murderers and rapists to make way for the 60 a dayers?
    'Passive' smoking and its associated woes are very much exaggerated and based on very poor science. I'd be more worried about all the vehicle pollution in our inner city hospitals. If you don't believe me, go back to a smokers house and sit there whilst they get through a pack of gaspers with the windows shut, and then sit in your garage with the car running and the doors closed, see which is most detrimental to your health!

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  • redpaddys12 | 6-Apr-2013 10:37 pm

    Redpaddy - Congrats for using just about every stereotype! However, I have to correct a common mistake. It is a 'Glesga Kiss', not 'Glasgae'. Say Glasgae up here...and you may be obliged with a Glesga Kiss. That will generally ruin the looks, but the back of head connecting with the pavement does the most damage.

    Why do you think I'm interested in seeing how things work out?

    At our hospital info session on the rolling out of the new measures, it was asked if the wardens would have stab vests and the ability to run sub-50 second 400 metres. (that being considered a safe distance over which a smoker could be outrun). I am personally very happy that more is being done to clear away the smokers from hospital entrances, but I do fear for the lives of the wardens.

    Comparing a roomful of smokers with running the car in your garage? Seriously? Poor science indeed. Don't be trying that at home. Better to compare a the CO levels in a roomful of smokers against a room with no smokers. Now that can be slap bang in the middle of the city or in heart of the countryside. The people in the smokers room will come off worst.

    I have (for another job) done a fair amount of research into tobacco and smoking, particularly passive/second hand smoke in relation to the newborn. It was certainly true that both the smoking and anti-smoking lobbies were guilty of 'poor science'. When reading some study reports and conclusions, I always knew which lobby had funded the research. However, as I was concentrating on the newborn, there was plenty of evidence (through routinely collected and freely available local health board stats) on the impact on the foetus and newborn, including higher rates of stillbirth, spontaneous abortion, pre-term babies and low birth weight (an average of 200-300g in the babies of smokers). Not poor science or biased research by the anti or pro smoking lobbies.

    I am as intrigued as my colleagues on how the anti-smoking wardens will be received around the Glasgow hospitals. It won't be dull.

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  • Mags
    I stand corrected on the spelling, must be the phonetics I learnt as a child!

    I'll tell you now, though, it won't work from personal experience, and this taking people to task will evaporate as soon as the first hard-knock takes umbrage. How are these wardens going to stop them? Telling an advanced COPD patient that smoking is bad for their health? Squirting them in the face with a soda-syphon ( never see them in pubs anymore do you?)?

    Nobody likes the crowds outside the main entrance puffing away, but when you take away the facilities for someone to light up out of the rain, which were well hidden in my trust, then what do you expect?

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  • redpaddys12 | 7-Apr-2013 2:50 am

    "How are these wardens going to stop them?"

    When we had the info session about the new policy, that was the question that everybody asked and the aspect that interests me most, (hence the staff remarks about stab vests and Olympic level running). In fairness to the Health Improvement Lead who spoke to us, she acknowledged that no health board or hospital trust in the UK had successfully dealt with this problem. They are currently recruiting the wardens (will they be rock steady, G4S types?) and plan to roll out the patrols by the end of May.

    My understanding is that this is being driven by public opinion. I routinely have patients and visitors moan and remark about the smokers lurking around entrances. More and more though, I have patients who are being challenged by other patients, visitors and members of the public for smoking in the doorways. I actually think that smokers are becoming increasingly at risk from pissed off non-smokers.(Particularly, if they are ex-smokers or have an illness for which smoking is a cause and /or a factor of exacerbation.) I recently witnessed a rather ugly, loud confrontation between a smoker and non-smoker outside one of our Out-Patients clinics. One of the porters and a receptionist, who were passing by, tried to defuse the situation. Not their job. Glaswegians are a fairly 'chatty' bunch and don't generally keep their opinions too well hidden, so I only see this type of encounter escalating.

    Like I said, I will be interested to see how this is tackled and it won't be dull. I'll keep you posted.

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  • mags | 7-Apr-2013 9:50 am

    My mate is a midwife in Glasgow and she says that some of the pregnant women are coming in for quite open criticism by the public if they are seen smoking around her maternity unit. Maybe wardens are needed to keep the peace?

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  • michael stone

    mags | 7-Apr-2013 9:50 am

    You and red are covering all of the logic in this one, so I'll divert to something linguistic I've never got the hang of.

    This hyphenation lark.

    'I actually think that smokers are becoming increasingly at risk from pissed off non-smokers.'

    That is probably right, because it is these 'chains of hyphenated things' that often look wrong to me.

    If that was smokers, not non-smokers, one would hyphenate the pissed-off, yes ?

    So, because you don't hyphenate pissed-off (presumably because the non-smokers is hyphenated), why doesn't that actually follow the 'rule' that the non-hyphenated adjectives are not firmly linked ? Why I like that one, is that if you separate the off and the pissed, you can arrive at:

    I actually think that smokers are becoming increasingly at risk from pissed non-smokers.

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  • DH Agent - as if ! | 7-Apr-2013 1:27 pm

    I'm afraid that you are reading too much into it, Mike.

    My English grammar is pretty crap at the best of times, mainly due to laziness. For the purposes of these posts, I pay even less attention as I am often in a hurry, or distracted by TV, family, the dog, etc. Grammar and spelling first out of the window!

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  • DH Agent - as if ! | 7-Apr-2013 1:27 pm

    not sure what you are on about but I always try to avoid hyphens as much as possible. it is the modern way of writing.

    I think Mags' comments are among the best expressed and written here although I don't always agree with all of the points she makes, and Mags I certainly wouldn't describe them as lazy, or even sloppy. It is more than one can say for many of the comments, some of which are almost unreadable and thus difficult to understand.

    I do try too but none of us are perfect all the time and sometimes far more rushed than others.

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  • Mike Stone
    Its better to be 'pissed-off' than pissed on.

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  • michael stone

    mags | 7-Apr-2013 2:06 pm

    Anonymous | 7-Apr-2013 7:07 pm

    I was assuming that Mags' grammar is correct, because I just do not understand the rules for 'lots of hyphenation'. I agree that Mags' comments are among the most clear and insightful.

    But I always link adjectives if I want the words never to be separated (large-red if the thing has to be both large and red) and for long chains of linked adjectives, and hyphenated subjects, I can never follow whatever rule people better at language than me, are using !

    Anyway, as well as that issue always confusing me, I wanted to get to the sentence (a sort of joke) you have if you do remove the 'off' !

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