Smoking is still the number one cause of preventable deaths in the UK, with 100,000 dying annually due to its affects, including 28% of all cancer deaths1. In England there were 454,700 hospital admissions attributable to smoking in 2013/142, whilst in Wales over the period 2008-10, an average of 5,605 smoking related deaths and 28,607 smoking related hospital admissions occurred3.
Smoking of course does not just pose a health risk to the individual smoker but has an impact on the health of non-smoking bystanders in the vicinity. The International Agency for Research on Cancer (IARC), convened by the World Health Organization, conducted a review of evidence on secondhand smoke and cancer in 2002 and found that “the evidence is sufficient to conclude that involuntary smoking is a cause of lung cancer in never smokers”. The report concludes that exposure to other people’s smoke increases the risk of lung cancer in non-smokers by 20-30% and coronary heart disease by 25-35%4.
Thousands of patients and visitors attend hospital every year and these secondary care institutions have a duty of care to protect the health of, and promote healthy behaviour among, those who use and work within their services5. Patients are a key audience for quitting smoking as there are additional advantages to them post-treatment, including shorter hospital stays and fewer complications6.
UK National Institute for Health and Care Excellence (NICE) has said that hospitals and clinics must do more to help patients to give up smoking, and this includes making their premises, including grounds, smokefree5.
The NHS should take an exemplar role to discourage smoking and this policy should be included throughout the NHS in Wales rather than on an ad hoc basis which is presently the case.
Current situation in Wales
All 7 Health Boards in Wales and Velindre Cancer Centre implement voluntary smoking bans throughout all of their premises and grounds. There is currently no legislation in place prohibiting smoking outside in hospital grounds, although a proposal to restrict smoking in hospital grounds has been included in the 2016 Public Health (Wales) Bill proposed by the Welsh Government.
We are calling on the Welsh Government, who has control of health in Wales, to continue with its proposal to enact smokefree hospital grounds in Wales and bring them into line with the smoking ban in enclosed public places.
At present some Health Boards, such as Cardiff and Vale and Aneurin Bevan, have a dedicated 'No Smoking Officer' to patrol the sites and ask all patients/relatives/visitors to stop smoking. Smoking on site by a member of staff would be a disciplinary offence. Contractors have it in their contracts to not smoke on Health Board premises. Attempts to enforce the ban include bin removal from entrances/altogether, removal of shelters, restricting access to adjacent parks etc, etchings on the ground saying no smoking, signage, staff training and awareness raising. The Police will not intervene unless a criminal act has been committed, such as when a situation escalates to aggression and someone needs removing from site.
In 2014 we commissioned a YouGov survey asking “How strongly, if at all, do you agree or disagree with the following statement?" – Smoking should be banned in hospital grounds” 71% of respondents agreed. The equivalent figure for smokers was 38%7.
1Smoking statistics: Illness and death. ASH England. November 2014.
2Statistics on Smoking in England 2015. Health and Social Care Information Centre. May 2015.
3Welsh Government and Public Health Wales Observatory (2012). Tobacco and health in Wales.
4Tobacco smoke and involuntary smoking. IARC Monographs on the evaluation of carcinogenic risks to humans. Vol 83. Lyon, France, 2004.
5Smoking cessation in secondary care: acute, maternity and mental health services. NICE. November 2013.
6Smoking and surgery. ASH England. March 2013.
7YouGov survey commissioned by ASH Wales. Total sample size was 1093 adults (aged 18+). Fieldwork was undertaken between 5th to 14th March 2014.