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
In July 2017, the Public Health Wales Act was passed by the Welsh Government. Included in this Act is the measure to ban smoking on hospital grounds, thereby making it against the law to smoke within any grounds that adjoin a hospital or are used/occupied by a hospital in Wales. It should be noted however that there is a provision included in the Act allowing the person in charge of the hospital to designate any area in the grounds as being an area in which smoking is to be permitted. In addition, premises consisting of an adult care home or of an adult hospice, or premises used to any extent as a dwelling, are not smokefree by virtue of this Act. There is currently a consultation period taking place with regards to the implementation of the measures contained in the Act, so the full implementation of these measures is likely to be in 2019 or 2020.
In 2017 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 27%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 1120 adults (aged 18+). Fieldwork was undertaken between 16th February and 19th March 2017.