For many, a ‘truly smoke-free NHS’ would be an act of cruelty

Public Health England has announced plans to persuade NHS trusts to ban smoking on all their premises in an effort to create a ‘truly smoke-free NHS‘. It is a move that has long been coming; some trusts already ask patients, staff and relatives not to smoke in the grounds of care homes and GP surgeries, but it remains, for now, optional: only one in every 10 NHS hospitals prohibit smoking on their grounds.

PHE’s chief executive, Duncan Selbie, said the aim was an environment conducive to getting patients to quit. ‘This isn’t about forcing people. This is about helping people, and seven out of 10 say they want to quit,’ he told the BBC.

Of course, the motives are well intentioned. Smoking rates are falling but, in many ways, not fast enough: PHE estimates that 96,000 deaths occur annually as a result of smoking. It’s understandable that it is looking for new ways to quicken the trend.

But would banning smoking on hospital grounds really help? Such a move seems more about posturing than patients. For many people, staff as well as the sick, it would be cruel. Doctors, for instance, work in incredibly stressful situations, endure long hours and receive little respite for their efforts. Why should they be hounded from the premises when they take a few moments, fag in hand, to collect and regroup?

Yet it won’t just be the workers who are inconvenienced. Dying patients who smoke shouldn’t be denied the small relief a cigarette can bring, nor should relatives who are faced with losing a loved one. Why should they be forced to leave the premises to smoke? What can it possibly achieve to prevent the very old or the dying, or their worried, grief-stricken families, from having the odd cigarette?

We have seen in the past the case of terminally ill patients in Yorkshire leaving their hospice to die at home specifically because they were denied cigarettes in their final days. How can this be good, when quality of life is surely the whole point of palliative care?

Duncan Selbie of PHE admitted that the key to helping people quit smoking, if they really wanted to, was getting patients ‘in touch with people who can help’ — that’s to say, professionals who can offer their expertise. Education is surely more productive than blanket bans.

PHE and the NHS should heed that advice: it is better to advertise support rather than bully people. I would argue that smoking rates are falling today primarily because of education, not because of ‘smoke-free zones’. If smoking is banned on hospital premises, it will only be as an act of grandstanding. It won’t really help people, just inconvenience those for whom there is no reason to quit.

  • tb_kol

    say it like it is. view from smoker’s point is quite well presented.

  • Pete Wood

    The best aspect of the Spectator is that it can make one think. My initial reaction it to say that smoking should be banned on hospital ground. One failing of the idea of the HNS is to remove the responsibility for good health from the individual to the state allowing people to correctly presume that when their bad habits catch up with them, tax payers money will be used to fix them.

    But the article makes many good points and I found myself correcting my ideas on a per paragraph basis. Oh of course the doctors and staff should be able to smoke. Oh of course those with terminal illnesses should be able to smoke etc.

    But the original point remains, why should the average taxpayer be paying to correct the health mistakes made by others? And if people knew that the NHS would not cover them for their own poor lifestyle choices would it offer greater encouragement for them to be healthier

    Quick calculation. Double lung transplant 357,000 GBP, tax paid of packet of cigarettes, 7.00 GBP (roughly). If a smoker smokes two packets of cigarettes a day for 70 years then they will pay for their own operation. This doesnt include after care, lost days of work and health effects in later life.

    • Flintshire Ian

      They weren’t taxed all that heavily until relatively recently.

      • Pete Wood

        I was anticipating a common response that people who smoke pay for the resultant care in thier taxes. I dont think it is even close.

  • Peter Roberts

    What about the right of non-smokers to clean air?

    As for NHS staff, a doctor’s duties include providing advice about health, A doctor’s opinion on a health matter can be inferred from their actions as well as their words. What message does it send to the public, especially those trying to quit smoking, to see a doctor smoking on hospital grounds?

    Recently, my father had to spend some time in hospital. It was infuriating to smell smoke all around the entrances of the hospital. It could even be smelt from some of the wards.

    It’s difficult to calculate the full monetary costs of smoking, as well as the full amount that the UK gains from the tobacco industry through tax. However, it’s nigh impossible to calculate the personal costs of emphesema, cancer, and reduced life-spans.

    • Wyisit Alwaysme

      HMRC makes about £12Bn in excise and VAT. British American Tobacco didn’t pay any tax on £4.9Bn profits, go figure. Both figures are from 2013/14. Took me less than 3 minutes on google.
      Costs?? that will take more time….

    • waltcody

      Everything in the world, then, is about and only about “the rights of nonsmokers” and “those trying to quit.” Smokers and those NOT trying to quit should have no rights whatever, even if they’re dying. Ooo-kay, but I’d rather have a calm unstressed surgeon who’s just had a smoke performing my brain surgery than a stressed-out role model for “those trying to quit.”

    • Dave Moran

      “It was infuriating to smell smoke all around the entrances of the hospital.” Snob!
      There is no proof whatsoever that second hand smoke is anything more than a cosmetic nuisance. Most Hospitals are in town centres so if no one smoked at all, you still have no right to clean air because no town or city has clean air. It’s infuriating that there are people so up their arse they feel superior to others.

  • Vinny Gracchus

    Reject this cruel outdoor smoking ban and stop the persecution of smokers. BTW there is no risk to others fro, second hand smoke (especially outdoors where the risk of vehicle emissions in the long-0standing health risk).

    • Pete Austin

      Re: “there is no risk to others fron second hand smoke”. That is wrong, so please don’t smoke near others.

      Anyone with asthma or other conditions affecting the lungs is likely to find second-hand smoke can be a trigger. This is because the chemicals in tobacco smoke irritate the airways and the lungs and trigger asthma

      • Vinny Gracchus

        No Pete, it fact. Somehow persons with asthma (which as a condition has been on the rise since the start of smoking bans) Were able to walk away and avoid smoke before smoking bans. On respiratory risks, see Mohagheghzadeh A, Faridi P, Shams-Ardakani M, Ghasemi Y. Medicinal smokes. J Ethnopharmacol. 2006 Nov 24;108(2):161-84. Epub 2006 Sep 9 or on asthma: Hjern, et al found that smoking and exposure to passive smoking/second hand smoke (SHS) was associated with a low risk for atopic disorders (asthma, allergic rhinitis, atopic dermatitis). See Hjern, et al, Does tobacco smoke prevent atopic disorders? A study of two generations of Swedish residents. Clin Exp Allergy. 2001 Jun;31(6):908-14.

        Also, see this 2016 study (meta analysis) disputing the risks of second hand smoke: Peter N Lee, John S Fry, Barbara A Forey, Jan S Hamling, Alison J Thornton, Environmental tobacco smoke exposure and lung cancer: A systematic review. World J Meta-Anal. Apr 26, 2016; 4(2): 10-43, doi: 10.13105/wjma.v4.i2.10 CONCLUSION: Most, if not all, of the ETS/lung cancer association can be explained by confounding adjustment and misclassification correction. Any causal relationship is not convincingly demonstrated.

        Consider Boffetta, et al: Multicenter Case-Control Study of Exposure to Environmental Tobacco Smoke and Lung Cancer in Europe, Journal of the National Cancer Institute, Vol. 90, No. 19, October 7, 1998: “public indoor settings did not represent an important source of ETS exposure.”

        (This case-control study used data from the IARC. The period of enrollment of case and control subjects was from 1988 to 1994–16 years; IARC=International Agency for Research on Cancer.}

        In addition, this large study looked at 38 years worth of data:

        Engstrom, JE and Kabat, GC. Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98 BMJ 2003; 326:1057.

        This study found “No significant associations were found for current or former exposure to environmental tobacco smoke before or after adjusting for seven confounders and before or after excluding participants with pre-existing disease.” (This prospective study used American Cancer Society dataset.)

        • Pete Austin

          It is indeed true that persons like asthma, such as myself, were “able to walk away and avoid smoke before smoking bans”. I well remember the 1970s when it was very difficult for an asthmatic to have a social life because of the huge amount of smoking everythere. Later, I once lost a well-paid job because the “smoking room” was too near my desk and I found breathing too difficult. It is hardly right that I should get reduced access to hospital treatment too, because smokers think I should walk away.

          BTW I am not saying that atmospheric irritants such as second-hand smoke cause asthma in the first place – I believe in the “hygiene hypothesis”. Your research references are explained by this, the use of weasel words like “important”, and publication bias. There is no doubt that second-hand smoke is unpleasant and somewhat dangerous for asthmatics.

  • Flintshire Ian

    My mother in law was a very heavy smoker from 14 to 86 years of age. She was admitted to hospital last autumn because of poor oxygen levels. She is consuming more high strength nicotine gum than the NHS seems to be prepared to give her on (free in Wales) prescription, but she hasn’t had a fag since she was admitted to hospital. If she can stop, anyone can.

    (She was only in hospital for about a week)

  • Dave Moran

    My wife and I are smokers and we both dread having to go to a hospital. Following a recent motorcycle accident resulting in broken bones the fear was not waiting 7 hours in A&E it was being prisoner in a puritanical institution while stressed out to the max. Because we smoke. I have seen hospital patients carrying drip lines stood outside the front of our hospital taking a cigarette. These institutions are socially pernicious. I fell like telling them that I pay their wages, they are my servants not my masters. The only reason they want to bring the rates down is so they can confidently criminalize it. They don’t have my welfare at heart they have my imprisonment at heart.

  • Fr. Jack Kearney

    Completely banning smoking violates medical ethics. The principle of autonomy dictates that competent patients can self-direct their own care, so denying medical care to smokers is both cruel and unethical. Instead of punishing smokers, how about doing more to help them quit? How about giving them e-cigs, which pose no real threat to user or bystander?