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.