NHS hospitals and clinics – including mental health services – should become smoke-free the National Institute for Health and Care Excellence (NICE) has said.
NICE wants patients who smoke to be offered smoking cessation drugs, nicotine patches, and counselling as soon as they are admitted to an acute, maternity or mental health setting to encourage them to quit.
In addition, NHS staff, visitors, and family members should also be encouraged to stop smoking as part of a cultural shift in the way in which the NHS tackles smoking.
NICE also recommends that smoking shelters and other designated smoking areas are removed from secondary settings. It has published new guidelines to support hospital smoke-free policies.
Smoking is responsible for more than 460,000 hospital admissions in England each year, and is the single biggest preventable cause of death – nearly 80,000 lives per year.
Smoking is especially common among people with mental ill health, with 70% of people in psychiatric units estimated to be smokers. Most of the reduction in life expectancy among people with serious mental illness is attributable to smoking, which also increases the dose requirements of psychotropic drugs by £40 million a year across the UK.
“It is absurd that smoking is still being passively encouraged within hospitals, said Professor Mike Kelly, director of public health at NICE.
“Smoking has been thought to be a difficult nut to crack and so it is high time for this guidance. It recommends strong leadership and individual trusts have to own this. The professionals have to be willing to take this guidance on.”
Professor John Britton, who led the development of this guidance and is director of the UK centre for Tobacco and Alcohol Studies at the University of Nottingham, said that stopping smoking needed to become a priority for the NHS.
“If you provide the support that people need, the medications they need, the behavioural support and counselling that they need, immediately and you put them in an environment where they are not seeing the drivers of smoking, like people standing outside the ward doorway or standing in the car park, then they can achieve it. That's what this guidance is all about,” he said.
Desire to quit
Professor Sue Bailey, president of the Royal College of Psychiatrists, said: “There is a common but mistaken belief among mental health professionals that it's alright for patients in their care to smoke.
“The majority, 90%, of patients with mental health problems who smoke want to stop smoking. It may take them a little longer but they can achieve it.”
Mary Yates, matron at the South London and Maudsley NHS Trust, added: “A lot of nurses are actually facilitating smoking among patients. There are cases where patients have quit smoking and have then taken it up again when they enter our wards.
“The new NICE guidance can help to change the culture whereby smoking is acceptable on NHS grounds and make it easier for hospital staff to set a clear example in helping patients to be successful in their attempt to quit smoking for good.”
Stephen Dalton, chief executive of the NHS Confederation's Mental Health Network, welcomed NICE’s guidelines. "We recognise the challenge of implementation, but there is a need for a step change in smoking cessation support across primary and secondary care settings to significantly reduce health inequalities. Smoking is a major contributory factor to health inequalities in people with mental health problems. We know people with severe mental illness die up to 25 years earlier than the general population. We also know that many people with mental health problems would like to stop smoking and, with the right support, they can.
"The report recommends commissioning smoke free secondary care services and for strong leadership to promote stop smoking support - for patients and for staff - to initiate a cultural change within an organisation. Our recent briefing Smoking and mental health identified the good work some of our members are doing in this area.
“A total ban on smoking in the buildings and grounds of secondary care services complements the duty of care on healthcare staff and the organisation to protect the health of people in their care and promote healthy behaviour.”