Why hospital smoking bans are wrong
Thursday, November 7, 2024 at 8:00 Smoking outside pubs may have been given a reprieve, but the Government will almost certainly ban it outside hospitals.
Few people will protest, but I will because I think it’s wrong to target people for whom a cigarette may offer comfort when they may be at their lowest ebb.
That’s why, for many years, Forest has fought an often lonely battle against hospital smoking bans, and I’m proud to have done so.
In October 2009, for example, under the headline ‘Call to defy hospital smoking ban’, the Dundee Courier reported that:
The director of a pro-tobacco lobby group last night urged smokers to rebel against the ban on smoking in the grounds of Ninewells Hospital in Dundee.
Simon Clark, who represents Forest, said measures by NHS Tayside to force smokers off hospital grounds before lighting up were “dictatorial and draconian.”
“It’s rather petty and vindictive to enforce a no-smoking policy in an outside area,” Mr Clark said.
“Hospitals are supposed to show compassion and demonstrate a duty of care towards all patients. I’m sure they think they’re acting in peoples’ best interests but they’re actually making people’s lives a misery.”
He continued, “It is also quite inhumane to expect patients who are ill to walk some distance just so they can smoke.
“I think hospitals need to show a little humanity because, like it or not, some people smoke as a form of stress relief and being sick or having a relative in hospital can be quite stressful.
I’ve employed the same arguments many times since, and although it’s been a thankless task we’ve never stopped fighting.
In Scotland, for example, we made headlines in 2015 when I was invited to give evidence to the Scottish Parliament's Health and Sport Committee in response to the Health (Tobacco, Nicotine etc. and Care) (Scotland) Bill.
Plans to make smoking in hospital grounds a statutory offence have been branded "inhumane, petty and vindictive" by a pro-smoking (sic) group.
Simon Clark from Forest made the remark while giving evidence to Holyrood's health committee.
Mr Clark told MSPs: "Going to hospital as a patient or a visitor can be a very stressful experience. It's also quite stressful for many members of staff.
“To ban smoking on all hospital grounds, we think, is totally inhumane, it's totally vindictive, it's petty, far pettier actually than banning smoking in pubs. At least people can still go outside.
“To extend it to entire hospital sites, we think, is absolutely outrageous."
The moral victory was the fact that the final Bill restricted the ban to within 15 metres of hospital buildings.
In England the situation has been a bit different. Although many hospital trusts have introduced no smoking policies, they are not universal and until now there’s been no law to say you can’t smoke on hospital grounds.
In 2019 therefore Forest published a report (Prejudice and Prohibition) that listed the smoking and vaping policies in NHS hospital trusts in England.
Based on freedom of information requests to 200 hospital trusts in England, we found that fewer than one in four NHS trusts allowed smoking on hospital grounds.
Three quarters (76 per cent) of the trusts that responded to our survey said they did not tolerate smoking anywhere on site, including hospital car parks, while only one in five provided a shelter for smokers.
At the same time, and more surprising perhaps, we discovered that vaping was increasingly banned both inside and outside many hospitals.
Fifty-five per cent of the 170 respondents prohibited vaping on hospital grounds, with nine in ten (89 per cent) banning the use of e-cigarettes in hospital buildings.
The report called for vaping to be permitted on all hospital sites with no restrictions in outdoor areas. The use of e-cigarettes, we said, should be allowed inside hospital buildings, including wards, at the discretion of hospital management.
Other recommendations include allowing smoking outside hospital buildings with smokers incentivised to smoke away from hospital entrances by the provision of designated smoking areas, clearly signposted.
On sites where smoking is prohibited, we argued that trusts must take steps not to discriminate against patients who are infirm or dependent on others to accompany them off site to smoke.
Our press release at the time included this quote from me:
“Banning smoking on hospital grounds demonstrates a staggering lack of compassion for smokers who may be stressed, upset and in need of a comforting cigarette.
“A reasonable policy would lift restrictions on vaping but give those who prefer to smoke the option of sheltered smoking areas.”
Five years later and the new Labour government is planning to ban smoking outside every hospital in England.
The details haven’t been published yet so I don’t know whether the legislation will prohibit smoking anywhere on site, including car parks, or within 15 metres of hospital buildings (as in Scotland), but we’ll find out soon enough.
The good news is that Forest is no longer a lone voice condemning hospital smoking bans. In the last 48 hours articles have appeared in the Telegraph and The Spectator (online) and they’re not by lobbyists like me.
Quoted by the Telegraph, leading cancer specialist Prof Karol Sikora argued that:
When it comes to hospitals, we have to be liberal about smoking out of sheer empathy for the patients – many of whom are at the end of their lives. There’s no doubt that smoking is bad for you, so I’m not suggesting that we should encourage people to do it. But for many patients it’s a lifeline – a practice that brings comfort and relief at times of deep distress.
Writing for The Spectator, by Druin Burch, a consultant physician and former junior doctor, goes even further:
Smoking on NHS property is already banned to the highest degree. No hospital is without its sign saying that smoking is not allowed. But beneath every sign stands a smoker. No one enforces these no-smoking rules, and it is perfectly obvious that nobody should. Staff, their smoking shelters taken away, make mild efforts to be furtive. Visitors don’t bother, and to see them puffing away in front of these signs tells you what weight hospitals put on their own rules.
Then there are the patients, often lacking the physical ability to leave the grounds. Some want to quit smoking but can’t, others freely choose to continue. Still more have no sane reason to quit at all. Many are dying already, and smoking gives them pleasure and comfort. This NHS policy, with its failure to provide anywhere for patients to smoke, with its pretence that putting up a sign means the issue is solved, with its utter indifference to enforcing its own rules, is simply hypocritical virtue-signalling, laced with dishonest cruelty.
I don’t doubt that many more health professionals, including hospital administrators, feel the same, but sadly they have chosen - over many years - to remain silent.
The lack of prosecutions in Scotland suggests that the law is not being enforced because reports indicate that smokers are still lighting up outside hospitals, and will continue to do so, regardless of the law.
The police, clearly, have better things to do and without resorting to heavy-handed enforcement that would be disproportionate and wholly inappropriate in a hospital environment, there is little anyone can do to stop it, which will make both the Government and the law look ridiculous.
PS. I’ve been writing about (and campaigning against) hospital smoking bans for many years. Here are a handful of blog posts on the subject:
Hospital admits defeat and reinstates smoking shelters (October 2012)
Why smoking should not be banned on hospital grounds (April 2013)
Hospitals, have a heart (April 2015)
Ban on smoking on hospital grounds sends wrong message about our ‘caring) NHS (July 2015)
Reporting Scotland: hospital smoking bans under attack (September 2015)
Scotland’s hospital smoking ban: law could be restricted to designated areas (November 2015)
Hospital targets patients who smoke (June 2017)
Smoking and vaping on hospital grounds in Scotland (June 2020)
Smoking banned within 15m of hospital buildings in Scotland (September 2022)
Scottish hospital smoking ban a failure (January 2023)
Reader Comments (3)
Smoking bans on hospital grounds only serve to show how those with the most power enjoy bullying the weakest and most vulnerable in society.
Hospital smoking bans are the most vile and anyone who supports them clearly enjoys seeing people suffer.
Bullying should not have any part to play in so called NHS "care".
I have of late become rather familiar with one of Ireland's largest teaching hospitals.
Back in the days when Ireland was in the middle of one of its most vitriolic attacks on smokers this same hospital had a series of hidden loudspeakers around the grounds. Visitors [and patients] were treated to a disembodied voice that would drone on about the campus proudly being a "no smoking area". I'm glad to say that they no longer bother and the voice is no more. Smokers now congregate outside the main doors and happily puff away. Even better, the staff are happy with this arrangement. On a recent stay, one of my fellow ward inmates used to vanish on a regular basis and the nurses would happily announce he was on a "smoke break". There is hope yet for a bit of compassion.
I think you’re right, Grandad. After the initial publicity I think most hospital staff will turn a blind eye to people smoking outside.