Why hospital smoking bans are wrong

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.

According to the BBC:

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)

Mistaken identity

Enough words will be written elsewhere, so I’m not going to comment on the re-election of Donald Trump.

I am however thrilled to see so many broadcasters and pundits with egg on their smug, self-satisfied faces.

The fact that so many manage to earn a living from their uninformed, myopic view of the world beggars belief, but there’s clearly a market for those who live in a bubble, surrounded by like-minded ‘friends’, and continually preach to the converted.

Anyway, to lighten the mood, here’s a true (and unrelated) story.

When the Adam Smith Institute revealed the identity of their new patron last month, I congratulated ASI president Madsen Pirie with the words:

‘Just seen the announcement about Peter Mandelson - quite a coup!’

Except it wasn’t Lord Mandelson, the former New Labour spin doctor, who had become a patron of one of Britain’s leading free market think tanks.

It was Lord Mendelsohn, another Labour life peer who, following his peerage, became the party’s business and international trade spokesman in the House of Lords.

To be fair, he too has been described as a ‘key New Labour fixer’ so, in my defence, an easy mistake to make!

Party pooper

I was very kindly invited to a US Election night party in Mayfair tonight.

I don’t think I’ve ever been to one before - not even in the heady days of Ronald Reagan when I was on good terms with the Young America’s Foundation - so my immediate reaction was, “That sounds like fun, I really ought to go”.

But then I had second thoughts.

Beginning at 7.30pm, the party is scheduled to go on until ‘late’. But how late?

Given the time difference, would we actually witness any election results? And would anyone be watching or would they all be talking over the TV coverage?

The last US-themed event I went to was a Superbowl party in London in January 1984 and you could count on one hand the number of guests who were actually watching the game.

I was one of them so it was quite annoying that so few people were interested in what I mistakenly thought was the whole point of the evening.

That party went on ‘late’ too but I was young then.

Today my definition of ‘late’ means midnight. Anything later and I’m liable to fall asleep, especially if I’ve been drinking for several hours.

And when I fall asleep I snore. Loudly.

After midnight and it would be too late to catch a train home so I’d have to stay overnight in a hotel and watch the results on TV in the morning which I could do just as easily in my own house.

It would be cheaper too.

Worst of all, I’m pretty sure I wouldn’t know many people, which would bring back memories of the Spectator Summer Party that I once gatecrashed.

Thinking about it still gives me nightmares.

Truth is, I have never enjoyed parties and I am such a party pooper I wouldn’t even invite myself.

But I genuinely appreciate the thought and I will keep the invitation as a reminder of what could, for better or worse, be an historic night.

Tory co-chair supported amendment to indoor pub smoking ban

Congratulations to Nigel Huddleston MP who Kemi Badenoch has appointed co-chair of the Conservative Party.

Curiously, one of his first tasks was to defend her opposition to a ban on smoking outside pubs.

“Kemi believes in individual personal responsibility and has got great concerns about government coming in and burdening business,” he told Sky News, adding that he was “glad” the plan for a ban on smoking in pub gardens had been dropped.

Funnily enough, although I’ve never met him, Huddleston did once declare his support for the Forest-led campaign to amend the smoking ban to allow designated smoking rooms in pubs and clubs.

In November 2009, while standing as a prospective parliamentary candidate for Luton South (a seat he didn’t win), the future MP for Droitwich and Evesham joined us at a pub in the town.

As I wrote at the following day:

Yesterday, at the invitation of the local Licensed Victuallers Association (LVA) which represents independent licensees, we held a Save Our Pubs & Clubs meeting at The Bramingham pub in Luton.

The meeting was well attended and we made some very useful contacts including Nigel Huddleston, Conservative PPC for Luton South, who even donned a SOPAC t-shirt for the obligatory photograph.

Registering his support for our campaign, Nigel told a colleague: "We've had enough of Gordon Brown's nanny state. Politicians should respect people's freedom to choose."

I doubt that any leading Conservative would advocate an amendment to the existing pub smoking ban today (that ship has sailed), but it’s good to know there are some senior Tories who still believe in personal responsibility and the freedom to choose.

Sadly, the only evidence I have of that meeting in Luton is a small, poor quality image of Huddleston gamely pulling a pint accompanied by a member of staff and Sean Spillane of Luton Social Club (see below).

Sean is retired now but I remember our first meeting because it was the first time I had been to a working men’s club.

See also: The fascinating story of Britain’s working men’s clubs

Small victories

We returned on Sunday from our seven-night cruise to Lisbon.

Our ship, Cunard’s Queen Anne, docked at Southampton early in the morning and after a quick breakfast we disembarked and were home in Cambridgeshire before eleven.

(That’s the advantage of sailing from Southampton. Unlike flying, with its tiresome airports and endless queues, you can be on and off a ship quite quickly, and with valet parking you can drive right up to the terminal.)

I would write more about the Queen Anne, the latest addition to Cunard’s fleet of (four) ships, but there’s no time at present.

Yesterday, after collecting our dog Roly from kennels, I had to catch a train to London to attend a tobacco-related lunch at the House of Lords.

The timing of the event was perfect because rumours were flying around that the Tobacco and Vapes Bill was to be published today (Tuesday).

Those rumours proved to be true, but more on that later.

First, I had to leave the lunch early because I was booked to do an interview for BBC Spotlight, the local news programme that covers the south west including Devon and Cornwall.

As it happens, I agreed to do the interview via Zoom three weeks ago, but when the producer heard I was going to be in London we arranged to do it at the Millbank studios that are just across the road from the Houses of Parliament.

In the event we did it outside in Victoria Tower Gardens, which is opposite Millbank and directly adjacent to the House of Lords.

The original reason for the interview was a report suggesting that Totteridge, a deprived area in Devon, has a higher than average rate of smoking, and I was asked for my thoughts on that.

However, with the Tobacco and Vapes Bill about to be published, I was asked about that too.

I then caught a train back to Cambridgeshire but when I got home I discovered there was an issue with Roly and I had to take him to the vet.

I won’t go into details but because it was after hours it required a visit to an emergency vet.

As I write he is currently on the sofa looking a bit sorry for himself but hopefully it’s nothing too serious.

Anyway, it’s six in the morning and I have woken up to find that the Government is indeed publishing the Tobacco and Vapes Bill today.

The good news, confirming recent reports, is that a ban on smoking outside hospitality venues will NOT be included in the Bill.

Instead the smoking ban will be extended to places where children are present - outside schools and playgrounds - but also hospitals, something Forest has fought against for many years.

The Bill however is arguably worse for vapers because the Government wants to have a discussion about banning vaping in certain public places.

In truth, while I oppose vaping bans, I have no sympathy for the many vapers (and vaping advocates) who sat on their hands and said nothing when it was announced that the Government wanted to ban smoking outside pubs.

The threat of public vaping bans is the inevitable ‘reward’ for their silence.

Anyway, you might think Forest would be inundated with requests for interviews or comment but that’s not happened.

Instead the ‘story’ is a complete stitch-up. The Government press release - embargoed no doubt until midnight last night - has been reported widely but with almost no comments opposing the Bill.

To date I’ve seen one quote by UKHospitality’s Kate Nicholls and that’s it.

Chris Whitty, the chief medical officer for England, is as prominent as ever, writing in The Times that children have to be “protected” from tobacco smoke, even outside.

Since I’ve yet to see any evidence of harm to non-smokers (including children) from exposure to tobacco smoke in the open air, it is truly staggering that anyone can make this claim and get away with it without some push back, but that’s where we are and few people want to challenge it.

ASH is also prominent in today’s reports but that’s to be expected. Not only are they quoted in the Government press release, they were described recently as one of the Government’s ‘partners’ (I kid you not).

I know that ASH and the Department of Health have enjoyed a close relationship for many years, but ‘partners’? That’s quite an admission.

Anyway, the Tobacco and Vapes Bill will now proceed through Parliament and given the Government’s huge majority there is nothing that can derail it.

Amendments may be tabled - raising the age of sale of tobacco to 21 instead of a generational ban, for example - but the chances of the Bill being watered down are small to non-existent.

Nevertheless, let’s enjoy the fact that plans for a ban on smoking outside pubs have not been included in the Bill. That’s a small victory at least, although I doubt it’s the last we’ve heard of it.

The omission of a tobacco levy in last week’s Budget was another little victory, so although the outlook for smokers under this Government is bleak the anti-smoking lobby hasn’t got everything it wants … for now.

All at sea on tobacco and vapes

I am currently at sea, sailing from Lisbon to Gijon in north west Spain before returning to Southampton on Sunday.

Our home for the week is the Queen Anne, the newest Cunard ship. Launched earlier this year, it’s one of four Cunard ships, the others being Queen Mary 2, Queen Victoria, and Queen Elizabeth.

Queen Anne is not the largest Cunard ship (Queen Mary 2, an ocean liner built for transatlantic cruises, holds that distinction) but it accommodates more passengers - 2,996 compared to QM2 (2,695).

Queen Elizabeth and Queen Victoria are smaller, holding 2,081 passengers apiece.

To put those numbers in perspective, many cruise ships now accommodate upwards of 4,000 passengers, with the largest - the Royal Caribbean's Icon of the Seas - accommodating 5,610 guests (plus 2,350 crew members).

The reason I mention all this is because we were in Lisbon yesterday when the Chancellor, Rachel Reeves, was announcing the details of her first Budget.

You can read Forest’s response to the predictable increase in tobacco duty here, but more noteworthy, perhaps, is the additional “one-off” hike in tobacco duty that will accompany the introduction of a flat rate tax on eliquid from October 2026.

According to the BBC:

That will be accompanied by an equivalent increase of £2.20 per 100 cigarettes in tobacco duty to "maintain the financial incentive to switch from tobacco to vaping".

But that’s not the end of it. Include VAT and the ‘one-off’ tax hike will actually add £3.30 per 100 cigarettes (or 66 pence per 20).

That of course is in addition to the annual tobacco escalator (inflation plus two per cent) that, following yesterday’s Budget, has added something like 54 pence to a pack of 20 cigarettes, and £2.33 to a 30g pouch of handrolling tobacco.

Anyway, Forest’s response was reported by The Sun and the Mirror so my efforts from the quayside in Lisbon weren’t entirely in vain.

Below: On board Cunard’s Queen Anne awaiting the Budget

Reality check as Number Ten reconsiders outdoor pub smoking ban

Good news.

It was reported last night that the Government is to drop its plan to ban smoking outside pubs, including beer gardens.

Nothing has been confirmed but if it’s true it’s a victory for common sense, and everyone who has been arguing against the policy.

I don’t think the issue will go away, though. After all, it’s been around for a decade at least and is currently being pushed by none other than the Chief Medical Officer Chris Whitty who seems to be on a personal mission to eradicate smoking.

Nor does it stop the devolved governments in Scotland, Wales, and Northern Ireland introducing the policy, should they choose to.

In the meantime health secretary Wes Streeting continues to promise a “tougher” version of Rishi Sunak’s Tobacco and Vapes Bill so nothing can be ruled out, including bans on smoking in other outdoor areas.

Funnily enough it's exactly ten years since Boris Johnson was urged, as mayor of London, to ban smoking in the city’s parks, a suggestion he rejected on the grounds that the plan was too interventionist:

“One of the glories of London is that we are generally pretty laissez-faire about how people live their lives – provided they do not break the law and provided they do no harm to others,” he said.

He said he might act on the [London Health] commission’s advice but only if he was convinced that doing so would save lives. “If we were to consider a ban on smoking in parks, we would need pretty clear evidence that this would have direct health benefits – in other words that it would actually save lives. It is time for London to have that debate.”

The reality is that no such evidence exists, as even Number Ten appears to admit, although that’s never stopped governments in the past. 

I’ve no doubt that the existential threat to the hospitality industry has influenced government thinking, but public opinion - as evidenced by a recent poll commissioned by Forest and reported by Guido Fawkes and The Sun - was clearly divided on the issue, with slightly more people being against the idea than in favour.

As for the timing of the Government’s alleged u-turn, can it be coincidence that it was reported just 48 hours after our Smoke On The Water reception attended by MPs and a host of parliamentary aides, including Labour staffers?

Or that one of our speakers was a prominent young Labour activist who opposed the policy on the grounds that it was fundamentally “illiberal”?

Anyway, the battle is not yet won and there are other significant challenges, notably the generational ban on the sale of tobacco, so it's back to work, beginning with an interview on GB News later this morning.

See also: Pub garden smoking ban set to be DROPPED by No 10 (The Sun)
No 10 blocking outdoor smoking ban amid hospitality opposition (Guardian)
Labour ‘will drop plans for outdoor smoking ban’ (Telegraph)
Government refuses to comment on reports of it dropping proposed outdoor smoking ban (Sky News)

Smoke On The Water 2024

Some images from Smoke On The Water 2024.

They include (above, top right) Mitchell Orchant, founder and director, C.Gars Limited; (above, bottom left) Tom Utley, columnist, Daily Mail; and (directly below) Reform MP Lee Anderson.

Below (clockwise from top left): Reem Ibrahim, Institute of Economic Affairs; Josh Cheshire, UK national coordinator, Students for Liberty; Jonathan Heywood, former secretary, Labour Students; and Sam Bidwell, Next Generation Centre at the Adam Smith Institute.

Click here for the full gallery.

For me, though, the photo below is the one that arguably reflects the convivial mood of the evening.

Photos: Stuart Mitchell