Tuesday, 3 August 2010

Update on NHS Grampian ban

The decision to ban smoking throughout NHS Grampian sites has been deferred for six months following concerns that it would not be enforceable, the BBC has announced. Freedom to Choose (Scotland)'s misgivings about the legality and enforceability of the measure have been vindicated.

Other health boards have acknowledged that there is no legal grounding to the ban. This article has come out today: the site manager of Ninewells Hospital in Dundee is quoted saying:
we can only ask them to respect our policy on smoking but if they say they don't respect it, and ask ‘What are you going to do about it?', then we have to walk away.
Furthermore yesterday another story came out yesterday from Cornwall with much the same message.
The Scottish Government has other ideas and asserts that NHS Grampian is acting within its powers. This implies that the smoking ban legislation has always been capable of being applied outdoors without further primary legislation. Yet NHS Grampian today decided that enforceability was too big a problem to force on its workforce and the Grampian public, at least until further discussions have taken place.

Last year the Scottish government held a consultation that was designed to engineer Scottish mental health services in a no-smoking direction. This would have had the result of removing the exemption that currently applies to smoking rooms in psychiatric units, but further questions were added in the mental health consultation asking respondents whether smoking should be banned outdoors too.

Meanwhile the NHS and Health Scotland have run a seminar on Health Improving Health Services – health services with a vengeance. Ridden with jargon about working together, it refers to 'the discussion of how we make hospitals exemplar centers for health and wellbeing'; 'asking for and valuing patient feedback', and finally 'clarifying, and then enforcing, our stance on issues such as smoking on hospital grounds'. Quite a confusion of objectives here. But the seminar does demonstrate that the effort to make hospitals smokeless zones is government-led.

The issue is simple. The NHS is there to deliver medical treatment to sick people. It employs people to treat patients and otherwise service the hospital. There seems no good reason to employ any of the staff as exemplars in public health. It makes no economic sense for staff to challenge visitors to the hospital for smoking, nor does it help anyone's health. Threatening disciplinary action against staff who possess tobacco and expecting them not to smoke in break-times on shifts that can extend to 12 hours marks an extraordinary departure from normal conditions of service.

Threatening to withdraw treatment from patients who smoke on a blanket basis, or depending whether they observe no-smoking requirements in hospital, is discriminatory treatment: not a decision made on clinical grounds.

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