Tuesday, 15 January 2013

NHS Tayside responds to complaints about smoking shelters

Late last year Smokers Justice presented a complaint to NHS Tayside about their smoking policy following this story.

Phil Johnson of Smokers Justice sent me this reply from NHS Tayside.
NHS Tayside, along with other Health Boards in Scotland, considers smoking to be the most serious threat to the health of the people of Tayside. In accordance with this view we believe that, as a public health organisation, it should contribute, in every way possible, to continuing the de-normalisation of smoking. A key component of this is NHS Tayside's policy which bans smoking in its grounds. Our own staff, visitors, other Health Boards and the Scottish Government has strongly supported our Smoking Policy.
[Links added]
In line with any other Policy, the smoking ban has to be enforced and our experience since 2006, (when the Policy was launched), has indicated that the employment of a Liaison Officer, along with support from NHS managers, is the most effective approach. The Courier and Advertiser is trained to persuade those NHS staff and visitors who smoke in our groundsto put out their cigarettes and signpost them to support services to help them quit smoking permanently. In the case of staff, he can also report smokers to their line managers for potential disciplinary action. Given the fact that our staff are viewed by the public as exemplars for health, then their behaviour can have a significant impact on the beliefs and attitudes of others. This is particularly important in the case of smoking.
I should stress that NHS Tayside staff who smoke are offered, and receive, considerable support from smoking cessation experts to quit smoking. Many of our staff have actually sought support to quit smoking as a result of our Policy.

We do have one smoking shelter in each hospital for in-patients to smoke. We decided not to have any others because our experience showed that this would dilute the message of our Policy. Also, when we tried to have more shelters pre-2006, staff and visitors saw this as an excuse to smoke anywhere they liked.

Therefore it is essential that we maintain the strength of our message within the Smoking Policy, which, along with other tobacco control initiatives, will eventually lead to a smoke-free Scotland. [Emphasis added]
Good luck with that one, NHS Tayside. The direction of travel has changed since anti-smoking rhetoric became an international government obsession, reflected in the smoking rate seen against anti-smoking government expenditure in Scotland:
Figures on tobacco control and smoking cessation expenditure obtained from FOI request from the Scottish Government, December 2012
Number of smokers taken from Scottish Household Survey reports
It is hard to find a way to say how unproductive tobacco control spending is on actual outcomes regarding smoking levels. And since we know so little about that, the figures on heart attacks and other health indicators are fairly meaningless as it remains as impossible as it ever was to measure either smoking levels or passive smoke exposure.

On the issue of smoking in hospitals, the casus belli in this case, read Smoking Scot, whose research and detailed accounts are worth pursuing.
I am very familiar with General Hospitals and their smoking shelters and I've had ample time to observe the dynamics of several shelters. During daylight hours the main users are hospital staff, able bodied patients and outpatients. During visiting hours those patients who need help with drips, catheters and such frequently enlist the help of family and friends - and they park themselves close to the entrance. There's nothing rebellious about this, the simple fact is the entrances to the shelters are not wide enough for a standard wheelchair and - in almost all cases I witnessed - we're talking about the aged or severely infirm, some with a terminal condition and all with something medical attached to them. Exposing them to rain, snow or extreme cold in a flimsy hospital gown is simply not an option for those who really care about them. Reality is so very far removed from the idealistic little vacuum of Simpson and McMahon.

After dark was a time of great poignancy when those without family had to make it to the entrance on their own. I spent a couple of evenings chatting to an aged widow (close to the entrance; even a hospital gets quiet after 21.00 hrs), who was remarkably candid about her condition and immediate future, despite having to wheel her drip which had her catheter reservoir dangling precariously on a hook. However they all had one thing in common, considerable personal dignity. None of us wanted to be in hospital yet those places, the entrance (after everyone had naffed off), or the shelters were great levelers. Met many very interesting people, got lots of tips and advice, even made a friend, and was delighted for him when he finally got what he wanted and passed over. And not one of them had any smoking related illness. Guts, bowels, breasts and brain cancers mainly.
Smoking Scot continues, discussing the perils of developing a culture of covert smoking, questioning who is demanding smoke-free health services, despairs at the myopic medical establishment view of smoking itself. The piece stands by itself but raises points that have been touched on this blog many times.

The main point is that actions enforcing the denormalisation agenda have no effect whatever on smoking rates, except perhaps to retard their decline. Like Sheila Duffy, NHS Tayside is living in a dream world if it believes the present trajectory will lead to a smoke-free Scotland.


Bill Gibson said...

Recent observations claim that 80% of detected lung cancers are in non-smokers thus leading researchers to consider that smoking is not the major cause that Health Authorities will have us believe. This then also suggests that greater emphasis should be placed upon directing more funding towards research and treatment by withdrawing funding from those who trumpet prohibition methods. Tobacco Harm nad Risk Reduction Methods should be considered ahead of Smoking Cessation thus allowing adults to make an informed choice instead of being forced into the Pharmaceutical Industry cash cow by the denormalisation methods of NHS Tayside.

Bill Gibson said...

In June last year The International Agency for Research on Cancer (IARC) designated diesel exhaust emissions as a Class A .Carcinoen and that it is more dangerous than secondhand smoke. Therefore in the interest of health, it would be better to have Indoor Smoking Lounges with Modern Air Management Technology that will capture and remove Air Particulate to an efficiency of 99.9999%