Airside smoking area at Aberdeen airport

Good. And I hope it's illegal. That is, indoors, so that smokers won't be subjected to the airport exhaust emissions that cloud all airports.

Did ASH Scotland see that one coming? Or are they to busy trying to protect Wales?

Getting cold for a good cause at 83?

This is a government health warning: 

Exposure to

 cold weather

 can seriously damage

 your health

This used to be fairly common knowledge, but a home for the elderly in Dunfermline plans to close its smoking room and turn it over to general use. Smoking will take place in a shelter in the grounds, subject to the usual legal restrictions.  The story is here. 

In line with government hopes and expectations, the home (Canmore Lodge) has waived the exemption that applied to residential accommodation when the ban came in. Andy Kerr, then Health Minister, said: 

Residential homes are where people live and have their home. We felt that, as long as there was a smoking policy in such places, people would have the right to smoke where it was deemed to be their home, just as others in the community have that right. There were obvious humanitarian and other reasons for that exemption.

Local MSP Helen Eadie has protested against the home's plans. It seems that some Labour MSPs did not realise what a Pandora's box they were opening by supporting the smoking legislation.

Note that this policy is introduced to a home that currently accommodates only two smokers. Among the reasons given is that they want the room to be available to more people. This goes beyond the requirements of the law, which allows designated smoking areas in exempted premises. Devoting resources to the construction of a legal smoking shelter is an appalling use of resources, including fees, whether privately or publicly paid to the parent company.

There are methods for dealing with secondary smoke exposure.

This is a frankly an abuse of power over vulnerable people who depend on others for their daily needs.   The relatives of the residents involved protest in the article, but they are clearly open to the suggestion that their elderly relatives would be much better off not smoking: a hypothesis that is clearly irrelevant to the absolute certainty that smoking in a warm room endangers health far less than smoking in a bus shelter that is 50 per cent enclosed.

The web site for the organisation is here. There are contact details if you wish to formally protest this decision. Incidentally I note that the section of their page entitled News Articles does not include any stories at all ...  what a shame they will really have to kick off with a story about allowing the elderly to freeze.

Press release, Freedom2Choose.

Today, Save our Pubs and Clubs Campaign goes to Westminster

BBC report here, and This is Bristol here. A reception will be held at Westminster today for the campaign to amend the smoking ban, involving three MPs, Forest, publicans and others. It will send a message that many, many people are not happy with the comprehensive smoking ban and see no reason that smokers must have nowhere to socialise except in their own homes.

Asking for permission to set up smoking rooms is a risky strategy as it concedes that secondary smoking is itself a specific problem that requires a legislative solution. The only legislative solution required is regulated indoor air quality standards. dealing not only with cigarette smoke but with all air-borne pollutants. No legislation is required to regulate where people may smoke in business establishments, or whether staff may enter specific areas to carry out their duties. The air must be cleared free of toxins, so that people can work anywhere.

Freedom to Choose (Scotland) supports the campaign to amend the ban, but would prefer the approach offered here. Still, it is magnificent to see growing opposition to the smoking ban – I look forward to hearing more reports of the day.

Many more hospitals build shelters ...

Five years after the smoking ban came in, this report says that it's not enforceable in the grounds of hospitals and many are rebuilding shelters.

Let's hope they have the sense to make the shelters comfortable enough to tempt people away from the doorways. This will save the security people a job. Four walls and a roof would be nice, although it's still against the law to treat smokers like civilised human beings.

The Daily Express does not specify which hospital trusts are involved. This is not limited to Scotland. Attempts to introduce no-smoking policies into the NHS have been attempted before and failed. Back in 2005, hospitals expressed doubts about being able to introduce no-smoking policies by the end of 2006.

... the results of its random survey of 80 hospital trusts showed that although 90% of them had brought in a partial no smoking policy, the 10% which had gone one step further and tried to introduce a total ban had failed.

Not that it stopped them trying, of course. Some people can't help trying to change human nature – they even keep referring to smoking as a 'preventable cause of death',* while also themselves calling it an addiction, and finding it quite impossible to prevent it from occurring.

* Still an interesting topic for debate.

And in by the back door ...

I'm travelling soon so many preparations to make but here in the meantime (reported from Malta) is a story of how smoking rooms are returning. (For some.)

Even as Spain prepares to ring in the New Year with a smoking ban in bars, renegade nightspots in Paris and Berlin are bucking the European trend, opening designer smoking rooms, complete with pianos, pool tables and cigar lockers.

Enjoy.

Asthma attack followed by call for tough action on doorway smoking, Cumbria

Every so often I despair of public attitudes on smoking, before reminding myself that a few thoughtless comments tacked on the end of a newspaper story does not represent humanity.

A patient's coughing fit was triggered as he entered the Cumberland Hospital via a doorway where people were smoking. Taking half an hour to recover, he considered that smokers should not be in the doorway, which is not an unreasonable point of view.

The only reason people are there is that they have been denied the comfort of a smoking area to sit down in. For some reason this is considered to be in everybody's best interests, including those patients who 'have' to exit the building for a smoke. Public outrage is expressed if anyone who dares to smoke when hospitalised continues to benefit from NHS care.

How simple can this get? The business of whether anyone smokes when s/he is ill is taken by the patient either alone or in consultation with his/her physician. It is not a hospital management decision. The decision of whether someone visiting hospital to visit a patient smokes is not even a clinical decision. Nor is the issue whether staff smoke. This is the only thing that approaches being a management decision, but a blanket ban on smoking during working hours seems to me peculiarly unwise.

It is absolutely none of the business of the general public.

The way to resolve the problem of smoking in doorways is to provide at the very least a comfortable  and robust shelter at the front of the hospital where it is easily reached by everyone including outpatients with mobility problems, and that provides a preferable solution to standing in a cold doorway. Seating and shelter would help. Coffee facilities in a proper room with comfortable seating would be even better. Nobody who is attending a relative they are anxious about wants to be stuck behind the hospital where they cannot be reached. Nobody in a wheelchair or on crutches will want to trail to the back of the hospital either. If you don't want smokers to be seen at the hospital by the world at large, give them a room that they will want to use. Just how difficult is that?

This is how to use 'nudge' properly. Give people a better alternative and they will choose it over an option that inconveniences everybody – or at least most of them will.

Here is some sense from a Czech legal expert.

It is often said that history repeats itself, but only rarely are we invited to look at the preponderant role of dogmatic ideologues in this recurring phenomenon. As always, they insist that the state should re-educate their fellow citizens by imposing their vision of what is “good,” and this is the case with anti-smoking activists, who are now leading the charge of the partisans of “progress.” Over the last few years, they have successfully campaigned for the introduction of increasingly severe anti-smoking legislation in most European countries, and in so doing, they have taken advantage of a widespread phenomenon in Western civilisation: the drift towards a nanny state and the growth of a culture that is hostile to even the slightest risk.

[...]

Experience has shown that social engineering projects that aim to curtail fundamental freedoms often have unexpected results and in most cases prove to be unqualified failures. This is the future that I foresee for the very strict repressive measures that the EU may be about to impose on smokers, who represent more than a third of the population of Europe’s member states. A few years from now, this kind of legislation could make smoking a symbol — and not just for smokers — of resistance to intrusive and paternalist public authorities and the relentless appetite for regulation in the EU, which is an increasing source of exasperation for a growing number of its citizens.

This observer sees any public health goals of the war on tobacco backfiring, reversing all the good that was done by tolerance.

Meanwhile the Third Estate has picked up the story of the ban throughout the buildings and grounds at The State Hospital at Carstairs: Scotland's secure hospital. Reuben points out that inmates/patients at Carstairs should have the dignity of choosing, just like the rest of us are meant to have.

Almost thinking outside the box on smoking

Well done the Telegraph for stating the obvious on smoking – that any arrangement resulting in patients smoking in beds and adjacent to oxygen tents is a thoroughly bad one and needs to be changed urgently. 'Let the patients puff away in their shelters,' it says. Well, that would be a marked improvement on having to go out on to the street. There was never any excuse for implementing comprehensive site bans in the first place – nobody can say they weren't warned.

But it didn't go far enough. Shelters are not the answer if you are confined to bed and have mobility problems. If on the other hand you are with a relative who is seriously unwell and you want to go for a quick smoke while they are undergoing treatment, the last place you want to be is in a shelter round the back of the hospital where you cannot be found if needed. I appreciate that the Telegraph might not want to condone breaking the law, but in this case they should have gone further.

The only solution to the problem of hospital smoking is large comfortable smoking rooms (preferably with coffee facilities) that will attract patients and visitors out of doorways and other places where they feel driven to smoke. Instead of treating smokers as culprits and driving them to situations where their smoke will inconvenience or endanger others, how about allowing them some dignity – or is that now considered to be against the national interest?

And well done Duncan Barkes of Talksport for making this very point on this morning's show (about 3.45 am)!

Did a cigarette cause the fire at Ninewells?

The cause of the fire at Ninewells might never be clearly established, but callers to the Courier office from employees and former employees at the hospital claim that smoking indoors continues and a cigarette end may have been to blame.

Illicit and covert smoking is frequently put forward as a reason not to apply comprehensive smoking bans: covert smoking is far more dangerous than smoking openly in a designated area with proper disposal facilities.

The obvious answer to the problems at Ninewells Hospital and hospitals everywhere is a smoking room that would be comfortable enough to attract people away from doorways, cloakrooms and other forbidden areas. The suggestion that smoking caused the disaster at Ninewells yesterday has forced revelations of how much illicit smoking goes on, and supports the call for such a smoking area.

A lesson for Grampian

In common with other hospitals, Royal Derby Hospital and others in Nottingham and Leicester are reviewing their smoke-free policies after they have been (according to policy) 'smoke-free' since 2006.

Patients, visitors and staff are all still smoking on site. The hospital spokesman recognises a need to restore smoking areas on compassionate grounds because of stress levels involved in being in a hospital environment – even for people who are 'receiving treatment themselves'. What a difference from the punitive approach adopted to all smokers adopted by both NHS Grampian and the Scotland Patients' Association.

The obvious solution to on-site smoking is a large comfortable, airy smoking room that will attract smokers away from the doorways. The law is an ass!

If anyone wants to advise the Scotland Patients' Association or NHS Grampian of these developments, contact details are here and here. English news stories don't always reach the Scottish public.

Three more fined at Ninewells including on-call emergency nurse

An emergency on-call nurse has been fined for smoking during her break time at Ninewells Hospital, Dundee. The details are here.

In spite of a commenter declaring 'public support = 0', personally my support for this person is high, because she's on a hiding to nothing. The enforcement officers have issued a fine to someone who is contractually bound, as an on-call duty officer, not to leave the grounds. She was unable to comply with the smoking policy's requirement to go off the site. Such a person is supposed to accept a requirement to renounce smoking throughout her shift or face criminal sanctions. Had she gone off site to smoke she would also been in breach of her contract. . I also don't see why people should expect employees of a health service (especially one that is free at the point of need) to be walking exemplars of how to live healthily in all their break times. Are we expected to raid nurses' lunch boxes and extract anything with too much sugar or salt in it?

I don't see why the Health Board should be entitled unilaterally to change her conditions of service without issuing a new contract of employment, in pursuit of anti-smoking dogma.

Just give them a big, airy room with ash trays, tea and coffee facilities, and comfortable seating. That will solve the doorway smoking problem instantly. Oh sorry, have I said that before?

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.