How to resolve a smoking problem: ban e-cigarettes in pubs?

Just a quickie: a headline article in the Evening News claims that Edinburgh Royal Infirmary has 'blown' £600,000 on clearing smoking-related litter since the smoking ban. Clearly this is another attempt to attempt to outlaw smoking on hospital grounds, but to my mind the real question is why anyone has tried to extrapolate smoking-related cleaning costs from total cleaning costs at the hospital. More observations that smoke has been seen curling its way into hospital windows. The way to prevent generalised hostility against smokers on hospital sites is to provide appropriate spaces for people to smoke where they can be comfortable, reasonably safe and won't get in the way of others, but such common sense would be interpreted as an attempt to 'normalise' smoking and cried off the agenda.

Anyone would think that an electronic gadget that produces no obvious waste problems and emits no tar would be a welcome addition to the anti-smoker's apparatus. But the e-cigarette has been widely attacked for not having been proven to be safe: not only concerning their direct use, but there have  been stories abound about e-cigs exploding while being charged, children swallowing cartridges, and doubtless others. Now, incredibly, Borders Council Licensing Board has tabled a motion to ban e-cigarette use in licensed premises. (Stop press: the licensing board has requested more information before agreeing to ban e-cigarettes. I hope they find it's more trouble than it's worth.)

These days there is not even the excuse that most e-cigs resemble real cigarettes and their use presents staff with potential difficulties in enforcing the smoking ban. It's a case of 'they may not be safe', and for some reason this is a reason to ban them. Is it really about normalising smoking? or the idea that people cannot assess safety, even with the help of widely available data?

Official objections to e-cigs versus Forest in debate two months ago here.

'Trust promises they will abide by the result of the vote', but Royal Bolton goes back on promise to build shelters

Going back on a decision that even an Action on Smoking and Health spokeswoman described as the 'lesser of two evils', trustees of the Royal Bolton Hospital have gone back on a promise to abide by the results of a poll held by the Bolton News to establish whether there was popular demand for the return of smoking shelters.

There were 1,629 votes to bring back the shelters, 49 more than the opposing side. Disquiet was caused by the revelation that shelters were ordered weeks before the vote took place, giving the impression that the vote itself was just window-dressing (which is frequently the case in smoking issues but with the vote going the other way).

Apparently in Bolton all the concern that smokers were needlessly blocking entrances to the hospital has come to nothing. A growing awareness that you cannot legislate smoking in the open air matters little. The prospect of allowing visitors, patients (wheelchairs, drips and all) and staff somewhere even minimally sheltered to smoke weighs nothing against the compulsion to simply get rid of the smoke. The medical director of the Trust said:

'We have just undertaken the exercise but having reflected on that and heard a lot of views, we feel perhaps we need to look at this in a different way and stand shoulder to shoulder with our public health colleagues.'

All that now matters is that the trust is seen not to condone smoking. Ironic that the public health community is referred to in this context, when even ASH gave qualified support to the proposal to build shelters in view of the numbers smoking outside.

There is no 'perhaps we need to look at this in a different way'. The Trust made a promise, published by the Bolton News. To say after the fact that 'we could not ignore the other people who voted against it because it was so close' is not a little insulting to the people whose votes are to be ignored – as so often – namely smokers and their supporters in the general public. The authoritarian approach prevails: 'Smoking is not allowed on site and the key is to enforce the ban,' says Cllr Andy Morgan. Well, good luck with that one.

The Trust should be ashamed of itself.

(Poll result shown here)

Three smoking wardens fail to manage the problem

The story is here. Three men hired (at £12,000 a year each) to ensure adherence to the smoking policy at Gartnavel Hospital in Glasgow left after days following abuse from smokers outside the hospital.

I sympathise with the wardens to the extent that £12,000 is very poor compensation for work that brings public ire upon you. But the basis on which they were employed was wrong. I was visiting a relative in hospital recently and was struck with how few smokers could be seen in the grounds of the hospital – considering how many smokers are around at any one time, a huge building, thirteen or so storeys high, I doubt whether I ever passed more than a dozen or so smokers in the 200 yards or so between the main door and the gate off the premises – the signs do seem to be observed by most people most of the time.

Unfortunately there are laws against managing this issue effectively. What these wardens were employed to do was effectively to tell these people off for not behaving considerately (even if they thought they were 'helping' them by offering them the opportunity to stop smoking). What the situation needs is an alternative that smokers can choose in preference to standing in the doorways, or shivering under a sign. This means a comfortable, air conditioned room in which they can enjoy a coffee and a newspaper.

Health authorities do not like to contemplate that such courtesies could be offered to smokers, as they believe that they will encourage other people to smoke. They should remember that at the time such facilities were offered, smoking rates were falling faster than they are now. They believe that public hostility will stop people smoking, in line with their support for denormalisation and stigmatisation (approaches to human behaviour that have no place in a public health setting).

I am not surprised at the hostility of smokers, who are tax-paying members of the public. Public hostility is being whipped up against them, with the use of posters explaining how their smoke drifts through open windows and into the lungs of desperately ill children (as if the smoke were distinguishable from general urban pollution).  This is a matter of policy, because it is easier to blame smokers for lack of consideration than to solve the problem by catering for them with respect, and in a way that does not inconvenience others.

Employing wardens (especially on the cheap) to deal with the consequences of a blanket ban on health service premises was never going to work. Solving the problem will take a reversal in the law to enable the provision of a proper smoking room – anything else will just be a sticking plaster.

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.

Greenock Telegraph's sketchy reporting of smoking ban problem

On learning from an outraged employee that Inverclyde Royal Hospital regularly sees smokers in its grounds, Greenock Telegraph reporters went 'straight to the health board chiefs'. There they learned more of what hospital trusts have been discovering up and down the country – that bans are not enforceable. Staff can be forced by contractual obligations to comply with rules (although how many of them will have been issued with new contracts outlining a complete ban on smoking on the premises – perhaps the threat of disciplinary action has been enough). But visitors and patients cannot be policed in the same way.

End of investigation. The story is that people are breaking the rules, and this version doesn't so much as attempt to understand these people's point of view. It's an old story, and has been a running sore on hospital premises for years now.

The absurd situation of people hanging about smoking in hospital doorways, obstructing entrances and upsetting people who have been frightened by passive smoking myths, has persisted for too long. The public has demonstrated its contempt for outdoor bans in hospitals everywhere. Health boards should insist on allowing the creation of proper, weather-proof shelters for people who need to smoke during their visit to hospital, whether as patients or visitors.  They should complain for a change in the law. Staff should not be prevented from smoking in their break times either.

And the Greenock Telegraph should also get its act together. Since people have not stopped smoking in hospital grounds since the ruling came in, it shouldn't be difficult to find one offender who is prepared to give his or her view of the issue. No smokers were interviewed. No staff who have been successfully restricted from smoking were interviewed (have they been banned from speaking to the press?)

Nul points.

Bristol Royal Infirmary reintroduces shelters

Says the hospital spokesman:

We have come to the conclusion, as have a number of other hospitals, that although we cannot and do not support smoking in healthcare and the impact it has on public health, what we do need to do is respect people's privacy and dignity and provide somewhere if they really are going to smoke.

And even better, from the trust's chief executive:

UHBristol chief executive, Robert Woolley, said: 'We would rather conserve the dignity and the health of patients than the smokefree initiative.'

Someone had to disagree of course:

Regional director of public health and Smokefree South West spokesman, Gabriel Scally, said he felt the proposals for smoking shelters were bad news. He said: 'I would regard that as very disappointing. I would not see that as the way forward.

'The NHS and its premises should be completely smoke free.This is our health service and I don't believe that people should be damaging their health in this particular way with the help of the NHS. That's not what people pay their taxes for.'

But even Cecilia Farren of South West ASH recognises a 'terrible dilemma', and that the alternative is 'people standing about smoking outside hospitals'.  If that means somebody in ASH recognises that smokers' health and dignity must be protected in spite of their choices, then we might be making some progress.

NHS Grampian smoking ban hits rocks

It's a great pleasure to share this story, not least because Freedom to Choose (Scotland) helped to publicise the issues back in the summer. You can review older blog reports on this story here. It seems to have been clear to everyone involved that a complete ban would have been ineffective and resented (see this story, for example).

A hospital spokesman said: “We are still proceeding with the aims and objectives of our existing tobacco policy. The aim is to ensure that all NHS Grampian premises become smoke-free within a very few years but, in moving towards this objective, a limited number of designated smoking areas will be permitted as an interim measure.

“NHS Grampian also remains committed to promoting healthy living and non-smoking as its normal culture. It will do this by establishing a smoke-free environment for all who wish it, while being sensitive to the needs of those who smoke, and offering support to those who wish to give up.”

I wonder how long this interim will be and what the bill for dismantling the smoking shelters will amount to? To an extent I can sympathise with Margaret Watt, of the [non-smoking] Patients' Association at the sheer lunacy of putting up smoking shelters to the tune of £150,000, only to tear them down again (one presumes) when the madness returns 'within a very few years': when they decide again that 'being sensitive to the needs of those who smoke' is against Trust policy.

It may be facile to say it, but none of this expenditure would have been proposed if the smoking ban had not created a huge problem (not to speak of extra costs: read about a PFI contractor charging an extra £2,600 a year for cleaning after removing smoking shelters from a hospital site). I would be interested to know whether a £150,000 shelter will be sufficiently attractive to lure people from doorways. If it's not made attractive enough I would sack the Trustees for wasting money.

The better way would be not to have made the whole hospital a no-smoking zone in the first place. A smoking room here and there, comfortable and inviting (non-smoking lounges also of course) would resolve the problem permanently and much more cheaply. Air can be cleaned.

Royal Oldham row about shelters

The Royal Oldham hospital is reluctantly conceding that it has a problem with smoking on site since its 2006 ban, but some trust bosses would rather spend £80k on smoking cessation treatments than allow a shelter to be built that might cater for smokers and give them an alternative to doorway smoking.

If it comes to wasting money I agree that these trust bosses have a point about the shelters. It would be far more effective to set aside ventilated indoor areas for smoking in, than build a shelter that is out of sight of the main building and inconvenient for people to use. Provide somewhere sheltered, comfortable and pleasant (with an option of coffee facilities) and people will use it without the need for persuasion.

The drawback: the nation's so-called tobacco addicts would thereby get confused and think they are being given a green light to smoke. That would be terrible: one couldn't run the risk of (possibly bereaved) smokers thinking they had any right to experience true hospitality in a public place. It would send out entirely the wrong message.

The best we can hope for in the current hostile climate is that the trust will permit a shelter to be built. A poster summarises the situation well in the Kent Medway hospital story:

The sound of grief and sobbing from an old person, or parents who have lost a child, is still hard to take. Would you make them walk half a mile so you couldn't get a whiff of their smoke? After all, this second hand smoke doesn't actually harm you, y'know.

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)!