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.
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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.

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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.

Plain packaging: acquiring commercial assets without compensation

It was announced recently that next Wednesday we will learn whether the tobacco companies' challenge to the Australian government on plain packaging has succeeded. The Australian government has been taken to task for preventing the use of brand packaging, which they regard as a breach of international law. The Australian government denies that there is any breach, claiming that it does not directly acquire the intellectual property that is constituted in the branding.

The government has no direct use for the branding and design of tobacco packaging. However it does acquire selling and marketing space by depriving tobacco companies of the use of their intellectual property in the shape of branding, and of the actual boxes and packaging in which they sell their tobacco. The hope is to prevent young people from smoking 'by encouraging them to pay more attention to the health warnings'. (See this debate.) This is a key selling point of the policy: removing the clutter of branding from the pack face in order to make health warnings more prominent. Not only are they rendering worthless the branding assets of companies, on which billions have been invested over time, but they expect packaging to dissuade the purchaser from buying the product – and the prominence of the health warnings are central to this idea.

The government does not acquire the branding directly via a plain packaging policy but it does acquire powers to control what goes on the wrapper, in this case to stipulate that health warnings advertising smoking cessation services are prominent. Clearly the aim is to stop smokers spending money on tobacco and encourage them to become clients of stop smoking services and smoking cessation medication. It is entirely right that tobacco companies (and others) should object to this daylight robbery, which is no less robbery because tobacco branding is not employed directly by the government.