If it ain’t broke, don’t fix it

Last month I recorded an interview for BBC Look North (about hospital smoking bans) but they sat on the story for three weeks until it was broadcast on July 2 and reported on the BBC News website.

It followed reports that, despite declaring its five hospital sites ‘smoke free’, the Humber Health Partnership (HHP) seems to be fighting a losing battle with people continuing to smoke on the hospital grounds “despite repeated warnings and multiple public appeals”.

This was my response:

Simon Clark, director of the smokers' advocacy group Forest, said people should be allowed to smoke outside hospitals.

“They're in the open air and there's not a shred of evidence that smoke in the open air is a risk to non-smokers,” he said.

“We have to remember hospitals are very stressful places, not just for patients, but also for visitors and even members of staff.

“A lot of people smoke not just for pleasure, but also because it brings them comfort in difficult or stressful situations.”

Clark said it would be “inhumane” to force people to go off site.

“If you want to ban smoking directly around the entrance, fair enough, but people still need to have somewhere where they can go,” he added.

See: Hospital smokers say there is nowhere to go (BBC News)

Smoking on hospital grounds was one of the issues addressed in the recent government consultation on ‘Smoke-free, heated tobacco-free and vape-free places in England’ and I have little doubt that, when the Government publishes its consultation report, a national hospital smoking ban will feature in its list of recommendations.

Enforcing it however will be a different matter, as many hospital trusts that have introduced their own unilateral ban have discovered. My local hospital is relatively small so there’s not a huge amount of green outdoor space. It’s enough however for a small outdoor smoking area, with a bench, to have been created some time ago.

Then, a few years ago, the entire site was declared a ‘Smoke Free Zone’ and the smoking area became a vaping area, although I have occasionally seen patients sitting there with a cigarette in hand. I’ve also seen one or two ambulance drivers standing by their vehicles, directly outside the hospital, smoking, and on my most recent visit I was impressed when another member of staff came out of an entrance at a brisk walk and immediately lit up.

If I’m honest, I gave a silent cheer when I saw that, but it’s worth noting that if the NHS can’t stop its own staff from lighting up outside hospitals, how are they going to stop visitors or patients? And if the law is unenforceable without spending a lot of money on wardens, signage, and CCTV, or threatening people with significant financial penalties (or, worse, arrest), what’s the point?

A rather better solution can be found at another, much larger, hospital I was at recently. About 20 yards from the main entrance there’s a reasonably large communal space with benches on either side where people are allowed to smoke and there are cig bins where they can dispose of any litter. It’s a large enough area that non-smokers can walk through the middle of the circular space and not be exposed to cigarette smoke so, unless the sight of someone smoking offends you, there’s nothing to complain about and everyone bar ASH and other tobacco control zealots should be happy.

My view therefore is that individual hospitals should be allowed to choose their own policy on smoking, as currently happens in England, and, if it ain’t broke, don’t fix it. Unfortunately a national ban is probably inevitable because I’m pretty sure that Forest is almost alone in arguing against it.

Nevertheless, given that we have been commenting on hospital smoking bans since at least 2006 (and probably earlier), as well as conducting countless interviews on the subject in the intervening years, I like to think we’ve put up a pretty good fight, and if we lose this battle I’m not sure there’s much more we could have done.

We’ve opposed hospital smoking bans in numerous submissions to government consultations, and in 2019 we saw off an attempt by Labour MP Tracy Brabin – now Mayor of West Yorkshire – to ‘stub out smoking on NHS hospital grounds’. That same year we also published a well-researched report – Prejudice and Prohibition: Results of a study of smoking and vaping policies in NHS hospital trusts in England – that featured this introduction:

At Hull Royal Infirmary they used to have a smoking shelter. Regrettably it was demolished and replaced with a stark ‘No Smoking’ sign. Today patients are forced to go off site to smoke. “It’s humiliating having to stand at a bus stop,” a 21-year-old woman wearing a nightgown and a catheter told BBC Look North. “It’s like being punished for smoking.”

The same report featured another patient ambling slowly off site with the aid of crutches. Walking alongside her was a “stop smoking specialist” who could be heard saying, “I was wondering if you’d like to take this opportunity to stop smoking.” Was he helping or harassing her? Either way, it looked and felt wrong.

Last year a hospital in West Yorkshire installed a public address system that at the press of a button plays messages to ‘shame’ smokers to stub out their cigarettes. Elsewhere a local radio presenter, no fan of smoking, has described how his terminally ill father was denied the ‘pleasure’ of a cigarette while he was in hospital because smoking was prohibited throughout the site.

Equally distressing scenarios are being enacted across the country. Banning smoking on hospital grounds may seem reasonable to many people but the policy demonstrates a staggering lack of empathy and compassion, targeting, as it does, people who may be feeling particularly vulnerable – stressed, upset and in some cases in need of a comforting cigarette.

I would go further and argue that it’s cruel and a shocking indictment of our ‘caring’ NHS. Where’s the compassion in forcing someone to go off site before they can light up? They may be infirm, physically and mentally. It could be dark, late at night and they might be alone. No-one who is already suffering from ill health or may be recovering from an accident or serious operation should be treated in such a callous fashion.

Yes, it can be unsightly if a group of people are smoking directly outside a hospital entrance, but this is one of many unintended consequences of the workplace smoking ban. Unable to light up indoors in a dedicated smoking room, smokers are forced to stand outside. Understandably they prefer to remain close to the entrance under a canopy that provides shelter from bad weather.

If the powers that be don’t want people to smoke next to the entrance incentivise them to move further away by providing a comfortable smoking shelter. Don’t ban smoking everywhere on site because that’s disproportionate to the problem. Some people may not like the smell of tobacco smoke but there’s no evidence that smoking in the open air is a health risk to anyone other than the smoker.

Even in these difficult financial times a smoking shelter represents money well spent. Enforcing outdoor smoking bans means CCTV cameras, public address systems and tobacco control wardens ordering smokers to ‘Put that cigarette out!’. What a waste of public money and scarce resources.

The public appear to agree. According to polls conducted by Populus for Forest, tackling smoking has consistently been considered the least important in a list of ten priorities for the NHS. The most important issues were investing in new doctors and nurses, addressing response times at A&E, and improving general waiting times.

Tobacco, lest we forget, is a legal product. Despite this anti-smoking campaigners justify the constant war on smokers by estimating that the cost of treating smoking-related illnesses is £2.7 billion a year in the UK. To put this in perspective, smokers contribute a staggering £12 billion to the Treasury annually through a combination of tobacco duty and VAT. In short, using a discredited financial argument to justify further discrimination against smokers is not only wrong, it’s unjust.

If this report offers some good news it’s the fact that an increasing number of NHS trusts are adopting a more relaxed attitude to vaping. The overwhelming majority of vapers are ex-smokers or smokers who wish to cut down or quit smoking altogether so banning the use of e-cigarettes on hospital premises never made any sense. It’s encouraging therefore to see more trusts amending their policies to allow vaping on site and even in hospital buildings.

Adopting a more sensible approach to vaping does not however justify further restrictions on smoking. Hospitals can be stressful places and for some smokers – patients, visitors and even staff – a cigarette provides comfort at a difficult time. The NHS has a duty of care to protect people’s health but that doesn’t include the right to nag, cajole or bully smokers to quit or switch to a state approved e-cigarette.

Just as bad is the despicable threat to punish staff who enable patients to smoke outside hospital buildings. In theory this could result in a member of staff, with years of dedicated service to their name, being disciplined because, with the best of intentions, they assisted or turned a blind eye to a patient who wanted to smoke and whose immediate mental well-being may have been helped by being allowed to have a cigarette.

The level of pettiness is such that smoking is not only prohibited outside the majority of hospital buildings but even in hospital car parks and private vehicles while they are on NHS sites. (Imagine you are alone in your own car, smoking a cigarette – a practice that is entirely legal. You turn off the public road and on to the hospital grounds. Even if the car windows are closed you are now in breach of the hospital’s smoking policy. You can’t even light up while your car is stationary in the hospital car park.)

Common sense and decency are being sacrificed on the altar of ‘public’ health. Increasingly, it seems, hospitals are in the hands of tick-boxing bureaucrats with little empathy and no compassion for those who don’t conform to today’s anti-smoking orthodoxy.

Hopefully this report can play a small part in highlighting the creeping prohibition that is becoming a worrying national trend. If it also encourages individual hospital trusts to consider a more humane approach to adults who choose to smoke, it will have done its job.

See also: Hospitals plan total smoking ban (BBC News, July 2006)
Cigarettes outlawed on entire hospital site (The Press, December 2006)
Ban patients and staff smoking outside hospitals, say official health advisers (Guardian, November 2013)
Hospital smoking ban plan 'petty', Holyrood committee told (BBC News, September 2015)
Health boss says hospitals should ban all smoking on their grounds (Telegraph, November 2016)
Smokers’ rights campaigners slam move to ban smoking across entire hospital site (Lynn News, March 2024)