THE NHS bans smokers from the inside of hospitals, which is reasonable.

But in Oxfordshire, smokers are also banned from the hospital grounds outside and the question is – does this make sense? Does banning an activity stop it or move it to another area?

Stephen Cole, from Headington, highlighted the difficulty: “The menace of smokers from the Churchill Hospital using the adjacent Massey Close to smoke, with the attendant issues of litter, smoke and the sight of staff indulging in their habit for all (residents, patients and visitors to the hospital) to see…(is) a direct result of the Oxford University Hospitals NHS Trust policy of creating a non-smoking environment on all trust sites.

“This policy has quite clearly failed. Having worked for the trust I know places on the Churchill Hospital site which are used as covert smoking areas for staff and this half-baked policy has also resulted in displacing the problem to adjacent residential areas.”

NICE (the National Institute For Health and Care Excellence) produced the guidelines to ban smoking in hospital grounds. Its view is clear: “A total ban on smoking in the buildings and grounds complements a duty of care on healthcare organisations to protect and promote the health of people in their care.”

Not all the usual suspects agree.

The Association for Improvements in the Maternity Services (AIMS), whose president is long-time Oxford resident Jean Robinson, takes a different view.

It says: “We have seen no evidence that banning smoking outside, as well as inside the building, is going to contribute to cessation.

“This will displace smoking to areas immediately adjacent, and in one residential area next to a hospital where this has already happened, a committee member reports objection among residents to the creation of a ‘smokers ghetto’ around their children.

“We think there should be an ‘under-cover’ designated smoking area, so that those unable to quit are not clustered around hospital entrances.

“While we are only too well aware of the harmful effects of smoking on women, unborn children and infants and support all reasonable evidence-based means to assist cessation, banning smoking in the open air outside the building feels like Big Brother gone too far.”

NICE rejects this view, saying: “Smoking shelters undermine objectives to promote healthy behaviour in healthcare settings.”

The thrust of the NICE guidelines to wean people off the weed is to tell staff: “If the offer of smoking support services is refused, continue to offer it at every future visit.”

According to AIMS, this can confuse support with nagging. It says: “We raise this because increasingly women are complaining to us of ante-natal care experienced as ‘bullying’ with threats (sometimes followed through) of reporting women to social services if they do not ‘comply’ and quit smoking.”

The no-smoking guidelines adopted in Oxford apply not only to maternity units but also to acute psychiatric units where patients are more likely to be smokers than the general population and to be more heavily addicted.

This extension of the smoking ban to the open air is not required by law.

It introduces a policy that does not apply in any other setting such as restaurants, pubs and colleges.

It could result in the criminalisation or sectioning of psychiatric patients.

Oxford Mail:

  • Ban: Oxford’s Churchill Hospital

According to AIMS: “Psychiatric in-patients gave reasonable and understandable reasons for smoking. It is ironic that the first listed was autonomy, showing how important this was to them. One patient said: ‘This is the one thing you can do to show they aren’t totally controlling you’.

“Other reasons included the view that smoking was pleasurable and enjoyable, and it was also a means of connecting with fellow patients and staff who smoked in their restricted surroundings.”

In one study on this problem, staff and patients pointed out that this policy can be dangerous, for example when patients attached to drips pushed them outside in freezing weather to reach smoking-freedom when they were forbidden to use the grounds of the hospital.

Jean Robinson said: “I am a lifelong non-smoker, and would like all smokers to stop tomorrow if possible. But I am not in favour of authoritarian methods to bring about public health improvements and, what is more, on inadequate evidence that it will do any good.

“Of course, it may well do harm with people discharging themselves from hospital early.”

This policy has a postcode lottery aspect because trusts can choose whether or not to ban smoking in the grounds. Hospitals in other parts of the country have not taken that step but obviously Oxford has.

So how big a problem is the present situation? If you are a former patient, staff or visitor, or if you are a neighbour to your local hospital, does the current policy of no-smoking in hospital grounds work for you? The NICE guidelines are up for a review in the near future.