A study by researchers at the University of Nottingham has found that smoking is still prevalent in hospitals, even by staff in uniform, despite smoke-free policies that have been introduced at all NHS Hospital Trusts.
Researchers in the School of Community Health Sciences conclude that effective enforcement is critical and more must be done to find better ways of supporting staff to engage effectively in enforcement, manage nicotine withdrawal and stop smoking on site.
The study was carried out to determine the extent of smoke-free policy implementation in English NHS acute and mental health Trusts and to explore the challenges and impact faced by management. The questionnaire-based survey also involved 22 telephone interviews. Researchers also visited 15 different Trusts in three English regions 10 of which were acute trusts covering 17 different sites.
Patients and visitors were observed smoking at 94 per cent of acute sites and staff were seen smoking in 35 per cent of them.
Lead researcher Elena Ratschen said: "Whilst I was encouraged that Trusts have made an effort to introduce comprehensive smoke-free policies, I was surprised about the lack of enforcement when I made the site visits. Smoking still appears to be the rule rather than the exception.
"Nevertheless the people I interviewed were very positive about the benefits of smoke free policies, and I believe with more support, a smoke-free NHS is achievable."
The survey showed that although smoke-free policies had been implemented in all mental health sites and 98 per cent of acute hospitals, exemptions were granted in half the acute sites and 78 per cent of the mental health settings. Typically these exemptions were for bereaved relatives or psychiatric patients in sheltered outdoor areas and smoking rooms. But nearly two thirds of acute and over a third of mental health trusts reported that policy infringements occurred on a daily basis.
Despite setting an example to other organisations researchers are warning that if smoking continues to be tolerated on NHS premises there is a risk that the NHS will now fall behind other work and public places.
Ann McNeill, Professor in Health Policy and Promotion said: "The NHS has a responsibility to promote health and achieving smoke-free premises is the best way to do this. Stopping smoking is probably the single most important thing a smoker can do to improve their health and every effort must be made to support smokers in being smoke-free whilst on NHS premises."
Elena Ratschen specialises in smoking and public health issues. She is now carrying out research into smoking and serious mental illness, with a special focus on acute settings.
According to the provisions of the Health Act 2006, NHS acute Trusts had to become smoke-free by July 2007. Mental Health Trusts were granted a further year before all indoor smoking areas have to be removed.