Smokefree Hospitals Proposal
Hospitals offer: a significantly under used opportunity to engage, refer and support smokers to stoP.
The secondary care setting offers a significantly underplayed opportunity to engage, refer and support smokers to quit. The large footfall through this setting provides thousands of clinical and non-clinical interactions which represent what Professor Robert West terms ‘teachable moments’ when smokers are more likely to respond to offers of support to quit if we can step up the frequency, volume and quality of brief and more intensive interventions in this setting. Successful quit attempts are four times more likely when smokers utilise NHS support (West & Shiffman, 2007). Cochrane review evidence (Rigotti et al, 2008) supports the rationale for the effectiveness of stop smoking support initiated in hospital and continued in the community after discharge via the NHS Stop Smoking Service. This requires partnership working between primary and secondary care.
Even where smokers have no intention of quitting at that point, the use of Nicotine Replacement Therapy (NRT) to reduce withdrawal symptoms during the hospital stay (Hughes, 2006; Hughes, 2007), not only encourages compliance with Smokefree policies and makes the patients’ stay more comfortable, but also presents a further ‘teachable moment’ with regard to the effectiveness of NRT in reducing the withdrawal symptoms.
There are also opportunities for significant cost savings for the NHS through enhanced action. Not only are many of the health problems attributable to smoking likely to require treatment through hospitalisation, but length of stay is also likely to be greater with increased risk of post-operative complications and slower recovery times (Moller et al, 2002). This has a negative financial impact for the NHS as a result of need for more bed days per admission and possible further surgery.
A reduction in smoking related staff sickness absence and reduced working days lost would be an additional cost efficiency benefit to acute trusts in taking a more comprehensive approach to the provision of cessation support to include support for staff.
The Safe Sociable London has associates, formerly from Smokefree South West, experienced in working with hospitals in successfully implementing a Smokefree Hospital Programme.
The objectives of this proposed work are to:
- Provide a review to assess the current smokefree activity, knowledge and staff attitudes in the hospital.
- Identify barriers and provide solutions e.g. staff engagement activities, training to underpin engagement with a smokefree hospital site policy
- Implement clear and direct smokefree policy
- Provide Brief Intervention training for all patient facing staff through a convenient and accessible medium
- Ensure pathways are in place for all admissions, A & E and outpatients
- Include key messages relating to a Smokefree Hospital and the support available on all admissions and patient paperwork
- Set up a temporary abstinence protocol and provide a choice of appropriate pharmacotherapy for patients
- Provide signposting and support for staff wishing to quit
- Agree a smoking cessation/smokefree CQUIN where appropriate
- Provide PR templates for local media to raise public awareness of the trust’s smokefree status and the rationale behind it.
We would welcome the opportunity to meet with you to discuss your ambitions in meeting this challenge which will benefit the health and wellbeing of NHS staff, patients and the finances of both the NHS and the local community.
Smokefree Social Housing: Advocacy, Consultation and Engagement Proposal
Smokefree social housing has increasingly become a topic for discussion in the tobacco control field. With the UK legislation to make smoking illegal in cars carrying a passenger under the age of 18 and the US Federal Government decision to ban smoking in social housing, there is now greater focus on the issue of tobacco control in private spaces. Child protection and health inequalities are priority public health reasons to consider this approach. Also, the risk of fires, the cost of cleaning and maintenance and providers’ responsibilities for the welfare of tenants are also areas of particular relevance to social housing providers. The US Centre for Disease Control and Prevention states that the smoke-free policy will save housing agencies $153 million every year in repairs, preventable fires and health care costs. There are clearly benefits to both health and public finances of a well applied approach to Smokefree social housing.
However, as with Smokefree bars and restaurants, there are concerns around public acceptability of such moves. Also, as with Smokefree enclosed public places, public support, particularly that of the smoking population, would be necessary for effective implementation of this policy. With the right approach to advocacy and consultation there is significant support to be gained from social housing tenants, including smokers.
We believe a staged approach would be right to assess support, build buy-in and engage the public in a way to build support for making the policy case within local authorities or social housing providers. These would include:
- Reviewing the current environment in social housing, assessing the numbers, costs and cost savings and using this to build the case to policy makers.
- Engaging with social housing tenants, social housing providers and public health teams to develop an understanding of all views.
- Working with all stakeholders, co-design approaches to smokefree homes in this setting that will work and be acceptable to all.
- Provide recommendations to increase understanding of the underlying issues around exposure of families and communities to second-hand smoke. This will include barriers and facilitators that determine exposure and relevant evidence informed approaches that reduce exposure and vulnerability to second-hand smoke.
- Where required, provide support with implementation of a social housing smokefree programme.
We would welcome the opportunity to meet with you to discuss your views and plans in this emerging and innovative area of tobacco control.