New NICE guidance recommends that all NHS hospitals and clinics become completely smoke-free: good idea or barbaric and cruel?

New NICE guidance recommends that all NHS hospitals and clinics become completely smoke-free: good idea or barbaric and cruel?

Hi all,

I blogged about the NICE public health guidance that was published at the end of November:

PH48 Smoking cessation – acute, maternity and mental health services: guidance. NICE, 27 Nov 2013.

This issue really divided the audience. Many people felt that the guidance was a sensible approach; a view that was summed up nicely by public health doctor Caroline Tomes:

"From a public health perspective – this new guidance is very welcome. I can foresee the following benefits:

1) reducing inequalities of smoke exposure (especially for mental health patients)

2) Trusts leading by example by encouraging a smoke-free NHS culture

3) empower NHS staff to ensure they are Making Every Contact Count

MH patients should be treated the same as patients with physical health issues. As such, any MH patient who is identified to be a smoker should be provided with brief advice and encouraged/supported to stop smoking. This may require a large culture shift for many trusts, but this is necessary and will help improve the health and well-being of patients – which surely, is what we all want!"

However, there was a large group of people who made their feelings about this ban very clear on Twitter. Comments from one reader ( were particularly memorable:

- Psychiatric inpatient wards should be supportive environments that nurture mental & physical health

- Enforcing a smoking ban in a coercive environment when you’re vulnerable is not supportive

- If every ward had an accessible outdoor space with a smoking area, smoking cessation could be supported

- Seeing an acute admission as an opportunity to impose further restrictions won’t help people stop smoking

- Instead, it’s just another example of professionals moralising & infantilising people with mental health problems

I'd be really interested to hear what everyone thinks of this issue and how it's reported in the news.



The Mental Elf

16 Replies

  • I think point three makes a lot sense - - If every ward had an accessible outdoor space with a smoking area, smoking cessation could be supported

    Obviously you want to protect staff from smoke exposure but I think it is important to be pragmatic.

    Simply saying "Smoking's bad mmmmkay" isn't going to help, As an ex-40 a day man, I can tell you if smoker doesn't want to quit, then they won't - they will just resent you for not letting them smoke

  • Many, many years ago I was a sound man on a film shoot of a real lung cancer operation. It was a very long op, very stressful and sadly, the chap did not make it through.

    After the op, those of us who smoked (which included the surgeon and the anaesthetist) went into the canteen of the hospital to light up and wind down. The surgeon, especially, was very affected by the loss of his patient and drew as much comfort from his cigarette as possible.


    What on earth did we think we were up to? That very scene now, thirty odd years later, seems completely mad. There was absolutely no excuse for it nor was there any need. All of us were completely capable of surviving that event without lighting up. Even though I did not give up smoking for another 20 years, I still knew that I did not really need the fix - it was laziness and pandering to an indefensible cause.

    There is no room for smoking on NHS property. Allowing some smoking in some areas is the easy way out of the problem. It would be better to find other policies to deal with the issue that did not involve letting people smoke, such as it remains.

  • I guess the argument that many mental health service users put forward is that it's different for people who are forcibly detained on NHS premises. After all, most NHS patients who are smokers can leave the hospital grounds for a fag should they be desperate, but this is not possible for many mental health patients.

  • To be honest, I am not sure what you do in such a situation. Though I suppose the very fact that they are forcibly detained means that they are away from the general population and not allowed outside. If they were forcibly detained in a police station they wouldn't be allowed to smoke in the cells.

    As an interesting comparison, this is a 2008 guidance from Thames Valley police on smoking on police property.

  • Whoa there Joss! Can you really compare people sectioned under the Mental Health Act with people detained in police stations?

    I would say that compulsory admission to hospital is quite different. Mind have a good guide to it if you're interested:

    People who aren't allowed to leave hospital are (at present) sometimes allowed to leave the ward. For example, to go to a smoking area within the hospital grounds with a member of the healthcare team.

    Clearly the new NICE guidance will make this impossible, which will in effect mean that people who are very ill, perhaps experiencing a psychotic or manic episode, will be forced to stop smoking. This is why many people are up in arms about the changes.



  • hehe - I wasn't actually comparing the people so much as the similarity in the action - both entail holding people without their consent and then dealing with people who would rather not be there including any needs. And of course, and controversially, many of the people that the police hold have mental health issues of one sort or another.

    Hence why I offered the guidance link as a comparison! :)

  • Yes indeed. The recent HMIC report on this made for very sobering reading:

    I still think that a blanket ban on smoking in hospitals is short-sighted and not something that is going to help foster good therapeutic relationships between service users and health professionals.

    Of course, smoking is something that we should be trying to eradicate from society as much as possible, but for me, this question is more about all of us gaining a better understanding of what it's really like to experience a severe mental illness.

  • This looks like an excellent opportunity for the NHS to distribute e-cigarettes.

  • Shall we permit alcohol, heroin, crack, etc.?

    Smokers are more susceptible to mental health illnesses.

  • Hi Concerned,

    "Smokers are more susceptible to mental health illnesses." < That's an interesting statement. Can you elaborate?



  • I used to smoke near on 60 a day ..... that might explain quite a lot ......

  • Thanks for the link.

    That article says that people with "mental health problems smoke significantly more and are therefore at greater risk", so perhaps it makes more sense to say that people with mental health problems are more susceptible to smoking..?

    Cheers, André

  • Rampton already does (or did) this. Back in 2007 I spoke to some of the people there who implemented it and they seemed to present a very good case.

    Here's a legal perspective following a challenge by "some" patients

  • Interesting read. Thanks Rob

  • Some years ago my friend was in hospital for treatment of the bowel cancer which finally killed her. She was in her eighties and had smoked all her adult life and at this very stressful time was unable to do so; on returning from a hasty "drag" in the loo a very young nurse said to her "You've been smoking - you stink" This lady had led a full and productive life, serving in the WAAF during WW2 then raising a family - I wonder if that girl will ever achieve as much.

    When my husband was in hospital there was a lovely guy in the bed opposite who was being discharged after a month. I asked what would be the first thing he'd do when he got home, he said "A good cup of tea and a fag". One of the senior nurses overheard this and said "Nev, why didn't you tell us, we'd have wheeled you down to our hidey-hole", a few of them smoked apparently.

    I honestly believe that the whole anti-smoking thing is way out of hand. I've switched to vaping and thought it was not going to be an issue for me, since e-cigs affect neither the user nor those around them, but I was mistaken.

    So many people are pulling down huge salaries just for being anti-smoking/vaping they've now demonized the latter.

    What a sad world we live in when an accommodation cannot be reached that would allow people to enjoy what could be the final days or weeks of their lives.