The board of the Norfolk and Norwich University Hospital NHS Trust is moving towards a full ban on smoking at its hospitals and has launched a consultation among the public and staff.

The Norfolk and Norwich University Hospital and Cromer & District Hospital will join the growing ranks of NHS hospitals and health centres in Norfolk that have already gone, or are about to go, smoke free.

To date, health centres and hospitals run by North Norfolk, Southern Norfolk, Broadland, and Norwich PCTs have already banned smoking completely on their premises as has the Norfolk and Waveney Mental Health Partnership NHS Trust (for staff and visitors).

The hospital trust policy supports a national campaign across the NHS to reduce the rate of heart disease and cancer, and has prompted the Trust to revisit its current policy on smoking on all Trust premises. The Trust currently allows smoking in shelters outside NNUH or in a smoking-only room at Cromer.

Members of the public who want to voice their views can clicking here. The consultation will end on January 31st, 2005. 

Smoking and health facts

• In the UK more than 300 people die every day die as a result of smoking.
• Smoking kills around five times more people in the UK than road traffic accidents (3,439), other accidents (8,579), poisoning and overdose (3,157), murder and manslaughter (513), suicide (4,066), and HIV infection (234) combined (22,833 in total – 2002 figures).
• About half of all regular cigarette smokers will eventually be killed by their habit.
• Smoking causes about thirty per cent of all cancer deaths (including around 84% of lung cancer deaths), 17% of all heart disease deaths and at least 80% of deaths from bronchitis and emphysema.
• Cigarette smoking increases the risk of having a heart attack by two or three times, compared with the risk to non-smokers.
• About 90% of cases of peripheral vascular disease which lead to amputation of one or both legs are caused by smoking – about 2,000 amputations a year in the UK.
• Women who smoke and take the contraceptive pill have 10 times the risk of a heart attack, stroke or other cardiovascular disease compared with those who take the pill but are non-smokers.  Smoking has also been linked with an increased likelihood of menstrual problems (although not with PMT).
• Smoking leads to an earlier menopause: on average women smokers go through the menopause up to 2 years earlier than non-smokers and are at a greater risk of developing osteoporosis.
• Smoking has been associated with increased sperm abnormalities and with impotence in men. 
• Smoking during pregnancy leads to an increased risk of:

            –          miscarriage;

            –           bleeding during pregnancy;

             –           premature birth;

             –           low weight of babies at birth;

             –           Sudden Infant Death Syndrome (cot death).

Proposed Smoke Free Policy

Introduction

 1. The aim of this Policy is to:  

• Protect and improve the health of patients, visitors, staff and contractors;
• Protect both smokers and non-smokers from the danger to their health of exposure to environmental tobacco smoke;
• Set a health improvement example to other employers and workforces

The Trust considers that as a health organisation we have a responsibility to encourage good health and to help tackle major causes of ill health.

We note that in the UK every year, around 114,000 smokers in the UK die as a result of smoking.  Smoking kills around five times more people in the UK than road traffic accidents (3,439), other accidents (8,579), poisoning and overdose (3,157), murder and manslaughter (513), suicide (4,066), and HIV infection (234). (2002 figures).

2. Section 2(2) of the Health and Safety at Work etc. Act 1974 places a duty on employers to: “…provide and maintain a safe working environment which is, so far as is reasonably practical, safe, without risks to health and adequate as regards facilities and arrangements for their welfare at work”.

3. Several EU Directives relating to health and safety in the workplace have come into force since 1st January 1993. These include the Management of Health and Safety at Work Regulations 1999 which, under General Principles of Prevention, include: Avoiding risks Combating risks at source Replacing the dangerous by the non-dangerous or the less dangerous Giving collective protective measures priority over individual protective measures.

4. Passive smoking – breathing other people’s tobacco smoke – has now been shown to cause lung cancer and heart disease in non-smokers, as well as many other illnesses and minor conditions.

5. The Trust acknowledges that breathing other people’s smoke is both a public health hazard and a welfare issue. Therefore, the following Policy has been adopted concerning smoking at all Norfolk and Norwich University Hospital NHS Trust premises, buildings and grounds.

6. This proposed policy recognises that passive smoking adversely affects the health of all employees. It is not concerned with whether anyone smokes, but with where they smoke and the effect that this has on patients, visitors, smoking and non-smoking colleagues and other members of the wider health community. It is also concerned with the presence of preventable carcinogenic substances in health sites.

7. The Trust sincerely encourages its employees to refrain from smoking outside the times and circumstances set out in this policy, both in their own interests and as representatives of a major public body, whose purpose is to improve health, whilst recognising this is a matter for the individual.

General Principles and Scope

 8. By arranging for Trust properties and vehicles to be ‘smoke-free’ and by requiring staff not to smoke whilst on duty.  9. This Policy is part of a range of policies, which together comprise the Trust’s Health and Safety Policy.

Work Areas

10. This Policy will apply to all staff, patients, visitors, contractors and other persons, who enter Trust owned or rented buildings or grounds for any purpose whatsoever. The Policy extends to cars leased by the Trust during business usage, however, it does not apply to the interior of cars owned privately and not being used for business purposes or during business hours.

11. Responsibility for implementing this Policy rests with the Chief Executive. Day-to-day responsibility for implementation lies with Directors and Managers.

12. Occupational Health will provide advice and support for staff. Those, who wish to stop smoking, will be helped to access individual or group support and nicotine replacement therapies as appropriate.

13. To ensure that everyone entering Trust sites understands that smoking is not allowed in the buildings and grounds, clear signs will be on display. Staff will be reminded of how the Policy relates to their use of vehicles.

14. Tenders and contracts with the Trust will stipulate adherence to this Policy as a contractual condition. Existing contracts will be modified as soon as possible. Patients will be advised of the new Policy on admission to Trust premises. GP practices will also be informed of the Policy.

15. Job advertisements will include reference to the non-smoking policy.

Exceptions

16. The Trust Board recognises that some patients have circumstances that will require staff to make an assessment as to whether special arrangements need be made so that the patient is permitted to smoke on a Trust site. Permission to grant an exception will rest with the Nurse in charge of the ward or department or the Responsible Medical Officer and be formally recorded within the Care Plan.  

17. In all cases where an exception has been made, there should be demonstrable evidence that smoking cessation has been fully considered as part of the patient pathway, in conjunction with the patient and/or their relatives. Where an exception is made, every effort must be made to minimise staff exposure and the exposure of other patients, to smoke. This means that smoking is only permitted outdoors where staff and other patients are not in close proximity to the smoker. Ideally, this would also be out of sight of other patients, who may be engaged in a cessation programme.