NHS Lothian fails to tackle hospital smokers

Staff and visitors smoke next to an open window at the ERI

Staff and visitors smoke next to an open window at the ERI

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SMOKERS are continuing to flout rules at the Capital’s flagship hospital – a week after the Evening News exposed shocking numbers of people lighting up outside wards.

Despite smoking around the region’s hospitals and health centres being officially banned, we revealed that the practice remained widespread at the Royal Infirmary, with patients, their visitors and even NHS staff lighting up in clearly designated non-smoking areas, causing carcinogenic smoke to waft back into wards.

Patients continue to flout the no-smoking rules

Patients continue to flout the no-smoking rules

The exposé prompted calls for NHS Lothian to stub out the problem once and for all, but on a return visit to the hospital we found that little had been done to put an end to the health hazard outside the very buildings in which the sick are 
supposed to go to get better.

Health bosses today said that it was “wholly unacceptable” for anyone to smoke outside the hospital’s three designated shelters and that NHS Lothian shared the concerns raised by this newspaper. The health board added that it was doing everything possible to tackle the problem and today announced that automated non-smoking announcements were to be introduced at the hospital’s main entrance.

However, proof that official guidelines had being ignored for years has been obtained in the form of NHS 
Lothian’s internal tobacco policy.

The document, which sets out the rules that came into force with the ban on smoking in public places in Scotland in March 2006, states that smoking should not be tolerated around NHS Lothian premises, entrances or its buildings, with the only exemption being for certain patients with specified residential accommodation.

It adds that “no member of NHS Lothian staff or user of NHS Lothian premises should be exposed to tobacco smoke”, and that staff smoking in uniform compromises a “public health message”.

However, in reality, visitors to the hospital are still being forced to walk through clouds of tobacco smoke to access buildings, often as a result of smokers clearly identifiable as NHS staff or hospital contractors.

Staff attempting to enforce the rules have complained that they are subjected to foul-mouthed abuse from smokers, and there were today calls for NHS Lothian to consider hiring specially-trained smoking wardens to be employed at the hospital, to mirror what has happened in other parts of Scotland.

High-profile MSPs from across the political spectrum also called on NHS chiefs to take real action to stamp out a practice that should have been addressed seven years ago, according to official NHS Lothian policy.

Labour Lothians MSP Sarah Boyack said that without effective enforcement, the policy amounted to “little more than a box-ticking exercise”.

She said: “Encouraging staff to set an example by using designated smoking areas is part of the answer, but it cannot just be down to them. There must also be backing from the board to ensure that those who challenge smoking where it’s clearly prohibited are not intimidated. The message must be that smoking right outside entrances is unacceptable and the board must support hospital staff to make that clear to all patients and visitors.

“However, it isn’t simply a case of out of sight, out of mind. Alongside no-smoking signs on hospital grounds there should be positive messages to highlight smoking cessation support to help people kick the habit.”

The SNP’s Jim Eadie, who represents Edinburgh Southern at Holyrood, said NHS Lothian’s policy must be “rigorously and robustly enforced”.

He said: “It is the responsibility of NHS Lothian to rigorously police its own policy and if people are smoking in areas they should not be, it must be clamped down on.

“People should be asked politely not to smoke in undesignated areas. If they are not prepared to do that, the health board must look at alternative means of policing it. No-one wants to see a disproportionate or heavy-handed approach, but if people are regularly or consistently flouting rules, alternatives such as wardens should be looked at.”

On our first visit to the hospital last week, the News observed 29 people breaking rules in little more than an hour. They included patients still in their pyjamas and staff in their scrubs. Not one was challenged by staff.

It even appeared that chairs had been put outside specifically for those who left the hospital temporarily for a fag break.

Alison Johnstone, Green MSP for Lothian, said she was disappointed that smokers were continuing to be allowed to break the rules after the News highlighted the issue last week.

“I’d like NHS Lothian to outline what support they intend to give staff who are understandably wary of 
challenging such behaviour and I’d also like to understand what the health service is doing about staff who light up where they shouldn’t,” she said.

“Entering a hospital through a cloud of tobacco fumes is hardly the best advert for our health service, and while it is understandable that smokers attending hospital may feel the need to light up to cope with stressful situations, we must do more to help people end their 
addiction.”

Sheila Duffy, chief executive of ASH Scotland, said she believed that innovative methods in combating rule-breaking, which have been successful in other areas, should be looked at. She added that employing smoking wardens to make sure policy is followed was an option that should not be ruled out.

She said: “We realise it is not always easy to monitor smoking in these locations or to take action if there are no dedicated wardens.

“However, there may be steps that could be considered by the hospital authorities to attempt to tackle the highly undesirable issue of tobacco smoke around the entrances to NHS buildings.

“For example, we have noted with interest that Edinburgh’s Waverley Station is currently using an audio message to deter smokers from gathering near one of the entrances during development work. First impressions are that the repetition of the message that it is a no-smoking area seems to have had an impact on the number of people standing there.”

Lyn McDonald, hospital site director at the Royal Infirmary, said it was “wholly unacceptable” for anybody to smoke away from the purpose-built shelters.

She added: “We share the concerns raised by the Edinburgh Evening News and would like to reassure the public that we are doing all that we can to tackle the 
problem.

“Our Tobacco Policy clearly states that smoking is not allowed outwith these designated areas and it is the responsibility of staff to ensure that this is adhered to.

“We have reminded staff that they may face disciplinary action if they smoke around entrances and have re-enforced this with our PFI partners, Consort.

“There are no-smoking signs displayed across the hospital and we have plans to reinstate the automated no-smoking announcements which are broadcast at the main entrance.

“We have specially trained smoking cessation advisers whose role includes approaching those who are not using the shelters provided, as well as providing advice and support to those looking to quit.

“Anyone seen to be smoking near entrances will be asked to move to a smoking shelter and we can and do ask people to stop smoking near 
entrances.”

Comment: This must be last gasp

It is now a week since we exposed how smokers were routinely flouting the rules by lighting up around Edinburgh’s biggest hospital.

Patients, visitors, and members of staff were seen happily puffing away beneath no-smoking signs.

Last week, NHS Lothian said it was committed to tackling the issue and that a “smoking audit” was being carried out. Why? As we tell today, its own tobacco policy set out pretty clearly in 2006 that smoking would not be allowed in any “premises, around entrances or buildings”.

Seven years is long enough. Stub it out now.

Tobacco policy sets out smoke-free aims

NHS Lothian’s tobacco policy, which was brought in by health bosses in 2006, set out a “smoke-free commitment”.

Then, it was promised that preventative measures would be put in place to deal with those who became aggressive after being asked to stub out their cigarettes. But seven years on, the issue appears to be as bad as ever, with the health board seemingly still blaming difficulties in enforcing the ban for the problem.

In the tobacco policy, it was stated that the document would “ensure that from March 26th, 2006, smoking will not be allowed in any NHS Lothian premises, around entrances or buildings, or in vehicles”.

The only exemptions were for residential psychiatric patients or some other patients who needed residential accommodation.

As a result, smoking shelters were placed away from hospital buildings. However, they are often ignored for the sake of convenience, and even at the city’s main hospital, little is done to enforce the rules.

The 17-page document, which accepts the dangers of passive smoking, also states that no NHS Lothian staff members or users of buildings would be exposed to smoke. In truth, it is a constant hazard for patients and visitors alike.

The policy is said to apply to NHS Lothian staff, even if they are identifiable to the public when off site. Patients, visitors, all contractors and even volunteers were all covered.

Even staff who work in the community and visit people in their own homes were told they would not be required to enter any areas in which they would be exposed to second-hand smoke.

It was stated that the policy would be reviewed by December 31, 2006 with a view to NHS Lothian becoming “smoke-free” in 2007. But the same policy remains in place.

The Scottish Government said in March that smoking is to be completely banned on all NHS property by March 2015.

In other parts of Scotland, a crackdown has been launched on hospital smokers, although in Lothian there has been little action to tackle the issue.

The NHS in Glasgow introduced wardens to patrol sites, while entrances to NHS building have been redesigned to promote its message. They brought in bright red wall and ground markings, along with giant posters, designed to be harder to ignore.

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