Cigarettes and hospitals: smoking out patients?

Why the proposed smoking ban on hospital grounds is an unwise policy move from the NHS

You might argue, from a policy perspective, that there is a delicate balance to be made between protecting people from harm and allowing them to exercise their own freedom of choice. Certainly, it’s a balance that the NHS hasn’t quite mastered judging by their latest proposal to ban smoking on hospital premises. In fact, their aim to get rid of the practice is likely to do more harm than good. Let’s be quite clear; smoking is not the best thing we can do for our health. Smoking is a habit – not a particularly good one – but a habit, nonetheless. And the thing about habits is that they are notoriously difficult to break. Everyone has their own individual modes and methods of ‘quitting’ – that is, if they choose to quit at all.

Let’s take the example of someone who smokes a few cigarettes a day for stress-relief purposes. Now let’s imagine that, unfortunately, they find themselves in hospital; understandably, their stress levels are likely to increase. Is it really wise then, to deprive said individuals – at this already trying time – of the thing that helps calm them down? Yes, this person is ill – perhaps in relation to their smoking habit, perhaps not – but does this really give the NHS the right to deprive them of the simplest of liberties?

When considering the idea of prohibiting smoking on hospital grounds, there is a temptation to compare the proposal to prior legislation; namely, the ban on smoking inside pubs, restaurants and other indoor public spaces. In its own terms, at least, this has largely proven a success. But by trying to replicate its’ outcome in hospitals across the country the policy is likely to come unstuck.

There was, at worst, resignation and, at best, wholehearted support for the original ban. Any initial hostility from some pub landlords and restaurant owners who feared that they would lose business was short-lived. Rather than oppose the ban, the majority of businesses did what they do best – they innovated, setting up increasingly fashionable outdoor smoking areas for the hoards of customers that decided to nip out for a quick cigarette. Smokers themselves seem to have gotten used to these new arrangements, and it’s now common for the ‘smoking area’ to be the busiest part of a venue.

The hospital ban, on the other hand, is something altogether different. Not only are patients who smoke likely to take issue with it; the chances are that staff will too.  Practically the implementation would be a nightmare – with healthcare workers expected to take on the dual roles of care-givers and smoke police. Against a backdrop of already stretched resources staff should not be expected to take on these responsibilities as well. The reality is they probably won’t be able to – resulting in policy failure and a lot of bad press for all involved.

Wouldn’t it be better to accept people’s individual choices anyway, rather than forever trying to prohibit certain behaviours? Of course, medical professionals should (and already do) advise their patients of ways they can improve their health – be that by cutting down on the cigarettes or taking a break once in a while. Ultimately though, it is not the place of the NHS to tell us what we can and cannot do. Quite besides the fact that we live in a democratic society whereby freedoms should be respected, it simply doesn’t work.

Written by Anna Carnegie. The Social Policy Forum challenges social policy by stealth in the age of the Big Nudge. We are on Twitter @SocialPolicyFor

One response to “Cigarettes and hospitals: smoking out patients?”

  1. Brid Hehir says:

    I wrote this piece for the Nursing Standard disagreeing with the (not so) NICE proposal that smoking be banned on NHS premises, favouring choice and the right to make decisions that may be bad for us..