Abstract
BackgroundAccording to the provisions of the Health Act 2006, NHS acute Trusts had to become smoke-free by July 2007. Mental health Trusts were granted a further year before all indoor smoking areas have to be removed. This study was carried out to determine the extent of smoke-free policy implementation in English NHS acute and mental health Trusts, and to explore challenges and impacts related to policy implementation.MethodsQuestionnaire-based survey of all English NHS acute and mental health hospital settings, supplemented by semi-structured telephone interviews with 22 respondents and direct observation at a sample of 15 Trusts (22 different sites). Human Resources Directors of all 245 English NHS Trusts providing acute and/or mental health inpatient care were identified as potential study participants. Main outcome measures comprised the proportions of Trusts reporting smoke-free policy implementation; whether these relate to buildings only or to whole premises including grounds; most frequently reported exemptions; reported and observed frequencies of policy breaches.ResultsSmoke-free policies were reported to be implemented in all mental health and 98% of acute settings studied. They applied to whole premises including grounds in 84% of acute, and 64% of mental health settings. However, exemptions were granted by 50% of acute and 78% of mental health settings, typically for bereaved relatives or psychiatric patients, in sheltered outdoor areas and smoking rooms. Reported challenges included policy enforcement and related risks of abuse, and litter on premises and adjacent public grounds. Nearly two thirds of acute and over a third of mental health trusts reported that policy infringements occurred on a daily basis. Indeed, patients and visitors were observed smoking at 94% of acute sites visited and staff smoking at 35% of them.ConclusionNHS hospitals should play an exemplary role in making a smoke-free environment the norm. Although smoke-free policies have been implemented in nearly all English NHS hospitals, exemptions are frequently granted and policy breaches appear to be commonplace.
Highlights
According to the provisions of the Health Act 2006, National Health Service (NHS) acute Trusts had to become smoke-free by July 2007
Studies indicate that the implementation of smoke-free policies in both acute and mental health hospital settings is achievable [5,6,7,8] with potentially beneficial impacts on aspects such as exposure to environmental tobacco smoke[9] and smoking prevalence among staff[10,11]
It has been found that the enforcement of smoke-free policies in health services remains a challenge after implementation and a national survey of smoke-free policies in the NHS in 2003 highlighted that many health services were not smoke-free and identified several problems and barriers in achieving this [12,13]
Summary
According to the provisions of the Health Act 2006, NHS acute Trusts had to become smoke-free by July 2007. This study was carried out to determine the extent of smoke-free policy implementation in English NHS acute and mental health Trusts, and to explore challenges and impacts related to policy implementation. In England, the Health Act 2006 [2] established the legal framework relating to smoke-free policies in work and public places. In England, since the 1980s, several edicts have required National Health Service (NHS) hospitals to implement smoke-free policies [3,4]. Studies indicate that the implementation of smoke-free policies in both acute and mental health hospital settings is achievable [5,6,7,8] with potentially beneficial impacts on aspects such as exposure to environmental tobacco smoke[9] and smoking prevalence among staff[10,11]. A further pronouncement was made by government requesting the health service to be smokefree by the end of 2006[14]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
