Government messages are still not getting through to NHS trusts

Chesterfield Royal Hospital unveiled a vaping ban in 2017 which has since been rescinded

In August, the government’s Science and Technology Committee produced a report detailing, amongst other recommendations, suggested policies on e-cigarette use on NHS property. Specifically dealing with mental health facilities, it stated:

NHS England should set a clear central NHS policy on e-cigarettes in mental health facilities which establishes a default of allowing e-cigarette use by patients unless an NHS trust can show reasons for not doing so which are demonstrably evidence-based.

The Committee went further, expressing disappointment that NHS England’s approach to e-cigarettes is not only confused, but also lacks leadership.

We also find it very concerning that there is not a dedicated person within NHS England responsible for implementing the Government’s Tobacco Control Plan.

Responding to the Science and Technology Committee’s report, the government accepted the recommendations in full.

The reference to the Tobacco Control Plan was to highlight that the government pledged “to support consumers in stopping smoking and adopting the use of less harmful nicotine products”. Public Health England has also stated that “e-cigarette use is not covered by smokefree legislation and should not routinely be included in the requirements of an organisation’s smokefree policy”, yet these government messages are still clearly not getting through to NHS trusts.

A new report from Forest – drawing on Freedom of Information requests sent to 200 NHS trusts in England and widely covered by media on Monday – revealed very disappointing results. The use of e-cigarettes was prohibited by 55 per cent of NHS trusts in all their grounds including private cars in the car park, and only 14 per cent planned to amend their policy this year to lift restrictions.

That a majority of NHS trusts are so out of touch with government policy on e-cigarettes betrays a distinct lack of awareness from NHS managers or, worse, a perhaps ideological and unprofessional reluctance to follow official guidance. In 2017 Chesterfield Royal Hospital (see image above) banned vaping sitewide to mark the start of their Stoptober campaign - despite the national 2017 Stoptober campaign's support for e-cigarettes. Their policy has since been rescinded but it’s clear that many other trusts are not taking any heed of government messages on reduced risk products.

It is clear there is a haphazard and uncoordinated approach to the way vapers are treated while on hospital grounds and it seems to us that opportunities are being missed. Banning vaping throughout NHS sites is a blinkered and outdated approach to helping smokers to quit and relies once again on using a big stick where a carrot would produce far more positive results.

In their zeal to banish smoking entirely from hospital sites, NHS trusts appear to be hyper-precautionary to the point of being counterproductive towards e-cigarettes too. If the spectacular success of vaping in the past six or seven years tells us anything, it is that smokers – like everyone else – react more favourably to incentives than restrictions, but there is no incentive being offered by a trust which bans vaping everywhere. The only message it sends is that e-cigarettes are as hazardous as lit tobacco so should therefore be avoided.

Where is the benefit to banning vaping in a car park? Especially if it goes against every pronouncement from government for the past four years on e-cigarettes? If trusts insist on banning all smoking in their grounds, the Forest report’s recommendation that vaping should be permitted in all outdoor areas is a clear incentive for smokers to try e-cigarettes instead. But NHS trusts could be more imaginative than that.

The report also urges that “use of e-cigarettes should be allowed inside hospital buildings (including wards) at the discretion of hospital management”. This may be difficult in a multi bed ward, but many facilities have single rooms or a day room where discreet vaping could be allowed. Instead of adhering to an unthinking policy of banning nicotine use of all stripes, create incentives across the board.

The sum of objections to smoking from hospital visitors is that smoking goes on in hospital entrances, but where else will smokers congregate when shelters have been taken away except where it is least inclement, this is a problem entirely made by managers who have removed any other option. Businesses pay to sponsor roundabouts, why not sell sponsorship to vape businesses of smoking shelters which will only ever be frequented by potential customers? It removes smokers from areas where visitors don’t want them to be and directs them to where they will see a plethora of messages about switching consistent with government advice.

We are in the second decade of the 21^st century but NHS trusts seem to be stuck in the past and not yet caught up on where the government is going.

If NHS England truly seeks to reduce smoking by any means, it should be more imaginative in its approach and, if nothing else, at least listen to the messages coming from government and its institutions.

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Government messages are still not getting through to NHS trusts

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