When did TEWV and Northumberland, Tyne and Wear (NTW) go smokefree?

Both TEWV and Northumberland, Tyne and Wear (NTW) went smokefree on 9 March 2016. 

What is smokefree?

Patients, carers, staff and all other visitors are not allowed to smoke on any Trust sites including all wards, buildings, grounds and vehicles. 

There are no designated areas where the use of cigarettes is allowed and if you smoke, we will support you to make a quit attempt or to temporarily abstain whilst in hospital. 

Why has TEWV and NTW gone smokefree?

Both Trusts want to reduce harm to patients, staff and everyone else who visits our sites. We want to create environments that promote health.

As NHS organisations, we have a duty to protect and care for both the mental and physical health of our patients. This includes supporting smokers to stop smoking.  

People with mental health problems are more likely to smoke and to smoke more heavily than the general population and this is one of the reasons that they have poorer physical health and a lower life expectancy than the general population. We want to reduce this unacceptable health inequality.

Our decision to go smokefree is in line with The Health Act (2006) and The National Institute for Health and Care Excellence (NICE 2013) guidelines, which state that all hospital sites, including mental health hospitals, should be 100 per cent smokefree. 

How is TEWV supporting patients who smoke?

Anyone who smokes and is already an inpatient or admitted to one of our sites will be assessed by a qualified smoking cessation member of staff and offered nicotine replacement therapies that are suitable to them. New patients will be offered this service within 30 minutes of being admitted.

Depending on the severity of their nicotine dependence, smokers are offered nicotine replacement therapy and/or behavioural support to manage nicotine withdrawal symptoms whilst they temporarily abstain from smoking. By offering nicotine replacement therapy to all patients we are ensuring that no one is forced to experience the effects of nicotine withdrawal.

Smokers who want to take the opportunity to make a quit attempt whilst in hospital will be referred to a trained staff member who will offer an individualised assessment and then refer on to community cessation support on discharge.

How is TEWV ensuring that patients don’t smoke on Trust sites?

Prior to planned hospital admissions, patients are advised that smoking is not permitted in the hospital or grounds and they are offered support to temporarily abstain or quit. This will include nicotine replacement therapy (NRT) and behavioural support. Patients are asked not to bring tobacco, cigarettes, lighters or matches with them to hospital.

Patients are not allowed to keep tobacco, cigarettes, lighters or matches on their person. If anyone arrives at hospital (planned or unplanned), a carer or family member will be asked to take the prohibited items home. If they are unaccompanied when they arrive at hospital staff will store the items and return them when the patient is discharged.

All patients will be offered an assessment and alternative nicotine replacement therapy options within 30 minutes of being admitted.

If a patient struggles to stay smokefree staff will review their care plan and consideration will be given to adjusting their nicotine replacement therapy and increasing the amount of behavioural support provided.

Patients in community settings are informed about the Trust’s smokefree policy and offered a referral to their local smoking cessation service. Community patients who are receiving treatment are asked to ensure that they do not smoke for two hours prior to or during their treatment session. The reason for this is that we want to protect staff from the harmful effects of second hand smoke. Also some of the cancer causing components of tobacco, continue to increase in the air after a cigarette is extinguished. 

How should staff react if a service user refuses to hand in tobacco related items and continues to smoke?

Tobacco products and any related items such as matches and lighters are classed as contraband.  As such, staff are able to ask service users to hand in any of these products following admission, as we would with alcohol and illicit drug supplies. These products will then be stored safely and only returned on discharge. No patient is allowed to continue to smoke tobacco products and staff will need to re-enforce this at all times.

Should a service user refuse to hand in tobacco related items staff are able to remove them from their property, as with alcohol and illicit drugs, although this would always be a last resort.

Neither informal nor detained patients will be allowed leave to smoke at any time. This also applies to escorted leave where service users are no longer allowed to smoke when escorted by staff due to the risks from secondhand smoke exposure. 

Are detained patients allowed smoking leave?

No patients, either informal or detained will be allowed leave to smoke. All contraband tobacco items will be removed and only returned on discharge.

How is TEWV ensuring that visitors and contractors don’t smoke?

Our aim is to develop a culture where smoking is viewed as unacceptable across our sites and for people to respect this.

Posters have been created to be displayed across Trust premises informing service users, visitors and contractors of our smokefree status. In a situation where an individual is breaching the policy, a staff member may approach the person to request that they extinguish their cigarette and to let them know that the Trust is now smokefree.  Staff can also advise that there are excellent smoking cessation services that we can put them in touch with if they wish. 

Has TEWV informed staff, patients, carers and other visitors that the Trust has gone smokefree?

We have let people know about the Trust going smokefree in several ways. These include:

  • explaining what smokefree means and what support is available in our internal communication channels such as e-bulletin and intranet site, as well as external communication channels including media, our website, social media and Trust Insight magazine
  • producing leaflets with specific information for staff, patients and carers
  • contacting stakeholders such as partner organisations and commissioners to brief them on the change and answer any questions
  • visiting wards to brief staff and patients and identify any potential issues and answer questions
  • holding events for patients and carers to ensure they have the opportunity to discuss their concerns
  • installing new signage, which highlights that smoking is not allowed anywhere on Trust premises
  • including information about being smokefree  in the staff induction so that new staff are fully advised of the policy
  • briefing local media
  • including information about the Trust being smokefree and the support available in outpatient letters so that patients know of the policy in advance of attending appointments. 

Is the Trust going smokefree likely to lead to a rise in incidents on wards?

Evidence from other Trusts who had previously gone smokefree is that a complete ban leads to a reduction in smoking related violence and aggression, rather than an increase.

South London and Maudsley NHS Foundation Trust highlighted an initial pilot where:

  • a reduction in the number of violent incidents associated with smokefree status was seen
  • a reduction in the use of supervised confinement episodes to manage smoking related conflict
  • a reduction in the use of promoting safer and therapeutic services (PSTS) techniques to manage smoking related conflict
  • the complete elimination of the use of rapid tranquilisation in response to smoking related conflict.

Partial smoking bans, where people can smoke in certain places or at certain times, can be more frustrating for some patients and lead to more conflict as there are grey areas for people to dispute. Inconsistent enforcement of a complete smokefree ban can also cause disputes. 

What forms of nicotine replacement (NRT) products are available?

There are currently eight different NRT products available. These are patch, gum, lozenge, sublingual tablet, nasal spray, inhalator, mouth spray and mouth strips. All of the products are absorbed through the skin, nose or mouth.

These medicines work well on their own, but are more effective alongside behavioural and psychological support from a trained stop smoking advisor.

No particular NRT product is significantly better than another and it is the patient’s choice about which product to use, in discussion with staff. 

How effective is nicotine replacement (NRT) and what are the risks?

NRT has been tested extensively and all products approximately double the chance of long term abstinence from smoking when compared to having no support.

There are no safety concerns with the long term use of NRT and smokers rarely become addicted. NRT is safe to use in people who smoke and is recommended by the National Institute of Health and Social Care Excellence (NICE) to be used during periods of temporary abstinence or whilst trying to cut down.

Because the tar in tobacco smoke speeds up the metabolism of mental health medicines, when patients reduce or stop smoking, medication doses need to be reviewed and sometimes be lowered. NRT does not interact with any mental health medications or affect the blood levels of medication.

There are very few restrictions about who can use NRT. Smokers over the age of 12 can use NRT (although there is very little research in the efficacy of NRT in young smokers). Using NRT is always safer than smoking. 

What are e-cigarettes (electronic cigarettes)

E-cigarettes are battery powered devices that deliver nicotine via inhaled vapour. They do not contain tobacco, so the user is not exposed to poisonous gases that are in tobacco smoke.

Devices come in many shapes or forms, sometimes resembling cigarettes, but others resemble pens or gadgets. E-cigarettes can be disposable, rechargeable in packs, or the cartridges can be refillable (tank models).

Tank models have been reviewed and approved for use across the Trust following an individual risk assessment.  

Can patients use e-cigarettes on Trust sites?

Disposable e-cigarettes can be purchased by patients or staff across TEWV services from main hospital sites (Lloyds Pharmacies) or brought into services by visitors.

Re-chargeable e-cigarettes are also available for use in TEWV and can be purchased from Lloyds by staff for self-use (during unpaid breaks only) or for the use of patients-following a risk assessment. In addition, patients can also provide their own re-chargeable e-cigarettes but these would need to be risk assessed by staff prior to individual use.

Unfortunately e-cigarettes are not allowed for use within forensic services at Ridgeway, Middlesbrough or on some other identified wards, and it is currently illegal to supply e-cigarettes to those under 18 years of age.

Patients should only use the identified e-cigarettes in designated and discrete areas, preferably in the hospital grounds. They should not be used in communal indoor areas, but in exceptional circumstances may be used in single occupancy bedrooms.  

Could not allowing a patient to smoke be detrimental to their mental health?

Some clinicians and patients believe that smoking helps with stress, anxiety, low mood and symptoms of psychosis but there is no clear or consistent evidence to support this.

However, there is emerging evidence that when patients with psychosis, depression and anxiety are supported to stop smoking, with psychological support and either nicotine replacement therapy (NRT) or other medication, on average their mental health symptoms actually improve.

Tobacco smoke also reduces the effectiveness of some medicines, which means a smoker needs a higher dose of medication compared to a non-smoker. When someone completely stops smoking their medication can be reviewed and the dosage lowered in some instances. 

Is there a risk that the Trust being smokefree will discourage voluntary admissions and attendance at outpatient appointments and lead to an increase in emergency admissions?

Other mental health settings that have introduced a comprehensive smokefree policy have not seen any evidence of this. 

Has the Trust got a legal right to be completely smokefree

Yes, it is legal for the Trust to go completely smokefree. Banning smoking in workplaces and enclosed public spaces is covered by legislation, introduced in England in July 2007.

Banning smoking in our grounds is a recommendation of the National Institute of Health and Social Care Excellence (NICE). 

Is not allowing a service user to smoke on Trust sites an infringement of their Human Rights?

It is not an infringement of a service user’s human rights for the Trust to be smokefree. This argument has been legally tested and was upheld by the Court of Appeal in 2008 after Rampton Hospital in Nottinghamshire went smokefree. It ruled that a hospital is not the same as a home environment and is instead a place that should support the promotion of health and wellbeing. Therefore patients can be prevented from smoking for health and security reasons.  

How will the Trust monitor the effectiveness of the policy?

The Trust is monitoring how effectively our smokefree policy is being implemented and we are working with staff, patients and carers to address any particular issues. 

Three, six and twelve month reviews will take place and feedback processes are in place ,which includes reporting from key organisational meetings, including the patients’ forums, staff forum and regular nursing and senior management meetings.



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