Smokefree trust

What is smokefree?

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

There are no designated areas where the use of cigarettes is allowed. If you smoke, we will support you to try and quit or to temporarily stop smoking while in hospital.

Why are we smokefree?

We want to reduce harm to patients, staff and everyone else who visits our sites and create an environment that promotes good health.

As an NHS organisation, 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. 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.

How do we support 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 suitable nicotine replacement therapies. 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 while they temporarily abstain from smoking. This means no one is forced to experience the effects of nicotine withdrawal.

Smokers who want to take the opportunity to try and quit while in hospital will be referred to a trained staff member. They will be offered an individualised assessment and then refered on to community cessation support once they leave hospital.

How do we make sure people don’t smoke on our sites?

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

Posters are displayed across our premises letting people know about our smokefree status. If an individual is breaching the policy, a staff member may approach the person to ask that they extinguish their cigarette and to let them know that we’re now smokefree.

Before a planned hospital admission, patients are advised that smoking is not permitted in the hospital or grounds and are offered support to temporarily abstain or quit. 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 items home. If they are unaccompanied when they arrive staff will store the items and return them when the patient is discharged.

If a patient struggles to stay smokefree staff will review their care plan to give further support.

Patients in community settings are told about our smokefree policy and offered a referral to their local smoking cessation service. Community patients who are receiving treatment are asked not to smoke for two hours before or during their treatment session. This is to protect staff from the harmful effects of second hand smoke.

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

Staff are able to ask service users to hand in any smoking related products following admission. These products will 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.

If a service user refuses to hand in tobacco related items staff are able to remove them from their property, 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.

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’s the patient’s choice about which product to use, in discussion with staff.

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.

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

Can patients use e-cigarettes on our sites?

Disposable e-cigarettes can be bought 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 and can be bought from Lloyds by staff for self-use (during unpaid breaks only) or for patients following a risk assessment. Patients can also provide their own re-chargeable e-cigarettes but these would need to be risk assessed by staff before they are used.

Unfortunately e-cigarettes are not allowed within forensic services at Ridgeway, Middlesbrough, or on some other identified wards. It’s currently illegal to supply e-cigarettes to people 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.

There is however 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.

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).