Frequently Asked Questions
The Trust becoming Smoke Free will impact on everyone, including all patient, service users, staff, visitors, and contractors. There will longer be any designated areas for patients to smoke tobacco.
From the 1 January 2018, the Trust will no longer have outside smoking areas for patients/service users. Staff will no longer facilitate smoking during escorted leave. Patients will not bring any type of smoking paraphernalia: lighters, cigarettes, tobacco, matches, e-cigs to the ward.
Becoming Smoke Free will raise a number of questions for staff and service users, this Frequently Asked Questions (FAQs) section attempts to answer these although we recognise that not everything may be covered.
Should you have questions that are not covered please email your questions to firstname.lastname@example.org.
When is Somerset Partnership NHS Foundation Trust going smoke free?
Somerset Partnership NHS Foundation Trust will go completely smoke free on 1 January 2018.
What does Somerset Partnership NHS Foundation Trust going smoke free mean?
Patients, carers, staff and all other visitors are not allowed to smoke on any Somerset Partnership NHS Foundation Trust sites including all wards, buildings, grounds and vehicles.
There are no designated areas where the use of tobacco products is allowed.
Electronic cigarettes can be used by service users in designated areas.
Support will be available for service users and staff who wish to stop smoking.
We recognise that smoking or not smoking is a matter of individual choice. We will help service users and staff who do not wish to stop smoking to manage tobacco dependency symptoms while on Trust premises and grounds (temporary abstinence).
Why has Somerset Partnership NHS Foundation Trust gone smoke free?
Our decision to go smoke free 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 smoke free.
The Trust wants to reduce harm to patients, staff and everyone else who visits our sites. We want to create healthy environments that promote wellness.
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 and this is one of the reasons that they have poorer physical health and a lower life expectancy than the general population. Going smoke free will help us to reduce this unacceptable health inequality.
Staff in our in-patient services spend a great deal of time facilitating smoking through activities such as helping to buy cigarettes or escorting service users to smoking areas. Reinvesting this time into facilitating healthy therapeutic activities will be beneficial to both service users and staff.
How are you ensuring that patients don’t smoke on Somerset Partnership NHS Foundation 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.
For unplanned admissions patients are not allowed to keep tobacco, cigarettes, lighters or matches on their person. If they arrive to hospital with a carer or family member they are 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.
How are you ensuring that visitors and contractors don’t smoke on Somerset Partnership NHS Foundation Trust sites?
All sites have appropriately placed notices advising visitors that they are entering a Smoke Free Site. As part of the contracting process contractors are advised at the outset that they will not be able to smoke.
In a situation where an individual is breaching the policy, a staff member may approach the person to let them know that the Trust is now smoke free and that there are excellent smoking cessation services that we can put them in touch with if they wish.
Is the Trust going smoke free likely to lead to a rise in incidents on wards?
Mental health Trusts that have already gone smoke free have reported that following implementation there has been a reduction in incidents onwards.
They have also reported:
- better engagement with service uses and greater use of therapeutic activities
- a reduction in the number of violent incidents
- reduction in the use of ‘when necessary’ (PRN) medication
What is the most effective way to stop smoking?
The Department of Health recommends a combination of intensive behavioural and psychological support alongside medication to minimise nicotine withdrawal symptoms and help with cravings. Effective medication includes Nicotine Replacement Therapy (NRT), bupropion and varenicline.
There is evidence to suggest that e-cigarettes and vaping can also help.
What forms of nicotine replacement therapy (NRT) 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.
Can patients use e-cigarettes on Trust sites?
Electronic cigarettes can be used by service users in designated outdoor areas.
How should patients store and dispose of their e-cigarettes?
E-cigarette users must store their e-cigarette safely and securely, should not share products with others for infection control reasons and should not use them near oxygen/naked flames.
If we supply E-cigarettes they will be disposable must be disposed of in a designated bin.
There are different types of e-cigarettes. Are all types allowed on Trust sites?
We are currently deciding on the use of e-cigarettes, but it is likely that we will agree to use a disposable e-cigarette to help patients refrain from smoking.
We will not be using re-chargeable e-cigarettes because of the fire risk that they may pose.
Could not allowing a patient to smoke be detrimental to their mental health?
There is no clear evidence to support this; however, some clinicians and patients believe that smoking helps with stress, anxiety, low mood and symptoms of psychosis but there is not any clear or consistent evidence to support this.
There is emerging evidence that when patients with psychosis, depression and anxiety are supported to stop smoking, with psychological support and either 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 smoke free?
Yes, it is legal for the Trust to go completely smoke free – prohibiting smoking in workplaces and enclosed public spaces is covered by legislation, introduced in England in July 2007.
Prohibiting 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 smoke free. This argument has been legally tested and was upheld by the Court of Appeal in 2008 after Rampton Hospital in Nottinghamshire went smoke free. 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 prohibited from smoking for health and security reasons.