Prohibiting smoking outside hospital buildings: consultation

Introduction

Aim

The primary aim of introducing a formal no-smoking area around hospital buildings is to support the de-normalisation of smoking and help reduce the use of tobacco across the population. The NHS should be an exemplar of health promotion and support people in their efforts to stop smoking.

We also aim to prevent or reduce exposure to second-hand smoke outside and inside hospital buildings to improve and protect public health.

This consultation seeks views on specific details required to introduce no-smoking areas in accordance with existing law. These details will be set out in Regulations.

In addition, it seeks views on permitting the use of Nicotine Vapour Products on hospital grounds, but beyond the no-smoking area, to assist those who may find it otherwise difficult to resist smoking on the grounds and to promote a less harmful choice and subsequent quit attempt.

Who will be affected?

The reduction in exposure to second-hand tobacco smoke outside hospital buildings should have a positive impact on everyone visiting a hospital and particularly to young people and adult non-smokers. It should also assist those who are attempting to quit tobacco products by removing the visibility of smoking in a health-promoting environment.

Those who may find it difficult to resist smoking tobacco products on hospital grounds due to stress and other factors, we suggest, should be permitted to use Nicotine Vapour Products beyond the mandatory no-smoking area. Providing this alternative should help alleviate some of the compliance problems experienced with the voluntary ban and encourage current smokers to attempt to quit through the use of this less harmful alternative.

Why are we proposing these Regulations?

These Regulations will implement the primary legislative provisions contained in the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016^[1] (“the 2016 Act”).

In passing the Act, the Scottish Parliament determined that offences should be introduced for smoking within the no-smoking area outside hospital buildings. These Regulations are needed to bring those offences into force as they define critical aspects of the offences – such as the size of the perimeter area, or fine tune aspects – such as hospital grounds or buildings.

Background

The Scottish Government is committed to raising a tobacco-free generation by 2034^[2] and to reduce the prevalence of smoking to five per cent or less by that same year.

While smoking rates have significantly declined with fewer people taking up the habit and the proportion of ex-smokers outnumbering the number of smokers for the first time in 2013, there is more that needs done to achieve our 2034 target.

Smoking tobacco products continues to be one of the greatest threats to public health in Scotland. It is the cause of around one in five of all deaths and kills two in every three long-term smokers. Smoking is known to reduce the effectiveness of medications, including those prescribed for mental health conditions, remains the most significant cause of preventable cancer and contributes to much of Scotland’s cardio-vascular and pulmonary health problems. In addition to the health inequalities smoking creates, it is a significant financial burden that contributes to social and economic inequalities.

Despite NHS Scotland introducing its policy to prevent smoking on hospital grounds in 2015 many people still choose to ignore the rules and continue to smoke there. This is not acceptable and especially close to hospital buildings which increases the nuisance and health risk to other people.

The Scottish Government’s tobacco control action plan builds on what has already been achieved in reducing the burden of tobacco on society. One of the many actions we have committed to pursuing is the making of an offence to smoke within 15 metres of hospital buildings. This will support the current administrative ban on smoking on hospital grounds by extending the statutory ban on smoking inside hospitals to a set distance outside those buildings.

This consultation refers to specific measures already in legislation, as contained in the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016. The full public consultation^[3] for the 2016 Act, which took place in 2015, identified substantial support for appropriate regulation.

An ASH Scotland/YouGov survey, undertaken in 2015, indicated that 73% of a representative sample of the Scottish population would be in favour of a complete ban on smoking on hospital grounds. There was also strong public support for national legislation to apply and enforce such a ban in a consistent and proportionate manner across Scotland.

Current restrictions

In March 2015, the Green Curtain Campaign^[4] introduced an administrative ban asking all patients, visitors and staff to wait until they were off grounds before lighting up. This voluntary ban was supported by a national TV and radio campaign and was part of the drive to create a tobacco-free generation by 2034.

Developed by NHS Health Scotland, the campaign asked smokers to refrain from smoking on grounds as part of a smoke-free commitment which extended to all NHS premises, hospitals, health centres, community facilities, offices and other non-patient buildings. It was a request designed to change behaviour and was not backed by any penalty or other sanction for non-compliance other than staff requesting that the individual stop smoking or leave the grounds.

Several complaints have been made to the Scottish Government and health boards about the continued visibility of smoking and the potential harm from smoking around buildings. These complaints have come from staff, visitors, patients, pressure groups and other concerned individuals.

It has been an offence to smoke or permit others to smoke in certain wholly or substantially enclosed public spaces for well over a decade in Scotland. The indoor smoking ban was received and supported by the public. The aim of the Smoking, Health and Social Care (Scotland) Act 2005 (“the 2005 Act”), was to encourage behaviour change and it would now be difficult to even imagine someone smoking inside an enclosed public space such as a hospital waiting room.