Smoke-free Scotland - Guidance on smoking policies for the NHS, local authorities and care service providers

Executive Summary

This guidance was commissioned by a working group comprising representatives of the Scottish Executive, ASH Scotland, the NHS, NHS Health Scotland, the Convention of Scottish Local Authorities ( COSLA), the Care Commission and the Scottish Centre for Healthy Working Lives (now incorporating Scotland's Health at Work).

It provides guidance to the NHS, local authorities and care sector providers on how to comply with Scotland's smoke-free legislation, including specific advice for those premises which are permitted exemptions under the new law. It builds on ' Helping to get your business or organisation ready for the new law on smoking: A guide for employers, managers and those in control of premises'¹, recognising the unique circumstances of these organisations and the challenges faced by staff and those who use their services.

In addition, it highlights the benefits of going further than the legislation and working towards completely smoke-free policies, maximising the health gain opportunity which the legislation presents in order to protect and improve the health of the people of Scotland and reduce health inequalities.

Introduction ( Chapter 1)

From 26 March 2006, Scotland joins a number of other countries benefiting from comprehensive legislation to remove second-hand smoke from most public places and workplaces.

International research suggests that a number of benefits can be expected, including increased protection from the health risks of passive smoking; healthier communities as smokers use the opportunity to stop smoking or reduce the number of cigarettes they smoke; much reduced health care and treatment costs; a more efficient and equitably treated workforce and an improved environment for all members of society.

Those working in the NHS, local authorities and other care service providers are invited, where possible, to go further than the legislation, working towards comprehensive smoke-free policies with the provision of cessation advice and support to those who wish to quit smoking.

Scotland's smoke-free legislation and how to comply - the legal imperative ( Chapter 2)

This section sets out the requirements placed on employers and managers of organisations in Scotland to comply with the smoking provisions of The Smoking, Health and Social Care (Scotland) Act 2005 ⁶ and The Prohibition of Smoking in Certain Premises (Scotland) Regulations 2006 ⁷; the minimum recommended action for those in control of premises; enforcement arrangements and penalties for non-compliance.

From 26 March 2006, employees, patients, clients and visitors will not be able to smoke in 'wholly or substantially enclosed' areas of public premises, including workplaces and vehicles which are used primarily for business purposes (heavy and light goods vehicles, not cars). Included within the scope of the legislation are NHS and local authority premises.

In adult care homes and residential psychiatric hospitals and units designated smoking areas can be established as long as certain criteria are met. Adult hospices are also permitted exemptions. However, there is no legal obligation on the proprietors of these premises to provide designated areas for smoking, if they do not wish to do so.

Specific issues facing NHS organisations, local authorities and care service providers ( Section 3)

It is recognised that there are a number of difficult and sensitive issues for NHS organisations, local authorities and care service providers in complying with the legislation. In addition, there is a health leadership role for these organisations that makes it desirable for them to be in the vanguard of smoke-free policy development.

These issues are examined in detail in this section, setting out good practice in terms of organisational responses to tobacco. The main issues are set out below.

No requirement to provide external smoking areas to comply with the legislation and strong evidence to suggest that their provision undermines the potential health gain to staff and those who use their services. Shelters may be useful on a time-limited basis, combined with work to encourage and support smokers to stop smoking. Care needs to be taken to ensure that existing or new shelters comply with the new law, that they are not 'wholly or substantially enclosed' within the meaning of the legislation.

Careful consideration needs to be given to the matter of staff leaving the site in order to smoke, particularly those working late into the evening or through the night. Above all else, the health and safety of the employee needs to be a major concern. This may lead to the need to discourage employees from this practice and instead encourage them to consider joining a smoking cessation programme.

The safety of patients is paramount to any agency with care or treatment responsibilities. Alternatives to allowing patients to exit the premises are explored, including the availability of cessation services whilst in hospital or care treatment centre and pharmacological aids to help them during their stay.

Proprietors may designate rooms for smoking, although they are not obliged to do so. Any 'designated' rooms should be enclosed spaces with ventilation systems that do not ventilate into any other part of the building, and should be clearly marked as a room in which smoking is permitted. These rooms are designed for the use of residents, not staff or visitors. Staff exposure to second-hand smoke should be minimised.

The principles which apply to adult care homes also apply to residential psychiatric hospitals and units. The Scottish Executive has established a short-life working group to oversee the development of a national framework which will deal more clearly with the specific challenges faced by mental health services and their users, particularly in relation to smoking cessation.

Adult hospices have been permitted exemptions from the smoke-free legislation on humanitarian grounds, although there is no obligation on management to allow smoking on these premises. Smoking should be contained and tobacco smoke restricted to designated smoking rooms.

Private residences are not covered by the legislation. Staff who visit or treat people in their own homes are at risk if the person being treated is a smoker. Advice is provided on how exposure and the subsequent health risks can be reduced.

Whilst only those heavy and light goods vehicles that are used primarily for work purposes come within the scope of the legislation, the ideal is that all vehicles used by employees as part of their work should become smoke-free. This is particularly relevant when a private vehicle is being used to convey passengers. The use of private vehicles as a 'smoking shelter' should be discouraged.

All such premises which are 'wholly or substantially enclosed' are required to be smoke-free under the legislation. However, local authorities will wish to consider the benefits of also introducing smoke-free policies in external areas frequented by children and young people, like playgrounds.

Outdoor areas are not covered by the legislation. However, employers will wish to consider whether having different approaches to smoking for those who work indoors or outdoors is equitable. Good practice indicates that a comprehensive, equitable approach is followed.

Local authorities are reminded that the communal areas of such accommodation are caught by the smoke-free legislation.

Offender accommodation in the community is caught by the smoke-free legislation. Smoking is prohibited in these premises except for those areas that are captured by the residential accommodation exemption. In all cases, staff exposure to second-hand smoke should be kept to a minimum.

Going Forward - The case for completely smoke-free ( Section 4)

To maximise the health and economic benefits to the organisation, compliance with the legislation should be supported by the development of a comprehensive workplace tobacco policy. Wherever possible, consideration should be given to going beyond the legal requirements and moving towards the goal of being completely smoke-free. This should be undertaken in communication and consultation with staff and accompanied by work to support smokers to stop smoking.

The health and business case are outlined in brief in this section. They are set out in full in Appendix 2.

Overcoming likely challenges and obstacles ( Section 5)

This section provides some of the counter measures that can be used to help people overcome resistance to the legislation or completely smoke-free workplace policies.

This work includes:

Smoking cessation ( Section 6)

Some of the most significant health benefits of the smoke-free legislation will only be realised if smokers use the opportunity to stop smoking. Responsible organisations should offer support to staff, patients, clients, residents and visitors, for example by publicising smoking cessation services and encouraging staff to access them.

Those responsible for cessation services need to gear up to the implementation of the legislation and ensure the availability of appropriate services, delivered where people need them.

This section highlights how smokers can be encouraged to stop whilst in hospital - in both in-patient and out-patient situations. It also provides advice on cessation methods.

Checklist for Action ( Section 7)

Sets out a checklist for action for managers to ensure that all steps are being taken to comply with the law and the development of an appropriate smoking policy.

Appendix 1

Contains three sections dealing with the legal requirements, including some relevant legal definitions, lists those premises classified as no smoking under the law, and those which are exempt.

Appendix 2

Sets out the health and economic case for becoming smoke-free.

Appendix 3

Contains practical guidance on preparing to become smoke-free, including a step-by-step guide to the development of a comprehensive policy.

Appendix 4

References and further resources/information.

Up to date information about Scotland's smoke-free legislation, including case studies, can be found at the Clearing the Air Scotland website: http://www.clearingtheairscotland.com