Appendix 1

NHS Grampian Tobacco Policy (2009) Consultation Report

Executive Summary

A consultation was carried out to inform the draft Tobacco Policy (2009) which aimed to move NHS Grampian to a smoke free environment throughout all grounds and premises, a commitment originally made in the 2006 Tobacco Policy.

A wide range of methods were used to consult with staff, patients, the public, voluntary and public groups, partner organisations and other interested parties. Nearly 500 responses were received during the consultation period, with just over half from staff and nearly three quarters of respondents stating they were non-smokers.

46% of respondents said they agreed with the proposed ban; 24% agreed to some extent; 28% did not agree. The main reasons given in support of the policy were the dislike of “running the gauntlet” of people smoking at hospital entrances; the smell of smoke entering into clinical areas from people smoking outside; having to treat the preventable illnesses caused by smoking; the accumulation of cigarette ends littering the site, particularly at entrance areas; the smell of smoke when being cared for by staff who have recently had a cigarette; hygiene and infection control concerns if staff are smoking in uniform; and the need for NHS Grampian, as a health organisation, to lead by example.

The main reasons given in opposition to the policy were it was “heavy handed” and “draconian”; showed a lack of compassion for patients and visitors at times of stress; raised safety concerns; would have an impact on staff morale; removed freedom of choice and would be very difficult to implement and enforce.

The most popular suggestions for raising awareness of the policy were signs and posters; advertising and information on hospital correspondence. The most common suggestion to ensure people comply with the policy was to police the grounds. However, 87% of respondents thought there would be problems going completely smoke free. The most commonly cited were:

Smoking going “underground” leading to a fire risk Non-compliance with the ban Infringement of human rights/ personal choice Rise in aggression, abuse and increase in levels of stress Difficulties in enforcing and policing the ban

The most frequently suggested way to deal with potential problems of implementation was to have a designated area for smoking away from hospital entrances.

The views of patients, the public and staff did not vary considerably, however there were different issues raised in terms of implementation for patients, visitors and staff. Responses from key stakeholders – the University of

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Aberdeen, UNISON and mental health services – raise important issues that need to be considered.

There were high levels of awareness of NHS Grampian’s smoking cessation support service and, those that had used it, had found it useful.

The consultation has resulted in the expression of strong views in support of and in opposition to the proposals within the Tobacco Policy (2009), though many people suggested a middle ground.

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Some Respondent Views on the Draft (2009) Tobacco Policy

“It’s the way forward.....It will be a cultural shock but if bars and restaurants can do it, so can NHS Grampian.”

“...To take any satisfaction whatsoever from forcing staff, patients and visitors out into the freezing cold and/or rain and snow at a time when they are under extreme duress, is nothing short of inhumane. Shame on you for even contemplating this needlessly cruel and insensitive action, and all the more for trying to justify it on “health” grounds.”

“..how to deal with all the [implementation] problems must be resolved before this policy is put into practice. To do otherwise will only devalue the admirable ideology behind this policy.”

“NHS Grampian should accept that smoking is a perfectly legal choice that certain people choose to do. NHS Grampian cannot tell the public that they are not allowed to do something that is legal, i.e. smoking in the outdoors. NHS Grampian need to accept this, even if they do not agree with it. “

“I think your resources would be far better spent ensuring your staff did not wear uniforms to and from facilities in an effort to improve infection control.”

“......unless it is intended with the draconian and inhuman measures that would be necessary to enforce a total no smoking ban across all NHS Grampian sites, I think common sense suggests that there may have to be, at a minimum, some out of the way, un-advertised location on all sites where those smokers who are totally unable to control their dependency, may be permitted to indulge their habit without affecting others and without fear of heavy handed repercussions. Whilst [NHS Grampian] should undoubtedly endeavour always to encourage smokers to quit, it would be helpful if those sometimes strident, overly eager no smoking enthusiasts who surface from time to time, could themselves be encouraged to exert a modicum of self restraint and understanding. “

“For far too long now non-smokers, like myself, have to wade through a cloud of smoke at whichever door you pick to access or exit work. The organisation has not taken non-smokers rights on board, I have a right to work in a smoke free environment and second hand smoke is recognised as a serious health hazard.”

“[NHS Grampian] is simply trying to go beyond the bounds of its remit. You cannot issue a directive that tells anyone what they may or may not carry [ref. to tobacco products] – it is unlawful.”

“I do agree that [smokers] should be away from the public eye and the front of the hospital but I think to be able to smoke is a person’s own right and I think if you ban it completely on hospital grounds, that you will experience problems and add risk factors as people will always find somewhere to smoke.”

“...Treat NHS staff as valued human beings. By removing safe areas to smoke on site there will be more risk of people smoking all over the site in unsafe

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areas....if there is an area that is safe, well ventilated, with no risk of passive smoking to non-smokers, this would be far easier to manage and police and would be safer for all concerned.”

“.....you are not allowing smoking on the grounds (which includes private cars parked on site). You will not accept liability should these vehicles be damaged, so what right have you to stop people from smoking in their own vehicles?”

“I work in a close supervision, secure unit. It is a long term ward for [people] with severe challenging behaviours and learning disabilities. At present there is a [designated] smoking room in the ward and they are restricted to smoking times. It is not feasible or safe to escort these patients out of hospital grounds for a cigarette, 12 times a day.”

“Patients who smoke who have no opportunity to leave hospital will have nowhere left to smoke at all. This will include amputees and terminal cancer patients. What are staff to say to patients such as these if they come upon them smoking in the grounds of the hospital? What opportunity will palliative care patients in Roxburghe House have to smoke?”

“Could be seen as big brother but I think that it sends out right message.”

“[Problem with] inpatients who wish to continue smoking but are not well enough to leave the site...as a junior doctor, we are often put in the difficult position of having an unwell patient threatening to discharge if they are not allowed out.”

“I think that because smoking is a recognised addiction, people will find it very difficult to go for long spells without smoking in their breaks in a designated area. Staff often work 12 hours plus and the expectation to not permit smoking during this time will be very difficult........already staff morale within [NHS Grampian] is at an all time low. Having worked here for [over ten] years as a senior nurse this is very evident. Recent events such as the introduction of parking restrictions, staff grading has all had a negative impact on morale.” “I have heard there is a waiting list for people trying to access a stop smoking support group. If this is true, [NHS Grampian] could be accused of not actually supporting those trying to stop.”

“A small minority will complain their rights are not being met – but the rights of non-smokers have to be prioritised and smokers must feed their habit elsewhere.”

“Smokers are stubborn. They all believe their right to smoke outweighs everyone else’s right to a smoke free life.” “Staff have to leave the grounds for breaks, unsuitable when staff shortages occur – which happens daily.”

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“Exceptional circumstances should either be deleted from the policy or there should be a phasing out over the next few years. This is a very subjective clause...”

“Provide decent shelters and stop trying to be big brother! I am a non-smoker but couldn’t last all day without tea/coffee!”

“I feel that rather than have shelters dotted about here, there and everywhere, there should be one main shelter. Smokers from all areas could use this facility. Make sure it is away from windows, walkways etc. Non-smokers could walk a safe distance away from the shelter which allows them their smoke free zone.”

“Explain to non-cooperative smokers that if people are not allowed to smoke in pubs, restaurants etc, then they certainly should not be permitted to smoke in a health care environment.”

“Smoking certainly should not be promoted and NHS should continue to encourage and support people to stop. NHS have to remember that we live in a democratic society and not dictatorship, individual right to choose should be respected.”

“One major problem is the proposal to allow exclusions for people with mental health problems. This completely goes against principle of treating people with a mental health problem in the same way as others. In effect, it means smoking is endorsed by NHS Grampian at Cornhill and Ward 4, Dr Gray’s….”

“I think help should be offered to staff as the organisation is saying they cannot smoke and up until now they have been allowed to do so – it would be wrong to expect people to change habits overnight.”

“As an ex-smoker I do understand the difficulties this will impose on some people. I also believe that telling people they cannot smoke is the way to ensure non-compliance as it just gets smokers backs up and they do opposite. Encouraging the policy may be more effective long term than laying down hard and fast rules.”

“....NHS Grampian should have acted on this years ago. I feel that this policy is a very long time coming for fear of being unpopular with a section of the public. ....what a first impression, how can we reassure the public on hygiene standards on the inside when the entrances are like one big dirty ashtray on the outside. It is not a case of cleaning it up afterwards, it needs to stop happening!!!”

“It is good to be sensitive to the needs of the minority that smoke. However, similar sensitivity should be shown to those that don’t smoke and who are offended by smoking. For example, women and their partners leaving the maternity hospital following a miscarriage usually have to pass by smokers at the front door, some of whom may be pregnant.”

“We must push ahead. No watering down of this long overdue policy please.”

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“This total ban will create “picket lines” at the hospital gates.”

“As a smoker, I still support the move to have a smoke free site but I think consideration needs to be further given to how this will be policed. It is unfair to expect staff to politely remind visitors etc about the no smoking policy as the backlash that is currently experienced, certainly personally, when I have asked contractors, visitors etc to move to the smoking shelter in Woodend has been quite distressing.” “I’m glad NHS Grampian is moving in the right direction – albeit slowly and slightly apologetically.”

“As both a member of staff and recently a patient.., I cannot say how much I resent having to run the gauntlet of the smokers at the entrances to ARI. As a non smoking patient I also dislike being cared for by nursing and other staff whose uniforms and breath smell of smoke – especially when feeling sick...this policy cannot come soon enough!”

“NHS staff should not be allowed so called “comfort breaks” to feed their addiction. Non smoking staff have to cover for their colleagues while they disappear for their “comfort break”.”

“Smoking in staff accommodation is ridiculous. There is no consideration taken for other non smoking residents on corridors next to the smoking room. Smoke crosses the corridors and enters bedrooms ...”

“A good idea from a moral perspective but impossible to have full compliance. ....There is a limit to what we take accountability for in NHS – we have to wake up and accept we are not the masters of all we survey. “

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NHS Grampian Tobacco Policy (2009) Consultation Report

1. Introduction

The Tobacco Policy (2006) stated that “all NHS Grampian premises [should] become smoke free within a very few years” and that the provision of smoking areas was only an interim measure. The draft Tobacco Policy (2009) aims to move NHS Grampian to “smoke free” status throughout all grounds and premises by September 2009.

Between 3 February and 31 March 2009, a consultation was carried out to inform the implementation of the 2009 policy and this report outlines the consultation process and results.

The consultation questions focussed on: Suggestions to raise awareness of the revised policy Measures that could be used to help smokers follow the policy Potential problems in implementing the policy Views on the proposed ban Awareness of NHS Grampian’s smoking cessation service.

2. Consultation Methods

A range of methods were used to ensure all stakeholders, including patients, the public, staff, representative groups and partner organisations, had the opportunity to respond to the consultation. These methods are outlined below:

A covering letter, summary consultation paper (highlighting the main points of the revised policy) and a piloted questionnaire were distributed widely to approximately 500 external recipients (patient and public groups, local organisations and other interested parties) and 300 internal recipients (GP practices, hospital wards and clinics, pharmacies). The information was also put on the NHS Grampian website.

A media release was issued, outlining the draft policy, launching the consultation and signposting people to the online questionnaire.

An image of a “stubbed out cigarette” (chosen by staff and members of the public) was used on the Internet and Intranet banners, on a poster and on staff canteen “table-toppers”, signposting people to the consultation.

A dedicated telephone answer phone was set up for people to request copies of the consultation documents. A “smoke-free” email address for people to send in their questionnaires and comments was also established.

Pictorial versions of the consultation documents were produced and the documents were also translated into Polish. Other alternative formats were available on request.

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Interviews were carried out with staff, patients and visitors on 7 NHS Grampian sites. A group interview was undertaken with the Learning Disability Group of Aberdeen

The NHS Grampian summary consultation paper gave a link to the national consultation about achieving smoke free mental health services in Scotland which was also being conducted at the same time.

Internal communication methods were used to inform and involve staff, including articles in the electronic Staff Weekly Bulletin and Information Update; the staff newspaper, "UpFront", and Team Brief.

Direct contact was made with staff partnership groups.

The questionnaire and supporting information were available via the Intranet, and paper copies sent to staff groups known to have Intranet access difficulties.

RESULTS

3. Number of Respondents

In total, 483 responses were received within the consultation period. These consisted of:

371 completed questionnaires (electronic and postal) 70 interviews & 1 group interview 41 responses by email or letter

77% (n=284) of questionnaires were received by post and 23% (87) were received by email. Although a higher percentage of staff (29%) sent in the questionnaire electronically compared to the public (16%), post was still the most popular method used by both groups.

4. Respondent Profile

The questionnaire and interview schedule asked for some basic demographic information and this is detailed below. For some questions, total percentages do not add up to 100, due to a small number of incomplete responses.

Out of 441 completed questionnaires and interviews, 58% (254) were from staff and 42% (184) were from patients or the public.

67% (297) of respondents were female and 28% (124) were male.

74% (325) stated they did not smoke and 22% (95) said they did smoke.

19% (84) of respondents were aged 34 and under; 48% (213) of respondents were aged between 35-54; 28% (123) were aged 55 and over.

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Staff that completed the questionnaire were asked to state the site they were based at. 41% (87) were at Foresterhill; 13% (28) Royal Cornhill Hospital; 11% (23) in the community; 10% (21) Woodend; 8% (16) Dr Gray’s Hospital; 8% (16) in community hospitals; 5% (11) Summerfield House; 0.5% (1) Roxburghe House.

5. Views on Smoke-free Environment

Respondents were asked for their views on the introduction of a smoke-free environment on all NHS Grampian premises and grounds. 46% (201) said they completely agreed; 24% (108) agreed to some extent; 28% (125) did not agree.

There was some difference between staff and public views on the proposed ban, with a higher percentage of staff disagreeing with the proposal compared to the public (32% and 23% respectively). However, there was a slightly higher percentage of smokers amongst staff respondents (23%) compared to the patient/ public respondents (20%).

The main reasons given in support of the policy were the dislike of “running the gauntlet” of people smoking at hospital entrances; the smell of smoke entering into clinical areas from people smoking outside; having to treat the preventable illnesses caused by smoking; the accumulation of cigarette ends littering the site, particularly at entrance areas; the smell of smoke when being cared for by staff who have recently had a cigarette; hygiene and infection control concerns if staff are smoking in uniform; and the need for NHS Grampian, as a health organisation, to lead by example.

The main reasons given in opposition to the policy were it was “heavy handed” and “draconian”; showed a lack of compassion for patients and visitors at times of stress; raised safety concerns; would have an impact on staff morale; removed freedom of choice and would be very difficult to implement and enforce (see Section 8).

6. Raising Awareness of a Smoke-free Environment

Respondents were asked for ways to let patients, visitors and staff know that they would not be allowed to smoke on NHS Grampian premises and grounds.

The majority of respondents suggested using signs and posters throughout hospital buildings, at all entrances to hospital and grounds, in car parks and in GP surgeries, pharmacies and other health premises.

Signs should be prominent, clear, bright and easy to read. Signs should be in other formats and languages and some at wheelchair height. A small number suggested including graphic images on the posters of the physical effects of smoking.

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The second most popular group of suggestions for raising awareness was using advertising, including television, radio, local press, magazines and buses. There were some references to cost and an understanding that widespread advertising using television would be expensive.

The third most popular suggestion was to include information in admission letters and appointment cards to inform patients about the policy before coming to hospital. Another popular suggestion was a leaflet about the policy made available to those coming into hospital buildings, sent out with appointment information and available in GP practices, information points etc.

Other suggestions included: Removal of smoking shelters and bins Smoking “wardens” Face to face/word of mouth Recorded messages at hospital entrances NHS Grampian website, Intranet and staff e-mails Information on payslips Logos/information on all correspondence Information in recruitment and induction materials Adverts on bus/ parking tickets, tea/coffee cups, café menus Information screens Answer phone/helpline messages As stated in policy

7. Compliance with Smoke-free Environment

Respondents were asked what NHS Grampian could do to ensure people do not smoke on its premises and grounds. The most common suggestion was to police the grounds – wardens employed specifically to monitor the grounds (especially areas where smokers are known to go) and to advise anyone who is found smoking, of the policy.

Another popular suggestion was to discipline anyone found to be smoking, especially staff, and some suggested fining “regular offenders” or having “on the spot” fines for anyone caught smoking.

Making people aware of the policy through effective communication, education and training were also common suggestions, as well as clear signage throughout hospital grounds.

Other suggestions included: Removal of all smoking shelters and bins Staff leading by example The policy actively being enforced by all staff, including managers Use of CCTV and webcams/talking signs Information and support to stop smoking Smoke detectors and sprinklers Clear boundaries so people know where grounds start/end Incentives/promotion of healthy lifestyle Information sessions for staff

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8. Identifying and Overcoming Problems “Going Smoke-Free”

Respondents were asked if they thought there would be any problems changing to a smoke-free environment. 87% (383) stated that they thought there would be problems, with only 10% (42) thinking there would be no problems. There was little difference between staff and public views in relation to this question.

When asked to identify what these problems might be, a number of issues were quoted. The main issue was that people felt smokers would be driven to smoke “underground”, in areas where they should not be smoking. This would increase the risk of fire in hospital buildings which, in turn, could put patients and staff at risk.

Many also said that people will ignore the policy, not adhere to the new rules and will smoke anyway. Some suggested that people do not care what the rules are; whilst others said people are too set in their ways.

There were also a number of people who said that smokers will feel that this is against their human rights and their right to have a choice.

Many identified a rise in aggression and abuse as a possible problem, arising from the implementation of the policy, particularly from patients towards staff.

Many also suggested that this could cause added stress to patients and visitors, as well as staff.

Implementation, enforcement and policing of the policy were also identified as likely problems.

There were a number of other possible problems identified for patients, visitors and staff, including:

Patients refusing admission, discharging themselves or putting themselves at risk

Terminally ill or long term inpatients being denied something they enjoy Difficulty distinguishing between patients/visitors flouting the policy and

those covered by exceptional circumstances – likely to be subjective Patients and visitors knowing that the ban cannot be enforced by law Non-compliance with request that inpatients and visitors do not take

tobacco products into hospital Non-compliance with not smoking in cars on site

Staff and patient safety and security, when off site to smoke, particularly at night

Staff who smoke taking extended breaks Staff not having time to escort patients off site to smoke Impact on staff absence, morale, recruitment, goodwill working Unscheduled home visits by staff to the home of a smoker

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People having difficulty in/ not wanting to give up smoking Waiting list for smoking cessation – support not available Local residents unhappy when staff and patients smoke on streets Potential increase in calls for fire brigade to respond to Negative media coverage for NHS Grampian

When asked to suggest ways to deal with the problems of implementation, the most common suggestion was to have designated/ safe area (s) for smoking, away from hospital entrances and to leave the current policy in place.

Many other suggestions made are already outlined in section 6 and 7. Other suggestions included:

Education and staff training Zero tolerance approach Staff to sign a “no smoking” agreement Disciplinary process for staff Clearly defined “exceptional circumstances” Free Nicotine Replacement Therapy Staged implementation Not allowing patients to leave the ward

9. Other Comments on the Policy

A number of respondents questioned the legality of some of the proposals within the draft policy. A response from NHS Grampian’s legal adviser includes a number of points which would need to be given serious consideration if the tobacco policy is implemented. One of the points raised is the reference to “grounds” - this is not covered under the Smoking, Health and Social Care (Scotland) Act 2005 and difficulties may be encountered in enforcing action taken against a breach of the policy.

A number of respondents sent in detailed comments on some of the wording contained in the draft policy, which would need to be taken into account before the policy is implemented. Some of the comments concern conflicting or ambiguous statements or gaps within the draft policy. Many people did not realise the policy has exemptions within the “exceptional circumstances” section and so this may need to be made more explicit.

Some respondents commented on the resource implications of fully implementing the policy. Examples include “policing” the smoking ban and the cost of re-printing information booklets/leaflets with updated information. There was also a concern that if the policy is mentioned in all NHS Grampian correspondence and literature, this would set a precedent, and may appear that NHS Grampian places a higher value on the Tobacco Policy over other policies.

A few respondents commented on the consultation itself, feeling that it was a “done deal” and NHS Grampian was conducting a “paper exercise”. A couple of respondents felt the questionnaire was biased and did not allow the opportunity for people to disagree with the policy. It is also worth noting that there was extensive media coverage and, in some cases, inaccuracies in the

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coverage (e.g. fines for non-compliance) of the policy and consultation, which some respondents referred to.

Due to the potential for communication difficulties if people with learning disabilities are approached about smoking on hospital grounds, NHS Grampian’s Equality and Diversity Manager facilitated a discussion with the Learning Disability Group of Aberdeen using pictorial versions of the consultation documents to gather their views. The group supported the proposed ban on smoking within premises and grounds. They felt smoking causes many diseases and people should be given as much help as they need to give up. They also recognised that many people did not want to give up and could not be persuaded. When the policy is implemented, the Group wanted a booklet to be produced in pictorial format explaining the policy and disseminated widely. The group requested that signs should also be pictorial and at eye level height for wheel chair users. The group felt the only way to enforce the ban was to have someone policing it full time.

10. RESPONSES FROM KEY STAKEHOLDER GROUPS

10.1 University of Aberdeen

A letter sent on 27 March 2009, to Richard Carey, NHS Grampian Chief Executive, responding to the consultation, states that the consultation documents were considered and discussed at the University Management Group and consensus was reached. The letter states that:

“In summary, while we support the aims of the paper to improve the health of people in Grampian and to decrease the prevalence of both active and passive smoking exposure we felt that the paper has gone too far in its recommendations which basically are to restrict smoking on the Foresterhill site.

As joint owners of the Foresterhill site we feel it is important to consider the University’s view and to ensure that while encouraging good practice around tobacco use that we are seen to be taking a proportionate and non-discriminatory approach......

We believe there should be a lengthy glidepath into any such approach and hence it may be that you wish to reduce the number of areas within the site where smoking can take place.

…the University does not support the total exclusion of tobacco use, particularly of smoking cigarettes, within the jointly owned site and would be happy to have further discussions with you to consider a policy that could be jointly upheld.”

10.2 UNISON

The response from UNISON states that:

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“UNISON Grampian Health fully supports the current ban on smoking in enclosed spaces on NHS Grampian premises and supports the action that the employer is taking to help people give up smoking. However, there is a widespread view that the current policy of permitting people only to smoke in designated smoking shelters is not being enforced properly. Therefore it is unrealistic to expect fair and consistent enforcement of a more stringent restriction.

UNISON Grampian Health believes that NHS Grampian should refocus its efforts on properly enforcing the current tobacco policy which restricts smoking to designated shelters only and continues to provide advice and practical support to those staff who wish to give up smoking.”

The response then states the reasons why UNISON does not support the proposed extension of the ban. Many of these reasons are similar to concerns raised by other respondents.

UNISON also included the results of their survey as part of their response to the consultation. However, although this was useful feedback, this did not state the number of members who completed the UNISON survey nor how this survey was disseminated.

10.3 Mental Health Services

A number of respondents raised issues specifically about the impact of the proposed smoking ban on patients and staff within mental health services – these were mainly from staff who work in the service but also from others who had an interest.

The main concerns were: For patients who are detained and who are not allowed to leave the

ward or hospital grounds unescorted. This includes mentally disordered offenders and people with both challenging behaviour and a learning disability. There were concerns around staff and patient safety and staff capacity.

The potential for increased aggression and agitation, with the view that patients sometimes use cigarettes as a coping mechanism.

The lack of understanding or forgetting about the ban amongst some patient groups such as those with short term memory loss.

When people are admitted to hospital at a time of crisis is the wrong time to enforce abstinence or place further restrictions.

The “Exceptional Circumstances” section was confusing because it would cover all of mental health services. One person felt that having exceptional circumstances went against the aim of treating those with mental illness in the same manner as everyone else.

Staff who smoke would take even longer to have a cigarette break if they had to leave the grounds.

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Other staff welcomed the policy because it would reduce their exposure to second hand smoke and would demonstrate leadership from a health organisation.

As well as the comments expressed during the local consultation, other activities will also inform future developments within mental health services. These are the recent national consultation about achieving smoke free mental health services in Scotland; positive local pilot work (for example, some wards, in partnership with patients, closing their designated smoking rooms at certain times of the day) and the successful provision and uptake of smoking cessation support for patients and staff at Royal Cornhill Hospital.

11. Awareness & Views on Smoking Cessation Support

The consultation provided an opportunity to ask respondents if they were aware of the support provided by NHS Grampian for people who wish to stop smoking. 89% (393) of respondents said they were aware of the support, whilst only 8% (37) said they did not know. Levels of awareness were only slightly higher amongst staff compared to the public.

Respondents who smoke were asked if they would consider using the help and support available if they wanted to stop smoking. 45% of smokers said they would, but 55% of smokers said they would not.

When asked for comments about the support available, the view expressed by most was that support should be offered to people when they choose to stop smoking and seek help. Many were aware of all the help but did not want to stop smoking. The proposed smoking ban was also felt by some to be taking away that freedom of choice and that enforcement of the policy would not make people stop smoking.

Most people who said they had used the smoking cessation service had found it very useful. Few people reported that they had used the service and were disappointed with it.

Suggestions made about the smoking cessation support service included: Promote the help available Make the help available in easily accessible areas e.g. town centre Physical presence in hospital to promote services Quicker appointments - waiting lists are too long Support available over the telephone Drop in facility Patients with learning disability will not be able to engage with the

smoking cessation classes It needs to fit in with work schedule Community pharmacy NRT scheme Some supported free classes, others felt there should be a charge Make help available in smoking room Provide support whilst people are in hospital Help and support should target younger people

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Some respondents commented specifically on nicotine replacement therapy, including low success rate and subsequent waste of time and resource and adverse effects.

12. Conclusion

The proposal to introduce a smoke-free environment in all NHS Grampian premises and grounds, contained within the draft Tobacco Policy (2009), has provoked much staff and public interest and media coverage.

There was a large number of responses to the consultation and these could be described as “polarised” with those who fully support the proposed ban and those completely against it. However, a number of respondents, including partner organisations, suggested “a middle ground”, with some commenting on the fact that the current, less stringent, policy is not adhered to.

Although, those who said they did not agree with the ban, made up only 28% of respondents, 87% of respondents stated they felt there would be problems implementing the ban and articulated wide-ranging concerns.

Encouragingly, most respondents were aware of the smoking cessation support provided by NHS Grampian and, those that had used it, commented positively about their experiences. Many people suggested that efforts are focussed on enforcing the current policy and enhancing and promoting smoking cessation support.

Prepared by:

Laura Dodds & Andrea GrayPublic Involvement OfficersCorporate Communications TeamNHS Grampian

25 May 2009

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