Fresh welcomes NICE guidance for smoking in secondary care
Fresh has welcomed new NICE guidance for NHS hospitals and clinics to go completely smoke free to help all patients to quit.
NICE, the health and social care guidance body, says in new guidance that all NHS hospitals and clinics should become completely smoke-free to help all patients who smoke, including those receiving mental health treatment, to stop smoking whilst they receive care, and preferably help them to stop for good.
Public health guidance published today (Weds 27 November) by the National Institute for Health and Care Excellence sets out clearly how to help people using acute, maternity and mental health services to stop smoking.
The new guidance makes a range of recommendations on effective actions including promoting cessation in advance of planned admissions, immediate provision of smoking cessation drugs and behavioural support after admission to hospital, and making all NHS secondary care settings completely smoke-free.
A huge toll of disease is caused by smoking – including heart disease, cancers and respiratory diseases – costing the NHS and wider society billions of pounds each year. Smoking is responsible for over 460,000 hospital admissions in England each year, and is the biggest avoidable cause of inequalities in health. Smoking in pregnancy causes up to 5000 miscarriages and stillbirths each year, and increases the risk of premature birth and low birth weight. In children, second-hand smoke causes cot death, middle ear disease and exacerbation of asthma. Smoking is especially common among people with mental health problems: whilst 1 in 5 of the general population smokes, the figure rises to 1 in 3 among people with longstanding mental illness and rockets to 70% of people in psychiatric units.
Ailsa Rutter, Director of Fresh, said: “Quitting smoking before surgery or during a hospital stay can speed up recovery, reduce heart and lung related complications, speed up wound healing times and ultimately reduce the amount of time spent in hospital.
“We need to ensure smokers are supported to quit and that is why we are hosting an event on the role secondary care can play in reducing smoking in December.”
Commenting on the new guidance, Professor Mike Kelly, Director of the NICE Centre for Public Health said: “Smoking is the most important health problem facing the NHS. It’s the leading cause of premature death in England – nearly 80,000 lives are lost each year due to smoking. Treating smoking-related illnesses costs the NHS around £2.7bn each year, and costs society an estimated £13.7bn a year. So it’s a no brainer, we must deal with the problems caused by smoking.
“NHS hospitals and staff have a duty of care to protect the health of people who use or work in their services. The guidance is clear that this responsibility should cover routinely giving stop smoking support to all patients and staff who smoke, as part of providing advice on how to improve health. Importantly, this includes mental health patients who too often don’t get help to stop smoking when attending clinics or hospitals, despite their smoking rate being over 50% higher than the general population.
“We need to end the terrible spectacle of people on drips in hospital gowns smoking outside hospital entrances. This guidance can help make that contradiction a thing of the past by supporting hospital smokefree policies to make NHS secondary care an exemplar for promoting healthy behaviour.”
The guidance is for all healthcare professionals in acute, maternity and mental health settings, with some recommendations also for staff in primary care. The recommendations include:
• Provide everyone with verbal and written information about the hospital’s smokefree policy before their appointment, procedure or hospital stay, including short and long-term benefits of stopping smoking and details of the support available to help them stop smoking before, during and after their stay or visit
• Provide intensive support for people using secondary care services, including discussing past and current smoking behaviour and developing a personal stop smoking plan. Provide immediate access to licensed nicotine containing products (for example, nicotine replacement therapy patches or gum) or other pharmacotherapies. Alert the person’s healthcare providers or prescribers to changes in smoking behaviour as other drug doses may need adjusting
• Provide relatives, carers, friends and other visitors with information about the risks of smoking and secondhand smoke. This should include advice not to smoke near the patient, pregnant woman, mother or child, and not in the house or car. Offer people who want to stop or reduce smoking a referral to a stop smoking service. Explain to visitors that smoking is not allowed on the premises. Direct people to places on site or in the hospital where they can buy nicotine replacement therapies
• For people using acute, maternity and mental health services, as part of the intensive stop smoking support provided, offer measurements of exhaled carbon monoxide (CO) during each contact, to provide feedback on progress and increase their motivation to stop completely
• Assign a clinical or medical director to lead on stop smoking support and the smokefree policy for the organisation. Promote stop smoking support for patients and staff and prohibit staff-facilitated smoking breaks and the sale of tobacco products in secondary care settings. Ensure smokefree plans include the removal of shelters or other designated outdoor smoking areas, and that staff, contractor or volunteer contracts do not allow smoking during working hours or when in uniform or on hospital business.
Professor John Britton, Chair of the NICE guidance development group and Director, UK Centre for Tobacco and Alcohol Studies, University of Nottingham said: “As a respiratory doctor, I see the victims of illness and death caused by smoking every working day – and smoking is a major cause of people coming into hospital in the first place. That’s why this new guidance is important – stopping smoking is essential to current and future health and hospitals have a vital role in helping smokers to quit. Doctors, nurses and other health staff are accustomed to detecting and treating other life-threatening problems such as diabetes and high blood pressure, but helping people to stop smoking is one of the most cost-effective things that the medical profession can do. We want to see a change of culture in NHS secondary care settings, to make smoking history”.
Angela Lomax, a patient who stopped smoking with help from her local hospital, said: “I’d smoked for 40 years when I collapsed with fluid on my lung, and was admitted to the Royal Bolton Hospital as an emergency. I was in hospital for two weeks, and the nurses gave me patches so that I wouldn’t have problems with cravings. I didn’t smoke the whole time I was in hospital but I did start again when I was discharged. But soon after I got home, I had a call from Helen, the Stop Smoking Advisor. I started seeing her every week, and with her help I gave up for good in July this year about two months after I’d first had support in hospital. I feel so much healthier now. I never would have given up without the help that I’ve had, so I hope that now other patients will also get the chance to quit smoking for good.”
People are already required by law not to smoke inside enclosed or mostly enclosed buildings, but in mental health units patients are often allowed to smoke in the hospital grounds. Most of the reduction in life expectancy among people with serious mental illness is attributable to smoking, and smoking increases the dose requirements of psychotropic drugs and therefore the costs, by an estimated £40 million per year across the UK. Research shows that people with mental health problems who smoke want to give up as much as any other smoker, but they are less likely to be offered help to quit, and smokefree policies aren’t well supported by mental health staff.
Welcoming the NICE guidance, Professor Sue Bailey OBE, President of the Royal College of Psychiatrists, said: “There is a common but mistaken belief among some mental health professionals that it’s alright for patients in their care to smoke. This is wrong. Patients with mental health problems are far more likely to smoke than the general population, they suffer disproportionately higher rates of physical illnesses, and they die earlier. It’s a disgrace that this section of our NHS patient population is left to suffer the consequences of smoking. This means that mental health patients should be given help to stop smoking when they are at outpatients’ clinics or admitted to hospital.
“Providing treatment for a patient’s mental health needs, especially in a crisis situation, is a priority, but there will be other opportunities to discuss stop smoking support as an essential part of the duty of care for that patient. I hope that mental health professionals across the NHS will use this new NICE guidance to help improve their patients’ health by offering stop smoking support.”
The guidance, ‘Smoking cessation: acute, maternity and mental health services’, is available at www.nice.org.uk/PH48 .