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Frequently Asked Questions about going smokefree (for patients and service users)

Q. What does ‘smokefree’ mean, and when is LPT going smokefree?

Being smokefree means that patients, carers, staff and other visitors will not be allowed to smoke on any LPT premises. This includes our buildings and grounds, as well as vehicles within those grounds. Anyone wishing to smoke will need to leave Trust premises.

Support will be provided for patients in our care to help them either abstain from smoking during their stay or to try and stop smoking permanently.

Q. Why is LPT going smokefree?

As a health and wellbeing Trust, we have a responsibility to create healthy environments for our patients, service users and staff. A core part of our service is in caring for people with mental health problems, a group who are much more likely to smoke, and to smoke more heavily, than the general population leading to poorer physical health and lower life expectancy. It is important that this inequality is addressed.

Our decision to go smokefree is in line with the National Institute for Health and Care Excellence (NICE 2013) guidelines, which state that smoking should not be allowed on any hospital sites, including mental health hospitals.

Q. Can LPT legally enforce being smokefree? What about my human rights?

In July 2007, the government introduced legislation in England banning smoking in workplaces and enclosed public spaces, and LPT’s decision to go smoke-free is covered by that legislation. In addition, National Institute for Health and Care Excellence (NICE 2013) guidance recommends that smoking is banned on hospital sites.

After Rampton Hospital in Nottinghamshire went smoke-free, the argument about infringement of a service user’s human rights was legally tested in the Court of Appeal in 2008. The court ruled that a hospital is not the same as a home environment and should support the promotion of health and wellbeing. Patients can therefore legally be prevented from smoking for health and security reasons.

Q. What is your policy on being smokefree? How will you monitor its effectiveness?

Our smokefree policy is due for publication at the end of March 2016. The policy will be reviewed regularly during 2016 and beyond as it is enforced across our Trust. We have already consulted with patients on our mental health wards as well as with staff, and will continue to work with patients, carers, service users and staff to monitor the effectiveness of the policy implementation and to ensure that any issues are addressed in a timely manner.

Q. What support will there be for patients who smoke?

Denying a smoker a nicotine substitute is like denying pain relief to someone in pain, so clearly it is very important that the appropriate support is in place to enable smokers to abstain from smoking while on our premises.

Department of Health guidance recommends a combination of intensive behavioural and psychological support alongside medication to minimise nicotine withdrawal symptoms and help with cravings.

Following assessment, smokers will be offered nicotine replacement therapy (NRT) and behavioural support. Those who wish to use the opportunity of a hospital stay to try and give up smoking will be referred to a trained stop smoking advisor.

Clinical experience shows that using e-cigarettes (vaping) can be just as effective as NRT for stopping smoking, and our advisors will help patients to explore the option of vaping if the patients so wish.

Q. What forms of nicotine replacement therapy (NRT) are available?

A range of licensed stop smoking medications are available on prescription. NRT medicines work most effectively alongside behavioural and psychological support from a trained stop smoking advisor, and this support will be made available to patients. Our advisors will also help patients make choices about which particular NRT product is most appropriate for them.

Q. Will e-cigarettes be available on prescription? How can I buy e-cigarettes?

Currently e-cigarettes have not been given pharmaceutical regulation (although some products are likely to be granted this during 2016), and consequently are not available on prescription, However, there are many licensed nicotine replacement therapy (NRT) medications which are available on prescription – see question above.

Service users wishing to use e-cigarettes (vape) on LPT property will need to use an approved e-cigarette. These are available to purchase via an approved supplier who visits wards at designated times, advertised locally. Wards within our mental health service for older people will have a separate supply that can be made available to inpatients where appropriate. We are also currently exploring the possibility of installing e-cigarette vending machines in some areas.

Q. Why are you promoting the use of e-cigarettes? Are they really safe?

Guidance from Public Health England suggests that e-cigarettes are likely to be at least 95% safer than normal cigarettes, including from an environmental point of view since they don’t release harmful chemicals like carbon monoxide into the air. Clinical experience shows that using e-cigarettes (vaping) can be just as effective as nicotine replacement therapy for stopping smoking, and are fast becoming the most popular choice among people who want to quit.

Q. Will e-cigarettes be allowed on wards and on LPT premises?

E-cigarettes will be available to service users to purchase from an approved supplier who has volunteer status at our Trust. The times when he will be visiting wards will be clearly signposted locally. In addition, we are exploring the use of specially-designed e-cigarette vending machines on wards.

Use of e-cigarettes (vaping) will be allowed in designated areas within our grounds and potentially within designated areas on wards. These areas will be agreed locally to reflect the needs of specific patient groups.

Q. Can I bring in e-cigarettes from home and charge them on the ward?

Patients will not be allowed to bring in their own e-cigarettes from home. The only e-cigarettes which will be available are those which have been cleared as safe for use on our wards by the health and safety team. Charging a range of different devices in rooms or even in dedicated charging cabinets poses a fire or electrical safety risk, and is therefore not allowed.

Q. How will you ensure that people don’t smoke on LPT premises?

Prior to planned admissions to hospital, patients will be advised that LPT is smokefree and consequently smoking is not permitted in the hospital or grounds. An individual’s smoking status will be logged on our clinical systems so they will be offered support to either temporarily refrain from smoking or to attempt to quit. This support will include nicotine replacement therapy (NRT) alongside behavioural and psychological support from trained stop smoking advisors. Patients and carers will be asked not to bring tobacco, cigarettes, lighters or matches with them to hospital.

For unplanned admissions, patients will not be allowed to keep tobacco, cigarettes, lighters or matches with them. If the patient arrives with a carer or relative, they will be asked to take the prohibited items home. If the patient is unaccompanied, our staff will store the items for them until they are discharged.

The level of support provided to patients who are abstaining from smoking will be constantly monitored as part of that individual’s package of care.

Patients in community settings will be informed about our smokefree policy and offered referrals to stop smoking service where appropriate.

We want to develop a culture where smoking is viewed as unacceptable across our sites, and for this to be respected. In situations where an individual is breaching the smoke-free policy, that person may be approached by a member of staff who will remind them of our smoke-free status and signpost them to the appropriate smoking cessation support.

Q. What are you doing to inform people that LPT is going smokefree?

Full signage to indicate that our Trust is smoke-free will be displayed as the policy is implemented in full. However, patient information leaflets, videos and posters will be made available as the policy begins to be rolled out across our Trust. Our policy and supporting materials will also be clearly signposted on our website.

All the information materials will explain what it means for LPT to be smoke-free and why this is important to us as a health and wellbeing Trust.

We are working closely with the Leicestershire Stop Smoking service in implementing the policy, and smoking cessation advisors are already visiting our wards and talking to patients and staff, identifying potential issues and answering questions.

We will be providing tailored information to staff (including new members of staff at induction), stakeholders (such as partner organisations and commissioners) and local media about our move to become smoke-free by the end of 2016.

Q. Will the move to being smokefree mean increased incidents on wards?

Understandably, this is an important concern. However, it is reassuring to note that other Trusts providing mental health services which have gone smokefree have experienced no significant rise in aggression. Partial smoking bans – where people can smoke in certain places of at certain times – can be more frustrating for some patients and can lead to more conflict due to inconsistencies.

We will ensure that patients and service users are made aware of the expectations around our smoke-free policy, as well as informed about the support available to them, from the moment they are admitted to hospital or access our services.

Q. Will there be exemptions, for example for patients in palliative care or those suffering severe dementia?

We have taken advice from a senior clinician in an end-of-life unit where this dilemma has already been tackled. He said they had no exemptions to their smoke-free policy, partly because end-of-life care is a uniquely difficult period to define. He suggested that for people with reduced capacity, all kinds of daily living activities need sensitive management, and that there is no reason to single out smoking as an activity that is exempted. He advised that the compassionate and thorough management of nicotine hunger, using nicotine replacement therapy (and in LPT’s case, e-cigarettes) should be the only solution to this dilemma.

Q. Where can I get more information?

If you have further questions, please email feedback@leicspart.nhs.uk.

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