NHS Lothian said it would not be following the example of other health boards such as NHS Greater Glasgow and Clyde by employing enforcers from Wednesday.
However, it admitted that making sure hospital grounds remain smoke-free would be a difficult task.
As our pictures today reveal, no smoking signs at the Edinburgh Royal Infirmary are routinely being ignored, by staff as well as patients.
Taken last Wednesday, they show a number of uniformed NHS employees – including paramedics and emergency staff – openly puffing away in front of signs clearly stating that smoking is banned.
A renewed crackdown by the Scottish Government will see all hospitals declared smoke-free from Wednesday, with smokers even banned from lighting up inside their own vehicles within NHS Lothian car parks.
E-cigarettes, however, will still be allowed.
A spokeswoman for NHS Lothian said the health board had no plans to routinely enforce the rules and would only ask staff to approach those breaking them “if they felt comfortable doing so”.
She said: “We are a health board, so it is only right that we prevent people from doing something that not only harms them but others around them.
“At the end of the day, it’s a personal choice whether somebody follows the rules or not. It’s our job to raise awareness as to what the rules are.
“The health risks associated with second-hand smoke are well known. We are relying on people taking a bit of responsibility for this themselves. It’s an attitude change and we know it’s going to take time.”
In recent years, the health board has spent £600,000 cleaning up discarded cigarette butts at the ERI. Complaints have also been made about smoke wafting into wards as staff and visitors stand smoking outside hospital doors.
Professor Alison McCallum, director of public health and health policy at NHS Lothian, admitted introducing the new policy would be challenging.
But she added: “We are confident that the majority of people will understand that as a health organisation, it is right for us to remove smoking from our sites and we will respect the health of others by following the new rules.”
Unison’s Davie Forbes insisted it was crucial NHS staff members were not expected to enforce the regulations themselves. He said: “How enforceable it’s going to be is anybody’s guess. The reality is our members will not be required to go up to people and demand they put their cigarette out.
“We will not accept staff being required to do it.
“It’s government policy to have a smoking ban in hospital grounds. One of the things that we have negotiated with the employers – and I think we’re the only health board in Scotland to do so – is we have agreed with the health board that staff can use e-cigarettes.
“I think that’s actually quite a proportionate response from NHS Lothian, to allow the smoking of e-cigarettes in the grounds. If you want to cut down on the amount of people smoking around hospitals then that’s a sensible halfway ground.”
He added: “If areas close to the hospital have been marked as ‘no smoking’ areas, then people are being a wee bit thrawn – and you could argue stupid and a wee bit selfish – by smoking there.
“But there should be a proportionate bit of common sense in the policing of that.”
Last week health bosses said staff were being offered help to quit cigarettes through the NHS Lothian stop-smoking service. Employees who don’t want to give up are being encouraged to use Nicotine Replacement Therapy – including patches, gum and nasal sprays – to manage any nicotine withdrawal symptoms while at work.
Jim Eadie, SNP MSP for Lothian, said it would take time for patients and staff to get used to the rules.
He said: “The first thing to say is that the ban on smoking in hospital grounds is absolutely the right way to go. I fully support the ban. It’s not right for either visitors or patients to have to walk through a smoky environment.
“Any new change takes time to bed down, but I think this is the right thing to do. The implementation of it has to be proportionate and supportive of staff, rather than taking a punitive approach.
“If there are staff flouting the ban then that is for the NHS to deal with in an appropriate and proportionate way. NHS staff are human like anyone else.
“It’s a very stressful job, and one of the ways that people deal with that is by smoking – but it is no longer appropriate to smoke in hospital grounds.
“I understand why people smoke, but it should be about trying to support them in quitting rather than coming down on them in a heavy-handed way. But, ultimately, if people are flouting the rules then that has to be dealt with.”
Sheila Duffy, chief executive of health charity ASH Scotland, said: “The policy of smoke-free hospital grounds sends a message that tobacco is an enemy of good health. Hospitals see so much misery caused by smoking and are rightly keen to discourage the use of tobacco. We realise it’s not always easy to monitor smoking in these locations or to take action. People need advice and support to manage their tobacco use.
“Wardens have had a marked impact on reducing the number of people smoking in hospital grounds. They are on hand to give advice and support about quitting tobacco as well as to remind people of the policy over smoke-free hospital grounds.
“There may be other steps that could be considered. Audio messages, eye-catching signage and markings on the ground can also help to alert patients, visitors and staff to this vital health policy.”
Hospitals to be smokeless zones
AS part of the Scottish Government’s tobacco control strategy, all NHS boards must make their entire hospital grounds smoke-free by Wednesday.
Many health authorities across Scotland have already outlawed smoking in the grounds of NHS buildings, but staff and patients at hospitals across the Lothians were previously allowed to smoke in designated areas.
But the government revealed no specific resources have been allocated to help health boards enforce the ban when it comes into play on April 1, sparking fears the prohibition will prove toothless.
Some health authorities, such as NHS Greater Glasgow and Clyde, employ smoking wardens to try to prevent staff and visitors from flouting the rules – but this approach has been ruled out by Lothian health chiefs.
And earlier this year it was revealed NHS Lothian was the only health board to allow e-cigarettes to be exempt from the ruling, provided they are used in designated outdoor areas.
Parked cars covered by policy
Earlier this year it was revealed smokers would even be banned from lighting up in their own vehicles within NHS Lothian car parks after the new “smoke-free” rules came into effect from April 1.
As part of the renewed government crackdown, visitors to hospital grounds throughout Scotland will be asked to stub it out if caught smoking in a car – even if they have the windows closed.
NHS Lothian was among the first to confirm the total ban would extend to private vehicles in hospital car parks, in a move that was hailed by health chiefs but slammed by Tory politicians who feared resources would be taken away from frontline services to enforce it.
Scottish Conservative health spokesman Jackson Carlaw insisted patients would resent seeing resources diverted away from emergency services in order to “target people smoking in their own private space”.
He said: “If only NHS boards were as concerned about hospital food as they were the public’s smoking habits. Many doctors, nurses and other healthcare workers continue to smoke – perhaps the NHS should focus on addressing their habits before worrying about the wider public.”
Simon Clark, director of pro-smoking group Forest, added: “It’s unbelievable that they would try to enforce a ban in private vehicles. It’s not harming anyone else. Hospitals can be very stressful places, not just for staff but for visitors.”