Consensus rather than bans is key

None of us wants to see smoking outside hospitals but we must have support of local communities to make it work, writes Sheila Duffy

Working to stop smoking outside hospitals must involve debate with local communities. Picture: Ian Georgeson

We are now seeing the start of an initiative that aims to put an end to smoking in all of Scotland’s hospital grounds.

The ban across NHS estates begins and is another step in the nation’s drive to achieve a tobacco-free generation in 20 years’ time.

Tobacco use is the enemy of good health and few people want to see smoking around a hospital building. Stubbing it out can help patients who are trying to quit, and help protect children and non-smokers from second-hand smoke exposure.

The smoke-free grounds initiative is NHS policy – not a new law. So some worry that smokers will flout the rules because there are no legal sanctions.

That led the Scottish Government to ask, in a recent consultation, for views on whether we should go a step further and introduce a law to make it an offence to smoke or to allow tobacco use throughout NHS grounds.

We’re well aware of the frustrations expressed by NHS boards which have already introduced restrictions and have struggled with voluntary enforcement. But we’re also concerned about the idea of imposing blanket legal sanctions on people who will often be vulnerable and may already feel stigmatised because they’ve been hooked into tobacco addiction.

So what we’d like to look at is devolving powers to define smoke-free areas to the local level, so that processes can be carried out with the involvement and approval of the communities affected.

In the case of NHS grounds, health boards might decide to make their entire grounds smoke-free anyway, or may choose a more closely defined area around buildings, depending on circumstances. But a process of local consultation could help identify the areas within NHS estates that would best be designated smoke-free. The consultation process may also help generate understanding and support for the motives behind the policy, and assist in implementation and enforcement.

NHS authorities could extend their monitoring and enforcement of the indoor smoking ban to include designated outside areas, with penalties for non-compliance in line with those for indoor breaches.

The same devolution of powers could apply to other locations where a case could be made for restricting smoking outdoors. The Scottish Government recently asked for views on whether more action needs to be taken to make children’s outdoor areas tobacco free. We fully support the desire to keep smoking away from children’s play areas and other appropriate locations where young people gather – but again would advocate a locally-led consultative approach rather than a nationally defined blanket ban.

Decision-making at a local level is key to developing plans that the public will be on board with. We need to clarify the powers councils have, so they can plan and introduce smoke-free areas that meet the needs of the communities they’re in.

That could mean different approaches in different areas of Scotland, but it would encourage councils to increase consultation and participation in their local tobacco control strategies and allow members of the public to have their say on the smoking restrictions they wish to see. But careful consideration must be given to how we define these areas and, more importantly, how we get the message across to people about the benefits that come from these locations being tobacco free.

A positive shift in attitude is what restrictive measures need to emphasise, rather than protection from second-hand smoke – the reason for the indoor smoking ban.

At the same time it is important to remember that most exposure to second-hand smoke occurs in the home.

Restrictions on outdoor smoking areas should not have the effect of driving smoking indoors, and a flexible, localised approach could take account of this.

It would be up to local planning partnerships to decide which areas should be included as part of consulting on their local plans.

Hopefully, this focus on outdoor smoking in specific locations, backed by understanding and support from local people, will ensure that change is in the air when it comes to tobacco use in Scotland.

• Sheila Duffy is chief executive of ASH Scotland www.ashscotland.org.uk