The ‘impossible dream’ Implementing a No Smoking Policy on hospital grounds - Why preventing smoking in the workplace requires more than just policy Trina Nealon Principal Health Promotion Specialist, Cardiff and Vale Public Health Team

Smoking in the Workplace

Smoke Free Workplaces Why a ‘No Smoking Policy’? 21% of our population smoke (Cardiff and Vale of Glamorgan) 1 in 5 of the UK workforce smokes Each smoker takes an average of 4 cigarette breaks during a working day lasting an average of 10 minutes each An estimated £8.4bn a year is lost on productivity A smoker (full time employee) could cost an employer up to £1,815 per year in lost productivity A smoker is 70% more likely to have at least one more day off sick per year than a non-smoker Smoking is more common in manual jobs where pay is lower The Culture is Changing

Smoke Free Workplaces The Culture is Changing The dangers of smoking and cigarette smoke are evidence based, well known and accepted Legislation – tobacco advertising (2003), age of purchase raised (2007), smoking in enclosed public places (2007), picture warnings on cigarette packets (2008), tobacco vending machine removal (2012), point of sale (2012) New legislation proposed – ban on smoking in cars carrying children, amendments to Regulations to include mental health patients, smoking in hospital grounds and plain packaging

Smoke Free Workplaces Why a ‘No Smoking Policy’? Policies have a role to play in reducing smoking prevalence Policies cannot work in isolation Workplace No Smoking Policies can reduce smoking prevalence by 3-5% with up to a 7% reduction in smoking incidence within 2 years

Smoke Free Workplaces Why a No Smoking Policy? NICE Guidance (2011) ‘Workplace Interventions to promote smoking cessation’ Employers should develop a smoking cessation policy which includes local stop smoking support services, publicity on interventions and allow staff time off work to attend Employers should provide staff with advice, guidance and support on quitting Employees who want information and support should contact a local stop smoking support service which is delivered by trained staff

Smoke Free Workplaces Why a ‘No Smoking Policy’ in the NHS? Smoking cost NHS Wales an estimated £386 million (2007/2008). Smoking related secondary care accounts for 67% of that cost Smoking accounts for 22% of all adult hospital admission costs, 6% of outpatients costs and 13% of GP consultation costs Over £690, was spent on prescriptions for NRT and other stop smoking products in Cardiff and Vale of Glamorgan WG have issued smoking prevalence targets to achieve by 2016 and 2020 WG has issued a Tier 1 Performance Target to Health Boards – 5% of all smokers to make a quit attempt and 40% of those, to have quit at 4 weeks

‘Smoke Free UHB’ Why a ‘No Smoking Policy’?

Smoke Free UHB Why a ‘No Smoking Policy’ in the UHB? The number of smokers accessing local smoking cessation services are low WG target means that over 4000 smokers must have made a quit attempt – this requires over 10,000 referrals (less than 1, !)

Smoke Free UHB Why a ‘No Smoking Policy’? Cardiff and Vale UHB agreed to act as a ‘Practising Public Health’ organisation in July 2010 “ to be a credible and effective advocate for population health improvement, the UHB as an organisation, must be able to demonstrate that we are actively promoting health and wellbeing and preventing ill health”

Smoke Free UHB What have we done? Mapping and Project Planning Smoke Free UHB Steering Group (Sept 2010) Policy Working Group (October 2010) Pre-operative Smoking Cessation Working Group (Aug 2010) Maternity Smoking Cessation Programme Engagement with staff – staff groups, training, communication Mapping of signage, entrances/roads, bins, smoking shelters, audio messaging and environment

Smoke Free UHB What have we done? Implementation in Phases Phase 1 – Smoke Free Entrances (March 2011) Phase 2 – Smoke Free staff (September 2011) Phase 3 – No Smoking Ban (with agreed exceptions) (March 2012) Phase 4 – Full No Smoking Ban (October 2013)

Smoke Free UHB What are the key lessons learnt? Leadership from the UHB Executive Team and Board Engagement with all sectors of the UHB for implementation Communication TIME! - Policy taken 30 months to develop and implement from Phases 1 – 4 Smoking Policies need to be embedded into a wider, multi- partnership strategy ‘a fully engaged scenerio’ (Marmot, 2010) which includes smoking cessation support Culture Change takes a long time – on-going monitoring and evaluation required Enforcement

Smoke Free UHB What key milestones have been achieved? No Smoking Policy approved and implemented – prohibiting smoking across all sites and grounds Smoking Enforcement Officer appointed and in post! Environment improvements – Litter Enforcement, Community Pay Back Scheme, ‘neighbour awareness’ and bin removal UHB Smoking Cessation Service – additional post funded Staff awareness - Brief Intervention Training, Manager’s Briefing Papers, Q&A Briefing Sheet, No Smoking Champions, communication (internal/external) UHB Clinical Board Tier 1 Smoking Cessation referral targets

Smoke Free UHB Policy to prevalence Legislation (including tobacco price increases) Prevention programmes (targeting young people) Mass Media campaigns/support Smoking Cessation Support Social Norming – smoking is not part of ‘our gang’

Smoke Free UHB Our role-models are not…….

Smoke Free UHB ….but the UHB ourselves!