1. Russ Moody Health & Wellbeing Programme Lead PHE South West
South West Clinical Senate Council Meeting A Public and Patient Perspective
Russ Moody
Health & Wellbeing Programme Lead
PHE South West

2. Comms Training Competition Exchange Audience Research Evaluation NOTE:
Compliance orientation as opposed to enforcement taking a ‘continuous quality improvement’ approach
Comms
(Promotion)
Training
Competition
(People)
(Policy, Place, Systems, Legal)
Evaluation
(what can we measure)
Audience Research
Exchange
(Networks, Engagement, Segmentation,
Collaboration, Product)
(Vaping, Treatment Pathways,
Activities, Price)
6 Benchmarks are: BC/Audience Research/Segmentation/Exchange/Marketing Mix/Competition

3. Focus Group Venue: Rivergate conference room 3 Date: 14 June 2017
Start: am – finish 1.00pm
PHE attendees: Russ Moody, Maggie Rae and Amy Burgess
External attendees: 5 men, 6 women, age range 20 – 79
2 female smokers, 4 female non-smokers
1 male ex-smoker, 2 male smokers, 2 male non-smokers
Aims of the session – To better understand:
How people feel about smoking on hospital sites
How PHE and NHS staff can support smokers to be compliant with smoke-free policy
How we can make it easier for smokers to give up smoking while in hospital?

4. Line of questioning Warm-up session: Your experiences
(Audience Research)
How would you know?
(Communications)
Accessing support
(Training, Exchange)
Tackling barriers to compliance
(Competition)
Incentives and alternatives
(Exchange)
Measuring success
(Metrics – Evaluation)

5. Results How do you feel about hospitals being smokefree?
The group were generally very supportive of completely smokefree hospitals, recognising the benefits, and there was unanimous dislike of people smoking directly outside hospital doors and the area being littered with used cigarettes – numerous examples were given, including a relatively new mother who walked out with her newborn baby into what she described as a “cloud of smoke”
Whilst the group felt that it is unfair for inpatients who want some fresh air to walk out into a smoky environment, they also expressed some concern that because smoking is an addiction, inpatients and relatives - both of whom may be under stress – will need somewhere on site to accommodate them
All felt that it was inevitable that hospitals will go smokefree eventually and that this will become the social norm, with examples given that smoking in pubs, cars and people’s homes is now totally unacceptable
The group favoured a phased approach to abrupt policy implementation – a variety of reasons were given for this, namely that you need to give people a chance to get used to change. There were comments made by some smokers in the group that hospital sites are large and “there are always places to hide”, and a phased approach is more likely to work. The group felt that, prior to phasing out smoking everywhere on site, there should be a designated area for smokers

6. Results How could we improve compliance?
The group were particularly ‘enforcement’ focused and felt strongly that clear lines and regulation should be in place and met (e.g. fines)
However there was concern about the practicalities of imposing penalties, and some discussion about places where smoking is now unacceptable (for example the tube) and how this is enforced (transport police). Without something similar there was concern that people would disregard the rules
The group were keen on a designated area and a ‘white line’ along with signage to make the boundaries very clear. Staff would need to play a role in ensuring that rules were followed

7. Results
What are the alternatives and does the hospital have a job to offer this?
Attendees were generally very supportive and in agreement that hospitals have a key role in promoting healthy lifestyles and that it is in all of our best interests
They supported provision of smoking cessation services and routine interventions with patients being on offer. The group felt that this type of support should be provided for patients and not visitors because ‘smoking is a choice’ and visitors can prepare – and be encouraged to do so - in advance
The group were supportive of e-cigarettes being used on site and suggested making this easy for people – purchasing options and vending machines on site

8. Results What support should hospitals provide?
Unanimous support for this – ‘sometimes all people need is a little push in the right direction’
An example was given by a female smoker who had given up during pregnancy of a conversation between her and a health professional. The health professional could see on the patients’ notes that she was an ex-smoker and without prompting asked if she required support to continue along this path after giving birth. There was strong support for advice not only within the hospital setting but also for once the patient was discharged
The smokers in the room agreed that professionals providing advice is more beneficial than family or friends telling you to – comments that this often comes across as ‘nagging’ and can have the opposite effect of creating frustration and increasing the impulse to smoke
A Smokefree support centre should be available within every hospital and in an obvious location with clear signposting
There was recognition in the room that giving up smoking is very difficult for people and step by step support is important, taking into account that some people have personal circumstances which mean that giving up is not necessarily a top priority - for example homeless people and the need for support to be a part of an overall package sensitive to their situation
Suggestions that nicotine patches should be made readily available for patients and visitors who are stressed through cigarette withdrawal, and the group were surprised to be told that it is withdrawal relief from nicotine, not the nicotine, which calms you

9. Results What support should hospitals provide?
Incentives were suggested as a means of encouraging people not to smoke – for example vouchers or linking back to a health related issue, it was felt that pregnancy is often a huge incentive to give up smoking
The group felt strongly that prevention rather than cure was a good approach, particularly encouraging children to not even start smoking. The influence of smoking on children was a huge concern to the entire group, both smokers and non-smokers, with the smokers unanimously agreeing that they would never smoke around children. It was felt that the smokefree campaign should start by actively focussing on anywhere where there will be large numbers of children, in particular children’s hospitals and maternity wards
It was felt by one attendee in particular that a more holistic support approach would also be worth considering, using the example of a choir as an effective means of reducing stress
The group were interested in whether or not there would be a backlash from the global tobacco industry, and supported a tobacco industry levy specifically to fund ‘Tobacco-free NHS’

10. Results How do hospitals communicate with you?
The group generally felt that, whilst all had seen smokefree signage, hospitals were not as effective as they could be at promoting a smokefree environment
It was suggested that care pathways and the way these pathways communicate with patients (such as appointment letters) should be more explicit about smokefree in advance
Staff should play a stronger role in approaching smokefree policy breaches, and be equipped and prepared to do so
The group were informed about the use of tannoy’s at Musgrove and Derriford, which play a recording of a child’s voice asking people to please stop smoking. There was unanimous support for this, and a strong feeling that this would be a very effective method
The group were supportive of a mixture of ‘carrots and sticks’ in communicating smokefree policy – a blend of posters and fines, as well as a blend of tone with both ‘supportive’ and ‘guilt inducing’ messages. In the run-up to entirely smokefree hospitals there should be a public advertising campaign with a date for going live

11. Results Tackling barriers to smoking – what promotes smoking?
The group felt strongly that nurses and doctors smoking does not give the right message and challenged PHE/the NHS to ‘raise the bar’ in terms of enforcement, practice and behaviour of hospital staff
Not smoking on site should form part of hospital staff job descriptions and contracts and there should be penalties for staff found to be smoking on site. It was felt that even off site hospital staff should be careful about smoking whilst wearing uniform
The group were sympathetic to the long hours and short breaks offered to hospital staff, and the difficulty this causes if they are addicted to smoking. They felt that staff be offered a range of support to go smokefree on shift, including free advice, counselling and medication, a dedicated room for someone to meditate/relax, a helpline, buddy system and other holistic approaches such as support groups or choirs
The group recognised the importance of leadership and in particular nurses as ‘key leaders’, noting the expectation of high standards of practice and the fact that this is powerful in encouraging staff not to smoke