Smoke Free: Frequently Asked Questions

 

Please see below answers to some FAQs. Please also look at our Information Leaflets, or for more information, please email smokefree@shsc.nhs.uk

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When is the new SHSC Nicotine Management and Smoke Free Policy being introduced?

We will be introducing nicotine management and going completely smoke free on Tuesday 31 May 2016.  Tuesday 31 May is World No Tobacco Day.

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What does the new Policy and being smoke free mean?

We will be 100 per cent smoke free. Service users, carers, staff and visitors will not be allowed to smoke on any Trust sites, including wards, buildings, entrances, grounds, gardens and vehicles.

There will be no areas where the use of tobacco is allowed. Electronic cigarettes can be used by service users in designated areas.  

Support will be available for service users and staff who wish to stop smoking.

We recognise that smoking or not smoking is a matter of individual choice. We will help service users and staff who do not wish to stop smoking to manage tobacco dependency symptoms while on Trust premises and grounds (temporary abstinence).

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Why is the Trust implementing nicotine management and going smoke free?

As an NHS organisation, we are fully implementing National Institution of Health and Social Care Excellence Guidance. The NICE Guidance (PH Guidance 48, 2013) states that all hospital sites should be 100 per cent smoke free, and should provide Nicotine Replacement Therapy  to support people admitted to hospital to be abstinent from tobacco, and offer smoking cessation support to staff and service users.  NICE recommends that Commissioners should commission smoke free services.  Within Yorkshire and Humber, Leeds and York Partnership NHS Foundation Trust, Bradford Care Foundation Trust, and Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH), have all recently become smoke free.

Implementing NICE Guidance enables us to meet our duty of care to protect both the mental and physical health of our service users and staff. 

People with mental health problems are more likely to smoke and to smoke more heavily than the general population and this is one of the reasons that they have poorer physical health and a lower life expectancy than the general population.  Going smoke free will help us to reduce this unacceptable health inequality.

Staff in our in-patient services spend a great deal of time facilitating smoking through activities such as helping to buy cigarettes or escorting service users to smoking areas.  Reinvesting this time into facilitating healthy therapeutic activities will be beneficial to both service users and staff.

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What will our new Nicotine Management and Smoke Free Policy mean for people admitted to hospital or an in-patient unit?

Our Trust will provide a safe, smoke free place for all service users, staff and visitors.  Smoking will not be allowed on any of our wards, ward gardens, premises or grounds, or when undertaking therapeutic activities on or off site with a member of staff.

If you smoke and are admitted to hospital, you will be introduced to a person who is trained to assess need and issue Nicotine Replacement Therapy (NRT).

We pledge to achieve this within 30 minutes of your arrival.  Support will be available throughout your stay, and you will be closely monitored to ensure any withdrawal side effects are limited and addressed.

If you are undertaking therapeutic activities off site, accompanied by a member of staff, you will be offered NRT to support you during this time.

If you are going home on leave and wish to continue to not smoke, you will also be offered NRT to support you during this time.

As well as NRT, activities will also be offered, to help to take the place of smoking.  If you wish to stop smoking for good, we will support you to do so.

Our staff are not allowed to help service users to smoke.  For example, they are not permitted to escort service users off the site to smoke, to buy tobacco products, or to light cigarettes. 

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Can I bring tobacco and related products on the ward?

No.  Tobacco, tobacco related products, lighters and matches are not permitted on our wards.

If you have these with you at time of admission, you will be asked to return these items home with family or friends.  We do not have facilities to routinely store tobacco or related products.

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As an in-patient, can I use e-cigarettes?

If you smoke we recommend you use nicotine replacement products, which can be issued by our staff.  These products are licensed as medicines and we know they are safe.

However, we recognise that you may prefer to use an electronic cigarette (e-cigarette).  If you wish to use an e-cigarette, please tell your care team, and they will support you. 

E-cigarettes do not contain tobacco and are not burnt.  Studies evaluating their safety have found them to be safer than smoking.  E-cigarettes deliver vapour rather than smoke.  E-cigarettes deliver nicotine by heating and vapourising a solution that typically contains nicotine, propylene glycol, plus flavours.

As e-cigarettes are quite a new product, we don’t know if there will be any impact on the health of people who use them over a long period, but experts suggest they are highly likely to be much safer than smoking.  Read our leaflet on Ecigarette Leaflet.

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As an inpatient, which type of e-cigarette can be used and where?

While in hospital we recommend the use of disposable e-cigarettes.

However, if you arrive in hospital as a user of a re-chargeable e-cigarette, your ward team will work with you to enable you to continue to use this, once necessary safety (PAT testing) checks have been made.  The safety checks are very important as there have been a number of fires caused by e-cigarettes where a charger was used incorrectly or an incorrect charger was used.  Until these are completed you will not be able to use your charger, but you will be able to use nicotine replacement products issued by our staff.

Once your charger has been successfully PAT tested you will be able to use this on the ward to charge your e-cigarette.  If your charger is left connected to the electricity supply for long periods of time it may cause a higher risk of fire.  Please remove your charger from the electrical socket as soon as your e-cigarette is fully recharged.  You must not use chargers intended for other purposes to recharge your e-cigarette, and you must only connect your charger to the mains electricity supply, not to a laptop or other device

We are unable to supply e-cigarettes.

E-cigarettes can only be used in designated areas. Your ward team will advise you where these are. E-cigarettes cannot be used in communal areas. 

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What will our new Nicotine Management and Smoke Free Policy mean for service users seen at home, or in the community?

If you are receiving treatment at home, or in a community setting, you will be asked if you smoke and if you would like help to stop.  If you do, you will be offered a referral to specialist support.

If you smoke and are receiving a visit from a member of staff at home, please can you help us?  While the 100 per cent smoke free part of the Policy does not apply to people’s homes, we have a duty of care to protect our staff from harm caused by breathing in second hand smoke, when they are working in the community.

You can help keep staff smoke free by:

  • Not smoking during the visit;
  • Where you can, asking other people in the house not to smoke during the visit;
  • Providing a smoke free room or ventilating the room for an hour before the visit, if you can (for example, by opening the window or door);
  • If you unable to do the above, please discuss with a member of staff, as we may be able to make an alternative arrangement.   

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How will being smoke free impact on staff?  What will be different from 31 May 2016?

The new Policy is about promoting health and wellbeing for all, and applies to all staff without exception.  All staff are expected to act as suitable role models to other staff and to service users.

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What support is available for staff who smoke?

We wish to encourage all staff who smoke to stop smoking.  Going smoke free presents an opportunity to do this, however, it is not an obligation.

Support is available if staff would like to quit.  This includes up to six weeks free Nicotine Replacement Therapy within a supported quit attempt. 

If staff are not looking to quit, advice and support is available on the use of Nicotine Replacement Therapy (NRT) for temporary abstinence while at work.  Staff can access a maximum of six weeks of free NRT. 

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How will you ensure that service users don’t smoke on Trust sites?

If a service user is struggling to stay smoke free, staff will look at providing additional support.  This will include reviewing the care plan with the service user, give consideration to adjusting their Nicotine Replacement Therapy, helping to understand triggers to using cigarettes, and increasing the amount of behavioural and other support provided.

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How will you ensure that visitors and contractors don’t smoke on Trust sites?

Our aim is to develop a culture where smoking is viewed as unacceptable across our sites and for people to respect this.  New signage will be in place to promote the smoke free site. ‘Welcome to our Smoke Free SHSC’ business cards will be widely available, and in a situation where a member of staff comes across a person who is not aware of the Policy, a staff member may approach the person and let them know of the new Policy, and/or give them a business card with further information.

Promoting culture change will take time, and the Nicotine Management and Smoke Free Project Team welcome ongoing feedback. Please email smokefree@shsc.nhs.uk

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How have you involved staff, service users, carers and visitors in preparing for the Trust going smoke free?

We have involved staff, service users, carers and our partners in developing our new Policy. We held a SHSC Going Smoke Free: Launch Event in April 2015, and our Going Smoke Free Staff Survey, which received over 1,400 responses. A Trust Nicotine Management and Smoke Free Implementation Group has overseen development of the Policy and consulted extensively on the draft Policy, and, where appropriate, revised the Policy in light of feedback.  The Group will continue to meet monthly until the Policy is reviewed in May 2017.

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What about education and training?

We have a dedicated Education and Training programme. We have trained over 50 staff as Level 2 Accredited Smoking Cessation Practitioners. We are training all registered nurses on in-patient units in Mental Health and Tobacco Dependence, so they are able to assess need, and issue Nicotine Replacement Products. 

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How are we letting people know about the new Nicotine Management and Smoke Free Policy?

We doing this in several ways.  These include:

  • Explaining what nicotine management and smoke free means and what support is available in our publications, website, intranet and on posters displayed in receptions and public areas;
  • Producing leaflets with specific information for service users, carers and staff;
  • Contacting stakeholders such as partner organisations and Commissioners to brief them on the change and answer any questions;
  • Setting up a ‘Smoke Free Open to All’ folder on the Trust shared drive, containing key information and resources  for staff;
  • Supporting wards and teams in developing implementation plans, which includes collaborative care planning with service users;
  • Holding Roadshows, ‘Count Down’, and ‘Drop In’ Information and Very Brief Advice Training Events;
  • Installing new smoke free signage;
  • Including information in the staff induction;
  • Briefing local media;
  • Including information about smoke free and the support available in out-patient letters so that service users know of the policy in advance of attending appointments.

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Is the Trust going smoke free likely to lead to a rise in incidents on wards?

There is no evidence from mental health Trusts that have already gone smoke free, that implementing smoke free environments leads to a rise in incidents on wards.

Evidence from our Trust site which has already gone smoke free, is that this has led to a reduction in smoking related violence and aggression, rather than an increase. At Forest Lodge, where smoke free was implemented in February 2014, there has been:

  • A reduction in the number of incidents;
  • A reduction in the use of supervised confinement;
  • No evidence of an increase in the use of PRN medication;
  • Better engagement with service users and more time spent in nursing, psychology and Occupational Therapy sessions.

Partial smoke free implementation – where people can smoke in certain places or at certain times – can be more frustrating for some service users and lead to more conflict as there are grey areas for people to dispute.  Inconsistent enforcement of a complete smoke free environments can also cause disputes.

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What is the most effective way to stop smoking?

The Department of Health recommends a combination of intensive behavioural and psychological support alongside medication to minimise nicotine withdrawal symptoms and help with cravings.  Effective medication includes Nicotine Replacement Therapy (NRT), bupropion and varenicline.

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

There are currently eight different NRT products available.  These are patch, gum, lozenge, sublingual tablet, nasal spray, inhalator, mouth spray and mouth strips.  All of the products are absorbed through the skin, nose or mouth.

These medicines work well on their own but are more effective alongside behavioural and psychological support from a trained stop smoking advisor.

No particular NRT product is significantly better than another and it is the service user’s choice about which product to use, following discussion with staff.

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How effective is nicotine replacement therapy (NRT) and what are the risks?

NRT has been tested extensively and all products approximately double the chance of long term abstinence from smoking when compared to having no support.

There are no safety concerns with the long term use of NRT and smokers rarely become addicted.  NRT is safe to use in people who smoke and is recommended by NICE to be used during periods of temporary abstinence or while trying to cut down.

Because the tar in tobacco smoke speeds up the metabolism of mental health medicines, when service users reduce or stop smoking, medication doses need to be reviewed and sometimes be lowered. For example, smokers generally need higher doses of clozapine than non-smokers, as smoking speeds up the body’s ability to breakdown clozapine.  Read our leaflet about Smoking and Clozapine.  

NRT does not interact with any mental health medications or affect the blood levels of medication.

There are very few restrictions about who can use NRT.  Smokers over the age of 12 can use NRT (although there is very little research in the efficacy of NRT in young smokers).  Using NRT is always safer than smoking.

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Could not allowing a service user to smoke be detrimental to their mental health?

Some clinicians and service users believe that smoking helps with stress, anxiety, low mood and symptoms of psychosis but there is not any clear or consistent evidence to support this.

However, there is evidence that when service users with psychosis, depression and anxiety are supported to stop smoking, on average their mental health symptoms actually improve. See Taylor G et al, 2014, Change in mental health after smoking cessation: systematic review and meta-analysis, BMJ 2014; 348.   

Cigarettes don’t reduce stress – they reduce the symptoms of nicotine withdrawal.

Tobacco smoke also reduces the effectiveness of some medicines, which means a smoker needs a higher dose of medication compared to a non-smoker.  When someone completely stops smoking their medication can be reviewed and the dosage lowered in some instances. Read our leaflet about Smoking and Clozapine.

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Is there a risk that the Trust being smoke free will discourage voluntary admissions?

Other mental health settings that have introduced a comprehensive smoke free policy have not seen any evidence of this. This is an issue that was raised during the consultation on our Policy, and as a Trust we will monitor this.  

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Has the Trust got a legal right to be completely smoke free? Is not allowing a service user to smoke on Trust sites an infringement of their human rights?

The National Institution of Health and Social Care Excellence Guidance (2013) states all secondary care settings, including mental health hospitals, should be 100 per cent smoke free, as does the recently published Five Year Forward View: Mental Health Taskforce Report (2014).

It is not an infringement of a service user’s human rights for the Trust to be smoke free.  This argument has been legally tested and was upheld by the Court of Appeal in 2008 after Rampton Hospital in Nottinghamshire went smoke free.  It rules that a hospital is not the same as a home environment and is instead a place that should support the promotion of health and wellbeing. 

Where service users reside in supported living schemes or community residential settings, such as Woodland View and Birch Avenue, or have private tenancy agreements, these settings are viewed as the service user’s own home and are not covered by the 100 per cent smoke free parts of the Policy.

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How will the Trust monitor the effectiveness of its nicotine management and smoke free policy?

We will monitor how effectively the new Policy is being implemented across the Trust and work with staff, service users and carers to address any particular issues.

The Trust Nicotine Management and Smoke Free Implementation Group will continue to meet monthly until June 2017. Implementation progress will be reviewed at one month and then quarterly, and formally May 2017.

Feedback will be sought from key organisational meetings such as SUN:RISE (the service user network), the Service User Safety Group, Service User Engagement Group, regular nursing and senior management meetings, and the Joint Consultative Forum.

As an active partner in the NIHR CLAHRC (Collaboration for Applied Research and Care), we are also working with academic and health partners across Yorkshire and Humber, to contribute to research on smoking and mental health.

We also welcome feedback from individuals and teams, including suggested improvements on how smoke free is being implemented. Please e-mail smokefree@shsc.nhs.uk

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More questions about smoke free?

If you have any additional questions about smoke free, please e-mail smokefree@shsc.nhs.uk