The ‘impossible dream?’ Implementing a No Smoking Policy on hospital grounds

1. The ‘impossible dream?’Implementing a No Smoking Policy on hospital grounds Trina Nealon Principal Health Promotion Specialist, Cardiff and Vale Public Health Team

2. Smoke Free UHB Why a ‘No Smoking Policy’? • 21% of our population smoke (Cardiff and Vale of Glamorgan) • 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 £690,000.00 was spent on prescriptions for NRT and other stop smoking products in Cardiff and Vale of Glamorgan 2012-2013 • WG have issued smoking prevalence targets to achieve by 2016 and 2020 • Workplace No Smoking Policies can reduce smoking prevalence by 3-5% with up to a 7% reduction in smoking incidence within 2 years

3. Smoke Free UHB Why a ‘No Smoking Policy’? • The number of smokers accessing local smoking cessation services are low • WG has issued a Tier 1 Smoking Cessation Target to health boards. Cardiff and Vale UHB requires over 10,000 referrals to support services (less than 1,500 2012-2013!) in order to achieve!

4. 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”

5. Implementing Smoke Free Hospitals – the Challenges we face

6. Challenge One: ‘The Jungle’ - Environment

7. Challenge 2: ‘The Celebrities – ‘the key to a successful show!’

8. Challenge 3: ‘The Hosts’– ‘the link between the public and celebrities!’

9. Challenge 4: ‘The Bugs’ - ‘where the unthinkable becomes reality!’

10. Challenge 5: ‘The Newcomer’ - ‘just when you thought you were getting somewhere!’

11. Challenge 6: ‘The Winner’ ?

12. Key Steps of becoming a ‘Smoke Free UHB’ • 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

13. Key Steps of becoming a ‘Smoke Free UHB’ • 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 – Revised No Smoking Ban (to include E Cigarettes) (October 2013) • Phase 5 – Full Ban (No Exceptions) (July 2014)

14. ‘Smoke Free UHB’Key Milestones • No Smoking Policy approved and implemented – prohibiting smoking across all sites and grounds • Smoking Enforcement Officer appointed • 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) • Patient awareness – Appointment letters, envelopes, press releases • Contractor awareness – Contract revised • UHB Clinical Board Tier 1 Smoking Cessation referral targets/Primary Care targets/CO monitors

15. ‘Smoke Free UHB’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) • Culture Change takes a long time – on-going monitoring and evaluation required • Enforcement • On going Review

16. ‘Smoke Free UHB’Marketing a Brand