Why middle lane smokers have little to fear

Cardiff & Vale University Health Board this week announced that it would ban smoking completely within all hospital grounds with effect from 1st October 2013


This came as something of a surprise to me (I thought they already had)

Alongside a total ban on smoking ‘real’ cigarettes, e-cigarettes will also be prohibited because there is currently no evidence to support their efficacy. Instead, patients will be offered nicotine patches and access to the Health Board’s smoking cessation service

Whilst the evidence that smoking is bad for health (and in particular that it delays recovery from illness or surgery) is clear and unambiguous, so is the evidence that practical implementation of a total smoking ban in hospital grounds is extremely difficult. Ratschen et al (2009 : Smoke-free hospitals – the English experience) conclude that where total bans had been attempted “policy infringements were widespread and appeared to be widely tolerated”. Similarly, Arack et al (2009 : An evaluation of the effects of the smoking ban at an acute NHS Trust) concluded that : “the ban is not sufficiently enforced and support services are either absent or not well-publicised”

Both studies found that a significant issue was the lack of rigorous enforcement of the ban on smoking, with staff in particular expressing a reluctance to challenge smokers on hospital grounds through fear of a hostile response. Given the financial constraints within which the Cardiff & Vale Board is already having to operate, and the size and scale of the grounds that are occupied by its main hospital sites in Cardiff and Llandough, it is very unlikely that there will be significant investment in additional security personnel to enforce the smoking ban. It seems that the change in policy will be little more than a gesture – an indication of good intentions but without the resource to properly see it through

There are parallels here with the recently announced ‘clampdown’ on so-called middle lane ‘hoggers’ and ‘tail-gaters’ on motorways. The policy intention is laudable – both driving behaviours are at best irritating, and at worst positively dangerous. The problem is that there are now so few police officers on patrol on the UK’s motorways that enforcement will be practically impossible

Given the continuing emphasis on deficit-reduction and financial stringency, perhaps its time for both politicians and public sector policy makers to start being a bit more honest about what’s do-able and what we will have to simply put up with. Gesture politics and policy announcements that are simply unenforceable are a luxury that we can no longer afford


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