Memorandum by the Royal College of Nursing
(SP03)
1. INTRODUCTION
1.1 With a membership of over 380,000 registered
nurses, midwives, health visitors, nursing students, health care
assistants and nurse cadets the RCN is the voice of nursing across
the UK and the largest professional union of nursing staff in
the world. The RCN promotes patient and nursing interests on a
wide range of issues by working closely with Government, the UK
parliaments and other national and European political institutions,
trade unions, professional bodies and voluntary organisations
1.2 The RCN welcomes and supports the proposal
to introduce smokefree legislation in the Health Improvement and
Protection Bill, but disagrees with some of the proposed exemptions.
In particular the proposed exemptions which would allow licensed
premises that do not serve food to be excluded from the ban or
for allowing an extra year for licensed premises to comply with
the legislation.
1.3 The Government is sending out mixed
messages. On the final day of the Government consultation on the
Smokefree Elements of the Health Improvement and Protection Bill
a high profile "Second-hand Smoke Kills" campaign was
launched. However, the Bill as currently drafted continues to
permit smoking in certain enclosed public places. It is proven
that second-hand smoke does kill. Therefore, the Government should
be sending out a clear message that it is unacceptable to smoke
in all enclosed public places without exception.
1.4 There are currently around 500,000 nurses
working in a variety of settings, including prisons, mental health
settings and hospices. These nurses are in key positions to influence
the development of healthy working environments. Nurses equipped
with smoking cessation skills working in communities throughout
the UK are well placed to work with their patients to help them
to quit smoking and improve their health as a result.
2. SUMMARY
2.1 The RCN supports legislation which aims
to reduce the number of deaths from smoking. However, only a complete
ban on smoking in all enclosed public places will protect people
from second-hand smoke, act to tackle the health inequality gap,
encourage people to give up and ultimately act as a deterrent.
This position was supported overwhelmingly by 86% of members at
the 2004 RCN Congress.
2.2 Smoking is the biggest cause of preventable
ill health and premature death in the UK, killing more than 114,000
people every year. The NHS spends approximately £1.5 billion
a year treating diseases caused by smoking rather than on preventing
ill health.
2.3 Closing the health inequality gap between
the richest and poorest communities is a key Government priority.
Far from decreasing inequalities this Bill could help to widen
existing inequalities. Evidence shows that licensed premises in
deprived areas are less likely to serve food and, therefore, more
likely to be excluded from a ban.
2.4 Second-hand smoke is a serious danger
to health. Exposure to second-hand smoke in the workplace causes
617 deaths each year, more than two and a half times those killed
in all industrial accidents every year in the UK.
2.5 The RCN believes that it is imperative
to the success of the Bill that all smokers are provided with
support to encourage and promote smoking cessation. Cessation
support is proven to double the success of quit attempts.
3. DEFINITION
OF "ENCLOSED"
3.1 The RCN is convinced that the legislation
should apply to all enclosed public places. The RCN recognises
that exposure to environmental tobacco smoke or second-hand smoke
is a significant public health hazard in its own right. [1]As
such the legislation should be comprehensive to ensure that all
workers are protected from the harmful effects of second-hand
smoke in their workplace—whether this is in a restaurant,
bar, beer garden or football stadium.
3.2 The RCN believes that introducing national
smokefree policies is the only effective means of health prevention
and promotion and the only effective way of ensuring that the
health benefits of a ban on smoking is felt across the social
spectrum. Secondhand smoke in a public place is a proven danger
to health with 30 people a day dying as a result of exposure to
second-hand smoke[2].
Exemptions, if any, should be restricted to outdoor areas in open
countryside.
4. LONGER LEAD
IN TIME
FOR LICENSED
PREMISES
4.1 The RCN sees no justification behind
the proposal for a longer lead-in time for licensed premises.
In Ireland where the law applies to most workplaces, with very
few exceptions, compliance within the first month of legislation
being introduced was extremely high with over 97% of workplaces
complying. [3]
4.2 Estimates suggest that at least one
hospitality worker per week dies as a result of exposure to second-hand
smoke[4].
By allowing a longer lead in time for a ban on smoking in licensed
premises hospitality workers lives would still be at risk from
the harmful effects of second-hand smoke and it would, therefore,
be unfair to discriminate against these workers. The RCN believes
that protection should be extended to all workers at the same
time and believes that a ban on smoking in licensed premises should
be introduced as part of the legislation in 2007. The RCN can
see no logical reason why licensed premises should not become
smokefree at the same time as all other workplaces and enclosed
public places.
5. EXCLUSION
OF LICENSED
PREMISES THAT
DO NOT
PREPARE AND
SERVE FOOD
5.1 The RCN sees no logic or justification
for this exemption. All licensed premises are workplaces and should
be regulated as such. People working in licensed premises should,
without question, be entitled to the same protection from the
health effects of second-hand smoke as those working in any other
environment. The proposed exemptions for pubs and clubs would
leave many of the employees who are currently at greatest risk
from second-hand smoke, still exposed to this danger and this
cannot be justified. The proposals to delay a ban on smoking until
2008 and exempt licence premises that do not serve food is nonsensical.
Whether a pub serves food or not is irrelevant, when considering
the damage caused by inhaling second-hand smoke.
6. IMPLEMENTATION
DATE
6.1 The RCN considers that the optimum time
of year to introduce comprehensive smokefree legislation is in
spring 2007. The impact on public health from an entire ban on
smoking in all enclosed public places will be such that this legislation
should be introduced as quickly as possible. However, it is necessary
to allow a long-enough lead in time to ensure that the public
and smoke-free premises are adequately prepared to enforce the
legislation. March 2007 would give over a year to ensure co-operation
for the ban and to gain maximum public co-operation.
7. IMPACT ON
HEALTH INEQUALITIES
7.1 The RCN welcomes the work that the Government
is doing to introduce health trainers and improve people's health
choices, however we believe that a full ban on smoking in all
enclosed public places should be viewed as a vital step in improving
the health of those living in Britain's poorest communities. Without
a full ban on smoking in all enclosed public places the inequalities
in health between the richest and poorest communities will continue
to exist and could even widen.
7.2 Smoking prevalence among manual groups
is consistently higher than in non-manual groups in the adult
population as a whole. In real terms in 2003 smoking prevalence
in manual groups was 48% higher than in non-manual groups. [5]
7.3 Evidence from a recent British Medical
Journal Survey found that rather than reducing health inequalities
the Health Improvement and Protection Bill, with the current exemptions
for licensed premises not serving food, could in fact lead to
widening health inequalities between the richest and poorest communities.
By looking at the most deprived areas in the Borough of Telford
and Wrekin the survey estimated that two thirds of pubs in the
most deprived areas would be excluded from a ban whilst only a
quarter of pubs in affluent areas would be excluded. [6]
8. CONCLUSION
8.1 The RCN supports the Smokefree elements
of the Health Improvement and Protection Bill but believes strongly
that it does not, as proposed, go far enough. We are urging the
government to learn from the experience of other countries and
implement comprehensive smokefree policies in all enclosed public
places and workplaces, without exception, by March 2007.
September 2005
1 The Scientific Committee on Tobacco and Health (SCOTH)
report-www.advisorybodies.doh.gov.uk/scoth Back
2
Jamrozik, K, estimates of death among adults in the United Kingdom
attributable to passive smoking. BMJ 2005, published online 1
March 2005. Back
3
Smoke-free Workplace Legislation Implementation: Public Health
(Tobacco) Acts 2002 and 2004 progress report, May 2004, http://www.otc.ie/article.asp?article=198 Back
4
Professor Konrad Jamrozik, University of Queensland, Australia
writing in the BMJ, 2 March 2005 Back
5
Department of Health, Tackling Health Inequalities: Status Report
on the Programme for Action, 11 August 2005. Back
6
Dr Alan Woodall, Telford & Wrekin Primary Care Trust, Published
in the British Medical Journal, 18 August 2005. Back
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