Select Committee on Health Written Evidence

Memorandum by Help the Hospices (SP33)


  Help the Hospices, the national charity for the hospice movement, welcomes the Health Committee's inquiry into smoking in public places. The dangers of exposure to second hand smoke affect all staff, volunteers and users of hospices and we are encouraged that the Government is addressing this issue.

  Help the Hospices acts as the national voice for 189 local charitable hospices in the UK. Help the Hospices also provides support for hospices through grant-aid; education; training; information and advice. Hospices work across traditional boundaries, operating across the health and social services in their work. They provide holistic care for people with life-threatening illnesses, often in the end stages of life. They also provide support for families and carers both pre and post bereavement. In financial terms, hospices provide a £500 million contribution to the UK health economy. In 2004-05, Help the Hospices provided £1,579,000, raised through direct fundraising, and a further £1,018,000 in grants to local hospices in the UK.


  Help the Hospices' evidence will be focused only on the issue of the inclusion of hospices in the list of exemptions discussed in question 6 of the DH consultation.


  In order to represent local charitable hospices as fully as possible in replying to this consultation Help the Hospices conducted a survey of adult hospices in England. Our results were used to formulate our evidence which is outlined below. Full details of this survey are appended.

3.1  The importance of choice at end of life

  Help the Hospices is keen to highlight the ramifications of denying a lifetime smoker the right to smoke in the last days of their life. Any ban on this would be contrary to the purpose of hospice care—to improve quality of life at the end of life. For some terminally ill people, smoking is one of the few pleasures remaining to them and it can be a coping strategy for patients at what can be a very stressful time.

  The responses we received from hospices formed a clear view on this issue. The aim of a hospice is to create as home like an environment as possible for terminally ill people. This often includes the right to smoke, as long as it is respectful of other users. Hospices seek to create a balance between freedom of choice and a smokefree environment.

  Some patients who wish to smoke are unable to leave their beds so do not have the choice to leave the building. For this reason the majority of smoking areas are inside the hospice building.

  In addition the specific patient group concerned, those receiving palliative care, are unlikely to suffer any disadvantages to their health by smoking and behaviour modification will have no affect on the prognosis of their disease.

  We would also like to stress the importance of maximising access to hospices. Hospice CEOs expressed concern to us that some people would not access the service if they were unable to smoke.

3.2  Hospices constitute a place of residence

  Help the Hospices agree with DH that all adult hospices should be exempt from smokefree legislation on the grounds that they can act as an individual's dwelling/home on a day-to-day basis. We understand the department's concerns that exempted groups should be clearly defined by law, and would be happy to work with them to draw up a definition of "hospice" for this purpose.

3.3  Hospice opinion

  The main risk cited with a ban without exemption in the consultation is that a total national ban may not reflect public opinion, and may therefore be controversial and difficult to enforce. Help the Hospices can confirm that a total ban in hospices does not reflect opinion amongst hospice CEOs.

  Help the Hospice's research amongst English adult hospices has shown that 83% of hospice CEOs in England are in favour of smoking facilities being available in adult hospices. This is broken down to 69% of CEOs being in favour of hospices being exempted from any smokefree legislation and 14% in favour of no smokefree legislation at all. Reasons given for this opinion are as those listed above and also the danger of unregulated smoking taking place.

3.4  Promoting best practice

  Hospices already actively pursue a reduction in passive smoking and are keen to strike a balance between smokefree environments and those service users who wish to smoke. All hospices that responded to our survey and that allow smoking provide designated areas of the hospice for this.

  Help the Hospices are keen to support the Government's smokefree agenda and would be interested in exploring how passive smoking can be minimised in the hospice environment with DH or any partner organisations.

3.5  Conclusion

  Help the Hospices recommend that the Department of Health pursue national legislation to make all indoor public places and workplaces completely smokefree with exemptions and that adult hospices be included in the list of exemptions.

September 2005

Annex 1

  Survey details

  Conducted: 29 July 2005 - 22 August 2005

  Distributed online to 142 independent adult hospices in England

  Response Rate: 61% (n=86)

  1.  Where are patients allowed to smoke in your hospice?

  2.  When are patients allowed to smoke in your hospice?

  3.  Where are staff allowed to smoke in your hospice?

  4.  When are staff allowed to smoke in your hospice?

  5.  Where are visitors allowed to smoke in your hospice?

  6.  When are visitors allowed to smoke in your hospice?

  7.  If your hospice also operates home visits please choose the option that most closely fits your home visit smoking policy.

  8.  If your hospice also operates a day unit where are patients allowed to smoke in the day unit?

  9.  If your hospice also operates a day unit when are patients allowed to smoke in the day unit?

  10.  If you have chosen "Smoking is allowed in certain situations" in the preceding questions please specify examples of these situations below.

  11.  How often would you say exceptions were made to these rules?

  12.  The Government consultation lists four possible options for smokefree legislation. Please read the options below and select which you believe is the most suitable government response. (From the perspective of your organisation/hospice)

  13.  Why have you chosen this option?

  14.  Who has previously discussed this issue within your hospice?

  15.  Who else, if anyone, has discussed this issue within your hospice?

  16.  Please use the space below to let us know anything regarding smoking in hospices that you do not feel has been addressed fully in your responses so far. Please feel free to write as much as you like.

  17.  Finally, please enter contact details: your name, your job title and your organisation below. Thank you for your time.

Annex 2

  Survey Results

  Patient smoking

    —  81% of hospices allow patients to smoke somewhere in the hospice buildings

      —  Smoking is allowed only in specific designated smoking rooms within the hospice—69%

      —  Smoking is allowed only in specific patient rooms within the hospice—12%

    —  18% of hospices do not allow patients to smoke anywhere in the hospice buildings

  Staff Smoking

    —  15% of hospices provide staff with an indoor smoking room

    —  83% of hospices do not allow staff to smoke anywhere in the hospice buildings

  Visitor Smoking

    —  19% of hospices allow visitors to smoke somewhere in the hospice buildings

    —  74% of hospices do not allow visitors to smoke anywhere in the hospice buildings

  Home visit policy (n=67)

    —  Patients may smoke freely during visits—55%

    —  Smoking is allowed at the discretion of the home visitor—31%

    —  Patients have been informed that NO smoking take place during home visits—6%

  Day unit smoking policy

    —  78% of day units allow smoking throughout the day in a designated area

    —  8% of day units do not allow patients to smoke indoors


    —  44% say exceptions are NEVER made to these rules

    —  45% say exceptions are RARELY made to these rules

  Favoured legislation

    —  Option One: Continue with a voluntary approach to reducing smoke—14%

    —  Option Two: National legislation to make all indoor public places and workplaces completely smokefree without exception—14%

    —  Option Three: Legislation giving local authorities new powers to control second hand smoke in indoor places—3%

    —  Option Four: National legislation to make all indoor public places and workplaces completely smokefree with exceptions—hospices are included in the proposed list of exempted premises—69%

  Level of internal consultation

    —  61 Management Committees, 60 multi-disciplinary teams, 53 informal discussions, 41 Boards of trustees, 19 service user groups and 9 Carer's groups in 86 hospices developed these views.


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