Memorandum by Help the Hospices (SP33)
1. HELP THE
HOSPICES BACKGROUND
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.
2. SCOPE OF
EVIDENCE
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.
3. EVIDENCE
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
Flexibility
— 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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