E-cigarettes - Science and Technology Committee

NHS Trust	Question 1	Question 2	Question 3	Question 4
Camden and Islington NHS Foundation Trust	No		We believe that e cigarettes can be a valuable alternative to smoking tobacco and as such helpful to those on our in-patient acute wards and on longer stay rehabilitation wards by reducing their frustration at not being able to smoke, reducing associated aggression on the wards and the risks of hidden smoking articles which may start fires. We believe they may support individuals in stopping smoking tobacco. To support this we are providing some e cigarettes for people to try out and if they find they are an acceptable alternative to tobacco then they can purchase.	It would be of help if some of these products could be prescribed in the future.
North East London NHS Foundation Trust	Yes	Yes, we are currently going through a procurement process and have identified a tamper proof, single use e cigarette that would be appropriate for use on our mental health inpatient wards. We have consulted health and safety colleagues, service user groups and stop smoking colleagues in reaching this decision.	Yes, we did	We are and to that end patients will be able to use them in open/garden areas of wards but not in rooms where other patients would be subjected to the vapour. We are looking at a single use cigarette to eliminate the risk posed by charging. We are only considering tamper evident e cigarettes to eliminate the risk of drugs being introduced to the product.
Berkshire Healthcare NHS Foundation Trust	Yes	The policy is kept under review and in the light of the growing evidence relating to e-cigarettes and the recent information published by Public Health England, the Drug and Alcohol Lead at Prospect Park Hospital is revisiting the possibility of E-cigarettes as an alternative form of nicotine replacement. She has recently been in touch with a London Mental Health trust that has successfully introduced E-cigarettes and has arranged to go and visit this trust (in March) to see how this is practically implemented and associated risks managed. A supplier has also agreed to send some samples and there are plans to undertake a focus group with patients.	When the Smoke Free Policy was first introduced, the Trust considered the use of E-cigarettes as a means of harm reduction as an alternative to smoking but at the time as there was little, if any evidence that supported the use of e-cigarettes as a reliable and safe alternative form of nicotine replacement, a decision was made to ban the use of E-cigarettes and a decision taken to offer other nicotine replacement options to patients admitted to the wards.	Issues relating to second hand harm will be considered as part of the review of the Smoke Free Policy and the use of E-Cigarettes.
South London and Maudlsey NHS Foundation Trust	No. The SLaM smoke free policy, which was launched on 1st October 2014 recognises the potential benefits for smokers to be able to use e-cigarettes as part of their harm-reduction or quit plan. We support all e-cigarette use, and are committed to making e-cigarettes affordable and accessible.	Yes, our policy was informed by the available evidence as well as collaboration with our service user, carer and staff groups–all were keen to find a way to accommodate this new technology.	N/A	No, but we do place what we believe to be reasonable restrictions on where e-cigarettes can be used within the hospital environment. For example, out of respect for others we do not support vaping in shared spaces (such as dining areas and lounges), or in therapeutic sessions.
Bradford District Care NHS Foundation Trust	The use of E cigs within Bradford District NHS Care Foundation Trust is currently under review. Initially our trust did not support the use of E cigarettes due to us being one of the first trusts to go smoke free. At that point there was very little support for the use of E Cigarettes. However due to the current advice and evidence this is now under review. The trust is currently reviewing the use of the E cig as a platform to reduce smoking. There has been a wealth of information from public health England regarding the use of electronic cigarettes and we are working with a multi-agency approach including stop smoking services regarding the use of these within hospital grounds.	Currently the trust is reviewing its policy and is consulting on the use of e cigarettes. An agreement was made by the trust would be looking at e cigarettes only to be used in open spaces, this would include courtyard areas. The trust would discourage their use in confined and indoor spaces.	The use of e cigarettes as always been on the forefront of decision making, there has been considerable discussion around the potential benefits/ harm in relation to conventional cigarettes. Information from public health England has supported the potential use of them in reducing/ stopping smoking. There has also been considerable debate of the different types of electronic cigarettes, these being pre filled, disposable or the tank type cigarettes, concerns have been highlighted around the use of illegal substances in the refillable electronic cigarette types.	There are concerns expressed by some groups regarding any potential harm from second hand vapour. There continues to be reviews into the potential harm of this. The trust does acknowledge that there are some concerns and this has supported the idea of electronic cigarettes only being used in outside spaces.
Lancashire Care NHS Foundation Trust	LCFT’s nicotine management policy allows the use of disposable e-cigarettes by service users on in-patient wards subject to a risk assessment. This is because although nicotine replacement therapy (NRT) is available and actively promoted, we recognise that for some people e-cigarettes are helpful in managing their nicotine addiction and stopping smoking. We only allow the use of disposable e-cigarettes because of the misuse risks associated with refillable e-cigarettes, and the safety risks associated with battery operated e-cigarettes. E-cigarettes cannot be used by staff or visitors. This is because we do not wish to re-normalise smoking in public places. Allowing the use of e-cigarettes in public areas would also make it harder to implement the smoke free requirement; from a distance it is hard to know if someone is smoking a tobacco cigarette or an e-cigarette. We need to make it easy for staff to adhere to the policy and being clear that smoking behaviour in any public space is not allowed does this.	We consider our position to be compatible with Public Health England’s advice and review our policies and procedures when new advice or guidance is published.	The decision to allow e-cigarette use by inpatient service users, subject to a risk assessment, was taken following; a survey of staff and service users, a pilot of e-cigarette use in two areas of the trust, and the PHE guidance.	This concern, and a concern that the long-term health impact of e-cigarettes is unknown, was raised by staff and service users in the survey. Given PHE’s advice it was decided to allow the use of disposable e-cigarettes for inpatient service users subject to a risk assessment.
Essex Partnership Universities NHS Trust	Yes originally as part of our approach following advice from Pharmacy. Note the former South Essex Trust went smoke free in 2009	Yes we are reviewing and will likely allow e cigarettes in our revision of policy	Yes we did but was originally based on licensing and perceived fire risks	Not currently as we would not support within our building only outside
Black Country Partnership NHS Foundation Trust	Electronic Cigarettes can only be used in the designated smoking shelters which are situated outside the building.	We are working towards a smoke free Trust. E-cigarettes are under review in light of this and the advice from Public Health England	This is part of the move to a smoke free Trust.	This is part of the move to a smoke free Trust.
Cheshire and Wirral Partnership NHS Foundation Trust	In our inpatient facilities yes, not in our community services.	We review this position several times a year and constantly review information relating to e-cigarettes.	Yes	Yes
Tees, Esk and Wear Valley NHS Foundation Trust	The Trust developed a smokefree Nicotine Management Policy (dated March 2016) in preparation to go fully smokefree on 9 March 2016. This policy is currently under review but the original version is attached (appendix 1). TEWV fully support the use of all models of e-cigarettes/Vapes Trust wide except within the Forensic service where the decision was taken not to allow these due to the potential risks for their individual service users. In the original Policy (March 2016) both first and second generation e-cigs/vapes were allowed for use but following consultation the third generation tank models were also allowed for use. All rechargeable models are allowed following individual risk assessments. The revised Policy will reflect this information. In addition we have provided e-cigarette/vapes guidance for TEWV staff (appendix 2). The Trust has also made available free disposable e-cigarettes to all inpatients over the age of 18 years and the Crisis team/136 Suite staff can also access these for service users at the earliest opportunity to help alleviate nicotine withdrawal. These have been well received and are readily available (other than Forensic service) Trust wide.	TEWV currently has no restrictions other than in the Forensic service. The Trust originally allowed the disposable and rechargeable models to be used but in October 2017 tank/reservoir models were also approved for use. Risk assessments are carried out for the rechargeable models. The Trust offer free disposable e-cigarettes on admission and work is ongoing to look at the possibility to provide free rechargeable models in the near future following discussion during the Nicotine Management Steering Group in January 2018.	Yes, TEWV fully considered the harm reduction potential hence the choice to allow their use Trust wide. Appendix 3 is the ASH 715 Briefing paper which was one of a number of guidance which supported the Trust’s stance on use of e-cigarettes.	Prior to going smokefree some ward staff were concerned about the side effects from the vape in bedrooms. The Nicotine Management team linked with PHE, FREShl and other national bodies to provide any evidence for staff on any risks or concerns with their use. Following implementation of the Policy and service user/staff use of e-cigarettes no further staff concerns have been raised and e-cigarettes are openly used throughout the Trust. E-cigarettes can be used in single occupancy bedrooms or outside but not in communal areas. The tank models are restricted to use outside as they have the potential to activate fire alarms.
Somerset Partnership NHS Foundation Trust	No. We are allowing the use of non-rechargeable, disposable, e-cigarettes. If patients are admitted without such devices we will supply a maximum of 3 e-cigarettes free of charge if the patient does not wish to use NRT	We have not banned e-cigarettes but will review the use of ‘tank’ e-cigarettes as the evidence of safe use is developed	Yes	Yes. With disposable e-cigarettes we are aware of the potential for the batteries to be ingested. With ‘tank’ e-cigarettes there is the potential for other substances to be smoked.
Sussex Partnership NHS Foundation Trust	No, we have not banned the use of electronic cigarettes in our facilities. We currently allow first generation disposable models.	We are currently reviewing this and the possibility to expand the range of e-cigarettes to second generation and exploring the use of rechargeable ones, whilst recognising the national alert.	Yes we did consider the harm reducing potential of e-cigarettes to conventional cigarettes in our decision making.	We have no evidence to support this at present but we remain open and continue to monitor this evidence and guidance from public health.
Devon Partnership NHS Foundation Trust	No, an agreed brand is allowed in outside areas and bedrooms.	N/A	Yes	Some staff have raised this, stating that as research has not yet been done, we cannot know if there is a risk of ‘secondary vaping.’ The e cigarettes we will allow produce very little vapour.
Derbyshire Healthcare NHS Foundation Trust	E-cigarettes have been banned for use by patients and also by visitors on our grounds. The initial decision was taken owing to lack of evidence regarding the longer term effects and more importantly the potential risk to mental health patients. The latter is owing to the potential alternative uses of the fluids or indeed the product itself regarding self-harm or harm to other people. However, following extensive benchmarking and feedback from patients and staff we have recently commenced a trial of e-burners which are single use e-cigarettes which do not have to be recharged and have proved less of a risk to MH patients. These have successfully been introduced in a number of MH Hospitals and secure units. As the trial only commenced after Christmas it is too early to assess the success or otherwise.	E-burners are classed as nicotine replacement by PH and this was part of the decision to introduce them.	Yes–mainly harm to staff from agitated patients. Also feedback from staff and patients.	Too early to review. We are only allowing the e-burners to be used outside and NOT on wards or other enclosed spaces.
Norfolk and Suffolk NHS Foundation Trust	No, we are encouraging the use of e-cigarettes as an alternative to burnt tobacco on the premises but outdoors	We understand and support PHE position that e-cigarettes are 95% safer than burnt tobacco	We do, that’s why we support use of e-cigarettes	We are not allowing use of e-cigarettes indoors for this reason, until the health risks are better understood
Coventry and Warwickshire Partnership NHS Foundation Trust	Smoking tobacco is not permitted in any part of any Trust property. As the Trust is a no smoking organisation staff are not allowed to smoke or vape e-cigarettes during paid working time. Therefore staff are not permitted to vape e-cigarettes on Trust property (inside or outside in our grounds). This restriction also applies to out-patients and visitors. We do allow e-cigarettes for in-patients who are resistant to “Quit” or nicotine replacement therapy [NRT] products, in line with the Trust’s NRT guidance. The use of e-cigarettes is permitted for our mental health in-patients in the gardens / fresh air areas, and, following clinical risk assessment and care plan, the patient’s own bedroom. Appropriate areas are identified locally.	We have no plans to review staff use of e-cigarettes within trust properties (either inside or outside). We have recently reviewed and re-confirmed our stance on banning refillable re-usable e-cigarette’s by in-patients.	Yes. There were initial ethical and safety concerns about allowing patients access to and the use of e-cigarettes within our services. These were debated as part of agreeing our above position. We considered the harm reduction potential to out-weigh any potential harm.	Yes. Due to concerns about “second hand” e-cigarette vapour and also being seen to normalise the smoking of tobacco, use of e-cigarette’s was restricted to outside open defined spaces or a patient’s own-bedroom (all our bedrooms are single occupancy).
Northamptonshire Healthcare NHS Foundation Trust	No. The Trust decision was to permit the use of E-cigarettes and vapes, subject to a risk assessment. Vapes and E-cigarettes are only permitted in the garden areas. We have a supply of disposable E-cigarettes on each ward available to patients for the first 48 hours of admission. Patients can bring in their own E-cigarettes or vapes.	We have not banned them, but our decision to permit their use will be reviewed periodically.	Yes we did, additionally we considered the fact that they are “the next best thing” and would help patient who are struggling with nicotine withdrawal.	The potential for second-hand harm has been considered, the Trust took the decision to allow their use on the basis that if evidence is released that suggests detrimental second-hand harm the decision will be reviewed.
South Staffordshire and Shropshire Healthcare NHS Foundation Trust	Yes, until December 2017–now permitted in designated areas only	Position reviewed in 2017, following PHE position change	Yes	No–apart from staff/patients preference and impact on smell of products
2gether NHS Foundation Trust	No. E-cigarettes can be used in outside spaces only; however, we may consider changing the policy in due course.	We do not ban the use of e-cigarettes; however, our policy is under constant review	Yes we did, using what information there was available at the time. We are aware that e-cigarettes deliver a higher level of nicotine compared to conventional NRT products, and this favours our client group due to their heavy smoking levels.	We would consider any advice from Public Health England. Currently we advocate the use due to the dramatically reduced risk of e-cigarettes compared to conventional cigarettes. The situation is being constantly reviewed.
South West Yorkshire Partnership NHS Foundation Trust	Our current policy for a smoke-free environment does include a ban on the use of electronic cigarettes in our facilities.	The policy is currently under review and due to be amended by June 2018. This will specifically take into account the advice from Public health England	We will be considering the harm reduction potential of e-cigarettes in the formulation of our updated policy.	There are considerable concerns about the potential for second-hand harm caused by e-cigarettes and these will need to be mitigated against within our updated policy.
Leicestershire Partnership NHS Trust	We allow the use of electronic cigarettes within designated areas both inside and outside facilities.	We are continually reviewing the use of e-cigarettes within our facilities	Yes	No–current evidence does not suggest that there is any second hand harm.
Leeds and York Partnership NHS Foundation Trust	Currently e-cigarettes are not banned but there is designated outside areas for patients and the use of e-cigarettes. This is within the context of health promotional advice and the offer of nicotine replacement therapy.	The approach to improving physical health of mental health patients is under constant review and the use of e-cigarettes will be part of that; see response to question 1–we do not currently ban.	Yes	This will be kept under review as further evidence becomes available on second-hand harm but is mitigated by the designated smoking areas being outside at present.
Central and North West London NHS Foundation Trust	No, we have not banned them. Service users are able to use e-cigarettes that are of the disposable, non-rechargeable variety in their rooms and outside. However, we do restrict their use–we ask that they are not used in communal areas as some service users and staff have objected to passive inhalation of vapour.	We have recently reviewed the Trust’s position and have agreed that e-cigarette vending machines are to be provided in in-patient facilities. Service users will be able to purchase e-cigarettes if they so choose. The review of the use of e-cigarettes has been ongoing over a considerable period of time, as evidence has been made available. The Public Health England guidance was part of that evidence, but we were already reviewing the Trust position prior to its publication. Although e-cigarettes are publicised as less harmful than cigarettes, there are gaps in the evidence base around long-term benefits and harms which should be addressed when encouraging their use with the general public. In line with NICE guidance, that licensed nicotine containing products should be used primarily for those wishing to stop smoking, e-cigarettes should not be recommended as these are not yet licensed with the Medicines and Healthcare products Regulatory Agency. This is a situation that will change this year and the Trust will fully review the use of e-cigarettes once a licensed product is available. It is recognised that patients with mental health problems suffer disproportionately high levels of harm from smoking and have low quit rates on standard smoking cessation approaches. Transition to e-cigarettes may be of benefit for this group, and should be actively encouraged as one part of a harm reduction approach. This should be aimed particularly at those who have tried and failed existing approaches including NRT and other smoking cessation medications, or are unwilling to try them.	We advise that prescription of Nicotine Replacement Therapy (NRT) or medication such as Varenicline, plus psychological support, is the preferred first choice of treatment for nicotine addiction/supporting smokers in a smoke-free environment. However, we recognise that many find e-cigarettes helpful and understand that, if people choose to use them, they are likely to be less harmful than conventional cigarettes (the smoke from which contains tar and many toxins).	Strong views are held by both staff and service users. Whilst smokers find them a useful option, others have expressed concerns about the risks of passive inhalation and adverse publicity - there have been many conflicting articles in the media about conditions said to possibly be caused or exacerbated by e-cigarette vapour (eg ‘popcorn lung’). This results in confusion. In our opinion the main concern is the effects of using of food flavourings in vaporised form to enter the lung. This is something which little is known about and represents the largest potential risk from ‘passive vaping’ in our opinion. The Trust stance is that if a service user chooses to use e-cigarettes to quit/abstain from their smoking habit, they should be encouraged to use them as a tool, rather than merely as a replacement, and be supported to gradually wean themselves off e-cigarettes.
Surrey and Borders Partnership NHS Foundation Trust	We have not banned the use of e-cigarettes but our policy is about banning all use of tobacco products on our premises. We actually provide e-lites for free for our inpatients as part of the cessation process.	N/A	Yes this is was fully considered when designing our Care 2quit programme and decided to not ban e-cigarettes, but to focus on the banning of tobacco products and their use on our premises. We also ensured that people had sufficient access to NRT and full screening was taking place on admission to ensure that all people who smoke receive brief advice on quitting and support where required.	Yes we reviewed this and the anxieties about possible unknown risks to both staff and people using services and as a result we banned the use of e-cigarettes in communal areas or in ward sleeping bays. People are only permitted to use these in their single bedrooms and/or gardens. We also considered the risk of the vaping smoke activating fire alarms and we took steps to mitigate these
West London Mental Health NHS Trust	No. However, we have banned electronic cigarettes purchased outside of the unit due to potential fire risks and the inability to monitor the contents of them. We sell a brand of electronic cigarette that has been accepted as ‘safe’. In two sites these are sold from a vending machine, in one further site they are sold directly from the wards.	We currently have no plans to ban or restrict the use of approved E-cigarettes sold on-site. The ECigs we sell on site are sold for £3 which is considerably cheaper than retail shops on the high street. Currently we do not have any plans to allow other Ecigs due to the potential fire risks and the inability to monitor the contents of them.	Yes we did. Hence, the active promotion of ECigs in addition to a range of NRT products when the Trust implemented the smoke-free policy in January 2016. Prior to introducing a trust wide ban on smoking we made the decision to allow the use of electronic cigarettes (not in wards communal areas) as a harm reduction intervention. In addition we put in place a comprehensive smoking cessation strategy and interventions.	Research has so far shown the potential second hand harm is minimal. However, we encourage these to only be used in the patient’s own bedroom to minimise any discomfort or harm to other patients, staff and visitors. Given current evidence and the fact that electronic cigarettes cannot be used in communal areas we do not have any significant concerns regarding second-hand harm caused by electronic cigarettes.
Cornwall Partnership NHS Foundation Trust	Yes	We are currently reviewing our policy	Yes	Yes
Barnet, Enfield and Haringey Mental Health NHS Trust	No, we have actively encouraged them as part of supporting our smokefree policy since 17.1.17 (and since 2015 in our forensic unit) and have provided them to service users ourselves in emergency (in addition to providing NRT in a range of forms); in other circumstances we make it possible for them to purchase e-cigarettes on hospital premises or encourage relatives to bring them in. We also encourage the use of vapes on our premises, noting that disposable e-cigarettes are not sufficient for all service users to help them to manage without cigarettes. Protocol attached. We have noted though that vapes can set off smoke alarms in confined spaces or when used deliberately to do so, so we have had to limit their use in certain ward areas.	N/A	Yes as above	Not really. A few people have raised it, both on health and nuisance grounds but mainly due to the fire alarm issue. But we support ward managers to limit vape use in areas where it causes a nuisance. This has not prevented widespread use of e-cigarettes.
Avon and Wiltshire Mental Health Partnership NHS Trust	We have implemented a smoke free policy. Patients and staff are not permitted to smoke inside the buildings. Service users can use approved eBurns and Vapes in the grounds away from the ward.	The Trust continually reviews implementation of the policy including the recent advice from PHE. We also need to consider other factors which would require the replacement of our current fire detection systems if eBurn and Vaping were to be permitted inside.	The risk and benefits were considered in preparing the current policy	The Trust is concerned regarding second-hand harm including the needs of non-smokers in relation to the smoke from vapes. We will continue to monitor the emerging evidence regarding the use of these devices and adopt best practice wherever possible.
North West Boroughs Healthcare NHS Foundation Trust	When the Trust originally committed to becoming smokefree in the summer of 2016, a decision was made to not allow electronic cigarettes within our mental health inpatient units. At the time, there were concerns regarding the safety of these devices and the potential associated risks for patients and staff. Therefore at this point, they were not included within the policy as a treatment option. However a further review was undertaken 12 months later as local intelligence and patient/carer feedback suggested a demand for these products, as many patients has used them before admission. The licensed Nicotine Replacement Therapy products were not accepted by all patients, so we looked at the least restrictive practice in relation to provision of nicotine replacing products for mental health in-patients within the Trust. With the benefit of shared experiences from other Trusts and taking into consideration the evidence review (McNeill et al, 2015) commissioned by Public Health England, a decision was taken to allow one specific brand of disposable e-cigarettes as a nicotine dependency treatment option. We commenced providing the choice of Nicotine Replacement Therapy or disposable e-cigarettes in December 2017.	We do allow the use of e-cigarettes as outlined in question 1 and have seen increased compliance with our smoke free policy as a result.	Yes. We also took into consideration the review of underpinning evidence (McNeill et al, 2015) commissioned by Public Health England.	Yes. We will continue to monitor this and ensure we deliver our services in line with national evidence base and best practice.
Kent and Medway NHS and Social Care Partnership Trust (Extracts from their smokefree policy)	Only disposable devices with prefilled cartridges may be used (see Appendix B). Rechargeable devices of this type are not permitted due to the risks associated with charging. E-cigarette use is only permitted for patients, visitors and contractors in designated areas e.g. hospital grounds and courtyards, but not in communal indoor areas or bedrooms.	N/A	E-cigarettes are battery powered devices that deliver nicotine via inhaled vapor. Since e- cigarettes do not contain tobacco and are not burnt, they do not result in the inhalation of cigarette smoke they are therefore regarded by most experts as much safer delivery devices for nicotine. This does not mean that they are completely safe, but they are envisaged to be much less harmful than cigarettes.	E-cigarette use should only be permitted in discrete places and never be permitted in areas where patients and staff congregate.
Mersey Care NHS Foundation Trust	We have not banned the use of e-cigarettes and are following the advice from PHE and the CQC about their benefits to support service users who are dependent on nicotine. E-cigarettes are in the repertoire of Nicotine Replacement Therapies we support for the people who use our services.	We have currently banned the use of e-cigarettes in our High Secure Service, which is consistent with the other two HSS Trusts. However, we are meeting to review this decision to clarify the clinical, risk and/or security grounds which inform this decision. We may also review the decision in the light of service users’ experience in using e-cigarettes in our medium and low secure services or if other appropriate products become available.	The Trust considered, and is supportive of, the harm reducing potential of e-cigarettes and recognises they may be of assistance to enable some smokers to move away from using harmful burnt tobacco towards a cleaner form of nicotine delivery, and may ultimately help them to give up smoking in the longer term if they make this decision. In addition, the Trust strongly supports service users’ choice and preferences in their recovery, and our service users informed us that having e-cigarettes as an available option would allow them to make positive improvements in both their physical and psychological well-being. We consider collaboration and choice to be an essential component of our least restrictive and co-produced approach to care within the Trust.	The Trust will continue to review its position on e-cigarettes, including if any risks are identified in future as new evidence and guidance emerges. This will include regular reviews, as it would any other new aspect of practice and care, to ensure the Trust, its staff and the people we serve are kept fully informed by contemporary findings and safety information so that we continue to support best practice and safe care in this developing area.
Dorset Healthcare University NHS Foundation Trust	No	N/A	Yes	We believe the potential for harm reduction through supporting the use of e-cigarettes to far outweigh any concerns regarding exposure to secondhand vapour. The NCSCT’s Electronic cigarettes briefing indicates that “some studies have found traces of toxicants in secondhand vapour, but at such low levels that they do not pose a health risk to bystanders. There is no evidence that secondhand vapour is dangerous to others; however, it helps to be respectful when using e-cigarettes around others, especially non-smokers.” We have taken this evidence into consideration in our smokefree policy. We do ask our patients and staff not to use e-cigarettes in communal spaces limiting such exposure and normalisation of their use.
Southern Health NHS Foundation Trust	No, we encourage their use.	We only restrict the use of some models of e-cigarette for reasons of fire safety.	Yes, based on strong research evidence of harm reduction.	No, but we discourage use in shared areas so as to not affect others at all.
Tavistock and Portman NHS Foundation Trust	Yes we have banned the use of electronic cigarettes in our facilities after careful consideration. We are an out -patient facility and the majority of our patients are children, young people and families. Our patients are on our premises for short periods to attend out -patient appointments. We banned the use of electronic cigarettes as we did not wish our young patients and families to see patients, staff or visitors using any form of cigarette which might imply our condoning this behaviour	Yes, our smoke free policy (May 2017) will be reviewed in May 2018 on the basis of an updated review of current evidence including PHE advice.	Yes, we did and we encourage and support staff and patients to take up interventions to stop or reduce smoking tobacco through appropriate means including switching to electronic cigarettes as a substantially safer alternative for when they are not on Trust premises.	Yes.
Nottinghamshire Healthcare NHS Foundation Trust	Staff and visitors–yes. Patients–Yes in the Trust’s Forensic Service Division No in the Trust’s Local Partnership Division (in-patient mental health units]. Use is restricted to just one type of disposable e-cigarette called E-burn due to unique safety features and the fact that numerous other Trusts and some prisons are allowing their use.	Yes our position will be under constant review and decisions will be made according to guidance and the emerging evidence-base.	Yes	We are guided by PHE advice, 2016 “the constituents of cigarette smoke that harm health–including carcinogens–are either absent in e-cigarette vapour or, if present, they are mostly at levels much lower than 5% of smoking dose (mostly below 1% and far below safety limits for occupational exposure)”
Cambridgeshire and Peterborough NHS Foundation Trust	In our facilities we do not permit the use of electronic cigarettes indoors. We do allow the use of electronic cigarettes among service users in ward gardens and allow staff members to use electronic cigarettes outdoors during break times.	On 1 October 2017 CPFT banned smoking and the use of all electronic cigarettes and vaporisers on our premises. This policy was amended in December 2017 to allow for the use of electronic cigarettes and vaporisers in outdoor areas in light of feedback from staff on our wards. The decision to allow the use of electronic cigarettes and vaporisers in outdoor areas was reflective of the evidence and recommendations presently available from Public Health England. The CPFT Smoke Free policy will be monitored and amended as additional evidence becomes available.	The harm reduction potential of electronic cigarettes was a factor in our decision to allow electronic cigarettes and vaporisers on our grounds. As noted above, the Trust will continually monitor our Smoke Free Policy as additional evidence becomes available from Public Health England around the risks and benefits of electronic cigarette use.	At the moment there is no evidence to suggest that electronic cigarettes or vaporisers cause harm to non-users. As we have restricted the use of electronic cigarettes and vaporisers to outdoor areas only we do not currently have any concerns around the potential for secondary harm to service users or staff. We welcome updates from Public Health England around the second-hand risks of electronic cigarettes as research in this field progresses.
South West London and St George’s Mental Health NHS Trust	SWLSTG NHS Trust has adopted an interim E-cigarette Protocol to support patients to manage their nicotine dependence whilst hospitalised. Patients wishing to use e-cigarettes as part of their nicotine management programme can bring/purchase the brand of their choice as long as those are disposable and non-rechargeable e-cigarette devices. Patients are allowed to use e-cigarettes in designated areas of the wards i.e. their individual bedrooms and courtyards but should refrain from vaping at indoor communal areas. The protocol prohibits the use of e-cigarettes in any other areas of the Trust grounds and/or buildings. E-cigarettes use by outpatients, staff and visitors is currently prohibited across Trust premises.	We are currently reviewing our existing e-cigarette protocol to ensure that it is in line with the new PHE and NICE recommendations. However, we also take into consideration the needs and views of our service users, carers and staff.	Despite the limited evidence on the long term health effects of e-cigarettes, there’s been some evidence that vaping is 95% less harmful than smoking. Our inpatients are being professionally supported to manage their nicotine dependence with the method of their choice whether this is NRT or disposable e-cigarettes. We combine either method with behavioural support.	We have considered the very few evidence of the effects of second-hand vaping on bystanders which does not support this possibility but also does not entirely dismiss the potential effects. Hence, our balanced decision to allow the use of e-cigarettes in open-air areas i.e. courtyards but not in communal indoor rooms.
Birmingham and Soilhull Mental Health NHS Foundation Trust	E-cigarettes use or ‘vaping’ must occur only outside, at no time inside any buildings.	This [e-cigarette policy] is currently under a review with our Smoking Steering Group. The e-cigarette section is part of that review and in particular the disposable and re-chargeable items.	Yes	Yes
Lincolnshire Partnership NHS Foundation Trust	In line with Lincolnshire Partnership NHS Foundation Trust (LPFT) Smoke Free Premises Policy (attached), we adhere to the following guidance: Restrictions on usage of e-cigarettes on LPFT Trust Premises • E-cigarettes can only be used in outside areas away from exits and entrances. They should not be used in proximity to other people who choose not to use them. • E-cigarettes should only be recharged using approved devices and methods. Recharging should be under the supervision of staff within a specific designated safe charging area away from sources of ignition and accelerants such as oxygen supplies. Once recharging is complete the device should be promptly disconnected and returned to safe storage. • Staff should be aware that fire risks whilst recharging e-cigarettes relate largely to:- - Use of incorrect or malfunctioning charger - Battery defects or overtightening of the battery - Overcharging of the product. • E-cigarettes contain batteries and must be disposed of in a designated bin as electronic waste.	LPFT has not banned E-cigarettes. Our current LPFT Smoke Free Premises Policy is scheduled for review in June/July 2018. We will reappraise our position at this time, taking into account PHE guidance and we will continue to work closely with our experts by experience, carers and staff to ensure our policies are evidence based, robust and usable.	Our vision at LPFT is to make a difference to the lives of people with mental health and learning disabilities. To promote recovery and quality of life through effective, innovative and caring services. We encourage smoking cessation and harm reduction through the use and availability of nicotine replacement therapy. We support the use of E-cigarettes rather than conventional cigarettes.	The evidence base is still limited and products are changing rapidly. At LPFT we support the belief that E-cigarettes are less harmful than conventional cigarettes and we will support our patients at every stage of their smoking cessation journey.
Oxford Health NHS Foundation Trust	We have banned them on our inpatient wards at the moment.	We have reviewed this decision–in light of the advice and new products that are now available. Plan is that we will pilot use with a particular brand of e cigarettes. We are working with patients on this pilot. The Pilot will be active within the next couple of months with short cycle before rolling out across all inpatient areas.	When the initial decision was made to ban e-cigarettes there was no guidance available. At the time there was concern about safety of the models available. However with the introduction of safe models to use on wards, the advice from public health and the fact that our patients are asking for them has meant that we have revisited our decision and are about to embark on a short pilot in one of our low secure wards with the aim to roll out across all services. Smoking cessation—encouraging their use as a proven aid to stop smoking.	We do not believe that there will be an increasing risk of second hand harm to patients by use of e-cigarettes. They are hazardous waste and need to be disposed of safely but we have plans in place to ensure that this happens.
Pennine Care NHS Foundation Trust	The Trust does not have a ban on the use of electronic cigarettes, they are however restricted. They cannot currently be used inside Trust Buildings. This includes Inpatient wards.	The Trust is currently considering its position on the use of e-cigarettes, particularly with regard to the implementation of Smoke Free NHS. This is both in the light of the advice provided from PHE and also as a result of the shared learning from a number of Trusts who are successfully managing the use of e-cigarettes. Additionally, the Trust has secured support from these Trusts in the reviewing of our position. This includes Trusts who have successfully managed this for mental health inpatient facilities. The advice and information from PHE together with the shared learning from these examples of successful implementation will contribute to the Trust’s review of it’s position with regard to e-cigarettes. The collation of this information for Board level discussions with regard to the way forward is currently being prepared.	The Trust considered this in formulating our initial decisions, however at that time the picture with regard to a wider variety of associated risks was significantly less clear than it now is. Genuine considerations such as fire/charger safety and unregulated products were also considered together with the unknown longer-term risks of e-cigarette use. As new and reliable information and experience has now been made available, the Trust is in a good position to consider our current approach. The health harm reduction benefits of e-cigarettes for individuals over tobacco cigarettes are now explicitly clear. The PHE advice and information with regard to this has been very helpful. Additionally, many of the other potential risks are far better understood now. The Trust feels this gives us an excellent base from which to consider and update our approach where appropriate.	The Trust considered any and all potential risks when developing it’s original position with regard to the use of e-cigarettes. This included any potential second-hand harm and tangential consequences (not only health related). The Trust will include any updated knowledge and information regarding these considerations as part of the review of our position. Our understanding of the current information and knowledge available is that there is not strong evidence of significant health harms from secondary ‘smoke’ as it is vapour and is not produced from a tobacco product, nor is it ignited as such. We are aware however of issues such as large clouds of strong smelling vapour being unpleasant for some people and possibly distressing to some people under some circumstances. We are also aware of the potential emergence of secondary markets associated with e-cigarettes (as there is with tobacco cigarettes). The Trust will remain vigilant with regard to this, particularly with our more vulnerable populations. We also remain vigilant about the possibility of e-cigarettes being implicated in fire setting (deliberate or accidental) and the very obvious second-hand harm that could bring. We are aware however of the significantly increased safety profile of these devices now over earlier, unregulated models.
Sheffield Health and Social Care NHS Foundation Trust	No, we permit these within our smoke-free policy	N/A	Yes, this is why we allow them	We only allow outdoor use; any second hand harm is likely to be small by comparison with either the direct or second hand effects of actual smoke
Northumberland, Tyne and Wear NHS Foundation Trust	No, selected e cigarettes are allowed	NTW has already agreed to supply a limited number of e-cigarettes on admission and allow purchase in hospital shops thereafter. We are modifying our policy and procedures accordingly.	Yes	We wish to avoid non-smokers being exposed to nicotine vapour so will restrict vaping in communal areas. We have concerns about possible long term effects of exposure to nicotine and/or excipients.
Oxleas NHS Foundation Trust	No	Yes as per policy	Yes	Monitoring please see policy about this
Dudley and Walsall Mental Health Partnership NHS Trust	The Trust currently has no ban in place. The draft smoke free policy which is in development does not exclude the use of electronic cigarettes, the policy stipulates that the devise must be a sealed unit identified by the Trust.	Currently we do not have a ban.	Yes this is under consideration by the smoke free steering group.	Yes this is under consideration by the smoke free steering group.
Worcestershire Health and Care NHS Trust	On review of the Trust’s smoke free policy it clearly states that we are mindful of common law and statutory duties to protect the health and safety of all our employees and therefore we do not support the use of e-cigarettes in the workplace. It is expected that staff treat e-cigarettes in the same way as other types of smoking. However, there are expectations to this in regard to patients as to whether special arrangements need to be made so that the person may be permitted to smoke on a trust site. I am aware that for inpatients the wards have no ban in place in regard to the use of e-cigarettes or vapes and this is encouraged for those individuals who wish to give up smoking. The ward environments treat e-cigarettes the same as normal cigarette and requests that patients use the outside areas to use these. It is expected that patients comply with this for the comfort of other patients. However the use of electronic cigarettes within our facilities is banned for staff.	At the present time there are no plans to review this position as our policy has been recently updated, however this will be kept under review to ensure any national guidance is reflected.	Physical health monitoring and promotion of positive physical health forms an important aspect of the work undertaken by our inpatient staff in supporting and promoting the physical health and wellbeing of our inpatients. As part of this the use of e-cigarettes or vapes is supported for those mental health patients who wish to give up smoking, alongside the use of other nicotine replacement products.	There does not appear to be evidence that second hand damage should be less of that than other types of smoking as the likelihood of individual harm is reduced. However, within the clinical environment there may be concern of different risks unrelated to the vapour that is expelled.
North Staffordshire Combined Healthcare	No, we allow the use of e cigarettes in outdoor spaces following our journey to “Tobacco Smoke Free” in April 2018.	N/A	Yes, in collaboration with our PH colleagues and supporting evidence.	We only allow the use of e- cigarettes in outdoor spaces.
Solent NHS Trust	Solent NHS Trust allows the use of disposable e-cigarettes, but not rechargeable vapes.		We did consider the harm of e-cigarettes, but compared it to the harm of normal tobacco and the implications on our patients.	In relation to second hand harm of e-cigarettes, this is minimised by only allowing their use in our open gardens.
Humber NHS Foundation Trust	No	N/A	Yes	Not presently

Camden and Islington NHS Foundation Trust

No

We believe that e cigarettes can be a valuable alternative to smoking tobacco and as such helpful to those on our in-patient acute wards and on longer stay rehabilitation wards by reducing their frustration at not being able to smoke, reducing associated aggression on the wards and the risks of hidden smoking articles which may start fires. We believe they may support individuals in stopping smoking tobacco. To support this we are providing some e cigarettes for people to try out and if they find they are an acceptable alternative to tobacco then they can purchase.

It would be of help if some of these products could be prescribed in the future.

North East London NHS Foundation Trust

Yes

Yes, we are currently going through a procurement process and have identified a tamper proof, single use e cigarette that would be appropriate for use on our mental health inpatient wards. We have consulted health and safety colleagues, service user groups and stop smoking colleagues in reaching this decision.

Yes, we did

We are and to that end patients will be able to use them in open/garden areas of wards but not in rooms where other patients would be subjected to the vapour. We are looking at a single use cigarette to eliminate the risk posed by charging. We are only considering tamper evident e cigarettes to eliminate the risk of drugs being introduced to the product.

Berkshire Healthcare NHS Foundation Trust

Yes

The policy is kept under review and in the light of the growing evidence relating to e-cigarettes and the recent information published by Public Health England, the Drug and Alcohol Lead at Prospect Park Hospital is revisiting the possibility of E-cigarettes as an alternative form of nicotine replacement. She has recently been in touch with a London Mental Health trust that has successfully introduced E-cigarettes and has arranged to go and visit this trust (in March) to see how this is practically implemented and associated risks managed. A supplier has also agreed to send some samples and there are plans to undertake a focus group with patients.

When the Smoke Free Policy was first introduced, the Trust considered the use of E-cigarettes as a means of harm reduction as an alternative to smoking but at the time as there was little, if any evidence that supported the use of e-cigarettes as a reliable and safe alternative form of nicotine replacement, a decision was made to ban the use of E-cigarettes and a decision taken to offer other nicotine replacement options to patients admitted to the wards.

Issues relating to second hand harm will be considered as part of the review of the Smoke Free Policy and the use of E-Cigarettes.

South London and Maudlsey NHS Foundation Trust

No. The SLaM smoke free policy, which was launched on 1st October 2014 recognises the potential benefits for smokers to be able to use e-cigarettes as part of their harm-reduction or quit plan. We support all e-cigarette use, and are committed to making e-cigarettes affordable and accessible.

Yes, our policy was informed by the available evidence as well as collaboration with our service user, carer and staff groups–all were keen to find a way to accommodate this new technology.

N/A

No, but we do place what we believe to be reasonable restrictions on where e-cigarettes can be used within the hospital environment. For example, out of respect for others we do not support vaping in shared spaces (such as dining areas and lounges), or in therapeutic sessions.

Bradford District Care NHS Foundation Trust

The use of E cigs within Bradford District NHS Care Foundation Trust is currently under review. Initially our trust did not support the use of E cigarettes due to us being one of the first trusts to go smoke free. At that point there was very little support for the use of E Cigarettes. However due to the current advice and evidence this is now under review. The trust is currently reviewing the use of the E cig as a platform to reduce smoking. There has been a wealth of information from public health England regarding the use of electronic cigarettes and we are working with a multi-agency approach including stop smoking services regarding the use of these within hospital grounds.

Currently the trust is reviewing its policy and is consulting on the use of e cigarettes. An agreement was made by the trust would be looking at e cigarettes only to be used in open spaces, this would include courtyard areas. The trust would discourage their use in confined and indoor spaces.

The use of e cigarettes as always been on the forefront of decision making, there has been considerable discussion around the potential benefits/ harm in relation to conventional cigarettes. Information from public health England has supported the potential use of them in reducing/ stopping smoking. There has also been considerable debate of the different types of electronic cigarettes, these being pre filled, disposable or the tank type cigarettes, concerns have been highlighted around the use of illegal substances in the refillable electronic cigarette types.

There are concerns expressed by some groups regarding any potential harm from second hand vapour. There continues to be reviews into the potential harm of this. The trust does acknowledge that there are some concerns and this has supported the idea of electronic cigarettes only being used in outside spaces.

Lancashire Care NHS Foundation Trust

LCFT’s nicotine management policy allows the use of disposable e-cigarettes by service users on in-patient wards subject to a risk assessment. This is because although nicotine replacement therapy (NRT) is available and actively promoted, we recognise that for some people e-cigarettes are helpful in managing their nicotine addiction and stopping smoking. We only allow the use of disposable e-cigarettes because of the misuse risks associated with refillable e-cigarettes, and the safety risks associated with battery operated e-cigarettes. E-cigarettes cannot be used by staff or visitors. This is because we do not wish to re-normalise smoking in public places. Allowing the use of e-cigarettes in public areas would also make it harder to implement the smoke free requirement; from a distance it is hard to know if someone is smoking a tobacco cigarette or an e-cigarette. We need to make it easy for staff to adhere to the policy and being clear that smoking behaviour in any public space is not allowed does this.

We consider our position to be compatible with Public Health England’s advice and review our policies and procedures when new advice or guidance is published.

The decision to allow e-cigarette use by inpatient service users, subject to a risk assessment, was taken following; a survey of staff and service users, a pilot of e-cigarette use in two areas of the trust, and the PHE guidance.

This concern, and a concern that the long-term health impact of e-cigarettes is unknown, was raised by staff and service users in the survey. Given PHE’s advice it was decided to allow the use of disposable e-cigarettes for inpatient service users subject to a risk assessment.

Essex Partnership Universities NHS Trust

Yes originally as part of our approach following advice from Pharmacy. Note the former South Essex Trust went smoke free in 2009

Yes we are reviewing and will likely allow e cigarettes in our revision of policy

Yes we did but was originally based on licensing and perceived fire risks

Not currently as we would not support within our building only outside

Black Country Partnership NHS Foundation Trust

Electronic Cigarettes can only be used in the designated smoking shelters which are situated outside the building.

We are working towards a smoke free Trust. E-cigarettes are under review in light of this and the advice from Public Health England

This is part of the move to a smoke free Trust.

Cheshire and Wirral Partnership NHS Foundation Trust

In our inpatient facilities yes, not in our community services.

We review this position several times a year and constantly review information relating to e-cigarettes.

Yes

Tees, Esk and Wear Valley NHS Foundation Trust

The Trust developed a smokefree Nicotine Management Policy (dated March 2016) in preparation to go fully smokefree on 9 March 2016. This policy is currently under review but the original version is attached (appendix 1).

TEWV fully support the use of all models of e-cigarettes/Vapes Trust wide except within the Forensic service where the decision was taken not to allow these due to the potential risks for their individual service users. In the original Policy (March 2016) both first and second generation e-cigs/vapes were allowed for use but following consultation the third generation tank models were also allowed for use. All rechargeable models are allowed following individual risk assessments. The revised Policy will reflect this information. In addition we have provided e-cigarette/vapes guidance for TEWV staff (appendix 2).

The Trust has also made available free disposable e-cigarettes to all inpatients over the age of 18 years and the Crisis team/136 Suite staff can also access these for service users at the earliest opportunity to help alleviate nicotine withdrawal. These have been well received and are readily available (other than Forensic service) Trust wide.

TEWV currently has no restrictions other than in the Forensic service. The Trust originally allowed the disposable and rechargeable models to be used but in October 2017 tank/reservoir models were also approved for use. Risk assessments are carried out for the rechargeable models. The Trust offer free disposable e-cigarettes on admission and work is ongoing to look at the possibility to provide free rechargeable models in the near future following discussion during the Nicotine Management Steering Group in January 2018.

Yes, TEWV fully considered the harm reduction potential hence the choice to allow their use Trust wide. Appendix 3 is the ASH 715 Briefing paper which was one of a number of guidance which supported the Trust’s stance on use of e-cigarettes.

Prior to going smokefree some ward staff were concerned about the side effects from the vape in bedrooms. The Nicotine Management team linked with PHE, FREShl and other national bodies to provide any evidence for staff on any risks or concerns with their use. Following implementation of the Policy and service user/staff use of e-cigarettes no further staff concerns have been raised and e-cigarettes are openly used throughout the Trust. E-cigarettes can be used in single occupancy bedrooms or outside but not in communal areas. The tank models are restricted to use outside as they have the potential to activate fire alarms.

Somerset Partnership NHS Foundation Trust

No. We are allowing the use of non-rechargeable, disposable, e-cigarettes. If patients are admitted without such devices we will supply a maximum of 3 e-cigarettes free of charge if the patient does not wish to use NRT

We have not banned e-cigarettes but will review the use of ‘tank’ e-cigarettes as the evidence of safe use is developed

Yes

Yes. With disposable e-cigarettes we are aware of the potential for the batteries to be ingested. With ‘tank’ e-cigarettes there is the potential for other substances to be smoked.

Sussex Partnership NHS Foundation Trust

No, we have not banned the use of electronic cigarettes in our facilities. We currently allow first generation disposable models.

We are currently reviewing this and the possibility to expand the range of e-cigarettes to second generation and exploring the use of rechargeable ones, whilst recognising the national alert.

Yes we did consider the harm reducing potential of e-cigarettes to conventional cigarettes in our decision making.

We have no evidence to support this at present but we remain open and continue to monitor this evidence and guidance from public health.

Devon Partnership NHS Foundation Trust

No, an agreed brand is allowed in outside areas and bedrooms.

N/A

Yes

Some staff have raised this, stating that as research has not yet been done, we cannot know if there is a risk of ‘secondary vaping.’ The e cigarettes we will allow produce very little vapour.

Derbyshire Healthcare NHS Foundation Trust

E-cigarettes have been banned for use by patients and also by visitors on our grounds. The initial decision was taken owing to lack of evidence regarding the longer term effects and more importantly the potential risk to mental health patients. The latter is owing to the potential alternative uses of the fluids or indeed the product itself regarding self-harm or harm to other people. However, following extensive benchmarking and feedback from patients and staff we have recently commenced a trial of e-burners which are single use e-cigarettes which do not have to be recharged and have proved less of a risk to MH patients. These have successfully been introduced in a number of MH Hospitals and secure units. As the trial only commenced after Christmas it is too early to assess the success or otherwise.

E-burners are classed as nicotine replacement by PH and this was part of the decision to introduce them.

Yes–mainly harm to staff from agitated patients. Also feedback from staff and patients.

Too early to review. We are only allowing the e-burners to be used outside and NOT on wards or other enclosed spaces.

Norfolk and Suffolk NHS Foundation Trust

No, we are encouraging the use of e-cigarettes as an alternative to burnt tobacco on the premises but outdoors

We understand and support PHE position that e-cigarettes are 95% safer than burnt tobacco

We do, that’s why we support use of e-cigarettes

We are not allowing use of e-cigarettes indoors for this reason, until the health risks are better understood

Coventry and Warwickshire Partnership NHS Foundation Trust

Smoking tobacco is not permitted in any part of any Trust property. As the Trust is a no smoking organisation staff are not allowed to smoke or vape e-cigarettes during paid working time. Therefore staff are not permitted to vape e-cigarettes on Trust property (inside or outside in our grounds). This restriction also applies to out-patients and visitors.

We do allow e-cigarettes for in-patients who are resistant to “Quit” or nicotine replacement therapy [NRT] products, in line with the Trust’s NRT guidance. The use of e-cigarettes is permitted for our mental health in-patients in the gardens / fresh air areas, and, following clinical risk assessment and care plan, the patient’s own bedroom. Appropriate areas are identified locally.

We have no plans to review staff use of e-cigarettes within trust properties (either inside or outside). We have recently reviewed and re-confirmed our stance on banning refillable re-usable e-cigarette’s by in-patients.

Yes. There were initial ethical and safety concerns about allowing patients access to and the use of e-cigarettes within our services. These were debated as part of agreeing our above position. We considered the harm reduction potential to out-weigh any potential harm.

Yes. Due to concerns about “second hand” e-cigarette vapour and also being seen to normalise the smoking of tobacco, use of e-cigarette’s was restricted to outside open defined spaces or a patient’s own-bedroom (all our bedrooms are single occupancy).

Northamptonshire Healthcare NHS Foundation Trust

No. The Trust decision was to permit the use of E-cigarettes and vapes, subject to a risk assessment. Vapes and E-cigarettes are only permitted in the garden areas. We have a supply of disposable E-cigarettes on each ward available to patients for the first 48 hours of admission. Patients can bring in their own E-cigarettes or vapes.

We have not banned them, but our decision to permit their use will be reviewed periodically.

Yes we did, additionally we considered the fact that they are “the next best thing” and would help patient who are struggling with nicotine withdrawal.

The potential for second-hand harm has been considered, the Trust took the decision to allow their use on the basis that if evidence is released that suggests detrimental second-hand harm the decision will be reviewed.

South Staffordshire and Shropshire Healthcare NHS Foundation Trust

Yes, until December 2017–now permitted in designated areas only

Position reviewed in 2017, following PHE position change

Yes

No–apart from staff/patients preference and impact on smell of products

2gether NHS Foundation Trust

No. E-cigarettes can be used in outside spaces only; however, we may consider changing the policy in due course.

We do not ban the use of e-cigarettes; however, our policy is under constant review

Yes we did, using what information there was available at the time.

We are aware that e-cigarettes deliver a higher level of nicotine compared to conventional NRT products, and this favours our client group due to their heavy smoking levels.

We would consider any advice from Public Health England. Currently we advocate the use due to the dramatically reduced risk of e-cigarettes compared to conventional cigarettes.

The situation is being constantly reviewed.

South West Yorkshire Partnership NHS Foundation Trust

Our current policy for a smoke-free environment does include a ban on the use of electronic cigarettes in our facilities.

The policy is currently under review and due to be amended by June 2018. This will specifically take into account the advice from Public health England

We will be considering the harm reduction potential of e-cigarettes in the formulation of our updated policy.

There are considerable concerns about the potential for second-hand harm caused by e-cigarettes and these will need to be mitigated against within our updated policy.

Leicestershire Partnership NHS Trust

We allow the use of electronic cigarettes within designated areas both inside and outside facilities.

We are continually reviewing the use of e-cigarettes within our facilities

Yes

No–current evidence does not suggest that there is any second hand harm.

Leeds and York Partnership NHS Foundation Trust

Currently e-cigarettes are not banned but there is designated outside areas for patients and the use of e-cigarettes. This is within the context of health promotional advice and the offer of nicotine replacement therapy.

The approach to improving physical health of mental health patients is under constant review and the use of e-cigarettes will be part of that; see response to question 1–we do not currently ban.

Yes

This will be kept under review as further evidence becomes available on second-hand harm but is mitigated by the designated smoking areas being outside at present.

Central and North West London NHS Foundation Trust

No, we have not banned them. Service users are able to use e-cigarettes that are of the disposable, non-rechargeable variety in their rooms and outside. However, we do restrict their use–we ask that they are not used in communal areas as some service users and staff have objected to passive inhalation of vapour.

We have recently reviewed the Trust’s position and have agreed that e-cigarette vending machines are to be provided in in-patient facilities. Service users will be able to purchase e-cigarettes if they so choose. The review of the use of e-cigarettes has been ongoing over a considerable period of time, as evidence has been made available. The Public Health England guidance was part of that evidence, but we were already reviewing the Trust position prior to its publication.

Although e-cigarettes are publicised as less harmful than cigarettes, there are gaps in the evidence base around long-term benefits and harms which should be addressed when encouraging their use with the general public.

In line with NICE guidance, that licensed nicotine containing products should be used primarily for those wishing to stop smoking, e-cigarettes should not be recommended as these are not yet licensed with the Medicines and Healthcare products Regulatory Agency. This is a situation that will change this year and the Trust will fully review the use of e-cigarettes once a licensed product is available.

It is recognised that patients with mental health problems suffer disproportionately high levels of harm from smoking and have low quit rates on standard smoking cessation approaches. Transition to e-cigarettes may be of benefit for this group, and should be actively encouraged as one part of a harm reduction approach. This should be aimed particularly at those who have tried and failed existing approaches including NRT and other smoking cessation medications, or are unwilling to try them.

We advise that prescription of Nicotine Replacement Therapy (NRT) or medication such as Varenicline, plus psychological support, is the preferred first choice of treatment for nicotine addiction/supporting smokers in a smoke-free environment.

However, we recognise that many find e-cigarettes helpful and understand that, if people choose to use them, they are likely to be less harmful than conventional cigarettes (the smoke from which contains tar and many toxins).

Strong views are held by both staff and service users. Whilst smokers find them a useful option, others have expressed concerns about the risks of passive inhalation and adverse publicity - there have been many conflicting articles in the media about conditions said to possibly be caused or exacerbated by e-cigarette vapour (eg ‘popcorn lung’). This results in confusion. In our opinion the main concern is the effects of using of food flavourings in vaporised form to enter the lung. This is something which little is known about and represents the largest potential risk from ‘passive vaping’ in our opinion.

The Trust stance is that if a service user chooses to use e-cigarettes to quit/abstain from their smoking habit, they should be encouraged to use them as a tool, rather than merely as a replacement, and be supported to gradually wean themselves off e-cigarettes.

Surrey and Borders Partnership NHS Foundation Trust

We have not banned the use of e-cigarettes but our policy is about banning all use of tobacco products on our premises. We actually provide e-lites for free for our inpatients as part of the cessation process.

N/A

Yes this is was fully considered when designing our Care 2quit programme and decided to not ban e-cigarettes, but to focus on the banning of tobacco products and their use on our premises. We also ensured that people had sufficient access to NRT and full screening was taking place on admission to ensure that all people who smoke receive brief advice on quitting and support where required.

Yes we reviewed this and the anxieties about possible unknown risks to both staff and people using services and as a result we banned the use of e-cigarettes in communal areas or in ward sleeping bays. People are only permitted to use these in their single bedrooms and/or gardens. We also considered the risk of the vaping smoke activating fire alarms and we took steps to mitigate these

West London Mental Health NHS Trust

No. However, we have banned electronic cigarettes purchased outside of the unit due to potential fire risks and the inability to monitor the contents of them. We sell a brand of electronic cigarette that has been accepted as ‘safe’. In two sites these are sold from a vending machine, in one further site they are sold directly from the wards.

We currently have no plans to ban or restrict the use of approved E-cigarettes sold on-site. The ECigs we sell on site are sold for £3 which is considerably cheaper than retail shops on the high street. Currently we do not have any plans to allow other Ecigs due to the potential fire risks and the inability to monitor the contents of them.

Yes we did. Hence, the active promotion of ECigs in addition to a range of NRT products when the Trust implemented the smoke-free policy in January 2016. Prior to introducing a trust wide ban on smoking we made the decision to allow the use of electronic cigarettes (not in wards communal areas) as a harm reduction intervention. In addition we put in place a comprehensive smoking cessation strategy and interventions.

Research has so far shown the potential second hand harm is minimal. However, we encourage these to only be used in the patient’s own bedroom to minimise any discomfort or harm to other patients, staff and visitors. Given current evidence and the fact that electronic cigarettes cannot be used in communal areas we do not have any significant concerns regarding second-hand harm caused by electronic cigarettes.

Cornwall Partnership NHS Foundation Trust

Yes

We are currently reviewing our policy

Yes

Barnet, Enfield and Haringey Mental Health NHS Trust

No, we have actively encouraged them as part of supporting our smokefree policy since 17.1.17 (and since 2015 in our forensic unit) and have provided them to service users ourselves in emergency (in addition to providing NRT in a range of forms); in other circumstances we make it possible for them to purchase e-cigarettes on hospital premises or encourage relatives to bring them in. We also encourage the use of vapes on our premises, noting that disposable e-cigarettes are not sufficient for all service users to help them to manage without cigarettes. Protocol attached. We have noted though that vapes can set off smoke alarms in confined spaces or when used deliberately to do so, so we have had to limit their use in certain ward areas.

N/A

Yes as above

Not really. A few people have raised it, both on health and nuisance grounds but mainly due to the fire alarm issue. But we support ward managers to limit vape use in areas where it causes a nuisance. This has not prevented widespread use of e-cigarettes.

Avon and Wiltshire Mental Health Partnership NHS Trust

We have implemented a smoke free policy. Patients and staff are not permitted to smoke inside the buildings. Service users can use approved eBurns and Vapes in the grounds away from the ward.

The Trust continually reviews implementation of the policy including the recent advice from PHE. We also need to consider other factors which would require the replacement of our current fire detection systems if eBurn and Vaping were to be permitted inside.

The risk and benefits were considered in preparing the current policy

The Trust is concerned regarding second-hand harm including the needs of non-smokers in relation to the smoke from vapes. We will continue to monitor the emerging evidence regarding the use of these devices and adopt best practice wherever possible.

North West Boroughs Healthcare NHS Foundation Trust

When the Trust originally committed to becoming smokefree in the summer of 2016, a decision was made to not allow electronic cigarettes within our mental health inpatient units. At the time, there were concerns regarding the safety of these devices and the potential associated risks for patients and staff. Therefore at this point, they were not included within the policy as a treatment option. However a further review was undertaken 12 months later as local intelligence and patient/carer feedback suggested a demand for these products, as many patients has used them before admission. The licensed Nicotine Replacement Therapy products were not accepted by all patients, so we looked at the least restrictive practice in relation to provision of nicotine replacing products for mental health in-patients within the Trust. With the benefit of shared experiences from other Trusts and taking into consideration the evidence review (McNeill et al, 2015) commissioned by Public Health England, a decision was taken to allow one specific brand of disposable e-cigarettes as a nicotine dependency treatment option. We commenced providing the choice of Nicotine Replacement Therapy or disposable e-cigarettes in December 2017.

We do allow the use of e-cigarettes as outlined in question 1 and have seen increased compliance with our smoke free policy as a result.

Yes. We also took into consideration the review of underpinning evidence (McNeill et al, 2015) commissioned by Public Health England.

Yes. We will continue to monitor this and ensure we deliver our services in line with national evidence base and best practice.

Kent and Medway NHS and Social Care Partnership Trust

(Extracts from their smokefree policy)

Only disposable devices with prefilled cartridges may be used (see Appendix B). Rechargeable devices of this type are not permitted due to the risks associated with charging. E-cigarette use is only permitted for patients, visitors and contractors in designated areas e.g. hospital grounds and courtyards, but not in communal indoor areas or bedrooms.

N/A

E-cigarettes are battery powered devices that deliver nicotine via inhaled vapor. Since e- cigarettes do not contain tobacco and are not burnt, they do not result in the inhalation of cigarette smoke they are therefore regarded by most experts as much safer delivery devices for nicotine. This does not mean that they are completely safe, but they are envisaged to be much less harmful than cigarettes.

E-cigarette use should only be permitted in discrete places and never be permitted in areas where patients and staff congregate.

Mersey Care NHS Foundation Trust

We have not banned the use of e-cigarettes and are following the advice from PHE and the CQC about their benefits to support service users who are dependent on nicotine. E-cigarettes are in the repertoire of Nicotine Replacement Therapies we support for the people who use our services.

We have currently banned the use of e-cigarettes in our High Secure Service, which is consistent with the other two HSS Trusts. However, we are meeting to review this decision to clarify the clinical, risk and/or security grounds which inform this decision. We may also review the decision in the light of service users’ experience in using e-cigarettes in our medium and low secure services or if other appropriate products become available.

The Trust considered, and is supportive of, the harm reducing potential of e-cigarettes and recognises they may be of assistance to enable some smokers to move away from using harmful burnt tobacco towards a cleaner form of nicotine delivery, and may ultimately help them to give up smoking in the longer term if they make this decision. In addition, the Trust strongly supports service users’ choice and preferences in their recovery, and our service users informed us that having e-cigarettes as an available option would allow them to make positive improvements in both their physical and psychological well-being. We consider collaboration and choice to be an essential component of our least restrictive and co-produced approach to care within the Trust.

The Trust will continue to review its position on e-cigarettes, including if any risks are identified in future as new evidence and guidance emerges. This will include regular reviews, as it would any other new aspect of practice and care, to ensure the Trust, its staff and the people we serve are kept fully informed by contemporary findings and safety information so that we continue to support best practice and safe care in this developing area.

Dorset Healthcare University NHS Foundation Trust

No

N/A

Yes

We believe the potential for harm reduction through supporting the use of e-cigarettes to far outweigh any concerns regarding exposure to secondhand vapour. The NCSCT’s Electronic cigarettes briefing indicates that “some studies have found traces of toxicants in secondhand vapour, but at such low levels that they do not pose a health risk to bystanders. There is no evidence that secondhand vapour is dangerous to others; however, it helps to be respectful when using e-cigarettes around others, especially non-smokers.” We have taken this evidence into consideration in our smokefree policy. We do ask our patients and staff not to use e-cigarettes in communal spaces limiting such exposure and normalisation of their use.

Southern Health NHS Foundation Trust

No, we encourage their use.

We only restrict the use of some models of e-cigarette for reasons of fire safety.

Yes, based on strong research evidence of harm reduction.

No, but we discourage use in shared areas so as to not affect others at all.

Tavistock and Portman NHS Foundation Trust

Yes we have banned the use of electronic cigarettes in our facilities after careful consideration. We are an out -patient facility and the majority of our patients are children, young people and families. Our patients are on our premises for short periods to attend out -patient appointments. We banned the use of electronic cigarettes as we did not wish our young patients and families to see patients, staff or visitors using any form of cigarette which might imply our condoning this behaviour

Yes, our smoke free policy (May 2017) will be reviewed in May 2018 on the basis of an updated review of current evidence including PHE advice.

Yes, we did and we encourage and support staff and patients to take up interventions to stop or reduce smoking tobacco through appropriate means including switching to electronic cigarettes as a substantially safer alternative for when they are not on Trust premises.

Yes.

Nottinghamshire Healthcare NHS Foundation Trust

Staff and visitors–yes.

Patients–Yes in the Trust’s Forensic Service Division

No in the Trust’s Local Partnership Division (in-patient mental health units]. Use is restricted to just one type of disposable e-cigarette called E-burn due to unique safety features and the fact that numerous other Trusts and some prisons are allowing their use.

Yes our position will be under constant review and decisions will be made according to guidance and the emerging evidence-base.

Yes

We are guided by PHE advice, 2016 “the constituents of cigarette smoke that harm health–including carcinogens–are either absent in e-cigarette vapour or, if present, they are mostly at levels much lower than 5% of smoking dose (mostly below 1% and far below safety limits for occupational exposure)”

Cambridgeshire and Peterborough NHS Foundation Trust

In our facilities we do not permit the use of electronic cigarettes indoors. We do allow the use of electronic cigarettes among service users in ward gardens and allow staff members to use electronic cigarettes outdoors during break times.

On 1 October 2017 CPFT banned smoking and the use of all electronic cigarettes and vaporisers on our premises. This policy was amended in December 2017 to allow for the use of electronic cigarettes and vaporisers in outdoor areas in light of feedback from staff on our wards. The decision to allow the use of electronic cigarettes and vaporisers in outdoor areas was reflective of the evidence and recommendations presently available from Public Health England. The CPFT Smoke Free policy will be monitored and amended as additional evidence becomes available.

The harm reduction potential of electronic cigarettes was a factor in our decision to allow electronic cigarettes and vaporisers on our grounds. As noted above, the Trust will continually monitor our Smoke Free Policy as additional evidence becomes available from Public Health England around the risks and benefits of electronic cigarette use.

At the moment there is no evidence to suggest that electronic cigarettes or vaporisers cause harm to non-users. As we have restricted the use of electronic cigarettes and vaporisers to outdoor areas only we do not currently have any concerns around the potential for secondary harm to service users or staff. We welcome updates from Public Health England around the second-hand risks of electronic cigarettes as research in this field progresses.

South West London and St George’s Mental Health NHS Trust

SWLSTG NHS Trust has adopted an interim E-cigarette Protocol to support patients to manage their nicotine dependence whilst hospitalised. Patients wishing to use e-cigarettes as part of their nicotine management programme can bring/purchase the brand of their choice as long as those are disposable and non-rechargeable e-cigarette devices. Patients are allowed to use e-cigarettes in designated areas of the wards i.e. their individual bedrooms and courtyards but should refrain from vaping at indoor communal areas. The protocol prohibits the use of e-cigarettes in any other areas of the Trust grounds and/or buildings. E-cigarettes use by outpatients, staff and visitors is currently prohibited across Trust premises.

We are currently reviewing our existing e-cigarette protocol to ensure that it is in line with the new PHE and NICE recommendations. However, we also take into consideration the needs and views of our service users, carers and staff.

Despite the limited evidence on the long term health effects of e-cigarettes, there’s been some evidence that vaping is 95% less harmful than smoking. Our inpatients are being professionally supported to manage their nicotine dependence with the method of their choice whether this is NRT or disposable e-cigarettes. We combine either method with behavioural support.

We have considered the very few evidence of the effects of second-hand vaping on bystanders which does not support this possibility but also does not entirely dismiss the potential effects. Hence, our balanced decision to allow the use of e-cigarettes in open-air areas i.e. courtyards but not in communal indoor rooms.

Birmingham and Soilhull Mental Health NHS Foundation Trust

E-cigarettes use or ‘vaping’ must occur only outside, at no time inside any buildings.

This [e-cigarette policy] is currently under a review with our Smoking Steering Group.

The e-cigarette section is part of that review and in particular the disposable and re-chargeable items.

Yes

Lincolnshire Partnership NHS Foundation Trust

In line with Lincolnshire Partnership NHS Foundation Trust (LPFT) Smoke Free Premises Policy (attached), we adhere to the following guidance:

Restrictions on usage of e-cigarettes on LPFT Trust Premises

• E-cigarettes can only be used in outside areas away from exits and entrances. They should not be used in proximity to other people who choose not to use them.

• E-cigarettes should only be recharged using approved devices and methods. Recharging should be under the supervision of staff within a specific designated safe charging area away from sources of ignition and accelerants such as oxygen supplies. Once recharging is complete the device should be promptly disconnected and returned to safe storage.

• Staff should be aware that fire risks whilst recharging e-cigarettes relate largely to:-

- Use of incorrect or malfunctioning charger

- Battery defects or overtightening of the battery

- Overcharging of the product.

• E-cigarettes contain batteries and must be disposed of in a designated bin as electronic waste.

LPFT has not banned E-cigarettes. Our current LPFT Smoke Free Premises Policy is scheduled for review in June/July 2018. We will reappraise our position at this time, taking into account PHE guidance and we will continue to work closely with our experts by experience, carers and staff to ensure our policies are evidence based, robust and usable.

Our vision at LPFT is to make a difference to the lives of people with mental health and learning disabilities. To promote recovery and quality of life through effective, innovative and caring services. We encourage smoking cessation and harm reduction through the use and availability of nicotine replacement therapy. We support the use of E-cigarettes rather than conventional cigarettes.

The evidence base is still limited and products are changing rapidly. At LPFT we support the belief that E-cigarettes are less harmful than conventional cigarettes and we will support our patients at every stage of their smoking cessation journey.

Oxford Health NHS Foundation Trust

We have banned them on our inpatient wards at the moment.

We have reviewed this decision–in light of the advice and new products that are now available. Plan is that we will pilot use with a particular brand of e cigarettes. We are working with patients on this pilot. The Pilot will be active within the next couple of months with short cycle before rolling out across all inpatient areas.

When the initial decision was made to ban e-cigarettes there was no guidance available. At the time there was concern about safety of the models available.

However with the introduction of safe models to use on wards, the advice from public health and the fact that our patients are asking for them has meant that we have revisited our decision and are about to embark on a short pilot in one of our low secure wards with the aim to roll out across all services.

Smoking cessation—encouraging their use as a proven aid to stop smoking.

We do not believe that there will be an increasing risk of second hand harm to patients by use of e-cigarettes.

They are hazardous waste and need to be disposed of safely but we have plans in place to ensure that this happens.

Pennine Care NHS Foundation Trust

The Trust does not have a ban on the use of electronic cigarettes, they are however restricted. They cannot currently be used inside Trust Buildings. This includes Inpatient wards.

The Trust is currently considering its position on the use of e-cigarettes, particularly with regard to the implementation of Smoke Free NHS. This is both in the light of the advice provided from PHE and also as a result of the shared learning from a number of Trusts who are successfully managing the use of e-cigarettes. Additionally, the Trust has secured support from these Trusts in the reviewing of our position. This includes Trusts who have successfully managed this for mental health inpatient facilities. The advice and information from PHE together with the shared learning from these examples of successful implementation will contribute to the Trust’s review of it’s position with regard to e-cigarettes. The collation of this information for Board level discussions with regard to the way forward is currently being prepared.

The Trust considered this in formulating our initial decisions, however at that time the picture with regard to a wider variety of associated risks was significantly less clear than it now is. Genuine considerations such as fire/charger safety and unregulated products were also considered together with the unknown longer-term risks of e-cigarette use. As new and reliable information and experience has now been made available, the Trust is in a good position to consider our current approach. The health harm reduction benefits of e-cigarettes for individuals over tobacco cigarettes are now explicitly clear. The PHE advice and information with regard to this has been very helpful. Additionally, many of the other potential risks are far better understood now. The Trust feels this gives us an excellent base from which to consider and update our approach where appropriate.

The Trust considered any and all potential risks when developing it’s original position with regard to the use of e-cigarettes. This included any potential second-hand harm and tangential consequences (not only health related). The Trust will include any updated knowledge and information regarding these considerations as part of the review of our position.

Our understanding of the current information and knowledge available is that there is not strong evidence of significant health harms from secondary ‘smoke’ as it is vapour and is not produced from a tobacco product, nor is it ignited as such.

We are aware however of issues such as large clouds of strong smelling vapour being unpleasant for some people and possibly distressing to some people under some circumstances.

We are also aware of the potential emergence of secondary markets associated with e-cigarettes (as there is with tobacco cigarettes). The Trust will remain vigilant with regard to this, particularly with our more vulnerable populations.

We also remain vigilant about the possibility of e-cigarettes being implicated in fire setting (deliberate or accidental) and the very obvious second-hand harm that could bring. We are aware however of the significantly increased safety profile of these devices now over earlier, unregulated models.

Sheffield Health and Social Care NHS Foundation Trust

No, we permit these within our smoke-free policy

N/A

Yes, this is why we allow them

We only allow outdoor use; any second hand harm is likely to be small by comparison with either the direct or second hand effects of actual smoke

Northumberland, Tyne and Wear NHS Foundation Trust

No, selected e cigarettes are allowed

NTW has already agreed to supply a limited number of e-cigarettes on admission and allow purchase in hospital shops thereafter. We are modifying our policy and procedures accordingly.

Yes

We wish to avoid non-smokers being exposed to nicotine vapour so will restrict vaping in communal areas. We have concerns about possible long term effects of exposure to nicotine and/or excipients.

Oxleas NHS Foundation Trust

No

Yes as per policy

Yes

Monitoring please see policy about this

Dudley and Walsall Mental Health Partnership NHS Trust

The Trust currently has no ban in place. The draft smoke free policy which is in development does not exclude the use of electronic cigarettes, the policy stipulates that the devise must be a sealed unit identified by the Trust.

Currently we do not have a ban.

Yes this is under consideration by the smoke free steering group.

Worcestershire Health and Care NHS Trust

On review of the Trust’s smoke free policy it clearly states that we are mindful of common law and statutory duties to protect the health and safety of all our employees and therefore we do not support the use of e-cigarettes in the workplace. It is expected that staff treat e-cigarettes in the same way as other types of smoking. However, there are expectations to this in regard to patients as to whether special arrangements need to be made so that the person may be permitted to smoke on a trust site. I am aware that for inpatients the wards have no ban in place in regard to the use of e-cigarettes or vapes and this is encouraged for those individuals who wish to give up smoking. The ward environments treat e-cigarettes the same as normal cigarette and requests that patients use the outside areas to use these. It is expected that patients comply with this for the comfort of other patients. However the use of electronic cigarettes within our facilities is banned for staff.

At the present time there are no plans to review this position as our policy has been recently updated, however this will be kept under review to ensure any national guidance is reflected.

Physical health monitoring and promotion of positive physical health forms an important aspect of the work undertaken by our inpatient staff in supporting and promoting the physical health and wellbeing of our inpatients. As part of this the use of e-cigarettes or vapes is supported for those mental health patients who wish to give up smoking, alongside the use of other nicotine replacement products.

There does not appear to be evidence that second hand damage should be less of that than other types of smoking as the likelihood of individual harm is reduced. However, within the clinical environment there may be concern of different risks unrelated to the vapour that is expelled.

North Staffordshire Combined Healthcare

No, we allow the use of e cigarettes in outdoor spaces following our journey to “Tobacco Smoke Free” in April 2018.

N/A

Yes, in collaboration with our PH colleagues and supporting evidence.

We only allow the use of e- cigarettes in outdoor spaces.

Solent NHS Trust

Solent NHS Trust allows the use of disposable e-cigarettes, but not rechargeable vapes.

We did consider the harm of e-cigarettes, but compared it to the harm of normal tobacco and the implications on our patients.

In relation to second hand harm of e-cigarettes, this is minimised by only allowing their use in our open gardens.

Humber NHS Foundation Trust

No

N/A

Yes

Not presently

Appendix 1: Analysis of replies from English NHS mental health trusts in response to the Committee’s questions