Smoke-free hospitals: finger-wagging at the working class?

Back in 2004 John Reid went against the grain by warning the anti-smoking lobby that they ran the risk of “patronising” the working class. 

His comments still echo into 2016 and through the announcement of a total ban on smoking in hospital grounds in Northern Ireland.

First things first, though: the ban isn’t about “smokers outside the hospital doors” and nor is the issue at hand, as this would be solved by a simple smoking shelter policed with the zeal (and funds) officials have now found to pester smokers at their lowest ebb. It isn’t about whether people should be smokers. And it isn’t about helping people to stop smoking either, as telling a concerned relative or sick patient to stop smoking right this second without the element of choice and the willpower to quit is hardly an ideal technique.

Instead, have a listen again to the vox pop on Nolan Live (see 42min 50secs) to see if you spot something interesting? In short; those for and against the total ban – neatly smoke-screened inside the emotive issue of those hospital door smokers – are broadly divided on the issue into two groups depending on the person’s accent. If you don’t want to watch the clip, you can probably guess the rest.

While I very much dislike attempting to stereotype strangers based on their accent, there’s something pretty distinct going on the vox pop in that the more ‘posh’ voices (who are statistically less likely to be smokers) were generally in favour of a ban.

A commentator on the show, Andrea McVeigh, felt that the smokers should either do without or accept the help offered to give up on the spot.

And therein lies the problem. A complete ban, including on those smoking in their own car, is essentially telling those with a genuine addiction visiting a sick or dying relative (and the medical staff trying to save that person’s life) that, in the case of the former they should stop smoking that second or go elsewhere at what could be one of the lowest ebbs in their life.

I wouldn’t have liked to have seen someone say that to my very elderly, former POW, grandfather when he was alive. A former professional barman, his family and “a wee smoke” were his favourite things in life. And in later his years and condition he would have been distressed and confused by being told to ‘just go without’ or wear a patch.

Statistics from England in 2014 show that unemployed people were twice as likely to smoke and that those in “manual” or “routine” jobs were over twice as likely to smoke as “managerial” and “professional” respondents.

And social policy academic Professor Paul Stickler has written that “figures from the UK show that people in lower social classes, including children, are more likely to suffer from infective and parasitic diseases, pneumonia, poisonings or violence” while “adults in lower social classes are more likely, in addition, to suffer from cancer, heart disease and respiratory disease”.

Meaning that those most likely to be most affected by the total ban could also be more likely to find themselves in hospital sooner. And for the worst possible reasons, at the worst possible time.


Full disclosure: there is something I find concerning about the health promotion lobby in that, among some excellent and valuable work, surely their support for one ban or another is limitless in nature as campaign after campaign must continue to be staged to keep the salaries – paid for by taxes and charity donations – flowing?

For example: I remember watching the Press Association (Northern Ireland) website in the days around the announcement that smoking would be banned in bars here. The debate moved on to binge drinking in less than 24 hours.

Back to the ban then and, while one South Eastern Trust patient is legally challenging the consultation behind the ban, I’m certain the surveys used by hospitals will be checked to ensure it was made clear that smoking in a person’s own car would be included as opposed to making the issue about smoking at hospital doors.

Notes from a Royal College of Nursing debate raised concerns about “policing the behaviour of our patients” and asked what this would do to the therapeutic relationship. A concerned hospital worker quoted in the Andersonstown News points out that one smoking warden is employed at the Royal Victoria Hospital. In the article the Belfast Trust responds that the warden is being paid for by the Public Health Agency and that “all staff” are expected to do their part to assist in enforcing the ban.

The hospital employee also explained that “there are leaflets everywhere” (i.e., more funding found in austere times) and wondered “what if a loved one has died?”.

Conscious that no one is on hospital grounds for any fun reason or likely to be in a mood to make an instant decision on their health choices, I’m mindful that those smokers (and non-smokers who support them) are – to use Nolan Live as an example – represented against officialdom and their backers by the likes of a drafted-in Anthony Worrall Thompson, if by anyone at all.

Who, then, represents those concerned in Northern Ireland when the quangos, charities and civil servants get fired-up and go too far? Although all that tax revenue might cause a few raised eyebrows in other government departments if they really did become far too effective.

Ultimately, there’s a difference between a helping hand held outwards and a wagging finger pointed downwards. And there’s a time and a place for strong-arm tactics and lecturing.

Among the sick and grieving is no place for either.

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