My doctor father used to regularly set his trousers on fire. Born in 1924, he started smoking cigarettes as a teenager. He died of a smoking related cancer in 2003. My doctor grandfather served in the Royal Army Medical Corps in the first world war and died, when my father was 14, of smoking related cancer (and possibly some damage from mustard gas). I never met him.
My father tried but failed to stop his tobacco use. As public and medical attitudes to tobacco changed, he reduced his tobacco consumption. He almost broke the habit at home and when caught out would stuff his still smouldering pipe in his pocket. I perfected my darning skills aged 10 fixing singed holes in his tweedy jacket. At work was the worst, as there was no ban on smoking and no pressure on him to cut back.
When my father practised medicine doctors used to prescribe cigarettes, and doctors and nurses were used in tobacco advertising campaigns. You could smoke in the Department of Health, smoke in hospital corridors, and ward coffee rooms—you could even smoke on NHS hospital wards. Have you seen the genial 1950s Doctor Turner seeing patients in a fug of smoke in BBC1’s excellent series Call the Midwife? I can go one better: in the early 1980s I was taught what was then known as venereology by a charming doctor who would put down his fag, don gloves, do a pelvic exam, take off the gloves, and finish the cigarette while his patient put her underwear back on.
This would all be unthinkable now. Attitudes changed, fought every step of the way by the tobacco industry. We know that tobacco use is addictive, but also that it’s a learnt and socially mediated behaviour.
A kind of misguided sympathy keeps the last vestiges of tobacco acceptability alive in the NHS. We falter before ill patients in pyjamas dragging their IV fluid stands out onto the winter street in front of a hospital to have a fag, we pass with no comment past colleagues clustered around the emergency department exit having a communal smoke—some staff even smoke with patients at the exits of mental health units or in the last few remaining smoking shelters. And everywhere there’s the evidence of cigarette butts crunching underfoot along NHS paths and garden areas.
I too used to thoughtfully wheel ill folks out on hospital balconies so that they could have a fag. I believe now that staff should focus their efforts on making sure every smoker (and that is one in six people admitted to the NHS and half of all admitted to mental health facilities) gets nicotine replacement therapy and stop smoking advice in the first critical hours. By actually doing this, I have seen many recalcitrant older smokers stop, including my own mother-in-law.
Working with the UN as a doctor during the Bosnian war in the 1990s, I would stop at checkpoints to have a cigarette with the local commanders to show solidarity and help get my convoys through. It might have been a bit harder, but I could have made the same bond with a cup of tea or a greeting in their language, and some of my co-workers did just that.
And finally, till six years ago I used to smoke a cigarette annually with my best friend in Belgrade, who lost her son in tragic circumstances. I stopped doing that and stick to coffee. We are still friends and I am still able to share that anniversary with her.
None of my justifications for colluding with tobacco use still hold water. Tolerating tobacco smoking on NHS premises is a form of collusion. Staff who smoke in NHS uniforms are sending a very clear pro-tobacco signal. Health staff who smoke with patients are empathising in a harmful way. Colleagues who smoke deserve all our support to kick the habit at work. A campaign to make the NHS smoke free was launched in 2006. Ten years on, the job is not done yet—here is the latest call to change that.
A tobacco-free NHS means:
• No smoking anywhere in NHS buildings or grounds
• Stop smoking support offered on site or with referrals to local services
• Every frontline professional discussing smoking with their patients
The NHS is not yet smoke free. But it’s time that it was. If this had happened years ago then perhaps I would not be able to darn so well. Perhaps my father would still be alive.
Mary E Black is head of digital strategy at Public Health England. She is on Twitter @DrMaryBlack.
Competing interests: I have no relevant interests to declare.