Front Line Focus: In a fug over smoking ban

So England will be smoke-free from next week. Implementing the ban is straightforward in places such as pubs and railway stations where people are there from choice and can go outside if they wish to smoke.

But what about people living in residential care settings? These may be public places for the care staff and others going into them, but for the residents they are their homes. These include people in adult residential care and nursing homes, long-stay hospitals, hospices, and mental health units.

For those who live in their own homes and receive domiciliary care, choice about what they do there may seem sacrosanct – until it is described as a workplace for domiciliary staff.

Many model policies and guidelines are available but putting them into practice presents challenges that are both ethical and practical. The Royal College of Nursing guidelines point out that “a time of acute crisis or ill health may be an inappropriate time to ask the patient to stop smoking”. And what about the personal safety issues and health risks to service users and staff if they have to go outside and away from the building at night or in bad weather to light up?

Some local authorities require people receiving domiciliary care to stop smoking one to two hours before staff visit, and to open the windows. Feasible, perhaps, if all appointments run to time and in warm weather, but what happens in winter, especially to frail older people already worried about heating costs?

If smoking is forbidden in communal areas but allowed in residents’ own rooms, will they be less well-supervised when they smoke and at more risk from dropped cigarettes? There is also a social dynamic to smoking, where friendships are made over the shared cigarette, or disrupted when the smoking lounge no longer exists.

For an organisation like ours – whose mission is to promote good practice to ensure high quality care services – the change in legislation poses many dilemmas. Many employers of social care workers too will be trying to find the balance between respecting service users choices and rights and carrying out their duty of care to staff. Watch this (smokefree) space.

Liz Willetts is head of education and training at the Social Care Association. SCA has produced a Practice Guide on the Smoking Ban to help organisations to address the issue. Contact for further details.

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