Introduction: scope and purpose of this guidance
The guidance supersedes recommendations 6, 7, 12, 15 and 16 in Smoking cessation services (NICE public health guidance 10), where they apply to secondary care.
The guidance complements but does not replace, NICE guidance on stopping smoking. (For further details, see Related NICE guidance.) In particular, it should be read alongside NICE guidance on quitting smoking in pregnancy and following childbirth (NICE public health guidance 26) and tobacco: harm-reduction approaches to smoking (NICE public health guidance 45).
Stopping smoking at any time has considerable health benefits for people who smoke, and for those around them. For people using secondary care services, there are additional advantages, including shorter hospital stays, lower drug doses, fewer complications, higher survival rates, better wound healing, decreased infections, and fewer re-admissions after surgery.
Secondary care providers have a duty of care to protect the health of, and promote healthy behaviour among, people who use, or work in, their services. This duty of care includes providing them with effective support to stop smoking or to abstain from smoking while using or working in secondary care services.
Strong leadership and management to ensure secondary care premises (including grounds, vehicles and other settings involved in delivery of secondary care services) remain smokefree – to help to promote non-smoking as the norm for people using these services.
All hospitals have an on-site stop smoking service.
Identifying people who smoke at the first opportunity, advising them to stop, providing pharmacotherapy to support abstinence, offering and arranging intensive behavioural support, and following up with them at the next opportunity.
Providing intensive behavioural support and pharmacotherapy as an integral component of secondary care, to help people abstain from smoking, at least while using secondary care services.
Ensuring continuity of care by integrating stop smoking support in secondary care with support provided by community-based and primary care services.
Ensuring staff are trained to support people to stop smoking while using secondary care services.
Supporting all staff to stop smoking or to abstain while at work.
Ensuring there are no designated smoking areas, no exceptions for particular groups, and no staff-supervised or staff-facilitated smoking breaks for people using secondary care services.
In this guidance, 'secondary care' refers to all publicly-funded secondary and tertiary care facilities, including buildings, grounds and vehicles. It covers drug and alcohol services in secondary care, emergency care, inpatient, residential and long-term care for severe mental illness in hospitals, psychiatric and specialist units and secure hospitals and planned specialist medical care or surgery. It also includes maternity care provided in hospitals, maternity units, outpatient clinics and in the community.
The term 'smokefree' is used to mean air that is free of tobacco smoke.
See About this guidance for details of how the guidance was developed and its current status.
The guidance is for: commissioners, clinical leads in secondary care services, health and social care practitioners, leaders of the local health and care system, managers of clinical services, estate managers and other managers, trust boards, and other staff with any aspect of secondary care or public health as part of their remit. The guidance may also be of interest to people using secondary care services, their families and carers and other members of the public.