• Mark Shipley and Robert Allcock.
• Gateshead Health NHS Trust, Queen Elizabeth Hospital, Sheriff Hill, Gateshead NE9 6SX, UK. drmdshipley@hotmail.com
• J Public Health (Oxf). 2008 Mar 1;30(1):2-7.

BackgroundIn December 2006, all UK NHS trusts introduced smoke-free regulations prohibiting smoking on all NHS sites. These rules are to be enforced by all NHS trust staff. We have investigated the implementation of these regulations by health care workers when they encounter smokers on a NHS hospital site.MethodsEighty-five medical and nursing staff working in acute medicine at the Queen Elizabeth Hospital, Gateshead, completed a questionnaire reporting their behavior when exposed to smokers on NHS hospital sites.ResultsOver 50% of medical and nursing staff reported that they would not challenge patients, staff or visitors smoking on NHS trust site. There was a trend for employees to be more likely to challenge patients than visitors, and to be more likely to challenge visitors than other staff. Fear of aggression was the most commonly reported reason for not challenging smokers.ConclusionsMost medical and nursing staff report that they do not enforce NHS smoke-free regulations and do not challenge smokers on NHS sites. This is due to many real and perceived barriers including fear of aggression. Overcoming these barriers is an important area of research to guide successful implementation of future smoking policy. There may be scope for improvement through training in NHS policy and in non-confrontational communication skills.

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