Posted By Katiem
Hi there,
ok I know this one is a political mine field, but I'm looking for some guidance on developing policy in this area.

I work for a large organisation that provides social care in scotland. In the coming year there is going to be a ban on smoking in public places.

We already have a "smoking policy" in terms of the current requirements, but more and more members of staff are rising the issue of passive smoke. For example, our staff have to work within the community, going into clients homes where the client might smoke or they might work in non residential setting where clients smoke. It is simple to give guidance in this area, in so much as asking clients to refrain from smoking whilst care staff are there etc...(this doesn't work with people how have dementia) but how can you actually construct a workable policy? That will enable staff and clients.

I would be grateful for any pointers and interested to know what other care providing organisations do.

I've heard anecdotally that one local authority down in England had suggested to clients that they would withdraw the care they provied if the clients did not refrain from smoke. Is this correct as it seems proposterous.....

Looking forward to sparking a debate.

Best Regards

Posted By Joe
I would suggest you do a search on 'smoking' on past discussion forums.

There has been some lengthy threads on this topic and if you look through them you will see a lot of information on current practices (some good, some bad) within various organisations.

I work in a Scottish LA and share your anxiety regarding the management of this issue once the new legislation comes into force.

Unfortunately we know only too well the prospect of withdrawing services in extreme or uncoperative cases will be almost impossible to achieve.

Posted By Ian Waldram
As many of you will know, I'm currently Scotland regional representative on IOSH Council, and thus could have a possible role in co-ordinating IOSH questions and recommendations about good practices as this legislation comes into force. I also have a contact with the person in Scottish Exec. (SE) responsible for this legislation. Finally, the new PHASS group for Scotland (see posting dated 31 August in Members-only area) is one possible route for collecting evidence about the actual risk.
I do know that SE didn't have much discussion with HSE before deciding the legislation should apply to "all workplaces", but they are aware that residential homes, mental hospitals and home visitors are all difficult areas - not much comfort to those who have to manage the hazard in those places of course!
Whilst there can be lots of emotion around this, we should remember that the actual risk from a small amount of passive smoking isn't as great as from lots of other common workplace hazards - though of course it does generally occur in lower-risk environments, so can't be ignored. I'm pretty sure that effective controls will have in some way to balance small risks to workers against the benefits of what they are doing for clients - unless of course SE set up an urgent national conversion programme for all smokers to become care workers!
I look forward to learning what others know about this - both the risks and some effective controls. After all, the Scottish no smoking legislation may be new, but our duty to protect workers from unreasonable risks isn't.

Posted By Rob T
The only person I have seen ranting is Jack W, funny that, as he always seems to have a pop at people who have a different viewpoint from his on the smoking issue. Obviously you're always right Jack!!!!

Why not have people wearing full BA when entering those premises Jack? That would certainly protect them from the horrendous dangers of passive smoking.

Oh by the way - I challenge anyone out there to find one Coroners report or post mortem result that attributes an untimely death to passive smoking. It's never happened and never will as passive smoking is a myth invented by ASH. (Tip: before you mention Roy Castle, find out first why ASH have dropped his case from there propaganda and check the difference between type 1 and type 2 lung cancer).

It's funny, I've kept out of the last few of these debates on purpose because I think most of what's needed to be said has been said but when you start having a go at people who may be slightly newer to this site and not aware of the previous debates - I find that rude and ignorant.

Posted By John Murgatroyd
I'm not that bothered about the long-term effects of passive smoking, although since I'm a non-smoker maybe I should be. I'm not nothered because if people "light-up" near me, I go away.
Impolite ?
No.
Self preservation.
The short-term effects are well known. reduced lung capacity (due to irritation and inflammation of the airways)
Lower blood oxygen levels (due to reduced lung capacity and also carbon monoxide inhalation)
Your clothing smells of tobacco smoke (short term problem, solved by changing clothes and bathing)
As I'm asthmatic anyway, keeping away from smokers/smoking is a high priority.
If you insist that your employees work in such an atmosphere then you deserve the solicitors letters coming your way.

Posted By J Knight
Hi Lorraine,

Afraid I can't agree with you on the relative scale of the risks; it must depend on the type of home visits you're talking about. I have spent 9 happy (;-)) years now in an H&S role with organisations that have active homecare functions. Here we have about 450 homecare workers, at my last place the care at home budget was worth over £15m p.a., and punches in the face are vanishingly rare; in fact I can't recall any such direct assault carried out by a homecare service recipient or their family. But we do take such risks quite seriously, and people are trained and supported just in case.

I've similarly never had anybody dead from passive smoking related disease yet, but I have had people off sick with asthma and chest infections which may well have been realted to heavy doses of second-hand smoke. So we take this risk seriously too.

Can I point out that those of you who are thinking in terms of an occasional cigarette are a bit short of the full picture of what we can face. I recall a care manager (not me, a care manager) cancelling one contract because it consisted of feeding somebody with cigarettes for every hour he was awake (he didn't sleep well) and not actually chewing food or drinking. The odd fag isn't much of a problem, and we tend not to treat it as too much of one.

BTW Rob T, since coroners investigate sudden and unexplained death we would probably have a hard time finding one attributing death to passive smoking, and no, I'm not thinking about Roy Castle, I try and keep 'celebrities' out of my head, even when they are figure heads for worthy causes. Nice to know that ASH is a world-wide conspiracy and are the force behind smoking reduction programmes wherever they occur, wonder where they get their money from?

John

Posted By Philip McAleenan
Here is a link to some of the long list that John has referred to,

http://www.davehitt.com/facts/howmany.html

Context and perspective are always important. As is evidence to support assertions, whether it is about people being killed by ETS or lawyers per se becoming richer.

The current witch-hunt against smokers, an emotive issue, fails to take into consideration smoking in a wider social/economic/political context, one in which giant corporations make billions per annum, governments benefit for tobacco taxes, land in third world countries is turned to the production of this crop to the detriment of small farmers and the destruction of food production, and the dependency of farm labourers on the crop as their only source of income.

ETS is the trivial end of the tobacco problem and it is neither sensible nor brave to demonise the tobacco smoker and to expend so much emotional and physical energy in beating him/her with the big OSH stick. You end up with a lynch mob mentality when you go down this route, solving nothing but creating different, more serious problems for yourself and others.

As John said, he’s not bothered if people light-up, he just moves away. When it comes to ETS, this is an appropriate response if you don’t like it. Draconian alternatives such as making it illegal to smoke in front of workers are way OTT.

Regards, Philip

Posted By Philip McAleenan
John,

Far from not grasping the problem, what I have attempted to show was that the problem is more conceptual than concrete. The link in my last posting was designed to illustrate that the number of cigarettes required reaching the threshold and therefore actionable level re. constituent chemicals, in a one hundred cubic metre sealed AND unventilated room would range from as low as 1,666 for the release of acetic acid to 1 million for the release of Toluene,

Outside of laboratory conditions it is unlikely that any worker would ever encounter an environment meeting these specific conditions, and even if they did asphyxiation due to oxygen depletion from breathing by so many smokers would kill before anywhere near that number of cigarette were consumed.

As I said, it is important to put matters into perspective. As for making it illegal to smoke in the presence of workers, this is the situation in Ireland and there are strong lobbies in other countries pushing for similar bans.

Philip

Posted By J Knight
John,

Agreed entirely. And Philip, I take your point about Ireland, but despite an opinion already voiced in this thread, a domestic house cannot be a workplace, though the people we ask to enter it are at work. Banning smoking in the workplace will not then, in the UK, forbid recipients of homecare services from smoking in front of workers. And I agree that perception is part of the issue, but there's a limit to the extent that we can tell people not to make a fuss, especially when they might be right. Certainly anybody with smoking related asthma, tobacco allergy or any of a number of other breathing and circulatory conditions can't be required to work in smoky atmospheres; for the rest, the fear that they might contract one of teh above by breathing in tobacco smoke can be real, and we have to work with and manage that,

John

Posted By Andy Petrie
What is the position if a care worker smokes, and light's up in the home of a pateint who is smoking.

Is the care worker then breaking the law for smoking in the workplace.

These people do great work and I would like to think that there is a bit of leneancy with the regs that works both ways.

Posted By Philip McAleenan
John M

Why do you feel the need to shout “YOU” as if you feel that I alone hold opinions about how small the risk is?

Your first paragraph, which is not your statement but is, in its entirety, a quote from the American Heart Association, is a call to authority to back your assertions. But such calls to authority have limited, if any validity, especially in the case where the authority is being disingenuous, as the AHA is in this statement, in which case your argument is seriously undermined.

Appreciating the research that you have done to find this statement it would have been a few minutes extra work to obtain a copy of the report referred to and to see exactly what the study found and to post those findings here, rather than someone else’s interpretation.

Let me quote from that report now:

“One hundred fifty-two [out of a cohort of 32,046] incident cases of CHD (including 127 nonfatal MI and 25 CHD deaths) occurred during 10 years of follow-up. The age-adjusted relative risk of total incident CHD was 1.97(95% CI, 1.20 to 3.24)”.

Now a relative risk of 1.97 is statistically insignificant and the authors of the report admit this when that compared their results with another, Chinese, report;

“Our finding of an increased risk of passive smoking at work is consistent with the results of a case-control study of Chinese women in full-time paid employment, which found an elevated though statistically nonsignificant risk of MI for passive smoking at work (adjusted RR, 1.85; 95% CI, 0.86 to 4.00).”

The authors further state that there may well be a number of confounding factors that would explain the increase in risk through they made every effort to be thorough in making adjustments for a number of factors that would account for the increased risk. However they did state that a limitation to their study was their reliance on self-reported assessments of exposure to passive smoking. The report stated that “[t]he effect of this type of measurement error is usually conservative; that is, it pushes the relative risk estimates in the direction of the null. When passive smoking has been assessed by questionnaire, self-reported duration has been found to be much less reliable than dichotomous responses (yes/no) to questions about exposure at home or work”

Though the authors accept that there appears to be a small, but statistically insignificant increase in risk of CHD for passive smokers, the report is not definitive, and certainly does not warrant the misleading claims of campaigning organisers or individuals who have an agenda that blinds them to objectivity. And certainly anecdotal evidence of a personal nature is not the basis on which to exercise professional judgement. It is tantamount to banning the crossing of roads because a car knocked you down once.

The report can be found here, http://circ.ahajournals..../content/full/95/10/2374

Regards, Philip