Test all pregnant women for smoking, say NHS chiefs

England’s public health chief is urging hospitals to give every pregnant woman a carbon monoxide test to see if they smoke, as part of an NHS-wide drive to persuade patients to kick the habit.

Duncan Selbie wants midwives and nurses to routinely screen mothers-to-be when their pregnancy is first “booked”, monitor them at all their antenatal appointments and support those who want to quit.

Hospitals would also ban smoking shelters used by staff and patients, hand out nicotine gum and patches and include helping smokers to quit in patients’ treatment plans under Public Health England (PHE)’s plans. It also wants doctors and nurses to use their conversations with patients to advise them how to give up tobacco or encourage them to switch to e-cigarettes instead.

“One in four hospital inpatients smokes, but too many hospitals do too little to try to help them to give up. I want people who are in a hospital bed or in a consulting room to have a conversation about their smoking with a member of staff and, if they want to quit, refer them on to stop smoking services”, Selbie, PHE’s chief executive, told the Observer.

“This isn’t about scaring or hectoring people. It’s about making people aware that if they want to give up, NHS staff can help them. The evidence shows that if someone is helped to quit, they are four times more likely to succeed than if they do it on their own.

“We talk a lot about sugar and diet as health risks, but smoking remains the UK’s biggest killer and is responsible for near half a million admissions to hospital each year. One in four beds is occupied by a smoker and seven in 10 of them want to quit. It is time to consign tobacco to history and for the NHS to help people to give up.

“There’s something anachronistic about the NHS being associated with smoking,” he added.

The Royal College of Midwives (RCM) backed carbon monoxide testing for expectant mothers as long as they had the right to refuse to undergo it if they chose not to.

“The RCM is supportive of pregnant women being offered carbon monoxide testing at a time when it is appropriate to do so. Depending on the circumstances, it could be at the initial antenatal booking or during subsequent antenatal visits. Women should have the ability to decline testing as with any other area of antenatal screening,” said Janet Fyle, the RCM’s professional policy adviser.

But the NHS needed to understand that some women, especially those from poorer backgrounds, smoke as a way of helping relieve the stress of preparing to have a baby, Fyle added. “Having a baby and caring for a newborn along with other family members is one of the most stressful life events for some women, as some new mothers struggle to adapt to their new roles with little or no social support,” she said.

“We know that the incidence of smoking is higher in lower socioeconomic groups. We cannot ignore the psychological, social or economic circumstances of new mothers when developing strategies for how we communicate the risks of smoking and health care.”

PHE officials are frustrated that hospitals are doing too little to tackle smoking. In a strongly worded blog for the British Medical Journal, Dr Mary Black, its head of digital strategy, accused them of displaying “a kind of misguided sympathy [that] keeps the last vestiges of tobacco acceptability alive in the NHS.

“We falter before ill patients in pyjamas dragging their IV fluid stands out into 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. Tolerating smoking on NHS premises is a form of collusion,” she said.

Black was especially critical of NHS personnel who light up outside their hospital. “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,” she said.

The National Institute of Health and Care Excellence (Nice) already advises hospitals to screen pregnant women to see if they smoke. However, many do not do so, even though recent evidence shows that it helps double the number of women who quit smoking during pregnancy and that those who do go on to have heavier and healthier babies. Smoking in pregnancy increases the risk of stillbirth, babies being small for gestational age, having trouble breathing and other problems.

Selbie praised Taunton and Somerset NHS Trust for playing messages recorded by children over the loudspeaker system in its grounds to ask those who are smoking to stop. The South London and Maudsley NHS Foundation Trust tells patients in all the letters it sends them that they should not bring tobacco, cigarettes, lighters or matches on to its premises or smoke anywhere in its grounds.

Selbie also highlighted Medway NHS Foundation Trust in Kent’s raft of anti-smoking measures, including its use of wardens to patrol the grounds telling people to stop smoking and a policy of frontline staff checking a patient’s smoking status and referring them for specialist help to quit if wanted.