Powys Patients' Council responds to Smoke-free Premises consultation

John Lilley (PPC volunteer), Owen Griffkin (Participation Officer) & Rhydian Parry (PPC volunteer)

Ever since learning of the Welsh Government's proposal to introduce a ban on smoking in all hospital grounds, Powys Patients' Council has been working hard with current and former patients of the mental health inpatient unit in Powys - Felindre Ward at Bronllys Hospital - to gather feedback. The Council was determined to prepare a formal response to the recent government consultation on the topic. 

Up until now mental health wards have been exempt from the regulations, and designated indoor smoking rooms have been allowed. The new regulations, if agreed, would give hospitals 18 months to close down their indoor provision, and, if appropriate, set up outdoor smoking areas instead. However, as the Council discovered, it is not necessarily straightforward to set up outdoor provision. In the case of Felindre Ward, patients smoking outdoors would require staff supervision due to the nature of the outdoor space. Obviously if already busy nurses have to watch people smoking then they're not able to do much else at the time!

In his Ministerial Forward to the consultation document, Cabinet Social Secretary for Health & Social Services, Vaughan Gething, noted:

"The consultation considers the removal of an exemption that allows designation of a room in which patients and residents of mental health units may smoke and replacing it with a time limited one that would expire 18 months after the new regulations come into force. Smoking prevalence among people with mental illness is substantially higher than the general population and is of great concern. Removing the exemption will bring the law in line with general hospital service users and will aim to address health inequalities for persons with mental heath conditions."

My colleague Owen Griffkin introduced the topic to readers last month when he wrote Powys Patients' Council: Kindles, smoking ban and more. 

Since then he joined PPC volunteers John Lilley and Rhydian Parry to circulate the relevant questions from the consultation to put to current and former patients, along with staff working on the ward. These included:

1. Do you agree with the proposal to remove the exemption that permits the designation of smoking rooms in mental health units? (Regulation 8) (Please note that the removal of the exemption would not prevent the person in charge of the premises from designating outdoor areas as places where patients can smoke).
2. Do you agree that the proposed transition period of 18 months after the 2018 Regulations come into force is sufficient time to allow mental health units to implement indoor smoke-free conditions in a safe and secure way? (Regulation 8(6).

Much feedback was gathered, and the Council pulled together a formal response which was submitted by the deadline earlier this month. Owen has now summarised this response for our readers:

Powys Patients’ Council's response to
The Smoke-free Premises & Vehicles (Wales) Regulations 2018 Public Consultation

A consultation was launched in May regarding changes to the Smoke Free premises and Vehicles' Regulations that will affect mental health wards, including the Felindre Ward in Bronllys Hospital. Rhydian and John from the Patients’ Council attended a meeting on the ward with Ward Manager Lisa Hale and Penny Price, Service Manager for Adult Mental Health Services in South Powys, to ensure that they had a voice in the hospital’s response to the consultations. The Council also responded themselves by completing the consultation form and we have summed up the main points here.

At the moment, the only option for people on the ward is to smoke indoors in a designated smoking area. These new regulations would end this practice and would force people into refraining from smoking for long periods. Some of the people with lived experience on the ward who smoke also used facilities in England where indoor smoking was banned and they said it was a very difficult time that made recovery more complicated. During a time of great distress it could cause extra stress to have an enforced period of nicotine withdrawal. It’s always possible for other hospital patients to leave their beds and ‘sneak out’ for a cigarette but due to the secure nature of mental health wards this will not be possible for Felindre patients. The Council was also concerned on the effect on staff time, with the staff having to accompany smokers to an unsecured outdoor smoking area.

One of the main barriers to giving up smoking in a mental health unit is that patients do not have enough activities to help keep them occupied. Patients have said that they have wanted to smoke more because of the boredom as it gives them something to do. We urged that there be increased funding specifically for activities on mental health wards.

We also want there to be access to a full range of cessation tools on the ward, including vaping/e-cigs, and for staff to be well trained in cessation techniques so that patients can be fully supported.

The consultation closed on 17 August 2018 so we will keep you informed as to the outcomes and findings.

Powys Patients' Council is facilitated by the Health & Wellbeing team at Powys Association of Voluntary Organisations and aims to give a voice to people staying on inpatient wards in Powys. For more information, please contact Participation Officer Owen Griffkin by emailing owen.griffkin@pavo.org.uk or ringing 01597 822191.

Powys Patients’ Council - Kindles, smoking ban & more

by Owen Griffkin, Mental Health Participation Officer

I have been facilitating Powys Patients’ Council, with the support of volunteers Rhydian Parry and John Lilley, since early 2018 as part of my role in the Powys Association of Voluntary Organisations (PAVO) mental health team.

Powys Patients' Council aims to give a voice to patients, currently in Felindre Unit at Bronllys Hospital in Powys, who are offered acute in-patient mental health services. Regular patient-only meetings give people an opportunity to express their views on the services they receive whilst they are in hospital. These views are then passed on anonymously to ward and hospital management staff, in addition to senior Powys Teaching Health Board (PTHB) staff, so that solutions can be found.

Owen Griffkin

It was a sweltering day for June’s Patients’ Council meeting and the ward was close to capacity. This was the first Patients’ Council session since we had left a suggestion box on the ward, so there were more issues than usual to deal with. Having the suggestion box means we can address issues or concerns that we might have previously missed from people who have had short stays on the ward. It can also follow that these might have been dealt with already, as was the case with a note about the heating being on in rooms at night.

Another note praised the caring environment and professional staff which the Patients' Council were pleased to pass on to the new permanent Ward Manager, Lisa Hale.

Concerns raised in the meeting included a lack of activities, the annoyance of an office door banging and not being allowed devices with cameras in communal areas due to privacy reasons. As all modern tablets/phones have cameras this unfortunately means no devices can be used in the day room. We have sent out an appeal over Facebook and Twitter to see if anybody has any 1st generation Kindle Fires as these tablets didn’t have cameras, so hopefully we will get some response to this. We are looking into raising some money for activities provided by an external facilitator as this will leave the ward affected less by staff leave and sickness.

Lisa Hale, Felindre Ward Manager

There has been a new advocacy service commissioned by PTHB and delivered by Conwy & Denbighshire Mental Health Advocacy Service (CADMHAS) and this was praised by patients who found it very good and non-judgemental. We spoke to Adrianne Cleverly who provides the service in Powys recently in How can mental health advocacy help you?

Proposed smoking ban in hospital grounds

The Patients’ Council is also attending an extra meeting this month to discuss smoking in the light of the recently announced news about banning smoking on ALL hospital grounds.

As this will include acute mental health in-patient wards such as the Felindre Ward, it is important that people associated with the ward(s) voice their views in relation to this consultation. 

The ban is due to come into force in Summer 2019, and this will give ward managers 18 months from then to ensure there are alternative measures in place to replace existing indoor smoking rooms, and that outdoor areas fall in line with the new rules. One of the proposed rules will prohibit an outdoor smoking area from being within 10 metres of any hospital building. This will mean that if there is no exemption for mental health wards it will be impossible for there to be a secure smoking area that people can use without staff members present and this creates other issues relating to staff health and second-hand smoke. 

I will be working with the Patients’ Council to look at the possible impact of these rule changes, and how the hospital can offset the disruption and distress that it may cause to people on the ward and potentially other wards/mental health facilities across Powys. This will very likely be a contentious issue and it will be interesting to see how other hospitals in Wales deal with it. If you have lived experience of an acute mental health ward, and would like to contribute to the consultation, please email owen.griffkin@pavo.org.uk or ring 01597 822191 with your comments or for more information.