Smoke Free Policy - NHS Wales€¦ · by The Smoke-free Premises etc (Wales) Regulations 20071. The...

1 of 15 V3

Smoke Free

Policy

Policy Number:

293 Supersedes: Classification Corporate

Version No

Date of EqIA:

Approved by: Date of

Approval: Date made

Active: Review Date:

V3 H&SEPC 7/2/2019 7/2/2019 7/2/2020

Brief Summary of Document:

This smoke free policy guarantees the right of everyone to breathe smoke free air on all Hywel Dda Health Board sites. The policy recognises that the Health Board has a responsibility to promote public health to all its employees, patients and visitors. The aim of this policy is to promote a smoke free environment in all premises and property occupied by the Health Board, to ensure compliance with current Smoke Free legislation, encourage staff to give up smoking and provide an example of good practice to the community.

Scope: All Health Board sites and premises and grounds are designated as smoke free areas. This policy applies to all staff, volunteers, contractors/service providers, patients*, visitors and the public.

To be read in conjunction

with:

010 - Health & Safety Policy 201 - All Wales Disciplinary Policy Lease Car Scheme 242 - Fire Safety Policy Policy (to be issued) 514 – Management & Investigations of Incidents Procedure Incident & Hazard Reporting Policy

Owning Group and Committee

Smoke Free Sites Working Group Health and Safety & Emergency Planning Sub Committee

HYWEL DDA UNIVERSITY HEALTH BOARD

Database No: 293 of 15 Version 3.0

Smoke Free Policy Please check that this is the most up to date version of this written control document

Executive Director:

Ros Jervis Job Title Director of Public Health and Co-chair of the Health and Safety & Emergency Planning Sub Committee with Director of Operations

Reviews and updates

Version no:

Summary of Amendments:

Date Approved:

1 New Policy 30.7.2013

2 Minor change 7.08.2013

3 Revised 7.2.2019

Glossary of terms

Term Definition

Keywords Smoke Free, Smoke Free Policy, Smoking, Tobacco, Passive




CONTENTS

1. INTRODUCTION ................................................................................................................... 4

2. POLICY STATEMENT .......................................................................................................... 4

3. SCOPE .................................................................................................................................. 5

4. AIM ........................................................................................................................................ 5

5. OBJECTIVES ........................................................................................................................ 5

6. POLICY ................................................................................................................................. 5

GENERAL PRINCIPLES .......................................................................................................... 5

7. RESPONSIBILITIES ............................................................................................................. 8

8. IMPLEMENTATION AND MONITORING .............................................................................. 9

9. ENFORCEMENT ................................................................................................................. 10

10. TRAINING AND AWARENESS........................................................................................ 11

10.2 PATIENTS AND PUBLIC .............................................................................................. 11

11. FURTHER INFORMATION .............................................................................................. 11

12. REVIEW ........................................................................................................................... 12

13. APPENDIX 1 - SMOKING CESSATION SUPPORT SERVICES ..................................... 13

14. APPENDIX B - REFERENCES ........................................................................................ 14

15. APPENDIX C - FURTHER INFORMATION AND LINKS ................................................. 15




1. INTRODUCTION Smoking is the UK’s leading cause of preventable death and the provision of a smoke free environment provides a clear and effective message about the importance that the Health Board places on this issue. Passive smoking (breathing other people’s tobacco smoke) has been medically proven to cause lung cancer and heart disease in non smokers, as well as many other illnesses and minor conditions. The Hywel Dda University Health Board (Health Board) has a legal duty to protect and minimise the risk for staff, patients and visitors who attend Hywel Dda University Health Board premises and grounds from the harmful effects of exposure to second hand smoke as directed by The Smoke-free Premises etc (Wales) Regulations 20071. The Health and Safety at Work Act 19742 places a duty on employers to ‘…provide and maintain a safe working environment which is, so far as is reasonably practical, without risk to health and adequate as regards facilities and arrangements for their welfare at work’. Action to tackle the harm caused by smoking continues to be a priority for the Welsh Government. The Well-being of Future Generations Act 2015 will ensure that well-being planning across communities will limit the impact of tobacco on individuals, now and in the future. One of the key themes of the Welsh Government’s ambitions for Public Health, detailed in the Public Health (Wales) Act 2017 3 is further reducing smoking and exposure to second-hand smoke by introducing legislation to make it an offence to smoke in the outdoor areas of school grounds, children’s playgrounds, hospital grounds and outdoor care settings for children This smoke free policy will be reviewed once this legislation has come in to effect in 2019. To take this forward a Tobacco Control Delivery Plan for Wales 2017-2020 has been developed with the key focus being on improving access to smoking cessation service and promoting smoke free environments. This smoke free policy guarantees the right of everyone to breathe smoke free air on all Hywel Dda University Health Board sites. The policy recognises that the Health Board has a responsibility to promote public health to all its employees, patients and visitors. It is recognised that implementation of this policy may encourage some people to stop smoking and therefore consideration has been given to providing support for employees and patients to stop smoking through access to smoking cessation services. 2. POLICY STATEMENT Hywel Dda University Health Board is continually working towards the provision and maintenance of a healthy workplace, environment and healthy lifestyle for all staff, patients and visitors. Therefore, in order to protect non-smokers and to promote good health the following Smoke Free Policy has been adopted by Hywel Dda University Health Board. This policy covers all Health Premises and grounds and applies to staff, contractors, patients*, visitors and the public. *There is an exemption available for those patients staying in residential mental health units under the Smoke-Free Premises (etc) Wales Regulations 2007. (See Section 6.4)




This policy supports the Health Board’s Business Plan which includes the goal of improving life expectancy of the population in terms of both quality and quantity of life over the next 10 years with smoking cessation being one of the focus areas. In addition this policy will support the Health Board in achievement of the targets contained within the following strategies/plans:

Public Health (Wales) Act 20173

Tobacco Control Delivery Plan for Wales 2017-20204

Public Health Wales Long Term Strategy 2018-305

Well Being of Future Generations (Wales) Act 20156

The Cardiac Disease National Service Framework for Wales7 and ensure that the Health Board complies with the following legislation:

The Smoke-free Premises etc (Wales) Regulations 20071.

The Health and Safety at Work Act 19742

3. SCOPE All Health Board sites and premises and grounds are designated as smoke free areas. This policy applies to all staff, volunteers, contractors/service providers, patients*, visitors and the public. *There is an exemption available for those patients staying in residential mental health units under the Smoke-Free Premises (etc) Wales Regulations 2007. (See Section 6.4) 4. AIM The aim of this policy is to promote a smoke free environment in all premises, grounds and property occupied by the Health Board, to ensure compliance with current Smoke Free legislation, encourage staff and patients to give up smoking and provide an example of good practice to the community. 5. OBJECTIVES The aim of this policy will be achieved by the following objectives:

Ensure a smoke free environment for staff, volunteers, contractors/service providers, patients, visitors and public.

Minimise additional risks to health associated with the effects of passive smoking.

Improve health by bringing in action to limit smoking but also to protect and promote the health of both the smoker and non-smoker.

Provide support and encouragement for those smokers who wish to stop smoking and thereby set an example to the local Community.

Minimise the fire, security and health and safety risks associated with smoking on Health Board property.

Ensure that all staff, volunteers, contractors/service providers, patients, visitors and public are aware of the policy.

6. POLICY General principles The Health Board has a duty to promote awareness to the community of the effects of smoking on health and in particular to advise patients on the danger of smoking. This relates to not only health but fire, security and health & safety in healthcare premises and grounds.




All Health Board sites and premises and grounds are designated as smoke free areas and this policy covers all staff, volunteers, contractors/service providers, patients*, visitors and the public. The use of electronic cigarettes is not permitted on Health Board sites. These restrictions include all premises and grounds (both owned and leased) from which the Health Board operates from and includes all areas up to the boundaries, car parks, vehicles parked on Health Board premises and grounds, outdoor seating areas, walkways and all other areas. This policy applies to Health Board vehicles, both owned and leased, and affects the vehicle during business and private use. The Health Board’s Lease Car Scheme re-iterates the Health Board’s policy that the Smoke Free Policy applies to Leased Cars as it does to other Health Board vehicles. Any person wishing to smoke must first leave the Health Board grounds. The Health Board considers that smoking near entrances of buildings and premises and grounds presents a poor image to visitors and the public. As such smoking is not permitted on these areas which are on the boundary of the Health Board. Smokers who wish to smoke off-site should note the following:

Neighbouring properties may also operate smoke free policies which must be complied with. For example, the Hafan Derwen site neighbours premises and grounds owned by Carmarthenshire County Council who operate a smoke free site policy.

Owners of private premises and grounds neighbouring Health Board sites may approach smokers asking them to refrain from smoking within the vicinity of their property.

Littering in open public places is an offence under section 87 of the Environmental Protection Act 19908.

In accordance with Government Legislation Health Board staff will at no time accept sponsorship from tobacco companies. Advertising and sales of tobacco products will not be allowed on Health Board premises and grounds or in publications. 6.2 Staff Health Board staff are prohibited from smoking on Health Board premises, grounds or vehicles. Staff are entitled to unpaid scheduled breaks as agreed with their line manager in accordance with their contract of employment. Hywel Dda University Health Board does not recognise smoking breaks and staff are only permitted to smoke during designated unpaid breaks which must be done away from Health Board premises and grounds. Staff who wish to smoke during designated unpaid breaks must ensure that any form of Health Board identification is completely covered up. Managers are responsible for ensuring equitable access to unpaid breaks. In line with customer care practices and common courtesy, Health Board staff will not smoke on any other premises or grounds whilst undertaking Health Board duties. This policy recognises that passive smoking adversely affects employee’s health and is not primarily concerned with whether anyone smokes, but where they smoke and the effect that this has on non-smoking colleagues. However, the Health Board recognises that this Smoke Free Policy will impact on smokers working lives.




It recognises that nicotine is an addictive drug and that most smokers would like to give up. Therefore, in an effort to help individuals adjust to the change the following help and support is available. Smoking cessation support services for those Health Board staff who smoke and wish to stop smoking is detailed at Appendix A. Reasonable time off during working hours will be allowed for staff to attend smoking cessation support that will help them to quit. There is no cost to the individual or the Health Board for smoking cessation services The Health Board’s Occupational Health Department also provide support and information for those who wish to stop smoking.. Third Party Premises Staff required to visit other premises during the course of their duties which are not covered by smoke free legislation should when arranging a visit advise the person of the Health Board’s Smoke Free Policy. Although the Health Board has a duty of care to protect its employees it cannot control the smoking policy on third party premises. Staff should agree with this person that they should arrange for a non-smoking area to be provided for the duration of the visit. Where this is not possible, staff should ask the person being visited to refrain from smoking inside the premises or in the meeting area/site for one hour before the visit and that the person being visited not smoke during the duration of the visit. In circumstances where it is not possible to pre-arrange a visit and it is subsequently found that staff are being exposed to second-hand smoke, staff should consider and decide on an individual basis whether they wish to be exposed to second hand smoke. The member of staff’s line manager must be informed of these circumstances. Staff Residences Smoking is not permitted in any area of the staff residences which includes bedrooms, kitchens, bathrooms, toilets, corridors and in all communal area such as common rooms and sitting rooms. Any infringement of this policy will be considered a breach in the terms and conditions of occupancy. 6.3 Volunteers and Contractors/Service providers Volunteers and contractors/service providers employed by other organisations are prohibited from smoking while working on Health Board premises, grounds, or vehicles, and are expected to abide by the terms of this policy at all times. Any volunteers, contractors/service providers who wish to smoke must do so away from Health Board premises and grounds during designated break periods, after agreement with their line manager. 6.4 Patients Smoking in hospitals/clinics is prohibited and patients will be made aware that smoking is not permitted on healthcare premises and grounds. It is emphasised that patients who leave the ward/clinic area to smoke do so at their own risk. It is not the responsibility of Health Board staff to accompany patients who wish to smoke.




Patient Information Information on the Health Board’s policy in relation to smoking on premises and grounds will be given to all patients via the letter advising of the inpatient or outpatient appointment, as well as in all patient information leaflets and on the Health Board website. All wards and outpatient departments will have information available to patients on giving up smoking. The managers of these areas will be responsible for ordering and updating displays. Support for patients who smoke Coming into hospital presents many patients with an ideal opportunity to stop smoking. It is therefore the intention of the Health Board to provide practicable help, support and advice to those who wish to take advantage of this opportunity. Each hospital site has a dedicated smoking cessation practitioner who is trained to offer expert behavioural support and have information and access to nicotine replacement therapy. Support is free, available to those wishing to quit or to reduce the harm from tobacco use, and is also offered to those using e-cigarettes. Prior to admission to the Health Board, the smoking status of all patients should be sought and the patient asked if they wish to obtain information on support to quit or on nicotine replacement therapy during their stay in hospital. For patients who are admitted as an emergency case their smoking status should be sought as soon as possible upon admission and the patient asked if they wish to obtain information on support to quit or on nicotine replacement therapy during their stay in hospital. Mental Health and Learning Disabilities Facilities It is recognised that for a number of long stay patients, the hospital is their home and attempts to restrict their smoking is not always appropriate. There is an exemption available in the Smoke-Free Premises Act (Wales) Regulations 2007 for designated internal smoking rooms. No such internal smoking rooms exist in Hywel Dda hospital premises, but relevant wards have enclosed private gardens, accessible only to those designated patients, where smoking is allowed. Shelters compliant with the Act are provided along with benches, bins and automatic wall-mounted safety lighters. 6.5 Visitors and Public Visitors and members of the public are to abide by the terms of this policy. 7. RESPONSIBILITIES 7.1. Executive lead A nominated executive will be the lead for this Smoke Free Policy. The Executive lead will be responsible for ensuring that this policy is fully supported by all staff and that there are sufficient resources available to enable its full implementation. 7.2 Director of Public Health The Director of Public Health is the lead officer for tobacco control for the Health Board, and is the executive lead for the Smoke Free Policy. 7.3 Managers

All managers are responsible for ensuring that the staff they line manage comply with this policy.




All managers are responsible for supporting staff who bring this policy to the attention of those in breach of it.

All managers are responsible for supporting any employee who wishes to quit smoking by providing reasonable time off during working hours to access support including Occupational Health or smoking cessation courses. Managers must agree any time in advance and attendance will be subject to the needs of the service.

Managers are responsible for monitoring this policy in their department. 7.4 Staff

Staff have a duty to fully comply with this policy.

Staff wishing to smoke must do so away from Health Board premises and grounds and can only do so during their official unpaid break times. Additional smoking breaks will not be taken. Managers are responsible for ensuring equitable access to unpaid breaks.

Staff are encouraged, where appropriate (in line with the implementation plan), to inform anyone who is seen smoking on Health Board property that the Health Board has a smoke free policy. Staff can politely remind individuals of the Smoke Free policy but should not enter into discussion regards its value or merits and on no account enter into an argument or debate.

Staff are reminded of their duties to report any incidents or hazards in accordance with the Health Board’s Incident & Hazard reporting policy.

Each member of staff has a responsibility to be available for work and to not be away from work on unauthorised breaks.

7.5 Volunteers, Contractors/Service providers, Patients, Visitors and Public

Patients, Visitors and the Public are to fully comply with this policy. 8. IMPLEMENTATION AND MONITORING This policy will be implemented via the Smoke Free Policy Action Plan. The key measures that will be implemented in order to support compliance with this policy will be as follows: 8.1 General

Signage throughout Health Board property advising visitors and members of the public that the Health Board premises and grounds are smoke free

Displays and supplies of literature on the subject available throughout Health Board premises.

The Health Board’s website will include details of the Health Board’s Smoke Free Policy. 8.2 Staff

Job advertisements, job descriptions, interviews and contracts of employment will include reference to this policy.

On appointment, all new staff, will be given information about this Smoke Free Policy at the Health Board’s Corporate Induction Course.

8.3 Patients

Information on the Health Board’s policy in relation to smoking on premises and grounds will be given to all patients via the letter advising of the inpatient or outpatient appointment.

Prior to admission the smoking status of all patients will be sought and the patient will be asked if they wish to obtain information on referring to smoking cessation support or for nicotine replacement therapy during their stay in hospital.




For patients who are admitted as an emergency case their smoking status will be sought as soon as possible upon admission in order and the patient will be asked if they wish to be referred for nicotine replacement therapy during their stay in hospital and to obtain information on referring to a smoking cessation support.

8.4 Volunteers

All recruitment information for volunteers will include reference to this policy and all new volunteers will be given information about this policy at induction.

8.5 Contractor/Service provider

The person greeting the contractor/service provider will inform them of the Health Board’s Smoke Free Policy

The following clause will be inserted into all contracts relating to work done within the Health Board by outside contractors/service providers. “Hywel Dda University Health Board operates a Non-Smoking Policy for its entire staff which expressly prohibits smoking throughout its premises and grounds.” Contractors must ensure that their staff are aware of this and comply with the Policy.

Progress on its implementation will be monitored on a quarterly basis by the Executive Lead. 9. ENFORCEMENT 9.1 General Authorised officers from the three Local Authorities serving Hywel Dda have the power to enter Health Board buildings in order to establish whether smoke-free legislation is being enacted in accordance with the law. They have the power to issue fixed penalty notices to those whom they believe are committing, have committed or are allowed to commit an offence under the legislation. 9.2 Staff, Volunteers, Contractors/Service providers, visitors and public Staff, Volunteers, Contractors/service providers, visitors and public are personally responsible for complying with this policy. Staff who are found to be in breach of this Smoke Free Policy may be subject to action being taken in accordance with the Health Board’s Disciplinary Policy. Staff are also responsible for ensuring that volunteers, contractors/service providers, patients, visitors and the public comply with this policy by acting on any breaches. Staff can, where appropriate (in line with the implementation plan), politely remind individuals of the Smoke Free policy but must not enter into discussion regards its value or merits and on no account enter into an argument or debate. Should any unacceptable behaviour result this must then be reported through the correct channels. Failure to adhere to the smoking policy must also be passed on to the relevant manager of each site. It is accepted that in exceptional circumstances (e.g. visiting a seriously ill child or terminally ill patient) it may be inappropriate to stop a visitor from smoking. In these circumstances staff should seek the advice of their line manager. 9.3 Patients If there is a breach of the Smoke Free Policy by a patient they should be politely informed of the Health Board’s policy and be asked to refrain from smoking. Staff can politely remind individuals of the Smoke Free policy but must not enter into discussion regards its value or merits and on no account enter into an argument or debate. Should any unacceptable




behaviour result this must be reported through the correct channels. Failure to adhere to the smoking policy must also be passed on to the relevant manager of each site. It is accepted that in exceptional circumstances (e.g. terminally ill patient) it may be inappropriate to stop a patient from smoking. In these circumstances staff should seek the advice of their line manager. 10. TRAINING AND AWARENESS 10.1 Staff and Volunteers Staff and Volunteers will be informed of the requirements of this policy through the following mechanisms:

Recruitment processes including job advertising, job descriptions, interviews, employment contracts, intranet and induction programme

In-service training programmes including Health & Safety and Fire Safety Awareness training.

Communications via regular newsletters, team briefs, messages in payslips, posters and leaflets on staff noticeboards, intranet, Partnership Forum, line managers, extensive signage on sites including the main entrances to promote the smoke free message and roadshows across the Health Board’s sites.

10.2 PATIENTS AND PUBLIC Patients and the public will be made aware of this policy through the Health Board’s communications processes via the internet, press/media, signage on sites in particular around main entrances, noticeboards, information contained within pre-admission correspondence across the Health Board’s sites, extensive signage on sites including the main entrances to promote the smoke free message and roadshows across the Health Board’s sites. 11. FURTHER INFORMATION Smoking is the main cause of preventable disease and premature death in Wales. Smoking cost NHS Wales £386 million in 2007/08, representing seven per cent of our total healthcare expenditure. Smoking accounts overall for an estimated 22 per cent of all adult hospital admission costs, 14 per cent of all prescription costs, 13 per cent of all GP consultant costs and six per cent of outpatient costs9. NICE Guidelines recommend the development of a policy that provides smoking cessation as part of a wider tobacco control strategy10. Crucially, smoking cessation support to staff is seen as a success factor in the effectiveness of smoking bans11. Evidence suggests that smoke free policies at work typically reduce the absolute prevalence of smoking by about 4 percent and partial policies by 2 percent. Combining the effects of reduced prevalence with lower consumption per continuing smoker yields a mean reduction of 1.3 cigarettes per day per employee which corresponds to a relative reduction of 29%12. Smoke free policies are also known to reduce the number of cigarettes smoked each day by those who continue to smoke13. A study published in 2009 further found that whilst a full workplace No Smoking Ban reduced the current smoking rate by 6.4% among all workers the average daily consumption amongst those continuing to smoke reduced by 3.7%14. There is some evidence that compares quit rates of employees working in a full smoking ban with that of a partial ban. Smokers in total bans were more likely to stop smoking during working hours whereas those in partial bans were more likely to increase their consumption15.




This proposed policy will ensure compliance with the Smoke Free Premises etc (Wales) Regulations 2007 and will also support the implementation of the Corporate Health Standard at Work 12. REVIEW This Policy will be reviewed in accordance with the progress of implementation of the actions contained within the Welsh Government’s Tobacco Control Action Plan, or sooner, as required.




13. APPENDIX 1 - SMOKING CESSATION SUPPORT SERVICES If you are one of the 63% of smokers that want to give up, then get in touch with any of these FREE local free stop smoking services:

Hospital smoke free support services Tel: 0300 3039652 Practitioners in each of the main hospital sites and covering community hospitals

Help Me Quit Tel : 0800 0852219

Your local Community Pharmacy




14. APPENDIX B - REFERENCES

1 The Smoke-free Premises etc (Wales) Regulations 2007, Welsh Assembly Government

2 The Health and Safety at Work Act 1974, HM Government

3

Public Health (Wales) Act 2017

4 Tobacco Control Delivery Plan for Wales, 2017 – 2020 Welsh Government

5 Public Health Wales Long Term Strategy 2018-30, Public Health Wales

6 Well Being of Future Generations (Wales) Act, 2015. Welsh Government.

7 The Cardiac Disease National Service Framework for Wales (June 2009), Welsh Assembly Government

8 Environmental Protection Act 1990, HM Government

9 Phillips, C. Bloodworth, A..(2009) Costs of smoking to the NHS in Wales. ASH Wales and BHF

10 National Institute for Health and Clinical Excellence. (2008) Smoking Cessation Services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities. PH10. London: NICE.

11 McKee,M. Gilmore, A. (2003) Smoke free hospitals. London: BMJ 2003;326: 941-942

12 Fichtenberg, C. Glantz, S.(2002). Effect of smoke-free workplaces on smoking behaviour: systematic review. London: BMJ 2002; 325:188

13 Nicotine Addiction in Britain. A report of the Tobacco Advisory Group of the Royal College of Physicians, February 2000.

14 Kim,B. (2009) Workplace Smoking Ban policy and Smoking behaviour. Journal of Preventative Medicine Public Health 2009:42: pp293-297

15 Styles, G. Capewell, S, 1998, No smoking at work: the effect of different types of workplace smoking restrictions on smokers' attitudes, behaviour and cessation intentions; Health Education Journal December 1998 vol. 57 no. 4 385-395




15. APPENDIX C - FURTHER INFORMATION AND LINKS

British Thoracic Society. (2005) Smoke Free Hospitals. London: The British Thoracic Society

National Institute for Health and Clinical Excellence. (2007) Smoking Cessation Services. London: NICE.

National Institute for Health and Clinical Excellence. (2007) Workplace interventions to promote smoking cessation. London: NICE

Welsh Assembly Government. (2009) Our Healthy Future. Cardiff: Welsh Assembly Government. http://wales.gov.uk/topics/health/ocmo/healthy/?lang=en

Welsh Assembly Government. (2010) Welsh Health Survey 2009. Cardiff: Welsh Assembly Government. http://wales.gov.uk/topics/statistics/theme/health/health-survey/results/?lang=en

Welsh Assembly Government. (2010) Annual Quality Framework 2011-2012. Cardiff: Welsh Assembly Government.

Welsh Government. (2012) Tobacco Control Action Plan for Wales. Cardiff: Welsh Government; http://wales.gov.uk/docs/phhs/publications/120202planen.pdf

ASH Wales: www.ashwales.org.uk

Royal College of Physicians: www.rcplondon.ac.uk

Stop Smoking Wales: www.stopsmokingwales.com

Welsh Government; Office of the Chief Medical Officer: http://new.wales.gov.uk/topics/health/ocmo/?lang=en

British Medical Association (BMA); Working towards a tobacco free society http://www.bma.org.uk/health_promotion_ethics/tobacco/index.jsp

http://wales.gov.uk/topics/health/ocmo/healthy/?lang=en

http://wales.gov.uk/topics/statistics/theme/health/health-survey/results/?lang=en

http://wales.gov.uk/docs/phhs/publications/120202planen.pdf

http://www.ashwales.org.uk/

http://www.rcplondon.ac.uk/

http://www.stopsmokingwales.com/

http://new.wales.gov.uk/topics/health/ocmo/?lang=en

http://www.bma.org.uk/health_promotion_ethics/tobacco/index.jsp

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