REPORT FOR RESOLUTION

EXECUTIVE COMMITTEE

DATE:                                   13 October 2004     

SUBJECT:                Tobacco control in Manchester

REPORT OF:            Deputy Chief Executive (Performance)

 PURPOSE OF REPORT

To propose changes to Manchester’s approach to tobacco control.

RECOMMENDATIONS

1. To commit to working towards achieving smoke free city status.
2. To establish a Member/Officer working group to ensure implementation of this policy.
3. To commend the draft revised City Council tobacco control policy to the Personnel Committee.

Financial consequences for the Revenue Budget

If smoking reduction amongst employees occurs, savings achieved through reduced sickness absence.

Financial consequences for the Capital Budget

None.

Wards affected

All.

CONTACT OFFICERS

Steve Mycio                                                 Jon Redfern

Deputy Chief Executive                              Head of Personnel

s.mycio@notes.manchester.gov.uk          j.redfern@notes.manchester.gov.uk

234 3031                                                      234 1800

BACKGROUND DOCUMENTS

Tobacco Control in Manchester

1.             Introduction

1.1        Over recent months, issues relating to public health have risen substantially up the national policy agenda. The government has conducted a major national consultation on the subject, Choosing Health? which will inform a new public health White Paper in the near future. Locally, the Manchester Health Inequalities Partnership has identified tackling tobacco as one of its top three public health priorities: the recently adopted Public Health Charter states that

“We will:

·        Improve the services offered to people to support them if they wish to give up smoking;

·        Work with the Smoke Free Greater Manchester campaign to encourage smoke free public places.”

1.2        This paper outlines the current situation with regard to smoking and health in Manchester, and proposes adopting a broad approach to reducing the problems associated with smoking. It outlines the concept of a “smoke free city”, and proposes that Manchester should work towards this objective.

2.             Smoking and health

2.1        Rates of smoking in Manchester are amongst the highest in England. There are few recent reliable data about smoking rates: the most statistically reliable comes from the Health Survey for England covering the years 1994-96: this indicated that the smoking rate in Manchester was 38.5%, compared with 28.8% in England as a whole – the highest rate in England. No comprehensive or statistically reliable surveys have been carried out since, but data collected by Sure Start areas suggest that in some parts of the city, smoking rates among pregnant women could be up to 80%.

2.2        Life expectancy in Manchester is the lowest in England, and the gap between Manchester and the England average is widening. In response to this, the city has adopted an improvement in life expectancy as one of its Public Service Agreement Targets. The major contribution to this reduced life expectancy comes from coronary heart disease and cancers. The link between smoking and ill health, particularly coronary heart disease and cancer, is not in doubt: approximately one third of cancers, and one fifth of coronary heart disease, can be attributed to smoking.

2.3        Smoking prevalence shows a particularly strong social class gradient, with 32% of people from manual social classes being smokers, compared to 21% in non-manual social classes – a 50% difference[1]. This gap has been widening due to a faster reduction in smoking prevalence among non-manual groups. Nearly half of coronary heart disease deaths of 35-64 year-olds in social classes IV and V are due to smoking.[2]

2.4        There is also a link between breathing environmental tobacco smoke (also called second-hand smoke, or passive smoking) and ill health. The 2002 Annual Report of the Chief Medical Officer states that:

“Second hand smoke contains five regulated hazardous air pollutants, 47 regulated hazardous wastes, more than 50 known or suspected cancer-causing agents, and more than 100 chemical poisons…Second hand smoke causes lung cancer, increasing the risk by 20-30% in people who live with smokers…Second hand smoke causes heart disease, increasing the risk by around 25% in people who live with smokers.”[3]

2.5        One recent research report has suggested that nation-wide, passive smoking kills 4,300 people every year – including one worker in the hospitality industry every week[4].

2.6        Children are at particular risk from environmental tobacco smoke, and are the age group most likely to start smoking in the first place. The Chief Medical Officer’s report cited above goes on to note that environmental tobacco smoke from parents is causally linked to many illnesses in childhood, including sudden infant death syndrome (a doubling of the risk); illness of the lower respiratory tract (a 50% increase in risk); and asthma (a 50% increase in risk).

2.7        At an individual level, patients with coronary heart disease who stop smoking could reduce their risk of death by 36%.[5]  Generally, stopping smoking seems to reduce the excess risk of smoking on coronary heart disease by half within one year. After several years of abstinence, the risk for an ex-smoker is similar to that of someone who has never smoked.[6] 

2.8        Given the links between smoking and ill health, it seems clear that if Manchester wants to do something to improve the life expectancy of its residents, it needs to tackle tobacco. This will require a multi-faceted approach which both helps current smokers to quit and – crucially – prevents young people from starting in the first place.

3.             The “Smoke Free City” concept

3.1        In recent years, the concept of the “smoke free city” has started to gain popularity. There is no formal definition of what makes a city “smoke free”: work is currently underway to discuss what it might mean for Manchester. As a minimum, it is likely to include action in a number of settings:

3.1.1.     Workplaces: In order to protect people from exposure to environmental tobacco smoke, workplaces should be completely non-smoking. Workplaces would include offices, shops, restaurants, bars, and factories. While it could be argued that for some people, places like parks could be seen as workplaces, in reality it would be impossible to enforce a no smoking rule in such open environments. Action in workplaces is very likely to require action from either local or national government so that it can be adequately enforced.

3.1.2.     Homes: In order to protect children in particular from environmental tobacco smoke, people should be encouraged to keep their homes non-smoking. This neither could be nor should be imposed or enforced; rather, it is a voluntary arrangement aimed in particular at parents, for example in partnership with Sure Start areas, in order to protect children.

3.1.3.     Schools: In order to protect children and staff from environmental tobacco smoke, schools should have a no-smoking policy throughout, including in the grounds. And in order to help prevent children from starting to smoke, they should have a cross-curriculum approach to education about smoking. Local Education Authorities can clearly facilitate this work.

3.1.4.     Hospitals: Again, hospitals need to have a clear policy about smoking in order to protect staff and patients from environmental tobacco smoke.

3.1.5.     Local communities: Given the variation that appears to exist between different parts of the city, specifically targeted work with action plans at ward level will also be essential.

3.2        In order to support work in all these areas, any smoke free city will also require a sustainable and easily accessible smoking cessation service to help people who want to give up smoking – generally estimated at approximately 70% of smokers – to achieve that goal.

4.             Local action

4.1        At the Manchester Local Strategic Partnership conference in March, the “Great Health Debate” workshop initiated discussions about a smoke free Manchester. There was widespread support for such an initiative. It was generally agreed, including by representatives of the pub and club industry, that if Manchester wishes to pursue a workplace smoking ban as part of achieving smoke free status, this should be done as part of a Greater Manchester initiative, thus minimising the risk of loss of business to surrounding areas.

4.2        Subsequently, the Health Inequalities Partnership identified tobacco control as one of its key public health priorities, and has indicated its desire to see Manchester achieve smoke free status by 2006.[7]

4.3        Many of the elements of smoke free city status described above are already in place or are being initiated. The Manchester Smoking Cessation Service runs various services in the community, primary care and schools aimed at helping people to stop smoking; a smoke free homes campaign is underway; there is education within schools, particularly those participating in the Healthy Schools Award initiative; hospitals and Primary Care Trusts are being encouraged to review their policies; and a smoke free workplace scheme is being initiated for those workplaces willing to take voluntary action.

4.4        In addition, the City Council’s smoking and tobacco control policy is being reviewed. While formal personnel processes are still underway, the draft policy (attached as Appendix A) strengthens the existing prohibition on smoking at work and in or around Council premises. The most substantial changes proposed are:

·         Smoking would be prohibited not just within offices, but also in Members’ rooms, access doorways and surrounding areas.

·         No facilities would be provided for smokers inside or outside Council premises.

·         Employees would not be permitted to absent themselves from work in order to smoke during work time.

·         There is an explicit recommendation to schools that they adopt a policy that prohibits all smoking in school buildings and grounds.

4.5        As part of the implementation of the City Council’s policy, additional smoking cessation support services are being developed for Council employees and elected Members. These will be provided through the Occupational Health Service and the city’s Smoking Cessation Service.

4.6        Realistically, however, the single biggest change required for smoke free status – smoke free workplaces, including pubs, clubs and restaurants – is unlikely to be achieved by voluntary action. Over recent months there has been considerable debate both nationally and locally about the possibility of banning smoking in workplaces and/or enclosed public places. There have been widespread calls for implementing such a ban in the UK, including from the Chief Medical Officer and the Royal College of Nursing, and bans have been enacted in places like California, New York, Ireland, and most recently Norway. In the UK, the government is considering whether to take action nationally or to give local government relevant powers, as part of the new public health White Paper expected shortly. To date it has indicated that it favours a local approach.

4.7        As this is likely to be the most controversial aspect of endorsing the goal of working towards a smoke free Manchester, sections 5 and 6 below set out the main arguments used in this debate, and attempts to demonstrate that those commonly used in opposition to smoking bans are not generally justifiable. Section 7 summarises the results of a recent opinion poll within Manchester on the subject of smoke free public places.

5.             The benefits of smoke free workplaces

5.1        As more places have instigated a workplace smoking ban, the benefits to health are starting to become clear. Smoke free workplaces appear to have two significant benefits: a direct improvement in health associated with reduced passive smoking, and providing an incentive for smokers to give up. They may (although there is little evidence either way) also have the effect of reducing the number of young people starting to smoke, through reduced normalisation of smoking and reduced associations between drinking and smoking.

5.2        The health improvements associated with reduced passive smoking are well evidenced, and in some cases may be dramatic. In California, there was an improvement in the respiratory health of bartenders (those who work in restaurants and bars are particularly vulnerable to exposure to environmental tobacco smoke) and a reduction in deaths from heart disease; and a study in Helena, Montana, showed that the number of heart attacks fell by 40% during the period of a 6 month smoking ban[8]. This study suggests that smoking bans can lead to rapid changes in health statistics.

5.3        When it comes to incentives to quit smoking, the Chief Medical Officer has suggested that a UK-wide ban were implemented, smoking rates could fall from 27% to 23%.[9] The experience in New York suggests that such estimates may not be unrealistic: there, the number of smokers fell by 11% in the first year following the implementation of a smoking ban. In addition, the number of cigarettes smoked dropped by 13%, implying that those who continued to smoke, smoked less[10]. This is one of the steepest short-term reductions ever measured, although it is likely that a simultaneous increase in the local tax on cigarettes contributed significantly.

6.             Arguments against a smoking ban

6.1        Arguments against a workplace smoking ban usually take one of two forms: a human rights / choice argument, and an economic argument.

6.2        The first type of argument suggests that people have a right to smoke, often associated with an argument in favour of having smoking and non-smoking areas, giving people a choice, and favouring ventilation systems as a way of reducing environmental tobacco smoke in areas where smoking is permitted. It could of course be argued that the 70% of people who do not smoke have a right to breathe clean air, and that this easily outweighs the right of the other 30% to breathe smoke. Recent research in pubs and bars in the Greater Manchester area has shown that having separate no-smoking areas reduces levels of environmental tobacco smoke by a small amount, and that mechanical ventilators may have little significant effect.[11]

6.3        The economic argument, usually advanced by the hospitality industry (including pubs, clubs and restaurants) is that a smoking ban would be bad for business. There is an assumption, supported by tobacco industry campaigns, that people will stay away from pubs and restaurants if they cannot smoke. However, studies in Australia[12], California[13] and New York refute this assumption. Indeed, one recent review of almost 100 studies on the economic effects of smoke-free policies concluded that “all the best designed studies report no impact or a positive impact of smoke-free restaurant and bar laws on sales or employment.”[14] In the UK, the Laurel Pub chain has concluded that, at least in food-led premises, going smoke free improves business; this conclusion is supported by a recent UK-wide Mori poll, which indicated that three quarters of people say a smoking ban would make no difference in whether they use a pub or restaurant; 8% say they would use it less, and 17% that they would use it more.[15]

7.             Public perceptions

7.1        Over the course of the last six months or so, there have been several surveys of public opinion about smoke free public places. They have usually found approximately 70% of the public in favour of smoking bans in enclosed public places, although this figure often drops off when specific places are mentioned. A recent MORI poll in Greater Manchester confirmed this pattern:

·        77% of respondents stated that they were bothered by smoke in public places;

·        74% favoured smoke free enclosed public places;

·        52% favour completely smoke free restaurants, with a further 46% wanting to see separate smoking and non-smoking areas;

·        25% favour completely smoke free pubs and bars, with a further 39% wanting them mainly smoke free with separate smoking areas;

·        90% agree that people who work indoors have the right to work in a smoke-free environment; and

·        77% favour legislation to prohibit smoking in enclosed public places.

8.             Conclusion and recommendations

8.1        If Manchester wishes to see rapid progress on improving the health of its residents, the single most urgent task is to tackle tobacco.  While much of this paper has been taken up with discussions concerning workplace/public places smoking bans, this is only one aspect (albeit a very important one) of achieving smoke free status.

8.2        Manchester has a history of being forward-thinking and unafraid of taking risks to bring about a modern, vibrant city. The smoke free city is an idea whose time has come: Manchester should be in the vanguard of this change. It is therefore proposed that Manchester should commit to working towards achieving smoke free city status.

8.3        In order to take forward the creation of a smoke free Manchester, a joint Member/Officer working group is proposed, with Member representation led by the Leader of the Council and the Executive Councillor for Health and Social Care, and officer representation co-ordinated by the Deputy Chief Executive (Performance). In order to ensure a common approach across the city, representatives from other organisations (such as Primary Care Trusts and Hospital Trusts) could also be co-opted as appropriate. This group will be tasked with setting a target date for achieving smoke free status and establishing the process for meeting this objective.

8.4        In order to demonstrate leadership and commitment to the creation of a smoke free Manchester, the City Council is revising its internal tobacco control policy. The Executive is therefore asked to commend the attached draft policy to the Personnel Committee.

APPENDIX A

Manchester City CouncilTobacco Control Policy (DRAFT)

1.             Introduction

1.1        The Health and Safety at Work etc Act (1974) requires that the City Council takes reasonable measures to protect the health and safety of employees and members of the public visiting Council premises.

1.2        Despite this, there are three million people still exposed to environmental tobacco smoke at work and smoking is still the largest preventable cause of death and disability in Britain today.

1.3        Smoking is associated with around 50 major illnesses including cancer, heart disease, stoke, bronchitis and emphysema as well as making smokers more susceptible to coughs, colds and flu. Smoking has also been found to have major impact on pregnancy, the unborn child and young people.

1.4        In addition to the damage done to smokers themselves, environmental tobacco smoke (passive smoking) causes an estimated 12,000 deaths each year in the UK.

1.5    Second hand smoke can cause misery in the work place for the non-smoking workforce, leading to increased costs to the Council from sick pay, absenteeism, loss of productivity and potential litigation.

1.6    In addition, smoking has significant impacts on the quality of the public environment via littering. One recent report on the quality of the public realm in the city centre found that 97% of litter was smoking related (discarded wrappers, packets or butts).

2.           Principles of the Policy

2.1        Manchester City Council recognises and fully accepts those responsibilities placed upon it by health and safety legislation to provide a working environment where the employees’ safety and health is of the utmost importance.

2.2        The purpose of the Tobacco Control Policy is to protect and improve the health, safety and well being of all elected members, employees and people who visit Council premises.

2.3        The Council recognises that both smoking and environmental tobacco smoke have harmful consequences and should be prohibited except in areas that have been designated exempt. For those areas suitable control measures should be applied (see Paragraph 3.11).

2.4        The Council recognises that smoking is an addiction and aims to provide a supportive environment for those wishing to overcome it. Employees will therefore be permitted 2 hours paid time leave to access an initial smoking cessation consultation with the Manchester Smoking Cessation Service.

3.           Policy statement

3.1        Paragraphs 3.2 – 3.8 below set out the normal policy position. Specific variations to this general policy are described in paragraphs 3.9 – 3.14.

General policy

3.2        The City Council supports the Tobacco Free Greater Manchester campaign for smoke free public places, and will actively work towards achieving this end across the whole city.

3.3        With effect from [date to be agreed] complete prohibition on smoking in all parts of City Council premises will be applied.

3.4        Where the City Council is renting office space, a prohibition on smoking will apply within those offices rented by the City Council. The Council will request that the policy is also applied to any communal areas, where applicable.

3.5        Smoking will be prohibited in all the following areas:

3.5.1.    Access doorways, surrounding areas, rest rooms, corridors and toilets. 

3.5.2.    All Council owned vehicles.

3.5.3.    Officers’ private vehicles while transporting official passengers on Council business (including service users).

3.5.4.    All Members’ rooms, including the Members’ lounge and dining areas.

3.5.5.    All Council owned public buildings, including function rooms, theatres, cafes, sports and recreational facilities. The sale of tobacco produce will also be prohibited in all of these outlets.

3.5.6.    Youth Clubs.

3.6        No facilities will be provided for smokers either inside or outside Council premises.

3.7        Council employees who wish to smoke may only do so in their own time. Employees must not absent themselves from their place of work during work time for the purposes of smoking.

3.8        Managers must not condone employees taking time off work in order to smoke.

Policy within schools

3.9        For schools, the policy recommends that school Governing Bodies and Head Teachers adopt a Tobacco Control Policy that prohibits all smoking in school premises and school grounds.

Residential homes

3.10    Residential homes must aim for the prohibition of smoking on Council premises. Where this is impractical for certain residents for whom the residence is considered a home, suitable control measures should be applied in order to minimise the risk to employees and other residents (see paragraph 3.11).

Hierarchy of measures for designated exemptions

3.11    The Health and Safety Commission’s draft Approved Code of Practice (A.Co.P) on control of environmental tobacco smoke proposes a ‘hierarchy of measures’ to minimise the risk of exposure to environmental tobacco smoke to employees and members of the public. These measures include:

·        Completely banning smoking;

·        Banning smoking except in designated rooms;

·        Having separate smoking and non-smoking areas;

·        Adopting a safe system of work.

3.12    It is essential that the most effective methods of controlling environmental tobacco smoke should be explored first.

3.13    Research by the Health and Safety Executive has found that provision of a ventilation system within a specific area of a workplace is inadequate in providing protection against environmental tobacco smoke, and therefore this cannot be recommended as a means of providing any protection to elected members, employees or visitors of the Council.

3.14    In line with the City Council’s aim of providing a supportive environment for those who wish to stop smoking, information about local smoking cessation services may be made available in any areas specifically designated for smoking.

4.           Implementation and enforcement of the Policy

4.1        Each Chief Officer will be responsible for the promotion and maintenance of a smoke-free working environment. The Manchester Joint Health Unit will co-ordinate training and support for suitable personnel within department on this issue, via the Manchester Smoking Cessation Service, for cascading to employees.

4.2        The Employee Health Strategy Group and the Manchester City Council Corporate Occupational Health Unit will promote the smoking cessation support services offered by the Manchester Smoking Cessation Service.

4.3        All job applicants shall be made aware of the Tobacco Control Policy at the interview stage, and a requirement to abide by it will be part of the person specification for new jobs.

4.4        A copy of this policy will be included in induction packs for new starters.

4.5        Failure to abide by the Tobacco Control Policy will result in the initiation of disciplinary action on the individual, in accordance with Manchester City Council procedures.

4.6        Non-employees who breach the Tobacco Control Policy will be asked to leave the premises concerned.

4.7   Smokers, employees and non-employees, may be fined for littering the streets when inappropriately disposing of cigarette ends.

5.           Policy Review

5.1        The Head of Personnel will ensure that this Tobacco Control Policy will be reviewed no later than 12 months from the date of implementation.

6.           Details of smoking cessation services

6.1        The Manchester Smoking Cessation Service can be contacted at:

Manchester Health Promotion Specialist Service

Victoria Mill

Lower Vickers Street

Miles Platting

Manchester M40 7LP

Tel: 0161 205 5998

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