29 September 2022

Di Hurley has worked in the NHS since 1981, starting out as an Occupational Therapist. She worked with CNWL from 1993 until 2020; by this time, she was Head Occupational Therapist in Harrow. Since her retirement, Di has continued to volunteer for CNWL to promote wellbeing for staff and patients.

In this article, Di speaks about her long history working in smoking cessation, looking at how far the Trust has come and where further progress can be made:

How prominent was smoking in hospitals when you first started working with the NHS?

Smoking was seen as the ‘norm’ in those days.  Smokers experiencing a state of stress or difficult life circumstances would rely on smoking to manage their emotions and most patients in mental health units smoked. Many staff also smoked at that time, and it felt supportive to offer patients a cigarette at a time of crisis. It seems awful to take away someone’s main way of managing their emotions but if you can offer the best alternative support to somebody, that can transform their lives for the better.  The problem is that addictions only address what’s happening in the moment. They don’t address the long term – addictions always exact a heavy, and often cruel price to pay in the end.

How have things changed over time? What are the differences between then and now?

There were always staff who were open to change, particularly non-smokers, because they were sick of having their health damaged and going home stinking of smoke. Kim Cox, Director of Nursing for Jameson Division, often tells of staff having to paint one smoking room about six times before they could get rid of the yellow on the walls – so just think what was happening to people's lungs! But those of us who wanted change were in the minority.

70-90% of our patients were smokers in those days. Now about a third of patients in the adult wards are smokers. It's gone down massively, but still not as much as the general population (which is down to under 14%).

What were the biggest challenges that you faced?

The hardest bit was to change the hearts and minds of colleagues and patients as we went through the phases of going smokefree. First, we closed the smoking rooms and escorted smokers outside, then we made the gardens smokefree, finally we aimed to go completely smokefree inside and outside. We’re not 100% there yet but we’re on the journey and we wouldn’t want to go back to where we started! 

Learning is key – once you attend the training then your eyes are opened, and you have the resources, tools and knowledge to go forward with it. Inside most smokers lives a person who knows how harmful their habit is and really wants a better future. If a smoker knows you're on their side and doing everything to make the process as comfortable for them as possible, they will be more confident and determined to stop.

It’s been a real struggle stopping smoking on the grounds around hospitals. Some hospitals were quite resistant or didn’t have the resources to enforce it. It can be hard because you might see somebody sitting on a bench crying and smoking because they’ve just had a bereavement so you have to be very sensitive about the way you communicate to someone smoking.

Up until recently, a hospital I worked in still had a smoking shelter for staff. I don't know how this happened but one night it burnt down! My colleagues all suspect me but I am innocent! It shouldn’t have been there though – how can you tell patients they can’t smoke when staff in their uniforms are smoking in plain sight? ‘Consistency and not hypocrisy’ is the key!

What’s been your own personal journey with smoking cessation?

I started smoking as a teenager. The way you asserted your teenage rebellion in those days was to start smoking but I stopped when I became pregnant with my daughter. The first two weeks were extremely tough but I've never touched a single cigarette since, no matter what's happened in my life. You’ve really got to have a no-puff rule. Occasionally I get a vague memory that reminds me that I was once a smoker, but it goes in seconds if I don't give into it. That conditioning fades away.

Can you talk about the effects of smoking on mental health and wellbeing?

I believe that smoking is a uniquely difficult addiction to quit because you attach it to other habits. You might reach for a cigarette after a cup of coffee, after every meal, when you get up in the morning or when you have a break. You pair it repeatedly with routine activities and it becomes conditioned. You also learn to manage and regulate your emotions using smoking – particularly the strong feelings like anger, anxiety, and depression. That's why people find it so difficult to stop; you literally have to change your mental settings in many ways as well as fight the physical addiction.

Is vaping just exchanging one addiction for another?

Vaping can bring huge harm reduction. One doctor said it was like comparing a skyscraper with a doorstep. Vapes contain a fraction of the toxins that cigarettes have, and no carbon monoxide. Introducing vending machines with vapes in them was a game changer; it reduced aggressive smoking-related incidents on our wards. The success rates of going cold turkey are very low for people but vaping or combination nicotine replacement therapy can be very effective. The problem with nicotine replacement therapies, such as patches, is that they don't mimic the smoking experience. For somebody who's very emotionally attached to smoking, vaping can be the best way for them to make that first step.

If you want practical support to quit smoking, please visit the NHS smokefree website.