The HM Prison Service is considering banning smoking in all areas of prisons in England and Wales. The ban is thought to stem from the threat of possible legal action by non-smoking staff and inmates citing the health implications of passive smoking. Currently, 80 per cent of prisoners are believed to be smokers.
Senior prison officers were informed of this move in a letter sent to them in September 2013 which outlined a number of prisons in the South West that are being considered as sites to pilot the ban from next March or April. It has been reported in a number of news outlets that pilots will be rolled out in a series of prisons across the South West including Exeter Prison and Eastwood Park Women's jail. If the pilots are successful the ban could be put in place by 2015. However, a Prison Service spokesperson said: 'No decisions have been made. We are considering banning smoking across the prison estate and as part of this are looking at possible sites as early adopters.'
The restriction of smoking in public places in 2007, meant that smoking has been allowed only in inmate's cells as these were considered domestic territory. This new ban would see smoking restricted across all areas of the prison including exercise yards and inmates' cells.
Prison nurses will be key to ensuring that effective smoking cessation services will be available for prisoners who decide to stop smoking entirely.
Ann Norman, the Royal College of Nursing's (RCN) criminal justice nursing advisor says, there are limited numbers of prison nurses, which means they will be under an increased workload and there will be greater demands on the current workforce to respond to fill those gaps. 'As a result there may be a need to increase the numbers of prison nurses,' she said.
The POA (the union for prison officers) has been campaigning for the ban since 2008, when it became illegal to smoke in public places. Their drive behind the campaign is to ensure that all non-smoking prison workers have a safe environment to work in. Joe Simpson, assistant general secretary of the POA says that more training for healthcare professionals working in prisons could be needed to support prisoners.
A career in prison nursing tends to attract community nurses, secure hospital nurses, A&E nurses, or mental health and learning disability nurses.
Emma Leegood, an advanced nurse practitioner at HMP Wandsworth Prison, says that nursing in a prison differs greatly to nursing in other community environments. 'The closed environment of a prison provides many challenges to providing nursing care such as security issues and having to provide care around the daily operational regimes of running a prison smoothly. I work in a health centre providing clinics to patients which are very much the same as a GP surgery in the community.'
Prison nurses see conditions that are very similar to those in the community such as back pain, skin conditions, substance misuse and long-term conditions such as asthma, diabetes, COPD and hypertension. Mental health issues are also prevalent in many prisons.
While there has been some disparity in opinion as to whether the smoking ban would be a good thing or not, most healthcare professionals are in agreement that it will improve the health of prisoners and reduce the number of chest infections and respiratory illnesses.
Ms Leegood agrees with this view. 'It is difficult to say whether a ban is a good thing or not as everyone should make decisions about their health themselves and it would be unfair to ban a certain community from smoking. However, I can understand the health promotion reasons behind it.'
However, Dr Liz Walsh, the forum chair for nursing in criminal justice with the RCN, said: 'I do think the smoking ban is a good idea, anything that promotes good health really.'
If the smoking ban is implemented nurses may need additional training in order to provide effective cessation support for both prisoners and officers. It is thought that prisoners who do not choose to quit smoking may be allowed to purchase their own e-cigarettes instead of purchasing tobacco products.
Dr Walsh believes that nurses would need more training on cessation services and it would have to be a multi-disciplinary team effort combining the efforts of nurses, doctors and pharmacists. There will also need to be more resources such as leaflets and patches. 'The cessation services already in place in prisons are very similar to the ones in the community, such as nicotine replacement therapy and patches. A lead in to the ban so that the prisoners are able to quit smoking before it comes in will be necessary. There will also need to be better links to community nurses for the prisoners once they leave to ensure the transition of care is smooth.'
Ms Norman agrees that there will need to be a greater number of resources. 'This will be a challenging ban to implement and it will have implications for nursing staff, but it will give them a chance to look at their skills and update them if necessary.
'Nurses will need to increase the services they offer alongside the coping strategies. A variety of prison pilot sites are receptive to the idea, and it is understandable that some of the staff will be nervous, but a ban is in the right direction of travel and will be a positive change, and by and large most professionals are positive.
'There is a high incidence of chest infections in prisoners and cigarettes can also be used to start fires. However, it will be difficult for smokers to adjust to the change.'
There have been concerns expressed on how a ban could affect the behaviour of the prisoners and whether it will lead to riots or antisocial behaviour as a result of withdrawal symptoms and boredom.As there is also a high prevalence of mental health problems and anxiety within prisons, there is a concern that these prisoners in particular may exhibit difficult behaviour if a complete ban is put in place.
Steve Gillan, the general secretary of the POA, has said that fears of riots are not a justifiable reason to prevent the ban. 'If the ban can work in secure hospitals such as Broadmoor, then there is no reason why it wouldn't work in prisons. Anything can spark riots, and the pilots will be a good way to identify any of the problems that arise and then they can be dealt with to ensure the ban is rolled out smoothly. There have been successful trials in the US, Canada and Scandinavia, which show the ban can work.
'It may involve more work for nurses, but the pilots will help to identify these areas. We have discussed it with the RCN and it seems that most nursing professionals are in favour of the ban.'
Nurses working directly with the prisoners in supporting their smoking cessation worry that they will be the ones dealing directly with the effects of riots should they happen.
Ms Leegood said: 'There is the possibility that that this could lead to riots as some of the prisoners live for their roll-ups, which are often provided alongside their essentials such as their toothbrushes and toothpaste.'
This highlights just how reliant some prisoners are on their cigarettes if they are categorised as everyday essential products.