Smoke-free Northern Ireland 10 years on: an unqualified success

On the 10-year anniversary of the smoking ban in workplaces, Nigel McMahon provides a unique insight into Northern Ireland’s experience with introducing legislation three months in advance of England. 

no smoking pub,restaurant 

It seems like a no-brainer doesn’t it? Why would we allow the exposure of non-smokers to harmful second-hand smoke in workplaces and enclosed public places?

It might be obvious now but we must acknowledge the courageous and ground breaking stance taken by the Irish Government in introducing smoke-free legislation in March 2004. This undoubtedly paved the way for the roll out of smoke-free places across the UK and beyond. As was said at the time, if you can do it in Ireland, you can do it anywhere! 

Securing public support 

More than 10 years ago, I served as Chief Environmental Health Officer in Northern Ireland’s Department of Health and it was while working here that I formed an integral part of the policy and legislation development team which was behind the new smoke-free regulations. 

I then played an active role in implementing the new legislation, working closely with a variety of stakeholders not to mention local-authority based environmental health teams. 

This significant public health project began in earnest when the Department of Health in Northern Ireland published a Tobacco Action Plan in 2003 with the overall aim of creating a tobacco-free society.  

The plan had three key objectives: preventing people from starting to smoke; helping smokers to quit; and protecting non-smokers from tobacco smoke. 

At the end of 2004, in the context of the 20-year Regional Strategy “A Healthier Future”, a public consultation considered three options for strengthening tobacco controls: 

  • encourage greater adoption of smoke-free provision in public places and in workplaces through self-regulation;
  • prohibit smoking in most enclosed public places and workplaces, while still allowing smoking in some pubs and bars other than those preparing and serving food; and
  • ban smoking in all enclosed public places and workplaces.

More than 70,000 responses were received, the most ever in relation to a consultation in Northern Ireland, with the overwhelming majority, more than 91%, supporting a ban on smoking in enclosed public places and workplaces. 

Given the overwhelming health arguments, cross-party political support and the support of the public, the then Health Minister, Shaun Woodward, announced on 17 October 2005, that he intended to introduce legislation to control smoking in all enclosed workplaces and public spaces with effect from April 2007. 

Getting things in place 

The proposals indicated that district councils would be enforcing the legislation. The Chief Environmental Health Officers’ Group (CEHOG) in Northern Ireland quickly established a Tobacco Task Group (TTG) to work with the Department of Health and a range of stakeholders to pave the way for the implementation of smoke-free. 

In the first instance, the TTG produced a series of frequently asked questions which helped council staff deal with queries raised by businesses and others in relation to the smoke-free legislation. 

11 Smoke-Free Environments Officers and a Smoke-Free Environments Project Manager were appointed in November 2006. Funded by the Department of Health, the new officers worked as a team across councils and with businesses to raise awareness and assist where possible on compliance issues. 

Funding was also made available to councils to appoint a further 12 additional Tobacco Control Officers to recognise that there were premises covered by the legislation that council officers would not normally visit for any other reason and for additional work out of hours. 

The TTG and the Smoke-Free Environments Project Manager met with a wide range of stakeholders including business representatives, Planning Service, Roads Service, HSE and FSA, to consider implications and identify areas for working together on implementation and compliance issues. 

The Health Promotion Agency (HPA) assisted the Department of Health in drafting guidance for businesses to provide advice on the requirements of the legislation. Copies of the guidance and examples of signage were issued to over 87,000 businesses in Northern Ireland and additional copies were made available from district council offices. 

The Department of Health also issued enforcement guidance to councils aimed at promoting a consistent approach. The Environmental Health Service seconded an EHP into the Department of Health for four months to assist with the production of the guidance to help ensure that it was as comprehensive and useful as possible. 

CIEH were awarded the contract to provide more detailed training for enforcement staff and service managers in relation to the requirements of the legislation and that seemed to be well received. 

The TTG also sought to dove tail this work with the Health Promotion Agency’s (HPA) communications programme. The strategy had a number of elements to ensure the general public, particularly smokers, and all employers and businesses were made aware about the legislation and encourage compliance and public support. 

The ‘Space to Breathe’ web site, developed by the HPA on behalf of the Department of Health, contained all of the information around the introduction of the legislation. It was regularly updated and became a valuable resource, a ‘one stop shop’ of information for business, enforcement staff and the public, particularly smokers. 

A compliance phone line was also established on 30 April as a convenient way for the public to report breaches of the smoke-free legislation if they wished. The phone line also used the intelligence received about breaches to target enforcement resources to where they were needed most. The compliance line was open from 12 noon to midnight and received 55 calls in the first 3 weeks. 

There was also a high profile advertising campaign. This comprised of TV advertising on UTV and Channel 4, radio advertising, outdoor adverts on buses and bus shelters and what I was told is called ambient advertising such as glow boxes, which are posters with lighting and beer mats. 

 NI bus shelter 

A range of print materials were produced to include the guidance document and signage for businesses, posters, primarily for pubs, clubs and large retail outlets and a leaflet to be inserted in daily newspapers.

The TV advertisement was the mainstay of the campaign. There were several versions of the ad featuring different settings and the ad continued to run after the restrictions came into force with a different commentary that reminded people that the ban was now in place. 

A parallel programme of media activity also helped to promote the legislation and highlight the dangers of passive smoking. Relevant television, radio and newspaper journalists were targeted and features on the legislation were provided to local trade magazines. 

It was also important to raise the profile of smoking cessation campaigns to offer help to those wishing to quit. The HPA activity around this involved advertising and promoting the Smokers’ Helpline, activity around No Smoking Day, the launch of a Smoking Cessation e-learning package for GPs and a competition for young people to highlight the issues and the legislation on the HPA young people’s web site www.up-2-you.net  

Early issues 

In November 2006, the Department of Health was criticised politically and in the media for funding the Smoke-Free Environments officers to assist businesses with compliance when ‘sure everyone knew it would be self-policing’. 

By 30 April, the Department received further criticism in the media for not having additional enforcement staff in place in time to police this difficult piece of legislation – damned if you do and damned if you don’t! 

NI sign  

Some businesses, particularly the hospitality sector claimed that they had not been given enough time to prepare and linked to this was the complaint that the planning system was too slow to react to applications for modifications to premises to accommodate smokers. 

Some complained of inevitable loss of business, not an argument that appeared to be supported by evidence from the Republic of Ireland. 

Complaints came from some sectors, particularly those that considered themselves to be smoke-free already, in relation to the requirement to display no-smoking signs. 

Over the weekend before Monday 30 April, there was some relatively negative press and media coverage of how things were about to change forever and the promotion by some establishments of smoke-in parties and so on. 

But after these initial concerns, on the day itself, 30 April, there was widespread coverage of the issue which was universally positive, welcoming what was seen as a positive public health measure. 

Compliance 

The media were interested in compliance as you might expect and the early reports were extremely positive. In the first week, including the first weekend, which was a Bank Holiday weekend, councils carried out over 12,000 compliance visits, a huge effort, and found very high levels of compliance. In the second week there were fewer inspections but even higher levels of compliance reported. Councils conducted a further 1,609 visits in the third week and revealed 98% compliance on signage and more than 99% in relation to no smoking. 

In December 2007 the CEHOG Tobacco Task Group and the Smoke-Free Team were jointly awarded the CIEH/Northern Group Systems Michael Cole Award in recognition of the contribution that both groups made to the implementation of the smoke-free legislation. 

This was a great achievement for everyone involved, with the Michael Cole Award recognising the efforts of individual EHPs or groups who show exceptional talent or innovation in their professional work. 

10 years on – 2017 

The legislation was not about whether people should or should not smoke. It was intended to protect the public and employees from exposure to tobacco smoke. 

10 years on compliance remains very high. The Tobacco Control Officers and the Tobacco Task Group are still in place, although the role has expanded to take in a wider range of tobacco control activity. A key focus of the work today is the sale of tobacco products to children. 

The main smoke-free issues today relate to the design and use of smoking shelters, the interpretation of ‘substantially enclosed’, the ‘mission creep’ of smoking areas becoming beer gardens, having their own bars within them and all sorts of covers and enclosures. There are also issues relating to smoke-free shared work vehicles, arguably the least well known and understood aspects of the legislation. 

Many people have experienced the benefits of smoke-free and the next generation coming through are incredulous that smoking was ever allowed in such premises. This is a key public health intervention, arguably the greatest of our generation, in which EHPs working in various roles across central and local government delivered a challenging policy that has gone on to produce a significant and positive societal change. 

The 10-year Tobacco Strategy for Northern Ireland (2012-2022) highlights that smoking remains the single greatest cause of preventable illness and premature death in Northern Ireland, and one of the primary causes of health inequality. There is still a lot to do and I am sure that the contribution of EHPs will remain central to the ultimate aim of delivering a tobacco-free Northern Ireland. 

 NI group shot
 At the smoke-free launch event (from left to right): Jim Gibson, Department of Health; Chief Medical Officer, Dr Michael McBride; Health Minister Paul Goggins; Brian Gaffney, Chief Executive of the Health Promotion Agency; and Nigel McMahon, Chief Environmental Health Officer, Department of Health).

 

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