SMOKERS IN Tayside who refuse to stub out when health service staff or volunteers arrive for a home visit may have to accept a drastically reduced service when a new protocol designed to protect NHS staff is introduced next month.

But Paul Ballard, NHS Tayside health promotion consultant, yesterday said the penalties would not be draconian, as the service had a duty of care to patients and could not withhold treatment.

The protocols were nodded through by Dundee Community Health Partnership in the week that a Dundee University study revealed the health benefits to bar staff in the wake of the Scotland-wide policy of no smoking in public places.

The protocol, designed to minimise the risk of passive smoking to staff and volunteers, sets guidelines that no staff or patients should be exposed to smoke against their will and patients who get home visits are asked not to smoke during the visit. Staff who do most home visits include chiropodists, district nurses, physiotherapists and health visitors.

Letters will be sent to all recipients of home visits asking them not to smoke. But if information, discussion and negotiation are unsuccessful, for whatever reason, a formal risk assessment will be launched.

Patients will be advised that although their right to smoke in their own homes will be respected, their refusal to help minimise the risk may affect the service they receive, to the point that could include providing the minimum possible service.

A report to the committee makes clear that ultimately, if the patient or a household member still refuses to comply, formal written notification will advise them of service changes or reductions.

In addition, the risk assessment at a patient’s house will log the sources, quantity and type of tobacco used, length of time staff are exposed to passive smoking and any other relevant circumstances.

The committee heard Dundee City Council had a similar scheme in place for social workers that had been highly successful.

Mr Ballard said the minimum possible service offered to people who would or could not refrain from smoking could only be worked out at a local level, and it was the staff involved who would have to decide what was going to be acceptable if the patient refused to stop smoking.