Travel sick - banning smoking in cars

Queuing in traffic around the north circular on the way to relatives was a feature of my childhood. As was my mother's stress at the combination of the length of the journey and my father's nose to tail break hard driving. Her need for a cigarette was pretty overpowering. I remember my brothers and I pleading with both our (health professional) parents not to smoke in the car - something they heeded as best as nicotine addicts can. We had to have the windows wound up to shut out the smell of traffic fumes only to be locked in the car with cigarette fumes. It was only the very real threat of me throwing up due to aforesaid breaking that stopped my mother lighting up.

This experience was probably pretty common in the 1970s and increasingly less common in the decades since - although Labour and co-operative MP Luciana Berger claims here that one in five children may still be exposed to smoke in cars. Whether it is out of ignorance of the harm they do or denial in the face of addiction, only legislation will force parents to confront what they are risking.

It's hard to know why banning smoking in cars is such a contentious issue. Yet it's a real fight - one that may well go down to the wire - just like banning smoking in public places - but we got there in the end with that. We have to hope that this government doesn't once again run scared of legislation to protect the public's health just as it did with plain packaging of cigarettes and minimum unit pricing of alcohol - although it may be tiptoeing back to reconsider the latter.

The House of Lords has backed Labour's proposal to ban smoking in cars carrying children. Ministers are now looking at how to implement such a ban. Disappointingly, however, deputy prime minister Nick Clegg said on his weekly LBC phone in that he was opposed to legislation that would allow the government to ban smoking in cars with children - calling it 'sub contracting parenthood'. But then I hadn't realised that Clegg was a smoker. Does he think car seats for babies is 'sub contracting parenthood' or is it just the smoking thing? Read the story here
Read @COPDdoc Nick Hopkinson's excellent dissection of Clegg's arguments here


There is widespread evidence here and here that second hand smoke harms those who breathe it in. That this is so was a strong feature of the argument for banning smoking in public places - those employed in pubs and clubs were forced to breathe in the cigarette smoke of punters hour after hour. Five years after the public smoking ban, there were reports of improved health amongst barworkers and it has been almost universally welcomed by them and by their customers. Although there are still hardy knots of people gathered outside pubs and clubs sharing nicotine and camaradrie with other smokers.

It was thought that the ban on smoking in public places would drive smokers back into the home to light up. But it seems this didn't happen. Many smokers took the opportunity to give up whilst many more at least took their smoking outside just as they had to when in a public place.

Of course, public health education must continue to be a big part of changing smokers' habits, together with support to help people give up. But we know from experience that public health campaigns are most effective in changing behaviour when they are backed by legislation. That was the lesson from introducing the law on wearing seatbelts, and the drink driving and smoking bans.

Children, of course, have no say in any of this but if they had, I don't believe one would say 'I wish Mum or Dad would smoke in the car.'

Cheap labour

Potential nursing students should spend a year working as health care assistants before they start training, says the government. A move described by the RCN as ‘stupid’ www.bbc.co.uk/news/health-22209634

I couldn’t put it better myself. The story first broke at the end of March but I hoped it had merely been suggested to test reaction and would not rear its head again. But no, here we are at the RCN congress www.rcn.org.uk/newsevents/congress/2013 and the government, dogged as ever, especially when it’s wrong, is going full tilt.

It’s an idea that completely misses the point of the recommendations of the Francis report and tries to lay the blame for the travesty of Mid Staffs on nurses, whilst Francis laid it on the NHS Trust Board and the strategic health authority. www.midstaffspublicinquiry.com/ 

How anyone thinks that unleashing untrained people, often teenagers straight out of school, on patients with multiple care needs, will improve the care of those patients is bewildering. It demonstrates a complete lack of understanding of nursing and, I would suggest, of education.  If you don’t believe me then read http://juneinhe.wordpress.com/  for a nurse who really knows her stuff.

Nursing is and should be a career, where educated people can be both caring and ambitious. The two are not mutually exclusive. Nurses can specialise and become expert in their field – increasingly a necessity in an advanced health service. There will always be room for generalist nurses but the days of a nurse being able to ‘work anywhere’ are about as realistic as expecting an athlete to be able to compete in any event just because they can run fast. Yes, nurses need to be caring and compassionate but they also need to be intelligent, educated and forward thinking.

How will a year spent as a wage slave facing the more grim aspects of life make someone compassionate and enthusiastic for more? Many young people will be more than up to the job and still want to go on to do their nurse training. But many, who would have made excellent nurses, will not. The ability to deal with the smell and misery and sheer grossness that comes with caring for the very sick, the very old and the dying takes maturity, understanding and compassion. The latter is not produced automatically like an inborn kindness duct present only in those who can be nurses. However, it will almost certainly develop as someone matures and is certainly something that can be learnt with the support of good tutors and good role models. 

The age old dichotomy between ‘educated’ nurses and ‘trained’ nurses is tedious and usually put forward by those who are not nurses or have been out of the profession so long that they can’t remember the bad old days.  Why would you not want your nursing workforce educated? At present student nurses spend more than 50% of their training in practical learning – on the wards, in the community and in skills labs. What will another year of hard graft at the minimum wage – making their training an unrealistic four years – add to the mix? 

Put young people fresh onto wards and into care homes and there is no knowing who their role models will be. Much of nurse training may be spent unpicking some bad habits and corner cutting learnt while on a year’s ‘compassion training’.  And anyone forced to do a year of apprenticeship might well see themselves above having to do any of the dirty work once they are trained – there is an army of untrained youngsters for that – thus having the opposite effect the government intended.

But of course this is not about nurses, nursing or patients. It’s about filling jobs cheaply with young people thus solving the care of older people and the young unemployed in one hit.

Learning unsupported and unsupervised will be bad for nurses, bad for nursing and bad for patients.

For more on the good old, bad old days: Remember when?