Use your loaf when it comes to quitting smoking – you know it makes sense.

Well, my cold and cough didn’t start to get better until last Friday, and even as I write this blog, I’m not feeling 100%. Thanks to all of you, who have sent me the warmest wishes and just to reassure folk, I have not been suffering with this new nasty Covid variant. It’s just a summer cold, albeit verging on man flu. I’m glad to have been told, however, that my Covid and flu jab will be available on 3^rd October. Despite the current GP ‘work to rule’ industrial action, my practice seems keen to try and keep me safe.

Now, as J will tell you, having a slightly incapacitated man about the house is not without its problems. One of which is that I’ve had plenty of time to read. And read and read and read. Which has resulted in my reading material getting into some fascinating weeds somewhat this past week. As I’ve done so I have been amazed, stunned, and saddened by what I didn’t know.

Here are some examples: I didn’t know it was an EU ruling that we all must now have tethered caps on our soft drink bottles. Brexit UK still must abide by these rules although we now have no MEPs to challenge any of them. Remember that, the next time you catch your lip on one of these annoying attached lids. TBH, I detach the cap, as soon as I open the drink.

I also didn’t know that anyone would be daft enough to pay £4.50 for a loaf of bread. Apparently, residents of Bathford (near Bath) are. They are rapturous about their locally-baked bread. But they are also up in arms because local AirBnB owners are buying up all the loaves, as soon as they are baked, to serve to their guests, before locals can get themselves out of bed and to the shops. Even though 3.12 million people used foodbanks during 2023/24, and there are over 14 million people living in poverty in the UK (4.2 million are children), one of the Bathford locals declared that getting good bread was practically a human right. A first world problem, if ever I saw one.

Something else I didn’t know until yesterday was that our current Deputy Prime Minister is into raves. She did seem to be enjoying herself, which after all, is the point of being away on holiday. And, more importantly perhaps, she wasn’t dancing, drinking, and having a good time in someone’s garden during a pandemic lockdown. I also hadn’t clocked that she was a smoker. How that will play out for her in the future as the Prime Minister introduces the no smoking ban in pub gardens and outside night clubs. It’s a policy long overdue. However, I know from the many occasions I have asked patients and visitors to stop smoking on hospital grounds and been told to go away and have sexual intercourse (or words to that effect), it can, and will be difficult to enforce.

The World Health Organisation estimated that across Europe, 2.7 million people a year die because of consumption or exposure to four products: alcohol, tobacco, ultra-processed food and fossil fuels. In Britain, this means there will be 184,000 people diagnosed with cancer, as a direct result of obesity, smoking, alcohol misuse or a history of sunburn. Total societal costs for obesity in the UK are estimated to be £95bn a year, alcohol harm £27bn and smoking £46bn a year. Providing health and social care to people living with such health-related conditions costs the NHS £4bn year. All told, it’s a lot of money that could better spent in other life-enhancing ways, such as reducing poverty.

To be honest, I’m not concerned with the proposed outside space ban on smoking. It makes perfect sense. However, there is one group of people that the ban could affect which does concern me. Whilst the overall number of people smoking continues to reduce, people living with a serious mental health problem and who also happen to smoke has remained at a relatively constant high level. Like all NHS services, smoking cigarettes on our premises is forbidden for all. This includes our mental health service users who may spend some time on an admission ward. Many of these folk smoke cigarettes. Helping them to stop can be a real challenge.

All our inpatient services have outside areas which people use for different activities. We do our bit to encourage service users to stop smoking, but where this isn’t right for the person at that point in time, we allow vapes to be used. Indeed, last year the NHS and Local Authorities spent between £50 and £70 million across England to help people stop smoking using free vapes. There is now a good body of evidence that suggests vaping is better for an individual’s health than smoking. Vaping is emerging as the best way to help smokers of all ages to eventually quit their habit.

However, there are some folk who would like to see no cigarettes and no vapes being available to anyone. The recently introduced Tobacco and Vapes Bill (which increases the age at which someone can buy tobacco, so anyone born after 2009 will never be able to buy cigarettes) will clearly help in the long term. The jury is out on the long-term effects of vaping, and clearly the exponential increase in the number of children and young people who have started to vape is of concern. We won’t know for a couple of generations what impact vaping might have on a young person’s physical health in later life.

Closer to home, the Care Quality Commission, during their reviews of our services, almost routinely criticise us for allowing our service users to vape, something service users can only do outside. I routinely praise my colleagues for encouraging our service users who smoke to switch to vapes. Giving up smoking can be as hard or even harder than giving up heroin. On the other hand, would I worry about missing out on a £4.50 loaf of bread, I don’t think so. That would be very easy to give up!