As New Zealand officially moves towards its appointment with smokefreedom in 20251 a wide variety of new policies together with improved smoking cessation treatments will be required to keep to the target.Initiatives already underway include removing the visibility of smoking in public areas, plain packaging all tobacco materials and ensuring that all tobacco products and associated advertising are out of sight in shops—this denormalisation will reduce children's and adolescents' interest in smoking.A peculiar perversity of the Smokefree Environments Act, which has very successfully prevented indoor smoking in public places is to very visibly concentrate smokers, both patients and staff, at the front entrance or close by the entrance to many New Zealand hospitals. As legislation prohibits smoking on hospital grounds this often involves moving smokers to the street. At Wellington hospital, for example, smokers have been gradually encouraged to move further and further away from the hospital's front entrance and down onto the street. Similarly, at the Hutt hospital, smokers have been moved further away from the hospital entrance.One potential risk associated with this is that should they [patients] collapse they will need to re-enter hospital by ambulance. Those on telemetry who collapse in the street will not be able to rapidly access the hospital resuscitation team thus decreasing the chances of successful resuscitation.Of course, for most hospitalised smokers in hospital, nicotine replacement which is now widely offered as part of the ABC programme2 is an important therapy which prevents much of the physical and psychological symptoms associated with nicotine withdrawal. It is likely to be only the very nicotine addicted smoker who needs to brave the elements and stand in the street to smoke.The smokefree environments legislation was not designed to stigmatise smokers or have them in hospital gowns on the street, but it is an unintended consequence. If we consider tobacco smoking, to be a nicotine addiction that is tough for many to break, and that nicotine replacement is insufficient for some smokers, then we should assume a more compassionate stance and consider the provision of at least some shelter and privacy for patients. The upside will be to reduce the visibility of smoking and have patients where they can maintain close contact with the hospital and where cessation advice and help could be offered directly. The downside is that this may be seen as condoning smoking, a retrograde step in the smokefree vision, and it may require a law change.So far smokers have generally been supportive of the measures to reduce smoking and the concept of a Smokefree New Zealand; it would be unfortunate to alienate that support by herding hospitalised smokers further and further away, both literally and metaphorically. Julian Crane*, Stephen Vega, Brent Caldwell, Marie Ditchburn, David Robiony-Rogers, Angela Thie, Alison Huxford *Department of Medicine, University of Otago, Wellington

As New Zealand officially moves towards its appointment with smokefreedom in 20251 a wide variety of new policies together with improved smoking cessation treatments will be required to keep to the target.Initiatives already underway include removing the visibility of smoking in public areas, plain packaging all tobacco materials and ensuring that all tobacco products and associated advertising are out of sight in shops—this denormalisation will reduce children's and adolescents' interest in smoking.A peculiar perversity of the Smokefree Environments Act, which has very successfully prevented indoor smoking in public places is to very visibly concentrate smokers, both patients and staff, at the front entrance or close by the entrance to many New Zealand hospitals. As legislation prohibits smoking on hospital grounds this often involves moving smokers to the street. At Wellington hospital, for example, smokers have been gradually encouraged to move further and further away from the hospital's front entrance and down onto the street. Similarly, at the Hutt hospital, smokers have been moved further away from the hospital entrance.One potential risk associated with this is that should they [patients] collapse they will need to re-enter hospital by ambulance. Those on telemetry who collapse in the street will not be able to rapidly access the hospital resuscitation team thus decreasing the chances of successful resuscitation.Of course, for most hospitalised smokers in hospital, nicotine replacement which is now widely offered as part of the ABC programme2 is an important therapy which prevents much of the physical and psychological symptoms associated with nicotine withdrawal. It is likely to be only the very nicotine addicted smoker who needs to brave the elements and stand in the street to smoke.The smokefree environments legislation was not designed to stigmatise smokers or have them in hospital gowns on the street, but it is an unintended consequence. If we consider tobacco smoking, to be a nicotine addiction that is tough for many to break, and that nicotine replacement is insufficient for some smokers, then we should assume a more compassionate stance and consider the provision of at least some shelter and privacy for patients. The upside will be to reduce the visibility of smoking and have patients where they can maintain close contact with the hospital and where cessation advice and help could be offered directly. The downside is that this may be seen as condoning smoking, a retrograde step in the smokefree vision, and it may require a law change.So far smokers have generally been supportive of the measures to reduce smoking and the concept of a Smokefree New Zealand; it would be unfortunate to alienate that support by herding hospitalised smokers further and further away, both literally and metaphorically. Julian Crane*, Stephen Vega, Brent Caldwell, Marie Ditchburn, David Robiony-Rogers, Angela Thie, Alison Huxford *Department of Medicine, University of Otago, Wellington