NSW Department of Health has phased in a smoke-free policy including smoke-free outdoor areas in all NSW public hospitals since 1999. The rationale for the policy is to reduce the harm associated with tobacco use amongst staff, patients, visitors and the community, especially exposure to ETS; to provide a clear and consistent message to staff, patients, visitors and the community about the hazards of smoking and to provide leadership in the community about reducing the harm associated with smoking.

Discussion: Implementing this policy in Australia's largest health system has presented challenges, including dealing with nicotine dependent inpatients and staff and non-compliance. Guidelines and protocols for managing these issues have been negotiated with union representatives and clinical staff, resulting in a supportive environment to encourage quitting among staff and support for patients.

Conclusion: Of eight NSW Area Health Services (AHS), two have all campuses now smoke-free outdoors, 64 other health campuses are also smoke-free, a total of 113 NSW campuses that ban smoking outside. All other AHSs have implementation committees, three have Area-wide deadlines in place for mid 2007. All provide free NRT and cessation support to staff wanting to quit. A taskforce is advising on implementation in mental health facilities. The policy has provided a framework for the introduction of evidence-based training in smoking cessation and care of hospitalised smokers.