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Since 2006/7 the UK has reduced the number of workers exposed to second-hand tobacco smoke (SHS) significantly. At a population level, data from Scotland indicates the number of non-smoking adults who show evidence of exposure to SHS has fallen from 83% to 19%, with most of this reduction the result of restrictions in workplaces and social settings1. With smoke-free prisons introduced in 2018 further protecting approximately 50,000 prison workers from exposure to SHS there is a need to develop appropriate policies for some of the final groups of workers who have duties that fall outside the original smoke-free public space legislation introduced in 2006/7, and who experience SHS as a result of their day-to-day work-tasks and activities. Domiciliary health and care workers are a large and growing group of over 700,000 workers in the UK. They are one of the final occupational groups likely to experience frequent and high concentrations of SHS as part of their work entering (smoking) patients’ homes. A recent review2 of the international scientific literature identified a need for developments in policy and practice to balance the needs and responsibilities of those requiring care in their home with the need to prevent the harmful effects of SHS on those whose jobs involve providing assistance in domestic settings. Care tasks involving entering homes where smoking takes place may lead to cumulative exposures that are substantial. Current guidance and policy measures used by Health Boards and Social Care providers to assess and manage the risks to health from SHS are fragmented and often poorly understood. Anecdotal evidence suggests that SHS exposure is a real concern for many domiciliary workers who feel left behind in terms of exposure to a known carcinogen that almost all other workers are protected from through legislation. Implementing appropriate and proportionate measures to protect domiciliary care workers from the harms posed by SHS should be a priority to help protect the health of this group of often over-looked workers.

We propose would that would aim to: (i) quantify the frequency, duration and concentration of SHS exposure experienced by domiciliary workers in the UK; (ii) review (in the UK and globally) current policies and guidance used to manage the risks to health of workers exposed to SHS, with particular consideration of measures in place for pregnant workers and those with chronic respiratory conditions; and (iii)better understand current experiences of domiciliary workers and their managers in relation to SHS exposure.