Stub it out: Smoking challenge for hospitals in Wales
On a crisp afternoon a group of school children stand outside Prince Charles Hospital holding their handmade no smoking posters.
"Please don't smoke outside our hospitals", they shout in unison.
As ambulances pull up outside the Merthyr Tydfil A&E department, the 10 and 11 year-olds watch as patients and visitors light up, puffing smoke into the air.
"We've seen a number of people smoking next to no smoking signs", their teacher Kelly-Anne Crane said.
In the last six months alone 783 smokers at Prince Charles and Royal Glamorgan hospitals, in Llantrisant, have been asked to stub it out by security guards.
Cwm Taf University Health Board - who manage the sites - say they are doing everything they can but people have a "total disregard" to the signs plastered across their NHS grounds.
And they are not alone. While all seven health boards in Wales have smoke free policies in place they say they are "powerless" to stop people lighting up, as they are not yet backed by legislation and so smokers are not breaking any laws.
The Public Health Wales Bill - which is currently going through the Assembly for the second time - would make it illegal to smoke on hospital grounds, giving the board's the much needed legal backing to issue fines to smokers flaunting the rules.
The Welsh Government said the bill will "build on existing voluntary smoking bans in order to aid enforcement".
Betsi Cadwaladr University Health Board - who manage hospitals across north Wales - said the public "do not respect" requests to not smoke on their sites.
They said that without legislation to back them up they had to rely on the "courtesy and consideration of smokers" not to light up, and despite extensive signage and recorded messages triggered a cigarette is sensed nearby, people still ignored their policy.
A spokesman said: "We do encourage members of staff to challenge smokers who are causing a nuisance but unfortunately this can provoke a negative or aggressive reaction, which understandably makes busy colleagues reluctant to continue asking people to put out their cigarettes or move away from entrances."
It is not just the contradictory image of patients in dressing gowns smoking outside the place they are being treated which concerns health boards and bodies like the British Medical Association (BMA).
Health boards have concerns about smoke drifting through windows into wards, passive smoking, and the impressionability of the growing number of young people receiving treatment on their sites.
Cwm Taf are now hoping the words of children will make people think twice about smoking outside their buildings.
Local school children like those from Cyfarthfa High, have designed special posters detailing the dangers of smoking.
If the posters fail the board is considering introducing push-button tannoys - which staff, patients and visitors can trigger if they spot someone defying the rules - which could use children's voices to tell smokers to stub it out.
Dr Chris Jones, chair of Cwm Taf, said: "Hospitals are for people who are sick and smoking causes illness.
"I don't think the health board is enforcing anything, we are encouraging people do to the right thing.
"We offer support and advice: it is not about being oblivious to the fact that giving up is difficult, but there is evidence that adults listen to children."
Hywel Dda University Health Board already has a push-button system at the entrances to their acute hospitals, but said it has not stopped some people.
A spokesman said: "Everyone has the right to breathe fresh air, especially when visiting a healthcare facility, and we regularly receive complaints about people smoking on our sites.
"We understand that visiting a hospital can sometimes be a stressful experience but we expect smokers to adhere to our smoke free policy and they should anticipate being asked to leave our hospital sites if they wish to continue smoking."
Cardiff enforcement officers challenged 6,708 smokers outside the University Hospital of Wales and University Hospital Llandough, in two years.
Trina Nealon, principal health promotion specialist for Cardiff and Vale University Health Board said hundreds of people were challenged every month.
While there have been no reported cases of verbal or physical abuse against staff challenging smokers, the board said it knows some staff feel uncomfortable challenging visitors and patients who are dealing with stressful situations.
"We are not taking away anything from anyone," Ms Nealon said, adding that patients were given support to try and quit smoking on admission.
"How we see it is smoking is an addiction, and we are giving people an opportunity to actually give up that addiction.
"Generally speaking people are receptive and they put out their cigarette, understanding that they are in a hospital where people are there to get better and are there to get treated."
Aneurin Bevan University Health Board said that while there had been a significant reduction in smoking at their hospitals "disappointingly there are some people who will continue to smoke despite all the messages."
Powys was the only health board who said they had little difficulty with smoking - "possibly as a result of only having community hospitals"
While there is hope that the new legislation would help health boards to challenge smokers, they appear to be under no illusion that the threat of fines will stub out the problem for good.
"It may not stop them smoking. We are hoping that it will lead to a culture change and people will accept that smoking in a hospital setting shouldn't be allowed," said Ms Nealon.