HOSPITALS across Glasgow and the west of Scotland are struggling to stop smokers lighting up directly outside.

Yesterday we printed pictures of staff, patients and visitors, smoking outside various entrances to the Royal Infirmary in Glasgow.

Today we show how the policy is being ignored at the Royal Alexandra in Paisley and the Southern General Hospital in Glasgow.

Health chiefs have said the Renfrewshire hospital is one of the worst for the rule being ignored.

Health board officials have admitted they are powerless to stop people lighting up despite introducing a ban two and a half years ago.

Warning notices have been displayed around the site in Paisley at entrances for staff and patients but they appear to have little effect on some people.

Our pictures show men and women who appear to be staff and visitors, possibly outpatients as well, smoking close to entrances.

In some cases a group are smoking close to where ambulances ferry patients in and out of the hospital. A large No Smoking notice is displayed on the wall only feet away.

The warning sign is clear and unmissable. Beside a three foot symbol it states "NO SMOKING. Smoking is prohibited in these grounds and premises therein."

Other pictures show men and women on their own within the grounds after lighting up.

A health board report into the problem of non compliance noted the difficulties reported by staff attempting to stop people smoking.

It concluded NHS staff were being subjected to abuse when they attempt to uphold the ban on smoking in hospital grounds.

After the health board ban was introduced in 2007, smoking wardens were put on duty at sites throughout Glasgow.

During trials at five sites, over three or four days 559 people were approached and asked to put out cigarettes.

Gartnavel General was highest with 145 people approached, 136 at the Royal Infirmary, (including 54 at the Princess Royal Maternity, 133 at the Southern General, 76 at the Western Infirmary and 69 at Inverclyde Royal).

The ban is being widely flouted and health bosses have since been forced to accept it is unreasonable to expect clinical staff to challenge smokers in the light of so many confrontations.

The policy is that all staff are responsible for enforcement but also that staff would not put themselves at risk.

The report states: "Due to the perception of the 'conflict' that this discussion with smokers may lead to, the anecdotal evidence is that very few staff challenge smokers at entrances or in grounds.

"Many site managers have taken a pro-active role in this regard due to a sense of responsibility for their own site, and this approach has to be commended.

"It has been noted that some site managers have been subject to significant verbal abuse in this regard."

NHS Greater Glasgow and Clyde introduced the no smoking on hospital property in 2007, one year after the government smoking ban came into effect in enclosed public places.

It was hoped that the ban would be complied with in a similar fashion to the law which has been widely accepted in pub, clubs, restaurants and workplaces.

However, after various attempts to ensure the policy is effective, health board officials have admitted that because the legislation only covers enclosed spaces it cannot be used to back up the ban, making their outdoors ban extremely difficult to enforce.

A spokeswoman for NHS Greater Glasgow and Clyde said: "In the case of staff smoking on our grounds, we have a policy which prevents staff from smoking and we can monitor this effectively.

"Unfortunately it is more difficult to enforce this policy with patients and visitors who persist in smoking. Some members of the public have been abusive to our staff when asked to desist from smoking at the doorways of our hospitals and on hospital grounds.

"We have deployed a range of posters and gadgets to persuade visitors and patients not to smoke on our grounds including large signs, posters, smoke detectors and "automated voice warnings systems".

"These measures have had some success but the problem remains and is of concern to us." WHAT YOU THINK... CRAIG WINTER, 39, Balloch, construction site manager: "Since the ban, smokers have become a minority, and I think we have bigger things to worry about in life. I just can't be bothered walking all the way out to the main road. If smoking is banned in hospital grounds, then cars should be banned too, due to exhaust fumes." SHARON BARRATT, 44, Cardonald, unemployed: "I won't stop smoking anywhere. It is an addiction and I feel it relaxes you. The ban on smoking in hospital grounds just doesn't work because if I don't smoke there, then I will just go into my car - which is parked there too - and smoke." LYNN ARBUCKLE, 41, Crookston, hairdresser: "When I see other people smoking in the hospital grounds, I somehow presume it must be OK to do it. But to stop it, the hospital would need to employ someone to patrol the area to warn smokers. Fining them would be too harsh." LOUIE MORRISON, 31, Kilmarnock, unemployed: "I wasn't aware smoking was banned in all hospital grounds. I know they have smoking shelters at Crosshouse Hospital. If I have to go out on to the street to smoke, then I will."