The paper draws upon the experience of the Preston Acute Hospitals NHS Trust in being a member of the European Network of Health Promoting Hospitals and, in so doing, places the health promoting activities of the Trust in its widest context. There is a discussion on the advice issued by the Department of Health towards making hospitals smoke free, which concludes that the advice is not helpful. It is suggested that successful attempts to eradicate smoking in hospitals must be part of a wider health promoting strategy. This, in turn, can be linked to the changing role of hospitals where there is an increasing emphasis on primary care services and a push towards rationalisation of district general hospitals.