I'd taken a drag on my first-ever cigarette and was basking in my new-found sophistication, when I began to feel sick.

What brand was I smoking? I asked, because I'd never smelt a fag this awful before. Only then did I realise that in lighting up I had also ignited my scarf. It was smouldering gently, singeing polyester creating two lums instead of one. Mortified, I've never smoked since.

But for that happy accident, I might now be a nicotine fiend. And if I were, I'd probably be feeling persecuted by the recent flurry of anti-smoking proposals intent on stamping out me and my dwindling kind rather than pleased that with each passing year, cigarettes are losing ground.

Newest of the threats are recommendations from the National Institute for Health and Care Excellence (NICE) advocating that NHS staff should be disciplined if found smoking while in uniform, and saying that rather than be allowed to stand puffing in smoking shelters, hospital patients should be offered nicotine patches. It also urges that relatives and friends of inpatients should not smoke before visiting them.

Meanwhile, there are purportedly plans afoot within the Civil Service to penalise smokers by docking their pay for each fag break. The motives for this crackdown are clearly more to do with productivity than with workers' well-being, but as treatment of smoking-related illness is estimated to cost the NHS £2.7bn a year, in the long term NICE's proposals are also as much fiscal as medical.

It can't be much fun having to nurse a fag in the windy smokers' bunker, or suck a peppermint before a business meeting for fear of offending a zealot. In fact, I doubt there's a smoker in Britain who's not now feeling like a woolly mammoth, knowing their days are numbered. American humorist Garrison Keillor brilliantly tapped into the idea of an endangered species in a short story called End of the Trail, which begins: "The last cigarette smokers in America were located in a box canyon south of the Donner Pass in the High Sierra by two federal tobacco agents in a helicopter who spotted the little smoke puffs just before noon."

A century earlier it had been outlaws who took to the hills to evade the sheriff's posse, but in his prescient tale it was that formerly glamorous creature – the suave dude in the Marlborough ads, or the heroine in a Hollywood movie – whose elegant cigarette had once been the epitome of chic but was now deemed more dangerous than a gun-toting bandit.

Keillor's wickedly funny story is a reminder of how dramatically society's attitudes can change, of how pariahs can be made from paragons, almost overnight. I was speaking to a nurse a couple of days ago who recalled a consultant doing his ward round while smoking a pipe. He also remembered how effective he had found it, when treating patients with mental health issues, to suggest they both sit down and have a cigarette to talk things over. In that situation tobacco had a calming effect no cup of tea could match.

While the therapeutic use of cigarettes in such cases probably outweighs their disadvantages, one could never now suggest it. And such exceptions aside, the sight of NHS staff and their patients emitting clouds of smoke outside the hospital is one of the most dispiriting and anachronistic portraits of modern Britain you could find. Given that even carbon residue on a smoker's clothes can be harmful to others, such licence is an affront to the hospital's life-saving purpose, as well as to its ailing inmates.

So offensive is it, that being a non-smoker should surely be made a condition of employment in the health service. After all, you wouldn't go to a gym class run by an obese instructor, so why would you trust the advice of medics in an institution that cannot persuade its own staff of its risks, and allows inmates to endanger their health while in their care?

However tough or unpopular it is to implement, the NHS must set the standard for the rest of the country to follow. Otherwise, until hospitals enforce a zero tolerance policy, smokers in every other walk of life can still breathe easy, if not very well.