Smoking could be banned at Derby's two main hospitals.
Smokers will have to leave the site to light up
Patients, staff and visitors can currently light up in designated areas at the Derbyshire Royal Infirmary and Derby City General.
But managers have announced they intend to implement a total ban from the summer, meaning people would have to go off site to smoke.
The move is consistent with the hospitals' work and could help people kick the habit, officials said.
Tony Riley, human resources director for Derby's hospitals, said: "The overwhelming majority of patients who smoke welcome this chance to stop.
"The fact that we are putting in place a framework to help people quit - with classes and advice - means 70% of patients have almost been biting our hands off saying they have wanted to stop for years."
The Queen's Medical Centre in Nottingham has had a similar ban in place since the beginning of the year.
The government wants all NHS buildings to be non-smoking by the end of 2006.