Aneurin Bevan Health Board. Smoke Free Environment Policy

Transcription

1 Smoke Free Environment Policy 1 Introduction The purpose of this report is to seek Board approval for an introduction of an Smoke Free Environmental Policy. Board members are asked to: Receive, note and consider approving the adoption of the Smoke Free Environmental Policy for Aneurin Bevan Health Board Consider and support a phased implementation plan for the introduction of the Policy. Financial Assessment and link to Financial Recovery Plan There will be financial implications to erect new signage estimated at 25K The cost of signage for new premises is already included in the budgets, however, the cost for SCCC will need to be factored in. Estimated cost of 3k associated with removal or change of use of 7 smoking shelters (potential change of use from smoking shelter to cycle storage). There should be no additional printing costs as reference to the new policy will be incorporated in to leaflets, patients letters during the reprinting run. Current Health Board secondary care expenditure ( ) is approximately 6k for NRT. It is anticipated that costs would increase to no more that 17k. Guidance asserts that cost benefits could 1

2 flow from savings on cleaning and from accidental fires, in addition to improved patient outcomes (reduced length of stay and reducing wound related complications). Risk Assessment Risks in implementing the policy relate to: - Requirement to protect and minimise the risk of harmful effects of secondhand smoke to staff, patients and visitors - Safety of individuals leaving ABHB premises to smoke. Both of these have been considered within the paper and will be addressed further by: - incorporating in individual patient risk assessment for staff exposed to smoke within service users home - site specific risk assessments during implementation phase. Annual Quality Framework This paper is relevant to:- AQF key action 1 Set and deliver against the key targets identified within Our Healthy Future : - Reducing smoking prevalence - Improving health at work - Reducing health inequalities. Directional statement - All LHBs will have engaged with the Corporate Health Standard programme, with a view to achieving Platinum by Standards for Health Services Wales Equality Impact Assessment This policy underpins all of the Standards for Health Services, and in particular: 3.1 Organisations and services work in partnership with others to protect and improve the health and wellbeing of citizens and reduce health inequities. No negative differential impacts are anticipated. 2

3 2 Introduction 2.1 Welsh Assembly Government Policy (ABHB) has a statutory responsibility for improving the health of the population as well as providing individual patient centred care for promotion, prevention, diagnosis, treatment and rehabilitation. Maximising health is a critical element in achieving a sustainable health service into the future. Action to improve the public s health is one of the five priority areas of the Board. One of the key themes identified in Our Healthy Future 1, Wales strategic framework for improving public health, is the need to further reduce the prevalence of smoking and exposure to secondhand smoke. 25% of adults report that they are smokers in the Health Board area which is similar to the Welsh average of 24% 2. A key aim identified in the Annual Quality Framework (AQF) is for NHS Wales to do more to protect and improve health for all. Key drivers identified include setting goals which underpin and promote health improvement and better outcome for citizens in Wales. The AQF ( ) 3 states that each Local Health Board must set and deliver against the key targets identified within Our Healthy Future 1. This includes implementing best practice and key interventions on smoking cessation which have been identified as having the greatest impact on preventable disease. The Director of Public Health will report progress made against reducing the prevalence of smoking. The National Prevention and Promotion Programme Board has been established to identify high impact cost effective public health interventions to support NHS Wales to achieve financial balance through the development of increased efficiency and sustainable services. Smoking cessation has been identified as one of the key interventions with the greatest impact on preventable disease. Four smoking cessation interventions have been identified for action and implementation by Health Boards, these being: Support to NHS employees who smoke to quit and introduction of smoke free policies 3

4 Pre operative smoking cessation Support to pregnant women who smoke to quit Brief intervention to smokers delivered by health professionals. The Standards for Health Services for Wales requires organisations and services to work in partnership with others to protect and improve the health and wellbeing of citizens and reduce health inequalities by: Supporting citizens to maintain and improve their health, wellbeing and independence Promoting healthy lifestyles and enabling healthy choices Promoting healthy and safe workplaces. ABHB is also working towards to the Corporate Health Standard, with a view to achieving Platinum by 2013, as directed by Welsh Assembly Government. The first draft Tobacco Control Action Plan for Wales 4 was published, in February 2011, by the Minister for Health. The Minister states that the NHS needs to be an exemplar in creating smoke free environments and promoting smoking cessation and has included the following action for Health Boards: Action 4.3 In recognition of the importance of the NHS taking an exemplar role in action to discourage smoking, introduce smokefree policies throughout NHS grounds, in addition to the enclosed premises. ABHB is cited as leading the way in establishing smoke free environment with Ysbyty Aneurin Bevan being smoke free, Aneurin Bevan Hospital is to be smoke-free and I want to see all NHS premises following suit. In addition to promoting smoking cessation for staff, the NHS should also encourage patients to stop smoking, particularly before elective surgery. The leadership role of the NHS is central to achieving a reduction in smoking prevalence, by taking action to discourage smoking, helping smokers to quit and in making smoke free environments the norm. Eliminating tobacco related harm will: enable people to lead healthier and longer lives prevent smoking-related illness lead to greater human and financial savings to the NHS, communities and families. 4

5 Implementing a Smoke Free Environment Policy will contribute towards ABHB further developing the Health Promoting Hospital concept. Other Heath Boards such as Cardiff and Vale and Betsi Cadwaladr are also introducing a total ban on smoking on their premises. 2.0 The current position within Following the ban of smoking in public places, from 2 nd April 2007, a no-smoking policy inside premises was introduced but smoking continued to be permitted in the grounds. The ABHB Environment Group advocated for Ysbyty Aneurin Bevan to be completely smoke free. Subsequently, the Health Board s No Smoking Policy was updated, in October 2010, to ban smoking in the hospital grounds of all new hospitals and children/health centres. The recently opened Ysbyty Aneurin Bevan is completely smoke free. This means that smoking is not allowed inside the hospital or anywhere in the hospital grounds with the exception of a designated room within the mental health unit for in-patients of the mental health unit. Health Board staff and visitors to the mental health unit are not permitted to smoke in the smoking room. It is for the sole use of in-patients of the mental health unit. The policy states that it is the intention of ABHB to deliver complete smoke free status on all sites and premises (including grounds) for all staff, contractors, patients and visitors. Notwithstanding occasional individuals who will not abide by the policy, most patients, staff and public have been very positive about the Smoke Free Policy including all Unions. 3.0 Rationale for introducing a Smoke Free Environment Policy The rationale for introducing a Smoke Free Environment Policy includes: Aneurin Bevan - a practising public health organisation The Health Board will be acting as an exemplar employer, and best in class, by promoting smoke free environments to discourage smoking and to promote health and wellbeing to patients and public. The Health Board also has responsibility for improving population health and the strength of evidence based demonstrating the causal relationship of tobacco use to ill health. It is supported 5

6 by extant legislation and the direction of travel set out it the Draft Tobacco Control Action Plan for Wales 4. A strong message is communicated about the dangers of smoking Smoking on NHS premises and staff smoking in uniforms in visible smoking areas sends a contradictory message regarding the public health risks and health outcomes of smoking. NHS staff also have the opportunity to act as role models for promoting health and healthy behaviours. Duty of care The Health and Safety at Work etc. Act 1974 places a duty of care on employers to provide and maintain a safe working environment which is, so far as is reasonably practical, without risk to health and adequate as regards facilities and arrangements for their welfare at work. People smoking at the entrance to NHS premises gives a very poor impression and also means that those entering and leaving the buildings have to pass through and are exposed to second-hand tobacco smoke. The Health Board has a duty of care to staff and patients for both physical and mental health. A smoke free environment policy will address problems such as smoke-drift and protect staff, patients and visitors from the proven harm caused by second-hand smoke. Allowing patients to smoke while in hospital also increases the risk of complications and delays in their recovery 5 which can lead to increase length of stays for patients. Patients who also stop smoking during hospital stay and continue to abstain from smoking during recovery can also reduce readmissions. Support for smokers to quit and manage cravings Introducing a smoke free environment policy will support people trying to stop smoking and remove triggers that cause many to smoke or relapse to smoking. There is also good evidence to support organisations to promote smoke free workplaces which contribute to decreasing smoking consumption during working hours 6. Help and support for patients and staff who wish to quit smoking can be accessed free from Stop Smoking Wales NHS service. Nicotine replacement therapy (NRT) should also be offered to patients to manage cravings, as part of normal treatment care, in line with NICE treatment guidelines 7. Table 1 outlines the numbers needed to treat for various routine 6

7 preventive interventions. The table demonstrates why brief advice to stop smoking is an effective preventive intervention. Smoke travels Smoking at entrances of buildings causes smoke to drift through doors and windows thereby continuing a health hazard. In addition, the smell of cigarette smoke on staff uniforms can be unpleasant for patients, and this can weaken patients attempts to stop as well as undermining a smoke free environment policy. Table 1 Numbers needed to treat for various routine preventive interventions Intervention Outcome Numbers Needed to Treat Statins Prevent one death over five 107 years Antihypertensive Therapy Prevent one stroke, MI, death 700 over one year Cervical cancer screening Prevent one death over ten 1140 years Physican brief advice Prevent one premature 80 to stop smoking (up to 5 mins) death* Add pharmacological Prevent one premature support death* Add behavioural support Prevent one premature death* *Over half of all continuing smokers will die prematurely from a smoking-related disease. For every two long term quitters, one premature death is avoided. Source: NHS England Smokefree Clinician s 30 second stop smoking advice. Department of Health. Fire risks Smoking on the premises increases the risk of fires. The Home Office reports that 10% of all fires in buildings other than dwellings are caused by smokers materials. During the last 12 months, the ABHB Fire Officer received seven calls relating to smoking; one relating to a fire in a mental health unit and six relating to alarms activated by smoking. Litter Cigarette related litter in and around entrances and in the grounds are both unsightly and creates more work to clean up these areas. 4.0 Areas for consideration 7

8 4.1 Legislation The ABHB has a statutory duty to protect staff and visitors who attend Aneurin Bevan premises from the harmful effects of smoking. From April 2007 the Smoke-Free Premises etc. (Wales) Regulations 2007 came into force which prohibits smoking in enclosed or substantially enclosed public places, including workplaces. The aim of the legislation is to protect workers and the public from the harmful effects of second-hand smoke. The smoke free regulations provide limited exemptions to the smoke free law, mainly to cover workplaces that are also a person s place of residence. These exemptions include mental health units (as defined in section 1(2) of the Mental Health Act 1983) which provide residential accommodation. Similar exemptions apply in relation to residential care homes as defined in Section 3 of the Care Standards Act, to adult hospices and for private accommodation (for example, staff accommodation within the Health Board). However, communal areas in shared accommodation are required to be smoke free. There is no exemption for hospitals per se. The exemption in the Regulations allows mental health units that provide residential accommodation to have designated rooms where smoking is permitted for in-patients of the mental health unit. The legislation does not require NHS Health Boards to provide a smoking room; it simply makes provision for the exemption. It is also against the law for anyone to smoke in enclosed parts of mental health establishments that do not provide residential accommodation (for example, day units). The Health and Safety at Work Act 1974 places a duty on employers to provide and maintain a safe working environment which is, so far as is reasonably practical, without risk to health and adequate as regards facilities and arrangements for their welfare at work. The draft Tobacco Control Action Plan for Wales 4 states that the Welsh Assembly Government will undertake further work to consider the possibility of amending the Smoke Free Premises etc Wales Regulation (2007) to ban smoking in specific designation areas of hospital grounds. Several Health Boards in Wales are introducing smoke free policies throughout their grounds as well as in enclosed premises. 4.2 Evidence base 8

9 The evidence base that tobacco smoke is a major health threat is incontrovertible and the context for the development of this smoke free policy has been set within the Smoking Cessation paper. The significant burden of illness due to smoking has major costs for the NHS in Wales. More than an estimated 1000 deaths each year in the areas are caused by smoking. One out of two regular and lifelong cigarette smokers will die from a smoking related disease 8. Smoking is associated with more that 50 different diseases and a major cause of health inequities; it accounts for more than half of the difference in risk of premature deaths between social classes. A recent study undertaken by Swansea University 9, reported that treating smoking related diseases costs NHS Wales, in 2007/08, an estimated 386 million, over 1 million a day, equivalent to 7% of total healthcare expenditure in Wales. A technical report by the London Health Observatory 10 calculated smoking attributable admissions, bed days and associated costs for the NHS in Wales in 2005/06. For ABHB area, smoking was calculated as the cause of an estimated: 5,000 hospital admissions; on average 14 admissions per day 132 beds occupied daily due to smoking related diseases Cost of more than 14million per year Smoking as a social norm? Societal norms around cigarette smoking have changed radically in recent years. Following the ban on smoking in enclosed public places, smoking is not allowed, for example, on buses, in bus shelters, in airports, sports stadiums and restaurants. People have had time to adjust to the new legislation, which has proved popular and achieved widespread compliance. Although the legislation applies only to enclosed or substantially enclosed premises, employers are not obliged to permit smoking in the grounds of their establishment if their preference is to make these smoke free. Smoke free policies promote a supportive environment for smokers which can in turn encourage staff to decrease smoking consumption 5. Provision of any smoking areas for staff or the public, including external smoking shelters, undermines this potential health gain. 9

10 Many organisations have introduced smoke free premises, including grounds. These include the Local Authorities of Caerphilly, Torfaen and Monmouthshire; Cardiff University and recently Cardiff and Vale Health Board. The Minister for Health has also called for the NHS to be an exemplar employer in creating smoke free environments. The first draft Tobacco Control Action Plan for Wales includes this as an action for Health Boards. By introducing smoke free grounds the ABHB will be acting as an exemplar role model for children and young people by sending a message that smoking is no longer a social norm, and encourages them not to start smoking. 4.4 Safety of staff Careful consideration needs to be given to the matter of employee safety. Some organisations insist that staff clock in and out when they leave the site effectively they insist they are smoking in their own time and at their own risk during official breaks. It is good practice to encourage employees to manage their cravings during working hours by using nicotine replacement therapy (NRT), similar to how many smokers manage their cravings when on aeroplanes. 4.5 Safety of patients smoking off site The safety of patients going off site was raised as an important issue. In relation to patients leaving the wards to smoke, other hospitals have included in their policy a clear statement relating to patients leaving wards and that they do so at their own risk and without staff assistance. It is good practice for organisations to offer NRT to patients as part of their medical care to manage nicotine cravings in line with NICE treatment guidelines. This is currently offered for inpatients of some wards of the Royal Gwent, Nevill Hall and Caerphilly District Miners Hospitals. In the unlikely event that patients become aggressive or abusive the Health Board s Violence and Aggression Policy should be invoked. In addressing this the policy stresses that patients should be: notified prior (where possible) to admittance of Health Board s policy at every point along the patient care pathway offered NRT in line with NICE treatment guidance for smoking cessation and pharmacotherapy (for in-patients) to deal with nicotine withdrawal cravings 10

11 patients should be notified on ward that they leave the site at their own risk. 4.6 Domiciliary visits by healthcare staff e.g. Community Nurse to patients homes Under the 2007 legislation, employers need to take steps to minimise the risk for their employees of exposure to second-hand smoke within private dwellings. Whilst it is recognised that it is an individual service users/patients right to smoke in their own home, this could create an environment in which staff are potentially at risk from the harmful effects of second-hand smoke. In some instances service provision involves staff spending prolonged periods in patients homes. There is no law to protect anyone working in a service user s home; employers and employees rely on the understanding and goodwill of the service user/patient. However, employers have a duty of care, under the 2007 legislation, to take steps to reduce the exposure of staff to second-hand smoke and to take reasonable care to protect the health of employees. The Royal College of Nursing has produced a guide 11 for staff and managers on how to protect community staff from exposure to second-hand smoke. This guide will be used (during the implementation phase) to further develop tailored guidance for staff and managers on how to manage this and reduce the risk of exposure to second-hand smoke. Action to minimise risk can include: Informing patient/service users of Health Board policy and duty to protect staff from second-hand smoke (include in appointment letters/correspondence with patient) In the case of scheduled visits, appointment letters to service users could include the following paragraph: has a duty to protect staff from the effects of second-hand smoke. If you are a smoker, or live in a household where someone else smokes, please help to minimise the harmful effects of passive smoking on NHS staff by not smoking during the visit. If an appointment is made over the phone the NHS member of staff can advise the service user and/or member of the household of the protocol. 11

12 Discussing with and encourage service user/patient to comply with request to refrain from smoking up to an hour prior to scheduled visit Providing leaflet for patients that explain why staff need a smoke free working environment (WAG leaflet available) Opening windows and doors to fully ventilate the area Discussing with patients/service users re possibility of trying to keep one room free of smoke Incorporating exposure to second-hand smoke in individual patient risk assessment If a service user/patient refuses to comply with the request, Line manager should be notified Line manager should take steps to further discuss with patient and inform that service users/patients refusal to comply may affect where the patient receives their appointment Identifying members of staff who have a pre-existing condition that is made worse by exposure to tobacco smoke (e.g. asthma, COPD) or who face additional risks (e.g. due to pregnancy) and take steps to prevent or minimise their exposure to tobacco smoke If service user refuses to refrain from smoking, the line manager, in conjunction with senior managers, should consider arranging an alternative venue for the appointment, where reasonably practical 4.7 Managing and monitoring a smoke free environment The policy has been updated to clarify and outline roles and responsibilities of all staff. There will be a robust communications and engagement plan for visitors, patients and public at each hospital site during the implementation phase. Patients should be notified of the policy at all points along the patient pathway. For example, outpatient appointment letters, visitors handbook, website etc. 4.8 Leadership of a cultural change The implementation of the policy requires a cultural shift in the attitude to smoking within health related premises. Such a shift would require leadership throughout the organisation, commitment to seeing the policy through the Implementation Plan, continual communication with staff, patients and visitors. 12

13 4.9 Cost Cost per quitter information is available for smoking cessation services in England but not currently from Stop Smoking Wales. The cost per quitter for services in England between April September 2010 was 249. This figure represents a small sum compared with the cost of potential treatment related to smoking related disease. Current Health Board secondary care expenditure ( ) is approximately 6k for NRT. Comparable secondary care spend by Cardiff and Vale Health Board for the same period is 23k (for NRT and for prescription only medicines). Whilst it is anticipated that ABHB s NRT expenditure would increase slightly, it is not envisaged that it would be to the level of Cardiff and Vale Health Board as they employ an in-house Smoking Cessation team (Counsellors and administrative support) to work within secondary care (cost 75,500). The prescribing of NRT would be in line with NICE treatment guidelines for smoking cessation and pharmacotherapy. Stop Smoking Wales has agreed to provide support to patients and staff who want support to stop smoking. Guidance asserts that cost benefits could flow from savings on cleaning and from accidental fires, in addition to improved patient outcomes (reduced length of stay and reducing wound related complications). Notwithstanding these benefits, there are costs relating to signage. Estimated costs by Works and Estates at 25k to include costs of materials and labour (details available on request). 5.0 Process and timeline for developing and implementing a smoke free ABHB 5.1 Smoke free policy task and finish group A Smoke Free Policy task and finish group was established under the Health and Work Group. The group, led by HR, has representatives from across the ABHB (see Appendix A). 5.1 Framework action plan and timeline There are various guidelines on content and process for organisations to follow to introduce a smoke free environment policy. 13

14 An introduction of a smoke free policy requires a detailed implementation phase involving good communication and engagement plans. The task and finish group is following the five main steps as outlined in Table 1, in Appendix B, and a detailed action plan has been developed (which is available upon request). The task and finish group is currently working through step 2 of the 5 steps. 5.2 Drafting smoke free policy The draft Policy has been drafted by the Task and Finish Group, and has been updated to reflect an introduction of a smoke free status for ABHB (see Appendix C). 5.3 Consultation process The draft policy was subject to consultation with the Employment Policy Group, senior managers, Patient Liaison Panel and Executive Team during January and February The policy has also been considered by the Public Health & Partnership Committee in January and May The Local Medical Committee is supportive of the policy. The policy addresses concerns frequently raised by the CHC concerning smoking at entrances, litter etc. Appendix D outlines the consultation responses and the policy has been updated to incorporate many of the responses. The introduction of a smoke free environment was welcomed by many. 5.4 Proposal for a phased implementation plan Following consultation with the Public Health & Partnership Committee, it is proposed that a phased approach is adopted to implement the smoke free environment policy. This will enable time to engage with staff, patients and visitors at each main ABHB hospital site during the implementation phase. This implementation phase would include establishment of task and finish groups for the main hospital sites of Nevill Hall and Royal Gwent, full staff and public engagement and communication plan. It is acknowledged that for patients, staff, visitors and contractors the shift in becoming smoke free will have organisational wide impact. A phased approach would also allow continued engagement and open communication to address issues pertinent to each hospital site during the implementation phase. A suggestion for phasing implementation across the Health Board would be by locality (see Table 2). In particular full implementation could not be achieved at the Royal Gwent site until risks relating to possibility of patients smoking on Bellevue Road which is a hazardous, narrow lane can be addressed. 14

15 For this site there may have to be compromises on actions, to be determined by the site specific group in conjunction with the Tobacco Action group. Table 2 Proposed phasing implementation plan Locality Hospital Suggested phased timeline Blaenau Gwent Ysbyty Aneurin October 2010 Bevan Proposed policy/environment Smoke free, including grounds Newport Caerphilly* Blaenau Gwent Monmouthshire Torfaen Newport South Gwent Children s Centre Ysbyty Ystrad Fawr Health Board premises not anticipated for closure Remaining community hospitals & Health Board premises Nevill Hall Health Board premises not anticipated for closure All community hospitals & Health Board premises not anticipated for closure Royal Gwent Hospital & St Woolas April 2011 September 2011 (to coincide with opening) October 2011 October 2011 March 2012 March 2012 No Smoking Day Smoke free, including grounds Smoke free, including grounds Smoke free, including grounds Smoke free, including grounds Smoke free, including grounds Concerted effort on shelters and avoidance of smoking at entrance. Review of shelter location. Phased approach to full implementation if patient safety issues able to be addressed All community hospitals & Health Board premises Smoke free, including grounds 15

16 *excluding community hospitals due to proposed closure with the opening of Ysbyty Ystrad Fawr. 6.0 Recommendation Board members are asked to: Receive, note and consider approving the adoption of the Smoke Free Environmental Policy for Aneurin Bevan Health Board Consider and support a phased implementation plan for the introduction of the Policy. Policy Prepared by: Smoke free Policy Task and Finish Group Kevin O Donnell Mererid Bowley Chris Overs Dr Pauline Anderton Elaine Lewis Rhiannon Hobbs Chris Giles Jane Jones Julian Hayman Cynthia Henderson Rebecca Lewis HR Manager Consultant in Public Health Divisional Nurse, Child & Families Division Consultant, Occupational Health Occupational Health Manager Stop Smoking Wales Senior Works & Estates Manager Facilities Press & Communication Manager Medical Records Stop Smoking Wales Paper prepared by: Dr Gill Richardson Director of Public Health Mererid Bowley Consultant in Public Health Kevin O Donnell Human Resources Manager Rhiannon Hobbs Health Promotion Practitioner (SSW) Rebecca Lewis Health Promotion Practitioner (SSW) Date: May

17 References: 1. Welsh Assembly Government. (2009) Our Healthy Future. Cardiff: Welsh Assembly Government 2. Welsh Assembly Government. (2010) Welsh Health Survey Cardiff: Welsh Assembly Government. 3. Welsh Assembly Government. (2010) Annual Quality Framework Cardiff: Welsh Assembly Government. 4. Welsh Assembly Government. (2011) Draft Tobacco Control Action Plan for Wales. Cardiff: Welsh Assembly Government. 5. Furlong, C. (2005). Pre-operative smoking cessation: A model to estimate short term health gain and reductions in length of stay. London: London Health Observatory. 6. Smedslund, G. Fisher, KJ. Boles SM. (2004) The effectiveness of workplace smoking cessation programmes: a meta-analysis of recent studies. Tobacco Control 13: National Institute for Health and Clinical Excellence. (2007) Smoking Cessation Services. London: NICE. 8. Doll, R. Peto, R. Boreham, J. Sutherland, I. (2004) Mortality in relation to smoking: 50 years observations on male British doctors. British Medical Journal (Clinical research ed.) 328: Phillips, C.J. and Bloodworth, A. (2009) Cost of smoking to the NHS in Wales. Cardiff: ASH Wales. 10. Bowles, C (2007). The preventable health burden of smoking and the short-term benefits of preoperative smoking cessation in Wales. A report by the London Health Observatory for the Welsh Assembly. London: London Health Obervatory. 11. Royal College of Nursing (2006) Protecting community staff from exposure to second-hand smoke. London: Royal College of Nursing. 17

18 Membership of Smoke Free Policy Group Appendix A Kevin O Donnell Mererid Bowley Chris Overs Dr Pauline Anderton Elaine Lewis Rhiannon Hobbs Chris Giles Jane Jones Julian Hayman Cynthia Henderson Rebecca Lewis HR Manager Consultant, Public Health Wales Divisional Nurse, Child & Families Division Consultant, Occupational Health Occupational Health Manager Stop Smoking Wales Senior Works & Estates Manager Facilities Press & Communication Manager Medical Records Stop Smoking Wales 18

19 Appendix B Table 1 Framework action plan to introducing a smoke free policy Step Main actions 1. Commit to the policy Identify a champion who will be responsible for policy Secure visible senior commitment Set up a working group Consider the pros and cons of including grounds 2. Create the policy Draft the policy Consult with all staff and representatives Anticipate and deal with common challenges Finalise policy and seek board approval Ensure adequate timescale for implementing the policy with lead-in period 3. Ensure Smoking Cessation support is widely available and accessible Local NHS services should be widely advertised Offer training in smoking cessation to healthcare staff Ensure smoking cessation medications are on the hospital formulary 4. Communicate the policy Adopt and advertise a firm date for implementing the policy Communicate policy requirements internally and externally (e.g. incorporate in patient letters etc.) Implement communications plan Inform ancillary services Ensure employee ownership of policy, especially at management level 5. Consolidate the policy Introduce and action the policy Engage and communicate the policy via written and verbal communication on a regular basis Deal with patients nicotine addiction appropriately Address challenges appropriately, and deal with abusive patients/visitors Ensure monitoring protocol whereby all staff are responsible for implementation Maintain strong leadership from senior managers Review the policy regularly. Adapted from NHS Health Development Agency. (2005) Guidance for smoke free hospital trusts. 19