The Newcastle upon Tyne Hospitals NHS Foundation Trust. Smoke Free Trust Policy

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1 The Newcastle upon Tyne Hospitals NHS Foundation Trust Smoke Free Trust Policy Version.: 6.0 Effective From: 07 December 2016 Expiry Date: 07 December 2019 Date Ratified: 29 vember 2016 Ratified By: Clinical Policy Group 1. Introduction The Newcastle upon Tyne Hospitals NHS Foundation Trust is committed to providing an environment that is safe and protects its staff, patients and visitors without risks to health. Smoking is the main cause of preventable illness and premature death in the United Kingdom (UK) (NHS Information Centre, 2010). In the UK 19% of adults smoke (Health & Social Care Information Centre, 2016). Smoking causes a wide range of diseases and medical conditions including circulatory disease, respiratory disease and cancer (Health & Social Care Information Centre, 2016). Whilst smoking rates in England are in long-term decline, tobacco use remains a major public health challenge with the harm increasingly concentrated in more disadvantaged (McNeill et al, 2015). Second-hand smoke is also a known health hazard (Britton & Bogdanovica, 2014). Smoking puts both smokers and non-smokers at risk from diseases such as chronic obstructive pulmonary disease, heart disease and lung cancer. Smoke can also act as an irritant on the eyes, throat and respiratory tract; aggravate asthma, cause premature skin ageing and pose a threat to the unborn child (Royal College of Physicians 2005). Giving up smoking 6-8 weeks prior to surgery reduces risk significantly (Jones 1985, Moor, Mills & Moore et al 2005, Thomsen et al, 2010). The Trust therefore has a clear mandate to minimise the health risks of smoking to its staff, patients and visitors. When considering its obligations regarding smoking and the production of this policy, the Trust has consulted the following legislation and guidance. Health and Safety at Work Act 1974, Section 2(2) places a duty on employers to: provide and maintain a safe working environment which is, so far as is reasonably practical, safe, without risks to health and adequate as regards facilities and arrangements for their welfare at work. Page 1 of 16

2 The Health Act 2006 Smoke free legislation made within this Act banned smoking in all enclosed and substantially enclosed work places, work vehicles and public buildings from 1st July The Smoke-free (Premises and Enforcement) Regulations 2006 Sets out definitions of "enclosed" and "substantially enclosed" and the bodies responsible for enforcing smoke free legislation. The Smoke-free (Exemptions and Vehicles) Regulations 2007 Sets out the exemptions to smoke free legislation and vehicles required to be smoke free. Healthy Lives, Healthy People: A Tobacco Control Plan for England 2011 This government document provides a comprehensive plan to tackle tobacco in England. Policy Scope This policy applies to all staff, patients, visitors, contractors and other persons who attend the Trust s premises and grounds whether on personal or Trust business. It applies across all sites/premises and land, whether owned or leased and occupied by the Trust. Smoking is not permitted in any building or grounds of the Trust, or any vehicle provided by the Trust for travel in connection with work (e.g. lease car and hopper bus/bus service).the policy also applies to community staff employed by the Trust who are required to visit patients homes. This policy applies to the use of all tobacco products including cigarettes and cigars. It also includes electronic nicotine containing devices, commonly known as vaporisers, shisha pens or e-cigarettes. E-cigarettes have evolved since 2003 and are growing in popularity. In 2015, there were an estimated 2.2 million current e-cigarette users aged 16 and over (Health & Social Care Information Centre, 2016). Since e-cigarettes do not contain tobacco and are not burnt, they do not result in the inhalation of cigarette smoke (Cahn &Siegel, 2011). Newer products personal vapourisers are now available. Vapours are produced by heating a solution of nicotine in propylene glycol or glycerine which is then inhaled. As e-cigarettes are a relatively new product evidence on the content and emission of electronic cigarettes is limited (Britton & Bogdanovica, 2014) and long term studies are awaited. However, the safety and efficacy of electronic cigarettes remains controversial. Public Health England state that e-cigarettes are estimated to be 95% less harmful than conventional smoked cigarettes and for those unable or unwilling to quit smoking (Public Health England, 2016). Whilst many experts including Public Health England believe that e-cigarettes are safer than cigarettes, this is not to say that they are completely safe. Analysis of certain electronic cigarettes has found they deliver inconsistent nicotine levels, contain human carcinogens and tobacco related Page 2 of 16

3 specific impurities that are suspected as being harmful to human health (Westenberger, 2009; BMA, 2013). If patients are not prepared to stop smoking using standard treatments such as nicotine replacement therapy e-cigarettes have been recommended by Public Health England (McNeill et al, 2015). E-cigarettes may help with reducing the harm from cigarettes. However, it is argued that e-cigarettes may undermine smoking cessation by promoting or normalising smoking (BMJ, 2013; NICE, 2013, Britton & Bogdanovica, 2014). Further research is needed to identify practical benefits, harms, opportunity costs or consequences of the use of electronic cigarettes (Britton & Bogdanovica, 2014). The Medicines and Healthcare products Regulatory Agency (MHRA) are now regulating nicotine containing products including electronic cigarettes. Regulation will provide some assurance on the safety, quality and effectiveness to consumers. This will make all such products safer and more effective in reducing the harms of smoking through stopping or cutting down. Licenced e-cigarettes are now available and are recommended by Public Health England as an aid to stop smoking. Until the long term effects of e-cigarettes are known the Trust cannot advocate the use of e-cigarettes on the premises or grounds. This decision has been taken due to current concerns about the unregulated content of some electronic cigarettes; the need to charge appliances electrically, the vapour produced imitating smoke and the potential normalisation of smoking resulting from their use. This policy will be reviewed when current guidance on the use of products approved has been updated. 2. Aim of policy The aim of this policy is to: Ensure compliance with current legislation. Protect and improve the health of staff, patients, visitors and contractors. Protect both smokers and non-smokers from the dangers of exposure to smoke. Provide a health promoting organisational culture and working environment. Provide support for smokers who want to stop. Promote the culture of a smoke free NHS. 3. Duties (Roles and responsibilities) 3.1. All Staff All Trust Employees are responsible for familiarising themselves and complying with the content of the Trust Smoke Free policy Line Managers To provide support and guidance to those staff requiring help and advice on smoking related issues. Page 3 of 16

4 3.3 Directorate managers and heads of service are responsible to the Executive Team for ensuring policy implementation. 3.4 The Executive Team is accountable to the Trust Board for ensuring Trust-wide compliance with policy 4. Abbreviations & Definitions Community Workers: GP: NHS: NHSLA: NICE: NRT: PDA Second-hand smoke: Staff working in community clinics/domestic environment General Practitioner National Health Service National Health Service Litigation Authority National Institute for Health and Clinical Excellence Nicotine Replacement Therapy Patient decision aid Breathing other people's tobacco smoke 5. Main Body of the policy The Trust has a responsibility to enforce the smoking policy by politely approaching individuals who are smoking or vaping on Trust Premises. However, the Trust does not want anyone to feel that they need to engage in difficult or overly challenging situations. Staff should not approach individuals (whether staff or patients) to ask them to stop smoking unless they are confident that it is safe to do so Trust Smoking Restrictions Smoking or vaping is not permitted by patients, service users, visitors, contractors and the public in buildings or within the grounds owned, leased or occupied by the Trust Smoking or vaping is not permitted by staff outside of the premises in uniform or displaying Trust identification Smoking is not permitted by staff in vehicles owned by or contracted by the Trust including privately owned or leased vehicles when they are being used for work purposes. All such vehicles (except privately owned) must by law display no smoking signage which complies with legislation. Staff choosing to smoke or vape must do so in their own time and adhere to the above restrictions. Page 4 of 16

5 5.2 Community Workers As an employer, the Trust is under a statutory duty to provide a working environment for employees which is safe and without risks to health. However, the smoke-free workplace legislation introduced in 2007 provides an exemption for private dwellings where the work undertaken on the premises comprises provision of personal care for a person living in the dwelling. As a result the Trust, and its community staff, have to rely on the understanding and goodwill of patients who they visit at home. Patient documentation includes information relating to the smoke free policy. A leaflet should be issued to patients and their carer s prior to a home visit asking them not to smoke or vape in the room where the treatment is to be undertaken for at least one hour prior to the visit and for its duration (see Appendix 1). Staff should ensure that if patients are not able to read the leaflet then this is explained to them using communication support, such as interpreters and British Sign Language interpreters, where required. Feedback from community teams suggests this seems to work well in most cases. Where a patient at home persistently refuses to refrain from smoking or vaping in the presence of the community staff the line manager should contact the patient and explain the Trust s Smoke Free policy and the reasons why staff require a smoke-free environment. If the situation persists, the line manager should send a letter advising the patient that the Trust may no longer be able to provide them with care at home and that arrangements will be made for the patient to attend an NHS clinic for their care instead. If the patient does not accept the alternative arrangements for treatment, they should be advised that the Trust is unable to continue to provide that treatment and those they should seek treatment elsewhere. Individual circumstances may involve changing the approach. Seek advice if needed. Where the patient lacks capacity a best interest s decision will need to be made with regard to arrangements for treatment. 5.3 Help and Advice on Smoking Clinical staff have a responsibility to provide advice and support to help patients to stop smoking. Advice and information is provided on the Trust Intranet. Information can be made available in Braille or other languages if required. The Newcastle Stop Smoking Service (Lifeline) can be contacted directly on , or the National Helpline on If patients are from outside the area then the Newcastle Stop Smoking Service can be contacted to identify a local service. Lifeline also provide home visits if necessary. Those wishing to quit smoking can also go online to find out about self-help options available such as text, or app support ( Page 5 of 16

6 Staff can refer patients directly to Newcastle Stop Smoking Service using the referral form (Appendix 2) which is also available on the Trust Intranet. The Stop Smoking Service can also offer support regarding any other forms of tobacco use Staff Staff who find it difficult to stop or refrain from smoking and adhere to this policy should be offered support and the following actions may be taken to assist them: In the first instance the employee s Line Manager should meet with the member of staff to assess any difficulties and how these may be overcome. If required, the Manager may refer the individual to any of the following services; Newcastle Stop Smoking Service (Lifeline) Newcastle Occupational Health Service (Newcastle OHS). Chest Clinic RVI Staff wishing to stop smoking can be referred to or self-refer to the Newcastle Stop Smoking Service ( ), the Newcastle OHS (Ext 21188) or Chest Clinic RVI (Ext 20161). Alternatively, they may choose to consult their own GP or a trained advisor in a local pharmacy (See the Trust Internet for participating pharmacies). Employees will be able to access these services in work time, dependent on service needs and subject to line manager approval. Alternatively, employees will be able to access details of the stop smoking clinic nearest to their home from the Stop Smoking Service. NICE guidance recommends that staff be given time off to attend stop smoking session Patients in Hospital Information leaflets are available to all wards and departments and are sent to patients prior to admission to advise them of the Trust Smoke Free policy. Patient decision aids (PDA) advising on smoking abstinence, treatment and referral are available on the Trust Internet. All patients invited for elective admission/out-patient appointment are sent a copy of the Information for Patients booklet, which includes details of the Trust s Smoke Free Policy and local Stop Smoking Services. Staff should ensure that within their Nursing and Medical assessment of all patients, they ascertain and record the smoking status of the patient and provide brief smoking cessation advice to the patient. Page 6 of 16

7 Brief advice should include information on and arrangement of suitable treatments for temporary abstinence of smoking; to act as a harm reduction strategy and to minimise withdrawal discomfort or to begin a quit attempt. Should the patient want to begin a quit attempt, they should be provided with smoking cessation medication at discharge and encouraged to accept referral to the Stop Smoking Service for continued support or to self-refer to the Service as appropriate. They should all be given contact details for The Newcastle Stop Smoking Service who will provide information of their local stop smoking services and encouragement to contact them. This should be recorded in the patient s documentation. 5.4 Procedure for hospital patients requesting to smoke Should a member of staff encounter a patient who wishes to smoke then the patient must be made aware of the Trust Smoke Free policy. Patients who choose to smoke must be advised that they may only do so off the premises. Patients who choose to leave Trust premises for the purpose of smoking should be advised they do so at their own risk and should be recorded in their clinical notes or by using the disclaimer form (Appendix 3). Patients should not to be escorted by a member of staff, except on the very rare occasions when they have a treatable, serious condition, and are at risk of absconding, which would put their own or others health at risk, and who insist on smoking. Where a relative/visitor is present they may wish to accompany the patient. 5.5 Staff guidelines for dealing with smoking incidents on hospital grounds Patients/visitors known to staff Where staff encounter patients known to them, who are smoking outside policy guidelines, the patient should be politely informed of this Trust Smoke Free policy and be advised that they may do so off NHS premises. If the patient fails to comply with this policy and the information given to them, they should be encouraged to handover smoking materials to staff to ensure the health, safety and wellbeing of other patients, visitors and staff. If these items are handed over by the patient for safe keeping, they should be returned on discharge. In the event that this action is not successful and the patient refuses to refrain from smoking or relinquish smoking materials then the patient s Consultant should be contacted, if known, and asked to approach the patient and to address the issue with the patient. Page 7 of 16

8 Patient s failure to comply with requests to cease smoking may result/necessitate in the patient being discharged from the hospital. In situations where the patient becomes verbally abusive or violent as a reaction to the request, reference should be made to the Policy for the Exclusion from Treatment for Violent or Abusive Patients in regard to further management Patients/Visitors that are NOT known to staff Patients /Visitors that are NOT known to staff and their compliance with this policy present a particular challenge in enforcing this policy. Staff should assess the situation and not put themselves at risk. On approaching the individual who is smoking the member of staff should introduce themselves. The member of staff should ask whether the individual is aware of the Trust policy and remind them politely that the Trust is Smoke free. The individual should be advised where they may smoke or vape (off site) and should be directed appropriately. If they refuse to stop smoking, they should be asked that in future they ensure they smoke off Trust premises. The member of staff should then withdraw. On the CAV, RVI and FRH sites a member of the Security Team, who can also provide information on the Trust policy, can be contacted for assistance if necessary to enable them to address the issue with the individual. Staff should be aware that Trust property is private property and therefore visitors do not have the right to smoke or vape on these premises. Staff who are subjected to verbal or physical abuse, resulting from attempts to enforce this policy should report such incidents immediately to either their line manager or Portering/Security Supervisor immediately, completing the appropriate Trust Incident Reporting documentation. 5.6 Community Visits Trust staff who visit patients in their own home or other private accommodation should request the patient/other person not to smoke or vape whilst the staff member is in attendance. It may be helpful for community staff to issue a leaflet (Appendix 1) to patients or incorporate information about smoking during home visits in their standard documentation. In the event of a patient/other person refusing to stop smoking in the presence of a staff member, that staff member should report the incident to their line manager, document the event in the patients notes and report it as an incident following Trust procedure (see Appendix 4). Page 8 of 16

9 Any arrangements should be made as soon as practicable, and if there is communication support required for the particular patient, this should be considered as part of this process. Line mangers should keep written records (Datix) of any breaches in the policy and the actions taken to show how as a responsible employer they are taking all reasonable steps to protect the health of their employees. Staff with a pre-existing health condition (e.g. asthma) that is made worse by exposure to second hand smoke or the vapor from electronic devices should be identified as part of a risk assessment. These staff are at higher risk and particular care must be taken to minimise their exposure to second hand smoke. Wherever possible, and practicable, these staff should not be asked to work in such an environment. Staff are reminded that the Trust operates a Zero Tolerance toward violence and aggression and all incidents should be reported. 6. Training The subject of Smoking and the Trust s stance is not part of the Mandatory Training Policy. However, an e-learning package on brief interventions for stop smoking and protecting others from second hand smoke is recommended as best practice for staff. This training is available for frontline staff on Breeze. Staff can also do further training at Centre for Smoking Cessation and Training). The Trust s smoke free position is highlighted to all new employees on every job specification and should be endorsed during HR recruitment. The online staff handbook makes reference to the Smoke Free Trust as does the standard corporate induction. 7. Equality and diversity The Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on any grounds. This policy has been appropriately assessed. Page 9 of 16

10 8. Monitoring compliance with the policy Standard / process / issue Monitoring and audit Method By Committee Frequency Compliance with enforcement of smoke free environment. Data collection via Datix on smokers challenged by staff at all sites. Trust Lead for Portering/Security Manager Trust Public Health Group Annually Evidence of onward referral to Stop Smoking Service Number of Contacts/Referrals to the Stop Smoking Service. Newcastle Stop Smoking Service 9. Consultation and review When carrying out a review of the Smoke free Trust Policy, the following guidance should be taken into consideration together with the legislation described in section 1 of this document. NHSLA Risk Management Standards for NHS Trusts providing Acute, Community, or Mental Health & Learning Disability Services and Independent Sector Providers of NHS Care. NHSLA Smoking Policy HR13 4E87-6D3C147FC5E18C/0/HR13SmokingPolicyversion2.pdf In the production of this Trust Policy, comments have been invited from the following persons or groups: Newcastle Stop Smoking Service Newcastle City Council Public Health Team Nursing & Patient Services Director Deputy Director of Nursing and Patient Services, Freeman Hospital Trust Public Health Group 10. Implementation of policy (including raising awareness) The previous version of this policy has already implemented. Awareness of the policy is raised to all staff at appointment and induction. Page 10 of 16

11 tification of any policy refresh undertaken is via the Policy Newsletter. Patients are informed of Smoke free policy through admission information and notices around Trust premises with information for patient in community setting provided as necessary. 11. References BMA Occupational Medicine Committee and the Board of Science (2012) E- cigarettes in Public Places and Workplaces: A Briefing (updated January 2013) BMA. Britton J. & Bogdanovica I. (2014) Electronic cigarettes. A report commissioned by Public Health England. Available from /E-cigarettes_report.pdf. Accessed Cahn Z, Siegel M. Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes? Journal of Public Health Policy 2011;32: Chapman, S. (2013) Should electronic cigarettes be as freely available as tobacco cigarettes?. BMJ. 346:F3840. Health & Social Care Information Centre. (2016). Statistics on Smoking, England HSCIC National Statistics Publication. Jones RM. (1985) Smoking before surgery: the case for stopping. BMJ 290, MHRA (2013) Press Release: UK moves towards safe and effective electronic cigarettes and other nicotine-containing products Medicines and Healthcare Products Regulatory Agency. Moor S, Mills B B, Moore R D et al (2005) Peri-surgical smoking cessation and reduction of post-operative complications. American Journal of Obstetrics and Gynaecology.192, NHS Information Centre. (2010) Statistics on smoking: England NHS Information Centre, Leeds. NICE (2013) Tobacco: harm-reduction approaches to smoking (PH 45) National Institute for Clinical Excellence. McNeill A, Brose LS, Calder R, Hitchman SC, Hajeck P. & McRobbie H. (2015) E-cigarettes: an evidence update. A report commissioned by Public Health England. Public Health England /Ecigarettes_an_evidence_update_A_report_commissioned_by_Public_Hea lth_england_final.pdf. Accessed Royal College of Physicians. (2005) Going smoke-free: the medical case for clean air in the home, at work and in public places: A report on passive smoking Page 11 of 16

12 by the Tobacco Advisory Group of the Royal College of Physicians. Royal College of Physicians, London. Thomsen T, Villebro N. & Moller AM. (2010) Interventions for preoperative smoking cessation. Cochrane Database Systematic Reviews. Westenberger BJ. (2009) US Food and Drug Administration: evaluation of e- cigarettes. St Louis, MO: US Food and Drugs Administration, Centre for Drug Evaluation and Research, Division of Pharmaceutical Analysis. 12. Associated documentation This policy should be read in conjunction with the following Trust policies:- Exclusion from Treatment for Violent or Abusive Patients Page 12 of 16

13 Appendix 1 Look after health care workers who visit you at home Newcastle Hospitals Community Health has a smoke free policy. Secondhand smoke or passive smoking can damage health. Breathing in this smoke can cause: heart disease, lung cancer, eye irritations, headaches, coughs, sore throats, dizziness and sickness. Please do everything possible to make your home smoke free when our staff visit. Please help by: t smoking inside the house for at least one hour before the home worker comes to your house. Do not smoke during the visit. Open the windows and doors if you have been smoking. Do not let other people smoke in the house. Try to keep one room in the house smoke free at all times. If your home is not smoke free when the home worker visits you they may have to arrange to visit you at some other place which is smoke free. The home worker will tell you about this. If you want to give up smoking If you are a smoker and wish to give up tell the home worker when they visit you, they can assist you to get help and support. Alternatively you can call your local NHS Stop Smoking Service on They provide free friendly help, support advice on giving up smoking and can also visit you at home if you are unable to attend any of the GP, community or hospital clinics. Thank you for your help and for helping to make your home smoke free for our staff Page 13 of 16

14 Appendix 2 Stop Smoking Service Referral Form Stop Smoking Service Referral Form - following Brief Advice Bridge View House, City Road, Newcastle upon Tyne. NE1 2AF Tel: Mobile: Fax: Please complete this form clearly and legibly NHS number not required Date of referral... Name.... Date of birth... Address... Postcode Tel.. essential GP Practice.. Best way to contact client: - Phone / text / /other. Comments (including, hearing impaired/interpreter/any safety concerns to be considered Referrer Name... Base.. District Nurse Team Health Visitor Team Secondary Care referral (Inpatient/Outpatient) Other Team/ role Referrer Tel. Housebound Client pregnant * *Please use pregnancy referral form Children under 4 Breastfeeding Under 18 Parent informed Yes/ Relevant or current medical history (including depression)... What treatment has commenced? NRT Champix ne Quit date.. Brief Advice given YES / NO IF NO REASON Client requires information pack only Yes The patient has consented to referral and contact from the Stop Smoking Service YES/NO The patient has been given information on clinics? YES Stop Smoking Service to complete:- Date received Date Contact Time/Initial 1 st 2nd 3 rd Unable to contact Agreed to attend SSS clinic Contacted by phone Info pack sent out Free Prescriptions Yes Male Female Letter sent Date. Ethnic code Other Page 14 of 16

15 Appendix 3 Disclaimer Form You are reminded that the Trust operates a Smoke Free Policy to protect patients, staff and visitors and smoking is not permitted anywhere within Trust buildings or grounds. Patients choosing to smoke whilst receiving care or treatment are reminded they do so at their own risk and must ensure they smoke outside of the hospital grounds For your own safety, we request that patients notify a member of staff when leaving the ward or department to smoke I understand the above comments advising me on the Trust Smoke Free Policy and would prefer to smoke rather than accept a suitable treatment to ease withdrawal Full Name of Patient/Representative.. Signature Date.. IF PATIENT IS UNWILLING TO SIGN: Obtain signature from patient relative or staff member confirming the patient has been advised as above Full Name of Witness Signature...Date. Relationship to patient/designation. Page 15 of 16

16 Appendix 4 Staff working in Patients homes/private Accommodation Datix completed The client s communication needs should be considered during this process. Page 16 of 16

17 The Newcastle upon Tyne Hospitals NHS Foundation Trust Equality Analysis Form A This form must be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval. PART 1 1. Assessment Date: 2. Name of policy / strategy / service: Smoke Free Trust Policy 3. Name and designation of Author: Karen Heslop-Marshall 4. Names & Designations of those involved in the impact analysis screening process: Karen Heslop-Marshall and Lucy Hall; Equality and Diversity Lead 5. Is this a: Policy x Strategy Service Is this: New Revised x Who is affected: Employees x Service Users x Wider Community x 6. What are the main aims, objectives of the policy, strategy, or service and the intended outcomes? (These can be cut and pasted from your policy) The objective of this policy is to: Ensure compliance with current legislation. Protect and improve the health of staff, patients, visitors and contractors. Protect both smokers and non-smokers from the dangers of exposure to smoke. Provide a health promoting organisational culture and working environment. Provide support for smokers who want to stop. Promote the culture of a smoke free NHS. Smoke Free Trust Policy Equality Assessment Page 1 of 4 Dec 2013

18 7. Does this policy, strategy, or service have any equality implications? If, state reasons and the information used to make this decision, please refer to paragraph 2.3 of the Equality Analysis Guidance before providing reasons: The policy has been reviewed and no evidence in relation to equality found. Information is available in different formats on request. Support is available to those who would like to stop smoking and consideration of those not able to comply with the policy included. 8. Summary of evidence related to protected characteristics Protected Characteristic Evidence i.e. What evidence do you have that the Trust is meeting the needs of people in various protected Groups related to this policy/service/strategy please refer to the Equality Evidence (available via the intranet Click A-Z; E for Equality and Diversity. Summary on front page and more detailed information in resources section) Does evidence/engagement highlight areas of direct or indirect discrimination? If yes describe steps to be taken to address (by whom, completion date and review date) Does the evidence highlight any areas to advance equal opportunities or foster good relations. If yes what steps will be taken? (by whom, completion date and review date) Race / Ethnic origin (including gypsies and travellers) Information available in different formats on request. Support is available to those who would like to stop smoking Mandatory EDHR training Sex (male/ female) Religion and Belief Support is available to those who would like to stop smoking. Mandatory EDHR training Support is available to those who would like to stop smoking. Smoke Free Trust Policy Equality Assessment Page 2 of 4 Dec 2013

19 Sexual orientation including lesbian, gay and bisexual people Mandatory EDHR training Support is available to those who would like to stop smoking Mandatory EDHR training Age Disability learning difficulties, physical disability, sensory impairment and mental health. Consider the needs of carers in this section Support is available to those who would like to stop smoking. Mandatory EDHR training Information available in different formats on request. Support is available to those who would like to stop smoking. Mandatory EDHR training Gender Reassignment Marriage and Civil Partnership Maternity / Pregnancy ne relevant to this policy Support is available to those who would like to stop smoking. Mandatory EDHR training ne relevant to this policy Support is available to those who would like to stop smoking. Mandatory EDHR training It is particularly important for pregnant women not to smoke. Specific support is available to them within midwifery services. Mandatory EDHR training Smoke Free Trust Policy Equality Assessment Page 3 of 4 Dec 2013

20 9. Are there any gaps in the evidence outlined above. If yes how will these be rectified? 10. Engagement has taken place with people who have protected characteristics and will continue through the Equality Delivery System and the Equality Diversity and Human Rights Group. Please note you may require further engagement in respect of any significant changes to policies, new developments and or changes to service delivery. In such circumstances please contact the Equality and Diversity Lead or the Involvement and Equalities Officer. Do you require further engagement 11. Could the policy, strategy or service have a negative impact on human rights? (E.g. the right to respect for private and family life, the right to a fair hearing and the right to education? PART 2 Signature of Author Karen Heslop-Marshall Print name Karen Heslop-Marshall Date of completion (If any reader of this procedural document identifies a potential discriminatory impact that has not been identified, please refer to the Policy Author identified above, together with any suggestions for action required to avoid/reduce the impact.) Smoke Free Trust Policy Equality Assessment Page 4 of 4 Dec 2013

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