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1 DOCUMET COTROL PAGE Title: Alcohol & Drug Misuse Policy Document Type: Policy Scope: All Staff Version umber as from December 2004: Two Classification: Policy Author: Dr Martin Seed - Consultant Occupational Physician Groups Consulted: JCC, Departmental & Senior Managers, HRBM s Validated By: JCC Equality Impact Assessed: Yes Date: 10 th June 2011 (If appropriate) Replaces: Description of amendments: Revised version of 2004 policy Authorising Body: Workforce Committee Master Document Controller: Charlotte Eckersley, Personal Secretary Date of Authorisation: October 2010 Review Key Words: Date: Alcohol, Drugs & Misuse ov 2011 IDEX Purpose and Scope of document Page 1 Definitions Page 1-2 Policy Statement Page 3 Guidelines/Procedure/Methods Page 4 Monitoring, Evaluation and Review Page 5-6 References Page 6-10 Appendices Page 11

2 ALCOHOL & DRUG MISUSE POLICY 1. ITRODUCTIO Royal Bolton Hospital HS Foundation Trust is committed to ensuring a safe, healthy and productive environment for patients and employees and to minimise problems arising from the misuse of alcohol and drugs. Workplace alcohol and drug issues reflect those in society. Alcohol is the most common substance of abuse in society and the most likely substance to cause problems in the workplace. More than 10 million people (31% of men, 21% of women) are now regularly drinking above the safe levels set out by government. Hospital admissions for the three main alcohol specific conditions (alcohol related liver disease, mental health disorder and acute intoxication) more than doubled in the 11 years between to In 2008 it was calculated that alcohol related problems cost the HS 2.8 billion each year. If crime and disorder, social and family breakdown and sickness absence are included, then the cost is said to be in the region of 25.1 billion per year.¹ Misuse of drugs is also a societal problem. 10% of year olds in the UK were recently found to have used one or more illicit drugs (appendix A) in the previous year 2, the most common being cannabis, cocaine, ecstasy and amphetamines. Such substances may lead to problems associated with performance and behaviour of employees as may the misuse of certain prescribed drugs. Misuse of alcohol and drugs by employees of the Trust is unacceptable if it adversely affects the safety and efficiency of achieving Trust goals, in particular patient care. However, the Trust also recognises the need to support any employee who acknowledges a problem with drug or alcohol misuse. This policy is intended as guidance for managers and employees of Royal Bolton Hospital HS Foundation Trust. It is written in accordance with relevant legislation (appendix B) and guidance PURPOSE AD SCOPE OF POLICY The aims of the policy are: To ensure that employees use of alcohol or drugs does not affect the health and safety of the individuals themselves, their fellow workers, or others with whom they come into contact in the course of their work. To ensure that employees use of alcohol or drugs does not impact on patient care or affect the efficient and effective operation of the Trust s activities in any other way. To set out the Trust s rules on alcohol, drugs and substance abuse. To provide procedures, whereby employees with an alcohol, drug or substance abuse problem can seek help in confidence.

3 To outline some of the symptoms and effects of alcohol, drugs and substance misuse and promote health. 3. RULES AD RESPOSIBILITIES In order to minimise risks to patients, visitors and employees the following rules will be enforced by the Trust. They apply equally to all employees regardless of grade or status. o employee or contractor shall attend or try to attend work when unfit (in the reasonable opinion of management) because of the influence of alcohol, drugs (whether legal or not) or substance abuse. o employee or contractor shall be in possession of illegal drugs in the workplace (see appendix A for list of illegal drugs). o employee or contractor shall consume alcohol or illegal drugs, or abuse any substance, whilst at work. The responsibilities for relevant sections of the organisation listed below takes into account the relevant legislation (see appendix B) whilst acknowledging that cooperation is necessary in situations that require a good degree of trust between employer and employee. 3.1 Employees Employees have the primary responsibility for adhering to the above rules and for ensuring that their work performance is not affected by the effects of alcohol or drug misuse. Breach of these rules may lead to disciplinary action. They are encouraged to come forward and seek assistance in confidence (see appendix C for available sources of support) if they feel they have a problem with alcohol or substance misuse as the Trust will endeavour to support an employee acknowledging a problem and engaging with the professional help available. Employees should not (even with the best of motives), cover up for or collude with a colleague who is thought to have an alcohol/drug or other substance misuse problem but instead should encourage the employee to seek help. Employees have a responsibility to raise any concerns about another employee whose behavior may represent a risk to health or safety of employees or patients, with the employee s line manager or HR. Any employee receiving a caution or conviction for an alcohol or drug related offence must consider their duties to report it to their professional regulatory body (e.g. MC 6 ). 3.2 Managers Managers need to be aware of the signs of alcohol/drug and other substance misuse and the effects on performance, attendance and health of employees (See Appendix D). They should intervene at an early stage where changes in performance, behavior, sickness levels, attendance patterns etc are identified, to establish whether alcohol/drug or substance misuse is an underlying cause.

4 Managers should ensure that staff are aware of the support available to them should they wish to discuss any problem in confidence (appendix C). They have a duty to respect confidentiality of information relating to an employee s drug or alcohol problem and to inform others only on a need-to-know basis e.g. in Human Resources or Occupational Health departments. Managers are responsible for monitoring the performance, behavior and attendance of employees as part of the normal supervisory relationship. They need to instigate disciplinary measures where appropriate to do so and adhere to occupational health advice on fitness for work issues. 3.3 Occupational Health The consultant occupational physician or occupational health nurses may be required to make decisions on an employee s fitness for work in relation to an alcohol or drug problem. This may be following a request by management or based on information arising during a medical consultation. The risk to health and safety of others, including patients, is a prime concern when making such decisions. However, the individual employee s health and wellbeing is also a key concern of occupational health staff who will seek to promote health in relation to advice on safe use of alcohol in accordance with ICE guidance. 5 Self referrals are encouraged to allow employees to discuss any concerns about their level of alcohol consumption or drug misuse in confidence. Acknowledgement of alcohol/drug and other substance misuse problems by employees is encouraged, and advice on available sources of support provided. Medical referrals for treatment and rehabilitation will be made where necessary but only with the employee s consent. Occupational health staff should also be alert to the possibility of an underlying alcohol or drug problem in employees referred in relation to sickness absence or concerns about health or performance. Strict confidentiality will be adhered to and the employee s consent will be sought when disclosure of information about a drug or alcohol problem to management is thought necessary. There may, however, be situations when disclosure of personal information without consent is deemed necessary in the public interest, for example the safety of patients being treated by the Trust Human resources The Human Resources department has a key role in providing advice and support to managers and employees in situations where difficulties occur as a result of a drug or alcohol problem. It will advise in possible disciplinary situations and encourage co-operation to achieve referral, treatment, rehabilitation and recovery of employees with alcohol or drug problems.

5 4. IDETIFICATIO OF A ALCOHOL OR DRUG PROBLEM Any Trust employee concerned about their level of alcohol intake or drug misuse is strongly encouraged to discuss their concerns with either their manager, in confidence with a doctor or nurse within the occupational health department or with one of the support agencies listed in appendix C. Such problems may also come to light following an incident at work, during routine return to work interviews or occupational health appointments following management referral. Some warning signs are listed in appendix D. o formal screening or testing of employees for substances of misuse is currently performed within the Trust. During clinical assessment of an employee with a possible alcohol problem the occupational health practitioner may, with the employees consent, take blood samples to help characterise the extent of alcohol misuse and any adverse health effects. Whilst a serum alcohol concentration may be requested on such samples the result will only be used to complement the confidential clinical assessment and will not be used as evidence in disciplinary matters relating to possible intoxication whilst at work, as this would require chain of custody proof of sample identity. 5. REHABILITATIO The Trust encourages employees to acknowledge problems with alcohol or drug misuse and will try to support such employees who need treatment. Support is available through a variety of sources (listed in appendix C). Some of these may be accessed directly by the employee and others require referral either by occupational health staff or the employee s general practitioner. For milder cases the staff counselling service available in Occupational Health may be sufficient. Employees concerned about alcohol or drug misuse may also arrange to see either the occupational physician or occupational health nurse to discuss their anxieties in confidence. The Trust ethos of supporting an employee who acknowledges the need for professional support in relation to a drugs or alcohol problem will be reflected in the Human Resources department s approach to monitoring of associated sickness absence. However the diversity of such problems means that each case has to be managed on its own merits taking into consideration occupational health reports. 6. DISCIPLIARY PROCESS The Trust will, as appropriate, take a constructive and supportive approach when dealing with employees who may be experiencing alcohol/drug or other substance dependency/addiction problems. However, an employee who breaches the rules outlined in this policy puts themselves at risk of facing disciplinary action. All cases will be dealt with on an individual basis taking into account available evidence and disciplinary action will be proportionate to the circumstances of the breach of policy. Disciplinary procedures may occasionally, and at the discretion of management, be suspended if the employee has a medical problem amenable to treatment for that treatment to be undertaken.

6 Where evidence warrants, a senior manager may be required to inform the police of illegal drug use or any activity or behaviour over which there are concerns about legality. The Accountable Officer for Controlled Drugs for the Trust has responsibilities to report possession of controlled drugs on site, suspicions of misuse and/or diversion. Medicines classified as Controlled Drugs which have not been specifically prescribed for the person in possession and are not connected to their roles and responsibilities within the hospital are also governed by the Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations The appropriate professional regulatory bodies may also need to be informed of allegations of professional misconduct related to alcohol/drug or other substance misuse by a registered healthcare professional.. 7. MOITORIG, EVALUATIO AD REVIEW The effectiveness of this policy in providing guidance for incidents of alcohol or drug misuse will be monitored and reviewed by annual meetings involving relevant staff from the Trust Occupational Health and Human Resources departments. Difficulties in managing situations and cases involving alcohol and drug misuse will be discussed anonymously and respecting confidentiality at all times. Policy changes will be considered in order to improve consistency of managing such cases balancing employees rights to rehabilitation and their contractual responsibilities. 8. REFERECES 1. ational Audit Office Reducing Alcohol Harm: Health Services in England for Alcohol Misuse 2. British Crime Survey 2005/ Faculty of Occupational Medicine Guidance on alcohol and drug misuse in the workplace 4. Health and Safety Executive Drug misuse at Work a guide for employers 5. ICE public health guidance 24, June Alcohol-use disorders: preventing the development of hazardous and harmful drinking. 6. ursing & Midwifery Council, July Policy for nurses and midwives who have received a caution or conviction for an alcohol or drug related offence. 7. General Medical Council Guidance for doctors - Confidentiality

7 Appendix A Some facts about Alcohol & Drugs of misuse Alcohol quantities Glass of wine (125 ml of 12.5%) Bottle of wine (12.5%) Spirit measure Bottle of spirits Half a pint of beer (4.5%) Pint of export lager Pint of strong cider Bottle of low alcohol beer 1.6 units 9.4 units 1 unit 28 units 1.5 units units according to strength 4.6 units 0.3 units Lower-risk drinking Increasing-risk drinking Higher-risk drinking Men: up to 21 units per week Women: up to 14 units per week Men: units per week Women: units per week Men: more than 50 units per week Women: more than 35 units per week For those requiring detoxification, consumption of the order of units weekly for men and 100 or more for women is a common presentation. The UK legal driving limit is: 80 mg/100mls blood 107 mg/100ms urine Misuse of drugs Act 1971 classification of drugs Class A includes: ecstasy, LSD, heroin, cocaine, crack, magic mushrooms (if prepared for use), amphetamines (if prepared for injection) Class B includes: amphetamines, methylphenidate (Ritalin), pholcodine, cannabis Class C includes: minor tranquilisers inc. benzodiazepines, GHB

8 Appendix B relevant legislation Health & Safety at Work Act 1974 Management of Health and Safety at Work Regulations 1999 Road Traffic Act 1988 Misuse of Drugs Act 1971 Data Protection Act 1998 Corporate Manslaughter Act 2008 It should be noted that Addiction to alcohol, nicotine or any other substance does not constitute an impairment for the purposes of the disability discrimination provisions of the Equality Act (formerly the DDA) but a person may be considered disabled due to impairments caused by the effects of such addiction e.g. liver cirrhosis. Appendix C sources of confidential help available to the employee with an alcohol or drug problem Local 1. Occupational Health Department - can be accessed by employee self referral or management referral. 2. Bolton Community Alcohol Team. Self referral or through occupational health or GP. Giles House 43 Chorley ew Road Bolton BL1 4QR tel Mental health services available through Royal Bolton Hospital HS Foundation Trust when referral deemed appropriate by occupational health. 4. The employee s GP can facilitate appropriate referrals and advice on all aspects of health related to alcohol misuse. 5. Addiction Dependency solutions. Tel:

9 External to Bolton 1. Alcoholics Anonymous. Tel: Referral through the Occupational Health Department or the employee s GP to alcohol or mental health services outside of the Bolton area 3. Self referral by the employee to any of the alcohol services listed below: LEIGH (ICLUDIG TYLDESLEY, ATHERTO AD ASTLEY) Leigh Street Based Services Bold Street Leigh W7 1AL WIGA Coops Business Centre 11 Dorning Street Wigan W7 1HR SALFORD (LITTLE HULTO, WALKDE, WORSLEY, PEDLETO AD SWITO) Haysbrook Centre 4 Haysbrook Avenue Little Hulton Manchester M28 0AY SALFORD (ECCLES) SALFORD (OTHER AREAS) 1 King Street 6 Acton Square Eccles The Crescent M30 0AE Salford BURY 4 Tenterden Street Bury BL9 0EG

10 APPEDIX D Possible warning signs of a substance misuse by an employee The following signs when occurring in combination or repeatedly may help a manager to suspect that an employee has a problem with substance or alcohol misuse. Attendance and performance Attending work in an obvious intoxicated condition e.g. smelling of alcohol, hand tremors, unkempt. Difficulties in concentrating on work Varying and sporadic quality of work Late arrival for work or high rates of absenteeism especially on Mondays and Fridays Early departures from workplace and increased rates of sick leave Frequent late return from breaks Behaviour Poor relationships at work, arguing with colleagues Sudden changes in behaviour, irritability, moodiness Borrowing money from colleagues Difficulty in respecting hierarchy within the organization Safety Hazards Increased accident rate at both work and home Carelessness in handling hazardous materials or dangerous equipment

11 Equality Impact Assessment Initial Screening Tool 1. Directorate Workforce 2. Department Human Resources 3. ame of activity being assessed Alcohol & Drug Misuse Policy 4. Person completing this form Dr Martin Seed 5. Date 10/6/ Monitoring data/statistics compare activity data with population data (see Guidance) Patients Staff Equality Target Groups (ETGs) (See guidance for detail) 7. Which of the following Equality Target Groups will this activity impact on? 8. Could this activity have a positive and/or negative impact? yes no Positive* egative* A. Age B. Disability C. Gender D. Race E. Religion/Belief F. Language G. Sexual Orientation H. Gypsy/Roma/Traveller I. Carers J. Employees 9. Consultation/Involvement during the development of this activity? (see Guidance) Staff side / Divisional Managers / JCC / Executive Board 10. Details of positive and negative impacts Positive Impacts Improved knowledge of sources of confidential support for employees with drug or alcohol problems. Improved framework to assist managers in dealing fairly with workplace problems related to alcohol or drug misuse. egative Impacts one identified 11. Give details of actions required to remedy any negative impact(s) identified above. Action to address negative impact Who Target Date one

12 12. If the actions in 11 above are completed (answer Yes or o) revisit section 12 when action in 11 complete egative Impact Positive impact 1. Will the activity present any problems or barriers to any community or group? 2. Will any group of people be excluded as a result of your activity? 3. Does the activity have the potential to worsen existing discrimination and inequality? Age Disability Gender Race Religion/Belief Language Sexual Orientation 4. Will the activity have a negative effect on community relations? Could the activity reduce inequalities? Will it (answer Yes or o) Age Disability 5. Promote equality of opportunity? Y 6. Eliminate discrimination? 7. Eliminate harassment? 8. Promote good community relations? 9. Promote positive attitudes towards disabled people? 10. Encourage the participation of disabled people? 11. Consider more favourable treatment of disabled people? 12. Promote and protect human rights? Y Gender Race Religion/ Belief Language Sexual Orientation Gypsy/roma Traveller Gypsy/roma Traveller Carers Carers Employees Employees