Appendix C Aneurin Bevan Health Board Smoke Free Environment Policy
Content 1. Policy statement 2. Introduction 3. Smoking restrictions within the Health Board 4. Responsibilities 5. Staff working in patients homes 6. Patients 7. Distressed relatives and friends 8. Mental Health Units which provide residential accommodation 9. Help for those who smoke 10. Enforcement of the policy 11. Communicating the policy 12. Training 13. Contact details for further information
1. Policy statement 1.1 Aneurin Bevan Health Board is continually working towards the provision and maintenance of a healthy workplace, environment and healthy lifestyle for all Health Board employees, patients and visitors. 1.2 This policy covers all employees of Aneurin Bevan Health Board as well as contractors, contracted staff, patients and visitors. 1.3 Therefore in order to protect all staff and to promote good health the following Smoke Free Environment Policy has been adopted by Aneurin Bevan Health Board. 1.4 All Aneurin Bevan Health Board sites and premises will be completely smoke free. This means there is a complete smoking ban. These restrictions include all areas up to the boundaries, and include car parks and vehicles parked on Health Board property, outdoor seating areas, walkways and all other areas. Any person wishing to smoke must first leave the grounds. 1.5 This policy reflects the goals in the Health Board s Annual Plan, Annual Quality Framework, Public Health Strategic Framework and the Welsh Assembly Government s Our Healthy Future:- Actions in Public Health Strategic Framework and Our Healthy Future:- Reduce smoking prevalence Improve health at work Reduce Health inequalities Annual Quality Framework:- Implement best practice on smoking cessation All LHBs will have engaged with the Corporate Standard with a view to be achieving a platinum award by 2013. 1.6 This policy reflects standard 3.1 of the Standards for Health Services:- Organisations and services work in partnership with others to protect and improve the health and wellbeing of citizens and reduce health inequalities. 2. Introduction 2.1 Passive smoking (breathing other people s tobacco smoke) has been medically proven to cause lung cancer and heart disease in non smokers, as well as many other illnesses and minor conditions. 2.2 Smoking is the UK s leading cause of preventable death and the provision of a smoke free environment provides a clear and effective message about the importance the Health Board places on this issue.
2.3 The Health Board has a duty to protect and minimise risk for staff, patients and visitors who attend Aneurin Bevan Health Board premises from the harmful effects of exposure to secondhand smoke under the Smoke-Free Premises etc (Wales) Regulations 2007. 2.4 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. 2.5 This smoke free environment policy guarantees the right of everyone to breathe smoke free air on all Aneurin Bevan Health Board sites. 2.6 The policy recognises that the Health Board has a responsibility to promote public health to all its employees, patients and visitors. 2.7 It is recognised that implementation of this policy may encourage some people to stop smoking and therefore consideration has been given to providing support for employees and patients to stop smoking through Stop Smoking Wales. 3. Smoking restrictions within the Health Board 3.1 This smoke free environment policy seeks to guarantee non-smokers the right to work in air free of tobacco smoke. 3.2 The Health Board is not primarily concerned with whether anyone smokes, but where they smoke and the affect this has on all individuals. 3.3 There is a complete smoking ban within all Aneurin Bevan Health Board sites. 3.4 Smoking is not permitted in all areas up to the boundaries, and including car parks and vehicles parked on Health Board property, outdoor seating areas, walkways and all other areas. Any person wishing to smoke must first leave the grounds. 3.5 The smoking restrictions will also include all Health Board owned or leased vehicles. All vehicles used for transporting patients are included in this policy. It is a legal requirement for all Health Board vehicles to be smoke free. 3.6 There will not be any smoking rooms or outdoor shelters for smoking. 3.7 Aneurin Bevan Health Board will ensure that the sale or promotion of tobacco products in not allowed on its premises.
4. Responsibilities 4.1 Chief Executive The Chief Executive is responsible for ensuring that this policy is fully supported by all staff and that there are sufficient resources available to enable its full implementation. 4.2 Managers 4.3 Staff All managers are responsible for ensuring that staff who report to them comply with this policy. All managers are responsible for supporting staff who bring this policy to the attention of those in breach of it. All managers are responsible for supporting any employee who wishes to quit smoking by providing reasonable time off during working hours to attend a smoking cessation course. Managers must agree any time off to attend such courses in advance and attendance will be subject to the needs of the service. Managers are responsible for monitoring this policy in their department. Staff have a duty to fully comply with this policy. Staff wishing to smoke must do so off Health Board property and only during their official break times. Additional smoking breaks may not be taken. (Managers are responsible for ensuring equitable access to breaks) Staff are encouraged to inform anyone who is seen smoking in any Health Board premises or grounds that the Health Board has a smoke free policy. However, staff should not engage in confrontation with anyone who refuses to comply with the policy. Each member of staff has a responsibility to be available for work and to not be away from work on unauthorised breaks. In areas or circumstances where patients are allowed to smoke on Health Board premises (eg: where a patient is detained under the Mental Health Act or where that area is considered their place of residence), staff nor visitors are not permitted to smoke.
5. Staff working in patients homes 5.1 It is important that staff are protected from the health risks associated with breathing second-hand smoke in all settings that they work in. 5.2 Aneurin Bevan Health Board recognise that it is an individual service users right to smoke in their own home but this could create an environment in which staff are potentially at risk from the harmful effects of second-hand smoke. 5.2 In order to protect staff who provide services for clients in their own homes, clients will be requested to refrain from smoking during the visit and ideally not to smoke for an hour before the visit is scheduled to take place. Information about this aspect of the policy will be made available to all clients before a home visit is organised. 5.3 If the client and/or other occupants do not respect this staff should inform their line manager. Line managers should contact the service user and provide further information, encourage co-operation and advise that although their right to smoke in their own home is respected, their refusal to help minimise the risk of passive smoking to NHS staff members may affect where they receive their appointment. If service user and/or member of the household still refuse to refrain from smoking, the line manager will (in conjunction with their senior manager) consider arranging an alternative venue for the appointment where reasonably practical. 5.4 Staff will be responsible for informing their line manager should a client continue to smoke during their visits. 5.5 In some instances service provision involves staff spending prolonged periods in patients homes. In these instances whether staff will be exposed to second-hand smoke will be included and considered as part of the individual patients risk assessment process and steps taken to minimise the risks of staff exposure, as far as is reasonably practicable. 5.6 The Royal College of Nursing guidelines Protecting community staff from exposure to second-hand smoke will be used to further develop, (in conjunction with community managers), tailored guidance for staff and managers on how to manage this and reduce risk of exposure to second-hand smoke for staff. 5.5 Staff on duty are not allowed to smoke in patients /service users homes.
6. Patients 6.1 Patients wishing to smoke must first exit the site: this will be at the patients own risk. 6.2 There is no provision for on site smoking for any individual patient. 6.3 Patients will be informed of the policy using all opportunities within the patient pathway: this will include pre admittance information, leaflets, posters and signage. 6.4 Patients who smoke on any Health Board site will be asked either to stop or exit the site. 6.5 Coping mechanisms for nicotine withdrawal for in-patients will be made available via the senior nurse on the ward. 6.6 Coming into hospital presents many patients with an ideal opportunity to stop smoking. Aneurin Bevan Health Board will provide practicable help, support and advice to those who wish to take advantage of this opportunity. 6.7 On admission to the Health Board, the smoking status of all patients will be sought and documented in patient notes in line with NICE guidelines Patients should expect staff to: - Ask them (patients) if they smoke - Advise them on the health effects and benefits of stopping - Act - offer and consider prescribing patients nicotine replacement therapy to help patient cope with nicotine withdrawal - refer patients who smoke and want to stop to Stop Smoking Wales for support to quit. 6.8 Support for patients who wish to stop smoking is available via referral to Stop Smoking Wales on 0800 085 2219. 6.9 Patients will be informed that if they leave the site they do so at their own risk. 6.9 Staff will not assist patients to exit the site to smoke. 6.10 Patients who are risk assessed as not being able to go outside the hospital to smoke, but do so, must be informed that they do so at their own risk.
7. Distressed relatives and friends 7.1 Distressed relatives and friends will be sympathised with and gently informed that the arrangements for smoking on all Health Board sites applies to all, and that if they wish to smoke, they must leave the site. 8. Mental Health Units which provide residential accommodation 8.1 The Smoke-Free Premises etc. (Wales) Regulations 2007 prohibit smoking in enclosed or substantially enclosed public places, including workplaces. There is an exemption for mental health units (as defined in section 1(2) of the Mental Health Act 1983) which provide residential accommodation 8.2 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. 8.3 The designated smoking room must be approved by the person in charge of the mental health unit and the Health Board Fire Officer. Any designated smoking room must be clearly marked as such, designated in writing and made available for inspection by an enforcement officer at any time. 8.4 Nevertheless, a balance is needed between allowing people to smoke in their own residential spaces and protecting others from exposure to second-hand smoke, including the other people who call the premises home and the people who work there. 8.5 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 inpatients of the mental health unit. 8.6 It is against the law for anyone to smoke in enclosed parts of mental health establishments that do not provide residential accommodation (for example, day units). 9 Help for those who smoke 9.1 This policy recognises that nicotine is an addictive drug and that most smokers would like to give up. Therefore, to help smokers adjust to the requirements of this policy, help and support to stop smoking is available through Stop Smoking Wales or through their GP. 9.2 Smoking cessation courses are available through Stop Smoking Wales. Stop Smoking Wales is a free NHS service available to staff
who smoke and wish to stop smoking. The service offers a seven week course (an assessment session followed by six weekly sessions), and will be advertised to all Health Board staff as widely as possible. Staff can access Stop Smoking Wales directly by contacting 0800 085 2219 to make an appointment. There is no cost to the individual or the Health Board for these stop smoking sessions. 9.3 Although reasonable time off during working hours to attend Stop Smoking Wales courses will be allowed, staff wishing to access this service should were possible book themselves on courses that are outside of their normal working hours (i.e. evening courses). Any time off to attend such courses must be agreed in advance with their line manager and will be subject to the needs of the service. It is recommended that if the initial attempt to stop smoking through these smoking cessation courses does not work, then there should be a six month gap before another course is accessed. 9.4 For in-patients who smoke and are unable to leave the site, on admission to the Health Board, the smoking status of all patients will be sought and documented in patient notes in line with NICE treatment guidelines. Patients should expect staff to: - Ask them (patients) if they smoke - Advise them on the health effects and benefits of stopping - Act - offer and consider prescribing patients nicotine replacement therapy to help patient cope with nicotine withdrawal - refer patients who smoke and want to stop to Stop Smoking Wales for support to quit. 9.5 Visitors who smoke can access smoking cessation support by either contacting their own GP or self referring to Stop Smoking Wales. 10. Enforcement of the policy 10.1 Staff who find compliance with this policy difficult and who are in breach of the policy will initially be dealt with though persuasion and encouragement. It is important that support is offered to staff to comply with the policy. 10.2 Staff who repeatedly or deliberately breach this policy will be subject to the normal disciplinary process within the Health Board. Patients and visitors who smoke on Health Board premises may be politely informed by staff of the Health Board s policy and informed that:
The Health Board operates a completely smoke free policy that means that there is a complete ban on smoking within all its buildings and grounds. If you wish to continue smoking you must first exit the grounds. If the patient/visitor or contractor insists on smoking, then a senior manager should be informed. Under no circumstances should staff engage in confrontation with smokers in these circumstances. 10.3 In the unlikely event that patients or visitors become aggressive or abusive the Health Board s Violence and Aggression policy will be invoked. 10.4 Patients who refuse to provide a smoke free environment for staff working in their homes, will be sent a letter explaining the Smoke Free Environment Policy, and may have future appointments scheduled to take place on Health Board sites. 11. Communicating the policy 11.1 Job advertisements, job frameworks and interviews will include reference to this policy. 11.2 Reference to the Smoke Free Environment Policy will be included in the Corporate Induction Course. 11.3 Smoke free signs will be displayed at all entrances to Health Board premises and all buildings will be clearly signed to indicate that the area is smoke free. 11.4 Information regarding Stop Smoking Wales will be displayed within hospitals and in all out patient and associated waiting areas. 11.5 Patients will be informed of the policy using all opportunities within the patient pathway: this will include pre admittance information, leaflets, posters and signage. 11.6 Reference to the Smoke Free Environment Policy will be included on the Aneurin Bevan Health Board website visiting times webpage and in the Visitor Information leaflet.
12. Training 12.1 Staff Guidance Leaflet, including Question and Answer guidance, is available to provide advice on implementation of the policy. 12.2 Stop Smoking Wales will offer and provide training for Health Board staff to raise the issue of smoking and refer patients interested in stopping onwards to Stop Smoking Wales. Contact Details for Further Information Stop Smoking Wales Tel: 0800 085 2219 Web: www.stopsmokingwales.com Smokers Helpline for Wales Tel: 0800 169 0169