SOUTH WEST LONDON & ST GEORGE S MENTAL HEATH NHS TRUST SMOKE FREE POLICY The primary function of the National Health Service is to improve health, cure the sick and alleviate suffering in the population. The almost inevitable consequence of smoking is to damage health and even cause early death. Document Information This policy deals with the ban on smoking within Trust buildings and vehicles as of July 2008. Smoking is not permitted inside the building or in Trust vehicles. This will ensure that, staff, patients and visitors are protected from exposure to second hand smoke while on South West London and St. George s Mental Health Trust property. Date: 27 th January 2014 Current Version: v1.2 First published: 4 th February 2009 Author: Rex Cassidy and Tony Johnson Owner: Commissioned by: Rex Cassidy Rex Cassidy Review date: January 2016 Number of pages: 14 pages Target Audience: All Staff, Services Users, Visitors, Contractors Equalities Compliant: HRA Compliant: Approved by: Fire Safety Manager Date: January 2014 Ratified by: Health and Safety Committee Date: 24 February 2014 Trust Smoke Free Policy 1
Amendment Number Date Detail Page Number(s) Paragraph Number(s) 1 January 2014 Policy Review and update All All 2 January 2014 Section 5. Arson and control of smoking materials added to Policy 7 5.1 5.5 3 January 2014 Section 6. Use of Electronic Cigarettes added to Policy 7 and 8 6.1 6.7 4 January 2014 Appendix 3: Equality Impact Assessment Tool added to Policy 11 Table added 5 January 2014 Appendix 4: Checklist for the Review and Approval of Procedural Document added to Policy 12-14 Table added Trust Smoke Free Policy 2
CONTENTS 1. Background 2. Workplace Smoke-Free Policy 3. Communication and Employment Contracts 4. Responsibilities 5. Arson and the Control of Smoking Materials 6. Use of Electronic Cigarettes within the Trust 7. Dealing with n-compliance Appendix 1: Help for Staff and Patients who wish to Stop Smoking Appendix 2: Guidance for staff when dealing with a person smoking in a nonsmoking area Visitors, Relatives and Contractors Service Users Appendix 3: Equality Impact Assessment Tool Appendix 4: Checklist for the Review and Approval of Procedural Document Trust Smoke Free Policy 3
1. Background 1.1 In the Public Health White Paper Choosing Health: making Choices easier, (vember 2004) the Government announced that the NHS would be required to go smoke-free by 2006. 1.2 On 9th March 2005, Smoking Day, the Chief Executives of the five London Strategic Health Authorities agreed that all NHS premises in London would be smoke-free by the end of 2005. 1.3 The Health Bill 2006 makes it an offence to smoke or knowingly permit smoking within an enclosed workplace or public place. 1.4 Passive smoking (breathing in another person s smoke) is a proven cause of lung cancer and coronary heart disease in non-smokers, as well as many other illnesses and conditions. Tobacco smoke has also been proven to cause asthma attacks and migraine attacks. 1.5 It has been established that smoke-free workplace policies assist and encourage smokers who wish to quit smoking. 1.6 An employer who receives a complaint about the effects of smoking, but ignores it, could be sued for any resultant damage to health. As part of the Management of Health Safety at Work (Amendment) Regulations 1994 employers may find themselves liable for damage to an unborn child if a pregnant employee has been exposed to passive smoking while at work. 1.7 Smoking on NHS property is a fire hazard. 1.8 Smoking on NHS property has cost implications for cleaning and maintenance. 1.9 All patients are entitled to receive treatment in a hospital which is not polluted with tobacco smoke. 1.10 All workers have the right to a smoke-free workplace. 1.11 South West London and St. George s Mental Health Trust has a responsibility to provide a safe and healthy environment for staff, patients, visitors and contractors. 2. Workplace Smoke-Free Policy 2.1 South West London and St. George s Mental Health Trust policy states that smoking is not permitted on the Trust property, including buildings, grounds and vehicles. Staff, visitors and contract workers are not permitted to smoke on or in Trust property, including buildings, vehicles and grounds. Patients are not permitted to smoke on or in Trust buildings or vehicles. The policy applies to all persons present on Trust premises, travelling in Trust owned vehicles and identifiable as employees of South West London and St. George s Mental Health Trust. Trust Smoke Free Policy 4
2.2 South West London and St. George s Mental Health Trust staff wearing uniform or NHS badges are not permitted to smoke within view of the public or patients. Staff in uniform wishing to smoke must cover their uniform and or remove their name badge. The NHS, as a provider of healthcare, must not be seen to advocate smoking. 2.3 Staff will not be permitted to smoke in Trust owned vehicles or while on or carrying out Trust business. 2.4 additional smoking breaks will be given to staff that smoke. Smoking must only take place during lunch and official breaks off of Trust sites and out of uniform. 2.5 Designated smoking areas will be provided for patients, where appropriate, in areas outside of the Trust s buildings (courtyards and secure gardens). 2.6 In order to protect Trust staff from exposure to second-hand smoke, patients should refrain from smoking when receiving care at home. Patients have a responsibility to provide a smoke-free environment to staff. Staff will be fully supported by the Trust if patients refuse to refrain from smoking during a home visit and are entitled to refuse to enter a home that is not smoke-free. 2.7 Patients who refuse to refrain from smoking during home visits may be required to attend the hospital to receive treatment. 2.8 The sale of cigarettes and tobacco products is not permitted on Trust premises, including grounds. Staff may not provide tobacco products to patients (accept for approved purchases, managers discretion or service commitments). 2.9 The use of tobacco as an incentive, reward or punishment is not permitted. 2.10 South West London and St. George s Mental Health Trust will support staff, patients, visitors and contractors who require help to stop smoking. Staff and patients wishing to quit smoking will be given access to Nicotine Replacement Therapy and access to specialist support through the local Stop Smoking Service (See Appendix 1). 2.11 Bins for the disposal of cigarettes will be provided at the entrances to the grounds, so that cigarettes can be disposed of safely and reduce littering on Trust sites. 2.12 South West London and St. George s Mental Health Trust will not enter into any agreement with any organisation that promotes smoking under any circumstances. 3. Communication and Employment Contracts 3.1 smoking signage will be prominently displayed throughout Trust premises and grounds. Contact details for the Stop Smoking Services must be included in or near the signage. The policy will be available on the Trust website and on notice boards throughout the Trust. Trust Smoke Free Policy 5
3.2 Recruitment advertisements will mention the Trust s smoke-free policy. Job descriptions will contain the following clause: South West London and St. George s Mental Health Trust is a smokefree Trust. Smoking is not permitted on the Trusts premises, grounds or in any Trust vehicle. Staff are not permitted to smoke in uniforms or in view of the public or patients. Staff making home visits will be protected from exposure to secondhand smoke. Taking smoking breaks outside of official breaks is not permitted. 3.3 Details of the policy and support are available for smokers should be routinely covered in an employee s induction. Information about the Trusts smoke-free status will be available in patient and staff handbooks, included in all recruitment literature and job offers and in departmental safety policies. 3.4 Patients will be informed of the smoke-free status of the Trust and given access to Stop Smoking support. Patients will be asked to refrain from smoking during home visits. 3.5 All Trust correspondence with patients, e.g. letters and appointment cards, and all Trust literature, e.g. leaflets and general publications, will contain the following statement: South West London and St. George s Mental Health Trust operate a no-smoking policy. 3.7 Service Level Agreements with other organisations must contain the following clause: South West London and St. George s Mental Health Trust is a smokefree Trust. Smoking is not permitted on Trust premises. All employees, patients and contractors must fully comply with this policy. 4. Responsibilities 4.1 The South West London and St. George s Mental Health Trust s Chief Executive is responsible for ensuring that the policy is fully supported by all staff and that there are sufficient resources available to ensure its full implementation. 4.2 All Trust staff have a duty to comply fully with the policy. 4.3 All Trust line managers are responsible for ensuring that staff who report to them comply fully with the policy. 4.4 All Trust line managers are responsible for fully supporting members of staff who wish to quit smoking. 4.5 Employees who smoke and do not wish to stop smoking will not be required to do so. However, they must not smoke in or on any of the Trust s premises, vehicles or grounds. NHS staff will be expected to set a good example by not smoking in view of patients, clients or the public when wearing uniform or name badge which identifies them as a member of staff. Trust Smoke Free Policy 6
4.6 All staff are encouraged to inform patients, clients, visitors and other Trust staff, if they are seen smoking in or on any of the Trust s premises, that the Trust has a smoke-free policy and that smoking is not permitted on Trust premises. However, staff should not put themselves at risk of abuse by doing this. 5. Arson and the Control of Smoking Materials 5.1 All in-patient areas have access to open air smoking facilities. However, approximately 9% of the total numbers of fire alarm activations within the Trust were caused because service users were smoking in non-approved areas. 5.2 There have been a number of fires within the Trust where the primary cause of ignition was arson. In each case the service user had a lighter or matches in their possession. 5.3 Wall mounted electronic cigarette lighters (ciglow unit) have been installed in all ward courtyards within the Trust. Lighters and matches have been added to the list of contraband items within the Trust searching policy, as the Trust has provided an alternative means for lighting cigarettes in patient smoking areas. 5.4 A number of actions have been taken in order to try and reduce these types of incident, which include reminding ward staff of their responsibilities and the importance of ensuring that the searching and smoking policies are enforced. These actions have been combined with cessation programmes, which have been offered to both our Service Users and Staff. 5.5 These measures have been taken in order to ensure that no persons are smoking within non-approved areas of the Trust and help reduce the risk of bedroom fires and arson related incidents within South West London and St. George s Mental Health Trust. 6. Use of Electronic Cigarettes within the Trust 6.1 Electronic cigarettes ("e-cigarettes") are battery-powered products that release a visible vapour that contains liquid nicotine that is inhaled by the user. 6.2 Currently e-cigarettes fall outside the scope of the smoke-free legislation; however the British Medical Association (BMA) believes that existing smoke-free legislation should be extended to e-cigarettes. 6.3 While admitting that electronic cigarettes may help some smokers to give up, the BMA points to the lack of evidence on the health risks that they pose to the individual using them and those in close proximity. 6.4 Exposure to nicotine from e-cigarettes (either directly through their use by an individual or indirectly from the vapours they produce) may adversely impact on patients, such as those with heart or circulatory conditions Trust Smoke Free Policy 7
6.5 Use of electronic cigarettes in Inpatients areas: The Trust has already taken an interim decision to include Electronic Cigarettes as part of the Trusts banned Contraband policy. The risks regarding the use of Electronic Cigarettes are that they are; t regulated they can be bought over the counter t tamper proof Potential source of ignition similar to a lighter Therefore Electronic Cigarettes cannot be used in in-patient services as they are deemed unsafe, and need to be considered as Contraband. 6.6 Use of electronic cigarettes by Staff: Some e-cigarettes can, particularly from a distance, look like real cigarettes, making a smoking ban difficult to implement, and creating an impression for visitors, customers or other employees that it is acceptable to smoke. As a smoke-free organisation, this is something that the Trust would want to avoid. The use of electronic cigarettes by staff may also become a source of conflict between staff and patients. Therefore the use of electronic cigarettes is not allowed within the Trust and the Smoking Policy will be amended to reflect this. 6.7 It is important that we continue to encourage our service users and our staff to stop smoking and that we support them with help from our Trust smoking cessation workers who will assist with any advice required. 7. Dealing with n-compliance 7.1 Breaches of the policy by Trust staff may lead to formal disciplinary action. An initial breach of the policy will be dealt with in an advisory way with help to quit smoking being offered. Subsequent breaches are to be dealt with under the Trust s formal disciplinary process. 7.2 Staff will be supported if they identify any breaches of this policy to their line manager. 7.3 Visitors who persistently refuse to refrain from smoking will be asked the leave the premises (See Appendix 2). Trust Smoke Free Policy 8
Appendix 1: Help for Staff and Patients who wish to Stop Smoking This policy recognises that passive smoking adversely affects the health of all employees. It is not concerned with whether anyone smokes, but where they smoke, and the effect that this has on non-smoking colleagues. However, it is recognised that the smoking policy will impact on smokers working lives. In an effort to help individuals adjust to this change, the following help is being provided: 1. Staff, patients and visitors are encouraged to call their local NHS Stop Smoking Service for advice on quitting smoking. Service Users should contact the following NHS Stop Smoking advisors: Wandsworth: 07736 167 350 Kingston & Richmond: 07595 400 904 Sutton & Merton: 07590 445 168 Staff and visitors should contact the following NHS Stop Smoking Service: Wandsworth: 0800 389 7921 Kingston & Richmond: 0800 085 2903 Sutton & Merton: 0800 652 8019 In the first instance individual members of staff should contact Robert Joseph on 07736 167 350 for support, as he may be able to provide details of a staff group that they can attend. If support is not available then staff can also contact: National Stop Smoking Helpline: 0800 169 0169 2. Trust staff may use the Stop Smoking Service during normal working hours with their line manager s agreement if this does not interfere with their own work or the work of others. Up to six hours leave may be taken. (One hours a week for six consecutive weeks). 3. A specialist advisor is available to support pregnant women, new mothers and their partners through any attempt to stop smoking. Support is offered in the home and at antenatal clinics. Trust Smoke Free Policy 9
Appendix 2: Guidance for staff when dealing with a person smoking in a non-smoking area 1. Visitors, Relatives and Contractors If a visitor, relative or contractor is found to be smoking in a non-smoking area, they are to be informed that it is against the law to smoke in trust buildings and asked to refrain from doing so. Contractors should be reported to Estate and Facilities Manager / Capital Planning so that the project Manager is informed. If you are aware of a designated smoking area on your site the person is to be informed that this is the only area they can smoke. Should the person become aggressive then the member of staff is to walk away or summon assistance by activating the panic alarm system (if available). Police should be called if the person becomes violent. 2. Service Users If you have a designated outside smoking area, (courtyard/garden), service users are to be informed that this is the only area they are permitted to smoke. If you do not have a designated smoking area the service user should be informed that they are not permitted to smoke and that Nicotine Replacement Therapy (NRT) can be provided for the time they are an inpatient. The service user should be referred to a member of the medical staff for NRT to be prescribed. Should the service user become aggressive then the member of staff should summons assistance by activating the panic alarm system and the aggressive incident managed in the usual way or according to that person s care plan. It should be noted that there are no exceptions to this policy in respect of service users, there are to be no designated area within buildings, (this will include 136 suites). The only areas that can be designated must be outside the building e.g. enclosed garden areas or courtyards. Trust Smoke Free Policy 10
Appendix 3: Equality Impact Assessment Tool To be completed and attached to any procedural document when submitted to the appropriate committee/group for consideration and approval. / Comments 1. Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality All no smoking signage printed in English. However symbols for no smoking are universal. Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 4. Is the impact of the policy/guidance likely to be negative? N/A Persons who smoke may be affected, however, policy gives clear information on support services 5. If so can the impact be avoided? N/A 6. What alternatives are there to achieving the policy/guidance without the impact? N/A 7. Can we reduce the impact by taking different action? If you have identified a potential discriminatory impact of this policy, please refer it to Fire Safety Advisor, together with any suggestions as to the action required to avoid/reduce this impact. For advice in respect of answering the above questions, please contact Fire Safety Advisor on 020 3513 6463. Trust Smoke Free Policy 11
Appendix 4: Checklist for the Review and Approval of Procedural Document To be completed and attached to any document which guides practice when submitted to the appropriate committee for consideration and approval. 1. Title Title of document being reviewed: // Unsure Comments 1.1 Is the title clear and unambiguous? 1.2 Is it clear whether the document is a guideline, policy, protocol or standard? 2. Rationale It is clear that this document is a Policy 2.1 Are reasons for development of the document stated? 3. Development Process 3.1 Is the method described in brief? 3.2 Are people involved in the development identified? Trust Fire Safety Advisor, minated Officer for Fire 3.3 Do you feel a reasonable attempt has been made to ensure relevant expertise has been used? 3.4 Is there evidence of consultation with stakeholders and users? Policy clearly outlines who is responsible for the control of smoking within Trust sites and what support is available. 4. Content 4.1 Is the objective of the document clear? All objectives are clear. The document is easy to read and follow 4.2 Is the target population clear and unambiguous? Policy clearly outlines who is responsible for the control of smoking within Trust sites and what support is available. 4.3 Are the intended outcomes described? Trust Smoke Free Policy 12
Title of document being reviewed: // Unsure Comments 4.4 Are the statements clear and unambiguous? 4.5 Are definitions included for terms requiring clarity? 4.5 Does the document meet the Trust template for procedural documents? 5. Evidence Base 5.1 Is the type of evidence to support the document identified explicitly? Document follows agreed Trust format 5.2 Are key references cited? 5.3 Are the references cited in full? 5.4 Are supporting (associated) documents referenced? Appendixes enclosed 6. Approval 6.1 Does the document identify which committee/group will approve it? 6.2 If appropriate have the joint Human Resources/staff side committee (or equivalent) approved the document? 7. Dissemination and Implementation N/A Ratified by the Health & Safety Committee 7.1 Is there an outline/plan to identify how this will be done? Published on Intranet for all staff to access 7.2 Does the plan include the necessary training/support to ensure compliance? 8. Document Control Policy content clearly outlines the support available for persons who smoke 8.1 Does the document identify where it will be held? Held by Trust Fire safety advisor 8.2 Have archiving arrangements for superseded documents been addressed? 9. Process to Monitor Compliance and Effectiveness 9.1 Are there measurable standards or KPIs to support the monitoring of compliance with and effectiveness of the document? 9.2 Is there a plan to review or audit compliance with the document? Document to be reviewed bi-annually Trust Smoke Free Policy 13
Title of document being reviewed: 10. Review Date // Unsure Comments 10.1 Is the review date identified? January 2016 10.2 Is the frequency of review identified? If so is it acceptable? Bi-Annually 11. Overall Responsibility for the Document 11.1 Is it clear who will be responsible for co-ordinating the dissemination, implementation and review of the document? Trust Fire safety Advisor Individual Approval If you are happy to approve this document, please sign and date it and forward to the chair of the committee/group where it will receive final approval. Name Tony Johnson Date January 2014 Signature A.R. Johnson Committee Approval If the committee is happy to approve this document, please sign and date it and forward copies to the person with responsibility for disseminating and implementing the document and the person who is responsible for maintaining the organisation s database of approved documents. Name Rex Cassidy Date February 2014 Signature R. Cassidy Trust Smoke Free Policy 14