MANAGERS GUIDANCE - Alcohol Or Drug Related Misuse Section 11.04 MANAGEMENT GUIDANCE ALCOHOL OR DRUG RELATED MISUSE This guidance details the Trust s aims to raise awareness of the risks of alcohol or drugs misuse and promote sensible and appropriate behaviour, actively encourage and support employees with problems that impair their work performance to seek help and facilitate a consistent and caring approach by managers to assist employees who have alcohol or drugs related problems AGREED BY: HR CORE GROUP IMPLEMENTATION DATE: NOVEMBER 2014 ASSOCIATED TRUST POLICIES AND PROCEDURES: Conduct Capability Sickness Absence Management
NOTTINGHAMSHIRE HEALTHCARE NHS TRUST MANAGERS GUIDANCE - ALCOHOL OR DRUG RELATED MISUSE CONTENTS 1.0 Introduction 2.0 Alcohol, Drugs and the Workplace 3.0 Employees should 4.0 Managers should 5.0 Disciplinary Rules Appendix 1 Procedure in Relation to Employees Suffering from Alcohol or Drug Related Misuse Appendix 2 - Sources of information & Advice Appendix 3 - Drugs Some Facts 1
NOTTINGHAMSHIRE HEALTHCARE NHS TRUST STAFF ALCOHOL AND DRUGS POLICY 1.0 INTRODUCTION 1.1 The guidance is applicable to all employees of Nottinghamshire Healthcare NHS Trust (the Trust),of all disciplines and at every level. The aims of the guidance are to: 1.3.1 raise awareness of the risks of alcohol or drugs misuse and promote sensible and appropriate behaviour; 1.3.2 actively encourage and support employees with problems that impair their work performance to seek help through their line management and/or Occupational Health Department or an outside agency, ensuring confidentiality and support to employees who are receiving treatment; 1.3.3 facilitate a consistent and caring approach by managers to assist employees who have alcohol or drugs related problems; 1.3.4 as a last resort, to take disciplinary action against employees whose conduct is not acceptable as a consequence of substance misuse. Those cases will be investigated and action taken where necessary under the Trust s Disciplinary Procedure (Conduct Policy and Procedure 11.02); 1.3.5 clarify the responsibilities of employees and management where it appears that drug or alcohol problems are causing work related problems. 2.0 ALCOHOL, DRUGS AND THE WORKPLACE Drinking or Drugs & Work 2.1 Employees are reminded that a statutory duty is placed upon them regarding safe systems of work. Consumption of alcohol and abuse/misuse of prescribed and non-prescribed drugs at the workplace is prohibited. At festive occasions and celebrations alcohol-free beverages only will be available. 2.2 All employees will be expected to exercise responsibility for their own behaviour. Those whose work involves driving, handling machinery, undertaking complex medical/technical procedures and direct contact with patients or the public should exercise particular care. Indeed, the attention of all employees is drawn to their own responsibilities towards themselves and to their colleagues and patients under Section 7 of the Health & Safety at Work Act 1974. This makes it the legal duty of every employee while at work to take reasonable care for the health and safety of themselves and of other persons who may be affected by their acts or omissions at work. The Trust views driving under the influence of alcohol very seriously and staff are reminded of the very strict legal limits on alcohol when driving. Members of staff who will have to drive to perform their duties (including travel to and from work) must not drive a vehicle if under the influence of alcohol. 2.3 Staff must not come to work under the influence of alcohol or drugs, nor will staff consume alcohol or illicit drugs whilst on duty or bring them to the workplace. It is a disciplinary offence to do so and may result in dismissal. Anyone who possesses, supplies or produces controlled drugs other than are set out in our addition to Section 2.2 above, commits a criminal offence 2
and that anyone who is involved in such activities on Trust premises or whilst working for the Trust will normally be summarily dismissed for gross misconduct. In addition, the Trust will report any such activity (including reasonable suspicion thereof) immediately to the police. 2.4 If controlled drugs (other than those properly required for clinical purposes) are found on Trust premises, management must be alerted immediately so that the drugs can be handed over to the police and appropriate investigations started. 2.5 For prescribed and over the counter medication, staff must check in advance whether such drugs are expected to produce any side-effects. If there are health and safety concerns or concerns related to work performance, then the employee is required to inform their manager who may refer the matter on. It may be appropriate to vary an individual s duties and the Occupational Health Department will discuss the matter with the employee and their manager. 2.6 The Trust accepts responsibility to offer support and guidance to any employee who has, or is suspected of having, an alcohol or drugs related problem whether or not performance or behaviour at work is affected. 2.7 Strict confidentiality will be maintained as with any other health matter, with disclosure limited to those on a need to know basis (HR/Occupational Health/line manager). 2.8 If the support and advice offered is accepted and time off work, such absence will be considered as sick leave during which normal entitlement to sickness benefits will be applicable. Following satisfactory completion of treatment every effort will be made to return the employee to the same job. However, each case will have to be considered on its merits to protect the statutory responsibilities of the Trust and to ensure that professional standards and the needs of patients are accorded the highest priority. Should an employee refuse help, drop out of a treatment programme, or suffer any recurrence of impaired performance or behaviour this will require further consideration and/or action with each case treated on its own merits. Note: Cases of professional misconduct amongst medical and dental staff involving alcohol or drugs related problems may be dealt with under the provisions of HC(90)9. 3.0 EMPLOYEES SHOULD a) seek help if they are worried about their own drinking or drug use. The Trust recognise that certain employees will have access to prescription drugs; b) encourage colleagues to seek help if they have a problem with their drinking or drugs habits; c) avoid covering up or colluding with colleagues whose behaviour/performance is affected by alcohol/drugs. Staff have an obligation to report concerns to a manager, HR Department or Occupational Health Department. The Trust should try to keep confidential the identity of the person giving the information. 3.1 Advice and help is available from a number of sources, initially from your line manager, Occupational Health Department, Human Resources Department, see external sources at appendix 2. 4.0 MANAGERS SHOULD a) be alert to changes in behaviour, performance, and attendance; b) adopt a non-judgemental approach; c) provide information and encourage employees to seek further advice from specialist services available 3
5.0 DISCIPLINARY RULES 5.1 Prior to any consideration of disciplinary action, an investigation of the circumstances will take place. Due consideration will be given to whether the employee has sought treatment or help. In the event of an employee withdrawing from an agreed programme of treatment, the need for any abated disciplinary action will be considered. 5.2 Whilst the Trust is concerned to prevent the need for disciplinary action to be taken in relation to the misuse of alcohol or drugs, all employees must be aware of the serious view the Trust takes of the misuse of alcohol or drugs and recognize that the possession of illicit drugs whilst on duty will be regarded as a case for the Disciplinary Procedure. Disciplinary action which may include summary dismissal, will be taken against anyone breaking these rules and it may be necessary to involve the Police in such circumstances. 4
APPENDIX 1 PROCEDURE FOR DEALING WITH EMPLOYEES AND COLLEAGUES SUFFERING FROM ALCOHOL OR DRUG RELATED MISUSE AT ALL TIMES CONFIDENTIALITY MUST BE MAINTAINED The Trust wishes to give employees who, at any time, and for any reason, may be suffering from alcohol or drug misuse, the opportunity to obtain specialist help, should an employee be found to have such a problem, then we are committed to offering every assistance in accordance with the principles of this policy. The procedural arrangements are below. 1 When an employee believes that they have an alcohol or drug problem, then that person should seek specialist help as soon as possible. The Occupational Health Department is available to initiate such help if required and the earlier this is done the greater will be the possibility of recovery, and the economic loss to the employee and the Trust will be kept to a minimum. 2 Immediately a supervisor/manager or colleague suspects that an employee has an alcohol or drug problem, they must draw this to the attention of the line manager concerned. The manager will then arrange to interview the employee and should advise them it is their right to be accompanied by their staff representative if desired. The interview will be confined to principally cover aspects of work performance and behavior. 3 The manager should, however, enquire of the employee whether they have a health problem, which might be a contributory factor to the work problem. Any reported concerns about the use of alcohol or drugs should be raised in a sensitive manner, if the employee concerned does not raise this first. Managers should not pass any opinion or judgement on alcohol or drug misuse. The aim should be to encourage the employee to admit to their problem and, if it exists, to seek help for the problem. However, managers should be aware of their legal obligations with respect to the possible use of illegal substances and report it immediately to the police. 4 In the event of the employee denying that there is any alcohol or drug problem, the manager should, nevertheless, offer the opportunity of referral to the Occupational Health Department. Alternatively, the employee may wish to propose some alternative therapeutic agency, and if this is acceptable should be arranged after consultation with the Occupational Health Physician. If the employee rejects the offer, the manager should counsel the employee about their work performance. Should poor work performance and behaviour recur, the employee must again be interviewed, with appropriate representation if desired, and again be offered as above. If the employee indicated that they have no health problem appropriate action should be taken within the framework of the disciplinary procedure. 5 Where the Occupational Health Department confirms that the employee has an alcohol or drug problem, the employee shall be referred by the Occupational Health Department to a General Practitioner, or to other agencies providing help with alcohol or drug problems. The recovery programme may be received either whilst the employee remains at work, or is absent on sick leave, duly certified. 6 When the employee accepts the programme offered, then they will return to normal work if considered fit by the Occupational Health Department. Should a return to their post carry with it a risk of recurrence of the drug or alcohol misuse, or a risk of jeopardising the welfare and safety of patients or employees a suitable alternative should be provided if available. If a suitable post is not available, then the employee will be placed or remain on sick leave. 7 When the employee does not accept the recovery programme offered, the Occupational Health Department would refer them back to the manager. The manager will then assess when the employee should return to work following liaison with and advice from Occupational Health. 5
If an employee returns to work and work problems recur, the manager will take appropriate action within the framework of the Disciplinary Procedure. 8 When the Occupational Health Department advises that the employee has no health problem, the manager must assess the position, and if necessary have resource to the Disciplinary Procedure. Note: The medical aspects of the above procedure are the responsibility of the Occupational Health Department acting in association with managers. Managers should note, however, that guidance on the operation of this procedure must be obtained from a senior member of the HR Department. 9.0 MONITORING PERFORMANCE 9.1 If, after a reasonable period of time, the assistance provided has not resulted in a satisfactory improvement, the Trust s Managing Sickness Absence Policy will be utilized to manage the case FOOTNOTE TO APPENDIX 1 No one characteristic identifies someone with an established alcohol or drug related problem but the following may indicate such a problem especially if they combine or occur over a period of time. Absenteeism Accidents and unusual incidents Fluctuating work performance Returning to work after breaches Unpredictable mood changes Poor relationship with colleagues Unkempt appearance Frequent borrowing of money Hand tremor Smelling of alcohol/illicit Substances It is important to note that other conditions/ impairments unrelated to alcohol or drugs can underlie any of the above characteristics. As most people spend a high proportion of their time in the work situation it is likely that colleagues will notice early signs of these changes. 6
PROCEDURE IN RELATION TO EMPLOYEES SUFFERING FROM ALCOHOL OR DRUG MISUSE The following stages in procedure are suggested regarding employees who come to notice as possibly suffering from alcohol or drug misuse, either from observation of behaviour or as a result of a deteriorating pattern of work performance. First interview between employee and line manager. Employee has the right to union representative. Focus restricted to work performance and behaviour. Opinions/judgements on alcohol or drug misuse avoided. If appropriate, employee offered referral to Occupational Health Service or alternative acceptable agency. Employee rejects referral Work performance problems continue to recur Work performance problems do not recur If appropriate, employee again offered referral Employee accepts referral Employee still rejects referral Alcohol or drug misuse problem diagnosed Other health or social problems diagnosed Alcohol or drug misuse not confirmed Employee referred via GP to appropriate specialist agency Employee co-operates and work performance returns to acceptable level Employee does not co-operate and work performance problems continue Problems resolved Employee referred back to line manager Appropriate disciplinary action taken No further action required 7
1. OCCUPATIONAL HEALTH MANAGERS GUIDANCE - Alcohol Or Drug Related Misuse Section 11.04 SOURCES OF INFORMATION AND ADVICE APPENDIX 2 Employees with an alcohol or drugs problem, affecting their health, work or domestic circumstances, may seek help from Occupational Health. Referral may be on a self-help basis, or from colleagues or management concerned about their work performance, or frequent spells of absence. Whatever the reason, Occupational Health offers a confidential support service for staff by Medical and Nursing personnel. Referral when necessary to other agencies, such as the Addiction Unit, Support Groups, Social Services Department, can be arranged, if appropriate. Liaison is maintained with General Practitioners and management, on the individual s behalf, with their permission. 2. Recovery in Nottingham This specialist team has its outpatient clinic at The Recovery Centre, 12 Broad Street, Hockley, Nottingham, NG1 3ALand offers a service to people experiencing difficulties with drug misuse. Referrals are accepted in strictest confidence from individuals or Nottinghamshire Healthcare NHS Trust, and most usually from the General Practitioner. Recovery in Nottingham is at The Recovery Centre, 12 Broad Street, Hockley, Nottingham, NG1 3AL and the telephone number is (0115) 854 2266. Referrals should be made in the first instance to the Consultant Psychiatrist, Recovery in Nottingham. This multi-disciplinary team offers input from social workers, medical and specialist nurse practitioners in the assessment, treatment and follow-up of substance misuse problems. 3. Last Orders Tel: 0115 970 9590 4. This service is now offered by Lifeline Journey Tel: 0115 948 4314, Head to Head Tel: 0115 8440501. 5. THE HEALTH SHOP, 12 BROAD STREET, HOCKLEY, NOTTINGHAM NG1 3AL (Telephone 0115 905 5001) healthshop@nottshc.nhs.uk The Health Shop offers a confidential service specifically relating to drugs and sexual health. This includes testing for blood borne viruses such as Hepatitis C and HIV. Staff will provide onward referrals where necessary. 6. a) ALCOHOLICS ANONYMOUS A self-help group for those who share in common, and acknowledge, the problem of alcoholism. There are meetings on every evening of the week except Sunday, when the meeting is in the afternoon. Meetings are at different venues, to suit various groups. AA telephone number (0115) 941 7100 is manned every evening (7.00pm 10.00pm) by AA members, for anyone needing to talk. b) ADFAM A self-help support group for the relatives of alcoholics who frequently find they have the need for sharing problems, and developing strengths to cope with the drinker in their family. Contact can be made via the same number as AA (0115) 941 7100. 7. Alcohol Concern (020 7264 0510) National Drugs Helpline (0800 77 66 00) Drinkline (0800 917 8282) Narcotics Anonymous (0300 999 1212) British Association for Counselling and Psychotherapy (www.counselling.co.uk) Frank 0300 123 6600 and the SMART Recovery web site. 8
DRUGS SOME FACTS APPENDIX 3 Some signs of habitual use or dependence on drugs may include a sudden change in behaviour patterns. Cannabis Signs of recent use include the characteristic red eye, impaired concentration and occasional irritability. Frequent use is likely to lead to altered perceptions of attitude to the individual s life. Hallucinogenic stimulants such as MDMA, or Ecstasy MDMA is very popular on the club scene and the larger music venues. Dehydration, increased irritability and depression are likely with frequent use. Stimulants This group includes amphetamine sulphate and its derivatives, as well as cocaine and crack cocaine. Prolonged use significantly increases irritability, greatly increases sensitivity and produces a higher risk of aggressive behaviour. Opiates Narcotic analgesics which when taken in excess will tend to induce a growing lethargy, insomnia, impaired concentration and greatly reduced work performance. The health risks to the individual are multiplied (as with any drug) when administered by injection. Frequent users of street heroin, morphine and codeine, cocaine or crack cocaine on a regular basis, are likely to experience extreme financial difficulties which may be a contributing factor to the impaired work performance. Where an individual, or a colleague of an individual, suspects there may be a problem with one or some of these drugs, advice should be sought at an early stage either from a professional or one of the other agencies listed in Appendix 1. 9