No Smoking Policy Author: Responsible Lead Executive Director: Endorsing Body: Governance or Assurance Committee Implementation Date: 2014 Version Number: V6.0 Review Date: Catriona Milošević Dr Harpreet Kohli NHS Lanarkshire Board and Human Resources Forum NHS Lanarkshire Board and Staff Governance Committee (3 years from sign off) Version No.6 09/12/2013 Page 1 of 16
CONTENTS CONSULTATION AND DISTRIBUTION RECORD... 3 CHANGE RECORD. 3 1 INTRODUCTION... 4 2 AIM, PURPOSE AND OUTCOMES.. 5 2.1 General 5 2.2 Protecting and improving health. 5 2.3 Legislation. 5 2.4 Quality Healthcare Services. 6 3 SCOPE... 6 3.1 Who is the Policy intended to Affect.. 6 3.2 Who are the Stakeholders. 6 4 PRINCIPAL CONTENT... 7 4.1 The Policy.. 7 4.2 Staff and Healthcare Partners.. 7 4.3 Exemptions 7 4.4 Exposure of staff to second hand smoke at work.. 8 4.5 Support for smokers... 8 4.6 Sanctions... 9 4.7 Signage. 11 4.8 Electronic cigarettes. 11 5 ROLES AND RESPONSIBILITIES. 11 5.1 NHS Lanarkshire Chief Executive. 11 5.2 Site General Managers. 11 5.3 Managers.. 11 5.4 All staff.. 12 5.5 Human Resources. 12 5.6 Staff side representatives Error! Bookmark not defined. 5.7 Lanarkshire Stop Smoking Service.. 12 6 RESOURCE IMPLICATIONS... 12 7 COMMUNICATION PLAN.12 8 QUALITY IMPROVEMENT Monitoring and Review... 13 9 EQUALITY AND DIVERSITY IMPACT ASSESSMENT.. 13 APPENDIX 1 15 APPENDIX 2 16 Version No.6 09/12/2013 Page 2 of 16
CONSULTATION AND DISTRIBUTION RECORD Contributing Author / Catriona Milošević Authors Elspeth Russell Geraldine Reilly David Boyd Harry Campbell Susan Lyttle Nancy Docherty Eddie Docherty Alison McCutcheon Jennifer Benson Helen Ballantyne Consultation Process / Stakeholders: Staff, patients, public via survey and Sounding Board Joint Policy Forum Distribution: All staff Public CHANGE RECORD Date Author Change Version No. Aug 2008 L Armitage 2.0 June 2012 C Milošević Addition of designated smoking areas. 3.0 Removal of disciplinary action against staff smoking during unpaid breaks. Updated to new policy template. May 2013 S Lyttle Deletion of designated smoking areas 4.0 July 2013 S Lyttle Amended flowchart and inclusion of Mental 5.0 Health facilities that have a designated smoking area. Dec 2013 E Russell Amended text at 2.2 to NHS Lanarkshire is committed to promoting healthy living and non-smoking as its normal culture. It will do this by establishing a smoke-free environment for all and offering support to those who wish to give up smoking or who are required to temporary abstain from smoking whilst in hospital 6.0 Version No.6 09/12/2013 Page 3 of 16
1 INTRODUCTION Tobacco smoking is an addictive habit which remains the biggest single preventable cause of ill health, disability and early death in Lanarkshire and Scotland as a whole. Second hand smoke also causes lung cancer and ischaemic heart disease. Children are particularly vulnerable and exposure in childhood is associated with a range of illness. NHS Lanarkshire has a responsibility to work towards national targets for reductions in the prevalence of smoking and the incidence of diseases caused by tobacco smoke. Around 30% of adults in Lanarkshire smoke with the prevalence significantly higher in areas of deprivation. Smoking rates amongst specific populations, such as people with mental health problems and young pregnant women, are of particular concern. The Smoking, Health and Social Care (Scotland) Act came into force on 26 March 2006, banning smoking in enclosed public places such as workplaces, pubs and restaurants. The new 5 year Tobacco Control Strategy for Scotland Creating a Tobacco Free Generation was published in 2013. The strategy outlines a number of challenges most notably that NHS Boards should be exemplars in providing smoke free environments. NHS Boards should also consider enforcement measures, exercising mandatory Health & Safety requirements where appropriate. The strategy also highlights that staff should be trained in awareness raising and enforcement skills, and staff, patients and visitors should have access to specialist Smoking Cessation Services. Awareness raising regarding smoke free grounds should include advice and support on managing temporary abstinence. The NICE Public Health Guidance Smoking Cessation in Secondary Care: Acute, Maternity and Mental Health services support Smoking Cessation, temporary abstinence from smoking and smoke free policies. Indeed its recommendations are based on the following principles; Strong leadership and management will ensure secondary care premises (including grounds) remain consistently smoke free. Version No.6 09/12/2013 Page 4 of 16
Delivery of behavioural interventions and pharmacotherapy to support abstinence from smoking, at least while using secondary care services, is an integral component of secondary care provision. Secondary care smoking interventions are integrated with those provided in the community, to ensure continuity of care when patients move between primary and secondary care. Behavioural support for managing temporary abstinence is available for all staff and for those who wish to stop pharmacotherapy is also available. No concessions are made to smoking in secondary care, that is, there are no designated smoking areas, no exceptions for particular groups, and no staff supervised and facilitated smoking breaks for people in their care. NHS Lanarkshire's March 2006 No Smoking Policy was developed to improve indoor air quality in accordance with the requirements of the legislation. The No Smoking Policy was revised in August 2008 extending the earlier policy to cover all NHS Lanarkshire premises, both grounds and buildings. The policy was reviewed in 2012. This included consultation with staff, patients and the public. NHS Lanarkshire remains committed to the provision of a smoke free environment and will continue to strive towards having completely smoke free hospital grounds. 2 AIM, PURPOSE AND OUTCOMES 2.1 General It is tobacco smoke and its effects on those using it or exposed to it that is the problem rather than the people who smoke. People who smoke have the right to exercise an informed choice to smoke, except where that choice compromises NHS Lanarkshire's legal and moral responsibility to ensure a smoke free environment. 2.2 Protecting and improving health Tobacco smoke in the environment is a health hazard to both smokers and non-smokers. The purpose of this policy is to ensure the provision of a smoke free indoor and outdoor environment for all patients, staff and members of the public working in or on, or visiting NHS Lanarkshire premises. It aims to protect health by preventing involuntary exposure to second hand smoke. NHS Lanarkshire is committed to promoting healthy living and non-smoking as its normal culture. It will do this by establishing a smoke-free environment for all and offering support to those who wish to give up smoking or who are required to temporary abstain from smoking whilst in hospital. Patients who cannot or choose not to stop smoking should be offered advice and pharmacological aid on admission. Every effort will be made to assist patients with temporary abstinence and for those who wish to quit this will include a referral to smoking cessation services. Version No.6 09/12/2013 Page 5 of 16
2.3 Legislation NHS Lanarkshire must comply with the Public Health (the Prohibition of Smoking in certain premises) Regulation 2006 which makes it illegal to smoke in public places and in vehicles other than private cars. NHS Lanarkshire is responsible under British and European 1 employment law to: maintain a safe and healthy working environment; protect the health of patients and staff, and not subject them to hazardous environments and materials; and make sure that staff understand their responsibilities to look after the health and safety of others. 2.4 Quality Healthcare Services NHS Lanarkshire aims to provide the highest quality healthcare services. Complaints have been received about the smoking outside NHS Lanarkshire premises and consultation has highlighted the extent of these concerns. This policy aims to improve the environment offered to staff and the public by ensuring smoke-free premises and grounds. 3 SCOPE 3.1 Who is the Policy intended to Affect This policy is intended for: All directly employed staff of NHS Lanarkshire, in respective of age, sex, disability, ethnicity/race, marital or civil partnership status, sexual orientation, religion or belief, pregnancy, maternity or gender reassignment. Patients; including out-patients, day cases, in-patients and long-stay patients; Visitors; and The wider NHS family (i.e. contractors, students, voluntary staff, other healthcare partners and anyone whose work, study or personal circumstances brings them into contact with NHS Lanarkshire) 3.2 Who are the Stakeholders All NHS Lanarkshire staff, regardless of staff group or designation; Patients, including out-patients, day cases, in-patients and long-stay patients; Visitors; and 1 European workplace regulations require employers to carry out written risk assessment. The risk posed to staff from tobacco smoke (from all sources, including staff, patients or visitors) and associated fire risks should be assessed and minimised. Version No.6 09/12/2013 Page 6 of 16
The wider NHS family (i.e. contractors, students, voluntary staff, other healthcare partners and anyone whose work, study or personal circumstances brings them into contact with NHS Lanarkshire) 4 PRINCIPAL CONTENT 4.1 The Policy Smoking is not permitted by any persons including staff, patients, visitors and healthcare partners within the premises or on the grounds from which NHS Lanarkshire services are delivered. Smoking is not permitted within vehicles parked on these premises. Smoking is not permitted within NHS Lanarkshire vehicles and pool cars at any time. Smoking is not permitted in leased cars and personal vehicles when transporting other staff or patients within working hours and/or when on authorised business. Any person found smoking in uniform or wearing a hospital ID badge may be subject to disciplinary action being taken against them. In line with NHS Lanarkshire's desire for active discouragement of tobacco use, tobacco products will not be sold, advertised or otherwise promoted on the premises. NHS Lanarkshire will not hold tobacco-related investments or accept sponsorship or donations from tobacco companies. 4.2 Staff and Healthcare Partners Staff and healthcare partners are not permitted to smoke whilst at work. Staff on authorised breaks are not considered to be at work. If staff wish to smoke at this time they must leave the premises to do so. This applies equally to all staff, and any such action is the responsibility of the individual member of staff. Smokers will not be allowed longer or more frequent breaks than non-smoking members of staff. NHS staff must observe the uniform policy and should not smoke when wearing a uniform or a name badge identifying them as a member of staff. Staff should consider the example they set to patients if seen smoking. 4.3 Exemptions The Smoking, Health and Social Care (Scotland) Act 2005 allows some legal exemptions to smoking in enclosed public places which are listed in The Prohibition of Smoking in Certain Premises (Scotland) Regulations 2006 and any subsequent amended versions of it. In order to maximise health improvement for NHS Lanarkshire staff and clients, our policy extends beyond these legal requirements. At present the following exempted categories apply within NHS Lanarkshire: Version No.6 09/12/2013 Page 7 of 16
Designated rooms 2 in adult care homes. Some long stay patients, for whom NHS facilities are their homes, come in to these categories. When the NHS facilities are considered to be their homes these patients are currently subject to legal exemptions. While they continue to be exempt their choice to smoke will be acknowledged by designated smoking rooms, but designated rooms will only be provided where space permits, with priority being given to the provision of a nonsmoking common room. NHS Lanarkshire will provide these inpatients with specialist stop smoking support if desired. 4.4 Exposure of staff to second hand smoke at work NHS Lanarkshire recognizes its duty of care to its staff with regard to second hand smoke, and staff s professional duty of care to their patients and to themselves. This policy reflects these duties of care when possible. 4.4.1 NHS premises Staff may occasionally be exposed under the current exemptions outlined in 4.3 above to second hand smoke. Where reasonably practical, staff should not normally be required to work in these designated smoking rooms. If they do enter them their time of exposure to second hand smoke should be kept to a minimum. Staff with pre-existing conditions known to be exacerbated by second hand smoke should not be asked to enter them at all. As far as reasonably practical, and taking into account staff s professional responsibilities toward their patients, staff are entitled to refuse to enter designated smoking rooms. 4.4.2 Patients own homes In order to protect staff who visit patients in their own homes, patients and their families, will be requested not to smoke for the duration of the visit and for an hour beforehand. Where patients and their families repeatedly ignore such requests, staff will be entitled to discuss alternative care arrangements with their line managers including, when feasible, to visit them at another agreed and smoke free location. A Smoking and Home Visits leaflet is available from the Health Improvement Library or available to download via the Stop Smoking Service page on Firstport this leaflet should be given to the patient prior to the first visit. If this is not practical this information should be communicated to the patient during the first visit. 4.5 Support for smokers 4.5.1 Staff 2 The Regulations state that a 'designated room' must have 'a ventilation system that does not ventilate into any other part of the no smoking premises in question (except any other designated rooms)'. Version No.6 09/12/2013 Page 8 of 16
NHS Lanarkshire are committed to support staff who want to stop smoking. Staff who are unwilling or unable to stop smoking completely should be encouraged to use NRT products to help them abstain while at work or in Uniform. Staff who smoke will be encouraged to seek support to quit. The Lanarkshire Stop Smoking Service provides free specialist 1:2:1 support and groups. These are held in the community throughout Lanarkshire at different times of the day. In order to support staff who want to stop smoking, specialist stop smoking support will be provided on acute hospital sites. Support may also be obtained from Community Pharmacies. 4.5.2 In-patients Written information on this policy will be provided to all planned care patients before they are admitted to hospital. All inpatients will be asked as part of their admission procedures about their smoking status. If they smoke or have quit in the last four weeks the health professional concerned will follow the Integrated Care Pathway. In accordance with the ICP staff should; Provide brief advice about the benefits of stopping and arrange nicotine replacement therapy (NRT) where appropriate to reduce withdrawal symptoms resulting from this policy. Offer to refer inpatients who wish to stop to the Lanarkshire Stop Smoking Service in hospital. Outline the policy, clarifying that smoking is not permitted anywhere on hospital premises and grounds. Document advice given and actions taken. Training on brief intervention for smoking cessation in order to help patients, staff, friends and family will be provided through the Lanarkshire Stop Smoking Service and may be requested by any member of staff. During their stay inpatients who have initially chosen not to quit should be reassessed regularly and offered a referral to the Lanarkshire Stop Smoking Service in hospital, or on discharge to the Lanarkshire Stop Smoking Service in the community. 4.5.3 Outpatients and members of the public Access to specialist support to quit smoking is available from the Lanarkshire Stop Smoking Service located in sites across NHS Lanarkshire health board area. The Stop Smoking Service telephone number is 08452 17 77 07. Alternatively text Advice to 81066 or access further information on-line at www.nhslanarkshire.org.uk. Assistance is also available from community pharmacies and GP practices across Lanarkshire, and from the national Smokeline (telephone number 0800 84 84 84). Version No.6 09/12/2013 Page 9 of 16
4.6 Sanctions 4.6.1 Smoking in breach of legislation (in enclosed or semi-enclosed spaces) Any person smoking in an enclosed space as defined by the Smoking, Health and Social Care (Scotland) Act 2005 and its associated Regulations are breaking the law and may be liable to a fixed penalty of 50 imposed by the external agencies legally responsible for its implementation. The Smoking, Health and Social Care (Scotland) Act 2005 allows the agencies charged with enforcing the Act to impose fines on the manager, or any other person in control of any no smoking premises, for allowing others to smoke within them. This applies whether or not the person is aware that smoking has occurred. It should be noted that the Director of Acute Services or other senior management staff could face prosecution by the courts because of the actions of others. Any person smoking within a building should be made aware that they are committing an offence, be politely asked to stop smoking. All incidents should be recorded on a Datix Incident Form. If a member of staff feels unable to approach the smoker they must report the matter to their line manager. If the person is member of staff; o The person should be advised that they are breaking the law and reminded about NHS Lanarkshire s No Smoking Policy. o The line manager of the staff member committing the offence should be informed and the incident investigated. o Disciplinary proceedings may be invoked as a result. If the person is a patient; o They should be advised that they are breaking the Law and reminded of the NHS Lanarkshire No Smoking Policy. o Alternatives should be considered as described in section 5.2. Patients should be made aware that repeated breaches of the legislation could affect the ability of NHS Lanarkshire to continue providing them care on healthcare premises. In some cases this may require an exploration of how the needs of the patient may be met in light of the legal requirements and will require written confirmation to the patient. If the patient is, at the time of inappropriately smoking, unable to recognise their actions as being unlawful or in breach of NHS policy then other means of compliance must be explored at the first opportunity. If the person is a visitor/relative; o They should be advised that they are breaking the Law and reminded of the NHS Lanarkshire No Smoking Policy; If the person carries on smoking they should be asked to leave the premises and advised that the police will be called. 4.6.2 Smoking in breach of policy Version No.6 09/12/2013 Page 10 of 16
Any member of staff found smoking during paid working time or in uniform or wearing a hospital ID badge may be subject to disciplinary action being taken against them. Staff breaching policy may be subject to procedures within NHS Lanarkshire's Policy and Procedures for the Effective Management of Employee Conduct. Managers are reminded that support for employees to comply with the policy is available and should form part of any agreed action plan. Where this breach involves a patient their ward should be informed, where possible, and they should be offered support and advice as outlined in 5.2. 4.7 Signage NHS Lanarkshire will display no smoking signs both internally and externally on all its premises and vehicles. Signs at the entrances to premises will be visible to pedestrians and drivers as they approach the premises. Signage at the entrance and within buildings will comply with the Smoking, Health and Social Care (Scotland) Act 2005. Signs will display the job title of who should be contacted with complaints or information about people observed smoking on the premises. 4.8 Electronic cigarettes The electronic cigarette or e-cigarette is a battery operated nicotine vapour inhaler device. Due to insufficient evidence on both the safety and efficacy of e-cigarettes as cessation/nicotine maintenance NHS Lanarkshire have prohibited use of e-cigarettes within NHS Lanarkshire premises and grounds. This position will be reviewed as evidence and national guidance becomes available. 5 ROLES AND RESPONSIBILITIES 5.1 NHS Lanarkshire 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. 5.2 Site General Managers On each site the General Managers are required to: Implement this policy and ensure their staff are aware and follow the policy. Ensure that no-smoking signs are prominently displayed. Ensure their area is monitored for evidence of smoking, taking appropriate action when evidence is found. Fully support staff who bring this policy to the attention of any person in breach of it, by reinforcing the no smoking message and by intervening in situations that become difficult for the staff member to handle. Investigate any incidences of policy breaches, taking remedial actions as appropriate. Version No.6 09/12/2013 Page 11 of 16
Receive and investigate incidents of staff breaches in accordance with NHS Lanarkshire's Policy and Procedures for the Effective Management of Employee Conduct. 5.3 Managers Managers are responsible for ensuring that; Their staff know, understand and comply with this policy; Contractors or non-nhs staff know, understand and comply with this policy; Contraventions are identified and are managed in accordance with NHS Lanarkshire s policies and; The policy is monitored in their own area. 5.4 All staff All staff, whether directly employed or working on a contract or locum basis; All staff must ensure they are familiar with the policy and comply with its provisions. To support the policy and to follow the guidance (see section 6 and Appendices 1 & 2) if they observe anyone smoking in breach of policy or legislation on NHS Lanarkshire premises. 5.5 Human Resources Provide support and advice to managers to help them to apply the staffing elements of the policy effectively. To ensure that the No Smoking Policy is featured during staff induction. 5.6 Lanarkshire Stop Smoking Service Provide cessation advice and support to any patients or staff who wish to stop smoking. Provide tobacco related training for NHS staff and partner agencies across Lanarkshire. This training equips staff with the knowledge and skills to raise the topic of Tobacco use, the nature of the addiction and how to manage withdrawal. For more information contact Pauline Brannigan on 01355 585502. 6 RESOURCE IMPLICATIONS There will be financial implications in terms of implementation and enforcement of the policy. Resources will be required to communicate the new policy and to maximise health improvement messages. Staff training will be provided via current induction opportunities and in line with PDP needs. Version No.6 09/12/2013 Page 12 of 16
7 COMMUNICATION PLAN Prior to the introduction of this policy a communication plan will be developed with the intention of communicating the revised policy to the public, staff and visitors. The revised policy will be communicated via some or all of the following channels: Local printed and radio media Inpatient information, both printed and electronic media Staff bulletin, electronic wallpaper Public website Firstport Use of social media where appropriate Other mediums which may be identified through devising the communications plan Staff team meetings Inductions Instructions to contractors. 8 QUALITY IMPROVEMENT MONITORING AND REVIEW A monitoring group will oversee implementation of the policy. The following indicators will be used to monitor how the policy is being implemented; Availability of appropriate information for staff, patients and visitors Policy covered at Induction and within job descriptions The number of challenges at Wishaw General Hospital (a reduction in the number of challenges or increased compliance). The number of complaints related to smoking Incident reports Repeat observational survey of smoking at entrances. Is the policy effectively and widely communicated? The policy will be subject to review on a three yearly basis. 9 EQUALITY AND DIVERSITY IMPACT ASSESSMENT This policy meets NHS Lanarkshire s EDIA - Does this need reviewed?? (tick box) Version No.6 09/12/2013 Page 13 of 16
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APPENDIX 1 FLOW CHART FOR STAFF OBSERVING ANYONE NOT ADHERING TO POLICY Staff member observes someone smoking outdoors on NHS premises in breach of policy Staff member politely informs the person that they are in a no smoking area and requests person to stop smoking If person refuses to do so, staff member should walk away and inform their own line manager or the Patient Affairs manager? If the person is a member of staff Smoker managed by same line manager Line manager discusses the incident with the smoker and if necessary s/he will take action in accordance with NHS Lanarkshire's Policy and Procedures for the Effective Management of Employee Conduct Smoker managed by different line manager Line manager will inform line manager of smoker who will discuss the incident with the smoker and if necessary s/he will take action in accordance with NHS Lanarkshire's Policy and Procedures for the Effective Management of Employee Conduct The line manager of the smoker should complete a Datix Incident Form. Version No.6 09/12/2013 Page 15 of 16
APPENDIX 2 FLOW CHART FOR PATIENT, MEMBER OF PUBLIC OR STAFF MEMBER AWARE OF SOMEONE SMOKING INDOORS ON NHS PREMISES Patient, member of public or staff member observes someone smoking indoors on NHS Lanarkshire premises If they feel able to do so. they should politely explain to the smoker that it is against the law to smoke indoors, request the person to stop smoking, and/or inform the departmental manager Smoker managed by same line manager Manager discusses the incident with the smoker and if necessary s/he will take action in accordance with NHS Lanarkshire's Policy and Procedures for the Effective Management of Employee Conduct. Smoker managed by different line manager Manager will inform line manager of smoker who will discuss the incident with the smoker and if necessary s/he will take action in accordance with NHS Lanarkshire's Policy and Procedures for the Effective Management of Employee Conduct Smoker is not a member of staff Manager discusses the incident with the smoker, reminds them they are breaking the law and, if necessary, s/he takes action in accordance with NHS Lanarkshire s Policy for the Prevention and Management of Violence and Aggression to Staff. All inpatients should be offered support as outlined in 5.2 The line manager of the smoker, or in the case of the smoker not being a member of staff the manager responsible for that part of the premises, should complete a Datix Incident Form. Version No.6 09/12/2013 Page 16 of 16