SMOKING POLICY Version Control Date Version No: 3 Implementation Date March 2006 Last Review Date March 2006 Next Formal Review Date May 2010 Impact Assessment Date August 2010 Engagement and Consultation Groups Date Health & Safety Committee June 2009 Local Partnership Forum June 2009 NHS 100 & PFPI Steering Group July 2009 Area Partnership Forum September 2010 Approval Record Date Shetland NHS Board (V.3.1) October 2010 We are happy to consider requests for translations in alternative languages and formats. Please contact our Corporate Services Department on 01595 743064. PHPOLHP001
2 TABLE OF CONTENTS 1. Introduction... 3 2. Scope of the Policy... 3 3. General Principles... 4 4. Aims and Objectives... 4 5. Smoking Cessation... 5 6. Contracts with Other Providers... 6 7. Domiciliary Visits... 6 8. Non Compliance with the Policy Rules... 6 9. Implementation of Policy & Monitoring Arrangements... 7 10. Review... 8 11. Equality & Diversity Impact Assessment... 9 12. References...13
NHS SHETLAND SMOKING POLICY 1. Introduction 3 Smoking is the biggest single cause of preventable chronic illness, disability and premature death in Scotland. It kills between one half and two thirds of longterm smokers and about 13,000 smokers die each year in Scotland. Many smokers are aware of the health risks and most want to quit, but around 30% of adults continue to smoke because of their addiction to nicotine. As a result, Shetland NHS Board (the Board) will act to discourage smoking. Smoking is the biggest cause of premature death and ill health in Scotland. One of the Board s main aims is a reduction in mortality and an improvement in health of the people of Shetland, and the advocacy of non-smoking is one of the most effective ways to achieve this end. The Scottish Government has taken action to reduce smoking in Scotland, and banned smoking from all public places through the Smoking, Health and Social Care (Scotland) Act 2005. In addition, the Board has a HEAT target, which is to, through smoking cessation services, support 8% of the Board s smoking population in successfully quitting (at one month post quit) over the period 2008/09 2010/11. This means that across Shetland 100 people have to quit smoking between April 2010 and March 2011 to meet this target. One of the most positive outcomes of the move to smoke-free status is that some smokers use the fact that they can no longer smoke at work as an incentive to quit smoking, while others reduce the number of cigarettes they smoke each day. i This policy also forms part of the Board s overall concern for the health, safety and welfare of staff. All workplaces have legal responsibilities to look after the health and safety of their staff through the Health & Safety at Work Act 1974 and the Safety & Health of Pregnant Workers Directive (92/85/EEC). 2. Scope of the Policy This policy applies to all employees of the Board, to all individuals or employees of companies working under contract to the Board and to other members of the public who may from time to time be present in premises or grounds owned by or leased by the Board. It also applies to Crown Cars (lease cars without private use) provided to employees of the Board for the conduct of their business. Smoking is also prohibited in private vehicles used by staff for work, when carrying passengers. Although the main provisions of this policy
4 do not apply to general practice premises, General Practitioners and their staff will be subject to the condition laid down in paragraph 6. 3. General Principles a) The Board accepts without reservation that smoking is damaging to health. This policy is designed to reduce levels of smoking amongst staff, patients and visitors and to provide support to those wanting to stop smoking. b) The Board also accepts without reservation that breathing other peoples cigarette smoke is a public health hazard. This policy therefore is also designed to protect non-smokers from the dangers of passive smoking. c) The Board recognises the important exemplar role of health professionals and other NHS employees in the advocacy of non-smoking. Employees of the Board who are cigarette smokers should therefore at no time smoke during working hours, except during agreed and unpaid designated breaks. If they choose to smoke, they must not be in uniform, nor be identifiable as NHS staff nor be on Board premises. This principle applies equally in hospital and other Board premises as well as in a community setting. 4. Aims and Objectives The aim of the Smoking Policy is to make all Board premises and grounds owned or leased by the Board, no smoking areas. The use of private vehicles as smoking shelters while parked on NHS premises is strongly discouraged. 1 The objectives are: a) to create a smoke free environment for Board employees, patients and visitors. b) to increase the awareness of the danger of smoking amongst all NHS staff in Shetland. c) to offer practical advice and smoking cessation support to staff who are cigarette smokers to give up smoking. d) to gain the support of the wider community for the policy as it affects patients and visitors. 1 National guidance on smoking in private vehicles on NHS premises is currently being developed, in recognition of the dangers of passive smoking. Once this guidance is published this policy will be updated accordingly
5 5. Smoking Cessation Staff The Occupational Health Department and Health Improvement Department offer a smoking cessation service free of charge, to all Board employees and staff of independent contractors, who may wish to stop smoking. The Board can provide free Nicotine Replacement Therapy (NRT) for 4 weeks to any staff member making a serious attempt to stop smoking. In respect of Board employees, an agreed course of smoking cessation support will be made available during the employee s normal working hours at times to be agreed with the employee s manager. Arrangements for attendance at smoking cessation activities for non-board employees will have to be agreed by the individual s employer. Patients Smoking Cessation support will continue to be provided through the existing smoking cessation service. All front-line staff will be offered training in brief intervention techniques to ensure that all smokers are identified and provided with the opportunity of support in stopping smoking. Every effort should be made to encourage patients not to smoke, and Nicotine Replacement Therapy may be offered with the consent of medical staff. However, staff should not compromise their own safety to enforce this policy. The Board s Smoking Cessation Protocol gives guidance on support available and how it should be accessed. If a patient becomes angry or violent on being asked not to smoke, the procedure in the Board s Guidelines on the Assessment and Management of Violence and Aggression to staff should be invoked. However, most smokers appreciate that smoking in hospitals and on NHS premises is inappropriate. The optimal solution is that patients should be encouraged to prepare for treatment by quitting smoking, although this is less easy to achieve in the case of emergency admissions. If they are admitted as smokers, then patients should be encouraged to make use of smoking cessation services while they are in hospital. If a patient is unwilling or unable to stop smoking while in hospital, and needs to be escorted outside the hospital grounds, it is recommended that where possible, a family member or relative should be asked to undertake this role, but this can be negotiated within the care planning process. Any staff member being asked to escort a patient who is smoking should be exposed to the tobacco smoke for
no more than 2 hours per day. However, all staff members have the right to refuse to escort a patient who is smoking. 6 6. Contracts with Other Providers Where the Board contracts for the provision for clinical services for its residents with external healthcare providers, it will be a condition of such contracts that the contractor has in place a smoking restrictions policy. 7. Domiciliary Visits ii Staff who visit / treat people in their homes are at risk if the person being treated is a smoker. Private houses are not covered by the Act iii. Several factors, therefore, need to be taken into consideration. It would be advisable for the organisation to develop a list of the homes visited by its staff which are occupied by smokers. Once the situation relating to individual properties is ascertained, steps can be taken to reduce the exposure the staff might face. Measures that can be taken include writing to all those who will be visited to ask them and those who may be with them, not to smoke during the visit, and ideally not to smoke for at least one hour before the visit is scheduled to take place. Second, it is important to identify members of staff who have a pre-existing condition that is made worse by exposure to tobacco smoke, such as asthma, COPD and cardiovascular disease or who face additional risks e.g. due to pregnancy. Members of staff who have such conditions are at higher risk and particular care should be taken to prevent or minimise their exposure to tobacco smoke. 8. Non Compliance with the Policy Rules Employees Any Board employee who breaches the rules of this policy will be offered smoking cessation support in the first instance, and free NRT to assist them in stopping smoking. Staff should note that repeated non-compliance with the Smoking Policy may be grounds for disciplinary action in accordance with the Board s Disciplinary Policy.
7 If there is a clear breach of the health and safety policy, procedures under the Board s Health and Safety Policy may also be initiated. Visitors It is not acceptable for a visitor to smoke on hospital or other Board premises in any circumstances. Staff should follow the guidance for dealing with breaches of the Smoking Policy. If visitors react with aggression or violence the procedure for the Board s Guidelines on the Assessment and Management of Violence and Aggression should be observed. Contractors If a contractor breaches the smoking policy they should be reported to their managing organisation, which should deal with the breach and report back to NHS Management. Any breach of the policy should be reported via the DATIX Incident Reporting system. 9. Implementation of Policy & Monitoring Arrangements It is the responsibility of all staff to Ensure that they comply with the terms of this policy Report any non-compliance to their line manager. If any staff have concerns about the implementation of this policy they should raise them with their line manager or with a member of the Health and Safety Committee. It is the responsibility of Senior Charge Nurses and Line Managers to Monitor and enforce this policy Monitoring will include: Awareness of policy Identifying breaches of the policy and action taken Positive outcomes such as number of additional staff trained in smoking cessation Numbers of Staff and patients seeking support in stopping It is the responsibility of the Director of Clinical Services to ensure the policy on smoking is outlined in all correspondence with patients. Letters sent out in advance of hospital treatment will highlight the policy on smoking, and also
advise patients to stop smoking, giving detail of the local smoking cessation services. The Chief Executive has overall responsibility for the implementation of this policy, but may delegate responsibility for particular areas to other staff, e.g. Director of Clinical Services. 8 A written summary of this policy will be made available to all staff and Contracts of Employment/ Staff Handbooks will make explicit reference to the key aspects, and promote the availability of support in stopping smoking. Organisational chart showing reporting arrangements NHS Shetland Health & safety Committee Staff Governance Committee Area Partnership Forum 10. Review The policy will be reviewed every three years.
11. Smoking Policy an Equality & Diversity Impact Assessment 1. General 9 The impact assessment of the Smoking Policy of NHS Shetland was carried out by the Health Improvement Manager with support from the Health Improvement Team. The initial draft findings will be circulated electronically to the Area Partnership Forum and the Health & Safety Committee to allow opportunity to comment, amend and otherwise endorse the final draft report. The Rapid Impact Assessment was used as the basis for formal impact assessment of this function. A copy of this is attached as Appendix A. A copy of the outcomes from the impact assessment in the format provide by the toolkit is attached as Appendix B. This report provides a translation of the toolkit format into what we believe is a more accessible narrative format. The Equality and Diversity policy is an existing policy coming under the management responsibility of the Director of Human Resources. 2. Aims of the Policy The aim of the Smoking Policy is to make all Board premises and grounds owned or leased by the Board, no smoking areas. 3. Evidence and data on the impact of the Function In looking to establish an informed basis for assessing the impact of the Smoking Policy on particular communities of people, the Team considered what evidence was available. The recommendations in Smoke Free Scotland: Guidance on smoking policies for the NHS, local authorities and care service providers: December 2005 have been followed. 4. Assessment of Impact On the basis of all the information available and the collective understanding of the legislation covering the main equality communities of people, the Team reached the following conclusions on the likely impact the current structure and delivery of the Smoking Policy will have on those communities.
10 Race It was concluded that the impact on this community of people would be no different to any other group. Disability The Team concluded that there might be some impact on this community of people as, depending on the nature of the disability, it might be harder for them to leave Board premises to smoke if they did not wish to stop smoking. Gender and Sex It was concluded that the impact on this community of people would be no different to any other group. Sexual Orientation It was concluded that the impact on this community of people would be no different to any other group. Faith & Religion It was concluded that the impact on this community of people would be no different to any other group. Age It was concluded that the impact on this community of people would be no different to any other group. Mental Health The Team believes that there might be some impact on people with mental health problems if they are already distressed or where they usually use nicotine to calm themselves down. The policy states that: Every effort should be made to encourage patients not to smoke, and Nicotine Replacement Therapy may be offered with the consent of medical staff. However, staff should not compromise their own safety to enforce this policy. In this situation a compromise could be made, with the support of the consultant in charge of the patient, to allow the patient to smoke in a clearly designated and well ventilated room which does not ventilate into any other area of the premises.
11 5. Need for changes in the Policy In order to remove the adverse impacts identified in the earlier sections of this impact assessment, ensure that appropriate information and data is gathered to evidence that general and specific legal duties and obligations are met, promote equality of opportunity, treat disabled people more favourably in order to deliver equality of opportunity, and comply with the obligations of the Human Rights Act, the Team concluded that "[summarise overall findings from toolkit here]". The conclusions of the Team are that: 1. There should be provision of information on the Smoking Policy and support for smoking cessation which meets diverse literacy needs. 6. Consultation The findings of this Equality Impact Assessment will be posted on the Equality & Diversity section of the NHS SHETLAND web site and flagged as available for comment. Where requested, the NHS SHETLAND Equality & Diversity Lead will meet with organisations, groups or individuals who prefer to debate the content of the report and offer comment on it in a direct exchange. 7. Monitoring & Review Arrangements for monitoring and reviewing the impact, planned and unplanned, of this Smoking Policy will be put in place as required, following and taking account of what we learn from comments and feedback received on these published findings. Signed Elizabeth Robinson. Designation Health Improvement Manager. Date 29 th July 2010.
Appendix A Rapid Impact Assessment Shetland NHS Board 12 Which groups of the population do you think will be affected by this proposal? minority ethnic people (incl. gypsy/travellers, refugees & asylum seekers) women and men people in religious/faith groups disabled people older people, children and young people lesbian, gay, bisexual and transgender people NB The word proposal is used below as shorthand for any policy, procedure, strategy or proposal that might be assessed. What impact will the proposal have on lifestyles? For example, will the changes affect: Diet and nutrition? Exercise and physical activity? Substance use: tobacco, alcohol or drugs? Risk taking behaviour? Education and learning, or skills? Will the proposal have any impact on the social environment? Things that might be affected include Social status Employment (paid or unpaid) Social/family support Stress Income Will the proposal have any impact on Discrimination? Equality of opportunity? Relations between groups? people of low income people with mental health problems homeless people people involved in criminal justice system staff What positive and negative impacts do you think there may be? Which groups will be affected by these impacts? All staff and patients The strategy hopes to have a positive impact on peoples lifestyle regarding tobacco use. Tobacco can often be used as a form of risktaking behaviour initially, but very soon becomes an addiction problem and although the use of tobacco is legal, it is a substance that causes great harm to individuals, communities and our environment. Education and learning are key components of this strategy. The perception of smoking has gradually changed over the past decade, from acceptance to a view that smoking is no longer the norm. Some people who smoke perceive that this has infringed upon their rights; the aim of this policy is to encourage everyone to consider their health and their responsibility in relation to smoking and second-hand smoke whilst offering help to those who want to stop smoking. No the policy impacts equally across all groups. We need to continue to offer smoking cessation services that are appropriate, accessible and non discriminatory, e.g. offering one to one smoking cessation appointments instead of groups, delivering the service in remote areas and consulting with patients on an ongoing basis regarding the smoking cessation service, ensuring promotional activities and information provided are offered in other languages and in Braille. Will the proposal have an impact on the physical environment? For example, will there be impacts on: Living conditions? Working conditions? Pollution or climate change? Accidental injuries or public safety? Transmission of infectious disease? Some patients may perceive that the ban on smoking in hospital affects their experience of being in hospital. It is hoped they will welcome the opportunity and support provided in stopping smoking.
13 Will the proposal affect access to and experience of services? For example, Health care Transport Social services Housing services Education Some patients may perceive that the ban on smoking in hospital affects their experience of being in hospital. It is hoped they will welcome the opportunity and support provided in stopping smoking. Rapid Impact Checklist: Summary Sheet Positive Impacts (Note the groups affected) Reduction in exposure to second hand smoke Reduction in smoking for staff members and some patient groups Negative Impacts (Note the groups affected) Smokers will be required to leave NHS Shetland grounds in order to smoke Additional Information and Evidence Required None Recommendations From the outcome of the RIC, have negative impacts been identified for race or other equality groups? Has a full EQIA process been recommended? If not, why not? No negative impacts for race or other equality groups have been identified and therefore a full EQIA is not necessary. 12. References i Fichtenberg, C.M. and Glantz, S. Effect of smoke-free workplaces on smoking behaviour: systematic review. British Medical Journal 2002: 325(7537): p.188 ii Royal College of Nursing (2006) Protecting Community Staff from exposure to second-hand smoke: RCN best practice guide for staff and managers: London iii The Smoking, Health and Social Care (Scotland) Act 2005.