3B. TOBACCO POLICY

MANAGING HEALTH AT WORK

3b. TOBACCO POLICY

introduction
sUMMARY
rATIONALE
sCOPE
pRINCIPLES
eXEMPTIONS
pOLICY DETAILS

PROMOTION OF TOBACCO

MONITORING AND REVIEW

RESPONSIBILITIES

SUPPORT FOR PEOPLE WHO SMOKE

SOURCES OF HELP TO STOP SMOKING

Appendix A:

Legal Obligations/NHS/ Government Documents

1. INTRODUCTION

The Smoking, Health and Social Care (Scotland) Act 2005 and the Prohibition of Smoking in Certain Premises (Scotland) Regulations 2006 came into effect on 26 March 2006 and NHS Highland implemented a Tobacco Policy in line with the new legislation.NHS Highland is committed to the improving the health of their population. Smoking is the single largest preventable cause of ill health and mortality, and is responsible for some 500 deaths per year in Highland. The Scottish Executive has encouraged all NHS organisations to lead by example and NHS Highland recognises that smoke-free grounds illustrate this. The Board has agreed to extend the existing policy, and with effect from 1st January 2008 the policy will cover all NHS premises and grounds in Highland.

Improved health for people at work offers real gains to employees and employers through lower rates of sickness absence, less time for recovery and a quicker return to work, fewer accidents and improved productivity, the policy supports the staff governance action plan to reduce the rate of sickness absence for employees of NHS Highland.

2. SUMMARY

NHS Highland is committed to providing a safe and healthy environment for the public it serves, particularly its patients, visitors and all staff. In line with this we have revised our Smoking Policy to have substantially smoke-free sites.

With effect from the 1st of January 2008 smoking will not permitted on any NHS Highland site or in, vehicles, and areas which ventilate into buildings.

The only exceptions to this rule will be:

Facilities for patients in specified psychiatric accommodation, e.g New Craigs Hospital and the Argyll & ButeHospital.

Staff accommodation wholly occupied by an individual or family will be considered a private residence and will therefore be exempt from this policy. (Shared residential accommodation will be covered by the policy and will be smoke free.)

Where appropriate, hospitals can designate for the use of inpatients, a discrete, designated smoking area outside which meets the requirements of current legislation.

All staff who smoke will be offered information regarding services provided by Occupational Health and locality based Smoking Cessation Advisers for smoking cessation support.

All patients who smoke will be offered access to smoking cessation support. Inpatients suffering nicotine withdrawal will be treated in a supportive manner and prescribed appropriate medication where required.

The clear message will be that smoking and the effects of passive smoking are a major cause of preventable ill health and should be discouraged.

3. RATIONALE

Smoking remains one of the biggest single preventable cause of ill health and early death in our community and causes the premature death of 13,000 people in Scotland every year.

As well as the current legislation, NHS Highland recognises the need for a Policy to encourage health improvement and disease prevention. Passive smoking or environmental tobacco smoke has been shown to be a hazard to health. Eighty five per cent of cigarette smoke cannot be seen. Breathing these invisible toxins has clear danger. Even in people who have never smoked the risk of heart disease surges by a quarter and they are at greatly increased risk of lung cancer. Secondhand smoke is invisible and odourless. Even if windows are opened up it will still be in a room after two and a half hours. Even if any smoke cannot be seen or smelt, it is probably still there. Secondhand smoke contains 4,000 toxic chemicals and it is estimated that it causes thousands of deaths each year. Children are particularly affected by secondhand smoke because their bodies are still developing.

4. SCOPE

This Policy covers all health service buildings and grounds in NHS Highland and applies to:

All NHS Highland staff including temporary and agency staff, contractors, volunteers and students.

Patients, including out-patients, day cases, in-patients and long-stay patients.

Visitors and members of the public.

Residents in shared residential accommodation.

5. PRINCIPLES

This Policy is designed to protect and improve the health of the population of NHS Highland by promoting a smoke-free environment for all, while offering support to those who smoke and would like to stop.

NHS Highland recognises that it is tobacco smoke, and its effect on those who use it and/or are exposed to it, which is the problem. No patient, visitor or staff member should be exposed to tobacco smoke. To achieve this, smoking is prohibited by law within health service premises in NHS Highland except within designated areas (See section 6).

The Smoking Cessation Service offers a range of support and advice to anyone who wishes to stop smoking and this will be promoted across NHS Highland. Staff should contact Occupational Health Services (OHS) for details. (See section 12)

Awareness raising, education, support and review will be key components of this policy

NHS Highland recognises the need to support health improvement by promoting a change in attitudes toward smoking and promote an environment whereby people are discouraged from starting to smoke.

6. EXEMPTIONS

Psychiatric patients

On sites solely used for psychiatric in-patients where designated smoking areas, compliant with the regulations, will be identified.

Residents in single occupancy residential accommodation

Houses and flats rented to single tenants or family homes will be considered private residences are therefore exempt from this policy

Vulnerable, Anxious and Distressed Inpatients

Where necessary, hospital managers can provide a suitable, discrete, outdoor designated smoking area, which meets with the requirements of the legislation for vulnerable, anxious or distressed patients.

With the exception of the categories noted above this will be the only area on NHS Highland sites where smoking will be permitted.

7.POLICY DETAILS

NHS Staff

Prospective employees will be informed of this policy at interview and the policy will be confirmed to the successful candidates in their letter of appointment and at Induction Training.

Staff cannot smoke unless during official unpaid breaks and off NHS Highland sites.

In line with current policy, staff must not smoke in uniform, as this would compromise the health improvement message for NHS Highland.

A staff information leaflet will be made available explaining the policy and providing advice on cessation support

Breaches of this policy will be treated sensitively. However, if a member of staff persistently fails to follow this Policy, the matter will be considered in line with NHS Highland’s Employee Conduct Policy.

Contractors Working on NHS Sites

It will be a condition of appointment that contractors and their staff should not smoke on NHS Highland sites, and must comply with smoke free legislation. Any contractor in breach of that condition will be contacted formally and if the problem continues may be removed from site and their contract terminated.

Patients

Where possible all inpatients will be advised prior to admission that they cannot smoke in NHS Highland buildings during their stay (this includes non-ward areas e.g. Kyle Court).

Patients will be encouraged to use their stay in hospital as an opportunity to stop smoking, if not permanently at least for the duration of their stay. Help will be offered to those who want to quit.

To protect staff who visit clients in their own homes and ensure the space where the visit is to take place is clear of smoke, clients and their families will be requested not to smoke one hour before and for the duration of the visit.

Patient information leaflets will explain the policy and provide advice on cessation support.

Where patients are reminded of their responsibilities under the Law not to smoke in the hospital buildings and continue to do so, the matter will be referred to Environmental Health Officers who can impose a fixed penalty of £50 for smoking in no smoking premises.

Day patients and outpatients will be advised that they should not smoke on the hospital site.

Visitors and members of the public

Visitors should not smoke on NHS Highland sites.

Visitor information will be made available to them explaining the policy and providing advice on cessation support.

Appropriate signage will be in place to advise patients and visitors that they are on a no smoking site.

If a visitor or member of the public breaches the No Smoking Policy, they will be asked to extinguish their smoking materials or leave the premises.

NHS Highland recognises that most people who smoke will adhere to the policy. Where an employee finds someone smoking in NHS Highland premises they should inform them of the policy and ask them to extinguish their smoking material. However, employees are expected to use their initiative and professional judgment in such situations. Under these circumstances, they are advised to discourage the person(s) from smoking rather than risk personal safety in attempting to enforce the policy. If concerned, they should refer the matter to their line manager.

Residents in Residential Accommodation

All shared staff accommodation or accommodation which is embedded in hospital buildings will be smoke free.

It will be a condition of residence that smoking will not be permitted in shared staff accommodation by residents or their visitors.

Residents will be responsible for implementation of the policy in their accommodation.

Failure to adhere to the policy may result in termination of tenancies

8. PROMOTION OF TOBACCO

Tobacco products will not be sold, advertised or otherwise promoted on NHS Highland premises or sites. NHS Highland will not hold tobacco-related investments, or accept sponsorship or donations from tobacco companies.

9. MONITORING AND REVIEW

Themulti-disciplinary Tobacco Policy Working Group, consisting of representation from Human Resources, Public Health, Facilities and Staffside will review the policy on an annual basis. Monitoring will take place on an ongoing basis and will include:

Uptake of smoking cessation services by staff and patients

Prescription of nicotine replacement therapy

Collation of all reported incidents by the appropriate support department e.g. Health and Safety Team / HR Services / Occupational Health Services.

Quarterly reporting to the Area Partnership Forum, Health and Safety Committee on incident statistics and safety improvement measures which have been introduced.

Annual reporting and recommendations for the forthcoming year to the Area Partnership Forum and Staff Governance Committee will form the basis of a report to the Board.

10. RESPONSIBILITIES

Employee

Have a responsibility to comply with the policy as part of their terms and conditions of employment -

To support the implementation of the policy with regards to patients, visitors and colleagues.

To report breaches of legislation i.e. smoking in the building, by completing an IR1 form

To raise any other breaches with the Line Manager

Manager/Supervisor

To support any employee who expresses a desire to stop smoking, to ensure that the policy framework is being adhered to and handle any breaches in a considered and thoughtful manner.

To support the Tobacco Policy by ensuring that there is no smoking within NHS premises and that no smoking notices are displayed.

Human Resources

To provide support and advice to managers to help them to apply the policy effectively, to monitor policy breaches and to include a briefing on the policy at staff induction.

Occupational Health

To provide support and advice to those employees who wish to stop smoking including referring staff to smoking cessation advisors.

11. SUPPORT FOR PEOPLE WHO SMOKE

NHS Highland is committed to improving health of their staff and the population covered by NHS Highland. The policy aims to encourage all smokers who are in contact with the NHS inHighland, whether as a user of the service or as an employee, to stop smoking. The provision of information, advice and specialist smoking cessation support is a key aspect of the Tobacco Policy. Staff and patients who wish help to stop smoking will receive structured support through the community and/or hospital based smoking cessation services. The organisation will make all reasonable efforts to support staff with attendance at smoking cessation services.

Health Boards have responsibility for the provision of smoking cessation services in their local area. Staff living out-with the Highland area can also access support through these services.

12. SOURCES OF HELP TO STOP SMOKING

Hospital Smoking Cessation Adviser (for Raigmore patients)

Jennifer Larsen, 01463 704000 x6576

Occupational Health (for employees only)

RaigmoreHospital

Tel: 01463 706147 (appointments can be made via Linda McFeat)

Local Smoking Cessation Service (for employees and patients) 0845 757 3077provides details of your local adviser and participating pharmacists

Smokeline

24 hour helpline 0800 84 84 84

On-line help such as ASH Scotland – and Go Smoke Free –

Legal Obligations

By law NHS Highland is responsible for:

Maintaining a safe, healthy working environment

Protecting the health of patients, staff, visitors and contractors from hazardous environments

Making sure that employees understand their responsibilities to take reasonable care of the health and safety of others.

Legal instruments:

Health & Safety at Work Act 1974

The Workplace (Health, Safety & Welfare) Regulations 1992

Employment Rights Act 1996

The Disability Discrimination Act 1995

Safety & Health of Pregnant Workers (Directive 92/85/EEC)

Control of Substances Hazardous to Health (COSHH) Regulations 2002
Smoking Health and Social Care (Scotland) Act 2005
Prohibition of Smoking in Certain Premises (Scotland) Regulations 2006

NHS/Government Documents

Department of Health: Smoking Kills: A White Paper on Tobacco. 1998

The Stationery Office, London

Scottish Office, Towards a Healthier Scotland: A White Paper on Health

The Stationery Office, Edinburgh 1999

Scottish Executive. Our National Health: A plan for action, a plan for change

The Stationery Office, Edinburgh, 2000

Scottish Executive. Cancer in Scotland: Action for change

The Stationery Office, Edinburgh 2001

Scottish Executive. Improving Health in Scotland – The Challenge

The Stationery Office, Edinburgh 2003

Scottish Executive. Partnership for Care – Scotland’s Health White Paper

The Stationery Office, Edinburgh 2003.

On the state of Public Health, Chief Medical Officer’s annual report, 2003

The Scottish Executive, A Breath of Fresh Air for Scotland – improving Scotland’s Health: The Challenge – Tobacco Control Action Plan.

The Stationery Office, Edinburgh, 2004

ASH Scotland/Health Scotland, Smoking Cessation Guidelines for Scotland,

Edinburgh, update 2004