Smoke Free Policy
Responsible Directorate:
Public Health
Responsible Director:
Dr Judith Hooper
Date Approved:
27 January 2009
Committee:
Governance Committee
NICE GUIDANCE Once NICE guidance is published, health professionals are expected to take it fully into account when exercising their clinical judgment. However, NICE guidance does not override the individual responsibility of health professionals to make appropriate decisions according to the circumstances of the individual patient in consultation with the patient and/or their guardian or carer.
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Version Control Document Title: Document number: Author: Contributors: Version: Date of Production: Review date: Postholder responsible for revision: Primary Circulation List: Web address: Restrictions:
Smoke Free Policy 1 Rebecca Elliott Rachel Spencer 1 June 2008 June 2010 Tobacco HIT Lead
Standard for Better Health Map Domain: First Domain: Safety Fourth Domain: Patient Focused Seventh Domain: Public Health Department of Health 2004, Choosing Health; Making Healthier Choices Easier Core Standard Reference: C4 C13B C24, World Class Commissioning Competencies (see reference) Performance Indicators: 1. All PCT premises are smoke free 2. Monitor the referrals to Kirklees Stop Smoking Service of staff and patients
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Contents
Section 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Introduction / Overview Associated Policies and Procedures Aims and Objectives Scope of the Policy Accountabilities and Responsibilities Core Principles of the Policy Equality Impact Assessment Training Needs Analysis Monitoring Compliance with this Policy References
Page 4 4 4 5 5 5 6 6 6 7
Appendices A B C D E F
Definitions Key Stakeholders consulted/involved in the development of the policy/procedure Equality Impact Assessment Tool Guidance for staff who undertake visits where second hand smoke may be present NHS Kirklees flow chart Kirklees Stop Smoking Service
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8 8 9 10 11 12
Policy Statement NHS Kirklees supports the rationale for being totally smoke free, to reduce the harm associated with tobacco use among the Trust’s staff, patients, visitors and the wider community, especially the harm caused by second hand smoke. For the purpose of this policy smoking is defined as the burning of lighted cigarette, cigar, pipe or any other matter of substance that contains tobacco.
1.
Introduction
Smoking is the largest preventable cause of death and ill health in the world today. It is estimated that in the UK 88,800 people die each year from smoking related diseases, (DH, 2004). It is estimated that in the Yorkshire and Humber region there are 9700 deaths attributable to smoking, (GOYH, 2007). Almost all enclosed workplaces have been smoke free in England since July 2007. It is estimated that this will help save thousands of lives over the next decade and protect people from the harmful effects of second hand smoke, (Smokefree England, 2007). All NHS premises were required to become smoke free by the end of December 2006 as stated in the White Paper ‘Choosing Health, Making Healthier Choices Easier.’ (2004). NHS Kirklees recognises its role in setting an example with regard to smoking and health: to its own staff, the patients who use its services and to the public generally, which naturally look at the Health Service to provide a guide on matters of health and illness. As part of this commitment, appropriate advice and support will be offered by Kirklees Stop Smoking Service (outlined in appendix F) for anybody who would like to stop smoking. This policy is concerned with where people smoke at work, not about whether they smoke. NHS Kirklees upholds the legislation and staff, patients, contractors and visitors who do not smoke should have the right to breathe smoke-free air. Non-smoking is the practice in all of the Primary Care Trust’s premises.
2.
Associated policies & procedures
A flow chart for guidance in relation to home visits has been developed (appendix E) which sets out NHS Kirklees commitment to protecting its staff from second-hand smoke. All staff visiting or treating service users in their own homes are entitled to the same level of protection as those working in NHS Kirklees premises.
3.
Aims and objectives
3.1
To comply with the Health and Safety Act 1974, which places a duty on employers to provide a work environment that is safe and without risk to health To comply with the recommendations in ‘Choosing Health’ which requires all NHS premises to be smoke free To protect all staff, visitors and patients from the harmful effects of second-hand smoke To encourage and support those smokers who wish to stop smoking To comply with the 2007 smoke free legislation
3.2 3.3 3.4 3.5
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4.
Scope of the policy
This policy must be followed by all NHS Kirklees employees. It must be followed by all staff who work for NHS Kirklees, including those on temporary or honorary contracts, bank staff and students. Breaches of this policy may lead to disciplinary action being taken against the individual. Independent Contractors are responsible for the development and management of their own procedural documents and for ensuring compliance with relevant legislation and best practice guidelines. Independent Contractors are encouraged to seek advice and support as required. This policy should be drawn to the attention of all job applicants and to people who work under contract to NHS Kirklees. All staff that work in a caring environment and come into contact with smokers as part of their core role should be giving advice to quit and referring to local stop smoking services. (NICE 2006). Training on giving brief advice to smokers is provided by the Trust and all staff are strongly advised to attend.
5.
Accountabilities and Responsibilities
5.1 Administration of the policy It is the role of every member of staff to ensure that the Trust remains smoke-free. It is the responsibility of line-managers to ensure staff adhere to the Policy. Any staff that are found to be contravening this policy may be subject to disciplinary action. 5.2 Senior Management The Director of Public Health is the Board level director with responsibility for this policy. 5.3 Management Managers should promote good practice and ensure staff are aware of the policy. 5.4 Kirklees Stop Smoking Service In cases where specialist support is needed, Kirklees Stop Smoking Service will provide tailored support to the individual’s needs. Clinics are available across Kirklees as well as evening appointments. Patients will receive weekly support and medication to help with withdrawal on prescription. 6.
Core principles of the policy
Smoking will be prohibited on all premises used by the Trust, whether owned or rented, including entrances to buildings, grounds and car parks. Smoking is not allowed in any vehicle when the member of staff is carrying out activities in connection with their employment. 6.1 Smoking by users, visitors and contractors The policy applies to all visitors, service users and contractors while on Trust premises. 6.2 Smoking by staff The policy applies to all staff, including bank, temporary staff and students while on Trust premises. Staff are viewed as ‘role models’ for the Trust and therefore will be encouraged not to smoke while on Page 5 of 13
Trust business elsewhere and to comply with the smoking policies in force in other locations or premises not owned or rented by the Trust. Staff who want to quit will be offered support to stop smoking by the local stop smoking services. Time off to attend stop smoking sessions may be given at the discretion of individual line managers. Line managers will be encouraged to look favourably upon staff who seek support to quit smoking. Staff are not permitted ‘smoking-breaks’ during their normal working hours, and will only be allowed to smoke during existing break entitlement. 6.3 Protecting staff from second hand smoke. This policy does not cover the significant proportion of Trust duties delivered in other venues, particularly client homes. The attached guidance (appendix D and E) clarifies how existing Trust policies should be applied to situations where staff are exposed to second-hand smoke, and clarifies how the Trust will support staff to make such decisions to protect their own health and safety. Before the first appointment staff should inform patients about the policy, which aims to provide safe work environments for all staff.
7.
Equality Impact Assessment
All public bodies have a statutory duty under the Race Relation (Amendment) Act 2000 to “set out arrangements to assess and consult on how their policies and functions impact on race equality.” This obligation has been increased to include equality and human rights with regard to disability age and gender. NHS Kirklees aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. In order to meet these requirements, a single equality impact assessment is used to assess all its policies/guidelines and practices. This Policy was found to be compliant with this philosophy (see appendix C). 8.
Training Needs Analysis
Brief Interventions for Stopping Smoking – contact Training Department on 01924 351479 for more information. Conflict Resolution – mandatory training provided by the PCT.
9.
Monitoring Compliance with this policy
9.1 All Trust premises are smoke free – legal requirement All staff are responsible for ensuring that this policy is adhered to. Anybody found smoking on the premises will be encouraged to seek support and help to enable them to stop smoking. If all means have been exhausted in assisting them to comply with the Policy and they continue to smoke on the premises, this will be treated as a disciplinary offence. All members of staff, irrespective of grade or discipline, are responsible for making the policy work. Staff and visitors who ignore the policy should be politely requested to comply, avoiding confrontation.
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All staff should receive full support of their managers in enforcing this policy. Training in conflict resolution and giving brief advice to smokers should be attended to help with the difficult nature of this policy. 9.2
Monitor the referrals to Kirklees Stop Smoking Service of staff and patients quarterly
10.
References
Department of Health (2004). Choosing Health: Making healthier choices easier, London, DH. Available at www.dh.gov.uk Department of Health (2007) World Class Commissioning Competencies. Available at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_0 80958 Government Office for Yorkshire and Humber (2007) Tobacco control. Available at www.gos.gov.uk/goyh/health/improv/tobcontrol/ National Institute of Clinical Excellence (2006). Brief Interventions and referral for smoking cessation in primary care and other settings. Available at www.nice.org.uk Smokefree England (2007). England Becomes Smokefree on 1st July 2007. HM Government. Available at www.smokefreeengland.co.uk/files/how_new_sf_law_affect_u.pdf West, R., McNeil, A., and Raw, M. (2000) smoking cessation guidelines for health professionals: an update, Thorax, 55, pp. 987-999
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11.
Appendices
A. Definitions No definitions necessary to explain.
B. Key stakeholders consulted/involved in the development of the policy
Stakeholders name and designation Deborah Collis Rebecca Elliott Health Improvement Practitioner Specialist Tobacco Sam Royal Clinical Governance Coordinator Tina Quinn Assistant Director in Kirklees Community Healthcare Services HR Policy Development Group
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Key Participant Yes/No Yes
Feedback requested Yes/No Yes
Feedback accepted Yes/No Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes Yes
Yes Yes
C. Equality Impact Assessment Tool To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval. Insert Name of Policy / Procedure Smokefree Policy 1.
Yes/No
Comments
Does the policy/guidance affect one group less or more favourably than another on the basis of: • Race
No
• Ethnic origins (including gypsies and travellers)
No
• Nationality
No
• Gender
No
• Culture
No
• Religion or belief
No
• Sexual orientation including lesbian, gay and bisexual people
No
• Age
No
• Disability - learning disabilities, physical disability, sensory impairment and mental health problems
Yes
2.
Is there any evidence that some groups are affected differently?
No
3.
If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable?
No
4.
Is the impact of the policy/guidance likely to be negative?
No
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?
N/A
People with some of these disabilities may not reasonably understand a request not to smoke.
If you have identified a potential discriminatory impact of this procedural document, please refer it to Rachel Spencer, 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 Rachel Spencer 01924 351422.
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APPENDIX D Guidance to staff who undertake home visits in which there is second-hand smoke present. Staff who visit clients in their own homes are entitled to work in a smokefree environment where this is reasonably practicable. The PCT is developing a smokefree workplace in relation to staff working in other people’s homes. In the meantime here is some advice on steps to take when visiting clients who smoke; •
• • • • •
Undertake a risk assessment, which should include any other relevant risks, for example if the client is smoking while on oxygen therapy, or if you are particularly at risk, i.e. pregnant or have a health condition which may be exacerbated by the presence of second hand smoke such as asthma. Prior to the visit request that they or their families do not smoke during the visit, or for an hour prior to the visit. Line managers to provide a letter to the client with the above request. If the client refuses to comply with this request, the line manager can ask for and arrange an alternative venue for the appointment where reasonably practicable. The risk manager should be consulted if the client/other occupants turn down this request. Ask the client/family if they would like help to stop smoking and if so refer to the local Stop Smoking Service.
Please note that a sensible approach should be taken when a patient/patients family has for example learning difficulties or a mental health problem that means they could not reasonably understand a request for them not to smoke. Staff should also bear in mind any extenuating circumstances, for example if the patient has suffered bereavement or is under considerable stress.
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Appendix E NHS Kirklees flow chart
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Appendix F Kirklees Stop Smoking Service Page 12 of 13
Kirklees Stop Smoking Service offers personalised one to one support and drop in sessions for anyone wanting help to stop smoking. The support sessions provide advice on medications to help with withdrawal as well as intense behavioural support. Evidence indicates that the most effective strategy to support smokers to quit is a combination of behavioural support, complemented by the use of stop smoking aids, (West et al, 2000) Nicotine Replacement Therapy, Zyban or Champix. If employees would like further information or advice about stopping smoking, they are encouraged to contact Kirklees Stop Smoking Service on 01924 351498 (North) or 01484 344285 (South).
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