MANAGING HEALTH AT WORK
Guideline 3 Tobacco, alcohol and other substances
In Scotland, smoking is judged to be the single most important contributor to ill health, and the cost to NHSScotland of treating smoking-related illnesses is enormous. The cost of employee smoking is also significant. Parrot et al (2000) estimated that the annual cost of employee smoking in Scotland may be in the region of 450 million as a result of lost productivity, 40 million from higher rates of absenteeism among smokers, and 4 million as a result of fire damage.
One of the most important issues concerning tobacco use is the impact of environmental tobacco smoke (ETS) on non-smokers. The weight of evidence directly linking ETS to ill health in non-smokers has been building considerably. In 1988 (revised 1992) the HSE published guidance for employers, Passive Smoking at Work, which explains what should be done in order to comply with health, safety and welfare regulations as they apply to ETS.
The HSE is developing an Approved Code of Practice (ACoP) on passive smoking at work. When adopted, this will provide authoritative guidance on minimum standards employers will be expected to reach. There has also been a voluntary code of practice published by ASH Scotland and HEBS on Smoking in Public Places, which is relevant to staff caring for long-term patients. These codes should provide guidance for those who are exposed to ETS when visiting patients' homes, and those who care for long-term patients in hospitals and homes.
Action to consider
Actively promote the workplace tobacco policy to make sure that non-smokers are protected from exposure to ETS at all times.
Monitor, review and evaluate the policy regularly (at least once every two years).
Provide advice, guidance and support services for staff who want to stop smoking, information, advice on nicotine replacement therapy (for example, patches, chewing gum, inhaler) and, if feasible, facilitate stopping smoking groups or encourage staff to visit stopping smoking services in the community.
Promote the HEBS SMOKELINE service.
3.2 Alcohol, drug and other substance misuse
Alcohol misuse is a direct cause of ill health as well as a key factor in domestic violence, road, fire and other accidents. Drinking, even at modest levels, also affects behaviour at work, impairing judgement and co-ordination, may cause problems in relationships and even put lives in danger. Many working days are lost as a result of alcohol-related sickness, and the resulting cost and inconvenience is considerable. Drugs and other substance misuse can equally affect health, wellbeing and safety. Many organisations are now developing integrated substance misuse policies which take account the misuse of alcohol, drugs and other substances.
Action to consider
Actively promote the workplace substance misuse policy to make sure that staff are not under the influence of alcohol or drugs while at work.
Provide information, support and advisory services for staff who want to change their lifestyles.
Have a clear disciplinary procedure for staff whose work and behaviour is affected.
Monitor, review and evaluate the policy regularly.
3.3 Drug testing at work
Government statistics show that drinking alcohol and taking drugs are on the increase. NHSScotland organisations have a duty of care to patients and visitors to make sure they are not at risk. This has to be balanced with the employment issues related to drug testing. If the performance of a staff member is impaired by the use of drugs or alcohol then the duty of care to patients and visitors may be breached. Failure to comply with health and safety legislation is a criminal offence.
Consumption of drugs and/or alcohol can have an adverse effect on work performance but the relationship is ill-defined. There are legally safe driving limits for alcohol consumption but there are no such clear definitions for other substances. In addition there is also an accepted test for alcohol consumption. This is not the case for many other substances.
Employers have no right to conduct alcohol or drugs tests without the consent of the staff member. It would be unwise to introduce alcohol and drug testing where there is no existing provision in the contract of employment, so proposed changes must be negotiated with staff representatives or with individual staff. Securing the agreement of the workforce to testing is essential except in the cases of pre-employment screening.
There are other general issues to consider in implementing testing including:
choosing the right laboratory;
deciding which drugs will be tested for;
making sure the samples are safe, to make sure samples tested are those provided;
what action will be taken after a positive result.
Testing may be carried out (with prior consent):
when staff are promoted or transferred;
before employment begins;
on a random or unannounced basis; or
following an incident or accident.
Testing for drugs and alcohol is controversial and needs careful consideration. An effective policy for controlling drug and alcohol use in the workplace will put an emphasis on promoting a safe culture.
Model Tobacco policy
1.1 Tobacco smoking is an addictive habit, which causes disability, disease and death, and represents the single largest preventable cause of ill health and mortality in Scotland. Tobacco smoke in the environment is also a health hazard to both smokers and non-smokers.
1.2 In [Name of Organisation], we are responsible under 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 take reasonable care of the health and safety of others.
1.3 In [Name of Organisation], we have a responsibility to set a good example in health promotion and to work towards national targets set to reduce smoking and the incidence of diseases caused by tobacco smoke.
We are also committed to promoting healthy living and non-smoking as the norm. We will do this by establishing a smoke-free environment for all who wish it, while being sensitive to the needs of those who smoke and offering support to those who wish to give up.
1.4 [Name of Organisation] should not profit from direct investment in the tobacco industry, or from the receipt of sponsorship, research grants or donations from tobacco interests.
1.5 This policy and its procedures have been developed and agreed through the local Partnership Forum.
This policy covers all health service premises in [Name of Organisation]. It applies to
patients, including out-patients, day cases, in-patients and long-stay patients;
the wider NHS family (that is, contractors, students, voluntary staff and anyone whose work, study or personal circumstances brings them into contact with the [Name of Organisation]).
3.1 This policy is designed to improve the health of the population of [AREA] by providing a smoke-free environment for all, while offering support to those who smoke and would like to stop.
3.2 No patient, visitor or staff member should be exposed to tobacco smoke against their will. To achieve this, smoking is prohibited within health service premises in [Name of Organisation].
3.3 However, we recognise that it is tobacco smoke, and its effect on those who use it and who are exposed to it, that is the problem, rather than the users themselves. Where it is not practical for staff or patients to access alternative areas to smoke outwith health service premises, limited designated smoking areas may be provided.
3.4 The Smoking Advice Service offers a range of support and advice to anyone who wishes to stop smoking, and this will be promoted across [Name of Organisation].
4 Commitment to a smoke-free environment
4.1 Except in designated smoking areas ( see 5.1), smoking is not permitted
within the buildings of [Name of Organisation];
on its grounds, including:
in any vehicle on health service premises; and
in the vicinity of entrances to hospitals.
The term "entrance" refers to any entrance to an NHS site or building.
4.2 Staff who smoke while in uniform should be aware that this compromises the health promotion message which is fundamental to the role of all NHS staff and that other people, including patients, may find the smell of smoke offensive.
4.3 Visitors are not permitted to smoke, even in designated areas. This does not preclude staff using discretion in situations of extreme distress or grief.
4.4 In [Name of Organisation], we wish to discourage all patients who smoke from doing so while on health service premises. Patients who choose to smoke in a smoking area will be made aware that routine medical care cannot be provided within such an area, though, as in other public areas of the hospital, emergency help may be called. In-patients must inform ward staff if at any time they leave their ward to go to a smoking area.
5 Exceptional circumstances
5.1 In most health service premises, there will be no need for designated smoking areas. However, if practicable on large sites, limited basic, well-ventilated facilities may be made available for smokers (including patients, staff but not visitors), where they may smoke without exposing non-smokers to smoke. On large sites, there may be a need for more than one such facility, the sole purpose of which is to provide an area for smoking other than entrances and/or public areas.
Staff using designated smoking facilities will be required to keep to a code of conduct governing the use of the facility, which should be kept tidy and any rubbish disposed of appropriately. The condition of the facilities will be monitored and withdrawn if continually found to be below an acceptable standard of cleanliness.
Any healthcare premises within [AREA] may agree in partnership not to provide smoking areas.
If it is not possible to provide a designated area, the right of non-smokers to a smoke-free environment will take precedence. Ultimately it is hoped that such areas may not be needed.
5.2 Staff using designated areas will only be permitted to do so during official tea- and meal-breaks. Smokers will not be allowed longer or more frequent breaks than non-smoking colleagues.
5.3 Where hospital accommodation is the patient's home, or where there are acute psychiatric in-patients, local management has the discretion to implement the policy sensitively and to protect the health and welfare of both smoking and non-smoking patients.
5.4 Communal areas are strictly non-smoking. In the interests of fire safety, staff residents are requested not to smoke in their bedrooms.
6 Support to stop smoking
6.1 All smokers who wish to stop smoking shall be given advice and support to help them do so. This support is free of charge and is available from a "menu" of options including one-to-one advice and support groups.
This support is available via the Smoking Advice Service and the Occupational Health Service, and will be widely advertised throughout all health service premises. We may also consider offering therapies such as Nicotine Replacement Therapy at no or reduced cost.6.2 Managers and staff will be offered training in implementing the policy and providing smoking cessation advice. Staff will be trained in the necessary skills to approach smokers politely but firmly, and will be supported by their managers at all levels should the need arise.
7 Policy implementation
7.1 This policy will be communicated throughout the premises of [Name of Organisation]. We will inform patients and visitors of the policy through admission booklets and we will offer advice through staff who have been trained in this.
This policy is part of each staff member's employment documentation and prospective staff must be informed of the policy at interview. The policy will be confirmed to successful candidates in their letter of appointment, at induction and in their contract of employment.
7.2 We will train staff and managers in implementation of this policy. ( See 6.2)
7.3 Managers, staff and Trade Unions/Professional Organisations are jointly responsible for making sure that:
individual staff know, understand and comply with this policy;
contractors or non-NHS staff know, understand and comply with this policy;
action is taken against anyone contravening this policy; and
application of the policy is monitored in their own area.
7.4 Staff are personally responsible for complying with this policy and also for making sure that patients and visitors are aware of and comply with the policy. Any breaches of policy should be communicated to the local monitoring group.
7.5 Staff smoking in areas other than designated areas will be regarded as misconduct, and repeated breaches of this policy will be dealt with under the 'Management of Employee Conduct' policy.
7.6 Visitors who smoke on the premises will be asked not to smoke and will be reminded of this policy.
8 Monitoring and reviewing
8.1 Outcomes and indicators which may be used to evaluate this policy include:
Is the policy effectively and widely communicated?
Is appropriate information available for staff, patients and visitors?
Are staff aware of the policy and its implications?
Is the policy addressed in local and organisational induction programmes?
8.2 At each site a local monitoring group will assess progress and compliance with the policy at regular intervals, reporting achievements and difficulties to the Tobacco Policy Review Group, who will collate the reports for review by [Name of Organisation]'s Board at least annually.
8.3 This policy will be reviewed one year from its effective date, and annually thereafter by the Tobacco Policy Review Group, reporting to the [Name of Organisation] Board.
Model policy for alcohol issues within the workplace
1.1 [Name of Organisation] recognises the need for a policy using a constructive and preventative strategy designed to encourage early identification of alcohol-related problems among our staff. Alcohol abuse frequently affects personal health and social functioning and can impair work capability. The latter can lead to absenteeism, lost time on the job, accidents, loss of training investment, waste, poor judgement and wrong decisions.
1.2 A policy on alcohol-related problems is necessary to:
prevent and reduce the prevalence of alcohol-related work impairment;
reduce the personal suffering of staff with drinking problems; and
create a climate which removes the tendency to conceal, deny, and cover up the problem while providing management, staff and Trade Unions/Professional Organisations with confidence when confronting alcohol-induced loss of capacity.
1.3 The aims of the policy are fourfold:
To alert staff to the risks associated with drinking and to promote an awareness of sensible drinking.
To encourage staff who suspect or know that they have an alcohol-related problem (or who are suspected or known by colleagues to have such a problem) to seek help directly.
Where, if using the 'Management of Employee Conduct' policy, it is suspected or known that the problem is alcohol-related, to offer to refer the staff member to an appropriate agency for assessment, counselling and, as necessary, other forms of help.
To restore effectiveness of any staff member who may need to use this policy.
1.4 This policy and its procedures have been developed and agreed through the local Partnership Forum.
2.1 This policy and procedure applies to measures to be taken to respond to situations involving alcohol or drugs impacting on the workplace.
2.2 Nothing in this policy and procedure is intended to override statutory or national arrangements applying to particular categories of staff.
2.3 The policy and procedure below is drafted in terms of alcohol and alcohol-related problems. It applies equally to other drugs and any drug-related problems.
2.4 [Name of Organisation] regards staff as our most important asset. We wish to help any staff member with an alcohol- or drug-related problem to recover their effectiveness on an agreed timescale.
2.5 The application of the policy and procedure is limited to those instances of alcohol-related problems which affect the capability or conduct of the staff member in relation to their work. The policy does not apply to staff who, because of excessive indulgence of alcohol on random occasions, contravene our standards of safety and conduct. Such cases will be dealt with according to our 'Management of Employee Conduct' policy.
2.6 Whilst this policy is limited to instances which affect the work capability or conduct of our staff, [Name of Organisation] also prohibits the consumption of alcohol during meal-breaks.
3 General principles
3.1 In [Name of Organisation], we recognise that alcohol-related problems are areas of health and social concern, and we want to offer staff with such problems access to help.
3.2 Alcohol-related problems are defined as any drinking, either intermittent or continual, which definitely and repeatedly interferes with a person's health, social functioning and work capability or conduct.
3.3 Staff who suspect or know that they have an alcohol-related problem are encouraged to seek help and treatment voluntarily either through our procedures, or through resources of the staff member's own choosing. This self-referral facility is a key part of the policy.
3.4 The possibility of a staff member having an alcohol-related problem may be brought to light because of problems with health or with work performance or behaviour, or other signs which may lead to action under our 'Management of Employee Conduct' policy. Where a manager identifies a possible problem, and if the staff member agrees, the opportunity for assessment and counselling can be given.
3.5 We recognise that managers and Trade Union/Professional Organisation representatives are not qualified to come to conclusions about whether an alcohol-related problem exists. Our OHS will undertake the critical role in determining whether a problem exists and what help is appropriate. The Director of the Service will ensure that OHS staff have the necessary knowledge and skills to do this, and where necessary will seek assistance from outside agencies.
3.6 In all instances within paragraphs 3.3 to 3.5 above, the encouragement, or offer of an opportunity, to seek and accept help and treatment are made on the clear understanding that:
If necessary, the staff member will be granted leave to undergo treatment and such leave will be treated as sick leave within the terms of the appropriate sick pay scheme.
Where appropriate, formal action in relation to the 'Management of Employee Conduct' policy will be suspended.
On resumption of duties, or on return to work following a period of treatment, the staff member will be able to return to the same job, unless the effects of the alcohol problem makes him or her unfit or unsuitable to resume the same job, or where resuming the same job would be inconsistent with the long-term resolution of the staff member's alcohol problem. When the same job cannot be resumed, every consideration will be given to finding suitable alternative employment. The staff member will be encouraged to seek Trade Union/Professional Organisation representation in discussions regarding alternative employment.
Having accepted help or treatment and resolved the alcohol-related problem, the employee's normal promotional prospects will not be impaired.
3.7 A staff member whose problems are suspected to be alcohol-related and who refuses the offer of referral for diagnosis and/or help and treatment or who discontinues a course of treatment before its satisfactory completion, and who continues to show unsatisfactory levels of work performance, may be subject to action under our 'Management of Employee Conduct' policy.
3.8 Following return to employment, should work performance suffer as a result of alcohol-related problems, each case will be considered individually. If appropriate, a further opportunity to accept and co-operate with help and treatment may be offered.
3.9 The confidential nature of any records of staff with alcohol-related problems will be strictly observed.
3.10 We recognise that there may be occasions when colleagues/ workmates will be placed under stress during the course of treatment and rehabilitation of a fellow staff member with an alcohol-related problem. We will be sensitive to this and are prepared to take appropriate measures to safeguard the interest and welfare of such staff.
3.11 We will apply any national arrangements to particular categories of staff.
3.12 Staff will be advised of the policy and procedures, in particular the arrangements for self-referral.
3.13 Training and guidance will be given to managers and staff organisation representatives to operate the policy and procedure effectively.
4.1 Identifying problems of abuse can come through a self-referral by a staff member (see 4.2 and 4.4) or through a referral by the organisation, normally in light of problems of conduct or capability of a staff member (see 4.6).
4.2 Staff may, at any time, approach the OHS if they are concerned about their consumption of alcohol. As with other contacts with the OHS, all consultations will be treated in the strictest medical confidence.
4.3 Colleagues, managers and Trade Union/Professional Organisation representatives may seek advice informally from the OHS should they require help in dealing with a suspected alcohol problem. These discussions will also be treated in the strictest professional confidence.
4.4 Any staff member may seek help by either:
voluntarily seeking help directly from the OHS or other agency; or
contacting their line manager or HR, when the manager or HR manager will see the staff member as soon as possible and arrange an immediate appointment with OHS.
4.5 OHS will:
assess the nature and extent of the problem and arrange, if indicated, a programme of help;
tell the HR manager if absence from work will be necessary as part of a course of help and/or if the co-operation of the work department is required around the staff member's duties, working conditions or continuing support; and/or
with the patient's consent, liase with the family doctor and outside agencies (for example, Alcoholics Anonymous) to encourage recovery.
4.6 Referral by the organisation
The procedure for this is attached at Annex 1. The effective operation of this procedure depends upon communication and co-operation between the manager, the Trade Union/Professional Organisation representative (if wanted) and OHS. While the process described in Annex 1 uses the normal route of referral as through HR, there will be situations where there will be direct referral and subsequent communication between the manager and the OHS. The manager, HR and OHS should agree the most appropriate line of communication for particular cases. The importance of all parties being kept fully informed is emphasised.
5 Monitoring and reviewing
5.1 Outcome and indicators which may be used to evaluate this policy include:
Is the policy effectively as of widely communicated?
Are staff aware of the policy and its implications?
Is the policy addressed in local and organisational induction programmes?
5.2 This policy will be reviewed one year from its effective date and annually thereafter by the steering group, reporting to [Name of Organisation] Board.
Referral by the organisation
Parrot S., Godfrey C., & Raw M.
Costs of employee smoking in the workplace in Scotland, Tobacco Control, Vol 9, No. 2, pgs 187 - 192, 2000
Recommended further reading
Income Data Services
Alcohol and Drug Policies, Income Data Services Ltd, 1998
Scotland's Health at Work and Scotland Against Drugs
Policies into Practice - Guidelines forDrugs Workplace Policies, HEBS, Edinburgh, 2001
The Health and Safety Executive
Passive Smoking at Work, HSE Books, London, 1997, ISBN 0717608824 Available at: http://www.hse.gov.uk/pubns/indg63.pdf
The Health and Safety Executive
Drug misuse at work. A guide for employers,et al. HSE Books, London, 1998, ISBN 0717624021 Available at: http://www.hse.gov.uk/pubns/indg91.pdf