- Background
- Rationale
- Scope
- Aims
- Responsibilities
- Smoking cessation support for patients
- Smoking cessation support for staff
- Non complaince
- Contractors
- Signage
1. Background
This policy underpins the trust’s intention to have a smoke-free environment, for the benefit of all patients, staff and visitors. It re-enforces the Royal Devon & Exeter NHS Foundation Trust’s (RD&E) health promotion role as a health care organisation. The policy recognises that second hand smoke adversely affects the health of all employees. It is not concerned with whether anyone smokes, but with where they smoke and the effect this has on patients, visitors and other members of the wider health community.
The key objectives of the policy are:
-
To protect and improve the health and safety of staff, patients and visitors.
-
To implement the Chief Medical Officer’s recommendations on smoking in NHS organisations.
To motivate and support smokers who wish to quit by providing smoking cessation advice.
2. Rationale
Smoking is the leading most preventable cause of death and disease in the UK. There is much evidence to support a move to a smoke-free environment. Some key facts include:
-
Passive smoke contains over 50 known carcinogens. The increased risks for adults who live with smokers are: lung cancer 20-30%; heart disease 25%. For children they are: sudden infant death syndrome 50%; lower respiratory tract illness 50%; asthma 50%; middle ear disease 40% (CMO Annual Report 2002).
-
In general, staff who smoke have higher sickness rates and should be helped to quit. Fichtenberg & Glantz’s 4 systematic review suggests that totally smoke-free workplaces where none currently existed can reduce overall smoking prevalence by around 4%.
-
Smoking outside entrances (and in other public places) presents a poor image.
-
Smoking can present a fire safety hazard. Section 2(2)(e) of the Health and Safety at Work Act 1974 places a duty on employers to “… provide and maintain a safe working environment which is, so far as is reasonably practical, safe, without risks to health, and adequate as regards facilities and arrangements for their welfare at work.”
Smoking has an extremely wide health impact and is cited in the following NHS documents:
-
Smoking Kills (DoH 1998)
-
NHS Cancer Plan DoH 2000)
-
NHS Plan (DoH 2000)
-
Coronary Heart Disease NSF (2000)
-
Older People NSF(2001)
Smoking cessation is about disease prevention and health organisations have a duty of care to staff and patients for both physical and mental health. Completely smoke-free hospitals and grounds create a smoke-free environment for people trying to stop smoking and removes triggers that cause many to smoke or relapse to smoking. The availability of a national network of specialist NHS Stop Smoking Services means that support is easily accessible for patients and staff. If smoking is allowed at entrances and outside buildings, the smoke will drift in through doors and windows thereby continuing to be a health hazard. In addition people dislike the smell of cigarette smoke on others. If employee smoking is allowed on site, this can weaken patient’s and staff’s attempts to stop.
3. Scope
The Trust acknowledges that breathing other people’s smoke is both a public health hazard and a welfare issue. The policy concerns smoking on all RD&E sites and buildings which include:
-
RD&E Wonford Hospital - all areas and buildings including the Residential Village
-
Accommodation and the Gladstones Social Club
-
Mardon Centre
-
Exeter Mobility Centre
-
Newcourt House
-
Honeylands
-
Bell House (Marsh Barton)
-
Heavitree
Having smoke-free grounds as well as buildings sends a strong message from the organisation about the established dangers of smoking and second hand smoke. People smoking at the entrance to NHS buildings give a very poor impression of the health organisation and this also means that those entering and leaving the buildings have to pass through tobacco smoke. People in the buildings who work or are treated near to open windows are also exposed to other people’s smoke.
4. Aims
The aim of this Policy is to:
-
Protect and improve the health of staff
-
Protect and improve the health of patients, visitors and contractors
-
Protect both smokers and non-smokers from the danger to their health of exposure to second hand smoke
-
Set an example to other employers and workforces particularly in health related locations
-
Demonstrate the Trust leadership role in health promotion by arranging for Trust buildings, properties and vehicles to be smoke-free and requiring staff not to smoke while on site.
5. Responsibilities
This policy will apply to all staff, patients, visitors, contractors and other persons who enter the RD&E for any purpose whatsoever. Responsibility for implementing this policy rests with the Chief Executive. Day to day responsibility for implementation rests with Directors and Managers.
6. Smoking Cessation support for Patients
Patients will be advised of the new policy on admission via communication methods such as the website and patient information leaflets. Coming into hospital presents many patients with an ideal opportunity to stop smoking. The RD&E will provide practical help, support and advice to patients who wish to take advantage of this opportunity. On admission the smoking status of all patients will be recorded and the patient will be asked if they wish to be referred to a smoking cessation advisor.
Patients who are admitted electively will be encouraged to seek the advice of their GP if they feel they will need Nicotine replacement therapy (NRT) for the duration of their hospital stay. Patients admitted as an emergency, and who smoke, will be offered NRT support in accordance with the Joint Formulary which can be accessed through ComEx.
Breaches of the smoking policy by patients will be reported to the manager, (or their representative), of the relevant clinical/non clinical area. If applicable, the clinical area may be asked to provide an escort to return the patient to their own ward or department. The Clinical Manager and the Patient Care Team should be informed of the event and decide upon appropriate action. Patients should be informed that staff will not support them in smoking.
7. Smoking Cessation support for Staff
The role of the Occupational Health Service (OHS) is to support staff and to assist the Trust in its legal duty to protect the Health, Safety and Welfare of all its employees. The OHS will assist with the delivery of information about the smoke-free policy and advice on resources available to assist with quitting smoking. This will be achieved by:
-
Delivery of an Occupational Health presentation to include information regarding smoking at the weekly corporate induction.
-
Appropriate displays in the Occupational Health department waiting rooms.
-
Liaising with PCT Smoking Cessation Services and Health Information Centre.
-
Participating in National Smoke Stop Initiatives.
In addition all occupational nursing and medical staff will undertake an opportunistic enquiry about smoking habits when appropriate and provide information and advice about smoking cessation opportunities with onward referral to the smoking cessation group leader as requested.
Smoking cessation groups will be available for staff who are motivated to quit smoking via the occupational health service (OHS). The groups will run for a period of six weeks and participants will be able to benefit from peer support. An assessment for appropriate NRT will be undertaken for those who request it. NRT is available on prescription via the individual’s GP.
The OHS will be in a position to support managers in their efforts to ensure that all staff adhere to the policy. Managers may refer members of their staff who are having difficulty in complying with the policy.
Individual members of staff may self-refer to the OHS for an appointment with an Occupational Health Advisor who has undergone training in brief and intermediate interventions for information, advice and support in relation to smoking cessation issues.
8. Non compliance
Staff who do not comply with the policy will be interviewed by their line manager and referred to Occupational Health for support and advice as appropriate. Should an individual or group of individuals continue to infringe this policy the manager may invoke disciplinary procedures as a means of encouraging adherence to the Policy. Patients and Visitors who refuse to comply with this policy may be removed from the site.
9. Contractors
Tenders and contracts with the RD&E will stipulate adherence to this policy as a contractual condition. Existing contacts will be modified as soon as possible.
10. Signage
To ensure that everyone entering the RD&E understands that smoking is not allowed in the buildings or the grounds, clear signs will be on display.