Paper 2
NHS GRAMPIAN BOARD
Tobacco Policy Review: Heads of Agreement
Aim
The Board is asked to note the progress of the policy development and endorse the Heads
of Agreement developed through the Tobacco Policy Review Group in partnership with the
Grampian Area Partnership Forum.
Strategic Context
Creating a Tobacco-Free Generation: A Tobacco Control Strategy for Scotland (Scottish
Government, 2013) requires all NHS sites in Scotland to be completely smoke-free by
March 2015. Locally, Tobacco Control 2020 sets out actions to support delivery of this
aim, in particular, action to revise the NHS Grampian Tobacco Policy.
The NHS Grampian Tobacco Policy 20061 has been reviewed to meet the requirements of
CEL 01 (2012)2 Health Promoting Health Service: Action in Hospital Settings and will be
further revised to meet the above national strategy requirements. NHS Grampian should
be an exemplar in providing a smoke-free environment.
The policy will require to cover the use of all tobacco related products and not just
cigarettes. Electronic cigarette use is increasing and should be treated in the same way as
normal cigarettes.
Discussion
Despite the clear benefits that smoke-free legislation has delivered, the harms from
second-hand smoke (also called environmental tobacco smoke) remain. The World Health
Organisation (WHO) states 'there is no safe level of exposure to tobacco smoke' and
creating 100% smoke free environments is the only way to protect people.
Second-hand smoke accounts for 1 in 10 tobacco-related deaths.
In adults, second-hand smoke causes serious cardiovascular and respiratory diseases,
including coronary heart disease and lung cancer. In infants, it can cause sudden death.
In pregnant women, it causes low birth weight.
• Separate or ventilated smoking areas do not protect non-smokers from second-hand
smoke.
• Young people exposed to second-hand tobacco smoke at home are 1½-2 times more
likely to start smoking than those not exposed.
•
•
(WHO Fact File: 10 facts on second-hand smoke www.who.int/features/factfiles/tobacco/en/)
Studies suggest that where smoke-free work and public places are the norm, parents are
more likely to make their home a smoke-free zone. Furthermore, smoke-free workplaces
encourage smokers to quit. The corresponding reduction in smoking among adults means
that fewer children are likely to be exposed to smoke in the home (Action on Smoking and
Health (ASH) Research Report).
(ASH Second-hand smoke impact on children
www.ash.org.uk/files/documents/ASH_596.pdf)
1 NHS Grampian Tobacco Policy (2006) Found at:
http://intranet.grampian.scot.nhs.uk/ccc_nhsg/13246.1230.html?pMenuID=460&pElementID=1230.
2 Chief Executive Letter 01 (Scottish Government, 2012). Found at: http://www.sehd.scot.nhs.uk/mels/CEL2012_01.pdf.
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The benefits of implementing a Tobacco Policy in a workplace go much wider that then
workplace itself.
Heads of Agreement
The NHS Grampian Tobacco Policy (2006) was reviewed in 2009 and since then an
exercise to ensure optimal implementation has taken place. Through partnership
arrangements, a consensus has developed that supports the need for change to meet the
strategic context outlined above. The Heads of Agreement is a clear statement of the
principles that underpin the proposed new policy. Following consultation a full policy
document will be prepared for implementation in 2014.
Implementation
The implementation process for this type of policy can be challenging. However, the
timescales and principles have been agreed in collaborative partnership with staff side
representatives. Maintaining this partnership will help overcome any challenges.
Staff and patients who experience nicotine addiction will be offered support through the
NHS Grampian smoking cessation programme. Like any member of the local community
our staff will have access to pharmaceutical nicotine and smoking cessation support free
of charge.
A programme of marketing, communication and training will be used to encourage and
promote the policy implementation.
Stakeholder Involvement
The stakeholders in this policy are NHS Grampian, patients, carers and visitors, staff and
all users of NHS Grampian sites and premises including contractors, tradesmen, those
who smoke and the majority who do not.
The Tobacco Policy Review Group has staff-side representation arranged through the
partnership structure.
A comprehensive consultation and communication process on the “Heads of Agreement”
is underway involving patients, staff and other users of NHS Grampian sites and premises
through a range of different media and channels of communication.
Impact assessment of the new policy will be carried out by the Equality and Diversity
Manager on completion of this consultation and once a final policy with implementation
guidance is complete. This will ensure that the policy meets the requirements of the
Equality Act 2010.
Implications
The policy will be effective if it is implemented consistently across all NHS Grampian sites,
at all levels in the NHS Grampian workforce and consistently with all visitors and patients.
This will require senior sponsorship and ownership of implementation by the Executive
Team and senior managers.
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Training on our Tobacco Policy will be offered to a range of staff. This will explain how to
approach and discuss issues with people smoking on NHS sites. It will be targeted at, for
example, security and frontline staff so that they are able to support implementation of the
Tobacco Policy.
All staff, but primarily health professionals, will be encouraged to use brief interventions to
raise the issue of smoking with patients/smokers attending for care. These brief
interventions may extend to carers and friends where it would support better health
outcomes for patients.
Other resource implications may include:
• Sectors will need to address all local costs arising from the implementation of the Policy
this will include signage, which will need to be enhanced to support implementation of
the policy
• Increased prescribing of nicotine replacement may be required to support compliance
with the policy. However, patients and staff who are smokers will be able to access
smoking cessation support either through their GP, the Smoking Advice Service or
through their local pharmacy Smoking Cessation Service (138 outlets) across Grampian
• Enhanced training for security staff at our major facilities in the lead up to full
implementation
• An e-learning package to train staff in brief intervention and their responsibility for
implementing the Tobacco Policy has already been developed.
Key Risks
There are a number of risks associated with not providing a smoke-free environment
including compromising patient safety, protecting our staff, financial risks arising from
increased costs of smoking related ill-health. These risks are being managed through our
current policy but action will be strengthened through the policy revision.
Conclusion
It is essential that this work is taken forward in the proposed timescale. This will happen
most successfully:
- in partnership with staff
- with strong sponsorship from senior management
- by proactive management with patients/visitors and staff.
In order to ensure progress, this issue should be added to the Board’s performance
reporting system and reported through the Tobacco Policy Review Group (TPRG) with
governance through the Tobacco Control Strategy Group (TCSG).
Executive leadership will be a joint responsibility between the Director of Workforce, who is
the Tobacco Control Strategy Group Chair, and the Director of Public Health.
Recommendations
The Board is asked to:
1. Note and endorse the Heads of Agreement and the proposed arrangements for
delivering the new Tobacco Policy for implementation during 2014.
2. Support development and implementation of the new Tobacco Policy so that NHS
Grampian is smoke-free by March 2015.
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Background papers/supporting information
1.
2.
3.
4.
5.
Creating a Tobacco-Free Generation: A Tobacco Control Strategy for Scotland,
Scottish Government, 20133
NHS Grampian Tobacco Policy 2006
Tobacco Control 2020 Action Plan, NHS Grampian, 2012
CEL 01 (2012) Health Promoting Health Service: Action in Hospital Settings
E-cigarettes and NHS Tobacco Polices – Position Statement by Scottish Directors of
Public Health (2013)
Executive Leads
Dr Annie Ingram, Director of Workforce
Sir Lewis Ritchie, Director of Public Health
Ray Watkins, Head of Health Improvement,
Derek Petrie, Tobacco Control Coordinator
July 2013
3
Creating a Tobacco Free Generation: A Tobacco Control Strategy for Scotland. (Scottish Government,.
2013) Found at: http://www.scotland.gov.uk/Publications/2013/03/3766.
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Appendix 1: Heads of Agreement; NHS Grampian Tobacco Policy: May 2013
1. People using NHS Grampian sites are entitled to breathe fresh air and should not
be exposed to tobacco smoke.
2. Smoking is prohibited in all NHS Grampian buildings, premises, sites and vehicles.
This applies to all staff, students, patients, visitors and to staff from external
agencies and contractors. It applies to company vehicles, light and heavy goods
vehicles and to private vehicles used by staff as part of their work and for carrying
passengers.
3. Staff should not smoke in uniform, work clothes, or when otherwise identifiable as
on NHS Grampian business.
4. All staff should actively implement the Tobacco Policy.
5. Risks associated with smoking will be routinely indentified, managed and monitored
through mandatory Health and Safety arrangements at local level.
6. NHS Grampian recognises that many people who habitually use nicotine have
become addicted, that they feel great discomfort without nicotine and meet this
need by smoking.
7. NHS Grampian will not support tobacco smoking as a way to use nicotine but
intends to help manage the discomfort of withdrawal in a sensitive manner.
8. To prevent the discomfort of nicotine withdrawal:
a. People who have a habitual need to use nicotine are asked to use a safe,
medically approved form of nicotine while using NHS Grampian sites or
premises.
b. Safe forms of nicotine will be prescribed to in-patients who need it.
9. To reduce the harm caused by smoking:
a. Visitors and staff who smoke will be routinely offered support to stop
smoking.
b. Routine brief advice on the benefits of not smoking and referral to smoking
cessation services will be a feature of all clinical pathways.
10. This policy will also apply to any device designed to represent a cigarette, for
example unregulated electronic cigarettes. Until medical regulation or evidence of
safety is produced these products should only be used in designated smoking
areas.
11. A revised NHS Grampian Tobacco Policy will be introduced in 2014
12. This will be implemented through a detailed implementation plan so that NHS
Grampian is completely smoke-free by March 2015.
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