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ALCOHOL AND DRUG MISUSE POLICY
Document type: Policy
Version: Three
Author (name and designation) Dr Martin Seed
Consultant Occupational Physician
Ratified by: Executive Directors
Date ratified: 24th December 2014
Name of responsible committee/individual Executive Directors
Name of Executive Lead Mark Wilkinson
Master Document Controller? Sandra Drysdale
Date uploaded to intranet 12th January 2015
Review date: December 2017
Equality Impact
Bolton NHS Foundation Trust strives to ensure equality of opportunity for all service users, local people and the workforce. As an employer and a provider of healthcare Bolton NHS FT aims to ensure that none are placed at a disadvantage as a result of its policies and procedures.
This document has therefore been equality impact assessed to ensure fairness and consistency for all those covered by it regardless of their individuality. The results are shown in the Equality Impact Assessment (EIA).
Version Control Schedule
Version Type of Change Date Revisions from previous issues
V. 3 Update of format
and associated
content
October
2014 Formatted as per 2014 document control policy
with associated addition of ‘Terminology and
Definitions’ section 3 and ‘Policy Implementation’
section 5.
Additional paragraph inserted in 4.2 to provide
guidance for managers when faced with an
intoxicated employee at work. (this was a point
raised during the consultation conducted in 2012)
Essential updates to Appendix C ‘Sources of
confidential help available to the employee with
an alcohol or drug problem.’ Minimal changes to
reflect the same policy for Bolton NHS (Bolton
Primary Care Trust).
CONTENTS
1.0 INTRODUCTION ..................................................................................................................................... 4
2.0 PURPOSE OF THE DOCUMENT ............................................................................................................... 4
3.0 TERMINOLOGY AND DEFINITIONS ......................................................................................................... 4
4.0 DUTIES AND RESPONSIBILITIES OF INDIVIDUALS AND GROUPS ........................................................... 5
5.0 POLICY IMPLEMENTATION .................................................................................................................... 7
6.0 MAIN CONTENT ..................................................................................................................................... 7
7.0 MONITORING AND REVIEW ................................................................................................................... 8
8.0 REFERENCES ........................................................................................................................................... 8
APPENDICES
Appendix A Useful facts about Alcohol and Drugs Misuse
Appendix B Relevant legislation
Appendix C Sources of confidential help available to the employee with an alcohol or drug
problem.
Appendix D Possible warning signs of a substance misuse of an employee
Appendix E Equality Impact Assessment Tool
Appendix F Document Control Tracking
Version 3 Policy Alcohol and Drug Misuse Policy Page 4 of 16
Date 09 January 2015 Next Review Date
ALCOHOL AND DRUG MISUSE POLICY
1.0 INTRODUCTION
Bolton NHS Foundation Trust is committed to ensuring a safe, healthy and productive environment for
patients and employees and to minimise problems arising from the misuse of alcohol and drugs.
Workplace alcohol and drug issues reflect those in society. Alcohol is the most common substance of abuse
in society and the most likely substance to cause problems in the workplace. More than 10 million people
(31% of men, 21% of women) are now regularly drinking above the safe levels set out by government.
Hospital admissions for the three main alcohol specific conditions (alcohol related liver disease, mental
health disorder and acute intoxication) more than doubled in the 11 years between 1995-96 to 2006-07. In
2008 it was calculated that alcohol related problems cost the NHS £2.8 billion each year. If crime and
disorder, social and family breakdown and sickness absence are included, then the cost is said to be in the
region of £25 .1 billion per year.¹
Misuse of drugs is also a societal problem. 10% of 16-59 year olds in the UK were recently found to have
used one or more illicit drugs (appendix A) in the previous year2, the most common being cannabis,
cocaine, ecstasy and amphetamines. Such substances may lead to problems associated with performance
and behaviour of employees as may the misuse of certain prescribed drugs.
Misuse of alcohol and drugs by employees of the Trust is unacceptable if it adversely affects the safety and
efficiency of achieving Trust goals, in particular patient care. However, the Trust also recognises the need to
support any employee who acknowledges a problem with drug or alcohol misuse. This policy is intended as
guidance for managers and employees of Bolton NHS Foundation Trust. It is written in accordance with
relevant legislation (appendix B) and guidance. 3 4 5
2.0 PURPOSE OF THE DOCUMENT
The aims of the policy are:
To ensure that employees’ use of alcohol or drugs does not affect the health and safety of the individuals themselves, their fellow workers, or others with whom they come into contact in the course of their work.
To ensure that employees’ use of alcohol or drugs does not impact on patient care or affect the efficient and effective operation of the Trust’s activities in any other way.
To set out the Trust’s rules on alcohol, drugs and substance abuse.
To provide procedures, whereby employees with an alcohol, drug or substance abuse problem can seek help in confidence.
To outline some of the symptoms and effects of alcohol, drugs and substance misuse and promote health.
3.0 TERMINOLOGY AND DEFINITIONS
Terminology and definitions relevant to alcohol misuse are provided in NICE public health guidance 24,
June 2010. Alcohol-use disorders: preventing the development of hazardous and harmful drinking: 5
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Date 09 January 2015 Next Review Date
Alcohol-use disorders Alcohol-use disorders cover a wide range of mental health problems as recognised within the international disease classification systems (ICD-10, DSM-IV). These include hazardous and harmful drinking and alcohol dependence. See 'Harmful' and 'Hazardous' drinking and 'Alcohol dependence'. Alcohol dependence A cluster of behavioural, cognitive and physiological factors that typically include a strong desire to drink alcohol and difficulties in controlling its use. Someone who is alcohol-dependent may persist in drinking, despite harmful consequences. They will also give alcohol a higher priority than other activities and obligations. For further information, please refer to: 'Diagnostic and statistical manual of mental disorders' (DSM-IV) (American Psychiatric Association 2000) and 'International statistical classification of diseases and related health problems – 10th revision' (ICD-10) (World Health Organization 2007). Harmful drinking A pattern of alcohol consumption that is causing mental or physical damage. Hazardous drinking A pattern of alcohol consumption that increases someone's risk of harm. Some would limit this definition to the physical or mental health consequences (as in harmful use). Others would include the social consequences. The term is currently used by WHO to describe this pattern of alcohol consumption. It is not a diagnostic term. Higher-risk drinking Regularly consuming over 50 alcohol units per week (adult men) or over 35 units per week (adult women). Increasing-risk drinking Regularly consuming between 22 and 50 units per week (adult men) or between 15 and 35 units per week (adult women). Lower-risk drinking Regularly consuming 21 units per week or less (adult men) or 14 units per week or less (adult women). It is also known as 'sensible' or 'responsible' drinking.
4.0 DUTIES AND RESPONSIBILITIES OF INDIVIDUALS AND GROUPS
In order to minimise risks to patients, visitors and employees the following rules will be enforced by the
Trust. They apply equally to all employees regardless of grade or status.
No employee or contractor shall attend or try to attend work when unfit (in the reasonable opinion of management) because of the influence of alcohol, drugs (whether legal or not) or substance abuse.
No employee or contractor shall be in possession of illegal drugs in the workplace (see appendix A for list of illegal drugs).
No employee or contractor shall consume alcohol or illegal drugs, or abuse any substance, whilst at work.
The responsibilities for relevant sections of the organisation listed below takes into account the relevant
legislation (see appendix B) whilst acknowledging that cooperation is necessary in situations that require a
good degree of trust between employer and employee.
Version 3 Policy Alcohol and Drug Misuse Policy Page 6 of 16
Date 09 January 2015 Next Review Date
4.1 Employees
Employees have the primary responsibility for adhering to the above rules and for ensuring that their work
performance is not affected by the effects of alcohol or drug misuse. Breach of these rules may lead to
disciplinary action. They are encouraged to come forward and seek assistance in confidence (see appendix
C for available sources of support) if they feel they have a problem with alcohol or substance misuse as the
Trust will endeavour to support an employee acknowledging a problem and engaging with the professional
help available.
Employees should not (even with the best of motives), ‘cover up’ for or collude with a colleague who is
thought to have an alcohol/drug or other substance misuse problem but instead should encourage the
employee to seek help. Employees have a responsibility to raise any concerns about another employee
whose behaviour may represent a risk to health or safety of employees or patients, with the employee’s
line manager or HR. Any employee receiving a caution or conviction for an alcohol or drug related offence
must consider their duties to report it to their professional regulatory body (e.g. NMC 6).
4.2 Managers
Managers need to be aware of the signs of alcohol/drug and other substance misuse and the effects on
performance, attendance and health of employees (See Appendix D). They should intervene at an early
stage where changes in performance, behaviour, sickness levels, attendance patterns etc are identified, to
establish whether alcohol/drug or substance misuse is an underlying cause.
Managers should ensure that staff are aware of the support available to them should they wish to discuss
any problem in confidence (appendix C). They have a duty to respect confidentiality of information relating
to an employee’s drug or alcohol problem and to inform others only on a need-to-know basis e.g. in Human
Resources or Occupational Health departments.
Managers are responsible for monitoring the performance, behaviour and attendance of employees as part
of the normal supervisory relationship. They need to instigate disciplinary measures where appropriate to
do so and adhere to occupational health advice on fitness for work issues.
If a manager strongly suspects that an employee is working under the influence of alcohol or drugs the
employee should be asked to leave work. The manager should advise the employee not to drive and
document that they have done so. If the employee is considered to be a risk to themselves or others whilst
leaving the Trust grounds then it is at the manager's discretion whether to seek the assistance of Security
personnel. If the manager suspects that the intoxicated employee may still intend to drive home despite
advice not to then it is also at their discretion whether to contact the police.
4.3 Occupational Health
The consultant occupational physician or occupational health nurses may be required to make decisions on
an employee’s fitness for work in relation to an alcohol or drug problem. This may be following a request
by management or based on information arising during a medical consultation. The risk to health and
safety of others, including patients, is a prime concern when making such decisions.
However, the individual employee’s health and wellbeing is also a key concern of occupational health staff
who will seek to promote health in relation to advice on safe use of alcohol in accordance with NICE
guidance.5 Self referrals are encouraged to allow employees to discuss any concerns about their level of
alcohol consumption or drug misuse in confidence.
Version 3 Policy Alcohol and Drug Misuse Policy Page 7 of 16
Date 09 January 2015 Next Review Date
Acknowledgement of alcohol/drug and other substance misuse problems by employees is encouraged, and
advice on available sources of support provided. Medical referrals for treatment and rehabilitation will be
made where necessary but only with the employee’s consent.
Occupational health staff should also be alert to the possibility of an underlying alcohol or drug problem in
employees referred in relation to sickness absence or concerns about health or performance. Strict
confidentiality will be adhered to and the employee’s consent will be sought when disclosure of
information about a drug or alcohol problem to management is thought necessary. There may, however,
be situations when disclosure of personal information without consent is deemed necessary in the public
interest, for example the safety of patients being treated by the Trust.7
4.4 Human Resources
The Human Resources department has a key role in providing advice and support to managers and
employees in situations where difficulties occur as a result of a drug or alcohol problem. It will advise in
possible disciplinary situations and encourage co-operation to achieve referral, treatment, rehabilitation
and recovery of employees with alcohol or drug problems.
5.0 POLICY IMPLEMENTATION
This policy is a point of reference for all Trust employees and its implementation is the responsibility of line
managers, HR advisors and Occupational Health staff as summarised in section 4. Policy review will take
place at the discretion of the Human Resources department in conjunction with the Occupational Health
department.
6.0 MAIN CONTENT
6.1 Identification of an Alcohol or Drug Problem
Any Trust employee concerned about their level of alcohol intake or drug misuse is strongly encouraged to
discuss their concerns with either their manager, in confidence with a doctor or nurse within the
occupational health department or with one of the support agencies listed in appendix C. Such problems
may also come to light following an incident at work, during routine return to work interviews or
occupational health appointments following management referral. Some warning signs are listed in
appendix D.
No formal screening or testing of employees for substances of misuse is currently performed within the
Trust. During clinical assessment of an employee with a possible alcohol problem the occupational health
practitioner may, with the employees consent, take blood samples to help characterise the extent of
alcohol misuse and any adverse health effects. Whilst a serum alcohol concentration may be requested on
such samples the result will only be used to complement the confidential clinical assessment and will not
be used as evidence in disciplinary matters relating to possible intoxication whilst at work, as this would
require ‘chain of custody’ proof of sample identity.
6.2 Rehabilitation
The Trust encourages employees to acknowledge problems with alcohol or drug misuse and will try to
support such employees who need treatment. Support is available through a variety of sources (listed in
appendix C). Some of these may be accessed directly by the employee and others require referral either by
occupational health staff or the employee’s general practitioner. For milder cases the staff counselling
Version 3 Policy Alcohol and Drug Misuse Policy Page 8 of 16
Date 09 January 2015 Next Review Date
service available in Occupational Health may be sufficient. Employees concerned about alcohol or drug
misuse may also arrange to see either the occupational physician or occupational health nurse to discuss
their anxieties in confidence.
The Trust ethos of supporting an employee who acknowledges the need for professional support in relation
to a drugs or alcohol problem will be reflected in the Human Resources department’s approach to
monitoring of associated sickness absence. However the diversity of such problems means that each case
has to be managed on its own merits taking into consideration occupational health reports.
6.3 Disciplinary Process
The Trust will, as appropriate, take a constructive and supportive approach when dealing with employees
who may be experiencing alcohol/drug or other substance dependency/addiction problems. However, an
employee who breaches the rules outlined in this policy puts themselves at risk of facing disciplinary action.
All cases will be dealt with on an individual basis taking into account available evidence and disciplinary
action will be proportionate to the circumstances of the breach of policy. Disciplinary procedures may
occasionally, and at the discretion of management, be suspended if the employee has a medical problem
amenable to treatment for that treatment to be undertaken.
Where evidence warrants, a senior manager may be required to inform the police of illegal drug use or any
activity or behaviour over which there are concerns about legality. The Accountable Officer for Controlled
Drugs for the Trust has responsibilities to report possession of controlled drugs on site, suspicions of misuse
and/or ‘diversion’. Medicines classified as Controlled Drugs which have not been specifically prescribed for
the person in possession and are not connected to their roles and responsibilities within the hospital are
also governed by the Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations 2001.
The appropriate professional regulatory bodies may also need to be informed of allegations of professional
misconduct related to alcohol/drug or other substance misuse by a registered healthcare professional. .
7.0 MONITORING AND REVIEW
The effectiveness of this policy in providing guidance for incidents of alcohol or drug misuse will be
monitored and reviewed by annual meetings involving relevant staff from the Trust Occupational Health
and Human Resources departments. Difficulties in managing situations and cases involving alcohol and
drug misuse will be discussed anonymously and respecting confidentiality at all times. Policy changes will
be considered in order to improve consistency of managing such cases balancing employees’ rights to
rehabilitation and their contractual responsibilities.
8.0 REFERENCES
1. National Audit Office 2008. ‘Reducing Alcohol Harm: Health Services in England for Alcohol Misuse’ 2. British Crime Survey 2005/2006 3. Faculty of Occupational Medicine 2006. ‘Guidance on alcohol and drug misuse in the workplace’ 4. Health and Safety Executive 1998. ‘Drug misuse at Work – a guide for employers’ 5. NICE public health guidance 24, June 2010. Alcohol-use disorders: preventing the development of
hazardous and harmful drinking. 6. Nursing & Midwifery Council, July 2010. Policy for nurses and midwives who have received a
caution or conviction for an alcohol or drug related offence. 7. General Medical Council 2009. ‘Guidance for doctors - Confidentiality’
Version 3 Policy Alcohol and Drug Misuse Policy Page 9 of 16
Date 09 January 2015 Next Review Date
Appendix A – Some facts about Alcohol & Drugs misuse
Alcohol – quantities
Glass of wine (125 ml of 12.5%) 1.6 units
Bottle of wine (12.5%) 9.4 units
Spirit measure 1 unit
Bottle of spirits 28 units
Half a pint of beer (4.5%) 1 unit
Pint of export lager 2.9 – 6 units according to strength
Pint of strong cider 4.6 units
Bottle of low alcohol beer 0.3 units
Lower-risk drinking Men: up to 21 units per week
Women: up to 14 units per week
Increasing-risk drinking Men: 22-50 units per week
Women: 15-35 units per week
Higher-risk drinking Men: more than 50 units per week
Women: more than 35 units per week
For those requiring detoxification, consumption of the order of 200-300 units weekly for men and 100 or
more for women is a common presentation.
The UK legal driving limit is: 80 mg/100mls blood
107 mg/100ms urine
Version 3 Policy Alcohol and Drug Misuse Policy Page 10 of 16
Date 09 January 2015 Next Review Date
Misuse of drugs Act 1971 – classification of drugs
Class A includes: ecstasy, LSD, heroin, cocaine, crack, magic mushrooms (if prepared for use),
amphetamines (if prepared for injection)
Class B includes: amphetamines, methylphenidate (Ritalin), pholcodine, cannabis
Class C includes: minor tranquilisers inc. benzodiazepines, GHB
* It is acknowledged that some listed substances can be found in prescribed or bought over the counter
drugs
Version 3 Policy Alcohol and Drug Misuse Policy Page 11 of 16
Date 09 January 2015 Next Review Date
Appendix B – relevant legislation
Health & Safety at Work Act 1974
Management of Health and Safety at Work Regulations 1999
Road Traffic Act 1988
Misuse of Drugs Act 1971
Data Protection Act 1998
Corporate Manslaughter Act 2008
It should be noted that Addiction to alcohol, nicotine or any other substance does not constitute an
‘impairment’ for the purposes of the disability discrimination provisions of the Equality Act (formerly the
DDA) but a person may be considered disabled due to impairments caused by the effects of such
addiction e.g. liver cirrhosis.
Version 3 Policy Alcohol and Drug Misuse Policy Page 12 of 16
Date 09 January 2015 Next Review Date
Appendix C- Sources of confidential help available to the employee with an alcohol or drug problem.
Local:
1. Occupational Health Department- can be accessed by employee self-referral or management
referral.
2. Bolton Integrated Drugs and Alcohol Service (BIDAS). Self-referral, through Occupational health or
GP.
BIDAS:
Beacon House
69-73 Manchester Road
Bolton
BL2 1ES
Self-present between 10am-12pm or 2pm-4pm Monday to Friday or call 01204 557977 to make an
appointment.
3. Mental health services available through Royal Bolton Hospital NHS Foundation Trust when referral
deemed appropriate by occupational health.
4. The employee’s GP can facilitate appropriate referrals and advice on all aspects of health related to
alcohol misuse.
External to Bolton.
1. Referral through the Occupational Health Department of the employee’s GP to local Alcohol or
Mental health services.
2. Self-referral to any of the alcohol services attached.
All patients can get information about their local Community Alcohol Teams from their GP
Any person experiencing alcohol misuse can access Alcoholics Anonymous.
Tel: 0161 236 6569
Version 3 Policy Alcohol and Drug Misuse Policy Page 13 of 16
Date 09 January 2015 Next Review Date
Preston.
Referal Line: 01772 825 492
Vickerstaffe House
53 Gastang Road
Preston
PR1 1LB
Initial appointment 2 weeks max- followed by 2-
3 wait for 1 to 1 session.
Bury Substance Misuse Service
Phone: 0161 253 6488
Humphrey House,
Angouleme Way,
Bury
BL9 0BQ
Drop in Triage Monday-Friday: 9-11.30 am
Salford ADS
Phone : 0161 703 8873
The Haysbrook Centre,
4 Haysbrook Avenue,
Little Hulton,
Salford, M28 0AY
Phone triage and then 4-6 week wait.
Wigan Alcohol Team
Referal line: 01942 487578
Coops Building,
11 Dorning Street.
Wigan
WN1 1HR
Max Wait 1 week.
Leigh Alcohol Team
Self referral: Phone: 01942 404299.
Kennedy House,
Brinswick Street
Leigh, WN7 2PJ
Will be seen within 2 weeks max.
Manchester CAT;
Self referral. 0161 234 5055
or online at www.manchestercat.org/
Will see patients at a local GP.
Current wait 4-6 weeks for initial assessment.
Version 3 Policy Alcohol and Drug Misuse Policy Page 14 of 16
Date 09 January 2015 Next Review Date
Appendix D
POSSIBLE WARNING SIGNS OF A SUBSTANCE MISUSE BY AN EMPLOYEE
The following signs when occurring in combination or repeatedly may help a manager to suspect that an
employee has a problem with substance or alcohol misuse.
Attendance and performance
Attending work in an obvious intoxicated condition e.g. smelling of alcohol, hand tremors, unkempt.
Difficulties in concentrating on work
Varying and sporadic quality of work
Late arrival for work or high rates of absenteeism especially on Mondays and Fridays
Early departures from workplace and increased rates of sick leave
Frequent late return from breaks
Behaviour
Poor relationships at work, arguing with colleagues
Sudden changes in behaviour, irritability, moodiness
Borrowing money from colleagues
Difficulty in respecting hierarchy within the organization
Safety Hazards
Increased accident rate at both work and home
Carelessness in handling hazardous materials or dangerous equipment
Version 3 Policy Alcohol and Drug Misuse Policy Page 15 of 16
Date 09 January 2015 Next Review Date
Appendix E
EQUALITY IMPACT ASSESSMENT TOOL
To be completed and attached to any procedural document when submitted to the appropriate committee
for consideration and approval.
Yes/No Comments
1. Does the document/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 (including gender reassignment) No
Culture No
Religion or belief No
Sexual orientation No
Age No
Disability - learning disabilities, physical disability, sensory impairment and mental health problems
No
2. Is there any evidence that some groups are
affected differently?
No
3. If you have identified potential
discrimination, are there any valid
exceptions, legal and/or justifiable?
n/a
4. Is the impact of the document/guidance
likely to be negative?
n/a
5. If so, can the impact be avoided? n/a
6. What alternative is there to achieving the
document/guidance without the impact?
n/a
7. Can we reduce the impact by taking different
action?
n/a
If you have identified a potential discriminatory impact of this procedural document, please refer it to your
divisional E and D lead together with any suggestions as to the action required to avoid/reduce this impact.
Version 3 Policy Alcohol and Drug Misuse Policy Page 1 of 16
Date 24th
December 2014 Next Review Date December 2017
Appendix F - Document Control Tracking
To be completed and attached to documents submitted for consideration and approval. After
ratification to be included within appendices
Document Title: Alcohol and Drug Misuse Policy
Author: Dr Martin Seed, Consultant Occupational Physician
New/revised: Revised Policy
Summary:
Formatted as per 2014 document control policy with associated addition of ‘Terminology and
Definitions’ section 3 and ‘Policy Implementation’ section 5.
Additional paragraph inserted in 4.2 to provide guidance for managers when faced with an
intoxicated employee at work. (this was a point raised during the consultation conducted in 2012)
Essential updates to Appendix C ‘Sources of confidential help available to the employee with an
alcohol or drug problem.’ Minimal changes to reflect the same policy for Bolton NHS (Bolton
Primary Care Trust).
Staff/Stakeholders Consulted:
Staff side, JNCC.
Section below to be completed by ratifying committee
Ratifying Committee: Executive Directors
Date presented for Ratification: 24th December 2014
Outcome:
Ratified Y Ratified subject to minor
amendments Not ratified
Comments: