ALCOHOL AND DRUG MISUSE POLICY - Bolton NHS FT · Misuse of alcohol and drugs by employees of the...

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 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



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.



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.



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



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’



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



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



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.



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



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.

http://www.manchestercat.org/



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



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:

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