Smokefree Policy. East Cheshire NHS Trust Smokefree Policy Paul Jackson - (January 2016) Page 1

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Smkefree Plicy East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 1

Plicy : Executive Summary: Smkefree Plicy The Trust Smke Free Plicy prhibits smking by staff, visitrs and patients whilst n Trust premises and in the grunds. Supersedes: ECT1561 Descriptin f Updated Cntact details f Hspital and Maternity Amendment(s): Practitiners. This plicy will impact n: All Trust Staff Financial Implicatins: N/A Plicy Area: Nursing and Patients Standards Dcument Reference: Versin Number: 3 Effective 01/02/2016 Date: Issued By: Paul Jacksn Review Date: 31/01/2018 Authr: (Full Jb title ) Paul Jacksn Stp Smking Service Manager Impact Assessment Date: 26.1.16 APPROVAL RECORD Cmmittees / Grup Date Cnsultatin: Medical Specialties SQS meeting 26.1.16 Apprval Cmmittee Medical Specialties SQS Meeting 26.1.16 Ratified by Cmmittee: Medical Specialties SQS Meeting 26.1.16 Received fr infrmatin: Medical Specialties SQS Meeting 26.1.16 East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 2

East Cheshire NHS Trust Smkefree Plicy Intrductin... 4 Ratinale... 4 Aims f the Plicy... 5 Scpe and Respnsibilities... 5 Smkefree Envirnment... 6 Patients and Visitrs... 6 Staff... 6 Envirnment... 8 Implementatin... 8 Enfrcement... 8 Training and Supprt... 9 Mnitring... 9 Resurces... 10 Infrmatin t be added t existing letters/leaflets... 12 Infrmatin fr patients receiving a hme visit... 13 Smkefree Hme Visit Pathway... 14 The term Smking is used t include the use f tbacc prducts in any frm (cigarettes, pipes, cigars etc.). The use f a vapuriser (e-cigarette) is nt currently allwed in Trust prperty and grunds. The future use f vapurisers is under review and the Plicy will be amended as and when apprpriate. East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 3

Intrductin East Cheshire NHS Trust recgnises that smking is still the largest single preventable cause f ill health and premature death in the UK. This plicy applies t all patients and visitrs, including parents and carers f any users f ur services. The plicy applies t all staff emplyed under a cntract f service by ECNHST, including permanent/temprary staff, vlunteers and students. Smking still has a big impact n the health ecnmy f ECNHST, as well as the surrunding cmmunity: Financial cst f lst prductivity due t emplyee smking related breaks and sickness at each NHS Secndary Care Trust acrss Cheshire and Merseyside, estimated t be 27.9 millin. Heart f Mersey Tbacc Cntrl Grup 2013. Smking related hspital admissins in Cheshire East were 2,977 in 2013/2014 csting the lcal NHS 6.8millin. In Cheshire East there are apprximately 1,128 smking related premature deaths per year. www.tbaccprfiles.inf Ratinale The purpse f this plicy is t clearly state the Trusts stance regarding smking and hw the plicy is t be implemented. Cmpliance with the Smkefree Regulatins 2006. Cmpliance with the Health and Safety at Wrk Act ensuring emplyees, patients, visitrs and cntractrs are nt expsed t risks due t smking, secnd hand smke r assciated risks f fire. Cmpliance with the Natinal Institute fr Health and Care Excellence guidance and its recmmendatin t prmte n smking as the nrm fr peple using ur services and a Smkefree hspital envirnment. The Trust s respnsibility t prtect and imprve the health and well-being f all patients, visitrs and staff and cmply with the Health Act 2006. The Trust s public health respnsibility t imprve the health f the lcal ppulatin beynd thse wh are currently receiving health care. The plicy recgnises the Trusts respnsibilities as an emplyer and health care prvider, whilst als recgnising the impact f restrictins n patients. Supprt and assistance will be ffered t smkers wh wish t stp smking by the Specialist Stp Smking Practitiner and, where they are medically suitable, this will include the prvisin f Nictine Replacement Therapy (NRT) r Varenicline (Champix). East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 4

Kickstart Stp Smking Service cntact details: Catrina Hlden (Specialist Stp Smking Practitiner - Hspital) Tel: 01625 66 3729 Mb: 07831 715513 Please phne and leave details n answerphne. Carline Jhnsn (Specialist Stp Smking Practitiner Midwifery) Tel: 01625 66 1163 Mb: 07712 783781 Fr cmmunity supprt please Freephne 0800 085 8818 fr mre infrmatin. Aims f the Plicy T have a Trust wide systematic apprach t supprt n smking whilst n Trust premises. T prvide a Smkefree envirnment fr patients, visitrs and staff. T cmply with Health and Safety Legislatin and Emplyment law. T supprt smkers wh wish t stp r abstain while in hspital. T demnstrate that we are a health prmting rganisatin by prmting gd health and publicising ur cmmitment t reducing smking and its assciated risks. T raise awareness f the dangers f smking and passive smking. T maintain the Trust s cmmitment t have smke-free grunds. Scpe and Respnsibilities The plicy applies t everyne entering r using the Trust s buildings, vehicles and grunds. The plicy applies t all staff identifiable as emplyees f East Cheshire NHS Trust n r ff Trust premises during their wrking hurs, r prviding services t patients n behalf f the Trust in any place, including a patient s hme. East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 5

Managers f all staff emplyed by the Trust are respnsible fr infrming their staff f their bligatins t cmply with this plicy. All staff are expected t actively prmte the plicy and act as rle mdels fr patients and visitrs. Staff are expected t infrm patients and visitrs f the plicy and t actively apply the plicy. Managers are respnsible fr fully supprting any member f staff wh wishes t stp smking, by prviding adequate time during nrmal wrking hurs fr them t receive relevant cunselling and treatment. Managers will be respnsible fr mnitring the plicy in their departments and ensuring that their department is adhering t the plicy. Smkefree Envirnment Patients and Visitrs Patients and visitrs are nt permitted t smke within Trust premises including the hspital grunds. In exceptinal circumstances (eg. extreme distress) temprary alternative arrangements can be made at the discretin f the senir clinical manager. Patients and relatives will be infrmed befre admissin f the Smkefree Hspital Plicy. Hspital in-patients and ut-patients mtivated t stp smking will be ffered specialist supprt frm the Specialist Stp Smking Practitiner - Hspital (details abve). Patients receiving treatment in their wn hmes will be requested nt t smke when Trust staff are present. If this request is denied a mutually acceptable Smkefree venue will be sught. Pregnant smkers will receive clear, accurate and specific infrmatin n the risks f smking and will be ffered specialist supprt frm the Specialist Stp Smking Practitiner - Midwifery (details abve). Clinicians, midwives and ther members f staff wh may be invlved in discussing smking with patients and clients will be ffered apprpriate training t enable them t d s effectively. Staff Accuntability is t the Directr f Nursing, Perfrmance & Quality where the imprtance f n smking is recgnised and prmted and where respnsibility fr patient and carer experience sits. The Directr f Nursing, Perfrmance & Quality is respnsible fr ensuring that: East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 6

The Smkefree Plicy is recgnised as a Trust wide initiative t reduce risks t patients and visitrs and prmte their health and wellbeing. The impact f patient and carer experience is cnsidered and included in the implementatin f this plicy. Effective prtcls are develped t supprt plicy delivery. The 10 minute Very Brief Advice (VBA) e-learning is accessible t all staff. Ensuring systems are established fr mnitring Trust Smkefree status. There is participatin in internal audits as required. The staff Smkefree Plicy is reinfrced acrss the rganisatin. Directrate Management Teams are respnsible fr: Ensuring that all staff are familiar with this and that they knw hw t signpst patients t Kickstart Stp Smking services. Ensuring cmpliance frms part f perfrmance reprting. Being advcates fr the plicy. Releasing staff fr the 10 minutes VBA e-learning. VBA e-learning frming part f lcal inductin. Clinical staff are respnsible fr: Assessing smking status as part f all clinical assessments (Making Every Cntact Cunt). Offering smking cessatin referral t all smkers. Dctrs ensuring Nictine Replacement Therapy (NRT) is prescribed t all in-patient smkers. Advising all planned admissins f the Trust s smke-free plicy and signpsting them t Kickstart Stp Smking services prir t admissin. Pharmacists ensuring there is adequate NRT available in wards and departments. Cntributing t audits as required. Staff are nt permitted t smke whilst n duty, either n Trust premises (including the hspital grunds) r when carrying ut duties ff site, eg. travelling t/frm r in patient hmes. Cntractrs, agency and vluntary staff (temprary r permanent) wrking n the Trust premises shuld bserve the Smkefree Plicy and acceptance f the plicy will be a requirement fr all cntractrs with the Trust. Staff may smke during their unpaid lunch break ff the premises but must ensure their unifrms are cvered in accrdance with the Trust s Unifrm/dress cde plicy. Cnfidential smking cessatin supprt is available t staff wh wish t stp smking via Kickstart Stp Smking Service (details abve). Time ff fr smking breaks is nt permitted. East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 7

Envirnment The Trust will have clear signs at all main entrances t ensure that everyne entering understands that smking is nt allwed inside the Trust premises, buildings r grunds. The Trust will keep grunds free f cigarette ends. The Trust will ensure that the sale f tbacc prducts n Trust premises des nt take place. Implementatin Each Directrate has respnsibility fr the implementatin and mnitring f the patients, visitrs and staff Smkefree Plicy within their sphere f cntrl. Patients and visitrs will be advised that n smking is permitted in the hspital, hspital grunds and fr hme visits thrugh written and verbal infrmatin and ntices. Recruitment prcedures, jb advertisements, jb descriptins and interviews will include reference t the Smkefree Plicy. All inductin sessins and fire lectures will refer t the Smkefree Plicy. Enfrcement All staff have a respnsibility t advise patients and visitrs n the Trust s Smkefree Plicy. When it cmes t the attentin f a Ward Manager/ Head f Department that patients are ignring the Smkefree Plicy, the plicy shuld be discussed with the individual and Stp Smking Service supprt ffered. The difficulty f enfrcing a Smkefree Plicy is acknwledged and staff will expect t receive the full supprt f bth their senir managers and Trust management. Ward Managers /Heads f Departments will be respnsible fr ensuring that the Smkefree Plicy is adhered t by their staff whilst n duty. All staff will receive the full supprt f Trust management in enfrcing this plicy. When it cmes t the attentin f a Ward Manager/ Head f Department that a member f staff is ignring this plicy, the plicy shuld be discussed with the individual and help t cmply with the plicy, with supprt frm the Stp Smking Service if required, shuld be ffered. Repeated breaches f the plicy shuld be dealt with using the disciplinary prcedure. Ward Managers/ Heads f Departments will be respnsible fr ensuring all meetings held utside Trust premises will be Smkefree envirnments. East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 8

Training and Supprt Kickstart Stp Smking Service will ffer access t brief interventin training (VBA) t all clinical staff. Managers and security staff will receive training as part f the brader Cnflict Reslutin Training Prgramme. Patients wh wish t stp smking will be given help and supprt frm Kickstart Stp Smking services. Cntact details fr Kickstart Stp Smking Service shuld be included when details f the Smkefree Plicy is given t patients. Literature giving details f Kickstart Stp Smking Service will be made available fr visitrs, patients and carers. Mnitring The Directr f Facilities and Patient Experience and Kickstart Stp Smking Service will mnitr the effectiveness f the plicy n an annual basis thrugh the fllwing perfrmance indicatrs: Number f referrals t Specialist Stp Smking Practitiner Number f cmplaints NRT issues t patients Levels f envirnmental tidiness Number f smking related fires East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 9

Resurces The fllwing are examples f leaflets, letters and straplines that can be used by Trust services and departments t raise awareness f the Smkefree Plicy. If the main rute f setting up appintments is by telephne, patients need t be verbally tld abut the Smkefree Plicy. Fr example: T prtect staff frm the dangers f secnd hand smke, East Cheshire Trust is asking patients t refrain frm smking during the health care prfessinal s visit and t keep a rm Smkefree fr at least 30 minutes prir t the visit. East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 10

Our Ref: Yur Ref. Date Name Address Address Address Address Department Lcatin Macclesfield District General Hspital Victria Rad Macclesfield Cheshire SK10 3BL Tel: Fax. N. Email: www.eastcheshire.nhs.uk Re: Helping East Cheshire NHS Trust Prvide a Smkefree Envirnment fr ur Staff East Cheshire NHS Trust enfrces a smkefree plicy in line with the smkefree legislatin fr wrkplaces (1st July 2007). We value ur staff and we knw yu appreciate the care they prvide during yur hme visits. In rder t prtect them frm risk f secndhand smke inhalatin we wuld ask that yu fllw these prcedures t help us prvide a smkefree envirnment: Please refrain frm smking during yur hme visit. Please cnduct yur appintment in a rm, which has been smkefree fr at least 30 minutes prir t the member f staff arriving and has als been well ventilated. Please nte that failure t abide by these prcedures may result in yur access t hme visits being withdrawn/alternative smkefree venue arranged. East Cheshire NHS Trust values yur supprt with this matter. Kind regards East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 11

Infrmatin t be added t existing letters/leaflets Add this t existing leaflets: The NHS is Smkefree The trust strngly requests that yu, yur relatives and visitrs d nt smke fr 30 minutes befre a visit frm a member f staff, r prvide a smkefree space fr ur staff t wrk in. Add this t existing letters: Patients shuld refrain frm smking during the healthcare prfessinal s visit and keep a rm smkefree fr at least 30 minutes prir t the visit. East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 12

Infrmatin fr patients receiving a hme visit Take care f the staff wh take care f yu The NHS has a duty f care t imprve health and prtect all f its staff whilst n duty. We wuld therefre appreciate yur help and supprt in refraining frm smking whilst ur staff are visiting yu. T assist us with this culd yu please prvide staff with a Smkefree envirnment? Hw can yu help? In preparatin fr the visit: All rutine visits are pre-bked and yu will be given a time fr the visit. Avid smking inside the huse fr at least 30 minutes befre Trust staff arrive. Open windws and fully ventilate the area. Try t keep ne rm Smkefree, which can be used during the visit. During the visit D nt smke r let anyne else in the huse smke in the area f the visit. Staff respnsibilities Staff are asked t assess whether the envirnment in which they are visiting is safe fr them t prvide their services in line with Smkefree laws. If staff feel that the visit may be unsafe, yu may be ffered alternative treatment ptins. East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 13

Smkefree Hme Visit Pathway Pre-appintment Infrmatin All cmmunicatin with the client must request a smkefree envirnment fr the duratin f the visit On Arrival Request the client t prvide a smkefree envirnment during the visit Client refuses t prvide a smkefree envirnment Assess persnal risk and decide whether r nt it is safe t cntinue, reserving the right t withdraw frm the visit at any time Withdraw Explain reasn fr withdrawal t client and that yur Line Manager will be in cntact. Smkefree Envirnment Prvided Cntinue Visit Dcument any agreement reached with the client in regard t their smking behaviur in all apprpriate recrds Recrd clients smking status and infrm them f the Stp Smking Service and refer if client wants t stp smking Line Manager t discuss the incident with staff Manager t cntact client and explain the plicy and reasns fr it and request a Smkefree envirnment fr the duratin f the visit If client still refuses t cmply the manager can, where apprpriate, arrange fr an appintment t take place within a Smkefree building Give client ntice that care may be withdrawn: advise f their right t cmplain via the Crprate Cmplaints Prcedure East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 14

The Rle f Staff When bking an initial hme visit, it shuld becme rutine t request that a service user shuld prvide a Smkefree envirnment befre and during the visit. The client shuld be aware that Smkefree means a well-ventilated rm, r area where n ne has smked in the previus 30 minutes. In practice, it is likely that mst peple will cmply with such requests frm cmmunity staff. If the client is smking at the time f the visit, then the cmmunity wrker shuld use their judgement as t what they shuld d in the circumstances. It may, fr example, be apprpriate t remind the client, that they shuld prvide a Smkefree envirnment fr staff. The member f staff culd then g back and wait in their car, giving the client a few minutes t finish their cigarette, befre the visit cmmences. There shuld be a recrd f the smking status f each client in their care plan. They shuld als be ffered advice and supprt n hw t stp smking. Cmmunity staff shuld use their prfessinal judgement when deciding whether r nt t implement the Smkefree plicy. There may be sme highly cmplex, r crisis situatins where staff may decide t allw a client t smke; where a smker is very acutely distressed. If a client s cmmunity care invlves a team f peple, all staff in attendance will need t agree t the exemptin, if it were t cntinue. When a client refuses t stp smking during a visit, the member f staff shuld assess their persnal risk and decide whether r nt it is safe t cntinue, reserving the right t withdraw frm the visit at any time. They have the discretin t make alternative arrangements fr the prvisin f services, whilst ensuring at all times that the safety and welfare f the client is nt cmprmised. If this is the case they shuld dcument any discussin they had with the client with regard t their smking behaviur in the apprpriate recrds. The reasn fr withdrawal shuld be explained t the client and that it will need t be discussed with the apprpriate manager. Staff have the supprt f the Trust t make decisins abut services in these cases. Each case shuld be judged n individual circumstances and staff shuld discuss these issues with their line manager. This incident shuld be reprted t the apprpriate line manager as sn as pssible, taking care t ensure that the client is nt put at risk. The Rle f Managers If a member f staff reprts a case f nn-cmpliance with the request fr the client t prvide a Smkefree envirnment, the manager will need t determine hw t prceed based n the duty f care, bth t the member f staff and the client. In these circumstances dcumentatin must be kept, regarding the plicy breach and the actins taken including the decisin-making prcess. The Trust s adverse incident frm shuld be cmpleted where a mre serius incident ccurs, such as if the client des nt cmply and this results in a visit nt taking place. East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 15

Equality Analysis (Impact assessment) 1. What is being assessed? Smkefree Plicy Details f persn respnsible fr cmpleting the assessment: Name: Paul Jacksn Psitin: Stp Smking Service Manager Team/service: Stp Smking Service State main purpse r aim f the plicy, prcedure, prpsal, strategy r service: (usually the first paragraph f what yu are writing. Als include details f legislatin, guidance, regulatins etc which have shaped r infrmed the dcument) East Cheshire NHS Trust recgnises that smking is still the largest single preventable cause f ill health and premature death in the UK. This plicy applies t all patients and visitrs, including parents and carers f any users f ur services. The plicy applies t all staff emplyed under a cntract f service by ECNHST, including permanent/temprary staff, vlunteers and students. 2. Cnsideratin f Data and Research T carry ut the equality analysis yu will need t cnsider infrmatin abut the peple wh use the service and the staff that prvide it. 2.1 Give details f RELEVANT infrmatin available that gives yu an understanding f wh will be affected by this dcument Cheshire East (CE) cvers Eastern Cheshire CCG and Suth Cheshire CCG. Cheshire West & Chester (CWAC) cvers Vale Ryal CCG and Cheshire West CCG. In 2011, 370,100 peple resided in CE and 329,608 peple resided in CWAC. Age: East Cheshire and Suth Cheshire CCG s serve a predminantly lder ppulatin than the natinal average, with 19.3% aged ver 65 (71,400 peple) and 2.6% aged ver 85 (9,700 peple). Vale Ryal CCGs registered ppulatin in general has a yunger age prfile cmpared t the CWAC average, with 14% aged ver 65 (14,561 peple) and 2% aged ver 85 (2,111 peple). Since the 2001 census the number f ver 65s has increased by 26% cmpared with 20% natinally. The number f ver 85s has increased by 35% cmpared with 24% natinally. Race: In 2011, 93.6% f CE residents, and 94.7% f CWAC residents were White British 5.1% f CE residents, and 4.9% f CWAC residents were brn utside the UK Pland and India being the mst cmmn 3% f CE husehlds have members fr whm English is nt the main language (11,103 peple) and 1.2% f CWAC husehlds have n peple fr whm English is their main language. Gypsies & travellers estimated 18,600 in England in 2011. East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 16

Gender: In 2011, c. 49% f the ppulatin in bth CE and CWAC were male and 51% female. Fr CE, the assumptin frm natinal figures is that 20 per 100,000 are likely t be transgender and fr CWAC 1,500 transgender peple will be living in the CWAC area. Disability: In 2011, 7.9% f the ppulatin in CE and 8.7% in CWAC had a lng term health prblem r disability In CE, there are c.4500 peple aged 65+ with dementia, and c.1430 aged 65+ with dementia in CWAC. 1 in 20 peple ver 65 has a frm f dementia Over 10 millin (c. 1 in 6) peple in the UK have a degree f hearing impairment r deafness. C. 2 millin peple in the UK have visual impairment, f these arund 365,000 are registered as blind r partially sighted. In CE, it is estimated that arund 7000 peple have learning disabilities and 6500 peple in CWAC. Mental health 1 in 4 will have mental health prblems at sme time in their lives. Sexual Orientatin: CE - In 2011, the lesbian, gay, bisexual and transgender (LGBT) ppulatin in CE was estimated at18,700, based n assumptins that 5-7% f the ppulatin are likely t be lesbian, gay r bisexual and 20 per 100,000 are likely t be transgender (The Lesbian & Gay Fundatin). CWAC - In 2011, the LGBT ppulatin in CWAC is unknwn, but in 2010 there were c. 20,000 LGB peple in the area and as many as 1,500 transgender peple residing in CWAC. Religin/Belief: The prprtin f CE peple classing themselves as Christian has fallen frm 80.3% in 2001 t 68.9% In 2011 and in CWAC a similar picture frm 80.7% t 70.1%, the prprtin saying they had n religin dubled in bth areas frm arund 11%-22%. Christian: 68.9% f Cheshire East and 70.1% f Cheshire West & Chester Sikh: 0.07% f Cheshire East and 0.1% f Cheshire West & Chester Buddhist: 0.24% f Cheshire East and 0.2% f Cheshire West & Chester Hindu: 0.36% f Cheshire East and 0.2% f Cheshire West & Chester Jewish: 0.16% f Cheshire East and 0.1% f Cheshire West & Chester Muslim: 0.66% f Cheshire East and 0.5% f Cheshire West & Chester Other: 0.29% f Cheshire East and 0.3% f Cheshire West & Chester Nne: 22.69%f Cheshire East and 22.0% f Cheshire West & Chester Nt stated: 6.66% f Cheshire East and 6.5% f Cheshire West & Chester Carers: In 2011, nearly 11% (40,000) f the ppulatin in CE are unpaid carers and just ver 11% (37,000) f the ppulatin in CWAC. 2.2 Evidence f cmplaints n grunds f discriminatin: (Are there any cmplaints r cncerns raised either frm patients r staff (grievance) relating t the plicy, prcedure, prpsal, strategy r service r its effects n different grups?) N evidence 2.3 Des the infrmatin gathered frm 2.1 2.3 indicate any negative impact as a result f this dcument? N East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 17

3. Assessment f Impact Nw that yu have lked at the purpse, etc. f the plicy, prcedure, prpsal, strategy r service (part 1) and lked at the data and research yu have (part 2), this sectin asks yu t assess the impact f the plicy, prcedure, prpsal, strategy r service n each f the strands listed belw. RACE: Frm the evidence available des the plicy, prcedure, prpsal, strategy r service affect, r have the ptential t affect, racial grups differently? Yes N X Explain yur respnse: Any smkers will be treated by Specialist Stp Smking Practitiner. Race is nt a barrier t available treatments. If a patient s first language is nt English, staff will fllw the trust interpretatin plicy. With regards t Eastern Eurpean smkers, their prevalence rates are much higher than the UK. Hwever they d seek supprt in their hme cuntries at an increasing rate. Fr Eastern Cheshire there is a Plish Specialist Practitiner in Crewe (the largest migrant ppulatin) wh can als ffer telephne supprt t Ples in ther areas f Eastern Cheshire. Fr any Eastern Eurpeans ther than Plish, the service fllws the trust interpretatin plicy. The service t these grups is prving very successful. All the resurces are prduced in Plish. Smking cessatin leaflets in ther languages can be accessed via Smkefree.nhs.uk. GENDER (INCLUDING TRANSGENDER): Frm the evidence available des the plicy, prcedure, prpsal, strategy r service affect, r have the ptential t affect, different gender grups differently? Yes N X Explain yur respnse: Any smkers will be treated by Specialist Stp Smking Practitiner. Gender is nt a barrier t available treatments. DISABILITY Frm the evidence available des the plicy, prcedure, prpsal, strategy r service affect, r have the ptential t affect, disabled peple differently? Yes N X Explain yur respnse: Any smkers will be treated by Specialist Stp Smking Practitiner. Disability is nt a barrier t available treatments. If a patient has cmmunicatin difficulties, staff will fllw the trust interpretatin plicy fr BSL interpretatin fr Deaf peple. Cmmunicatins bks are available in the trust t supprt patients with learning disabilities. Infrmatin can be prvided in a range f frmats as required. AGE: Frm the evidence available des the plicy, prcedure, prpsal, strategy r service, affect, r have the ptential t affect, age grups differently? Yes X N Explain yur respnse: Available medicatin can nly be prescribed t a smker under the age f 12 by a Dctr. Behaviural supprt will still be available as nrmal. LESBIAN, GAY, BISEXUAL: Frm the evidence available des the plicy, prcedure, prpsal, strategy r service affect, r have the ptential t affect, lesbian, gay r bisexual grups differently? Yes N X East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 18

Explain yur respnse: Any smkers will be treated by Specialist Stp Smking Practitiner. Sexual rientatin is nt a barrier t available treatments. RELIGION/BELIEF: Frm the evidence available des the plicy, prcedure, prpsal, strategy r service affect, r have the ptential t affect, religius belief grups differently? Yes N X Explain yur respnse: Hwever, the Or-mucsal Spray des cntain sme alchl and is therefre nt recmmended as an ptin fr religius grups that frbid alchl. CARERS: Frm the evidence available des the plicy, prcedure, prpsal, strategy r service affect, r have the ptential t affect, carers differently? Yes N X Explain yur respnse: Carers, friends and family can als receive smking cessatin supprt and treatment if apprpriate. OTHER: EG Pregnant wmen, peple in civil partnerships, human rights issues. Frm the evidence available des the plicy, prcedure, prpsal, strategy r service affect, r have the ptential t affect any ther grups differently? Yes N X Explain yur respnse: Specialist Stp Smking Practitiner (Midwife) als available fr pregnant wmen and their family. 4. Safeguarding Assessment - CHILDREN here a direct r indirect impact upn children? Yes N X es please describe the nature and level f the impact (cnsideratin t be given t all childr en in a specific grup r area, r individual children. As well as cnsideratin f impact nw future; cmpeting / cnflicting impact between different grups f children and yung pep please describe why there is cnsidered t be n impact / significant impact n children ren are prtected under the Plicy in the same way as adults. Treatment is available t all, ugh an under 12 smker needs a dctr t prescribe treatment (NRT). 5. Relevant cnsultatin Having identified key grups, hw have yu cnsulted with them t find ut their views and that the made sure that the plicy, prcedure, prpsal, strategy r service will affect them in the way that yu intend? Have yu spken t staff grups, charities, natinal rganisatins etc? Annual patient surveys used t seek patients views n service prvisin. The Trust has a duty t cmply with Natinal regulatins and guidance: Cmpliance with the Smkefree Regulatins 2006. Cmpliance with the Health and Safety at Wrk Act ensuring emplyees, patients, visitrs and cntractrs are nt expsed t risks due t smking, secnd hand smke r assciated risks f fire. Cmpliance with the Natinal Institute fr Health and Care Excellence guidance and its recmmendatin t prmte n smking as the nrm fr peple using ur services and a Smkefree hspital envirnment. The Trust s respnsibility t prtect and imprve the health and well-being f all East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 19

patients, visitrs and staff and cmply with the Health Act 2006. The Trust s public health respnsibility t imprve the health f the lcal ppulatin beynd thse wh are currently receiving health care. 6. Date cmpleted: 01/01/2016 Review Date: 31/01/2018 7. Any actins identified: Have yu identified any wrk which yu will need t d in the future t ensure that the dcument has n adverse impact? nne t be Achieved 8. Apprval At this pint, yu shuld frward the template t the Trust Equality and Diversity Lead lynbailey@nhs.net Apprved by Trust Equality and Diversity Lead: Date: 10.2.16 East Cheshire NHS Trust Smkefree Plicy Paul Jacksn - (January 2016) Page 20