Supporting employees with drug and alcohol related issues policy

1. Introduction
2. Purpose
3. Scope
4. Responsibilities, accountabilities and duties
5. Procedure or implementation
6. Training implications
7. Monitoring arrangements
8. Equality impact assessment screening
9. Links to any other associated documents
10. References
11. Appendices

1 Introduction

The trust is committed to supporting and protecting the health, safety and welfare of its employees, patients, clients, or service users and visitors. In doing so, it is recognised that maintaining both the physical and mental health of its workforce results not only in more effective delivery of services but also assists in the trust being an employer of choice.

Evidence shows that employees who drink excessively, or inappropriately, or misuse other substances are more likely to have an accident, be absent from work and be less efficient, This policy and procedure recognises how, unless proper arrangements are in place, drug and alcohol related issues in the work place can impact adversely on the delivery of the trust’s strategic objectives, patient care and the individual’s objectives and performance.

This policy and procedure recognises the importance of identifying and managing such issues and also in providing a positive and supportive environment for employees that have to deal with these issues. The trust wishes to give employees who may be experiencing drug and alcohol issues, the opportunity to obtain advice and specialist support. Management are committed to offering employees assistance in accordance with the provisions of this policy in a supportive and confidential manner.

An effectively implemented policy will help the trust manage this challenging issue by ensuring:

• there are clear rules in the workplace relating to alcohol and drug misuse
• there is a greater awareness amongst employees regarding the effects of drugs and alcohol and consequently the early recognition of any problematic issues
• the necessary procedures and support mechanisms are in place
• employees are aware support is available to them if they acknowledge they have developed a dependency issue and require support

A policy can provide a framework to enable the trust to:

• improve health, safety and wellbeing standards
• reduce employee absence levels
• enhance productivity
• retain key talent
• improve patient care
• become an employer of choice

2 Purpose

This policy and procedure outlines the legislation, support and action to taken in relation to the misuse of drugs and alcohol within the workplace. The policy also defines the responsibilities of the board of directors, managers, employees, occupational health, human resources, and staff side representatives regarding the management of health, safety, and wellbeing in relation to drug and alcohol issues identified within the workplace.

3 Scope

This policy and procedure applies to those employees who are directly employed by the trust and for whom the trust has legal responsibility. For those staff not directly employed by the trust but working in partnership, on an honorary basis, secondment, as a student or trainee or via an employment agency, volunteer or contractor then the principles of this policy will apply whilst undertaking duties on behalf of the trust or working on trust premises and forms part of their arrangements with the trust. However it is accepted that the employment policies of their employing organisation or professional body or place of study would apply.

This policy covers the use of illegal drugs and misuse of alcohol or substances including controlled and prescription medication, and other psychoactive substances such as those known as ‘legal highs’. The terminology ‘substance misuse or abuse covers alcohol and drugs (whether legal or otherwise).

This policy will be managed in line with the practice of a restorative just and learning culture

4 Responsibilities, accountabilities and duties

4.1 Board of directors

• The board of directors have overall responsibility for the health, safety, and welfare of the trust workforce. The board of directors will ensure there is a system in place for establishing and maintaining this document and for meeting all statutory requirements and adhering to guidance issued in respect of procedural documents
• Create the right environment to support employees who may come forward with concerns for themselves or others

4.2 Line managers

• Managers should ensure the policy is communicated to employees and should encourage employees who believe they may have issues with alcohol or drugs to discuss these openly and to avail themselves of any support available.
• Managers must identify and respond effectively to employees with problematic issue and recognise symptoms which indicate there is a issue (refer to 5.4 for symptoms).
• With the agreement of a HR representative wherever possible, managers can request alcohol or drug screening, but only where this course of action can be justified and is in line with appendix F.
• Employees must be referred to the occupational health service (wellbeing referral) for support and advice if alcohol or drug misuse is suspected or identified as a problematic issue or is a reason for sickness absence or other absence.
• Managers should be sensitive to the fact that the Doncaster local treatment agencies are part of the trusts services and therefore particular attention should be paid to issues of confidentiality.

4.3 Human resources

• Human resources will provide guidance to managers and employees on this policy and procedure.
• They will offer support and advice to both managers and employees experiencing issues with drug and alcohol use.
• Support and advise line managers where screening may be required
• Encourage referral to the occupational health service and counselling where appropriate.

4.4 Employees

• Employees should comply with the trust expectations as detailed in section 5.1.
• Individuals need to be aware of any symptoms of drug or alcohol misuse in themselves and the warning signs being shown by colleagues. (refer to section 5.4 for symptoms to look out for).
• Employees should approach their line managers with regard to any issues they may have. If they feel unable to do so, they may contact human resources or staff side for advice. They may also contact the employee assistance programme (EAP).
• Employees should seek professional advice and support from either their line manager who may make a referral to occupational health or by self referral to an appropriate agency or general practitioner.
• Employees must notify their line manager if they have been prescribed drugs which they understand may affect their behaviour or performance and this will be managed as a health issue.
• Employees should report any concerns regarding other employees of the trust if they suspect them to be under the influence of drugs or  alcohol or have a drug or alcohol dependency.
• Employees should declare any convictions as a result of drug or alcohol misuse.
• Employees must be aware of their responsibilities in accordance with appendix A.

4.5 Occupational health service

• Will provide the appropriate level of confidential support to employees who are referred by their line manager because of concerns about their wellbeing. This may include advice to access the employee assistance programme and the counselling service. Employees are unable to self-refer to occupational health but are able to access the employee assistance programme without line manager involvement. They will promote awareness of drug and alcohol issues and encourage early identification of individuals in need of help.

4.6 Staff side

• Staff side will provide guidance to their members on this policy and procedure.
• They will offer support and advice to their members experiencing issues with drugs and or alcohol.
• Support and advise their members where screening may be required.
• Encourage referral to the occupational health service and counselling service where appropriate.

5 Procedure or implementation

5.1 Overview

The procedural section of this policy and procedure is concerned with the prevention, recognition, identification of substance misuse or abuse and the appropriate interventions and guidance on what actions management should take when an employee may be under the influence of drugs and alcohol whilst at work or where an employee requires support.

In seeking to ensure the effectiveness of this policy, the trust will:

• ensure that employees use of drugs or alcohol does not impair the safe and efficient running of the trust, or result in risks to the health and safety of themselves, other employees, patients, clients, service users and public
• support staff where they are prescribed medication that may impair their work duties
• complies with all relevant legislation in this area
• create a culture that encourages employees experiencing issues with drug and alcohol to speak up, acknowledging the issue with a view to seeking support
• help protect employees by raising awareness of the problems of drug and alcohol use to encourage those with a issue to seek help.
• support managers to identify any alcohol and drug issues with employees at an early stage
• provide adequate resources to ensure the implementation of the policy
• provide a framework within which drug and alcohol issues can be managed in a fair and consistent way
• Set out the rules regarding the use of intoxicating substances so that employees are aware of the likely consequences for their employment if they misuse them.

5.2 Trust expectations on the consumption of alcohol and the use of drugs

• The taking of illegal drugs or the misuse of prescribed and non-prescribed medication in the workplace is prohibited
• Employees will not bring illegal substances onto trust premises
• Employees will not engage in the supplying of illegal substances either at work or outside of work
• The possession of illegal drugs and prescription medication or controlled drugs, which are not prescribed for them will also be reported to the police.
• No alcohol should be opened or consumed on any trust premises or in the course of duty, this includes whilst working at home. Employees are not allowed to drink alcohol while at work or on duty including any break periods and any periods an employee is on call.
• Employees must not drive vehicles which are leased by the trust for them to use on trust business or vehicles which are their property for the purposes of work whilst, under the influence of alcohol or other illegal substances. This may lead to prosecution and disciplinary action including dismissal.
• All employees must be fit to commence their duties and must remain so throughout their working day. If an employee is unfit or becomes unfit, in the managers opinion, because of drunkenness, drugs or substance misuse, they will not be allowed to commence or continue work and immediate suspension will be considered. Should immediate suspension not be appropriate, the employee will be sent home, with the absence recorded as sickness. In extreme circumstances, where an employee appears to be unfit for work due to an excess of alcohol, substances, or drugs taken the previous evening a decision can be made to send that employee home and the use of testing will be considered.
• Some acts of misconduct whilst under the influence of alcohol and drugs may be so serious that they must be considered gross misconduct which may result in the employee being dismissed. This will include endangering the health and safety of themselves, colleagues or patients or clients or service users.

5.3 Symptoms of substance misuse or abuse

If an employee is misusing alcohol or drugs they may display some of the following symptoms:

• mood changes
• irritability
• lethargy
• fatigue from sleeplessness
• erratic performance
• overconfidence
• inappropriate behaviour
• reduced response times
• impaired concentration and memory
• reduced productivity
• absenteeism, both through sickness, last minute requests for annual leave, lateness and unauthorised absence.
• deterioration in relationships with colleagues, management or patients, clients, or service users
• dishonesty and theft
• financial irregularities
• smelling of alcohol
• hand tremors, slurred speech, facial blushing, bleary eyes, poor personal hygiene
• accident at work

This list is not exhaustive.

5.4 Managing employees with alcohol or drug issues

The trust appreciates the value of work and identifies that work can be a stabilising factor for employees dealing with dependency. To that end, and wherever possible, the trust will seek to support employees to engage in work, with access to treatment and ongoing support, if possible whilst acknowledging patient and colleague safety is paramount.

Behind an alcohol or drug issue, there may be personal or work issues that need to be recognised and acknowledged so that assistance can be sought where possible.

Without intervention these symptoms can develop into serious long term health conditions. Managers should refer to the management of performance (capability) policy and procedure for guidance on cases involving poor performance. Advice must be sought from human resources before initiating any action.

The trust will seek to provide every support to employees who at any time and for whatever reason may be experiencing issues relating to drugs and alcohol.

Employees with drug and alcohol related issues have the same rights to confidentiality and privacy as they would if they had any other medical or psychological condition. Health information is sensitive personal data under the Data Protection Act.

The management of drug and alcohol issues will be undertaken with a caring and supportive approach, based on the individual circumstances of the employee. However, it is recognised that in some circumstances the persistent use of substances, non-engagement with treatment and support, and or the procurement, dealing of substances whilst onsite, may be classed as either a performance or conduct issue, which will be managed in accordance with the associated trust policy.

It is the expectation of the trust that staff act responsibly, and professionally in line with the trust values whilst at work, this includes not attending work under the influence of drugs or alcohol.

Where applicable employees taking prescribed or over the counter medication, should check in advance whether such drugs are expected to produce any side effects. If there are health and safety concerns related to work performance, employees should inform their manager and may be referred to occupational health for further assessment.

5.5 Employees requesting assistance (refer to appendix D flowchart)

When an employee believes they have an alcohol, substance or drug issues, or feels they may be developing one, then the employee should seek specialist help as soon as possible by speaking to their GP, treatment services, line manager, HR or occupational health service, refer to Appendix D.

If a line manager is approached by an employee, they should make time for a supportive confidential discussion with the employee and make a file note of the meeting to be retained on the employee’s personal file. Advice should be sort from the HR department at the earliest opportunity and consideration should be given to whether the employee is fit to remain at work and what further support and guidance can be offered to the employee. If it is considered that the employee is not fit to remain at work guidance should be sort from the HR department to determine the most appropriate course of action.

Contact should then be made with occupational health to agree the best course of action.

Where occupational health confirms that the employee has an alcohol or drug issue they will be supported or signposted to appropriate agencies, for example, general practitioner, counselling service, drug and alcohol treatment service.

Any treatment or recovery plan devised will be determined between the individual and treatment agency. However occupational health may with the permission of the employee request a report for consideration to be given as to how the plan can be supported in the workplace.

Once a course of action has been determined, it is important to come to a decision about reasonable timescales for supportive treatment or counselling etc. This will be based on the advice from occupational health and following discussion with HR, the individual and the line manager. Employees will be entitled to be accompanied by a trade union representative and colleague of the trust.

Consideration should be given to undertaking a risk assessment concerning the appropriateness of returning to the same role and as part of an employees continued employment or return to work plan, to protect the trust and support the employee the trust may ask the employee to sign a return to work agreement which may drug and or alcohol screening, if required (see appendix G). The line manager must make sure the employee is aware of this requirement.

Following completion of any treatment plan, the situation will be monitored for an agreed period. If after returning to employment, during or following a treatment programme, if there is a recurrence of the drug or alcohol issue, then the situation will be re-assessed on a case by case basis.

Should an employee remain absent from work long term, this should be managed in accordance with the trust’s sickness absence policy.

Whilst it is acknowledged that alcohol and drug dependency can be a chronic and relapsing condition, further opportunities for the trust to support recurrent requirement for treatment and rehabilitation will need to be assessed in relation to the impacts these have on individuals and in addition service delivery.

Employees who decline a referral for diagnosis and or specialist help or discontinue an agreed course of action before its satisfactory completion and continue to produce an unsatisfactory level of work performance or conduct, could be subject to action under the disciplinary policy or the management of performance (capability) policy and procedure.

5.6 Managing suspicious of alcohol or drug intoxication (refer to appendix E to flowchart 2)

Where a line manager suspects that an employee is under the influence of alcohol or other substances whilst in the workplace or a concern has been raised by a member of the public, a patient or a colleague and the manager considers the employee’s condition to be likely to affect their performance or be a health and safety risk then the manager should take advice from the HR department and agree a plan of action. It may be that the line manager is concerned or has suspicions about alcohol or drug intoxication from a range of different sources and may wish to consider screening the employee in question.

If following consultation with HR there is an agreement that there may be an issue, then the manager should arrange to speak to the individual, in a private and confidential environment. The conversation should be documented by the manager, and shared with the employee following to ensure the context of the conversation is correct. This document may then be retained on the employee file.

The manager should explain their concerns to the employee. If the employee admits they have taken alcohol, drugs and or are under the influence and the manager still has concerns regarding the effect on performance or health and safety, then advice should be sought from human resources and consideration should be given as to whether the employee should be advised to absent themselves from work, recorded as sickness absence, or suspended from duty and escorted from trust premises.

If necessary, arrangements will be made for the employee to be accompanied to their home or place of safety. Following this, the employee should be referred to occupational health. If a situation occurs outside of office hours and a HR representative is not available, then the manager must seek advice from the designated on call manager.

For employees who admit they have taken alcohol, drugs and or are under the influence, the procedure as detailed in section 5.5 should be followed.

If the employee denies being under the influence of drugs or alcohol and the manager is not satisfied with their explanation, for example, the manager believes that the employee is under the influence of alcohol or drugs and this is evident from their actions and or appearance, and the employee continues to deny they are under the influence, they will be asked to submit to alcohol or drug screening.

The manager will explain to the employee the nature of the test and likely outcomes if the test is positive, for example, further support, screening, redeployment (where applicable).

The employee will be asked to sign a consent form for testing. This form and the testing procedure can be found in appendices C and F.

Subsequent action will depend on the result of the test and whether or not alcohol or drugs have been consumed or used, whether this is the first instance or a repeated occurrence and will need to take into account the seriousness of the behaviour exhibited.

If the test is positive the employee should be immediately sent home, either r recorded as sickness absence, or consideration given as to whether the employee is suspended in accordance with the disciplinary policy. In this situation the principles and documentation (suspension checklist) contained with the disciplinary policy must be followed.

If the individual refuses to take a test, then they should be advised that a decision will be taken based on the evidence available. In collaboration with the HR department the manager should review the people practices tool before deciding on an appropriate course of action. The trust reserves the right to review all cases in line with restorative practice, and as such cases will be dealt with on an individual basis.

If the test is negative a further discussion will take place with the employee to explore the reasons for their concerning behaviour and further advice maybe sort from the trust’s occupational health service. Consideration will also need to be given to whether the behaviour being displayed needs to be managed in accordance with other Trust policies.

5.7 Manager concerned about work performance

Where a line manager suspects that an employee has an alcohol, substance or drug issue which is affecting their work performance, then the line manager should speak to HR to discuss the appropriate approach.

This will normally result in an informal discussion which should take place between the manager and the employee. The meeting should focus on the behaviour or work or performance issues. It is important that the approach taken at this initial meeting is supportive and not confrontational, to give the employee the opportunity to request assistance. The performance issue(s) that have been occurring should be defined and possible reasons or causes discussed (not assumed)

If the employee admits to an alcohol or drug issue then the procedure regarding managing an employee with an alcohol or drug problem will be followed in accordance with section 5.5.

If the employee states that the performance issues are due to causes other than alcohol or drugs and this is considered to be a reasonable explanation, then the line manager will determine whether the management of performance (capability) policy and procedure is appropriate.

5.8 Managing alcohol or prescribed drug use and substance misuse as a health related matter

Alcohol or substance misuse can lead to a number of health issues, including addiction and or other health or behavioural disorders which may be amenable to treatment. Employees must notify their managers if they have been prescribed drugs which may affect their behaviour or performance and this will be dealt with as a health matter. If necessary, advice can be sought from occupational health and the employee’s work plan and duties adjusted accordingly.

Some acts of misconduct whilst under the influence of alcohol and drugs may be so serious that they must be considered gross misconduct which may result in the employee being dismissed. This will include endangering the health and safety of themselves, colleagues or patients or clients or service users.

Disciplinary action may be taken where there is a case of possession, use or distribution of any of the above substances. Incidents involving these cases will be regarded as potential gross misconduct may result in the employee’s dismissal from the trust.

5.9 Relevant legislation

5.9.1 Misuse of Drugs Act 1971

Under this statute, charges can be brought against an employee in possession of, or supplying drugs at work, or against a business or its managers for allowing the possession or supply of drugs at work.

5.9.2 Psychoactive Substances Act 2016

This act contains provisions about psychoactive substances, defining what is meant by ‘psychoactive substances’ and contains provisions in relation to offences relating to psychoactive substances, along with exceptions to those offences and powers for dealing with prohibited activities.

5.9.3 Health and Safety at Work Act 1974 or Management of the Health and Safety At Work Regulations 1999

This statute imposes a standard of care on employers for employees in the workplace. It makes it the duty of every employer to provide and maintain a safe and healthy working environment. Failure to deal with an employee as well as others on their premises, such as temps, casual workers, the self-employed, clients, visitors and the general public who is under the influence of drugs or alcohol who may constitute a risk to others and could leave a business open to prosecution.

5.9.4 Data Protection Act 2018

All health and medical information is classified as sensitive personal data under the terms of this statute. All information surrounding possible drug or alcohol misuse must be handled securely and confidentially and abuse of this information is a criminal offence.

5.9.5 Management of Health and Safety at Wwork Regulations 1992

This regulation requires all employers and self-employed people to assess the risks to workers and any others who may be affected by their work or business. This will enable them to identify the measures they need to take to comply with health and safety law.

5.9.6 Corporate manslaughter

Business managers who knowingly allow misuse of drugs and alcohol at work that leads to death could find themselves liable to prosecution for corporate manslaughter.

5.9.7 The Employment Rights Act 1996

This statute gives an employee the right not to be unfairly dismissed. This claim might apply where an employer dismisses an employee in relation to a drug or alcohol offence either in inappropriate circumstances or following a defective procedure. Rights may also arise if an employer seeks to force an employee to undertake a drug or alcohol test in unreasonable circumstances. Therefore, it is of paramount importance that the Human Resources team are contacted prior to making the decision to conduct screening.

5.9.8 Road Traffic Act 1988

This sets out the offence of driving or attempting to drive a motor vehicle while unfit through drink or drugs in the event a staff member has driven, securing car keys or asking a loved one to collect the staff member or getting a taxi is good practise.

5.9.9 Transport and Work Act 1992

This act makes it a criminal offence for specified jobs to be undertaken by those unfit through drink or drugs. Employers may be liable unless they can show ’all due diligence’.

5.9.10 Human Rights Act 1998

This act covers all the individual rights contained in the European convention on human rights.

5.9.11 Equality Act 2010

Addiction to alcohol, nicotine or any other substance is to be treated as not amounting to an impairment for the purposes of the Act. However, employees may be considered disabled if, the addiction has caused an impairment.

6 Training implications

6.1 Managers

• How often should this be undertaken: On revision of the policy or new appointments or promotions.
• Delivery method: Team communications and managers overview policy.
• Training delivered by whom: Human resources advisors or line managers and human resources advisors.
• Where are the records of attendance held: ESR.

6.2 Human resources

• How often should this be undertaken: On appointment or revision of the policy.
• Delivery method: On the job training mentoring formal in house training.
• Training delivered by whom: Team leaders or HR department.

6.3 Staff side

• How often should this be undertaken: On appointment or revision of the policy.
• Delivery method: Awareness or briefing sessions on policy.
• Training delivered by whom: People and OD directorate.

7 Monitoring arrangements

7.1 Support offered to colleagues in line with the policy

• How: Review of HR data through compliance to policy, alongside monitoring of cases and testing requests.
• Who by: HR.
• Reported to: Care group directorate HR meeting.
• Frequency: Annually.

7.2 Number of disciplinaries in relation to drug or alcohol abuse

• How: Review of HR data through compliance to policy, alongside monitoring of cases and testing requests.
• Who by: HR.
• Reported to: Care group directorate HR meeting.
• Frequency: Annually.

7.3 Number of referrals for testing

• How: All referrals are made through the HR team and recorded.
• Who by: HR.
• Reported to: Care group directorate HR meeting.
• Frequency: Annually.

8 Equality impact assessment screening

To access the equality impact assessment for this policy, please see the overarching equality impact assessment.

8.1 Privacy, dignity and respect

The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.

As a consequence the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).

8.2 Mental capacity act

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individuals informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all employees working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005) to ensure that the interests of an individual whose capacity is in question can continue to make as many decisions for themselves as possible.

8.2.1 How this will be met

All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act 2005 (section 1).

9 Links to any other associated documents

• Disciplinary policy
• Flexible working policy
• Health and safety policy
• Healthy workplaces, staff support and stress at work policy
• Performance (capability) policy
• Sickness absence policy

10 References

• Agenda for Change Terms and Conditions Handbook.
• Corporate Manslaughter.
• Data Protection Act 2018.
• Disability Discrimination Act 1995 or Equality Act 2010.
• Health and Safety at Work Act 1974.
• Human Rights Act 1998.
• Management of Health and Safety at work regulations 1992.
• Misuse of Drugs Act 1971.
• Road Traffic Act 1988.
• The Employment Rights Act 1996.
• Transport and Work Act 1992.

11 Appendices

11.1 Appendix A Individuals responsibilities, regarding alcohol and drugs

Individuals’ responsibilities regarding alcohol and drugs

• Consumption of alcohol, illicit drugs and substance abuse or misuse of prescribed and non-prescribed medication in the workplace is prohibited.
• If an employee is found in possession of or supplying or taking illegal substances when at work or not at work, disciplinary action may be taken and possession, use or distribution will be regarded as potential gross misconduct. The possession of illegal drugs and prescription drugs or controlled drugs, which are not prescribed for them will also be reported to the police.
• Disciplinary action may be taken where there is a case of possession, use or distribution of any of the above substances. Incidents involving these cases will be regarded as potential gross misconduct may result in the employee’s dismissal from the trust.
• No alcohol should be opened or consumed on any trust premises at any time. Employees are not permitted to drink alcohol or possess, consume, sell or give away drugs while at work or on duty.
• It is the expectation of the trust that staff act responsibly, and professionally in line with the Trust values whilst at work, this includes not attending work under the influence of drugs or alcohol.
• Where applicable employees taking prescribed or over the counter medication, should check in advance whether such drugs are expected to produce any side effects. If there are health and safety concerns related to work performance, employees should inform their manager and may be referred to occupational health for further assessment.
• Employees must not drive vehicles which are leased by the trust for them to use on trust business or vehicles which are their property for the purposes of work whilst, under the influence of alcohol or other illegal substances. This may lead to prosecution.
• If the test is positive the employee should be immediately sent home, either recorded as sickness absence, or consideration given as to whether the employee is suspended in accordance with the disciplinary policy. In this situation the principles and documentation (suspension checklist) contained with the disciplinary policy must be followed.
• Some acts of misconduct whilst under the influence of alcohol and drugs may be so serious that they must be considered gross misconduct which may result in the employee being dismissed. This will include endangering the health and safety of themselves, colleagues or patients or clients or service users.
• All employees must ensure that any concerns relating to the potential alcohol or substance misuse of others is reported in a timely manner to the most senior manager on duty at that time.
• All employees must declare any convictions as a result of alcohol or substance misuse. Failure to do so could result in disciplinary action and counter fraud investigation.

Employees will read and clarify any aspects of the policy which they don’t understand as part of their induction or policy updates, its aims and their responsibilities in relation to alcohol and or substance misuse.

There are situations where colleagues try to ‘cover up’ for or ‘protect’ a fellow employee or colleague who is misusing alcohol or drugs. Whilst this action may appear supportive it does not in fact help the individual with the issue and may delay their treatment and subsequent recovery. Colleagues should therefore remember their own responsibilities in relation to health and safety. Any employees or colleague who attempt to deliberately cover up a situation which could lead to a risk or harm to patients or colleagues may be subject to further investigation or action in accordance with the trusts policies and procedures leave themselves open to disciplinary action.

11.2 Appendix B Definitions

Definitions

Term	Definition
Intoxicating substance	A substance that changes the way the user feels mentally or physically. It includes, but is not limited to, alcohol, illegal drugs, legal drugs, prescription medicines, psychoactive substances formerly known as ‘legal highs’, solvents, glue and lighter fuel
Controlled drugs	These are drugs covered by the Misuse of Drugs Act 1971. They include both drugs with no current medical uses as well as medicinal drugs that are prone to misuse. All are considered likely to result in substantial harm to individuals and society
Harmful or problematic use or misuse	Use of an intoxicating substance or substances that harms health, physical, psychological, social or work performance but without dependency being present
Dependency	A compulsion to keep taking an intoxicating substance either to avoid effects of withdrawal (physical dependence) or to meet a need for stimulation or tranquillising effects or pleasure (psychological dependence)
Addiction	A state of periodic or chronic intoxication produced by the repeated intake of an intoxicating substance. This creates a dependency which can have serious detrimental effects on the individual who will have great difficulty discontinuing their use
‘For cause’ screening	Screening for alcohol or substance misuse where an employee is suspected of being unfit because of possible intoxication or following return to work after detoxification treatment or as part of an agreed abstinence programme

11.2.1 Alcohol or substance misuse in the workplace is either

• Consumption of alcohol or drugs whilst on duty or whilst off duty, but that has an impact on work such as not leaving enough time for the alcohol or drug to leave the system before the start of work, and thus the effects of alcohol or drug consumption are evident whilst at work.
• Consumption or dependence on alcohol or drugs that continually or repeatedly interferes with an employee’s work performance, conduct and or attendance or resulting in unacceptable conduct or dangerous and unreasonable behaviour.

11.2.2 Chain of custody

The stringent process for collecting, handling, transporting, storing and screening biological samples for alcohol or drug misuse to prevent any possible contamination or interference. The purpose is to ensure that the results of any biological screening can indisputably be connected with the individual who produced the test sample. This is to ensure that any test is not interfered with.

11.3 Appendix C Consent form

• Appendix C Consent form

11.4 Appendix D Flow chart, employees requesting assistance

1. Manager approached by employee.
2. Meeting with employee, employee discloses alcohol or substance misuse issue.
3. Manager contacts HR for advice, consideration given as to whether employee is fit to remain at work.
4. Manager contacts occupational health, problem identified.
5. Signpost to appropriate support agency.
6. Recovery or treatment programme devised, recovery or treatment plan successful.
7. Return to work plan devised (if necessary) and abstinence or return to work agreement signed if appropriate, following advice from occupational health.
8. Agree formal monitoring period.
   • no recurrence, conclude formal monitoring and ensure that support is always available. End process
9. No sustained recovery, consideration given as to whether time for further rehabilitation or treatment can be offered.
   • treatment accepted or facilitated, disciplinary procedure instigated. End process
   • employee declines or treatment not, disciplinary procedure instigated. End process

11.5 Appendix E Flow chart, manager suspects alcohol or drug abuse

1. Manager suspicious that employee is under the influence of alcohol or drugs.
2. Manager contacts HR for advice. If outside of office hours and or unable to contact a HR representative then the on call arrangements should be utilised for advice and guidance.
3. Plan of action agreed.
4. Manager arranges meeting with the employee and concerns are explained.
   • employee admits, assess employees suitability to be at work and take necessary action. If necessary arrange for employee to be accompanied home
   • manager to arrange referral to occupational health
   • refer to flow chart 1 for treatment pathway
   • consider whether action under the policy and procedure for the management of disciplinary matters is required. End process
5. Employee denies.
   • manager satisfied with explanation, No further action taken. End process
6. Manager not satisfied with explanation, continued denial of managers concerns, employee will be subject to alcohol and or drug screening.
7. Manager explains nature of test and possible implications.
   • employee refuses test, employee advised a decision of further action is to be taken based on available information or evidence
   • employee suspended on full pay and escorted off premises. If necessary arrangements to be made for employee to be accompanied home
   • consider action under the policy and procedure for the management of disciplinary following referral to occupational health. End process
8. Employee signs consent form and test is carried out
   • test is negative, consideration given to implementation of other policies, for example, performance (capability) policy. End process
9. Test is positive, assess employees’ suitability to remain at work and take necessary action, for example, send home, suspended on full pay. If necessary arrange for employee to be accompanied home.
10. Consider action under the policy and procedure for the management of disciplinary following referral to occupational Health. End process.

11.6 Appendix F testing for alcohol or drug misuse

11.6.1 ‘For cause’ screening

Any managers who have concerns regarding any employee as described in section 5.2 can arrange for testing.

11.6.2 Screening for alcohol and drug misuse

Alcohol and drug screening will only be carried out at a manager’s request if an employee is suspected of being unfit because of possible intoxication, following return to work after detoxification treatment, or as part of an agreed abstinence programme or return to work agreement.

11.6.3 Procedure

If the manager has reason to believe that an employee is under the influence of alcohol at work, and when questioned is denied by the employee, the employee will be instructed to wait in a private area. The manager will explain to the employee the nature of the test for alcohol and the possible consequences for the employee’s employment if the test is positive.

The employee will be invited to sign a consent form for screening. If the employee refuses to sign the consent form then the manager should make a note of this fact on the consent form and advise the employee that a view will have to be taken on the visual and sensory evidence available.

If the employee complies with the request and signs the consent form, the manager will arrange a request for a drug or alcohol test, and the consent form will be sent immediately to the approved provider. A qualified individual on behalf of the contractor will administer the test as soon as practicable, usually within 2 hours.

The approved provider for drug and alcohol screening is Abbott toxicology. Should you be required to utilise their services you should contact the human resources department, or if out of hours, the manager on call.

If the alcohol test is over the drink driving limit (over 35 mcg per 100 ml is the driving threshold), the test will be repeated. If the second test is also over this limit, the employee may be suspended, pending the disciplinary proceedings, which could lead to dismissal.

If the test result shows a breath alcohol content below 35 mcg per 100 ml but above zero, the employee will not be permitted to resume any work that the trust considers safety-critical or otherwise likely to be affected by their consumption of alcohol, but will either be deployed to other work, if this can be facilitated, or sent home with the day recorded as sickness absence. The employee will be paid from their sick pay entitlement.

Where a manager has reason to believe that an employee is intoxicated and unfit because of drug misuse at work, the employee will be asked to wait in a private area. The manager will explain to the employee the nature of the drugs test and possible consequences for the employee’s employment if the test is positive.

The employee will be asked to sign a test consent form. A qualified individual on behalf of the contractor will carry out the test as soon as is practicable. The employee will be required to provide a sample of hair, urine, or blood for the test. The chain of custody process will be adhered to at all times.

In cases where employees are working from home or have been sent home from work due to suspected drug and alcohol usage, home screening can be arranged in exceptional circumstances by agreement of the relevant senior manager. If home testing is agreed, a member of RDaSH senior management will be expected to attend the home with the Abbott testing practitioner.

Arrangements for either home or onsite screening can be made by contacting the Human Resources team.

While the test results are awaited, the employee may be suspended on full pay. If the test is positive for any illegal drug, the trust reserves the right to review all cases in line restorative practice, and the people practices tool, to that end, all cases will be dealt with on an individual case by case basis.

All screening results will be returned to the rdash.staffdrugandalcoholtesting@nhs.net, and forwarded to the relevant human resources practitioner supporting the case. These results will then be forwarded and discussed with the relevant manager before consideration given to next steps.

11.6.4 Limitations to drug screening

A positive test does not in itself imply impairment, but it is a marker for behaviour involving misuse of drugs that may affect safety at work. Generally speaking these tests cannot determine when the drugs were taken as many drugs of misuse may be detected a considerable time after use. Also the tests cannot indicate whether the user is a habitual user or a one-off user.

11.6.5 Refusal to undergo screening

If an employee refuses to sign the consent form or fails to supply a sample for alcohol or drugs screening the manager should remind the employee of the possible sanctions and give them a further chance to comply. If the employee still refuses the manager should carry out a thorough investigation into the reason why. If no good reason is provided the manager should seek advice from human resources representative.

11.7 Appendix G Suggested abstinence or return to work agreement

• Appendix G Suggested abstinence or return to work agreement

11.8 Appendix H Understanding alcohol

11.8.1 Sensible drinking guidelines

Sensible drinking is drinking in a way that is unlikely to cause yourself or others significant risk of harm.

The government advises that:

• you are safest not to drink regularly more than 14 units per week, to keep health risks from drinking alcohol to a low level
• if you do drink as much as 14 units per week, it is best to spread this evenly over a week. If you have one or two heavy drinking sessions, you increase your risks of death from long term illnesses and from accidents and injuries.
• if you want to cut down how much you’re drinking, a good way to help achieve this is to have several drink-free days each week

The risk of harm from drinking above sensible levels increases the more alcohol that you drink, and the more often you drink over these levels.

Sensible drinking also involves a personal assessment of the particular risks and responsibilities of drinking at the time, for example, it is sensible not to drink when driving or when taking certain medications.

11.8.2 Binge drinking

Binge drinking is drinking lots of alcohol in a short space of time, for example, over the course of an evening or drinking to get drunk. It has immediate and short-term risks to the drinker and to those around them.

People who become drunk are much more likely to be involved in an accident or assault, be charged with a criminal offence or contract a sexually transmitted disease.

After an episode of heavy drinking, it is advisable to refrain from drinking for 48 hours to allow the body to recover.

11.8.3 What is a unit?

A unit of alcohol is 10ml of pure alcohol. Counting units of alcohol can help to keep track of the amount drunk. The list below shows the number of units of alcohol in common drinks:

Health risks associated with excessive alcohol:

• weight, amount of calories
• strokes
• cancer
• liver damage
• heart disease

One unit is equal to:

• half pint of regular beer, lager or cider
• one small glass of wine
• one single measure of spirits
• one small glass of sherry
• one single measure of aperitifs

The follow quantities of alcohol contain more than one unit:

• pint of regular beer, lager or cider, 2 units
• pint of premium beer, lager, or cider, 3 units
• alcopop or can or bottle of regular lager, 1.5 units
• can of premium lager or strong beer, 2 units
• can of super strength lager, 4 units
• glass of wine (175ml), 2 units
• bottle of wine, 9 units

11.8.4 The amount you’ve eaten:

If you drink a unit of alcohol on an empty stomach, almost all of it will be absorbed in an hour. But if there’s food in your stomach, the process will be slower and the alcohol reaches your brain and the rest of your body more slowly.

11.9 Appendix I Support available