Andrew Attfield Cecilia Clarke The Charter and its challenges: A Barts Health perspective

Very large NHS Trust in East London - 14,000 staff + 2,500 contracted support staff Five Hospitals (Royal London, Barts, Whipps Cross, Newham, Mile End) 50 + community clinics Regional Trauma Centre/London Air Ambulance Heart Hospital/Specialist Cancer services 1.5 million OP appointments 0.5 million presenting to A & E 15,000 births in Mat. services Barts Health NHS Trust

Part of Public Health vision for Trust – addressing health inequalities by improving health upstream – “causes of the causes” (Marmot) Staff group a significant population in its own right – 50% locally resident Staff survey reveals high proportions of inactivity and overweight/obese staff, smaller groups of smokers and problematic alcohol use Hospitals important for environmental influence on staff, patients and visitors e.g. food, smoking and physical activity Drivers of Barts Health

Improving staff health and wellbeing response to Duncan Lewis report on bullying (2014) and to quality improvement plan (2015) Healthy Workplace Charter used to pull together HWB plan across corporate and clinical services Staff Representatives engaged in process Charter provided impetus for improvement and exposed gaps in programme Changing environment and behaviour provided particular challenges…. Safe and Compassionate

Consultation Help to quit - Self referral Staff compliance with the policy Recruitment pack Staff induction Environmental changes HR support Security training Smoke Free Policy Smoke free vision Implementation of National Referral System Learning from other Trusts Leadership & Communication Staff engagement Partnership work with LA Promotion stands national day Smoke free staff health and wellbeing

Survey Q1 to Q3 Q3 “Is it reasonable to take formal action with staff (including volunteers and contractors) who breach the smoke free policy?” 65% in favour Q8 “Do you think it is reasonable to ask staff not to smoke during their paid working hours?” 57% agreed this was reasonable Q9 “Is it is reasonable to ask staff not to smoke while wearing a recognisable Barts Health uniform or ID badge?” 80% agreed this was reasonable

Protect and support people to improve their health by stopping smoking or using tobacco. Protect staff and visitors and other patients from second hand smoke. Empower staff to feel confident and supported to ask people to stop smoking in or on Trust premises; this also includes home visits by community staff. Staff routinely support all patients who smoke by offering them a referral to stop smoking service ; Barts Health Smoke Free Policy

E- referral form

Creating a smoke free environment

Challenges Engaging with ward staff Working over multiple sites Smoke free is not everyone’s priority Resources Evaluation

Smoking is a lifestyle Choice…

Sharon’s story

Which of these are the most addictive? A. Cocaine B. Cigarettes C. Heroine Source: Nicotine Addiction in Britain. A report of the Tobacco Advisory Group of the Royal College of Physicians. London, RCP, Quitting smoking is difficult

Staff who smoke % % ? Source: National Staff Survey, Barts Health NHS Trust