Aim
This guide is designed to support the implementation of the NHS Scotland Alcohol and Other Substance Policy within NHS Lanarkshire.
Scope
In line with the the NHS Scotland Alcohol and Other Substances Policy, this guide applies to all employees. It also applies to workers i.e. bank, agency and sessional workers. References to employees should be taken to apply to workers unless otherwise stated.
Referral to Occupational Health
A referral can be made to Occupational Health where concerns are raised relating to inappropriate alcohol or substance use in work.
Work is defined as attending for rostered shift, attending meetings, attending hearings or training events.
For cause testing
This type of testing may be requested through involvement in a specific issue arising at work.
Reasons for considering for cause testing would be smelling of alcohol, the employee is suspected to be under the influence of alcohol/substances demonstrated through:
- a pattern of poor work performance,
- unacceptable behaviours or inappropriate social interactions at work where it is suspected that alcohol and/or substance misuse may be, at least, a contributing factor.
In such cases, the manager must:
- Discuss their concerns with the employee immediately
- Request the employee to attend Occupational Health for testing where it is suspected they may be under the influence of alcohol/substances. While this is usually requested by the manager via telephone, it must be followed up immediately by a written request to the occupational health department to ensure this can be included in the employee’s confidential occupational health record
- Send the employee home or if appropriate suspend from duty pending investigation, depending on test results and when results will be available. Please refer to the suspension checklist contained within the NHS Scotland Conduct Policy to determine if suspension is appropriate and for guidance on making sure that the employee gets home safely. This includes making sure that they do not use their own vehicle and safe alternative provision is made
- Inform Human Resources as soon as practical and make arrangements to follow up as appropriate in line with the NHS Scotland Workforce Policies
Out of Hours For Cause Testing
Where an incident occurs out with Occupational Health’s normal workings hours (i.e. Monday – Friday 8.30am – 4.00pm) contact must be made with the on-call manager to ensure patient/staff safety particularly in remote areas and the on-call Occupational Health Physician for testing, who can be contacted via Monklands Hospital Switchboard (01236 748 748).
Supportive Plan
A template Supportive Plan is available as part of the NHS Scotland Alcohol and Other Substances Policy. This should be used to identify the support and arrangements that are being put in place for an employee who admits to having an alcohol and/or substance problem. This may include an agreement for random testing. Consideration must be given to the role the employee undertakes, the shifts, the area of work, impact on colleagues and recommendations from Occupational Health.
Random testing
Random testing means that the employee will be subject to an alcohol or substance test without prior notification.
Random testing will take place where it is agreed with management, Occupational Health and the employee. Occupational Health will coordinate this and will link with the manager, who will provide the employee’s rota in advance. Random testing is normally conducted within normal working hours. In exceptional circumstances, random testing can be provided outside of normal hours. In this situation, an approved third party provided may carry out this testing.
A management referral may also be appropriate where an employee has approached their manager seeking support for a suspected or known alcohol substance problem. The referral must state that the manager is referring the employee under the Alcohol and Other Substances Policy.
Where random testing is being requested, a copy of the supportive plan should be included with the referral with detail of what is required from Occupational Health. The named contacts for Occupational Health to liaise with around testing arrangements should also be confirmed. It is recommended that the manager discusses the proposed content of the supportive plan prior to submitting the referral to Occupational Health.
It should be noted that random testing does not negate the need to carry out for cause testing should a need arise.
Following receipt of the referral, an assessment will be completed taking into account the following:
- Signposting the employee to relevant help and support
- The employee’s fitness for normal working and where appropriate alternative duties during this period
It is the employees’ responsibility to acknowledge that they have an alcohol and/or substance misuse problem. However, it is possible that the Occupational Health Professional may believe that the employee has an alcohol or substance misuse problem, and in some circumstances, may feel that this belief should be conveyed to management. This is likely to be the case where there is a risk to the safety of patients, staff or the public.
When an employee requires to be absent from work, this will be regarded as sick leave under NHS Lanarkshire’s sick pay scheme.
If an employee denies that they have an alcohol and/or substance related problem and/or refuses to attend the Occupational Health, issues surrounding misconduct, attendance and\or performance will be dealt with through the appropriate NHS Scotland Workforce policy.
Testing Procedure
Testing will be undertaken if an employee :
- Is suspected of being under the influence of alcohol and/or substances whilst at work,
- Admits having a problem which is affecting their work performance, or is causing work related issues, and makes this known to management.
Testing can only be done with the employee’s written consent. Consent should be included as part of the Conditional Agreement.
Process
The process will be followed whether an employee is being tested for alcohol and/or substances as part of an organised follow-up programme involving random testing or for cause testing.
The procedure will be explained to the employee by the Occupational Health Practitioner and fully informed written consent will be sought on each occasion testing is carried out.
The employee will be informed that management will be advised of the result either being negative or non-negative. Actual results will only be shared with management if requested and with the employee’s written consent.
Substances
If substance testing is to take place, a urine sample is required to test for the presence of substances. The employee will be informed which substances will be included in the test.
The employee will be required to provide details of prescribed medications that they are taking and documentary evidence to support this which will be requested and recorded prior to testing. If the testing is carried out ‘for cause’ and therefore the employee does not have such evidence to hand then they will be requested to produce this as soon as is reasonably practicable.
An immediate result can be shown and if non-negative, the sample will be sent to a certified off site laboratory for further analysis. The employee will be asked to declare what medications have taken over an identified period of time which will be taken into account when results are analysed.
The test is undertaken in line with chain of custody, a process where the sample has been controlled throughout the entire procedure to ensure it cannot be tampered with or mixed up with other samples.
Alcohol
If alcohol testing is to be undertaken the devices used give an immediate result for presence of alcohol via a breath test. If a non-negative result (i.e. alcohol present) is revealed, the employee will be given the opportunity to provide a further sample of breath after 20 minutes to ensure results are accurate