Published: 14/07/2005, Volume II5, No. 115 Page 43

It is not enough for organisations to have 'nice words written on a piece of paper' to handle alcohol and drug abuse, according to NHS Employers deputy director Alastair Henderson.

He stresses that 'fitness for work' is crucially important for all NHS staff. NHS Employers promotes support and rehabilitation rather than straightforward punishment.

Last month the BBC's Real Story programme found that 750 medical staff have been formally disciplined for alcohol and drug offences at work in the last three decades.

In the latest edition of its Management of Health, Safety and Welfare Issues for NHS Staff , NHS Employers lays out key elements organisations should include in their substance misuse policy. These range from raising awareness and training line managers to recognise and deal with problems to the importance of selfreferral to GPs for staff with substance abuse problems.

But it does not believe random testing of staff is 'appropriate'.

The British Medical Association has called on the NHS to invest in a programme of intervention, treatment and monitoring to tackle the problem of alcoholic and drug abusing medics.

The BMA claims doctors are more than three times more likely to have cirrhosis of the liver than the general population and one in 15 is addicted to alcohol or drugs, or both. A survey of 150 consultant surgeons found one in five knew a colleague whom they believed to be affected by alcohol while on call.

Browne Jacobson employment law specialist Helen Badger warns that with the Licensing Act ushering in 24-hour drinking, the issue of medical staff under the influence will be more pressing than ever.

'What can trusts do to protect patient safety and support the rehabilitation of their staff?' she asks. 'We advise trusts to take a five-step approach to tackling the workplace drink and drugs issue: ' l Have a clear substance misuse policy.

Make sure all staff are aware of the dangers of substance misuse. The policy should state that being under the influence while on duty or on call is a serious offence and detail the steps that will be taken if such circumstances arise.

Provide training.

All managers and supervisors should receive training on the policy, in particular how to recognise and manage known or suspected cases of substance abuse in their staff.

Make confidential help available.

Encourage staff to seek help via their GP.

All employees should be made aware that they can also seek confidential advice and assistance through their local occupational health service.

Treat staff with compassion.

Procedures should encourage staff to seek help on a voluntary basis. Employees should be referred either to their GP or to occupational health for rehabilitation and treatment before disciplinary action is considered.

Encourage a culture of openness.

A substance misuse policy should set out the common signs of drug or alcohol misuse and encourage employees to report genuine concerns.

www. nhsemployers. org/docs/blue_ book_chapter_12. pdf