01 April 2007
Jocelyn Dorrell

For some time now, the HSE has used the "business benefit" argument to promote proactive health and safety management in the workplace. The executive has produced several high-profile case studies that demonstrate how moderate investment in employees' health and wellbeing can reap significant rewards, in terms of reduced absence, lower staff turnover and increased productivity.

Most health and safety professionals, too, have well-rehearsed arguments for persuading board executives to allocate extra money for training or new protective equipment.

Fortunately for any health and safety manager pleading for funding, the case for offering smoking-cessation support to staff is a convincing one - and not just because the smoke-free legislation that comes into effect in July (April in Wales and Northern Ireland) will make it more difficult for staff to smoke during work hours. On top of the legal and moral motivations, there are sound financial reasons for offering staff help to quit.

Counting the cost

Camilla Peterken, director of Smokefreeworking, a company that offers support to smokers and organisations going smoke-free, has a simple formula for calculating the cost of smoking breaks to businesses. She estimates that an employee who smokes will lose half a day's work per week to smoking breaks. If the employee earns £10 an hour, that equates to £40 a week in lost productivity. This adds up to £1760 per smoker per year. If you have 10 employees who smoke, that amounts to £17 600 in lost productivity, before you consider other factors such as increased sickness absence among smokers.

Peterken gives the example of a call centre that employs a large number of young adults on low salaries. With this workforce demographic you would expect higher-than-average smoking rates. If smokers take a cigarette break every hour or two, the cost to the employer adds up very quickly.

"I think the trouble is that employers have got used to it," she says. "It's always been that smokers disappear out for a cigarette or that they might be off sick, and employers have never really stopped and thought about it ... For a small investment, employers could be saving huge amounts."

Open dialogue

Offering cessation support to staff may seem like a daunting prospect if your organisation hasn't gone in for workplace health-promotion activities in the past.

Ruth  Bosworth, director of services at smoking-cessation charity QUIT, advises employers to start by consulting staff to see how much support there is for a workplace stop-smoking initiative.

"Employers need to work to engage the workforce," she says, "to try to identify what they would like, what they don't like and what they're concerned about, so you start an open dialogue. It's about trying to find out about what the entire workforce thinks through active consultation."

Consulting staff will help you establish how many employees smoke and how many want to give up; if you have already banned smoking from the building, you may be less aware of how many of your staff smoke, and some employees may be quite private about their smoking habits. "Most businesses have some idea of who smokes," says Camilla Peterken, "but any business can 'guestimate' on the national prevalence rate, which is 25%. If you've got a younger, lower-paid workforce you can assume it's going to be 25% or more."

Bosworth emphasises the need for "flexible services" that will meet the needs of different people.

"One of the things I think is really key is to find a solution that is tailor-made to the organisation and the employees.

Employers need to do what they can within their environment while recognising that some employees may not want to quit through work - it may be something they want to do privately," she says. "If this is what your consultation tells you, then it may be appropriate simply to provide information about quitting, rather than launch an intensive work-based support programme."

Tar in a jar

There are various types of support available from outside organisations, including local NHS services, stop-smoking charities and private companies. Many organisations will conduct informal site visits to talk to employees, offer general advice on giving up and gauge the level of support for a work-based scheme before you need to commit to formal smoking workshops or counselling services for staff. Such a visit might form a useful part of a consultation exercise.

"The first thing we suggest is a staff information or roadshow session," says Camilla Peterken. "It works really well for us to be there informally, for a couple of hours over lunchtime, with lots of information about the legislation and about quitting smoking."

QUIT offers a similar service in the form of a "display day", where a representative from the charity makes an initial visit to talk to staff about how to manage a quit attempt and give out information.

Smokers may be sensitised by the amount of publicity the legislation is getting and the pressure to give up, so an informal drop-in session can be a useful starting point.

"They feel got at and they think that we're going to stand there with a whip," says Peterken. "It's important for us to show a human face and say, 'We're just here to be interested and to offer you help and support'."

Christine Owens, head of tobacco control at the Roy Castle Lung Cancer Foundation, agrees; starting with a straightforward information session will avoid giving the impression that "it's Big Brother watching," she says.

A popular part of the roadshows Peterken runs is carbon-monoxide monitoring, using a small machine - like a breathalyser - that employees blow into to reveal how much carbon monoxide is in their lungs and blood.

"That's a really good way of people seeing what the effects are ... it's really motivating," she says. Other popular props on show include nicotine-replacement therapies and "tar in a jar".

"Seventy per cent of smokers say they want to give up," Peterken points out. "So we know that of the smokers we see, a lot of them will be thinking about it, and obviously the ban is going to make more think about it."

Group therapy

As with so many things, it is worth shopping around for help with cessation programmes.

"Different organisations offer different benefits," says Bosworth. "An NHS service will be local and may have a better understanding of the locality but might be less flexible over times. And fees vary in different areas and from organisation to organisation." Charging is often based on a fixed fee per head.

A common method of support offered by stop-smoking organisations is group-based sessions in the workplace, either at break times or during work hours. Based on the NHS model, these sessions ypically take place weekly for six to nine weeks, and each session lasts for an hour or 90 minutes. Some quit organisations also offer one-to-one sessions.

Smaller organisations that have only a small number of smokers - say two or three - may find it more difficult to arrange stop-smoking support on-site. Christine Owens suggests small companies in this situation "band together" with other local employers to arrange joint sessions for staff. "This is the kind of situation where employers can be proactive in thinking of ways that they can make it easier for their staff to give up," she says.

A telephone counselling service for staff to use at work can be really useful, says Bosworth, as employees can phone for support when they experience cravings. Some stop-smoking organisations also offer email counselling and web-based support services.

If your company has its own occupational health department, you might want to consider offering nicotine replacement therapy to staff. "Basically, with quitting support, the more you do, the more effective it's going to be," argues Peterken.

When planning a programme, it is important not to neglect shift workers and mobile workers who may not be able to attend scheduled sessions; such employees might benefit from phone and web-based support.

Employers also need to be realistic about the characteristics of the workforce; for example, will employees have time to attend sessions? "We find that some larger organisations prefer a more 'drop-in' orientated session," says Bosworth, "so staff who want to stop but can't free themselves for the full hour or 90 minutes can pop in as their workload allows them."

Another option for larger organisations is to have a member of staff train as a smoking-cessation adviser so they can offer support to employees directly in a way that suits the organisation and its workforce. Bovis Lend Lease in Liverpool and Scottish Gas, which won a Clean Air Award for its smoking policy, both trained their own advisers (see boxes).

"I think staff feel supported when they've got the option to give up with some of their peers," says Tracy O'Hanlon, who trained as an adviser and ran smoking-cessation sessions at Scottish Gas's Uddingston site. "It's more motivating than going to a smoking-cessation class at a local health centre where they don't know anybody. It's a lot easier to run and I think a lot more successful because it's in the workplace. Possibly they felt under more pressure as well, because I had my beady eye on them! But they said that was a good thing."

Be prepared

Organisations need to market their initiatives to encourage potential quitters to take advantage of the support on offer and to ease the transition to smoke-free working.

"Businesses need to present it as something positive they're doing for people, rather than something that they're taking away," says Peterken.

"Because, of course, giving up smoking is about losing something, so we try to present it as, 'This is what you will gain by quitting' and how brilliant it is. We try to project the positive aspects of quitting in terms of having more energy, more money, and feeling more in control of things."

Christine Owens believes smoking cessation could be a good starting point for other workplace initiatives.

"Maybe now's the time to look at health as an issue in the workplace," she argues. "Even in the smallest organisation, there are things that they can do. And if you make smoking cessation part of an overall health-improvement initiative, there'll be options for non-smokers to take up."

Once you have finalised your smoking policy and decided on the kind of quit support you will offer staff, make sure all employees know where they can smoke, when they can smoke and what support is available if they want to quit.

"It's all about preparation for businesses and it's all about preparation for the individual smokers," says Peterken. "I would say to companies, don't wait for your letter from the Department of Health about what the legislation says - find out now." 

Get help

For information about NHS stop-smoking services, visit www.gosmokefree.co.uk

Information about QUIT's services and guidance on giving up smoking can be found at www.quit.org.uk

More information about the smoke-free regulations is available at www.smokefreeengland.co.uk, www.smokingbanwales.co.uk and www.spacetobreathe.org.uk (for Northern Ireland).

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Five steps to success

QUIT's Ruth Bosworth outlines five key steps for making the switch to smoke-free pain-free.

1. Research the legislation and what it means for your business.
2. Consult staff on what the changes will mean. Will you provide shelters? Will you allow smoking breaks? What kind of cessation support - if any - would employees like?
3. Develop a policy and ensure all staff are familiar with it.
4. Implement changes in good time to make sure you are compliant with the new legislation.
5. Signpost stop-smoking support - whether it is workplace-based or simply information about outside sources of help.

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Bovis Lend Lease and Fag Ends

Construction company Bovis Lend Lease operates a smoke-free policy at its Liverpool site (see Ahead of the game, HSW March, page 18) and provides quit support for employees with assistance from the Roy Castle Lung Cancer Foundation's stop-smoking team, Fag Ends.

The company has had three visits from the charity in the past year and "there's been a great response to it," says site nurse Claire Campbell. Lots of information is displayed around the site for workers, including posters and cards with the Fag Ends support-line number, and Campbell has trained with Fag Ends to become a smoking adviser so she can offer cessation support to staff as part of her wider role.

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Scottish Gas's smokeless graduates

Before the Scottish smoke-free regulations came into force in March 2006, Scottish Gas ran a workplace stop-smoking initiative for staff at its Uddingston site.

With support from the nicotine replacement therapy brand Nicotinell, the company planned a 12-week support programme which included providing staff with nicotine patches. "We asked staff, if they wanted to give up, would they be interested in joining a smoking-cessation group? And the response was really high," says support delivery manager Tracy O'Hanlon. "But we wanted to pilot it because of the cost involved, so we decided to limit the group to 12."

O'Hanlon and a colleague trained to be smoking-cessation advisers so they were able to mentor the 12 employees and offer one-to-one support as necessary.

"We would go round daily and check how they were feeling," she says. "And we would give out gimmicks such as stress balls and gum and sweets."

The company also used plasma screens around the site to display messages of encouragement for the quitters.

The group met once a week for an hour over the 12 weeks so they could share their experiences and collect patches. The company also invested in an inhalator so the group could monitor the drop in their carbon monoxide levels.

At the end of the 12 weeks, the group had a graduation ceremony. Eight of the 12 employees quit successfully by the end of the programme, which was "a great success rate," says O'Hanlon.

Scottish Gas plans to run another programme in the next few months and the successful quitters from the pilot group will act as mentors and "buddy up" with the new recruits.

Scottish Gas also provides employees with information about local NHS services and organises regular visits from stop-smoking organisations.

"After our success we passed all the information onto the offices in Edinburgh and Glasgow, and Edinburgh has also run some successful smoking-cessation groups," says O'Hanlon.

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