'Stark challenge' for NHS from alcohol consumption

The growing burden of alcohol-related activity on hospitals in England is uncovered today in a new study from the Nuffield Trust (note 1), with the authors concluding the NHS faces a ‘stark challenge’ in trying to deal with the consequences of harmful drinking.

The report finds that emergency admissions to hospital specific to alcohol have increased by over 50% in nine years and now top a quarter of a million a year (note 2), while the rate of people attending A&E with probable alcohol poisoning has doubled in six years.

The authors of the report set out to assess the extent of alcohol-specific activity in hospitals in England, whether it had increased over time, and whether these trends were different across demographic, socio-economic and regional patterns.

The researchers looked at only measures of hospital activity specific to alcohol, thereby excluding conditions where alcohol was a contributing factor, such falls, domestic violence or heart disease. The figures in their report are therefore an underestimate the true levels of alcohol-related activity.

The measures included attendances at A&E likely to be due to alcohol poisoning (note 3), which tends to result from binge-drinking; and admission to hospital for alcohol-specific conditions, which are generally due to chronic or excessive alcohol consumption. The report also takes an in-depth look at patterns of hospital use in people with the specific condition alcohol-related liver disease (ARLD), which arises from prolonged heavy drinking over long periods, to assess whether there were opportunities over time to tackle patients’ harmful drinking. The researchers used Hospital Episode Statistics (HES) data from April 2003 to March 2014, covering all patients aged 15 years and over.

The researchers call for much better recording of alcohol-related activity in hospitals, particularly the measure which counts attendances at A&E due to alcohol poisoning, which they point out could include a small number of other types of poisoning as well – they say that these are likely to largely comprise poisoning by alcohol, but that it is impossible to be certain (note 3).

The findings show that:

• From 2008/9 to 2013/14 (ie over six years), A&E attendance rates likely to be due to alcohol poisoning doubled, from 72.7 per 100,000 of population to 148.8 per 100,000 – a 104.6% increase (note 4).
• Within this group, the highest rates of likely alcohol poisoning were seen in younger age groups (15 to 24 year olds), and in particular young women aged 15 to 19 years, where the rate was approximately one and half times higher than men in the same age group. Rates were higher in the North of England (note 5). Attendance rates likely to be due to alcohol poisoning were also three and a half times higher among those living in the 20% most deprived areas in England.
• In 2013/14, over half of all A&E attendances likely to be due to alcohol poisoning took place on a Friday, Saturday or Sunday (51.1%, or 33,653 out of 65,882). Across the week, attendance increased throughout the evening and peaked between midnight and 2am, before reducing to its lowest level at about 7am (note 6). The highest volume of attendances likely to be due to alcohol poisoning in the early hours of the morning was seen in younger age groups, particularly those aged 15 to 24.
• Over a nine year period from 2005/6 to 2013/14, alcohol specific in-patient admissions to hospital increased by 63.6% - within this group, emergency admissions increased over the period by 53.9%, from 374.9 per 100,000 population to 577.1 per 100,000 population, and elective admissions by 143.3%, from 45.5 per 100,000 population to 110.8 per 100,000 population. The actual figure for emergency admissions specific to alcohol was 255,567 in 2013/14.
• The rate of emergency admissions specific to alcohol was consistently higher in men than in women, across all age groups. In 2013/14, the highest rates of emergency admission were found in the 45 to 64 age group, for both men and women – a much older age group than those who had the highest rates of attendance at A&E with likely alcohol poisoning. Rates of admission were four times higher among those living in the 20% most deprived areas than those living in the 20% least deprived areas. Rates were also higher in the North of England and in some urban areas (note 7).

The authors of the study discovered that 90% of those who attended A&E for probable alcohol poisoning, and 72% of those who had an alcohol-specific emergency admission, only attended hospital (in any setting) once in 2013/14 – highlighting the importance of taking full advantage of these opportunities to provide advice on alcohol consumption. NICE recommends commissioning hospital alcohol workers to assess and manage people who drink alcohol at harmful levels – but a survey in 2013 by Public Health England (PHE) suggests that one in four hospitals considered a suitable size to merit a team do not have any form of alcohol service.

The researchers express concern that as a large proportion of hospital alcohol services are funded through local authority public health budgets, recent announcements by the Government of cuts to these budgets raise questions about the sustainability of funding for local alcohol services.

Joint author of the report Claire Currie said:

“With the Christmas party season in full swing, it’s worth considering the full burden over-indulgence in alcohol is placing on our NHS, as well as the obvious human cost. Our research has uncovered a picture of rising and avoidable activity in hospitals, representing a stark challenge for the Health Service at a time when it’s already great pressure. Hospitals alone cannot tackle this issue – the Government must consider measures such as minimum unit pricing, restricting availability and limiting marketing and advertising”.

Fellow author Dr Alisha Davies, Senior Research Analyst at the Nuffield Trust, added:

“With one in four hospitals already without some form of alcohol team, we’re worried that cuts to NHS and local authority budgets could put services for a particularly vulnerable group of people at risk”.