Once again this winter, our hospitals are buckling under pressure. The ambulance service and A&E departments are missing key targets yet again, and it has been announced that the London Ambulance Service has been put into special measures. Indeed, the situation for hospitals is looking even worse than this time last year – which was deplored as the most difficult winter for a generation.
A year ago, I wrote a blog highlighting the toll of alcohol on individuals and on the NHS. Over the last 12 months even more evidence has emerged linking alcohol to detrimental health outcomes – including one study highlighting a small increased risk of cancer even as a consequence of moderate drinking.
New Nuffield Trust analysis published this week examines alcohol-related activity in England’s hospitals. It will come as no surprise that the picture looks bleak, with our research highlighting that:
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Alcohol-related harm is placing increasing demand on our hospitals, with alcohol-related activity being particularly evident in emergency care.
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People who experience alcohol-related harm appear to use hospital services more. This highlights opportunities to intervene in a hospital setting.
Meanwhile, in spite of a strong narrative from NHS England emphasising prevention as key to a sustainable NHS; shrinking public health budgets (which sit in local authorities) and limited investment in alcohol services from clinical commissioning groups have so far led to a very different reality.
Ambulance services under pressure
According to our figures, in 2013/14 three quarters of A&E attendances in English hospitals for alcohol poisoning arrived by ambulance. Almost two ambulances every hour were needed to transport those aged 15-24 to hospital for this purpose alone. This is a real problem and will doubtless come as no surprise to frontline staff.
The London Ambulance Service (LAS) (along with many other areas) work proactively to free up ambulances from dealing with alcohol-related calls to instead deal with potentially life-threatening calls through booze bus initiatives. Until 2013, LAS operated a recovery centre which provided medical care and prevented people attending A&E despite needing to respond to an increasing number of alcohol-related incidents.
The North East Ambulance service has also spoken out on the physical and verbal abuse paramedics face in responding to alcohol-related callouts, highlighting that the issue is far more serious than merely being a drain on resources.
The longer-term implications of alcohol
It is very difficult to tease out the full burden of alcohol-related activity from routinely collected hospital data. However, our report describes an increasing trend of people being admitted for alcohol-related conditions. In 2013/14 approximately one in every 20 emergency admissions had an alcohol-related diagnosis recorded (although it was not the primary reason for admission in all these cases).
The picture we paint in our report highlights deep-seated inequalities where alcohol-related harm is experienced. In 2013/14, rates of alcohol-related emergency admissions were four times higher in those living in the 20 per cent most deprived areas compared to those living in the 20 per cent most affluent areas.
In light of government spending cuts to public health budgets, it seems likely that efforts to improve population health in more deprived areas will be hardest hit.
The need to take every opportunity to reduce harm
Alcohol-related liver disease (ARLD) is a specific consequence of long-term harmful alcohol consumption. In our analysis, people who went on to be diagnosed with ARLD had higher rates of hospital contact for several years leading up to diagnosis. While three quarters of individuals had contact with hospital services (inpatient, outpatient or A&E services) in the year leading up to diagnosis, a quarter of these individuals had only one or two contacts during this time. This emphasises that every opportunity needs to be taken to ensure that individuals are offered support to address harmful levels of drinking as early as possible.
The Royal College of Emergency Medicine has set out some practical actions which A&E departments and hospitals can take in tackling the issue of alcohol-related harm. The key messages in this toolkit resonate with our report and include a call for alcohol care teams. While it’s an encouraging sign that 73 per cent of hospitals have access to such teams, the severity of the situation requires that all hospitals should be investing in these vital measures.
There are numerous other examples of initiatives being championed to tackle alcohol-related harm in hospitals: for instance, incentivising identification of individuals in A&E departments who would benefit from support. However, ensuring sustainability of these initiatives as budgets have been tightened has been challenging.
Where next?
As we endorse in our report, a package of interventions are needed to tackle alcohol-related harm, from prevention to treatment and from individually targeted interventions to population-level measures.
There is overwhelming recognition of the harm alcohol can cause as well as plenty of will to turn the tide. However, there is only so much that single organisations and local areas can do with budgets being squeezed and working within a system set up to deliver health care rather than to focus on achieving health.
The Government plays an important role in implementing population-level measures to prevent alcohol-related harm. Of the countries within the UK, Scotland (which has pushed this agenda) has been said to have the strongest approach to evidence-based policy. Their alcohol strategy incorporates both legislative and policy measures to shift changes in alcohol-related behaviours and is supported by a monitoring and evaluation programme. I am hopeful that in England more can be done.
So, in the same way as last year, I ask that we all play our part in easing this headache for our health services and for ourselves, not just this Christmas, but all year round. Individuals could make a personal commitment to their health by taking part in the ‘Dry January’ campaign which is just around the corner.