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Call for stronger services and specialist leadership to Improve Britain’s alcohol services

24th March 2010

With as many as 40,000 deaths annually attributed to alcohol misuse, at a cost to the NHS of £2.7billion, doctors are today urging major reforms to the structure of services with 11 key recommendations. The report recommends hospitals should have a co-ordinated approach to alcohol-related disease, across hospital and community departments, through an Alcohol Care Team including a designated consultant lead and a multidisciplinary team, which includes a 7-day Alcohol Specialist Nurse Service and an Outreach Service.

The report published by the British Society of Gastroenterology, the Alcohol Health Alliance UK and the British Association for Study of the Liver sets out an evidence based case for establishing a joint hospital and community Outreach Service, which together with a 7-day Alcohol Specialist Nurse Service, could result in a 5% reduction in alcohol related hospital admissions, resulting in the potential for each District General Hospital to save £1.6 million annually.

The report draws on best practice across the UK to focus in new ways on alcohol problems within hospitals and to intervene earlier in cases where alcohol misuse is implicated in patients presenting for different reasons.  It calls for dedicated specialists to lead on alcohol in hospitals and to work with community partners to reduce alcohol harm and its cost to the NHS.

The report also calls for a re-assessment of cost-effective alcohol treatments. 13-20% of all hospital admissions are alcohol-related. However, on average, PCTs only spend 0.1% of their budgets on alcohol services every year, working out at £197 per dependent drinker, whereas the amount spent annually on dependent drug users equates to £1744.

Lead author, Dr Kieran Moriarty points out that for every 8 people who receive brief advice on alcohol consumption and harm, one will reduce their drinking to within lower risk levels. This compares to smokers, where only one in twenty will act on the advice given and suggests that brief interventions in alcohol are effective. A range of interventions can be made available, depending on the needs of individuals. The report specifically highlights the role of psychosocial treatments for dependent drinkers, finding that the public sector would save £5 for every £1 spent on treatment.

Dr Moriarty of the British Society of Gastroenterology and lead author states:

“We strongly support the Chief Medical Officer’s calls for a substantial increase in the effective cost of alcohol, but we recognise that such preventive measures may take 10 years to impact on the scale of the problem. In the meantime, it will grow at an increasing rate. We therefore need to urgently re-evaluate practical measures, which can be implemented to improve detection in primary care and ensure appropriate management of patients with alcohol problems in secondary care. We can then implement an alcohol pathway to facilitate rapid but appropriate discharge, followed by the right levels of support in the community.”

Prof Ian Gilmore, Chair of Alcohol Health Alliance and President of Royal College of Physicians comments:

“Education of the public about alcohol and alcohol-related problems is essential for to our long-term health, but it will take many years to have a major impact. Therefore, we really do need to evaluate the treatment services that are currently in place, if we are to ever address the effects of Britain’s alcohol epidemic on our hospitals and on the health of our nation. The recommendations outlined in the report set out how to achieve tangible results for patients, through effective team working and clinical leadership, whilst helping to save the NHS money. Through simple service redesign, highly cost-effective alcohol treatment can help mitigate against the most serious cases and save the public sector £5 for every £1 spent on treatment. I welcome this report and its recommendations.”

 

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