Alcohol - can the NHS afford it?

A report from the Royal College of Physicians shows that alcohol misuse places a huge burden on the National Health Service, costing up to 12 per cent of the total expenditure on hospitals, £3 billion every year. In addition, one in five patients admitted to hospital for other reasons are consuming alcohol at levels potentially hazardous to their health.

The report says: "General Household Survey data from 1998 showed that more than one in three men and one in five women in the UK regularly consume more alcohol than the currently recommended sensible limits. Since this misuse of alcohol can lead to a wide range of physical and psycho-social harm it is not surprising that it places a significant burden on the workload of the NHS – both primary care and hospital services."

The Royal College stresses the point that the effects of alcohol are complex and can often lie behind other presenting causes for patients' use of hospital services: "Alcohol misuse is a major cause of attendance and admission to general hospitals in both the A&E/trauma and non-emergency setting. It may cause admission directly, or together with other causes contribute to admission. Alcohol may also increase the burden on hospital services by adversely affecting the course of illness following admission."

It is important to note that the burden of alcohol misuse on the workload of general hospitals results from damage not only to the misuser himself, but also to other people affected by the excessive drinking such as friends and relatives and those involved in accidents caused by intoxicated drivers.

Because of the huge size of the burden placed by alcohol on hospital services and the consequent financial implications, the writers of the report urge that appropriate strategies be put in place for the early identification and management of harmful and hazardous drinkers. "For effective early detection, detailed alcohol histories must be sought from patients who present with conditions often associated with alcohol misuse. However, considering the high frequency of hazardous drinking in all patients presenting to hospital services, a strong case can be made for incorporating screening for alcohol misuse into the routine health care provided in the general hospital setting."

The RCP is particularly concerned about teenage alcohol consumption. This age-group appears to be drinking larger amounts of alcohol - in 1998, over half of 14-15 year-olds had drunk alcohol in the past week. Younger teenagers are also drinking more, and research shows that heavy drinking teenagers are more likely to continue their habit as young adults. This indicates that alcohol is not only a huge problem for the NHS now, but will be increasingly so in the future unless prompt action is taken. Professor Ian Gilmore, Registrar of the Royal College of Physicians and Chairman of the working party, said:

"Alcohol is an issue which needs to be tackled on all fronts, especially by changing attitudes to alcohol-related problems across the NHS. If we start at the sharp end of hospital admissions with detection and simple interventions for patients who are starting to drink dangerously, there is good evidence that we can make a real difference."

This authoritative report's recommendations are intended to improve the management of the vast number of patients presenting to general hospitals in the UK who drink alcohol in excess of sensible limits. Their main points are:

• The creation of a National Alcohol Director to give the issue a higher profile

• Early publication and implementation of a National Alcohol Strategy

• Every acute NHS hospital Trust to have a defined hospital strategy to identify, assess, refer, treat and follow-up problem drinkers

• Better education on alcohol for doctors, nurses, medical students and other health workers.