Reducing Alcohol Harm:
Health services in England for alcohol misuse

Alcohol related ill-health is an increasing burden for the National Health Service, and alcohol harm costs the health service in the order of £2.7 billion a year, but efforts to address it locally are not in general well planned, according to the National Audit Office (NAO).

In a report published in October 2008, the NAO examined the NHS response to the rising levels of alcohol-related disease. Hospital admissions for the three main alcohol specific conditions (alcohol-related liver disease, mental health disorders linked to alcohol, and acute intoxication) have doubled in the last 11 years. There were also twice as many deaths from alcoholrelated causes in the UK in 2006 as there were 15 years before, increasing from 4,100 to 8,800.

The Department of Health is raising the profile of alcohol misuse by providing information and guidance to underpin local action, centred on encouraging Primary Care Trusts (PCTs) to gauge their performance against the rate of alcoholrelated hospital admissions. However, the NAO found their response to be patchy.

Primary Care Trusts are responsible for setting local health priorities. But around a quarter of PCTs surveyed by the NAO had not fully assessed alcohol problems in their areas. Many PCTs do not have a clear picture of their spending on services to address alcohol misuse and its effects on health. PCTs have often looked to their local Drug and Alcohol Action Teams to take the lead, but these bodies focus primarily on specialist services for dependent users of illegal drugs and alcohol. The NOA concluded that there is scope for the Department of Health to provide greater leadership to PCTs on alcohol misuse, and the NAO report recommends a number of specific measures to that end, such as guidance to help PCTs assess causes and to forecast trends in the level of alcohol harm in their localities.

There is evidence that ‘brief advice’ by GPs and health workers, can reduce alcoholconsumption and help to prevent longer term damage to health and there are some good local examples of this. From September 2008 the Department has provided an additional £8 million in support for such services. For people who have developed severe alcohol problems, there are considerable variations between different localities in access to specialist treatment services, and scope for better integration of hospital treatment with follow on services such as psychiatry.

The Department has recently undertaken a series of new publicity campaigns to encourage `sensible drinking’. Research has shown that consumers tend to underestimate the amount of alcohol their drinks contain and are not clear about what is meant by a ‘unit’ of alcohol. Department of Health funding for such work was tripled to £6 million in 2008/09.

Tim Burr, head of the National Audit Office, said:

“Alcohol misuse constitutes a heavy and increasing burden on the NHS. If services to tackle alcohol misuse are going to make a bigger difference, Primary Care Trusts need to understand better the scale of the problem in their local communities. With its increased focus on the prevention of lifestyle-related illness, the Department of Health could, for example, do more to convince Trusts about the value of timely advice to help people develop safer drinking patterns."

The National Audit Office report ‘Reducing alcohol harm: health services in England for alcohol misuse can be downloaded at:
http://www.nao.org.uk/publications/0708/reducing_alcohol_
harm.aspx