Department of Health under fire

The Department of Health’s approach to reducing alcoholrelated harm has been heavily criticized by the House of Commons Public Accounts Committee (PAC) in its report ‘Reducing Alcohol Harm: health services in England for alcohol misuse’. The report examines how the Department responds to alcohol-related harm through Primary Care Trusts, responsible for determining local priorities and spending. It states:

“Many PCTs …. do not know what they spend on [alcohol] services and across England there is little correlation between need and expenditure. Where services Launching the report, the PAC’s Chairman, Edward Leigh MP, said:

“Too many people are drinking too much. In England, nearly a third of all men and a fifth of all women are regularly drinking more than the official guidelines say they should. In doing so, many are on course to damaging their health and general well-being.

“The burden on local health services is of course huge, with the rate of alcohol-related hospital admissions climbing sharply and A & E departments flooded on weekend nights with drink-associated injury cases.

“The responsibility for are commissioned there is frequently a lack of performance monitoring and examination of whether what is provided represents value for money.” addressing alcohol harm has been handed to the Primary Care Trusts. But many have neither drawn up strategies to tackle alcohol harm in their areas nor even have much idea what they are spending on the relevant local services. These services are often ill-coordinated, increasing the risk that dependent drinkers, after immediate medical care, will simply relapse into their former drinking habits. Each PCT should have to demonstrate what progress it has made towards reducing the number of alcohol-related hospital admissions in its area.

“None of this is helped by poor coordination between Whitehall departments on such relevant matters as licensing, taxation and glass sizes. The Department of Health should look across all departments, identify all the initiatives and policy areas bearing on alcohol misuse and determine the extent to which each is helping or hindering the Department’s objectives. Where the latter are being stymied, the Department should communicate its concerns to senior officials in the relevant departments.”

Mr Leigh was speaking as the Committee published its 47th Report of this Session which, on the basis of evidence from the Department of Health (the Department), examined the current performance of the National Health Service in addressing alcohol harm, the Department’s influence on local commissioners, and the Department’s work to encourage sensible drinking.

Responding to the publication of the Public Accounts Committee’s report ‘Reducing Alcohol Harm: Health services in England for alcohol misuse’, Professor Ian Gilmore, President of the Royal College of Physicians and Chairman of the Alcohol Health Alliance said: “It clearly demonstrates that the delivery of alcohol policy locally has been uncoordinated and muddled, and the effect on those particular interventions left unevaluated. The Government must now focus on better policy coordination and a clear mandatory framework rather than voluntary partnerships with industry. Above all it must prevent harm and drive down overall consumption through introducing a minimum unit price for alcohol.”

Background

In 2004, alcohol harm became subject to a national government strategy, which was updated by the Department and the Home Offi ce in 2007. Since April 2008, the Department has also been responsible for delivering against a Public Service Agreement (PSA) indicator on the rate of increase of alcohol-related hospital admissions.

Primary Care Trusts (PCTs) are responsible for determining local health priorities and have control over the majority of NHS spending. PCTs are free to decide for themselves how much to spend on services to address alcohol harm. Many PCTs, however, do not know what they spend on such services and across England there is little correlation between need and expenditure. Where services are commissioned, there is frequently a lack of performance monitoring and examination of whether what is provided represents value for money.

In 2008, the Department introduced a number of new measures designed to help address alcohol harm: providing extra funding for GPs to screen new patients, increasing alcohol specific training for doctors, and creating 20 pilot sites designed to improve specialist treatment services. The Department has, however, yet to demonstrate its ability effectively to influence local commissioners, the drinks industry, and people’s drinking behaviour. The Department also needs to work more closely with the other government departments which are responsible for policies affecting alcohol consumption, such as taxation and licensing.

Achieving this will be necessary if the Department is to reduce levels of alcohol harm and succeed against the PSA indicator. The PAC report makes 10 key conclusions and recommendations:

Alcohol misuse places a large and growing burden on local health services; in particular, accident and emergency departments.

Some preventive services, such as ‘brief advice’... can be delivered effectively by...other officials outside the health service, but this requires effective partnership working at the local level. There is little evidence that this is happening.

General Practitioners (GPs) have an important role to play... but are not doing so consistently. A new scheme [the DES] to encourage such work is likely to have only limited effects.

Only around 1 in 18 people who are dependent on alcohol receive treatment and the availability of specialist services differs widely across England.

...there is frequently a lack of monitoring of whether what is provided by the public, private and voluntary sectors represents value for money.

[Treatment] services are often not joined up, increasing the risk that people will simply relapse into their former drinking habits.

The Department’s sensible drinking guidelines were changed from weekly to daily limits in 1995, but 11 years later almost two-fifths of people did not know the current recommended guidance.

By July 2008, only 3% of alcoholic products had fully complied with the drinks industry voluntary labelling scheme.

There is little evidence that Whitehall-wide action on other policies and regulations which affect alcohol consumption - such as licensing, taxation and glass sizes - is effectively coordinated.

Alcohol has become steadily cheaper in relation to income; meanwhile, consumption and health damage have increased.