Report reviews alcohol and health services

• Report: Reducing Alcohol Harm: health services in England for alcohol misuse
• Public Accounts Committee

Edward Leigh MP, Chairman of the Committee of Public Accounts, today 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 accident and emergency (A&E) departments flooded on weekend nights with drink-associated injury cases.

“The responsibility for 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.

Alcohol misuse is a significant and growing problem in England, with more than 10 million people now regularly drinking above the guidelines set by Government. Alcohol misuse places a considerable burden on the National Health Service, costing an estimated £2.7 billion per year. In 2006–07, there were some 811,000 alcohol-related hospital admissions, representing a 71 per cent increase in four years. Between 12am and 5am on weekend nights, nearly three-quarters of all attendances at accident and emergency departments are alcohol-related.

In 2004, alcohol harm became subject to a national government strategy, which was updated by the Department and the Home Office 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 to effectively 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 (Prostate Specific Antigen) indicator.