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Reducing Alcohol Harm: Health services in England for alcohol misuse

Alcohol-related ill-health is an increasing burden for the National Health Service. Alcohol misuse 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, the National Audit Office reported today. The Department of Health is however raising the profile of alcohol misuse by providing information and guidance to underpin local action, centred on encouraging PCTs to gauge their performance against the rate of alcohol-related hospital admissions.

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 alcohol-related causes in the UK in 2006 as there were 15 years before, increasing from 4,100 to 8,800.

Primary Care Trusts are responsible for setting local health priorities. But around a quarter of PCTs surveyed by the NAO have 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. 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 preventive services, such as ‘brief advice’ by GPs and health workers, can reduce alcohol consumption 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.

“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.”

Tim Burr, head of the National Audit Office

Notes for Editors

  1. A unit of alcohol is defined in the UK as 10 millilitres (ml) of ethanol. For example, a pint of ordinary strength lager contains two units and a standard pub measure of spirits has one unit. A 175 ml glass of wine at 13 per cent strength has 2.3 units and a 125 ml glass of wine at 9 per cent has one unit.
  2. Press notices and reports are available from the date of publication on the NAO website, which is at Hard copies can be obtained from The Stationery Office on 0845 702 3474.
  3. The Comptroller and Auditor General, Tim Burr, is the head of the National Audit Office which employs some 850 staff.  He and the NAO are totally independent of Government.  He certifies the accounts of all Government departments and a wide range of other public sector bodies; and he has statutory authority to report to Parliament on the economy, efficiency and effectiveness with which departments and other bodies have used their resources.

PN: 44/07