Report warns over growing burden of alcohol on hospitals

A new report by the Nuffield Trust highlighting the impact of alcohol on hospitals drew significant media attention last month. It warns that as the burden of alcohol on the NHS continues to mount, further preventative action and opportunities to identify problems within hospitals need to be taken.

The report focuses on trends in A&E attendances and alcohol-specific hospital admissions. Figures showing that alcohol-related poisoning attendances had doubled in six years in particular hit the headlines, as did a 64% rise in alcohol specific admissions over the last nine years. A Full Fact analysis verified the figures, whilst clarifying important distinctions between A&E attendances and hospital admissions (i.e. to a ward).

See here for a blog post from one of the report's authors which explores the key findings identified in the report:

• There is an increasing alcohol-related burden on England’s hospitals. For example, from 2008/09 to 2013/14, A&E attendance rates likely due to alcohol poisoning doubled, from 72.7 per 100,000 population to 148.8 per 100,000 population (a 104.6% increase). Additionally, from 2005/06 to 2013/14, inpatient admissions specific to alcohol increased by 63.6%.
• There were higher admission rates among older, poorer men. In 2013/14, the highest rates of emergency admission were found in 45–64-year-old men (1,126.0 per 100,000 population). And more generally, A&E attendance rates likely due to alcohol poisoning and hospital emergency admissions specific to alcohol were three to four times higher in the poorest fifth of the population.
• There is a need to take better advantage of opportunities to intervene. 90% of those who attended A&E due to likely alcohol poisoning and 72% of those who had an alcohol-specific emergency admission only attended hospital (in any setting) once in 2013/14. On the other hand, about 75% of those diagnosed with alcohol-related liver disease (ARLD) during 2009/10 had contact with hospital services in the year before diagnosis. This presents an opportunity to identify issues of alcohol dependency, and to provide specialist advice and onward referral, which may prevent progression to ARLD.
• Greater preventative measures should be considered. Approximately 73% of hospitals (deemed to be of an appropriate size) have some form of alcohol service. But recent cuts, both to public health and local government budgets, raise concerns over the sustainability of funding for local alcohol services. Population-based approaches to reducing alcohol-related harms – such as increased taxation, minimum unit pricing, restricting availability and limiting marketing and advertising – should also be considered.

The Nuffield report highlights an alcohol toolkit released by the Royal College of Emergency Medicine, which also identified the need for further investment in Alcohol Care Teams and brief interventions to be carried by all medical staff in emergency settings.

Last year Public Health England (PHE) released a 'minimum dataset' guidance document to support monitoring and evaluation of hospital based alcohol services. It followed a PHE review into the level of provision and an A&E pathways document for young people.