The Government recently announced its new NHS Long Term Plan (LTP), which includes a commitment to establish Alcohol Care Teams (ACTs) in hospitals with the highest rate of 'alcohol dependence-related admissions'.
A PHE blog sets out ten key public health priorities including ambitions on smoking, diet, mental health and support for problem gamblers, with the Health and Social Care Secretary Matt Hancock stating 'the principle that prevention is better than cure' was at the heart of the plan.
However an article in the BMJ subsequently criticised Hancock who in the same week stated to Sky News he was 'dead against minimum pricing', considered a key evidence based strategy by health groups, academics and PHE's own evidence review.
Indeed health group's optimism over firmer alcohol policy may have been waning in the build up to a new national alcohol strategy expected this year. Last year Scotland's refreshed alcohol strategy continued its commitment to policy areas seen as key determinants of alcohol harm, most notably through it's evaluation of minimum pricing. However Hancock has repeatedly spoken in a similar tone to industry favoured 'anti-nanny state' arguments, saying people should take greater personal responsibility for their health to take pressure off the NHS.
Government alcohol policy of course has continued to attract criticism from health groups calling for firmer action on areas of pricing, advertising and availability. Instead policy has focused largely on local partnerships and continued voluntary regulation in areas such as advertising and labelling. Recently a PHE partnership with industry funded body Drinkaware for the Drink Free Days campaign also prompted significant criticism and debate, though even Dry January, independent of industry and Government, has also attracted concerns. In particular, some argue that Dry January focuses attention on those with less serious problems, whilst investment in alcohol treatment faces ongoing cuts.
Hancock however advocates targeting the minority 5% of harmful drinkers who consume one third of all alcohol, but the BMJ response points to PHE's own evidence review which states; “the combination of increasing-risk, higher risk, and extreme drinkers accounts for about 25% of the population and consumes over 75% of the total self-reported alcohol consumption.” Government policy has by no means excluded efforts to address increasing risk (or 'hazardous') drinkers, particularly via brief intervention efforts. However question marks have been raised over how well these have been embedded in primary care, though a current CQUIN programme is underway to implement widespread IBA in hospitals.
Perhaps at least some will see room for optimism via further investment in hospital based ACTs as a headline pledge of the LTP, though it is unclear how many of the key hospitals already have such provision. A 2014 PHE report identified that many hospitals had at least some form of specialist alcohol provision, whilst models such as assertive outreach or targeting frequent attenders are regularly championed. The LTPs pledge though states funding for the ACTs will come from 'their clinical commissioning groups (CCGs) health inequalities funding supplement', thus the commitment appears to amount only to 'support' to establish them, rather than the provision of any specific funding (see PHE guidance here).
Whilst national pledges for prevention and support around alcohol may hit at right notes, whilst treatment services continue to face cuts and no firmer national policy action is taken, it is not only alcohol groups who are likely to argue there is further to go for national plans to improve the nation's health.
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