COMMENTARY

A&E Perspective: Calling Time on Alcohol-Related Harms

Dr Dan O'Carroll

Disclosures

May 28, 2019

Prior to the on-going concerns regarding large tax bills due to the incredibly complex arrangements around NHS pensions and tapered annual allowances, I regularly did extra shifts at a major trauma centre (MTC), to maintain my skills in the management of major trauma. During my most recent one of these I observed that my specialist subject for Mastermind would be 'dealing with intoxicated patients that have fallen down the stairs'. I thought back over the last 3 years of these major trauma shifts and realised that alcohol was a contributing factor in at least 75% of the patients that I had seen in my role as trauma team leader (TTL).

   

Dr Dan O'Carroll

Due to the Chancellor and the Government's ill-conceived pensions policy, many doctors, myself included, have reduced the extra work that the NHS has come to rely on. As this traditional way of earning extra no longer always pays I have been searching for my Dragon's Den idea.

Alcohol Costs

I can only imagine what the Dragons' response would be if I were to have invented alcohol and I were trying to bring it to the market. This new 'wonder drug' people may enjoy drinking in moderation, may help some people to relax and lubricate social occasions. And the down sides? Well, there may be one or two. I'm reasonably certain I'd be leaving the Den with my tail between my legs, as the Dragons would realise that there was no chance of getting a licence to sell this product!

In 2018 there were nearly 80,000 admissions to hospital because of unintentional injuries as a result of alcohol. These will range from the minor bumps and bruises where the patient will need to be admitted to sober up and be discharged safely, to the major trauma patients I've mentioned above.

Let us consider my specialist subject - 'an intoxicated patient that has fallen down a flight of stairs'. The costs associated with this are massive to the NHS. It's not just the cost of the bed, estimated to be £400 per night – making an overnight hospital stay more expensive than the most pricey hotel in most parts of the country -we also have to consider the cost of taking a patient to hospital via ambulance at £250, multiple investigations, eg full trauma CT, and often intensive care management, which can cost nearly £2000 per night. It quickly becomes apparent that the costs associated with just one patient can spiral into thousands of pounds.

This does not even consider the cost to the victim. I have, unfortunately, seen many life- changing injuries, and several deaths, in the years of fulfilling the TTL role, and the on-going damage to the victim and their families that should not be underestimated in terms of fiscal or personal cost.

Regular Attenders

Emergency departments (ED) throughout the UK will have their regular attenders, coming in on a daily basis, known to the staff on first name terms and greeted with often weary 'oh, hello again'. We can sometimes identify which one of our regulars it is without even seeing them, just by the level of noise and disruption that they bring with them. Many departments will have some patients that attend several times in a 24-hour period, with no actual acute medical problem, 'just' collapsing secondary to excessive alcohol intake, and well-meaning passers-by calling emergency ambulances who have no choice but to bring the patient to a place of safety. These patients can be disruptive and often require the presence of hospital security for their own and the staff's protection and there are many shifts where police officers will spend many hours accompanying a drunk patient who is under arrest. We see the latter situation daily, and in these times of police cut backs, I often consider whether this is a good use of tax-payer money.

When we consider alcohol and its effects on society and more broadly than just the ED, it is alarming to learn that in 2012 alcohol consumption was responsible for approximately 6% of deaths and 5% of disease burden globally. This paper also claims that 20% of the population of England had suffered alcohol-related harm. 2.1% of hospital admissions in England (338,000) in 2017/18 were attributable to alcohol.

Funding and Tax Revenue

Funding for drug and alcohol services has been cut by £162m since 2013-14, so there is little prospect of these services significantly reducing the demands being put onto the NHS or other public bodies. Despite an ever-increasing tax on alcohol resulting in significant tax revenue for the Chancellor - in the financial year 2015/16 it was £10.7bn - this barely dents the costs thought to arise from alcohol to the UK economy on the whole, as it is suggested that up to £52bn is lost from the UK economy due to crime, ill-health, and lost productivity.

It's unlikely that there will be any significant shift in public attitudes or government policy in the near future. So, we will continue to see patients and families having their lives irrevocably changed by alcohol, whether that be from acute injuries or as a result of the complications of chronic misuse.

From an ED perspective this is such a frustrating misuse of increasingly squeezed resources, resources that could be much better deployed. But I'm unsure what we can do differently.

Perhaps we can mitigate some of the risk? I'm back in the Dragon's Den pitching my idea for adult stair gates that are operated by a breathalyser test and will only open with a suitably low alcohol reading! My idea is very much in its first draft stage, but I'm confident that by this time next year we'll be millionaires.

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