How to reduce alcohol-related admissions to A&E?

25% of hospital admissions are involved with alcohol. Weekdays see alcohol presentations to A&E at 40% and 70% on a Saturday night. Alcohol consumption has raised 120% since 1950 per capita which shows that we are consuming more. Undoubtedly, alcohol related issues are an enormous strain on the NHS, consuming too great resources at a time when they are greatly squeezed. How can this be reduced/stopped whilst ensuring there is no deterrent to receiving healthcare?

If you were to charge a patient for being drunk, say £40, this may put off someone with a suspected head injury from going to hospital, a dangerous situation. Similarly, a police charge would dissuade many from attending but is not ideal for similar reasons. A financial penalty is not a suitable solution.

I posit that you cannot stop this problem once the person is intoxicated. The solution has to come from reducing alcohol consumption so, logically, reducing alcohol related incidents.

My suggestion would be limiting under 21's to buying alcoholic drinks under 4% alcoholic content and introducing a high tax on alcohol, especially spirits. Although this would be unpopular, it's required to improve the NHS which we need dearly.

It does appear that many incidents are connected to nightclubs/pubs. Should government focus its efforts on this?


Facts taken from:
http://www.alcoholpolicy.net/files/alcohol_problems_in_ae.pdf

Nematode

One thing that could be done is to actually enforce the laws and regulations as applied to Licenced premises - bar staff are supposed to refuse service to customers who are excessively drunk and disorderly.

As you say, I think by the time someone is significantly drunk and being admitted to A&E, whether as a result of a fight, a fall or alcohol poisoning, it is too late to do much other than patch them up and send them on their way - I'm sure hardly anyone sets off on a night out with the intention of them ending up in the hospital (unless they are trying to pull a nurse...). Stopping people getting so drunk has to be the first step - prevention being better than cure.

What next?

Stop treating smoking patients with related illnesses?

Stop accepting people with injuries from extreme sports?

Once you start trying to tailor and restrict free access to the NHS it'll all end up a mess.

Agree it's a problem, but a frankly unsolvable one IMO, especially not without encountering the age old problem of using a sledge-hammer to crack a nut - i.e. impacting on the responsible for the sake of the irresponsible.

TopHat24/7 wrote:What next?

Stop treating smoking patients with related illnesses?

Stop accepting people with injuries from extreme sports?

Once you start trying to tailor and restrict free access to the NHS it'll all end up a mess.

Agree it's a problem, but a frankly unsolvable one IMO, especially not without encountering the age old problem of using a sledge-hammer to crack a nut - i.e. impacting on the responsible for the sake of the irresponsible.

Take Bob, 24, office worker. He decides he's going to get drunk on a night out with friends at a club. He gets drunk and decides to drive home with 3 friends. On a quiet country lane, he crashes into an oncoming car with 2 passengers, who suffer serious injuries. Their are 3 fatalities in the drunk driver's car, and the drunk driver suffers minor injuries. This requires police, fire an air ambulance and 4 ambulances. The injured stay in intensive care for a long duration.

Take Jo, 19, student. She gets drunk and hits her head off the floor when falling in the street. An ambulance is called. She goes to A&E and has her head scanned, delaying Mark, 76, who has fallen down the stairs and has a sore head.

Take Bill, 45, office worker. He smokes, gets ill and well, you get the rest...

Alcohol related problems have far wider implications than smoking does. A&E is there for incidents like extreme sport.

Bill goes out for a few drinks, walks home, then gets beaten up for no reason.

Shall we not treat Bill as he's had a few?

Ass-r*** everyone who comes through drunk. Then the only one attending A&E drunk will be Duty.

Alas...I'm teetotal.

Still, your idea probably means I'll start drinking!

     

It's an impossible problem, although one way to try and curb drunken aggression is if someone is admitted to hospital after being battered by another, the other person (if found guilty etc etc,) are then ordered to pay hospital costs as well.

Nematode, your explanations don't really work, a smoker that suddenly can't breathe, rings an ambulance etc, also takes away from the person round the corner that doesn't smoke but also needs an ambulance.

Derbymanc wrote:It's an impossible problem, although one way to try and curb drunken aggression is if someone is admitted to hospital after being battered by another, the other person (if found guilty etc etc,) are then ordered to pay hospital costs as well.

Nematode, your explanations don't really work, a smoker that suddenly can't breathe, rings an ambulance etc, also takes away from the person round the corner that doesn't smoke but also needs an ambulance.

I don't think it's impossible, just huge and would require massive social adjustments to fix it.

Unless you make being drunk in public (not in your house) a crime, there isn't a deterrent.

It's more it just grinds my gears seeing drunken people in A&E taking up resources because they've fallen over and hit their head, got into a fight, been involved in a car crash etc, impacting on others because they've gone too far. You can drink and have a good time without going that bit too far.

A lot of closet homosexuals on this forum I suspect.

It's a social adjustment which needs to be made.

Bar staff need to stop serving those who have had too much. This will not happen unless serious penalties are handed out.

I'd also fine drunken morons who require treatment because of drunken stupidity. If they decide not to attend hospital then that is their own look out.

Lumbering_Jack wrote:A lot of closet homosexuals on this forum I suspect.

Got something else you wanna say, LJ?   

The sexual tension is dripping in here - Are any of you wearing purple at the moment?

My advice..People pay taxes so they have access to the NHS in their hour of need...So why not stop sending aid to Countries where the people never see it...

Pump the money into the best idea your Country ever had...instead..

Everyone is entitled to care...

Don't get like my Country..

And, should a useless layabout with no job get the same treatment as someone who pays more tax/national insurance?

This being 'drunk' reason is lame really.

There's a lot of issues that would have to be sorted and i think like everyone's implied. It's a social problem more than anything else.

Charging could be a dangerous road, as Stella said above where does it stop after that?

A useless lay about is in the eye of the beholder....

How do you decipher what is useless lay about..

Someone who is made redundant ??....

Someone who's Son died and he turned to drink because he couldn't cope..

These types get caught in the trap If you discriminate...

As well you know..

TRUSSMAN66 wrote:A useless lay about is in the eye of the beholder....

How do you decipher what is useless lay about..

Someone who is made redundant ??....

Someone who's Son died and he turned to drink because he couldn't cope..

These types get caught in the trap If you discriminate...

As well you know..

That's my point. You cannot judge. a drunken man could be hospitalised by a sober man, a layabout may have become one thanks to a number of reasons.

I have no time for lazy no gooders Stell..

But I also know Governments are figure driven often at the expense of the individual..

Nematode wrote:

TopHat24/7 wrote:What next?

Stop treating smoking patients with related illnesses?

Stop accepting people with injuries from extreme sports?

Once you start trying to tailor and restrict free access to the NHS it'll all end up a mess.

Agree it's a problem, but a frankly unsolvable one IMO, especially not without encountering the age old problem of using a sledge-hammer to crack a nut - i.e. impacting on the responsible for the sake of the irresponsible.

Take Bob, 24, office worker. He decides he's going to get drunk on a night out with friends at a club. He gets drunk and decides to drive home with 3 friends. On a quiet country lane, he crashes into an oncoming car with 2 passengers, who suffer serious injuries. Their are 3 fatalities in the drunk driver's car, and the drunk driver suffers minor injuries. This requires police, fire an air ambulance and 4 ambulances. The injured stay in intensive care for a long duration.

Take Jo, 19, student. She gets drunk and hits her head off the floor when falling in the street. An ambulance is called. She goes to A&E and has her head scanned, delaying Mark, 76, who has fallen down the stairs and has a sore head.

Take Bill, 45, office worker. He smokes, gets ill and well, you get the rest...

Alcohol related problems have far wider implications than smoking does. A&E is there for incidents like extreme sport.

Yeh, all that pesky alcohol-caused cancer.......

Really want to compare death & serious illness stats between smoking and drinking?

Want to list of a thousand, maybe million, examples of people going out getting hammered and not needing the services of A&E/hospital/docs? Perhaps starting with every night out I've ever had in my life.....

TRUSSMAN66 wrote:My advice..People pay taxes so they have access to the NHS in their hour of need...So why not stop sending aid to Countries where the people never see it...

Pump the money into the best idea your Country ever had...instead..

Everyone is entitled to care...

Don't get like my Country..

With Trussy 100% on this one.

You can't pick and choose who you think is sufficiently irresponsible to be denied access to what is considered a fundamental right in this country - free healthcare.

If you want to 'internalise the externality', to use economist speak, you have to (as Truss suggests) adopt the US system and make everyone carry their own medical insurance to pay for their own medical care.

I know which system I'd prefer....

Yep, give me the NHS every time.

I've had family living over there for 15 years now and, even though they're pretty rich so can afford all the right insurances etc, they still swear by the NHS. Aunty always says you don't realise how good/important it is until you don't have it anymore.

A factor to remember, and I am willing to stand corrected if this is wrong, but I am sure that alcohol taxes and revenues still generate far more for the treasury than the cost of treating drunks takes out. I would not pretend to have the answers to this problem, but it does slightly annoy me that whenever a problem like this arises the default position it to address it by increasing taxes, which by dint means the price of a pint.

I like to drink, frequently and very often copiously. My preferred drink is Guinness which is already ridiculously expensive. Despite my penchant for reasonably heavy drinking I never end up in A&E, do not throw up in the street and don’t try and punch anyone’s lights out when I have had a few, why should I pay even more because some teenage bell end can’t handle his Bacardi Breezers?

Rowley wrote:A factor to remember, and I am willing to stand corrected if this is wrong, but I am sure that alcohol taxes and revenues still generate far more for the treasury than the cost of treating drunks takes out. I would not pretend to have the answers to this problem, but it does slightly annoy me that whenever a problem like this arises the default position it to address it by increasing taxes, which by dint means the price of a pint.

I like to drink, frequently and very often copiously. My preferred drink is Guinness which is already ridiculously expensive. Despite my penchant for reasonably heavy drinking I never end up in A&E, do not throw up in the street and don’t try and punch anyone’s lights out when I have had a few, why should I pay even more because some teenage bell end can’t handle his Bacardi Breezers?

In 2003 (what I could find quicklu)

http://www.telegraph.co.uk/foodanddrink/8730010/Punters-could-pay-tax-to-cover-cost-of-clearing-up-mess-caused-by-binge-drinking.html

- The government says binge drinking costs £20bn a year.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/274406/20140113_Dec_v0.2.pdf

- 2003 - alcohol tax revenue only amounts to £7bn

NB It costs the NHS around £3bn - a lot more for police and social services - but that is billions that could be spent on better equipment, more nurses = better healthcare for more serious incidents.

I'm all for having a good time, but this is a serious social issue that is damaging an invaluable institution - the NHS - that we cannot afford to lose.

My initial thought was increasing taxes but thinking it over I don't think it'd be that effective. I think really what we need - as you say - is stricter enforcement of rules in pubs/clubs about selling alcohol.

Lumbering_Jack wrote:A lot of closet homosexuals on this forum I suspect.

'Lumbering_Jack' - the name makes me think you're opening your creaky doors (oi oi) and coming out to be     

  

PS It's fine if you are though.   

And let's stop people doing extreme sports while we're at it......

And reduce cigarette sales to 1 pack per person per week.......

And restrict fast-food sales to 1 item per week.......

I love it when people say Education is the answer....Bollox..

1. I used to drink under age...21 where I lived the minimum age and I used to go out to get drunk..

2. Like sex...The more you are warned off something..the more you want it...

Unfortunately red adair is still warning me.

Someone put the responsibility on those serving it and I agree.

There's a code you have to follow at the bookies too. Ive worked in both the bookies and the pub, the bookies were far more concerned with these guidelines being burned into my mind than anyone at the pub.

Of course, someone smashed at home is harder, but it would certainly cut the problem down.

Still means the majority getting responsibly smashed are getting hit due to the minority f*** ups.

I echo Rowley's comment:

Despite my penchant for reasonably heavy drinking I never end up in A&E, do not throw up in the street and don’t try and punch anyone’s lights out when I have had a few, why should I pay even more because some teenage bell end can’t handle his Bacardi Breezers?

Not always the offender that buys the drink is it..

Onus has to be on individual responsibility...

But I draw the line at tax payers being denied the service they pay for..

If the NHS (and every other public sector service) didn't squander it's revenue, there'd be more than enough money to treat everyone. Millions is p!ssed away every year on new "initiatives" that have frig all to do with patient care (essentially what the NHS is there for)

This country is like the embodiment of some chav who wins the lottery and then spends it all on sh!t. Do we need to spend £20 billion on HS2 especially when India can put a rocket in space for under £500 million? "Without HS2 we'll suffer years of cancelled services and price increases" (Govt Spokesman) Really? I wonder what THAT will be like, mate.

Anyway, re the OP, simple answer...close all the hospitals...ZERO admissions due to alcohol related incidents.

Or open up minor injuries unit and get trainees to work as a part of their course. Pay them a decent whack (for students) about £12ph (or waive a large chunk of their loans)

You have to be a professional to treat people, never mind the majority of medical students don't know their arse from their elbow.

Also you wouldn't want to put them off making them look after the drunk tank.

Drunk people are annoying in a+e, but people injure themselves in unbelievably stupid ways whilst sober. Most people who go drinking don't end up in a+e but even if you end up there once in your life through drinking it all adds up to a significant work load.

Those road side ambulances do a good job of reducing the burden on a+e.

Ent wrote:You have to be a professional to treat people, never mind the majority of medical students don't know their arse from their elbow.

Also you wouldn't want to put them off making them look after the drunk tank.

Drunk people are annoying in a+e, but people injure themselves in unbelievably stupid ways whilst sober. Most people who go drinking don't end up in a+e but even if you end up there once in your life through drinking it all adds up to a significant work load.

Those road side ambulances do a good job of reducing the burden on a+e.

That'll explain the pot they put on my ar$e after I fell and banged my elbow

DAVE667 wrote:If the NHS (and every other public sector service) didn't squander it's revenue, there'd be more than enough money to treat everyone. Millions is p!ssed away every year on new "initiatives" that have frig all to do with patient care (essentially what the NHS is there for)

This country is like the embodiment of some chav who wins the lottery and then spends it all on sh!t. Do we need to spend £20 billion on HS2 especially when India can put a rocket in space for under £500 million? "Without HS2 we'll suffer years of cancelled services and price increases" (Govt Spokesman) Really? I wonder what THAT will be like, mate.

Anyway, re the OP, simple answer...close all the hospitals...ZERO admissions due to alcohol related incidents.

The main reason HS2 is costing £20billion is because we live in a small, densely-populated country that is full of NIMBYs, not to mention an absolute minefield of rules and regulations and legal issues, when it comes to any major infrastructure project.

India is still struggling to grasp the basic concepts of Health & Safety and the government tends to run roughshod over the majority of the population, who in any case are too busy just trying to make ends meet to bother objecting to the space program. Thats why they can put a rocket in space for a small fraction of the cost...

Agree though that the majority of rail users probably won't notice any difference.

Ent wrote:You have to be a professional to treat people, never mind the majority of medical students don't know their arse from their elbow.

Also you wouldn't want to put them off making them look after the drunk tank. [1]

Drunk people are annoying in a+e, but people injure themselves in unbelievably stupid ways whilst sober [2]. Most people who go drinking don't end up in a+e but even if you end up there once in your life through drinking it all adds up to a significant work load.

Those road side ambulances do a good job of reducing the burden on a+e.

1. If you end up in a drunk tank, you should have to pay a whacking great fine to be released, or else serve 100 hours community service, or something like that.


2. Apparently they have to deal with a large number of weirdos who "accidentally" fall /slip / trip and end up with all manner of things lodged in various orifices...

Personally I'd make them eat nothing but bran and drink nothing but prune juice until they can expel these items without medical assistance...

A lot of the time the drunk tank candidates are just left alone by their mates or lifted by the police when wandering alone.

It's annoying but really they just need someone to fire them into a taxi and get them home.

I was tempted to kill a group of drinkers who couldn't get a taxi so rang an ambulance, nominated one of them to be assessed then asked to be left home after.

Stella wrote:And, should a useless layabout with no job get the same treatment as someone who pays more tax/national insurance?

Yes, they should.

That's why the NHS is called a "universal" service.  


universal
/juːnɪˈvəːs(ə)l/

adjective

1. relating to or done by all people or things in the world or in a particular group; applicable to all cases.


Here endeth the lesson.

The Fourth Lion wrote:

Stella wrote:And, should a useless layabout with no job get the same treatment as someone who pays more tax/national insurance?

Yes, they should.

That's why the NHS is called a "universal" service.  


universal
/juːnɪˈvəːs(ə)l/

adjective

1. relating to or done by all people or things in the world or in a particular group; applicable to all cases.


Here endeth the lesson.

I agree with you. I was asking the OP.

Great, Fourth 'Getting My Message Out' Lion is back......