The government’s cuts to addiction services have displaced the burden of alcohol onto an already overstretched NHS hospital system, say Emmert Roberts and Colin Drummond

The burden of alcohol on the NHS in England continues to rise, with official data showing that there were more than 1.2 million alcohol related admissions to hospitals in 2017/18. However, our recent study showed that around 20% of people admitted to UK NHS hospitals are harmful drinkers (i.e. alcohol is having a negative impact on either their mental or physical health), and a further 10% are alcohol dependent. These estimates were generated by pooling data from over 1.6 million patients in 124 previous studies. 

Our findings therefore suggest that the true prevalence of alcohol related conditions in NHS hospitals is approximately 20 to 30 times higher than the official UK government statistics. This underestimate is most likely due to a combination of a lack of training and support for staff within the NHS to diagnose, treat, and record the number of people with alcohol related conditions.

Meanwhile specialist community drug and alcohol services in England have experienced real term funding cuts of over £100 million, an average of 30% per service, since the implementation of the Health and Social Care Act in 2012 and cuts to the government’s public health funding to local authorities. What we’ve been left with is a fragmented system of care. Alongside specialist NHS addiction inpatient units closing across England, we’ve seen a 22% reduction in the number of people accessing specialist community alcohol treatment since 2013/14, and a 54% reduction in specialist inpatient alcohol detoxifications since 2011/12. People in England now have effectively less than half the level of access to specialist alcohol treatment compared to either Wales or Scotland.

All of this has been accompanied by a worrying brain drain. Since 2006 there has been a 48% reduction in the number of NHS specialist addiction consultants, and a 60% reduction in the number of specialist addiction trainee doctors.[1] Similar problems have affected other key professions involved in delivering addiction treatment, including nursing and clinical psychology. The NHS workforce is therefore increasingly ill equipped to address the alcohol epidemic. Instead, the evidence suggests that the burden of alcohol related conditions is simply being displaced onto an already overstretched NHS hospital system. 

As part of the NHS Long Term Plan, the UK government has committed to developing alcohol care teams (ACTs) in the 25% of hospitals in England that have the greatest burden of alcohol related admissions. While we welcome this as a step in the right direction, we do not think it goes far enough in tackling what is evidently a national epidemic. Given the prevalence of these conditions within NHS hospitals across England, as a first step an ACT in every hospital would appear warranted, not merely the top 25%. Specialist care teams exist nationally for many other conditions (e.g. diabetes mellitus), which have a lower in hospital prevalence than the 30% of people with either harmful use of alcohol or alcohol dependence. Why is this not the ambition for alcohol?

While ACTs might be a reasonable start, improving alcohol care in hospitals does not address the full pathway of care needed by people with alcohol related conditions once they leave hospital, and seems more like locking the door after the horse has bolted. Given that specialist alcohol treatment saves over £3 for every £1 spent, the ongoing cuts to these services is clearly a false economy. The government urgently needs to reverse funding cuts, invest in addiction services, and return them to joint NHS and local authority control to create joined-up pathways of care. These steps could be the start of what is needed to tackle the national epidemic of alcohol related admissions to hospital.

Emmert Roberts is an MRC clinical research fellow at King’s College London and an honorary SpR in general adult psychiatry at the South London and the Maudsley NHS Foundation Trust.

Competing interests: ER is funded by an MRC addiction research clinical training fellowship. 

Colin Drummond is professor of addictions psychiatry at the Institute of Psychiatry, Psychology, and Neuroscience, King’s College London and a consultant psychiatrist at South London and Maudsley NHS Foundation Trust. He is also a National Institute of Health Research senior investigator.

Competing interests: CD is part funded by the NIHR Specialist Biomedical Research Centre at South London and Maudsley NHS Trust and the NIHR Collaborations for Leadership in Applied Health Research and Care South London. The views expressed do not necessarily reflect the views of the funding organisations.

References

[1] Drummond, C. Workforce Strategy for Addiction Psychiatry Training. RCPsych, 2017