House of Commons - Alcohol - Health Committee

Alcohol - Health Committee Contents

5 NHS policies to address alcohol related problems

94. Alcohol imposes an ever increasing burden on the health service. Such is the scale of this burden that small reductions in the number of people misusing alcohol could save the NHS large sums of money. Unfortunately, despite recent initiatives and improvements the NHS remains poor at dealing with alcohol-related problems. Clinicians are poor at detecting alcohol abuse and urgently need to do better, but this will only be done effectively if there are specialist services which patients can be referred to. These are poorly funded and commissioning alcohol services remains a low priority for PCTs, despite the long-term returns it could produce.

95. The NAO report in 2008 found that many PCTs had no strategy for alcohol, no idea of local needs or of their spending on services. There was a wide variation on the provision of services.[108] The NAO recognised that specialist treatment for dependency was effective and cost effective and criticised the reliance of PCTs on local Drug (and Alcohol) Action Teams (DATs);[109] pointing out that the Home Office holds the main DAT budget and ring fences it illegal drugs. The NAO were also concerned over possible limitations of the PSA indicator on alcohol related hospital admissions, and pointed out that more than a third of PCTs have not included the alcohol target in Local Area Agreements Recent Initiatives.

96. When asked why alcohol services are so unimpressive, Gillian Merron, Minister of State for Public Health, replied:

The truth and simple answer: yes, local services are patchy; yes, we can do better, but I think we have now got the things in place that will allow that to happen.[110]

The improvements include:

i) Drug and Alcohol Action Teams (DAATs) which were set up to take the lead in commissioning services to tackle drug and alcohol harm.. They are partnerships of professionals from local authorities, Primary Care Trusts (PCTs), police, probation and from private and voluntary sector providers. Initially they tended to focus on drug misuse, but following encouragement by the 2004 National Alcohol Strategy the proportion commissioning alcohol services has increased to 81%.[111]

ii) In 2006 the DH and the National Treatment Agency (NTA) published 'Models of Care for Alcohol Misusers' (MoCAM)[112] outlining best practice guidance on commissioning of alcohol services.

iii) In April 2008 the DH introduced two strategies in an attempt to direct commissioners to address alcohol needs. The first was a new Public Service Agreement (PSA-25) on alcohol and illegal drugs. This included 5 'vital signs' indicators to measure progress, which can be selected by PCTs. One of these aims to secure a reduction in the rate of increase of alcohol-related hospital admissions, whilst the others focus on the effects of illegal drug use and alcohol related social disorder. Secondly, Local Area Agreements (LAAs), which are developed by local councils through negotiation with the Regional Government Offices, can include an alcohol measure.

iv) In November 2008, an Alcohol Improvement Programme was set up by the DH. This included initiating a National Alcohol Treatment Monitoring System, an Alcohol Learning Centre and a new network of Regional Alcohol Offices (with £2.7 million funding per year), each with a Regional Alcohol Manager to support commissioners in delivering the PSA.[113]

The state of alcohol services

97. Despite these initiatives and the growing awareness that alcohol is a serious problem, services remain poor, as we describe below.

COMMISSIONING SERVICES

98. Although the DH encourages them to do so, PCTs are not required to commission any alcohol-specific services or assess local alcohol related needs. The Operating Framework, which applied to all PCTs from 2005 to 2008, included 36 national targets, but made no specific reference to alcohol.[114]

99. Many memoranda welcomed MoCAM's introduction, but the Royal College of GPs noted that no assessment had been made of its effectiveness.[115] The respondents to the recent 2009 inquiry by the All Party Parliamentary Group on Alcohol Misuse gave mixed views about MoCAM's usefulness, with some feeling it had helped to focus on need for better alcohol provision in the area, but others saying it had made little difference to the work of their organisation.[116]

100. The NHS Confederation informed us that all the 36 PCTs (about 25%)responding to a survey it had undertaken in November 2008 had a strategy for alcohol related harm.[117] In contrast, the NAO survey conducted about the same time found that only 65% of PCTs had adopted the PSA-25 alcohol vital signs indicator and only 52% of the Local Area Agreements, also introduced in April 2008, included this measure. It recommended that the DH should assist PCTs further in aiding their ability to commission services more effectively.[118]

101. PCTs spent an average of just £600,000 on commissioning alcohol services in 2006-07, representing just over 0.1% of a typical PCT's total annual expenditure.[119] This figure included funding the provision of brief advice from GPs and weekly alcohol clinics as well as more intense specialist treatments. There was little correlation between PCTs spending on alcohol services and the extent of alcohol problems in their local population, as shown in figure 9.[120]

Figure 9: PCT expenditure patterns for services to reduce alcohol harm

Source: National Audit Office

NOTES:

1. The PCT expenditure figure includes dedicated alcohol-specific funding from PCTs to Drug and Alcohol Action Teams.

2. The Index of Alcohol Harm, developed for the National Audit Office by the North West Public Health Observatory (NWPHO) which compiles the Local Alcohol Profiles for England, combines a number of indicators of alcohol harm. A score of 1 indicates the lowest level of alcohol harm and 152 the highest.

102. PCTs give a much higher priority to drug than alcohol services. The DH established that in 2004 an average of just £197 was spent on each dependent drinker, compared to £1744 for each dependent drug users.[121] In 2009-2010 the pooled budget for drugs and alcohol services is £406m, but most of this is ring-fenced for drug treatment.

103. DAATs' overriding concern is also drug abuse, with their main source of funding (a budget of £385 million in 2006-07) ring-fenced for that purpose.[122] The Royal College of GPs informed us that:

Still too much responsibility lies with the DAATs, many of whom do not have the capacity or capability to respond. Many DAATs do not have sufficient links with primary or acute hospital care to commission effective alcohol interventions in these areas.[123]

PRIMARY CARE SERVICES

104. Alcohol has a big effect on a GP's workload. They have to cope with a host of medical problems, from raised blood pressure or depression through to increased cancers, liver problems and skin problems, to minor injuries and domestic abuse. Paul Cassidy, a GP, told us that treating the effects of alcohol misuse is a routine part of his clinical work.[124]

105. Despite the workload alcohol creates for GPs and although some GPs have a special interest in alcohol-related problems, the Royal College of GPs admitted that both screening and the provision of 'Brief Advice' were only rarely provided by GPs.[125] The BMA commented that presently there is no system for routine screening and management of alcohol misuse in primary or secondary care settings in the UK.[126] Furthermore very few GPs offer formal interventions to encourage people to cut down their drinking.

106. However a new Directed Enhanced Service (DES), in which newly registered GP patients will be screened for alcohol consumption, with an additional £8 million incentive for GPs to undertake screening and brief advice has been set up.[127] Additionally the DH has developed a new E learning programme available from February 2009 for GPs wishing to give brief interventions.

107. It remains to be seen how much effect these initiatives will have. In the meantime, most GPs struggle to do anything due to cynicism and pessimism about the help available beyond primary care.[128]

SPECIALIST ALCOHOL TREATMENT SERVICES

108. People with established alcohol dependency need much more intensive treatment than a simple brief intervention, and these treatment modalities are delivered by specialist alcohol treatment services. There is a wide regional variation in their prevalence, which is not related to the size of the region's population, ranging from an estimated 198 organisations in London and 130 in the South East to just 32 in the North East and 20 in the East Midlands.[129] The best evidence of regional variation is from the Alcohol Needs Assessment Research Project (ANARP) report in 2004 which showed the level of support expressed as a ratio of those in need. In the. North East only one in 100 of those in need are treated which reflects both the small size of service provision and high levels of alcohol misuse The proportion of PCTs providing each type of specialist treatment is shown below[130]:

Figure 10: Provision of specialist services by PCTs

Source: National Audit Office survey of PCTs

NOTE: Medically assisted withdrawal or relapse prevention relates to the prescribing of the drugs acamprosate and disulfiram.

109. Specialist Alcohol services are currently poorly planned and poorly funded. The NAO found that:

"Only a small minority of dependent drinkers were receiving treatment, estimating that approximately 1 in 18 (5.6%) alcohol dependent people were accessing specialist alcohol treatment in England each year. These figures are low, both in comparison to other countries and to the treatment of illegal substance misuse. A study in North America found an access level of 1 in 10 (10%) which the researchers considered to be 'low'. The study considered a level of access of 1 in 7.5 (15%) to be medium and 1 in 5 (20%) to be high. In England, an estimated 1 in 2 (55%) problem drug misusers gain access to treatment each year."[131]

110. According to Gillian Merron MP, Minister of State for Public Health, the Government has:

increased the number of treatment places up from 63,000 to over 100,000, so we are now reaching 10% of the numbers that we need to.[132]

However, according to the National Treatment Monitoring Service, in February 2009 there were just under 55,000 people in treatment for alcohol use disorders in England. PCT priorities are reflected in the better provision of drug treatment services: more than 190,000 people were engaged in drug treatment at some point in the past year.

Detoxification and rehabilitation in the community

111. Dependent patients may present with symptoms of acute withdrawal, requiring acute detoxification, whereby a drug, usually cholordiazepoxide is given in a reducing dose regime over several days to prevent serious withdrawal symptoms. In some areas patients are 'detoxed' at home, but the lack of community detox resources means that hospitals are increasingly being used as detox centres.[133]

The voluntary sector

112. In 2003, of £95 million spent each year on specialist alcohol services, £71 million of this was spent by the voluntary sector.[134] A wide range of services is provided, from rehabilitation programmes in residential centres and in prisons to community support and counselling services.

113. However, some witnesses had concerns about the voluntary sector's ability to manage alcohol problems. Dr Duncan Raistrick told us:

I think there possibly is an over enthusiasm by some non-statutory sector services to go for contracts that possibly they are not likely to be competent to deliver; indeed, that has happened recently somewhere I know, where a non-statutory agency got a contract to deliver an arrest referral scheme and then phoned a specialist service saying, "Our staff do not know how to deal with alcohol problems; how do we refer to you?" So there is, I think, a bit of a problem. Having said that, the staff in the NHS are not always competent to deal with these problems either.[135]

114. Alcohol Concern commented:

The voluntary sector plays a key role in delivering social care and psycho-social interventions for treating alcohol problems. The vast majority of treatment provision is delivered in the voluntary sector and good links exist between voluntary and statutory health providers. However, the voluntary sector suffers from short-term funding, excessive competitive tendering and client loads that are increasingly complex and multi-faceted.[136]

Both Alcohol Concern and the Socialist Health Association recommended the voluntary sector be awarded 5-year commissioning contracts, mirroring the long time a patient will be in treatment.[137]

115. Alcoholics anonymous is an independent self help organisation with an outstanding track record in helping people with alcohol dependency using the 12 step approach. The experience of clinicians in the field is that when AA works for an individual person it can be highly effective, and can offer very high levels of lifelong support, but the approach does not suit everyone and is not a substitute for properly funded NHS alcohol treatment services.

HOSPITAL BASED SERVICES MANAGING ALCOHOL RELATED HARM

116. In a survey undertaken for the Royal College of Physicians and the Royal College of Nursing, 88% of doctors and nurses replying said that NHS investment in staff and services for treating alcohol related harm had not kept up with demand or was suffering from serious under-investment and was currently inadequate.[138]

Over-stretched Liver Services

117. The rise in alcohol consumption and other factors have led to dramatic increases in the incidence of liver disease in the UK. The British Society of Gastroenterology (BSG) and the British Association for the study of the liver (BASL) stated in their submissions:

Services for patients with liver disease have developed in an unplanned manner as an offshoot of general gastroenterology, and many liver patients are managed at District General Hospital level by general gastroenterologists, many of whom have had no training in a specialised liver unit. The service structure developed at a time when liver disease and death from liver was relatively uncommon and the 10 fold increase in young liver deaths over the last 30 years has not been matched by the development in services needed to cope.[139]

There are significant variations in the distribution of liver units in the UK. Certain regions have neither liver units nor inpatient alcohol units, as shown below:[140]

Figure 11: Provision of liver units and specialised inpatient alcohol wards

118. The proportion of liver transplants to people with alcoholic liver disease has increased from 14% to 23% from 1997-8 to 2007-8.[141] However, the British Liver Trust stated that the true number of alcohol related liver disease patients who could benefit from a transplant is much higher.[142] The British Liver Trust told us that the average wait before diagnosis and referral for treatment for alcoholic liver disease is 564 days.[143]

How to improve the situation

COMMISSIONING

119. Alcohol Concern recommended that PCTs be obliged to produce an Alcohol Needs Assessment for their areas.[144] The Alcohol health alliance UK and Alcohol Concern recommended the DH should encourage local commissioners to ensure that waiting time targets for alcohol treatment match target for drug treatment in the next NHS operating framework.[145]

120. However, the Minister of State for Public Health told us that alcohol treatment should not be compared with drug misuse treatment and further pointed out that it was for PCTs to choose how much to spend on alcohol treatment and vary this depending on their local needs.[146]

PREVENTION

Stopping people drinking too much in the first place

121. During the past few years the DH has stressed the importance of prevention and public health measures. They are prominent in the White Paper, Choosing Health (2004), and in Lord Darzi's review of the future of the NHS, 'High Quality Care for All' (June 2008). The most important of these measures are public education campaigns, which are thought to be inadequate. They are discussed in the next chapter. In this chapter we look at measures the NHS has taken.

Better data collection

122. Better health data collection has an important role to play in better prevention. The NHS Confederation provided us with an example of how this works: members of the South Central Ambulance Service have been filling out patient report forms after each emergency response, which are scanned into a reporting system. The information can then be used by PCTs and other commissioners to identify gaps in provision and unmet patient needs. This system led to the change of licence conditions for a club where many alcohol related assaults had occurred, leading to a reduction in emergency responses by 90% in the following 12 months.[147]

123. Alcohol Concern indicated how good data could play a wider role:

Licensing authorities should have access to a nationally standardised collection of A&E, ambulance, hospital admissions and treatment data. This would allow local authorities the power to refuse additional licenses or extensions if local alcohol-related health harms were increasing or a matter of significant concern.[148]

Helping to reduce the intake in people already drinking too much

124. If hazardous and harmful levels of drinking can be detected, there is scope for intervening before patients either acknowledge their own drinking problem or seek help. Detection should be a matter for all parts of the NHS. A health practitioner may notice signs of alcohol abuse in the history, physical examination or investigation results of a patient and there are number of 'tools' for improving screening. We were told:

The routine use of a structured brief assessment tool can help clinicians to detect problem drinking. The National Treatment Agency (NTA) reviewed the management of alcohol use disorders in 2006[149] and recommended their use. There are a number of screening tools available, such as the [Alcohol Use Disorder] Identification Test (AUDIT), Fast Alcohol Screen Test (FAST) or Paddington Alcohol Test (PAT).

The British Liver Trust recommended that Liver Function Tests (LFTs)[150] should be included in the vascular health checks being introduced for over 40s in primary care, which already include a cholesterol blood test.[151]

125. There are estimated to be 10m hazardous or harmful drinkers in the UK, all of whom could potentially benefit from 'Brief Interventions'. These are short, focused discussions, taking between 5 and 10 minutes, designed to promote awareness of the negative effects of drinking and to motivate change. 'Extended brief advice', is a longer version of this. According to Professor Mike Kelly of NICE the evidence for brief interventions is unusually strong for such public health interventions, with numerous systematic reviews showing that they reduce alcohol consumption, injury, mortality, morbidity and the social consequences of drinking.[152] Under sceptical questioning a GP, Paul Cassidy, insisted that brief interventions by GPs were effective:

We can get the biggest gains early on with the hazardous/harmful [drinkers]. We use the expression "numbers needed to treat": we need to treat eight patients with a Brief Intervention to get one of them to drink healthily. That is much better than for smoking cessation with the use of patches. The evidence is that it is incredibly effective.[153]

126. A single brief intervention reduces drinking effectively in 1/8 of those approached for up to 2 years and possibly 4 years[154] but, as Dr Raistrick explained, brief interventions work best if repeated by several different health workers:

If everybody in the Health Service every time they saw somebody with a drink problem did something motivational, even if it was just the one question, the cumulative effect would add to the impact of these interventions.[155]

127. A meta-analysis has shown that Brief Intervention is not only clinically effective, but also cost-effective.[156] By supporting early interventions on alcohol misuse, such as 'brief advice', the NHS may avoid or reduce the costs of later, more intensive and specialist support for people who develop dependency or suffer from an alcohol-related illness.

128. Professor Ian Gilmore told us that GPs could be given incentives to improve early detection of problem drinkers by including a measure for alcohol consumption in the Quality and Outcomes Framework (QOF),which provides financial incentives for GP practices.[157] The evidence for implementing brief interventions outside of primary care is less well established, but its use in A&E and criminal justice settings is currently being evaluated in the Screening and Intervention Programme for Sensible Drinking, commissioned by the DH and led by Professor Colin Drummond.[158]

129. Some witnesses proposed using brief interventions in maxillofacial clinics (25% of 'maxfax' admissions are alcohol related, often glass injuries), hepatology wards, gastro units and prison healthcare centres.[159] The Royal Pharmaceutical Society of Great Britain recommended that pharmacists administer Brief Interventions for alcohol.[160]

130. Some criticisms of Brief Interventions were raised. Dr Duncan Raistrick suggested that their inexpensiveness may underpin their popularity, diverting attention from investing in more expensive treatment for dependent drinkers.[161] Furthermore, if they work in 1:8 people, they can at best reduce problems by around 13%;[162] raising the price of alcohol would be more effective.

Nurse Alcohol Specialists

131. In 2001 the Royal College of Physicians recommended that every acute hospital should have a consultant or senior nurse lead for Alcohol Misuse, plus alcohol nurse specialists, who should educate, audit and liaise with community services.[163] The specialists would administer brief psychological interventions. The Socialist Health Association recommended that alcohol advisors should be extended to polyclinics.[164]

132. Dr Lynn Owens, Nurse Consultant informed us of an innovative nurse-led alcohol service she developed in an acute hospital in Liverpool. The service trains Trust staff and runs clinics in both the hospital and GP surgeries. Dr Owens reported that a follow-up study demonstrated both its effectiveness and cost-effectiveness (due to saving bed-days) compared to treatment as usual in a neighbouring trust.[165] She highlighted the benefits of using nurses rather than generic, non-medically trained 'alcohol workers', as nurses can manage the comorbid medical problems and nurse consultants can prescribe detoxification medication.[166]

133. The Alcohol Education and Research Council (AERC) funded a study which revealed that A&E attendants who were referred on to an alcohol health worker, after screening positive for alcohol misuse, had on average fewer visits to the A&E department over the following 12 months. At 6 months they were drinking 23 units per week less than those just given an information leaflet. At 12 months the difference was 14 units.[167]

134. However, as the Royal College of Nursing pointed out, there are no nurse alcohol specialists in most acute hospitals and there is a dearth of nurse-led alcohol services in most of the country.[168]

BRIDGE FUNDING FOR COMMISSIONERS

135. Southampton Commissioner Carole Binns explained that her PCT spends just short of £1 million on alcohol services per annum. It plans to shift some of the unallocated £4 million per annum spent on treating the impact of alcohol towards investment in prevention and early intervention, but various factors obstruct this. She argued for transition or bridge funding (ie the DH would provide initial funding for prevention and early intervention services which would cease once the services were established).

136. Carole Binns also argued for joint investment:

Most planning cycles and most targets you are expected to deliver change within two, three, perhaps five years. Some of the changes that lots of people have been arguing about today would not show impact for much longer than that, so you are talking about impacts over ten, fifteen years. Very good but long term health gains, so difficult to fit into planning and funding cycles that only last two or there years. Also, I think probably the answer to investment is to get a number of agencies to act together—criminal justice agencies and agencies like police, probation, health and social care. It is a complex area where lots of people are spending in an unproductive way and it is a question of getting all of those agencies to join together in a joint investment plan to all spend their money together in a more productive way.[169]

IMPROVE TREATMENT OF SPECIALIST ALCOHOL SERVICES

137. Better specialist alcohol services would not only bring advantages through the services themselves, but would also encourage GPs to put more effort into detecting alcohol misuse since better detection of problem drinking is of little use unless there are services to which drinkers can be referred.[170]

Investment in alcohol treatment services

138. The DH agreed that investment in alcohol treatment services would yield net savings for the NHS.[171] Analysis by the UKATT[172] led the NTA to conclude that overall for every £1 spent on treatment, £5 is saved elsewhere and that provision of alcohol treatment to 10% of UK dependent drinkers would reduce public sector resource costs by between £109 million and £156 million each year.[173] The BMA recommended that funding for specialist alcohol treatment services should be significantly increased and ring-fenced.[174] The Royal College of Psychiatrists commented in its submission:

If the government is serious about tackling alcohol misuse as purported in the Alcohol Harm Reduction Strategy and subsequent updates, it will need to make a similar investment in treatment of alcohol misuse as it has done in the case of drug misuse. Alcohol dependence affects 4% of the population and alcohol misuse considerably more, whereas problem drug use rates are closer to 0.5%. Access to treatment is considerably better for drug misusers (1 in 2 gains access to treatment per annum) than for alcohol misusers (1 in 18 gains access to treatment per annum).[175]

139. The bulk of treatment for alcohol dependency is psychological and social support. The NTA review supported the effectiveness of a large range of psychological interventions, many of which are cognitive or behavioural. Planned and structured aftercare is effective after initial treatment, e.g. extended case monitoring. Dr Duncan Raistrick explained to the committee that the UK Alcohol Treatment Trial (UKATT), which he led, found that approximately 40% of people given Social Behaviour and Network Therapy (which draws on people's own social network to support them) were achieving abstinence.[176] Dr Raistrick highlighted the importance of the quality of psychosocial interventions:

I think it is really important to understand that we are talking about interventions that are fundamentally different to, for example, having a course of Tamiflu. The difference is that we are talking about a process of change and it is the way that the treatment is delivered and when it is delivered that matters as much as the particular treatment.[177]

IMPROVE THE MANAGEMENT OF ALCOHOL-RELATED HARM

Relieve the strain on Ambulance Services

140. London Ambulance Paramedic Brian Hayes spoke to the committee about a 'booze bus' he set up 5 years ago, the concept of which is currently being replicated in a few places around the country:

The problem we were having was that we would be on our way to hospital with someone who was drunk in the back and they would be putting out broadcasts asking for ambulances to free up because we had 60-year-olds, 70-year-olds with chest pains and people involved with RTAs, and I came up with an idea that what we should do is put a paramedic and two patient transport people on to one of our patient transport vehicles. So instead of being able to take one person we could take up to five at any one time—especially between the hours of ten and two in the morning, where we would just be directed at calls that had come in and the sole indicator was that this person was drunk.[178]

Mr Hayes explained that at almost £200 per ambulance call and over 60,000 purely alcohol-related call-outs per year in London, the savings for the NHS were probably very large.

THE NEW NATIONAL PLAN FOR LIVER SERVICES

141. BSG and BASL have drafted a National Plan for Liver Services, recommending the appointment of a National Clinical Lead, a national electronic registry of liver patients, major restructuring of services, increased early detection of liver disease, the development of a comprehensive Alcohol Liaison Service across the UK and promotion of research into liver disease.[179] This approach is supported by the DH, and was approved by the National Quality Board in June 2009.[180] A Clinical Director for Liver Services was appointed in November 2009 in order to help develop a national liver strategy, but it remains to be seen if the funding to implement the strategy will be found. BASL/BSG suggest that the funding be found from increases in the duty on alcohol.

Conclusions and recommendations

142. Alcohol related-ill health has increased as alcohol consumption has increased, but there are no more services to deal with these problems. Indeed in many cases there are fewer, partly as a result of the shift in resources to addressing dependency on illegal drugs. The most effective way to deal with alcohol related ill-health will be to reduce overall consumption, but existing patients deserve at least as good a service as that provided to users of illegal drugs, with similar levels of access and waiting times.

143. Early detection and intervention is both effective and cost effective, and could be easily built into existing healthcare screening initiatives. However, the dire state of alcohol treatment services is a significant disincentive for primary care services to detect alcohol-related problems at an early stage before the serious and expensive health consequences of regular heavy drinking have developed.

The solution is to link alcohol interventions in primary and secondary care with improved treatment services for patients developing alcohol dependency. In time we believe such a strategy will result in significant savings for the NHS but will require pump priming and intelligent commissioning of services. Specifically, the NHS needs to improve treatment and prevention services as follows

Treatment services:

Each PCT should have an alcohol strategy with robust needs assessment, and accurate data collection.

Targets for reducing alcohol related admissions should be mandatory

Acute hospital services should be linked to specialist alcohol treatment services and community services via teams of specialist nurses.

There should be more alcohol nurse hospital specialists

Treatment budgets should be pooled to allow the cost savings from reduced admissions to be fed back into treatment and prevention, with centrally provided 'bridge' funding to enable service development.

Access to community based alcohol treatment must be improved to be at least comparable to treatment for illegal drug addiction

These improved alcohol treatment services must be more proactive in seeking and retaining subjects in treatment with detailed long term treatment outcome profiling.[181]

Funding should be provided for the National Liver Plan

Prevention services:

Improved access to treatment for alcohol dependency is a key step in the development of early detection and intervention in primary care.

Clinical staff in all parts of the NHS need better training in alcohol interventions.

Early detection and brief advice should be undertaken in primary care and appropriate secondary care and other settings. Detection and advice should become part of the QOF.

Once detected patients with alcohol issues should progress through a stepped program of care; seven out of eight people do not respond to an early intervention and it is these people who go on to develop significant health issues.

Research should be commissioned into developing early detection and intervention in young people.

108 National Audit Office, Reducing Alcohol Harm: Health Services in England for Alcohol Misuse, 2008 Back

109 Drug Action Teams (DATs) are funded by the Home Office via the National Treatment Agency (NTA) to provide intervention and treatment for users of illegal drugs, some DATs focus purely on drugs, others now include some alcohol treatment services and have changed the name to Drug and Alcohol Action Teams (DAATs). Back

110 Q 1065 Back

111 NAO, op. cit., p 20. 2008 Back

112 The National Treatment Agency, Models of care for alcohol misusers (MoCAM), 2006. Back

113 Ev 6 and Q 233 Back

114 NAO, op. cit., p 17. Back

115 Ev 56 Back

116 All Party Parliamentary Group on Alcohol Misuse. The future of alcohol treatment services,. Alcohol Concern. 2009 Back

117 Ev 142 Back

118 NAO, op. cit., p 21, 8-9. Back