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
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.
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);
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
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.
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%.
ii) In 2006 the DH and the National Treatment Agency
(NTA) published 'Models of Care for Alcohol Misusers' (MoCAM)
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.
The state of alcohol services
97. Despite these initiatives and the growing awareness
that alcohol is a serious problem, services remain poor, as we
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.
99. Many memoranda welcomed MoCAM's introduction,
but the Royal College of GPs noted that no assessment had been
made of its effectiveness.
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. 
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.
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.
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.
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.
Figure 9: PCT expenditure patterns for services to
reduce alcohol harm
Source: National Audit Office
1. The PCT expenditure figure includes dedicated
alcohol-specific funding from PCTs to Drug and Alcohol Action
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.
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.
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
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.
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. 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.
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.
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.
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
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:
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
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
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.
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.
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.
A wide range of services is provided, from rehabilitation programmes
in residential centres and in prisons to community support and
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.
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.
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.
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
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
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.
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:
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.
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.
The British Liver Trust told us that the average wait before diagnosis
and referral for treatment for alcoholic liver disease is 564
How to improve the situation
119. Alcohol Concern recommended that PCTs be obliged
to produce an Alcohol Needs Assessment for their areas.
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.
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.
Stopping people drinking too much in the first
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.
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.
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
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
The British Liver Trust recommended that Liver Function
Tests (LFTs) should
be included in the vascular health checks being introduced for
over 40s in primary care, which already include a cholesterol
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.
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
126. A single brief intervention reduces drinking
effectively in 1/8 of those approached for up to 2 years and possibly
4 years 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.
127. A meta-analysis has shown that Brief Intervention
is not only clinically effective, but also cost-effective.
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.
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.
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.
The Royal Pharmaceutical Society of Great Britain recommended
that pharmacists administer Brief Interventions for alcohol.
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.
Furthermore, if they work in 1:8 people, they can at best reduce
problems by around 13%;
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.
The specialists would administer brief psychological interventions.
The Socialist Health Association recommended that alcohol advisors
should be extended to polyclinics.
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.
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
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.
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
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 togethercriminal
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.
IMPROVE TREATMENT OF SPECIALIST
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.
Investment in alcohol treatment services
138. The DH agreed that investment in alcohol treatment
services would yield net savings for the NHS.
Analysis by the UKATT
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.
The BMA recommended that funding for specialist alcohol treatment
services should be significantly increased and ring-fenced.
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).
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.
Dr Raistrick highlighted the importance of the quality of psychosocial
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.
IMPROVE THE MANAGEMENT OF ALCOHOL-RELATED
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 timeespecially 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.
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
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.
This approach is supported by the DH, and was approved by the
National Quality Board in June 2009.
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
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
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
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.
Funding should be provided for the
National Liver Plan
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
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
Q 1065 Back
NAO, op. cit., p 20. 2008 Back
The National Treatment Agency, Models of care for alcohol misusers
(MoCAM), 2006. Back
Ev 6 and Q 233 Back
NAO, op. cit., p 17. Back
Ev 56 Back
All Party Parliamentary Group on Alcohol Misuse. The future
of alcohol treatment services,. Alcohol Concern. 2009 Back
Ev 142 Back
NAO, op. cit., p 21, 8-9. Back
NAO, op. cit., p 17. Back
NAO, op. cit., p 18. Back
Ev 176 Back
NAO, op. cit., p 20. Back
Ev 56 Back
Q 109 Back
Ev 57 Back
Ev 23 Back
Ev 5 and Ev 23 Back
Q 113 Back
The Department of Health's Alcohol Needs Assessment Research Project
(ANARP) 2004 Back
NAO, op. cit., p 33. Back
Ev 43 Back
Ev 140 Back
The Prime Minister's Strategy Unit, 2003 interim report Back
Q 219 Back
Ev 41 Back
Ev 41 & Ev 55 Back
Ev 105 Back
Ev 69 Back
NAO, op. cit., p 33. Back
HC Deb, 10 February 2009, col 1924W Back
Ev 33 Back
Ev 34 Back
Ev 43 Back
Ev 43 & 176 Back
QQ 1057 and 1066 Back
Ev 141 Back
Ev 43 Back
Heather, Raistrick & Godfrey, Review of the Effectiveness
of Treatment for Alcohol Problems,. National Treatment Agency
for Substance misuse, 2006 Back
LFTs are a blood test which can detect signs of liver damage. Back
Ev 34 Back
Q 114 Back
Q 113 Back
National Audit Office report: Reducing Alcohol Harm: Health Services
in England for Alcohol Misuse, 2008 Back
Q 225 Back
Kaner EFS, Beyer F, Dickinson HO, et al. Effectiveness of brief
alcohol interventions in primary care populations. Cochrane
Database of Systematic reviews, 2007. Back
Q 46 Back
Q 1070 Back
Ev 16 & Ev 57 Back
Ev 12 Back
Q 221 Back
Chief Medical Officer, On the state of the public health,
Ev 176 Back
Ev 55 Back
Q 158 Back
Q 170 Back
Ev 15 Back
Ev 106 Back
Q 232 Back
Q 135 Back
Ev 5 Back
UKATT Research Team, , Cost effectiveness of treatment for
alcohol problems. Findings of the UK Alcohol Treatment Trial,
BMJ, 2005, 544-547 Back
The National Treatment Agency for Substance, Review of the
Effectiveness of Treatment for Alcohol Problems , 2006. Back
Ev 23 Back
Ev 173 Back
Q 204 Back
Q 202 Back
Q 250 Back
Ev 34 and 69 Back
Q 1059 Back
Treatment outcome profiling (TOP) is a structured analysis of
treatment outcomes used in the UK drug treatment field as a measure
to ensure services are performing up to standard. We suggest that
the same system is adopted to ensure that the quality of alcohol
treatment services match the high standards now provided in drug