Health Committee - The Government's Alcohol StrategyWritten evidence from the Royal College of Anaesthetists (GAS 15)


The Royal College of Anaesthetists is a member of the Alcohol Alliance and supports their views on alcohol-related issues.

Two key issues for anaesthetists are:

(a)Dealing with the effects of the acute overconsumption alcohol in relation to binge drinking and motor vehicle collisions. During some nights on call, and particularly at weekends, over 90% of the patients being anaesthetised in emergency theatres would not be there but for the harmful over-consumption of alcohol. This might be following personal harmful consumption or that of someone else resulting in violent injuries from glass or knives. This uses up valuable NHS resources and reduces the anaesthetic services capacity to deal with other surgical emergencies whose treatment can sometimes be delayed as a consequence. Reduction of permitted alcohol level for driving should help this, see paragraph 9.

(b)Anaesthetising and treating patients on Intensive Care Units or in Pain Clinics may be more complex because of comorbidities produced by the long term harmful consumption of alcohol. Such comorbidities eg liver failure increases mortality risk for these patients, prolongs their length of stay and increases the amount of resources the NHS has to devote to them compared to other patients.

The Royal College of Anaesthetists has recently contributed to the Academy of Royal Medical Colleges working party to agree core competencies for dealing with alcohol related issues. These are being incorporated into the FRCA curriculum.

Response to Questions On Call for Evidence

1. Establishing who is responsible within Government for alcohol policy in general, policy coordination across Whitehall and the extent to which the Department of Health should take a leading role

This College would not have a preference as to who is responsible within government other than it be the Department which can most reliably and effectively implement the alcohol strategy and start to address the very serious problems that the population now faces.

2. Coordination of policy across the UK with the devolved administrations, and the impact of pursuing different approaches to alcohol

Ideally this will be coordinated across all the devolved administrations and implemented in the same way. Different approaches would confuse the public about the important and sometimes difficult messages to be conveyed and in the border areas lead to problems such as used to occur with differing Welsh/English licensing hours.

3. The role of the alcohol industry in addressing alcohol-related health problems, including the Responsibility Deal, Drinkaware and the role of the Portman Group

The alcohol industry should be involved in addressing alcohol-related problems. The Responsibility Deal seems fine on paper but removing 1 billion units over 10 years is a small part of the market. It will be interesting to see if this is actually achieved voluntarily as: reducing the strengths of their brands, reducing the volume of their products, and curtailing irresponsible marketing innovations is exactly the opposite of what they have been doing in the for the last 30 years. Indeed as the Government Alcohol Strategy says—consumption in the UK used to be the lowest in Europe, therefore the UK was the nation with the best potential of market growth and was specifically targeted with very successful marketing campaigns and lobbying for beneficial changes in legislation on licensing hours etc. As a result, alcohol consumption increased and after a lag death rates of from cirrhosis have gone from below average to some of the worst in Europe.

4. The evidence base for, and economic impact of, introducing a fixed price per unit of alcohol of 40p, including the impacts on moderate and harmful drinkers; evidence/arguments for setting a different unit price; the legal complexities of introducing fixed pricing

This College fully supports a minimum price per unit of alcohol. We are also persuaded by the evidence of University of Sheffield and others that 50p will be better. This is a measure that should be effective in reducing alcohol consumption at home and reducing the consumption of even moderate drinkers will also produce health benefits over time. A uniform UK national policy for a minimum price would be ideal. In the absence of this some large urban, conurbations in the North of England and Midlands are considering their own regional minimum pricing measures; it would be better to be a UK wide initiative.

5. The effects of marketing on alcohol consumption, in particular in relation to children and young people

One of the reasons for the large increase in alcohol consumption in the last 30 years has been the effectiveness of its marketing particularly in relation to young people. Regulation should be tightened up with consideration of banning it in the broadcast mediums and removing promotion at sporting activities.

Drinking should not be a feature of films classified 12.

6. The impact that current levels of alcohol consumption will have on the public’s health in the longer term

Current levels of alcohol consumption underpin further increases in liver disease etc. for the health service to deal with in the coming years.

7. Any consequential impact on future patterns of service use in the NHS and social care, including plans for greater investment in substance misuse or hepatology services

The full results of current levels of alcohol consumption have yet to be seen and increased investment in the relevant areas of the NHS and social care will be needed over the coming years.

The impact of harmful alcohol consumption on anaesthetic emergency services might be worthy of a study funded by the NHS to determine the exact extent and commitment of resources to this activity.

8. Whether the proposed reforms of the NHS and public health systems will support an integrated approach to future planning of services for people who experience alcohol-related harm

This is too early to tell but the Health and Well-Being Boards may have an important developing role in this area.

9. International evidence of the most effective interventions for reducing consumption of alcohol and evidence of any successful programmes to reduce harmful drinking, such as:

Public health interventions such as education and information;

Reducing the strength of alcoholic beverages;

Raising the legal drinking age; and

Plain packaging and marketing bans.

We would add—the permitted blood alcohol concentration for driving should be reduced as a matter of urgency. Great Britain and Ireland are the only countries in Europe with a limit of 80mg per 100ml, a number are 50mg per 100ml and we are persuaded that levels of 0 mg per 100ml would be best. Six countries in Europe and 17 in the world have Zero as their limit. We note the government is currently tightening up on the rules for driving under the influence of other drugs, with UK pedestrian death rates being highly unsatisfactory this will be an opportunity to send a coordinated message that anyone wishing to drive a car should never do so with their judgement and reflexes impaired.

Tightening up on the driving limit will also create further downward pressure on alcohol consumption levels in a particularly significant group.

May 2012

Prepared 21st July 2012