Clinical areas - Alcohol

The case for addressing alcohol-related harm within the NHS and public sector is strong. The Government have prioritised action through their National Alcohol Strategy 2012.

National estimates of the incidence of alcohol use and morbidity per 100,000 people per year include:

• 2,000 people will be admitted to hospital with an alcohol-related condition
• 1,000 people will be a victim of alcohol-related violent crime
• Over 400 11-15 year olds will be drinking weekly
• Over 13,000 people will binge-drink
• Over 21,500 people will be regularly drinking above the lower-risk levels
• Over 3,000 will be showing some signs of alcohol dependence
• Over 500 will be moderately or severely dependent on alcohol

Substantial increases in alcohol related harm have also been reported by the Royal College of Physicians. Thirteen children per day are hospitalised as a result of alcohol misuse. Alcoholic liver cirrhosis increased by 95% from 2000 to 2006. Deaths related to alcohol increased by 18% from 2002 to 2005. Non-health related adverse impacts include rape, sexual assault, domestic and other violence, drunk driving and street disorder.

In South London the impact of alcohol is significant. The recent Screening and brief Intervention Programme for Sensible drinking study (SIPS) found that 40% of attendances at King’s College and St Thomas’s Hospital emergency department were alcohol related. Alcohol related inpatient admissions to acute care have doubled in the past 8 years in England and now account for 14% of all acute admissions in King’s Health Partners (KHP). A study in South West London found that 50% of adult mental health admissions were alcohol related.

During 2011, emergency department attendances at St Thomas’ Hospital and Kings College Hospital, coded with ‘apparently drunk’, ‘alcohol dependent’ or ‘alcohol cited on the GP letter’ totalled 400 patients per month.

In outer London, the Sutton Health Profile 2011 indicates an above national value for rates of ‘Increasing and higher risk drinking’. Although ‘hospital stays for alcohol related harm’ were below average at 1,523 admissions per 100,000 population.

The case for action in South London is strong, six out of 12 South London Health and Wellbeing Boards have prioritised alcohol harm reduction, and most others have priorities that are affected by alcohol. There are early gains that can be made to reduce the burden on the health and social care system by addressing service access, early interventions and prevention approaches.

Priority areas in South London

Initial priority areas for project implementation have been identified. These are partly indicated by existing work and need in South London. There are two specific areas where there is scope to focus on research and implementation:

  • Alcohol-related Frequent Attenders: This is an area of high cost to the NHS and of high harm to the individuals involved. There is significant scope to manage these attendances better, providing additional and appropriate support, and to develop early interventions to avoid the need for frequent attendance occurring. Work is likely to be developed around this theme to take advantage of existing work and to apply real outcomes quickly.
     
  • Identification and Brief Advice: This is one of the key prevention efforts that the NHS and others can implement. The evidence of effectiveness for IBA is strong; however, implementation continues to be an issue. There is significant scope to develop improved methods of delivery for IBA across the NHS and boroughs in South London, with particular focus on technological solutions to delivery.

Other areas of work will be scoped and engagement with South London stakeholders will help inform the shape of the above projects and further development of projects.