The NHS should not foot the bill for alcohol misuse

6 January, 2010 | By Mark Radcliffe

Looking back on the now distant festive season I can say it was the excess of cheese that most surprises me. Every time someone called in, out came a cheese board. So varied were our cheeses that some of them had fruit in them and one of them was blue. On purpose. I put on half a stone of cheese.

Still, Christmas is a time for excess it seems. We spend too much, we eat too much and sometimes we drink too much. Of course what constitutes “too much” varies for each of us; personally I peak at about two glasses of wine, everything from there is downhill. At three glasses I insist people play Scrabble and Twister - at the same time. One more and I start telling people I used to be all of Siouxsie and the Banshees and three sips later I try to prove it.

For others this is a staging post for the long night ahead. A night that will include putting a traffic cone on your head, trying to have sex with a tree and being sick in all of your coat pockets. Drink makes us stupid. Sometimes it makes us dangerous but usually it makes us stupid. Increasingly, however, it also makes us ill.

‘Christmas is a time for excess. Personally I peak at about two glasses of wine. At three glasses I insist people play Scrabble and Twister - at the same time’

Immediately after the New Year celebrations, when half the country was hungover and really not paying attention, a report by the NHS Confederation and the Royal College of Physicians emerged telling the population that alcohol addiction was costing the NHS £2.7bn a year. It called for more primary care intervention and investment in out of service provision. On hearing this most of the population said “Shhh” and went back to bed.

Meanwhile a right leaning think tank (no, I have no idea where they get their money from either) called Policy Exchange claimed alcohol misuse was so rife it constituted an epidemic and the drain it caused on NHS resources was such that people admitted because of drunkenness should be charged the cost of their bed for the night - £532.

Of course one’s first response is to never trust any suggestion that compromises the NHS premise of providing healthcare that is free at the point of access. But then I found myself thinking, “hang on… why not?”

Now, of course, this may be a slippery slope. Next, I may start believing in things like “wealth creation” and corporal punishment. I understand the idea that charging anyone for anything to do with the health service could create a premise upon which all sorts of charges could be built. And anyway a drunk could easily claim he paid for his bed when he paid his taxes and he’d have a point.

But we have also paid our road tax and that doesn’t mean we don’t get fined for speeding. It may be that we need to confront the space that exists between our so called rights and responsibilities.

We have the right to good treatment when we need it but we have a responsibility to treat the NHS as a valuable resource not to be abused. If we make choices that abuse it, is it wholly wrong that we should be asked to pay for the treatment we receive?

Readers' comments (16)

Anonymous | 6-Jan-2010 2:49 pm
An interesting thought but how do you define a "drunk". Long term alcohol misuse can result in admission to hospital but the needs of the person who struggles with this addiction are very real. How do you distinguish between and those with long standing problems who need help and the irresponsible, reckless drunk. Where is the line drawn?
Can we go on an apply your principle to those who take illegal drugs or people who are involved in extreme sport.
When the going gets tough the vulnerable are often easy targets for quick headlines. Who is going to make the value judgements about the deserving and undeserving drunk in A&E on a Saturday night?
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Anonymous | 10-Jan-2010 9:37 am
At first I thought that Mark's idea of charging intoxicated people for the use of the NHS a good one. However, upon reflection I don't think it will work. People who get drunk don't care about the consequences and ultimately people who can pay the levy will fork out and those who can't will ignore it. What we need is a radical rethink by a government and a culture that thinks alcohol is O.K. Sorry to sound conspiratorial but I'm sure the government keeps the unhappy masses chilled with cheap alcohol. Furthermore, look at our popular culture: everyone in Coronation Street meets at the pub.It's almost as though putting mind altering chemicals in your head is as natural as eating or smiling.As Steve pulls a pint in the Rovers no warning comes on the screen saying "Alcohol can ruin your liver or family". The State could never ban alcohol completely but it could go some way to reducing its consumption by quadrupling its price. We might then see an improvement in the physical and mental health of our population.
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Anonymous | 10-Jan-2010 9:46 am
Probably because the alcoholic will not be the pillock in A&E on a Saturday night who has been on a night out with 'mates'. I have mixed feelings about this subject, on the one hand my sister was an alcoholic and died as a result, so have an understanding of addiction....but for the life of me I cannot stand the weekend nightly parade of stupid people young and not so young, getting paraletic on alcohol. In some respects it has always happened in all generations....it's almost like a right of passage to the young. However, now it seems as though it is an aim to go out and drink as much as possible for as cheap as possible regardless of consequences. If anyone has tried to walk through a town or city centre on a Friday or Saturday night you will know how uncomfortable it is with large groups of 'revellers' milling around or hanging around outside venues (smoking) with no thought or care of who else is in the vicinity. I think there are obvious causes to this (although establishment would argue about right to chose!!!) - but in essence I agree to a point with Mark. If the idiots were aware that any treatment required as a direct result of their drinking was chargeable then maybe they would take better care of themselves. I think the police should charge too!
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Anonymous | 10-Jan-2010 9:57 am
Me again...yes I know there is a typo error *choose* not chose! One other point I wanted to make and agree with is that alcohol is far too cheap and too readily available. Although all countries have a certain amount of alcohol related problems the way it is available here is a contributary factor in it's abuse. I don't wish to sound like an old fart, but I recall as a teenager drinking cider, because it was the only thing we could afford....wine and spirits were never consumed because they were like a luxury items and too expensive. Now they are all affordable and available everywhere and practically 24 hrs. It doesn't take a genius to work out the consumption would rise! Or perhaps it does and we don't have any!
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Judith Wanstall | 10-Jan-2010 12:04 pm
I work as a triage nurse in an ambulance control, and so see all of the types of incidents mentioned above. Friday and Saturday nights are terrible; one call after another comes in 'my friend is unconcious'. They of course are not unconcious just very very drunk, but they may be diabetic, or with some other problem and have to be checked out.

There is also the assaults, many precipitated by alcohol; there are those with the cut fingers who do not have any money to get home, and think oh I shall call an ambulance it is my right to have one. They do not get one if my colleagues or I can get to the call and re triage it with a more clinical focus.

Again there are the alcoholics, the support for them is difficult, as the Alcohol and drug services will often not help them if they are drinking, yet how does the initial step to stop drinking happen without help? They become frequent callers to the ambulance service, sometimes phoning 7-8 times a day wanting help, wanting detox NOW. You get to know these people and are aware that they have been in for detox before but self discharged part way through the detox course, or made it to the end and within a few days are back drinking. They also lie to get an ambulance, saying something like they are vomiting blood, yet there is no sign of splattered blood in the toilet, so they change their mind and say they vomited in the sink, again no sign of any blood, and the sink is dry.

Something does need to be done about alcohol, whether it is a price rise to stop the lager lout syndrome, or joined up support for the alcoholics, of whom there are more than we get to hear about. I am unsure where we need to start, but start we certainly need to.
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mark radcliffe | 10-Jan-2010 1:43 pm
Anon 1: I suspect you can tell the difference between someone with an alcohol related disease and someone who is drinking for fun on a saturday night? Might there not be something of a therapeutic benefit in creating a relationship of responsibility around that recreational past time? I'm not sure either but surely we need to explore beyond the 'slippery slope' argument to see if we can begin to help people change their relationships if not with us than with themselves?
As for 'dangerous sports' when falling off a roller blade costs the NHS 27 billion a year we can look at them pesky skaters then eh? :-)

Anon 2: So how might we help people to care about themselves or the impact their choices have? To be honest I just think more nurses should be engaged with the debate and am curious about what options are available to us. (as for price controls see below)

Judith: What interests me is that when we talk about these things the voice of the triage nurse, the paramedics, the A and E nurse etc is quieted by the politics of alcohol. There was a spokesperson for beer or something on the radio yesterday arguing against minimum pricing because it punishes the 'consumer' - a consumer who cannot cope it seems without really cheap bulk bought vodka?

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Anonymous | 10-Jan-2010 2:33 pm
Thanks for the answers, Mark. In theory the answer to helping people looking after themselves lies with central government. In a country where the average reading age is nine years for an adult we need improved education to help people express their feelings. Perhaps then they would be less inclined to turn to alcohol, drugs and violence to sort out their inner conflicts. In some respects though you can't blame people for not taking responsibility for themselves when they see what poor role models they have in our decadent parliament. My utopian society then: you don't leave school until you can read and write properly, alcohol does not exist, every type of abuse of human beings is eliminated. I feel as though all three areas are related somehow.
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Anonymous | 10-Jan-2010 5:03 pm
I agree that there needs to be a balance between rights and responsibility, and also that those who fail to exercise responsibility may not be keen to pay a bill for their lack of responsibility. It's a difficult debate but one that should be had. Similar debates have been had about smoking.

PS. Given the amount of cheese Mark has consumed, will he be paying for his own statins?
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Anonymous | 10-Jan-2010 6:20 pm
Perhaps if the young reckless 'weekend' binge drinkers were brought to the gastro ward to see the jaundiced, dying alcoholics of a similar age to themselves they might start to see the consequences of alcohol. Make this a part of there treatment before sending them home to do it again, might they think twice before ending up as a regaular admission with a dnar before there 35th birthday?
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Doug Langdon | 10-Jan-2010 11:11 pm
I have felt for a long time that people who are brought into an A & E Department suffering from the acute effects of alcohol abuse, should be treated in the same way as those involved in a road traffic accident. They should be sent a bill for being conveyed to hospital, which will cover the cost of transport and ambulance personell.

I do not agree with charging for "hotel" services.

Equally those people who undertake extreme sports activities and subsequently get injured should also be charged through their insurance companies.

I appreciate that there may well be problems in getting some to pay, but the idea should be considered.

I also agree that the way in which the NHS and other services deal with the problems associated with alcohol abuse is in many ways pathetic, as it is seen as self induced.

When people are picked up off the streets, by the police, or ambulance service, and they are under the influence of alcohol, they should be taken to specialist alcohol assessment centres, where they are detained and then assessed both physically, psychologically and then given advice about their use or misuse of alcohol.

These centres should be staffed by specialist teams of medical, nursing, and security staff.

Police stations and general A & E Departments are not the place to deal with people who are drunk. They present a danger to other people, but are also a danger to themselves.

If in doubt, there should be protocols which deal with medical emergency first and alcohol issues after.

I am not sure what happened to the days, when licensees could lose their licence for serving people who were or appeared drunk.

Those people with serious issues associated with alcohol abuse would need to be treated much more sympathetically.

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Anonymous | 11-Jan-2010 9:54 am
Things don't change. I remember the mid '70's in Leeds A&E. The Thursday before Christmas was a nightmare, trolleys full of suited drunks from mid afternoon til the next day. All vomiting and having diarrhoea all at the same time - an absolute nightmare. Though CCTV could be sold for £250 a pop to the silly video TV show, or £500 not to!
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katrina riley | 11-Jan-2010 9:05 pm
I work on a ward directly above the A&E department and I too find the drunken weekend attenders at best annoying and at worst a waste of my tax money! However, is the great thing about our National Health Service not that it is 'without predjudice'? If we are denied health care depending on our lifestyle choices, does it not fly in the face of freedom of choice that our ancestors fought so courageously for and people in other countries around the world still cannot take for granted today?
I accept that we should make our choices wisely and with responsibility for their outcomes, but not have the consequences foisted upon us. This is where education comes in.
My arguement obviously precludes choices that are against the law! I accept we can't go around doing what we like, when we like, but where do we draw the line??
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Anonymous | 13-Jan-2010 12:05 pm
It is not the role of healthcare professionals to act as moral police who decide which patients have a right to treatment and those who have not due to OH-related or other problems as is against the ethical principles of all healthcare professions. This may also lead to some professionals on a power trip to abuse their percieved feelings of 'power' over others who feel it is their right to make moral judgements over others and reject patients in need of urgent care with disasterous consequences for the patient themselves and for other innocent individuals - think about the patient, their families and their potential victims through violence, aggression and accidents.
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Anonymous | 13-Jan-2010 12:20 pm
there should be staff with specialist training in alcoholism in the emergency rooms and on the wards where these patients are sent as well as specialised liaison officers and community carers so the patient has the choice of being followed up wherever they are sent. They shouldn't just be sent home because nobody wants to care for them. They have got drunk or are alcoholic for some reason such as life's problems and pressures, depression, underlying disorders etc. and should be offered help and empathy they need like any other individual accessing the health services or in the community.
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Anonymous | 14-Jan-2010 4:52 pm
I think its great to engage with this debate and keep it a current issue as it relates to all other addiction issues for people in society whether that is food, drugs, work, religion...and reflection for us as healthworkers regarding our investment in our responses.
How helpful would charging people actually be with regard to effectively penalising people for behaviour that is largely unconsciously driven and who often lack the training and role models that enable positive self care and responsible behaviour?
It also allows the industry that is fuelling and driving the situation to knowingly abdicate its responsibility whilst profiteering unimaginable sums, much like the tobacco industry, the porn industry, the illicit drug industry, the food industry..... Us tinkering with the symptoms and fallout of those policies will not only make no difference but will condone and enable the situation to continue, and eventually put us in the line of fire of responsibility for not fixing it or doing enough.
Nothing will change until as a community we accept that alcohol is a drug, plain and simple, and how as a nation we deal with and express our conflicts (as said above) internal or outward relational. Do we self medicate, blame others or talk?
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Anonymous | 10-Apr-2010 10:25 pm
alcohol abuse is considered as a mental health disorder like any other physical or mental illness. Why should the NHS then pass moral judgement and penalise patients for some disorders and not others and discriminate between those who should receive free treatment (paid for by every tax payer in the land) and who should not.
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