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OPINION

'Should we call last orders on drunks and traffic cones in A&E?'

I have never been very good with drunks. They are often earnest and inarticulate and, if you are both of those things at the same time, you just sound like John Prescott.

Sometimes they shout or sing really badly and they make poor relationship choices - I once saw a very drunken man lay down in the street, wrap himself tightly round a traffic cone and fall asleep. I felt the traffic cone could have done better but you don’t like to say anything do you?

Anyway I mention this because of a call this week for drunks to pay a contribution toward the cost of their treatment in accident and emergency departments. Proponents say that charges would act as a deterrent to binge drinkers who cause delays to treatment given to patients who are genuinely ill - sometimes for hours. This position was lent poignancy by a bereaved husband who spoke out last month about his wife, a mother of two, dying after being kept waiting in A&E as a succession of drunks were seen before her.

The Patients Association and members of parliament have spoken in support of the idea and, given the underpinning health service principle of trying to incentivise good public health, it has some logic doesn’t it?

But I suspect it makes a lot of nurses uncomfortable. In part maybe it’s because it lacks sympathy? But perhaps it’s also partly because if we introduce charging to the NHS - particularly with this type of government in power - we will find ourselves rushing toward a tariff that charges smokers and doughnut lovers for treatment for heart disease and anyone injured playing sport for bone repair and physiotherapy.

However I am no fan of the “slippery slope argument”. It is lazy and belligerent; relying on it is something like using logic as a baseball bat to hit complex dilemmas over the head with.

It seems we have a strange relationship with alcohol. Men measure themselves according to how many beers they can drink, and young people choose to celebrate anything from passing their A-levels to getting rid of a persistent spot by drinking until they fall over and wet themselves, then sobering up and texting everyone they know exclaiming: “I was so blathered last night I was sick in my own ear. I had to be resuscitated on the bus. Same again next week.”

Of course it’s sad and ugly and I understand that it is some sort of expression of youth, freedom, disaffection, self loathing or whatever you feel like calling it. But it is also expensive, time consuming and it does have an impact on other people. Surely in these times of austerity, where important services are being cut, behaviour that is destructive - and I don’t mean to the individual here, I mean to the ability of a health service to function adequately - really does need to be addressed.

Perhaps doing so is a bit of an unsavoury idea because it smacks of social manipulation? Who are we to tell people how they should live their lives? Who are we to punish them for wanting to have a good time or developing feelings for a traffic cone?

But perhaps we might look at it another way; perhaps we should entertain the idea that sharing a health service demands something like a collective responsibility to the resources that we require? And I think if that idea is worth exploring, a good place to start is with the good time drunks treating A&E visits as routine party stops.

Readers' comments (7)

  • This is not punishment or telling people how to live their lives, it's making them take responsibility for the consequences of the choices they make and the negative impact those choices have on other people.

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  • I agree with 'beady eye'. Standards of behaviour in public areas have slipped in recent times. The culture of making complaints has made it difficult to challenge unacceptable behaviour.

    Yesterday, as I went to collect my next patient from the waiting area in the General Practice Surgery I work in, the noise from the rioting children hit me. We provide a play area where parents generally sit quietly with their children.

    However on this occasion there were two young children in the general waiting area, where there were elderly patients waiting. The children were running around screaming as they would in a play ground and the Parents were ignoring this. Would they be allowed to run around screaming in a Public Library or a Museum or Restaurant?

    Having regard to the other Patients waiting (frail/elderly), I pointed out to the Parents that this was a Doctor's waiting room and could they please keep their children under control. Yes you have guessed the outcome. There has been a complaint made against me! Do I regret my actions? No.

    If antisocial and inconsiderate behaviour is never challenged then it will only escalate.

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  • I think it's important to ask why are these drunks visiting A&E? Self medication with alcohol or even alcoholism can be a signal of greater problems that need to be addressed in order to prevent the behaviour happening again. Also, a number of cases present similarly to being drunk (Hypoglycemia, Rohypnol doping...).

    I think it's very dangerous to start charging people with these real and underlying conditions (and indeed stigmatising them as occurs at the moment).

    Finally where does this end. Self harmers or attempted suicides get charged because they did it to themselves? If a driver was doing 40 in a 30 zone he gets charged for treatment? If a nurse hurts his back while helping manipulate a bariatric patient he gets charged because he wasn't following the prescribed handling rules?

    Slippery slope.

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  • This article brought to mind, a time in my training back in 1985-7, in A&E. A patient had been brought in with respiratory arrest after a binge drinking session with his mates, after one of the rugby internationals. Whilst he was sleeping it off afterwards, his 'friend' was trying to wake him up, as he was worried about the valuable drinking time that was being lost!

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  • Mark is right times are hard and tough decisions have to be made. Anyway its time to allow people to take responsibility for their own health and stop treating grown adults as though they are children who dont understand what they are doing. And by the way I'm sick of the chain smokers and doughnut eaters as well.

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  • instead of ambulances bringing drunks to A&E, they should be taken to some kind of detox centre for the night. When I worked in A&E, the Dr's would prescribe a bag of saline or two and some antiemetic. Come morning they would wake up feeling top of the world, (usually feeling better than the staff finishing the night shift making sure they didn't aspirate all night!).

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  • it is not our job to make people responsible for their own lives. They are responsible! Nursing is about caring for the sick and delivering the treatment they need and helping them in daily living activities they are unable to perform for themselves. No more, no less. If people are ill, as a result of their poor habits or difficulties then they need care. If not they need to be treated in a dedicated facility for their disorder.

    The model used by the police in Zurich following street parties seems a good one. The individual who needs intervention is transported to a padded police cell which contains the bare basics.
    All their belongings and clothing are removed from them and returned the next morning. Medical attention is available and in the case of urgent medical necessity the patient is transported to the nearest hospital, otherwise the 'customer' is billed for their night's lodgings which is about the same as a night in a Swiss five-star hotel. A sobering thought which might make the clients think before they act but could also be an excellent source of revenue for the State of Zurich coffers!

    As an alternative in the UK, perhaps admission to a detox centre for all substance dependent or substance abuse individuals with all the necessary medical support for small emergencies would lighten the load in A&E so that other patients are dealt with more quickly and in a less stressful and quieter environment for both patients and staff.

    From this centre, as in Zurich, they could then be transferred to the appropriate department in hospital in case of a more serious medical emergency.

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