News Analysis: Can NHS reforms cut alcohol abuse?

The alcohol strategy for England, expected to be launched later this month, will set out the government's programme for tackling alcohol misuse.

One in five women drink above the recommended levels and there are 1m alcohol-related hospital admissions every year (Photograph: Istock)
One in five women drink above the recommended levels and there are 1m alcohol-related hospital admissions every year (Photograph: Istock)

Although most details have been kept under wraps, prime minister David Cameron is thought to be considering minimum unit pricing for alcohol, a move supported by public health experts for a long time.

Alcohol misuse continues to present a huge problem for the NHS.

One in four men and one in five women drink above recommended levels and every year there are 1m alcohol-related hospital admissions and 6,000 alcohol-related deaths in England.

The government in England has long stalled on introducing legislation on alcohol misuse, but a range of measures will soon provide local authorities and others with more powers to tackle alcohol misuse.

The NHS reforms may also help to improve alcohol services, according to RCGP chairwoman Dr Clare Gerada, not usually known for her support for the Health Bill.

Dr Gerada believes local authorities will be able to balance the social impact of alcohol with the cost of investing in services designed to tackle alcohol misuse.

Alcohol measures

NHS reforms
The Health Bill will move responsibility for alcohol services to local authorities.

Outcomes frameworks
The NHS outcomes framework and the public health outcomes framework include alcohol-related targets.

Local authorities will be able to review licences and it will be easier to withdraw problematic licences.

Evidence is emerging of the benefit of screening, brief interventions and drug therapy to reduce drinking.

Benefits of NHS reforms
The DH is also keen to stress ways in which the government's NHS reforms will help tackle the burden of alcohol-related disease.

At a meeting of the all-party parliamentary group on primary care and public health in London last month, the DH's director of implementation for health and wellbeing boards, John Wilderspin, drew attention to some of these mechanisms.

He said that 'you don't have to read very far' to find targets relating to alcohol in the public health outcomes frameworks and NHS outcomes framework.

'As well as being held to account, people tend to like incentives, and there is an incentive in there in terms of the public health premium,' he added.

Mr Wilderspin also stressed the importance of having protected public health budgets. 'For once in our lives, the budget for public health will be ringfenced for local government,' he said. 'That is a profound change.'

Also at the parliamentary meeting, the DH's deputy director for drugs and alcohol, Chris Heffer, said he would expect councils to give 'line-item by line-item' accounts for how they had spent their public health budgets, including alcohol services funding.

Licensing legislation
Mr Heffer pointed to the fact that local authorities would be made responsible authorities under the licensing legislation, allowing them to initiate reviews of premises' licences.

'The government is also lowering the evidential burden required to withdraw a problematic licence,' he said. 'So that provides a greater role for health in thinking about licensing decisions.'

Mr Heffer said the DH was also looking at how alcohol screening could be incorporated into the NHS health checks given to everyone aged 40 to 74 years. NICE estimates that screening all patients for harmful drinking when they register with a GP practice could lead to 'significant' savings and that, overall, improved alcohol prevention services could save £100m a year.

Last week, Professor Colin Drummond of King's College London presented new data on the effectiveness of alcohol screening in primary care.

Professor Drummond's team showed that the four-item Fast Alcohol Screening Test is the most efficient and effective screening tool to use in a primary care setting. Such testing can be introduced in primary care when supported by financial incentives, training and continuing specialist support, the researchers found.

Aside from policy and interventional strategies, drug therapies are also being developed to help dependent drinkers reduce consumption.

Data presented last week showed that nalmefene, which has yet to be licensed, can halve alcohol consumption and reduce heavy drinking days among dependent drinkers.

The DH is looking at how alcohol screening can be incorporated into the NHS health checks given to everyone aged 40 to 74 years

Minimum pricing
But for all the work on screening and therapy, the real hope of everyone speaking at the parliamentary meeting was that the government tackles the price, availability and marketing of alcohol.

Alan Higgins, director of public health at NHS Oldham, said that, although there were other ways of looking at alcohol pricing, minimum unit pricing was the one that has the evidence base to support it.

'It's not a magic bullet,' he said. 'It's not something that will change things overnight, but if that's not in place, then I don't think the other measures really stand a chance of affecting the turnaround in alcohol that we need to see.'

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