Reducing Alcohol Harm: health services in England for alcohol misuse

Public Administration Committee - Forty-Seventh Report 30 July 2009

Alcohol misuse is a significant and growing problem in England, with more than 10 million people now regularly drinking above the guidelines set by Government. Alcohol misuse places a considerable burden on the National Health Service (NHS), costing an estimated £2.7 billion per year. In 2006-07, there were some 811,000 alcohol-related hospital admissions, representing a 71% increase in four years. Between midnight and 5am on weekend nights nearly three-quarters of all attendances at accident and emergency (A&E) departments are alcohol-related.

In 2004, alcohol harm became subject to a national government strategy, which was updated by the Department of Health (the Department) and the Home Office in 2007. Since April 2008, the Department has also been responsible for delivering against a Public Service Agreement (PSA) indicator on the rate of increase of alcohol-related hospital admissions.

Primary Care Trusts (PCTs) are responsible for determining local health priorities and have control over the majority of NHS spending. PCTs are free to decide for themselves how much to spend on services to address alcohol harm. Many PCTs, however, do not know what they spend on such services and across England there is little correlation between need and expenditure. Where services are commissioned there is frequently a lack of performance monitoring and examination of whether what is provided represents value for money.

In 2008, the Department introduced a number of new measures designed to help address alcohol harm: providing extra funding for GPs to screen new patients; increasing alcohol-specific training for doctors, and creating 20 pilot sites designed to improve specialist treatment services. The Department has, however, yet to demonstrate its ability to effectively influence local commissioners, the drinks industry, and people's drinking behaviour. The Department also needs to work more closely with the other government departments which are responsible for policies affecting alcohol consumption, such as taxation and licensing. Achieving this will be necessary if the Department is to reduce levels of alcohol harm and succeed against the PSA indicator.

On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department on the performance of the National Health Service in addressing alcohol harm; the Department's influence on local commissioners, and the Department's work to encourage sensible drinking.

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