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Government's Alcohol Strategy

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Government's Alcohol Strategy House of Commons Health Committee Government’s Alcohol Strategy Third Report of Session 2012–13 Volume II Additional written evidence Ordered by the House of Commons to be published 10 July 2012 Published on 23 July 2012 by authority of the House of Commons London: The Stationery Office Limited The Health Committee The Health Committee is appointed by the House of Commons to examine the expenditure, administration, and policy of the Department of Health and its associated bodies. Membership Rt Hon Stephen Dorrell MP (Conservative, Charnwood) (Chair)1 Rosie Cooper MP (Labour, West Lancashire) Andrew George MP (Liberal Democrat, St Ives) Barbara Keeley MP (Labour, Worsley and Eccles South) Grahame M. Morris MP (Labour, Easington) Dr Daniel Poulter MP (Conservative, Central Suffolk and North Ipswich) Mr Virendra Sharma MP (Labour, Ealing Southall) Chris Skidmore MP (Conservative, Kingswood) David Tredinnick MP (Conservative, Bosworth) Valerie Vaz MP (Labour, Walsall South) Dr Sarah Wollaston MP (Conservative, Totnes) Powers The Committee is one of the departmental select committees, the powers of which are set out in House of Commons Standing Orders, principally in SO No 152. These are available on the Internet via www.parliament.uk. Publications The Reports and evidence of the Committee are published by The Stationery Office by Order of the House. All publications of the Committee (including press notices) are on the Internet at www.parliament.uk/healthcom. The Reports of the Committee, the formal minutes relating to that report, oral evidence taken and some or all written evidence are available in printed volume(s). Additional written evidence may be published on the internet only. Committee staff The staff of the Committee are David Lloyd (Clerk), Martyn Atkins (Second Clerk), David Turner (Committee Specialist), Frances Allingham (Senior Committee Assistant), and Ronnie Jefferson (Committee Assistant). Contacts All correspondence should be addressed to the Clerk of the Health Committee, House of Commons, 7 Millbank, London SW1P 3JA. The telephone number for general enquiries is 020 7219 5466. The Committee’s email address is [email protected]. 1 Mr Stephen Dorrell was elected as the Chair of the Committee on 9 June 2010, in accordance with Standing Order No. 122B (see House of Commons Votes and Proceedings, 10 June 2010). List of additional written evidence Page 1 Professor Robin Touquet Ev w1 2 Miss Renate van Nijen Ev w3 3 Redcar & Cleveland Joint Commissioning Team Ev w5 4 Institute for Social Marketing, University of Stirling Ev w7 5 Balance, North East Ev w8 6 The Salvation Army Ev w12 7 Office of Fair Trading Ev w15 8 Alcohol Focus Scotland Ev w17 9 Scotch Whisky Association Ev w21 10 Heineken Ev w25 11 Quaker Action on Alcohol and Drugs Ev w27 12 British Retail Consortium Ev w31 13 Royal College of Anaesthetists Ev w35 14 Royal College of Physicians Ev w36 15 National Society for the Prevention of Cruelty to Children Ev w39 16 British Liver Trust Ev w41 17 Crime Reduction Initiatives Ev w41 18 Association of Convenience Stores Ev w44 19 Sport and Recreation Alliance Ev w47 20 British Horseracing Authority Ev w49 21 Baptist Union of Great Britain, the Methodist Church and the United Reformed Church Ev w50 22 Advertising Standards Authority Ev w53 23 National Heart Forum Ev w62 24 St Mungo’s Ev w64 25 Royal College of Nursing Ev w68 26 Newcastle City Council and Newcastle Primary Care Trust Ev w71 27 Pharmacy Voice Ev w74 28 Northumberland Alcohol Strategy Implementation Group Ev w76 29 British Medical Association Ev w77 30 Diageo Ev w88 31 Waitrose Ev w91 32 British Society of Gastroenterology Ev w93 33 British Brands Group Ev w97 34 Wine and Spirit Trade Association Ev w99 35 Business In Sport & Leisure Ev w103 36 Mentor Ev w105 37 Family Planning Association Ev w108 38 Medical Research Council and the Economic and Social Research Council Ev w109 39 Professor Keith Humphreys and Professor the Baroness Finlay of Llandaff Ev w116 40 Royal College of Psychiatrists Ev w117 41 Institute of Alcohol Studies Ev w122 42 Drink Wise North West Ev w128 43 Royal Geographical Society (with the Institute of British Geographers) Ev w132 44 DrugScope Ev w135 45 Mr Christopher Snowdon Ev w137 46 Cancer Research UK Ev w139 47 Institute of Practitioners in Advertising Ev w142 48 The Advertising Association Ev w144 49 All Party Parliamentary Group on Alcohol Misuse Ev w149 50 Ofcom Ev w152 51 2020health.org Ev w156 52 Greene King Ev w160 53 Scottish Health Action on Alcohol Problems Ev w163 54 Local Government Association Ev w164 55 Lundbeck Ev w166 56 The Alcohol Harm Reduction Group in County Durham and the Alcohol Strategy Implementation Group in Darlington Ev w169 57 London Health Improvement Board Ev w172 58 NHS Confederation Ev w176 59 Association of Licensed Multiple Retailers Ev w179 60 Royal College of General Practitioners Ev w182 61 Joseph Rowntree Foundation Ev w184 cobber Pack: U PL: COE1 [SO] Processed: [20-07-2012 14:29] Job: 021687 Unit: PG01 Source: /MILES/PKU/INPUT/021687/021687_w061_michelle_67 GAS - Joseph Rowntree Foundation.xml Health Committee: Evidence Ev w1 Written evidence Written evidence from Professor Robin Touquet (GAS 02) Emergency Departments I highlight successful implementation of the above—having recently completed 25 year as A&E (Emergency Medicine) Consultant/Professor at St Mary’s Hospital, Paddington, Emergency Department (ED)—Imperial College Healthcare Trust—where ED work led to the inception of the Paddington Alcohol Test, together with ED based Alcohol Health Workers from 1994. 1. Brief Advice (BA) is relatively unthreatening for ED staff to implement as it takes only one to two minutes by definition; if longer it is no longer true Brief Advice. It is unstructured (NOT using any specific format)—giving simple feedback on “cause” (drinking alcohol) and “effect” (ED attendance), to stimulate reflection by the patient (“contemplating change”)—with the offer of further help from an Alcohol Health Worker (AHW)—who may be present in the ED at the time. 2. Brief Intervention (BI) is much longer, being structured (may be based on “FRAMES”), given by those trained to give it (and who are specifically paid to give BI, having the allocated time), ie by AHW’s (who may or may not be qualified RMN or SRN nurses: then Alcohol Nurse Specialists, ANS’s) and lasts 20–30 minutes (or longer). This should include, for the truly dependent drinker, arrangements for the patient to be followed up in the community (Patton R, 2011) 3. “Clinical Inertia” is “a reluctance to update practice”, and “NIMBYism” is “not my job”. The key point is ED doctors and nurses have a wariness of anything that they perceive to slow down patient through-put, because ED staff are under such pressures of time, space and staffing—remembering that the ED workload is both variable and unpredictable. Using the term “Screening” risks precipitating negative responses because screening—implying for every patient—will inevitably slow patient through-put. If clinicians muddle BA (one to two minutes) with BI (20–30 minutes) such that they perceive that they, and their staff, will have to spend in excess of say even five extra minutes with every patient, quite simply there will be great resistance to implementing even the simplest of “Early Identification and Brief Advice” (EIBA). However, if it is clearly understood that all that it expected is one to two minutes of BA for those presentations likely to be associated with alcohol misuse (ie fall, collapse, head injury, assault, accident), that there are readily available AHWs to be of stress-relieving support (and are the ONLY staff who enact BI), and vitally that as a consequence unscheduled alcohol-related re-attendance will be reduced—then negative attitudes by ED leaders will be changed to being positive. Hence why it is vital that BA (very short and unstructured) is differentiated from BI (Huntley et al, 2001; Huntley et al, 2004). 4. For ED staff and indeed patients it matters far less what basic questionnaire is used (eg PAT, FAST, AUDIT C or RAPS4), rather that question(s) are indeed actually asked about alcohol—this may be only one question eg SASQ, effective as SIPS has shown (www.sips.iop.kcl.ac.uk). What is used depends on what suits that particular ED. Key for successful implementation are Education, Audit and on-going Feed-back (together with BI from the AHW, forming the anagram “BEAF”) with support from ED senior doctors and nursing sisters themselves. It must be remembered that in the majority of ED’s junior doctors change (ie move to another job) every four months now—so it is constant and unending Education, Audit and Feed-back. ED senior support (Consultants, Nurses) is the pre-requisite for success, again as SIPS has shown (www.sips.iop.kcl.ac.uk). 5. With PAT, Paddington Alcohol Test—PAT(2009) being the latest edition—please note the following (Touquet, Brown WHO 2009): (a) Patient Information Leaflet (PIL). PAT(2009) states: “Give alcohol advice leaflet to all PAT+ve patients, especially if they decline ANS appointment”. The cost effectiveness of this advice has been confirmed by SIPS ED research results (www.sips.iop.kcl.ac.uk). Together with PIL (Patient Information Leaflet)—as used in SIPS—feed-back is given, which is equivalent to Brief Advice— and which is what BA actually is—cause/effect relating to the precipitating unpleasant episode that necessitated the inconvenience of an ED attendance. (b) PAT(2009) is used “back-ended”, ie it is applied at the end of the consultation by the busy clinician who, hopefully by relieving pain, showing care and compassion etc, has generated “the gratitude factor”.
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