Wednesday, 11 December 2013

Sorry but fortysomething drinking isn't that big a problem, it really isn't


Dr Foster has published some not entirely helpful (indeed a tad ingenuous) statistics about drinking and our friends at the Guardian are all over them:

A total of 533,302 people in England have been admitted to hospital as an emergency since 2010 with serious health problems related to their consumption of alcohol or illicit substances. The vast majority were admissions for conditions specifically related to alcohol abuse, such as liver problems. Of those, 60,738 were aged 40 to 44 and another 60,083 were 45 to 49 – together, more than a fifth of the total. Some were admitted a number of times between 2010 and 2013.

The headlines tell us that one-in-five admissions for fortysomethings are related to booze or drugs. This is a little over 120,000 across three years. The figures don't tell us whether this number is rising or falling, nor do they look at trends in overall hospital admissions. As I said, not especially helpful.

There are around 5 million emergency admissions per year (5.3 million in 2012/13), a figure that has risen by about 50% over the last 15 years. So those 120,000 admissions of drunk or drugged fortysomethings  represent just 0.8% of emergencies. What the figures actually tell us is just how few people in their 40s are admitted to hospital - just 4% of total admissions.

What this evidence actually tells us is that alcohol really isn't the big pressure on the NHS that the New Puritans claim - it represents 9% of admissions (even on the generous definition of 'alcohol-related' used in today's NHS) and this number is set to fall in line with the long-term decline in consumption. Even this particular assessment the cost of this problem to the NHS is set at £607m - a figure that should be set against the £15,000m and more raised in alcohol taxes.

What this information really tells us is that, if anything, alcoholics, street drinkers and the most excessive consumers of booze (and Dr Fosters note that 36% of the admissions were from the poorest neighbourhoods) begin to present with crippling emergency problems in their 40s. And there's a comment from Turning Point, the drugs charity, on the Dr Fosters website that is telling:

Over 20% of admissions due to people with a drug or alcohol problem do not have a recorded GP.

These are society's drop outs not those 'mddle class' drinkers the New Puritans keep speaking of - indeed the admissions seem inversely related to social class. The poorer you are the more likely to be a fortysomething admitted with a booze problem.

It's clear to me that our response should be about better targeting of resources, focusing on those relatively few people who get into a serious problem with alcohol. Partly this is about GPs doing their job but mostly it's about us taking the resources we currently waste on nannying people without a problem and spending them instead on talking to those - especially those who have multiple admissions that relate to alcohol.

Sadly, the doctors are still proposing something that we know won't work and which merely penalises less well off responsible drinkers:

The BMA urged ministers to embrace "a comprehensive system of minimum unit pricing for alcohol, that has already been taken forward in Scotland, and improved labelling on alcohol products so that consumers understand the damage that might result from excessive consumption", as well as a crackdown on "irresponsible marketing practices".

These people really should be let anywhere near public policy-making. They really shouldn't.

There are between nine and ten million fortysomethings in the UK - 120,000 is around 1.5% of them. Let's get some focus please!



Leg-iron said...

I have a problem with booze. I can't afford it!

So I have taken to brewing up some of my own. As a doctor of microbiology, you can be sure mine is safe but when the untrained try making their own moonshine... well, if the NHS think they have a problem now, they ain't seen nothing yet!

They just have to look back at US Prohibition to see what to expect.

Ivan D said...

The BMA is a trade union. Its views on alcohol are utterly irrelevant in the wider scheme of things. It is frequently economical with the truth and where I a medic, I would be ashamed to be associated with it. Sadly, most medics are too busy practicing to bother with politics, so the profession is dragged ever further into the mud by a few very bad apples.