Friday 5 October 2018

Supping with the devil

It’s an established dogma of the so-called public health movement that partnering with the alcohol industry to reduce harms is tantamount to supping with the devil. It’s not that they think you should use a long spoon, you shouldn’t even be at the meal. 

It was entirely predictable that when Public Health England (PHE) announced a partnership with Drinkaware to jointly campaign for “drink-free days” to reduce heavy drinking and promote moderate consumption, the usual anti-alcohol groups shrieked in horror.

This alarmist concern resulted in a letter sent to PHE by the Alcohol Health Alliance (AHA) signed by 50 anti-alcohol pressure groups and individuals. The concern arises from the fact Drinkaware is funded by the alcohol industry and therefore, in the view of the AHA, tainted by Big Alcohol. I defy anyone viewing the Drinkaware website to conclude it is an industry shill. The level of paranoia by these single-issue pressure groups verges on the pathological – “don’t fraternise with the enemy” is their credo!

Their view is that partnership working with the alcohol industry leads to the dilution of policies that really work and to the substitution of ineffective policies – such as education. So even though the PHE “low risk” drinking guidelines promote drinking no more than 14 units of alcohol a week interspersed by one or two alcohol-free days, and all these groups are signed up to that advice, if the alcohol industry supports it in conjunction with PHE it is tantamount to heresy. So much so professor Sir Ian Gilmore, chairman of the AHA and a key advisor to PHE, threatened to resign his post in protest. If you point a gun to your head and say: “Do as I say or I’ll shoot” you run the risk your bluff will be called, and it was. Professor Gilmore has resigned!

It seems to me if the AHA and its membership want to separate itself from the industry that produces the products they profess to be experts on, they will isolate themselves in an academic ivory tower and their policy prescriptions will lack any relevance to the real world in which they are enacted. This bone-headed, know-nothing approach does have one advantage, however, it enables them to make things up in their heads and ensure their own ideological purity by burying themselves deeply in the temperance rabbit hole. This immunises them from any kind of reasoned compromise with an industry they despise as comprised of capitalist bad guys engaged in a conspiracy against public health.

And, of course, the policies they describe as “best buys” for reducing alcohol-related harm are whole-population policies designed to reduce overall consumption through minimum unit pricing, tax rises and bans on advertising and promotions.

Contrast this with the pragmatic approach taken at Walsall NHS Trust. It recognised a disproportionate amount of time and NHS resources were being spent on a small number of “frequent flyers” – people with alcohol problems who turned up at A&E for treatment multiple times. They identified a cohort of just ten patients who were admitted 499 times between them in six months. On average, each patient was admitted twice a week.

Walsall NHS Trust identified 38 frequent flyers whose needs were complex and varied – alcoholism, mental health, family breakdown – and by taking a joined-up approach it was able to achieve a 54% drop in alcohol-related A&E admissions and a 68% reduction in bed days. Overall the trust saved more than £250,000.

Daniel Hodgkiss, patient safety manager at Walsall NHS Trust, said: “We identified a small number of hospital patients with complex needs that were discharged only to return multiple times, which accounted for a very disproportionate number of admissions.

“This was due to a lack of cohesion between social care, mental health services, police and a range of other services. By bringing these agencies together to co-ordinate patient care, we were able to substantially reduce admissions.”

This is the kind of pragmatic approach to alcohol-harm reduction we need to see. An approach that recognises the locus of alcohol-related harms lies with a minority of drinkers, the heaviest drinking 4%, who are people with complex needs and for whom drinking is a symptom as much as a cause of their problems. Why aren’t the AHA, Alcohol Concern and Alcohol Focus Scotland championing this approach instead of throwing their dummies out of the pram because PHE has, for once, adopted a sensible, partnership approach with the industry?