When a man in his early 20s, who was an alcohol-dependent heroin user, turned up at hospital with a gastrointestinal bleed, Helene Leslie didn’t think he had long left to live.
Yet three weeks later, Leslie, an alcohol liaison nurse at the Royal Infirmary of Edinburgh, saw him in intensive care and was tasked with trying to get him to give up drinking: “I was surprised that he was alive given how sick he’d been,” she remembers. “I thought I wouldn’t get anywhere, but amazingly, with support, the guy’s really turned his life around and hasn’t drunk for 10 years. People like that keep me going.”
Leslie, 53, who has been an alcohol liaison nurse for 24 years, was one of the very first. But in 2001, the Royal College of Physicians called for there to be an alcohol specialist nurse in every hospital in the UK. What has happened since then, and have they had an impact?
“On the whole, it’s been a success,” says Prof Sir Ian Gilmore, ex- president of the Royal College of Physicians and chair of the Alcohol Health Alliance. “They keep patients out of hospital. There’s good evidence that the nurses are able to send patients home. They can deliver interventions that have been shown to be highly cost-effective.”
Dr Kieran Moriarty, consultant gastroenterologist at Bolton NHS foundation trust and alcohol lead for the British Society of Gastroenterology, did an evidence-based review looking at the impact of specialist alcohol workers. It cited a study at St Mary’s hospital in Paddington, London, which showed that for every two referrals to an alcohol health worker, there was one fewer reattendance to A&E the following year.
Gilmore says that in 2000 there were fewer than 10 alcohol care teams, whereas now the majority of acute hospitals have some sort of service.
Alcohol-related admissions are still rising – more than 1 million were related to alcohol consumption in 2013-14 – despite a fall in per capita consumption in the UK in the past few years. And it’s not just people getting drunk and fighting, says Gilmore. The NHS estimates that about 9% of adult men and 4% of adult women in the UK show signs of alcohol dependence. Alcohol is also a contributing factor in many diseases, including cancers – and the number of people with alcohol-related brain damage is rising.
Amid this pressure, however, cuts are being made to public health budgets responsible for alcohol services. In 2015-16, 46% of local authorities implemented cuts in alcohol services, and this has risen to 72% for 2016-17.
Moriarty is concerned: “A lot of the good is going to be lost. Alcohol nurses can play a major role in prevention and identification of alcohol problems at an early stage.”
Gilmore is keen to emphasise their impact: “A brief intervention – a semi-structured interview of up to 20 minutes by a health worker – is highly effective in changing behaviour even six months down the line.”
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Life-saving alcohol services face devastating cuts
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