LONDON, England / The Telegraph / Lifestyle / Health / June 1, 2010
All patients are to be routinely questioned by their doctors about their alcohol consumption under new Government plans to tackle the country's problem drinking culture.
By Rebecca Smith, Medical Editor
GPs are being advised by the official health advisory body to routinely quiz new patients about their drinking when they join a surgery.
Doctors are also being told to ask patients about how much alcohol they consume when medicines are being reviewed and when they are being treated for minor injuries.
The advice over patients and their drinking habits are being issued to doctors as part of the first ever official medical guidelines from the National Institute for Health and Clinical Excellence (Nice) on how to deal with the country's spiralling drink problems.
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One in four people - a total of 10 million - is estimated to be putting their health at risk by drinking more alcohol than the recommended limits.
But it is feared that not enough is being done to identify those at risk and that more opportunities should be taken to ask patients about their alcohol habits.
In the new Nice guidelines, GPs are being advised to ask 10 "alcohol screening" questions - including how much and how frequently they drink - of patients.
Hospital doctors are being told to ask patients who come into accident and emergency departments over whether their injuries might be related to drinking.
Children as young as ten who are thought to be drinking alcohol should also be questioned and offered advice or referred on to social or mental healthcare services, according to Nice.
But patient campaigners questioned whether the new guidelines for doctors were really necessary or would have an effect.
Joyce Robins, co-founder of campaign group Patient Concern, said: "GPs seem to have to ask so many things that there is none left for what you went in about.
"I really don't see the point of them asking about alcohol all the time. If you are drinking too much and are probably ashamed of the fact you are not going to tell your doctor about it are you?
"People are very clever about disguising the fact they are drinking too much."
Others considered it an invasion of privacy.
Alex Deane, Director of Big Brother Watch, said: “This is typical nanny statism from a bullying, increasingly authoritarian organisation. We are entitled to have a drink when we want one. Doctors are there to heal us, and can keep their opinions about lifestyles to themselves unless asked – after all, we pay the tax which pays for the health service.
“A database of smoking or drinking could, in the long run, be used to charge us when we need medical help and may frighten people away from seeing doctors or from being honest with them.”
Professor Eileen Kaner, from the University of Newcastle, who worked on the guidance released today, said drinking had moved from third to second place, after smoking, in terms of its impact on people's health and is the highest cause of premature death among young people.
She said people who are drinking too much are seen twice as often by doctors, A&E and other healthcare professionals, but that opportunities to pick up their habit are too often being missed.
"It should become a common part of medical practice," she said. "But we are not suggesting that they need to be asked at every contact with the health service."
She said research has shown that, as long as the questions are asked alongside others about lifestyle and they are delivered in a non-judgemental way, then patients do not mind.
Prof Ian Gilmore, President of the Royal College of Physicians, welcomed the guidance and screening, and said that traditionally doctors' have been 'woeful' at asking patients about their alcohol consumption.
"We have a long way to go to get to a point where people get fed up with being asked."
He added that he saw the evidence of the problem on his wards every day.
"There are a lot of middle age and old age people who are opening a bottle of wine a night and are not managing to get the cork back in again."
The guidance on preventing harmful drinking also recommended:
* a minimum national price per unit of alcohol
* a possible ban on all alcohol advertising in order to protect children
* reducing how much alcohol travellers are allowed to bring into the country from abroad
* reducing alcohol licensing hours at pubs, clubs and off-licences.
The guidance was drawn up by Nice under its public health programme and calls on the Government, public bodies, the police, local authorities and the health service to act, although it has not direct legal powers to enforce its recommendations.
Prof Mike Kelly, public health director at Nice, said signals from the new coalition Government were 'promising'.
He said: "Alcohol misuse is a major public health concern which kills thousands of people every year and causes a multitude of physical, behavioural and mental health problems.
"It is clear that policy change is the best way to go about transforming the country's unhealthy relationship with alcohol and prevent people from getting to the stage where they are drinking worryingly large amounts."
The Department of Health recommends that women drink no more than two to three units a day and men no more than three to four.
One unit is roughly the equivalent of half a pint of standard strength lager, beer or cider; a pub measure of sprits or a small 125ml glass of wine.
Around one in four people regularly drink above these levels which is considered hazardous to health.
It is estimated that every year 15,000 people die and almost 900,000 others are admitted to hospital with alcohol-related problems at a cost to the NHS of £2 billion. In addition, excessive drinking is blamed for 500,000 crimes, 1.2 million violent incidents and 17 million lost working days.
Last month Sir Terry Leahy said he was in favour of minimum pricing on alcohol and the coalition Government has said it will act to stop alcohol from being sold at below cost.
However, Prof Kelly and Prof Anne Ludbrooke, from the University of Aberdeen, who was on the Nice group, said this was very difficult as there was no definition of what below cost meant.
The group said the evidence on minimum pricing was substantial but they did not recommend what level it should be set at.
Previously it has been suggested that 50 pence per unit would have an effect on those who drink the most without hitting the moderate drinker.
A 50p minimum price would mean a bottle of wine would be at least £4.50, a pint of 4% strength beer would be at least £1.14 and a ten-pack would be around £10. Prof Gilmore said this shows that pubs and restaurants would not be affected.
Studies have shown that alcohol has become 75% more affordable since 1980 as incomes have risen much faster than the price of alcohol.
Gavin Partington, of the Wine and Spirit Trade Association, said: “Sadly, this guidance proposes measures that will not address the root causes of alcohol misuse and will merely punish the majority of British consumers who drink responsibly.
“We need to educate people better and earlier about the risks associated with excessive drinking and we need proper enforcement of laws to address misuse and related anti-social behaviour.”
“Minimum pricing is probably illegal and won’t stop problem drinkers. Advertising is already tightly regulated and banning it would hit the pockets of millions of consumers and threaten the loss of thousands of jobs.
“We all want to tackle alcohol misuse, so let’s focus on those who have the problem not punish everybody.”
Simon Litherland, Managing Director, Diageo GB, which makes beer, wine and spirits, said: “Yet again it is disappointing to see continued support for minimum pricing despite no credible empirical evidence that it would be an effective measure in reducing alcohol related harm.
"Alcohol consumption figures released last week by the NHS show that frequency and level of drinking is in fact highest among higher income groups so blunt measures, such as minimum pricing, will not only unfairly penalise those who drink responsibly – and in particular the poorest in society – but will also do little to influence the drinking habits of the minority who consume most and cause harm to themselves and others."
Health Secretary Andrew Lansley said: "The Government is committed to taking tough action to tackle problem drinking, including the price of problem drinks, stopping supermarkets from selling alcohol below cost price and introducing a tougher licensing regime.
"Regarding NICE's recommendations on minimum pricing for units of alcohol, it is not clear that the research examines specifically the regressive effect on low income families, or proves conclusively that it is the best way to impact price in order to impact demand.
"Supply and price are far from the only factors in driving alcohol misuse. Demand and attitudes are crucial. We need to understand much better the psychology behind why different groups of people drink alcohol in excess.
"The root causes of social problems lie not just in government policies – although 24-hour drinking legislation has severely undermined clinician and police efforts to get to grips with this problem - but in social norms and peer influence."
Previously it has been suggested that 50 pence per unit would have an effect on those who drink the most without hitting the moderate drinker.
A 50p minimum price would mean a bottle of wine would be at least £4.50, a pint of 4% beer would be at least £1.14 and a ten-pack would be around £10. Prof Gilmore said this shows that pubs and restaurants would not be affected.
Other guidance from Nice called for better treatment of people with health complications caused by heavy drinking.
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