Hospital beds needed for coronavirus victims are being blocked by alcoholics depending on the NHS

Alcohol related deaths are at record levels in the UK. Past political decisions which have led to a lack of specialist alcohol treatment proved to be fatal

It’s taken awhile but at last the government has issued guidance to healthcare staff on how to manage people who are dependent on alcohol. This is not a niche group: an estimated 589,000 people are deemed to be dependent in the UK. That guidance is needed as there is a risk that, with all the attention given to Covid-19, this group of people are forgotten.

Arriving anywhere from general practice through to accident and emergency, before the coronavirus outbreak these patients would be seen by staff who were familiar with how to manage someone in alcohol crisis, particularly if going through abrupt withdrawal, which can be fatal. But these are no ordinary times; health staff are being moved into positions that they have little experience or knowledge of to fill gaps created by the emergency.

This lack of staff experience will inevitably be combined with an increase in alcohol related cases, as some people will not be coping with isolation well or will struggle to maintain their usual drinking levels due to loss of income and supply disruption. It’s a significant problem for the NHS.

Public Health England estimates that 5 per cent of acute hospital beds are occupied by people who require treatment for alcohol dependence. This at a time when there is unprecedented pressure on those spaces.

The new guidelines suggest every hospital should appoint an alcohol lead to provide specialist knowledge and practical advice on how to manage this group of patients. This expertise will be required as alcohol dependence is potentially life threatening if not managed correctly. Alcohol related deaths are at record levels in the UK: 7,551 died in 2018, the last year that data is available. Add this to the increased vulnerability to Covid-19 of people with alcohol dependence due to compromised immunity, and it looks like we will see a new record for alcohol related deaths.

Some of these patients will require hospital admission – but many could be managed just as effectively in the community, freeing up thousands of scarce hospital beds. The research evidence suggests that for most people a community managed detoxification is just as effective as a hospital based one. But, of course, you need specialist community services to be in place to offer this alternative.

Years of cuts to specialist community alcohol treatment budgets have unfortunately left services stripped of staff and capacity. In a race to the bottom many of these third sector providers competed in response to service tenders to see who could offer the best value bid, which often meant the cheapest. As a result, addiction psychiatrists are now an endangered species as their skills and experience are too costly for most providers to include in their ‘best value’ bids when they attempt to capture these scarce treatment contracts.

As with other health problems those with means will find the private sector ready and willing to provide support when they need it, compounding inequality as those without money, but in no less need, will be left to whatever their local NHS provider can put in place among the many competing demands they will be presented with.

Finding the new alcohol leads, that PHE suggests should be competent and credible in such a role, will be tough, as the staff pool has all but evaporated. Yet another example of how politics has adversely affected the NHS's ability to free up hospital bed capacity. Individuals with alcohol dependence have every right to expect and be given optimum care, but its difficult to see how this can be done.

Past political decisions which have led to a lack of specialist alcohol treatment proved, and will still prove to be, fatal for some. That’s something that should never be repeated, but I fear we all have short memories.

Ian Hamilton lectures in mental health at the department of health sciences at the University of York