Drunk and Disorderly
As this recent article from The Observer shows it's the time of year for recycling old arguments about the disruption caused in accident and emergency departments by drunk and disorderly binge drinkers.
So instead of these circular arguments which are so typical of the NHS, why not trial a different approach in areas where the problem is particularly troublesome, and publish the results?
Arrest drunks who clog up hospital A&E wards, says medical chief
Police urged to adopt zero-tolerance strategy towards binge drinkers as emergency services brace for New Year’s Eve
By Denis Campbell - The Observer
Ambulances arriving at the Accident & Emergency department at Addenbrooke's Hospital in Cambridge. Photograph: David Levene for the Guardian
The leader of Britain’s A&E doctors is urging the police to adopt a “zero-tolerance” strategy towards binge drinking that would see troublesome drunks arrested, charged and given a criminal record. Dr Cliff Mann wants police forces to mount campaigns over several successive weekends against those who are drunk and disorderly to try to reduce the numbers needing help from A&E staff, diverting resources from patients he said were “more deserving”.
Mann, president of the College of Emergency Medicine, told the Observer: “If more people knew that if they got drunk they were going to be arrested, they wouldn’t drink in the first place and then end up in A&E. If more people knew that they were facing the prospect of a prosecution and having to pay a fine, that would be an effective sanction or deterrent to drinking too much.”
He said robust action by police would deter binge drinkers and help combat Britain’s worsening problem of “gratuitous consumption” of alcohol. “There’s far too much acceptance that this is normal for a Friday or Saturday night,” he said. “It’s not normal. It shouldn’t be normal.”
Mann’s call for a crackdown on drinking comes as emergency services prepare for the annual strain on resources caused by revellers at New Year celebrations. The number of arrests for being drunk and disorderly has sharply declined in recent years, as a result of changing police priorities. Metropolitan police figures show that the number of people arrested dropped from 20,096 in 2001 to 5,472 in 2010 – a fall of 73%. Those aged 18 to 25 are most likely to be arrested, followed by 26-to 40-year-olds. Many of those found to be drunk and disorderly are now fined up to £90.
“These days very few people are arrested, despite being incapacitated,” said Mann, who is a senior emergency medicine doctor in Musgrove Park hospital in Taunton. “[Police] tend to try to get people home or to hospital, and then they do it again the next week, because we aren’t really using carrots and sticks to change their behaviour. There are no sanctions on people for being a nuisance and for taking up vital A&E resources as a result of their own alcohol excess. Fines have clearly not worked. They are based on the premise that a small financial penalty temporally distant from the event is a deterrent.”
He said public education campaigns asking drinkers not to consume more than they should were doomed to fail and only tougher tactics, including the introduction of a minimum unit price to ensure people drink less, would have any real effect.
He also voiced concern that disruptive behaviour by drunks and their friends poses a risk to other patients. “A&E staff are fed up of dealing with verbal and physical abuse associated with alcohol intoxication; not just the patients, but their companions. This is a problem that is getting worse. In already stretched departments their behaviour is an unwelcome and potentially dangerous distraction from the care of people who might reasonably be described as more deserving,” said Mann. “Patients who are acutely intoxicated can become abusive, argumentative, obnoxious or physically abusive. The worst are the drunk companions, who are an unnecessary further distraction for doctors and nurses dealing with their mates. They can end up just roaming around... being a nuisance.”
The Police Federation, which represents rank-and-file officers in England and Wales, dismissed Mann’s call as “simplistic” and said the proposals would lead to an unrealistic drain on limited police time. Its chairman, Steve White, said: “Forces up and down the country regularly have campaigns to tackle drunk and disorderly behaviour. Alcohol is well known to be a contributory factor in incidents of disorder but it is a complex issue and a crackdown on ‘troublesome drunks’ is too simplistic an answer.
“Yes, our colleagues in the NHS should not be subject to abuse; nor should our officers or anyone working in the public sector. But hauling people through the courts isn’t always the answer either. That takes valuable time and resources to process, not just for the police, but also as people go through the courts and criminal justice system.”
He added: “Police officers are well-versed in being used as social and health workers, but locking up people isn’t the answer and we are just not able to step into the void where we have before. Campaigns to target disorderly behaviour are welcomed, but I would question whether that would really deal with the heart of the issue long-term.”
Responding to Mann’s comments, crime prevention minister Lynne Featherstone said: “The coalition government is determined to tackle alcohol-fuelled harm, which costs society around £21bn a year. We have improved the tools and powers available to the police and licensing authorities in tackling alcohol-related crime and disorder and I have recently written to local authorities and police and crime commissioners to remind them of these important measures.
“We have given local areas the power to restrict the sale of alcohol in the early hours and to ensure those who profit from a late-night licence help pay towards the costs of policing. We have also introduced a ban on the worst cases of very cheap and harmful alcohol sales.”
Katherine Brown, director of the Institute of Alcohol Studies thinktank, said: “Before addressing individual drinkers it’s important to begin by tackling the problem at the source, making it less easy to access cheap strong drink in supermarkets at all hours. This means minimum pricing and restricted licensing hours. This also means dealing with the issue of serving to drunks, which is against the law but rarely enforced.
“We need to find a way of effectively tackling this issue and de-normalising the antisocial, unhealthy drinking behaviour that has become part and parcel of a night out in Britain.”
Dr Mark Porter, leader of Britain’s doctors, backed Mann’s call for a 50p minimum unit price and called for a total ban on the advertising of alcohol to reduce consumption.
Emily Robinson, director of campaigns at charity Alcohol Concern, said: “Alcohol-related crime and health problems are a burden for all the emergency services. As taxpayers, we’re all paying the price. Our hospitals are straining under the burden, our police forces and ambulance services are stretched to the limits and communities are left picking up the pieces. It’s a serious situation that requires immediate action on the cause of the problem – namely the easy availability of cheap alcohol.”
She also rejected Mann’s “zero tolerance” call. “In the face of a lack of action from [the] government, it’s tempting to find other solutions to reduce the problem, such as ‘booze buses’ touring high streets at weekends picking up intoxicated people. But if we just shift the problem to another part of the emergency services, it will still cost the taxpayer money and won’t get to the heart of the problem.”
Drunk Tanks (1 September 2014)
In recent weeks ideas have been floated in the media about ways of reducing the strain on the NHS.
For example by creating 'drunk tanks' and charging people for the privilege of helping them to sober up in a safe place and for treatment they receive if they turn up, in a drunken state, at their local Accident & Emergency department.
Now this has brought the usual storm of protest from the usual suspects who argue that this is a slippery slope and before you know it the NHS would be charging for all kinds of services, instead of remaining free at the point people need treatment.
Drunken revellers should be treated in just the same way as drug abusers, said one commentator, and it's not the job of the NHS to sit in judgment over the rights and wrongs of how people end up requiring treatment.
Which I agree with in a general sense, but there is a big difference between a drug abuser who is an addict and clearly ill, and the out of control binge drinkers who can be seen every weekend in busy city centres up and down the country.
In the latter case there is nothing wrong with people, other than on a very temporary basis, while they are out of their heads from drinking too much alcohol and they also have money to burn, of course, if their are sitting in pubs and clubs all night before heading out on to the streets and causing general mayhem.
So why shouldn't they pay for the cost of sleeping it off in a 'drunk tank' or getting their self-inflicted injuries bandaged up before they head home, because it might even teach them a valuable lesson.
For example by creating 'drunk tanks' and charging people for the privilege of helping them to sober up in a safe place and for treatment they receive if they turn up, in a drunken state, at their local Accident & Emergency department.
Now this has brought the usual storm of protest from the usual suspects who argue that this is a slippery slope and before you know it the NHS would be charging for all kinds of services, instead of remaining free at the point people need treatment.
Drunken revellers should be treated in just the same way as drug abusers, said one commentator, and it's not the job of the NHS to sit in judgment over the rights and wrongs of how people end up requiring treatment.
Which I agree with in a general sense, but there is a big difference between a drug abuser who is an addict and clearly ill, and the out of control binge drinkers who can be seen every weekend in busy city centres up and down the country.
In the latter case there is nothing wrong with people, other than on a very temporary basis, while they are out of their heads from drinking too much alcohol and they also have money to burn, of course, if their are sitting in pubs and clubs all night before heading out on to the streets and causing general mayhem.
So why shouldn't they pay for the cost of sleeping it off in a 'drunk tank' or getting their self-inflicted injuries bandaged up before they head home, because it might even teach them a valuable lesson.
