Should we fine drunks at A & E?

The DUP Health Minister Ed Poots has suggested fining patients who turn up at A&E drunk. Cue meltdown on Nolan…

This is not a recent problem. I recall that in the 80s in Liverpool attacks on staff was a regular occurrence at the weekends. In NI in July and August you’ll see members of loyal orders in varying states of sobriety awaiting treatment, some more patiently than others.

Edwina Curry thought it would act as a disincentive for people who are genuinely ill to even go, and therefore should not be countenanced. Which leaves the original question unaddressed: how to bring some form of relief to medical (who to be fair are working at full stretch throughout the hospital system (we just don’t hear as much about it).

Patricia McKeown called for the resignation if the Minister. But to what end if no one else is articulating an alternative approach?

Your thoughts?

  • Chris Donnelly

    We shouldn’t fine people for simply drinking and ending up drunk.
    However, we most certainly should be robustly defending our frontline health service workers who too often have to put up with disgraceful conduct in A & E, and I personally believe that there should be hefty fines and strong sentences imposed on those guilty of threats or actual violence against staff and others there.
    If we demand better conduct and show that we mean it, then the penny will eventually drop.
    We should also look at the Alcohol Recovery Centre pilot initiative launched in Bristol and see if it merits being rolled out alongside a new, robust approach to supporting A & E staff.

  • chrisjones2

    Having seen the drunks laying around our A&Es how do we get money out of them? Some are just tramps in from the cold who doss down on seats for a sleep. Others are on drugs. Some in their PJs loudly demanding an ambulance to take them home.

    I think ebvery A&E should have stronger security and a clear policy on ejecting these individuals> Harsh yes but at the moment they just tuirn up time after tme

  • babyface finlayson

    Should drunken patients be charged at A&E?
    No, I think it would be safer to just sidle up to them.

  • peepoday

    Take money out of their DLA

  • chrisjones2

    “Patricia McKeown called for the resignation if the Minister”

    ……. well she would do wouldn’t she. That’s the Union’s stock in trade after all. Bit why then is every A&E festooned with posters complaining about violence to staff? No point sounding off if you cant offer even a glimmer of a solution

    To be serious though there are a series of issues here.

    1 the Ambulance callers need to be discouraged by backing up crews who refuse to bring fit and healthy drunks to hospital …and that includes when some o them later collapse because they have effectively drunk themselves to a stupour

    2 the drunks who can afford a taxi to A&E should afford one home. They should be shown the door and not allowed to hang around in the waiting areas

    3 the walk ins show are full should be made to walk out again

    4 The Trust should pay for cops in the key wards at key times. Any disorder or violence should lead to arrest of a quick £100 fixed penalty Regular customers should get a banning order with harder penalties

    All this seems harsh but visit the RVH or Ulster at say 2am on a busy night and you will see what I mean

  • Belfast Barman(ager)

    So we had Jim Wells of the DUP crying against this sort of problem, when their DSD minister, #BlameNelson McCausland currently legislates that on Good Friday of Easter, before 5pm, alcohol can only be purchased from off licences…thereby encouraging solitary trouble drinking. Pubs & bars & nightclubs are the safest places to consume alcohol, we know what to look out for and we know how to help people in need. Yet the DUP campaign against alcohol….the problem is the environment alcohol is consumed in….educate and inform, not legislate and head towards de facto prohibition.

  • Michael Henry

    What- and just fine people out of their pockets who are not on DLA-

  • Tacapall

    Lets all be honest about the problem, on the one hand we have people stuck in the cycle of alcoholism who we recognise as having an addiction an illness, we even give them extra money to help them and now we’re complaining when they turn up at hospital looking help. Theres already warnings about hefty fines and strong sentences plastered all over the A+E departments its more like a police station than a hospital, people get agitated when they feel they are waiting too long and if truth be told some hospital staff are there only for the money, they are indifferent to patients, they couldn’t give two fks what their condition or how long they are waiting. I wouldn’t wish it on anyone to find themselves landed in a hospital bed unable to care for themselves, they’ll quickly find out the hard way that there are very few Florence Nightingales working in our health service. There is an attitude that needs to be looked at but blaming drunks on the poor state of the health service is denying reality, a good hard look is needed at the attitude of some members of their own staff.

  • chrisjones2

    “we’re complaining when they turn up at hospital looking help.”

    Very noble. Biut waht about the child with a high fever or the lady with stomach pains stuck in the 5 hour queue while they wander up and down shouting because they want attention

  • Comrade Stalin

    Calls for the minister to resign for making an off the cuff suggestion that is not even policy, let alone a proposal within his department, amounts to some sort of bizarre ThoughtCrime stuff on the behalf of Patricia McKeown. But this is par for the course on any debate in this country about the health service. Dogma rules the day; meanwhile the service continues to deteriorate.

    I like a wee drink myself and occasionally I drink more than I should. I’ve never ended up in A&E, but I think I’d accept that if I did it would be my fault and my (ir)responsibility. I am not sure how it would be practical to actually charge drunks, but there certainly needs to be a drunk tank where such people can be quickly triaged and if necessary moved to the full A&E if they are in real trouble. This would at least stop them from distressing other patients/sick people and interfering with A&E staff.

    I think alcoholics and other addicts are a related, but separate, issue. They should of course be entitled to free treatment on the health service for their illness, the same as everyone else. What we are talking about is the state of A&E and the people who make things worse than they need to be.

  • Tacapall

    Chris I haven’t seen a drunk yet at the Children’s A+E in the Royal and yes very unfortunate for the old lady but sorting those type of situations like that out is what the security staff are employed for at the royal.

  • Sergiogiorgio

    Nelson’s on holiday this week, so it falls to that other DUP mastermind Eddy Poots to come with the hard hitting, intelligence led strategies, for our public services.

  • derek alister


  • babyface finlayson

    Those stuck in the cycle of alcoholism are usually known to the A&E staff. I would have thought it is the weekend binge drinkers who are the main problem
    It seems unfair to blame the staff for wanting to be paid for their work.
    Why do you put no emphasis on the personal responsibility of the drinker?

  • gunterprien

    Fine people injured by over marching.

  • Tacapall

    Babyface Im not blaming staff for wanting to be paid for work im saying there is a lot of people in those jobs who carry out their responsibilities in a methodical and uncaring manner simply for money. They are not the type of people we expect would want to enter a profession that requires a certain level of compassion and understanding when dealing with sick people.

    The personal responsibility of the drinker comes into effect when s/he sobers up. If someones comes looking aid, regardless what state their in they should be seen by medical staff at the earliest opportunity.

  • Comrade Stalin


    I think you are right. I got a lot of hassle on twitter for saying this. Conclusions quickly get jumped; if you want to penalize irresponsible drinkers that means you must be taking urgent treatment away from alcoholics. At one point I was told that charging a fee to A&E would lead to children dying.

    Jim Wells claimed on the Nolan show that something like 80% of the admissions to A&E on Saturday nights are alcohol-related. I would have thought alcoholics had to deal with an illness every day of the week so clearly the ones attending A&E are mostly binge drinkers.

  • Mister_Joe

    Agree totally. It is not against the law to be drunk but to be drunk and disorderly is against the law. The staff and public need protection and robust action should be taken against those who offend.

  • Croiteir

    Surely there is a wider question be asked, should we be charging people who avail of services through their own stupid actions instead of sheer misfortune, I suppose the problem is where misfortune ends and stupidity begins, but getting fall down drunk is stupid and it is also a crime I think. On another note the drinking culture needs confronted too, 14 year olds in bars drinking, which happens locally, should not be tolerated, being too drunk/drugged to take care of yourself should also be unacceptable.

  • gendjinn

    Record their behaviour and publish it online. If you act like a fool or assault A&E then the public square should know exactly what you are.

    Sunshine is the best disinfectant!

  • gendjinn

    Paging Dr. Freud.

  • babyface finlayson

    I do take tacapall’s point that personal responsibility is secondary at the point of need. Treatment comes first.
    I don’t know if some kind of fine would work or not, I suspect not. Maybe if the individual was given a choice of a fine or a 3 day drink awareness course? I suspect most would opt for the fine.
    I think it harsh to blame hard pressed staff in a job most of us would never want to do. They are paid to care for us and if they do that competently that is all we are entitled to.
    If they care about us that is a bonus.
    The long term solution lies with more resources in our hospitals and somehow changing the binge culture.

  • chrisjones2

    I have at the Ulster. Last time at 2am the place was full of them including one large drunk lady in her PJs who (when not outside smoking) was walking up and down demanding that she be seen first and threatening to complain.

    And at the RVH i have seen well oiled local pissheads and tramps fast asleep on trollies in the public area or stretched across benches of seats – quite literally trollied

  • hugodecat

    Currently we charge people who arrive at A&E following a Traffic accident ( mostly because insurance companies will pay it) We don’t charge if you play Rugby and break something, eat too much cake and have a hear attack, smoke too much ( although smokers pay that much excise duty that they could argue they have more than pre paid) so why should a person who falls over and splits their lip whilst drunk be singled out? many of the problems in A&E are illnesses that may not be directly related to being drunk, many of the drunks are accompanying patients and not the patient themselves? I’m loathe to defend Edwin Poots but all he has done is put a suggestion out there to start a debate…whats needed is a reasoned debate and not a Nolan style oversimplified demonisation of large chunks of society..What is A&E for is where the debate should start and then move on to why are so many resources in A&E devoted to frequent flyers, 7 days a week? solving these questions may help…other UK cities have set up low cost “drunk Tanks” for weekend nights allowing the drunk and incapable somewhere to sleep it off without causing too much trouble : perhaps a more effective way of allocating resources without trying to bill those who are least likely to pay. There is a greater debate to be had about us all taking personal responsibility for out health and stopping the assumption that we can do what we like and the NHS will pick up the pieces.. but that can’t be a debate that focuses only on those who get drunk at the weekends

  • babyface finlayson

    Perhaps a better way to look at it is to address the behaviour regardless of the type of person presenting. So if a Rugby player while sober causes a problem in A&E they incur some kind of penalty in the same way as a weekend drinker coming in and causing bother.
    Exemptions could be agreed for those with chronic alcoholism or mental health problems,for example.

  • hugodecat

    Way to miss the point entirely, the charge is for the drain on resources, not the behaviour in a&e. The implication being if you are drunk, its your own fault, rather like if you play sport its your own fault… The argument then becomes muddied with the behaviour of patients and their entourage .. But the principle for charging is about the cause of the injury and who is deserving of free treatment.. Which is why I and many others have issues with the concept and dont want one group and targeted in an oversimplified argument.

  • babyface finlayson

    The drain on resources is at least in part because of the behaviour of the people presenting.
    I think it is not practical or right to start charging people on the basis of whether they are drunk or not.
    But surely at least part of the reasoning behind that idea is because of the behaviour related to drunkenness. I’m just saying targetting the bad behaviour is a better approach than trying to focus on the reasons behind the behaviour,which implies a judgement (as you say) on who is most deserving