We get the inside track from a serving paramedic… Given that we are now over the festive season but still very much in the grip of the annual winter pressures it was interesting to read the article by the Chief Executive of NHS England regarding drunk tanks (officially Alcohol Intoxication Management Services, Safe Havens or Alcohol Treatment Centres), as well as the associated social media reaction.
Winter is traditionally a time when we see an increase in ambulance call-outs and hospital admissions due to elderly and chronically unwell patients becoming more vulnerable to various infections. The situation at all of our acute hospitals is the worst I have witnessed, especially at the Ulster and Antrim, with handover times (time from entering the hospital with the patient until we can transfer them to the care of the ED team) regularly becoming 3-4 hours with at least one 10 hour handover being reported. Treatment is having to be given in corridors and patients are enduring extended trolley waits prior to admission to hospital wards. I have seen one patient still in the ED at the end of a shift having brought them in at the beginning of the previous shift. We are seeing ED’s shutting their doors to ambulances for hours at a time.
Alcohol-related ED attendances place a huge burden on an already stretched service. We have all seen first-hand the disruption caused by those under the influence of alcohol in our ambulances and ED’s. Finding specific statistics for alcohol-related ED attendance in Northern Ireland is not an easy task but individual trusts report it at 70% for weekends without any reference to a primary source. On investigation this number seems to come from studies in England and not necessarily generalisable to the population here given our different hospitals, licensing laws and care systems. It also refers to the peak that occurs in the early hours of Friday and Saturday mornings and not the weekend as a whole.
It is important to differentiate between the various types of alcohol-related ED attendance, as simply being ‘drunk’ would only account for a minority of cases. We often look after patients experiencing a fall or other accident where alcohol is seen to be a factor but would be much more likely to see attendances as the result of chronic alcohol use, presenting as liver problems, withdrawal, various cancers and mental health problems. Figures available do not always reflect this.
Despite the lack of concrete figures, alcohol is perceived by both ambulance and ED staff, as well as the public, as taking up a large part of our time. The loud, obnoxious drunk with minor or no injuries is the most obvious example, but we encounter these people at all times of the week due to the widespread nature of alcohol dependency throughout our society. There is a noticeable rise in cases in the early hours of Friday and Saturday as people go out socialising but not as bad as most would think. Obviously, some shifts are worse than others but the hordes of drunk young people laying siege to our Emergency Departments every weekend fails to materialise to the extent portrayed in the media, although those that do attend can be problematic and use up more than their fair share of staff time.
Any way of appropriately diverting patients from the ED should be welcomed and those presenting with alcohol-related problems seem to be popular candidates. We have one “drunk tank” in Belfast City Centre that can take pressure off the Royal and Mater ED’s to a certain degree, but the admission criteria is quite narrow. Those with chronic alcoholism or decreased consciousness levels would not be taken there and it is only really for people who have over-indulged. As I have mentioned earlier I do not think that these patients represent as much of a problem as we think, at least at present.
I would also suggest that drunk tanks create their own problems, as alcohol can mask or mimic many serious or life-threatening conditions. Simply thinking a person is drunk can discourage proper assessment and in any case, a full work-up is not possible due to a lack of full facilities in these centres. There is little evidence regarding the effectiveness of these drunk tanks although there is research currently ongoing, however, they have been shown to reduce violence towards ED staff which is to be welcomed. More security in ED’s or dedicated areas within existing departments could prove to be a happy medium.
Young people are natural risk takers, but they shouldn’t be stigmatised and provided with a poorer standard of healthcare due to the moralising of older people who have grew out of this type of behaviour but are still happy to take medications for conditions such as hypertension and high cholesterol that result from a less than healthy lifestyle, all at a cost of many times more to the health service than the young person who gets too drunk and ends up in ED on a single occasion in their life. Very few young people would be repeat attenders after overindulging on a night out.
We need a culture change throughout society rather than punishing young people for not knowing their limits, possibly with fatal consequences. Without a doubt, the biggest problems facing the health service are nothing to do with young people on a weekend night out but are the consequences of chronic alcohol abuse, smoking, poor diet and lack of exercise. All things we seem a lot less eager to address.
Headline-grabbing initiatives such as drunk tanks are allowing us to wrongly scapegoat young people and distract us from examining the real reasons behind the crisis we are currently experiencing in our hospitals. The reduction in acute beds, a growing and ageing population, inability to retain staff, failure to fill existing vacancies and unwillingness to adequately fund social care have rendered the system unsafe and frankly unfit for purpose. Only the professionalism, goodwill and sheer determination shown by staff are keeping it afloat. Let’s get our politicians back to work and make them properly fund and manage our health service to allow us to provide the standard of care we want to give and above all, that which our patients deserve.