Abstract
ABSTRACTAimsWe assessed the relationship between specialist and non-specialist admissions for alcohol withdrawal since the introduction of the UK government Health and Social Care Act in 2012.MethodsUsing publicly available national data sets from 2009 to 2019, we compared the number of alcohol withdrawal admissions and estimated costs in specialist and non-specialist treatment settings.ResultsA significant negative correlation providing strong evidence of an association was observed between the fall in specialist and rise in non-specialist admissions. Significant cost reductions within specialist services were displaced to non-specialist settings.ConclusionsThe shift in demand from specialist to non-specialist alcohol admissions due to policy changes in England should be reversed by specialist workforce investment to improve outcomes. In the meantime, non-specialist services and staff must be resourced and equipped to meet the complex needs of these service users.
Highlights
In England, alcohol-related hospital admissions have risen from 493,760 in 2003/04 to over 1.26m in 2018/19 (Public Health England, 2020)
We examined publicly available data to estimate the potential impact of the HSCA policy changes before and after 2013 in relation to access to specialist and non-specialist inpatient admissions for alcohol withdrawal care
Prevalence estimates of the number of adults with alcohol dependence in potential need of specialist treatment remained static over the assessed period
Summary
In England, alcohol-related hospital admissions have risen from 493,760 in 2003/04 to over 1.26m in 2018/19 (Public Health England, 2020). A disproportionate impact of alcohol on the National Health Service (NHS) is exerted by those with chronic alcohol disorders accessing care via emergency departments (Phillips et al, 2019). Alcohol-related disorders have been estimated to cost the NHS £3.5bn per year (Department of Health, 2013). Effective treatment services should respond to the full spectrum of risks and acute, chronic and complex needs (Babor et al, 2008), with inpatient care treating those at greatest risk of severe presentations by providing medically assisted alcohol withdrawal (National Institute for Health and Care Excellence (NICE), 2010, 2011). Reductions in public health funding in England to commission specialist alcohol treatment since the introduction of the Health and Social Care Act (2012) (HSCA) have been associated with the closure of numerous specialist inpatient units and increasing pressures on acute hospital services (Robertson et al, 2017; HC Deb 2019; Drummond, 2017)
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