'Difficult' questions are being asked about the sincerity of the government's oft-quoted commitment to tackling the growing problem of alcohol misuse. Paul Stephenson reports

Whatever has clouded his vision? Five years ago Opposition MP Alan Milburn was quite sure what was wrong with government policy on alcohol misuse. The problem, said the Commons all-party group on the subject, chaired by Mr Milburn, was that no central government strategy existed. Nor does it now.

The 1995 report said it was 'odd' that alcohol misuse - with effects 'no less socially damaging and costly' than those associated with drugs, was treated as 'an inevitable fact of life'.

The government continues to swear commitment to such a strategy, with promises in last year's Saving Lives white paper for a strategy early this year.

In April public health minister Yvette Cooper promised a consultation paper would be out later this year.

But there is no sign of the paper yet, and many working in the field are doubtful that they will see action before the next election.

Last week a conference run by charity Alcohol Concern put Richard Carter, head of the alcohol and drug branch of the Department of Health, on the spot. He admitted that in questioning where the national strategy had got to, the organisation had got government 'bang to rights'.

Mr Carter told the conference that junior minister Gisela Stuart had now taken responsibility for alcohol policy and had a strong personal commitment to ensuring that action was taken, an announcement which came as a surprise to Alcohol Concern, which had not been aware of the minister's new responsibility.

Mr Carter insisted the strategy was on its way, and would be likely to raise 'awareness of problem drinking and binge drinking, and action about the short-term effects of drinking. It will also need to address the long-term effects on health'. It would therefore link up with initiatives on coronary heart disease and cancer.

He added: 'The proof of ministerial commitment is that it is in the NHS plan.'

The extent of the scale of the problem is equally difficult to define. What is clear is that deaths and illness related to alcohol are rising at high speed.

Officially recorded alcohol-related deaths registered by hospitals rose from around 3,000 in 1986 to almost 5,000 in 1997. But Alcohol Concern believes the true number of all deaths connected with alcohol misuse is closer to 33,000 a year.

Director Eric Appleby says:

'Alcohol is just about the only area mentioned in the government's Our Healthier Nation report where there hasn't been any real progress, and it's about time ministers treated alcohol misuse with the seriousness it deserves - not lip service.'

Sandwell health authority director of public health Dr John Middleton told the conference that there were 285 separate actions listed in the NHS plan that should include an alcohol component.

Mr Appleby said that only a central strategy could provide 'some proper co-ordination of the eight departments that deal with alcohol' and that the logical home for a controlling department would be the DoH.

Delegates heard that although there are a number of good local initiatives, many alcohol workers feel they are working in a 'strategic vacuum'. One of the problem areas is accident and emergency departments where up to 80 per cent of admissions at peak times can be alcohol-related.

A survey conducted at the Royal Liverpool University Hospital A&E department found that of nearly 2,000 admissions over a two-month period, 12.4 per cent had an alcohol component to the admission.

Of these cases, 88 per cent of the patients were actually under the influence of alcohol, 21 per cent had a medical condition related to alcohol and 33 per cent had a trauma injury related to alcohol.

The hospital now has a specialist alcohol nurse who works with the patients to assess whether they should be receiving counselling services.

UK Public Health Association chair Geof Rayner told HSJ: 'It is drugs rather than alcohol (for which there are strategies), but we know that alcohol is generally more serious in terms of things such as crime, accidents etc.'

Mr Rayner suggested alcohol was treated as 'the poor relation' when issues like drugs and tobacco were tackled.

Director of public health and health policy at Oxfordshire HA Dr Sian Griffiths told HSJ that although there were a lot of strategies on drugs, 'actually the burden of cost by alcohol is much worse than drugs. It is a really big issue'.

Dr Griffiths suggested policy 'misses the point' with strategies focusing on issues like heart disease that did not tackle alcohol.

But she said national strategy and targets should form part of existing initiatives. 'You could link it in with mental health and have joined-up thinking.'

As far as those dealing with alcohol are concerned, the government is drinking in last-chance saloon.

The cost of drink

Four out of five attendances at A&E during peak times involve alcohol.

Alcohol is associated with 65 per cent of suicide attempts and 76,000 facial injuries each year, and 23 per cent of child neglect calls to a national helpline.

One in 20 people are dependent on alcohol, compared to one in 45 who are hooked on all other forms of legal and illegal drugs, including prescription drugs.

The number of women drinking above medically recommended sensible levels increased by 50 per cent between 1988-98 from 10 per cent to 15 per cent.

37 per cent of men and 23 per cent of women aged 16-24 regularly drink twice the recommended daily limits.

£2.8bn is being lost by British industry each year in terms of alcohol-related sickness, absence, unemployment and premature death.