At the top of every accident and emergency form at London's St Mary's Hospital, Paddington, London, is a checklist of 10 conditions most likely to be alcoholrelated. These include a fall, collapse, fits, head injury, assault, self-neglect, feeling unwell, non-specific gastro-intestinal complaints, psychiatric problems, cardiac problems and just being a repeat attender.

If the patient falls into any of these categories, doctors carry out the Paddington alcohol test (PAT) - three questions taking less than a minute to complete. They ask:

what is the most the patient will drink in any one day;

if the total units are more than eight for a man (equivalent to four pints of beer) or six for a woman (four small glasses of wine), then how often this happens;

whether the patient feels their attendance is alcohol-related;

If they are drinking a lot, they are asked if they would like to see a health worker and, if they agree, are given an alcohol advice card and appointment for the next clinic.

A standard discharge letter is sent to their GP informing them their patient may have a problem with alcohol abuse.

Robin Touquet, director of A&E services, says: 'This scheme has increased our referrals to the alcohol health workers tenfold. '

But the workers are employed by Brent, Kensington & Chelsea and Westminster Mental Health trust, not the hospital.

When it decided to reduce the service from five to three days a week, follow-up attendance fell from 50 per cent to 33 per cent as people did not bother coming back unless they could do so the next day.