As Dr Steve Brinksman pointed out , this was just ‘ the tip of an iceberg ’ as there were so many other conditions in which alcohol played a significant factor . While there had been a lot in the press about increased alcohol consumption during COVID , ‘ the vast majority of alcohol-specific deaths are not acute deaths ’ but related to people ’ s drinking patterns in the years running up to the pandemic .

BRUTAL BUDGETS So with the graphs showing a steady increase since 2001 , how had we ended up in this situation – and what could we do to reverse the trend ? Kieran Doherty , head of quality and governance at

Inclusion , believed that alcohol services had been eroded by changes to the way they were funded and commissioned . ‘ Moves to competitive tendering and the brutal reductions in local authority budgets mean that alcohol services have been squeezed to near extinction ,’ he said .

Another factor had been the move to integrated substance misuse services , which had led to a loss of specialism and people , including the nurses , medics , psychologists , counsellors , recovery workers , community support workers and social workers who made up the multi-skilled team . ‘ If we ’ re going to attend to alcohol problems across the system it needs to be working with colleagues in primary care ,’ he said .

Outreach work had suffered and there were only five NHS detoxification units in operation now – a stark reduction in the last 20 years . The Carol Black review , while welcomed , ‘ didn ’ t specifically look at alcohol , which for me pretty much showed where people ’ s priorities were ,’ said Doherty . The alcohol strategy promised for 2019 had not

materialised and he was concerned that the alcohol focus could be ‘ further diluted ’ in the forthcoming national addiction strategy .

The problem with all of this was that ‘ people who are coming into our services now are really quite poorly by the time they get to us ’. The opportunity for early improvement interventions had been lost and staff were increasingly doing end of life care .

Back in the 1980s and ‘ 90s there were alcohol surgeries , residential services , drop-in centres , detoxification services – ‘ all by different providers working together ’. While those days were gone , we needed to ‘ look at how we link into our wider networks ’, he said . Commissioning had to improve , with alcohol services commissioned as part of an integrated care system .

SEPARATE AND SILOED The loss of connection with primary care had led to services becoming ‘ too separate , too siloed ’, agreed Kate Hall , head of operations in the substance misuse division of Greater Manchester Mental Health

' Moves to competitive tendering and the brutal reductions in local authority budgets mean that alcohol services have been squeezed to near extinction '

KIERAN DOHERTY