Alcohol and health: is it really wise to go the way of the Tsars?
Dear Sir
We read with interest the item by Kmietowicz (BMJ
2001;322:259 3 February) in which he referred to the recent
report of the Royal College of Physicians, Alcohol – can the
NHS afford it?. The authors of the report advocate the
appointment of an alcohol ‘tsar’ to lead the national
strategy, long awaited in England, its equivalent in
Scotland being the subject of current consultation.
Commitment and support in the form of strategic direction by
government for more positive action in the identification
and management of problem drinkers by members of the health
care professions is to be welcomed. However, we suggest
that it is the responsibility of the professions themselves
to take action to involve all their members in addressing
the serious issue of alcohol misuse.
The Nursing Council on Alcohol has recently been established
to raise awareness within the nursing profession of the
health consequences of harmful alcohol use. It aims to
encourage nurses at all levels and in all aspects of nursing
to contribute to the prevention of alcohol-related health
problems or to the provision of effective care for those who
are experiencing harm. This includes those nurses who work
directly with patients, nurse managers who can influence
local and national policy, as well as those in nurse
education and the regulatory bodies who develop and approve
nursing curricula.
The aims of this new organisation are therefore congruent
with the recommendations of the Royal College of Physicians
report, one of which is to improve the education of doctors,
nurses and other health professionals on alcohol-related
issues. Since its launch in November 2000 the Council has
secured the agreement of the regulatory body for nursing in
Scotland that the nurses’ health promoting role with regard
to alcohol consumption will be require to be evident in
future nursing and midwifery courses. There have also been
opportunities to inform national and a number of local
policy developments both within the NHS and in Occupational
Health Services. Time will tell whether this will be
translated into changes in practice, but there are
encouraging signs already that the concerted efforts of
nurses working at all levels within the professions will
reap benefits.
It is clear that all doctors and nurses, irrespective of the
area in which they work, have a role to play. The Royal
College of Physician’s report suggests that each Trust
should appoint an individual to ensure that the Trust’s
alcohol strategy is implemented, a proposal which we
strongly endorse. However, there is a danger that
appointing one individual to such a post may result in staff
feeling exonerated from addressing the issue themselves.
There is indeed a reluctance by many doctors and nurses to
discuss alcohol consumption in a meaningful way with their
patients. This may reflect a view that their advice will
not be heeded.
Despite this impression, the provision of advice about
sensible drinking to those whose consumption is within
low-risk levels and brief interventions for moderated
drinkers is well within the scope of generalist doctors,
nurses and others, as opposed to specialists whose focus is
working with substance misusing patients. It is known that
25%, i.e. one in four people who are admitted to general
hospitals are drinking in excess of the limits for sensible
drinking; 5% will already have had treatment for a primary
alcohol problem, but the remaining 20%, i.e. one in five,
are at risk of developing alcohol-related problems. In most
brief intervention studies even patients in the control
groups report improvements in health and reductions in
consumption, although to a lesser extent that those who
received an active intervention. Just asking the questions
therefore seems to be sufficient to raise awareness of the
health implications of drinking too much, so surely this is
a health promotion opportunity which our patients cannot
afford us to miss? Each of us has a responsibility to do
so. Such a health promotion initiative needs to develop
from political, educational and clinical strategies if
health care professionals are to screen and administer brief
interventions effectively.
Hazel Watson RN MN PhD, Senior Lecturer, Department of
Nursing and Community Health, Glasgow Caledonian University
Aisha Holloway RN BSc(Hons) PhD, Research Fellow, Division
of Primary Care, Public and Occupational Health, Depart
Competing interests:
No competing interests
03 March 2001
Hazel Watson
Senior Lecturer
Aisha Holloway
Department of Nursing and Community Health, Glasgow Caledonian University
Rapid Response:
Alcohol and health: is it really wise to go the way of the Tsars?
Dear Sir
We read with interest the item by Kmietowicz (BMJ
2001;322:259 3 February) in which he referred to the recent
report of the Royal College of Physicians, Alcohol – can the
NHS afford it?. The authors of the report advocate the
appointment of an alcohol ‘tsar’ to lead the national
strategy, long awaited in England, its equivalent in
Scotland being the subject of current consultation.
Commitment and support in the form of strategic direction by
government for more positive action in the identification
and management of problem drinkers by members of the health
care professions is to be welcomed. However, we suggest
that it is the responsibility of the professions themselves
to take action to involve all their members in addressing
the serious issue of alcohol misuse.
The Nursing Council on Alcohol has recently been established
to raise awareness within the nursing profession of the
health consequences of harmful alcohol use. It aims to
encourage nurses at all levels and in all aspects of nursing
to contribute to the prevention of alcohol-related health
problems or to the provision of effective care for those who
are experiencing harm. This includes those nurses who work
directly with patients, nurse managers who can influence
local and national policy, as well as those in nurse
education and the regulatory bodies who develop and approve
nursing curricula.
The aims of this new organisation are therefore congruent
with the recommendations of the Royal College of Physicians
report, one of which is to improve the education of doctors,
nurses and other health professionals on alcohol-related
issues. Since its launch in November 2000 the Council has
secured the agreement of the regulatory body for nursing in
Scotland that the nurses’ health promoting role with regard
to alcohol consumption will be require to be evident in
future nursing and midwifery courses. There have also been
opportunities to inform national and a number of local
policy developments both within the NHS and in Occupational
Health Services. Time will tell whether this will be
translated into changes in practice, but there are
encouraging signs already that the concerted efforts of
nurses working at all levels within the professions will
reap benefits.
It is clear that all doctors and nurses, irrespective of the
area in which they work, have a role to play. The Royal
College of Physician’s report suggests that each Trust
should appoint an individual to ensure that the Trust’s
alcohol strategy is implemented, a proposal which we
strongly endorse. However, there is a danger that
appointing one individual to such a post may result in staff
feeling exonerated from addressing the issue themselves.
There is indeed a reluctance by many doctors and nurses to
discuss alcohol consumption in a meaningful way with their
patients. This may reflect a view that their advice will
not be heeded.
Despite this impression, the provision of advice about
sensible drinking to those whose consumption is within
low-risk levels and brief interventions for moderated
drinkers is well within the scope of generalist doctors,
nurses and others, as opposed to specialists whose focus is
working with substance misusing patients. It is known that
25%, i.e. one in four people who are admitted to general
hospitals are drinking in excess of the limits for sensible
drinking; 5% will already have had treatment for a primary
alcohol problem, but the remaining 20%, i.e. one in five,
are at risk of developing alcohol-related problems. In most
brief intervention studies even patients in the control
groups report improvements in health and reductions in
consumption, although to a lesser extent that those who
received an active intervention. Just asking the questions
therefore seems to be sufficient to raise awareness of the
health implications of drinking too much, so surely this is
a health promotion opportunity which our patients cannot
afford us to miss? Each of us has a responsibility to do
so. Such a health promotion initiative needs to develop
from political, educational and clinical strategies if
health care professionals are to screen and administer brief
interventions effectively.
Hazel Watson RN MN PhD, Senior Lecturer, Department of
Nursing and Community Health, Glasgow Caledonian University
Aisha Holloway RN BSc(Hons) PhD, Research Fellow, Division
of Primary Care, Public and Occupational Health, Depart
Competing interests: No competing interests