27 October 2004
Dr. Henry: I welcome the Minister of State to the House. I am particularly glad that it is Deputy Batt O’Keeffe. When he was Chairman of the Joint Committee on Health and Children, of which I am a member, we spent a great deal of time on the issue. We both take it very seriously, as does everyone in the House.
The Tánaiste and Minister for Health and Children, Deputy Harney, has said that she is making it her priority to address the chaos in accident and emergency units and act to free up acute hospital beds. If she takes this report seriously, she will free up approximately 25% of acute hospital beds and make a significant difference regarding what is happening in accident and emergency departments. The Minister and many Members have already recounted what is going on in such units and what a serious effect on attendance the over-indulgence in alcohol is having.
In my juvenile career, I worked in accident and emergency departments. It was decades ago, and, while we had trouble with people who were drunk, it was nothing like what is happening nowadays. I occasionally visit accident and emergency units to see how they are getting on. I do not go as often as I should as the staff recognise me and give out to me in no uncertain manner about their claim that I am doing little or nothing to get the problem addressed. The problem is extremely serious; as stated in the report, 38% of people under 31 admitted to accident and emergency departments were drunk. They were out of their minds, and 25% of all admissions to hospital involve the abuse of alcohol. The number of beds involved is staggering, never mind the cost.
As Senator Glynn pointed out, it is not simply a matter of the cost to the health service but to the economy. He is of course only too well aware that alcohol is the second most common cause of acute admissions to psychiatric institutions, depression being the only complaint with which patients are more likely to be admitted. I was interested to see the other day that €640 million is spent by the Department of Social and Family Affairs on long-term benefits for people with psychiatric illnesses, including those related to alcohol. At the same time, €500 million is spent on adult psychiatric services, including the upkeep of hospitals. There is something peculiar going on there. We will not even try to achieve a reversal of those figures, which might help to do something in this area.
We have concentrated a great deal on the problem but have not said too much about solutions. Many fellow members of the medical profession say we are not active enough in trying to deal with people whose main problem is obviously alcohol. We wring our hands about the situation but do little to find a solution. The statistics involved are shocking. The situation has been made clear regarding accidents, unintentional injuries and intentional injuries. The latter are important with regard to parasuicides, those brought to hospital with gastrointestinal upsets and those who proceed to more serious conditions such as cirrhosis and pancreatitis. We have also noted how many women are drinking much more, a most unwelcome development. The Minister of State may recall what Dr. Mary Holohan from the Rotunda’s sexual assault unit told the Joint Committee on Health and Children. She stated:
The pattern of ingestion of our clients has changed markedly since the middle of the 1990s. Spirits are being consumed at home before people go out. Younger clients are drinking in mixed sex groups, often in parks and abandoned buildings. While boys continue to drink beer, in the main girls are drinking undiluted spirits. Later, in clubs and bars, the concentration of alcohol in the individual drinks being consumed is very high, often three or four units in a single drink, as the youngsters call it. Also worrying is the fact that the alcohol is mixed with stimulants. The median number of units of alcohol remembered by clients coming to us is eight, but 20% of our clients in the past three years remember ingesting 12 to 22 units of drink.
I will not query how any Member of this House might feel after such drinking, but these figures are unbelievable. Dr. Holohan went on to say that the drug Rohypnol is frequently referred to, with young people saying their drink must have been spiked. She said that the sexual assault unit does toxicology testing on all patients and has never had a positive for Rohypnol. She goes on to say, “However, the toxicology service has remarked to us that the levels of alcohol in the samples we send are only seen in one other service — the coroner’s office”. That is unbelievable and truly shocking. I have seen reports of cases of young girls with blood alcohol levels of 350 mg., a staggering amount when one considers what it must do to people.
Looking at this report one also sees that in the mortality figures for alcohol poisoning the percentage change from 1992 to 2002 has been nearly 100%. Those figures represent people who have died from drink, from acute poisoning, which is quite shocking. All the figures for alcohol-related mortality have risen enormously. The most important figure is for alcohol poisoning. The numbers suffering from chronic alcoholism have increased by over 60%, those from cirrhosis of the liver are up by nearly 80%, drink-related suicides are up nearly 20% and cancer deaths related to alcohol are up by about 10%.
Senator Glynn raised the issue of drinking by young pregnant women, which has serious effects on the foetus. There are suggestions that foetal alcohol syndrome, when the baby is born affected by alcohol to a serious extent, may be associated with attention deficit disorder later on. There may be long-term effects on the child.
We must take all this very seriously. The Minister of State will recall that numerous consultants from accident and emergency units around the country spoke to us about how bad the situation was. Dr. Luke from Cork spoke of the very significant increase in the level of domestic violence as a result of alcohol abuse. Dr. Martin from Galway spoke of the fights outside fast food units. Senators Browne and Glynn noted that those drinking too much late at night do not have access to food. Perhaps we should close down the fast food units before such people arrive because it seems that people will not queue when drunk, and get into the most appalling fights, sometimes killing each other. Some 25% of people brought to hospital accident and emergency units by ambulance following accidents are there because of the abuse of alcohol. How can we get a pre-hospital emergency service running if we are going to have such abuse of the emergency services?
The recommendations made are very important. Moaning and groaning and wringing our hands is no good if we do not implement some of the recommendations. It is suggested on page 40 of the report that we should establish a national screening protocol for early identification of problem alcohol use for all relevant sectors of the health care system. That is very important. We must look at the totality of the situation. I recall people calling to me at 10 a.m. smelling like a Christmas pudding. One would need to talk to such people about what is going on. When it happened a second time I always asked, because while the incident might first have seemed frightening, the people would have got used to me on the second occasion.
The report recommends the establishment of an early intervention programme in primary care to introduce and establish brief intervention as standard practice to reduce high risk and harmful drinking patterns, in other words to get general practitioners involved in discussing alcohol problems with people whom they think have such a problem.
The report also recommends that for those presenting with alcohol-related problems in the emergency room and general hospital, someone should be present to address the issue. A specialist nurse is suggested so that people who are comatose on the ground will come round at some stage. One must remember that some of those comatose people will have head injuries. This is why the unfortunate accident and emergency staff must waste so much of their time taking these people’s blood pressure, checking their eyes and so on. The time consumption is appalling in such situations, so intervention is needed in the emergency room and general hospital for those presenting with alcohol-related problems. We need to address that issue immediately, not just in acute cases, but also in chronic ones. In health clinics, excess alcohol is noted as a contributory factor in presenting conditions. The report notes the connection in this area with emergency contraception, sexually transmitted diseases, parasuicide and mental illness.
The Minister of State may have seen in the newspapers that the Well Woman Clinic has decided to open at the weekends from 12 p.m. to 3 p.m. for emergency contraception when I presume people will have got out of bed and will attend for such contraception. In such cases it is likely that the girl and her partner may have had far more drink than was good for them, so that issue has to be addressed in such clinics and by those dealing with sexually transmitted diseases. The approach must be very broad.
We also need to intervene in the area of those convicted in court of alcohol-related offences involving public order, drink driving, etc. For those under 18, there is the Garda juvenile diversion programme, the Springboard initiative and other community-based interventions. It is also recommended that all third-level colleges provide support services — perhaps brief intervention and counselling for students as outlined in the college alcohol policy framework document.
We should also require that as part of employee health and welfare considerations, there should be procedures in the workplace to address workplace alcohol-related problems. Senator Glynn mentioned absenteeism but there is also the problem of accidents in the workplace, which are frequently alcohol related.
Any initiatives we introduce should be considered on an EU basis. When alcohol abuse advertising campaigns are running it is important that they do so on an all-island basis, with advertisements perhaps being shown on UTV as well as RTE, since one cannot rely on people to watch only the national channel. We must ensure good value for our advertising.
The time for moaning and groaning is over. We must ask the Minister to consider what has been recommended. If she wants to resolve the problems with accident and emergency services and acute beds, the people to whom I refer are not elderly and they will not be transferred to nursing homes. They are young people who will leave hospital and who will be in a position to return home. They are occupying beds which are desperately needed for other people. We must not forget that elective operations are frequently postponed. The first thing the Minister could do to solve the problems with accident and emergency services and improve the position as regards acute beds is to address the recommendations in the report.
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