Half-ahrsed

The publication of the alcohol harm reduction strategy for
England last March came more as a relief than a celebration. After
six years of waiting we finally knew what we were dealing with. Or
so we thought. The reality of the strategy is that it has promise
but no promises. Nothing is ruled out, but nothing much is ruled in
either.

Affectionately known as AHRSE, the strategy is enigmatic in the
area of social care. While there is a welcome emphasis on the need
for health service staff to be trained to identify and deal
appropriately with problematic drinkers, there is no parallel
reference to the wide range of social care staff whose caseloads
are complicated by alcohol.

The lack of social care involvement makes the proposed audit of
service needs even more crucial. The disappointment felt by local
specialist services at having to wait another 12 months could be
offset if the audit results in the dovetailing of alcohol treatment
with other forms of care in a way that reflects drinking’s
role in daily problems.

Although work has not yet begun on the audit of services and
needs, the government has taken its first steps towards
alcohol-specific models of care. This should go a long way towards
giving social workers and others the knowledge and responsibility
they might be expected to have, and puts into context some of the
recommendations made by last year’s commission on the future
of alcohol services.

So there is plenty of scope for action, but little impetus in
taking the strategy forward. By contrast, the pillar of the
strategy highlighting the role and responsibilities of the alcohol
industry is getting a great deal of attention. There is a growing
realisation that the government’s confident assertions that
the new regime due to be introduced by the Licensing Act will, at a
stroke, eliminate the scourge of binge drinking and its
after-effects are over-optimistic.

This is matched by an understanding that the alcohol
industry’s actions do not always match its rhetoric when it
comes to cleaning up its act. By far the most vigorous activity in
moving the strategy on occurs in the discussions between government
and industry in pursuit of the “progress” that is to be reviewed
early in the next parliament.

Whatever the private conversations, alcohol is a very public
problem. The current emphasis on binge drinking provides a useful
focus for the debate but it is by no means the whole story. The
hidden harm often seen only by the family and their supporters
needs to be brought into the conversation and those who know most
about it given a leading role.

A few weeks ago Tony Blair asked the alcohol industry to set up
an event at which he could remind it of its responsibilities.
That’s good news, but the industry can only ever be part of
the problem rather than the solution. Tackling the problem has to
involve something more than just a private debate between industry
leaders and ministers. When will the discussions with leaders in
health, social care, probation and local planning happen?

A great deal can be done at a local level. This week Alcohol
Concern launched a toolkit for developing local alcohol strategies.
Part of this process involves building trust, confidence and energy
to tackle problems across local communities and services.

A national strategy surely needs to instil a similar energy and
confidence, as well as direction, into the key players at national
level. After six years that is something we are still waiting
for.