So that just about wraps up our Friday night live. Key conclusions: 1. drink is a problem 24/7 in hospitals, not just in the evenings, 2. for every teenager with a sprained wrist and hiccups there’s a serious recidivist who is on first-name terms with all the triage nurses, and 3. Britain may have its problem drinkers, but it has many great people trying to help them, from the staff in A&E departments to the street volunteers who try to protect people from themselves.
Right, I’m off for a stiff drink. Cheers.
Just as we leave the assessment area a sixth patient, so drunk he is barely conscious, is brought in by ambulance. Ambulance staff brief reception – “he’s a student” – as another talks to the patient. “Hello, do you know where you are?” He starts to vomit and a struggle ensues to keep him in recovery position. “Open your eyes and let us turn you around so you don’t choke.”
“They take more time from us than other patients and they can be less sick,” said Catherine Chipande.
The 19-year-old who was admitted before him and is semi-conscious has wet himself and the staff have had to cut off his clothing.
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It’s getting busy at the ATC, the alcohol treatment centre in Cardiff. Another student arrives – this one wheeled in with a street pastor – and accompanied by a bunch of friends. Water and rest is prescribed. She is sat in the waiting room. A middle-aged woman is brought in by police officers. She failed to make it to a toilet and needs cleaning up as well as sobering up. Hours to go on the shift at the ATC here but nothing from the staff but patience, kindness and good humour.
Back in Stoke, there are 99 patients in A&E at 2am, which is an achievement for the staff, the first time numbers have dropped below 100 since 4.30pm yesterday. Patients are being discharged, or waiting to be admitted to other departments as beds there become available. Though some staff are beginning to end their shifts, many others are here until the morning. More than 100 people have come through the doors already since midnight; some who have overindulged tonight are on trollies in the corridor making emotional phone calls. There is more work to do before the night is over for A&E staff - five more ambulances are on their way...
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It is gearing up to be a big night in Leicester. Three thousand people, mostly students, are expected to head to the O2 nightclub to celebrate the end of university exams.
Some may end their night at A&E, but one young woman is heading there before her night has even begun.
A 21-year-old student who has, according to the friends who escort her to the ambulance, drunk a lot at the pre-drinks before the party, has slammed her finger in a door, detaching it partially.
“Well you’ve had a lot to drink, so that will have dulled the pain,” says Constable Joe Couchman.
Jane Squire, the paramedic working with Couchman in Leicester’s two-person “Polamb”, bandages the finger as the girl apologises profusely. “I’m so sorry, I’m so sorry” over and over until Squire has to tell her firmly to stop. Then the woman vomits on the floor of the ambulance. “I’m so sorry,” the girl begins again.
“You’re alright,” Squire says as she begins mopping the floor. “I’m alright with vomit, it’s poo I can’t cope with. I had man poo himself while I was treating him. I don’t like that.”
Squire and Couchman take the woman to the hospital where patients line the corridors in chairs, on beds and stretchers waiting to be seen.
The woman can barely walk, she is so drunk and so Squire puts her in a wheelchair. She is seen quite quickly because Squire gets the woman into the minor injury ward, though the prognosis is bad. It looks like the tip of the finger has died and unless they can get blood flow to the area, it will have to be amputated.
“She’s going to be devastated,” says Couchman.
“I’m just glad we weren’t there when they told her. I hope they wait until she’s sober,” says Squire.
Two more alcohol admissions in Southampton in the space of 10 minutes, one so inebriated he is semi-conscious.
“The worry here is that the alcohol might mask a head injury,” says nurse Sam Carter. “So we do a set of neuro obs [observations] and lactate assessment to see if he is dehydrated. We might also resort to pain stimuli, squeeze his trapezium really hard to check his responses,” she adds. Ouch
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More breathtaking intoxication in Manchester...
An 18-year-old student is found lying alone, and clearly drunk, on the pavement close to the university. There were a series of sexual assaults on women in this area last year so passers-by are worried and dial 999.
She has not been assaulted but has simply drunk too much at a house party. An ambulance crew arrives and takes her to the alcohol treatment centre – ATC. She is sick on the way and sick several times at the ATC.
At the ATC she is assessed and given water. Ceri Martin, a sister, and Charlotte Pritchard, a healthcare support worker tend to her. She is joined by a friend at the ATC and they sit together, slumped in a corner, waiting for her to recover.
“She’ll be here for two or three hours while she gets herself together,” said Martin. “We’ll get her to drink water, observe her and keep her warm. Then we’ll make sure she gets home safely.
“I’m just glad that there’s a place like this for young women like that. She’s in a safe place and we’re helping keep pressure off A&E.”
A street pastor radios in to say she is bringing someone in to the ATC. “So it begins,” says Pritchard. It still could be a long night/morning here.
But it’s not always a thankless task, as this note at the ATC indicates:
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Dr Ben Arnold, a SHO in emergency medicine, loves a Friday night in the minor injuries section.
“I like drunk people when they are not so unwell, you can joke with them. Their friends have brought them in because they’re worried about them, but from a medical point of view, they’re healthy, you can have a chat. There’s a common theme which colours the excuses made by revellers as they come round in A&E.
“They say their drink has been spiked, their friends say ‘they always drink this much, it must be something in the drink.’ But it obviously is because they have had more than unusual or haven’t eaten enough.
“It’s younger ones, 18 year olds, who are more honest about it. They do get very embarrassed especially if they have had a loss of continence. And they have to go home in a hospital gown.”
Sometimes, it’s not just the patients causing Arnold all the bother. “It’s friends and relatives who might be a bit drunk. They get bored, they dress up in the gloves and gowns, mucking about and you have to go and remind them that a hospital is a serious place.”
Outside Deansgate Locks, a popular party spot with several bars and clubs, it’s not quite kicking out time but we’re already seeing a couple of early casualties. A drunk girl has fallen, cut her knee badly. She’s crying on the phone to her parents while being treated by the Street Angels. Another job saved from paramedics.
Another offering from GuardianWitness:
Hannah, an ED sister working in Derbyshire has told us that though young people are drinking less, there are more incidents of legal highs:
https://witness.theguardian.com/assignment/56a0c6d0e4b077e685c5faf8/1893549
She adds: “Several times a week, sometimes more, we see young people (adolescents) who have taken legal highs. Some night we may see 3 or 4 within a few hours. I do think it’s a rapidly growing problem. Young people can easily get their hands on these substances and are unaware of the dangers of these drugs which we as a medical profession know very little about. Just because they are not illegal does not make them safe.”
Students at Keele university have been celebrating the end of January exams and two of the youngsters are slumped in A&E brought in by local first aiders. One has been sick over two other waiting patients, another catatonic on a trolley. Two of eight the beds in resus - the most critical ward - are occupied by drunk revellers.
“I do feel sorry for the ones who come in on their own,” receptionist Debbie Hammond said. “One girl was brought in by first aiders and I shouted to them to cover her up, she had everything out and you have to give them some decency. I had to come down and cover her with a sheet.”
If things heat up too much, the receptionists have buzzer to press get help fast. “Fire, a fight, a collapse, if it’s something serious, everyone comes running,” she said.
All calm in the assessment area in Southampton until now when a very aggressive drunk man is admitted with a cut to his face, swearing at anyone in sight. He is being held down by two policemen. We are advised not to go near him. “Fuck off,” he shouts to a female ambulance crew member accompanying him.
The man is refusing to co-operate as he is placed in a bay next to an elderly lady, beaming with a grateful smile towards the two nurses attending to her.
It takes a while for experienced staff to calm down the 29 year old. Then it’s all sweetness and light, with a friendly hello for staff as he is wheeled in to “majors” for further assessment.
“Sometimes it’s like that but sometimes they don’t calm down at all and they get carried out in handcuffs. If it gets too bad and they have been assessed and they are not too bad they are just taken away by police,” said receptionist Sarah Jones.
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Two Mikes, 23 and 32, a Carl, 18 and a Tom, 23, are sat in a pub in the small hours. None has ever ended up in A&E, though Tom’s “ended up in the drunk and disorderly, you know, the police.” He got tangled up in the theft of a plastic ornament and jostled a plain clothes police officer leaping from a Vauxhall Corsa, five years ago. “This is my time,” he says triumphantly, “to get my story out. If I’d known he were a copper, things would have gone very differently. I was at my auntie’s 40th!”
Mike the younger said, “things happen when you’re drunk. I hit my cousin in the face on my 20th birthday.”
“The bottom line,” said Mike the older, “is that if you’re trouble, trouble will find you.” “Yes,” said the younger Mike resoundingly. “My cousin went to Krazy House…” “Is that with a C or a K?” “How can you ask that?” (they all shake their heads). “And the next thing you know, he’s had his nose broken.” “Is this the same cousin you punched in the face?” “I gave him a black eye. Someone else broke his nose. There’s levels. I know this, I studied law at A level.”
The older Mike takes control. “This is a beautiful place. This isn’t a degenerate place. Independent bars, independent clubs, independent eateries. The transformation of Liverpool, the systemic regeneration of every part of this city, is almost beyond compare. I love this city and the people of this city.”
“We always say it’s a thankless job,” says Rachel Goddard, one of three generations of Goddards in the Manchester Street Angels along with her mum and grandma. We’re preparing to go back out for the second - busier - half of the shift. “Sometimes we come out and it’s really quiet but we know we’re making a difference.”
She adds: “You’ve only got three seconds to make that connection otherwise they don’t want to know.”
One of the biggest perils facing intoxicated young women now is lads who will curb crawl in hire cars, the volunteers say. “They rev their engines to try get the attention of these girls. It’s always the same type of people.”
“If there was an incident, we’re connected to the control rooms and the venues - so if there’s any trouble they ring through and say can the Manchester Street Angels come through,” explains Nikki Breen, a 29-year-old Street Angel volunteer. “We can also get the cameras put on people - last week someone was quite erratic, we think he had mental health problems – it was for his safety and ours as well.”
Huge queues outside the clubs and pubs on Greyfriars Road in Cardiff. The students are enjoying the start of the weekend after exams.
It’s going to get even busier tomorrow (Sunday). An event called Refreshers Rumble: Zoo is being organised. Revellers pay a flat fee to get into three clubs - Glam, Pryzm & Tiger Tiger. They are being encouraged to dress as jungle animals and embark on a “unique safari experience, Cardiff style.”
That spells potential trouble and the police has asked the ATC - alcohol treatment centre - to open up.
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A night out in Southampton has turned into a night in A&E for one young woman who has just been admitted with a head injury. “She had been at a party and fell and hit her head. There was alcohol and drugs,” said nurse Catherine Chipande.
There are about 20 other patients in the “majors” area with two sleeping off their alcohol and a third about to be assessed.
Alcohol: key points
Just to reiterate that tonight’s reporting is not a one-off exercise in preachy moralising but just part of a four-week series on the NHS in all its glorious complexities. Today we’ve been looking at the impact of alcohol on accident and emergency departments, including:
- An exclusive report on how problem drinkers provide the lion’s share of revenue for booze companies
- A hugely watchable film on Britain’s dangerous love affair with alcohol
- A dispatch from Northumberland on the new-style emergency hospital that could be the future of the NHS
- A slew of sobering statistics on Britain and booze
Next week, we’ll be training our attention on other aspects of healthcare such as mental health and obesity.
Before we go on, a quick late-night quiz question:
Right, let’s get back out to the medics and the masses
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A sad post from our GuardianWitness callout to readers
Older drinkers
My brother had been an alcoholic all my life - I am 45. Somehow, he has reached 65. He has had two strokes, resulting in left-sided weakness, tremors, cellulitis and many other ailments. It doesn't stop him drinking and smoking. We are talking a bottle of rum a day. Two days ago, my brother was persuaded by social worker, community nurse and I to go into a rehab bed, having refused any interventions since his last hospital admission in late August '15. Even as we were waiting for the ambulance, he asked the social worker to pass him his bottle of rum, and he was glugging it from the bottle. It is not just young drinkers causing the problems within the NHS. He has had at least 25 hospital admissions in the last 3 years. The NHS gets him to a certain state, and then he discharges himself against medical advice and the process starts again. He has trashed our childhood home. It is devastating to watch someone enact this slow, sorry suicide. I am sat in a hotel room, worried that the hospital will phone to say he is discharging himself again. This is his last chance.... But then he has no-one other than his other brother and I. Could and should we turn our backs on him??
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It’s choc-a-bloc at Royal Stoke A&E at midnight, but senior sister Nicola Beckett is actually trying to find a patient. One man, a regular alcohol abuser, has run off from hospital, and she has to send police to find him, because he is now deemed a vulnerable adult as he has not had full medical check ups.
The hospital now has so many regular attendees they have a special group for them all, which flags up if someone has been in more than three times a month. Sometimes Beckett sees someone twice a day.
“You do get friendly with them, they are as nice to you as you are to them. You do see them decline, the physical decline. You admit them to rehab but you just know you’ll see them again. It’s an addiction, an illness. So many, you are discharging them and they say ‘I’ve got no home to go to.’ You sometimes do get a sense they are here for a hot meal and a bed and a kind face.”
Beckett has seen some terrifying moments too. “I don’t want to make it too dramatic. But yes, I have feared for my life. You are trained in conflict management, self-defence. But if someone is drunk and aggressive, I can’t handle that myself.”
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“She was a bit intoxicated, visibly so, just wanted to go home, but she didn’t have a credit card, so we called her a taxi. She’s going home for tea, toast and biscuits.”
“We’re a very respectable bar,” said White Goodman, 26, the security guard outside Santa Chupitos.
“You can see how cosmopolitan it is,” a passer-by says.
Two guys approach and are respectfully turned away. They didn’t look drunk to me, but maybe I haven’t got my eye in.
“No, we’re an over-21 bar now,” Goodman explains. It’s a bit early in the night to be turning away drunks, but when they are turned away, Goodman says, “they’re turned away everywhere. It’s not if they’re violent or not violent, things turn when people are drunk. They won’t be getting in anywhere.”
I don’t want to say it in this company, and of course, it’s early days yet… but it looks a little bit like Continental cafe society.
One patient has a can of Skol under the trolley...
Patients are queuing on beds in the corridor at the ambulance triage in Stoke where paramedic Tracy Proud is liaising with A&E staff to speed up the transfer of people.
“It’s ridiculous,” she said, looking over her shoulder at the queue of beds behind her. One patient has a can of Skol under the trolley.
“I think if you went through most of the patients, 85% shouldn’t be here. People have a different view about what an emergency is. If I’m called to look after a teenager or young person who is drunk, I call their parents straight away. Parents don’t realise it, but it’s not our job to just be watching a drunk person who has passed out.”
Agitated patients have lashed out in the back of moving ambulance. “I had one patient who I thought was asleep and he came to, and he turned on me. I had to jump out the side door of the van.”
Legal highs are a terrifying new problem, on top of alcohol. “They don’t know what they’ve taken. And they are totally off their heads.”
On top of the added burden of inebriated patients, consultants and junior doctors working in the resuscitation area are also dealing with patients who are critically ill with sudden or pre-existing conditions. The medics have just restarted the heart of Kyle Baker, a local South African, who has a condition which can lead to irregular heartbeats. He started feeling the telltale symptoms around 5pm and called an ambulance an hour ago.
“I live near the hospital in case I need to come in. This happens all the time,” he said. “They do such an amazing job.”
Consultant Ruth Kinston is coaching her fifth year medical student as the team sedate Baker, preparing to stop and restart his heart back to its regular rhythm with a defibrillator. He is woozy as he comes around after the shocks, asking for his mobile phone almost straight away, but will be well enough to go home tonight.
Drunken patients can cost the NHS in ways you may not expect. Doctors have to be sure the symptoms are not other medical issues, especially if a patient cannot communicate. If Kinston orders a CT scan for a patient, it may well be just alcohol causing the problem with memory loss or headaches, but medics have to be sure. And that can cost hundreds of pounds. “We didn’t come into medicine to judge people, we came in to treat people. If I start to lose my empathy, we shouldn’t be doing this job,” she said.
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On some nights the Polamb - police-ambulance alcohol treatment vehicle in Leicester - is a hub for treating people with alcohol-related injuries, attending up to 15 incidents in a night. It gets to the point that some of the locals recognise the Polamb and the paramedics who drive it. Jane Squire, East Midlands Ambulance Service paramedic, says one man she used to see regularly in the streets, a heavy drinker who would often call the ambulance for help, called her his “green angel”, for the dark green of the ambulance service uniform.
“Sometimes they’ll come up have a conversation with you and say ‘I’ve cut my finger, can I have a plaster?’” says Squire. “Other times they’ll come up and say, ‘I’ve hurt my hand, can you take me to hospital?’ and I’ll say: ‘It says ambulance, not taxi.’”
But the first call-out the Polamb has received now that the policeman for the evening, Constable Joe Couchman, is on board is more serious - treating a man in his 40s who suffered a cardiac arrest on the street. This isn’t a typical call-out for the Polamb, not being alcohol-related, though it is believed the man was a heavy drinker, but they go where the need arises.
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Street Angels on the move...
A hundred or so yards back from the Brink is Leaf, “Like us, only with alcohol,” the manager of the Brink told me, as he pulled down his shutters. It isn’t dissimilar in wholesomeness - Lebanese style butter bean stew on the menu, an illuminated wall saying “Where there’s tea, there’s hope.” Mellow tables of twos and fours talk to one another equably. The main difference is that the lighting is much more flattering, and nobody is desperate to go home.
Becky, 44, has lived in Liverpool all her life, and says, “It’s always been exactly the same. There are three generations of us here (she’s with her two daughters and her aunt), “nobody’s threatened, everybody’s relaxed.” “Every holiday I’ve been on,” says Molly, 18, “there’s been more trouble than I’ve ever seen in Liverpool. I’ve been in Amsterdam and there’s been a kick-off in a coffee shop.” “Trouble,” says Jan, 59, the above-named aunt, “is only there for people who go out and look for it.”
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As in Edinburgh, the street pastors are also out and about in Cardiff.
They carry bottled water, flip-flops, emergency blankets, power-banks to charge up phones of people who have run out of charge, plastic gloves to protect themselves against infection.
“We are a visible presence on the street,” said team leader Tristan French, a hotel worker by day. “We help people who are vulnerable.” They help ease pressure on A&E by taking those who are so drunk that they need medical attention to the ATC - alcohol treatment centre. If they can they walk them to the centre, if not they have wheelchairs stashed around the city centre and can push them there. They are linked into the police and ambulance so can call for help from them if needed.
Meanwhile, the ATC - alcohol treatment centre in Cardiff – has treated its first patient. A 30-year-old reveller had gone flying on the dance floor and ended up in a heap. She blamed a slippy dance floor. John, the ambulance paramedic, thought it might have had more to do with Jägerbombs.
She is taken to the ATC where the staff establish she has a broken wrist. It means she will have to go to hospital – but straight to the X-ray department rather than into A&E – a good example of how this scheme takes the pressure off emergency rooms.
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At Greenside parish church on Royal Terrace, in the centre of Edinburgh, the city’s Street Pastors are preparing for the night with tea, home baking and a rousing hymn or two.
Street Pastors is an initiative of the Ascension Trust and was pioneered in London in 2013. It is now active in 270 towns and cities across the UK.
Street Pastors are volunteers from local churches who patrol in teams of men and women, usually from 10 p.m. to 4 a.m. on a Friday and Saturday night, to care for, listen to and help people who out on the streets, whether celebrating on a hen night or homeless.
Two teams are going to Grassmarket and another to George Street, with backpacks containing flasks of hot drinks and biscuits.
As team leader Tony Clapham explains, some of these volunteers have been working on the night time streets and have built up strong relationships with local homeless people, as well as police and paramedics and other concerned with health and safety of the night time economy.
The Street Pastor’s secret weapon is the flip flop, which are famously doled out free to wearers of high heels that are no longer functional, safe or comfortable.
They also prevent those worse for wear deciding to walk home in bare feet and risking accidents with broken glass.
Tony says the snapping of shoe straps tends to be an issue later in the night but a stock have been packed just in case.
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The view from the professionals
We’ve had some heartbreaking responses from professionals about the people they routinely come across. The general message seems to be that doctors and nurses try not to judge those with alcohol problems who repeatedly end up in hospital, but sometimes find it hard not to be moved by this tragedy.
Susi Harris, a West Yorkshire GP, said that two young people particularly unsettled her.
He simply didn’t heed the warnings about his liver; he would turn yellow, be admitted, detoxified and discharged again and again for a year and a half until finally on one admission he died. He was a good-looking guy; his girlfriend and family deserted him because they were so angry that he chose alcohol over them, so he died alone.
She was the life and soul of the clinic; she was like a ray of sunshine whenever she walked in. She was so chatty and sociable, knew everyone’s names, and was afraid of no one. She had migrated on to alcohol from heroin, and saw this as real progress, she kept stopping to prove she could do it, and that was her undoing. She got Wernicke’s encephalopathy from recurrent detoxification which caused memory problems, confusion and a severe tremor, which meant she lost the ability to care for herself and had to go into a nursing home. I heard a year or two later she died there.
Others are less patient. Beverley Bostock, a nurse practitioner in Gloucestershire has a novel suggestion.
I’m appalled by the amount of time and resources spent by the NHS treating people who get drunk. New army recruits spend much time preparing for active service without necessarily engaging in it. Why can’t incapacitated drunks be assessed and treated by trained army personnel on the streets or in mobile units? This takes the pressure off paramedics and healthcare professionals in A&E and gets army personnel actively and visibly serving their communities, teaching them how to manage people who are incapacitated through alcohol and/or drugs, how to contain situations where aggression may be a problem and how to defuse volatile situations. It is not the role of the NHS to babysit people who don’t know when they’ve had enough. We should also charge people who abuse the NHS in this way – and by charge I mean financially, legally or both.
Don’t forget: we’d like to hear from you too. Do you work in an A&E department or the ambulance service? Have you or people you know had to call go to because of the effect of alcohol? Tell us what your night’s like tonight. Just click on the blue button to share your your stories and photos - or get in touch.
Up and down the country there are units and voluntary organisations that aim to keep people out of A&E.
The Alcohol Treatment Centre in Cardiff looks after around 1,000 people a year who are suffering the effects of alcohol or have sustained minor wounds. The idea is to keep them safe – and out of the A&E department at the University Hospital of Wales.
There’s a senior nurse, sister and healthcare support worker here. A police officer and two ambulance crews are also based at the ATC. They’ve just started shift and will carry on to around 4am, though they can be stuck here until 7am.
They are referred people not just from the city centre (via pub and club door staff, ambulance, street pastors and police) but from neighbouring villages and towns. They can treat people who have drunk too much with saline drips. They can also close wounds and treat fractures.
Thirty nine people were treated here on New Year’s Eve – that’s 39 that kept out of A&E.
Senior nurse Wayne Parsons said they had to deal with challenging – and often vulnerable – patients. “There are some who play up. But you can’t judge them. We are there to help.”
One of the trickiest jobs is spotting patients who come in looking drunk – but end up being diabetic or having a hidden head injury.
Parsons has just looked on his screen to check the number of people waiting in A&E up the road at the University Hospital – there are already 36 there, par for the course at this time of night.
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Manchester’s Street Angels, a group of eight volunteers, have just had a briefing from Inspector Phil Spurgeon in the city tonight. Dubbed Operation Custodian, the volunteers are shown mugshots of two individuals wanted by police - we can say no more - and pictures of cars suspected to be involved in drug dealing.
“99.9% of people out tonight are decent people,” Spurgeon tells the volunteers. “Our job is to look after them. 0.1% are not very nice but we still have to look after them and get them home properly.” As uniformed officers file out of the city centre office, next door to the town hall in Albert Square, one says they have already dealt with a group of seven men fighting tonight, one reportedly unconscious. The night is still young, however.
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What concerns Tonia Donnelly, emergency medicine consultant who also has an interest in vulnerable children are young parents who get so inebriated they can’t cope with their children on a Saturday morning.
“People don’t do this on purpose. People don’t set out to get drunk and end up in emergency departments. It’s about risk assessment. We want people to be safe and safeguard themselves against finding themselves in a vulnerable position collapsed on a street,” said Donnelly.
I didn’t realise until Donnelly pointed it out that a bottle of wine, which many can easily consume of an evening, is 10 units of alcohol. That’s just four short of the amount advised for women in a full week.
“One unit of wine is 125ml which is like a sherry glass full. A normal wine glass that you might buy in Sainsbury’s and you drink at home can be 250ml easily,” says Donnelly.
It’s kicking out time in the dry bar.
“Time, ladies and gentlemen,” Ian’s yelling across the braying ferment. “I don’t care that you only just bought it, neck it.”
Actually, he said nothing of the sort. It’s all rather genteel. The Frontline Church just left. “Come back and see the Community Spirit food bank next time,” Robbie, 27, calls on his way out. Emma, 41, is hoovering. All the chairs are on the tables except for mine.
There will be no A&E traffic generated here.
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And before we go back out to the nation at large, herewith a sneak preview of tomorrow’s front page, leading on the aforementioned article about how the booze industry cashes in on problem drinkers. With lots more from our #thisistheNHS series inside. Oh, and a story about Charlotte Rampling, too, by the looks of things.
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Here’s a nuggety little fact to throw into the debate about tax, alcohol, health, the treasury and the NHS: two thirds of the price of spirits goes straight to the government in tax. Too much? Not enough?
"We detox them for a week and they leave - and return to drinking"
“I’m going to get political about this now,” laughs Dr Stephen Hitchin, surveying the majors section of A&E. The emergency doctor became a councillor at Chesterfield borough council, Tony Benn’s old seat, because of his frustration with how patients are driven into A&E by failing social care, including for alcoholics. He has already treated two inebriated patients, one vomiting blood, another with pancreatic damage.
“I went into politics because I felt like I wanted to help people more. Which sounds silly because I’m a doctor. You see people coming back to A&E because of alcohol constantly and they are not getting proper care in the community. It costs three times as much to treat them here.
“They come here, we detox them for a week in hospital but the support isn’t there for them when they leave, there’s nothing to occupy them, no employment and they return to drinking, and the cycle goes on. It’s a huge strain on the NHS, and the whole system is being set up to fail because of these social care cuts. I think people need to know that.”
One hour into the night shift at University Hospital Southampton, and two of the 15 patients in the “majors” treatment area are here because of alcohol.
The first, a man in his 30s, was found collapsed in the street. The second, another man in his 30s was “just drunk” says staff nurse Catherine Chipande, but appeared to be having an epileptic fit. She assessed him and thinks he was just pretending because she talked to him during his shaking episode and “he just sat up” and listened.
She was the first to see them in the assessment area. They will be further assessed by a doctor because of the risk they may have a head injury.
Consultant Diana Hulbert says there are four types of alcohol-related patients typically in A&E.
The first is the drunk who falls over on the street and a passer by calls 999.
“It’s sensible because the worry is always a head injury and the symptoms can be the same – drowsiness.”
The second group are those that fall over and break an ankle or a wrist while the third is the worst, the boy racers who end up in a road traffic collision.
There’s lots of bravado fuelled by alcohol: “Quite often they are young men and a passenger may not have their seat belt on. They are a tricky group.”
The last type presenting at A&E are those mixing drinks and drugs and overdosing. Some of these will be sadly familiar to hospital staff.
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Staff nurse Clair Graham has learned exactly the right moment to duck when an aggressive drunk patient might swing. “You learn it over time, obviously you get trained as well. But they can’t help it, they don’t know what they’re doing, they don’t know if you’re trying to help them.”
Drunks aren’t always aggressive.
“We have giggles too, we have a laugh sometimes with the girls, I know I go like that,” she said. Weekends are still the busiest time, but drunks can now come in any time of the night or day, all week long, which never used to be the case, she said. “You can’t predict it, Friday and Saturday are still bad but it can happen any time.”
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They’re playing The Drugs Don’t Work in The Brink, but the music doesn’t generally have a temperance theme. Sophie, 22, has been working here for three months, on a Work programme placement. “I love it here,” she says. “The people are really lovely. It’s not busy tonight, it’s really busy for football matches and that. Lots of guys in recovery who would have watched the game in the pub. You really get to know people.” She does over 30 hours a week as a volunteer, which is the condition of her receiving jobseekers allowance. I’ll just leave that there. Now isn’t the time for my thoughts on the Work Programme.
Along a table on the back wall sit ten younglings; they could be the students that Ian Wilson described earlier: “It’s got quite trendy, not to drink. Freshers are much more likely to come in here than people in their 30s”. But these are no students.
“Why’re you here, then?”
“There’s no exciting reason, I’m afraid,” said Mark, 28. “There’s no recovering alcoholics.”
“Mmm… but you’re in a bar, that doesn’t serve alcohol.”
“I don’t know why we chose it,” Sam, 27, reiterates mildly, smiling. “Ruth, do you know?’
Finally, they put me out of my misery. They’re from the Frontline Church.
“I think a lot of people drink because of isolation,” said Mark, “If you could build good communities, you wouldn’t need it.”
“But there’s a lot of judgment, people saying ‘no, no, no, no, no,’ there has to be a ‘yes’ to go to”, Sam adds. “Whether it’s faith or meaning or just meeting another person’s need.”
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The view from Manchester
Manchester paramedic Dan Smith has been talking to me about what a typical Friday night here looks like. The key surprise - it’s not all about closing time and pubs turning people out. The pressure on the emergency services goes on all night.
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Interesting that some of our sources talk about young people and drink. It’s my impression that the younger generation DOESN’T drink as much as their forebears. Data bears that out: this may be the only UK alcohol graphic that actually goes down...
And in an attempt to keep things in perspective and deflect accusations below the line of being “sanctimonious” “self-righteous” and a bit of a party pooper, let’s set a bit of international context. Yes, the UK has a problem. But it is by no means as soaked as some of its continental peers.
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Dr Anthony Taylor was born in the Royal Stoke. As a medical student, he worked with the consultant who delivered him. “He didn’t like me reminding him of that,” he laughed.
Now he’s the senior doctor overseeing the accident and emergency department at Royal Stoke. Stoke A&E is already busy tonight - 113 people in, and possibly the same number again expected by midnight. The department currently has a fairly large overflow - which means beds in corridors - of around 14 people. Many of the patients are also waiting in the ambulatory medicine queue - people who need attention but don’t need to lie in a bed.
Alcohol just makes everything worse, says Taylor.
“If someone is whacked on the head and passing in and out of consciousness, that could be because of alcohol or the head injury,” he says. “And then you have to assume it’s the injury and then we may have to over treat the injury.”
The department had what it calls frequent flyers, one of the patients in the ambulance queues is on his 155th visit to the A&E and he is only 39 years old. “He’s not the most frequent by any means. The guidelines state that 200mg of alcohol in your blood leaves you unconscious, 300mg should be fatal. We’ve had patients with 500mg in their blood.”
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The emergency department at University Hospital Southampton already has a busy air with nurses, paramedics, consultants and a few police busy around the “majors” treatment area during handover between shifts.
Emergency consultant Diana Hulbert, who is in charge tonight, explains that not all alcohol-related attendances happen after a night on the town.
“A classic one is people waking up the next day and finding their wrist turned the wrong way,” says Hulbert. So people are just as likely to present on the morning after.
She doesn’t judge people who turn up in the department because of alcohol-related injuries or accidents, but says over the past 20 years she had noticed changes that are concerning.
“People drink differently. Spirits is more a young person’s drink and they can make people profoundly drunk very quickly. A beer is two units and you can’t drink that many, maybe 10 pints. But if you’re drinking shots, you can down five in five minutes. That’s what young people do.”
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"I like the drunks..."
Tonight I’m out on the streets of Leicester with Jane Squire of the East Midlands ambulance service. Squires has been with the service for 16 years, the last nine as a paramedic.
Tonight her shift will be divided into two halves, for the first half, Squires will be responding to 999 calls around the city. At 10pm, she will be joined by a police officer and her ambulance will become the Polamb, a police-ambulance combo, that specifically responds to alcohol-related incidents in the city centre. They will be based in the city centre and aim to treat people on the scene as incidents arise, the police officer is there to offer protection to Squires, who will be treating people who are quite drunk and occasionally violent.
The Polamb has been running in Leicester for the last four years as a way of reducing the number of alcohol-related cases presenting to the hospital, which Squires says tonight is “absolutely heaving”.
“I like the drunks. Some people don’t like doing Polamb, because they don’t like the drunks. But I do, because they’re vulnerable and they’re someone’s daughter, someone’s son,” says Squires.
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On a train, all the physical rules of the drinker’s universe - the time of the yardarm, what mixes with what, critically, how much you should drink before you stop - are suspended.
At 7:21pm, the train pulled into Liverpool Lime Street. A man with his trousers at rapper-height but his pants dragged somewhere invisible punched the door opener button determinedly, on the wrong side of the train. Only the miracle of modern engineering saved him from tumbling onto the tracks. Maybe rules exist for a reason.
Five minutes from the station is the Brink, the most successful dry bar in the country, owned by Action on Addiction (patron: the Duchess of Cambridge, and there is a pretty wee portrait of her, perched above the coffee machine and the juice ingredients). “Some people have been in to have a look from Scotland,” said Ian Wilson, 53, the supervisor, “but they’ve never made a success of it. He started working here when it first opened five years ago. “It was fate, really. I’d just been through treatment [for alcoholism], and I had that dilemma. All I knew was the bar and catering industry. But I couldn’t have done it.”
David, 42, works in construction as was having a coffee and a fizzy water on his way back to the West of Ireland, gamely ploughing through an article about an antique restoration business. “I’m a recovering alcoholic, ten years. For me, it doesn’t make any difference being around alcohol or not. To be very honest, there’s a big difference between being around drink and being around drunk people. It was only years after my recovery that I went to a wedding and realised that only one person at the whole thing was drunk. Whereas before that, I thought that everybody was.”
“I don’t think this place is like a pub,” he continued. “Not at all. I think it’s a good facility for people who want to meet people. You talk to younger people in recovery, and they say that in a drinking culture, it’s very difficult to meet someone.”
At a table across the room, Sarah, 38, and Felix, are holding hands; it could plausibly be a beautiful, dry romance. “No, we didn’t know. We just walked in. We were quite disappointed, actually.” They are visiting from Berlin, where the classic English drinker has a terrible reputation, “especially the young guys, they don’t have the best behaviour and they don’t know their limits.”
“There’s nothing wrong with drink,” David said. “If there was a problem with drink, everyone would be a drunk. The problem is humans. I felt the emptiness before I drank, and when I drank, I didn’t feel it.”
On Friday nights, bouncers at the Cat House and the Garage – two of Glasgow’s longest-established and most popular nightclubs – use the community safety radio band to keep in touch with the nearest police control centre, to warn officers about brewing incidents or individuals they have concerns about on the street.
Club owner Brian Fulton explains how involvement in Glasgow Community Safety’s Best Bar None scheme has produced a best practice guide that is now “recognised across the trade and has really benefited the whole of the city centre”. This ranges from offering easy access to drinking water in bars and clubs to improved CCTV coverage outside them.
“For our managers, it’s a competition now: what can they do to make things better?” So tonight, for example, door stewards will be particularly scrupulous if a woman is leaving on her own, ensuring she’s sober enough to get home safely, and letting her use the in-house phone to call a taxi if necessary. Likewise, if a woman who seems the worse for wear is leaving in a couple, stewards will check that she knows her partners and is comfortable leaving with her.
It may demand a level of interpersonal skill absent from the bouncers of my Glasgow youth, but it’s evidence of a change in attitude to women’s drinking safety right across the city.
Elsewhere, the Allison Arms is perhaps not – landlady Babs Steele is first to admit – the truest representation of Friday night drinking in Glasgow. Then again, much of this is down to Steele herself – landlady here for nearly three years and a three times gold award winner in the Best Bar None Scotland, which rewards contributions to reducing binge drinking and antisocial behaviour.
Various corners of the Allison Arms double up as ‘stay safe zones’, offering complimentary bottles of water as well as condom packs: this is also the only pub in Glasgow registered as a NHS free condom distributor. On boards above the bar, drinkers are encouraged to downloads taxi apps to ensure a safe ride home, while behind the bar personal alarms and alcohol breath test kits are sold on a not for profit basis.
“I also drum it into my staff that we have a responsibility to look after vulnerable people,” says Steele. “You get people in here who don’t know if it’s New Year or New York”.
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And here’s what Cardiff police will be contending with tonight
Anyone up for a prink?
The pressure on hospitals in Wales caused by alcohol is huge. According to the devolved government, almost 1,200 people are admitted to hospital with alcohol-related conditions in Wales every week. Approximately 1,500 deaths are attributable to alcohol each year (1 in 20 of all deaths).
At the busiest times, as many as 70% of attendances at some A&E departments are as a result of excessive alcohol consumption.
The potential for problem drinking in Cardiff city centre in particularly acute. More than 3m come into the centre of the Welsh capital in a typical month. The majority of the partying takes place within a square mile and there is no shortage of choice of watering hole – there are 300 licensed premises.
“Pre-loading” - drinking at home or at a friend’s before hitting the streets late in the evening – is seen as a particular problem for the emergency services.
Little wonder health chiefs and other emergency services have taken innovative measures to tackle problem drinking. One such project is the Cardiff ATC – alcohol treatment centre, a collaboration between Cardiff and Vale University health board, local councils, South Wales police, the Welsh ambulance service and Cardiff Street Pastors.
Right now, the police are preparing for the evening with a “Cardiff After Dark” meeting in the Welsh capital’s main police station.
Sgt Gavin Howard briefs his team on what they’re doing tonight, with a slideshow with some interesting facts and figures. Last month, there were 145 people treated at the ATC – the alcohol treatment centre run by the local health board and others, which is designed to ease pressure on hospital A&E staff by treating people with minor injuries and people suffering from too much drink.
Owen reminds officers to look out for revellers who “pre-load” - drink heavily and cheaply at home before heading into the city centre (the groovy alternative word the kids are using is “prink” - pre-drink.
The emphasis here is that this is very much a team effort – police, NHS staff, volunteer street pastors, council workers operating together. “We’re Team Cardiff,” says Howard. The “Cardiff model” is being looked at by cities not just in the UK but across the world.
All important meal-break times and overtime are also discussed.
Then it all goes a bit Hill Street Blues (you may have to be a certain age – anyone remember the “Let’s be careful out there” warning before cops were sent on to the streets of a never-named US city. Here’s a link. https://www.youtube.com/watch?v=Jmg86CRBBtw
Sgt Howard’s version is: “Everyone have a safe night, kit up and get out there.”
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We’ll head out to hear from some of our correspondents in just two minutes, but before we do, it’s been pointed out that we’re a bit absent in the north-east tonight. Apologies. Not everything works out in this business. But to make up for it, Sarah Boseley has been finding out more about the impact on hospitals in the region.
The headline figure is this: as many as two in seven visits to A&E in north-east England are alcohol related. Read that in conjunction with this piece which reveals rising numbers of patients being turned away from A&E.
Of course, it’s not just the north-east. Every two minutes, someone somewhere goes to A&E because of something they’ve drunk.
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Now part of the drink problem is of course down to the industry, which sells about £45bn worth of alcohol in Britain every year. Sarah Boseley has an exclusive story tonight which establishes that problem drinkers make up the lion’s share of the market for drinks companies, a controversial point given that the industry insists it supports responsible drinking.
What this graphic shows is that the 20% of people considered harmful or risky drinkers account for almost two-thirds of the booze market.
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Now if there’s not much on television, watch this instead: a really compelling short film about alcohol and us. Two things really stand out here: that nine million of us drink more than we should (according to government guidelines)...
....and that it is not just problem drinkers who damage their health. As one of the contributors says, if alcohol was a new drug seeking approval today, it would not get a look in.
As I said earlier, our team is in half a dozen cities up and down the country. This map shows where they are. Twitter accounts are as follows: Scotland @libby_brooks; Liverpool @zoesqwilliams; Manchester @joshhalliday; Stoke @jessicaelgot; Leicester @mskatelyons; Cardiff @stevenmorris20; Southampton @lisaocarroll. And I’m @markriceoxley69 in London.
If you are out and about and have any tips on incidents, do get in touch in the comments below.
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Friday night live
Good evening. Welcome to a rather experimental attempt to cover an entire nation’s Friday night out. I’m here for the next six hours with a team of seven Guardian reporters who have fanned out across the UK to find out how Britons like to let their hair down - and the damage they can cause when they do.
The Guardian is currently embarking on a major piece of reporting about the state of the NHS, its pressures and successes and the people who work in it. You can read more about it here http://www.theguardian.com/society/series/this-is-the-nhs. In the first week we’ve been in hospitals, GPs surgeries, maternity wards and out with the paramedics. Today we’ve been looking at A&E and in the conversations we’ve had our reporters heard time and again the impact that alcohol has on admissions.
Every year more than a million people end up in hospital because of booze. That means that up and down the country tonight several hundred people will turn up in A and E the worse for wear. Perhaps that’s not surprising when one considers that by my calculations as many as 5 million pints will be drunk this evening. Other alarming facts about Britain and booze are poured into this single article by my colleagues George Arnett and Delphine Robineau. Sobering stuff.
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