Study suggests safe alcohol guidance unrealistic

UK government guidelines on how much alcohol it is safe to drink are unrealistic, largely ignored and should be changed to reflect modern drinking habits.

UK government guidelines on how much alcohol it is safe to drink are unrealistic, largely ignored and should be changed to reflect modern drinking habits
Men are currently recommended to drink no more than three or four units a day, and women no more than two or three.

But the study found that the guidelines are largely ignored because most people do not drink every day. Instead they drink heavily at the weekend – in order to get drunk.

Many people taking part in the research also found the idea of alcohol “units” confusing as they measured their intake in pints, bottles and glasses.

The results suggested that people think the recommended quantities of drink are unrealistic, as they don’t recognise that many people are motivated to drink to get drunk.

When participants did regulate their drinking, this was usually down to practical issues such as needing to go to work or having childcare responsibilities, rather than health concerns or due to guidance on safe limits.

Researchers found that participants preferred the current Australian and Canadian guidelines, which include separate advice for regular drinking and for single occasion drinking, which were regarded as more relevant and flexible to occasional drinkers.

Australia recommends drinking no more than four standard sized drinks on one occasion, or two drinks a day.

The study was carried out by researchers from the UK Centre for Tobacco and Alcohol Studies, which includes the universities of Stirling and Sheffield.

They interviewed focus groups in Scotland and the north of England. The results have been published by the Addiction journal.

The chief medical officers in both England and Scotland are looking at new guidelines to be published next year, and the researchers have been feeding their results to them.

Prof Linda Bauld of the University of Stirling’s Institute for Social Marketing told BBC Scotland that the advice on “safe” alcohol limits was helpful, but needed to be revised.

And she said more emphasis should be put on helping people to drink more sensibly rather than simply telling them what they need to do.

Prof Bauld added: “The Scottish government is trying to push forward with pricing measures, for example, we need to look at marketing, we need to look at glass sizes.”

NHS trusts told financial plans unaffordable

Hospitals and health trusts in England have been told by regulators to look again at their financial plans as current ones are “simply unaffordable”.

Hospitals and health trusts in England have been told by regulators to look again at their financial plans as current ones are "simply unaffordable
Monitor has written to the 46 foundation trusts with the biggest deficits “challenging” their plans. It urged money saving measures such as filling only essential staff vacancies.

David Bennett, chief executive of Monitor, said the NHS was facing an almost unprecedented financial challenge this year.

“We are already reviewing and challenging the plans of the 46 foundation trusts with the biggest deficits,” he wrote in a letter to trusts.

NHS trusts are caught between a rock and a hard place. On the one hand they have the number crunchers – like Monitor – demanding they keep a tight control on the finances and on the other they are being asked to ensure standards don’t slip.

This is only likely to get worse. While the NHS has been promised an extra £8bn a year by the end of this Parliament, it is being asked to make £22 billion in efficiency savings to plug the predicted shortfall of £30bn by 2020. That is a monumental task.

Within the health service there is a desire for the £8 billion to be front loaded in November’s government spending review – that is to say they want all or most of it from next year rather than seeing it gradually dripped fed in over the years.

That, so the argument goes, would allow them to get a grip of the deficits and make the changes needed to (hopefully) improve efficiency. The next year or two is crucial for the NHS.

“However, it is clear that this process will not close the funding gap and so we need all providers – even those planning for a surplus this year – to look again at their plans to see what more can be done.”

He urged trusts to leave non-essential vacancies unfilled, and to follow guidelines on safe staffing in a way which was “proportionate and appropriate”.

Rosters should be rigorously managed to deploy staff efficiently across all required shifts, including evenings and weekends, he said.

In May, NHS trusts in England reported a total deficit of £822 million in 2014-15, compared with £115 million the previous year.

A big rise in spending on agency nurses contributed to the deficits.

At the time, Monitor said figures for this financial year were likely to be even worse.

How to have a good death

For more than a decade a system called the Liverpool Care Pathway was used by hospitals and hospices in an effort to give people comfortable, dignified deaths.

For more than a decade a system called the Liverpool Care Pathway was used by hospitals and hospices in an effort to give people comfortable, dignified deaths
Among other things, it involved checklists prompting staff to consider whether invasive procedures and drugs should no longer be given to people in the last stage of life.

But two years ago it was abolished in response to fierce criticism.

An independent report suggested that, on some occasions, the balance had swung too far, from preventing unnecessary treatment to denying some people basic care.

It found some patients on the pathway had been left thirsty and deprived of food and water, while others were given sedative drugs they did not need.

Now the National Institute of Health and Care Excellence (NICE) is re-writing the rules for England. Its draft proposals are wide-ranging. But can new guidance really improve how people die?

Families had described loved ones being put on the Liverpool Care Pathway without their knowledge. Others viewed it as solely a tick-box exercise, that took health care staff away from people’s last needs

But retired palliative care expert Dr Claud Regnard, writing just after the LCP was scrapped, said it was not the pathway itself that was to blame

He suggested the guidance was “made a scapegoat”.

Instead Dr Regnard suggested, bad decision making, insufficient training and poor communication all played a part in the tragic cases.

And as he pointed out lists can be extremely important – asking if people would choose an airline that had no tick boxes to check all safety procedures were in place?

NICE accepts the problems were caused by the poor way the document was implemented – rather than a direct consequence of the pathway itself.

But the question remains, with increasing financial pressures on the NHS and concerns that staff are over-worked, whether these issues can once more get in the way of a dignified death.

Charities and the Royal College of Physicians warn training for healthcare staff must not be skimped.

And some have warned the focus on these caring skills has been displaced as more and more technical knowledge is required of nursing and care staff.

The new proposals make no mention of lists or tick boxes.

And much of the content comes as no surprise – there are calls for basic daily checks to make make sure patients are well hydrated and nourished.

Families might also be encouraged to be more closely involved in care if appropriate and safe – for example helping to give loved ones sips of water.

Throughout clear communication and involving patients and relatives in decisions is paramount.

While focusing on some simple, fundamental areas of care, NICE recognises there is still much we don’t know about the final stages of life – particularly how to predict who is approaching their last few days.

And it suggests some drugs – for example those used to reduce fluid in the chest – might be causing more harm than good.

More research is needed to find out when best to give medicines and when best to withhold them, its experts say.