Should Drinkers Pay For Their Treatment?


Should Drinkers Pay For Their Treatment?

Once again the issue of drinkers paying for their treatment has reared its ugly head. This time it is Manchester City Council who are considering the radical proposals. The article in the Express online on the 27th March 2012 highlights the level of the problem for Greater Manchester NHS and taxpayers in general. According to the article, alcohol related admissions are costing £400m a year. Nationwide these figures rise to £2.7bn if we accept the advice of the Royal College of Physicians and NHS Confederation who raised their concerns in a BBC item in January 2010. In both news reports those interviewed expressed grave concerns over the levels and trends in alcohol abuse and its growing burden on the NHS. Glynn Evans of Manchester City Council said:

“We have to start being imaginative – alcohol is a cancer in our communities. If you spend any time at A&E over the weekend, you’ll find 80 per cent of people are there because of alcohol. “If you drink irresponsibly you should pay the price. Perhaps the best way to get people to change their behaviour is to hit them in the pocket.”

Professor Ian Gilmore, president of the Royal College of Physicians, said:

“The nation’s growing addiction to alcohol is putting an immense strain on health services, especially in hospitals, costing the NHS over £2.7 billion each year.” And this sum has doubled in under five years. “This burden is no longer sustainable,”

But, critics of Manchester Council’s proposals include the TaxPayers’ Alliance. Their representative Matthew Elliott responded:

“Taxpayers already pay huge sums for the NHS, they shouldn’t face hidden charges.”

Is There Any Merit To These Proposals?

As one would expect there is always a knee jerk reaction to any radical policy proposals. The main objections, as per a variety of internet based commenters on previous similar articles, reveal some familiar themes.

  • I am an ex-smoker and I paid £70.00 a week in tax for my cigarettes as well as tax and national insurance and tax on petrol so I have contributed more than my share towards the cost of the treatment for the illnesses caused by my smoking.
  • Where will it end? Will they be charging someone who falls off a roof while adjusting his aerial?
  • What about overweight people – will they have to pay too?

In my opinion these arguments are missing the point. Firstly, no tax or duty is ring-fenced for a particular area of spending, and to the best of my knowledge, the duty on tobacco is not ring-fenced for the NHS. It is therefore, impossible to claim that every penny she spent on cigarettes has been sitting in a “health insurance fund” in readiness for the onset of her smoking related diseases. Secondly, without knowing how much she paid in duty over her life as a smoker and comparing it to the cost of her ongoing treatment there is no way to confirm that this assertion is true on a fiscal basis. Thirdly, this is missing the point of taxes. They are levied with the purpose of redistributing the funds raised throughout the wide range of public services in order to meet the needs of every citizen. The average tax-payer probably receives far more in public services than they pay for each year. Furthermore, if we all stopped paying for services we didn’t use then the budget deficit we are currently experiencing would be even worse than it is now.

It seems to me that these critics are throwing the baby out with the bath water. Whilst billing injured drunks for their A&E treatment on a Saturday might not be practical there may be some validity in discussing the underlying principles in more depth. No-one is expecting people to pay for their healthcare when it is an illness that was not caused by them directly or through their poor decision making. But is it right that those who knowingly and deliberately choose a lifestyle that is dangerous to their health should receive all their treatment at the taxpayers’ expense? Are they not using the NHS as an insurance policy. This would equally apply to smokers and yes………sharp intake of breath……………the obese! Am I picking on these groups of society unfairly? No, I don’t believe I am. And before you start throwing brickbats and rotten tomatoes in my direction, let us add another dimension to this discussion. How many times are we being told that pensioners who have worked hard, lived a sensible and healthy lifestyle and accrued savings as well as property must rightly pay for the care they receive in their old age, because the burden on the taxpayer is too much due to a growing elderly population. If we accept our smoker’s viewpoint then surely these people have already paid their fair share in taxes!

How Much Do These Lifestyle Caused Diseases Cost The NHS?

  • Tobacco- £5bn per annum as of 2009
  • Alcohol – £2.7bn per annum as of 2010 and growing
  • Obesity – £4.2bn per annum as of 2011 (expected to rise to £50bn by 2050 if nothing is done)

That means approximately £12bn is being spent directly by the NHS on these illnesses every year. To put this into perspective it would pay for somewhere in the region of 2181 new primary schools. This is particularly poignant when you consider that we will need the equivalent of 2000 new primary schools in the next few years to fill the shortfall in places needed.

What Is The Solution?

There are several schools of thought on this. The first is, that at the very least, when it comes to the unacceptable and growing numbers of drunk and disorderly people needing support on a Friday and Saturday night the pubs and nightclubs should bear some of the costs of treatment. One suggestion is that they should pay for the extra paramedics required. Although the nightclub industry objects to this, the idea does have its merits. After all, it is illegal to serve alcohol to someone who is intoxicated and these people could not become drunk and incapable if the licensed premises abided by the law and refused to serve them. A second option is to use the drunk and disorderly laws already in place more fully and fine the guilty parties £150 through the magistrate’s courts. With regard to the problems of obesity related conditions it would be more difficult if not impossible to prove a direct causal link between patient and “enabler” although it might be reasonable to consider ring-fencing a proportion of tobacco duty revenue for the NHS budget.

The report on alcohol I referred to at the beginning of my piece suggests a broader approach. The report’s authors believe that more out of hospital provision is needed which would include GPs screening and counselling their patients on alcohol misuse. They say that trials show that brief advice from a GP or practice nurse leads to 12.5% of people reducing their drinking to within sensible levels. They claim that this is more effective than it is with smoking cessation, where only 5% change their behaviour.

I would propose that we go even further. We must first accept that many people who binge drink every weekend have an alcohol problem. In this respect they are addicts just like smokers and other substance abusers. Additionally, there are many obese people who have an unhealthy relationship with food for a whole host of reasons that cannot be put down to greed. Where people are suffering from the effects of any of these problems we must treat them with respect and understanding and help them uncover the root causes. We need to ascertain whether the issues are physical or psychological. If they are physical and there is a cure then a cure must be provided. If they are psychological or the result of poor lifestyle choices then full counselling support should be offered to help them change their habits. It will then be up to the individual to accept the support and work to overcome their problems. If they make every effort to overcome their addictions or change their behaviour patterns then any associated health care should be provided at no extra cost. If however, they refuse the help and continue to follow their unhealthy and damaging lifestyle then the taxpayer has every right to ask them to make a larger contribution to the costs of their treatment. I know that this sounds harsh but if we are asking the elderly to pay extra for their care when they can’t help getting old why should we treat those who do or can have a choice more leniently?

Whilst we do need to think creatively because of the financial issues these are placing on the NHS the greater burden is the emotional one imposed on the families of those concerned and the wasted lives. Each of the 100,000 deaths through smoking in the UK every year is a human being who can never be replaced. This is not just a ‘let’s punish people’ proposal. I know only too well from first-hand experience the suffering caused by alcohol and tobacco addictions and how it can damage families and wreck lives. My grandfather was both an alcoholic and a smoker and my father died prematurely from lung cancer because of his addiction to cigarettes. My grandfather suffered from the agonies of gangrene and endured the amputation of part of his leg before ending up in a coma, from which he never recovered, a few weeks later. In my father’s case, I watched a vibrant, healthy man waste away in unimaginable, excruciating pain as the disease took an ever greater hold of his helpess body. I cannot do anything to bring either of them back but if thinking the unthinkable and expressing those thoughts helps contribute to a debate that ultimately reduces suffering and improves lives then I make no apologies for this piece.


Another aspect of the issues of alcoholism was brought into sharp focus as I was writing this. We were alerted to a problem with the alarm at our Kip Centre. When we arrived at around 10:30pm we discovered, after a brief tour of the perimeter of the premises, that the fire door was open and an adjacent window had been broken. We called the police who arrived very quickly and they arrested two drunks (a middle aged man and woman) reeking of alcohol who were led from the building in handcuffs. It appears that they were just looking for somewhere to sleep or squat. Their alcoholism had reduced them to taking desperate measures. We have had to pay for a replacement window and who knows how much the arrest and criminal justice process will end up costing the taxpayer. When it comes to the impact of alcoholism on society we are all victims on one level or another.

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