Background Alcohol harm is increasing in the UK. Alcohol harms are socially patterned, with the lowest three socioeconomic deciles carrying the burden of half of the annual 1 million alcohol related admissions in England. Non-specialist healthcare staff can reduce individuals’ risk of harm from alcohol through identification of alcohol use, delivery of brief advice and referral on to Alcohol Care Teams but variation in this service provision is thought to exist. This study aims to identify the perceptions of healthcare staff regarding alcohol care and the barriers and enablers to its safe delivery, in order to inform future service improvements.

Methods Twenty-six semi-structured interviews were carried out with healthcare staff from across eight NHS trusts across North-East and North Cumbria. Participants were purposively sampled from emergency departments, medical and surgical specialties and psychiatry liaison, to provide a heterogenous group and representative geographical spread.

Interviews were conducted and recorded over Microsoft Teams by specialty trainee doctors from the region, who had undertaken a training workshop in qualitative research.

The topic guides included seven sections: [A]Alcohol Training, [B]Conversations with patients about alcohol, [C]Referrals to services, [D]Conversations with families/carers about alcohol, [E]Medical Assisted Alcohol Withdrawal, [F]Trust policy about alcohol related harm [G]Joint working/Partnership arrangements. Interviews were conducted between June 2021 and October 2021. Interviews averaged 33 minutes. Transcripts were analysed using Normalisation Process Theory.

Results Three key themes with sub-themes were found

Theme A:Stigma Lack of visibility of a commitment to alcohol in Trust e.g. no visible alcohol lead

No mandatory training: lack of, skills to manage Alcohol Use Disorder (AUD), and understanding of AUD

AUD seen as personal failing and therefore a personal responsibility

People with AUD perceived as difficult to help

Theme B:A focus on the acute presentation

Need to focus on acute presentation (physical or mental ill health) first

Prevention is not prioritised

Theme C:System level constrictions

Limited time

Little recording or monitoring of screening and brief intervention

Lack of understanding of services outside the hospital

Lack of staff awareness of patient outcomes post-discharge

Conclusion This study identifies a need for system wide support for non-specialist healthcare professionals to access high quality training in alcohol care, for services to adopt robust systems for screening and brief intervention, for better integration of hospital and community services and for healthcare organisations to adopt a strategic approach to alcohol harm reduction across all functions ‘from ward to board’.