Six reporters in city centres across the country report on one night of British drinking and its impact on the National Health Service
The calm before the storm
Were at 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 capitals main police station.
Sgt Gavin Howard briefs his team on what theyre doing tonight, with a slideshow with some interesting facts and figures. Last month, there were 145 people treated at the ATC, which is designed to ease pressure on hospital A&E staff by treating people with minor injuries and people suffering from too much drink.
Howard reminds officers to look out for revellers who pre-load drink heavily and cheaply at home before heading into the city centre. Pre-loading is seen as a particular problem for the emergency services the kids call it prinking pre-drinking. Steve Morris
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 doesnt 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 persons drink and they can make people profoundly drunk very quickly. A beer is two units and you cant drink that many, maybe 10 pints. But if youre drinking shots, you can down five in five minutes. Thats what young people do. Lisa OCarroll
Keeping people out of A&E
Across the country, teams of people tour the streets treating relatively minor injuries suffered by people out on the town. In Manchester, they are called the Street Angels; Cardiff and other cities have their Street Pastors and, in Leicester, they are the Polamb.
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 local people 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 theyll come up have a conversation with you and say: Ive cut my finger, can I have a plaster? says Squire. Other times theyll come up and say: Ive hurt my hand, can you take me to hospital? and Ill say: It says ambulance, not taxi.
But the first call-out the Polamb has received now that the policeman for the evening, Const Joe Couchman, is on board is more serious treating a man in his 40s who suffered a cardiac arrest on the street. This isnt 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. Kate Lyons
At Greenside parish church on Royal Terrace, in the centre of Edinburgh, the citys 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 10pm to 4am 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 out tonight, one to the 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 homeless people, as well as police and paramedics and other concerned with health and safety of the night time economy. Libby Brooks
One man, a regular alcohol abuser, has run off from hospital, and senior sister Nicola Beckett has to send police to find him, because he is now deemed a vulnerable adult as he has not had full medical checkups.
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 youll see them again. Its an addiction, an illness. So many, you are discharging them and they say: Ive 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 dont 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 cant handle that myself.
Elsewhere, she reported, patients were queuing on beds in the corridor at the ambulance triage. Paramedic Tracy Proud was liaising with A&E staff to speed up the transfer of people.
Its 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% shouldnt be here. People have a different view about what an emergency is. If Im called to look after a teenager or young person who is drunk, I call their parents straight away. Parents dont realise it, but its 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. Jessica Elgot
Josh Halliday speaks with chief Angel, Rachel Goddard.
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 the alcohol and a third about to be assessed.
Two Mikes, 23 and 32, a Carl, 18 and a Tom, 23, are sitting in a pub in the small hours. None has ever ended up in A&E, though Toms 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 Id known he were a copper, things would have gone very differently. I was at my aunties 40th.
Mike the younger said: Things happen when youre drunk. I hit my cousin in the face on my 20th birthday.
The bottom line, said Mike the older, is that if youre 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, hes 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. Theres levels. I know this, I studied law at A level.
The older Mike takes control. This is a beautiful place. This isnt 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. Zoe Williams
The view from the professionals
All has been 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 cooperate 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 its all sweetness and light, with a friendly hello for staff as he is wheeled in to majors for further assessment.
Sometimes its like that but sometimes they dont 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. Lisa OCarroll
Outside Deansgate Locks, a popular party spot with several bars and clubs, its not quite kicking out time but were already seeing a couple of early casualties. A drunk girl has fallen and cut her knee badly. Shes crying on the phone to her parents while being treated by the Street Angels. Another job saved from paramedics. Josh Halliday
Dr Ben Arnold, a senior house office 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 theyre worried about them, but from a medical point of view, theyre healthy, you can have a chat. Theres 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 usual or havent eaten enough.
Its 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, its not just the patients causing Arnold all the bother. Its 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. Jessica Elgot
An 18-year-old student is found lying alone, clearly drunk, on the pavement close to the university. There were a series of sexual assaults on women in this area last year so passersby 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.
Shell be here for two or three hours while she gets herself together, said Martin. Well get her to drink water, observe her and keep her warm. Then well make sure she gets home safely.
Im just glad that theres a place like this for young women like that. Shes in a safe place and were 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 its not always a thankless task, as this note at the ATC indicates:
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. Lisa OCarroll
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. Jessica Elgot