I've worked in ambulances and am sick of seeing people bingeing on alcohol without having to face consequences

David Cameron has called for "innovative solutions" to tackle the problem of alcohol in society. Having been ambulance staff, I have spent a lot of my time picking up people who had been injured or just rendered incapable due to alcohol, which means I am well-placed to talk about the evils of alcohol and certainly wouldn't agree with Nicholas Lezard's comments on the issue.

Dealing with vomit and violence I would take these patients to the local A&E department. Overworked and often understaffed, the nurses there would have to deal with these high-dependency patients, cleaning them up, trying to stop them urinating over the side of the trolley and dodging their flailing fists.

For every quiet drunk slumped in a public place there are three or four similarly intoxicated patients with head injuries, lacerations, or people who have made suicide attempts ? not to mention those who seem to have turned up just because they want to fight with hospital staff.

While this goes on, the staff are trying to look after an older woman who fell and broke her hip, the woman having a miscarriage or the anxious, mentally ill man who all suddenly find themselves in Hogarth's Gin Lane.

The police can't arrest these patients ? strangely, the public get concerned when drunks start choking to death on their own vomit, so custody sergeants won't allow heavily intoxicated people in their cells. Instead, they go to A&E.

The problem is that people drink, and continue to drink, because there are no consequences. I could go out this afternoon, buy a load of alcohol and drink myself into a stupor in a public place. At 10pm, as I finally slump over into someone's front garden, a free ambulance will arrive and take me to hospital where I will be looked after ? I'll have some IV fluids and painkiller that will reduce any hangover I would feel in the morning. If I try to hit the staff, the police won't be called because I never managed to connect and it's "part of the job". I may even be given fresh clothes from a charity hamper. At no point will I have to talk to the police about being drunk and disorderly.

Tomorrow, I can do the same thing again. My friends will hear about the consequence-free night and will be encouraged to do the same. The "innovative solutions" so far mentioned include more police in A&E departments, specialised "Booze bus" ambulances and so called "drunk tanks". Given that the police are overstretched and budgets are being cut, I'd like to know where these extra police will come from to take charge of the drunks in A&E. Given the previously mentioned "choking to death on their own vomit" worry what would the police do with them anyway?

The booze bus and drunk tank ideas, while no doubt welcomed by A&E staff, are just wallpapering over the cracks ? an attempt to make resources go further without actually addressing the root cause of people acting without consequences.

I have two simple proposals ? one economic and one legal. First, the government should increase the tax on privately bought alcohol and slash the tax on pub-bought alcohol. This would create jobs in the service industry, provide a social atmosphere for drinking and allow publicans to stop serving alcohol to the heavily intoxicated. I'd want more enforcement of the civil offence of serving alcohol to someone who is intoxicated.

Second, I propose a drinking licence, something very similar to the driving licence. On your 18th birthday you are given a laminated card that entitles you to drink as much as you like. When at the pub or off-licence buying alcohol you show them your card.

If you find yourself spending time in A&E for being drunk, charged with drunkenly smashing a restaurant window, or punching your girlfriend in the face because you are drunk and she "winds you up" then you get points on your drinking licence.

A point here, a point there, and when you accumulate enough points to prove that you are not adult enough to use a mind-altering substance responsibly then, much like someone who is too dangerous to drive, your drinking licence is taken away.

I don't see this as infringing liberties any more than a driving or firearms licence. Certainly, alcohol kills more people a year than cars and guns put together. Suddenly, there are consequences. The fines from drinking without a licence could go to domestic violence support, to local A&E departments and to alcohol treatment programmes.

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