Liver Disease and Liver Cancer: Diagnosis

Tuesday 11th October 2022 Westminster Hall

16:30

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

I beg to move,

That this House has considered the diagnosis of liver disease and liver cancer.

It is a pleasure to serve under your chairmanship, Mr Betts. I am proud to sit as a vice-chair on the all-party parliamentary group on liver disease and liver cancer. I am delighted to have succeeded in securing today’s debate.

While health policy may be devolved in Scotland, I believe that work in this area across our four nations is vital. We can support each other in cutting mortality rates and improving outcomes across the UK. The liver is a remarkable organ. Like something from science fiction, it can regenerate. It is one of the more forgiving pieces of our anatomy. We can make lifestyle changes and treat it a bit better, and it has the capability to heal itself and undo some of the damage we may have caused in the past.

Considering that the liver is one of our most important organs in terms of its function, we probably do not give it the attention it deserves. Some 49% of liver cancer cases in the UK are preventable, and 20% of liver cancer cases in the UK are caused by smoking, according to Cancer Research. There are around 6,200 new liver cancer cases in the UK every year and 5,800 deaths. That is roughly 17 diagnoses a day and 16 deaths. There are five types of liver-affecting cancer, with hepatocellular carcinoma, or HCC, being the most common, accounting for more than three quarters of liver cancer cases globally.

While mortality rates for other cancers have improved over the decades, liver cancer mortality has more than doubled since the ’70s, with only 13% of patients surviving more than five years from diagnosis. Right now, the United Kingdom is facing a liver disease crisis. The number of deaths from the disease have doubled in the last two decades, while other disease outcomes, for example from diabetes or respiratory diseases, have stabilised or even improved. Around 10,000 people die from liver disease and liver cancer each year in the UK. It is the second leading cause of premature mortality in England and Wales after suicide. These statistics come in spite of the fact that 90% of liver disease is preventable.

As a Scottish MP representing a Scottish constituency, this hits even closer to home. Scotland has the highest mortality rate for liver disease in the whole United Kingdom. We also have one of the highest mortality rates for chronic liver disease across central, northern and southern Europe. This health crisis is affecting my constituents, and the statistics are sobering. In 2020, Scotland saw an 11% rise in chronic liver disease deaths on the previous year. It is one of the leading causes of premature deaths, above breast cancer and suicide. Approximately seven in 10 people who died of liver disease were of working age, so under 65. In a country with an average life expectancy at birth of 76.6 years for males and 80.8 years for females, these are premature deaths.

I want to look at why liver disease and cancer outcomes are so poor in Scotland and across the UK and at what work needs doing to address that. Let me start with the why. One of the biggest barriers to effective diagnosis and treatment is the social stigma that continues to cloud how we view patients with liver disease and cancers. It is crucial to acknowledge and understand the part that poverty has to play in the demographic of patients with these conditions. As the UK grapples with the cost of living crisis and a drastic drop in living standards, this is not a contributing factor that can be overlooked or ignored—it will be a huge risk to public health and the lives of those living in our most vulnerable communities—and it would be a catastrophic mistake to do so.

There are over 100 causes of liver disease, but the ones that contribute to the most cases are also factors much more likely to be present in poorer communities: alcohol misuse and obesity. In Scotland, 58% of liver disease deaths are alcohol related. Across the UK, alcohol-related liver disease accounts for 60% of diagnoses. Like most addictions, alcohol abuse is statistically higher in poorer communities and carries a heavy stigma: the resulting harm is seen as self-inflicted. To improve outcomes for alcohol-related liver disease, we need to look at alcohol dependency and the reasons for its prevalence. Most importantly, we need to support patients in making positive lifestyle changes. Access to the right care is paramount, and increasing the availability and quality of support available at a primary care level is essential.

On the impact of obesity, which is also higher in Scotland than the rest of the UK, non-alcohol related fatty liver disease, or NAFLD, is expected to become the leading variation of the disease in the UK within the next decade. Nearly one third of Scottish adults are obese and two thirds are overweight, but the statistics across the UK are similar. Again, obesity is more prevalent in deprived communities; it is seen as a choice. Obese people are seen as greedy or lazy, and societal conditioning teaches us that we do not need to look much closer at the reasons why.

There are many reasons why obesity is on the rise in those communities, including underlying health conditions, eating disorders and a lack of access to high-quality healthy foods. Like alcohol abuse, this challenge needs to be met with increased access to the right support, such as weight management programmes, but by far the most important tool on the road to prevention is early detection. That goes for alcohol-related liver disease, NAFLD or viral hepatitis, autoimmune or genetic-related.

Liver disease is largely asymptomatic in the early stages. Three quarters of patients with cirrhosis are diagnosed only when it has progressed too far for intervention or treatment. Without early detection pathways and investment in treatment, we will continue to see mortality rates rise. The British Liver Trust’s 2021 survey showed massive disparities in access to patient care pathways for early diagnosis in primary care settings region to region. It revealed that just 26% of local health bodies in the UK have effective pathways in place. It is calling for every integrated care system or health board to ensure that there is a named person responsible for liver disease and the identification of high-risk patients, and for all GPs to have the means to assess fibrosis.

CT and MRI scans are a critical tool for diagnosis and informing treatment plans, but this is an area that has been overlooked. The key problems are access to the right equipment and the quality of the equipment available. Some 41% of clinical radiologists state that they do not have the equipment they need to deliver a safe and effective service for patients. Industry surveys show that one in 10 CT scanners and almost a third of MRI scanners are more than a decade old—the age at which the equipment is considered obsolete. That is shocking.

This area of the NHS, like so many others, it is struggling with workforce numbers. The British Liver Trust welcomed the Government’s 15-year workforce strategy earlier this year, and I back its calls for gastroenterology and hepatology to be given due recognition through that process.

In May, I visited the Royal Free Hospital in Hampstead with the hon. Member for Caerphilly (Wayne David), as part of the APPG’s work, and we saw the Sheila Sherlock Liver Centre, a leading centre for liver disease treatment. It is well equipped with excellent, highly skilled staff. I would like every area of the UK to have something similar in place for patients. I met the chief executive, John Connolly, and Dr Thorburn, a consultant hepatologist, along with some of the patients. My conversations with Lucy and Hannah, two young women undergoing treatment at the centre, really brought home the human aspect of the disease. I am grateful to them for taking the time to speak to me about their experiences.

This morning, I received some very disappointing statistics from my local health board, NHS Lanarkshire, which is categorised as “red”, with no effective pathways in place for early detection and disease management. I have reached out to NHS Lanarkshire to request an urgent meeting so I can discuss this and seek assurances on its plans for improvement. The stats for my local board have cemented just how fundamental it is to properly fund detection and treatment of liver disease and liver cancer, and to give the NHS the tools it needs to support our communities.

While NHS Lanarkshire falls under the remit of the Scottish Government, I want to make some requests to the Minister here, too. The all-party parliamentary group on liver disease and liver cancer, along with the British Liver Trust, is calling for a full review of adult liver services by NHS England. I urge the Minister to make that a priority. I hope that I have set out enough reasons to illustrate why that is so essential, and I am sure that other Members will have more to add.

As part of the plans to improve early detection rates, the NHS health check must routinely include assessment for non-alcoholic fatty liver disease, as it looks to become the leading cause of liver disease over the next 10 years. Pathology is also vital, providing the study of disease and informing the development of treatment. I back calls for a new, nationally endorsed pathology pathway. That is another area that desperately needs support with its workforce supply and funding. I hope that the Minister will be able to address her Department’s plan for that support. Overarching all of this is the need for Government commitment and direction to address the disparities in access to care through policymaking and implementation.

Before I finish, I thank several organisations for supplying briefings to inform so much of this speech, and for their ongoing work in this area. I thank The British Liver Trust—particularly Paul, Richard and its chief executive officer, Pam—as well as Cancer Research, the Royal College of Pathologists and the Royal College of Radiologists. I look forward to the Minister’s response; I hope that, through collaboration, we can accelerate progress across the four nations to improve outcomes for patients and for our constituents.

[Mr Clive Betts (in the Chair)]

The wind-ups have to start at about quarter past, so that is six Back Benchers in about an hour. I think you can probably work out the time limits for yourselves in that respect. First of all, from the Government Benches, I call Peter Gibson.

18:42

[Peter Gibson (Darlington) (Con)]

It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) on securing this debate. I also welcome the Minister, my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), to her place. I wish her every success in her new role. I have known her for over 30 years, and I have every confidence that she will be a thoughtful, listening Minister in a Department where she has professional experience and expertise.

Last month, my father should have celebrated his 80th birthday. Instead, his life was cut short by liver and pancreatic cancer. He died at 47—the age I am now—exactly six weeks to the day from being diagnosed. Looking back on the events of his passing in 1990, I would have assumed that things had improved. Advances in screening, treatment and diagnosis surely must have led to a very changed picture. However, in preparing for today’s debate, I have sadly learned that things do not look better. The British Liver Trust reports that there were around 200,000 deaths from liver disease in 1990, and in 2018 that figure had risen to almost 400,000.

In the north, the picture is quite bleak. It has the highest levels of liver disease, the highest admissions and the highest deaths. Liver disease is the second biggest cause of premature mortality and lost working years of life. We have seen a 400% increase in deaths from liver disease over just the last two generations. Liver cancer has seen the second fastest increase in incidence of any cancer in the UK, and the fastest increase in mortality rates over the past decade of any cancer for both men and women. Liver cancer mortality rates have more than doubled since the 1970s. I am reliably informed by the British Liver Trust that, sadly, the mortality rate in Darlington is the worst in the north-east, at 46 deaths per 100,000. Those are the worst results of any constituency in the north-east, which in itself is the worst in the country.

Those figures are not worrying or troubling; they are shocking. That is why I am pleased that we are having this debate. It is essential that the Government focus on tackling the causes of liver disease and cancer, so that we can prevent further families from losing a loved one prematurely.

As we know, liver disease is largely preventable, however symptoms often do not present until the damage is irreversible, making early diagnosis difficult but key to tackling disease. We know that liver disease deaths are higher in more deprived areas and are increased by higher levels of alcohol harm and obesity. When we talk about levelling up—improving our roads and railways, improving our homes and hospitals—we must not forget, and indeed must have a keen focus on, the health mission element of our levelling-up goals: to narrow the gap in healthy life expectancy and increase healthy life expectancy by five years.

The British Liver Trust’s “Make early diagnosis of liver disease routine” campaign in Parliament earlier this year was welcome, as are the Government’s efforts to improve diagnosis times and make testing more readily available. The evidence from this debate, however, is clear: we need to go much further and much faster to have a real impact on the dreadful mortality figures.

As I said at the beginning, I know that the Minister is someone who listens and who will have listened closely to the debate. I know too that, as someone who was born in the north-east, she will share my concerns about those families robbed of their fathers or mothers too early. She will want to do all that she can to reduce those losses in the future. I look forward to her response to the debate.

[Mr Clive Betts (in the Chair)]

Those Members who were listening intently to what I said earlier will have noticed that I tried to extend the debate by a further half hour, although we do have to start the wind-ups at about quarter past. For guidance, that gives about five minutes for each speech.

18:47

[Wayne David (Caerphilly) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Betts.

I congratulate the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) on her excellent contribution. I also thank her for her tremendous commitment to the work of the all-party parliamentary group on liver disease and liver cancer, which is really appreciated.

This is an important debate, and I speak as the chair of the APPG on liver disease and liver cancer. As we have heard, unfortunately the incidence of liver disease is increasing dramatically, although 90% of liver disease is clearly preventable. However, it has to be addressed in its early stages. Worryingly, three quarters of people with cirrhosis are diagnosed when it is too late for effective intervention or treatment. To say that there is a liver disease public health emergency in our country is not an exaggeration. That needs to be addressed, and addressed urgently.

These days, in particular over the past two years, we hear a great deal about levelling up, but it is important that we see a health aspect to that agenda as well. It is truly shocking that liver disease deaths are four times higher in deprived areas. In those areas, people with liver disease die 10 years earlier than people with the disease in the most affluent areas. That needs to be addressed as part of a wider debate about creating a more balanced and equal society.

A short time ago, the British Liver Trust conducted a survey, which was published in the British Journal of General Practice in August last year. The survey identified widespread variation in the identification, treatment and management of chronic liver disease in primary care. It found that only 26% of local health bodies have an effective patient pathway in place for the early detection of liver disease. That survey was reinforced by the fact that a number of Members of Parliament wrote to their local health bodies: in total, 31 letters were sent by parliamentarians to their relevant health bodies to call for urgent action to improve liver disease pathways. Sadly, good practice is a postcode lottery.

It is important to bear in mind that we are not just talking about an abstract disease but about real people in terrible circumstances. Last July, the all-party parliamentary group on liver disease and liver cancer took evidence on the need for a comprehensive review of adult liver services in this country. We heard from a patient called Steve, who gave a moving address. He shared his experience of running a business for some 36 years and fighting for his life in accident and emergency with end-stage liver failure. Steve fell through gaps in the system and faced a life-threatening late diagnosis, due to the stigma that has been referred to, which is all too prevalent in this disease. He was discharged from A&E with little more than a dietitian’s sheet. He did not have access to any support or resources, and had no idea how to manage his condition. Steve’s story is a poignant reminder that we need urgently to improve the quality of care for people at risk of liver disease across the United Kingdom.

There is hope across the United Kingdom. In particular, under the leadership of the Welsh Government, Wales was the first UK country to introduce a dedicated liver disease delivery plan in 2015. The all-Wales liver blood test pathway is providing for the early diagnosis and management of liver disease across the whole of Wales. I am very pleased that the work was based initially on the local pilot project in Gwent, from which I come, and ensured an 81% increase in diagnosis of cirrhosis at a treatable stage.

Yesterday I was pleased to receive a letter from the deputy head of external affairs for NHS England. I thought, “Good! He has something positive to announce in readiness for this debate.” However, I was disappointed, because the letter says that “internal discussions” have taken place about whether there should be a review of adult services, and if there is, it will be done in the future. I think we have gone beyond that stage. The evidence is there. We need to go beyond discussing whether we should have the review—we should get on and do it.

The letter is disappointing and I urge the Minister to ensure that England is not left behind in the early diagnosis of liver disease. We urgently need a new, nationally endorsed pathology pathway that will save lives, drastically improve early diagnosis and transform outcomes for liver disease patients.

[Several hon. Members rose—]

[Mr Clive Betts (in the Chair)]

I remind hon. Members to try to keep to five minutes. The next Member indicated that he has to leave before the end of the debate, and I accept his reasons, so I call Anthony Mangnall.

18:54

[Anthony Mangnall (Totnes) (Con)]

It is a pleasure to serve under your chairmanship, Mr Betts. I begin by congratulating the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) on securing this debate on an important issue. It is striking how similar the points she made about her constituency are to the issues affecting many constituencies across the country, especially down in the south-west. It is a pleasure to follow my hon. Friend the Member for Darlington (Peter Gibson), who added such a personal point to his speech, as well as the hon. Member for Caerphilly (Wayne David) and his extremely good work on the APPG.

I can be very brief, because I want to make just a few points. I come to the debate having not known a great deal about the issue before I was elected. Like so many people, I was lobbied and introduced to the subject by constituents, specifically the Meredith family, who are very involved in liver diagnosis and transplant services and the need to improve them in the south-west. Over the last three years, I have met them regularly to discuss the issue, to see how the UK can improve its services across the whole of the country and to look at some of the positives and negatives. Of course, I am participating in the debate to point out some of the negatives, but it has been a fascinating journey. I met Professor Cramp of University Hospitals Plymouth NHS Trust to discuss the matter, to see where we might be able to improve it and to lobby my colleagues in the south-west about beginning a campaign to improve south-west transplant and diagnosis services. There is a real need to do so, and the statistics speak for themselves.

I continue to learn about this issue. In fact, I was completely unaware of the link between smoking and liver disease; given the fact that I am trying to quit smoking, that has only redoubled my efforts. It is important, because we talk in this debate about where we can tackle things at source: people who have alcohol addiction, smoking addiction or issues around obesity. We must address those at-source points.

However, I will focus very briefly on geographical disadvantages. The hon. Member for Rutherglen and Hamilton West described what she sees in her own constituency, but it is absolutely the same in mine. People who are in need of liver transplants have to travel across the country for a potential transplant, and they are then rejected when they arrive at the hospital. They then travel back to the south-west, which on a good day can be a four, five or six-hour round trip—far more if they are travelling by car. That is incredibly debilitating for them. It is incredibly destructive, and it hurts their health. We need to look at where we can improve that geographical disadvantage, and the south-west is more than a good case in point.

As I understand it, there is due to be a review of adult liver disease services this year. I understand that it was meant to be 2022-23. Would the Minister update the House—I apologise for not being here for her concluding remarks, but I will look at Hansard tomorrow—on whether that will be undertaken this year, and when it is likely to report? It is hugely important. A great many of us are banking on that report to identify some of the pitfalls across the country. May I also invite the Minister to meet the Meredith family and Professor Cramp to discuss the issue, get a better sense of where we are in the south-west and get a sense of where there are disadvantages for those who are suffering?

We have a real opportunity. I do not think there is any politics in the issue. We all recognise the pitfalls across the country—where the problem is increasing, and why it is increasing—and we have the opportunity to address it. I look forward to seeing the Minister’s response, and I again congratulate the hon. Member for Rutherglen and Hamilton West on securing the debate.

18:58

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) for raising this issue and for giving us all an opportunity to participate in the debate. I am my party’s spokesperson for health, and also a vice-chair of the all-party parliamentary group on liver disease and liver cancer, so it is good to be here to discuss how we can better improve our services for the diagnosis of liver disease and cancer.

There are over 100 types of liver disease and cancer. They impact some 2 million people across the United Kingdom, so it is of the utmost importance that our services are up to scratch to ensure quick and efficient diagnosis. The British Liver Trust has raised concerns about the difficulty of diagnosing liver disease, given that it can take some time for real symptoms to show. Perhaps the Minister would come back to us on that issue. I am very pleased to see the Minister in her place, which is well deserved, and we look forward to her response to all the issues raised by Members.

Many may wish to keep an eye out if they have been indulging in what are classed as the three main causes of liver disease: excessive alcohol consumption, undiagnosed hepatitis and potential obesity. The hon. Member for Rutherglen and Hamilton West set that out very clearly. Since the 1970s, liver disease has been on the increase, with a 400% increase in deaths. That cannot be ignored. I am one of those—probably one of many here—who have had a liver capacity test. It has also been said that there is a stark disparity between liver disease and diseases such as cancer and heart disease: figures show that deaths from those diseases have remained stable or decreased.

This is a nationwide issue, of course. As of 2019, one in five people in Northern Ireland—I always like to give a Northern Ireland perspective in these debates—who was suffering from liver disease was completely unaware of the fact. It is staggering that that could be the case: that is 20% of those people. In addition, since 2011, there has been a 28% increase in hospital admissions due to liver diseases and cancer.

Unlike some diseases, liver disease is something that we have real control over if we are on top of it and looking out for the potential symptoms. We must become knowledgeable as to how we prevent liver disease to start with: keeping an eye on our consumption of sugar, fat and alcohol can be instrumental in preventing some 90% of liver diseases, so there are a lot of things we can do ourselves. Before covid, Parliament’s Health and Social Care Committee released a publication that alerted people to the concern that exists about alcohol-related diseases and deaths—about a potential spike in deaths of young people due to alcohol or needle-induced hepatitis, which are extremely preventable. The Government have a role to play in schools and at universities to ensure that young people who may be experimenting with alcohol are fully aware of its long-term impacts.

There are things we can do to prevent liver disease, and to diagnose it earlier. Along with personal awareness, more must be done to gather as much information as possible through research. As with all diseases, the more funding we are able to pump into researching liver disease, the more we can investigate, learn and prevent in the future. That is ultimately the role of Governments, not only here in Westminster but across all our devolved Assemblies, whether in Wales, Scotland or Northern Ireland. They are responsible for funding our wonderful charities to enable them to commission and implement great liver disease and cancer services for all our constituents. It is important that we as elected representatives align ourselves very closely with liver disease charities. Those charities do incredible work, carrying out investigations and tests to find ways of making people’s lives better and, ultimately, to try to do away with liver disease.

We are on the right path, but there is no doubt that there is still work to be done on this issue. When we compare liver disease with other diseases, such as heart diseases and cancers, we can see the success stories in some of those areas, but we can make today’s debate an important step forward in curing liver disease. I hope that today’s turnout has encouraged the Minister to come back with something good when she responds; I also look forward to the contribution of the shadow Minister, the hon. Member for Enfield North (Feryal Clark). Today is a true representation of our goal to do better, and whether we are in Wales, in Scotland, in Northern Ireland or in England, we can do it together.

19:02

[Andy Carter (Warrington South) (Con)]

It is a great pleasure to follow the hon. Member for Strangford (Jim Shannon), and I congratulate the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) on securing the debate. It is also a pleasure to listen to the chair of the APPG on liver disease and liver cancer, the hon. Member for Caerphilly (Wayne David). I am grateful for the input he gave from Wales in particular, because it is very interesting to hear how different Administrations that have responsibility for health are tackling this issue.

I will spend the brief time I have talking about issues in the north-west of England. Similarly to my hon. Friend the Member for Totnes (Anthony Mangnall), liver disease was not an area that I was particularly familiar with until I became a Member of this House and heard from constituents, particularly families who had seen loved ones go through the terrible, very fast process of hearing about a liver disease and, sadly, passing away. I am particularly grateful to Dr Tim Cross, a constituent who is also a consultant hepatologist at the Royal Liverpool and Broadgreen University Hospitals NHS Trust. Talking to him has really helped me to understand some of the issues, and in particular some of the regional disparities that affect not only my constituents in Warrington, but people in towns and cities such as Blackpool, Manchester and Liverpool. These major centres in the north-west of England are woefully underserved when it comes to transplant facilities for tackling liver disease and liver cancer.

All those areas of the north-west record some of the highest rates of liver disease mortality, with the most recent statistics from 2020 highlighted by the British Liver Trust showing a shocking 1,838 deaths, the highest of any region in England. Per 100,000 people, that equates to 28.4 deaths. By comparison, an area such as the east of England has almost half that figure—16.1 deaths per 100,000. Over the course of 2021, the north-west saw around 10,000 admissions to hospital due to liver disease, which is by far the highest figure in the country.

As hon. Members have said, early diagnosis is fundamental to treating the disease and preventing premature deaths. The critical issue for the north-west of England is the total lack of liver transplant facilities. There is not a unit that does it. Patients are routinely travelling to Birmingham, Leeds and a further afield to be assessed for liver transplants. There is no service for an area covering 7.3 million people, including major cities such as Manchester and Liverpool. It is clear to me that one of the reasons that we have such high levels is the poor facilities in those cities in the north-west of England. My constituents are also disadvantaged because they have to spend a lot of their own money travelling to those centres to get clinical guidance—people in other areas are not having to do that. That takes a toll on the constituents who face those challenges.

In Warrington alone, 51 lives were lost due to liver disease last year. Our town’s diagnoses, hospital admissions and premature deaths far exceed the national average. When we talk about the need to level up areas of the UK, particularly in the north of England, that is not just about economic growth. Regional inequalities in healthcare need to be addressed. I am pleased that this Government see that as a priority and are tackling it, but they could address that by looking at liver disease, and liver cancer in particular.

I welcome the Government’s commitment to narrowing the gap in healthy life expectancy, but I urge the Minister to look at liver disease and see what we can do. She will be aware that there are areas of the UK that are asking for better healthcare and better hospitals. Warrington is one of the areas bidding for funding to secure a new hospital. I say to the Minister that Warrington would be a great place to have regional transplant facilities for the north-west of England, and a new facility could accommodate that. I am keen to hear the Minister’s thoughts on the additional capacity that could be released in the north-west of England to help those people in my area who are suffering from this terrible disease.

19:07

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) on securing this important debate, as well as on the important work that she and my hon. Friend the Member for Caerphilly (Wayne David) do with the APPG.

While there are multiple causes of liver disease, such as from viral hepatitis, obesity and alcohol, I particularly want to focus on alcohol. Successive Health Ministers will know that, over a period of time, I have consistently raised concerns about the absence of a comprehensive alcohol strategy. This afternoon we have heard only too clearly why that is so important. For too long, alcohol has been promoted as a social norm, and not to imbibe as an anomaly, yet the scale of alcohol harm, psychologically and physically, is off the radar. It is something that is causing me significant concern, whether it is used for pleasure or to address pain. It must become a priority of this Government.

In a city where I see more and more licensing of premises, I am aware of the impact and harm that that is having on livers. We see it in the statistics. My discussions with the British Liver Trust over the summer highlighted the fact that more and more people with liver harm were younger and sicker. Our excellent public health team in York says that it is their No. 1 concern. When we match that against the fact that 90% of liver harm is preventable, we realise that there must be a more comprehensive strategy. As the profile of those with liver disease changes, so must investment in prevention, diagnostics and disease management.

Astoundingly, since 2010 hospital admissions for liver disease have risen by a staggering 45%. NHS Humber and North Yorkshire ICS currently has no clinical pathway for the early detection of liver disease. I have written to express my concern, and the ICS tells me it will respond on 4 November.

There are many causes of liver disease and cancer, but prevention and early detection can make a significant difference to outcomes. In Yorkshire and the Humber, our pressurised NHS is seeing a 13% increase on the national average for admission rates due to liver disease, and rates are 38% higher for alcohol-related liver disease. In York, alcohol is a major factor in A&E attendance. For women in York, admissions due to liver disease are 30% higher than the national average. As we focus on York being a drinking capital, we have to look at those correlations.

Over the covid period, many people turned to alcohol as a means of addressing other needs. When so many people are dying from alcohol-related disease, the Government must turn their attention to that matter—not least because we know the impact it has on the most deprived communities, as we have heard. In York, the mortality differential is 10 years between the most deprived communities and the wealthiest. One in four with alcohol-related liver disease will die in hospital within 60 days of detection.

I know from working on a ward specialising in hepatology how important this subject is, but also how tragic it is for families. That is why I urge the Government to focus attention on this public health matter in a way akin to Dame Carol Black’s work on drug-abuse harms. There were 4,859 drug deaths in 2021. I am not belittling that statistic at all, but the fact that there are 10,000 liver deaths—over double—really demands the Government’s attention and a strategy. However, there is none in place.

That is why the Minister has a unique opportunity—one that she must take hold of. Ministers can turn their attention to so many things, but getting on top of this issue, driving a strategy that makes that difference and ensuring that every community has a diagnostic centre, as York longs to, could make a serious difference to our communities and our nation. I trust that she will embark on an alcohol strategy and ensure that there are community diagnostic centres, that alcohol harm is properly addressed and focused on, and that we also understand and focus on non-alcohol related fatty liver disease. We have an opportunity to double down on tackling liver disease, and I trust that this Government will not let this moment pass.

[Mr Clive Betts (in the Chair)]

To co-operate with the timing, we head to the Front Benches, with five minutes for the Opposition, 10 minutes for the Minister and a couple of minutes at the end for the mover to wind up.

19:13

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Betts. I thank the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) for securing the debate and for her continued advocacy on this issue. I welcome the Minister to her place, and I look forward to many constructive discussions with her in the months ahead. I praise the contributions from the hon. Members for Darlington (Peter Gibson), for Totnes (Anthony Mangnall), for Strangford (Jim Shannon) and for Warrington South (Andy Carter), and from my hon. Friends the Members for Caerphilly (Wayne David) and for York Central (Rachael Maskell). I particularly thank the hon. Member for Darlington for sharing his personal experience. As the hon. Member for Strangford often reminds us at these debates, it is those personal experiences that remind us of the impact of what we are discussing.

Liver disease is increasing rapidly across the country, with deaths doubling over the past 20 years, as we have heard. Too often people with liver disease have little to no recognition of the condition, which is often asymptomatic in its early stages. As a result, as every hon. Member has set out tonight, diagnoses often come too late, with mortality rates from liver disease far outpacing those for other major conditions, such as diabetes or respiratory conditions, which have stabilised or improved over the past 40 years.

This is a condition that is only getting worse, with the 2020 covid-19 lockdowns seeing a 21% increase in alcohol-related liver disease deaths. We have heard tonight that the stats on liver cancer in particular are deeply concerning, with incidences rising by almost half in the past decade. With the poorest and most vulnerable in our society facing dire consequences from the cost of living crisis this winter, we are at real risk of seeing such a spike happen again. Given the serious inequalities we have already observed for liver disease patients, we know the devastating effects that that would have.

Statistics from the British Liver Trust show that prevalence of liver disease is four times higher in our most deprived communities than our most affluent. The most deprived patients are also expected to die a decade younger, as set out by my hon. Friend the Member for Caerphilly. This snapshot highlights the most glaring of inequalities. How can it be that, before we even look at the provision of services, people are facing such a glaring postcode lottery?

It is bitterly disappointing for liver disease patients, who are so badly affected, that the new Secretary of State for Health and Social Care has decided to scrap the health inequalities White Paper. Given the evidence we have heard from colleagues today, I look forward to hearing from the Minister how the Government plan to address this issue following that decision.

The picture for liver disease patients is deeply concerning, but when we look at the state of care and treatment services on offer, the situation gets even worse. Although, as we heard, access to specialist care improves survival rates by around 20%, provision of specialist liver disease services across the country is incredibly varied. Each year, thousands of patients are dying unnecessarily because they cannot access specialist services or because the services they can access are stretched to breaking point.

The rise in the prevalence of liver disease, combined with the shortage of specialist care, is compounding the crisis facing all parts of our NHS. More people are being admitted to hospital with no specialist care services available to them and no primary or social care capacity in their communities. We must break this all too common vicious cycle if our NHS is to have any chance to recover. The NHS desperately needs a workforce plan—something that has been called for consistently by not only Labour, but the cross-party Health and Social Care Committee. Can the Minister tell us what plans her Department has to address this issue facing all parts of our NHS?

As well as ensuring that we get the fundamentals such as workforce right, when it comes to liver disease, we should be learning from places where things are going right. Fortunately, my local integrated care system—North Central London—was categorised as green by the British Liver Trust survey, indicating that it has a fully effective pathway in place for the early detection and management of liver disease in primary care. Whether it is proactive case finding to identify those at high risk, GPs having the means to assess fibrosis, or effective management of patients, including referrals to secondary care where necessary, we know what effective care looks like, and we know what works.

I will conclude shortly. We need centres such as the North Central London integrated care system to exist not just in north London, but across the country. I urge the Minister to look at the positive examples of ICSs, such as North Central London, and see how the great work they are doing can be replicated more widely across the country. We know what works. We know we can do it. It is time for the Government to deliver.

19:19

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Caroline Johnson)]

I thank the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) for securing a debate on this important issue. She has been a great advocate on this topic, and I share her commitment to tackling this serious disease. I also thank my hon. Friend the Member for Darlington (Peter Gibson) for his kind words and for sharing his family story and speaking about some of the personal, family impact of these terrible conditions.

It is a year ago this month that our colleague, Sir David Amess, was tragically taken from us. He had a huge interest in liver disease. He was the co-chair of the APPG for hepatology and did so much to raise awareness of this disease in Parliament. One of the many ways we can take forward his legacy is to improve the lives of those with liver disease. That is why, although the Minister responsible for this topic was unable to attend, I wanted to ensure that I took forward this important debate and updated hon. Members on the work we are doing.

Many have talked about the scale of the problem, so I will not go further into that, but I want to talk about what we will do to address it. First, the NHS plan will help us to do that. It recognises the importance of preventing avoidable liver disease through targeted policies to address alcohol consumption and obesity. Unfortunately, most people are diagnosed with liver disease at a late stage, when it is less treatable, and they are often diagnosed during an emergency hospital admission. It is for that reason that liver disease is often called the silent killer.

To help detect early signs of liver disease, NHS England has a number of trials in train. One is evaluating intelligent liver function tests. That is when patients get a normal liver function test, and the laboratory has a process in place, based on those results, to test the same sample further, not necessitating a further appointment, so we can work out which patients need further investigation and treatment.

The NHS health check for 40 to 74-year-olds also identifies people particularly at risk of alcoholic liver disease and refers them in for further treatment and investigation. On top of that, we have the fibroscans, which have been rolled out through community diagnostic centres. They help to identify fibrosis in the liver at a time when we can try to treat it and before it becomes worse. Last year’s spending review allocated £2.3 billion for diagnostics to increase the number of community diagnostic centres to at least 100 by March 2025. That will boost diagnostic capacity to diagnose liver disease and improve earlier diagnosis and health outcomes.

The hon. Member for Strangford (Jim Shannon) talked about education for children about alcohol. Education on alcohol is now a statutory component of relationships, sex and health education in England.

My hon. Friend the Member for Totnes (Anthony Mangnall) talked about a review of liver disease and liver care. That is taking place in 2022-23, and there should be a report after that. He and my hon. Friend the Member for Warrington South (Andy Carter) raised transplant care. I will ask the responsible Minister to write to them with further details about what is being done in that area.

The hon. Members for York Central (Rachael Maskell) and for Strangford said that many liver diseases can be prevented and are preventable, particularly in relation to alcohol, obesity and hepatitis, and I want to talk a little about what we are doing in those areas. Alcohol is the leading risk factor for liver disease, and identifying disease early in those at risk and supporting them to stop drinking is critical. If they stop drinking, that can halt or even reverse damage to the liver. People at risk of alcoholic liver disease are being identified and given early access to tests, to detect emerging liver disease through the health check and other means.

The NHS has also invested in the treatment of alcoholism: £27 million has been used to establish specialist alcohol care teams in hospitals with the highest rates of admissions related to alcohol dependence. Those specialist teams will help identify alcohol-dependent patients, start them on specialist alcohol treatment in hospital and support their transfer to community alcohol services.

Since April 2022, NHS England has introduced a measure known as commissioning for quality and innovation, which incentivises providers to improve earlier detection of liver disease for alcohol-dependent in-patients in acute and mental health services. We are also committed to increasing liver health investigations in community treatment settings. Through the drugs strategy, we are making the largest ever single increase in drug and alcohol treatment and recovery funding, with £780 million of additional investment over the next three years.

As hon. Members said, another major risk factor is obesity. Tackling obesity is a major priority for the Government. We have seen some important successes since 2016. The average sugar content of drinks subject to the soft drinks industry levy decreased by about 43% between 2015 and 2019. This month, regulations have been brought in about store placement of products that are high in fat, salt and sugar, so that they cannot be displayed in areas of the store that are attractive and available to children. There have also been the provisions set out in the Calorie Labelling (Out of Home Sector) (England) Regulations 2021 and an investment in further weight management services for people living with obesity.

I would like to turn to hepatitis B and C, which are also important risk factors for liver disease and primary liver cancer. Through the NHS hepatitis C virus elimination programme, we have reduced the number of people living with chronic hepatitis C virus infection in England by 37% since 2015. New treatment with direct-acting antivirals has massively improved the success of the treatment, with mortality from hepatitis infections falling by 35% since 2015. So that has already reaped rewards.

There is a new opt-out pilot programme of testing for HIV, hepatitis B and hepatitis C in emergency departments in areas of the country where HIV is most prevalent, which is a proven way of identifying new cases. During the first 100 days of the pilots in London, Blackpool, Brighton and Manchester, 328 people with hepatitis B were newly diagnosed, with 30 found to be lost to care. Each of them is an individual who will now be able to be treated effectively for the condition, which will reduce the risk of passing it on. Similarly, 137 people were newly diagnosed with hepatitis C, of whom 23 were found to be lost to care. Those are promising early results in just the first 100 days, and we now looking at what we can do to perhaps roll this programme out to other centres.

Many hon. Members talked about primary liver cancer, which has a tragic impact. As my hon. Friend the Member for Darlington said, the number of recorded deaths has more than doubled in the last two decades. Cancer Research UK statistics show that there are around 6,200 new cases diagnosed each year and, tragically, 5,800 deaths. Unfortunately, the five-year survival rate for people with liver cancer is poor, at only 13%, and that could be markedly improved by earlier diagnosis, as I mentioned.

To contribute to achieving a long-term plan ambition to diagnose 75% of cancers at an earlier stage by 2028, the NHS cancer programme has launched the early diagnosis liver programme. The programme aims to detect more liver cancers at an earlier stage, so that more patients can benefit from treatment. More people at a high risk of liver cancer are referred to six-monthly liver surveillance. The national cancer programme is working in partnership with the hepatitis C virus elimination programme to deliver 11 community liver health check pilots.

The pilots aim to support early detection and diagnosis of liver cancer by identifying and referring people with cirrhosis or advanced fibrosis into a liver surveillance pathway, and providing them with a peer supporter who can help and guide them through future appointments. The pilots will target people experiencing significant inequalities and those who disengage from the healthcare service, including homeless people, those with alcohol and substance addiction, sex workers, people in the justice system, disabled people and others. The hon. Member for Enfield North (Feryal Clark) mentioned the workforce; she will be interested to know that over the last five years there has been a 20% expansion in the number of consultant hepatologists.

This is an important debate on a very important issue. We have heard some heartfelt contributions about the pain that liver disease and liver cancer bring to so many people and their loved ones across the United Kingdom. This Government are determined to take action and to make the changes that are needed to tackle this deadly disease.

[Mr Clive Betts (in the Chair)]

Margaret Ferrier has one minute to wind up.

19:28

[Margaret Ferrier]

Thank you, Mr Betts. I would like to speedily thank all the hon. and right hon. Members who took part in the debate. We heard from the hon. Members for Darlington (Peter Gibson), for Caerphilly (Wayne David) and for Totnes (Anthony Mangnall), who said there were no politics in this issue, which I absolutely agree with, and who spoke about transplants and the need to improve the geographical spread of adult liver services.

The hon. Member for Strangford (Jim Shannon) reminded us of the charities in this field, which are all doing such great work, and the hon. Member for Warrington South (Andy Carter) offered his area for a new transplant facility for the north-west. I thank the hon. Member for York Central (Rachael Maskell), who said we have a unique opportunity to make a difference.

This is about early detection pathways, because rates vary considerably from region to region. We must have a full review of adult liver services, and GPs must have the means to assess fibrosis. Thank you, Mr Betts, for letting me wind up.

19:29

Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).