Liver Disease and Liver Cancer

Alison Thewliss Excerpts

Thursday 25th April 2024 Westminster Hall

[Alison Thewliss (Glasgow Central) (SNP)]

It is a pleasure to see you in the Chair, Sir Christopher. I am very grateful to the British Liver Trust for its comprehensive briefings and support for this debate. The Alan Morement Memorial Fund, the cholangiocarcinoma charity, has also provided a very helpful briefing on liver cancer.

I often do not speak in debates on health matters, because they are devolved to the Scottish Parliament, but I have a personal link to this issue. My husband, Joe, was diagnosed with stage 2 non-alcoholic fatty liver disease in 2019. He has taken significant efforts to deal with that condition, because when caught at that stage it is reversible. Like many men, he did not go to the doctor for far too long, and he had that diagnosis when he finally went to get it checked out. He has been clear that tackling it has been challenging—we consciously have to do an awful lot more to keep ourselves healthy; we live in an obesogenic, alcohol-focused environment, so there are always things to tempt us back into bad habits—but he continues to go on with that challenge.

Joe has talked about the stigma around the disease. Almost three quarters of people with a liver condition have experienced stigma, and almost a third feel that it has prevented them from receiving medical care. It often comes from the association of liver disease with alcohol misuse and viral hepatitis. We must do everything we can bust that stigma so that people go and get the treatment they require as soon as possible, rather than putting it off, because the risks of doing so are very serious.

I also want to mention the read-across to the contaminated blood scandal. Some of those infected with hepatitis C did not know they had been infected because of the subsequent cover-up of their medical records, and some did not find out until serious damage had been done to their livers. For some, the news sadly came too late. I have heard stories at the all-party parliamentary group on haemophilia and contaminated blood about people whose death certificates cite chronic alcoholism as the cause of the disease, even though they had never touched a drink. There is a real stigma around liver issues, which we must do our best to bust.

We have a public health emergency that the Government ought to take very seriously indeed. Liver disease and liver cancer continue to be significant issues in Scotland. Liver disease is a leading cause of premature deaths in Scotland, above breast cancer and suicide, and deaths due to chronic liver disease in Scotland have increased by 85% in the last three decades. There was an impact during the pandemic, as the hon. Member for Stockport (Navendu Mishra) and my hon. Friend the Member for East Renfrewshire (Kirsten Oswald) also mentioned. I think that speaks a little to the alcohol culture that we are all focused on. I mean, how many people have heard the phrase “wine o’clock”? It has been minimised and reduced to not really mattering at all, but that alcohol culture leads people into harmful habits, and society downplays that.

I was glad to see the Scottish Government respond to the alcohol culture with minimum unit pricing, which has reduced the consumption of alcohol in Scotland by 3%, reducing deaths wholly attributable to alcohol by 13.4% and hospital admissions due to chronic conditions such as alcohol-related liver disease by 4.1%. Alcohol-specific deaths have risen more slowly in Scotland than in England, highlighting that the situation could have been much worse had Scotland not taken the bold step of introducing minimum unit pricing. The greatest harm reduction impact has been among the more deprived groups in Scotland, so there is an important protective factor.

Will the Minister consider bringing in minimum unit pricing in England? The small weakness of minimum unit pricing is that it puts the profits back into the hands of those selling the alcohol, because we do not have full control over the taxation system for alcohol in Scotland. It would be incredibly useful if we had all those powers in Scotland, but an intervention in England might provide an opportunity to do that. Removing the duty escalator on alcohol has meant that alcohol has got relatively cheaper.

I also want to mention the work happening in Scotland, which is showing signals of incremental improvements following the Scottish Government’s focus on prevention and earlier diagnosis. The same progress has not been seen in England, where liver disease mortality rates are at their highest level in decades; hospital admissions for liver disease have risen by almost 80% over the last decade alone.

In Scotland, by comparison, liver disease death rates between 2021 and 2022 decreased from 17.9 per 100,000 to 17.4 per 100,000, and hospital admissions caused by liver disease decreased by 1.5% between 2021-22 and 2022-23. My own health board area, Greater Glasgow and Clyde, has seen the largest fall in chronic liver disease death rates, which is really quite impressive given the health challenges that we have faced. That is quite significant.

When the British Liver Trust “Love Your Liver” roadshow was on Argyle Street in my constituency, I was struck by the number of people interested. Glaswegians are a very curious bunch; you cannot do anything without somebody asking a question and stopping to find out what is going on. People were like, “Oh, a liver test. I’ll queue up and wait for my liver test in a van in the middle of the city centre.” Around 100 people were scanned that afternoon and 15 of my constituents were later given a referral to their GP as a result, so there needs to be more testing and encouragement of people to go forward and check. It really is important.

Such screening in a community setting is a lifesaving intervention—we should make no bones about that. People should be able to access that at a simple community level. I am sure many colleagues in this place will have had their liver scanned in Parliament, which was welcome. Fibroscan readings have been reassuring in a lot of ways although, with health charities’ propensity to come in and do tests on MPs, I am sure they will find something wrong with me at some stage. However, it is welcome and important that people feel they can go for tests and that there is not a stigma in doing so.

So, there has been progress in Scotland. The intelligent liver function testing pathway developed by the University of Dundee uses an automated algorithm-based system to further investigate abnormal liver function test results based on initial blood samples from primary care, so further important development is happening in Dundee. I am sure the Minister would be interested to hear that the technology is also cost-saving to the NHS by over £3,000 a patient, which is significant. The tests are now being rolled out and piloted in parts of England.

I will touch on what my hon. Friend the Member for East Renfrewshire said about austerity and its impact on public health. The Glasgow Centre for Population Health in my constituency has done a lot of research into the subject over the years. It says that the years of Tory austerity have cost people dearly, through damage not just to public health services but to people’s life outcomes. My hon. Friend was correct to point out further cuts to social security for people from the Westminster Government, because that makes it more difficult for people to make good and healthy choices in the foods they buy and the lifestyles they have. The Glasgow Centre for Population Health said that it will take another decade just to get us back to where we were in 2010. That is 20 lost years of people’s good health, which will have a significant impact for a long time to come.

[Navendu Mishra]

The hon. Member is making an excellent speech. We already know that people who live in lower-income and more deprived areas have a lower life expectancy than people who live in more wealthy areas. The data from Alcohol Change UK tells us that people from more economically deprived groups experience higher rates of liver cancer and are less likely to receive treatment. There are also higher rates of liver cancer among people from Asian and black African backgrounds than among people from white backgrounds. That tells us that people who have a lower income or live in more deprived areas will die sooner. On the hon. Member’s point about austerity, does she agree that the Government have not done enough in the last 14 years to address the issues?

[Alison Thewliss]

I absolutely agree. I see that very much from the varied communities that I represent. It is baffling that the more recent Marmot findings have come as a surprise to some in government. I remember doing modern studies at high school and learning about the Black report and the inverse care law. It feels as though this Government are no further forward. In fact, in some respects they are much further back in tackling long-lasting health inequalities.

I shall now discuss the public health aspects. The Scottish Government are consulting on advertising restrictions on food and drinks that are high in fat, salt and sugar, which again are disproportionately marketed towards children and vulnerable groups. That marketing is also found in poorer areas, where there is often a lack of availability of fresh fruit and vegetables. That is significant because one in four children with obesity are estimated to have fatty liver disease, which has huge implications for their health and wellbeing for the future. It is caused by an accumulation of harmful fat in the liver and is present in around 70% of people who are overweight and obese. Fatty liver disease and excess weight together significantly increase the risk of premature death due to cardiovascular disease and a range of cancers, including liver, colon, breast, prostate, lung and pancreatic cancers.

Although Scotland tries to do its best within the devolved settlement that we have, sadly a number of key commitments from the UK Government to curb childhood obesity are yet to be implemented, including the 9 pm watershed plans to protect children from junk food advertising on TV and the ban on multibuy junk food deals. We have brought in some of those things in Scotland where we can. It does make a small difference but an awful lot more needs to be done, particularly for those in younger age groups. They are being targeted with all kinds of multiple snack-type foods, which are largely unnecessary. Both Labour and the Tories need to stand up to the multinational companies that wish to push those foods on our young people. These things do not come cost-free, certainly not to society.

Will the Government build on the simple, cost-effective diagnostic pathways already in place across the devolved nations? Will they commit to sustainable funding in the next spending review for new technology to improve earlier detection of liver disease? The fact that early intervention—that technology—can permit treatment before things get worse is significant. Will they also introduce a new nationally endorsed pathway to improve early diagnosis, and will they ensure that every community diagnostic centre can provide an assessment for fibrosis? All of those things will help to improve this public health emergency that we have.

It is important that we have discussed the issue today, but I hope that the Minister will listen and make the changes that she can, and that the Labour Front Bench, should they form the next Government, take this seriously. The alcohol-soaked and obesogenic society that we have poses fundamental challenges that Government should intervene on to prevent the next generation of people developing liver disease and liver cancer; we can prevent that progression if the public health imperative is there.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I have to say that I am a bit disappointed, because the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), in particular, knows very well my personal commitment to the best start to life, so to hear her saying that the Government have done nothing and Labour is going to fix it is a bit rich, but there we are.

I congratulate the hon. Members for Stockport (Navendu Mishra) and for Glasgow Central (Alison Thewliss) on securing this important debate; it is an absolutely vital debate. All hon. Members, including the hon. Members for East Renfrewshire (Kirsten Oswald) and for Washington and Sunderland West (Mrs Hodgson), have raised the importance of prevention, early intervention and, in particular, early diagnosis. I commend them all for doing that. The Government are taking significant steps. The hon. Member for Glasgow Central talks about what the Scottish Government are doing. I can absolutely assure her that the Government of the United Kingdom are totally committed to improving early diagnosis and treatment, and I will go on to explain exactly what we are doing.

First, it is important to set out that we know that there are 6,000 new cases of liver cancer each year, making it the 18th most common cancer, with 5,000 deaths a year; that is 5,000 deaths too many. As my right hon. Friend the Member for Bromsgrove (Sir Sajid Javid) said during his tenure as Health Secretary, regional inequalities are “the disease of disparity”. He was absolutely right because—as the hon. Member for Stockport stated in his opening speech—economic and health inequalities go hand in hand.

Blackpool is a perfect example. It is one of the most deprived cities in England and flashes red on every indicator—for life expectancy, alcohol dependence and liver cancer. No fewer than 40% of the people unemployed there are not fit to work due to ill health, and the rate of death from chronic liver disease is almost two and a half times the average for England. That is an area that I have visited a number of times, to visit its family hubs and to look at the excellent work and huge efforts that go on there to level up to improve the disparities. Nevertheless, there is so much more to be done, and our strategy to eliminate disparities in liver disease and liver cancer is based on two key facts.

First, 90% of liver diseases are caused by alcohol dependency, obesity or viral hepatitis. Secondly, the five-year survival rate for liver cancer is only 13% precisely because people do not come forward with their symptoms until it is too late; early detection is vital. We know what causes liver disease, and we know that diagnosing it more quickly will save thousands of lives. That is why prevention and diagnosis are the twin pillars of our strategy to end inequalities in liver disease and liver cancer across our country.

To be clear, this is not about criticising people for drinking alcohol, but stopping the level of drinking that leads to liver disease and liver cancer. We know that rates of alcohol dependency are double in the most deprived local authorities. That is why, in December 2021, we published our drugs strategy, which does three things. First, it has brought the greatest-ever increase in funding —an extra £780 million—for drug and alcohol treatment, over £500 million of which is going straight to local authorities with the highest levels of deprivation and alcohol dependence. Secondly, the strategy is boosting screening capacity for liver disease, and thirdly, it is beefing up referral pathways to build a seamless system from diagnosis to treatment.

Since we published our strategy, we are treating more people than ever before for alcohol use. In February, almost 135,000 people were receiving treatment, compared with just over 117,000 just under two years ago, which is an increase of more than 15%. NHS England is investing almost £30 million to bring specialist alcohol care teams to hospitals in the most deprived parts of England. Those experts in addiction identify people in hospital with alcohol dependence, start their treatment and refer them to local authority community services where they can complete their treatment, overcome their dependence and move forward with their lives. I pay tribute to all those brilliant clinicians who are helping vulnerable people to turn their lives around.

Obesity is another major risk factor for liver disease and is a real scourge on the poorest parts of our country. During last week’s debate on the Tobacco and Vapes Bill, we came under fire from hon. Members on both sides of the House who said, “Well, what about sugar? Are you going to ban that too?” This Government are not in the habit of banning things, but I am proud of our record on sugar reduction, healthy eating and obesity.

We have made strong progress in reducing the average sugar content in soft drinks through the soft drinks industry levy: we almost halved the sugar content in soft drinks between 2015 and 2019. I want to make the point that that is not with people saying, “Oh, this drink I used to like, I don’t like it anymore because it’s not sweet enough,” but was actually the result of reformulation that nobody noticed, which is the great thing about reformulation. If we can reduce the sugar, salt and fat content in foods so that people can carry on as normal without having to undertake some punishment routine, that is a good way to tackle the obesity problem.

[Alison Thewliss]

Having paid close attention to the sugar tax when it was brought in, there was a particular exemption in the products that required reformulation. Milkshakes could contain as much sugar as any of the full-fat fizzy drinks, but were somehow exempted because they had milk in them. Will the Minister perhaps take the opportunity to go away and think about whether they ought to be contained within a future iteration of the scheme?

[Dame Andrea Leadsom]

The hon. Lady will not be surprised, because she knows me well, that I am absolutely determined to tackle childhood obesity in particular, so that we can reverse the problems that we have seen in recent years, especially the spike in unhealthy eating and overeating during the covid pandemic. We know that people—both adults and children—are consuming too many calories. As she would expect, I am all over this and I am happy to debate any point with her. I agree on the sugar content in milkshakes, but there are many other foods that we also need to focus on. I hope I can reassure her on that.

For two years, we have been restricting the placement of less healthy products in shops and online to help consumers to make healthier choices. We are building on that progress. By the end of next year, further restrictions on price promotions on television and three-for-the-price-of-two offers in shops will come into force. I have been encouraging the big takeaway companies, the big supermarkets and so on to try to do it anyway— to get ahead of the regulations and to take action now. A number of them, I am pleased to say, are doing just that.

I am also pleased to update the House on the recent success of the NHS digital weight management programme. This week, the Obesity journal published a study showing that almost 32,000 people achieved sustained weight loss with the programme over a single year, which is really positive news. The programme is helping people from deprived backgrounds: more than a third of those referred were from black, Asian and minority ethnic communities. It is obviously early days, but there are positive signs.

The other major contributor to liver disease is hepatitis. Thanks to increased testing and improved access to treatment, we have reduced the number of people living with chronic hepatitis C virus in England by more than half since 2015. Deaths related to hepatitis C have fallen by just over a third since 2015, well above the World Health Organisation’s 10% target.

Liver disease is known as the silent killer because many people are unaware of their condition until it is too late. That is why, as part of our ambition to detect 75% of cancers at an early stage by 2028, NHS England has launched the early diagnosis programme for liver cancer, which aims to prevent liver cancer by actively checking for liver disease in our most deprived areas.

An important part of the early diagnosis programme includes 19 community liver health check pilot sites that were launched in 2022. The most recent data shows that the CLHC programme reached more than 7,000 people in our most deprived areas using mobile units between June ’22 and January ’23. These units are equipped with fibroscans, which is a fantastic new technology, as many hon. Members have mentioned, for detecting liver damage and identifying liver disease before it becomes life threatening. These non-invasive tests have diagnosed more than 830 patients with cirrhosis or advanced fibrosis. I am pleased to update hon. Members that there are now eight community diagnostic centres providing fibroscans and a further 14 planned.

For my entire career, I have fought for the principles of fairness and equal opportunity—from helping children and babies in deprived areas to get the best start in life to levelling the playing field for small businesses when I was Secretary of State for Business, Energy and Industrial Strategy and encouraging young women in my constituency to get into politics. I have done that throughout my career and I will not stop now. I am passionate about making our health service faster, simpler and fairer for all who use it, and tackling liver disease and liver cancer is at the heart of that mission. We have already delivered significant progress and, through prioritising prevention and driving early diagnosis, we have a plan to go further and faster in the years ahead.