Liver Disease and Liver Cancer

Debate between Alison Thewliss and Navendu Mishra

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.