Liver Disease and Liver Cancer: Diagnosis

Caroline Johnson Excerpts

Tuesday 11th October 2022 Westminster Hall

[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.