Liver Disease and Liver Cancer

Debate between Gregory Campbell and Navendu Mishra

Thursday 25th April 2024 Westminster Hall

[Navendu Mishra (Stockport) (Lab)]

I beg to move,

That this House has considered health inequalities in liver disease and liver cancer.

It is a pleasure to serve under your chairship, Sir Christopher.

I thank the hon. Member for Glasgow Central (Alison Thewliss), who is covering Front-Bench duties in this debate, and who was kind enough to co-sponsor the application for it with me to the Backbench Business Committee. She is a long-standing champion of public services and better healthcare provision for all.

I am grateful to several organisations, including charities, that have helped me with my speech: the British Liver Trust—several representatives are in the Public Gallery—Liver Cancer UK and the Roger Williams Institute of Hepatology. Alcohol Change UK has also been good. I have met its representatives in the past, although not recently, and it has been a long-standing campaigner on this issue.

Before I start on the main points of my speech, I pay tribute to Bob Blizzard, a former Labour Member of Parliament in Norfolk. He did a lot of work in this House on the Hunting Act 2004 and in the fight for animal rights. His family have been in touch and wanted me to mention him. Sadly, he passed away in 2022, with a rare form of cancer, having been diagnosed with it in December 2020. His family therefore wanted me to mention the work of the Alan Morement Memorial Fund, which helps patients and healthcare workers.

To start on my key points, this is an important debate about health inequalities in liver disease and liver cancer. It is particularly timely, given the shocking new data released this month, which shows that we are facing the worst mortality and hospital admissions rates for liver disease in a generation. Ninety per cent of liver disease is preventable and, if diagnosed early, damage can often be reversed and the liver can recover fully. Tragically, however, premature deaths from liver disease have surged to their highest levels in decades, and hospital admissions due to liver disease have risen by almost 80% over the past decade alone, driven by obesity, alcohol and viral hepatitis.

We have seen more than a decade of cuts under this Government. Successive Conservative Governments have neglected patients and failed to take liver disease seriously. Our most marginalised communities, the most at risk of liver disease, have been silenced, overlooked and left behind. The liver disease crisis is almost entirely preventable and reflects a decade of decline in our nation’s health, widening health inequalities and worsening life expectancy.

Geographical inequalities in health outcomes for patients are stark, and the north of England is disproportionately impacted, accounting for more than a third of premature deaths in liver disease in 2022, or 3,728. New data from the Office for Health Improvement and Disparities highlights that the north-west, my own region, has the highest mortality rate for liver disease in the country, at 35% higher than the national average. The healthy life expectancy in Blackpool is now the same as in Angola, at 54.5 years.

The Government have failed to deliver on their manifesto pledge and levelling-up mission to narrow the gap in healthy life expectancy. They scrapped the promised White Paper on health disparities, repeatedly cut the public health grant and in effect decimated the Office for Health Improvement and Disparities. They have also overlooked liver disease entirely in their major conditions strategy, and U-turned on their commitment to roll out non-invasive liver scans to 100 community diagnostic centres. Our nation’s liver disease effort is faltering, which is costing lives and piling huge, avoidable pressure on to our NHS. Thousands of people die unnecessarily without access to specialist care, because liver services are consistently overlooked and under-resourced.

Risk factors such as obesity, viral hepatitis and alcohol are most prevalent in our most disadvantaged communities, and mortality rates from liver disease in our most deprived communities are now four times higher than in the most affluent.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Gentleman and the hon. Member for Glasgow Central (Alison Thewliss) on successfully securing this debate. Does he agree that, in the 21st century, the wider expectation in society is that we need to see improving mortality rates from serious conditions? The concern here is that mortality rates are worsening, as he has correctly outlined. That is something we all need to address as a matter of urgency.

[Navendu Mishra]

I thank the hon. Member for his intervention; he makes an important point. As one of the most advanced economies in the world, we expect our population to have the best healthcare, and we want life expectancy increasing for everyone, not just in certain postcodes, so I agree with his point.

Almost two thirds of adults are overweight or obese, and nearly four in 10 children with obesity—38%—are estimated to have early stage fatty liver disease. Deaths due to alcohol-related liver disease in England have increased by 87% over the last two decades, due a rise in harmful and hazardous drinking.

The cost of living crisis is exacerbating inequalities and the risk factors facing vulnerable families in deprived areas, with cheap junk food and high-strength alcohol being widely available. It is estimated that over 206,000 people in England are living with chronic hepatitis B, the majority of those cases undiagnosed and unlinked to care. Undetected, it can lead to cirrhosis, liver cancer and premature death caused by liver failure.

Liver disease is a silent killer that is often asymptomatic in its early stages. Shockingly, three quarters of people with cirrhosis are diagnosed in hospital when the damage is irreversible and it is too late for effective treatment or intervention. The impact of late diagnosis and crisis-point hospital admissions on our already overstretched NHS frontline services is pushing the hepatology workforce to breaking point, yet pressures are projected to increase at pace.

My own constituents are at the sharp end of this public health emergency. In Stockport, the premature mortality rate for liver disease in women has surged by 80% since the pandemic. In 2020, it was 12.5 per 100,000, and 2022, it was 22.5 per 100,000. In Stockport, the overall premature mortality rate from liver disease between 2020 and 2022—a three-year range—was 16.5% higher than the national average. I was greatly concerned to learn that the British Liver Trust’s “Love Your Liver” roadshow visit to Stockport last year identified that one in four members of the public had elevated fibroscan readings, which are indicative of liver damage.

Ethnic minorities are disproportionately impacted by liver disease. South Asian populations are particularly vulnerable to fatty liver disease, due to genetic and sociocultural factors, while migrants from countries where hepatitis B is endemic are at higher risk of developing liver cancer.

Liver disease patients also face stigma and misconceptions, which is hampering earlier detection and costing lives. Liver disease and liver cancer continue to be falsely labelled as self-inflicted, despite being linked to poverty and social deprivation. Almost half of patients with a liver condition have experienced stigma from healthcare professionals, according to recent surveys by the British Liver Trust.

Everyone at risk of liver disease and cancer should have equal access to faster diagnosis, no matter where they live. Accelerating earlier diagnosis is pivotal to tackling health inequalities and narrowing the gap in healthy life expectancy. Yet new research by the British Liver Trust shows that fewer than one in five integrated care systems in England currently have fully effective pathways in place for the early detection and management of liver disease. Alarmingly, my local ICS—Greater Manchester ICS—reported the highest premature mortality rate for liver disease in the country, but it is yet to implement an optimal pathway.

The evidence is overwhelming. We can and must do more to support liver disease and liver cancer patients across the UK. The next Labour Government will have a relentless focus on prevention and earlier diagnosis to turn the tide of this epidemic of preventable deaths. When the previous Labour Government first asked Professor Marmot to review health inequalities, then Prime Minister Gordon Brown said that

“the health inequalities we are talking about are not only unjust, condemning millions of men, women and children to avoidable ill-health, they also limit the development and the prosperity of communities, whole nations and even continents.”

Since then, we have had over a decade of austerity and deep cuts to public health, which have caused improvements in life expectancy to slow and even reverse. Health inequalities are widening and a growing number of people live a greater proportion of their lives in ill health.

We need to look upstream, which is why the next Labour Government will be committed to taking bold action to halt the promotion of junk food targeted at children that is high in fat, salt and sugar.

We also need to talk about early detection. To build an NHS fit for the future, Labour is committed to hitting all NHS cancer waiting time and early diagnosis targets within five years. Recently, I tabled a number of written parliamentary questions on this matter, and the answers do not fill me with confidence about the healthcare that my constituents are receiving. We also need to accelerate earlier detection by doubling the number of CT and MRI scanners in hospitals in England.

I urge the Minister to mirror this upstream focus on early detection by committing sustainable funding in the next spending review for new technology, in order to improve the early detection of liver disease in primary and community care. I also call on the Minister to introduce a new nationally endorsed pathology pathway to improve early diagnosis of liver disease and to ensure that every community diagnostic centre has an assessment for fibrosis.

Liver cancer is the fastest rising cause of cancer death in the UK. As one of the six least-survivable cancers, it has a shockingly poor five-year survival rate of just 13%. Yet public awareness remains very low, and liver cancer patients are overwhelmingly diagnosed at a later stage. Outcomes for many types of cancer have seen huge improvements over recent decades, yet deaths from liver cancer in the UK have increased by 40% in the last decade alone, hampered by the lack of funding, research and innovation.

Before I come to the end of my speech, I want to mention a couple of staggering points provided to me by Alcohol Change UK. Sadly, it is a fact that harm caused by alcohol is on the rise. The pandemic has had a serious impact on alcohol consumption in England. People are drinking at harmful levels and increasing their drinking. One in five people in the UK is drinking above the recommended weekly amount; many want to cut down. Alcohol causes the majority of liver disease, and drinking alcohol increases the risk of liver cancer.

Alcohol has become the leading risk factor for death and ill health among those aged 15 to 49 in England. Alcohol Change UK found, only this week, that alcohol-specific deaths in the UK are the worst on record— 32.8% higher than in 2019. In 2022, 76% of alcohol-specific deaths were caused by liver disease.

This is an extremely serious topic. I am grateful to the Backbench Business Committee for allocating time for the debate and I am grateful to everyone who has turned up in the Public Gallery, as well as to the Back-Bench MPs who have come to support the debate.

Private Rented Sector: Regulation

Debate between Gregory Campbell and Navendu Mishra

Wednesday 24th May 2023 Westminster Hall

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does the hon. Member agree that one factor that should be taken into account is Government support for greater availability of good-quality social housing, which would help to suppress the increase in rents? Allied with that, the Bill and the tax regime should pursue bad landlords, support good landlords and protect tenants at the same time.

[Navendu Mishra]

I agree, although my experience is that Stockport Homes, one of the major local social housing providers, has been struggling to secure properties because their cost has risen significantly. Recent census data shows that Stockport has seen a 48% increase in property values in the past five years, whereas the average in England is 20%. For social housing providers, securing or building new properties, particularly with the rising cost of building materials, is a significant financial commitment that many of them are not able to make. I agree that bad landlords need to be pursued. I do not think the enforcement regime is good enough. Of course, there are good landlords out there—I am not going to dispute that—but they often get tarred with the same brush that bad landlords leave us with.

The Renters (Reform) Bill is a positive step, but there are many loopholes. The rules around section 21, on landlords evicting tenants by claiming to move families in, need to be looked at. There is no provision on rising rents. It is unclear what the penalties will be for landlords who break the rules. There are so many loopholes that we need a serious discussion about how to deliver for people across England.

I have already mentioned the statistics on the average rent values in my constituency. I would like to conclude by making two further points. Owner-occupiers spend 18% of their household income on mortgage payments, while private renters spend 31% of their household income on rent. That is simply unfair, and it is also unsustainable. It is evident from the data for constituencies across England that many—not all—private landlords are making large amounts of money out of the cost of living crisis.

Yesterday, Labour MPs, along with those of several opposition parties, voted to end the unfair leasehold system. Labour is serious about reforming the housing sector; it is not just warm words. I am sorry to say that the Government have failed and continue to let down renters consistently, year after year. In 13-plus years of this Government, we have not seen serious action. I hope the Minister will address these points.