Liver Disease and Liver Cancer

Navendu Mishra Excerpts

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.

--- Later in debate ---

[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 ---

[Navendu Mishra]

I will end on a few remarks. I thank everyone who has contributed to this debate from the Front and Back Benches, though I am a bit surprised that we did not have any speakers from the Government Benches other than the Minister. This is an important issue for everyone.

The rate of hospital admissions for liver disease is higher in deprived areas. In 2021-22, there were 211.4 hospital admissions for every 100,000 people living in areas of multiple deprivation, compared with 125.1 in the least marginalised areas. That is quite serious. Additionally, I agree with the Minister about alcohol consumption; indeed, Alcohol Change UK made the point that it is not anti-alcohol, but against alcohol harm.

I will leave the Minister with a few questions. On a personal level, whenever I have gone to her with various issues, she has been extremely helpful and tried to do her best, but I think this is an important issue for the broader Government and the Department of Health and Social Care. I urge the Minister to take urgent action to improve earlier detection of liver cancer and the less survivable cancers. It is critical that the Government deliver on their pledge to diagnose 75% of all cancers at an early stage by 2030, which is the date I have written down—I think the Minister mentioned 2028, which is even better.

To reduce the staggering health inequalities we still face, the Minister must commit to delivering a cross-Government strategy to curb health inequalities and a prompt, comprehensive review of adult liver services by NHS England. We also need a comprehensive cross-Government alcohol strategy that tackles the social and commercial determinants of health. I also ask the Minister what assessments, if any, the Department has made of the inequalities impact of funding cuts to alcohol treatment services. Those are very serious issues.

I thank the shadow Minister, my hon. Friend the Member for Birmingham, Edgbaston (Preet Kaur Gill), for her contribution. I hope to work with the Government on this issue. Once again, I thank all the charities and campaign groups that do so much on it.

Question put and agreed to.

Resolved,

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