Liver Disease and Liver Cancer: Diagnosis

Wayne David Excerpts

Tuesday 11th October 2022 Westminster Hall

[Wayne David (Caerphilly) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Betts.

I congratulate the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) on her excellent contribution. I also thank her for her tremendous commitment to the work of the all-party parliamentary group on liver disease and liver cancer, which is really appreciated.

This is an important debate, and I speak as the chair of the APPG on liver disease and liver cancer. As we have heard, unfortunately the incidence of liver disease is increasing dramatically, although 90% of liver disease is clearly preventable. However, it has to be addressed in its early stages. Worryingly, three quarters of people with cirrhosis are diagnosed when it is too late for effective intervention or treatment. To say that there is a liver disease public health emergency in our country is not an exaggeration. That needs to be addressed, and addressed urgently.

These days, in particular over the past two years, we hear a great deal about levelling up, but it is important that we see a health aspect to that agenda as well. It is truly shocking that liver disease deaths are four times higher in deprived areas. In those areas, people with liver disease die 10 years earlier than people with the disease in the most affluent areas. That needs to be addressed as part of a wider debate about creating a more balanced and equal society.

A short time ago, the British Liver Trust conducted a survey, which was published in the British Journal of General Practice in August last year. The survey identified widespread variation in the identification, treatment and management of chronic liver disease in primary care. It found that only 26% of local health bodies have an effective patient pathway in place for the early detection of liver disease. That survey was reinforced by the fact that a number of Members of Parliament wrote to their local health bodies: in total, 31 letters were sent by parliamentarians to their relevant health bodies to call for urgent action to improve liver disease pathways. Sadly, good practice is a postcode lottery.

It is important to bear in mind that we are not just talking about an abstract disease but about real people in terrible circumstances. Last July, the all-party parliamentary group on liver disease and liver cancer took evidence on the need for a comprehensive review of adult liver services in this country. We heard from a patient called Steve, who gave a moving address. He shared his experience of running a business for some 36 years and fighting for his life in accident and emergency with end-stage liver failure. Steve fell through gaps in the system and faced a life-threatening late diagnosis, due to the stigma that has been referred to, which is all too prevalent in this disease. He was discharged from A&E with little more than a dietitian’s sheet. He did not have access to any support or resources, and had no idea how to manage his condition. Steve’s story is a poignant reminder that we need urgently to improve the quality of care for people at risk of liver disease across the United Kingdom.

There is hope across the United Kingdom. In particular, under the leadership of the Welsh Government, Wales was the first UK country to introduce a dedicated liver disease delivery plan in 2015. The all-Wales liver blood test pathway is providing for the early diagnosis and management of liver disease across the whole of Wales. I am very pleased that the work was based initially on the local pilot project in Gwent, from which I come, and ensured an 81% increase in diagnosis of cirrhosis at a treatable stage.

Yesterday I was pleased to receive a letter from the deputy head of external affairs for NHS England. I thought, “Good! He has something positive to announce in readiness for this debate.” However, I was disappointed, because the letter says that “internal discussions” have taken place about whether there should be a review of adult services, and if there is, it will be done in the future. I think we have gone beyond that stage. The evidence is there. We need to go beyond discussing whether we should have the review—we should get on and do it.

The letter is disappointing and I urge the Minister to ensure that England is not left behind in the early diagnosis of liver disease. We urgently need a new, nationally endorsed pathology pathway that will save lives, drastically improve early diagnosis and transform outcomes for liver disease patients.

[Several hon. Members rose—]