Found: provision of better and more integrated responses to physical and mental health – and from a liver

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps she has taken to tackle changes in the level of premature deaths caused by liver disease in women under 75 between 2001 and 2022.

Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)

Through the 2021 Drugs Strategy, we are making the largest ever single increase in drug and alcohol treatment and recovery funding, with £780 million of additional investment. Of this, £532 million is being invested to rebuild local authority commissioned drugs and alcohol treatment services in England. This is in addition to the funding invested through the Public Health Grant

By February 2024, the funding had enabled an additional 9,878 people to benefit from treatment for alcohol problems, where alcohol was their only substance misuse problem, and a further 6,258 people where, as well as their alcohol problems, they were also being treated for problems associated with non-opiate drug use.

Local authorities are responsible for understanding the drug and alcohol treatment needs of their local communities, and planning and commissioning services to meet that need, including ensuring women have good access to the most effective treatment. The Department supports them in doing this, with data and guidance.

The National Health Service’s piloting of early diagnosis and prevention through 19 community diagnostic hubs reached over 7000 people in 2022/23, and is identifying undiagnosed liver disease. The Community Liver Health Check pilot provides FibroScans in one-stop community clinics, where patients also have other investigations as required.

Beyond treatment and early diagnosis, we are committed to tackling alcohol harms, including reducing consumption levels, and in 2023 the Government introduced reforms to alcohol duty, meaning products are taxed directly in proportion to their alcohol content.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps she is taking to support the detection of liver disease in Washington and Sunderland West constituency.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The Northern Cancer Alliance (NCA) is supporting services to enable the early detection of liver disease across the North East and North Cumbria (NENC) Integrated Care Board (ICB), including in the Washington and Sunderland West Constituency. The focus of work has been to support liver services across NENC to invite more than 80% of patients with cirrhosis, a type of liver disease, to monthly ultrasound surveillance. For 2024/25, the NCA has invested just over £200,000 into trusts across NENC to help improve their monitoring systems for cirrhosis patients.

The NENC ICB is also enrolled in a Community Liver Health Check pilot in Newcastle, being delivered by the system’s Hepatitis C Operational Delivery Networks. This will provide FibroScans in one stop community clinics where patients have relevant blood testing, liver ultrasound, and other investigations, as required. The pilot has expanded into North Tyneside and when resources allow, they intend to develop additional clinics across the area.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps her Department is taking to reduce levels of liver disease in Darlington constituency.

Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)

Through the 2021 Drugs Strategy we are making the largest ever single increase in drug and alcohol treatment and recovery funding, with £780 million of additional investment. Of this, £532 million is being invested to rebuild local authority commissioned substance misuse treatment services in England. As alcohol and drug services are commissioned together, this will benefit people seeking treatment for alcohol use.

In the financial years 2022/23 to 2024/25, Darlington has been allocated just over £1.9 million through the Supplementary Substance Misuse Treatment and Recovery Grant and Inpatient Detoxification Grant, to increase the number of people benefiting from alcohol and drug treatment and recovery services, and the outcomes they achieve. This is additional to the amounts invested through the Public Health Grant.

Work in the National Health Service, specifically piloting early diagnosis and prevention through 19 community diagnostic hubs, is identifying undiagnosed liver disease. The North East and North Cumbria Integrated Care Board is enrolled in a Community Liver Health Check pilot in Newcastle, being delivered by the system’s Hepatitis C Operational Delivery Networks. This will provide FibroScans in one-stop community clinics, where patients also have other investigations, as required. The pilot has expanded into North Tyneside, and when resources allow, they intend to develop clinics elsewhere.

Beyond treatment, we are committed to tackling alcohol harms including reducing consumption levels, and in 2023 the Government introduced reforms to alcohol duty, meaning products are taxed directly in proportion to their alcohol content.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether she has made an estimate of expected liver cancer mortality rates by the end of 2025.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

No estimate has been made of expected liver cancer mortality rates by the end of 2025. The care of and treatment for patients with cancer, including liver cancer, is a priority for the Government. Early diagnosis of liver cancer is critical to improving rates of survival. NHS England’s Early Diagnosis of Liver Cancer Programme is contributing to the NHS Long Term Plan’s commitment to diagnose 75% of all cancers at stage one or two by 2028. This programme includes three workstreams: improving liver surveillance programmes; community liver health checks pilots; and primary care pilots. Identifying those at risk and ensuring patients are tested and referred to a surveillance programme, where necessary, will lead to improved patient outcomes.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what recent assessment she has made of the effectiveness of (a) community liver health checks, (b) primary care pilots and (c) surveillance for hepatocellular carcinoma as part of NHS England's early detection of liver cancer programme.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The care of and treatment for patients with cancers, including liver cancer, is a priority for the Government. National Health Service cancer standards have been reformed with the support of clinicians to speed up diagnosis for patients, which means people will receive a diagnosis or have cancer ruled out within 28 days from urgent cancer referral from their general practice. NHS England’s Early diagnosis of Liver Cancer Programme is contributing to deliver the NHS Long Term Plan’s commitment to diagnose 75% of all cancers at stage one or two by 2028.  Identifying those at risk and ensuring patients are tested and referred to a surveillance programme, where necessary, will lead to improved patient outcomes.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, with reference to the letter of 7 March 2023 from the then Minister for Social Care to the Chief Executive of the British Liver Trust, whether it remains his policy that fibroscans will be in use at 100 community diagnostic centres by March 2025; how many fibroscans have been delivered to community diagnostic centres since March 2023; and whether he has made an assessment of the potential merits of setting a new target.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

There is currently no national target specifically relating to the availability of FibroScan equipment, or testing for liver fibrosis, through Community Diagnostic Centres (CDCs) in England by March 2025.

The CDC modality offer is based on the recommendations in the Sir Mike Richards Review, in which Fibroscans were included as a suitable optional additional test for use in CDCs. Decisions on what modalities are offered outside of the core requirements of CDCs will be based on local need and decisions.

I can confirm there are currently plans for 12 CDCs to offer FibroScan testing, of which seven are operational. A further five CDCs plan to offer this service by the end of March 2024.

However, the Government takes very seriously the importance of preventative action, and of identifying patients at risk of liver disease and diagnosing it earlier. It is a fast-growing cause of mortality and morbidity; and one we want to make progress in tackling.

The Government is working with the National Health Service to support earlier diagnosis of liver disease and identifying patients at risk. This includes plans agreed as part of the £2.3 billion diagnostics transformation programme, including upgrading laboratory digital capabilities to ensure that labs across the country have the capability required to offer Intelligent Liver Function Tests. This test is highly effective as a first line diagnostic test to identify patients at higher risk, who may benefit from a FibroScan, or enhanced Liver function test.

The Government is also working with the NHS to deliver and consider the result from the pilot of the community liver health check programme – which in its first year delivered over 17,000 FibroScans to individuals at particular risk of liver disease, through the use of 40 FibroScanners, 12 of which were located in mobile units, across 19 local areas. This is in addition to wider work on health prevention, including vaccination and alcohol awareness programmes.

The Government will continue to look at options to go further. Over the coming year, NHS England are due to pilot a new diagnostic pathway it has developed for liver disease, which will include Fibrosis scanning in CDCs – we look forward to seeing the results of that pilot.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps she is taking to support the detection of liver disease in Darlington constituency.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The Northern Cancer Alliance (NCA) is supporting services to enable the early detection of liver disease across North East and North Cumbria Integrated Care Board (ICB). More than 80% of patients with liver cirrhosis, a type of liver disease, have been invited to monthly ultrasound surveillance. For 2024/25, the NCA has invested over £200k into trusts across the ICB to help improve their monitoring systems for cirrhosis patients. This investment has also included £30,000 for County Durham and Darlington NHS Foundation Trust who will be using their funds to improve systems in relation to call and recall of patients to their six-monthly checks.

The ICB is also enrolled in a Community Liver Health Check pilot in Newcastle, being delivered by the systems Hepatitis C Operational Delivery Networks. This will provide FibroScans in one stop community clinics where patients have relevant blood testing, liver ultrasound and other investigations as required. The pilot has expanded into North Tyneside and when resources allow, they intend to develop clinics elsewhere including Gateshead and Sunderland.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps her Department is taking to increase access to FibroScan testing for liver fibrosis through Community Diagnostic Centres.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

There are currently plans for 12 community diagnostic centres (CDCs) to offer FibroScan testing, of which six are operational. A further six CDCs plan to offer this service by the end of March 2024.

The CDC core diagnostic tests offer is based on the recommendations in the Sir Mike Richards Review, and decisions on what tests are offered outside of the core requirements of CDCs is taken at a local level based on need.

The Government is working with the National Health Service to support earlier diagnosis of liver disease and identifying patients at risk. This includes plans for upgrading laboratory digital capabilities as part of the £2.3 billion diagnostics transformation programme, to ensure that labs across the country have the capability to offer Intelligent Liver Function Tests, that can effectively and quickly identify patients at high risk of advanced fibrosis.

The Government is also working with the NHS to deliver and consider the result from the pilot of the community liver health check programme, which is due to deliver 22,000 FibroScans per year to communities at particular risk of liver disease. From June 2022 to September 2023, over 26,500 FibroScans were delivered through the pilots, and 8% of people scanned have already been enrolled into liver surveillance programmes. The programme is being delivered across 19 areas by Hepatitis C Operational Delivery Networks to FibroScan patients at high risk of cirrhosis or advanced fibrosis, utilising 40 FibroScan machines.

NHS England is reviewing existing liver diagnosis pathways as part of its wider diagnostic transformation work, to determine what the best approach should be to identify patients at an earlier stage of liver disease, through a liver pathway starting in primary care and involving pathology labs and CDCs. This will include a combination of blood tests and FibroScans.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps her Department is taking to help improve the diagnosis of liver disease.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

There are currently plans for 12 community diagnostic centres (CDCs) to offer FibroScan testing, of which six are operational. A further six CDCs plan to offer this service by the end of March 2024.

The CDC core diagnostic tests offer is based on the recommendations in the Sir Mike Richards Review, and decisions on what tests are offered outside of the core requirements of CDCs is taken at a local level based on need.

The Government is working with the National Health Service to support earlier diagnosis of liver disease and identifying patients at risk. This includes plans for upgrading laboratory digital capabilities as part of the £2.3 billion diagnostics transformation programme, to ensure that labs across the country have the capability to offer Intelligent Liver Function Tests, that can effectively and quickly identify patients at high risk of advanced fibrosis.

The Government is also working with the NHS to deliver and consider the result from the pilot of the community liver health check programme, which is due to deliver 22,000 FibroScans per year to communities at particular risk of liver disease. From June 2022 to September 2023, over 26,500 FibroScans were delivered through the pilots, and 8% of people scanned have already been enrolled into liver surveillance programmes. The programme is being delivered across 19 areas by Hepatitis C Operational Delivery Networks to FibroScan patients at high risk of cirrhosis or advanced fibrosis, utilising 40 FibroScan machines.

NHS England is reviewing existing liver diagnosis pathways as part of its wider diagnostic transformation work, to determine what the best approach should be to identify patients at an earlier stage of liver disease, through a liver pathway starting in primary care and involving pathology labs and CDCs. This will include a combination of blood tests and FibroScans.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps she is taking to reduce geographic variations in the provision of non-invasive liver scans in community diagnostic centres.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

FibroScan capacity is being increased across England via the Community Diagnostics Centre (CDC) programme, backed as part of a £2.3 billion investment in diagnostic transformation. The National Health Service currently plans for 11 sites to be live with FibroScans by the end of this financial year, with seven presently live with the test. By March 2025 we expect there to be 15 CDCs offering FibroScans.

The CDC test offer is based on the recommendations in the Sir Mike Richards Review, and decisions on what modalities are offered outside of the core requirements of CDCs, including FibroScans, will be based on local need as well as local funding decisions and considerations.

Through the £2.3 billion diagnostics transformation programme, NHS England is ensuring that laboratories across the country have the digital capability required to offer Intelligent Liver Function Tests.

The NHS is also delivering and considering the result from the pilot of the community liver health check programme, which is due to deliver 22,000 FibroScans per year to communities at particular risk of liver disease. From June 2022 to September 2023, over 26,500 FibroScans were delivered through the pilots, and 8% of people scanned have already been enrolled into liver surveillance programmes. The programme is being delivered across 19 areas by Hepatitis C Operational Delivery Networks to FibroScan patients at high risk of cirrhosis or advanced fibrosis, utilising 40 FibroScan machines.

NHS England is reviewing existing liver diagnosis pathways as part of its wider diagnostic transformation work, to determine what the best approach should be to identify patients at an earlier stage of liver disease, through a liver pathway starting in primary care and involving pathology labs and CDCs. This will include a combination of blood tests and FibroScans.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what assessment she has made of the potential merits of expanding the FibroScan rollout to community diagnostic centres in areas with high prevalence of liver disease.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

There are currently plans for 12 community diagnostic centres (CDCs) to offer FibroScan testing, of which five are currently operational. A further seven CDCs plan to offer this service by the end of March 2024.

The CDC modality offer is based on the recommendations in the Sir Mike Richards Review, and decisions on what modalities are offered outside of the core requirements of CDCs will be based on local need and decisions. The Government is working with the National Health Service to deliver and consider the result from the pilot of the community liver health check programme, which in its first year delivered over 17,000 FibroScans to individuals at particular risk of cirrhosis or advanced fibrosis, using 40 FibroScanners, across 19 local areas.

25th Anniversary of the Royal Victoria Hospital Liver Support Group

Found: the previous overall lung cancer early diagnosis rate of 28% • in 2022/23, we launched Community Liver