In a major new Lancet Commission, led by Professor Roger Williams, Director of the Institute of Hepatology, London, UK, doctors and medical scientists from across the UK call for a radical scale up of liver disease treatment and detection facilities in the country, which has one of the worst rates of death from liver disease in Europe.
The UK is the only country in western Europe (except Finland) where the prevalence of liver disease has increased in the past three decades, and the rate of death from the disease for those under the age of 65 years has increased by almost 500% since 1970.
"There is a human, social, and financial imperative to act now if the UK's burden of liver disease and all its consequences are to be tackled and the NHS is not to be overwhelmed by the cost of treating advanced stage liver disease," says Professor Williams.
Although 1 in 10 people in the UK will experience liver disease at some stage in their lifetime, the Commission shows that nationally, early detection of liver disease through primary care services (such as GPs and walk-in centres) is virtually non-existent, despite the fact that the disease is much more effectively treated when identified early.
As a recent Public Health England (PHE) report showed, the burden of liver disease in different regions of the UK is closely linked to socioeconomic deprivation, with areas such as the north west of England experiencing nearly four times as many deaths from liver disease as more affluent areas.
Despite the fact that these regions experience a far greater burden of death and illness from liver disease, the Commission shows that specialist treatment services for liver disease in its advanced stages are unevenly distributed throughout the UK, with some of the regions most badly affected having inadequate specialist provision, leading to a postcode lottery for patients which is resulting in unacceptable rates of death and illness in many regions of the UK.
As well as improving treatment and detection services, the Commission demonstrates that a powerful commitment is needed from UK policymakers to implement policies which address the lifestyle factors leading to most death and illness from liver disease, especially excessive alcohol use and obesity. This includes recommendations to implement minimum pricing policies for alcohol, prominent health warnings on alcohol packaging, and regulation of sugar content in food and soft drinks.
The Commission provides a cost-effective and achievable blueprint for improving hospital care for people with severe liver disease, by recommending that Liver Units providing acute services are established in every District General Hospital in the UK, linked with 30 Specialist Centres -- for more complicated cases -- distributed equitably around the country. Screening of high risk individuals using new diagnostic techniques are part of proposed improvements at GP and community level.The authors also recommend a review of the transplant services to ensure better access for patients in some areas of the country, and to ensure sufficient capacity for an anticipated 50% increase in availability of donor organs by 2020.
Although the report highlights shortcomings of the current national provision for liver disease in adults, it shows that UK services for childhood liver disease -including genetic disorders or viral infection -- could, in terms of their centralised funding and organisation, provide a positive example for improving adult services.
The report also suggests that another major cause of liver disease, hepatitis C, could be eliminated from the UK by 2030, now that safe and highly effective antiviral drugs are available. The spread of hepatitis B also needs to be controlled, with monitoring of immigrants from countries with high prevalence of the infection bringing new infections into the country a priority.
According to Professor Williams, "This Commission builds on recent work by the All Party Parliamentary Group on Hepatology and Public Health England, amongst others, to clearly identify the scale of the problem posed by liver disease in the UK, and current deficiencies in NHS care provision. The evidence outlined in the report, contributed by some of the UK's leading experts in the field, should leave nobody in any doubt about the present unacceptable levels of premature death and the overall poor standards of care being afforded to liver patients."
"The good news is that if our recommendations -- many of which will require additional government regulatory action -- are followed, deaths from liver disease will fall, with profound benefits in health and social wellbeing and economic productivity, as well as reduced costs for the NHS. However, the health and policy reforms we are recommending need to take place now -- the scale of the problem is too great for it to take second place to short-term political considerations."
- Roger Williams, Richard Aspinall, Mark Bellis, Ginette Camps-Walsh, Matthew Cramp, Anil Dhawan, James Ferguson, Dan Forton, Graham Foster, Sir Ian Gilmore, Matthew Hickman, Mark Hudson, Deirdre Kelly, Andrew Langford, Martin Lombard, Louise Longworth, Natasha Martin, Kieran Moriarty, Philip Newsome, John O'Grady, Rachel Pryke, Harry Rutter, Stephen Ryder, Nick Sheron, Tom Smith. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. The Lancet, 2014; DOI: 10.1016/S0140-6736(14)61838-9