New research conducted by the Trust and published in the British Journal of General Practice has revealed significant discrepancies across the UK in the pathways for diagnosing and managing liver disease, putting thousands of lives at risk. Wales is leading the way with more comprehensive coverage of early detection pathways, while 80% of England lacks an effective pathway.
An effective early detection pathway includes case finding those most at risk, effectively assessing abnormal liver blood tests in line with national guidance, an assessment for liver fibrosis, and appropriate referral to secondary care.
The research team surveyed all of the Integrated Care Boards in England as well as the similar relevant bodies in Scotland, Wales and Northern Ireland to determine the current provision of commissioned pathways for people with early stage liver disease. They looked at how widely the recommended diagnostic tests, such as assessments for liver fibrosis, were being used and explored whether there were processes in place to identify and monitor those most at risk.
The results revealed that:
- Scotland now has comprehensive primary care pathways in 69% of areas, compared to 42% in 2020, with much greater coverage of early detection pathways than England and Northern Ireland.
- England falls behind both Scotland and Wales, both of which have greater coverage of early detection pathways.
- Wales now has 100% coverage of comprehensive pathways of care for liver disease available in all health boards, compared to 36% across the rest of the UK.
- Only 27% of Integrated Care Boards (ICBs) in England had a named individual responsible for liver disease, which is essential for coordinating efforts to diagnose and manage the condition.
- 80% of England does not have an effective pathway for the early detection of liver disease despite the huge rises in numbers of deaths as a result of liver disease.
- Only 52% of the Independent Care Boards in England have access to a fibrosis or liver scarring assessment which is vital to assess early stage disease.
- Wales is the only UK nation where all of the Health Boards proactively recognise alcohol consumption and diabetes as risk factors, so that patients at risk of liver disease can be diagnosed and effectively managed. This is as a result of the 2021 introduction of the All-Wales Liver Blood Test Pathway, which aims to improve the early detection and management of liver disease across all 7 Health Boards across the country.
- Northern Ireland did not report any effective pathways at all in primary care.
Although 90% of liver disease is preventable, the UK saw a 27% increase in deaths from liver disease between 2019 and 2023, and this is only rising.
The new data highlights the urgent need for nationwide improvements to detect liver disease early, which will save NHS money and prevent thousands of avoidable premature deaths. The British Liver Trust is calling for:
- Effective early detection pathways to be implemented in every region, to identify and test anyone at higher risk but who currently don’t have symptoms.
- Assessment for liver fibrosis or scarring assessments for those whose basic blood tests are abnormal and, where appropriate, referral to specialist care. The risk factors for liver disease should be included in routine health checks for conditions such as diabetes and obesity across all community healthcare settings.
Dr Helen Jarvis, Clinical Advisor for the British Liver Trust and lead author of the research, said: “Everyone with liver disease, or at risk of developing it, should have access to essential medical care and advice, no matter where they live in the UK. GPs and primary care professionals are working tirelessly under challenging conditions, but often within a system that limits their ability to properly diagnose and treat liver disease.”
British Liver Trust Chief Executive, Pamela Healy OBE, said:
“Our research shows that when it comes to the early detection of liver disease, there is a postcode lottery. Although there have been some improvements since the last survey and there are pockets of good practice – this variation is not good enough and widespread preventative measures are woefully inadequate. We need to ensure that there is an effective pathway right across the UK so that everyone has equal access to care.”
But Pamela also praised the positive work that is being carried out in Wales and highlighted the lessons that could be learned by the other UK nations:
“The work in Wales to improve liver disease diagnosis, treatment and care serves as an excellent example for the rest of the UK on how to tackle the growing challenge of liver disease in the UK. We need the rest of the UK to take a similar approach to Wales, by implementing a national liver disease delivery plan to effectively identity and manage at-risk patients before their symptoms start to cause a problem.”
Welsh media were eager to shine a light on how their nation is leading the way in the early identification of liver disease, and our research was covered across much of the Welsh national and regional newspapers and websites. And although Scottish media highlighted the improvements in the development of pathways, they led with concerns about the rising death rates from liver disease.
An effective early detection pathway includes case finding those most at risk, effectively assessing abnormal liver blood tests in line with national guidance, an assessment for liver fibrosis, and appropriate referral to secondary care.
Professor Stephen Ryder, Consultant Hepatologist, said “If we are to tackle the huge increases in the numbers of people dying from liver disease then prevention and early diagnosis are key. We need joined up effective pathways that link primary care and secondary care together to ensure more people are diagnosed early and receive treatment as soon as possible.”
The survey was a repeat of a survey first undertaken in 2020 and published in 2021.