Many of the UK’s leading liver disease clinicians, policy makers and a small number of interested Members of Parliament met on the 22nd April 2021 to discuss how the recommendations from the latest Lancet Commission report could be turned into action.
The Foundation for Liver Research and the British Liver Trust jointly hosted the virtual launch of the Lancet Commission’s final and Seventh Report into Liver Disease: ‘New Dimensions for Hospital Services and Early Detection of Disease’.
The report addresses the unacceptably high mortality of patients with liver disease and promotes the need for an integrated approach to reduce mortality levels and improve care.
Pamela Healy, Chief Executive of the British Liver Trust, opened the event welcoming over a hundred guests.
Alex Norris MP, Shadow Minister for Public Health and Patient Safety, set the context, highlighting the sharp increase in liver disease over the last few decades and the cross-cutting environmental factors impacting liver disease, including alcohol and obesity, which have underpinned the significant increase in liver disease compared to other key major diseases. Mr Norris highlighted that 90% of liver disease is preventable and that it is also the biggest cause of death in his age group of 35-49 year olds. A number of other MPs and policy makers also attended the event.
Professor Sir Ian Gilmore, chaired the discussions which focused on how the clinical community could work with policy makers and politicians to turn the recommendation in the report into action.
There were a number of emerging themes across the presentations around strengthening collaboration, environmental drivers of health inequalities and Covid impacts, and the next steps to ‘turning the tide on liver disease’.
Collaboration, networks and champions
Collaboration was a key emerging theme from speakers who emphasised the need to share knowledge and best practice, build networks and place champions across healthcare teams to improve outcomes. Dr Helen Jarvis focused on the challenges around early detection of liver disease in primary care, advocating for collaborative community pathways and developing consensus around the policy agenda and networks of interested GPs to share best practice.
On the secondary care side, Professor Graham Foster, discussed improving survival rates from liver disease by transforming secondary care. Prof. Foster emphasised the need for every secondary care hospital to have a liver disease champion or lead. Smaller hospitals without specialist care should form networks so that they can easily refer more serious cases to specialist centres.
The liver disease networks would adopt a similar approach to that currently seen in stroke and heart attack care. He also observed the need for attitudinal change to embrace a more collaborative culture – so that clinicians can ensure patients get the best possible care.
Environment drivers of health inequalities and coronavirus
Political and clinical speakers emphasised the overwhelming impact of physical, social and economic factors that impact lifestyle, 90% of these factors drive health inequalities. Professor of Global Public Health, Harry Rutter, concluded that these environmental factors create social patterns leading to major health inequalities. Our response must therefore also focus on behavioural change to improve outcomes in liver disease.
Professor Colin Drummond discussed the rise in alcohol related hospital admissions since the start of the century and, in parallel, cuts to addiction services. He advocated for the expansion of alcohol care teams in acute hospitals. There was also a recognition of the need to tackle stigma around liver disease at a societal, political and clinical level.
The Report advocates for the need to respond to health inequality through fiscal and other regulatory measures to reduce the prevalence of obesity. These measures include the food sugar levy and the introduction of the minimum unit price policy to reduce alcohol consumption.
Turning the tide on liver disease
Shadow Health Minister, Alex Norris, reflected on the importance of prioritising liver disease and emphasised the need to rebuild better after Covid and to reconfigure services.
While there is a long road to levelling up outcomes in liver disease, Dr Jarvis reflected on ‘where are we now’. Early detection of liver disease in primary care since the start of the Lancet commission in 2017, has significantly improved. Liver disease was not previously on the agenda, there was general ignorance of the disease in primary care and limited knowledge on non-invasive testing and non-alcohol related liver disease (NAFLD). Liver disease is now included in the GP training curriculum, it is part of health checks in community-based early detection pathways and there is much wider collaboration. Graham Foster characterised the ‘spectacular progress’ that has been made to date but recognised there is still a long way to go.
The event included a tribute to the late Professor Roger Williams CBE, recognising his considerable contribution to the Lancet Commission and long and illustrious career.
Natalie Day, CEO of the Foundation for Liver Research, wrapped up proceedings thanking the 70 clinicians who had contributed to the Commission since its inception. She also announced that the Foundation will be working more closely with the British Liver Trust moving forward.
Pamela Healy, CEO of the Trust said “I am delighted that we will be working more closely with the Foundation for Liver Research in the future. By working together, we believe we will be able to have a louder voice and achieve real change in progressing the work of the Lancet Liver Commission and driving up standards of care for patients.”