Liver health updates

July 2020 APPG on Liver Health update

APPG on Liver Health news

APPG on Liver Health Vice Chair Virendra Sharma MP this month tabled two Parliamentary Questions regarding hepatitis C, one asking for 2019-20 hepatitis C treatment rates by operational delivery network area and the other asking whether the Health and Social Care Secretary has made an assessment of the potential merits of including hepatitis C in the Public Health England (PHE) Public Health Outcomes Framework.

For both questions, the Department of Health and Social Care has indicated that it will not be possible to answer the question within the usual time period, saying an answer is being prepared and will be provided as soon as it is available.

Liver news

Guidance for those advised to ‘shield’ during the Covid-19 outbreak will change on 6th July and end on 31st July. British Liver Trust has updated its FAQs on shielding in all four nations of the UK here.

Outreach projects by NHS Trusts, The Hepatitis C Trust and other partners have been taking place across the country offering screening for hepatitis C and liver damage to previously homeless individuals being accommodated in hotels and hostels during the Covid-19 outbreak. A summary of the outreach work being done in Surrey is available here and in Leeds here.

HCV Action held a webinar on hepatitis C services in England during and beyond the Covid-19 outbreak on 18th June, featuring speakers from NHS England, The Hepatitis C Trust, substance misuse service Change Grow Live and the Nottingham Hepatitis C Operational Delivery Network. The full webinar can be viewed here and a summary report is available here. A webinar on hepatitis C services in Scotland during and beyond the Covid-19 outbreak will be taking place on 4th August at 2.30pm. You can see further details and register here.

The Alcohol Health Alliance is holding a ‘virtual drop-in’ for MPs on alcohol harm and Covid-19, taking place on 15th July. Further details here.

British Liver Trust has warned of a potential future rise in non-alcohol related fatty liver disease (NAFLD) following a new survey which revealed that four out of ten people in the UK have gained weight during lockdown. Read more on the warning here.

The BMJ reported on new analysis by Public Health Scotland the University of Glasgow showing that alcohol sales from supermarkets and off-licences in Scotland fell by 4-5% in the year after minimum unit pricing (MUP) was introduced in May 2018. There has been no further reduction in consumption since, although this means alcohol consumption in Scotland remains at its lowest level since 1994. Read a summary of the report here. The World Health Organization (WHO) praised the “promising” evidence for Scotland’s MUP cutting alcohol consumption in a report, but suggested linking MUP to inflation in order to ensure that the positive impacts will last. Read a summary here.

An editorial in The Lancet Gastroenterology and Hepatology argued that alcohol-related harm may have been exacerbated by the Covid-19 pandemic and that action to address the problem cannot wait until the pandemic is under control. Read the editorial here.

New research published in The Lancet Gastroenterology and Hepatology this month found that people on opioid substitution therapy (OST) are twice as likely to clear hepatitis C if they receive medication from their community pharmacist than through conventional care pathways. The APPG on Liver Health has previously lobbied ministers to remove barriers to delivering hepatitis C medication through community pharmacies. A summary of the findings can be accessed here.

The Journal of Viral Hepatitis published new research which identified barriers to uptake of hepatitis C tests among people in prison. The main themes were ‘Fear, Insufficient Knowledge, Stigma, Privacy, Choice and Prison Life’, with the authors concluding that “providing information to people in prison about HCV transmission and treatment may reduce fears and enable the test uptake target to be met.” The paper can be accessed here.

A new blog by substance misuse service provider We Are With You focused on the need to provide support to ‘the hidden generation of drinkers’ – those aged over 50 – noting that the number of alcohol-related deaths among over-50s has increased by 45% since 2001. Read the full piece here.

Relevant parliamentary activity

Parliamentary debates

During a debate on the Finance Bill in the House of Commons on 16th June, Wes Streeting MP pressed Treasury Minister Kemi Badenoch on whether the Government’s forthcoming alcohol duty review will take into account the case for MUP.

Parliamentary Questions

In response to a question from Daisy Cooper MP, Health Minister Helen Whately revealed that an estimated 122 liver transplants have been unable to take place during the Covid-19 outbreak.

Richard Holden MP asked the Department of Health and Social Care to respond to the Lancet Commission on Liver Disease’s latest report. Health Minister Helen Whately said that NHS England’s Hepatobiliary Clinical Reference Group has already taken action in response, such as starting work on the development of liver networks in England, and that the Department is also taking action regarding key liver disease risk factors such as excessive alcohol consumption and obesity, referring to the prevention green paper.

Baroness Bennett asked what steps the Government is taking to increase provision of services to address alcohol-related issues related to any increase in the consumption of alcohol during the Covid-19 pandemic. Health Minister Lord Bethell said that NHS England and NHS Improvement have published a specialty guide for alcohol dependence to support clinicians in acute and mental health trusts treating patients with alcohol dependence. Additionally, a national alcohol clinical expert network has been established to provide advice and support.

Fiona Bruce MP asked a question (yet to be answered) on what assessment DHSC has made of trends in the level of alcohol use during the Covid-19 lockdown and received an answer to a question on steps the DHSC is taking to prevent a rise in alcohol use during the Covid-19 outbreak, which referred to the availability of PHE guidance.

June 2020 APPG on Liver Health update

APPG on Liver Health news

Prior to the Spring Budget, APPG on Liver Health Co-Chair Sir David Amess wrote to the Chancellor calling for alcohol duty reform to tackle alcohol harms. Sir David received a response from Treasury Minister Kemi Badenoch at the beginning of May saying that the Government “recognises the importance of having a fiscally responsible alcohol duty regime” but that the Treasury “aims to strike a balance between addressing alcohol harms, raising revenue for the Exchequer, and supporting producers and consumers”. The letter further states that “alcohol duties are not the only mechanism for tackling harms”, citing an increase in the Public Health Grant to local authorities and the roll-out of Alcohol Care Teams as part of the NHS Long Term Plan.

Liver News

Parliament this month passed regulations to move to an ‘opt-out’ system for organ donation in England, meaning that all adults will be considered organ donors when they die, unless the family intervenes or the individual had previously stated that they wish to opt out. The new measures, which are expected to lead to an increase in liver donations, were welcomed by the British Liver Trust when they were initially proposed by the Government in August 2018 . Read more about the new system here.

Public Health England this month released the latest annual Hepatitis C in England report. PHE now estimates that 89,000 people have a chronic HCV infection in England, down from 99,000 last year. The report states that HCV-related liver transplantations have halved over the last decade, from 18% in 2009 to 9% in 2018. A total of 11,756 people accessed treatment in 2018/19, up 2% on the previous year and 131% on pre-2015 levels when the drugs were made widely available. However, the report makes clear that more must be done to reduce new infection rates and make improvements in harm reduction provision so that these gains are maintained. The full report can be read here.

HCV Action will be hosting a webinar on hepatitis C services during and beyond the Covid-19 outbreak, which will involve a discussion on how hepatitis C services have been affected in different areas of the country and how services can most effectively be re-established as we emerge from the early phase of the outbreak. The webinar will feature contributions from Mark Gillyon-Powell from NHS England, Dr Steve Ryder from the Nottingham Hepatitis C Operational Delivery Network and Rachel Halford from The Hepatitis C Trust. Further details and registration are here.

People with liver disease are among those who have been informed by text message that they have been dropped from the Government’s coronavirus shielding list. The British Liver Trust has complained to the Department of Health and Social Care (DHSC), noting that DHSC guidance says that people should have been contacted by their consultant in the first instance, rather than receiving a text as the first piece of communication. Read more here.

The Institute of Alcohol Studies has released a briefing marking one year from the introduction of Minimum Unit Pricing (MUP) in Scotland. Their analysis of the evidence suggests the introduction of MUP has reduced alcohol consumption in Scotland but that evidence of the impact on health harms is, so far, less conclusive. Read the briefing here.

Baroness Finlay, Chair of the Commission on Alcohol Harm, and Sir Ian Gilmore, Chair of the Alcohol Health Alliance, warned in a British Medical Journal article that alcohol-related harms may have increased during lockdown, and argued that tackling harmful drinking will be “an integral part of the nation’s recovery” from Covid-19. Read the article here.

Drug and alcohol service provider We Are With You (previously Addaction) commissioned a YouGov poll which found that people are drinking more in lockdown but accessing health services less. The research findings are outlined in this report, which argues that the Covid-19 outbreak means new forms of support for people experiencing issues with drugs, alcohol or mental health is vital.

Interim data on outcomes for people with liver cirrhosis who contract Covid-19 was published in a letter to the Journal of Hepatology. The authors conclude that “accepting that data from registries are subject to selection bias, preliminary findings suggest that baseline liver disease severity is strongly associated with COVID-19-related morbidity and mortality.” The letter can be read here.

Relevant parliamentary activity

Parliamentary Questions

Dr Luke Evans MP asked the Health Secretary what steps his Department is taking to increase the five-year survival rates for the least survivable cancers, including liver cancer.  

Alex Norris MP asked whether the Department of Health and Social Care has made any assessment on levels of tobacco and alcohol use during the Covid-19 outbreak.

Neil Coyle MP asked what plans the Government has to recommence drug and alcohol cessation support services once Covid-19 lockdown restrictions have ended.

Baroness Bennett of Manor Castle asked what steps the Government are taking to increase provision of services to address alcohol-related issues related to any increase in the consumption of alcohol during the Covid-19 pandemic.

May 2020 APPG on Liver Health update

Liver News

Alcohol Change UK released findings of research into changes in drinking habits during lockdown. The research found a mixed picture, with around a third of respondents having stopped or reduced their drinking, but around a fifth (21%) saying they are drinking more frequently since the lockdown was implemented. While almost half of drinkers said they are drinking about the same amount on a typical drinking day, 15% said they have been drinking more per session since lockdown. The full report from Alcohol Change UK can be found here.

New research, reported in The Guardian and elsewhere, has found that almost 18,000 more people could die from cancer over the next year in England due to the impact of COVID-19. Pamala Healy, Chief Executive of the British Liver Trust, called the findings “highly concerning” and noted that “liver cancer is one of the least survivable cancers in the UK and even before the COVID-19 pandemic, the majority of patients were being diagnosed far too late to receive effective treatment”.

The COVID-Hep Registry has been established to monitor the impact of COVID-19 on patients with liver disease, with data submitted so far showing “ongoing high rates of mortality in patients with cirrhosis and COVID-19”. Read the latest update here.

HCV Action has published an overview of how hepatitis C services are operating across the UK in light of changes to the health service in response to COVID-19. The overview can be read in full here.

The Hepatitis C Trust has produced a resource on harm reduction advice for people who use drugs during the COVID-19 pandemic, which can be accessed here.

The National Institute for Health and Care Excellence (NICE) has released guidance for the management of gastrointestinal and liver conditions treated with drugs affecting the immune response during the COVID-19 pandemic. The guidelines provide clinicians with advice on how to adjust care to reduce patients’ exposure to COVID-19 and how to balance the risks and benefits of taking drugs that affect the immune response during the pandemic. The full guidelines can be found here and a press release summarising the guidelines here.

The British Liver Trust has published patient and carer-focused guidance on COVID-19 for people with liver disease and liver transplant patients, which can be accessed here.

Relevant parliamentary activity

Parliamentary Questions

Layla Moran MP asked what assessment the Home Office has made of the effectiveness of the minimum unit pricing on alcohol policy in Scotland and Wales; and what plans there are to introduce MUP in England.

Fiona Bruce MP asked when the planned roundtable between the Department of Health and Social Care, Public Health England and the alcohol industry on low and no alcohol products will take place, and who else will be invited.

Mary Glindon MP asked what steps the Department of Health and Social Care is taking to reduce alcohol-related cancer diagnoses and deaths.

Gregory Campbell MP asked what preparations the Department of Health and Social Care is taking to tackle the potential increase in domestic alcohol abuse as a result of reduced social interaction during the covid-19 outbreak.