Liver health updates

December 2020 APPG on Liver Health update

APPG on Liver Health news

Thank you to those of you who joined our meeting last month; it was good to re-connect after not being able to hold a meeting since February due to Covid-19-related disruptions.

At the meeting, the group heard from Mark Gillyon-Powell from NHS England about the impact of the pandemic on the UK’s hepatitis C elimination targets. While lockdown undoubtedly presented challenges, particularly around testing in drug services and prisons, the ‘Everyone In’ policy to house those rough sleeping led to excellent work across England to test people for hepatitis C and support those found to be positive onto treatment. These case-finding initiatives resulted in treatment numbers being only around a third to half of what had been expected pre-Covid-19, and significantly better than all other countries in Europe.

Jennifer Keen from the Institute of Alcohol Studies and Baroness Finlay, Chair of the Commission on Alcohol Harm, then presented to the group on the Commission on Alcohol Harm’s report, ‘It’s Everywhere’, published in September 2020. The report highlights the sheer inescapability of alcohol in society, impacting not only on the individual drinker but also families and communities. Jennifer outlined the recommendations in the report, which cover alcohol services and action on the price and availability of alcohol, among others.

Minutes from the meeting can be found here. We expect our next meeting to take place early in the new year and will keep you informed as to the date.

Liver news

Alcohol Awareness Week occurred last month between the 16th and 22nd November, with this year’s theme focusing on the link between alcohol and mental health. Alcohol Change UK reported that 4,000 organisations, places and communities took part in awareness raising activities, many of which were documented in this blog.

The Institute of Alcohol Studies has released a second briefing on alcohol and Covid-19 which warns of the hidden harm from alcohol and the need for the Government to pay further attention to the issue. The briefing highlights that whilst there has been a modest overall decline in sales receipts, this masks important differences between lower risk/non-drinkers and heavier drinkers, many of whom report drinking more.

Research commissioned by Alcohol Change UK found that almost one in three drinkers have been drinking at increasing or high-risk levels over the past six months. In addition, over half of drinkers (53%) said they have drunk alcohol to try to manage how they were feeling the past six months, with people from BAME backgrounds, young people and parents most affected.

Two teams working on hepatitis C were announced as regional winners for the Health Equalities Award at the NHS Parliamentary Awards, nominated by Steve Baker MP and Jeremy Hunt MP for the South East region, and Hilary Benn MP for the North East and Yorkshire region. The overall winners will be announced in July 2021.

The Alcohol Health Alliance UK has written a report calling for a minimum unit price for alcohol in England, the only country in the UK not to have one, and warns that current costs are at “pocket money prices”. It is worth noting that the Government’s Alcohol Duty Review closed at the end of last month. Any developments and publications will be featured in future APPG updates.

More than two-thirds of serving and ex-Service personnel who reported an alcohol problem have not sought help, according to a new report from University of Liverpool and King’s College London. The research shows that recognition of alcohol misuse problems and help-seeking for self-reported alcohol problems among serving and ex-Service personnel is particularly low.

Drink Wise Age Well has launched a new, national helpline for over-50s which runs seven days a week. This follows the publication of research that finds more than four million over-50s in the UK are binge drinking at least once a week during lockdown.

The Covid-19 guidance for commissioners and providers of services for people who use drugs and alcohol was updated in November. It specifically recommends testing all service users for hepatitis C and offering a variety of options for treatment delivery, as well as offering harm reduction advice and needle and syringe programmes.

A global systematic review published in The Lancet of hepatitis C prevalence and incidence in men who have sex with men found that those who are HIV-positive had a substantially increased risk of hepatitis C, compared to just a slightly elevated risk for those who are HIV-negative. Co-infection of HIV and hepatitis C is common and worsens health outcomes for both diseases: this World AIDS Day (1st December) the Scottish Government has announced its ambition to eliminate transmission of HIV by 2030.

Relevant parliamentary activity

Parliamentary debates

In a debate on obesity and Covid-19, Andrew Selous MP pressed the minister on when the Government plans to publish its consultation on the labelling of alcoholic drinks.  

Parliamentary questions

Munira Wilson MP asked whether the Government will introduce a new cross-government alcohol strategy which takes account of the effects of the Covid-19 outbreak and what steps are being taken to prevent an increase in harmful drinking during the pandemic. Public Health Minister Jo Churchill pointed to various existing resources and guidance in her response.

Alan Campbell MP asked, with reference to the September 2020 report by the Commission on Alcohol Harm, whether the Government plans to publish a new alcohol strategy. Jo Churchill’s response stated that the Government’s “wide-ranging approach negates the need for a separate stand-alone alcohol strategy”.

Navendu Mishra asked what assessment the Government has made of the effect of Covid-19 restrictions on levels of alcohol consumption. Jo Churchill referred to Public Health England findings that “intake across the population as a whole remained about the same during the pandemic. Those aged 18 to 34 were more likely to report consuming less alcohol each week than before and those aged 35 to 54 were more likely to report an increase. There was also an increase in the proportion of ‘high risk’ drinking from April to September”.

November 2020 APPG on Liver Health update

APPG on Liver Health news

Our next APPG meeting is taking place this coming Tuesday 10th November, 2-3pm. The link to attend is here. The APPG will hear an update on the effect of Covid-19 on hepatitis C services and how this has impacted on progress towards elimination from Mark Gillyon-Powell, Head of Programme for HCV Elimination at NHS England. Jennifer Keen, Head of Policy at the Institute of Alcohol Studies, will then present on the Commission on Alcohol Harm’s ‘It’s Everywhere’ report, published this summer. There will be time for attendees to ask questions to the speakers and to raise AOBs after the presentations.

Liver news

Liver Cancer Awareness Month in October got off to a positive start with the announcement that the Nobel Prize for Medicine had been awarded to three scientists whose work led to the identification of hepatitis C during the 1970s-90s. The combined efforts of Harvey J. Alter, Michael Houghton and Charles M. Rice revealed the cause of non-hepatitis-A non-hepatitis-B chronic hepatitis – a.k.a. hepatitis C – and made possible blood tests and new medicines that have saved millions of lives. The announcement led to many MPs (including Matt Hancock) tweeting about the news and raising awareness of hepatitis C, which at one point was trending on Twitter.

A study from the University of Oxford on the outcomes of Covid-19 patients with chronic liver disease was published by the Journal of Hepatology. It indicates that patients with advanced cirrhosis had death rates four times higher than those without liver disease, though there was no increased risk for people who had had a liver transplant. The research further noted that the majority of deaths in cirrhosis patients in the spring and early summer of 2020 were from Covid-19 lung disease.

A survey from the British Liver Trust found that almost half of respondents would delay making an appointment with their doctor during the pandemic if they had symptoms of liver cancer. The research also showed that only half of respondents knew there was a link between liver disease and viral hepatitis. The British Liver Trust launched a new campaign, Sound the Alarm on Liver Disease, to urge the Government to improve early diagnosis and care outcomes for liver disease.

The Infected Blood Inquiry, the public inquiry investigating why thousands of members of the public were infected with blood-borne viruses such as HIV and hepatitis C in the 1980s and early 1990s on the NHS,re-commenced hearing evidence this autumn, starting with former health minister Lord David Owen. In recent days the Inquiry has ceased allowing people to attend the hearings in person, though it is still possible to watch online.

Public Health England published its annual report monitoring blood-borne virus infection and injecting habits among people who inject drugs in England, Wales and Northern Ireland. Its findings indicate that more investment is needed into harm reduction initiatives in order to reduce infection rates for hepatitis C.

The Institute of Alcohol Studies and Scottish Health Action on Alcohol Problems launched a report in September highlighting how alcohol consumption is closely linked to male identity and mental health. The report recommends strengthening restrictions on alcohol availability, advertising and affordability. In October the IAS published a briefing expressing concerns about the loosening of regulations on alcohol availability during the pandemic and how these may undermine longer term progress on alcohol harm.

NHS England began its hepatitis C pharmacy antibody testing project, initially delayed due to Covid-19. The scheme aims to test people who inject drugs and are not currently accessing community drug and alcohol treatment services. Where people test positive, they will be referred to the relevant NHS Operational Delivery Network.

HCV Action hosted a series of webinars in October to identify ways people can be tested and treated for hepatitis C. Summaries of the presentations, recordings and slides can be found on HCV Action’s website.

Relevant parliamentary activity

Parliamentary debates

Hepatitis C treatment was raised by Baroness Walmsley and Baroness Sheehan in the Medicines and Medical Devices Bill debate in the House of Lords on 26th October, and by Lord Patel on 28th October, as examples of medicines which had previously been withheld from the public because of high costs. They proposed amendments which would make access to medicine without discrimination a basic human right. At the same debate, Lord Ribeiro noted that liver transplants in China and other countries can be offered at very short notice, while patients in the UK are often waiting several months.

Minimum unit pricing for alcohol was mentioned on numerous occasions in the context of the devolved nations being able to dictate their own policies as the UK Internal Market Bill made its way through the Lords at the end of October. Peers raised concerns that Scotland and Wales could face legal action over MUP and other public health policies if the Internal Market Bill went ahead in its current form. The Bill will continue to progress through the Lords in Committee and Report stages through November.

Parliamentary Questions

Alex Norris asked how the Government’s obesity strategy would affect the number of people with non-alcoholic fatty liver disease and liver cirrhosis. Jo Churchill answered that the strategy included a commitment to consult on companies providing calorie labelling on alcohol, noting that an impact assessment would be published alongside the consultation later this year.

Gregory Campbell asked about trends in the level of alcohol consumption in domestic settings since March 2020. The response from Jo Churchill pointed to Public Health England data which found that people aged between 18 and 34 were more likely to report consuming less alcohol than before the pandemic, while those aged 35-54 were more likely to report an increase. There had also been an increase in the proportion of “high risk” drinking in the first half of this year.

Kenny MacAskill asked whether the September 2019 deadline to remove the outdated Chief Medical Officer’s low-risk drinking guidelines from alcohol labels had been met. Jo Churchill responded that it had, though any products from before the deadline could continue to be sold until stocks were exhausted.September 2020 APPG on Liver Health update