May 2021 APPG on Liver Health newsletter

Liver news

New figures published by NHS Digital showed there were more than three quarters of a million alcohol-related hospital admissions to the NHS during the height of the Covid-19 pandemic between April and December 2020. Three quarters (587,501) of the 773,523 admissions involved patients over the age of 50. Read a write-up of the new figures here.

A research breakthrough by King’s College Hospital has identified new clinical criteria to more accurately predict which patients with acute liver failure (ALF) will most likely benefit from a liver transplant. Read more here.

NHS England has launched a new Hepatitis C Operational Delivery Network dedicated to treating children and young people with hepatitis C. Read more in The Hepatitis C Trust’s news story here.

British Liver Trust published its new three-year strategy, setting out six key areas of progress the charity will prioritise between 2021 and 2024. The strategy can be accessed here.

New research by the Institute of Alcohol Studies, published in the Alcohol & Alcoholism journal, found that alcohol adverts may commonly appeal to underage adolescents. Read the full paper here and a summary here.

Relevant parliamentary activity

Parliamentary debates

Baroness Finlay of Llandaff led a debate on the Commission on Alcohol Harm’s report, ‘It’s Everywhere: Alcohol’s public face and private harm’, during which the report’s findings on the individual and societal harm of alcohol were highlighted. Responding to the debate for the Government, Lord Bethell stated that the forthcoming addiction strategy would include measures on alcohol addiction, but reiterated that there are no current plans to introduce Minimum Unit Pricing (MUP) for alcohol in England. An excellent Twitter thread by the Alcohol Health Alliance summarising the debate can be read here and the full transcript is here.

Dan Carden MP led a debate on alcohol labelling, highlighting the minimal labelling requirements for alcoholic drinks and urging the Government to use the forthcoming consultation on calorie labelling for alcoholic drinks as an opportunity to introduce a requirement for wider health information on labels.

Parliamentary questions

Fiona Bruce MP asked whether the addictions strategy will include measures to prevent as well as treat alcohol addiction; what plans there are to protect funding for alcohol treatment; and what steps are being taken to ensure the strategy will help reduce alcohol harm. Public Health Minister Jo Churchill responded that the scope of the strategy is still being developed but that it will consider a range of issues including drugs, alcohol and problem gambling, adding: “The Department will consider the emerging evidence around increased alcohol harms during the COVID-19 pandemic and what further action is needed as we develop the strategy.”

April 2021 APPG on Liver Health newsletter

APPG on Liver Health news

The latest APPG on Liver Health meeting took place in early March, with talks from Jeff Smith MP of the Labour Campaign on Drug Policy Reform, Crispin Blunt MP from the Conservative Drug Policy Reform Group and Graham Parsons from the Turning Point drug service for an enlightening look at drug policy, harm reduction and hepatitis C. The minutes from the meeting are available here.

Later in the week, APPG on Liver Health Co-Chair Sir David Amess spoke in a debate on community pharmacies, highlighting the importance of delivering testing and treatment for hepatitis C in community settings. You can read his full remarks here and Public Health Minister Jo Churchill’s response here.

Responding to the Budget, APPG on Liver Health Vice Chair Lord Brooke of Alverthorpe called for more focus on the costs that arise from issues such as obesity, asking why the Government failed to extend the sugar tax and continued to freeze taxes on alcohol, “when that is a silent contributor to obesity”.

Liver news

The latest report of the Lancet Commission on Liver Disease was published this month. The report advocates a ‘hub and spoke’ model for delivering integrated clinical services for liver disease, similar to the Operational Delivery Network system already established for hepatitis C care. Other recommendations include: full implementation of alcohol care teams in hospitals and improved working links with acute medical services; assertive outreach for frequent hospital attenders with alcohol use disorders; expanded access to FibroScan; and introduction/expansion of fiscal and regulatory measures to reduce the prevalence of obesity. The full report can be accessed here.

A survey of liver disease patients carried out by the British Liver Trust found that a fifth of respondents thought the Covid-19 vaccine may not be suitable for them, despite advice from leading liver experts to the contrary. The survey also found that 40% of all respondents are worried about their mental health and a third have been worried about their liver condition worsening and urgent treatment being delayed. Read more about the survey’s findings here.

The Royal College of Psychiatrists has issued a warning that cuts to drug and alcohol services mean young people in need of support are missing out on specialist help, following analysis which shows £26m (37%) in real terms has been cut from youth addiction services in England between 2013/14 and 2019/20. Read more here.

HCV Action hosted a webinar looking at how hepatitis C services have been affected over winter amid the Covid-19 pandemic and plans for getting services back on track, during which NHS England’s Mark Gillyon-Powell revealed that a new budget with a 25% increase in funding for hepatitis C case-finding has been approved for 2021/22. Watch the recording here.

The London Joint Working Group on Substance Use and Hepatitis C held an online conference at the start of the month, featuring talks from all London Hepatitis C ODN Clinical Leads, Public Health England, NHS England and The Hepatitis C Trust, among others, as well as a message of support from Mayor of London Sadiq Khan. Recordings of the presentations are available here.

Relevant parliamentary activity

Ministerial statements

Paymaster General Penny Mordant announced updates to support for those infected and affected as part of the infected blood scandal, which saw tens of thousands of people received blood contaminated with hepatitis C and HIV between the late 1970s and early 1990s. Support payments have been standardised across the UK, resolving previous disparities in levels of support for people infected and affected. The Government has also committed to the appointment of an independent reviewer to carry out a study looking at options for a framework for compensation, to report to the Government prior to the conclusion of the Infected Blood Inquiry. Read the full Government announcement here.

Public Health Minister Jo Churchill announced an additional £100 million over 2021/22 to support people living with obesity to lose weight and maintain a healthier lifestyle. £70 million will be invested into weight management services available through the NHS and local authorities and £30 million will be used to fund a variety of initiatives, including providing access to the free NHS 12 week weight loss plan app and continuing the Better Health marketing campaign to motivate people to make healthier choices. The full announcement can be read here.

Parliamentary debates

During a debate marking one year of Covid-19, Baroness Finlay of Llandaff said that in the recovery from the pandemic “we must tackle head-on inappropriate use of alcohol and recognise the associated harms with its links to violence. Nutrition policies need to change to recognise the links between malnutrition, obesity and loss of life years.”

Parliamentary questions

Shadow Public Health Minister Alex Norris asked what comparative assessment has made of the support available to liver disease patients prior to and during the Covid-19 outbreak, and what support will be provided after. Jo Churchill stated that no comparative assessment has been made and referred to support available through Alcohol Care Teams.

Alex Norris also asked for data on premature deaths due to non-alcoholic fatty liver disease and Covid-19 deaths of patients with diagnosed non-alcoholic fatty liver disease. Jo Churchill’s response said that the data in the format requested is not available but referred to alternative PHE data on fatty liver disease.

Tracey Crouch asked a series of questions on liver disease, regarding:

  • The annual cost to the public purse of liver disease, alcohol-related liver disease and non-alcoholic fatty liver disease. Jo Churchill stated that it is not possible to disaggregate expenditure to show solely liver disease.
  • Steps being taken to ensure effective implementation of liver disease and cirrhosis assessments in routine NHS health checks in England. Jo Churchill described the process involved in the NHS health checks around alcohol consumption.
  • Deaths from Covid-19 of people with liver disease; steps being taken to include liver disease in Covid-19 recovery plans and Integrated Care System plans; and geographical variation in liver care service provision. Answering the questions together, Jo Churchill said that data is not available related to liver disease and Covid-19 and noted the NHS Long Term Plan’s focus on targeted policies to address alcohol consumption and obesity. The response also highlighted NHS England work to develop liver networks in England to enable quicker access to specialised liver services, as well as providing clinical advice on disease prevention and referral practice.

Shadow Prisons Minister Lyn Brown asked for an assessment of the potential merits of funding the provision of hepatitis C diagnostic testing machines to prisons to reduce the time between testing and treatment, reduce the need for liver transplants and make progress towards the elimination of hepatitis C. Jo Churchill stated that testing machines have been offered to trusts who lead the diagnosis and treatment pathways, including those in prisons, and referred to High Intensity Test and Treat initiatives and peer support by The Hepatitis C Trust.

Kenny MacAskill asked what assessment has been made of the potential merits for public health of introducing scaled taxation for alcohol where stronger alcohol products are taxed more per unit of alcohol than lower strength products. Treasury Minister Kemi Badenoch said that the Treasury is considering the merits of various taxation methods as part of its alcohol duty review, with updates to follow in due course.

Kenny MacAskill further asked what consideration the Treasury has given to the public health benefits of setting alcohol duty at a level that covers the estimated costs of alcohol to society. Kemi Badenoch stated that protecting against alcohol-related harms remains a key objective of the alcohol duty system but that it is not the sole consideration and “any duty changes must be assessed within the wider economic and business context”.

Derek Thomas asked what steps are being taken to reduce the cost of alcohol to the NHS. Jo Churchill pointed to Alcohol Care Teams.

Derek Thomas also asked what steps are being taken to apply the same labelling standards to alcohol products as currently apply to other food and drink products. Jo Churchill said the Government is “committed to consult shortly on our intention to make companies provide calorie labelling on all pre-packaged alcohol they sell. The consultation will also cover introducing calorie labelling on alcoholic drinks sold in the out of home sector, for example bought on draught or by the glass.”