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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.”

March 2021 APPG on Liver Health newsletter

APPG on Liver Health news

The next APPG on Liver Health meeting will take place from 4pm-5pm on Tuesday 9th March. The meeting will focus on drug policy, harm reduction and hepatitis C, and will feature contributions from parliamentary members of the Labour Campaign for Drug Policy Reform and the Conservative Drug Policy Reform Group, as well as Graham Parsons of substance use service provider Turning Point.

Liver news

New figures published by the Office for National Statistics revealed the number of alcohol-related deaths in England and Wales jumped to a record in the first nine months of 2020, with liver disease accounting for most of the fatalities. Read more here.

Polling by the Less Survivable Cancers Taskforce found low public awareness of symptoms for the six ‘less survivable cancers’, including liver cancer, with just 5% of people able to correctly identify all symptoms of liver cancer from a list presented to them.

New research by Professor Nick Sheron of the Foundation for Liver Research, supported by the British Liver Trust, has shown that results of blood tests routinely performed by GPs contain a ‘hidden fingerprint’ that can identify people silently developing potentially fatal liver cirrhosis. An algorithm has been developed to detect this fingerprint, which could be freely installed on any clinical computer, making it a low-cost way for GPs to carry out large scale screening using patient data they already hold. Read more here.

The Alcohol Health Alliance UK and its membershave been campaigning ahead of tomorrow’s Budget for an increase in alcohol duty. A blog from Balance Director Colin Shevills and a BMJ Opinion piece by the AHA set out the case in favour of a rise.

The National Institute for Health and Care Excellence (NICE) published final draft guidance recommending that selective internal radiation therapy (SIRT) can be used as an option for some people with hepatocellular carcinoma (HCC). The British Liver Trust welcomed the news.

A new study in BMC Public Health found that universal opt-out testing for hepatitis C was offered to newly registering migrant patients by just 17% of services questioned between October 2017 and January 2018, with the authors concluding: “BBV testing for migrant patients in primary care is usually ad hoc, which is likely to lead to testing opportunities being missed.”

In the first of three webinars as part of the online conference of the London Joint Working Group on Substance Use and Hepatitis C, Clinical Leads for the four hepatitis C Operational Delivery Networks in London hailed the partnership working around hepatitis C during the Covid-19 pandemic and urged continuation of a pan-London approach. The registration page for the final session from 12.30pm-2.30pm on Thursday 4th March is here.

Relevant parliamentary activity

Parliamentary debates

Responding to a Covid-19 update, Shadow Health and Social Care Secretary Jonathan Ashworth noted that “the number of excess deaths from liver disease is up 11% in the pandemic—a huge increase—and many children are in lockdown in homes under the shadow of alcohol abuse”.

During Health and Social Care Oral Questions, Tracey Crouch asked what plans the Government has to improve liver disease treatment pathways. Responding, Health Minister Helen Whately pointed to work by NHS England’s hepatobiliary clinical reference group on the development of liver networks in England “to enable quicker access to specialised liver services, as well as providing clinical advice on disease prevention and referral practice”.

During an update on Business of the House, Fiona Bruce highlighted “a concerning rise in alcohol harm during the pandemic, including in death rates due to increased alcohol consumption” and called for a debate on the need for sufficient addiction recovery programmes across the country to be available, on the benefits of reforming the alcohol duty system, and on the need for a revised Government alcohol strategy. Leader of the House Jacob Rees-Mogg said that the Government “share the concerns about reports of increases in alcohol-related deaths” and “have committed to publish a new UK-wide cross-Government addiction strategy”.

Parliamentary questions

APPG on Liver Health Vice Chair Lord Brooke of Alverthorpe asked what progress has been made towards producing a cross-addiction strategy which includes consideration of alcohol addiction. Responding, Health Minister Lord Bethell said that work on the cross-Government addiction strategy was paused during the Covid-19 pandemic and will resume this year.

Shadow Public Health Minister Alex Norris asked what steps are being taken to improve the early diagnosis of liver disease. Public Health Minister Jo Churchill pointed to the NHS Health Check and NHS Standard Contract, alcohol care teams, the hepatitis C detection programme and Public Health England funding for Fibroscan machines to increase early detection of fibrosis/cirrhosis and access to treatment for those with alcohol-related liver disease.

Alex Norris also asked what assessment has been made of support available for patients with non-alcoholic fatty liver disease and what plans there are to prevent cases and increase support for those with fatty liver disease. Jo Churchill said that the Government is working to expand weight management services available through the NHS to help prevent non-alcoholic fatty liver disease.

Mary Glindon asked what plans there are for national public health campaigns to increase knowledge and awareness of the impact of drinking, and developing and promoting tailored solutions for harm prevention and resilience-building to reduce alcohol harm among the over-50s. Jo Churchill referred to measures as part of the Public Health England Better Health campaign.

Baroness Hayter of Kentish Town asked what assessment has been made of the impact of improving labelling on alcohol products on reducing obesity. Lord Bethell said that 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”.

Baroness Hayter also asked what assessment has been made of the potential financial benefit of increasing alcohol duty to reduce the cost of alcohol-related illness and harms to the NHS, receiving a response that all taxes are kept under review and the impact of a change to alcohol duty is considered at each fiscal event, including its effect on health.

Derek Thomas asked what assessment the Government has made of the effectiveness of the minimum unit pricing for sales of alcohol in Scotland in reducing alcohol consumption; and what plans the Government has to introduce a similar policy in England. Home Office Minister Kit Malthouse stated that “there are no plans to introduce minimum unit pricing (MUP) in England at this time”.

Shadow Prisons Minister Lyn Brown asked how many prisons have machines capable of running diagnostic tests for hepatitis C on site in England and Wales. Health Minister Nadine Dorries stated that “NHS England and NHS Improvement have offered ‘point of care’ PCR testing machines to every trust leading hepatitis C diagnosis and treatment pathways, including prisons. NHS England and NHS Improvement also offer the option of taking machines into 30 prisons per year as a part of the ‘High Intensity Test & Treat’ programme, to supplement reception screening.”