Minutes of meeting held on Tuesday 10th November 2020
Sir David Amess MP – Co-Chair, APPG on Liver Health
Baroness Masham of Ilton – Co-Chair, APPG on Liver Health
Baroness Finlay of Llandaff – House of Lords and Chair, Commission on Alcohol Harm
Mark Gillyon-Powell – Head of Programme – HCV Elimination, NHS England
Jennifer Keen – Head of Policy, Institute of Alcohol Studies
Crispin Acton – Expert Adviser, Institute of Alcohol Studies
Professor Ashley Brown – Consultant Hepatologist, Imperial College Healthcare NHS Trust and Clinical Lead, West London Hepatitis C Operational Delivery Network
Dr Roswitha Dharampal – Adviser to Lord Brooke of Alverthorpe
Rachel Halford – CEO, The Hepatitis C Trust
Vanessa Hebditch – Director of Communications & Policy, British Liver Trust
Miriam Jassey – Southern Regional Manager, The Hepatitis C Trust
Tony McClure – Prisons Peer Educator, The Hepatitis C Trust
Leila Reid – Director of Corporate Services, The Hepatitis C Trust
Peter Shand – Associate Director, Government Affairs UK & Ireland, Gilead Sciences
Iona Casley – Policy and Parliamentary Adviser, The Hepatitis C Trust (Secretariat)
Aidan Rylatt – Policy and Parliamentary Adviser, The Hepatitis C Trust (Secretariat)
Baroness Randerson – Co-Chair, APPG on Liver Health
Virendra Sharma MP – Vice Chair, APPG on Liver Health
- Welcome and introductions (Sir David Amess, Co-Chair)
Sir David Amess MP welcomed attendees and explained that, while the Covid-19-related disruption meant this was the first meeting of the APPG since February, activity had continued in the background. A range of Parliamentary Questions have been tabled by members to secure information on hepatitis C prevention, testing and treatment and the secretariat has instituted a monthly newsletter to keep members and supporters updated on news and parliamentary activity related to liver health.
- Effect of Covid-19 on hepatitis C services and progress towards elimination (Mark Gillyon-Powell – Head of Programme – HCV Elimination, NHS England)
Mark Gillyon-Powell provided attendees with an overview of how hepatitis C services in England had responded to the challenge of continuing progress towards elimination during the Covid-19 pandemic. The implementation of lockdown presented challenges to the initiatives taking place as part of the elimination programme, with many of the key settings – prisons, probation services and drug and alcohol services – heavily affected.
However, the ‘Everyone In’ programme to provide temporary accommodation to previously homeless individuals presented an opportunity to provide hepatitis C testing and treatment to individuals usually less likely to be in touch with health services.
As a result of the hard work of peers, nurses, clinicians and others, treatment numbers during Q1 and Q2 were around a third to a half of the rates that had been expected pre-Covid, significantly better than had been feared when the pandemic first hit.
There have been positive innovations in service delivery in response to the pandemic, such as postal testing (with a new web-based portal for assessment due to be launched soon). Policies around medication dispensation were changed, meaning patients are able to be provided with a full treatment course in one go. Peer-to-peer support workers from The Hepatitis C Trust have been supporting delivery of medication to patients.
The original target for 2020/21 was for 12,500 people to be enrolled in treatment. The disruption from Covid-19 means this will not now be possible but it is hoped that we may be able to have reached 10,000 in treatment by the end of the financial year. During the new lockdown we have just entered, blood-borne virus testing, including for hepatitis C, should keep running. NHS England remains committed to achieving hepatitis C elimination by 2025.
In response to a question from Baroness Masham of Ilton, Mark confirmed that hepatitis C outreach workers are well stocked with PPE for continuing work over winter and that protocols have been put in place to ensure engagement in prisons can continue safely.
Responding to a question from Aidan Rylatt from the group’s secretariat, Mark agreed that there are potentially lessons from providing hepatitis C interventions to vulnerable groups that could be applied during the roll-out of a Covid-19 vaccine. Ensuring services are as close as possible to patients is vital: outreach vans can play a crucial role.
Professor Ashley Brown from the West London Hepatitis C Operational Delivery Network (ODN) said that in his area he has observed from testing data that hepatitis C positivity among the high-risk groups tested this year was lower than he had expected and questioned whether this has implications for the overall Public Health England (PHE) estimates of hepatitis C prevalence. Mark agreed that this is something that needs to be explored. PHE are currently working on updating prevalence estimates for each individual ODN which will be disseminated in due course.
- The Commission on Alcohol Harm’s ‘It’s Everywhere’ report (Jennifer Keen – Head of Policy, Institute of Alcohol Studies)
Jennifer Keen presented some of the key findings and recommendations from ‘It’s Everywhere’, a report published in September 2020 by the Commission on Alcohol Harm, a group of independent experts convened by the Alcohol Health Alliance UK.
The Commission received over 140 submissions of written evidence from a wide range of stakeholders, including around 40 from people with lived experience. One of the overarching themes of the evidence received was the sheer inescapability of alcohol in society which led to the title of the report. The report also sought to demonstrate that the harms of alcohol are multifaceted, affecting the individual drinker but also families, communities and society as a whole.
The Commission was established in the context of there having been no UK Government alcohol strategy since 2012. Since then, there have been a range of developments in our understanding of alcohol harm, for example the link with cancer. In place of an up-to-date strategy, the country’s approach to alcohol has been to promote industry self-regulation and appeal to ‘individual responsibility’. The former has led to a lack of meaningful action from industry and the latter does not take account of the harm alcohol causes to others and places the burden on the individual, rather than the product, which can also serve to enhance the stigma often felt by individuals who use alcohol harmfully.
Alcohol harm has a significant impact on society, with alcohol-related crime estimated to cost £11.4bn per year and the cost of alcohol to the health service estimated at £3.5bn. In terms of the individual health risk, we now know more about the role alcohol plays in enhancing the risk of cancer, with drinking one bottle of wine an equivalent cancer risk of smoking ten cigarettes for women and five cigarettes for men. There was a 400% increase in liver disease deaths between 1970 and 2010, with alcohol playing a significant part in the increase.
The Commission found that there are many missed opportunities for intervention to help people to address their harmful alcohol use. There is a need for further roll-out of identification and brief advice, including in less usual settings – for example, the Commission heard of hairdressers and driving instructors taking on this role. The Commission also heard that there are many barriers to treatment, such as lack of join-up with mental health services, inadequate funding, poorly designed pathways and lack of personalisation and flexibility of treatment.
The Commission’s recommendations to reduce harm to children and families included encompassing alcohol in the remit of the Domestic Abuse Commissioner; better support for professionals in contact with families to identify and intervene around harmful alcohol use; and better communication of pregnancy drinking guidance and guidelines to support foetal alcohol spectrum disorder (FASD).
Other recommendations included:
- A new alcohol strategy with evidence-based measures
- Action on price, through alcohol duty and the introduction of minimum unit pricing (MUP) in England and Northern Ireland (to match the policy’s introduction in Scotland and Wales)
- Reducing availability through better licensing powers, allowing local authorities to take into account public health in licensing decisions
- Action on marketing, with restrictions on advertising and sponsorship
- Roll-out of identification and brief advice in all settings
- More investment in treatment services
- Requirement for health messaging on all alcohol products
- Introduction of a lower drinking driving limit.
Following the presentation, Rachel Halford from The Hepatitis C Trust asked whether the report covered the link between alcohol and obesity. Jennifer responded that obesity is featured in the report, including the fact that people with obesity who drink get 10% of their calories from alcohol. There is an opportunity for action around the Government’s next obesity strategy which will feature consultation on whether alcohol products should have to list calorie information.
On a question regarding whether education is an important part of preventing future harmful alcohol use, Jennifer remarked that it is very important but it can be an “uphill struggle” due to the competing messaging from alcohol industry marketing. There should be a requirement for health warnings to accompany alcohol advertising and marketing.
Rachel noted the lack of action on duty as a big contributor to alcohol harm. Jennifer agreed and highlighted the importance of the Government’s current consultation on alcohol duty.
Baroness Masham of Ilton asked whether Covid-19 lockdowns have led to issues with people accessing treatment and also what understanding we have of the effect of the introduction of MUP in Scotland. On the impact of Covid-19, Jennifer referred to an Institute of Alcohol Studies briefing which examined the effect. There is a mixed picture in relation to treatment services – some are finding support harder to access but services moving online has helped others and the overall picture is more positive than might be expected.
It will be years before we get the full picture regarding MUP’s effect in Scotland but early indications are very encouraging. Compared to England, consumption has gone down around 6-7% since the introduction and a number of products have been reformulated, such as high strength cider being reduced in size and strength.
Vanessa Hebditch from the British Liver Trust said that during the pandemic their helpline has received calls from people with alcohol-related liver disease who have been missing the support they used to access and relapsing and also from people reporting concern at how much their drinking has increased.
Professor Ashley Brown noted the difficulty in achieving political action around alcohol harm despite other major public health progress in recent decades. Sir David Amess remarked that the economic challenges following Covid-19 may open the door to alcohol duty increases as the Government is in need of revenue-generating measures.
Baroness Finlay, as the Commission on Alcohol Harm’s Chair, then provided her perspective on tackling alcohol harm. Responding to Professor Brown’s point, Baroness Finlay stated that the way society, influenced by industry, portrays alcohol causes issues for political action. However, there are two good opportunities for politicians to address alcohol harm at the moment, with the Internal Markets Bill and the Domestic Abuse Bill.
Baroness Finlay emphasised the need to address the way alcohol is promoted and sold in supermarkets. We also need to link alcohol harm with the other major public health challenges of today (e.g. obesity and addiction) and be much clearer about talking about harmful alcohol use as an illness. The link between alcohol and obesity is particularly pertinent during the Covid-19 pandemic, given we know outcomes are worse for people with obesity who contract the virus.
- AOB and close
Sir David Amess said that the parliamentary members of the APPG on Liver Health will be happy to support on the issues raised in the meeting and thanked all those who attended.
Minutes of AGM held on Tuesday 11th February 2020
Sir David Amess MP (Co-Chair)
Baroness Masham of Ilton (Co-Chair)
Jeff Smith MP (Vice Chair)
Virendra Sharma MP (Vice Chair)
Lord Brooke of Alverthorpe (Vice Chair)
Iona Casley – Policy and Parliamentary Adviser, The Hepatitis C Trust (Secretariat)
Noah Froud – Policy and Parliamentary Adviser, The Hepatitis C Trust (Secretariat)
- Welcome and introductions (Sir David Amess, Co-Chair)
Sir David Amess MP welcomed the attendees.
- Election of officers
Dr Philippa Whitford will be standing down as a Vice-Chair due to increased workload, having gained additional SNP Spokesperson responsibilities. All other current officers were re-elected.
Three new Vice Chairs were elected: Sir Peter Bottomley MP, Jeff Smith MP and Lord Brooke of Alverthorpe.
- The Hepatitis C Trust’s Peer Support Work (Iona Casley – Policy and Parliamentary Adviser, The Hepatitis C Trust)
Iona Casley presented members with The Hepatitis C Trust’s report into peer support. She explained that the lived experience of people who have previously had or been at risk of hepatitis C can be a crucial way of engaging and supporting marginalised patients to be tested and treated for hepatitis C.
Plans for the year were discussed. Iona Casley reported that the Royal College of Pathologists had been in touch about speaking to the APPG.
Lord Brooke noted he was also a commissioner for the Commission on Alcohol Harm and so members of the APPG were welcome to feed into the Commission through him. The secretariat is linked in with the Commission and will explore the possibility of holding a meeting following up on the final report.
Virendra Sharma asked whether the APPG could do more work on hepatitis C in the BAME community. Noah Froud said that the secretariat could feed back to members on the best way to proceed, noting that there has been a considerable amount of work into increasing testing and treating hepatitis C in BAME communities in the last few years, but that barriers still existed.
Sir David Amess invited members to join the meeting with Baroness Blackwood, Parliamentary Under-Secretary of State for Life Science, which the APPG had secured and would take place shortly after the meeting. This meeting was secured after Sir David had written to the Public Health Minister to talk about potential changes to the legal prohibition on the dispensing of hepatitis C medication from community pharmacies.