In March 2014, the All-Party Parliamentary Hepatology Group (APPHG) released the report of its inquiry into outcomes in liver disease, entitled ‘Liver Disease: Today’s Complacency, Tomorrow’s Catastrophe’. On the basis of evidence the APPHG had received from royal colleges, clinicians, charities, patients, industry and Government bodies, the report highlighted the catastrophic consequences of failing to act immediately to reverse the rising tide of liver disease, and made a number of recommendations.

Nineteen months on from the 2014 Liver Inquiry, the APPHG has taken a look at how far we have come in terms of policy action to address liver disease. For the purposes of this briefing, the APPHG consulted organisations that had submitted written evidence to the 2014 inquiry, including Public Health England (PHE), Alcohol Concern, the British Liver Trust and the Alcohol Health Alliance, to gather their perspectives on progress in addressing liver disease since March 2014.

Hepatitis C is a preventable and curable cancer-causing, blood-borne virus. However, poor awareness and stigma have meant that it has been overlooked and misunderstood by many health professionals as well as by the general public since its discovery in 1989. It is therefore imperative that the planning, organising, purchasing, management and evaluation of services (commissioning) for hepatitis C is undertaken by those who fully understand the virus and the implications of ineffective co-ordination between public health, the NHS and adult social care services.

The All-Party Parliamentary Hepatology Group (APPHG) has worked since 2005 to raise awareness of hepatitis C and its patients’ needs amongst politicians, the media and the public. Our pioneering campaign with The Hepatitis C Trust led the former government to announce that they would introduce a national liver strategy to improve services and outcomes in England. The Department of Health was in the process of developing this strategy, with the support of the Coalition Government. This report aimed to inform its development. It sets out the challenges to improved outcomes for liver disease presented by poor hepatitis C service commissioning and the opportunities presented by changes to public health, NHS and social care systems for building robust, responsive services that improve outcomes for patients and reduce unnecessary deaths from liver disease.

This report of the APPHG provides the first public audit of the quality and outcomes of hospital hepatitis C services at a national level. The responses uncovered an alarming shortage of data collection. Where hospitals were able to provide information, the audit reveals stark differences in services and care available to patients in different parts of the country.

The report aims to usefully inform national and local service developments, particularly as the NHS is reformed. Ultimately, the APPHG hopes the audit will help towards our overarching aim: to eradicate hepatitis C in the next 30 to 40 years by diagnosing all patients, preventing further transmissions and ensuring high quality care and treatment for all.

In response to the public health challenge of Hepatitis C, national Governments in England, Scotland and Wales have taken radically different approaches. The All-Party Parliamentary Hepatology Group convened a meeting to explore the impact of the different national strategies. The meeting provided an opportunity for Parliamentarians, experts and stakeholders to compare and contrast the effectiveness of each approach and identify areas of best practice, which can be shared across national borders. The APPHG heard from speakers from England, Scotland and Wales who described the strategy that each country had taken, the reasons why they had taken their approach and their plans for the future. 'Divided Nations' provides a report on this meeting, comparing the approaches of England, Scotland and Wales in tackling Hepatitis C.

Over 1,000 people die each year waiting for an organ transplant in the UK because there is a national shortage of organ donations.

Sir Liam Donaldson, the Chief Medical Officer, highlighted the shortage of organs for transplant in his annual report in 2007 and the Government’s Organ Donation Taskforce recently reported that a 50% increase in organ donation could be made possible within five years.

The Taskforce Report has already made important recommendations about the health service changes needed to improve transplant services. They are now looking into the issue of presumed consent, and are due to report to ministers on this controversial topic in the summer. The All Party Parliamentary Hepatology Group (APPHG) decided to organise a joint meeting with other All Party Parliamentary Groups (APPGs) with an interest in transplant issues, in order to have a valuable debate on the ethical and practical issues around organ donation and transplant. It is vital that both the public and Parliament are involved so that a consensus can be reached on how best to save more lives from organ failure.

In July 2004 the Department of Health published a Hepatitis C Action Plan for England, setting out required actions for Primary Care Trusts (PCTs) and NHS Hospital Trusts. Over the following 18 months the All-Party Parliamentary Hepatology Group (APPHG) became concerned by anecdotal evidence from patients and clinicians that the Action Plan was not being implemented in their area. In spring 2006 the APPHG audited hepatitis C services in PCTs and NHS Trusts across the country. The resulting report, ‘A Matter of Chance’, highlighted many areas of deficiency with only 8% of PCTs implementing the Plan effectively. 18 months on, in September 2007, the APPHG decided to repeat the audit to see whether, more than 3 years after the Hepatitis C Action Plan was published, it was finally being implemented nationwide and whether patients across the country were receiving a universal standard of care.

In February 2006, more than 18 months after the launch of the Department of Health's 2004 Action Plan for Hepatitis C setting out required actions for Primary Care Trusts (PCTs) and NHS Hospital Trusts, the All-Party Parliamentary Hepatology Group undertook a survey of PCTs and NHS Hospital Trusts in order to audit what actions they had taken to fulfil the Action Plan’s stated requirements. 'A Matter of Chance' reports on the findings of this research.