Liver Disease and Liver Cancer: Diagnosis

I beg to move,

That this House has considered the diagnosis of liver disease and liver cancer.

It is a pleasure to serve under your chairmanship, Mr Betts. I am proud to sit as a vice-chair on the all-party parliamentary group on liver disease and liver cancer. I am delighted to have succeeded in securing today’s debate.

While health policy may be devolved in Scotland, I believe that work in this area across our four nations is vital. We can support each other in cutting mortality rates and improving outcomes across the UK. The liver is a remarkable organ. Like something from science fiction, it can regenerate. It is one of the more forgiving pieces of our anatomy. We can make lifestyle changes and treat it a bit better, and it has the capability to heal itself and undo some of the damage we may have caused in the past.

Considering that the liver is one of our most important organs in terms of its function, we probably do not give it the attention it deserves. Some 49% of liver cancer cases in the UK are preventable, and 20% of liver cancer cases in the UK are caused by smoking, according to Cancer Research. There are around 6,200 new liver cancer cases in the UK every year and 5,800 deaths. That is roughly 17 diagnoses a day and 16 deaths. There are five types of liver-affecting cancer, with hepatocellular carcinoma, or HCC, being the most common, accounting for more than three quarters of liver cancer cases globally.

While mortality rates for other cancers have improved over the decades, liver cancer mortality has more than doubled since the ’70s, with only 13% of patients surviving more than five years from diagnosis. Right now, the United Kingdom is facing a liver disease crisis. The number of deaths from the disease have doubled in the last two decades, while other disease outcomes, for example from diabetes or respiratory diseases, have stabilised or even improved. Around 10,000 people die from liver disease and liver cancer each year in the UK. It is the second leading cause of premature mortality in England and Wales after suicide. These statistics come in spite of the fact that 90% of liver disease is preventable.

As a Scottish MP representing a Scottish constituency, this hits even closer to home. Scotland has the highest mortality rate for liver disease in the whole United Kingdom. We also have one of the highest mortality rates for chronic liver disease across central, northern and southern Europe. This health crisis is affecting my constituents, and the statistics are sobering. In 2020, Scotland saw an 11% rise in chronic liver disease deaths on the previous year. It is one of the leading causes of premature deaths, above breast cancer and suicide. Approximately seven in 10 people who died of liver disease were of working age, so under 65. In a country with an average life expectancy at birth of 76.6 years for males and 80.8 years for females, these are premature deaths.

I want to look at why liver disease and cancer outcomes are so poor in Scotland and across the UK and at what work needs doing to address that. Let me start with the why. One of the biggest barriers to effective diagnosis and treatment is the social stigma that continues to cloud how we view patients with liver disease and cancers. It is crucial to acknowledge and understand the part that poverty has to play in the demographic of patients with these conditions. As the UK grapples with the cost of living crisis and a drastic drop in living standards, this is not a contributing factor that can be overlooked or ignored—it will be a huge risk to public health and the lives of those living in our most vulnerable communities—and it would be a catastrophic mistake to do so.

There are over 100 causes of liver disease, but the ones that contribute to the most cases are also factors much more likely to be present in poorer communities: alcohol misuse and obesity. In Scotland, 58% of liver disease deaths are alcohol related. Across the UK, alcohol-related liver disease accounts for 60% of diagnoses. Like most addictions, alcohol abuse is statistically higher in poorer communities and carries a heavy stigma: the resulting harm is seen as self-inflicted. To improve outcomes for alcohol-related liver disease, we need to look at alcohol dependency and the reasons for its prevalence. Most importantly, we need to support patients in making positive lifestyle changes. Access to the right care is paramount, and increasing the availability and quality of support available at a primary care level is essential.

On the impact of obesity, which is also higher in Scotland than the rest of the UK, non-alcohol related fatty liver disease, or NAFLD, is expected to become the leading variation of the disease in the UK within the next decade. Nearly one third of Scottish adults are obese and two thirds are overweight, but the statistics across the UK are similar. Again, obesity is more prevalent in deprived communities; it is seen as a choice. Obese people are seen as greedy or lazy, and societal conditioning teaches us that we do not need to look much closer at the reasons why.

There are many reasons why obesity is on the rise in those communities, including underlying health conditions, eating disorders and a lack of access to high-quality healthy foods. Like alcohol abuse, this challenge needs to be met with increased access to the right support, such as weight management programmes, but by far the most important tool on the road to prevention is early detection. That goes for alcohol-related liver disease, NAFLD or viral hepatitis, autoimmune or genetic-related.

Liver disease is largely asymptomatic in the early stages. Three quarters of patients with cirrhosis are diagnosed only when it has progressed too far for intervention or treatment. Without early detection pathways and investment in treatment, we will continue to see mortality rates rise. The British Liver Trust’s 2021 survey showed massive disparities in access to patient care pathways for early diagnosis in primary care settings region to region. It revealed that just 26% of local health bodies in the UK have effective pathways in place. It is calling for every integrated care system or health board to ensure that there is a named person responsible for liver disease and the identification of high-risk patients, and for all GPs to have the means to assess fibrosis.

CT and MRI scans are a critical tool for diagnosis and informing treatment plans, but this is an area that has been overlooked. The key problems are access to the right equipment and the quality of the equipment available. Some 41% of clinical radiologists state that they do not have the equipment they need to deliver a safe and effective service for patients. Industry surveys show that one in 10 CT scanners and almost a third of MRI scanners are more than a decade old—the age at which the equipment is considered obsolete. That is shocking.

This area of the NHS, like so many others, it is struggling with workforce numbers. The British Liver Trust welcomed the Government’s 15-year workforce strategy earlier this year, and I back its calls for gastroenterology and hepatology to be given due recognition through that process.

In May, I visited the Royal Free Hospital in Hampstead with the hon. Member for Caerphilly (Wayne David), as part of the APPG’s work, and we saw the Sheila Sherlock Liver Centre, a leading centre for liver disease treatment. It is well equipped with excellent, highly skilled staff. I would like every area of the UK to have something similar in place for patients. I met the chief executive, John Connolly, and Dr Thorburn, a consultant hepatologist, along with some of the patients. My conversations with Lucy and Hannah, two young women undergoing treatment at the centre, really brought home the human aspect of the disease. I am grateful to them for taking the time to speak to me about their experiences.

This morning, I received some very disappointing statistics from my local health board, NHS Lanarkshire, which is categorised as “red”, with no effective pathways in place for early detection and disease management. I have reached out to NHS Lanarkshire to request an urgent meeting so I can discuss this and seek assurances on its plans for improvement. The stats for my local board have cemented just how fundamental it is to properly fund detection and treatment of liver disease and liver cancer, and to give the NHS the tools it needs to support our communities.

While NHS Lanarkshire falls under the remit of the Scottish Government, I want to make some requests to the Minister here, too. The all-party parliamentary group on liver disease and liver cancer, along with the British Liver Trust, is calling for a full review of adult liver services by NHS England. I urge the Minister to make that a priority. I hope that I have set out enough reasons to illustrate why that is so essential, and I am sure that other Members will have more to add.

As part of the plans to improve early detection rates, the NHS health check must routinely include assessment for non-alcoholic fatty liver disease, as it looks to become the leading cause of liver disease over the next 10 years. Pathology is also vital, providing the study of disease and informing the development of treatment. I back calls for a new, nationally endorsed pathology pathway. That is another area that desperately needs support with its workforce supply and funding. I hope that the Minister will be able to address her Department’s plan for that support. Overarching all of this is the need for Government commitment and direction to address the disparities in access to care through policymaking and implementation.

Before I finish, I thank several organisations for supplying briefings to inform so much of this speech, and for their ongoing work in this area. I thank The British Liver Trust—particularly Paul, Richard and its chief executive officer, Pam—as well as Cancer Research, the Royal College of Pathologists and the Royal College of Radiologists. I look forward to the Minister’s response; I hope that, through collaboration, we can accelerate progress across the four nations to improve outcomes for patients and for our constituents.

The wind-ups have to start at about quarter past, so that is six Back Benchers in about an hour. I think you can probably work out the time limits for yourselves in that respect. First of all, from the Government Benches, I call Peter Gibson.

It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) on securing this debate. I also welcome the Minister, my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), to her place. I wish her every success in her new role. I have known her for over 30 years, and I have every confidence that she will be a thoughtful, listening Minister in a Department where she has professional experience and expertise.

Last month, my father should have celebrated his 80th birthday. Instead, his life was cut short by liver and pancreatic cancer. He died at 47—the age I am now—exactly six weeks to the day from being diagnosed. Looking back on the events of his passing in 1990, I would have assumed that things had improved. Advances in screening, treatment and diagnosis surely must have led to a very changed picture. However, in preparing for today’s debate, I have sadly learned that things do not look better. The British Liver Trust reports that there were around 200,000 deaths from liver disease in 1990, and in 2018 that figure had risen to almost 400,000.

In the north, the picture is quite bleak. It has the highest levels of liver disease, the highest admissions and the highest deaths. Liver disease is the second biggest cause of premature mortality and lost working years of life. We have seen a 400% increase in deaths from liver disease over just the last two generations. Liver cancer has seen the second fastest increase in incidence of any cancer in the UK, and the fastest increase in mortality rates over the past decade of any cancer for both men and women. Liver cancer mortality rates have more than doubled since the 1970s. I am reliably informed by the British Liver Trust that, sadly, the mortality rate in Darlington is the worst in the north-east, at 46 deaths per 100,000. Those are the worst results of any constituency in the north-east, which in itself is the worst in the country.

Those Members who were listening intently to what I said earlier will have noticed that I tried to extend the debate by a further half hour, although we do have to start the wind-ups at about quarter past. For guidance, that gives about five minutes for each speech.

It is a pleasure to serve under your chairmanship, Mr Betts.

I congratulate the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) on her excellent contribution. I also thank her for her tremendous commitment to the work of the all-party parliamentary group on liver disease and liver cancer, which is really appreciated.

This is an important debate, and I speak as the chair of the APPG on liver disease and liver cancer. As we have heard, unfortunately the incidence of liver disease is increasing dramatically, although 90% of liver disease is clearly preventable. However, it has to be addressed in its early stages. Worryingly, three quarters of people with cirrhosis are diagnosed when it is too late for effective intervention or treatment. To say that there is a liver disease public health emergency in our country is not an exaggeration. That needs to be addressed, and addressed urgently.

These days, in particular over the past two years, we hear a great deal about levelling up, but it is important that we see a health aspect to that agenda as well. It is truly shocking that liver disease deaths are four times higher in deprived areas. In those areas, people with liver disease die 10 years earlier than people with the disease in the most affluent areas. That needs to be addressed as part of a wider debate about creating a more balanced and equal society.

A short time ago, the British Liver Trust conducted a survey, which was published in the British Journal of General Practice in August last year. The survey identified widespread variation in the identification, treatment and management of chronic liver disease in primary care. It found that only 26% of local health bodies have an effective patient pathway in place for the early detection of liver disease. That survey was reinforced by the fact that a number of Members of Parliament wrote to their local health bodies: in total, 31 letters were sent by parliamentarians to their relevant health bodies to call for urgent action to improve liver disease pathways. Sadly, good practice is a postcode lottery.

I remind hon. Members to try to keep to five minutes. The next Member indicated that he has to leave before the end of the debate, and I accept his reasons, so I call Anthony Mangnall.

It is a pleasure to serve under your chairmanship, Mr Betts. I begin by congratulating the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) on securing this debate on an important issue. It is striking how similar the points she made about her constituency are to the issues affecting many constituencies across the country, especially down in the south-west. It is a pleasure to follow my hon. Friend the Member for Darlington (Peter Gibson), who added such a personal point to his speech, as well as the hon. Member for Caerphilly (Wayne David) and his extremely good work on the APPG.

I can be very brief, because I want to make just a few points. I come to the debate having not known a great deal about the issue before I was elected. Like so many people, I was lobbied and introduced to the subject by constituents, specifically the Meredith family, who are very involved in liver diagnosis and transplant services and the need to improve them in the south-west. Over the last three years, I have met them regularly to discuss the issue, to see how the UK can improve its services across the whole of the country and to look at some of the positives and negatives. Of course, I am participating in the debate to point out some of the negatives, but it has been a fascinating journey. I met Professor Cramp of University Hospitals Plymouth NHS Trust to discuss the matter, to see where we might be able to improve it and to lobby my colleagues in the south-west about beginning a campaign to improve south-west transplant and diagnosis services. There is a real need to do so, and the statistics speak for themselves.

I continue to learn about this issue. In fact, I was completely unaware of the link between smoking and liver disease; given the fact that I am trying to quit smoking, that has only redoubled my efforts. It is important, because we talk in this debate about where we can tackle things at source: people who have alcohol addiction, smoking addiction or issues around obesity. We must address those at-source points.

I thank the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) for raising this issue and for giving us all an opportunity to participate in the debate. I am my party’s spokesperson for health, and also a vice-chair of the all-party parliamentary group on liver disease and liver cancer, so it is good to be here to discuss how we can better improve our services for the diagnosis of liver disease and cancer.

There are over 100 types of liver disease and cancer. They impact some 2 million people across the United Kingdom, so it is of the utmost importance that our services are up to scratch to ensure quick and efficient diagnosis. The British Liver Trust has raised concerns about the difficulty of diagnosing liver disease, given that it can take some time for real symptoms to show. Perhaps the Minister would come back to us on that issue. I am very pleased to see the Minister in her place, which is well deserved, and we look forward to her response to all the issues raised by Members.

Many may wish to keep an eye out if they have been indulging in what are classed as the three main causes of liver disease: excessive alcohol consumption, undiagnosed hepatitis and potential obesity. The hon. Member for Rutherglen and Hamilton West set that out very clearly. Since the 1970s, liver disease has been on the increase, with a 400% increase in deaths. That cannot be ignored. I am one of those—probably one of many here—who have had a liver capacity test. It has also been said that there is a stark disparity between liver disease and diseases such as cancer and heart disease: figures show that deaths from those diseases have remained stable or decreased.

This is a nationwide issue, of course. As of 2019, one in five people in Northern Ireland—I always like to give a Northern Ireland perspective in these debates—who was suffering from liver disease was completely unaware of the fact. It is staggering that that could be the case: that is 20% of those people. In addition, since 2011, there has been a 28% increase in hospital admissions due to liver diseases and cancer.

It is a great pleasure to follow the hon. Member for Strangford (Jim Shannon), and I congratulate the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) on securing the debate. It is also a pleasure to listen to the chair of the APPG on liver disease and liver cancer, the hon. Member for Caerphilly (Wayne David). I am grateful for the input he gave from Wales in particular, because it is very interesting to hear how different Administrations that have responsibility for health are tackling this issue.

I will spend the brief time I have talking about issues in the north-west of England. Similarly to my hon. Friend the Member for Totnes (Anthony Mangnall), liver disease was not an area that I was particularly familiar with until I became a Member of this House and heard from constituents, particularly families who had seen loved ones go through the terrible, very fast process of hearing about a liver disease and, sadly, passing away. I am particularly grateful to Dr Tim Cross, a constituent who is also a consultant hepatologist at the Royal Liverpool and Broadgreen University Hospitals NHS Trust. Talking to him has really helped me to understand some of the issues, and in particular some of the regional disparities that affect not only my constituents in Warrington, but people in towns and cities such as Blackpool, Manchester and Liverpool. These major centres in the north-west of England are woefully underserved when it comes to transplant facilities for tackling liver disease and liver cancer.

All those areas of the north-west record some of the highest rates of liver disease mortality, with the most recent statistics from 2020 highlighted by the British Liver Trust showing a shocking 1,838 deaths, the highest of any region in England. Per 100,000 people, that equates to 28.4 deaths. By comparison, an area such as the east of England has almost half that figure—16.1 deaths per 100,000. Over the course of 2021, the north-west saw around 10,000 admissions to hospital due to liver disease, which is by far the highest figure in the country.

It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) on securing this important debate, as well as on the important work that she and my hon. Friend the Member for Caerphilly (Wayne David) do with the APPG.

While there are multiple causes of liver disease, such as from viral hepatitis, obesity and alcohol, I particularly want to focus on alcohol. Successive Health Ministers will know that, over a period of time, I have consistently raised concerns about the absence of a comprehensive alcohol strategy. This afternoon we have heard only too clearly why that is so important. For too long, alcohol has been promoted as a social norm, and not to imbibe as an anomaly, yet the scale of alcohol harm, psychologically and physically, is off the radar. It is something that is causing me significant concern, whether it is used for pleasure or to address pain. It must become a priority of this Government.

In a city where I see more and more licensing of premises, I am aware of the impact and harm that that is having on livers. We see it in the statistics. My discussions with the British Liver Trust over the summer highlighted the fact that more and more people with liver harm were younger and sicker. Our excellent public health team in York says that it is their No. 1 concern. When we match that against the fact that 90% of liver harm is preventable, we realise that there must be a more comprehensive strategy. As the profile of those with liver disease changes, so must investment in prevention, diagnostics and disease management.

Astoundingly, since 2010 hospital admissions for liver disease have risen by a staggering 45%. NHS Humber and North Yorkshire ICS currently has no clinical pathway for the early detection of liver disease. I have written to express my concern, and the ICS tells me it will respond on 4 November.

To co-operate with the timing, we head to the Front Benches, with five minutes for the Opposition, 10 minutes for the Minister and a couple of minutes at the end for the mover to wind up.