Liver Disease and Liver Cancer

Thursday 25th April 2024 Westminster Hall

12:30

[Navendu Mishra (Stockport) (Lab)]

I beg to move,

That this House has considered health inequalities in liver disease and liver cancer.

It is a pleasure to serve under your chairship, Sir Christopher.

I thank the hon. Member for Glasgow Central (Alison Thewliss), who is covering Front-Bench duties in this debate, and who was kind enough to co-sponsor the application for it with me to the Backbench Business Committee. She is a long-standing champion of public services and better healthcare provision for all.

I am grateful to several organisations, including charities, that have helped me with my speech: the British Liver Trust—several representatives are in the Public Gallery—Liver Cancer UK and the Roger Williams Institute of Hepatology. Alcohol Change UK has also been good. I have met its representatives in the past, although not recently, and it has been a long-standing campaigner on this issue.

Before I start on the main points of my speech, I pay tribute to Bob Blizzard, a former Labour Member of Parliament in Norfolk. He did a lot of work in this House on the Hunting Act 2004 and in the fight for animal rights. His family have been in touch and wanted me to mention him. Sadly, he passed away in 2022, with a rare form of cancer, having been diagnosed with it in December 2020. His family therefore wanted me to mention the work of the Alan Morement Memorial Fund, which helps patients and healthcare workers.

To start on my key points, this is an important debate about health inequalities in liver disease and liver cancer. It is particularly timely, given the shocking new data released this month, which shows that we are facing the worst mortality and hospital admissions rates for liver disease in a generation. Ninety per cent of liver disease is preventable and, if diagnosed early, damage can often be reversed and the liver can recover fully. Tragically, however, premature deaths from liver disease have surged to their highest levels in decades, and hospital admissions due to liver disease have risen by almost 80% over the past decade alone, driven by obesity, alcohol and viral hepatitis.

We have seen more than a decade of cuts under this Government. Successive Conservative Governments have neglected patients and failed to take liver disease seriously. Our most marginalised communities, the most at risk of liver disease, have been silenced, overlooked and left behind. The liver disease crisis is almost entirely preventable and reflects a decade of decline in our nation’s health, widening health inequalities and worsening life expectancy.

Geographical inequalities in health outcomes for patients are stark, and the north of England is disproportionately impacted, accounting for more than a third of premature deaths in liver disease in 2022, or 3,728. New data from the Office for Health Improvement and Disparities highlights that the north-west, my own region, has the highest mortality rate for liver disease in the country, at 35% higher than the national average. The healthy life expectancy in Blackpool is now the same as in Angola, at 54.5 years.

The Government have failed to deliver on their manifesto pledge and levelling-up mission to narrow the gap in healthy life expectancy. They scrapped the promised White Paper on health disparities, repeatedly cut the public health grant and in effect decimated the Office for Health Improvement and Disparities. They have also overlooked liver disease entirely in their major conditions strategy, and U-turned on their commitment to roll out non-invasive liver scans to 100 community diagnostic centres. Our nation’s liver disease effort is faltering, which is costing lives and piling huge, avoidable pressure on to our NHS. Thousands of people die unnecessarily without access to specialist care, because liver services are consistently overlooked and under-resourced.

Risk factors such as obesity, viral hepatitis and alcohol are most prevalent in our most disadvantaged communities, and mortality rates from liver disease in our most deprived communities are now four times higher than in the most affluent.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Gentleman and the hon. Member for Glasgow Central (Alison Thewliss) on successfully securing this debate. Does he agree that, in the 21st century, the wider expectation in society is that we need to see improving mortality rates from serious conditions? The concern here is that mortality rates are worsening, as he has correctly outlined. That is something we all need to address as a matter of urgency.

[Navendu Mishra]

I thank the hon. Member for his intervention; he makes an important point. As one of the most advanced economies in the world, we expect our population to have the best healthcare, and we want life expectancy increasing for everyone, not just in certain postcodes, so I agree with his point.

Almost two thirds of adults are overweight or obese, and nearly four in 10 children with obesity—38%—are estimated to have early stage fatty liver disease. Deaths due to alcohol-related liver disease in England have increased by 87% over the last two decades, due a rise in harmful and hazardous drinking.

The cost of living crisis is exacerbating inequalities and the risk factors facing vulnerable families in deprived areas, with cheap junk food and high-strength alcohol being widely available. It is estimated that over 206,000 people in England are living with chronic hepatitis B, the majority of those cases undiagnosed and unlinked to care. Undetected, it can lead to cirrhosis, liver cancer and premature death caused by liver failure.

Liver disease is a silent killer that is often asymptomatic in its early stages. Shockingly, three quarters of people with cirrhosis are diagnosed in hospital when the damage is irreversible and it is too late for effective treatment or intervention. The impact of late diagnosis and crisis-point hospital admissions on our already overstretched NHS frontline services is pushing the hepatology workforce to breaking point, yet pressures are projected to increase at pace.

My own constituents are at the sharp end of this public health emergency. In Stockport, the premature mortality rate for liver disease in women has surged by 80% since the pandemic. In 2020, it was 12.5 per 100,000, and 2022, it was 22.5 per 100,000. In Stockport, the overall premature mortality rate from liver disease between 2020 and 2022—a three-year range—was 16.5% higher than the national average. I was greatly concerned to learn that the British Liver Trust’s “Love Your Liver” roadshow visit to Stockport last year identified that one in four members of the public had elevated fibroscan readings, which are indicative of liver damage.

Ethnic minorities are disproportionately impacted by liver disease. South Asian populations are particularly vulnerable to fatty liver disease, due to genetic and sociocultural factors, while migrants from countries where hepatitis B is endemic are at higher risk of developing liver cancer.

Liver disease patients also face stigma and misconceptions, which is hampering earlier detection and costing lives. Liver disease and liver cancer continue to be falsely labelled as self-inflicted, despite being linked to poverty and social deprivation. Almost half of patients with a liver condition have experienced stigma from healthcare professionals, according to recent surveys by the British Liver Trust.

Everyone at risk of liver disease and cancer should have equal access to faster diagnosis, no matter where they live. Accelerating earlier diagnosis is pivotal to tackling health inequalities and narrowing the gap in healthy life expectancy. Yet new research by the British Liver Trust shows that fewer than one in five integrated care systems in England currently have fully effective pathways in place for the early detection and management of liver disease. Alarmingly, my local ICS—Greater Manchester ICS—reported the highest premature mortality rate for liver disease in the country, but it is yet to implement an optimal pathway.

The evidence is overwhelming. We can and must do more to support liver disease and liver cancer patients across the UK. The next Labour Government will have a relentless focus on prevention and earlier diagnosis to turn the tide of this epidemic of preventable deaths. When the previous Labour Government first asked Professor Marmot to review health inequalities, then Prime Minister Gordon Brown said that

“the health inequalities we are talking about are not only unjust, condemning millions of men, women and children to avoidable ill-health, they also limit the development and the prosperity of communities, whole nations and even continents.”

Since then, we have had over a decade of austerity and deep cuts to public health, which have caused improvements in life expectancy to slow and even reverse. Health inequalities are widening and a growing number of people live a greater proportion of their lives in ill health.

We need to look upstream, which is why the next Labour Government will be committed to taking bold action to halt the promotion of junk food targeted at children that is high in fat, salt and sugar.

We also need to talk about early detection. To build an NHS fit for the future, Labour is committed to hitting all NHS cancer waiting time and early diagnosis targets within five years. Recently, I tabled a number of written parliamentary questions on this matter, and the answers do not fill me with confidence about the healthcare that my constituents are receiving. We also need to accelerate earlier detection by doubling the number of CT and MRI scanners in hospitals in England.

I urge the Minister to mirror this upstream focus on early detection by committing sustainable funding in the next spending review for new technology, in order to improve the early detection of liver disease in primary and community care. I also call on the Minister to introduce a new nationally endorsed pathology pathway to improve early diagnosis of liver disease and to ensure that every community diagnostic centre has an assessment for fibrosis.

Liver cancer is the fastest rising cause of cancer death in the UK. As one of the six least-survivable cancers, it has a shockingly poor five-year survival rate of just 13%. Yet public awareness remains very low, and liver cancer patients are overwhelmingly diagnosed at a later stage. Outcomes for many types of cancer have seen huge improvements over recent decades, yet deaths from liver cancer in the UK have increased by 40% in the last decade alone, hampered by the lack of funding, research and innovation.

Before I come to the end of my speech, I want to mention a couple of staggering points provided to me by Alcohol Change UK. Sadly, it is a fact that harm caused by alcohol is on the rise. The pandemic has had a serious impact on alcohol consumption in England. People are drinking at harmful levels and increasing their drinking. One in five people in the UK is drinking above the recommended weekly amount; many want to cut down. Alcohol causes the majority of liver disease, and drinking alcohol increases the risk of liver cancer.

Alcohol has become the leading risk factor for death and ill health among those aged 15 to 49 in England. Alcohol Change UK found, only this week, that alcohol-specific deaths in the UK are the worst on record— 32.8% higher than in 2019. In 2022, 76% of alcohol-specific deaths were caused by liver disease.

This is an extremely serious topic. I am grateful to the Backbench Business Committee for allocating time for the debate and I am grateful to everyone who has turned up in the Public Gallery, as well as to the Back-Bench MPs who have come to support the debate.

12:41

[Kirsten Oswald (East Renfrewshire) (SNP)]

It is a pleasure to serve under your chairship, Sir Christopher. I am grateful to the hon. Member for Stockport (Navendu Mishra) and my hon. Friend the Member for Glasgow Central (Alison Thewliss) for securing this important debate on health inequalities in liver disease and liver cancer. It is a particularly timely debate, given the recent publication of statistics showing that alcohol deaths in the UK surged during the covid-19 pandemic. While alcohol misuse is not the only cause of liver disease, it is, as we have heard, responsible for a large proportion of cases, and that does need to be addressed.

As the hon. Member for Stockport set out, we need to acknowledge that liver disease has an inescapable link to deprivation. The incidence of liver disease and the risk of hospitalisation and death are all significantly higher in regions and nations of the UK that have higher levels of deprivation relative to London and the south-east of England. It is important to discuss this, and it is welcome that we are having a debate on the topic today. We should do so from the starting point that deprivation leads to poorer health outcomes. In the case of liver disease and liver cancer, that means that someone from the most deprived area is four times more likely to die than someone from a more affluent area. That is not acceptable.

It is now conventional wisdom that preventing a disease is far more desirable than having to treat or cure it. In Scotland, we have rates of liver disease that are far too high. However, I am grateful that the Scottish Government have introduced policies that are making a real difference by reducing deprivation, decreasing the incidence of liver disease and improving early detection.

The Scottish Government, looking at the issue in the broadest sense, have introduced policies such as the Scottish child payment, which anti-poverty charities have described as a “game changer”. Combined with other interventions, it has the potential to lift an estimated 100,000 children out of poverty. That investment is just one example of the Scottish Government intervening at the early stages of life to reduce inequality, and it will undoubtedly help in our fight against conditions such as liver disease, and indeed all other diseases associated with inequality and deprivation.

The introduction of minimum unit pricing in Scotland has also delivered results. In England, where there is no minimum unit pricing, liver disease mortality and morbidity continue to rise, whereas in Scotland, health inequalities are gradually decreasing. This has resulted in chronic liver disease deaths in Scotland decreasing from 17.9 per 100,000 in 2021 to 17.4 per 100,000 in 2022. Let me be clear: those figures are still stark, and more action needed. However, minimum unit pricing has reduced alcohol-related harms and alcohol-specific deaths by 13.4%. That is surely an intervention that we should now see across the whole UK to help to tackle liver disease, among other issues.

Scotland’s innovative life sciences sector has produced groundbreaking tests to help to diagnose liver disease at earlier stages, when damage can be reversed and the progression to cirrhosis or cancer halted. Unfortunately, as we have heard, the reality is that three in four liver disease patients present at crisis point, usually in A&E, with cirrhosis and all the horrible symptoms that come with that condition. Researchers from the University of Dundee have developed the new intelligent liver function test, which uses an algorithm to perform additional investigations on abnormal blood test results. The test can help to refer patients to specialists earlier than would otherwise be the case, minimising the workload of GPs in primary care and increasing the diagnostic rate of liver disease threefold. It has the potential to revolutionise the diagnostic pathway.

Focusing on tackling alcohol misuse, obesity and viral hepatitis are all important in lowering the rate of liver disease and liver cancer, but we cannot escape the fact that the UK Government’s decision to inflict more than a decade of austerity has exacerbated the inequalities and deprivation associated with liver disease. If the UK Government want to get serious about tackling liver disease, they need to get serious about tackling inequality. Threatening to cut the benefits of disabled people who are unable to work does nothing to tackle inequality. Forcing real-terms cuts on departmental budgets that are already strained because of inflation does not deliver the services needed to tackle inequality.

The UK has one of the highest levels of regional inequality in Europe, and until there is a real and concerted effort to change that basic fact, poorer outcomes for liver disease and liver cancer, particularly among the most deprived communities, will remain stubbornly hard to improve. I hope that we will hear today about the action that the UK Government are willing to take to ensure that that statistic quickly becomes a thing of the past.

12:47

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship today, Sir Christopher. I thank my hon. Friend the Member for Stockport (Navendu Mishra) and the hon. Member for Glasgow Central (Alison Thewliss) for securing this important debate, and hon. Members for their excellent opening speeches, setting the scene.

Addressing liver disease and cancer has for far too long been put on the back burner. Despite the vital work of organisations like the British Liver Trust and Liver Cancer UK, liver disease remains a leading cause of premature death, and is now the fastest rising cause of cancer death in the UK, yet 90% of liver disease is preventable, and it is in many cases reversible. It is a travesty, and an indictment of the state of our healthcare system, that three quarters of people living in the UK are diagnosed when it is too late for effective intervention or treatment.

I am acutely aware of the effect that liver disease has, because Washington and Sunderland West is at the heart of this public health crisis, which disproportionately affects those living in the north-east. In Sunderland, hospital admission rates due to liver disease were, shockingly, 84% higher than the national average in 2022-23, and the region suffers one of the worst hospital admission rates in England for women with liver disease. We see the hand of inequality stretch even further, as over a third of all premature deaths reported in 2022 were in the north of England, despite the Government’s manifesto pledge and levelling-up mission to narrow the gap in healthy life expectancy. The Government’s inaction on tackling health inequality is clearly indicated by the simple fact that, since the Marmot review was published in 2010, health inequalities have widened.

If we are to tackle this issue, we must finally start to tackle its root causes. We must reform our approach to liver disease and cancer, no longer allowing the prevailing myth of it being self-inflicted—as my hon. Friend the Member for Stockport said in his opening speech—to impact policy decisions, when we know the fatal consequences of the status quo. Despite hospital admissions caused by liver disease having risen by almost 80% over the last decade, liver disease was omitted from the major conditions strategy and was overlooked in the core modalities for community diagnostic centres.

We owe it to all those affected by liver disease to set out a proper plan to improve diagnosis and treatment. We must take a holistic approach, focusing on improving every area, from research to prevention to treatment. I believe the creation of the new nationally endorsed diagnostic pathway will be key to ensuring earlier diagnosis, with less regional disparity. In the short term, I urge Ministers to deliver a prompt and comprehensive review of adult liver services by NHS England, and to ensure that local health commissioners learn from areas where fully effective pathways for the early detection and management of liver disease are already in place.

We must no longer ignore the simple truth that we cannot improve outcomes for liver disease and cancer if the staffing crisis, long waiting times for diagnosis and barriers to accessing specialist care once diagnosed continue. We are seeing it with liver disease, where the cross-over of specialist services means that those affected experience the pressures on the NHS acutely, but the same story is told in every aspect of healthcare. We must deliver more scans and more appointments every year if we are to catch cancer early.

I am pleased that Labour has committed to a £171 million a year investment to provide the NHS with state-of-the-art equipment and new technology to cut waiting times and speed up diagnosis and treatment. I very much hope we can take momentum forward from this debate and push the Government to finally implement measures to increase diagnostic rates, invest in preventative measures and improve treatment for liver disease and cancer, because those seeking treatment cannot afford for us not to.

12:52

[Alison Thewliss (Glasgow Central) (SNP)]

It is a pleasure to see you in the Chair, Sir Christopher. I am very grateful to the British Liver Trust for its comprehensive briefings and support for this debate. The Alan Morement Memorial Fund, the cholangiocarcinoma charity, has also provided a very helpful briefing on liver cancer.

I often do not speak in debates on health matters, because they are devolved to the Scottish Parliament, but I have a personal link to this issue. My husband, Joe, was diagnosed with stage 2 non-alcoholic fatty liver disease in 2019. He has taken significant efforts to deal with that condition, because when caught at that stage it is reversible. Like many men, he did not go to the doctor for far too long, and he had that diagnosis when he finally went to get it checked out. He has been clear that tackling it has been challenging—we consciously have to do an awful lot more to keep ourselves healthy; we live in an obesogenic, alcohol-focused environment, so there are always things to tempt us back into bad habits—but he continues to go on with that challenge.

Joe has talked about the stigma around the disease. Almost three quarters of people with a liver condition have experienced stigma, and almost a third feel that it has prevented them from receiving medical care. It often comes from the association of liver disease with alcohol misuse and viral hepatitis. We must do everything we can bust that stigma so that people go and get the treatment they require as soon as possible, rather than putting it off, because the risks of doing so are very serious.

I also want to mention the read-across to the contaminated blood scandal. Some of those infected with hepatitis C did not know they had been infected because of the subsequent cover-up of their medical records, and some did not find out until serious damage had been done to their livers. For some, the news sadly came too late. I have heard stories at the all-party parliamentary group on haemophilia and contaminated blood about people whose death certificates cite chronic alcoholism as the cause of the disease, even though they had never touched a drink. There is a real stigma around liver issues, which we must do our best to bust.

We have a public health emergency that the Government ought to take very seriously indeed. Liver disease and liver cancer continue to be significant issues in Scotland. Liver disease is a leading cause of premature deaths in Scotland, above breast cancer and suicide, and deaths due to chronic liver disease in Scotland have increased by 85% in the last three decades. There was an impact during the pandemic, as the hon. Member for Stockport (Navendu Mishra) and my hon. Friend the Member for East Renfrewshire (Kirsten Oswald) also mentioned. I think that speaks a little to the alcohol culture that we are all focused on. I mean, how many people have heard the phrase “wine o’clock”? It has been minimised and reduced to not really mattering at all, but that alcohol culture leads people into harmful habits, and society downplays that.

I was glad to see the Scottish Government respond to the alcohol culture with minimum unit pricing, which has reduced the consumption of alcohol in Scotland by 3%, reducing deaths wholly attributable to alcohol by 13.4% and hospital admissions due to chronic conditions such as alcohol-related liver disease by 4.1%. Alcohol-specific deaths have risen more slowly in Scotland than in England, highlighting that the situation could have been much worse had Scotland not taken the bold step of introducing minimum unit pricing. The greatest harm reduction impact has been among the more deprived groups in Scotland, so there is an important protective factor.

Will the Minister consider bringing in minimum unit pricing in England? The small weakness of minimum unit pricing is that it puts the profits back into the hands of those selling the alcohol, because we do not have full control over the taxation system for alcohol in Scotland. It would be incredibly useful if we had all those powers in Scotland, but an intervention in England might provide an opportunity to do that. Removing the duty escalator on alcohol has meant that alcohol has got relatively cheaper.

I also want to mention the work happening in Scotland, which is showing signals of incremental improvements following the Scottish Government’s focus on prevention and earlier diagnosis. The same progress has not been seen in England, where liver disease mortality rates are at their highest level in decades; hospital admissions for liver disease have risen by almost 80% over the last decade alone.

In Scotland, by comparison, liver disease death rates between 2021 and 2022 decreased from 17.9 per 100,000 to 17.4 per 100,000, and hospital admissions caused by liver disease decreased by 1.5% between 2021-22 and 2022-23. My own health board area, Greater Glasgow and Clyde, has seen the largest fall in chronic liver disease death rates, which is really quite impressive given the health challenges that we have faced. That is quite significant.

When the British Liver Trust “Love Your Liver” roadshow was on Argyle Street in my constituency, I was struck by the number of people interested. Glaswegians are a very curious bunch; you cannot do anything without somebody asking a question and stopping to find out what is going on. People were like, “Oh, a liver test. I’ll queue up and wait for my liver test in a van in the middle of the city centre.” Around 100 people were scanned that afternoon and 15 of my constituents were later given a referral to their GP as a result, so there needs to be more testing and encouragement of people to go forward and check. It really is important.

Such screening in a community setting is a lifesaving intervention—we should make no bones about that. People should be able to access that at a simple community level. I am sure many colleagues in this place will have had their liver scanned in Parliament, which was welcome. Fibroscan readings have been reassuring in a lot of ways although, with health charities’ propensity to come in and do tests on MPs, I am sure they will find something wrong with me at some stage. However, it is welcome and important that people feel they can go for tests and that there is not a stigma in doing so.

So, there has been progress in Scotland. The intelligent liver function testing pathway developed by the University of Dundee uses an automated algorithm-based system to further investigate abnormal liver function test results based on initial blood samples from primary care, so further important development is happening in Dundee. I am sure the Minister would be interested to hear that the technology is also cost-saving to the NHS by over £3,000 a patient, which is significant. The tests are now being rolled out and piloted in parts of England.

I will touch on what my hon. Friend the Member for East Renfrewshire said about austerity and its impact on public health. The Glasgow Centre for Population Health in my constituency has done a lot of research into the subject over the years. It says that the years of Tory austerity have cost people dearly, through damage not just to public health services but to people’s life outcomes. My hon. Friend was correct to point out further cuts to social security for people from the Westminster Government, because that makes it more difficult for people to make good and healthy choices in the foods they buy and the lifestyles they have. The Glasgow Centre for Population Health said that it will take another decade just to get us back to where we were in 2010. That is 20 lost years of people’s good health, which will have a significant impact for a long time to come.

[Navendu Mishra]

The hon. Member is making an excellent speech. We already know that people who live in lower-income and more deprived areas have a lower life expectancy than people who live in more wealthy areas. The data from Alcohol Change UK tells us that people from more economically deprived groups experience higher rates of liver cancer and are less likely to receive treatment. There are also higher rates of liver cancer among people from Asian and black African backgrounds than among people from white backgrounds. That tells us that people who have a lower income or live in more deprived areas will die sooner. On the hon. Member’s point about austerity, does she agree that the Government have not done enough in the last 14 years to address the issues?

[Alison Thewliss]

I absolutely agree. I see that very much from the varied communities that I represent. It is baffling that the more recent Marmot findings have come as a surprise to some in government. I remember doing modern studies at high school and learning about the Black report and the inverse care law. It feels as though this Government are no further forward. In fact, in some respects they are much further back in tackling long-lasting health inequalities.

I shall now discuss the public health aspects. The Scottish Government are consulting on advertising restrictions on food and drinks that are high in fat, salt and sugar, which again are disproportionately marketed towards children and vulnerable groups. That marketing is also found in poorer areas, where there is often a lack of availability of fresh fruit and vegetables. That is significant because one in four children with obesity are estimated to have fatty liver disease, which has huge implications for their health and wellbeing for the future. It is caused by an accumulation of harmful fat in the liver and is present in around 70% of people who are overweight and obese. Fatty liver disease and excess weight together significantly increase the risk of premature death due to cardiovascular disease and a range of cancers, including liver, colon, breast, prostate, lung and pancreatic cancers.

Although Scotland tries to do its best within the devolved settlement that we have, sadly a number of key commitments from the UK Government to curb childhood obesity are yet to be implemented, including the 9 pm watershed plans to protect children from junk food advertising on TV and the ban on multibuy junk food deals. We have brought in some of those things in Scotland where we can. It does make a small difference but an awful lot more needs to be done, particularly for those in younger age groups. They are being targeted with all kinds of multiple snack-type foods, which are largely unnecessary. Both Labour and the Tories need to stand up to the multinational companies that wish to push those foods on our young people. These things do not come cost-free, certainly not to society.

Will the Government build on the simple, cost-effective diagnostic pathways already in place across the devolved nations? Will they commit to sustainable funding in the next spending review for new technology to improve earlier detection of liver disease? The fact that early intervention—that technology—can permit treatment before things get worse is significant. Will they also introduce a new nationally endorsed pathway to improve early diagnosis, and will they ensure that every community diagnostic centre can provide an assessment for fibrosis? All of those things will help to improve this public health emergency that we have.

It is important that we have discussed the issue today, but I hope that the Minister will listen and make the changes that she can, and that the Labour Front Bench, should they form the next Government, take this seriously. The alcohol-soaked and obesogenic society that we have poses fundamental challenges that Government should intervene on to prevent the next generation of people developing liver disease and liver cancer; we can prevent that progression if the public health imperative is there.

13:05

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a pleasure to serve under your chairship, Sir Christopher. I thank the hon. Member for Glasgow Central (Alison Thewliss) and my hon. Friend the Member for Stockport (Navendu Mishra) for securing this debate. I thank my friend, the hon. Member for Glasgow Central, for sharing her personal experiences. I know that both Members are great champions for improving health outcomes for all, and I am grateful to them for bringing forward this debate to discuss a neglected but major killer. I also thank my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) for sharing the shocking figures on liver disease in her constituency.

As my hon. Friend the Member for Stockport highlighted, new data released this month shows that we are facing the worst mortality and hospital admission rates for liver disease in a generation. Over 70,000 people die of liver disease and liver cancer each year, over half of whom are people of working age—15 to 64—at a huge cost to the NHS and the economy. We have heard from Members that 90% of liver disease is preventable, and if diagnosed at an early stage damage can often be reversed and the liver can fully recover. It is an avoidable epidemic, which is being driven by obesity, alcohol and viral hepatitis. All those issues increase in prevalence in the most deprived communities, and drive the health inequalities that we are debating today.

The debate is timely because it comes in the week when we received the sobering news that annual figures for alcohol-specific deaths had passed 10,000 for the first time ever. Seventy-six per cent of those deaths were from liver disease, including liver cancer, and it is the third year in a row that deaths have risen across the United Kingdom, breaking previous records each time. The rise was not inevitable and it cannot be explained away as the product of the pandemic. It is a policy failure, and Ministers today must answer for it.

Outcomes for many types of cancer have seen huge improvements over recent decades, but as we have heard, deaths from liver cancer in the United Kingdom have increased by 40% in the last decade alone. It is the fastest-rising cause of cancer death in the United Kingdom. It has a shockingly poor five-year survival rate of just 13%. Public awareness remains very low, with liver cancer patients overwhelmingly diagnosed at a late stage.

To her credit, the Minister for Social Care, the hon. Member for Faversham and Mid Kent (Helen Whately), recognised the problem when she committed in a letter to the chief executive of the British Liver Trust that the Government would make fibroscans available for use at 100 community diagnostic centres by March 2025. I have used one of those fibroscans, and they are a fantastic piece of kit that can tell if someone has liver damage or early signs of liver disease.

Why then, in the answer to my parliamentary question, which I received in February, did the Minister say that the Government had plans for fibroscans not in 100, but rather 12 diagnostic centres at the end of March? What about the other 88? It is all very well the NHS announcing funding for a new diagnostic pathway, but without the kit in local communities, how will that actually work? How and where will patients access scans and tests? Will they be available in the most deprived communities, where outcomes are far worse? What about in GP practices and pharmacies?

Perhaps the Minister could take up Labour’s fully costed plan for a “fit for the future fund” to double the number of MRI and CT scanners, so that we can catch illness earlier and treat it faster, before it is too late. To tackle health inequalities, we must get serious about public health and a prevention-first approach. Under this Government, for the first time in a century, life expectancy has dropped in England, and a growing number of people live more of their life in ill health.

While the decline affects us all, as we have heard from many Members it is not spread equally across the country. Over a third of all premature deaths were reported in the north of England in 2022, and in my city of Birmingham, life expectancy has dropped by nearly two years in just three years. A person in Blackpool is three times more likely to die from chronic liver disease than people living elsewhere in England. In parts of that town, life expectancy for men is just two years above the retirement age—but what do we expect when the Prime Minister boasted about changing funding formulas to take money away from deprived urban areas?

As I mentioned, alcohol consumption alone caused more than 7,500 untimely deaths from liver disease in 2022, and those mortality figures have risen three years in a row. Yet faced with that, the Government have decided to dismantle the central public health function and, as far as I can tell from the non-answer that I have received to written questions on this, they have abolished the Department of Health and Social Care’s alcohol policy team. Can the Minister confirm whether it is the case that there are no dedicated alcohol specialists in the Office for Health Improvement and Disparities, and that that team have now been redeployed? Should we take that as an indication of how much Ministers care about this issue, and does that help us to understand why there was no real-terms increase to the public health grant in the spending review in March, even as alcohol treatment services have been hollowed out over the last 14 years?

It does not bode well for the prevention strategy that the Health Secretary has promised before the summer recess. I hope that that does not go the same way as the major conditions strategy and the health disparities White Paper before that. I am encouraged to hear that measures to tackle the obesity epidemic should feature in it, if not alcohol. Fatty liver disease and excess weight significantly increase the risk of premature death due to not just liver cancer but colon, breast, prostate, lung and pancreatic cancers, not to mention heart disease. When one in six children are obese by the time they finish primary school and one in four children with obesity are estimated to have fatty liver disease, this Government have been sitting on a ticking time bomb for the last 14 years, without taking action. Labour is committed to ensuring that all children get a healthy start to life, with free primary school breakfast clubs serving healthy food, an active and balanced curriculum and a pre-watershed ban on advertising junk food. Can the Minister confirm that concrete prevention policies to tackle the obesity epidemic will be included in the prevention strategy, and will she finally publish the consultation on the junk food ban and get on with legislating for it?

Mortality rates from liver disease are now four times higher in our most deprived communities than in our most affluent. That makes a mockery of the Government’s rhetoric on tackling health inequalities and levelling up. To build an NHS fit for the future, Labour is committed to hitting all NHS cancer waiting time and early diagnostic targets within five years. We will drive a prevention revolution, with measures to tackle alcohol harms and the obesity epidemic: banning junk food ads to children, boosting capacity in local public health teams and recruiting thousands of mental health staff to give more people access to treatment before they reach a crisis. As part of our 10-year health mission, we will improve healthy life expectancy for all and halve the gap in healthy life expectancy between different regions of England.

13:12

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I have to say that I am a bit disappointed, because the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), in particular, knows very well my personal commitment to the best start to life, so to hear her saying that the Government have done nothing and Labour is going to fix it is a bit rich, but there we are.

I congratulate the hon. Members for Stockport (Navendu Mishra) and for Glasgow Central (Alison Thewliss) on securing this important debate; it is an absolutely vital debate. All hon. Members, including the hon. Members for East Renfrewshire (Kirsten Oswald) and for Washington and Sunderland West (Mrs Hodgson), have raised the importance of prevention, early intervention and, in particular, early diagnosis. I commend them all for doing that. The Government are taking significant steps. The hon. Member for Glasgow Central talks about what the Scottish Government are doing. I can absolutely assure her that the Government of the United Kingdom are totally committed to improving early diagnosis and treatment, and I will go on to explain exactly what we are doing.

First, it is important to set out that we know that there are 6,000 new cases of liver cancer each year, making it the 18th most common cancer, with 5,000 deaths a year; that is 5,000 deaths too many. As my right hon. Friend the Member for Bromsgrove (Sir Sajid Javid) said during his tenure as Health Secretary, regional inequalities are “the disease of disparity”. He was absolutely right because—as the hon. Member for Stockport stated in his opening speech—economic and health inequalities go hand in hand.

Blackpool is a perfect example. It is one of the most deprived cities in England and flashes red on every indicator—for life expectancy, alcohol dependence and liver cancer. No fewer than 40% of the people unemployed there are not fit to work due to ill health, and the rate of death from chronic liver disease is almost two and a half times the average for England. That is an area that I have visited a number of times, to visit its family hubs and to look at the excellent work and huge efforts that go on there to level up to improve the disparities. Nevertheless, there is so much more to be done, and our strategy to eliminate disparities in liver disease and liver cancer is based on two key facts.

First, 90% of liver diseases are caused by alcohol dependency, obesity or viral hepatitis. Secondly, the five-year survival rate for liver cancer is only 13% precisely because people do not come forward with their symptoms until it is too late; early detection is vital. We know what causes liver disease, and we know that diagnosing it more quickly will save thousands of lives. That is why prevention and diagnosis are the twin pillars of our strategy to end inequalities in liver disease and liver cancer across our country.

To be clear, this is not about criticising people for drinking alcohol, but stopping the level of drinking that leads to liver disease and liver cancer. We know that rates of alcohol dependency are double in the most deprived local authorities. That is why, in December 2021, we published our drugs strategy, which does three things. First, it has brought the greatest-ever increase in funding —an extra £780 million—for drug and alcohol treatment, over £500 million of which is going straight to local authorities with the highest levels of deprivation and alcohol dependence. Secondly, the strategy is boosting screening capacity for liver disease, and thirdly, it is beefing up referral pathways to build a seamless system from diagnosis to treatment.

Since we published our strategy, we are treating more people than ever before for alcohol use. In February, almost 135,000 people were receiving treatment, compared with just over 117,000 just under two years ago, which is an increase of more than 15%. NHS England is investing almost £30 million to bring specialist alcohol care teams to hospitals in the most deprived parts of England. Those experts in addiction identify people in hospital with alcohol dependence, start their treatment and refer them to local authority community services where they can complete their treatment, overcome their dependence and move forward with their lives. I pay tribute to all those brilliant clinicians who are helping vulnerable people to turn their lives around.

Obesity is another major risk factor for liver disease and is a real scourge on the poorest parts of our country. During last week’s debate on the Tobacco and Vapes Bill, we came under fire from hon. Members on both sides of the House who said, “Well, what about sugar? Are you going to ban that too?” This Government are not in the habit of banning things, but I am proud of our record on sugar reduction, healthy eating and obesity.

We have made strong progress in reducing the average sugar content in soft drinks through the soft drinks industry levy: we almost halved the sugar content in soft drinks between 2015 and 2019. I want to make the point that that is not with people saying, “Oh, this drink I used to like, I don’t like it anymore because it’s not sweet enough,” but was actually the result of reformulation that nobody noticed, which is the great thing about reformulation. If we can reduce the sugar, salt and fat content in foods so that people can carry on as normal without having to undertake some punishment routine, that is a good way to tackle the obesity problem.

[Alison Thewliss]

Having paid close attention to the sugar tax when it was brought in, there was a particular exemption in the products that required reformulation. Milkshakes could contain as much sugar as any of the full-fat fizzy drinks, but were somehow exempted because they had milk in them. Will the Minister perhaps take the opportunity to go away and think about whether they ought to be contained within a future iteration of the scheme?

[Dame Andrea Leadsom]

The hon. Lady will not be surprised, because she knows me well, that I am absolutely determined to tackle childhood obesity in particular, so that we can reverse the problems that we have seen in recent years, especially the spike in unhealthy eating and overeating during the covid pandemic. We know that people—both adults and children—are consuming too many calories. As she would expect, I am all over this and I am happy to debate any point with her. I agree on the sugar content in milkshakes, but there are many other foods that we also need to focus on. I hope I can reassure her on that.

For two years, we have been restricting the placement of less healthy products in shops and online to help consumers to make healthier choices. We are building on that progress. By the end of next year, further restrictions on price promotions on television and three-for-the-price-of-two offers in shops will come into force. I have been encouraging the big takeaway companies, the big supermarkets and so on to try to do it anyway— to get ahead of the regulations and to take action now. A number of them, I am pleased to say, are doing just that.

I am also pleased to update the House on the recent success of the NHS digital weight management programme. This week, the Obesity journal published a study showing that almost 32,000 people achieved sustained weight loss with the programme over a single year, which is really positive news. The programme is helping people from deprived backgrounds: more than a third of those referred were from black, Asian and minority ethnic communities. It is obviously early days, but there are positive signs.

The other major contributor to liver disease is hepatitis. Thanks to increased testing and improved access to treatment, we have reduced the number of people living with chronic hepatitis C virus in England by more than half since 2015. Deaths related to hepatitis C have fallen by just over a third since 2015, well above the World Health Organisation’s 10% target.

Liver disease is known as the silent killer because many people are unaware of their condition until it is too late. That is why, as part of our ambition to detect 75% of cancers at an early stage by 2028, NHS England has launched the early diagnosis programme for liver cancer, which aims to prevent liver cancer by actively checking for liver disease in our most deprived areas.

An important part of the early diagnosis programme includes 19 community liver health check pilot sites that were launched in 2022. The most recent data shows that the CLHC programme reached more than 7,000 people in our most deprived areas using mobile units between June ’22 and January ’23. These units are equipped with fibroscans, which is a fantastic new technology, as many hon. Members have mentioned, for detecting liver damage and identifying liver disease before it becomes life threatening. These non-invasive tests have diagnosed more than 830 patients with cirrhosis or advanced fibrosis. I am pleased to update hon. Members that there are now eight community diagnostic centres providing fibroscans and a further 14 planned.

For my entire career, I have fought for the principles of fairness and equal opportunity—from helping children and babies in deprived areas to get the best start in life to levelling the playing field for small businesses when I was Secretary of State for Business, Energy and Industrial Strategy and encouraging young women in my constituency to get into politics. I have done that throughout my career and I will not stop now. I am passionate about making our health service faster, simpler and fairer for all who use it, and tackling liver disease and liver cancer is at the heart of that mission. We have already delivered significant progress and, through prioritising prevention and driving early diagnosis, we have a plan to go further and faster in the years ahead.

13:23

[Navendu Mishra]

I will end on a few remarks. I thank everyone who has contributed to this debate from the Front and Back Benches, though I am a bit surprised that we did not have any speakers from the Government Benches other than the Minister. This is an important issue for everyone.

The rate of hospital admissions for liver disease is higher in deprived areas. In 2021-22, there were 211.4 hospital admissions for every 100,000 people living in areas of multiple deprivation, compared with 125.1 in the least marginalised areas. That is quite serious. Additionally, I agree with the Minister about alcohol consumption; indeed, Alcohol Change UK made the point that it is not anti-alcohol, but against alcohol harm.

I will leave the Minister with a few questions. On a personal level, whenever I have gone to her with various issues, she has been extremely helpful and tried to do her best, but I think this is an important issue for the broader Government and the Department of Health and Social Care. I urge the Minister to take urgent action to improve earlier detection of liver cancer and the less survivable cancers. It is critical that the Government deliver on their pledge to diagnose 75% of all cancers at an early stage by 2030, which is the date I have written down—I think the Minister mentioned 2028, which is even better.

To reduce the staggering health inequalities we still face, the Minister must commit to delivering a cross-Government strategy to curb health inequalities and a prompt, comprehensive review of adult liver services by NHS England. We also need a comprehensive cross-Government alcohol strategy that tackles the social and commercial determinants of health. I also ask the Minister what assessments, if any, the Department has made of the inequalities impact of funding cuts to alcohol treatment services. Those are very serious issues.

I thank the shadow Minister, my hon. Friend the Member for Birmingham, Edgbaston (Preet Kaur Gill), for her contribution. I hope to work with the Government on this issue. Once again, I thank all the charities and campaign groups that do so much on it.

Question put and agreed to.

Resolved,

That this House has considered health inequalities in liver disease and liver cancer.

13:26

Sitting suspended.