Asked by: Rachael Maskell (Labour (Co-op) - York Central)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if she will introduce (a) liver and (b) blood tests for (i) young and (ii) any other people with high alcohol use.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
Decisions on the use of diagnostic tests for individual patients both under and over 16 years old, are the responsibility of a referring clinician or a healthcare professional, where delegated, taking into account local priorities and clinical guidance.
Alcohol-related liver disease is relatively uncommon in patients under 16 years old as it usually results from several years of heavy drinking. There are no National Institute for Health and Care Excellence (NICE) guidelines and guidance, recommending the use of liver and blood tests for young people.
NICE has made the following recommendations about the use of liver and blood tests for patients over 16 years old: for adults referred to specialist alcohol services, it recommends considering blood tests to help identify physical health needs, but to not use blood tests routinely for the identification and diagnosis of alcohol use disorders; and it recommends liver testing for all men who regularly drink more than 50 units of alcohol per week or women who drink more than 35 units per week. However, routine liver blood tests should not be used to rule out liver fibrosis and cirrhosis.
NHS England is currently reviewing existing liver diagnosis pathways as part of its wider diagnostic transformation work, to determine what the best approach should be to identify patients at an earlier stage of liver disease, through a liver pathway starting in primary care and involving pathology labs and community diagnostic centres. This will likely include a combination of blood tests and transient elastography.
Asked by: Alison Thewliss (Scottish National Party - Glasgow Central)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if she will make an assessment of the implications for her policies of the development of intelligent liver function tests by the University of Dundee; and if she will make it her policy to increase the rollout of these tests in areas with the highest levels of liver disease in England.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
The Government is working with the National Health Service to support earlier diagnosis of liver disease, and to identify patients at risk. This includes plans agreed as part of the £2.3 billion diagnostics transformation programme, to upgrade the digital capabilities of laboratories across the country and ensure that they have the capability required to offer Intelligent Liver Function Tests (iLFTs).
NHS England is reviewing the liver fibrosis pathways, and looking at developing a diagnosis pathway starting in primary care that will make use of both laboratory-based tests, such as iLFTs, and community diagnostic centres. The Government will make a further assessment of this work once it is complete, including the benefits of an increased rollout of iLFTs across England.
Asked by: Rachael Maskell (Labour (Co-op) - York Central)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether she plans to take steps to (a) roll out intelligent liver function testing nationally and (b) help ensure that Integrated Care systems implement pathways for early detection of liver disease.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
The Government is working with the National Health Service to support earlier diagnosis of liver disease and the identification of patients at risk. This includes plans agreed as part of the £2.3 billion of diagnostics transformation programme funding, to upgrade laboratory digital capabilities to ensure that labs across the country have the capability required to offer Intelligent Liver Function Tests.
Over the coming year, NHS England is due to pilot a new diagnostic pathway for liver disease, which will include fibrosis scanning in community diagnostic centres. The Government looks forward to seeing the results of that pilot.
Asked by: Wera Hobhouse (Liberal Democrat - Bath)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, how many and what proportion of hospital admissions were due to liver disease in 2022-23.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
The Office for Health Improvement and Disparities publishes liver disease profiles. These provide data on the number and rate of hospital admissions for liver disease in England and local areas. The profiles currently include hospital admissions data up to the financial year ending 31 March 2022.
In the financial year ending 2022, there were 82,290 hospital admissions in England due to liver disease. The profiles do not include the proportion of all hospital admissions that are due to liver disease. Data on hospital admissions is updated regularly in the profiles, and data for the financial year ending 2023 will be published this summer.
Asked by: John Hayes (Conservative - South Holland and The Deepings)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what estimate she has made of the rate of liver disease in (a) South Holland district, (b) South Kesteven district, and (c) Lincolnshire.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
The Office for Health Improvement and Disparities (OHID) publishes liver disease profiles that compare local areas within England. Data for the prevalence of liver disease is not collected. The profiles provide liver disease mortality and hospital admissions rates for local authorities to assess their level of disease.
The main findings for the South Holland Non-metropolitan District Council were that during 2022, the rate of mortality from liver disease in people under the age of 75 years old was 18.3, or between 10.8 to 28.9, per 100,000. In the financial year ending 2022 the hospital admission rate due to liver disease in all ages was 109.9, or between 50.8 to 178.0, per 100,000.
The main findings for the South Kesteven Non-metropolitan District Council were that during 2022 the rate of mortality from liver disease in people under the age of 75 years old was 13.3, or between 7.9 to 20.8, per 100,000. In the financial year ending 2022 the hospital admission rate due to liver disease in people of all ages was 80.9, or between 60.8 to 103.9, per 100,000.
The main findings from the profiles for Lincolnshire County were that during 2022 the rate of mortality from liver disease in people under the age of 75 years old was 19.5, or between 16.4 to 22.9, per 100,000. The Lincolnshire County rate was similar to the national mortality rate of 21.4 per 100,000. In the financial year ending 2022, the Lincolnshire County hospital admission rate due to liver disease in people of all ages was 144.3, or between 119.1 to 170.7, per 100,000 population. The Lincolnshire County hospital admission rate was similar to the national rate, of 150.6 per 100,000.
Asked by: Navendu Mishra (Labour - Stockport)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, pursuant to the Answer of 22 January 2024 to Question 8221 on Liver Diseases: Screening, what assessment has been made of the potential impact of the Government's planned measures on geographic variations in the provision of non-invasive liver scans in community diagnostic centres.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
The Government is aware that its planned measures will lead to geographic variation in the provision of non-invasive liver scans in community diagnostic centres (CDCs). This is because it is up to individual National Health Service integrated care boards to determine, based on local need and local diagnostic pathways, whether introduction of non-invasive liver scans in CDCs is necessary.
NHS England is reviewing existing liver fibrosis pathways as part of its wider diagnostic transformation work to determine the best approach for identifying patients at an earlier stage of liver disease. This includes looking at developing a pathway starting in primary care, making use of laboratory-based tests, as well as diagnostics in other settings such as CDCs.
Asked by: Helen Morgan (Liberal Democrat - North Shropshire)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps her Department is taking to ensure there are effective pathways for early detection of liver disease in Shropshire.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
Early detection of liver disease is vital to enable interventions, and encourage behavioural changes that can potentially lead to recovery. Liver disease is one of the primary risk factors for liver cancer. Across the Shropshire, Telford, and Wrekin Integrated Care Board (ICB) area, the early detection of liver disease is led by primary care partners, and the ICB encourages general practitioners to follow best practice in the delivery of patient care pathways, to ensure the early detection of liver disease in patients. The Shrewsbury and Telford Hospital NHS Trust is working with primary care partners to increase awareness and provide tools to support this work. The hospital also carries out active outreach into the community for drug and alcohol patients.
Asked by: Kate Osamor (Labour (Co-op) - Edmonton)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps her Department is taking to increase access to FibroScan testing for liver fibrosis through Community Diagnostic Centres.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
There are currently plans for 12 community diagnostic centres (CDCs) to offer FibroScan testing, of which six are operational. A further six CDCs plan to offer this service by the end of March 2024.
The CDC core diagnostic tests offer is based on the recommendations in the Sir Mike Richards Review, and decisions on what tests are offered outside of the core requirements of CDCs is taken at a local level based on need.
The Government is working with the National Health Service to support earlier diagnosis of liver disease and identifying patients at risk. This includes plans for upgrading laboratory digital capabilities as part of the £2.3 billion diagnostics transformation programme, to ensure that labs across the country have the capability to offer Intelligent Liver Function Tests, that can effectively and quickly identify patients at high risk of advanced fibrosis.
The Government is also working with the NHS to deliver and consider the result from the pilot of the community liver health check programme, which is due to deliver 22,000 FibroScans per year to communities at particular risk of liver disease. From June 2022 to September 2023, over 26,500 FibroScans were delivered through the pilots, and 8% of people scanned have already been enrolled into liver surveillance programmes. The programme is being delivered across 19 areas by Hepatitis C Operational Delivery Networks to FibroScan patients at high risk of cirrhosis or advanced fibrosis, utilising 40 FibroScan machines.
NHS England is reviewing existing liver diagnosis pathways as part of its wider diagnostic transformation work, to determine what the best approach should be to identify patients at an earlier stage of liver disease, through a liver pathway starting in primary care and involving pathology labs and CDCs. This will include a combination of blood tests and FibroScans.
Asked by: Kate Osamor (Labour (Co-op) - Edmonton)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps her Department is taking to help improve the diagnosis of liver disease.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
There are currently plans for 12 community diagnostic centres (CDCs) to offer FibroScan testing, of which six are operational. A further six CDCs plan to offer this service by the end of March 2024.
The CDC core diagnostic tests offer is based on the recommendations in the Sir Mike Richards Review, and decisions on what tests are offered outside of the core requirements of CDCs is taken at a local level based on need.
The Government is working with the National Health Service to support earlier diagnosis of liver disease and identifying patients at risk. This includes plans for upgrading laboratory digital capabilities as part of the £2.3 billion diagnostics transformation programme, to ensure that labs across the country have the capability to offer Intelligent Liver Function Tests, that can effectively and quickly identify patients at high risk of advanced fibrosis.
The Government is also working with the NHS to deliver and consider the result from the pilot of the community liver health check programme, which is due to deliver 22,000 FibroScans per year to communities at particular risk of liver disease. From June 2022 to September 2023, over 26,500 FibroScans were delivered through the pilots, and 8% of people scanned have already been enrolled into liver surveillance programmes. The programme is being delivered across 19 areas by Hepatitis C Operational Delivery Networks to FibroScan patients at high risk of cirrhosis or advanced fibrosis, utilising 40 FibroScan machines.
NHS England is reviewing existing liver diagnosis pathways as part of its wider diagnostic transformation work, to determine what the best approach should be to identify patients at an earlier stage of liver disease, through a liver pathway starting in primary care and involving pathology labs and CDCs. This will include a combination of blood tests and FibroScans.
Asked by: Conor McGinn (Independent - St Helens North)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what recent estimate she has made of the rate of liver disease in (a) St Helens North constituency and (b) the North West.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
The Office for Health Improvement and Disparities (OHID) publishes Liver Disease profiles that compare local areas within England. Data for the prevalence of liver disease is not collected. The profiles provide liver disease mortality and hospital admissions rates for areas to assess their local level of disease.
The profiles do not publish data by constituency; however, the profile does publish data for local authorities. For St. Helens Metropolitan District Council, the rate of mortality during 2021 from liver disease was 31.3 (23.4 to 40.9) per 100,000 population aged under 75 years old. In 2021/22, the hospital admission rate due to liver disease was 196.8 (150.9 to 246.4) per 100,000 population across all ages.
For the North West region, the rate of mortality during 2021 from liver disease was 29.3 (28.0 to 30.7) per 100,000 population aged under 75 years old. The regional rate was significantly higher than the England mortality rate of 21.2 per 100,000 and was the highest regional rate in England. In 2021/22, the hospital admission rate due to liver disease was 160.6 (154.5 to 166.7) per 100,000 population across all ages in the North West region. The regional rate was significantly higher than the England hospital admission rate of 150.6 per 100,000 and was the fourth highest regional rate in England.