Asked by: Theresa Villiers (Conservative - Chipping Barnet)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if she will take steps to ensure that all general practice clinicians have access to training on the (a) risk factors and (b) symptoms of liver (i) disease and (ii) cancer.
Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)
General practitioners (GP) are responsible for ensuring their own clinical knowledge, including on liver disease and cancer, remains up-to-date and for identifying learning needs as part of their continuing professional development. This activity should include taking account of new research and developments in guidance, such as that produced by the National Institute for Health and Care Excellence, to ensure that they can continue to provide high quality care to all patients.
All doctors registered in the United Kingdom are expected to meet the professional standards set out in the General Medical Council’s (GMC’s) Good Medical Practice. In 2012 the GMC introduced revalidation which supports doctors in regularly reflecting on how they can develop or improve their practice, which gives patients confidence that doctors are up to date with their practice, and promotes improved quality of care by driving improvements in clinical governance. The training curricula for postgraduate trainee doctors is set by the Royal College of General Practitioners and must meet the standards set by the GMC.
Asked by: Peter Gibson (Conservative - Darlington)
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 29 January 2024 to Question 10925 on Liver Diseases: Darlington, how much and what proportion of the £30,000 for County Durham and Darlington NHS Foundation Trust will be spent in Darlington.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
The breakdown of funding requested is not held by the Department.
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: 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.
Asked by: Peter Gibson (Conservative - Darlington)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps she is taking to tackle liver disease in the North East.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
The Northern Cancer Alliance is supporting services to enable the early detection of liver disease across the North East and North Cumbria Integrated Care System (ICS). More than 80% of patients with liver cirrhosis, a type of liver disease, have been invited to monthly ultrasound surveillance. This investment has also included £30,000 for the County Durham and Darlington NHS Foundation Trust who will be using their funds to improve systems in relation to call and recall of patients to their six-monthly checks.
Liver disease has several causes and can be associated with alcohol use or being overweight. The Government is investing significant amounts year on year in alcohol treatment through our 10-year drug strategy. In 2024/2025 the North East will receive a further £27 million, beyond funding provided by the Public Health Grant. Partners are also using a whole system approach to develop a healthy weight and treating obesity strategy for the North East and North Cumbria.
The Department is supporting people with alcohol dependency through the Drug Strategy and NHS Long Term Plan by facilitating more people in need of treatment into local authority commissioned alcohol treatment services. Additional treatment and recovery funding, made available through the Drug Strategy, can also be used to increase capacity for screening for liver fibrosis in treatment settings and to establish effective referral pathways into treatment for liver disease.
Asked by: Peter Gibson (Conservative - Darlington)
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) Darlington constituency and b) the North East.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
The Office for Health Improvement and Disparities 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. These profiles do not publish data by constituency; however, the profile does publish data for local authorities.
In the Darlington Unitary Authority, during 2021, the rate of mortality from liver disease was 26.4 (17.3 to 38.4) per 100,000 population aged under 75 years old. In 2021/22, the hospital admission rate due to liver disease was 177.8 (122.6 to 239.3) per 100,000 population across all ages.
In the North East region, during 2021, the rate of mortality from liver disease was 28.8 (26.7 to 31.0) per 100,000 population aged under 75 years old. The North East regional rate was significantly higher than the England mortality rate of 21.2 per 100,000 and was the second highest regional rate in England. In 2021/22, the hospital admission rate in the North East region due to liver disease was 190.1 (178.6 to 201.7) per 100,000 population across all ages. The North East regional rate was significantly higher than the England hospital admission rate of 150.6 per 100,000 and was the highest regional rate in England.
Asked by: Peter Gibson (Conservative - Darlington)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps she is taking to support the detection of liver disease in Darlington constituency.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
The Northern Cancer Alliance (NCA) is supporting services to enable the early detection of liver disease across North East and North Cumbria Integrated Care Board (ICB). More than 80% of patients with liver cirrhosis, a type of liver disease, have been invited to monthly ultrasound surveillance. For 2024/25, the NCA has invested over £200k into trusts across the ICB to help improve their monitoring systems for cirrhosis patients. This investment has also included £30,000 for County Durham and Darlington NHS Foundation Trust who will be using their funds to improve systems in relation to call and recall of patients to their six-monthly checks.
The ICB is also enrolled in a Community Liver Health Check pilot in Newcastle, being delivered by the systems Hepatitis C Operational Delivery Networks. This will provide FibroScans in one stop community clinics where patients have relevant blood testing, liver ultrasound and other investigations as required. The pilot has expanded into North Tyneside and when resources allow, they intend to develop clinics elsewhere including Gateshead and Sunderland.
Asked by: Chloe Smith (Conservative - Norwich North)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what assessment she has made of the potential impact of the rollout of community diagnostic centres on the time taken to diagnose less survivable cancers.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
The Government is taking steps through NHS England to improve outcomes for cancer patients, including those cancers mentioned by the Less Survivable Cancer Taskforce, namely lung, liver, brain, oesophageal, pancreatic and stomach. Diagnostic checks are a key part of cancer pathways and the 150 community diagnostic centres (CDCs) opened by the Government will give earlier diagnostic tests, benefitting millions of patients including those who are referred with suspected less survivable cancers. National Health Service systems have been asked to prioritise CDC capacity towards their most challenged cancer pathways, where this is clinically appropriate, and these centres have delivered over six million additional tests for all elective activity since July 2021. The CDC programme is on track to meet its target to open up to 160 CDCs by March 2025, with many due to open ahead of schedule.
In November 2022, the NHS also announced an expansion of direct access to diagnostic scans across all general practices, to help cut waiting times and speeding up cancer diagnosis, or all-clear for patients. The NHS is now looking to widen the clinical pathways for which this is offered.
Making improvements across different cancer types is critical to helping achieve the NHS Long Term Plan ambition of diagnosing 75% of patients at an early stage by 2028 and reducing inequalities in cancer survival. NHS England has commissioned new cancer clinical audits covering six cancer types, some of which are less survivable: pancreatic cancer, ovarian cancer, non-Hodgkin lymphoma, kidney cancer and primary and metastatic breast cancer. All six audits will cover care delivered in England and Wales.
Asked by: Kate Osamor (Independent - 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 (Independent - 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.