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 7 July 2023 to Question 191385 on Liver Diseases: Screening, which 10 community diagnostic centres provide FibroScans; and whether she plans to increase the number of such centres that will provide transient elastography for earlier detection of liver disease in 2024.
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 following CDCs are currently offering FibroScan testing:
- Bexhill CDC in Bexhill-on-Sea, East Sussex;
- New QEII Hospital CDC in Welwyn Garden City, Hertfordshire;
- St Helen’s CDC in St Helen’s, Merseyside;
- Woking CDC in Woking, Surrey;
- Hereford City CDC in Hereford; and
- Andover CDC in Andover, Hampshire.
The following CDCs plan to offer this service by the end of March 2024:
- Bolton CDC in Bolton, Lancashire;
- Ely CDC in Ely, Cambridgeshire;
- Wisbech CDC in Wisbech, Cambridgeshire;
- Gloucestershire Quayside CDC in Gloucester;
- Northampton CDC in Northampton; and
- Queen Mary’s Hospital Roehampton CDC in Roehampton, Surrey.
We do not hold information on how much of the £2.3 billion allocated for diagnostics in the Spending Review 2021 has been spent on expanding the FibroScan rollout in CDCs, as this information is not routinely collected.
Asked by: John Penrose (Conservative - Weston-super-Mare)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, when she plans to respond to the letters of 10 November and 13 December 2023 from the hon. Member for Weston-super-Mare sent on behalf of a constituent on liver scans.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
I replied to the hon. Member on 18 January 2024.
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, what steps she is taking to reduce 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)
FibroScan capacity is being increased across England via the Community Diagnostics Centre (CDC) programme, backed as part of a £2.3 billion investment in diagnostic transformation. The National Health Service currently plans for 11 sites to be live with FibroScans by the end of this financial year, with seven presently live with the test. By March 2025 we expect there to be 15 CDCs offering FibroScans.
The CDC test offer is based on the recommendations in the Sir Mike Richards Review, and decisions on what modalities are offered outside of the core requirements of CDCs, including FibroScans, will be based on local need as well as local funding decisions and considerations.
Through the £2.3 billion diagnostics transformation programme, NHS England is ensuring that laboratories across the country have the digital capability required to offer Intelligent Liver Function Tests.
The NHS is also delivering and considering 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: Ian Byrne (Labour - Liverpool, West Derby)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, with reference to the guidance entitled FibroScan for assessing liver fibrosis and cirrhosis outside secondary and specialist care published by the National Institute for Health and Care Excellence on 7 June 2023, what assessment his Department has made of the potential merits of expanding the use of FibroScans in (a) primary and (b) community care.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
A practice has clinical discretion to decide if a FibroScan is necessary and appropriate for a patient and can either provide directly or through a provider, typically a hospital out-patient appointment.
FibroScan capacity is also being increased via the community diagnostics centre (CDC) programme, backed as part of a £2.3 billion investment in diagnostic transformation. We currently have plans for 11 sites to be live with FibroScans by the end of 2023/24; seven are currently live with the test. By March 2025 we will have 15 CDCs offering FibroScans.
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: Navendu Mishra (Labour - Stockport)
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 potential merits of commissioning a clinical audit of changes in rates of liver cancer.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
The Government has no current plans to commission a clinical audit of changes in rates of liver cancer. NHS England is implementing wider Long Term Plan actions for both liver cancer and liver disease detection and management including monitoring outcomes for liver cancer in England through published sources including cancer incidence, mortality and survival data which is collected through our disease registration service.
Asked by: Ian Byrne (Labour - Liverpool, West Derby)
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 potential merits of including non-alcohol related liver disease assessments in the NHS Health Check programme.
Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)
Following the launch of a digital NHS Health Check in spring 2024, consideration will be given to extending coverage of the NHS Health Check to include the assessment of conditions beyond cardiovascular disease. The Government is investing nearly £17 million in the development and national roll out of a digital NHS Health Check which will give users choice about where and when to have a check, enable us to reach more people, improve efficiency of the programme, and free up National Health Service staff time.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what consideration they have given to the potential of (1) a new national clinical director, and (2) new targets, to improve gastroenterology services.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
National Clinical Director (NCD) posts within NHS England are aligned with its major clinical programmes of work, which in turn are aligned with the NHS Long Term Plan. NHS England keeps consideration of which areas would benefit from an NCD under review, and new NCDs are appointed as necessary.
The Getting It Right First Time (GIRFT) programme has invested in clinical leadership in gastroenterology, which is one of its priority workstreams. The programme will be establishing a liver disease programme in 2024/25, including recruiting to a clinical lead role.
A NCD provides clinical advice and leadership on the NHS England Internal Medicine Specialised Services portfolio, which includes specialised gastroenterology and liver disease. Additionally, a National Speciality Advisor provides clinical advice more specifically to the hepatobiliary and pancreas programme.
NHS England already has work in place to improve the diagnosis, treatment, and care of those with gastroenterological conditions. Through its GIRFT programme, NHS England is aiming to reduce unwarranted variation in treatments and services though in-depth review of services, benchmarking and presenting a data-driven evidence base to support change.
The GIRFT specialty report on gastroenterology, published in September 2021, sets out actions and recommendations for the National Health Service to improve patient care and ensure consistency of care across the country. The Department and NHS England expect National Health Service trusts and clinical teams to consider how best they can implement these recommendations to ensure consistent and high-quality care for gastroenterological conditions.
Asked by: Wayne David (Labour - Caerphilly)
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 merits of expanding the FibroScan rollout to community diagnostic centres in areas with high prevalence 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 five are currently operational. A further seven CDCs plan to offer this service by the end of March 2024.
The CDC modality offer is based on the recommendations in the Sir Mike Richards Review, and decisions on what modalities are offered outside of the core requirements of CDCs will be based on local need and decisions. The Government is working with the National Health Service to deliver and consider the result from the pilot of the community liver health check programme, which in its first year delivered over 17,000 FibroScans to individuals at particular risk of cirrhosis or advanced fibrosis, using 40 FibroScanners, across 19 local areas.
Asked by: Dan Carden (Labour - Liverpool, Walton)
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 implications for her policies of the finding on p.134 of the Chief Medical Officer’s annual report, published on 10 November 2023, that deaths due to alcohol-related liver disease increased 87% between 2001 and 2021.
Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)
The Department has an existing agenda to tackle alcohol harms, including alcohol-related liver disease (ARLD). Continued alcohol consumption is the main risk for dying of ARLD. However, damage to a person’s liver can be effectively halted if it is identified early and there is an intervention to change the course of their disease. The most effective way to prevent ARLD is drinking within the United Kingdom Chief Medical Officers’ low-risk drinking guidelines, namely under 14 units per week.
The Department is supporting people who drink above low-risk levels to reduce their alcohol consumption, by encouraging substitution of standard-strength drinks with no- and low-alcohol alternatives. The Department’s consultation on updating labelling guidance for no- and low-alcohol alternatives closed on 23 November 2023 and a response will be published in due course.
As part of the NHS Health Check, information on alcohol consumption is provided to support people to make healthier choices. NHS Health Check guidance recommends that those identified to be drinking at higher-risk levels are referred for liver investigation.
The Department is also 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: Virendra Sharma (Labour - Ealing, Southall)
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 survival rates for people with liver cancer.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
The Department is supporting the National Health Service to increase survival rates for all cancers including for liver cancer in England by taking steps to diagnosing and treating cancers at an early stage. The NHS is working towards the NHS Long Term Plan ambition of diagnosing 75% of stageable cancers at stage 1 and 2 by 2028, meaning 55,000 more people each year will survive their cancer at least five years after diagnosis. To deliver this, the Department is driving faster roll-out of additional diagnostic capacity, establishing 135 community diagnostic centres, with capacity prioritised for cancer.
NHS cancer standards have been reformed with the support of clinicians to speed up diagnosis for patients which means people will receive a diagnosis or have cancer ruled out within 28 days from urgent cancer referral from their general practitioner (GP). In addition, the NHS-Galleri Trial is looking into the use of a new blood test to see if it can help the NHS to detect cancer early when used alongside existing cancer screening, including liver cancers.
The Government is working jointly with NHS England on implementing the delivery plan for tackling the COVID-19 backlogs in elective care and plans to spend more than £8 billion from 2022/23 to 2024/25 to help drive up and protect elective activity, including cancer diagnosis and treatment activity.
The Department has also committed support to the Less Survivable Cancers Taskforce, which targets cancers with stubbornly poor survival rates. This partnership focuses on liver, pancreas, lung, brain, oesophagus, and stomach cancers, raising awareness of these less survivable cancers so more people understand their symptoms and go to see their GP if they have concerns.
In addition to the immediate action to support cancer services, the Government announced on 24 January 2023 that it will publish a Major Conditions Strategy. The Strategy will tackle conditions that contribute most to morbidity and mortality across the population in England, including cancer.