Liver Disease in Wales

11 May 2015

Article by Victoria Paris, National Assembly for Wales Research Service

Mortality rates for liver disease have increased 400% since 1970 and premature deaths in Wales from chronic liver disease have more than doubled in the last twenty years.  While there have been improvements in mortality from most other chronic disorders, such as stroke, heart disease, and many cancers, the number of deaths from liver disease has increased in people aged under 65.

Liver disease is the third most common cause of premature death in the UK and the rate of increase of liver disease is substantially higher in the UK than other countries in western Europe.

Graph showing mortality rates for various diseases

Source: Welsh Government, Together for Health – Liver Disease Delivery Plan

 

There are more than 100 types of liver disease, which together affect at least two million people in the UK.  The three most common types of liver disease in the UK are:

  • Obesity – Of the 25% of the UK population categorised as obese, most will have fatty liver disease, and many will have scarring and prolonged inflammation that will lead to cirrhosis.
  • Alcohol misuse – Alcoholic liver disease accounts for well over a third of liver-disease deaths. In 2012 alcoholic liver disease accounted for 63% of alcohol related deaths in England and Wales, 18% higher than the number of deaths in 2002.
  • Blood borne viral hepatitis (liver inflammation) – An estimated 12,000 to 14,000 people in Wales are chronically infected with hepatitis C. Currently only acute hepatitis B infections are recorded so no estimates exist for chronic infection of hepatitis B within Wales. However, the World Health Organization (WHO) estimates that in the UK the prevalence of chronic hepatitis B infection is 0.3% of the population.

Liver disease as a result of these three factors is almost entirely preventable.  The co-existence of more than one factor may lead to more serious liver disease and higher rates of liver cancer.  These underlying causes of liver disease are linked to social deprivation and therefore disproportionally affect the poorest communities.

As part of the Welsh Government’s Together for Health and Prudent Healthcare approaches, the Welsh Government launched the Liver Disease Delivery Plan on 5 May 2015.  Assembly Members are due to debate the Delivery Plan in Plenary on 12 May.

The Delivery Plan sets out the Welsh Government’s vision for liver disease services and focusses on how to prevent the disease in the first instance and ensure people have access to ‘excellent care’ where necessary.  On launching the Plan the Deputy Health Minister, Vaughan Gething AM, stated that ‘our NHS will continue to play its part in treating those who need it but all of us have to take responsibility for the health consequences of our lifestyle choices’.

The Plan is split into six themes, with each theme setting out key service issues, specific priorities, population outcome indicators and NHS assurance measures.  The six themes are:

  • Preventing liver disease: The risk factors contributing to liver disease are being actively addressed and fewer people are at risk of developing liver disease.
  • Timely detection of liver disease: People with liver disease are detected early and referred for treatment.
  • Fast and effective care: People with liver disease receive appropriate care by specialist multi-disciplinary teams.
  • Living with liver disease: People with liver disease are supported to manage their condition and reduce the risk of their disease progressing.
  • Improving information: NHS Wales and its partners provide better information and support to people at risk of developing or already suffering with liver disease.
  • Targeting research: Active collaboration in research related to liver disease delivers improvements in diagnosis, treatment and management.

The Plan will be supported by £1m of new Welsh Government funding. An extra £1.37m of annual funding, which is linked to the Blood Borne Viral Hepatitis Action Plan, which came to an end this year, will also continue as part of the Plan.

The Plan will be taken forward by establishing an NHS-led national implementation group, which will be required to produce an annual progress report on delivery against the Liver Disease Plan.  The group will be chaired by an NHS executive director, include service representation from health boards, third sector representation, the Chair of the Gastroenterology National Specialist Advisory Group and a representative of the Wales Association Gastroenterology and Endoscopy (WAGE).

Local health boards will be required to develop liver disease plans and report progress annually to the implementation group.  At local level, a lead clinician in each health board will lead a working group of a wide range of stakeholders including public health, local service planners, primary care, local government and third sector representatives, to coordinate and drive forward improvements at the local level.