Written question WQ86304

Welsh Government is committed to ensuring that anyone with liver disease in Wales should have access to the best possible care.

The Substance misuse Delivery Plan 2019-22 requires Area Planning Boards, which have Health Boards as a member, to offer a comprehensive range of interventions for both drug and alcohol associated conditions. A needs assessment is conducted by each Area Planning Board which subsequently informs the commissioning of suitable services to meet local need. Welsh Government does not assess specifically the quality of care for patients with alcohol related liver disease but does work with Health Boards to ensure they have effective internal systems of quality assurance and governance.

The Liver Disease Implementation Group (LDIG) has been supporting Health Boards to increase the use and capacity of transient elastography (Fibroscan) through the All Wales Abnormal Liver Blood Test Pathway. The Pathway helps doctors recognise advanced disease (including cirrhosis) at a much earlier stage, and how to address the patient’s risk factors for liver disease, including alcohol cessation and weight management. The aim of the pathway is to reduce the devastating consequences of late diagnosis.

The All Wales Abnormal Liver Blood Test Pathway was launched 1 year ago. The LDIG is reviewing the impact on new liver disease diagnoses since launch using the Liver Disease Registry data dashboard. There has been an increase in liver disease and cirrhosis diagnoses and just over a quarter of the GPs in Wales have used the educational resource that supports the pathway. Assessment of the clinical effectiveness has been complicated by clinical service disruption and an increase in liver disease risk factors due to COVID-19. The LDIG will continue to raise awareness of optimal management of abnormal liver tests within primary care.

Reducing the stigma associated with liver disease is crucial in preventing late presentation and diagnosis of liver disease. That is why the LDIG has been working in partnership with the British Liver Trust to destigmatise liver disease through education and improving public understanding of a wide range of different liver conditions. The “Love Your Liver” events are one of the many ways the British Liver Trust helps to fulfil this function. Through the LDIG Welsh Government has enabled the commissioning of the British Liver Trust to work in partnership with LDIG to improve the knowledge of liver disease risk factors in Wales and to de-stigmatise the condition.

In addition, the Wales Infected Blood Support Scheme (WIBSS) provides support to people who have been infected with hepatitis C and/or HIV as a result of NHS treatment with blood, blood products or tissue in Wales. Individuals registered with WIBSS, their family members and bereaved family members can access psychological assessment and treatment concerning the emotional difficulties of being given and living with a diagnosis of hepatitis C and/or HIV, this will include the stigma associated with liver related diseases. The hope is that by offering a specialist psychology service there will be some acknowledgement and recognition of the physical and psychological complexity and the impact on quality of life and relationships.

Chronic liver disease is the most significant risk factor for hepatocellular carcinoma, with 80%-90% of new cases occurring in the background of cirrhosis. Studies have shown that early diagnosis of hepatocellular carcinoma through surveillance programs improve prognosis and availability of curative therapies. We expect the NHS in Wales to deliver care in line with standards from the National Institute for Health and Care Excellence (NICE) which recommend surveillance of patients with liver cirrhosis normally by ultrasound every six months. This should be offered to all such patients as part of routine clinical care unless co-morbidity (such as liver failure or severe cardio-respiratory diseases) would preclude active treatment of an identified liver cancer. The Registry dataset, launched later this month, and funding by the Welsh Health Specialised Services Committee for the South Wales Liver Cancer Multi-Disciplinary Team will support Health Boards with in-house discussions and act as a mechanism to oversee operational standards with a view to improving performance and standardisation