New research highlights Wales’ progress in tackling liver disease, but rising death rates remain a concern across UK

New research published today in the British Journal of General Practice has revealed that Wales is leading the way in the early detection and effective management of liver disease.

Wales now has 100% coverage of comprehensive pathways of care for liver disease available in all health boards, compared to 36% across the rest of the UK.

The research also highlights how Healthcare Professionals across all of the Welsh Health Boards proactively recognise alcohol consumption and diabetes as risk factors, so that patients at risk of liver disease can be diagnosed and  managed effectively.

In October 2021 Wales was the first UK nation to launch a country-wide initiative - the All-Wales Liver Blood Test Pathway - to improve the early detection and management of liver disease across all 7 Health Boards in Wales.

Although 90% of liver disease is preventable, the UK saw a 27% increase in deaths from liver disease between 2019 and 2023, and the British Liver Trust is calling for urgent change to identify and monitor all those at risk, prevent countless early deaths, and reduce NHS spending across the UK.

Each year in the UK, more than 12,000 people die of liver disease, a silent killer that is often symptomless in the early stages, leading to three-quarters of people being diagnosed with advanced liver disease when it is too late for effective intervention or treatment. If found early, the progression of disease can be halted or reversed.

The study analysed the results from a survey undertaken by the British Liver Trust, that was completed by all the Health Boards in Wales as well as similar bodies in England, Scotland and Northern Ireland.

The survey questioned the current provision of a commissioned pathway, the use of recommended diagnostic tests and asked whether there were processes in place to identify and monitor those most at risk.

The research shows:

• Wales and Scotland both have much greater coverage of early detection pathways than England and Northern Ireland
• Only half (52%) of England has access to a fibrosis or liver scarring assessment which is vital to assess early stage disease.

The results are depicted in the map below

 An effective early detection pathway includes case finding those most at risk, effectively assessing abnormal liver blood tests in line with national guidance, an assessment for liver fibrosis, and appropriate referral to secondary care.

The new data highlights the urgent need for UK wide improvements to detect liver disease early, which will save NHS money and prevent thousands of avoidable premature deaths. The British Liver Trust is calling for:

• Effective early detection pathways to be implemented in every region, to identify and test anyone at higher risk but who currently don’t have symptoms.
• Assessment for liver fibrosis or scarring assessments for those whose basic blood tests are abnormal and, where appropriate, referral to specialist care. The risk factors for liver disease should be included in routine health checks for conditions such as diabetes and obesity across all community healthcare settings.

Dr Helen Jarvis, Clinical Advisor for the British Liver Trust and lead author of the research, said: "Everyone with liver disease, or at risk of developing it, should have access to essential medical care and advice, no matter where they live in the UK. GPs and primary care professionals are working tirelessly under challenging conditions, but often within a system that limits their ability to properly diagnose and treat liver disease.

“Many GPs also admit to lacking the confidence and knowledge needed to diagnose and manage this condition effectively. This has led to far too many cases being identified too late and at a point when treatment options are limited, resulting in thousands of avoidable deaths. This work points to the urgent need for a central directive to mandate regional health bodies to develop a locally agreed pathway of care for early detection and management of their populations at risk of liver disease, with strategies including liver fibrosis risk assessment as a minimum requirement.”

Pamela Healy OBE, Chief Executive of the British Liver Trust said: “Our research shows that when it comes to the early detection of liver disease, there is a postcode lottery. Although there have been some improvements since the last survey and there are pockets of good practice – this variation is not good enough and widespread preventative measures are woefully inadequate. We need to ensure that there is an effective pathway right across the UK so that everyone has equal access to care.

The work in Wales to improve liver disease diagnosis, treatment and care serves as an excellent example for the rest of the UK on how to tackle the growing challenge of liver disease in the UK. We need the rest of the UK to take a similar approach to Wales, by implementing a national liver disease delivery plan to effectively identity and manage at-risk patients before their symptoms start to cause a problem.

“The liver is an incredibly resilient organ, but only up to a point. Symptoms of liver disease often only appear once damage has progressed, and the liver is starting to fail. If found early, disease progression can often be halted or sometimes even reversed.”

Professor Stephen Ryder, Consultant Hepatologist, said “If we are to tackle the huge increases in the numbers of people dying from liver disease then prevention and early diagnosis are key. We need joined up effective pathways that link primary care and secondary care together to ensure more people are diagnosed early and receive treatment as soon as possible.”

The survey was a repeat of a survey first undertaken in 2020 and published in 2021.

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