WHY A FOCUS ON LIVER DISEASE PREVENTION WOULD SAVE THE NHS

The liver has achieved some stark headlines and column inches this week, and rightly so. Not only did Public Health England publish local liver disease profiles, highlighting that liver disease kills four times as many men in some parts of England as others, but also the NHS’ Five Year Forward View generated more headlines that arguably relate to liver disease. The report called for a focus on better prevention of alcohol and obesity (also smoking) to reduce the £30billion gap between available resources and the demand for care that is predicted to open up by 2020/2021. With the prevention of obesity and alcohol being hailed as a way to help manage the NHS system of the future, I started thinking. My thoughts were increased when I read excerpts of the report, which said: Health problems associated with obesity, smoking and drinking are growing, and the NHS is facing a rising financial burden from dealing with them. “The future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.” As a result, “the NHS will now back hard-hitting national action on obesity, smoking, alcohol and other major health risks”. Surely it is blindingly obvious that, if we are actually serious about addressing issues with alcohol and obesity, then we should start with the organ that is most affected – the liver. However, there appears to be a consistent ignorance and a ‘head-in-the-sand’ approach from decision-makers. It is safe to say that the liver has been ignored by government and policy makers, despite calls from the Chief Medical Officer and related health groups and charities. The missed opportunity of the National Liver Disease Strategy (canned in 2012, because ‘strategies’ were deemed ‘out of fashion’ by the coalition government) compounded by the laissez faire approach to curtailing the lobbying power of the alcohol and food industries, means that the problems remain and will continue to cause a unprecedented burden to the NHS. There is no ignoring the fact that liver disease is the fifth biggest killer in the UK, and the only one in the top five showing an upward trend in incidence. Yet, crucially, an estimated 95% of liver conditions can be prevented. Yes, you read that right, 95%! So, why is it that the liver continues to be unnoticed? Why is it that millions of pounds are spent to tackle heart disease and GPs are now being given £55 for every dementia diagnosis? Why is it that the ‘Live Well Health Checks’ do not include the liver as a main feature? Is it because other health areas have shouted the loudest? Is it because they have the celebrity endorsement that the liver sadly lacks? Or, is it the inertia of society who doesn’t want to tackle the taboo subjects associated with the liver. After all, the level of stigmatisation that liver conditions face (including those that are arguably not preventable like autoimmune/genetic conditions etc.) is unfounded, judgmental and helps no one. Liver disease is almost always deemed the ‘blamable’ condition, it is the disease that someone has caused himself or herself, and so deserves no sympathy. At this point in an argument, I always like to point out that excess alcohol and obesity is also linked to other health conditions such as breast cancer and bowel cancer. For conditions such as these, the reaction from society is one of sympathy, understanding and support, and not the hushed tones and questions of a secret alcohol problem that they’re not admitting to. I really do not enjoy comparing health conditions, but it is the inequities of spend, profile and service configuration in liver that has got us in to this situation. Let’s get back to the facts, liver disease is the third commonest cause of premature death in the UK, and the rate is considerably higher than for other countries in Europe. The average age of death is 59 years old. Over 1 million hospital admissions a year are the result of alcohol related conditions and 1 in 4 of us are thought to be obese. We have a huge problem on our hands yet three words shone out from the text in the report mentioned above – prevention, alcohol and obesity. If we are to actually achieve a sustainable NHS then we must focus on the liver as being the anchor point to this success. I may be a little biased towards the liver, and frustrated with the inaction so far, but it just means that we’ll keep campaigning for liver patients and liver services so that the liver is recognised as an important player in the public health arena and one of the solutions to a sustainable, future health service.