LARGE parts of Scotland do not have an effective way of identifying people with liver disease, resulting in late diagnosis.
New research published today shows for the first time a postcode lottery in detecting the potentially fatal condition.
It reveals how many areas across the country have little or no formal structures in place for detecting and managing liver disease and liver cancer.
This was in sharp contrast to other chronic conditions such as diabetes and heart disease, where patients receive standardised care.
The British Liver Trust is now calling for earlier detection of liver disease and better patient care across all regions of the UK to be prioritized, and is working to influence healthcare commissioners.
Its survey found that NHS Dumfries and Galloway, NHS Lanarkshire, NHS Fife and NHS Orkney were the health boards identified in Scotland as not having any effective patient pathway for diagnosis in place. The trust said they had no route for either the interpretation of liver blood tests or the disease more generally.
READ MORE: Liver cancer surge as study shows Scotland has highest rates in UK
NHS Highland and NHS Shetland had a pathway for the interpretation of liver blood tests only or they were in development.
NHS Ayrshire and Arran, NHS Borders, NHS Tayside and NHS Forth Valley and NHS Western Isle had what was considered to be effective patient pathways for diagnosis in place.
But the biggest health boards in Scotland, NHS Greater Glasgow and Clyde, and NHS Lothian did not take part in the survey.
Liver disease is the fifth largest cause of death in the UK, with alcohol the biggest factor.
There were 16.3 chronic liver disease deaths per 100,000 population in Scotland in 2018.
The survey, details of which are published today in the British Journal of General Practice looked into the structural workforce and processes in place specific to liver disease. It alsofocused on the use of recommended guidelines and diagnostic tools to detect liver disease as well as more proactive risk factor-based detection.
Only half of Scots health boards that responded had a named individual within their organisation responsible for liver disease.
Two in three had an endorsed pathway in place for acting on liver blood test results and 42% had pathways in place for other aspects of liver disease management.
None were aware of any processes in place to monitor the adoption and efficacy of endorsed pathways.
And only half reported monitoring current statistics relating to liver disease locally.
READ MORE: Scotland has the highest rate of liver cancer deaths in the UK. We must do more to stop it. By Linda Bauld
Dr Helen Jarvis, clinical advisor for the British Liver Trust and lead author of the research, says: “Anyone who has liver disease, or is at risk of getting it, should get the medical care and advice they need no matter where in the country they live. The publication of this new data shows that, unfortunately, in the UK this is not yet the case. There are pockets of good practice, but there are also many areas that do not have a consistent approach to testing for and diagnosing liver disease. It shouldn’t be a postcode lottery.
“GPs and other healthcare professionals in primary care are doing a fantastic job under a lot of pressure, but in many areas, they’re working within a system that doesn’t allow them to detect and treat liver disease effectively. Unfortunately, many GPs also report a lack confidence and knowledge when it comes to managing the condition. Sadly, this means that in many cases, people with liver disease are diagnosed far too late when treatment options are limited. This had led to thousands of avoidable deaths.
“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. However, 90% of liver disease is preventable and, in many cases, it’s reversable if caught in time. That’s why early detection and prevention are key.”
NHS Fife medical director, Dr Chris McKenna said: “NHS Fife is currently in the process of establishing a streamlined approach to the investigation of abnormal liver function tests and will be the second Health Board in Scotland to adapt the Intelligent Liver Function Testing (iLFT) lab system, which was first developed in NHS Tayside.
“Patients in Fife who have liver disease or the suspicion of liver disease are seen by one of our three Hepatologists and are managed in a multi professional team of doctors, nurse specialists and dietitians.”
An NHS Dumfries and Galloway spokesman said: “All GPs in Dumfries and Galloway are able to access advice on interpretation of Liver Function Tests (LFT) directly from the consultants with an interest in liver disease or the Gastroenterology Team.
“This is a readily accessible and very well used pathway which ensures that they receive consultant advice and that there is a pathway to fibroscans.
“There has been and continues to be a continually operating service to access a fibroscan clinic, as well as Hepatitis B and Hepatitis C clinics, and a very close link between medical teams and Dumfries and Galloway Alcohol and Drug Partnership.
“Expansion of the consultant body takes place in mid-August with the appointment of a hepatologist. This will tie in to the work currently taking place around developing pathways for patients with fatty liver disease, which is increasingly seen as a similar concern as alcohol in terms of avoidable end stage liver disease.”
NHS Lanarkshire and NHS Orkney were approached for comment.
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