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Report: 'Very little progress' made on shortage of liver specialists in UK
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Since The Lancet Commission on Addressing Liver Disease in the UK was published last year, there remains a significant shortage of liver specialists, with less than a third of hospitals employing one full-time, according to a new report.
“Although the total number of liver specialists in the UK has actually increased in recent years, they are concentrated in a small number of large specialist liver centers,” Roger Williams, MD, director of the Foundation for Liver Research in London, UK, said in a press release. “The UK’s specialist liver centers provide an excellent standard of care for their patients, but they aren’t evenly distributed throughout the country. This results in a postcode lottery for patients with liver disease, who may not be able to access specialist care when they need it. We’ve seen very little progress on this problem since we first reported it last year, and the rising numbers of patients with liver problems in the UK means that we can’t afford to ignore these shortcomings any longer.”
The report details results from a survey of 141 English hospitals (70% of which provided data) on hospital staffing and liver disease facilities, which show “substantial deficiencies at all levels.” The number of full time equivalent consultant hepatologists increased by 29% since 2010, but 31% of them were in the country’s six transplant centers and 40% were in its 16 larger specialist regional centers. Among the 76 remaining hospitals that provided data, only nine met criteria for “an adequately staffed acute service,” and of the 67 district general hospitals that did not meet criteria, 44 did not have a full-time equivalent specialist hepatologist on staff.
“Ensuring that district general hospitals have adequate hepatology staffing to provide a 24-hour, 7-days-per-week service for acutely ill patients is an urgent priority and without progress further adverse National Confidential Enquiry into Patient Outcome and Death (NCEPOD) reports are likely,” according to the report.
The report also details initial progress made on other key recommendations the commission made in its original report, concluding there is a continued need for increased government leadership in reducing alcohol abuse and obesity.
“One of the most important challenges facing the NHS today is how we deal with rising obesity and excess alcohol consumption when such a high proportion of the population are affected,” Williams said in the press release. “There is convincing evidence to suggest that measures such as minimum unit pricing for alcohol and curbing advertisement and promotional offers for high sugar products work to reduce consumption, but the current government appears to be ideologically opposed to measures like this, which will make tackling these problems difficult.”
The report does acknowledge Scotland and Wales for making progress in addressing liver disease. Scotland’s government alcohol strategy, for example, was shown to reduce alcohol-related deaths by 35% since 2003 and alcohol-related new patient hospitalizations by 25% since 2007 and 2008.
The report also highlights the UK’s widespread lack of surveillance for early detection of liver cancer in patients with cirrhosis, promising advances in HCV treatments, lack of progress in HBV, and some improvements in physician and nurse training and in public and physician awareness of liver disease. Liver transplant services are also currently undergoing a comprehensive national review, according to the report.
“Over three quarters of liver disease cases are potentially preventable, yet the last three decades have seen a fourfold increase [in] the number of people dying from this unpleasant and debilitating illness,” Williams said. “Reducing obesity and alcohol misuse — responsible for the majority of liver deaths in this country — won't just reduce the number of people in the UK suffering from liver disease, but it will also hugely reduce the burden of heart disease and other related illnesses, so there are enormous and quite obvious benefits to acting on this problem now.” – by Adam Leitenberger
Disclosures: One of the authors reports he received grant funding and personal fees from Gilead, Merck, Boehringer Ingelheim, Janssen, Roche and Bristol-Myers Squibb.
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