Public Health England has published the 2nd Atlas of variation in risk factors and healthcare for liver disease in England. The outcomes for residents in Blackburn with Darwen and across Pennine Lancashire are poor.
Liver Disease is a silent killer and the only major cause of death and illness which is increasing in England, whilst it is decreasing among our European neighbours. It is the third biggest cause of early death, behind ischaemic heart disease and self-harm including suicide. However, most liver disease is preventable with only about 5% of deaths are attributable to autoimmune and genetic disorders and over 90% are due to three main risk factors: alcohol, viral hepatitis and obesity.
Dr Phil Huxley, Earby GP and Chair of East Lancashire Clinical Commissioning Group (CCG) said:
“As a GP I see the shocking toll of alcohol abuse, whether that is binge drinking or excessive drinking over time. There is no doubt that alcohol, in moderation can be enjoyed and can contribute to an enjoyable social life; however because too much alcohol over a long period of time can cause irreparable damage to the liver and can ruin peoples’ lives – I would urge people to drink sensibly and really think through the dangers of abusing alcohol. Simply alternating an alcoholic drink with a non-alcoholic drink may be a sensible way of managing your alcohol consumption”
People in the most deprived areas are more likely to go into hospital with an alcohol related condition than those from more affluent areas; and people deprived areas of the country with liver disease earlier than those in the most affluent.
Blackburn with Darwen, which has more than half of its residents in one of the most deprived areas of the country has poor outcomes for liver disease for people going into hospital and early death. However the problems caused by excess alcohol consumption extend across East Lancashire and the figures are a stark warning of the dangers of excessive alcohol consumption for everyone.
Dr Sakthi Karunanithi, Director of Public Health for Lancashire County Council, said: “Liver disease is a concern in Lancashire as in many other areas of the country.
“It has been estimated that 90% of liver disease is preventable. The main risk factors are excess alcohol consumption, obesity and viral hepatitis.
“Because so much liver disease is linked to the amount of alcohol people drink, we’re actively promoting safe drinking messages and encouraging people to be aware of drinking limits to tackle this issue. It’s important that people avoid binge-drinking and that they are also aware of the long-term damage alcohol causes if they drink too much on a regular basis.
“Lancashire County Council offers support through its range of commissioned services for people who have concerns over their alcohol use, as well as testing for viral hepatitis for those at risk and, where appropriate, provision of needle exchange services.
“If you feel you or anyone you know is concerned over these issues, you can contact your local GP or one of our treatment services who will give you the support you need.”
In Blackburn with Darwen the data shows that 50% more people are admitted into Hospital for Liver Disease than would be expected and the admission rate has increased consistently since 2012/13. Premature deaths (mortality aged <75) from Liver Disease are increasing year on year and the rate remains significantly higher than the England figure of 18.0 per 100,000. Hospital Admission Rates for Alcoholic Liver Disease (74.3) were more than double the England rate (34.8). The number of premature deaths attributable to alcoholic liver disease was 45, a rate of 12.1 per 100,000, which is now significantly higher than the England figure of 8.7.
Professor Dominic Harrison, Director of Public Health, Blackburn with Darwen Council said:
“The new liver disease atlas shows that outcomes are poor but in Blackburn with Darwen we are taking strategic and practical action to address the key drivers of liver disease. Our prevention programmes in partnership with communities will encourage people to consume less alcohol, specifically address harmful drinking and encourage people to be more physical active.”
“Action to tackle liver disease in Blackburn with Darwen includes our 2014-17 Alcohol strategy backed up with major programmes on alcohol including; improved community awareness and education, prevention, treatment and recovery. Improved licensing processes to reduce the harms to communities and lobbying on the minimum unit price for alcohol. Current data suggests that more than half of people who access specialist alcohol support in Blackburn with Darwen (53.8%) successfully complete their treatment and don’t return to services for 6 months. This is a notable achievement as the national rate is 39%.”
More information about alcohol and liver disease is available on NHS Choices at http://www.nhs.uk/Livewell/Alcohol/Pages/Alcoholhome.aspx.
Across Pennine Lancashire new anti-viral treatments for Hepatitis C are available through the Lancashire Hepatitis C Operational Delivery Network run by East Lancashire Hospitals NHS Trust. This has improved opportunities for screening and access and increased take-up of new and highly effective treatments which have improved outcomes. Blackburn with Darwen is part of this proactive partnership with Public Health England, East Lancashire Hospital Trust’s Hepatology specialists and Inspire community drug and alcohol service. There is also a strong campaign to improve the rates of hepatitis vaccinations and screening among high risk cohorts such as the homeless, injecting drug users and those who present for specialist support around their alcohol use.
Work is ongoing to continue to improve access and engagement utilising revised treatment pathways, improved training for staff and service users and ongoing peer support from people with lived experience. This form of treatment has the potential to have a significant impact on mortality rates in the future should the treatment be rolled out fully by NHS England. Currently developing an improved protocol for liver disease testing in Primary Care which will begin to tackle Non Alcoholic Fatty Liver Disease (NAFLD).
The Blackburn Eat Well Move More Shape up nutrition and physical activity strategy alongside joint signing of the Declaration on Healthy weight by the Council and CCG will begin to encourage our residents to be more active and address levels of obesity, which will impact on the obesity and diabetes drivers of NAFLD.