Unacceptable failures: the final report of the Lancet Commission into liver disease in the UK

Abstract

This final report of the Lancet Commission into Liver Disease in the UK stresses the continuing increase in disease burden of liver disease from excess alcohol consumption and obesity, with high levels of hospital admissions and a worsening in deprived areas. It concludes that only with comprehensive food and alcohol strategies based on fiscal and regulatory measures including the Minimum Unit Price (MUP) for alcohol and the alcohol duty escalator, as well as an extension of the sugar levy on food content which has been proven by previous experience in this country, can the disease burden be curtailed. Further evidence of the value of MUP is shown by initial published results (1) of its introduction in Scotland showing an overall 3% reduction in consumption, with the major effect as predicted on heavy drinkers of low-cost alcohol products The major contribution of obesity and alcohol to the high rates of the ten most common cancers is also discussed. The measures outlined by the departing Chief Medical Officer, Dame Sally Davies, to combat rising levels of obesitythe highest of any country in the Westare described along with the estimated health costs. The latest audit analysis of unacceptable levels of mortality for severely ill patients with liver disease in District General Hospitals (DGHs)(2) indicates the need for developing a masterplan for improving hospital care and such a plan is proposed in this report based around specialist hospital centres linked to DGHs by Operational Delivery Networks (ODNs). It has received strong backing from the British Association for Study of the Liver (BASL) and British Society of Gastroenterology (BSG) but is held up at NHS England (NHSE). The value of day-case care bundles to reduce high hospital readmission rates with greater care in the community is described, along with examples of locally derived schemes for the early detection of disease and in particular schemes to allow general practitioners (GPs) to refer patients directly for elastography assessment. New funding arrangements for GPs will be required if these are to be taken up more widely around the country, as is recommended. A new ComRes poll, to be published in autumn 2019, shows an appalling lack of understanding of harm to health from lifestyle causes, with a poor knowledge of alcohol consumption and dietary guidelines. The Commission has serious doubts as to whether the initiatives described in the Prevention Green Paper(3), with the onus placed on the individual based on the use of information technology and the latest in behavioural science will be effective. The final section of the report raises questions of meaningful survival in paediatric liver disease where despite excellent overall survival results, there are high levels of cognitive impairment. In the Conclusion, a strong plea is made for greater coordination between the various official and non-official bodies that have expressed views on the unacceptable disease burden from liver disease in this country in presenting a single, strong voice to the ...

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