Revealed: Scotland’s ‘postcode lottery’ of effective liver disease diagnosis

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 prioritised, 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 it had no route for either the interpretation of liver blood tests or the disease more generally.

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 also focused 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 per cent 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.

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 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 reversible if caught in time so early detection and prevention are key.”