Summary
Strategic Issue 1
There is age-related vulnerability to liver disease and damage. Young people are showing signs of liver disease by age 24 and the rate of under 75 mortality from liver disease is higher than the national average.
What needs to be done
There is a need for targeted intervention in those aged 20 to 49. There is age-related vulnerability therefore there is a need for early prevention and screening in this age group.
There is high mortality within the 35-49 age range, so this group in particular should be a priority for screening and targeted intervention such as health checks, alcohol misuse support and community outreach.
Improving early diagnosis in this age range in deprived and underserved groups, using All Our Health. Tools such as mobile scanning units (NHS Community Liver Health Programme) can be directed to areas of highest need in community settings such as football matches, local hubs and foodbanks.
Within this age group there should be clear care pathways between substance misuse, mental health and liver services. Integration of services and data sharing will ensure this age group receive all facets of care.
Strategic Issue 2
Deprivation is a key driver to liver disease, a high proportion of Hartlepool’s LSOAs are in the top 10% most deprived nationally. Deprivation increases exposure to risk factors such as alcohol, the admission rate for alcohol-specific conditions is higher than the national average and increasing.
What needs to be done
There is a need for early prevention and screening among groups of high deprivation, high rates of risk factors and social determinants, particularly in working-age adults.
Early prevention of lifestyle risk factors including alcohol use and obesity is essential to limiting liver disease.
Individuals attending substance misuse services who are alcohol-dependent should be screened for cirrhosis and fibrosis for early detection, providing more time for intervention.
Individuals with lifestyle risk factors associated with liver disease (e.g. obesity) should be encouraged to contact their GP for liver function tests, to ensure early detection as advised by All Our Health policy.
Primary care, services and family hub staff can provide opportunistic advice when presented with the opportunity. As All Our Health guidance advises that screening and brief intervention for alcohol is effective and cost effective.
Strategic Issue 3
There is a link between substance misuse (drug and alcohol) and liver disease, there are high levels of substance misuse in the Borough which residents have highlighted through the Big Conversation.
What needs to be done
There is a need for targeted intervention in groups of substance misuse to prevent liver disease caused by the misuse of substances.
Work to strengthen and integrate substance misuse and mental health services will improve data sharing, pathways to support and individual engagement.
Drug and alcohol misuse prevention activities can be part of existing services and / or undertaken opportunistically.
Individuals who are identified as vulnerable (such as those transitioning from custody to community, children and young people at risk, etc.) can be provided with skills training and given information in settings that they regularly attend such as within clinics or in community settings such as criminal justice health pathways.
Taking inspiration from the NHS Community Liver Health Check Programme, opportunistic screening and information provision can be taken out into the community in areas at most risk (high deprivation) within foodbanks, homeless shelters and at local events.