What needs to be done and why?
Strategic Issue 1
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.
Why
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.
A study by the University of Bristol found that 1 in 5 people had signs of fatty liver by the age of 24 and 1 in 40 people had developing fibrosis (scarring) by age 24.
Liver disease is the leading cause of death among 35-49 year olds. This age group is particularly vulnerable due to cumulative lifestyle factors such as harmful drinking patterns and metabolic dysfunction6.
There is a high prevalence of Year 6 obesity (including overweight) in the Borough (2nd highest in the North East), as this group transitions into young adulthood there will be growing risk of liver disease.
Guidance and evidence advises individuals should be supported with lifestyle health choices and emotional wellbeing, by taking screening into the community and setting up clear pathways between services, individuals can be supported within their community.
Strategic Issue 2
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.
Why
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.
Those living in areas of deprivation can suffer worse outcomes from the same risk exposures in comparison to those living in areas of lower deprivation.
There are high rates of obesity in the Borough (highest rate in England among 18 years+) which is strongly linked to metabolic dysfunction-associated steatotic liver disease (MASLD). Whilst there is work being done in the Borough for healthy weight and obesity there should be liver-specific strategy to ensure those at risk receive intervention early on.
The rate of admissions for alcohol is increasing in Hartlepool and is higher than the national average.
Strategic Issue 3
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.
Why
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.
NICE guidance focuses on targeted interventions for vulnerable groups which deliver drug misuse prevention activities as part of existing services, provide skills training for children and young people who are vulnerable and information about drug use in settings that people who use or who are at risk may attend. Taking screening and targeted advice into the community provides opportunity to reach individuals who do not typically attend clinical settings.