This final report of the Lancet Commission into liver disease in the UK stresses the continuing increase in burden of liver disease from excess alcohol consumption and obesity, with high levels of hospital admissions which are worsening in deprived areas. Only with comprehensive food and alcohol strategies based on fiscal and regulatory measures (including a minimum unit price for alcohol, the alcohol duty escalator, and an extension of the sugar levy on food content) can the disease burden be curtailed. Following introduction of minimum unit pricing in Scotland, alcohol sales fell by 3%, with the greatest effect on heavy drinkers of low-cost alcohol products. We also discuss the major contribution of obesity and alcohol to the ten most common cancers as well as measures outlined by the departing Chief Medical Officer to combat rising levels of obesity—the highest of any country in the west. Mortality of severely ill patients with liver disease in district general hospitals is unacceptably high, indicating the need to develop a masterplan for improving hospital care. We propose a plan based around specialist hospital centres that are linked to district general hospitals by operational delivery networks. This plan has received strong backing from the British Association for Study of the Liver and British Society of Gastroenterology, but is held up at NHS England. The value of so-called 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 to refer patients directly for elastography assessment. New funding arrangements for general practitioners will be required if these proposals are to be taken up more widely around the country. Understanding of the harm to health from lifestyle causes among the general population is low, with a poor knowledge of alcohol consumption and dietary guidelines. The Lancet Commission has serious doubts about whether the initiatives described in the Prevention Green Paper, with the onus placed on the individual based on the use of information technology and the latest in behavioural science, will be effective. We call for greater coordination between official and non-official bodies that have highlighted the unacceptable disease burden from liver disease in England in order to present a single, strong voice to the higher echelons of government.
Bibliographical noteFunding Information: We thank all those who attended meetings of the working groups of the Commission, including Charles Alessi; Lawrence Atkins (Incisive Health); Neeraj Bhala (Queen Elizabeth Hospital Birmingham and University of Birmingham); Romain Baujard (Echosens); Graham Boal; Nick Bosanquet (Imperial College London); Adrian Chiles; John Dillon (Medical Research Institute, University of Dundee); Kevin Fenton (Public Health England); Neil Guha (University of Nottingham); Mark Hudson (Freeman Hospital, Newcastle); Camille Manceau (Echosens); Alan Maryon-Davies; Neil McDougall (Belfast Health and Social Care Trust, Northern Ireland); John O'Grady (King's College Hospital NHS Trust); Robin Poole (Public Health England), Thomas Stephens (Incisive Health); John Wass (Oxford University); Indra van Mourik (Birmingham Women's and Children's NHS Trust) and Suzanne Davison (Children's Liver Unit, Leeds Children's Hospital). We thank Norgine for their unrestricted grant to the Foundation for Liver Research, which has enabled the Commission to work with Incisive Health in bringing the work of the 2018 Commission to the attention of UK Parliament. PN was supported by the National Institute of Health Research Birmingham Biomedical Research Centre. The Southampton Liver Pathway was devised by Mead Matthews and Nick Sheron, and further developed by Lucie Lleshi, Janisha Patel, and Saima Faizi.
MA reports personal fees from MedImmune/AstraZeneca, personal fees from E3Bio, personal fees from Intercept, grants from GlaxoSmithKline/Takeda, outside the submitted work. RA reports personal fees from Gore Medical, personal fees from Falk Pharma, personal fees from Norgine UK, outside the submitted work. RBa reports other from Novo Nordisk, other from Novo Nordisk, other from International Medical Press, Medscape, Fractyl, and Nestle, outside the submitted work. MEC reports grants and personal fees from Gilead, grants and personal fees from Merck, grants and personal fees from AbbVie, outside the submitted work. He also reports roles as President of the British Association for the Study of the Liver, membership of the Hepato-Pancreato-Biliary Clinical Reference Group advising NHS England and specialist commissioners about organisation and delivery of specialist liver services, and is clinical lead for the Peninsula Hepatitis C Virus Operational Delivery Network. GF reports grants and personal fees from AbbVie, Gilead, MSD, Springbank, Shinogi, GSK, during the conduct of the study. JG reports other from Norgine via the Foundation for Liver Research during the conduct of the study, outside the submitted work. JM reports grants from the Medical Research Council, during the conduct of the study. PR reports personal fees from World Health Organisation, non-financial support from Scottish Health Action on Alcohol Problems, non-financial support from European Alcohol Policy Alliance, outside the submitted work. NS reports personal fees from Gilead outside the submitted work. All other authors declare no competing interests.
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Publisher Copyright: © 2019 Elsevier Ltd. All rights reserved.
Citation: Roger Williams, Guruprasad Aithal, Graeme J Alexander, Michael Allison, Iain Armstrong, Richard Aspinall, Alastair Baker, Rachel Batterham, Katrina Brown, Robyn Burton, Matthew E Cramp, Natalie Day, Anil Dhawan, Colin Drummond, James Ferguson, Graham Foster, Ian Gilmore, Jonny Greenberg, Clive Henn, Helen Jarvis, Deirdre Kelly, Mead Mathews, Annie McCloud, Alastair MacGilchrist, Martin McKee, Kieran Moriarty, Joanne Morling, Philip Newsome, Peter Rice, Stephen Roberts, Harry Rutter, Marianne Samyn, Katherine Severi, Nick Sheron, Douglas Thorburn, Julia Verne, Jyotsna Vohra, John Williams, Andrew Yeoman, Unacceptable failures: the final report of the Lancet Commission into liver disease in the UK, The Lancet, Volume 395, Issue 10219,
2020, Pages 226-239, ISSN 0140-6736.