Contribution
I thank my hon. Friend the Member for Worthing West (Dr Cooper) for securing this very important debate. I also thank the British Liver Trust and the Foundation for Liver Research for providing me with a lot of data and information. As a GP, I have learned quite a lot from preparing this speech—we will come to that a little later.
As my hon. Friend said, what we really need is the right type of reform. My Government are proposing three shifts in care. Probably the most important is from cure to prevention, and this issue fits in very well with that. It also fits into the other shifts that we want. We want to get out of hospitals and into the community, and a lot of work around fatty liver disease can be done in the community. We also need to use data properly to target people and to look at the digital ways in which we can identify high-risk people.
Fatty liver disease affects 20% of the population. I do not want to repeat all the statistics that we have heard, but 12% of those people go on to develop very severe disease, and that is 90% preventable. That is a perfect example of our being able to prevent disease rather than just allowing it to happen.
As GPs, we often do a liver function test—often if someone is on a statin or something similar—as a screening test, and we find that the alkaline phosphatase is slightly raised. We then do an ultrasound scan and, lo and behold, people who are overweight often have fatty liver disease. That is often as far as it goes in GP land, so we need to change that pathway. There is an obesity epidemic and two thirds of adults are overweight. As my hon. Friend the Member for Worthing West said, children also carry a great burden of obesity and overweightness—by year 6, 32% of children are obese.
As my hon. Friend also said, there has been a massive increase. Most diseases are going down in frequency, but there has been a 400% increase in fatty liver disease. That leads first to fibrosis, then cirrhosis and even liver cancer. As she pointed out, detection is often at the acute stage when people are admitted to hospital with cirrhosis and sometimes hepatic failure. That is a sign of a poor medical system. We are failing those people.
Where I come from in Stroud, we have the fourth-highest hospital admission rate for liver disease in the whole south-west, and Gloucestershire has the highest. We need to get on and start dealing with fatty liver disease. How do we do that? As we have heard, prevention is probably the single most important thing, so I urge the Government to grab that ethos of preventing disease and really go for it. We have a national food strategy—there is plenty in there, which I will not talk about now—and ultra-processed foods are obviously causing a lot of harm. There are also some exciting options in the 10-year plan in relation to supermarkets, such as how they need to keep their data and about starting to sell healthier foods, rather than foods that are high in fat, sugar and salt. The plan also refers to the reformulation of some products.
I will point out two other things: first, free school meals reduce obesity in children; and secondly, as a Government, we are bringing in rules about advertising unhealthy food before the 9 o’clock watershed, which I welcome. We also need to halt brand advertising before that time, because when people see a sign saying “McDonald’s”, they do not think about salads, do they? That is also important.
Screening needs to be data driven. In general practice, we know that a lot of people with a BMI of over 27, for example, should get near-patient testing for liver function, and those who have raised liver function should then have a fibroscan in their neighbourhood practice. That would be a fantastic community response to the problem: neighbourhood practices could take hold of the issue and start screening properly, reducing the burden of disease on our population.
Training is also important. I am a standard sort of GP, and I did not know as much before preparing this speech as I do now. We need to educate GPs on the importance of detection.
Lastly, although GLP-1 agonists are not authorised for treating fatty liver disease, we are certain that they are effective at reducing weight and would certainly reduce fatty liver disease. We must invest in weight-management services to wrap around that treatment. We have a great opportunity to prevent disease.