National liver disease strategy (NLDS)

Published: 02 December 2011

In the last 10 years it has become clear that the rising mortality from liver disease in England was in complete opposition to what was happening worldwide and also with our closes comparator countries (USA, Canada and France) where mortality rates were reducing.

Within the liver health care profession this had been raised in different publications (references 1, 2, 3, 4) highlighting the trends and the need for action which has resulted in the setting up of a national clinical strategy by the Department of Health (DH) to tackle liver disease in England.

The reasons why the NLDS was required included:

liver disease burden is rising
liver mortality rising as other major causes of mortality are declining
liver patients die younger than other major groups
huge and growing costs to the NHS
significant cost to the economy.

Also there are challenges for the future such as:

liver care being underdeveloped in primary care
poor awareness and stigmatisation of liver disease
poor access to tests and robust pathways for referral to liver units
underdeveloped prevention strategies
expensive treatments.

Improving outcomes for people with, or at risk of, liver disease

Aim and purpose of the NLDS:

enable people to stop themselves from developing liver disease
support the NHS and public health services to identify those at risk
offer early intervention for people with early liver disease
better deliver NHS treatment to patients with liver disease.

The liver strategy recognises the need for NHS and public health services to become more focussed on identifying and addressing local needs through better co-ordination of services on the ground (reference 5).

In the last year or so there have been some challenges to the development of the NLDS mainly due to the change of government and the financial austerity that the NHS is facing. The introduction of the White Paper, Equity and Excellence – Liberating the NHS (2010), set out wide ranging reforms and targets for a very different NHS but one that was also constrained by financial cuts across every part of the NHS [now part of the Health and Social Care Bill].

The challenge has now became how to develop a NLDS that reflects this, which is easy to access, treats people as individuals and offers care that is safe and of the highest quality.

What does it mean for nursing staff working with patients with liver disease?

There is a Specialist Nurses Expert Reference Group, one role of this group was to undertake a census of liver nurses across England as there were no clear numbers how many nurses there were working with patients with liver disease across primary and secondary care. This is an important baseline, it is recognised that the census still has gaps in the data and will need to be undertaken again in the future. The census was an important exercise to allow for forward plan for educational and service needs to produce a competent liver nursing workforce to meet the future demands of the increasing numbers of patients with liver disease.

Work has also been taking place on developing liver nursing which has resulted in a competence framework being commissioned and developed by Dr Kim Manley and the Specialist Nurse Group of the NLDS. The competence framework has made good progress and is expected to be in a final format by the end of 2011.

References

'Reducing Mortality from Liver Diseases’ Report from the Liver Advisory Group of the Royal College of Physicians. December 2007
Opinion leader workshop – May 2008
The Forgotten Killer – A Stakeholder Review. Bell Pottinger 2009
A Time to Act. BASL/BSG report. October 2009
`Reducing Mortality from Liver Diseases’ Report from the Liver Advisory Group of the Royal College of Physicians. December 2007
Opinion leader workshop – May 2008
The Forgotten Killer – A Stakeholder Review. Bell Pottinger 2009
A Time to Act. BASL/BSG report. October 2009
Williams R (2010) Hepatology Service Provision Survey. BASL.