Meeting of the Parliament

Meeting date: Wednesday, June 14, 2023

Official Report 1075KB pdf

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Liver Cancer

The final item of business is a members’ business debate on motion S6M-08629, in the name of Stuart McMillan, on Scotland’s liver cancer crisis. The debate will be concluded without any question being put.

Motion debated,

That the Parliament understands that 90% of liver disease is preventable, but that rising alcohol misuse, obesity and viral hepatitis are reportedly contributing to a liver disease and liver cancer crisis in Scotland; notes reports that liver disease burden is highest in deprived areas, such as those within the Greenock and Inverclyde constituency, which, it understands, had the highest rate of alcohol-specific deaths in 2017-2021, the majority of which were caused by alcohol-related liver disease; highlights what it sees as the importance of prevention and earlier detection of liver cancer, as one of the less survivable cancers, which, it understands, has seen the highest increase in mortality rates of all cancer types in Scotland over the last decade, and commends the work of the British Liver Trust and other charities in promoting the use of intelligent liver function tests and non-invasive liver scans in primary and community care to accelerate earlier detection of liver disease and liver cancer in order to save lives and reduce long-term pressures on the NHS.

17:41  

First, I remind members—erring on the side of caution—that I am the vice-chair of Moving On Inverclyde, which is a local addiction service.

I am pleased to have brought this important debate to the chamber, and I thank my colleagues on all sides of the chamber in advance for their contributions, as well as those who signed the motion to allow the debate to take place.

The title of the debate, which is “Scotland’s liver cancer crisis”, might appear drastic to some. Until recently, I did not realise that liver disease and liver cancer were such an acute problem in Scotland. However, figures from the British Liver Trust show that deaths as a result of chronic liver disease in Scotland have increased by 85 per cent in the past three decades and that they surged by almost a fifth—19.3 per cent—during the pandemic, between 2019 and 2021.

Sadly, Scotland has consistently had the highest mortality rate for liver disease in the United Kingdom and one of the highest rates in Europe. Those two facts paint a harrowing picture. When we consider that 90 per cent of liver disease is preventable, the need to tackle the situation becomes even more urgent. The main risk factors for liver disease are alcohol misuse, obesity and viral hepatitis. However, the liver has a remarkable ability to regenerate and repair itself. If diagnosed earlier, liver damage can be reversed, and risks can be drastically reduced through diet, exercise and drinking in moderation.

Despite that, however, a quarter of liver disease patients die on readmission to hospital, and the rate of death after discharge has not improved in two decades. It is clear, therefore, that we cannot continue with the status quo—we must consider new ways of preventing and treating liver disease.

Policies such as minimum unit pricing are very welcome, and from talks that I have had with the British Liver Trust and others, I know that clinicians in England and Wales want that policy to be replicated UK-wide as a result of its positive impact in Scotland. However, minimum unit pricing alone is not driving down preventable liver disease. As well as looking at other policies to address alcohol-related harm, we must tackle the availability of junk food and encourage people to make healthier choices. That is difficult in a cost of living crisis, and it is all the harder when we consider the health inequalities that make obesity and alcohol misuse more likely in the deprived communities that exist in parts of my Greenock and Inverclyde constituency.

During a recent meeting with the British Liver Trust, I was told that Inverclyde had reported the highest rate of alcohol-specific deaths between 2017 and 2021, the majority of which were caused by alcohol-related liver disease. Marginalised and disadvantaged groups are also most at risk of viral hepatitis, including, for hepatitis C, people who inject drugs and, for hepatitis B, migrant communities from countries where it is endemic. Alarmingly, one in two people with hepatitis C live in the 20 per cent most deprived areas of Scotland. That is why I was so determined to secure a members’ business debate on the issue. It is evidently having a major impact on the lives of some people in my constituency.

When people think about cancer, there are certain specific types that typically spring to mind first, most likely because of prominent charities or campaigns that are focused on them. However, it is important that greater attention is given to liver cancer, as it has seen the largest increase in mortality rates of all the cancer types over the past decade. Members may be aware that I have also been raising awareness of bladder cancer—I hosted Fight Bladder Cancer’s first Scottish Parliament event in February this year. That, too, is not a type of cancer that people often think of when they hear the word “cancer”.

Reducing the rate of liver disease among Scotland’s population is not going to happen solely through policies such as minimum unit pricing or taxing unhealthy foods, and we will not prevent more deaths simply by asking people to change their unhealthy habits. Those policies have an important role to play, but we need to improve patient pathways for the early detection and management of liver disease.

Three quarters of people are diagnosed with cirrhosis when it is too late for effective treatment or intervention, so we must improve detection rates and work to get treatment in place as soon as possible. That is why I support the British Liver Trust’s call for new national guidance on liver disease to improve early diagnosis, including through the national roll-out of intelligent liver function testing and fibroscans in primary and community care.

Some colleagues will have had the opportunity to undergo a fibroscan yesterday if they visited the British Liver Trust’s love your liver roadshow. Those free scans are quick, easy and painless, and the roadshow unit has private rooms for people to have their scan. The fibroscan checks for signs that the liver has been damaged. I hope to bring the love your liver roadshow to Inverclyde so that people in my constituency can access that technology, which could lead to their learning whether they might have liver damage and being given a letter to take to their general practitioner for further investigation.

I also agree with the charity’s call to expand treatment and support for people with alcohol dependency—specifically integrating non-invasive tests for liver fibrosis in alcohol services to target high-risk dependent drinkers. Alcohol recovery services will, understandably, focus, at least in the first instance, on helping people to progress on their recovery journey and to live a life free of addiction. However, it is crucial that those organisations are supported to work in partnership with health services to ensure that people receive the healthcare that they need as a result of their alcohol dependency.

In closing, I hope that today’s debate will give us all greater impetus to work towards improving early detection and survival rates for the less survivable cancers, including liver cancer, and I hope that that will be at the heart of the Scottish Government’s policy making as we move forward.

17:48  

I congratulate my colleague Stuart McMillan on bringing this important debate to the chamber.

We know that 90 per cent of liver disease is preventable but, sadly, it is one of the leading causes of premature death in Scotland. In addition, liver cancer has seen the largest increase in mortality rates of all cancer types over the past decade, and it is now the fastest-rising cause of cancer deaths in the UK.

It is vitally important that we focus on the prevention of liver disease and liver cancer, and step up efforts to detect them earlier. For that reason, I welcome the news that NHS Lanarkshire has partnered with the British Liver Trust to launch a series of love your liver roadshows across Lanarkshire this summer.

The love your liver mobile unit will stop at 10 locations in Lanarkshire over the next three months to find people who have been exposed to the hepatitis C virus, which is a silent disease that can lead to severe liver complications if it is left undetected. Visitors to the unit will have the opportunity to gain information about hepatitis C and receive a non-invasive liver scan, and a swab test if they are identified as being at high risk of hepatitis C and liver disease. The roadshow will be in my Rutherglen constituency, at Morrisons in Cambuslang, on Wednesday 26 July. I greatly encourage constituents to attend it.

Would Clare Haughey acknowledge that the love your liver roadshow will be in Coatbridge this Friday? I, too, encourage my constituents to attend it.

Thank you.

In the remainder of my speech, I will focus specifically on alcohol misuse and its contributory impact on liver disease. Alcohol harm is on the rise, with a 22 per cent increase in alcohol-specific deaths in the past two years. Nearly one in 15 of all deaths in Scotland is caused by alcohol, mainly due to cancer, stroke and heart disease. An estimated 16 per cent of ambulance call-outs in Scotland are alcohol related, and one person is admitted to hospital as a result of alcohol every 15 minutes.

In 2021, NHS Lanarkshire, which is the health board that covers my Rutherglen constituency, reported the second-highest mortality rate as a result of chronic liver disease of all health boards in Scotland. Earlier this month, I had the opportunity to meet Alcohol Focus Scotland and clinicians who specialise in the harm that is caused by alcohol misuse. One of the main issues that they raised with me was how normalised drinking alcohol is in the UK and how readily available alcohol is to buy. According to the Scottish liquor licensing statistics for 2021-22, there are 710 places from which to buy alcohol in South Lanarkshire, around 460 of which are in pubs and restaurants, with the remainder in shops.

During my discussion with Alcohol Focus Scotland and the clinicians, they spoke of the beneficial effects of minimum unit pricing, without which the impact of alcohol-related harm or liver disease would likely be even greater. The recent Public Health Scotland and University of Glasgow study “Evaluating the impact of alcohol minimum unit pricing (MUP) on alcohol-attributable deaths and hospital admissions in Scotland” indicates that a 13.4 per cent reduction in deaths and a 4.1 per cent reduction in hospital admissions were wholly attributable to alcohol consumption in the first two and a half years after minimum unit pricing was introduced.

I know that the Scottish Government is currently reviewing the 50p minimum unit pricing rate, with calls from Alcohol Focus Scotland for an increase to the level. As convener of the Parliament’s Health, Social Care and Sport Committee, I look forward to seeing more details of the Government’s plans regarding that in due course.

Alcohol-related harm is one of the most pressing public health challenges that we face in Scotland. There were 2,340 alcohol-related hospital admissions in South Lanarkshire in 2021-22. Over the same period, 77 people died in South Lanarkshire from conditions solely caused by alcohol. Every year, alcohol costs South Lanarkshire an estimated £301 per person.

In truth, however, the cost is not just financial. The impact of a loved one being hospitalised or dying due to alcohol can be devastating not just for the person involved but for their friends and family and for the wider community. The Scottish Government has taken action to prevent and reduce that through the introduction of the minimum unit pricing policy, the reduction in the drink-driving limit and the multibuy discount ban. However, we should not be complacent. We should recommit to doing all that we can to tackle the challenges of liver disease and liver cancer in order to save lives.

17:53  

It is my privilege to take part in today’s debate on liver cancer, and I thank Stuart McMillan for bringing this important topic to the chamber. I join him in commending the promotion of intelligent liver function testing and non-invasive liver scans by charities and by primary and community care. Those methods help in early detection of liver cancer and liver disease, which can lessen the existing pressure in our national health service and, most importantly, save lives.

The scale of this public health crisis is all too common in our nation. That is the grim reality concerning the pervasiveness of the problem here in comparison with the rest of the UK and other European countries. That is precisely why I join my colleagues on all sides of the chamber tonight to address a destructive issue that plagues many Scots.

For context, the British Liver Trust mentions the fact that

“Anyone can develop liver disease”.

However, it notes that non-genetic risk factors, which include alcohol, excessive body weight and viral hepatitis, comprise nine out of 10 cases of liver disease. Those factors affect a plethora of groups. Disadvantaged individuals are most at risk of developing viral hepatitis, and that includes residents of areas that lack sufficient patient care pathways.

Liver disease is not only one of the leading causes of premature death; it is also one of the principal risk factors for developing liver cancer. Mortality rates from liver disease itself are very alarming. Men are two times more likely to die from liver disease, and among women there has been a 16 per cent increase in deaths between 2012 and 2020.

Public Health Scotland states that improved lifestyle factors, including a healthy diet, lower alcohol consumption and reducing obesity have

“considerable potential to prevent cancers”.

In addition, it has said that, from 1995 to 2020,

“Of the most common cancers, liver cancer had the biggest increase in mortality rates in the last decade”,

with the rate sitting at 38 per cent. It goes on to note that

“Survival from liver cancer is poor in most cases. The main risk factors for liver cancer are obesity, alcohol and infection with hepatitis B and C viruses.”

The average one-year survival rate for liver cancer in Scotland stands at 40 per cent, which means that liver cancer has a lower survival rate than any other form of cancer. That has had tragic consequences, as the greatest rise in liver cancer among people in parts of the UK has been among Scottish men.

Although liver cancer constituted only 2 per cent of cancers across our nation in 2017, there has been a greater increase in rates in Scotland than in nearly all other parts of the UK. Professor Linda Bauld of the University of Edinburgh has described the number of liver cancer deaths and diagnoses in Scotland as “shocking”. She continued by saying that the rise in liver cancer rates over the past few decades should concern all of us.

Groups including charities that focus on liver disease and liver cancer provide invaluable support and information to enable Scots, through lifestyle changes, to lower their chances of developing liver cancer. I would welcome additional input from those charities in scrutinising legislation and reports such as the Scottish Government’s national cancer plan. From the speeches today, I know that MSPs on all sides of the chamber will work constructively as we take the issue forward.

17:57  

I, too, thank Stuart McMillan for bringing to the chamber this timely and important debate. To say that we have a liver cancer crisis in Scotland is both patently true and deeply concerning for all of us who have, for decades, been seeing the introduction of various reforms to limit alcohol misuse and obesity that do not go far enough. Progress has been made, but the statistics speak plainly to the damage that has been done, and lives continue to be lost, with all the knock-on effects of that on families across the country.

We know that nine out of 10 cases of liver disease are associated with risk factors that could, with lifestyle change, be preventable; I will come back to our responsibility as legislators on that issue. We need not say any more than simply reiterate the fact that Scotland continues to have the highest mortality rate for liver disease in the UK, and one of the highest rates in Europe. That is not acceptable, and we can never allow it to be seen as such.

To come back to my earlier point about avoidable deaths, I say that I believe that much of the root of the issue is health inequalities. The rate of alcohol-related stays when someone is admitted to hospital is seven times higher in more deprived areas, and the rate of alcohol-specific deaths—as we have heard—is 5.6 times higher. When a person is born in one of the poorest communities in Scotland, they are considerably more likely to suffer serious liver damage over their shorter lifetime than anyone in a better-off community is. That is a plain fact, and it cannot be avoided. If we are to address the problem, we need to be aware of that fact and factor it into any remedies that we look to pursue.

Doing so requires us to understand that alcohol is a toxic substance and that when it is drunk to excess it can, and does, cause lasting damage that results in on-going health problems for people and their families. We are not talking solely about people who are suffering from severe misuse issues—it applies across the board, including to what is sometimes seen as casual or social drinking.

I often wonder whether, if we saw the same levels of alcohol-related problems in richer parts of our towns and cities as we do in the poorer areas, a national emergency would already have been declared, but that seems to be the case—as, I am sure, members would agree—with so many things that we talk about with regard to health inequalities.

When excessive drinking and unhealthy eating are mixed with underlying genetic susceptibility to alcohol and obesity-related disease, we have a recipe for serious ill-health that can blight much—in fact, most—of some people’s adult lives, and can carry forward into other generations. That is why—as, I think, we accept across the parties—a public health response is crucial to making sure that we change those things.

We require serious efforts at all levels of government and we need committed and serious discussions across sectors. I respect the fact that some of that consideration should be UK wide, but we have pinpointed things that can happen here in Scotland to tackle accessibility, promotion of alcohol and it being a key part of advertising in areas including sport and in the wider media. Many younger people are exposed to casual and dangerous drinking in that way. If they have not seen it at home, that might be how they are exposed to normalisation of alcohol and alcohol drinking.

Members may have been at a reception earlier in the session at which we saw that members of the Scottish Youth Parliament had done work on that. It was shocking to hear that people as young as eight can recognise cans of beers and lagers. I certainly would be unable to do so, but there is a wide range that children can recognise. That just shows us how exposed they are, time and again.

Another important point is that public consultation and opinion polling indicate that the public support some measures that we could put in place through a public health response.

I am conscious of time, Presiding Officer, so I will not go any further, but I have appreciated hearing members’ contributions and look forward to hearing from the minister.

I call the minister, Maree Todd, to respond to the debate, for around seven minutes.

18:01  

Thank you, Presiding Officer. [Interruption.] I apologise. Knocking my microphone was a rookie error.

I thank my colleague Stuart McMillan for bringing the motion to the chamber. We all know how important it is to tackle liver cancer and liver disease. Despite liver cancer being relatively uncommon in the UK, we know that survival is, sadly, poor in most cases, and that in the past decade liver cancer has had the biggest increase in mortality rates, compared with other cancers.

Liver disease has a bigger impact. It affects at least 2 million people in the UK and is often related to harmful alcohol use, as we have heard, and an unhealthy diet. We must continue to address those.

I thank colleagues for sharing such valuable contributions in the debate. It is great to experience such a united front across all the parties in identifying the need to support the citizens of Scotland to prevent liver cancer and liver disease.

I welcome the love your liver roadshow, which is an absolutely fantastic initiative. Its efforts to get around Scotland are to be commended and I absolutely recommend that anyone who has the opportunity to do so drop in and get a liver health check.

I am grateful to Stuart McMillan for mentioning hepatitis C, which is a particular passion of mine. Scotland is world renowned for its leading approach in tackling hepatitis C. We have committed to, in effect, eliminating the hepatitis C virus by 2024-25, and we have made significant progress, even during the past few years, when we have been struggling with a global pandemic of another disease. The prevalence of chronic HCV infection among people who inject drugs has nearly halved, having gone from 37 per cent down to 19 per cent. There was a reduction of as much as 60 to 70 per cent in the parts of Scotland that had the greatest scale-up of HCV treatment in that population group. By 2021, 80 per cent of individuals who had been diagnosed with chronic HCV infection in Scotland had been initiated on HCV treatment. That is phenomenal progress, and evidence indicates that the vast majority have cleared infection because of that therapy.

The Scottish Government will continue to work collaboratively with health boards, clinicians and public health experts, but it is phenomenal that, in this day and age, we have the opportunity to eliminate such a major cause of liver disease.

I want to pay particular attention to the importance of preventing liver cancer and liver disease. As is recognised in the motion, the risk of liver cancer and liver disease is increased by the impacts of harmful alcohol use and obesity. We are determined to do all that we can to reduce alcohol-related harm, which continues to be one of the most pressing public health challenges that we face in Scotland. We take a whole-population approach to tackling such harm, in line with the World Health Organization’s focus on the affordability, availability and attractiveness of alcohol.

The Government’s “Alcohol Framework 2018: Preventing Harm” contains 20 actions to tackle alcohol-related harm. One of the key actions, as has been mentioned today, has been implementation of minimum unit pricing in May 2018. Since then, we have seen a reduction of 3 per cent in total alcohol sales, with a focus on cheap high-strength alcohol, which is often drunk by people who drink at harmful levels. Recent research by Public Health Scotland found that MUP has saved more than 150 lives a year and has led to 411 fewer hospital admissions.

It is also encouraging—Carol Mochan will be particularly interested in this—that the research has highlighted that the policy is having the greatest effect in Scotland’s most deprived areas, which experience higher death rates and levels of harm from alcohol problems. As we consider what more we need to do, it is really important that we remember that that universal untargeted measure has had the biggest impact in the poorest areas, because that is where the problem is greatest.

We also want everyone in Scotland to eat well and have a healthy weight in order to reduce the impacts of a range of diet-related ill-health conditions, including liver disease. We continue to implement the wide-ranging actions that were set out in our 2018 “A Healthier Future—Scotland’s Diet & Healthy Weight Delivery Plan” to address the challenge. That includes our commitment to restrict promotions of less-healthy food and to improve availability of healthier options when people are eating out, as outlined in our out-of-home action plan.

Where those preventative measures have not had the anticipated outcome, we know that liver disease can increase the risk of liver cancer. Cancer remains a national priority for the Scottish Government and across NHS Scotland. We have developed an ambitious 10-year cancer strategy, which we will launch imminently. We conducted a public consultation on what its aims and principles should be and there was general agreement on priority areas, including placing an emphasis on the role of prevention and the less-survivable cancers, such as liver cancer. The strategy will take a comprehensive approach to improving patient pathways, from prevention and diagnosis through to treatment and post-treatment care. Its vision and aims will be supported by an initial three-year action plan.

We know that the earlier that cancer is diagnosed, the easier it is to treat. That is why the Scottish Government is committed to raising awareness of all forms of cancer, including liver cancer, through our “Detect cancer early” programme. Work to develop for Scotland a new earlier cancer diagnosis vision that will outline the future of the programme will form part of the new cancer strategy. The programme helps to ensure that people with suspected symptoms of cancer are put on the right pathway at the right time. Our aim is to reduce later-stage disease so that cancer, when it is detected, is much more likely to be curable. That is all the more important when it comes to the less-survivable cancers, such as liver cancer.

I thank everyone who supports our NHS and patients who have had a liver cancer diagnosis, including the British Liver Trust for its role in raising public awareness and taking its incredible roadshow around Scotland.

Meeting closed at 18:09.