Seòmar agus comataidhean

I refer the member to the answer to question S6W-09029 on 20 June 2022. All answers to written Parliamentary Questions are available on the Parliament's website, the search facility for which can be found at https://www.parliament.scot/chamber-and-committees/written-questions-and-answers

Living with overweight or obesity is linked with an increased risk of developing a range of health conditions, including non-alcohol-related fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). According to the 2019 Scottish Health Survey , two-thirds of adults in Scotland were overweight or obese. Obesity prevalence in Scotland has remained relatively stable since 2008.

The Scottish Government has not carried out a specific assessment of the impact of rising levels of obesity on NAFLD or NASH.

We want everyone in Scotland to eat well and have a healthy weight. We continue to implement our 2018 Diet and Healthy Weight Delivery Plan . We also continue to support NHS boards to improve weight management services in line with our Type 2 Diabetes Prevention, Early Detection and Intervention Framework and Public Health Scotland’s national standards .

Further information on NAFLD and NASH is available to the public and clinicians on NHS Inform and other professional groups such as British Society of Gastroenterology , and charitable organisations such as British Liver Trust .

Scottish Government is committed to ensuring that everyone with liver disease is able to access the best possible care and support and benefit from healthcare services that are safe, effective and person-centred.

We are working with the UK Government and other devolved administrations on the development of the revised UK-wide clinical guidelines for alcohol treatment, which will include the treatment of liver diseases. The updated guidelines are expected to be published for consultation later this year.

We are improving our ability to detect cancer and to treat it successfully. That is why we continue to invest in our £44m Detect Cancer Early Programme, which adopts a whole systems approach to diagnosing and treating cancer as early as possible. This will include the early detection of liver cancer.

General Practice and Primary Care multi-disciplinary teams will continue to play a key role in supporting patients with long-term condition management, including those with a diagnosis of liver disease, alongside specialist treatment services within Scotland’s healthcare system.

We know people living in poverty have poorer health outcomes and this is why we are committed to addressing the underlying causes of health inequalities and increasing healthy life expectancy. There is a stark social gradient to alcohol harms and outcomes linked to poor diet with those in the most deprived areas being the most affected

Population-wide measures to transform the food environment are more likely to be effective in reducing health inequalities than measures aimed only at encouraging individuals to change their behaviours. That is why we will introduce a Bill in this Parliament that includes powers to restrict promotions of foods high in fat, sugar or salt and introduced Minimum Unit Pricing for alcohol. The Scottish Government’s Alcohol Framework 2018 sets out our priorities for preventing alcohol-related harm, including our world-leading minimum unit pricing policy.

A recent study by Scottish Health Action on Alcohol Problems has highlighted the effectiveness of alcohol nurses in Deep End practices in Glasgow, in supporting people with alcohol problems who have complex needs. The Scottish Government will carefully consider the findings of the report which highlight the need for more research into the effectiveness of these services.

The information requested is not held centrally.

Data on the proportion of NHS boards that have an effective patient care pathway for the early detection of liver disease is not available.

However, we understand there is variability in liver disease management across Scotland. The Scottish Government has identified the intelligent Liver Function Testing pathway (iLFT) used in Dundee, Tayside as best practice which is eligible for adoption across NHS Scotland as part of its Modern Outpatient Programme.

The Tayside iLFT group is collaborating with other NHS Scotland Boards to assist with the implementation of iLFT within their laboratories and primary care services.

In 2020, the latest year for which data are available, there were 912 chronic liver disease deaths in Scotland. Of these, 759 were alcohol-related liver disease deaths. Data are not available for obesity related liver disease deaths.

Liver diseases are generally avoidable or treatable if diagnosed at an early stage and stigma often prevents people from accessing treatment; 75% of people are currently being diagnosed at a stage when it is too late for lifestyle changes or intervention.

We take a whole population approach to reducing alcohol consumption and the risk of alcohol-related harms across the population and that’s why we’ve taken a range of actions to reduce the availability, attractiveness and affordability of alcohol.

We are also taking action to reduce the impact of poor diet on people’s health which is also a significant and growing contributor to liver disease. We are taking wide-ranging action to support healthier choices, as set out in our 2018 Diet and Healthy Weight Delivery Plan , and have set a challenging aim to halve childhood obesity by 2030 and significantly reduce diet related health inequalities.

The Scottish Government intends to publish the summary report on the responses to the public consultation alongside the Implementation Plan for the Framework for Pain Management Service Delivery later this summer.

Scottish Government is committed to ensuring that everyone with liver disease is able to access the best possible care and support and benefit from healthcare services that are safe, effective and person-centred.

We are working with the UK Government and other devolved administrations on the development of the revised UK-wide Clinical guidelines for alcohol treatment, which will include the treatment of liver diseases. The updated guidelines are expected to be published for consultation later this year.

We are improving our ability to detect cancer and to treat it successfully. That is why we continue to invest in our Detect Cancer Early Programme, which adopts a whole systems approach to diagnosing and treating cancer as early as possible. This will include the early detection of liver cancer.

General Practice and Primary Care multi-disciplinary teams will continue to play a key role in supporting patients with long-term condition management, including those with a diagnosis of liver disease, alongside specialist treatment services within Scotland’s healthcare system.

The existing National Institute for Health and Care Excellence (NICE) guideline on the diagnosis and management of cirrhosis recommends that very heavy daily drinkers (men drinking up to 50 units per week or women 35 units per week) should be screened for cirrhosis using one of the newer non-invasive diagnostic technologies.

NICE suggests FibroScan and in 2020 published a Medtech innovation briefing around its use in primary care settings, but blood tests for fibrosis markers are also accurate and should be available to any clinician.

The Scottish Government currently has no plans to increase the use of FibroScan and enhanced liver fibrosis (ELF) tests in primary care in order to improve the early diagnosis of liver disease.

However, the Office for Health Improvement and Disparities is developing UK Clinical Alcohol Treatment Guidance, which is expected to include the issue of liver disease. These are expected to be published for consultation later this year. Once finalised, the Scottish Government will consider recommendations regarding early diagnosis of liver disease.