WQ85458 (e) Tabled on 10/06/2022

What steps is the Welsh Government taking to address workforce shortages for: hepatologists; liver nurse specialists and alcohol care teams?

Answered by Minister for Health and Social Services | Answered on 22/06/2022

Welsh Government remains committed to ensuring that anyone with liver disease in Wales has access to the best possible care.

There were 37 Welsh residents on the active transplant waiting list as of the end of March 2022, of those 10 have waited over a year. There were also a further 10 patients currently suspended on the list, usually as they are unwell and not fit enough to have surgery at the current time and will be initiated if and when their condition has improved.

The transplant list matches donated organs to the patients based on many different factors. It is a list of all the people in the UK who are waiting for an organ from a deceased donor. It is not possible to accurately predict how long a resident will wait for a liver transplant as each case is different and any liver that does become available will be best matched to a recipient whose characteristics match those of the deceased donor i.e., blood group, weight and height.

Liver transplants are not undertaken in Wales, but established relationships are in place with transplant centres in England. In 2021/22, 27 liver/lobe transplants by deceased donors were carried out.

Reducing the stigma associated with liver disease is crucial in preventing late presentation and diagnosis of liver disease. That is why the Liver Disease Implementation Group (LDIG) has been working in partnership with the British Liver Trust to destigmatise liver disease through education and improving public understanding of a wide range of different liver conditions.

In addition, the Wales Infected Blood Support Scheme (WIBSS) provides support to people who have been infected with Hepatitis C and/or HIV as a result of NHS treatment with blood, blood products or tissue in Wales. Individuals registered with WIBSS, their family members and bereaved family members can access psychological assessment and treatment concerning the emotional difficulties of being given and living with a diagnosis of Hepatitis C and/or HIV. This will include dealing with the stigma associated with liver related diseases. The offer of a specialist psychology service provides the recognition of the physical and psychological complexity and the impact such conditions on quality of life and relationships.

Health boards and NHS trusts are responsible for recruitment and workforce planning, supported by Health Education and Improvement Wales and other partner organisations. The Welsh Government is investing record levels in healthcare professional education for NHS Wales - £260m of funding in 2022-23 – with more training places available than ever before.

Liver disease has resulted in a significant rise in outpatient and inpatient episodes and an expansion in hepatology consultants is required.

There is currently no provision for gastroenterology trainees in Wales to undertake advanced hepatology training leading to sub-specialty accreditation to become consultant hepatologists; Welsh trainees have had to apply for posts in England or Scotland before returning to Wales. To improve recruitment, from September 2022 with the introduction of the new training curriculum, trainees in Wales will complete two years of core training in gastroenterology and will then have a choice of spending the final two years in luminal gastroenterology or hepatology in Wales. Three months of this training time will be spent in a specialist centre outside of Wales to address training requirements.

Chronic liver disease is the most significant risk factor for hepatocellular carcinoma, with 80%-90% of new cases occurring in the background of cirrhosis. Studies have shown that early diagnosis of hepatocellular carcinoma through surveillance programs improve prognosis and availability of curative therapies. 

We expect the NHS in Wales to deliver care in line with standards from the National Institute for Health and Care Excellence (NICE) which recommend surveillance of patients with liver cirrhosis normally by means of ultrasound every six months. This should be offered to all such patients as part of routine clinical care unless co-morbidity (such as liver failure or severe cardio-respiratory diseases) would preclude active treatment of an identified liver cancer.

In terms of what assessment the Welsh Government has made of the inclusion of liver disease assessments in NHS health checks for people aged 45 and over, I refer to my answer provided to WQ85384 published on 16th June 2022.