Tuesday, March 12, 2013

Charity warns lack of planning in hepatitis C services risks future chaos and huge healthcare costs

Charity warns lack of planning in hepatitis C services risks future chaos and huge healthcare costs

New report finds that local authorities and NHS organisations need to prioritise hepatitis C now or risk missing a rare opportunity

A new report published by The Hepatitis C Trust today found that local authorities are not ready to take responsibility for hepatitis C from April 2013. The report based on an audit of English commissioners and local authorities showed that:

· Only a quarter of local authorities who responded know how many people in their area are living with, or at risk of, hepatitis C.

· Only 20 per cent have a lead for hepatitis C and even fewer have a strategy in place for tackling the virus

· Only 40 per cent of local authorities have arrangements in place with the relevant local NHS commissioners to ensure work is coordinated to tackle hepatitis C

Charles Gore, Chief Executive of The Hepatitis C Trust called for urgent prioritisation: “Deaths from liver disease are increasing and within liver disease it is deaths from hepatitis C that are increasing the fastest. Failure to tackle hepatitis C will result in a significant increase in costs to the NHS and wider society.”

The launch of the report comes at a time when despite calls from the Chief Medical Officer and a personal commitment from the Prime Minister for liver diseases, including hepatitis C, to be tackled as a priority no real action has yet been taken. The Liver Strategy promised by the Government is now 15 months overdue. 

Mr Gore called for urgent relationship building between local authority and NHS commissioners: “We face a real challenge in ensuring that public health and NHS services are commissioned holistically. 2013 is a critical year for the NHS and local authorities. With the correct action, it can also be a turning point for hepatitis C.” 

Hepatitis C is a blood-borne virus that currently affects 216,000 people in the UK. It can cause cirrhosis and liver cancer yet more than half of those living with the condition are undiagnosed. If caught early, it can be treated and cured. However, only three per cent of people with the virus receive treatment each year. 

The report - Opportunity knocks? An audit of hepatitis C services during the transition – also found:

· Not enough people are being tested in GP practices: Only half of NHS commissioners encourage testing for hepatitis C at GP surgeries

· Not enough people are being treated: Almost half of NHS commissioners do not have measures in place to increase the treatment of hepatitis C

· Monitoring of hepatitis C outcomes is not routine: Many NHS commissioners have not been effectively monitoring the uptake of hepatitis C treatment. Only half hold information about the number of patients initiated on treatment and just a third know how many people have cleared the virus as a result of treatment

To support NHS and public health commissioners through the transition, the report makes 14 recommendations for how services and outcomes for hepatitis C could be improved and ultimately eradicated from the UK. 

Mr Gore concludes: “We could eradicate hepatitis C in the UK in a generation. What a tragedy to look back in 20 years and realise that we didn’t eradicate it when we had the opportunity.”

Opportunity knocks? An audit of hepatitis C services during the transition 


1. Local authorities should have a designated liver health lead on their local health and wellbeing board, with hepatitis C designated as a clear part of their remit.

2. Clinical commissioning groups should assess local oversight for hepatitis C and ensure that a lead for either liver disease, blood borne viruses or hepatitis C is in place. 

3. As part of their preparations for taking on full public health responsibilities, local authorities should ensure that they develop a comprehensive hepatitis C strategy which is jointly agreed with clinical commissioning groups and takes local need into account. 

4. The NHS Commissioning Board should support pilot clinical liver networks, with a view to their being hosted nationally in the future. 

5. Local authorities should ensure that health and wellbeing boards are equipped with relevant information about the burden of hepatitis C in the community.

6. Public Health England should outline plans to establish a national liver intelligence network. 

7. Local authorities should ensure that measures to prevent hepatitis C transmission are targeted to all at risk groups within local communities. 

8. Local authorities must develop clear mechanisms to scrutinise their public health measures to tackle hepatitis C. 

9. Health Education England should raise awareness of the Royal College of General Practitioners’ training module on the detection, diagnosis and management of hepatitis B and C, and encourage GPs to undertake it as part of their professional development. 

10. Local authorities and clinical commissioning groups should regularly obtain information about hepatitis C testing uptake in community and acute settings. 

11. Clinical commissioning groups should regularly work with providers to gather data on how many patients with hepatitis C are initiated on treatment and how many achieve a sustained virological response. 

12. The NHS Commissioning Board should consider models that may improve the uptake of hepatitis C treatment.

13. Local authorities should refer to the HCV Action commissioning toolkit to help inform the public health commissioning process.

14. Clinical commissioning groups, in partnership with local authorities, should assess current and future local needs related to hepatitis C to inform the commissioning process.

Report methodology

The Hepatitis C Trust undertook this report to evaluate current commissioning arrangements at NHS commissioner level and to assess the extent that local authorities are prepared to take on responsibility for the public health elements of hepatitis C commissioning.

In order to inform the evaluation, an audit was undertaken using the Freedom of Information (FOI) Act 2000. 

The audit sought to assess the extent to which NHS commissioners and local authorities are:

· Ensuring a strategic approach to hepatitis C commissioning

· Working together to ensure coordination between local NHS and public health services

· Estimating the extent of the burden of hepatitis C

It then explores the quality of services available for:

· Prevention of hepatitis C

· Hepatitis C testing and diagnosis

· Hepatitis C treatment and care

Every NHS commissioner (primary care trust) and local authority in England was contacted as part of this process. Almost 80% of NHS commissioners and more than 70% of local authorities were able to provide some response to our audit. 

Public bodies are not duty-bound to respond to FOI requests in a set format so the information that we received was not directly comparable. The analysis used in this report is therefore based on The Hepatitis C Trust’s own interpretation of the evidence received. Where relevant, an explanation is provided as to how the data have been interpreted.

Cost of hepatitis C

Research by RAND (Hepatitis C: A projection of the healthcare and economic burden in the UK, January 2013) found that failure to act on hepatitis C would lead to an increase in prevalence from 0.44% in 2010 to 0.61% in 2035. 

Based on these calculations, it was found that:

· Healthcare costs would increase from £82.7m in 2012 to £115m in 2035

· Productivity losses would increase from£184-367m in 2010 to £210-427m in 2035, depending on whether minimum wage or median income was chosen for the selected population

 Available Here 

About The Hepatitis C Trust 

The Hepatitis C Trust is the only UK-wide charity focused on hepatitis C, supporting the estimated 216,000 people living with the virus. It is led and driven by people with personal experience of hepatitis C. The Trust is committed to increasing prevention, diagnosis and treatment and achieves this by raising awareness and funds, driving policy and providing testing, training and support. 

To contact The Hepatitis C Trust helpline call: 0845 223 4424 or visit www.hepctrust.org.uk.

For further information: 

Please contact The Hepatitis C Trust’s Communications Manager, LĂ©ann Lavery, on:

020 7089 6224 / leann.lavery@hepctrust.org.uk 

The preparation of this press release was supported by Roche Products Ltd

Editorial control rests with The Hepatitis C Trust

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