Agenda item

Susan Lloyd, Public Health Consultant, Matthew Cole (LBBD) and Dr Paul Kooner, Liver Consultant (BHRUT), jointly presented information to the Board regarding the extent of liver disease in Barking and Dagenham, which indicates that it is the sixth biggest cause of death for men in the Borough with the number of women suffering from the disease on the increase.  The presentation highlighted the main causes of the disease being alcohol, obesity and infection, the associated demand on services including both the financial costs to the NHS and the wider costs to society from mainly alcohol abuse in terms of social disturbance, crime and domestic violence.  In the past year alone there have been a total of 89 liver disease related deaths in the Borough of which 85% were preventable.

Matthew Cole, Director of Public Health highlighted the Council’s current prevention approach being delivered through a number of initiatives linked to the Council’s substance misuse and healthy weight strategies as well as health protection generally. The Council’s substance misuse strategy aims to address education to prevent misuse, treatment and social responsibility linked to alcohol related disorders, however the Borough does not currently have an agreed approach to prevent or detect liver disease at an early stage, which the paper sought to address. It put forward a new model of care which in summary includes community assessments of local need, effective interventions, the development of an integrated care pathway, benchmarking  and early detention through periodic opportunist screening such as the pilot screening session that was conducted at Dagenham Library last November, and which from thirty seven people scanned sixteen were found to have varying degrees of liver abnormalities.

In response to the presentation the Board raised a number of questions concerning the effects of the disease on specific ethnic groups and explanations as to the significant rise in the number of women suffering from the disease. Although it is a known fact that men are more affected than women there is little data on the ethnicity breakdown. As for the sharp increase in reported cases of women the consensus view is that there are two principle influencing factors namely the way fat is broken down in a woman’s body and increased binge drinking in women generally. 

The Chair stated that the statistics including those from the pilot screening make for difficult reading and consequently the Council needs to develop a communication strategy in partnership with others to get the hard-hitting messages across to the local community about taking personal responsibility for lifestyle changes so as to reduce the number of hospital admission in the longer term. Anne Bristow, Strategic Director for Service Development and Integration added that it will be important to shape the communications so we match the interventions with the messages that we want to get across to the public in such a way that it positively encourages behavioural change.

Councillor Bright enquired of the incentives there are for people to lose weight to which the Chair replied that there are several Council programmes aimed particularly at older residents. There is also a GP referral system to get on healthy eating and other programmes.

The report has recommended that the Board support Barking and Dagenham Partnership engagement in the development of a tri-borough liver disease prevention strategy. The Chair whilst supportive of this as a starting point made the point that the problem is more acute in this Borough than both Havering and Redbridge and therefore the danger is that a tri-borough approach may mean we lose out on funding opportunities. 

With that in mind, the Board agreed to endorse a tri-borough liver disease prevention strategy as outlined in the report and presentation, to be developed over the next 12 months through an appropriate commissioning strategy which recognises the particular needs of Barking and Dagenham. Alongside this, the Council will run a more immediate media campaign to publicise the preventive programme such as the screening at Dagenham Library, highlighting to residents the fact that many deaths from liver disease are preventable.