The following amendment has been selected: amendment 1 in the name of Lesley Griffiths.

Item 7 is the first Welsh Conservatives debate this afternoon, on liver disease. And I call on Joel James to move the motion.

Motion NDM8171 Darren Millar

To propose that the Senedd:

1. Notes the recent publication of the Quality Statement on Liver Disease by the Welsh Government.

2. Regrets that while 90 per cent of liver disease is preventable, liver disease deaths have doubled in the last two decades and 9 in 10 liver cancer patients die within 5 years of being diagnosed.

3. Recognises that alcohol, obesity and viral hepatitis are the main risk factors for liver disease which is projected to increase with over 3 in 5 people in Wales being overweight or obese and 1 in 5 people in Wales drinking alcohol above recommended levels.

4. Calls on the Welsh Government to publish a clear timetable for the delivery of the outcomes and targets in the quality statement, including:

a) the doubling of the hepatology workforce, including liver nurse specialists, to address huge variation in access to specialist care;

b) when all health boards will have seven-day alcohol care teams in place to meet local need;

c) when and how the all-Wales abnormal liver blood test pathway will be adopted by all GPs to improve the early detection of liver disease.

Motion moved.

Thank you, Dirprwy Lywydd, and it's my pleasure to open this debate today in the name of Darren Millar. There are a number of very important reasons for bringing this debate forward on what is the national awareness day for less survivable cancers, with the main one being that we need to highlight both to the Welsh Government and Members across this Chamber that, tragically, Wales has the highest mortality rate due to liver disease across all four nations of the UK, with death rates almost doubling in the last 10 years, from 5.7 per 100,000 to 11 people per 100,000. And this is, sadly, because of the stark inequalities in prognosis between different cancers. Moreover, we have a chronic workforce shortage of hepatologists and liver nurse specialists across Wales, which is exacerbating these inequalities, particularly in deprived areas and underserved health boards. In Cardiff and the Vale health board, within the region I represent, liver cancer mortality rates are 50 per cent higher than the Welsh national average and have increased by 28 per cent in 2019-20 alone. And I make no apologies when I say that this is proof enough that we are failing liver cancer and liver disease patients here in Wales. 

The second reason that we need this debate is that we cannot bury our heads in the sand on this issue. We need to realise that this problem is not going to go away but will more than likely get even worse. The number of people diagnosed with liver disease in Wales has now more than tripled in the last 20 years to the highest level ever recorded, meaning that at a time when NHS services are experiencing their greatest pressure, more patients are needing to be treated. 

Thirdly, we need to acknowledge that liver disease patients in Wales face huge geographical inequalities in accessing specialist care. Thousands die unnecessarily because they cannot gain sufficient access to the expertise they need, as liver services in health boards are being consistently overlooked and underresourced. 

The final reason is that we need to recognise how Wales is behind other UK nations in tackling health problems. Wales is now the only UK nation not to have a target of achieving hepatitis C elimination. Hepatitis C can cause a range of health impacts and primarily affects the liver. And whilst NHS England is on track to achieve hepatitis C elimination by 2025, Northern Ireland has set the same target and Scotland is going further by aiming to achieve elimination by 2024, Wales is woefully behind. In fact, recent modelling found that, without any target and the continuation of current treatment rates, Wales would not eliminate hepatitis C until at least 2040, which is quite shocking, really, as the estimated number of people affected is 8,300 and hep C is easily curable through the use of direct-acting antiviral treatments.

Liver cancer has the second-lowest five-year survival rate amongst all less survivable cancers. In Wales, around nine out of 10 people diagnosed will not survive more than five years, which is more than the UK national average. And this means that we urgently need more investment in research and a dedicated focus on earlier and faster diagnosis in order to help patients. I urge the Government to recognise that this investment is desperately needed and can help to drastically increase life expectancy as well as to improve the quality of life of thousands of people in Wales and for the Welsh Government to acknowledge that this should be a higher priority for health boards. 

The liver disease crisis we are facing in Wales is placing a huge burden on the NHS and is projected to rise further. Hospital admissions due to liver disease surged by 25 per cent in 2020-21, with nearly 26,000 crisis-point admissions last year alone. Yet despite this, in Wales, there are fewer than 14 liver doctors supporting a population in excess of 3.1 million people, and nine of them are based in Cardiff and Gwent. In June 2022, the health Minister acknowledged that liver disease has resulted in a significant rise in out-patient and in-patient episodes, and an an expansion in hepatology consultants is required. I want to point out that, to address this workforce crisis, we desperately need the quality statement for liver disease, published in November, to have a long-term funding settlement in order to recruit and train a resilient and better distributed liver-care workforce.

We need to ensure that the move from the liver disease implementation group to the quality statement does not diminish the priority of liver disease within the NHS and health boards in Wales, and we need the Government to ensure that the new quality statement for liver disease is effectively implemented. This will require having a dedicated liver health strategic clinical network to drive progress and to keep up momentum following the termination of funding for the previous liver disease delivery group and the liver disease delivery plan.

The sad truth is that 90 per cent of liver disease is preventable, and though it is predominately caused by alcohol misuse, obesity and viral hepatitis also play their part. We know that hospital admissions are four times higher in the most deprived areas compared to the most affluent, and we also know that Wales is facing an obesity epidemic, with around two thirds of the adult population in Wales being overweight or obese, and one in three having early stage fatty liver disease. It is estimated that around one in five of these will ultimately go on to develop more serious diseases. Therefore, we need to think more carefully about the long-term prevention strategies that are needed on how to raise awareness of the dangers of alcohol misuse and of being overweight or obese. I acknowledge the efforts by the Government to try and encourage healthier lifestyles with initiatives to help people to cycle, access safe walking routes and to tackle carbon emissions, but the reality is that we need to do more to maintain longer term habits and behavioural change.

We need to do much more in addressing the massive geographical variation that exists in accessing pathways for early diagnosis of liver disease in primary care, and addressing the stigma that is associated with liver disease because of perceived alcohol misuse. Indeed, a recent British Liver Trust survey of over 1,400 people revealed that almost half of those surveyed had experienced stigma from healthcare professionals, and this culture desperately needs to change, because it is hampering early diagnosis as people become too afraid to seek help and attend routine or repeat appointments.

Unfortunately, the symptoms of liver disease often don't present until the damage is irreversible, and we believe, like many others, that a national screening programme is needed, where GPs can refer people if they have concerns or where there's a family history of liver problems. As the Minister will know, chronic liver disease is the most significant risk factor for hepatocellular carcinoma, the most common form of primary liver cancer. It is therefore vital that in order to improve liver cancer survival, we must diagnose people with liver disease earlier and provide a clear strategy for the surveillance of people with liver disease to detect hepatocellular carcinoma liver cancer cells, and introduce better and more robust mechanisms to review. This will not only help save lives, but save huge resources for the NHS by reducing the need for very costly treatments at later stages. An example of what this would look like can be found in the British Liver Trust's campaign to make early diagnosis of liver disease routine. It was launched in Wales last year and aims to drive public awareness of the liver disease crisis.

In closing my contribution, I'd like to point out that I recognise that the Welsh Government have broken new ground by introducing the all-Wales abnormal blood test pathway in October 2021, and this has the potential to improve liver disease diagnosis. However, I would like to remind the Government that it is only of any real use if this pathway is annually audited and regularly monitored, so that it can be used to drive improvements to earlier detection and address persistent disparities in care outcomes across boards.

Finally, I would like to thank the British Liver Trust for their tremendous work in campaigning for better liver services, diagnosis and treatments, and I'd like to urge everyone here to support this motion today. Thank you.

I have selected the amendment to the motion and I call on the Deputy Minister for Mental Health and Well-being to move formally amendment 1, tabled in the name of Lesley Griffiths.

Amendment 1—Lesley Griffiths

Delete point 4 and replace with:

Recognises the need for the Welsh Government, health boards and the emerging NHS Executive network structures to work closely together to drive forward implementation of the liver disease quality statement and deliver better outcomes on the prevention, diagnosis and treatment of liver disease in Wales.

Amendment 1 moved.

Formally.

This is a very timely debate as January is Love Your Liver Awareness Month, and today, 11 January, is National Less Survivable Cancers Awareness Day. This debate emanates from the work of the cross-party group on liver disease and liver cancer, which is a group that I'm proud to be a part of. Through that group, I and others commit to drawing attention to the crisis that we are facing in terms of liver disease—because as the motion demonstrates, it is a crisis—and the policy options then to improve early diagnosis, to improve treatment and, vitally important, to improve outcomes for patients in all parts of Wales. 

As I say, liver disease and liver cancer are a public health crisis in Wales. The number of people who receive a diagnosis of liver disease has more than trebled here over a period of 20 years, and of all of the nations of the United Kingdom, Wales has the highest mortality rate from liver disease. Nine of every 10 liver cancer patients in Wales dies within five years of receiving a diagnosis, which is, again, higher than the UK average. I'm afraid that things could get even worse, and it could get worse this winter as the poorest face the impacts of the cost-of-living crisis and fuel poverty. We could see an increase in mortality as a result of liver disease, as we saw back in 2020 during the COVID pandemic.

We are also talking here, of course, about something that places a huge burden on the NHS. Admission rates to hospital due to liver disease increased 25 per cent between 2020 and 2021. Last year, the figure was almost 26,000 admissions, and considering the pitiful situation facing the NHS at the moment and the pressure on it from every which way, we don't need to emphasise the need to get that figure down.

It's worth drawing attention to the fact that there is a large variance from area to area and between different health boards in terms of outcomes. For example, in 2020, the mortality rate resulting from liver disease in the Swansea bay health board, around 26.7 for every 100,000 people, was more than twice the rate in Hywel Dda, and it was around 33 per cent, a third, higher than the national average. Any inconsistency from area to area is something that is always very important to tackle.

But—and this is very, very important—we can prevent liver disease almost entirely. Around 10 per cent of cases are a result of genetic conditions and auto-immune conditions, but around 90 per cent are caused by alcohol misuse, by obesity and by viral hepatitis. That's why investing in preventative measures is crucial, and we have to ensure that strategies to tackle obesity, strategies to tackle alcohol misuse are robust. That's vitally important. We also have to ensure that, within wider public health measures, liver disease receives the appropriate attention. We have to deal with stigma. We also have to be very clear about how we meet the target in terms of reducing cases of liver disease, targets that are outlined in the quality statement.

But where the disease develops in individuals, we do need to ensure access then to specialist care, and thousands are dying needlessly, I'm afraid, without access to that specialist care, because of the lack of resources in services. The most important resource, as across the NHS, of course, is the workforce, and in bald terms, the Welsh Government needs to double the hepatology workforce in Wales, as the motion states.

And finally, as the liver disease implementation group is abolished, there is a danger that there'll be less supervision and oversight in this area. We can't afford to let that happen, because as a result of the frightening increase in cases in recent years, the size of the crisis is clear. The Senedd needs to support this motion as a clear statement that we realise the scale of the challenge, and the Government's amendment doesn't do that adequately, I'm afraid.

I would like to thank my colleague Joel James for tabling this important debate today. It also is a timely debate, coming as it does during Love Your Liver Awareness Month, as well as during a liver disease public health emergency. We know that the number of people aged 65 and under dying from liver disease has grown by a staggering 400 per cent. Nine out of 10 of those deaths are preventable. It is therefore vital that we do all we can to ensure that nobody dies unnecessarily from liver disease. As a former trustee and now a patron of Brynawel Rehab, I want to focus my contribution on alcohol-related liver disease.

Alcohol-related liver disease rose by nearly a third between 2019 and 2021, overwhelmingly due to alcohol-related liver disease, according to the latest statistics from the Office for National Statistics. Alcohol-related liver disease accounts for nearly two thirds of all liver diseases, and a fifth of adults in Wales consume alcohol in ways that could be harmful to their liver. Despite these shocking facts, we have a real shortage of alcohol care teams across Wales. Seventy per cent of local health boards do not have alcohol care teams in place seven days a week. We therefore have a postcode lottery in access to specialist care and prevention support. Where seven-day service provision and alcohol care teams exist, we see dramatic improvements in health outcomes. In the Aneurin Bevan University Health Board, they provide a seven-day service, and despite the health board having the highest per capita hospital admissions for liver disease in Wales, they have one of the lowest mortality rates. Sadly, my own health board, Swansea Bay University Health Board, has the highest recorded mortality rate for liver disease in Wales.

Over the past two decades, we have seen a 60 per cent rise in alcohol-related liver disease diagnosis, and the diagnosis rate is three times higher in the most deprived parts of Wales compared to the most affluent areas, as said earlier. Surely, if we are to tackle alcohol-related liver disease, we must ensure that every part of Wales has access to seven-day alcohol care teams. We must invest in specialist liver nurses and doctors, and we must roll out best practice across every health board.

For example, a doctor in Cwm Taf is doing excellent work on opportunistic fibroscanning of the general public, as well as within the prison population. A FibroScan is a simple, painless and non-invasive procedure used to accurately assess the health of the liver. During the scan, a probe is placed on the surface of the skin. This can detect liver scarring or fibrosis, which can ultimately lead to cirrhosis and liver cancer. Opportunistic fibroscanning has been proven, in numerous studies, to increase early diagnosis, especially in those at high risk of advanced liver disease, and, as a result, increased longer term survival rates. We should be replicating the work under way in Cwm Taf across all health boards and in all settings.

Let us, during this dry January and Love Your Liver Awareness Month, commit to ending deaths due to alcohol-related liver disease. I urge Members to support this motion. Diolch yn fawr.

Whilst Rhun ap Iorwerth and Altaf Hussain have produced some interesting differentials between different health boards in the way we successfully treat liver disease, I want to focus on the beginning of this story, which is the prevention and early intervention aspects of it.

We only have one liver and the body can't survive without it. I had the misfortune to have hepatitis A in my 20s, so I am fully aware of how unpleasant having liver disease is, but I certainly wouldn’t put it into the same category as having viral hepatitis. If we don’t look after our livers we will die, because we can’t survive without our liver. Transplant operations for livers are rare and, in any case, not available in Wales. So, let’s protect our livers and then we won’t have these problems.

Altaf mentioned the importance of looking at alcohol as a cause of liver cancer, and that’s absolutely right. But I also think that it’s important to realise why it is that alcohol is so endemic in our society. Last week, I was standing in a queue, waiting to pay for petrol, and the man in front of me was not just paying for petrol, he was also buying a bottle of spirits. He wasn’t buying bread or milk. No, he was buying alcohol. It’s an interesting combination, isn’t it? It would be fascinating to look at the statistics for purchases of alcohol from petrol stations. I hope that he wasn’t planning to drink it while he was driving, but I am fairly confident that he was representative of the one in five people in Wales who drink alcohol above recommended levels.

We have to ensure that we are working with people to make them understand that they do need to give their livers a break so that they can recover. Many people abstain form alcohol in January because of the excesses of alcohol that they have consumed during the festive period, but anybody who is struggling to achieve that pledge may need to worry whether they need help to reduce their dependency on alcohol before it kills them.

But I want to focus the rest of my remarks on the role of obesity and the role of food as the main driver of obesity, which I think is the main challenge for us here. The statistics are terrifying. Over 1.5 million adults in Wales are overweight, and 655,000 are obese. That’s scary because we only have a population of about 3 million, and not all of them are adults. So, we do have a major public health crisis. We know that we are unlikely to lose weight if we are quaffing large quantities of alcohol. But it is not the main driver, which I think is adulterated food, not least because many of the people who are overweight or obese drink no alcohol at all. Obviously, that is not the case when it comes to the one in four children in Wales who are overweight or obese by the time they start primary school. It has to be because of what they are given to eat. I have yet to meet a breast-fed baby who is overweight. So, increasing breast-feeding would reduce the number of babies and toddlers who are in that situation. Goodness knows what’s in the milk formula, but the diet that we are adopting when it comes to weaning is a very significant element in all of this. The food that children eat aged two sets the scene for what they are prepared to eat, both as children, as well as adults.

Sixty per cent of the UK population never prepare food from scratch. The main culprit is processed food, which has become the dominant diet across the UK. The food industry spends billions of pounds every year on advertising, encouraging us to eat stuff that our grandmothers simply wouldn’t recognise as food. So, it’s not just children who need protection from this relentless advertising, which is causing such an extraordinary level of self-harm. If you haven’t prepared food yourself, you are unlikely to be aware that processed food is routinely laced with sugar, salt and fat, to make it taste of something at all, and to drive profitability. We simply can’t go on like this. Obesity costs the NHS £6 billion a year across the UK, and a whole-system change is required in our relationship with food. It’s not just liver cancer that is the problem. Obesity is now the second-largest cause of all cancers, after smoking. That’s why we have to have a whole-system change in our relationship with food, and why we cannot afford not to have a food Bill to drive the change that we need.    

As we know, loving your liver is loving your entire health and well-being. However, as this day tells us, liver disease and liver cancer have lifelong impacts on sufferers’ lives. This day also highlights how liver cancer is increasingly affecting more lives, with it becoming the fastest cause of cancer deaths in the UK, with mortality rates almost doubling between 2010 and 2020. The problem is more concerning in Betsi Cadwaladr University Health Board, with mortality rates being 50 per cent higher than the national average.

With liver cancer having the second-lowest survival rate in Wales it’s vital that the Welsh Government take action immediately to address this. Equally, the Welsh Government must take action to raise awareness of the causes and symptoms of this deadly cancer. Liver disease is the leading cause of liver cancer and it falls on individuals, organisations and the Government to be aware of what causes liver disease and how to prevent it causing unnecessary pain.

The risks of liver disease impact people in my own constituency at a 15 per cent higher rate than the rest of the country, and with Betsi Cadwaladr already under immense pressure, addressing liver disease and cancer will aid in relieving such pressures. In north Wales a resident was diagnosed aged just 45. He was not a drinker and was at a healthy weight. However, he’d developed cirrhosis due to a genetic liver condition and both his brother and father had died of liver-related complications. Despite this, he was removed from the liver cancer surveillance list for two years, despite the fact that he was of high risk. This is a reminder of the stress and anxiety that disruptions in care and the NHS can cause to the most needing of patients.

The functions of the liver are non-exhaustive in many ways, because liver functions include processing digested food from the intestine, controlling levels of fats, amino acid and glucose in the blood, combating infections, clearing the blood particles of infections, including bacteria, neutralising and destroying all drugs and toxins, manufacturing bile, storing iron, vitamins and other essential chemicals, breaking down food and turning it into energy—carbohydrates—manufacturing, breaking down and regulating numerous hormones, including sex hormones, and making enzymes and proteins that are responsible for most of the chemical reactions in the body, for example those involved in blood clotting and the repair of damaged tissues. It also plays a large part in our blood pressure as portal hypertension is controlled through the liver and the portal vein, which is a major vein that runs to the liver. The five major symptoms of portal hypertension can be blood in the vomit, blood in the stool, bloated stomach with rapid weight gain from fluid, oedema, which is swelling in your legs and feet, and mental confusion or disorientation. So, just a few examples, but all in all, a better liver is a better you, so support our motion this afternoon and let’s get this on the agenda. Thank you.

I’m pleased to have this opportunity to speak on this in the Chamber today. I thank you, Joel James, for bringing this important debate to the Senedd. Around 90 per cent of liver disease is caused by modifiable risk factors such as alcohol intake, diet and lifestyle factors, yet liver disease deaths in Wales have surged by almost a quarter in the last two years alone, to the highest-ever recorded level. Swift and co-ordinated action is needed at the highest level of Government and across health boards to turn the tide on this liver disease epidemic. Tackling the pace and scale of this complex public health emergency demands robust oversight and accountability mechanisms. I urge the Minister to commit to introducing a dedicated liver health strategic clinical network to ensure the ambitious targets identified in the new quality statement on liver disease are implemented effectively and efficiently.

Aneurin Bevan health board, my local health board, is at the forefront of local innovation and good practice in improving earlier detection and outcomes for liver disease patients. A pilot project in Gwent, which is a pathway for earlier diagnosis of liver disease, led to an 81 per cent increase in diagnosis of cirrhosis, the most severe form of liver disease. The pilot pathway has since been brought up to scale across the country through the roll-out of the all-Wales abnormal blood test pathway in October 2021, a step change in efforts to accelerate earlier detection of liver disease in primary and secondary care, the first UK nation to do so. Aneurin Bevan health board was also the first health board in Wales to introduce the seven-day alcohol care team support.

Skilling up service provision has a significant impact in tackling harmful drinking behaviours, reducing hospital admissions and improving health outcomes, particularly amongst those most at risk of developing severe alcohol-related liver disease. Despite local innovation and adoption of a national pathway for the early detection and management of liver disease, significant unwarranted variation persists in liver disease care and outcomes across health boards, as my colleagues have already referred to. Provision and delivery of liver care services across Wales is variable, despite evidence that access to specialist care improves survival rates for liver disease patients by approximately 20 per cent.

As has been said—and it's an important consideration—the liver disease burden and risk factors are more prevalent in the most deprived communities. Hospitalisation rates due to liver disease are four times higher in the most deprived areas compared to the most affluent. The number of people diagnosed with fatty liver disease in secondary care is 95 per cent higher in the most deprived areas versus the least deprived by about 1,000. Alarmingly, people with liver disease in deprived areas will die 10 years earlier than those in the most affluent areas, worsening the gap in healthy life expectancy.

Public Health Wales estimate that tackling health inequalities facing the least deprived communities could save the NHS up to £322 million a year, particularly through reducing emergency admission and A&E attendance. Urgent action is needed to scale up the use of non-invasive liver fibrosis assessments—e.g. fibroscan technology—in primary and community care across every health board. The use of fibroscan technology in community settings is likely to be highly cost-effective in detecting liver disease at an earlier stage, and reducing the need for emergency secondary and specialist care.

Hospital admission rates due to liver disease in Aneurin Bevan health board—95.2 per 100,000—were well over 40 per cent higher than the national average, and more than twice as high as Hywel Dda University Health Board, in 2020. This burden on the NHS could be mitigated by scaling up this use of the non-invasive fibrosis assessments in primary care and community settings, and I hope that we will see this preventative action soon. I urge everyone to support this motion today.  

I call on the Deputy Minister for Mental Health and Well-being, Lynne Neagle. 

Thank you, Deputy Llywydd. Firstly, I'd like to thank the Conservatives for bringing this important issue to the Chamber, and to all Members who've contributed to today's debate. I've listened carefully to all speakers, and there have been many important points made.

Liver disease is the third leading cause of premature death in the UK, and regrettably deaths in Wales from chronic liver disease have more than doubled over the past 20 years. It is now the commonest cause of death in those aged 35 to 49 in the UK. We know that liver disease can lead to liver cancer, which is one of the so-called less survivable cancers as it is difficult to diagnose, having no early and non-specific symptoms. This is why people with liver cancer tend to present late and have poor survival rates. 

I welcome that today is Less Survivable Cancers Awareness Day. It is so important to raise awareness of the less survivable cancers and their symptoms with the public, and to encourage people to see their GP if they're concerned. As with many health conditions, the way people lead their lives directly influences the risk of developing liver disease. Excessive alcohol consumption and obesity remain the commonest causes of liver disease in Wales, and cases are also linked to hepatitis infection.

Welsh Government's 10-year 'Healthy Weight: Healthy Wales' strategy sets out our ambitions to prevent and reduce obesity across Wales. The strategy is supported by a series of two-year delivery plans. For 2022-24, we have continued to invest over £13 million into the delivery of a range of approaches that focus on both prevention and intervention. Our approach includes delivery of revised all-Wales weight management pathways for adults, children and families, which aim to put in place a range of equitable and diverse options for individuals to access information, advice and support. 

We know that in addition to interventions at an individual level, the environment around us plays a significant role in driving unhealthy behaviours. That's why last year we consulted on a range of proposals to enable healthier food environments to make the healthy choice the easy choice. We will be publishing the consultation responses this month and announcing our next steps in the spring.

Alcohol misuse is also a major health issue affecting individuals, families and communities, and preventing the harm caused by alcohol continues to be a priority for the Government. We are committed to ensuring that our services provide early intervention and prevention, so that longer term harms are prevented before they occur. In 2022 to 2023, we increased our investment in the substance misuse agenda to almost £64 million, of which over £36 million was allocated to area planning boards, who commission alcohol services. A further £3 million has been earmarked for area planning boards in 2023-24 as part of the draft budget. We believe the introduction of a minimum unit price for alcohol will help reduce alcohol-related harm and support people to drink responsibly. Evidence shows that introducing an MUP for alcohol will make an important contribution in tackling the health risks associated with excessive alcohol consumption and alcohol-specific deaths in Wales by reducing alcohol consumption in hazardous and harmful drinkers.

Welsh Government also remains committed to the World Health Organization elimination agenda for hepatitis B and C, which includes targets to reduce viral hepatitis incidence by 90 per cent, and to reduce mortality due to hepatitis B and C by 65 per cent by 2030. A new hepatitis B and C elimination programme oversight group has been established to drive the elimination agenda here in Wales. The group includes representation from Welsh Government, Public Health Wales, hepatitis B and C health services and the third sector. The first action of this group was to agree on the content of a communication that will set out a road map in order to reinvigorate the drive to eliminate hepatitis B and C as a public health threat by 2030. This is due to be published imminently.

In terms of our wider approach to liver disease, Welsh Government, health boards and the emerging NHS executive network structures are working closely together to drive forward implementation of the liver disease quality statement. The quality statement sets out our vision for high-quality liver disease services over the next decade. It aims to deliver better outcomes on the prevention, diagnosis and treatment of liver disease here in Wales. This includes supporting a range of initiatives, some of which were put forward in point 4 of today's motion: initiatives such as continuing to highlight the significant benefits of introducing emergency department alcohol screening and seven-day alcohol care teams in secondary care to meet local need; expanding the use of the all-Wales liver blood test pathway in primary care, underpinned by the Institute of Clinical Science and Technology; funding of staff to reduce waits for non-invasive detection of chronic liver disease; funding of Love Your Liver campaigns by the British Liver Trust; improving provision for gastroenterology trainees in Wales to undertake advanced hepatology training leading to an improved pipeline of consultant hepatologists.

The liver disease implementation group are currently developing a work programme to support the implementation of the quality statement, and timescales and priorities will be considered as part of this process. In terms of the call for a doubling of hepatology staff in Wales, health boards and NHS trusts are responsible for recruitment and workforce planning, supported by Health Education and Improvement Wales and other partner organisations. We need to develop an approach to the hepatology workforce that achieves the right match between demand and supply, and we are determined to address the underlying issues of staff recruitment, retention and effective workforce planning, to ensure that we can provide the right number of healthcare staff to meet the care needs of our patients. The workforce strategy, published by HEIW and Social Care Wales, sets out our long-term vision and actions for the health and social care workforce. We have also developed a shorter term workforce plan to help with the current pressures on our workforce, which the Minister for Health and Social Services expects to publish in the coming weeks.

In conclusion, I would like to reassure the Chamber that reducing deaths from liver disease through prevention and early diagnosis remains a priority for the Government, and I ask the Chamber to support the Government's amendment today. Diolch.

I call on Mark Isherwood to reply to the debate.

Diolch. I thank the Member for South Wales Central, Joel James, for securing this timely and important debate in this Love Your Liver awareness month, and national awareness raising day for less survivable cancers. He's been a great advocate on liver health as chair of the cross-party group on liver disease and liver cancer, and I share his commitment to tackling unwarranted variation in liver disease care and outcomes. We also welcome recent innovation and good practice championed by the Welsh Government, including the recent introduction of the quality statement on liver disease and the roll-out of the all-Wales abnormal blood test pathway across seven health boards.

In his introduction, Joel noted that Wales has the highest mortality rates due to liver disease in the UK, and he says that we can't bury our heads in the sand over this issue. He noted that Wales is behind other UK nations on tackling hepatitis C, and he called for investment in research and in earlier and faster diagnosis of liver disease.

Rhun ap Iorwerth noted that liver disease and liver cancer are a public health crisis in Wales, and he highlighted the need for investment in preventative measures, tackling alcohol abuse and obesity in particular. Altaf Hussain noted that it's vital that we do all we can to ensure that no-one dies unnecessarily from liver disease, and especially alcohol-related liver disease, which accounts for nearly two-thirds of liver diseases. He noted that Wales has a postcode lottery in accessing specialist care and prevention support. Jenny Rathbone quite rightly said that we only have one liver, our bodies can't survive without it, and if we don't look after our liver, we will die. Gareth Davies pointed out a particular problem in Betsi Cadwaladr University Health Board where the hospital admission rate due to liver disease is 15 per cent above the national average, and liver cancer mortality rates are 50 per cent higher than the national average in Wales. He concluded that a better liver is a better you. Laura Anne Jones called for swift and co-ordinated action at the highest level in Welsh Government and the Welsh NHS to tackle the liver disease crisis in Wales, incorporating the good practice that she identified in some health boards. She said that liver disease is most prevalent in the most deprived areas.

The Deputy Minister, Lynne Neagle, acknowledged many of the points made by the speakers and even reiterated some of them. She listed what the Welsh Government is doing, and I've acknowledged some of that, as did colleagues, but unfortunately, she failed to support the evidenced needs identified in this motion—needs identified not by politicians, but by the sector bodies themselves.

The number of people diagnosed with liver disease in Wales more than tripled between 2002 and 2021, rising to 53,261 people. Liver disease deaths in Wales continue to rise, with mortality rates surging by 23 per cent between 2019 and 2021. As we heard, it's vital that the Welsh Government publishes a timetable for the delivery of outcomes set in its quality statement on liver disease, following the increased prevalence of liver disease amongst the Welsh population.

Despite 90 per cent of liver disease being preventable, the number of people dying from the disease has doubled in the last two decades and increased, as we heard, by 400 per cent in people aged 65 and under, with nine in 10 liver cancer patients dying within five years of being diagnosed. With mortality rates having increased since the previous policy was published, Welsh Ministers must seek to improve prevention of the disease, including: doubling the hepatology workforce, including liver nurse specialists to address huge variation in access to specialist care; seven-day alcohol care teams in place in all health boards to meet local need; and adoption of the all-Wales abnormal liver blood test pathway by all GPs to improve the early detection of liver disease.

Hepatitis C is a blood-borne virus that can cause a range of health impacts, primarily affecting the liver. Although it is preventable, treatable and curable, we heard the figures from the Hepatitis C Trust showing that Wales is now the only UK nation not to have a target of achieving a hepatitis C elimination in advance of the World Health Organization's 2030 target, with England and Northern Ireland having set an ambition of elimination by 2025, and Scotland by 2024. By contrast, recent modelling found that continuation of current treatment rates in Wales would mean elimination would not be reached until at least 2040.

As they've stated again for this debate, the Welsh Government should implement the recommendations made by the Health, Social Care and Sport Committee following its inquiry into hepatitis C in Wales, including producing a national elimination strategy, setting out a clear route map to achieving hepatitis C elimination by 2030 at the latest, and launching a hepatitis C awareness campaign. Wales has a liver disease and liver cancer public health emergency. 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. Across health boards, liver disease mortality rates have doubled in two decades, and liver cancer deaths have almost doubled in just 10 years up to 2020, placing a huge and unsustainable burden on the NHS in Wales.

The motion put forward today is ambitious, but necessary to keep pace with the rising scale and severity of the liver disease and liver cancer public health crisis. We therefore call on the Welsh Government to double prevention efforts, accelerate earlier detection of liver disease in primary care and expand alcohol care teams across health boards to help those in critical need of support. We urge the Minister to deliver a long-term funding settlement to recruit, train and retain a specialist workforce, and we believe that these objectives can be best achieved through the introduction of a dedicated liver health strategic clinical network to keep up momentum and build on the great work of the liver disease implementation group.

As the British Liver Trust state in their correspondence to all Members, 'We would ask Members to vote in favour of the motion as tabled, and not for amendment 1, so we can keep the specific deliverables in the motion. I encourage Members to use their consciences and vote accordingly.’

I conclude by referring to the fact that, as January marks Love Your Liver Month, Members are invited to attend the British Liver Trust Love Your Liver roadshow at Roald Dahl Plass on Tuesday, 14 March. It’s part of a national awareness raising campaign to improve public awareness of the risk factors for liver disease and provides an opportunity for Members of the Senedd to find out more and have  a free liver health screen and scan any time between 10:00 a.m. and 4:00 p.m. Diolch yn fawr.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] There is objection. Therefore, I will defer voting under this item until voting time.

Voting deferred until voting time.