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.