Liver disease patients found to have hospital discrimination

A report into patient deaths across England, Wales and Northern Ireland, has concluded that the NHS has been guilty of showing a dismissive, negative and discriminative attitude towards people who are suffering with alcohol-related liver disease.

The findings are part of a new report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), which state there are poor levels of care in the health service, not enough specialist doctors, as well as shortcomings in regards to screening, managing patient’s drinking habits and caring for acutely ill patients.

NCEPOD assessed almost 200 hospitals and thoroughly examined the cases of 385 patients who had died from alcohol-related liver disease.

The research found that as many as 32 of the deaths – one in 12 of those examined – could have been prevented if the patients had received better quality care, and shockingly, under half of the patients reviewed were deemed to have received what could classed as ‘good’ care.

It was found that despite three-quarters of the patients being admitted into hospital more than once; a third had never been referred to alcohol support services for help in stopping their drinking.

In addition, a quarter of the patients whilst in hospital had never been given the chance to see a specialist in diagnosing and treating liver disease – a gastroenterologist or hepatologist. In fact, the presence of consultant hepatologists were only discovered at 28% of the 191 hospitals studied in the report.
The NCEPOD strongly argue that every patient who attends hospital should be screened for alcohol misuse and any patient with worrying drinking behaviour should be given alcohol support services. The report also says that anybody suffering with urgent alcohol-related liver disease should never have to wait more than 24 hours before being seen by a specialist such as a gastroenterologist or hepatologist.

Report author Dr Mark Juniper, NCEPOD clinical co-ordinator and consultant physician at the Great Western Hospitals Foundation trust, said: “Many people with alcohol-related liver disease have multiple admissions with this condition. This gives clinicians an ideal opportunity to offer appropriate treatment and advice to patients to help them stop drinking and improve their future health. Unfortunately, this isn’t happening and in over a third of patients reviewed in this study, referral for support to stop drinking was not made, despite most hospitals reporting to have alcohol liaison services. This is partly because the services are not available at all times that they are needed.”
Dr Juniper, a consultant physician the Great Western hospitals NHS foundation trust, Swindon, continued: “Similarly, patients were not always seen by a specialist in liver disease, and when they were, this was often not for several days after admission. We know that abstinence works, and that when simple advice is offered to patients, one in eight will reduce their harmful drinking levels – that’s better than the results from ‘stop smoking’ support services. There are misunderstandings. It is quite difficult to predict the patients who will do well and who will do badly once they get into hospital and are very sick…there are patients who are being denied intensive care and aggressive treatment who do have the potential to survive.”

Liver disease, also known as ‘hepatic disease’, is where the liver is damaged or develops a disease. Alcoholic liver disease is just one of many varying types of liver disease and covers numerous conditions and associated symptoms that emerge after the liver becomes damaged because of alcohol misuse.

Unfortunately, symptoms of alcoholic liver disease do not often appear until the liver is severely damaged so it is important to monitor drinking levels before it is too late.

Alcohol misuse can lead to alcoholic fatty liver disease, alcoholic hepatitis and cirrhosis of the liver. All have a number of symptoms but common signs are loss of appetite, nausea, weakness and abdominal pain. However, when cirrhosis reaches its more serious second stage, the person will experience total loss of liver function, known as liver failure, and other symptoms can include: personality changes (as a result of toxins in the bloodstream interfering with the brain), vomiting blood, rapid heartbeat, staggering when trying to walk, dark urine, jaundice, hair loss, muscle cramps and more weight loss.

If you are misusing alcohol, you could still have liver damage even though you are displaying none of the above symptoms. Medical Specialists Pharmacy recommend that if you are drinking too much alcohol, contact your GP as soon as possible and request a liver function test in addition to a blood test to detect enzymes that are usually only present in the blood due to liver damage.