Mortality from liver disease is increasing in the UK. In 2000 liver disease killed more men than Parkinson's disease and more women than cancer of the cervix. Deaths from alcoholic liver disease has doubled in the past 10 years, while liver disease arising from hepatitis C infection is expected to treble by 2020.

Evidence also suggests that the standard of care may vary widely from place to place.

But are there enough specialist staff and facilities in the UK to manage these projected increases in liver disease, or even the current workload, asks the author?

He conducted a survey on the staffing and facilities of liver centres at 28 English hospitals. Relatively few were able to provide a full range of liver services and there were serious shortages of staff at all levels.

Lack of dedicated beds was one of the most common problems, while waiting times for outpatient appointments were often unacceptable, with only seven hospitals able to offer an urgent appointment within two weeks. An earlier survey also showed the need for a substantial increase in consultant liver specialists (hepatologists).

Recent initiatives to improve teaching and specialist training are a step forward, says the author, but liver services need better funding as well as better staffing.

Increasing the number of transplant centres would be one way to provide liver services more widely in the United Kingdom, he suggests. At present, large areas of the country currently lack a transplant centre, and it was once estimated that a patient living in Cornwall was four times less likely to be referred for a liver transplant than someone in Leeds.

Clearly, specialised services for liver disease and transplantation will have to improve substantially to meet the considerably increased burden of liver disease that is predic
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Contact: Emma Dickinson
edickinson@bmj.com
44-20-7383-6529
BMJ-British Medical Journal
13-Oct-2005