Fibroscan for Liver Imaging

UK Government

We accept this recommendation but will balance its implementation against NHS England’s role to promote equitable access for all, the principle that patients should receive the same treatment irrespective of how the disease was acquired, the practicability of implementing different pathways for cohorts of patients, and the latest evidence-based care and clinical guidelines.

The Government’s acceptance in full or in principle of 6a) i-v. is contingent on the clarifications received from the Inquiry.

DHSC and the NHS are committed to ensuring that all hepatitis patients receive appropriate care, including those patients who contracted hepatitis via a blood transfusion or blood products. All patients will have their care overseen by a consultant hepatologist and NHS England has undertaken an audit of current pathways to satisfy itself that patients with a Hepatitis C diagnosis receive appropriate follow-up and monitoring in line with the relevant National Institute for Health and Care Excellence (NICE) and professional guidance.

NHS England will additionally be pro-actively identifying patients with bleeding disorders:
who may have been infected with Hepatitis C but never received a fibrosis test, so not had fibrosis staged, and may have been lost to hepatology services. A framework is being developed to define these individuals and enable haemophilia centres to refer forward to local ODN for fibroscan, and assessment for onward monitoring if appropriate; and
who are known to have been exposed to ‘factor’ blood products. but not known to have been tested or treated for hepatitis. These patients will be contacted and offered testing and signposted to onward care as appropriate.

A new NHS cirrhosis surveillance registry will be introduced to ensure there is a single data source to support the long-term surveillance of patients with cirrhosis.

While the numbers of patients who may require testing and follow-up are expected to be small, NHS England is committed to making every effort to ensure all patients with bleeding disorders who may have historically been exposed, have received appropriate testing, treatment and ongoing monitoring.

Scottish Government

In line with the subsequent clarification issued by the Infected Blood Inquiry, which confirmed that fibroscans were recommended to assess fibrosis (liver scarring), while ultrasound scans should be used to monitor patients for hepatocellular carcinoma (liver cancer), the Scottish Government fully accepts recommendation 6a) iv. and is content that this aligns with current clinical guidance.

Welsh Government

The Welsh Government published the Liver Disease Quality Statement in November 2022, which sets out our vision for good quality liver disease services for the next ten years. We are working closely with the Liver Disease Implementation Network (LDIN) to implement the quality statement. Priority areas include improving early detection of liver disease and Hepatitis B and C elimination.

Wales is able to meet recommendation 6 in general and the Welsh Government is currently working at UK level to seek a common position. The Welsh Deputy Chief Medical Officer for Health Services wrote to all Health Board Medical Directors in July 2024 to ask that they consider recommendation 6 in relation to liver disease.

Northern Ireland Executive

Currently in Northern Ireland, as is the case in Scotland, most patients with cirrhosis are already offered ultrasound scans every six months as part of their long-term clinical monitoring.

Complexity arises for those who have been treated in the past and are not being actively clinically reviewed due to their diagnosis predating the availability of fibroscans.