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Data on the proportion of NHS boards that have an effective patient care pathway for the early detection of liver disease is not available.

However, we understand there is variability in liver disease management across Scotland. The Scottish Government has identified the intelligent Liver Function Testing pathway (iLFT) used in Dundee, Tayside as best practice which is eligible for adoption across NHS Scotland as part of its Modern Outpatient Programme.

The Tayside iLFT group is collaborating with other NHS Scotland Boards to assist with the implementation of iLFT within their laboratories and primary care services.

In March 2021, we published our Respiratory Care Action Plan for Scotland, setting out our commitments to drive improvement in the prevention, diagnosis, care, treatment and support of people living with respiratory conditions such as bronchiectasis.

We recognise the importance of data in understanding respiratory care in Scotland. Our Plan contains a key commitment to build a core respiratory data set, which will enable the Scottish Government, NHS Boards and clinicians to identify improvements needed in delivery of respiratory care and also monitor how the implementation of our Plan is delivering better outcomes for people in Scotland.

At its first meeting in October, the Scottish Respiratory Advisory Committee (SRAC) identified data as one of the 3 key priorities for year 1 of implementation.

We have since established a sub-group consisting of clinical experts representing health boards across Scotland, Public Health Scotland and third sector representation to progress and deliver this commitment. The sub-group have held their first meeting and are in the process of commencing a scoping exercise on the data currently available across Scotland, before determining what data should be collected in the future in order to improve respiratory care.

Scottish Government is committed to ensuring that everyone with liver disease is able to access the best possible care and support and benefit from healthcare services that are safe, effective and person-centred.

We are working with the UK Government and other devolved administrations on the development of the revised UK-wide Clinical guidelines for alcohol treatment, which will include the treatment of liver diseases. The updated guidelines are expected to be published for consultation later this year.

We are improving our ability to detect cancer and to treat it successfully. That is why we continue to invest in our Detect Cancer Early Programme, which adopts a whole systems approach to diagnosing and treating cancer as early as possible. This will include the early detection of liver cancer.

General Practice and Primary Care multi-disciplinary teams will continue to play a key role in supporting patients with long-term condition management, including those with a diagnosis of liver disease, alongside specialist treatment services within Scotland’s healthcare system.

The intelligent Liver Function Testing pathway (iLFT) used in Dundee, Tayside has been identified as best practice of early detection of liver disease.

It uses an automated, algorithm-based system to further investigate abnormal liver function test results on initial blood samples from primary care.

The Scottish Government has identified the iLFT pathway as eligible for adoption across NHS Scotland as part of its Modern Outpatient Programme.

The Tayside iLFT group is collaborating with other NHS Scotland Boards to assist with the implementation of iLFT within their laboratories and primary care services.

Living with overweight or obesity is linked with an increased risk of developing a range of health conditions, including non-alcohol-related fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). According to the 2019 Scottish Health Survey , two-thirds of adults in Scotland were overweight or obese. Obesity prevalence in Scotland has remained relatively stable since 2008.

The Scottish Government has not carried out a specific assessment of the impact of rising levels of obesity on NAFLD or NASH.

We want everyone in Scotland to eat well and have a healthy weight. We continue to implement our 2018 Diet and Healthy Weight Delivery Plan . We also continue to support NHS boards to improve weight management services in line with our Type 2 Diabetes Prevention, Early Detection and Intervention Framework and Public Health Scotland’s national standards .

Further information on NAFLD and NASH is available to the public and clinicians on NHS Inform and other professional groups such as British Society of Gastroenterology , and charitable organisations such as British Liver Trust .

In 2020, the latest year for which data are available, there were 912 chronic liver disease deaths in Scotland. Of these, 759 were alcohol-related liver disease deaths. Data are not available for obesity related liver disease deaths.

Liver diseases are generally avoidable or treatable if diagnosed at an early stage and stigma often prevents people from accessing treatment; 75% of people are currently being diagnosed at a stage when it is too late for lifestyle changes or intervention.

We take a whole population approach to reducing alcohol consumption and the risk of alcohol-related harms across the population and that’s why we’ve taken a range of actions to reduce the availability, attractiveness and affordability of alcohol.

We are also taking action to reduce the impact of poor diet on people’s health which is also a significant and growing contributor to liver disease. We are taking wide-ranging action to support healthier choices, as set out in our 2018 Diet and Healthy Weight Delivery Plan , and have set a challenging aim to halve childhood obesity by 2030 and significantly reduce diet related health inequalities.

The Scottish Government is committed to tackling stigma.

In December 2021 a national campaign was launched to tackle the stigma people with problematic alcohol and drug use face. This campaign sought to communicate that drug or alcohol problems are health conditions; people should receive help and support, not judgement.

We are working with Scottish Health Action on Alcohol Problems to develop an action plan in relation to alcohol and stigma. This will include advice from those with lived experience, third sector organisations and academics.

We are supporting the development of the forthcoming UK-wide clinical guidelines for alcohol treatment, led by the Office for Health Improvement and Disparities. The guidance will look to introduce new approaches to treatment, including non-stigmatising service delivery.

On 20 June 2022, Public Health Scotland launched the Challenging Weight Stigma Learning Hub. The learning hub aims to raise awareness of the impact weight stigma can have on people living with overweight and obesity and what health professionals can do to mitigate this. It is interactive and has been developed alongside academics, health professionals and those with lived experience of stigma.

NHS Boards do not currently collate numbers of bronchiectasis diagnoses over and above the usual coding of patients that happens as standard at local level. We do recognise the importance of data in understanding and improving respiratory care in Scotland, and improving access to respiratory data is a key commitment in our Respiratory Care Action Plan. One of the three priority areas for year 1 of the Plan’s implementation is data and a sub-group has recently been established to progress this commitment. The first task for this group will be to determine what data should be collected in order to improve respiratory care. This will include consideration of which individual conditions would benefit from additional data collection.

The Scottish Government intends to publish the summary report on the responses to the public consultation alongside the Implementation Plan for the Framework for Pain Management Service Delivery later this summer.

The information requested is not held centrally.