Charles Core on Hepatitis C

1 October brings World Hepatitis Awareness Day, but on the domestic stage the NHS is struggling to cope, writes Charles Gore

Hepatitis C is a public health time-bomb for the UK. The National Institute for Health and Clinical Excellence estimates that up to 500,000 people are chronically infected, yet less than 5,000 have been successfully treated. A third of people with untreated hepatitis C are at serious risk of developing end-stage liver disease, which means that, unless we seize the opportunity to act now, hepatology services will face a capacity crisis.

It would be overwhelming to manage end-stage liver disease for more than 100,000 people as it is hugely resource intensive. To put this in context, there are 110,000 acute hospital beds in England in total. Hepatitis C will have very major implications for how we plan our health services.

With new NICE guidance taking effect last month, anyone with hepatitis C, not just those with moderate to severe liver damage, will be eligible for treatment. This is good news for patients but will nonetheless present a challenge for health service capacity.

A recent audit by the all-party parliamentary hepatology group shows that many hepatitis C services leave a lot to be desired, and that progress on implementing the government's action plan is painfully slow. Yet both the Department of Health and the voluntary sector are committed to ensuring that more people with hepatitis C are diagnosed. The challenge for health services is clear: find new ways to treat more people. And do it fast.

With the government promoting more community-based health services, there might be an opportunity to deliver more hepatitis C care closer to the patient. However, this is a controversial issue. Treatment is complex, with some patients developing severe side-effects. Hepatitis C care is not the relatively simple type of procedure seen by many as an ideal candidate for delivery in primary care. Nevertheless, there are some good examples of how and where treatment has been delivered safely and effectively in a variety of community settings, with high levels of patient satisfaction.

But can these isolated examples be replicated elsewhere?

This is why the all-party group decided to hold a discussion forum to examine whether it is feasible, safe and indeed desirable to deliver more hepatitis C care in community settings. The potential benefits seem compelling, increasing convenience for patients who often have very difficult personal circumstances which can make sticking with treatment a challenge, freeing up scarce specialist services for the most difficult cases and helping to solve the capacity headache facing NHS managers.

But how does the cost of community-based care compare to that in a specialist setting? If care closer to home is rolled out, will treatment outcomes be as good? Are there enough skilled professionals to make it work?

Far from being an excuse for inaction, these unanswered questions show the pressing need to explore the issue further. The group's report Expanding the Options: an examination of new models for delivering hepatitis C treatment sets out a series of principles which should underpin any decision about where best to provide care and makes recommendations on how we can find the answers to these important issues.

The professional community and the Hepatitis C Trust, the national hepatitis C charity, are fully supportive of further investigation. Hepatitis C provides an ideal opportunity for the government to make real on its vision of care closer to home. If it is serious about this, it should act on the report's recommendations now.

Charles Gore is chief executive of the Hepatitis C Trust. For more information on its work or to download a copy of the all-party parliamentary hepatology group's report Expanding the Options, visit www.hepctrust.org.uk