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01 November 2019
The Health, Social Care and Sport Committee conducted an inquiry into progress towards hepatitis C elimination in Wales, which will be debated in the Assembly on 6 November. The Committee’s report concluded that urgent action is required from the Welsh Government to develop a new elimination strategy and provide sustainable investment until the elimination of hepatitis C achieved.
Members of the Committee were concerned to hear evidence that Wales is not on track to meet the agreed World Health Organisation 2030 target to eliminate the disease in Wales, and about uncertainty past 2020/21 in terms of Welsh Government strategy and funding, particularly for dedicated staff posts.
The Committee warned that ‘without urgent action to address these matters, the elimination opportunity will be lost’. However, the Welsh Government accepted just one of the Committee’s recommendations, with the other three ‘accepted in principle’.
What is hepatitis C?
The hepatitis C virus (HCV) is a blood borne virus (BBV) affecting the liver. If untreated, four-fifths of those infected develop chronic hepatitis C, which can cause fatal cirrhosis (scarring of the liver which can lead to liver failure) and liver cancer. The virus is spread when the blood of an infected person gets into the bloodstream of another person.
Around 210,000 people are chronically infected with HCV in the UK, with 12,000-14,000 of these in Wales.
The World Health Organisation (WHO) produced a global health sector strategy on viral hepatitis which sets out to eliminate hepatitis B and hepatitis C as significant public health threats by 2030. Wales is signed up to this strategy.
Hepatitis C is currently covered in the Liver Disease Delivery Plan in Wales which runs to 2020. The liver disease implementation group, with dedicated posts (including the national lead for hepatitis), only has confirmed funding until 2021 (a one year extension).
The Committee’s view
The Committee concluded that the elimination of hepatitis C is achievable, but only with a commitment from the Welsh Government to produce a clear elimination strategy without delay, with sustainable funding, ambitious targets, and a workforce plan.
Members noted that this must be done as a matter of urgency, given that the current plan will end next year, and funding for dedicated posts is only confirmed until 2021. There was a strong consensus in the evidence received that a dedicated strategy and sustained investment is needed to deliver progress.
The Committee believes that the need to get out into communities to proactively seek out, test and treat ‘at risk’ individuals is crucial, along with increased funding for testing and treatment in prisons. It also notes that there is still stigma around the condition and past treatment options. It believes a targeted public awareness campaign is required to tackle the stigma, and get the message out there that treatment is simple, safe and effective.
How did the Welsh Government respond?
The Welsh Government accepted one of the four Committee recommendations; to write to Local Health Board Finance Directors and Chief Executives to emphasise that national treatment targets for hepatitis C must be considered as minimum targets, to be exceeded wherever possible. This reflected the fact that the Committee heard concerns that the targets were being seen by some as a ceiling rather than a floor.
The other three recommendations were ‘accepted in principle’ by the Welsh Government, although the key call to develop a dedicated strategy is not being taken forward.
The Welsh Government argues that its policy has moved away from very specific disease strategies ‘because their limited focus, together with the administrative burden of a formalised strategy, create limitations’. It says ‘irrespective of its inclusion in wider strategies, it is known what is required to successfully eliminate hepatitis C: increased testing and treatment in the community’.
The Welsh Government anticipates significant improvements through the introduction of a KPI for Area Planning Boards in relation to testing for BBVs in substance misuse services. It states that the Welsh Government will introduce formal health board hepatitis C testing and treatment targets as part of the NHS Delivery Framework for 2020/21. It will also ‘produce periodic Welsh Health Circulars for NHS Wales outlining progress and highlighting specific actions necessary to eliminate hepatitis C by 2030 at the latest’.
The Welsh Government also says that whilst it is agreed that key national posts will be required beyond March 2021 if we are to successfully achieve elimination, ‘any decision for funding beyond the period for which we have a settlement will be taken around the appropriate budget planning round’.
There is likely to be disappointment amongst stakeholders that a new national hepatitis C elimination strategy will not be produced. Hepatitis C Trust told the Committee that it would be concerned if there wasn’t a new replacement plan that addressed hepatitis C beyond the current arrangements, noting the elimination target of 2030 ‘is really not that far away, so now is certainly not the time to be taking the foot off the gas – quite the opposite, really’.
Public Health Wales also called for a dedicated strategy:
Having a focused strategy on an all-Wales basis, which encompasses all the key interventions, and identifies the roles for different stakeholders with appropriate local delivery plans, is something that will really help us refocus our attention and bring us back to the target of elimination by 2030.
It has been estimated that on the current trajectory, Wales is set to miss the target deadline by over a decade, therefore it is clear that urgent and sustained efforts are required to turn this around and achieve elimination by 2030.
Article by Amy Clifton, Senedd Research, National Assembly for Wales