Earlier Detection of Liver Cancer. Secondary Care Liver Surveillance Programme

The East of England Cancer Alliance are implementing a Liver Surveillance Programme that will cover the six Integrated Care Systems within the East of England Cancer Alliance footprint.

This population health surveillance programme will ensure that patients diagnosed with conditions that qualify them to be considered for the 6-monthly surveillance programme are identified, supported and where appropriate prioritised onto the programme.

The main risk factor for primary hepatocellular carcinoma (HCC) is cirrhosis (scarring) of the liver, which can often go undiagnosed for many years before symptoms develop. Many of us are at risk of cirrhosis due to alcohol misuse, type 2 diabetes, obesity, or viral hepatitis. Earlier diagnosis leads to better outcomes in hepatocellular cancer, so 6 monthly surveillance for HCC should be offered to cirrhosis patients. We hope that by making earlier diagnosis of cirrhosis we will be able to support earlier diagnosis of HCC and better outcomes for our patients. It will also allow them to optimise their cirrhosis care and engage with their hepatology services.

Long Term Ambition

  • A key long-term ambition of the liver surveillance programme is to significantly increase the proportion of cancers diagnosed at early stages. Specifically, the NHS Long Term Plan set an ambitious target that by 2028, 75% of cancers should be diagnosed at stages 1 and 2. This represents a substantial increase from the current rate of around 50% of cancers being diagnosed at early stages.
  • To realise this ambition, patient data held at the Trust level must be integrated with primary and other secondary care data to improve case-finding for cancer alliances, enabling targeted patient engagement.

This integrated approach aims:

  • To ensure that the right people are identified for the programme.
  • To ensure those on the programme have the appropriate level of surveillance.
  • To optimise the effective utilisation of scanning and clinic time.
  • To Identify patients qualifying for the liver surveillance programme that are not already known.
  • To provide an effective way of communicating with all patients within the programme through a centralised automated patient support platform.
  • To offer remote pathways to patients to engage digitally and support patients that may be less digitally enabled.
  • To create a standardised research interface to ensure that there is live data within a trusted research environment to allow the East of England (EoE) to lead on liver cancer surveillance insights.

 

Earlier detection of liver disease and cancers in people living with multiple disadvantages. 

- Framework and competencies for health navigator roles. (Sept 2024)

Document is available for download, includes topics below: 

Introduction to Health Navigator Roles 
Background to this programme 
A Trusted Person 
Making Every Contact Count 
Boundaries 
Cancer Prevention 
Cancer Screening 
Early Detection of Cancer 
Competency Framework for the Health Navigator 

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Pioneering project to tackle cancer among homeless

 19 December 2024

The East of England Cancer Alliance is working with Anglia Ruskin University to remove barriers to healthcare (the content below was issued as a press release in December 2024)

HOMELESS people are to be helped get vital healthcare in a unique new project aimed at tackling cancers in the East of England.

The pioneering, two-year scheme will operate in Cambridge, Peterborough, Wisbech and King’s Lynn, with specially trained Health Navigators working from health centres and homelessness services.

Led by the East of England Cancer Alliance in a unique link up with Anglia Ruskin University, the initiative recognises that people who are homeless often face significant barriers to getting basic healthcare.

The new scheme is based on an initial pilot project called Cancerless, involving public health and clinical experts from across Europe, led by Lee Smith, Professor of Public Health at Anglia Ruskin University. It was established to help identify ways of eliminating differences that homeless people experience when accessing healthcare.

Many people who are homeless experience poor health and die from treatable conditions because they cannot access the care they need. According to homelessness charity Shelter, the average age at death was 45 for men and 43 for women – this is more than 30 years lower than the average age at death of the general population.

The new team will aim to overcome these barriers by working with people to identify their health needs, connect with appropriate services and stay engaged with ongoing care.

The programme will place a particular focus on raising awareness of symptoms which may be linked to cancer, especially the early detection of liver cancer, which claims the lives of more than 500 people every year in the East of England.

Across the region, around 560 liver cancers are diagnosed in local hospitals each year, with 40 per cent of these diagnosed through NHS emergency settings such as A&E departments. This compares to an overall emergency diagnosis rate of 18 per cent for all cancers combined.

Liver cancer rates have increased by more than two-fifths (42%) in the UK over the past decade, according to Cancer Research UK.

Professor Peter Hoskin, Consultant Oncologist and Clinical Director at the East of England Cancer Alliance, said: “The fact that so many liver cancers are diagnosed in emergency departments shows that these are being diagnosed at a late stage, when they are harder to treat, and this leads to worse outcomes.

“This new initiative, involving Health Navigators who are known and trusted by people facing homelessness in our region, is an important and effective way to address an urgent problem.”

The initiative comes as latest figures estimate that one in 160 people in England are now homeless.

What Health Navigators will do:

         Health conversations and screenings

  • Health Navigators will meet people in locations that are convenient for them. They will discuss health concerns, perform basic health checks and work with people to identify their healthcare needs. Whether helping to book and attend appointments, supporting self-referrals or encouraging self-care, Health Navigators will help enable people to receive the care they need. 
  •  
  • Health advocacy
    Acting as advocates, Health Navigators will accompany people to appointments when needed, or with consent, help communicate essential health information in discussions with healthcare providers. This will ensure that no vital details are missed.

 

  • Improving healthcare engagement
    Working closely with both community and hospital healthcare teams, Health Navigators will help identify people experiencing homelessness, or at risk of homelessness, and help them attend appointments – whether in person or online – and stay engaged with their treatment plans.

 

  • Health promotion workshops
    In collaboration with healthcare professionals, Health Navigators will organise workshops aimed at promoting health awareness and well-being. These sessions will focus on raising awareness of key health issues, such as early cancer symptoms, empowering people to take control of their health and seek help when needed.

 

GP Dr Damita Abayaratne who is co-ordinating the work from the Cambridge Access Surgery said: “Our aim is to actively support people across this region to overcome barriers to accessing healthcare; empowering them to get the right help at an early stage, so that serious disease can be prevented, or diagnosed and treated.

“This is a direct way to address what we know is a significant health inequality across the country. We will be charting its progress and hope it may inform models of care in other areas.”

Following on from his role as UK lead in the European Cancerless project, Lee Smith, Professor of Public Health at Anglia Ruskin University, will evaluate the impact of the East of England’s new Health Navigators.

Professor Smith said: “We have seen some incredibly promising results from the European pilot project, including an increase in homeless clients attending screening programmes.

“This new initiative is focusing on liver disease, and this is so important as the Cancerless project identified a high prevalence of behaviours that put people at risk of cancer and multiple other chronic conditions.

“Our pilot project, which directly addressed such behaviours, involved partnerships with The Purfleet Trust in King’s Lynn and Winter Comfort in Cambridge, and it is fantastic to see this being rolled out, led by this team of new Health Navigators.”

The project is part of a national NHS England liver surveillance programme.

Professor Peter Johnson, NHS clinical director for cancer said: “Homeless people who develop cancer face particular challenges in getting help, meaning the early symptoms may not be picked up and their cancer is much harder to treat by the time it is detected.

“This unique pilot by East of England Cancer Alliance is tackling some of the problems by reaching out to this group to offer screening as part of a national NHS England liver surveillance programme.

“The NHS is determined to make sure everybody has a fair chance of the most effective cancer treatment, and it comes after a record year for the number of diagnostic tests and checks.”

Liver surveillance, as recommended by the National Institute for Health and Care, is significantly associated with improved early-stage detections, curative treatment rates, and prolonged survival. But there remains variation in the quality of delivery of these services with patients not routinely being invited for surveillance or supported to attend those appointments.

In partnership with the NHS Hepatitis C Elimination Programme, liver scans are being offered to under-served communities to identify people at risk of liver cancer and ensure they are enrolled in local surveillance programmes.

Wintercomfort, Overstream House, Victoria Ave, Cambridge CB4 1EG. 

Wintercomfort was established by Henry Rothschild and a group of local volunteers in response to the increasing number of homeless people in Cambridge. In 1990, the volunteers began distributing warm clothing, sleeping bags and food from what was known within the community as ‘the blue bus’. In 1991, Wintercomfort became a registered charity and in 1994, moved into Overstream House on Victoria Avenue which has remained our home ever since. Today, the charity is the only day-time service in the city, providing year-round advice and support for homeless or vulnerably housed people.

Clinical Oversight of the programme is led by The Cambridge Access Service (CAS). CAS offers help to single homeless people, asylum seekers; vulnerable people who are housed but at risk of losing their tenancy or whose needs are too complicated for other GP surgeries to manage.

 

The Light Project Peterborough

Boroughbury Medical Centre work closely and in partnership with The Light Project Peterborough which run a 7 day a week drop in facility for homeless people in the city.

Currently they provide one GP outreach session a week and 2 x weekly nursing sessions. Other services such as CGL, AA. Physiotherapy and opticians also visit regularly, and they are developing the concept of a health hub. 

Light project staff are very supportive of the project and hosting the Health Navigators, they have recently trained a small number of volunteer peer advocates with lived experience to support the guests. The Garden house hosts a number of groups including a new group for families of those experiencing homelessness and problem drug and alcohol use. 

The Health Navigators at the Light Project also attend specific groups such as women’s only sessions at Outside links which is a drop-in centre run by prison / probation for homeless clients.

Further to these 2 locations they also have an outreach clinical bus, the bus currently goes out to the soup kitchen where they see a large number of homeless clients particularly with problem alcohol use. Their aim with the bus is to start to visit all the local hostels on a regular basis to promote healthy living, encourage vaccination especially hepatitis B vaccine and screening for cervical cancers, bowel cancers (FIT) smoking cessation and others especially those at increased risk of developing cancer and other chronic disease. 

The female Health Navigator attends the wildflowers women’s clinic at Boroughbury Medical Centre to support the women and development of that service which has transformed access to cervical screening and Hysteroscopies if needed for women who have been victimised. Cervical screening has been a huge success and 98% of the women on their register have been supported to engage with the screening programme.

The Health Navigators are involved in small group focussed health education and promotion sessions at The Garden House, working to help people to understand their health and make better choices.

 

The Ferry Project (FP) is a homelessness charity based in Wisbech Cambridgeshire.

The focus of The Ferry Project is helping and supporting homeless individuals, towards independence. Each year FP supports approximately 300 homeless people. They come from a range of backgrounds and have support needs including unemployment and mental health issues.

FP offers clients Trauma Informed support along with a range of accommodation types each designed to suit the individual needs of the client and they also provide an employment support service, access to art projects, life skills development including access to a cookery school and sign posting to alcohol and drug support.

They link in with North Brink GP surgery, in Wisbech, and have dedicated support from a Nurse. FP also runs a community centre called the Queen Mary Centre which receives approximately 70,000 visits a year. The centre is part of our prevention work.  The services provided in the centre help people avoid homelessness.

 

The Purfleet Trust

The Purfleet Trust was established in 1993 to help to provide essential services to support single people experiencing homelessness in Kings Lynn & West Norfolk. They have evolved to deliver services across local authority boundaries; operating wherever they are needed. 

They currently deliver a range of services that provide comprehensive support to individuals experiencing homelessness with complex needs and facing multiple barriers to engagement. 

Services include:

  • A Health and Well-being hub offering access to a range of support services to both prevent homelessness and respond to rough sleepers who may be presenting for the first time as homeless. The Health and Wellbeing Centre is often the first point of contact for anyone needing help with accessing accommodation, debt advice and support to move on into sustainable housing; preventing homelessness. They provide access to a safe space where showers, clothing, food and robust help is available We work with partners to empower our clients and offer specialist support services including mental health, drug and alcohol support and access to employability training and job search as well as in work support to those who wish to move into employment.
  • They operate 7 pathways houses. These are houses offering temporary accommodation (up to two years) where individuals will have access to intensive support that will offer training, advice and guidance to develop the essential skills and build the confidence needed to sustain a tenancy. They  then support the individual into long term accommodation and provide ongoing wrap around support to ensure sustainment. 
  • Their housing related support team work with rough sleepers and those who are considered to be challenging and face multiple barriers to engagement. This team will support individuals to access services including health (GPs, hospital appointments, court appearances, probation appointments etc…) that will help them into accommodation and services that might save their lives and reduce reoffending. 
  • They run a social supermarket which offers a solution to the cost-of-living crisis and helps the community by offering access to affordable, healthy, good quality and an extensive range of food products to help reduce the financial burden as a result of the current cost of living crisis. They have over 1100 household memberships and support almost 4000 people including children, elderly and disabled who are struggling. 

They also provide a House2Home package that includes furniture and other essential household products that help individuals who are moving into accommodation and need help with furniture.

Infographics

The Cancer Alliance has worked with key stakeholders, including those with lived experience to produce an infographic ‘guide’ to support the creation of posters and booklets. The artist, Sorrel Milne, joined us for a day to discuss and map out how best to portray key messages to service users about the service. (Illustration Animation | Sorrel Milne | England). We plan to have these translated into other languages we have identified for each location.

Our poster infographics are available for: Wintercomfort, Purfleet, Ferry Project, Light Project Peterborough. 

Booklets are also available for each location: Wintercomfort booklet, Purfleet booklet, Ferry Project, Light Project. 

 

Health navigator posters are provided below and available to download, for the various locations of Wintercomfort, Purfleet, Ferry Project and the Light Project Peterborough. 

Video introducing the health navigator project for homeless people in East of England. 

We have received quite a bit of media interest in the Health Navigator project, including a visit to our centres by The Big issue journalists. Big issue included a write-up about the project in their Health and Wellbeing special, issued on 7th April 2025, see content below.