This project was funded by the Manchester Academic Health Science Centre (MAHSC) Applied Health and Care Research Group, a joint initiative between MAHSC and NIHR ARC-GM. 

 

 

What did we do?
This project evaluated the introduction of a new liver fibrosis screening pathway, based in the NHS Addictions Service in Greater Manchester, which is aimed at homeless and hard-to-reach dependent drinkers. 

The project looked at how successful the introduction of this pathway was based on the opinions of service users, their clinical outcomes and satisfaction. We also looked at what made delivering the service easier or more difficult. 

 

Why was it important?
Alcohol-related illnesses are a huge concern for society and cost the NHS a lot of money. Evidence suggests alcohol-related deaths are increasing in Greater Manchester, and some groups of people are far more likely to experience harms related to alcohol. This includes people with physical or mental health problems, and people experiencing homelessness or insecure living.   

One way to reduce harms and deaths due to alcohol-related liver disease is by finding and treating liver disease caused by alcohol dependence as early as possible. 

A simple liver scan can measure how elastic the liver is and find out whether someone’s liver is starting to become stiff and hard because of alcohol. If someone’s liver hardens, it means they are at risk of developing scarring (called cirrhosis) of the liver. Cirrhosis is usually permanent and can lead to liver failure, the need for a liver transplant, and death.  

 

How did we do it?
We studied a new liver fibrosis screening pathway in Greater Manchester Mental Health Foundation Trust (GMMH) which is run by GMMH Addictions Services (in collaboration with the Rough Sleepers Drug and Alcohol Team, Big Life Group and Bolton and Salford Hospitals). 

The aim was to see how this pathway was set up and run so we could find out what made it easier or more difficult to become a routine part of care. Ultimately, we wanted to improve the experience for patients. 

We did this by interviewing patients who used the service, the staff running the service and the people who helped to set up the service.  

 

 

Findings

People experiencing homelessness have a high risk of liver disease, but often struggle to access routine healthcare. This study looked at how people experienced a new liver screening pathway using FibroScan (vibration-controlled transient elastography), delivered through an assertive outreach drug and alcohol service for people experiencing homelessness in Greater Manchester.

 

Service users took part in interviews after having a scan, alongside brief questionnaires about substance use, social support, and readiness to change. Participants described long-standing difficulties accessing GP and hospital care, often linked to stigma, past negative experiences, and unstable housing. Having the scan delivered through an outreach service was seen as easier to access and more supportive, particularly because outreach staff helped with appointments and explained results. For some people, getting immediate feedback on their liver health encouraged reflection and conversations about reducing risk.

 

The findings suggest that offering non-invasive liver screening within outreach drug and alcohol services can support earlier detection and improve engagement with care for people experiencing homelessness.

 

The research team

• Principal Investigator - Dr Stephen Kaar (Greater Manchester Mental Health NHS Foundation Trust - GMMH)
• Professor Karina Lovell (University of Manchester)
• Professor Paul Wilson (University of Manchester)
• Dr Helen Brooks (University of Manchester)
• Dr Nikolaos Mylonas (GMMH)
• Dr Tracey Myton (GMMH)
• Dr Chris Daly (GMMH)
• Eloise Weymouth (GMMH)
• Savannah Campbell (GMMH)
• Laura Hazeldine (GMMH)
• Maria Johnson (GMMH Rough Sleepers Drug and Alcohol Team)
• David Steele (The Big Life Group)

 

 

Who we worked with

• GMMH Addiction Services
• GMMH Rough Sleeper Drug and Alcohol Team
• The Big Life Group
• Northern Care Alliance NHS Foundation Trust
• Bolton NHS Foundation Trust

 

 

Funding:

This research project received an award of £39,746 from the 2024-2025 MAHSC Applied Health and Research Group.

 

 

Useful information

 

 

Contact information

 

 

 

Dr Stephen Kaar
Consultant Addictions Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust
stephen.kaar@gmmh.nhs.uk