About our services

Our specialist team assesses patients with abnormal liver function tests and cares for patients with acute and chronic liver disorders. We work closely with drug and alcohol services to help patients withdraw from alcohol safely and efficiently. We also work closely with the Transplant unit at the Freeman Hospital in Newcastle upon Tyne.

We are dedicated to providing first-class hepatology care and continually improving the service we provide to our patients. As part of this we're committed to an ongoing programme of service and quality improvement for accreditation with the national Improving Quality in Liver Services (IQILS) programme.

We provide a range of services, including:

  • 24/7 gastrointestinal bleed service
  • endoscopic diagnosis and treatment of oesophageal and gastric varices
  • endoscopic retrograde cholangiopancreatography (ERCP) - gallstone removal from the bile duct
  • laparoscopic cholecystectomy/open cholecystectomy - gallbladder removal
  • biliary and pancreatic endoscopic ultrasound (EUS)
  • fibroscan - a non-invasive method of assessing liver fibrosis
  • liver biopsy
  • venesection for haemachromatosis

Inpatients

We have a dedicated 32-bed Gastroenterology and Liver unit on ward 5 at University Hospital of North Durham and a 26-bedded unit on ward 51 at Darlington Memorial Hospital where we look after patients with liver, bile duct and pancreatic diseases. We usually admit patients through the Acute Medical Unit.

Day case paracentesis (drainage of abdominal fluid)

If you have an accumulation of fluid in your abdomen, it may need to be drained using a procedure called paracentesis (or abdominal tap).We do paracentesis as day surgery, so, unless you're already staying in hospital, you won't need to stay overnight. During a paracentesis a small drainage tube is placed through the skin into the fluid. You'll be given a local anaesthetic before the drain is put in. The nurse will then use ultrasound to guide the tube into place. The drain stays in place for around six hours. We offer day case paracentesis on our medical day unit at Durham and Darlington.

Alcohol liaison services

Our alcohol liaison service helps alcohol-dependent patients with a variety of health conditions. Our support includes:

  • Assessing patients for alcohol misuse and harmful or hazardous drinking behaviours
  • Working closely with patients who are frequently admitted with alcohol-related harm
  • Helping patients manage their withdrawal from alcohol
  • Advice and support on alcohol detoxification
  • Access to local alcohol support services

Fibroscan clinics

We provide Fibroscan clinics from Durham and Bishop Auckland Hospital. A fibroscan is a type of ultrasound that can measure the degree of scarring in your liver, which allows us to plan your treatment. It is a simple, painless test that uses high frequency sound waves. A fibroscan gives immediate results. It does not have any potential complications or risks and is non-invasive, which means that it does not break the skin or enter your body.

Endoscopy clinics

We run a number of endoscopy clinics to assess and treat conditions such as gastrointestinal bleeding, jaundice due to malignancy or gallstone disease or bile duct and pancreatic disease.

Clinical research

We take part in a number of local, national and international liver-related disorder studies in conjunction with the Research, Development and Innovation department. We specifically focus on fatty liver disease and cirrhosis of liver. We're also taking part in an ongoing national study (CALIBRE Study) about the prevention of bleeding from enlarged veins in the oesophagus (varices). It is funded by the National Institute for Health Research.

We treat the following liver diseases:

  • Fatty liver disease
  • Abnormal liver tests
  • Alcoholic liver disease
  • Primary billiary cholangitis (PBC)
  • Autoimmune hepatitis
  • Primary sclerosing cholangitis
  • Autoimmune cholangitis
  • Cirrhosis
  • Portal hypertension
  • Genetic liver diseases such as haemochromatosis

We do not treat viral liver disease (Hepatitis B and C). We refer patients with hepatitis B and C to the Freeman hospital in Newcastle.

We provide patients with the following diagnostic and treatment services:

  • 24/7 gastrointestinal bleed service
  • endoscopic diagnosis and treatment of oesophageal and gastric varices
  • endoscopic retrograde cholangiopancreatography (ERCP) - gallstone removal from the bile duct
  • laparoscopic cholecystectomy/open cholecystectomy - gallbladder removal
  • biliary and pancreatic endoscopic ultrasound (EUS)
  • Ultrasound scan
  • CT sacn
  • MRI scan
  • fibroscan - a non-invasive method of assessing liver fibrosis
  • liver biopsy
  • venesection for haemachromatosis

We have an agreed 3 year departmental plan adopted by the care group. The plan sets out our vision to improve care for patients with liver disease in CDDFT. We will aim to focus on quality and individual experience to deliver the improvements we all want to see.

Liver services will promote early diagnosis and treatment, deliver expert and high standards of care, facilitate self-management and ongoing care, support the availability of quality information and help to target research into the disease.

Improving Quality in Liver Services (IQILS) is an accreditation scheme for UK hospitals that care for people with liver conditions to demonstrate that they provide high-quality liver services for patients. This includes inpatient and outpatient services.

We will be undertaking the Improving Quality in Liver Services (IQILS) programme to improve liver services through a standards framework and assessment process. As part of the IQUILS, we plan to improve the quality of liver services for our patients by:

  • Promoting early diagnosis and treatment thus reducing hospital admissions and readmissions, LoS besides improving liver morbidity and mortality.
  • Reviewing performance metrics via regular planned audits
  • Regular review of service and resources
  • Reviewing patient information and feedback
  • Reviewing and improving research participation/output
  • Active engagement with care group and hospital management to improve delivery of the service

The delivery plan is split into three themes:

  • Well organised outpatient/day case care
  • Quality inpatient care.
  • Palliative care

For each theme this Delivery Plan sets out: Key service issues and Specific priorities.

We are currently working towards Improving Quality in Liver Services (IQILS) accreditation.

What is accreditation?

Accreditation is a supportive process of evaluating the quality of clinical services against established standards.
Accreditation promotes quality improvement through highlighting areas of best practice and areas for change, encouraging the continued development of the clinical service. Accreditation is a voluntary process for services to engage in.
Having developed standards with a multi-professional group of clinicians, managers and patient representatives, services participating in IQILS accreditation work to an accreditation pathway which involves self-assessment and quality improvement against the standards. Accredited services submit evidence annually to demonstrate that they are continuing to meet the standards and have a 5-yearly on-site assessment carried out by our experienced assessment team.

The accreditation standards have been put together in collaboration with the liver community and are aligned to the CQC's key lines of enquiry (KLOE). The framework used is based on the British Standard Institution's (BSI) specification for accreditation of clinical services.

Standards

The standards cover all aspects of a high-quality liver service and are organised into six domains:

  • leadership and operational delivery
  • person-centred care
  • risk and patient safety
  • clinical effectiveness
  • workforce
  • systems to support service delivery.

To support services to go through the accreditation journey, the standards are split into two levels. Level 1 are the initial standards to improve service quality and the level 2 standards further enhance this. Accreditation assessments are based on services meeting all of the level one and two standards and meeting set evidence requirements.

Full accreditation IQILS standards - level one and two

Domain 1: Leadership and operational delivery

1.1 The service has an operating plan which is reviewed annually

1.2 There is a comprehensive service description available on the organisation's website

1.3 The service has a leadership team that is visible, approachable and communicates regularly

with all staff members

1.4 The service works collaboratively across health and social care boundaries

Domain 2: Person centred care

2.1 The service embeds principles of shared decision-making with patients

2.2 Patients/carers are encouraged to feedback on their experience

2.3 The service strives to improve as a result of feedback, complaints and concerns

2.4 The service supports person-centred care

2.5 The service has a documented procedure for patient scheduling

2.6 The service reviews and acts on did not attend (DNA) rates

2.7 The service has a procedure for managing patients being transferred in/out from other

services

Domain 3: Risk and patient safety

3.1 The service sets and monitors safety improvement targets

3.2 The service has a procedure and reporting system for recording and investigating incidents,

adverse events or near misses

3.3 The service uses incidents, adverse events and near misses to improve care

3.4 The service has a risk management policy and communicates this to staff members

Domain 4: Clinical effectiveness

4.1 The service monitors clinical performance

4.2 The service has a quality improvement plan based on the clinical metrics

4.3 The service has a research register

4.4 The service participates in local and national audit programmes

Domain 5: Workforce

5.1 A workforce skillmix review is undertaken a minimum of once a year, or whenever there is a

significant change in the service

5.2 The service has an appraisal process for staff members

5.3 The service has training plans and development opportunities in place for staff

5.4 There is a service-specific orientation and induction programme

Domain 6: Systems to support clinical service delivery

6.1 The service assesses its facilities and equipment

6.2 There is a process for document management and control

You can access more information about liver conditions on the British Liver Trust site here.

Liver disease tests, diagnosis and screening

You can access further information about specific liver conditions by clicking the links below:

Other useful websites

You might find the following websites useful for information and advice. Please note that CDDFT is not responsible for the content or updating of these sites.

Alcohol Change UK A charity promoting alcohol change, working towards improved knowledge, better policies and regulation, shifted cultural norms, improved drinking behaviours, and more and better support and treatment.

British Liver Trust The UK's leading liver health charity.

Haemochromatosis UK Helping people live with iron overload.

UK-AIH UK-AIH is a research collaboration with a shared interest in understanding and treating the autoimmune liver disease autoimmune hepatitis.

The Hepatitis B Positive Trust Aiming to end the silence around hepatitis B infections and draw together people with hepatitis B to give them a collective voice and the ability to support each other.

The Hepatitis C Trust Raising public awareness of the virus, ending discrimination about people with hepatitis C, and creating an active community of patients.

PBC Foundation A charity offering support to PBC sufferers, their family and friends.

PSC Support Helping anyone affected by PSC and driving research towards a cure.

Wilson's Disease Support Group UK Support, education and outreach for people living with Wilson's disease, their family and friend

How to access our services

Hepatology is part of the gastroenterology department. We provide inpatient care on our specialist Gastroenterology and Liver Unit in ward 5 at University Hospital of North Durham and ward 51 at Darlington Memorial Hospital. We also provide outpatient specialist liver services from some of our other sites. 

You can call us: 0191 3332847 or contact the Liver Services admin team: