A decade of transforming liver disease detection
More than 10,000 patients assessed, a nationally recognised care pathway, and now an NIHR Impact Prize. Ten years after joining the inaugural NHS Innovation Accelerator (NIA) cohort, Prof Neil Guha’s Scarred Liver Project stands as a powerful example of how innovation can achieve lasting impact when supported to spread across the NHS.
When Prof Neil Guha joined the first cohort of the NHS Innovation Accelerator (NIA) in 2015, he was tackling a significant challenge in healthcare. Chronic liver disease is one of the leading causes of premature mortality in the UK, yet it often remains undetected until the disease has reached an advanced stage.
“The liver is the only solid organ that can regenerate, so early diagnosis is key. The problem was that liver disease rarely causes symptoms until very late, often when opportunities for prevention and intervention have already been missed.”
“The liver is the only solid organ that can regenerate, so early diagnosis is key. The problem was that liver disease rarely causes symptoms until very late, often when opportunities for prevention and intervention have already been missed.”
At the time, diagnosis relied heavily on blood tests with limited accuracy or invasive procedures such as liver biopsy. Access to specialist expertise and diagnostic tools was largely confined to hospitals, creating a disconnect between primary and secondary care.
A patient-led challenge
The origins of the Scarred Liver Project can be traced back to a patient engagement event in 2011. During discussions about emerging non-invasive tests for liver scarring, patients asked a simple but powerful question: “Why aren’t these tests available through our GP?”
For many living with liver disease, delayed diagnosis had already resulted in significant health consequences. Their challenge prompted Neil and his team to rethink how liver disease could be detected much earlier.
With initial seed funding from the Department of Health, the team developed pilot pathways in Nottingham targeting patients at increased risk of liver disease, particularly those with alcohol-related risk factors and type 2 diabetes. Using GP records to proactively identify patients, they introduced community-based FibroScan assessments delivered by trained nurses.
The results were striking. The pilots doubled the detection of both significant and severe liver disease while providing patients with immediate results and lifestyle support. Yet despite the evidence, commissioning remained elusive.
Overcoming the barriers to adoption
Like many health innovations, the pathway faced challenges moving from successful pilot to routine NHS care.
Commissioners wanted further evidence of cost-effectiveness. Financial incentives across the system were not always aligned, with savings generated through prevention and reduced hospital interventions difficult to capture in short-term budgets. Meanwhile, traditional research funding routes were often too slow for a team determined to respond quickly to patient need.
It was at this pivotal stage that Neil joined the NIA.
Although still a new programme in 2015, it offered something distinct from traditional academic pathways.
“The NIA gave me three things. Firstly, it allowed me to interact with some brilliant people who truly inspired me. Secondly, it gave me confidence that I wasn’t alone. Innovation in the NHS was often happening in silos. Finally, the NIA badge grew in credibility and visibility, helping me justify the time and effort dedicated to implementation and adoption.”
“The NIA gave me three things. Firstly, it allowed me to interact with some brilliant people who truly inspired me. Secondly, it gave me confidence that I wasn’t alone. Innovation in the NHS was often happening in silos. Finally, the NIA badge grew in credibility and visibility, helping me justify the time and effort dedicated to implementation and adoption.”
Neil credits the NIA with helping him think differently about scaling innovation.
“The programme made me think about strategic opportunism, timing and influence rather than following the traditional academic pathway and assuming implementation would happen naturally after generating evidence.”
The Fellowship also helped shift the team’s focus from simply generating more evidence to generating the right evidence needed by commissioners, providers and adopters.
From innovation to commissioned service
The breakthrough for the Scarred Liver Project came in 2016, when the pathway became the first commissioned service in the UK enabling GPs to directly access non-invasive FibroScan testing through an integrated primary and secondary care pathway.
Initially serving a population of 700,000 people, the commissioning represented a defining milestone.
Success was built upon strong clinical evidence, patient acceptability, health economic evaluation, and strong relationships. Locally, the East Midlands Academic Health Science Network (now Health Innovation Manchester) provided support and guidance.
“We had to work closely with primary care, commissioners and local partners to co-design the pathway, deliver education and continuously evaluate the service. Understanding adoption and implementation was just as important as generating evidence.”
Evolving to meet population need
Following the COVID-19 pandemic, the team recognised that some of the most vulnerable communities were underrepresented in referrals. In response, they adopted a population health approach across Nottinghamshire, identifying communities at greatest risk and proactively inviting patients for assessment through their GP practices.
This shift allowed the programme to address health inequalities more directly while ensuring earlier intervention for people who may otherwise have presented with advanced disease.
The pathway has since influenced liver disease services far beyond Nottingham, supporting wider adoption across the NHS and contributing to national discussions around the future detection and management of metabolic associated liver disease (MASLD).
More than 10,000 patients assessed
Since commissioning, more than 10,000 patients have been assessed through the pathway.
For Neil, the impact extends beyond any single statistic.
“We’ve produced over 25 scientific papers demonstrating improvements in diagnostic effectiveness, cost-effectiveness, behaviour change and service delivery. But it’s the combination of patient stories and quantitative data that tells the full story.”
What makes him most proud, however, is the programme’s longevity.
“Part of that is our desire to listen, iterate and evolve the service. We’ve continually adapted the pathway based on evidence and patient need.”
Recognition through the NIHR impact prize
This year, that decade of impact was recognised nationally when the Scarred Liver Project team received a prestigious NIHR Impact Prize.
“It was a great honour to receive this award on behalf of the team. We have an incredibly diverse group of people involved, including hepatologists, primary care clinicians, nurses, public health specialists, commissioners, health psychologists, laboratory scientists and data scientists. Without this team, we would not have delivered such durable impact.”
The award reflects not only the innovation itself, but the sustained commitment to improving care through collaboration, evidence and implementation.
Looking ahead
Reflecting on his journey, Neil describes the NIA fellowship as a catalyst that accelerated both the innovation and his development as an innovator.
“The national exposure and credibility were invaluable. The learning around implementation and adoption cannot be understated. Innovation can be a lonely journey at times, and having fellow companions on that journey matters enormously.”
His advice for current NIA Fellows is simple:
- Experiment with courage.
- Be strategically opportunistic about where you invest your time and energy.
- Recognise that even the best ideas need the right timing to succeed.
As for what’s next? The work continues. The team is focused on integrating liver disease detection within wider approaches to multimorbidity, tackling health inequalities and ensuring that emerging treatments are aligned with early diagnosis pathways.
From a patient challenge in a workshop to national recognition through an NIHR Impact Prize, the story of the Scarred Liver Project is a powerful reminder that innovation is not simply about new ideas. It is about turning evidence into adoption, adoption into impact, and impact into lasting change.
