Dr Nick Stern is the IQILS lead at Aintree University Hospital in Liverpool, where he has been a hepatology consultant for 15 years. Having completed the majority of his training in Merseyside and Cheshire, he has formed a deep connection with the area over a career spanning 25 years.

As Liverpool is home to many of the UK’s most deprived areas, inevitably the city also has some of the highest rates of alcohol related liver disease in the country. Consequently, this is a heavy focus for the Aintree team, who also provide regional services for liver and biliary cancers.

Aintree liver service gained accreditation in 2024 and Dr Stern is now in training to become an IQILS assessor himself. In this piece he shares his experience of the process and advice for other services.

I first learned about IQILS at a launch event for the programme in 2017 and determined to lead my service through the accreditation process. However, this goal was hindered by changes to my operational team and then more significantly by a merger between the acute hospital trusts in Liverpool.

After stepping back from various management roles in 2021, I finally had the capacity to deliver accreditation for my service.

During the accreditation process, the greatest challenge we faced was collating and presenting the necessary evidence.

I was quietly confident that my service was operating at a good level, however, there were not necessarily methods in place to evidence that we were meeting the IQILS standards. Documenting processes was an important part of the process, which also enabled the team to reflect on our strengths and weaknesses. I found the accreditation process realistic in its requirements, but allocating dedicated time and focus was important for my service’s success.

Despite inevitable nerves, the day of our site assessment was positive for the team. Not wanting to be caught out by the assessors, I felt it was important to be aware of any challenges faced by our service and to have strategies in place to deal with them. However, in practice I found the assessors’ approach to be professional and friendly and I was comfortable that evidence and discussions were critiqued with impartiality and constructive feedback was given.

Following our assessment, IQILS and the accreditation process has provided assurance to my team and is supporting a platform for future improvement.

Receiving an accredited outcome created a sense of validation within the team, especially given the relatively small number of liver units currently accredited in the UK. 

While I had a lot of confidence in my service going into the assessment, I found it very valuable to receive impartial feedback from external assessors.

In particular, we appreciated the contribution of the lay assessor, who assesses patient experience. After conducting interviews, the lay assessor provided detailed feedback from patients that we would not normally receive and the number of positive comments boosted team morale.

 I believe the best way to approach the accreditation process is to focus initially on the areas within your control and build from there. Every service will have its own specific obstacles but making sure your processes are up to scratch and that you can evidence their effectiveness is a great place to start. A good example of this is providing documented pathways and clear standard operating procedures where necessary.

Looking to the future, we hope to expand the hepatology service at Aintree. There are plans to recruit an additional consultant and a desire to recruit more specialist nurses too. The IQILS assessment report has been helpful to me when requesting resources for recruitment from my trust. An external report containing recommendations from the wider hepatology community, which echo the suggestions from my team, has added validity to requests for development.

However, we must balance this desire to expand with the everyday challenges facing most NHS services. Our service is particularly affected by the current lack of social care support available, meaning vulnerable patients cannot be discharged in a timely manner. This in turn increases the strain on our service and team.

We are grateful to Dr Nick Stern for his contribution and we’re happy to have the excellent Aintree hepatology service as part of the IQILS community.