Foreword by Sir Bruce Keogh, OBE, national medical director, NHS England
The NHS is getting serious about cardiovascular disease (CVD) prevention – and it needs to.
Although premature mortality from CVD has fallen substantially in the last 30 years, it continues to impose a substantial burden on individuals and society. A heart attack, stroke or dementia is always life changing for individuals and their families. CVD accounts for a quarter of all premature deaths and is a major contributor to health inequalities, with death rates being almost three times as high in the most deprived communities than among the better off. And it is very expensive, with NHS costs alone approaching £7 billion per year.
CVD is also highly preventable, through population measures such as tobacco control and salt and sugar reduction, through support for individual behaviour change and through the clinical management of high risk conditions such as high blood pressure, atrial fibrillation (AF) and diabetes.
The Size of the Prize, published last month by Public Health England and NHS England, shows the scale of the opportunity to improve secondary prevention of CVD. For every sustainable transformation partnership (STP) it identifies how many people have undiagnosed high blood pressure and AF, how many have under treated high blood pressure and AF, and how many strokes and heart attacks could be avoided if treatment were optimised in all these individuals.
The numbers are compelling: for every STP it amounts to thousands of people with undetected or under treated conditions and hundreds of life changing events avoided. Aggregating these numbers across England over three years, optimising blood pressure treatment could prevent up to 9,000 heart attacks and 14,000 strokes and save £270 million, and optimising AF treatment could prevent 14,000 strokes and save £240 million. This will be the focus of the NHS RightCare CVD Prevention Pathway that is now being rolled out across every CCG.
The NHS Health Check is a key pillar of our approach to preventing CVD. It is the largest prevention programme of its type in the world, with almost 1.5 million people having the check every year. As well as helping individuals to recognise and tackle their behavioural risk factors, it also provides a systematic approach to identifying people with previously undiagnosed high risk conditions.
The recent evidence synthesis from Cambridge University and RAND Europe gives early encouragement that the programme is having some success, with equal uptake between the highest and lowest deprivation quintiles and significant numbers of people with undiagnosed conditions are being detected.
However, a key learning from the evidence review was that ongoing support for behaviour change and clinical follow up in primary care could be better. And getting this element of the NHS Health Check pathway right will be crucial if the programme is to deliver its prime objective: a reduction in heart attacks, strokes, dementia and other cardiovascular events.
Operational update by Associate Professor Jamie Waterall, national lead for cardiovascular disease prevention and associate deputy chief nurse
PHE’s chief executive Duncan Selbie recently announced a new drive for England to take greater action on preventable cardiovascular death and ill health.
He called for a new approach in terms of identifying and treating people with conditions such as high blood pressure and atrial fibrillation, which we know are responsible for many thousands of preventable heart attacks and strokes across England. We have developed a short video clip of Duncan Selbie’s address to the PHE conference, when this announcement was made.
We now have growing evidence that the NHS Health Check programme is contributing to this call for a system which ‘puts prevention first’, by encouraging people to make positive lifestyle changes and where required, receive evidenced based clinical interventions.
Our latest official statistics show that since April 2013, when local government became responsible for commissioning the programme, over 12 million people have been offered a check. More importantly, over 5.8 million people have taken up the offer to receive a check. This makes the NHS Health Check one of the largest prevention programmes of its type worldwide.
The latest data does demonstrate significant variation in coverage across England. This is something that PHE remains committed to support local areas to address, to ensure that all adults are able to access the important programmes, while also ensuring that we see equitable uptake among the most high risk and vulnerable communities.
At the start of September, we launched the latest version of the Heart Age Test, which has been developed in partnership with NHS Choices, British Heart Foundation, British Cardioascular Society and a number of academic institutions. The new test allows people to discover for themselves the major risk factors which may lead to them having a preventable heart attack for stroke.
By presenting someone’s results in a more meaningful way ‘heart age’ provides a new method of allowing members of the public access information that would have traditionally only been available in a clinical consultation. We have now seen over 1.4 million completions of the test and we intend to publish a follow-up paper to the one published on BMJ Open last year.
Many areas are already using the online test to engage members of the public in their NHS Health Check programme, which could be helpful in increasing uptake, in addition to supporting people to understand their results and take action in reducing their risk following the check. More information on the test and resources can be found on our website.
Our Expert Scientific and Clinical Advisory Panel has recently recommended that dementia risk reduction messaging should be a mandated part of the NHS Health Check. Prior to the panel making recommendations to minister and the Department of Health, we have agreed to undertake a public consultation of this recommendation.
The consultation will close on the 23 October, so please do respond and let us know your thoughts on the proposed changes to the programme.
Webinars
We have a number of informative webinars on the horizon for our CVD prevention webinar series including; NHS Health Check and Diabetes Prevention Programme: alignment in the South East (31 October); the migration to the clinical coding system SNOMED CT (15 November) and; Using the Health Equity Audit in practice (23 November). To be included on the mailing list for this webinar series, please register your interest.
National Institute for Health Research
The team of Professor Martin O’Flaherty (Liverpool University, Department of Public Health and Policy) has been awarded grant funding from NIHR/Health Technology Assessment (HTA) for 24 months to deliver workHORSE: working Health Outcomes Research Simulation Environment.
“The project will deliver an open source, scalable model for use with local or national data, with flexible scenario design features to accommodate and assess changes in Programme delivery and eligibility criteria. It will provide a detailed development and implementation plan with recommendations for deployment, sustainability and open access.
Furthermore, the study will explore and report on the potential for increased effectiveness and cost-effectiveness of the NHS HCP for population health gain.”
The project will start on 1 November 2017.
CVD action plan
To mark World Heart Day, on 26 September, we published our Action plan for cardiovascular disease prevention, 2017 to 2018. The document follows on from last year’s Action on cardiovascular disease: getting serious about prevention. The new action plan provides an overview of some of PHE's key initiatives on cardiovascular disease prevention in 2017 to 2018, as well as highlights of some of our work in the previous year.
PRIMIS
The latest version of the PRIMIS NHS Health Check Recall audit tool and specification has been developed and published. The tool helps GP practices in identifying their eligible population free to all practices in England that are registered with the PRIMIS Hub online membership service. Visit the PRIMIS website for more details on registration.
Data extract
At present, data on the NHS Health Check programme is only routinely collected for offers and uptake of the programme. PHE is working with colleagues in NHS Digital to conduct a national data extraction through the General Practice Extraction Service (GPES).
The extract is proposed for 2018 and will aim to provide PHE with the information it needs to monitor the programme, and help local commissioners and service providers address variation by locality and across different patient groups.
In August, the Standardisation Committee for Care Information recommended that the proposed data extraction is fit to proceed. We are now working to develop the final stages of this process in preparation for the data extraction itself.
For further information contact nhshealthchecks.mailbox
Conference 2018
The ‘Getting Serious About Cardiovascular Disease Prevention 2018: Reducing Variation and Optimising Care conference’ will be hosted in London on Thursday 8 February 2018, and is already shaping up to be a fantastic event, one not to be missed. The opening plenary will include addresses from PHE chief executive Duncan Selbie, and Professor Kevin Fenton, director of health and wellbeing, London Borough of Southwark.
The conference will feature our first ever balloon debate, with the following speakers set to participate: Jan Proctor-King, practice nurse in Bradford and Et Al Training tutor, Professor Matthew Cripps, national director of NHS RightCare, NHS England, Dr Jeanelle de Gruchy, director of public health for Haringey, Professor John Deanfield, British Heart Foundation, Professor of cardiology at University College Hospital, London, Councillor Jonathan McShane, cabinet member for health, social care and devolution, London Borough of Hackney, and Dr Danny Ruta, director of public health, London Borough of Lewisham.
If you would like to be included onto the mailing list to receive a reminder of the event, please send an email to events@phe.gov.uk with the subject "preventCVD18 mailing list”.
Physical Activity Nurse Champion
Current statistics state that 33% of men and 45% of women are not active enough for good health (1). In addition, physical inactivity is one of the top five non-communicable disease risk factors for mortality (2). Despite these statistics, how many healthcare professionals are confident to deliver brief interventions on this topic?
A recent article published in the British Journal of General Practice in August 2017 reviewed responses from 1013 GPs and concluded that 80% were unfamiliar with national physical activity (PA) guidelines (3). The study also identified a need to improve knowledge, skills and confidence to maximise the potential for physical activity consultations.
Physical activity is an important element of the NHS Health Check and also links with other PHE work streams aiming to improve the quality of the NHS Health Check and the skills and competency of those that deliver them.
Physical activity nurse champions are available to deliver free workshops and educational sessions for nurses until March 2018.
Karen Davies, nurse and physical activity champion
“It is a privilege to be one of the 15 nurse champions across England. The peer-to-peer education model has developed from the success of the GP PA clinical champions, who continue with their ongoing valuable work.
“Since May this year I have delivered several of these presentations/workshops and it is fantastic to promote and enthuse a variety of nurse audiences regarding this underestimated, and Cinderella risk factor.
“In West Sussex, the session was delivered as part of an NHS Health Check update for providers and was received enthusiastically by attendees. Key messages taken away were the dangers of sedentary behaviour and how to use the PHE infographic to support delivery of physical activity brief interventions.”
For more information on this program of work or to arrange a booking please contact physicalactivity@phe.gov.uk
References
1 Health Survey for England 2012(HSE) Active people Survey April 2014. National Travel Survey 2014
2 WHO 2009 Global health risks
3 R. Chatterjee, T. Chapman, M.Brannan and J. Varney 2017 GP’s knowledge, use and confidence in national physical activity and health guidelines. British Journal of General Practice
New e-Learning for Health programme
PHE has been working with Health Education England to produce a new e-Learning for Health programme on community-centred approaches to health improvement.
These two new e-learning modules are suitable for practitioners, managers and commissioners who want:
- an update on evidence and guidance on community-centred approaches to health improvement
- to take a more strategic and planned approach to scaling-up community-centred approaches
Communities matter for health. A community where people are well connected, are inclusive and respectful of all and are involved in local decision-making, are healthy communities. Improving population health and reducing health inequalities requires us to address these community factors and work with and alongside community members to improve the things that matter for their health.
The modules are based on our guide to community-centred approaches for health and wellbeing and support PHE’s growing programme of work on community-centred and asset-based approaches.
Module 1 covers the evidence and theory on why and how communities matter for health and what approaches work. Module 2 involves practical exercises to apply the knowledge to practice and to help develop strategic and practical plans for taking community-centred approaches forward within local places and organisations.
Promising practices for healthy workplaces
PHE is inviting workplace wellbeing providers and employer organisations to submit their health and wellbeing practices as part of a new project reviewing what interventions are available in England’s workplaces.
The most promising and innovative practices will be featured as case studies and infographics in the public report. These will be available to organisations for wider promotional activities. Participating organisations will also be invited to a networking event in 2018 hosted by PHE and RAND Europe to recognise promising practices and launch the report. Each submission will also receive tailored, confidential feedback from the research team and all submitted practices will be listed in the final report.
The final report will be used by UK employers as a guide to identify the best health and wellbeing practices. The aim is to help employers improve the health and wellbeing of staff. Poor health and wellbeing is estimated to cost the UK economy around £58 billion each year through productivity losses in the workplace.
Taking part in this market-leading study is simple. All we need is several minutes of your time to submit details of your practice.
For any questions about participation in this project you can reach the research team at RAND Europe, a not-for-profit research organisation, on healthatwork@rand.org. The survey closes on 29 October 2017.