Foreword by Professor Kevin Fenton, National Director, Health and Wellbeing
Increasing uptake of the NHS Health Check is an important challenge for the coming year. Recent research says that higher levels of coverage are achievable and would lead to substantial gains for public health. In short, thousands more people could live healthily, for longer, because early-stage disease is detected during a check.
A recent, independent, study in three of the country’s most ethnically diverse and socially deprived areas, compared NHS Health Check attendees with a matched group of non-attendees from 2009 to 2014. Among attendees, 30 per cent more new cases of diabetes, 50 per cent more new cases of hypertension and 80 per cent more new cases of chronic kidney disease were diagnosed than among non-attendees.
NHS Health Checks also led to 40 per cent more statins being prescribed, the study found. Replicated nationally, this additional statin use would prevent an estimated 4,600 to 8,400 heart attacks, strokes or death from these causes in five years. Treatment of hypertension, diabetes, and kidney disease, as a result of attending an NHS Health Check, would further reduce cardiovascular events.
The researchers, led by Dr John Robson of Queen Mary University of London, say the benefits are of “public health importance”. This is evidently the case. In the NHS Health Check, we have a world-leading programme to identify and prevent the major risk factors for premature death and ill health. To say it’s the ‘best thing we’ve done in decades to prevent non-communicable disease’ is no exaggeration. However, we can do more to increase the number of people receiving a check and ensure they gain access to the appropriate clinical or lifestyle support.
The Queen Mary study looked at three clinical commissioning groups (CCGs)—City & Hackney, Tower Hamlets and Newham - that serve disadvantaged populations with high CVD risk. In these areas, coverage of the NHS Health Check increased year on year to 85% compared with around 50% nationally. Attendance was higher for South Asian patients, older patients and those in more deprived sections of the population.
All three CCGs had good infrastructure, including web-enabled IT support with near real-time performance dashboards. In Tower Hamlets, managed practice networks, including financial incentives, may also have been factors in high performance. More new diagnoses were made in City & Hackney and Tower Hamlets where higher-risk individuals were targeted for first invitation. Rates of diagnoses were lower in Newham, which had a non-selective approach.
Whilst being the bearer of good news, the study also shows that there are still ways to improve the programme. Currently rates of coverage vary considerably across the country. In the year ahead we need a system-wide response, with local authorities, the NHS and PHE working together to improve delivery so that we achieve similar outcomes to East London.