NHS Health Check eBulletin - July 2021
Deputy Director, Priorities and Programmes Division, Public Health England
The last 15 months have been extremely difficult, we all have felt the impact of COVID-19 professionally and personally and continue to face challenges in responding to the pandemic as it evolves. As we emerge from this pandemic there is an opportunity to consider the contribution which can be made to mitigating poor COVID-19 outcomes and reducing health inequalities through tackling cardiovascular disease (CVD).
Emerging evidence is clear; CVD and COVID-19 severity are interconnected, and share common underlying risk factors, as we highlighted in Health Matters earlier this year. Our evidence review, in collaboration with the University of Liverpool, shows that people with pre-existing CVD, diabetes, obesity and high blood pressure experience more severe outcomes from COVID-19, including hospitalisation, ventilation and death, as well as being at greater risk of having a heart attack, stroke or developing some forms of dementia.
In addition to sharing common risk factors, CVD and COVID-19 both contribute considerably to a disparity in health equity. Out of the most common causes of death, CVD is the largest contributor to the gap in life expectancy between the most and least deprived, accounting for up to 25% of the difference. Similarly, evidence has shown that severity of outcomes from COVID-19 amplifies existing underlying health issues and deep-rooted health inequalities.
It is important that we acknowledge this and recognise that now, more than ever, there is a need to support people in order to reduce these risk factors and ensure that individuals at greatest risk benefit from our greatest efforts. Prevention programmes which target CVD risk factors, such as the NHS Health Checks programme, are more critical than ever not only for detecting and treating CVD risk, and reducing health inequalities, but also for mitigating against the severity of consequences of COVID-19.
The Government continues to support the national implementation of the NHS Health Check programme. This is why we have been working to deliver an evidence-based review of the programme, which will report in summer 2021. The findings of the review will inform how the NHS Health Checks can evolve in the next decade to maximise the future benefits of the programme in preventing illness and reducing health inequalities.
Head of Cardiovascular Disease (CVD) Prevention Programme, Public Health England
As the impact of COVID-19 continues to be felt, it’s likely that going forward we will see an effect on population health from delayed access to preventive services including the management of cardiovascular diseases and CVD risk. Each year the NHS Health Check programme can identify and support 315,000 people with obesity, 21,000 with high blood glucose and 325,000 with high blood pressure. The significant reduction in provision of the programme over the last 12 months will have had an impact on those outcomes.
Given the growing evidence on the associations between CVD, its risk factors and COVID-19, the NHS Health Check has an important contribution to make. The pause in delivery offers a fantastic opportunity to consider how best to restart the NHS Health Check programme in a way that will maximise impact. I’m delighted that County Durham will be sharing their experiences of making most of the recent pause to evaluate and re-design the NHS Health Check programme in a forthcoming webinar.
In a recent scientific paper evaluating the programme researchers found that NHS Health Check attendees were more likely than non-attendees to be diagnosed with type 2 diabetes, hypertension, and chronic kidney disease, and to receive treatment with statins and antihypertensives. However, most attendees received neither treatment nor referral. PHE data shows that there are high levels of overweight and obesity, abnormal cholesterol levels and physical inactivity among NHS Health Check attendees. Ensuring that individuals with these risk factors are able to access support to reduce that risk is essential if we are to captialise on the benefits of the NHS Health Check.
This requires action across the system. It is fantastic to see NHSE/I invest £2,000,000 into improving uptake of preventative services across Integrated Care Systems, as well as the recent publication of the NHSE/I cardiac network specification which contains a specific objective to focus on preventative and proactive care. In the coming month NHSE/I is also taking action to launch a digital weight management service which will complement the funding going to local government to bolster the provision of tier 2 weight management services. These developments provide a great opportunity for local NHS Health Check commissioners to collaborate with local system partners, and embed the NHS Health Check as a pivotal route for identifying and referring individuals that have much to gain from accessing these services.
Finally, I wanted to highlight the important work being led by our system partners; September 2021 sees the 21st anniversary of Know your Numbers, the UK's biggest blood pressure testing and awareness event. This year's campaign will take place from 6-12 September 2021 and will focus on home monitoring. Blood Pressure UK are asking for your help to spread the word in your community. If you would like to be involved or simply share the message – register your interest now. It is important that we continue to promote the excellent work taking place across the system as it happens. Please do follow my twitter account @thomp_katherine.
Local Case Study
Review and redesign of the NH S Health Check Programme in County Durham.
Luke Robertshaw, Public Health Speciality Registrar, North East, Public Health England and Clare Patel, General Practitioner
The pause in NHS Health Checks due to COVID-19 in 2020 presented a unique opportunity to review our local service and consider improvements for future delivery. As a collaboration between Public Health and Primary Care we collated and analysed information from patient records, insights from front line health professionals, and feedback from patients who had recently attended NHS Health Checks. We found that the programme was performing well in identification and treatment of established CVD. However, we also found that the programme was not so effective in addressing unhealthy behaviours that drive occurrence of CVD (e.g. smoking, unhealthy diet, physical inactivity).
Following our review we ran a stakeholder workshop focussing on the areas identified for improvement, involving Public Health, Primary Care, community wellbeing services and commissioners. During the development and analysis of potential new models, it was clear that we wanted to preserve existing high quality care from primary care whilst improving and standardising the health behaviour component of the NHS Health Check. This led to the design of our new two-stage integrated approach. This includes an initial appointment in primary care followed by a remote appointment with a Wellbeing Advisor to discuss participants’ results, deliver brief behaviour change interventions and offer referrals to relevant community programmes to support healthy behaviours. This service has now been commissioned to start in July and will be evaluated by Teesside University.
If you are interested in hearing more then please join us for the Cardiovascular Disease Prevention webinar: Learnings from County Durham NHS Health Check service evaluation and re-design, taking place on Thursday 8 July from 12:00 to 13:00. Sign up here: www.phe-events.org.uk/cvdcountydurham
Call for Expressions of Interest: Evaluating Digital NHS Health Checks
In 2020, PHE commissioned the health app assessment company, ORCHA, to identify and assess existing digital health products capable of delivering a complete NHS Health Check. This process has been completed and we are now seeking to collaborate with several local authorities on the trial and evaluation of some of these products. We are inviting expressions of interest from local authorities. For more information, please contact firstname.lastname@example.org
Continuing with our exploration of digital solutions, we have recently published a compilation of international practice examples of digital products for cardiovascular disease risk assessment and risk reduction. We will be holding a webinar on the practice examples and their relevance to the NHS Health Check on 14 July from 12.00 to 1.00 pm. To register, please go to: https://www.healthcheck.nhs.uk/commissioners-and-providers/webinars/ .
National Cardiovascular Intelligence Network (NCVIN) CVD prevention packs
We are delighted to let you know that the CVD prevention packs are now available for Clinical Commissioning Groups (CCGs).
In response to stakeholder feedback, CCG level packs have been produced showing the hypertension and Atrial Fibrillation detection and treatment data by Primary Care Network (PCN). For related behavioural risk factors and NHS Health Checks data please see the relevant Sustainability and Transformation Partnerships (STP) level pack.
These new packs use the same style charts as the STP level packs and follow the same format. Each section begins with an overview chart showing the England, STP, CCG and PCN level values. GP practice variation across the CCG is then shown in a vertical bar chart, followed by the GP practice horizontal bar charts with identified gaps to the national ambitions, grouped by PCN. For PCNs with large number of practices, these charts may span multiple slides.
The new CCG packs can be found alongside the existing STP packs on PHE Fingertips here.
Cardiovascular Risk Factors, Cardiovascular Disease and COVID-19:
An Umbrella Review
Public Health England commissioned the Liverpool Centre for Cardiovascular Science, University of Liverpool to conduct an umbrella review to systematically examine the associations between cardiovascular risk factors, cardiovascular disease (CVD) and COVID-19. The evidence shows that people with CVD have 3.9 times higher odds of severe COVID-19 and 2.7 times higher odds of mortality. High blood pressure, obesity, diabetes and current and former smoking were also associated with more severe outcomes from COVID-19.
These findings highlight that prevention programmes which target CVD risk factors, such as the NHS Health Check programme, are more critical than ever in not only detecting and treating CVD risk and reducing health inequalities, but also mitigating against consequences from COVID-19.
The full umbrella review report produced by the University of Liverpool can be found here. A summary paper produced by Public Health England detailing the key findings can be found here.
Learnings from County Durham NHS Health Check service evaluation and re-design, Thursday 08 July,12:00 to 13:00. For more information and to sign up visit: www.phe-events.org.uk/cvdcountydurham
Examples of digital products for CVD risk assessment & management, Wednesday 14 July, 12:00 to 13:00. For more information and to sign up visit: www.phe-events.org.uk/cvddigitalproducts
Cardiovascular Disease Prevention and Blood Pressure - the role public health specialists can play, Faculty of Public Health, Friday 16 July, 9.30am - 12.00pm. For more information and to sign up visit: https://www.fph.org.uk/news-events/events-courses-and-exams/2021/cardiovascular-disease-prevention-and-blood-pressure-the-role-public-health-specialists-can-play/