NHS Health Check Ebulletin - January 2020
Director of Patient, Public and Professional Involvement, British Heart Foundation
Heart and circulatory diseases remain a leading cause of premature death, and worryingly we have seen improvements in life expectancy stall in this area since 2011. While heart attack and stroke survival is improving; more people are living into old age, with multiple chronic conditions that require person-centred models of treatment and care, empowering shared decision making and self-management. The number of people living with dementia, for instance, is expected to almost double every 20 years. Rising prevalence of obesity and Type 2 diabetes are also putting our progress at risk, and health inequalities persist.
To tackle some of these challenges, the British Heart Foundation (BHF) is working with partners, including Public Health England and NHS England, on a shared ambition to tackle the high risk conditions that are major causes of heart and circulatory diseases.This will support the national CVD ambitions and the commitment set out in the NHS Long Term Plan to prevent 150,000 heart attacks and strokes through early detection of atrial fibrillation, high blood pressure and high cholesterol over the next ten years. All three conditions are largely asymptomatic, meaning people often don’t know they’re at risk until they present in the Emergency Department. We need to find new and innovative ways of detecting those at greatest risk of these conditions and least likely to engage in current healthcare solutions.
We know from international exemplars such as Canada, where the detection and management of blood pressure has seen significant improvements, that the key to success is an integrated approach. To make a real difference, we need to combine system leadership and optimal case-finding and management pathways, with strong community mobilisation. With this in mind, the BHF is developing a programme of work, using behavioural insights to help change perceptions and behaviours in the community.
We will do this by helping people in their communities to understand their risk and feel motivated to take action to reduce it. This will include reaching out to underserved communities to address health inequalities. Initially the focus will be on the single biggest risk factor: high blood pressure.
We’re not starting from a zero base, over the past three years, the BHF has launched two community-based blood pressure testing programmes, funding and supporting 15 projects across the UK. These 2-year projects combine awareness-raising and testing interventions in non-clinical settings, such as workplaces, football clubs, community centres and libraries, as well as testing the impact of self-service options such as testing kiosks.
Together, we can prevent more people developing heart and circulatory diseases, and make sure those with existing conditions and risk factors are detected and treated early. We can ensure that everyone, regardless of factors like gender, age, ethnicity or where they live, has access to the treatment, care and support that they need.
Head of Cardiovascular disease prevention, Public Health England.
Firstly, a very happy new year to you.
With an intervening general election and the holiday period it’s been some time since we published our last ebulletin. However, I wanted to take this opportunity to let you know that there have been some changes to PHE’s national cardiovascular disease prevention programme team. In October 2019 Jamie Waterall became deputy to PHE’s chief nurse. It’s been fantastic working with Jamie over the last five years. He has achieved a huge amount on the NHS Health Check programme and CVD. I know his passion and commitment to reducing morbidity and mortality from CVD will remain but I wanted to take this opportunity to relay my heartfelt thanks for all he has done to help us get to where we are. You can find more information on who’s who in the National team in the text below.
I’m pleased to say that since our last update we’ve published the NHS Health Check best practice guidance. Updated versions of the competence framework and workbooks will also be published in the coming months. Excitingly we have now also published, in partnership with NHS Digital, the first version of our NHS Health Check dashboard. The dashboard contains metrics which use data from a primary care extraction of data from over 90% of GP practices in England. For the first time, we are able to share data on NHS Health Check attendees and non-attendees by age, gender and ethnicity at a local authority and CCG level. This is fantastic news as it provides us with an extremely rich source of intelligence which will support local monitoring and national evaluation of the programme.
Following on from the announcement in the prevention green paper Advancing our Health Prevention in the 2020s the Department of Health and Social Care (DHSC) has received a huge number of consultation responses on how the effectiveness of the NHS Health Check could be improved. It’s been fantastic to see such a high level of engagement and PHE is working closely with DHSC on the scope and terms of reference for the NHS Health Check review. We will be using future editions of the ebulletin as well as our latest news section on our website to keep you posted so please do watch this space.
On the 6 February I will look forward to seeing over 500 delegates join our CVD prevention conference 2020: proactive, predictive, personalised at the KIA Oval. We have a fantastic line up of local, national and international speakers including Dr Steve Powis, National Medical Director, NHS England and Improvement and Dr Tom Frieden Chief Executive Officer of Resolve to Save Lives in New York. We will again have a vibrant exhibitor area with a range of stands including the British Heart Foundation and BHR pharmacuticals Ltd, a provider of Point of Care diagnostics and neurostimulation treatments, will be our gold sponsor. We will also have over 50 poster presentations. If you are unable to be with us on the day you can still join the conversation at #preventcvd2020 and we will publish videos and conference content on our website.
Head of the CVD Prevention Programme, Public Health England
CVD Prevention webinar series
The next CVD prevention webinar will take place from 11am – 12pm on Thursday 27th February 2020. This will focus on the value of Health Equity Audits (HEAs) in supporting NHS Health Check implementation to support local system priorities and population needs.
HEAs provide robust data that can help inform local decision making about how the NHS Health Check is implemented locally to:
- Maximise impact on health outcomes and health inequalities through application of proportionate universalism principles
- Make the most of the flexibilities with the universal programme
Whilst limited resources may make conducting HEAs seem challenging, it is at just such times when they are most valuable, as a means of informing sometimes difficult decisions about resource allocation.
This webinar will provide an introduction to what the benefits can be found by conducting HEAs on your NHS Health Check programme and encourage pragmatism in scoping approaches to suit local need, resources and priorities. We will hear from four local authorities who will share their learning from undertaking HEAs on their NHS Health Check programmes. Lancashire Council will share details of how they have designed and implemented the first HEA that we are aware of to assess equity of outcomes as well as access to NHS Health Checks, the limitations and lessons learnt. We will then hear from Oxfordshire, Hampshire and Kent County Councils about their approaches, the benefits, challenges and learning from undertaking HEAs.
If you would like to join this session but have not already received an invitation, please contact email@example.com to register or to receive CVD prevention webinar series invites, sign up here.
Best Practice Guidance
The 2019 Best Practice Guidance has now been published and is available on the NHS Health Check website. Key changes from the 2017 guidance include: new advice on using QRISK® 3 as part of the NHS Health Check risk assessment and new advice on the clinical management of people with an AUDIT risk score of 16 or more.
Atrial Fibrillation High Impact Intervention Tool
Too many people are still living with undetected, high-risk conditions such as high blood pressure, raised cholesterol, and atrial fibrillation (AF). RightCare and Imperial Health College Partners have collaborated to develop an Atrial Fibrillation High Impact Intervention Tool. The tool supports commissioners to measure the value of identifying and treating patients with AF, including the impact of screening and treatment-based interventions.
Health systems, supported by their Delivery Partner, can use this tool as a framework to detect and optimally manage AF in their population, to reduce the risk of strokes.
You can hear more about the tool and how to use it at the CVD Prevention Conference on Thursday 6 February 2020.
Delivering Dementia Risk Reduction in the NHS Health Check: What’s good for your heart is good for your brain
The importance of dementia risk reduction was highlighted earlier this year with the publication of WHO Guidelines on Risk reduction of cognitive decline and dementia, which provide evidence-based recommendations on ways to delay or prevent cognitive decline and dementia.
Dementia risk reduction has been part of the NHS Health Check since 2018, enabling healthcare professionals to provide people over 40 with advice about reducing their dementia risk based on the latest evidence.
A range of training material and other resources are available to support healthcare practitioners to include dementia risk reduction messages in the NHS Health Check. This includes a range of videos, an updated slide deck on “Helping your brain to stay healthy”, which can be adapted for local training purposes, as well as Dementia e-Learning tool which is aimed at those providing the NHS Health Check and includes a self-assessment section and a certificate of completion.
In addition, the dementia leaflet, which has been developed to support the dementia information given to those 65-74 who attend an NHS Health Check appointment is available to order free of charge in a variety of formats and languages.
Together, the resources cover all three components of dementia in the NHS Health Check:
- General awareness of the signs and symptoms of dementia
- Risk reduction, raising awareness that ‘what is good for your heart is good for your brain’.
- Signposting to places to find out more information about dementia
For further information about dementia resources, contact firstname.lastname@example.org
Launch of the Health Inequalities Menu of Interventions and Approaches
The NHS Long Term Plan (LTP) sets out specific ambitions for the NHS to take a ‘more concerted and systematic approach to reducing health inequalities’. In support of this ambition, NHS England, collaborating with Public Health England (PHE) and partners in the voluntary and community sector and local government, has worked to develop a ‘menu of evidence-based interventions for addressing health inequalities – (Menu).
Phase one of the Menu has was published on the 23rd October 2019 on the NHS England website. The Menu provides a catalogue of interventions and approaches that local healthcare systems and commissioners, working with partners across the system, can draw upon to take effective action at neighbourhood, place and system-level to reduce health inequalities, through their local improvement plans.
The Menu complements the content of the Place Based Approaches for Reducing Health Inequalities (PBA), which was published by Public Health England on the 29th July 2019.
The Menu is available online on the NHS England/ NHS Improvement website at https://www.england.nhs.uk/ltphimenu/
Submissions are welcome for Phase 2 of the menu. If you want to contact NHS E/I about this work, or you want to share evidence, please email the Menu planning team on: email@example.com.
Local Authority reported NHS Health Check data
For those who are responsible for submitting your local authority data returns, please be advised that the data portal closes at midday on 3rd February for quarter three submissions. Quarter three data for 2019/20 will then be published on Fingertips on 3 March.
As we enter a new financial year it is time to revise NHS Health Check five-year total eligible population (TEP) figures. The new values are based on latest Office for National Statistics population estimates will be calculated by PHE using the same methodology as 2019. By the end of February 2020, PHE will share 2020/21 TEP estimates: as per previous years, local authorities who have access to local data will be invited to submit revisions and supporting documents using our online portal. The deadline for submitting revisions will be early May 2020. For more information, please contact firstname.lastname@example.org