Foreword by Dr Matt Kearney, National clinical director for Cardiovascular Disease Prevention
A recently published review of the NHS Health Check reminds us of the strong public health rationale for the programme and reviews the evidence that has emerged from the two published national evaluations (Chang at al and Robson et al).
The aim of the NHS Health Check is to improve health and wellbeing of adults aged 40–74 through earlier detection and management of individual risk factors for vascular disease and other conditions associated with them. It is estimated that around two thirds of premature deaths can be avoided through improved prevention, detection and management of these behavioural and physiological risk factors. The 2013 Global Burden of Disease Study identified and ranked the top 20 risk factors which contribute to premature death and disability. In England, diet is the leading cause, followed by tobacco, high body mass index, high blood pressure, alcohol and drug use, raised blood sugar, high cholesterol and abnormal kidney function. These factors are linked with a range of health conditions, but the largest impact is through cardiovascular disease.
It is important to acknowledge that population-level interventions are the most important in tackling the structural causes of preventable ill health. But support for risk reduction at an individual level is also crucial, and a core function of the NHS. The NHS Health Check offers a systematic approach to supporting this kind of preventative health care by specifically targeting the leading behavioural and physiological risk factors identified in the Global Burden of Disease Study.
Each of the interventions delivered by the NHS Health Check is based on robust NICE evidence of effectiveness. Where we lack evidence is on whether a national programme of this sort is an effective means of delivering these interventions and improving outcomes for the population. The first two national evaluations of the NHS Health Check programme have recently been published. Between them these studies looked at 300,000 health checks. Key findings are that the programme is helping tackle health inequalities, with no difference in uptake between poor and affluent communities; that attendees are more likely to have lifestyle risk factors identified and to be referred for behaviour change support; and that attendees are more likely to have high risk conditions (such as undiagnosed hypertension or diabetes) detected.
Both studies, however, highlight the low uptake rates in the early years up to 2013, and quite rightly identify uptake as a key determinant of the success of the programme. From routinely collected data we know that uptake has improved considerably since Local Authorities took over commissioning of the programme in 2013: almost 100% the eligible population are now receiving their invitations, and just under 50% are taking up the offer. This is encouraging but there is still scope for improvement if the NHS Health Check is to deliver on its promise.
Operational update by Jamie Waterall, National lead for Cardiovascular Disease Prevention & Associate Deputy Chief Nurse
The NHS Health Check is becoming a key foundation for a number of prevention strategies. For example, the NHS Health Check is now recognised as one of the principle referral routes into the National Diabetes Prevention Programme. In addition, pilots are underway this year to explore how the NHS Health Check can be used to inform the public of the key risk factors for dementia. NHS England is also piloting the delivery of NHS Health Checks to their workforce, to focus on the key risk factors for ill health. What is clear is that we need a radical upgrade in prevention and the NHS Health Check provides us with multiple opportunities in supporting this agenda.
Last month we published the latest official statistics for the NHS Health Check programme. This data showed that between April 2013 and April 2016, 8.7 million people have been offered an NHS Health Check and 4.2 million people have received a check. Many local authorities managed to improve upon the number of people receiving a check within the last year and I would like to congratulate those teams. We know that the NHS Health Check provides us with an important public health programme, which is addressing the principle risk factors for premature death and ill heath, so we must work together in ensuring more people are able to access these checks.
Our Expert Scientific and Clinical Advisory Panel (ESCAP) met last month to discuss the existing diabetes filter used in the programme. It was agreed that a public consultation would be held, detailing the group’s intention to align with the NICE guidance on Type 2 Diabetes but also identifying clear thresholds for when people should go on to receive follow-up blood testing. Further information will be made available on our NHS Health Check website over the coming weeks.
Finally, I wanted to inform colleagues that PHE have been advised by the Medicines and Healthcare products Regulatory Agency (MRHA), that the TPP Q-Risk tools has been reinstated and is now working correctly. NHS England is leading on activity to ensure anyone affected by the incident is followed up appropriately. Further information can be found on the MRHA website.
All Our Health – a call to action
The NHS Health Checks programme was established in 2009 to help reduce major causes of ill health and death within England and as such it is a cornerstone of the prevention strategy. Nurses are central to the delivery and success of NHS Health Checks and it provides a wonderful example of how healthcare professionals can influence and impact on behaviour and outcomes to make a difference to people’s lives. It also provides an inspiration to all other healthcare professionals working in the health system on how they can contribute to achieving the prevention ambitions set out in the Five Year Forward View. To help deliver and support this ambition PHE have developed ‘All Our Health’ for all healthcare professions: a ‘call to action’ to help close the health and wellbeing gap, radically upgrade prevention and create a social movement for health. It has been published as an on-line resource with topics on a wide range of key prevention areas such as obesity, alcohol and smoking etc and there is naturally a topic for NHS Health Checks, which I would encourage you to check out to begin with. Each topic contains a wealth of evidence-based information, metrics and outcomes, links to useful resources and tools and details on appropriate interventions at the individual, community and population level. It is designed to empower and provide healthcare professions with the knowledge and confidence to, for example, have those difficult conversations and make every contact count.
All our Health is aligned with and supportive of other programmes, such as the Five Year Forward View, Right Care, Make Every Contact Count and the new National Nursing, Midwifery and Care Staff Framework, ‘Leading Change, Adding Value’.
If you have any comments on topic formats, accessibility etc please send them to email@example.com
NHS Bolton CCG marketing campaign for NHS Health Checks
NHS Bolton Clinical Commissioning Group (CCG) has joined forces with Dave Spikey, a Bolton-born comedian and television personality, to try and increase the number of people having a health check. The campaign has been developed by Dr Stephen Liversedge, who is the Director of Primary Care Development & Health Improvement, and the CCG Clinical Lead for CVD and Diabetes. Dr Liversedge is also responsible for the success of the BIG Bolton Health Check (2008-2009) - an industrially-scaled vascular check programme. At the end of one year, 82% of the eligible population were recorded as having had a health check.
The current health check programme is jointly commissioned by Bolton Council and the CCG. All 50 GP Practices are engaged, and delivery is now well established in primary care. Whilst NHS Health Checks have been marketed widely across the town, this year the CCG has decided to take a very different approach. In an attempt to match, or even exceed the previous achievement of 82%, it was decided to try celebrity endorsement. Features of the 2016 campaign include a life-size cut-out of Dave Spikey in the waiting rooms of every GP surgery, as well as radio adverts, featuring Dave, airing on the local station - Key 103. Posters are also being displayed in a variety of venues such as libraries, shopping centres, local shops, pubs and clubs. Future plans include using Dave to advertise on the big screen at Bolton Wanderers FC during the new season.
Please contact Lesley Hardman at firstname.lastname@example.org if you would like further information about the campaign.
Cheshire & Merseyside cross-sector blood pressure strategy
World Hypertension Day on 17 May 2016, saw the launch of the Cheshire & Merseyside five year cross-sector blood pressure strategy – which sets out the vision, aims, objectives and high level action plan for the prevention, detection and management of high blood pressure.
At the heart of the strategy, which was informed by learnings from Professor Norm Campbell who developed the world leading Pan-Canadian Framework for tackling high blood pressure, is the vision to ensure local communities have the best possible blood pressure and that Cheshire & Merseyside becomes the most improved sub-region in England for blood pressure outcomes.
Co-chair of the Cheshire & Merseyside Blood Pressure Partnership Board Cllr Janet Clowes of Cheshire East Council said “I am extremely pleased to see the launch of our new blood pressure strategy. With 625,000 people in Cheshire & Merseyside affected by high blood pressure and almost half of this number thought to be unaware that they have the condition, it’s critical we take urgent action to prevent, identify and manage people at risk of developing serious diseases such as heart attack, stroke, heart failure and chronic kidney disease”.
Dr Heather Grimbaldeston, lead Director of Public Health for blood pressure in Cheshire & Merseyside and who sits on the National Blood Pressure System Leadership Board said “This strategy is an exciting development, much progress has been made so far but this now gives us a clear focus for how we will go about tackling high blood pressure in our sub-region. A great deal of hard work and consultation has gone into the production of the strategy and I would like to thank our partners for their fantastic contributions. I am now looking forward to working together across the system to make our vision a reality.”
The ‘Saving lives: Reducing the pressure’ five year cross-sector blood pressure strategy is now available at www.champspublichealth.com
PRIMIS - NHS Health Check Recall audit tool
The NHS Health Check Recall audit tool has been developed by PRIMIS on behalf of Public Health England. The tool enables a practice to review if any patients between the ages of 40 and 74 (without any specific diagnosis codes or a prescription for statins within the last 12 months) need to be invited or recalled for an NHS Health Check appointment. It also incorporates an inbuilt mail merge for invitation letters.
Use of the NHS Health Check Recall audit tool is FREE to all practices in England that are registered with the PRIMIS Hub online membership service, which is also a free service. Visit the PRIMIS website for more details, or email Kerry Oliver, Managing Director of PRIMIS at Kerry.Oliver@primis.nottingham.ac.uk