Foreword by Kevin Fenton
We were recently invited to debate the NHS Health Check programme in the Journal of Public Health. While our critics argued that we should abandon the programme on the grounds of cost, flawed delivery and lack of evidence about its effectiveness, we described how the programme offers an increasingly useful, credible and place-based approach to prevent, diagnose and manage an epidemic of largely avoidable chronic diseases.
NHS Health Check is now the backbone of many local authority programmes to improve the health of adult populations, providing a systematic way of engaging individuals in conversations about their health, risk factors and lifestyle modification. It has provided, and will increasingly provide, under the National NHS Diabetes Prevention Programme launched in March a major platform for identifying people at high risk of developing type 2 diabetes.
Millions of adults in England are living with undiagnosed diabetes, hypertension, kidney disease or high cardiovascular risk that could be alleviated through lifestyle and medical interventions. Early detection is key so that behavioural and physiological risk factors associated with these conditions can be treated or managed. NHS Health Check offers a flexible and practical tool to address this rising burden of disease. Discarding the programme at a time when local leadership and delivery systems are in place, when coverage and uptake are increasing, and when implementation studies are highlighting evidence of impact and areas for improvement, would be irresponsible. Rather, we should continue to refine and improve its implementation and delivery, as experience and evidence indicates, so that we maximise the benefits.
Local authorities are finding new ways to deliver the programme, targeting individuals and communities at greatest risk and using initiatives such as health buses and health trainers to reach different groups. Public Health England has introduced measures to strengthen scientific governance, support local authorities with implementation, and increase uptake by marketing and promotion. We are improving the quality of delivery, follow-up and referral to provide better management of patients. More strategically, we continue to improve the data required to evaluate impact and support research that will extend our knowledge.
A local evaluation found that NHS Health Check assessments resulted in a large increase in the appropriate prescribing of statins to patients with a high risk of cardiovascular disease. There is a pressing need to prevent CVD, and although the evidence base is incomplete, there is an increasingly compelling case that NHS Health Check will deliver substantial health benefits in the longer-term. We have much to gain by extending coverage, optimising delivery and running NHS Health Check in concert with other health improvement strategies.
To read the papers go to jpubhealth.oxfordjournals.org/content/current (you will need to be registered to access these papers)