Foreword by Professor Kevin Fenton, National director, Health and Wellbeing
In recent weeks, Public Health England has focused on how it can reduce the number of people who develop dementia.
Dementia will be one of our biggest health challenges in the coming years. Today, 850,000 people in the UK are living with dementia. By 2025 it could reach 1m. The UK spends an estimated £26bn a year caring for people with dementia and that figure will inevitably rise.
The facts, figures, and uncertainty obscure what we know, which is that the effects of dementia on individuals and families are profound. The progressive, irreversible decline in our ability to think and remember is a prospect many of us dread.
In the past, dementia was seen as an inevitable part of ageing. However, we now know that up to one-third of dementia cases could be prevented if people modified unhealthy behaviour. Some risk factors for dementia mirror those for cardiovascular disease. Put simply, what is good for the heart is good for the brain. So, dementia would decline if more people stopped smoking, avoided excess alcohol, improved their diet and took regular exercise.
Clinical commissioners and local authorities have an important role to play in strategies to prevent or delay the onset of dementia. One way is to increase the NHS Health Check among adults aged 40 to 74. This programme offers a great opportunity to inform adults about the steps they can take to lower dementia risk. By focusing on major risk factors such as smoking, blood pressure and cholesterol, the NHS Health Check can identify issues that heighten people’s chances of developing dementia and help them respond accordingly.
The programme can also be used to target socioeconomic and ethnic groups at most risk from dementia.
Presently, the NHS Health Check for the 65 to 74 age group includes a component to raise awareness about dementia and signpost local services. As part of a pilot project, people aged 40 to 64 will be given information about dementia risk reduction during their NHS Health Check. PHE, the Alzheimer’s Society and Alzheimer’s Research UK are also working to improve dementia training for health professionals who undertake an NHS Health Check.
At PHE we have developed a number of online resources for local and national use. Our dementia profile tool provides information on local risk factors for dementia. The dementia edition of Health Matters provides evidence, infographics and advice on midlife approaches to reduce dementia risks.
I hope these resources prove useful in spreading the message about dementia risk and how people can help to protect themselves against the condition.
Operational update by Jamie Waterall, National lead - NHS Health Check and blood pressure programmes
This month, Imperial College London published its latest national evaluation paper on the NHS Health Check programme in the Canadian Medical Association Journal. This was followed by media coverage suggesting that the programme is only providing modest patient benefits. Given the importance of this study, our expert scientific and clinical advisory panel has reviewed the paper and developed a response which allows us to consider the implications of this important work. I believe we should be encouraged by certain findings, such as the 2.5mmHg drop in systolic blood pressure in the NHS Health Check group, while also using this data to bolster our focus on increasing uptake and quality of the lifestyle and clinical interventions that follow the NHS Health Check. Many local teams are now using our new NHS Health Check systematic approach to raising standards StARS framework and programme standards to drive a focus on quality and outcomes locally.
I am delighted to be able to share with you a recent PHE video that captures the views of key national and local colleagues. The clip includes comments from Duncan Selbie, PHE’s CEO, explaining why he believes the NHS Health Check is so important in England’s response to ‘getting serious about prevention’.
I want to thank everyone who has been involved in our commissioned research, which will support an update to the NHS Health Check stocktake, originally published in July 2014. We will use this stakeholder feedback to reflect on what we are doing well and the things that you would like us to focus on more over the coming year. We aim to publish the stocktake findings and our action plan in the summer.
Finally, I want to congratulate Dr Matt Kearney, our GP advisor, who has recently been appointed as national clinical director for cardiovascular disease prevention. It is tremendous that NHS England has recognise the importance of this field by creating this new role and I know that Matt will bring a huge amount to this position.
RightCare programme by Dr Matt Kearney, National clinical advisor, PHE
As well as identifying behavioural risk factors, a core objective of the NHS Health Check is to detect high-risk physiological conditions such as hypertension, atrial fibrillation (AF), diabetes, raised cholesterol and chronic kidney disease (CKD). Although we have one of the best primary care systems in the world, these conditions are often diagnosed late. This matters because individuals affected have substantially increased risk of life-changing events such as heart attacks and stroke. In each case, robust evidence shows that early intervention with behaviour change and medical treatment significantly improves outcomes.
The recently published national evaluation of the NHS Health Check provides encouraging early evidence that the programme is helping to plug this gap in primary care: for example, one in 27 attendees had undiagnosed hypertension and one in 110 undiagnosed diabetes.
Over the next few months, further support for detection and management of these high-risk conditions will come from the NHS RightCare programme. RightCare assists local health economies to maximise value by focusing on unwarranted variation. The programme draws on a broad range of metrics to show clinical commissioning groups (CCGs) where to look, what to change and how to change in order to improve value for their populations.
RightCare is currently developing a new cardiovascular disease (CVD) prevention pathway for its work with CCGs. The pathway takes a holistic approach to include the key primary care activities that influence cardiovascular outcomes such as stroke and heart attack - i.e. detection and management of hypertension, AF, high cholesterol, diabetes, nondiabetic hyperglycaemia and CKD. So in CCGs where CVD is identified as a commissioning for value priority area, RightCare will be providing support to improve detection and management of these high-risk conditions. And one of the cross-cutting solutions to late diagnosis and under treatment will be to improve uptake of the NHS Health Check in the local population.
Training to improve quality, by Dr Neel Bhaduri, Health improvement manager, PHE London region
Public Health England London region sees the NHS Health Check programme as an opportunity for local government and health care services to engage their populations in raising awareness of behavioural and physiological risk factors for cardiovascular disease and a chance to work together to take steps to reduce or manage those risks.
London is very diverse, and the clinicians and staff who provide NHS Health Checks echo this diversity. In addition to the nurses, health care assistants and pharmacists, there are also different types of community workers, health trainers and private companies who provide the checks to meet the needs of Londoners. While this is great for access and equality, it is key to ensure that consistency in delivery is maintained and quality is at the forefront.
One way to ensure this is around training and competency of staff. So far there has been no formal review of staff competency across London. Training has been the responsibility of the individual commissioners in the public health departments and access to training varies across each borough:
The NHS Health Check competency framework should underpin any training delivered along with a tailoring to local programme delivery. Some boroughs have undertaken needs assessment for training and only one area has a process for signing off staff as competent to deliver the checks.
While some areas recommend the use the competency learner workbook, few areas ensure that it is used.
In East London three boroughs have come together to jointly commission training, Newham, Tower Hamlets and Hackney. However, these often run separately as their programmes are all slightly different.
Organogram, roles and responsibilities of the NHS Health Check and blood pressure team
The current NHS Health Check and blood pressure team can be viewed by clicking on this Organogram.
Roles and responsibilities:
Jamie Waterall, national lead
- Building and strengthening the leadership for the NHS Health Check and blood pressure programmes in the emerging political and place based landscape
- Providing and supporting system wide leadership for the blood pressure programme
- Aligning and strengthening PHE’s contribution to CVD prevention
Dr Matt Kearney, national clinical advisor
- Right Care – development of cardiovascular disease pathway to reduce variation in CVD
- National primary care network – lead for the development of acknowledged primary care leaders, through the facilitation of training development and leadership opportunities and activities
Katherine Thompson, deputy national lead
- ESCAP (expert scientific and clinical advisory panel) – supporting the panel and ensuring transparency of its work.
- StARS framework – support and training for local authorities to improve the quality of delivery
- Implementing the content review process
- NHS Health Check stocktake exercise
- Annual national conference
- National advisory committee
- Third sector engagement
- Blood pressure staff pilot
Slade Carter, deputy national lead
- Leading on PHE’s national data extraction of NHS Health Check data
- Aligning and strengthening agency-wide contributions on cardiovascular disease through the cardiovascular disease working group
- Stocktake of PHE’s contributions to CVD prevention in England
- Blood pressure system leadership board
- Information governance and data flow guidance
- National steering group
Catherine Lagord, data analyst
- Quarterly local authority data reports (official statistics standards).
- Health Profile and Longer Lives tools
- National data extraction
- Data intelligence and information governance sub-group
- Heart age tool
- Bridge between the chief knowledge officer and health and wellbeing for issues relating to information governance, modelling, dataset development and intelligence
Hannah Rees, senior support manager
- NHS Health Check Competence and training
- Local Implementer National Forum (LINF)
- One You and the NHS Health Check
- NHS Health Check and blood pressure content on NHS Choices
- Blood pressure Evidence into Action review
Kay Thomas, support manager
- Best Practice guidance
- NHS healthy workforce pilot
- Regional and centre leads meetings
- Comminssioners and providers website
- Lead for webinars
- Quarterly NHS Health Check data returns from local authorities and submission to ministers
Jennifer Ankrah, operational support administrator
- PA to national lead
- Administrative support for the NHS HC team
- E-bulletin publication
- Blood pressure resource hub
- Patient information leaflets