Foreword by Professor Kevin Fenton
Professor Kevin Fenton - National Director, Health and Wellbeing, PHE
Cardiovascular disease (CVD) affects around 7 million people in the UK and is a significant cause of disability and death, affecting individuals, families and communities.
Although deaths from CVD have fallen, it remains the second highest cause of death in England and can cause considerable disability. It also costs the NHS £6.8 billion every year.
To ensure that we continue to make progress in reducing the number of deaths and years lost to ill health caused by CVD – as well as the financial burden – we must do more to prevent these conditions and to support people to reduce their risk.
Public Health England (PHE) works with the health service across all levels of CVD prevention: primary prevention, which is designed to reduce the instances of disease; secondary prevention, which aims to detect and treat disease as soon as possible to halt or slow its progress; and tertiary prevention, which aims to reduce the impact of ongoing illness.
Over the past few months we have been gathering information on all the work being done across the organisation to address CVD, in order to review our activity and see how we can maximise our impact in this area. This has resulted in the publication of a new framework, Action on cardiovascular disease: getting serious about prevention, which provides an overview of this work and outlines how we provide support to the NHS and wider partners at both national and local level.
The journey towards creating this framework has allowed us to look across the breadth of our activity on CVD prevention and identify opportunities for further integration and shared learning. It has helped us to determine exactly what assets we have across the organisation and how we can bring these together in a more integrated approach in order to maximise value and impact.
We hope that many of the principles demonstrated here will be relevant to those working in local government and local services. Some great examples are already being seen, for example in Leicester City CCG and Medway, and I look forward to hearing about similar work taking place elsewhere, including examples of best practice and lessons learned.
And crucially, the framework details the many tools and guides that PHE provides to support clinicians, local authorities, service commissioners, public health specialists, the third sector and PHE staff in the vital work they are doing to prevent CVD and improve cardiovascular health.
The NHS Health Check programme is of course central to this work in providing risk awareness, assessment and management at scale. Do look out for the new Heart Age tool, launching this month, which now recommends interventions and advice on how to lower the risk of cardiovascular disease, and can show how much your heart age could decrease following lifestyle changes such as quitting smoking.
Operational update by Jamie Waterall
Jamie Waterall, National Lead for Cardiovascular Disease Prevention and Associate Deputy Chief Nurse
We have recently published the latest official statistics for the NHS Health Check programme, detailing activity for 2016/2017 ‘quarter one’ and accumulative activity for the past 3.25 years. Since April 2013, 4.5 million people have received an NHS Health Check, making this one of the world’s largest prevention programmes of its kind. I would like to take this opportunity to congratulate those local authorities who continue to make improvements in the number of people accessing this important prevention programme For those local areas who require support in improving their service, I would encourage them to make contact with their PHE centre leads, as various tools and examples of best practice are available to support you in delivering the NHS Health Check.
Our Expert Scientific and Clinical Advisory Panel have now reviewed the first cycle of content review submissions and have identified two proposals which require further assessment. These include options for extending the dementia risk reduction messaging for the entire eligible population aged 40-74 years and a review of the diabetes risk assessments tools used in the programme. Pilots are now underway to assess the feasibility of the dementia risk reduction proposal and we will keep you informed as these start to report. In terms of the diabetes risk filter and assessment tools, please do take the time to share your feedback through our consultation on the proposed recommendations from the Expert Scientific and Clinical Advisory Panel.
I have once again been invited to speak at the annual Issues & Answers in Cardiovascular Disease 2016 Conference, which takes place between the 4-5 November 2016 in Nottingham. On behalf of the British Journal of Primary Care Nursing (BJPCN), they are offering a complementary free place to the first 20 delegates to book using PHECVD16 offer code, which includes registration, materials and conference dinner. I look forward to seeing those of you who will be attending the event this year.
Finally, I would encourage you to read the article by Dr Matt Kearney on the NHS RightCare CVD Optimal Pathway. This is going to be a hugely valuable resource for primary care colleagues in ensuring that those patients who require further clinical assessment and treatment following the NHS Health Check receive the very best care.
Launch of the NHS RightCare CVD Prevention Pathway, Dr Matt Kearney
Dr Matt Kearney, GP and National Clinical Director for Cardiovascular Disease Prevention, NHS England and Public Health England
A core purpose of the NHS Health Check is to prevent cardiovascular disease (CVD), the underlying cause of strokes, heart attacks and some forms of dementia. It aims to achieve this in two ways: firstly, by spotlighting behavioural risk factors, and supporting people in individual behaviour change; and secondly through the detection of high risk undiagnosed conditions such as hypertension, atrial fibrillation, high cholesterol and raised blood sugar. Once detected, the next step is to confirm the diagnosis of these clinical conditions and to provide appropriate preventive treatment in primary care.
This week sees the launch of the NHS RightCare CVD Prevention Pathway, a major new tool that will help CCGs to optimise the detection and management of these conditions. NHS England has invested significant funding to enable every health economy in England to embed the NHS RightCare approach at the heart of their transformation programmes through a two-stage national rollout. This is expected to reach all local health economies by the end of 2016 and will be implemented across the country by a team of RightCare Delivery Partners. NHS RightCare's core objective is to reduce unwarranted variation in order to improve people’s health and outcomes. It aims to achieve this by ensuring that the right person has the right care, in the right place, at the right time, making the best use of available resources. A key element of the approach is development of Optimal Value Pathways, and CVD is the first new pathway to be launched.
The NHS RightCare CVD Prevention Pathway includes six high risk CVD conditions where early detection and optimal management can significantly improve outcomes and which are managed almost entirely in primary care. The pathway is accompanied by metrics that show local performance in diagnosis and treatment, with benchmarking of each CCG against demographically similar CCGs, and benchmarking of the local practices. This allows clinicians and commissioners to identify unwarranted variation and to spotlight opportunity for improvement.
The RightCare package also includes high impact interventions that can be expected to improve detection and management of the high risk conditions, with links to case studies, exemplars and other resources:
- Ensure systematic collection and analysis of real time audit data from practices using tools such as GRASP, national audits and other local data solutions.
- Build local primary care leadership to challenge unwarranted variation and drive quality improvement in high risk conditions
- Maximise NHS Health Check uptake and follow up as a systematic approach to detecting undiagnosed high risk CVD conditions.
- Commission new models of diagnosis and management of the high risk CVD conditions that support local practices and do not add to their workload: for example, using community pharmacists and other staff and settings, self-monitoring solutions, telehealth and new technologies.
The RightCare CVD Prevention Pathway can be expected to bring significant new support to local NHS Health Check programmes by facilitating a systematic approach to early detection and management of the high risk conditions that contribute so substantially to cardiovascular outcomes.
NHS Health Check data extraction
Public Health England is making good progress with its national data extraction of the NHS Health Check programme in 2016-2017. The extraction is being conducted by the General Practice Extraction Service (GPES) at NHS Digital (formerly the HSCIC), in conjunction with PHE. Until now, PHE only has a national record of offers and uptake of NHS Health Check by local authority. Following the extraction, PHE will have information showing variation between areas and different demographic groups. The extraction will provide comprehensive detail about the outcomes, reach and effectiveness of the programme.
The intention is that GPES will provide access to pseudonymised patient-level data via the GP IT system suppliers. It remains to be seen whether PHE will have data from all four suppliers, but the aim is to maximise the size of the extract, as resources permit. The extract aims to draw comparisons between those invited for an NHS Health who attended their check, with those who were invited but did not attend. It is anticipated that the extraction will take place in March 2017, with the data analysis following thereafter.
By comparing areas, we can look at where improvements might be made, with the extract presenting opportunities for learning and sharing knowledge between areas. Given the scale of the programme, the extract will provide the largest dataset of its kind in the world (8.79 million checks offered, 4.2 million received, and counting). Pseudonymised patient-level data will allow PHE to link in the future to hospital and mortality data, affording a longer term understanding of the impact of the NHS Health Check.
NHS Health Check Dementia Pilot
PHE are working with the Alzheimer’s Society and Alzheimer’s Research UK on a pilot project, to extend the mandatory dementia component of the NHS Health Check to all 40-64 year olds with the aim of reducing the number of people who develop dementia.
Dementia is not an inevitable part of ageing and there is evidence that it could be prevented if people modified unhealthy behaviour. The dementia awareness raising component of the NHS Health Check aims to increase understanding of dementia and risk reduction. It encourages people to consider healthy lifestyle changes, such as stopping smoking, being physically active, eating healthily, maintaining a healthy weight, drinking less alcohol, connecting with people and keeping mentally active. The pilots will test the effectiveness of using the NHS Health Check to raise awareness of dementia risk reduction amongst people in midlife.
The pilot project was launched on 16th August to coincide with the DH Dementia Moment, and is running across 4 areas, Birmingham, Bury, Manchester City and Southampton City. GP surgeries and community models will be used to deliver the Health Checks.
There are two key outcomes:
- Assessing the feasibility of extending the dementia risk reduction component of the NHS Health Check to all ages
- Assessing whether, through the intervention there is increased awareness of dementia risk reduction among people aged 40-64
There will be minimal change to the NHS Health Check process itself. Dementia risk reduction will be included in discussions alongside cardiovascular disease and diabetes. The Alzheimer’s Society has developed a training package focussing on risk reduction, and training sessions are being delivered to pilot site practitioners throughout September. The key message is “What is good for your heart is good for your brain”.
The pilots will be evaluated by an external market research company, Solutions Research, and the findings will be shared in Spring 2017 with the NHS Health Check Expert Scientific and Clinical Advisory Panel (ESCAP) to consider whether the pilot approach can be rolled out on a wider scale in the future.
Getting serious about prevention 2017: tackling cardiovascular disease together
After another successful and well attended event in 2016 we will be hosting our next conference in Manchester on the 9 February 2017. Next year’s event will not only share learning on NHS Health Checks but will also include content on the wider cardiovascular disease agenda.
We are pleased to be able to confirm that the event will be chaired by Dr Dawn Harper, GP and media medic from Channel 4’s embarrassing bodies and that Duncan Selbie, Chief Executive of PHE will be speaking. The day will include a variety of sessions from the truth about statins to practical training on motivational interviewing.
Registrations for the event will open in November. If you would like to attend or exhibit you can find more information on the website.
NHS Health Check webinar series
We have two webinars available for you to book onto in October, as part of our NHS Health Check series:
- Physical Health Checks in Prisons (3rd October)
- Delivery of the NHS Health Check by health trainers can improve conversion into uptake of lifestyle services (20th October)
Click here to book your free place
**Please share with your contacts**
Community approaches to the testing and detection of high blood pressure in the UK
The British Heart Foundation are launching a new award programme to develop, test and implement community approaches to the detection of high blood pressure across the UK. We will communicate the first round of funding via established national groups in the 4 nations e.g. in England, via the Blood Pressure Systems Leadership Group.
BHF are seeking expressions of interest from organisations that have already identified blood pressure as a local priority and adopted a system leadership approach. There will be two award rounds, with round one this year for early implementers and a second round in 2017/18. Applicants can apply for up to £60,000 in year one and £40,000 in year two. Successful round one applicants will be awarded in March 2017 for implementation in 2017-2019 financial years.
- Increase the detection and management of people who have undiagnosed high blood pressure
- Increase accessibility to blood pressure testing in wider community settings
- Increase support for patient self-management and self-testing of blood pressure in the population to become routine practice
- Add to the evidence base on the detection and management of high blood pressure and implementation into practice (through external evaluation)
For further information and details on how to apply, please visit the BHF webpage via this link.