Foreword by Professor Kevin Fenton, National Director, Health and Wellbeing
Increasing uptake of the NHS Health Check is an important challenge for the coming year. Recent research says that higher levels of coverage are achievable and would lead to substantial gains for public health. In short, thousands more people could live healthily, for longer, because early-stage disease is detected during a check.
A recent, independent, study in three of the country’s most ethnically diverse and socially deprived areas, compared NHS Health Check attendees with a matched group of non-attendees from 2009 to 2014. Among attendees, 30 per cent more new cases of diabetes, 50 per cent more new cases of hypertension and 80 per cent more new cases of chronic kidney disease were diagnosed than among non-attendees.
NHS Health Checks also led to 40 per cent more statins being prescribed, the study found. Replicated nationally, this additional statin use would prevent an estimated 4,600 to 8,400 heart attacks, strokes or death from these causes in five years. Treatment of hypertension, diabetes, and kidney disease, as a result of attending an NHS Health Check, would further reduce cardiovascular events.
The researchers, led by Dr John Robson of Queen Mary University of London, say the benefits are of “public health importance”. This is evidently the case. In the NHS Health Check, we have a world-leading programme to identify and prevent the major risk factors for premature death and ill health. To say it’s the ‘best thing we’ve done in decades to prevent non-communicable disease’ is no exaggeration. However, we can do more to increase the number of people receiving a check and ensure they gain access to the appropriate clinical or lifestyle support.
The Queen Mary study looked at three clinical commissioning groups (CCGs)—City & Hackney, Tower Hamlets and Newham - that serve disadvantaged populations with high CVD risk. In these areas, coverage of the NHS Health Check increased year on year to 85% compared with around 50% nationally. Attendance was higher for South Asian patients, older patients and those in more deprived sections of the population.
All three CCGs had good infrastructure, including web-enabled IT support with near real-time performance dashboards. In Tower Hamlets, managed practice networks, including financial incentives, may also have been factors in high performance. More new diagnoses were made in City & Hackney and Tower Hamlets where higher-risk individuals were targeted for first invitation. Rates of diagnoses were lower in Newham, which had a non-selective approach.
Whilst being the bearer of good news, the study also shows that there are still ways to improve the programme. Currently rates of coverage vary considerably across the country. In the year ahead we need a system-wide response, with local authorities, the NHS and PHE working together to improve delivery so that we achieve similar outcomes to East London.
Operational update by Professor Jamie Waterall, National Lead for Cardiovascular Disease Prevention, Associate Deputy Chief Nurse
Many of us start a New Year by reflecting on what changes we want to make to ensure that the year ahead is a successful one. The team that leads on this e-Bulletin have also been reflecting on how we can improve this publication. We are keen to ensure that the e-Bulletin provides helpful information and access to key resources to those colleagues involved in the NHS Health Check programme. We are therefore asking our readers to make contact and provide feedback on ways in which you think we can improve. You can do this by emailing email@example.com, and we promise to consider all suggestions, so let us know what you think. Also let us know about the topics you would like us to cover during 2017!
Last year we delivered 18 webinars as part of our implementation support for the Health Check programme. The topics varied from local case studies, illustrating innovation and improvement examples, to national resources and tools such as our top tips for increasing uptake. We know that colleagues value the opportunity to link with peers from across the country to discuss achievements and problems together. Given the success of these sessions, we are intending to run more throughout 2017, so please register now to receive more information. Topics being covered soon include national updates on cholesterol and physical activity.
On 9 February, we will be hosting our 4th national NHS Health Check conference, which is due to take place in Manchester. I am thrilled that media medic and GP, Dr Dawn Harper will be chairing the day, when we will also be joined by various speakers, including the Parliamentary Under Secretary of State for Community Health and Care, David Mowat. There are still limited spaces available, so if you would like to attend the event, please book soon. For those unable to attend, you will be able to follow us on twitter by using #NHSHealthCheck2017 and follow my tweets @JamieWaterall.
Finally, I wanted to remind colleagues that we have a huge number of resources, including latest news section, case studies, recorded webinars, and quarterly published data on our programme website. Please do use these materials and feel free to make contact if there are items which you think should be added. For those who are responsible for submitting your local authority data returns, please be advised that the data portal closes midday on 31 January for quarter 3 submissions. Quarter 3 data for 2016/17 will then be published on our website on Thursday 23 February.
Health Matters: combating high blood pressure
Health Matters is an information resource from Public Health England which includes infographics, videos, case studies and slide sets alongside written content. The tool brings together in one place the most informative data and the best evidence of what works in tackling major public health problems. The latest edition on combating high blood pressure through improved prevention, detection and management was launched on Tuesday 24 January 2017. Please click here to access the resources.
Health Equity Audit guidance tool
To maximise the impact of the NHS Health Check programme and ensure it is contributing to reducing health inequalities, it is important to understand not only equity of access to checks but also equity of outcomes. NHS Health Check Programme Health Equity Audit (HEA) guidance has been produced collaboratively with local authorities and aims to promote and support local audits. An HEA is a review process which examines how health determinants, access to health services and related outcomes are distributed in relation to the health needs of different groups and areas. HEAs are undertaken once a programme or policy has been implemented, to assess whether resources, opportunities and access are being fairly distributed according to need, following the principles of proportionate universalism. The process can provide local evidence which can be used to inform action to improve equity of access and outcomes, inform resource allocation and demonstrate compliance with the requirements of the 2010 Equality Act.
The guidance sets out a six stage cyclical process which can be used to consider inequities arising across the whole NHS Health Check pathway. HEAs can be carried out on the whole programme, focused on a specific point of the pathway or on certain providers. The guidance aims to support the scoping and design of the audit and includes a detailed appendix providing ideas, case studies and resources to help with developing recommendations to address any inequities which may be identified through the audit.
The guidance can be found on the NHS Health Check website here
New Dementia NHS Health Check training resources
PHE together with Alzheimer’s Society and Alzheimer’s Research UK have developed a range of training resources (from slide decks that can be used by trainers to short instructive films) to support staff delivering the dementia component of the NHS Health Check. Two key outcomes of this work are to increase staff confidence and knowledge on dementia, and to ensure that the materials can integrate into existing training packages. Given that commissioning, training and delivery of the NHS Health Check is locally determined, this project aims to offer a flexible approach by developing resources that can be used within broader Health Check training sessions. Materials can freely be added to and edited by trainers to meet their local training needs. Resources will also be available to support practitioners seeking to independently improve their knowledge and skills.
The training resources cover all three mandated components of dementia;
- 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.
The training resources particularly focus on the potential to use risk reduction messaging to introduce dementia as part of the NHS Health Check as the messages complement existing cardiovascular risk messaging. The resources also introduce practitioners to the specific NHS Health Check dementia leaflet, which can be used as part of the NHS Health Check appointment.
The new material will be available online at the NHS Health Check webpage from 9 February, to coincide with the NHS Health Check conference.
National Institute for Health Research (NIHR) call for bids
National Institute for Health Research (NIHR) call for bids
The NIHR have now issued a call for an evidence synthesis on: Modelling the potential for health gain and cost effectiveness of the NHS Health Check Programme (16/165). The deadline for responding is by 1pm on 6 April 2017. You can find more information here.