Foreword - Professor Kevin Fenton, director of Health and Wellbeing, PHE

I am pleased to use my first foreword of 2016 to report on the largest and most comprehensive national evaluation of the NHS Health Check programme to date. The study, published in the British Medical Journal Open this month, presents some very positive findings, while also recognising opportunities for improvement.

Researchers from three universities, led by Queen Mary University of London, conducted an observational study over four years (April 2009 to March 2013), analysing QResearch data from 655 general practices across England. The research team reviewed data relating to 214,295 people who attended an NHS Health Check and compared these findings against 1.4 million people who had not yet been offered or taken up their checks.

The study shows that coverage, while “lower than expected”, increased steadily as the programme progressed, from 5.8% of eligible adults in 2010 to 30.1% in 2012. We know that coverage has continued to improve since local authorities became responsible for commissioning, with 3.5 million people receiving checks since April 2013. Attendance by groups at greater CVD risk, such as the more socially disadvantaged, was higher than the more affluent (14.9% vs 12.3%), refuting criticism that the programme is skewed towards the worried well. The study also shows equitable provision in certain high-risk ethnic groups, which is most encouraging. However, people under 65 were less likely to attend a check than those over 65. This requires further investigation to establish whether it is the result of targeting those at high CVD risk or access difficulties for those of working age.

The findings provide evidence that NHS Health Check is fulfilling one of its key objectives, which is to promote and improve the early identification and management of behavioural and physiological risk factors for vascular disease and the other conditions associated with these risk factors. Comparisons between those receiving an NHS Health Check and those who have not yet received a check show improved risk factor recording, referral and diagnosis among the attendees. For example, those receiving an NHS Health Check were three times more likely to be diagnosed with hypertension than people who had not yet received checks. Alcohol identification and brief advice was significantly higher in the NHS Health Check group, with 33.9% vs 5.1% receiving a referral if found to need further support.

Another “important feature” of the findings was the detection of 7,844 new cases of hypertension (1 per 27 checks), 1,934 new cases of type 2 diabetes (1 per 110) and 807 new cases of chronic kidney disease (1 per 265). Identifying comorbidities earlier and referring people for evidence-based interventions are crucial preventative measures that will lessen future demands on the NHS.

The rate of statin prescribing leaves room for improvement, since only 1 in 5 of those found to have a ten-year risk score of greater than 20% received treatment. However, the authors believe that at national scale, treatment for 1 in 5 attendees at highest CVD risk was likely to have contributed to “important reductions in CVD events”. They estimate that, over five years, 2,529 people will have avoided a major CVD event as a result of treatments initiated by their NHS Health Checks.

The study has limitations. It is based entirely on data from GP practices (where more than 90% of NHS Health Checks are carried out) and may not include data from pharmacies or other community settings. Due to the nature of the study, it was not possible to make direct comparisons between attendees and non-attendees. The authors say referral rates were generally low and little is known about the attendance or the quality of behavioural programmes for those at higher CVD risk. The impact of NHS Health Checks on people at lower CVD risk also requires further research, as do patient behaviours after an NHS Health Check and the communication of results.

Evidence about the success of the programme comes at a difficult time for local authorities as a result of public health budgets being cut. However, this study should reassure them that investing in NHS Health Check will produce major benefits for their populations. Unless we get serious about prevention and early intervention, the increasing burden of avoidable illness will compromise the sustainability of the health and social care system in England. This research shows that NHS Health Check is helping to provide a more systematic approach to tackling many of the risk factors contributing to premature death and disability. Combined with wider population strategies, including effective health policy to tackle NCDs and their determinants, and targeted interventions to engage those at greatest risk, we have a genuine opportunity to protect and improve people’s health and wellbeing.

Link to article: http://bmjopen.bmj.com/content/6/1/e008840.full

Date of publication: 14/01/2016

Link to infographic:

http://www.healthcheck.nhs.uk/commissioners_and_providers/programme_governance1/expert_scientific_and_clinical_advisory_committee_escap/evidence/