NHS Health Check e-Bulletin - August 2020
Foreword
Professor John Deanfield
Chair of the NHS Health Check programme review
The NHS Health Check Programme was established in 2009 to improve cardiovascular health in the population by assessing risk factors, communicating opportunities for health gain and assisting with management including lifestyle initiatives. It has achieved a lot reaching more than 6 million people, and importantly involving communities at increased risk of cardiovascular disease and its complications. Many things have changed in medicine over the last decade, including appreciation that earlier reduction of cardiovascular risk factors can result in greatly improved gains over a lifetime. We have also learnt that many chronic diseases of ageing share common drivers including cardiovascular disease, dementia, diabetes and even cancer. These new insights present tremendous opportunities for further population health gains.
We believe the time is right to take a step back and consider whether changes to the NHS Health Check programme could help it deliver even greater benefits. That was the thinking behind the Minister’s proposal for an evidence based review of the NHS Health Check programme, set out in the prevention green paper, Advancing our health: prevention in the 2020s, last year. Additionally, the COVID-19 pandemic has really emphasised the importance of background health and strategies to empower the public to improve and maintain ‘wellness’ are now top of everyone’s agenda.
The Department of Health and Social Care has now commissioned Public Health England to undertake that review, and I’m very pleased to be leading it as Chair.
The review will provide evidence-based advice to Ministers on how the NHS Health Check can evolve in the next decade to maximise the future benefits of the programme in preventing ill-health and reducing health inequalities. We are aiming to provide Ministers with our final report in December this year.
The review has a broad remit, with scope to consider the content and delivery of NHS Health Checks, as well as how the programme fits with the wider system. It will provide a clear link to other existing and planned prevention initiatives, such as the current focus on obesity, and together this should propel England to become leaders in population wellness.
It won’t however be reviewing the organisational question of who commissions the programme.
I’m keen to understand the opportunities that have arisen since the original development of the programme: in our improved understanding of the value of prevention, in the increased interest and efforts to help support people’s wellness and wellbeing, and in the opportunities that digital offers to provide additional ways to support people to achieve their own aims to live more healthily.
I also want the review to reflect what we’ve learned from over a decade of implementing the programme, and the more recent lessons from those who have looked to adapt the delivery of NHS Health Checks in response to COVID-19.
To ensure this we’ll be engaging widely, initially to understand what you value about the NHS Health Check at present, where you see opportunities for improvement and your ideas on the future of the NHS Health Check programme.
If you want to get in touch about the review, please contact the review team at ReviewofNHSHealthCheck@phe.gov.uk
Operational Update.
Katherine Thompson
Head of the Cardiovascular Disease (CVD) Prevention Programme, Public Health England.
COVID-19 is continuing to have a huge impact on our lives. Every week brings new challenges as we strive to adapt to the ‘new normal’. I wanted to express my deepest gratitude and recognise everyone who is contributing to the response and doing all possible to keep people safe and well.
Emerging evidence indicates that people with heart disease, diabetes, kidney disease, liver disease and obesity are more likely to experience poorer outcomes from COVID-19. Not only that but with COVID-19, as with CVD, we see considerable disparity in health equity. This highlights that now, more than ever, there is a need to support people to reduce these risk factors and ensure that individuals at greatest risk benefit from our greatest efforts.
As a national prevention programme the NHS Health Check has a crucial role to play on both counts. The Government’s COVID-19 recovery strategy recognises that it offers a systematic opportunity to engage and empower people to live healthier lives. As highlighted in the review of disparities in the risk and outcomes of COVID-19 it can also aid work to accelerate culturally competent health promotion and disease prevention by prioritising Black, Asian and Minority Ethnic groups.
The importance of restarting the NHS Health Checks cannot be overstated, however, this must be balanced against considerations such as risk of COVID-19 to the workforce and patients, and national NHS guidance on service restoration. To help local authorities make decisions about how and when to restart we have published the NHS Health Check Restart Preparation document and welcomed 250 stakeholders who joined the webinar.
Restoring the NHS Health Checks service also compliments the government’s new obesity strategy. Data shows that 62% of 5.1 million people having a check between 2012 and 2017 were overweight or obese. Ensuring that there are appropriate services in place to support individuals to lose weight following a check is key to maximising the programme’s impact. The increased focus on obesity through the ‘Better Health’ campaign presents a real opportunity to strengthen behaviour conversations and onward referral.
I’m delighted to welcome Professor John Deanfield as Chair of the NHS Health Check review. The review offers a timely opportunity to cogitate on learning so far and consider the action that needs to be taken to ensure that we maximise the benefits from the programme for the next ten years and beyond. What is certain is that we will need every part of the system playing its part if we are to realise the programme’s full potential. Please do use the opportunity that the review presents to share your thoughts, experiences and views.
Finally, thank you to all local authorities for getting quarter 4 2019/20 data in on time, the portal is now open again for the quarter 1 2020/21 return which closes on the 4 September.
Competency Framework
The NHS Health Check Competency Framework and accompanying Learner and Assessor Workbook have been refreshed and the updated documents can be found on our website.
The Competency Framework details the core, clinical and programme competencies that the NHS Health check workforce is required to have. There are seven NHS Health Check programme competencies in the updated version, these are not new competencies, but consolidate ten competencies published in the previous version.
In the workbook learners are encouraged to progress through units with their assessor and produce a portfolio of evidence demonstrating how they meet the competencies prior to delivering NHS Health Checks. We encourage commissioners and providers to make use these resources to assure that staff delivering checks are competent to do so, and to support improvement in the quality of local programme delivery.
Programme Standards
The NHS Health Check Programme Standards have also been updated and can be found on our website.
As local commissioners and providers prepare to restart the service the programme standards can be used to ensure a minimum level of quality across the NHS Health Check pathway. They set out achievable standards, which will help to ensure that local NHS Health Check services are delivered safely and consistently at every step of the pathway.
CVDPREVENT: new national primary care audit for CVD prevention
PHE’s National Cardiovascular Health Intelligence Network (NCVIN) has now been confirmed as NHSE/I’s official analytical partner for the delivery of CVDPREVENT, the new national primary care audit for CVD prevention. NCVIN has been commissioned to work in partnership with NHS Digital and Healthcare Quality Improvement Partnership’s (HQIP) ‘preferred provider’ who will provide the strategic governance for the audit and facilitate clinical and professional involvement.
The audit will automatically extract routinely held GP data covering diagnosis and management of cardiovascular disease and the six high risk conditions that cause stroke, heart attack and dementia: atrial fibrillation (AF), high blood pressure, high cholesterol, diabetes, non-diabetic hyperglycaemia and chronic kidney disease. It will support primary care in understanding how many people with cardiovascular disease (CVD) or conditions that lead to a higher risk of developing CVD are potentially undiagnosed, under treated or over treated.
Analysis and reporting of the audit will support systematic quality improvement to reduce health inequalities and improve outcomes for individuals and populations to support the NHS Long Term Plan. The initial reporting outputs from CVDPREVENT are scheduled for March 2021.
More information about CVDPREVENT is available here.
Webinars
Our Cardiovascular Disease webinar series has now restarted, you can subscribe to our webinar mailing list here.
Our next webinar will now be taking place on Wednesday 16th September, 11:00-11:45am. The Race Equality Foundation will share insights and learnings from their community based blood pressure testing pilots for Black Caribbean and African men.
You can find the presentations and videos for past webinars here.
Quarterly Data Returns
The data portal opened for the quarter 1 2020/21 NHS Health Check data return on 31 July 2020, the deadline for submission is midday on 4 September 2020. Although delivery activity stopped in the first financial quarter local authorities must still return activity data via the portal, even if this is zero.
As an exception, due to the current circumstances the quarter 4 2019/20 data can also be amended as part of the quarter 1 return. The publication of Q4 2019/20 data has been postponed allowing for more comprehensive data publication following amendments made during Q1 2020/21.