NHS Health Check eBulletin - February 2021

Foreword

Dr Shahed Ahmad

National Clinical Director for Cardiovascular Disease Prevention, NHS England and NHS Improvement

When I reflect on why I’m passionate about Cardiovascular disease (CVD) prevention, it’s because it’s the best and fastest way to reduce health inequalities. In England, CVD kills about 136,000 people a year; which is very roughly similar to the number of lives we’ve lost from COVID-19. CVD is the largest cause of health inequalities, as measured by the life expectancy gap. Like COVID-19, there’s emerging evidence about what works to prevent it, but there’s also a lot we already know and need to ensure we apply well and equitably.

Like COVID-19 prevention, leadership is needed at a national, regional, Integrated Care System (ICS) and local level. That leadership needs to be properly resourced and supported, and it needs to be multidisciplinary, including public health experts, data analysts, social marketing leads, and personalised care specialists, doctors, nurses, pharmacists and allied health professionals. As with preventing COVID-19, faith leaders, the voluntary sector, local politicians and many other leaders can help to deliver the best outcomes.

Nationally we have established a CVD Prevention Cardiac Delivery Board, a CVD Prevention Clinical Leadership Group, and a #ZeroCVD social media group which includes hundreds of people across the country, as well as expert advisory groups for hypertension, atrial fibrillation (AF) and familial hypercholesterolaemia. Patients and our third sector partners are key to these groups. As part of this, we have just commissioned NHS Benchmarking to be a delivery partner for CVD Prevent - a national primary care audit that will automatically extract routinely held GP data covering diagnosis and management of six high risk conditions. 

Many places have established regional CVD prevention leadership groups and areas such as Cheshire and Merseyside, and West Yorkshire and Harrogate have excellent ICS level leadership groups. Detecting the undetected and reducing unwarranted clinical variation are the major challenges for all the groups. As a national prevention programme the NHS Health Check has a crucial role to play in detecting and preventing CVD in adults aged 40-74. Emerging evidence shows that many of the risk factors assessed during an NHS Health Check are not only major contributors to the burden of CVD, but some of these risk factors such as obesity and diabetes are also associated with poorer health outcomes from COVID-19. This is why the NHS Health Check programme continues to be vital and I would like to take this opportunity to thank you for your continued support of the programme.

We have made huge strides nationally in reducing smoking and detecting and managing atrial fibrillation. Where we have made less progress, is in tackling high blood pressure. Some other countries have done better than us. In 2021 we intend to improve hypertension detection and management. Our main national drive on this is to support people to remotely monitor their blood pressure at home. GPs have told me how much this reduces their own workload and how their patients like it. We have already distributed nearly 18,000 blood pressure monitors to CCGs, building on our learning from COVID-19 oximetry. As the year goes on the NHS will look to increase blood pressure detection in pharmacies, general practice and other venues and will look to further improve control.  Repeating the key message that if we want to tackle the gap in life expectancy, we need to move the dial on CVD prevention. With our support, people will be able to self-manage their own CVD health, but we must continue to focus on those most at need and do this in a multidisciplinary way. If we apply the energy and discipline to CVD prevention that we have to preventing COVID-19 and ensuring equitable immunisation, we will save thousands of lives.

Operational Update

Katherine Thompson

Head of Cardiovascular Disease (CVD) Prevention Programme, Public Health England

@thomp_katherine

I hope you and your families are keeping well as we continue to navigate the third national lockdown. With the ongoing pressures from COVID-19 I would like to take this opportunity to relay my thanks to everyone for doing their bit, from staying at home to supporting the vaccination programme in order to keep us all safe.

I know that many colleagues have worked extremely hard over the last eight months to keep some level of provision of NHS Health Checks in operation despite the continually changing context and pressures from COVID-19. I wanted to thank you for your ongoing commitment and leadership and again emphasise that due to the ongoing extenuating circumstances, we will not be scrutinising NHS Health Check delivery activity at this time.

As set out in our restart guide, I would like to encourage all Local Authorities to use the current context and any pauses in delivery as an opportunity to consider how NHS Health Check implementation might be improved in the future. In particular by giving thought to how a proportionate universal offer – where resources are unequally distributed in order to maximise engagement from those individuals who most likely to be at higher risk of CVD - and alternative delivery models could be adopted. Its been great to hear from Cornwall and Medway on their experiences in one of our recent webinars.

On the 1 March we will be publishing our findings from a recent survey we’ve undertaken to understand the local models used to deliver NHS Health Checks in 2019/20. Over 100 people joined us on the recent webinar which shared the findings of this work, if you weren’t able to make the session you can still find it on our website. We will also be publishing findings from an analysis of physical activity and alcohol consumption measurements in NHS Health Checks, and the researchers will be sharing the key findings at our webinar on 11 March 2021. Join others in staying up to date on all our recent publications via our latest news page and by subscribing to our CVD prevention webinar series.

Clearly, we are still, and will continue to be, faced with evolving challenges as the COVID-19 response continues. However, as we emerge from this pandemic there is a real opportunity to consider the contribution that tackling cardiovascular disease (CVD) can make to mitigating against poor COVID-19 outcomes. Find out more in our recent blog to mark two years since the national CVD ambitions were launched and why action on CVD prevention remains as important as ever.

NHS Health Check Review Update

Thank you to everyone who contributed to the review of the NHS Health Check programme through the workshops and online survey. The insights and views provided have been invaluable in shaping and informing the work of the review. Together with evidence from other sources, including academic literature and the analysis of data from the programme, they have been crucial to the development of the review’s findings and recommendations.

All of this information is now being brought together in the final report of the review, which will be published in the Spring. This will set out the review’s conclusions on how the programme should evolve to maximise its potential over the next decade and beyond in preventing ill-health and reducing health inequalities; and its recommendations for the government on how best to achieve this.

Digitalisation of the NHS Health Check

As a key component of the work exploring digitalisation of the NHS Health Check, Public Health England (PHE) have commissioned the health app assessment company, ORCHA to identify and assess existing digital health products capable of delivering a complete NHS Health Check. This has been achieved through an open call, web and database searching, followed by a staged quality assessment process, which includes a detailed clinical and technical review. We will be sharing the findings of this work through a national webinar, so join others in subscribing to the CVD prevention webinar series.

Continuing with our exploration of digital solutions, we will be publishing a compilation of practice examples of digital solutions identified through the international literature. This is an opportunity to showcase some of the digital solutions and platforms being used internationally to assess CVD risk.

Cardiovascular Disease Prevention Programme data packs

The National Cardiovascular Intelligence Network (NCVIN) at PHE will soon be releasing the latest iteration of their Cardiovascular Disease (CVD) Prevention Programme data packs.  This fourth version is designed to provide up to date information to help meet the National CVD Prevention ambitions published in 2019.  The packs include the latest Quality Outcomes Framework (QOF) data including the new measures for hypertension. In addition to showing the variation in the detection and treatment of hypertension and atrial fibrillation included in previous versions, the new packs have been significantly expanded to include a number of other risk factors for cardiovascular disease. Data on NHS Health Checks are now displayed alongside behavioural risk factors and data on inequalities. The slides display General Practice level data and can be used by local areas to prioritise prevention efforts across Clinical Commissioning Groups and Strategic Transformation Partnerships/Integrated Care System footprints. The packs will be available on PHE fingertips at the beginning of March.

Our Future Health

At the very end of 2020, after extensive stakeholder and public engagement, the Accelerating Detection of Disease programme was renamed: Our Future Health (OFH). As a reminder of the purpose, OFH will be the UK’s largest ever health research programme, designed to enable the discovery and testing of more effective approaches to prevention, earlier detection and treatment of diseases. It will collect and link multiple sources of health and health-relevant information, including genetic data, across a cohort of 5 million people that truly reflects the UK population. This will create a world-leading resource for academic and commercial researchers to undertake discovery research on early indicators of disease, plus the opportunity to re-contact participants on a risk-stratified basis for secondary studies.

Over the course of 2020 many NHS Health Check commissioners and providers volunteered to participate in a pilot project to test the delivery of OFH through the NHS Health Check, which was due to begin in Spring 2021. However, because of the ongoing COVID-19 restrictions across the country and the vaccine roll-out, it is now expected that there will be a delay of between 3 to 6 months on the delivery of the pilots. OFH remain committed to working in partnership with primary care and alongside NHS Health Checks. Do reach out to Claire Levermore at Claire.levermore@ourfuturehealth.org.uk  if you would like to discuss plans and options for future involvement or if you have any questions.

Cardiovascular Disease (CVD) Prevention Webinar Series

You can subscribe to our webinar mailing list here. Upcoming webinars include:

• Alcohol consumption and physical activity measurements in NHS Health Checks - 11 March 2021, 11:30 – 12:30. For more information and to book a space click here
• Identification of digital products capable of delivering an NHS Health Check – 24 March 2021, 12:00 – 13:00. For more information and to book a space click here

Please note webinar times are subject to change.

You can find the presentations and videos for past webinars here.