Foreword by Kevin Fenton

 

 

 

 

 

 

We were recently invited to debate the NHS Health Check programme in the Journal of Public Health. While our critics argued that we should abandon the programme on the grounds of cost, flawed delivery and lack of evidence about its effectiveness, we described how the programme offers an increasingly useful, credible and place-based approach to prevent, diagnose and manage an epidemic of largely avoidable chronic diseases.

NHS Health Check is now the backbone of many local authority programmes to improve the health of adult populations, providing a systematic way of engaging individuals in conversations about their health, risk factors and lifestyle modification. It has provided, and will increasingly provide, under the National NHS Diabetes Prevention Programme launched in March a major platform for identifying people at high risk of developing type 2 diabetes.

Millions of adults in England are living with undiagnosed diabetes, hypertension, kidney disease or high cardiovascular risk that could be alleviated through lifestyle and medical interventions. Early detection is key so that behavioural and physiological risk factors associated with these conditions can be treated or managed. NHS Health Check offers a flexible and practical tool to address this rising burden of disease. Discarding the programme at a time when local leadership and delivery systems are in place, when coverage and uptake are increasing, and when implementation studies are highlighting evidence of impact and areas for improvement, would be irresponsible. Rather, we should continue to refine and improve its implementation and delivery, as experience and evidence indicates, so that we maximise the benefits.

Local authorities are finding new ways to deliver the programme, targeting individuals and communities at greatest risk and using initiatives such as health buses and health trainers to reach different groups. Public Health England has introduced measures to strengthen scientific governance, support local authorities with implementation, and increase uptake by marketing and promotion. We are improving the quality of delivery, follow-up and referral to provide better management of patients. More strategically, we continue to improve the data required to evaluate impact and support research that will extend our knowledge.

A local evaluation found that NHS Health Check assessments resulted in a large increase in the appropriate prescribing of statins to patients with a high risk of cardiovascular disease. There is a pressing need to prevent CVD, and although the evidence base is incomplete, there is an increasingly compelling case that NHS Health Check will deliver substantial health benefits in the longer-term. We have much to gain by extending coverage, optimising delivery and running NHS Health Check in concert with other health improvement strategies.

To read the papers go to jpubhealth.oxfordjournals.org/content/current (you will need to be registered to access these papers)

 

Operational update from Jamie Waterall

 

 

 

 

 

We have this month published the latest official statistics on the NHS Health Check programme. This data provides information on offers and uptake for 2014-15 and the two consecutive years since local authorities became responsible for commissioning the programme. It is hugely promising to see that almost 20% of the eligible population were offered an NHS Health Check over the past 12 months and that an extra 100,000 checks were delivered compared to the same time period during 2013-14. Although uptake has remained at just under 50%, quarter four data for 2014-15 showed the highest uptake reported since the programme started at 56%. This is likely to be attributed to the tremendous efforts being made locally to address low uptake in certain regions and I would like to thank all those involved.

Supporting local implementation remains a key priority for PHE. Over the coming year we will be looking at how we can continue to strengthen our support on marketing, programme improvement and research and evaluation. We continue to work with the Health and Social Care Information Centre (HSCIC) to move towards agreeing a national data standard for the programme and we will also be exploring options for collecting a representative or national data collection system.

We have recently been reviewing the frequency and structure of this e-bulletin and would value your feedback on what works and does not. We are keen to capture your local case studies and would request that you flag these via our PHE centre teams. This month we feature a case study from Enfield but we are aware that many areas have useful learning to share with colleagues across England. Further case studies can be accessed here.

Information governance and IT

Many colleagues will be aware that we are pursuing development of a data standard with the Health and Social Care Information Centre (HSCIC) see here. Several of you have supported us in this project. This is a protracted process with several lengthy stages; however we are presently expecting achievement of the new data set within this financial year.

Although the change is essentially an increase in the scope of codes that can be used to record actions and outcomes from an NHS Health Check, there is the introduction of SNOMED CT codes (systematized nomenclature of medicine – clinical terms) for the first time. SNOMED CT has been selected and approved as the terminology to be adopted by the NHS in England. It is the most comprehensive international terminology currently available (>50 countries) and can be used across all care settings and all clinical domains. It is managed and maintained internationally by the International Health Terminology Standards Development Organisation (IHTSDO) and in the UK by the UK Terminology Centre (UKTC).

Commissioners should be preparing their providers for the introduction of a new standard while reinforcing that there will be minimal disruption to the programme. Key messages are that most of this data is already collected, minimising additional burden, there will be no change to the information governance protocols and there will be no change to the safety of the data.

The exact method for extraction of the data standard has not been agreed but we will keep you informed through the normal routes as we progress this detail. System suppliers should align to the new data set once it becomes a standard. However, you should have these discussions in your local contract management groups and particularly where you use third party software providers to extract data.

This upgrade will support the continued development of the programme, allow us to create more comprehensive research methodology and enable us to enhance our epidemiological understanding of the modifiable risk factors for disease.

Special webinars

How Canada transformed outcomes for high blood pressure, Tuesday 14 July, 4-5pm

Since the late 1990s Canada has achieved dramatic improvements in blood pressure diagnosis and control. It is now a world leader. Seven in ten patients are diagnosed and controlled compared to four in ten in England. This webinar is your chance to engage direct with Canada’s leading lights on hypertension to understand how they achieved this transformation. You will hear from national leads as well as individual stories from a doctor, nurse and pharmacist giving their perspective.

This webinar is being hosted by GovToday. Click here to register.

Places are limited, but a video will be released after the event.

 

NHS Health Check webinar series

On Thursday 30 July we will be partnering with GovToday to bring you a special webinar on digital and social marketing. The session will look at the recent development of the heart age tool as well as sharing local experiences in developing social marketing campaigns.

Date: Thursday, July 30, 2015

Time: 2pm

Duration: 1 hour

Register for this webinar: NHS Health Check Webinar Series: Digital and Social Marketing

Reaching high-risk communities - NHS Health Checks in Enfield

In 2014-15 Enfield had the eighth highest modelled prevalence rate of CVD across London and a higher proportion of people diagnosed with diabetes than in London or England. As a result, considerable effort and progress has been made towards achieving the national uptake ambition of 66%.

Between December 2013 and December 2014 Enfield more than doubled the number of residents who had participated in an NHS Health Check by delivering a targeted outreach programme. Enfield wanted to build on this success and increase uptake among more deprived communities. To achieve a proactive approach was adopted to make NHS Health Checks more accessible through the use of community venues such as schools, the local over 50s forum, Jobsnet, a nursing home and the wellbeing centre.

This increased the opportunities for residents to access an NHS Health Check in a known and trusted environment. Importantly for the local authority it has the benefit of increasing partnership working with Enfield’s vibrant voluntary and community sector, many of whom work directly with people from high-risk populations.

For more information on the Enfield NHS Health Check Programme contact Julie Boyd, public health manager, Enfield Council at julie.boyd@enfield.gov.uk

 

Update from CVD leadership forum

Primary care is key to improving outcomes in CVD because primary care is where much prevention and most detection and management take place. Primary care is also a core part of the NHS Health Check pathway because people found to have high CVD risk, high blood pressure, CKD or ‘pre-diabetes’ need appropriate investigation and management and most of this is delivered in primary care.

Although we have a very effective primary care system we also know there is considerable room for improvement with substantial variation between practices in diagnosis and treatment rates that is not accounted for by population differences.

In response, a group of 27 GPs, nurses and pharmacists from across England has recently established the Primary Care CVD Leadership Forum. The aim of the group is to offer an authoritative primary care voice and to generate a constructive dialogue around early diagnosis and prevention. Royal College of General Practitioners (RCGP) has also now established CVD as a clinical priority and has appointed a college lead for CVD. The shared priorities of the leadership forum and the RCGP programme are improved detection and management of hypertension, atrial fibrillation and CVD risk.

So far the forum has helped develop the CVD Intelligence packs and linked regional workshops, submitted consensus responses to NICE consultations on CVD risk, published an editorial on blood pressure and written to Pulse challenging an article suggesting the NHS Health Check should be abandoned. We are now developing key message documents to support improved detection and anticoagulation in atrial fibrillation.

Update on the National Diabetes Prevention Programme (NDPP)

The NHS Diabetes Prevention Programme (NDPP) was launched in England on Thursday 12 March 2015 as a collaborative programme between NHS England, PHE and Diabetes UK. Seven initial demonstrator sites have been selected to implement the first phase of the programme and represent a portfolio of diverse geographic and population characteristics. These are:

• Birmingham South and Central clinical commissioning group (CCG)
• Bradford City CCG
• Durham County Council
• Herefordshire CCG and local authority
• Medway CCG and local authority
• Salford CCG and local authority
• Southwark Council and CCG

These demonstrator sites will test the real-world applications of the approaches described in the randomised controlled trials. A national rollout is planned from April 2016 with a goal to have 10,000 high-risk individuals from demonstrator sites enrolled onto the programme in 2015-16.

In parallel, a national procurement exercise is underway and we witnessed around 50 organisations attend the provider day on 19 May 2015. The discussions in the room highlighted the excitement and buzz around this programme.

NHS Health Check will play an integral role in identifying high-risk individuals onto this programme and we are engaged with the team to make this happen.

Supporting NHS Health Checks uptake

We in PHE marketing are big fans of the NHS Health Checks and are actively looking for ways to improve consumer awareness and uptake. During 2014-15 we launched the marketing tool kit, PR tool kit, image bank and poster and outdoor visuals to support all those promoting and implementing the NHS Health Check programme.

The role of the PHE marketing team is to change the behaviour of individuals, families, workforces, communities and businesses, so that it becomes easier for all of us to live healthier, longer and more fulfilled lives.

We do this by:

• gaining insight into why people behave as they do
• deploying learning from the behavioural sciences to change behaviour
• understanding the needs of local communities
• developing impactful creative campaigns

The NHS Health Check is a national programme implemented locally, so our national marketing campaigns need to support local variation and supply. Consequently we have worked with NHS Choices, Jamie Waterall and his team to refresh the consumer-facing content on NHS Choices, launched a national service directory tool, allowing members of the public to search for their local NHS Health Check service, and launched the heart age tool. On average the NHS Health Check pages on NHS Choices receives 100,000 visitors per month, 6,000 searches are completed every month using the service directory tool and 666,000 people have calculated their heart age.*

In 2015-16 we will continue to support those promoting and implementing the programme locally. We will design a regional testing programme to identify which messages and media are most effective at creating awareness, driving usage and assessing the level of local demand generated. We are also exploring ways in which to include the Health Checks message in our upcoming national adult Live Well campaign which will launch in January 2016.

Access free NHS Health Check marketing and branding resources here.

*Number of people who have completed the heart age tool between 14 February 2015 and 16 June 2015.

Schedule of publication for 2015-16 quarterly data returns

We have now finalised the schedule of publication for 2015-16 quarterly data returns.

For your convenience data submission deadlines for this year are also detailed below:

Financial Quarter	Date portal opens for data submission	Deadline to return data	Date of publication
2015-16 Quarter 1	1 July 2015	31 July 2015	Wednesday, 26 August 2015 at 9:30am
2015-16 Quarter 2	1 October 2015	30 October 2015	Wednesday, 25 November 2015 at 9:30am
2015-16 Quarter 3	4 January 2016	29 January 2016	Thursday, 25 February 2016 at 9:30am
2015-16 Quarter 4	4 April 2016	13 May 2016	Wednesday, 15 June 2016 at 9:30am