Yorkshire and Humber Public Health Network

Did you know that Cardio-vascular disease is the leading cause of disability and death in our country?  Not only does it account for 1 in 4 premature deaths – it costs the NHS around a staggering £9 billion per year. 

We know that prevention is the most sensible approach to tackling this, and so I find it significantly heartening that this has such a prominence in the NHS Long Term Plan.

The stated ambition is to prevent 150,000 heart attacks, strokes and cases of dementia. We need to see this as an opportunity to review locally, how we work with the NHS, to make this ambition a reality.

The NHS Health Check was introduced in 2009 across the country.  The aim was to prevent cardiovascular disease – including heart disease, stroke, diabetes, kidney disease and certain types of dementia. In other words, a contribution to match the ambitions of the NHS Long Term Plan. People aged 40 – 74 without those conditions are offered a NHS Health Check once every five years. An assessment of risk is undertaken, and where appropriate lifestyle support and guidance are offered to tackle behaviour risk factors.

Between April 2012 and March 2018, 6.3 million people have had a NHS Health Check. There has been a 48% uptake. For every 30 – 40 checks one person was diagnosed with hypertension, for every 80 – 200 checks one person was diagnosed with type 2 diabetes and for every 6 – 10 checks one person was identified as being of high risk of CVD.

So does this mean the Health Check has been a success?

Since its introduction, the programme has received a great deal of criticism. In 2012 research from the Cochrane Group found the NHS Health Check did not reduce mortality. In 2013, the Royal College of GP’s said the NHS Health Check was a complete waste of money. On the other hand, a national research study in 2015 stated that the programme is cost effective; can prevent illness and potentially can save 250 – 500 lives each year across England.

The responsibility for the NHS Health Check moved to Local Authorities in 2013, as a mandated service. Many took the opportunity to tailor the delivery model of NHS Health Checks to meet the needs of their local population, with a particular focus on reducing inequalities in health. Many local authorities procure the service via primary care where others have commissioned this outside primary care and joined it with their healthy living services. All of this has occurred through continuing cuts to the Public Health Grant.

So what does the future hold for the Health Check?

We do know that it is going to change. The governments Green paper, Advancing our Health: Prevention on the 2020’s states that the NHS Health Check should be targeted to those at high risk or from disadvantaged communities - those who shall benefit the most from risk reduction interventions. The Green paper states the government will commission an evidence based review of the programme. Although details (and timescales) are to be confirmed, it is likely that the review will look at ways of increasing uptake, specifically amongst high risk groups. Plus a focus on new ways of delivery including greater use of digital delivery options.

I believe that Local Authorities should be working jointly with the NHS to deliver the ambitions of the NHS Long Term Plan. At the moment it looks as though the NHS Health Check is here to stay in some shape or form. We need to get the greatest benefit from this. An issue for debate alongside the nature of the NHS Heath Check is whether responsibility should/will move from local authorities back to the NHS. What is your view?

Dr Ian Cameron is the Director of Public Health at Leeds City Council.