NHS England’s National Clinical Director for Cardiovascular Disease Prevention looks at the evidence so far:
Public Health England’s Expert Scientific and Clinical Advisory Panel published a report this month summarising the emerging evidence on the NHS Health Check programme.
This world-leading programme, launched in 2009, is one example of how the NHS getting serious about prevention.
The NHS Health Check is offered to all eligible adults between 40 and 74 every five years. Currently around 1.5 million people take up this offer every year – that is 1.5 million one-to-one conversations that help people to understand their personal risk profile and to take steps to modify that risk.
The check includes lifestyle risk factors such as diet, physical activity, smoking and alcohol, and physical risk factors like high blood pressure, blood sugar and cholesterol. Together these risk factors contribute to cardiovascular disease (CVD) and other non-communicable conditions such as dementia, respiratory disease and some cancers.
So how effective is the NHS Health Check?
The early evidence summarised in the report is encouraging and provides important lessons. Firstly, undiagnosed high-risk conditions are being identified. For example, at current rates we can expect that over the five-year cycle 700,000 people at high risk of cardiovascular disease will be detected. An additional 175,000 patients with hypertension, 35,000 patients with type 2 diabetes and 11,500 patients with chronic kidney disease will be diagnosed earlier so that they can be offered more timely support and clinical interventions. The value of early diagnosis is that in each of these conditions, there is robust evidence that medical treatment substantially reduces the risk of life changing events such as heart attack, stroke and dementia.
Secondly, the programme is achieving its objective of tackling health inequalities – people from the most deprived populations are at least as likely to have the check as people in affluent communities, addressing early concerns that only the ‘worried well’ would be attracted.
The report also shows where improvement is needed. Currently only half of all people invited for the NHS Health Check take up the offer. Increasing uptake must be a priority if we are to maximise the programme’s potential for preventing premature death and disability.
The emerging evidence also suggests that people attending the NHS Health Check are often confused by their cardiovascular risk score. Communication of risk is a crucial step in supporting behaviour change, and work is needed to understand the value of tools such as Heart Age in making this communication more effective.
In addition, studies have shown there is significant variation in how well risk factors are managed after the NHS Health Check. For example, there is evidence of variation in referral to lifestyle services such as smoking cessation and weight management. And while statin prescribing for people with high cardiovascular risk is more frequent among attendees than non-attendees, prescribing rates are significantly below what might be expected from implementation of the NICE CVD prevention guidance.
So, the early evidence is encouraging but there is clear potential for improvement and the report makes a number of recommendations for the NHS. These include:
Everyone having an NHS Health Check should benefit from tailored lifestyle advice and access to local services, such as stop smoking services, and/or clinical management to help them reduce their CVD risk.
Statins and antihypertensives should be prescribed to patients in line with NICE guidance, and general practice should be incentivised to prescribe them in addition to lifestyle advice where appropriate.
The NHS RightCare CVD Prevention Optimal Value Pathway should be used to optimise clinical management of high cardiovascular disease risk conditions such as raised cholesterol and hypertension.