NHS Health Checks

LTP Priority: Cardiovascular Disease (CVD) Prevention

Population Intervention Triangle: Segments (link to Section 1 PHE PBA): Service

Type of Interventions: NHS Health Checks

Major driver of health inequalities in your area of work

Cardiovascular disease (CVD) is one of the conditions most strongly associated with health inequalities. If you live in England’s most deprived areas, you are almost four times more likely to die prematurely than those in the least deprived areas. CVD is also more common where a person is male, older, has a severe mental health illness, or ethnicity is of a South Asian or African Caribbean descent.  CVD accounts for more than a quarter of deaths (> 124,000) in England and is the largest cause of premature mortality in deprived areas.

Target groups

Deprivation. Protected characteristics . We promote a proportionate universalism approach to delivering the NHS Health Check, therefore providing an opportunity to target several protected characteristic groups, including: age, ethnicity, sexual orientation and disability.

Intervention

NHS Health Check Programme

The NHS Health Check programme is a world leading non-communicable disease prevention programme, targeting key conditions such as heart disease, stroke, diabetes and certain cancers and dementia. The check includes assessment and management of key behavioral risk factors such as obesity, physical inactivity, smoking and alcohol, and physiological risk factors such as high blood pressure, blood glucose and cholesterol. These factors are highlighted as the leading risk factors detailed in the Global Burden of Disease Study contributing to the greatest sum of DALYs across the population. It aims to improve health and wellbeing of adults aged 40 to 74 years, focussing on evidence-based risk reduction interventions supported by NICE and which are detailed as priority areas included in the NHS LTP.

By developing and redesigning approaches to the NHS Health Check and working with local authorities, commissioners, voluntary sector partners, community pharmacists and GP practices, there are further opportunities to improve the effectiveness and reach to specific health groups to rapidly case find and treat those identified with behavioural and high-risk conditions as committed within the NHS LTP.

Responsibly for delivering the NHS Health Check sits with local authorities (LAs), who need to work closely with their CCGs to ensure that there is a joined-up approach to the risk assessment and behavioural and clinical follow-up risk reduction interventions.

Evidence

A comprehensive rapid evidence synthesis completed by The University of Cambridge and RAND in 2017 confirmed that a NHS Health Check detects risk factors and disease in members of the public who attend:  a new case of raised blood pressure is found identified in approximately every three to four NHS Health Checks delivered, with a new diagnosis of hypertension made in approximately every 30-40; a new diagnosis of diabetes is made for every 80-200 NHS Health Checks and a person with a cardiovascular disease risk ≥ 20% identified in every six to ten checks provided.

It is estimated that the NHS Health Check programme is preventing approximately 300 premature deaths (before 80 years) and resulting in an additional 1,000 people at age 80 years being free of cardiovascular diseases, dementia and lung cancer each year in England.   The absolute effect on health was greatest for those living in the most deprived areas. (Mytton OT, Jackson C, Steinacher A, Goodman A, Langenberg C, Griffin S, et al. (2018) The current and potential health benefits of the National Health Service Health Check cardiovascular disease prevention programme in England: A microsimulation study. PLoS Med 15(3): e1002517.

The NHS Health Check can successfully engage people with the greatest health needs, actively reducing health inequalities, and individuals having a check are more likely to be diagnosed with a disease and to receive behavioural or clinical management to help them reduce that risk or manage the health condition.  Additional research by Robson et al, BMJ Open confirmed that NHS Health Check attendance by the more socially disadvantaged, a population group at higher cardiovascular disease (CVD) risk, was higher (14.9%) than that of the more affluent 12.3%. (2016: Robson J, Dostal I, Sheikh A, et al. The NHS Health Check in England: an evaluation of the first 4 years. BMJ Open 2016;6:e008840. doi: 10.1136/bmjopen-2015-008840)

Guidance for Commissioners