It’s always encouraging to hear how an NHS Health Check has changed someone’s life. Take Rajiv, who discovered he had type 2 diabetes after taking up the offer of an NHS Health Check. On the doctor’s advice, he reduced sugar in his diet and started to walk more every day. Within time, he was able to come off insulin and control his blood sugar levels just by diet and being more active, which of course was also beneficial for his wider health and wellbeing
That’s just one man. Imagine that story multiplied thousands of times. According to the first major evaluation of NHS Health Check, published in the British Medical Journal Open last month, the programme is helping to identify an estimated 10,000 new cases of diabetes, 4,500 new cases of kidney disease and 44,000 new cases of hypertension every year.
The research also suggests that, over the first five years of the programme, at least 2,500 people would have avoided a heart attack or stroke as a result of medication recommended and started after their Check.
In other words, we’re finding potential or early stage diseases before they become a danger to people’s health. By identifying these conditions earlier and referring people for evidence-based interventions, the NHS Health Check is providing a valuable prevention programme that will help people live longer, healthier lives and reduce future demands, and importantly costs, on the NHS.
NHS Health Check is the first programme of its kind in the world. It seeks to reduce the burden of largely preventable disease by encouraging people to take an active part in improving their health. Adults aged 40 to 74, who have not previously been diagnosed with a vascular disease, are offered a free Check every five years to assess risk factors such as high blood pressure, smoking, cholesterol, inactivity, harmful drinking and obesity and, if necessary, provide medical treatment or referral to a range of lifestyle interventions.
During the latest evaluation of the programme, a study team, led by Queen Mary University of London, analysed data from 655 general practices in England in the four years from April 2009 to March 2013. Data relating to 214,295 people who attended an NHS Health Check was reviewed and compared against 1.4 million people who had not yet been offered or taken up a Check.
The researchers found that the NHS Health Check has made a ‘modest, but successful start’ in identifying people at risk of cardiovascular disease (CVD) and other chronic conditions. On a positive note, the study found that the programme is helping to tackle health inequalities. It is reaching black and minority ethnic groups and people from deprived areas, who are most at risk of their condition being missed or diagnosed too late. For example, attendance by the most socially disadvantaged people was higher than the most affluent (14.9% vs 12.3%), refuting criticism that the Checks are skewed towards the ‘worried well’.
Overall, one new case of hypertension was identified for every 27 Checks carried out. For diabetes, one new case was found every 110 Checks and for kidney disease the detection rate was one case per 265 Checks. One in eight attendees were found to have a high risk of CVD.
The evaluation - the largest and most comprehensive to date - also usefully highlight a number of areas where there is room for improvement. For example, people under 65 were less likely to attend a Check than those over 65. We need to investigate whether this is the result of targeting those at high CVD risk (those aged over 65) or whether people of working age have difficulty accessing the Checks.
While attendance has increased progressively since 2009, the programme’s coverage across the target population needs to further expand. We are making good progress. During 2014/15, an additional 100,000 people received a Check compared to the year before, and latest figures show that 48% of all eligible people attend when invited. Ideally, however, we want uptake rates of 75% and beyond. PHE is working with local authorities, who commission NHS Health Checks in their areas, to increase uptake so that the programme reaches its full potential.
There is also scope to increase treatment with statins. The study found that only 20% of those at highest CVD risk were prescribed medication. While the researchers say this could be higher, they believe that at a national scale, treatment for 1 in 5 attendees at highest CVD risk was likely to have contributed to “important reductions in CVD events.”
In England, two-thirds of deaths among people under the age of 75 are thought to be avoidable. In addition, there are many, many cases of undiagnosed disease, including largely preventable illnesses such as type 2 diabetes, stroke, cancer and heart disease. That’s why the NHS Health Check programme is so important. Through early identification, people have a chance to address lifestyle or clinical risk factors before it is too late.
We should be encouraged, and influenced, by the results of this important research. For members of the public, it provides a persuasive argument to attend their Checks when invited. The results should also galvanize health professionals and commissioners into improving rates of uptake, referral and follow-up of the interventions that are included in the NHS Health Check.
If it can reach its full potential, the programme will not only save thousands of more lives, but help large numbers of people live healthier and have a better quality of life for longer – as well as hugely contributing to reducing the burden on the NHS.