An article from my research group examined coverage of the NHS Health Check programme in England. The article was published in the journal Preventive Medicine. We found that coverage of the programme was low in the first four years and there was a wide variation in coverage between general practice.
There was an increase in statin prescribing but only about one in three people who attended for a Health Check and who were found to have a cardiovascular risk score (20% or more 10-year risk of cardiovascular disease) were prescribed a statin.
We concluded that unless coverage of the NHS Health Check programme improved and uptake of statins in high-risk groups increased, the programme would not deliver its predicted benefits in reducing morbidity and mortality from cardiovascular disease.
The article was covered by a number of media outlets including the Daily Mail and Pulse.
Our analysis of impact of the NHS Check programme on cardiovascular disease risk was published in the Canadian Medical Association Journal in May 2016. The programme had statistically significant but clinically modest impacts on the risk for cardiovascular disease (CVD) and individual risk CVD factors, although diagnosis of vascular disease increased.
Overall program performance was substantially below national targets, which highlights the need for careful planning, monitoring and evaluation of similar initiatives internationally. The effect of the programme on CVD risk was the equivalent of one CVD event (e.g. heart attack) prevented for every 4,762 people who attended a health check in a year.
For the NHS health check scheme to be effective, it needs to be better planned and implemented – our work will help highlight how this can be done. In future we plan to evaluate whether particular groups – for instance older patients – have greater health benefits from the check than younger patients. It would also be interesting to investigate the reasons why the health check produced such modest benefits. For instance, to evaluate the advice patients are given during the health check.
The article was covered by a number of media outlets including The Guardian, Daily Mirror, Daily Mail, Science Daily, Independent, Times, Western Daily Press, Pulse, GP, Sun, BMJ, OnMedica, Nursing Times and BT.
A study from my department published in the journal BMC Health Services Research assessed how effective the NHS Health Check Programme was in reaching under-served groups.
Cardiovascular disease (CVD) is the leading cause of premature mortality and a major contributor of health inequalities in England. Compared to more affluent and white counterparts, deprived people and ethnic minorities tend to die younger due to preventable CVD associated with lifestyle. In addition, deprived, ethnic minorities and younger people are less likely to be served by CVD prevention services. This study assessed the effectiveness of community-based outreach providers in delivering England’s National Health Services (NHS) Health Check programme, a CVD preventive programme to under-served groups.
Between January 2008 and October 2013, community outreach providers delivered a preventive CVD programme to 50,573 individuals, in their local communities, in a single consultation without prescheduled appointments. Community outreach providers operated on evenings and weekends as well as during regular business hours in venues accessible to the general public. After exclusion criteria, we analysed and compared socio-demographic data of 43,177 Health Check attendees with the general population across 38 local authorities (LAs).
Using Index of Multiple Deprivation, the mean deprivation score of the population reached by community outreach providers was 6.01 higher (p < 0.05) than the general population. Screened populations in 29 of 38 LAs were significantly more deprived (p < 0.05). No statistically significant difference among ethnic minority groups was observed between LAs. Nonetheless some LAs – namely Leicester, Thurrock, Sutton, South Tyneside, Portsmouth and Gateshead were very successful in recruiting ethnic minority groups. The mean proportion of men screened was 11.39% lower (p < 0.001) and mean proportion of 40–49 and 50–59 year olds was 9.98% and 3.58% higher (p < 0.0001 and p < 0.01 respectively) than the general population across 38 LAs.
We concluded that community-based outreach providers effectively reach under-served groups by delivering preventive CVD services to younger, more deprived populations, and a representative proportion of ethnic minority groups. If the programme is successful in motivating the under-served groups to improve lifestyle, it may reduce health inequalities.