Foreword by Professor Kevin Fenton
How will we know whether the NHS Health Check programme is working? It’s a huge question and when you start to unpick it, you realise how many questions it actually implies.
First, we want to know what the uptake is: who is getting the checks and where? Even more importantly, we need to know who isn’t using the service, and why? We will want to know what the pattern of risk factors and disease looks like, and what interventions have been offered. As we gain more experience we’ll be asking whether there are ways of implementing and delivering the NHS Health Check programme that work better than others. Ultimately, of course, what we want to know is: what impact is NHS Health Check having? Is it improving health outcomes at the individual or community level?
These are fundamentally important questions to be asking because it’s imperative, for both scientific and ethical reasons, to understand that the investments we are making in the programme are achieving the desired outcomes. This can only be achieved through a process of rigorous and systematic evaluation of a programme that involves the health of 15 million people. So what does the evaluation look like for NHS Health Check programme?
The first thing to mention is the two small-scale independent studies on the NHS Health Check programme, commissioned and funded by the Policy Research Programme in the Department of Health. The aim of these studies is to provide an early assessment of the programme outcomes since implementation began in 2009. The studies will assess uptake, describe variations in risk factors, estimate the impact on health outcomes and - where possible- assess different models of local implementation. In addition, we are aware that many local areas are undertaking their own research and evaluations looking at various components of the programme: how it is governed, delivered and its outcomes. PHE is very supportive of these “real world” studies, and in the months ahead we will be systematically collecting information on all of this activity so that we share information on what is being learned, and help promote dissemination, translation and implementation of findings.
But in the meantime, we have a lot to learn from published research that provides some early, local evaluations of the NHS Health Check programme (please see below for links to the abstracts). For instance, Artac et al looked at uptake of the programme in Hammersmith and Fulham, London. They also looked at the pattern of statin prescribing in patients who were confirmed with high cardiovascular disease risk. They found an increase in the percentage of such patients who were prescribed a statin after the programme.1 This is important because recent research has highlighted a problem in the UK of under-use of statins in high-risk patients (and over-use in low-risk patients).2
Another early study, also by Artac et al looked at whether the NHS Health Check programme is associated with a reduction in cardiovascular disease risk after one year.3 They found significant but modest reductions among screened high-risk individuals. These are early assessments, of course, but we can still learn from their insights and conclusions. For instance, some call for further cost and clinical effectiveness analysis, to better assess the impact that the programme could have at a population-level. Another paper highlighted the need to increase coverage of the NHS Health Check programme, stressing a multi-disciplinary approach.4
As you know, we are committed to leading this programme with the highest scientific credibility. This means ensuring we have appropriate scientific governance in place - through our Expert Clinical and Scientific Advisory Panel - which will review emerging evidence and promote future research and evaluation. It means promoting, supporting, disseminating and learning from programme research and evaluation. It means being able to make the economic case for NHS Health Check via a refresh of the modelling undertaken in 2008, and supporting related studies in the future. And finally, it means that we continue to challenge our assumptions in light of new data and experience. Doing all of these things right is part of our moral obligation to make sure we are being good stewards of the public’s trust and resources, and that we are not, inadvertently, causing any harm in our mission to improve the population’s health.
1 Artac M, Dalton ARH, Majeed A, Car J, Huckvale K, Millett C. Uptake of the NHS Health Check programme in an urban setting. Family Practice 2013;30(4):426-35.
2 Soljak Michael A, Majeed A, Millet C. NHS Health check or government by RCT? Response to Krogsboll et al BMJ2013;347:f5227
3 Artac M, Dalton ARH, Majeed A, Car J, Millett C. Effectiveness of a national cardiovascular disease risk assessment program (NHS Health Check): Results after one year. Preventive Medicine 2013(0).
4 Artac M, Dalton .RH, Soljak M, Babu H, Bates S, Millett C, Majeed A. Primary care and population factors associated with NHS Health Check coverage: national cross-sectional study. Journal of Public Health, Vol. 35, No. 3. (01 September 2013), pp. 431-439, doi:10.1093/pubmed/fdt069