NHS Health Checks programme ‘evidence based’, public health chief insists
The head of NHS Health Checks had defended the programme against criticisms it is not evidence based.
Professor Kevin Fenton, head of health and wellbeing at Public Health England (PHE), told Pulse the programme was being run on sound principles and rejected calls from GP leaders and academics to change track and focus on more opportunistic checking in people known to be at high risk.
The NHS Health Checks programme involves a five-yearly cardiovascular risk check-up in everyone aged 40-75 years and was taken over by PHE in April last year, but has been heavily criticised since it was introduced for not being based on outcomes evidence and for potentially increasing health inequalities.
Research has also questioned the impact of the programme, with one recent study finding it did not increase diagnoses beyond usual opportunistic testing in primary care. Even advisors to PHE have suggested targeting only the highest risk people would be a more evidence-based method.
But speaking to Pulse at the annual PHE conference at the University of Warwick, Professor Fenton insisted the public health body was taking an evidence-based approach in taking the programme forward.
Professor Fenton said: ‘We have a research and evaluation strategy, where we’re going to be supporting more research to look at different models that are evolving, so we can see what works and how we can enhance the programme.’
He added: ‘There are various schools of thought on this. [Professor] Michael Marmot often talks about whether you focus on the 20% who are most deprived, or whether you shift an entire population distribution – so, offer your interventions to everyone, but intensify in the highest risk.
‘We’re excited [various areas] are looking at different models, but we can’t change the whole programme based on one study here or there. We need to have a strategic way of doing this.’
Professor Fenton said the poor record up to now on diagnosing chronic conditions meant simply doing more opportunistic testing would not work.
‘If opportunistic was the way forward and if we knew that worked, we would have been doing a much better job of tackling some of the high levels of undiagnosed chronic diseases that we have in this country,’ he said.
‘Given the pressures on GP practices and what we know about opportunistic screening, perhaps that’s not the only solution. What Health Checks offers is a systematic way of looking at your population, offering them this test and then intensifying it for those at greatest need.’
According to PHE, the programme is making significant progress since local authorities took over commissioning services, reaching an ‘all time high’ in terms of coverage, although Professor Fenton conceded the actual uptake of offers has plateaued at around 50%.
He said: ‘Over the past 18 months we’ve seen a gradual and sustained increase in the number of people offered the Health Check in England and we’re now at an all-time high in terms of coverage
‘Uptake is still hovering at about 50% and in the second year we’ve set ourselves a real target to focus on what we can do with local partners to raise uptake of the programme. Our ambition is to see what we can do to reach a 66% [uptake] goal, but recognising there is a lot of variation across the country - some areas have already surpassed that [level], others are still behind. So, what we need to do is tailor things locally to achieve that.’