Gerada: Scrap health checks programme
RCGP chair Professor Clare Gerada has backed a call from Danish researchers for the NHS Health Checks programme to be scrapped.
Professor Gerada spoke out after the researchers had a letter published in The Times newspaper, in which they claim UK public health ministers are ignoring evidence the programme to identify and treat patients at high risk of cardiovascular disease does more harm than good.
Dr Lasse Krogsbøll and colleagues from the Nordic Cochrane Centre last year published a systematic review that concluded general health checks were not beneficial and would likely lead to unnecessary diagnoses and treatments.
In their letter today, the researchers complain that the NHS Health Checks website put out an eBulletin at the time saying the research was ‘irrelevant’, but then refused to publish the team’s rebuttal.
They write: ‘Instead of defending the existing programme, the leaders of the NHS Health Check should have opened a debate with Government about closing the NHS Health Check, which currently operates in direct conflict with the best available evidence, and against the criteria of the UK National Screening Committee.’
Dr Gerada said the team’s evidence showed population screening would not reduce deaths, and said the programme risked overtreatment and wasting NHS resources that would be better put into other public health projects such as cutting smoking rates.
She said: ‘We run the risk of putting people on unnecessary medication or worrying them unduly. At a time when the NHS is having to slash its budgets and GPs and practice nurses are already at breaking point as a result of rising workloads and dwindling resources, this is not the best use of time or money that should be spent on caring for people who are sick or at high risk of illness.
‘We should be focusing on what we know and the biggest reductions in cancer and cardiovascular disease have come from major public health campaigns such as the ban on smoking in public places.’
Laying out their criticisms further in the BMJ, Dr Krogsbøll and team contrast the UK’s response to that of the Danish Government: ‘In Denmark, systematic health checks had not yet been implemented, but they were high on the then new Government’s agenda. Even so, the Danish Minister of Health stated: “The analysis from the Nordic Cochrane Centre does not come as a surprise… I have put our old suggestion of systematic health checks on ice because they will not have the desired effect”.’
They continue: ‘An administration’s automatic defence of an existing screening programme can be viewed as a defence of its own interests and of the public funds and personal prestige that have been invested, but it threatens the very idea of evidence-based public health care, particularly when it involves censorship of an open scientific debate.
‘We urge the NHS Health Check Programme to start a discussion with the Government about closing the programme. The programme consumes vast resources, £332m per year, that could be used for a better purpose, e.g. on interventions with documented benefits.’
Their criticism follows a steady flow of disappointing headlines for the programme, with studies revealing patchy implementation and evidence it is failing to capture those most in need of intervention, and GPs raising concerns it is worsening health inequalities.
Public Health England (PHE) recently announced it remains committed to NHS Health Checks but will be reviewing evidence coming out of the programme as it is rolled out further.
In a statement issued today, PHE medical director Paul Cosford said: ‘Although we recognise that the programme is not supported by direct randomised controlled trial evidence, there is nonetheless an urgent need to tackle the growing burden of disease which is associated with lifestyle behaviours and choices.
‘All elements of the health checks follow well recognised and evidenced clinical pathways approved by NICE and the existing relevant evidence, together with operational experience accruing on the ground, is compelling support for the programme.
‘As part of PHE’s management of the programme, an Expert Clinical and Scientific Advisory Panel is being established. This panel will be responsible for reviewing emerging evidence and research needs. It will also promote future research, development and evaluation of this programme. The economic modelling behind the programme will also be refreshed to update the assumptions in the light of new information and experience.’