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Reconsider age-based approach to health checks, urges Public Health England adviser

Exclusive A leading Public Health England adviser has called for a major rethink of the Government’s flagship NHS Health Checks programme, saying that a targeted approach to cardiovascular screening should be considered.

Professor Nick Wareham, who is director of the Medical Research Council epidemiology unit, told Pulse the current programme – which involves inviting everyone aged 40–75 for screening of cardiovascular and other risk factors – may not the best use of resources.

Instead, the advisor to Public Health England urged public health leaders to high-risk individuals as the evidence suggested this was likely be cost-effective.

Public Health England programme at the heart of its strategy on reducing premature mortality in England and recently announced a commitment to rolling the scheme out further and finding ways to improve its implementation.

But GPs and commissioners in some areas have been slow to implement the programme because of doubts about its cost-effectiveness. And evaluations have shown uptake and coverage is falling well behind projected rates – and even cast doubt on the suitability of the screen for picking up diabetes.

Speaking at the PHE annual conference in Coventry, Professor Wareham – who also heads up the East of England Diabetes Research Network - told delegates he did not agree with criticism of the evidence base for NHS Health Checks, which recently reignited the debate on the future of the programme.

He said this is misguided, because current randomised trial data are not entirely relevant, being based on different targets and interventions and limited by relatively short follow-up.

He highlighted the findings of a recent MRC study from 2010, which favoured a targeted, pre-screening approach over mass screening under the NHS Health Checks.

Professor Wareham said: ‘The evidence for “Health Checks” screening suggests you can get most of the benefit by targeting the top 60% at highest risk in the population. There are simple ways of doing that using information that is already available in primary care.’

Professor Wareham told Pulse after the session he understood why critics have said the NHS Health Checks is a waste of limited resources and could worsen health inequalities, although he said he was less worried it could cause patients harm from anxiety or over-treatment.

He said: ‘I don’t think there is any evidence screening does any harm – but any focused intervention tends to widen health inequalities, so we have to worry about that. And certainly there’s a logistics and workforce issue so I agree with those concerns.’

Asked about PHE’s decision to press ahead with the universal NHS Health Checks screening programme, Professor Wareham told Pulse he thought this should be ‘reconsidered’.

He said: ‘I personally think that’s a decision that ought to be reconsidered – it may not be the best use of money, there are work force issues.

‘I think there is value in Health Checks, but I’m just not sure through a universal approach.’