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Review the evidence for health checks? Why bother



The NHS Health Check is under review and proposals are being sought for the inevitable public consultation process that seems de rigueur for all consultations these days.

To me, the key question is why they have to get any consultation on the Health Check, since they should already know what needs to be fixed.

And they should know, because we have a publicly-funded body whose entire remit is to look at these questions, the UK National Screening Committee (NSC): a body that has already looked in detail at each and every aspect of the Health Check.

For instance, take the assessment of vascular risk in adults over 40, which is backbone of the Health Check. The UKNSC recommends that we don’t do it. There isn’t a good enough balance between its benefits, and harm to patients, and the benefits of an active screening programme (over opportunistic assessment, as per now) has not been shown to be cost-effective.

What about assessment of the risk of diabetes? The NSC is clear: don’t do it.

Obesity? Not recommended.

Kidney disease? You guessed it, the NSC says not to screen for that either.

The committee has systematically looked at the evidence and found not a lot of benefit for patients on all fronts.

This is all a bit awkward for Public Health England (PHE). Health Check supporters are so convinced that they can save lives by encouraging people to get a health MOT that they don’t want listen to the NSC. They are singing a loud metaphorical, ‘La-la-la, I’m not listening!’ while stomping angrily around their bedroom. And like any child knows: when you don’t like what one parent tells you, the best tactic is to ask the other parent and hope for a better answer.

A new 28-strong group – the Expert Scientific and Clinical Advisory Panel (ESCAP) – now meets every three months to provide ‘strong scientific and clinical grounding and steer’ the Health Checks programme.

ESCAP exists as a sort of NSC for the Health Check topped up with single-disease enthusiasts. Minutes of its meetings read like the collective views of a group of opinion leaders rather than a rigorous assessment of the evidence. And it is incapable of removing any of the key components, which would be too much of a U-turn to be politically acceptable. Calling into question the need for a Health Check would destroy its very raison d’etre.

And while this consultation has been going on, with the great and the good in public health being called to expensive quarterly meetings in order to determine how best to entice the well to attend for Health Checks they don’t want or need, there was a GP practice in Devon that was so overstretched in its attempts to treat the genuinely ill that it felt the need to remind its patients that there might be other services they could use.

Might they not have had a slightly greater capacity if they weren’t so busy dealing with Health Checks?

Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.