The National Audit Office, the government’s watchdog on spending, has called for an overhaul of the NHS Health Checks. It says that the current system for checking over-40s is ‘not working effectively’.
The government announced over the summer that NHS Health Checks will be offered through workplaces. However, in its review, the NAO recommended a wider shake-up to the preventative health check.
It has been argued that Health Checks should be improved to better detect and prevent cardiovascular disease (CVD), a condition which affects millions in England and costs the healthcare system as well as the wider economy tens and billions of pounds every year.
Since 2009, anyone between the ages of 40 and 74 without a heart condition can receive a NHS Health Check.
The NAO stated that while the checks are helpful in detecting CVD cases, they do not reach enough people. The NAO recommends a review of the way Health Checks are offered to increase uptake.
It pointed out that a decade ago in 2013, the responsibility for ordering Health Checks from the NHS was transferred to local authorities as part of a transfer of responsibility of elements of public healthcare.
The local authorities were required to provide Health Checks for all individuals eligible over a period of five years. The NAO report concluded that the number of Health Checks completed in 2023-24 had increased to 1,42 million, following the implementation of Covid.
In 2023-24, less than 50% of eligible residents attended a health check.
Local authorities could not require general practitioners or other providers of Health Checks to provide them, instead relying upon voluntary agreements.
The NAO stated that local authorities are unable to access data on a regular basis to monitor the Health Check Programme and determine whether the checks are being delivered to the most vulnerable.
It was argued that primary care professionals were also concerned about the capacity of general practices to perform Health Checks.
The amount that local authorities spend on Health Checks has fallen in real terms between 2014-15 and 2023-24 from PS56 per check to PS43.
The NAO recommends that the Department of Health and Social Care examine improvements in a number of areas, such as assessing whether local councils are the best-placed to deliver Health Checks and providing incentives for the delivery of Health Checks among people who are at the highest risk of CVD.
The report also stated that clear targets should be set to ensure that the Health Checks are actually attended by the population eligible for them, and not simply offered.
Gareth Davies said, “Each and every year, cardiovascular disease claims thousands of lives, and billions of pounds are spent to combat it.”
Health Checks are a vital tool in reducing these figures, but they don’t work effectively. This leads to fewer people getting checked. It is not a satisfactory basis on which to deliver an important public health intervention.
Davies continued, “The Department of Health and Social Care must address the weaknesses of the current system of targeting and delivering Health Checks in order to achieve the prevention effect that it desires.”
William Roberts said that the Royal Society for Public Health’s chief executive, William Roberts, responded to the report by saying that Health Checks are valuable because they allow those at risk “to have conversations and to take steps to support them in improving their health.”
He added that “we can’t do anything if we don’t have the information. If uptake in the areas where people would most benefit is low, then we should look into ways to increase it.”
It is sensible to consider primary care settings such as pharmacies and dentists for the purpose of offering a check. Public health interventions that are most effective meet people where they live. In addition to primary care, policymakers need to consider the workplace as an important place where we can build health.
Roberts said that helping people live longer and in better health would have huge benefits for our health services, our economy and, most importantly, the individuals who will get to enjoy more healthy years.
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