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NHS health checks have not matched expectations in terms of improving health

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The NHS health check programme has “fallen considerably short” of expectations, with the impact on the nation’s health still unclear nearly a decade on from when it was first introduced, according to the first full review of research evidence.

However, there are promising signs the programme is reaching some vulnerable groups most in need of health advice, according to the study by the universities of Cambridge and Leeds.

“Published attendance, uptake, and prescribing rates are all lower than originally anticipated”

Study authors

The research, published in the British Journal of General Practice, set out to examine the impact of the health check programme in its first eight years.

Launched in England in 2009, the programme offers a five-yearly check-up to everyone aged 40 to 74 who does not have cardiovascular disease, kidney disease, diabetes or dementia.

Under the scheme, those who attend appointments get an assessment of their risk of developing these conditions plus advice on medication and lifestyle changes.

Since 2013, local authorities have had a statutory responsibility to offer the programme to everyone eligible with funding provided by Public Health England.

However, there continue to be questions about the impact and cost-effectiveness of the programme which was introduced nationwide “without robust economic evidence from a randomised controlled trial and with very limited available evidence on health check strategies implemented in other countries”, according to this paper.

The researchers carried out a systematic review of the evidence to date with 26 different studies and one additional set of data included in their analysis.

Overall they found take up of health checks was lower than anticipated and the programme had “fallen considerably short” of expectations.

Department of Health modelling suggested everyone eligible would be invited for a health check in the first five years and about three quarters – 75% – would attend.

“There remains a significant shortage of data on the health impacts, particularly longer term, and the costs”

Study authors

However, the review shows that since 2013, just over 45% of eligible individuals attended a health check – with just under half – 48.2% – of all those invited actually taking up the invitation.

But contrary to expectations among some health professionals who feared those who showed up would be mainly the “worried well” or so-called easy-to-reach groups, the review suggests the programme is reaching some of the more vulnerable sections of society.

In terms of coverage, older people, those with a family history of coronary heart disease, those living in the most deprived areas, and certain ethnic minority groups were more likely to have attended for health checks. Of people actually invited for health checks, take up was higher among older people and women, but lower among those living in the most deprived areas.

When it came to effectiveness the review found the programme was linked to a small increase in diseases being diagnosed. It was also linked to increased prescribing of blood pressure and cholesterol lowering medication such as statins, and a consequent decrease in anticipated cardiovascular disease.

The Department of Health hoped 85% of people with high cholesterol or high risk of cardiovascular disease would be prescribed statins, which would mean significant savings down the line.

But the review shows the proportion of health check attendees who were found to have a greater than 20% risk of cardiovascular disease and were then prescribed statins varies from 18% to 63%.

Roughly one “cardiovascular event” such as a heart attack is likely to have been prevented for every 4,762 people attending health checks equating to more than 1,400 events in a five year cycle of checks, according to the paper.

Meanwhile, there is very little evidence on whether the scheme has encouraged people to adopt a healthier lifestyle.

Overall, the study concludes Department of Health predictions for the programme were “too optimistic” both when it came to overall coverage and take up. As a result, anticipated benefits to the overall health of the population have not come about, say the review authors.

“Published attendance, uptake, and prescribing rates are all lower than originally anticipated, and data on impact are limited, with very few studies reporting the effect of attendance on health-related behaviours,” they stated. 

While some of the data looks promising, they say there is simply not enough evidence to say with any certainly whether the health check programme works and is good value for money.

“There remains a significant shortage of data on the health impacts, particularly longer term, and the costs,” said the paper, which highlighted the need for further research and economic analyses.

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