First national evaluation of NHS Health Check programme published

The study, published in the British Medical Journal Open, presents some positive findings and also recognises opportunities for improvement.

The first major evaluation of the NHS Health Check in England has found that the programme is effectively identifying people at risk of developing a major cardiovascular incident such as heart attack or stroke. It estimates that over the first 5 years it has prevented 2,500 cases due to treatment following the check. In addition, the programme is helping diagnose conditions commonly linked to cardiovascular disease, including type 2 diabetes, high blood pressure and chronic kidney disease.

The study, led by Queen Mary University of London, also found that those from the most deprived areas and black and minority ethnic groups, who are at greatest risk of cardiovascular disease, are more likely to attend an NHS Health Check. This makes a positive step towards tackling health inequalities in England.

The programme, managed by Public Health England (PHE), is the first in the world to tackle prevention of heart attacks and strokes by offering a free check to every adult aged 40 to 74 years. It provides a personal review of the behavioural factors, such as harmful drinking and obesity, that might increase the risk of developing a heart attack or stroke and offers professional advice on lifestyle change and treatment. It also identifies any new or undiagnosed serious conditions such as hypertension, diabetes and chronic kidney disease.

The study is based on robust data from 655 GP practices with 1.7 million eligible people in the nationally representative QResearch database. In addition to the 2,500 people avoiding a major cardiovascular incident, the programme has also successfully identified:

• a new case of hypertension in every 27 appointments
• a new case of diabetes in every 110 appointments
• a new case of chronic kidney disease in every 265 appointments
• 14% of attendees referred to lifestyle interventions due to obesity, smoking, alcohol or blood pressure compared to just
• 6% of those who were referred through standard care 6 times more people with high alcohol consumption than those who do not attend, offering brief advice and support

However, the number of eligible people having an NHS Health Check still needs to increase for the programme to reach its full potential. The most recent annual data from PHE shows that about 48% of all eligible people attend when invited. PHE is continuing to work with local authorities to help them deliver the programme more effectively and increase the numbers taking up their NHS Health Check.

The study also shows that there is still room for improvement. The latest evidence suggests the programme is most effective at targeting the older end of the eligible population (those aged over 60) and more work is needed to encourage uptake among the younger age group (aged 40 to 60). However, as cardiovascular risk increases with age, this evidence suggests that the programme is effective in identifying and providing an NHS Health Check for those with the highest risk and not just the ‘worried well’.

Professor John Newton, Chief Knowledge Officer at PHE said:

"It’s good to see the clear initial successes highlighted by this comprehensive and robust study of the NHS Health Check programme in its early stages. The evidence shows that the programme is working and working well for its target group, effectively reaching black and minority ethnic groups and people from deprived areas, who are most at risk of their condition being missed or diagnosed too late.

"While this study shows a positive start and the numbers attending their NHS Health Check significantly up in the past few years, there is still more to be done to improve numbers and ensure those that need help get referrals for follow up treatment – which ultimately saves lives."

Study lead Dr John Robson from Queen Mary University of London said:

"The NHS Health Check programme is the first of its kind anywhere in the world and our study demonstrates a modest but successful start. We estimate that the programme could help identify 44,000 new cases of hypertension, 10,000 new cases of diabetes and 4,500 new cases of kidney disease in England every year. In the first 5 years of the programme, an estimated 2,500 people were also prevented from having a stroke or heart attack through treatments following their NHS Health Check.

"Uptake of the programme during the study period showed year-on-year improvement, but much still needs to be done as there is considerable scope for even better coverage."

Background information

1. Find out more information on the NHS Health Check programme.

2. The figure of 2,500 avoided events over 5 years is estimated on the treatment of those at high risk being treated through statins. The NHS health check programme covers many risk factors, and this is likely to make a conservative impact on the total number of events avoided through the programmes full benefits.

3. Read the full evaluation paper

4. The NHS Health Check is an opportunity to engage 15 million people to live well for longer. Those aged 40 to 74 in England are assessed and enabled to take control over their own health, taking early action to reduce their risk of developing serious health problems such as heart disease, stroke, kidney disease, type 2 diabetes and certain types of dementia.

5. NHS Health Check is made up of 3 components: risk assessment, risk awareness and risk management. During the risk assessment standardised tests are used to measure key risk factors and establish the individual’s risk of developing cardiovascular disease. The outcome of the assessment is then used to raise awareness of cardiovascular risk factors, as well as inform a discussion on, and agreement of, the lifestyle and medical approaches best suited to managing the individual’s health risk.

6. Estimates carried out when the programme was introduced by the Department of Health in 2009 showed that NHS Health Checks could prevent 1,600 heart attacks and strokes, at least 650 premature deaths, and over 4,000 new cases of diabetes each year. At least 20,000 cases of diabetes or kidney disease could be detected earlier allowing individuals to be better managed and so improve their quality of life.

7. Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. Follow us on Twitter @PHE_uk.