The National Audit Office (NAO) is recommending a review of how NHS Health Checks are provided in England to help prevent cases of cardiovascular disease that affects millions of people and costs the economy tens of billions pounds each year.
Cardiovascular disease: a public health burden
Cardiovascular disease is a general term for conditions affecting the heart or blood vessels, such as heart attacks. It is estimated to affect 6.4 million people in England, costing the healthcare system £7.4 billion each year, with estimated annual costs to the wider economy of £15.8 billon.
Cardiovascular disease contributed to a quarter of all deaths in England in 2022. Rates of people under 75 dying with CVD halved between 2001 and 2014; since then, progress has stalled, with premature deaths rising from 74 per 100,000 people to 77 per 100,000 people in 20233. Those born in the least deprived areas are four times more likely to die of the disease than those born in the most deprived areas.
The NHS’s 2019 Long Term Plan stated that cardiovascular disease was ‘the biggest area where the NHS can save lives over the next 10 years.’ Through this plan, it aims to prevent 150,000 heart attacks, strokes and dementia cases by 2028-2029. But the NAO said NHS England cannot fully assess ongoing performance against its targets.
Health Checks were introduced in 2009 with the aim of saving lives and money by helping people to tackle cardiovascular disease, where it is not identified through primary care. Everyone aged 40-74 who does not have a pre-existing heart condition is eligible for a Health Check once every five years.
The NAO has found that the current system to make sure that eligible people in England are offered and attend Health Checks isn’t working effectively.
NHS Health Checks are not working
The independent public spending watchdog highlighted that, in 2013, responsibility for commissioning Health Checks was transferred, through legislation, from the NHS to local authorities, as part of the transfer of responsibility for elements of public health. This created a statutory requirement on local authorities to offer Health Checks to all eligible individuals over a five-year period.
In 2023-24 the level of Health Checks had recovered, post-Covid, to 1.42 million Checks completed. However, only 3% of local authorities delivered a Health Check to all of the annual eligible population in their areas in 2023-24 and less than half of the eligible population attended a check.
The legislation transferring responsibility for Health Checks to local authorities did not provide the Department for Health and Social Care (DHSC) with levers to influence local authorities’ performance. In turn, local authorities weren’t able to require general practices or other providers to deliver Health Checks, instead relying on voluntary agreements.
Problems further arise with local authorities unable to routinely access practice data to monitor the Health Check programme and see whether checks are delivered to those most at risk. There is also concern among primary care professionals about general practice’s capacity to conduct Health Checks; between 2014-15 and 2023-24, the amount local authorities spent on individual Health Checks fell in real terms from £56 to £43 per check.
The Public Health Grant, used by local authorities to fund Health Checks and other health services, reduced in real terms from £4.48 billion in 2015-16 to £3.53 billion in 2023-24, a 21% decline. Over the same period, local authority spending on stopping smoking, obesity and physical activity, decreased by 23% in real terms, from £340 million to £262 million (in 2023-24 prices).
Change is needed for cardiovascular disease
The NAO is recommending the DHSC considers improvements in several areas around cardiovascular disease, including:
- Assessing whether local authorities are best placed to deliver Health Checks.
- Incentivising delivery of Health Checks to people at highest risk of cardiovascular disease to help mitigate health inequalities and reduce potential longer-term costs falling on the NHS in the future.
- Setting clear targets for the numbers or percentages of the eligible population who should attend Health Checks, so they are attended and not just offered.
Gareth Davies, head of the NAO, said:
Each year thousands of lives are lost to cardiovascular disease, with billions of pounds spent tackling it.
Health Checks can play a crucial role in bringing these numbers down, but the system isn’t working effectively, resulting in not enough people having checks. This is an unsatisfactory basis for delivering an important public health intervention.
The Department of Health & Social Care needs to address the weaknesses in the current system for targeting and delivering Health Checks if it is to achieve the preventative effect it wants.
Featured image via the Canary
