This report presents a ‘deep dive’ into the implementation and outcomes of the NHS Health Check Programme across Kent and Medway.
Kent County Council’s Director of Public Health introduced the report which presented a detailed review of the implementation and outcomes of the NHS Health Check Programme in Kent and Medway. It was explained to the Joint Board that the Health Check was a national cardiovascular screening programme which sought to assess an individual’s risk of developing cardiovascular disease and take appropriate action where required.
Local Authorities had a statutory obligation to offer an NHS Health Check to 100% of eligible people over a period of five years and seek continuous improvement in the number of people having an NHS Health Check each year. Public Health England (PHE) aspired to achieve a national take up rate in the region of 75% of the eligible population receiving a health check once every 5 years. The overall Kent and Medway performance was set out at paragraph 3.19 of the report.
It was emphasised that the NHS Health Check Programme was a critical element of the prevention workstream because it aimed to prevent diseases with a cardiovascular component such as heart disease, stroke, type 2 diabetes, as well as dementia and, in general, prevent people progressing to frailty. The programme also provided a significant opportunity to address health inequality and reduce early death.
The Joint Board was advised that Kent and Medway had invited the whole eligible cohort. He explained that the focus now needed to be on how individuals could be encouraged take up the offer of a Health Check and ensuring that GPs undertake the necessary diagnostic work, referring individuals to the appropriate lifestyle support to manage their health risk.
In response to a question regarding the services available for individuals aged 75 and over, above the upper threshold of eligibility, and a question asking how routine health testing could be normalised at earlier age, i.e. below the age of 40, the lower threshold for eligibility, the Joint Board was advised that the age range was nationally mandated. With respect to the query on the upper threshold, Kent County Council’s Director of Public Health considered that at the age of 70 most individuals would already be on the GP register and therefore likely to be receiving adequate support. Referring to the prevalence of cardiovascular disease in the poorest communities, he explained that with respect to the lower threshold, starting Health Checks at the age of 40 would provide two opportunities to provide health interventions (it was noted that in disadvantaged communities healthy life expectancy was as low as age 52). He expressed a view that for some populations where the cardiovascular risk was high, the age range should be lowered. However, he noted that the challenge in this respect would be affordability.
A Member commented that Health Checks had a positive impact on the health of an individual and were cost effective for the health service in the long term as ill health was prevented. As result, it was considered that this was a useful argument to lower the age threshold. With respect to the upper threshold, the Member commented that clarity was needed on support available to individuals aged over 75.
Kent County Council’s Director of Public Health commented that whilst trained professionals were needed to undertake a Health Check, this did not need to be a GP and could be, for example a practice nurse. It was added that individuals outside the age criteria could be offered a Health MOT, which would measure weight and blood pressure and could help individuals familiarise themselves with the tests at an earlier age.
It was recognised that people respond well to data and Medway’s Director of Public Health explained that tools were available to help individuals measure and monitor their own health, for example apps on a smartphone and smartwatches. He stressed the importance of encouraging individuals to take responsibility for their own health and the importance of self-care and self-management.
A Member commented that cardiovascular disease was not a disease of older people but rather young people and expressed that people may not appreciate the need for a Health Check. Another Member expressed support for lowering the age threshold and commented that introducing a focused test within the workplace at age 30 would be beneficial.
A Member suggested that officers review the age thresholds. In response, the Director of Public Health for Medway Council recognised that the suggestion to expand the age range for the eligibility criteria for Health Checks was positive, although the age range was prescribed nationally. He advised the Joint Board that a key priority area was increasing the current number of eligible people taking up an NHS Health Check invite per year, as only circa. 40% of the population at risk had accessed this service in 2017/18. It was particularly important to reach more challenged areas such as disadvantaged communities and support individuals who were not currently eligible to take more care of themselves and signpost them to existing support available. The Director of Public Health for Kent County Council expressed support for focusing on illness prevention and increasing uptake of Health Checks offered. He suggested that an analysis could be undertaken on the cohort of the eligible population that continued to be eligible over 70, it was considered that this cohort would be small. By way of a summary, the Chairman asked officers to take into account the points raised during the discussion and report back to the Joint Board. It was noted that much of the discussion had centred on communication and the Director of Public Health for Kent County Council undertook to revert back to the Joint Board with a communications report.
The Kent and Medway Joint Health and Wellbeing Board:
a) noted the difference in uptake between the most affluent areas of Kent and Medway and the most disadvantaged;
b) agreed to work with the NHS to increase the uptake of Health Checks across the eligible population; and
c) agreed that the following reports be added to work programme for the June meeting of the Joint Board:
· Learning Disabilities Health Checks and the outcomes of the review set out at paragraph 3.39 of the report; and
· Health Check Communications Report.