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Decade on, still not clear what overall health benefits of NHS Health Check are

Government estimates for coverage and uptake, ‘too optimistic,’ study finds

Caroline White

Friday, 22 June 2018

Almost a decade on from its roll-out, it’s still not clear what overall benefits the NHS Health Check is having, but figures for uptake and coverage suggest that Department of Health estimates were “too optimistic,” concludes a study* published in the British Journal of General Practice.

More research and health economic analyses are needed, say the authors.

Since 2009 the NHS Health Check has been offered to everyone in England between the ages of 40 and 74 who doesn’t yet have cardiovascular or kidney disease, diabetes or dementia in a bid to stave off the risk of developing these conditions, by making lifestyle changes or taking appropriate drugs.

But it was introduced nationwide without solid economic data to back it up and with very limited available evidence on similar strategies in other countries. And it’s not been clear who turns up for it, or what impact it has on their health, say the authors.

They therefore decided to carry out the first systematic review of the available evidence and scoured 11 databases and additional internet sources up to November 2016. In all, 26 observational studies and one additional dataset were included in their analysis.

In the current cycle (since 2013) just over 45% of eligible adults across England attended an NHS Health Check, with just under half of all those invited taking up the invitation, which is lower than the Department for Health and Social Care estimate of 75%. 

“Both the anticipated coverage and uptake used in the Department of Health model were too optimistic,” write the authors. “When judged against the (ambitious) objective of inviting all eligible individuals in each five-year cycle, and the expected aggregate gains in population health arising from high coverage (expected in the model to be 75%), the evidence shows the programme has fallen considerably short,” they add.

But despite concerns voiced in some quarters that the only people likely to pitch up for the check would be the ‘worried well’ and ‘easy to reach’, uptake is higher among older people, those with a family history of heart disease, and those living in areas of greatest deprivation, the analysis showed.

Turning up for the check is associated with small increases in disease diagnosis, falls in cardiovascular disease risk, and increased prescribing of drugs to lower blood pressure and cholesterol.

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 the check on health-related behaviours, the authors point out.

While the evidence is promising, the shortage of data on the long-term health impacts and costs emphasises the need for more research and health economic analyses, they conclude.

* Martin A, Saunders CL, Harte E, et al. Delivery and impact of the first 8 years of the NHS Health Check: a systematic review. Br J Gen Pract 18 June 2018; bjgp18X697649.

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