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Public Health England defends NHS Health Checks

PHE fights claims that checks are not cost effective

Jo Carlowe

Monday, 28 September 2015

Public Health England (PHE) is refuting claims made in a peer review journal, that NHS Health Checks are a waste of time and money.

Last week, the Journal of Public Health published a paper in which researchers from the University of Liverpool and London School of Economics, argued that the NHS Health Check (NHSHC) programme fails in its primary objectives of preventing heart disease, diabetes, kidney disease, stroke and dementia and of providing support and advice to help individuals manage and reduce their risk of future disease.

“Furthermore,” argued the researchers, “it [the NHSHC] relies on weak concepts, denies strong scientific counter-evidence and ignores persistent implementation issues.”

They assessed the programme against each of the 10 World Health Organisation screening criteria, and found it failed in areas including suitability, acceptability and effectiveness, and argued that it was not cost-effective, estimating at best the programme may prevent 1,000 deaths at a cost of £450,000 for saving one life. 

But in a letter to The Guardian newspaper, Duncan Selbie, chief executive of PHE, said Public Health England disagreed with the authors of the journal article. 

“First, PHE is committed to the highest standards in evidence and research. We could not do our job of providing the best advice to government if we didn’t speak to the evidence as we find it. We keep under review data relating to NHS Health Check. If the data suggested the programme was harmful, or demonstrably cost-ineffective, we would advise the Department of Health accordingly,” he stated.

The letter continued: “Second, we disagree with the article’s assumptions on cost-effectiveness. The Department of Health estimated NHS Health Check could cost around £3,000 for a year of life in good health (quality-adjusted life year). To compare that to academics’ estimates of £450,000 per one death avoided is comparing apples with oranges: £3,000 includes the potential to reduce illness, not just avert deaths.”

And it stated: “Third, the article suggests we’d be better off tackling the causes of ill-health. This is a false dichotomy. We’re doing both. NHS Health Check is a way of raising awareness about health risks and managing these for individuals. But we also support effective and popular campaigns and programmes to tackle unhealthy diets, physical inactivity, smoking and alcohol. Both individual-based and population-wide interventions are necessary.”

The letter concluded: “Lastly, local authorities can, and do, target the NHS Health Check programme to serve the needs of their communities, for instance by focusing efforts on socioeconomically disadvantaged groups.

"Two-thirds of deaths among people under 75 are avoidable. NHS Health Check can help tackle this unacceptable burden.”

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