A mobile pilot in Hastings and Rother has demonstrated how the NHS Health Check programme can help successfully battle against vascular disease. East Sussex Community Health Services health development manager Hayley Martin explains.
The NHS Health Check programme, formerly known as vascular checks, offers preventive checks to men and women aged 40-74 to assess their risk of vascular disease – heart disease, stroke, diabetes and kidney disease.
The public health white paper Healthy Lives, Healthy People states that the checks will continue to be offered and also proposes that the programme becomes part of the new public health service, Public Health England.
For primary care trusts, and soon commissioning consortia or public health executives, full implementation of the programme is required by 2012-13. However, there are challenges in implementation, such as funding, capacity and targeting harder to reach populations.
A pilot outreach programme in the South East was set up to develop a business case for a full NHS Health Check outreach programme based on this model.
Hastings and Rother is an area with high social deprivation and evidence of health inequalities, and is home to an older population with a poor lifestyle. There is a high proportion of people with diabetes, cardiovascular disease, high blood pressure and heart problems compared with other local PCTs and with the national UK average.
People screened in the roadshow who were advised to see their GP for further diabetes screening
The PCT had already set up the Investing in Life programme, which aimed to reduce health inequalities and improve life expectancy in specifically targeted wards. In addition, the local health improvement team provided advice and support to help people lead healthier lifestyles, and had the skills and infrastructure in place to engage adults experiencing health inequalities.
The challenge remained to implement health checks, particularly for harder to reach people and high priority wards.
The local health development team in Hastings and Rother worked in partnership with Pfizer to develop a pilot outreach NHS Health Check model, using a mobile unit to screen adults aged 40-74 across the area.
This programme took a targeted approach to getting to the people who were at greatest risk, including those who would not normally go to their GP or pharmacy for a check-up. A mobile NHS Health Check service was seen as a convenient and attractive way of taking screening services to the target audience directly. National pilot programmes have reported approximately a 25 per cent take-up of GP invitations for health checks.
The locations the bus visited were prioritised using local health intelligence on life expectancy and high risk factors for vascular disease from Pfizer plus NHS tools. This model aimed to ensure these people were screened and offered preventive treatment.
People were targeted through posters and leaflets in local health centres and pharmacies. In addition, information was sent to approximately 50,000 households in main target areas. Local media, the mayor, the local MP and healthcare professionals further supported the initiative.
Venues were chosen carefully as they played an important role in capturing the target audience.
Sixteen events were held in June and July last year, at nine locations across Hastings and Rother. Of the 3,011 people who visited the bus, 311 received a free health check.
Of the 311 screened, 177 were female (57 per cent) and 134 were male (43 per cent). There was a fairly even distribution of clients across the age range; approximately half were under 60 years old.
People screened in the roadshow who were referred to the health trainer for support
While the social mix of those screened was broad, the ethnic mix was not – 284 of the 311 were white British.
The bus attracted many who may not have visited their GP: 102 had not seen their GP in the last 12 months, and 200 (63 per cent) were from one of the 10 NHS Hastings and Rother priority wards for tackling health inequalities.
During the roadshow, of the 311 people screened:
- 37 per cent were advised to see their GP for further diabetes screening;
- 5 per cent were identified as having more than a one in five risk of developing cardiovascular disease in the next 10 years;
- 11 had risk scores of 40 or higher (see graph);
- 25 per cent of those screened were advised to seek further advice from a healthcare professional for high blood pressure;
- 20 per cent were referred for high body mass index;
- 16 per cent were referred for drinking more than the recommended units of alcohol each week;
- 28 per cent were referred to the health trainer service for support;
- 7 per cent were referred to the local smoking cessation service for support.
Follow-up at four months with clients who had been advised to see their GP as a result of the health check was positive. Many reported positive lifestyle changes to improve their health and reduce their risk of vascular disease (see graph).
A mobile outreach approach can help address the challenges of implementing NHS Health Checks for all eligible 40-74 year old adults in England by 2012-13, and reaching the more difficult to reach population and supporting them in making positive lifestyle changes to improve their health.
Combining the mutual interest of patient welfare with expertise and experience, joint working between the NHS and the pharmaceutical industry can improve outcomes for all involved.
THE ECONOMICS OF NHS HEALTH CHECKS
Department of Health assessments have shown that NHS Health Checks result in savings over the long term, particularly in relation to identifying and treating pre-diabetes through intensive lifestyle intervention (it is estimated that up to 9,700 cases of diabetes – 63 per PCT – could be prevented each year, with 8,000 cases likely to be prevented even in the early years).
Cost per quality adjusted life year is low (£2,142) compared with National Institute for Health and Clinical Excellence thresholds for recommendations (£20,000-£30,000). For the rest of this financial year, NHS health checks remain as a tier 3 vital sign although, in some primary care trusts, the programme is being linked to health inequalities (tier 2 vital sign). A Top Ten Reasons for Health Checks document is being finalised to act as a crib sheet for PCTs making the case to finance departments.
Clearly, the health check alone does not provide the savings and health improvements identified in the DH economic assessments and QALYs; rather, it is the action taken following the check that will lead to this outcome. This will largely depend on the quality of the lifestyle interventions made, in addition to ongoing follow-up and medicine management.
Delivering health checks varies in cost. DH modelling was based on £23.70 per health check being provided through existing primary care practices. Outreach activity is expected to cost significantly more and varies across localities, largely due to the nature of using point of care testing and securing outreach venues and creative methods of engagement, for example hire of venues or mobile vehicles. Costs vary from £30-£100, depending on the skill mix of staff providing the checks and costs.
Top tips for working with industry
- Identify common goals and objectives when choosing a partnership
- Work closely together from the outset as a true partnership
- Include all stakeholders
- Maximise the strengths of all parties
- Ensure there is a clear written agreement in place
- Build on relationships that already exist, but be open to new ideas, ways of working and service redesigns
- Embrace the mutual benefits of joint working to maximise patient outcomes and provide a value-added service
- Allow time for projects to evolve
- Share key learnings and best practice models with others
- Enjoy a new way of working; it is rewarding, effective and successful