The NHS health check scheme was welcomed by public health experts, but it has not closed inequalities as hoped, writes Paul Whitehouse.

According to the NHS Choices website, we are all at risk of developing heart disease, stroke, type 2 diabetes or kidney disease. Fortunately, as medical care evolves, these diseases can often be prevented or managed better if diagnosed at an early stage. 

From acorns to oak trees, so was born the NHS health check scheme. It was launched for adults in England to help assess the risks and give personalised advice on how to reduce it. The scheme has been endorsed by the government and will be in place for the foreseeable future. This is really good news for health inequalities. Or is it?

So, when the announcement was made that everyone aged 40-74 would be entitled to a free NHS health check every five years, many “public health” minded members of the health community were understandably pleased. The system swung into action and started organising itself to work through the population to identify those medium and high risk people as well as positively supporting the low risk groups.

Those with medium or high risk were signposted into relevant interventions (either their own GP or services run by the local NHS for example smoking cessation, sensible drinking, obesity services) to enable them to modify their risk factors thus reducing their overall risk.

However, the programme has had some counterintuitive results. For example, to ensure the health checks are carried out in significant numbers, primary care is often the delivery mechanism employed and that route will predicate for members of the public “known” to but not those unseen by the NHS.

Evidence suggests that medium or high risk individuals are less likely to be regular users of health services, so using primary care alone to drive the NHS health check programme is making health inequalities worse.

What is needed to achieve the laudable aims of the NHS health check scheme is a programme to use outreach or near patient testing routes to access these seldom seen and poorest health inequality populations.

Some innovative NHS areas in England, including London, the Midlands and the North West are doing this using HealthCheckPods located in pharmacies, mobile units and leisure centres.

This approach has resulted in a significant number of people being diagnosed with cardiovascular disease that otherwise would not have been identified, and countless others avoiding developing such conditions due to the advice received.

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