NHS Health Checks under scrutiny

In July last year, Public Health England, the Local Government Association and NHS England backed the NHS Health Check programme through a “10 point plan” for increasing its take-up and benefits.

Recognising that council scrutiny can stimulate local and national action to tackle health inequalities and improve services, the Centre for Public Scrutiny was commissioned to support Devon and Lancashire county councils, South Ribble Borough Council, Tameside Metropolitan Borough Council and the London boroughs of Barnet, Harrow and Newham, with the aim of increasing awareness of the benefits of the Health Check programme, the barriers to take-up in their areas and how it can be improved.

‘Scrutiny was a catalyst to bring GPs, councillors and other stakeholders together with people who use services to improve health and wellbeing’

The centre’s “return on investment” approach to council scrutiny helped councillors to hear beyond traditional stakeholders about the costed and consequential benefits of the programme in their areas.

Our report outlining details of the work, Checking the nation’s health – the value of council scrutiny, was launched at Public Health England’s national conference, NHS Health Check – Share, Listen, Act, in February.

The report shares the learning and recommendations for local and national health system leaders as they seek to improve health inequalities or provide support and advice.

Coordinated local action

Our report demonstrates the importance of clinicians’ “medical model” and councillors “social model” coming together to put NHS Health Check at the heart of coordinated local action to reach those people who are at risk of poor health. It found that scrutiny was a valuable catalyst to bring general practitioners, councillors and other stakeholders together with people who use services to improve the health and wellbeing of their local communities.

‘The programme can be a gateway to potential health improvement if it can reach isolated or vulnerable groups’

The lessons chime well with the actions that are being taken forward nationally by the Health Check programme. Our support programme has confirmed opportunities for improved leadership, quality, consistency and integration that are identified within the “10 point action plan”.

The support programme was not without its challenges. Health Check is a relatively new programme, established when public health functions were transferred last April to local councils. NHS Health Checks are delivered in primary care and the lines of accountability for effectiveness of the programme are still settling down. In some areas, the reviews were pivotal to changing and enhancing the relationship between council scrutiny and local public health teams. For many, there had not been the opportunity for councillors and public health teams to work together and scrutiny provided that link. 

Councillors reported that a particularly successful element of the support was stakeholder engagement, moving scrutiny away from a traditional “committee meeting” approach and providing a neutral space for stakeholders to have open and honest dialogue about Health Check action learning events. Tameside’s event built on the established above-average take-up of NHS Health Check and provided the vehicle to get the right people in room at the same time in a way that hadn’t happened before.

Insight with impact

In Barnet and Harrow, an engagement specialist was commissioned to gather views from the public, with scrutiny acting as a conduit between the public and the commissioners and providers of the checks. In Devon and Lancashire and South Ribble, councillors used questionnaires to establish data from primary care and worked with GPs to begin to create a whole system approach to NHS Health Check, bringing primary care and councils closer together.

‘Sharing data and insight and better joint working can help make NHS Health Checks more effective’

Newham councillors produced a collaborative partnership agreement with commissioners and providers to provide a vision for future commissioning and delivery of Health Checks. They found that this helped clarify and overcome an important cultural difference – that clinicians work with absolutes and scrutiny is more comfortable with possibilities. Colleagues in Barnet and Harrow found that their review developed relationships between scrutiny and the public health team and they will be using scrutiny to explore care pathways in future.

Devon councillors recognised that the programme can be a gateway to potential health improvement if it can reach isolated or vulnerable groups. By working across rural and urban settings, they recognised that geography is not the only factor that impacts health inequity. Those at risk of the poorest health outcomes could reap the most benefit from NHS Health Check if it is visible and accessible.

Tameside had already achieved above-average level of take-up of NHS Health Check but wanted to look at how it could be improved for everyone through a community based model.

Sharing data and insight and better joint working can help make NHS Health Checks more effective, with scrutiny a catalyst for bringing local health system leaders together. The knowledge and experience of councillors can enhance the work of health partners to tackle inequalities and improve health services. Scrutiny is a vehicle for connecting clinicians who rightly focus on patients and the symptoms they present and councillors who rightly focus on the risks and causes of poor health. By uniting the two, a shared health and care improvement culture can be developed.

Focused scrutiny

Councillors found that support from the Centre for Public Scrutiny helped keep their reviews focused and on track. Stakeholder engagement was strong and identifying potential financial savings helped demonstrate the value of scrutiny for better outcomes and economic benefits. But as well as this, scrutiny also brings qualitative benefits. In total, more than £4m in potential savings was identified.

In each area, scrutiny provided a safe space to work through issues and arrive at solutions, leading to recommendations for improving the take up and effectiveness of the NHS Health Check programme. Overall, council scrutiny has identified that the checks are important in the fight against poor health and can be an excellent tool to help to reduce health inequalities. But it needs to be accepted as part of the wider health and care pathway.

‘The reviews have gone some way to overcome some scepticism regarding the validity of the Health Check programme’

Inviting the right people to receive NHS Health Checks and deliver them are fundamental to a successful programme. However, it is important for leaders of local programmes to ensure there are effective follow-up procedures in place to make sure that people are supported once results from the check are known.

The programme demonstrates the diversity of good scrutiny to tackle local health inequalities in the best way suited to localities. The reviews have gone some way to overcome some scepticism regarding the validity of the Health Check programme. Council scrutiny has been a valuable way to independently review the rollout of the programme, with findings that can be used locally and nationally to inform commissioning decisions.

A whole system approach can maximise the impact of NHS Health Checks and help to feed into joint strategic needs assessments and joint health and wellbeing strategies. This means a greater role for health and wellbeing boards as they ensure that Health Checks are supporting local priorities and outcomes, helping those most at risk and with the poorest health outcomes.

We will continue to support and demonstrate how council scrutiny is important in the fight against poor health. 

Tim Gilling is deputy executive director at Centre for Public Scrutiny