The National Audit Office (NAO) has criticised the NHS’s tool for preventing heart disease, stating it “is not working effectively” as less than half of those eligible are participating. The NAO is calling for a review of the NHS Health Checks in England.
Launched in 2009 and often referred to as a midlife MOT, these checks aim to identify individuals at increased risk of certain health issues and provide advice on prevention. Despite the potential to “save lives and money”, uptake remains low, with just 44% of eligible adults attending one in the past five years, the NAO reports.
Annually, about 20% of the eligible population is invited, aiming to cover everyone within a five-year period. Those aged between 40 and 74 without pre-existing conditions should be offered a check by their GP or local council every five years.
However, in 2023/24, only five local authorities managed to deliver checks to all eligible participants. One local authority reported an uptake as low as 0.1%.
The report also points out issues arising from legislation that shifted responsibility for Health Checks to local authorities.
Local government specialists have warned that reductions in public health funding have resulted in a “shift towards reactive care” rather than preventing illness before it happens. The National Audit Office (NAO) has urged the Government to evaluate whether local authorities are the best entities to deliver Health Checks.
It suggested that the central Government should establish clear targets for the number or percentage of eligible individuals who should attend Health Checks, ensuring they are attended and not merely offered. The NAO also recommended incentivising the delivery of these checks to those at the highest risk of cardiovascular disease.
“Each year thousands of lives are lost to cardiovascular disease, with billions of pounds spent tackling it,” stated Gareth Davies, head of the NAO. He added that Health Checks could play a vital role in reducing these figures, but the current system is ineffective, resulting in insufficient people having checks.
“This is an unsatisfactory basis for delivering an important public health intervention.”
He concluded by saying, “The Department of Health and Social Care needs to address the weaknesses in the current system for targeting and delivering Health Checks if it is to achieve the preventative effect it wants.”
The Chairman of the Public Accounts Committee, Geoffrey Clifton-Brown, criticised the low uptake of Health Checks, asserting: “Health Checks have the potential to save lives and public money – it is a missed opportunity that less than half of those eligible are attending these checks. The Department of Health and Social Care needs to take action to systematically boost uptake, target checks at those most in need, and drastically improve its data if the programme is to deliver the financial and health benefits intended.”
David Fothergill from the Local Government Association emphasised the value of the checks, but lamented funding cuts: “For many councils, NHS Health Checks are a key part of their health improvement programmes, engaging people in early conversations about health risks and lifestyle changes. However since 2015, the Public Health Grant has been reduced by £858 million, limiting councils’ ability to fund these crucial services.”
He continued, “This has led to a shift towards reactive care, despite evidence of the benefits of early intervention.”
Reacting to the situation, a Department of Health and Social Care Spokesman admitted challenges but remained committed to improvements, stating: “Lord Darzi’s report laid bare the extent of the issues facing the nation’s health service, and we recognise that there is more to do to improve this programme. We will carefully consider the findings of this report. This Government is committed to taking action on preventable, deadly diseases like cardiovascular disease.”
“Since this research was conducted, we have begun to pilot comprehensive heart health checks in workplaces , and we are developing a digital version of the check to provide an even more accessible and convenient service for people. Our reforms will help us prevent and catch disease earlier, so it can be treated faster.”
This comes as a new study reveals that patients with specific combinations of conditions – including cardiovascular diseases – put significant strain on the NHS during the hectic winter months. Researchers who analysed NHS data in England from winter 2021/22 found that certain combinations of long-term conditions significantly contribute to the additional pressures the NHS faces each winter due to their association with considerably higher risks of hospital admissions and death.
For example, individuals with a combination of cancer, chronic kidney disease, heart disease, and type 2 diabetes had an 11-fold increased risk of hospital admission compared to those without any long-term conditions. Furthermore, there was a 24-fold increased risk of death for those with a combination of chronic kidney disease, cardiovascular disease, dementia and osteoarthritis, according to the study published in BMJ Medicine.
Heart disease and dementia were present in all five combinations of multiple long-term conditions associated with the highest increased risk of death.