interviews

England still faces an epidemic of preventable illness

Jamie Waterall, national lead for the NHS Health Check programme at Public Health England, discusses the progress being made to tackle preventable diseases in England. David Stevenson reports.

The NHS Health Check programme attempts to help prevent people developing some of the most disabling – but preventable – illnesses such as heart disease, stroke, diabetes, kidney disease and certain types of dementia.

Since its introduction by the Labour government in 2009, NHS Health Check, which targets adults in England aged 40 to 74, has become instrumental in many local authority programmes to improve the health of their populations.

NHS Health Check recently published official data on the programme, which provides information on offers and uptake for 2014-15 and the two consecutive years since local authorities became responsible for commissioning the scheme.

Increasing uptake?

While uptake has remained just under 50%, Jamie Waterall, national lead for the NHS Health Check programme at Public Health England, said it was positive that almost 20% of the eligible population were offered an NHS Health Check over the past 12 months, and that an extra 100,000 checks were delivered compared to the previous year.

“I’m always cautious when looking at any individual quarterly data that we publish, but it was interesting that in Q4, uptake was the highest we have ever seen since the programme data has been reported,” he said.

“In Q4 alone, uptake for that three month period was 56.3%. We’ll only know as we go into this year and we start to see the reporting coming back from local authorities if this is a genuine signal of the system responding to the challenge to increase uptake.

“Previously, the highest individual quarter was 51% – so it is a significant increase. I’m optimistic that this is a signal, but we’ll have to see what happens over the coming months.”
NHS Health Check is a mandated public health service and there is a requirement that local government has to prioritise implementation and roll-out, including a requirement to show year-on-year improvement on uptake.

Despite the difficult times ahead in terms of funding and resource for local government, Waterall said that directors of public health, councillors and NHS colleagues all understand the urgent need to tackle the key risk factors of people developing preventable illnesses.

“England still faces an epidemic of largely preventable non-communicable diseases, such as heart disease, cancer, type 2 diabetes and liver disease,” NHE was told. “Premature mortality in the UK is falling, but not as fast as in many other European countries.”

He added that an estimated two-thirds of deaths among people under the age of 75 in England are avoidable through public health interventions or through early diagnosis and effective treatment.

Tackling diabetes

The NHS’s Five Year Forward View contains an ambition for England to become the first country to implement a national evidence-based diabetes prevention programme modelled on proven UK and international models, and “linked where appropriate to the new Health Check”.

The National Diabetes Prevention Programme was launched in March, with the identification of seven demonstrator sites across England. These demonstrator sites are testing innovative ways of identifying those at risk, for example using the NHS Health Check. The feasibility of nationally procuring a lifestyle modification service or establishing a national framework contract for such services is also under exploration.

“Already in the Health Check we have a diabetes risk assessment,” said Waterall. He added that those who are tested through the Health Check will be eligible for support through the prevention programme. “I see it as being a major programme that will sit alongside the NHS Health Check and will ensure that people we are identifying have the correct support, advice and evidenced-based intervention to help them reduce or manage their risk,” said Waterall. “We are working alongside Diabetes UK and NHS England on what that programme looks like.”

Still learning

Waterall told us that he still feels Health Check is “relatively new in terms of implementation”.

“It wasn’t until 2013 that we had full coverage across the country, and that was intentional by the Department of Health at the time – as we had staged implementation,” he said. “And actually, that was during a time of huge change across health and social care – particularly to public health given that the bulk of the local workforce moved out of PCTs to local government.

“This has been a time of great change, and there has been a lot of reorganisation.”

Waterall added that in the next five years – after being able to invite 19.7% of the eligible population for a Health Check in the last 12 months – the programme will be on track for inviting 100% of the eligible population.

“We are still learning through the implementation of the programme and I don’t doubt that there will be areas where we find we could be doing better,” he said. “What it should do, though, is fire us up even more to ensure we improve the things we are doing.”