We've moved!

Our blog now lives over at www.healthdiagnostics.co.uk/latest-news along with our new website and learning hub!

Developments coming soon at Health Diagnostics

Over the coming months, the teams at Heath Diagnostics will be driving forward a number of developments in our products and services. In this blog post, we’ll be giving you a taster of the evolution due to take place. So what can you expect to see?

A new website and online learning hub

Www.healthdiagnostics.co.uk is currently undergoing a substantial re-design and update. With the existing website having been up for a number of years, we felt it was about time we revamped it to reflect how we're responding to the current priorities of public health bodies across the UK.

The new site will have two sections: a front and back end. The public-facing front end will offer visitors a full and concise overview of what we do and our approach to promoting health and wellbeing. We’ll be documenting our involvement in research that’s helping to establish the evidence base for conducting population health checks and all the latest news and views will be shared through our soon-to-be updated blog.

For those that use Health Options® software or have been on a Health Diagnostics training course, we’re creating a comprehensive online learning hub. Health Check providers will be able to use the learning hub for training and support purposes and also to improve their overall grasp of the UK’s public health agenda. The section will house a range of videos, documents and useful links specifically designed for those delivering and commissioning health check programmes. Users will also be able to get immediate online support through instant messaging and remote desktop facilities.

We’re really excited to go live with the new website; look out for it towards the end of February where we’ll be launching it at the NHS Health Check national conference.

Attendance at the NHS Health Check national conference 

On the 26^th February a team from Health Diagnostics will travel to Leeds Royal Armouries to attend Public Health England’s annual NHS Health Check conference. With this year’s theme being ‘Improvement through Collaboration’, we’ll be taking the time to show how we’ve worked with both public and private sector organisations to create an integrated end-to-end solution for delivering and managing NHS Health Check programmes. 

In addition to launching the new website at the conference, we’ll also be distributing the latest issue of NHS Health Check News. Following on from the success of the previous issue (which is available online), the new issue will lead with a case study on Wokingham Borough Council’s innovative new service delivery model. Articles on brief Motivational Interviewing, the emerging evidence base and a case study on how Health Options® has improved delivery at a GP practice will all feature. In addition to being available in hard copy at the conference, you’ll be able to access the new edition online via issuu.com.

Release of our Call and Recall module

Having run a successful pilot with Durham County Council, our Call and Recall module is now being made available for general release. The module works through Health Options® to allow GP practices to risk stratify and invite an eligible cohort of patients for a health check.

The ability to invite an identified cohort has, for some time, been a priority for public health leads involved in running NHS Health Check programmes. When our partners requested that we come up with a solution that would allow them to perform the process through our software, we got to work devising a mechanism to do precisely that.

The module that’s the result of this development not only allows for the generation of targeted invites, but it’s also able to seamlessly pull all relevant patient data into Health Options® in preparation for a health check. GPs are therefore saved valuable time due to there being no need to manually re-key any data. The potential for human error is also eliminated from the administrative process.

In short, Health Diagnostics can now offer a unique solution that allows councils and providers to find the cohort, invite the patients, deliver a health check, and transfer all results to patient records. 

We’re sponsoring Berkshire’s Inspiration and Participation Awards

On 6^th February sporting heroes, coaches and volunteers will be honoured at the third annual Berkshire Inspiration and Participation Awards evening at the Blue Mountain Gold Club, Binfield. The awards evening recognises the vital contribution that local people make towards inspiring others to take up physical activity as well as individual and team excellence in sport. Olympic gold medalist rower Katherine Copeland is due to speak as special guest at the event.

This year Health Diagnostics will be sponsoring the Lifetime Achievement Award. In the words of Julie Evason, MD of Health Diagnostics, ‘we’re delighted to be sponsoring this award. As a company that have maintained a long-standing commitment to promoting cardiovascular health, we’re full of admiration for the individuals that work tirelessly in their own communities to empower people to lead more active lifestyles.

With all this on the horizon it's set to be an exciting start to 2015. As usual, you'll be able to keep up with everything we're up to via our twitter and blog.

Provider focus: Delivering NHS Health Checks via GP practice

Having recently revamped their health check service, Bewick Crescent Surgery in County Durham conducted almost six times as many health checks as they had done prior to implementing their new approach; they’re now amongst the top performing practices in the local authority for the delivery of NHS Health Checks. We caught up with Tracy Fleming – the surgery’s NHS Health Check Lead – to find out what the team had done to turn their service around…

Q: What was it about Bewick Crescent’s previous approach to delivering NHS Health Checks that wasn’t working well? 

A: Our doctors were telling people that they needed an NHS Health Check, but we found that people often weren’t turning up to their appointments despite having been booked in. This meant that we were often allotting time that ended up being wasted when patients didn’t attend. We also found however that when patients were in a less formal situation – with the healthcare assistants for example – they would often have the confidence to say ‘well actually I don’t want one’. We saw that taking advantage of this would allow us to be far more efficient with our time and resources.

Q: How did you take advantage of this and alter the service?

A: I’ve taken it upon myself to start asking people as they come in. For example, a patient might feel unwell and come into the surgery for a blood test; if they’re eligible I’ll ask them if they’re interested in having a health check and, if so, book them in there and then. I’ve found you tend to get a much better response when the person is in front of you. For us, it works better than sending out letters that you might not get a reply to

Q: So does Bewick Crescent Surgery not send out invite letters? 

A: We do send invite letters, yes. With those people that we can’t get on the telephone to make an appointment, we send a letter informing them of the service and asking them to ring us if they’d like to book in for a health check. Instead of saying ‘come in at this time on this day’ – which we’ve found doesn’t really work – those that are interested get in touch and those that aren’t don’t ring back. This just allows us to be more efficient and not waste our time with unattended appointments. 

Q: It sounds like efficiencies are at the heart of a lot of the changes? 

A: Yes, that’s true; the fact that I’ve taken a leadership role in delivering the service has made that easier. Patient-centeredness is also really important. We’ve made sure that patients come first and any changes work for them. For example we’ve introduced a Tuesday evening clinic that runs between 5pm and 7.30pm. 

Q: What was the rationale for putting on this out-of-hours service? 

A: We put on the evening clinic to accommodate for those people that wanted to have a health check but who weren’t able to get the time off work during the day. It means that we’re engaging a large number of people that we wouldn’t otherwise get to see. It’s been really well received by patients, as has the quality of the health checks that we’re delivering.

Q: What is it about your health checks that patients appreciate? 

A: Health Options software is a lot nicer and more patient-friendly than the software we used before. I tilt the screen so that I’m not talking at the patients, but instead we go through the process together. They can see what I’m doing – I don’t hide anything – and I use the on-screen info to help explain things to them. In that sense, the computer becomes more of a shared focal point; patients therefore don’t feel as though they’re being spoken at, they’re actively involved in their health check. 

Q: And what do people leave with after their health check? 

A: Everyone gets a colourful personal report in a folder; this is another thing that’s really well received. The reports are full of good information on blood pressure, cholesterol, weight management etc, as well as containing the patient’s results. Often people don’t grasp everything that’s said to them when they come into a doctor’s surgery but with this, they’re able to go home and digest the information at their leisure. The report also contains a graphic that clearly explains the individual’s heart age, cardiovascular risk and the potential effects of lifestyle change. This tends to have a much more powerful impact that just saying ‘stop smoking’ or ‘eat healthily’.

Q: Do you see the health checks having an impact then? 

A: Yes, we’ve had a number of patients take up our smoking cessation service after having had their health check. People are also very interested to learn about the different types of cholesterol – HDL (good) and LDL (bad) – and what they can do about their levels. I’ve found people leaving saying ‘I didn’t realise eating more fruit and veg and stopping smoking could make the difference’. There have also been individuals like a man we had in recently who was quite fit – on his bike all the time – but the health check revealed he had dangerously high cholesterol levels. When he looked into his family history, he saw that high cholesterol was a hereditary trait that he hadn’t known about. This was something he was then able to address.

Q: What sorts of things are you doing to promote the service? 

A: We have a big Check4Life banner and notice board in the waiting room with leaflets that patients can take away. These tend to catch peoples’ eye. The notice board clearly says who’s eligible so people can make appointments while they’re waiting if they’re interested. We also include stuff for kids – things like the Change4Life activity wheel – as we’ve found that if the kids start getting into it, it can help mum and dad to keep moving. Word of mouth within families is also a really powerful way to promote the service. We have a lot of people saying ‘‘This is brilliant, I need to my husband to have one’. A lot of wives actually book their husbands in whilst they’re here and make them come down! 

Top tips from Bewick Crescent 

1. Have a member of staff take the lead on the service 

2. If people in the surgery are interested and eligible in having a check, book them in there and then 

3. Use patient-friendly software and share the screen with the patient 

4. Adapt to patients’ needs and put on evening clinics if necessary

5. Advertise the service and look to involve kids in any lifestyle change programmes 

Thanks Tracy. Wishing you all a happy and healthy Christmas and New Year!

NHS Health Check learning resources digitally published online

In a bid to increase access to Health Diagnostics’ library of published materials, a large amount of content has been made digitally available online. The contents of this library can be viewed as online magazines through a range of devices including computers, tablets and phones. Having been closely engaged with reporting on the national programme since its inception, the hope is that these materials will enhance the rich array of free NHS Health Check learning resources available online. So what’s included in Health Diagnostics’ digital library?

NHS Health Check News

The first edition of NHS Health Check News is featured in the library, as will be a forthcoming issue. The newspaper's first issue - released at Public Health England’s February 2014 conference - includes a range of articles that focus on issues such as the latest research and developments in provider competencies. The centerfold features a case study on County Durham’s Check4Life programme and documents how the ‘end-to-end’ solution is being implemented in the North East. Click the title link to view the newspaper.

Example Training Materials

This section features the Motivational Interviewing workbook that’s supplied to providers on training days. The workbook is intended to give guidance and advice on how to encourage constructive lifestyle conversations that promote positive lifestyle change. Whilst Health Diagnostics offer a number of training materials and guides to providers, this workbook is the only example that’s made freely available online for public use. Get in touch to find out more about Health Diagnostics’ range of training resources. Click the title link to view the workbook

NHS Health Check Leadership Forum

This report contains the summary and findings from the first NHS Health Check Leadership Forum. The forum took place during the 2013 Commissioning Show where public health professionals came together to share learning and experience of NHS Health Check programme delivery. An expert panel presented the findings from a range of local projects and public health researchers reported on the early indications from the national evaluation. Click the title link to view the report.

Picture of Health Reports

During 2012 – amid unprecedented changes being made to the commissioning and delivery of NHS services – Health Diagnostics sponsored the production of the Picture of Health reports. This series of three reports and a case study offered clear and comprehensive information on the transition of public health from PCT to local authority control. Produced by Andy Cowper, editor of Health Policy Insight and Achieving Commissioning Excellence, the documents were made up of interviews with experts from around England. They continue to offer unique insights into the commissioning and delivery of NHS Health Checks through local authority. A case study on the North East of England’s service model is included. Click the title link to view the reports and case study.

Motivational Interviewing and the NHS Health Check

The big picture

When it comes to the UK’s heart disease problem, the social and economic costs are dizzyingly high. Every year the condition is responsible for around 74,000 deaths; the cost to the economy comes in at £29 billion. At the current rate, Britain is spending more of its health budget on heart disease than any other EU country. 

Whilst the figures are bleak, many of the risk factors associated with the condition – including high cholesterol, high blood pressure, smoking, inactivity and diabetes – are largely, if not entirely, preventable. This being the case, the simple answer to reversing the trends lies with the not-so-simple process of changing collective lifestyle behaviours. It’s with precisely this preventative agenda that the NHS Health Check programme is concerned.

Despite representing the most comprehensive effort to proactively bring down the national burden of ill health, the success of the programme lies, according to Public Health England (PHE), ‘in part with the ability of the chosen provider to inspire behaviour change in those attending’. To this end, the practice of Motivational Interviewing (MI) has become a central feature of the programme delivery framework.

The inclusion of MI is not without justification. According to the research, MI is ‘effective when delivered in brief consultations’ and has the potential to have ‘robust effects across outcomes’ when used in medical care settings. This consensus is perhaps unsurprising however if we accept that health and care are improved when patients are at the forefront of any decision-making. Such patient-centeredness is exactly what effective MI is able to support and enhance.

Integrating MI into the NHS Health Check framework

As was emphasised in the previous blog post on Reviewing the evidence base for NHS Health Checks, quality is key to the success of the programme. Whilst a number of factors go in to making a quality consultation – from the professionalism of the provider to the functionality of the systems – on a personal level, they’re fundamentally characterised by engagement, empowerment and respect. As was highlighted during a recent MI workshop for the Health Diagnostics team, these are precisely the principles fostered by a truly motivational session.

The coordinator of that two-day workshop was Brett Nicholls (pictured right), Chief Executive of Get Berkshire Active and MI trainer. With nearly two decades of experience using MI in his role as an RAF officer, Nicholls brought to the table both a high-level overview of MI philosophy and a host of nuanced insights on how the techniques can be used in different settings. Focusing in on the NHS Health Check, the core objective in this instance was to further develop the ways in which Health Diagnostics support the process of making every contact count.

Working on the principle that ‘people learn best that which they discover themselves’, Nicholls and the Health Diagnostics team explored how the behaviour change techniques originally developed by Drs Rollnick and Miller can be adapted and applied to the context of a 20-30 minute cardiovascular health check. Despite only offering a brief window of opportunity, the reach and availability of the checks mean that people often use them as a gateway to lifestyle change. Whether this change is catalysed by an individual realising what the future may hold for their health, or simply gaining a knowledge of the local support services on offer, many who’ve had a check confirm that the personal discoveries they make cause them to stop, think and very often take action.

How then do we maximise the opportunities offered by the health check? In short, by an approach that draws out and bolsters commitment to lifestyle change when it emerges in the session. In this regard, a chief finding from the workshop was that ‘the spirit’ of MI should be present right from the point at which the client walks through the door (rather than the provider only thinking within an MI framework when results are being discussed). In other words, the entire consultation should be defined by the understanding that:

• A non-judgemental style that favours collaboration, evocation and autonomy will offer the best chance of success.
• Motivation to change is elicited from the client, and not imposed from the outside.
• It’s the client’s task to resolve their mixed feelings towards their lifestyle behaviours, not the provider’s.
• The provider is there to encourage this reflection and offer the tools with which the client can generate insights and pursue their own goals.
• Expressing empathy, affirming self-competence and helping to strategise clients’ next steps are key provider qualities.

       (Insights drawn from Brett Nicholls' MI course manual and training days)

Whilst these elements form the backdrop of a motivational approach, a number of specific strategies and skills are on hand to facilitate a discussion about the client’s personal concerns and potential changes. Ranging from asking open and evocative questions that establish the priorities of the person having the health check, to showing attentive engagement by reframing and reflecting client statements, these and other techniques give MI its signature quality. Despite requiring training and practice, when used well, the basic skills can often have the powerful effect of helping individuals connect with the things that are important to them. Health Diagnostics have produced a digital workbook for any providers seeking more in-depth guidance.

As the name Motivational Interviewing would also suggest, the techniques are particularly well suited to reinforcing a client’s ability to take control of their lifestyle. Whilst the principle of a ‘non-judgemental style’ is regarded as key to exploring and imparting this confidence, it remains the case that making certain judgements may in fact have the effect of encouraging behaviour change. Although resisting negative judgements is essential to the practice of MI, it should be noted that making the assumption that clients have the capacity to achieve their goals can, in itself, influence behavioural outcomes.

Dubbed the ‘Pygmalion effect’, research has found that people may be positively and negatively influenced by the expectations of others. In other words, holding high expectations can positively affect real performance. For the NHS Health Check provider then, preconceived ideas of a certain type may in fact be beneficial. In addition to helping avoid unnecessary resistance and bringing about a constructive conversation, a positive approach that assumes clients have the capacity to change their lifestyles may itself be a factor in bringing about behaviour change.

Whilst maintaining faith in the possibility and benefits of change, the latest research on Evidence-based risk communication also underlines the importance that providers are able to ‘effectively communicate evidence’ on the harms of certain lifestyle behaviours. Working on the principle of patient-centeredness, Health Diagnostics has developed interactive tools with which providers can demonstrate to clients their current cardiovascular risk and the effects that any lifestyle change could have. 

Intuitive icon arrays, ‘heart age’ calculations and simple-to-understand betting probabilities are used to express both ‘current’ and ‘what if you change’ risk scores to the client. What’s more, thanks to these uniquely personal risk calculations, clients are free to draw their own conclusions without providers needing to extol the virtues of a healthy lifestyle. Providers are therefore able to fill the role of supporting and reflecting any concerns, as well as helping to strategise the next steps that clients may be motivated to take.

Whilst this blog offers only a snapshot of how MI is being integrated into Health Diagnostics' systems and training, the principles of behaviour change are at the core of a number of exciting software and service developments. If you'd like to find out more about how Health Diagnostics are advancing and enhancing the NHS Health Check delivery model for local authorities, please contact info@healthdiagnostics.co.uk. To find out more details about MI training opportunities contact brett.nicholls@getberkshireactive.org.

Reviewing the evidence base for NHS Health Checks

The debate as to whether NHS Health Checks represent value for money was given renewed impetus towards the end of 2014 when two new studies into the programme were published in the Journal of Public Health and the British Journal of General Practice. 

The first of these—a cohort study by Forster et al published in October 2014 in the Journal of Public Health—used a significant sample of patient data (65,324 men and 75,032 women) ‘to estimate the yield of NHS Health Checks’ and assess the programme’s impact. The conclusions of this large-scale study were that the ‘universal prevention programme identifies substantial risk factor burden in a population without known cardiovascular disease’. In other words, NHS Health Checks are effectively revealing CVD risk factors in a large proportion of the 40-74 year old population that were previously presumed to be healthy.

Despite the weight of these findings, those calling for the programme to be abandoned appear to have paid little attention to them. The same however cannot be said for the amount of attention that critics gave to a recent study by Caley et al—published in August 2014 in the British Journal of General Practice—which claimed to assess ‘the impact of NHS Health Checks on the prevalence of disease in general practice’. The authors of this study assert that in 38 GP practices providing NHS Health Checks, the change in reported disease prevalence did not differ from 41 practices that did not provide the checks.

Whilst the programme’s detractors have cited this as evidence that the health checks should be scrapped, a number of researchers and clinicians have since pointed out that Caley et al’s study was, in fact, ‘not powered to support this conclusion’. In addition to there being concerns over the methodology and conclusions, further questions have been raised as to whether those calling for the national programme to be abandoned are basing their arguments on evidence that doesn’t accurately reflect the reality of what’s happening on the ground.

As Dr Matt Kearney—GP and National Clinical Advisor to Public Health England and NHS England—and others have identified, the study was ‘not randomised’, which may explain why it was underpowered to show an increase in disease prevalence. Perhaps more problematic however is that fact that researchers formed conclusions after having considered conditions that are not routinely included in the NHS Health Check.

Despite the authors examining the prevalence of 'hypertension, coronary heart disease (CHD), chronic kidney disease (CKD), atrial fibrillation (AF), and diabetes', as Dr Kearney and others note, CHD and AF are not assessed in the national programme. Although in the longer term you would expect CHD to fall if the health checks proved effective, this would take longer than the three year time frame that the study was confined to. 

This highlights a particular recurring issue in the debate; calls to abandon the health checks have often relied on research that doesn’t relate to the current model put forward by Public Health England (PHE). This was similarly found to be the case with the 2012 Cochrane Review, the conclusions of which the Department of Health say have 'little if any relevance to the NHS Health Checks'. There are a number of reasons for this, one of which was that most of the trials considered were out of date, some from as long ago as the 1960s.

Whilst a number in the health sector have identified Caley et al’s most recently published non-randomised study as lacking the evidence to justify its conclusions, rigorous randomised controlled trials into the NHS Health Check programme do exist. One such study monitored population changes in CVD risk factors over the first year of a new NHS Health Check service. This study – which is available in the Cochrane Library – concluded that the programme resulted in a 'significant reduction in estimated population CVD risk'.

The study also established that NHS Health Check programmes that incorporate Motivational Interviewing and ongoing tailored lifestyle support can 'significantly reduce the prevalence of central obesity'. Given that the UK was recently found to be among the worst in western Europe for the level of overweight and obese people, this insight into the value of high quality consultations is particularly timely. As the evidence suggests, the programme currently promoted by PHE – which is fundamentally conceived of as a supportive and motivational lifestyle intervention – will represent an important component in tackling the nation’s obesity problem, amongst other conditions.

For any public health agenda that takes seriously the notion of patient-centeredness, an essential consideration must clearly be the perspectives of patients themselves. As Janet Krska et al found from carrying out a study that investigated patients' views and experiences of the NHS Health Check, 'both attenders and non-attenders had positive views towards NHS Health Checks in general practice and resultant self-reported lifestyle change in attenders was high'. For this to be the case however, 'clear written information and explanation of personal CVD risk are required'. In other words, the quality of the consultation and support should be noted as repeatedly surfacing as the key to coordinating a successful programme. 

Whilst a number of the aforementioned studies firmly support the value of conducting NHS Health Checks, a nation-wide evaluation is yet to be completed. A forthcoming study by Imperial College London however will address specifically that issue by evaluating whether the national programme 'reduces the burden of heart disease and stroke and other vascular diseases while reducing inequalities in them'. In addition, researchers are investigating the effect of providers delivering patient-focussed health checks that 'extend beyond ticking the contractual boxes'. As has been emphasised in this article, (and as many in the sector would affirm), assessing the quality of health checks must be a fundamental consideration for any meaningful evaluation. 

The politics of wellbeing: how health checks can help us to know ourselves

Much of the debate surrounding the NHS Health Checks has focussed, quite rightly, on how the programme is most effectively delivered and the ways in which communities are best engaged. At times, opponents of the scheme have even raised questions as to whether the national programme should feature as part of public health policy. Whilst these issues are amongst the main topics to have been featured on this blog, this post looks more generally at the politics of wellbeing and how individuals are being empowered to take the reigns when it comes to their heart health. 

As Jules Evans – the author of Philosophy for Life – explores, as far back as the Ancient Greeks the promotion of physical and mental health has been an important concern of many governments. Indeed, Aristotle and Plato’s idea that the state should encourage the flourishing of its citizens has become the overwhelming consensus today. For Evans, the fact that the UK government recently agreed to spend half a billion pounds training 6,000 new CBT therapists shows the extent to which the nation’s wellbeing has become a prominent concern of policy makers.

As the ancient philosophers would be the first to acknowledge however, taking steps to improve mental wellbeing represents only part of the whole picture. Working to improve the nation’s physical health and lifestyle are equally fundamental to a progressive wellbeing agenda, particularly at a time when waistlines are steadily expanding and populations are ageing.

In the UK today, the NHS Health Check programme represents perhaps the most comprehensive and wide-ranging attempt to improve peoples’ general awareness of their health and cardiovascular risk. Indeed, the Socratic assertion that one should ‘know thyself’ is arguably, in the physical sense at least, exactly what an NHS Health Check aims to promote.

During a health check, individuals are presented with an opportunity to find out about how factors such as their cholesterol and blood pressure may be affecting their health. With this knowledge in hand, these individuals are then able to discuss with a trained health professional the ways in which they might go about making any lifestyle changes they regard as important. Information about local support services is also on offer, with providers able to make any appropriate referrals.

As Rashmi, a 55 year-old service user reports in this interview, ‘if it wasn’t for the health check', he would not have known that he had diabetes. After gaining the insights into his personal health, Rashmi decided it was time ‘to take control’ of the situation and began looking closely at his lifestyle in order to make the changes that would bring his diet and weight under control. In essence, that short appointment with his GP allowed Rashmi to address some fundamental questions about how he felt he should have been living. Rashmi has since been able to come off using insulin and tablets altogether and now manages his diabetes with a controlled diet.

Whilst a number in the medical profession continue to cite a lack of evidence for the national programme, feedback from service users repeatedly points in a different direction. For many like Rashmi, the NHS Health Checks bring the notion of making lifestyle changes to the very top of their personal agendas. It's case studies such as this that show how these brief consultations are helping many individuals take personal responsibility for their cardiovascular wellbeing.

Why however should 'knowing our numbers' be so important and conducive to improving our lifestyles? One suggestion may be that becoming aware of one's health status and prospects makes a crucial difference to the way in which health messages are received. Though it seems common that people choose to turn a blind eye to the well-known virtues of eating healthily for example, clearly and tangibly seeing how diet may be influencing the personal likelihood of developing heart disease gives these messages a potency and an immediacy that's difficult to ignore.

As the British Heart Foundation reaffirmed by including it as one of their 'top 10 tips to lead a heart healthier lifestyle', taking up an NHS Health Check can be the gateway to making the changes that make the difference. What's more, in terms of England's NHS Health Check model, harnessing peoples' ability to reconfigure their own lives is seen as essential to any profound and long-lasting improvement in our collective cardiovascular health. At a time when GPs are increasingly under pressure and with that trend looking to continue, promoting this preventative and patient-focussed agenda is as important as ever.

With yesterday having been World Heart Day, it's as good a time as any to acknowledge that ultimate responsibility lies with individuals themselves; whilst many of the most common lifestyle related diseases are preventable, taking steps to avoid them may mean making decisions to change. That said, the tools with which we can generate insight and implement this change have been put in place. For anyone between the ages of 40 and 74 who's not been previously diagnosed with a chronic condition and hasn't had a health check in the past 5 years, they're here to be taken advantage of.