Wednesday 24 July 2013

NHS Health Checks Compete with tobacco and alcohol policy for headlines

Plain cigarette packaging as has been introduced in Australia. Photo: AFP
July has turned out to be a topsy turvy month for public health. Whilst Public Health England has revealed its plans to drastically scale up the delivery of NHS Health Checks, other policy announcements have delivered significant blows to those campaigning for public health reforms.

Despite a drive to deliver 15 million NHS Health Checks over the next five years, July also saw the shelving of plans to introduce minimum unit pricing on alcohol and a rejection of proposals that would have meant cigarettes needing to be displayed in plain packets.
For many, this contradiction is likely to prove problematic. Whilst the government’s commitment to assess and advise the population on cardiovascular risk is ambitious, the political messages are mixed. Decisions that are likely to have a detrimental effect on people’s health mean that the government’s overall approach cannot really be deemed ‘holistic’.
As David Cameron has stated ‘health inequalities in 21st century Britain are as wide as they were in Victorian times. We can't go on like this.’ Despite sounding decisive, there is arguably a mismatch between the rhetoric and the policies actually being implemented (or not in the case of tobacco and alcohol).
In regard to plain packaging, the government argued last week that there was lack of evidence that such measures would work. This is no longer the case. On the 22nd July a study entitled Introduction effects of the Australian plain packaging policy on adult smokers: a cross-sectional study’ was published by the BMJ. A very brief summary of the study’s conclusion is as follows:
‘‘The early indication is that plain packaging is associated with lower smoking appeal, more support for the policy and more urgency to quit among adult smokers.’’
The above was strongly suspected by many involved in public health. The Faculty of Public Health even felt it appropriate to withdraw from responsibility deals and issue a strongly worded statement when the government decided in favour of allowing cigarette manufacturers to continue branding their goods.
What does seem clear at this stage is that the introduction of plain packaging would constitute an extremely grim medicine for those with vested interest to swallow. The importance of a market identity to cigarette companies is perhaps most potently demonstrated than by the fact that, in 2003, the industry allegedly spent a combined total of $15.12 billion on promotion and advertising. To remove the ability to brand the products is therefore, arguably, to take away one the tobacco industry’s most effective and refined tools.
Given that the evidence has now been published, the government can re-establish the debate armed with the knowledge they were previously lacking. Hopefully in doing so they’ll be able to standardise a consistent approach to promoting healthy living.
That said, if the contradictions ensue, one could argue that the drive to deliver 15 million health checks runs the risk of having its rationale undermined by the detrimental impacts of other big decisions that promote damaging lifestyle behaviours. Despite being a crucial element in the country’s public health programme, the NHS Health Checks need to be part of an overall set of directives that work towards preventing widespread poor health from overwhelming the NHS over the coming decades.
Yes, the issue is ultimately one of education, however the potency that lies within regulating the pricing, advertising and branding of unhealthy, ‘demerit’ goods cannot be underestimated.

Wednesday 10 July 2013

Published findings from the NHS Health Check Leadership Forum

On 12th June, the first NHS Health Check Leadership Forum took place during the 2013 Commissioning Show. Initial findings from the National Evaluation were announced and discussed by public health experts from around England. Ambassadors from successful programmes also presented on innovative strategies for commissioning, delivery and management of NHS Health Checks. The event was filmed and key findings have been collated as video and PDF thought piece. These are freely available at

The long-term outcomes of the NHS Health Checks have yet to be measured. However,
Dr Michael Soljak, Clinical Research Fellow at Imperial College London, kicked off the Forum by presenting encouraging early results from his team’s National Evaluation of the programme. These indicate that uptake has been greater in more deprived areas, suggesting the health checks had been targeted effectively to address those at highest risk from cardiovascular disease, stroke, diabetes, liver or kidney disease. The findings have been accepted for publication in the Journal of Public Health.

The Leadership Forum identified the ‘top five’ factors key to successful provision and uptake of NHS Health Checks:-

1.      Flexibility to fit local needs
2.      Complete quality assurance
3.      Delivery of the check in a single session
4.      A patient-focused IT solution
5.      Seamless data transfer to patient records

Jayne Herring, Public Health Contracts Manager for NHS Tees, explained the need to be flexible and to fit local needs. Tees Public Health has carefully targeted the NHS Health Checks to over 65,000 local individuals, 20,000 of whom were found to be at high risk. Underpinning this project – which has achieved year-on-year DH performance targets – is reliable and efficient IT support. Herring went to lengths to say: “I cannot overestimate the importance of investing in good primary care informatics and IT solutions for the health checks.”

The need for total quality was underlined by panel member
Jacqui Deakin, Quality and Health Improvement Lead for Durham County Council. In an article featured in the Guardian on 10th July, Deakin described her team’s approach as a ‘‘non-medical lifestyle intervention’’. Many of County Durham’s NHS Health Checks are carried out in community settings rather than surgeries or hospitals, making the quality of delivery essential if GPs are to trust the data landing on their clinical systems. Deakin also emphasised the importance of, “Doorstep provision, making every contact count (MECC), and offering choice so that individuals feel they ‘own’ their care pathway.”

Julie Evason, Managing Director of Health Diagnostics, drew attention to the advantages of delivering checks in a single session using Point of Care testing, (as opposed to asking patients to return to their GP to collect results). ‘‘Individuals can then be given brief opportunistic advice immediately after they’ve had a pin-prick blood test and received their health check results. This is about maximising every single intervention.’’ Similarly, a software programme which is patient-focused and designed for use during a consultation can enable individuals to conceive of their level of risk easily through the use of intuitive illustrations, graphs and imagery. Evason explained ‘‘Health Diagnostics have tried to incorporate all of these practical features into Health Options®.’’

Recent innovations in paperless data transfer to patient records were also announced. Evason stated, “If we’re not getting the data back, it simply won’t count towards local authority targets,” adding that data should be getting onto clinical systems within a matter of clicks. The paperless approach doesn’t require data to be re-inputted by GP surgery staff, therefore avoiding the potential for human error and reducing administrative costs to practices. Ultimately, it enables those at particularly high risk to be immediately flagged as the data is sent to the patient’s record quickly and securely.

As the
Guardian Healthcare Network stated earlier this month, “We don’t need to wait around for technology to improve to meet this challenge, but instead use the technologies available to us now, to leapfrog our way closer to 2018, when Hunt wants the NHS to go paperless.”