Health+Care show, 2014: Showcasing the latest tools for NHS Health Check delivery at London's ExCeL centre

With the 2014 Health+Care show getting under way in London today, the country’s public health authorities are gathering to discuss the state of the nation’s health and the innovative ways in which the NHS is evolving to manage the £2 billion funding gap it’s faced with.

Health Diagnostics are present and amongst the show’s official top 20 ‘must see’ exhibitors. In addition to showcasing Health Options® – one of the leading risk assessment software programmes for NHS Health Checks – we’ll be taking delegates through some of the latest tools for delivering and managing the national programme.

Amongst the tools displayed on stand M40 will be the new 'call and recall' system that’s allowing public health leads to find, invite and deliver health checks to their target cohorts. Our secure data transfer module for returning patient data to any GP system will also be on show alongside a series of new health check training videos that we've produced with the help of our NHS and Local Authority partners.

With all the elements in place, Health Diagnostics’ system represents the complete solution for delivering health checks:

Identify and invite with 'call and recall'

As the first link in the chain of delivery, the call and recall module allows for targeted NHS Health Check invites to be sent to individuals. By sampling the population, the software can determine precisely those that are eligible and at risk, as well as generate tailored invites for the identified cohort.

Deliver a health check with Health Options® software

We’ll be taking delegates through the CVD risk assessment software that’s used by Local Authorities up and down the country. Having been designed with ease-of-use in mind, the software structures and supports the delivery of motivational consultations. With a range of additional functions for data management, the IT solution is both at the core of the data transfer process and the front-line of health check delivery.

Receive detailed public health analysis

We’ll be showing examples of our reports that provide commissioners with detailed analysis on local health trends and provider performance. Generated by analysing data that’s been securely sent to us over an encrypted network, these reports are there to help those in charge make fully informed decisions when shaping local public health policy.

Transfer data to any GP system

Returning data to any GP clinical system securely via the N3 network has, for a long time, been the holy grail of a complete ‘end-to-end’ delivery model. Health Diagnostics have responded to this need and will be taking delegates through the tool we’ve developed for transferring data back from service providers, to individual patient records.

Use the latest training resources

We've worked closely with our Local Authority and NHS partners to produce training videos demonstrating full consultations that adhere to best practice. In addition, a promotional video that can be used by providers in venues and online has been made freely available. These can be viewed here.

So if you're at the show today or tomorrow and are interested in how NHS Health Checks are being managed centrally and delivered locally, we'd love to have a chat. You'll find us at stand M40!

Share, listen, act: Update on the NHS Health Checks in East London ~ Part 2

Part 2:

Following on from Part 1 of the 'Share, listen act' series where we had the initial reaction to last month's NHS Health Check conference, this post will focus on the achievements of the NHS Health Checks in ethnically-diverse East London.

Dr John Robson, a GP working in East London who co-authored the QRisk algorithm with Julia Hippisley-Cox, was responsible for delivering the latest findings in relation to coverage and uptake of NHS Health Checks in the area. 

For the purposes of the project, three Local Authorities comprised ‘East London'. These are listed below, as well as ranked out of the UK's 150 Local Authorities in terms of overall premature mortality:

- Newham (ranked #110)
- City & Hackney (ranked #132)
- Tower Hamlets (ranked #139)

Despite all featuring in the bottom third of UK LAs for premature deaths, the percentage uptake of the scheme in 2011/12 was 74%. This indicates that 21,194 people from those 3 areas had an NHS Health Check; a figure above the current national average of 50% and well above the upper target of 66% as set by Professor Kevin Fenton. Newham even managed 81% uptake.

In regards to the equity of the uptake of the health checks by age, ethnic group and deprivation, Dr Robson echoed much of what Health Diagnostics have seen in collating and analysing NHS Health Check data:

Main findings

1. Older people (>60 years) were more likely to attend a health check (perhaps because they are more likely to be high risk, are stratified as such and are therefore offered a health check).

2. There was no particular difference of uptake based upon quintile, although this is misleading in the three East London areas that the research covered, as the areas were almost exclusively in the 4th and 5th quintile. In 2011/12, 11% of health check attendees had a Townsend Quintile score of 4, whilst 88% had a Townsend Quintile score of 5.

3. There was a significant uptake of the health checks amongst South Asian and black African/Caribbean populations. In 2011/12, 41% of the Health Check attendees were from a South Asian or black African/Caribbean ethnicity band, compared to 28% of non-attendees. 

Overall 

Of those attending an NHS Health Check, 31% had a CVD risk score of at least 10%. In real terms this equated to 15,876 people identified as medium/high CVD risk. These figures would suggest a significant number of people could benefit enormously from identifying risk increasing behaviours earlier in life. For the Local Authorities concerned, responding with targeted educational and health awareness campaigns may prove crucial.

Following on from the risk identification of the health check, of those classified as at high CVD risk overall (200,000 people out of 2 million attendees), around a third (60,000) were prescribed a statin. This would result in an overall decline of instances of CVD by 25%, accounting for a reduction of CVD events by 1500 cases in 5 years. 

The findings from this study point to the significant, positive effect that the NHS Health Check programme can have in lowering CVD risk. In the face of such encouraging evidence, it is understandable that the debate on the utility of the health check programme has subsided in recent months.

Findings conveyed by Health Diagnostics’ Systems and Data Manager, Michael Storry.

Share, listen, act: Reaction to Public Health England’s NHS Health Check conference, 2014 ~ Part 1

Part 1:

This year’s NHS Health Check conference was the largest to date, with hundreds of delegates from across England and Wales coming together to share best practice. 

Taking place at London’s Kennington Oval cricket ground (right), the invited audience was comprised of individuals currently designing the future of this country’s preventive health and lifestyle services.

Amongst the range of speakers asked to present their expertise was Health Diagnostics’ MD, Julie Evason, who after 30 years in the health check business, was ‘‘very pleased to be able share the accumulated learning!’’

Commercial providers role in the NHS Health Check programme: featuring Julie Evason as a panel member

Julie took to the panel after lunch alongside Public Health England’s (PHE) Director of Health and Wellbeing, Professor Kevin Fenton, and a number of other commercial providers from the likes of Boots and Asda. 

Taking the opportunity to discuss some of the pressing issues facing those coordinating health check programmes, Julie outlined Health Diagnostics’ approach to developing answers to the most commonly-voiced problems. Emphasising a particular interest in IT, she stated that Health Diagnostics ‘‘strive to create simple solutions to what can often appear to be overly complex scenarios.’’

The importance of partnering with organisations in order to be able to generate swift resolutions to local authority (LA) issues was a key feature of the speech. As Julie stressed, ‘‘Health Checks are here now. The solutions are required now.’’ Giving an example of precisely what's required, Julie informed the audience:

‘‘Health Diagnostics partner with a number of like-minded specialist companies who can see the strength in working together and they have helped fast track the development of our range of IT solutions which now include modules for cohort identification (that all elusive call and recall) and the ability to return data to any GP clinical systems well within the expected 48 hours.’’ 

Moving from topics such as the available range of delivery mechanisms, to the financial advantages to using point of care equipment, this address covered significant ground in speaking directly to the concerns of the commissioners and programme leads present.

Reflecting on the discussion, Julie remarked that it ‘‘really feels like momentum is building for the NHS Health Checks and I’m very pleased that Health Diagnostics’ offer fits the bill so well. It was a pleasure to be invited onto the panel. It’s really refreshing to see that PHE recognise us as a quality provider in this arena.’’

Conference feedback from Health Diagnostics' delegates

Jen Sutherland, Systems Support and Account Manager

‘‘There was a real buzz about the place - a very pro-active and can-do feel. LAs that are currently using a spreadsheet to record the health check results were very impressed with Health Options® software for recording the information, receiving reports and also how patient focused it is. It really feels like we have an answer to a lot of the problems they’ve experienced.

A number of people commented on their existing software companies taking a long time to implement new changes, (e.g. dementia awareness and pulse palpation requirements). They were pleasantly surprised to learn that we listen carefully to customer feedback and respond quickly to new changes.’’

Julie Evason, Managing Director

‘‘The quality of the delegates was excellent. We had more focused discussions in that one event than at any other show going over two or three days. The fact that this year's event involved as many people as it did really stimulated discussion across all areas with lots of practical advice and tips being shared.

I was surprised by the misconception that much of the IT capability isn’t available when it is, however it’s great to know that we’re fulfilling the evolving requirements of the programme.

What seemed slightly strange was that so many LAs are spending months researching the requirements to put a tender in place. It would make a lot of sense if PHE could provide a template that could be tweaked locally.’’

Selina Donnelly, Training and Account Manager

''It was refreshing that everyone I spoke to was looking for a way to really drive the quality of the health check service.

Hearing that PHE are in favour of looking to alternative providers to GPs was very exciting. It’s great to have been closely involved in the research that’s helping to inform the debate.''

Keep an eye out for parts 2 and 3 of the Share, listen, act blog series, which will feature:

• Part 2: A report on the National evaluation update by Health Diagnostics’ Systems and Data Manager, Michael Storry.
• Part 3: A report on the The new guidelines for NHS Health Check information governance and data flows by Pete Roberts, Senior Solution Developer & Information Security Manager
 at Health Diagnostics.

New NHS Health Check training videos: service users share their experiences

March 2014 is set to be a significant month for the NHS Health Check campaign, with the release of the JBS 3 cardiovascular prevention guidelines and a series of comprehensive new training videos for providers and service users.

Featuring full-length consultations, the training videos will offer providers an invaluable insight into what best practice looks like in action. The individuals carrying out the checks are all experienced Check4Life providers who’ve been responsible for delivering a consistently high volume of checks for a number of years.

In addition, the materials – which will be freely available on YouTube – will serve as an information source for any member of the general public interested in finding out what having a check is all about.

With the health checks being real as opposed to staged, the videos really capture the impact that effective, non-judgemental consultations can have. Keith and Bruce, two men that received consultations as a part of the project had only positive things to say about their experiences:

Bruce, 40 years old, from Durham, was given a health check by Dawn from John Low’s Medical Centre in Consett, County Durham

Bruce before his first health check five years ago

‘‘It was really interesting. I actually came for a health check five years ago when the scheme was first being introduced and functioned as a bit of a guinea pig for the pharmacists to train on!

The results I got today are phenomenal in comparison to last time. When I came first time around, I was leading a completely different lifestyle to what I am now and it was a real eye-opener when I saw my results. I was drinking a huge amount more than I am now and I was a heavy smoker as well. As a result of the health check, I put a stop to both these habits and began eating a lot healthier.

In short, the health check had an extremely positive impact, so much so that I’ve since been able to complete a number of Ironman challenges and am planning to race seven marathons in seven days across the Sahara this year! I couldn’t even run to the pub five years ago!

Even last time, I remember Dawn being really professional and very non-judgemental in her style. Today was no different, I felt very relaxed and comfortable.

I’d recommend it 100% to others. Five years ago, I thought that I was pretty healthy because my job’s always been fairly active. It turned out that I really wasn’t doing enough though. In fact, because of my lifestyle I was building up real problems for myself. My results today have confirmed that I’ve been able to turn all this around.’’

Bruce in August, 2013

Keith, 55 years old, from Durham, was given a health check by Nicola of County Durham’s Check4Life team:

‘‘From the greeting onwards, I thought the whole thing was really professional. Nicola explained everything really well for me and I understood precisely what was going to happen.

What was quite surprising was how I wasn’t being judged in any way, shape or form. I wasn’t told I was fat, drinking too much or not exercising enough, Nicola just gave me the information and let me make my own judgement about it.

The health check has certainly given me the evidence and incentive to make more changes to my lifestyle.

I’d definitely recommend it to anybody; there’s nothing to be frightened of. Even the finger-stick sample is nothing really. The thing is, it lets us find out how we are because we don’t know what we’re like inside until somebody helps you to see what you are.’’

The training videos will be officially released in March. Keep an eye on this blog for details.

Obesity: what's to be done about the UK's expanding waistline?

The extent of the problem

National Obesity Awareness Week started with something of a bang on the 13th January when the National Obesity Forum released its State of the Nation’s Waistline report. In the document’s opening address, Professor David Haslam – Chair of the Forum – states that the prediction that half of the UK’s population could be obese by 2050 may, in fact, represent an underestimation of the true situation. Professor Haslam writes:

‘We are now more than seven years on from the publication of the Foresight Report and, if anything, the situation is now worse than it was in 2007. Without action across the board - from government, business, society and individuals – we might feel fortunate if only 50% of the population is obese and the annual cost is only £50 billion in 2050.’

The claims act as a sobering realisation of the scale of the impending health problems faced in this country. On a global scale, the picture is equally as alarming. According to the Oversees Development Institute, the number of overweight and obese adults in the developing world has quadrupled since 1980 and now stands at one billion.  

The problem is somewhat confounded in the UK by the challenges posed to the NHS by an ageing population that will inevitably require increasing levels of medical attention. Given the close relationship between obesity and a whole range of cardiovascular and lifestyle-related diseases, Professor Haslam is entirely correct to state that the current situation is completely ‘unsustainable’.

What can be done?

With the projections coming from the independent think tanks and charities being as they are, the question as to what can be done is foremost. The answer is certainly complex, however the aforementioned report offers a number of practical recommendations, from promoting the nationwide Change4Life programme, to spelling out ways in which GPs could be encouraged to further engage with helping overweight and obese people change their lifestyles. That said, if the market forces stay as they are, there is likely to remain a huge barrier in the way of any real sustained change.

It’s for this reason that campaign groups such as Action on Sugar have a crucial role in the debate and on-going policy making. The pressure applied by the group – whose manifesto and membership can be read here – must be meaningful if we’re to see the appropriate action taken, rather than a repeat of the ways in which the drink and tobacco industries were softly dealt with in 2013.

In addition to getting a grip on the inconspicuously high levels of sugar in many of the foods that we consume, a debate needs to be had on whether we can really afford to allow trans fats to be so widely used in food production. In November, the American Food and Drug Administration moved to ban virtually all artificial trans fats from the American food supply. The result, according to the New York Times, should be to save thousands of lives and potentially billions of dollars in medical and economic costs each year.

For the UK health authorities, taking similar action to ban these extremely unhealthy elements of the food chain could represent an important move in adopting a consistent approach to tackling the issues. The message sent to producers and vendors of processed and fast food needs to be unequivocally clear if we’re to prevent the kind of widespread illness and disease that’s otherwise predicted.

Of course however, the responsibility cannot all lie on government and organisations to alleviate these issues. Ultimately, we’re all answerable for the lifestyles we lead and the ways in which we either abuse or respect our quality of life. In terms of the individual level then, one thing that we might work towards is to reduce the ways in which we willingly sacrifice our long-term health and self image ‘for a few minutes of pleasant mouth feel and belly comfort’. This kind of activity is known as ‘temporal discounting’ and, according to Scientific American MIND, it may well be more modifiable than some of us might be willing to concede. Research conducted at the University of California has shown that:

‘When you evoke people’s moral obligation to take care of a future self who is dependent on them, in the same way we take care of our children and elderly parents, they make better choices.’

The simple idea is that if people are able to envisage a future self as a third person who’s dependent on their behaviour now, the effect on decision making can be surprisingly profound. Despite only being intended as a brief example of the potential strategies that stand to be gained from psychological research, it does attest to the idea that small, yet targeted changes can really add up.

Insofar as the NHS Health Check is concerned, with an increasing emphasis being placed on behaviour change and Motivational Interviewing, the programme is actively moving to incorporate such techniques as its practitioners up and down the country work to tackle the growing health burdens so poignantly demonstrated by this week’s announcements. The more positive support they’re able to get from wider government policy, the better.

Rounding-up 2013's public health debates and looking forward to the coming year

2013 has proved to be a significant year for English primary care. With the transition of public health from PCT to local authority, April saw the introduction of a whole new system of structures for healthcare commissioning and provision. Whilst it’s still too soon to say whether this move has delivered the desired effect of making local health services more relevant for the communities they’re provided for, the indications from the second half of the year suggest that there’s an increased sense of stability in the sector by comparison to this time last year. For many however, this will hardly come as a surprise given how many NHS departments, let alone individual positions, had uncertain futures twelve months ago.

Plain packaging

One of the biggest public health stories from 2013 was the debate around the plain packaging of tobacco products. The issue became increasingly mired in controversy after it emerged that Lynton Crosby – a campaign consultant at the heart of Downing Street – was also actively representing the interests of the tobacco industry. Although out of the limelight for the time being, this issue along with other public health measures such minimum unit pricing are unlikely to be out of focus for long. Their importance in combating what Dr Zafar Iqbal and others have described as the ‘social and market forces which help to perpetuate health inequalities’ will undoubtedly mean their re-emergence in 2014. Our coverage and perspective on the story can be revisited here.

CVD prevention

The summer also saw Public Health England placing an increased emphasis on promoting cardiovascular disease prevention. However as PHE and the Health Secretary served up the evidence on the predicted benefits of England’s flagship CVD prevention programme – the NHS Health Check – others were voicing their doubts as to the projected net gain. As it has emerged, many of the charges levelled against the programme by critics have been based on misrepresentations of the English model of CVD prevention. Again, our in-depth critique which draws out the specifics of the argument can be read here.

Going forward: the macro view

Fortunately, for those on the ground and working hard in communities to provide the health checks and increase awareness on the effects of poor lifestyle behaviours, the news looks positive. Recognising that ‘doing nothing’ in regard to national health inequalities ‘is not an option’, NHS England’s chief financial officer this week announced an increase in funding for NHS commissioners from £96bn to £100bn over the next two years. As well as the increased budget, a new funding formula for local health commissioners ‘that more accurately reflects population changes and includes a specific deprivation measure’ is said to be being introduced. With the NHS Health Check at the very centre of CVD prevention policy, these announcements should provide the means to continue increasing the efficiency and effectiveness of a programme that is already estimated to ‘prevent 1,600 heart attacks and strokes, at least 650 premature deaths, and over 4,000 new cases of diabetes each year’.

Developments at Health Diagnostics

With this comprising the macro-outlook, a big question going forward for us at Health Diagnostics is: how can we best support the drive to alleviate health inequalities and the growing social and economic burden of cardiovascular disease in our own capacity? We’ll certainly be working hard to continue providing a first-class service to all our NHS partners, however in addition a handful of the new developments will include:

• Working closely with reputable academic institutions to help establish empirical outcome data on the efficacy of the NHS Health Check. The potential benefit of using Health Options® software in delivering the health checks will be investigated in particular.

• A new software release is planned for January 2014. This latest version will include some exciting new developments including the integration of the Diabetes UK questionnaire.

• To coincide with this software release, Health Diagnostics are launching the new range of client report fact sheets. With a keen emphasis on design and clarity, the new reports are intended to facilitate the communication of essential health information. With tens of thousands set to be distributed, the team at Health Diagnostics have been working hard to make the reports as coherent, concise, and informative as possible.

• We’ll again be attending the Commissioning Show in June, with details set to be announced closer to the time. To view the findings of the events run in conjunction with the 2013 show, click here.

Until 2014 then, wishing you a happy and healthy Christmas and new year!

Evidence and outcomes: research into pharmacy delivered NHS Health Checks

Questions over measurable outcomes have been a consistent feature of the NHS Health Check debate since the programme was rolled out in 2009. Given the scope and ambition of the service, as well the vocal opposition to it, articles calling for evidence have become a regular feature in public health journals. In this post, we’ll be drawing attention to some of the empirical studies that are currently informing the debate. Specifically, these studies focus on alternative delivery methods, particularly via pharmacy.

A crucial factor to bear in mind when considering the evidence is that despite the programme being nationally mandated, there is no single mandated way of delivering it. The systems in use across England vary widely in terms of the emphasis they place on design, user-friendliness, and encouraging lifestyle improvement. The studies cited here all use a patient-focussed solution developed by Health Diagnostics. A demo of the software component of the solution may be watched here).

Evaluating Leicester City’s Healthy LifeCheck programme

This evaluation focussed on a service that was delivered by community pharmacists in Leicester City.

In the introduction to the research that was published in the Journal of Public Health in March 2013, the rationale for evaluating the pharmacy-led programme is explained:

‘‘In the past, risk screening programmes have been exclusively undertaken within primary care sites. It has been suggested that such an approach may widen health inequalities by excluding those who do not routinely access organized health care… Subsequently, emphasis has been placed on the importance of incorporating second sector organizations in delivering a vascular risk assessment service’

This work thus assess precisely how important it is to have a ‘many-pronged’ approach when tackling local health inequalities. The study involved a sample of 2,521 individuals, which were recruited from 39 pharmacies. The method and results may be read in full here.

In short, the conclusions to the study spoke resoundingly in favour of pharmacy’s ability to identify and engage with people that may otherwise slip under the radar:

‘‘Cardiovascular risk assessment led by community pharmacists can successfully assess people from large, multi-ethnic UK populations and identify those at high cardiovascular risk or with undiagnosed cardiovascular disease. The service may improve rates of assessments undertaken by individuals who do not access health care through traditional routes.’’

By way of a comment on the particular advantages offered by pharmacy, the study’s authors noted:

‘‘The current study demonstrates the suitability of a pharmacy-led system in including those from a minority ethnic background; perhaps due to the extent to which pharmacies are integrated within local communities and their ability to provide information in a number of languages and formats.’’

Evaluating Sefton PCT’s Cardiovascular screening programme

This second study was carried out in the School of Pharmacy and Biomolecular Sciences at Liverpool John Moores University. It engaged 10 pharmacies delivering the NHS Health Check programme and was published in June 2010.

The report makes the following comment in regard to the collated views on the pharmacy CVD screening service:

‘‘Almost all of the participants had a positive experience of the screening process, with 96 (99.7%) agreeing that they were given enough time for the screening and that pharmacists made them feel at ease. Similar high numbers felt comfortable discussing their lifestyle with the pharmacist. Indeed for many, their expectations of what the screening would cover were exceeded. A further 91 (93.8%) participants agreed that the screening had been done in a suitable place. However, nine (10.8%) had questions that were not discussed during their consultation.’’

Seeing empirical research confirm that NHS Health Checks are being well-delivered by providers outside of GP practices is dispelling the myth that targeted lifestyle interventions can only be carried out by doctors. Given the strain that GP’s are under, as well as the pressing need to raise widespread awareness about the importance and practicalities of leading a healthy lifestyle, looking to the secondary sector should really be something for local authorities across England to consider.

For further information or a localised appraisal of the potential impact of extending the provider network, contact Health Diagnostics at info@healthdiagnostics.co.uk or on 01244 311811. All reports are produced using evidence-based economic modelling.