The government’s spending watchdog the National Audit Office (NAO) has called for a review of NHS Health Checks, as the current system of checks for over-40s ‘isn’t working effectively’.
Over the summer, the government announced that NHS Health Checks would begin to be offered via workplaces, but the NAO in a review has recommended that a more widescale shake-up of the preventative health checks is needed.
In particular, it has argued Health Checks need to become much better at spotting and preventing cardiovascular disease (CVD), which currently affects millions of people in England while costing the healthcare system and wider economy tens of billions of pounds each year.
NHS Health Checks have been offered since 2009 to anyone aged 40 to 74 who does not have a pre-existing heart condition.
While the checks do help to spot cases of CVD, the NAO said, not enough people are being offered or receive checks. It is therefore recommending a review of how Health Checks are delivered to boost uptake.
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A decade ago, in 2013, responsibility for commissioning Health Checks was transferred from the NHS to local authorities, as part of the transfer of responsibility for elements of public health, it pointed out.
This created a statutory requirement on local authorities to offer Health Checks to all eligible individuals over a five-year period. Positively, the NAO report found that, for 2023-24, the level of Health Checks had recovered, post-Covid, to 1.42 million checks completed.
However, only 3% of local authorities delivered a Health Check to all of the annual eligible population in their areas in 2023-24 and less than half of the eligible population attended a check.
Local authorities were not able to require general practices or other providers to deliver Health Checks, instead relying on voluntary agreements.
Problems further arise with local authorities unable to routinely access practice data to monitor the Health Check programme and see whether checks are delivered to those most at risk, the NAO said.
There was also concern among primary care professionals about general practice’s capacity to conduct Health Checks, it argued.
Between 2014-15 and 2023-24, the amount local authorities spent on individual Health Checks fell in real terms from £56 to £43 per check.
The NAO is therefore recommending the Department of Health and Social Care considers improvements in several areas, including assessing whether local authorities are best placed to deliver Health Checks and incentivising the delivery of Health Checks to people at highest risk of CVD.
It has also argued clear targets need to be set for the numbers or percentages of the eligible population who should attend Health Checks, so they are attended and not just offered.
Gareth Davies, head of the NAO, said: “Each year thousands of lives are lost to cardiovascular disease, with billions of pounds spent tackling it.
“Health Checks can play a crucial role in bringing these numbers down, but the system isn’t working effectively, resulting in not enough people having checks. This is an unsatisfactory basis for delivering an important public health intervention.
“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,” Davies added.
In response to the report, William Roberts, chief executive of the Royal Society for Public Health, said Health Checks did provide value in that they “enable those at risk to have conversations and take steps that support them to improve their health”.
However, he added: “We can’t act on what we don’t know – so if uptake is falling in those who would benefit the most, we need to look at how we increase it.
“Looking at primary care settings like pharmacies or dentists as a place to offer the check is a sensible step. The most effective public health interventions meet people where they are. As well as primary care, policymakers should be looking at the workplace as a key place we can build health.
“Helping people to live longer in better health will have huge payoffs for our health service, our economy, and, most importantly, individuals who get to enjoy more years lived in good health,” said Roberts.
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