Guidance

NHS Health Checks: applying All Our Health

Updated 10 March 2022

The Public Health England team leading this policy transitioned into the Office for Health Improvement and Disparities (OHID) on 1 October 2021.

Introduction

This guide is part of All Our Health, a resource which helps health and care professionals prevent ill health and promote wellbeing as part of their everyday practice.

This information will help front-line health and care staff use their trusted relationships with individuals, families and communities to promote the benefits of attending an NHS Health Check.

This guide promotes the benefits of attending an NHS Health Check and provides information on what health and care professionals can do to help a person reduce their risk of cardiovascular disease, once they have had an NHS Health Check.

Health and care professionals play an important role in supporting members of the public with evidence-based risk reduction interventions such as accessing behavioural programmes and pharmacological treatments, which will support them to lower or manage their risk of premature death and ill health.

We also recommend important actions that managers and staff holding strategic roles can take.

Further information is provided by the full range of All Our Health topics.

Access the NHS health checks e-learning session

An interactive e-learning version of this topic is now available to use.

The Office for Health Improvement and Disparities (OHID) and Health Education England’s ‘e-Learning for Healthcare’ have developed this content to increase the confidence and skills of health and care professionals, to embed prevention in their day-to-day practice.

Completing this session will count towards your continued professional development.

Start the NHS health checks e-learning session.

Promoting the NHS Health Check in your professional practice

The NHS Health Check offers advice to help prevent the onset of cardiovascular disease for eligible people - not currently on a cardiovascular disease register or being treated as at risk - aged between 40 and 74.

Cardiovascular diseases are amongst the preventable forms of non-communicable diseases, of which England faces an epidemic that includes:

• heart disease
• cancer
• diabetes
• dementia

Non-communicable disease and disability has the greatest impact on the most deprived communities, so the NHS Health Check provides an opportunity to address entrenched health inequalities. While cancer prevention is not an aim of the programme, many of the risk factors are the same.

The NHS Health Check programme aims to prevent cardiovascular disease, and associated conditions, through the early assessment, awareness and management of individual behavioural and physiological risk factors.

In doing so it promotes the early identification of cardiovascular disease and the other associated conditions. It also supports individuals to manage and reduce behavioural risks and associated conditions through information and evidence-based risk reduction interventions.

The programme has the potential to:

• prevent 1,600 heart attacks and strokes
• prevent 4,000 people a year from developing diabetes
• detect 20,000 cases of diabetes or kidney disease each year
• avoid at least 650 premature deaths a year

A total of 15 million people are eligible for free NHS Health Checks in England.

Under the Health and Social Care Act 2012, responsibility for commissioning and monitoring the programme passed to local authorities.

Therefore, local authorities have a legal responsibility to offer an NHS Health Check to 100% of their eligible population once every five years.

Core principles for health and care professionals

This ‘All Our Health’ NHS Health Check information has been created to help all health and care professionals:

• understand the specific activities and interventions of the NHS Health Check that can help prevent the onset of cardiovascular disease
• think about the resources and services available in their area, that can help people to find out about the NHS Health Check and subsequent risk reduction interventions

Taking action

If you’re a front-line health professional:

• understand your role in helping people reduce their risk of developing cardiovascular disease
• familiarise yourself with the local NHS Health Check service, and know how individuals can access this as well as subsequent risk reduction interventions in your area
• check if eligible patients aged 40 to 74 have been offered an NHS Health Check
• promote and encourage eligible people who you may come into contact with as part of your work, to have an NHS Health Check
• access training to become more confident in identifying, managing and communicating cardiovascular risk to individuals you may care for within your practice
• use everyday interactions with people to discuss the importance of knowing and understanding their cardiovascular risk or heart age, and communicating ‘what’s good for the heart is good for the brain’

If delivering NHS Health Checks:

• use best practice and ensure that National Institute for Health and Care Excellence (NICE) guidance is followed throughout the NHS Health Check pathway
• ensure your competencies and skills are in line with the NHS Health Check Competence Framework, and access any training where required
• promote and support the Better Health Campaign, which encourages positive behavioural change and take-up of the NHS Health Check
• promote the use of the Heart Age Test which encourages people to better understand their heart health and provides them with advice on reducing their heart age and promote the message that ‘what’s good for the heart is good for the brain’
• familiarise yourself with England’s cardiovascular disease prevention ambitions and seek opportunities to get involved in supporting their delivery

If you’re a team leader or manager:

• ensure the teams you manage are aware of NHS Health Check services within your local area
• share information and evidence about the NHS Health Check with your teams, in a format that is accessible for all
• promote a team culture where staff know that they should talk to individuals about the NHS Health Check
• provide learning and development opportunities on CVD prevention, and on communicating CVD risk for team members
• allow staff time to access an NHS Health Check and promote this opportunity within your own teams
• if appropriate, consider NHS Health Check research and evaluation opportunities

If you’re a senior or strategic leader:

• use the Cardiovascular Disease Prevention Packs
• use national data profiles or tools to understand the health needs of the local population and know the local services available - such as NHS Health Check providers, stop smoking services and weight management services
• promote the NHS Health Check as a route through which to detect, manage and prevent non-communicable disease
• work in partnership with local authority public health teams to ensure that the NHS Health Check is reaching high-risk and vulnerable communities
• support and promote community-based health and wellbeing services, which will benefit local service users
• if you are an NHS Health Check provider, look at the education and training needs of the workforce, to equip them to deliver high-quality checks
• seek opportunities to work collaboratively with local partners, including sustainability and transformations partnerships (STPS) and integrated care systems (ICS) to ensure the NHS Health Check is embedded as part of wider prevention initiatives

Understanding local needs

NHS Health Check Data

You can explore your local NHS Health Check data using the heat map, which provides information on offers and uptake of the checks by region and local authority area.

The NHS Health Check interactive data dashboard provides data on the characteristics of those attending and not attending NHS Health Checks using GP records from 9.5 million people between 2012 to 2018.

National Cardiovascular Intelligence Network

Public Health England provides intelligence and data through the National Cardiovascular Intelligence Network (NCVIN). This information is useful to identify how well people are being diagnosed and treated for CVD. It includes:

• Cardiovascular Disease prevention packs
• Fingertips profiles for cardiovascular disease
• a digital platform providing CVD data and analysis guidance for health professionals and commissioners

Other useful data and information sources include:

• NHS datasets
• NCVIN is a delivery partner in the new national CVD prevention audit, CVDPREVENT. This audit will commence reporting in December 2021 via a Data Explorer.

Measuring impact

As a health and care professional, there are a range of reasons why it makes sense to measure your impact and demonstrate the value of your contribution.

This could be about sharing what has worked well in order to benefit your colleagues and local people - or help you with your professional development.

Ready Reckoner

The impact of the NHS Health Check on local populations can be assessed using the Ready Reckoner.

The NHS Health Check Ready Reckoner helps health and social care commissioners, providers, elected members, local government officers as well as academics, to give an idea of the potential cost savings that can be made by NHS Health Checks.

Public Health Outcomes Framework

The Public Health Outcomes Framework examines indicators that help us understand trends in public health such as premature mortality in individuals with CVD. There are 3 indicators related to NHS Health Check and a number of additional indicators related to cardiovascular disease.

CVD Return on Investment tool

The CVD Prevention Return on Investment Tool can help you to understand the costs, savings and health benefits likely to be produced by implementing a range of interventions or improvements in detection, or management of cardiovascular disease in your local authority (LA), clinical commissioning group (CCG) or sustainability and transformation plan (STP) footprint.

Further reading, resources and good practice

Advice for people accessing the NHS Health Check

• the NHS Health Check website gives you information about the check, and what to expect
• you can also locate your local NHS Health Check Service
• The Heart Age Test tells you your heart age in comparison to your real age - and explains why it is important to know your blood pressure and cholesterol
• Better Health contains information and applications to support healthy lifestyle choices on diet, exercise and alcohol consumption

Find out more about what your blood pressure reading means.

Professional resources and tools

• the NHS Health Check website contains a wealth of resources for Commissioners and Providers of the NHS Health Check
• there is a regular NHS Health Check programme e-bulletin which features programme developments and signposting to learning network events and resources
• The NHS Health Check Competency Framework sets out the core competencies, clinical skills competencies and programme competencies required to carry out a NHS Health Check
• the NHS Health Check StARS framework provides a structured and systematic approach to support with raising the NHS Health Check delivery standards
• The Health Matters: NHS Health Check sets out the role of the NHS Health Check in the prevention and detection of CVD in England
• the NHS Health Check Health Equity Audit Guidance will support in understanding why and how to conduct an audit on the programme
• the Health Matters: CVD Building Back Better blog outlines the importance of re-starting CVD prevention programmes, such as the NHS Health Check, as part of COVID-19 recovery
• find out about the CVD Ambitions, which set out to improve the detection and management of atrial fibrillation (AF), high blood pressure and raised cholesterol, and reduce the health inequalities associated with CVD, over the next 10 years
• the NHS Long Term Plan has identified the NHS Health Check as a priority area for improvement

NICE Guidance

Interventions to manage the risk of cardiovascular disease are based on the following NICE guidance.

Type 2 diabetes: prevention in people at high risk (PH38) offers 20 recommendations to use alongside the NHS Health Check programme.

Hypertension in adults: diagnosis and management (CG127) offers evidence-based advice on the care and treatment of adults with primary hypertension.

Alcohol-use disorders: prevention (PH24) is one of 3 pieces of NICE guidance addressing alcohol-related problems among people aged 10 years and older.

Chronic kidney disease in adults: assessment and management (CG182) offers evidence-based advice on the care and treatment of people with chronic kidney disease.

Obesity: identification, assessment and management (CG189) offers evidence-based advice on the care and treatment of obesity.