NHS health checks: Failing to care?

We know that diabetes is the number one health threat in the UK, as currently 3.7 million people are living with the condition, with a further 7 million at high risk of developing type 2 diabetes. Over £10 billion of the NHS budget is spent every year on diabetes care, yet 80% of these costs are spent on complications that are, with good care, avoidable. The number of people with type 2 diabetes in the UK is rising rapidly and is estimated to exceed 5 million by 2025. Many people with type 2 diabetes already have serious complications when they are diagnosed.

The NHS Health Check programme, launched 4 years ago by the Department of Health, had huge potential to detect people with type 2 diabetes and to identify those at high risk, who can then be given support and lifestyle interventions to reduce their risk and prevent onset of the condition. There is plenty of evidence to show that lifestyle modifications, such as healthy eating, weight reduction and increased physical activity, can delay the onset of type 2 diabetes (Lindström et al, 2003). Unfortunately, according to the new report “Let’s Get it Right”, published by Diabetes UK in September 2012, thousands of people in England are missing out on being diagnosed with type 2 diabetes owing to the failure to effectively implement the NHS Health Check programme.

Over the last year, less than half (40%) of people who could have gained benefit from an NHS Health Check, which tests people aged 40–74 for their risk of heart disease, stroke, kidney failure and type 2 diabetes, actually had a health check. The report identifies that:

• Only 36 primary care trusts (PCTs) set the recommended target of offering an NHS Health Check to 18% of their eligible population.
• Forty-two PCTs had lower targets in place.
• Seven PCTs offered an NHS Health Check to less than 1% of their eligible population and three PCTs did not offer a single person an NHS Health Check in 2011–12.
• Over half (58%) of the PCTs in England offered NHS Health Checks to less than 18% of their eligible population in 2011–12.
• Only three-quarters (77%) of the NHS Health Checks that were expected to be offered in 2011–12 have been offered.
• Only half (51.6%) of the NHS Health Checks offered have been taken up.

Do you think that these health checks would have been carried out if they had been included in Quality and Outcomes Framework – or is that just me being cynical?

Barbara Young, Chief Executive of Diabetes UK, said (Diabetes UK, 2012b):
“The failure to deliver the NHS Health Check has potentially dire consequences for the state of diabetes care in this country. It is vital that people with type 2 diabetes are diagnosed as early as possible to reduce their risk of developing complications. We are concerned that the estimated 9,500 people who missed being diagnosed last year are at increased risk of amputation, blindness, kidney failure and stroke.”

Just days after the Let’s Get it Right report (Diabetes UK, 2012a) was published, the Government announced that it has made it mandatory to deliver the NHS Health Check; however, if this scheme is to achieve a reduction in those people progressing to type 2 diabetes, then the Government needs to go a step further by monitoring how well this is being done, and by holding poorly performing areas to account for this. Is this likely to happen amongst the current turmoil that is our beloved NHS? I’m not holding my breath but watch this space!