Free health checks for the over 40s
This week, several sources reported that free health checks could save 650 lives per year in England.1-3 These reports refer to a government drive to boost the uptake of the NHS Health Checks programme for people aged 40 to 74. The aim of the programme is to screen all 15 million eligible people for diabetes, chronic kidney disease, chronic lung disease, cardiovascular disease, and stroke risk by 2018/19.
One of the first of its kind in the world, the NHS Health Checks scheme was first introduced in April 2009. Since then, uptake has been variable across regions so Public Health England has been tasked with supporting local authorities in meeting screening targets over the next five years.
If uptake is successful, what are the effects of this scheme likely to be? A search of DARE reveals that there is already some systematic review evidence on health checks in the general population.4,5 Most recently, a 2012 Cochrane review of randomised controlled trials concluded that health checks increased the number of new diagnoses but did not reduce morbidity or mortality.4 An earlier systematic review evaluating a diverse group of “periodic health evaluations”, suggested possible benefits such as improved delivery of preventative services and reduced patient worry.5 Taken together, these reviews do not suggest any obvious direct clinical benefits of health checks in the general population.
Public Health England has however questioned the quality and relevance of the existing research evidence, suggesting that studies included in the Cochrane review were outdated and looked at interventions less rigorous than the current NHS Health Check programme..6 They assert that “In the absence of scientific certainty it is necessary to make a decision on the basis of minimising harm, by comparing the likely risks and harms of action with likely risk and harms of not acting”.6References
1. Free health checks could save lives, Jeremy Hunt says http://www.bbc.co.uk/news/health-23394314
2.Free test ‘will save 650 lives’ http://www.thesun.co.uk/sol/homepage/news/5025670/free-nhs-health-checks-save-lives.html
3.Public Health England launches drive to widen NHS Health Checks http://www.pulsetoday.co.uk/clinical/therapy-areas/cardiovascular/public-health-england-launches-drive-to-widen-nhs-health-checks/20003692.article
4. Krogsbøll LT, Jørgensen KJ, Grønhøj Larsen C, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD009009. DOI:10.1002/14651858.CD009009.pub2. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009009.pub2/abstract
5. Boulware L E, Barnes G J, Wilson R F, Phillips K, Maynor K, Hwang C, Marinopoulos S, Merenstein D, Richardson-McKenzie P, Bass E B, Powe N R, Daumit G L. Value of the periodic health evaluation. Rockville, MD, USA: Agency for Healthcare Research and Quality. Evidence Report/Technology Assessment; 136. 2006 http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?AccessionNumber=12006008282#.UfaQyY2G2So
6. Public Health England. NHS Health Check: our approach to the evidence. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/
224537/NHS_Health_Check_our_approach_to_the_evidence_v2.pdf