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Public health: will councils provide required checks? Public health: will councils provide required checks?
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In towns and villages across County Durham, Check4Life roadshows are becoming a familiar sight. As an area which has some of the most severe health inequalities in the country, local people are being offered the opportunity for preventive health checks as a way of tackling the roots of ill-health. The teams carry out the community health checks for people aged between 40 and 74 in a variety of settings including town halls, leisure centres, local supermarkets and pharmacies.In towns and villages across County Durham, Check4Life roadshows are becoming a familiar sight. As an area which has some of the most severe health inequalities in the country, local people are being offered the opportunity for preventive health checks as a way of tackling the roots of ill-health. The teams carry out the community health checks for people aged between 40 and 74 in a variety of settings including town halls, leisure centres, local supermarkets and pharmacies.
The Department of Health estimates that national uptake of health checks could prevent about 9,500 heart attacks and strokes a year, and expects that 20% of people screened will be high risk, with the figure higher in areas of greater deprivation. In 2009, it introduced free NHS health checks for older adults, but in 2011-12, a year before primary care trusts (PCTs) were abolished, figures show that two-thirds of PCTs were failing to provide sufficient health checks to meet their 20% target. In addition, only 54% of eligible adults attended for a check in 2011-12, compared with 60% the previous year.The Department of Health estimates that national uptake of health checks could prevent about 9,500 heart attacks and strokes a year, and expects that 20% of people screened will be high risk, with the figure higher in areas of greater deprivation. In 2009, it introduced free NHS health checks for older adults, but in 2011-12, a year before primary care trusts (PCTs) were abolished, figures show that two-thirds of PCTs were failing to provide sufficient health checks to meet their 20% target. In addition, only 54% of eligible adults attended for a check in 2011-12, compared with 60% the previous year.
The main factor in the fall appears to be a lack of attractive financial incentives for GPs to carry out the checks, according to health experts. But in County Durham, Mike Lavender, a consultant in public health medicine, and his team have developed a proactive health check programme.The main factor in the fall appears to be a lack of attractive financial incentives for GPs to carry out the checks, according to health experts. But in County Durham, Mike Lavender, a consultant in public health medicine, and his team have developed a proactive health check programme.
"There was a huge variation in terms of health checks being delivered by GP practices, so we knew we had to do something in the communities that the practices weren't reaching," says Lavender. "We also saw that men and women in the younger age groups – 40s to mid-50s – weren't really going in for the health checks … so the programme was aimed at that younger adult population.""There was a huge variation in terms of health checks being delivered by GP practices, so we knew we had to do something in the communities that the practices weren't reaching," says Lavender. "We also saw that men and women in the younger age groups – 40s to mid-50s – weren't really going in for the health checks … so the programme was aimed at that younger adult population."
In April 2011, the then PCT started to offer a "mini-MOT" to younger adults aged up to 40 in disadvantaged areas at a variety of community settings. As a result of the 3,378 mini-MOTs carried out, 483 adults were sent to have a fuller health check at the Check4Life project, and of these 418 were signposted to lifestyle services, including physical activity, stop-smoking services, a health trainer team and healthy cooking courses.In April 2011, the then PCT started to offer a "mini-MOT" to younger adults aged up to 40 in disadvantaged areas at a variety of community settings. As a result of the 3,378 mini-MOTs carried out, 483 adults were sent to have a fuller health check at the Check4Life project, and of these 418 were signposted to lifestyle services, including physical activity, stop-smoking services, a health trainer team and healthy cooking courses.
The Check4Life sessions are delivered by a combination of nurses and other workers trained by the team, including leisure centre staff and pharmacists. The session involves a 10-15 minute health assessment, including measuring waist circumference, a body mass index (BMI) calculation, blood pressure check and pinprick blood testing. "People feel more relaxed in these settings, as it's not a surgery or hospital, and we find they're more willing to discuss their health and lifestyles, and are more open to possible changes," says Jacqui Deakin, health improvement lead at County Durham and Darlington NHS Foundation Trust, which delivers the service for Durham county council and Darlington borough council.The Check4Life sessions are delivered by a combination of nurses and other workers trained by the team, including leisure centre staff and pharmacists. The session involves a 10-15 minute health assessment, including measuring waist circumference, a body mass index (BMI) calculation, blood pressure check and pinprick blood testing. "People feel more relaxed in these settings, as it's not a surgery or hospital, and we find they're more willing to discuss their health and lifestyles, and are more open to possible changes," says Jacqui Deakin, health improvement lead at County Durham and Darlington NHS Foundation Trust, which delivers the service for Durham county council and Darlington borough council.
One factor in its success has been the use of advanced software for relaying results to GPs' surgeries to flag up high-risk patients. Yet there are fears that the future of heath checks may be jeopardised following the transfer in April of public health responsibilities to local authorities. One former director of public health says he thinks cash-strapped councils will "get round" the ringfencing of public health money and dip into funds. "It's very difficult to define exactly what is meant by public health, and how much money is currently going into it. It's a mix of money you can clearly identify – for example, cost per immunisation – and money you can't – such as HIV prevention budgets," he says.One factor in its success has been the use of advanced software for relaying results to GPs' surgeries to flag up high-risk patients. Yet there are fears that the future of heath checks may be jeopardised following the transfer in April of public health responsibilities to local authorities. One former director of public health says he thinks cash-strapped councils will "get round" the ringfencing of public health money and dip into funds. "It's very difficult to define exactly what is meant by public health, and how much money is currently going into it. It's a mix of money you can clearly identify – for example, cost per immunisation – and money you can't – such as HIV prevention budgets," he says.
Professor Kevin Fenton, director of health and wellbeing at Public Health England says how councils choose to use their ringfenced public health budget is their decision, reflecting their priorities and meeting their statutory requirements. Health checks, he says, have been shown to be a highly cost-effective intervention. "The programme offers a real opportunity to reduce premature mortality and health inequalities in England. A number of areas are achieving good takeup, while others have been slower to get going."Professor Kevin Fenton, director of health and wellbeing at Public Health England says how councils choose to use their ringfenced public health budget is their decision, reflecting their priorities and meeting their statutory requirements. Health checks, he says, have been shown to be a highly cost-effective intervention. "The programme offers a real opportunity to reduce premature mortality and health inequalities in England. A number of areas are achieving good takeup, while others have been slower to get going."
Jonathan McShane, a member of the Local Government Association's community wellbeing board, is upbeat about the future of health checks. He says: "We think the transfer [to councils] means that the approach to public health will be significantly refreshed." But he cautions: "In the current climate, it would be naive to think that public health funding would be immune to any change."Jonathan McShane, a member of the Local Government Association's community wellbeing board, is upbeat about the future of health checks. He says: "We think the transfer [to councils] means that the approach to public health will be significantly refreshed." But he cautions: "In the current climate, it would be naive to think that public health funding would be immune to any change."
In County Durham, the service has been so successful in engaging with hard-to-reach groups that other councils in the north-east, from Northumberland to Tees Valley, hope to roll out the model.In County Durham, the service has been so successful in engaging with hard-to-reach groups that other councils in the north-east, from Northumberland to Tees Valley, hope to roll out the model.
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