NHS Health Checks 'waste £450m' a year - report

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The NHS Health Check programme is spending up to £450,000 per death avoided, which could be better spent, a report from the London School of Economics and University of Liverpool has said.

The programme invites all those aged between 40 and 74 without cardiovascular disease for a check every year, modelling suggests it may prevent 1000 deaths a year.

The report: Invited Debate. NHS Health Checks - a naked emperor? Assessed the programme against the World Health Organisation's Screening Criteria, with the programme failing six of the ten criteria.

It passes the criteria that the condition:
• The condition should be an important health problem.
• There should be a recognisable latent or early symptomatic stage.
• The natural history of the condition including development from latent to declared disease should be adequately understood.
• There should be facilities available for diagnosis and treatment - though the report warns this is less true for dementia

Cardiovascular disease, diabetes, dementia and other non-communicable diseases account for 80% of deaths and disability in the UK, while sharing the same risk factors of poor diet, tobacco alcohol and physical inactivity.

The report found the Health Checks had an average uptake of 50% of the eligible population, while much of the risk management is already being done by GPs during normal consultations.

Consequently the tests could be replicating tests already done in general practice and risk changing what is covered in primary care.

The report also warns that the global risk scores used to calculate the likelihood of cardiovascular and related disease has "frustratingly low sensitivity and specificity" for individual patients with current calculators missing over a third of people who subsequently have strokes or heart attacks.

The report suggests schemes promoting healthy eating could halve premature cardiovascular disease rates, while child and maternal health interventions would also be more effective.

The cost of the scheme, originally estimated at £350m a year in 2008, is now around £450m a year the report estimates.

The report criticises the National Institute for Health and Care Excellence (NICE) for doubling the number of people eligible for treatment following health checks.

The report said: "Thus, preventing 1000 deaths annually could cost up to £450,000 per death avoided. And costs will obviously spiral substantially now that NICE have roughly doubled the number of potentially eligible people for treatment.

"These high costs are rarely acknowledged and often dismissed. They also make the much quoted NICE estimate of ‘around £3000 per QALY (quality-adjusted life-year)' look rather fanciful."

It adds: "Health care professionals, services and local authorities are all mandated to implement NHSHCs. In spite of austerity policies, they are required to commit time and scarce resources to activities of debatable effectiveness and cost-effectiveness.

The report said: "This saps morale, particularly considering the substantial opportunity costs of failing to invest those scarce resources in alternative, more effective interventions. For instance, many child and maternal health interventions are proven to be cost-saving."

The report adds: We believe that many of our colleagues in the Department of Health, Public Health England and NHS England privately agree that NHSHC are costly and ineffective.
"However, as civil servants they are obliged in public to ‘toe the party line'.

"Lacking an independent voice, they must be seen to support ministers even when the scientific evidence points in the opposite direction - they are obliged to see the Emperor's clothes where none exist.

Further reading: 

NHS misses two cancer targets

NHS commissions healthcare from French providers

Five million people at high risk of Type 2 diabetes

 

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