Review Into One-Size-Fits-All NHS Health Checks

Peter Russell

August 16, 2019

A review into the effectiveness of NHS health checks, improvements to care for people with neurological conditions, and guidance by NICE on a breast cancer drug, featured in announcements this week.

NHS Health Checks

An evidence-based review into England's NHS Health Check service has been commissioned by the Government.

The checks, currently offered to everyone aged between 40 and 74, paid little attention to people's individual risks or needs, according to the Department of Health and Social Care (DHSC).

It said that over the last 5 years the programme identified over 700,000 people at high risk of cardiovascular disease, and it had saved an estimated 500 lives each year.

However, fewer than half of people in England eligible for a check actually received one, recent figures suggested.

The review would explore how to improve the system, and increase uptake, with a focus on offering personalised interventions. These would be based on factors such as a person's age, where they lived, and their DNA.

The DHSC said the review would also consider:

  • A check-up for people approaching retirement age to help prevent or delay future care needs

  • Increasing the range of advice the checks can offer, including prevention of musculoskeletal problems, or early action on hearing loss

  • The digitisation of health checks, where appropriate

In a news release, Matt Hancock, Secretary of State for Health and Social Care, said: "Personalised, preventative healthcare is mission critical to the future-fit healthcare service we want to build. We must harness the latest technology and techniques to move away from the one-size-fits-all approach of the past.

"The review we are announcing today will be an important step towards achieving that, helping us to find data-led, evidenced-based ways to support people to spot, manage and prevent risks to their health through targeted intervention."

Duncan Selbie, CEO of Public Health England, said: "Predictive prevention becomes ever more possible through genomics and the application of cutting edge behavioural science.

"NHS health checks have been phenomenally successful, and this review is a great opportunity to make the next generation the most effective in the world."

The Royal College of GPs said it had questioned the benefits of blanket health checks for some time and welcomed the review.

However, Prof Helen Stokes-Lampard, RCGP chair, said that "while the focus on only offering health checks to certain groups at risk of certain conditions is a move in the right direction, we need to ensure the methods used to determine who should be invited for one are properly thought through and based on rigorous evidence".

The RCGP said that careful consideration was needed to address unintended consequences of predictive genetic testing, the increased workload for GPs, and the technological and training resources for providing new checks.

Toolkit to Improve Care for Patients With Brain and Nerve Conditions

The NHS joined forces with seven charities to produce a toolkit to help improve services for people with neurological conditions including multiple sclerosis (MS), motor neurone disease (MND), and Parkinson's disease.

Initiatives included rolling out fast-tracked blood tests, and offering consultant appointments over Skype. People would also be supported to better understand and manage their symptoms at home.

The initiative could mean quicker diagnoses, better coordinated care, and save up to 2500 emergency admissions to hospital a year, according to NHS England. It estimated that up to £10 million could be freed up to fund improved services.

The toolkit was developed in association with Parkinson's UK, the Multiple Sclerosis Trust, the MS Society, the MND Association, the Sue Ryder Foundation, the Multiple System Atrophy Trust, and the Progressive Supranuclear Palsy Association.

Dawn Chamberlain, programme director for clinical improvement at NHS England and NHS Improvement, said: "This is an opportunity for the NHS to work directly with patients and their families to deliver better care closer to home for the thousands of people with progressive neurological conditions.

"As they work with staff, patients, and stakeholders to implement the NHS Long Term Plan, this toolkit provides the information local health leaders need to understand how to deliver high quality neurology services."

Steve Ford, chief executive at Parkinson's UK, commented: "For too long, services have neglected progressive neurological conditions. This is as dangerous as it is unjust, putting people at higher risk simply because of the kind of condition they have.

"We are urging all Clinical Commissioning Groups to work with charities and implement the new toolkit, so they can make the changes so desperately needed to reduce hospital admissions and unlock these vital cost savings."

Drug Poisoning Rate Rise

Deaths related to drug poisoning in England and Wales reached their highest ever recorded level in 2018, new data showed.

There were 4359 deaths related to drug poisoning last year, the highest number since records began in 1993.

The figures from the Office for National Statistics (ONS) also showed the highest annual increase, with a 16% rise between 2017 and 2018.

Other main points highlighted by the ONS were:

  • The male drug poisoning rate has significantly increased from 89.6 per million males in 2017 to 105.4 in 2018, while the female rate increased for the ninth consecutive year to 47.5 per million females in 2018

  • Two-thirds of drug-related deaths were linked to drug misuse, accounting for 50.9 deaths per million people in 2018

  • The North East of England had a significantly higher rate of deaths relating to drug misuse than all other English regions, while London had the lowest rate

  • Between 2017 and 2018, there were increases in the number of deaths involving a wide range of substances, although opiates continued to be the most frequently mentioned type of drug

  • Deaths involving cocaine doubled between 2015 and 2018 to their highest ever level, while the numbers involving new psychoactive substances returned to their previous levels after halving in 2017

Ben Humberstone, deputy director for health analysis and life events at the ONS, said: "The number of deaths registered from drug use in 2018 was the highest since our records began in 1993. We have also seen the biggest year-on-year percentage increase.

"Previously, this had been linked to a rise in deaths related to opiates like heroin and morphine, but last year there were also increases in deaths across a wider variety of substances including cocaine and what had been known as 'legal highs'."

Drug poisoning deaths involve a broad spectrum of substances, including controlled and non-controlled drugs, prescription medicines, and over-the-counter medications.

Mike Dixon, chief executive for drug and alcohol charity Addaction, called for a boost to investment in community outreach programmes. "Many local services have faced cutbacks and the reality is that outreach services barely exist anymore," he said. "We need to go where people are. When we wait for people to come to us, too many of them don’t make it."

Breast Cancer Drug Recommended for CDF

Ribociclib (Kisqali, Novartis) in combination with fulvestrant (Faslodex, AstraZeneca) was recommended for use within England's Cancer Drugs Fund as an option for treating hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, locally advanced or metastatic breast cancer in people who have had previous endocrine therapy.

The National Institute for Health and Care Excellence (NICE) noted that clinical trial evidence suggested that, compared with fulvestrant alone, ribociclib with fulvestrant increased the length of time before the disease progressed in people who have had previous endocrine treatment. However, until final trial results were available, it was not known whether ribociclib increased the length of time people lived.

The recommendation for inclusion in the CDF would allow time for further data to become available, NICE said in final guidance.

It said that the manufacturer had entered into a managed access agreement.

Lung Cancer Drug Approval

In final guidance, NICE recommended dacomitinib (Vizimpro, Pfizer) for adult patients with untreated locally advanced or metastatic epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC).

It said that evidence from a randomised controlled trial showed that people who took dacomitinib lived longer than people who take gefitinib (Iressa, AstraZeneca), one of the usual first-line treatments. It said they also lived longer before their disease got worse.

The recommendation was dependent on the manufacturer supplying the drug at an agreed, confidential discount.

Approval for Hereditary Transthyretin Amyloidosis Treatment

Patisiran (Onpattro, Alnylam) was recommended by NICE as an option for treating hereditary transthyretin amyloidosis in adults with stage 1 and stage 2 polyneuropathy.

In final highly specialised technology guidance, appraisers said the ribonucleic acid interference agent reduced disability and improved quality of life, by enabling patients to return to work, carry out daily activities, participate in a more active family and social life, and maintain their independence and dignity.

It said clinical evidence also suggested that patisiran might provide long-term benefits by stopping the progression of amyloidosis and potentially reversing it.

Alcohol Education for School Children From 11

Children should be taught about alcohol as part of the school curriculum, NICE said.

In final public health guidance, it said information about alcohol should form part of relationships education, relationships and sex education (RSE), and health education or personal, social, health and economic education (PSHE).

It said this could be achieved by:

  • Classroom curriculum activities

  • Pastoral support, school policies (including school ethos), and other actions to support pupils in the wider school environment

  • Activities that involved parents or carers, families, and communities

Offer Antiseptics Over Antibiotics

A topical antiseptic such as hydrogen peroxide 1% cream was just as effective at treating localised non-bullous impetigo as a topical antibiotic, draft prescribing guidance said.

The guideline aimed to optimise antibiotic use and reduce antibiotic resistance.

NICE said that topical antiseptics should be offered to young people and children aged 72 hours and over with localised, non-bullous impetigo, providing they were not systemically unwell or at risk of developing any complications.

It said that if antiseptic treatment was not suitable, or a person had widespread non-bullous impetigo, a topical antibiotic should be given instead (fusidic acid 2%).

An oral antibiotic (flucloxacillin) was also an option for people with widespread non-bullous impetigo and should be given first line if a patient had bullous impetigo or if they were systemically unwell or at risk of developing any complications, the guidance said.

Also, combination treatment with a topical and oral antibiotic should not be used to treat impetigo as these were no more effective than using a single topical treatment alone.

A consultation period ends on 11th September, and final guidance was expected in February next year.

Intracranial Aneurysm Treatment

NICE backed routine NHS use of endovascular insertion of an intrasaccular wire-mesh blood-flow disruption device for intracranial aneurysms.

In final interventional procedures guidance, it said standard arrangements should be in place for clinical governance, consent, and audit. Also, patient selection should be made by a multidisciplinary team, except in an emergency.

The procedure should only be carried out in specialised centres with expertise in the use of this technology and access to neurosurgical facilities, an appraisal committee said.

Evidence on Papillon Technique 'Inadequate'

There was insufficient evidence on the safety and efficacy of low-energy contact X-ray brachytherapy (the Papillon technique) for locally advanced rectal cancer to persuade NICE to recommend its routine NHS use.

In final interventional procedures guidance, it said the procedure should only be used in the context of research.

NICE said further research should include randomised controlled trials comparing the procedure with standard care.

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