The National Health Service in England is currently introducing a programme to screen all 40-74 year olds for a range of common conditions. This is a bold plan but not without its critics. I recently went through the NHS Health Check, as the scheme is called, and I wrote an article for the Marshwood Vale Magazine on my experience:
First the bad news: we are all at risk of developing heart disease, stroke, diabetes and kidney disease and our risk increases as we grow older. Our risk also increases if we smoke, drink too much alcohol, have a poor diet, are overweight or don’t do enough physical activity. The good news is that we can all do something to reduce our risk by making changes to our lifestyle. The NHS Health Check has been introduced to help people make those changes. The NHS Health Check assesses a person’s risk of suffering from these conditions and provides lifestyle advice to reduce risk; it has been called a “mid-life MOT” and will be offered to 40-74 year olds every five years. I recently received an invitation to have the Check; it sounded like a good opportunity, so I decided to go.
My NHS Health Check
On a bright, sunny morning in early March I strolled down to my local health centre where one of the practice nurses carried out the Health Check. It took about 20 minutes, it was very supportive and not the least bit judgmental. She began by asking about my family history: was there anyone in my family with heart disease, stroke or diabetes? If the answer was yes, this could raise my own risk. My age, gender and ethnicity were also noted; type 2 diabetes is more prevalent in older people and in some ethnic groups.
We talked about my lifestyle: did I smoke, how much alcohol did I drink, what sort of diet did I eat, did I take exercise? Smoking is known to cause cancer and respiratory disease and is a risk factor for heart disease and stroke. High consumption of alcohol can cause liver disease, cancer and raised blood pressure. Diet is an important factor in overall health and regular exercise can be beneficial for several diseases.
She took some simple measurements: my weight and my height and from these she calculated my Body Mass Index (BMI). The BMI is a useful indicator of whether someone is carrying excess fat, whether they are “overweight” or “obese”, increasing the risk of type 2 diabetes, heart disease and stroke. Excess fat carried around the midriff is the most dangerous so she also measured the circumference of my waist.
She determined two important indicators of heart health: my blood pressure and pulse; high blood pressure can predispose to heart disease, stroke or kidney problems. I had also been asked to bring a urine sample and she tested that for protein (an indicator of kidney disease) and glucose (a crude indicator of diabetes).
By now, she had a rough idea of my risk of suffering from heart disease, stroke, diabetes and kidney disease and was able to advise me on changes in lifestyle. To complete the Check, she took samples of blood for analysis of glucose (raised levels might indicate diabetes) and two forms of cholesterol (risk indicators for heart disease and stroke). She told me that these results would take a few days to come and I would be contacted if there were any problems. And that was it, I was free to go.
Debate about the NHS Health Check
Health screening sounds like a good idea but at a time of diminishing resources there will always be debate about these sorts of schemes. The NHS Health Check has been criticised on a number of grounds. Some think it may generate undue worry and lead to unnecessary medication of patients. Some believe it only accesses the “worried well” and a better approach would be to target high risk groups.
In contrast, Diabetes UK has come out strongly in favour of the Check as an important and integral part of Type 2 diabetes prevention. If fully implemented, they say, it could prevent 4000 people a year from developing diabetes. The Check can also identify those who are unaware they have diabetes and enable them to access treatment to reduce life threatening complications. The potential savings to the NHS budget are obvious.
Diabetes UK is, however, concerned about the poor and patchy implementation of the scheme which, they say, should have a higher priority. There are huge disparities in the number of people having the Check in different areas and only a handful of local authorities meet their yearly target of delivering the Health Check to 20% of the eligible population; some, including Dorset and Devon, fall far short. Of particular concern is the take-up rate which fails to reach even 50% of those invited, so that many potentially unwell people are being missed. Patients also need to act on any lifestyle advice they are given and this will require vigorous follow up.
How was it for me?
The Health Check was, for me, a positive experience and I valued having some of my basic systems tested. There was a chance that I might be given bad news but I felt it would be better to know if I am at risk for certain diseases so that I could do something about it. For example, if my blood pressure is elevated, this might increase my risk of heart attack, stroke or kidney disease. If my blood glucose levels are elevated this could mean that I am in the early stages of type 2 diabetes. In either case I would be unaware of the problem but once I knew, I could make simple changes to my lifestyle including taking more exercise, losing weight and changing my diet.
To get a free NHS Health Check, either wait for the letter of invitation or contact your Family Doctor.
The pictures are from the information leaflet I was given and from the NHS Choices web site