Scrap NHS Health Checks, study urges

A damning analysis of the government's plans for the public health service in England finds many proposals lack evidence or have been shown not to work.

BMJ review: NHS Health Check programme should be disbanded (Illustration:
BMJ review: NHS Health Check programme should be disbanded (Illustration:

A review of 51 interventions in the government's public health reforms found many are 'likely to be ineffective or lack evidence to establish effectiveness'.

In particular, researchers said the NHS Health Check programme to screen everyone aged 40-74 for cardiovascular risk should be disbanded as it is not supported by evidence.

Targeted screening would be a more cost effective option, they said.

The review, published in the BMJ, was conducted following claims by health secretary Andrew Lansley that: 'Our new approach across public health services, must meet tougher tests of evidence and evaluation… We must only support effective interventions that deliver proven benefits.'

To test these claims, Srinivasa Vittal Katikireddi of the Social and Public Health Sciences Unit in Glasgow and colleagues looked at evidence underpinning proposals in the white paper, Healthy Lives, Healthy People. The rigour of their analysis was assessed and passed by advisers.

They found that:

  • Interventions in areas such as access to green space, housing and neighbourhoods lacked sufficient evidence base.
  • Although there was supportive evidence for promoting walking in schools, a recent analysis labelled exercise referral schemes that make up part of the 'Let's Get Moving' programme as ineffective at improving population health.
  • Promotion of fruit and vegetables in convenience stores under the Change4Life banner had little effect on food purchasing.
  • Stricter alcohol licensing reduces alcohol related harm but only with adequate enforcement. Researchers said this would be 'unlikely' as local authorities are cutting back on this area.

Other areas did show good evidence of positive effect, including plain packaging of tobacco and removal of cigarette vending machines, incentivising welfare payments towards work and provision of health advice in pharmacies.

In all, just four of 51 interventions had strong evidence of a positive effect.

Eighteen actions had weak evidence of benefit and 25 had mixed or no evidence. Four initiatives were shown to be ineffective.

But researchers concluded many evaluations of government programmes were not robust. Common problems included lack of controls, bias, failing to reduce confounders in designing the assessment and reporting on satisfaction or uptake of interventions where the actual aim was to improve health.

They concluded: 'Our systematic assessment shows that although some interventions in the public health white paper are in keeping with the existing evidence base, many are likely to be ineffective or lack evidence to establish effectiveness.'

Although lack of robust evidence should not prevent an intervention from being implemented, it must be 'rigorously evaluated' when it is, they said.

They said it should be remembered that, as with medical interventions, many public health interventions have the potential to cause harm.

'In the words of the Commons health select committee: 'Such wanton large-scale experimentation is unethical, and needs to be superseded by a more rigorous culture of piloting, evaluating and using the results to inform policy.'

Click here to read the review


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