'Use life checks cash, for screening instead'

Life checks are being introduced at the expense of evidence-based screening, finds Tom Simonite.

One of the highest profile policies in last week's health White Paper was the NHS 'life checks' to determine patients' risk of ill health at five key stages.

Simply filling in a questionnaire will tell patients their risk of developing conditions, such as diabetes, heart disease or cancer, health secretary Patricia Hewitt said (GP, 3 February). Health trainers will help people to understand the results.

But GPs and other medical experts say that an effective screening strategy is not as simple as that.

A regular health MOT was the most common request made by the public during the DoH consultation exercise prior to the White Paper.

Professor Nicholas Wald, president of the Medical Screening Society and head of the Centre for Environmental and Preventive Medicine at Bart's and the London School of Medicine, said the concept of health checks had became policy too quickly.

'This has sprung up very suddenly, without expert opinion.

It came out of consultation at the end of last year and now it's in the White Paper at the beginning of this one,' he said.

'A non-specific health check could do more harm than good. Not only is it a waste of money, it also gives false expectations of what medicine can do.'

Not validated

In fact, the published evidence undermines the whole concept of life checks.

Professor Wald said: 'Studies have shown that general health checks are not effective but some specific conditions are worth screening for. Experts should judge what is worthwhile and what is not before the public is consulted.'

The lack of evidence may explain why the White Paper makes no mention of any plans for the life checks to be evaluated by either NICE or the National Screening Committee (NSC), which advises ministers and the national assemblies on the evidence supporting screening programmes.

A spokesman for NICE said: 'If asked, we will evaluate life checks in the usual way but it's really a political decision. If we looked at them and decided they weren't cost-effective, it would be a bit of a problem for the DoH.'

The DoH intends to judge the effectiveness of life checks itself.

'There will be no trials, life checks will be rolled out across the country,' a spokeswoman said. 'They will be evaluated internally through the department.'

Target individual cases

Dr Richard Stevens, Oxford GP and chairman of the Primary Care Society for Gastroenterology, said the lack of evidence behind life checks contrasted badly with the amount of evidence needed to launch national screening, such as the bowel cancer screening programme, starting in April.

'Against years of evidence and trials for bowel cancer screening, this somewhat untested and slightly retro idea of health MoTs is a bad one,' he said.

Rosa Legood, a senior researcher at the Health Economics Research Centre, University of Oxford, explained that the body of research probably needed to judge the effectiveness of the life check programme was the same as for any screening programme.

'You need large randomised trials to measure the effects of screening on average length and quality of life, the costs of screening and the costs saved by picking up patients early. It's also important to look at who, when and how often to screen.'

Ms Legood explained that a four-year study of 67,800 men aged 65-74 had been used to show that screening for abdominal aortic aneurysm was cost-effective in that age group.

There is evidence to suggest screening for diabetes and cardiovascular disease would be effective, but experts say a questionnaire-based life check is not the best way of doing this.

'It requires a lot more than that,' said Dr Terry McCormack, Whitby GP and Primary Care Cardiovascular Society chairman. 'You need to measure blood LDL and cholesterol, and BP.'

'We know this is the best for individual patients, but the health economics aren't really known. I'm an advocate of screening, but you have to know it is effective,' said Dr McCormack.

Diabetes screening

Dr Colin Kenny, a GP in County Down and chairman of the Primary Care Diabetes Society, said he also would have liked to see the life check money be directed toward screening for more specific conditions, such as diabetes.

'General population screening has been shown not to be useful, so this would be targeted.

But it will have to be resourced,' he said. 'Money that has been allocated for life checks could be better spent on this.'

Pilot work by some GPs on the effectiveness of targeted screening has had favourable results and the NSC is expected to report this year on the proposal.

However, the DoH seems to be bypassing the evidence-based approach that it demands and actually exists for disease-based screening.

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