Here is my response to PHE consultation on Healthchecks.
It has to be submitted by the 19th Dec.
The tone of the document is disappointing. The Healthchecks programme has been mandated for some time, in the ‘absence of direct randomised controlled trials to guide it’ – in the words of PHE. Despite the evidence showing that this type of intervention (seen most recently in the Inter99 trials published in the BMJ) does not work, the programme of research does not acknowledge this. The research which is suggested makes assumptions that the programme will work.
– If the Healthchecks programme is going to run at all, it should be done as part of an RCT adequately powered to detect all cause mortality differences. If the possibility that it does not work is not considered harms will be done, by a) creating the illusion that an effective programme is in place b) directing resources to people least likely to benefit (as has been seen in initial studies) and c)diverting GPs from people who are most in need of their services.
-PHE should seek a higher quality of evidence than simply measuring quality of delivery. The programme should not be continued without robust evidence in support of it. PHE should seek govermental approval to search for high quality evidence of mortality and morbidity benefit (not misleading proxy measures) and seek assurances that the programme can be disbanded on the basis of evidence, not policy.
Comments on review.
– Literature review. You have not included for example searches for diabetes screening which means that you have failed to include large UK based RCTs which show that screening for diabetes (as the Healthchecks programme does) is beneficial. Nor has lifestyle interventions (exercise and weight loss) been included.
-the references supplied do not appear to support Healthchecks. There are no comments made on this or attempts to sythesise the meaning of the research, which shows that healthchecks do not work.
-the claim is that “If the NHS Health Check programme is to achieve its potential as one of the largest
systematic prevention programmes in the world, it must be grounded in and led by the
best possible evidence. That evidence base is currently incomplete. This can and must
be addressed by generating relevant new knowledge, and then translating that
knowledge into practice.” This does not seem to allow for the fact that Healthchecks are not proven to work. The ‘best possible evidence’ so far shows that it does not reduce mortality or morbidity. If the ‘best possible evidence’ is being sought, then it should be run as an RCT. Yet you do not propose to do this.
– Almost unbelievably, there is no comment made about the need to involve patients in the results obtained by the Healthcheck. Where is the research about decision aids for deciding whether or not to have a Healthcheck, models for informed consent, best practice with invitations for an intervention of unproven value, methods of informed choice with results for people of varying needs?
You have not addressed or taken account of the recent Science Committee report into screening. This states clearly that the UKNSC should have been asked to review the Healthchecks programme. Why is the opportunity to do this being missed now?