NHS Health Checks Health Equity Audit (HEA) Guidance: Update for Strategic Partners Group 13th December 2016 Nicky Saynor, Health Improvement Manager Public Health England South East nicky.saynor@phe.gov.uk

Cardiovascular Disease & Health Inequalities Global Burden of Disease Study 2013 – CVD accounts for 15% of total disability adjusted life years (DALYs). Deaths from CVD falling but in England but remains responsible for about a quarter of deaths each year. Strongly associated with health inequalities: key risk factors greater in lower socio-economic groups (e.g. smoking, physical inactivity, obesity). Higher prevalence in certain groups including some with protected characteristics (e.g. CVD prevalence higher in men, older people & those with learning disabilities and MH; CHD higher in Pakistani & Indian men; diabetes higher in South Asians; LGBT some evidence of greater risk factors (e.g. smoking). NHS Health Check Healthy Equity Audit Guidance – SPG update 13th December 2016

NHS Health Checks: a key enabler for CVD prevention Mandatory responsibility of local authorities to offer checks to all those aged 40-74 with no pre-existing CVD. 3 components: risk assessment, risk awareness & risk management. Provides mechanism through which to access at scale evidence based lifestyle (e.g. smoking cessation, NHS Diabetes Prevention Programme) & clinical interventions (e.g. statins) Modelling indicates potential to prevent 1,600 heart attacks and strokes, at least 640 deaths and over 4,000 new cases of diabetes each year. Up to March 2016: 8.79 million offered a check and 4.2 million received (take up rate 48%). But is access equitable? NHS Health Check Healthy Equity Audit Guidance – SPG update 13th December 2016

National evaluation (Robson et al, January 2016) Programme effective at identifying people at risk of heart attack and stroke & diagnosis diabetes, high blood pressure & kidney disease Higher levels of diagnosis & referral to lifestyle interventions than for those not receiving checks Greater proportion of people from poor communities found to be high risk Under 60s less like to attend Equitable take up from high risk ethnic groups Uptake across deprivation quintiles equitable NHS Health Check Healthy Equity Audit Guidance – SPG update 13th December 2016

Ensuring equity of access & outcomes Legislation: Health & Social Care Act 2012: duty to “ give regard to the need to reduce inequalities” Service must be offered in line with Equality Act 2010 Health Equity Audits (HEA) – common tool for ensuring equity in public health interventions but applying process to NHS Health Checks tricky Local Authority national forum (LINF): reviewed existing HEAs & requested tool to support HEAs Scoping paper taken to national forum April 2015 Task & finish group established June 2015 NHS Health Check Healthy Equity Audit Guidance – SPG update 13th December 2016

Who was involved? Collaborative initiative, led by Sue Dewhirst, PHE South East, via the Wessex NHS Health Checks Network: Partners: Local Implementer National Forum (LINF) PHE South East & PHE Yorks & Humber (NHSHC leads, support officer, business coordinator) Task & finish group: LAs (Cumbria & Surrey), PHE national CVD prevention & Health Equity Teams, PHE South East, PHE London National NHS Health Check (CVD Prevention Team) Supported pilot sites: Surrey & Kent County Councils Unsupported pilots: Warrington, Oldham, Thurrock, Blackpool Medwyn Surgery (GP & Service Redesign Manager) KSS NHS Health Check Network Knowledge & intelligence: South East, West Mids & Northern & Yorkshire KITs National Cardiovascular Intelligence Network Strategic Partners Group NHS Health Check Healthy Equity Audit Guidance – SPG update 13th December 2016

Developing the guidance Aims: To promote the use of HEAs To support audits that go beyond equity of access to consider outcomes – a pathway approach To provide a mechanism to support robust decision making about allocation (targeting) of resources Process: Task & finish group scoped & developed guidance Consultation round 1: LINF (Dec 2016), LAs (Jan 2016) Piloting: supported (2) and unsupported (4) Consultation round 2: SPG and additional interested LAs NHS Health Check Healthy Equity Audit Guidance – SPG update 13th December 2016

SPG consultation: how was feedback used? Added valuable references & resources: e.g. Accessible Information Standard, LGBT Companion to the PHOF, sense Equal Access to Healthcare report. Addressed technical points: e.g. limited availability of LGBT data in GP systems meaning alternatives sources or proxy indicators required. Added to existing references on community development and voluntary sector: e.g. Faith Action and sense as examples of role national organisations can play Greater clarity on purpose of specific sections e.g. sections 3, 4 & 5 are about understanding what inequity, section 6 & appendix are about understanding why it exists and how to address it.. NHS Health Check Healthy Equity Audit Guidance – SPG update 13th December 2016

SPG consultation: how was feedback used? Great emphasis on the role of the third sector in developing recommendations to address diversity e.g. linked to existing references to gaining insights via local groups and organisations Changes to language: “groups who experience barriers to services” rather than “hard to reach” (quote from DH PH ring-fenced grant circular); ‘behaviour’/’CVD behavioural risks’ in place of ‘lifestyles’. Removing and/or defining jargon (e.g. ‘data controllers’) Amending typos NHS Health Check Healthy Equity Audit Guidance – SPG update 13th December 2016

Next steps: Guidance going through internal publications standards and gateway process – publication before end of calendar year Launch & awareness raising: webinar, PHE conference, NHS Health Checks website, PHE Health Equity intranet, possible training via Knowledge & Intelligence Services Advice and suggestions on ongoing role of SPG and/or local third sector organisations in implementing NHS Health Check HEAs welcome Potential for similar consultations in the future – health equity and/or other? NHS Health Check Healthy Equity Audit Guidance – SPG update 13th December 2016

Any Questions? Wessex NHS Health Check training guidance development