NHS Health Checks Health Equity Audit HEA Guidance

NHS Health Checks Health Equity Audit (HEA) Guidance: Update for Strategic Partners Group 13 th 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). 2 NHS Health Check Healthy Equity Audit Guidance – SPG update 13 th 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%). 3 NHSis Health Check Healthy Equity Audit Guidance – SPG update 13 • But access equitable? th 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 60 s less like to attend • Equitable take up from high risk ethnic groups • Uptake across deprivation quintiles equitable 4 NHS Health Check Healthy Equity Audit Guidance – SPG update 13 th 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 5 NHS Health Check Healthy Equity Audit Guidance – SPG update 13 th 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 6 NHS Health Check Healthy Equity Audit Guidance – SPG update 13 th 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 7 NHS Health Check Healthy Equity Audit Guidance – SPG update 13 th 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 8 • 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 13 December 2016 th

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 9 NHS Health Check Healthy Equity Audit Guidance – SPG update 13 th 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? 10 NHS Health Check Healthy Equity Audit Guidance – SPG update 13 th December 2016

Any Questions? 11 Wessex NHS Health Check training guidance development