Norfolk County Council have turned their NHS Health Check programme performance around, going from one of the lowest-ranked councils in the East of England region, in terms of percentage of the eligible population receiving a Health Check, to one of the best in England.
The challenge and response
Recognising the need to improve performance on NHS Health Checks in the post-COVID period, Norfolk County Council’s public health team undertook a structured review of the service.
Ciceley Scarborough, Acting Consultant in Public Health (Healthy Lifestyles), said this began with a review of the evidence base. “We looked at the data – at what was going on where. We conducted benchmarking and spoke to lots of other areas about their approach to NHS Health Checks.”
This review led to the creation of a five-year improvement plan. Public health staff were invited to a workshop to help develop a set of ambitions linked to the recommendations. “We used the word ‘ambitions’ very carefully and set them over a five-year period. We knew that we could achieve some things very quickly, but we also wanted to take a longer-term view.”
At around the same time, the Director of Public Health oversaw the investment of one million pounds to implement a post-pandemic recovery programme, delivered by a third party, to provide supplementary assistance to Norfolk’s primary care services by repurposing the existing COVID-19 testing teams.
The impact
This work has led to a marked improvement in the percentage of the eligible population receiving an NHS Health Check. Norfolk has gone from being one of the lowest-ranked councils in the region to one of the best in the country – ranked ninth in England in 2022/23 (Office for Health Improvement & Disparities).
Ciceley Scarborough said having the ambitions in place helped to focus everyone’s work. In terms of NHS Health Checks delivered to the total eligible population, Norfolk was at 26.4 per cent and wanted to reach 52 per cent by 2027. Projections suggest that if current delivery levels continue, that target will be reached by September 2025.
For invitations, the ambition was to invite 98 per cent of the total eligible population – Norfolk is on course to reach this in March 2024 and to reach 100 per cent by December 2024. Underpinning all this work is a focus on health inequalities and an ambition to offer 25 per cent of all NHS Health Checks to residents in the most deprived areas.
The review involved a structured programme management approach and the creation of a dashboard to monitor progress against the ambitions. There are now well-resourced workstreams on different themes: communications and engagement, training, evaluation and quality assurance. An internal group meets monthly to discuss progress on the workstreams; an external improvement group brings together public health and representatives from each of the providers.
Norfolk has commissioned a specialist training provider which will help to raise the quality of NHS Health Checks. This will be monitored through a quality assurance model. Using a specialist provider is helping the team to understand the needs of healthcare professionals and the future training requirements.
Looking ahead
The plan was to try this new approach for a year, then consider the next steps. The team is now looking at how to continue with this model, developing and adapting it using the learning so far and the insights provided by the dashboard.
Ciceley Scarborough said: “We are in year two of a five-year improvement programme but we have already had good results from paying attention to NHS Health Checks in a really organised way. We were honest with ourselves about what wasn’t working. We have put structure around why we want to improve and where the investment should go.”
The team also listened to feedback on where people wanted to go for an NHS Health Check. “We learnt that people value going to a location that is convenient to them. That may be their primary care surgery, but we are also using locations such as village halls and libraries.”
Norfolk has replicated this structured review approach across other public health topics such as smoking, physical activity and healthy weight. In terms of NHS Health Checks, other conversations are going on around trialling a digital approach at the earliest opportunity; potentially expanding the age group (although not until the uplift in numbers is sustained); workplace provision; and how to improve the pharmacy offer.
This improvement work has support from Norfolk County Council councillors. Councillor Bill Borrett, Cabinet Member for Public Health and Wellbeing, said: “Our structured approach to the NHS Health Check programme in Norfolk has meant an increase in the number of Health Checks that are actually being delivered, and also that we are focussing on where NHS Health Checks can make the most difference to Norfolk residents’ health.”
Contact:
For more information contact Ciceley Scarborough, Acting Consultant in Public Health – Healthy Lifestyles: [email protected]