Public Health England Cardiovascular Disease Prevention Initiatives

Objectives

Public Health England’s cardiovascular disease (CVD) prevention agenda aims to protect and improve health and wellbeing, reduce health inequalities, and apply evidence-based expertise to prevent disability, premature death and avoidable variation in outcomes.[1][2]It uses the World Health Organization health-system building blocks as a strategic frame and combines population prevention, risk detection, secondary prevention and service improvement across the CVD pathway.[2][3]

• Strengthen detection and optimal management of atrial fibrillation, hypertension and high cholesterol, including familial hypercholesterolaemia, as high-priority conditions for reducing CVD mortality, morbidity and costs.[4][5]
• Improve secondary prevention and cardiac rehabilitation, and support local systems to use effective interventions and sustainable models of care.[3][5][6]
• Expand the National Health Service Diabetes Prevention Programme (NHS DPP), including remote digital interventions, with a target of 100,000 enrolments in the 2019 to 2020 financial year.[7][8]
• Reduce behavioural and dietary risks by supporting smoking cessation, lower-risk alcohol consumption, physical activity, reductions in salt, sugar and excess calories, and healthier food reformulation.[4][9][10]
• Engage the public in heart-health improvement through the Heart Age Test and Active 10, particularly sedentary adults, people aged 40 to 60 and groups experiencing socioeconomic disadvantage.[11]
• Address inequalities in CVD risk, prevention access and outcomes, including through prevention support for people with severe mental illness and improved use of NHS Health Checks.[4][8][5]
• Develop evidence on the cardiovascular effects of air pollution and the risks and benefits associated with electronic nicotine and non-nicotine delivery systems.[12]

Implementation

Delivery combines national leadership, regional and local implementation, data-led quality improvement, public-facing prevention, and collaboration across the health, care, voluntary, academic, commercial and local-government sectors.[2][13]Public Health England works with NHS England, NHS Improvement, NHS RightCare, the British Heart Foundation, Diabetes UK, the Stroke Association, local authorities, clinical commissioning groups, Sustainability and Transformation Partnerships, Integrated Care Systems, professional bodies and community organisations.[2][14][13]

• Mobilise local action through Public Health England’s four regions and nine centres, working with Sustainability and Transformation Partnerships and Integrated Care Systems on needs assessments, gap analyses, treatment pathways, communications and stakeholder arrangements.[5][6]
• Secure commitments from at least 80% of Sustainability and Transformation Partnerships or Integrated Care Systems to act on one or more priority high-risk CVD conditions by March 2019.[4][5]
• Use the Cardiovascular Disease System Leadership Forum, comprising 35 members, to develop collective national prevention ambitions with expert input.[4]
• Provide local intelligence through CVD data packs, primary-care intelligence packs, profiles, the Public Health Outcomes Framework, the Public Health Dashboard, Local Authority Health Profiles and related surveillance resources.[14][12]
• Develop a national primary-care CVD prevention audit using routinely held general-practice data on atrial fibrillation, blood pressure, cholesterol, chronic kidney disease, diabetes and pre-diabetes, with metrics informed by National Institute for Health and Care Excellence guidance.[7]
• Update the NHS DPP provider framework and service specification using evidence and operational learning, while supporting managed access to digital delivery for working-age people.[7][8]
• Support clinical and community delivery through Making Every Contact Count resources, professional training on physical activity, social prescribing, community pharmacy engagement, blood-pressure checks and local awareness activity.[11][12][8]
• Deliver communications and behaviour-change initiatives through digital tools, paid media, printed materials and partnerships across charity, pharmacy, healthcare, commercial and local-authority sectors.[10]
• Engage food businesses, including out-of-home restaurants, in salt, sugar and calorie-reduction programmes, prioritising phase-two engagement largely by market share.[10][5]

Monitoring combines programme activity measures, equity analysis, published surveillance and targeted evaluation. NHS DPP monitoring covers referrals, assessments, session attendance, enrolment and participant characteristics by sex, age, ethnicity and deprivation; early outcome analysis also assessed programme completion and weight change.[14][11]Digital behaviour-change interventions for people with non-diabetic hyperglycaemia are subject to a service evaluation, supported by National Diabetes Audit data collection.[8]

• Track implementation through the 80% local-system commitment target, regional boards, advisory groups, steering groups, working groups and partnership governance.[5][6][13]
• Publish evaluation outputs for the secondary-prevention project, case-study toolkit, annual CVD prevention activity and sugar-reduction programme.[12][5]
• Assess air-pollution evidence through reviews commissioned from the Committee on the Medical Effects of Air Pollutants, including consideration of effective and cost-effective interventions.[12]
• Monitor Heart Age Test completions, Active 10 downloads, NHS DPP uptake and healthcare-professional training against stated activity targets.[11][8][10]

Financing is only partly specified. Public Health England invested approximately £1 million in planning, delivery and evaluation capacity for the high-risk-condition work programme.[4]The source otherwise does not provide an overall budget, detailed financing model, funding gap or consolidated resource-mobilisation plan for the CVD agenda.[5][6]

Monitoring & Evaluation

Monitoring and evaluation combine national surveillance, programme-specific activity data, local intelligence products, formal reviews and governance arrangements. Public Health England (PHE) aims to use these mechanisms to identify variation in cardiovascular disease (CVD) outcomes and prevention delivery, support local action, and assess progress on priority high-risk conditions, diabetes prevention and population-risk interventions.[2][3][12][13]

• Monitor NHS Health Check delivery through national data extraction, covering three of four primary-care information-technology suppliers and 89% of general practices in England; more than 6.86 million people received a Health Check between April 2013 and March 2018.[3]
• Analyse NHS Diabetes Prevention Programme (NHS DPP) reach through referrals, assessments and intervention attendance. By the end of July 2018, the programme recorded 252,130 referrals, 95,823 initial assessments and 47,884 first-session attendances.[14]
• Assess participation inequalities in the NHS DPP by sex, age, ethnicity and deprivation, with lower attendance among men and variation by ethnic group and deprivation quintile.[14][11]
• Evaluate early NHS DPP outcomes among the first 12,498 programme completers. Of these, 6,647 participants, or 52%, attended at least eight of 13 sessions; reported mean weight change was 4.2% overall among participants excluding those with a normal body mass index, and 3.6 kilograms among those attending at least eight sessions.[11]
• Use National Diabetes Audit collection for people with non-diabetic hyperglycaemia, initiated in November 2017, to support longitudinal assessment of NHS DPP impact.[8]
• Evaluate digital behaviour-change interventions for 3,500 people with non-diabetic hyperglycaemia, with an interim descriptive analysis planned for the fourth quarter of 2018 to 2019 and a service-evaluation report planned for the fourth quarter of 2019 to 2020.[8]
• Track delivery targets including 100,000 NHS DPP enrolments in 2019 to 2020, 12,000 healthcare professionals trained to incorporate physical activity into routine care in 2018 to 2019, and commitment by at least 80% of Sustainability and Transformation Partnerships or Integrated Care Systems to act on priority high-risk CVD conditions by March 2019.[4][7][8][10][5]
• Measure public engagement with digital prevention tools. The Heart Age Test had been completed more than 2 million times, while the Active 10 application had more than 732,000 downloads by mid-September 2018, including 74,000 following the campaign launch.[11]
• Monitor food reformulation through industry assessments of sugar, calorie and salt reduction, including assessment of progress against 2017 salt targets by the end of 2018 and publication of a detailed sugar-reduction progress report in spring 2019.[4][10][5]
• Track participation and achievement in the Commissioning for Quality and Innovation programme on alcohol and tobacco prevention. In its first year, 54 of 62 mental health trusts and 65 of 103 community health trusts participated.[9]
• Use surveillance products, including the Public Health Outcomes Framework, Public Health Dashboard, Local Authority Health Profiles, Segment tool, race disparity audit and Health Profile for England, to monitor premature mortality, behavioural risks and inequalities.[12]
• Develop primary-care intelligence and a proposed national CVD prevention audit using routinely held general-practice data on atrial fibrillation, blood pressure, cholesterol, chronic kidney disease, diabetes and pre-diabetes. The proposed audit would apply National Institute for Health and Care Excellence metrics and business rules to improve transparency on performance and variation.[7]
• Publish annual progress reporting on the 2018 to 2019 prevention initiatives, an evaluation and case-study toolkit for the secondary-prevention project, and data packs mapping activity against atrial fibrillation, hypertension and cholesterol indicators.[12][5][6]
• Commission evidence reviews by the Committee on the Medical Effects of Air Pollutants and the Committee on Toxicity on cardiovascular effects of air pollution and the risks and benefits of switching between tobacco smoking and electronic nicotine or non-nicotine delivery systems.[12]
• Oversee regional implementation through advisory boards, steering groups, working groups, partnership arrangements and local self-assessment frameworks, supported by NHS RightCare, National Cardiovascular Intelligence Network, Local Knowledge and Intelligence Service and burden-of-disease modelling.[6][13]

A complete plan-wide indicator set, unified reporting timetable, formal outcome evaluation findings and quantified accountability framework are not specified in the supplied extracts.[4][8][10][13]

Costing & Financing

Costing information is limited. The extracts identify one quantified PHE investment and one quantified prospective savings estimate, alongside several unquantified investments and references to cost-effectiveness. They do not provide an overall CVD action-plan budget, consolidated financing model, resource-mobilisation strategy or funding-gap assessment.[4][12][8][5][6]

• Invest approximately £1 million in planning, delivery and evaluation capacity for the programme addressing high-risk CVD conditions.[4]
• Estimate that achieving a 20% calorie reduction could prevent 35,370 premature deaths and generate approximately £4.5 of combined social-care and National Health Service healthcare savings over 25 years; the supplied text does not retain the unit associated with the £4.5 figure.[4]
• Undertake a feasibility assessment and publish a return-on-investment tool for secondary prevention, supported by evidence on intervention effectiveness and cost-effectiveness.[3]
• Commission review work on effective and cost-effective air-pollution interventions, without specifying its budget or financing arrangements.[12]
• Record unquantified national investment in the Digital Exemplar Programme, paid media for the Heart Age campaign, regional CVD-prevention programmes, local insight work, smokefree National Health Service activity and communications intended to increase Heart Age uptake in disadvantaged communities.[10][6]

No monetary allocations are specified for the NHS DPP, primary-care audit, surveillance tools, Making Every Contact Count resources, NHS Health Check digital work, regional delivery arrangements or wider prevention actions.[12][7][8][10][5][6]