Public Health England Cardiovascular Disease Prevention Initiatives

Objectives

Public Health England’s cardiovascular disease (CVD) prevention programme seeks to protect and improve health and wellbeing, reduce health inequalities, and reduce variation in CVD outcomes across England through evidence-based prevention, early detection and effective management.[1][2][3]It prioritises secondary prevention while addressing the full CVD spectrum, including coronary heart disease, stroke, peripheral arterial disease and related conditions.[1]

• Strengthen prevention, detection and management of atrial fibrillation, hypertension, high cholesterol, familial hypercholesterolaemia, chronic kidney disease, diabetes and pre-diabetes.[4][5][6][7]
• Develop sustainable, evidence-based models of care at scale for people with high-risk CVD conditions, with local and regional system leadership.[7][8]
• Reduce population risk factors by supporting smoking cessation, reducing harmful alcohol and tobacco behaviours, improving physical activity, addressing obesity and unhealthy diets, and mitigating air-pollution harms.[9][10]
• Improve diet by reducing salt, sugar and excessive calories in foods, including a 20% calorie-reduction ambition by 2024 against a 2017 baseline.[5]
• Increase public awareness and action on heart health through the Heart Age Test, with an aim to engage more than 1 million adults, and promote at least 10 minutes of daily brisk walking among sedentary adults through Active 10.[11]
• Use the NHS Health Check, offered every five years to adults aged 40 to 74 in England, to identify CVD risk and reduce geographical and population-group variation in prevention.[4]
• Support diabetes prevention, including a target of 100,000 enrolments in the NHS Diabetes Prevention Programme during the 2019 to 2020 financial year.[12]
• Train 12,000 healthcare professionals to integrate physical activity into routine patient care through the Moving Healthcare Professionals Programme.[12][13]
• Address inequalities in CVD risk, mortality and morbidity, including through action for people with severe mental illness and through analysis by sex, age, ethnicity and deprivation.[14][6][12]
• Improve dementia risk-reduction messaging through NHS Health Checks and related prevention resources.[15]

Implementation

The programme uses a system-leadership model in which Public Health England works nationally, regionally and locally with the National Health Service, local authorities, professional bodies, charities, academic partners, commissioners, providers and communities.[1][16][7][8]Activity is organised around the World Health Organization’s six health-system building blocks: leadership and governance, service delivery, health-care financing, health workforce, medical products and technologies, and information and research.[16]

• Coordinate national leadership through the Cardiovascular Disease System Leadership Forum, a 35-member forum involving subject experts, and through collaboration with the British Heart Foundation, NHS England, the National Institute for Health and Care Excellence, NHS RightCare and other partners.[1][5]
• Deploy Public Health England’s four regions and nine centres to provide local delivery capacity, coordinate partners, strengthen health and social care systems, and support sustainable models of care.[5][15][7]
• Establish regional and local boards, advisory groups, networks and working groups to identify gaps, coordinate prevention activity, develop local strategies and share good practice.[7][8]
• Provide commissioners and providers with CVD data packs, primary-care intelligence packs, diagnostic workbooks, self-assessment tools, intervention databases and practical action frameworks.[4][14][7][8]
• Develop a return on investment tool for secondary CVD prevention, supported by evidence and cost-effectiveness reports, to model combined improvements in risk-condition detection, management and intervention uptake.[4]
• Use routinely collected general-practice information on major CVD risk conditions to generate practice, Primary Care Network, Clinical Commissioning Group and national reports, with consultation prompts to support clinicians.[6]
• Collect NHS Health Check data through NHS Digital’s General Practice Extraction Service, securely transfer it to Public Health England, and analyse it for publications and stakeholder reports.[4]
• Develop a national primary-care CVD prevention audit with the British Heart Foundation, NHS England, PRIMIS, the Primary Care Information Service and a national reference group.[6]
• Deliver national campaigns, digital tools and local awareness activity, including the Heart Age Test, Active 10 app, free blood-pressure checks, communications resources and paid media focused principally on adults aged 40 to 60.[11][13]
• Support health-service prevention through Commissioning for Quality and Innovation 9, focused on risky alcohol and tobacco behaviours, and extend implementation to acute trusts with resources and tools for identifying smokers and supporting cessation.[9]
• Implement the NHS Diabetes Prevention Programme through providers across Sustainability and Transformation Partnership footprints, with a new provider framework, updated specification and managed access to remote digital interventions.[14][12]
• Develop social prescribing and severe-mental-illness pathways with NHS Improvement, the Royal Society for Public Health and NHS RightCare to improve physical health and CVD prevention.[12]
• Commission evidence reviews and expert advice on air pollution, including input from the Committee on the Medical Effects of Air Pollutants and the Committee on Toxicity, to identify effective and cost-effective interventions.[6]
• Monitor implementation through NHS Health Check participation and uptake data, programme referral and attendance measures, risk-factor outcomes, industry reduction assessments, population-health indicators and regional intelligence.[4][14][5][10][15]
• Report progress through annual CVD prevention publications, evidence reviews, evaluation reports, national profiles and stakeholder-facing reports.[1][4][10][15]

Monitoring & Evaluation

Monitoring combines national data collection, programme evaluation, publication of evidence, and regional oversight, although no single consolidated accountability framework or national reporting schedule is specified for all cardiovascular disease prevention activity.[1][7][8]

• Provide progress updates against commitments in the 2017 to 2018 cardiovascular disease prevention action plan and report progress on 2018 to 2019 initiatives in the subsequent annual cardiovascular disease prevention publication.[1][10]
• Monitor NHS Health Check coverage through NHS Digital’s General Practice Extraction Service, with 89% of English general practices participating in the summer 2018 extraction and further collection planned from the remaining primary-care information technology supplier.[4]
• Track NHS Health Check uptake, which exceeded 6.86 million participants between April 2013 and March 2018, and use analysis and stakeholder reporting to inform delivery.[4]
• Assess NHS Diabetes Prevention Programme delivery, including 252,130 referrals, 95,823 initial assessments and 47,884 first intervention sessions by the end of July 2018.[14]
• Evaluate diabetes prevention attendance, risk-factor change and inequalities by sex, age, ethnicity and deprivation; among the first 12,498 completers, 52% attended at least eight of 13 sessions, with mean weight change of minus 3.6 kilograms among those attending at least eight sessions.[14]
• Evaluate digital behaviour-change interventions for 3,500 people with non-diabetic hyperglycaemia, with interim analysis planned for Quarter 4 of 2018 to 2019 and a service evaluation report for Quarter 4 of 2019 to 2020.[12]
• Use National Diabetes Audit data collected from November 2017 to support longitudinal assessment of the NHS Diabetes Prevention Programme’s impact on people with non-diabetic hyperglycaemia.[12]
• Track public engagement through the Heart Age Test, completed more than 2 million times, and the Active 10 application, downloaded more than 732,000 times by mid-September 2018.[11]
• Measure implementation of high-risk-condition work through the target for at least 80% of Sustainability and Transformation Partnerships or Integrated Care Systems to commit to action on one or more priority conditions by March 2019.[5]
• Publish an evaluation of the secondary prevention project after its planned conclusion in March 2019, including findings, case studies and achievements across England.[15]
• Monitor food-industry progress through salt, sugar and calorie-reduction assessments, including assessment against 2017 salt targets by the end of 2018 and publication of sugar-reduction progress reports.[5][13][15]
• Use the Public Health Outcomes Framework, Public Health Dashboard, Local Authority Health Profiles, Segment tool, Race Disparity Audit and Health Profile for England to monitor population health and inequalities.[10]
• Apply indicators covering child obesity, NHS Health Checks, tobacco control, premature mortality, behavioural risks, physical activity, overweight, smoking and healthy eating.[10]
• Map prevention activity against cholesterol, hypertension and atrial fibrillation indicators, undertake gap assessments, and share intelligence with local system boards.[7]
• Use data packs, burden-of-disease modelling, NHS RightCare, the National Cardiovascular Intelligence Network and the Local Knowledge and Intelligence Service to identify opportunities and support local action plans.[7][8]
• Provide oversight through regional boards, advisory boards, networks and working groups, including workshops to share good practice and inform local self-assessment frameworks.[7][8]
• Publish evidence reviews, international case studies, cardiovascular disease datasets and air-pollution evidence, including a report from the Committee on the Medical Effects of Air Pollutants on long-term exposure.[4][14]

Costing & Financing

Financial information is limited and fragmented: the material identifies a small number of investments, estimated health and economic costs, and projected savings, but does not provide an overall cardiovascular disease prevention budget, consolidated funding gap, or comprehensive resource-mobilisation plan.[1][5][7][8]

• Record annual health-care costs in England relating to premature cardiovascular disease at 7.4 billion pounds sterling in 2016 to 2017.[16]
• Estimate the annual wider-economic cost of premature cardiovascular disease at 15.8 billion pounds sterling in 2016 to 2017.[16]
• Invest approximately 1 million pounds sterling in capacity for planning, delivery and evaluation of the high-risk-condition work programme.[5]
• Estimate that achieving a 20% calorie reduction over five years could prevent 35,370 premature deaths and save approximately 4.5 billion pounds sterling in social care and National Health Service healthcare costs over 25 years.[5]
• Develop a return on investment tool for secondary cardiovascular disease prevention, with evidence and cost-effectiveness reports and an intervention database, but provide no monetary estimate for this work.[4]
• Identify the need to assess the cost-effectiveness of air-pollution interventions, while providing no budget, expenditure, allocation, funding source or financing gap.[6]
• Publish a report and tool to estimate National Health Service and social-care costs associated with air pollution, including cardiovascular disease, without specifying a financial value.[10]
• Commission a review of effective and cost-effective air-pollution interventions without specifying its value.[10]
• Describe NHS Health Check digital work as involving significant national investment during a discovery phase, but provide no amount.[13]
• Include paid-media investment for the Heart Age campaign without providing a budget or amount.[13]
• Provide funding to enhance local programmes during the transition to centre-based programmes in the South West and South East, without specifying an amount.[15]
• Describe funding and investment for enhanced local programmes, insight work, communications and prevention activities, but provide no totals, unit costs, funding sources or economic assumptions.[7]