• Cardiovascular disease (CVD) affects millions of people in England while costing the healthcare system and wider economy tens of billions of pounds each year.
  • NHS Health Checks help to spot cases of CVD and prevent loss of life and money by tackling the disease, but not enough people are offered or receive checks.
  • The National Audit Office (NAO) is recommending review of how Health Checks are delivered to boost uptake.

The NAO is today recommending a review of how NHS Health Checks are provided in England to help prevent cases of CVD that affects millions of people and costs the economy tens of billions pounds each year.

Health Checks1 were introduced in 2009 with the aim of saving lives and money by helping people to tackle cardiovascular disease, where it is not identified through primary care. Everyone aged 40-74 who does not have a pre-existing heart condition is eligible for a Health Check once every five years.

The NAO has found that the current system to make sure that eligible people in England are offered and attend Health Checks isn’t working effectively.  

The independent public spending watchdog highlighted that, in 2013, responsibility for commissioning Health Checks was transferred, through legislation, from the NHS to local authorities, as part of the transfer of responsibility for elements of public health. This created a statutory requirement on local authorities to offer Health Checks to all eligible individuals over a five-year period.

In 2023-24 the level of Health Checks had recovered, post-COVID, to 1.42 million Checks completed. However, only 3% of local authorities delivered a Health Check to all of the annual eligible population in their areas in 2023-24 and less than half of the eligible population attended a check.

The legislation transferring responsibility for Health Checks to local authorities did not provide DHSC with levers to influence local authorities’ performance.  In turn, local authorities weren’t able to require general practices or other providers to deliver Health Checks, instead relying on voluntary agreements. Problems further arise with local authorities unable to routinely access practice data to monitor the Health Check programme and see whether checks are delivered to those most at risk. There is also concern among primary care professionals about general practice’s capacity to conduct Health Checks2; between 2014-15 and 2023-24, the amount local authorities spent on individual Health Checks fell in real terms from £56 to £43 per check.  

The Public Health Grant, used by local authorities to fund Health Checks and other health services, reduced in real terms from £4.48 billion in 2015-16 to £3.53 billion in 2023-24, a 21% decline. Over the same period, local authority spending on stopping smoking, obesity and physical activity, decreased by 23% in real terms, from £340 million to £262 million (in 2023-24 prices).

The NAO is recommending the Department for Health and Social Care (DHSC) considers improvements in several areas, including:

  • Assessing whether local authorities are best placed to deliver Health Checks
  • Incentivising delivery of Health Checks to people at highest risk of CVD to help mitigate health inequalities and reduce potential longer-term costs falling on the NHS in the future
  • Setting clear targets for the numbers or percentages of the eligible population who should attend Health Checks, so they are attended and not just offered

“Each year thousands of lives are lost to cardiovascular disease, with billions of pounds spent tackling it.

“Health Checks can play a crucial role in bringing these numbers down, but the system isn’t working effectively, resulting in not enough people having checks. This is an unsatisfactory basis for delivering an important public health intervention.

“The Department of Health & Social Care needs to address the weaknesses in the current system for targeting and delivering Health Checks if it is to achieve the preventative effect it wants.”

Gareth Davies, head of the NAO

Read the full report

Progress in preventing cardiovascular disease

Notes for editors

CVD is a general term for conditions affecting the heart or blood vessels, such as heart attacks. CVD is estimated to affect 6.4 million people in England, costing the healthcare system £7.4 billion each year, with estimated annual costs to the wider economy of £15.8 billon.

Cardiovascular disease contributed to a quarter of all deaths in England in 2022. Rates of people under 75 dying with CVD halved between 2001 and 2014; since then, progress has stalled, with premature deaths rising from 74 per 100,000 people to 77 per 100,000 people in 2023.3 Those born in the least deprived areas are four times more likely to die of the disease than those born in the most deprived areas.4

The NHS’s 2019 Long Term Plan stated that CVD was ‘the biggest area where the NHS can save lives over the next 10 years.’ Through this plan, it aims to prevent 150,000 heart attacks, strokes and dementia cases by 2028-2029. But the NAO said NHS England cannot fully assess ongoing performance against its targets.

  1. The purpose of the Health Check programme was to establish a systematic, integrated approach to assessing risk of CVD for people aged between 40 and 74 who do not have a pre-existing heart condition, followed by the offer of personalised advice and treatment and individually tailored management to help individuals manage their risk more effectively. Health Checks are not an NHS screening programme.
  2. The NAO warned in a report last year of increasing pressure on general practices. The latest data shows there were 353 million appointments in 2023-24 compared with 290 million in 2018-19. A PHE survey of local authorities published in 2021 found 93% of local authorities used general practices to deliver at least some Health Checks.
  3. Figure 7, page 20, contains a heat map of under 75 mortality rates from CVD in England by upper tier local authority, 2023
  4. Figure 6, page 19, details premature deaths from CVD by deprivation in England, 2020.
  5. In a report published in July 2024, the NAO said: “…the extent to which citizens choose to and are assisted to lead active lives and have healthy diets, and get access to good social care when they need it, is critical to determining what kind of financial future awaits the NHS”. (Key finding 16, page 12).

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