Supporting the NHS, upskilling leisure staff to deliver a comprehensive health check service

Simon Alford, Senior Lecturer in Preventative Medicine, University of Central Lancashire


Simon presented a brief history of public health through the ages from The Public Health Acts of 1848 / 1875 to the 2012 Health and Social Care Act which returned public health to local authority control.
He commented that there has been very little change in the last 20 years and that there are lots of opportunities for our sector to work collaboratively with public health.

Successes and challenges

Public health has had successes, namely:

  • Vaccination

  • Motor-vehicle safety

  • Safer workplaces

  • Control of infectious diseases  

  • Decline in deaths from coronary heart disease & stroke 

  • Safer and healthier foods

  • Healthier mothers and babies 

  • Family planning

However, causes of death are now changing.  There has been a reduction in infectious diseases but an increase in non-communicable diseases such as diabetes and obesity. Life expectancy in the UK is lower than France, Portugal, Spain and Germany.

Challenges facing public health are:

  • Health damaging behavior (tobacco, alcohol, sexual health)

  • Decrease in physical exercise

  • Rising levels of poor mental health

  • Increase in musculoskeletal problems, arthritis, CHD and stroke

  • Issues of long-term care, dementia and multiple diseases

  • Poverty - health inequalities between the various social groupings

Financing of initiatives is becoming an increasing problem.  Between 2015/16 and 2019/20 there has been a £531m cut in the public health budget which represents a 9.6% reduction in cash. According to Ms Seccombe, chair of the Local Government Association’s community wellbeing board, “Cutting the public health budget is short-sighted and will undermine the objectives we all share to improve the public’s health and to keep the pressure off the NHS and adult social care.”

The NHS has a preventative approach via their Health Checks which cover:

  • Local authority commissioned

  • 40 - 74 year-olds (every 5 years)       

  • Delivered by doctors, nurses, healthcare assistants

  • Measurements - waist; cholesterol; blood pressure; weight; height; BMI; CVD risk%

  • Topical discussion areas - diet; exercise; weight; alcohol; smoking; dementia awareness (65 to 74 years)

Unfortunately there are no standards across England.  A patient is more likely to see a health care assistant rather than a doctor.  Whilst the Health Check is every 5 years, the number of appointments offered to eligible participants varies widely across England and the actual take-up is equally varied.  Those that do attend probably don’t need to see a doctor because what they need is lifestyle advice.

Other findings are:

  • Reluctance amongst GPs to discuss physical activities with patients. (Booth et al, 2015)

  • Some GPs are not fully aware of the guidance and recommendation in relation to the physical activity. (Savill et al, 2015)

  • 48% of trainee GPs lack confidence in providing advice and support around physical activity. (Dunlop & Murray, 2013)

  • The ability of any brief intervention to impact upon participants is in part down to the quality of the interaction and the staff delivering the intervention. (Mills et al, 2017)

University of Central Lancashire (UCLAN) School of Medicine have looked at other methods of delivery rather than through an ill-prepared doctor.  The have developed the Certificate of Competency in Health Checks Assessments (COCHA) which has been endorsed by CIMSPA. It is a 5 day CPD course aimed at individuals with qualifications such as gym instructor, personal trainer or those with a lifestyle management qualification.  Full details can be seen here.

This has potential for leisure providers:

•       Areas of development

o   Tender for commissioned work (i.e. NHS Health Check)

o   Workforce wellbeing

o   Support 3rd sector organisations (i.e. housing trusts)

•       Income generation

o   Commissioned/commercial work

o   Increased footfall

o   Building upon social and cultural capital

Further benefits are:

  • Promote prevention, support people in making good choices, help to reduce illness and physical difficulty.

  • Services transformation / sustainability

  • Create opportunities to link to the community/3rd sector

  • Promote working together across public services - collaboration

Questions from the audience included:

Q.  Social prescribing – how does this fit in?

A.  There are no clear lines or pathways at the moment.

Q.  Do you see Health Checks taking pace in leisure centres/gyms?

A.  It doesn’t matter so long as those conducting them are trained.

Q.  Do you see that there will be NHS gyms?

A.  Probably not.