On day 2 of our celebration, we’re looking back at how Haelo, commissioned by Salford City Council from 2013-2016, used improvement science methodologies to increase the uptake of NHS Health Checks in Salford.
Haelo implemented Planned Experimentation, an advanced improvement science technique that allows you to test multiple ideas and theories simultaneously. Not only to understand what the best combination of those ideas are, but to also understand the complex interactions between those individual ideas.
We implemented this approach alongside a GP practice with the overall aim to improve the rate of patients booking and attending an NHS Health Check. We wanted to understand what is the best combination of invitation methods to maximise the number of people coming through the door for a Health Check.
Levels of deprivation and poor health in Salford are higher compared with the national average. Whilst premature mortality due to heart disease has fallen, rates are again still higher than average. The NHS Health Check acts as a mid-life MOT for those aged 40-74, providing a cardiovascular disease risk assessment and follow up prevention programme.
The NHS Health Check programme offers a fantastic opportunity to tackle avoidable deaths, disability and reduce health inequalities in England.
Salford City Council commissioned Haelo to deliver a Breakthrough Series Collaborative improvement programme in order to increase patient uptake of NHS Health Checks in Salford.
The check itself takes approximately 30 minutes and consists of a small number of questions, simple measurements, plus a blood test to measure a patient’s cholesterol level. The results are then used to calculate the patient’s risk of developing conditions such as heart/kidney disease, diabetes, stroke and dementia.
The check also provides an opportunity for delivery staff to provide an individualised plan for the patient to improve their health and wellbeing.
In 2014, Haelo began its programme of work with Salford City Council, Salford Clinical Commissioning Group, The University of Salford and other organisations, to deliver a programme which aimed to increase the uptake of the NHS Health Checks in Salford.
Haelo worked with partners and stakeholders to develop a programme of work to meet the set aim, which was represented in a single driver diagram. The driver diagram acted as a road map for improvement activities. In addition, Haelo delivered a suite of measures to monitor the progress of interventions.
Haelo and its partners aimed to increase the uptake of NHS Health Checks in Salford from 38% in 2013, to greater than 60% in 2014/15.
All partners worked collaboratively to determine how this could be achieved through the following methods: informing the population and providers about the health checks, capturing eligible population, conducting the health checks and ensuring support systems were in place to support the delivery of the health checks.
Using the Breakthrough Series Collaborative model, a series of workshops were held, interspersed with action periods for intervention testing. Participants found these workshops were a useful forum for sharing ideas, talking about breakthroughs and barriers, and celebrating success.
Below are some of the comments from attendees:
“I gained some good ideas to try in my GP practice regarding invites and completing health checks.”
“I will share this information on quality improvement and cascade it to other staff to improve the uptake of health checks.”
“I want to work with Haelo to get patients in for appointments and to meet our target for the year.”
With facilitation from Haelo, participants identified key interventions which could increase the uptake of the health checks in Salford, with the potential of being shared with a wider audience.
NHS Health Checks improvement bundle
After implementing the changes in 2014/2015, there was a clear increase in the uptake of NHS Health Checks in Salford. Since the collaborative began, those delivering health checks have been working hard to improve uptake. The culture of cooperation and collaborative activity was particularly relevant in this programme.
The work undertaken by Haelo yielded positive outcomes and improvements in uptake of NHS Health Checks particularly in the 2014/15 year to 56.4%. Although the specific target of 60% uptake was not met, there was a significant increase in uptake compared to the previous 2013/14 year.
In 2015/16, after the initial collaborative came to an end, Haelo continued to work across Salford – managing data related to the NHS Health Checks work; including the dashboard of measures, outcome measures and the quarterly update of data from practices. Haelo continued to monitor and ensure that the NHS Health Checks are of a satisfactory quality and delivered consistently throughout Salford.
Progress was sustained at this level during the 2015/16 year although no further increase was seen. One of the more positive aspects of this programme was the vast amount of partnership work that occurred between various Salford partners paving the way for further joint programmes of work to benefit the Salford population. Other significant improvements were made in regards to increased engagement with primary care, intelligence gathering, collaboration with the Salford City Council, the Salford CCG and Third Sector organisations such as Salford Healthy Communities.
In April 2016, Haelo were invited to attend The International Forum on Quality and Safety in Healthcare Conference.
Representatives from Haelo travelled to Gothenburg, Sweden, to present a Planned Experimentation poster at the Science Symposium, on how planned experimentation could be used to increase the uptake of NHS Health Checks in Salford.
As a result of NHS Health Checks now being included in the Salford Standard clinical commissioning framework from April 2016, all GP practices now have an obligation to provide NHS Health Checks to their population. The work completed by Haelo and partners during 2013 – 2016 should assist organisations delivering Health Checks in Salford in meeting the NHS Health Check targets within the Salford Standard.
The Greater Manchester Devolution also provides an opportunity for increased uptake of the NHS Health Checks programme as they fit a major drive to encourage everyone in the region to take charge of their own health: often through prevention and screening plans.
A document review was conducted by the University of Salford. The aim of this review was to explore the outcomes of the 2014-2016 collaboration between Salford City Council (SCC), Haelo and other Salford Partners with respect to improving the uptake of NHS Health Checks.
The outcomes of this project are split into three separate reports: Part A – Executive Summary; Part B – Research Report and Part C – Technical Report. All documents can be viewed on the University of Salford Institutional Depository.
You can find the Executive Response from Haelo and Salford City Council here.
Day 3 of our Haelo celebration will be looking back at Haelo Hosts. Keep up with the conversation on twitter, using @_Haelo #celebratinghaelo