High-Level Overview

A November 2024 National Audit Office (NAO) report on cardiovascular disease prevention highlighted key challenges, including low attendance rates for NHS Health Checks (NHSHCs) and a lack of systematic targeting of high-risk individuals. Medway Council, in partnership with Health Diagnostics, is tackling these issues through digital innovation and expanded, unconventional community outreach. Their approach is enhancing accessibility, reducing health inequalities, and achieving measurable reductions in cardiovascular risk.

Solution components supplied

• • Integrated Digital Health IT Solutions: Streamlining workflows, automating data integration, and improving efficiency. 
  • Automated Patient Invitation Process: Ensures comprehensive and targeted outreach through tailored letters/SMS and follow-up reminders. Fully tracked and traceable to reduce duplication.
  • Interactive Consultation Module: Improving patient engagement to help understand the impact of lifestyle on health and wellbeing. Simplifies data integration, eliminating manual transfers and reducing transcription errors. 
  • Patient-Facing Digital Portal: Provides access to personal health check results and local support/educational resources, helping to facilitate self-management.
  • QRISK® Score Visualisation: Offers color-coded, intuitive risk assessment for predicted cardiovascular conditions.
  • One-Click Referrals: Connects patients seamlessly with recommended local health services like the NHS Diabetes Prevention Programme and national free resources.
  • Real-time Data Reporting & Analysis Tools: Generating actionable insights to improve public health decision-making and service planning.
  • Training: Expert delivered and tailored to products and services supplied.
  • Support: Delivered by a highly knowledgeable team, ensuring projects maximise the functionality and features.

 Local Outcomes

• • A significant increase in NHSHC accessibility, particularly among under-served populations.
  • Efficient electronic record-sharing between providers and GPs, eliminating manual data entry.
  • Personalised patient engagement, motivating individuals to adopt healthier lifestyles.

 Notable Public Health OutcomesPatient satisfaction levels:

• • 98% of individuals that have received an NHS Health Check have rated the quality of the service as either ‘excellent’ or ‘very good’.
  • 89% of people have stated that they are either ‘confident’ or ‘extremely confident’ about maintaining the lifestyle changes they discussed during their NHS Health Check.
  • 98% of people have stated that they are either ‘likely’ or ‘extremely likely’ to recommend the NHS Health Check to family and friends.

 Year one general practice satisfaction statistics:

Detailed below is a snapshot of outcomes following a satisfaction survey distributed to KCC practices at the end of the first year:

• • Medway Council’s community outreach approach, using our system, led to a 10.5% average reduction in CVD risk scores when individuals were followed up within a year of having had an NHSHC. In contrast, a matched population of GP practices using a conventional system saw only a 0.002% reduction, which was not statistically significant.
  • Over 1,500 blood pressure (BP) checks were conducted during Medway’s ‘Measure Your Pressure’ month. More than 300 patients were flagged for clinical follow-up and over 50% of attendees came from the most deprived areas, demonstrating effective community reach.

 Project management testimonials:

• • Georgina Crossman, Senior Public Health Manager at Medway Council, highlights the success of the program:

  “The outreach team offers the gold standard of health check delivery in Medway. The use of Health Diagnostics’ digital solution, combined with a highly skilled team, has been crucial in achieving this standard.”

• • Julie Evason, Founder and Managing Director at Health Diagnostics, adds:

  “We’re thrilled to collaborate with Medway’s Public Health team as they lead the way in heart health innovation. Together, we’re making a lasting impact on cardiovascular disease prevention.”

Full Case Study