Public Health England will continue providing five-yearly health checks for all people aged 40–74 years, despite expert claims that these are of limited value.

The NHS health checks, introduced by the Labour government in 2010, have been criticised by leading GPs as diverting resources from those at higher risk.

As Shadow Health Secretary, Andrew Lansley also criticised the policy, saying the checks were “not entered into on the basis of research” and should be either scrapped or refocused on people with stronger risk factors.

The checks screen a total of 15 million people for diabetes, chronic kidney disease, chronic lung disease, cardiovascular disease, and stroke risk.

A recent review by the Cochrane Commission concluded: “General health checks in adults may not reduce morbidity or mortality from disease.”

However, PHE will not only continue the checks but will extend them to include dementia awareness and alcohol consumption.

A spokeswoman for PHE claimed the NHS health check programme to be “highly cost effective,” with an annual cost of £332m and an estimated annual benefit of £367m.

According to John Middleton, Vice President of the UK Faculty of Public Health, the checks should be selectively targeted: “Risk stratification and identification of people most at risk through practice lists may be a more cost effective approach.”

In Nottingham, Stoke and Sandwell, he added, such an approach is already being used to “identify unmet needs for treatment, particularly for hypertension and reducing cardiovascular risk.”

The ‘metabolic’ health of younger adults is worse than that of previous generations, exposing them to greater risks of cardiovascular disease.

A large cohort study from the Netherlands found the incidence of obesity, high blood pressure and high cholesterol were much higher among adults in their twenties and thirties than formerly.

This increase in risk factors for diabetes, stroke and heart disease could offset the advantage of reduced incidence of lung cancer from the decline in smoking.

The researchers analysed data on more than 6,000 individuals in a cohort study that began in 1987, with follow-up examinations after six, 11 and 16 years, measuring body weight, blood pressure and total cholesterol level.

The subjects were divided into ten-year age groups to help determine whether there were ‘generation shifts’ in risk profile.

The results showed that while the prevalence of obesity and hypertension increased with age, the younger generations had a higher prevalence of these risk factors than those 10 years had shown at the same age. For example:

• incidence of overweight among men in their thirties had increased over 11 years from 40% to 52%

• incidence of hypertension had increased between generations in both sexes

• incidence of diabetes had increased between generations in men.

The investigators concluded that “the more recently born adult generations are doing worse than their predecessors”.

Lead study author Gerben Hulsegge commented that in terms of the prevalence of obesity, the younger generation was “15 years ahead” of the older.

He predicted: “We are likely to see a shift in non-communicable disease from smoking-related diseases such as lung cancer to obesity-related diseases such as diabetes.” As a result, he warned, increases in life expectancy could level off.

Health Secretary Jeremy Hunt has published strategy documents on tackling premature mortality and cardiovascular disease (CVD).

The DH strategy on premature mortality calls for improvements in the prevention, diagnosis and treatment of cancer, heart disease, stroke, respiratory disorders and liver disease.

The CVD strategy emphasises treating CVD as a single family of diseases with integrated NHS treatment, and making wider use of NHS Health Checks.

Hunt pointed to a current report in the Lancet, according to which the level of premature deaths in the UK has fallen in the last decade but remains higher than in most of Europe.

He claimed that the measures outlined in the two strategy documents could save 30,000 lives by 2020.

Key actions outlined in the CVD strategy include:

• Providing integrated and co-ordinated care by treating CVD as a single family of diseases, and ending the pattern of ‘silo consulting’.

• Using NHS Health Checks to improve the prevention and management of CVD with targeted advice and support.

• Ending the postcode variation in treatment of CVD.

• Better detection and management of CVD risk factors such as atrial fibrillation.

Peter Hollins, Chief Executive of the British Heart Foundation, commented: “We welcome the Outcomes Strategy. It has all the ingredients to tackle the threat posed by cardiovascular diseases, which remain the major public health challenge of our time. We are particularly pleased to see the emphasis on an integrated approach to patients with multiple conditions.”

The strategy document on avoiding premature mortality argued that over half of premature deaths (under the age of 75) could be prevented through more effective public health.

It highlighted the need to address the increasing prevalence of multiple morbidities, where individuals suffer from two or more major conditions.

Alongside action on risk factors and lifestyles, the strategy called on the NHS Commissioning Board to facilitate early diagnosis and “access to the right treatment”, with consistency of outcomes between hospitals.

The document did not explain how, with hospitals that meet clinical targets but overspend facing closure, the emphasis on treatment quality would be funded.

UK Science Minister David Willetts intervened with NHS leaders to promote AstraZeneca’s anticoagulant Brilique (ticagrelor).

According to the department for Business, Innovation and Skills (BIS), Willetts was acting within his remit of “strategic relationship management”.

However, a Cass Business School expert has suggested that his action on behalf of the pharma company was anti-competitive.

Brilique is recommended by NICE for prevention of strokes and heart attacks in patients with unstable angina, but take-up of the medicine has been uneven.

Vanessa Rhodes, a spokeswoman for AstraZeneca, justified the company’s action: “Despite this recommendation and the NHS target of reducing the mortality rate from cardiovascular disease, it is currently only routinely available to patients in some parts of England.

“We share the NHS and the government’s objective of broadening patient access to innovative medicines.”

After Willetts’ intervention was reported in The Times, BIS issued a press release explaining: “He regularly meets with companies to discuss issues of importance to them, and has a strong interest in making sure that the environment for the life-sciences industry is conducive to innovation and growth.”

AstraZeneca is undergoing major austerity measures under new chief executive Pascal Soriot, who has said the heads of R&D and global commercial operations will leave the company at the end of this month.

Willetts’ action could be justified as an attempt to enforce the Government’s innovation strategy by ensuring that NICE-recommended drugs are available through the NHS, or as an attempt to protect British jobs.

However, Stefan Haefliger, Lecturer in Strategic Management and Innovation at London’s Cass Business School, said it was merely commercial lobbying.

Politicians “are supposed to support the best drug for the patient and not promote local jobs,” he argued.

A BBC investigation has exposed nine London pharmacies that sold prescription-only drugs, including powerful sedatives, for cash.

Undercover reporters were sold sedatives (Valium and temazepam), opiates (Oramorph), antibiotics (amoxicillin) and Viagra for much higher prices than the cost of a prescription.

The BBC’s Inside Out programme has led to calls for stronger controls over pharmacies, which legally can provide such drugs without a prescription only in an emergency.

The easiest of the drugs to obtain by this illegal route were Valium (diazepam) and amoxicillin.

All of the illegal drug sales provoked concern from medical experts:

• Diazepam and temazepam are highly addictive and fatal overdoses are common.

• Oramorph (a bottle of which was purchased by a journalist for £200) is a potent oral form of morphine.

• Antibiotics are widely over-used, leading to poor patient response and the development of antibiotic-resistant disease strains.

• Viagra is dangerous for patients with cardiovascular disease.

Sedatives such as Valium are not controlled as strictly as opiates, but are widely linked to addiction, abuse and overdose.

There is concern that the overlapping regulatory roles of MHRA and the General Pharmaceutical Council (GPhC) may be leading to poor control over some widely prescribed drugs.

The GPhC has the power to cancel a pharmacist’s right to practise, but does not compile a list of pharmacies known to have sold drugs illegally.

Health spending is falling across Europe, leading to neglect of public health strategies, the Organisation for Economic Co-operation and Development (OECD) has warned.

The OECD report observed that austerity measures are leading governments to focus spending on acute care, while preventative strategies such as immunisation and smoking cessation are neglected.

Health spending per person in the EU has fallen from an average annual growth rate of 4.6% between 2000 and 2009 to −0.6% in 2010.

The UK is typical, with a drop in health spending of 0.5% in 2010 after a decade of annual growth at 4.9%.

Other countries further along the austerity road show a steeper decline – for example, health spending in Ireland fell by 7.9% after a decade of 6.5% growth.

As Shadow Chancellor, George Osborne stated in 2006 that Ireland’s economy was a model the UK should follow.

The OECD report notes that smoking and obesity are the major risk factors for cardiovascular disease, which caused 36% of all deaths in Europe in 2010.

Obesity rates have doubled across Europe since 1990, now at 17% of the population – and 25% in the UK.

“Governments under pressure to protect funding for acute care are cutting other expenditures such as public health and prevention programmes,” noted the OECD.

“In 2010, on average across EU countries, only 3% of health budgets were allocated to prevention and public health programmes in areas such as immunisation, smoking, alcohol, nutrition, and physical activity.”

The effects of this neglect of preventative healthcare will be seen in the coming years, the report warned.

Hundreds of NHS clinical experts look set to lose their jobs under plans by the NHS Commissioning Board.

The Board plans to reduce the number of cancer and heart and stroke networks around the country from 54 down to 12 – reducing staff levels from around 700 to less than 100.

Concerns have been raised that a host of dedicated teams of clinical experts around the country will lose their jobs and progress made within the last decade lost.

The plans have been met with criticism by healthcare professionals and health charities. Professor Tony Rudd, NHS Stroke Director for London, said it would be a “tragedy” if progress was halted under the proposals.

The 12 new networks will have fewer staff and smaller budgets. But the Commissioning Board claim that more patients will benefit due to experts focusing on a broader number of conditions.

However, directors of the existing networks insist the streamlined counterparts will not be able to promote new types of surgery or help patients through treatment and recovery programmes.

Professor Rudd said his network was now in discussions with the Department of Health and Strategic Health Authority for London to ensure the “expertise” of clinicians is retained in the NHS.

The Commissioning Board estimates it will spend around £42m creating the “network support areas”. Each will cover four types of major types of healthcare: cancer; cardiovascular disease; maternity and children; and mental health, dementia and neurological conditions. At least one network will cover each of the four areas of care.

“These arrangements represent an increase in the range of conditions/patient groups that will benefit from nationally supported clinical networks which have the potential to make huge improvements in the way care is managed in the NHS,” the Board said.

One in five PCTs will miss the mandatory ‘MOT’ health check target in 2012–13.

GPs are required to give the MOT check, which provides early warning of cardiovascular problems, to all patients aged 40–74.

However, according to data obtained by GP magazine, up to nine million eligible patients will not be given the relevant checks and questions.

A PCT that has not even started giving the MOT checks blamed “other pressures” for the omission.

The health MOT records age, height, weight, blood pressure and blood cholesterol (plus blood glucose in certain cases), as well as responses to enquiries about current medication, smoking and family history.

This can provide early warning of heart and circulatory disease and diabetes.

In the year 2011–12, before the MOT became compulsory, the NHS set a target of 20% of eligible patients receiving the checks. However, only 14% did so.

In that year, four PCTs gave no or very few MOTs, and two-thirds of PCTs did not meet the interim target.

A spokeswoman for NHS Cornwall and Isles of Scilly said the programme could not be delivered “owing to other pressures”.

Dr Richard Vautrey, Deputy Chairman of the BMA’s GP Committee, commented that giving the scheme “greater national standards” and “national rates of payment” would have led to “better cost and clinical effectiveness”.

From April 2013, offering five-yearly MOT checks will be among the public health responsibilities of local government.

Teva UK has launched a generic atorvastatin tablet on the day after the expiry of UK patent protection on Pfizer’s cholesterol-lowering drug Lipitor.

According to the British Generic Manufacturers Association (BGMA), buying generic alternatives to Lipitor could save the NHS up to £350m per year.

Pfizer could lose 85% of its UK revenue from Lipitor by the end of this year.

Atorvastatin is the most widely prescribed statin, used in millions of patients worldwide to help prevent cardiovascular disease.

Kim Innes, Commercial Director at Teva, commented: “Millions of prescriptions are written each year in the UK for atorvastatin, and the availability of the generic will save the NHS millions of pounds each year.”

“The expiration of Pfizer’s patent exclusivity on Lipitor is hugely significant for the NHS and a demonstration of the valuable role generic drugs play in patient care in the UK,” said Warwick Smith, Director General of the BGMA.

Responding to recent claims that generics harm innovation, he argued: “It is generic competition that sustains innovation. Without competition from generic products, originators could continue to make their money out of established products and the patent system would simply not work effectively.”

The use of prescribed aspirin is not suitable for primary prevention of cardiovascular diseases, according to a new UK-led study.

The study found that a small reduction in heart attack risk achieved by regular aspirin doses was outweighed by a greater increase in the risk of serious internal bleeding.

The authors concluded that regular prescription of aspirin in people with no history of cardiovascular disease is not appropriate.

A research team at St George’s University of London analysed data from nine clinical trials with over 100,000 healthy people over six years to determine the effects of taking aspirin daily.

Regular aspirin doses reduced the total incidence of cardiovascular events by 10%, but this difference was entirely in non-fatal heart attacks and not in strokes or fatal heart attacks.

In addition, regular aspirin doses increased the incidence of severe or potentially fatal internal bleeding by 30%.

Aspirin, a mild anticoagulant, has been shown to reduce the risk of blood clotting. It is widely prescribed in both secondary and primary prevention of cardiovascular events.

The study authors concluded that since the risks outweigh the benefits, “routine use of aspirin for primary prevention is not warranted”.

Lead study author Dr Rao Seshasai emphasised that the use of aspirin in secondary prevention of cardiovascular disease (in people with a history of such disease) is undoubtedly worthwhile.

However, he noted, the benefits of aspirin to patients without a history of cardiovascular disease are “far more modest” and the risks greater than had been thought.

“It would be worthwhile to review the existing recommendations, such as the Joint British Societies' Guidelines, for the use of this agent in low-risk populations, and consider aspirin treatment more selectively on a case-by-case basis,” he said.