When it comes to preventive healthcare, improving uptake is the name of the game.
This is reflected in the targets set by NHS England, with programmes like cervical cancer screening setting an ‘acceptable’ floor of 80% uptake. Beyond the intuitive feeling that more is better, we rarely talk about the difference that increased uptake makes. We’d argue that not speaking about this is a missed opportunity.
A better understanding of how the health service and the public stands to benefit from increased uptake can help focus the efforts of healthcare teams. In turn, this will increase the uptake of their preventive healthcare programmes.
So, who stands to benefit from increased uptake?
In short, we all benefit from increased uptake. Any preventive healthcare programme; from the long-established NHS Health Check, to the new Targeted Lung Health Check programme; are subject to rigorous evaluation. To be accepted into the national portfolio, preventive healthcare programmes must but cost effective with how they deliver better health outcomes. Data suggests that they do. The UK Government’s green paper, Prevention is Better than Cure has shown that for every £1 invested in preventive healthcare, £14 of social value is generated.
Preventive healthcare directly benefits individuals who have undiagnosed health issues by identifying them earlier at a more treatable stage. Yet, it also has a positive indirect impact on the general public. With fewer people falling seriously ill, there will be a lower tax burden on the public and less pressure on the already stretched NHS. This will free up more human and financial resources, which can be directed where the public need them the most
The public and the wider health service aren’t the only ones to benefit. Healthcare providers benefit through the incentives paid for the delivery of preventive healthcare. For example, local councils pay out between £20 and £35 for each competed NHS Health Check. Around 16 million people are eligible for an NHS Health Check in each 5-year cycle, meaning around £320 million in incentives are available. Whilst some incentives are effective, others may not be. Between 2018 and 2023, providers only achieved an uptake rate of 27.4%, leaving £230 million in incentives unclaimed.
What difference would a 1% improvement make?
To break things down a little more, it is worth looking at how a small improvement in uptake can make a difference. Let’s use the cervical screening programme as an example.
There are an average of 3,200 new cases of cervical cancer every year. Cancer Research UK reports that between 2016 and 2018 there were 9.5 new cervical cancer cases per 100,000 people with a cervix. Incidence rates were shown to be highest amongst 30–34-year-olds, whilst incidence rates for the most deprived population were 65% higher than for the least deprived population. Clearly this is a healthcare issue that is worthy of attention.
The NHS Cervical Screening Programme was established in 1960 to address the incidence of cervical cancer and its delivery is well established in primary care. It takes a population approach to eligibility, where every person with a cervix is eligible on a routine basis based on age and results of previous screenings. NHS Digital data suggests that every year 4.5 million patients become eligible for cervical. However, due to previous underperformance, the NHS sent over five million screening invites in 2021/22, a figure that was up by 10.5% on pre-pandemic levels. Despite this, approximately 4.6 million eligible members of the public have never been screened or are not up to date with their tests.
The screening itself is for high-risk human papillomavirus (HR-HPV). When HR-HPV is identified, a cytology is conducted to identify abnormal cells that are at risk of becoming cancerous. According to Public Health England, a positive HR-HPV is found in 8%-13% of cases. This kind of population approach depends on high uptake of screening so that individuals with abnormal cells are identified at an early stage. Higher rates of screening mean that more HR-HPV cases will be identified and treated.
In England, cervical screening uptake is at an ‘unacceptable’ level in all but one commissioning region. This underperformance means that fewer positive HR-HPV cases are identified than would otherwise be the case. An acceptable rate of screening uptake in England would mean an additional 688,500 cervical screenings per year, and an additional 68,850-103,275 positive HR-HPV cases identified each year. If uptake was only 1 percentage-point higher, we would still deliver 69,000 additional cervical screenings and identify 7,000-10,000 additional positive HR-HPV cases that could then be treated.
It is clear that even small improvements in public uptake of preventive healthcare can make a huge difference. This is particularly encouraging at a time when workforce challenges make significant increases in administrative or clinical capacity unfeasible. Small tweaks to engagement processes can lead to small increases in public uptake of preventive healthcare, and many of these tweaks can actually save care providers time and money. Taken together, a number of these small changes can lead to significant improvements in health outcomes, and a more sustainable health service.
If you are interested in improving the uptake of your healthcare programmes, book a demo of Appt Health with a member of our team here.