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IVF success rates may be boosted by time lapse embryo imaging

May 23, 2013 By: Dr Search- Principal Consultant at the Search Clinic Category: Doctors, IVF, maternity, Pregnancy, Private Healthcare, Uncategorized

Time lapse imaging- which takes thousands of pictures of developing embryos can boost the success rate of IVF, according to British research.IVF success rates may be boosted by time lapse embryo imagingThe article Retrospective analysis of outcomes after IVF using an aneuploidy risk model derived from time-lapse imaging without PGS was reported in Reproductive BioMedicine Online, can be used to select embryos at low risk of defects.

Scientists at the CARE fertility group say such informed selection can improve birth rates by 56%.

Other experts say the result is exciting, but the study of 69 couples is too small to be definitive.

The research followed the couples at the CARE fertility clinic in Manchester last year, when 88 embryos were imaged and implanted.

The process involves putting the embryos into an incubator and imaged them every 10 to 20 minutes.

Continual embryo monitoring through time-lapse imaging is aimed at selecting those with the lowest risk of aneuploidy – where the cells have chromosome abnormalities. Aneuploidy is the single biggest cause of IVF failure.

But this form of embryo screening is a predictive rather than diagnostic tool.

Couples at high risk of passing on a chromosomal abnormality may prefer to have Pre-implantation Genetic Screening. This invasive test removes cells from the early embryo for analysis. It costs around £2,500 on top of the £3,000 charged for conventional IVF.

The researchers classified the embryos as low, medium or high risk of chromosome abnormalities based on their development at certain key points.

Eleven babies were born from the low risk group (61% success rate) compared to five from the medium risk group (19% success rate) and none from those deemed high risk.

“In the 35 years I have been in this field this is probably the most exciting and significant development that can be of value to all patients seeking IVF,” said Prof Simon Fishel, managing director of CARE Fertility Group.

“This technology can tell us which embryo is the most viable and has the highest potential to deliver a live birth – it will have huge potential. This is almost like having the embryo in the womb with a camera on them.”

In standard IVF, embryos are removed from the incubator once a day to be checked under the microscope. This means they briefly leave their temperature-controlled environment and single daily snapshots of their development are possible.

Dementia affects 80% of care home residents

March 11, 2013 By: Dr Search- Principal Consultant at the Search Clinic Category: Accident & Emergencies, Care Professionals, Dementia, Doctors, Healthcare, Mental Health, NHS Cash Shortages, Private Healthcare, Uncategorized

More than 320,000 of the 400,000 people living in care homes in England, Wales and Northern Ireland now have dementia or severe memory problems, the Alzheimer’s Society charity estimates.Dementia affects 80pc of care home residentsIt said the figure was almost 30% higher than previous estimates because of the rise in the ageing population and improvements in data collection.

Of 2,000 adults surveyed, 70% said they would be scared about going to a home.

Another two thirds felt the sector was not doing enough to tackle abuse.

And just 41% of 1,100 family members and carers surveyed thought their loved ones’ quality of life was good.

Alzheimer’s Society chief executive Jeremy Hughes said: “Society has such low expectation of care homes that people are settling for average.

“Throughout our lives we demand the best for ourselves and our children. Why do we expect less for our parents?”

“We need government and care homes to work together to lift up expectations so people know they have the right to demand the best.”

David Rogers, of the Local Government Association, which represents councils, said: “This report shows the lack of confidence in a care system which is buckling under the weight of rapidly growing demand and years of underfunding.”

“Local authorities want to offer a service which goes beyond a basic level of care but this is becoming increasingly difficult as our population ages, costs climb and the already significant funding shortfall becomes even more severe.”

Around one in three people over the age of 65 will develop dementia in their lifetime.

It is estimated that there are around 800,000 people in the UK who have dementia, but many have not yet been diagnosed.

By 2021 the number of people in the UK with dementia will have risen to almost 950,000, experts believe.

Postcode dementia care is disgraceful according to the Alzheimer Society

January 15, 2013 By: Dr Search- Principal Consultant at the Search Clinic Category: Doctors, Health Direct, health insurance, Health Websites, Mental Health, postcode lottery, Preventable Crisis, Private Healthcare, Uncategorized

There is a “disgraceful” variation in the number of proportion with dementia being diagnosed across the UK, according to the Alzheimer’s Society. Postcode dementia care is disgraceful according to the Alzheimer SocietyAbout 800,000 people in the UK have some form of dementia, but most have not been diagnosed.

Estimates by the charity suggest only 32% were diagnosed in the East Riding of Yorkshire compared with 76% in Belfast.

The government said the variation was “unacceptable” and caused “unnecessary suffering”.

Predicted levels of dementia across the UK were compared with data from GPs on the actual number of patients being diagnosed.

The map suggests a north-south divide, with the highest rates of diagnosis in Scotland (average 64%) and Northern Ireland (average 63%).

Rates dropped to 50% in the north-east of England, 41% in the south-west of England and 39% in Wales.

Across the whole of the UK, the percentage of people with dementia who have been diagnosed has gone from 43% in 2011 to 46% in 2012.

Jeremy Hughes, the chief executive of the Alzheimer’s Society, said: “It’s disgraceful that more than half of all people with dementia are not receiving a diagnosis, and disappointing to see such a disparity in diagnosis rates in different regions of the UK.

“This goes against best clinical practice and is preventing people with dementia from accessing the support, benefits and the medical treatments that can help them live well with the condition.”

The charity said one explanation was variation in “stigma”, which resulted in people not visiting their GP. The higher figures in Scotland were put down to a better relationship between social services and the healthcare system.

Health Secretary Jeremy Hunt said: “The small improvement in dementia diagnosis is good news, but the extreme variation across the country is unacceptable.

“It’s time for the worst performing areas to wake up to the dementia time bomb.”

He said failing to diagnose dementia was delaying treatment and “causing unnecessary suffering”.

Sexual healthcare at risk from NHS changes

October 31, 2012 By: Dr Search- Principal Consultant at the Search Clinic Category: Health Professionals, NHS Cash Shortages, Patients, postcode lottery, Private Healthcare, Sexual Health, Uncategorized

In April 2013 many health services are being put out to private tender – and will be overseen by amongst others the GP-led Clinical Commissioning Groups (CCGs).Sexual healthcare at risk from NHS changesBut CCGs will not commission sexual health or public health services such as obesity and smoking prevention.

This function will fall to local councils, and elected officials. The directors of public health who will advise on these decisions will need to be strong advocates for the disadvantaged and stigmatised.

HIV services, meanwhile, will be commissioned centrally by the NHS Commissioning Board.

This separation is fraught with difficulties: especially when both sexual health and HIV care are currently provided by the same healthcare professionals on the same premises.

It is similarly unclear who will pay for HIV prevention campaigns.

Over 85% of all people attending NHS sexual health clinics take up HIV testing, with referral and retention rates both excellent – resulting in world-class patient outcomes.

Currently, we are able to treat patients, map epidemiological trends (disease patterns in the population) and target our prevention campaigns in a manner which is the envy of the world.

Any private company tempted to bid for a contract from a local council, may have subtly different priorities.

There will certainly be a handsome profit to be made from delivering straight-forward tests for sexually transmitted infections and HIV.

But diagnosis, management and treatment of the more complicated cases or assiduous epidemiological data collection might not be such money-spinners.

Is the private sector willing to provide such expertise, to perform ‘contact-tracing’, the unique NHS service which helps us track the spread of pathogens and identify outbreaks?

The worried well are an easy market.

But will private companies really target the hard-to-reach populations who need the services most, such as prisoners, commercial sex workers and intravenous drug users?

The difficulty with splitting HIV service provision apart from sexual health provision will also begin to tell.

Relatively expensive HIV services may become untenable without the staff and stability offered by providing the two services together.

Instead, there is a very real risk that currently joined-up services will become fragmented, with huge variation in service.


Surgery death rate twice as high as previously thought

October 05, 2012 By: Dr Search- Principal Consultant at the Search Clinic Category: Accident & Emergencies, Doctors, Health Professionals, National Health Service, NHS, NHS Deaths, Patients, postcode lottery, Uncategorized

Twice as many people die after surgery in NHS hospitals as previously thought according to a new report that finds serious shortcomings in the way many patients are treated.Surgery death rate twice as high as previously thoughtThe overall chance of dying within two months of surgery is one in 28 (3.6 per cent), found the study published in The Lancet.

Dr Rupert Pearse, who led the research, described its findings as “very worrying” and said many patients were simply not getting the care they should. “We need to act,” he said.

People at a high risk of dying from surgery were routinely not being told of the dangers, said doctors, often because hospital staff were not identifying them properly.

Patients were also being sent back to general wards after surgery rather than critical care beds because of a “one-size fits all” approach that was “ingrained” in the NHS.

Dr Pearse, a reader in intensive care medicine at Barts and the London School of Medicine and Dentistry, said lessons needed to be learnt from cardiac surgery, where information on death rates was freely available and hospitals vied to be the best

A previous report, published last December by the National Confidential Enquiry for Patient Outcome and Death (NCEPOD), found the chance of dying within 30 days of surgery was just one in 63 (1.6 per cent).

But Dr Pearse said the difference between the two figures could not simply be explained by more patients dying in the second month.

“The great majority of deaths happen in the first seven to 10 days after surgery.”

Patients undergoing specialist surgery are treated differently, for example by dedicated teams on dedicated wards. Dr Pearse argued that meant they essentially received better care.

He said the mortality rate among adult cardiac patients was now less than two per cent – even though they tended to be older, have worse health, and require more dangerous surgery than average.

“If we did the types of things that we did in cardiac surgery, in all types of surgery, outcomes would improve.

Cardiac patients are treated by specialist teams of surgeons and anaesthetists and cared for by specialist nurses on dedicated wards.

Dr Pearse also said outcomes for cardiac surgery had improved markedly since the mid 90s, partly due to changes triggered by the Bristol Royal Infirmary scandal. Between 1990 and 1995, 35 babies died in its cardiac unit and dozens more were brain damaged due to lack of staff, leadership, and scrutiny.

This led to cardiac units being constantly audited, with results now published online.

“I think the reason we see such amazing care and excellent outcomes with cardiac surgery, is that hospitals compete with each other,” he said.  “If they find that their hospital is below par, they want to improve it.”

Doctors concede that there is simply not the money to provide such a level of care for all patients.


NHS under pressure with more trusts in the red

October 01, 2012 By: Dr Search- Principal Consultant at the Search Clinic Category: Health, Health Professionals, National Health Service, NHS, NHS Targets, Patients, PFI, postcode lottery, Uncategorized

The number of NHS trusts in financial difficulty has more than doubled in a year an Audit Commission report warns.NHS under pressure with more trusts in the redThe NHS ended 2011-12 with a £1.6 billion surplus- but the differences between solvent trusts and struggling ones is growing, warns the Audit Commission.

Hospitals on the outskirts of London and across the south east are struggling to balance their books, according to the report, while those in the centre of the capital, the Midlands and northern England are tending to fare much better.

Across England, the Audit Commission found 31 ended the 2011-12 financial year with a deficit. That compares with just 13 at the end of the previous year.

The NHS Financial Year 2011-12 report, published today, notes that most trusts reported “an improved financial position”, with the NHS overall recording an unspent “surplus” of £1.6 billion, up on £1.5 billion the previous year.

“However, there is a growing difference between those organisations that are struggling financially and those that are not,” it goes on.

It warns of “stark geographical differences” such as those “between the relatively financially comfortable inner London NHS bodies and financially harder pressed outer London bodies”.

That fact was baldly revealed this summer when South London Healthcare NHS Trust, responsible for three hospitals in south east London and metropolitan Kent, effectively went bust.

It was placed under the authority of a special administrator because it was losing £1 million a week.

The Audit Commission report said the trust had the largest deficit of any NHS body, at £65 million for the year. Its cumulative deficit is £148 million.

Part of the problem stems from two public finance initiatives (PFIs) costing it £61 million a year in interest.

But the report highlights serious financial problems at other hospital trusts on the edge of the capital, notably in north west London.

Senior NHS figures believe long term problems are now coming to the fore. Inner London hospitals have been able to pull in talent, patients and funding due to their reputations, but elsewhere in London and the south east, some hospitals without star attractions have withered.

There are seriously troubled trusts outside the south east too. The report mentioned Peterborough and Stamford Hospitals NHS Foundation Trust, which has a £46 million deficit.

Andy McKeon, managing director of health at the Audit Commission, said: “While nationally the NHS appears to be managing well financially, and preparing itself for the changes and challenges ahead, a number of primary care trusts and trusts are facing severe financial problems.

“The Department of Health and other relevant national authorities need to focus their attention on the minority of organisations whose financial position is deteriorating, and on their geographical distribution and service standards.”

The 31 trusts in deficit include 21 foundation trusts, which are financially independent of the Department of Health, up from six in 2010-11.

The report also found the health service was on track to make £20 billion of efficiency savings by April 2015, and was “in a good position to meet the challenges of spending within its limits”. However, it warned there was “no room for complacency”.

A Department of Health spokesman said: “We know the NHS is facing even greater pressures, not least from rising demand and costs.

“That’s why we are investing an extra £12.5 billion in the NHS, modernising it and improving efficiency while at the same time improving choice for patients to drive up the quality of patient care.”


Third of health authorities still imposing postcode lottery treatment bans

September 27, 2012 By: Dr Search- Principal Consultant at the Search Clinic Category: Conservatives, GPs, IVF, NHS Cash Shortages, NHS Targets, Patients, postcode lottery, Uncategorized, Waiting Times

A third of local health authorities are still imposing postcode lottery treatment on certain ailments including hernia operations, IVF, varicose vein removal and even hip and knee replacements, according to a survey of GPs.Third of health authorities still imposing postcode lottery treatment bansLast November Andrew Lansley- the then Health Secretary, banned primary care trusts (PCTs) and health commissioning groups from imposing across-the-board restrictions, describing them as “unacceptable”.

He said patients should always be able to be treated if their doctors said they needed it.

He reiterated his edict this June, after a study found nine in 10 local health authorities were imposing tight thresholds on at least one treatment deemed to be either ‘non-urgent’ or of ‘low clinical value’.

However, there are still widespread bans in place, according to a survey of 682 family doctors by GP magazine. It found 35 per cent said authorities or commissioners were restricting access on the base of cost alone.

GPs who responded to the survey said they were being forced to “fob off” patients until they could refer them on.

Some PCTs were not imposing blanket bans as such, but making it more and more difficult for patients to qualify for treatment, for example by raising the threshold of pain and immobility needed to qualify for a joint replacement.

One wrote the PCT was “not imposing a blanket ban, but it is made increasingly difficult in terms of the hoops you have to jump through to obtain funding, even to get a patient seen for an ever growing list of conditions.”

Some feel Mr Lansley had it both ways on the issue – on the one hand restricting funding and then blaming PCTs who had to reduce their spending.

One respondent said Mr Lansley had been “asking the impossible, with GP commissioners being the fall guys”.

Dr Richard Vautrey, deputy chairman of the British Medical Association’s GP committee, called on Jeremy Hunt, Andrew Lansley’s replacement to sort out the problem.

He told GP: “’The Department of Health has repeatedly said it would prevent PCTs and clinical commissioning groups (CCGs) from rationing treatments on cost alone.

“They are clearly not doing that and need to start putting words into action,” he said.  “This will be a big challenge for the new health secretary, and one he needs to address quickly.”

According to the poll, GPs seem to be strongly in favour of an England-wide list of services it will not fund, to eliminate the current postcode lottery.


NHS rationing is putting health at risk says doctors’ leader

September 18, 2012 By: Dr Search- Principal Consultant at the Search Clinic Category: Doctors, Drugs, health insurance, Health Professionals, IVF, NHS Cash Shortages, NHS Deaths, postcode lottery, Preventable Crisis, Uncategorized

Dr Mark Porter, the new head of the BMA, says NHS cuts are ‘morally wrong’ and present a serious risk to patients. NHS rationing is putting health at risk says doctors' leaderThe NHS is putting patients’ health at risk by denying them drugs and operations because of growing rationing being imposed to save money, the new leader of Britain’s doctors has warned.

The drive to meet demanding efficiency targets is so serious that the NHS is offering some GPs surgeries extra money if they send fewer patients for tests and treatment in hospital — a move condemned as “morally wrong” by Dr Mark Porter, the British Medical Association’s recently elected chair of council.

In his first interview since taking up the post Porter said the NHS was offering fewer and fewer services to patients and that many had been “cut out”, often against doctors’ wishes.

The shrinking of the NHS’s “offer” to the public was being hastened by the coalition’s health reforms, creeping privatisation of services and the system’s need to save £20 billion by 2015, Porter claimed.

Those pressures mean the fear that a patient may be harmed because they are denied a test or treatment “is a realistic concern”, said Porter. The same changes, especially the growing number of  private firms providing NHS services, also threaten to fragment the health service by making it less of an integrated system and have a severe impact on recent improvements in the quality of care, he added.

The NHS has come under growing criticism for making it harder for patients to have operations for routine conditions such as hernia, cataracts, grommets, wisdom teeth, or hip or knee replacement, and denying infertile couples IVF.

Rationing of access to certain procedures deemed not worthwhile by the NHS- postcode lottery- which is still piecemeal and localised, will soon become much more widespread as the spending squeeze in the service tightens, said Porter. “You see it happening in examples now, but it’s when it becomes service-wide in a few years’ time, if the current policies continue, that the population will notice in the wider sense.”

NHS organisations’ lists of treatments they will no longer pay for mean that “bits of the NHS are being parcelled off and taken out of the NHS offer year by year”. Although the NHS constitution guarantees universal and comprehensive healthcare “there’s lots of areas where bits of the NHS have been taken out of the offer”, Porter said. “It’s no longer a comprehensive service. We can see the effect of people to whom we have to say: I’m sorry, this treatment is no longer available.”

The use of referral management centres, in which family doctors’ decisions to refer a patient to hospital are analysed by a third party before any treatment can be given, “are particularly distressing for GPs who know how they would like to deal with patients but find their ability to do so is more constrained than ever before”. The situation was in stark contrast to “rhetoric” from ministers about how patients and GPs are being given more power than ever before as a result of their changes to the NHS in England, Porter added.

Both existing NHS primary care trusts (PCTs) and the clinical commissioning groups (CCGs) led by local GPs that will replace them next April are offering GP practices money in return for sending fewer patients to hospital to receive what can be expensive care there, despite NHS leaders and ministers having told them to restrict access only on clinical, and not financial, grounds.

Porter said that while the BMA supported schemes to improve the quality of referrals, such offers potentially gave GPs a conflict between their clinical judgment and personal self-interest, as GPs who run a practice can decide either to spend income on improving services or use it to boost their salaries. “It’s morally wrong and professionally wrong. Paying a direct financial incentive like that can be a direct financial incentive to the person themselves and that incentive shouldn’t be there. Doctors’ minds should be on what’s best for the patient, not on whether the PCT will sub them for certain types of financial behaviour,” he said.


Hospitals to pay price for postcode lottery failure to innovate

September 04, 2012 By: Dr Search- Principal Consultant at the Search Clinic Category: Health Professionals, Healthcare, National Health Service, NHS, NHS Cash Shortages, NHS Deaths, NICE, postcode lottery, Quangoes, Uncategorized

NHS hospital patients across the country will soon be able to see whether their local hospital or health authority is rationing care as part of government plans to eradicate “postcode prescribing” in the NHS.Hospitals to pay price for postcode lottery failure to innovateFrom this autumn, every hospital and commissioning body in England will be forced to start publishing statistics showing how many of its patients are being provided with the latest drugs and treatments recommended by the National Institute for Curbing Expenditure (Nice).

The move will mean that, by next year, every hospital and health trust will be rated using an “innovation scorecard” allowing patients to compare services and treatments offered in different parts of the country.

Those health authorities found to be denying approved treatments are likely to face censure from the Department of Health.

The plans are due to be announced by the head of the NHS, Sir David Nicholson, next month. At first the “scorecard” is likely to be made up of around 20 key treatments and interventions where uptake across the NHS is known to be inconsistent. It is expected to be expanded over time to include all new drugs recommended by Nice for widespread use in the NHS.

Ministers hope that the move will bring an end to the problem of “postcode prescribing” where health authorities deliberately restrict access to approved drugs to save money.

Last year it emerged that about a quarter of primary care trusts were blacklisting more expensive drugs in favour of cheaper generic versions, which are sometimes not as effective. Among those banned in some areas were Lipitor and Crestor, two branded statins for cutting cholesterol in people at raised risk of strokes.

Three weeks ago Sir Michael Rawlins, the chairman of Nice, accused trusts of “messing around with the law”. “They want to use their money for other purposes: I understand that. But the law is the law, and … the law clearly says that when Nice gives a positive view of a drug, patients are entitled to it if their doctors think it is appropriate,” he said.

Announcing the move, the Health minister Paul Burstow, said allowing patients to see where drugs were being restricted would be a key catalyst for change. “Patients have a right to drugs and treatments that have been approved by Nice.

“NHS organisations must make sure the latest Nice-approved treatments are available in their area, and if they are not, then they will now be responsible for explaining why not.

“Being transparent with data like this is the hallmark of a 21st-century NHS. It is a fundamental tool to help healthcare professionals improve care.”

Sir Andrew Dillon, chief executive of Nice, said the organisation has been working with the NHS Information Centre on drawing up a scorecard of around 20 indicators to assess how NHS organisations were adopting Nice appraisals.

He said the intention was to launch the scorecard in September and it would act as a “benchmark on expected levels of uptake” which would be relevant to patients, doctors and commissioners.

“This is a step change in the detail with which we will be able to see how trusts respond to our recommendations,” he said.

“It will be valuable not just to patients but also help hospitals assess how well they’re performing and ensure that best practice is disseminated across the NHS.”

Sir Andrew added that, in the past, there had been numerous barriers to uptake of new drugs – sometimes financial but often organisational.

“We know that changing professional practice can take time. Doctors, although positively orientated, nevertheless take time to be made aware of the benefits of new treatments for patients.

“What we hope is that the scorecard will help rapidly get a consistent response to national guidance.”

Katherine Murphy, chief executive of the Patients Association, said it would be crucial the information be made available in a format that was meaningful to patients. “They must be in a position to hold the NHS to account because at the moment that doesn’t happen. We know the NHS is hopeless at introducing new ideas.”

Clare Gerada, president of the Royal College of GPs, said that, while she supported the aims of the scheme, she was sceptical about how effective a scorecard would be. “Will it be a bureaucratic tickbox or will it be something more sensible?” she asked.


Hospitals fail to check for potentially fatal conditions

August 24, 2012 By: Dr Search- Principal Consultant at the Search Clinic Category: Accident & Emergencies, diabetes, GPs, Health Professionals, Heart Disease, NHS Cash Shortages, NHS Deaths, Patients, postcode lottery, Preventable Crisis, Uncategorized

Millions of people are missing out on health checks for potentially fatal conditions, an investigation has revealed, because cash-strapped hospitals deem them to be a low priority.Hospitals fail to check for potentially fatal conditionsAs many as nine million patients may be missing out on checks designed to spot potentially fatal conditions such as heart disease and diabetes, unless current provision and uptake improve, according to the GP magazine investigation.

GP magazine sent Freedom of Information requests to all 151 primary care trusts (PCTs) in England, of which 118 responded.

The figures obtained show that, in 2011-12, 1.7 million checks were offered to patients: 14% of all those eligible for the programme. Around 920,000 checks were actually carried out. This is an increase on 2010-11 when 1.1 million checks were offered and 645,000 were carried out.

Around two thirds (64%) of PCTs did not provide enough NHS health checks to meet the Government’s 20% aspirational target in 2011-12, GP magazine said.

One fifth (21%) of PCTs admitted they will fail to meet the compulsory target in 2012-13, despite being given three years to prepare, the figures show.

Three PCTs did not provide a single check in 2011-12 and another provided just four checks.

A spokeswoman for NHS Cornwall and Isles of Scilly, which did not provide any checks in 2011-12, told GP magazine that the programme is not prioritised, “owing to other pressures”.

Nationally, patient uptake is falling, with only 54% attending a check in 2011-12, down from 60% in 2010-11. Just 11% of patients in NHS Portsmouth turned up for their check.

Despite government funding, six PCTs spent nothing on their programmes in 2011-12.

The figures also reveal a geographical disparity in funding for checks. In 2012-13, funding from PCTs varies from £1.3m in NHS West Sussex to just £28,452 in NHS Southampton City, GP magazine said.

Dr Richard Vautrey, deputy chairman of the British Medical Association’s GP committee, said: “The programme is done in such an ad hoc way, without central guidance. That’s why it is so patchy in uptake and, probably, effectiveness.

“It would have been far better to have greater national standards for the scheme, and national rates of payment for the scheme. This would have led to better cost and clinical effectiveness.”

Jules Payne, chief executive of the Heart UK charity, said: “It’s encouraging that the number of health checks conducted has increased on the previous year. However, these findings aren’t all good news. Some PCTs have indicated that they will deliver far fewer health checks than they should be, and there is enormous variance in PCT spending on health checks.

“This has all the classic ingredients of health inequalities and a postcode lottery for accessing services.”

Baroness Barbara Young, chief executive of the Diabetes UK charity, said public awareness needs to be raised.

“Something like this (the health checks) is pretty fundamental to tackling the rising tide of diabetes,” she said.

“I think the problem with the geographical disparity is that it has not actually been mandatory, it has been optional. Some PCTs have taken it very seriously, some haven’t.  The other missing link in this is public awareness. It is hugely patchy.”

Natasha Stewart, senior cardiac nurse at the British Heart Foundation, said the lack of provision or uptake means many people are unaware that they have cardiovascular disease.

“The results of this survey reflect concerns that people aren’t being offered the check, or they are not taking the NHS up on their offer,” she said.

“This means there are a lot of people who are unaware they are living with cardiovascular diseases, or the risk factors which lead to them. Local authorities need to take health checks out into the community, rather than expecting the community to come to them.”