By Dr Mel Roche, Public Health Consultant and Blood Pressure Lead, Champs Public Health Collaborative
Cardiovascular disease (CVD) is the single biggest area where the NHS can save lives over the next ten years, and it is responsible for the second largest burden of disease in the UK.
More than half of heart attacks and strokes are attributable to high blood pressure (BP, hypertension), and as CVD/high BP are associated with worse COVID-19 outcomes, restoration of CVD prevention programmes is a vital part of COVID recovery.
High BP remains an important public health challenge across Cheshire and Merseyside. There are over 416,000 patients on general practice hypertension registers across Cheshire and Merseyside (PHE Fingertips October 2020). In order to achieve the BP ambitions for 80% detection and 80% control by 2029, it is estimated that over 41,000 additional known BP patients need improved control, and more than 69,000 additional people with high BP need to be diagnosed (and numbers are likely to be higher still due to disruption to prevention opportunities during the pandemic).
British Heart Foundation’s new report ‘The Untold Heartbreak’ highlights COVID-19’s devastating impact on cardiovascular care and makes the case for urgent action to ensure patients can access the care they need within a stronger and more resilient health system. For further information about the campaign, visit www.bhf.org.uk/untoldheartbreak
And in a recent webinar, the Faculty of Public Health president, Maggie Rae, highlighted the importance of tackling high BP as a healthcare public health priority to save lives and reduce inequalities. Click here to view the webinar, ‘Cardiovascular Disease Prevention and Blood Pressure – the role public health specialists can play’. Directors of Public Health and public health teams can play important roles driving this important health and inequalities agenda at a challenging time for the whole system.
Exciting national developments to tackle high BP
There have been some exciting national developments to help tackle high BP and CVD prevention this year. These include:
- Cardiac Networks return across England this summer and will play a key role in ICS-level CVD transformation, including CVD prevention as well as the recently launched Cardiac Pathways Improvement Programme. James Boyes is welcomed as the new Cheshire and Merseyside Cardiac Network lead, and work is underway for the Cheshire and Merseyside Cardiac Network to align, integrate with and build on the progress of the Cheshire and Merseyside Health and Care Partnership (C&MHCP) CVD Prevention Network and CVD board moving forwards.
- NHS England, NHS Improvement and NHSX launched the flagship Blood Pressure@home (BP@home) programme in late 2020 to support home monitoring and BP optimisation in high-risk BP patients during the pandemic.
- Publication of plans for the 2021/22 and 2022/23 CVD Prevention and Health Inequalities Primary Care Network (PCN) DES requirements. These will play a key role in supporting local Primary Care Networks (PCNs) to detect and manage CVD risk factors including high BP, Atrial fibrillation (AF) and cholesterol, and to tackle health inequalities.
- The first data outputs from the national CVD PREVENT audit will be available later this year, supporting quality improvement in CVD prevention in primary care. Cheshire and Merseyside colleagues are working with NHS Benchmarking to help shape how this valuable dataset can inform and drive local population health and quality improvement initiatives for best impact on outcomes and inequalities.
- Updated PHE Fingertips CVD Prevention packs provide a valuable insight into variation in BP control at Clinical Commissioning Group, practice and now PCN levels, and provide local benchmarking against the national ambitions.
- A new major new national initiative has been announced that will see community pharmacies offer BP checks for over 40’s, starting from October this year.
Tackling high BP in Cheshire and Merseyside
CVD prevention and tackling high BP remain strategic priorities for Champs Public Health Collaborative and for C&MHCP, where they are embedded into CVD, Population Health and Prevention, and Digital First in Primary Care programmes. Throughout the pandemic, partners from a range of sectors and organisations have been leading innovative whole system approaches to tackling BP/CVD prevention that strengthen awareness, access, care quality and empowerment of self-care.
How you can get involved
Public health teams and health partners across Cheshire and Merseyside can support and build on a number of initiatives, work streams and resources to strengthen sub-regional efforts to tackle high BP, for example:
Know Your Numbers! Week
Know Your Numbers! Week is the UK’s biggest blood pressure testing and awareness campaign and is just around the corner, running from 6th to 12th September 2021. Blood Pressure UK’s annual BP campaign theme this year is home blood pressure monitoring. Register here to get involved.
Join a Cardiovascular Disease Prevention webinar: ‘Know Your Numbers’ week – raising awareness of high blood pressure on Thursday 2nd September, 11.30am to 12.30pm. Register here.
Happy Hearts
The Happy Hearts website includes BP and CVD prevention information and links for patients and professionals, and further updates are planned for 2021/22. The successful targeted Happy Hearts social media campaign will continue to run from the Liverpool Heart and Chest Hospital Facebook account until April 2022 and free digital resources including leaflets, posters, animations and social media assets are available via the Happy Hearts toolkit. Following a period of consultation (details to follow) further print runs of hard copy resources will be available.
BP@home and BP quality improvement in primary care
A cross-sector Cheshire and Merseyside steering group, supported by a jointly funded (Innovation Agency/Champs Public Health Collaborative) programme manager, Jane Briers, is driving the adoption of remote BP monitoring in general practices and community pharmacies across Cheshire and Merseyside.
The group is supporting distribution of over 11,000 nationally procured BP monitors and has relaunched the roll out of an updated (and nationally acknowledged) BPQI package to continue important quality improvement work across Cheshire and Merseyside. The steering group is working in close collaboration with the C&M Digital First in Primary Care (DFPC) programme and supporting Hypertension Accelerator sites in Cheshire, Liverpool and Wirral CCGs). Funding has been secured through the DFPC programme for approximately 5,000 additional BP monitors and 5,000 extra-large cuffs to scale up BP@home across digital Accelerator sites and all Cheshire and Merseyside CCGs, to support implementation of digital enablers and help to address health inequalities.
Cheshire and Merseyside Integrated Care System funds are enabling an academic evaluation that will shine a light on the impact of the pandemic on BP control and inequalities across Cheshire and Merseyside and evaluate the impact on outcomes and inequalities of BP@home, quality improvement and Digital First initiatives across Cheshire and Merseyside.
NHS Health Checks
NHS Health Checks are an important systematic opportunity for early preventative interventions and the restart programme is supported locally by the North West Steering Group led by Caroline Holtom, Public Health England (PHE) North West. NHS Health Checks leadership will transition from PHE to the new Office for Health Promotion in due course.
C&MHCP has been successful in an NHS Prevention award of £200k to improve uptake of NHS Health Checks in target populations (further details to follow), and good luck to teams awaiting news on the PHE NHS Health Check digital pilots.
Wellpoint blood pressure kiosks
Public health teams in Cheshire West and Chester, Cheshire East and Knowsley will host WellPoint (BP) kiosks this autumn, as will community pharmacies in priority areas right across Cheshire and Merseyside. A great opportunity to boost opportunistic BP detection and diagnosis, and to reach communities who may not access BP testing in traditional healthcare settings.
Find out more
For further information contact melanieroche@wirral.gov.uk. Dr Mel Roche is a Public Health Consultant and the BP Lead for Champs Public Health Collaborative and Cheshire and Merseyside Health and Care Partnership.