The NHS’s tool to prevent heart disease “is not working effectively”, the National Audit Office (NAO) has said after figures revealed that fewer than half of eligible adults take part.

The NAO has called for a review of how NHS Health Checks are provided in England.

Introduced in 2009, the checks – also known as a midlife MOT – are designed to help spot people at higher risk of getting certain health problems and offer practical tips on how to prevent them.

The programme has the potential to “save lives and money”, experts said, but it is not being used to its full potential.

Health Checks have the potential to save lives and public money – it is a missed opportunity that less than half of those eligible are attending these checks

Just 44% of eligible adults attended one over the last five years, according to the National Audit Office (NAO).

Each year, around 20% of people eligible for one of these checks are invited to come forward – with a view to reach the entire eligible population in a five-year cycle.

Everyone aged 40 to 74 who does not have a pre-existing health condition should be invited for an NHS Health Check by their GP or local council every five years.

But in 2023/24, just five local authorities delivered health checks to all of those who could take part in the scheme.

The lowest level of uptake in a local authority was 0.1%, according to the NAO report.

The report highlights problems with the legislation which transferred the responsibility for Health Checks to local authorities.

And local government experts have said that cuts to public health funding have led to a “shift towards reactive care” instead of preventing ill health before it occurs.

The NAO has called for the Government to assess whether local authorities are best placed to deliver Health Checks.

It said that central Government should also set clear targets for the numbers or percentages of the eligible population who should attend Health Checks, so they are attended and not just offered.

It should also incentivise the delivery of these checks to people at highest risk of cardiovascular disease, the NAO added.

Since 2015, the Public Health Grant has been reduced by £858 million, limiting councils' ability to fund these crucial services. This has led to a shift towards reactive care, despite evidence of the benefits of early intervention

“Each year thousands of lives are lost to cardiovascular disease, with billions of pounds spent tackling it,” said Gareth Davies, head of the NAO.

“Health Checks can play a crucial role in bringing these numbers down, but the system isn’t working effectively, resulting in not enough people having checks. This is an unsatisfactory basis for delivering an important public health intervention.

“The Department of Health and Social Care needs to address the weaknesses in the current system for targeting and delivering Health Checks if it is to achieve the preventative effect it wants.”

Chairman of the Public Accounts Committee Geoffrey Clifton-Brown said: “Health Checks have the potential to save lives and public money – it is a missed opportunity that less than half of those eligible are attending these checks.

“The Department of Health and Social Care needs to take action to systematically boost uptake, target checks at those most in need, and drastically improve its data if the programme is to deliver the financial and health benefits intended.”

David Fothergill, from the Local Government Association, said: “For many councils, NHS Health Checks are a key part of their health improvement programmes, engaging people in early conversations about health risks and lifestyle changes.

“However since 2015, the Public Health Grant has been reduced by £858 million, limiting councils’ ability to fund these crucial services.

“This has led to a shift towards reactive care, despite evidence of the benefits of early intervention.”

A Department of Health and Social Care Spokesman said: “Lord Darzi’s report laid bare the extent of the issues facing the nation’s health service, and we recognise that there is more to do to improve this programme. We will carefully consider the findings of this report.

“This Government is committed to taking action on preventable, deadly diseases like cardiovascular disease.

“Since this research was conducted, we have begun to pilot comprehensive heart health checks in workplaces , and we are developing a digital version of the check to provide an even more accessible and convenient service for people. Our reforms will help us prevent and catch disease earlier, so it can be treated faster.”

It comes as a new study revealed that patients with a specific combination of conditions – including cardiovascular diseases – put significant pressure on the NHS during the busy winter months.

Researchers, who cross-referenced NHS data in England during winter 2021/22, said that specific combinations of long term conditions play a major role in the additional pressures the NHS faces every winter because they are associated with significantly higher risks of hospital admissions and death

For instance, people with a combination of cancer, chronic kidney disease, heart disease, and type 2 diabetes had an 11-fold increased risk of being admitted to hospital compared to those with no long term conditions.

And there was a 24-fold increased risk of death for those with a combination of chronic kidney disease, cardiovascular disease, dementia and osteoarthritis, according to the study, which has been published in the journal BMJ Medicine.

Heart disease and dementia appeared in all of the five combinations of multiple long-term conditions which had the highest increased risk of death.