Less than half of people over the age of 40 in England are getting the heart health checks they are entitled to, according to the government’s spending watchdog.

The National Audit Office called for a review of how NHS health checks are provided in England, after it found that only 44% of eligible adults attended one in the past five years.

The checks, known as a midlife MOT, were introduced in 2009, to help identify those at higher risk of developing heart disease, stroke, kidney disease and diabetes and offer tailored advice and treatment to help them manage their risk more effectively.

Heart disease is estimated to affect 6.4 million people in England, costing the healthcare system £7.4bn a year and the wider economy an estimated £15.8bn a year. It contributed to a quarter of all deaths in England in 2022. In 2019, NHS England’s long-term plan set a target to prevent 150,000 heart attacks, strokes and dementia cases by 2028-29.

People aged 40 to 74 without pre-existing cardiovascular disease or certain other health conditions are eligible for a health check every five years.

Around 20% are invited for a check each year, so that the entire eligible population is reached over a five-year cycle. But only 8.8% attended in 2023/4 – equating to 44% coverage over five years, according to the NAO.

Local authorities have had responsibility for commissioning health checks since 2013, when elements of public health were transferred to councils. But the NAO found that in 2023/24, just five local authorities delivered health checks to everyone entitled to one.

The report, “progess in preventing cardiovascular disease”, calls on the government to assess whether local authorities are best placed to deliver health checks.

The Department of Health and Social Care 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”, the NAO said. And there should be incentives to ensure those at highest risk of cardiovascular disease, receive their checks.

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

“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 preventive effect it wants.”

Responding to the findings, David Fothergill, chair of the Local Government Association’s community wellbeing board, said a £858m cut to the public health grant since 2015 had inevitably limited local authorities’ ability to fund these services. “This has led to a shift towards reactive care, despite evidence of the benefits of early intervention,” he added.

Prof Sir Stephen Powis, the national medical director of NHS England, urged people aged between 40 and 74 to get the NHS health check, saying: “These free mid-life MOTs are a vital way of spotting the early warning signs of potentially life-threatening conditions such as high blood pressure, heart disease or type 2 diabetes.”

John Maingay, director of policy and influencing at the British Heart Foundation, said: “So many cases of cardiovascular disease are preventable, yet alarmingly, premature death rates have risen since 2019 in England.

“The government has an opportunity to think more radically about how we can better detect and prevent cardiovascular disease as it develops a 10-year health plan and drives forward its health mission.”

William Roberts, chief executive, Royal Society for Public Health, said policymakers should consider offering health checks in the workplaces, alongside pharmacies and a dentists. “The most effective public health interventions meet people where they are,” he added.

A Department of Health and Social Care Spokesperson said: “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.”