NHS explores paying people to become healthier

By Nick Triggle
Health reporter, BBC News

Financial incentives could be used to encourage people to stop smoking

The NHS is exploring the possibility of using financial incentives to encourage healthier lifestyles.

Several areas have already started their own schemes - and the results have given some encouragement.

NICE, which advises the NHS in England and Wales, believes they may help tackle obesity, smoking and drinking.

It described rewarding lifestyle changes as an "idea whose time has come" but wants to gather more evidence before a formal recommendation.

It is not the first time the body - the National Institute for Health and Clinical Excellence - has considered incentives. It has already backed rewards to encourage people off drugs.

PAYING PEOPLE TO QUIT SMOKING Tayside, which covers part of the east coast of Scotland, runs perhaps the most advanced lifestyle rewards scheme in the UK. The local NHS board started offering weekly grocery vouchers for pregnant women in exchange for stopping smoking in 2007. The £12.50 credits cannot be exchanged for alcohol or cigarettes and are offered throughout pregnancy and up to three months after birth. So far 450 women have taken part with a fifth still not smoking at the end - twice the success rate of standard stop smoking services. Indeed, those behind the scheme have been so impressed they have recently expanded it to include all smokers in one part of the region.

To gauge public reaction to rewards for healthy behaviour, NICE is putting the concept before its citizen's council on Thursday and Friday.

In an interview with the BBC ahead of that event, Professor Mike Kelly, NICE's head of public health, said: "We will want to see evidence that it provides value for money, there is a question over whether behaviour is sustained when incentives end.

"But the benefit of getting a child to become more active or a person to give up smoking at 25 is clear for the individual and for society.

"We are storing up so many future problems and this is something within our grasp. There are no mysterious causes, it is about behaviour.

"Humans respond to incentives, we know that. What we now need to see is whether the economic behaviour can be repeated in terms of health behaviour. It is an idea whose time has come."

However, Professor Kelly accepted there were concerns that would need to be overcome first.

"There are moral questions. Is becoming healthy something people should already be doing anyway? Should public money be used for it? Is there a sense that it is a bribe?"

If NICE did end up backing incentive schemes of some kind, recommendations covering England and Wales would still be a year away at least.

In the meantime, the body is working closely with a team of London-based experts from King's College, Queen Mary University and the London School of Economics, who are carrying out research into the issue.

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They are reviewing international evidence on rewards and are planning to carry out trials.

Professor Theresa Marteau, who is heading up the study, said: "Incentives seem to work in some cases, not all. We want to find out exactly what works best."

Concern

Nonetheless, some parts of the NHS in the UK have already started pushing ahead with their own schemes.

In Tayside smokers have been offered vouchers for groceries in return for quitting. The scheme has proved twice as effective as standard support.

And in Kent cash payments have been given to people who lose weight.

Incentives have also been used elsewhere in the world. For example, in Germany social insurance contributions are reduced if people attend services such as smoking cessation and screening.

But Roger Goss, of Patient Concern, questioned the merits of the NHS adopting such an approach.

"My instinct is that this should not be a priority. I can't see how it can be enforced.

"There is also the question about rewarding people for behaviour some people do voluntarily."