Reward people making healthy choices – Going with the Flow: Guardian coverage

Reward healthy people with tax rebates to save the NHS, urges thinktank

‘Payment by results’ incentives to quit smoking or manage blood sugar could help reduce burden on services, says 20/20 Health
Woman takes a break from jogging

People with healthy lifestyles should be rewarded for the money they save the NHS, according to a thinktank Photograph: Alamy


Britons should be rewarded with tax rebates for giving up smoking, staying slim or drinking less as a way of relieving the “mind-boggling” increase in demand for NHS care, a thinktank urged on Thursday.

20/20 Health says incentive schemes that reward healthy lifestyles would encourage people to be more responsible about looking after themselves and avoiding damaging habits. They should be available for those who do not become ill or prove good at managing conditions such as diabetes, it suggests.

“We propose ‘payment by results’, a financial reward for people who become active partners in their health, whereby if you, for example, keep your blood sugar levels down, quit smoking, keep weight off, [or] take on more self-care there will be a tax rebate or an end of year bonus,” it says in a report on the NHS’s future.

GPs could monitor patients’ habits, while the payments family doctors receive for performing certain checks on or interventions with patients and patients’ electronic medical records would also underpin such a system.

The thinktank cites the example of Tayside in eastern Scotland where the local NHS has since 2007 been offering mothers-to-be weekly grocery vouchers in return for stopping smoking. Women are offered the £12.50-a-week credits, which cannot be used to buy alcohol or tobacco, throughout pregnancy and up to three months after the baby’s birth.

It is believed that of the 450 women who have taken part in the “give it up for baby” and “quit4u” schemes so far, about 20% are still not smoking – double the success rate achieved by more conventional NHS stop smoking services.

“More money spent on making healthy choices rather than pursuing unachievable choices would be the best stewardship of NHS funds and taps into our human desire to save money,” say co-authors Julia Manning and Gail Beer.

Manning said that as GPs already receive financial incentives for hitting certain targets, patients with healthy lifestyles should be similarly rewarded.

The Department of Health said England’s 211 GP-led clinical commissioning groups, which control local NHS budgets, were free to offer rewards if they wanted. “The use of incentives is a decision for local public health services. We believe that making sure people have the right information to make choices about their lifestyle is key,” said a spokeswoman.

NHS England has warned that the service is facing a £30bn gap by 2021 between the money it has available and the demand for care that ageing and the rise of conditions such as diabetes will produce.

The thinktank also proposes ending the existing “postcode lottery” in what services and treatments patients receive by drawing up a list specifying what every patient in England should get irrespective of where they live, although such a move would inevitably involve rationing of certain treatments as too expensive.

The NHS is about to run out of money and needs billions of pounds a year in extra fund to keep afloat, a new report from the King’s Fund thinktank warns.

Without extra funding it will slip into a financial crisis which will damage patient care, according to its analysis of the NHS’s future sustainability.

More money is needed to bail out the growing number of hospital trusts which are ending up in deficit, and also to keep existing hospital-based services going while new services are set up elsewhere – what health experts call “double running” – which will form the basis of a more patient-centred future NHS, it says.

Professor John Appleby, the King’s Fund’s chief economist, said that while the NHS could improve its efficiency, “it is now a question of when, not if, the NHS runs out of money. Without significant additional funding, this will lead to rising waiting times, cuts in staff and deteriorating quality of care.”

Politicians from all parties needed to be honest with the public about the scale of the task facing the NHS, Appleby said.

Meanwhile, Heatherwood and Wexham Park Hospitals NHS Foundation Trust has become the latest hospital trust to be put into special measures because it was found to be providing poor care and being badly led.

Monitor, an NHS regulator, has told it to produce an action plan to drive through improvements and has arranged for Frimley Park NHS Foundation Trust to “partner” with it to help it improve.


About Julia Manning

Julia Manning is a social pioneer, writer, campaigner and commentator. Formerly a clinical optometrist specialising in diabetes and visual impairment, she is the founder and Director of 2020health, an independent, social enterprise Think Tank whose aim is to Make Health Personal and Social. 2020health has through research, events and campaigning influenced opinion and action in fields as diverse as bioethics, alcohol, emerging technologies, fraud, education, consumer technology and vaccination. In 2014, 2020health were founding partners of the Health Tech and You Awards with Axa PPP and the Design Museum. Since 2016, 2020health has increasingly focused on digital health and public health in the community. Julia is a Fellow of the RSA and now also a part-time PhD student at the UCL Interaction Centre, studying the use of digital technology for stress management in the workplace. Julia has shared 2020health's research widely in the media (BBC News, ITV, Channel 5 News, BBC 1′s The Big Questions & Victoria Derbyshire, BBC Radio 4 Today, PM and Woman's Hour, LBC) and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week.
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