NHS could offer incentives to improve health

The NHS could use incentives to help people quit unhealthy habits if proposals from the National Institute for Health and Clinical Excellence (NICE) are adopted.

The measure has been suggested by NICE's citizens council and is now open to the public for comments before being considered for recommendation by the body's board.

Twenty of the council's 32 members (62.5%) voted in favour of incentive schemes, providing conditions were in place.

These include:
• incentives should never be exchangeable for tobacco or alcohol;
• they are only offered to people who are committed to changing their health behaviours;
• cash incentives should be only offered as a last resort;
• the progress of participants is monitored throughout;
• and the results of the schemes are analysed so that more can be learnt about their effectiveness.

Reasons for voting against the use of incentives include:
• uncertainty over their long term benefits due to a lack of evidence;
• their potential for abuse;
• cost;
• and the perceived unfairness towards people who are able to live healthy lives without them.

Incentives are becoming more common in the private health industry, particularly in corporate plans, where employers and providers and seeking to preserve or lower the cost of maintaining benefit packages and claims rates.

Sir Michael Rawlins, chairman of NICE, believes the citizens council provides an important snapshot of what the general public thinks about controversial health challenges.

"Their views do not constitute formal guidance, but they do advise us about the social values that should underpin our work," he says.

"For these reasons I am extremely grateful that the council has considered whether there is a place for incentive schemes to encourage people to change their bad habits and live healthier lives. We clearly face several public health challenges in today's society, some more obvious than others, and we must seek to improve these in ways that are likely to achieve the best health outcomes for those affected.

"The majority of the council has voted in favour of the use of incentives under certain circumstances, but this clearly remains a divisive issue," he adds.

The National Institute for Health and Clinical Excellence (NICE) advises clinical and public health professionals on promoting good health and preventing and treating ill health.

The report is available on the NICE website and comments must be received by 5.00pm on 26 November, before it and a summary of the comments are presented to NICE's Board in January 2011 for consideration.