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Should the NHS reward lifestyle changes?

09:29 UK time, Thursday, 20 May 2010

The NHS is exploring the possibility of using financial incentives to encourage healthier lifestyles. Is this a good idea?

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

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

However, Roger Goss, of Patient Concern, questioned the merits of the approach and said "My instinct is that this should not be a priority. I can't see how it can be enforced." He went on to say "There is also the question about rewarding people for behaviour some people do voluntarily."

Should public money be used to reward healthier lifestyles? Is becoming healthy something people should already be doing anyway? What's the best way to promote healthy living?

This debate has now been closed. Thank you for your comments.

Comments

Page 1 of 2

  • Comment number 1.

    I think it's a stupid idea.

    The NHS is there to fix problems, not prevent them. If people want to get fat or smoke let them, they should not be paid for doing something which will be of benefit to themselves only.

    This country needs to stop trying to force people to live in a particular way and reduce the state intervention in people's lives.

    If something does need to be done, why not subsidise healthy food, rather than taxing the unhealthy?

    Also, we are heading to a pensions crisis, where we are going to have more people on pensions that in work. I think this should be solved before we start getting people to live to age 150.

    Oh and I'm betting along will come the comment sooner or later about smokers, that says 'Yeah but they cost the NHS lots of money when they get ill'. Yeah and smokers pay £4.50 per pack of 20 in tax. That's more than enough over a lifetime to pay for any illness caused by smoking.

  • Comment number 2.


    Rewards are a waste of money.

    Put the money into deterant advertising and warn people we will start reducing the healthcare available for self induced problems, eg: exessive drinking.

  • Comment number 3.


    On second thoughts, I've lived a healthy life to date, I'm very fit 50+ how much do I get?

  • Comment number 4.

    Bribery and health? Isn't that what just about any private corporation wishing to make money does? Suck it and see and to hell with the consequences....

  • Comment number 5.

    Oh no ! Here we go again, more new ways to waste tax payers money. The NHS was created for everyone in a non judgemental way. I was hoping this new government would scrap all these silly ideas, it seems they are just thinking of new ways. Stop health tourism and Immigrants using the NHS and Im sure there will be enough money in the pot for the people that have paid in for it.

  • Comment number 6.

    Should the NHS reward lifestyle changes?

    Look, its not a bad idea and I'm sure it will save lives.

    But Im was rather hoping that as a society we could now begin to get away from the government choosing what's best for us and then pressuring us to make that choice.

    I just think we should also have the right to choose an unhealthy lifestyle if we so wish without being guilt tripped by the authorities.

    Not all of us want to live forever.

  • Comment number 7.

    Paying someone to stop stuffing their face with cheesecake and chocolate éclairs?

    That definitely sounds like a socialist Labour scheme.

    Let's hope the Conservatives step in and remind the NHS who's in charge now. Fat people, smokers & drinkers are given adequate warning through government adverts which the tax payer spends millions on. Now we have to pay a fatty not to eat?.

    What a catastrophe Labour have been. Social engineering at its most heinous.

  • Comment number 8.

    I gave up smoking three years ago. If the NHS is now going to start paying people to quit, maybe I should start again so I don't miss out. In fact if I take Mark Twain's approach and stop smoking hundreds of times it could be a nice little earner. A pity really, I was enjoying the health benefits of being rid of the habit.

  • Comment number 9.

    The biggest health problem the population of this country face is caused by stress.

    The largest influence on peoples stress levels come from unemployment, low wages, high mortgage payments and general insecurity.

    These are the problems that need to be addressed, once everyone can afford the basic needs of life, food, clothing and a roof over their heads, a healthier lifestyle will result

    Sinking more money into the NHS is not the answer; treat the cause not the consequences


  • Comment number 10.

    Hmm. Really depends to the extent and tone (i.e. non patronising and non forceful, helping those who actively want to help themselves) in which they roll this out.

    If done sensibly and is cost effective, in that the money spent by the drive is offset by the savings of people who would otherwise be a drain on the NHS resources, then why not?

  • Comment number 11.

    I really do not agree wit this, you can not bribe people into living more healthily, it will be almost impossible to enforce and if you are giving rewards to people to stop smoking, what about all the people who don't smoke in the first place. That's like rewarding the naughtly kid who once manages to stay quiet through a class while ignoring those that always do.

    I think there are much better ways the NHS could spend the money

  • Comment number 12.

    All this user's posts have been removed.Why?

  • Comment number 13.

    It would be less controversial to penalise those who adopt a lifestyle which will cause ill health. Much higher taxes on tobacco, alcohol and unsuitable food for example.

    Also restrictions on the activities of those who peddle these things, like restrictions on advertising and linking their products with other activities such as entertainment, sport and leisure, parking vans selling these things outside schools, etc.

  • Comment number 14.

    Commercial pressure is exerted daily upon the populace, advertising, two for ones, colour, packaging even the promise of lifestyle augmentation. We are all influenced to a greater of lesser extent and it takes a lot to reject the facile nature of their messages and walk a different road if we so choose. Populations dislike groups and individuals who act against the the common perception of normality and are unsettled by the possibility of an alternative viewpoint regarding lifestyle and health if it opposes their own. Perhaps financial inducements will sway some who are so far down the road of market indoctrination and influence their attitude and behavior, after all that is precisely what free market forces exist to do and very successful they are at to. What is good for the goose may also be good for the gander as far as better health is concerned.

  • Comment number 15.

    Stupid idea. Let people choose. Besides with the tories in government they will probably be charging us for using the NHS soon anyway.

  • Comment number 16.

    No absolutely not, the reward is a longer and healthier life!

    Besides we need those that do not change to die off so that they are not a drain on the NHS & pension resources

  • Comment number 17.

    What a load of rubbish, I guess (hope) this idea was one of labours before they got their backsides kicked out of office.
    Stop foreigners and illegals from bleeding the NHS dry and use it for the benefit of the people who have worked to pay for it.
    I have a severe back pain problem and have been waiting four months to see a physio and it looks like I will have to wait a lot longer.
    Now is this due to a lack of therapists or a lack of funding, I dont know but it is a scandalous situation. Meanwhile I,m swallowing pain killers like a man possesed.
    So to waste our money on a fruitless exercise such as this where the great unwashed and unemployable get paid to loose weight or stop smoking/drinking is disgracefull.
    Get a grip NHS!!!!

  • Comment number 18.

    Red Herring and a big one, what has happened to our health service, chief execs spending £80,000 on doing out their office, managers everywhere, meetings about nothing. What needs doing? Medical staff need to run the place and tell managers what they need to do the job, NOT the other way round, if you are ill you get treated, fair deal, turn up drunk, out you go, save much money and stress particularly at week end.
    A good revenue earner would be to sell heroine and cocaine through the NHS, supervised @ £1.00 a shot. make a fortune and get rid of the drug gangs overnight. Then you have the money for daft schemes like paying people to change their habits. NUTS

  • Comment number 19.

    1. At 10:08am on 20 May 2010, jono-been wrote:
    I think it's a stupid idea.

    The NHS is there to fix problems, not prevent them. If people want to get fat or smoke let them, they should not be paid for doing something which will be of benefit to themselves only.
    _________________________________

    What an idiot you are. People need to realise that PREVENTION is the only way to solve the national epidemics of obesity, diabetes and heart disease.

    However, bribing people to be healthy is not the answer. It is social engineering and immoral on every level. Maybe if processed food wasn't so comparatively cheap and easy to access, if fresh fruit and vegetables didn't cost the earth, and if cigarettes and alcohol weren't so accessible then we would not be in the mess that we are.

    Everybody has a responsibility to be healthy, otherwise the NHS is a laughing stock.

  • Comment number 20.

    "Why should the N.H.S. spend our money on people whose live style choice i.e. heavy drinking and chain smoking and very bad diet wont keep them heatlh for long ? its a waste of they skill and time it cost a small fortune, to keep them going for a while longer, Because other people need urgent treatment who will look after they heatlh that should be the reward {Treatment} but the heavy drinker and smokers pay the extra tax every day?

  • Comment number 21.

    1. At 10:08am on 20 May 2010, jono-been wrote:

    The NHS is there to fix problems, not prevent them.


    Nonsense! You obviously have never worked in the NHS! The NHS does all kinds of health promotion to help prevent future problems - IN ORDER TO SAVE MONEY!

    It is far, far, far cheaper, for example, to employ a smoking cessation nurse to give nicotine replacement therapy and counselling to people and pay for it through future savings in not having to treat as many people for the myriad of conditions that smoking increases the risk of.

    However, back to the point:

    No, I don't think the NHS should offer financial incentives. What they should do is refuse to treat people who won't stop engaging in high-risk behaviours.

  • Comment number 22.

    No - certainly not when ill people are refused drugs or other treatment solely on cost grounds.

    I've never smoked. So should I get a payment for life-long 'virtue' or is such only reserved for those who choose to smoke and then decide to quit?

  • Comment number 23.

    Dont they already for a lot of managers, how have made the life style change of getting a job in the nhs?

  • Comment number 24.

    I do not think cash hand outs are a good idea for the NHS. It is not always over eating causes weight gain, but can be caused by ill health itself like gland problems and also drugs prescribed can cause weight to go up.
    Patients who ate destroying their health through bad health style like smoking, alcohol and drugs should be given stern warnings that if they continue to ruin their health after being offered treatment to cure their addictions that no further help would be given.
    Unfortunatley Doctors should be leading an example to patients, which they are not all doing, but would this also mean that a Doctor would also receive cash payments to change their lifestyle.
    The NHS should be for the use of the genunine sick who care about their health

  • Comment number 25.

    Is this just the start of privatisation?

    Why not tax the sellers/suppliers/manufactuers of these unhealthy items so that they are not available to us stupid non thinking humans!

    I think Bevan just may turn slightly in his grave.

  • Comment number 26.

    The idea is to offer incentives for people to slim down, reduce acohol consumption or stop smoking.

    I have to say that the mere act of doing these things creates its own incentive. If you slim down a bit you have more energy, allowing you to continue the trend. If you reduce your alcohol intake you think more clearly and save money, creating the incentive to stop completely. Likewise with smoking, the money saved creates the incentive, along with increased lung capacity to help your other problems.

    Having smoked when I was younger, drank to excess on occasions and been well overweight I can testify to the rewards that a healthier lifestyle brings. I understand why NHS want to offer incentives, but the wish to change needs to come from inside in the first place, and that is down to education. Perhaps NHS needs to get more involved within schools, in the same way that community police now do.

  • Comment number 27.

    Why not penalise people with unhealthy lifestyles instead? That way the NHS could make some money to help their budgets. What a daft idea!

  • Comment number 28.

    All this user's posts have been removed.Why?

  • Comment number 29.

    If it can be proven that providing incentives actually saves money, what's the problem?

  • Comment number 30.

    All this user's posts have been removed.Why?

  • Comment number 31.

    This appears to be an abuse of public money; but if you think about it, there's something to be said for it.
    Substance-addicted people do pay a lot more tax into the system in the first place - let's not forget that. And if they avoid serious long-term illness, they will deduct less through better health and pay more normal taxes through a longer, more productive working life.
    If you look at this like a balance sheet, instead of human health, I can see why this has at least been piloted.
    On the other hand, the illnesses are preventable for free by the individual, and there are people dying for lack of medicines the NHS is unwilling to pay for as "uneconomic".
    If you were to ask me who was to get a particular sum of cash - a single dying breast cancer patient whose life could be extended by 6 more months, or 1,000 people who would be given a token sum of cash to quit, I'd have to plump for the cancer patient. I can see how the advocates of this would argue that 1,000 quitters means maybe 20 less breast cancer patients in the future; but I couldn't live with the choice of being the person who has to tell the current cancer patient that the statisticians and bean counters don't think her 6 months of life isn't worth 20 potential saved cancers.

  • Comment number 32.

    the next thing they will ban driving as so many car injuries cost the NHS to much and it will reduce imports of fuel and it waon`t need to build or repair roads ,

  • Comment number 33.

    This is a bit silly, if people want to smoke or drink themselves to death then so be it.

  • Comment number 34.

    Imagine receiving these subsidies - you'd have to be thinking to yourself - "this could have bought pain relief to an MS-sufferer, or a decent meal for a getriatric patient, a toy for a kid on the leukemia ward...."
    I think people need to find some self-respect - that's a better long-term solution than a short-term life-style subsidy.
    Self-respect can be a hard commodity to find when so many people tell you how worthless you are for not being able to control your appetites. Maybe a good place to start would be for us to stop ostracising, ridiculing and bullying the substance-addicted?

  • Comment number 35.

    There they go again-tell me where it was written or talked about anywhere by politicians in the election?The NHS is there to make you better when ill.We dont need any of the thousands of backroom boys thinking up ideas of how to keep their rubbish jobs which is costing us a fortune. Toss this idea into the briefcases of the billy no mates managers as they collect their P45's.

  • Comment number 36.

    No! No! A thousand times No! The NHS is there to provide health care for those who need its services at a time when such services are required. It is not there to interfere with the (often gross, I admit) lifestyles of those who are incapable of controlling their personal urges.
    And as for penalising those who develop life-threatening diseases from their non-PC habits, just remember how strapped the NHS would be for cash without the punitive taxes and duties applied to tobacco and alcohol products. These sort of addicts are not saints or saviours but thank God they stop my own taxes soaring to replace their contributions.
    The day that just one medic takes the moral high ground and refuses treatment to a needy patient is the day that their licence to practice in the UK should be cancelled.

  • Comment number 37.

    The government should enforce a comprehensive and understandable nutritional labelling system for all foodstuffs commercially produced. The NHS should run a permanent campaign on a healthy lifestyle, secondary schools should re-introduce home economics classes for all.
    People should then be left to use that information as they see fit.
    If people want to life a junk food lifestyle they can but they will know the consequences.
    Its a dilemma, it is not for government to tell people what to eat or how to live, yet diet and lifestyle choices cost the NHS(which we as tax payer fund) billions.Food manufacturers(a telling description) are driven by profit, the nutritional quality of their products is not a paramount concern.
    Successive governments have followed a cheap food policy(it keeps wages down), too many people view food as merely fuel, Interest in food quality is seen as a middle class interest, certainly it is expensive to eat well, Someone on JSA is going to find it hard to enjoy a healthy diet unless they have an allotment, 10 burgers for a £1 ,just what do you think is in those burgers?

  • Comment number 38.

    How much do these people get paid to dream up ideas like this ???

    On the one hand we see people being refused help on cost grounds, and yet if this were to come true people being paid to give up smoking ??? or eating chocolate ???

    Someone wants to get real here,its the biggest encouragement to start smoking i have seen in a long while.

  • Comment number 39.

    Not keen on the idea. How many other lifestyle choices would be considered fair game for a small possible reduction in NHS costs? Pay people to stop doing extreme sports due to the risks of injury? Maybe even pay people to give up cycling to avoid damaged knees (forgetting the health benefits of cycling)?

  • Comment number 40.

    Why the hell should people be paid to get themselves healthy? If they want to kill themselves eating hamburgers and smoking, let them do it. Why should tax payers money be paid to fat people and smokers? Its ridiculous.

  • Comment number 41.

    I don't drink alcohol. I've never smoked. I go for long walks every weekend. Show me the money!

  • Comment number 42.

    Isn't being health, feeling better, living longer, incentive enough?

    But it has long been argued the NHS is an illness service when we need a 'well-ness' service. If this marks a step in that direction I welcome it.

  • Comment number 43.

    I'm not in favour of this proposal but I do not like the abuse of the addicted present in this stream, either. I've met many people who starve/binge on food, abuse alcohol or drugs - and they all have a story to tell. It might be beatings from a drunken parent, parental-abandonment into social care at a young age, sexual experiences that the person just couldn't cope with, bereavement, divorce, redundancy, retirement and on and on.
    Very few people get to go through life without encountering some kind of trauma - if you've been through all of these and come out without leaning on some kind of substance, then you can point the finger. But if you don't know what it's like to be homeless, bereft or comfortless, then keep your condemnation to yourself.

  • Comment number 44.

    Using taxpayers money to bribe those who cannot control their urges to eat, smoke or drink excessively is WRONG, WRONG, WRONG. It is also an insult to the majority of the people who can control themselves, who work hard and pay taxes in order to give us all a national health service.

    I cannot understand how, at a time when government has grossly overspent, society can think it morally justified to throw taxpayers' money away in this fashion. Having watched my elderly mother recently die from dementia-related illness, I would much prefer taxpayers' hard-earned taxes going toward better supporting the increasing number of dementia sufferers, rather than being given as cash prizes to those who will not take responsibility for their actions.

  • Comment number 45.

    Absolutely not. When people seek help for problems like obesity and drug addiction or alcoholism, they should be treated only if they sign a legally binding contract that states that if they do not fully cooperate with the regimen agreed upon by their doctors and meet several key conditions, such as passing monthly drug tests, losing a certain amount of weight or stopping drinking after a transplant, they will be refused all further medical treatment on the NHS for that condition, unless further developments occur that are not their fault. Then it’s a case of ‘well, if you won’t help yourself, we won’t help you. Why should the taxpayer foot the bill for supporting people who cannot be bothered to change? Why use the carrot when the stick is cheaper?

  • Comment number 46.

    Yes and no. I can see the logic of it as if people were encouraged to change their lifestyles because of the incentives, the NHS could actually save money. However why should people who are not prepared to move to a healthy lifestyle voluntarily be offered a reward for doing so, when the majority of people who are sensible receive absolutely nothing.
    At the end of the day I don't think you should offer incentives, we should continually try and educate people to encourage them to be have a more healthy lifestyle and leave it to the individual then to make their own minds up. I am sure my lifestyle could be better, I could eat more fruit and vegetables, exercise more, and drink less, and it might increase my lifespan, but do i really want to? I might get run over tomorrow, and if I lived another 5 years it would be a further drain on the country as I would be paid a pension for longer.

  • Comment number 47.

    Have they gone stark raving mad, haven't they got the message yet. WE ARE BROKE!

    Considering Post #2 Withdraw treatment for self induced problems: that would apply to sporting injuries as well or just the ones you don't like?

  • Comment number 48.

    I have never smoked, do not drink, eat decent food and exercise regularly. Where's my parade?

  • Comment number 49.

    Is NICE a quango by any chance? If so, perhaps it whuld join the list of those being scrapped.

  • Comment number 50.

    "The local NHS board started offering weekly grocery vouchers for pregnant women in exchange for stopping smoking in 2007."

    So people aren't willing to stop smoking for the benefit of THEIR OWN CHILDREN, but they'll do it for £12.50 a week? That is disgusting.

    Still, I could use some extra money. I'm off to get fat and start smoking.

  • Comment number 51.

    How about you be warned of the consequences of your actions. Smoke, drink to excess and stay unfit if you want. It's YOUR decision. YOUR fault if you suffer ill health because of it. Get over it.

  • Comment number 52.

    Hopefully, our new government will privatise the NHS so we can all eat, drink, and smoke as much as we like as we will all be responsible for paying for the care we use.

  • Comment number 53.

    How about making sure that all NHS employees are fit and healthy first.

    Lead by example.

    If they don't get fit and stay healthy they get a pay cut or lose their job.

    Show us how low their employee sickness rate is, compared to commercial industry.

    Watch how quickly this idea for patients gets dropped....

  • Comment number 54.

    No! Not at all. No way should people be paid to do something that is better for themselves. If someone is obese and wants to lose weight, give them support, yes, but cash? Surely it's this type of decision which has put this country in the financial state we are in! The NHS could do with using that cash elsewhere. I think it's a terrible idea.

  • Comment number 55.

    Its not my fault that someone chooses to smoke or gorge themselves in tons of chocolate and burgers, so why should my taxes be used to bribe these people to stop? Why should they be bribed at all? Its their choice to live like pigs so let them suffer the consequences. Do we bribe people to stop snowboarding, paragliding, skiing etc in case they get hurt? No and likewise neither should these people.

  • Comment number 56.

    I have an incentive, if they are told they are too fat or they are smokin g too much, get them on a fat camp or smoking camp where they will go through a tough regime to get them to stop their ways. That will solve the problem and give us value for money. Giving them money to stop smoking or gorging themselves is not value for money as they will stop and when they get the money, they will just spend it on fags, booze, burgers etc.

  • Comment number 57.

    Why is the NHS looking to do this whilst thousands of school kids are being served a hot dog and chips in the school canteen every day and school sports days are being cancelled because of 'health and safety'? We should tackle the cause of the problems and some joined up thinking will work far better.

    Invest the money into the youth of the country and into schools. Try and teach more children that taking up smoking and living off takeaway isn't the best path to take in life. Promote sports and activities in schools, healthy eating and a good nights sleep before the kids have developed all these bad habits. The state shouldn't have to do this but we need to break the cycle.

    When they grow up and have kids of their own, they will pass on the lessons. Hopefully then we can start to break the cycle of physical wrecks breeding more physical wrecks which will massively reduce the strain on the NHS.

  • Comment number 58.

    Clearly none of the above people have actually read the article (surprise surprise).

    What they are suggesting is offering grocery vouchers to pregnant mothers who insist on smoking.

    The success rate of getting mothers to quit is twice that of any other method.

    Sad state of affairs though this is it demonstrably works, protects an innocent party (the unborn child), and saves the NHS money in the long term.

    Good work from NICE, who once again have to make difficult decisions in the teeth of the Tabloid press. Good on them.

  • Comment number 59.

    9. At 10:19am on 20 May 2010, sssmith wrote:
    The biggest health problem the population of this country face is caused by stress.

    I really agree with this post, my job worries are making me so stressed and miserable, I feel that I am letting myself go, putting on weight and not eating like I should because mentally I am completely focussing on trying to cope at work and looking for other employment so other areas of my life are suffering.

    Having said that, its my responsibility alone to address this issue and will do so when I am in a better mindset, financial bribes are not the answer.

  • Comment number 60.

    We could fund it by a tax on unhealthy foods!

  • Comment number 61.

    I dont neccesarily want what is considered a Healthy Lifestyle. That is my choice; I eat junk food, I drink occassionally, I smoke very occasionally. I just live my life making my choices. Of course if I get ill, then I expect the National Health Service to treat me regardless of the cause. That is why I pay taxes. Am I missing something? Of course if you want me to not pay taxes and pay privately for any Healthcare I may need as a result of my lifestyle choices then that could be arranged. I expect the NHS to treat injured Mountain Climbers and those who indulge in Extreme Sports, even though I would never climb or get extreme personally. I wouldnt expect a service that is funded indescriminately by everyone through taxation to treat just 'certain' conditions for 'certain' people.

    The NHS should NOT reward me to change, shouldnt lecture me, shouldnt judge me, just show me the medicine if I need it. I am the boss of me. I decide what lifestyle choices to make. I dont get it. Surely the NHS just provides treatment to anyone for anything, thats the point of it.

  • Comment number 62.

    Try the reverse of this;

    if it's self inflicted then charge them for NHS services. If those who smoke can afford the fags & the obese afford the quantities of food, they can afford to pay for treatment.
    Same for dangerous drivers who should be charged for medical treatment to themselves and anyone else they involve in their stupid acts.

  • Comment number 63.

    Personally I think it would just be nice if the NHS helped!!!! I have heard from quite a few people that when they asked their GP for help to lose weight or stop smoking they were given a leaflet to read with helplines and sent on their way. So what? This plan would give them a leaflet and send them on their way with some cash. Complete codswollop!

    As someone said - the NHS should devise a system where it isn't drained of their budget by people who don't contribute through taxes!

    Then use that budget wisely to actually HELP people who genuinely need it.

    It seems to me that they spend too long coming up with ways to avoid doing their job!

  • Comment number 64.

    It will be abused. Simple as. Go to your anti-smoking class and buy a pack on the way out after collecting your vouchers. How on earth, without having cameras in the home (!!!) can it possibly be monitored? And what happens once you've quit? Voucher's instantly cut - surely that's an incentive to stay addicted!! I hate to be cynical, and I'm sure some would use the scheme honestly, but many wouldn't.

    Why not reward those who DON'T smoke/drink/whatever with voucher's and not reward the addicted? I'm fed up with being penalised in every way for trying to live my life right.

  • Comment number 65.

    This idea has been bounced around for a number of years. I work as a clinician in frontline NHS and can safely say that trying to reward patients for a healthy lifestyle will only result in more NHS waste with no improvement in lifestyles.

    How about removing the duty of the NHS to treat people with unhealthy lifestyles?

    For example, overweight diabetics who smoke will cost vast sums of money to treat (heart disease, lung disease, leg ulcers and amputations, infections, blindness to name a few). If such a patient chooses to carry on eating junk and smoking, fine. Why should the rest of us pick up the bill? If they were told the NHS was no longer funding their healthcare, I bet they'd stop eating cakes, bin the cigarettes and do a bit of exercise.

    While some may feel this a little over the top, they probably don't see what NHS staff have to put up with every day. Large numbers of joe public seem to think it is healthcare professionals jobs to sort out every facet of their lives for them. Is it too much to ask that people take a little responsibilty for their own healthcare, especially considering it is free at the point of care? Perhaps people should have a look at how much their medications cost next time they want to moan about the GP running 30 minutes late.

  • Comment number 66.

    What a load of rubbish, who ever thought of that idea I'm sorry but it's just stupid, people shouldn't want to lose weight or stop smoking for money, they should want to do it for their own health, how about use the money wisely like put it towards dimensia research or cancer where the money would actually go to a good cause!!!

  • Comment number 67.

    This is a good idea. They should charge for treatment and then refund those charges if the person changes their life style.

  • Comment number 68.

    I'm not in favour of this proposal but I do not like the abuse of the addicted present in this stream, either. I've met many people who starve/binge on food, abuse alcohol or drugs - and they all have a story to tell. It might be beatings from a drunken parent, parental-abandonment into social care at a young age, sexual experiences that the person just couldn't cope with, bereavement, divorce, redundancy, retirement and on and on.
    Very few people get to go through life without encountering some kind of trauma - if you've been through all of these and come out without leaning on some kind of substance, then you can point the finger. But if you don't know what it's like to be homeless, bereft or comfortless, then keep your condemnation to yourself.

    12:03pm on 20 May 2010, John McCormick

    If this is the case, then their addiction is evidently a side affect of a much serious psychological issue (or trauma as you put it), and needs to be dealt with at the root, not covered over with a stcky plaster monetary reward.

  • Comment number 69.

    Absolute rubbish. If someone is only prepared to change their lifestyle if someone pays them to then I would question their commitment. Either you want to stop smoking, eat healthier etc or you don't. Give them all the information, facilities, helplines etc but please don't start paying them. Will we pay them for the rest of their lifes, or will it be limited? What if someone stops being paid and reverts to old habits - do we start paying them again? Too many serious decisions to be left in the hands of the civil service, sorry NHS. Sorry but as a taxpayer I would rather my hard-earned taxes were spent on people who actually needed help (cancer, A&E etc)

    Plus, won't this just lead to another class and/or generation of benefit scroungers ... start smoking, then demand the NHS pays you to stop!!


  • Comment number 70.

    21. At 11:06am on 20 May 2010, Custador wrote:

    No, I don't think the NHS should offer financial incentives. What they should do is refuse to treat people who won't stop engaging in high-risk behaviours.

    Like...skiing? Mountaineering? Rugby? Just about everything has an element of risk. Where do you draw the line?

    Any, obesity, alcoholism and smoking are all self-terminating habits. Eventually.

  • Comment number 71.

    Of course it is a stupid idea.

    Nor will it ever be allowed - I don't want my hard earned taxes being spent on lazy fat people who are unhealthy out of choice.

    Cash incentives = more burgers

  • Comment number 72.

    A nice idea in theory and prevention is most definitely better then cure and the NHS should be doing both (in answer to post 1).

    However I can't see this working very well in practice, what about those who already lead healthy lifestyles? Will they be rewarded?

    Also the human rights fanatics will scream unfair since they'll argue that it conflicts with people’s rights to lead whatever lifestyle they choose.

  • Comment number 73.

    44. At 12:04pm on 20 May 2010, geoff hughes wrote:
    Using taxpayers money to bribe those who cannot control their urges to eat, smoke or drink excessively is WRONG, WRONG, WRONG. It is also an insult to the majority of the people who can control themselves, who work hard and pay taxes in order to give us all a national health service.

    mmmm excuse me Geoff I smoke and I also work very hard and pay all my taxes and national insurance. I also pay approx 80% tax on my cigarettes. I am sick of people like you who think I should be penalised for this.

  • Comment number 74.

    Here we go middle England up in arms again, well if this idea was aimed at you it would be a stupid idea. Most likly it would be targeted at certain groups I.e the very poor. Also very likly some greedy individuals will try to abuse it, to those individuals middle England give them hell.

  • Comment number 75.

    How about free McDonald's for people who give up smoking and free Ciggies for people who slim below obese!
    ...groan...

  • Comment number 76.

    We all pay taxes - yes, even the smokers, drinkers and overeaters!The smokers and drinkers pay more tax than most in fact; however,everyone should be entitled to the same level and quality of care regardless.

    Financially'incentivising' people for giving up frowned-upon lifestyles is not an appropriate use of NHS funds.

  • Comment number 77.

    Rewards for being healthy ??? If you are lucky enough to inherit healthy genes you could make a mint but if like me your inherited bad lungs from your mother and bad stomach from your father and dodgy hips from Uncle Bert you've got no chance.

    NHS should concentrate on healing the sick - leave the preaching to others.

  • Comment number 78.

    Before we worry about rewarding individuals for lifestyle improvement, we should put the money toward healthier hospitals, in particular hospital food that is, quite honestly, disgusting. It does not make healthy eating at all. The daily person/expenditure allowance for food is about half that for a prisoner.

    I had to take meals to hospital for a patient who simply couldn't stomach the stuff on offer. Wholemeal bread? What? D'you think we're some kind of health farm? Apples? All right so these horrid little green things were rejected by cider brewers but that's all we have, take 'em or leave 'em. Tea? That's not tea, it's soup for pete's sake!

    Trouble is, hospitals are now so large that everything has to be done factory-styled with the patient being on the last step of a conveyor. That might work with some things but not edible food.

  • Comment number 79.

    It was announced yesterday that the NHS in Scotland is to increase the number of operations to fit gastric bands to those who are overweight.

    Should this be extended to the rest of the UK?

    Will this then reduce the need for diabeties care and therefore save money in the long run?

  • Comment number 80.

    There should only be one reward for a "healthy lifestyle" and that is "good health".

  • Comment number 81.

    `Besides we need those that do not change to die off so that they are not a drain on the NHS & pension resources`

    Before they die off they will cost the NHS a fortune, far more than some one with a healthy life style so I don't follow your logic. On current projections obesity alone could bankrupt the NHS if current rates continue. Personally I favour a salt,fat & sugar tax similar to tobacco. These commodities are at an all time low cost so manufacturers load food up with them to make cheap but addictive food. This is why we have sugar routinely added to every conceivable product. Check the sugar content on say a loaf of bread or a tin of soup. Its actually very hard to stay within your recommended daily limit eating processed food, especially as one third of your allowance is supposed to come from fruit and veg, something the manufacturers don't put on their labels.
    One more thing, why do mail readers on this forum think every suggestion comes from the Labour party? If you bothered to read the article you'd have seen that the suggestion was put forward by NICE which to the best of my knowledge are politically neutral.

  • Comment number 82.

    Not a good idea. Its time for individuals to take responsibility for themselves - no more Labour Party feather-bedding now. If not, could I be paid for an annual winter holiday to a warm country in order change my own lifestyle?

  • Comment number 83.

    Absolutely not. What a stupid idea.

    As if we're not short enough of money, to go wasting it in this way. Ridiculous.

    The NHS exists to treat the sick and injured, not 'persuade' us to behave in ways it deems appropriate. Who is it who is going to decide what is appropriate???

    Smoking would be an obvious first target (the NHS already wastes a fortune on its anti-smoking campaign). They reckon smoking costs the NHS £5bn a year. The Treasury will tell you tobacco duties produce £10bn a year in revenue. Turkeys voting for Christmas springs to mind.

  • Comment number 84.

    #7. At 10:15am on 20 May 2010, SystemF wrote:
    Paying someone to stop stuffing their face with cheesecake and chocolate éclairs?

    That definitely sounds like a socialist Labour scheme.

    Let's hope the Conservatives step in and remind the NHS who's in charge now. Fat people, smokers & drinkers are given adequate warning through government adverts which the tax payer spends millions on. Now we have to pay a fatty not to eat?.

    What a catastrophe Labour have been. Social engineering at its most heinous.

    ----------------------------

    I am sorry but what on earth are you going on about. This incentives proposal was put forward by NICE, who happen to be a body which advises the NHS and have absolutely nothing to do with the Labour party (Socialist or otherwise). Just because NICE have these ideas, does not mean that the NHS have to take them up. May I also remind you that the Conservatives are not strictly in charge at the moment, they are in a coalition with the LibDems.

    In my opinion this idea of offering incentives is not a good idea and is most unlikely to work anyway.

  • Comment number 85.

    There is a danger in looking at fat people, drinkers and smokers and assuming that they are to blame for the resultant illnesses.

    It is true that most of these people know what they should be doing, and a least measures have been taken to make smpking unfashionable.

    but what about the celebration drink, the giving of sweets as a reward,the birtday cake, the chocolate easter egg, the Christmas dinner. All of these imprint an image that eating and drinking is a reward or something special.

    Its no wonder then that people confort eat, or have a drink to wind down.

    We need to change the message.

  • Comment number 86.

    58. At 12:42pm on 20 May 2010, Halfbreed wrote:

    Clearly none of the above people have actually read the article (surprise surprise).

    What they are suggesting is offering grocery vouchers to pregnant mothers who insist on smoking.

    The success rate of getting mothers to quit is twice that of any other method.

    Sad state of affairs though this is it demonstrably works, protects an innocent party (the unborn child), and saves the NHS money in the long term.

    Good work from NICE, who once again have to make difficult decisions in the teeth of the Tabloid press. Good on them.

    ----------------------------------------------------

    I do believe it is you who should read the article. It does not mention anything about "offering grocery vouchers to pregnant mothers who insist on smoking". It states that vouchers could be offered for "anything from food to gym membership". So, because someone smokes, they can get free groceries and gym membership, but because I am not fat and do not smoke, I have to pay for groceries and gym membership. Fair? Not really. If fatties and smokers want groceries and gym membership, they should pay themselves. It is in their interests and their families to stop eating like a pig or smoking like a chimney. If they don't see that, then more fool them, its their problem.
    I am all for helping these people to try and better their lives, but bribery is not a good way to do it.

  • Comment number 87.

    Now they come up with this after i've already given up a 30+ yr cigarette habit and the same for alcohol..... typical.

    No it shouldn't is the answer.

  • Comment number 88.

    Is it April 1st? Or has the NHS gone mad???

    Incentices to stay healthy is an outstandingly bad idea, staying healthy is in fact the incentive. Tax payers money should not be wasted on those that are too lazy or idle to look after themselves.

    Educating people to eat a healthy diet and do some exercise would be better. And ultimately if they choose not to take this option then let them become fit/ill/unhealthy/etc and if they require NHS support make them pay for it not us pay for them. I would far rather tax payers money went to those that deserve it.

  • Comment number 89.

    I don't agree with this at all unless it's extended to ALL of us who help ourselves!

    In my late-teens, over the space of a couple of years I got down from a 40" to a 32" waist (at a height of only 5ft 8"!) through exercise and sensible eating. Almost 10yrs on, I've maintained that by continuing to keep an eye on what I eat, and visiting the gym three times a week.

    So, why shouldn't I get £12.50 per week or my monthly gym membership paid?

    Nope - the irony is that for someone who can't lose weight/stop smoking until they start getting paid to do so, it's not right that they get paid when they clearly had the capability to do it had they wanted to do so in the first place.

  • Comment number 90.

    Shocking! I believe that the investment should go on things such as money off at Gyms, classes or work out DVDs etc....But giving people CASH to get off their bums and do something about their weight is outrageous! Being out of breath going up the stairs was an incentive for me to get off my bum! and so I ditched the car and cycle to and from work every day losing 22lbs in 2010. GRRRR - Once again spending our money on total rubbish. Give them the cash and they will go out and spend it on takeaways/beer at weekend!

  • Comment number 91.

    The doctor who carried out the first studies of this in the US found that after the incentives are taken away people revert to their former lifestlyes. His conclusion was that it was not a viable long term option to increase the health of a nation. Quite why we're wasting time and money on further studies in the UK when our preliminary evidence points to the same conclusions is beyond me.

  • Comment number 92.

    OK. So let me get this right. I'm a non-smoker, non-drinker, paying my National Iinsurance contributions, much of which is for funding the NHS. Now the NHS want to give that cash away to someone for giving up smoking (which they might start again immediately after getting the handout while celebrating down the pub), while other poor souls are being denied life-prolonging cancer treatment due to lack of NHS funding? Sorry, I'm lost!!

  • Comment number 93.

    And here was me thinking a change of Government might mean they get off our backs about how we choose to live our lives and treat our bodies. No such luck - the more things change, the more they stay the same. Never mind that the alleged 'public health crisis' is manufactured, exaggerated nonsense to give the immense number of DoH-funded pressure groups like ASH, the BHF and Weight Concern something to wax all apocalyptic about.

    We're living longer, generally healthier lives than any generation before us and yet the degree to which our health is now scrutinised, monitored and moralised about, and the amount of energy, verging on obsession, we're now expected to expend on following healthy living and lifestyle diktats are similarly unprecedented. Smoking has dropped to a hard-core of around 20% of the population, lower than most EU countries, and will continue to fall, albeit slowly, The 'binge drinking' moral panic rests on a relatively tiny minority of students, young people and dependents who genuinely drink to excess and the definition of a 'binge' being set so low (two drinks in a sitting) that virtually everyone is pathologised.

    Even obesity - that condition that it's now heresy to deviate from mainstream opinion and defend - is far more complicated than the 'eat less, move more, now to convince the stupid fatties of that' peddled by the media and health establishment. People have been convinced by lurid media stories (and it's not just tabloids; the BBC is one of the worst) about 40st mothers and the headless shots of very fat people used to illustrate obesity panic items that such people are commonplace when they actually represent about 2-3% of the population. Studies going back to the 1970s put the heritability of body size at between 70 and 80%. In fact the vast majority of the 'epidemic' comprises those of BMI 25-35 which has been has been linked with increased survival rates and other benefits, yet even the elderly folk who benefit most from having extra reserves are still told to lose weight at any cost.

    No-one seems to be able to decide whether fat children become fat adults, and in any case the expensive and intrusive interventions they've tried thus far have produced only weight-obsessed, neurotic teens and an explosion of eating disorders and weight-based bullying and victimisation, but still they persist with the same disproven methods causing immense damage in the process because they've no other ideas and because the ideas that there exists a problem to be solved and that fat people are broken thin people in need of being 'fixed' have become so ingrained and pervasive.

    As a larger person myself (and perfectly happy being so) I don't want to see people paid to lose weight. With so many other better uses for limited resources this will only breed deeper resentment against fat people, many of whom don't want the sort of attention currently focused on them to continue. Whilst I'm not entirely convinced that we have the level of control over our weight that as assumed I think it should be a matter of individual, uncoerced choice and priorities, and I certainly don't believe it is the place of Government to tell us how big we should be or to mobilise and manipulate social pressure that will make life more difficult for people who can't or won't comply with their demands.

  • Comment number 94.

    Please tell me that it's April 1st and this is a joke. Of 450 women who went on the scheme in Scotland a fifth a still not smoking? Well pat yourselves on the back because by that math 360 still are, and I assume they are/were paid the credits too.
    Question: According to the NHS, at 6"2 and 14st2 I am overweight. I also used to smoke (so could again). How much money will the Government give me (back) to lose a few pounds and give up smoking which I can easily take up again? I'll even throw in refraining from binge-drinking for a token fee...
    Why is everything in this country someone else's fault? Why is it up to the Government to fix all of our problems? Why are self-inflicted medical requirements treated for free?

  • Comment number 95.

    The reward is already there - You live longer.

    But then again depending on circumstances maybe not a reward.

    How about the people that live or work amongst city pollution, never smoked but are breathing in the equivelant of a 20 a day smoker. They would probably be very glad to be assisted with changing their lifestyle.

    How do we know the food we eat is healthy? That fish you ate for supper could be contaminated with mercury, cyanide or chromic acid depends where the fish came from. We may have strict pollution control but many of the countries we import from do not.

    Take a look at all of the staff in the NHS, should they be setting an example?

    Classify healthy foods and subsidise very heavily with no tax whatsoever to produce.

    Why is there no healthy options takeaways - because it is too expensive to market.

  • Comment number 96.

    · 58. At 12:42pm on 20 May 2010, Halfbreed wrote:
    Clearly none of the above people have actually read the article (surprise surprise).

    What they are suggesting is offering grocery vouchers to pregnant mothers who insist on smoking.

    The success rate of getting mothers to quit is twice that of any other method.

    Sad state of affairs though this is it demonstrably works, protects an innocent party (the unborn child), and saves the NHS money in the long term.

    Good work from NICE, who once again have to make difficult decisions in the teeth of the Tabloid press. Good on them.

    ###################

    The Question being asked is


    “Should public money be used to reward healthier lifestyles? Is becoming healthy something people should already be doing anyway? What's the best way to promote healthy living?”




  • Comment number 97.

    They'd do better to send Health Toursists home before doing this.

    At least those here have paid for it.

  • Comment number 98.

    Which idiot came up with this idea in their 'brainstorming' session.
    Then which other idiot santioned it.
    If the NHS concentrated on the job it had to to instead of the job it would like to do, there might be enough money to cut waiting lists, create 'real' nurning jobs and get rid of the tiers of management, that seem to be paid to come up with more hair brained schemes.

    Hopefully the new government will put a stop to the likes of this and get us back to basics

  • Comment number 99.

    smoking cessation is already funded - it is possible in some areas to get vouchers for nicotine replacements that are redeemed at the local chemist and they then test the carbon monoxide levels in your breath to check you really are giving up. this type of funding is acceptable, handing out money isn't, but I imagine this is the sort of scheme they hve in mind - I certainly hope so

  • Comment number 100.

    Another cracking idea. We had child tax credits to give 'some' people an incentive to overpopulate the country with children they don't actually want so they can spend the money on alcohol and basically not get a job.
    Now we're going to offer cash incentives to people who stop smoking and lose weight? Crikey, i've never smoked i wonder if they could backdate the payments. I wonder also how many who bleed the country on other weak areas are going to start smoking so they can give up for cash.
    No incentives should have cash values. Surely if we're going to adopt another namby pamby stance we could at least make them as someone else stated in the form of facility vouchers/discounts.

 

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