Health Incentives Scheme — House of Lords, 2021-10-28
Topic: Health
Syed Kamall (Conservative, Centre-right): I am pleased to hear that, because the Tony Blair Institute has actually recommended more of these schemes using wearable tech to ensure that we have a healthier population. So this is not politically motivated in any way; it is led by a desire to do the right thing, and to learn lessons from previous schemes about what works and what does not work. One problem, as many noble Lords have said in the past, is that some of these schemes have not worked. We need to make sure that we have evidence, and that anything that we roll out is evidence-based. On that basis, it is absolutely right that we pilot a scheme rather than do a one-size-fits-all scheme, only to find where the errors are Also, as Hayek has said, we have limited knowledge. Some people express the conceit of knowledge and think they know everything, and sometimes—in economics and in politics—quite often we become aware of consequences, both intended and unintended. It is important that, when piloting a scheme such as this, we are able to identify potential unintended consequences that would not have been foreseen. I know that the noble Lord, Lord Scriven, can already predict the outcome and has infinite knowledge, but what is really important is that we see what works and what does not work, rather than predicting in advance that something will fail—and I acknowledge that the noble Lord, Lord Scriven, was asking a question, as he is entitled to do I will try to answer a few of the specific questions. One of the things that we are seeing is that obesity is costing our health service and healthcare system more than £6 billion a year. Clearly, schemes have been attempted in the past, and some have worked and some have not. We looked around the world to see what we could learn from the rest of the world. In particular, we looked at the Singapore health challenge, and also the Amsterdam programme, to see what we could learn. One of the things that I noticed when I worked on projects in the past in one particular area was that, just because they worked in one area, it did not mean that they would necessarily work in another area. We have to understand the local factors that might make a project a success or not In addition, it is really important that we do tackle disparities, and I am very pleased that many noble Lords have brought up the issue of disparities. We now have the Office for Health Improvement and Disparities: the clue is in the title. "Disparities" means that we want to identify these disparities—all sorts of disparities: sometimes they are gender disparities; sometimes they are based on ethnic minorities; and sometimes within communities there are different disparities. It is always far more complex than we can predict in advance. One of the best ways of tackling things is to look at pilot schemes Let me see if I can now answer some of the specific questions. This is based on understanding what incentives people respond to. Many noble Lords will have read of schemes in the past that simply have not worked. We need to work out what works with certain communities and certain demographics. One of the bits of academic research that has been found to be quite helpful is that, quite often, people from lower-paid communities respond better to price incentives or reward systems, and we are going to put that to the test. We are not saying that this is definitely the case: we are saying that we are going to pilot this to see if what we think is going to happen will happen—and, if it does not happen, why does it not happen and what can we learn from that in the future The noble Baroness, Lady Merron, asks what assessment the department has made of the changes in the level of the public health budget. Public Health England has monitored and published data on trends, with a wide range of indicators of public health, set out in the Public Health Outcomes Framework. That function has now transferred to the Office for Health Improvement and Disparities, which shows the fact that we want to identify those disparities and see how we can tackle them The ring-fenced grant that we have provided to local authorities to spend on public health services comes with a condition that they consider the need to reduce health inequalities in their areas. The grant’s distribution is heavily weighted towards areas facing the greatest population health challenges. Per capita grant funding for the most deprived decile of local authorities is nearly 2.5 times greater than that for the least deprived What is the breakdown, as we go over this? The publicly available information will contain the contract value, inclusive of £3 million to be spent on rewards for participants. The budget will be managed through standard contract procedures and there will be provisions in place to prevent overspend I shall go over the timescales. There was open procurement for the pilot, which closed on 16 August. The contract was awarded and unsuccessful bidders notified on 27 September. The pilot mobilisation period that we are looking at is 11 October to 31 December. The press release announcing the pilot provider was issued on 22 October. The pilot launches in January 2022 and closes in June 2022 with an evaluation report. That is critical. We want this to be evidence led; it is about time that we pushed for more evidence-led research. Before I came here, I had read reports from think tanks that had analysed government programmes, only to find that the evidence always backed it up. We want to make sure that this process is clearly evidence led and also to be aware of unintended consequences In terms of whether people can afford to eat a healthy diet, the Eatwell Guide represents government recommendations on a healthy, balanced diet to promote long-term health at the population level. Analysis by Scarborough et al in 2016—I shall not give a Harvard reference here—of the cost of achieving a diet in line with the Eatwell Guide concluded that in some cases it was 3p cheaper than the current diet In terms of audience and location, the pilot will target adults over the age of 18 in a chosen local authority. The approach will be tested to ensure that it combines wide appeal across the adult population with an ability to engage those who could get the most benefit from adopting healthier behaviours for physical activity and diet, such as those not meeting recommended guidelines. The pilot will take place in one local authority in England where there is a high proportion of our target groups. I hope that the information will become available publicly, or I will be able to update the House. We will be releasing further information in due course on the pilot location and on how residents can sign up to take part in the work. The scheme will be for England only but we will continue to work across the devolved nations to learn shared best practice. One of the things that we need to do is to make sure that we learn from what works well and what has not worked so well How will we safeguard data and privacy? I am sure that the noble Lord, Lord Scriven, will have recognised that I come to this post as a bit of civil libertarian, and perhaps civil liberties is one of the few things that we agree on. All data will be collected, stored, shared and used in alignment with all applicable law regarding the processing of personal private data and security standards, including the UK Data Protection Act and the UK General Data Protection Regulation. Full data collection and processing requirements will be shared with potential pilot users as part of the sign-up process. Consent to take part in the pilot is, I stress, voluntary. The Department of Health and Social Care is the data controller for the pilot, with HeadUp Systems as a limited data processor that collects data on the department’s behalf The noble Lord asked about the supplier. We contacted HeadUp Systems to deliver the pilot, and it has partnered with a number of organisations to deliver the requirements, including the Behavioural Insights Team. The advice of Sir Keith Mills who successfully launched and ran the Air Miles and Nectar programmes has also been sought. We are therefore trying to work with the best experts out there, including the Behavioural Insights Team, to bring knowledge and expertise on behavioural economics. I am sure that many noble Lords have read many interesting works on behavioural economics over the years. If the pilot does not work, we will work out why and how we can improve the scheme to make sure Given that obesity costs this country over £6 billion a year, surely it is worth a little investment, experimentation and discovery to see if we can make sure that we nudge our citizens, wherever they come from, whatever their background, towards healthier living.