A proposal to cut benefits for obese and unhealthy people who fail to attend exercise sessions has hit the headlines. People of ordinary weight and in good health could lose money too.
GPs prescribe exercise to many people who are overweight or have conditions such as depression or heart disease. They may use facilities such as swimming pools and gyms. .A report by the Local Government Information Unit and Conservative-led Westminster Council urged local authorities to use “financial incentives” to promote public health, for instance reducing council tax benefit for those not doing exercise prescribed by GPs.
A Dose of Localism: The Role of Councils in Public Health explained that “The increasing use of smart cards for access to leisure facilities, for instance, provides councils with a significant amount of data on usage patterns” which could be used to reward or punish people.
But many low and middle-income households in England already face harsh welfare benefit reductions at national level. Further cuts at local level would be damaging and unfair to people who are already disadvantaged. Some might find it obtrusive to be monitored by their council. And GPs might find themselves facing ethical dilemmas, as schemes aimed at helping patients ended up harming them.
If some councils decide to act on this, increasing numbers of people could find themselves subject to such penalties, as exercise on prescription is rolled out more widely. As a result of a public health drive and the Quality and Outcomes Framework (QOF), which affects how much GP practices are paid, more patients are likely to be prescribed exercise.
The indicators for 2013/14 include assessing exercise levels every year in patients with high blood pressure, and encouraging those who are not active enough to exercise more. The National Institute for Health and Clinical Excellence (NICE) is consulting on including health checks for dementia carers in QOF from 2014/15. Many carers have health problems such as high blood pressure which might lead to exercise prescriptions.
In fact, under proposed new NICE guidance, doctors and nurses might be encouraged to ask all patients aged 19 or over how much exercise they take. If they are judged as not active enough, they might be advised them to get fit, which might involve prescribing exercise. It is not just the overweight who would be targeted: “Do not rely on visual cues (for example, body weight) to determine whether people are physically active.” This might find its way into QOF.
Not all doctors are happy at the shift towards such an emphasis on lifestyle, which they fear would swallow up scarce time and fail to recognise that patients are responsible adults. But the trend is likely to continue.
So, for example, someone caring for her elderly father with dementia could miss a few exercise sessions if he took a turn for the worse, only to find her benefits docked. Or a busy teacher or X-ray technician unable to get to the gym because he was standing in for an absent colleague could lose much-needed benefits, putting his family at risk of losing their home. Some patients, to protect themselves, might refuse to talk frankly with health professionals.
If local authorities were encouraged to use technology to monitor people’s leisure activities, and reduce benefits to those who failed to turn up to prescribed exercise sessions, this might turn out to be extremely unpopular.
In Pulse (http://www.pulsetoday.co.uk/) and GP online (http://www.gponline.com/) there is more background information to the issues covered here.
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(c) Savitri Hensman works in the cae and equalities sector. She is a regular commentator on welfare, politics and religion, and an Ekklesia associate.
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