On 14 August 2014 VHS members Waverley Care co-facilitated a debate in Edinburgh as part of the Just Festival , exploring the ethical issues around giving financial rewards to people in relation to their healthcare.
Broadcaster and journalist Sheena McDonald chaired the debate and speakers included John Dillon, Clinical Lead at NHS Tayside, a health board that gives incentives to encourage people with hepatitis C into treatment. The debate asked: is this a good use of NHS resources for the greater good or an undermining of personal responsibility? Where is the line between personal responsibility and public health?
John Dillon wants to stop the spread of Hepatitis C, and is paying patients to help him. He explained how Scotland has a world-leading action plan to prevent liver failure and liver cancer, and the number of patients affected is now flat-lining, as predicted. Dr Natasha Martin made a mathematical model for how Hepatitis C spreads among the drug-using population. Assuming a 20%-40% prevalence among that population in Scotland, and if just 10 to 20 in 1000 of these are treated, then prevalence can be reduced to under 5%. Eventually, Scotland could eradicate Hepatitis C.
It was assumed to be impossible to treat drug users, because the treatment is unpleasant and has to be completed to be effective, but in fact heroin users in Tayside are engaging with this programme.
Patients at a needle exchange in Dundee who agreed to undergo treatment were given £5 Asda vouchers (not to be used for cigarettes or alcohol), along with protein supplements. Patients were not asked to change their drug use. There are currently 43 patients involved, of whom 14 have completed the course and 12 have been cured of Hepatitis C. One initially agreed but then committed a crime and was apprehended, and was treated in prison. The drop-out rate was low. It is still early days in the project, but there is some initial evidence of crime and drug use rates among the group going down too.
Read Waverley Care’s transcript notes of John’s presentation and the debate here: A SPOONFUL OF MONEY – INCENTIVISING HEALTHCARE NOTES
The Just Festival involves over twelve faith, belief and non-faith committees “encouraging community by exploring diversity”. JUST organises an annual festival in Edinburgh each August and other events throughout the year, including conversations, civic cafes, films, talks and workshops. Visit their events page or sign up to their mailing list