In his speech at NHS Confed Expo 2025, SoS Wes Streeting outlined a vision for a new NHS operating model - one that shifts from reacting to sickness to investing in prevention.
Would you be persuaded to eat healthier, exercise more, or attend that overdue screening if you were offered a shopping voucher or cinema ticket?
For some, the answer is yes - at least in the short term.
But the real question for public health is this: can financial incentives drive meaningful, equitable and lasting improvements in population health?
In his speech at NHS Confed Expo 2025, Secretary of State Wes Streeting outlined a vision for a new NHS operating model - one that shifts from reacting to sickness to investing in prevention. Among the many levers mentioned, he stated:
"We will use financial incentives to invest more in public health outcomes, not just in more activity that reacts to sickness.”
This signals a subtle but important shift: incentives as a means to drive outcomes, not just outputs.
What are financial incentives?
Financial incentives have increasingly been explored as a way to encourage healthier behaviours. These schemes vary in form - from direct cash payments and shopping vouchers to prize draws and lottery-style rewards - and have been used to promote actions such as quitting smoking, attending vaccination or screening appointments and increasing physical activity.
In a review by academics from Fuse, the Centre for Translational Research in Public Health, research found that such incentives were particularly effective in supporting individuals to stop smoking, engage in physical activity and attend preventive health services like vaccinations and screenings.
More recently, Nesta’s Blueprint for Halving Obesity proposes investing £500 million over five years in incentive-based programmes in areas with the highest obesity rates in the UK. Their modelling suggests this could lead to a 0.7 per cent relative reduction in national obesity prevalence and generate £300 million in annual benefits to government.
But what do we know about incentives in practice?
Some examples show that financial incentives can support behaviour change:
- In Nottinghamshire, Sherwood Forest Hospitals piloted a maternity tobacco treatment scheme offering shopping vouchers to help pregnant women quit smoking. The most recent data available indicates the current smoking at time of delivery at SFHT is now 12.9 per cent, a decline of 6 percentage points since the pilot began in 2022/23.
- A study led by the University of East Anglia found that offering financial incentives - such as cash, vouchers, or returned deposits - significantly helps people quit smoking, including pregnant women. The research, involving over 21,900 participants across 48 studies, showed that success rates remained high even after the rewards ended. For example, 13 out of 100 pregnant women who received incentives quit smoking long-term, compared to just 6 without incentives. The findings support continued investment in financial incentive programs to combat nicotine addiction.
- Cheshire East Council launched a pilot smoking cessation incentive scheme in 2023 aimed at pregnant women and their household members, offering vouchers for reaching verified quit milestones. The initiative, supported by local maternity services and the "One You Cheshire East" program, provided up to £400 for pregnant women and £200 for household members. Following the introduction of a national scheme for pregnant women, the council now plans to continue only the household element. This decision reflects the proven health risks of second-hand smoke to unborn children and the scheme’s effectiveness in encouraging long-term cessation.
- A large US NIH-supported study (2019–2024) involving over 1,000 adults at risk of cardiovascular disease found that short-term incentives, such as financial rewards or game-based points, led to sustained increases in physical activity. Participants increased their daily steps by over 1,500 on average, and many maintained these improvements six months after the incentives ended. The most effective approach combined financial and behavioural nudges, suggesting that well-designed, time-limited incentives can help establish lasting habits.
- A US 2024 meta-analysis of 29 randomised controlled trials found that financial incentives produced short-term, clinically significant increases in physical activity. While only a small number of studies examined long-term (n = 5) or follow-up (n = 8) effects, those that did reported promising sustained outcomes. The review also highlighted that contextual factors, including goal setting and the use of wearable trackers, moderated the effectiveness of incentives, highlighting the importance of thoughtful programme design.
- In 2022, the UK Government announced it was piloting an app in Wolverhampton which offers incentives (e.g., vouchers for shops, cinema tickets) for people who eat healthily and exercise more. An evaluation of the pilot is currently underway.
What does the public think?
Effectiveness is only part of the picture. According to research from Fuse, public support for incentives can be conditional.
Health-promoting financial incentives are viewed as more acceptable if they are perceived as fair, if individuals engage voluntarily and if they do not discriminate against any one population group. The public is also generally more supportive of financial incentives if they’re framed as enabling healthy choices, not as rewards or punishments – and if rewards are given as vouchers, compared to direct cash payments.
Important considerations
While financial incentives can drive behaviour change, their use should be considered carefully. The biggest concern? Limited evidence on long-term effectiveness. Many studies show promising short-term results, but few track whether changes are sustained once the rewards disappear.
There's also a motivation paradox. When people are rewarded for behaviours they might do naturally for personal or health reasons, the removal of that reward can lead to a drop-off in engagement. This raises questions about the sustainability of incentive-driven interventions.
Equity is critical. Poorly designed schemes risk widening health inequalities, benefiting those already equipped to engage - people with time, resources, and digital access. Many programmes rely on apps or online platforms, potentially excluding those without smartphones or digital literacy.
There are also ethical considerations, especially around the potential for coercion or undue inducement. Some population groups may feel pressured to participate in programmes that offer financial rewards, even if they have reservations or face barriers to participation.
Public trust matters too. If incentives are perceived as manipulative or turn health into a transaction, they could damage confidence in public health initiatives.
Implications for policy
If the Government is to use incentives effectively as part of its prevention strategy, several principles should guide their design and implementation.
Incentives should be targeted at specific, measurable behaviours where there is a clear link to improved health outcomes. They should be integrated with broader support systems, such as coaching, community services or environmental changes that make healthy behaviours easier to sustain.
Programmes should be fair, voluntary and inclusive by design - not just in appearance. They must also be evaluated rigorously, tracking long-term outcomes rather than just short-term wins.
Crucially, incentive schemes must be delivered in ways that do not exacerbate digital exclusion. This means offering offline options and ensuring accessibility for all communities.
Finally, incentives should complement - not replace - efforts to make healthy choices easier, more accessible and more affordable.
Incentives are not a silver bullet - but they could be a strategic tool in a broader prevention-first approach. The challenge now is to ensure they are evidence-informed, publicly acceptable and embedded in local systems that understand their communities best.