to be furious that pregnant women in derbyshire are to be offered a cash incentive to give up smoking while pregnant.

[Wormshuffler]

Just reported on central news. Up to £750 in shopping vouchers.

"We are once again rewarding bad behaviour whilst the people who are doing everything right get nothing."

I agree.

What message does this give to the non-smoking pregnant mothers? The ones who gave up before they got pregnant?

That they shouldn't have bothered, or that they would have been rewarded if they started smoking.

It creates an incentive to get pregnant while smoking, and to take up smoking again before you get pregnant again.

So it is encouraging people with small children to smoke.

I think callme's point is valid too - if smoking is so hard to give up, why will a cash incentive work?

The logic of the scheme is that if you want to enough, you will stop.

YY- a system which relies on giving cash incentives to people simply to STOP doing things which are bad for them is on a slippery slope. Where do you draw the line? As someone said earlier, do you pay people to stop shoplifting? Or beating up old ladies? I'm sure the same short term financial arguments could be applied- after all, the criminal justice system is hugely expensive.

The problem is twofold as I see it. First, important issues like this should not just be about money anyway. It's about the message sent out to wider society. It's about society making a stand and saying, 'we're not going to be seen to be rewarding undesirable behaviours just because it might be a bit cheaper than dealing with the consequences of those behaviours'.

Secondly, I am not convinced it even is cost effective long term. It can't be economically sustainable to create a society where people will automatically begin to feel they are entitled to rewards for something which is not a positive contribution to society. Giving up smoking is not some amazing gift to society. It's clearly far better not to start.

As a long term solution, if the money aspect is allegedly an incentive (whereas children's Health allegedly isn't) then the govt should look more creatively at systems which would put the personal responsibility back on the smoker . Obviously raising tax on tobacco doesn't work, because smokers often Carry on, but creating a clearer link between having to pay more for self inflicted illnesses might be a way forward. Obviously there will be shouts of disagreement from those who think the nhs is there to mop up their self inflicted illnesses- but if we're saying cash incentives work, then ......

Some good points raised there thank you.

As I said further up thread it is the idea that someone could find money more a motivator to quit than the health of their unborn child that fuels my fury. I do stand my statement that the kind of person who couldn't give up for the baby but could for the money wouldn't then be bothered about bringing up the child in a healthy lifestyle, be that a sweeping generalisation or not. Hopefully I will be proved wrong on this.

I hadn't considered the fact that once they had quit for pregnancy they then wouldn't take it up again. That would definately be a benefit and I suppose thinking about it, had my own mother, who smoked through pregnancy with me causing prematurity and low birth weight, been bribed to quit and not smoked all through my childhood, I wouldn't have had to endure growing up in a smoke filled house.

YANBU especially as they are closing our maternity unit (midwife led) and sending us to an over subscribed hospital 15 miles away because we apparently can't afford to keep it open, BTW the bright spark who came up with this idea is the same Man closing our unit, i'm more than fuming.

"I hadn't considered the fact that once they had quit for pregnancy they then wouldn't take it up again."

Well unless this is a one-time offer and you won't get money for quitting in multiple pregnancies, this is actually giving people money for starting up again.

Of course if you quit, you SAVE yourself £750 in no time at all given a pack of fags is £7.

On a purely pragmatic level, if this pilot in Derbyshire "works" - reduces harms to babies born to women who would have otherwise smoked, then it is an efficient use of public money (assuming it costs more than £750 to care for small/prem babies across their lifetime).

According to this the average cost of a baby staying in NICU for one night is £1200.

So as Lashing said, for that reason alone then it is an efficient use of money.

Bogey face- I am not convinced, because you are adopting a short term, simplistic approach- ie- 'smoking is bad for you, the consequences can be financially costly to the NHS, therefore £750 paid to smokers to stop = money well spent'

I think in reality there are many more variables when you

Sorry posted too soon

There are many more variables when you place this in the context of the long term. Other people have already raised the issue of people taking up smoking again. Or the possibility of people starting to smoke when a financial incentive to give up is offered . (and don't dismiss that idea- because you said yourself that youngsters are impressionable and easily swayed)

Plus as I alluded to earlier, you have all the costly complexities of fostering a society where people feel entitled to a reward for what basically amounts to poor decision making. I think in the long term, it makes society less economically viable . It encourages a culture of dependency on the state to sort out self imposed problems.

If it were as simple as £750= cheaper than cost of smokers baby in hospital, then there might be at least some financial (though not ethical) sense to the decision. But as I say, I seriously doubt that if the complexities of all the knock ons from this were explored, it would make financial sense anyway

Exposure to smoke during pregnancy means exposure at the most vulnerable time in a person's life. Even if the parent takes up smoking again after the child is born, protecting them from smoke via the mothers blood may have very important health consequences. One example is that smoking during pregnancy is one of the biggest risk factors for SIDS, moreso than exposure to smoke in the home after birth.

I would be surprised if the lifetime NHS cost savings of preventing a child being exposed to smoke via the mother in utero were not greater than £750 on average.

The caveat would be that the mother would have to demonstrate via ongoing CO measurements that she had in fact quit for the duration of the pregnancy and the issues raised about would people be eligible for a second paymentt in a second pregnancy are valid.

People may not like that fact that someone might give up for £750 but not just for the health of their baby alone. However, this is the reality. Loads and loads of women smoke during pregnancy. If payments like this are demonstrated to be effective then in my view it is money well spent to protect the health of the child.

The effects of smoking around children after the pregnancy- ie the whole of their childhood, which is far longer than 9 months, is also dreadful and hugely costly to the nhs, in terms of hospital admissions for asthma and other conditions.

What do you propose happens post- pregnancy? Would these people be monitored until their Youngest child reaches 18? I bet there would be huge cries of breach of human rights if that were the case.

All of this is based on short term projections. It might be the case that a longitudinal study will disprove that it is saving any money at all in the long run. If it encourages youngsters to take up smoking (which isn't outside the realms of possibility when they see big cash handouts on offer) then it certainly won't be cost effective

Isn't it better for them to quit for the duration of the pregnancy than not at all? Yes, the effects of smoke in childhood are huge as well. I don't think the fact that someone might relapse is necessarily a reason not to offer an intervention. If an incenttive increases participation and is cost-effecttive then I don't have a problem with it.

The monitoring required to ensure they remain smoke-free for the pregnancy means the opportunity of reglaur contact witth an appropriately-trained HCP who would hopefully be working with the person on longer term strategies to keep them off smoking. This might mean people accessing stop smoking services who wouldn't ususally do so. I think that's potentially a v good thing.

I see no reason why this sort of strategy shouldn't be tried. If it is shown not tto work, then it can be dropped.

It would be very easy for a non smoker to smoke one cigarette immediately prior to going into her booking appt. She will low quite a high reading on the co monitor and by the next reading she will be able to say she's stopped and get the money!

Blow a high reading