Editorial: The NHS and Demos - it’s a bad idea to stigmatise the poor

Nudge theory is the latest fashion among those paid to think up ways we might better be governed.

If properly applied, the Government would no longer need to issue orders, it would merely create conditions that – discreetly – encourage advantageous behaviour. The latest suggestion on healthcare policy from a think-tank, Demos, has a slight twist: rather than nudging along those who are doing the wrong thing, it would leave them waiting in a queue while the more virtuous walk by.

In fairness, Demos has begun from the sensible premise that individuals should take responsibility for their own health. After all, those who live unhealthy lives – smoking cigarettes, for example, or eating lots of junk food – not only harm themselves, they also make additional demands on the already overstretched NHS. The solution, suggests Demos, might be a system under which the health service operates a fast-track appointments system so those prepared to share data on their living habits – and who live healthily – might jump the queue for non-emergency treatment. Such data could include details of shopping habits and proof of visits to a gym.

The root of the problem with Demos’s scheme is that it threatens to recreate the Victorian distinction between the deserving and the undeserving poor. The NHS will feed in data so that a computer can calculate which patients deserve fast-track treatment. Those who do not supply the data, or whose data tells the wrong story, will have to wait that much longer. Hardly the egalitarian health system of which Britain is deservedly proud.

And most of the undeserving patients will be poor. The link between poverty and unhealthy living is well established. Those with lower incomes eat cheaper food and are the least likely to be reached by advice on healthy habits. Though well meant, Demos’s proposal would inevitably punish those already at the bottom of the social ladder. The idea is a reasonable one. In practice, it needs more work.