Now you must email your GP: Patients are told not to come to surgery, instead describe symptoms online
Patients are to be told to examine themselves at home and email their GP with the results rather than meeting face to face. They would send in a short message describing symptoms which would be answered by a doctor between appointments or at the end of the working day.
Those with long-term conditions such as heart failure, diabetes or lung disease could even be asked to measure their own blood pressure, glucose levels and temperature, sending the results to the surgery.
Ministers want to cut ‘unnecessary’ appointments in the hope of saving up to £1billion a year while at the same time allowing GPs to devote their attention to the most seriously ill.
Thousands of patients in England have already been issued with handheld devices and asked to send in their own measurements to their surgeries. But leading doctors are worried about the ‘remote’ diagnosis plans and fear life-threatening illnesses will be missed.
The British Medical Association has warned that standards of care will be jeopardised and GPs will be forced to spend much of their day answering emails rather seeing patients.
In addition, the General Medical Council, the health watchdog, is opposed on the grounds that patient confidentiality could be jeopardised. It fears that anyone could send a message to a GP pretending to be a patient, to try to tease out highly sensitive, personal information.
In November the Mail revealed government plans to introduce a national call centre for all appointment bookings to try to save money. It has since emerged that surgeries are already using operators hundreds of miles away to make bookings under a pilot scheme.
Under the latest Department of Health proposals, patients would be encouraged to email their GP with a short description of symptoms. The doctor would send a short reply with advice or, if concerned, urge the patient to visit the surgery. Those issued with electronic devices would email or text the results every few days to the surgery and, if a reading was abnormal, an appointment or home visit would be arranged.
The proposal states that it would be far more ‘cost-effective’ if patients were encouraged to communicate with their doctor ‘remotely’ rather than coming in for an appointment.
However, it refers to a pilot study carried out in Dundee, where rather than visit the surgery patients sent messages referring to possibly serious conditions. One said he was concerned about ‘frequent’ chest palpitations. Another emailed to report being kept awake all night with ‘acute sickness’ and shaking.
A separate report by the think tank 2020Health, which has been seen by ministers, estimates that the NHS could save £1billion a year if those with certain long-term conditions are encouraged to manage their illness at home rather than visiting a GP several times a month.
The authors of this study claim that it would lead to a dramatic fall in the numbers of emergency hospital admissions as doctors would have a regular update of patients’ conditions and would be more likely to spot any sudden deterioration.
The Department of Health is carrying out a pilot of 6,000 patients with long-term illnesses such as heart failure and diabetes to see if they can monitor and treat their condition at home. All have been given electronic devices to record blood pressure, heart rate, glucose levels and the measurements are sent to the surgery. The results of the trial, in Cornwall, Kent and East London, will be published in the spring.
The BMA warned that would be only a matter of time before a serious illness is missed. Dr Laurence Buckman, chairman of its GP committee, said: ‘My worry is that the patient won’t realise the severity of their disease and neither will the doctor as it won’t have been conveyed in the message. People with a very serious chest infection might just think it’s a cough. ‘The safest method of dealing with patients is seeing them. People will get worse care. Most doctors are scared of email consultation.’
Dr Buckman warned that patient confidentiality was at risk and a family member could email a GP pretending to a patient to find out information – such as a mother wanting to find out if her daughter has had sexual intercourse.
Katherine Murphy, chief executive of the Patients Association, said: ‘There are certainly patients who will not be able to do this. It could be dangerous. The technology might give inaccurate readings.’
BBC looks into multicultural Britain and finds some unwelcome truths
Are young men of Pakistani origin really fizzing with testosterone, and do they target young white women for sex because they see them as easy meat, as Jack Straw claimed last week? The Today programme went to Bradford this morning to find out, and you got the distinct impression that no one was more shocked than the BBC to find young Asian men, by and large, confirming what Mr Straw said.
A minority of interviewees sounded a note of caution, said everyone was equal and there was no such thing as an “easy target”. A more typical response, however, was: “It’s the way the white women dress, innit. Miniskirts. Encourages them, innit, to go jack ‘em and that, d’you get me?” (That’s an exact quote, by the way.) Or: “A lot of Asian women wouldn’t actually have their body showing, whereas white women you would find them like that.” Or: “White women drink, so when they [are] under the influence of alcohol the Pakistani men probably – the ones from Pakistan that have recently come – probably think they can take advantage, innit.”
Zubeida Malik introduced her report by saying: “Given the huge controversy that Jack Straw’s comments raised, you might be surprised by what you hear.” But were listeners really shocked by what they heard? Over at the BBC they might have been surprised, but no one else the programme interviewed sounded as though the comments were news to them. In fact, just before the end of programme, at ten to nine, they brought on David Aaronovitch and Nihal from the BBC Asian Network. I’m afraid the show’s producers will have been disappointed if they hoped Aaronovitch and Nihal might offer an alternative reading of the situation.
“What you have is a level of anecdotal evidence that something of this sort is going on,” Aaronovitch said. “It does seem that there is really something going on that people need to deal with.” Justin Webb struggled manfully to present a more innocent and less damaging case, proposing that, perhaps, some Asian men simply “fancied western women”.
Then Nihal from the Asian Network came on and I can only imagine the hand-wringing among BBC multiculturalists when they heard what he had to say: “We did this story back in November and we asked the question whether there is something in the Pakistani culture that led men to do this. Many people called in my phone-in show and said: ‘Yes we know that this is happening. Our men have this attitude towards white girls.’ [On Monday] a caller said: ‘White girls are easy. Fact.’ That’s what he said and he was unapologetic about that. I told him it wasn’t fact it was an opinion.”
Webb responded that that was very tough on young men of Pakistani origin. And he’s right, of course: it certainly is not good for respectable young Asian men. The fact is, though, that hardly anyone now denies that there is a real issue here and it has be faced. Perhaps only Keith Vaz is left insisting the whole thing’s an invention, and no one takes him seriously. As Nihal said: “Even Keith Vaz, chairman of the home affairs select committee, on my show this week said that he had never heard anybody say this, that white women were easy or promiscuous. I said to him: Well, why don’t you check out the iPlayer, because ten minutes before he came on my show someone had said that very thing!”
“It’s certainly been well mentioned now,” Webb said, a bit testily, as he wound up the interview. Small wonder if he was inwardly peeved. Today the BBC took a good look at multicultural Britain – and they didn’t like what they saw.
Britain: Bullies, liars and shameless hypocrites are trying to kill our “free” school
Towards the end of last year, I was summoned to appear before the education scrutiny panel of my local council. Why? Because I’m leading a campaign by a group of parents and teachers to set up a free school in West London.
Worried about falling standards in state education, we want to create an outstanding school to which all children in the neighbourhood have access. We call it a grammar school for all.
I hoped I’d be able to cope with the panel’s questions. But what I hadn’t anticipated was just how far the NUT – the most militant of the teaching unions – would go to try to discredit me.
The union had circulated a document to councillors in which I was accused of sleeping with prostitutes – a false allegation lifted from my former colleague Julie Burchill’s autobiography published 13 years ago. I’m a happily married father of four and the council’s lawyers had moved to suppress the document on the grounds it was libellous.
But the damage had been done. In retrospect, I shouldn’t have been surprised. Unions such as the NUT are controlled by the hard Left and will stop at nothing to protect the state’s monopoly over taxpayer-funded education.
Shortly after my appearance, the secretary of the Ealing branch of the NUT, who is also a member of the Socialist Workers Party, organised an event for opponents of our new school. The guest speaker was Bob Crow, leader of the Tube drivers’ union and a communist.
The Department for Education has been inundated with applications concerning free schools. Starting a school is a huge undertaking, but thousands of people are so concerned about education that they are willing to do it.
Yes, there are some outstanding state schools, but they tend to be grammar schools, faith schools or comprehensives in middle-class suburbs where only those who can afford the inflated house prices can get in.
Britain once prided itself on being a fair society, where anyone could get on in life if they were prepared to work hard. Not any more. We’re at the bottom of international league tables for social mobility, with our schools ranked below those of Poland, Latvia and Estonia.
Thanks to the decimation of grammar schools, it’s harder for someone born to working-class parents to enter one of the professions than at any time in the past 45 years. Our class system is stronger than ever. Ironically, the most energetic defenders of the status quo are those who claim to represent the interests of the working class.
There’s a primary school near my house that serves one of the most deprived council estates in London. Due to the dedication of its staff, it has been ranked ‘ outstanding’ by schools inspectorate Ofsted and, as a result, had an opportunity to become an academy [charter]. That would have meant being free of the control of local bureaucrats and no longer at the mercy of unions.
Needless to say, the NUT opposed this school’s bid for freedom tooth and nail. The headteacher allegedly received threatening emails from a union representative. The school has now shelved its plans.
What makes this sort of apparent bullying particularly galling is that the officers of the NUT don’t practise what they preach.
Last week, my group unveiled plans to turn a dilapidated old building in Hammersmith into its school site. Dennis Charman, secretary of the Hammersmith and Fulham NUT, accused us of running down local schools. Charman is the partner of NUT general secretary Christine Blower. What he didn’t add is that the couple chose to educate their children outside the borough.
In Wandsworth, parents campaigning for a new secondary school were targeted by the GMB. One activist investigated more than 600 people who had signed a petition supporting the plan and found that 25 had a connection to the banking industry. The union dubbed it a ‘bankers’ school’.
Labour used to be in favour of education reform, but not any longer. When I told Old Labour warhorse Roy Hattersley that I wanted a school with grammar school standards but a comprehensive intake, he dismissed that concept as ‘a contradiction in terms’. I reminded him that the phrase ‘grammar schools for all’ was Harold Wilson’s [former Labour Party PM], not mine.
One of our most vocal opponents in West London has been local Labour MP Andrew Slaughter, who calls our efforts to set up a high-performing secondary school ‘ideological nonsense’.
Given that he is the product of Latymer Upper School, one of the best fee-paying schools in London, he knows how useful a rigorous education is. Yet he wants to deny the same educational opportunities to those who aren’t as privileged as him.
In many ways the opposition of these champagne socialists is even more irksome than that of the trade unions. At least they have a rational motive. A BBC Panorama programme revealed last year that only 18 teachers had been sacked for incompetence in the last 45 years, so great is the stranglehold of the teaching unions. The unions are opposed to free schools because they want to protect their members’ interests.
But why are the standard-bearers of the Left, people who claim to be looking out for the interests of the most vulnerable members of our society, so opposed to improving state education? In the name of equality, they are standing in the way of our best hope of dismantling the class system.
When I embarked on this campaign, I had no idea how nasty the enemies of reform would be. But I take heart from the fact that there are tens of thousands of people behind us. So far, more than 1,600 local parents have expressed an interest in sending their children to our school and expressions of support continue to stream in every day. I’m confident we will prevail – we have to.
Britain’s schools are now ranked 23rd in the world. If we want to compete with countries such as China, we need to reform our education system and once again unleash the native talent that made this country great.
Homosexual messages built into school maths lessons for British children as young as FOUR
Young children are to be taught about homosexuality in their maths, geography, science and English lessons, it has emerged. As part of a Government-backed drive to ‘celebrate the gay community’, maths problems could be introduced that involve gay characters.
In geography classes, students will be asked why homosexuals move from the countryside to cities – and words such as ‘outing’ and ‘pride’, will be used in language classes.
The lesson plans are designed to raise awareness about lesbian, gay, bisexual and transsexual issues and, in theory, could be used for children as young as four.
They will also mean youngsters are exposed to images of same-sex couples and books such as And Tango Makes Three, which tells the story of two male penguins raising a chick, which was inspired by events at New York’s Central Park Zoo.
Meanwhile, statistics students may use census data on the number of homosexuals in England.
However critics warn that the drive is an unnecessary use of resources and distracts attention from learning, as British schools tumble down international league tables in maths, English and science. Although the lesson plans are not compulsory, they are backed by the Department for Education and will be available for schools to download from the Schools Out website.
Sue Sanders, from Schools Out, said: ‘All we are attempting to do is remind teachers that LGBT people are part of the population and you can include them in most of your lessons when you are thinking inclusively.’
David Watkins, a teacher who is involved in the scheme, said: ‘When you have a maths problem, why does it have to involve a straight family or a boyfriend and girlfriend? Why not two boys or two girls? ‘It’s not about teaching about gay sex, it is about exposing children to the idea that there are other types of people out there,’ he added.
However, Craig Whittaker, who is a Conservative MP and a member of the education select committee, said: ‘We are too far down the national comparative league tables in core subjects. Teachers should concentrate on those again. ‘This is not about being homophobic, because there are other schemes around the education which support the LGBT agenda.’
John O’Connell, of campaign group the TaxPayers’ Alliance, said: ‘Parents will wonder if this is a right use of funds and time, particularly when we keep hearing how tight budgets are.’
The plans are funded by a £35,000 grant from education quango the Training And Development Agency For Schools. They will be launched in February at the start of LGBT History Month.
A Department for Education spokesman added: ‘These are optional teaching materials. ‘It is for head and teacher to choose the most appropriate teaching resources to help promote equality and tolerance.’
LGBT History Month started in 2005 and has previously focused more on raising awareness of prominent figures said to be homosexual. A list on its website includes Hadrian the Roman emperor and Michaelangelo the Renaissance painter.
UK Government Goes MAD: Plans to Airlift Fish to “Cope With Global Warming”
The British Government appears to have been poisoned with LSD or a similar hallucinogen, and has announced that it will be releasing more than ONE HUNDRED reports on how it intends to cope with global warming.
The first of the reports, due to be released later this week, will lay out plans – apparently in all seriousness – to airlift fish from areas like the lake district hundreds of miles north to Scotland. As The Ministry of Truth reports:
Fish from the Lake District will be moved to cooler waters in Scotland under radical plans – which will be unveiled this week – aimed at coping with climate change.
The first seven of more than 100 reports by government agencies and utility companies will set out how Britain needs to change to cope with hotter summers and wetter winters. They will highlight the risks – and potential costs – of more landslides, buckled railway lines, crumbling water pipes and rising sea levels threatening lighthouses around the coast. Officials say the studies are needed because levels of carbon emissions mean climate change over the next four decades is unavoidable
You have to marvel at the complete circularity of the reasoning presented by this palpably barking mad idea. This is necessary because it’s going to get very hot – and why is it going to get very hot? Because of the amount of carbon dioxide being released.
Thus, even though temperatures in the UK have shown no discernible change from normal, despite Co2 emissions going up and up, the government is spending a fortune in taxpayer’s money to fund 100 reports on how we’re going to cope. Madness.
British public sceptical of all-electric cars
THE electric car revolution is unlikely to get out of first gear any time in the near future, motor dealers in Britain have warned.
The slow uptake is forecast despite the promise of tens of millions of pounds in government subsidies.
Senior figures at the Retail Motor Industry Federation said that battery-driven electric vehicles were causing anxiety over their range, the lack of charging infrastructure in place and because of their cost – starting at about œ24,000 ($38,800) even after a œ5000 government incentive.
Paul Williams, chairman of the RMI, said: “At a meeting with dealer groups last week, I was particularly disappointed at the lack of involvement from the motor industry in general with the retail sector in promoting the case for electric cars to consumers.
“There is a distinct lack of awareness by the consumer of this product group, which, given the opportunity, the motor retailers could enhance substantially.”
Rob Foulston, the RMI’s chief executive, said: “If the range of the average production electric vehicle is only 100 miles (161k), then we are still a long way off a mass market consumer proposition.
“The long-awaited battery-driven Nissan Leaf is due in dealerships in March and Peugeot’s iOn has already been soft-launched. However, all-electric cars look likely to be superseded by the next generation of plug-in hybrids, such as the Toyota Auris and the Chevrolet Volt.
“These cars use petrol to extend the vehicle range to hundreds of miles. Last autumn, the coalition cut the Labour Government’s pledge of œ230m in support for electric car subsidies to œ43m. It plans to review the scheme next January.
The original Moonbat in 2002
Are you beginning to feel starved? No? Well you will next year, so there! Or so said gorgeous George in 2002. No wonder the Green/Left hate history. George is revealed as yet another false prophet
In a recent article George Monbiot lambasted his opponents (and to be fair, they are legion) for claiming that many of his fellow greenies were anti-human and spouted hate-filled rhetoric. “The great majority of greens are powerfully motivated by a concern for social justice, and recognise that if we don’t defend our life-support systems, humanity will suffer grievously” he wrote sententiously.
Really? Let’s examine that claim. In fairness to Monbiot, rather than picking someone from the green movement at random we’ll restrict ourselves to people whom Monbiot himself relies on when writing his articles.
Back in 2002, Monbiot warned us of a meat-apocalypse by as soon as 2012:
Within as little as 10 years, the world will be faced with a choice: arable farming either continues to feed the world’s animals or it continues to feed the world’s people. It cannot do both.
The impending crisis will be accelerated by the depletion of both phosphate fertiliser and the water used to grow crops. Every kilogram of beef we consume, according to research by the agronomists David Pimental and Robert Goodland, requires around 100,000 litres of water. Aquifers are beginning the run dry all over the world, largely because of abstraction by farmers.
And it wasn’t just eating meat, that Monbiot was demanding we ditch – “vegetarians who continue to consume milk and eggs scarcely reduce their impact on the ecosystem”. As the title puts it, “Vegans were right all along”. Give up meat, eggs, cheese, butter and milk, or we’ll all be starving within as little as ten years, he warned.
100,000 litres of water to produce 1 kilogram of beef is a big claim – so who is Monbiot relying on for his argument here? He cites “agronomists Robert Goodland and David Pimental”. And who is David Pimental? He is a professor at Cornell University, an environmentalist and, according to the SPLC and others, an anti-immigrant campaigner.
The anti-racist organisation, the Center for New Community, notes that Pimental was at the centre of attempts to comandeer the respectable conservationist outfit, the Sierra Club to turn it into an anti-immigrant organisation:
By the 2004 Sierra Club elections, SUSPS needed to elect only three additional candidates to the board in order to control the organization and impose its anti-immigration plank. Its three main candidates were Richard D. Lamm, national advisor to Tanton’s Federation for American Immigration Reform (FAIR); Frank Morris, board member of Tanton’s Center for Immigration Studies; and David Pimental, board member of the Carrying Capacity Network whose president, Virginia Abernethy, described herself as a “white separatist.”
Pimental is an advisor to “Progressives for Immigration Reform” as well as being a board member of the Carrying Capacity Network, which the Southern Poverty Law Center (SPLC) describes as a “hate group”. Pimental was listed by the SPLC in its report “Greenwash: Nativists, Environmentalism, and the Hypocrisy of Hate” as one of the “Key Groups and Individuals” of concern.
Pimental gladly works with racists, Malthusians and people who defend Holocaust deniers -is this the sort of person Monbiot really wants to be getting his information from?
No matter, because as 2012 meat-apocalypse day drew near, Monbiot threw his ideology into reverse gear and reversed his edict on veganism. Echoing the contemptuous “Let them eat cake” quip of pre-revolutionary France, Monbiot now decreed “let them eat meat” – and admitted that his 2002 claim on the end of meat-eating was total BS:
Like many greens I have thoughtlessly repeated the claim that it requires 100,000 litres of water to produce every kilogram of beef. Fairlie shows that this figure is wrong by around three orders of magnitude. It arose from the absurd assumption that every drop of water that falls on a pasture disappears into the animals that graze it, never to re-emerge. A ridiculous amount of fossil water is used to feed cattle on irrigated crops in California, but this is a stark exception.
At least Monbiot admitted that in this case he was wrong “by about three orders of magnitude” – hopefully when the global warming theory is finally seen to be bogus he will feel capable of issuing a similar mea culpa.
Monbiot is not a racist. He is not even a neo-Malthusian. But in his eagerness to impose austerity on everyone, he gets taken in by the arguments of those who are. It’s why he earnestly believed the patently ludicrous claim that it took 100,000 litres of water to make 1 kilogram of beef, a risible claim that anyone not ideologically blinded would instantly dismiss as nonsense, as he himself was forced to do as 2012 approached.
More HERE (See the original for links)
Defending moral autonomy against an army of nudgers
Frank Furedi slams the ‘choice architects’ who bypass public debate in their zealous effort to reshape our minds and bodies
This year, spiked will be upping the ante in our culture war against the new politics of nudging and in defence of individual autonomy. In this new essay, Frank Furedi takes the nudge-obsessed authorities to task for denigrating our right to make moral choices.
I have always had a visceral revulsion for the idea of ‘false consciousness’. As a student radical in the early 1970s, I was continually being warned about the dangers of this social disease. Many on the left argued that the general public, specifically the working classes, did not understand what their real interests were. The self-appointed carriers of true consciousness pointed to certain areas of plebian behaviour, such as seeking solace in football or voting for the UK Conservative Party, as proof of the widespread nature of ‘false consciousness’.
Herbert Marcuse’s claim that people are driven by ‘false needs’ was continually talked up by the apparently enlightened minority, who presumed to know what the ‘real needs’ of their fellow citizens were. In recent decades, this outlook has come to be astonishingly influential within the professional middle classes, particularly in the United States. Consider the writings of the American journalist Thomas Frank, who frequently espouses an updated version of the idea of false consciousness. His 2004 book, What’s The Matter With Kansas?, exemplifies this patronising outlook; it concludes that ‘people getting their fundamental interests wrong is what American political life is all about’.
In recent years, the idea that people are too thick to know what is in their best interests has influenced and shaped policymaking on both sides of the Atlantic. In one sense, this diagnosis of intellectual poverty among the masses is simply a new expression of an old idea. Nineteenth-century social engineers regarded the targets of their work – the masses – as both irrational and easily suggestible. In the twentieth century, psychologists and advertisers argued that the world would be a better place if they could successfully manipulate the public to act in accordance with the latest ‘scientific’ insights. They expressed their assumption of moral authority openly and with little concern for insulting people’s sensibilities.
So in 1941, Dr Ernest Dichter, the president of the Institute for Motivational Research, stated that ‘the successful ad agency manipulates human motivations and desires and develops a need for goods with which the public has at one time been unfamiliar’. Today, manipulating human motivations remains a key aim of both the public and private sectors. Only now, the old-fashioned motivational techniques have been given a new boost by so-called behavioural economics and evolutionary psychology.
In the twenty-first century, motivational research has been embraced by governments that have effectively given up on the idea of morally or politically motivating their citizens. Policy advisers frequently complain that citizens refuse to acknowledge the wisdom that they are offering and instead adopt forms of behaviour that are antithetical to expert advice. In effect, these policy advisers, along with government officials and politicians, have concluded that the time for open debate and argument is over, since arguing with people who act irrationally is pointless. They claim that what is now required are new techniques of behaviour management and motivational manipulation, in order to encourage the public to act in accordance with best practice.
That is why both the British and American governments have embraced the doctrine of ‘nudge’, as most explicitly espoused by the American academics Richard Thaler and Cass Sunstein. Relying on behaviour-management techniques, this doctrine, described as ‘libertarian paternalism’, aims to manipulate people into making choices which the powers-that-be consider ‘right’.
Bypassing public debate
In Britain, a Cabinet Office Behavioural Insight Team, otherwise known as the Nudge Unit, has been busy advising different departments of state about which psychological tricks are likely to achieve the best results. In a report published last month, it explained that the ‘traditional tools of government’ have failed to alter people’s ‘behavioural problems’, and therefore it is spearheading a mission to ‘help the UK government develop and apply lessons from behavioural economics and behavioural science to public policymaking’.
The main justification for displacing the ‘traditional tools of government’ with behaviour-management techniques is the apparently novel discovery that people do not always act rationally. The report states: ‘Many of the most pressing public policy issues cannot be addressed without thinking about the behaviour of individuals. Behavioural science and behavioural economics show us that, very often, we do not behave in a way that we would be expected to if we were perfectly “rational” human beings.’
As it happens, we don’t need behavioural science to ‘show us’ that people behave in ways that violate the dictates of expert advice and sophisticated cost-benefit analysis. We all know that human beings are subject to habit, slothfulness and passion. Some people take pleasure from indulging in activities that come with a health warning or which run counter to the latest expert advice. Sometimes we even display altruistic behaviour that might directly contradict our self-interest.
For centuries, these different forms of behaviour have kept moral entrepreneurs and experts – those concerned with understanding and remoulding our behaviour – in employment. In principle, of course, people who object to certain kinds of human behaviour are entitled to speak out and warn the public about the potential unhappy consequences of such behaviour. In a democratic society, argument and debate about the negative or destructive consequences of specific forms of conduct can help to encourage the flourishing of a vibrant public life. Tragically, however, the aim of today’s ‘libertarian paternalism’ is to bypass public debate and opt for psychological manipulation instead.
Outwardly, some of the techniques of behaviour management proposed by the UK government’s Nudge Unit seem harmless. For example, it boasts about introducing a trial of ‘prompted choice’ for organ donation in order to increase the number of donor registrations. This trial will ask people if they would like to be organ donors when they are applying online for a driving licence. The unit believes that this will significantly increase the number of organ donors.
It may well do that, and in many ways the trial makes perfect sense. However, the premise of this proposal, and of the numerous other nudge proposals, is fundamentally regressive. Instead of opting to have a grown-up public debate about the responsibilities that citizens have towards one other, today’s ruling elite prefers to treat adults as children who need to be prompted and coaxed to do the right thing. This strategy of altering behaviour displaces the political challenge of influencing people through ideas and argument.
Paternalistic behaviour is entirely appropriate in relation to childrearing. Many parents realise that there is little point in arguing with a toddler; it is far better simply to use childrearing techniques that will encourage little Mary to act in accordance with her mother’s desires. However, when similar techniques are used in relation to grown-up citizens, then we really can glimpse the corrosion and ultimately the corruption of public life.
Paternalistic behaviour towards children is seen as acceptable because we presume that parents possess the experience and knowledge that their infants lack. Parents are responsible for their children and therefore are expected to have some authority and control over their behaviour. Infants lack experience and more importantly they lack the capacity for autonomy and moral independence. But things are fundamentally different when it comes to the relationship between government and adults. For a start, it is far from clear where behavioural economists, policymakers and politicians get the moral authority to manipulate people’s behaviour. Experience shows that experts do not always possess wisdom and that ordinary people have very little to learn from them.
Denying us moral responsibility
Advocates of nudging describe themselves as ‘choice architects’ and claim that their policies help people make the right choices. What they mean is that their aim is to construct a scenario where people make the kind of choices that our moral superiors believe to be right. The aim of behavioural-management techniques is to prevent, or at least discourage, people from making the ‘wrong’ choices. In effect, the implicit objective of these techniques is to deprive people of the capacity for making wrong choices. But if citizens are freed from the burden of distinguishing between right and wrong, then they cease to be choice-makers.
Proponents of choice architecture delude themselves into believing that their paternalism is libertarian, that their policies are neither authoritarian nor coercive. In truth, their objectives echo those that have traditionally been associated with totalitarian regimes. Recently, the UK deputy prime minister Nick Clegg casually said that his government’s Nudge Unit could ‘change the way citizens think’. But since when has it been a democratic government’s brief to wage an ideological crusade aimed at altering its citizens’ thoughts? From this viewpoint, governing is not so much about realising people’s aspirations as it is about changing those aspirations so that they correspond to the worldview of the ‘choice architects’.
The project of remoulding the way that people think and act requires the erosion of people’s right to assent to, or reject, government policies. There has to be an implicit elimination of the two-way process of discussion between citizens and their rulers. The UK Cabinet Office paper Mindspace: Influencing Behaviour Through Public Policy explains this in the following terms:
‘“Mindspace” effects depend at least partly on automatic influences on behaviour. This means that citizens may not fully realise that their behaviour is being changed – or, at least, how it is being changed. Therefore, there may be little opportunity for citizens to opt out or choose otherwise; the concept of “choice architecture” is less use here. Any action that may reduce the “right to be wrong” is likely to be controversial.’
The authors of Mindspace make it quite clear that some of their objectives will have to be achieved behind the backs of the electorate. Consequently, the public ‘may not fully realise’ what is happening, and of course there will no ‘opt-out’. In short, citizens have no choice but to acquiesce.
The presumption of a public that is powerless to determine its own future is central to the nudge industry, to the project of constraining people’s private preferences through behaviour management. The authors of Mindspace put forward a fantasy which says that government action can ‘augment freedom’ by acting as the ‘surrogate willpower’ of the populace. A government that substitutes itself for the exercise of human free will clearly has very little attachment to the idea of freedom. As the American political theorist Alan Wolfe warns us, ‘under the rules of liberal paternalism, all power goes to the choice architects’.
Four compelling reasons to reject nudging
There are three moral reasons and one practical reason for saying no to the new politics of nudging.
1) It denigrates moral independence
The German philosopher Immanuel Kant argued that the capacity to make choices about one’s life is central to the development of moral autonomy. In his famous statement What is Enlightenment? (1784), he argued:
‘It is so easy to be immature. If I have a book to serve as my understanding, a pastor to serve as my conscience, a physician to determine my diet for me, and so on, I need not exert myself at all. I need not think, if only I can pay: others will readily undertake the irksome work for me.’
As far as Kant was concerned, it was preferable to make a wrong choice through the exercise of moral independence than to follow the ‘right’ advice. Why? Because through the exercise of moral autonomy people gain the experience that is necessary for maturity. An autonomous person is presumed to possess moral independence, in other words to act with moral responsibility. Through the exercise of autonomy, people can develop their personality through assuming responsibility for their lives. The cultivation of moral independence requires that people are free to deliberate and to come to their own conclusions about how best to live.
2) It erodes our capacity to make judgments of value
A central virtue for Aristotle was phronesis. Phronesis is difficult to translate into English. It means the capacity to exercise judgment in particular circumstances. According to Aristotle, making judgments and choices is the precondition for virtuous behaviour. So telling a colleague something they don’t want to hear may in some circumstances express the virtue of honesty and in other circumstances spring from the vice of boasting. It is in the very act of making moral choices that we develop the virtue of phronesis. That is why judgment cannot be left to choice architects. Phronesis is not something that can be outsourced to an expert – it is a virtue that we need to learn for ourselves, and it is possibly the single most important virtue when it comes to pursuing and conducting a good life.
3) It devalues the private sphere
Nudging encourages the colonisation of private life as our personal conduct becomes the target of the behaviour-management industry. One of the most significant gains of liberalisation in recent centuries was the development of the idea of the private sphere. The seventeenth-century English philosopher John Locke was a key architect of this idea. Locke claimed that government has no business controlling people’s beliefs and personal behaviour. He recognised that moral development required that people should have the freedom to behave in accordance with their beliefs and emotions. Sadly, today, individual behaviour is no longer treated as a private matter by government. And the more that governments become incapable of dealing with the challenging issues thrown up in the public sphere, the more they will opt for the quick-fix solution of manipulating individual behaviour instead.
4) It empties out public life
As tools of public policy, behaviour-management techniques rarely achieve positive results. Decades of experience show that the billions of pounds spent on parenting classes, sex and drugs education and early-intervention programmes fail to have the desired results. Why? Because social problems are only in part the outcome of individual behaviour.
Individual behaviour is mediated through cultural and moral norms and is influenced by social circumstances. And yet the raison d’être of nudging is to avoid engaging with the cultural, moral and political questions that dominate people’s lives. That is why one can predict with the utmost certainty that the Behavioural Insight Team’s plans for reducing teenage pregnancy rates, for example, will not work. The assumption that teenage mothers-to-be are akin to rats in a laboratory will founder on the rocks of cultural and social realities. However, provide teenagers with greater opportunities for a better life – in short, think about the bigger social picture – and then watch pregnancy rates drop.
The most regrettable consequence of the nudge industry is its stultifying effect on public debate and political life. No doubt its advocates mean well. But in encouraging the manipulation of people’s imaginations, they corrupt the very meaning of public life.