Carrot or Stick

There has been talk in the Tory leadership contest about fines for people who fail to make their NHS appointments.

Aside from the usual problems of enforcement, collection and proof of valid reason, there is is another issue that precludes implementation until research is done or a trial initiated.

In Haifa, Israel, a group of psychologists conducted a control experiment in order to see if fines would cut the number of late collections from child day-care centres. Counterintuitively, the result was that late collections went up, increasing by double, rather than declining. The problem was not solved and made worse.

The theory was that parents assuaged their guilt at being late by paying what they saw as a fee for the privilege and not seeing it as a fine at all. 

Perhaps, given people put more value on something gained for nothing, a better idea would be to give people £10 in cash on arriving for their appointments - a carrot, rather than a stick, and much easier to manage. It might be rather expensive though. However, every person above 18 could be allocated a certain sum (£50, perhaps) at the start of the year as a benefit, but could stand to lose it all if a single appointment is missed. It would still have the same problems of justifiable proof, however,