Julia Neuberger: 'A nudge in the right direction won't run the big society'

Baroness Julia Neuberger at the West London Synagogue. Photograph: Sophia Evans for the Observer

Ever since her appointment a year ago to head the House of Lords inquiry into behavioural change, Baroness (Julia) Neuberger has noticed that her grocery shopping habits have altered. "I've been looking at the labels very closely," she says. "Takes much longer. The usual thing of throwing it all into the trolley – no!"

The labels that Neuberger has been examining with such intent are designed to provide customers with colour-coded guidance on the amounts of salt, sugar and fat within each product. It is hoped that by using the "traffic light" system to highlight the more harmful ingredients, in say, a chocolate Hobnob, members of the public will be persuaded to eat more healthily.

It is an example of "nudge", the belief, promulgated by two American professors in a 2008 book, that human beings can be encouraged to make life-improving choices through incentives and social cues rather than through regulation and government legislation.

The theory – outlined by Richard Thaler, professor of economics and behavioural science at Chicago Graduate School of Business, and by Harvard law professor Cass Sunstein – has been eagerly adopted by David Cameron, who set up a behavioural insight team last October. The unit was charged with introducing nudge to the "big society" or, as the coalition agreement puts it, "finding intelligent ways to encourage people to make better choices for themselves".

It was hoped issues such as the obesity crisis could be tackled by nudges – clearer food labelling, placing fruit not chocolate near supermarket checkouts – rather than by heavy-handed (and expensive) state intervention.

The problem, as Neuberger saw it, was that there was "precious little" evidence to show that nudge worked beyond a purely individual basis. So the Lords set up a subgroup of its respected science and technology committee to examine the issues. After 12 months of research, 148 written submissions and evidence from 70 witnesses, the report will be published on Tuesday. It will make uncomfortable reading for Cameron because, according to Neuberger, nudging people is not normally enough.

"Basically you need more than just nudge," she says, when we meet in the Lords. "Behavioural change interventions appear to work best when they're part of a package of regulation and fiscal measures," she adds, putting down her papers and a large canvas bag from Daunt Books in Hampstead. She notices me looking at the bag. "I use it for everything! I don't like briefcases."

The difficulty with nudge theory, she says, is that "all politicians love quick fixes. I mean, they look at very short time frames. I think one of the problems with all of this is if you really want to change people's behaviour it takes a very long time … you have to look at a 20- to 25-year span before you get a full change of behaviour."

As an example, Neuberger points to the efforts to persuade people to wear seat belts in the 1970s, which incorporated an advertising campaign and legislation. "So it was a whole series of measures that did eventually change the climate." Later, she adds: "I think politicians would be well advised to use these sorts of behavioural interventions as part of an armoury."

"Politicians all have a split personality," she adds. "On one level, they engage their brains and they know perfectly well that things do take quite a long time to happen. On the other, they've got a very short time frame: they want to get re-elected, they need to make a mark. They have been, I think, very persuaded by the work of Richard Thaler and Cass Sunstein. I think they found that very appealing because, broadly, they prefer the idea of using behavioural change interventions to legislating or using fiscal measures."

Presumably, part of the appeal is also that, in a time of austerity, nudging costs much less than legislating? Neuberger nods. "There needs to be a huge amount of work, which I think the government will eventually have to pay for."

Did she enjoy Nudge when she read it? "It's quite engaging," she replies, not entirely enthusiastically. "It's quite compelling as a book but, like all of those sorts of book – like The Tipping Point, like Bowling Alone, those books that have made quite an impact on politicians – I would say, you want to stand back for a few minutes and say: 'But, but, but'."

From September, Neuberger will become a full-time rabbi at the West London Synagogue and going on to the crossbenches. "Because I've got members of the congregation of all religious faiths and none, I don't want people to think I'm preaching Lib Dem politics from the pulpit."

She has clearly enjoyed heading the select committee – "it's been a fantastically good experience" – but there is one thing she won't miss. "There was a huge amount of written evidence," she says, holding her hands at least 10 inches apart. "I mean, it's like that – absolutely vast. It's been with me backwards and forwards to Leamington Spa [where she lives with her husband, Anthony], but it always has to go in the car because it's just too much to lug about." She pauses, then adds with an impish grin: "Even in my Daunts bag."

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NHS hospital wins right to challenge closure of children's heart surgery unit

The Royal Brompton is one of three London hospitals with a children's heart surgery unit and the only one to face closure. Photograph: Dominic Lipinski/PA Archive/Press Association Ima

The Royal Brompton hospital in London has won permission for a judicial review of what it argues are "fundamentally flawed" NHS plans that threaten to close its children's heart surgery unit.

The hospital stands to lose its unit under proposals to reduce the numbers of hospitals carrying out children's heart surgery from 11 to six or seven. Experts agree that children will be safer if heart surgery is concentrated in fewer, larger units where surgeons are more experienced.

But the proposals put forward by the "Safe and Sustainable" NHS review, run by a joint committee representing all primary care trusts, have outraged the Royal Brompton, which is one of three hospitals in London undertaking this very specialised surgery and the only one earmarked for closure in the capital. Their services would be merged into those of Great Ormond Street and the Evelina children's hospital.

The Royal Brompton and Harefield NHS Foundation Trust has now been granted permission to proceed to a full judicial review later this year by Mr Justice Burnett at the high court. It argues that the process leading to the public consultation (which has just ended) on a number of different closure options was fundamentally flawed.

"This is extremely good news, first and foremost for patients," said Bob Bell, chief executive of the trust. "We have always supported the principle that all babies and children who undergo heart surgery deserve the best possible care, but decisions about the future of such vital services have to be made on the basis of sound, objective evidence and the decision-making process must, of course, be entirely transparent. These conditions were not met by those responsible for this review."

However, the trust did not succeed in getting the reorganisation stopped in its tracks. Mr Justice Burnett said it "is desirable for the joint committee to continue its work of improving paediatric cardiac surgery for the nation". It was with "some hesitation" that he agreed that the Brompton had an arguable case, he said.

The Brompton claims that the decision to reduce London centres from three to two was not based on any evidence, but was an attempt to ensure London shared "the pain of closure" with other units around the country.

The trust also argues that it was not represented on the decision-making body, while the other two London centres were. It says its results are very good and that closure of the heart unit would have a damaging impact on its other services, including adult heart surgery.

Hospital reorganisation plans are invariably hard fought and the Brompton is not the only centre to campaign against the proposed closure of its children's heart surgery unit, but it is the only one to take legal action. Others have sent in mass petitions and MPs from Leeds succeeded in obtaining a debate on the floor of the House of Commons. There have been 70,000 responses to the public consultation exercise, including 20,000 text messages.

Jeremy Glyde, programme director for Safe and Sustainable, said: "The rationale for change is supported by medical experts, professional associations and leading national heart charities. Pooling expertise will help the NHS make further improvements to patient outcomes and deliver a truly excellent service." An independent panel would now look into the Brompton's claim that other services would be damaged if the children's heart unit closed, Glyde said.

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