Further statement by the Health Minister

Seven days ago I presented 5 questions to Mike O'Brien, Minister of State (Health Services) regarding the announcement "NHS TO BAN PREMIUM RATE CHARGES".

I stated that in the absence of the necessary clarification and explanation, I would draw the conclusions stated below. I am still awaiting a reply and record these conclusions for now. I will adjust or withdraw them as necessary when a reply is received.

1. The announcement is rendered meaningless by the indication that use of revenue sharing 084 telephone numbers by local GPs and Hospitals will not be banned. Many of those who call them incur a charge greater than that of calling a normal landline number. Changes to the GMS contract and directions to NHS PCTs and Trusts cannot affect these premium charges. Use of 084 numbers would have to be banned in effect, regardless of the intention, for the announcement to have any meaning. The BMA's welcome of the announcement as indicating "Changes to charges for 084 numbers" has not been challenged or disputed, despite the fact that there is no basis for such an assumption in the DH statement.

2. The announcement that "The use of phone numbers that charge the public or patients a premium rate to contact the NHS are to be banned in England" is untrue. The ban will only cover local GPs and Hospitals. It will not cover providers of NHS dentistry, NHS pharmacy, nationally provided and contracted NHS services, nor the many other locally provided and contracted NHS services that cannot be described as being GPs or Hospitals.

3. There are good reasons for NHS Direct not undertaking the trouble and expense of a complete change of its 0845 4647 number, as the number is likely to be phased out shortly. I have long been suggesting that the alternative 0345 4647, which is set up ready and waiting, should be brought into use in parallel so that many callers could at least have the possibility of avoiding a premium charge, even though some would inevitably suffer it. This is not to be announced. This means that either NHS Direct itself, or BT Global Services, as claimed by NHS Direct, will continue to benefit from the full £1 million a year of subsidy provided at cost to callers because this alternative, although in use and working, is not connected.

4. The Department of Health implicitly suggests that all telephone subscribers should fund the revenue share provided to users of 084 numbers, by there being no difference in call charges between these and ordinary landlines. Any NHS provider that did not avail itself of the benefit of this extra funding would therefore be wasting money. As it is extremely unlikely that telephone companies could offer special rates for calling NHS providers, this would have to apply to all users of 084 numbers. In time, everyone who did not wish to incur extra cost by having an unsubsidised geographic number would choose 084. This bizarre suggestion has not been properly explained and remains on record to be seen as the nonsense that it must be.

5. The Minister is invited to respond to my suggestion that we have seen an appalling, but typical, example of populist politics being applied by aggregating a variety of misled and misleading subjective opinions presented in a consultation to come up with an unworkable solution. A consultation is not some exercise in democracy, although it may potentially be used to confirm the existence of strong opinions. Its primary purpose is to obtain such useful advice and information as may be available from those with an interest, so as to inform a careful determination of the policy to be pursued.

This matter must be addressed properly. I look forward to receiving confirmation that it will be.

NHS TO BAN USE OF PREMIUM RATE CALL CHARGES

The Department of Health has spent over 18 months looking into the issue of use of 084 numbers in the NHS and on Monday 14 September 2009 announced:

NHS TO BAN USE OF PREMIUM RATE CALL CHARGES

This was a considerable victory for campaigners, including myself, as it acknowledges the key point of principle:

NHS services are “free at the point of need”. The true and fair cost of providing them must be carried by taxpayers, not patients.

(As I am not totally obsessed with telephones, I can write at length about how this principle applies to issues such as car parking, retail concessions in hospitals, prescription charges, dental fees, eye tests, non-approved drugs, personal care, privatisation, local control and the price paid to one’s telephone company for connecting a normal call, but will not do so in this posting.)

I have had a few days to consider this announcement and the reactions to it.

Everyone applauds the announcement

Some who responded to the public consultation that informed the reported outcome expressed the view that patients should pay NHS providers for access to NHS services. I have however seen very little serious public comment to this effect.

We in the UK value the principles of our NHS and the fact that it has largely survived for over 60 years. We are therefore rightly quick to criticise any failure in its delivery. It seems that very few have spotted that what is stated in the detail of this announcement is undeliverable.

In particular, I have noted support for the announcement from those who have previously defended the use of revenue sharing 084 telephone numbers by NHS providers. I refer to Dean Rayment, Managing Director of Network Europe Group, which provides systems to around 1,000 GPs partly funded by the revenue share earned on 0844 numbers, and Richard Vautrey, Deputy Chairman of the General Practitioners Committee of the BMA, also a contented customer of NEG in his Leeds practice.

There has been no announcement from any telephone company.

Why does everyone agree

The absence of any comment from residential telephone service (fixed and mobile) providers is highly significant. It is they who determine the charge they impose on callers.

When placing calls to 084 numbers they have to share their revenue with the recipient's telephone company. This is at a fixed rate, according to the particular "type" of 084 number, which was selected by the person being called (one hopes with an understanding of what they were doing, and the likley effect). It is therefore quite reasonable and proper for them to charge the caller a premium, i.e. more than they charge when they do not have to give away some of their revenue.This is indeed mostly what happens. There are a few cases where this additional cost is not recovered directly from the caller, but from customers in general through other charges; I do not see this indirect way of distributing the cost of revenue sharing as particularly desirable.

Some seem to believe that all residential telephone service providers, and indeed all of their customers, will be affected by this announcement. It is implied that they will all have to distribute the cost of calls to (some) revenue sharing numbers, rather than apply it as a charge to the caller. Many have reported that there will be changes to telephone tariffs. There is no firm basis for this false and misleading suggestion.

The Department of Health has announced that:
“The ban means that GPs and other NHS organisations remain free to use 084 numbers, providing patients are not charged more than a local rate number.”

• This leads Dr Vautrey to comment “we’re pleased that the phone companies who supply these lines to practices have agreed to ensure that their tariffs are in line with local charges”.

• Mr Rayment announces that “new legislation will be introduced to ensure that local patients do not pay more than the cost of a local call to contact the NHS”.

• The Department of Health explains, “The ban will be enforced through proposed changes to the GP contract (in consultation with the British Medical Association’s GP Committee), and the issuing of Directions to NHS PCTs and Trusts. These changes will be put in place as soon as practicable.”

As these three parties have been involved in intense discussions about this matter over the last few months, it is interesting that they hold completely different views about how a ban on premium call charges will be implemented, whilst allowing use of 084 numbers to continue. To put it simply, what is proposed (in detail) –

CANNOT BE DONE.

The Department of Health’s proposed changes to the GMS contract cannot bear on telephone companies.

The BMA has failed to respond to an invitation to offer evidence that the agreement it refers to exists, after this was denied by a number of telephone companies.

NEG is right to suggest that new legislation would be required to fix telephone call charges in this way, however the only legislation referred to by the DH is the Statutory Instrument that will contain the revised standard terms for the GMS contract.

Ofcom has confirmed that any attempt at statutory price-fixing of the type that would be necessary to actually enforce the ban as it is described would fall foul of EU competition law. (Ofcom has been trying something similar with 0870 numbers over the last 2-5 years. This has now resulted in the fact that many, not all, telepohone companies still charge a premium for calling 0870 numbers, even though the receiving party no longer benefits. Ofcom was only seeking to neutralise the position. In this case the DH appears to be trying to be even bolder, going one step further, by seeking the precise opposite of what has been achieved with 0870.)

It is my belief that attempts to resolve this situation are still ongoing and these announcements are simply part of a continuing negotiation process. Each party is trying to ensure that the blame for the expected failure falls elsewhere.

What happens now

Some NHS bodies may abandon use of 084 numbers as they will be advised, by me if no one else, that some callers are incurring premium charges.

GPs will probably stick to the letter of their contracts, ignoring representations from patients on the basis that the necessary changes have not yet come into force and telling them to complain to their telephone company.

NEG will undoubtedly resume signing up GPs to seven year contracts. It can now use the announcement that use of 084 numbers will not be banned to remove the doubt that has hung over it for the last 3 years.

If the proposed discussions between the DH and the BMA on the GMS contract go ahead, it is likely that the BMA will be happy to accept a clause prohibiting premium telephone charges, so long as licence to use 084 numbers is clearly in place. No GP could be held contractually responsible for the actions of telephone companies, as these are totally outside its control.

Is this a Political issue

Some may draw comfort, or seek to take advantage, from this failure by the government. Making an announcement of a change that cannot be implemented should be seen as worse than the years of inaction that followed its previous false announcement that 084 numbers offer patient a "guaranteed low call rate".

The NHS belongs to the nation, to us all, not to any government that happens to be in power for a period of up to five years. The current Ministers of the Crown in the Health Department are but the temporary custodians of a national asset. They have a duty that extends beyond their partisan desire to secure re-election (or not, as the case may be). Similarly, all those accepting election to serve as Members of Parliament have a duty to all their constituents in respect of the affairs of the nation that extends far beyond a wish for them to be served by the best possible candidate following the next election.

All the major parties are committed to the NHS and its principles. The key principle of “free at the point of need” is under threat of being permanently undermined. There is very little room for partisan Politicking here.

What do we do

The apparently worthless announcement must be strongly challenged now. It must be corrected or explained.

The issue has been returned to the public domain. The question of what is to happen must be resolved there, before necessarily private negotiations on how it may be achieved can be resumed.

Those of us who care for our NHS must use whatever resource we have to prevent these negotiations from failing to achieve the intended and declared objective.

The ban must go ahead in a way that works.

Briefing to Liberal Democrats on telephone numbers used by public service organisations

The following is the text of a message sent to leading Liberal Democrats.

I was concerned to read John Thurso’s proposals for a “Universal Service Code” for “organisations providing a service to the public”, in particular the suggestion that there must be a commitment to

“Make their customer service phone number free to call from both mobiles and landlines”.

This suggests that LibDems do not understand the issues on which I am campaigning. By proposing an excessive response to a genuine issue, it distorts debate by making it too easy to reject the arguments for change. I would propose a commitment to

not impose charges on telephone callers for access to public services

(I have subsequently been directed to the relevant policy paper).

Free from mobiles!

There are presently no standard arrangements in place for making calls to customer service lines free to call from mobiles. At present, any organisation wishing to achieve this would have to negotiate some sort of deal with each of mobile companies. A special arrangement exists for mobile companies to waive their charges on calls to clearly defined “helplines”, however this voluntary scheme could not be extended to cover all customer service calls.

The costs of mobile telephony are presently reflected in call charges, rather than line rental. The simplest way to address the problem of these high call charges would be to transfer the costs onto line rental charges, but think of the implications! This proposal suggests that these costs should be carried by customers in general in the private sector and taxpayers in the public sector, rather than those who use mobile phones.

In the absence of any suggestion about how free calls from mobiles could be achieved, it is foolish to suggest that organisations be required to commit to something they would have great difficulty in achieving, even if they were willing to do it and it was the right thing to do.

Who pays for what?

I believe that in most cases it is reasonable for the caller to incur the cost of a “normal” call from their selected telephone service provider when contacting an “organisation serving the public”; I include providers of “free at the point of need” NHS services. Incidental third party costs are invariably incurred when accessing services, e.g. the bus or taxi fare, or cost of parking in a public car park, when attending an appointment, the cost of a broadband service to access an organisation online and the cost of a stamp when writing. Whether or not unlimited “normal” calls are inclusive in one’s telephone package, I see no reason why these costs should invariably be subsidised by taxpayers or other customers.

The issue on which I am campaigning is use of “revenue sharing” 084x telephone numbers. These cause the caller to incur a premium charge (in one way or another) to subsidise the cost of providing the service. I believe that the “neutrality” offered by 03xx or ordinary geographic numbers, whereby the caller incurs only their own incidental costs, is quite appropriate for most cases and that nothing more should be demanded.

The essential point is that callers should not be subject to a charge imposed by the “organisation serving the public” (through use of a revenue sharing number), except where this is a justified and fully explained service fee. That is very different from saying that organisations should pick up the bill for whatever type of telephone service the caller happens to use.
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Expecting an imminent announcement by the Department of Health

Pending an imminent announcement of the outcome of the consultation by the Department of Health into a proposal to ban use of revenue sharing 084 telephone numbers in the NHS, I have circulated the following comments indicating my hopes and expectations for this announcement.

I must express my hope that it will properly addresses the issue covered in my comments - NHS GPs using 0844 numbers can change to 0344 [1]. The other key issue to which I have repeatedly referred is the need for NHS Direct, unable at this time to comply with a ban, to immediately introduce 0345 4647 as an alternative working in parallel with 0845 4647 [2].

I will react as best I can to whatever is said, hoping to do so in a spirit of congratulation and rejoicing at a reaffirmation of the principles of the NHS, as they apply to all providers of NHS services. We will await a definition of what is understood to be “NHS services” and how far any ban will extend to those who also provide other services, such as NHS Hospitals, GPs, Dentists and Pharmacies [3].

A ban on the use of 084 telephone numbers must address the simple fact of revenue sharing, which applies to them all. It must not be confused by reference to the often perverse means by which telephone companies raise the money to provide the revenue share through complex tariff structures. Any repetition of the concept of “the cost of a local call”, as used in current guidance, would cause any regulatory prohibition to be utterly worthless as this has no meaning in general terms.

The relative costs of different types of calls vary between providers, between different tariffs and even between times of the week and day. With reference to one widely used tariff, calling any revenue sharing number would be cheaper for some than a local call for some during weekday daytimes, but not in the evening or at weekends, yet for others it would be invariably much more expensive. On some tariffs, subscribers benefit from free calls to local numbers at all times, but may need to access NHS services outside their “local” telephone charging area. I do hope that we are not going to have to get into this type of nonsense [4].

Given that the Department of Health has been working on this issue for over 18 months, since an “evidence gathering” exercise began in January 2008, there can be no excuse for not getting all of the detail right. One must hope that the four numbered specific matters to which I refer above have not been overlooked, and if so, that they will be addressed before a public statement is published.