Questions for the Secretary of State for Health - Tuesday 25 January 2011

Briefing to MPs concerned for the future of the NHS

As the Secretary of State for Health appears before parliament today, members may be interested to note that he has taken no action to ensure that the ban on the use of expensive telephone numbers by NHS bodies and GPs is effectively introduced and enforced.

Will the new "patient centred" NHS allow patients to pay extra for access to NHS services if they do not vote with their feet by choosing alternative GPs and hospitals?

•	A number of NHS bodies continue to use expensive 084 numbers after the supposed ban came into effect on 21 December 2010.
•	Very many NHS GPs intend to continue using their expensive 084 numbers after the deadline passes on 31 March 2011.
	This is commonly on the advice of the BMA, which suggests that they rely on false guidance from an interested commercial party to avoid their direct duty to respect the terms of their NHS contract.

These NHS service providers, and those who regulate their activities, are all in breach of their duty under the terms of the Health Act 2010 to have regard to the terms of the NHS Constitution.

If a patient's "right" to choose how much they pay for access to NHS treatment is more important than strict adherence to the principles of the NHS, then we have publicly-subsidised healthcare, rather than a National Health Service.

This relatively modest matter of telephone numbers presents the Secretary of State with an ideal opportunity to demonstrate where he stands on this issue. He, and the government as a whole, may be judged by the way in which he acts to deal with this current situation.

Many PCTs are already losing the capability to enforce the terms of GP NHS contracts. A clear statement from the Department of Health is needed if the principle of "free at the point of delivery" is to be retained.

Message to MPs brought into the fight to eliminate NHS telephone Service Charges

This posting simply contains the draft and circulation of a circular letter to MPs. Supportive comment is posted here.

Draft of email message sent to MP's

This message is offered as a briefing, and suggests action that you may wish to take on behalf of your constituents.

According to my records, obtained from the NHS Choices database some time ago, there are 5 or more NHS GP surgeries located in your constituency using expensive "Business Rate" 0844 telephone numbers - they are listed below.

Patients who call them pay a Service Charge of 5p per minute in addition to the Access Charge applicable according to their chosen telephone tariff. Ofcom is currently consulting on proposals to require users of such numbers to openly declare this Service Charge, from which they and their telephone service provider benefit. Ofcom also proposes separate declaration of the Access Charge - currently ranging from a call setup fee of 11.5p to a surcharge of 35p per minute.

Clearly any such Service Charge is forbidden by the terms of the NHS Constitution. When the Ofcom proposals are implemented, the unacceptability of this use of 084 telephone numbers (along with many other examples) will become transparent.

The GP contract with the NHS was amended last year to give GPs until 31 March 2011 to cease use of telephone numbers that are more expensive to call than an equivalent call to a geographic number. Calls to these 0844 numbers are invariably more expensive, the only exception being some cases where a caller would face an excessive penalty charge for making a call to a geographic number outside the terms of their selected Call Plan, which could be greater than the cost of calling a Business Rate number. I cannot believe that there is any surgery where all of its patients find themselves in this unusual position, so as to provide a perverse justification for the application of a Service Charge.

Many surgeries claim that they need to retain a non-geographic telephone number to support their telephone system, for which they have committed to a long term contract. There is no need for them to cancel any such contract. All network telephone services providers permit migration from a 0844 number to the equivalent (Geographic Rate) 0344 number, even within the term of a contract for network telephone service. The only cost incurred in such a change would be due to the loss of revenue from patients - revenue which is being obtained improperly and must now be foregone.

Very few GPs have taken the action necessary and changed their telephone numbers during the months that have passed since the contract revisions were introduced and notified to them. The BMA GPC has advised them to retain their 0844 numbers, as it holds the view that NHS patients should meet the costs of improved NHS services, according to the quality of service provided. To evade the intended purpose of the contract changes, which it negotiated, the BMA GPC advises members to rely on false assurances from system providers regarding the cost of calling.

The Department of Health has indicated that it is not offering any support to PCTs, nor does it intend to take any action of its own, so as to ensure that use of these expensive telephone numbers is ceased.

You may therefore wish to make representations to your PCT, on behalf of your constituents or join me in seeking to draw national attention to this issue.

Now that Ofcom has revealed the true situation with these numbers, the Department of Health should no longer be hiding behind misleading and false information that it has obtained from some unreliable source - you may also wish to call Ministers to account for the lack of clear guidance on this matter. It is quite absurd for every practice and PCT to have to go through exactly the same process of looking up nationally published tables of telephone charges, when the conclusion should be the same in every case - all 084 numbers are more expensive to call than Geographic Rate numbers, apart from a few specific anomalous and perverse cases.

Regardless of how parliament may decide that the NHS is to be managed most effectively, I would see it as vital that its fundamental principles, e.g. the delivery of NHS services without providers levying charges on patients, are maintained. The way in which this particular issue of principle is resolved can be used in consideration of the provisions of the coming Health Bill and will help our understanding of how (what may continue to be known as) the NHS will develop in future.

Further details and references for published items relating to this message are given in my blog posting - MPs brought into the fight to eliminate NHS telephone Service Charges. There is also a link to the draft of this circular message with a full circulation list.

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The surgeries referred to above are as follows:

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Circulation

MP	Constituency	GPs
David Anderson	Blaydon	5
Hilary Benn	Leeds Central	5
Nicholas Boles	Grantham and Stamford	5
David Burrowes	Enfield, Southgate	5
Yvette Cooper	Normanton, Pontefract and Castleford	8
Nicholas Dakin	Scunthorpe	7
Justine Greening	Putney	7
William Hague	Richmond (Yorks)	5
Margaret Hodge	Barking	6
Martin Horwood	Cheltenham	9
Jessica Lee	Erewash	5
Phillip Lee	Bracknell	5
Edward Leigh	Gainsborough	5
Brandon Lewis	Great Yarmouth	5
Andrew Love	Edmonton	5
Karen Lumley	Redditch	6
Jason McCartney	Colne Valley	5
Karl McCartney	Lincoln	5
Anne Milton	Guildford	6
Greg Mulholland	Leeds North West	6
Andrew Murrison	South West Wiltshire	6
Andrew Percy	Brigg and Goole	8
John Redwood	Wokingham	5
Linda Riordan	Halifax	7
Barry Sheerman	Huddersfield	5
Alec Shelbrooke	Elmet and Rothwell	7
Marsha Singh	Bradford West	6
Dennis Skinner	Bolsover	5
Henry Smith	Crawley	8
Peter Soulsby	Leicester South	8
Andrew Turner	Isle of Wight	6
David Ward	Bradford East	6
John Whittingdale	Maldon	6

MPs brought into the fight to eliminate NHS telephone Service Charges

I have today provided each of the 33 MPs having 5 or more 0844-using NHS GP surgeries in their English constituency with a list of the relevant cases from the table found here - UK GPs using 0844 numbers.

A copy of the draft message, along with the circulation is published here.

The following comments supplement the message, providing links to the related information and further explanation.

1. The Ofcom consultation document.

This explains how call charges for "Business Rate" numbers, including all 0845 and 0844 numbers, have a Service Charge and Access Charge element, which are presently bundled together. It proposes separate declaration of the two elements, by the respective beneficiaries - the Service Provider being called and the call originating telephone company. Under the terms of the proposed regulatory changes GPs would have to make the following statement whenever their 0844 number was quoted:

"Calls to the Surgery are charged at 5p per minute plus your telephone company's Access Charge."

The 5p per minute reflects the current value of the Service Charge from which the Surgery and its telephone service provider benefit. Access Charges levied by the call originating telephone company currently vary from a 11.5p call setup fee to a surcharge of 35p per minute.

2. The revised GMS contract. Clause 29B contains the relevant provisions.

Somehow the Department of Health was persuaded not to correct the error it made in 2004 when it erroneously omitted 084 numbers from the list of proscribed numbers given in clause 29A. In fact, there are no 084 numbers that are not more expensive for patients to call. Some BT and other landline subscribers incur high Penalty Charges when calling Geographic Numbers outside the terms of their selected Call Plan, which can distort the expected natural position.

The requirement to have regard to "the arrangement as a whole" however means that GPs cannot disregard the interests of patients who use mobile telephones, public payphones and Virginmedia landlines, or use BT and other landlines within their agreed terms. The NHS is a universal service and so cannot be provided on the basis that all patients incur service charges for contacting NHS providers by telephone simply because this helps some to avoid a penalty charge for calling a normal number outside the terms of their agreement.

3. Guidance from the BMA GP Committee.

The BMA policy that patients should pay for access to NHS services, according to the quality of the service provided, is stated here clearly. This recommendation was however firmly rejected by the government in 2009. The present government proposes that GPs take over responsibility for the local provision of NHS services "liberated" from central control - there must be concern that this may allow implementation of such a policy, in direct contravention of the first of the rights in the NHS Constitution, as currently drafted.

Having negotiated contract provisions that do not explicitly proscribe use of 084 numbers, the BMA advises that (false) statements from telephone system providers should be used as the basis for claiming (falsely) that some 084 numbers are not more expensive to call.

4. A circular letter from NEG, the primary provider of Surgery telephone systems that are generally funded out of the revenue derived from 0844 telephone numbers.

This false and misleading letter misrepresents the position in several respects.

It suggests that total call charges are set by a system provider, such as NEG. Although the Department of Health was somehow persuaded to believe this falsehood, it is only the Service Charge that is determined by the user of a Business Rate number. The rate of 5p per minute (actually 5.105p with 20% VAT) is selected by nearly all NEG Surgery Line users - this is the highest Service Charge that can be imposed whilst avoiding the classification of "Premium Rate". There is no Service Charge applied to calls to a Geographic Rate number.

The call originating telephone company determines the total charge - at present this includes the Service and Access Charge elements bundled together. The only relevant current regulation is a prohibition on BT from applying an Access Charge at a pence per minute rate to any Business or Premium Rate call. Ofcom proposes to remove this restriction on BT. BT can presently only apply the Service Charge as the pence per minute element, plus the standard call setup fee that it applies to all calls made outside the terms of a Call Plan.

There are many other points of detail in the NEG letter which are simply false, e.g. the suggestion that Ofcom regulates tariffs for calls to geographic numbers (it does not). This clearly demonstrates that NEG has no competence in the area that it seeks to address. NEG is not a network telephone service provider and so there is no reason why it should be able to demonstrate competence or awareness of the cost of making telephone calls. This was seen most clearly in the example of comparative call costs that it offered in its representations to the Department of Health as a response to the public consultation. This failed to prove anything of value, as the example used misquoted and atypical rates from only one highly atypical telephone company (see my lengthy comments on this disgraceful item).

The Department of Health has confirmed to me that NEG is mistaken in its alleged understanding that its assurance about call costs would provide sufficient evidence to demonstrate compliance with the terms of the GMS contract. Given the weight of the pressure from the BMA and NEG, the DH has retreated to a neutral position on this issue, leaving it to practices to satisfy their PCT that they have undertaken proper investigation into the cost of calling them. Enquiries suggest that this is not happening; practices are not properly researching the cost of telephone calls, nor are they confirming that they have the option to change their telephone number whilst retaining their Surgery Line system.

Whilst NEG may pretend to be offering an assurance that the cost of calling a 0844 number is no higher than that of calling a geographic number, such a statement would be demonstrably untrue. Although the letter contains a number of falsehoods and conveys a wholly misleading impression to this effect, the author is very careful to avoid actually making this clearly false statement, although it attributes such a conclusion to the Department of Health.

Further comment

I will be delighted to assist anyone with further explanation on any of these matters, which have been made complex to conceal would must be seen as impropriety. I deeply regret the fact that the Department of Health has once again been drawn into promoting confusion and false information. 084 numbers should have been banned from the NHS in 2004.

Now that 03 (Geographic Rate, but non-geographic) numbers are available, (Business Rate) 084 numbers have no valid use in taxation-funded public services. Ofcom is now at last bringing forward measures that will enable this situation to be recognised more clearly.