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Sunday, 21 August 2011

NHS Bodies in Breach of Directions to uphold the principles of the NHS

On 21 December 2009, the Department of Health imposed "Directions to NHS Bodies concerning the cost of telephone calls".

The Directions

The Directions covered the costs incurred by callers contacting the NHS, which are set by their respective telephone company. All telephone companies have to pay on a "revenue share" when connecting calls to all 084, 087 and 09 numbers. They pass this cost on to callers.

The Directions required that:
"having regard to the arrangement as a whole,
persons will not pay more to make relevant calls to the NHS body
than they would to make equivalent calls to a geographic number

The terms are defined to apply to all NHS patients, with no exclusion from NHS entitlements for those who do not have a landline telephone or are on the social tariff "BT Basic". It is well known and understood that landline providers charge more for calls to 084 numbers than to geographic numbers, for the reason given above.

Because NHS bodies do not themselves provide telephone service to those who call them, the only way that they can comply is by ensuring that the number they choose is never subject to additional charges from telephone service providers.

The Implications in practice

There are some perverse situations where the penalty charge for calling a geographic number outside the terms of a Call Plan exceeds the premium paid to fund the revenue share to the benefit of the receiving party on 084 calls. Exceptional marketing practices, enabled by special regulations which apply only to BT, create further perverse effects with 0845 numbers. These distort the natural situation for some BT customers, but not those on its social tariff "BT Basic".

There is however no doubt whatsoever that all calls from Virgin Media landlines, mobile phones and public payphones to 084 numbers are more expensive than those to geographic numbers. The situation with other providers may be mixed.

The statement "having regard to the arrangement as a whole" can only refer to the fact that NHS services are provided on a UNIVERSAL basis. Entitlement to access NHS services under the terms of the NHS Constitution (i.e. without charge from the service provider) and as specified in these Directions cannot be sacrificed as a result of not calling under certain specific and unusual terms from a particular type of telephone service provider.

Unless the assertions made above can be shown to be false,

The above comments relate to the situation as it is today, has been since 19 December 2009 and is likely to continue (with some of the perverse exceptions likely to be removed) in future. Potential regulatory changes anticipated by the comment "Organisations remain free to use non-geographical number ranges such as 084, providing that patients are not charged more than the equivalent cost of calling a geographical number to do so" HAVE NOT OCCURRED, indeed Ofcom has taken a totally different direction from that which some anticipated. As things have remained, and are likely to continue, there are no 084 ranges or numbers that meet the stated conditions.

For those reluctant to verify the truth of the matter for themselves, I can offer a quotation from a formal Ofcom statement on this matter:

"Only 03 is charged precisely the same as 01 and 02 numbers by all telephone companies.

"084 numbers are frequently charged at a higher rate than a 01, 02 or 03 number. Where they are not charged at a rate above a 01/02/03 number they are, however, frequently not included in a calling plan, thus callers will pay an additional charge for the call."

If anyone wishes to challenge these assertions, I would be most grateful if they would contact me, so that I may consider revising these comments, and attempt to persuade Ofcom to change its position also.


The Directions imposed a deadline of 21 December 2010, by which those already using numbers which cause a greater expense to be incurred must, notwithstanding other possibilities, "vary the terms of the contract or other arrangement". As all telephone companies allow migration from a 084 number to the equivalent 034 number at any point during a contract, there can be no case where the NHS body was unable to comply with this requirement. (Calls to all 03 numbers are charged on the same basis as calls to geographic numbers.)

If anyone wishes to challenge my assertion, with evidence of a case where a request to migrate from 084 to 034 was refused, I would be most grateful if they would contact me, so that I may consider revising these comments.

Many of those listed from research undertaken some years ago have now moved into compliance with Directions. (My publication - NHS bodies using revenue sharing telephone numbers - is now OUT OF DATE.)

There are however many other NHS bodies which are both

    •    defying these explicit Directions, and

    •    continuing to breach their duty under the Health Act 2009 to "have regard to the NHS Constitution".

By benefitting from the subsidy provided by use of revenue sharing telephone numbers, at the expense of patients, they are effectively imposing a charge for accessing NHS services which is not "sanctioned by parliament".

NHS Bodies in breach

I list those seen to be in breach below, along with the name and position of the senior officer responsible, to whom I have written.

Cases where an alternative geographic number is advised alongside the 084 number are annotated "*". Unless it could be shown that sufficient advice is provided to ensure that nobody would ever call the 084 number in error, then the breach remains uncorrected by advice of an alternative number. (I have excluded cases where two numbers are published simply to cover a period of transition.)

Barking, Havering and Redbridge Hospitals NHS Trust0845 130 4204 *Averil Dongworth - Chief Executive
Barnet and Chase Farm Hospitals NHS Trust0845 111 4000 *Mark Easton - Chief Executive
Basildon & Thurrock University Hospitals NHS Foundation Trust0845 155 3111 *Alan Whittle - Chief Executive
Calderdale and Huddersfield NHS Foundation Trust0844 8110101 *Diane Whittingham - Chief Executive
Gloucestershire Hospitals NHS Foundation Trust08454 222 222Frank Harsent - Chief Executive
Luton and Dunstable Hospital NHS Foundation Trust0845 127 0 127Pauline Philip - Chief Executive
Maidstone and Tunbridge Wells NHS Trust0845 155 1000Glenn Douglas - Chief Executive
Mid Yorkshire Hospitals NHS Trust0844 811 8110Julia Squire - Chief Executive
Northumbria Healthcare NHS Trust0844 811 8111Jim Mackey - Chief Executive
Plymouth Hospitals NHS Trust0845 155 8155 *Helen O'Shea - Acting Chief Executive
University College London Hospitals NHS Foundation Trust0845 155 5000 *Robert Naylor - Chief Executive
East Kent Hospitals University NHS Foundation Trust
      (Patient Service Centre)
0845 084 0500Stuart Bain - Chief Executive
Blackpool Teaching Hospitals NHS Foundation Trust
      (National Artificial Eye Service)
0845 60 50 561Aidan Kehoe - Chief Executive
North East London NHS Foundation Trust0844 600 1200 *John Brouder - Chief Executive
Northumberland, Tyne and Wear NHS Trust0844 811 5522Gillian Fairfield - Chief Executive
Marie Stopes International
     (many centres - providing NHS services)
0845 300 3740Di Hendry - Head of Marketing
Spire Parkway Hospital, Solihull
     (providing NHS services)
0845 850 1451Will Knights - Hospital Director
Bradford and Airedale Teaching Primary Care Trust0845 111 5000 *Matt Neligan - Acting Chief Executive
Gloucestershire Primary Care Trust08454 221500Jan Stubbings - Chief Executive
North Staffordshire Primary Care Trust0845 602 6772Graham Urwin - Chief Executive
NHS Direct NHS Trust; Health Advice and Information Line0845 4647Nick Chapman - Chief Executive

Note on NHS Direct

The NHS Direct Health Advice and Information service is to be withdrawn in the near future, once the mandate for the Urgent-Only NHS access 111 service has been enforced in all localities. It is therefore reasonable not to incur the expense and confusion of a complete number change for the Advice and Information service, which now has less than two years of operation left. The alternative number - 0345 4647 - (charged at the same rate as a call to a geographic number for all callers) has however been configured ready for use in parallel.

There is no justification for the decision to continue to totally withhold availability of this alternative number for the remaining life of the service. The total exemption from the terms of the Directions, which applies to all telephone services provided by the NHS Direct NHS Trust, was totally unnecessary. It being ruthlessly exploited by the NHS Direct NHS Trust and the many NHS bodies which use it as an agency to deliver their services, covering many other numbers not listed above, in disregard of the clear duty under the Health Act 2009.


  1. Barking, Havering and Redbridge Hospitals NHS Trust takes patient access very seriously. We promote the geographic number in all materials and on our website: http://www.bhrhospitals.nhs.uk/contactus/addresses.php

  2. BHRUT

    Thanks for engaging. It is good to know that you take your responsibilities seriously, however I do not believe that this was ever questioned and I hope that it was never in doubt!

    It would appear that you see some benefit in having an alternative non-geographic number. Perhaps those who pay a premium to call it, so as to fund the financial subsidy from which you benefit, will expect some type of premium service.

    You were given 12 months in which to change your arrangements (perhaps to adopt a 03 number) in order to comply with Directions that simply reflect the principles of the NHS. The deadline for compliance was 21 December 2010, however you continue to openly promote the 0845 number as an option.

    NHS patients do not have the option to receive standard NHS services without charge from the provider or purchase premium NHS services with such a charge. "Co-payment" is not (yet!) permitted. Many of us believe that it could never have a place in "our NHS".

    You will shortly be required to apply for Foundation Trust status. If you believe so strongly in the patient's right to pay for premium services that you can disregard an explicit Direction, perhaps the Trust Board would be happier outside the NHS altogether and will be inviting offers from prospective new private owners!

    Our NHS is proudly a universal and single status service. Promoting cheaper alternative means of access serves to demonstrate total disrespect for its principles, NOT compliance.

    (Please understand that similar comments could be directed at any of the bodies listed. I thank you for having chosen to engage in commenting on this piece.)



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