From: David Hickson – campaigner for the NHS
SummaryThis is a great victory for campaigners, as the principle has been ceded and action to apply it finally promised, for the first time. The suggestions about implementation create some cause for concern, as they appear not to recognise the implications of the primary announcement.
It is vital that the Minister is asked to confirm that he truly means what he says and that it applies now, rather than being an aspiration for what may be achieved in many years time. As such confirmation would render many of the other comments meaningless, if that it is confirmed we can describe this as a ban on use of revenue sharing 084 numbers in the NHS.
Three cheers for our beloved NHS
Simple Points of Concern
The Heavy Stuff
Specifying the "ban"
Further action for campaigners
GPs and Hospitals that do not use 084 or revenue sharing numbers
Further information and comment
Three cheers for our beloved NHSThis is what I have been campaigning for over the last two years. I cannot but celebrate this announcement and congratulate the Department for finally recognising the need to act to re-affirm the principles of the NHS in this way. It is "our NHS", of which governments in power from time to time are only the temporary custodians.
"Free at the point of need" means that NHS services are delivered without charge to the patient by the service provider. Fees set by the NHS (approved by parliament and subject to exemptions) and charges for non-NHS services are a different matter. Elimination of any indirect charge, e.g. through use of a revenue sharing number for which any patient's telephone company imposes a premium rate, is vital and long overdue.
We will always incur incidental third party costs in accessing public services, for example, the bus or taxi fare or the cost of parking in a public car park when attending an appointment. It is not unreasonable to incur the cost imposed by our chosen telephone service provider for an ordinary call when contacting the NHS by telephone. When the ban is delivered, this will be "free at the point of need".
When the Department of Health is able to deliver the promised reassurance that "when they contact their local GP or hospital, the cost of their call will be no more expensive than if they had dialled a normal landline number", I will be totally content. I have been assured that this applies to all NHS patients, not just some subjective interpretation of the concept of "patients in general".
As things stand, this will therefore (in effect, if not by intention) have to represent a ban both on revenue sharing and use of 084 numbers. It will not be possible to provide this reassurance whilst revenue sharing and use of 084 numbers continue.
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CreditIn addition to the 3,000 who responded to the Department of Health consultation, one must mention the 40,000 citizens who have signed the e-petition to the Prime Minister on this very subject. Their demand that the promised reassurance be delivered remains in place and the Prime Minister must respond to this at the end of November in the light of what is seen to be being delivered at that time. Guy Mayhew, the originator of this petition is deserving of particular credit, and also has a good personal story to tell.
Those who may have doubts about the reassurance offered by Mike O'Brien should be encouraged to sign the petition now.
There are also many other campaigners, some of whom have been working on this issue for much longer than myself, who should be credited. I have the names and contact details of those who have worked closely with me, however I know that there are many others.
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ImplementationSome aspects of what is proposed as the method of implementation are worthy of positive comment.
Addressing the issue from the point of principle, rather than by specifically prohibiting use of particular types of telephone number, i.e. 084, represents a necessary correction to the mistake that was made when addressing this issue four years ago.
There is some good sense shown in expressing reluctance to prohibit NHS providers from gaining the benefit of revenue sharing when this can be done at no cost to callers, i.e. where the benefit to call recipients is funded purely out of excess profits earned by telephone companies.
We will only know whether this ban will work in practice when we see the detail of how the reassurance is going to be delivered. We will join the Minister in checking that the action taken ensures delivery of his reassurance. Department of Health officials have been engaged continually on this issue since an evidence gathering exercise was begun in January 2008. They have benefitted from extensive briefings from contributors to the public consultation and in other ways. One must expect that they therefore have gained a full appreciation of all of the issues and been able to apply it. There should be very little left to do.
BUT, the comments accompanying the announcement suggest otherwise.
I would be delighted to conclude at this point, however I continue in order to address matters of concern that are raised in the notes accompanying the basic statement in the news release.
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Simple Points of Concern
- The National Health Service does actually include services that are provided nationally. These would appear to fall outside the terms of the quoted reassurance as it refers only to "their local GP or hospital". The reassurance would also appear to exclude other local NHS services provided and commissioned by PCTs, such as Dentistry and Pharmacy.
- It has already been announced that the NHS Direct telephone advice service (but not the other services provided by the NHS Direct Trust) will be retaining its 084 number - 0845 4647. In order to meet the reassurance offered by the Minister, it will be necessary for the alternative 0345 4647 to be brought into use in parallel so that all patients may access this service at a cost that is "no more expensive than if they had dialled a normal landline number".
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The Heavy Stuffclick here to skip this section
To support my further detailed remarks, I refer to useful and relevant publications by Ofcom and the Contact Council, which explain how revenue sharing applies on all 084 numbers. I have confirmed that the named senior representatives of these bodies will be happy to assist with verification of the comments that I make.
Officials from the Department of Health have declined my offer to discuss what appears to be confused thinking. I have been thanked for the contributions I have made and told that their work is done! I am therefore left with the task of trying to make some sense of what has been published. I regret that I cannot explain it, but only react.
- One must initially express surprise that it has apparently not been recognised that use of 084 / revenue sharing numbers currently causes most callers to incur a premium charge. Regardless of how the intentions and method of implementation are described, the stated reassurance cannot be delivered without effectively banning their use, although this seems not to be understood.
- It would take a considerable amount of time (several years), and Ofcom intervention of an unprecedented scale, in pursuit of new objectives and possibly requiring amendments to EU competition law, for "a marketplace to evolve where 084 numbers compete alongside 01, 02 and 03 numbers, but where patients will pay no more than the cost of a local call". That is certainly not what is in place today, as telephone companies quite properly pass on the costs of revenue sharing to their customers, in one way or another.
- If "the ban on the use of numbers charging patients a premium rate to call NHS services" is introduced before such an unexpected, perverse and probably undesirable change occurs, all use of 084 numbers would be covered by such a ban.
- The only way in which one could see this perverse approach to pricing been achieved is if all telephone companies that are not regulated in their charges for revenue sharing numbers follow the example of BT, the only one that is. With effect from 1 October, BT will increase its unregulated charge for ordinary calls to a level above that set for revenue sharing calls by regulation. BT customers with an inclusive call plan in effect are not affected by this change - they are now compelled to pay for some types of revenue sharing calls as part of their package fee and always pay for others only if they make them, at the unchanged regulated rate. This is obviously greater than the zero charge for inclusive calls to ordinary landline numbers.
- There is a disturbing suggestion of conditionality in the statement, "GPs and other NHS organisations remain free to use 084 numbers, providing patients are not charged more than a local rate number". One must hope that this is not evidence of the sadly common misconception that those acquiring a telephone number can determine the rate that is charged for calling it. This is completely untrue. The only influence one may have is by selection of a particular type of number, in the knowledge of the rates currently being charged for calling numbers of that type by the various providers.
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Specifying the "ban"In determining the necessary changes to the GMS contract and the terms of directions to PCTs and Trusts it will be necessary to offer more clarity than is offered in this statement about precisely what is being banned. Terms such as "premium rate", "a normal landline number", "the cost of a local call", "local rate", "national charge rate", "normal geographical", "cost of calling an 01 or 02 number", are all used regarding call costs that will be relevant to the specification of the ban. One could believe that so many different terms have not been used for the purpose of providing clarity.
Anyone with an understanding of the UK telephone system and its charges knows that one must try to avoid unnecessary reference to "local rate", or even "local call" in the context of charging, at any cost. (I will not address this horribly difficult topic any further here, but I must urge those reporting these matters to avoid these terms.)
The simplest and most accurate way to express the requirement necessary to meet the Minister's desired reassurance would be to state that the cost of accessing NHS services by telephone must be no greater than the cost of a national UK call. This means the cost of a call to any number beginning 01 / 02 / 03.
Because there is no general regulation of the charges for calling any other type of number available to NHS providers, there can be no assurance that the cost of a call would not be greater. Indeed there is no such type (including 0800) that meets this condition at present. There is no expectation of any further new cost-regulated type of number being introduced and recent experience with 0870 has shown that Ofcom is unable to regulate the cost of calling existing ranges.
With all other options effectively needing to be banned, one may as well stipulate that only 01 / 02 / 03 numbers may be used. That is certainly what must be delivered at present to achieve the intended effect of the announcement. Yes – it could have been this simple!
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Further action for campaignersThe best way for someone to ensure that the cost of calling a GP or Hospital is no more expensive than if they had dialled a normal landline number is by dialling a normal landline number.
Many revenue sharing numbers simply re-direct calls to a normal landline number – others use more sophisticated call delivery mechanisms. Despite attempts to suggest otherwise, because the potential does exist, in many cases all of the advanced features offered are actually provided locally (by equipment at the hospital or surgery), and are therefore fully accessible by calling that normal number. Those who feel entitled to benefit from the premium charge paid to call the revenue sharing number will aim to conceal the normal number, so that callers cannot avoid paying the premium and thereby deny them that benefit.
Now that the Minister of State has offered a reassurance that the cost of calls to GPs and Hospitals will be no more expensive than if a normal landline number had been dialled, there would appear to be no good reason why the normal numbers should be concealed in such cases.
I do not support the idea of a two-tier NHS, with advanced telephone features funded by revenue sharing on numbers that attract a premium charge and only basic features on a normal landline number. I totally reject the idea that patients should have the "choice" of which number to call, depending on what they are prepared to pay, as this would be a fundamental breach of the principles of the NHS. Whatever may be the benefits of "choice", there is no place for this type of consumerism in the NHS.
I would not wish for anyone to disrupt the provision of NHS services or show any discourtesy towards staff of the NHS or its contractors. It is also important that revisions to the GMS contract are dealt with properly, although I think it fair to refer to clause 483 of the existing GMS contract.
I am however keen for the Minister to be supported in the prompt delivery of his reassurance. Given these qualifications, if anything can be done to hasten and ensure the swift implementation of the "ban" then I cannot oppose it. In most cases this could be quickly and easily achieved by the replacement of 084 numbers with the equivalent 034 number in every case where a non-geographic number provided benefits in respect of the service provided, or where a contract for provision of telephone service from Talk Talk has to be honoured.
http://www.saynoto0870.com/ collects and displays the normal numbers that may be used as alternatives to all types of expensive numbers. If any NHS provider makes the relevant number available, directly or indirectly, then this could be added to those already appearing there. It would obviously be preferable if these numbers were published in the normal way. One may however expect that many will keen for the Minister's reassurance to be delivered more quickly than if the processes associated with the long-delayed implementation of the ban were left to take their natural course.
Dave Lindsay of saynoto0870 has already issued a briefing on this topic and will, I am sure, be ready to help with further information.
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GPs and Hospitals that do not use 084 or revenue sharing numbersWe must remember that most GPs and Hospitals do not obtain any subsidy from callers in their provision of telephone facilities and would share the view that this means of funding is wholly unacceptable.
Many would endorse the view of the Head of the General Practice that I attend who would "not touch one of these numbers with a bargepole". The BMA appears to only represent the views of a minority of its members.
The University of Leicester Hospitals recently introduced a 084 number, but on belatedly recognising the implications for its patients reversed this decision within a few days and adopted a 03 number instead.
NHS Blood and Transplant recently changed from using 084 numbers to 03. There are many other similar examples, which demonstrate that 03 numbers are appropriate and that it is only a minority of NHS providers who need to be reminded of the need to respect the principles of the NHS.
It is unfortunate and perhaps disturbing that this has had to be achieved through a ban. Even if the attempts at a ban are found to be ineffective as a means of compulsion, it may be hoped that many NHS providers will give up their 084 numbers in advance of, or even without, it being implemented.
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Further information and commentThere is plenty of information about this topic on my campaign resource website. I have also recently started blogging on relevant topics and publishing circulated material.
In addition to the contacts included in the cc: of this email, I also have the details of many other campaigners and interested people.
As this release is necessarily rather lengthy in order to provide a comprehensive briefing whilst under the terms of an embargo, I will happy to provide exclusive brief comments to meet particular requirements and address any questions. (In due course I will publish this document and relevant comments on the detailed issues separately.)
I will comment further in the light of any further developments and on seeing the formal response to the consultation when it is published.
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