Health Bill – Report and 3rd reading debates – Monday 12 October – NHS Constitution - Briefing
This briefing, with comments, is in addition to previously circulated material covering the issue of the part funding of NHS services by patients, through use of revenue sharing 084 telephone numbers.
It is highly relevant to the Health Bill, which gives the NHS Constitution statutory relevance. Under the terms of the Constitution this method of "joint funding" is proscribed.
If the Bill passes with only currently proposed actions in place, all those who continue to use, and permit the use of, 084 telephone numbers in the provision of NHS services will be breaking the law.
From: David Hickson – campaigner for the NHS
As the House of Commons prepares to discuss the Health Bill on Report on Monday, I draw the attention of Members to some relevant comments made during the Public Bill Committee proceedings. This may be particularly useful to those who are to contribute to the debate, and to that on Third Reading.
These comments (from 16 June) are placed in current context by a subsequent announcement by the Department of Health (on 14 September). This stated that, despite views strongly expressed by the majority of respondents to a consultation, and over 44,000 signatures on an e-petition to the Prime Minister, use of revenue sharing 084 telephone numbers will NOT be banned in the NHS.
This failure to introduce a ban is based on a spurious and groundless assumption about changes to telephone tariffs. It is stated that the cost of the revenue share subsidy, from which all those who use 084 numbers benefit, will be funded by telephone company customers in general, rather than just those who call such numbers. This would be achieved by ensuring that the cost of a call to a 084 number is no greater than the cost of a call to an ordinary number. The respective non-inclusive pence per minute rates would have to be equated and where inclusive packages were offered for ordinary calls, calls to all 084 numbers would have to be included also.
I provide further briefing on the detail of this nonsense in the appended Notes.
Contrary to misleading commentaries from the BMA and others, which have fuelled media reports, (see note 1) the government is not to take any action that will require telephone companies to make these radical, and generally unwelcome (see note 3), changes to their tariffs.
This announcement has been taken as clear licence to continue and extend use of 084 numbers – "NHS free to choose 084 numbers for local patients". This tolerance of joint funding must therefore now be supported by parliamentary sanction. If not, then the terms of the NHS Constitution will continue to be breached, once it is "made law" through the provisions of the enacted Health Bill.
Comments in Committee
In the Public Bill Committee, when asked to address the issue of use of 084 telephone numbers with reference to the right under the constitution to services provided free of charge, the Minister, Mike O'Brien, stated as follows (Hansard: Health Bill [Lords], Public Bill Committee, Second Sitting, 16 June 2009 - Column 53):
"It is important to recognise that there are a number of areas in the NHS where organisations have the ability to not only provide services, but to jointly fund them through patients' contributions; I gave the obvious example of prescription charges earlier. That is allowed within the terms of the constitution. Particular problems arise on telephone numbers, however, which I want to look at with a great deal of care. As my hon. Friend has said, a considerable degree of concern has been expressed by patients about the way in which certain premiums have been charged in relation to such numbers. If he bears with us, I hope that we will be able to deal with the issue at greater length."
Prescription charges are indeed covered by the constitution, as an "exception sanctioned by Parliament"; it states:
"You have the right to receive NHS services free of charge, apart from certain limited exceptions sanctioned by Parliament".
Mr O'Brien's careful consideration has not only failed to understand the present (and likely future) situation with telephone tariffs, but also the critical importance of parliamentary sanction for any breach of the principle of NHS services being provided free of charge.
Mr O'Brien's understanding of the principles of the NHS is neatly expressed in the following comment at the earlier stage of the Committee proceedings to which he refers. This is found at Column 12, when discussing prescription charges:
"The core principle of the NHS—that it is funded by the taxpayer to ensure that the provision of healthcare is available when it is needed, sometimes with a charge, but more often without—must remain intact. We have not announced anything that would undermine that principle."
If Mr O'Brien believes that the point of principle relates only to the frequency with which charges are imposed, rather than their restriction to the closely defined and heavily qualified circumstances that are covered by specific sanctions approved by parliament, then he clearly does not see the defined rights under the NHS Constitution as having any value whatsoever.
In the earlier quoted comment Mr O'Brien appears to believe that prescription charges paid are (or should be) to the financial benefit of the organisations that bear the budgetary cost of prescribing, as permitted "joint funding". Prescription charges are set and collected for the NHS as a whole, not by prescribers to offset the cost they incur. Anyone who would happily entertain the horrible concept of provider organisations being granted the opportunity to secure contributions from NHS patients for NHS services in the context of a discussion about the principles of "our NHS" must be seen as its enemy.
I am rarely drawn into making partisan points, however this section of the debate suggests that it is the opposition parties which have a greater regard for the true principles of "our NHS" than the Minister who represents the party in government. The NHS belongs to us all, as we are represented by all those we send to our parliament. That parliament has a duty to the people not to allow any government to undermine "our NHS" in the way that is proposed.
If Part I of the Health Bill is to have any value then your constituents need to know that their rights are properly described in the Constitution, and therefore use of revenue sharing telephone numbers requires parliamentary sanction. If a ministerial statement in parliament may be taken as having greater force in law and the government disowns the NHS Constitution (having never sought to undermine the principle that the NHS is only free more often than not), then we must know that Part I of the Bill is worthless.
- The false, and in some cases possibly mischievous, suggestion that the Department of Health announcement of 14 September was of a change to telephone tariffs is found in items published that same day:
1.1 BMA press release – "Changes to 084 number tariffs, which will ensure that patients who call them do not pay more than the equivalent cost of a local number, are the fairest way forward for patients and practices ... 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"
1.2 Network Europe Group press release – "NHS free to choose 084 numbers for local patients ... Health Minister Mike O'Brien announced today that the use of 084 numbers would not be banned in the NHS ... They will be supported by a new framework to ensure that local patients do not pay more than the cost of a local call to contact the NHS."
1.3 Daily Mirror article - "Patients will pay no more than the price of a local call when ringing an 084 number to contact services"
1.4 Times article - "Patients will still dial 084 numbers to get through but tariffs will be adjusted to ensure that they pay only for the cost of a local call".
These comments are totally unfounded. The Department has not stated any action that will be taken to impose any change to telephone tariffs, nor is there any evidence of how this will happen without compulsion.
- The respective situations with the two groups of 084 numbers - 0845 and 0844/3 are a little different.
2.1 It is widely known that BT now includes calls to 0845 numbers in its packages. It is less widely understood that for many years BT's rates for calling 0845 numbers have been lower than those for ordinary numbers, when both are chargeable. This gives a clue to the unique regulatory position of BT.
Put simply, the margins available to BT on calls to all 084 numbers are regulated to be at a minimal level. This keeps the rates that it charges for such calls low when compared with its unregulated rates for calls to ordinary numbers.
Although there are some providers who mirror BT tariffs, there is no reason why Virgin Media, other competing landline providers and the mobile providers should be expected to be able to copy what BT has done with 0845 call charges.
2.2 I do not have authority to directly quote the BT representative who described the idea that 0844 calls should be included in packages to me as "financial suicide". Whilst BT could meet the cost of including 0845 calls in packages by a relatively modest increase in the charge for packages, the higher revenue share payments involved with 0844 numbers would make the necessary change unrealistic.
If BT, with its regulated margins, could not do it, then it is quite inconceivable that it could be a commercial reality for any other provider.
The same point applies to achieving an equivalence in pence per minute rates. A call originator pays around a halfpenny a minute to the terminator for an ordinary call, for the top rate 0844 numbers (as used by GPs) the equivalent is around 4 pence per minute.
- If the cost of calling all 084 numbers from unregulated providers were to be equated with that of calling "local" numbers then there would be some undesirable effects.
3.1 Firstly, the cost of local calls would increase (assuming no secret treasure trove from which to pay the revenue share).
3.2 Secondly, the level of revenue share on 0844 numbers is sufficient to extend beyond the cost of the telephone line itself – the features of the "Surgery Line" system are mostly provided by equipment installed in the surgery, funded by the surplus from the revenue share passed on by the telephone company (Talk Talk).
If callers incurred no greater cost, then every telephone user would wish to take advantage of the financial benefit of revenue sharing.
It may be noted that the cost of calling 03 numbers is fixed at being no more than that of calling ordinary numbers. The crucial difference is that revenue sharing is not permitted on 03 numbers. The cost of additional features is carried by the renter of the line. Those who switch from 084 to 03 find that their costs increase (barring the effects of better negotiation and more efficient use of services), because they lose the subsidy provided by their callers.
The only way that the cost of calling 084 numbers will become the same as that of calling local numbers is if the revenue share were to be removed. This would put them in the same situation as exists for 03 and as is intended for 0870. Following these two initiatives, Ofcom is currently considering undertaking a review of the situation with 0845 numbers, which could perhaps lead to such a change in two to three years time. There are no current plans to review 0844.
Representatives of all the telephone companies and those able to speak on this matter with authority, e.g. Ofcom, will be happy to confirm that there is no way that the tariff adjustments that may prevent the need to ban use of 084 numbers will come about.