From: David Hickson – campaigner for the NHS
On Monday 12 October, the Health Bill is scheduled to receive its 3rd Reading in the Commons. This will complete its parliamentary proceedings.
If passed, the Act will impose a duty on all NHS service providers to have regard to the NHS Constitution. (Health Bill [HL] Section 2)
The first of the rights in that Constitution states:
"You have the right to receive NHS services free of charge, apart from certain limited exceptions sanctioned by Parliament".
It will therefore be necessary for parliament to sanction use of revenue sharing 084 telephone numbers, as an exception to this right, until such time as a ban on their use has been put into effect, or at least proposed.
I have campaigned on this issue for some time and note that the recent consultation received an overwhelming response in favour of a ban on use of 084 numbers in the NHS. Furthermore, an e-petition to the Prime Minister on this same topic has so far attracted over 43,000 signatures.
If there is no such sanction and no such ban, then I will encourage (and myself instigate) the necessary action against every relevant body as soon as that duty falls upon them, as the terms of the Constitution are clearly being breached.
Charges on patients, in the form of premium rates for telephone calls, are presently used by many NHS providers to subsidise the costs of their activities – this is what happens in every case where a 084 number is used (see this clarification). The premium is in addition to the cost of a normal telephone call, which should be considered to be a perfectly proper expense carried by a patient.
Although applied and received indirectly, this is unquestionably a charge imposed on patients for access to NHS services, in addition to the normal cost of a telephone call. It is to the benefit of the NHS provider in offsetting their own costs. Although sometimes hidden as a component of an aggregated figure, it is over and above (as a surcharge and discount) the costs properly incurred by both parties in the respective normal charges levied by telephone companies.
The recently announced "ban"
The recent announcement was of a decision not to ban use of 084 numbers in the NHS.
On 14 September the Department of Health made an announcement (from which I quote):
"The use of phone numbers that charge the public or patients a premium rate to contact the NHS are to be banned".
This statement was however rendered meaningless, as the announcement however went on to say that "The ban means that GPs and other NHS organisations remain free to use 084 numbers" and that it would not prohibit 'Revenue-sharing' arrangements that "allow for a proportion of the money paid to the supplier to go towards the ongoing cost of running an 084 number".
The Department, along with others, appears to be entertaining, or maybe just seeking to promote, the preposterous idea that all telephone tariffs will undergo a radical change at some point in the near future. It states a desire 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". Whether or not it is desirable for the price for local calls to increase, so that the premiums presently imposed to fund the revenue share on 084 numbers disappears, is a matter for debate - it would certainly lead to a considerable growth in the use of 084 numbers, for obvious reasons! There has been no announcement, nor any indication whatsoever of any telephone company making any such change (what BT has done recently appears similar, but can be misunderstood). These issues are sadly complex, not generally understood and wide open to misunderstanding and misrepresentation – I will be happy to help anyone with further explanation. Ofcom and the telephone companies themselves will be happy to confirm that no such change is proposed, or indeed likely.
As the ban relies entirely on this ridiculous proposition, there will no ban on the basis of what is announced.
The government has no plans to impose the necessary tariff changes on telephone companies - "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". I fear that the Minister and the BMA are simply hoping for someone else to pick up the cost of subsidising some GPs and other NHS providers, i.e. telephone companies and their customers in general, rather than patients calling these numbers.
The Minister, Mike O'Brien, states a wish "to reassure the public 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". This desire to offer a reassurance will have to remain as a fanciful aspiration for the time being, as nothing has yet been done or proposed to enable it to be fulfilled.
Dr Richard Vautrey, of the BMA GPC is quoted as saying "Patients who call their surgery because they're ill shouldn't be penalised because they have to call an 084 number, so 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. ... it's good to see that the government has recognised this and has not gone for a complete ban on the use of these numbers". I draw the attention of Dr Vautrey and the government to the fifth item in the example given below (Talk Talk may wish to confirm what it has agreed).
The NHS Constitution and the duties under the Health Bill are not about unrealistic aspirations. This issue has to be addressed properly, without misleading statements that are reported as if true. If there is not to be a ban on use of 084 numbers and charging for NHS services is thereby to be permitted, it must be declared as such and properly sanctioned.
To illustrate the situation as it exists today, I offer the example of a NHS patient in Leeds calling during the daytime to arrange an appointment with Dr Richard Vautrey, at Meanwood Health Centre under contract to the "NHS Leeds" PCT. This practice has been reported by the BBC as using a 084 number. It is shown on NHS Choices as Dr Newbound A D & Partners - 0844 477 1799.
The charges given are for a call of 3 minutes duration during the weekday daytime, under various current telephone tariffs that are likely to apply to NHS patients. The cost is compared with that of calling a local number, which in some cases would be free of charge under the terms of a calls package. Calls to 0844 numbers are not included in any package on the same terms as calls to ordinary numbers.
0844 477 1799
0113 xxx xxxx
|1.||BT - Unlimited Evening and Weekend plan|
|2.||BT - Unlimited Anytime plan|
|3.||Virgin Media - Talk Evenings and Weekends|
|4.||Virgin Media - Talk Anytime|
|5.||Talk Talk (the supplier of 0844 477 1799) - both plans|
|6.||Post Office Homephone|
|7.||O2 - contract with inclusive calls|
|8.||O2 – PAYG|
|9.||Orange - contract with inclusive calls|
|10.||Orange – PAYG|
In the first and third of these cases, callers incur a penalty charge when making otherwise inclusive calls outside the times when their selected call plan is in operation. In the first case the penalty actually exceeds the premium, which applies to all callers at all times. The fifth, which offers free local calls at all times to all customers, is of particular relevance to the comments from Dr Vautrey that are quoted above.
Unless all of Dr Vautrey's patients can be shown to be subscribed to the first, or any similar, tariff, then there is no ban, the Minister's reassurance is unfulfilled, and a sanctioned exception to the first of the "Constitutional rights" is necessary to prevent this practice and this PCT being in breach of the terms of the Health Act (as it will be shortly).
This example is purely illustrative of the situation with GPs, hospitals and other NHS providers throughout England, many of whom are listed on this web site. There are very many other tariffs in use, I know of no other (except those which are modelled on BT) that would give the same result as the first case above.
Changes to the GP contract and the issuing of Directions to NHS PCTs and Trusts will not alter these tariffs.
I must urge MPs to ensure that the existence or absence of a ban on use of revenue sharing telephone numbers is properly reflected in the provisions of the Health Bill as it is enacted. If absent, then sanction for this means of charging for NHS services must be provided to prevent action under the terms of the Act against those who use them.
I urge journalists to confirm the points that I make above from authoritative sources. I believe that I know the answers to these questions, but I do not have any authoritative statements to quote.
- Mike O'Brien – will use of 084 numbers be banned in the NHS if telephone tariffs remain as they are?
- Talk Talk (and all other telephone companies) – what have they agreed to do about changing their tariffs?
- Ofcom – does the Department of Health announcement make any sense?
- The Contact Council (Cabinet Office) – how does any aspect of this issue relate to use of 084 numbers throughout the public sector?
Please contact me if I can assist in any way.