On its release, I immediately questioned Mike O'Brien about his announcement of 14 September. After waiting for a month, I have now received confirmation from the Department of Health note1 that ...
use of expensive telephone numbers will not be banned in the NHS
... in any meaningful way. Contrary to misleading statements and reports ...
there will be no change to the rates charged to call 084 numbers.
There is to be no change to the mistakenly framed "ban" which was introduced in 2005 – "PREMIUM RATE PHONE NUMBERS BANNED". This covers only use of the more expensive "Premium Rate Service" numbers (e.g. 0871, 09xx). Subsequent guidance, that was generally ignored, will simply be re-stated. Use of 084 numbers was explicitly permitted in 2005 and is explicitly permitted again with nothing more than a repetition of meaningless and misunderstood guidance. This is despite "overwhelming" consultation responses in favour of a proposed ban and over 45,000 signatures on an e-petition to the Prime Minister. The mistake from 2005 has not been corrected, it has been repeated. note2
THE ANNOUNCEMENT BY MIKE O'BRIEN OF 14 SEPTEMBER WAS ESSENTIALLY A REPETITION OF OLD NEWS
No change to existing arrangements
The 1,000 or so GPs already using 0844 numbers are not even covered by the proposals, because the change to the GP contract will only affect new arrangements.
There was no reference to this most significant exception from the terms of the "ban" (meaningless as it may be anyway) in the 14 September announcement. It was universally assumed that something was being done about the present situation.
No ban unless numbers are invariably more expensive
084 numbers do, and will continue to, cost more to call than "local" or geographic numbers at all times under the terms of most telephone tariffs, as they apply throughout the UK. These numbers are however not deemed to cost more than a call to a local or geographic number by the Department of Health. Such a determination would apparently be too "simple".
For new arrangements, I am told that the Department decided against a "simple ban" on use of 084 numbers. This is said to be because calls to 084 numbers are not invariably more expensive than calls to local numbers. The absolute and relative costs are features of whatever telephone tariff applies to the caller at the time the call is made. It costs every originating telephone company more to place a call to a 084 number, because their revenue has to be shared, so this additional cost is (not unreasonably) generally passed on to the caller. The complication arises because the perverse effects of residual partial regulation on some of BT's charges creates an anomalous situation for some callers at some times – (see "BT is to blame" below).
There is nothing that a GP or NHS provider, or their telephone service supplier can do to set the rates charged by the telephone companies used by every caller. Furthermore, it is not a condition of NHS service that one must subscribe to a BT call plan, but not the Unlimited Anytime plan, always use this to call the doctor and never call other than during weekday daytimes. There is therefore no way that anything other than a "simple ban" on use of 084 numbers (in effect, if not by specification) could achieve the desired effect of ensuring that nobody pays more than the cost of a call to a geographic number.
If the intention were to provide the cheapest possible calls for all callers (although that is not what is actually stated), then one would have to demand use of many different alternative numbers by every NHS provider to suit the particular arrangements applicable to every different telephone tariff at different times.
The absence of a "simple ban" can only mean that there is no ban at all.
A simple statement banning use of numbers that cause any caller to pay more than the cost of a call to a geographic number would suffice. This would effectively prohibit use of 084 numbers, whilst permitting use of 03 numbers, as they are subject to this specific condition by regulation. Stating that use of 084 numbers is not "banned" totally undermines the declared intention to move forward from the mistake that was made in 2005.
This was immediately recognised by NEG, the supplier of the "Surgery Line" system, which announced on 14 September - "NHS free to choose 084 numbers". NEG's submission to the consultation had quoted only selected BT rates, suggesting that there were no other landline providers and that nobody used mobile phones. NEG is now recruiting more GPs to sign up to 7 year contracts for leased surgery equipment that will be subsidised by NHS patients, who will continue to pay up to 40p per minute to call.
When the "ban" comes into force in the next few months, it will be immediately recognised that the effect is not as expected. I am keen for this to be recognised NOW so that action can be taken promptly to put matters right, before ineffective directions and contract changes are made. I also wish to avoid the misattribution of blame, and structure the following remarks with an eye to who may have been "set up".
The Media got it wrong!
News releases issued in parallel with that of the Department of Health on 14 September, notably that from the BMA which refers to "Changes to Charges for 084 numbers", caused some confusion. Some were led to mistakenly report that the Department of Health would be somehow instigating changes to telephone tariffs, so that the cost of calling 084 numbers would be reduced note3.
This nonsensical suggestion is now clearly denied.
Please see the notes below and contact me for further explanation and comment. It is regrettably not a simple matter to pick out the truth from amongst the various statements. I continue with further explanation.
The Department of Health decided against a "simple ban" on use of 084 numbers because BT customers who call local numbers in the daytime now pay more for these calls (5.25p per minute) than the 5p per minute rate for 0844 numbers, where around 4p per minute is passed to the GP's phone company note5.
BT has increased its unregulated rate for calling local numbers by over 30% in the last twelve months, in an attempt to persuade more of its customers to sign up for its Unlimited Anytime plan, when they would be "free". It cannot increase the charge for calling 0844 numbers because this is regulated, and these cannot be included in packages. BT is uniquely subject to regulation of its charges for calling all "NTS" numbers, including 0844 and 0845. There is however no regulation of the "penalty charge" that it imposes on those who call ordinary numbers outside the times covered by their call plan.
Because of the consequently perverse nature of BT's tariffs it can now be said that even the most expensive 0844 numbers are "not more expensive to call than local numbers", because this is true for some callers at some times. This is of course untrue for those who subscribe to the BT Unlimited Anytime package, or who call when their time-limited package is in effect. In these cases all calls to geographic numbers (local and national) and 03 numbers are "free" for the first hour.
Virgin Media and All the Mobile Companies invariably charge more
All calls to 0845 and 0844 numbers are more expensive at all times for all customers of Virgin Media and all the mobile companies. It is normal and to be expected that the increased cost of funding the revenue share that applies to calls to all 0844 and 0845 numbers is reflected in premium charges to the caller. In the absence of partial regulation, this is exactly the effect that is seen.
Talk Talk will also be blamed
The vast majority of NHS GP 0844 numbers are provided by Talk Talk note5. In welcoming the Department of Health announcement of 14 September, Dr Richard Vautrey of the BMA said "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".
Talk Talk offers local calls "free" at all times for all residential customers. Calls to the 0844 numbers which it supplies to GPs are charged at 4.89p per minute, plus a 9.05p call connection fee, at all times note5.
These rates are confirmed in the new Talk Talk prices to apply from 1 November. I am reliably informed that Talk Talk has NOT agreed to make 0844 calls free, or to increase the charge for local calls, at some future time note5. Dr Vautrey was wrong about the phone company that supplies the line to his practice and to most others.
Ofcom is always a "fair target" for attack
Ofcom will continue to enforce compliance with the terms of the "The National Telephone Numbering Plan", which for 0845, 0844 and 0843 numbers only bears on BT. Suggestions that any other provider is required to charge 084 calls at a "local" or "lo-call" rate are totally false. There are no plans to introduce any additional regulation on charges for calling 084 numbers note5.
The real culprits
The preceding comments indicate where the blame may be placed when the so-called "ban" comes into effect and we see that nothing has changed.
For a NHS "free at the point of need" it is simply unacceptable for any NHS provider to use a "revenue sharing" telephone number. That is what John Hutton should have banned in 2005, not just the sub-set of revenue sharing numbers that are classified as being used for "Premium Rate Services". All 084 numbers are revenue sharing. They are therefore generally subject to premium charges as they invariably provide financial benefit to the user at the expense of the originating telephone company. There is no "if" about it. All 084 numbers do cost some callers more than the cost of a local call.
The suggestion of doubt can only mean that those who can point to a particular example where this is not the case are free to continue to adopt 084 numbers. Telephone tariffs are set nationally by telephone companies, not by local NHS providers, nor by those whom they contract to supply telephone services. Leaving decisions about whether or not to use 084 numbers to individual NHS providers is nothing more than a failure to protect the principles of the NHS.
Responsibility for the principles of "our NHS" belongs totally with the Department of Health and those it appoints to manage the NHS. When recently debating the final stages of the Health Bill, Mike O'Brien made an impassioned speech demanding that parliament did not enshrine these principles in legislation, so as to make the executive accountable for its application of them - see "Theft of the NHS".
I am aware of two contributors to the consultation who have publicly advocated the imposition of charges to the benefit of the NHS provider for access to NHS services by telephone note4. It is understood that both of their organisations had a major role in agreeing the action that was to be taken. Both gave a unqualified welcome to the outcome that was announced, implicitly or explicitly taking credit for having influenced it. Both felt able to add detail to their announcements that was not contained in the text of the Department of Health new release. I refer to Dr Richard Vautrey, Deputy Chairman of the BMA General Practitioners Committee, and Dean Rayment, Managing Director of Network Europe Group.
I can see the way that the situation has been set up for misattribution of blame when the failure of the ban comes to light and offer these comments in the hope that this will not be allowed to happen. My primary concern is for the situation to be recognised and brought to light NOW so that action can be taken promptly to correct it.
- I attach a copy of my exchanges with the Department of Health. The points from the message to me that are referred to above are highlighted in the corresponding colour. Unrelated material is removed from the messages.
- My developing comments on these matters may be found in my blog and published media releases. There is one item in which I refer to a sense of déjà vu with relevant links to the material going back to 2005.
- I have collected a selection of links to news items published on and after 14 September 2009.
- Published contributions to the consultation on this topic that sought to re-define the principles of the NHS are seen as follows. The BMA suggests that the cost of accessing NHS services should be proportionate to "the quality of service the patients are accessing". NEG suggests that "Patients main concerns are about access and quality of service, not about cost" – see my comments on the NEG submission.
- I must urge authoritative confirmation for all of my points. If necessary, I can provide details of my contacts at the bodies referred to. I can also provide links to published tariffs from all sources, along with the necessarily complex directions about how to find the relevant rates and interpret when and how they apply. This document is big enough as it is without me providing further supportive evidence for my points here. I will be happy to cover every point in detail where necessary.