NHS Charges - car parking consultation to follow failed telephone charges consultation last year

From: David Hickson – campaigner for the NHS

Whilst we wait for the Department of Health to properly sort out the failure and mess that followed the consultation on premium rate telephone charges last year, another issue has been put out to consultation.

Fairer NHS car parking charges – a consultation is launched today.

NHS providers are not always able to provide car parking facilities for in-patients, out-patients and visitors. Where they are, it is vital that this is done without breaching the principles of the NHS.

In looking at this issue, it is too easy to take a “consumerist” view, forgetting that the principles of the NHS make this wholly unacceptable as a starting point.

The realities of funding the NHS make it appropriate that proper use is made of land owned by NHS providers. A delicate and well refined approach is however necessary to ensure that proper financial management of assets does not conflict with the principles of treatment “free at the point of need”. It is vital that this does not descend into an argument about which patients should contribute towards the cost of providing NHS services and which should not.

Payment for NHS services by citizens can only come from taxation. Income from proper charges for car parking facilities must never be confused with this.

Noting the (still unresolved) mess that followed the consultation on premium rate telephone charges last year, where the clearly expressed wish of respondents was effectively disregarded, we must hope for a better outcome from this consultation.

Please contact me for further comment and information on either of these issues.

Expensive telephone numbers for calling the NHS - The Department of Health funks it

After a 3½ month consultation, a 6½ month delay, a confusing and misleading announcement on 14 September and a further 3 month delay ...

the Department of Health yesterday issued the following directions:

Directions to NHS Bodies concerning the cost of telephone calls 2009

These directions fail to protect the principles of the NHS. They explicitly permit the continuing use of revenue sharing 084 telephone numbers, which cause patients to pay (indirectly) for access to NHS services.

Patients who call these numbers are subject to a premium charge, necessarily imposed by their telephone service provider in order to recover the money paid over in revenue share.

This truth remains, notwithstanding the fact that regulation, cross subsidy and other factors sometimes lead to the perverse situation where an equivalent call to a geographic number (not subject to revenue sharing) costs more. The payment by the patient may be hidden in a package subscription, or a cheap rate, and that received by the NHS provider may be concealed within a discounted price for telephone services, but the flow of money between the two is always in effect when a “revenue sharing” number is used. All 084 numbers are “revenue sharing”.

These directions totally miss this fundamental point by inviting providers to consider whether “having regard to the arrangement as a whole persons will not pay more to make relevant calls than they would to make equivalent calls to a geographic number.”

The “persons” will be subject to a wide variety of telephone tariffs.

For the principles of the NHS to be protected, a revenue sharing number could not be used unless EVERY CALLER was somehow protected from bearing the cost of the revenue share that is paid to the benefit of the NHS provider.

As may be seen from the information which follows, it is highly unlikely that any NHS provider would only be serving those who benefitted from this protection.

What are NHS Trusts being asked to do?

“Having regard to the arrangement as a whole” at the very least requires them to have comprehensive knowledge of the general characteristics of the telephone tariffs to which all possible patient callers will have subscribed - I address this in the grouped table below.

A more measured consideration would require knowledge of the precise detail of the cost differentials for the respective tariffs, along with the average call durations for callers from each. This is made more ridiculous by the fact that all forthcoming changes would also need to be considered.

The whole concept is however simply wrong in principle. The idea of balancing out discounts obtained by some patients against costs incurred by others has no place in the NHS. This type of consumerist nonsense is totally unacceptable in the context of any public service.

Who pays less and who pays more?

For these purposes, callers may be broken into the following general groups:

A) BT customers outside the terms of an inclusive package (some other landline providers copy this tariff).

For this group the rates for calling 084 numbers are set at a low level by regulation. Rates for calling geographic numbers are not regulated, and are subject to a “penalty” rate to encourage subscription to inclusive call plans (this rate is steadily increasing, at 30% per annum).
The current differences are 0.25 (0844) and 3.25 (0845) pence per minute against geographic numbers.

B) BT customers within the terms of an inclusive package (some other landline providers copy this tariff).

Calls to 0845, but not 0844, numbers are treated as inclusive, i.e. at the same rate as calls to geographic numbers.
In the worst case the difference is 0 vs. 9p + 5p per minute.

C) Virginmedia customers.

Whether or not an inclusive package is in effect only affects the degree of difference. In the worst case it is zero vs. 10p plus 10p per minute.

D) Most customers using mobile telephones (PAYG or contract).

In the worst case it is zero vs. 40p per minute.

E) Subscribers to some selected mobile contracts.

F) Users of public payphones.

The determination of whether calls to a 084 number are more expensive than to a geographic number may be made for each group as follows:

Group	0845	0844
A	Cheaper	Cheaper
B	Same	more expensive
C	more expensive	more expensive
D	more expensive	more expensive
E	Same	more expensive
F	more expensive	more expensive

It is important to note that BT (Group A) is the exception. It is common to quote BT rates with the qualification that others may vary. This table shows how this approach has things the wrong way around.

Notes

1. A list of 164 of the numbers covered by these directions is found here on my NHS.Patient website.

2. The NHS Direct NHS Trust is totally excluded from this requirement.

An exemption for the 0845 4647 Health Advice and Information Line had already been announced. There is however no good reason why 0345 4647 could not be used alongside as a lightly publicised alternative for the remaining life of this service.

The Choose and Book Appointments Line 0845 608 8888, as well as other 0845 numbers used by NHS Direct (68 of them) are also excluded from these directions.

3. There is no clarification of whether NHS Foundation Trusts are covered by these directions; one might fear that they are not.

4. GPs will be covered by forthcoming amendments to their respective contracts. It is likely that these will be expressed in similar terms. It must be noted that NEG Ltd provider of the “Surgery Line” system used by perhaps 1,000 GPs in England claims that calls to its 0844 telephone numbers are no more expensive than those to geographic numbers. Its GP clients are likely to rest on this advice.

5. There is no provision for other contracted providers of NHS services, e.g. dentists, pharmacists and ophthalmologists, to be covered by similar requirements.

6. The devolved national governments are likely to follow this lead, as the same situation exists in Scotland, Wales and Northern Ireland.

I will return to this issue in conjunction with MPs, PCTs and other NHS Trusts (and with formal confirmation of the charging information from Ofcom), once all relevant personnel have returned from the Christmas and New Year Holiday.

Rip-off NHS Telephone numbers - New statement from the Department of Health

To:       Concerned MPs and media
CC:       Department of Health enquiries
From:  David Hickson - campaigner for the NHS

Yesterday (9 December 2009) BBC South East broadcast a new statement from the Department of Health on the issue of use of revenue sharing 084 telephone numbers by NHS service providers. I quote,

“The government’s position is very clear. Where there is evidence that patients are being charged more than the equivalent of a geographic call, then GPs and all NHS bodies should take all reasonable steps to rectify this. Whilst terminating their contract is an option open to them, the practice could consider altering or re-negotiating the terms of their contract, providing a call back facility for patients, or other options.

Every one of these numbers costs some patients more

The majority (in numeric terms) of telephone tariffs charge more for a call to any 084 number than to a geographic number. There are several exceptions to this rule in respect of 0845 numbers, as used by services such as NHS Direct, and just one in respect of 0844 numbers, as used by over 1000 GPs. Put simply, every patient using a mobile phone to contact the NHS on a 084 number is being charged more, as is every user of a VirginMedia landline.

BT is subject to special and unique regulation of its charges for calling 084 numbers, which therefore vary from the normal pattern.

Does the Department of Health require specific evidence of every individual case before it will take appropriately firm action to apply the principles of the NHS? NHS services must not be funded by payments made by patients as they access those services. I would be happy to become engaged in collecting the necessary evidence, if my general assertion is disputed.

Action required

The first thing that must be done is to prohibit any further 084 numbers being adopted by NHS providers. Waiting for the evidence in new individual cases and then considering alteration to a newly signed long term telephone supply contracts is not a satisfactory way to proceed.

For those already contracted for the provision of non-geographic numbers, there is a simple solution. Telephone service providers allow migration from any 084x number to the equivalent 034x number within the term of a contract. (Calls to all 03xx numbers must, by regulation, be charged at no higher rate than calls to geographic numbers, in all circumstances including through packages and for mobiles and payphones as well as landlines.)

Whilst a possible major change in the near future causes NHS Direct to retain some of its existing 0845 numbers, it would require no effort whatsoever to arrange for the equivalent 0345 numbers to operate in parallel with suitable, but modest, publicity.

The suggested “call back” option is of very limited use and is potentially unnecessarily expensive for all. It is not necessary for NHS providers to relieve callers of the normal cost of a telephone call, they must simply not use revenue sharing numbers that may cause a premium charge to be incurred. On a simple call to arrange a GP appointment, the time taken to arrange a call back is likely to be almost as great as that to complete the transaction; furthermore this would be of little help if the caller has been paying at a premium rate for a lengthy period whilst waiting to get through. The DWP has recently introduced this approach for lengthy calls that are answered swiftly, however this is only an interim step towards a proper and more cost effective resolution.

Action not being taken

We are still waiting to see the Directions to NHS bodies and proposed revisions to the GMS contract announced on 14 September. It is quite extraordinary that in all the time that this issue has been under consideration the Department of Health has failed to recognise that calls to 084 numbers do cost (at least some) patients more than a geographic call. Despite ill-considered suggestions that this will change, there is only one telephone company that has increased the cost of geographic calls to overtake that for calls to revenue sharing numbers.

As the government strives for fairness and equity in difficult times it is a disgrace that those less well off, relying on PAYG mobiles, not only incur the highest call charges, but also incur the highest additional premiums when calling NHS services using 084 numbers.

Rip Off Britain - update

The episode of Rip Off Britain broadcast by BBC1 this morning highlighted a number of important issues regarding use of revenue sharing telephone numbers.

Relevant portions are in the clip shown below:



The campaign led by Guy Mayhew is worthy of greater support and coverage now that his e-petition has concluded.

I offer the following points of clarification and update on the matters covered.

The public has recognised that the Department of Health announcement of 14 September was NOT a ban on the rip off, and breach of the fundamental principles of the NHS, caused by use of 084 numbers. The figure of 37,000 signatures on Guy Mayhew’s e-petition to the Prime Minister grew to over 51,000 in the few weeks since that announcement, and the making of this programme.

Gareth Davies of Ofcom was correct in saying that Ofcom cannot demand use of 03 numbers by public bodies. The appalling lack of public recognition of 03 confirms Ofcom’s failure to effectively promote their use, which it has both the powers and the duty to do. This is seen particularly in the case of the NHS where every present user of a 084 number could readily transfer to the equivalent 034 number so as to continue to provide the same service, but funded properly. This point has not been recognised by the Department of Health, which has allowed use of 084 numbers to continue. It has even failed to permit use of 0345 4647 as an alternative number for NHS Direct during the remaining months of its life, despite the fact that this number has been set up ready for use for over 12 months.

Unless BT and 3 are simply trying to retain a bigger share of the pot of money spent on calls to mobiles, or to put their competitors out of business, their one-way “Terminate the Rate” campaign will simply put more upward pressure on the costs of calls from mobile networks to landlines. This is a commercial dispute which has cleverly engaged the support of some who have been persuaded that it is in the consumer interest. What business would not allege that its competitors are engaged in a rip off to some degree?

It is the same concept of a “termination rate” which is the basis of the revenue sharing on 084 and Premium Rate Service numbers, as used by many FSB members (and also Citizens Advice Bureaux). That is what is causing the particular rip off being suffered by Louise and David Mason. All telephone calls, like other utilities, have to be paid for somehow; it is not always the utility provider that is to blame if the cost burden is unfairly distributed.

BBC1 Daytime TV highlights revenue sharing Telephone Number Rip Off

From: David Hickson - public services campaigner

In the first of a series of programmes on “Rip Off Britain”, to be broadcast on BBC 1 tomorrow (Monday 30 November) at 9:15 am, three “Rottweilers” get their teeth into the rip off behind 084 telephone numbers.

Veteran reporters Angela Rippon, Gloria Hunniford and Jennie Bond present the series. This episode will expose the subsidy obtained by both commercial and public service providers at the expense of their users who pay premium rates to call 084 telephone numbers, although they are not honoured with the classification of being a “Premium Rate Service”. Where no fee is advised as being levied for the service, callers are being ripped off by the provider, the organisation they are calling, not by their telephone company.

Contributors, including myself, highlight the impropriety of this means of funding public services. Most notable is “our NHS”, which we proudly proclaim to be “free at the point of need”, funded exclusively through progressive taxation. This rip off will continue, despite a recent government announcement. This declared a ban on use of “expensive” telephone numbers to contact the NHS, but inexplicably excludes 084 numbers from its provisions. This is despite a total of 51,367 signature on a e-petition to the Prime Minister demanding a ban.

The fact that some (generally more wealthy) users benefit from perversely reduced rates for calling these numbers (because the non-premium element is made minimal by regulation) is not only a red herring, it actually highlights the unfairness, because the cost burden falls heavily on the less wealthy. Unlike other more contentious cases that are raised in the series, this is one rip off that it clearly wrong, affects almost all of us (not least because we “own” the NHS) and could be ended swiftly and effectively.

Please contact me for further comment and information.

New Premium rate telephone number for London Travel Information

Transport for London ready to launch new premium rate telephone service for London Travel Information

Transport for London requires a “non-geographic” telephone number for a new Travel Information service which will ultimately replace that offered on 020 7222 1234. Ignoring Ofcom advice and the practice now being followed by many public bodies it has not selected a 03xx number, which would be charged to all callers on exactly the same basis, but has gone for a number that provides it with a subsidy, at the expense of callers.

All 084x numbers are “revenue sharing”, which means that the recipient of the call benefits (through their telephone service provider) from the premium rates charged to callers.

The number selected by TfL , 0843 222 1234, is from the group (call type “g6”) that is the most expensive to call, and thereby most generous in revenue share income to the user, short of those which are formally classified as being used for Premium Rate Services. The premium rate that is charged for calls to this number is not quite sufficient to warrant the acknowledgement that a genuine “Premium Rate Service” is provided.

Over two years ago, Ofcom introduced the 03 range for those, especially public service providers, who need the benefits of non-geographic numbers but find it inappropriate or undesirable for callers to incur more than the cost of an “ordinary” call to a 01/02 number, which may be included in a package. By regulation, calls to 03 numbers must be charged on the same, or better, terms. For this reason the Metropolitan Police chose a 03 number for its new London-wide non-emergency contact service around a year ago. I was pleased to welcome this, and the example it set for others, on BBC TV
– see this clip.

BBC Breakfast 17 October 2008

The effect of partial regulation on BT’s charges causes perverse effects for some of its customers during the working day, however it is generally true to say that all callers will pay a premium over what they pay for an “ordinary” call to call this 0843 number.

The higher cost of calling is due to the fact that a revenue share of around 4p per minute is paid over from the originating to the terminating telephone company on calls to numbers of this type. This means that callers incur a premium rate as well as a connection fee in some cases and are denied the benefits of competitive prices for ordinary calls. This loss of benefit is seen in exclusion from packages and in some mobile callers paying a premium of 100%, e.g.  40p per minute, rather than 20p, for Orange PAYG. The benefit gained by TfL may not be seen in a fat monthly cheque, but one hopes that it is reflected in the price it will pay for its telephone service. If not, then TfL is allowing its telephone service provider to simply profiteer. One may dress this up in various ways and refer to peripheral issues, however choice of a 084 number means that TfL is charging its users for its service.

I would never suggest that TfL should meet the costs of callers by offering a “freephone” service, however if it is to impose an indirect charge on callers then it is right that this be acknowledged, declared and justified. If TFL is ready to provide a proper acknowledgement of the situation, a proper declaration of the costs to callers (other than quoting the exceptionally regulated prices perversely available to some BT customers) and its justification for the introduction of a charge for a previously free service (so far as TfL is concerned) then I would be ready to join in proper debate of the issue. The argument that a non-geographic number is needed fails to address the relevant issues, given that 03 is available.

I hope that it is not too late for the option of using a 03 number to be reconsidered. Whilst some undoubtedly call TfL from BT lines, it is important to understand that it is BT’s charging structure that is unusual, because it alone is regulated in its charges for calls to 084 numbers. It is BT that varies from the general pattern, not the other way around.

As a renowned campaigner on these issues, I will be delighted to assist TfL and anyone else in gaining a proper and complete understanding of the issues and in ensuring that the right decision is taken.

The Department of Health confirms that NHS "access charges" are permissible

From: David Hickson – campaigner for the NHS

Quoted below is a most helpful reply I have received from the Department of Health. The relevant section is highlighted. I quote it here:

The restriction on charging applies only to the provision of services
and does not extend to ways in which services are accessed,
including for example charges relating to telephone calls to access services.

This confirms that NHS providers are free to levy “access charges” in connection with NHS services, although not for the services themselves.

As “access” is what happens “at the point of need”, then the statement “free at the point of need” has no meaning.

This finally confirms why the Department decided not to ban use of 084 telephone numbers in the NHS, although seeking to pretend that it had.

All calls to 084 numbers earn money for the person called, through their telephone service provider. This cost is normally passed on in a premium charge to the caller.

The Health Act 2009 has now been granted Royal Assent. The status of the NHS Constitution and this interpretation of the first of the rights that it declares will have to be tested in court.

This statement declares the following. All NHS services accessed by telephone, e.g. the NHS Direct advice and information service, the Choose and Book appointments line and any other service with an appointment making service operated by telephone may be subject to a charge at the discretion of, and to the financial benefit of, the provider. We are not talking about the charge imposed by a telephone company for a normal telephone call, but the surcharge applied to fund a share to the recipient.

It implies that other “access charges” are acceptable also. This could include an appointment booking fee applied to all patients and charges for the services of hospital porters and ambulance drivers who only provide access to services. There could also be a vehicle access charge for those who use ambulances or taxis or get lifts to hospitals in order to avoid car park charges (which are themselves fully cleared by this statement).

“Our beloved NHS” has been stolen by the government currently in power – see Theft of the NHS. We will have to go to court to see if parliament has truly sanctioned this in legislation.

Dear Mr Hickson,
 
Thank you for your further emails to the Department of Health about 084 numbers used by the NHS.  I have been asked to reply.
 
I note that the only new question you have posed in your latest emails asks about how 084 numbers are compatible with the NHS Constitution, and so I will reply solely on this point.
 
Part 1 of the NHS Act 2006 sets out the primary duty on the Secretary of State to promote a comprehensive health service and to provide or secure the provision of services for that purpose.  The section goes on to state that those services must be provided free of charge (unless charges are expressly provided for).  The NHS Constitution reflects the existing legal position by setting out the right to receive NHS services free of charge, apart from certain limited exceptions sanctioned by Parliament.  Charges related to telephone calls are not currently exempted and the NHS Constitution does not alter this.  The restriction on charging applies only to the provision of services and does not extend to ways in which services are accessed, including for example charges relating to telephone calls to access services.
 
I hope this reply is helpful.
 
Yours sincerely,
 
xxxxxxxxx
Customer Service Centre
Department of Health

Rip- off Telephone Numbers - The Department of Work and Pensions starts to get a grip

From: David Hickson – campaigner for the NHS, and on public service issues

The problem

Calls to 0800 numbers from mobile phones are NOT FREE. Whilst some mobile companies waive their charges on calls to registered “helplines” on 080 numbers, under a scheme arranged by the Telephone Helplines Association, this does not cover the 0800 benefit claims lines used by DWP agencies.

Although BT is required by regulation to offer cheap rates for calls to 0845 numbers, this does not apply to other providers who charge a premium. DWP agencies make extensive use of 0845 numbers, allowing the interests of those who have service from BT to override those of callers who do not.

At last, this problem is recognised, and starts to be addressed

In giving evidence before the House of Commons Work and Pensions Committee on Monday 9 November, Jeremy Groombridge CB of the DWP, was invited by the Minister, Jonathan Shaw MP, to explain what DWP agencies are doing to start to address this problem.

See this extracted recording of the relevant comments.

It has been taken from this item on Parliament Live TV (around 01:27:000), as the written transcript of the evidence is not yet published.

I can be quoted as commenting: “The worthwhile measure of proactively offering to call back all mobile callers to 0800 and 0845 numbers represents a necessary acknowledgement of the issue and a significant first step on the road to properly addressing it.”

This also shows that at least one major government department understands the problem, whilst others (notably the Department of Health) appear to totally misunderstand it.

Further action is needed

The following further steps, as alluded to in the comments, that are required to follow are:

·        Arranging for calls to 0800 numbers used by the DWP to be free to all callers, including those from mobiles - the necessary special arrangement with the mobile providers would probably end up being cheaper for the Department, as well as being more effective, than the present interim measure.

·        Replacing all 0845 numbers with numbers from the 03xx range - this would ensure that callers from all networks paid no more than the cost of a call to an ordinary (01 /02) number and benefitted from inclusion in call packages where these apply.

---

Notes

1. The Department for Work and Pensions has now overtaken the Department of Health in understanding this issue. The Department of Health is still content for NHS providers to use 0845 and the more expensive 0844 numbers, even though some patients will undoubtedly be calling from mobiles. The DH should note what the DWP has learned and adjust its present misconceived proposals accordingly – would NHS Direct or GP surgeries consider calling back to callers from mobiles? – there is no need; NHS Direct has a 03 number sitting waiting to be offered as an alternative, GPs on 0844 could readily switch to 0344 numbers!

2. We look forward to hearing of the next steps in this process by the DWP. We also await similar steps by all other public bodies, notably HMRC.

3. This welcome step only represents an interim measure. It is important to note that those who withhold their number cannot recognised as mobile callers and those unwilling to provide it cannot be called back. It does not address the problem of paying a premium rate whilst waiting in a queue before speaking with an agent.

The problem of those paying a premium to call 0845 numbers from Virgin Media and other landline providers is not addressed.

The process is also costly in time to both the agency and the caller as it requires a, hopefully brief, conversation about the telephone call itself as well as that taking up in dialling and receiving the return call.

It is possible that it would cost the department considerably less to pay the full cost of receiving calls on 0800 numbers from mobiles and in using 03xx numbers, rather than 0845, than it does to return calls.

4. All calls to 084 numbers cause the revenue paid to the originating telephone company to be shared with that terminating the call. The recipient of the call should therefore benefit in some way (unless it is happy for its telephone company to profit at the expense of its callers).

This cost is reflected in the charge to the caller. This may be disguised within a package fee. In the case of BT, the amount that it can retain is regulated to be well below the amount that it normally retains on non-revenue sharing calls. We now have the bizarre situation where BT’s wholly retained charge for ordinary calls, when outside the terms of a package, at 5.25p per minute is greater than the highest charge for calls to a revenue sharing 084 number at 4.89p per minute.

5. Ofcom clearly intends for all public bodies to move from the 084 to the 03 range, on which revenue sharing is prohibited. Revenue sharing is obviously improper for public services, except where a service charge is proper and declared. BT customers outside the terms of their package could however benefit from the 0845 rates imposed by regulation, because BT’s unregulated normal rates are higher. This poses a problem to which there is a simple answer.

Use of the neutral 03xx numbers should now be the norm. There is no reason why any service provider that wishes to do so could not offer a series of special alternative numbers to enable users of particular telephone services to benefit from special discounts: 0845 for BT, “own network” numbers for each of the mobile providers etc.

6. All BT customers pay the premium to cover the revenue share on 0845 numbers, because these are now included in packages. This cost appears modest because the amount that BT is allowed to retain on these calls is kept artificially low by regulation.

Whilst it would suit the beneficiaries of revenue sharing to have their costs subsidised by all telephone users, rather than just their callers, getting 084 calls included in packages is in no sense a proper way for this situation to be resolved.

---

Evidence to the Work and Pensions Committee on DWP use of 0800 and 0845 numbers

This clip is to accompany my release - Rip-off Telephone Numbers - The Department of Work and Pensions starts to get a grip

Ban on use of expensive GP telephone numbers will not happen

Further to previous briefings (notably this epic, which contains all of the relevant links), I have now finally confirmed that the ban on use of expensive telephone numbers to call a NHS GP (also hospitals and other NHS services) will not come into effect at any time in the foreseeable future.

Under the terms of the "ban", use of 0844 and 0845 numbers is tolerated on the basis that all telephone companies will remove their premium charges from calling these numbers and will add them into the call-inclusive package used by any NHS patient.

I have now confirmed that the major landline providers, e.g. BT, Virgin Media and Talk Talk, have no such plans; the same applies to all of the mobile and payphone providers. Whilst they continue to have to pay over a share of their revenue to the "terminating" provider it is reasonable that they continue to pass this cost on to the caller.

This year? / Next year? / Sometime? / NEVER

The Department of Health has said that the "ban" will come into effect "early in the new year". It has not however yet issued the directions to NHS bodies referred to in the 14 September announcement. Formal negotiations on the revisions to the NHS/GP contract, which include a three month consultation period, have not yet begun.

It is therefore not too late to get the Department of Health to correct the appalling error it has made in allowing wholly unreasonable assumptions about forthcoming changes to telephone tariffs to be an essential feature of what it proposes. On recognition of the truth of the situation, its plans must be changed to effect a ban on use of all 084 numbers until such time as they cease to yield revenue share and consequently cause the imposition of premium rates. (Ofcom may be considering such a change to perhaps start for some 084 numbers in around 2-3 years time.)

The Prime Minister will have to comment shortly

The e-petition to the Prime Minister, calling for an effective ban, has just three more weeks to run. The many signatures added since 14 September demonstrate that there is no confidence in the announcement made that day. We await the response from the Prime Minister, over 47,000 emails, which are due to be sent out shortly after 28 November.

Notes:

1. I have been in private conversation with a number of telephone companies and am confident of the comments I make. As a private citizen, I have not been able to secure the issuing of a public statement.
2. I would urge formal enquiries about the timing of the "ban" to be made of the Department of Health, to confirm suggestions in a letter to me and to a number of MPs. The telephone companies will then be ready to confirm what changes they will guarantee to have in place by that time.
3. As explained previously, BT is in an odd position because some of its rates are regulated, whereas others are not. This confuses the situation and also leads to some perverse effects. I can explain this in detail if necessary. It is sufficient to say that the BT rates for those who do not benefit from the terms of an inclusive package are atypical of the general position and therefore misleading, even though they are commonly used as examples.
4. I am totally confident that we will find the present proposals never to deliver the ban that many were quick to announce.

Ofcom's trickery is extended

From: David Hickson – Stop Silent Calls campaigner

Following media coverage of the trick referred to in my release "Ofcom's Halloween trick, a treat for Silent Callers", Ofcom denies the suggestion that its new rules will mean more Silent Calls.

See these contradictory items –

'Silent calls' to increase after Ofcom changes rules - Telegraph
A change to Ofcom rules should further reduce the amount of silent calls suffered by consumers - Ofcom

Arguments about whether Silent Callers will make "more" or "less" Silent Calls are not really the key issue. Ofcom should be focussed exclusively on stopping the practice altogether. As it has chosen to try to tweak around with the rules that allow up to 3% of the total number made being Silent Calls, I am however prepared to engage on this point.

I maintain that the rule change will lead to an increase in the number of unnecessary Silent Calls for the following reasons:

• Answering Machine Detection technology (AMD) is an inevitable cause of Silent Calls.
  Many in the contact centre industry refuse to use it, and join me in campaigning for its use to be banned, for this reason. (I can provide contacts and references.) Whatever its merits, any tolerance of AMD is a tolerance of Silent Calls.
• Increasing the time before an agent is connected means more Silent Calls.
  The delay before a message has to be played when no agent is available obviously applies to every call, including those where an agent is available to speak to a live person.
  This makes every call potentially sound like a Silent Call. The longer the delay, the more likely this is.
• When AMD is used the first two seconds of the recipient's greeting are now guaranteed not to be heard by the calling agent.
  Failure to respond promptly to the greeting not only damages the quality of the conversation that may follow.
  It is likely to lead to the (correct) assumption that there is nobody listening at the other end – a Silent Call.
• When AMD is not used callers still have two seconds in which to connect an agent (or message).
  That time is considered sufficient for 1) obtaining an adequate sound sample, 2) processing it and 3) completing the appropriate connection.
  It must be far more than is necessary for those not using AMD, who only have to perform the third of these steps.

Ofcom's statutory duty is to prevent and penalise "persistent misuse of the telephone network" (habitually making Silent Calls), whenever it is made aware of it.

It is not only wrong for Ofcom to seek to get Silent Calls to reduce the number of Silent Calls that they make by regulation, it has no authority to impose and enforce general regulations on users of the telephone anyway. The powers can only be applied in particular cases.

It is now more than 12 months since anyone was made subject to use of the powers.
Ofcom shows no sign of being ready to fulfil its duty to parliament – expressed when the previous increase to the maximum penalty was granted (on 28 March 2006) as follows -

"We expect you to use your powers to eradicate the nuisance of Silent Calls".

Until Ofcom is ready to obey "rules" made by parliament, parliament must not grant it another increase to the penalty used against those who fail to follow its "rules".

Ofcom's Halloween trick, a treat for Silent Callers

From: David Hickson – Stop Silent Calls campaigner

OFCOM LOOSENS RULES ON SILENT CALLS

Ofcom must be playing a Halloween trick with spooky and frightening Silent Calls. Whilst the possibility of bigger fines is out to consultation, Ofcom loosens its rules as a treat for Silent Callers!

One week after the government launched a consultation on whether Ofcom should be allowed to impose greater penalties, Ofcom has softened the rules it follows in assessing whether to penalise Silent Callers.

The announcement, published on 30 October, is found here - http://www.ofcom.org.uk/consult/condocs/persistent_misuse/amendment/.

The policy changes will apply in two ways:

• Answering Machine Detection (a known major cause of Silent Calls) is now expressly permitted.
• The number of "assumed" Silent Calls (caused by an unacceptably long delay before the caller speaks) will increase.

Explanation

It is very easy to get lost in the detail of Ofcom's policy. Ofcom chooses to leave it to people like me to provide an explanation (- please ask why!).

In simple English, this change represents acquiescence to requests from dialler users who want to use Answering Machine Detection Equipment (AMD), but remain free from the risk of action by Ofcom. Everyone acknowledges that use of AMD inevitably leads to Silent Calls. Many in the contact centre business have urged Ofcom to effectively ban it by formally identifying it as an inevitable cause of Silent Calls. Ofcom has previously refused to do this, and now actually takes a further step towards its approval.

• AMD users may now "choose" to use a longer sound sample to assess whether the sound from the receiving end is of a live person or a recording. This can now run for just short of two seconds from when they detect someone speaking, rather than from when the call is answered.
• Those who do not use this detection equipment have inherited the full two second limit in which to deal with an answered call - either passing it to an agent or playing an Informative Message if none is available. (This excessively long interval was originally granted solely for the sake of AMD users.) To understand why this limit is excessive, one may consider the situation of AMD users. They have to complete dealing with the call within two seconds from the start of the greeting – but this is after they have also collected and processed a sound sample that is large enough for their determination!

THIS JUST MEANS MORE SILENT CALLS

AMD itself is a cause of Silent Calls, even for those who play an Informative Message when no agent is available. This extended sample time will not come anyway near eliminating the "false positive" detections that are accepted as inevitable. The nuisance of Silent Calls is no less if someone reasonably assumes that the caller will not speak, even though they would have eventually done so. An unnecessary tolerance of, or extension to, a lengthy interval before the caller speaks will cause more Silent Calls to be experienced.

Ofcom refers to its highly complex and absurdly detailed Statement that defines the way it considers cases of persistent misuse of a telephone network or service. It refers to the need for greater clarity - because those who make Silent Calls are not totally clear on what they can be sure of getting away with. It is all based on the complex calculation of an "abandoned call rate", when it should be simply saying – NO SILENT CALLS.

If Ofcom were to listen to the victims of Silent Calls it would hear that NO SILENT CALL IS ACCEPTABLE. Any habitual practice of making Silent Calls is "Persistent Misuse". The greater the number of Silent Calls, the greater the need for immediate and proportionate action using the powers granted by parliament. The longer the practice of making Silent Calls continues, the greater the number of occasions on which a proportionate penalty has to be imposed. Repeated disregard of a properly imposed requirement to cease making Silent Calls should lead to an injunction with the potential for criminal penalties being imposed by a court. Proper use of Ofcom's existing powers (as they have existed since 2003) could be that simple. A penalty of up to £5,000 per Silent Call would have been quite adequate.

The "Ofcom rules"

It is important to understand that the so-called "Ofcom rules" (which actually only bear legally on Ofcom itself) do not prohibit the making of Silent Calls.

They allow up to 3% of calls to be "abandoned" (including those arising from false answering machine detections, which are always Silent). Only if that limit is seen to have been breached will the possible failure to deliver an Informative Message, to cover every situation where there is no agent available to take an answered call, be considered.

Ofcom has penalised companies who have exceeded the 3% limit, but without being found to have made a single Silent Call. Those who remain within the 3% limit, regardless of the scale of their activities which could amount to making millions of Silent Calls, remain untouched by Ofcom's policy.

 

Ofcom's tinkering around with this foolish and improper attempt at refined regulation, which it has no proper powers to impose anyway, must be brought to an end. Parliament must not offer an endorsement of this ridiculous policy by granting an increase to the maximum penalty that may be imposed on its application.

Please contact me for any further explanation and comment. There is more information on my blog

The truth about the alleged “ban” on use of expensive telephone numbers by NHS GPs

From: David Hickson, campaigner for the NHS

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.

---

BT is to blame

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.

Notes

1. 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.
   
   
2. 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.
   
   
3. I have collected a selection of links to news items published on and after 14 September 2009.
   
   
4. 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.
   
   
5. 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.

Health Bill debates – Monday 12 October - Briefing

Health Bill – Report and 3^rd reading debates – Monday 12 October – NHS Constitution - Briefing

Introduction

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.

Background

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.

Notes

1. 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.

   I cannot quote to prove a negative, but must urge close examination of the statement and the formal consultation response to confirm that there is no basis for these comments.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

Health Bill - NHS Constitution - 084 telephone numbers - Briefing to MPs and media

From: David Hickson – campaigner for the NHS

On Monday 12 October, the Health Bill is scheduled to receive its 3^rd 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.

Example

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	24p	25p
2.	BT - Unlimited Anytime plan	24p	0p
3.	Virgin Media - Talk Evenings and Weekends	29p	25p
4.	Virgin Media - Talk Anytime	29p	0p
5.	Talk Talk (the supplier of 0844 477 1799) - both plans	23p	0p
6.	Post Office Homephone	23p	22p
7.	O2 - contract with inclusive calls	60p	0p
8.	O2 – PAYG	75p	15p
9.	Orange - contract with inclusive calls	36p	0p
10.	Orange – PAYG	£1.20	60p

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.

Action points

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.