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.