The end of NHS Direct - misuse of expensive 0845 telephone numbers will continue for some time

From: David Hickson – campaigner for the NHS

There is no great news story in the "revelation" that the NHS Direct Health Advice and Information service is to be withdrawn. It has long been recognised as being a very expensive way of delivering non-emergency primary health care.

The new 111 service was always intended to replace it, acting simply as a signpost for callers, rather than as a means of delivering care. (Andy Burnham seems to have changed his tune from when he was Health Secretary.) That is why 111 will be cheaper - the only assessment necessary is of the type of care that is required.

111 will however take some time to get up and running. If, as originally conceived, it will incorporate access to social care services then local bodies will need to engage in significant re-organisation and incur expense to adopt it. The 101 concept showed that local bodies are reluctant to invest in amalgamated services, even when offered additional government funding. This was withdrawn from 101 and will not be offered with 111. Many see the risk of 111 withering as a potentially good idea that never worked, like 101.

0845 4647 - an expensive number for most callers, delivering £1 Million pounds per annum in subsidy due to the revenue that it generates - will continue for some years yet. Likewise, access to many Out of Hours GP services and the Choose and Book helpline, which are also operated by the NHS Direct NHS Trust using expensive 0845 telephone numbers. If, as is claimed by the NHS Direct NHS Trust, it allows BT Wholesale to keep this money, then the whole organisation needs to be reviewed.

Those who do not benefit from the regulated low rates offered by BT, incur premium rates to call 0845 numbers – up to 40p per minute. This includes the 26% of socio-economic group DE households who rely entirely on mobiles.

Last December all NHS bodies were directed to cease using expensive telephone numbers (obviously including those beginning 0845) within one year, but the NHS Direct NHS Trust was exempted from these provisions.

I have long proposed that alternative 03 numbers (including 0345 4647, which is already configured and ready for use) must be introduced to work alongside the existing numbers during this lengthy period of transition, given that a full number change would incur inappropriate expense.

The government may be short of money - but so are citizens - it is not acceptable to continue using revenue sharing 0845 telephone numbers to subsidise the cost of providing public services at the expense of NHS patients as they access healthcare, Tax Credit claimants as they make enquiries of HMRC and Jobseekers as they contact JobCentres.

Please contact me for further comment and information. (I can supply references to support the preceding comments.)