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Thursday, 2 September 2010

NHS Direct - a telephone rip-off (also HMRC and Ofgem)


·       The, as yet un-covered, news story revealing that the NHS Direct NHS Trust gifts over £1 million pounds per annum to BT Wholesale, as alleged by the organisation itself, may warrant confirmation and inclusion in the current debate about its future.

·       The fact that the NHS Direct telephone service is configured for use only by those with BT landlines may also have a place in current discussion. Regulation ensures that only other telephone callers pay a premium over their “normal” rate to call 084 numbers. (Ofcom provides assistance to those who may wish to draw social conclusions.)

·       I seek support and publicity for my demand that alternative "03" numbers (non-premium rate from all types of telephone, free in many cases) be immediately made available to enable equitable access to public services, with no indirect charge on service users. NHS Direct has such a number set up and ready for use.

·       The government may wish to comment on whether it intends to continue the strategy of subsidising the cost of public services provided by telephone, through use of expensive "revenue sharing" numbers. (e.g. £2.20 rather than 60p for an average call to NHS Direct from a payphone; £3.60 rather than £1.35 from a PAYG Mobile.)

Many of my points apply equally to other public services using 084 numbers, including HMRC, DWP agencies and even the Consumer Direct number 08454 040506 currently being used and publicised by Ofgem.

(Numbered annotations 0 refer to linked notes and links at the foot of this message.)

Some of us look forward to celebrating the end of the expensive 0845 4647 number being used for NHS services, but we may well have for up to 5 years to wait before 111 is adopted throughout England. Given that there will be many other re-organisations going on, it will take some time for new local NHS commissioning bodies to get their act together and to find the money necessary for the 111 service. It is highly unlikely that they will be able to afford to extend the service to provide on demand call-backs from nurses to give medical advice by telephone, as this was never part of the plan for 111, whatever dreams of further empire building Nick Chapman may have 1.

Unless 111 is adopted there also, NHS Patients in Wales will continue to call 0845 4647 and in Scotland 08454 242424. The Choose and Book Appointment Line 0845 608 8888 will remain, as will 60 other 0845 numbers operated by the NHS Direct NHS Trust in England 2.

All 0844 and 0845 numbers are revenue-sharing, yielding a subsidy to the user (or its telephone company) at the expense of the caller's telephone company. The NHS Direct NHS Trust has proudly confirmed to me that it does not accept the benefit of over £1 Million per year which it should be receiving from the revenue share on its 0845 numbers. The same point is made clearly and explicitly in a written ministerial answer 3.

If the NHS Direct NHS Trust is being honest in stating that it allows its telephone service provider (BT) to keep this money, then it is allowing both patients and the taxpayer to be ripped-off. This is just one example of why this particular organisation is far too costly in the way it provides services, which may be valuable and appreciated.

BT is uniquely prohibited by regulation from making money on placing calls to 0845 numbers from landlines, so it gives them away cheap or for free. Apart from this exceptional case of calls from BT Landlines (less than 25% of calls made in the UK), call originating telephone companies charge a premium, to recover the money that is passed on through revenue share, when any 084 number is called.

Some typical examples of the relative cost of calling a 0845 number:

The average duration of a call to NHS Direct is 528 seconds 3; this is used to give the typical call cost in brackets. (These typical examples are extracted from a more comprehensive analysis 4.)

·       Virgin Media landline: normal calls - inclusive; 0845 calls - 11p + 10p per minute. [0 vs. £1.01]

·       Orange Racoon (pay monthly): normal calls - inclusive; 0845 calls - 20p per minute. [0 vs. £1.80]

·       Orange Racoon (pay as you go): normal calls - 15p per minute; 0845 calls - 40p per minute. [£1.35 vs. £3.60]

·       BT Public Payphone: normal calls - 30 minutes for 60p; 0845 calls - 1 minute for 60p, then 20p per minute. [60p vs. £2.20]

N.B. "normal calls" includes calls to all 03 numbers, which must be provided on the same terms as calls to "geographic" (01/02) numbers.

Calls to 0845 numbers from mobile phones are invariably more expensive than equivalent calls to "normal" numbers. A recent Ofcom report confirms that 26% of socio-economic group DE households rely entirely on mobiles, 2% on public payphones 5.

NHS Direct has an alternative number available

0345 4647 is already set up and available for use as an alternative to 0845 4647 6. It is however withheld from use.

This must now be immediately introduced to work in parallel through the lengthy period whilst 0845 4647 will remain in use. This needs formal acknowledgement, but there is no need to incur the expense of extensive publicity and reprinting of the mass of literature carrying 0845 4647. All those who do not benefit from the regulated cheap rates available to BT landline subscribers should be encouraged to use the alternative 0345 number.

Similar arrangements need to be made for all other 0845 numbers used by NHS Direct.

The December deadline is approaching

All NHS Bodies have been directed that they must cease use of telephone numbers that are more expensive to call than a geographic number, before 21 December 2010 7. There are many 2 which have so far failed to take the necessary action. (NHS GPs have until 31 March 2011 to do the same, but they are also failing to comply.)

The NHS Direct NHS Trust is explicitly exempted from this requirement - the Department of Health expressly permits the NHS Direct NHS Trust to use expensive telephone numbers. There is however no good reason why the NHS Direct NHS Trust should not itself give a lead as the primary provider of NHS service by telephone. One notes its declared desire to continue to serve the NHS when more power is devolved to local commissioning bodies 1. Its continuing failure to adhere to the first principle of the NHS (“free at the point of need”), even securing an exemption from having to comply with that principle, does not leave it well placed to take on this role.

Offering alternative numbers is a relatively weak move, because most callers have no idea about which numbers are cheaper to call, but it does go some way to remove accusations that public bodies such as NHS Direct (as well as HMRC and the DWP agencies, which also use 0845 numbers) are deliberately securing funding from service users. Using 0845 telephone numbers is a particularly nasty way of subsidising the cost of providing a service, because the greatest financial burden falls on those least able to bear it. Continuing to raise money in this underhand manner may help to relieve the public spending deficit, as it has the added “benefit” of discouraging the poor from accessing public services at all, thus saving even more money. This may not be the intention, however I would be very interested to hear comment on the fact that it undoubtedly has this effect.


1. See letter from Nick Chapman, Chief Executive of the NHS Direct NHS Trust, published here.

2. A list of expensive telephone numbers used by NHS bodies is found here.

3. Written answers provided 19 January 2009 Column 1200W (comment at foot) and 3 Feb 2009 Column 1109W.

4. See a more extensive discussion of the issue, published here.

5. The relevant numbers are found in figure 5.68 and the preceding text on page “338” (62/81 in Acrobat reader) of this document.

6. Details of the introduction of 0345 4647 are found here.

7. The Directions to NHS Bodies in England are published here.

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