One NHS hospital finally gives up its expensive 084 telephone numbers - what about the rest?

From: David Hickson – campaigner for the NHS, and for equity in access to public services

A media release from the Mid Essex Hospital Services NHS Trust, announces the end of its use of expensive 0844 telephone numbers starting from 4 December.

Local MP, and Minister of State for Health, Simon Burns, will doubtless be delighted at this news.

NHS bodies must cease using expensive numbers by 21 December 2010

Mr Burns may however be less keen to acknowledge that his Department has failed to get the many other NHS bodies still using expensive 084 telephone numbers to comply with a Direction for them to cease the practice by 21 December 2010.

NHS Direct is a special case, as its 0845 4647 number is due to be shut down within the next five years. The cost and confusion of a complete number change would not therefore be appropriate at this point. The 0345 4647 alternative, which is set up and ready, should therefore be brought into use alongside to operate in parallel. (This approach of using equivalent 034 numbers in parallel is appropriate for many other situations – all 03 numbers are charged on the same basis as calls to ordinary geographic numbers from every type of telephone service and contract.)

NHS GPs must cease using expensive numbers by 31 March 2011

Many GPs use expensive 084 telephone numbers. As they will shortly be taking responsibility for applying the principles of the NHS locally, they should be able to set an example to the hospitals, whose services they will be commissioning.

They have been subjected to a contract revision, requiring them to cease use of expensive telephone numbers by 31 March 2011. This is however not happening.

The BMA advises its members not to give up their 084 numbers. It has a policy that patients should pay for access to NHS services, according to the quality of the service provided.

Primary Care Trusts currently enforce the principles of the NHS

Until GPs take over their new responsibilities, it is for Primary Care Trusts to ensure that GPs fulfil the terms of their contract with the NHS and that commissioned NHS providers comply with the Directions from the Department of Health. To my knowledge, not one PCT is demanding that NHS GPs, Hospitals, Dentists, Pharmacists or Ophthalmologists give up their 084 telephone numbers.

The appropriate Minister, whether this be Simon Burns, Andrew Lansley or Earl Howe, must remind PCTs of their duty to the patients they serve. Centrally imposed micro-management through PCTs may have no place in the NHS of the future, however its principles must be retained and adherence to those principles enforced.

My message to Simon Burns, Andrew Lansley and the rest of the government

If Health Service providers are to continue to receive subsidy through use of revenue sharing 084 telephone numbers, thereby inevitably at the expense of patients, then that is not the NHS whose enduring principles we recently celebrated on its 60^th birthday. The coming deadlines give the government a chance to show us where it stands.

·       Does "Liberating the NHS" mean freeing providers from a duty to adhere to the principles of the NHS, by allowing them to fund services at the expense of patients as they access them? A failure to ensure compliance with the current deadlines for abandonment of expensive telephone numbers would suggest that it does.

·       Mid Essex Hospitals has chosen to re-affirm the principle of free at the point of need. Should not all other NHS providers be seen to be compelled to do the same!

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Notes

1.    A list of NHS bodies in England using 084 telephone numbers is published on my "NHS Patient" web site at http://homepage.ntlworld.com/davidhickson/NHS.Patient/NHS%20Hospitals.htm. Please contact me for qualification of a few cases where changes are in hand.

2.    Lists of GPs in the UK using 0844 telephone numbers are published on my "NHS Patient" web site at http://homepage.ntlworld.com/davidhickson/NHS.Patient/0844%20GPs.htm. There are some more cases where 0844 numbers have been adopted whilst the matter has been under review.

3.    I will be happy to provide further briefing and comment to anyone concerned to maintain the NHS or reporting on its possible demise. I will be happy to engage in debate with anyone who does not see the NHS as being a universal service, where all are treated equally, or who believes that the time for such a service has passed.

4.    I am also engaged on exactly the same issue with expensive 084 telephone numbers, as it applies to HMRC, DWP agencies and other public services.

111 in chaos - the fee charging 0845 4647 NHS Direct number will remain for many years - but there is an alternative

From: David Hickson – campaigner for the NHS

A published letter from Andrew Lansley, Secretary of State for Health to Stephen Dorrell, Chair of the Health Committee of Parliament, shows that plans for the new NHS 111 telephone service are in chaos.

Firstly, there is confusion about what the new service will provide, as against the telephone services currently offered by NHS Direct.

NHS Direct offers a telephone Health Advice, Information and Reassurance service, covering urgent and non-urgent issues. The 111 service was conceived and planned to address ONLY URGENT matters. There is however considerable doubt about whether this is what will be expected by callers. 111 is described in the letter simply as a “non-emergency” NHS telephone line, with no specific reference to the exclusion of non-urgent matters, as marking one of the differences between the new service and that currently in place. This exclusion is however seen to be a key factor (by repeated references to “urgent” in quoted materials) in making the dispersed and free-to-call 111 cheaper to run than the centralised and patient-subsidised NHS Direct service. There may well be a sizeable gap between what is covered by funding and what is expected.

Secondly, it is stated that the wholly conceptual "GP consortia", expected to emerge to serve every part of England, will be established in time and be ready and able to commission and adopt a conformant local 111 service by 2013, in every case. It is perhaps "optimistic" to assume so early a deadline for completion of the total roll-out, before the pilots have been evaluated so that the issues of mandatory service standards and levels of funding can be resolved. The legislation to create the consortia that will design and commission each local service has not yet been laid before parliament, and many of the “willing providers” will be new social enterprises that have not yet been established.

Andrew Lansley offers a firm assurance that the NHS Direct service, on 0845 4647, will not be withdrawn until the roll-out of 111 has been completed. There must therefore be a strong likelihood that 0845 4647 will remain in use for very many years to come - at least until 2013, and probably well beyond. Every call to that number is subsidised at the rate of about 1.7p per minute, for which callers incur a surcharge of up to 40p per minute above the cost, if any, of an ordinary call. Although, under the terms of their telephone service calls package, many callers pay nothing extra to make an additional call to an ordinary number, 111 has been set up so that the NHS provider pays the telephone companies the full cost for every incoming call. In addition to the cost of the switching equipment used to route every call made to a single national number to the correct local service, this is one of a number of costs that will make the take-up of the 111 service difficult to achieve. It is not clear that each consortium will be able to see the financial benefit (if any) of adopting the 111 service in place of that offered by NHS Direct.

The Department of Health has explicitly exempted NHS Direct from a Direction to all NHS bodies to cease using telephone numbers that are more expensive to call than a geographic number. Whilst the 28% of telephone calls made from BT landlines benefit from the perverse effects of legacy regulation, THE VAST MAJORITY OF TELEPHONE CALLS TO 0845 NUMBERS ARE MORE EXPENSIVE than those to geographic numbers. This certainly applies to all calls from Mobiles, Public Payphones and Virgin Media landlines. All of these services are used by NHS Patients, who retain the same right to access to treatment without charge under the terms of the NHS Constitution. Although BT provides telephone service to NHS Direct, its customers should not be entitled to special terms for access to NHS treatment, perhaps especially as this causes customers of other telephone service providers to incur a surcharge when accessing NHS services.

Under the terms of this Direction, all NHS bodies, except for NHS Direct, are required to cease use of 0845 and 0844 numbers by 21 December 2010. Many are leaving it very late, or are content for some patients with telephone service from BT to benefit, at the expense of other patients!

As 0845 4647 has only perhaps 5 or more years to run in England (it will continue in Wales), it is reasonable that it is not immediately withdrawn to be replaced by another number. There is however no reason why the 0345 4647 alternative could not be brought into use in parallel immediately. This number has been set up and ready for use for over two years now. All providers of all types of telephone service, by regulation, do not charge any more than the cost of a call to a geographic number to call 03 numbers - where a package applies, it applies to 03 calls on the same basis as geographic calls.

National Audit Office attacks Ofcom's failure on Silent Calls

From: David Hickson - campaigner against Silent Calls

A report from the National Audit Office, Ofcom: The effectiveness of converged regulation, published today, attacks Ofcom's failure to address the issue of Silent Calls.

Despite fines issued following investigations undertaken in 2007, Ofcom has not subsequently issued even one company with a simple Notification indicating that its practice of making Silent Calls represents a persistent misuse of a telecommunications network or service. Such a Notification may be followed by the imposition of an enforceable requirement to cease the practice and then a financial penalty in the event of a breach. The maximum level of penalty has recently been increased, but if nobody is breaking Ofcom's so-called "rules", which are currently in the course of being relaxed even further, then this cannot be expected to have any effect.

The NAO report looks at the levels of complaints about Silent Calls which are a potentially misleading indicator, as the peaks in levels of complaints are invariably associated with public discussion of the issue, i.e. an awareness of Ofcom's role. There is no evidence to show that the amount of nuisance being caused does not simply remain constant due to Ofcom's failure to use its statutory powers against those who perpetrate the nuisance. Despite often containing vital evidence of Silent Calls being made (10,000 instances in 2009) not one complaint (since 2007) has led to any use of Ofcom's powers.

A recent broadcast by BBC Watchdog (otherwise full of misinformation) suggested that the major perpetrators of the nuisance, e.g. British Gas and BT, are those who fully comply with Ofcom's tolerant and misguided policy of "regulation", which allows, and even encourages, the making of Silent Calls, under certain conditions.

The Ofcom policy on "Silent Calls" is a total disaster for the citizens that Ofcom has a duty to serve. During the period addressed by the NAO report, annual complaint levels have been rising, (5230, 7120, 7200, 9320) suggesting that the action taken has had no effect whatsoever.

The major problem in this area is with the convergence of Ofcom’s separate duties to further the interests of citizens in relation to communications matters,  which applies here, and it’s quite separate duty to regulate the market for communications services. Ofcom’s failure to understand the distinction makes it totally ineffective in the former role.

Please contact me for further comment, information and proposals. (There is more to read on my blog at http://scvictim.blogspot.com).

 

HMRC makes over half a million pounds a year by NOT answering telephone calls

From: David Hickson - campaigner for equity in the delivery of public services

Every call to the 0845 telephone numbers used by HMRC (and every other body that uses 0845 numbers) earns subsidy of its costs at the rate of around 1.7p per minute. The £5M HMRC earns in this way will not clear the public spending deficit, nor would one argue that it is a bad thing for public bodies to save money. The government should however only be taking our money through properly applied taxation, not by undeclared access charges levied on public service users.

When we call these numbers our telephone companies reflect this cost to them in premium charges on us. (BT alone is regulated, so that it cannot itself charge for these calls, it can only recover the premium. BT customers are only paying the premium. Regulation prevents them from also paying BT, except through its standard call setup fee.)

The answer to a parliamentary question, Revenue and Customs: Telephone Services - Written Answer - 11 October 2010, reveals some interesting statistics.

97.1 Million calls were made to the 0845 numbers used by the HMRC network of contact centres in the year to July 2010. 35.6 Million of these got no response.

I will make some (conservative) assumptions of the average durations for the three categories of call and the respective annual percentages given in the written answer:

·       Calls to an agent (54.2%) - 5 minutes

·       Calls to hear recorded information (9.1%) - 2 minutes

·       Calls which were never connected (36.7%) - 1 minute

Given these reasonable assumptions about call duration (which I am happy to revise if alternative data is provided) the annual subsidy earned by HMRC would be as follows:

·       From handling enquiries - £4,772,012 (97.1 M x ((54.2% x 5) + (9.1% x 2)) x £0.017)

·       From not handling enquiries - £605,739 (97.1 M x (36.7% x 1) x £0.017)

Not only is HMRC subsidising its costs at the expense of those whose call it by over £5 Million, HMRC is earning well over half a million pounds a year by NOT answering the telephone.

By failing to benefit from the low rates and inclusive packages available for calls to "normal" (01/02/03) numbers, callers in general are effectively paying far more than this in premium charges. (As stated above, BT callers are only paying the premium, either through the call charge or their package subscription.)

To end this unacceptable rip-off, HMRC and other public bodies using 0845 numbers, must adopt the 0345 equivalent numbers (charged as a "normal call" in all cases).

I propose that, for example, 0345 3000 627 be offered for 0845 3000 627. I calculate that this would save an additional cost to callers of around £27.5 Million a year, which dwarfs the £5.3 Million that HMRC is earning. Smart procurement, in conjunction with other public sector bodies, along with retention of the 0845 number for those who benefit from the perverse effect of regulation of BT, would mean that HMRC would not suffer anything like this in additional cost on making the alternative available.

This low-cost, quick and simple option is the perfect solution for the present environment when all budgets are under pressure and the expense of complex number changes is not worth considering. Instructions to swap the first "8" for a "3" in every published number would be easy to communicate. The equivalent 0345 numbers are all reserved and ready for use within the term of any existing contract for telephone service.