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Andrew Lansley offers a firm assurance that the NHS Direct service, on 0845 4647, will not be withdrawn until the roll-out of 111 has been completed.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.