David Hickson's Media Releases

Parliament to debate 'Use of 084 telephone numbers in the NHS'

2012-01-20T07:17:00.001Z

Bob Ainsworth MP for Coventry North East will be leading a debate on this topic in Westminster Hall, at 12:30 next Tuesday, 24 January. A government minister will reply.

This will cover the fact that nearly 1,300 NHS GP surgeries in England continue to use these expensive numbers, despite revisions to their contracts which should have brought this to an end by 1 April 2011.

I hope that Mr Ainsworth, and other MPs who may contribute, will stress the need for the government to make the situation clear to all, and in particular to ensure that officers of the Primary Care Trusts fulfil their duties properly by enforcing the terms of the contracts on their GPs.

The key points are as follows:

•	As telephone tariffs stand, there is no 084 number that can be used in the NHS.
	The NHS is universal in its scope and available to all on equal terms. There will always be some who will pay more to call 084 numbers. (See current tariff examples.)
•	GPs tied into long term telephone system arrangements must still comply.
	If necessary, they can change to the 034 equivalent of their 084 number.
	This would mean that they will henceforward incur the full cost of their chosen telephone system, without the benefit of subsidy at the expense of patients.
	The revised contracts demand that they "take reasonable steps" to ensure that patients do not pay more - this step must be considered to be "reasonable".
	Migration to 03 is an option offered by all telephone service providers, including that responsible for most of these cases. (See this note.)
•	The terms of the GP contracts are clear, but are made confusing by those who oppose their intention and purpose.
	Local NHS officers, who have to enforce the terms of the contracts, have not been able to overcome resistance from those who argue that patients should pay some of the costs incurred by GPs and other NHS providers. This is the privatisation of the NHS, which many fear that the government is prepared to tolerate.
	If the government truly believes in the principles of the NHS, now and for the future, then it must intervene to ensure that these principles are fully respected - if necessary, by strong enforcement action against those who continue to breach them.

GPs may be quick to point out that some NHS hospitals and other NHS bodies also use these numbers, in breach of equivalent Directions issued to them. I argue that these bodies are not only in breach, but are making enforcement of similar requirements unnecessarily difficult. (See the list in my blogging - "NHS Bodies in Breach ...".)

GPs using expensive telephone numbers - the "escape route" is revealed by NEG

2012-01-06T03:44:00.000Z

Many NHS GPs use expensive 084x telephone numbers as a means of subsidising the cost of their telephone system at the expense of patients. (See my database of cases and a map.) Since April 2011, those in England and Wales have been doing so in breach of their NHS contracts.

Many claim that use of a 084 number is essential to support use of a telephone system called "Surgery Line", provided by NEG, part of The Daisy Group. I am now delighted to be able to report that NEG now confirms on its website - Different Number Ranges - that this is untrue.

It is particularly significant that NEG confirms that Surgery Line may be used with 034 numbers.

Calls to all 03 numbers are charged at no more than the equivalent cost of a call to a geographic number, from all types of phone and including the terms of packages.

034 numbers are however special. They are only available to existing users of 084 numbers for the purpose of migration to the equivalent number, e.g. 0844 477 1799 to 0344 477 1799.

This means that:

all existing users of "Surgery Line" can take advantage of NEG's offer for them to migrate to 034 numbers,
to comply with their NHS contracts, whilst retaining all the benefits of the Surgery Line system.

It has been claimed that NEG imposes contract termination penalties on its customers if they cease use of their 084 number. As it now clearly offers use of numbers from a "migration only" range, it would be absurd for it to penalise those who wish to take advantage of this offer.

It must be noted that those who migrate to 034 will be incurring the full cost of the "Surgery Line" system, as they lose the benefit of subsidy at the expense of patients, which funds the system when a 084 number is used. It is however perfectly normal for NHS GPs to meet the costs of running their surgeries using only the NHS funding provided for the purpose. It would be absurd for them to pretend that meeting the cost of their chosen telephone system is "unreasonable".

I am delighted that Daisy Group, the owner of NEG, has finally made this very positive move.

I hope that this news will be swiftly communicated to:

• all "Surgery Line" users

• their patients, and

• the local NHS bodies who enforce GPs compliance with their NHS contracts.

This option of migration has always been available, but it is now directly offered to Surgery Line users.

I also hope that the BMA, which has shown great interest in this topic, will now advise its members that this option of migration is now explicitly made available, rather than urging them to claim that the cost which would be incurred is "unreasonable".

Doctors face regulation as providers of "Premium Rate Phone services"

2011-12-18T13:57:00.002Z

Premium rate phone service regulator PhonePay Plus has invited over 1,400 NHS GPs and other users of 084x telephone numbers, including NHS Direct, HMRC and the DWP agencies, to present their views on the prospect of having to pay it a fee and submit to its regulation - see this news release.

Ofcom will be consulting on use of PhonePay Plus as a potential enforcer for its revised regulation of 084 numbers, in the New Year. Ofcom will need to apply an effective means of compelling those who benefit from the revenue sharing mechanism to declare the Service Charge which is indirectly paid to them by callers. This applies to all users of 084 numbers, who generally apply the financial benefit to offset the cost of their telephone service, rather than taking it as a cash payment.

PhonePay Plus explains its regulatory role in its consultation document - Call for inputs around the extension of PhonePay Plus regulation to remaining revenue-sharing ranges. This covers services delivered by telephone "which are charged above standard rate to a consumer’s phone bill and/or pre-pay account", including downloading ringtones, voting on TV shows, directory enquiry services and chat-lines.

It explains how its regulatory framework is well suited to deal with those who benefit, on a lesser scale, but in exactly the same way as those who provide the services listed above.

GPs who have evaded the ban in their contracts on use of 084 numbers may wish to comment on the prospect of being regulated in the same way as providers of "adult" chat-lines.

HMRC may wish to express a view on having to pay a levy of perhaps 0.35% of its revenue share from telephone calls to a regulator of its activities.

JobCentre Plus and the Pensions Service may not be wholly content to be classed as members of the same industry as the producers of "the X factor" and "Strictly".

For myself, I hope that as the reality of what is involved with 084 numbers is finally recognised, we will find that all providers of taxation-funded public services at last cease using them. The 03 range of numbers is available for them to utilise geographic anonymity and certain advanced functions, with the option of easy migration to the equivalent 034 number. Calls to 03 numbers are invariably charged at no greater rate than calls to 01 or 02 numbers, under all tariffs, and use of the revenue sharing mechanism is prohibited.

Will Talk Talk be fined for Silent Calls - and what about undermining the NHS?

2011-11-20T10:00:00.001Z

An article by a Mail on Sunday reporter - TalkTalk facing new Ofcom fine over silent calls – suggests that I may have been wrong to make the assumption headlined in a previous release.

It is claimed that sources now suggest that Ofcom will not follow the same approach with Talk Talk as it recently did with Homeserve and nPower.

Although Ofcom issued Notifications of Misuse to both companies, neither was subject to a penalty nor an enforceable obligation to cease the practice.

Ofcom treats many millions of Silent Calls as not being misuse at all; it applies a percentage tolerance and recently introduced a “one a day is OK” rule.

We know that Ofcom “has issues” with Talk Talk, having previously taken action against it on another matter.

I too “have issues” - it is expensive Talk Talk telephone numbers that are being used by many NHS GPs to subsidise the cost of their telephone systems at the expense of patients and in breach of their NHS contracts. I have published a list of 1,115 NHS surgeries using expensive Talk Talk numbers (80% of the total of such cases).

If Talk Talk were, exceptionally, to be subjected to a financial penalty for persistent misuse, this could appear to be spite by Ofcom, as many other Silent Callers do not even have their known Silent Calling brought to public attention. Furthermore, as Ofcom is in the habit of not publishing details of the scale of the misuse, we will have no idea about whether or not the penalty is proportionate.

Neither Talk Talk, nor its agent, can be fined for undermining the NHS. It is the GPs who may follow their guidance who are actually breaching their NHS contracts by using expensive telephone numbers. Talk Talk is however a major part of the problem – it could become a major part of the solution.

Daisy Group endorses "co-funding" for access to NHS services

2011-11-10T12:01:00.000Z

The government argues that through the reforms to the NHS, its principles will remain intact. Suggestions that increased commercial involvement may lead to hidden charges and disguised co-funding arrangements have been denied. But is this assurance a little shallow and too late ...

The Surgery Line telephone system, allegedly used by up to 20% of doctor's surgeries in England, is claimed to be "The revolutionary co-funded enhanced telephony service, designed specifically for GP surgeries".

Daisy Group, led by Chief Executive Matthew Riley, featured as a business guru on "The Apprentice", bought the company behind the product last year and now presents it under its own name as Daisy Surgery Line.

Daisy may be one of many commercial providers of services used for the NHS, who would argue that patients should pay through co-funding arrangements. The BMA, representing those who will lead Clinical Commissioning Groups, supports this argument.

I believe that this issue has to be nailed now, before we are talking about paying thousands of pounds for "NHS" treatment, rather than a few pounds to book an appointment with a NHS GP.

The arguments

I have sought to engage with Mr Riley, in the hope of persuading him that co-funding is not currently acceptable for access to NHS services. I have tried to explain that the benefits of Enhanced Telephony can only be used by NHS providers via a 03 number, so that callers do not incur a premium charge.

Things may change in future for the NHS, but the principles of universal equal access and "free at the point of need" remain in the NHS Constitution at present. Proponents of the co-funding of telephone access to NHS services have argued their point strongly in responses to recent public consultations, but their view has been rejected.

Despite the ban on use of numbers that cost more, Daisy Group continues to maintain that use of 084 telephone numbers to co-fund the Surgery Line system at the expense of callers is acceptable in the NHS. It appears to defend this by leaning on the fact that some BT callers incur penalty charges for calling geographic numbers outside the terms of their Call Plan, which are greater than the premium charged for calling 084 numbers.

This increasingly rare and wholly anomalous situation cannot be exploited to provide a justification for "co-funding", when NHS providers have to consider all whom they serve.

•	Daisy Group seems to ignore the fact that those subscribed to the most used BT tariff (Unlimited Anytime), and its social tariff (BT Basic), pay nothing to call geographic rate numbers (including 03), whereas they pay a call setup fee plus 4p or 5p per minute to call the numbers used for Surgery Line.
•	Daisy Group seems to regard as irrelevant the fact that all mobile and public payphone callers pay more, often amounting to many pounds more for a call, despite a ministerial statement regarding the relevant terms of the NHS GP contract - "It is absolutely clear that there is no distinction between landlines, mobiles or payphones".

The public debate

Statements of fact from Daisy Group, The BMA, Ofcom and many others are covered in this blogging - Daisy Surgery Line and "Enhanced Telephony".

Daisy Group has declared itself ready to participate in factual public debate on these issues. I am delighted to engage. In particular, I would be delighted to read that Daisy Group and the BMA no longer hold the positions referred to above, despite them being fairly derived from existing published material.

Virgin Media STILL overcharging callers trying to avoid Tesco Business Rate numbers | Ofcom does nothing (no news there!)

2011-10-28T01:13:00.000+01:00

Further to my release of 22 September, Virgin Media overcharging callers trying to avoid Tesco Business Rate numbers, I understand the problem is still continuing. Virgin Media has not refunded the historic overcharges and some callers to Tesco geographic numbers are being charged for operator connected calls to MOBILE, as well as 0845, numbers.

I have been in direct contact to confirm the detail of cases that continue to be reported on the SayNoTo0870 and MoneySavingExpert forums (Links available here).

Virgin Media and Tesco need to get the situation sorted and issue public apologies for what is clearly a mistake.

Ofcom should get involved in cases like this, which are obviously having a serious impact on many people, without waiting for every victim to come forward and register a formal complaint with it.

When Ofcom is seen to be ineffective and reluctant to act – why would people bother to raise individual complaints?

We have the right to expect Ofcom to act with intelligence, not shuffle papers, collect statistics and deliberately discourage receipt of the information which would cause it to act.

There is an echo of the way in which Ofcom deals with my other focus of attention – Silent Calls – see my Silent Calls Victim blog.

Barking, Havering and Redbridge University Hospitals NHS Trust - poor patient services and charges for access to the NHS

2011-10-27T16:13:00.001+01:00

I quote a Department of Health Media Release today:

"Health Secretary Andrew Lansley today said that the standard of patient services provided by Barking, Havering and Redbridge University Hospitals NHS Trust must improve substantially."

I endorse this view. “BHR” is one of a number of NHS bodies which continue to use 084 telephone numbers, so as to obtain subsidy for their costs at the expense of patients. (See this briefing.) This is despite clear Directions issued by Mr Lansley's Department in December 2009, demanding compliance by December 2010.

I hope that Mr Lansley will ensure that this is amongst the issues which this rogue Trust will have to address, albeit nearly two years late.

It is vital that NHS Bodies cease use of telephone numbers that cause patients to incur a premium charge, primarily to follow the principle that the NHS does not levy charges on patients.

This is also important so as to demonstrate to GPs, contracted providers of NHS services, that they too need to comply with the terms of their contracts by ceasing use of 084 numbers.

At last - HMRC responds to the call to adopt 0345 telephone numbers !!

2011-10-21T09:15:00.000+01:00

I wrote to David Gauke, Exchequer Secretary, on 7 June 2010 asking him to review the use of 0845 telephone numbers by HMRC and consider the need to move to 03xx numbers. (See Ministerial briefing - Fees for access to public services by telephone)

Around 18 months later, the necessary action starts. Mr Gauke announced on Wednesday 19 October, in a written answer, that

"HMRC expect that they will, by the end of the year be able to offer an 0345 number for those customers calling its tax credit helpline (which last year accounted for around 40% of the total calls handled by its contact centre network).

"The provision of a 0345 number is expected to result in significant cost savings for the majority of callers to the line."

This long overdue admission that use of 03xx numbers is not only more equitable, but that it does indeed result in cost savings for the majority of callers, is a most satisfying result.

We now look to the DWP agencies, NHS Direct and other misusers of 084x numbers for the provision of public services (not least NHS GPs) to follow this fine example by immediately adopting 034x alternatives for their primary numbers. There are indeed many others (from the 60%) which HMRC should be addressing immediately.

Points of detail

My specific proposal to use the option of 034x equivalent alternatives to 084x numbers has been widely promoted. See the following items for extended coverage of the arguments:

• My proposal for those using 084x numbers for the delivery of public services - September 11, 2010.

• Coverage of the issue by "BBC Five Live Investigates" - September 12, 2010.

• My evidence to the Commons Treasury Committee investigating HMRC - November 2010.

This matter has been under review by HMRC at least since the time when I was invited to join a working group addressing the matter in August 2010. Representatives of a number of organisations also serving on this group, who themselves use 084 numbers to obtain subsidy from callers, urged HMRC not to change at that time!

HMRC (and others) are not bound to await a new telephony contract to utilise the simple option of migration to the 0345 equivalent of any 0845 number. Any delay is simply playing for time and extending the period during which service users will continue to subsidise the cost of providing the service. All providers of network telephone service permit migration from 084 to 034 equivalent numbers at any time within the term of a contract without penalty.

The only callers who would not enjoy a cost saving on a total move from 0845 to 0345 are those who incur penalty charges from their telephone service provider, generally BT, for calling geographic rate (01/02/03) numbers outside the terms of their selected Call Plan. If it wished, HMRC could retain a 0845 number, as an alternative, for the benefit of those in this perverse position.

A set-back in the position of DWP was reflected in a written answer this week – see DWP allows Work Programme providers to "charge" participants

DWP allows Work Programme providers to "charge" participants

2011-10-20T09:31:00.000+01:00

(See the exchange and the additional information provided by my annotation at this item on TheyWorkForYou)

Background

The current scandal of imposing potentially modest charges for access to public services through use of telephone numbers where the charge paid includes "a revenue sharing component" is rife.

The fact that such charges are collected indirectly, often received only as a subsidy to offset costs and sometimes lost amongst the complexity of telephone tariffs makes it easy for them to be hidden.

This applies to all use of 0843, 0844, 0845, 0871, 0872 and 0873 numbers, which are now classified by Ofcom as " Business Rate". New regulations covering their use are expected to be announced by Ofcom early in 2012.

The benefit derived is (roughly) between 2p and 10p per call minute,
whereas the additional cost (over that of a call to a 01/02/03 number) can be over 40p per minute.

There is not even a direct proportionality; calls to 0845 numbers yielding 2p per minute can incur an additional cost (e.g. for T-Mobile contract customers) of 41p per minute.

My campaigning focus, for this issue, is on HMRC, the DWP agencies, NHS Direct, a number of other NHS Bodies and the large number of NHS GPs who are now in breach of their NHS contracts, by using numbers that cost more than the cost of "equivalent calls to a geographical number". These are perhaps the most important cases, but there are many others.

NEWS STORY

The government's position on the issue of charging for access to public services is neatly summarised in a written answer from Chris Grayling, Minister of State - DWP, to a question about whether Work Programme providers are permitted to use 084 / 087 numbers. See Hansard 17 October c644W.

Mr Grayling confirms that, so long as they meet the minimal requirements on call cost declaration (which currently permit the denial of there being any financial benefit to the user of the number), Work Programme providers are permitted to levy a charge on those seeking to move from benefits to work in this way.

My comment

This scandal will continue until the government - probably through the Cabinet Office - gets to grips with the issue. It must clearly determine where it is appropriate to charge users for access to public services and demand that the existence of this charge be declared (notwithstanding the perversity of telephone tariffs, which are outside the control of users).

I await acceptance of my offer to place my understanding and knowledge of this issue at the disposal of the government.

Talk Talk joins the list of Silent Callers not likely to receive a £2 Million fine

2011-10-14T00:30:00.000+01:00

Ofcom has today announced (see Consumer Bulletin) that Talk Talk has been served with a formal Notification of Persistent Misuse of the Telephone Network on account of making an excessive number of Silent Calls.

It is important to note that Ofcom regards a number of Silent Calls that is proportionately small as being acceptable, even if the number is very large in absolute terms.

This is of particular interest to me in the context of my other campaigning role - Talk Talk is the company behind the vast majority of the expensive telephone numbers being used by NHS GPs (see below for the NHS related aspect of this story).

No use of the increased maximum penalty

This follows two other recent cases of Notifications of Misuse by making Silent Calls - against Homeserve and nPower. In both cases Ofcom has decided, after receipt of representations, not to impose the financial penalty, of up to £2 Million, which it recently claimed was necessary.

Ofcom sought, and the government has granted, an increase to the previous maximum penalty of £50,000, because it was not thought large enough to address the misuse by large companies. (see the government announcement and my comment at the time.)

We now see these cases of companies which are amongst the largest in their respective sector, and therefore likely to be making very many automated calls, where Ofcom has decided that it does not even need to impose a penalty of up to £50,000. This increased penalty is thereby seen neither to be necessary, nor effective as a deterrent.

No requirement to cease the practice

Whilst the financial penalty is available to deal with past misuse that Ofcom has failed to address, Ofcom also has the power to impose a specific requirement for a company not to make Silent Calls. Neither Homeserve nor nPower have been made subject to an "Enforcement Notification" requiring them to cease the practice of making Silent Calls.

Ofcom's statutory duty "to further the interests of citizens in relation to communications matters" would best be fulfilled by preventing Silent Calls from being made, not by leaping in with penalties to cover events that occurred many months ago and publishing meaningless over-complex and unenforceable pseudo-regulations.

Not one company is currently subject to a specific regulatory requirement not to make Silent Calls, even though Ofcom has always held the power to impose such a requirement and to have it enforced through an injunction, if necessary.

No publication of the misuse

Some time after the issuing of a Notification, Ofcom publishes a redacted copy of the Notification that has been served. In the case of Homeserve this was nearly 2 months later, that for nPower is still not published after more than 3 months.

Viewing the published copy of the Notification on Homeserve, one sees that all of the information detailing the scale of the misuse has been redacted.

We therefore have no way of knowing the seriousness of the Misuse undertaken by Homeserve (or any other offender) nor the proportionality of Ofcom's decision not to impose a penalty.

I have long held the view that Ofcom is persistently misusing its Persistent Misuse powers

Talk Talk is alleged to prevent application of the principles of the NHS by GPs

Perhaps now is a good time to draw attention to the fact that Talk Talk is the provider to 1,114 (80%) of the 1,401 cases of NHS GPs using expensive telephone numbers - in England and Wales this is in breach of their contracts.
[see my tables - including the "Top 20" summaries]

To retain the technical benefits available from a non-geographic number without causing callers to incur any additional cost, it is standard practice for telephone companies to allow customers to migrate from a 084 to a 03 number, at any point during their contract and without penalty. All calls to 03 numbers are charged on the same basis as those to 01/02 "geographic" numbers. The option to change only the second digit of the number is guaranteed to be available, e.g. 0844 477 1799 to 0344 477 1799. This provides the obvious route open to NHS GPs who are required to vary the terms of their arrangements to avoid patients paying a premium to call them.

The BMA however advises that "many GP practices have signed multi-year contracts with telephone services providers which cannot be varied, renegotiated or terminated without substantial financial penalty". It suggests that this provides a valid basis for a practice claiming that migration to a 03 number would be "unreasonable".

If the BMA is correct, as many practices claim, then this would imply that Talk Talk is preventing GPs from being able to comply with the principles of the NHS. Talk Talk receives a revenue share of roughly 4-5 pence per minute on calls to the 0844 numbers used by GPs. This is paid by the call originating telephone company, which obviously passes this cost on in its call charges. Talk Talk does pass some of this benefit on to the GP directly, however it is claimed that this cannot be more than 2p per call minute.

GPs obviously benefit by the full value of the 4-5p per minute, because they do not have to pay Talk Talk for their line and the facilities deployed, nor for the lease on the equipment provided to support their system. Talk Talk must however have some questions to answer if, as is alleged, it is exceptionally preventing GPs from giving up this improper subsidy of their costs at the expense of patients.

Premium telephone numbers still being used by NHS GPs - 18 months on from the ban and 6 months after the deadline for necessary changes

2011-10-07T14:30:00.000+01:00

Please see the briefing issued to MPs, quoted below. Those copied are found, along with the relevant details, on this "league table".

The key story is that, six months after the deadline, little or no action has been taken to enforce the contractual requirement for NHS GPs to cease funding their surgeries at the expense of their patients.

The NHS is owned by us all. It is only through our MPs that we can apply pressure on the Government to, in turn, provide the assistance necessary to officers of the NHS who have the power and duty to enforce its principles. (Clear eyes are needed to watch the speed at which the buck is passed around on this issue!)

If, as is alleged by the BMA, it is the surgery telephone system providers who are, unnecessarily, blocking the action that needs to be taken, then this needs to be brought into the open so that they may account for their unwarranted interference in the operation of the NHS, in public. At present I have no reason to believe that this is the case.

To: All MPs with constituents who are not being properly served by the NHS

Further to previous briefings on this topic ...

There are NHS GPs in your constituency in breach of their NHS contracts

... according to NHS Choices, they are continuing to use 084 telephone numbers 6 months after the deadline (31 March 2011) for their removal has passed. In some cases, these numbers have been freshly adopted up to 18 months after such adoption was prohibited (April 2010).

Please find your place on this "league table" and review the relevant list for details, or view this map. Other presentations of my list of NHS GPs funded their surgeries at the expense of NHS patients are indexed here.

The problem

Parliament approved the variations to the NHS GP contracts which are being breached [see SI 2010/578: GMS / PMS]. Responsibility to enforce compliance rests exclusively with the 50 Chief Executives of the clustered Primary Care Trusts.

Many PCTs have failed to act in the interests of the patients they serve, because they claim to have had difficulty in understanding the clearly and explicitly drafted regulations. They are seen to have commonly relied on guidance issued by the BMA GPC - representing the (conflicting) interests of the GP contractors – which offers a very particular interpretation.

At the beginning of this guidance, the BMA declares its continuing opposition to the purpose of the regulations, repeating its proposal that patients should pay more to subsidise the costs incurred by GPs with improved telephone systems (contrary to the principles of the NHS)! This proposal was specifically rejected. The Guidance goes on to outline a wholly unsatisfactory approach to application of the new requirements - use of a meaningless and demonstrably mistaken assurance about call costs from a highly interested but unaccountable party as representing proof of compliance. (Some may say that it would be natural to seek to undermine effective implementation of a measure which one openly opposes!)

Since spring of this year, PCTs have been seeking assistance from the Department of Health, but this has not been provided, despite a request to the Minister from Andrew Love [Hansard 12 July 2011 Col 150].

The unequivocal statement of clarification, given only to the House in response, is seen to have been ignored by PCTs. It may be noted that the BMA immediately issued a statement suggesting that the Minister's statement was untrue [see "Guidance for practices using 084 numbers" on p7 of this BMA GPC newsletter].

Action to resolve the matter

For the sake of the integrity of the NHS and in the interests of your constituents, I must suggest that you urge your local PCT to address this matter properly, by enforcing the terms of the contracts as drafted, not as interpreted by the BMA and others.

I also believe that it would be of benefit to urge the Secretary of State for Health, and / or whichever Minister now holds the relevant brief, to instruct Department of Health officials to ensure that PCTs have all of the assistance that they need to use their powers to enforce the existing contracts, and to require officials to ensure that this is being done.

The Department of Health may not be able to direct PCTs, however it should be able to respond to requests for assistance. It should also be able to deny false assertions that have been made about its own position, including alleged endorsement of a particular system - unless the allegations are true [see this copy of a widely used letter]. The system in question is proudly "co-funded" by patients [see references to co-funding, as well as "co-founding", on this site]. Many PCTs have been provided with copies of this letter and may be inclined to treat it in good faith!

Ministers may be asked to report to parliament on the successful (or otherwise) implementation of measures approved by parliament. The principle of "free at the point of need" is far from secure in the NHS, as a loosening of control is proposed.

(I note that the ministerial team will be answering Oral Questions on Tuesday 18 October.)

The resistance by GPs

Some practices claim that patients do not pay more to call their 084 number than to make an equivalent call to a geographic number. This claim is based on the absurd assumption that all patients have a landline phone and subscribe to a particular BT Call Plan, which BT now declares is no longer even its most popular.

Such a claim is clearly false (except where evidence has been produced to show that all patients of a practice do indeed subscribe to one particular unusual telephone tariff and never call the surgery from mobiles, payphones or under the terms of other landline tariffs, including that which is most popular for BT customers).

Other practices claim that they cannot vary their existing arrangement for telephone service, because this would allegedly cause them to incur “unreasonable” penalty charges. Those who are contractually committed to maintain a system which requires a non-geographic number may readily comply by migrating to a 03 number. It is standard practice for network telephone service providers to allow such migration at any time and without penalty. I have been assured by the leading provider of surgery telephone systems that it would not deviate from this principle by blocking a request to migrate from 084 to 03.

There is no evidence to show that some network telephone service providers fail to follow industry standard policy, by not permitting migration to 03 without penalty. If such evidence were to be produced, then the provider in question would need to be subjected to some very serious questions, as it would be seen to be responsible for impeding proper application of the principles of the NHS.

Despite my repeated briefings to PCTs on this subject, they appear to be more ready to follow the guidance offered by the BMA, as the representative of those holding the contracts which are being breached, than to make their own determinations. As an analogy, I am inclined to think of a branch office of a major firm following national guidance on employment policy that is presented by a trades union - the "head office of the firm" must act directly to address this!

I would be delighted to provide all necessary further references, additional explanation, examples of specific cases and information on points of detail. There are a number of relevant briefings on my "NHS Patient" blog.

Virgin Media overcharging callers trying to avoid Tesco Business Rate numbers

2011-09-22T16:30:00.000+01:00

Virgin Media has acknowledged a systemic billing error, which involved charging callers who dialled local geographic numbers as if they had made an "Operator Connected" call to a 0845 number!

The error has been corrected and I am told that all overcharges will be refunded.

The problem

Tesco recently introduced Business Rate 0845 telephone numbers, at any additional cost of up to 41p per minute, for calls to its local stores.
(This decision warrants comment and attention in itself.)

The website www.SayNoTo0870.com publishes the original local geographic numbers as alternatives for the 0845's, because these are found to be still working.

A member of the SayNoTo0870 discussion forum reported that Virgin Media had mischarged them for a call to one of these local numbers - others reported identical experiences.

Virgin Media billing representatives maintained the charges, claiming that they were correct and proper. They even suggested that SayNoTo0870 and Tesco were responsible for misrepresenting the charges for calling geographic numbers!

Achieving the resolution

I made a test call, dialling a 0121 number on my Virgin Media line when such a call should have cost me nothing.
I was charged £4.87, for an "Operator Connected" call to a 0845 number! This reflected the experience reported by others.

I had discussed my intention to make this call with Virgin Media before doing so and followed up when I saw the incorrect charge being levied. After initial resistance - "the call was charged at the correct destination rate", Virgin Media agreed to investigate this matter properly, as that statement was clearly untrue.

The outcome of this investigation was a determination that all calls such as mine had been billed incorrectly.

I am told that the error has been corrected and that all overcharges will be refunded.
(I understand that Virgin Media has prepared a statement giving full details.)

Tesco is not alone

Although its main competitors appear to retain local numbers for their stores, Tesco is not alone in choosing to use Business Rate 0845 numbers for callers who are making enquiries by telephone.
Her Majesties Revenue and Customs, the Department for Work and Pensions agencies, NHS Direct and NHS 24 do the same.

They could all readily use 03 (Geographic Rate) numbers to support the complex telephone technology used, without causing callers to pay to subsidise it. Although 0845 numbers provide a subsidy of around 2p per minute from every call, the premium cost to the caller can be as great as an additional 41p per minute.

(Some telephone providers, not Virgin Media, include calls to 0845 numbers in packages - so that all customers are compelled to fund the premium, whether or not they actually call these numbers.)

I Comment

All those who wish to add a "Service Charge" to what we each pay our own provider for a telephone call should declare the level of the charge and justify its imposition. This applies to Tesco, but even more so to the public bodies listed above. They may not be responsible for the level of the "Access Charge" added by the telephone service provider, but it is the imposition of the "Service Charge", from which they benefit, which causes premium charges to be applied to these calls.

Those who simply want to take advantage of the additional features available with "non-geographic numbers", without imposing the cost of these features on callers, must now be using 03 numbers. These are charged at "Geographic Rate"(i.e. no more than the cost of a call to a 01/02 number) from all types of telephone and all types of contract - if 01/02 calls are free of a call charge, as is now generally the case, so are 03. Migration to 03 is assisted by the equivalent 034 number for every 084 number being reserved for the purpose of migration.

I cannot see how HRMC, DWP and NHS bodies can possibly justify their imposition of a service charge on callers. Tesco may struggle, but that is its business.

Whilst I am pleased to have been able to assist Virgin Media in getting this particular problem resolved, I am concerned that others who raised the issue were batted away. My call was purely for test purposes, whereas others had genuinely called these numbers, which are still published in various places.

Notes

•	I have published a summary of calling costs for various types of numbers under commonly used arrangements - this includes links to the published tariff tables.
•	"Business Rate" is the term now used by Ofcom to describe numbers which have a lower level of "Service Charge" (up to 10p per minute) than "Premium Rate". The principle is exactly the same, although the regulation is different.
•	Virgin Media has prepared a statement - contact their Senior PR Manager, Joanna Smith, for details.
•	Tesco has declined my invitation to comment. The claim on its website (see How to contact us), that a call to a 0845 number "costs 6p, plus up to 2p per minute for BT Calling Plans", is completely wrong and totally misleading.
•	The discussion thread in the SayNoTo0870 forum is found at this link. (I use the forum nickname "Silent Calls Victim")
•	To find the list of numbers involved enter "Tesco" at this link
•	Whilst Virgin Media was imposing and enforcing these charges, it stood in breach of its duties under the regulatory "General Conditions". I have therefore formally notified Ofcom. It will be for Ofcom to decide whether or not to investigate this matter and consider imposing a financial penalty on Virgin Media.
•	I campaign primarily against improper use of 084 numbers by public bodies - in general, and in particular in the NHS. I am however engaged in other issues relating to home telephones and call centres.

Calling Citizens Advice for advice? - best to use a mobile and check SayNoTo0870 first

2011-09-11T16:21:00.004+01:00

The website SayNoTo0870.com has revealed a telephone scam being practised by Citizens Advice. See this posting in its discussion forum.

From next April, Citizens Advice will take over the function of providing consumer advice by telephone on behalf of the government, as the present "Consumer Direct" service is withdrawn.

Citizens Advice is starting to roll out a new national advice line telephone number for England - 08444 111 444. (Like all such 0844 numbers, the revenue share that it passed on to the called party causes it to be charged at a premium when called from landlines, mobiles and payphones and excluded from call inclusive packages.)

SayNoTo0870 has discovered that there is an alternative number available - 0300 330 0650. (Like all 03 numbers, this is charged at the same rate as calls to geographic numbers, i.e. included in calling packages free of any call charge for most contract mobiles and landlines.)

There are however two catches for this alternative number:

•	It is only available to callers from mobiles. Those with both a landline and a contract mobile phone are best advised to call using the latter. Payphone users must recognise that they have been overlooked.
•	It is not publicised by Citizens Advice. One assumes that mobile callers are expected to pay to call the expensive number first, in order to be told the number that they should have dialled. Even then, they are offered the opportunity to continue with the call at premium rates! Those who would expect a landline call to be cheaper are not made aware that this is probably untrue.

This causes concern in two ways:

•	Citizens Advice declares a principle that "The service provides free, independent, confidential and impartial advice to everyone on their rights and responsibilities".
	The 5p per minute subsidy which it earns from calls to the 0844 number, at the expense of callers and without being declared, directly contradicts that principle.
•	In its consultation on the arrangements for the transfer of responsibility for the Consumer Direct advice function to Citizens Advice, the government states "For consumers to be empowered it is essential that they have information about goods and services which they can use to exercise choice"
	By understating the cost of calling from a landline and withholding details of the alternative option, Citizens Advice places itself in direct contradiction of this principle.

Government-funded consumer advice already comes at a price, as the present Consumer Direct service uses 08454 04 05 06. Calls to this number include a "Service Charge" of 2p per minute, plus an "Access Charge" of up to 39p per minute. Calls to 08444 111 444 invariably include a "Service Charge" of 5p per minute, plus an "Access Charge" of up to 36p per minute.

Although some landline callers pay the service charge on 0845 calls through their package subscription, there is little difference between 0845 and 0844 – both are now classed by Ofcom as "Business Rate".

From April 2013, Citizens Advice will also take on the role of Consumer Advocacy currently being undertaken by Consumer Focus and a variety of other bodies.

Citizens Advice advocates use of 0845 numbers by HMRC and DWP agencies. It also advocates 080 helpline providers losing the benefit of calls from mobiles being at no greater cost to them, whilst callers incur no charge.

With this position on advocacy, charging for a “free” service without saying so and failing to give sound advice to its service users so that they may make the appropriate choice to call its alternative (mobile only) number, the suitability of Citizens Advice to take on the role that it has been granted by the government must be called into question.

David Hickson said:

"I have long been involved with Citizens Advice, myself advising it on ways that it could dig itself out of a terrible problem it had got into with the funding of its telephone service. As a strong supporter of Citizens Advice, I am deeply disappointed at the decision that has now been put into effect.

"I can understand some of the reasons, however it cannot be acceptable for Citizens Advice to behave in this underhand way. The danger of reputational damage in the light of the forthcoming larger role for the charity means that this foolish decision must be urgently reviewed.

"To charge for advice services is contrary to the stated Principles of Citizens Advice and offensive to the volunteers who make up a sizeable proportion of its workforce. To withhold information and misrepresent the costs incurred is an intolerable breach of what Citizens Advice stands for.

"The advocacy position taken by Citizens Advice is clearly weak and ill considered. I cannot say how far this is influenced by the need to defend its own improper policy on use of telephone numbers, but one must fear that it feels unable to expect others to achieve higher standards than those which it sets for itself."

The information worth up to 41p per listen

Click to hear the announcement that is played to those who pay up to 41p to call 08444 111 444 from a mobile.

N.B. The information about the cost of calling from a landline is false. All landline callers pay more than 5p per minute to call the 0844 number. 5p per minute is the (VAT inclusive) value of the subsidy provided to Citizens Advice through its telephone company. Originating telephone companies do take some revenue for themselves from these calls, whether from landlines, mobiles or payphones.

Additional Information

•	For comment from SayNoTo0870 – please contact Dave Lindsay
•	The service is announced on this web page.
•	An explanation of why a non-geographic (e.g. 03) number is required for the service is given here.
	Any "review of the telecommunications market" which failed to identify that 03 numbers provide exactly the same facilties for "systems that increase our capacity for answering calls", whilst being charged at no more than the cost of call to a geographic number for ALL people, would be unworthy of a body with the capacity to represent the consumer interest. It is for Citizens Advice to say whether it misunderstands or is deliberately withholding relevant information.
	(It is true that SOME people incur a penalty charge for calling geographic numbers outside the agreed terms of their package which is greater than the premium charge incurred when calling 0844 numbers. This is however totally irrelevant to the point at issue and should not be conflated with it.
	I do not believe that Citizens Advice would advocate consumers selecting the wrong telephone Call Plan, so as to incur the penalty charges which make 0844 and 0845 calls appear "cheaper" in some cases. If it did, then this could provide a reason for "Why we use 0844/ 0845 numbers) ". Again, it is for Citizens Advice to explain.
•	An article on Page 10 of this CAB newsletter explains that the AdviceLine service is funded by a publicly owned body – RBS. It may be argued that a 0844 number has had to be used because the funding offered by RBS was insufficient to avoid clients having to also contribute towards the cost of the service. RBS may care to comment on this point.
•	The Communications Consumer Panel, which Citizens Advice will be replacing in the role of Consumer Advocacy on telecommunications issues, has no stated position on the issue of expensive telephone numbers. It neither engaged in nor mentioned the recent extensive Ofcom consultation on this topic in its publications. To the CCP, this is not an issue of "current consumer concern"!

NHS Bodies undermine attempts to end the GP telephone number rip-off

2011-08-22T14:02:00.000+01:00

Whilst efforts to enforce the ban on use of expensive telephone numbers by NHS GPs in England continue, they are undermined by NHS bodies doing the same.

NHS bodies in breach

I have picked out a list of 20 significant cases, where Directions issued by the Department of Health in December 2009 to NHS bodies in England have been disregarded. (See my blog.)

The most notable examples however are the NHS Direct Health Advice and Information service for England (0845 4647) - shortly to be withdrawn, NHS Direct Wales (0845 4647) and NHS 24 for Scotland (08454 24 24 24).

By their "approved" use of revenue sharing telephone numbers it may be seen that the principle of "co-payment" - i.e. subsidy from patients through payments made as they access NHS services - is sanctioned by the respective governments, although not by the respective parliaments.

GPs in breach

Not only are cases like this seen to breach the very principles of the NHS, they also make it more difficult for independent contracted providers of NHS services to be brought in line with those principles.

My database of officially listed cases of use of expensive telephone numbers by NHS GPs, currently shows the following total numbers of cases:

•	England	1,270
•	Wales	61
•	Scotland	48
•	Northern Ireland	22

Failure by Governments

Following a public consultation, the then Minister of State (Health Services) said on 14 September 2009:

"We want 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."

As we approach the second anniversary of that statement, it can be seen that both the previous and the current UK government have failed to deliver that reassurance. The governments holding devolved authority are in no different position, indeed that have not even declared the intention.

By proposing reform that does not address the problem of the projected massively increased costs of publicly provided health services, indeed by loosening the mechanisms that may hold back their scope to within the bounds of public affordability, the UK government clearly intends that payment for access will become necessary in England.

With England having thereby opted-out from the NHS, can we be sure that it will continue in the remainder of the UK?

NHS Dentists warned of the danger of being misled about the cost of calling 084 telephone numbers

2011-08-09T13:59:00.000+01:00

Like their colleagues in General Practice, NHS Dentists are committed to upholding the principles of the NHS as they deliver NHS services to patients.

This article, by practice consultants PSDS, warns that practices can be misled when choosing a telephone system.

The article refers to a particular un-named company providing systems for Dentists and GPs, which requires practices to adopt a 0844 telephone number. All 0844 telephone numbers are "revenue sharing" which means that a premium payment by callers is used to subsidise the cost of the system to the user.

This could be a reference to "the original and still best telephony solution in the UK for dentists", which is described as being a "revolutionary co-funded telephone systems solution , designed specifically for dentists".

The same company also offers "the original and still best telephony solution in the UK for GP’s", which is described as being a "revolutionary co-funded enhanced telephony systems service designed specifically for GP surgery and general practice".

One could reasonably assume that "co-funded" means that part of the cost of the system is paid for by patients, as is the case when 0844 telephone numbers are used.

There is however a further extraordinary claim made about the telephone numbers used to part-fund these particular systems, as they allegedly defy the standard charges levied by all telephone call service providers. It is claimed that the 084 numbers used are "not more expensive to call than using an ordinary number".

I must urge those able to identify the provider of these systems to obtain a clear and accurate understanding of how the systems are "co-funded" and accurate details of how exceptional charges are applied by all telephone call service providers for calls to these numbers.

I see it as most important that inaccurate information about this company and the services it provides is not placed in the public domain. It is vital that the issues raised are discussed with total respect for accuracy by all parties.

NHS Contracts

The contractual terms which apply to delivery of both NHS GP and Dentistry services make it clear that any payment by patients to the benefit to the practice (or a third party, e.g. a telephone system provider) can only be those on standard scales approved by parliament and with exemptions applied as defined. (See GMS contract clause 483 and GDS contract clause 241.)

As this principle had been widely abused, general regulations about telephone numbers have now been applied to GP contracts (see GMS contract clause 29B). It has not yet been seen to be necessary to apply similar general conditions to NHS Dentists.

In 2005, specific regulations regarding only some particular types of telephone number were applied to both. (See GMS contract clause 29A and GDS contract clause 70.) Unfortunately in 2005, the government had itself been misled about the cost of calling 084 numbers, as it made the extraordinary and inaccurate claim that these "offer patients a guaranteed low call rate" (see this media release).

Enhanced telephony

The "enhanced telephony" facilities available on 0844 numbers are equally available on 03 numbers, and may be available on some 01/02 numbers. (Identical facilities are available on all non-geographic numbers: 03, 070, 080, 084, 087 and 09 ranges.)

Calls to 03 numbers are charged on the same basis as calls to geographic numbers for all callers. Use of 03 numbers is therefore fully compliant with the principles of the NHS.

Those offering NHS services, paid for only through NHS payments to the practice and specifically stated and authorised charges, cannot use 0844 (or indeed 0843 or 0845) numbers. Use of 070, 080, 087 and 09 numbers is also prohibited (except where exceptional arrangements are made in the case of 080).

Returning to compliance

The PSDS article fails to indicate that it is not necessary to terminate the entire contract to move into compliance with the principles of the NHS.

Provision of network telephone service is only part of the contract, which is primarily a leasing agreement covering the provision of locally installed equipment. Whilst the revenue sharing financial benefits are derived from use of a 084 number, the enhanced telephony features are available on other numbers.

Any practice which wishes, or has already chosen, to invest in "enhanced telephony" for the benefit of its patients can adopt or migrate to a 03 number at any time - the equivalent 0344 number is reserved for this specific purpose.

It is standard practice in the telephone industry to allow migration from one type of non-geographic number to another at any point in the term of a contract, without penalty. There is no good reason why any system provider would wish to impede a move from 0844 to 0344, as this would do nothing more than shift the on-going cost of the system from the patient to the Dentist / GP.

Any system provider that sought to prevent its clients from complying with the principles of the NHS (and the terms of their NHS contracts), when this involved no compromise of its own interests, would be taking a most extraordinary position. I hope that nobody would suggest that any company is behaving in this way without first verifying the accuracy of such a claim.

It may be noted that the BMA makes such a claim about provider(s) to GPs - "many GP practices have signed multi-year contracts with telephone services providers which cannot be varied, renegotiated or terminated without substantial financial penalty" (I quote from comments on this specific issue in the latest BMA Guidance).

"The leading provider of enhanced telephony to the health sector"

Many would assume that the comments made above all relate to a company which describes itself as "the leading provider of enhanced telephony to the health sector".

My concern is that only accurate information about this company is placed in the public domain. There are concerns about inaccurate information having been published, which have been heightened as a result of its new owner having chosen to take a prominent public position, through the broadcast media.

Ofcom shows why public service providers must cease using 0845 telephone numbers, initially providing 0345 alternatives

2011-08-09T12:47:00.002+01:00

Some interesting figures emerge from the Ofcom Communications Market Report 2011 - published on 4 August 2011. See Conclusion.

It is well known that, due to special regulations which apply only to it alone, BT is able to offer calls to 0845 numbers without charging a premium over the cost of an ordinary call. (BT does however charge a premium for 0845 calls made by those who subscribe to its "social tariff" - BT Basic.)

All call originating telephone companies have to pay on a revenue share of around 2p per minute to the call recipient on 0845 calls. Except when under the conditions which apply to BT, they may pass this on directly to the caller as a premium over the charge for a call to a geographic number. Most commonly they exclude these calls from discounted and call inclusive arrangements, thereby effectively applying a much greater premium. This is seen most clearly in the mobile market where intense competition causes the cost of calls to ordinary landline numbers to be kept very low. Calls to 0845 numbers from public payphones are charged at 30 times the rate of calls to ordinary numbers.

It is common to refer to BT Call Plans (which provide free calls to geographic and 0845 numbers) as if these applied to an overwhelming majority of callers, with the dismissive comment that "others may vary".

The figures shown below indicate the proportion of the population who are being dismissed in this way by public service providers.

I refer, in particular, to NHS Direct, HMRC and the various DWP agencies - all of whom primarily use 0845 numbers for enquiries.

Public service providers must consider the whole of the population they are serving, not some selective group, nor what may be (perhaps wrongly) thought to be a majority.

Those requiring "non-geographic" telephone numbers must move away from 0845 numbers and IMMEDIATELY OFFER THE 03 EQUIVALENT AS AN ALTERNATIVE.

Citizens who cannot afford a telephone, choose Virgin Media as their telephone provider, find a mobile phone best for their needs or subscribe to BT Basic, should not be required to suffer a premium charge for contacting public services providers.

The Cabinet Office sets the standard for all public services, through Guidance or Direction. I note that an e-petition to the Cabinet Office, on this very point, has just been started.

I refer below to data from Section 5 - Telecoms and Networks of the Ofcom Communications Market Report 2011 - published on 4 August 2011.

Shares of non-business call origination

Calls from Landlines

The report notes on page 286 - "BT’s share of retail residential UK voice call volumes falls below 40%".

The most recent, and fully inclusive, figure (from Table 8 of the Telecommunications market data tables for the three months to March 2011) is 39.9%.

This means that significantly less than half of all residential landline calls are made under the specially regulated terms which apply only to BT.

Share of all Calls

By breaking down the respective totals for Business and Non-Business calls (see note) it may be seen that only 61.4% of non-business calls are made from landlines.

This shows a BT percentage of total call volumes at (39.9% x 61.4% =) 24.5%.

Less than a quarter of all non-business calls are made under the specially regulated terms which apply only to BT.

Household availability of landlines

Where important services are provided by telephone, one must have regard to those households which are unable to access these from a landline, and would therefore use a mobile or public payphone.

The Ofcom report publishes (on page 319) the proportions of households, categorised in various ways, which DO NOT have a landline telephone:

Total Population: 16%

Socio-economic groups DE: 27%

Households aged 16-24: 32%

Households aged 25-34: 23%

Over a quarter of households both of the socially disadvantaged, and of younger families, do not have a landline.

Conclusion

BT may be the largest single provider of telephone call services, however its charges for calls to 084 numbers are wholly atypical due to unique regulation. Attempts to justify use of revenue sharing 084 numbers on the basis of BT charges are thereby fundamentally invalid.

The figures given above indicate the proportions of the population who are being subjected to improper premium charges when required to access pubic services through a 0845 number.

Where non-geographic numbers are required, 03 numbers offer the only equitable option - * Callers pay only the cost of a normal telephone call. * Providers meet the cost of their telephone operations, unsubsidised.

Migration to 03 numbers – initially parallel operation of the 0345 equivalent of every 0845 number, as an alternative – is not only vital, but conveniently and inexpensively achieved.

The Cabinet Office, which initially pressed for the introduction of 03 numbers, must sieze this issue as a way of demonstrating the government’s commitment to equity.

Department of Health decides to roll out 111 nationally - without knowing the cost

2011-08-04T16:09:00.000+01:00

In a letter published today, demanding plans for implementation of the 111 telephone service throughout England, it is announced that the roll out will happen. This decision has been taken before the planned evaluation of the pilots which was scheduled for the Autumn. Most disturbingly, it has been taken before any of the costing figures from the pilots have been assembled.

Cost was a primary motivation behind the decision to abandon the nationally managed NHS Direct health advice and information service, in favour of the locally run 111 service.

The modest subsidy which NHS Direct derives from its use of a 0845 telephone number (at much greater premium cost to callers, e.g. 1.7p per minute vs. 41p per minute) goes little way towards offsetting the considerable costs it incurs in providing a comprehensive health advice and information service by telephone.

The 111 service was said to be ONLY for URGENT, but non-emergency, calls. The evidence from the few pilots that are currently running shows that many non-urgent calls are being received and handled. This is not identified as an issue that needs to be addressed.

The NHS Direct NHS Trust has been awarded the position of being the default provider of the 111 service, despite its poor record for economy. The idea that each locality could address the needs of its people in the most suitable manner has been abandoned. A needless rush will, most likely, simply transfer the same costly NHS Direct service from one number to another, whilst also adding further costs.

Rather than benefitting from a fraction of the premium rates paid by patients to call the 0845 number, calls to the 111 service will be at no charge to the caller. Even if the caller would have been able to call a local or 03 number at no cost, the NHS will pay every telephone company for every call to 111. When the figures are assembled and released we will know how much that amounts to.

At a time when great care is being taken with public spending, it is extraordinary to see such recklessness. I am not opposed to spending money on the NHS, nor to the concept of the 111 service. I am however disturbed to see so much money being spent on ill-justified reorganisations and unproved projects at a time when resources are under pressure.

There are some who think that the present NHS re-organisation (which will be simply rubber-stamped when the Health Bill is passed) is just phase 1 of something bolder. Some think that the NHS is being deliberately fattened up with cash denied to others.

**** disrespecting the NHS

2011-08-03T03:23:00.005+01:00

On 3 August I published a news release in which I referred to Daisy Group Plc.

I now understand that this may contain material which is misleading and inaccurate.

I must ask that anyone who has read this item contact Daisy Group Plc before using any of this material to ensure that only accurate information about this company is published.

Please accept my apologies if you have been misled in any way.

The telephone rip-off for aspiring university students is here again

2011-08-01T14:26:00.000+01:00

As results day approaches, UCAS has apparently doubled the number of staff ready to take calls on its PREMIUM RATE TELEPHONE LINE. (See The Independent - 1 August 2011.)

UCAS advises that calls to its (Phonepay Plus-regulated) premium rate number 0871 468 0 468 "will cost no more than 9p per minute" from a UK BT landline. This statement is false.

The facts

Those looking to study mathematics may be able to work out that after paying a call setup fee of 12.5p and a rate per minute of 9.19p, with the total call cost rounded up to the nearest penny, those using a BT landline will be paying more than 9p per minute. For example, a 7 minute call will cost 77p, 11p per minute. Students of the law may however recognise that such deception is not explicitly prohibited under Phonepay Plus regulations.

Budding economists or students of commerce will perhaps be aware that nearly all of the 9.19p per minute BT charge (including VAT) is passed over to the provider of telephone service to UCAS (Cable & Wireless) as a subsidy towards the cost of its telephone system - at the expense of callers.

Historians will perhaps understand that this unique regulation on BT is a legacy from when it was the monopoly provider. Other telephone companies are able to add their own charges to the rate amount paid to UCAS.

BT charges vary from the rest

UCAS declares that "Calls from mobiles and other networks may vary".

Pedantic logicians may argue that because BT alone is prohibited from adding its own charge - it is BT that varies from the norm by having unusually low charges for these calls.

Virgin Media, for example, charges a call connection fee of 13.24p plus 10.22p per minute for these calls.

Calls from Mobiles

Many 6^th form students will have mobile phones loaded with packages and bundles to offer text messages and / or calls to normal landline numbers and other mobiles at relatively low rates. None of these bundles cover calls to Premium Rate numbers.

All of the major mobile providers charge between 35p and 41p per minute for calls to the UCAS premium rate number. Excluding VAT, only around 7.5p per minute of this benefits UCAS - the rest is simply revenue for the mobile companies.

UCAS may argue that this is a fair "service charge" for use of its Customer Services Unit, including the time spent waiting to be connected to an advisor. This does not however seem to be a particularly effective way of collecting such a charge, when the "agent" (the telephone company) takes so great a premium over its normal call charges.

Budding philosophers will note that this may be a valuable lesson for those starting an independent life. If they cannot secure a place in higher education and call their local job centre; the number is 0845 6060 234. This yields Job Centre Plus only around 2p per minute in subsidy, but the per minute charge rates to call this number from Virgin Media and the Mobile Providers are exactly the same as for the premium rate UCAS number.

The same is true for tax or tax credit enquiries of HMRC - 0845 300 0627 / 0845 300 3900, and even for NHS Direct - 0845 4647.

Conclusion

The modest subsidies which these public bodies achieve from use of these expensive telephone numbers are dwarfed by the additional cost incurred by callers. If they need the benefits of a non-geographic number, these are fully available on 03 numbers.

All calls to 03 numbers are charged on the same basis as a call to a geographic number - in many cases this means that they are covered by an inclusive call package.

Gradual and highly cost-effective migration to 03 is possible by introducing the 03 equivalents of the 08 numbers as alternatives. In every case the equivalent number is reserved for the very purpose and may be very readily put in place, as a replacement or an alternative; i.e.

0371 468 0 468, 0345 6060 234, 0345 300 0627 / 0345 300 3900 and 0345 4647.

If one or more public service providers were simply to advise callers that they could get through at much lesser cost by swapping the second digit "8" for a "3" on any published 084 or 087 number, then this disgraceful and unnecessary rip-off could be ended very easily and swiftly.

Parliamentary Committee urges HMRC to stop using "premium charge" 0845 telephone numbers

2011-07-30T11:00:00.000+01:00

In its report on "The Administration and effectiveness of HM Revenue and Customs", the Treasury Select Committee calls on HMRC to "investigate alternatives to 0845 numbers, including 0345".

This falls short of my demand that HMRC immediately make available the 0345 equivalent for every one of its 0845 numbers.

This pragmatic and easily adopted solution could enable callers to save up to 41p per minute in premium charges. By simply allowing the second digit of any published HMRC number to be swapped from a "8" to a "3", the cost and confusion of lots of individual number changes could be avoided. Furthermore, such a measure could be adopted immediately, without waiting for a new telephone service contract.

The loss of the modest subsidy which HMRC derives from its use of 0845 numbers would be more than offset by the saving to callers. In most cases calls to 03 numbers are included in call packages, whereas 0845 numbers are subject to a premium charge. The one exception to this rule is BT, which originates around 25% of non-business calls. BT includes both 0845 and 03 numbers in its call packages and is prevented by regulation from adding its own charge to the money it has to pay to HMRC on 0845 calls.

I have demanded that the same approach of providing 0345 equivalent numbers be adopted by DWP agencies, NHS Direct, NHS 24 and all other public bodies (including BBC local radio stations) currently using 0845 numbers. When circumstances permit, or number rationalisation is being undertaken, then proper changes to 03 numbers can occur.

If Ofcom goes ahead with its proposals for revised regulation of non-geographic numbers, HMRC (and others) will shortly be required to always advise the "Service Charge" of around 2p per minute which is imposed on callers to 0845 numbers, to its benefit. Telephone companies will also be required to publish their associated "Access Charge". When this long overdue transparency is applied to this murky area, HMRC will not be able to hide from the need to justify its Service Charge, which is presently hidden within "bundled" telephone call charges.

All 03 numbers are classified as “Geographic Rate” as calls must be charged at no greater rate than that for a geographic number. Service Charges and Access Charges do not apply to calls to geographic or 03 numbers.

Notes

1.	The Report is summarised here - note the first listed Recommendation.
2.	The Conclusions and recommendations are listed here - see item 27.
3.	The relevant item in the report is found here - see sections 112 / 113.
4.	My evidence to the committee is published here.
5.	Details of the effect of Ofcom's proposals and further comments are found here.

The BMA advises its members to continue the 084 telephone number scam

2011-07-27T10:51:00.001+01:00

In its July 2011 newsletter the BMA General Practitioners Committee disputes the accuracy of a statement made to parliament, and advises members using 084 numbers that they are not bound by the terms of their NHS contracts.

See "Guidance for practices using 084 numbers" in BMA GPC Newsletter July 2011 (p7).

See "GPs (Premium Rate Telephone Numbers)" in Hansard 12 July 2011 Cols 149/150.

The essential argument from the BMA GPC is that if members have been misled by their own telephone system provider, they can continue to breach the terms of their NHS contract, obtaining subsidy at the expense of patients, for the 5 year duration of their arrangement with that provider.

A number of NHS GPs have entered into such arrangements in the last few weeks (contact me for details).

The BMA claims that the Minister misled parliament when stating: "Since April this year, GPs have not been allowed to use a number that charges patients more than the cost of an equivalent geographical call."

To make its point, the BMA relies on the fact that one provider of surgery telephone systems has decided that the only "patients" covered by this statement are those who happen to be subject to a particular tariff of charges from a particular telephone company.

Furthermore, the BMA also denies the fact that all network telephone service companies allow customers to migrate from 084 to 03 numbers at any point during the term of a contract, without penalty.

IT IS A DISGRACE FOR AN ORGANISATION WHICH IS NOW COMMITTED TO CAMPAIGN AGAINST THE DANGERS POSED BY GOVERNMENT NHS REFORMS TO ITSELF BE ACTIVELY ENGAGED IN SUPPORTING THIS MEANS OF UNDERMINING THE PRINCIPLES OF THE NHS.

I am at a loss to understand how the BMA can support and promote the notion that only some patients are entitled to access NHS services "free at the point of need".

BMA Guidance to Members

The BMA made its policy position very clear in the original guidance to members it published in January 2010 -
GPC GUIDANCE: USE OF 084 NUMBERS IN THE NHS, January 2010)

"... calls to NHS services should incur as low a charge as possible, but that this must be balanced by the quality of communications service that the patients are accessing."

The government had rejected this argument, refusing to alter the NHS Constitution to cause NHS patients to pay according to the "quality of service" received. Through this guidance, the BMA therefore sought to undermine the objectives of the regulations intended to outlaw use of subsidy from patients.

Following the recent statement in parliament, the BMA has now revised its guidance -
GPC GUIDANCE: USE OF 084 NUMBERS BY GP PRACTICES, July 2011.

It no longer states its policy position, but continues to oppose attempts to eliminate the illegal practice of NHS providers subsidising their costs at the expense of patients.

There are three points in the guidance which highlight this approach.

1 - Cost of calling from Mobile Phones

The answers to questions in parliament included the comment: "It is absolutely clear that there is no distinction between landlines, mobiles or payphones. The directions are very clear that patients should not expect to be charged any more."

The BMA disagrees that this is a fair interpretation of the following statement from the contracts: "persons will not pay more to make relevant calls to the practice than they would to make equivalent calls to a geographical number".

The BMA argues that because there is no specific reference to mobile phones, GPs may ignore the fact that many patients will use a mobile phone to call the practice -

"The regulations do not include any specific requirement for practices to consider the cost of calls from mobile phones. In terms of call tariffs, the call rates which patients are charged depend on their mobile phone service provider. It is a matter for individual members of the public to ensure that they are happy with the terms and conditions of the mobile phone arrangements that they enter into with their mobile phone provider."

It is most odd to suggest that in 2009, when the regulations were drafted, "calls to the practice" would not be reasonably understood to include calls from mobile phones and that "persons" who are unable to obtain a landline are not covered by the rights under the NHS Constitution. That is however the BMA position.

2 - Providers of telephone systems to GPs

The BMA suggests that providers of GP telephone systems are competent to advise on whether the number used by the GP is compliant with the terms of their NHS Contract. THIS IS DEMONSTRABLY UNTRUE.

"It is the practice’s responsibility to satisfy itself that the requirements of the regulations are met. One way for a practice to do this is to contact the company providing telephone services for the practice, and ask them to confirm that the practice’s contract is compliant with the current GMS and PMS regulations. As noted above, the main telephone service providers are aware of the new regulations, and should be able to provide this statement on request."

The major provider of surgery telephone systems - Network Europe Group, now owned by Daisy Group (led by "The Apprentice" star Matthew Riley) - advises that all 084 telephone numbers are compliant with the relevant regulations.

In doing so, it disregards the possibility of calls being made:

• ... from Mobile Phones

• ... from Public Payphones

• ... from Landline Call Providers other than BT

• ... within the terms of a BT Call Plan

Whilst there will be some who remain after all of these possibilities are excluded, the NHS is a universal service. There is nothing in the drafting of the contracts under which GPs provide NHS services to suggest that this type of extensive qualification should be applied to a determination of whether or not use of a particular number is prohibited.

3 - The need to incur penalties on varying a contract

The BMA suggests that GPs in long term contracts for telephone service could not vary the terms of this arrangement so to become compliant with the terms of their NHS contract without penalty.

"...many GP practices have signed multi-year contracts with telephone services providers which cannot be varied, renegotiated or terminated without substantial financial penalty"

In respect of the point at issue - the type of non-geographic number being used - THIS IS SIMPLY FALSE.

GPs are commonly using the revenue share earned from 084 numbers (at the expense of patients) to fund lease payments and pay service charges on surgery telephone systems. Early termination of the leasing arrangement would undoubtedly cause a penalty to be incurred, similarly the terms of the commitment to the system may also be rigid. The requirements do not however address these matters, only the improper manner in which they are being funded.

All network telephone service providers (notably Talk Talk - the provider of network telephone service to most of the NHS GPs using 084 numbers) allow customers to migrate from 084 to 03 numbers at any point during their contract for telephone service WITHOUT PENALTY. Calls to 03 numbers are (by regulation and in practice) charged at no greater cost than that of an equivalent call to a geographic number.

There may be other options open, but there is no question that this variation could be accomplished, without penalty, in every case.

All GPs are expected to meet the costs of running their NHS surgery from payments received from the NHS - not from patients as they access NHS services. All NHS GPs should be paying for their telephone system in the same way. The loss of the revenue share benefit derived from the 084 number on migration to 03 returns those GPs currently in breach of their contracts to the same position as other BMA GP members.

I find it extraordinary that the BMA GPC is actively supporting the idea of competition between members on the basis of the cost of calling them!

Some of my other recent comments on this issue

• Apprentice star Matthew Riley asked to stop undermining the NHS

• Ban on use of 084 telephone numbers in the NHS confirmed in parliament

• PCTs failing to understand DH Guidance

• NHS GPs using expensive telephone numbers - new database

**** asked to stop undermining the NHS

2011-07-17T17:34:00.010+01:00

On 17 July I published a news release in which I referred to Daisy Group Plc.

I now understand that this may contain material which is misleading and inaccurate.

I must ask that anyone who has read this item contact Daisy Group Plc before using any of this material to ensure that only accurate information about this company is published.

Please accept my apologies if you have been misled in any way.

Ban on use of 084 telephone numbers in the NHS confirmed in parliament

2011-07-13T06:17:00.004+01:00

Many GPs and NHS bodies are failing to comply with the ban on the use of 084 numbers for patients to contact the NHS. They have been pretending that the ban does not apply to patients calling from mobile phones or public payphones.

Calls to ALL 084 numbers from mobile phones and public payphones are invariably more expensive than equivalent calls to geographic rate (01/02/03) numbers. See published provider tariffs and summary, showing that the same is true for many landline callers also. This fact is rarely denied, some pretend that it is not relevant!

This pretence was most "clearly" dismissed in parliament yesterday by Health Minister Anne Milton. In answers to questions, she said -

"Since April this year, GPs have not been allowed to use a number that charges patients more than the cost of an equivalent geographical call."

"It is absolutely clear that there is no distinction between landlines, mobiles or payphones. The directions are very clear that patients should not expect to be charged any more."

"The Department is very clear, and the general medical services contract makes it very clear, that GPs are not allowed to do this."

NHS Campaigner David Hickson comments:

"This unambiguous clarification of some very simple words should cause those who have been seeking for PCTs to misunderstand their duties to change their approach.

"I call on the BMA GPC and Network Europe Group to admit defeat in their attempts to get the principle of co-payment introduced to the NHS. They should aim to assist GPs in working to provide the best possible service to patients UNDER THE TERMS OF THE NHS. Their argument, that patients should pay for an improved NHS service as they use it, was rejected in September 2009.

"PCTs have the clarity that they have been waiting for. They can now easily dismiss attempts to fudge the terms of the requirements. If GPs are under contract for a system which requires a non-geographic number, they can switch to the equivalent 034 number at any time.

"There is no reason why the NHS could not be free of the need to call 084 numbers within a few months. All NHS Bodies are subject to the same Directions as GPs. Even NHS Direct, exempted from the ban, can adopt 0345 4647 as a clearly, but gently, advised alternative to 0845 4647 for the remainder of the life of the service."

Further points

The Department of Health only covers the NHS in England. The Welsh and Scottish Governments should note and copy this action.

It is now time for the Cabinet Office to direct all public bodies to follow the same approach. The only exceptions may be cases where it is valid to impose what Ofcom calls a "Service Charge" on those who access public services by telephone. The charge should be declared, explained and justified in all cases where 084 or Premium Rate telephone numbers are used.

Bodies such as HMRC and the DWP agencies can avoid the initial cost and confusion of a complete number change by adopting the 034 equivalents as alternatives to all of their many published 084 numbers. The present imposition of a “Service Charge” for telephone enquiries from Tax Credit and benefit claimants, jobseekers and pensioners surely cannot be justified!

Please refer to my briefing PCTs failing to understand DH Guidance, for detail, references and links. I cannot say what part this publication played in informing the exchanges in parliament.

News Alert - "premium rate telephone numbers" - announcement expected

2011-07-12T00:00:00.006+01:00

Health Questions, Tuesday 12 July 2:30 pm
"(8) ... the use by GP surgeries of premium rate telephone numbers"

It is hoped that in answer to this, the 8^th question on the Order Paper, the Health Minister will confirm that many PCTs are misinterpreting the terms of GP contracts by continuing to permit use of 084 telephone numbers, on quite spurious grounds.

This briefing shows that the terms of the regulations are perfectly clear and cannot be interpreted other than as a ban on use of 084 telephone numbers by GPs. The briefing also indicates how PCTs have been misled so as to arrive at a misunderstanding.

My database and maps, covering all of the PCTs and Health Boards in England, Wales and Scotland, show a total of 1,372 GP surgeries where the principles of the NHS are shown to be breached. Clear and specific regulations introduced in December 2009 and April 2010 have simply not been enforced.

We wait to hear what action the government will take in defence of the principle that all of us are entitled to access NHS services without being subject to a charge to the benefit of the NHS provider. (A premium on the telephone bill is no different in effect to a till at the surgery reception desk.)

Ofcom misuses its persistent misuse powers against Silent Callers, again

2011-07-07T15:00:00.007+01:00

Ofcom has today announced a further misuse of the powers it holds to take action against all those found to be causing unnecessary inconvenience annoyance or anxiety by misuse of the telephone network. (See update notes (i) and (ii) - 7 July 2011 on this "Competition Bulletin".)

Sadly, Ofcom only uses these powers against those who breach a formal tolerance limit, based not on the amount of nuisance caused, but as a proportion of other activity by the same company on the same day.

The action by Ofcom against nPower and Homeserve is to be welcomed, if only because it draws attention to the nuisance which they will be permitting to continue causing. This only amounts to the issuing of Notifications and the consequent public shaming at this stage. Looking at previous cases, precedent and proportionality make it unlikely that the previous limit of £50,000 for a fine will be exceeded.

The limited detail of these cases which has been revealed so far demonstrates how Ofcom is tolerating the practice of hanging up in Silence when a call is answered - only intervening when an offender tells Ofcom that it has breached the rules. Furthermore, the Silent Calls made by nPower are not covered by the action and only some of those made by HomeServe are deemed to be in breach of the Ofcom tolerance "rules".

Silent Calls are totally unnecessary

If no agent is free to handle an answered call a very simple message, simply naming the caller and apologising, could be played. Ofcom suggests a far more elaborate version of this, but does not demand its use, so long as the 3% allowance of abandoned calls is not exceeded.

Many companies, including BT and British Gas publicly declare that they make Silent Calls up to this limit. They will not however say how many calls and how much nuisance they are knowingly causing to their customers and others.

The only acceptable limit for SILENT calls is 0%. Those who are prepared to say who they are when they abandon calls can take the consequences!!

Answering Machine Detection

Ofcom has muddied the waters with new rules covering the use of this obsolete equipment, designed to detect the clicks and whirrs of a mechanical answering machine.

Ofcom now declares that when this notoriously inaccurate equipment detects an answering service it is acceptable to hang up in Silence, but callers must wait until the next day before repeating the call - probably with the same effect if the detection was erroneous.

Many in the Call Centre industry would wish for providers of network answering services to provide a clear signal of some sort whenever the answering service is engaged. This would enable 100% accurate detection of use of such services, rather than the present unacceptable method of listening to the tone of voice and mode of speech from the answer.

Ofcom has explicitly rejected this option, known as Answering Service Detection, firmly supporting the use of a technology that became obsolete when mechanical tape recorders ceased to be the primary way of applying an answering service.

The present method of AMD is obsolete and wholly unacceptable, as it is perhaps the primary cause of Silent Calls. Requiring a Silent Call to be repeated on the next day, rather than the same day is no answer.

The NHS GP - 084 "co-payment" club

2011-06-29T13:37:00.003+01:00

Another pair of NHS GP surgeries join the 084 "co-payment" club by adopting revenue sharing telephone numbers

The proposed "NHS reforms" do not explicitly allow patients to pay towards the cost of the NHS treatment, however many GPs have long been benefitting from co-payment; another practice joined the “084 co-payment club” only last week.

The River Lodge and Ringmere surgeries in Lewes have just adopted a 0844 telephone number. This number enables the practice to have the cost of a new telephone system subsidised (to the tune of around 4p per minute on every incoming call) at the expense of patients and other callers.

There is nothing unusual about the particular surgeries in Lewes. Like all other NHS surgeries in England and Wales using 084 numbers, the practice is in breach of its NHS contract. Co-payment cannot be a feature of the NHS. I do however have a database of 1372 cases from NHS Choices (for England) and other official sources (for Scotland and Wales). These are all represented on a map – this view shows the 38 cases in Sussex.

In common with the overwhelming majority of cases in my database, these surgeries have a Talk Talk telephone line from which the revenue subsidises the cost of a system known as “Surgery Line” provided by Daisy Communications (the identity of the relevant Chief Executive Officer is deemed confidential).

If the government will not intervene to ensure that the terms of contracts are enforced and whilst the BMA continues to support the principle of co-payment, one assumes that we must look forward to this principle being continued and extended – the end of the NHS as a service that is universal and “free at the point of need”.

Denial

Some surgeries seek to hide their breach by claiming that the revenue share benefit, which is accrued on all 084 numbers, is a free gift to them from the telephone companies and that the cost should not be passed on to callers. Most of us recognise that the cost is (obviously and properly) passed on to the caller. Because these calls are excluded from packages and telephone companies also add their own additional charges, as a rate per minute or a call setup fee, the caller commonly ends up paying a lot more than just the amount passed on to the surgery.

Contract mobile callers pay up to 41p per minute, when a call to a "geographic rate" 01/02/03 number would incur no call charge. BT is prohibited by regulation from adding to the pence per minute rate that is passed on, although it does add a 12.5p call setup fee. BT subscribers are required to stick to the terms of their selected Call Plan when making (inclusive) calls to geographic rate numbers; severe penalty charges are incurred on calls made outside the terms of the plan. It is however commonly claimed that these penalty charges are “the standard BT rate” – a gross misrepresentation being used to exploit an admittedly complex situation.

There are others, notably the BMA GPC, who argue positively in favour of "co-payment", suggesting that patients should pay according to the quality of NHS service they receive. This argument is used to justify use of an expensive telephone number to meet the cost of a telephone system that the practice does not wish to pay for itself. After this proposal was not accepted by government however, the BMA GPC urged its members to state that co-payment was not happening, with support from a friendly source. (see this guidance note.)

Prohibition

Since April 2010, NHS GPs have been prohibited from adopting a telephone number which costs patients more than the cost of an equivalent call to a geographic number. Those with one of these numbers already in use had to change to a geographic rate number before a deadline of 31 March 2011. It is important to note that there is no prohibition on use of advanced telephone systems requiring "non-geographic" numbers. These can be used on 03 numbers, which are invariably charged at “geographic rate”. On 03 numbers the practice benefits from all of the same technical features, but must meets the cost of their system out of the funding provided for this purpose, without subsidy from patients – that is how the NHS works. Migration from a 084 number to the equivalent 034 number can be made, without penalty, at any point during the term of contract for telephone service.

I cannot understand how any Primary Care Trust that has taken the trouble to check on the cost of calling these numbers, from a reliable source such as the telephone companies used by patients, can allow this to continue. Subjective opinions about what telephone companies should charge and which tariffs patients should be using are of no value in determining compliance with the terms of the revised contract, especially when they originate from highly interested parties.

Co-payment for Health Services replacing the NHS

Many of us fear that "co-payment" will eventually become a feature of a new health service in England that is partially funded by public money - the term "NHS" refers to a service that is universal and “free at the point of need”, albeit subject to charges set by parliament. If pressure for more choice and better outcomes (like advanced telephone systems) cannot be met out of the money paid to NHS providers from our taxation, then elective patient contributions would seem to be a likely route to be followed. Surgery telephone systems are only a very modest part of the cost of providing NHS services, however they have been used to blaze a trail.

If no action is taken to deal with the "co-payment pathfinders" - GPs with 084 telephone numbers - we will be able to recognise that the coalition government is leading us towards co-payment - the end of the NHS in England. This must be either stopped or formally acknowledged as an acceptable feature of the “English Health Service”.

The most sickening part of this is that the necessary regulations are in place to prohibit it (except for NHS Direct, which has been explicitly exempted so that it may continue to benefit from co-payment). They are being deliberately flouted, no enforcement action is being taken by PCTs and the government is standing back.

Links

The following recent blog items may be of interest:

>>>	Links to telephone company tariffs with a summary of the relevant call costs
>>>	Copy of a message to PCT Cluster Chief Executives (the enduring guardians of the principles of the NHS) about their position on "co-payment"
>>>	Detailed notes on how the regulations are being evaded
>>>	A news release covering another recent adopter of a 084 number and the approach of the government

Primary Care Trusts accused of sanctioning "co-payment" in the NHS

2011-06-16T13:23:00.003+01:00

Many Primary Care Trusts have failed to enforce GP contract revisions that should have eliminated use of 084 telephone numbers by 1 April 2011 - see my database of those in breach. If this is anything more than falling for the misrepresentations made by those who believe that patients should pay to fund GP telephone systems, then it is a positive sanction for co-payment.

Many of us fear that co-payment will have to become a general feature of the NHS, as the proposed "reforms" are unlikely to achieve the cost savings on which they depend. More choice and improved outcomes may be desirable goals, but they cannot be expected to deliver cost savings. Replacing one centralised bureaucracy with lots of separate versions of the same thing is not guaranteed to save money either.

Sanctioned co-payment (which is presently prohibited) is undoubtedly coming on a grand scale. Do we see a model in the way that revenue sharing telephone numbers are used by 12.25% of English NHS GP surgeries? The Department of Health declares no interest in this matter - see this written answer.

I have written to the Chief Executives of the PCT's who are clearly having the greatest difficulty in protecting the patients they serve from being forced into co-payment. See my letter - see my "Top 20" lists.

I have asked them to confirm whether or not their failure to ensure compliance with contract revisions within the specific time limits indicates incompetence, or a policy of sanctioning co-payment by the NHS patients that they serve.

Amidst all of the politicking around the "NHS Reforms", the fact that co-payment is already here and likely to increase significantly has perhaps been missed. The relatively modest issue of use of revenue sharing telephone numbers has however perhaps been pointing the way forward.

The BMA GPC has expressed the principle of co-payment very clearly by its policy on use of expensive telephone numbers. The following quote is from its guidance to members on how to get around the contract revisions - by offering a meaningless, and essentially false, assurance about telephone call charges from an interested party with no competence in the matter being addressed.

"Calls to NHS services should incur as low a charge as possible, but that this must be balanced by the quality of communications service that the patients are accessing."

Balancing cost to patients with the quality of service delivered by the NHS is exactly what co-payment is all about. A patient's right to choose cannot be divorced from their "right" to pay for a quality of service that the NHS "cannot afford". That however is the end of a universal comprehensive National Health Service "free at the point of need".

IF "OUR NHS" IS TO SURVIVE, THE GP RIP-OFF TELEPHONE NUMBER SCAM MUST END

2011-06-07T07:00:00.001+01:00

•	If the UK Government believes in the principles of the NHS it must prove this by acting to protect them NOW. Otherwise we cannot believe its alleged intentions for the future when it proposes changes that can only undermine their application.
•	My revised, extended and enhanced database lists 1,366 NHS GP surgeries in England, Scotland and Wales which benefit from subsidy at the expense of patients through use of 084 telephone numbers – a clear breach of the principle of “free at the point of need”. All data is from NHS sources.
	Visit http://tiny.cc/GP084 for links to detailed lists, summaries, league tables and MAPs.
•	084 numbers are invariably more expensive than “geographic rate” (01/02/03) numbers for most, if not all, NHS patients to call.
•	GPs can vary their arrangements to switch from 084 to 034 numbers at any point during their contract FOR TELEPHONE SERVICE.
•	Contracts for advanced surgery telephone systems including leases on equipment must be paid for in full by GPs. Our taxes provide them with NHS funding to meet their expenses in providing NHS services. That is how “our NHS” works - not through private arrangements made between patients and GPs.
•	English PCTs and Welsh Health Boards must enforce the contractual conditions already imposed on GPs. NHS Scotland must act.
•	The UK and National governments must drive and support this effort. If not, they will be seen to permit an abuse of the NHS to persist.

IF THE SCAM IS ALLOWED TO CONTINUE THIS WOULD PROVE THAT “OUR NHS” IS DEAD

At the same time, the respective managements of NHS England, Scotland and Wales must ensure that they (and their subsidiary bodies) also cease relying on the subsidy earned from use of 084 telephone numbers.

Where a non-geographic number has a benefit, e.g. for a national or regional service, the 034 equivalent must be immediately brought into use and offered, at least as an alternative - e.g.

NHS Direct England - 0345 4647

NHS Direct Wales - 0345 4647

NHS 24 Scotland - 0345 4 24 24 24

(As the cost of publicising a complete number change is perhaps prohibitive - these alternatives must simply be switched on immediately. This will take only a few days to arrange.)

Notes

1.	This message is distributed to the media, MPs, MSP and AMs, NHS Management in government, local NHS management.
2.	Detailed notes on avoidance of the provisions of the revised GMS contract are published in this blogging - Resistance to the ban on use of 084 numbers by NHS GPs.
3.	Recent comments on NHS Direct (and NHS 24) are found in - NHS Direct has caught up with mobile apps - but not mobile voice calls!
4.	Features of the database of GPs using 084 numbers include:
	•	Links to the website holding the data published by (or, in the case of Scotland, linked to) the commissioning NHS Organisation - on NHS Choices for England. Each item may thereby be verified at any point in time.
	•	A map - seen here for all of Great Britain. This may be zoomed and panned. Use View>Search from the map menu to select only particular NHS Organisations etc.
	•	A sortable (sic) and filterable (sic) version of the data list.
	•	A "Top 20" list of the NHS organisations with most work to do.
5.	I will be very happy to extract / prepare listings to cover a particular area. The data can be copied directly from a browser into a spreadsheet for local treatment, if desired.

NHS Direct has caught up with mobile apps - but not mobile voice calls!

2011-05-27T14:07:00.000+01:00

NHS Direct has announced the launch of a useful app for smart mobiles - "NHS Direct mobile app - for trusted health advice straight to your pocket",
but it continues to withhold the 0345 4647 alternative "Geographic Rate" telephone number, which would save mobile callers from incurring unnecessary premium charges.

0345 4647 has been set up for use as an alternative to 0845 4647, but NHS Direct refuses to make it available for use.
Only around 25% of non-business voice telephone calls are now made using BT, where the effect of perverse legacy regulation enables callers to 0845 numbers to avoid the premium charges which are normally associated with calls to 084 ("revenue sharing") numbers.

The cost subsidy of around 2p per minute from which NHS Direct benefits through use of a 0845 number is generally translated into a premium charge to callers. Tariff arrangements however mean that these calls are excluded from packages which include unlimited calls to Geographic Rate numbers. The effect is seen with landlines but most markedly with all mobiles. Of the common providers, T-Mobile shows this most clearly.

A T-mobile contract holder would be able to call 0345 4647 for free, but pays 41p per minute to call 0845 4647, only 2p of which is a charge for accessing a NHS service.

No need for the expense and confusion of a complete number change - NHS Direct must make the 0345 4647 alternative available immediately.
This applies to the proposed non-NHS English Health Service, as well as NHS Wales.

NHS Scotland must do the same with NHS 24, by adopting 0345 4 24 24 24 alongside 0845 4 242424.

The NHS "Free at the point of use" - in future ? - now?

2011-05-10T10:34:00.007+01:00

NHS GPs are continuing to adopt expensive telephone numbers - the latest goes live tomorrow!

When there are more than 1000 to choose from, it seems unfair to highlight a single case, but it serves as a good example.

On Wednesday 11 May, the West Pottergate Health Centre in Norwich will adopt its new 0844 telephone number.

This will enable a new telephone system to be largely paid for by patients, through the "revenue share" that applies to these numbers, causing callers to pay more than for an ordinary call.

This is NOT the "NHS free at the point of use" to which Minister of State, Simon Burns MP, claimed to be committed in parliament yesterday [see end of para].

In its published information about the change, the practice encourages patients to " use a landline", acknowledging that calls from mobiles cost more than the cost of an equivalent call to a geographic number (this is not conditional, it is true in every case).

Patients are not however advised to avoid inclusive packages, landline providers other than BT or public payphones, although the same is true for these. It is only those who would incur a penalty charge, for making a daytime geographic call outside the terms of their Call Plan, who would not pay more to call this number.

The NHS is a universal service and GPs are required to have regard to " the arrangement as a whole" when considering the cost of calling them, relative to that of an equivalent call to a geographic number. This practice will therefore (admittedly) be joining the many others who are in clear breach of the terms of their NHS contract.

Hoping that patients will change their type of telephone, provider and type of Call Plan so as to keep the practice inside the terms of its contract, does not reflect the purpose for which patients expect to receive advice from their GP.

Responsibility for enforcing the terms of the contract rests with Primary Care Trusts, described by Mr Burns as one of the "layers of unnecessary management" that he is removing [see start of para], through the upcoming reforms.

I comment,

"We may think it right that patients in England should pay to receive improved health services - if we do, then we must say so, and stop confusing ourselves and each other with meaningless slogans.

"If England wants to opt out of the NHS because it cannot afford the overheads, wants patients to be given true "choice" and aims to produce better outcome statistics than can be obtained from a taxation-funded system that treats everybody - then let us be honest about it.

"I am a joint-owner of 'our NHS' and I will continue to fight to keep England within it."

Rip-off GP telephone number provider openly seeks to undermine the NHS

2011-05-01T23:29:00.002+01:00

In a most extraordinary development, Network Europe Group (the provider of the "Surgery Line" GP telephone system part-funded by patients, who pay premium rates to call 0844 numbers) has publically declared its opposition to the principle that NHS services are funded by taxation, rather than by patients as they access services.

Quoted in this article - Company defends charges for calling GP practices, in the Leamington Spa Courier,
NEG opposes the action that its GP customers need to take to comply with their NHS contracts, by saying ...

“the cost would be borne by the practice and ultimately the taxpayer”

The reason given is the very reason why practices MUST make the necessary change - switching to a 03 number so as to provide the technical benefits required by Surgery Line, but at no greater cost than that of a geographic call for the caller. It is quite odd to see the basis of funding for NHS services being given as a reason why NHS GPs should not adhere to this principle.

The cost of providing NHS services is properly carried by the practice, ultimately funded by the taxpayer, not the patient as they access the service. This has been the whole basis of my involvement in this issue - I am delighted to see "the other side" now being open about its position of opposition to the principles of the NHS. (NEG continues to misrepresent the position of the Department of Health and misinterpret the requirements actually imposed on GPs. By declaring its clear intention to work against the fundamental principles of the NHS, we can see all of its other statements in a clear context.)

The Surgery Line telephone system is admittedly too expensive for GPs to pay for in the normal way. The number used is however nothing to do with NEG, it is a matter of the arrangement between the practice and the network telephone service provider - normally TALK TALK in the case of Surgery Line users.

Talk Talk allows migration from 084 to 03 numbers at any point during the term of a contract. This is exactly what all of the 1000 or more GPs who are currently in breach of their contract (see below), but want, or are committed, to use non-geographic numbers must do immediately. Other NHS GPs pay for their telephone systems, and other surgery expenses, out of the money given to them from our taxes. That is how the NHS works!

As we are now “pausing and reflecting” on the NHS reforms, perhaps we need to get our thinking clear on the meaning of "free at the point of need". A commercial company, like NEG, finds it difficult to understand and easy to oppose. It can even use an undisguised attack on the fundamental principles of the NHS as a “defence”. As we look for more commercial involvement in the NHS - do we understand this principle and do we want to keep it?

References to other material

	I cover the detail of the requirements under the GPs contract with the NHS in this blog entry.
	My league table of the areas of England with GPs in breach, and lists of those surgeries.
	The equivalent list for Wales, where the situation is identical.
	The list covering NHS Coventry and NHS Warwickshire - "the Arden Cluster" (as referred to in the Courier article).
	I have previously commented on the views of NEG, although not expressed with the clarity seen in the quote covered by this item.

Expensive GP telephone numbers are now relatively even more expensive for BT customers

2011-04-28T00:00:00.005+01:00

BT has today made further adjustments to its prices for residential customers (see "Some of our prices are changing").

•	The price of the Unlimited Anytime Call Plan is reduced from £5.00 per month to £4.70.
•	The "penalty rate" for weekday daytime (7am - 7pm) calls to geographic numbers outside a calling plan goes up from 7p per minute to 7.6p per minute.
•	The Call Setup fee (which applies to all non-inclusive calls) goes up from 11.5p to 12.5p.

The latter directly affects calls to GP 0844 telephone numbers, which are never included in packages, but the other changes make a difference too.

The "break even" point

It is worthwhile to select the Unlimited Anytime Call Plan, even if one only makes a few weekday calls to geographic numbers. Following these changes, anyone who makes at least the equivalent of 3 calls, each of more than 3 minutes, per week to a geographic number before 7pm, is now best served by the Unlimited Anytime Call Plan (see calculation below).

This should leave very few people paying the "penalty rate" for making otherwise inclusive calls outside the period covered by their Call Plan. Having subscribed to this plan, all other calls (of up to one hour, to "geographic rate" 01/02/03 numbers) at any time are made without any further charge.

Only those who NEVER use their landline during the day, perhaps because they use a mobile for daytime calls, would be likely to choose to continue paying for daytime calls to geographic numbers at these newly increased “penalty rates”.

THIS MAKES CALLS TO (always non-inclusive) GP 0844 NUMBERS INFINITELY MORE EXPENSIVE.

False claims

Some providers of the 0844 (type 'g6') numbers used by many GPs claim that because BT is compelled to charge no more than 5.105p per minute (plus the 12.5 call setup fee), calls to the surgery are "cheaper" than calls to geographic numbers. By regulation which applies only to BT, it is only permitted to charge the amount which is passed on to the other end on these calls - the subsidy from which the GP benefits.

The "cheaper" claim relates to the odd circumstances of BT being unable to add its own charge for these calls. It is only true in relation to those who would pay a "penalty charge". There will now be fewer of them! Furthermore, the increase to the call set-up fee makes the additional cost of calling 0844 numbers greater for all.

Aside from the regulated rates forced on BT; callers using Virgin Media, all mobile phone tariffs and public payphones invariably pay far more to call these 0844 numbers, whether they benefit from a package for geographic calls or not. Mobile voice call packages generally include calls to geographic landline numbers, but never 0844. The highest surcharge for 0844 calls amongst the major providers is 41p per minute (T-Mobile).

Breach of contract

GPs who cause ANY caller to pay more than the cost of a geographic call (by choosing to benefit from the revenue share earned from these expensive numbers) are already in breach of their contract. The noose is tightening around this scam - the BT changes from today will serve to pull it a little tighter.

This briefing addresses enforcement of the regulations on NHS GPs.

Please refer to this table for illustrative call cost examples and links to published tariffs.

Calculating the break-even point

From today, non-inclusive weekday daytime calls to geographic numbers are charged at 7.6p per minute with a call-setup fee of 12.5p.

Charges include VAT, durations are rounded up to the nearest minute, call charges are rounded up to the nearest penny.

A call of between 3 and 4 minutes costs: 4 x 7.6p = 30.4p + 12.5p = 42.9p rounded to 43p

43p x 3 = £1.29 per week x 4 = £5.16 per month vs. £4.70 Unlimited Anytime subscription

There are innumerable other examples; e.g. 5 calls of just over 10 minutes each per month:

11 x 7.6p = 83.6p + 12.5p = 96.1p rounded to 97p x 5 = £4.85

My point is that this is not "heavy" usage, it is just "someone using their phone". Having passed this point, there is no further charge for any other inclusive call.

The "penalty charges" shown in these examples are clearly not the "standard" charge for a telephone call.

NHS Reforms - Government says "PCTs must carry on with their work"!

2011-04-18T09:12:00.001+01:00

The government has confirmed that it is the PCTs, under threat of abolition,
who are responsible for ensuring that GPs provide NHS services “free at the point of need”.

This article in a GP journal raises the issue of over 1,000 GP practices shown by NHS Choices to be in direct breach of their NHS contract, by continuing to use expensive telephone numbers past the 1 April deadline for compliance with new regulations. In response, the Department of Health is quoted as confirming -

"It is up to PCTs to ensure that GP practices comply".

THIS LEAGUE TABLE shows how many cases each clustered grouping of PCTs has to address. I have published a geographic version.

Both link to a full listing of all of the surgeries shown by NHS Choices to be still using expensive telephone numbers, after they should have been given up.

I support my claim that ALL ‘084’ NUMBERS ARE MORE EXPENSIVE for NHS Patients to call, with linked information from published telephone tariffs. All may be readily verified.

I comment:

“We need PCTs to ensure that GPs do not breach the principles of the NHS by charging patients through use of expensive telephone numbers. They have much work to do before the NHS can move forward.
The government needs to explain how GPs will be able to do this job themselves when they take over the work of PCTs!

“The NHS will always benefit from improved effectiveness and efficiency.
The principle of access to NHS services ‘FREE AT THE POINT OF NEED’ cannot be compromised.”

Notes

♦	My full briefing is published here - PCT Clusters to enforce principle of "free at the point of need" before the NHS can move forward
♦	This is a national release. Local and regional briefings could be as follows:
	•	South Yorkshire tops the table for illegal expensive GP telephone calls
	•	149 West Midlands GPs in breach of their contract! - listed
♦	Details of the contractual requirements are given and summarised here
♦	A summary of the basic facts and confusion raised about the cost of telephone calls is provided here
	•	Actual telephone call costs and links to published tariffs are given here
♦	The information as published provides links to the MP covering the area where the surgery is located and to the source information on NHS Choices.

GP telephone system provider NEG joins the debate on NHS reforms - to question "free at the point of need"

2011-04-06T23:30:00.007+01:00

In its response to the Ofcom consultation on Simplifying Non-Geographic Numbers, leading Primary Care Telephone System Provider, NEG, argues that the principle of "free at the point of need" does not work for “enhanced” GP telephone systems. Its Surgery Line system is too expensive to be funded properly by GPs themselves.

"Since 2008 we have offered our customers the choice of using a 03 number. None to date has chosen to do so." ....
"Our years of experience of delivering enhanced telephony solutions in NHS Primary Care organisations leads us to conclude that
the reason is the crucial contribution made to their infrastructure and technology costs by revenue sharing, which is permitted on 084 numbers, but not on 03 numbers."

It is of course the revenue sharing element of 084 numbers which makes them more expensive to call than geographic numbers. Calls to 03 numbers must be charged at no more than the rate of a call to a geographic number and included in packages on the same basis.

As the government pauses in its considerations of the NHS reforms, it is surely vital that this argument in favour of using money from patients to provide “investment” in “enhanced” telephone systems be considered - openly and honestly, with the facts on the table. I have always been ready to participate in any such discussion.

My latest published contribution to this debate includes examples of call costs and links to published telephone tariffs. The NEG document, and its supplement, is heavy on quotations and opinion, but light on relevant facts.

I will leave it to readers to draw their own conclusions about why (on page 65/75) NEG pleads with Ofcom to qualify its efforts to introduce greater price transparency, because this would threaten its business (and the NHS!), whilst NEG seeks to suggest that it has nothing to hide.

(The mythical ‘084 number that is not more expensive than a geographic number to call’ has still not been sighted by myself or Ofcom! Whilst it is spoken of by NEG, the BMA and the Department of Health, and even claimed to exist in vast numbers; until an example has been seen one must doubt its existence in truth!)

There is some urgency as, since 1 April, NHS GPs using 084 telephone numbers stand in breach of their NHS contract!

The government will need to move swiftly to amend the NHS Constitution if it wishes to make this, and perhaps other provider-set NHS charges, legal. There is no such provision currently in the Health and Social Care Bill. The only NHS charges currently permitted are those explicitly set by parliament.

We must be clear on whether the reformed and liberated NHS is to be “free at the point of need” or not. I have my view, which is different to that of NEG, but it is most important that we understand what is the true position for “our NHS” in England as we move forward.

GPs now in breach of their NHS contracts - named and shamed by NHS Choices

2011-04-04T15:00:00.005+01:00

Breach of Contract

NHS Choices shames over 1000 GPs who obtain subsidy for the costs of running their surgeries at the expense of NHS patients. From 1 April 2011 they stand in explicit breach of their NHS contract.

31 March 2011 was the deadline for compliance with a contractual requirement to cease using telephone numbers which provide subsidy at the expense of callers. The Department of Health chose to identify these cases by the fact that the numbers cost more to call than the cost of a call to a geographic number, rather than because they have the dialling prefix 084. (It all comes to the same in the end, although some like to entertain the hypothetical possibility that there could be 084 numbers that are not more expensive to call.)

This published table provides links, sorted by Primary Care Trust, to the details of over 1000 GPs shown as having failed to comply with contractual requirements that came into effect on Friday 1 April. In every case the GP is still offering a 084 telephone number on "NHS Choices" as the means for patients to contact the surgery.

I have urged every PCT to refer to this information, and take the necessary action to promptly enforce the terms of clause 29B of the GMS contract. Given that there was a twelve month period given during which compliance should have been achieved, it is disturbing that we have got to this point with so many breaches uncorrected.

As well as the links to NHS Choices the document also summarises and provides links to published telephone tariff information from a number of leading providers. By bringing this all together it is very easy for anyone to see what is going on.

The Government and “Free at the Point of Need”

The number of breaches that have remained past the deadline for compliance, demonstrates how the measures introduced by the previous government have not been implemented effectively. I wait to see what action the present government will take to convince us of its commitment to the principle of "free at the point of need".

Will it stand back to allow this present abuse and breach of contractual provisions to continue in an "un-reformed" NHS? If so, what may we expect when GPs are given more authority and further "liberated" from the need to follow centrally set rules?

If Cameron, Clegg and Lansley are doing roadshows, they must be asked if they believe that GPs should be "liberated" to continue taking Service Charges from NHS patients as they make contact by telephone. If not, then they must demand and support necessary enforcement action by PCTs.

Ofcom, mobile termination rates and the future of telephone costs

2011-03-15T13:48:00.000Z

Ofcom has today published its statement on the future regulation of mobile termination rates (see statement and press release).

The effect of this regulation will be to reduce the cost of calling mobiles, essentially to the same rate as those for calling Geographic Rate landlines. There will be other effects.

•	Mobile operators will need to recover the loss of revenue from incoming calls somehow. Ofcom predicts it as being likely that the whole structure of charging for use of a mobile phone will change. A serious danger is that the impact of this will fall most heavily on the "financially disadvantaged", who are commonly part of a diminishing group of PAYG users.
•	It will be highly likely that calls to mobile phones will join calls to Geographic Rate numbers by being primarily covered by inclusive call packages for landline users. This will cause the premium rates incurred when calling "Business Rate" 084 and 087 numbers, due to the inclusion of a "Service Charge" to the benefit of the called party, to stand out more clearly.
	If public bodies, such as HMRC, DWP and NHS service providers continue benefitting from a Service Charge by using 084 numbers then they will be seen to be more expensive to call than a mobile!
•	The general restructuring of mobile charging will enable calls to 080 numbers to be made "free to caller" from mobiles without any excessive cost being imposed on those who receive them.

I am wholly in favour of this move, however the impact will need to be watched during its progressive implementation. Ofcom admits to the possibility of certain users of PAYG mobiles being priced out of the market, or having services on which they rely withdrawn.

Note: The consultation on proposals to require users of 084 numbers to declare the Service Charge that they impose on callers has been extended. Those who wish to support this proposal have until 31 March to present their responses to the consultation - Simplifying Non-Geographic Numbers.

The Co-operative Revolution - still stuck in the past!

2011-03-08T00:37:00.000Z

I fully support the Co-Operative movement as reflected by its current "Revolution" campaign. It aims to give power to all through co-operative endeavour for mutual benefit, unlike the "Big Society" which offers power to those having the time, skills and other resources to replace that exercised by democratically accountable bodies.

The Co-Operative movement must however move forward with its use of telephone numbers. 0845, 0844 and 0800 numbers dominate its lists of contact points. This policy fails to reflect the fact that BT now originates only around 25% of non-business telephone calls.

The least well-off tend to use mobile telephones and therefore incur surcharges of up to 41p per minute, over the cost of a call to an ordinary (01/02/03) number, to call these expensive 08 numbers. Even landline users commonly pay high premiums to call 0845 and 0844 numbers.

There is no justification for public bodies like HMRC and DWP sticking with 0845 numbers. It is totally unacceptable for NHS GPs, NHS Direct and some hospitals and other NHS bodies to use 0845 and 0844 numbers.

In the spirit of a Revolution, now is the time for the Co-Operative movement to show that it is up to date and ready to set a lead by revising its telephone numbering policy.

This Thursday (10 March) is the deadline for responses to the Ofcom consultation on expensive telephone numbers

2011-03-07T00:38:00.008Z

Back in December, Ofcom launched a consultation on proposals to deal with the "rip-offs" on expensive telephone numbers - Simplifying Non-Geographic Numbers.

People presently pay up to 41p per minute extra to call NHS Direct, HMRC, JobCentre Plus, their bank and many others by calling a 0845 number. These numbers are promoted with meaningless comments such as "local rate from BT, others may vary". It is BT that varies from the rest because it alone is currently subject to regulation of its charges (BT originates around 25% of non-business telephone calls).

Ofcom proposes that the Service Charge which recipients gain from these calls be clearly advertised as such and the Access Charge added by the telephone company be advised and charged separately.

I believe that these proposals should receive the strongest possible support. Ofcom requires responses by Thursday 10 March.

If all those who use 0845 and other expensive numbers (including GPs on 0844) and presently gain a subsidy from telephone calls were forced to declare it as being a "Service Charge", then they would have to switch their numbers or we could debate the propriety of their Service Charge properly.

NHS providers cannot levy Service Charges on patients, unless the NHS is to no longer be "free at the point of need". NHS GPs have until the end of this month to switch from 0844 to 0344 numbers, or stand in breach of their NHS contracts. If the government allows them to continue imposing (undeclared) Service Charges, then we will know where it stands!

Premium telephone charge for pensioners facing tax demands

2011-03-02T10:26:00.000Z

This story - Pensioners given days to meet shock tax demands - advises that pensioners should call HMRC on 0845 3000 627 "to discuss payment options".

They pay a premium to HMRC even to call this number.

HMRC benefits from a subsidy on its phone bill from calls to this number, at the expense of callers, depending on their telephone service provider.

Whilst unique regulation on BT denies it the chance to make any money on 0845 calls (it makes its profits elsewhere) most providers add their own "Access Charge" to the HMRC "Service Charge" - see this table of call costs to various type of number.

•	Pensioners at home all day with cable TV and therefore using a Virgin Media landline would pay nothing to call a Geographic Rate (1/02/03) number, but pay a connection charge of 12.24p plus 10.22p per minute to speak to HMRC on its 0845 numbers.
•	Those who cannot afford a landline and may have to use a mobile phone could be paying up to 41p per minute to speak to HMRC.

HMRC (along with the DWP, NHS Direct and other public service providers) must immediately adopt 03 numbers.

The case is made for HMRC and DWP to migrate from their 0845 telephone numbers to 03 NOW

2011-02-24T22:52:00.004Z

HMRC and DWP agencies have decided to continue charging for enquiry calls on their "Business Rate" 0845 telephone numbers, rather than migrating to "Geographic Rate" 03 numbers. This decision is apparently supported by a determination that despite the premium charge, allegedly “callers pay less to call 0845 numbers than 03”! Such a perverse determination sadly requires some effort to challenge.

I have some important points to make, on issues of principle and matters of detail. I also touch on the NHS in passing.

Introduction and Summary

I understand it to be accepted that a 1.7p per minute subsidy is derived from receiving calls on 0845 numbers, and that this cost is passed on to callers by their telephone company, which has to pay it. If anyone does not accept this fundamental point, then I must ask that they please make contact with me, or Ofcom, most urgently.

When 0845 numbers are used by taxpayer-funded bodies, part of the cost of providing the service is being passed from the taxpayer to the service user.

For the NHS, this represents a breach of the terms of the NHS Constitution, which demands explicit parliamentary sanction for all NHS charges. Parliament does not sanction any charge for NHS services that is levied at the discretion of the NHS service provider, or can be thought to have a variable impact dependant on the patient's choice of telephone service provider.

The Department of Health has failed to enforce the terms of the Directions to NHS bodies and revisions to the GP contract, which should have had the effect of removing all 084 numbers from the NHS by now (0844 numbers yield a subsidy of around 5p per minute). The DH even repeats the total fiction that there are some 084 numbers that are not expensive to call than geographic numbers and fails to recognise that users of 084 numbers may migrate to the equivalent 034 number during the term of their contract for telephone service. Serious action on this failure will have to follow. (As I continue, focussed on HMRC and DWP, my mind is also on NHS Direct, certain PCTs and hospitals and many NHS GPs.)

The "constitutional" constraint on the NHS is however not matched by any equivalent restriction on the commercial activities of HMRC or the DWP agencies; they are free to levy charges for their services as they may choose. I understand that both intend to continue to do so through their use of 0845 numbers. (Asking about PAYE errors, pensions, benefits and jobseeking is not " free at the point of need".)

I trust that many to whom this briefing is circulated will stop reading here, regarding the practice of charging fees for telephone enquiries by benefit claimants and victims of HMRC errors to be wholly improper. Parallel adoption of the equivalent 0345 numbers as alternatives, is the first easy step that could be taken to address this issue.

I urge those who share my views to make their point loudly and clearly, as I move on to address some of the confusion that is brought out by those who wish to obfuscate this issue.

Those interested to learn more about the issue may wish to understand the detail and the ways in which the impact of this cost to service users may be assessed. I have attached, and published, a detailed spreadsheet which not only demonstrates that there is no sound basis for any determination that 0845 calls are "cheaper overall" than "Geographic Rate" 01/02/03 numbers, but provides those who wish to attempt to substantiate such claims with a basis for demonstrating how they reach their conclusion.

Background

The 03 range enables those who find a worthwhile use for the additional technical facilities and locational anonymity provided by non-geographic telephone numbers to do so without imposing a charge on callers. Other non-geographic ranges provide these same benefits, but with the associated costs paid for (in part, in full or in excess) by callers.

The option to migrate (in full or to parallel operation), from any 0845 number to the equivalent 0345 number, offers a ready means for those who wish to avoid the expense and confusion of a full scale number change. I have long been proposing the minimal step of simply offering the 0345 equivalent number as an alternative to every published 0845 number. This facility could be advised through a general statement, without the expense of re-publishing literature etc.

The extra cost/benefit associated with calls to 0845 numbers (2p per minute including VAT) is now known by Ofcom as a "Service Charge". It is paid by callers in addition to an "Access Charge", which is added by the caller's telephone company. Under the present regulatory regime, the Access Charge is not clearly identified as such, as it is bundled in with the Service Charge to give a consolidated rate for the call.

This should therefore be a simple issue of a "premium"; however it is complicated due to certain historic factors. Those who may wish to conceal the fact that their callers are paying them a Service Charge would naturally wish to exploit these complications to obfuscate the issue.

BT is the leading provider of telephone calls, being responsible for originating around 25% of all non-business calls made in the UK. Currently BT is prohibited by regulation from adding any Access Charge on calls to 0845 numbers, so callers through BT only pay the "Service Charge" when calling 0845, and some other non-geographic numbers. All telephone companies are required to charge for calls to 03 numbers on the same basis as calls to other "Geographic Rate" (01/02) numbers. BT is not regulated in its charges for calls to Geographic Rate numbers.

Since January 2009, BT has taken payment of the Service Charge for calls to 0845 numbers as part of its "Call Plan" subscriptions, making no further charge when calls to 0845 numbers are made under the terms of the Call Plan.

The major complication arises when BT customers make calls outside the terms of the Call Plan which they have selected. An un-regulated and severe “penalty charge” is imposed for calls to 01/02/03 numbers, however BT is only able to recover the lower "Service Charge" on 0845 calls. (I repeat this same point later.)

Call Cost declarations

Because BT is the largest single provider of telephone call services, it is common for its rates to be quoted as if they were some sort of norm, from which others vary. This practice totally misses the point that BT is in fact unlike all other providers, being compelled to charge unusually low rates when originating calls to 0845 numbers.

The fact that all telephone service providers now base their contracts on packages including calls to Geographic Rate numbers, makes quoting rates for such calls largely meaningless. The intention is that these calls are made without a specific call charge, which is why penalty rates are applied when calls are made outside the terms of the package. Even some PAYG top-up deals provide a package of calls, contrary to the principle of PAYG.

Because of the need to not only cover costs and make a margin but also to pay on a Service Charge, most telephone companies exclude calls to 0845 (and other 084, 087 etc.) numbers from their packages. BT is in a wholly unusual position in that it can afford to include 0845 calls in packages without pushing the price for the package unreasonably high, because it cannot include any charge of its own.

Using the highly unusual case of BT when giving an example of call costs can be very misleading. IF BT rates are the only example given then it may appear that an attempt is being made to conceal the impact of the "Service Charge" on callers in general. Referring to those who apply an Access Charge as well as the Service Charge as being the ones who "vary", is to misstate the situation; it is BT that is the odd case.

Current Ofcom proposals for clarification

To deal with the fact that many users of 084 and other non-geographic numbers seek to conceal the benefit that they derive, Ofcom is currently consulting on proposals for them to be made subject to regulatory requirements to be transparent. (I hope that public bodies such as HMRC and DWP would not wish to be seen to be waiting to be compelled to do so by regulation before they are transparent about their Service Charges.)

To achieve this through its regulatory powers, Ofcom would have to classify them as providers of "Premium Rate Services". This would require them to subscribe to Phonepay Plus and adhere to the conditions it sets as the self-regulator of the "phone-paid services" industry. (I am not sure if it is distressing or amusing to think of JobCentre Plus as being in the same industry as providers of telephone chat-lines.)

Ofcom suggests that in place of references to the uniquely regulated rates charged by BT, a statement in the following form be used to describe the cost of calling 0845 numbers:

"Calls to our 0845 numbers cost 2p per minute, plus an additional charge added by your telephone company".

Ofcom also proposes that the present regulation on BT be replaced by regulation to cover all telephone companies, requiring them to adopt a simple structure of Access Charges which are clearly declared as such and to show the Access Charge and Service Charge as separate items on the telephone bill.

Whatever may emerge from Ofcom in future:

there is no good reason why such a statement could not be used today.

If reference were to be made to particular charges from particular widely used telephone companies, then information about the absence of an Access Charge from current BT tariffs should perhaps be accompanied by a reference to the fact that T-Mobile currently charges contract customers 41p per minute for calls to 0845 numbers.

The effect of "the BT anomaly"

One would naturally expect that with a 2p per minute additional cost to the call originator, all calls to 0845 numbers would be more expensive than equivalent calls to 03 numbers. The Ofcom proposals will undoubtedly have that effect, if and when they are adopted, as they will release BT to compete alongside other providers with Access Charges and Service Charges unbundled.

In the meantime there remains this historical anomaly dating from the time when BT was the monopoly provider of all telephone services; before widespread use of mobile phones, competition in the landline call market and inclusive packages as the primary basis for charging for ordinary calls.

To encourage use of advanced telephone features, BT was compelled to charge for calls to 0845 numbers at what was then the "local rate" - the distinction between "local" rate and "national" rate disappeared for charging purposes in 2004. Regulation of BTs charges for calls to "ordinary" numbers has been lifted, whereas that covering 0845 (and other non-geographic ranges) remains in place, in the form of a prohibition on BT making any money from originating these calls. No other provider is regulated in this way.

Back up to date

(Please forgive some repetition of points made previously.)

Most telephone companies now bundle calls to "Geographic Rate" (01/02/03) numbers into inclusive packages - the BT term is "Call Plans". For those who do not use their landline during weekday daytimes, there are cheaper Call Plans available (covering Weekends and optionally Evenings). If calling a "Geographic Rate" number outside the period covered by the Call Plan which the subscriber selects, a "penalty charge" is imposed. Those who use their BT landline for anything but the most occasional of calls during weekday daytimes (now up to 7.00 pm) are best advised to subscribe to the "Anytime" Call Plan.

The current BT penalty charge for weekday daytime calls to "Geographic Rate" (01/02/03) numbers, when not covered by their Call Plan, is a call setup fee of 11.5p plus 7p per minute. This is obviously greater than the 0845 service charge of 2p per minute which is all that BT may charge for such calls. (This was recently adjusted to 2.042p per minute to reflect the increase in the VAT rate.)

From April this BT penalty rate will increase to 7.5p per minute and the call setup fee to 12.5p; at the same time, the cost of the Unlimited Anytime Call Plan will be reduced from £5.00 to £4.70 per month. These changes will provide a further incentive for those who make calls through BT to switch to the appropriate Call Plan.

It may therefore be seen that the perverse effect of the current regulatory position is to cause those who would incur penalty charges for making daytime calls to 01/02/03 numbers outside the terms of their call plan to benefit greatly from the fact that BT cannot add any charge of its own for calls to 0845 numbers.

Non-BT providers

There are some landline call providers who choose to follow the same approach that BT is required to follow. Others however (notably Virgin Media) do not inflate their package fees so as to include the (higher) cost of 0845 calls. Neither do these others take inflated margins on other calls so as to cross subsidise to cover a failure to take any margin on originating 0845 calls. This is what is currently forced on BT, and some choose to copy it.

Virgin Media currently charges 10.22p per minute for weekday daytime calls to 0845 numbers, which fairly reflects the additional costs that it incurs over its charge of 8.68p per minute for non-inclusive calls to Geographic Rate numbers.

I note that some have argued that all telephone companies should be subject to the same regulatory requirements that are imposed on BT. I fear that such suggestions can only come from those who do not understand the situation. Alternatively they may be trying to defend an indefensible position as "improper" users of 084 numbers seeking to have their subsidy paid for by all telephone users rather than just those who call them.

What callers pay

The fact that some callers do not bear any additional relative cost as a result of paying the Service Charge on 0845 numbers, leads some users of 0845 numbers to rush out with claims that they (or taxpayers) are benefitting from subsidy at no cost to callers! If the recognition that this exemption from additional cost is neither natural nor universal is not enough to halt them in their tracks, then I have to press on.

In seeking to determine the extent of the financial impact on callers as a result of the use of 0845 numbers, it is necessary to make some determination about what they pay. I address this point with reference to four methods, all of which are reflected in the attached spreadsheet, which I will describe later.

Method one - the "Service Charge"

I personally take the view that one should look first at the impact of the "Service Charge". That is the sum of money which is passing (indirectly) from the caller to the person called. It is for the caller to decide if this is a reasonable fee to pay the person they are calling for the service provided, in addition to whatever they pay their telephone company. To make such a decision however, they must either be well acquainted with the issue or told about the Service Charge.

Every caller pays the Service Charge, even if this is bundled into a package fee or imposed without any Access Charge being added.

If HMRC and DWP are not content to impose a charge on callers for calling them, they cannot continue to use 0845 numbers, and must migrate away immediately. If they are content to impose this charge, then many would think it improper not to announce it to callers.

Method two - adding the effect of the Access Charge

Secondly, one may wish to consider the additional impact of the Access Charges imposed by the various telephone companies. As these are not currently declared separately, this can only be done by looking at the total cost of the call. It is therefore reasonable to make comparison with the equivalent cost of a call to a "Geographic Rate" number. In the current situation, the Access Charge inflates the impact of the Service Charge considerably, when it applies.

There are anomalous cases where the inability to impose an Access Charge (or even take a fair margin) on the cost of calls to 0845 numbers actually makes them cheaper. Where the Service Charge and Access Charge are bundled into a package fee, along with charges for calls to ordinary numbers, there is no clear distinct price for a single call.

Such cases therefore have no place in an assessment of the impact of the Access Charge and Service Charge. Any such assessment must therefore exclude cases where there is no impact.

Method three - aggregating cases

A third, and somewhat irregular, approach would be to consider the net overall relative cost (0845 vs. 03) as if one could play off one group of callers against another. This calculation is achieved by adding in the cases excluded under Method Two as neutral or negative. I understand that this approach is popular, although I struggle to see how it could be valid.

I cannot see how the fact that one caller can exploit BT's inability to impose a significant penalty when they call a 0845 number outside the terms of their call plan can have any bearing on the case of someone who is unable to rent a BT landline (due to their poor credit rating) or who chooses Virgin Media because of its broadband or cable TV services.

I certainly cannot see how public bodies would wish to promote BT against its competitors and furthermore discourage BT customers from selecting the "Anytime" Call Plan, so that they incur penalty charges at a lower rate for 0845 than 03 numbers.

Method four - "winners vs. losers"

A fourth, even more odd, approach is the "winners" and "losers" game. I am astonished to see this favoured by DWP, a department with agencies that are specifically focussed on meeting the needs of minority groups using funding from the majority of citizens.

This method looks at whether more callers would gain by calling a 0845 number than would so by calling a 03 number. This would cause 8 "winners" who breach the terms of their BT Call Plan and thereby each save 25p (a total of £2.00) on a 5 minute weekday daytime call to a 0845, rather than 03, number to outweigh a single caller on T-Mobile who "loses" by paying a premium of £2.05 - by a factor of 8:1.

My personal view is that 100 "winners" would do nothing to eradicate the damage to a single "loser", even if the respective individual amounts were the same. The "loss" is caused purely by the fact that a public body is obtaining subsidy; the effect is compounded by the vagaries of telephone tariffs, but that is not the cause of the loss.

If we are thinking about the administration of social benefits, there will (we hope) always be more taxpaying "losers" than "winner" beneficiaries. If the "winners and losers" game were to be taken as being a sound basis for policy decisions then all benefits would have to be scrapped.

My calculations

I have constructed some tables based on currently published telephone tariffs and the apportionment of calls between the various providers as published by Ofcom.

On top of this I have the added "parameters" to deliver models based on certain assumptions to give what amounts to an average call cost for calls of a particular duration.

The variables I use are as follows:

•	Call duration (differing approach to duration rounding make this best seen in terms of whole minutes to avoid odd distortions caused by calculating actual call costs)
•	The proportion of calls at Daytime rates (100% is applied in the cases used)
•	The proportion of calls from Landlines / Mobiles / Public Payphones.
•	The proportion of landline callers paying penalty rates vs. calling under the terms of their package.

I have extracted the spreadsheet (published at tinyurl.com/dhtiny/0845costs) from my tables to provide a standalone tool to demonstrate the results of the four different methods of assessment referred to above.

The only variable explicitly offered in the extract is that of the call duration. The distribution factors are shown and could be amended, on a copy of the worksheet, to reflect an alternative view of the different sources of calls. The tariff information is also shown, so this could be adjusted to reflect upcoming changes or alternative providers and terms. The calculation formulae may be copied to add new rows to the table.

For those interested in the schoolboy mathematics: A proportion for the total population of callers is attributed to each line for which call cost information is held, and extended by the duration. The proportion factor is applied to give "weighted costs" which may be totalled to give an overall average cost (for Method 3). Average costs for groupings (or the selection, in the case of Method 2) are obtained by aggregating the respective "weighted costs" and then dis-applying the respective aggregated factor. Method 1 is very simple. Method 4 avoids the "weighted costs" using simply the call cost and the factors. To reflect the structure of the original from which this extract was taken, the Totals for Methods 2 and 3 are assembled at the bottom of the worksheet and then presented at the top.

To produce absolute values, I provide the opportunity to enter a number of calls, so that the ratios and averages may be extended to give actual figures.

The conclusions as presented

The model in place reflects a ratio of 82%:15% for landline to mobile, with 3% for public payphones. I have also reflected an assumption that 90% of landline callers are paying penalty charges rather than calling under the terms of a package.

These are assumptions that have been applied by others, but I must stress that I do not think that these assumptions are reasonable at present. (I cannot believe that anything like as many as 90% of landline calls are subject to penalty charges. Furthermore, I believe that these assumptions will become less valid over time, as more callers recognise that they should not be suffering BT penalty charges.

I have however deliberately understated my case, as the conclusions quash any suggestion that callers benefit overall from use of 0845 numbers under present tariff conditions.

•	Under method 2 the excess cost to callers grossly exceeds the benefit of the subsidy to the taxpayer. This suggests that certain telephone companies are the primary beneficiaries of a decision to retain 0845 numbers.
•	Under method 3, where the excess cost to some is offset by perverse savings by others, not only is the net relative additional cost of 0845 calls still positive, it also exceeds the benefit of the subsidy to the taxpayer. Even when we allow for the current restricted position of BT, telephone companies as a whole are still net beneficiaries of the decision to retain 0845 numbers.
•	Under method 4, there are more 03 "winners" than 0845 "winners", except for a call duration of 1 minute, where the minimum call charge for payphone calls consumes the 0845 excess, tilting an always close overall balance on lower durations (2-6 minutes) in favour of 0845. If this odd method, which equates a 50p saving with a 1p or £4.10 loss, cannot produce the result that advocates of charges for public services may seek, then the game must be up.

I hope that those responsible for these matters will take the time to look into this in detail. I continue to offer my services to assist in the cause of a proper objective understanding of the issues.

I will be very happy to answer any questions from any source and to provide further information.

(The spreadsheet to accompany this release is published at tinyurl.com/dhtiny/0845costs. Please refer to the explanatory notes above).

Conservative Health Minister repeats Labour mistakes by not banning expensive GP telephone numbers

2011-02-15T23:40:00.006Z

In a written parliamentary answer Simon Burns, Minister of State (Health), shows that he is repeating a key mistake made by his predecessor.

When referring to what should be a total ban on use of 0844 and 0845 numbers for delivery of NHS services, in effect by 31 March 2011, he says:

"Organisations remain free to use non-geographical number ranges such as 084, providing that patients are not charged more than the equivalent cost of calling a geographical number to do so."

This is mindless repetition of nonsense issued by the previous government. ALL 084 NUMBERS ARE MORE EXPENSIVE – there are no exceptions.

(The same mistake has already been repeated by the Welsh government and there are fears that Scotland may also follow.)

All calls to 0844 and 0845 numbers, at what is now known as "Business Rate", are subject to a "Service Charge" - a premium which is paid on to the telephone company at the receiving end of the call. The premium is used to subsidise the cost of the telephone service provided, or paid over as a "cash-back". This applies to every 0844 and 0845 number. Charges for calls to Geographic Rate (01/02/03) numbers do not include this premium.

This means that for all calls from Virgin Media landlines, all PAYG and contract mobiles and public payphones every call to a 084 number is charged at "more than the equivalent cost of calling a geographical number". Unless it could be shown that calls from these sources are blocked, then 084 numbers cannot be used.

I continue with more briefing, concluding with my Message to Mr Burns.

Calls from BT landlines - why they are different

BT landlines are seen to be omitted from the list of sources given above. BT landline call charges are currently subject to special regulations intended to prohibit BT from making any money out of calls to 084 and other "Business Rate" and "Premium Rate" numbers. BT is however now free to charge whatever it wishes for calls to "Geographic Rate" numbers. This makes the situation for BT landline callers more complex.

Like other providers BT provides calls to "Geographic Rate" numbers through inclusive packages, imposing a penalty charge for calls made to these numbers outside the terms of the package. For weekday daytime calls, the BT out of package penalty charge rate for calling Geographic Rate numbers is greater than the level of the "Service Charges" that apply to calls to 084 numbers.

Patients who incur the BT penalty charge for making calls to Geographic Rate numbers outside the terms of their Call Plan therefore would not pay more to call any 084 number. This is the exceptional case - it has got nothing to do with particular 084 numbers – it applies to all of them.

The situation is further confused by the fact that because the Service Charge for calls to 0845 number is relatively low (around 2p per minute, rather than up to 5p per minute for 0844) BT can get away with recovering this money through its fees for Call Plans and therefore makes 0845 calls inclusive. BT landline users therefore do not pay more to call 0845 numbers under the conditions imposed by present regulations. This additional confusion does not apply to calls to 0844 numbers, BT landline customers who do not breach the terms of their Call Plan will always pay more to call 0844 numbers.

Although not compelled to do so by regulation, there are some other telephone companies offering calls through BT lines who are able to copy the BT approach to charging.

The big mistake

The attempt to address the problem with use of Business Rate numbers for access to the NHS was sadly made in apparent ignorance of how telephone tariffs apply through the UK – there are no local variations. The new government is continuing to apply this ignorant approach to implementation of rules which are sound if applied properly.

The exceptional cases where callers do not suffer the impact of the Service Charge on calls to 084 numbers, relative to the cost of calling geographic numbers, have got nothing to do with the particular number they are calling, but with their choice of telephone service provider. Due to unique regulation, BT is the exception to the general rule – it is BT rates that vary from the norm. It is because some BT charges are regulated, whereas others are not, that one has the situation where a call that includes a Service Charge is cheaper than one which does not!

I am not aware of any sponsorship deal between BT and the NHS! NHS patients are no longer required to have BT landlines in order to access NHS services by telephone – even if the situation was different 62 years ago.

Virgin Media provides rental free (inclusive) lines to those who subscribe to its cable TV or Broadband service. Many are unable to afford landlines, or may not be at home at times when they need to contact the NHS - they would therefore use mobiles or public payphones. 75% of non-business telephone calls are NOT originated by BT.

BT currently originates less than 25% of non-business telephone calls. Ofcom is therefore consulting on proposals (supported by BT) to implement the long-overdue removal of the remaining restriction on its charges. This currently creates the perverse effect of encouraging use of premium rate numbers and offers the potential for misrepresentation of the relative cost of calling them.

This is linked in with other proposals for making the cost of calling 084, and other ranges that include a Service Charge, clearer. Under the terms of these proposals GPs would have to make the following statement wherever they gave their 0844 number:

"Calls to the surgery cost 5p per minute plus your phone company's access charge."

There is no good reason why such a statement could not be made today. The difficulty is that the phone company "access charges" vary enormously, even within tariffs, with BT compelled to have an access charge of 0 pence per minute. This issue is also addressed by the Ofcom proposals.

If these proposals come into effect in perhaps one or two years time, I wonder if this issue will be seen as insignificant alongside other provider-set charges for access to NHS services!

My message to Mr Burns

Your suggestion that there may be 084 numbers that are not more expensive to call than geographic numbers is FALSE.

If the government is committed to maintain access to NHS services "free at the point of need", then the ban on use of 084 numbers must be implemented NOW.

NHS bodies should have stopped using them by 21 December 2010, GPs have until 31 March 2011. Users of 084 numbers may migrate to the equivalent 034 (Geographic Rate) number within the term of a contract for telephone service - so there can be no excuse for failing to comply.

Whilst it would be absurd for a complete number change for 0845 4647 to be implemented at present, it seems rather greedy of NHS Direct not to formally, but quietly, offer the 0345 4647 alternative for those who could thereby save up to £3.70 (58p on average) on an average duration call, even though this would cost NHS Direct 15p per average call in lost subsidy. A bonus of 43p per average call is a generous gift to the telephone companies. (The NHS Direct NHS Trust also operates many other 0845 telephone numbers, which were excluded from the ban for no apparent reason.)

N.B. The above text includes some drafting revisions from the circulated version of this release.

Ofcom is allowing - not stopping - Silent Calls

2011-02-10T06:00:00.040Z

In a press release issued today - Ofcom 'must stop more silent calls', Margaret Hodge MP, chair of the Public Accounts Committee, rounds on Ofcom’s persistent failure to use the powers that it holds to properly address the problem of Silent Calls.

Ofcom has been told by parliament – “We expect you to use your powers to eradicate the nuisance of Silent Calls”.

Despite being granted a higher possible penalty, Ofcom has responded by revising its policy on Silent Calls to include an even greater tolerance of this unacceptable and unnecessary nuisance than that which it has applied for the last 8 years.

When asked to explain the new policy on BBC television last week, Lynn Parker, Ofcom Director of Consumer Protection confirmed the point that I have been making:

Interviewer: "So companies are allowed one silent call per day?"

Parker (Ofcom): "YES"

¾ See BBC News item with recording

This is, of course, one per recipient per caller per day. If a large call centre makes 20,000 calls a day in total Ofcom is already content if 600 of these are Silent Calls. They can now make a further Silent Call to any victim the following day, whereas a three day gap was previously suggested.

Telephone calls to the NHS - an expensive mess - NHS Direct now at the heart of this

2011-02-10T04:55:00.000Z

NHS Direct - a model for NHS Charges

Whatever the rights and wrongs of it getting involved in making GP appointments behind the highly expensive 111 telephone service, NHS Direct has long been a model to demonstrate how patients can be made to contribute to the funding of NHS services as they use them.

The current NHS Direct telephone number 0845 4647 delivers a subsidy of around £749,700 (¾ million) per annum - 15p per call - from patients.

Patients pay premiums of up to 41p per minute (an average of 58p per call) over the cost of a call to an ‘ordinary’ number. Other 0845 numbers used by NHS Direct probably deliver a similar level of subsidy.

(These figures are based on current tariffs, an average call duration of around 9 minutes and a total of 4.9 million calls per annum - see notes below.)

Landline and contract mobile customers generally do not pay call charges for calls to "ordinary" (01/02/03) numbers. They are included in unlimited packages or bundles, so an extra call costs nothing extra. NHS Direct has long made provision to take advantage of this by having the alternative number - 0345 4647 - set up and ready for use. It has however continued to refuse my urgent pleas for this to be introduced, even as an alternative running in parallel with 0845 4647, to avoid the expense and confusion caused by a total change of number. (Even for PAYG mobile callers, 0845 4647 is on average 43% more expensive to call than 0345 4647.)

It appears that NHS Direct is keen to retain a 15p (0.6%) subsidy towards the £25 it spends in handling each call, despite the fact that this subsidy costs callers an average of 58p, a maximum of £3.69, extra. (Yes, some callers pay £3.69 so that NHS Direct can gain a 15p subsidy – see notes 4/5.)

The cost of 111

At a time when reducing the deficit was not seen as such a priority, arrangements were made for the cost of every call to the new 111 number to be met by the NHS, even if a caller would have paid nothing to call a 03 number.

Consortia who adopt 111 not only pay to handle each telephone call they also pay the telephone companies to receive it. When we see the analysis of the pilots in the Autumn, I hope that this aspect of the costing will be published.

Even more barmy

Whilst NHS Direct is taking subsidy from patients, as well as helping the telephone companies (by 43p per call), and consortia are needlessly going to have to pay for incoming calls, a further abuse of the principles of the NHS is being allowed to continue.

Despite the fact that NHS GPs should by now be complying with a contract variation which prohibits use of expensive telephone numbers, many are continuing to use the even more expensive 0844 numbers, despite a deadline of 31 March for this to cease.

The Department of Health and the relevant Minister have confirmed that they are taking no action to ensure that this important embodiment of the principles of the NHS is enforced.

Conclusions

Public money and patient's money (all of it "ours") is being thrown around with abandon out of a misguided sense of urgency to cure an illness that does not exist. The private health sector and the telecoms industry do not need injections of our money to keep them alive.

At the age of 62, "our NHS" needs to do some work to keep fit; it does not need further extensive surgery, as that which was delivered, whilst vital at first, had started to become purely cosmetic. "Our NHS" is not a candidate for euthanasia, even though those who are currently charged with caring for it argue that this would be for the best, whilst claiming to have its best interests at heart.

Ofcom is currently consulting on proposals to classify NHS Direct and GPs with expensive telephone numbers as providers of "Premium Rate Services", along with TV quiz lines.

With the high cost base of NHS Direct and of the 111 service, it will not be difficult for a commercial competitor to undercut these options.

The NHS is in a very precarious position.

Notes

1. I will be happy to provide any level of detail from my calculations to support the figures quoted above. The primary sources are Ofcom and the telephone companies it recognises as being the major providers of call services.

2. An average duration of 528 seconds for calls to the NHS Direct was given in this written answer - 3 Feb 2009 Column 1109W.

3. The figure of 4.9 million calls a year is found on this web page - http://www.nhsdirect.nhs.uk/News/FactsAndFigures.

4. Ofcom suggests that calls to 0845 numbers attract a termination fee that is enhanced by around 1.7p per minute. (9 x 1.7p = 15.3p)

5. T-Mobile charges its “pay monthly” customers 41p per minute to call 0845 numbers. (9 x 41p = £3.69). All its price plans include calls to 01/02/03 numbers.

OFCOM AND SILENT CALLS - NO NEWS | THE NEWS

2011-02-01T08:27:00.007Z

Silent Calls - NO NEWS

The fact that Ofcom can now impose penalties of up to £2 Million against Silent Callers is no news. (e.g. - http://www.bbc.co.uk/news/uk-12331160)

Since 2008, when it last used its powers against Silent Callers:

•	Ofcom received a total of over 15,000 complaints about Silent Calls
•	Ofcom claims to have secretly investigated 22 companies

Every one of the companies covered by these complaints and investigations were found NOT to breaking the rules which Ofcom applies in determining what is "persistent misuse of an electronic communications network or service".

Not one company has been even subjected to a public notification that it is practising misuse, let alone any financial penalty.

Silent Calls - THE NEWS

From today, Ofcom not only allows 3% of calls made to result in silence if no agent is available, it now approves use of Answering Machine Detection equipment (AMD). AMD listens to our voice as we answer the phone, so we hear a period of silence - often assuming that this is a Silent Call - as indeed it is, but not for Ofcom.

Ofcom acknowledges that AMD is not guaranteed to accurately tell the difference between a recorded message and a live person. It therefore qualifies this new tolerance of AMD by suggesting that each caller may only make one silent call each day to any person. Ofcom actually encourages AMD users to repeat each of their Silent Calls on the next day.

OFCOM FORMALLY TOLERATES SILENT CALLS - FROM TODAY, MORE OF THEM

New "rules" for when to make Silent Calls (is this a joke?)

2011-01-31T12:40:00.001Z

To follow this briefing, I react to Ofcom's news release - Ofcom warns industry as new silent calls rules come into force.

The point about the “warning” is that Ofcom is asking Silent Callers to comply with rules about how many Silent Calls they make and when they make them.

Ofcom is not saying that habitually hanging up in silence is unacceptable.

Not one of the 9,000 complaints to Ofcom from citizens receiving Silent Calls in 2010, nor of the 6,600 received in 2009, enabled Ofcom to identify even one company that was breaking its rules. 22 unnamed companies have been investigated – not one was found to be practising “persistent misuse of an electronic communications network or service”.

The new rules that will be applied from tomorrow add tolerance of one Silent Call per caller per recipient per day, when obsolete technology designed to detect the clicks and whirrs of a mechanical answering machine mistakes a person for a machine.

This newly formalised tolerance of use of Answering Machine Detection fails to address the fact that every call when this is used begins with a possibly lengthy period of silence, whilst the technology samples and analyses your voice to see if you sound like a machine. Even though an agent was eventually going to speak, many assume these to be Silent Calls.

The existing tolerance of up to 3 in every 100 calls resulting in silence if no agent is available to handle an answered call that has been dialled automatically remains. Ofcom has a "guideline" that such calls should be handled by a live message announcing the name of the caller and apologising for the error, but this is not applied as an absolute requirement.

Rather than using its powers to act whenever it is made aware of a "persistent misuse of an electronic communications network or service", Ofcom fudges the issue by pretending to have regulatory powers and showing a tolerance (albeit qualified) of Silent Calls.

Silent Calls are unnecessary and unacceptable; Ofcom's policy is unacceptable.

New Ofcom "rules" for Silent Callers - Tuesday 1 February

2011-01-29T07:00:00.011Z

Summary

On Tuesday 1 February, Ofcom implements revisions to its policy on when it may take action against Silent Callers.

Ofcom already disregards cases where up to 3% of automatically dialled calls result in silence if no agent is available to handle an answered call.

From Tuesday it will increase its tolerance of Silent Calls by applying formal approval of the use of equipment that imposes a period of Silence at the beginning of every call and then commonly hangs up in the mistaken belief that a person is an answering machine.

What Ofcom calls its "new rules to ban repeat Silent Calls", permit the first Silent Call and then suggest that further Silent Calls from that caller be deferred until the next day. Ofcom may be expected to emphasise the latter element, which qualifies this weakening of its policy.

In 2006, Ofcom was told by parliament - "we expect you to use your powers to eradicate the nuisance of Silent Calls".

Many reputable companies, including BT and British Gas, proudly admit to making Silent Calls within the terms of the Ofcom policy.

Ofcom's Powers

Ofcom has powers to Notify, Regulate and Penalise specific organisations that commit a "persistent misuse of a communications network or service".

Most of us would regard the habitual practice of hanging up in Silence when calls are answered as a persistent misuse of the public telephone network.

Ofcom has a policy for its use of these powers which specifically rejects this view.

Silent Calls (Type 1)

Ofcom has long applied a policy which treats hanging up in Silence as acceptable if the person responsible makes 33 times as many other calls as they make Silent Calls on any day. This applies to the situation where there is no agent is available to deal with an automatically dialled call that is answered.

This policy has meant that not one of around 20,000 complaints received since Ofcom last used its powers in October 2008 has resulted in Ofcom even issuing a Notification of Persistent Misuse, let alone imposing enforceable regulations or a financial penalty. If not one complaint covered what Ofcom regards as persistent misuse, it is reasonable to assume that all those who are making Silent Calls are doing so with Ofcom's consent.

Probably a more common cause of Silent Calls is where a call centre uses technology designed to detect the clicks and whirrs of a mechanical answering machine (known as AMD). This is what is addressed by the revisions to the policy.

Silent Calls (Type 2)

Use of AMD causes the call to be Silent from the beginning, whilst the technology (not the calling agent) listens to the voice of the person answering. It then analyses the sound in the hope of being able to tell the difference between a live and recorded voice. Many who answer the phone and hear no immediate response to their greeting naturally assume that the caller will remain Silent and hang up.

Ofcom does not even regard this situation as representing a Silent Call!

Ofcom approves and encourages use of the technology that causes it. Ofcom argues that this nuisance is in the public interest because the cost savings achieved are passed on in lower prices!

Because there is no definitive way of detecting use of an answering service by analysing what is said, it is common for the AMD technology to make a mistake. Agents are commonly connected to answering services, wasting their time.

Accurate detection rates are improved by using a longer sample, but even the shortest pause before the caller speaks is likely to result in this type of Silent Call. The longer the pause, the more likely it is.

Silent Calls (Type 3)

Where the technology mistakes a person for a machine the period of Silence is concluded by the caller hanging up.

Ofcom now acknowledges that this happens and has consequently revised its policy.

The new policy is for Ofcom to disregard cases where a caller does this only once per day to any person.

The 3% limit for the "no agent available" situation (see above) considers all calls made regardless of who they are to. This could include many calls to the same person.

The new rules only cover the practice of calling to the same person again on the same day after thinking a machine has answered. This will now be regarded as "persistent misuse".

Ofcom does not regard repeating a Silent Call on another day as a "repeat Silent Call".

My conclusion

(In fairness, I must point out that Ofcom’s policy includes consideration of mitigating factors including use of the Informative Message and repetition. These are however only factors that feature in consideration of the severity of the action that is taken – they do not feature is in the vital determination of what is and is not “persistent misuse”.)

Ofcom's position is complete nonsense and represents a neglect of its statutory duty to citizens.

The point about the Silent Call is that the caller fails to respect the basic courtesy required when making a voice telephone call - when someone answers your call you say who you are and why you are calling. Any habitual or systemic failure to follow this practice must be regarded as "persistent misuse".

Ofcom has powers to deal with particular cases of persistent misuse that come to its attention; it has no statutory powers to regulate the activities of call centres in general. In the telecoms area, Ofcom’s regulatory powers only cover providers in the market for telecommunications services. (Part of its timidity in using the persistent misuse powers could be due to the lack of legal support for the light-touch regulatory approach that Ofcom likes to follow in all of its activities.)

By its failure to use its powers and its adoption of a para-regulatory approach, Ofcom has effectively advised call centres that habitually hanging up in silence can be acceptable. Most reputable organisations follow Ofcom's guidance, making the Silent Calls that we are suffering from within the limits that Ofcom sets.

In 2009 Ofcom received reports of 100,000 instances of Silent Calls made by identified callers. It has allegedly investigated 22 of these companies and found not one to be breaching its "rules". After receiving 6,600 complaints about Silent Calls in 2009, Ofcom received around 10,000 in 2010.

This is the clearest evidence we have that the Silent Calls which plague us are all approved by Ofcom - which should be fulfilling the expectations of parliament - "we expect you to use your powers to eradicate the nuisance of Silent Calls."

The solution for the Call Centre Industry

Contrary to what Ofcom is prepared to accept - Silent Calls are unnecessary.

Avoiding "Type 1" Silent Calls

If no agent is available to handle an automatically dialled call that is answered, the obligation for the caller to state their name can be fulfilled by use of a recorded "Informative Message". A simple message giving the name of the caller and apologising for not being able to complete the call is exceptionally permitted under these particular circumstances. Recorded message calls are generally prohibited, primarily under specific statutory regulations, (which should be) enforced by the Office of the Information Commissioner.

This generous gesture in recognition of the needs of the call centre industry for the use of predictive diallers should be acknowledged, as the alternative would have to be a ban on the use of such technology.

Those callers who are (or claim to be) unable to identify themselves immediately when a call is answered have to accept that they must therefore always be ready to conduct a conversation in person. If machinery cannot complete the call, then an agent must always attend. The wording of the Informative Message should be thought of as being the response to the request "Who is calling, please?". One has to wonder who can approach making a telephone call if unable to answer that question!

Avoiding "Type 2 and 3" Silent Calls

If callers wish to avoid an agent being connected to an answering service, they should be using Answering Service Detection technology. This technique detects a "beep" issued by the answering service when it takes a call. This is best suited to network based answering services but may be used on locally connected machines also.

In its consideration of the issue of AMD, Ofcom totally dismissed this alternative, which accepts the reality of the current situation. Network based answering services have always been used for mobile phones and are now commonly used with landlines. Digital answering machines are now more common than the tape based mechanical machines for which Answering Machine Detection technology was designed.

It is quite extraordinary for Ofcom to dismiss ASD, preferring the obsolete AMD and even encouraging its use, despite the inevitability of it causing Silent Calls in TWO ways.

From 1 February 2011, along with a continuing qualified tolerance of "type 1" Silent Calls, that will be the official policy of the public body with a primary principal duty "to further the interests of citizens with regard to communications matters".

My efforts to cause Ofcom to be called to account before parliament will continue.

DWP claims no benefit from use of expensive telephone numbers - it could therefore save callers a fortune at no cost to the taxpayer

2011-01-29T02:11:00.005Z

DWP agencies such as JobCentre Plus and the Pension Disability & Carers Service use non-geographic telephone numbers to provide a better service to callers making enquiries about their benefits and other services.

All of these are currently "Business Rate" 0845 numbers, which are charged to callers at premium rates (see below). Normally this premium is used to provide a subsidy to the organisation using the number.

In a written answer on 25 January Chris Grayling, Minister of State at DWP, confirms that there are "no savings from the use of non-geographical telephone numbers".

There is therefore no good reason why the DWP could not migrate immediately to the use of "Geographic Rate" non-geographic 03 numbers, which impose no "Service Charge" on callers. This could be done most readily by initially offering the equivalent 0345 number for every 0845 number as an alternative. This would avoid the need to change existing publicity - callers could simply be invited to substitute a "3" for the first "8" in the number to save money on their call.

If there are no savings from use of 0845 numbers, then clearly it would not cost the DWP any more to use 03 numbers. (That is the only logical meaning that can be applied to the statement from Mr Grayling! - if one assumes that it is accurate and truthful)

If the DWP honours its promise to always call back to those who pay more to call a 0845 number, then it is likely that the 0845 numbers actually end up costing the DWP and the taxpayer (as well as the service user) more, rather than simply offering no saving.

The DWP gave up a revenue share benefit of £500,000 per annum in 2008 (see this written answer), but did so without changing its numbers, so this was of no benefit to callers.

The long overdue switch to 03 numbers must be implemented immediately.

The cost of calling (0845 vs. 03)

The following table shows what it costs users of common telephone services to make average duration calls of 4 minutes to DWP agencies on 0845 numbers. Typical call durations (charges are generally rounded up to the next minute) are given in this written answer. The rates used are from current published tariffs, based on information assembled by Ofcom.

Service	4 minute call cost		Note
Service	0845 Business Rate	03 (01/02) Geographic rate	Note
Landline			Assuming compliance with the terms of the call plan (penalty charges are otherwise incurred on 01/02/03 calls)
BT	(inclusive)	(inclusive)
Virgin	£0.53	(inclusive)
Talk Talk	(inclusive)	(inclusive)
Sky Talk	£0.35	(inclusive)
Contract			Assuming a package that allows for landline calls (penalty charges are otherwise incurred on 01/02/03 calls)
Vodafone	£0.82	(inclusive)
Orange	£0.82	(inclusive)
O2	£0.82	(inclusive)
T-Mobile	£1.64	(inclusive)
Three	£0.62	(inclusive)
PAYG			01/02/03 call rates are commonly lower where a top-up package is acquired
Vodafone	£1.00	£0.84
Orange	£1.60	£0.80
O2	£1.00	£0.60
T-Mobile	£1.60	£1.20
Three	£1.02	£1.00
Public Payphone	£2.00	£0.60

The DWP telephone service providers receive a benefit of around 8p per 4 minute call to a 0845 number. Normally this would be used to offset the cost of the facilities provided, however Mr Grayling is adamant that no such saving is being made.

The higher premiums charged to callers are explained by the administrative cost of passing on this charge and competition to offer the best rates for normal geographic calls.

The DWP is to be commended for its decision to pay for calls from mobile phones, as well as landlines, to its 0800 numbers, which are used for initial claims. It is quite extraordinary that such an exceptional move was not matched by the much simpler, and apparently cost free, action of adopting 03 numbers for enquiries.

It may however be noted from the table that paying to receive calls by using 0800 numbers, as against using 03 numbers, is only generally of benefit to those with PAYG mobiles. For landlines and contract mobile phones, it is only those with who rarely make calls to Geographic Rate numbers who pay call charges for them. The DWP could have probably saved the taxpayer an enormous sum by adopting 03 numbers throughout and making arrangements to pay only for PAYG calls from mobiles. The only callers who would have been disadvantaged by such an arrangement would have been those who incur penalty charges for calling outside the terms of their contract.

The Department of Health is NOT implementing a contractual ban on use of expensive telephone numbers by GPs - according to the Health Minister

2011-01-27T12:00:00.000Z

In the course of changes to the NHS, the government is reluctant to impose regulatory constraints on GPs. This apparently includes neglecting enforcement of a contractual requirement to adhere to the principle of not charging patients for access to NHS services!

Changes to the GMS contract were introduced in April 2010 to prohibit use of telephone numbers that cost more than "Geographic Rate" (see clause 29B of the GMS contract). Many NHS GPs continue to use "Business Rate" 0845 and 0844 numbers as the deadline for compliance (31 March 2011) approaches.

I have been pressing Simon Burns, the Minister, to take strong action to ensure that Primary Care Trusts rigidly enforce the terms of this contract revision.

I now have an answer ...

In his response to a parliamentary question on the subject, Mr Burns makes no reference to the changes to the GP contract, referring only to Directions to NHS bodies, which came into force on 21 December 2010. He even uses the term "guidance" when referring to action necessary to protect the fundamental principles of the NHS!

This serves to confirm my fear that "liberating the NHS" means freeing GPs from the obligation not to charge patients for access to NHS services. If existing contractual provisions are not to be enforced, there can be no assurance that further "liberation" will not open up greater opportunities to obtain funding for NHS services from patients, as they access them.

It may be noted that the Directions to NHS Bodies have not been enforced, as many continue to use expensive telephone numbers - e.g.
Northumberland, Tyne and Wear NHS Trust - 0844 811 5522;
Northumbria Healthcare NHS Trust - 0844 811 8111;
North East London NHS Foundation Trust - 0844 600 1200;
Gloucestershire Hospitals NHS Foundation Trust - 08454 222 222;
Gloucestershire Primary Care Trust - 08454 221500.

NHS Direct refuses to offer 0345 4647 (which is setup and ready to use) as an alternative to 0845 4647 for remainder of its life in England - it will continue in Wales. NHS Direct has also taken advantage of an exemption from the terms of the Directions to retain very many 0845 numbers for the Out of Hours GP and other contact services that it provides to a very large number of PCTs.

It should also be noted that access to NHS Dentistry, Pharmacy and Ophthalmology services is not covered by the (supposed) prohibition on use of expensive telephone numbers.

The principles of the NHS - challenged now - will this get worse or better?

2011-01-19T07:00:00.001Z

I respond to the speech on the principles of public service by the Prime Minister on Monday and anticipate reaction to the publication of the Health and Social Care Bill today.

Now is the time for the Government to demonstrate that the principle of the National Health Service being delivered without charge to patients is to be retained and that National principles can only be enforced by clear action from the National government.

If this cannot be achieved now, then will giving GPs more “freedom from central control” make it easier?

Many GPs are part-funding their services through use of "Business Rate" 0844 telephone numbers, which cause a "Service Charge" of 5p per minute to be imposed on patients who call these expensive numbers. This Service Charge is to the benefit of the person called and their telephone service provider. In a current consultation, Ofcom confirms that this is the current position (for all 084 numbers) and proposes that this Service Charge should be declared wherever the telephone number is stated, i.e.

"Calls to the surgery on 0844 xxx xxxx cost 5p per minute plus your telephone company's Access Charge".

If, as he said, the Prime Minister wishes for the delivery of public services to be "more transparent", then those who choose to impose Service Charges, through use of Business Rate telephone numbers, should be using such statements now, without waiting to be required to do so by new regulations. (The same applies to all other public service providers using Business Rate numbers – e.g. NHS Direct, HMRC and DWP agencies.)

If, however, access to NHS services is to be "free to all who need it", as promised by the Prime Minister, then use of Business Rate 084 telephone numbers MUST BE PROHIBITED. (In truth, if transparency was to be applied then use of these numbers would most likely not be sustained anyway! It is only because of public misunderstanding that they are tolerated, with the blame being wrongly placed on telephone companies!)

As a result of contract changes introduced in 2010, NHS GPs have to cease their use of 0844 numbers by 31 March 2011. The terms of the contract however fail to make this explicit, leaving each practice to make the necessary determination.

The BMA believes that patients should pay for access to NHS services according to the quality of service delivered and therefore advises its members to retain these expensive numbers to fund their activities at the expense of patients. To evade the terms of the contract revisions the BMA encourages its members to exploit the current public confusion about telephone charges by falsely claiming that their Business Rate numbers are not more expensive to call than Geographic Rate numbers. (These comments are derived from published guidance.)

Observations and specific enquiries show that these false claims are being granted credence by many PCTs.

If this abuse and lack of control is able to occur under the current regime, then one must fear for the protection of the principles of the NHS if GPs are to be given yet more "freedom from central control", as proposed by the Prime Minister.

However strong its commitment to public service, any private body (such as a GP practice) has a primary financial duty to its owners and shareholders, which demands that it exploits every permitted opportunity to derive income from service users. It is the absence of such a distinct duty from public bodies which causes users to see a difference in who is delivering a public service.

The Prime Minister confirmed on Monday that the government is "in no way abrogating" its responsibility to ensure that "the rights of [public service] users are maintained". If that is to be proved, then the government must take action to affirm this responsibility NOW.

ealth HEalth I invite all those concerned for the principles of "our NHS" to join me in calling on the Secretary of State for Health and his ministers to demand that all Business Rate 084 telephone numbers be removed from the NHS immediately.

Alleged technical or contractual difficulties are spurious. Arrangements for migration from 084 to the equivalent 034 number could be made swiftly and undertaken within the term of existing contracts for telephone service. Where, as in the case of NHS Direct, the cost and confusion of complete removal of a 084 number would be inappropriate, the Geographic Rate equivalent (e.g. 0345 4647) could operate in parallel with the Business Rate (e.g. 0845 4647) number.

The Prime Minister was very clear in stating that the fundamental principles of the NHS must not be diluted by the proposed "modernisation" - LET US SEE HOW TRUE THAT IS.

(Telephone access to other public services, e.g. those provided by HMRC and DWP agencies, is also not "free to all who need it" as they too use Business Rate 084 telephone numbers. As the Prime Minister is not yet proposing that these agencies be granted "freedom from central control", there can be no doubt about where the responsibility for this breach of the principles of public service lies!)

MPs recruited to fight to eliminate NHS telephone service charges

2011-01-09T20:29:00.001Z

As Pathfinder GP Consortia stand ready to take over the NHS from public bodies and parliament prepares to debate a NHS (Abolition?) Bill, I seek to recruit MPs to defend the principles of the NHS on behalf of their constituents and all other citizens. (See my message.)

A change to the GP contract was introduced last year, giving GPs 12 months in which to cease use of what are now known as "Business Rate" telephone numbers. Ofcom is currently consulting on proposals which would require all users of 084 telephone numbers to advise the Service Charge incurred by callers e.g.

"Calls to the Surgery are charged at 5p per minute plus your telephone company's Access Charge."

Under the terms of their revised contract NHS GPs have until 31 March 2011 to cease use of telephone numbers that are more expensive to call than a Geographic Rate number, which cannot cause a Service Charge to be incurred. Network telephone service providers enable their customers to migrate from Business Rate 084 numbers to the equivalent Geographic Rate 034 number within the term of their contract for network telephone service, so no major disruption is demanded. One would therefore think that is was a quite straightforward matter for the principle that NHS services are provided without charge to the patient to be re-asserted in practice.

The BMA GPC opposes the principles of the NHS

The General Practitioners Committee of the BMA declares a policy position stating that patients should pay for improved NHS services according to the quality of service provided. It therefore supports use of Business Rate numbers by NHS GPs. As this view was not shared by the (previous) government when it introduced the GP contract revisions, the BMA has sought to undermine their implementation. Working with the primary provider of surgery telephone systems partially funded through Service Charges paid by patients, the BMA has urged its members to utilise a false assurance from this company that Business Rate telephone numbers are not more expensive than Geographic Rate numbers.

This assurance is of course untrue, however there are some cases where landline callers subscribe to a tariff that is based on normal calls being inclusive. They therefore incur a Penalty charge for calling a Geographic Rate number outside the terms of their Call Plan. This Penalty Charge can be greater than the cost of calling a Business Rate number, which is never included in their Call Plan. This perverse effect is a feature of some caller's telephone tariffs and it results from legacy regulation of BT, which Ofcom now proposes to belatedly remove.

This effect has nothing whatsoever to do with the alleged capability of any GP or their telephone company to set a generally low rate for callers – there is no such facility, they can only determine the scale of the premium “Service Charge”. Unfortunately the Department of Health has allowed itself to be misled on this point, into the false assumption that some 084 numbers are not more expensive than Geographic Rate numbers, when this situation can only occur when patients select an inappropriate landline tariff from some telephone companies.

The Department of Health stands back

The Department of Health has refused to acknowledge its error, taking a neutral stance by resting on the fact that if the terms of the contract revision are applied correctly then use of expensive numbers must be ceased. As the terms of the requirement are explicitly based on a false assumption and a false basis for compliance is being recommended to contractors, proper application will not come easily. It is clearly seen that in the nine months which have passed only a handful of the 1000 or so GPs have changed away from their 084 numbers, or intend to do so.

(A similar effect was seen with NHS bodies, who were subjected to the same requirement with a deadline of 21 December 2010. A number of Hospitals and PCTs continue to use 084 numbers in breach of Directions that they should cease the practice. Most notable is NHS Direct, which has the 0345 4647 Geographic Rate alternative to its Business Rate 0845 4647 number set up and ready for use in parallel, but refuses to make this available.)

Parliament to rescue the NHS?

I have today written to the 33 MPs with 5 or more 0844-using GPs in their constituency urging them to become engaged in this matter on behalf of their constituents. As our parliament starts to consider changes to the NHS management structure to "LIBERATE" it from the central control that enforces adherence to its fundamental principles, I urge all those who claim to support "our NHS" to join the fight to ensure that these principles remain and to show that, in this relatively modest case, they can be re-asserted.

The draft of my message to the MPs is published as - Message to MPs brought into the fight to eliminate NHS telephone Service Charges. Further comment, detailed explanation and references is published as - MPs brought into the fight to eliminate NHS telephone Service Charges.

Ofcom announcement causes public bodies to come under attack for use of "Business Rate" 084 telephone numbers

2011-01-07T04:08:00.001Z

Further to my earlier release, Public service providers must immediately cease using "BUSINESS RATE" telephone numbers, I address the situation with HMRC and NHS GPs in particular.

HMRC

The Low Income Tax Reform Group has renewed its attack on HMRC for its use of what are now called "BUSINESS RATE" 0845 telephone numbers.
See - Telephone call charges – time for HMRC to act.

This announcement refers to a current Ofcom consultation, which confirms what is happening at present as well as proposing long overdue clarification of the position with all non-geographic telephone numbers.

When the Ofcom proposals are implemented, HMRC, in common with many other public sector bodies including DWP agencies and NHS Direct, would have to add the following statement wherever they publish their 0845 telephone numbers:

"Calls to our 0845 numbers are charged at 2p per minute, plus your telephone company's access charge".

This is the current situation, with access charges varying from a 12p fixed charge per call to a surcharge of 38p per minute. (BT is currently exploiting a specific regulatory provision, which requires it alone to cross subsidise these calls through other charges, by covering them in its Call Plan charges. Ofcom proposes to revise this regulation.)

The Ofcom proposal is essentially for the Service Charge levied by HMRC and others to be unbundled from the Access Charge, which each telephone company would have to advise separately. Whilst there would be expected to be adjustments to regularise the Access Charges; it is proposed, and expected, that the Service Charge will remain largely unchanged.

Once this clarity and transparency is achieved it will clearly be intolerable for benefit claimants, NHS patients and citizens seeking help with errors in their tax to be seen to be paying a Service Fee to a public service provider for a telephone enquiry. This is however exactly what is happening at present - it is just not being declared for what it is.

HMRC and other public bodies must now face up to the truth and either declare it, justifying the imposition of a Service Charge on callers, before they are compelled to do so, or move swiftly to use of 03 (Geographic Rate) numbers wherever a geographic number is not suitable.

NHS GPs

NHS GPs who use the more expensive “Business Rate” 0844 numbers impose a Service Charge of just over 5p per minute for obtaining NHS Services - the highest charge possible to avoid classification as "Premium Rate". This is in addition to an Access Charge of up to 35p per minute added by the telephone company. This is a clear breach of the principles of a NHS that is funded by taxation.

Recent revisions to their NHS contract give them until 31 March 2011 to cease using these expensive numbers – see clause 29B of the Standard General Medical Services Contract. They could do so by changing their telephone arrangements totally, or more simply by migrating to the equivalent 0344 (Geographic Rate) number, which is permitted by network telephone service providers within the term of a contract for network telephone service.

The GP Committee of the BMA opposes this move (see this briefing). It promotes a policy which states that it is patients who should bear the cost of improved NHS services, according to the quality of the service delivered. Many would see this as being a most disturbing position to be held by this professional body, especially when the government proposes to hand over the local management of the NHS to GPs, “liberated” from central control!

Despite being content with the idea of patients paying service charges, the BMA GPC briefing however encourages members to get around the terms of the revised contract by pretending that there is no Service Charge applied and that patients do not pay any more to call 0844 numbers. One Surgery system provider even claims to be able to give assurances to this effect. The Ofcom paper clearly shows this to be complete nonsense.

THE GOVERMENT NEEDS TO SEE THIS SITUATION RESOLVED BEFORE WE COULD THINK OF GP’s BEING ALLOWED TO TAKE OVER “OUR NHS”.

Ofcom writes to Silent Callers to tell them "Merry Christmas - it's OK - and a Happy New Year of Silent Calling"

2010-12-22T13:49:00.002Z

Ofcom yesterday issued a circular letter to those it knows to be making Silent Calls - "Tackling ... Silent Calls".

This is intended to draw the attention of those who make Silent Calls to Ofcom's policy of qualified approval of the practice. It follows a consultation, to which I responded.

Most of us believe that habitually hanging up in Silence when a telephone call is answered must invariably be regarded as "Persistent Misuse of a Communications Network or Service". This is NOT the policy being followed by Ofcom. By this letter, that fact is made very clear to Silent Callers.

In 2006, Ofcom was informed of the expectation of parliament -
"we expect you to use your powers to eradicate the nuisance of Silent Calls"

In its letter, Ofcom tells Silent Callers of the steps it expects them to take
"where such calls are made, ways to LIMIT consumer harm"

Ofcom tolerates what it chooses to call “consumer harm”.

Silent Calls may readily be avoided in two ways:

•	Always using an Informative Message, played live when the call is answered, to apologise and inform the person called of the true identity of the caller whenever no agent is available to handle an answered call that was dialled automatically.
•	Ceasing use of unreliable Answering Machine Detection technology, designed to hear the clicks and whirrs of a mechanical answering machine, in favour of Answering Service Detection, where the use of any answering service is detected reliably from a signal issued by the service.

Confirmation of Ofcom's approval of the practice of making Silent Calls and its absurd suggestions of how consumer harm may be "LIMITED" may be seen in the following further quotations from the letter:

•	"... an abandoned call rate ... of no more than 3% ..." - 1 in every 33 calls may result in silence.
•	*"not contacting consumers within 72 hours of their receiving an abandoned call"* - leave people waiting for 3 days before the next Silent Call, or perhaps the chance for a caller to acknowledge their previous error and apologise.
•	"... they can trace who rang them by dialling 1471 in the event of a silent call" - the chances of being able to recognise the identity of a caller from the number given as CLI are remote. Using the callback feature of 1471 is generally expensive and unlikely to reveal the full identity of the caller. I would personally never advise anyone to call back to someone who has just made a Silent nuisance call to them; if the unknown purpose of call was perhaps malicious, this is the very last thing that one should do. The suggestion that it could be acceptable to leave a “trace” of who one is, rather than clearly stating one’s name when a call is answered, is quite ridiculous.
•	"... where a call has been identified by AMD technology as being picked up by an answer machine any repeat calls to that specific number within the same 24 hour period may only be made with the guaranteed presence of a live operator". This suggestion acknowledges that AMD technology is unreliable and a common cause of Silent Calls. The foolish feature of the suggestion to wait 24 hours before trying again ignores the fact that if a false detection has occurred once it is highly likely to occur again. Ofcom is actually encouraging a pattern of one Silent Call per day from a Silent Caller.

Seven years after I succeeded in getting Ofcom to launch its first investigation into a Silent Caller who had been calling me (which led only to approval of a limited number of Silent Calls being made - 10,000 per day in the case in question) I am somewhat dismayed to find that Ofcom is still approving the practice of making Silent Calls.

I accept that Ofcom does not have the resources to identify and penalise every Silent Caller. Writing to them to tell them that it is OK to make Silent Calls is a quite different matter.

Public service providers must immediately cease using "BUSINESS RATE" telephone numbers

2010-12-20T15:27:00.002Z

Ofcom announcement

Ofcom has published a consultation on proposals for the future regulation of non-geographic telephone numbers - Simplifying Non-Geographic Numbers.

The published information includes a comprehensive analysis of the current costs of calling 0845 and 0844 numbers. 1 This clearly demonstrates that the cost of calling these numbers (now designated "Business Rate") is greater than that of calling "Geographic Rate" numbers for most callers.

Legacy regulation has caused BT landline customers to benefit from a discount when calling these numbers. Ofcom proposes that this special treatment, which does not apply to users of other landlines, mobiles or payphones, be ended.

NHS Regulations

Any NHS body or GP seeking to pretend that their 0844 or 0845 number is not more expensive to call is now seen to be engaged in a deliberate or misguided deceit. Because the NHS is a universal service, such determinations cannot be made using the limited assumption that all patients are BT customers who do not have a call plan in place when calling.

Directions to NHS bodies give them until Tuesday 21 December 2010 to review this matter and make alternative arrangements. In some cases, it may be too late to do the latter, but there can be no excuse for not now declaring an intention to remedy the situation as soon as possible.

Revisions to their NHS contract give GPs until 31 March 2011 to do the same. It must be noted that telephone service providers allow the option to migrate to 03 ("Geographic rate") numbers within the term of their contracts. Associated telephone systems are supported equally by 03 and 084 numbers, so there is no requirement to consider use of a particular system when selecting the type of telephone number, 03 ("Geographic rate") or 084 ("Business rate"), to use.

Bundled tariff

The Ofcom document explains that the present cost of calling 0845 and 0844 numbers (along with many others) includes two "bundled" elements:

1.	The "service charge" - to the benefit of the Service Provider (the user of the number).
2.	The "access charge" - retained by the telephone company originating the call.

Ofcom proposes that these costs be unbundled

Under Ofcom's proposals, NHS Direct, HMRC and DWP agencies would be required to present the cost of calling their 0845 numbers as follows:

"Calls to (0845 4647 / 0845 3000 627 / 0845 604 3719) 2 cost 2p per minute plus your phone company’s access charge".

For 0844 numbers, as used by many GPs, the presentation would be:

"Calls to the surgery on 0844 4771799 3 cost 5p per minute plus your phone company's access charge."

These statements would simply represent the truth as it exists today, notwithstanding the fact that the phone company access charge element is currently totally opaque, highly variable and unrelated to the cost of calling an ordinary (geographic rate) number. The "service charge" element exists today - the Ofcom proposals are simply for it to be made transparent, by regulation.

NHS and other public service providers that may not levy a "service charge" for telephone contact must immediately desist from use of what are now designated as "Business Rate" numbers. Citizens do not engage with NHS providers, HMRC or the DWP agencies on commercial terms.

It is for businesses to determine whether or not they are content for it to be seen that they are levying a charge for access to certain services provided by telephone. Taxpayer-funded service providers cannot be seen to be levying a second charge, on service users.

Geographic rate numbers

Ofcom confirms that only 01, 02 and 03 numbers may be considered to be charged at "Geographic rate". The historic link which once applied to 0845 numbers, BUT ONLY EVER FOR BT LANDLINE CUSTOMERS, will be finally broken.

Only those Service Providers who serve only BT landline customers can claim a link between 0845 calls and geographic rates, until such time as the changes proposed by Ofcom are implemented.

Those who require non-geographic numbers, but cannot present them as being proper to be charged at "Business Rate" or "Premium Rate", must adopt "Geographic rate" 03 numbers.

For ease of migration, the 0344 and 0345 equivalent number for each 0844 and 0845 numbers is reserved. Such migration is permitted by telephone companies within the term of an existing contract for telephone service.

Where considerable cost may be involved in fully changing a number, a sensible pragmatic approach is to offer 0344 or 0345 alternatives as a standard, possibly covering many numbers, operating in parallel with the 0844 or 0845 equivalents and advised as such, as a general principle.

I see the option of parallel operation (0845 / 0345) as particularly suitable for NHS Direct, where the cost of a complete number change would be highly inappropriate as 0845 4647/0345 4647 has only a limited remaining life.

Parallel operation would also be most appropriate for the many 0845 numbers used by HMRC and all DWP agencies. Major number changes are planned for the future and tight budgets make it most suitable to simply issue a general advice that any 0845 number may be replaced with the 0345 equivalent.

To provide full information, HMRC and DWP could make the following statement at present:

"All 'Business rate' 0845 numbers are subject to a service charge of 2p per minute. This is in addition to the access charge levied by your telephone company, which may also include a call connection fee. Current access charges are known to vary from -2p per minute to +38p per minute." 4

If adopting my recommended approach, the following could be added:

"To contact us at 'Geographic rate', call our 0345 alternative numbers. Simply replace the 0845 with 0345 and dial the remainder of the number as quoted."

Circulation of these comments

These comments are published in my blogs 5, and as a general media release. They are circulated to relevant personnel in the NHS 6, HMRC and DWP, to MPs and to others concerned with the issues of fairness and propriety that are brought most clearly into focus by the Ofcom announcements.

I also include members of the "Non-Geographic Numbers Review Team" at Ofcom (NGCSReview@ofcom.org.uk) who will, I am sure, be happy to confirm the points I make here.

I will be pleased to assist with any further information and comment.

David Hickson

Notes

1.	See http://stakeholders.ofcom.org.uk/binaries/consultations/nongeo/summary/non-geo.pdf - Tables A2.4 & A2.5 (p140) vs. A2.7 & A2.8 (p147).
2.	The numbers quoted are as follows:
	0845 4647 - NHS Direct - telephone health advice and information service
	0845 3000 627 - HM Revenue and Customs - for enquiries about tax over/under -payments
	0845 604 3719 - JobCentre Plus - to contact any Jobcentre
3.	The number quoted is that used make an appointment with NHS practising GP - Dr Richard Vautrey - Deputy Chairman of the BMA General Practitioners Committee.
	Dr Vautrey is a strong public advocate of the use of "Business Rate" numbers for provision of NHS services. We exchanged views on this issue on the Radio 4 Today programme 2 years ago.
	The BMA GPC also advocates a service charge for telephone calls to some NHS providers and encourages exploitation of the "Confusion about the price" which the Ofcom proposals seek to address (see GPC GUIDANCE: USE OF 084 NUMBERS IN THE NHS).
4.	The maximum charge for calling a 0845 number is given by Ofcom as 40p per minute, as at August 2010. Prices will be reviewed to reflect the increase in VAT to apply from 5 January 2011.
5.	NHS.Patient blog, Public Services Campaigner blog, Media Releases blog.
6.	My NHS.Patient website includes lists of NHS service providers using Business Rate numbers - NHS Bodies and GPs.

The Government and the NHS must stop using "Business Rate" telephone numbers, where the call charge includes a "service charge"

2010-12-16T12:30:00.001Z

Ofcom has today published extensive information about 0845 and 0844 telephone numbers - Simplifying Non-Geographic Numbers.

This includes proposals to rename these ranges as "business rate" and to require the call charges to be "unbundled", so that the "access charge" paid to the telephone service provider is separated from the "service charge" to the benefit of the user of the number.

This is a long overdue clarification and simplification of what is happening today. The proposed change is only in how the situation is presented.

Many NHS service providers, HMRC and DWP agencies use 0845 and 0844 "business rate" numbers. It is now clearly revealed that the charges for calling these numbers include a "service charge". Once this is declared separately, "unbundled", it will become quite clear that use of such numbers is quite improper, except where a service fee may fairly be levied for the call.

The 03 range will remain available for those who require "non-geographic" numbers that are charged at the standard "geographic" rate. All public bodies must recognise the need to move to 03 numbers immediately. The direct equivalent alternative 0345 and 0344 numbers are available and may be adopted at any time (within the term of an existing telephone service contract). Where appropriate these alternative numbers may be operated in parallel to save the expense of total number changes.

Ofcom continues to fail to address the problem of Silent Calls

2010-12-08T11:43:00.001Z

From: David Hickson - Stop Silent Calls campaigner

In its summary of its Consumer Experience Report 2010 (Telecoms complaints fall – but challenges remain) Ofcom reports that complaints about Silent Calls are running at record levels. It has however failed to use the statutory powers that it holds to simply notify the offender of what it calls "a breach of the rules" since October 2008.

This can only mean that every one of the 6,600 complaints received in 2009 and the 8,600 in 2010 to date was about a company making Silent Calls within the generous allowance that Ofcom's policy permits. Ofcom says that it will "continue with our policy of enforcement", however there is only one company which Ofcom has made subject to use of its statutory powers of enforcement.

BBC Watchdog recently highlighted BT and British Gas as being amongst the companies making Silent Calls. They both claim to be doing so within the terms of what BT calls "the Ofcom Persistent Misuse Policy". Ofcom clearly agrees, as neither has been notified of a breach; I therefore agree with BT's choice of terminology to describe the Policy.

Ofcom refers to a change of policy that will be implemented on 1 February 2011. This policy suggests that those who make a Silent Call (when caused by use of obsolete and ineffective Answering Machine Detection technology) should repeat the call on successive days. Ofcom's suggestion that "companies will no longer be able to call consumers without the guaranteed presence of a live operator more than once a day" is complete nonsense.

Ofcom does not have the authority to impose such a rule as a general requirement - it can only do so in specific cases, following a Notification of Persistent Misuse. As stated above, Ofcom has only ever used this power once in relation to Silent Calls. Furthermore, Ofcom has no way of monitoring or enforcing such a requirement.

It may be that some companies will follow this policy. The cases reported by Watchdog indicate that the problem with repetition is having every day predictably blighted with suspicion every time the phone rings. The fundamental problem with an intended limitation on repetition is that it confirms tolerance of every initial instance. Ofcom's actual policy, if applied, will simply ensure that more people get a single Silent Call on any particular day.

The fundamental point that Ofcom has always failed to grasp is that NO CALL SHOULD RESULT IN SILENCE from the caller. A tolerance limit of 3% and of only one per person per day is simply an unacceptable tolerance of Silent Calls. Under Ofcom's policy, this is what has to be exceeded for even the first stage of its statutory powers to be used. The potential for a severe fine, which is available at the third stage of use of the powers, may sound impressive. If however companies such as BT and British Gas admitting to making Silent Calls and over 15,000 complaints can fail to cause even the first stage to be used, then Ofcom cannot claim to be addressing the problem effectively.

There will always be cowboys and offshore operators that Ofcom will have difficulty in detecting and acting against. It cannot be seen to be fulfilling its duty when it permits and even encourages large responsible UK companies to make Silent Calls.

No Silent Call is necessary.

Those who use predictive diallers can use an "Informative Message" when a system failure exceptionally leads to there being no agent available to handle an answered call. This is referred to, but poorly specified and not mandated, by Ofcom.

Answering Machine Detection has failed to be effective since general use of tape recorders was replaced by use of network based answering services. Ofcom is wrong to oppose the potential introduction of Answering Service Detection as an effective means of ensuring that calls have been answered by a person. Ofcom is yet more wrong to encourage the use of the obsolete Answering Machine Detection technology, on the spurious and irrelevant grounds that the money saved as a result of inevitably making Silent Calls leads to reduced prices for consumers in the markets for energy and other products and services.

Homeserve investigates improper telephone marketing - Ofcom and the Information Commissioner are seen to have lost the plot

2010-12-04T07:23:00.006Z

According to an article published by FT.com - "Homeserve to probe phone campaign", Homeserve is to conduct an internal investigation into the activities of one of its marketing agencies, which leaves repeated marketing messages on the telephone answering services used by prospective customers. (See my clipped summary.)

It seems that these messages are abusing a technique, which I successfully promoted back in 2005, designed to prevent Silent Calls without prohibiting the use of automated dialling equipment. This "Informative Message" technique has already been abused by Ofcom, which uses it as the basis for permitting 3% of calls to result in Silence.

Consent to use of the "Informative Message" was negotiated between Ofcom and the Office of the Information Commissioner (ICO), both of which are quoted in the FT article. If the quotes are genuine and complete, then both bodies have missed the point.

Ofcom suggests that automated callers are able to distinguish between calls that are answered in person and those directed to answering services, as it claims that its policy is based on such an assumption. This is nonsense, there is no reliable means of doing so in use.

Ofcom actively opposes the introduction of a technique ("Answering Service Detection") that could address this. Furthermore, Ofcom approves and promotes the use of an obsolete, unreliable method of detecting mechanical answering machines ("Answering Machine Detection"). Ofcom has even had to add a proviso that the inevitable Silent Calls are repeated on successive days, rather than all on one day - it seems that this is exactly what this caller has done.

The ICO refers to there being no requirement to deliver recorded marketing messages. It fails to mention that such messages are totally prohibited by the terms of the Privacy and Electronic Communications Regulations (regulation 19), which it enforces. This prohibition applies regardless of registration with the Telephone Preference Service!

BOTH OFCOM AND THE ICO HAVE TOTALLY LOST THE PLOT IN DEALING WITH TELEPHONE NUISANCE CALLS

Please contact me for further information and comment on this story and related issues. The issues are inevitably complex, so please bear with me as I seek to assist with attempts to untangle a web of regulatory provisions.

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

2010-11-30T10:52:00.003Z

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!

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

2010-11-17T06:00:00.001Z

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

2010-11-10T06:45:00.001Z

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).