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Friday, 18 September 2009


It is now time for politicians of all the major parties to be honest and admit that after 61 years they are prepared to formally sacrifice the principles of the NHS for the sake of consumerism.

I note the comments of Andy Burnham in his speech to the King's Fund and related commentary. Mr Burnham's speech includes the extraordinary phrase, for which I cannot find a proper context, "pay more for better patient experiences". I do not believe he meant that government spending would inevitably increase if experiences improved, or that having to spend less would be expected to make things worse for patients. His focus was on a "people-centred NHS" being upgraded from "good" to "great".

I read this after becoming very familiar with the following parts of the announcement about premium rate call charges on Monday.

"The ban on the use of numbers charging patients a premium rate to call NHS services will allow a marketplace to evolve where 084 numbers compete alongside 01, 02 and 03 numbers, but where patients will pay no more than the cost of a local call. The ban means that GPs and other NHS organisations remain free to use 084 numbers."

"The ban will be enforced through proposed changes to the GP contract".

Notwithstanding other less oblique comments in the announcement, it must be understood that it is telephone companies, not the DH or GPs, who determine the cost of a call to any particular type of number. As they compete with one another, they have to decide how to fund the additional cost they incur in providing the revenue share that benefits all users of 084 numbers. One option for them is to do as BT will be doing from 1 October, increasing the price of a non-inclusive call to a local number (by 33% in 12 months) so that it becomes greater than the most expensive type of 084 number (the type used by GPs). Maybe GPs will be able to point to this isolated and atypical example to prove compliance with their contract. (This perverse effect arises because some of BT's prices are still regulated, whereas others are not.)

Those who subscribe to BT packages and all customers of every other telephone company will continue to pay a premium to call 084 numbers. There is nothing that GPs can do about that.

Health policy now clearly seeks for "choices" to be exercised by "consumers" in a "market". If there is no price distinction between the cost of calling different GP's telephone numbers, then there is no "market". It cannot be fair "competition" for some GPs to benefit from the extra funding derived from a revenue share on their 084 telephone numbers, whilst others (on 01/02/03) do not, unless the patient has to set this off against some negative consideration. If it is considered acceptable for some patients to pay a premium rate to call their GP because that premium is used to pay for a telephone system or some other feature of the surgery (e.g. a smart waiting room or a smiling receptionist) that may offer "a better experience" than may have been enjoyed previously, then my arguments about "free at the point of need" can be seen as outdated and irrelevant.

I have always argued; if it is acceptable for NHS providers to indirectly charge for telephone calls when delivering or providing access to NHS treatment, then how will we be able to stop providers using other, perhaps less indirect, ways of imposing charges for NHS services.

If getting patients to pay for NHS services is the only way that the NHS spending can be maintained whilst dealing with the National Debt, then now is the time to be honest about this difficult choice that has been made in order to achieve cuts. Alternatively, this may be seen as desirable policy in its own right - there is no better way of "empowering" patients than by giving them direct control of the purse strings.

The issue of premium rate call charges may not itself be central to the debate on public spending and the future of the NHS, however it is the subject of the second most supported e-petition on the number 10 website, with over 40,000 signatures. A lot of people value the principles of the NHS above their own direct personal interests. Such a level of support must show that this is about more than what is for many just a few pence on the phone bill.

By proposing that a "ban" be implemented through contractual arrangements with those who are totally unable to have any influence on what is allegedly being banned, the government is clearly doing nothing at all about this issue. It may not be the biggest issue in itself, however it does provide a clear indication of what happens when the principles of the NHS are tested – that is why I got involved in this matter. If "competition" and "consumer choice" in "markets" is now seen to be more important than "free at the point of need" here, then why not elsewhere?

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