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Monday, 1 March 2010

The cost of calling NHS Direct - as it is, and as it should be

Open message to Mike Penning MP, copy Mike O’Brien MP and many others

Mr Penning

I note the written answer to your question provided on 25 Feb 2010 at Column 753W and published here.

You asked for “the average cost of a call to NHS Direct in 2009”.

Mr O’Brien could not provide the answer, I can.

Using figures released by HM Government in mid 2009 1, the average cost of NHS Direct calls (average 528 seconds 2) to 0845 vs. “ordinary” 01/02/03 numbers are as shown below. This table shows the average cost for different types of call. It uses government assumptions about the proportions of calls from each type to give an overall average cost.


% of calls

Average cost - 528 second call



0845 vs. 01/02/03






Other Landline





















This table clearly shows that only BT landline users are advantaged by use of a 0845 number 3. Using the percentages suggested by the government, this perverse effect does not even outweigh the disadvantage improperly incurred by other callers.

NHS Direct should have indirectly benefited to the tune of around 18.5p per 0845 call from the fact that BT Global Services received this amount in revenue share throughout 2009. NHS Direct has however alleged that it lets BT Global Services keep this money 4. Whoever benefitted did so at the expense of callers - there is no revenue sharing allowed on 01/02/03 numbers.

I have proposed that NHS Direct must immediately bring the alternative number 0345 4647 into use. This number is already configured in readiness for a possible change with a period of parallel operation 5. This has been put aside whilst the future of 111, as a possible single national number for contacting the NHS, is determined. I agree that 0845 4647 may exceptionally be retained in these particular circumstances.

The significant additional cost incurred by all those not calling from BT landlines demands that the 03 number be made available for their use, in parallel, as an optional alternative. I accept that it may not be appropriate to incur the cost and disruption of a total number change from 0845 to 0345 at this time for a number that may shortly be changed yet again.

Other NHS Providers

Under the terms of Directions issued by the Department of Health on 21 December 2009 6, all NHS bodies will have to cease use of 084 numbers within 12 months. The table demonstrates that only those who can show that all of their patients only ever call from BT landlines will be able to retain 084 numbers. (Surely there can be no such case!)

The relative difference for the more expensive 0844 calls is of course greater. It is understood that GPs will similarly have 12 months in which to cease using any 084 numbers from the point where their revised contracts come into effect; this is expected to be in the next month or two. Tariffs are set by the telephone company with whom the call is made, not by an agent of the telephone company providing network service to the NHS provider. Suggestions to the contrary are false and deliberately misleading. (I refer, latterly, to the Talk Talk Group, which charges far more for 0844 calls than ordinary calls.)

My Personal Comments

The average cost being greater for a 0845 number than an ordinary number makes a powerful point. More important is that a universal public service must not favour customers of one particular telephone company. There is a cost neutral option (03) available for those who need non-geographic numbers.

It is now agreed that NOBODY should pay more than the cost of an “ordinary” call to contact the NHS, according to the applicable tariff determined by their own particular telephone service provider. 03 is the only non-geographic range that provides this guarantee. Such claims for other numbers are simply false.

Where, as in the case of 084 numbers, the additional cost results from revenue sharing to the indirect (or direct) benefit of the NHS provider, this is a simple breach of the first of the rights in the NHS Constitution.

Many NHS users of 084 numbers falsely believe themselves to be in compliance with the terms of the December 21 Directions and to be showing regard for the first of the rights in the NHS Constitution. This mistaken impression must be corrected.

There must be no equivocation and no tolerance of those who seek to deceive with false or misleading information about call costs. Use of revenue sharing (084) telephone numbers has no place in our beloved NHS, which must remain “free at the point of need”.

I hope that this is useful. I will be very happy to discuss the detail of the assumptions underlying the figures in the table and related issues 7.

I have no Party Political allegiance. I see “our NHS” and its principles as belonging to the people, as represented in our sovereign parliament, not to the Government in power at any time - see Theft of the NHS. I believe that the present government has not gone far enough to clearly explain that its current policy requires elimination of all 084 numbers from the NHS - indeed it expressly contradicts this essential truth. It is for all MPs and others with a public voice to declare the truth about 084 telephone numbers, so that the principles of “our NHS” may be re-instated in practice.

Notes and References

1.  The spreadsheet containing all of the cost data used to prepare the table was provided in the Government response to a Freedom of Information request dated 4 September 2009 - published here by WhatDoTheyKnow. (The spreadsheet is embedded in the Microsoft Word document, which may be downloaded from here.)

2.  Written answer provided 3 Feb 2009 Column 1109W (seen here) - “The average duration of a call to NHS Direct is 528 seconds”.

3.  I explain the reasons for the figures that are seen in a blog posting – Why are calls to 084 numbers more expensive, but not from BT?

4.  My explanatory blog posting addresses the situation with NHS Direct in particular.

5.  Detail of the announcement, and then the halting, of the introduction of 0345 4647 is given here. The number remains live in test mode.

6.  Directions issued by the Department of Health 21 Dec 2009 - “persons will not pay more to make relevant calls to the NHS body than they would to make equivalent calls to a geographical number”.

I believe that a total exemption from this requirement was given to the NHS Direct NHS Trust in error. It should have only been granted permission to retain 0845 4647 in use given that an alternative was made available. There is no justification whatsoever for granting exemption in respect of the 68 other 0845 numbers used by the NHS Direct NHS Trust (included in this list).

7.  The assumptions used by the government are very particular. Sources are given for the charge rates, but not for the assumed breakdown between providers or the proportions by call type. The rates given are for daytime calls. At other times some of the costs are lower which would affect the figures. If the relevant evening and weekend rates were factored in then the proportional difference would tilt more strongly in favour of 03 in each case. In the case of BT, there is barely any difference at weekends, as all call plan customers benefit from inclusive calls at this time.

I am working with other campaigners on a more comprehensive version of this information. We lack alternative authoritative sources of profile data so that we may provide it with confidence. I would be delighted to be invited to research and produce further such tables.


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