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.
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.
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.
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