Release of
list of additional telephone numbers
NHS Direct and
the Consultation on banning use of 084 numbers
Withdrawn
public announcement of an intention by NHS Direct to change to 0345 4647
These notes address
some of the issues that arise with the very particular case of NHS Direct. They
cover the general way in which revenue sharing telephone numbers work, notably
0845 numbers. They are relevant to all NHS service providers and indeed any
public service delivered “free at the point of need”.
All 084x and 087x
telephone numbers are classified by Ofcom as “revenue sharing”.
(BT Global Services
and BT Retail are separate businesses within the BT Group.)
NHS Direct and how it is funded by calls to 0845 4647
Charges for calling revenue sharing numbers
The NHS Direct
telephone advice service is partly funded by patients who call this “revenue
sharing” telephone number.
Whilst at the
inception of NHS Direct in 1997/8 the 0845 number was charged by BT (now BT
Retail) at the same rate as calls to “local” numbers, this is no longer true,
as it was never true for all telephone service providers.
BT Global Services,
which provides the telephone infrastructure for this service, receives
additional income from every call made to this number. That is the basis of
“revenue sharing” numbers. That is why calls are charged differently to those
to “ordinary” numbers. Revenue sharing is not permitted on calls to
“geographic” (01/02) or 03xx numbers. That is why these are charged at lower
rates and offered in “call inclusive” packages.
Rather than
accepting the revenue share as income, NHS Direct allows BT Global Services to
retain it, thereby achieving a discount in the fees paid for its services to
NHS Direct. As NHS Direct, like many NHS providers, is not a profit-making
organisation there is no effective difference between income and subsidy
through reduced cost. Any suggestion that a user of a revenue sharing number
does not “profit” thereby are meaningless. (Even for a profit-making
organisation, reduced costs contribute to net profit.)
Telephone service
providers normally obtain the money required to share their revenue by
increased charges to callers. BT Retail and some other residential telephone
service providers offer some callers, at some times, rates to call 0845 numbers
that are less than, or the same as, those for “geographic” numbers. This
selective and perverse approach to a fair distribution of costs to callers
should not be allowed to distort an understanding of the principles of revenue
sharing.
Whenever a NHS
patient calls a revenue sharing number, part of the call charge paid is shared
to the benefit of the NHS provider being called. In most cases this means that
the charge is greater than that for calling a number where revenue sharing does
not apply. The fact that some callers, at some times, do not incur an
additional charge does not affect the essential point that those who use
revenue sharing numbers are not delivering services “free at the point of
need”.
I understand from communications with NHS Direct that:
“NHS Direct recognises that since its launch in 1997/8, the cost of calling 0845 4647 from certain numbers has increased … and has been in discussions with regard to an alternative number for some time. … NHS Direct fully supports the move to an alternative number.”
The possibility of a new three digit national number (probably “888”) for accessing urgent non-emergency NHS and care services being introduced is being discussed in various circles. This would seriously disrupt the current operations of NHS Direct, which provides non-urgent services, and also uses many other different 0845 numbers.
I have been told that a decision has been taken in principle for an alternative 03xx number to be adopted in the event that the “NHS Next Stage Review Final Report”, published by Lord Darzi on 30 June, did not require that 888 be adopted. This report suggests only that local plans for a single number for access to local urgent non-emergency NHS and care services be allowed to go ahead.
There is no prospect of a national number and the consequent
re-organisation of NHS Direct, and the equivalent services covering
Whilst the objective behind the idea is simplification, it is likely to be found that the necessary designation of the scope of a “888” service, as distinct from those around it, will actually make matters more complex. It could only be made to work if the scope of NHS Direct and the skills of its staff were increased significantly, probably beyond realistic expectations.
The government has given a “cast-iron guarantee” that use of 0845 4647 will not continue beyond the life of the current contract with BT – Hansard 21 Jan 2008: Col 1334.
I have been told that this contract “… expires in 2011. However, this does not tie NHS Direct into the use of 0845 4647 and instead allows the use of any non geographic number hosted by BT”. This fact undermines the sense of this government guarantee, as it denies the implied need to retain this number for another three years. The logic of the arguments behind the guarantee therefore suggests that there should be no delay at all.
At the beginning of
the 61st year of the NHS, I see no good reason why NHS Direct should
not immediately go ahead with its plan to move from 0845 to 03xx. All other NHS
providers and other public service bodies with a genuine need for a
non-geographic number should do the same.
David Hickson
5 July 2008
BT Wholesale
published a Briefing on 23 July 2008 indicating that 0345 4647 has been opened
up as the number “which will eventually replace the existing NHS Direct number 0845 4647”.
After attempts to
draw attention to this published declaration of a clear intention, this
announcement was withdrawn, without comment or any note of cancellation.
A retained copy is available here. This is for historical reference only.
It had been
published at the following URL (which no longer works):
The announcement of
a three month consultation on a proposed ban on use of 084 numbers in the NHS
on 16 December 2008 is interesting the context of NHS Direct. I offer some
reflections.
The government had
stated that an announcement in respect of the single national urgent
non-emergency number and any potential NHS Direct involvement would be made by
this time, but nothing has been said. Whilst one could stick firmly to the
basic position that I hold, stating that the non-urgent health advice and
information service operated by NHS Direct is a totally separate issue, it is
foolish to pretend that the two will not be linked in practice.
Enormous efforts
are being made to stress to the public that the 999 emergency ambulance service
should only be used in appropriate circumstances. If a national number for
access to urgent non-emergency health and social care services were to be
launched and the number to call for non-urgent health advice and information
were to be changed (e.g. to 0345 4647) within a short time of one another,
there would be enormous confusion generated if the two were not to be
publicised at the same time.
There is
considerable doubt being expressed about the cost-effectiveness of the NHS
Direct telephone service. Much of the possibly excessive cost incurred in
handling calls is due to the fact that procedures cover the possibility of
calls being of urgent or emergency status. This begs the question of whether,
given that we are already perhaps paying for an urgent or emergency service, we
want to establish another.
Despite a
government decision to refuse the NHS Direct Trust the opportunity to apply for
Foundation Trust status, it continues to recruit members with a view to having
this decision reviewed at some stage in the future.
Although the
consultation is only about the type of telephone numbers that are used, the
particular nature of NHS Direct means that this cannot be considered in
isolation, especially when there are other issues of current contention. It is
even possible that it was the need to sort out some of these issues that led to
the delay of at least three months in proceeding with a ban which is caused by
the process of a consultation.
In response to a
Freedom of Information request, NHS Direct has released a list of all the telephone
numbers used for the various NHS services that it provides on behalf of various
bodies.
68 of these are
seen to be revenue sharing 0845 numbers, 7 are "freephone" 0800
numbers that are free to landline callers, but charged at a premium to mobile
callers. The 0845 4647 number is not included in this list.
This is the final list of numbers as
provided to me.
My original request was for the detail omitted from this written answer to parliament, including the relevant telephone numbers. An invitation to discuss the detail of the request was not taken up resulting in provision of this list of contracts with no telephone number shown. After a formal review of the decision to withhold all information regarding the telephone numbers, the final list was released, with an admission that it does not correspond with that initially provided. (A full copy of the exchanges of correspondence can be provided on request).
In the course of
further correspondence over the handling of the Freedom of Information Request,
I received this letter containing the
most extraordinary comment from the Interim Chief Executive of NHS Direct -
"we must categorically state that NHS Direct receives no revenue share
from the use of 0845 numbers either directly or indirectly."
Please contact me
at NHS {dot} Patient {at} ntlworld {dot} com