Personal Statement from David Hickson
I leave the statement published previously unchanged (see below).
We now have a Department of Health Consultation underway until 31 March 2009. The government has belatedly recognised that use of all revenue sharing telephone numbers is unacceptable for contact by NHS patients. We wait to see how this recognition is applied by other Departments that seek to offer services that are "free at the point of need", funded by taxation.
The purpose of the DH consultation is solely to ensure that high quality telephone systems can continue to be used when properly funded, with use of revenue sharing rightly prohibited.
The alleged technical need to use "non-geographic" numbers to enable delivery of some valuable features is covered simply. 03 numbers address this completely, with only the modest inconvenience of a change to the second digit for any existing 08 number. Such migration is fully supported by Ofcom's number allocation processes and possible as a variation to the terms of any existing telephone service supply contract.
I see my role in this process as being to support all those who serve the NHS and share my belief in its principles in making this change. I oppose those who do not support and follow the principle of the NHS being "free at the point of need" funded by taxation, rather than by payments by patients as they access services.
I do not oppose those who seek to use advanced telephone systems to improve NHS services except where their action or inaction, their failure to understand the issues or any deliberate attempt to impede the understanding of others serves to undermine the acknowledgement and implementation of this principle.
I may have views on the quality of particular telephone systems, the levels of remuneration for NHS practitioners and the tariffs of telephone companies. These may indeed be closer to those held by my "opponents" than my "allies"; however they are not directly relevant to the points at issue. The fact that revenue sharing telephone numbers are misused by other public and private bodies is relevant, but does not provide a reason to deny or delay necessary action to preserve the principles of the NHS.
David Hickson
3 January 2009
I joined this campaign in July 2007 after retiring from a modestly successful campaign for Ofcom to use its existing powers to take action against those making “silent telephone calls”.
My father, who had died some three months earlier, had made
a great contribution as a voluntary worker for the NHS in the family home city
of
My underlying “political” motivation was to try and help save the NHS from creeping “consumerism”. Where the price mechanism and competitive markets offer the best way of delivering benefits to citizens, I have no problem with them being used. I do not however believe that this applies to what we understand to be “public services”. I will always be drawn to fight around the difference between being treated as a citizen and as a “consumer”.
The NHS provides a perfect example of where these differences are exposed. The principle of “free at the point of need” means that NHS services must be funded from progressive taxation, not from payments by patients. This must ultimately undermine the consumerist principles which are being adopted in the false belief that this is the only model that users and providers can understand as the basis for delivering good services.
The consumerist principle has been cleverly applied in this case by getting patients to make a modest contribution to the funding of improved NHS services through higher telephone charges that are paid to the telephone company. Attempts are even made to obscure the fact that charges for calling revenue sharing 084 numbers are bound to be higher than those for calling “local” numbers. This suggests the absurd fiction that network telephone companies are themselves effectively paying for features of telephone systems.
Clause 483 of the GMS contract stands to ensure that GPs do not fund their services using money from patients. It is therefore being breached. Because in 2005, the DH apparently bought the fiction referred to above, it has encouraged use of revenue sharing 0844 numbers. It is therefore most reluctant to advise PCTs to take legal action against GPs who are following its advice to breach their NHS contracts.
It is to be hoped that when the DH finally concludes its “evidence gathering”, and the associated deliberations and negotiations, a proper solution will emerge. System providers will have to find a way for GPs to fund their solutions properly (i.e. not paid for by patients). Once such solutions have been developed for new customers, a way will have to be found for getting existing customers who still owe money to transfer over to the new model. Whilst in some cases it may be possible for the system to be delivered through a geographic number, in other cases it will be necessary to use 03xx numbers.
It is acceptable for patients to incur third party costs in accessing NHS services, e.g. the taxi fare to the surgery or the cost of a telephone call, at the normal rate their chosen provider charges. It would not be acceptable for the GP to have an arrangement with the local taxi firms whereby patients paid extra to fund a kick back to the surgery that was used to pay the taxi firm owner’s brother to furnish the waiting room. That is the precise equivalent of what is happening here.
The essential point is that provision of NHS services cannot be funded through payments by patients. Celebrations for the 60th anniversary of the NHS have now passed without that principle having been re-instated in practice. Focus must now turn to the proposed NHS Constitution. As currently drafted, this would require specific parliamentary sanction for use of revenue sharing telephone numbers as a means of imposing fees on patients.
David Hickson
6 September 2008