084 Telephone Numbers (NHS)

Debate between Andrew Smith and Simon Burns

Tuesday 24th January 2012 Westminster Hall

[The Minister of State, Department of Health (Mr Simon Burns)]

I congratulate the right hon. Member for Coventry North East (Mr Ainsworth) on securing this debate on the use of 084 telephone numbers in the NHS. The Government’s position is extremely clear—when patients contact their GP or anyone else in the NHS, they should not be charged more than they would be to call their next-door neighbour’s landline. Those are the rules. That is why we have retained the previous Government’s directions, published in December 2009, and regulations, passed in April 2010, which make it a contractual requirement for GP surgeries to ensure that that is the case.

Under the directions and the amendments to the general medical services and primary medical services regulations, it became compulsory for GP practices and NHS bodies to review how much it cost patients to call them. If they found that patients were being charged more than a standard local landline call, they had one year to take all reasonable steps, which could include varying the terms of their telephony contract, cancelling the contract, or offering an alternative number to call, such as an 03 number, which charges callers at a local rate. GP practices should not, in any case, enter into, extend or renew their contracts with their telephone supplier if patients are being charged more than a local call.

This legislation was the result of a lengthy consultation by the Department in 2009, to which there were about 3,000 responses. The vast majority agreed that patients should not be charged additional costs to contact their GP. However, many also valued the enhanced services they receive when calling their GP, such as queuing and additional booking options, but we are clear that that should not cost patients any more than a local landline call.

[Mr Andrew Smith]

Will the Minister give way?

[Mr Burns]

I will not at the moment, because I do not have much time to answer all the points raised by the right hon. Member for Coventry North East. [Interruption.] I might give way in a moment, although hon. Members should remember that the right hon. Gentleman did not give way to me either.

We must also be clear that the additional services can also be offered on other number ranges—such as 01, 02 and 03—and GP practices should feel able to choose the number that is most suitable for their patients, provided that it does not cost them any more to call.

Many people ask why we do not simply ban 084 numbers outright. I fear that that would not solve the real problem, which is that some patients continue to be, or believe that they are being, charged too much to contact their GP.

[Mr Andrew Smith]

Given that the Minister has said that practices should not charge more than the cost of a landline call to a neighbour, if a patient can demonstrate from their bill that they have been so charged, will they be able to get the money back, and how would they go about that?

[Mr Burns]

The right hon. Gentleman has anticipated something that I will deal with shortly, namely the 1,300 GP practices mentioned by his right hon. Friend the Member for Coventry North East that have allegedly been abusing the system.

As I have said, I fear that banning 084 numbers would not be the panacea that Opposition Members might believe it to be. The Department, to its credit, banned the use of premium-rate telephone numbers beginning 087 and 09 in 2005, but new number ranges with additional costs began to appear. Although it seems to be a simple solution, I do not think that it will be over the medium and longer term, because people will seek to avoid it. That is why it is crucial that the previous Government rightly sought to tackle the problem at source and why we have continued the policy that they introduced in the dying days of their regime. The 2010 regulations make it clear that patients must not be charged more to contact their GP than they would be if they called a local number.

Since the rules came into force, I understand that there has been confusion in the NHS about what the regulations and the directions include. I am grateful for this opportunity to clarify some of those misconceptions in the NHS and elsewhere. There have been claims that mobile phones are not covered by the 2010 regulations, but that is not true. The regulations cover landlines, mobiles and payphones equally. The legislation is absolutely clear that if a person calls a GP surgery with an 084 number from a mobile, landline or payphone, they should not pay more than they would if they called a local landline number from the same phone.

That is very important, because more and more people now use mobile phones as their primary form of communication, as has been mentioned by the right hon. Member for Coventry North East. That is particularly true of the less well-off—the right hon. Gentleman also made this point—where 25% of households only have access to mobile phones, and for young people, where a third of people under 25 only use mobile phones for communications purposes. In 2011, for the first time, the majority of call minutes originated from mobile phones.

Questions have also been raised about how a patient can challenge their GP practice or PCT if they believe that they are being charged more than the cost of an equivalent local call. Any action taken should be on the basis of robust evidence. GP practices and their PCTs should look at evidence of call costs to determine whether their patients are being charged more than they should be. Such evidence could include cost-per-call information from providers, such as O2, Vodafone and BT. A suitable sample should be considered, bearing in mind the different contracts that patients can choose to sign up to.

A practice can also look at cost-per-call information that is provided by patients. Using that information, it would be possible to compare directly the cost of calling a GP practice’s 084 number with the cost of calling a local land-line number. If the evidence suggests that using a specific number is not costing patients more than it should, the GP practice should be free to continue using 084 numbers. If patients are being charged more than they should be, they should take the steps that I have already mentioned to rectify the situation.

Innovation (NHS)

Debate between Andrew Smith and Simon Burns

Wednesday 12th October 2011 Westminster Hall

[The Minister of State, Department of Health (Mr Simon Burns)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I congratulate my hon. Friend the Member for Salisbury (John Glen) on securing this debate on what is widely recognised as an important issue for the NHS because of the crucial role that innovation plays in the present and will play in the future. Given his ideas, views and thoughts, he might seek to arrange a meeting, if he has not already done so, with my noble Friend the Earl Howe, who is the Health Minister with responsibility for innovation.

I shall respond by first setting out the Government’s approach to innovation, before looking at the specific issues that have been raised by my hon. Friend. As we all know, and as he has reiterated, we face a significant challenge. Without real change, the cost of health care will grow faster than the rest of the economy. Moreover, the quality of care in vital areas such as cancer will lag behind other countries, and the gap between the best and the worst NHS care will continue to grow. More of the same simply will not do. We cannot afford it and patients do not deserve it. We need, in other words, to innovate, as my hon. Friend has said.

Fortunately, there is a vast reservoir of innovation to tap within the NHS. It has a long history of innovation, invention and research by great people and great institutions. Ian Donald, for instance, pioneered the use of ultrasound in the 1950s. Sir Peter Mansfield’s work led to the MRI scanner in the 1970s. The Sanger Institute developed the first working draft of the human genome in 2000. We continue to lead the way in cutting-edge research, as the recently announced first European trial of embryonic stem cell research at Moorfields eye hospital demonstrates.

The creative spark that kick starts the long and difficult journey from initial idea to widely adopted treatment is a precious and delicate thing. We need to do all we can to encourage that creativity within the NHS—to grow and propagate the ideas that clinicians and others have for the benefit of their patients. While we continue to achieve great things, we must always strive for more.

Innovation does not happen when power is centralised and people are told what to do, so the single biggest thing that we are doing to encourage innovation is to devolve power to clinical professionals, trusting their professional judgment and their desire to do their best for their patients.

Our modernisation of the NHS will encourage innovation in three main ways. First, it will place the patient at the centre of decision-making about their own care—informed, empowered and able to choose the best possible appropriate care—so that providers will have to innovate to stand out. Secondly, it will have a resolute focus on improving health outcomes—publishing the data and rewarding excellence—so that hospitals and others will have a powerful incentive to innovate and improve. Thirdly, it will place power in the hands of local clinicians, thereby getting rid of the huge and wasteful bureaucracy that can strangle and frustrate innovation, and let the knowledge and expertise of clinicians drive innovation locally.

That will lead to a more personalised NHS, with services tailored to patients’ needs; a more integrated NHS, with solutions that tackle inequalities, improve access and deliver care closer to home; and a better quality NHS, with every provider encouraged, rewarded and incentivised to constantly improve outcomes for patients.

There is also a wider economic imperative for innovation. The health care sector, including pharmaceuticals, medical technology, research, equipment and services, directly or indirectly employs hundreds of thousands of highly skilled people in companies, from small and medium-sized enterprises to global giants, generating billions of pounds in revenues, all helping to drive future economic growth. Innovation in health care applies to everyone—scientists, nurses, doctors and managers. In fact, it applies to all those working to deliver better health, better care and better value. We must ensure that innovation is not simply the preserve of elite minds at the top of august institutions, because it is not just about the latest drugs or high-tech pieces of equipment. The spirit of innovation should be part and parcel of every part and every level of the NHS.

One of my favourite examples of innovation in action is a jug—a health care assistant in Milton Keynes decided that patients whose fluid intake needed close attention should each have a bright red water jug. That particular innovation gave ward staff a clear visual reminder of those patients’ specific needs, helped them to better care for patients, avoided the need for drips, reduced the risk of infection, cut patients’ stays in hospital and consequently cut the cost of their care. That is all because of a bright red jug and one very bright idea from a health care assistant.

We have also made a strong and ongoing commitment to innovation through research. The Government’s plan for growth cements our commitment to health care and the life sciences as a force for growth in the economy. The Government’s National Institute for Health Research aims to support outstanding individuals, working in world-class facilities and conducting leading-edge research focused on the needs of patients and the public. We have recently announced a record £800 million in additional NIHR funding for experimental medicine and translational health research. We will also streamline regulation and improve the cost-effectiveness of clinical trials, speeding up the process of translating research into better lives for patients, their families and their carers.

However, no matter how extraordinary the innovation or how miraculous the invention, it is worthless if it is not used, as my hon. Friend the Member for Salisbury said. Any innovation that is not widely adopted is a tragic waste. Like many large organisations, the NHS’s uptake and spread of innovation has often been slow. We need to raise our game, as my hon. Friend alluded to. We need to do more to recognise the contribution that innovators and innovative organisations make and to encourage adoption and diffusion across the NHS on a scale never seen before.

[Mr Andrew Smith]

In that context, can the Minister say what future he sees for the work presently being undertaken by the regional NHS hubs, especially in the area to which I alluded earlier where there might not be an immediate commercial return?

[Mr Burns]

I am grateful to the right hon. Gentleman for that intervention. I will certainly come to that matter during my comments and before we finish the debate.

A substantial amount of work is already under way, including the £60 million that has been invested in regional innovation funds, which support front-line staff to develop and spread new ideas and validate the notion that it is good to challenge the way things have always been done. The funds are massively over-subscribed and have to date given money to more than 300 projects. Further work includes the innovative technology adoption procurement programme, which aims to encourage the NHS-wide adoption of high-impact innovative medical technologies, and the innovation challenge prizes, which reward the ideas that tackle some of our big health and social care challenges, improving productivity and the quality of health care. The first innovation challenge prizes—ranging from £35,000 to £100,000—were awarded in March. Winning entries helped to reduce waste and increase the benefits of medicines, helped people with kidney failure to lead a more independent lifestyle and helped in the early diagnosis of cancer. An expert panel is going through this year’s round of applications and I very much look forward to seeing the results later in the autumn.

There is also much of value in the innovation hubs, to which the right hon. Gentleman referred. Identifying, developing and commercialising new ideas within the NHS is a must, and we need to adopt a systematic approach to that. We also need to ensure that all parts of the innovation pipeline—invention, adoption and diffusion—are more efficient and effective. The NHS chief executive’s innovation review will consider that and how we can achieve better value for money.

As announced in “The Plan for Growth,” NHS Global is being developed to help NHS organisations to compete in the global market. NHS Global seeks to build and grow the NHS brand and reputation overseas, enabling the NHS to compete in the international health care market and to exploit the commercial value of its technologies, products and knowledge. In doing so, NHS Global acts as another mechanism to support great ideas generated in the NHS being widely accepted across the world.

In the case of the company mentioned by my hon. Friend the Member for Salisbury—Odstock Medical Ltd—if it has not done so already, I suggest that it contacts the NIHR’s invention for innovation scheme. i4i supports product development and the guided progression of innovative medical product prototypes, and I strongly advise the company to get in touch with it if it has not done so.

The Health and Social Care Bill, now passing through the House of Lords, will place a legal duty on the NHS commissioning board and on clinical commissioning groups to promote innovation and research. Soon the NHS chief executive, Sir David Nicholson, will set out achievable, high-impact recommendations that will inform the strategic approach to innovation that is so important within a modernised NHS. We will open up NHS procurement to small and medium-sized enterprises, simplify the process and challenge them to come up with solutions to problems within the NHS. We have committed £10 million to the small business research initiative.

Innovation can never be mandated and it should never be restricted to a particular group. Innovation in health and social care will come from a wide variety of partners—for example, NHS staff and patients, private companies, the voluntary sector and academia. They all have a crucial role to play in pushing forward the boundaries in developing and dreaming up innovative products and services to meet the ever-increasing demands of a modernised NHS.

Innovation is not easy. It takes more than just a good idea to innovate; it takes courage to speak out against how things have always been. Innovators have to hold and develop an idea often in the face of opposition and keep pushing forward until it begins to bear fruit. I fully appreciate that the process of innovation can be a very frustrating time. We must encourage people, so that they do not become frustrated and give up. They should be able to pursue dreams and ideas that will bring a greater improvement to the general provision of health care and the NHS.

Let us imagine a world without antibiotics, without insulin, without cancer screening. Then let us imagine a world with a cure for cancer or where we can reverse dementia and end heart disease. Without innovation none of that would be, or could be, possible. Innovation is essential for the future of our NHS and for the future of the UK economy. I assure hon. Members that the Government will do everything in their power to continue to promote innovation, so that it can flourish and develop along the lines that we would wish.