NHS Commissioning Board (Mandate)

Bob Ainsworth Excerpts

Tuesday 13th November 2012 Commons Chamber

[Mr Hunt]

I thank my right hon. Friend for the work he did at the Department, which is widely recognised on both sides of the House. He is right to talk about the critical role of carers. We have spoken a lot today about dementia. Dementia puts huge pressure on partners of the people affected. Very often, because we do not give the support we need to give at an early stage, people with dementia end up having to go to residential homes, whereas with that support, they would be able to stay at home happily for much longer. It is a critical issue. I hope he will be pleased to see in the section on long-term conditions explicit mention of the role of carers. We will follow the matter closely as the NHS Board implements at a local level the support he mentions.

[Mr Bob Ainsworth (Coventry North East) (Lab)]

My constituent Michael Wade was wrongly refused surgery for a life-threatening condition. What in the mandate improves patients’ rights, or will they have to continue to have to rely on MPs and campaigning local newspapers?

[Mr Hunt]

Any such examples are totally unacceptable. The rights that people have to the treatment they need clinically are enshrined in the NHS constitution. There will always be a need for MPs and other campaigners to highlight problems in the system, but we hope to make it much easier by exposing unacceptably low levels of clinical care much earlier than happens currently. As a result of the changes in the next two years we will see the NHS becoming the most transparent health care system of any in the world, which we hope will enable us to identify failures before they lead to the kind of tragedy the right hon. Gentleman mentions.

084 Telephone Numbers (NHS)

Bob Ainsworth Excerpts

Tuesday 24th January 2012 Westminster Hall

[Mr Bob Ainsworth (Coventry North East) (Lab)]

Thank you very much, Mr Streeter, for presiding over my debate.

In 2008, in response to a consultation, the Department of Health concluded that for some individuals on low incomes and unable to access a fixed line, the use of NHS 084 telephone numbers constituted a significant proportion of their weekly income. In April 2010, as a result of that conclusion, the Department amended the general medical service contract and the personal medical service agreements for GP practices to ensure that

“persons will not pay more to make relevant calls to the practice than they would to make equivalent calls to a geographical number.”

GP practices were given until April 2011 to comply with the amended terms, but unfortunately, now, nine months after the deadline, Which? and other organisations estimate that 13% of surgeries in England continue to use 084 or 085 numbers that cost more than the equivalent geographical call.

One might think that as the amendment was made at the end of the previous Labour Government and we now have a new Conservative-led coalition, there would have been a change of policy, but that is denied. The Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton) said, on 12 July:

“It is absolutely clear that there is no distinction between landlines, mobiles or payphones. The directions are very clear that patients should not expect to be charged any more.”—[Official Report, 12 July 2011; Vol. 531, c. 150.]

So we can only conclude that 13% or thereabouts of GPs, including at the Crossley practice, which serves a deprived part of my constituency, and at least one other service in Coventry, are in breach of their own contracts, which were agreed by the previous Government and are supported by the current one. We have to ask why they are being allowed to continue to do that.

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

Will my right hon. Friend give way?

[Mr Ainsworth]

If my hon. Friend can wait, I will try to give way later. A number of Members want to intervene.

The GPs argue that they have entered into contracts that give them enhanced telephony solutions, and that they cannot get out of them. That is the kind of thing that they say to justify their non-compliance, but none of it is true. All the arguments are flawed, and there is the simple solution of migrating to an 034 number, which provides the same supposedly enhanced telephony services. As an aside, I will say that what we mean by such services is call queuing and call diversion options. When in the middle ages people fell foul of the inquisition, they were shown the instruments of torture but not made to pay for them, but people are now being made to pay for these supposedly enhanced telephony solutions.

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

Will the right hon. Gentleman give way?

--- Later in debate ---

[Mr Ainsworth]

If the Minister does not mind, a number of Members want to intervene, and he will have an opportunity to respond in a moment.

The people affected are disproportionately the more deprived members of our community. It is no longer the case that people who use mobile phones are among the better-off. That might have been the case once upon a time, a generation or so ago, but there is proven evidence that people who do not have access to a fixed line and therefore depend on a mobile phone are disproportionately from the poorer sectors of society. The other people who are disproportionately affected by the excessive charges are those who are concerned about the cost of their fixed lines and have therefore entered into contract agreements that charge for the use of the access numbers for GP surgeries because they do not fall under the contracts. How can we can allow GPs to continue to flout their contracts? Why are we not effectively enforcing them?

At the moment, the Minister is trying to convey to the House that the NHS will not be made unaccountable through his health Bill, and it would really help his argument if he made an effort to show that he is prepared to make the NHS accountable, as it currently is. I would therefore like to know what he intends to do about this. I want him to issue new Department of Health guidance that makes it clear to the GPs who are effectively trying to deny it that the use of such telephone numbers is in breach of their contract and that they must comply without further delay and migrate to an 03 number or provide a landline equivalent. He must not take no for an answer.

I wonder whether all the changes that the Minister is imposing upon the NHS are affecting PCTs’ ability to enforce what they are supposed to be enforcing. I want him to ensure that PCTs, to which he appears to have passed the buck of responsibility for this, enforce compliance by GPs. GPs must stop evading their responsibilities, under the very principles of the NHS, to enable people to access services without enhanced costs.

[Mr Jim Cunningham (Coventry South) (Lab)]

Has my right hon. Friend been able to measure the profit being made from the poorer members of society, who are most likely to need the services? That might be difficult; it might be a question for the Minister. Less well-off patients are clearly being exploited, so does he have any idea how much they are being exploited by?

[Mr Ainsworth]

The GPs will deny that there is any profit and will say that they provide an enhanced service for which the customers pay. But if there is profit in the partnership at the end of the year, it returns to the doctor, so potentially there is a profit, and that would clearly be in breach of the contract. People could be provided with access to their GP services without any enhanced charges, but GPs, because they have chosen to enter into the contracts, are passing the costs on to their patients.

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate my right hon. Friend on securing this important debate, on an issue that my constituents, in Risinghurst in particular, have raised with me. I commend his suggestion to the Minister that renewed guidance be issued. Could the Department not send out with it a legally watertight template letter that any GP practice that is genuinely worried about its legal status regarding its present contract could use, to change to the cheaper alternatives that he has mentioned?

[Mr Ainsworth]

That is a good idea. If the Minister communicates with GPs again, he should do so in the strongest of terms, because it is clear that well over 10%—the estimated figure is 13%—of GPs have totally ignored the Department of Health to date. They are determined to continue not to pick up the costs of the systems that they have put in place and to pass them on.

[Jim Shannon (Strangford) (DUP)]

I am grateful to the right hon. Gentleman for bringing this critical issue to the House’s attention. Many of my constituents do not have landlines, but they have mobiles, the costs of which are extreme. A call to a doctor can cost £4, and some of my constituents’ tariffs have run out while they were on the phone. Does the right hon. Gentleman agree that it is time to return to a landline number rather than an 084 number?

[Mr Ainsworth]

The 03 number would give people an opportunity to use the system for no enhanced charge, and the GP should, if they are not prepared to migrate to an 03 number, provide a landline alternative. Since I first raised this issue, most of the people who have contacted me have been pensioners. They have told me that they have contracts with their telephone provider and have found that, at the end of the quarter, the charges under discussion are additional to the contract and therefore to their bill. People who use mobile phones are probably not as ready to contact a Member of Parliament, or do not listen as closely as pensioners to such debates. People who use mobile phones—overwhelmingly poorer people—are being charged extortionately for access.

[Dr Eilidh Whiteford (Banff and Buchan) (SNP)]

This is a very important issue, because it affects all parts of the UK. A much smaller percentage of people in Scotland are affected by 084 numbers, but more than half of them are in the Grampian health board region. I am concerned, because although I share the right hon. Gentleman’s sentiments on the difficulties faced by people in lower income groups in relation to 084 numbers, if we secure a ban on them, how will we prevent the goalposts from shifting and another revenue-sharing number from taking their place?

[Mr Ainsworth]

We can do that only if the Department of Health is determined, right up to ministerial level, to enforce the contract. The terms of the contract are clear, as I hope the Minister will say when he responds. No one should pay enhanced charges to access their GP.

[Mr Simon Burns]

indicated assent.

[Mr Ainsworth]

The Minister is nodding. Let us hope that he says that and that, for heaven’s sake, we do not have non-Government and that, having made a decision, they make sure that it is complied with across the board. I look forward to hearing the Minister’s response.

--- Later in debate ---

[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.

[Mr Ainsworth]

Although I welcome a lot of what the Minister has said, I am not at all sure that we can afford to leave this problem to the individual. There is deference towards doctors and people are loth to offend or upset their doctor. The Department and the local PCT must be prepared to take action to ensure compliance, and they should not expect individual patients to do so.

[Mr Burns]

The right hon. Gentleman anticipates a point that I was about to make. As a preface to that point, however, I must say that patients can be extremely helpful in providing evidence that can help to prove if this practice of overcharging, which is in defiance of the regulations and directions, is going on.

I now come on to the point that the right hon. Gentleman made about the figure that is in the public domain and that is used a lot, namely that there are 1,300 GP practices that are—in effect—defying the regulations and charging patients more than they should. I have made inquiries and I can find no evidence to support that figure. People say that there are 1,300 GP practices that charge more than they should; what they do not say is which practices they are, and they do not provide the robust proof that overcharging is happening.

I say to the right hon. Gentleman, and to anyone else who has an interest in this important subject, “Please send us the evidence”, because we cannot find concrete evidence that overcharging is going on. If it is going on, we want to see the evidence and we want to see which GP practices are engaged in it, so that the PCTs, which enforce these regulations, can take action. I assure the right hon. Gentleman that if we get the evidence and if it is proven that overcharging is happening, the PCTs and—after the modernisation of the NHS—the NHS Commissioning Board, which will have responsibility in this area, will also vigorously pursue the matter because, like his Government, we believe that such overcharging is unacceptable.

However, I must reiterate that we need the evidence. We do not need anecdote or the “friend of a friend”, who has said this or that. We need precise, concrete evidence, to be able to pursue this matter.

As I have said, PCTs are currently responsible for ensuring that GP practices meet the terms of their contracts, including ensuring compliance with these regulations. The Department will soon clarify the existing guidance, which I hope will help GP practices and PCTs to understand this issue more fully and to dispel some of the myths and misunderstandings about the use of 084 numbers.

This Government are committed to creating a patient-focused NHS, as the right hon. Gentleman said we were planning to do; I can confirm that he was accurate when he said that. One of the key elements of that process is ensuring that patients find it easy to access the services they need, when they need them. Using an 084 number can help a GP practice to offer additional services that improve patients’ access to care. It is right that GPs remain responsible for their own access arrangements, including their telephone number, opening hours and booking arrangements. Those arrangements will be different for different practices, and the ability of GPs to be locally responsive is something that we know patients value. Primary care is the cornerstone of the NHS. Around 90% of patient contact with the NHS takes place in a primary care setting, with around 300 million consultations per year, so it is essential that patients can easily access care, and have a choice about how to do so.

One way that we are improving access to care is through the roll-out of the NHS 111 service, which will be available to everyone in England by April 2013. That service will give the public a phone number that is easy to remember and free to call when they need help urgently but do not know where to turn. Callers will be quickly assessed, and sent to the right service on the first point of contact. The primary aim of NHS 111 is to ensure that patients get to the right service, and quickly, at any time of the day or night. In most areas, patients can also expect to be able to see their out-of-hours GP through NHS 111, which will simplify how patients access NHS services and improve patient experiences.

NHS 111 will replace NHS Direct’s 0845 4647 service, which obviously uses an 084 number. NHS Direct was exempted by the last Government from the directions and regulations, and rightly so. That is because the Department had already begun considering plans to implement NHS 111, and it would have been confusing to the public to change NHS Direct’s number shortly before introducing a new number for patients to call that will be free to the user.

By April 2013, there will be a simple system in place, whereby patients can access care quickly and easily. If there is an emergency they should dial 999, but if people do not know where to go they should dial 111, and otherwise they should continue to use their GP as usual.

I give an assurance that we take these directions and regulations very seriously indeed. We expect them to be adhered to and obeyed. I can assure Opposition Members who raised this issue that PCTs carefully monitor the situation to ensure that, when there are complaints about 084 numbers, GP practices are adhering to the regulations and not costing patients more than they should. The PCTs vigorously enforce the regulations. I also reconfirm that we are issuing clarification guidance to GPs, which I hope addresses another point that the right hon. Gentleman made.

I cannot emphasise strongly enough, however, that despite the numbers that are bandied around—as I said earlier, 1,300 is the number that is most commonly used to describe the number of GP practices that are not adhering to the regulations—we cannot find any evidence to establish the accuracy of that figure. Nevertheless, we are anxious that the regulations are enforced. So, if there is any concrete information, proof or evidence that GPs are abusing the system and not abiding by the regulations, it is important that that it is provided to the PCT, which acts as the enforcement officer. If the right hon. Gentleman himself has concrete evidence— following the research that he has conducted to secure this debate and then take part in it—and wants to send it to me, I would be more than happy to accept it and I will direct it to the appropriate body, whichever PCT it is, so that the allegation can be investigated.

In conclusion, the use of 084 numbers is controversial but we are very clear that patients should not be charged more than they would be to make an equivalent call to a local number. That is the belief and principle that underlies the policy, one that we are continuing from the last Government’s term in office. However, we also believe that we should not restrict the freedom that GPs have to improve access arrangements for their patients, provided that they are complying with the regulations. I hope that this debate has not only clarified the situation but has set a challenge to the right hon. Gentleman and others to provide evidence if they have it or come across it, so that if there are any abuses we can put an end to them.