I am sure that it is on behalf of the whole House that I say that we send out our sympathy to families suffering from flooding during the past few days. I know that my constituents in Burstwick and the surrounding area are concerned tonight that the Burstwick drain may overflow and cause flooding there.
I am grateful for the opportunity to speak about an issue of great importance to my constituents and an increasing number of people throughout the country: the use of 0844 telephone numbers in GP surgeries. This matter first came to my attention last year when I was contacted by several constituents. They were upset and angry that almost a dozen GP surgeries in the East Riding of Yorkshire had switched to automated phone systems using 0844 numbers, which are significantly more expensive to use than local calls. After looking into the issue in closer detail, it quickly became obvious that this was causing alarm in other parts of the country too.
According to the service provider Network Europe Group, more than 1,200 GP surgeries—about a fifth of the total number of practices in England—are now using these numbers, and it is believed that more than 300 others have had 0844 or 0845 numbers installed by other companies. In November, I tabled a motion in the House calling for an end to this use of 0844 numbers. Almost 60 MPs, from all over the House, have signed it. The Department of Health has also admitted that it has received more than 100 letters of complaint on the subject since January 2007. This issue has united politicians, residents and patients groups alike—people who can spot an unfair practice when they see one, and who do not like it when the chronically ill, the old, the disabled and those on low incomes are taken advantage of. That is what I believe is currently happening, under the present system, under the present Government.
I would like to talk a little about these numbers in more detail, and then discuss how they came into existence in the first place, before giving my reasons why they should cease to be used in this way. Such numbers are part of a revenue-sharing telephone system. I have corresponded on this subject with various people, including the British Medical Association, which suggests that no one has benefited from it. However, in case anyone is any doubt, I looked on the internet this evening, and I can tell the House that Call Sure business telephone numbers will provide basic 0844 special rate G6 telephone numbers and that they have
"Other revenue generating opportunities available".
If someone installs an 0844 number, the company will ensure that the business concerned earns up to 1.45p per minute. I believe that on the scale that GPs operate, that could be up to 2p per minute—albeit that, I am sure, the money is recycled for the benefit of patients.
The money generated from each individual call is shared between the phone operator and the GP practice in question. Although they are not officially classed as premium-rate numbers, the new numbers are up to 4p per minute more expensive to call from a standard BT line and can cost up to 40p a minute from a mobile phone. As I said, 2p of that can be contributed to the GP's practice.
Is my hon. Friend saying that in the NHS, which was set up to be free at the point of delivery, people are now having to pay—on top of the basic cost of their call—to get through to their GP? If so, I find that quite extraordinary. I did not know that before I came to the Chamber just now.
It is a shocking fact that after 10 years of this Labour Government—the principle behind the NHS being that it should be free at the point of delivery—my constituents, as they travel to shift work in Hull from rural Holderness, can find themselves, as they drive along, unsure about whether they will secure an appointment that day, whether they will be at work or whether they will have to ask their boss to allow them to go back and see the doctor, and when the systems open at 8 o'clock, they are on their mobile phones—
Yes, using a hands-free kit. They may be being driven by a colleague, in a car-share—I am sure that the green inhabitants of my constituency would be doing that. They call up, and when they are put in a queue, it can cost 40p a minute. Whom will it affect most? The chronically ill. Among the chronically ill, on whom will it impact hardest? Those with the lowest incomes. I cannot believe or accept that the Government and the Minister—who I know is a hard-working campaigner for all the people in our system, and takes a great interest in social care and other matters—are comfortable with that ongoing scandal.
May I suggest to the hon. Gentleman that things are worse than that? If his constituents decide to phone NHS Direct, they use an 0845 number. If they lose their jobs, they might be faced with an 0845 number when claiming jobseeker's allowance through the Department for Work and Pensions. If they get tax credits, they might have to call an 0845 number. Even worse, if they are fed up with all that and complain to the parliamentary ombudsman, they still have to call an 0845 number.
The hon. Gentleman makes a powerful point. I am sure that the House welcomes his intervention.
The system directs patients to services and clinics at their local practice. Network Europe Group claims that it benefits patients because it allows them to be placed in a queue, rather than having to put up with a constant engaged tone. Previously, it says, 92 out of every 100 people who called their local GP surgery were greeted with an engaged tone. Patients groups, and many of my constituents, however, have complained that people are queuing for much longer under the new system, and consequently being left out of pocket. Katherine Murphy, of the Patients Association, said:
"It's a scandal and it's blighting the vulnerable and the elderly. You ring up and you're confronted with a long menu of options. And all the time it's costing, costing, costing an absolute fortune."
This is not the first time that the issue of high call charges to GP practices has been brought to the attention of the wider public. In April 2005, the Department of Health issued guidance over complaints that GPs were using premium-rate 0870 numbers, which are even more expensive than 0844 numbers. A memo sent to all primary care trust chief executives on
"stopping GP Practices adopting high cost telephone numbers. A ban on...0870, 0871 and 09 numbers comes into force on 14th April."
It went on to say:
"Ofcom recently consulted on proposals to change the regulatory regime that supports Number Translation Services (including the 0870, 0844, 0845 and 09 number ranges)...This could mean that revenue sharing on 0844 numbers is not possible."
The memo warned GPs that they should
"bear this in mind if they are considering a move to non-geographical numbers, such as 0844, particularly until Ofcom have published the outcome of the review and the implications are understood."
The thinking was that Ofcom would come to the rescue and rule out that practice. It tells us that, in addition to the abolition of 0870 numbers, which then cost around 10p per minute from a landline, the Department had recognised that the use of 0844 numbers within the public sector was unacceptable. That was reinforced in 2006, when Ofcom, as a result of the consultation, decided to create a new countrywide number range, "03", which would be charged to the consumer at the same rate as calling a geographical number and could be included in any inclusive or low-cost call packages offered by landline or mobile phone companies.
In my area, Kingston Communications provides most of the telephone supply, and my constituents could call 03 numbers free of charge within that package. However, the 0844 system means that they are charged a premium rate. The 03 number was to be an attractive alternative for GP surgeries and other public sector bodies. Unfortunately, however, its take-up was not made mandatory. A Department of Health memo, sent to all PCT chief executives in December 2006, stated:
"The '03' number range is due to be introduced in early 2007. There has been no explicit requirement made by Ofcom for practices to adopt a '03' telephone number but this clearly had its attractions."
What has happened since is entirely predictable. Once the 0870 numbers were abolished, GP surgeries moved quickly to install the 0844 numbers. That practice has continued unabated. As I said, 1,200 practices across the country are now using the new system, and the Network Europe Group are thought to be installing the lines in up to 40 surgeries every month, while the Under-Secretary simply sits on the Bench.
The Department of Health has failed to take responsibility for the problem. Its December 2006 memo stated that it is for
"individual practices to decide what is in their customers' best interests, taking account of the COI guidance on Cost to the Citizen. Normally this will mean the lowest cost per call to the patient (local geographic number or adopting a '03' number)."
It went on to say that individual PCTs should ensure that
"patients telephoning practices do not pay more than they would if they called a local geographic number."
That aspiration, which the Government stated, has not been realised. We are here tonight in the hope that the Under-Secretary will tell us that the Government have recognised where they have gone wrong, and will take steps to remedy the problem.
The message was reinforced in October 2007 when the Minister of State, Department of Health, Mr. Bradshaw, stated in a letter to the chair of the East Riding of Yorkshire patient and public involvement forum:
"we do not want to see people charged excessively for contacting their GP...We believe that NHS organisations, as providers of public services, have a duty to ensure that they provide the best service possible for those whom they serve."
The Government have subsequently said that although they do not expect GPs to break existing contracts with suppliers, they should not enter into new ones that would mean patients being charged more than for a local call. Clearly, with up to 40 surgeries a month choosing to install the new system, that guidance is not being followed.
While the Department has continued to shirk responsibility for the situation, patients have been suffering. One constituent wrote to me, saying:
"I am a district nurse in Hull and one of my GP surgeries has installed this type of phone system! The patients are commenting frequently about the cost and length of time that the surgery takes to answer. I have one patient who says he was on hold for 45 minutes. There are many who initially complained when the system was installed but the system remains. I regularly have to phone them using the community trust mobile which no doubt costs a fortune, however I find it quicker to leave the office and drive to the surgery."
Another constituent wrote:
"I pay £5 per month and all 01 calls are free, any time, any day, anywhere but I have to pay for 0844, 0845 numbers and mobiles. I have to see the doctor four times a year for check-ups, but I don't phone in for opps any more—I have to go to the surgery. I'm 84 years old and don't see why I should have to do this."
For many people, calling their local GP surgery can be stressful and worrying. That is especially true for the poor, the elderly and the disabled. They should not have to put up with high call charges, too. The Department agrees with that assessment. It has said that patients should not pay more than they normally would for a geographical number. Ofcom also agrees. In a written memo sent to me last week, it stated:
"Ofcom does understand the particular concerns about public sector use of 084 and 087 numbers and has sought to raise awareness of this issue in the public sector. Ofcom has also made clear its view that it is inappropriate for public bodies to use chargeable 08 numbers (without also publishing a geographic number) when dealing with those of limited means and other vulnerable groups."
Most of us would agree that there are few more vulnerable groups than the sick and the elderly, yet those phone charges disproportionately affect those two groups of people.
Ofcom has made great progress, in issuing more than 13 million 03 numbers, including to the Ministry of Defence and the Royal Society for the Prevention of Cruelty to Animals. However, the problem will be resolved only when the usage of 0844 numbers in GP surgeries is outlawed.
Will my hon. Friend confirm that one of the difficulties with the current system is that it is so unclear about what charges are made for which numbers? How much it will cost a patient to call his or her surgery is often a mystery, because it is not clearly advertised on the link to the phone number for that surgery.
My hon. Friend is right: the costs are not transparent. Some of the 0845 numbers have a different tariff from the 0844 numbers, but what they have in common is that they are typically not included in the standard call charges covered by a telephone package.
As I was saying, the problem will be resolved only when the use of 0844 numbers in GP surgeries is outlawed. Neither Ofcom nor the local PCTs have the power to dictate which telephone lines are used by GPs. That can be a matter for only one person—the Secretary of State. I urge the Minister to look again at the issue and put an end to this rip-off practice, which is hurting the poor and the vulnerable, and causing a great deal of distress to thousands of people throughout the country.
I congratulate Mr. Stuart on securing this Adjournment debate on an important subject. He has raised the issue in a number of ways over a period of time. He is right to maintain the focus and the pressure on an issue that should concern all hon. Members and that does concern many patients and families in different communities up and down the country.
May I also associate myself with the hon. Gentleman's remarks about people facing concerns connected with flooding? I would say to him that, as in the past, this Government—a Government of a state that is on people's side when they have difficulties—will intervene to support those communities that are most affected by flooding.
I do not think that the hon. Gentleman sought to make a major part of his contribution a party political speech, but I should also tell him, very gently, that people in this country were not that long ago not simply waiting for a few minutes in a queue to have their calls answered, but waiting years to have major operations for serious, life-threatening conditions. Let me say one more gentle thing to the hon. Gentleman—
I will be even more gentle. One of the inconsistencies that presents itself in the Chamber, day in and day out, is when Opposition parties demand a command-and-control approach to public service intervention, but when in their manifestos and public pronouncements about everything that is wrong with public services they say that they would trust the people and devolve power into the hands of front-line professionals and, on occasions, managers. That is one of the great tensions—when Opposition Members, on populist issues or an issue of direct concern to their constituents, demand ministerial intervention at every opportunity. I would therefore say to the hon. Gentleman—again, very gently—that there must be some consistency and integrity in the arguments that hon. Members use about the appropriate responsibilities and accountabilities in our public services.
"Sick people and their families should not be asked to pay over the odds to contact local NHS services", changes were made to deal with 0870 numbers. There is already a system established. From
May I say gently to the hon. Gentleman that of course the Government believe that, on occasion, it is appropriate for Ministers to intervene to make clear what is acceptable in regard to the decisions made about our public services? That has been the hallmark of this Government over the past 10 years. The difficulty we have is that the Opposition parties constantly question that way of governance and decision making in public services.
I want to address this point seriously and to comment on the substantive contribution that the hon. Gentleman has made. It is entirely unacceptable for any professional working under the banner of the national health service to rip patients off by charging them more than the standard local call rate for contacting their surgeries. That is the Government's position. Difficulties arise, however, when individuals are tied into existing contracts. That involves a commercial arrangement. The hon. Gentleman will be aware that GPs are self-employed; they are not employees of the state. I am not sure whether he is proposing to change that arrangement.
We need to consider the best way to achieve our common goal of preventing the exploitation of patients and stopping this practice being regarded as acceptable. It is regrettable, and almost disappointing, that politicians have to make this point to the national health service.
Does the Minister think that the problems that people have getting through to their GPs' surgeries are a significant contributory factor, particularly in regard to the premium rate numbers that charge more than the local call rate, when people sometimes have to wait upwards of 20 minutes to get through? Does he think that that contributes still further to the problems relating to charging?
I am now being asked to get even further into micro-management by analysing the demand on a telephone system and the reason why people might have to wait for a specific period of time. Hon. Members will be familiar, from their own household experiences of trying to contact utility companies, with the often inordinate length of time that they have to wait before their call is taken. It is impossible for me to make a sweeping, generalised statement about whether people are having to wait an unduly long time because GPs and other professionals are choosing inappropriate telephone systems with inappropriate cost levels, or whether they have to wait a significant length of time because of the demand and pressures that any phone system would experience.
Surely the question here is one of transparency, as the hon. Member for Beverley and Holderness said. The charging implications should be absolutely clear to patients and, indeed, to other professionals telephoning GP practices in these circumstances. Transparency is incredibly important, as is fairness. The hon. Gentleman was also right to talk about people on low incomes, isolated older people and people with chronic conditions. We do not want to see such people being ripped off or exploited in any way.
If calls are being charged for in this way, there must surely be an incentive for those who err on the side of the unscrupulous to keep their patients waiting even longer, so that they can get even more money. On the Minister's point about transparency, perhaps the last thing people who are in ill health need to know is that it is going to cost them 50p a minute to be kept waiting for 10 minutes. That might put them off waiting, and the GP practice would have spoiled the ship for a hap'orth of tar.
There may be one or two candidates in the Chamber for interpreters of the hon. Gentleman's contribution, but he makes a valid point. There are incentives within GP contracts—response times, including telephone response times, for example—and they are usually measured through patient satisfaction surveys. The system of contractual relationships with GPs thus provides some incentive for them to respond as quickly as possible.
I would also say to the hon. Member for Beverley and Holderness that it is important to be measured. The vast majority of GPs would not dream of deliberately seeking to exploit patients by keeping them hanging on the end of a telephone simply to generate income. It would be extremely unfair and unfortunate if any Member were to give the impression that significant numbers of GPs would engage in such practices. I do not believe that they would.
My hon. Friend has characterised these numbers as unfair, particularly for the sick and the elderly, and I quite agree with him. He also made a valid point about how much command and control can be exercised from Whitehall, and he referred to GPs who already have contracts in place. Will he assure the Chamber that when the contract next comes up for NHS Direct, which is under the control of Whitehall, it will not be renewed at an 0845/46/47 or similar higher-rate telephone charge?
I can give my hon. Friend a cast-iron guarantee that that will not be allowed to continue when the NHS Direct contract comes to an end. That provides a very important example of the Government leading by example in this area.
The hon. Member for Beverley and Holderness and I have a shared objective and belief in transparency and fairness. The question is how we achieve our objective. I think that, as a precursor to further guidance or diktat from Westminster or Whitehall, we need to gather some hard evidence in the period ahead, so that we can be absolutely clear about the nature and extent of this problem and the range of potential solutions. For example, it is important to establish what proportion of GP practices—and it applies to other professionals in similar circumstances—are tied into long-term contracts on this basis, which would render hollow any Government promises issued from the Dispatch Box about patient experiences.
What I will commit to tonight is ensuring that the Department begins a serious and substantive gathering of evidence. I invite hon. Members to submit their evidence to that process so that, having established the facts, we can look into the case either for guidance or for going beyond it. I believe that it is an all-party view that no patient or user of the national health service in this country should be ripped off or exploited in this context.
I am grateful for what the Minister has just said and I believe anyone listening to the debate will also be grateful. I put it to him that in addition to having extensive and proper research into the issues, he should look further into dealing with the surgeries that have not yet signed a contract. If the Minister could try to influence the Government as soon after tonight as possible so that guidance could be issued to stop any more practices signing contracts that will doubtless have to be honoured in some way, that would represent at least some steps forward. We could then see the way forward to the future.
I am happy to send a strong signal to any practices currently contemplating decisions on the issue. I urge them to reflect on the fact that many of their patients will be on low incomes and particularly vulnerable. In those circumstances, they should consider whether it is consistent with best professional practice to go down the road of charging patients above the local rate. I am happy to make that clear from this Dispatch Box.
I also caution such practices that as the Government are consistently focusing on the issue and will begin a serious evidence-gathering process, that might lead in the not-too-distant future to even stronger guidance on what will be expected of GPs and associated professionals. GP and primary care practices were cited in the debate, but it is unclear, and we must establish, whether other organisations—my hon. Friend Rob Marris referred to a range of public services in which this is an issue—such as NHS provider organisations, are engaged in the activity.
The issue is an important one, and the Government are determined to get to grips with it. Our common duty is to ensure that patients are not exploited and not ripped off, and that we create a system that is both fair and transparent.
Question put and agreed to.
Adjourned accordingly at nine minutes to Eleven o'clock.