Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 460 - 479)



  Q460  Mr Amess: Do you think the current charging agreement does actually have a viable future or do you think the whole thing is going to have to be looked at again?

  Mr Lewis: We believe it is viable, but unsatisfactory at present and we would very much like to see change and we hope, therefore, that this review group that is being set up by the Department of Health will, first of all, consider a wide range of options, will look at the way these services are funded in other countries which do not involve high levels of charges for incoming calls, will consider ways of encouraging other uses to the system, and also more effective operation on the boundaries between the services that the providers offer and the things that the hospital does. Our belief is that, if there is an open mind in approaching those issues, there are a number of ways in which those charges can be reduced and we very much hope that it will operate to a very tight timetable as it is not something we would like to see drift on for any great length of time and we would like it to work to conclusions within a few months so that we can actually implement some changes quickly.

  Q461  Mr Amess: This may be a bit difficult for you to answer, but how much money do you think would have to be generated from the National Health Service to reduce the charges to a reasonable level?

  Mr Lewis: It is extremely difficult to answer that question because it depends entirely on the mix of services provided and what some of the additional costs are of providing those services. We do not see a single solution to this, but we do see, if you like, there being a menu of actions which, brought together, should enable incoming call charges to be reduced to a level that callers would consider to be acceptable and would remove a number of other irritations, one of which is the need at present for the warning at the beginning of all incoming calls about the cost of those calls.

  Q462  Mr Amess: Finally, and you have sort of already answered this, Ofcom and the criticisms—what is it your intention to do about these criticisms?

  Mr Lewis: Well, I am not usually someone who would make complimentary remarks about a regulator, but they did actually, I think, do a quite thorough job to a reasonably tight timetable. Their conclusions were that the level of incoming call charges, which was the specific bit they were investigating, were a cause for concern, they were a source of complaints and they looked out of line with other telecoms charges. However, they did conclude, first of all, that the level of those charges was heavily influenced by the specifications that had been set by the NHS for these systems back in 2000: the highly sophisticated technology; the requirement to put one of these units at every bed even though it is uneconomic; and the requirement to provide a range of free services for the NHS, such as free radio, free information services and so on. They concluded, as a consequence of that and combined with the cap that has been established on charges to patients, that the providers had very little choice other than to effectively charge these higher prices to incoming callers, and they described the charges as being the result of a "complex web of government policy and agreements". In addition to the published report—

  Q463  Mr Amess: What does that mean, do you think?

  Mr Lewis: I think you would probably have to ask Ofcom, but I think it relates back to the policy when the programme was set up and the way it was funded. They have published a report and they have also written to the Secretary of State with a series of recommendations, we understand, although we have not seen that letter as yet, but hope to do so as part of the work of the review party.

  Q464  Dr Taylor: Is it fair to say, Mr Lewis, because you have said that your system will have a computer by the bedside which would show an electronic patient record, that the relatives who are paying 49p a minute for their incoming calls are in some way subsidising the national programme for IT?

  Mr Lewis: Not at present because at present the usage of the system—

  Q465  Dr Taylor: But it is there.

  Mr Lewis: Well, indeed. The usage of the system for that purpose is at present very limited. There is just one hospital, Chelsea & Westminster, which is using our system to access an electronic clinical record at the bedside, and very successfully so, so effectively—

  Q466  Dr Taylor: Does your warning message say, "Thank you very much for using this service. It is going to cost you 49p, but you are helping the NHS towards its aim of having readily available electronic patient records at the bedside"?

  Mr Lewis: In principle, that is a correct conclusion. We do not include that in the message for fear of lengthening it further.

  Q467  Jim Dowd: Because that would cost them a further 49p! We are actually talking about the kind of charges for incoming calls that people were desperate to pay 10 or 15 years ago in the early days of mobile technology, but I will put that to one side. I am sure it is difficult to estimate, but what proportion of inpatients take advantage of your services?

  Mr Lewis: A very high proportion do. Approximately 70% of the terminals we have at the bedside at any one time have a patient registered to them and about half of those on any one day will be paying for a service or people will be paying to call them. The other half will be making use of the free services, radio, television, if they are children or have special needs, or may not be using the service on that particular day, so it does have a very high level of usage.

  Q468  Charlotte Atkins: You have said here that the installation costs are something up to £2,000. Given the changes in technology, is there the opportunity for these costs to come down? It seems to me that you have got something a bit like a white elephant in many situations because the full range of services which are provided in these units are not being exploited, so people are having to pay the cost of more than actually ringing Australia to access a friend or relative in hospital, and I speak with experience here, having ended up with a charge of £60 when a member of my family used your service. It seems to me that they are paying for something which is not being fully exploited.

  Mr Lewis: I think the answer to that is that they are not white elephants by any means. In fact our technology is regarded outside the UK as being leading edge, and hospitals in the United States, for example, are bearing the full capital costs of the magnitude you have just described in order to install these systems because they see a very wide range of benefits from them. In a US hospital there is already television and telephone there and US hospitals are paying up to £2,000 a bed in order to provide devices which will provide the full range of clinical services and other services that I have been talking about.

  Q469  Charlotte Atkins: But it is a white elephant if it is not being used. That is the point. It is not a white elephant in the sense that it is being used in other countries, but it is a white elephant if it is not being appropriately used and the full system is not being exploited, which means in fact, as Richard was saying, that patients' friends and relatives, by and large, because they are ringing the hospital and they are the ones that are being charged excessively, are   subsidising a system which is not being appropriately used in the NHS.

  Mr Lewis: In that sense, I would agree with you. I think the solution to that is to ensure that they are fully used. This investment is now largely a sunk investment; it has been made and the systems are there. The challenge, I think, is to make sure that the full potential of it is used to improve patient care, to generate the sort of cost savings we were talking about, to reduce medical errors and so on, for which there is considerable potential.

  Q470  Charlotte Atkins: But the contract was agreed when, in 2000?

  Mr Lewis: The contracts were specified in 2000, yes.

  Q471  Charlotte Atkins: So presumably technology has now moved on and you presumably have stage two, stage three of your systems which presumably, given that the cost of computers and other technology is coming down, are not as expensive as they were back in 2000?

  Mr Lewis: The actual capital cost is very similar. Technology has moved on and it has become slightly more sophisticated but the core costs, which are in designing the physical hardware that goes in at the bedside and all the cabling, have not changed significantly in that period.

  Q472  Charlotte Atkins: And as to the people who are being exploited effectively when they ring in, are you doing any sort of analysis about what sort of people are facing these huge charges, because it seems to me that the people who are more likely to use the system are the ones who cannot visit the relative, who are ringing in as a substitute for a visit, and therefore my instinct tells me that the people who face these high charges are more likely to be the people who are less likely to be able to afford them?

  Mr Lewis: The evidence we have is anecdotal but it is that the people who use the service to call in do cover a very wide range of both friends and relatives. They certainly do include those who are on lower incomes and those who may not be able to make the trip into hospital and for whom it is an important means of contact, and I think that is a further compelling reason for the need to change the structure of the provision of these services to enable a reduction in those charges.

  Q473  Charlotte Atkins: And also, of course, because the charges come on your normal phone bill, it is quite likely that complaints will not be made direct to yourselves because it is just a nasty shock when your quarterly bill comes through the door.

  Mr Lewis: That is true and that is one of the reasons why the NHS has insisted and we have wanted to make sure there is a warning at the beginning of every call so that there is less risk of there being an unpleasant shock when callers receive their bill, but it is an inherent problem with this type of service.

  Q474  Charlotte Atkins: We all know that if you are ringing someone whom you are very worried about the likelihood of you listening very closely to that particular warning message is not going to be great.

  Mr Lewis: We do have five to six million people who call using Patientline systems each year and the proportion of those who get an unpleasant shock when they receive their telephone bill and are unaware of what they are being charged is quite small.

  Q475  Charlotte Atkins: Thank you. Gill, did you want to come in?

  Dame Gill Morgan: Quite a few of those complaints that come do come to individual organisations and it is one of the strands in hospitals, complaints about the charges when the bill comes in. There are a number of reasons why the NHS is not getting the functionality. The first is that when Patientline started it was an orphan project. It was an idea about improving accessibility for patients and linking into things but I do not think at the time, in the way that it was introduced into the NHS, anyone had begun to grasp these other functionalities. Where the NHS is now is that it is not quite ready to get these functionalities because they really do depend, as Richard has pointed out, on having some of the   functionality from Connecting for Health universally available. That is why projects like Chelsea and Westminster, which are showing how you can begin to link these things together, saving staff time, giving patients much more information about themselves, giving much more information about individual conditions, are the model for the future. I think things will change but you have to have something to link that system in and that is not yet available uniformly across every hospital in the country.

  Q476  Dr Taylor: Can they look up on Google all about their illness while they are lying in bed?

  Mr Lewis: They can indeed. We provide internet access.

  Q477  Dr Taylor: Internet access as well?

  Dame Gill Morgan: Yes.

  Mr Lewis: A number of hospitals have also asked us to provide access to a variety of different information sources that they have quality control over, which may indeed include NHS Direct online.

  Q478  Dr Taylor: I shall be very well informed because I am going to visit one of the hospitals in the recess. Coming back to Gill and going back to prescription charges, could you tell us again what the piece of paper you have handed over tells us?

  Dame Gill Morgan: There was a Commonwealth Fund survey of five different countries in 2002 that asked the question had you ever not cashed a prescription or not had dental treatment, and a whole range of things, and it just showed that in the UK we had some people who had not done things because of money but it gives a comparator internationally.

  Q479  Dr Taylor: So it does give us a bit of fact?

  Dame Gill Morgan: It gives you a bit of fact, yes.

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