Examination of Witnesses (Questions 460
THURSDAY 9 FEBRUARY 2006
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 criticismswhat
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
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
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
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
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
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.