89. A recent chargeable service in the NHS is the
provision of bedside television and telephone units. The NHS
Plan set a target to increase the availability of bedside
televisions and telephones in all major hospitals in England by
the end of 2004 as part of the Patient Power programme.
90. Several private companies were contracted to
supply the telecommunications services;
most signed 15-year contracts with the NHS and were given exclusive
rights to install, maintain and operate the systems. Under the
agreement there was to be no subsidy from the NHS; the system
had to be installed for free by providers and paid for by users.
The companies were required by the NHS to provide several free
services such as radio for all and television for children. The
systems were also required to provide internet access and to be
capable of calling up the electronic patient record, and sending
and receiving information both for patients and professionals.
Ten licences were granted after 2000. Private sector investment
was approximately £150 million and, by the end of 2004, over
75,000 bedside television/telephone units had been installed in
122 major hospitals and 33 smaller hospitals in England.
91. The range of services and prices differ from
provider to provider. Television use costs up to £3.50 per
day. Outgoing telephone calls are capped at around 10p per minute.
Some companies offer discounts to older patients and long-stay
patients; some allow unused credits to be distributed to patients
who cannot afford the service.
92. Bedside telephones and televisions are popular
with patients. Patientline stated that 10-15 million patients,
relatives and friends use the systems each year, with 70% of terminals
usually registered as in use by a patient. Half of these terminals
incur a charge at any given time (other terminals may be being
used by children or adults listening to the radio). We were told
by the NHS Confederation that:
The surveys that have been done show that 88%
of patients really love these things, and certainly have found
the availability of a bedside personal phone of great benefit
to them. There is very high patient satisfaction
are] a problem outside the hospital and for relatives rather than
for patients. The patients like it and value it.
93. However, incoming calls are a source of anger
and distress. They are charged at a very high rateup to
49p per minute. A recorded message, which cannot be skipped, makes
incoming calls even more expensive. This has been the subject
of an Ofcom investigation, described in the box above. At the
same time restrictions have been placed on the use of mobile phones
which may or may not have acceptable clinical or privacy rationales.
94. The cause of these very high charges is the Government's
decision to install bedside units which can be used by health
professionals to access the new electronic patient record, allow
electronic prescribing, ordering of X-rays, investigations and
the patient's choice of food, patient surveys and provision of
information and email services to patients. The private companies
believed that they would be able to charge the NHS for additional
services the Government insisted on. However, most hospitals have
not yet taken up these services, so the company's means of recouping
costs is limited to charges for telephone and television usage.
As a result, overall revenues have been lower than expected and
charges to users have been very high. Patientline has incurred
losses each year of operation, totalling £50 million.
Ofcom's investigation noted the extensive requirements set by
the Department, highlighted the initial capital expenditure required
of the provider and concluded that the providers were not wholly
to blame for the high costs imposed on callers.