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Personal view: Derek Hodgson

Tags: Government   GP   Imperial College   Information   iS   London   mobile   Network   Office   Savings  
29 Oct 2008

Derek Hodgson, head of telecommunications for the Imperial College Healthcare NHS Trust, takes on 08 numbers.

E-Health Insider recently reported that a freedom of information request had forced an NHS trust to admit it had earned £80,000 from an 0844 telephone number.

What the news item did not touch on is that a very significant proportion of a trust's incoming telephone calls are from other parts of the NHS; so using income generating numbers is forcing one part of the NHS to subsidise another.

It is also forcing trusts to pay much higher costs than they need to. In recent times, the Office of Government Commerce and the NHS Purchasing and Supplies Agency have negotiated contracts with the majority of telecoms suppliers to make sure the NHS obtains the best rates when making telephone calls.

Yet some parts of the service are undermining this good work by installing 0844/0845 telephone numbers and forcing other NHS trusts to pay up to 1,000% more to call them than they would if they were using a standard telephone number. Calls to 08 numbers are excluded from most discounted contracts for both business and domestic customers.

One London trust estimates it is spending in the region of £50,000 making telephone calls to general practitioners and other hospitals using 0844/0845 numbers. The cost of these calls using standard landlines would be in the region of £5,000. Multiply this across the country and the amount of money being wasted is horrendous.

Trusts and GPs adopting these numbers are also turning a blind eye to the fact that calls to 08 numbers are significantly more expensive from a mobile telephone. How can anyone justify forcing a patient, their relatives or indeed a member of staff to pay anything between 20p and 50p per minute to contact a 'free at the point of delivery' service?

There are now more mobile telephones than land lines in the UK, so it is extremely worrying that public organisations are using anything other than standard UK telephone numbers.

Additionally, 08 numbers cannot be called from outside the UK. So if you are on holiday and desperately need advice from your GP or your local hospital, you might be placed in the ludicrous position of having to call a relative to act as an intermediary - not much help if the practice insists on speaking to the patient themselves.

When the XL tour company collapsed recently, it was reported that every telephone number that was published for people to make alternative arrangements was an 08 number. This caused massive confusion because all of the people who were trapped abroad could not contact anyone - only adding to their frustration and anxiety.

Many GP's were encouraged to use the 0844 service on the basis they would get new telephone equipment "free" - but they are now finding they are paying for this in other ways.

Not only are they having to contend with an increasing dissatisfied customer base – patients - but they now realise they have a long term contractual commitment which forces them to pay extremely high call charges for their own outbound calls.

In London, the NHS internal data network (N3) can now be used for voice services; this allows participating trusts to call each other free of charge for a flat monthly service fee. This is producing considerable cost savings.

It is also providing London with a resilient network that will provide those trusts with the foresight to join with the assurance that they will be able to continue to communicate with neighbouring NHS sites if there is any disruption to the mobile or public networks – as a result of a terrorist attack or natural disaster.

Instead of looking at what I regard as unethical ways of generating income, trusts should also be using other new technology, such as speech recognition, which provides the opportunity for significant cost savings and enhancing customer care.

It is bad enough that some parts of the NHS are willing to make patients pay higher prices than they have to. But forcing other parts of the NHS to use high cost numbers to contact their professional colleagues is beyond any justification. Surely, the only people who are truly benefiting from this are the telecoms operators?

It is time someone took this issue on board an issued an immediate directive that all public services MUST publish a standard UK landline telephone number that can be used for routine telephone calls, even if this is in addition to any other numbers which they may wish to use.

 

Derek Hodgson is the head of telecommunications for the Imperial College Healthcare NHS Trust, which hosts ThamesNet.

ThamesNet is one of the largest private voice communications networks within the NHS and provides a service to a number of NHS trusts and associated research and teaching establishments. Derek has over 30 years experiencing of managing telecommunications within the NHS.

 

Is there a subject you feel strongly about? If so, why not submit a “personal view” to Lyn Whitfield, managing editor, E-Health Insider: lyn@lynwhitfield.co.uk. Articles should be no more than 800 words in length and will be subject to editing.

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1

patients and 08 numbers

04 Nov 08 21:18

Derek Hodgson says: ' ... they [are] having to contend with an increasing dissatisfied customer base – patients'

Where's your evidence, Derek? In our patient survey satisfaction with the telephone system leapt from worst to best in one year - that in which we introduced our 0844 number. It has not budged since.

We switched to an 08 number in part to control our spiralling costs for outgoing calls. The cause: our patients who you claim object to paying for calls to speak to us now expect us to contact them, almost exclusively, on mobile phones. There are two sides to telecomms, you know!

The other (actually more important) reason for us making the switch was that it permitted us to radically improve the user experience of trying to contact us - hence the patient survey results. Not only that but we only realised that all this potential was there after a minister of state wrote to us (and all other GPs) endorsing the entire approach. In the light of a ministerial endorsement my partners and I are not inclined to accept any burden of guilt, thank you!

Free at the point of use, you say. Totally spurious. The NHS has never been free at the point of use in the sense you argue. From 1948 on patients have always had to pay for the postage stamp, the phone bill, the taxi fare, the bus fare, the petrol for the car, the shoe leather etc., etc.

Not as simple an issue as you thought.


2

patients and 08 numbers

05 Nov 08 14:06

"our patients now expect us to contact them". Are you surprised when you charge them over the odds to call you, and often in my experience to hang on the line? Why shouldn't you contact them anyway, we all pay your phone bill indirectly through taxes.

"patients have always had to pay for the postage stamp, the phone bill ...". Yes, we are happy paying the ordinary cost of these but not the inflated costs for 08 numbers.

And where does this aditional revenue go? Into your pocket?

I agree with Derek Hodgson's view.


3

N3 as an alternative?

keith.baldry@nhs.net

10 Nov 08 09:47

In this piece Derek also cites the use of N3 for voice as an alternative to conventional public telephone services. All that I can say is that he must have access to a dramatically superior implementation of N3 in his local Trust to the one that others of us are experiencing. The performance and reliability of N3 that most of us have to endure mean that putting critical voice traffic over that network is the last thing on our mind.


4

Misguided wrath

10 Nov 08 09:48

Why are we (them that answer the phones) being blamed for the exorbitant costs that the mobile companies inflict upon their customers?

Call us from a landline....4ppm. Call us from a mobile....50ppm. If it's outrageous that patients pay up to 50ppm to contact their GP, then blame who they pay that money to, not us.

(No, there is no revenue share with mobile providers)


5

Mobiles and 0844 numbers

john.bishop@leics-his.nhs.uk

13 Nov 08 12:21

The point is that my mobile contract gives me 1,000 free minutes a month (which never gets used up), except when I phone an 0845/0844 number and then it costs me money.

Similarly, patients who have bought the cards for cheap international calls (I live in Leicester, and this is very common) find the surgery 0844 number eats their credit up very quickly.

John Bishop Primary care IT manager and EPS lead Leicestershire Health Informatics Service


6

N3 Voice

chris.butler@wmas.nhs.uk

29 Nov 08 13:29

N3 voice isn't actually as crazy as it sounds. The N3 network has been enabled for voice for little over a year. Like most products there are advantages and disadvantages that need to be considered. Have a look at the portal - http://www.n3.nhs.uk/n3voiceservices/ and view some of the case studies. My NHS Trust has implimented both N3 Local Gateway Service (LGS) and N3 Hosted Voice Service (HVS) solutions to link our regional sites together, with some least cost routing programming built into the switches at each of our locations we can force users over the n3 route without them even knowing as a primary and fall back to pstn as a secondary route. When you consider the options available using N3 voice to contact other NHS organisations the scheme is quite admirable in my opinion. But to re-iterate the solution has to fit your requirements and therefore requires proper analysis - you need the bandwidth and the resilience in your comms systems to ensure your communications aren't compromised if the N3 solution fails. NHS organisations should not be over-charging other NHS organisations to call each other.


7

Sound quality on mobile phones helps the partly deaf

22 Mar 09 14:14

I noticed a comment earlier in this discussion that people expect to be called back on mobiles. There is a very good reason why I use my mobile phone rather than a landline. I have become rather deaf and I find the sound quality on my mobile phone is far better than the often "mushy" sound on our landline. If someone calls on the landline, I often find I must offer to call them back on my mobile to be able to continue the conversation. The difference is quite striking and rather surprised me. (We have modern landline handsets which I believe to be good quality.) I don't know if other partly deaf people have also noticed this? Perhaps it is one benefit of the digital transmission used in modern GSM phones. Landlines involve longish stretches of analogue transmission in the local loop, which in our case is several miles.

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