Under the NHS Plan in 2000, telephone, television and radio services were to be installed at every bedside within major hospitals, to improve patient experience.
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However, 10 years on these systems are still not profitable, according to the companies who provide the services. The patients say they are costly and unfair and patient's groups such as the Patients Association have labelled them 'an unfair tax on the sick'...
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Long stays in hospital are tough both for the patients and their relatives. Small things can come to mean a huge amount for those who spend time in the wards, cut off from home life, like watching their favourite television programmes or being able to speak to family and friends on the phone. The NHS delivers some of the best, most complex medical care in the world, so surely providing bedside telephones and televisions should be simple?
In 2000, the then-government set up a new system which enabled private companies to bid to install and manage bedside facilities. The successful ones would then recoup their investment by charging patients to use them. But ten years later, all of these companies are struggling to break even and as they try to make a profit there's only one place the cash can come from, and that's the patients.
For years, those patients and their families have been contacting Watchdog about the prices they've been asked to pay. It's clear that for some, these charges are only adding to the stress they're under while in hospital.
David Moran who went into hospital with suspected cancer last year. He found out, too late, that his bedside phone unit was charging 39p a minute for incoming calls. He had one half-an-hour conversation with his wife and it cost him £12. David told us:
"I was in hospital, suspected cancer, been operated on, and I couldn't speak to my wife. 39 pence per minute was just too much for us, and I think it was very, very unfair that I should be isolated from my wife."
David later got a refund due to a bad connection on the line, but he didn't use the phone again.
And David's not the only one. Alina Lacob's partner Antonio was in and out of hospital throughout 2009. Antonio suffered from a disease of the immune system. Alina said they were not able to use the telephone, particularly for incoming calls.
"The charges were outrageous, absolutely huge."
As Antonio was in hospital for weeks at a time, he came to rely on the television as the main source of entertainment. If you watch TV at home, the licence fee adds up to 40p a day. However, if you watch it in hospital, you can pay more than 12 times that.
Some of the hospital TV providers will charge you for watching television in continuous blocks of time, even if your set isn't actually on. So, for example, if you are in hospital and it's a Tuesday. All you want to watch is the lunchtime news and Eastenders, both of which are 30 minutes, but on at different times of the day. You can't just pay for an hour's worth of viewing and use it when you want. Instead, in some hospitals, you would have to pay for a whole day's worth and the cost can be up to £3.50. And should it be that on top of those two programmes, the only other thing you wanted to watch is Watchdog on the Thursday, then you'd have to buy two whole days' worth of viewing and the cost would be up to £7.
Some hospital TV providers do now let you buy an hour's worth for £1, or two hours for £2. But you can't stop and start it, so if your programmes are on throughout the day, you'd need to shell out each time they are on. Watchdog has had complaints about systems developing faults and no-one being on hand to fix them. However, some patients feel they have no option but to pay for the service. Alina Lacob explained just how important the television was for her partner Antonio:
"It was very important. He used to watch the news and all of his favourite programmes, it's a way of disconnecting yourself from what's happening".
Sadly Antonio passed away in October 2009. Over the five months he was in hospital, they'd spent nearly £500 - simply for him to watch TV.
"It was very difficult, the mortgage was still coming out of his account, the bills were still coming out, his wages were going down," Alina said, "Considering what he'd been through, the television should be the last thing to worry about."
Groups who represent hospital patients agree. Mike Hobday, Head of Policy at Macmillan Cancer Support told us:
"It's shocking that people with cancer are forced to pay a premium to watch television and speak to friends and family while in hospital receiving life-saving treatment. These are extra costs for cancer patients who have already been stung by having to pay high prices travelling to and parking at hospital. These charges are just another tax on the most sick and vulnerable. The very last thing that seriously ill cancer patients need to worry about is money."
Michelle Mitchell, Charity Director at Age UK said:
"Almost two thirds of hospital beds are used by people over 65, many of which can experience long or repeat admissions. Access to a telephone and television can be extremely valuable to many older patients. It is very unfair that using such services means patients face an additional expense at the end of their stay, which can add up to a considerable amount over time. Older people, many on low incomes, do not choose to spend time in hospital and burdening them with additional costs for basic services is unhelpful during what will be a distressing time."
Katherine Murphy, Chief Executive of the Patients Association said:
"Going into hospital is a stressful and worrying time, but most patients do not anticipate quite how expensive hospital stays can be. With car parking charges, inflated shop prices and in particular the exorbitant cost of some hospital phones, the cost mounts very quickly, making a mockery of the NHS being 'free at the point of care'. When a hospital stay is extended, people will naturally want to stay in contact with loved ones. With a ban on mobile phones still operating in some hospital wards, some patients are forced to use the expensive hospital phones which have an effective monopoly to charge what they like for calls to be made. The price of a local call can exceed the normal rates for international calls making it harder for people to stay in touch with their loved ones, often when they are at their most vulnerable. These charges represent an unfair tax on the sick, who will have no choice but to pay up if they want to keep in contact with the outside world."
For elderly patients, hospital TVs are not just expensive, they can also be confusing and complicated. Len Liggins was admitted to hospital on Boxing Day last year. He was 92. Buying a £5 card for a day's viewing was easy. But getting the system to actually work wasn't. Mr Liggins' son, also called Len, said:
"It was really, really complicated. There was absolutely no way my father could have set up this system for himself. You'd think that if you were buying a card for a day you would have 24 hours worth of use for the five pounds, but it actually lasts for 24 hours once you put the card in. Then, as did happen with my father, ten minutes later he might be carted off for x-rays or some sort of procedure or treatment. There was one occasion when he watched TV for twenty minutes and that was it. It's shockingly inappropriate, it's difficult to use and it's far too expensive".
The company that provided the bedside units for David, Len and Antonio was Hospedia which is the largest supplier in the UK. But there are others, including Hospicom, Premier Telesolutions and the Wandsworth Group, and Watchdog has received complaints about them too. Their incoming call charges can be just as high and the television packages just as expensive and ill-suited to patient needs. All of the companies have reduced some of the costs for using the television and the telephone, but they're still expensive.
The problems haven't gone unnoticed. As regards phone calls, there have been three official investigations, by Ofcom, the Health Select Committee and the Patient Power Review Group. Each agreed that inbound call charges are too high and all said that a solution needs to be found. But none were able to say who is at fault. Perhaps that is because all of the companies involved have struggled to make a profit. It turned out that the equipment was expensive to install and the decision by hospitals to allow mobile phones to be used on some of the wards has eaten into their potential profits even further. So we have a system that fails to make money for the operators and which also fails to provide a fair and workable service for patients. But is anyone, the individual hospitals or the Department of Health, able or prepared to change it?
The companies supplying the systems told Watchdog:
Hospedia
Hospedia took over the running of Patientline entertainment systems in late 2008 and since then we have been working hard to improve the value and services available to patients. Hospedia has made no profit and is currently operating at break even. Our aim is to grow the business through improving value for money and choice for both patients and hospitals.
Entertainment packages are now provided for as little as £1.67 a day, which includes 25+ TV channels, games, internet, unlimited free calls to UK landlines, and free access to radio, including hospital radio. We also provide free TV to children during the day.
We have introduced the choice to buy packages as short as a few hours or as long as 12 days - priced to reflect the different lengths of time people stay in hospital. We are continually reviewing our pricing, to try and provide the best value we can for patients. Hospedia uses patient feedback extensively to help us shape pricing trials and offers, and try to cater for as many individual needs as we can. Although NHS Trusts do not receive an income from the bedside systems, we do discuss our proposals prior to implementing any significant change, and take into account the Trust's views.
We are also now introducing further choice, such as a selection of the latest films available to view whenever a patient wants. Many patients opt to access the internet free of charge - keeping in touch with others using Facebook and other similar sites. Over the coming year we also want to enable patients to use BBC iPlayer and other catch-up TV style services which will help them keep up to date despite the disruption of being in Hospital.
Our pricing packages now receive an overwhelmingly and increasingly positive response from patients, with over 70% now rating the current packages as value for money. Our free calls packages have seen a 10 fold increase in calls being made by patients, indicating that these offers are valued and needed to help keep patients in touch with friends & relatives - also reducing the number of calls nurses have to deal with at the nurse station.
We understand that some patients are frustrated that the television packages run continuously from the time they are activated, however some patients have also found other charging methods to be confusing, given the short length of most hospital stays. Prior to August 2009, TV could only be bought in 24hr blocks. Following patient feedback, we introduced shorter package options for as little as a couple of hours. This option is now available in the vast majority of Hospedia sites and chosen by many patients every day.
We are aware that the cost of incoming calls is currently high, causing some concern to users, and in order to mitigate this we have introduced unlimited free outgoing calls with every package. This enables patients to phone out for free, reducing the need for their friends and relatives to make incoming calls at a higher cost. We have a few sites trialling incoming call rates at 10p per minute - whilst these sites are currently losing money we are monitoring them closely as we would like to be able to offer this price point everywhere within the next 2 years.
We also appreciate that some patients find the units complicated to use and we are continually looking at ways to improve this experience. We have introduced a new instruction leaflet, available at each bedside, which explains how to get started and use the system, as well as new on-screen help options. Our customer care centre is available 24 hours a day, to help and support patients in using the system and to answer any questions.
We are also currently carrying out a complete review of the way patients are able to interact with the service and choose the entertainment or communication services of their choice - we expect these further improvements to be complete by March 2011.
The ultimate solution to ease of use is our new touchscreen systems, which we are working with Trusts to roll out across the country. This system has a much larger screen and more flexibility to help users get what they want from the system - representing millions of pounds worth of new investment being made by the company, on top of the £160m invested to date. It is worth noting that the bedside systems were all originally installed at no cost to the NHS, allowing Hospitals to focus their resources on patient care.
Reviews of the industry by Ofcom, the Health Select Committee and the Department of Health all recognised that the pricing options available are limited by the way the government initiative was originally set up. Most reviews recommended that the systems be more widely used by hospitals to help deliver day to day operational benefits, thereby giving alternative income to providers which can be used to offset and reduce patient charges - something we are discussing already with a number of Trusts.
With a number of consultations regarding the NHS being conducted over the coming months, the new Coalition Government is showing a great deal of interest in addressing the issues in the industry and Hospedia are currently contributing to a number of these consultations, most notably on the subject of Patient Information Delivery.
In order to be in a position to offer substantially lower charges to patients, it is critical that Hospedia forms part of the discussions on delivering services to patients in the NHS. Only through a combination of innovation by ourselves, the support of Trusts, cooperation from the Department of Health and the vision of the Coalition Government can these valued services be provided at much lower costs.
Furthermore, this combined working could crucially provide millions of pounds of annual savings to the NHS through services like real-time patient surveys, interactive meal ordering, and clinician's access to patient information at the bedside. Hospedia has already started to deliver its part of this through free calls packages for patients, further investment in practical systems that can help the NHS save money and gathering feedback from patients and hospitals on what they want to see.
In response to the people featured in Watchdog's report, Hospedia said:
David Moran:
We received a request for a refund on October 6th 2009 for the cost of a call made by Mr Moran's wife during his stay in hospital.
As only 5% of incoming calls to patients are more than 15 minutes in duration, and the average call length is only some 3 minutes, a 29 minute call seemed unusually long. It wasn't entirely clear from Mr Moran's complaint what the primary issue was, nevertheless, an investigation by our customer relations team determined that the call may not have been properly disconnected in order to result in such a lengthy phone call being made. We therefore refunded Mr Moran in full as a gesture of goodwill.
All callers are informed of the cost of the calls made to the bedside at the start of the call. Mr Moran was concerned that, as an inpatient, he was unaware of the cost of incoming calls, which at the time of the call he received was 39p per minute. Since his stay in September 2009 we have introduced additional marketing material that states the cost of these calls, to ensure that both patients and callers are aware of the charges.
We are aware that the cost of incoming calls is currently high and as a result have introduced unlimited free outgoing calls with every package since Mr Moran's stay in September 2009. This enables patients to phone out for free, reducing the need for their friends and relatives to make incoming calls at a higher cost. Our free calls packages have seen a 10-fold increase in calls being made by patients, indicating that these offers are valued and needed to help keep patients in touch with friends and relatives. This also reduces the number of calls nurses have to deal with at the nurse station. In addition, we have a few sites trialing incoming call rates at 10p/minute and we are monitoring these trials closely as we would like to be able to offer this price point everywhere within the next 2 years.
Alina Lacob:
Since Ms Lacob's experience with the system in early 2009, we have introduced new pricing packages that reduce the cost of watching television to as little as £1.67 per day. The new pricing came directly as a result of patient feedback, and a survey of patients has shown that 70% now feel that the service is value for money. Although we do understand that some patients are frustrated that the television packages run continuously from the time they are activated, some patients have also found other charging methods to be confusing, given the short length of most hospital stays. What we are doing is looking to improve the choice of methods by which patients can pay for the service.
Ms Lacob also raised concerns about the cost of the telephone calls. Over the last year we have changed our pricing packages to increase value, and all patients now receive free unlimited calls to UK landlines with any TV package. We're aware that the cost of keeping in touch was a concern to patients, so we introduced this offering to ensure that patients are able to talk to their friends and relatives for as long as they like. Since Ms Lacob's partner experienced the system we have implemented significant cost reductions, with patients now typically enjoying savings of up to 30% on the previous prices.
In reference to Ms Lacob's complaint that she did not receive a refund for a card that her partner was unable to use due to a fault in the system, if Ms Lacob would get in touch with us directly we would be more than happy to ensure this refund is processed immediately, and sincerely apologise that this was not resolved at the time as per our normal practice.
Len Liggins:
We're sorry that Mr Liggins and his father found the system difficult to use. Comments like these support our continuous process of improving the way the system works, to try and make the service as simple to access as possible. We are currently carrying out a complete review of the way patients are able to interact and pay for with the services they choose - we expect further improvements to be complete by March next year. Entertainment packages are now provided for as little as £1.67 a day, which includes 25+ TV channels, games, internet, unlimited free calls to UK landlines, and free access to radio, including hospital radio. Since Mr Liggins' father was in hospital, we have also produced a new instructions leaflet, available at each bedside, which explains how to get started and use the system, as well as on-screen help. We have a customer care centre available 24 hours a day, to help and support patients in using the system and to answer any questions patients may have. Royal Berkshire hospital, where Mr Liggins' father was being treated, now also has a self service registration system, which many patients have found much easier to use.
Hospicom
1. Does Hospicom agree that there are issues with regards to the costs of incoming calls and television usage associated with the bedside units?
Yes, we do, however the issue for telephone charging lies solely with the major network providers, they seem to be a law unto themselves, all our rates are set under the Ofcom regulations and whilst we do receive a revenue share on these numbers we don't receive anywhere near what is charged, in addition to this we only receive a fixed share against the Ofcom charging structure and any addition revenue is retained by the network provider for those that apply the higher charges
2. Does Hospicom agree that for some patients the bedside units are very complicated, if not impossible, to operate without assistance which is not always available?
Yes, we agree the units can seem complicated but not impossible, under the initial licence agreement set out by the then NHS Estates there were varying criteria that had to be provided in order for the licence to be granted. We at Hospital Telecommunication Services designed a multi media unit to satisfy this criteria so as to obtain a license.
3. Does Hospicom agree that there are issues with regards to the cost of watching the television, and to the fact that the television packages are time-continuous?
No, based on research with the NHS Trust staff and customer surveys we changed from the initial design back in 2002 where by we charged for TV on an hourly basis - this was found to be both complicated for the patients and resulted in far more complaints as patients credit would often expire during a TV program being watched thus needing further credit to be added and causing the patient to then miss their viewing. Therefore we changed to a continuous 24hr period not only to resolve this issue but also to bring the system we offer into line with other providers
4. Does Hospicom offer television packages for less than 24 hours? If so, when did they become available?
No, we don't for the reason outlined above
5. What are the costs for incoming calls at Hospicom sites, and have these charges changed? If so, when, and by how much?
Prices range 23p per min to 42p per min and depend upon the hospital sites bed closures, for example we have a Trust who have closed over 300 beds yet we still have to meet the bank repayments on the costs of these 300 beds that no longer earn any revenue, therefore the remaining beds pay more for the service due to the Trusts decision to close beds, this is appropriate for most trusts who have closed beds over the past 2 years and is the reason why over the past 2 years more than half of our sites are now on the higher charge whereas before they were on the lower charge.
6. Has Hospicom made any profit supplying bedside units to NHS hospitals?
No, the business has run at a breakeven level with any addition funds being used to cope with the ever changing requirements to the NHS. Currently the service is running at a loss in many locations across the country and the business is being forced in taking action to resolve this.
7. What has Hospicom done to address concerns about the costs of incoming telephone calls and television usage, particularly after the publication of the Ofcom, Health Select Committee and Patient Power Review Group reports were published?
We keep an open dialogue with all our NHS Trusts and constantly review the position.
The Patient Power review group does not exist and has not for years. The Health Select committee has taken no action and has never asked us for any views or proposals on moving this forward. OFCOM have stated that it is a complex web of Government Policy and in conclusion have no power in the matter to assist. (See Ofcom Report Attached section 38 in particular)
8. What constraints does Hospicom believe there are towards further reducing the costs of telephone calls and television usage?
We obviously are bound by running costs and the usage of the service, currently we receive no funding from either the Trust or Central Government and with further cuts to the NHS budgets the number of beds requiring the service is likely to reduce further. Unfortunately the costs are not scalable in a direct parallel to the number of beds that the service is offered at.
9. What plans does Hospicom have to further address concerns about costs in the future?
We would openly welcome further discussions with either individual NHS Trusts or the Department of Health in order to reduce the costs by the patient. We have already identified a possible reduction of 20% to the patient by making the service Vat exempt inline with all other services provided by the NHS however unless this service comes under the NHS Trust provision we have been advised this is not possible. Further more we have been in direct correspondence with OFCOM regarding the retention by BT of additional revenue for the provision of pre call announcements, (see attached correspondence to which we still do not have an answer)
10. Has Hospicom entered in to discussions with individual Trusts or the Department of Health to look at ways in which costs can be reduced? If so when, and what was the outcome of these discussions?
We are in constant discussion with our Trusts regarding the services we provide and these are ongoing, with regard to the Department of Health the last communication we had was (14th October 2009) at which point we where informed in no uncertain terms that the agreements in place are between the Trusts and ourselves and that the Department has no influence over these agreements (copy of letter attached)
11. Whose responsibility is it to address these issues, and to affect change?
We believe that the Department of Health has to take some responsibility in adhering to the contracts that it drafted originally however as explained we have been informed that this lies with the individual Trusts, Therefore we are forced to understand that this responsibility lies with the individual Trust not only to ensure that it is offering its patients the best possible service but also to ensure that in the process the contract agreements with the Bedside Entertainment providers is not breached.
Premier Telesolutions
We would very much like to assist you in the production of this programme, so that you are better able to present a properly informed report of the problems faced in this industry.
We will try to deal with all of the issues you raised, outlining the history behind the current structure of the industry and why we continue to face difficult decisions and dilemmas in trying to satisfy the numerous and complex stakeholders that exist. We will, of course, endeavour to explain what we are doing to address the very real concerns of some of your viewers which we take very seriously.
The provision of telephone and television services to patients was set up by the government in their 2000 plan to modernise the NHS. The decision taken by the Department of Health/Government of the day, as part of the 'Patient Power' programme, was to deliver multi-media entertainment and communication services to patients, but at no extra cost to the NHS. In order to accommodate this, these services would have to be charged for in a similar way as for other non clinical services such as car parking and cafeteria and restaurant services
This plan was to be achieved by licensing a number of private sector suppliers to install equipment free of charge to the NHS and to recoup their investment over the lifetime of the equipment by charging patients and their families and friends to use the services should they wish to.
A key element to the original agreement between the NHS and private providers of these services was the ban on mobile phone use in hospital wards. The rationale being that mobile phones were deemed to be intrusive, disruptive and had the potential to interfere with sensitive medical support technology. Also, given that most phones have video and photographic capability, it was important to safeguard patient privacy and rights. Against this background, Premier along with other suppliers invested millions of pounds to provide bedside telephone services to patients so they could more readily communicate with family and friends.
In reality, this model never really worked due to the high capital and running costs of these systems and the fact that insufficient revenue was generated to cover these costs. Consequently, all of the suppliers of these services got into severe financial difficulty and have only been able to continue to trade and provide these services through the patience of their providers of capital who have already lost many millions of pounds.
This situation was then made significantly worse when, in January 2009, the ban on the use of mobile phones in hospitals was lifted thereby fundamentally changing the basis of the original agreement. As a consequence, the revenue generated by the suppliers of these services has fallen dramatically.
The current situation is not sustainable and this is recognised by hospitals and trusts. The business model needs and, has in fact, started to change, otherwise there is a risk that these services will no longer be able to be provided. We at Premier are in active dialogue with hospitals and trusts to develop a model, which not only is able to continue to provide patient entertainment, but will include additional services such as meal ordering, patient questionnaires and access to hospital records which will both improve patient care and lower costs for hospitals.
We would like to deal with some of your specific concerns as follows:
As part of Premier Bedside service, all of our Bedside terminals provide free access to the internet, free radio and free access to hospital television information channels. We also supply free headphones to every patient. Charges for the use of television is based on the time purchased and, at the moment, charges are £2 for 2 hours, £4.50 for 24 hours, and £9.50 for 3 days. The package includes a choice of 15 channels. . It should also be remembered, of course, that television is not a 'free service' at home. There is, naturally, a daily cost associated with the licence fee, cost of electricity and the obvious purchase price of the television itself.
As far as telephone charges are concerned, these vary according to location. At Patient Power sites where the install costs to Premier were very high (in the region of £2,000 per bedside unit), charges to patients for calls to UK, European and US landlines are 10p per minute (calls to other geographic areas and mobiles may be higher). Charges to friends and family who call into the patient's bedside terminal are 50p per minute. To reduce this charge the caller has an option to purchase a card from Premier which enables them to make a call at 25p to the patient's bedside. This facility is widely advertised on our incoming call announcement and around our hospitals.
Premier is responsible for cleaning the equipment at the bedside and this cost clearly needs to be covered in the charging structure.
Notwithstanding the above, we are currently working on fundamental systems changes to allow a more flexible pricing strategy tailored to individual patient requirements. Furthermore, the above charging structure is still not sufficient to cover Premier's costs of providing this service.
We are not aware of any significant operational issues with our bedside units, although we are about to implement new procedures to ensure each new patient admitted to a ward can benefit from a proper demonstration of how the bedside terminals work, their features and benefits.
However, it is important to point out that the system is a sophisticated multimedia terminal which uses a touch screen interface. The touch screen interface was designed to provide a flexible means of controlling the system without having a number of buttons which would be confusing, inflexible and more difficult to clean, a vital part of the hospitals programme to drive down hospital acquired infection. The terminal will be new to many people, but we do provide a large number of on-site staff who are trained to provide bedside assistance to patients, and we are constantly reviewing our on screen help, site staff training, and support literature, to help all patients get the most from their bedside system.
It should be remembered that the pricing and provision of all these services has been looked at by Ofcom, the Health Select Committee and the Department of Health Patient Power Review Group, all of whom have agreed that suppliers are not using any provision of the Patient Power Project to overcharge patients.
The Wandsworth Group
On a general note Wandsworth Group would comment that the NHS "Patient Power" project was ill considered. Patientline already had 22 hospitals up and running at the time (2000) and the level of charges for both TV and telephone calls was already established and was considered by the DoH to be perfectly acceptable to patients and their relatives. Suppliers were required to install expensive equipment and provide a full service at every bed regardless of whether it was economical to do so. The high level of charges is entirely necessary to cover the fact that less than 50% of patients actually use the services.
Wandsworth developed (and piloted in an NHS hospital) a computer based solution in 2003 that was no more expensive than television systems and which could be used by both patients for entertainment and communications as well as by hospital staff to access clinical information, patient administration and medical imaging systems at the patient's bedside. We recommended that the NHS should stop installing television based systems that are only of use to patients and to use computer based solutions instead that would provide real benefits to the hospital. Such a system would have provided hospitals with a low-cost method of providing bedside computers as well as lower cost services for patients. The NHS, in the form of the now disbanded NHS Estates, refused to wait for the new technology as they had a deadline from the DoH in which to complete the installation of TV/telephone systems. As a result of this decision Wandsworth withdrew from the Patient Power project to concentrate on selling bedside computing to hospitals in other countries.
In the Patient Power legal agreements the NHS is required to ban the use of mobile telephones in Ward areas whilst it is both lawful and reasonable to do so. The DoH has subsequently issued guidelines that effectively allow hospitals to use mobile telephones in normal ward areas at their discretion.
1. Does the Wandsworth Group agree that there are issues with regards to the costs of incoming calls and television usage associated with the bedside units?
Wandsworth now operates phones in only one hospital (Closing Nov 2010). Phone revenue has been insignificant since the general ban on mobile phones was lifted in January 2009.
2. Does the Wandsworth Group agree that for some patients the bedside units are very complicated, if not impossible, to operate without assistance which is not always available?
The interface to our bedside entertainment system was greatly simplified when the phones were removed.
3. Does the Wandsworth Group agree that there are issues with regards to the cost of watching the television, and to the fact that the television packages are time-continuous?
Our prices are generally acceptable to patients. We tailor packages to various short stay patients' e.g. renal patients attending for kidney dialysis - £1 for 6hrs.
4. Does the Wandsworth Group offer television packages for less than 24 hours? If so, when did they become available?
See above answer to question 3
5. What are the costs for incoming calls at the Wandsworth Group sites, and have these charges changed? If so, when, and by how much?
See above answer to question 1
6. Has the Wandsworth Group made any profit supplying bedside units to NHS hospitals?
No
7. What has the Wandsworth Group done to address concerns about the costs of incoming telephone calls and television usage, particularly after the publication of the Ofcom, Health Select Committee and Patient Power Review Group reports were published?
Removed phones (see above)
8. What constraints does the Wandsworth Group believe there are towards further reducing the costs of telephone calls and television usage?
The main constraint to further reducing the costs of telephone calls and television usage would be for The Wandsworth Group to make even more losses.
9. What plans does the Wandsworth Group have to further address concerns about costs in the future?
None
10. Has the Wandsworth Group entered in to discussions with individual Trusts or the Department of Health to look at ways in which costs can be reduced? If so when, and what was the outcome of these discussions?
The missed opportunity was the short-sighted decision not to use bedside computing solutions instead of television systems. At various times we have sought unsuccessfully, to provide additional paid services to Trusts to offset the cost of patient TV. These include educational video, patient menus and patient satisfaction surveys.
11. Whose responsibility is it to address these issues, and to affect change?
The responsibility lies firmly with the DOH as they introduced the Patient Power project and have since abandoned it. If they want to address the issues, then they should work with providers and individual Trusts to provide subsidies to those companies so that they can provide services for patients at reduced rates, or even better still, to purchase those systems from the suppliers at their current depreciated values and provide their patients with those TV and telephony services free of charge - something that some NHS Trusts are currently doing.
The Department of Health told Watchdog:
"We understand patients' concerns about the cost of bedside services and that is why Health Minister Simon Burns recently looked into the work carried out on the provision of bedside services.
"He concluded that as the provision of bedside services is a local matter between individual trusts and their chosen service provider, it would not be helpful to look at the issue in detail again."
Background:
The Department has already conducted a comprehensive review, which concluded that it could not take any action to reduce the cost of the incoming telephone calls. This is because the Department has no authority to impose any price changes on the suppliers of the services.
Patients groups and charitable organisations told Watchdog:
Patients Association
Katherine Murphy, Chief Executive of the Patients Association, said:
"Going into hospital is a stressful and worrying time, but most patients do not anticipate quite how expensive hospital stays can be. With car parking charges, inflated shop prices and in particular the exorbitant cost of some hospital phones, the cost mounts very quickly, making a mockery of the NHS being "free at the point of care".
When a hospital stay is extended, people will naturally want to stay in contact with loved ones. With a ban on mobile phones still operating in some hospital wards, some patients are forced to use the expensive hospital phones which have an effective monopoly to charge what they like for calls to be made. The price of a local call can exceed the normal rates for international calls making it harder for people to stay in touch with their loved ones, often when they are at their most vulnerable.
These charges represent an unfair tax on the sick who will have no choice but to pay up if they want to keep in contact with the outside world."
The helpline number is 0845 608 4455 and is open between 9.00am and 5.30pm.
Macmillan Cancer Support
Mike Hobday, Head of Policy at Macmillan Cancer Support, said:
"It's shocking that people with cancer are forced to pay a premium to watch television and speak to friends and family while in hospital receiving life-saving treatment. These are extra costs for cancer patients who have already been stung by having to pay high prices travelling to and parking at hospital. These charges are just another tax on the most sick and vulnerable. The very last thing that seriously ill cancer patients need to worry about is money."
Age UK
Michelle Mitchell, Charity Director at Age UK, said:
"Almost two thirds of hospital beds are used by people over 65, many of which can experience long or repeat admissions. Access to a telephone and television can be extremely valuable to many older patients. It is very unfair that using such services means patients face an additional expense at the end of their stay, which can add up to a considerable amount over time. Older people, many on low incomes, do not choose to spend time in hospital and burdening them with additional costs for basic services is unhelpful during what will be a distressing time".
Are hospital bedside service providers being hospitable?
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However, 10 years on these systems are still not profitable, according to the companies who provide the services. The patients say they are costly and unfair and patient's groups such as the Patients Association have labelled them 'an unfair tax on the sick'...
(Do you have something to say about this story? Tell us what you think by emailing us here. Don't forget to include 'Hospedia' in the subject line. Watchdog will publish a selection of viewers' comments underneath each story, both throughout and after the programme is on air. Please remember to include your name as you would like to see it published).
Long stays in hospital are tough both for the patients and their relatives. Small things can come to mean a huge amount for those who spend time in the wards, cut off from home life, like watching their favourite television programmes or being able to speak to family and friends on the phone. The NHS delivers some of the best, most complex medical care in the world, so surely providing bedside telephones and televisions should be simple?
In 2000, the then-government set up a new system which enabled private companies to bid to install and manage bedside facilities. The successful ones would then recoup their investment by charging patients to use them. But ten years later, all of these companies are struggling to break even and as they try to make a profit there's only one place the cash can come from, and that's the patients.
For years, those patients and their families have been contacting Watchdog about the prices they've been asked to pay. It's clear that for some, these charges are only adding to the stress they're under while in hospital.
David Moran who went into hospital with suspected cancer last year. He found out, too late, that his bedside phone unit was charging 39p a minute for incoming calls. He had one half-an-hour conversation with his wife and it cost him £12. David told us:
"I was in hospital, suspected cancer, been operated on, and I couldn't speak to my wife. 39 pence per minute was just too much for us, and I think it was very, very unfair that I should be isolated from my wife."
David later got a refund due to a bad connection on the line, but he didn't use the phone again.
And David's not the only one. Alina Lacob's partner Antonio was in and out of hospital throughout 2009. Antonio suffered from a disease of the immune system. Alina said they were not able to use the telephone, particularly for incoming calls.
"The charges were outrageous, absolutely huge."
As Antonio was in hospital for weeks at a time, he came to rely on the television as the main source of entertainment. If you watch TV at home, the licence fee adds up to 40p a day. However, if you watch it in hospital, you can pay more than 12 times that.
Some of the hospital TV providers will charge you for watching television in continuous blocks of time, even if your set isn't actually on. So, for example, if you are in hospital and it's a Tuesday. All you want to watch is the lunchtime news and Eastenders, both of which are 30 minutes, but on at different times of the day. You can't just pay for an hour's worth of viewing and use it when you want. Instead, in some hospitals, you would have to pay for a whole day's worth and the cost can be up to £3.50. And should it be that on top of those two programmes, the only other thing you wanted to watch is Watchdog on the Thursday, then you'd have to buy two whole days' worth of viewing and the cost would be up to £7.
Some hospital TV providers do now let you buy an hour's worth for £1, or two hours for £2. But you can't stop and start it, so if your programmes are on throughout the day, you'd need to shell out each time they are on. Watchdog has had complaints about systems developing faults and no-one being on hand to fix them. However, some patients feel they have no option but to pay for the service. Alina Lacob explained just how important the television was for her partner Antonio:
"It was very important. He used to watch the news and all of his favourite programmes, it's a way of disconnecting yourself from what's happening".
Sadly Antonio passed away in October 2009. Over the five months he was in hospital, they'd spent nearly £500 - simply for him to watch TV.
"It was very difficult, the mortgage was still coming out of his account, the bills were still coming out, his wages were going down," Alina said, "Considering what he'd been through, the television should be the last thing to worry about."
Groups who represent hospital patients agree. Mike Hobday, Head of Policy at Macmillan Cancer Support told us:
"It's shocking that people with cancer are forced to pay a premium to watch television and speak to friends and family while in hospital receiving life-saving treatment. These are extra costs for cancer patients who have already been stung by having to pay high prices travelling to and parking at hospital. These charges are just another tax on the most sick and vulnerable. The very last thing that seriously ill cancer patients need to worry about is money."
Michelle Mitchell, Charity Director at Age UK said:
"Almost two thirds of hospital beds are used by people over 65, many of which can experience long or repeat admissions. Access to a telephone and television can be extremely valuable to many older patients. It is very unfair that using such services means patients face an additional expense at the end of their stay, which can add up to a considerable amount over time. Older people, many on low incomes, do not choose to spend time in hospital and burdening them with additional costs for basic services is unhelpful during what will be a distressing time."
Katherine Murphy, Chief Executive of the Patients Association said:
"Going into hospital is a stressful and worrying time, but most patients do not anticipate quite how expensive hospital stays can be. With car parking charges, inflated shop prices and in particular the exorbitant cost of some hospital phones, the cost mounts very quickly, making a mockery of the NHS being 'free at the point of care'. When a hospital stay is extended, people will naturally want to stay in contact with loved ones. With a ban on mobile phones still operating in some hospital wards, some patients are forced to use the expensive hospital phones which have an effective monopoly to charge what they like for calls to be made. The price of a local call can exceed the normal rates for international calls making it harder for people to stay in touch with their loved ones, often when they are at their most vulnerable. These charges represent an unfair tax on the sick, who will have no choice but to pay up if they want to keep in contact with the outside world."
For elderly patients, hospital TVs are not just expensive, they can also be confusing and complicated. Len Liggins was admitted to hospital on Boxing Day last year. He was 92. Buying a £5 card for a day's viewing was easy. But getting the system to actually work wasn't. Mr Liggins' son, also called Len, said:
"It was really, really complicated. There was absolutely no way my father could have set up this system for himself. You'd think that if you were buying a card for a day you would have 24 hours worth of use for the five pounds, but it actually lasts for 24 hours once you put the card in. Then, as did happen with my father, ten minutes later he might be carted off for x-rays or some sort of procedure or treatment. There was one occasion when he watched TV for twenty minutes and that was it. It's shockingly inappropriate, it's difficult to use and it's far too expensive".
The company that provided the bedside units for David, Len and Antonio was Hospedia which is the largest supplier in the UK. But there are others, including Hospicom, Premier Telesolutions and the Wandsworth Group, and Watchdog has received complaints about them too. Their incoming call charges can be just as high and the television packages just as expensive and ill-suited to patient needs. All of the companies have reduced some of the costs for using the television and the telephone, but they're still expensive.
The problems haven't gone unnoticed. As regards phone calls, there have been three official investigations, by Ofcom, the Health Select Committee and the Patient Power Review Group. Each agreed that inbound call charges are too high and all said that a solution needs to be found. But none were able to say who is at fault. Perhaps that is because all of the companies involved have struggled to make a profit. It turned out that the equipment was expensive to install and the decision by hospitals to allow mobile phones to be used on some of the wards has eaten into their potential profits even further. So we have a system that fails to make money for the operators and which also fails to provide a fair and workable service for patients. But is anyone, the individual hospitals or the Department of Health, able or prepared to change it?
The companies supplying the systems told Watchdog:
Hospedia
Hospedia took over the running of Patientline entertainment systems in late 2008 and since then we have been working hard to improve the value and services available to patients. Hospedia has made no profit and is currently operating at break even. Our aim is to grow the business through improving value for money and choice for both patients and hospitals.
Entertainment packages are now provided for as little as £1.67 a day, which includes 25+ TV channels, games, internet, unlimited free calls to UK landlines, and free access to radio, including hospital radio. We also provide free TV to children during the day.
We have introduced the choice to buy packages as short as a few hours or as long as 12 days - priced to reflect the different lengths of time people stay in hospital. We are continually reviewing our pricing, to try and provide the best value we can for patients. Hospedia uses patient feedback extensively to help us shape pricing trials and offers, and try to cater for as many individual needs as we can. Although NHS Trusts do not receive an income from the bedside systems, we do discuss our proposals prior to implementing any significant change, and take into account the Trust's views.
We are also now introducing further choice, such as a selection of the latest films available to view whenever a patient wants. Many patients opt to access the internet free of charge - keeping in touch with others using Facebook and other similar sites. Over the coming year we also want to enable patients to use BBC iPlayer and other catch-up TV style services which will help them keep up to date despite the disruption of being in Hospital.
Our pricing packages now receive an overwhelmingly and increasingly positive response from patients, with over 70% now rating the current packages as value for money. Our free calls packages have seen a 10 fold increase in calls being made by patients, indicating that these offers are valued and needed to help keep patients in touch with friends & relatives - also reducing the number of calls nurses have to deal with at the nurse station.
We understand that some patients are frustrated that the television packages run continuously from the time they are activated, however some patients have also found other charging methods to be confusing, given the short length of most hospital stays. Prior to August 2009, TV could only be bought in 24hr blocks. Following patient feedback, we introduced shorter package options for as little as a couple of hours. This option is now available in the vast majority of Hospedia sites and chosen by many patients every day.
We are aware that the cost of incoming calls is currently high, causing some concern to users, and in order to mitigate this we have introduced unlimited free outgoing calls with every package. This enables patients to phone out for free, reducing the need for their friends and relatives to make incoming calls at a higher cost. We have a few sites trialling incoming call rates at 10p per minute - whilst these sites are currently losing money we are monitoring them closely as we would like to be able to offer this price point everywhere within the next 2 years.
We also appreciate that some patients find the units complicated to use and we are continually looking at ways to improve this experience. We have introduced a new instruction leaflet, available at each bedside, which explains how to get started and use the system, as well as new on-screen help options. Our customer care centre is available 24 hours a day, to help and support patients in using the system and to answer any questions.
We are also currently carrying out a complete review of the way patients are able to interact with the service and choose the entertainment or communication services of their choice - we expect these further improvements to be complete by March 2011.
The ultimate solution to ease of use is our new touchscreen systems, which we are working with Trusts to roll out across the country. This system has a much larger screen and more flexibility to help users get what they want from the system - representing millions of pounds worth of new investment being made by the company, on top of the £160m invested to date. It is worth noting that the bedside systems were all originally installed at no cost to the NHS, allowing Hospitals to focus their resources on patient care.
Reviews of the industry by Ofcom, the Health Select Committee and the Department of Health all recognised that the pricing options available are limited by the way the government initiative was originally set up. Most reviews recommended that the systems be more widely used by hospitals to help deliver day to day operational benefits, thereby giving alternative income to providers which can be used to offset and reduce patient charges - something we are discussing already with a number of Trusts.
With a number of consultations regarding the NHS being conducted over the coming months, the new Coalition Government is showing a great deal of interest in addressing the issues in the industry and Hospedia are currently contributing to a number of these consultations, most notably on the subject of Patient Information Delivery.
In order to be in a position to offer substantially lower charges to patients, it is critical that Hospedia forms part of the discussions on delivering services to patients in the NHS. Only through a combination of innovation by ourselves, the support of Trusts, cooperation from the Department of Health and the vision of the Coalition Government can these valued services be provided at much lower costs.
Furthermore, this combined working could crucially provide millions of pounds of annual savings to the NHS through services like real-time patient surveys, interactive meal ordering, and clinician's access to patient information at the bedside. Hospedia has already started to deliver its part of this through free calls packages for patients, further investment in practical systems that can help the NHS save money and gathering feedback from patients and hospitals on what they want to see.
In response to the people featured in Watchdog's report, Hospedia said:
David Moran:
We received a request for a refund on October 6th 2009 for the cost of a call made by Mr Moran's wife during his stay in hospital.
As only 5% of incoming calls to patients are more than 15 minutes in duration, and the average call length is only some 3 minutes, a 29 minute call seemed unusually long. It wasn't entirely clear from Mr Moran's complaint what the primary issue was, nevertheless, an investigation by our customer relations team determined that the call may not have been properly disconnected in order to result in such a lengthy phone call being made. We therefore refunded Mr Moran in full as a gesture of goodwill.
All callers are informed of the cost of the calls made to the bedside at the start of the call. Mr Moran was concerned that, as an inpatient, he was unaware of the cost of incoming calls, which at the time of the call he received was 39p per minute. Since his stay in September 2009 we have introduced additional marketing material that states the cost of these calls, to ensure that both patients and callers are aware of the charges.
We are aware that the cost of incoming calls is currently high and as a result have introduced unlimited free outgoing calls with every package since Mr Moran's stay in September 2009. This enables patients to phone out for free, reducing the need for their friends and relatives to make incoming calls at a higher cost. Our free calls packages have seen a 10-fold increase in calls being made by patients, indicating that these offers are valued and needed to help keep patients in touch with friends and relatives. This also reduces the number of calls nurses have to deal with at the nurse station. In addition, we have a few sites trialing incoming call rates at 10p/minute and we are monitoring these trials closely as we would like to be able to offer this price point everywhere within the next 2 years.
Alina Lacob:
Since Ms Lacob's experience with the system in early 2009, we have introduced new pricing packages that reduce the cost of watching television to as little as £1.67 per day. The new pricing came directly as a result of patient feedback, and a survey of patients has shown that 70% now feel that the service is value for money. Although we do understand that some patients are frustrated that the television packages run continuously from the time they are activated, some patients have also found other charging methods to be confusing, given the short length of most hospital stays. What we are doing is looking to improve the choice of methods by which patients can pay for the service.
Ms Lacob also raised concerns about the cost of the telephone calls. Over the last year we have changed our pricing packages to increase value, and all patients now receive free unlimited calls to UK landlines with any TV package. We're aware that the cost of keeping in touch was a concern to patients, so we introduced this offering to ensure that patients are able to talk to their friends and relatives for as long as they like. Since Ms Lacob's partner experienced the system we have implemented significant cost reductions, with patients now typically enjoying savings of up to 30% on the previous prices.
In reference to Ms Lacob's complaint that she did not receive a refund for a card that her partner was unable to use due to a fault in the system, if Ms Lacob would get in touch with us directly we would be more than happy to ensure this refund is processed immediately, and sincerely apologise that this was not resolved at the time as per our normal practice.
Len Liggins:
We're sorry that Mr Liggins and his father found the system difficult to use. Comments like these support our continuous process of improving the way the system works, to try and make the service as simple to access as possible. We are currently carrying out a complete review of the way patients are able to interact and pay for with the services they choose - we expect further improvements to be complete by March next year. Entertainment packages are now provided for as little as £1.67 a day, which includes 25+ TV channels, games, internet, unlimited free calls to UK landlines, and free access to radio, including hospital radio. Since Mr Liggins' father was in hospital, we have also produced a new instructions leaflet, available at each bedside, which explains how to get started and use the system, as well as on-screen help. We have a customer care centre available 24 hours a day, to help and support patients in using the system and to answer any questions patients may have. Royal Berkshire hospital, where Mr Liggins' father was being treated, now also has a self service registration system, which many patients have found much easier to use.
Hospicom
1. Does Hospicom agree that there are issues with regards to the costs of incoming calls and television usage associated with the bedside units?
Yes, we do, however the issue for telephone charging lies solely with the major network providers, they seem to be a law unto themselves, all our rates are set under the Ofcom regulations and whilst we do receive a revenue share on these numbers we don't receive anywhere near what is charged, in addition to this we only receive a fixed share against the Ofcom charging structure and any addition revenue is retained by the network provider for those that apply the higher charges
2. Does Hospicom agree that for some patients the bedside units are very complicated, if not impossible, to operate without assistance which is not always available?
Yes, we agree the units can seem complicated but not impossible, under the initial licence agreement set out by the then NHS Estates there were varying criteria that had to be provided in order for the licence to be granted. We at Hospital Telecommunication Services designed a multi media unit to satisfy this criteria so as to obtain a license.
3. Does Hospicom agree that there are issues with regards to the cost of watching the television, and to the fact that the television packages are time-continuous?
No, based on research with the NHS Trust staff and customer surveys we changed from the initial design back in 2002 where by we charged for TV on an hourly basis - this was found to be both complicated for the patients and resulted in far more complaints as patients credit would often expire during a TV program being watched thus needing further credit to be added and causing the patient to then miss their viewing. Therefore we changed to a continuous 24hr period not only to resolve this issue but also to bring the system we offer into line with other providers
4. Does Hospicom offer television packages for less than 24 hours? If so, when did they become available?
No, we don't for the reason outlined above
5. What are the costs for incoming calls at Hospicom sites, and have these charges changed? If so, when, and by how much?
Prices range 23p per min to 42p per min and depend upon the hospital sites bed closures, for example we have a Trust who have closed over 300 beds yet we still have to meet the bank repayments on the costs of these 300 beds that no longer earn any revenue, therefore the remaining beds pay more for the service due to the Trusts decision to close beds, this is appropriate for most trusts who have closed beds over the past 2 years and is the reason why over the past 2 years more than half of our sites are now on the higher charge whereas before they were on the lower charge.
6. Has Hospicom made any profit supplying bedside units to NHS hospitals?
No, the business has run at a breakeven level with any addition funds being used to cope with the ever changing requirements to the NHS. Currently the service is running at a loss in many locations across the country and the business is being forced in taking action to resolve this.
7. What has Hospicom done to address concerns about the costs of incoming telephone calls and television usage, particularly after the publication of the Ofcom, Health Select Committee and Patient Power Review Group reports were published?
We keep an open dialogue with all our NHS Trusts and constantly review the position.
The Patient Power review group does not exist and has not for years. The Health Select committee has taken no action and has never asked us for any views or proposals on moving this forward. OFCOM have stated that it is a complex web of Government Policy and in conclusion have no power in the matter to assist. (See Ofcom Report Attached section 38 in particular)
8. What constraints does Hospicom believe there are towards further reducing the costs of telephone calls and television usage?
We obviously are bound by running costs and the usage of the service, currently we receive no funding from either the Trust or Central Government and with further cuts to the NHS budgets the number of beds requiring the service is likely to reduce further. Unfortunately the costs are not scalable in a direct parallel to the number of beds that the service is offered at.
9. What plans does Hospicom have to further address concerns about costs in the future?
We would openly welcome further discussions with either individual NHS Trusts or the Department of Health in order to reduce the costs by the patient. We have already identified a possible reduction of 20% to the patient by making the service Vat exempt inline with all other services provided by the NHS however unless this service comes under the NHS Trust provision we have been advised this is not possible. Further more we have been in direct correspondence with OFCOM regarding the retention by BT of additional revenue for the provision of pre call announcements, (see attached correspondence to which we still do not have an answer)
10. Has Hospicom entered in to discussions with individual Trusts or the Department of Health to look at ways in which costs can be reduced? If so when, and what was the outcome of these discussions?
We are in constant discussion with our Trusts regarding the services we provide and these are ongoing, with regard to the Department of Health the last communication we had was (14th October 2009) at which point we where informed in no uncertain terms that the agreements in place are between the Trusts and ourselves and that the Department has no influence over these agreements (copy of letter attached)
11. Whose responsibility is it to address these issues, and to affect change?
We believe that the Department of Health has to take some responsibility in adhering to the contracts that it drafted originally however as explained we have been informed that this lies with the individual Trusts, Therefore we are forced to understand that this responsibility lies with the individual Trust not only to ensure that it is offering its patients the best possible service but also to ensure that in the process the contract agreements with the Bedside Entertainment providers is not breached.
Premier Telesolutions
We would very much like to assist you in the production of this programme, so that you are better able to present a properly informed report of the problems faced in this industry.
We will try to deal with all of the issues you raised, outlining the history behind the current structure of the industry and why we continue to face difficult decisions and dilemmas in trying to satisfy the numerous and complex stakeholders that exist. We will, of course, endeavour to explain what we are doing to address the very real concerns of some of your viewers which we take very seriously.
The provision of telephone and television services to patients was set up by the government in their 2000 plan to modernise the NHS. The decision taken by the Department of Health/Government of the day, as part of the 'Patient Power' programme, was to deliver multi-media entertainment and communication services to patients, but at no extra cost to the NHS. In order to accommodate this, these services would have to be charged for in a similar way as for other non clinical services such as car parking and cafeteria and restaurant services
This plan was to be achieved by licensing a number of private sector suppliers to install equipment free of charge to the NHS and to recoup their investment over the lifetime of the equipment by charging patients and their families and friends to use the services should they wish to.
A key element to the original agreement between the NHS and private providers of these services was the ban on mobile phone use in hospital wards. The rationale being that mobile phones were deemed to be intrusive, disruptive and had the potential to interfere with sensitive medical support technology. Also, given that most phones have video and photographic capability, it was important to safeguard patient privacy and rights. Against this background, Premier along with other suppliers invested millions of pounds to provide bedside telephone services to patients so they could more readily communicate with family and friends.
In reality, this model never really worked due to the high capital and running costs of these systems and the fact that insufficient revenue was generated to cover these costs. Consequently, all of the suppliers of these services got into severe financial difficulty and have only been able to continue to trade and provide these services through the patience of their providers of capital who have already lost many millions of pounds.
This situation was then made significantly worse when, in January 2009, the ban on the use of mobile phones in hospitals was lifted thereby fundamentally changing the basis of the original agreement. As a consequence, the revenue generated by the suppliers of these services has fallen dramatically.
The current situation is not sustainable and this is recognised by hospitals and trusts. The business model needs and, has in fact, started to change, otherwise there is a risk that these services will no longer be able to be provided. We at Premier are in active dialogue with hospitals and trusts to develop a model, which not only is able to continue to provide patient entertainment, but will include additional services such as meal ordering, patient questionnaires and access to hospital records which will both improve patient care and lower costs for hospitals.
We would like to deal with some of your specific concerns as follows:
As part of Premier Bedside service, all of our Bedside terminals provide free access to the internet, free radio and free access to hospital television information channels. We also supply free headphones to every patient. Charges for the use of television is based on the time purchased and, at the moment, charges are £2 for 2 hours, £4.50 for 24 hours, and £9.50 for 3 days. The package includes a choice of 15 channels. . It should also be remembered, of course, that television is not a 'free service' at home. There is, naturally, a daily cost associated with the licence fee, cost of electricity and the obvious purchase price of the television itself.
As far as telephone charges are concerned, these vary according to location. At Patient Power sites where the install costs to Premier were very high (in the region of £2,000 per bedside unit), charges to patients for calls to UK, European and US landlines are 10p per minute (calls to other geographic areas and mobiles may be higher). Charges to friends and family who call into the patient's bedside terminal are 50p per minute. To reduce this charge the caller has an option to purchase a card from Premier which enables them to make a call at 25p to the patient's bedside. This facility is widely advertised on our incoming call announcement and around our hospitals.
Premier is responsible for cleaning the equipment at the bedside and this cost clearly needs to be covered in the charging structure.
Notwithstanding the above, we are currently working on fundamental systems changes to allow a more flexible pricing strategy tailored to individual patient requirements. Furthermore, the above charging structure is still not sufficient to cover Premier's costs of providing this service.
We are not aware of any significant operational issues with our bedside units, although we are about to implement new procedures to ensure each new patient admitted to a ward can benefit from a proper demonstration of how the bedside terminals work, their features and benefits.
However, it is important to point out that the system is a sophisticated multimedia terminal which uses a touch screen interface. The touch screen interface was designed to provide a flexible means of controlling the system without having a number of buttons which would be confusing, inflexible and more difficult to clean, a vital part of the hospitals programme to drive down hospital acquired infection. The terminal will be new to many people, but we do provide a large number of on-site staff who are trained to provide bedside assistance to patients, and we are constantly reviewing our on screen help, site staff training, and support literature, to help all patients get the most from their bedside system.
It should be remembered that the pricing and provision of all these services has been looked at by Ofcom, the Health Select Committee and the Department of Health Patient Power Review Group, all of whom have agreed that suppliers are not using any provision of the Patient Power Project to overcharge patients.
The Wandsworth Group
On a general note Wandsworth Group would comment that the NHS "Patient Power" project was ill considered. Patientline already had 22 hospitals up and running at the time (2000) and the level of charges for both TV and telephone calls was already established and was considered by the DoH to be perfectly acceptable to patients and their relatives. Suppliers were required to install expensive equipment and provide a full service at every bed regardless of whether it was economical to do so. The high level of charges is entirely necessary to cover the fact that less than 50% of patients actually use the services.
Wandsworth developed (and piloted in an NHS hospital) a computer based solution in 2003 that was no more expensive than television systems and which could be used by both patients for entertainment and communications as well as by hospital staff to access clinical information, patient administration and medical imaging systems at the patient's bedside. We recommended that the NHS should stop installing television based systems that are only of use to patients and to use computer based solutions instead that would provide real benefits to the hospital. Such a system would have provided hospitals with a low-cost method of providing bedside computers as well as lower cost services for patients. The NHS, in the form of the now disbanded NHS Estates, refused to wait for the new technology as they had a deadline from the DoH in which to complete the installation of TV/telephone systems. As a result of this decision Wandsworth withdrew from the Patient Power project to concentrate on selling bedside computing to hospitals in other countries.
In the Patient Power legal agreements the NHS is required to ban the use of mobile telephones in Ward areas whilst it is both lawful and reasonable to do so. The DoH has subsequently issued guidelines that effectively allow hospitals to use mobile telephones in normal ward areas at their discretion.
1. Does the Wandsworth Group agree that there are issues with regards to the costs of incoming calls and television usage associated with the bedside units?
Wandsworth now operates phones in only one hospital (Closing Nov 2010). Phone revenue has been insignificant since the general ban on mobile phones was lifted in January 2009.
2. Does the Wandsworth Group agree that for some patients the bedside units are very complicated, if not impossible, to operate without assistance which is not always available?
The interface to our bedside entertainment system was greatly simplified when the phones were removed.
3. Does the Wandsworth Group agree that there are issues with regards to the cost of watching the television, and to the fact that the television packages are time-continuous?
Our prices are generally acceptable to patients. We tailor packages to various short stay patients' e.g. renal patients attending for kidney dialysis - £1 for 6hrs.
4. Does the Wandsworth Group offer television packages for less than 24 hours? If so, when did they become available?
See above answer to question 3
5. What are the costs for incoming calls at the Wandsworth Group sites, and have these charges changed? If so, when, and by how much?
See above answer to question 1
6. Has the Wandsworth Group made any profit supplying bedside units to NHS hospitals?
No
7. What has the Wandsworth Group done to address concerns about the costs of incoming telephone calls and television usage, particularly after the publication of the Ofcom, Health Select Committee and Patient Power Review Group reports were published?
Removed phones (see above)
8. What constraints does the Wandsworth Group believe there are towards further reducing the costs of telephone calls and television usage?
The main constraint to further reducing the costs of telephone calls and television usage would be for The Wandsworth Group to make even more losses.
9. What plans does the Wandsworth Group have to further address concerns about costs in the future?
None
10. Has the Wandsworth Group entered in to discussions with individual Trusts or the Department of Health to look at ways in which costs can be reduced? If so when, and what was the outcome of these discussions?
The missed opportunity was the short-sighted decision not to use bedside computing solutions instead of television systems. At various times we have sought unsuccessfully, to provide additional paid services to Trusts to offset the cost of patient TV. These include educational video, patient menus and patient satisfaction surveys.
11. Whose responsibility is it to address these issues, and to affect change?
The responsibility lies firmly with the DOH as they introduced the Patient Power project and have since abandoned it. If they want to address the issues, then they should work with providers and individual Trusts to provide subsidies to those companies so that they can provide services for patients at reduced rates, or even better still, to purchase those systems from the suppliers at their current depreciated values and provide their patients with those TV and telephony services free of charge - something that some NHS Trusts are currently doing.
The Department of Health told Watchdog:
"We understand patients' concerns about the cost of bedside services and that is why Health Minister Simon Burns recently looked into the work carried out on the provision of bedside services.
"He concluded that as the provision of bedside services is a local matter between individual trusts and their chosen service provider, it would not be helpful to look at the issue in detail again."
Background:
The Department has already conducted a comprehensive review, which concluded that it could not take any action to reduce the cost of the incoming telephone calls. This is because the Department has no authority to impose any price changes on the suppliers of the services.
Patients groups and charitable organisations told Watchdog:
Patients Association
Katherine Murphy, Chief Executive of the Patients Association, said:
"Going into hospital is a stressful and worrying time, but most patients do not anticipate quite how expensive hospital stays can be. With car parking charges, inflated shop prices and in particular the exorbitant cost of some hospital phones, the cost mounts very quickly, making a mockery of the NHS being "free at the point of care".
When a hospital stay is extended, people will naturally want to stay in contact with loved ones. With a ban on mobile phones still operating in some hospital wards, some patients are forced to use the expensive hospital phones which have an effective monopoly to charge what they like for calls to be made. The price of a local call can exceed the normal rates for international calls making it harder for people to stay in touch with their loved ones, often when they are at their most vulnerable.
These charges represent an unfair tax on the sick who will have no choice but to pay up if they want to keep in contact with the outside world."
The helpline number is 0845 608 4455 and is open between 9.00am and 5.30pm.
Macmillan Cancer Support
Mike Hobday, Head of Policy at Macmillan Cancer Support, said:
"It's shocking that people with cancer are forced to pay a premium to watch television and speak to friends and family while in hospital receiving life-saving treatment. These are extra costs for cancer patients who have already been stung by having to pay high prices travelling to and parking at hospital. These charges are just another tax on the most sick and vulnerable. The very last thing that seriously ill cancer patients need to worry about is money."
Age UK
Michelle Mitchell, Charity Director at Age UK, said:
"Almost two thirds of hospital beds are used by people over 65, many of which can experience long or repeat admissions. Access to a telephone and television can be extremely valuable to many older patients. It is very unfair that using such services means patients face an additional expense at the end of their stay, which can add up to a considerable amount over time. Older people, many on low incomes, do not choose to spend time in hospital and burdening them with additional costs for basic services is unhelpful during what will be a distressing time".
Are hospital bedside service providers being hospitable?