NHS: calling in sick

Why, ask ministers, when patients everywhere say the NHS is wonderful on the important things, does

The government is peddling a new line about the health service. In précis, it is this: individual experience of the NHS is very good; it's just our overall impression of it that's poor. I've heard it from Patricia Hewitt and Andy Burnham, minister for delivery and quality at the Department of Health, but it's like an Arctic Monkeys song - if you listen to the radio long enough you'll hear it from everybody.

What a silver bullet it is, this conspiratorial, wink-wink blame-the-media rhetoric. "If it were just you and me," it leans over and whisp ers to the electorate, "we'd be getting along fam ously." It's really hilariously sleazy; it's been adapted from a saloon bar. And yet it sticks. I put the NHS notion, con versationally, to a retired civil servant, latterly of the DoH, and she said exactly the same: if we're taking positive experiences away, and transmuting them into a negative impression, that must be the fault of media.

But it doesn't stack up. When have the media ever been able to turn us against anything that had genuinely left us with a good impression? Despite their best efforts, with package holidays and pit bull terriers and saturated fats, when have they ever wielded that kind of influence? Furthermore, when have the media ever been united in a determination to peddle one view over another? Surely, disunity is the media's defining characteristic?

If it's not the media, though, it must be something. MRSA and Clostridium difficile have had a great impact, for sure, but if we were to confine ourselves, for the time being, to matters of direct policy, involving no bad luck or deus ex machina, what would a "poor impression" boil down to?

People who see hospitals at close range may have their lives saved and write the most impassioned thank-you cards to the nurses, but they still emerge feeling they've been had. Why? Because of the daylight robbery of hospital phones and the bloody car parks. We can cope with a lot of aggressive upselling in our day-to-day lives, but not when we're ill. It's dishonourable.

In March, a totting-up of car-parking profits for the year came to £100m (and 71 of the 249 NHS trusts didn't get their returns in in time to be counted). In January last year, Ofcom's investigation into bedside consoles found that calling a patient was, at 49p a minute, more expensive than calling Australia. In addition, callers were subjected to a long recorded message that, even the first time, was needless; to have to pay for it on every call was simple theft.

The Ofcom report found that, in short, the calls were expensive because of the agreement the NHS trusts had with their contractor Patientline, which provides, free of charge, bedside consoles that could otherwise cost up to £1m per hospital. So the call charges reflected the fact that it was trying to claw back its outlay as fast as possible. Since the report expressed serious concerns but did not find the company to be in violation of the letter of its licence, Patientline took the opportunity this past week to raise outgoing call prices. Not in line with inflation, don't be absurd. By 160 per cent, from 10p a minute to 26p.

Patients and their families have had no say in any of this, as they had to communicate some how, and as mobile-phone use has until now been barred from hospitals, for "interfering with the equipment". This year, however, the Medicines and Healthcare products Regulatory Agency (MHRA) recommended that mobile-phone use be allowed everywhere but intensive care and specialist baby units. Mobile phones do not, apparently, interfere with equipment at distances of greater than two metres.

So, unless you are in surgery, or connected to actual machinery, phone use poses no threat, and doctors have been saying as much since 2004. Some healthcare trusts have been allowing mobile-phone use since then, but across the board there is considerable lag, and I cannot count the number of times I have seen it attributed to pressure from Patientline. However, when I put this to Andy Burnham via the DoH press office, this was his reply. Literally. "There are issues to consider in relation to the use of mobile phones in hospital [that] have increased with the onset of camera and video phones. Although the issue of mobile phones' effect on medical equipment still exists, what has become more important is the privacy and dignity of patients." Well, it's very charming of you to reply, I replied, but this doesn't answer my question, which I reiterate: Was this due to pressure from Patientline? Is there anything in the contract that requires trusts not to allow mobile use?

No response, absolutely stonewalled. It is only when you approach individual trusts that you discover, yes, the original Patientline contracts did have a clause in them requiring the hospitals not to allow mobile use, but many of these trusts rather sniffily point out that, at the time these contracts were signed, they had a mobile-phone ban in place anyway. It leaves a nasty taste in the mouth, doesn't it, though? Decisions that are fiscal have been held up as medical and/or scientific. "Ooh, little blinking lights," we're supposed to think. "Very sensitive! Mustn't check the football scores on the phone, might accidentally kill a baby two floors away."

Another sour note was struck by Patientline numbers, which began 070 and suckered people into thinking they were dialling a mobile, with mobile rates - a very expensive phone number should be flagged up with something less apparently familiar, like an 090. It might seem a small point, but if you're not trying to rip people off, why does it look so much like a rip-off?

The main questions seem to be - why was there such a rush for these bedside consoles that they had to be financed in this way? With all the money coming upfront from Patientline (or its smaller competitor, Premier), of course that outlay would have to be recouped, of course it would be recouped from patients, and of course it would happen according to business and not humanitarian principles. Why has parking turned, overnight, into such a money-spinner? Why, if they're going to net a million quid a year in parking, could hospit als not use the money to fund their own consoles?

Fast expansion

Patientline was founded in 1993 by Colin Alton, its first managing director, who put in £100,000 of his own money. It was first introduced into a hospital in Harrow in 1995. Alton remarked later, "If we could have funded the business without private equity capital, then we would have done so, but we needed to expand fast. If we had taken time out to borrow money we wouldn't have been able to roll the business out quickly enough. Since it costs more than £1m per hospital to provide the system, banks were unlikely to want to take on that sort of risk."

Well, the obvious question is, why did it have to be done so fast that it had such an impact on the way it was funded? From a business perspective, the answer is obvious - there was just so much money in it, or so they thought.

The next managing director, Derek Lewis, was at this time head of the prison service. He was fired from Patientline in 2005 after the major shareholder, Shore Capital, blamed him for the Ofcom investigation: "The damage caused had been significant. Shore Capital were firmly of the view that the investigation was largely self- inflicted and should have been avoided."

It's daft, really - the only way Ofcom could have been headed off at the pass is if Patientline had immediately halved its prices. Even then, this would have influenced but not halted the investigation. But the big puzzle is why the bedside TVs turned into such a rush, a 2000 promise that had to be fulfilled by 2004? Why not wait until the trusts could afford the infrastructure themselves? Judging by the turnover from the car parks, they wouldn't have had to wait long.

Now, those car parks. Most hospitals do have exemptions, typically for pregnant women, relatives of long-term in-patients, low-income patients and those on dialysis. The real point of contention is cancer patients, who are exempted by some trusts only. Furthermore, according to Macmillan, the cancer care charity, many people who are entitled don't know about it. There is no suggestion of actual corruption - all trusts insist that the money raised goes back into the hospital, but you have to pester them to find out even the type of spending it might constitute, and you have to know a hospital well to understand the claims. St George's Trust in Tooting, which last year raised £866,549, says: "All money raised through car-park charges contributes towards the maintenance and upkeep of the hospital, for example maintaining the car-park facilities, upgrading the ward environment, or improving signage for patients and visitors around the site."

Most patients would quibble with paying through the nose for a car park just so it looked nice; as for the "improved signage", I have lost a mother and an uncle at this hospital. I don't mean they died, I mean I lost them. My mother showed up only when I'd wandered from ward to ward for so long that I finally shouted: "What do you want me to do, hire a private detective?" My mother heard me from an ante-room. The signage sucks. If the wards have been upgraded, I'm a monkey's uncle.

Still, the parking isn't privatised, so it undermines the anti-privatisation argument if the public service itself is going to start behaving like a loan shark as well.

From the birth of the NHS, there has been one shared principle: we may disagree about the proportion of income we want to spend on healthcare, but we tend to agree that the last time you want to be stung for services is when you are ill. The last people we want to be paying for "improved signage" are those spending a day a week in the chemotherapy units. The last people we want to be funding the bedside consoles are those calling up for news that probably isn't good. If we perceive a service poorly, when in many ways it is phenomenal, this is why.

This article appears in the 16 April 2007 issue of the New Statesman, Iran