Paying the price for hi-tech hospitals

PETE Lambourne is pleased with his bedside TV/radio/telephone set.

It is mounted on a long arm, like an old-fashioned angle-poise lamps. Pete can twist it and turn it so it is comfortable to use whether he is sitting or lying in bed.

There are 16 TV channels, five radio channels, internet and email access here at his bedside in York Hospital.

On top of that, his wife can telephone him at his bed to check how he is, without having to ask busy nursing staff to pass a message to him or wheel in a cumbersome payphone on a trolley.

Twenty-first century convenience, in other words - just as patients should have the right to expect.

"It is convenient," says 69-year-old Pete, who was admitted to York hospital's Ward 32 with angina on Friday the 13th, of all days. "I use the TV regularly. I can watch what I want without disturbing anybody else. When I first came in, in fact, my first reaction was that I'll have to get two of them for home: one for me and one for her his wife. I'm a bit hard of hearing!"

Such convenience comes at a price. Patientline, the company which installed terminals such as this at almost every one of York hospital's beds, spent about £1.2 million on setting up the system.

Neither the hospital nor the NHS paid anything towards that - so the only way the company can get its money back is by charging patients.

Using the radio is free. The TV costs £3.50 a day - although it is free for under-16s and there are discounts for the over-60s and patients staying in hospital for more than 14 days.

Accessing the internet costs four pence a minute, playing a computer game 30p a time. Most controversial of all, however, are the telephone charges. It's 10p a minute for local and national calls if you are in the hospital and calling out.

For friends and family calling a patient in hospital, however, the cost is 39p a minute off peak, and 49p a minute at peak times.

Doug Allwright, who spent some time in York hospital last November with heart problems, describes those rates as "obnoxious".

The charge for outgoing calls is OK, he says. "But if someone is calling in to speak to a family or friend, it is almost a premium rate."

Mr Allwright, from Raskelf, says he knows of patients who racked up hefty bills during their stay in hospital - either through using the TV sets and internet facilities, or on their home telephone bills because of their families ringing them in hospital.

Pete Lambourne isn't as critical as Mr Allwright. Overall, he says, the price of using the system is affordable - and it's far better than the old days when there was only a single old TV in the day room which all patients had to watch together.

But he agrees that in-coming calls are expensive. "If someone rings me, I say I'll ring back," he says.

The telecommunications regulator Ofcom is so concerned about the prices being charged by companies such as Patientline for hospital bedside systems that it has asked the Department of Health to launch a review.

The telecom watchdog launched its own investigation last July after relatives and patients complained that the host of calling someone in hospital could be more than that of dialling Australia.

Now Ofcom has asked the DoH to look into "all aspects" of the installation and operation of bedside telephone and entertainment systems in hospitals - with particular attention being paid to the high cost of incoming calls.

So are the new bedside systems, introduced in York in 2004, an example of the modern NHS at its best, using private cash to offer the best possible service to patients? Or are vulnerable patients and their families being exploited for private profit?

Hospitals across the country were required to introduce the systems by December 2004, under an NHS initiative. They were given a choice of three different private companies to install and run the systems - and York opted for Patientline.

Theresa Glassett, another patient on Ward 32, agrees with Pete Lambourne that the new system is better than noisy TVs and mobile payphones which had to be wheeled around.

"They are a great idea," says Theresa. "Some people watch more TV than others - but the TV is a very good distraction when you've got some pain."

The system is a bit too expensive, she says - especially those incoming telephone calls. She worries that her home phone bill could end up being expensive. "I think the system would get more use if it were a bit cheaper."

So why is it so expensive?

Danny Morgan, York Hospital's director of facilities, points out that no one is obliged to use the systems.

There are a number of free services available, he says - such as free radio access, and a free first day's use of the TV. And patients worried about the cost of incoming calls can always ring back, at a much cheaper rate.

The £1.2 million system installed in York cost the hospital nothing, he points out - and it has real benefits for staff, because it means relatives can phone patients directly, without nurses having to be bothered.

But is it really right that vulnerable patients should have to pay so much?

Patientline insists that its prices are dictated by the way the Government set up the whole programme.

All the costs of installing expensive and sophisticated equipment are carried by the company.

Patientline chairman Derek Lewis said Ofcom's view was that companies such as his had been forced to put up the cost of telephone calls to cover installation costs.

But far from raking in the profits, Patientline made a loss of £5.3 million this year, a spokesman said. The business plan is to break even in a couple of years.

So is this, in fact, just a prime example of why the NHS and private finance should never meet?

Perhaps, or perhaps not. With hindsight, a Patientline spokesman said, matters could have been organised differently, with the NHS bearing more of the initial cost of installing the systems.

But at the Government's request, the equipment installed uses very sophisticated technology. In principle it allows hospitals to store patients' records in such a way that they were accessible at the bedside at the touch of a button - which would, for example, reduce the risk of the wrong medicines being prescribed - and even allow patients to order their meals electronically.

Some hospitals were already doing those things - and ultimately the idea would be for hospitals to pay companies such as Patientline to use the systems in that way.

Those contributions from the NHS would allow the company to bring down the cost of calls for patients, he said.

"We have long wanted to reduce the burden placed on the relatives and friends of patients in funding this service," he said.

"We will continue to work with the Department of Health to secure a more appropriate method of funding for this important NHS service."

Stephen Lewis tries out the system

The cost isn't the only grumble that some patients at York Hospital have expressed.

Doug Allwright found registering to use the system difficult - even though he only wanted to listen to the radio.

"I'm in hospital, I'm unwell, and I'm having to register and have to go through so many selections on a menu: menus followed by sub-menus," he says, recalling his experience last November.

Yes, he says, there are nurses and Patientline staff on hand or at the end of a telephone who can help - but they're not always available when you need them.

Theresa Glassett agrees that it is a bit daunting at first. "Some older people did find it a bit difficult to use. But once you know how to do it, it is straightforward."

So how does it work? I had a go. The terminal has two phones, one at each side: one to access the various TV and radio channels and to register to use the system, the other to make telephone calls.

To register, you press a green button with the word operator written on it, which takes you to a recorded voice with a series of options.

"Welcome to Patientline," the voice says. "Thank you for calling. Please listen to the following four options."

It sets the teeth on edge, and it's a fair bet it is not what people want when they are feeling unwell and have just arrived in hospital.

But it is fairly straightforward, once you have negotiated the options suggesting you pay by credit card, and asking if your personal hospital telephone number can automatically be circulated to family and friends.

Within about three minutes, and having torn out only a few hairs, I had signed on and was away.

The cost of using the hospital TV and phone

Outgoing telephone calls: 10p a minute local and national

Incoming calls: 39p a minute off peak, 49p a minute peak time.

Radio: free access to Radio 1, 2, 3 and 4, Radio York and York Hospital Radio

TV: £3.50 for 24 hours (access to 16 channels. Under 16s free. 60 and over, or those staying in hospital for more than 14 days: £1.70 for 24 hours).

Internet: 4p a minute

Computer games: 30p a game.

Updated: 10:01 Thursday, January 19, 2006