Why it's 'nurse, the syringe' for patients' pockets

An initiative to bring TV, phone and internet to every bedside promised a nicer stay in hospital. But, finds Sam Dunn, the costs are a suitable case for treatment

Welcome to the dawn of the hi-tech hospital ward. If patients want to call home, they no longer have to rely on nurses wheeling in a telephone on a trolley. If they want to watch TV, it can be a programme of their choice. If they want to go on the internet or read their emails, they can.

Welcome to the dawn of the hi-tech hospital ward. If patients want to call home, they no longer have to rely on nurses wheeling in a telephone on a trolley. If they want to watch TV, it can be a programme of their choice. If they want to go on the internet or read their emails, they can.

It's all down to the introduction of the "bedside entertainment console", a government-backed initiative to bring the world of multimedia to Britain's big hospitals.

It seems a healthy idea, but in practice the diagnosis has not been so good, because both patients and their families and friends will feel the pain in their pockets.

For example, people putting in phone calls to the hospital consoles could end up paying nearly £5 for a 10-minute conversation with their loved one or friend. And, while patients will pay less for an outgoing call - 10p a minute - watching the TV next to their bed could cost £3.50 a day and access to the internet £2.40 an hour.

The scheme was created five years ago under an NHS plan called Patient Power. The idea was to give greater independence to patients and improve the quality of their hospital stay. As part of this remit, the consoles were to be installed in all Britain's major hospitals - those with more than 400 beds - by the end of 2004.

The problem, however, was that this wasn't going to cost the NHS a penny. So the firms that stepped up to devise and install the systems are looking to recoup the costs. In doing so, they have been criticised for over-charging and not communicating the prices properly.

"Patients are a hostage to fortune. They may be about to have surgery or be seriously ill, and families don't realise that it's costing them a fortune to ring up," says Michael Summers, the chairman of the Patients Association, a charitable body set up to represent their interests.

"Yes, the technology is wonderful, but only if it's affordable. Not one company offers a cheap call."

But the firms - Patientline, HTS and Premier - point to the 10p-a-minute charge for patients to call a landline locally and nationally as a sign of value for money. "That is a reasonable fee; it's comparable to BT's payphone rates," says Steve Martin of Premier.

That may well have been the case a couple of years ago, but not today.

The charge for an hour-long chat made by a patient using a Premier bedside system is £6. If you use cash in a BT payphone, local and national calls are charged at 30p for the first 15 minutes, then 10p for each seven-and-a-half-minute block thereafter. So the total hourly cost would be 90p.

The console prices are not set to come down any time soon. "We are required to fund all of the costs [of installation] and they have to be borne by patient users - it's an inescapable logic," says Derek Lewis, Patientline's chairman and former director general of the Prison Service.

In other countries where Patientline's systems are used, such as Holland, hospital staff also use the bedside machines for administrative tasks. "For example, they can be used to hold patient data, print daily food menus and take orders," adds Mr Lewis, explaining that the hospital then bears some of the costs, enabling patient charges to fall.

"But less than 1 per cent of UK hospitals currently use them for this," he adds. "So our objective is to encourage them to use these other [capabilities] and bring down costs."

Around 60 per cent of target hospitals have been equipped so far, he estimates; the Department of Health could only say that those without the units were on track to get them.

Neil Quentin, recently a patient at Christie Hospital in Manchester, told The Independent on Sunday of his dismay at the cost of Patientline's incoming calls and the poor choice of TV channels. "I'm going back in again soon and definitely won't be using it; it's lousy value for money."

Christie Hospital also displays a webpage suggesting that the Patients Association endorses its Patientline system; Mr Lewis admits this is not the case and says it should be removed.

Patients don't have to sign up to one of these units, but right across Britain's hospitals, the alternatives are becoming more limited. Although relatives can still ring up and be put through to the ward, they can only ask a nurse how the patient is getting on - not speak with them.

A spokeswoman for the Department of Health says payphones and free terrestrial TV "will not cease to exist in hospitals". She adds: "There will remain an alternative for patients who may not be able to afford the bedside services or do not wish to use them."

But the trolley phones do not allow incoming calls, and mobiles have largely been ruled out on health and safety grounds.

As a matter of hospital policy, TVs are not allowed on wards where bedside entertainment has been installed.

In defence of their costs, the firms point out that TV is free for children (under 16) and that elderly and long-stay patients can get discounts.

They also cite an NHS survey in February of 327 patients in six hospitals with bedside services. According to this, 72 per cent said the systems offered "good value" - with an average spend of £24.89.

However, a quarter said they were unaware of outgoing call costs and a fifth reported that the system had broken down.

The survey also found that it was up to the patients to tell the company if they qualified for a discount.