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Charging for parking at hospitals has become a controversial and politically sensitive issue. There has been a huge impact on the numbers of people wishing to park at hospital as a result of issues such as increased car ownership, the concentration of specialist medical services in fewer areas, the construction of new hospitals on the outskirts of towns with poor public transport access and the treatment of more people as outpatients.

From 2011 patients, staff and visitors will be able to park without charge at almost every NHS hospital in Wales or Scotland. This has placed politicians under additional pressure to operate a similar system in England. However, ministers maintain that subsidising car parking fees for all staff and public would not be a sensible use of resources. The subject has attracted high media interest and increasing scrutiny from patient and staff organisations. Claire Bentley takes a look at the issues involved.

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 Reasons for charging parking fees

Ministers and others argue that charges are necessary for the majority of users of hospital car parks. Their reasons are as follows:-

  • there are significant costs associated with a hospital car park that is secure and well maintained that need to be met;
  • a total ban on charging would almost certainly mean that funding would be taken away from NHS healthcare services;
  • as the transport costs of non car owners are not subsidised, it would be inequitable to spend NHS budgets on car parks;
  • the provision of free car parks discourages people from finding alternative forms of transport. This will not reduce NHS carbon footprint targets; and,
  • free car parks encourage commuters to park in hospital car parks inappropriately.

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Reasons for abolishing parking fees

The view of patient groups and staff organisations is that no charges should be made for hospital car parks and that any charge is an indirect tax on the sick. In addition, they argue that:-

  • NHS care is based on the principle of free care at the point of delivery and this should include car parking;
  • in 2003 the Social Exclusion Unit (“SEU”) estimated that 1.4m people each year miss turn down or choose not to seek healthcare because of transport problems. The SEU suggested that a combination of a poor supply of public and specialist transport, lack of financial support for those on low incomes and the location of healthcare facilities was to blame. Some parties believe that free car parking may alleviate this problem;
  • many staff work unsocial hours or live in rural areas. Both of these factors mean that regular public transport is not always available and hence staff are obliged to drive to work.
  • if free parking was available staff and patients would not park locally on residential streets around the hospital; and
  • a visit to a hospital can be a stressful time and patients do not want to worry about having the correct change or feeding a meter if an appointment takes longer than expected.

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Current position for hospital trusts in England

Although NHS facilities should have sustainable public transport plans in place they are not obliged to provide parking. Government policy is non prescriptive and individual hospital trusts in England are able to decide whether or not to charge for car parking and the level of any charges in the light of local circumstances. Inevitably this has meant that there is a variation in charges across the country.
Department of Health guidance states that all NHS Trusts should have exemption and concessionary schemes in place to support specific types of patient and to ensure that patients and relatives who visit hospital regularly are not disadvantaged. There are also various schemes in place to assist as follows-

  • relatives who are receiving income support can receive help from a Social Care Grant towards transport costs to visit hospital;
  • patients on low incomes referred for non-primary medical care can reclaim the cost of travelling to and from their appointments via the Hospital Travel Costs Scheme;
  • patients with a clear medical need authorised by a doctor, nurse or midwife can use the non-emergency Patient Transport Service; and
  • dispensations for certain groups such as visitors to patients who are near to death and regular visitors such as radiotherapy patients also qualify for free or reduced charges at many hospitals.

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Demonstrating a fair system - good practice

In April 2009, the NHS Confederation published a report entitled "Fair for all, not free for all" suggesting five principles for fair car parking and transport policies. This report proposes that if NHS trusts followed these principles they would be able to demonstrate to their communities that car parking and transport policies were fair. These are:-

Have a travel plan for users of all types of transport.
This includes service planning, building design, access routes and other transport modes. The following should be considered:-

  • provide a secure and well maintained car park and encourage car sharing schemes
  • provide secure cycle parking and facilitate tax free bike purchase;
  • negotiate with local authority travel facilities to improve the travel service; and
  • reducing the need to travel to acute hospitals by providing care closer to home, reducing waiting times and staggering outpatient appointments can be a way of improving access.

Control parking fairly with concessions for those whose health conditions or work commitments mean they have to park frequently or at anti-social hours.
Guidance from the Department of Health states that NHS bodies should have arrangements for concessionary parking including permits and season tickets for those who need to use it frequently and that this is clearly advertised.  

Show car park and transport costs and how charges are invested
 A clear and transparent system should be in place so that receipts from car parking are reinvested into improvements in alternatives. This would allay concerns that charges are being used to raise money for healthcare.

Think about the environment and how transport can reduce the impact of the NHS
5 % of UK road emissions of CO2 are from NHS related journeys. Travel is responsible for 18% of the NHS carbon footprint. The NHS has a target to reduce carbon emissions by 10% by 2015. For environmental and health reasons the NHS should endeavour to encourage people to use other forms of transport.

Be open and involve patients and the public
Clear information should be available to make all hospital visitors aware of the policy in relation to car parking charges and potential entitlements. The following should be considered:-

  • notices should be displayed in patient areas and provide details of hospital charges and concessionary schemes/exemptions at pay points and with appointment or admission letters;
  • information should be provided about Hospital Travel Costs Scheme or NHS low income scheme;
  • clear guidance is needed for disabled users when all spaces are taken;
  • refunds of car parking charges should be available retrospectively;
  • a clear complaints procedure should be in place and this should be communicated to service users.

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The most recent National Patient Choice Survey indicated that 46% of respondents rated car parking as one of the key factors in choosing a hospital. In order to maintain commercial sustainability hospital managers need to continue to endeavour to improve patient and staff experience, access to services and the reputation of their hospital.

It is important that NHS trusts ensure that patients and staff can park on site where necessary, that finances are focused on patient care and that the impact of healthcare on the environment is reduced in line with the NHS carbon reducing strategy. Each hospital needs to establish what works best for them locally. However, the system that is operated must be seen to be fair.

If you are setting up a car parking scheme or reviewing an existing one, Bevan Brittan can assist you in drafting any formal agreements and policies and advise you in relation to relevant issues.

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