This Westminster Health Forum seminar will discuss the future of funding in the NHS, looking at priority areas, productivity and integration.
Should NHS budgets be spent on parking?
Should patients using NHS services be charged for parking? It is the topic that refuses to drive away. Glenn Dives of the British Parking Association explores the current situation
There has been a great deal of comment lately about parking in hospitals. Parking facilities at hospitals are usually oversubscribed with demand often outstripping supply, and, for this reason, parking facilities and transport links need to be effectively managed to provide a better experience for all, whether they are a patient, visitor or employee. In some cases, this has led to hospitals charging for parking, resulting in political and media attention calling for the abolishing of all charges. These calls have crystallised in a new Bill which begun its progress through the House of Commons on 14 November 2017, sponsored by Robert Halfon, the Conservative MP for Harlow. This Bill seeks to ban outright the charging for parking spaces in England’s NHS hospitals and while it is well intentioned, it fails to address several practical issues concerning the provision of parking. Indeed, it may be a case where the proposed cure may be worse than the disease.
Before considering the Bill, let’s investigate a philosophical question. Is anything free? I’m sure everyone is familiar with the saying ‘there’s no such thing as a free lunch’. Everything built or maintained by people has a cost associated with it and that goes for parking. There is no such thing as a free parking space – somebody, somewhere is paying for it. This is true everywhere: in town centres, at the beach, in the countryside and at the hospital. While some NHS car parks and car parks in general may be free at the point of use the upkeep and maintenance is provided from somewhere else. If it is being patrolled to keep users safe, then someone is paying for that too. These operating costs will not disappear if the charges at point of use are abolished. The question of how and ultimately who is funding this service remains.
Hospital parking is no exception to this rule. If hospital parking was not charged for at the point of use, as proposed currently by Halfon’s Bill, then where would the costs of maintenance be paid from? Those maintenance costs in the form of surface repairs, painted lines and grass verges would have to come directly from healthcare budgets, either centrally funded or from the operating budget of the local NHS trust. This is unfortunately the reality of the situation - if those sites are not maintained then they can become dangerous. But funding NHS car parks like this is likely to become a contentious issue and is the first reason why we feel free parking at hospitals doesn’t protect the most vulnerable in our society.
This issue is not limited to the existing parking infrastructure of hospitals, it is an ongoing one that could have significant effects on the behaviour of administrators for years to come. This was evidenced when the Bill was proposed in the House of Commons. James Duddridge, Conservative MP for Rockford and Southend East, highlighted his concern that capital expenditure will not be found to provide more parking spaces. He believed that future capital expenditure on car parks would be limited, because there would be no revenues associated from the expenditure. He went on to ask the question ‘what happens in cases where existing car parks are being built?’. If those plans anticipated a revenue stream following a car park’s construction, the removal of the charges would undermine the budgeting process for the expenditure, possibly leading to the cancelling of the construction of that car park. He also believed if demand for parking increased in the future, that there would be no market mechanism to enable more car parking spaces to be built to cater for it. In the end, he conceded that while the ‘Bill is a popular move—it would be popular with my constituents’, but concluding that it didn’t mean it was the right thing to do.
Beyond the financial and budgetary concerns there is some real-world experience of removing parking charges, which those supporters of the Bill in Parliament, the media and the wider public space, should consider. When parking charges were abolished in hospitals in Scotland and Wales patient accessibility didn’t improve; instead nearly all the spaces were taken up by commuters and staff to the detriment of visitors and patients. And because demand wasn’t managed properly it spilled onto yellow lines, grass verges and nearby residential streets. In some cases, bus companies refused to offer a service because they couldn’t get through, further disadvantaging the most vulnerable from accessing the hospital.
Finally, there are cries all the time for more money to support the NHS, but not one of those desires parking to be the recipient of that money. For someone who needs treatment, they would not want the hospitals budget to be spent on parking facilities either. What they would want is to receive their treatment and to access the hospital with as minimal amount of stress as possible. We believe that healthcare budgets are for providing healthcare, not parking spaces and with that in mind we contend that there should be some exemptions for long term or vulnerable patients who would receive discounted or free parking. But how to achieve this?
Availability and demand
We would advocate that charges must be reasonable and reflect availability and demand. That a concessionary system should be given to the following people if public transport may be impractical for them or if parking charges could become a burden over time: disabled people; patients with a long-term illness or serious condition needing regular or long-term treatment (for example, people having dialysis, radiotherapy or chemotherapy); visitors (such as careers) who need to visit patients regularly; staff working shifts that mean public transport cannot be used; and other concessions, e.g. for volunteers or staff who car-share, should be considered locally.
Where such a system is in operation, NHS trusts and operators should work together to make sure they give the maximum publicity to such concessions and that they are taken up by eligible patients.
We have long been interested in this topic, publishing a Charter for Healthcare Parking in 2010 and working with the Department of Health in updating parking guidelines for NHS trusts, which was published in March 2015. The guidelines include case studies of good practice that other NHS trusts are encouraged to emulate. NHS patient, visitor and staff car parking principles - Rules for managing car parking in the NHS is an excellent guide to good practice that we commend to all trusts and parking operators to ensure they strike the right balance between being fair to patients, visitors and staff and ensuring facilities are managed effectively for the good of everyone.
No one enjoys a visit to a hospital or a doctor’s surgery. If someone does make that visit, it is generally because they are ill or are visiting a loved one who is ill. Why, on top of that, should they feel stressed about parking? It does not help them if a doctor, nurse or surgeon is also stressed about parking too. A professional organisation should look to manage its car parks and take steps to help minimise anxiety. Hospital parking is a complex issue which stirs ups a range of emotions, that is why it should be looked at as dispassionately as possible, weighing up the evidence before deciding. Finding a resolution to this situation is not difficult and our suggestions above could prove the basis for such a solution. The British Parking Association stands ready to work with any and all organisations involved to find a reasonable solution suitable for all parties involved.