Published: 30/01/2003, Volume II3, No. 5840 Page 38 39
Parking is an increasingly pressing issue for many hospitals, as space is squeezed and public dissatisfaction grows.
Seamus Ward examines progress in reducing car dependence, from better bus services to car shares The UK's love affair with the car is creating a crisis.
Not only is it snarling up our roads, but it is getting more and more difficult to find a parking space. It also creates problems for the NHS - more traffic means more accidents, while poorer air quality leads to more patients with respiratory diseases.
Yet the health service contributes to the problem.
With around a million staff and a million patient and visitor journeys a day, the NHS generates a lot of traffic. But it is taking steps to minimise its environmental impact.
Since 1999, there have been a number of national initiatives aimed at improving the service's record. That year, a transport standard was introduced requiring NHS organisations to show improvements in transport.
The national service framework for coronary heart disease asked trusts to develop travel plans to limit car journeys taken by staff, patients and visitors by April 2002. NHS Estates admits that not every trust met this requirement and insisted they be in place by October 2002.
Transport strategies should include a transport survey, set targets and benchmarks, involve unions, councils and public transport co-ordinators, consider partnerships and include measures to review performance.
As yet, there are no figures on compliance but there are signs that transport plans are becoming more important.
'If you ask any chief executive what the challenges facing them are, one of the top 10 will be traffic management, ' says Mike Gallagher, facilities director at Blackpool, Fylde and Wyre Hospitals trust.
'Most trusts would say an increasing number of complaints are about car parking. Everybody has a view on it and it frustrates all of us if we can't park our cars. We are projecting a 2 per cent increase in traffic over the next 10 years, so we thought it was time to do something.'
The hospital rebuilding programme is one of the main factors driving the development of transport plans. Local authorities, with their own targets to reduce traffic and environmental damage, are unwilling to grant planning permission for a new building without a pledge to minimise its effects on car use.
Trevor Payne, Oxford Radcliffe Hospitals trust facilities director, has experienced this first hand.
'We have been working on transport management for a couple of years because part of the planning permission for our PFI is that we must demonstrate we are managing car parking effectively. We have to manage down demand because they will not allow us more car parking for staff, ' he says.
So what are trusts doing to reduce congestion? The Department for Transportsponsored transport energy programme is helping some.
The project offers free consultancy advice on developing and implementing transport plans.
'We can get a consultant on site to work with the hospital to address transport issues for up to five days over a period of time, ' says programme manager Christof Marx. 'We review the existing travel plan, hopefully improve on it and help them when they are implementing it.'
Some trusts are exploring partnerships with other local organisations, such as supermarkets, to use their spare parking capacity. In Blackpool, for example, trust staff use spaces at the local zoo.
However, Mr Marx says opening new car parks is not a long-term solution. 'To cope with the increasing demand, some hospitals will want to expand their parking spaces but the problem is that local authorities will not give them permission. Even where they do, building a multi-storey car park is a huge investment.
'Some trusts have gone down this route and found the new car park fills up quickly so they are facing the same problem once again.
Strategies should be about addressing the root of the problem, not the symptoms.'
Failure to address the causes is also a cost issue, he adds.
'Not doing something has huge cost implications. It costs£250-£500 a year per parking space in terms of maintenance and resurfacing. If you expand parking, you have the investment plus ongoing costs.'
Most trusts' strategies involve simultaneously squeezing out car users while encouraging alternatives.
The squeeze usually involves increasing car park charges and limiting access for staff, using smart cards or parking permits. Southampton General Hospital restricts parking for staff who live within a mile, while Royal Devon and Exeter Hospital uses the city limits.
Oxford Radcliffe's restriction is determined by ease of access to public transport. Those who live in areas deemed to have sufficient public transport do not get a parking permit, unless they are disabled or need their car for work.
Many trusts plough the money they receive from parking charges into subsidising or promoting alternatives.
In common with many trusts, Blackpool has encouraged car sharing, cycling to work and the use of public transport. It offers grants of£300 for staff to buy bicycles, provides all cyclists with a free cycle lock and has invested in improved shower and changing facilities.
Staff car sharing is an obvious solution to the congestion problem but it has proved difficult to establish in some trusts. Oxford Radcliffe set up a car-sharing database, but staff were reluctant to use it. There are a variety of reasons for this - perhaps a perceived loss of flexibility, a fear of being without transport when a child or relative takes ill or simply not wanting to share their space with another.
'We had some success during the fuel crisis but two weeks after the dispute had died down people were back in their own cars, ' Mr Payne says.
NHS Estates says incentives are needed - Derriford Hospital in Plymouth has attracted more than 600 lift sharers by offering them free parking, priority spaces and a guaranteed ride home in the event of an emergency.
The problems trusts have encountered with car sharing illustrates a wider issue - the need for culture change. But perhaps a more pertinent issue, for staff at least, is the very nature of the NHS itself.
Shift work, on-call, split sites, emergency work and lack of security (real or perceived) contribute to car use.
'As employers, we have to be flexible because of people who work out-of-hours, particularly female staff, ' Mr Payne says. 'There is a conflict between the transport strategy and security but we look at each case individually and try to come up with a solution.' l Notts City: charge ahead Failure to receive planning permission for new buildings prompted Nottingham City Hospital to formulate a community plan in 1996, which included transport management.
Clive Young, the trust's logistics manager, says parking charges were introduced to fund traffic reduction initiatives, such as a free internal shuttle bus. Staff are charged about 19p a day, while patients and visitors pay between£1 for two hours and£5 for the day, though those attending on a long-term basis can receive a discount. All the pay and display ticket machines are solar powered.
'Car parking is still under pressure. In our first plan we reduced spaces from 2,400 to 1,800, but we still get about 14,000 vehicles a day on site.'
The trust has many initiatives to encourage alternative transport.
'We have moved the buses from the periphery of the site to going through the site and we have pooled cycles for staff. When they hire the bikes they get insurance, gloves, a helmet and a car rack and there are cycle lockers and racks around the site. We do not charge for the cycle lockers apart from a£5 deposit for the key, which is refundable.'
'Car sharing is starting to take off, but it is difficult, particularly with female staff on rotational shifts.'
'We are lucky that the trust has allowed us to ringfence the proceeds of the charges. This is vital to our transport and security plans and I know it does not happen in every trust.'
Cambridge: two wheels good, four wheels bad
Think of Cambridge and you may think of cyclists or punting on the Cam, but in reality travelling in the city is much less sedate. The local NHS is a significant contributor to the city's congested roads with visitors, patients and staff on the Addenbrooke's trust campus accounting for 18,000 vehicles on site a day.
The trust has been working to reduce car use since 1993, when the city council linked planning permission for new buildings to controlling traffic.
It has been successful. Wyn Hughes, the trust's access travel manager, says that in 1993, 74 per cent of staff travelled to work in their cars, but by 2001 the figure had fallen to 59 per cent. He is confident it will fall further this year. More than 1,300 employees regularly cycle to work.
Staff parking costs 40p a day and there is a higher scale of charges for patients and visitors, though there are concessions for long-term patients and their visitors.
'All the funds for our plans come from car parking charges. If we didn't have this money, we wouldn't be able to do half the things we are doing, ' Mr Hughes says.
Initiatives include interest-free loans for staff buying a cycle or motorcycle. And in January 2002, the trust struck a deal with local bus operator Stagecoach giving£3 off weekly unlimited bus tickets, which normally cost£8. By early December, 27,400 had been sold.
Mr Hughes says permit-less staff wedded to their cars have to be up early to get a space. 'It is first come, first served and they really need to be on site at 7.45am to get a space.'