Published: 16/09/2004, Volume II4, No. 5923 Page 31 32 33
Trusts are facing difficult decisions over car parking, ranging from environmental impact to who manages them. Sally Mesner reports
As the number of cars on the roads has rocketed over the last 30 years, provision of car parking at NHS trusts has become increasingly difficult to manage.
Until the 1980s, car parking had traditionally been provided free of charge to hospital staff, patients and visitors. But the growth of car ownership has meant the provision that hospitals were making became inadequate and charging was brought in to control supply and demand.
As parking management has become more and more complicated, many trusts have opted to contract out services to facilities management companies such as CP Plus, which manages car parks on 50 sites for 20 trusts.
'We can run car parks more efficiently and cost-effectively than hospital trusts, ' says CP Plus head of development Grahame Rose.
'Car parking is not a trust's business; they do not understand it. They come to us when they are in a mess because they have no control over their car parks or if they need to change their car parks because of supply and demand issues, ' he explains. 'If the hospital is near a station, you'll get lots of people parking there who are not using the hospital. In a town centre hospital you get people turning up and not being able to park - driving round and round trying to find a space. There are all sorts of issues that may influence what needs to be done.'
North Staffordshire Combined Healthcare trust contracted out its car parking services when it began charging in 1995. 'We have the expertise to run a hospital, not a car park, ' explains spokesman Mervyn Gamage.
'When we first introduced charges the main reason was to pay for staff to supervise our car parks to improve security, as we had suffered rising levels of car crime. The result was an immediate and dramatic fall in crime. We also introduced a 24hour monitored and recorded closed-circuit TV system. All of this is paid for by the parking fees.'
Contracting out car parking services can also be an attractive option for hospitals that want to build a new car park but do not have the capital investment necessary.
Royal Bournemouth and Christchurch Hospitals trust, which did not have sufficient parking spaces to serve its two hospital sites, opted to enter into a 25-year public-private partnership with CP Plus earlier this year, which provided the capital for the development and construction of the car park.
Income generated from parking charges will pay for the capital development over the contract period.
But not all trusts think the contracting out of parking is the right approach.
Oxford Radcliffe Hospitals trust transport and planning manager David Edwards says:
'We brought the management of our car parks back in-house about six years ago because we were paying probably about twice as much as it would cost to employ the staff that were patrolling the car park.
'It was a costly and poor service, and difficult to control. We were losing revenue when the contractors were not clamping vehicles that were parked illegally, losing income for the trust. These issues are difficult to sort out when you are working with an outside contractor - it is easier in-house.'
Another factor to take into consideration, says Mr Edwards, is the contractor keeping a proportion, say 10 per cent, of the car parking charges, 'so you end up with less income to the trust without a better service'.
'It is better value to manage it yourself. Potentially, in-house management could cost half as much, ' he adds.
'Contracting out is only of benefit if you are trying to get investment for car parking. It is more of a financing option. We are planning to spend£1m on the site this year. If we can't get the money from the strategic health authority we would use a car parking management company, but this would be a last resort.'
According to Mr Edwards, whether or not a trust contracts out its parking services, there is a problem with how revenues raised from charging are used.
'You can generate a fair amount of income from pay and display but keeping that money ringfenced is virtually impossible; it goes into the big pot, ' he claims.
'And there is a tendency for car parking to fare badly in costcutting reviews. You are more likely to get approval for a new physiotherapist or nurse than a car parking attendant.'
One insider, who wishes to remain anonymous, agrees with Mr Edwards' sentiment. He says his hospital makes in excess of what it costs to maintain its car parks and that the money goes back to the trust to pay for health.
'The revenue raised from car parking is more than£250,000 a year, ' he says. 'But only£20,000 is put back into car parks. Charging is a big money-maker for trusts.
In the last five or six years, trusts have cottoned on to the revenue potential of charging for car parks and turned it into a tax for health.'
But independent parking consultant David Lenz says the amount of revenue generated by car parking charges depends on the objectives of individual trusts.
'Car parking charges can bring in revenues that are the envy of a small business, ' he says. 'But NHS trusts are independent financial organisations - they can charge, not charge, enforce, not enforce, or have a free-for-all.
'It depends whether their objective is simply management or to raise revenue. At the lowest end of the scale, trusts' charges are sufficient just to meet costs, others make enough profit to enhance services and there are others that charge market rates and receive market revenue.'
Royal Cornwall Hospitals trust director of planning and performance management Mike Coupe says his trust still has to subsidise parking from the capital budget.
'Our car parks are not completely self-funding. Charges are very modest and there are discounts for staff, ' he says. 'We have a contract with a facilities management company and any cash generated goes back into improving car parking facilities.
'We will soon be investing substantially in improving car parking facilities. To change a gravel car park into a tarmac car park, you're looking at a quarter of a million pounds.'
He adds: 'Unless you charge a parking premium, like in the centre of a city, there will always be a need for the NHS to pick up part of the tab.'
Another instance where trusts opt to contract out their parking services is when they are involved in a private finance initiative deal.
The car parking at Mid-Essex Hospital Services trust's Broomfield Hospital in Chelmsford is tied into a deal which will involve the centralisation of two sites into one, with some extension. The car park will be run by a facilities management company that will be part of the PFI consortium.
Car parking is integral to the new hospital design. Currently there are two sites - one in the centre of town and one on the edge. Both sites will be centralised at the rural site, with total reconfiguration of the parking, which will include a multi-storey car park.
One issue for trusts building a new hospital is that as part of the planning approval there must be an S106 agreement. This is a legal agreement on transport involving a green travel plan.
'One of the conditions is to cut down on staff parking with an emphasis on reducing the number of single-occupancy car journeys, ' says Mid-Essex Hospital Services trust director of estates Norman Bruce.
'We have to spend£1m over five years to implement a green travel plan, which includes reducing single occupancy car trips by staff by 5 per cent and increasing the number of people who cycle.
'We are providing covered bicycle parking spaces with washing and drying facilities, cycle routes up to and past the hospital and car-sharing schemes.
There is also a bus terminus right outside the main entrance of the new hospital and we are subsidising ticket costs for staff.'
Staff parking is also a problem at Oxford Radcliffe Hospitals trust, which is consolidating two hospitals on one site.
'We can't have more staff parking than we already have because of strict planning regulations, ' says Mr Edwards.
'That is why we have a travel plan. It is designed to help us move the old hospital in the city centre to one of the suburban sites. This means the site will have more staff but we are not allowed to increase the number of car parking spaces. We have to get staff out of their cars and on to public transport.
'After the move there will be enough visitor parking - we are increasing it from 500 to 800 spaces - but the problem is staff parking.'
He explains: 'Car culture is very embedded, especially outside London. It is very difficult to get people to see that there are alternatives to the car. But We have got staff commuting by car to our sites down from 63 per cent to 55 per cent, and 12 per cent of staff are now cycling to one of the sites.'
Another problem for trusts is government guidance that sets out the number of car parking spaces a hospital should have.
Planning guidance document PPG13 specifies ratios of car parking spaces for staff and patients.
Mr Coupe of Royal Cornwall Hospitals trust says that these are at odds with the needs of his trust.
'The trust has three hospitals, in Penzance, Hayle and Truro. Each is a rural location with poor bus services, so cars are relied on heavily to get patients and staff to the hospitals, ' he says.
'PPG13 says we have 40 per cent more car parking spaces than we should have but we think the capacity we have is barely adequate. We need 150 more spaces. There is a conflict between the guidance and the realities we have in Cornwall.'
Mr Coupe says that although the trust has a green travel plan, there is a limit to the impact such planning can have in Cornwall.
'A green travel plan here will not make as much impact as somewhere like London, ' he argues. 'Car parking is a vital part of the infrastructure for the hospital. Rural areas like ours should be given more leeway.
'There is no other alternative than to increase capacity, ' he insists. 'But we can't build a new car park without planning permission. We are in discussions with the county council about how to do this, but it will either be on-site car parking or park and ride.'