Hospital car parking has become an impassioned talking point. While it may seem a side issue to the real work of healthcare, the heated arguments over charging won’t subside until policies are seen as fair and fixed, writes Joe Farrington-Douglas

The supposedly simple business of parking raises passion and fury. More cars than ever before on the roads, driven by motorists who expect to be able to use them when they want and where they want, has created a level of demand for NHS car parks which the system is having serious problems meeting.

Managers fairly ask how much time and what resources should be spent on this

The solution to rising demand for spaces has been, in many parts of the country, to invest in concrete. Multistory car parks, like those built at Addenbrooke’s Hospital in Cambridgeshire and the Heath Hospital in Cardiff, help satisfy the demand, but that kind of expenditure needs to be paid for, so charges have risen.

As well as helping pay for the maintenance and capacity, charging has also been used to help manage sites where there is limited space and to encourage visitors or staff to think about alternatives to their car. There is also little doubt, at least in some places, that the extra revenue has come in handy on stretched hospital balance sheets.

But as charging for a precious space becomes more widespread and more noticeable on the pocket, so public disquiet has grown and the mailbags of NHS leaders have started to bulge.

Macmillan Cancer Support has run a high profile campaign against the practice, arguing that cancer patients are a special case who should not be forced to take public transport to their appointments with all the dangers of infection that might pose.

The unions have waded in on behalf of their members, maintaining that charging staff on night shifts with lengthy commutes to areas with no public transport cover represents a tax on their employment and should not be tolerated.

Newspapers and broadcasters, both local and national, have taken up the cry that charging to park is a “tax on the sick”, a pernicious grab for more money from the unwell and vulnerable - and politicians have sniffed the air, felt the mood and marched in with suggestions of compromise or change.

Banning charges

Bans on most types of charging are already in place in Scotland and Wales, while it is being discussed in Northern Ireland.

In England health secretary Andy Burnham says visitors to inpatients in hospital should be given free parking and is consulting on the policy, a curious halfway house given that most attention has focused on outpatients and staff, two groups explicitly not covered.

Consultation on this policy among NHS Confederation members found concerns that it could prove counter-productive.

These range from predictable concerns that the loss of revenue would have to be made up in some other way, either by increasing charges on other users or by raiding hospital budgets, to the impact on congestion of free parking, concerns about how to administer free spaces for visitors and issues around sustainability.

And at trusts where there are already good provisions for outpatients and night workers the concern is that this new provision for visitors could force a rethink of existing exemptions to charges.

In the final analysis there is only so much space to go round and the only really crucial question is who has the final decision on how they are allocated, distributed and, if necessary, charged for.

The NHS Confederation, in its own report Fair for All, Not Free for All, was clear that it should be for individual trusts to develop policy consultation with local users, unions and patients’ groups. Local sites are just that - local - with their own unique constraints and opportunities. We felt it made little sense to expect the same policy to work for a large rural site in Cumbria as for a cramped teaching hospital in central London.

The British Parking Association, not an organisation familiar to most leaders in the NHS, is drafting its own parking charter, with the cooperation of the confederation. This will aim to foster best practice and self-regulation and we hope will see off any further tinkering with the rules by government.

The hope of hospital chief executives will also be that an approach based on concessions for specific groups of patients, night workers and others, allied to proportionate charging and transparency, will go some way to brokering a peace deal with the anti-charging lobby.

Concession concerns

But there are understandably concerns that systems based on concessions are likely to be unwieldy and bureaucratic.

How do we view the cancer patient who visits hospital for another condition? Or to see a relative? Staff who use the car park on a day off? How do we decide which conditions get free parking, and which do not?

Managers also fairly ask how much time and what resources should be spent on this: should it really be considered a big part of healthcare and funded accordingly?

Despite these reservations it is clear there is understandable public concern about cancer patients getting parking fines after being delayed by late- running procedures or where relatives of gravely sick children have found the cost too heavy.

While the campaigning of organisations like Macmillan might sometimes seem to focus just on the one illness, their claim that well over half (59 per cent) of cancer patients are still not getting free or discounted parking when they visit hospital is worrying and runs contrary to government guidance.

The consultation, which the NHS Confederation has been working hard to encourage its members to take part in, runs until 23 February and is probably the last chance for the NHS in England to make its case and put its own house in order.

It states clearly that charges should not be removed from all car parks but also seeks views on whether the solution is better adherence to guidance, free parking for inpatients or their main visitor or capping charges.

NHS leaders are busy people and may find parking an infuriating distraction, but while our relationship with the car remains one of entitlement combined with a nascent persecution complex the issue will continue to inspire the letter writers, campaigners and complainers.

Four nations: four ways to run a car park

England

  • Trusts set their charges autonomously, subject to guidance. Government consultation is underway on changes, including provision of free parking for people visiting inpatients.

Scotland

  • A number of reviews have seen policy develop from a general view in 2007 that the NHS should not charge for parking except where it is necessary through to a decision that from January 2009 all NHS boards would be required to abolish charges.

Wales

  • Free parking policy was announced by the new government in 2008 despite concerns from NHS managers about how £5m parking income would be recouped, and how the costs of security would be covered.
  • Some hospitals have found their free car parks being used by non-hospital visitors, including tourists and students.

Northern Ireland

  • Decisions about car parking charges are, as in England, left to local trusts.
  • Guidance issued in June 2008 requires trusts to apply exemptions for certain categories of patients (those suffering from cancer and requiring chemotherapy or radiotherapy, those receiving renal dialysis, and the next of kin or partner of a critically ill or high dependency patient).
  • The Northern Ireland executive has confirmed it considers charging is a recognised means of discouraging inappropriate parking by commuters and that the resulting revenue is required to pay towards the costs of running car parks.