News / News analysis: Car trouble

The abolition of car parking charges at NHS hospitals in Wales has sparked a lively debate. But how will it affect trusts in Wales and across the wider NHS?

The NHS has discovered its own version of road rage. In the wake of the decision to scrap car parking charges at Welsh hospitals and the revelation that trusts in England can collect millions of pounds from their car parks, the charges have been described as a ‘stealth tax on the sick’, ‘exploitation of the vulnerable’ and ‘morally wrong’. But behind the hyperbole there lies a major headache for many trusts across the UK.

Patients and their visitors expect car parking. Staff, particularly those who work unsocial hours, demand safe, secure parking. Yet trusts are duty-bound to reduce car use under government green policies.

If a trust is to operate its own car parks, some upfront investment is needed together with ongoing costs for maintenance and security. Guidance for the NHS in England published in 2006 says charges can cover these costs and ensure no funds are diverted away from patient care.

Some trusts have opted to contract out car parking to specialist firms, sometimes as part of private finance initiative deals. The firms will wish to turn a profit, although the NHS England guidance insists that the trust should retain control over pricing.

Department of Health guidance effectively ties the hands of trusts that levy charges. In order to charge for car parking, it must be seen as an income-generating scheme. But the rules governing such schemes mean the NHS body must make a profit, regardless of whether they are operating it themselves or have subcontracted it to a private operator.

Hospitals situated in prime positions – near offices or shops – argue that charges are necessary to prevent abuse. Free parking would see an influx of motorists who are not attending the hospital, perhaps denying patients, staff or visitors a space.

The row over parking fees started brewing in December, when Scottish cabinet secretary for health and wellbeing Nicola Sturgeon announced a £3 a day cap for all hospitals. Many do not charge at all but Ms Sturgeon insisted the limit represents the best balance between costs to patients, visitors and staff and the need to meet ongoing costs.

In March Welsh health minister Edwina Hart decided all parking should be free from April. The only exception is where trusts have arrangements with private contractors. These will be phased out by 2011 with charges being reduced by June this year.

Welsh trusts collected £5.4m in parking charges in 2006/07 and local finance staff have told Healthcare Finance that trusts will have to find this from their budgets at short notice. The Welsh NHS Confederation said it was inevitable that funding would have to be diverted from patient care and some in the principality believe the local service will have to find close to £10m once all the charges are scrapped.

One finance director said the £5m would be ‘a real cost to the service’ in 2008/09 on top of an already tight settlement. Another predicted chaos as trusts used charges to prevent abuse. ‘Trusts haven’t had time to react to the change. How can we stop people coming onto our site?’ he said.

Some trusts will also be in the invidious position of having free parking on one site but not at another, where a private firm operates the car park. They fear a backlash from staff as well as patients in these cases.

Before the minister’s intervention, most trusts in Wales charged for parking, though the trusts insist charges were levied just to cover cost. Indeed, some said free parking could lead to even more costs.

Trusts report that parking generally ‘looks after itself’, with charges collected using pay-and-display machines. Now, trusts may have to put extra resources into managing car parks. They may have to hire parking wardens, for example, to check motorists are bona fide visitors to the hospital.

The Welsh and Scottish decisions have put pressure on the English and Northern Irish systems. In both, trusts are allowed to decide what they charge, although the Department of Health, Social Services and Public Safety told Healthcare Finance it had instigated a review of charging that would take the Scottish and Welsh moves into account.

Five of the 18 acute hospitals in Northern Ireland currently charge for parking. At one of the five, Altnagelvin, part of the Western Health and Social Care Trust, parking is predominantly free although it charges for spaces closest to the hospital.

Fees at the Royal Group Hospital go directly to a PFI contractor, but in 2006/07 the other four hospitals collected £1.466m. As in Wales, the local NHS is struggling with an already tight settlement. Finance staff have predicted the service will find it difficult to remove the 9% in efficiency savings needed in the next three years, never mind a further £1.5m to cover car park costs.

In England, the Department of Health has shown no sign of reviewing its policy on parking charges. Patients’ groups condemned the policy when the Department revealed at least 14 hospital and primary care trusts collected more than £1m from staff, patients and visitors in 2006/07.

The figures have a caveat: the returns are not compulsory, so they are incomplete and do not take account of the costs of providing the facilities. Headline figures can be misleading. Big trusts argue that they have more patients and will thus collect more in parking fees.

Costs per hour are possibly more revealing. Of the hospitals that do charge – and many do not – the lowest for patients and visitors was 8p an hour at two hospitals. Staff at three hospitals pay 1p an hour. Four trusts charge more than £4 an hour.

Trusts insist the money is being levied to pay for the car parks and they try to be fair to those who attend regularly. Cambridge University Hospitals NHS Foundation Trust raised more than £2m in 2006/07. It is about to open a new multi-storey car park and although prices will increase it insists they are not being used as income generators.

‘All the car parks at the hospital are self-funding, which means that no money that is intended for patient care is spent on providing and improving parking facilities and access services,’ a trust spokesman said. The price rises would also fund a range of projects, including improved bus links, security and maintenance.

Trusts across England will be going through a similar process but perhaps the market will have the final say in the matter. With this month’s launch of free choice, trusts will feel the need to sell themselves to patients – free parking may be enough to tip the balance in their favour.


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