Healthcare Parking: Pain, Problem, Process or Potential?

A recent newspaper front page article was covered by the headline: “£2.6m for just four extra car spaces at Bronglais!”¹ The article, in the Cambrian News, was the only ‘news’ on the front page with only a small pointer to a page three article on someone who was “lucky to be alive after explosion.” It is interesting to see how the media in general still responds to healthcare parking issues and the priority that is given to this issue, which is in reality a side issue to the real purpose of the NHS – providing healthcare. On page six of the same paper is an article on the ombudsman’s report about a Ward Sister who falsified an entry in a deceased patient’s records.

Hospital redevelopment
For those who don’t know, ‘Bronglais’ refers to Ysbyty Cyffredinol Bronglais (Bronglais District General Hospital), Aberystwyth and the above mentioned £2.6m is the cost of an enabling scheme, including provision of a new multi-storey car park, for the major phase two redevelopment of the hospital site by the Hywel Dda Health Board. This Board runs this important hospital on the West Wales Coast that serves a massive area of central Wales.     
    
The £2.6m expenditure does not provide four extra car parking spaces; it provides for the diversion of major services, enabling works for the main scheme and the re-provision of car parking spaces to be lost.
    
Having recently had my third grand daughter born in this excellent hospital facility I know the parking problems here only too well. The site is in the only major town in the area; is surrounded by rural communities that are almost totally reliant on the car to access the hospital and is fully enclosed by residential and University buildings so any work has to be carefully planned to ensure that service provision can continue without unnecessary interruption.

Affecting healthcare premises
These are issues that we face constantly throughout the UK healthcare sector as we strive to improve the quality and functional suitability of the premises in which our healthcare is provided.
    
Whilst the acute hospital based issues will often hit the headlines the same issues are equally applicable on a smaller scale to all other premises used to provide our healthcare. This includes Community and Mental Health Hospitals, drop in centres, GP and Dental Surgeries and many others. With 30 million cars registered with DVLA and car usage increasing there is pressure on all healthcare providers to manage down their staff and visitor reliance on the motor car.
    
Clearly there is a conflict as our expectation to drive and park easily increases but the political pressure, quite rightly, is that we should be looking to more sustainable forms of transport. This is effected through planning applications and sustainable transport plans that have to be produced by both healthcare providers and local authorities – and these two have to align with each other. So it was with great interest that I attended the British Parking Association (BPA) Hospital Parking Special Interest Group meeting at Sandwell Hospital on the 18 November 2010.

Charter for hospital parking
The BPA launched its Charter for Hospital Parking in March this year along with the NHS Confederation (NHSC) and the Healthcare Facilities Consortium (HFC). There has already been an article in an earlier edition of this magazine² and Patrick Troy, CEO of the BPA has been interviewed on national media and also on Focused FM TV³ outlining the purpose of the charter.
    
Following on from this there has been so much interest that BPA and HFC decided that there was merit in calling together the providers and operators to see what can be developed by sharing experiences and good practice from around the country and the wider parking industry. To say the day was intense is an understatement and many topics were covered and concerns aired.
    
Importantly David Pennington, from the Department of Health, gave an overview of how car park charges came about in the NHS and further developments including the impact of devolution with Scotland and then Wales abolishing charges on hospitals within their countries.
    
Whilst the intention was to abolish charges completely this has not been fully possible because of contracts already in place, especially on PFI sites, as a speaker from one of the large Welsh Health Boards noted later in the day.
    
From the English side of things the government had responded in October to the consultation instigated by the previous administration and the real outcome of this is ‘local autonomy’. As another speaker pointed out later in the day the NHS is actually made up of a number of independent autonomous organisations providing healthcare under the NHS brand through central funding. Some of the points raised from the consultation process are interesting to note:
•    There is a dislike of hospitals making profit from patients
•    Individual patients want free parking
•    Patient advocate groups recognise the need to cover the costs of parking provision
•    Concessions are variable and not well publicised
The government position is that the NHS must:
•    Provide fair concessions for regular patients
•    Be transparent
•    Be accountable (for policy) to the local community

Whilst government will not provide guidance on car parking policy it is clearly expected that local standards and policies for healthcare parking must be built on the codes of practice already available (BPA), good and best practice (NHSC and HFC) and that the implementation of these will be influenced by Patient Choice, Local Communities (through Foundation Trust board involvement and local networks), national and local campaigns (Macmillan and WHICH? for example) and national and local media as hospital parking in particular is an easy story.

Airing concerns
We had three presentations from hospitals in Sandwell, Cardiff and Leeds on their issues and progress and it was interesting to note that in Wales some £5.45m of car parking income has been lost – so the costs related to this provision are now having to come from the healthcare budget rather than being self funded.
    
Putting this into the previous day’s announcement from the Welsh Assembly Government of a 7.7 per cent cut in budget for the NHS in Wales, this clearly shows a problem in the making. In all three areas income from car parking across the wider organisations funds, the in house management of parking and related security including CCTV upgrades in Sandwell contributes to the Facilities Cost Improvement programme for the Trust.
    
However, as car parking technology has moved on users expectations rise and they have to look at new payment processes and equipment including pay by mobile phone, credit card, and so on.
    
It was interesting to note the use of a salary sacrifice scheme approved by HM Revenue and Customs for the staff permit scheme. Leeds, which has been cited by WHICH? as being bad for issuing enforcement notices, noted that the majority of these had been to staff. Patients did not seem to have issues with the charges but rather the lack of spaces, which is a problem of having city centre sites. Issues of transparency and fairness were cited as important in their enforcement programme. The Trust has recently been granted the Park Mark award, noting good practice in car park safety and security.

Parking permits
Travel Plans are central to car parking policy because, as Chris Hanley from Colin Buchanan noted, ‘travel’ is the cause of the problem, ‘parking’ is only a symptom. Studies have shown that best value for permit schemes comes from emissions based charging for annual permits with occasional use permits for staff who do not need to use a vehicle all the time. The importance of this kind of integrated planning was reinforced by Dr Wyn Hughes from the Addenbrooke’s hospital in Cambridge; a site which is often cited as a prime example of good practice. He noted that subsidised bus travel had been funded by ring fenced income from car parking and that staff parking fees had risen from 20p in 1999 to £1.40 in 2006. This had been tracking the cheapest local bus service return trip. Where Addenbrooke’s have been running park and ride schemes with the local authority and bus service provider they recently acquired their own vehicles for a service and Leeds has also recently leased two buses to provide inter-site transport which has reduced staff journeys and alleviated parking pressures in the city centre.

Good practice
Looking forward, the issue of good or best practice was raised and a new Healthcare Parking Good Practice Guide is being developed as number 11 in the series of Facilities Management Good Practice Guides originally funded by the Department of Health in 1999 and published in 2001. A skeleton document has already been circulated to interested parties and initial feedback has been both positive and constructive.
    
The guide will cover all aspects of Healthcare Parking and one concern is if this is too wide a remit. As with other good practice and guidance in the healthcare sector, where there is area specific guidance the healthcare guide will refer to this and so the BPA Charter is a starting point and all organisations are encouraged to sign up to this.
    
The NHS Confederation Best Practice document ‘Fair for All; Not Free for All’⁴ cites several examples of good practice in a number of differing areas and the Park Mark is an example of what every provider should be aspiring to. The current problem with moving things forward is going to be the constraints of budget as new technology comes with an associated cost and car parking charges may not necessarily cover this short term.

Meeting client needs
In closing, it is often easier for a visitor to a site to point out what is not as good as it could be. The involvement of patient and visitor groups is vital if, as healthcare providers, we are to aspire to meet our clients’ needs. An example of this is at our local acute hospital where a very nice sculpture has been placed in the centre of the roundabout at the main road entrance to the site. This sculpture is often used by the Trust in their publicity with a beautifully taken photograph from the grass to the left of the roundabout looking across towards the buildings. The shame is that from the drivers seat of a car the sculpture hides the very large sign that indicates where the car parks are and which ones have spaces. Once on the roundabout a driver can only see the sign through their sunroof, if they have one. The photograph shows the sculpture – note the parking symbol at the top right of the sculpture. Also note the car driving onto the wrong side of the road; this small section of road is two way where the rest of the main drag around the site is all one way. Why?
    
Because emergency vehicles have to run contra to the main flow in order to gain access from a site boundary slip road onto the road network. An accident waiting to happen. The second shame is that since they changed car parking contractor the sign has not been functioning. It can be very easy to get something wrong by simply not noting all the aspects of what is being done and very difficult to put it right.

Footnotes
1 Cambrian News – 21st October 2010
2 Health Business Magazine
    Volume 10.2 Page 69
3 Focused FM TV Article available at:
    www.focused-fm.tv/node/249?sid=4532
4 Fair for All; Not Free for All was published
    by the NHS Confederation in 2009 and
    can be downloaded from their web site.

Web: www.hfc.org.uk