Hospital parking – the big squeeze

According to Department of Transport statistics (Transport trends, 2007), by 2007 only 25% of British households were without a car while, between 1980 and 2006, total UK road traffic increased by 84%, with car traffic alone rising by 87%. Interestingly, while the distance travelled by bus and coach actually rose by 18% between 1992 and 2006, overall UK usage of these public transport modes is still lower than it was back in 1980. Such statistics, emphasising just how car-reliant the UK has become, have significant ramifications for the health estates, facilities and transport managers responsible for optimising patient, staff and visitor parking arrangements at healthcare sites, and for ensuring good site access for vehicles ranging from ambulances to building contractors’ lorries. Lorraine Holme, sustainable development programme manager, Gateway Reviews, Estates and Facilities Division, at the Department of Health (DH), whose wide-ranging remit includes transport management and parking across the English NHS estate, explains that, while car parking and car park charges must, by their nature, be a local NHS Trust responsibility, the Department does seek to offer guidance on transport management, accessibility and car parking to help Trusts effectively manage their parking and general site access.
Local authority influence She says: “It is essential that patients get to their appointments with as little inconvenience as possible, and that visitors and others can access healthcare facilities when needed. The whole patient experience therefore needs to be as considerate of their needs as possible. However, if this falls down, while patients have every right to complain about ‘inadequate’ parking provision on some hospital sites, they will frequently not realise that the number of spaces provided is often not entirely in the Trust’s gift. Local planning authorities have a major say and, with increasing pressure to maintain green spaces, local residents’ concerns, and the need to consider whether more spaces will simply increase congestion or hit safety, councils can these days be quite restrictive on the number of extra spaces they will allow when considering applications for healthcare developments.” The key to adequate provision must, she believes, be good co-operation between local authorities, highways personnel, transport co-ordinators, and Trusts. She says: “We also all have a duty to use parking at healthcare sites responsibly. There are still many people not needing to use healthcare facilities who will use these car parks for personal reasons simply because they are cheaper or they cannot easily find a space elsewhere.” While English NHS Trusts are not obliged to produce annual transport plans, Lorraine Holme believes around a third now have one in place, and most take car parking provision “very seriously”. She says: “Many local authorities now stipulate that detailed transport plans are essential if a Trust wants approval for new parking spaces.” The emphasis is increasingly on encouraging motorists to think about car sharing, using public transport, walking, or cycling, to get to their healthcare facility. This also accords with DH policy to encourage healthy activity opportunities for those suffering from coronary heart disease or those addressing obesity problems.” Lorraine Holme feels that, whatever parking problems already existed have been exacerbated by the fact that, while a decade ago, many people might have walked or cycled to hospital, transport managers today tell her even staff living a short distance away often insist on driving. She says: “Some may well have justifiable personal, security, or safety concerns, or have no option but to drive, but whatever the reasons, there is undoubtedly increasing demand for hospital parking space, despite all our efforts under the sustainable transport agenda to persuade Trusts to provide secure cycle parking facilities, good pedestrian access routes, and showers, for staff cycling or walking in.”
Charges a ‘high profile’ issue Hospital parking charges, and the level they are set at, have been a high profile discussion topic in recent months. Patient groups and the press, using Freedom of Information routes, have raised the issue of the revenue generated and the “rights and wrongs” of charging. Lorraine Holme says: “DH’s belief is that charging is not simply easy profit-making, but rather an essential way to fund upkeep without diverting resources from direct patient / clinical care requirements. Parking charges can also be a significant deterrent to non-hospital visiting motorists using hospital car parks simply because other nearby sites are full.” Guidance on good hospital parking provision and wider traffic management policy for estates managers is, she stresses, available from numerous sources, including the Department of Transport, and from the DH’s own HTM 07-03 Healthcare Technical Memorandum, Transport management and car parking. There are now also plenty of private sector transport consultants offering broad guidance on sustainable transport policies for hospitals, and individual estate manager training. With the NHS estate having grown significantly, another challenge is providing adequate car parking for building contractors’ staff. Lorraine Holme says: “Here we generally encourage Trusts to advise site managers to insist that every individual worker does not come in in their own car. The ideal is car sharing or a minibus.”
Minimising disruption When additional hospital parking is being constructed, the number one priority is minimising disruption to existing services – including ensuring emergency vehicle access, limiting the effects of dust, vibration etc on surrounding buildings, and ensuring, as far as possible, that disruption to existing parking is minimised. Tim Naidu, business development manager at Osborne’s Civil Engineering Division, says that, over the past 5-10 years, the division has seen increasing demand for new hospital car parks, recently primarily multi-storey facilities due to the space constraints at many NHS locations. He says: “Expanding hospitals that have been located on their current site for many years frequently have little scope to extend their ground floor parking, so tend to opt either for single-storey deckover facilities, or a multi-storey. When building these we must ensure that any impact on adjoining buildings is minimised. On sites with ample space this is generally not difficult, but sometimes we may be working extremely close to clinical and ward buildings. “It is also vital to maintain a good relationship with hospital visitors, who may arrive stressed, not realise construction work is ongoing, and then panic on not immediately finding a space.” In one “fairly typical” healthcare sector project, Osborne last year completed a new three-storey 1,600-space car park at Basildon University Hospital for Basildon and Thurrock University Hospital NHS Foundation Trust, first constructing an additional 500 temporary spaces on an adjoining field, which helped ensure the amount of available parking was largely unaffected. The programme was phased to build over approximately half the existing 800-space surface car park in the first phase, with the temporary adjacent facility used to replace the lost spaces, and, in the second, the same approach was adopted. The temporary car park took Osborne eight weeks to complete, and was subsequently returned to its original condition. In a second project, at Frimley Park Hospital, Surrey, Osborne faced constructing an additional level over an existing surface car park, this time directly opposite the entrance to the A&E department, and with just 3 m of working space around the perimeter. Careful traffic management and close liaison with the Trust’s estates team ensured no service interruption and, in particular, that ambulances were never prevented from arriving or departing. The £1.5 million project saw site parking increased from 200 to 486 spaces.   
 Abolition advocated Aside from ensuring adequate parking provision, however, the highest profile issue for many Trusts remains charges. Unsurprisingly, a recent Patients’ Association survey showed taht 88% of respondents favoured their abolition in England. Many Trusts, of course, already offer exemptions and concession schemes. Nevertheless, the Association, which claims some £100 million was paid over by patients visiting English NHS hospitals alone in 2006-7, believes that, despite initiatives already taken, more English Trusts need to examine their arrangements to avoid “punitive charging of the sick and needy”. The Association’s survey followed the 2 September announcement last year by Scotland’s Cabinet Secretary for Health and Wellbeing Nicola Sturgeon that, from 31 December 2008, car parking charges at the 14 Scottish hospitals where fees still applied would be abolished. Parking charges at Scottish PFI hospitals will not, however, be scrapped, because, the Minister explained, terminating existing long-term parking contracts would be “prohibitively expensive”. The charge abolition decision followed a review of Scottish NHS Boards’ car parking charges; an interim cap of £3 per day had applied throughout Scotland since last January.
Welsh announcement Six months earlier the Welsh Assembly Government had itself announced that patients, staff and visitors will be able to park free “at almost every NHS hospital in Wales” by the end of 2011. Welsh Health Minister Edwina Hart said free parking would apply from 1 April last year at all the country’s NHS hospitals, except where Trusts had external contracts in place. Trusts with such contracts would have to reduce parking fees, and propose and fund schemes to do this “until contracts expire or are ended”. By the end of the current Welsh Assembly term in 2011 she said just four hospital sites out of 130 in Wales would still have parking charges. The move was especially welcomed by Macmillan Cancer Support, a longstanding campaigner for free hospital parking, whose general manager for Wales, Cath Lindley, said: “On average cancer patients make 60 trips to hospital from diagnosis, to treatment, to follow-up and, consequently, are hit particularly hard, both financially and emotionally, by travelling costs and unfair parking charges. This announcement will go some way towards reducing the financial burden.” Tina Donnelly, director of RCN Wales, added: “This is good news for patients, hospital visitors and our members alike. Our members are taxed daily by these charges in carrying out their duties and delivering care; this will help alleviate that issue.” In tandem with the announcement Welsh NHS Trusts were told that, by 1 May last year, they would need to submit “action plans” on how they would deal with the resulting reduction in income, handle the potential increased demand for spaces, promote “green” transport modes, and tackle the anticipated increased use of hospital car park spaces by shoppers, commuters or nearby residents, often dubbed “fly-parking”. The Welsh Assembly Government made clear the plans should actively promote “more sustainable alternatives to single occupancy car journeys” and detail measures to encourage drivers to use more “environmentally-friendly” transport modes. Welsh Trusts now also have to nominate an executive director responsible for sustainable travel plans and, by 31 March this year, must have developed and implemented a “sustainable travel plan” for their major hospital sites to include annual targets. By 31 March 2010 all Welsh NHS Trusts will be required to implement site-specific sustainable traffic plans at all their hospital sites.
‘Teething problems’ anticipated Sid Johnson, senior FM advisor at Welsh Health Estates, admits that, when the plans were announced, there were fears about, for instance, local shoppers exploiting the system at city centre hospitals to the detriment of those genuinely needing hospital parking, and there have since been some press reports of problems. “However,” he says, “with any such new system there are inevitably teething issues, coupled with intensive press interest initially, but how smoothly the new system is actually working will only become apparent when we receive the first sustainable transport plans.” Alongside identifying the overall travel policy direction Trusts intend taking in future, Sid Johnson says the sustainable travel plans should identify any problems experienced to date so they can be addressed on an “all-Wales” basis. Cardiff and Vale NHS Trust operates a number of hospitals in and around the Welsh capital but, according to Mike Spencer, general manager, facilities and clinical support services, has seen few major problems since free parking was mandated last April. He says: “The only site where we have had an issue is the University Hospital Llandough, some six miles from the city centre. There we have had to demarcate a certain car parking area for patient and other visitor use since, once free parking came in, we anticipated that some staff without permits would start using spaces intended for patients. We now have at least one member of our in-house car parking team patrolling who will challenge anyone heading towards the patient/visitor spaces who he believes should not be parking there. “At our University Hospital of Wales PFI hospital campus,” he continues, “we have had to freeze charges in line with Edwina Hart’s instruction; there staff pay a lower rate (of £1.05 per day) than others wanting to use the car park, while at the St David’s Hospital, which provides elderly rehabilitation services, we have always had barrierbased entry, restricting parking to staff only until around 2 pm on weekdays, when we open the car park to the public. There is also free parking available here at weekends (in fact parking as always been free at this PFI facility), but generally there’s been no noticeable increase in problems, or reported parking shortages, since free hospital parking’s introduction. The only one of our sites where parking charges now apply is the University Hospital of Wales.” One organisation to approach the whole issue of hospital parking, and indeed travel to hospital sites, from a strongly “sustainable” standpoint, is campaigning body Sustrans, which promotes healthy, sustainable transport UK-wide. While acknowledging that, particularly with more remote hospital sites, where local transport provision may be poor, providing ample parking space is effectively a Trust duty, Philip Insall, Sustrans’ director of active travel, says the NHS “cannot indefinitely go on adding to hospital car parking infrastructure at the expense of more sustainable options like good cycle and walking routes”. He says: “The NHS overall is responsible for 5% of UK travel; it must thus look not at micro-managing transport, but at the bigger picture.” One factor which may well curb a significant expansion in parking provision is, of course, that many NHS sites are running out of space.
‘Heavily subsidised’ While in favour of lower car parking rates for the long-term sick, those with reduced mobility, and car sharers, Sustrans believes it “especially inequitable” that some NHS Trust staff get their car parking “heavily subsidised”, while those without a car, “often society’s poorest”, receive no equivalent benefit. Philip Insall says: “How to rectify this is very difficult. However, to show how anomalies can arise, one PCT we advised found it could rent out its surplus car parking spaces for £1,000 apiece annually, yet many of it own staff were paying a subsidised annual rate of just £150. This was a nice perk for them, but did nothing to help local, low income people. Happily the Trust recognised this could not continue and raised staff car parking charges accordingly.” When I pointed out that charging for spaces at a “market rate” might be fine for higher earners, but less so for those on lower incomes who, due to shift times, or a lack of good public transport provision, might have little option but to drive in, Phil Insall admitted this was “a much more difficult question”. He said: “What we encourage NHS Trusts to do is develop an effective transport plan which, wherever possible, makes good cycle and pedestrian route provision, and consider schemes like car sharing, park and ride, and lifts home. If you can encourage staff to car share you reduce carbon emissions and ease congestion, and free up more spaces for the genuinely needy”. Phil Insall acknowledges that, while encouraging all staff living, say, within a mile of a hospital, to walk in to work might be desirable, there may be instances where, for practical, safety or other reasons, this can be impossible. Darryn Kerr, estates and facilities director at Leeds Teaching Hospitals NHS Trust for the past two years, says car parking has occupied more of his time than any other estates issue.
Prices doubled The Trust operates two large acute hospitals in Leeds itself – the Leeds General Infirmary is close to the city centre and shopping area which, in the past, particularly, led to “a good deal” of unauthorised parking on site, while in contrast, in recent months particularly, following the completion of a new multistorey car park in tandem with the building of its new PFI-funded £200 m Bexley Wing oncology centre, parking problems have eased at the St James’s Hospital site, on the east of Leeds three miles away. Darryn Kerr said: “One of the first things I did was double the price of both public and staff car parking at all our sites. While the move was initially unpopular, by explaining that, previously, we were subsidising our car parking to the tune of about 50%, which meant money being diverted away from clinical services, we brought most staff round. Currently providing a manned car parking service, in-house, costs around £2.5 million annually, and, if we abolished charging, the cost would have to come from elsewhere. “We have also reviewed our car parking permit scheme, making permits available to staff not able to apply for them previously, but who definitely warranted one, and simultaneously removing them from some personnel living very close to their particular site. One tough issue is that we employ some 650 consultants and 2,000 junior doctors, many of whom travel between sites, and thus need spaces readily available”.
Deterrent effect Darryn Kerr says doubling car parking charges, and raising all-day parking costs at Trust sites so that it is as, if not, in some cases slightly more, expensive than at local municipal car parks, has deterred many non-hospital visitors, including local office workers, from leaving their cars in hospital car parks all day. The Trust does offer parking exemptions to those repeatedly visiting sick children, dialysis patients and to the chronically ill, effectively giving them free parking for as long as they need it. He says: “Fly-parking had been an issue at the LGI for years, and is still a problem to some extent (the site has a multi-storey car park built around a decade ago, alongside surface parking) due to its closeness to the city centre, but our various initiatives, including issuing penalty charge notices, have seen a marked reduction, while at St James’s, close to terraced housing, the challenge has been more how to deter hospital visitors from using residents’ spaces. While the Bexley Wing was being built we had around 1,000 contractors on-site, meaning an additional 300-400 vehicles seeking spaces. We had an excellent relationship with the contractor, but some of its staff inevitably used local residents’ spaces, and we still have a few hospital visitors keen to avoid charging parking using these spaces today. Hopefully, with our new 1,300 space multistorey, this will lessen.”
Awards achieved In fact the Trust has won several awards for the safety and security at the new multi-storey, which has over 100 CCTV cameras monitoring lifts, lobbies, stairwells and pay machines, plus 24/7 security patrols. Darryn Kerr explains: “All our traffic and car park management is handled in-house. We have a car park security office within the multi-storey and, last summer, opened Europe’s largest in-house hospital security room within the Bexley Wing. Much of the feedback from both visitors, and particularly from staff working late, has been that they felt intimidated on returning to a virtually empty car park, so we sought to address this. “We are also keen to encourage training of car park personnel to assist with general site security, and to offer a ‘meet and greet’ facility; you should never underestimate the fact that the first people patients or relatives see are often car parking staff.” Peter Foy who, as Trust security advisor, manages all site security at the LGI and St James’s Hospital sites, and at the Seacroft Hospital and Chapel Allerton sites in Leeds and the Wharfedale General Hospital some 22 miles away, says general site security has been greatly enhanced since the recent completion of a five-year, £3.5 m revamp of the Trust’s security equipment and facilities, including last August’s opening of the new security control room.
Video wall monitoring He explains: “The room, handling CCTV, access control, intruder detection and other alarms, enables us to manage security at all five sites 24/7, and incorporates a huge video wall where we can monitor numerous locations simultaneously. We were lucky to be able to use a redundant fibre optic cable that spans the entire city to link all the sites to the centre. I have some 60 security officers, plus a mobile incident response team equipped with ‘headcams’, with team members working alongside car parking personnel when required.” Back on the subject of the fairness of charging clinical and nursing staff, Darryn Kerr says: “While I have some sympathy with doctors and nurses arguing they should not pay, if we didn’t charge them we would have to find much of the £2.5 m needed annually to operate our car parking by cutting other services. We feel we have set charges that are as fair as possible for the bulk of our personnel.” Darryn Kerr says the Trust decided to run its traffic and car parking services in-house for both budgetary and practical reasons: “With a private contractor you not only run the risk that costs will rise annually, but there is also less flexibility in re-engineering staff roles.” He feels there has also historically been “a considerable issue” with high staff turnover within private contracting firms, “partly because car parking staff have “never been that well rewarded, partly because the job carries its fair share of abuse, and partly because car parking staff often fee undervalued, none of which encourages them to stay”.
 Initial lenience In charge of car parking at the Leeds hospital sites is Bob Bilton, senior facilities manager (security operations), who says: “We feel that, generally, car parking issues have significantly lessened since the new multi-storey’s opening at St James, and a policy of strong, but fair, enforcement at LGI. If people overstay perhaps by 20 minutes a couple of times we will generally be lenient, but those regularly flouting our regulations receive a penalty charge notice. If we regularly see a visitor parking on site and walking out of our grounds, we will challenge them and suggest they should not be parking here.” “Staff-wise, we charge a £28 monthly fee for all full-time staff, apart from consultants, who get a space nearer to the clinical buildings, but pay £58 for the privilege. Staff do complain about paying, but the reality is that, otherwise, the money would have to come from elsewhere. We are also looking, alongside the concessions already offered, at introducing a reduced weekly charge for those who must be at the hospital for longer periods.” Michael Summers, vice-chair of the Patients’ Association, was interested to hear Darryn Kerr and Bob Bilton’s views on the necessity of charging, but feels that “if some Trusts are making £3 million annually from car parking, then they can surely afford to employ somebody at the gate to distinguish which motorists are genuinely sick or visiting sick relatives or friends, and which are just exploiting a convenient car parking opportunity because it’s closer to where they want to go than the local council car park.” He says: “While I acknowledge that running an efficient hospital car parking facility is a significant task, with substantial financial obligations, why do more Trusts not offer concessionary free parking to the chronically sick etc? The last thing a cancer patient, for instance, needs, is to feed the meter to maximum, find their outpatient radiotherapy treatment takes longer than anticipated, and return to find a penalty charge notice. More Trusts need to better organise their car parking systems and, if charges must apply, significantly lower them.” Recognised by many in the NHS as an exemplar in on-site hospital traffic management at the city’s famous Addenbrooke’s Hospital is the Cambridge University Hospitals NHS Foundation Trust, which, in formulating its parking strategy, has recognised the fact that Cambridge has some of the UK’s best cycle provision. Working with Cambridge City Council it has provided cycle tracks leading to the site from several city locations, offers “parking” for over 1,300 bicycles, and opened a new multi-storey, 770-space multi-storey car park last April incorporating 63 disabled parking spaces, security lighting, and over 50 CCTV cameras. Staffed 24 hours a day, seven days a week, with a customer service desk to provide information and concession tickets for outpatients with appointments, it incorporates a wind turbine and solar cells to contribute to its energy needs. Car parking revenue is used to fund improvements such as external lighting, pedestrian walkways, cycle racks, cycle ways, security, and improved travel facilities. Addenbrooke’s also operates its own Trust-funded bus service, operating every 15 minutes ferrying passengers back and forth from the city’s Trumpington Park and Ride facility, and has its own on-site bus station.
Local media ‘flak’ Despite its good work, however, Addenbrooke’s, and the Trust running it, have not escaped criticism, receiving considerable flak from the local press, for instance, last spring, when The Trust announced rises in both staff and patient parking charges. The new rates, introduced on April 1 shortly before the new NCP-operated multi-storey facility’s opening, saw the outpatient day parking fee rise from £2.50-£3. Meanwhile day parking rates for visitors rose from £10-12 for those parking for between 6 and 8 hours, with the fee for over eight hours’ parking rising from £12.50 - £15. Staff charges went up simultaneously from £1.40-£2 a day, with the ensuing controversy not helped by the publication of figures suggesting that Addenbrooke’s made £2.26 m from parking charges in 2005-2006 alone. Addenbrooke’s does, it should be emphasised, offer a range of concessionary parking tickets, for instance charging £3 a week for oncology, rehabilitation and dialysis patients, while The Trust, which argues it is encouraged to “maintain a surplus to invest in healthcare and new medical facilities” by regulator Monitor, not only insists it ploughs back charges into site improvements, but also states that charging both staff and patients helps ensure elements such as excellent security, and good lighting. A spokesman elaborated: “Car park income funds a high-quality parking service and our transport initiatives. If we didn’t charge then that money would have to come out of our clinical care budget. £2 m a year is equivalent to 400 hip replacements, or 74 nurses’ salaries. Our efforts to encourage alternative methods of transport to the site have been successful. Bus services are well used, and improved cycle storage areas have proved popular.” While many NHS Trusts continue to manage and operate their car parks in-house, and may, unless England follows Scotland and Wales’s examples, be forced to grapple with charging for some time, Phillip Herring, commercial director at VINCI Park, part of Frenchowned transport infrastructure specialist Vinci Group, argues there are many advantages to outsourcing parking management and enforcement to a company like VINCI Park.
Outsourcing benefits These, he says, include handing over all aspects of parking management, enforcement and traffic management to a specialist with many years’ experience, and a major reduction in the amount of processing, paperwork and ticket issuing that managing a car parking operation entails. In a recent project for Liverpool’s Broadgreen Hospital timed to provide additional parking in tandem with a major expansion of clinical facilities, VINCI Park demonstrated what it claims is its “unique design, build, finance and operate (DBFO) approach” with a new 759-space car park for the Royal Liverpool and Broadgreen University Hospital Trust at the site. A new car parking deck was built over the existing surface car park, with work carefully phased so the most spaces lost over any period was 100. To ensure adequate parking throughout VINCI Park leased additional spaces from a local supermarket and, once part of the new deck was built, was able to provide some parking while completion of the remainder continued. Phillip Herring says: “Not only does the existing structure allow for the addition of a further deck in future, raising the car park’s potential capacity to 1,500 spaces, but we also financed the car park’s construction under a public/private finance agreement, and have taken over every aspect of the everyday running of parking across the entire site, including managing another 12 surface-level car parks.” VINCI Park is unusual in the parking sector in being able to draw on the resources for such DBFO projects, of sister construction companies such as Norwest Holst, who built the Broadgreen car park, and road construction specialist The Ringway Group. Phillip Herring says: “At Broadgreen we took the car park from concept to operation in under a year. Not only can we refurbish even the most tired car park in a way that ensures a return on investment, but we also offer significant upfront financial investment, a long-term partnership approach, and improved customer services.”
Reducing abuse In another recent car parking contract, for which it won two British Parking Awards, VINCI Park worked with Dundee’s Ninewells Hospital and Medical School to reduce abuse of disabled parking spaces close to the hospital, discourage staff from taking spaces close to the entrance at the expense of more “needy” patients, and, in the process, was able to use surplus revenue raised by a review of parking arrangements to provide a fleet of electric scooters and wheelchairs free of charge by disabled hospital visitors from a new customer service/mobility building. Phillip Herring explains: “Among the measures we implemented was enforcing a four-hour maximum stay for able-bodied patients for spaces nearest to the hospital, charging for disabled spaces to deter those not entitled to use them, and issuing some 2,800 vouchers every month to the Trust to provide free parking for outpatients undergoing long-term treatment. “While the whole issue of disabled parking provision is highly sensitive, we undertook extensive consultation with the Trust and disabled groups to gauge views before proceeding. The upshot has been that disabled and mobility-impaired visitors now find it much easier to find a space, while ‘turnover’ in the nondisabled spaces is also far better. “We also now have several hundred people signed up to use the scooter and wheelchair service. Here disabled people can go to a special cabin, hire out, freeof- charge, one of a fleet of scooters or electric wheelchairs, and then use them both to get around the car park and to get to their destination inside the hospital. The project is an excellent example of how a parking contractor and a hospital can work together for the patient’s benefit.”