Select Committee on Health Third Report



75. Increased car use, the concentration of specialist services in fewer areas, the treatment of ever more people as outpatients and the construction of new out-of-town hospitals with poor public transport access mean that car parking and transport costs have become matters of serious concern. Giving more choice to patients is likely to exacerbate the problem. Witnesses' main complaint was about car parking charges, but we also received evidence about the cost of public transport and taxis. These are not charges made by the NHS but we include them in the inquiry because they add to the sums patients have to pay.


76. According to Macmillan, cancer patients make an average of 20-30 round trips to hospital for radiotherapy alone, and an average of 60 visits overall.[124] Chief Executive Peter Cardy told us:

    If we take a typical cancer career of perhaps nine months or so…they will be paying travel costs which because of the concentration of specialities in cancer centres…means that people are often travelling long distances… and they will be paying car parking charges. When discharged from hospital they will be paying prescription charges. So costs, each of which is modest in itself, will be piling up very considerably for people who have this quite typical trajectory.[125]

Patients with other conditions, such as renal failure, suffer similar, often longer-term, problems.

77. NHS facilities are not obliged to provide parking. Where they do so, individual trusts decide on the level of the charge. According to the Department, charges are necessary to meet the costs incurred by the provision of car park spaces, including the provision of security. Charges may also be used as a means of raising revenue for the hospital.[126]

78. Guidance is in place on the range of factors that should be considered if a trust wishes to introduce parking charges, such as local user needs and management of the scheme.[127]

79. A survey by Macmillan of car parking charges in 285 of the 292 UK hospitals with cancer units found that 92% of English hospitals charged patients for car parking, compared to 53% of hospitals in Wales, 20% in Northern Ireland and 6% in Scotland. The survey showed that hourly rates varied from 30p to £4.00 an hour in England (average £1.22) and that 24-hour stays cost up to £30.

80. The total number of parking spaces available and the overall income provided from car parks is shown below.[128]

Hospital parking spaces and income
Total Parking Spaces
Income from Staff Parking (£)
Income from Visitor Parking (£)

Figures provided on a voluntary basis. 80% of NHS hospital trusts responded.
Source: Estates Return Information Collection 2004/05

81. The sums raised from parking charges represent a very small proportion of the NHS budget—less than 0.1%. The figures suggest that the average income per parking space is around £200, but there is wide variation. For some trusts the income generated can be much greater, from about £2,000 per space for some provincial general hospitals (eg. Southend, Good Hope in Sutton Coldfield, Luton, Frimley Park in Surrey, and Epsom). In contrast, other hospitals generate less than a quarter of this (for example East and North Hertfordshire, North Hampshire and Queen Mary's Sidcup). For individual trusts, income from car parking generally equates to less than 0.25% of their total budget but there are a number of cases where the proportion exceeds 1%.

82. It is not altogether clear why such variation exists. The provision of parking spaces generally reflects site constraints. Charges are usually higher in London and the South East. Variations in the level of charges or the income raised from parking, however, cannot be fully explained in this way or by demand for spaces. There is some evidence that car park charges in PFI hospitals are higher but the differences are not statistically significant because the comparison is based on a small sample. A more detailed analysis of the information is available in the written evidence.[129]

83. Some hospitals exempt, or offer concessions to, patients and visitors who drive to hospital regularly,[130] but they do not always advertise the fact clearly nor do they make it easy to obtain the concession.[131] Some hospitals make special arrangements for specific types of patients. Contact a Family cited a survey of 67 hospital trusts, of which seven offered free parking and 25 offered concessions to families with sick children.[132] Macmillan's survey showed that 41% of hospitals that charged for parking made exceptions for cancer sufferers.[133]

84. Ministers believe that costs and car parking facilities in English hospitals are acceptable:

    Obviously nothing is ever perfect but I think they are getting it broadly right.[134]



85. In 2003, the Social Exclusion Unit (SEU) estimated that 1.4 million people each year miss, turn down or choose not to seek healthcare because of transport problems.[135] The report suggested that a poor supply of public and specialist transport, lack of financial support for those on low incomes and the location of healthcare facilities were to blame.

86. Patients with a clear medical need (as authorised by a doctor, nurse or midwife) can use the non-emergency Patient Transport Service (PTS) to get to hospital. Patients on low incomes can get some help with the cost of travelling to hospital to receive consultant-led care from the Hospital Travel Costs Scheme (HTCS).

87. The recent White Paper, Our health, our care, our say, announced that the HTCS was to be extended to certain non-hospital settings. However, some witnesses pointed out that there were still shortcomings: for example, initial GP visits are not included and the Patient Transport Service (PTS) is not available for patients seeking healthcare from primary care facilities. Dentistry is also not included under either scheme. Citizens Advice stated:

    If the PCTs cannot deliver dentistry in the local community, then at least there should be help through the [HTCS] for people on low incomes who actually have to make journeys of 30 or 50 miles…one of the main reasons people have not been taking up any dentistry that they can get hold of from the NHS [is] that they cannot afford to get there[136]

While the NHS Confederation considers that the HTCS is "widely advertised in the majority of hospitals", the Socialist Health Association argued that information about the scheme was hard to find.[137] The SEU seemed to agree: it recommended that the Department "develop options" for information and advice on accessing healthcare facilities.[138]

Hospital visitors

88. There is no financial help for hospital visitors, unlike, for example, prison visitors. Relatives or friends can receive help towards transport costs to visit hospital only through a Social Care Grant, and this is open to those receiving Income Support only, not other types of benefit.[139] According to Citizens Advice:

    If you compare that with the Assisted Visitors Scheme for prisoners…they can get help every two weeks for a visit, yet you might have an elderly person who is long-term in hospital and her health is very much affected by the fact that she cannot get visits from her spouse because he cannot afford it. Those are exactly the kind of cases we are getting in bureaux which are really heart-rending.[140]

Bedside telecommunications

89. A recent chargeable service in the NHS is the provision of bedside television and telephone units. The NHS Plan set a target to increase the availability of bedside televisions and telephones in all major hospitals in England by the end of 2004 as part of the Patient Power programme.[141]

90. Several private companies were contracted to supply the telecommunications services[142]; most signed 15-year contracts with the NHS and were given exclusive rights to install, maintain and operate the systems. Under the agreement there was to be no subsidy from the NHS; the system had to be installed for free by providers and paid for by users. The companies were required by the NHS to provide several free services such as radio for all and television for children. The systems were also required to provide internet access and to be capable of calling up the electronic patient record, and sending and receiving information both for patients and professionals. Ten licences were granted after 2000. Private sector investment was approximately £150 million and, by the end of 2004, over 75,000 bedside television/telephone units had been installed in 122 major hospitals and 33 smaller hospitals in England.[143]

91. The range of services and prices differ from provider to provider. Television use costs up to £3.50 per day. Outgoing telephone calls are capped at around 10p per minute. Some companies offer discounts to older patients and long-stay patients; some allow unused credits to be distributed to patients who cannot afford the service.

92. Bedside telephones and televisions are popular with patients. Patientline stated that 10-15 million patients, relatives and friends use the systems each year, with 70% of terminals usually registered as in use by a patient. Half of these terminals incur a charge at any given time (other terminals may be being used by children or adults listening to the radio). We were told by the NHS Confederation that:

    The surveys that have been done show that 88% of patients really love these things, and certainly have found the availability of a bedside personal phone of great benefit to them. There is very high patient satisfaction…[high charges are] a problem outside the hospital and for relatives rather than for patients. The patients like it and value it.[144]

93. However, incoming calls are a source of anger and distress. They are charged at a very high rate—up to 49p per minute. A recorded message, which cannot be skipped, makes incoming calls even more expensive. This has been the subject of an Ofcom investigation, described in the box above. At the same time restrictions have been placed on the use of mobile phones which may or may not have acceptable clinical or privacy rationales.[145]

94. The cause of these very high charges is the Government's decision to install bedside units which can be used by health professionals to access the new electronic patient record, allow electronic prescribing, ordering of X-rays, investigations and the patient's choice of food, patient surveys and provision of information and email services to patients. The private companies believed that they would be able to charge the NHS for additional services the Government insisted on. However, most hospitals have not yet taken up these services, so the company's means of recouping costs is limited to charges for telephone and television usage. As a result, overall revenues have been lower than expected and charges to users have been very high. Patientline has incurred losses each year of operation, totalling £50 million.[146] Ofcom's investigation noted the extensive requirements set by the Department, highlighted the initial capital expenditure required of the provider and concluded that the providers were not wholly to blame for the high costs imposed on callers.

124   Ev 52 Volume II Back

125   Q 261 Back

126   Ev 51 Volume II Back

127   Income Generation: Car Parking Charges-A Guide to Implementation. Department of Health. Further information is contained in NHS Standard Service Level Specifications,  Back

128   A full breakdown of this data, from the trusts that responded, is shown in Ev 108-Ev 110 Volume III Back

129   Ev 159 Volume III (Professor John Mohan) Back

130   Eg. Gloucestershire Foundation Trust exempts parents staying overnight with children in the children's wards or feeding babies in the Special Care Baby Unit as well as patients having dialysis, radio- or chemotherapy. Addenbrookes in Cambridge has a weekly concession rate for Oncology and Rehabilitation patients of £2.20 and South Tees issues permits for regular patients and visitors at a cost of £13.20 for 3 months. See hospital websites for details Back

131   Ev 80 Volume II Back

132   Ev 36 Volume II Back

133   59% versus 41%, respectively. Ev 51 Volume II Back

134   Q 675 [Jane Kennedy] Back

135   Chapter 11, Access to Healthcare. Making the Connections: Final Report on Transport and Social Exclusion. Office of the Deputy Prime Minister. February 2003 Back

136   Q 222 [Ms Phelps, Citizens Advice] Back

137   Ev 80 Volume II Back

138   Chapter 11, Access to Healthcare. Making the Connections: Final Report on Transport and Social Exclusion. Office of the Deputy Prime Minister. February 2003 Back

139   Ev 36 Volume II Back

140   Q 222 [Ms Phelps, Citizens Advice] Back

141   Ev 67 Volume II Back

142   This is in contrast to other countries. In the US, for instance, hospitals bear the full cost of installation Back

143   Ev 67 Volume II Back

144   Q 487 Back

145   Q 534. David Stewart, from Ofcom, stated, "There are clearly some very important clinical reasons related not only to the need to give patients time undisturbed during their care but also, more recently, with the development of camera phones… There are some good reasons why hospitals should have and do have the right to restrict the use of mobile technology" Back

146   Ev 67 Volume II Back

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