Memorandum submitted by John Mohan, University
of Southampton (CP 45)
ANALYSIS OF CAR PARKING (PROVISION, CHARGES
AND INCOME) AT NHS TRUSTS
SUMMARY
This analysis demonstrates that there are substantial
variations between NHS trusts in the availability, cost of and
income generated by parking for patients and their visitors. It
is possible to develop statistical explanations of some of these
variations but in others there does not appear to be a systematic
pattern. In summary there is:
— Variability in the availability of
parking whether this is expressed in terms of ratio of parking
spaces to beds (a measure of hospital capacity) or to the ratio
of parking spaces to patient numbers (a measure of demand for
parking spaces). Some, but by no means all, of this variation
seems to be related to site constraints.
— Variability in parking charges which
does not appear to be systematically related to demand (the ratio
of patients to parking spaces), suggesting that other unobserved
factors affect the way prices are set for car parking. There is
some evidence that prices in London and the South East are higher
than elsewhere.
— Variations in the cost to the patient
of car parking: on the figures provided by the department, these
range up to a maximum of £4.35 though in the majority of
cases a figure of £1 per hour is more usual. It is not possible
to estimate the total cost per patient because we do not have
data on the number of times they attend hospital from this source,
and nor do we have details about how patients get to hospital.
— Great variability in the income generated
by car parking. When this is related to the Trust operating income,
in the great majority of cases it accounts for under 0.25% of
the budget but there were 15 cases where it exceeded 0.5% of the
budget and in two cases it exceeded 1%. If this reflects the costs
of establishing and running car parks, it is not easy to see why
the cost of running car parking should vary to this extent.
INTRODUCTION
1. The Department of Health supplied data
to the Committee on a range of variables pertaining to the provision
and cost of car parking and to revenues derived from charges for
parking at NHS acute hospital trusts. The data were drawn from
a number of statistical returns which Trusts make to the department.
They included information on: total numbers of inpatients, patients,
and casualty attendances at each trust; average number of beds
available; total trust income; the proportion of the site which
was occupied by buildings; numbers of parking spaces, sometimes
broken down to give the numbers available for staff, visitors,
and places reserved for disabled drivers; total income derived
from parking for visitors and patients; the hourly parking rate
charged to visitors and patients. The data related to trusts,
not to individual hospital sites. Information was provided on
203 hospital trusts, containing nearly 150,000 beds.
2. The data do not include information on
several variables which it would have been desirable to include
in the analysis, such as: the availability of parking in the vicinity
of each Trust; accessibility by public transport; and the modal
split of journeys to hospital (ie the proportion of journeys made
by various modes of transport). In addition not all hospitals
were able separately to identify the provision of parking specifically
for patients and their visitors (as opposed to staff) or the revenue
generated by it.
3. Several additional variables were computed
from the data, such as average income per parking space, the ratio
of parking income to the operating income of the trust, average
income from parking per patient treated, and indicators of patient
throughput, such as the number of patients treated per bed. It
was also possible to identify which Strategic Health Authority
each trust was located in, permitting some contrasts between places
to be assessed. The analysis largely consisted of tests for differences
between means, correlation and regression analysis; further details
are available from the author.
4. Evidence from the Department of Health[29]
argued that car park charges will vary because the situations
of and constraints on trusts will vary, so the imposition of a
central directive on Trusts was not feasible, as it could not
have dealt with the range of local circumstances. As they pointed
out, some trusts were in heavily-built-up areas while others were
in rural locations with large amounts of land. Trusts also incur
costs in running car parks and the Committee was told that these
should not be a charge against the NHS budget, so charges had
to be levied to cover them. NHS Trusts therefore had to make individual
decisions on the provision of and charges for car parking; there
are no national instructions or guidelines, and the matter is
left to individual trusts. They are not obliged to provide car
parking, nor to charge for it, but if they wish to charge for
it they are free to do so within income generation rules.
5. Consequently it is not surprising that
there are clear variations in the availability of parking, the
cost of it to patients and visitors, and the income generated
by it. But are these variations justified by the circumstances
of individual Trusts? Here I examine the pattern of car parking
charges and the variations that exist, and I seek to identify
any systematic underlying factors that might explain the pattern.
AVAILABILITY
6. There is great variability in the availability
of car parking, whether this is measured in terms of the ratio
of car parking spaces per bed or in terms of the ratio of patients
to parking spaces. Of those hospitals giving specific figures
for patient and visitor parking, 45 trusts have at least one parking
space per bed, 12 have at least two, and the maximum value is
3.3. As might be expected the ratio seems to be lowest in urban
general hospitals, and provision is significantly lower in London,
with an average of 0.5 spaces per bed compared to 0.79 at hospitals
outside it.
7. Provision is, as the Department suggested,
strongly associated with availability of land—one measure
of this was the extent to which the Trust site was built up (measured
by the ratio of the area occupied by buildings to the area of
the site as a whole). This is strongly negatively correlated with
the ratio of parking spaces per bed, and it is a strong predictor
of the availability of spaces—in other words, the more constricted
the hospital site the fewer parking spaces, and this will account
for some of the differences between London trusts and others.
Provision of parking is not associated with throughput—there
are no significant statistical associations, suggesting that site
constraints are more important. To some extent, therefore, this
supports the Department's view.
8. There are also significant variations
in the ratio of patients (inpatients and outpatients combined)
to parking spaces, which is a better measure of demand for car
parking than the total number of beds in a Trust. There are a
number of Trusts where there are more than 10 patients per parking
space per day, and in around a quarter of all hospitals there
are roughly five patients for every available parking space per
day. We do not know how many visitors should be added to this
total, though many of these will visit in the evenings when outpatients
are generally not attending). Of course, many Trusts are in city
centres where it can reasonably be assumed that many patients
and visitors will arrive by public transport.
9. Provision for disabled drivers can be
assessed because figures were given for the numbers of disabled
parking spaces, although the dataset did not allow exploration
of the availability of concessionary spaces (eg the extent to
which permits were made available to individuals to exempt them
from charges in unreserved parking places; evidence to the Committee
suggested that some Trusts grant concessions to those attending
for regular outpatient appointments). There are variations in
the availability of such spaces but in the great majority of trusts
they accounted for up to 25% of patient and visitor parking spaces,
and the ratio of spaces per bed does not seem to vary systematically
with hospital size, location or patient throughput. It is associated
with site constraints, but not as strongly as is the case for
the ratio of all parking spaces to beds, suggesting that Trusts
are giving some priority to the needs of disabled drivers.
COST TO
PATIENTS
10. While nearly half of all hospitals charge
less than £1 per hour (this is consistent with the Department's
oral evidence that this is the median charge), 41 (or 27%) charged
at least £1.50 per hour, the maximum being £4.35. The
hospitals in London appear to charge more than their counterparts
elsewhere, since the average hourly rate for car parking in London
hospitals in the sample was £1.42 compared to an average
outside London of £1.08; this difference is statistically
significant. Of course, there are numerous, central London hospitals
which do not provide car parking themselves. Patients and visitors
travelling by car therefore must rely on local car parks and the
average cost of parking for those who do attend London hospitals
by car, including NHS and non-NHS car parks, would most likely
be significantly higher than elsewhere. If parking charges for
the South East of England are compared with those elsewhere, the
average charge is £1.41 compared to £0.97, which is
a significant difference.
11. It could be argued that higher prices
were a way of rationing parking space and if so we might expect
to be able to relate these charges to the availability of parking
or to the ratio of patients per parking space. However there appears
to be no systematic relationship between the hourly charges for
parking, the availability of parking, and throughput; whatever
it is that determines parking prices is not captured in these
statistics. It is possible that the pricing policies adopted by
Trusts relate to the availability of parking and the degree of
congestion in the surrounding area.
12. Much concern was expressed by witnesses
to the Committee about the costs incurred by individual patients,
but calculating the income from parking per patient is not possible
because the data only give us total numbers of attendances, which
does not tell us how many times a particular patient went to hospital
as part of their course of treatment. There are some patients
who, depending on the nature of the treatment, will incur higher
parking charges (this point was made repeatedly in evidence to
the inquiry; several organisations observed that there is quite
a difference between attending for a very short outpatient checkup,
and having to spend most of the day in hospital on a regular basis,
receiving chemotherapy). Nor do the data include information on
exemption policies of individual Trusts and we have no information
on the numbers who travel by public transport.
INCOME
13. There have been suggestions that car
parking is being used as an income generation measure for Trusts
so that the prices charged are higher than might be justified
if the aim was solely to cover costs. One way to explore this
is to see whether there are variations in the income generated
by car parking both in absolute terms and as a proportion of a
trust's total operating income; the higher the figure the more
plausible would be a suggestion that Trusts were raising more
money than was strictly justified.
14. There are variations in income per parking
space which to a large degree are a combination of charges and
throughput of patients. However there is a substantial range—over
£2,000 per parking space in several provincial hospitals
(Southend, Sutton Coldfield, Frimley Park and Epsom) to less than
a quarter of this even within the same region, such as East and
North Hertfordshire, North Hampshire, and Queen Mary's Sidcup.
Generally hospitals in London and the South East have a higher
average score on this indicator than is the case elsewhere in
the country.
15. As for the proportion of income generated
by car parking charges, in the majority of cases, this proportion
is very small—for over half of the Trusts reporting this
information, it accounted for less than 0.25% of the hospital's
budget. However, in 15 cases, hospital parking revenue accounted
for more than 0.5% of the Trust's annual expenditure, and in two
cases it exceeded 1% of the revenue expenditure of the hospital
trust. For comparison, figures provided by the Department suggested
that the total income from car parking at NHS Trusts was c £62
million, or around 0.1% of the NHS's budget.
16. If, as the Department of Health implied,
the primary aim of NHS Trusts is to cover the costs of running
car parks, it is not clear why there should be such large variations
between apparently similar institutions, particularly when the
third-largest figure recorded was 0.7%. The proportion of a Trust's
operating income derived from parking is statistically related
to patient throughput, which we might expect—the more rapid
the turnover of patients, other things being equal, the greater
the demand for parking spaces. Interestingly, however, hospitals
in London and the South East of England typically generated a
lower proportion of their revenue from car parking than was the
case elsewhere in the country. We would probably expect property
and labour costs to be higher in these regions which would imply
that above-average costs would be incurred in running car parks.
17. What about NHS foundation trusts? Some
data were supplied for NHS foundation trusts. There are differences
between these trusts and non-foundation trusts in respect of hourly
charges and the income per patient are not statistically significant.
It does appear that for foundation trusts, car parking income,
when expressed as a proportion of the revenue budget, is significantly
higher than is the case with non-foundation trusts. However, since
only 16 foundation trusts reported data to this analysis, this
result should be treated with some caution, and as the data relate
to the first year of operation of Foundation Trusts, it probably
reflects the historic pattern of charges and is not necessarily
a consequence of the change of status of these Trusts.
CONCLUSIONS
18. There are clear variations in the availability
and cost of parking at NHS hospital trusts. The question is whether
the variations are justified. If the Department of Health is correct
these variations should reflect site constraints and local circumstances
such as demand for parking. To some extent this is true of provision,
which is associated with site constraints, but not of charges
(though these are higher in London and the South East) or the
income raised from them. In particular variations in the proportion
of income raised by parking charges are not easily explicable
in terms of site constraints or throughput of patients.
19. As lengths of stay continue to decline,
and as the number of patients treated as day cases or as outpatients
continues to grow, the numbers of people competing for these spaces
will rise, posing additional problems of managing transport to
and parking at hospitals.
20. Some of these demands might be mitigated
if more people travelled to hospital by public transport, or if
more services were delivered locally, eg through GP surgeries.
Otherwise the numbers of people competing for these spaces are
going to rise. Trusts could deal with these demands by increasing
prices as a rationing mechanism, which would impose additional
costs on patients of the kind described by several witnesses to
this inquiry. Alternatively they could deal with them by providing
more parking spaces, or by developing travel plans which would
facilitate access to hospital by public transport.
John Mohan
School of Social Sciences, University
of Southampton
May 2006
29 Ev 9 Volume II and Qq 77-88. Back
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