Select Committee on Health Written Evidence

Memorandum submitted by John Mohan, University of Southampton (CP 45)



  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.


  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.


  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.


  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.


  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.


  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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