Select Committee on Health Written Evidence

Memorandum submitted by the Department of Health (CP 1)



  1.  When the National Health Service was established in July 1948 the principle was to provide healthcare for all based on need, not on the ability to pay, except where regulations provide otherwise. Initially, the prescription charge was introduced in 1952 based on a charge per form. In 1956 a charge per item prescribed was introduced. The charge was abolished in 1965 and re-introduced in 1968. The categories of exemption are fundamentally unchanged since their introduction in 1968.

  2.  Government policy in England is that entitlement to help with prescription charges is based on the principle that those who can afford to contribute should do so, while those who are likely to have difficulty in paying should be protected.

  3.  The legal basis of the current arrangements is derived from sections 77, 83A and Schedule 12 to the NHS Act 1977 and in the National Health Service (Charges for Drugs and Appliances) Regulations 2000 and the National Health Service (Travel Expenses and Remission of Charges) Regulations 2003.

  4.  Charging arrangements are a devolved matter and arrangements in the rest of the UK are a matter for the Devolved Administrations.


  5.  A charge is payable for each item prescribed (ie the NHS medicine or appliance prescribed by a GP or other authorised prescriber) or quantity dispensed unless the patient is entitled to free prescriptions. The charge, as of 1 April 2005, is £6.50. Categories of exemption from the prescription charge can be grouped as follows:

    —  Age.

    —  Medical condition.

    —  Income.

    —  Type of item prescribed. For example, contraceptives or treatment for a sexually transmissible infection.

    —  Method of delivery; for example to an in-patient or supplied and administered by a GP.

  A detailed list is in annex 1.

  6.  People who hold a valid Prescription Prepayment Certificate (PPC) do not pay a further charge at the point of dispensing. A PPC costs £33.90 for four months and £93.20 for 12 months, for an unlimited number of items. This means that patients can obtain as many items as they need for less than £2 per week. It also means that the threshold number of items where it is cheaper to buy the PPC is six items for four months and 15 items for 12 months supply.

  7.  The current arrangements mean that around 50% of the population are exempt from prescription charges and around 87% of prescription items are dispensed free of charge. As a consequence of the current arrangements, a charge was paid for only 8.4% of prescription items, and 4.7% of prescriptions were charged at the reduced PPC rates.


Are prescription charges equitable and appropriate?

  8.  The charge, and fees for PPCs, have been increased over time by varying amounts. Between 1979 and 1998 the charge rose from 20p to £5.80. Since 1998 the charge has increased by 10p each year. This increase has been below the rate of inflation. The level at which income based entitlement to free prescription begins has been increased by the same percentage as increases in Income Support.

  9.  In 2004, to assist those just above the Low Income Scheme (LIS) limits the cut off entitlement to free prescriptions via the NHS low income scheme was extended to patients whose income exceeded their requirements by up to 50% of prescription charge, currently £3.25.

  10.  For 2004 (the latest year for which statistics are available) the average net ingredient cost of a non-exempt item was £14.32 when the prescription charge from April that year was £6.40.

What is the optimal level of charges?

  11.  The prescription charge is a flat rate fee. This ensures that:

    —  patients know exactly what the cost of the medication will be before they get the prescription dispensed. They do not have to worry about whether they will be faced with a variable price at the point of supply;

    —  there is equity between patients at all levels of income;

    —  patients can receive the medication that they require and that those requiring more expensive medication are not penalised.

  12.  For those that do have to pay prescription charges the PPC was introduced to reduce the expense of multiple prescriptions. A PPC holder may obtain as many items as are prescribed (with an average of 46 items per head per annum dispensed in 2004-05) at a cost to the patient of less than £2.00 per week.

  13.  A 12 month PPC thereby effectively provides a maximum cost ceiling, currently set at £93.20. Similar arrangements operate in other EU countries that operate schemes setting an annual limit on the amount of prescription charges an individual may be required to pay.


  14.  The basic charge is transparent in that each item attracts the current £6.50 charge.

  15.  The various arrangements currently in place were introduced to ensure that a wide range of patients would either have entitlement to free NHS medicines or an easement of the amount that they would have to pay by using a PPC. The rate of uptake by benefit claimants and those on low income indicates a widespread understanding by these patients of their entitlements.

What criteria should determine who should pay and who should be exempt?

  16.  The following addresses the various types of exemptions:

Age related

  Medication needs increase disproportionately with age whilst at the same time income usually decreases. When charges were re-introduced in 1968, free prescriptions matched the retirement age for men and women at that time (ie aged 65 and over).

  Children under school leaving age are also exempt as access to medication should not depend on the parents' ability to pay. From 1988 those children who stay in education until they are 19 also receive free prescriptions.

Medical condition

  The current arrangements for exemption on the grounds of specified medical conditions have been in place since 1968. The medical conditions qualifying for exemption were agreed in discussion with the BMA. The list of these conditions contains some readily identifiable permanent medical conditions which automatically called for continuous life long (and in most cases replacement) therapy. A person exempt on medical grounds was, and is, entitled to all medication free to avoid doctors needing to specify which medication should be dispensed free; that means that someone with, say, myxoedema (underactive thyroid) can have free prescriptions for, say, gout, heart disease, peptic ulcer, varicose ulcer and anything else as well.

Pregnant women and nursing mothers are also exempt from prescription charges if they hold an exemption certificate. This is to protect the health of the unborn child and the nursing mother. The exemption is provided regardless of the mother's income.

Income related

  Those who are likely to have difficulty in paying charges may qualify for exemptions which take two forms:

  (1)  There is an automatic entitlement to help with health costs for some who therefore do not have to complete a separate claim form. This is called "Passporting" and applies to people receiving some state benefits eg Income Support. "In work" benefits, such as Tax Credits and its predecessors have entitled recipients to free prescriptions, latterly if their total income is below a specified threshold. People receiving Incapacity Benefit or Disability Living Allowance are not "Passported" because these benefits are not income related but they can make a National Health Service Low Income Scheme claim.

  (2)  The National Health Service Low Income Scheme (LIS) provides income related help for people who are not exempt nor automatically entitled to remission of NHS charges. The scheme covers help with NHS prescription and dental charges, wigs and fabric supports, entitlement to NHS sight tests and optical vouchers and payment of travel expenses to receive NHS treatment.

  The LIS provides full help whereby a qualifying patient will not pay any charges. However, those with a slightly higher income may receive partial help with health costs. The extent of any help is based on a comparison between a person's resources and requirements at the date a claim is received by the PPA or the date the charge was paid if a refund is claimed. There is a ceiling based on capital and the calculation is referenced to income support arrangements with "needs" being equivalent to the income support applicable plus full housing costs and council tax payable.

Type of item prescribed

  Where treatment is desirable on public health grounds (eg vaccination and treatment of Sexually Transmissible Infections) then it is provided free of charge.

  Contraceptives prescribed for women are also free of charge. This ensures that women are able to take responsibility for their own reproductive health irrespective of ability to pay.

Method of Delivery

  Charges are not made where a need to pay could impede the delivery of urgent treatment. Accordingly, treatment in or at hospital, including medication administered at the hospital, is free. Medication to take away is subject to the normal charging arrangements.

How should relevant patients be made more aware of their eligibility for exemption from charges?

  17.  The Department has an annual budget of £416K for England held by the Prescription Pricing Authority (PPA) from which it funds a range of posters and leaflets aimed at informing people about how they may obtain help with health costs. All material is provided free on request by phoning the DH publication orderline or by phoning the PPA helpline. The PPA also regularly send mailouts to stakeholders to advise them of changes. Further promotional activities are carried out by the PPA including holding roadshows in shopping malls, broadcasting information over local radio networks, taking part in conferences and training days for professionals and placing advertisements in appropriate free and paid publications.

  18.  In addition to the above:

  (1)  Jobcentre Plus offices also hold supplies of the information leaflet and the claim forms for the NHS LIS;

  (2)  Hospitals, dentists, opticians, doctors and pharmacists are all encouraged to keep supplies of leaflets available for patients and to display posters. Two major supermarkets now hold supplies of the "quickguide";

  (3)  The Department has a contract with the Waiting Room Information Service which supplies stocks of leaflets to participating GP surgeries; and

  (4)  New materials have been developed working with NUS and NACAB.

Whether charges should be abolished?

  19.  Abolition or an increase in exemptions could increase GP appointments if patients opt to seek medication rather than practise self-care such as healthy activities or modifying diet. The revenue from prescription charges and PPC fees also provides a valuable contribution to the National Health Service. Abolition would increase GPs' workload, increase the Drugs Bill and cost the NHS of some £430 million in lost income (before taking into account extra drugs expenditure).



  20.  Charges for dental treatment were introduced in 1951 since which time they have been periodically revised: eight times between 1952-79, and 20 times between 1980-2003. Dental charges rose annually each year between 1991-2000.

  21.  Dental charges became a significant part of the total cost of treatment when they were raised to 75% of the cost of treatment and extended to dental examinations (not just treatment) in 1989; in 1993 the proportion rose to 80%.


    —  Dental patient charges apply to adults but not to children, pregnant women, people on income support or those who receive care in a hospital out-patients or from the Community Dental (salaried) service.

    —  Dental patient charges account for approximately one-third—about £630 million—of overall expenditure on NHS dentistry.

    —  The current maximum charge is £384. From April 2006, the maximum charge for a course of treatment will be £189.


  22.  Primary care dental services are about to undergo the most significant reform since the General Dental Services were established in 1948. From next April PCTs will have resources for dentistry devolved to them and will locally commission services via the new General Dental Services (GDS) and Personal Dental Services (PDS) contracts. Dentists will be paid for a contracted level of activity over the course of a year and not for each individual course of treatment (item of service) performed.

  23.  This reform requires changes to the system of patient charges, which are currently linked to the individual fees paid to dentists. There are currently 400 different patient charges reflecting the various items of service. The Department has taken this opportunity to produce a much simpler and more transparent system of charges. The proposed new system is based on the recommendations of a working party chaired by Harry Cayton, National Director for Patients and the Public. The working party included representatives from the British Dental Association, Consumers Association, Dental Practice Board and other stakeholders. Over the summer, the Department carried out a 12 week formal consultation on a simplified three banded system of patient charges, based on the working group's recommendations. The three bands of charges correspond to the three bands of courses of dental treatment, which will in future be used to gauge the level of service provided by a dentist over the course of a year.

  24.  The proposed three charging bands (which have been uprated since the consultation to reflect inflation) will considerably simplify a system which the public currently find very hard to understand:

    (1)  band 1 (£15.50) for a preventative course of treatment (which might include an examination, a scale and polish and x-ray and preventative advice);

    (2)  band 2 (£42.40) for dental interventions (fillings or restorative treatment);

    (3)  band 3 (£189.00) complex treatments including dental appliances.

  25.  Regulations covering the new charges were placed before both Houses of Parliament in November for agreement by affirmative resolution during December. The regulations include amendments to take account of some specific concerns raised during consultation (eg a 70% reduction in the charge for repair of dentures or other appliances).

  26.  The consultation responses confirmed broad support for simplifying the current system of dental charges. Consumer representative organisations broadly supported the reforms, whilst expressing some concerns about the level of charges, particularly for Band 3. The British Dental Association (despite having been represented on the working party) raised a number of concerns, including the lack of testing. Other responses showed strong support for overhauling the current system, but no single common view about how best to do this. Many of the responses indicated a need for the Department to undertake further work to explain the new charging system to patients and the public, and work on a public communications programme is now underway.

  27.  In publishing the revised charges regulations, the Department has emphasised the following key points:

    (1)  the new system reduces a complex system of over 400 patient charges to only three charges;

    (2)  the maximum charge for patients will reduce from £384 to £183—the Consumers Association and others have welcomed this move;

    (3)  on average, the costs for NHS patients will be no greater than now (in real terms) and may in fact be lower. Under the new NICE guidelines on recall intervals for routine dental consultations, which end the current practice of routine six monthly visits, dentists will use their clinical judgement to recall patients at intervals of between three months and two years. This is expected to reduce the average frequency of patient visits, which in turn should free up time for dentists to see a greater range of patients and reduce the average cost per patient.


Are dental charges equitable and appropriate?

  28.  Charges for dental services have existed since 1951, and we believe they are a fair way of raising important revenue that supports the provision of dental services. Public opinion surveys do not cite cost of NHS treatment as a significant reason affecting take-up of NHS dentistry. The most recent Healthcare Commission survey (2003) indicated that, of those patients who had not been to an NHS dentist in the last year, the more important factors influencing their decision were the perception that they did not need to go to the dentist; access to NHS dental services (which the Department has since been tackling through a £250 million programme of investment and workforce expansion); preference for using a private dentist; fear of going to the dentist; and other factors. We have, however, used the opportunity of the forthcoming dental reforms to design a new patient system that will be fairer and more transparent.

What is the optimal level of charges?

  29.  Charges for dentistry have traditionally reflected a percentage of the overall cost of an item of treatment. But the over 400 charges which the previous system generated led to confusion in the public, compounded by some patients paying privately for treatment and not being clear where NHS payment ends and private payment begins. The new system is designed to raise the same overall level of charge income (as a proportion of gross expenditure on NHS dental services), but with much greater clarity for patients as to what they will pay for an overall course of treatment.

Whether the system of charges is sufficiently transparent?

  30.  The simplified three band system of patient charges will make it easier for patients to understand the cost of treatment. With 400 current items of service it is very difficult for patients to understand what they are paying for on the NHS, and even more so when this is combined with private treatment. Patients generally welcome the opportunity to have "mixed" NHS and private treatments from the same dentists. However, this makes it all the more important to ensure that patients understand both the cost of proposed NHS treatments and the cost of any proposed private treatment. The new arrangements will greatly increase transparency in this respect.



  31.  Until 1989 everybody was entitled to an NHS-funded sight test. From 1989, eligibility was restricted to children, people on low income or those suffering from or predisposed to certain eye diseases. In 1999, the Government reintroduced NHS-funded sight tests for people over 60.

  32.  There is no system of NHS charges for optical services. Rather, eligibility for free, NHS-funded sight tests is targeted at children, older people, those with or at risk of eye disease, and people on low incomes. There are similar, though not identical, eligibility arrangements (set out below) for optical vouchers, which patients can use to contribute to the costs of buying glasses or contact lenses.

  33.  The groups eligible for free sight tests are as follows:

    —  those under 16 years of age;

    —  students in full time education aged between 16 and 19;

    —  those aged 60 or over;

    —  individuals on low incomes including those receiving Income Support, Jobseeker's Allowance and Pension Credit Guarantee Credits;

    —  individuals diagnosed as having, or being at risk of, glaucoma; and

    —  diabetics.

  34.  Opticians who provide a NHS sight test currently receive a fee of £18.39 per test. This rate is negotiated with representatives of optometrists and ophthalmic medical practitioners.

  35.  The Health Bill removes current restrictions on who PCTs may contract with to provide NHS funded sight tests, subject to contracts ensuring safeguards and quality and the use of qualified and registered optometrists and ophthalmic medical practitioners to undertake clinical work. The Bill also creates a more robust framework for commissioning similar to other parts of primary care and which allows for commissioning of enhanced services locally.

  36.  The Health Bill removes some current restrictions on who may provide NHS funded sight tests. At present, only optometrists, ophthalmic medical practitioners and corporate bodies registered with the General Optical Council may contract directly with Primary Care Trusts to provide sight tests. Businesses owned by dispensing opticians or by lay people (if they are not registered with the General Optical Council) can only provide services by arranging for one of their employees (ie an individual optometrist or ophthalmic medical practitioner) to enter into an agreement with the Primary Care Trust to be the contractor. The Health Bill will remove this cumbersome arrangement and allow for direct contracts with these practice owners, provided that those undertaking the clinical work are qualified, registered optometrists or ophthalmic medical practitioners on a PCT's "performers list". This will make it more straightforward for a range of providers to enter NHS service provision and will help sustain and promote choice for patients.

  37.  The Bill also creates an integrated legal framework within which Primary Care Trusts can commission enhanced ophthalmic services. This will support PCTs, where appropriate, in increasing work undertaken in primary care, reducing inappropriate referrals to hospital and enhancing the role of primary care professionals in diagnosing and managing eye conditions. The Department is currently sponsoring a number of NHS pilots that involve expanding the role of primary care professionals in managing low vision, glaucoma and age-related macular degeneration.

  38.  Subject to the Bill becoming law and being implemented, we envisage the sight testing service operating like the General Ophthalmic Service (GOS) system now. Eligibility for NHS funded sight tests will be maintained for all those currently eligible. Contractors will (as now) be able to establish themselves in areas and have a contract with the NHS provided they meet agreed national criteria. Patients will be able to choose the GOS contractor who provides their NHS funded sight test. We also envisage continuing, as now, to have a centrally negotiated sight test fee. NHS sight testing will, we anticipate, continue as a demand led service with consistent standards across the country and patient choice of the practitioner who they wish to go to for their NHS funded sight test.

  39.  Patients who have received a NHS sight test, and who need glasses or contact lenses to correct their eyesight, receive a prescription showing the required strength and type of glasses or contact lenses. Eligible patients also receive an NHS optical voucher, which they can use to meet (in whole or in part) the cost of these glasses or contact lenses. Eligibility for optical vouchers is primarily targeted towards children and people on low incomes. There are eight voucher bands, each to a set value according to the strength and type of the prescription. The current voucher values vary from £32.90-£181.40. We recognise that the higher an individual's prescription the more the glasses will cost. This is why the higher the prescription the more financial help an individual would get with costs. The optician who dispenses the glasses or contact lenses redeems the value of the voucher from their local Primary Care Trust.

  40.  The groups eligible for optical vouchers are:

    —  those under 16 years of age;

    —  students in full time education aged between 16 and 19;

    —  individuals who have been prescribed complex lenses; and

    —  individuals on low incomes including those receiving Income Support, Jobseeker's Allowance and Pension Credit Guarantee Credits.


Are funding arrangements equitable and appropriate?

  41.  These arrangements are designed to provide support to people most at risk from eye disease or who might otherwise be discouraged on financial grounds from having their eyes examined. Eligibility for optical vouchers relates predominantly to income and is targeted on those who might have most difficulty in purchasing glasses or contact lenses.

  42.  Vouchers provide eligible patients with flexibility in respect of which glasses or lenses to choose. They allow patients to top up the voucher value (if they wish) to buy a more expensive pair of glasses or lenses.

Whether the system of charges is sufficiently transparent?

  43.  The conditions for entitlement are simple and straightforward and are designed to minimise any possible abuse of the system.

  44.  For example, sight tests are recommended every year for persons over 60 years of age. Further tests within any year are not free of charge unless the optometrist or ophthalmic medical practitioner is satisfied that the sight test is necessary. These arrangements prevent individuals from seeking a sight test for which there they do not have a clinical need unless they are willing to pay privately.

What is the optimal level of funding?

  45.  There are no central limits on expenditure on NHS sight tests or optical vouchers. Expenditure is demand-led, in the sense that it is driven by the numbers of eligible patients who visit their optician for NHS-funded sight tests and the numbers of optical vouchers issued as a result of these sight tests. The number of NHS funded sight tests increased by 3.1% from 2003-04 to 2004-05.

  46.  Levels of funding are also clearly affected by rules on eligibility. In 1999, the Government reviewed the eligibility rules and extended eligibility for sight tests to those over 60. The available evidence suggests that this resulted in a transfer of sight tests from the private sector to the NHS, rather than any material increase in the overall number of sight tests undertaken. This does not suggest that any further extension in eligibility (and the associated increase in NHS funding) is likely to affect significantly the overall number of sight tests undertaken or the associated health outcomes.

What criteria should determine who may receive funding and those who should not?

  47.  As set out above, the eligibility criteria for NHS-funded sight tests (which in turn affect levels of NHS expenditure on sight tests) are designed to ensure that children, older people, other patients who are or may be predisposed to eye disease, and those on low incomes are not discouraged from having their sight tested. The criteria for optical vouchers are, similarly, designed to support those who might otherwise have difficulty buying glasses or contact lenses, either because they are on low incomes or because they require complex lenses.

How should relevant patients be made more aware of their eligibility for NHS optical services?

  48.  Information about the extensive arrangements for providing help with NHS optical services and other health costs are publicised in the leaflet HC11, "Are you entitled to help with health costs?" Posters are also available for display in optical practices and hospital out-patient departments.

Whether the current arrangements should be abolished?

  49.  The Department is not persuaded that extending eligibility for NHS-funded sight tests and/or optical vouchers would be a cost-effective use of NHS resources. As indicated above, the evidence from the most recent extension in eligibility (in 1999) does not suggest that further extensions would significantly alter the overall take-up of sight tests (ie taking into account both NHS and private sight tests).



  50.  The NHS Plan "A Plan for Investment, A Plan for Reform" was published in July 2000 and set out Government Policy for investment in the NHS and for reform of the way the NHS delivers care for patients. As part of improving the environment in which the patient is treated and to make available services that they take for granted at home, it was decided to set a target for the availability of bedside televisions and telephones in every major hospital by the end of 2004.

  51.  NHS Estates undertook two competitive tender exercises (July 2000 and January 2001) and Licensed a number of Providers to install these services in NHS Trusts. The object being to utilise the private sector in the provision of the services so that the installation was funded by the private sector with the recovery of capital operating costs being met by the system users.

  52.  Installation of these services went well and at the end of 2004, bedside televisions and telephones had been installed in 122 major hospitals (more than 400 beds) and in 33 smaller hospitals (less than 400 beds). Over 75,000 units had been installed at that time, the NHS Plan target was largely met.

  53.  The Office of Communications (OFCOM) has opened an investigation into the provision of bedside communication and entertainment services recently installed in NHS hospitals under the Competition Act 1998.

  54.  The terms of the investigation are as follows:

    a.  whether the agreements that are in place between certain NHS Trusts and both Patientline and Premier each infringe the Chapter I prohibition of the Competition Act 1998 ("the Act") and/or Article 81 of the EC Treaty (anti-competitive agreements); and

    b.  whether the prices that Patientline and Premier each charge consumers for making calls to hospital patients each infringe the Chapter II prohibition of the Act and/or Article 82 of the EC Treaty (abuse of a dominant position).

  55.  The Department of Health is co-operating with this investigation. No further action should be taken until the OFT publishes its conclusions.


Why was it decided to charge patients for these services?

  56.  These facilities provide additional services to improve the patient environment, and are not related directly to the provision of clinical care. The private providers took the financial risk in installing and operating the systems; they are essentially a free good to NHS Trusts. It would not have been appropriate to divert funding for the provision of essential clinical services to pay for televisions and telephones.

  57.  If patients wanted to watch TV in the past, they had a choice of watching a communal TV in the dayroom, free of charge, or in some cases could rent TVs to watch at the bedside. Patients have always had to pay to make an outgoing call from the hospital on ward payphones.

Whether charges for bedside televisions and telephones are equitable and appropriate?

  58.  The Project to install the bedside televisions and telephones was structured so that the provider chosen by the NHS Trust would install and operate the bedside communications at its own cost. The NHS patient is charged directly for the services used and the contract is between the user and the provider. It was the intention of the Project that the installation of these services would not be a cost for NHS Trusts. Over £115 million of private funding has been used to introduce these services into NHS hospitals. This capital funding will of course be recouped by the private providers over time, through the revenue streams generated.

What is the optimal level of charges?

  59.  The provision of bedside televisions and telephones was (and is) an emerging market. NHS Estates considered the experience of providers already in the market to assess a reasonable measure of likely costs. The procurement process was designed to establish the market rate for the provision of these services by appealing to a range of applicants to make offers against the parameters set out as part of the tender exercise.

  60.  Each of the suppliers offers a different range of services and prices. The cost of TV ranges from £2.50 to £3.50 per day. The cost of outgoing telephone calls is around 10p per minute. The cost of incoming telephone calls ranges from 15p to 49p per minute.

Whether the system of charges is sufficiently transparent?

  61.  The suppliers of the service advise the user of the cost of the services when they apply to use the system. In addition, incoming callers are advised at the onset of the telephone call of the charges to be levied (apart from HTS who do not offer this service).

What criteria should determine who should pay and who should be exempt?

  62.  Private providers are responsible for the costs of installation and ongoing operation of the services. In order for them to realise a return on their investment the revenue stream must provide them with an adequate return. Patients and other users pay for the services provided.

  63.  All providers have offered to provide children with free TV. Some suppliers offer discounts on TV charges for the elderly and long stay patients. In addition, some suppliers offer unused credits handed back by patients to be distributed, at the discretion of ward staff, to those patients who may benefit from the services but are not able to pay for them.

  64.  For patients who cannot afford or do not wish to use the services provided, TVs usually remain in day rooms and messages from friends and relative can be passed to and from the nurse's station, as happened in the past.

How should relevant patients be made aware of their eligibility for exemption from charges?

  65.  Under the provision of these services, the only patients with a guaranteed exemption for charges are children and they are advised of this as appropriate.

Whether charges should be abolished?

  66.  The services are provided by private providers, most of whom have entered into 15 year contracts with NHS Trusts. The providers are not able to operate the service if they do not get a return on their investment. The only way for charges to be abolished, and to retain these services in NHS hospitals would be for the NHS to pay for the services and buy out the remaining capital charges. There may be a number of other options that could be considered further at a later stage.



  67.  All NHS bodies have powers to undertake activities to increase the amount of income available to them. It is under these powers that, for example, NHS trusts can charge for car parking on their premises, or rent out retail units (the gift and flower shops found in the main concourse of most hospitals). This part of this Memorandum of Evidence provides some specific information about car parking charges.


  68.  NHS trusts do not have to provide car parking facilities on their premises. However, if they do, then they will necessarily incur costs in terms of maintenance and security, and even staffing depending on the particular arrangements put in place. If no charges were made, then these unavoidable costs would have to be found from elsewhere, at the risk of taking funds away from patient services. Having said that, NHS trusts are not obliged to charge for car parking, but are free to do so within the income generation rules.

  69.  Thus, it is a matter for individual Trusts to decide whether they wish to introduce such charges, and if they do, then at what level the charge should be set, taking into account local circumstances. Hospitals' locations differ with regard to the amount of space available for car parking and the pressure they face on available spaces. NHS Trusts must therefore decide on the arrangements for car parking in the light of their particular circumstances, including whether or not, and whom, to charge. When making such judgements, Trusts have to consider the needs of all users of the hospital, including consultants, junior medical staff, nurses, other staff, patients, visitors, emergency vehicles and others. Where spaces are limited, it may be impossible to offer all or any of these groups free or subsidised parking as to do so would affect the space available for others.

  70.  These factors have meant that it is neither practical nor helpful to issue national blanket guidelines on car parking charges on NHS premises setting, for example, maximum levels or requiring free parking to be available for certain categories of user. However, as indicated above, guidance has been in place for some years advising on the range of factors that need to be considered if an NHS trust is thinking about introducing car parking charges. This includes information on the different types of arrangement that might be available, the needs of the various users, consulting and reaching a decision, and how to manage the scheme once it is in place.

Department of Health

7 December 2005

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2006
Prepared 18 January 2006