Parking Charges

Rich 1 posted:

This is a tricky one because if you scrap parking charges you'll have all and sundry taking up spaces and not for hospital visits. This may then make it difficult for hospital workers, patients and visitors to park. Hospital workers should have a pass card as should those on regular treatment. Agree it's a rip off but some thought needed to have a workable system. Rich 

I don't know where you live Rich 1 but I'm in Oxfordshire. Oxford was one of the first cities to go "car free" and provide park and ride services. It's served by 4 hospitals and I can tell you from first hand experience that I don't believe anybody would choose to park in any of them out of choice even if they were free because the queues for spaces are absolutely horrendous at pretty much any time of the day and evening.

winkyincanada posted:

MDS posted:

winkyincanada posted:

Don Atkinson posted:

winkyincanada posted:

Paper Plane posted:

 

Why should people who choose to drive to work, receive a subsidy over those who commute by other means? I'll get behind free parking when the true value of the subsidy/perk provided to those using it is paid in cash to those who do not. Anything else is grossly unfair.

Here in the U.K., public transport is heavily subsidised. Bus and train services bear little or no relation to the actual cost of provision.

If train commuters had to pay the true value of train services in cash, to those of us who don’t use them, I’d be laughing all the way to the bank and back.

Now, I don’t pay to park at work, (I work freelance) but if I did need to pay, I would easily add it to my chargeout rates, much the same as I cover the cost of travel to airfields, which by their very nature, tend to be out of town.

Cheers, Don

 

And if drivers paid the true cost of private vehicle use, we'd all be better off.

In the UK I think Treasury has accepted that through road fund licence, road fuel duty, and VAT on fuel and vehicles, motorists pay significantly more than is spent on providing the infrastructure.    

You perhaps don't think any of this counts, but to those costs we need to add the subsidies accruing to fossil fuel industry, the health care costs due to pollution from the manufacture and use of cars, the health care costs due to chronic inactivity of drivers, the health care costs due to the killing and maiming of people, the current and future environmental costs, the costs of policing the roads (due to the inherently dangerous nature of motor vehicles), the loss of quality of life suffered by those living near and having negotiate the ubiquitous car sewers.

Winky - there will always be arguments about the extent to which external cost factors should be accounted for. You identify some but if some of these external factors were to be included it would also be appropriate and consistent to include external benefits. For example, the taxes that flow from the direct economic activity in motor vehicle manufacture and maintenance eg the corporation tax paid by the companies and the income tax and NICs paid by the employees, consumption taxes paid by those enjoying the economic benefit. Plus the wider boost to the economy generated by motor vehicles eg people being able to work in locations inaccessible by rail, or walking; accessing goods and services in the same locations.  The list could go on and on. 

Jonners posted:

I don't know where you live Rich 1 but I'm in Oxfordshire. Oxford was one of the first cities to go "car free" and provide park and ride services. It's served by 4 hospitals and I can tell you from first hand experience that I don't believe anybody would choose to park in any of them out of choice even if they were free because the queues for spaces are absolutely horrendous at pretty much any time of the day and evening.

Sorry to turn this into a local issue,  but its Jonners thread & is of interest

Oxford centre might be car free,  the buses now fill up the available road space.  And the suburbs are now the rat runs.

The three Oxford hospitals are all grouped in the Headington (suburb) area,  the Churchill & Nuffield are adjacent to each other.    Patient numbers have increased by 37% in 10 years,  car parking places remain the same,  but all made more complicated by staff parking.   

In February 2017 OUH (NHS) Trusts made public the plans for multistory parking at the hospitals.    Two at the JR,  two at the Churchill & one at the Nuffield.         In an online poll 89% of local press readers voted in favour of the plan as a means of dealing with ongoing traffic problems in the Headington area & hospital sites.    Oxford council objected as it does not solve the traffic problems in the Headington area.  Progress to date = zero.  

Bruce Woodhouse posted:

Cheers Tony

I am not defending these systems or the way they are run, and I know they could do things better, but they are also public bodies with a significant degree of accountability. I don't think it is fair or accurate to assume that when a Trust says any profits go to patient care they are not telling the truth.

Best leave this now maybe

Bruce

I guess it's how you perceive what constitutes spending on patient care Bruce. Maybe I'm just an old cynic, but my cynicism is borne out of past and a degree of present experience, and I've yet to see anything to change my cynical opinions. Yes, best leave things there.

Mike-B posted:

Jonners posted:

I don't know where you live Rich 1 but I'm in Oxfordshire. Oxford was one of the first cities to go "car free" and provide park and ride services. It's served by 4 hospitals and I can tell you from first hand experience that I don't believe anybody would choose to park in any of them out of choice even if they were free because the queues for spaces are absolutely horrendous at pretty much any time of the day and evening.

Sorry to turn this into a local issue,  but its Jonners thread & is of interest

Oxford centre might be car free,  the buses now fill up the available road space.  And the suburbs are now the rat runs.

The three Oxford hospitals are all grouped in the Headington (suburb) area,  the Churchill & Nuffield are adjacent to each other.    Patient numbers have increased by 37% in 10 years,  car parking places remain the same,  but all made more complicated by staff parking.   

In February 2017 OUH (NHS) Trusts made public the plans for multistory parking at the hospitals.    Two at the JR,  two at the Churchill & one at the Nuffield.         In an online poll 89% of local press readers voted in favour of the plan as a means of dealing with ongoing traffic problems in the Headington area & hospital sites.    Oxford council objected as it does not solve the traffic problems in the Headington area.  Progress to date = zero.  

This shows one of th policy conflicts of public bodies, where , generally councils are trying to reduce private car dependency, and more reliance on public infrastructure, as opposed to hospitals that are enabling access to their sites.

the use of multi storey solutions is good use of land space and efficient footprint, where hospital development space is always in high demand. The cost issue with this is the higher price of building the facility.typically surface car park spaces can be provided for around 1500 per space, whereas multi storey costs are a factor of 10 increase on these prices 

Mike-B posted:

  Oxford council objected as it does not solve the traffic problems in the Headington area.  Progress to date = zero.  

Why would the council link the creation of more car parks with local traffic congestion, unless their plan is to make motorists' lives so completely miserable that they just won't get in their cars? Actually, that probably is their rationale. The areas they're talking about are residential as well, people aren't just going to stop using their cars, it's a bit like trying to univent the jumbo jet. In the case of hospital visitors who probably stay for 2 hours max at visiting hours, using a park-and-ride isn't practical - it would make it a 3-4 hour visit and they're set up for long term parking, not short term at £7 a day. Great value for 24 hours, poor for an hour or two. 

ISTM there are two or three key issues associated with this Hospital parking.

The first is the current situation in England and N. Ireland where each Hospital Trust has to (provide ? and) maintain its hospital car park.

The second, is whether the Trust should be entrusted with Government funding to (provide ? and) maintain these car parks as is done in Wales and Scotland.

OK, there is the additional, and I am going to suggest trivial, issue of ensuring that hospital car parks are not abused by commuters and shoppers. Plenty of solutions there IMHO.

This thread was started as a (justifiably ?) angry response to the first issue based on the news that many Trusts are increasing parking charges disproportionately this year and have been so doing for many years, with a captive clientele. I for one, am grateful to Bruce and a few others in the National Health industry for clarifying who is responsible at present for car parking. And also how any surplus in ring-fenced and limitations placed on its use. I’m not sure I have gained full disclosure, but it’s been an eye-opener.

Quite separately, it seems, is the political issue of who SHOULD fund car parks and the maintenance thereof. It seems the Gov COULD do it. It’s done so in Wales and Scotland and the Labour Party have said they would include such a change in their manifesto for England. So why the resistance ? Is it just political dogma ? Or is there a real benefit one way or the other ?

Jonners posted:

Mike-B posted:

  Oxford council objected as it does not solve the traffic problems in the Headington area.  Progress to date = zero.  

Why would the council link the creation of more car parks with local traffic congestion, unless their plan is to make motorists' lives so completely miserable that they just won't get in their cars? 

Traffic into the town in general, without the addition of the three hospitals traffic. is seriously bad enough, crawling for miles, stationary tailbacks for no reason, out to Eynsham one way & the M40 in the other..  Oxford was not designed, it just happened.  I guess in place of a better plan,   & that has to include near bottomless government funding,  they can't really do much.  Its time to abandon any in-city & inside ring road developments (unless is a large scale demolition & brown-site rebuild)   & go for out of town malls meaning we'll upset the green belt tree-huggers & that includes me.

Mike-B posted:

Traffic into the town in general, without the addition of the three hospitals traffic. is seriously bad enough, crawling for miles, stationary tailbacks for no reason, out to Eynsham one way & the M40 in the other..  Oxford was not designed, it just happened.  I guess in place of a better plan,   & that has to include near bottomless government funding,  they can't really do much.  Its time to abandon any in-city & inside ring road developments (unless is a large scale demolition & brown-site rebuild)   & go for out of town malls meaning we'll upset the green belt tree-huggers & that includes me.

Oxford traffic like any big city's is heavy but the thing is, we're a nation of car drivers and people live and work in big cities with all the knock-on effects you describe in your post Mike-B. I think a congestion charge would probably persuade more commuters to use the train and the park-and-ride but I don't see hospital visitor habits changing and I think the Trusts know this, otherwise they wouldn't be so brazen with their parking tariffs. Car parking contributed £270m+ in extra funding for "patient care" this year. Given figures like these, why would Hospital Trusts actually want to discourage visitors from bringing their cars in? It's a cash cow. 

Jonners, Pompey QA, whenever I've been there the que is usually no more than 6 or at most a dozen car's. That's just queing, not waiting for people to leave. I know the area well and never pay to park as I use off street parking, 10 min walk or 20 at most pushing a wheel chair. Rich 

Rich 1 posted:

Jonners, Pompey QA, whenever I've been there the que is usually no more than 6 or at most a dozen car's. That's just queing, not waiting for people to leave. I know the area well and never pay to park as I use off street parking, 10 min walk or 20 at most pushing a wheel chair. Rich 

Good on you Rich 1, I admire your determination and it must be very helpful to know the local area well enough to find a street you can park in for free, in Headington and Cowley that must take some doing I imagine! 

Broadening the discussion........

..... young, 22 year old man in Kent has changed his life style and reduced weight from 34 stone to c. 14 stone. One consequence is that he now has excess folds of skin which is a different problem, but a problem it is !

NHS in Kent won’t fund the £25k procedure to solve the problem. NHS in Hampshire would fund the operation as would several other HHS Trusts.

Why this inequality ? And more importantly, what is needed to eliminate it ?

Don Atkinson posted:

Broadening the discussion........

..... young, 22 year old man in Kent has changed his life style and reduced weight from 34 stone to c. 14 stone. One consequence is that he now has excess folds of skin which is a different problem, but a problem it is !

NHS in Kent won’t fund the £25k procedure to solve the problem. NHS in Hampshire would fund the operation as would several other HHS Trusts.

Why this inequality ? And more importantly, what is needed to eliminate it ?

 

I think £25k is best spent elsewhere than what is fundamentally a cosmetic procedure. 

Don Atkinson posted:

Broadening the discussion........

..... young, 22 year old man in Kent has changed his life style and reduced weight from 34 stone to c. 14 stone. One consequence is that he now has excess folds of skin which is a different problem, but a problem it is !

NHS in Kent won’t fund the £25k procedure to solve the problem. NHS in Hampshire would fund the operation as would several other HHS Trusts.

Why this inequality ? And more importantly, what is needed to eliminate it ?

 

Don

Sorry, more education on the way the NHS is organised. I'll do my best to be brief.

Decisions like this are made at a local level by your CCG (Clinical Commissioning Group). They choose which services to purchase from their provider Trusts. CCGs are primarily led by GPs but they also have significant lay input and are mandated to include patient views. CCGs are based around the location of you GP surgery-you don't get to choose which you belong to as a patient. CCGs have a finite budget to purchase patient services, and must balance the books at year end.

What this means is that you can have differences across boundaries. My CCG chooses to purchase 1 cycle of IVF, one adjacent 2 cycles, another zero for example. Some ration access to certain medications or procedures such as for people who smoke or are obese.

Individual 'exceptional' requests are referred to a CCG panel of doctors and lay members for decision. These would often be procedures considered cosmetic-such as above (which is not that unusual actually), another common one is requests for breast reduction. Also can be requests for unusual treatments or operations that are generally not NHS standard practice. Each individual request is assessed against specific criteria relating to symptoms, availability of alternatives and evidence for the treatment requested. Some such decisions are easy, many very hard. If the panel declines to fund it this means the hospital Trust won't be able to bill us for the procedure-so it does not get done.

The harsh reality is that if we spend £20k on a single operation for one patient that could also have been spent on about four hip replacements. Money is tight; which do we choose?

This localisation of decision making (and the formation of CCGs) is a product of the legislation in 2012 but the purchaser-provider split has been in the NHS for a lot longer than that. It means postcode-lottery access to Rx has been an NHS feature for a very long time in various guises. There is no such things as a single NHS policy on what can and cannot be provided to patients.

I have long wished for a real national discussion about these sorts of patients and what the NHS will and will not provide. I think everyone would agree that there do have to be limits to what the NHS should and should not be responsible for, but many of these will be very individual scenarios and are not easy to resolve

Bruce

Chair Council of Airedale Wharfedale Craven CCG and Governing Body member)

(as ever I'm not defending the system, just explaining it and trying my best to make it work)

Thank you Bruce. Nicely explained (and confirmed what I had rather guessed).

Your last paragraph..."I have long wished for a real national discussion...." sums up more or less what I had in mind. There are things we can do, but we don't always have the funds available. Politicians can only tax us to a limited degree and then allocate resources in line with their manifesto (yes, I believe in fairy tales )

And my guess is that if we had a national NHS "one solution fits all" situation, there would be problems with that, both perceived and real. eg different life-style induced illness between North and South. Age-related illness differences between coastal retirement areas and industrial cities etc etc. This probably means you can't win ! but please keep trying - for all our sake's "

Thanks again for the enlightenment. (and I think we all know that your last comment in parenthesis, goes without saying - but worth saying anyway !)

many thanks, Don

Bruce Woodhouse posted:

Don Atkinson posted:

Broadening the discussion........

..... young, 22 year old man in Kent has changed his life style and reduced weight from 34 stone to c. 14 stone. One consequence is that he now has excess folds of skin which is a different problem, but a problem it is !

NHS in Kent won’t fund the £25k procedure to solve the problem. NHS in Hampshire would fund the operation as would several other HHS Trusts.

Why this inequality ? And more importantly, what is needed to eliminate it ?

 

Don

Sorry, more education on the way the NHS is organised. I'll do my best to be brief.

Decisions like this are made at a local level by your CCG (Clinical Commissioning Group). They choose which services to purchase from their provider Trusts. CCGs are primarily led by GPs but they also have significant lay input and are mandated to include patient views. CCGs are based around the location of you GP surgery-you don't get to choose which you belong to as a patient. CCGs have a finite budget to purchase patient services, and must balance the books at year end.

What this means is that you can have differences across boundaries. My CCG chooses to purchase 1 cycle of IVF, one adjacent 2 cycles, another zero for example. Some ration access to certain medications or procedures such as for people who smoke or are obese.

Individual 'exceptional' requests are referred to a CCG panel of doctors and lay members for decision. These would often be procedures considered cosmetic-such as above (which is not that unusual actually), another common one is requests for breast reduction. Also can be requests for unusual treatments or operations that are generally not NHS standard practice. Each individual request is assessed against specific criteria relating to symptoms, availability of alternatives and evidence for the treatment requested. Some such decisions are easy, many very hard. If the panel declines to fund it this means the hospital Trust won't be able to bill us for the procedure-so it does not get done.

The harsh reality is that if we spend £20k on a single operation for one patient that could also have been spent on about four hip replacements. Money is tight; which do we choose?

This localisation of decision making (and the formation of CCGs) is a product of the legislation in 2012 but the purchaser-provider split has been in the NHS for a lot longer than that. It means postcode-lottery access to Rx has been an NHS feature for a very long time in various guises. There is no such things as a single NHS policy on what can and cannot be provided to patients.

I have long wished for a real national discussion about these sorts of patients and what the NHS will and will not provide. I think everyone would agree that there do have to be limits to what the NHS should and should not be responsible for, but many of these will be very individual scenarios and are not easy to resolve

Bruce

Chair Council of Airedale Wharfedale Craven CCG and Governing Body member)

(as ever I'm not defending the system, just explaining it and trying my best to make it work)

 

Thanks for that explanation, Bruce. I have had some very difficult and frustrating experiences with CCGs in relation to the process to determine qualification for continuing health care, which seemed to me mostly about form-filling, obstacles and an objective of shifted costs to some-else's budget. In the age of austerity I could understand some of this but then had to navigate the boundary between two CCGs. I became very obvious to me that each had very different policies to one another and 'interpreted' NHS policy guidance very differently.  I found myself on more than one occasion asking the various CCGs staff I dealt with, up to and including the Head of Service of one, what the "N" in NHS stood for. There was some stumbling in the response on every occasion.  I know of course that the problem of inconsistency in decisions/treatment and the resultant 'postcode lottery' is not the fault or invention of the the people in the CCGs I found myself dealing with but politicians but it still left me with a dim view of how this process was conceived and is implemented, even though I eventually won the decision is was arguing for.  

MDS posted:

winkyincanada posted:

MDS posted:

winkyincanada posted:

Don Atkinson posted:

winkyincanada posted:

Paper Plane posted:

 

Why should people who choose to drive to work, receive a subsidy over those who commute by other means? I'll get behind free parking when the true value of the subsidy/perk provided to those using it is paid in cash to those who do not. Anything else is grossly unfair.

Here in the U.K., public transport is heavily subsidised. Bus and train services bear little or no relation to the actual cost of provision.

If train commuters had to pay the true value of train services in cash, to those of us who don’t use them, I’d be laughing all the way to the bank and back.

Now, I don’t pay to park at work, (I work freelance) but if I did need to pay, I would easily add it to my chargeout rates, much the same as I cover the cost of travel to airfields, which by their very nature, tend to be out of town.

Cheers, Don

 

And if drivers paid the true cost of private vehicle use, we'd all be better off.

In the UK I think Treasury has accepted that through road fund licence, road fuel duty, and VAT on fuel and vehicles, motorists pay significantly more than is spent on providing the infrastructure.    

You perhaps don't think any of this counts, but to those costs we need to add the subsidies accruing to fossil fuel industry, the health care costs due to pollution from the manufacture and use of cars, the health care costs due to chronic inactivity of drivers, the health care costs due to the killing and maiming of people, the current and future environmental costs, the costs of policing the roads (due to the inherently dangerous nature of motor vehicles), the loss of quality of life suffered by those living near and having negotiate the ubiquitous car sewers.

Winky - there will always be arguments about the extent to which external cost factors should be accounted for. You identify some but if some of these external factors were to be included it would also be appropriate and consistent to include external benefits. For example, the taxes that flow from the direct economic activity in motor vehicle manufacture and maintenance eg the corporation tax paid by the companies and the income tax and NICs paid by the employees, consumption taxes paid by those enjoying the economic benefit. Plus the wider boost to the economy generated by motor vehicles eg people being able to work in locations inaccessible by rail, or walking; accessing goods and services in the same locations.  The list could go on and on. 

Taxes aren't benefits. Nor is economic activity isn't a benefit in and of itself. The benefits of cars are wholly restricted to what good they provide in use. They are often/usually very convenient and useful. Some people also value them as status symbols and as possessions. But they're costly. Far more costly than the incremental cost per kilometer paid by the user would indicate.

winkyincanada posted:

Taxes aren't benefits. Nor is economic activity isn't a benefit in and of itself. The benefits of cars are wholly restricted to what good they provide in use. They are often/usually very convenient and useful. Some people also value them as status symbols and as possessions. But they're costly. Far more costly than the incremental cost per kilometer paid by the user would indicate.

I like this paragraph. It applies to everything, not just cars.

Mind you, that second sentence is difficult to read.