{"id":49185,"date":"2020-12-08T13:16:51","date_gmt":"2020-12-08T12:16:51","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=49185"},"modified":"2020-12-11T15:19:20","modified_gmt":"2020-12-11T14:19:20","slug":"caring-for-those-who-care-free-parking-is-not-it","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/08\/caring-for-those-who-care-free-parking-is-not-it\/","title":{"rendered":"Caring for those who care\u2014free parking is not it"},"content":{"rendered":"<p class=\"standfirst\"><span style=\"font-weight: 400\">Focusing on free car parking as a way to &#8220;reward&#8221; hospital staff is neither equitable, nor beneficial to health and wellbeing, say Harriet Larrington-Spencer and Matthew Jackson<\/span><\/p>\n<p><!--more--><span style=\"font-weight: 400\">Last month <\/span><i><span style=\"font-weight: 400\">The Mail on Sunday<\/span><\/i><span style=\"font-weight: 400\"> reported that<\/span><a href=\"https:\/\/www.dailymail.co.uk\/news\/article-8949913\/Thousands-NHS-staff-face-disgusting-200-cent-hike-hospital-parking-fees.html\"> <span style=\"font-weight: 400\">King&#8217;s College London Hospital Trust planned to increase the cost of annual parking permits by 200%<\/span><\/a><span style=\"font-weight: 400\">.<\/span><span style=\"font-weight: 400\"> Although the implementation of this price rise has since been deferred, this article is the latest chapter in an ongoing debate about hospital parking charges, including <\/span><a href=\"https:\/\/www.independent.co.uk\/news\/uk\/politics\/labour-hospital-parking-charges-pledge-free-jeremy-corbyn-general-election-manifesto-government-healthcare-a7723866.html\"><span style=\"font-weight: 400\">Labour pledging to end hospital parking fees<\/span><\/a><span style=\"font-weight: 400\"> and<\/span><a href=\"https:\/\/www.theguardian.com\/society\/2020\/jul\/08\/free-hospital-parking-to-end-for-nhs-staff-government-says\"><span style=\"font-weight: 400\"> the announcement of <\/span><span style=\"font-weight: 400\">free parking for NHS staff during the covid-19 pandemic<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The centrality of parking to hospital care is the result of <\/span><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0965856405001849\"><span style=\"font-weight: 400\">car-centric transport policy and urban planning<\/span><\/a><span style=\"font-weight: 400\">, which has seen the consolidation of hospital services into larger units with wider catchments, often in areas that are difficult to access without a car. Accessibility is about more than \u201cgetting there\u201d without a car; it also encompasses getting somewhere within <\/span><a href=\"https:\/\/www.ilo.org\/wcmsp5\/groups\/public\/---ed_emp\/---emp_policy\/---invest\/documents\/publication\/wcms_asist_8210.pdf\"><span style=\"font-weight: 400\">a reasonable time, cost, and ease<\/span><\/a><span style=\"font-weight: 400\">, and safely. To illustrate what this means in practice, <\/span><a href=\"https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/784685\/future_of_mobility_access.pdf\"><span style=\"font-weight: 400\">a recent study<\/span><\/a><span style=\"font-weight: 400\"> found that 66% of elderly people are unable to reach a hospital within 30 minutes by public transport.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Popular reactions to rising hospital parking charges have <\/span><span style=\"font-weight: 400\">centralised the financial hardship that parking fees inflict upon healthcare workers who, due to unsociable working hours and inaccessible (using the above definition) public transport,<\/span><span style=\"font-weight: 400\"> rely upon private vehicles. Yet we\u2019d argue that the real injustice is experienced by hospital staff who cannot afford a car or cannot drive for reasons of health or disability and low income hospital workers who experience <\/span><a href=\"http:\/\/eprints.whiterose.ac.uk\/122016\/\"><span style=\"font-weight: 400\">forced car ownership<\/span><\/a><span style=\"font-weight: 400\">. The former must rely on travel options that are made less than ideal by our car-centric planning processes, while their colleagues receive subsidies through parking. The latter group experience significant financial burden as a result of having to own a car to access hospitals as workplaces.\u00a0<\/span><\/p>\n<p><a href=\"https:\/\/www.icevirtuallibrary.com\/doi\/10.1680\/jtran.15.00073\"><span style=\"font-weight: 400\">Research shows<\/span><\/a><span style=\"font-weight: 400\"> that for low income groups, the costs of owning, maintaining, and running a car often results in deprivation in other areas of their lives\u2014such as fuel poverty, food poverty, and participation in social activities. Considering the existing financial precarities among low income health professionals (<\/span><a href=\"https:\/\/nursingnotes.co.uk\/news\/workforce\/nhs-staff-top-list-those-applying-payday-loans\/\"><span style=\"font-weight: 400\">NHS staff are top of the list in accessing payday loans<\/span><\/a><span style=\"font-weight: 400\">)<\/span><span style=\"font-weight: 400\">, forced car ownership is an additional financial burden.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Public objections to the cost of hospital car parking also don\u2019t account for the environmental consequences of private vehicle commuting and its wider public health implications. Car and taxi traffic on UK roads <\/span><a href=\"https:\/\/www.racfoundation.org\/motoring-faqs\/mobility#:~:text=Compared%20with%202018%2C%20car%20and,to%20a%20new%20peak%20level.\"><span style=\"font-weight: 400\">is growing annually<\/span><\/a><span style=\"font-weight: 400\">, and road transport contributes <\/span><a href=\"https:\/\/www.ons.gov.uk\/economy\/environmentalaccounts\/articles\/roadtransportandairemissions\/2019-09-16#:~:text=In%202017%2C%20GHG%20emissions%20from,increasingly%20stringent%20exhaust%20emission%20limits.\"><span style=\"font-weight: 400\">one fifth of greenhouse gas emissions<\/span><\/a><span style=\"font-weight: 400\"> in the UK, with climate change<\/span><a href=\"https:\/\/ehjournal.biomedcentral.com\/articles\/10.1186\/s12940-017-0328-z#:~:text=In%20the%20UK%2C%20climate%20change,water%2Dborne%20diseases%20and%20increased\"><span style=\"font-weight: 400\"> expected to have extensive detrimental health outcomes<\/span><\/a><span style=\"font-weight: 400\">. Air pollution is the <\/span><a href=\"https:\/\/www.eea.europa.eu\/themes\/air\/health-impacts-of-air-pollution#:~:text=Air%20pollution%20is%20a%20major,lung%20diseases%20and%20lung%20cancer.\"><span style=\"font-weight: 400\">biggest environmental health risk across Europe<\/span><\/a><span style=\"font-weight: 400\">, with attributable deaths including heart disease, stroke, lung diseases, and lung cancer. <\/span><a href=\"https:\/\/oem.bmj.com\/content\/73\/5\/300\"><span style=\"font-weight: 400\">UK research<\/span><\/a><span style=\"font-weight: 400\"> also suggests an association between traffic related air pollution and the number of adult cardiovascular and paediatric respiratory hospital admissions.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The pressure of private vehicle use on hospitals can be directly observed: firstly, through onsite parking becoming a scarce resource and the associated frustrations of locating a parking space, and the encroachment of car parking on to residential streets (see <\/span><a href=\"https:\/\/www.yorkshirepost.co.uk\/news\/opinion\/why-illegal-pavement-parking-near-hospital-must-be-stopped-yorkshire-post-letters-67904\"><span style=\"font-weight: 400\">Bradford<\/span><\/a><span style=\"font-weight: 400\"> and <\/span><a href=\"https:\/\/www.blogpreston.co.uk\/2020\/01\/council-to-consider-parking-restrictions-on-roads-around-royal-preston-hospital\/\"><span style=\"font-weight: 400\">Preston<\/span><\/a><span style=\"font-weight: 400\">), and, secondly, that <\/span><a href=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0221\/4446\/files\/PM_Report_FINAL_web_40b0715b-8775-4ee1-a092-2199f9c48a46.pdf?14854756238904833688\"><span style=\"font-weight: 400\">many UK hospitals are in areas<\/span><\/a><span style=\"font-weight: 400\"> which exceed safe and legal limits of fine particulate matter (PM2.5).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Underlying popular reactions to charges for hospital parking is the idea that free or cheap parking for NHS staff is a reward for sacrifice. When <\/span><a href=\"https:\/\/www.gov.uk\/government\/news\/government-to-provide-free-car-parking-for-nhs-and-social-care-staff\"><span style=\"font-weight: 400\">the government announced free parking for NHS staff<\/span><\/a><span style=\"font-weight: 400\"> working in hospitals during the first wave of the covid-19 pandemic, it was because staff were \u201cgoing above and beyond every day.\u201d This is problematic on many levels. Using free or cheap parking to (inequitably) reward NHS staff applauds the notion that the everyday running of NHS hospitals should be achieved through the sacrifice(ing) of staff. It also reinforces the unsustainable increase in private car use and the associated negative environmental and physical health sequelae. Subsidised parking removes the natural market drivers that should force alternative solutions to be explored.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">A new paradigm is needed. We should work towards a health service where those who care are also cared for, while simultaneously modelling <\/span><a href=\"https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/757756\/Cycling_and_walking_for_individual_and_population_health_benefits.pdf\"><span style=\"font-weight: 400\">healthy, environmentally friendly behaviours<\/span><\/a><span style=\"font-weight: 400\">. Free staff parking is not caring. It creates poverty through forced car ownership, it stresses hospital parking facilities that are already at capacity, and it promotes polluting behaviour<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">with the ensuing economic and health consequences.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">A caring health system would place staff and patient health and wellbeing at the centre of policy decisions and promote improved public transport and active travel options as a way to achieve this, while also contributing to wider environmental and public health benefits.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The challenge, then, is how to make sustainable forms of travel feasible for all hospital workers. We propose that some starting points would be to<\/span> <span style=\"font-weight: 400\">work with local councils to ensure hospitals become local hubs for public and active transport; discount public transport instead of subsidising car parking; introduce means tested parking permits, with increased parking charges for shorter commutes; and expand onsite changing rooms and cycle storage.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The NHS of the future must work with <\/span><span style=\"font-weight: 400\">local authorities, public transport providers, patients, and staff to develop a diverse range of pragmatic, economic, and accessible transport options to hospital sites.<\/span><\/p>\n<p><i><span style=\"font-weight: 400\"><strong>Harriet Larrington-Spencer<\/strong>, research associate, Healthy Active Cities, University of Salford. Twitter <a href=\"https:\/\/twitter.com\/harrielspencer\">@harrielspencer\u00a0<\/a><\/span><\/i><\/p>\n<p><i><span style=\"font-weight: 400\"><strong>Matthew Jackson<\/strong>, consultant in anaesthesia and intensive care medicine, Deputy CD Critical Care, Stockport NHS Foundation Trust. Twitter <a href=\"https:\/\/twitter.com\/doc_matt_jacko\">@doc_matt_jacko<\/a><\/span><\/i><\/p>\n<p><strong>Competing interests:<\/strong> None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Focusing on free car parking as a way to &#8220;reward&#8221; hospital staff is neither equitable, nor beneficial to health and wellbeing, say Harriet Larrington-Spencer and Matthew Jackson [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/08\/caring-for-those-who-care-free-parking-is-not-it\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":419,"featured_media":49187,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-49185","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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