Hospital Parking Charges (Exemption for Carers) Bill
(Limited Text - Ministerial Extracts only)
Read Full debate
The Minister for Community and Social Care (Alistair Burt)
It is a pleasure to respond to the debate. I want to make some general comments before I go into the details of the Bill and before time beats us, but let me first congratulate the hon. Member for Burnley (Julie Cooper) on her success in the ballot, and on using it to present this Bill. I am very grateful to her for discussing it with me in advance—we have met twice—and for prompting others to take an interest in it.
I think I have made it clear to the hon. Lady from the outset that the Government cannot support the Bill, for reasons that have been mentioned by my hon. Friends in connection with the discretion that we need to give to hospitals. I shall say more about that shortly. I think that I also made it clear to the hon. Lady—and she was very generous in remarking on this—that we were willing to change our guidance principles, which I shall read out later in order to show where the changes have been made. Those changes are amendments, and as far as I am concerned, they are the “Julie Cooper amendments”, because if the hon. Lady had not presented them to us, we would not have had them. Although I cannot support a change in the legislation, a material change will be made, and I hope that trusts and hospital authorities will take advantage of it when they feel that that is in their interests and also the right thing to do.
Let me now say a few words about carers. The hon. Member for Worsley and Eccles South (Barbara Keeley) knows a great deal about the subject, having spent considerable time dealing with carers’ issues over the years in her previous role as consultant to the Princess Royal Trust for Carers and on the local council. She understands the carer’s world very well, and I pay tribute to her for that.
Although I will say a little bit about carers, I want to say something about the car parking aspects of the Bill as well. There is no dispute between anyone in this House about the value associated with carers. I felt it was reasonable for me to mention the support I believed carers had from the Government at present. I did that not only because of what we say about valuing what carers do but because of our recognition that the system could not exist without them. However, the system could not exist if it had to compensate carers for every particular cost; that just cannot be done.
The 2011 census identified 5.4 million carers in England. To put that in context, the state spends £16 billion each year on adult social care. The total market is estimated to be worth £22 billion. The Office for National Statistics has valued informal care at about £61.7 billion. Whatever the actual figure may be, it is immense and this could not be done without the voluntary contribution of carers.
Philip Davies
If it is the case, as the shadow Minister seems to be indicating, that the only way one can show recognition towards what carers do is to support this Bill on hospital car parking charges, does the Minister agree that the shadow Minister ought to explain why in 13 years of a Labour Government they never passed legislation to exempt carers from hospital car parking charges?
Alistair Burt
My hon. Friend, who made a strong contribution to this debate, makes a fair point. The difficulties of life are such that, no matter that we have a string of things we would like to do, the finances do not enable us to do them. It is amazing that when we are in opposition we find things we were unable to do when we were in government.
One or two colleagues also made the point about the basic economics of this. It is tempting to add up a cost and say that because the value given by carers to the national economy is as it is, therefore everything can be netted off against it and it is a benefit. The economics just do not work that way. As hospitals would have to find the money to maintain their car parks and everything else, it is not netted off by the benefit to carers. So tempting though it is, and an understandable argument though it may be, it does not actually work. It only works when we do the difficult things that some of my colleagues have pointed out today, which seem to be very tough. After all, who would not give free car parking to carers? Indeed, who would not give free car parking at hospitals to everyone, which the hon. Member for Heywood and Middleton (Liz McInnes) went down the road of saying? That ignores the fact that it was not done when her Government had a chance to do it, and it ignores the fact that trying to find something like a quarter of a billion pounds when the NHS is stretched is going to be very difficult. These things are lovely to talk about, but they cannot always be done. It is much better to concentrate on what we can do.
Barbara Keeley
This is about more than just sending a message. We are increasingly not exempting carers who are on this very low basic income of carer’s allowance—only £3,229 plus whatever extra benefits they might qualify for. They are not exempt from the bedroom tax because the Government have not made them so, they are not exempt from the benefit cap, and now they are not exempt from car parking charges. Some hospitals can do this: Torbay can make concessions, and Scotland and Wales can do it, so clearly it is not impossible.
Alistair Burt
No, it is not impossible, but the whole point of what we are talking about is to provide discretion, and I will come back to one or two of the elements related to carers.
As I have discussed with the hon. Member for Burnley, we are looking at the strategy for carers in the round, and I have got the responsibility of doing that. We will look at all sorts of things for the future. The economics will come into it—I take that point—and I think it is best to look at this as an overall strategy. I have offered to involve the hon. Lady, who has agreed; indeed, I would like one or two Back-Bench colleagues from all parties to assist me when that consideration of strategy gets up and going because of their particular interest in the subject. The overall impact on carers of all sorts of things that are happening at present can be taken into account. There will still be finite financial limits, which I will come to soon, but where life can be made easier, we obviously are looking to do that.
The hon. Member for Worsley and Eccles South mentioned the bedroom tax. The relevant rules already take account of the needs of carers. For example, non-spouse resident carers plus others who need to stay overnight are allowed an extra bedroom—[Interruption.] Well, if that is not true, perhaps the hon. Lady would like to intervene on me, but that is what the law says. Discretions are also offered by local authorities, and that too provides an opportunity to take account of what carers might need.
Barbara Keeley
The figure of 60,000 carers who are having to pay the bedroom tax comes from the Department for Work and Pensions. There are at least 60,000 of them who have to pay.
Alistair Burt
As I have said, the opportunities for discretion exist, but perhaps the way in which discretion is exercised is something that the carers strategy can look at.
It was this Government who passed the Care Act 2014. For the first time, carers—as well as those they were caring for—were given the right to be assessed by a local authority. We gave an extra £400 million for respite care, to be used by those who needed it during the last Parliament. It is therefore reasonable, given the availability of the carer’s allowance and the other measures I have mentioned, for the Government to indicate that carers are valued in ways that they have not been in the past. There has been an incremental increase in support for and recognition of the carer’s role over the years.
I stand four-square behind what my colleagues have done. The Secretary of State’s determination to devise a new carer strategy, on top of what is already there, is a recognition of the fact that more might well need to be done, but it also recognises the value of carers. Nothing we have heard today on either side of the House, including some graphic examples, has suggested that we do not value carers.
Before I respond to the points on car parking charges, I should like to mention the speeches that have been made today. The hon. Member for Burnley set out her case extremely well, and I shall come back to that in a moment. My hon. Friend the Member for Shipley (Philip Davies) is a necessary piece of grit in the oyster of the workings of Parliament. Mrs Thatcher said that every Government needed a Willy, but in addition, every Parliament needs either an Eric Forth or a Philip Davies. They remind us that, at the end of the day, this is not a game. If we pass a piece of legislation, it has consequences and, accordingly, it has to be right. Occasionally, my hon. Friend will say things that people find uncomfortable, but he is just doing his job.
The process of a private Member’s Bill is not easy. Indeed, as I go on talking for a while this afternoon, there will be plenty who say that these processes should be handled differently, but they are not. This is the way in which some things are examined. My hon. Friend made a good speech. Above all, he talked about the problems of economics that I referred to earlier. There are many things that we would all love to do, but often we cannot. We have to make choices. When the Government of the hon. Member for Worsley and Eccles South were in office, they had to make choices, and so do we.
The hon. Member for Birmingham, Perry Barr (Mr Mahmood) made a strong personal plea for the Bill. He mentioned patients on dialysis, and I would like to reassure him that those patients are already covered in our principles as frequent out-patient attenders. The amendment that we have just made to our provisions will ensure that carers of patients on dialysis will be covered by the guidance.
My hon. Friend the Member for Bury North—God bless it!—(Mr Nuttall) went into forensic detail about the Bill. I ask him to convey my good wishes to all at Fairfield hospital, which I remember very well. Both my children were born there, and my wife still has a plaque up on the wall from when she opened a piece of equipment there. My hon. Friend also went into forensic detail when he described the difficulties that would be created by the Bill. He gave it a necessary examination.
The hon. Member for Heywood and Middleton (Liz McInnes), whom we should thank for her services to the NHS over many years, made it clear how passionate she felt about this issue. In a perfect world, everything would be wonderful, and she finished by saying that it would be great if everyone could park for free at hospitals. They cannot do so, however, because the money would have to be found from somewhere. I will come back to that point in a little while.
My hon. Friend the Member for Solihull (Julian Knight) detailed his own personal campaigning for fairer charges in his constituency. He is a perfect example of how an MP of any party can take up an issue and how, when something is wrong that can be worked through, it can be done in a local capacity. He provided a series of perfect examples of what to do as a local Member.
The hon. Member for Ealing Central and Acton (Dr Huq) made a passionate plea for change. My hon. Friend the Member for Christchurch (Mr Chope) examined the Bill in depth, especially in relation to clause 1. He gave examples of where the present discretionary arrangements could work to people’s advantage, and we will come back to those later. If there was no example anywhere of guidance and of opportunity for discretion being used, then the strictures of the hon. Member for Burnley would be much stronger. The fact is that discretion is used in some areas. Various figures were quoted: some 63% of hospitals do not charge, and some 86% or 87% offer discretion. That allows local areas to take notice of the principles and make their own decisions about what is necessary.
May I just add a word about the phrase “postcode lottery”, which is a favourite of mine? A postcode lottery implies a situation in which there is no chance to do anything about it. Many of the things in modern political life that we term postcode lotteries are not postcode lotteries at all, because they all contain the opportunity for people to make a difference, or to change things. The point of local discretion and of transparency in the delivery of services is precisely that it enables people who represent an area to say, “Why isn’t it as good here as it is next door? What is it they are doing that we are not?” They can then apply pressure locally to get something done. They should not always run to Government to say, “It is your fault. You must standardise everything.” Neither should they throw their hands up in the air and say that there is nothing they can do about it. Therefore, I reject the term postcode lottery on most of the times that it is used. This is an example of where, if discretion is used in some areas, why is it not used in others, and what will people do locally to encourage it? Clearly, it happens in some, but not all, places, and it is not always the responsibility of Government.
My hon. Friend the Member for Shipley said that he longed for the day when Ministers could stand up at the Dispatch Box and say, “It is nothing to do with me.” Actually, local discretion is nothing to do with me. All too often people come running towards Government and demand that something is done, when, actually, the answer lies in their own hands, their own constituents’ hands, their own local decision-makers’ hands and, in this particular case, the hands of those who are making decisions about hospital charges. It is fair that responsibility is very widely spread.
Let me move on and say a little bit about the car parking matter. I will do my best to be quick. Everything that the NHS does is on an epic scale, and that is true even in relation to car parking. At hospitals alone, there are around half a million car parking spaces to finance, manage and maintain, and every day, millions of users need to be seen safely on and off the sites. Parking is an amenity that the NHS has to provide if the service is to function properly—or indeed to function at all. Problems are particularly thorny in large acute hospitals, but they also exist in others. Our aim is always to see that parking provision is sufficient, efficient and fair.
The level of car parking provision required is a reflection of massively increased car ownership. When I was a boy and used to go with my father, a GP, to visit our local hospital, there were no car parking charges and the car park was half empty. I was born and brought up in the late ‘50s and early ‘60s, and life was very different. The more people who use our hospitals, the more car parking spaces we will need. Very recently, I went to the Lister hospital, a local hospital used by my constituents, and saw its new car parking facilities, which make a huge difference, but they have to be paid for.
Car parking, like any other service, is provided at a cost. Owning land costs money, so hospitals have to meet finance costs as well as maintenance, lighting, security and so on. Across the NHS, we now see better and better facilities. It is inevitable that some form of charge needs to be levied to cover those very real costs. From this perspective, it is perhaps remarkable that the average cost of parking across the NHS is only £1.15 an hour—and has fallen slightly this year. Once we accept that there is a real and unavoidable cost associated with parking we have to ask ourselves, “If hospital parking costs are not paid for by drivers, who are they paid by?” Again, that was a hard question asked by Members on the Government Benches.
Julie Cooper
I just want to clarify that the Bill is not asking for free car parking for all; it is asking to protect a vulnerable group who suffer great financial hardship from car parking charges. Despite the figure he has just mentioned, I am sure that the Minister will agree that the average car parking cost is £39 a week and significantly higher in some areas. Should the most vulnerable—those on the lowest incomes, who are already providing invaluable support to the NHS—be made to carry that burden?
Alistair Burt
As the hon. Lady knows, we have adjusted our principles to ask trusts to consider carers as a particularly special category. I do not think the Bill will work because of the technical issues that colleagues have mentioned and the difficulty of defining carers. I know how the hon. Lady wants to do it, but others would want to stretch it further. There is also the question of whether it is right to pick out particular groups in legislation and not others, a case that has been made very strongly. I entirely accept that she is not asking for free car parking for everyone, although some are, but the question remains that if this group is advantaged in this way, what might others work towards?
The principle remains the same. I do not think that anyone disagrees that if local hospital authorities can provide carers with free car parking within their budget without affecting any of their other costs, that is good and we would like to see it. However, that is not the view that we believe is held by all and, accordingly, we think that it is a matter for local discretion.
Let me briefly mention a couple of issues relating to the provision of car parking. I said that we had changed the principles. The principles, which my hon. Friend the Member for Shipley also mentioned, are delivered by the Government to the NHS and used to read:
“Concessions, including free or reduced charges or caps, should be available for the following groups…disabled people…frequent outpatient attendees…visitors with relatives who are gravely ill…visitors to relatives who have an extended stay in hospital…staff working shifts that mean public transport cannot be used”.
The “Julie Cooper amendments” mean that the reference to visitors with relatives who are gravely ill will now include the words
“or carers of such people”.
Where the principles refer to visitors who have an extended stay in hospital, the words
“or carers of such people”
will be added, and a new line has been inserted reading
“carers of people in the above groups where appropriate”.
The word “carers” has been inserted in the principles for the first time, and that is due to the hon. Member for Burnley. I hope that the examples we have heard of where discretion has been exercised might be used by others.
It is reasonable to suggest that if the NHS as a whole had to find costs upwards of £180 million, perhaps even towards £250 million, they would have to come from somewhere. It is therefore reasonable to ask who else would pay for them and whether that would be done through higher charges for others or at the expense of other parts of the NHS. I think that that is a matter for local discretion.
We heard about Scotland and Wales, and the devolved Administrations have decided what works for them. I also understand, however, that their free car parking policy has brought its own problems. Since charges were abolished at Edinburgh’s Western general hospital, the car park has been constantly full and staff have resorted to parking in nearby residential streets. In the first three months of free car parking on the Western general site, 70 complaints were received whereas before there were no complaints at all. In some areas, residents were complaining that people were parked in front of their driveways and Lothian health board has already had to employ wardens to police the overcrowded car park and is now paying for new car parks to be built.
The question of where car parks are sited was also raised, and the majority of hospital car parks where there are charges are in city centres. It is fanciful to believe that if free car parking was available in a city centre near a station or shopping centre, it would not be used by people who were not going to the hospital. There would have to be another method of policing it. Although the free car parking in Scotland and Wales sounds wonderful, it has its problems and we need to be clear about that. It is not an option for many hospitals in city centres.
The Bill was examined in relation to who might be eligible and who might not. Carers and those with underlying access to carer’s allowance include nearly 1 million people, which raises salient questions about where the costs would be diverted to.
I want to talk a little about the availability of car parking and access to it. A sensible, measured approach to car park charges can dramatically increase the availability of spaces. This matters to people who are looking for a car park space in a busy place at a busy time. It is in no one’s interest for a very small number of people to be able to park for free if everyone else, including, potentially, large numbers of carers, are then denied the chance to park at all. Quite reasonably, people who have cars expect to be able to use them to carry out their daily routine, but the available land for parking is limited and we cannot make it grow at the rate we wish. More people driving means more people competing for space, and hospitals have to find a way to make sure that as many people as possible can have access.
Without fair charges, car parks become congested and there is no turnover of spaces. Patients who arrive at 8.30 am may find that they can park, but those whose appointments are for later in the day are likely to be faced with a long and ultimately fruitless search for somewhere to leave their car. This cannot be fair. The Government take the view that it is not sensible to impose central requirements in relation to car parking. We cannot possibly know what each local situation requires. In city centres the cost of the land may be too high, if land is available at all. We are all familiar with St Thomas’ just across the bridge. It has 900 beds, yet has only 380 parking spaces. Those spaces have to work hard, and to do that they need to be in constant turnover. The situation is repeated again and again across the country. I am sure there is not one of us in the House who has not heard of a friend, colleague or loved one who has struggled to find a place to park at a city-centre hospital.
Hospitals outside the cities might well have more space for parking, but they have increased demand from people who have no viable alternative to driving. My hon. Friend the Member for Solihull, speaking about the importance of local transport provision, again made an important point which will benefit carers, patients and others alike. Some will never be able to travel by public transport—it will not be suitable—but others will, and the car will not always be the most convenient option. NHS organisations must have the autonomy to make their own decisions.
These challenges are not an excuse to ignore the principles which, as I mentioned to the hon. Member for Burnley, now include her amendments. Patients, carers and visitors deserve to have consistent concessions across the NHS. The charges may vary, but we can all agree on the groups of people who should benefit. As I indicated, we have identified five groups for whom we believe concessions can enhance access. By adding carers to those principles, we will have made a valuable contribution, very much as a result of what the hon. Lady has done.
A further area of concern for me is the way that car parks are managed and charges set. One aspect that concerns me is when patients, carers and visitors report unfair charges when appointments overrun, through no fault of their own. A number of colleagues have mentioned the problem faced by people trying to decide how much time they are going to spend at hospital, and the need to make sure that people are not worried about making that decision when they are under stress. That is why our principles support pay-on-exit schemes where drivers pay only for the time that they have used. Too often, patients are forced to guess how long their appointment will take, with the consequence that some of them put too much money in, just to be on the safe side. Others run back and forth between clinic and car park, adding money as their time runs out. How much more reassuring it would be for them to know that the amount to be paid will exactly reflect the time spent at the hospital. Over half of our hospitals currently have pay-on-exit systems and we expect that to increase.
In the time allowed to me, I have tried to indicate our support for the principle of what the hon. Lady has said. That is why we have changed our principles. However, we consider that a national decision is not right. The reason why I am carrying on speaking is that I am not going to leave it to any of my colleagues to do the procedural business of talking the Bill out; that must fall to me. What we have done by changing the principles is to recognise what the hon. Lady has done. I hope that authorities have listened to the examples given by colleagues, showing what their authorities have been able to do, and I hope we see more.
I am sure that the shadow Minister will play a keen part and take a great interest as we work through the carers strategy. I am sure that we will find a strategy that recognises some of the other issues that she mentioned. I hope that in doing so we will be able to keep a cross-party, cross-House sense of the importance and value that we associate with carers, while recognising that the hard economics of the world mean that we cannot provide everything and so must provide the things that are of most advantage.