Hospital Parking Charges (Exemption for Carers) Bill

Baroness Keeley Excerpts

Friday 30th October 2015 Commons Chamber

[Philip Davies]

I do not want to get distracted so early in my speech, but I will come to my local hospital during the course of my remarks, so I hope the hon. Lady can be patient. Of course, if I fail to deal with that point, she can always come back and chastise me for not having done so.

Let us look at the origin of the Bill. On 4 July, the hon. Member for Burnley explained it on her website blog—I am a keen reader of it, as I am sure are many others both here and in Burnley; indeed, I am sure that the Minister has a great regard for the hon. Lady’s blog. This is what she wrote:

“Having read through over 100 suggestions, and after much deliberation, I have finally chosen the subject for my Private Member’s bill: I intend to try to help carers by making provision for them to be exempt from hospital parking charges. During recent years, I have met with carers from across the constituency from different backgrounds, all of whom had different stories to tell but all with one thing in common: their willingness to support a sick person, whether it be a child with cancer, an elderly person with complex needs or a person attending hospital for regular treatments such as chemotherapy. All of these carers often have reason to be parked at hospitals for long periods and can incur charges which they can often ill afford. It seems to me that it is time we put an end to this ‘tax on illness’.”

Ten days later, however, the hon. Lady said something else in her blog; there was a subtle difference on which I would like to focus. She said:

“Many of you may know that I am trying, through the bill, to obtain free hospital parking for carers. Support for this is growing but, if I am to be successful, I really do need your help. I know from my conversations with so many of you, that hospital car park charges are a problem for many carers, who often spend a lot of time hospital visiting. If you are a carer, and this is a problem for you, please get in touch and share your problem with me. Sometimes it is more than the charge (though these are quite hefty and can mount up) because I understand that visiting, particularly for extended hospital stays during winter months, can be quite stressful and distressing, and queueing for parking can sometimes feel like the last straw. If I am to get this bill through government, I need plenty of evidence.”

In my experience, people usually get the evidence of a problem first, and then bring forward a Bill to tackle it. On this occasion, we seem to have had a more novel approach to legislation, which is to bring forward a Bill and then ask people for the evidence to support it. Personally, I view that as a novel approach, but I commend the hon. Lady for starting a trend that we may see more of in the months to come.

It strikes me from the hon. Lady’s blog that the Bill has been brought forward only on the basis of a worthy sentiment, from which very few people would dissent, because she was still collecting evidence to show the need for the Bill after she had announced she was going to introduce it. She did not look at the reality of situation, find a problem and then try to find a solution.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I have to wonder whether the hon. Gentleman listened to the beginning of my hon. Friend’s speech. She said that she had based the Bill on her own experience. She had been a carer, and she had had to pay the charges. I myself have asked constituents to get in touch with me about the issue. As all Members of Parliament should know, carers are busy, stressed people, who do not have the same time that everyone else has. All of us undoubtedly hear more about issues such as football governance than about caring, but there are 6 million carers in the country, and this is an issue for them.

[Philip Davies]

I entirely agree with everything that the hon. Lady has said. I do not think anyone would disagree with anything that she said about carers. She said that there were 6 million in the country, and that is a point to which I shall return. If we are talking about free hospital car parking, the number of people with whom we are dealing is clearly a factor, to which the hon. Lady has helpfully drawn attention.

[Barbara Keeley]

The hon. Gentleman really should have been listening. My hon. Friend’s Bill applies to carers who receive carer’s allowance, of whom there are 700,000. As I said a moment ago, there are 6 million carers, and at various times this will be an issue for them, but my hon. Friend has restricted her Bill to the 700,000 who do the most for caring and for society.

[Philip Davies]

We are already slightly all over the place with this Bill, and now the hon. Lady has drawn attention—probably not intentionally—to what a dog’s dinner it is. We are already arguing about how many carers there actually are, but in fact the Bill will apply to only a few of them, and the hon. Lady has just suggested that the vast majority will not even benefit from it. The hon. Member for Burnley has said in the past—and I may say more about this later—that the Bill is just a starting point, and that she intends to extend it further and further, so we have no idea where we may end up.

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[Philip Davies]

I am pleased to hear that. I am sure that it will be a matter of great reassurance to the East Lancashire Hospitals NHS Trust that the hon. Lady was not interested in its opinion, even though Burnley happens to be her local hospital. I was surprised to find, given that she is trying to make such a fundamental change to hospitals, that the one in her own constituency—Burnley general hospital—had not received a request from her to discuss the impact of her proposals. I would have thought that, as the MP for Burnley, she would have taken an interest in that. I personally believe that the people who tend to know best about things are the people who deal with them every single day of their lives, be they nurses, teachers or checkout operators in supermarkets. When assessing the impact of her Bill on hospitals, I would have thought that Burnley general hospital would have been a good place to start.

We have already discussed who currently decides hospital car parking charges. The hon. Lady is right that such matters are decided locally. We should also note that there are guidelines around hospital car parking charges. NHS services are responsible locally for their own car parking policies for patients, visitors and staff. Back in August 2014, the Government published new guidelines on NHS patient, visitor and staff car parking principles—I hope the Minister will expand on this matter when he responds to the debate. They are guidelines only; they are not mandatory. The car parking guidelines recommend the provision of concessions to groups that need them, such as disabled people—both people with blue badges and people who are temporarily disabled—frequent out-patient attenders and visitors with relatives who are gravely ill. The Government guidelines on car parking charges say:

“Concessions, including free or reduced charges or caps, should be available for the following groups: people with disabilities…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…Other concessions, e.g. for volunteers or staff who car-share, should be considered locally.”

It was also reiterated in the previous Parliament that relatives of people who are gravely ill or who require a long stay in hospital should also be exempt from car parking charges. The then Health Minister made that clear in an answer to a parliamentary question, in which he set out the people who should be exempt as far as the Government were concerned.

[Barbara Keeley]

What the hon. Gentleman is showing is the fact that we have a postcode lottery on this matter now. I want to give him a recent example that was given to me of relatives of somebody who was gravely ill and who then died on the 13th day that she had been in hospital. They were helpfully told, “If you had been coming here one more day, you would have got free car parking.” That was said to a distressed family on the day that their relative died. Does he really think that that is a suitable way for hospitals to go on?

[Philip Davies]

Everyone will have a massive amount of sympathy for the relatives in that example. However, I must point out to the hon. Lady that this Bill will not end terrible situations such as the one she has just described. Even if this Bill is introduced, there will be very many other similar cases, for which we can all feel sympathy. I am not entirely sure why she thinks that this Bill will eliminate any other terrible situation involving someone paying car parking charges; it will not.

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[Barbara Keeley]

No one on the Labour Benches is suggesting that the Bill will eliminate the issue; it will ameliorate it and send an important signal to carers, who repeatedly find themselves in this situation. The example I gave was to show how badly some hospitals behave.

[Philip Davies]

If I had a pound for every time somebody brought forward a private Member’s Bill, or supported a private Member’s Bill, on the basis that it would send a signal, I would be a very wealthy person. Unfortunately, the problem is that we do not pass legislation to send signals. We pass legislation to bring something into the law of the land. The hon. Lady has sent a signal by making that point in this debate. If the whole purpose of this was to send a signal to show how important carers are to the country and how important it is that hospitals show some compassion for carers when they come to visit hospitals, the hon. Lady has achieved that by making that intervention. Perhaps therefore she may feel satisfied that we can leave the matter at that. We have all sent a signal about how important carers are, and I now want to move on to the Bill that is being proposed, which goes way beyond sending a signal.

We already have Government guidelines that set out a range of people who they think should be exempt, all things being equal. When hospital car parking charges were debated back in September 2014, the Minister stated that

“40% of hospitals that provide car parking do not charge and of those that do, 88% provide concessions to patients. However, I am aware that there are 40 hospital sites—which is 3.6% of hospitals in acute and mental health trusts—that have charges and do not allow concessions to patients who need to access services. As a Government, we want to see greater clarity and consistency for patients and their friends and relatives about which groups of patients and members of staff should receive concessions and get a fairer deal when it comes to car parking.”—[Official Report, 1 September 2014; Vol. 585, c. 89.]

Furthermore, in his latest position on the Bill, Lord Prior said that NHS organisations must have autonomy to make decisions that best suit their local circumstances and community interests, and that although the principles provide clear direction and leadership, a one-size-fits-all policy is not appropriate for car parking.

Although the Government have given strong guidance on where concessions should be made for hospital car parking they have, rightly in my opinion, left the final decision to be made by the hospital implementing the policy. Therefore, importantly, each hospital sets its own parking policies and is not required under law to make any exemptions. The Bill today will be the first time that Parliament has intervened to demand that hospitals give free car parking to a particular group of people.

The Government have set out guidelines about the people who, in their opinion, should be exempt from parking charges, or should receive concessions. They are people with disabilities, all frequent out-patient attenders, visitors with relatives who are gravely ill, staff working shifts who cannot use public transport and visitors to relatives who have an extended stay in hospital. Why does the hon. Member for Burnley not believe that those people should have the same benefit as regards hospital car parking charges as the people she includes in the Bill? Is she saying today that the people in the list I have just given are not as important as the people she wants the Bill to cover? Does she think that people with disabilities are not as important as carers? Is she saying that their needs are not as great? Is she saying that staff who cannot get there by public transport are not as important as the carers to whom she refers? Why are the carers so much more important? We all agree that they are important, but why are they so much more important than all the other vulnerable groups who she has spectacularly not included in her Bill while the Government are saying to hospitals that they should make some provision for those people? There is a great unfairness in her proposals.

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[Philip Davies]

Absolutely, Mr Deputy Speaker.

Although there are no official statistics on this matter, in the NHS car parking impact assessment for 2009, the Department of Health provided an estimate of the revenue raised from hospital car parking charges as a whole, which was in the range of £140 million to £180 million. University Hospitals Birmingham NHS Foundation Trust raised £1.5 million from car parking in 2004-05. This measure would clearly leave a substantial hole in NHS hospital budgets.

As I have made clear, one consequence of the Bill would be increased car parking charges for people who do not apply for the free parking. One of my concerns is that we have already seen considerable increases in car parking charges at hospitals. Wye Valley NHS Trust has increased its average hourly rate from 33p in 2013-14 to £3.50 in 2014-15. I would be loth to put any additional cost on people who are using that car park. The Whittington health trust in London doubled its average hourly rate from £1.50 to £3, and Medway Maritime hospital in Gillingham increased its price for a five-hour stay from £5 to £8. Given that we are already seeing such huge increases in parking fees, I would not want to pass a Bill that would see people paying even more.

That point was highlighted by the British Parking Association in 2009, following the scrapping of hospital car parking charges in Scotland. It said:

“Car parks need to be physically maintained, somebody somewhere has to pay. Charges were not introduced to generate income but rather to ensure that key staff, bona fide patients and visitors are able to park at the hospital. Without income to support car park maintenance…funds which should be dedicated to healthcare have to be used instead.”

[Barbara Keeley]

On a point of order, Mr Deputy Speaker. The hon. Gentleman has been speaking for an hour and nine minutes, and we are now getting a lot of repetition. Many other people want to speak.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

In fairness, it is for me to decide whether there is repetition. I certainly do not need any advice. You should not be questioning the Chair’s ability to hold the speaker to account. I am sure that Mr Davies is well aware that many people wish to speak and that he wants to hear those other voices. He is in order, but I am worried that we will get into repetition. I certainly do not want to get bogged down in the maintenance of Scottish car parks. I am sure that he will move on quickly.

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[Mr Chope]

The costs may vary from one hospital to another, but it is clear from the debate that the hon. Member for Burnley does not have the first clue about what the costs would be. We have established that they would be significant, but we have not established who would pay them. Would they be borne by the taxpayer through subventions to hospitals? The Scottish health boards were given £1.4 million to implement a similar policy.

If the money does not come from the taxpayer, would it come from increasing the charges of those who will continue to pay them? My hon. Friend the Member for Shipley (Philip Davies) made some really good points about that. According to the Government’s guidance, they believe that concessions should be disbursed more widely than just to carers. The perverse and unintended consequence of the Bill—this would be inevitable, in my view—would be that higher charges would be borne by people who are worse-off. To take a topical example, a working family on tax credits may be a lot worse-off financially than a carer affected by this Bill, but they would have to pay higher charges to use the hospital car park. That is an example of the perversity of the Bill.

[Barbara Keeley]

If I ever get the chance to make my speech I will come to this, but it is not just families who are on tax credits. A lot of working carers on the carer’s allowance will be hit by tax credit cuts, too.

[Mr Chope]

I hear what the hon. Lady says. I will not go down that route, Madam Deputy Speaker, because we have had enough debate about tax credits and I do not think you want time taken up on them. My point is that many people less well-off than the carers exempted under the Bill will actually pay for the cost of such exemptions. Interestingly, the hon. Lady did not disagree with that point in her intervention, but that is one of the Bill’s perverse consequences.

There is another problem. Clause 1(1) states:

“providing bodies shall make arrangements to exempt…carers engaged in…the qualifying activities…from charges for parking their cars in spaces provided for service users at hospitals”.

It does not state by whom the spaces are provided.

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

I warmly congratulate my hon. Friend the Member for Burnley (Julie Cooper) on securing fourth place in the ballot for private Members’ Bills and choosing this important topic. I commend her on her excellent work. She deserves our thanks for raising awareness of this issue. The Bill and this debate enable us to shine a spotlight on the increasing challenges that many unpaid family carers face.

I want to talk specifically about carers and their finances, but first I want to add my perception of an unpaid carer to the comments we have just heard from the hon. Member for Christchurch (Mr Chope). Almost everybody in the sector counts carers who receive carer’s allowance, which is only £62 a week, as unpaid carers. I do not think many of us would think of £62 a week as payment. The term “paid carers” tends to refer to care workers. Apart from my hon. Friend the Member for Ealing Central and Acton (Dr Huq), we have not touched enough on carers’ finances and how they manage, but it is important that we do so. If a Bill, such as this one, would defray costs for a group, it is essential that we understand whether they need that help, and I will argue that they do need it.

The Bill has the full support of the Labour Opposition, and despite the many negative comments I hope that it receives the backing it deserves from both sides of the House. We have heard some rather curmudgeonly comments about the Bill, but much of it deserves our backing, and I hope it will get it. It would exempt carers who receive carer’s allowance from paying hospital parking charges in England. This is an important issue for those unpaid family carers, many of whom make regular trips to hospital with those they care for. The right hon. Member for Harlow (Robert Halfon) carried out research in 2014 and found that people are having to pay anywhere between £11 and £131 a week in hospital parking charges. As I mentioned, these carers get a carer’s allowance of £62, so clearly any week in which they clock up £131 in hospital car parking charges would be a rather frightening time.

One of my constituents, Patricia, tells me:

“My husband is disabled and I am his carer, we can sometimes have two appointments in a day at Salford Royal Hospital that can take up to five hours. The fact that disabled people have to pay car parking charges is disgraceful. Hopefully sometime in the not too distant future the people who have decided on these charges will see the error of their ways.”

When she spends six to eight hours at hospital, she pays £6 to park.

Carers Trust also cites the example of Rachel, who was a carer for her husband, who had Alzheimer’s, Parkinson’s and type 2 diabetes. The combination of his conditions meant regular trips to hospital so that her husband could receive the healthcare he needed. Owing to his dementia, Rachel stayed with him on the ward to feed and clothe him and calm him when he became anxious, and nurses and doctors were grateful for her support and the insights into her husband’s condition she could provide. Over the final five weeks that her husband was in hospital, she paid out £120 in car parking charges. To Rachel, having to check every day that she had put enough money in the meter seemed like a cruel punishment for providing care for her husband in the NHS.

Rachel’s experience is not uncommon. As many Members have said, there are over 6 million unpaid carers in the UK, and the thing to focus on is that they take a great deal of pressure off our healthcare services, but despite this great contribution, many carers are now deeply concerned about extra charges for care and about losing the support on which they rely because of Government budget cuts. Caring for someone else can be overwhelming and demanding, and can have a significant impact on the carer’s own health, on their finances and on their work and career. We know that carers can find that their incomes fall dramatically if they have to work fewer hours or leave work to care. According to the Carers UK “State of Caring” survey, almost half of the carers who responded said they were struggling to make ends meet. Of those, four out of 10 said they were cutting back on essentials, such as food and heating; almost four in 10 said they were using up their savings; and one in four said they had to borrow money from family and friends.

We are talking about carers struggling financially and now finding themselves cutting back on food, dipping into their savings or even borrowing money, and then they find they have to pay these hospital parking charges. Charging carers to park at hospitals adds stress to their lives and takes money out of their purses and pockets. It is no way to reward those unpaid family carers for the vital contribution they make to the NHS.

In a speech to the Local Government Association annual conference in July, the Health Secretary talked about the role of carers and about people taking more responsibility for their family members. He talked about developing a new carers strategy that examines what more we can do to support existing carers and the new carers we will need. This measure is one of those things that we could be doing.

If Health Ministers want to increase the number of family carers, which will be essential, they must consider the impact that caring has on a carer’s income and their future financial security. They should be arguing for carers to be exempt from some charges. The 2010 Government report, “A Vision for Adult Social Care” acknowledges that carers are the first line of prevention. Their support often stops problems from escalating to the point where more intensive packages of support become necessary.

Carers need to be properly identified and supported. Indeed, failure to identify and support carers has serious implications both for the NHS and social care services, but there are many indications that cuts to services have caused, and are causing, mounting pressure on carers. The Minister and I have stood across the Dispatch Box from each other only once before today, but he recently told the House in answer to Health questions:

“I do not think that carers’ invaluable contribution to society has ever been better recognised.”—[Official Report, 13 October 2015; Vol. 600, c. 156.]

I was surprised to hear that comment, and I am sure that many carers and many carers organisations were surprised, too. I feel that the reality is very different from the picture the Minister sought to convey. I can tell him that many carers actually feel unsupported, unrecognised and singled out by the Government’s austerity measures. With cuts of over £4.6 billion to local authority budgets, adult social care support has been reduced or removed in many areas, with many people now paying higher charges and depending on unpaid family carers to cover the shortfall in care.

Financially, unpaid carers have been hit by Government cuts and austerity measures in ways that I feel they should not have been. Around 5,000 carers have been hit by the benefit cap, and at least 60,000 have been hit by the bedroom tax. I brought forward a Bill to exempt carers from the bedroom tax, but the Government and some Conservative Members who are present opposed that sensible proposal.

The hon. Member for Christchurch raised the issue of tax credit cuts. It is becoming clearer that hundreds of thousands of carers in receipt of carer’s allowance and working tax credits could be hit by the Government’s proposed cuts to tax credits, yet many working carers rely on them. Carers UK gives the example of Michelle, who is a lone parent who cares for her son, Jake, who has cerebral palsy. Jake receives disability living allowance and, as his carer, Michelle claims carer’s allowance. She also works three short shifts at a local supermarket each week and is paid just over the national minimum wage. As she works 16 hours and is on a low income, she is also entitled to working tax credit alongside some child tax credit.

Michelle, in common with many carers in her situation—even some Conservative Members seemed concerned about parent carers such as Michelle—finds it very difficult to get the right specialist support for Jake outside school hours, so she cannot increase her hours of work. Jake often has hospital appointments, which also means she cannot take on any more work. If the tax credit changes due in April 2016 were in place now, Michelle’s income would be reduced by over £1,400 per year. As well as losing that £1,400, Michelle would have to continue to pay hospital car parking charges when her son has hospital appointments. That goes to the heart of the point raised by the hon. Member for Christchurch.

Is the Minister content to see a working family carer have her income reduced by £1,400? Carers on carer’s allowance are already caring for 35 hours a week or more, and they cannot be expected to take on more hours to try to make up the loss. I hope the Minister is fighting on behalf of those working family carers and making sure that the Chancellor considers them when he is looking at measures that might mitigate the tax credit cuts. If there is no protection or exemption from charges for carers, they might feel that the Government are turning their backs on them and taking for granted the support they provide and the benefit they bring to the economy.

Age UK’s report, “Briefing: The Health and Care of Older People in England 2015” paints a very clear picture of the current climate in health and social care. Since 2010, 400,000 fewer people are getting the care they need, so the reliance on unpaid family carers will be ever greater. An estimated 1.6 million people currently provide care for 50 hours plus per week, which is an increase of 33% since 2001. Over the next five years, around 10 million people will become carers, so support for carers and help for them to manage their finances will remain big issues.

Carers UK says:

“The growing cost of providing good quality care and support to an ageing population with more complex care needs means that putting in place the right support for carers is both a way of limiting the rise in care costs and a way of supporting carers to have a good life balance”,

to which legislation states they are entitled. As more of us are living longer, one in five of us will become a carer to a family member or a friend in the future, and that care role needs to be supported, financially, socially and in the workplace.

During the long hours I have been sitting here, a number of carers have commented on the debate via social media. One described some of the remarks that have been made today as

“a disgraceful and childish reaction to a very sensible Bill”.

Another said that the remarks were “shameful” and “insulting to carers”. Others said

“I’m glad this is being discussed”,

but that it was

“such a shame this issue is being degraded”,

and that the debate had brought the House into disrepute.

Carers also made very specific comments about Conservative Members, saying that they are “out of touch” and should be reminded that carer’s allowance is only £3,229 a year. One spoke of spending “a fortune” on parking

“for my son’s medical appointments both routine and emergency”.

Many observed that there seemed to be a suggestion that carers would abuse the free parking, which was deeply resented.

Carers’ lives can be made easier by relatively small changes. Ministers have so far turned down the case to exempt them from the bedroom tax. Exempting them from car parking costs is a simple but effective measure, which would show them that we understand the social, financial and emotional difficulties that are associated with caring. It is a small gesture that would show carers that we value their contribution to society. I commend my hon. Friend’s Bill to the House, and I hope that the Minister and all other Members will give it their support.

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[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.