On the campuses of most busy hospitals in Ireland, people are consistently struck by three interconnected things - cars, cranes and confusion!
Recent surveys at major hospitals indicate that they have about 4,000 vehicles entering the facilities each day. More than 1,000 of these are staff cars, and a similar number are the cars of visitors. Patients account for perhaps 25% of traffic although this varies greatly from site to site. The balance are service and construction vehicles, taxis, delivery trucks and in many cases, ‘rat runners’ taking short cuts through the site.
With the possible exception of Beaumont, there are cars parked in every nook and cranny of the hospital grounds. They are parked on footpaths, in gardens, between skips, under awnings, in delivery bays and even in car parks – everywhere! They block fire routes and access to A&E apparently without a second thought. These cars are the property of hospital staff, patients, visitors and service organisations.
Ignoring any growth in hospital services or capacity, the numbers of cars looking to park on hospital grounds is set to increase by 50% over the next decade or so. This development is going to be particularly evident amongst groups such as nurses, junior administrative staff, domestic staff etc., and will have very significant impact on parking demand patterns at hospitals and throughout society.
One of the effects of the Health Strategy will be increased numbers of staff, patients, visitors and other vehicles being drawn into already overcrowded sites with inadequate parking provision.
Acute hospitals are very busy places, and, as part of the Health Strategy, the Government is investing heavily in expanding facilities and services at all of them. Few of them have large tracts of open space on which to accommodate the building of new clinics, departments and wards. On a number of sites, private clinics are also being developed. As a result, the sites are becoming very congested and this process is expected to increase.
During the construction phase of these new developments, the hospital grounds tend to be very difficult and complex ‘spaghetti junctions’ with temporary signage, mixed construction and hospital traffic, closed roads, hard hats and builders going about their business, jackhammers beating – and all in a location which should be ordered and peaceful!
The principal cause of confusion is the lack of a traffic and parking management plan, which would cater for the known and predictable volumes and flows of vehicles into and out of the site during the normal day.
Nursing staff generally work 12 hours shifts from 8 to 8, and this means that they arrive on site in advance of the administration staff (9 to 5) and the daytime patients and visitors. Unmanaged, they naturally park in the spaces closest to their workplace, and thus tie up these spaces for 12 hours. I have heard it said that, if it was possible, many staff would park their cars outside the nursing station on the wards but I don’t believe that for a minute! If there are 600/700 nurses on the day shift, then today they are probably bringing 300 to 400 cars on site between 7.30 and 8.00am Monday to Friday, and these cars occupy 2 acres of surface space. This figure is expected to double within 10 years.
Patients arriving for 9.00 am clinics have to compete for parking with both the nurses who are already on site, and the administrative staff arriving to start their day's work at 9.00am also. After lunch, patients for early afternoon clinics compete for spaces with mid-day nursing shifts and the start of the visiting period. Night nurses coming on at 7.30 for an 8.00 pm start find parking difficult to locate close to the hospital, because the day nurses cars are still in place and the evening visitor levels are at their peak.
- The increased demand for, and expectation of, access to professional healthcare services associated with an increasing, aging, and a more affluent population, is set to increase pressures on the existing facilities.
- The increased concentration of resources at the major teaching hospitals, most of which are land locked, will see available open space being steadily consumed by the hospital buildings.
- The increased levels of car ownership amongst all users of the hospitals will result in increased demand for parking accommodation at all facilities, and increased competition between them for an ever diminishing scarce and valuable resource – a parking space.
In my experience, hospital management face hard choices and will have to make ‘rationing’ decisions.
Given a limited allocation of funds for the operation of the hospital, can the management justify spending any of that on parking spaces rather than on nurses' pay, CAT scanners, radiotherapy units etc.
- In a labour market where demand for healthcare staff exceeds supply, and where the difference between being in a position to attract, say, an experienced staff nurse to work at one hospital rather than another, which one can offer her/him a parking spot for their car might become a strategic issue.
- In a ‘business’ where the customers are the patients, and patients welfare is greatly enhanced by easy access for their families to visit, then the priority for the managers may have to be to provide parking for patients and their visitors in preference to others, including staff.
In city centre hospitals, the ‘value’ of parking is easy to establish by reference to the charges for parking in nearby commercial parking facilities. In Dublin today €2.00 per hour is the norm, and annual parking contracts are available for between €1,000 and €4,000 p.a.
Apply say 5% p.a. growth to these numbers, and over 15 years they will have doubled. At 10% p.a. they will quadruple!
Pay parking can also fund commuter services, new multi-storey car parks etc.
At today’s costs and assuming good surface, marked out and lit to a good standard, a surface space costs about €2,000 to €2,500 to build, while a modern multi-storey like those at Tallaght or Beaumont cost €10,000 per space. It is possible to erect a light ‘no frills’ structure for about €5,000 per space. These figures however exclude the cost of land or of any special foundations.
Based on the patterns observed at Park Rite hospital car parks, the following ratios may be useful:
|Daytime Staff Cars to Staff || 2:3
Patient/Visitor - Cars to Beds|| 3:1
Peak Patient/Visitor/Cars to Beds|| 1:2
|Average Stay - Patient/Visitor - Cars||1.5 to 2.0 hours|
Patient/Visitor - Cars per Space/Day ||5|
At a busy acute hospital, it would not be unusual to have 7,000 to 8,000 patient/visitor cars park there each week, i.e. 350,000 to 400,000 p.a. At a charge of €1.00 per hour and an average stay of 2 hours, this would represent a potential revenue stream of €700,000 to €800,000 p.a.
Professionally managed on a 24-hour/7-day-a-week basis, the car park will cost €250,000 + p.a., leaving a potential surplus of €500,000 p.a.
In the short term, the key strategic decision is to organise the existing resources, and in particular, to dedicate one or more blocks of parking area exclusively for staff, and another for use by visitors and/or patients or visitors. This immediately defuses the situation, and allows for appropriate strategies to be applied independently in both.
It is our experience that short stay parkers are pleased to pay for their parking if they know they can find spaces and that they don't have to walk too far from their car to their destination. This solves two issues – how to pay for any car park developments and how to improve customer service.
In the medium term, hospitals have to recognise that they probably cannot meet the ever increasing demand for parking, and that they should look for alternative solutions. Amongst the options are:
- To restrict access to staff parking on the basis of need – disabled staff, staff who require cars for their work, people without alternative means of transport to the hospital.
- To encourage car pooling etc., by setting up clubs and providing reserved parking for members.
- To encourage modal switching, i.e. use of public transport, bicycles and walking!
- To work with staff and private coach operators to provide a dedicated bus service, which will collect staff from nominated locations, and return them on a highly reliable basis – perhaps at hospital cost and paid for from parking revenues!
In the medium to longer term, it may be appropriate to work with private car park operators to develop on-site multi-storey (Tallaght, Beaumont and St. Vincent’s) or underground car parking (The Mater), in order to address some of the capacity challenges.