Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank Deputies Tóibín and Berry for giving me the opportunity to set out the Government's view on the issue of car park charges at our hospitals. The Bill seeks to provide for an entitlement to parking free of charge for outpatients attending public hospitals. The question of car park charges for those attending hospitals and the financial burden this can place on patients is well recognised and has been spoken about in this House recently. I acknowledge the spirit and intent of the Bill in seeking to ease the financial burden on those attending hospital and the difficulties that may be faced in paying car parking charges by those with no alternative to using their car. For these reasons, the Government does not intend to oppose the Bill at Second Stage.

The issue of hospital car parking charges is under active consideration. Programme for Government: Our Shared Future, makes a commitment to introducing a maximum daily car parking charge for patients and visitors at all hospitals, where possible, and to introduce flexible passes in all public hospitals for patients and their families. That is a reflection of the Government's appreciation of the financial challenge that can be faced by people in meeting these expenses, in particular, as the Deputy said, where they are frequent users of hospital services. Consideration is being given to how best to ensure this commitment is addressed, taking account of existing arrangements.

There is a good deal of variation in such arrangements and it will be useful to set out the overall position across the country. The most recent information provided by the HSE indicated that the majority of acute hospitals charge for parking, although there are reported to be nine acute hospitals which provide free parking. The HSE does not have in place a single contract to provide parking services at all hospitals; instead, each hospital has its own arrangements, which vary depending on the circumstances. Data gathered by the HSE on this issue in 2018 showed that 16 hospitals used a third party provider to manage their car parks, although the car parks may still be owned by the hospital in question. Some hospitals have a third party to service parking meters, entry and exit barriers and security.

It is important to say that the HSE has been clear that hospitals that charge car parking fees are cognisant of the financial implications of parking costs. With that in mind, many hospitals have already introduced concessionary arrangements of one kind or another, in particular to assist long-term patients and visitors for whom the payment of the full rate would cause hardship. The HSE has confirmed that all hospitals that charge for parking already have a maximum daily rate. That rate is €10 or less in 27 out of 34 hospitals which charge for parking. I believe Roscommon University Hospital and Portiuncula Hospital Ballinasloe are the only hospitals to offer free parking, though I am open to correction on that.

Almost all hospitals are reported to have some form of exemptions or concessions in place. A small number have the option of flexible day passes or multitrip entry passes for regular hospital attenders. The vast majority offer concessions based on the type of inpatient.

In examining this issue in recent years, the HSE acknowledged that the concessions in place were not necessarily widely advertised, as the Deputy stated, and were often only communicated to the patient or family member via the ward manager or ward staff, or through the hospital's social work department. There is undoubtedly a need to make sure there is clear, straightforward information that is well advertised and easily found.

It is important to know how much is raised in car park charges and how that money is used. The HSE has reported that over €17 million was generated from parking charges at HSE hospitals in the past two years, comprising €12 million in 2019 and €5 million in 2020. Of course, 2020 was an atypical year in our hospitals so it is likely the 2019 figure is a more accurate reflection of charging income year by year. The HSE has indicated that parking revenue is used for a range of purposes. This might be maintenance and re-investment in parking facilities, including repayment of loans obtained for upgrading such facilities, or investment in security. It may also cover the cost of parking provision more generally, with any additional income being used to contribute to the general hospital budget for provision of care or research.

That means that if less money is to be raised from car park charges, the shortfall in hospitals' income will need to be met from another source. That might be from the Exchequer or by charging some groups more and others less. One consideration is how to ensure that car parking concessionary rates are targeted at those who need them and not at occasional users. In that respect, while I welcome the spirit of the Deputies' Bill, I wonder whether a blanket elimination of charges for outpatients is the optimal approach. It does not make any distinction between someone who arrives for a first outpatient appointment and is then discharged back to their GP, and someone who is attending for a series of outpatient appointments. Neither does it address the needs of other hospital users, such as those visiting, collecting inpatients or arriving for day case procedures. There are also people who may arrive at emergency departments, whether with a family member or on their own. While these are outpatients, they would not have a letter or message in relation to an appointment as a means of verification, even if they had letters of referral from a GP. I appreciate that the Deputies will have considered all of this as fully as possible, but it is clear that in examining how best to address the commitment in our programme for Government, we will need to take account of all car park users.

There is some evidence that removing car park charges can make it more difficult for patients to find parking. Where car parking charges were eliminated in other jurisdictions, that led to an increase in demand for car parking spaces, resulting in full car parks and further frustration for users. In areas in Wales and Northern Ireland, hospitals had to introduce measures to prevent people abusing free car parking amid concerns that patients were struggling to park, including in some cases the re-introduction of charges or penalties.

It is clear that any car park charging regime will need to be cognisant of how to ensure that car parking spaces are available to those who need them. That will be core to the Government's consideration of how best to implement our commitment in the programme for Government. I appreciate that the Deputies have sought to acknowledge this possibility in their Bill by proposing an arrangement to revoke free car parking when hospitals are full. This would mean that some users who arrive expecting free parking suddenly have to pay. This will be more of a problem for some than others but, in general, having the potential for someone to be faced with a surprise charge may not be the optimal way to manage this issue.

I assure the House that the needs of patients, accompanying persons and visitors must be core to consideration of the Government's commitment to easing the financial burden of car park charging and ensuring the full implementation of the programme for Government commitment as consistently as possible across our hospitals. In particular, those who are frequent users of hospital car parks, whether due to recurring treatment or longer stays, are more financially impacted by charges than those who may be ambulatory outpatient attendees. It is important to reflect this.

It has been the general principle and policy that future car parks should be self-funding so as not to divert money from patient care. That is not to suggest that previous policy cannot be replaced, but it will be important to have an appropriate balance in ensuring that public funding is used in the most appropriate way. In easing the financial burden on users of hospital car parks, it will be important to, as much as possible, direct public funding towards those who need it and not those who are infrequent users of the hospital car park or are otherwise in a position to bear the cost of car parking with some ease.

All of these issues will be considered as we implement the Government's commitment to ease the financial pressure on patients, in particular, in relation to car parking.

I share the Deputy's views. Often, when going to visit people the cost of car parking could be €10. It is a high charge, and it would be good to see some mechanism put in place to address these charges. It is certainly an issue that many of my constituents have complained about, Sligo hospital being one of the locations mentioned. We all share the view that this must be done. While I have indicated some limitations with the Deputy's Bill, the Government is happy to acknowledge the spirit and intent this legislation sets out in seeking to ease the financial burden on those attending hospitals. We will not oppose the Bill on Second Stage.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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Gabhaim buíochas leis an Teachta Tóibín as an reachtaíocht seo a chur os ár gcomhair. Tá sé tábhachtach go bhfuil sé os ár gcomhair. Cuireann sé leis an mbrú atá ar an Rialtas rud éigin a dhéanamh. Glacfaidh siad leis ach ní ndéanfaidh siad faic faoi. Is trua sin. Tuigim an méid atá ráite ag an Aire go bhfuil siad ag féachaint ar an gceist. Tá sé cosúil leis an seanscéal faoin gcúigear fear ag féachaint isteach i bpoll. Ní leigheasfaidh sé sin an fhadhb. Sa deireadh, caithfimid rud éigin a dhéanamh do na hothair, a bhfuil ailse nó a leithéid orthu, a mbíonn orthu freastal a dhéanamh ar ospidéal rialta go leor, uaireanta gach lá, chun a chinntiú nach mbeadh pionós gearrtha orthu, mar is é sin atá i gceist. Tá sé níos measa fós anois toisc go bhfuil costais taistil arduithe de thairbhe ardú luach breosla. Anuas air sin, tá an costas a bhaineann le carrchlóis na n-ospidéal.

I was interested to hear the experience that Deputy Tóibín mentioned in Galway hospital, I think it was, where people had 20 minutes and they came in and went out in that time. From my wife's experience in St. James's Hospital, I know there was a 20-minute period for people to get into the car park, go up the stairs, get their bloods done and then get back out to the car park and out before charges kicked in. The system for giving blood was that good. What did the hospital car park regime do then? It lowered the allowable time to ten minutes, which means there is no hope in hell of getting in and out that quick. That was done just to ensure that everybody using the car park ended up being penalised. It was stupid, especially since most of the people managing to get in and out within ten or 15 minutes were the first people in at 8 o'clock in the morning. It was a great use of time, but now these people are being penalised.

The car park at St. James's Hospital is full to the brim. It is causing traffic chaos, including blocking buses using the hospital, because the car park entrance is full of cars waiting to go in once other vehicles have vacated a space. These cars are just sitting there. People going to outpatient services have nowhere else to go because the car park is full. I am not sure if that is because of the workers on the building site of the national children's hospital, NCH, or hospital staff taking up spaces. It is the same experience in other hospitals. The same is true at St. Vincent's University Hospital, which is completing, or has just completed, the building works for a new car park. The hospital is obviously confident the project will pay for itself. The car park was full when my father went into St. Vincent's for a visit, so he parked in a church across the road. He ended up being in hospital for seven days and his car was clamped in the church car park. Those are the consequences that arise when patients cannot park next to a hospital. We could have gone to collect the car if my father had managed to get a message out to us. We went later and found that the car was missing.

Turning to Children's Health Ireland, CHI, at Crumlin, anybody who has tried to visit the car park of that hospital on the Drimnagh Road will have seen the same problem. Every visitor's car is parked in the local neighbourhood. We are talking about people bringing sick children to hospital. The car parks are not good enough and then there is also the matter of the charges. No provision has been made for people in this situation, despite the suggestions we have made to add additional car parking, not paid car parking, to facilitate people bringing children to hospital. The result is that people are parking on local streets and further and further away from the hospital entrance. When the national children's hospital was being planned, I met members of the National Paediatric Hospital Development Board, NPHDB. They had great plans for staff parking off-site elsewhere, being bussed in, encouraged to use the Luas, etc. That approach does not seem to be working at the rate it should to ensure the car park will have free spaces for the patients.

As I mentioned, the major problem is that patients often do not know when they go in to hospital, for dialysis treatment, for example, whether they will get their own slot. They might be in hospital for half a day. We are lucky in Dublin because a bus comes around or a taxi can bring people to their appointments. Not everybody has access to those services. People coming up from the country to some of the main hospitals for an outpatient's appointment or an appointment with a specialist could be in the hospital for half the day thinking about the car parking charges ramping up throughout their stay.

Car parking can be made free. There are practical solutions to this issue. I heard what the Minister of State said about there being chaos when parking was opened previously. There was chaos before the parking charges were introduced in some of the hospitals I mentioned because people were parking and then walking to work. It is the same anywhere in those localities where there is free parking. People will abuse something that is free but that does not prevent us from having an app which would allow parking to be pre-booked. To give the example of hotels, I was in one hotel in Galway - it was probably three years ago - where there was no attached parking and the hotel used a nearby car park. Guests were given a card, which they validated at the reception desk, and that enabled them to avail of free or discounted parking. It is a very simple process and is done everywhere else in the world. Why can we not do something like that?

I have a parking app on my phone which means I can pull up at any parking space along a street, type in how long I am going to be there and the money is taken out of my account. We do not want money taken out of people's accounts but when patients are making appointments, the staff in the hospital should be able to ask them what time they will arrive and book them in for that time in the car park based on the car registration. People going to Dublin Airport in the morning who have paid in advance will pull up to the car park barrier, where the camera will read the car registration number. Up goes the barrier, in goes the car and back down comes the barrier. The charge accrued is docked when the vehicle leaves the car park. The same type of principle can be applied to anybody. This kind of approach would allow people to go up to the reception desk on the way out of hospital, after what may have been a traumatic day, and give details of their car registration number. It could just be typed into a computer system. This is not rocket science. There are practical solutions to the problems that have been pointed out about free car parking in hospitals. This is about getting real.

There was a hint in what the Minister of State and the Deputy before him said about what some of this is about. The hospitals have become reliant on the income generated from parking charges. This just shows the state of our funding for hospitals, which are reliant on penalising patients through car parking fees to meet their running costs. That needs to end. I have absolutely no problem with cars being clamped and towed away if there is abuse of parking spaces, such as in the cases I mentioned of people leaving their cars and going to work. There is no reason on earth, however, why we cannot devise a system to facilitate patients who are regular visitors to the hospitals. We are talking about those going to outpatient services in particular. God love the people who end up in accident and emergency departments. They often park, abandon their car and run straight in to the hospital. Hospitals are usually sympathetic in those cases and move the vehicle to one side or whatever.

I am referring to people who regularly attend appointments in hospitals. It is not possible for all patients to get the Luas to St. Vincent's or Tallaght hospitals. Not everybody can afford to get a taxi to an appointment. People from outside Dublin are especially reliant on car parks. Hospitals in rural Ireland may be in places where there are no bus, Luas or DART services. In such circumstances, people are dependent on their cars. They may drive to the hospital themselves but often a neighbour will drive them and he or she will have to park and wait around.

A move must be made on this issue and there need to be practical solutions. This is not a political issue or a matter of this side versus that side.

This is about patients. This is about relieving a burden that should not be on people when they are ill. They need to concentrate on getting better and the fact that they are going to see a doctor who will, hopefully, make them better so that they come out the other side, rather than thinking that the appointment is taking too long and that it will cost them another €3 because they have gone into the third or fourth hour parking rate. That is absolutely crazy. I know that is what happens. When patients are being treated and the doctor is explaining something to them, they are distracted by hoping the doctor will shut up soon because they have gone into the next hour. We have not even touched on visitors going to see people who are in hospital. That is another issue. Most visitors attend at night when the car parks are relatively empty. The question is whether we make car parking free or make it a nominal sum. It should never be for profit.

David Cullinane (Waterford, Sinn Fein)
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I welcome the Bill and commend Teachta Tóibín for bringing it forward. My party has supported free car parking in public hospitals for many years. In fact, in the North, Sinn Féin introduced a similar Bill in the Assembly recently that seeks to abolish similar charges. I would do the same if I were the Minister for Health or if Sinn Féin was in government in this State.

We must decide whether we will agree to the principle of free car parking in hospitals and move away from it being a revenue raiser for hospitals and whether we consider the removal of car parking charges as being part of reducing the cost of health care. That is the first question that has to be asked. If we agree with that principle, the difficulties and challenges and the unintended consequences the Minister of State spoke about, some of which were referred to by Deputies Tóibín and Ó Snodaigh, would not be insurmountable and could be resolved.

Let us consider people who are sick and have to attend hospital. If they are on a very low income, they may not be able to travel to the hospital by public transport. This also affects people who visit patients in hospital. Some people can get to the hospital using public transport but there are many others who cannot, particularly those who have mobility problems and have to be driven to the hospital to see a relative. It could be an older person whose husband or wife is in hospital. There is a cost in that. If a person is in hospital for a number of days or weeks, the cost can become quite significant. We have all seen examples of it. People complain to us about it because it adds to the burden of somebody who is sick and of people visiting those who are sick. In my view, it simply is not fair.

I have seen it a number of times when I have visited University Hospital Waterford and St. Luke's General Hospital, Kilkenny. It is very costly. When attending St. Luke's hospital, people can buy a ticket that will, technically, do them for the day. However, if they have to leave for some reason and return in the evening, they have to find a Portakabin where the ticket can be put through a machine to make sure they can leave and come back again. Sometimes nobody is in the Portakabin. People are left hanging around waiting for a person to do this for them. It adds to the inconvenience that visitors and, sometimes, patients are put through.

We are creating a difficult situation for many patients simply because we want to charge people for going to hospital. Deputy Ó Snodaigh gave an example of how we could get around what the Minister of State said might become a difficulty if we make car parking free in hospitals. Some people, depending on where the hospital is located, might use it to park there for other purposes. That is a possibility and we would need to take it into consideration. The vast majority of hospitals are not located in city centres or areas where there are shops and restaurants and so on. They are located mainly around residential facilities. I gave two examples of hospitals. I cannot see why people would park in St. Luke's hospital. There is no benefit in doing that unless they were going to the hospital. It may be more likely in University Hospital Waterford, but I do not believe many people would go to the hospital simply for parking. There may be some hospitals where that may be an issue. I am not sure why people would park at St. James's Hospital for the day unless they were working nearby, then that might be an issue. All hospitals could be gone through and an analysis of them could be done. The way around that is to use the technology that is available.

By way of an example, and I am sure the Minister of State has had to do this as has an Teachta Tóibín, as a Member of the Oireachtas I have to occasionally meet senior management in University Hospital Waterford. When attending, I park my car in the car park and take my ticket. When the meeting concludes, I am offered a ticket that has already been put through a machine that allows me to leave the car park without paying. I discard the ticket I took when coming in and I use the one given to me by the hospital when leaving the car park. I do not always take the ticket. Sometimes, I pay because I want to and do not want to take the ticket. That is a system that could be put in place. It could be linked to visiting a patient whereupon the patient's name is given and the ticket is then validated and the visitor can exit without charge. There are many options we can look at to get around the notion that there may be an abuse of the system. When I hear that, I hear it as an excuse. Yes, it may be a problem, but I would say it is in very few hospitals. I do not believe it is the biggest barrier - pardon the pun - to the lifting of car parking charges; the biggest barrier is the fact that far too many hospitals have become dependent on car parking charges as a funding stream.

If the Minister of State were to abolish car parking charges, hospitals that use the revenue from those charges as part of their overall budget would need that money replaced. The cost of doing it would not be significant in the context of the HSE budget. To abolish the car parking charges, my understanding is that it would cost less than €13 million. I am not saying it is an insignificant sum but in the context of a €22 billion budget in healthcare, it is not significant.

Oireachtas Members collectively made a decision regarding Sláintecare. We have had many lively and robust debates, including the Acting Chair, Deputy Durkan, who, as a member of the Joint Committee on Health, met with senior officials of the Department of Health and the HSE yesterday in regard to commitments in healthcare reforms that were promised. Many of the reforms that were promised are too slow in coming on stream. There is a perception from some that there is a bit of pushback against some of the promised reforms. We promised that we would look at reducing the cost of healthcare, and removing car parking charges is one of those issues.

In addition, I would like prescription charges to be abolished. I would also like further changes to the drugs payment scheme threshold. By the way, I welcome the cut introduced by the Government as part of the cost-of-living measures. The monthly threshold was reduced from €100 to €80, and in last year's budget it was reduced from €120 to €100. We are going in the right direction and I welcome the changes. We still have in-patient charges in hospitals, which can be quite difficult for some payments to pay. There is also the big promise of universal primary care and, in particular, universal GP care. We are a long way away from that happening because we are simply not doing the planning. There is no strategy from the Government as to how to do it. We all agreed we would do it. There was the Sláintecare programme. As is the case in the programme for Government, when car parking charges were agreed to be a part of it, there is no plan on how to deliver it. We are waiting and waiting. I had hoped to hear from the Minister of State that the Government had a plan on how to do this, not excuses as to why it will not do it. I had hoped to hear a plan that sets out what we are going to do. We cannot, forever and a day, offer excuses as to why we cannot do it when we know the consequences can be overcome.

I welcome the fact that Deputy Tóibín has given us an opportunity to have this discussion, to again put this issue on the agenda and to put pressure on the Minister of State and the Government to move on this. Let us do the planning. Let us not come back to this in a year, or two or three, or go into another election where we will make the same promises again regarding healthcare.

People are sick to their back teeth of hearing about reports, promises, reform and all of the things politicians say they will do when it comes to healthcare that do not get done. It erodes confidence and shores up the public's view that these politicians are simply not interested in making changes in healthcare that make life better and easier for patients. When there are simple things like this that can be done, even when there are some consequences that can be worked out, we should do them and send out a clear message to the public, patients and their families that where we can, we will reduce the burden of the cost of healthcare. I have given many examples of where we can do that. One very clear, straightforward start would be to commit the funding and deal with the practicalities to make that difference to patients and their families.

Bernard Durkan (Kildare North, Fine Gael)
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The list of speakers is completed. We move to the Minister of State, who has five minutes.

David Cullinane (Waterford, Sinn Fein)
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May we note for the record that Sinn Féin is the only party here to support Deputy Tóibín, apart from the Minister of State of course?

Bernard Durkan (Kildare North, Fine Gael)
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It is noted.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank all the Deputies who contributed to today's discussion, in particular the Bill's sponsors, Deputies Berry and Tóibín. The Minister, Deputy Stephen Donnelly, and I acknowledge the spirit and intent of the Bill in seeking to ease the financial burden on those attending hospital. It is important to acknowledge that hospitals are already aware of the financial implications of parking costs, and do have various concessionary arrangements in place. Separate to reviewing and improving on these arrangements as needed, it is essential to ensure the current arrangements are clear and readily communicated to all.

The Government is more than aware that hospital car parking charges may represent an additional financial burden at a difficult time for people, and that this can simply add to the anxiety and stress of hospital visits and admissions. We have heard that patients and their advocates consider that parking services in some hospitals are inflexible and not patient-centred and we know that there are some groups of patients who are much more affected by this issue, people who have to attend regularly for the treatment of chronic conditions, as Deputy Tóibín rightly pointed out, such as cancer patients and patients undergoing dialysis, for example. That is why the Programme for Government, Our Shared Future, agreed in 2020, explicitly addresses this issue. To restate our commitment, it is to introduce a maximum daily car parking charge for patients and visitors at all hospitals, where possible, and to introduce flexible passes in all public hospitals for patients and families. We are moving to implement that commitment. In considering how best to do that, we will strive to take account of all users but in particular those who are most affected. Deputy Tóibín outlined the cost to cancer patients.

A lot of people will take another way out. Nobody wants to pay car parking charges. I do not want to pay them myself. I grew up in a town and a county that does not have car parking charges. In Roscommon hospital there are no car parking charges. It is difficult. Irish Rail has car parking charges at certain stations and people will just go up the line to another town where there are no charges. We see the same thing in Maynooth, Hazelhatch and places like that as the Acting Chairman will know. There are issues there.

It was stated here that about €17 million was generated. I am not sure if that was profit or money generated. I would think by the time one pays the various attendance and all the hospital charges, I am not sure if it is really value for money. That is only my view. In Sligo hospital I think the charge is €3 up to four hours and €6 for between five and 24 hours. It is not uncommon and I have done it myself that if I get a 12 or 24-hour ticket but leave the car park after two or three hours, if I see somebody coming in I might wind down the window and give them the ticket so they can save €6. It is in the spirit and I do not think it is breaking the law. We do not like to see other people paying car parking charges. That is just my opinion. Deputy Ó Snodaigh rightly said that this is not a political issue. There are practical solutions. Deputies Cullinane and Tóibín said that the issues are not insurmountable. Technology will play a huge role. We have to look at all the options from a climate change perspective. Sometimes if something is free, it can be abused. We need to look at that.

I believe there are limitations to this Bill, as I have outlined earlier, but I am happy to reiterate that the Minister acknowledges the spirit and intent of the Bill in seeking to ease the financial burden on those attending hospital. This is a goal that we all share and that is reflected directly in the programme for Government. The Minister does not intend to oppose the Bill on Second Stage. I thank Deputies Tóibín and Berry for bringing in the Bill which I fully support. I hope we will be able to work together to get practical solutions on car parking charges.

It was an own goal in St. James's Hospital when it reduced the free parking time from 20 minutes to ten minutes. I think it was wrong. When people are in the hospital they have to keep track of how long they are parked, if they are there three hours, if they need to send somebody out again. Deputy Ó Snodaigh's father's car was clamped. It is a barrier to people attending hospitals. I think we can work together to reduce or get rid of the charges.