Tag Archives: hospital

‘I knew I was in labour’ – why are women being turned away from hospital during childbirth?

As a number of women recount how they were mistakenly told to go home and wait, before giving birth on the pavement or in a lift, experts warn that more investment in early-labour care is needed

Some women who have been turned away from maternity units have soon after given birth in the street.


Some women who have been turned away from maternity units have soon after given birth in the street. Photograph: Alamy Stock Photo

Because her first baby had arrived quickly, Lizzie Hines was told at all her antenatal midwife appointments that she should go to hospital as soon as she recognised the first signs of labour. So, a couple of hours after she first felt twinges, cramps and contractions, she and her husband set off for a hospital in central London, but when she arrived, the midwife who examined her told her she wasn’t in labour. “I knew that not to be true,” she says. “I knew I was in labour.”

They were told to go home for a few hours; Hines asked if she could stay, but was told she couldn’t unless she wanted to wait in the corridor. Her husband booked them into a nearby hotel to wait it out, and they walked around the corner, with Hines, wearing pyjamas and a coat, steadying herself against the walls of the building with each contraction. It was 7am.

“We checked in at the hotel and I was probably there all of about 15 to 20 minutes when I said to my husband, ‘I’m having the baby. This is happening.’ I couldn’t really talk to him, but I could feel this was imminent. He said: ‘No, I’m going to get you [to hospital], we can’t do this here.’” He carried her across the road, and as another contraction came, Hines sat down on the street. “Apparently I let out a huge noise, but I don’t remember that at all. People came over, and I do remember ankles starting to appear around me.”

Then, she says, her son Louis “came out, and I remember feeling every limb fly out of my body and on to the floor and into my pyjamas. Someone in the crowd reassured me, saying, ‘Don’t worry, we’re going to get to the hospital, you’re going to be fine’. I said: ‘No, he’s here.’ They opened my pyjamas and saw him red and squirming, attached to me with the umbilical cord. He wasn’t screaming at first. Someone said put him against you so I lifted up my T-shirt and put him against me.”

She doesn’t remember much of what happened next, but last month she pieced her son’s birth together after a post she put on Facebook to search for the strangers who helped the family in December 2016 went viral. People have told her that her waters were running down the street, that someone in the crowd had tried to film her giving birth and a fight broke out to stop them. She didn’t even know when Louis was born – she was told it was 7.30am.

Lizzie Hines, in the street outside a hospital, moments after giving birth to her son Louis.


Lizzie Hines, in the street outside a hospital, moments after giving birth to her son Louis. Photograph: Courtesy of Lizzie Hines

The temperature was zero degrees. Some people in the crowd who helped her worked at the hospital. Hines and her newborn were taken there, using a wheelchair. She had a few stitches but all was well, and they went home that afternoon.

It was, she says, “a wonderful experience. He was healthy, I felt physically and mentally good about it, and I felt really joyful – I think the hormones were a huge part of that.” But, she adds: “There is also the thought that there was a misjudgment there.” It was a straightforward birth. “I feel very fortunate,” she says. “He didn’t have the cord round his neck or any immediate problems.”

Michelle Booth had a similar experience in 2013 with the birth of her son George, her first baby, who arrived in a hotel bathroom across the road from the hospital she had been turned away from a few hours earlier. She had been told she wasn’t dilated at all, and to go home. “The really stressful thing about it was I felt I was really on top of it, and then all of a sudden people were telling me I wasn’t in labour. When you haven’t had a baby before you don’t know. It freaked me out – if this wasn’t labour then what was it going to be like?”

Nearly three hours later, she called the hospital for advice and to ask if she should come in, but they told her to take a paracetamol. Soon afterwards, she gave birth in the hotel room. Like Hines, she says, it was a “really positive experience”, but she puts that down to being very prepared before the birth, having practised hypnobirthing and reading a lot about the birth process. “I think if I hadn’t done that, and had that experience, it would have been really scary.” She did, however, lose a lot of blood, and she and George were taken to hospital by ambulance quickly afterwards.

It was frustrating not to have been listened to, she says. “You’re having an experience and someone is telling you that it isn’t the experience you’re having. If you’ve never had a baby before, you’re reliant on the professionals giving you advice. I suppose what I’ve learned is the whole thing about birth is based on data.”

Being turned away in early labour, only to give birth soon afterwards, is “a symptom of something that affects women in maternity care a lot, which is not being listened to,” says Rebecca Schiller, chief executive of the charity Birthrights. “One of the problems we’re keen to address is changing culture in maternity care, so that women’s perceptions, experiences and information about their own bodies, own pregnancies and own labour is taken seriously. It’s something that’s important from a safety point of view. It’s been shown that some women who have had serious problems like stillbirths have reported worries and concerns, turned up to their maternity unit several times and been ignored, and gone to have tragic consequences.”

It can also be distressing to be told that you are not in labour when you feel you are, she says. “We know that how women feel giving birth can have an impact on their emotional wellbeing for quite a long time. It’s important for safety, and it’s important for women’s entry into motherhood and how they go on to feel about themselves and their experience of birth that they’re listened to.”

Michelle Booth and her son George.
Michelle Booth and her son George. Photograph: Courtesy of Michelle Booth

For Antonia Kennedy, who lives in the north-east, the birth of her fourth child, Oscar, in December 2016, was distressing. “Once you’ve had three other children, you know when you’re in labour,” she says. “[The midwife] said I was 1cm dilated and I should maybe go shopping – there was a shopping centre not far from the hospital – for a couple of hours.” She asked if she could stay at the hospital, but “they were adamant that I couldn’t. I said I really didn’t want to go back home. I felt ‘thank god we’re here’ but they said they wouldn’t let us stay.”

By then, she had been having contractions for a couple of hours, and at the hospital they were so strong, she couldn’t move. Her partner drove them the 15 minutes home, where they stayed for five minutes, before heading back to hospital. She made it through the doors, but gave birth to her son in the hospital lift. Her partner caught him. There were people watching and she says she felt really embarrassed. Since then, she has been plagued by thoughts about what might have happened if her partner had not caught the baby, if he’d hit the floor, and she believes the experience has contributed to the anxiety she has felt since the birth.Labour is unpredictable, acknowledges Schiller. “In my second labour, I went suddenly from not really feeling I was in labour to having a baby 40 minutes later. Sometimes you can’t predict those things and there will be women who give birth very quickly, and won’t be able to make it to a unit in time. But I think if a woman is at a unit and that’s where she feels safe, and she says like she feels like she’s in labour, it’s important that medical professionals don’t just rely on their traditional observations and vaginal examinations. It can be very easy to reduce a woman’s labour to measurements and standards, but we’re individuals and our bodies don’t often play that game.”

Early labour should be a time when women can feel safe, and while many women prefer to be at home, for some women, being in hospital might provide more reassurance, particularly if the hospital is not close to home, or an uncomfortable drive away.

The Royal College of Midwives declined to comment, but some hospitals have invested in early labour care. At Chelsea and Westminster hospital, they have a room called the Nest, which opened in 2012 and can be used by women in the early stages of labour, before going on to the hospital’s midwifery-led unit, or the labour ward if they choose to. There is low lighting, comfortable seating, such as beanbags, and relaxing music. It is staffed by doulas, who support women at this stage, rather than (expensively) trained midwives.

“There isn’t a lot of investment in maternity services at the moment,” says Schiller, but a simple, comfortable room might not be unreasonable to expect. “It’s a vulnerable time,” says Hines. “There is so much care taken by the NHS during pregnancy and after the birth, to such a high level of expertise, but for this splice of time in early labour, for maybe two hours or 10 hours, that doesn’t seem to be considered part of the care.”

Have you had a difficult experience going into labour? Please comment below.

NHS cancer hospital may have to delay or reduce treatment

An NHS cancer hospital may have to make patients wait to undergo chemotherapy, or reduce the amount of treatment that dying patients receive, because it has so few nurses, a leaked memo has revealed.

Macmillan Cancer Support said the prospect of the Churchill hospital in Oxford in effect rationing life-extending and potentially life-saving chemotherapy was “deeply worrying”, especially for people dying of the disease.

The warning is thought to be unprecedented in cancer care. It is set out in an email from Dr Andrew Weaver, the chemotherapy lead, to fellow cancer specialists at the hospital.

Sent on 3 January, Weaver refers to the difficulties on the day treatment unit (DTU) caused by a shortage of specialist cancer nurses who administer chemotherapy.

He makes clear that limiting access to the treatment could affect both newly referred cancer patients and those in their final weeks or months of life.

Weaver writes: “Currently we are down approximately 40% on the establishment of nurses on DTU and as a consequence we are having to delay chemotherapy patients’ starting times to four weeks.”

Two types of cancer patients will continue to receive their chemotherapy as normal: dying patients undergoing their first course of chemotherapy and those who are receiving it in addition to other cancer treatment, such as surgery or radiotherapy.

In future, however, dying patients could receive less chemotherapy as a result of the lack of nurses.

Weaver said: “We propose that for second, third and fourth line palliative treatments the cycle length is increased by one or two weeks and/or the total number of cycles administered is reduced – for example, where normally six cycles are given then teams should consider reducing to four cycles in total.

“I know that many of us will find it difficult to accept these changes but the bottom line is that the current situation with limited numbers of staff is unsustainable in the short, medium and long term. Sadly we cannot see the staffing levels on DTU improving for at least 18-24 months.”

Q&A

Does the UK have enough doctors and nurses?

The UK has fewer doctors and nurses than many other comparable countries both in Europe and worldwide. According to the Organisation for Economic Co-operation and Development (OECD), Britain comes 24th in a league table of 34 member countries in terms of the number of doctors they have relative to their populations. Greece, Austria and Norway have the most; the three countries with proportionately the fewest medics are Turkey, Chile and Mexico. Jeremy Hunt, the health secretary, regularly points out that the NHS in England has more doctors and nurses than when the Conservatives came to power in 2010. That is true, although there are now fewer district nurses, mental health nurses and other types of health professionals.

NHS unions and health thinktanks point out that rises in NHS staff’s workloads have outstripped the increases in overall staff numbers. Hospital bosses say that understaffing is now their number one problem, even ahead of lack of money and pressure to meet exacting NHS-wide performance targets. Hunt has recently acknowledged that, and Health Education England, the NHS’s staffing and training agency, last month published a workforce strategy intended to tackle the problem.

Read a full Q&A on the NHS winter crisis

Dr Karen Roberts, Macmillan’s chief nursing officer, said patients’ lives could be shortened if the hospital implemented Weaver’s proposals.

“Such a situation is deeply worrying and delays cause untold distress to patients. A group who may be particularly affected by such a decision would be those who have treatable but not curable cancer.

“Chemotherapy can help relieve their symptoms, extend survival and enable people to spend precious time with their family. If access to treatment is reduced, all these factors may be affected.”

Oxford Universty hospitals NHS trust, which runs the Churchill, said it had not decided to implement any of the suggested measures, but did not rule out doing so.

“We have not made any decisions to delay the start of chemotherapy treatment or to reduce the number of cycles of chemotherapy treatment which patients with cancer receive,” it said in a statement.

“We would like to reassure our patients that no changes to chemotherapy treatment have been made or will be made before thorough consideration has been given to all possible options.”

David Bailey, a nurse with the trust who is being treated for cancer at the Churchill, said the high vacancy rate for cancer nurses, and any consequent reduction in chemotherapy, would affect the outcomes for patients..

“I am lucky, I’m part of a clinical trial, which will not be affected; but how frightening is this for other, newly diagnosed cancer patients?”

NHS cancer hospital may have to delay or reduce treatment

An NHS cancer hospital may have to make patients wait to undergo chemotherapy, or reduce the amount of treatment that dying patients receive, because it has so few nurses, a leaked memo has revealed.

Macmillan Cancer Support said the prospect of the Churchill hospital in Oxford in effect rationing life-extending and potentially life-saving chemotherapy was “deeply worrying”, especially for people dying of the disease.

The warning is thought to be unprecedented in cancer care. It is set out in an email from Dr Andrew Weaver, the chemotherapy lead, to fellow cancer specialists at the hospital.

Sent on 3 January, Weaver refers to the difficulties on the day treatment unit (DTU) caused by a shortage of specialist cancer nurses who administer chemotherapy.

He makes clear that limiting access to the treatment could affect both newly referred cancer patients and those in their final weeks or months of life.

Weaver writes: “Currently we are down approximately 40% on the establishment of nurses on DTU and as a consequence we are having to delay chemotherapy patients’ starting times to four weeks.”

Two types of cancer patients will continue to receive their chemotherapy as normal: dying patients undergoing their first course of chemotherapy and those who are receiving it in addition to other cancer treatment, such as surgery or radiotherapy.

In future, however, dying patients could receive less chemotherapy as a result of the lack of nurses.

Weaver said: “We propose that for second, third and fourth line palliative treatments the cycle length is increased by one or two weeks and/or the total number of cycles administered is reduced – for example, where normally six cycles are given then teams should consider reducing to four cycles in total.

“I know that many of us will find it difficult to accept these changes but the bottom line is that the current situation with limited numbers of staff is unsustainable in the short, medium and long term. Sadly we cannot see the staffing levels on DTU improving for at least 18-24 months.”

Q&A

Does the UK have enough doctors and nurses?

The UK has fewer doctors and nurses than many other comparable countries both in Europe and worldwide. According to the Organisation for Economic Co-operation and Development (OECD), Britain comes 24th in a league table of 34 member countries in terms of the number of doctors they have relative to their populations. Greece, Austria and Norway have the most; the three countries with proportionately the fewest medics are Turkey, Chile and Mexico. Jeremy Hunt, the health secretary, regularly points out that the NHS in England has more doctors and nurses than when the Conservatives came to power in 2010. That is true, although there are now fewer district nurses, mental health nurses and other types of health professionals.

NHS unions and health thinktanks point out that rises in NHS staff’s workloads have outstripped the increases in overall staff numbers. Hospital bosses say that understaffing is now their number one problem, even ahead of lack of money and pressure to meet exacting NHS-wide performance targets. Hunt has recently acknowledged that, and Health Education England, the NHS’s staffing and training agency, last month published a workforce strategy intended to tackle the problem.

Read a full Q&A on the NHS winter crisis

Dr Karen Roberts, Macmillan’s chief nursing officer, said patients’ lives could be shortened if the hospital implemented Weaver’s proposals.

“Such a situation is deeply worrying and delays cause untold distress to patients. A group who may be particularly affected by such a decision would be those who have treatable but not curable cancer.

“Chemotherapy can help relieve their symptoms, extend survival and enable people to spend precious time with their family. If access to treatment is reduced, all these factors may be affected.”

Oxford Universty hospitals NHS trust, which runs the Churchill, said it had not decided to implement any of the suggested measures, but did not rule out doing so.

“We have not made any decisions to delay the start of chemotherapy treatment or to reduce the number of cycles of chemotherapy treatment which patients with cancer receive,” it said in a statement.

“We would like to reassure our patients that no changes to chemotherapy treatment have been made or will be made before thorough consideration has been given to all possible options.”

David Bailey, a nurse with the trust who is being treated for cancer at the Churchill, said the high vacancy rate for cancer nurses, and any consequent reduction in chemotherapy, would affect the outcomes for patients..

“I am lucky, I’m part of a clinical trial, which will not be affected; but how frightening is this for other, newly diagnosed cancer patients?”

NHS cancer hospital may have to delay or reduce treatment

An NHS cancer hospital may have to make patients wait to undergo chemotherapy, or reduce the amount of treatment that dying patients receive, because it has so few nurses, a leaked memo has revealed.

Macmillan Cancer Support said the prospect of the Churchill hospital in Oxford in effect rationing life-extending and potentially life-saving chemotherapy was “deeply worrying”, especially for people dying of the disease.

The warning is thought to be unprecedented in cancer care. It is set out in an email from Dr Andrew Weaver, the chemotherapy lead, to fellow cancer specialists at the hospital.

Sent on 3 January, Weaver refers to the difficulties on the day treatment unit (DTU) caused by it being drastically short of specialist cancer nurses who administer chemotherapy.

He makes clear that limiting access to the treatment could affect both newly referred cancer patients and those in their final weeks or months of life.

Weaver writes: “Currently we are down approximately 40% on the establishment of nurses on DTU and as a consequence we are having to delay chemotherapy patients’ starting times to four weeks.”

Two types of cancer patients will continue to receive their chemotherapy as normal: dying patients undergoing their first course of chemotherapy and those who are receiving it in addition to other cancer treatment, such as surgery or radiotherapy.

In future, however, dying patients could receive less chemotherapy as a result of the lack of nurses.

Weaver said: “We propose that for second, third and fourth line palliative treatments the cycle length is increased by one or two weeks and/or the total number of cycles administered is reduced – for example, where normally six cycles are given then teams should consider reducing to four cycles in total.

“I know that many of us will find it difficult to accept these changes but the bottom line is that the current situation with limited numbers of staff is unsustainable in the short, medium and long term. Sadly we cannot see the staffing levels on DTU improving for at least 18-24 months.”

Q&A

Does the UK have enough doctors and nurses?

The UK has fewer doctors and nurses than many other comparable countries both in Europe and worldwide. According to the Organisation for Economic Co-operation and Development (OECD), Britain comes 24th in a league table of 34 member countries in terms of the number of doctors they have relative to their populations. Greece, Austria and Norway have the most; the three countries with proportionately the fewest medics are Turkey, Chile and Mexico. Jeremy Hunt, the health secretary, regularly points out that the NHS in England has more doctors and nurses than when the Conservatives came to power in 2010. That is true, although there are now fewer district nurses, mental health nurses and other types of health professionals.

NHS unions and health thinktanks point out that rises in NHS staff’s workloads have outstripped the increases in overall staff numbers. Hospital bosses say that understaffing is now their number one problem, even ahead of lack of money and pressure to meet exacting NHS-wide performance targets. Hunt has recently acknowledged that, and Health Education England, the NHS’s staffing and training agency, last month published a workforce strategy intended to tackle the problem.

Read a full Q&A on the NHS winter crisis

Dr Karen Roberts, Macmillan’s chief nursing officer, said patients’ lives could be shortened if the hospital implemented Weaver’s proposals.

“Such a situation is deeply worrying and delays cause untold distress to patients. A group who may be particularly affected by such a decision would be those who have treatable but not curable cancer.

“Chemotherapy can help relieve their symptoms, extend survival and enable people to spend precious time with their family. If access to treatment is reduced, all these factors may be affected.”

Oxford Universty hospitals NHS trust, which runs the Churchill, said it had not decided to implement any of the suggested measures, but did not rule out doing so.

“We have not made any decisions to delay the start of chemotherapy treatment or to reduce the number of cycles of chemotherapy treatment which patients with cancer receive,” it said in a statement.

“We would like to reassure our patients that no changes to chemotherapy treatment have been made or will be made before thorough consideration has been given to all possible options.”

David Bailey, a nurse with the trust who is being treated for cancer at the Churchill, said the high vacancy rate for cancer nurses, and any consequent reduction in chemotherapy, would affect the outcomes for patients..

“I am lucky, I’m part of a clinical trial, which will not be affected; but how frightening is this for other, newly diagnosed cancer patients?”

Why free hospital parking isn’t as good as it sounds | Peter Walker

The Daily Mirror has an illustrious history of campaigning, most recently helping to persuade ministers to enact an opt-out system for organ donation in England, as already existed in Scotland and Wales. But I’m afraid their latest crusade is a mistake.

Backed by, among others, trade unions and Jeremy Corbyn – for whom it is official Labour policy – the paper seeks the abolition of all parking charges at NHS hospitals in England, for patients, visitors and staff.

It is generally popular, and billed as an obvious and fair reform, which would benefit those most in need. Unfortunately, it’s a lot more complicated than that.


Free parking is fundamentally regressive, a subsidy to people who tend to be richer than average

The first point to stress is that I’m not arguing against reforms to the way hospital parking is currently administered and charged. As is regularly documented, too many systems are unwieldy and over-complex, with many only permitting cash payments, or forcing visitors to pay in advance when they might have little idea how long they will stay.

Charges can sometimes also seem unreasonably high, and there could be an argument for imposing a cap, or perhaps systems whereby regular visitors such as relatives of long-term patients could avoid the fees racking up.

But opening up all NHS hospital car parks to free parking at any time, for any duration, to anyone who works there or has reason to visit? That’s a different matter altogether.

The first error is that it won’t necessarily make parking any easier, just hard in a different way. There are something close to 600,000 staff at hospitals in England, and about 40,000 inpatient admissions a day. That’s a lot of people seeking a free resource.

In Scotland, patients’ associations have complained that car parks at many hospitals, made free in 2008, are so permanently full that some people have had to leave their vehicle a 15-minute walk away – thus missing appointments. In Wales, which also has free parking, one hospital had to build a new multistorey car park and employ an external contractor to enforce rules. Without fees to cover the costs, this is money that could otherwise be spent on patient care.

This is a vital point. Parking is never free – parking without a charge is merely a subsidy to the motorist, and it can be a significant one. Donald Shoup, a US economist with a long-standing fascination with parking, has calculated that in 12 US cities the average construction cost for an above-ground parking space is about £18,000, several times the average net worth of an African-American family.

This is the other key point – free parking is fundamentally regressive, a subsidy to people who tend to be richer than average. Many politicians, and newspapers, see the car as the default travel choice for everyone, and of course if you’re outside a town or city, often dreadful public transport means a motor vehicle might be your only means of getting to the nearest hospital.

But this ignores the fact that the poorer you are, the less likely you are to drive. Government statistics show that in the lowest income quintile, 44% of English households have no access to a car, with about a third of the second-lowest band facing the same situation. In the top income quintile, just 12% are car-less, with about half owning two or more.

‘Many people lead inactive lives, a problem linked very closely to over-reliance on the car’ (picture posed by model).


‘Many people lead inactive lives, a problem linked very closely to over-reliance on the car’ (picture posed by model). Photograph: Alamy

It is therefore better-off patients and visitors who are more likely to take advantage of free hospital parking, rather than use public transport, or walk, cycle or take an expensive cab. It’s the same for staff: the Mirror’s campaign is statistically far more likely to benefit a consultant than a porter.

It thus seems odd for the paper to argue so vehemently in favour of such a subsidy rather than, for example, campaigning for better public transport to hospitals, or safe cycling and walking routes, changes which would bring benefits, however poor you are.

The final reason this is a misplaced crusade is ever more simple still. A very large number of people are in hospital in the first place, thus requiring people to treat and visit them, because they lead inactive lives – a problem linked very closely to over-reliance on the car.

It’s hard to over-stress the significance of this public health catastrophe, which many experts predict will eventually bankrupt the NHS. An estimated 85,000 people in England and Wales die early every year because of sedentary living, with hundreds of thousands more needing treatment for ailments associated with such lifestyles, such as type-2 diabetes, cardiovascular disease and many cancers.

The statistics for inactivity can shock. One study from August found that 41% of middle-aged English people fail to walk for 10 minutes or more continuously every month.

This isn’t to argue that nurses on a night shift at a rural hospital, let alone ill patients, should be forced to walk or cycle to the wards. But it does seem perverse to specifically incentivise inactive travel when other options might be there, not to mention placing even more demands on the NHS through factors connected to driving such as smog and crashes.

Parking is a strange subject, at once arousing hugely passionate feelings in many people, and yet rarely understood properly. Andrew Gilligan, the journalist who was formerly London’s commissioner for cycling, once described it as “the third rail of politics – if you touch it, you die”.

I understand why people believe England’s hospitals should all have universal free parking. I also see why the Mirror and Corbyn would see it as a good cause.

But the more you look into it, the worse an idea it seems.

  • Peter Walker is a Guardian political correspondent

Why free hospital parking isn’t as good as it sounds | Peter Walker

The Daily Mirror has an illustrious history of campaigning, most recently helping to persuade ministers to enact an opt-out system for organ donation in England, as already existed in Scotland and Wales. But I’m afraid their latest crusade is a mistake.

Backed by, among others, trade unions and Jeremy Corbyn – for whom it is official Labour policy – the paper seeks the abolition of all parking charges at NHS hospitals in England, for patients, visitors and staff.

It is generally popular, and billed as an obvious and fair reform, which would benefit those most in need. Unfortunately, it’s a lot more complicated than that.


Free parking is fundamentally regressive, a subsidy to people who tend to be richer than average

The first point to stress is that I’m not arguing against reforms to the way hospital parking is currently administered and charged. As is regularly documented, too many systems are unwieldy and over-complex, with many only permitting cash payments, or forcing visitors to pay in advance when they might have little idea how long they will stay.

Charges can sometimes also seem unreasonably high, and there could be an argument for imposing a cap, or perhaps systems whereby regular visitors such as relatives of long-term patients could avoid the fees racking up.

But opening up all NHS hospital car parks to free parking at any time, for any duration, to anyone who works there or has reason to visit? That’s a different matter altogether.

The first error is that it won’t necessarily make parking any easier, just hard in a different way. There are something close to 600,000 staff at hospitals in England, and about 40,000 inpatient admissions a day. That’s a lot of people seeking a free resource.

In Scotland, patients’ associations have complained that car parks at many hospitals, made free in 2008, are so permanently full that some people have had to leave their vehicle a 15-minute walk away – thus missing appointments. In Wales, which also has free parking, one hospital had to build a new multistorey car park and employ an external contractor to enforce rules. Without fees to cover the costs, this is money that could otherwise be spent on patient care.

This is a vital point. Parking is never free – parking without a charge is merely a subsidy to the motorist, and it can be a significant one. Donald Shoup, a US economist with a long-standing fascination with parking, has calculated that in 12 US cities the average construction cost for an above-ground parking space is about £18,000, several times the average net worth of an African-American family.

This is the other key point – free parking is fundamentally regressive, a subsidy to people who tend to be richer than average. Many politicians, and newspapers, see the car as the default travel choice for everyone, and of course if you’re outside a town or city, often dreadful public transport means a motor vehicle might be your only means of getting to the nearest hospital.

But this ignores the fact that the poorer you are, the less likely you are to drive. Government statistics show that in the lowest income quintile, 44% of English households have no access to a car, with about a third of the second-lowest band facing the same situation. In the top income quintile, just 12% are car-less, with about half owning two or more.

‘Many people lead inactive lives, a problem linked very closely to over-reliance on the car’ (picture posed by model).


‘Many people lead inactive lives, a problem linked very closely to over-reliance on the car’ (picture posed by model). Photograph: Alamy

It is therefore better-off patients and visitors who are more likely to take advantage of free hospital parking, rather than use public transport, or walk, cycle or take an expensive cab. It’s the same for staff: the Mirror’s campaign is statistically far more likely to benefit a consultant than a porter.

It thus seems odd for the paper to argue so vehemently in favour of such a subsidy rather than, for example, campaigning for better public transport to hospitals, or safe cycling and walking routes, changes which would bring benefits, however poor you are.

The final reason this is a misplaced crusade is ever more simple still. A very large number of people are in hospital in the first place, thus requiring people to treat and visit them, because they lead inactive lives – a problem linked very closely to over-reliance on the car.

It’s hard to over-stress the significance of this public health catastrophe, which many experts predict will eventually bankrupt the NHS. An estimated 85,000 people in England and Wales die early every year because of sedentary living, with hundreds of thousands more needing treatment for ailments associated with such lifestyles, such as type-2 diabetes, cardiovascular disease and many cancers.

The statistics for inactivity can shock. One study from August found that 41% of middle-aged English people fail to walk for 10 minutes or more continuously every month.

This isn’t to argue that nurses on a night shift at a rural hospital, let alone ill patients, should be forced to walk or cycle to the wards. But it does seem perverse to specifically incentivise inactive travel when other options might be there, not to mention placing even more demands on the NHS through factors connected to driving such as smog and crashes.

Parking is a strange subject, at once arousing hugely passionate feelings in many people, and yet rarely understood properly. Andrew Gilligan, the journalist who was formerly London’s commissioner for cycling, once described it as “the third rail of politics – if you touch it, you die”.

I understand why people believe England’s hospitals should all have universal free parking. I also see why the Mirror and Corbyn would see it as a good cause.

But the more you look into it, the worse an idea it seems.

  • Peter Walker is a Guardian political correspondent

Why free hospital parking isn’t as good as it sounds | Peter Walker

The Daily Mirror has an illustrious history of campaigning, most recently helping to persuade ministers to enact an opt-out system for organ donation in England, as already existed in Scotland and Wales. But I’m afraid their latest crusade is a mistake.

Backed by, among others, trade unions and Jeremy Corbyn – for whom it is official Labour policy – the paper seeks the abolition of all parking charges at NHS hospitals in England, for patients, visitors and staff.

It is generally popular, and billed as an obvious and fair reform, which would benefit those most in need. Unfortunately, it’s a lot more complicated than that.


Free parking is fundamentally regressive, a subsidy to people who tend to be richer than average

The first point to stress is that I’m not arguing against reforms to the way hospital parking is currently administered and charged. As is regularly documented, too many systems are unwieldy and over-complex, with many only permitting cash payments, or forcing visitors to pay in advance when they might have little idea how long they will stay.

Charges can sometimes also seem unreasonably high, and there could be an argument for imposing a cap, or perhaps systems whereby regular visitors such as relatives of long-term patients could avoid the fees racking up.

But opening up all NHS hospital car parks to free parking at any time, for any duration, to anyone who works there or has reason to visit? That’s a different matter altogether.

The first error is that it won’t necessarily make parking any easier, just hard in a different way. There are something close to 600,000 staff at hospitals in England, and about 40,000 inpatient admissions a day. That’s a lot of people seeking a free resource.

In Scotland, patients’ associations have complained that car parks at many hospitals, made free in 2008, are so permanently full that some people have had to leave their vehicle a 15-minute walk away – thus missing appointments. In Wales, which also has free parking, one hospital had to build a new multistorey car park and employ an external contractor to enforce rules. Without fees to cover the costs, this is money that could otherwise be spent on patient care.

This is a vital point. Parking is never free – parking without a charge is merely a subsidy to the motorist, and it can be a significant one. Donald Shoup, a US economist with a long-standing fascination with parking, has calculated that in 12 US cities the average construction cost for an above-ground parking space is about £18,000, several times the average net worth of an African-American family.

This is the other key point – free parking is fundamentally regressive, a subsidy to people who tend to be richer than average. Many politicians, and newspapers, see the car as the default travel choice for everyone, and of course if you’re outside a town or city, often dreadful public transport means a motor vehicle might be your only means of getting to the nearest hospital.

But this ignores the fact that the poorer you are, the less likely you are to drive. Government statistics show that in the lowest income quintile, 44% of English households have no access to a car, with about a third of the second-lowest band facing the same situation. In the top income quintile, just 12% are car-less, with about half owning two or more.

‘Many people lead inactive lives, a problem linked very closely to over-reliance on the car’ (picture posed by model).


‘Many people lead inactive lives, a problem linked very closely to over-reliance on the car’ (picture posed by model). Photograph: Alamy

It is therefore better-off patients and visitors who are more likely to take advantage of free hospital parking, rather than use public transport, or walk, cycle or take an expensive cab. It’s the same for staff: the Mirror’s campaign is statistically far more likely to benefit a consultant than a porter.

It thus seems odd for the paper to argue so vehemently in favour of such a subsidy rather than, for example, campaigning for better public transport to hospitals, or safe cycling and walking routes, changes which would bring benefits, however poor you are.

The final reason this is a misplaced crusade is ever more simple still. A very large number of people are in hospital in the first place, thus requiring people to treat and visit them, because they lead inactive lives – a problem linked very closely to over-reliance on the car.

It’s hard to over-stress the significance of this public health catastrophe, which many experts predict will eventually bankrupt the NHS. An estimated 85,000 people in England and Wales die early every year because of sedentary living, with hundreds of thousands more needing treatment for ailments associated with such lifestyles, such as type-2 diabetes, cardiovascular disease and many cancers.

The statistics for inactivity can shock. One study from August found that 41% of middle-aged English people fail to walk for 10 minutes or more continuously every month.

This isn’t to argue that nurses on a night shift at a rural hospital, let alone ill patients, should be forced to walk or cycle to the wards. But it does seem perverse to specifically incentivise inactive travel when other options might be there, not to mention placing even more demands on the NHS through factors connected to driving such as smog and crashes.

Parking is a strange subject, at once arousing hugely passionate feelings in many people, and yet rarely understood properly. Andrew Gilligan, the journalist who was formerly London’s commissioner for cycling, once described it as “the third rail of politics – if you touch it, you die”.

I understand why people believe England’s hospitals should all have universal free parking. I also see why the Mirror and Corbyn would see it as a good cause.

But the more you look into it, the worse an idea it seems.

  • Peter Walker is a Guardian political correspondent

Why free hospital parking isn’t as good as it sounds| Peter Walker

The Daily Mirror has an illustrious history of campaigning, most recently helping to persuade ministers to enact an opt-out system for organ donation in England, as already existed in Scotland and Wales. But I’m afraid their latest crusade is a mistake.

Backed by, among others, trade unions and Jeremy Corbyn – for whom it is official Labour policy – the paper seeks the abolition of all parking charges at NHS hospitals in England, for patients, visitors and staff.

It is generally popular, and billed as an obvious and fair reform, which would benefit those most in need. Unfortunately, it’s a lot more complicated than that.


Free parking is fundamentally regressive, a subsidy to people who tend to be richer than average

The first point to stress is that I’m not arguing against reforms to the way hospital parking is currently administered and charged. As is regularly documented, too many systems are unwieldy and over-complex, with many only permitting cash payments, or forcing visitors to pay in advance when they might have little idea how long they will stay.

Charges can sometimes also seem unreasonably high, and there could be an argument for imposing a cap, or perhaps systems whereby regular visitors such as relatives of long-term patients could avoid the fees racking up.

But opening up all NHS hospital car parks to free parking at any time, for any duration, to anyone who works there or has reason to visit? That’s a different matter altogether.

The first error is that it won’t necessarily make parking any easier, just hard in a different way. There are something close to 600,000 staff at hospitals in England, and about 40,000 inpatient admissions a day. That’s a lot of people seeking a free resource.

In Scotland, patients’ associations have complained that car parks at many hospitals, made free in 2008, are so permanently full that some people have had to leave their vehicle a 15-minute walk away – thus missing appointments. In Wales, which also has free parking, one hospital had to build a new multistorey car park and employ an external contractor to enforce rules. Without fees to cover the costs, this is money that could otherwise be spent on patient care.

This is a vital point. Parking is never free – parking without a charge is merely a subsidy to the motorist, and it can be a significant one. Donald Shoup, a US economist with a long-standing fascination with parking, has calculated that in 12 US cities the average construction cost for an above-ground parking space is about £18,000, several times the average net worth of an African-American family.

This is the other key point – free parking is fundamentally regressive, a subsidy to people who tend to be richer than average. Many politicians, and newspapers, see the car as the default travel choice for everyone, and of course if you’re outside a town or city, often dreadful public transport means a motor vehicle might be your only means of getting to the nearest hospital.

But this ignores the fact that the poorer you are, the less likely you are to drive. Government statistics show that in the lowest income quintile, 44% of English households have no access to a car, with about a third of the second-lowest band facing the same situation. In the top income quintile, just 12% are car-less, with about half owning two or more.

‘Many people lead inactive lives, a problem linked very closely to over-reliance on the car’ (picture posed by model).


‘Many people lead inactive lives, a problem linked very closely to over-reliance on the car’ (picture posed by model). Photograph: Alamy

It is therefore better-off patients and visitors who are more likely to take advantage of free hospital parking, rather than use public transport, or walk, cycle or take an expensive cab. It’s the same for staff: the Mirror’s campaign is statistically far more likely to benefit a consultant than a porter.

It thus seems odd for the paper to argue so vehemently in favour of such a subsidy rather than, for example, campaigning for better public transport to hospitals, or safe cycling and walking routes, changes which would bring benefits, however poor you are.

The final reason this is a misplaced crusade is ever more simple still. A very large number of people are in hospital in the first place, thus requiring people to treat and visit them, because they lead inactive lives – a problem linked very closely to over-reliance on the car.

It’s hard to over-stress the significance of this public health catastrophe, which many experts predict will eventually bankrupt the NHS. An estimated 85,000 people in England and Wales die early every year because of sedentary living, with hundreds of thousands more needing treatment for ailments associated with such lifestyles, such as type-2 diabetes, cardiovascular disease and many cancers.

The statistics for inactivity can shock. One study from August found that 41% of middle-aged English people fail to walk for 10 minutes or more continuously every month.

This isn’t to argue that nurses on a night shift at a rural hospital, let alone ill patients, should be forced to walk or cycle to the wards. But it does seem perverse to specifically incentivise inactive travel when other options might be there, not to mention placing even more demands on the NHS through factors connected to driving such as smog and crashes.

Parking is a strange subject, at once arousing hugely passionate feelings in many people, and yet rarely understood properly. Andrew Gilligan, the journalist who was formerly London’s commissioner for cycling, once described it as “the third rail of politics – if you touch it, you die”.

I understand why people believe England’s hospitals should all have universal free parking. I also see why the Mirror and Corbyn would see it as a good cause.

But the more you look into it, the worse an idea it seems.

  • Peter Walker is a Guardian political correspondent

In my role as chaplain, I have seen joy in hospital at Christmas as well as sadness

Enid* had become the granny of the ward. She had been in the hospital for some time. The staff loved her; she knew them all by name and they would seek her advice. The ward was the place where she felt loved and wanted. She had attended services I led in the hospital chapel when she could – and this had become her church.

I went to visit Enid a week before Christmas and this time she was miserable. It was so unlike her: she was usually such a cheerful person and always had a tale or two of her childhood to tell. I asked her what the matter was and she told me that the decision had been made to discharge her. She knew that she did not need to be in an acute hospital any more – but she was going to miss what she saw as her community and ward family.

She would have community support at home, but she would be on her own for most of the time. We sent her home with a food parcel as we have links with a local food and clothes bank.

That day I was interviewed by the local BBC TV news for a short piece about being in hospital at Christmas. I talked about the difficulties of people being separated from families and friends at a time when everyone else seemed to be having a good time. Although Enid was not going to be in hospital, I was thinking about her distress and anxiety. It was due for broadcast in the following day or two, but got bumped as there was a snowstorm that filled the news.

I was working on Christmas Eve – and there is always a lot to do, such as catching up with people who were being discharged for Christmas Day. Most, unlike Enid, were very happy to go home, even if it was only for a day or two. I also wanted to see those people who were staying in.

There were the families waiting by their loved ones’ bedsides for their lives to come to an end: the family of a young man who had come off his motorbike, and the relatives of a 40-year-old woman with cancer who was not going to see another Christmas. There were people, too, from long distances away, whose families would not be able to visit over Christmas. I guess this is what I had reflected in the TV interview.

We have an army of volunteers who come in on Christmas Eve to go around every ward and sing carols. I tell the teams, “If you make the nurses cry, you are doing your job properly!” They, and the patients and their families, are so touched that people care enough to come in on such a busy day to sing to them.

As we worked our way around the wards, I was surprised to see Enid back on the ward she had been in before. She looked very happy indeed. I was concerned that she had had to be admitted again. Enid told me afterwards that this was the best Christmas she had had for years. The ward manager had sat with her as she had her Christmas dinner and all the staff made a great fuss of her.

We talk a lot about holistic care in the NHS and this seemed to me a fine example of it. As it turned out, it was Enid’s last Christmas: what a wonderful gift.

I got home at about 9.30pm with a sore throat – and heartily fed up with carols. My family and I caught the news before going out again to the midnight service. There I was on the TV talking about what it was like to be in hospital over Christmas. I had forgotten about it completely. I realised that Enid’s experience had altered my thinking and that, if asked again, I would say something different about being in hospital over Christmas. I would say that I have seen joy in hospital at Christmas as well as sadness. Joy and hope can arise in the most unpromising circumstances.

*Name and some details have been changed

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Doubt over EU staff in NHS threatens patient care, hospital bosses say

Uncertainty over the future of EU staff in the NHS is so damaging that it threatens the quality of care received by patients, hospital bosses are warning.

The lack of clarity over the status of EU nationals working in the NHS is especially worrying as government plans to increase the supply of homegrown doctors and nurses will take years to bear fruit, NHS trust chiefs believe.

A report by NHS Providers, which represents health trusts in England, paints a bleak picture of an already understaffed service, with fears that Brexit could exacerbate existing difficulties.

It says staff shortfalls are so widespread that they affect every area of care, but pose particular problems in A&E units, acute care, pathology, psychiatry, cancer and eyesight services.

“Any significant reduction in the number of overseas staff in the next few years is likely to have a serious and damaging impact on services for the public,” says the report. It follows evidence of a growing brain drain of EU staff from the NHS, especially nurses.

Trust bosses want the NHS to be able to keep recruiting key staff from abroad in the next few years, despite the political sensitivity around immigration, to help plug extensive gaps in staff rotas.

“In the absence of quick fixes to domestic supply, there is a continued need for provider trusts to recruit and retain staff from the EU and the rest of the world to mitigate the workforce gap,” the report says.

In a survey of 151 trust chairs and chief executives, 85% said it was very important that their hospital could continue to hire staff from overseas over the next three years.

“Uncertainty linked to Brexit was seen by chairs and chief executives as the main barrier to the recruitment of non-UK staff over the next three years, with more than one in three (38%) mentioning this issue,” the report says.

Among trust bosses, 93% said staff supply posed the biggest challenge to ensuring they could recruit and retain enough people to give patients the right care. This was followed by work pressures (60%) and pay and reward (38%).

Chris Hopson, the chief executive of NHS Providers, said the government must “deliver certainty” for the 62,000 EU workers in the NHS, who represent 5.6% of the total workforce of 1.2 million.

“It should reassure them that their commitment to the NHS is greatly valued and will continue to be welcome. It should also provide reassurance on immigration policy so trusts can continue to recruit overseas while we strengthen our workforce here,” Hopson said.

Around 10,000 EU nationals quit the NHS in the 12 months after the Brexit vote in June 2016, according to official workforce figures from NHS Digital. The Nursing and Midwifery Council revealed last week that the number of nurses coming to work in the UK from the EU had fallen by 89% in the past year.

“The NHS finds itself at the heart of a vicious circle. As demands on the health service grow, and pay continues to dive as prices soar, staff are understandably attracted to jobs where the pressures are less extreme and the wages more competitive,” said Sara Gorton, the head of health at the union Unison.

The chancellor, Philip Hammond, could help alleviate understaffing by giving all NHS workers an above-inflation pay rise in the budget on 22 November, Gorton said.

Understaffing has been caused by years of bad decision-making by ministers and NHS bodies, hospital bosses believe. Nine in 10 are worried or very worried by NHS workforce planning.

Danny Mortimer, the chief executive of NHS Employers, said trusts welcomed pledges from the health secretary, Jeremy Hunt, on training more nurses and providing more affordable housing for NHS workers from the sale of surplus NHS land. But they wanted action to be taken to expedite the changes, he said.

A Department of Health spokesperson said ministers were keen to secure the rights of EU staff in the NHS. “The NHS has over 12,700 more doctors and 10,600 more nurses on wards since May 2010, but we know that we need more staff.

“That’s why we recently announced the biggest ever expansion of training places for doctors and nurses, as well as being clear that the future of EU nationals is a top priority in the Brexit negotiations and we want their valued contribution to the NHS to continue, to ensure the NHS has the staff it needs both now and in the future.”