Travel to St Mary's Hospital - Consultation

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Consultation on travel arrangements to St. Mary’s Hospital, Newport for patients, visitors and staff

This document sets out the various methods of travel, including by car, public

transport, walking and cycling, to the Island’s major healthcare site and asks for the comments on how arrangements can be improved

Responses to this document are requested by: 13th May 2011

31st March 2011

Your views are important to us. The consultation response form can be found at the back of this document in Appendix 11. We welcome responses to all the different areas of the document

but if you want to respond to just one or two sections please do so. Please make your comments by e-mail to [email protected] or by mail to Travel to Hospital Consultation Estates Management Department, St. Mary’s Hospital, Parkhurst Road, NEWPORT, PO30 5TG. Further copies of this document can be downloaded from the Travel to Hospital consultation page at

www.iow.nhs.uk/yoursay or by e-mailing or contacting the Estates Management Office.

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Introduction from Local Involvement Network (LINk) Chair

The IW LINk is pleased to be involved in the consultation on travel arrangements to St Mary’s Hospital, Newport for Patients, Visitors and Staff. Since its inception in 2009, local organisations and residents have informed the IW LINk of a number of issues both specific and general regarding transport and travel difficulties. Some of the more specific

concerns are centred around difficulties when attempting to park at St Mary’s Hospital; others around a perceived lack of sufficient disabled parking bays both resulting in delays and missed appointments. Difficulties in utilising public transport to attend hospital and other NHS appointments at specific times and a lack of transport available to help patients requiring off island treatment or support to return home from hospital have also been raised. Through working with the IW NHS, the IW LINk hopes that this consultation document, which covers a wide range of options open to the PCT will encourage members of the public to engage with the PCT to identify priorities and work together to address their transport problems in a way that will be of benefit to patients, visitors and staff alike.

Nancy Ellacott Chair, IWLINk Steering Board

Introduction from NHS Isle of Wight Chief Operating Officer

St. Mary’s Hospital plays an important role in the lives of both Islanders and visitors. Put crudely it is a truly ‘cradle to grave’ service that is much loved by Islanders. However with all large organisations there are issues that we struggle with and car parking on the St. Mary’s Hospital site has been one of those. On the one hand there are those who say we should simply build more car parking spaces and on the other those who say we should adhere to planning regulations, support initiatives to reduce our ‘carbon footprint’ and encourage Islanders to move more – whether that be by walking or cycling – to both improve our health and reduce our reliance on the car.

This document seeks to set out a menu of options open to the PCT and seek your views on which ones we should prioritise. Undoubtedly there are some things we have direct influence over and others we can only hope to influence. We do however need your assistance in deciding what is important and what you think will have the most impact. With your contribution to this process and the assistance of the Patient Council, Local Involvement Network (LINk) and Staff Partnership Forum we will create an action plan which you will then be able to monitor progress against.

Karen Baker Chief Operating Officer, NHS Isle of Wight

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Contents Page

Introductions 2

Executive Summary 4

Cycling to St. Mary’s Hospital 5

Public Transport to St. Mary’s Hospital 6

o Park and Ride 6

o Southern Vectis Bus Services 6

o Help with travel costs 7

o Wight Bus 7

Vehicle access to St. Mary’s 7

o Car Parking – the number of spaces 7

o Car Parking – parking costs and permits 8

o Car Parking – Shift and Clinic Patterns 10

o Car Share 10

o Mobility scooters 10

o Motorcycles 10

o NHS Pool Cars 11

o Patient Transport Service 11

o Voluntary Car Services 11

o Road network on the St. Mary’s Hospital site 12

Walking to St. Mary’s Hospital 12

Appendices Page

1. Encouraging Cycling To Work 14

2. Southern Vectis Bus Route Map 16

3. Site Map of St. Mary’s Hospital 17

4. Travel distances to St. Mary’s Hospital return journeys 18

5. Ministerial statement on NHS Parking 19

6. Car Parking Information 20

7. Parking Fees Comparison 22

8. Travel Survey 23

9. Optio Voluntary Car Service 24

10. Who is being consulted? 25

11. Consultation Response Form 27

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Executive Summary

For a number of years the NHS has sought to both centralise work on hospital sites where that is necessary and expand the delivery of services more locally (e.g. in GP surgeries and Pharmacies) where that is possible. As a result the St. Mary’s Hospital site has become busier and with our fondness for the car, parking spaces are difficult to find, particularly on Tuesdays, Wednesdays and Thursdays.

In 2010 the Department of Health held a national consultation1 on hospital car parking which concluded that:

• Patients undergoing extended outpatient treatment, and long-stay inpatients, should not be further disadvantaged, and nor should their health needs be possibly compromised by high cumulative parking costs.

• A fair scale of concessionary rates should be offered.

• All eligible patients should be fully informed and helped to take advantage of them.

• These standards are fundamental to patient centred care and informed choice.

There is also a strong drive across the NHS2 to reduce our ‘Carbon Footprint’. NHS Isle of Wight’s target in our Carbon Management Programme3 is to achieve a 25% reduction in our carbon footprint by 2015. A reduction in car usage and increase in the use of other forms of transport would assist the NHS to achieve this target and contribute to the Eco Island objectives of creating a sustainable and pleasant Island for both residents and visitors.

The NHS Constitution4 for England makes clear that the NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is committed to working jointly with local authorities and a wide range of other private, public and third sector organisations at national and local level to provide and deliver improvements in health and well-being.

This document seeks to set out a menu of options open to the PCT and seek your views on which ones we should prioritise. Undoubtedly there are some things we have direct influence over and others we can only hope to influence. We do however need your assistance in deciding what is important and what you think will have the most impact.

This document is split into sections and throughout asks questions for everyone and questions for staff to consider. The Consultation response form at Appendix 11 sets these questions out and we would be very grateful if you could complete whole of the form. We do however recognise that some respondents will only want to focus on the area of particular interest to them.

A balance has to be struck between:

• ensuring that patients, visitors and staff have access to the St. Mary’s Hospital site;

• managing the limited parking space available – even if that is expanded

• promoting healthy and active modes of transport; and

• meeting our commitments to reduce the carbon footprint of the NHS

We welcome constructive contributions from all members of staff, patients and visitors and are seeking through this consultation process to prioritise the action we take.

Your views are important to us. The consultation response form can be found at the back of this document in Appendix 11. We welcome responses to all the different areas of the document but if you want to respond to just one or two sections please do so. Please make sure you return your comments by 13th May 2011 by e-mail to [email protected] or by mail to Travel to Hospital Consultation Estates Management Department, St. Mary’s Hospital, Parkhurst Road, NEWPORT, PO30 5TG. Further copies of this document can be downloaded from the Travel to Hospital consultation page at www.iow.nhs.uk/yoursay or by e-mailing or contacting the Estates Management Office.

1 National consultation on car parking:

http://collections.europarchive.org/tna/20100509080731/http://dh.gov.uk/en/Consultations/Closedconsultations/DH_110557 2 Sustainable NHS: http://www.sdu.nhs.uk/

3 NHS Isle of Wight Carbon Management Programme: www.iow.nhs.uk/green

4 NHS Constitution for England:

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_113613

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Cycling to St. Mary’s Building Britain’s Future5 committed the Government to develop an Active Travel Strategy6 and National Cycle Plan which is being led across Government by the Department for Transport (DfT) and the Department of Health (DH). Through this strategy the Government aims to: o Promote better public health and well-being by increasing

levels of physical activity, particularly among the most inactive people in our society;

o Increase accessibility and reduce congestion; o Improve air quality and reduce carbon emissions. The Government wants key destinations to be more accessible by active modes of travel (e.g. cycling and walking) encouraging a greater take up of active travel. They also aim to contribute to wider road safety outcomes, by reducing the risk to cyclists and walkers of death and serious injury per km travelled in road traffic accidents. The Government want cycling to be the preferred mode of local transport in England in the 21st Century, and want to see: o Local authorities introduce 20mph zones and limits into more residential streets (and other streets

where there are many pedestrians and cyclists), making streets safer and more attractive for cycling and walking.

o Every major public sector employer signed up to the Cycle to Work Guarantee. o Cycle parking at or within easy reach of every public building.

NHS Isle of Wight was an active participant in the 2010 Wight Wheels Challenge7 and with Isle of Wight Council will be promoting the challenge again in 2011. A workshop is being organised for those interested in setting up a Bicycle Users Group (BUG) at St. Mary’s. The St. Mary’s Hospital site already has a number of cycle shelters and stands. Two of these were installed during summer 2010 but the others are older. Whilst there are shower facilities around the St. Mary’s site for staff these are not always well publicised or accessible to all staff. There are no cycle paths which lead onto the St. Mary’s Hospital site although the cycle path to Cowes is very

accessible from the site. NHS Isle of Wight pays cycle users 6.2p per mile for using their bicycle on official business. Appendix 1 details some of the ways in which cycling could be encouraged.

Please consider the following questions and then complete the Cycling section in the consultation response form.

For everyone

Q1 What would encourage you to cycle to and from the St. Mary’s Hospital site?

Q2 Where should additional cycle shelters be made available on the St. Mary’s Hospital site?

Q3 Should charging points be made available for electric bikes?

For NHS staff

Q4 Would a year round salary sacrifice scheme8 assist you with the purchase of a bicycle?

Q5 Where should additional shower facilities be made available on the St. Mary’s Hospital site?

5 Building Britain’s Future was published in June 2009 and the full document can be accessed at

http://www.hmg.gov.uk/media/27749/full_document.pdf. 6 Active Travel Strategy:

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_113102 7 More information about the Wight Wheels Challenge can be found at http://www.wightwheelschallenge.org.uk/.

8 A salary sacrifice is quite simply the giving up of gross salary i.e. the deduction for 'bike' will be seen on the gross side of

the payslip under pay and allowances as a minus. For further salary sacrifice guidance refer to the HMRC website at

http://www.hmrc.gov.uk/specialist/sal-sac-question-and-answers.htm

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Public Transport to St, Mary’s Hospital

Park and Ride

Apart from the public bus service provided by Southern Vectis (see below) there are no park and ride facilities for either patients and visitors or staff to and from the St. Mary’s Hospital site.

During the cold weather and period of snow in early 2010 the PCT operated minibuses for staff to and from Cowes and Ryde. This appeared to work well and was popular, in those unusual circumstances, with staff.

Please consider the following questions and then complete the Park and Ride section in the consultation response form.

For everyone

Q6 Would you use a minibus service if it were available on a daily basis?

Q7 Which routes should this service be provided on?

• Cowes to St. Mary’s

• Ryde to St. Mary’s

• Sandown to St. Mary’s

Q8 What would be a reasonable charge for a single journey?

Southern Vectis Bus Services

Southern Vectis are the islands bus operator. All the Island’s towns are connected to Newport by the Southern Vectis bus network and have routes serving them at a range of hourly, to every 8 minutes, operating day and night, seven days a week. Please see Appendix 2. Southern Vectis has a modern Bus Station in Newport that is staffed and has a high quality waiting room. From Newport buses serve St Mary’s every 8 minutes during the day on Monday to Fridays, and between every 10 and fifteen minutes at other times. Both Southern Vectis8, via their website, and Travel Line9 provide assistance with route planning.

The hospital has dedicated laybys which have shelters for poor weather. A pedestrian crossing controlled by lights ensures that patients, visitors and staff can cross the road safely.

Over 50% of bus journeys on the Island are made by those entitled to free travel for the over 60s. Around 20% of current customers use ‘contract’ season passes, which offer a substantial discount on single ‘pay as you go’ fares. These are priced at £22 for 7 days, £77 for 30 days and £198 for 90 days. Under 19s and students benefit from half-price travel on all ‘pay as you go’ and ‘contract’ passes.

For ‘pay as you go’ customers, through fares are available from any bus stop on the Island to St Mary’s, including journeys where a change of buses is required.

Please consider the following questions and then complete the Southern Vectis section in the consultation response form.

For everyone

Q9 What would encourage you to use a bus to get to and from St. Mary’s Hospital?

Q10 If you rely on a bus service affected by changes what alternatives are you considering for travel to and from St. Mary’s Hospital?

For NHS staff

Q11 Would you be interested in a salary9 sacrifice scheme for bus transportation?

Southern Vectis will be on hand at St. Mary’s Hospital on some days during the consultation period to answer your questions about bus services on the Island.

9 See note 8 on page 5.

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Help with travel costs

Some patients are eligible to claim a refund of their travel costs under the 'Healthcare Travel Costs Scheme' (HTCS) for the cost of travelling to hospital or other NHS premises for NHS-funded treatment or diagnostic test arranged by a doctor or dentist. More details about this scheme can be found on the NHS Choices website10.

Wightbus The Wightbus fleet, managed by Isle of Wight Council, comprises 19 vehicles with capacities ranging from 9 to 70 passenger seats. Wightbus operates a number of registered local bus services available to the general public over a variety of routes. Details of the Wightbus schedule are available on the Council website. During its recent budget deliberations the Council decided that it could no longer fund Wightbus and it will cease operations on 2nd September 2011. Please consider the following questions and then complete the Wightbus section in the consultation response form. For everyone Q12 What effect will the closure of Wightbus have on patients, visitors and staff travelling to St.

Mary’s Hospital and what could be done to mitigate that impact. Vehicle access to St. Mary’s In December 2009 the Department of Health published a consultation document on NHS car parking. The consultation closed in February 2010 and the Government published its response on 16th September 2010. The ministerial statement to the House of Commons on that date is shown at Appendix 5. The busiest days in the car parks at St. Mary’s Hospital are Tuesday, Wednesday and Thursday. Over a period of two weeks the car parking contractors monitored the number of cars having to park in un-designated spaces to provide an indication of the number of over-spill spaces required on a typical day. The average over the daily period totalled 195 spaces. Car Parking – The number of spaces There are 1,195 allocated parking spaces on the St. Mary’s Hospital site. Of these 377 are designated for patient and visitor use; 49 designated for disabled use; 6 are designated for the hospital car service and 762 designated for staff use. The PCT employs a contractor, CP Plus, to manage the car parks. Additional car parking spaces would require planning permission from Isle of Wight Council. Under the old Unitary Development Plan, published in 1997, St. Mary’s designated use was allowed one space per four beds plus one space per five members of staff working on the St. Mary’s Hospital site. This is an allocation of 739 spaces. In 2004 the then Isle of Wight Healthcare NHS Trust was given temporary planning permission for an additional 456 spaces to take account of the building work required to reclad the hospital.

10

NHS Choices website: http://www.nhs.uk/NHSEngland/Healthcosts/Pages/Travelcosts.aspx

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There are fields adjacent to the St. Mary’s Hospital site, owned by the PCT, which might be suitable for this purpose if planning permission were given and capital were available to invest in the creation of additional parking and walkways to and from the new facility. The estimated cost per space is £1,100. The tenancies on these fields can be ended by serving 6 months notice. An alternative would be to build a decked car park over an existing level car parking area. The costs of this would be approx £10,000 per space to buy or £30/£40 per space per week for a rental solution. Another alternative would be to review all green space on the hospital site and using latticed concrete (through which grass can grow) create overspill parking to be brought into use by the car parking contractor at times of peak demand. The cost of this is approximately £700 per space. There is also the possibility of negotiating with the owners of adjacent land for example HMP Isle of Wight, B&Q, etc. This has been done in the past and may be worth reviewing. Please consider the following questions and then complete the ‘Car Parking – Number of Spaces section’ in the consultation response form. For everyone

Q13 Should the balance of spaces between staff and patients and visitors be changed?

Q14 Should the PCT seek planning permission for additional parking?

Q15 How far is it reasonable to walk from the car parking to the clinic or office?

Q16 Should the PCT spend money on car parking spaces which could be spent on healthcare?

Q17 Should charging points be made available for electric cars?

Q18 Should there be more Disabled parking spaces on the St. Mary’s Hospital site?

Q19 Should utilising surplus land close to the St. Mary’s Hospital site be reviewed? Car Parking – Parking Costs and Permits Since 2002 patient and visitor parking has been operated on a ‘pay and display’ basis. This was introduced because the hospitals previously free car parking was being abused by individuals who were not using or working at the hospital. For staff and hospital volunteers the PCT operates a parking permit scheme. Whilst the permits are free to volunteers, staff pay a fee for parking (see Appendix 6). There are 230 permits issued to volunteers and 3,165 permits issued to staff. Although the number of permits issued appears to far exceed the number of spaces it should be remembered that some staff work both part time and on shift patterns which spreads the demand across the week including weekends. In 2009/10 the fees charged to patients, visitors and staff provided the PCT with income of £416,000 of which £102,000 comes from staff. Approximately half the £416,000 covers the cost of maintaining the car parks and hospital security. The other half helps to pay for health services. The difference between in-patients, out-patients and visitors is not monitored. The fees charged, when compared with charges elsewhere on the Island and our nearest hospitals on the mainland compare well (see Appendix 7). Whilst the parking attendants try to help individuals find spaces persistent offenders who park inappropriately or incorrectly (e.g. on double yellow lines, in disabled spaces without permits, or do not have a valid staff parking permit or ticket) are subject to a £60 fine. Vehicles which block fire routes and other essential access are towed. Currently the car parking contractors do not clamp vehicles. One option to manage the availability of parking spaces would be to increase the parking fees for staff. As a comparison Southampton University Hospitals currently charge the following per month:

o Bands 1-4= £15 (£180 pa) o Bands 5,6,7= £30 (£360pa) o Bands 8A-8B= £45 (£540pa) o Bands 8C and above = £60 (£720pa)

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And this gives the employee the 'right to roam' for a parking space, i.e. no guarantee of a space. The PCT receives a substantial number of complaints about the difficulty with car parking each year. These range from aggrieved staff who have received a parking charge notice to patients/consultants who arrive late for appointments due to not being able to find a parking space. Please consider the following questions and then complete the Car Parking – Costs section in the consultation response form. For everyone

Q20 Should the cost of pay and display parking for patients and visitors be increased?

Q21 Should parking charges for patients, visitors and staff be more expensive than a return bus journey?

Q22 Should the PCT increase enforcement of parking by: (a) increasing fines? (b) introducing clamping?

Q23 Should disabled persons be charged for parking? For staff Q24 Should a restriction on parking permits for staff be introduced? Q25 Should the purchasing of the permits be run as a Salary Sacrifice Scheme11? Q26 If a parking restriction zone were introduced for staff how far should that extend (i.e. how far is

it reasonable for staff to walk to cycle to the St. Mary’s site)? Such a scheme would require administration including an appeals process.

Q27 Should a restriction on the numbers of days a permit is valid be introduced? For example

permits might be introduced for use on four days in a week with the member of staff required to find alternative ways of getting to St. Mary’s Hospital (e.g. walk, cycle, bus or car share) on the other days.

Q28 Should the cost of parking permits for staff be increased?

Q29 Should parking permit charge be based on the engine size – e.g. cars with a smaller engine

size (and a smaller carbon footprint) would pay less than cars with larger engines? Q30 How do we cater for staff who require their own car for use on NHS business and have to

make frequent journeys to and from St. Mary’s during the course of a day (e.g. for example a District Nurse service the Newport area might make several return trips to St. Mary’s between visits – there could be a significant waste of resource if the nurse has to search for a car parking space every time)?

Q31 Should PCT subsidise incentives for travel to work by bus and cycle by an increase in permit

charges? Q32 Would you be prepared to pay more for a guaranteed parking space?

11

See note 8 on page 5.

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Car Parking – Shift and Clinic Patterns Planning for the future car parking requirements of the NHS on the Island depends on (a) changes in where services are located, (b) changes in clinic and (c) changes in shift patterns. At present most shifts start at 07:00hrs and 19:00hrs but they can vary. Most office based jobs start at 09:00 and end at 17:00. Please consider the following questions and then complete the Car Parking – Shift and Clinic Patterns section in the consultation response form. For everyone

Q33 Should more clinics be held at times when the site is not so busy e.g. early evenings, Mondays, Fridays, Saturdays or Sundays?

Q34 Should the practice of calling all patients for a clinic at the same time be stopped (e.g. ten patients for a clinic running from 09:00 to 12:00 are all asked to attend at 09:00)?

Q35 Do you feel that the PCT should increase home working and flexi-time and do you think this would benefit your service? Car Share The PCT has a car share scheme on its intranet which is underused and not well publicised. Isle of Wight Council, Isle of Wight College and Isle of Wight Chamber of Commerce, Tourism and Industry are members of Car Share Wight (www.carsharewight.com), an Island wide car share scheme. For everyone Q36 Should the PCT sign up to Car Share Wight? Q37 How should the PCT publicise car sharing? Q38 The PCT is considering reducing the permit cost for car sharing. What other incentives should the PCT offer to staff for sharing cars? Mobility Scooters The Isle of Wight has a larger than average elderly population and this is predicted to increase over the coming years. Alongside this increase there has been a growth in the availability and popularity of electric powered mobility scooters. Please consider the following questions and then complete the ‘Mobility Scooter’ section in the consultation response form. For everyone Q39 Should there be dedicated parking areas for mobility scooters? Q40 Should dedicated charging points for mobility scooters be installed? Motorcycles There are a number of designated parking areas at St. Mary’s Hospital for motorcycles. Motorcycle parking is free. Please consider the following questions and then complete the ‘Motorcycle’ section in the consultation response form.

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For everyone

Q41 Should motorcyclists pay for parking at St. Mary’s Hospital? Q42 Are more parking areas for motorcycles required at St. Mary’s Hospital?

NHS Pool Cars

The PCT has several ‘pool’ cars. These are booked through the Transport Department which are publicised to staff via the organisations intranet. There are no designated parking spaces on the St. Mary’s site for the cars.

Please consider the following questions and then complete the ‘NHS Pool Car’ section in the consultation response form.

For staff

Q43 Should the PCT expand the number of pool cars available?

Q44 What criteria should be used to manage their use?

Q45 How can we encourage staff to use pool cars?

Q46 How can we avoid the scenario where staff park at the hospital site and then use a pool car for official business?

Patient Transport Service The Island’s Ambulance Service is commissioned to provide a Patient Transport Service for those who meet medical criteria which operates in accordance with national guidelines which are available on the Department of Health website12. Please consider the following questions and then complete the ‘Patient Transport’ section in the consultation response form. For everyone Q47 How can we better publicise the availability and criteria of the Patient Transport Service? Voluntary Car Services The Island’s ambulance service is supported by a number of voluntary hospital car drivers who freely donate their time and are reimbursed for their fuel / vehicle wear and tear. The service is available Monday to Friday 8:00a.m. to 4:30p.m.. The Island has other voluntary car schemes. This includes Optio provided by the Isle of Wight Rural Community Council (RCC). More details are provided in Appendix 10. Please consider the following questions and then complete the ‘Hospital Care Service’ section in the consultation response form. For everyone Q48 Should the PCT seek to expand the Hospital Car Service? Q49 Should the PCT seek to work more closely with or perhaps even seek to merge the Hospital

Car Service with the voluntary car scheme operated by the Rural Community Council?

12

Eligibility criteria for patient transport services (PTS): http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_078373

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Road Network on the St. Mary’s Hospital site The road network on the St. Mary’s Hospital site provides access to a variety of locations and buildings on the site. Work has been undertaken in recent years to improve the signage on the site to assist patients and visitors to find their way around. A St. Mary’s site map is shown in Appendix 3. Because of its location the roads also provide a convenient route for road users seeking to avoid the bottle necks caused at peak travel times by the St. Mary’s Roundabout. At these peak times the site effectively becomes a ‘rat run’ for those attempting to avoid congestion but the additional traffic can be a danger to patients, visitors and staff. A recent survey (see Appendix 9) has shown that during the course of one week (22nd to 28th November 2010), between 08:00hrs and 18:00hrs, over 6,000 vehicles travelled through the St. Mary’s site with no purpose other than to avoid the roundabout outside St. Mary’s. The flow of traffic peaks between 08:00hrs and 10:00hrs and then again between 16:00hrs and 18:00hrs. The speed used by some of these vehicles far exceeds the site limit of 20 miles per hour. Please consider the following questions and then complete the ‘Road Network’ section in the consultation response form. For everyone Q50 How can the PCT further improve the signage on the site? Q51 Would it be useful to name the roads on the St. Mary’s Hospital site? Q52 How could the St. Mary’s Hospital site map (Appendix 3) be improved? Q53 Would you support traffic calming measures (e.g. speed bumps, pinch points, barriers, etc.) on key roads on the St. Mary’s Hospital site? Walking to St. Mary’s Hospital The PCT is encouraging as many Islanders including staff to walk. Walking is a natural, accessible and essential transport mode. Journeys made by car or public transport typically include a walking component in order to reach the final destination. Walking also represents a vital transport mode for certain demographic groups, for example the young, or older people who may no longer be able to drive, for example because of visual impairment. The Government’s plans to get more people walking more often are founded on two pillars:

• Wherever possible creating an environment in which walking is safe, convenient and enjoyable.

• Encouraging people of all ages to find their feet through programmes like Walking for Health, 2012 Active Challenge Routes, Walk Once a Week (WoW) and web-based walking route finders.

The PCT is already supporting Islanders of all ages to find their feet through programmes such as Walking for Health and Walk 4 Life. Programmes like this give people the chance to re-evaluate walking opportunities in their local environment and provide them with the confidence to undertake short journeys on foot. Similarly, Walk Once A Week is helping to stimulate a new school travel culture by encouraging parents and pupils to walk to school at least once a week. There is a good network of footpaths onto the St. Mary’s Hospital site from Parkhurst Road. However footpaths from Dodnor Lane onto the site are limited and in places non-existent, requiring

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those on foot to walk in the road with traffic. There are some issues with a lack of footpaths on the hospital site. Following the Government’s Comprehensive Spending Review (CSR) the Council led Private Finance Initiative (PFI) scheme has been scaled back. One of the areas to be removed from the scheme was funding for the renewal or creation of footpaths. Please consider the following questions and then complete the ‘Walking’ section in the consultation response form. For everyone Q54 What would encourage you to walk to the St. Mary’s Hospital site?

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Appendix 1

ENCOURAGING CYCLING TO WORK There’s more to it than showers and cycle parking …. Note for Acute NHS Trusts in the south west by Rob Marshall, Transport Initiatives

Cycle parking Essential – convenience and security for bicycles

• secure and under cover

• lockable compounds are preferable

• always use inverted ‘U’ shaped Sheffield stands (and definitely not ‘wheelgrabbers’)

• easily accessible and located close to workplace

• additional provision for visitors Lockers and showers Essential –

somewhere to store any bike essentials, change and freshen up

• secure storage locker and changing facilities are more useful than showers to most staff

• drying and ironing facilities, complimentary shower packs and towels

• work with your staff Bicycle User Group to determine what the priorities are

Bicycle User Group (BUG)

Essential – forum and voice for staff cyclists. They help you, you help them.

• invaluable local knowledge and experience

• test proposals, feedback and new initiatives

• ensures any initiatives meet cyclists’ needs

• co-operation and collaboration

• members assist and deliver many other initiatives

• allow BUG to meet in work time?

• provide staff bike tool kit and allow trained or experienced BUG members to repair punctures, make minor repairs, etc

Barriers to Cycling - Survey

Essential – seek views from all staff about what would encourage them to cycle more.

• determine potential for change – who are the ‘Could but Won’t’; ‘Could and Might’; ‘Existing cyclists’?

• work with Existing cyclists (BUG) on how best to target the ‘Could and Might’ potential cyclists

• identify barriers and think about how to help ‘Could and Mights’ overcome them (see below)

• identify positive aspects and opportunities

• develop a targeted strategy for: infrastructure, marketing, support & encouragement

1. Try before you buy - see which bike suits and just how easy it is to cycle to work

• provide selection of bikes for free week’s loan: road bikes, folding bikes (useful if train/bus journey involved), electric bikes (hills or fitness worries)

• remember that cheap bikes are not cost-effective and are less efficient than a good bike

• sale/loan of good quality bike locks and other equipment

• may be possible to work with local bike shop, supply and discounts may be offered

• group insurance cover (e.g. through CTC) 2. Cycle lease – bike purchase assistance on lease back scheme

• provision of bike, leased to employee at modest monthly rate

• or interest-free loans

3.Salary sacrifice bike purchase

• purchase of new bike at about 60% cost through government’s ‘cycle to work’ tax incentive scheme

4. Cycle auctions – bike purchase

• collaboration with police and/or local cycle group to use refurbished, recovered bikes

Overcoming the barriers to cycling: a range of practical help and assistance to overcome the usual reasons given for not cycling. All or most of these initiatives should be included as essential elements in a cycling to work action plan.

5. Dr Bike cycle ‘health checks’- bike maintenance

• offer periodic bike checks

• organised through BUG or local cycle shop

• labour charge covered by employer, staff pay cost of parts

• offer bicycle maintenance course

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6. ‘Get you home’ scheme – peace of mind

• reassurance in event of mechanical breakdowns or emergencies, or just a change of plan

• provide recovery service

• particularly reassuring for female staff

• deliver through car share scheme or provision of taxi

7. Cycle training – improves skills and confidence

• cycle training for new, returning or less confident cyclists

• training is available through local authority or specialist companies

8. Bike Buddy - reassurance from existing cyclist

• advice and company to start cycling from fellow staff

• help with routes, techniques, safety

• deliver through BUG 9. Cycling distance and routes to work -

• determine who lives where (from staff survey or HR records)

• 3 miles is easy cycling

• 5 miles is quite possible for most people

• over 5 miles generally for enthusiasts

• determine the adequacy of main routes for cyclists

• remember that on-road cycling is often the most direct and quickest (and not as dangerous as some may think – cycle training will help overcome this)

• existing cycle maps may be available or site-specific route maps could be developed

• personalised route planning (i.e. one-to-one advice, maybe with help from BUG)

• investigate possibility of providing useful short-cuts onto the site (not available to car drivers)

• consider contributing funds to LA for cost-effective route improvements more distant from the site

10. New staff induction - cycling induction session and info/goodies pack

• ensure positive, informed session is provided that highlights benefits and opportunities for cycling to work

• include a pack that includes all the offers and incentives

• consider a site tour by bike highlighting routes within the site and associated facilities

Cycle miles • reward staff based on cycle distance

• helps encourage those who live further away Extra holiday allowance

• reward staff who cycle regularly with extra holiday or time off entitlement

• e.g. 1 day off every 50 days cycled to work, or 5 or 10 minutes per day – many possibilities!

Discount vouchers • accrue vouchers on days biked for bike merchandise or more general goods (M&S, etc)

Reward regular cycling or non car parking use – direct payments, discounts, additional holiday allowance, shorter working week. Incentives such as these are very powerful when associated with limited and/or charged on-site car parking.

Annual credit for giving up car parking space

• reward staff who give up a parking space by cash or vouchers or other perks

Promotion and marketing. The so-called ‘soft measures’ are just as important as infrastructure and incentives.

A programme of cycling events that drip-feeds the benefits and opportunities for cycling throughout the year. Staff BUG will be a key delivery aid and mechanism.

• regular Bike to Work days (hopefully with senior management leading by example)

• Bike Week (breakfasts, ‘CATI’ (‘Come and try it’) events

• sponsored charity rides linked to health benefits

• commuter challenge – advantage of cycling to work

• commitments to cycling to work on one or two days per week

• remember to publicise events and make most of it in press and media

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Appendix 2 Southern Vectis Bus Routes

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Appendix 3 Site Map of St. Mary’s Hospital

Source: http://www.iow.nhs.uk/index.asp?record=1203

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Appendix 4

Distances to St. Mary’s Hospital, Parkhurst Road, Newport (Return Journeys)

PLACE MILEAGE Alum Bay 32 Apse Health 19 Arreton 11 Bembridge 27 Binstead 14 Blackgang 21 Bonchurch 27 Brading 21 Brighstone 17 Brook 23 Calbourne 13 Carisbrooke 6 Chale 17 Cowes 10 East Cowes 13 Fishbourne 11 Freshwater 24 Gatcombe 9 Godshill 14 Lake 20 Luccombe 24 Newport 3 Newchurch 13 Ningwood 18 Niton 20 Parkhurst 3 Ryde 16 St. Helens 23 St. Lawrence 23 Sandown 21 Seaview 20 Shalfleet 15 Shanklin 22 Shorwell 13 Thorley 18 Totland 29 Ventnor 25 Whippingham 9 Whitwell 21 Winford 16 Wootton 11 Wroxall 23 Yarmouth 20 Yaverland 23

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Appendix 5

WRITTEN MINISTERIAL STATEMENT DEPARTMENT OF HEALTH

NHS Parking: Response to Consultation

Thursday 16 September 2010

The Minister of State, Department of Health (Mr Simon Burns): I am today publishing the

government’s response to the recent public consultation13

on car parking at National Health Service

hospitals issued by the previous administration before the election.

That consultation set out proposals to introduce mandatory free parking for many inpatients and

outpatients. Those proposals would cost the NHS in excess of £100m. The impact assessment states

that it would lead to a net disbenefit to patients valued at almost £200m. This negative impact arises

from substantial health benefits foregone from not investing this income in healthcare, offset by lower

financial benefits to favoured car park users. The impact also does not include environmental costs

associated with the policy, which would also clearly be adverse. At a time when the NHS needs to

make every penny of its budget count the government cannot support such a proposal.

Moreover, the government has embarked on a very clear strategy for the NHS that reduces central

control and intervention in operational decisions, giving NHS managers the autonomy to make

decisions that reflect the needs of their local community. Telling the NHS how to run their car parks

would be inconsistent with this principle.

However, our strategy also puts patients at the centre of decision making, and supports patients to be

able to make informed choices. It is clear from the consultation feedback that the parking policies and

practices in some trusts fall short of these standards. Patients undergoing extended outpatient

treatment, and long-stay inpatients, should not be further disadvantaged, and nor should their health

needs be possibly compromised by high cumulative parking costs. A fair scale of concessionary rates

should be offered, and all eligible patients should be fully informed and helped to take advantage of

them. These standards are fundamental to patient centred care and informed choice.

Through our announcement today we are:

- ensuring that the NHS is made aware of patients’ concerns;

- asking trusts to work with local groups to examine their current policies and practices and

ensure that they are genuinely fair;

- emphasising the importance of promoting these fully to eligible patients, prior to and during

their treatment; and

- asking the NHS Confederation, who already provide best practice guidance on parking policy,

to engage further with parking providers and patient advocate groups to respond to the

concerns identified through the consultation.

Local autonomy requires local accountability. It is for trust boards to ensure that their policy is fair and

patient centred, and has the support of its local community. The challenge now is for the NHS

collectively and locally, to take action to deliver the fair access that their patients expect.

The government’s response and a summary of the responses to the consultation have been placed in

the Library. Copies of the government’s response are also available to hon Members in the Vote

Office.

13

The consultation documents can be found at http://collections.europarchive.org/tna/20100509080731/http://dh.gov.uk/en/Consultations/Closedconsultations/DH_11055

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Appendix 6

St Mary’s Hospital Car Parking Information

Charges for patients and visitors

The car parks and site security at St Mary’s Hospital are managed on behalf of the Primary Care Trust by CP Plus. CP Plus has a base on the St Mary’s site adjacent to the main visitor’s car park at the front of the hospital.

The CP Plus Team can be contacted by phoning 01983 534500 or 07887 501371 or in an emergency paged by the switchboard.

From April 2006 until December 2010 parking charges for patients and visitors saw no increase. The prices were increased from January 2011 to reflect increased costs and the 2.5% increase in VAT from 17.5% to 20%. Parking fees between 2006 and 2010 were and from 2011 are:

Period of parking April 2006 to December 2010 From 1st January 2011

Up to 2 hours £1.20 £1.30

Up to 4 hours £2.40 £2.50

Up to 6 hours £3.60 £3.70

6 to 24 hours £6.00 £6.20

Individuals requiring assistance can press the red button on the side of the pay machines.

Penalty tickets are issued for infringement of the sites parking conditions shown on notices in each car park at the rate of £60 (reduced to £30 if paid within 7 days).

Concessions

Disabled Drivers (blue badge holders)

• Free parking for the first 3 hours thereafter the public rate will apply

• Blue badge holders are asked when ever possible to park in disabled parking bays but if full may use the main car park free of charge for 3 hours

Long-term inpatients

• First 7 days at the concessionary rate of £1.50 for 24 hours

• Thereafter free of charge

The ward staff will advise CP Plus if concessionary tickets are requested and if necessary one of the CP Plus team will go to the ward to issue the tickets

Visitors of Long Term patients

• First seven days at public rate

• Following 7 days at the concessionary rate of £1.50 for 24 hours


• Thereafter free parking (to those making 4 or more visits a week) for the duration of the patients stay upon production of a letter of authorisation from the ward manager to CP Plus

Parents who are required to stay overnight with their children

• The concessionary rate of £1.50 for 24 hours for the first two weeks will apply


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• Thereafter free parking for the duration of the child’s stay upon production of a letter of authorisation from the ward manager to CP Plus

Motor cycles

Free of charge in designated spaces

Charges for staff

From April 2006 until December 2010 parking charges for staff saw no increase. The prices were increased from January 2011 to reflect increased costs and the 2.5% increase in VAT from 17.5% to 20%. Parking fees between 2006 and 2010 were and from 2011 are:

Daily Rate April 2006 to December 2010 From 1st January 2011

Under four hours 30p 40p

Over four hours 50p 60p

Source: http://www.iow.nhs.uk/index.asp?record=1205

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Appendix 7 Parking Fees Comparison Charges to the public and visitors

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Appendix 8

St. Mary’s Hospital Traffic Survey – November 2010

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Appendix 9

Optio Voluntary Car Service Who is eligible? Elderly, frail or less mobile residents who are unable to access public transport, to get to appointments and access the services and support they need. About the Scheme Across the Island there is a network of volunteer drivers who give their time freely, using their own cars to provide a door to door service. The service is available to support users to attend:

• Medical appointments • Hospital appointments/visits • Day Centres • Memory clubs and activities • Visiting friends and social trips • Shopping

How to book a trip Phone the Helpline on 522226 to book your trip. Journeys must be arranged in advance (at least 48hrs if possible). The helpline is open from 9.00 am till 3.00 pm Monday—Friday. There is an answer phone service for out of hour’s calls which will be dealt with promptly when the office reopens. What will it cost? Optio is a membership scheme. There is an annual or 6 monthly membership fee, please see the attached leaflet for prices. There is also a driver’s mileage charge of 40p per mile, reimbursed directly to the volunteer driver, who will provide you with a receipt for the cost of the trip. (A minimum charge of £2.50 per trip, e.g. journey under 6 miles) Mileage costs are calculated from the driver’s home and return, not from the user’s address. Volunteer Drivers Optio is reliant on the goodwill of the volunteer drivers and it is not possible to guarantee that every trip request will be met but we will do our best. More volunteer drivers are always needed. If you are a car driver with some time to spare why not give a little time to help your community. For more information please download the driver’s information from the Isle of Wight Rural Community Council website at http://www.iwrcc.org.uk/community_transport.aspx or e-mail [email protected]. Source: http://www.iwrcc.org.uk/community_transport.aspx

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Appendix 10 Who is being consulted? The consultation is being brought to the attention of:

• Voluntary organisations registered with NHS Isle of Wight as having an interest in health issues

• NHS Isle of Wight staff

• Local Involvement Network (LINk) Members (circa 400 members of the public)

• Patient Panel Members (circa 250 members of the public) The following organisations are being sent a copy of the consultation directly:

• Ambulance Service

• Chamber of Commerce, Tourism and Industry

• Companies and organisations on the roads which access the St. Mary’s Hospital site including B&Q, HSS Hire

• Cycle Wight

• CP Plus (the car park operator at St. Mary’s Hospital)

• Friends of St. Mary’s Hospital

• GP Commissioning Consortium

• GP Practices

• Help and Care

• HMP Isle of Wight

• Island Line

• Isle of Wight Bus Users Group

• Isle of Wight College

• Isle of Wight Council inc the Transport and Environment departments

• Isle of Wight Environment Forum

• Isle of Wight Scrutiny Panels

• Children and Young People

• Economy and Environment

• Health and Community Wellbeing

• Local Involvement Network (LINk) Steering Group

• NHS Isle of Wight Staff Partnership Forum

• Parish Councils

• Patient Council

• Pharmacies

• Rural Community Council (IWRCC)

• Southern Vectis

• Sunshine (Hospital) Radio

• Taxi companies

• Tenants leasing the fields owned by the PCT adjacent to the St. Mary’s Hospital site

• Town Councils

• Voluntary Car Services – Optio and the Hospital Car Service

• YMCA Nursery

The consultation document will be available on Travel to Hospital consultation page of the NHS Isle of Wight website at www.iow.nhs.uk/yoursay.

A press release will be issued to local media and information sent to the IWRCC’s, Isle of Wight Council and voluntary organisations for inclusion in their newsletters.

Copies of this document will be available at Reception in the Main Entrance at St. Mary’s Hospital and in the Full Circle Restaurant from Monday 4th April.

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This page blank – available for notes

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Appendix 11

Travel to St. Mary’s Hospital Consultation Response Form

We would prefer this form to be returned to us electronically as an email attachment. The email address for responses or queries is [email protected]. You can provide a covering letter by email if you wish. Postal responses can be sent to:

Travel to Hospital Consultation Estate Management Department St. Mary’s Hospital Parkhurst Road NEWPORT PO30 5TG

Email responses to the consultation will receive an acknowledgement of receipt. Postal responses will not receive an acknowledgement. The consultation closes on the 13th May 2011.

YOUR CONTACT DETAILS Name Contact address Postcode Contact Telephone E-mail

Freedom of Information I do not wish my response to be published in a summary of responses

Please delete as appropriate. I am responding:

- as a member of the public - as a health care or health protection professional or expert - on behalf of an organisation

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If you are responding as a professional, please supply the following details: Area of work:

NHS

Social Care

Private Health

Third Sector

Regulatory Body

Professional Body

Education

Trade Union

Local Authority

Trade Body

Other (Please give details)

Independent Contractor to NHS [

Manufacturer

Supplier

Other (where relevant)

If you are responding on behalf of an organisation, please indicate which type of organisation you represent:

NHS

Social Care

Private Health/Independent Sector

Third Sector

Regulatory Body

Professional Body

Education

Trade Union

Local Authority

Trade Body

Other (Please give details)

Please provider the post code of where you:

Live Work

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About You Please provide us with some information about yourself. This will help us to determine whether we have captured the views of everyone. All the information you provide will be kept completely confidential. No identifiable information about you, will be passed to on to any other bodies, members of the public or press.

1. What is your sex? (Tick one box only)

Male � Female �

2. Which age group do you belong to? (Tick one box only)

0-15 yrs �

16-24 yrs �

25-34 yrs �

35-44 yrs �

45-54 yrs �

55-64 yrs �

65-74 yrs � 75-84 yrs �

85 yrs and over �

3a. Do you have a disability as defined by the Equality Act 2010 (Tick one box only)

Yes � No �

The Disability Discrimination Act (DDA) defines a person with a disability as “someone who has a physical or

mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal

day to day activities”. 3b. If yes, please tick all which apply

Partial or total loss of hearing �

Partial or total loss of vision � Speech impediment or impairment �

Other communication difficulty �

Mobility impairment or difficulty moving around �

Learning difficulty or learning disability �

Mental health condition or disorder �

Severe physical disfigurement � A long standing illness or disease �

Other medical condition or impairment (please specify) _______________________________

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Cycling For everyone

Q1 What would encourage you to cycle to and from the St. Mary’s Hospital site?

Q2 Where should additional cycle shelters be made available on the St. Mary’s Hospital site?

Q3 Should charging points be made available for electric bikes? For NHS staff

Q4 Would a year round salary sacrifice scheme assist you with the purchase of a bicycle?

Q5 Where should additional shower facilities be made available on the St. Mary’s Hospital site?

Comments on Cycling

Park and Ride For everyone

Q6 Would you use a minibus service if it were available on a daily basis?

Q7 Which routes should this service be provided on?

• Cowes to St. Mary’s

• Ryde to St. Mary’s

• Sandown to St. Mary’s

Q8 What would be a reasonable charge for a single journey?

Comments on Park and Ride

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Southern Vectis Bus Services

For everyone

Q9 What would encourage you to use a bus to get to and from St. Mary’s Hospital?

Q10 If you rely on a bus service affected by changes what alternatives are you considering for travel to and from St. Mary’s Hospital? For NHS staff

Q11 Would you be interested in a salary sacrifice scheme for bus transportation?

Comments on Southern Vectis Bus Service

Wightbus For everyone Q12 What effect will the closure of Wightbus have on patients, visitors and staff travelling to St.

Mary’s Hospital and what could be done to mitigate that impact.

Comments on Wightbus

Car Parking – The number of spaces For everyone

Q13 Should the balance of spaces between staff and patients and visitors be changed?

Q14 Should the PCT seek planning permission for additional parking?

Q15 How far is it reasonable to walk from the car parking to the clinic or office?

Q16 Should the PCT spend money on car parking spaces which could be spent on healthcare?

Q17 Should charging points be made available for electric cars?

Q18 Should there be more Disabled parking spaces on the St. Mary’s Hospital site?

Q19 Should utilising surplus land close to the St. Mary’s Hospital site be reviewed?

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Comments on Car Parking – The number of spaces Car Parking – Parking Costs and Permits For everyone

Q20 Should the cost of pay and display parking for patients and visitors be increased?

Q21 Should parking charges for patients, visitors and staff be more expensive than a return bus journey?

Q22 Should the PCT increase enforcement of parking by: (a) increasing fines? (b) introducing clamping?

Q23 Should disabled persons be charged for parking? For NHS staff Q24 Should a restriction on parking permits for staff be introduced? Q25 Should the purchasing of the permits be run as a Salary Sacrifice Scheme? Q26 If a parking restriction zone were introduced for staff how far should that extend (i.e. how far is

it reasonable for staff to walk to cycle to the St. Mary’s site)? Such a scheme would require administration including an appeals process.

Q27 Should a restriction on the numbers of days a permit is valid be introduced? For example

permits might be introduced for use on four days in a week with the member of staff required to find alternative ways of getting to St. Mary’s Hospital (e.g. walk, cycle, bus or car share) on the other days.

Q28 Should the cost of parking permits for staff be increased?

Q29 Should parking permit charge be based on the engine size – e.g. cars with a smaller engine

size (and a smaller carbon footprint) would pay less than cars with larger engines? Q30 How do we cater for staff who require their own car for use on NHS business and have to

make frequent journeys to and from St. Mary’s during the course of a day (e.g. for example a District Nurse service the Newport area might make several return trips to St. Mary’s between visits – there could be a significant waste of resource if the nurse has to search for a car parking space every time)?

Q31 Should PCT subsidise incentives for travel to work by bus and cycle by an increase in permit

charges?

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Q32 Would you be prepared to pay more for a guaranteed parking space?

Comments on Car Parking – Parking Costs and Permits Car Parking – Shift and Clinic Patterns For everyone

Q33 Should more clinics be held at times when the site is not so busy e.g. early evenings, Mondays, Fridays, Saturdays or Sundays?

Q34 Should the practice of calling all patients for a clinic at the same time be stopped (e.g. ten patients for a clinic running from 09:00 to 12:00 are all asked to attend at 09:00)?

Q35 Do you feel that the PCT should increase home working and flexi-time and do you think this would benefit your service?

Comments on Car Parking – Shift and Clinic Patterns Car Share For everyone Q36 Should the PCT sign up to Car Share Wight? Q37 How should the PCT publicise car sharing?

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Q38 The PCT is considering reducing the permit cost for car sharing. What other incentives should the PCT offer to staff for sharing cars?

Comments on Car Share Mobility Scooters For everyone Q39 Should there be dedicated parking areas for mobility scooters? Q40 Should dedicated charging points for mobility scooters be installed?

Comments on Mobility Scooters Motorcycles For everyone Q41 Should motorcyclists pay for parking at St. Mary’s Hospital? Q42 Are more parking areas for motorcycles required at St. Mary’s Hospital?

Comments on Motorcycles

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NHS Pool Cars For NHS staff Q43 Should the PCT expand the number of pool cars available? Q44 What criteria should be used to manage their use? Q45 How can we encourage staff to use pool cars? Q46 How can we avoid the scenario where staff park at the hospital site and then use a pool car for official business?

Comments on NHS Pool Cars Patient Transport Service For everyone Q47 How can we better publicise the availability and criteria of the Patient Transport Service?

Comments on Patient Transport Service Voluntary Car Services For everyone Q48 Should the PCT seek to expand the Hospital Car Service? Q49 Should the PCT seek to work more closely with or merge the Hospital Care Service with the voluntary car scheme operated by the Rural Community Council?

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Comments on Voluntary Car Service Road Network on the St Mary’s Hospital Site For everyone Q50 How can the PCT further improve the signage on the site? Q51 Would it be useful to name the roads on the St. Mary’s Hospital site? Q52 How could the St. Mary’s Hospital site map (Appendix 3) be improved? Q53 Would you support traffic calming measures (e.g. speed bumps, pinch points, barriers, etc.) on key roads on the St. Mary’s Hospital site?

Comments on Road Network on the St Mary’s Hospital Site Walking to St Mary’s Hospital For everyone Q54 What would encourage you to walk to the St. Mary’s Hospital site?

Comments on Walking to St Mary’s Hospital

Documents

Travel to St Mary's Hospital - Consultation