A general view of the Gloucestershire Royal Hospital. Photograph: Getty Images.
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To be truly free, the NHS needs to scrap hospital parking charges

Patients should not be put off going to hospital, nor relatives from visiting their loved ones, by parking fees.

The NHS is one of the greatest aspects of Britain’s society that makes us proud to be British, according to a 2010 survey. This is no surprise - our health service provides an excellent standard of care, free at the point of delivery, for all of its citizens. But for millions of people across England, using this service and visiting their loved ones can result in a them being significantly worse off
 
Since being elected as MP for Harlow in 2010, I have contacted countless times by constituents who have been outraged at the cost of hospital parking. I therefore decided to launch an investigation into the costs of parking at hospitals across England. 
 
The results were shocking: not only were some hospitals charging extortionate amounts for even short stays, but there were also huge variations in the prices that visitors face across the country. The average charge for car parking at hospitals across England as a whole is around £1.50 per hour, sliding up to around £7.80 per day. Yet there is a stark contast between the regions, ranging from £3.50 per day in the East Midlands, up to £26.00 per day in South East London. Overall, three quarters of hospitals in England charge patients and visitors to park in their car parks, whereas hospital parking is free in Scotland and Wales.
 
Notably, many of the hospitals who charge do offer concessions for particular types of patients, but not only are there often countless sets of circumstances that a patient must meet to fulfill the requirements, they normally have to plan ahead and apply for discounted parking. Naturally, this will be the last thing on the mind of many patients and visitors, who therefore end up paying in full.
 
So how are these charges justified?
 
Many hospitals say that they reinvest the money in clinical services. In effect this means that people who drive to hospital for any number of reasons, are subsidising those who come by other means. This seems an arbitrary and wholly unfair way to decide how much somebody should pay for an essential service. Additionally many patients have no choice in how they get to hospital. As well as those who live in rural areas or have to travel at unconventional times, Macmillan (which campaigns on this issue for cancer patients) has pointed out that “public transport and hospital transport are often neither adequate nor suitable for cancer patients.”
 
Everyone should have fair and equal access to NHS treatment. Ideally this would mean making hospital parking free, but there are a number of problems to address in doing this. 
 
First, there is the worry that non-visitors would abuse the free parking spaces. However, this can be addressed fairly easily by introducing a voucher or token system similar to what is used in many supermarkets. Already, this system is in place at many of the 25% of hospitals that have free parking. 
 
Second, there is the issue of cost. A consultation in 2010 estimated the cost of scrapping car park fees at around £200m. Understandably, many people worry that this money would be taken from vital frontline care budgets, but there are many other areas in which savings could be made without impacting patient welfare. One example of this is the prescription and administration of branded drugs in GP surgeries and pharmacies. 
 
Many attempts have been made to encourage both groups to use generic drugs more consistently. Where they have been successful, there have been huge savings, with almost £400m cut from the drugs budget in 2008 by prescribing more generics for common conditions. A study by Prescribing Analytics in 2012 showed that we are still wasting £200m every year on branded statins alone. Progress has been impeded, however, by the drug companies themselves. 
 
As well as the ability they have to influence clinicians in their choices of prescriptions, a consultation on generic substitution in 2010 was met with a letter of criticism co-authored by patients and doctors. It later transpired that the letter had been organised by a PR company, themselves commissioned in the task by a drugs company, Norgine.
 
Even if the money could be saved, some would argue, it would be better put to use in improving patient care. This underestimates the importance many place on the availability of hospital parking. In the last National Patient Choice Survey for September 2008, car parking was rated as one of the factors in choosing a hospital by 46 per cent of respondents. 
 
Patients should not be put off going to hospital, nor relatives from visiting their loved ones, by parking charges. A case study by Macmillan featured a man who had to cut down on food to afford parking charges and other costs associated with getting to hospital.
 
This is against the founding principle of the National Health Service. We are punishing many of the most vulnerable people in the country, not only very ill people but also their worried friends and relatives. A system in which not all patients can equally and freely access services does not seem to me to be equal or free.

Robert Halfon is Conservative MP for Harlow. He tweets at @halfon4harlowMP

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Is defeat in Stoke the beginning of the end for Paul Nuttall?

The Ukip leader was his party's unity candidate. But after his defeat in Stoke, the old divisions are beginning to show again

In a speech to Ukip’s spring conference in Bolton on February 17, the party’s once and probably future leader Nigel Farage laid down the gauntlet for his successor, Paul Nuttall. Stoke’s by-election was “fundamental” to the future of the party – and Nuttall had to win.
 
One week on, Nuttall has failed that test miserably and thrown the fundamental questions hanging over Ukip’s future into harsh relief. 

For all his bullish talk of supplanting Labour in its industrial heartlands, the Ukip leader only managed to increase the party’s vote share by 2.2 percentage points on 2015. This paltry increase came despite Stoke’s 70 per cent Brexit majority, and a media narrative that was, until the revelations around Nuttall and Hillsborough, talking the party’s chances up.
 
So what now for Nuttall? There is, for the time being, little chance of him resigning – and, in truth, few inside Ukip expected him to win. Nuttall was relying on two well-rehearsed lines as get-out-of-jail free cards very early on in the campaign. 

The first was that the seat was a lowly 72 on Ukip’s target list. The second was that he had been leader of party whose image had been tarnished by infighting both figurative and literal for all of 12 weeks – the real work of his project had yet to begin. 

The chances of that project ever succeeding were modest at the very best. After yesterday’s defeat, it looks even more unlikely. Nuttall had originally stated his intention to run in the likely by-election in Leigh, Greater Manchester, when Andy Burnham wins the Greater Manchester metro mayoralty as is expected in May (Wigan, the borough of which Leigh is part, voted 64 per cent for Brexit).

If he goes ahead and stands – which he may well do – he will have to overturn a Labour majority of over 14,000. That, even before the unedifying row over the veracity of his Hillsborough recollections, was always going to be a big challenge. If he goes for it and loses, his leadership – predicated as it is on his supposed ability to win votes in the north - will be dead in the water. 

Nuttall is not entirely to blame, but he is a big part of Ukip’s problem. I visited Stoke the day before The Guardian published its initial report on Nuttall’s Hillsborough claims, and even then Nuttall’s campaign manager admitted that he was unlikely to convince the “hard core” of Conservative voters to back him. 

There are manifold reasons for this, but chief among them is that Nuttall, despite his newfound love of tweed, is no Nigel Farage. Not only does he lack his name recognition and box office appeal, but the sad truth is that the Tory voters Ukip need to attract are much less likely to vote for a party led by a Scouser whose platform consists of reassuring working-class voters their NHS and benefits are safe.
 
It is Farage and his allies – most notably the party’s main donor Arron Banks – who hold the most power over Nuttall’s future. Banks, who Nuttall publicly disowned as a non-member after he said he was “sick to death” of people “milking” the Hillsborough disaster, said on the eve of the Stoke poll that Ukip had to “remain radical” if it wanted to keep receiving his money. Farage himself has said the party’s campaign ought to have been “clearer” on immigration. 

Senior party figures are already briefing against Nuttall and his team in the Telegraph, whose proprietors are chummy with the beer-swilling Farage-Banks axis. They deride him for his efforts to turn Ukip into “NiceKip” or “Nukip” in order to appeal to more women voters, and for the heavy-handedness of his pitch to Labour voters (“There were times when I wondered whether I’ve got a purple rosette or a red one on”, one told the paper). 

It is Nuttall’s policy advisers - the anti-Farage awkward squad of Suzanne Evans, MEP Patrick O’Flynn (who famously branded Farage "snarling, thin-skinned and aggressive") and former leadership candidate Lisa Duffy – come in for the harshest criticism. Herein lies the leader's almost impossible task. Despite having pitched to members as a unity candidate, the two sides’ visions for Ukip are irreconcilable – one urges him to emulate Trump (who Nuttall says he would not have voted for), and the other urges a more moderate tack. 

Endorsing his leader on Question Time last night, Ukip’s sole MP Douglas Carswell blamed the legacy of the party’s Tea Party-inspired 2015 general election campaign, which saw Farage complain about foreigners with HIV using the NHS in ITV’s leaders debate, for the party’s poor performance in Stoke. Others, such as MEP Bill Etheridge, say precisely the opposite – that Nuttall must be more like Farage. 

Neither side has yet called for Nuttall’s head. He insists he is “not going anywhere”. With his febrile party no stranger to abortive coup and counter-coup, he is unlikely to be the one who has the final say.