Jeremy Laurance: Why we should pay to park – and be glad the care is free

Medical Life

Wanted: the chairman of a Foundation NHS Trust with the bottle to put two fingers up to the Government over its barmy decision to abolish hospital car parking charges. Don't bet on a rush of volunteers. Andy Burnham's move, announced last week, is so obviously popular, and its conception so nakedly populist, that anyone with the temerity to question it risks being strung up from the nearest pay station.

But I would be reassured to see a prominent NHS figure prepared to put their mouth where the money should be and parade around, say, the mammoth car park of the gleaming Walsgrave hospital, Coventry, with a placard reading: "I am sorry it costs a fiver to park here, but please remember the care is completely FREE."

This is, is it not, what the NHS is about – providing free care to ill people who need it, not free parking for healthy people who don't? OK, the charges cause hardship for some, and – politically more important – irritation to many, but the fact is that the £120 million cost will have to come out of patient care.

Turn the issue round the other way and imagine some benefactor – a Bill Gates figure – had decided to gift the NHS £120 million. Would he, or we, be happy to see it used to run hospital car parks? While the NHS languishes close to the bottom of the Euro cancer treatment league? To remove patient charges at a time when the NHS is sailing into the stormiest economic weather for a decade looks not just foolish but plain irresponsible.

Next time you pop a coin in the hospital parking meter think of it as a contribution to the cost of someone's cancer drugs – and give thanks that you do not live in America.

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The most arresting story of last week was the account of the suicide of Kerrie Woolterton, the 26-year-old who drank anti-freeze and then called an ambulance, telling doctors she did not want to be saved but merely made comfortable while she died. The 'Daily Telegraph', whose front page headline read: "Let me die, it's the law", reported that doctors let her go because she had signed a "living will". This sent other sections of the press into a paroxysm of indignation over living wills.

But the living will was a red herring. Its purpose is to make known to doctors a patient's wishes when they are unconscious and unable to explain what they want themselves. Ms Woolterton was conscious and – after close questioning by her doctors – judged to be legally competent. She didn't need her living will. As Sheila Mclean, professor of law and medical ethics at the University of Glasgow pointed out on BMJ Blogs, she rejected treatment as was her right, and this had to be respected.

The case does raise difficult questions over how doctors assess competence and when they have a duty to intervene. But these were not the questions the 'Telegraph' asked.