Free, Available or Equitable? Hospital Car Parking as Healthcare Access Infrastructure: A Critical Narrative Review with a Four-Nation UK Policy Analysis

Hospital car parking is usually managed as an estates or revenue matter, yet it can shape whether and how people reach care. Evidence is dispersed across oncology, disability, transport and policy literatures. This review examined what burdens hospital parking imposes, who bears them, how parking relates to patient experience, attendance and quality, and how the four UK nations respond. A critical narrative review with a four-nation policy analysis was conducted by a single author. PubMed (two search rounds), Scopus, Web of Science, PsycINFO, CINAHL and OpenAlex were searched on 29 October 2026, with semantic searches, citation tracking and official policy sources. Records from 2000 onward were screened against PICOS criteria, and 52 studies with parking-specific findings were charted and informally appraised by directness, design and setting. Evidence is concentrated in cancer care (23 of 52 studies) and high-income countries and is mostly cross-sectional and self-reported. Parking was the most frequently selected service-improvement priority in two Australian surveys (56% and 60.3%), and accounted for 60% of drivers’ travel costs in one single-centre Australian neurology study (n = 155), a figure that should not be generalised. Findings on satisfaction were inconsistent, and a randomised trial of free parking in a neonatal unit found no improvement in visitation. No evaluation of abolishing parking charges in Scotland or Wales was identified. England mandates free parking for defined groups through the NHS Standard Contract; Wales and Scotland have removed charges; Northern Ireland has deferred abolition to no later than 12 May 2029. Free, available and equitable parking are distinct objectives. Parking should be managed as access infrastructure, with targeted relief, accessible capacity, clear information, transport integration and evaluation of reforms.