Speech by Jack Bloom, MPL, Democratic Alliance Gauteng health spokesman, in the debate on the provincial health budget, Gauteng legislature, May 21 2010

Madam Speaker, I have been criticized in this House for not claiming credit for all the proposals that I have advocated over the years that have now been adopted by the ruling party.

I don't want to disappoint my fan club on the benches opposite me, so let me congratulate the Gauteng Health Department for introducing dual antiretroviral therapy for HIV-positive pregnant mothers that has brought down the HIV-transmission rate from 9% in 2008 to 6% in 2009.

It will no doubt come down further now that HIV-positive mothers will be put on the full antiretroviral cocktail.

I also congratulate the Honourable MEC for getting rid of 3P consultancy and cancelling a number of fishy tenders, including the woefully mishandled Smart Card and Health Information System.

I am the most sympathetic member of this House to the difficulties that the Honourable MEC has in cleaning up the most awful mess that she inherited.

This included an enormous head office staff of 1000 people, full of useless political appointments and all manner of intrigue that badly affected service delivery.

All sorts of people needed to be fired or redeployed, and some of this has been done.

I am told that the Honourable MEC Mahlangu is an honorary colonel and looks great in uniform. Well, she has shown real bravery in taking hard decisions in this department, but much remains to be done.

There are still too many hospital managers who don't seem to realize that patients come first, and that staff must do their jobs. This is why we still have hospital horror stories, a number of which I have referred directly to the Honourable MEC for her attention.

Babies should get a good start in life in our hospitals, not die from infections caused by poor hygiene. I suggest that quality control at head office closely monitor all hospitals to pick up problems before they become tragedies.

There are lots of hospitals I could name for bad service, but I could start with Leratong Hospital which is probably the worst hospital in Gauteng. Please do something about the dysfunctional management at this hospital and some staff who seem to delight in tormenting patients.

This is one of the reasons why the DA will not be supporting this health budget. As you are aware, we largely agree on the aims, but financial management is still too poor for effective spending of what is available.

It is admitted that this budget falls short by R3.7 billion of what is required by institutions. You can add R650 million to the deficit because this is what has still to be paid this year for debts incurred in the previous financial year.

The Honourable MEC is losing credibility every time she says "cash flow problems" and sets a date when all suppliers will be paid. They were supposed to be paid by the end of September last year, then they were told January, then they were told to hold on till April, and now they are told the end of June.

This asinamali problem must be solved. We saw the effects this week when Chris Hani Baragwanath Hospital had to be partly shut down when unpaid suppliers refused to deliver diesel for the generators after the power was cut off.

We obviously need to ensure that every rand is spent in the most cost-effective way, which is why I support the move to upgrade clinics and district hospitals as patients with minor illnesses should be treated there at less cost.

The problem is that the regional hospitals should also be upgraded to take the strain off the expensive academic hospitals, but this is not happening.

We are guaranteed an overspend this year because 18 out of 26 hospitals are getting a lower budget than what they spent last year. The real crunch for all the hospitals is with goods and services, which are massively squeezed because of the unanticipated extra expense of the OSD increases.

The budget for goods and services for 26 hospitals is R2.75 billion, which is R832 million less than what was spent the year before. This is a 23% cut.

How exactly does the MEC expect hospitals to operate with such a drastic cut in this crucial budget item?

Surgical backlogs and waiting times for operations are going to get longer and longer.

18000 cataract operations were supposed to be performed last year, but only 9600 were done. This means that 8400 people are waiting to have their sight restored, and no doubt many more are waiting just to get on the waiting list.

There are also 100 people who can't walk because they are waiting for hip operations.

100 people also wait for angiograms at the Chris Hani Baragwanath heart unit.

On top of all the other problems that hospitals have are the delays in getting essential items and supplies, and the bureaucratic nightmare of going through the GSSC.

The MEC has said that hospital CEOs will be empowered to do their own ordering and tenders for things such as waste removal, so why isn't this happening?

Then there is the lack of maintenance, so we get a hospital like Natalspruit without water for two-and-a-half days because of a plumbing problem, and there is a laundry shortage because the tunnel washers at the Dunswart Laundry frequently break down.

This department has to learn to work smarter, and finally get a decent computer system so that files don't get lost, queues are shortened, and we can ascertain what our real costs are and where savings can be made.

Another area where little progress has been made is emergency services. A lot of money is being spent on new ambulances, but response times just don't improve. Only about 50% of priority one patients are attended to within 15 minutes instead of the required 80%, and the unambitious target is to raise this to 57%, which is not encouraging at all.

I don't see how provincialising emergency services will improve matters especially since the metros are resisting this, so this restructuring will probably cause more problems.

Our ambulance services are the Achilles heel of our World Cup preparations. The only solution at this stage is a collaboration with private ambulances, which I certainly hope is happening because the state service is appalling.

Another area of concern is that only 52% of rape victims complete ARV treatment because of poor follow-up. This figure has decreased from 56%, so it is vital that something is done otherwise we have the double tragedy of rape followed by HIV-infection.

This is again poor management.

One of the biggest areas of waste is in building projects like the Jabulani Hospital, the Mamelodi Hospital and the Natalspruit Hospital.  The pattern is massive over-expenditure, expensive changes to plans, and delays in the final product.

I hope this is improved, but we also need to ease the asinamali problem by collecting more revenue.

As you know, I have long been a critic of the Folateng private wards as I do believe that they are a drain on funds, rather than providing a real surplus. The department acknowledges that three of the four Folateng units do indeed make a loss, but insists that some sort of profit is made at the Charlotte Maxeke Johannesburg Academic Hospital.

Our committee has asked for years now for a separate breakdown of the finances of Folateng, but has yet to receive it, so it appears to me that there is something to hide.

The department anticipates collecting R448 million this financial year, but only collected R406 million last year.

This figure needs to go up dramatically, which means better efficiency in collecting from private medicals aids, the Road Accident Fund, Workmens Compensation, and other government departments including those in other provinces.

In general, there needs to be a creative partnership with the private sector, as is happening in a big way in the Western Cape.

We need dynamic leadership at state hospitals so as to find extra funding sources including local and overseas philanthropy.

Hospitals need to be freed from the state bureaucracy and turned into non-profit corporations that can provide a better service to the poor.

This is the DA's vision for health care in this province, not the state-takeover model of a national health insurance.

Staff need the right incentives, they should have proper attitudes, they should have good working conditions, and should be promoted on merit.

The Honourable MEC knows that she has the support of this side of the House in this endeavour, but we will raise the alarm whenever we see areas that need improvement.

This is our role in a democracy for the greater good of everyone.

Issued by the Democratic Alliance, Gauteng

Click here to sign up to receive our free daily headline email newsletter