Order! Hon members, you are alerted to the fact that there is a printing error in the Bill's number on the Order Paper, the second B having been omitted. The Secretary has corrected it by referring to the Bill as B52B. I would like members to take note of that. I would like to take this opportunity to welcome the hon the Minister of Health and call upon her to address this House.
Chairperson, hon members, I am indeed delighted that the second reading debate on the National Health Laboratory Service Bill heralds the final stage of a long process in the restructuring of laboratory services in South Africa.
Members will recall that in 1994 my predecessor, Dr Nkosazana Zuma, established several committees which were to advise her on how to restructure the health services. Many of these committees laid the foundations for the present health services, which are designed to improve access to quality health services.
Among the committees which were established was a committee on the restructuring of health laboratory services which was chaired by Prof Jan van den Ende. This committee noted that public health laboratory services were fragmented, partly due to the historical policy of separate development. Laboratory services were often duplicated in urban areas and lack of co-ordination resulted in wastage of resources. Many laboratories were involved in research which had no direct impact on improving service delivery. [Interjections.]
Order! I am sorry to interrupt you, hon Minister. I think the information on the screen is misleading, and if the screen is not functioning properly I ask that it be switched off. Thank you. Continue, hon Minister. You were being referred to as Tshivhase.
No, I am Dr Tshabalala-Msimang. [Laughter.]
This was not the beginning of the debate on the restructuring of laboratory services. This need was identified even by the old regime as early as 1973. The then South African government established the Meiring-Naud commission of inquiry into laboratory services. The commission of inquiry recommended the establishment of a single nationally controlled and co-ordinated laboratory service. It also recommended that laboratory research be better co-ordinated to support the national health system. It is, however, regrettable that the previous regime did not have the courage and political will to implement the recommendations of the commission of inquiry, because, frankly speaking, those recommendations are as relevant today as they were 27 years ago.
After considering many options on the restructuring of laboratory services, the Health Minmec opted for the establishment of a public entity as a vehicle for amalgamating all health laboratory services under a single umbrella. Thus, in 1998, the Ministry of Health established a task team on the restructuring of laboratory services, chaired by Prof Kallichurum, to advise Government on the implementation of these recommendations. The Health Minmec accepted the report of Prof Kallichurum and appointed Dr Nicholas Crisp as the project manager to implement the recommendations of the task team.
There are approximately 6 000 health workers employed in public health laboratory services in South Africa. They are mainly pathologists, medical technologists and technicians, research scientists, professional nurses, administration staff and general assistants.
The SA Institute for Medical Research was established in 1917 by the government, in partnership with the Chamber of Mines, primarily to conduct medical research into diseases which were common on the mines. This institute now employs over 2 000 people and provides almost 50% of all laboratory services in the public health sector, the rest being provided by the provincially owned health laboratory services.
The Department of Health opened negotiations with the Chamber of Mines with a view to integrating all laboratory services into a public entity. When the Chamber of Mines withdrew unconditionally from the SA Institute for Medical Research, as of 1 January 1999, this paved the way for the comprehensive restructuring of all publicly owned laboratories into a new public entity.
I would like to thank the Chamber of Mines for its commitment to medical research, which they have demonstrated throughout the years through their participation in the SA Institute for Medical Research as joint partners with Government.
The intention of this Bill, therefore, is to establish a new national health laboratory service to support the national health system. The new organisation will be formed by disestablishing the SA Institute for Medical Research, the National Institute for Virology, the National Centre for Occupational Health and the forensic chemical laboratories, and amalgamating these institutions with the provincial health laboratory services under a new public entity. The aim of this entity will be to provide integrated, co-ordinated, affordable, accessible and equitable health laboratory services, primarily to the public health sector.
This consolidation of health care resources will promote the harmonisation of laboratories, standards and quality assurance, efficiency, cost- effectiveness and the rational use of resources, amongst other things, through benefits from economies of scale. It will also promote access to new and appropriate technologies.
South Africa also has a firm academic background of research and development to improve service delivery. An important component of the National Health Laboratory Service will be the possible creation within it of a national institute for communicable diseases, which will be formed from the National Institute for Virology together with the public health microbiology laboratory at the SA Institute for Medical Research and an epidemiology unit.
This new institute will play a crucial role in the surveillance of communicable diseases not only for South Africa, but also for the SADC region. The National Institute for Virology, which came into being in April 1976 when the laboratories of the Poliomyelitis Research Foundation were transferred to the Department of Health, currently serves as the national reference laboratory for South Africa and the region for viral diseases of medical importance. The institute is also a World Health Organisation reference laboratory for viral haemorrhagic fevers and for vaccine- preventable viral diseases such as poliomyelitis. Scientists from the institute have played a key role in diagnosing and assisting in the control of viral haemorrhagic fevers in Africa and the Middle East.
The institute is also a key laboratory in the global network of the WHO involved in the global polio eradication campaign. It carries out research in support of the South African Aids vaccine initiative, popularly known as SAAVI, which many hon members may have read about after the press briefing by the president of the Medical Research Council yesterday. May I add that we fully support this initiative and that we have contributed large amounts of resources for the work they do.
I am outlining all these details for everyone to appreciate that what we are doing is to consolidate these national scientific resources to enhance South Africa's competitive advantage and to harness scientific expertise in support of our health system and of the region.
It is therefore my vision that, through the National Health Laboratory Service, we will establish a truly competent organisation to support Government in its efforts to provide quality care to its citizens. Through this organisation we will be able to monitor new and re-emerging diseases through a robust and integrated national disease surveillance system.
We should develop this organisation into a centre of excellence where we will train our young scientists, especially those who come from historically disadvantaged backgrounds, to take up their rightful place in science. The aim is to raise others as we rise. The benefits of amalgamating our health laboratory services will be felt throughout the region. This Bill provides for the National Health Laboratory Service to provide services beyond our borders. We will have a vehicle to harmonise laboratory standards throughout the SADC region and support those neighbours on the continent who do indeed need our support.
The National Health Laboratory Service also provides a mechanism for harnessing the energy and resources of all the provinces, as the Health Minmec will become the supreme policy-making body whose policies will be implemented through a board. This will allow the National Health Laboratory Service greater flexibility to manage the organisation on sound business principles, whilst also attending to the values of access to quality and equitable health care services.
The process of amalgamating the various laboratory services into a single public entity is clearly spelled out in the Bill. Our Government is committed to implementing progressive labour relations legislation to ensure that the transition and transfer of personnel to the new public entity will be as smooth as possible.
The Bill makes provision for proper transitional arrangements. We also conducted an in-depth audit of all the assets which will be transferred to the new entity in order to ensure that the transition will be as smooth as possible. To avoid chaos in the implementation process, the Bill allows for different dates for the commencement of different provisions of the Act.
I would like to thank the Select Committee on Social Services for carefully considering this Bill. I was regularly informed by officials from my department about progress in the discussions with the select committee and was able to give guidance whenever needed. I have studied some of the submissions from the various provinces and stakeholders. The level of debate and comments which were reflected in those submissions did indeed impress me. I am sure that many members were almost becoming experts on many technical matters relating to laboratory medicine.
In a special way I would like to thank the chairperson of the select committee and her staff for piloting the Bill up to this stage. I sincerely hope that the NCOP will pass the Bill and refer it to the portfolio committee in the National Assembly for its perusal and ratification. This is an important piece of legislation. It is one of the final pillars of the transformation of service delivery in our country. I am sure that everyone will agree that, in the light of dwindling resources for basic services, we need to consolidate our basic health care resources to ensure better co- ordination, efficiency and effectiveness, and this is the primary objective of this Bill. [Applause.]
Chairperson, hon Minister, special delegates and members, the National Health Laboratory Service Bill before us today, as the Minister has already indicated, represents the culmination of a long process of discussions and consultations which started as early as 1998, and is another step towards the transformation of the health sector.
The purpose of this Bill, as stated in its preamble, is, firstly, the establishment of a single national public entity that will provide laboratory services in the country; secondly, the restructuring and transformation of the public health sector laboratory services; and thirdly, the development of policies that will enable this entity to provide health laboratory services as the preferred service provider for the public health sector.
Government's programme of transforming the state demands that we develop efficient, user-friendly and accountable governance structures, recognise the Public Service to more effectively meet the priorities of social delivery, and support the ongoing transformation of public institutions to ensure that their resources and skills contribute to accelerated change.
State-owned laboratories, dotted all over the country and duplicating services, definitely did not live up to the objectives outlined above. Rather, the practice currently in place lends itself to huge amounts of wastage and poor management of both financial and human resources.
It is commonly believed that the so-called urban provinces have generally better access to specialised services. Gauteng has 57 laboratories, 23 of which are state-owned, whereas the Northern Cape has zero state laboratories and only three belonging to the SAIMR. The statistics confirm that state-owned laboratories, especially in rural areas, are inequitably spread across the nine provinces. The Bill before us is intended to redress this inequity. The Bill is also intended to ensure that the norms and standards are maintained across all laboratories in the country.
It is recognised that the amalgamation of the various laboratory services into a single parastatal unit will be a complex one, and will present many challenges to those participating in the process. Some of these challenges and concerns articulated through our provinces are concerns about job security, redeployment or transfers, future relations between unions and employers in the new entity, and so on.
These insecurities are very valid and understandable, particularly when a number of organisations or bodies are merged into one. What we always have to keep in mind are the principles that underpin any human resource transition process. Regarding the first principle - professionalism, we should always ensure that staff of a national parastatal consist of persons of the highest professional standard and competency to ensure quality service delivery. The second is accountability. Each and every new employee within this new entity should be made aware of their responsibility to both the state and the public, as the ultimate beneficiary of the services. Thirdly, there should be transparency. If decisions are taken without proper consultation, the fears and concerns that I mentioned earlier will continually arise, and the provision of a secure and professional environment will not be realised.
Fourthly, this process should be inclusive. It is important that all persons and groupings that will be affected by this process are properly consulted on issues that will affect them.
It is evident, throughout the Bill before us today, that these principles will be, and would continue to be, adhered to. Over a period of time workshops were held with all stakeholders in eight of the nine provinces, and there were four common positive outcomes identified that will arise out of this amalgamation process.
Firstly, there would be a better service to clients; secondly, there would be standardisation, or a common management structure; thirdly, there would be improved access to career opportunities and training, and lastly, there would be standardised benefits and conditions of employment, amongst other things.
By highlighting these positives, I am by no means diminishing or negating the serious concerns articulated around possible retrenchments and transfers that I mentioned earlier on. These are concerns that were not only raised by the current employees and their various representatives, but also by the respective provinces, as the Minister pointed out. After intense engagement around this matter, we were assured by the department, and the leader of the task team, that these concerns were given serious consideration, that job losses, if these were to occur at all, would be very minimal, and that alternatives, such as reskilling and retraining, were being considered. This is one of the matters that is currently on the table of the Interim Negotiating Forum for discussion.
Some of the significant amendments that we agreed upon will be elaborated upon by my colleagues who will speak after me, and some of these have already been touched on by the hon the Minister. I must say that we were all of one mind that this Bill, with the amendments as proposed, goes a long way in the creation of quality service delivery and in making accessible a highly specialised service to not only our fellow South Africans in the most remote areas of our country, but also to the Southern African region, and indeed the continent.
In concluding, I want to also thank the Minister and her department for assisting us throughout the Bill. It was definitely a painstaking exercise that we went through. I also want to thank the task team that was with us throughout the process, and the members of the committee and their respective provinces.
In conclusion, I want to present the committee report, as tabled in the ATC, for adoption by this House. I must add that all provinces but one, the Western Cape, voted in favour of the Bill as amended: B52-2000. [Applause.]
Chairperson, hon members, recognising that Act 108 of 1996 provides for the right to health care services and requires the state to take legislative and other measures to achieve the progressive realisation of that right, this Bill then is clearly a step towards meeting that basic requirement, and, further, shows determination by Government and the Minister of Health to ensure that it is adhered to.
We believe, as a province, that this Bill is a step in the right direction as it further seeks to provide for the establishment of professional boards, and to facilitate accountability and democratisation of the council. This is quite an important piece of legislation that the nation enjoys. It can be associated with the transformation process of the laboratory services sector. In fact, the Bill purports to unify laboratory services in the country, and it also constitutes part of the rationalisation process of integrating former TBVC states' laboratory services.
As the province of the Eastern Cape, we were honoured to be part of the process involved in considering this piece of legislation, and we have done that successfully.
We wish to thank key stakeholders in our province for their input when developing our views around this piece of legislation. Whilst we, as a province, are faced with many challenges with reference to health care facilities, it is noted that the main objectives of this Bill outline positive solutions which will be implemented to combat the challenges we confront today.
We further note, and welcome, the inclusive nature of the council. Stakeholders will be part of the process of decision-making and direct the processes of this new council. The labour movement in this country has also been reflected in the proposed Bill, in that it will be part of the decision-making process, and we welcome that.
The health sector is the most critical area which we need to give priority into this country, as it seeks to establish academic standards and criteria for registration, and the right to practice in the profession. We want to congratulate the Minister and the Government on taking that direction. The South African community will participate in the council, and this development represent the realisation of our constitutional mandate as a province.
We salute the Minister of Health for the role she plays towards the realisation of this health need in our country. We also note the fact that currently South Africa, particularly its health sector, is confronting critical challenges, and we believe, as a province, that we need to provide the necessary support so that we can realise our basic interventions in the life of the country.
We also, in conclusion, want to accept the intervention in order to make sure that there are no duplications of services in South Africa. We have experienced this kind of exercise, precisely because we were constituted by two former homelands, and the Cape provincial administration, which provided these services separately. We also wish to make sure that we cannot proceed alone in isolation from Africa.
We note the fact that this service will not only provide for South African citizens, but will be a service for the entire region. We believe this is within the context of realisation of the African renaissance as a Government programme. Therefore, we believe, this Bill is very progressive and we support it as a province. [Applause.]
Chairperson, for many years we searched for a solution in order to unite the fragmented services of our laboratories. We did that because we had promised people a better life, and a better life for all, now. We had promised our people accessibility to services now, not tomorrow.
This Bill shows that the transformation agenda is on track, that it is on course. Transformation never makes for popular talk. Why? Because it mostly brings fears and uncertainties, and has done so, even during the years of discussion about this Bill.
The Free State supports this Bill. We support it because it is going to be cost-effective. It is going to integrate fragmented services.
Just to give hon members a picture of how things were in the Free State, all the hospitals and clinics in the eastern and northern Free State were using the SA Institute for Medical Research, while other services in the southern Free State, in the same province and the same department, were using provincial laboratories. Also, in the big municipalities such as Bloemfontein, they had their small laboratories. This is how fragmented the service was.
I am happy to say that in the Free State all stakeholders were involved, for quite a long time, in trying to alleviate this uncertainty. Hence I am pleading with the Minister for speedy implementation to allay these fears. Yes, we never promised that there would not be one or two who might fall by the wayside, but we said that almost everybody would be accommodated.
My other plea to the Minister is for her please to assist the institutions of higher training in recruiting students, black female students in particular, in the fields of technology, medical technology and haematology, with the aim of creating gender balance. In reality this field is still dominated by males.
My other plea to the Minister and the department relates to the field of epidemiology. One has to be a doctor in order to be able to study epidemiology. We do not dispute that. But because we are talking transformation and are talking about empowering people, it is possible for other sectors in the health field to be taught extensively about epidemiology without lowering any standards.
I congratulate the Minister and the department on the good work done so far. [Applause.]
Mrs T E MILLIN (KwaZulu-Natal): Chairperson, hon members of this House, at the outset may I state that the IFP and KwaZulu-Natal support the Bill in question, bearing in mind the letter and spirit of co-operative governance.
We in KwaZulu-Natal have a unique situation, a government of coalition. Whereas our respective parties do share some similarities, chief of which might be that we both derive a considerable majority of our support from a large black power base, as well as some common aims and objectives with regard to uplifting, empowering and enriching that hitherto oppressed majority, the IFP and KwaZulu-Natal, in coalition with the ANC, and in the GNU at national level, is nevertheless a party with its own policies and goals, by which we seek to facilitate, uplift and empower our oppressed people. This we do by assisting people to help themselves to succeed, while facilitating an enabling environment for an investor-friendly, yet equitable labour market, conducive to a sophisticated, market-driven, free- enterprise economy, by decentralising, by privatising wherever practicable and by devolving maximum powers to the lower levels of government.
Thus, in view of the above, some concerns are noted with regard to the nationalising and centralising of the various institutions in terms of this Bill, particularly at a time when our Government has extensively embarked on a programme of privatisation. Similar moves to centralise continue apace in other spheres of Government policy.
Concerns have also been expressed by my party and others in KwaZulu-Natal, as well as other provincial members in the ruling party and national Government during the NCOP process, regarding the frenetic rate at which some Bills, such as the one before us, are being fast-tracked through the NCOP. The term ``fast-track'' derives primarily from railway transport, whereby various stations on route are eliminated to speed up passage from point A to point Z. In applying that principle to the fast-tracking of Bills, one could contend that a bypassing or curtailment of the democratic consultative process, as a consequence of fast-tracking, might well lead, in the likely event of this Bill becoming law once passed in the National Assembly, to certain constitutional challenges and concomitant amendments. Labour legislation is a current case in point.
May one ask whether or why it is necessary to centralise under one umbrella the bodies contemplated in this Bill? Is this not a case of attempting to fix something that ain't broke in the first place? And, do the unions not have valid concerns, in that many unionised workers would be retrenched when too many jobs are already being shed?
The time does not permit further comment, save to say that notwithstanding the concerns raised on behalf of my party, the majority coalition partner in KwaZulu-Natal, as stated earlier, in a spirit of co-operative governance, we give our support herewith to the Bill before this House. [Time expired.] [Applause.]
Mrs L JOHNSON (KwaZulu-Natal): Madam Chair, thank you for affording me the opportunity to participate in this debate. KwaZulu-Natal welcomes and supports the National Health Laboratory Service Bill as amended. I want to place on record that as we were deliberating on this Bill in our portfolio committee we never had serious concerns. We went through the Bill until it came to the NCOP and we were briefed on the Bill.
I would like to quote section 27 of our Constitution: (1) Everyone has the right to have access to -
(a) health care services, including reproductive health care; (b) sufficient food and water; and (c) social security, including, if they are unable to support themselves and their dependants, appropriate social assistance.
(2) The state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.
We come from a history of fragmentation, duplication and maldistribution of health services in this country, which were not accessible to the majority of our people, in particular those residing in rural areas. The National Health Laboratory Service Bill seeks to establish a single, national public entity to provide public health laboratory services in the country. The object of the service, among others, is to provide cost-effective and efficient health laboratory services to all public-sector health care providers.
The Bill will ensure that laboratory services are not urban-biased, but can be made available to rural areas as well. As was mentioned earlier by speakers before me, there are other provinces that do not have the service, and we hope that the provinces will, for the first time, have access to the laboratory services.
The Bill will also empower the Minister to accelerate the restructuring and transformation of the public health sector laboratory services in order to make them part of a single, national public entity.
We also appreciate the work done over the years by the SA Institute for Medical Research, the National Institute for Virology, the National Centre for Occupational Health and all provincial health laboratory services that have been providing this service.
Once more, we wish to congratulate the department and the Minister on bringing this Bill before us, and we are looking forward to its addressing the inequalities of the past. [Applause.]
Chairperson, hon Minister, special delegates and members of this House, the Northern Cape is now fully aware of the huge task which the Minister, her Department of Health and provincial MECs set themselves when they embarked on the process to establish the National Health Laboratory Service in 1998. It is truly a mammoth task.
The proposed organogram which details the structures envisaged for this new service is comprehensive and indicative of the hard work that is still waiting for the service once this legislation is passed. This organogram shows how the previous, historically fragmented service of the public health laboratory service will be accommodated under one umbrella body.
We see this Bill as achieving the goal of merging the fragmented laboratory service into a comprehensive service that will be cost-effective to the Public Service sector, which is still the primary user of this service. We also see this Bill as achieving the intention of providing co-ordinated and efficient lab services in all the provinces. The Northern Cape is also aware of the thorough consultation process undertaken by the department and project task team. Part of this consultation was the communication of the process of transformation for the new laboratory service to all provinces.
It became clear that in almost all provinces and in the various areas of voluntary service there were overlapping areas of concern about this new entity. Northern Cape employees were particularly concerned about retrenchments, changing service conditions and salary structure, redeployment and the future of lab technicians. The Northern Cape believes that this Bill comprehensively addresses most of the concerns of the various stakeholders. We are satisfied that our amendments, which include organised labour on the board of the National Health Laboratory Service and in the transition phase, will assist in the process of transformation in the laboratory service envisaged by this Bill.
We were also concerned that the functions, powers and duties of the service would give way to unilateral decision-making, but we are convinced that the amendment which instructs the service to exercise its responsibility in accordance with the national health policy will ensure that these powers are not ad hoc or for personal enrichment. We want to congratulate the department and the task team on the sterling work they have put into setting up such a complex entity as the National Health Laboratory Service Bill. We in the Northern Cape have fully deliberated all aspects of this Bill and we support the Bill with all its amendments. [Applause.]
Chairperson, hon Minister and hon members, transformation has never been an easy process to undertake and successfully accomplish. That fact notwithstanding, and no matter how slow, painful or complicated the task may be, the continuation along the path of the improvement of the delivery of services to the benefit of all the people of this country must be sustained. The provision of cost-effective and efficient health services is part of the Government's programme to realise that goal.
At this point one needs to point out that this particular Bill was not fast- tracked, but rather has the distinction of having had two meetings for dealing with initial negotiating mandates, after provinces were given an extra week during which to further consider the Bill. The National Health Laboratory Service Bill seeks to put in place enabling mechanisms and processes for the purpose of realising the objective of creating a single unified laboratory service out of the fragmented state and state-funded laboratory services which exist at present, some as a result of historical developments and past policies of separation.
It can be expected that restructuring the laboratory services will have unavoidable casualties and opponents, just as in any other exercise. However, in this process the positives outweigh the negatives because it will result in an improved quality of service to clients, brought about by, among other things, a centralised one-management structure at national level. That will provide better co-ordination and an improvement in the capacity to manage delivery.
The integration of the disadvantaged laboratory services will also benefit provinces through, among other things, the standardisation of services through national norms and standards, as well as improved financial viability through better business practices that reduce the duplication of services. Contrary to fears in some quarters, the one-management structure that will result from the integration process will not disadvantage provinces in any way. Instead the system will enhance, through the pooling of resources and expertise, the provinces' ability to receive quality service through the numerous branch areas that will be established, taking into consideration provincial and regional boundaries, thereby establishing service points where previously none existed. The Northern Province supports the Bill as amended. [Applause.]
Chairperson and hon members, our laboratory services have always been world-renowned. We have successfully won the battle against polio through our comprehensive immunisation drive, spearheaded by the efforts of our laboratories. In recent weeks, especially in those provinces that were at the receiving end of the devastating floods earlier this year, we have seen an increase in malaria cases. Through our laboratory services we were once again able to establish that the DDT could be used to prevent an outbreak of malaria by spraying the homes of people most at risk from the malaria-carrying mosquitoes. I am talking about these two success stories because I believe that our success can benefit not only South Africa, but also our brothers and sisters in the region.
In the case of the polio vaccine, we are already sharing the fruits of our expertise with our neighbours. This Bill, in terms of clause 16, allows us formally and in a structured manner to render laboratory services to foreign countries. South Africa this year ratified the protocol on health in the Southern African Development Community. Almost all the articles of this protocol refer to how we in the region can better co-operate with one another to offer a full range of cost-effective and quality integrated health services.
This Bill brings into sharp focus how, through our new National Health Laboratory Service, we can assist ourselves and our neighbours in health systems research and civilian communicable disease control, and also in the control of HIV/Aids and sexually transmitted diseases, malaria and many other diseases. This Bill allows us to share our technical skills with our neighbours on the continent and throughout the world, and for them to share their skills, so that together we can better combat the old and the new diseases which confront our society every day.
The North West takes very seriously the responsibilities we have to the rest of Africa. We believe, like our President, that Africa's time has come to emerge from the scourge of disease that thas ravaged our continent for far too long. We believe that this Bill will assist South Africa's endeavours to make Africa disease-free. This newly structured National Health Laboratory Service will provide us with the tools to assist us in our own fight to overcome some of the worst diseases known to mankind. To a large extent we have succeeded in the urban areas, but our rural areas need an efficient lab service which will match the standards and quality of those in the most sophisticated urban areas. We know that this Bill provides the framework to bring about the standardisation and quality control needed in our country. The North West therefore supports this Bill with all its amendments, Madam Speaker. [Applause.]
Order! I do not think the Constitution has been changed, so I remain Chairperson of the NCOP. [Laughter.]
Madam Chair, hon members, I thank you for the opportunity to raise the Western Cape's concern and objections to this National Health Laboratory Service Bill. The department of health in the Western Cape has raised concerns around the establishment of the NHLS on numerous occasions. We hope that after the Minister has heard our arguments she will agree with us that the fast-tracking of this Bill will certainly not be in the interests of the people it intends to serve.
We strongly object to the preferred provider status of the NHLS. One of the main motivations of the creation of the NHLS outside the Public Service is a rationalised, efficient and cost-effective service. The NHLS, as a precondition for stimulating efficiency, must open itself to competition, especially in terms of the tariffs it charges and the quality of service it provides. The Western Cape objects to clause 15(1) in terms of which public health sector providers are bound to purchasing their laboratory services from the NHLS. Surely, the word ``must'' should be substituted by the word ``may''.
Regarding provisional management autonomy, the NHLS Bill only makes reference to the national board and the executive management committee. No reference is made to the provincial management structures, powers and functions. This could infringe upon the province's functional or institutional integrity as protected in section 41(1)(g) of the Constitution.
About the transfer of assets to the NHLS, item 7 of the transitional provisions in the schedule to the Bill makes provision for the automatic transfer of movable and immovable assets from the province to the NHLS. It could be argued that these provisions also infringe upon the functional and institutional integrity of the province, as contained in section 41(1)(g) of the Constitution. We feel that legal opinion needs to be sought on the implications, mechanisms and constraints of the transfer of assets from a province to the NHLS.
Furthermore, concerns have been raised about the transfer of designated staff from the province to the NHLS, because negotiations around conditions of service have not been finalised. The interim negotiating forum was suspended before agreement could be reached. The transfer of employees from a province to the NHLS must not commence until there is a properly constituted bargaining chamber, there is agreement and all conditions of service have been defined. The bargaining chamber needs to have all the labour unions represented that will represent the staff of the NHLS.
The range of complexity of these issues cannot be overemphasised. Many of the provisions need to be agreed upon before they can be included in the Bill. The following should be added to item 3 of the schedule of transitional provisions regarding persons transferred from the service of departments: The transfer of employees to the NHLS from provincial and state laboratories must be in terms of section 41 of the Public Service Act of 1994 and section 197 of the Labour Relations Act. The consequences of staff not wanting to be transferred needs to be investigated. This could have serious cost implications because of having to pay the remaining staff within provinces and being forced to buy services from the NHLS.
The Western Cape is concerned about the contravention of the Competition Act, No 89 of 1998. The creation of the NHLS, as the preferred provider of laboratory services to the public sector and as an organisation available to provide services to the private sector, may also contravene the Competition Act. A legal opinion will need to be sought in this regard. Concerning local government as stakeholder, minimal reference is made to local government as a stakeholder. As far as we are aware there has been minimal, if any, consultation with local government structures. However, they are an important user of laboratory services and will become more so with the proposed primary health care devolution of to local government in most provinces.
With reference to clause 18 and funding for the NHLS, any moneys referred to in this clause must not refer to a shift of budgeted funds from the provincial health departments to the NHLS, irrespective of whether these funds are part of the equitable share or conditional grant.
We are aware of the discussions between universities and the NHLS project team around a hybrid model, etc, but want to emphasise the important implications the outcome of these discussions will have on provinces and the existing joint agreements. Therefore, provinces should be included in the discussions. The universities in this province and the NHLS project team have reached a working agreement acceptable to both parties to date.
The above-listed concerns are but some of the major concerns with regard to this NHLS Bill which the NCOP intends to rushing through. We cannot appreciate the national Health Department's ignoring our concerns. Why the haste? This Bill should, in fact, be referred back to the drawing boards. [Interjections.] The Western Cape therefore strongly questions the desirability of this Bill.
Order! I would like to welcome the leader of the Free State delegation, Premier Direko. Welcome to the NCOP. [Laughter.]
Mevrou die Voorsitter, dit is vir die Nuwe NP in beginsel onmoontlik om hierdie wetsontwerp te steun, en wel om die volgende redes.
Teenstrydig met die privatiseringsbeleid van die Regering, beoog hierdie wetgewing om laboratoriumdienste te nasionaliseer en te monopoliseer. Dit sal 'n kwade dag wees vir gesondheidsdienste as mediese dienste nie meer op 'n kompeterende basis gelewer kan word nie. (Translation of Afrikaans paragraphs follows.)
[Dr P J C NEL: Madam Chairperson, in principle it is impossible for the New NP to support this Bill, for the following reasons.
In contrast to the policy of privatisation of the Government, this legislation envisages nationalising and monopolising laboratory services. It will be a bad day for health services when medical services can no longer be rendered on a competitive basis.]
Clause 15(1) reads as follows, ``Public health sector service providers must purchase laboratory services from the Service'' - the NHLS. The New NP is of the opinion that a more cost-effective and quicker service can be provided by the private sector in certain instances, and it should not be excluded as an option for the public sector service provider. The New NP is concerned about a possible decline in the standards of services owing to the amalgamation of 110 branches of the SA Insitute for Medical Research, the National Institute for Virology and eight provincial health laboratory services. The centralisation of the service could create endless transport problems, causing a delay in receiving of results from tests by doctors in hospitals.
In the Free State we are extremely concerned about the closing of the provincial laboratory service.
Tans is die oorgrote meerderheid van die laboratoriumpersoneel sowel as die akademiese komponent op die diensstaat van die provinsie. Met die sluiting van die provinsiale laboratorium beteken dit dat die totale personeelkomponent nou op die universiteit se betaalstaat sal wees. Dit word beraam dat dit die Universiteit van die Vrystaat ongeveer R30 miljoen per jaar gaan kos, wat hulle net eenvoudig nie het nie.
Die mediese natuurwetenskaplikes is hoogs gekwalifiseerde mense en het te doen met die opleiding van nagraadse mediese studente sowel as navorsing. Hulle is tans besig met baie belangrike navorsingsprojekte waarmee hulle reeds internasionale bekendheid verwerf het. Met die sentralisering van laboratoriumdienste loop mediese fakulteite die risiko om gemarginaliseer te word ten opsigte van basiese navorsing wat dan hoofsaaklik deur die twee groot sentra gedoen sal word, en wat sal beteken dat die fakulteite net 'n doodgewone laboratoriumdiens sal lewer.
Ek het gister met ontsteltenis verneem dat die taakspan van die departement nog geen ooreenkomste gesluit het met enige van die agt universiteite nie. Intussen hang die toekoms van al hierdie werknemers in die lug. Ek het rede om te glo dat die betrokke vakbonde ook ontsteld is oor hierdie aangeleentheid. Dit wil vir my lyk asof hierdie stuk wetgewing meer probleme gaan skep as wat dit gaan oplos. [Applous.] (Translation of Afrikaans paragraphs follows.)
[Currently the vast majority of the laboratory staff as well as the academic component are on the payroll of the province. The closing of the provincial laboratory means that the entire staff component will now be on the university's payroll. It is estimated that this will cost the University of the Free State approximately R30 million per year, which they simply do not have.
The medical scientists are highly qualified people and deal with the training of postgraduate medical students, as well as research. They are currently busy with very important research projects which have already earned them international renown. With the centralisation of laboratory services the medical faculties run the risk of being marginalised with regard to basic research, which will then primarily be done by the two big centra, and which will mean that the faculties will render just a normal laboratory service.
I learnt with concern yesterday that the task team of the department has not reached agreements with any of the eight universities. In the meantime the future of all these employees hangs in the balance. I have reason to believe that the relevant trade unions are also upset about this matter. It seems to me that this piece of legislation is going to create more problems than it is going to solve. [Applause.]]
Mevrou die Voorsitter, agb Minister en lede, die DP is al dikwels in hierdie Huis daarvan beskuldig dat ons ondemokraties en teen hervorming en nuwe wetgewing gekant is.
Die regerende party noem gerieflikheidshalwe nie die feit dat ons die oorgrote meerderheid wetgewing heelhartig steun nie. Ek sou s dit is 'n blatante poging om ons af te maak as 'n party vasgevang in rigiede rels en dat ons eintlik die vyand van demokrasie is. Hoekom kan die DP nie hierdie wetgewing steun nie? (Translation of Afrikaans paragraphs follows.)
[Ms E C GOUWS: Madam Chairperson, hon Minister and hon members, the DP has often been accused in this House of being undemocratic and opposed to reform and new legislation.
The governing party neglects to mention the fact that we wholeheartedly support the overwhelming majority of legislation. I would say this is a blatant attempt to laugh us off as a party that is caught up in rigid rules and that is, in fact, the enemy of democracy. Why can the DP not support this legislation?]
Because we must put our money where our mouths are. Creating new jobs must be the priority of the Government. That is what they make the people believe they are trying to do. How on earth does this work if one closes down 110 SA Institute for Medical Research laboratories, the National Institute for Virology, the National Centre for Occupational Health, provincial health laboratory services and three forensic laboratories?
Furthermore, they are limiting the role of research at our universities. We thought that the Government was looking at privatising most parastatals, but now we see they are creating one. The DP submit that, while there may be some justification for the rationalisation of all public-sector laboratory services into a single national laboratory service, such service should not have the monopoly over the provision of laboratory services to public-health-sector providers. It should be impelled to provide a service competitive with that provided by the private sector. In the absence of such competition, there will be no guarantee that the NHLS will feel impelled to provide a cost-effective, efficient service to public sector service providers.
Die Huis het gehoor van die groot rol wat ons gaan speel ten opsigte van hulp aan lande in Suider-Afrika. Dit moet 'n bonus wees en nie as primre motivering vir hierdie wetgewing dien nie. Ons eerste prioriteit is Suid- Afrika. Ons moet kyk na meer werkgeleenthede, na die afwenteling van mag na die private sektor en na die doeltreffendste en bekostigbaarste wyse waarop voorsiening vir medisyne vir die behandeling van ons siek mense gemaak kan word.
Hierdie wetgewing gaan nie hiertoe bydra nie. Die DP steun nie hierdie wetsontwerp nie. [Applous.] (Translation of Afrikaans paragraphs follows.)
[The House has heard of the great role which we are going to play with regard to aid to countries in Southern Africa. This should be a bonus and should not serve as the primary motivation for this legislation. Our first priority is South Africa. We must look at more job opportunities, at the devolution of power to the private sector and at the most effective and affordable way in which provision can be made for medicine for the treatment of our sick people.
This legislation will not contribute to that. The DP does not support this Bill. [Applause.]]
Chairperson, hon Minister and hon members, Mpumalanga is very impressed with the active participation and inclusion of organised labour in the preparation of and deliberations on this Bill.
The dialogue that ensued and the suggestions made, especially by these stakeholders, signal a very good precedent for the future of the National Health Laboratory Service.
The department and all stakeholders have shown a keen interest in ensuring that the Bill is indeed inclusive of the needs of all workers who are currently employed in this very tenuous position. No one should be held in a state of limbo where his or her future is determined by a piece of legislation, thus our concession.
While it is true that some of the workers currently employed in laboratories across the country have found themselves in this very unpleasant situation for some time now, it is nevertheless imperative that we, as responsible legislators, provide a more permanent environment for those workers in the numerous laboratories across the country and for those workers who will, in future, be participating in this service.
The provinces wanted to be sure that this Bill would be conducive to personal growth and the improvement of skills and have clear career pathing for all those hoping for promotion in the future in this service.
Mpumalanga is sure that we have succeeded in this Bill as it now stands. We understood and empathised with the frustration of workers who, in one laboratory, will be overworked whilst others in another would have very little or no work to do at all. We have seen the need to level the playing field so that workers have job satisfaction in their workplace. We believe that this Bill successfully addresses this problem.
This Bill also shows further concern for the wellbeing of workers by the inclusion of comprehensive transitional provisions which deal with the complex period of transition. This foresight will ensure that workers who are currently in the employ of the various laboratories are transferred to the new service. Even those workers who are dissatisfied with the transfer will have recourse to refer their dispute to the Commission for Conciliation, Mediation and Arbitration.
Hopefully, no one will need to resort to this course of action. We are confident that all the parties involved in the National Health Laboratory Service will find the new structure a viable option for their future, except, of course, people who are used to flying kites instead of flying parachutes. They would go for the very cosy option of flying kites because there are no challenges involved. They would not get involved in deliberations and come to waste the time of this Chamber.
In addition to our concern about workers' rights, our province was very concerned that this new public entity might not be accessible to the needs of the community. We were assured, though, through our interactions and deliberations in the select committee process as well as in the other provincial committees, that although it was never the intention that laboratory services should provide direct access to the community, the community will nonetheless feel the direct benefit when their local pubic health care service uses the laboratories. [Time expired.] [Applause.]
Chairperson, let me first of all quickly deal with the New NP and DP. I just want to respond to them by saying that I am surprised by the response of the Western Cape and the New NP because it was their own party which, in 1973, started this process. All that we have done is to show the courage and political will to indeed, once more, engage in extensive and robust consultations for the implementation, of course with improvements, of the recommendations that were made by the NP itself. When did they change? I do not understand.
In a way the Western Cape must begin to understand that they are not an island, not just a holiday mecca in South Africa, that they have to support and share expertise with the rest of the country. They do have expertise and we need to tap into that expertise. In fact, they should be proud that we are trying to tap into their expertise.
I hope one day they will realise that they are part of South Africa, not just on an island out there.
I thought Mr Nel understood that we live in the world of IT today. So his concerns about the delay in laboratory results are really unfounded. [Interjections.] As we indicated, these days results are transmitted electronically. So his grounds for concern are really unfounded. [Interjections.]
The DP starts off by convincing us that they have been supporting the Bills because they are interested in transformation, but they do exactly the opposite. I think the most upsetting thing they have said today is that they do not support integration. They are very concerned that the new public entity will provide services for SADC as well. Nobody has said we are going to start with SADC. I do not think one can start out there and omit one's home, but obviously, in the spirit of globalisation, we must start with regional integration. I do not know to which region those hon members belong, and yet, they are the people who support liberalisation.
Let me also just address, very briefly, my sister from KwaZulu-Natal, Mrs Millin. Let me start off by saying I really need to thank KwaZulu-Natal for having been very objective and co-operative in the process leading up to today with regard to the Bill under discussion. Mrs Millin's concerns will be accommodated in the fact that the implementation of the Bill will be staggered. We will not immediately implement all the provisions of the Bill.
Let me also dispel the notion that this has been fast-tracked. We have just heard that the process started in 1987. We came into power in 1994. We picked it up. From 1994 to date is actually six years. So hon members will agree with me that the train has indeed been very, very slow. The people, our passengers, have been able to come on board, including those who perhaps might not have wanted to get onto this train. So the train has been deliberately been slow to allow all of us to get used to the fact that the train moves on. However, from now onwards the implementation is going to be fast indeed.
Obviously, transformation, by its nature is quite threatening. It does indeed bring about uncertainties. Sometimes it brings fears and sometimes it is not easy, but transform we must. We have indeed been understood by most of the stakeholders. I do not know about the Western Cape and the DP, but most of the stakeholders, including the people who are employed in the different laboratories, have understood the direction in which we want to proceed. We have reassured them, to the best of our ability, that we will ensure that the creation of this new single national public entity will be as smooth as possible. Obviously, we seek their support and also their co- operation to ensure that indeed this transformation is as smooth as possible. [Interjections.]
As I have said, what we are trying to do, and I think we will succeed in doing this, is to ensure that we indeed create quality services, that we consolidate ...
Chairperson, would the hon the Minister please take a question?
Chairperson, no, can I please finish.
The Minister says she will not take a question. [Interjections.]
Chairperson, the hon member can put the question in writing and I will come and answer it here. [Interjections.]
What we are trying to do is to consolidate all our basic health care resources so that we can ensure co-ordination, efficiency, effectiveness and quality services.
The hon member from the Northern Province referred to casualties, and I think some of those casualties are indeed, the Western Cape and the DP. However, they can be assured that this public national entity we create will provide quality diagnostic services - quality capacity for us to diagnose, to ensure that people indeed recover as speedily as possible from their injuries. [Applause.]
Debate concluded.
Bill agreed to in accordance with section 65 of the Constitution (Western Cape dissenting).