Hon House Chair and hon members, it is both an honour and a pleasure for me to present to this House for a second reading a very important Bill, namely the National Health Amendment Bill. The deteriorating quality of health care in our public hospitals has been a thorn in the flesh of our country for quite some time. For this term of office of government, it was illustriously captured by the President of the country during his very first state of the nation address in 2009. He said:
Fellow South Africans, we are seriously concerned about the deterioration of the quality of health care, aggravated by the steady increase in the burden of disease in the past decade and a half.
As a department, we have set ourselves clear goals and objectives, as set out in the Negotiated Service Delivery Agreement. These four goals are: increasing life expectancy; decreasing maternal and child mortality rates; combating HIV and Aids and tuberculosis; and strengthening health system effectiveness.
While we have experienced tremendous progress in the first three outcomes, as evidenced by the events in Washington DC at the International Aids Conference three weeks ago, we experience very serious and disturbing challenges with respect to the fourth outcome, which is the effectiveness of the health care system. We have identified five areas where we need to deal with this issue of the effectiveness of the health care system. I will deal with only one of these five outcomes today, which is the issue of quality. The others, of course, are infrastructure, human resources, the re- engineering of primary health care and the cost of health care in the country.
There will be many debates as to what constitutes quality and what leads to deterioration. However, under this Act, we have decided to focus on six standards, which we call core standards. They are very basic, minimum standards. We believe no facility should be called a health facility if they are not able to comply with these basic standards. We thought that in order to be sure that these standards were adhered to we needed to establish a well-oiled and well-structured institution whose sole purpose is to ensure and enforce these standards. Today, we are presenting to this House a Bill to do exactly that.
The Bill is intended to amend the existing National Health Act to establish a public entity called the Office of Health Standards Compliance, OHSC. This body or entity, styled along the same lines as the British Quality Care Commission, will have three units. The first unit will be the Inspectorate. In terms of this Bill, it will be mandatory for this unit to inspect each and every public health facility on a regular basis. The problematic ones will be inspected as often as possible so that they are monitored frequently to avoid deterioration until there is a crisis, as is now happening in some hospitals around Gauteng, Limpopo and the Eastern Cape.
We would like to avoid as much as possible the deterioration that we are now seeing in three of our provinces. We have already sent 20 individuals to Britain to be trained as inspectors of our facilities. During the public hearings, people were often confusing these inspectors with environmental care inspectors or the inspectors who were called health inspectors in the past. In terms of this Bill, there will still be environmental health inspectors in the system, but the inspectors we are referring to will specifically inspect quality standards, including the six core standards that I mentioned earlier. The environmental care inspectors will still be there to work on issues pertaining to the environment. Once inspected, the facilities will be graded from grade A to grade F and the report will be released publicly.
The second unit will be a Health Ombudsperson. This unit will function as an area where members of the public will lodge complaints about the negative experiences they might have encountered during their visits to health facilities. These complaints will range from poor staff attitudes, long waiting times or the nonavailability of drugs to safety and security, etc.
Again there has been confusion during public hearings about the role of the ombudsperson vis--vis professional bodies like the Health Professions Council of South Africa, HPCSA, the SA Nursing Council, SANC, and the SA Pharmacy Council, SAPC. These professional bodies usually deal with individual professional misconduct like negligence, unethical behaviour or unprofessional behaviour. It is usually well-to-do people in society who know about these professional bodies and how to approach them. Ordinary members of the public are usually at a loss.
As the department, we did not fold our arms and wait for this entity to be launched in terms of this Bill in order to act. As early as April this year, we trained at least 40 individuals and divided them into what we call facility improvement teams. They have been moving from district to district to help institutions to improve basic standards of care. They have made progress but, unfortunately, their work is often overshadowed by extremely disturbing events generating severe negative publicity in the three provinces I mentioned earlier. We will try to increase the teams and expedite their involvement in these particular provinces.
We have even identified 400 unemployed graduates in three major fields - finance and accounting, human resources and information communications technology. These 400 unemployed graduates have undergone training in governance by the Public Administration Leadership and Management Academy, Palama. We have divided them into teams of 45 each and dispatched them to various provinces to help in the fields of supply chain management, asset reconciliation and the management of human resources, especially in the cleaning up of Persal, or the public salary management system, in our provinces. They started work in April this year and we hope to see changes brought about by their work in a short space of time. We hope that given the establishment of the Office of Health Standards Compliance, our institutions will be on tenterhooks.
There have often been debates in the public about whether our health care institutions or the individuals managing them are ever held accountable for their actions. We have pointed out that they were held accountable, but without a clear legal framework or an institution that would monitor them. However, we do sometimes experience problems. Now each and every health facility manager will have to take full accountability and responsibility for his or her actions or omissions that may lead to any of the adverse events that our facilities have experienced way too often. So, I appeal to members of this House to please support this Bill. [Applause.]
Hon Chairperson, Ministers, Deputy Ministers and Members of Parliament, may we all unite and speak with one voice in passing this Bill. An independent office of health standards is something we should have done yesterday. Health and safety has no colour, race, sex or creed. It affects all of us directly or indirectly. When you are sick and ill, you are vulnerable; you have no choice but to go to the nearest centre so that somebody can look after your health and safety. After the passing of this Bill, health services and the perception of the Department of Health in South Africa will never be the same. I've been admitted to hospital with a dislocated shoulder but I came out of the hospital with a chest infection. This was a direct result of the cleanliness of the institution. I am sure I'm not the only one who has experienced this. I've been attended to at a hospital only to be told that there were no doctors to examine me and make a diagnosis. To my mind, the definition of a hospital is not only about the walls of the institution but the human resources and the equipment that make a hospital. Hence I say that the health and safety in our institutions are not up to standard.
I've been to a hospital or a clinic only to be told that there were no drugs or, if there were drugs that could cure my ailment, that they didn't have them in stock and they could give me a substitute. A substitute can never be as good as the original drug that was meant to be used for a particular disease. A substitute is not the real thing.
I've been told in health institutions that the machine that would confirm my diagnosis was broken, so I had to go back later to make sure that they made a diagnosis. When you are told this, one wonders whether the disease will wait until you get a proper diagnosis.
Some of these scenarios are familiar to those of us sitting in this House. We have experienced some of these things. There can be only one reason - that there have been no norms and standards in our institutions. It has always been a free-for-all. This is why I urge you to unite and pass this piece of legislation.
The amendment is about considering the health and safety of the vulnerable users of our health institutions. It will be managed by the chief executive officer but the main person who will monitor, investigate, receive complaints and act on this in an impartial, humble, independent and honest way is the ombudsperson. This is the main person who will change the perception of the health services in South Africa forever.
Although this office will advise the Minister, it is totally independent. Money is appropriated by Parliament to this office, in addition to the money it charges. There is a board that makes policy and is the governing structure. The CEO and the ombudsman will not be appointed without the board's approval.
Another aspect of the Bill is placing the Port Health Services under the national Department of Health, no longer under the provinces. This makes a lot of sense.
One other important area is to make users understand the health service. It is not about preventing death but making sure that we do everything possible. When death occurs, you must know that you did all the things you were supposed to do. In any case, where there is birth, we can be sure there is death. The health department and its services are merely there to prolong the time between birth and death. As the saying goes, "God, grant me the serenity to change and prevent what I can and accept those things that are beyond my capability with present technology."
The main aspect of the Bill is the ombudsperson, the first of its kind in South Africa. As I have said, our health services will never be the same again after passing this Bill.
Let me thank all members of the committee who managed to work so hard, sacrificing their time to make sure that this Bill was ready to come to this House. I want to thank the department for their work and for supporting us, especially the legal directorate. I also thank the Legal Directorate of Parliament for helping us make sure that this piece of legislation was ready to be presented here. I also want to thank the Committee Secretariat and the Research Unit. Health services will never be the same again. Let's all pass this Bill. [Applause.]
Motsamaisi wa dipuisano ya kgabane le Maloko a Palamente a hlomphehang, ntlafatso ya bophelo bo botle ke e nngwe ya dintlha tse hlokehang ho fedisa masalla a kgethollo. Kgethollo e ile ya qhelela batho ba batsho ka thoko mme ba iphumana e le hore ba mahlatsipeng, ha ba tsebe hore na mahlonoko ana a ho kotelwa ka thoko batla a etsa jwang. Ke ka hona mmuso o tlamehang ho etsa makgobonthithi ohle a hlokehang ho tlisa tekano le boleng ditshebeletsong tsa bophelo bo botle ho Maafrika Borwa ohle, haholoholo bathoo ba ileng ba eba mahlatsipa a kgethollo. (Translation of Sesotho paragraph follows.)
[Mrs S P KOPANE: Hon Speaker and hon members of Parliament, the improvement of the health care system is one of the measures necessary to eradicate remnants of apartheid. Apartheid was biased against Black people, who were victimised and who don't know how to handle the pain of discrimination. That is why the government must make every effort necessary to bring about equity and quality of life through service delivery with regard to health care for all South Africans, especially victims of apartheid.]
In an open-opportunity society, only people who are healthy, energetic and mobile are able to properly use their talents, follow their dreams and care for their families. Therefore, no society can prosper without an affordable, quality and easily accessible health care system that allows people to manage chronic disease and overcome serious illness.
Allow me to use these words of wisdom by Mahatma Gandhi, who said, "A nation's greatness is measured by how it treats its weakest members." If that is so, then the Department of Health must be held responsible for holding us back from the greatness we aspire to.
The primary problem with the public health care system is not about accessibility. The real problem with the public health care system is that it offers low-quality health care outcomes. This compromises the health of the nation and makes it virtually impossible to achieve the development improvements that we all aspire to.
The government's own National Planning Commission explains that the health care system is fractured, with pervasive disorder and multiple consequences, such as poor authority, poor accountability, the marginalisation of clinical processes, and poor staff morale. Centralised control has not worked because of a general lack of discipline, inappropriate functions, weak accountability, a lack of adherence to policies, inadequate oversight, and poor institutional links between different levels of services. The sad part is that all these issues that affect quality or standards are hardly mentioned in the national health care proposal.
Quality is ultimately a question of standards, targets and accountability. However, the National Health Insurance proposal focuses so little on the question of what minimum norms and standards are required to achieve quality health care outcomes. It does not set targets for health improvement that the system must attain. According to the Ministerial task team, "No part of the health system is held properly accountable for the poor health outcomes, or poor service delivery." This fact alone makes it virtually impossible for the system to improve since no one in it has any incentive to perform better.
The absence of a statutory body and independent quality assurance regulator further reduces the imperative of any health authority or service provider to become concerned about gaps in the standard of care offered, as they face no consequences and avoid publication of embarrassing information on their performance. The public health sector does not assess itself according to any known benchmark or target. The government does not know how to evaluate its own health care performance. This is a major problem.
During the public hearings, different stakeholders raised their concerns that there should be definitions of norms and standards. This is one of the private sector's biggest concerns, as they are worried that within the context of the NHI, these norms would include tariff norms. The majority of them were concerned about the independence of the office concerned.
The DA welcomes the establishment of an Office of Health Standards Compliance to accredit and regulate institutions, so performing a crucial oversight function. We believe that this is a step in the right direction. As the Portfolio Committee on Health, we agreed that board members should be appointed and that the Minister of Health should appoint members of the Office of Health Standards Compliance in consultation with board members. According to the National Health Amendment Bill, a chief executive officer and ombudsman will be appointed. The Minister will appoint the ombudsman only after calling for public nominations, including consultation with the board. The function of the ombudsman includes investigating complaints related to the norms and standards. The major problem with the Bill as it stands is clause 81A, which says:
(9) After each investigation, the Ombud must submit a report together with his or her recommendations on appropriate action to the Chief Executive Officer.
(10) The Chief Executive Officer may, subject to subsection (9), request the intervention of the Minister.
(11) Where the Chief Executive Officer fails to act in accordance with the findings and recommendations of the Ombud, the Ombud may request the intervention of the Minister.
From the international review it is clear that the ombudsman's office is essentially an alternative to going to court. The ombudsman should be someone who has the legal authority to take decisive action and set a precedent; thereby building consistency, predictability and deterrence.
For the sake of the independence of the office, the ombudsman must assume an adjudicative role and must be empowered to make findings against the inspectorate or standard-setting division of the same regulatory authority to which it is aligned. If the Office of the Ombudsman does not have powers of determination, then it cannot be called an ombud.
The fact that the ombud should report to the CEO, not directly to Parliament, means that the office will not be truly independent but will be open to political pressure and influence. This is undesirable and unnecessary. I believe that the ombudsman can submit the report to both the Minister and the CEO. However, reports must be tabled in Parliament and must be made public. Chapter 10 of the National Planning Commission document states that there needs to be "clear separation of policy-making from oversight and operations".
The DA strongly believes that the creation of effective accountability and governance structures requires an independent, neutral and transparent body. The DA will object to the current proposal as it stands now. [Applause.]
Hon Chairperson, Ministers, Deputy Ministers, hon members and guests present, I stand here on behalf of Cope to express our support for the Bill under discussion. The reason for our support is that we believe the Office of Health Standards Compliance will ensure that quality health care is guaranteed at all health institutions in the country.
Cope supports this Bill because it empowers South Africans to challenge mediocrity and bad service within the health sector. They will be able to do this with the assurance that all investigations will be done by an independent and impartial institution. Cope supports this Bill because the public and private health services will be held equally accountable.
I look forward to the ombud's investigation and report on how and why private health institutions find it morally acceptable to exhaust a patient's medical aid and then chuck them out of their facilities as soon as the funds are exhausted.
Cope supports the Bill because it creates mechanisms to protect and promote the health and safety of the users of health services, as stated in clause 78 of the Bill. This will be done by enforcing and monitoring compliance with norms and standards. In this regard, health professionals and management should understand that it cannot be business as usual. Cope supports this Bill because the ombud will have to be independent, impartial and accountable.
In terms of clause 81A(9), the ombud must submit a report on appropriate action, together with his or her recommendations, to the chief executive officer of the Office of Health Standards Compliance. Once the investigation is finalised, the ombud is expected to inform the complainant, the respondent - or both -regarding the findings and recommendations. The Bill has an impact on how health services will be provided or delivered. As a result, the Minister of Health has a huge responsibility to ensure that the men and women he will be appointing as members of the board, as the chief executive officer of the Office of Health Standards Compliance and as the ombud are people with credibility and honour.
The Minister should be conscious of the fact that a lack of consequence for poor performance and for transgression results in mediocrity being regarded as an acceptable standard. The consequence of this unacceptable way of doing things is that the quality of health care provision is compromised.
Those who will be appointed in terms of this Bill should be conscientised to the fact that institutional credibility is vital to the confidence of the public. Credibility is required from institutions like the Office of Health Standards Compliance. In this regard, it is important that the ombud should not only become independent and impartial but should also be seen to be independent and impartial. [Applause.]
Hon Chair, the formation of the Office of Health Standards Compliance, OHSC, through the National Health Amendment Bill, would mark a decisive step in the Department of Health's aim to reign in the chaos that plagues it. In aiming to introduce affordable and accessible health care to the majority of our people, it is imperative that the OHSC is truly an independent body that can effectively enforce norms and standards for the quality and safety of the entire health system.
The Bill must ensure that the organisational structure and powers of the OHSC and the proposed ombud are not subjected to political interference, especially with regard to issues of staff and other necessary resources for them to work with. This is crucial if the department seeks to rebuild the public's trust and confidence in the health system. The powers that would be given to the health officers and inspectors need to be tempered with effective ways of holding them accountable and of curbing any abuses that could arise.
Noncompliant health care institutions will need support to improve their health care standards so that our people can truly have access to the best possible care. The IFP supports this Bill. [Applause.]
Hon Chairperson, hon Ministers and Deputy Ministers, hon Members of Parliament, distinguished guests, the Department of Health, under the leadership of this Minister, Deputy Minister and director- general, is moving in the direction of improving the health of South Africans. I am very excited that since the Minister took over this portfolio, health, as a sector, has had a positive reception in the minds of South Africans. Minister, you are being celebrated by our fellow South Africans as the light that has come to shine for many. Health is a fundamental human right, indispensable for the exercise of other human rights. Despite what some might choose to dismiss as a hopeless situation, for us, a lot is happening. A baby is being born, and it's not an easy birth; it is going to take longer. We have overcome much that many thought insurmountable through adherence to those practices. I am convinced that this strategy is capable of addressing the key problems that the Department of Health has been having. I am excited, because this department has identified what have been the main problems for the health sector, and some of these have tarnished the image of this glorious profession of ours.
The National Health Amendment Bill deals with the composition of the board, which is dealt with in clause 79(b). It stipulates that the board should consist of between seven and 12 members, appointed by the Minister. Five members should be experts in the health and related fields, and one each should have knowledge of the law; economics and financial matters; the private health care sector; public health care and administration; quality assurance; and one representative each from organised labour and civil society or the community. Finally, the two ad hoc members of the board include the chief executive officer and the chief financial officer.
The appointment of members of the board is done by the Minister, after a process of public nomination of suitable persons and after consultation with the relevant bodies and institutions. Board members hold office for at least three years - the term may be determined by the Minister - and they are eligible for reappointment for an additional term. Disqualification from the membership of the board could be as a result of not being a South African citizen, being an unrehabilitated insolvent, having been convicted of a criminal offence involving dishonesty and sentenced to imprisonment, and/or having been removed from an office of trust.
The appointment of the CEO is done by the Minister after consultation with the board. The CEO holds office for a term of five years, which may be renewed for an additional five years. The clause also makes provision for the Minister, after consultation with the board, to remove the CEO due to serious misconduct, incapacity or incompetence and to appoint an acting