Analysis Of Service Pressures at Health Facilities Across the Province
Analysis of service pressures at health facilites across the province demonstrates a 28, 8% population increase. Bed occupancy rates at certain hospitals exceed 100%.
Western Cape Minister of Health, Theuns Botha, briefed the media on the enormous challenges that face health staff every day. “In the past four years we have introduced several ground-breaking initiatives to reduce waiting times at facilities, but the results are not visible, because the patient numbers keep increasing. The more we improve our service, the more patients we attract.”
Minister Botha said: “The statistics confirm that there is a large in-migration to the Western Cape from especially the Eastern Cape. We are prepared to service the new patients who require our health services, but our stance is that it is national government’s constitutional obligation to compensate provinces for services rendered. This will require a formula to allocate budgets to provinces on the grounds of population size and alternative criteria.
This follows a presentation to the provincial cabinet on the increasing service pressures experienced at health facilities across the province, culminating in longer waiting times and negative staff attitudes.
Minister Botha said that the provincial cabinet had requested that legal advice be sought on how to challenge the formula that National Treasury applies when allocating provincial budgets. “It cannot be justified constitutionally that funding from the National Fiscus is allocated to a provincial government who is unable to render the required services and not to a provincial government where more than expected services are rendered at a high standard. This necessitates an adjustment to the formula to ensure fair National funding distribution. We live in a liberated era where people have the freedom to move as they wish. It cannot be that we then deprive the very same people of the opportunity to enjoy the services they deserve, simply because government's formula for the distribution of funding does not follow the services rendered.”
The presentation offers an analysis of the service pressures, resulting from an increase in population and the quadruple burden of disease that faces the Western Cape. The data confirms that since 2001 there has been a 28, 8% increase in the population of the Western Cape, and this trajectory continues, indicating that current pressures will not diminish.
A poignant example is Tygerberg Hospital, with 1384 beds and 4478 staff members, but 14 000 people moving through the hospital on a daily basis. The hospital was not designed or constructed to handle this number of people, and it speaks for itself that even the 800 toilets are inadequate. In the 2014/2015 financial year Western Cape Government Health will have a shortfall of almost R193 million to maintain the hospital in its present state, which is in itself inadequate necessitating the replacement of the hospital as already announced.
The largest pressure is experienced currently at the province’s acute hospitals, in particular in the Metro and Paarl. The hospitals that are affected the most are Khayelitsha Hospital with a bed occupancy rate of 131%, Wesfleur Hospital in Atlantis at 107%, Eersteriver Hospital at 103% and Helderberg Hospital at 101%. This pressure is also reflected by the number of patient complaints about the conditions and service received from these facilities.
Ambulance services reflect a similar trend - since 2010 EMS transported 69% more patients to hospitals and the HealthNET service transported 116% more patients from rural districts to specialised hospitals.
The symptoms of the escalation in service pressures are tangible and visible in the patient complaints, a diminished staff motivation, and negative media reports that further impacts negatively on staff morale.
Not only are long waiting times at facilities a daily reality, but waiting lists for emergency as well as elective surgical procedures continue to be at unacceptable levels:
- Patients with open fractures can wait for longer than 12 hours before the first operation is performed.
- Patients with an enlarged prostrate wait an average of one year for an operation.
- Patients requiring hip- and knee-replacements can wait between 1 and 8 years for an operation.
- Cancer surgery patients may wait between 6 and 16 weeks.
- Spinal surgery patients can wait for 4 months.
There is a consistent demand at emergency centres, resulting in patients having to be treated on beds in corridors and trolleys in wards – despite adding 140 acute beds to the system over the past two years. Minister Botha said “This treatment is not in line with this government’s goal to improve the patient experience, and certainly not in line with the Healthcare 2030 vision of patient-centred quality care.”
Minister Botha reinforced that in response to these pressures, the Department has strengthened its management and systems. “We continue to provide robust healthcare planning with focus on quality, efficiency and effectiveness. We have tight resource management systems in place and in the past two years have increased our responsiveness to monitoring and evaluation outcomes.
“Clinicians and management are working together to alleviate service pressures, and we are continuously initiating new decongestion strategies. There is hardly a measurable public health care aspect or outcome in which the Western Cape Department of Health is not outperforming the rest of South Africa by far. This is not achieved by coincidence or by chance - it is possible due to a strong vision, proper strategies, well executed plans, programs and projects, excellent management, dedicated staff, low staff vacancy rates (4 - 5%), financial accountability and political responsibility.
“However, our successes, in combination to the deteriorating public health services in our neighbouring province, the Eastern Cape, lead to in-migration and eventually the service pressures that we experience.”