Committee Report on Free State oversight

NCOP Health and Social Services

14 August 2018
Chairperson: Ms L Dlamini (ANC; Mpumalanga)
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Meeting Summary

The Select Committee met for the adoption of the follow-up Oversight Report to the Free State Province.

In its consideration of the draft oversight report the Committee included the issue of a nurse that had raised the alarm about the conditions at clinics and other health facilities in Gariep District Municipality. The nurse has since been fired and after an investigation by the MEC, it was found she had been unfairly dismissed and would be reappointed and deployed to Mangaung.

Among other issues, the Committee also resolved to look into the contracts of private emergency service providers and how those had been concluded and why a private service provider had an office inside the casualty ward of a public hospital whilst the actual government ambulance services were 50 meters away from the casualty ward.

The report also contained the Committee’s concern at the acting positions at Albert Nzula District Hospital, the water concerns at Mamela Local Municipality and the procurement of ambulances.

The Committee adopted its report with amendments.

Meeting report

The Chairperson welcomed Members and suggested that the Committee browse through the draft oversight report before the meeting officially started.

Mr C Hattingh (DA; North West) wanted to know whether Pelonomi Regional Public Hospital (PRH) was functioning or only the private hospital was operational. He had also noted easy access movement of persons between the PRH and the Pelonomi Netcare Private Hospital and wondered what actually was happening.

The Chairperson said that it seemed that people had been moved just for that day as the Committee’s visit was known to hospital staff before the Committee’s arrival.

Mr Hattingh wondered how much that exercise of moving patients would have cost the Free State Department of Health (FSDoH).

The Chairperson advised that Mr Hattingh write down his questions for the follow-up meeting with the hospital when the Committee would be returning to the Free State. The Committee would be visiting on Monday 27 August 2018, the day before the ‘Taking Parliament to the People’ week would be starting.

Ms T Mpambo-Sibhukwana (DA; Western Cape) asked whether the Chairperson had informed staff to include in the draft report the leaking ceiling and the letters that staff at one hospital had given to Members during the oversight.

The Chairperson noted that the FSDoH had alluded to procuring 60 ambulance vehicles whereby she had inquired about where they were housed.

Ms Mpambo-Sibhukwana said when the Committee arrived at the garage it had only found 10 ambulances.

Ms P Samka (ANC; Eastern Cape) noted that the Committee had done unplanned visits to Gariep District Municipality and to the Free State provincial vehicle fleet garage.

After officially opening the meeting, the Chairperson noted that the report the Committee was to consider would form part of the report back the Committee would be taking back to the people of the Free State on 27 August 2018. Of the issues considered at the oversight there had been the matter of mobile clinics for the rural areas in the Free State where the Committee had found that the procured mobile clinics had to be retrofitted to enable them to access rural areas. The Committee had been frustrated with the fact that the Free State had accepted mobile clinics that had not been fitted for rural areas work and the province had reported that retrofitting would be done for free, which did not convince the Committee. The FSDoH had been found to be lacking in fleet vehicles to service other functions of hospitals and clinics and the Committee found that the vehicles were parked at the State fleet garages awaiting registration. The Committee had been ensured that by the time it returned the vehicles would have been registered and distributed appropriately.

Most of the FSDoH did not have warm bodies guarding the infrastructure and personnel and when the Committee inquired about this, it had been told about close circuit television (CCTV). It was then queried how CCTV would protect personnel from attacks and the FSDoH had only then responded that it would appoint 500 security personnel by the end of September 2018.

There had been reports of dysfunctional or non-existent medical equipment at most FSDoH facilities but the facilities the Committee had visited, it had found the medical equipment had been procured and delivered although there remained a lot of infrastructure challenges in the province.

The Committee had not visited PRH as it had not formed part of the report given to the Committee which had necessitated the oversight visit to the entire FSDoH. The Committee had to decide whether it would use the follow-up to visit PRH.   

Ms L Zwane (ANC; KwaZulu-Natal) thanked and appreciated the Members that had attended the oversight. She recalled that during the oversight the FSDoH had placed a moratorium on new employment of emergency medical services (EMS) and there had also been extended acting positions of people still in the employ of the FSDoH without permanent appointments or otherwise.  Lastly there had been a matter of medicines stored at inappropriate temperate which affected their efficacy and expiration.

Ms Mpambo-Sibhukwana said that on the issue of acting-positions the Committee had emphasised that it wanted it resolved when it returned to the Free State in August 2018

Mr Hattingh said although the Chairperson alluded to considerable progress made in FSDoH facilities, it had also been clear that all the facilities personnel had been told that Parliament would be visiting and therefore the Committee had found the facilities with personnel in abnormal states. The progress made therefore was difficult to extrapolate to the whole province or district which the Committee had visited as things seemed to have been stage managed.  He therefore proposed that the Committee had to plan for unannounced visits when ‘Taking Parliament to the People’.

He recommended that instead of requiring a detailed report on the agreements with Buthelezi Emergency Medical Services from the FSDoH the Committee had to give a deadline to the FSDoH for that report and that Buthelezi had to be separated from other ambulance service providers. At Albert Nzula District Hospital the Committee had to note that it had found an ambulance service provider provided with office space inside the casualty ward whereas; there was an ambulance facility 50 meters away from the casualty. It had also been clear and suggestion had abounded that Buthelezi EMS had a choice in taking the most lucrative trips because of its proximity in the hospital. How and why could a private contractor have an office inside a public hospital casualty ward? The Committee was never answered satisfactorily in that regard.

The Committee had also been informed and had observed contracts for security services and fire extinguishers had not been renewed or had been stopped and the fire extinguishers had all expired at all the facilities the Committee had visited. Seeing that those were only two contracts the Committee had to be furnished with an explanation of how many other contracts had been terminated, not renewed or paid-up by the FSDoH.

The Chairperson replied that as most of the issues the Members had raised were issues not covered in the report which would then be added going forward. She recalled and hoped that what had been done in the facilities the Committee had visited would be issues that would get attention across the entire FSDoH facilities in the province as the Committee would be unable to cover the entire province.

Mr Hattingh said the Committee did not know what the contractual agreement was between Netcare Pelonomi and the PRH but there were interleaving doors in-between the two hospitals and the Committee could not be sure whether there was no sharing of resources.

Ms Mpambo Sibhukwana noted that the letters that staff at one hospital had given to the Members during the oversight had not been included in the draft report.

The Chairperson said staff would not have known about those. Gariep District Municipality and staff members at the facilities had been stage managed to not divulge information to the Committee about their working conditions such that the letters had been secretly given to the Committee by three staff members at Albert Nzula District Hospital.

In almost all the facilities visited, facility managers that had been acting had been appointed permanently however; the Committee still had to follow-up on what the status was in other facilities where it had not visited. Notably, the entire executive management at Albert Nzula was acting officials. Possibly when the Committee would be returning the FS the positions would have been filled. In some facilities visited, there was new medical equipment and indeed medicines had been stocked and well stored but there remained a shortage of pharmacists because the Committee discovered that when the Albert Nzula pharmacist was off sick no medication was dispensed on that day.

The Committee staff had to include in the report the matter of the nurse who had raised the alarm about the conditions in the facilities at the FSDoH and had been assaulted by a district or provincial manager. That nurse had told the Committee she would be fired when the Committee left. Indeed she had been fired, but the Chairperson reported to the Committee that she had followed-up that case with the Health MEC and that nurse would be re-appointed to Mangaung.

The nurses at all the facilities in the Gariep District had been complaining about the area manager and had recommended that she be deployed to another region in an earlier oversight. When the Committee had returned; it had found that manager was still at Gariep but the Committee had emphasised with the FSDoH leadership that the manager would be moved by the time when the Committee returned on 27 August.

Ms Samka requested that the Committee staff included the details of the debriefing meetings the Committee had with the FSDoH.

Ms Zwane asked whether it was procedural to include the correspondence within the body of the draft oversight report or was could it be included as annexures instead.  

Ms Marcelle Williams, Committee Secretary, said that she did not see any challenges with including the letters but her concern was whether the staff that had given the letters to the Committee would want their names divulged in the report. She proposed that the correspondence could be included as part of the report without identifying the staff.

Ms Zwane said that the staff had to ensure though, that the content of the letters would not be edited out of the report.

The Chairperson noted that acting allowances had not been included in the report  because the Committee had found that people had been in acting positions for many years without allowances, appointment letters and the Committee had resolved that the FSDoH had to approach all those people and engage them on how those issue would be sorted out financially and contractually.

Consideration of the follow-up Oversight report to the Free State Province

The Chairperson read through the report page by page. Page 2 of the report should mention the apologies for Members who were absent because it was formally mentioned in the meeting. Page 3 should indicate that Members were supposed to visit other clinics but they took them out because they were 100 km away from the route, and instead they added another clinic. It should be in the report that they visited this clinic. Page 6 of the report should show that the MEC did her own investigation and the findings of her investigation should be reflected in this report because Committee needed to cover her side of the story as well. In that report she (MEC) found that the nurse was unfairly dismissed and will be reappointed in Mangaung. The issue of the Area Manager can be put in the report under the Briefing by the Province, which was where it was mostly discussed.

Mr Hattingh said it should be remembered that the sister in charge said that all the staff accommodation was full; in fact he was told that there was more accommodation than staff but it was rented out to the public.

The Chairperson said they should indicate that in the report because it was reported that accommodation was fully occupied by the staff, but a question was asked if staff was paying rent.

Mr Hattingh asked whether all those accommodated are employees of the hospital.

The Chairperson said it should be in the report and make a follow-up on whether all the occupants in the hospital accommodation are employees of the hospital.

The Chairperson said page 8 of the report should indicate the issue of de-briefings. The issue of medical equipment that were procured in the clinics they visited should be indicated in this report, like minor renovations such as paintings and fixing of small things such as taps and doors, etc. It should also be included on page 8 that at MUCTP there was an Acting Security Manager in a position which did not exist for 7 years. Page 9 should indicate that the pipes burst and water came out and people that were called for renovations did nothing because there was no equipment to fix the pipe and that there was no space for medication. There were renovations and an office for the Head of the clinic who was appointed permanently was built but the people who sent there for renovations did not do a good job because some of the doors cannot be closed. The staff just saw people coming in and out not without knowing what they were doing and what they were hired for.

Mrs Mpambo-Sibhukwana said she did not see where the challenge was with the water because there was water in other clinics and she was not sure where they can put that issue in this report.

The Chairperson said the challenge of water was in Mamela Local Municipality. It was reported that there were JOJO TANKS tprocured for the clinics, which should be indicated in the report as an achievement. Things that were raised for renovations in that clinic were resolved although it was a shoddy work.

Page 11 of the report covered the conversation about inviting private ambulances or emergency services together with the department and those provinces that are using them. There had been no clarity from the HOD when they asked her if she had procured 110 ambulances and still needed more because that was the entire fleet they needed, and there was no clear indication as to when they would be terminated

Mrs Mpambo-Sibhukwana asked whether it was possible to invite emergency services operators to come and brief the Committee on their challenges.

The Chairperson said the programme could be a challenge. It could be possible to invite them before the PRH meeting so as to allow them (emergency services) to speak out their frustrations, challenges and why they have to procure private emergency services whilst they are there.

Ms Zwane suggested that they invited emergency services to the PRH meeting because it will address the hospital issues.

The Chairperson said their meeting with the emergency services could not take place at PRH and the meeting should be a day before PRH. She said the Committee needed to balance their report by mentioning all the achievements and challenges.

Mrs Mpambo-Sibhukwana moved for the adoption of the report.

Ms P Samka seconded the proposal.

The Committee adopted the report with amendments.

Consideration and adoption of minutes

Minutes dated 29 May 2018; and 5, 12 June and 19 June 2018 were adopted without amendments.

The Chairperson thanked Members and support staff for their inputs.

The meeting was adjourned.


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