Chiropractors, Homeopaths & Allied Health Services Professions Amendment Bill

Meeting report

HEALTH PORTFOLIO COMMITTEE; SOCIAL SERVICES SELECT COMMITTEE: JOINT MEETING
23 August 2000
CHIROPRACTORS, HOMEOPATHS & ALLIED HEALTH SERVICES PROFESSIONS AMENDMENT BILL; NATIONAL HEALTH LABORATORY SERVICE BILL

Relevant Documents
Draft Chiropractors, Homeopaths and Allied Health Services Professions Amendment Bill
Revised Constitution of Chiropractors, Homeopaths and Allied Health Service Professions Interim Council [see Appendix 1]
National Health Laboratory Service Bill [see Appendix 2 for Memorandum]

SUMMARY
Professor Gumbi, Dr Chetty and Dr Crisp of the Department of Health introduced the draft of Chiropractors, Homeopaths and Allied Health Services Professions Amendment Bill which aims to replace the interim Council with a permanent Council and extensively amends the original Act. [Note: the earlier amendment bill this year merely extended the term of office of the interim Council].

The Committee was briefed on the National Health Laboratory Service Bill which aims to amalgamate most laboratories in the public health sector into one body known as the National Health Laboratory Service.

MINUTES
Chiropractors, Homeopaths & Allied Health Services Professions Amendment Bill
Dr Chetty briefed the committee on the amendments to the current Act:
- To insert certain definitions not provided for in the old Act
- To provide for the establishment of a new council referred to as 'Allied Health Professions Council of South Africa'
- To democratically restructure the relationship between the Chiropractors, Homeopaths and Allied Health Service Professions Interim Council and its professional boards, their powers and functions
- To allow for democratisation and transparency of the new Allied Health Professions Council of South Africa.

Questions
Dr Rabinowitz (IFP) requested definitional clarification from the presenters on the comparison between a professional and a therapist and between therapeutic and cosmetic practices.

Dr Chetty explained that the gazetted copy of the Bill had been amended from the earlier version and that the revised version has a different definition for practitioners and therapists in Section 1.
The practitioner is an individual that meets the professional and legal requirement to:
(a) diagnose and treat or prevent physical and mental illness or deficiencies in man: and
(b) prescribe and/or dispense medicine: or
(c) provide or prescribe treatment for such disease, illness or deficiencies in man.

On the other hand a therapist is a person who has met with the professional and legal requirements to:
(a) treat or provide treatment for diagnosed disease, illness or deficiencies in man: or
(b) prevent such disease illness or deficiencies in man. However a therapist cannot diagnose and use medicine.

On the question of the difference between cosmetic and therapeutic practices, Dr Chetty answered that the latter involves aspects that have been diagnosed and are known (for example, a sports injury). The difference between the two is important because the board would like to know which therapeutic practices they are willing to pay for if any.

In answer to a question on groupings are involved in the Council and as to whether there is gender representation, Prof Gumbi provided a breakdown and explained that the Council could not have more than 16 members as they could not carry the cost. The constitution proposed by the Department of Health provides sixteen members as follows:
- Ten elected: one person to represent Ayurveda, three persons to represent Chiropractors, three persons to represent Homeopathy, one vacancy for a person to represent Naturopathy, one vacancy for a person to represent Osteopathy and one vacancy for a person to represent Phytotherapy.
- Six members appointed by the Minister: four community representatives, one person to represent the Department of Health and one person with legal knowledge.

A committee member raised a concern as to whether having a number of people with different qualifications on the same board causes problems regarding the scope of the different groups. Dr Chetty responded that the Bill has a section to explain the reason why there are people from different groupings on the board and that this is mainly to allow for representation by each group and no dominance by any particular group. She stressed the importance of including all the groups as they do exist and have undergone training. She however pointed to a need for a governing framework to ensure groups do not go beyond their boundaries which may be dangerous to people's health. To allow for this governance, there must be a body to which all the groups belong.

Another committee member requested clarification on accreditation. Professor Gumbi explained that chiropractors undergo five and a half years of training where as homeopaths undergo six. After this period, the latter adopt the title of 'doctor'. Naturopaths and herbalists both undergo three years' training. However she noted that in some places, chiropractors and homeopaths are both referred to as 'doctors' and as such there is a need to look at accreditation done by the Council.

Dr Rabinowitz asked whether there was a concern that giving therapists the title of professional may open up horrific practices and that it may become difficult to police wrong doing. She was concerned that it would not be easy to see who is mis-practising and that this would result in a blurring of differences between one practice and another. Ms Njobe (ANC) added by enquiring whether there were any norms and standards laid down that ensure people are assessed as qualified before being registered.

Professor Gumbi answered that the Council brings together a number of individuals to assess what each group practises and in so doing allows them to see which individuals they should bring on board. Secondly there are interest groups that provide checks and balances for the particular groups. As such there are two sets of accreditation committees. There will be clear regulations that govern each group to allow the monitoring of each group.

National Health Laboratory Service Bill
This Bill has been introduced in the National Council of Provinces as a section 76 Bill (see Appendix 1 for Memorandum on the Objects of the Bill) . Dr Chetty said there had been much discussion amongst the various stakeholders on the Bill due to the great deal of fragmentation between different services, it is not very cost-effective and issues of implementation are problematic. The National Health Laboratory Services Bill has therefore the purpose of abolishing individual laboratory services and amalgamating all into one service with the exclusion of; (a) forensic science services provided by the South African Police Service; and (b) the South African Military Health Services at the Military Hospitals situated in Pretoria and Cape Town.

Questions
Asked for the names of the laboratories to be amalgamated, Dr Crisp said that there are 110 laboratories country-wide. Among these are those under the National Centre for Scientific Research, Provincial Centre for Laboratory Services and Forensic National Laboratories.

Dr Rabinowitz asked what the cost of this National Health Laboratory Service would be. Another committee member enquired as to what the implications of this service would be and as to whether costs would be recovered. Dr Crisp explained that laboratories are highly technical and need volumes to be effective. He went on to say that most laboratory services are very automated and by working together may decrease costs over time. The South African Institute for Medical Research is currently running at a budget deficit because volumes have decreased due to the squeeze on provincial laboratories and as such needs to amalgamate for the purpose of increasing volumes. Dr Crisp estimated the expected turnover to be approximately R700 million per annum and based on current spending this will be able to cover costs.

A committee member followed up an earlier query on resistance from some stakeholders to the Bill and wanted to find out what progress there had been from the universities that had said that they would submit proposals. Dr Chrisp responded that all eight medical schools have had input and they have agreed in principle with this model and are currently moving in line with it. The medical schools had wanted to run an area of it but this would have ultimately led to fragmentation.

Ms Njobe asked if the restructuring of laboratories would result in the retrenchment of any staff. Dr Crisp responded that the service tries to create an environment that ensures that no one falls short in the intellectual environment. Dr Crisp explained that the service aims at increasing volumes for expensive tests by pulling demand from surrounding states. He gave an example that approximately one third of Botswana's tests come through South Africa.

In response to a question on how the service would be co-ordinated, Dr Crisp pointed out that there were a total of seven branches, each of which has a set of tertiary services provided through universities. He stated that road infrastructure and provincial boundaries had been used to set the boundaries of these branches.

Dr Jassat asked what proportion of laboratory services in the country is in the private sector and what proportion is in the public sector. Dr Crisp replied that he did not know the comparative volumes. However, the average cost is 38% higher in the private sector than those presently in the South Africa Institute for Medical Research.

In conclusion Dr Chetty added that the restructuring process does not involve the grouping of similar practices, but the intended outputs and outcomes. An evaluation was carried out and the results indicated that the expected outcome of the service would be a cost-effective, co-ordinated service, more affordable service and one that uses economies of scale.

Appendix 1:
REVISED CONSTITUTION OF CHIROPRACTORS, HOMEOPATHS AND ALLIED HEALTH SERVICE PROFESSIONS INTERIM COUNCIL
The number of registered practitioners as of 31 July 2000.
(a) open registers

(b) closed registration

CONSTITUTION AS PROPOSED BY THE DEPARTMENT OF HEALTH (TOTAL (16))
ELECTED MEMBERS (10)
One person to represent Ayurveda
Three person to represent Homeopathy
One vacancy for a person to represent Naturopathy
One vacancy for a person to represent Osteopathy
One vacancy for a person to represent Phytotherapy

APPOINTED BY THE MINISTER (6)
Four Community representatives, appointed by the Minister
One person to represent the Department of Health, appointed by the Minister
One person with legal knowledge, appointed by the Minister

Appendix 2:
MEMORANDUM ON THE OBJECTS OF THE NATIONAL HEALTH LABORATORY SERVICE BILL, 2000

1. BACKGROUND
1.1. The Bill seeks to provide for the establishment of a public entity, the National Health Laboratory Service ("the Service"), that will amalgamate all existing laboratories in the public health sector except those managed by the South African Military Health Service and the South African Police Service. Research laboratories or the health science faculties of universities are excluded from the Service, but may be incorporated by agreement.
1.2. Provincial health departments, other State departments or the private sector requiring health laboratory services will purchase the services from the Service. The Service may in turn purchase services from tertiary educational institutions or any other source.

2. OBJECTS OF BILL
2.1. Clause 1 provides for the definitions.
2.2. Clause 2 aims to provide for the exclusion of certain laboratories from the operation of the Act once the Bill becomes an Act. It aims to exclude among others, laboratories managed by the South African Military Health Service and the South African Police Service.
2.3 Clauses 3,4 and 5 provide for the establishment of the Service. its objects and functions. powers and duties.
2.4 Clauses 6 provides for the control of the Service. It provides among other things, that the Service will be controlled by a Board appointed by the Minister of Health (the Minister).
2.5 Clauses 7, 8, 9, 10, 11, 12 and 13 provide for the composition of the Board, appointment of members of the Board, chairperson and vice-chairperson of the Board, disqualification from membership of the Board and vacation of office, meetings of the Board arid Committees of the Board and the Executive Management Committee respectively.
2.6 Clause 14 seeks to provide for the staff of the Service.
2.7 Clauses 15 and 16 aim to provide for the purchasing of services from the Service and the rendering of services to foreign countries by the Service.
2.8 Clause 17 provides for discoveries, inventions and improvements by employees of the Service.
2.9 Clause 18 provides for the finances of the Service. It provides, among other things that the funds of the Service may consist of income earned from fees for services rendered, income earned on surplus moneys deposited or invested money by appropriated by Parliament, grants, donations and bequests made to it.
2.10 Clauses 19 and 20 deal with defrayment of expenditure and charges for services.
2.11 Clauses 21, 22, 23 and 24 deal with borrowing powers of the Service, accounting records, audits, and annual reports.
2.12 Clause 25 deals with proceedings by the Minister in instances where the Service fails to comply with the provisions of the Act.
2.13 Clause 26 deals with the delegation of functions by the Board.
2.14 Clause 27 provides for the making of rules by the Board relating to the day to day functioning of the Board and the Service.
2.15 Clauses 28 and 29 provide for Transitional provisions and short title of the Act.
2.16 There is also a Schedule that provides for transitional provisions mainly relating to the abolition of existing laboratories, and matters connected therewith.

3. FINANCIAL IMPLlCATIONS
The Service will be funded from the current sources and it is not envisaged that the cost will be more than the current level of expenditure. There will be significant restructuring of the manner in which the budget and expenditure will he designed.

4. IMPLICATIONS FOR THE PROVINCES
The Bill provides for a medical service which falls under the functional area of concurrent national and provincial legislative competence. All provinces have been consulted and they support the Bill.

5. PERSONS/ORGANISATIONS/BODIES CONSULTED
The following were consulted:
· All national departments.
· All provincial health departments.
· Deans, Departmental Heads of Pathology and Principals of all Medical Schools.
· Principals of all technikons.
· All relevant professional associations.
· All relevant trade unions.
· Members of the public in general.

6. PARLIAMENTARY PROCEDURE
The State Law Advisers and the Department of Health are of the opinion that the Bill must be dealt with in accordance with section 76 of the Constitution because the Bill falls within a functional area listed in Schedule 4 of the Constitution, namely "Health services".