ATC170515: Report of the Portfolio Committee on Defence and Military Veterans on its 23 March 2017 oversight visit to 2 Military Hospital in Wynberg and the Regional Works Unit Western Cape at Youngsfield Military Base, dated 15 May 2017
Report of the Portfolio Committee on Defence and Military Veterans on its 23 March 2017 oversight visit to 2 Military Hospital in Wynberg and the Regional Works Unit Western Cape at Youngsfield Military Base, dated 15 May 2017.
The Portfolio Committee on Defence and Military Veterans (PCODMV) engaged with the South African National Defence Force’s (SANDF) 2 Military Hospital in Wynberg and the Regional Works Unit Western Cape at Youngsfield Military Base on 23 March 2017. This formed part of the Parliamentary programme and took place during Parliament’s oversight week.
1.1 Purpose of the visit
The purpose of the first part of the visit was for the Committee to be briefed and updated on the status and progress with the 2 Military Hospital Refurbishment project. The purpose of the visit to the Regional Works Unit Western Cape was for the Committee to observe the quality and scope of repair and maintenance projects by the Unit at the Youngsfield Military Base. This allowed the Committee to gain first-hand knowledge of the activities of these units and the challenges they are experienced. Given that the Gauteng (provincial) counterparts of these units were visited earlier by the Committee, Members could draw comparisons and asked related questions.
1.2 Committee members and support staff
The Delegation comprised of the following people:
Members of the Committee:
Hon. M.S. Motimele Chairperson
Hon. J.J. Skosana Committee Member
Hon. N.A. Mnisi Committee Member
Hon N Dambuza Committee Member
Hon. S. Esau Committee Member
Hon. S. Marais Committee Member
Peter Daniels - Committee Content Advisor
Calvin Manganyi Content Advisor: Joint Standing Committee on Defence
Mandy Balie Committee Secretary
Alutho Nwandla - Committee Assistant
Peter Nkabinde Department of Defence: Parliamentary Liaison Officer
2. OVERSIGHT VISIT TO 2 MILITARY HOSPITAL
2.1 2 Military Hospital staff
Col (Dr) I Bux Officer Commanding 2 Military Hospital
Lt Col (Dr) R Ismael SO1 Force Preparation
Lt Col Mbuqe SO1 Force Support
Capt. U. Cohn Adjudant
MWO Z.S. Jini RSM
The Committee was briefed by the Officer Commanding 2 Military Hospital Col (Dr) I Bux, Lt Col (Dr) R Ismael the SO1 Force Preparation and Lt Col Mbuqe the SO1 Force Support. The hospital is one of the seven units belonging to specialist formation. It is a Level 3 Specialist hospital (It can be equated with a regional hospital which administers primary health care with limited professional/surgical services and can perform more advanced surgery) one level below that of 1 Military Hospital which is a Level 4 hospital (The highest and most complete medical facility in a country and is also a tertiary hospital where advanced and specialist medical support can be administered). 2 Military Hospital has various Special Projects that it initiated and these include the Biggest (weight) loser, a museum, an Outreach programme as well as a Learn to swim project.
The gender split of staff at the hospital is 67.18% female while the demographic split is 39% African, 31% Coloured, 21% White and 8.42% Indian. The overall staffing level is 52.6%.
2.2 Refurbishment project
The Refurbishment Project started with the Acceptance of Tender on 30 July 2012 with a contract period of 54 months. The Site Handover took place on 22 August 2012 and the initial Contract completion date was 29 January 2017, which has been extended to 30 June 2018. The Management indicated that it has the cooperation of the Regional Department of Public Works (DPW) which is fully effective. Given the challenges that were observed by the Committee at 1 Military Hospital, the Committee expressed its satisfaction for the good progress made, especially regarding the effective management of the Project. The cost associated with the Refurbishment project is R 877 million and is believed to be one of the biggest projects of the Department of Public Works (DPW). The planned completion date is June 2018 and most of the construction work has been done leaving the completion of internal work.
The Magnetic Resonance Imaging (MRI) facility (MRI scanning is a medical investigation that uses an exceptionally strong magnet and radio frequency waves to generate image of the body) is the first one in the SANDF and is hosted on Ground Floor. The hospital has an X-ray machine on the second floor that can do a full-body scan within 12 seconds, one of the few in the country and which assist tremendously with diagnosing patients.
2.3 Tour of facilities
The Committee was taken on a tour of the hospital and first visited the various floors as follow:
- The 5th floor which hosts the Outpatients Clinic.
- The 4th floor which hosts the Dialysis unit (still to be completed), neonatal ward and general ward.
- The 3rd floor which houses the following facilities: Trauma, Emergencies, ICU, etc.
- The 2nd floor hosts the Pharmacy, Sonar and Ultra sound section, etc.
- The 1st floor is mostly used for the Human Resource Section as well as a cafeteria.
- The Ground Floor houses the completed Dental Section as well as the Radiology Department where X-rays, CT scans and MRI scans can be done.
After visiting the various floors of the hospital, the Committee went to the newly completed Administrative and Logistics building, which was handed over in October 2016. It hosts various sections including the Logistics Section comprising of different stores, loading bays, parking areas and the Command Section of the Hospital. It was clear that much thought has gone into the design of the building to enhance the flow of activities and to ensure that it is user-friendly for the different stakeholders. At the time of the visit, the Nurses Home was 60% completed, while the new parking area has been used since December 2012 and assisted to address the parking challenges.
2.4 Intensive Care Unit (ICU)
The ICU of 2 Military Hospital is one of the best and private hospitals use it as a benchmark. However, the ICU is one of the biggest challenges for the management of the hospital. It is a fully equipped ICU ward; yet, it is not functioning because there are no doctors to man it. Until the end of December 2016, this unit was manned by Community Service doctors very effectively. Since the beginning of 2017, no Community Service doctors could be employed by the hospital, leaving a perfectly functioning ICU idle because of this decision. The decision was apparently made in Pretoria and the Committee resolved to investigate this matter. The Community Service doctors were instrumental in ensuring that most services are done in-house rather than being outsourced, in the process saving the hospital a lot of money. The cost to host ICU patients at other hospitals in the area is enormous, as evidenced by the one case that cost the hospital more than a R1 million for a short period. This is an issue that needs to be followed up with the Surgeon-General, as it is unacceptable that a fully functional facility is left idle while outsourcing comes at a huge price.
Various challenges have been identified by the management of 2 Military Hospital and some of these are:
- Retention of Skills: The hospital is unable to retain much needed skills due to several challenges including centralised command, Occupational Specific Dispensation (OSD) allowances and delays in filling posts. The hospital has not appointed any new doctors in three years due the centralised command which delays the appointment process. A retention strategy is urgently needed for doctors. Between December 2016 and January 2017, a total of 9 doctors were lost.
- Ageing Military Veterans: The ill-health of military veterans is a challenge to the hospital. Their health needs are different from that of the Regular Force Members. Some military veterans had inadequate health care before they commenced receiving health benefits from the Department of Military Veterans. They are also experiencing difficulties in accessing the medical records of military veterans from public health facilities.
- Medical inflation. One of the challenges with the annual budgetary allocation, is that it does not keep track of the inflation on medical goods and equipment, as the medical inflation is higher than the average consumer goods inflation.
- Commuted Overtime: The DOD has a different policy when it comes to commuted overtime. The regulations are not in line with those of the Department of Health. This creates a challenge for medical professionals as they do not enjoy the same benefits as their peers in public service, leading to frustrations and the loss of medical professionals.
- Procurement – as with other units, the long delays and related challenges in procuring commodities, is one of the biggest frustrations experienced at the unit.
- Medical Stock (consumables), linked to the challenges in procurement, the purchase of consumables often lead to medical practitioners purchasing these out of their pockets in order to ensure that operations, treatment etc, goes ahead. Sterilisation material is a serious challenge. Medical practitioners often use their own funds to purchase consumables in order to carry out their work. Transport is another major challenge as the unit has an inadequate number of serviceable vehicles to execute its mandate.
- There is no protection structure at the Hospital and a 30-member structure is required to adequately secure the hospital. Other security measures such as closed circuit cameras and access cards are currently being utilised.
- The funding for the call-ups of Reserve Force personnel are not guaranteed, resulting in a lack of sufficient personnel to manage the hospital’s security. In addition, Reserves are only called up for a few months, leading to time being wasted on re-training them in security as they were trained in the medical environment.
- Outsourcing: Given the capacity constraints mentioned, outsourcing of patients occur frequently at a very high cost to the DOD, where these services could have been performed in-house.
Various observations were made by Committee Members and these include:
- The Committee should create another platform to further discuss the issues raised by the hospital’s management, especially the recommendations.
- The Procurement issue is a major challenge, especially consumables and medical equipment. The Committee resolved to engage with the Surgeon-General (S-G) and Chief of Logistics on this issue as soon as possible.
- The security situation around the hospital is unacceptable and needs to be addressed as the safety and security of the hospital should not be compromised.
- Concern was expressed at the low stock levels in the pharmacy as they are expected to carry at least three-month’s worth of stock but at best have only stock for two weeks.
- The Committee enquired about the need for a medical technologist in the Refurbishment Project, as this appointment was a challenge at 1 Military Hospital in Thaba Tshwane. The management of 2 Military Hospital indicated that they did not have the same problem as they followed a participatory process in the design of the different sections of the hospital. The Head of Departments were involved in the planning phases of the project after which the architect accommodated their preferences as much as possible, in the process eliminating the need for a medical technologist.
- The Committee enquired about the role of the Surgeon-General (S-G) regarding the challenges being experienced at the hospital and whether he was consulted regarding these. The hospital’s management indicated that they report through the normal command and control channels and they could therefore not vouch whether it was brought to the attention of the S-G.
- The ICU ward and the appointment of Community doctors necessitating the outsourcing of this service, were some of members’ main concerns.
- The Committee commended the management of 2 Military Hospital for the sterling job, and that despite the challenges, the staff manage to maintain high standards and is living up to their motto “Committed to care” in many ways.
- The high cost of outsourcing is of concern to the Committee and should be addressed within the broader SAMHS environment, especially where a capacity exist to offer such services in-house.
The Committee made the following recommendations:
- An opportunity (platform) should be created as soon as possible to discuss the issues raised during the oversight visit with the Surgeon-General, Chief of Logistics and the Secretary for Defence.
- The non-utilisation of a fully equipped ICU is unacceptable given the huge costs associated with outsourcing this service. The Department should address the issue of Community doctors to man the ICU as a matter of urgency.
- The fact that a strategic facility such as 2 Military hospital is not being properly safeguarded is unacceptable and should be addressed as a matter of urgency.
- Urgent attention should be paid to speed up the purchase of especially medical consumables to enhance the effectiveness of the services delivered by the hospital.
- Where in-house services exist, the Hospital should be capacitated to avoid the constant need for outsourcing of patients.
6. REGIONAL WORKS UNIT WESTERN CAPE AT YOUNGSFIELD MILITARY BASE
After the visit to 2 Military Hospital the Committee went to Youngsfield Military Base, where it paid a visit to the Regional Works Unit Western Cape.
6.1 Regional Works Unit Western Cape
The Unit is the provincial leg of the Defence Works Formation and is responsible for the maintenance and repair of various defence facilities and infrastructure in the area. These include facilities and infrastructure at Air Force Base Langebaanweg, SAS Saldanha, Military Academy, 4 Special Forces Regiment, 2 Military Hospital, Youngsfield Military Base, Infantry School and Air Force Base Ysterplaat.
6.2 Tour of projects
In the absence of the Officer Commanding, the unit’s second in command, Lt Col M.I. Waqu led the Committee to three of their projects in their unit lines. The first was the newly build unit headquarters which was recently completed and the Committee was briefed on the various sections of the Headquarters which includes toilets, a reception area, conference room, etc, which was built by members of the unit.
The second area visited was the still under-construction Operations Room where Col. Waqu explained what the Room will look like once it is completed. It will host the statistics of various projects, personnel information and other essential information. One of the main issues was the replacement of the asbestos roof.
The third building visited was the Lembede Guest House, which was built from scratch by unit members. It is being viewed as one of the flagship projects of the unit. It has various divisions such as a kitchen, toilets, a bar, dining room, bed rooms, etc. Once completed it will be able to host VIP guests from other units. The Committee expressed its satisfaction with the quality of these projects and especially the Unit’s ability to save costs on such projects.
The Committee Members asked various questions around the different projects and also enquired about the challenges facing the unit. The following are some of the observations:
- Similar to other units, one of the main challenges is the restricted budget which impact on the on-time completion of projects.
- Procurement is a challenge as the unit struggles to procure especially building items which do not have a National Stock number, leading to long delays as these numbers first have to be acquired.
- These delays impact on the utilisation of trained staff as they have to wait for building items to complete projects.
- The utilisation of the Unit means that the Department can make significant savings on the costs of maintenance and repairs of Defence facilities and infrastructure.
The Committee recommended that:
- The procurement challenges experienced by the Unit, be taken up at the next engagement with the Chief of Logistics.
- Given that the Defence Works Formation can save the Department money through its repair and maintenance activities, the budgetary allocation to the Formation should be taken up with the Accounting Officer.
- Training of members of the Defence Works Formation should be enhanced and extended to ensure that they are able to expand their capabilities to repair and maintain defence facilities and infrastructure.
Report to be considered
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