Speech notes by Celeste Barker MPL. Annual Report 2016-2017, Department of Health. 29 November 2017

Honourable Premier, Madam Speaker, MECs, distinguished guests and colleagues, it is a privilege to participate in the Health Debate today because “ I stand for simple justice, equal opportunity and human rights,  the indispensable elements in a democratic society and well worth fighting for”.

These are not my words.  They were used by Helen Suzman over 20 years ago in a parliamentary debate. Now they keep memories alive in the preamble to our national constitution and root the present in the shared history that brought change to this country.

Umtu ngumtu ngabantu, we exist together,  connected to each other by Ubuntu in a shared space because – in this instance – we want to oversee the provision of reliable healthcare services throughout the Eastern Cape.

So while there is talk of trains and factions in the run-up to a Congress that shall remain nameless Hon Martin, let’s remember our shared humanity and the ties that bind each of us to service in the Eastern Cape.

The World Health Organisation (WHO) links health practitioners in a shared global practise that aims to provide accessible healthcare and enjoins those of us who are members of the Health PC to exercise oversight and monitor health services in the Eastern Cape.

So the half-year financial and non-financial oversight report for the 2017/2018 financial year highlights the following findings in its eight programmes:  47% of the budget allocated to Programme 1 (Administration). With the exception of programmes 6 and 8, all programmes have used 50 % or more of their allocated funds for the first half of the current financial year.

Programmes 3 and 5 have overspent their year to date allocated budgets and at the end of the second quarter, the Department had spent 53 % of the main appropriation and 101% of the year to date budget.

It is a cause for concern that the delivery of Primary Health Care Services has suffered administrative and possibly other delays which have delayed delivery and held back the payment of stipends to volunteers on Hospital Boards and Clinic Committee members. The DA urges the Department to put its money where its mouth is and to treat its volunteers with dignity and justice.  Let’s not mimic the messy failure to deliver equally or create a human version of Orwell’s Animal Farm in the Eastern Cape.

The delivery of Emergency Medical Services is fraught and particularly challenging in the rural areas when roads are old and neglected and it’s a struggle to transport patients to hospitals.  Furthermore many EMS vehicles appear to be “grounded “and countable but not usable.

Programme 3 carries a substantial financial burden because of the high costs of COE caused by previously unpaid overtime allowances.  The DA wants to know why overtime pay was delayed and who was responsible for the delay.

Programme 4, on the other hand, suffers from underspending for COE and overspending to fund leave gratuities and the unbudgeted cost of medico-legal claims.  We support recommendations that request that the Department should prioritise the finalisation and adoption of its elusive organogram.

As far as programme 7 is concerned there has been a severe shortage of orthotic devices from time to time in the province. This is unacceptable! Particularly as in some instances crutches have been out of stock and staff have had to assist patients by carrying them on their backs!   In the NMBM retired amputees actually outshone the Department when they went door to door and collected crutches in the suburbs.

The DA supports recommendations in the report that will force the Department to develop corrective measures and to ensure that it improves its service delivery to amputees and all patients who depend on assistive devices.

Programme 8 – Health Facilities Management – has spent only 33% of the main appropriation and cites appointment delays as the cause.  Furthermore, Programme 8 has underspent on Goods and Services because of delayed payment by contractors and is inadvertently putting the Department at risk because payment is not guaranteed.

The good news story in the DOH is that Treasury has allocated an amount of R546 Million to the Department of Health in a bid to help it to reduce its debt burden.

The DA welcomes suggestions that the Department should work hand in hand with public reps to assist with public relations and the dissemination of information and feedback to local communities.

As described in the CDC report to the Economic Development Portfolio Committee it appears that the Eastern Cape Department of Health is the biggest outstanding debtor to the DOH with outstanding accounts mounting up over 361 days and less.

Findings based on the 2017 Annual Report are extremely worrying.

I say so because underspending appears to be a deliberate strategy to delay payment beyond 30 days so that funds can be used to defray other outstanding costs that amount to fruitless and wasteful expenditure and make rollovers to the next financial year possible.

The Department is slow to process corrective measures based on fruitless and wasteful expenditure and this creates a bad impression of its commitment to consequence management.

The Department has incurred high medico-legal costs and it has, therefore, defaulted on other contractual obligations and incurred more debt through added interest charges.

Level 3 of the Management Performance assessment tool was not achieved because the Department did not submit the required documents about EXCO decisions and the implementation of these decisions.

Broadband access was possible because it was funded by the OTP.

The Department committed to providing an organogram which has not yet been finalised or distributed.

While the Department has received an unqualified audit from the Auditor General for the year under review,  challenges around recurring findings such as irregular expenditure of R26.9 Million, a shortage of information to verify legislative compliance and insufficient information to corroborate stated compliance with pre-determined objectives.

No virements were affected during the 2016/17 period but underspent funds/savings were “shifted” to pay medico-legal costs arising from programmes 2 and 4.  The Department recorded no unauthorised or irregular expenditure but recorded the condonation of R143.3 Million. Six.9 Million was recorded as late payments to providers, damages and vehicle abuse plus payment on final accounts for infrastructure projects.  R 587 000 was transferred to receivables for recovery and investigations into prior fruitless and wasteful expenditure resulted in R29 434 Million being resolved.

The Auditor General found that medico-legal claims constitute an emerging risk that may impact the liquidity of the Department and further identified that a significant number of the medico-legal claims relate to maternal care and Cerebral Palsy at the Mthatha General Hospital. Procedures were thus designed around the following areas:  HR Selection and Management, access to the facility via EMS Services, Patient Records Management, Dispensing of medicines and the commission and use of medical equipment.

It was also found that  83 of 146 Nursing Posts were vacant, 5 0t 9 Doctors’ posts were unfilled and 2 of 34 Professional Nurses received training in the Essential Steps in managing Obstetric Emergencies.

Challenges with EMS were also experienced as well as with patient records and the administration of medicine.

The AG also found that if just medico-legal expenses were paid the shortfall would consume the entire budget!

And that at the current trend the contingent liabilities and commitments are increasing at an average of R5.3 Billion per year with an expected balance at the end of the 2017/2018 financial period of R24 .6 Billion.

With an approved appropriation of R21.7 Billion for the 2017/18 financial period of R24 .6 Billion in the event that all claims become payable the Department may experience a shortfall of funds of up to  R2.9 Billion that can negatively impact on service delivery.

Furthermore, an analysis was performed to determine the expected payment of medico-legal costs in the next financial period.

In the last 5 years, a total of R937 Million (R 343 Million in the current period) has been paid as a result of legal claims with an expectation of R423 Million that could be incurred in the 2917/18 period.

Since these claims are not budgeted for appropriation, funds would have to be shifted from other line items in order to make payments. These monies could have been used on expenditure initially budgeted to implement service delivery and could impact negatively on liquidity.

This is no laughing matter!  The Department should heed these stats and start planning for its future.