/ 2 September 2011

Where public meets private

Where Public Meets Private

When Sune Rudman’s* 10-year-old son was hit by appendicitis last year — he was clutching his stomach, screaming and vomiting — she did something she would not have considered until recently. She drove him to the state health facility closest to her home, Grahamstown’s Settlers Hospital.

“Three years ago I wouldn’t have sent my worst enemy to Settlers,” she said. “It was such a dirty place, with blood on the floors, rude nurses and one doctor for hundreds of patients.”

She said she would have been forced to drive her son to a private health facility in Port Elizabeth, 90 minutes away.

But two years ago black empowerment consortium Nalithemba Hospitals, in which the private hospital group Netcare is a 50% shareholder, entered into a partnership with the Eastern Cape government to refurbish the run-down facility.

Under its 17-year contract with the state, Nalithemba has spent millions of rands on overhauling Settlers, including building a private wing. It now manages all non-medical services, including cleaning, security and general maintenance.

The provincial government pays it a monthly fee of R3.8-million, much of which goes to servicing a loan for the initial investment in Settlers and the building of a new hospital in Port Alfred.

Rudman said she was “very comfortable” with the Settlers casualty unit, which now serves both public and private patients. “The service was truly excellent,” she said. “My son got help in minutes. While the nurses cared for him, the hospital offered to contact our GP so that he could attend to him.”

Private patients at Settlers can choose between being treated by the government doctor on duty or their own practitioner.

“Using their own doctor means they mostly don’t have to wait for service and it takes pressure off the state doctor,” said hospital manager Darlene de Vos of Netcare.

State working with the private-sector
About a third of Settlers’ casualty unit is staffed by Netcare and the rest by government nurses. Netcare manages the unit, but both state and private nurses attend to all casualty patients. “We don’t have private nurses serving private patients and vice versa. It’s only when a patient is admitted to hospital that there’s a choice of service,” De Vos said.

Bongiwe Moyake, who manages medical staff in the hospital’s government wing, acknowledged that state nurses were initially “apprehensive” about working with private-sector colleagues and adhering to private-sector protocols. “They thought they’d get fired straight away if they did anything wrong; they perceive the private sector as being more disciplined than the public sector,” she said. “But their attitudes changed and they now realise that they benefit from the Netcare training.”

Both De Vos and Moyake are former nurses. That, De Vos said, gave them a good understanding of the “nuts and bolts” of a hospital.

Elvera Meier, the state’s quality assurance manager at Settlers, said staff morale had improved enormously. “We no longer have to work in a place that’s falling apart and we’ve got working equipment.”

Meier said all wards now had wheelchairs, whereas previously only the casualty unit had them. “We now also have three times more drip monitors for patients and decent resuscitation trolleys.”

Moyake said that a crucial improvement had been the speed of repairs to broken medical equipment.

“I didn’t use to have the authority to contract private companies to fix equipment. We used old boilers to sterilise theatre equipment – when they broke down, it took weeks to get them fixed and I had to send the equipment to PE to be sterilised,” she said.

Costs and equipment
With new apparatus, it now took 15 minutes to sterilise a theatre pack, and if “the equipment breaks down, it’s fixed in a few hours”, she said.

Nalithemba is fined if equipment is not repaired promptly.

She is convinced that the proposed National Health Insurance scheme could learn “quite a bit” from the Settlers’ partnership.

“It’s extremely costly and complex to refurbish and maintain a hospital, and the private sector is often better equipped to do it. I can now use the time I used to spend managing cleaners and maintenance people to attend more to medical staff and patients’ needs,” she said.

In Grahamstown, people who regularly visit state medical facilities, such as Elise de Lange, said the service at Settlers was “very different” from what they experienced at other government hospitals. A 72-year-old state patient, De Lange moved from Johannesburg to Grahamstown two years ago. Once every two months she collects chronic medication at Settlers. “In Johannesburg I had to go to Helen Joseph [Hospital] to fetch my drugs. I waited in queues for hours on hard, filthy wooden benches. At Settlers I wait 20 minutes.

There are cleaners busy every­where and the staff are helpful. It feels like private healthcare.”

Strolling through the government wing of Settlers indeed reminds one of a private hospital. Framed paintings decorate the walls, every ward has a kitchen with wooden laminated cupboards and there are separate partitioned units for mothers in the maternity ward.

In the paediatric ward, nurses give mothers sterilised gowns to wear to protect their children from infections, and mothers can stay overnight.

Hospital management said the facility still struggled to attract specialist doctors who generally preferred the bigger centres “where there’s more money”.

In both wings, only half the medical staff positions are filled. But Settlers’ government section has benefited from the presence of an ear, nose and throat specialist in its private wing, who has agreed to charge state patients at government rates.

De Lange said: “If the NHI embraces the Settlers’ model, I think it will work. Everyone in Grahamstown now has access to good healthcare, no matter where they’re from or the size of their bank balance.”

*Not her real name.

Mia Malan works for the Health Journalism Centre at Rhodes University