Plans to restructure many of Gauteng’s hospitals have been delayed following much criticism, reports Andy Duffy
THE Gauteng government’s plans to close or downgrade nearly a third of its hospitals have been put on hold, pending further investigation.
The provincial health department, which has faced a barrage of criticism, says it is “sympathetic” to calls from academics, unions and communities for more time to comment, and plans to assess arguments against the proposals.
Delays will reduce projected savings from the plans for the next financial year.
It also emerged this week that the province will have to spend an estimated R100-million on retrenchment packages if the staff identified as surplus are shed.
The plans, unveiled last month, include closing three hospitals, converting seven into clinics, redeploying 6 000 employees and axing a further 2 500 staff.
The programme was to have kicked in from January. But the department decided this week to extend the consultation from the end of this month possibly to the end of January, pushing the programme’s implementation back to June.
Officials say the basic aims of the programme – to cut costs and redistribute resources more equitably -will remain. But the lengthy consulting process could herald changes in meeting these goals.
The department insists the delay is neither a climbdown, nor a tacit admission that it should have consulted more before going public with the reshape plans.
“If we had consulted in advance of putting something on the table there would have been a process of endless consultation,” says department deputy superintendent general Eric Buch.
“The core of the plan will remain intact, but there may be some substantive changes.”
Savings expected from the plan in the 1997/98 financial year were originally projected at R550-million, before the cost of retrenchments. More than 60% of this saving would come from the proposed staff cuts.
The figure for staff retrenchment costs remains a rough estimate. The province still has to secure agreement from central government to lift the moratorium on public service retrenchments.
The hospitals facing closure are Andrew McColm (Pretoria) and Kempton Park, and the Westfort (Pretoria) psychiatric hospital. Those to be downgraded are Hillbrow, Lenasia, Nigel, Willem Cruywagen, Hendrik van der Bijl, Laudium and Ontdekkers.
Much of the opposition focuses on the plans for Hillbrow – widely viewed as a crucial medical facility in the heart of the city.
The department and the University of the Witwatersrand’s faculty of health sciences have established a task team to investigate the closure plans.
The team – which is also assessing what the Hillbrow downgrade would save (savings from individual closures and downgrades have not been spelt out) – is due to report at the end of this month.
Faculty dean Max Price says the problem is with the process, rather than the department’s overall aims.
“It’s outrageous in our view. There’s been a loss of faith in the planning process,” he says. “They haven’t checked the facts and they haven’t heard people’s opinions.”
He says downgrading Hillbrow cannot happen before the end of next year anyway. It could take at least 18 months to shift Hillbrow’s radiation unit – one of two in the public sector in the province – to Johannesburg Hospital. It is also not clear where the patients Hillbrow serves will go.
The department’s plans also threatens to deter interns – Hillbrow’s workhorses – from taking up their one-year posts with the hospital.
Buch counters that the department’s data is based on figures provided by the hospitals over the past year. He adds that opponents have still to support their argument that the immobility of the radiation unit is a reason to keep the whole hospital going in its current form. A plan to draft the interns into Johannesburg Hospital’s pool has also been tabled.
Price says options for Hillbrow include outsourcing various activities, and bringing in private sector management. Buch agrees, saying Hillbrow cannot continue in its present form.