Health: State of the Province 2017

Mama uSomlomo ohleniphekileyo

Ohloniphekileyo Premier kwiphondo lentshona Koloni,

Ahloniphekileyo  amalungu epalamente yase Ntshona Koloni kunye nabaphathsiwa,

Iiindwendwe, indwalutho nezidwangube ezizozimasa lengqungquthela

Members of the different media houses

And most importantly, goeie middag mense van die Wes-Kaap.

On Friday, 18 February, the Premier tabled in this House the State of the Province address.

It was factual. It was hard-hitting. It gave a snapshot of the work this administration has managed to deliver from 2009 to date.

I am very proud to have joined a team of dedicated hardworking cabinet with leadership that prioritised people first, accountability, and instill vales based on respect of rule of law and capable state. We are lead! I am not sure if I can say about other cabinets.

I think it is safe to say that even if you are sitting on the opposite side of this House, the account of the Western Cape’s delivery over the past nine years was inspiring.

Members, South Africa is at a crossroads.

The economy has been crippled and slowed down to a 0.5% growth rate which has shed jobs instead of creating them.

We are in desperate need of leaders who govern with the humility that the act of service requires.

In this province, while we suffer the same fate as other provinces during this tough financial climate- we never allow this to get in the way of delivering critical services to those we serve.

We have never been complacent about what we have been entrusted to do by the people of the Western Cape: service delivery.

People voted and put us into power to render corrupt-free, clean, efficient, effective government.

That is why Health, the department with biggest budget allocation, continues achieving unqualified audits for the 12th consecutive year.

And for the first time in SA history, a health department being the to achieve a clean financial audit in year 2015/2016.

That this government for the past years, has been allocating biggest slice of the budget to Health, it just shows how serious the Premier is when it comes to health of the people. Thank you Premier. We salute you. Your action speaks louder and people of the Western Cape hear you. Only a healthy population can be productive and contribute towards economy. Only a healthy person can make healthy decision and choice about self.

Members, while Auntie Sarah or Mam’ uNozamile will never truly grasp the impact of clean governance - it is crucial we improve her experience in our facilties. True, with an increase in population, burden of disease increasing with patients presenting with more than one disease, budget shortages, to name the few, service pressures are inevitable. Our facilities are congested and waiting times for elective patients are longer.

The increase in psychiatric patients fuelled by the substance abuse epidemic is of concern at our acute hospitals. It is for this reason, this year I dedicate it to patient centred care, which I will table our interventions at health vote speech.

But today, Speaker, I would like to dedicate this speech to Mental Health service and for people living with mental illness in view that this has been a topic that will go down in books of Guiness record on how SA government, including myself, by association, as a member of national health council: how we failed people living with mental illness. Mental health is third contributor to quadruple burden of disease in SA. The Western Cape Health Department admitted 6 733 people living with mental illness and attended to 43 921 people living with mental illness at outpatient departments. This is no small feat, but it takes a highly effective system, governed by ethical leadership to get these basics right.

 You and I, not only Gauteng, but all of us in the position of authority, we will be judged harshly by history for allowing the most vulnerable members of our society to suffer in this way. It inexcusable and inhumane.

Mental Health as a discipline within the system is often the neglected step-child.

Due to the very nature of the illness, the people who suffer from these diseases are often alienated from society and rely on government to provide them with the necessary care they need.

This is why a failure by government is a massive blemish on democratic South Africa. Members of parliament exercise oversight on the executive.  Whilst the national government is responsible for norms & standards and policy formulation, they were once responsible for mental health and Esidimeni contracts whilst the provinces took over mental health services and start the process of deinstitutionalisation in the 1990’s. 

The world has come a long way in terms of how people living with mental illnesses were treated.

Back in the day, people were locked up, restrained and placed in dungeons away from society.

Through pieces of legislation like the Mental Health Act, we have seen a shift in the way that we treat our patients, but this has not been enough.  

In the Western Cape we have created systems which will assist us with mitigating tragedies of this nature from occurring.

Don’t get me wrong, Speaker, we too feel the pinch of a lack of resources, and we too often have to make difficult choices and prioritize.

However, those decisions are always underscored by patient-centred care.

In this province, we have sought to the quality of health services and the patient experience for mental health care users by integrating mental health care services into general health services.

We are busy strengthening district mental health service provision. This is crucial so that the quality of care is at every level of our services.

In addition to having mental health trained nurses at Primary Health Care districts, regional and central hospital levels – we have Advanced Mental Health Nurses who service districts and perform outreach services across our facilities in that district.

In addition to this, Home and Community Based Care Workers package of care is inclusive of mental health screening at household level.

The Mental Health Act of 2002 established Mental Health Review Board (MHRB) to ensure good governance and effective oversight. The relationship with the MHRB needs to be managed exceptionally well. In order to be effective, this body needs to retain its independence and be able to hold the department accountable.  

Consequently, the MHRB conducts investigations, makes house calls, interviews with patients and their families and makes binding recommendations. This is an important part of the service that we cannot ignore.

As the Health Ombudsman reiterated a couple of weeks ago, the independence of the MHRB is key.

The deinstitutionalisation of people living with mental illnesses began as an international norm over two decades ago.

The undertaking was that patients can be accommodated at facilities which are not mental healthcare hospitals where they would receive the requisite care.

The move to transfer these facilities had to be carefully managed. National Department of Health started the process until the passing of the Mental Health Act of 2002 which brought mental healthcare under the ambit of the provinces.

Again, the move was to ensure the effective continuum of care and offer a comprehensive package of services to our patients. 

Due to decentralisation and the lack of capacity in our hospitals, Service Level Agreements (SLA) were signed with registered NPOs to look after the less critical patients while hospitals continue to look after the critical patients.

Each funded NPO is legally obligated to meet the standards which we have set out.

The process of deinstutionalisation wasn’t our way of out-sourcing responsibility, it was our way of improving care for these patients.

The signed agreement contains standards of care and governance requirements as well as monitoring, reporting and accountability measures.

These contracts are managed through quarterly visits and monitoring by the department.

Accountability measures are key to all this, we have seen what results would be yielded by the lack of accountability.

As a caring government we understand that our NPO partners are an extension of who we are and the service that we have undertaken to provide.

Speaker, what happened in Esidimeni in an indictment to us all.

Transfer of patients from a certain level of care facility to another without the requisite step-down approach can be seen as a death sentence.

As a result over a 100 people died because of this grave error.

May this be a lesson to us all.

It will take the whole society to ensure that people living with mental illnesses are no longer ill-treated as if they are the second-class citizens.

A few weeks ago, I was touched by a report of a retired social worker in Mitchells Plain, who converted her place into a home for people living with mental illness, disabled and elderly persons. Mrs “X” was doing the right thing in a wrong way and we will endeavour to assist her in realising her dream of having a home that is registered and licensed. Unfortunately, it has to be closed down.

It is people like Mrs X that really understand the importance of putting others first and giving a helping hand where necessary. The closing down of the home is due to living to our promise of good governance and accountability.

When we preach clean governance and effective accountability mechanisms it is not merely out of self-righteousness.

It is because, in health, issues like this are often life and death situations. We dare not fail the people that voted us into this office.

In conclusion, I am not asking you to observe moment of silence for Esidimeni, but I am requesting you to remember one thing: People living with mental illness matter! They are human too!

I thank you!

Media Enquiries:  Zimkitha Mquteni Spokesperson to the Western Cape Minister of Health, Dr Nomafrench Mbombo Mobile: 078 0534451 Tel: 021 483 5862 Email: Zimkitha.Mquteni@westerncape.gov.za