Department of Health Budget Speech 2012

25 March 2012

Tags:

Mr Speaker,
Honourable Premier, Ms Helen Zille,
Cabinet Members,
Leaders of the Opposition,
Honourable members,
Colleagues and friends,
Citizens of the Western Cape,

Introduction
The compilation of both the health budget and indeed the budget speech, which I will deliver today, is the end result of dedicated work by a team of officials in the Department of Health together with the Provincial Treasury and the support of my colleagues in the provincial cabinet. I would especially like to thank the Minister of Finance, Economic Development and Tourism, Alan Winde, for his support, the Head of Health, Professor Craig Househam, for the significant contribution he and his staff make to healthcare delivery in the Western Cape and my office staff for their support. It would be remiss of me not to mention my wife, Sarie, and my family for their continued support.

Western Cape's Health Economy
I'd like to share some statistics with you, only recently acquired, about the contribution of the Western Cape healthcare sector to the national Gross Domestic Product:

The total output of the Western Cape public and private healthcare sector is estimated to be R29.7 billion.
The public and private health sector employs about 75 800 people, but if you take the multiplier effects into account, the sector sustains more than 157 000 jobs.
The employees in the sector earned R10.1 billion in salary and wages, at an average of R133 400 annual salary per person.
In terms of percentage, the provincial contribution amounts to 14.5% of the national GDP.
The sector generated tax revenues to the tune of R1.2 billion.
In the period 2004 to 2010, the sector's growth was 3.1% per annum on average.

The noteworthy fact is the sustained 3% growth - even during the 2008/2009 recession, which reflects the defensive nature of the sector not being affected by economic cycles. In fact, the growth pattern is consistent with evidence that health spend tends to increase in times of economic recession.

In order to put the current size of the Western Cape health sector in perspective, it is interesting that 14% of the country's hospitals are located in this province - 89 versus 626.

The province ranks second in terms of the number of private hospitals and third in terms of the number of public hospitals in the country.

The Western Cape hosts more than 13% of the country's beds - roughly 3.2 hospital beds per 1 000 of the population. The national bed ratio is 2.5 per 1 000 population. The Western Cape bed ratio compares well with that of Australia, 3.7 per 1 000 population.

Seen from this perspective, the concept of the Western Cape becoming an international health destination is not far-fetched, and should be a driver for the approval of hospital licensing to stimulate economic growth and job creation.

Creating Wellness
The department is now engaged in planning for 2020 to determine the service requirements going forward to 2020 and beyond. It will enable human resources, infrastructure and other requirements to be identified that will shape the future services. At the heart of the vision for 2020, there is a renewed commitment to a quality, caring and patient-centred health service and improved health outcomes where the care pathways will be designed to respond to patient needs.

The shift in focus from illness to one of promoting and seeking wellness that gained significant ground during 2011/2012 culminating with the Wellness Summit and the ensuing Cape Town Declaration will be further strengthened in the coming year. In particular, I am committed to developing wellness centres that will increase the access in communities to health services and activities promoting a healthier lifestyle.

These "wellness clinics" will deal with lifestyle health issues that should be monitored on a regular basis, but which too often remain undetected until someone goes to the hospital for treatment. Wellness clinics will offer testing services that allow citizens to monitor their health, detecting emerging issues before they become a major problem.

Funded by the private sector, the clinics will provide the opportunity to every state patient to have an annual health check up. We envisage these clinics to operate where there are feet - at schools, libraries, shopping centres. The priority is to give every citizen of this province an opportunity to access health services. Among the priorities are learners, offering every learner access to a mobile wellness centres at least once a year.

The wellness centres, fixed or mobile, will aim to enhance wellness through educational on healthy lifestyles, early detection, prevention and referral for treatment. This will be a first in public healthcare worldwide.

But more than this - we will promote the responsibility that people must take to protect and enhance their own good health. Health and wellness requires responsible decisions about lifestyle, eating and exercising habits. This government undertakes to care for people who take responsibility for their own health. This supports the Better Together concept. If you take care of your health, we will take care of the health service.

Public Private Partnerships
Partnerships with a range of stakeholders have increased year-on-year during the term of this government. In the past two years, the province has been able to secure successful partnerships with the private sector that have led to significant contributions to our healthcare system. These public-private partnerships leverage the talents of the private sector for the benefit of public sector patients. It is based on a win-win philosophy that improves the physical health of patients and the financial health of the economy.

A few examples are:

Clicks Helping Hand Trust
The project offers free immunisation, baby feeding and nutritional advice, baby weighing and family planning at selected Clicks stores on Thursday afternoons. 5% of the proceeds of Clicks-branded baby products marked with the Helping Hand logo are donated to the Trust. This a model for strategic partnerships and co-operation in which the state taps into existing private facilities for the sake of providing services to public patients.

Mobile Diagnostics Laboratory
This partnership is supported by the German Consulate in Cape Town, the University of Stellenbosch, the National Health Laboratory Service (NHLS) and the Fraunhofer Institute for Biomedical Engineering (IBMT) in Saarland, Germany, and enables the province to offer accelerated laboratory results to patients in rural areas.

Surgical Skills Training Centre
Located at the Red Cross War Memorial Children's Hospital, this centre is a partnership with the Children's Hospital Trust and Karl Storz Endoscopy SA, the latter having donated R10 million in equipment and technical assistance. It is the only training centre on this continent for surgeons-in-training from across Africa.

GVI Oncology Partnership in George/Hessequa
This partnership agreement with GVI Oncology in George saves our patients the trip to Groote Schuur in Cape Town, where they used to have to go for treatment. This has resulted in such a financial and emotional benefit for our patients that we are in process of looking at similar partnerships in renal care and other niche medical areas.

Western Cape Health Foundation
Supporting our efforts increase departmental income to address the R800 million maintenance backlog, we have appointed Ernst and Young Consultants, which resulted in the establishment of the independent Western Cape Health Foundation.

The Foundation will take responsibility for the Commercial Rights project and independently spearhead new and innovative initiatives to generate resources for health. This is a significant step in strengthening this key relationship between the department and the private sector. I am encouraged that a number of prominent people, including Dr Paul Cluver, who will chair the board of directors of the Health Foundation, have been willing to give of their time and energy to promote better health in the Western Cape. Clearly an example of people who also feel that it is better together! The Foundation will be publicly introduced in the coming months.

These examples certainly demonstrate that the Western Cape has succeeded in responding with solutions which have proved to bring about better health outcomes. At the heart of our provincial system is a commitment to accountability, affordability and efficiency - all necessary elements for high-quality health outcomes.

Key Focus Areas
Today I am tabling a budget of R14.632 billion that funds the provision of public health services largely to the estimated 4.6 million uninsured people, of the estimated total population of 5.9 million, in the Western Cape.

In addition to providing health services, the department will focus on strengthening its advocacy role to ensure that the upstream factors, which contribute to the burden of disease, are addressed by the appropriate departments and stakeholders. As indicated earlier on 8 November 2011 the Premier hosted a summit aimed at reducing the burden of disease. The delegates to the summit adopted the Cape Town Declaration on Wellness and defined an agenda to advance the collective effort of stakeholders in the reduction of the burden of disease. The summit and the declaration emphasise the philosophy of this government that the burden of disease can be addressed better together.

The department has established the following working groups to address the quadruple burden of disease which are coordinated through the Provincial Transversal Management System in support of the Strategic Objective Increasing Wellness as outlined in the Provincial Strategic Plan:

Violence and road injury prevention.
Healthy lifestyles.
Women's health.
Maternal and child health.
Infectious diseases (HIV and TB).
Mental health.

Improving quality of care remains central to the business and functioning of the department. These initiatives include:

Building on the baseline assessment of compliance with the national core standards undertaken at all facilities during 2011/2012.
Building the capacity and systems at the level of district management.
Primary healthcare re-engineering.

Foreign Nationals and People from Other Provinces
Although the department does not keep track or statistics of the number of patients moving to our province for health services, education and economic opportunities, I believe the latest census will tell the story - once the numbers are release.

The fact is that the more we improve our services, the more we initiate new ideas and new plans to decrease the queues at our facilities, the longer the queues will get - because people will wait for good service. To date we have not yet taken up this matter with national government, but at some point there will have to be a discussion with national government about additional resources to deal with additional patients.

Patient Communication Projects
In an effort to address complaints about health services effectively and efficiently, we have now established the Independent Complaints Advisory Committee where the minister and head of department can refer complaints when existing structures have not resolved such complaints to the satisfaction of the complainant. This Advisory Committee is a temporary body whilst legislation is in draft process for an independent complaints authority. The ICC was the very first initiative of this kind in the favour of patients, and the process provided for an assessment after the first year. Upon legal advice obtained, and to provide more efficient and effective outcomes, we are now preparing draft provincial legislation to establish a formal structure which will operate within a legislative framework.

I remain committed to create more communication channels for the users of our services, and have become very aware that current complaints channels do not always satisfy our patients. We are exploring the setup of an SMS communication line whereby complaints can be directed via a cell phone, with a commitment from the department to respond rapidly. At the same time I have to say that the department receives more compliments than complaints, but the latter always seem to make the headlines.

We believe that the key to improving the patient experience and quality of care is caring for the department's staff. The department aims to become a values-based organisation. Through the Barrett survey undertaken during the last two years the department adopted the values of Care, Competence, Accountability, Integrity, Respect and Responsiveness. (C2AIR2). The leadership within the department is committed to leading by example through living the values in their daily work. The department will engage external expertise to widen the change management process throughout the organisation.

The commissioning of the Khayelitsha Hospital at the beginning of this year is one of the most significant achievements of the department in the last several decades and more importantly a milestone in health care delivery for the people of the Western Cape. This hospital is the result of years of careful planning as set out in the Healthcare 2010 strategy, which will see, in addition, the completion and commissioning of the Mitchell's Plain Hospital later in the year.

The focus areas of the department in the coming 2012/2013 financial year include:

Developing action plans to improve overall patient experience and quality of clinical care.
The full commissioning of the Khayelitsha Hospital.
Commissioning of the Mitchell's Plain Hospital.
Finalising the 2020 strategy and plan for health services in the Western Cape.
Finalising the priority projects related to the Cape Town Declaration on Wellness including the:

High Five area approach to reduce alcohol-related injuries.
Healthy lifestyle campaign to decrease the incidence of chronic disease.
Programme to reduce intimate partner violence.

Improving maternal and child health outcomes.
Achieving an unqualified audit for finance, human resources and pre-determined objectives.

At the heart of the success of the Department of Health is a commitment to accountability, affordability and efficiency - all necessary elements for high-quality health outcomes. We will continue to do all what is necessary to maintain our status of clean audits. In 2011, the department received discounts from NHLS for early settlement of accounts to the value of R4.3 million. We will continue with this policy of paying our creditors on time.

Challenges
The allocation to the department in 2012/2013, although increasing in nominal terms, is marginally less in real terms than the 2011/2012 Adjusted Budget. The gap between the need for health services and the available resources remains the challenge and increases the need to increase efficiency, work smarter and reprioritise services within the existing baseline allocation.

Budget Details
The Department of Health is allocated R14.632 billion in 2012/2013, R15.740 billion in 2013/2014 and R16.751 billion in 2014/2015, which amounts to R47.134 billion over the three-year 2012 MTEF. This represents a nominal increase of R1.203 billion or almost 9 % in comparison to the revised estimate of 2011/2012.

National conditional grants contribute almost R4 billion to the provincial health allocation while the projected departmental revenue in 2012/2013 is R536 million. The 2012/2013 allocations for health represent 36.7% of the total provincial budget, for which I acknowledge the support of the Premier and my provincial cabinet colleagues.

Provincial Equitable Share:
The Western Cape receives a proportional share of the national adjustments to the provincial equitable share and conditional grants. Over the 2012 MTEF the provincial equitable share grows annually by an average 6.8%. The inflation adjustments cater for the impact of the higher than anticipated adjustments to salaries following the Public Service Bargaining Council (PSBC) Resolution signed during 2011. The Western Cape's portion of the provincial equitable share formula, which since 2011 includes a health component, increases from 10.5% in the 2011 MTEF to 10.6% in the 2012 MTEF.

Conditional Grants
The department receives a major portion of its allocation through the following conditional grants, which have to be allocated and utilised in terms of the conditions as outlined in the Division of Revenue Act:

R2.182 billion for the National Tertiary Services Grant.
R738 million for the Comprehensive HIV and AIDS Grant.
R496 million for the Hospital Revitalisation Grant.
R428 million for the Health Professions Training and Development Grant.
R131 million for the Health Infrastructure Grant.
R11.5 million for the National Health Insurance Grant.
R10 million for the Nursing Colleges and Schools Grant.
R1 million for the Expanded Public Works Programme Integrated Grant for Provinces.

Revenue
The department remains committed to maximising revenue generation and collection from current sources of revenue whilst exploring alternative revenue streams to counter ongoing budget constraints.

The tariffs that are applicable to funded patients, for example medical scheme patients, will be increased by 5.4% with effect from 1 April 2012. However, I am pleased to announce that the tariffs for unfunded patients without medical insurance will remain at the current levels. This tangibly illustrates the manner in which this department cares for those in need.

The tariffs for licence registration and inspection of private health establishments are under review and will be adjusted upward to allow full cost recovery in the coming year.

Distribution of the Budget
The budget of the department is divided between the eight budget programmes with R12.722 billion or 87% of the vote being allocated to Programmes 2, 3, 4 and 5 which fund the direct operational costs of providing health services.

Compensation of employees accounts for R8.478 billion or 58% of the total budget. The department has allocated approximately 31 % or R4.456 billion to the procurement of goods and services, which amounts to approximately 55% of the goods and services procured by the Western Cape Government.

Programme One: Administration
Programme one, which is responsible for the strategic management and overall administration of the department, receives R489 million which amounts to 3.3% of the vote for the 2012/2013 financial year.
Funding is specifically allocated to the following projects:

An additional R19 million is allocated to fund the additional cost of a new with the service provider to operate the Chronic Dispensing Unit, which will process an increased number of prescriptions and service delivery points. While there may be teething problems during the transition between the current and new service providers, the expansion of this important service is an exciting initiative which demonstrates our commitment to patient centeredness. The dispensing of medicine parcels for chronic patients to different geographic areas of the province will significantly reduce the waiting times at facilities - one of the key complaint areas for our patients.
After a lengthy legal battle, the R5 million tender contract was finally allocated to the company who originally won the tender, UTI. Their contract will officially commence on 1 April 2012 but they have been working in tandem with the former contractor for the past two months. The home delivery service is part of a roll-out plan that will be expanded incrementally, starting with the hotspots where waiting times are the longest. At present home delivery services is also provided by contracted home based care non-profit organisations. In addition, we are looking at the piloting of automated dispensing pharmacies for central hospitals, which will allow patients to collect their medicine parcels at the machine, rather than wait in queues at the pharmacy.
R12 million is allocated to provide for an increased number of medico-legal claims being lodged against the department.
R11 million is allocated for posts that are required to improve the reporting on financial, human resources and performance management data.

Programme Two: District Health Services
Programme two is responsible for the provision of district health services within the district health system and is allocated R5.498 billion in 2012/2013 which is 37.6% of the vote. This amounts to a nominal increase of R559.348 million or 11.3%.

These funds are divided amongst the ten component sub-programmes with 80% or R4 372 billion allocated to community health clinics, health centres and district hospitals. These facilities will provide approximately 16 million primary healthcare headcounts, in excess of 250 000 admissions and 1.1 million patient day equivalents in district hospitals.

District health councils have been established in terms of the Western Cape District Health Councils Act, 5 of 2010, in each of the six districts of the province and will be further strengthened during 2012/2013.

As I mentioned previously, a watershed event is the phased commissioning of the Khayelitsha Hospital that began in January 2012 and will be completed during the year. This will be followed by the completion of the Mitchell's Plain Hospital during the course of the year.

The focus of primary healthcare will be on the prevention of disease and the promotion of health or wellness, in particular: maternal and child health, chronic diseases of lifestyle including the impact of substance abuse, mental well-being and infectious diseases such as HIV and AIDS, and tuberculosis.

In our efforts to reduce the mortality of children under the age of five years, the department is running a "saving mothers and children" plan with a Road to Health Booklet to monitor the newborn baby's health and development right from birth and in this process detect and treat disease as early as possible.

On this road towards child health, we can be proud that 17 of our hospitals have been awarded Baby-Friendly Status. It is an international accreditation promoting breastfeeding as the only form of feeding after birth. The accreditation is re-evaluated every three years, and requires dedication and hard work from the staff in the maternity units.

Community-based services, which are provided by home-based carers who are appointed through non-profit organisations, are allocated R157.842 million. It is anticipated that this will enable the department to increase the number of home-based carers from approximately 2 900 in 2011/2012 to 3 050 in 2012/2013. Community-based services contribute significantly to improving access to health care, providing employment opportunities and fostering a sense of community involvement in the provision of health services.

The HIV and AIDS programme receives R738 million, which is further supplemented by R203 million from the Global Fund. The department appreciates the ongoing support of the Global Fund whose contribution over the MTEF amounts to R643 million.

Reducing the burden of HIV and AIDS and tuberculosis is an objective that is common to all of the overarching health policies, such as the Millennium Development Goals, the Negotiated Service Delivery Agreement, between the President of South Africa and the National Minister of Health, and the provincial strategic objective of Increasing Wellness.

Some of the measures that the Western Cape Government will implement to address HIV and AIDS and tuberculosis include:

The provision of anti-retroviral therapy to 135 018 children and adults during 2012/2013.
An HIV counselling and testing rate of 98%.
Reducing the number of babies on the on the prevention of mother-to-child transmission (PMTCT) programme who test positive to HIV at six weeks to 1.8%
Improving the new smear positive TB cure rate of cases cured at the first attempt to 82% which is close to the international WHO benchmark of 85%.During 2012/2013, the department aims to:

Reduce the facility infant mortality to 10.2 per 1 000 live births or less.
Reduce the facility child mortality to 12.2 per 1 000 live births or less.
Reduce the facility maternal mortality to 65 per 100 000 or less.

Focus areas for improving women's health include increasing the cervical cancer screening coverage to 67.3%, increasing the number of women who seek antenatal care before the 20th week of their pregnancy to almost 60% and reducing the delivery rate of women under the age of 18 years to 6.4%.

The department also plans to perform approximately 6 900 cataract operations, which will dramatically improve, and in some return, sight and quality of life of the recipients.

Programme Three: Emergency Medical Services
Emergency Medical Services, which is responsible for the provision of emergency medical transport including inter-hospital transfers and planned patient transport, is allocated R701 million or 4.8% of the vote.

An amount of R15 million has been allocated provisionally for the Information Communication Technology system. This new computer-aided dispatch system, required to replace the existing system, will provide both the communication centre solution and the vehicle-based solution. It is anticipated that the system, once implemented, will improve the efficiency of the ambulance dispatch process and will also provide real-time information.

Emergency Medical Services deliver ambulance, rescue and patient transport services from 52 stations in five rural district EMS services and four divisions in the Cape Town Metro, with a fleet of 248 ambulances, 1 424 operational personnel and 98 supervisors (officers).

We have 248 ambulances in our fleet, which are upgraded every 200 000 to 300 000 km. In the past year, four state-of-the-art paediatric ambulances were added to our EMS fleet. Babies require specific equipment for intensive care transfers between facilities. These ambulances provide a comprehensive suite of everything required to safely transfer a sick baby or child into health facilities. This is part of an initiative to meet strategic objectives in line with the millennium goals, to enrich and strengthen mother and child emergency medical care in the province.

In 2012/2013, 70% of priority 1 calls in urban areas will be responded to within 15 minutes, while 89% of priority 1 calls in rural areas will be responded to within 40 minutes.

It is anticipated that the service will transport approximately 487 781 patients during 2012/2013.

Volunteers make up a big component of our EMS personnel, especially in rural areas. They are required to have some medical training, a code 10 driver's licence and be registered with the Health Professionals Council of SA. We pay for their registration and annual membership.

Using both fixed and rotor wing aircraft the Air Mercy Service (AMS) provides for the transfer of acutely ill or injured patients to referral hospitals. This rapid evacuation of patients to specialised care benefited approximately 1 400 patients during 2011/2012 and in doing so frees ambulances from long road trips enabling them to remain in their designated service areas.

HealthNET is a transport service for our patients and the only-of-its-kind in the country. We have a fleet of 78 HealthNet vehicles, adapted for ill patients, which transport approximately 4 000 patients from rural areas across the province to central hospitals per month. The service employs 95 personnel and performs outpatient transfers between levels of care. This transport infrastructure also transfers patients from primary healthcare facilities to regional and district hospitals. Although the service is often under unfair scrutiny, the new electronic supply and demand system will certainly improve the booking system, and address the problems of misuse.

The emergency medicine component of the service works with staff in emergency centres to improve the quality of service provided through training, advising on relevant issues such as the design and layout of emergency centres and improving the quality of care in emergency services within facilities.

Programme Four: Provincial Hospital Services
This programme is responsible for the provision of general specialist and specialised hospital services that include tuberculosis, psychiatric, rehabilitation and dental training hospitals. Central hospitals, which are large functional service delivery structures, are integral to a coherent health care delivery system at provincial level. These hospitals are the health facilities where a majority of health sciences trainees are trained to become health professionals, and where much of the health professional service skills, health research and knowledge capital resides.

The Western Cape is the only province that over a number of years attempted to define and manage general and highly specialist services separately within the central hospitals. The funding of these services was distributed accordingly to separate budgetary programs however after concluding that with the current information and management systems that this was not possible the department has reverted to funding the hospitals as functional entities. This reinforces the argument that to attempt to manage and fund these hospitals divorced from the health system within which they function is not viable.

National Government's plan to remove central hospitals from the responsibility of provincial departments of health infringes on the powers and functions of provinces as the infrastructure is a provincial fixed asset and cannot be summarily transferred to the National Department of Health without due process.

The funding of these hospitals does not necessarily originate solely from the National Tertiary Services and Health Professions Training and Development conditional grants and requires additional funding from the provincial equitable share. It is noteworthy that the national grants fund only 57% of the total cost of all three current central hospitals.

Programme four is allocated R2.310 billion or 15.8% of the vote. This amounts to a nominal increase of R146.860 million or 6.8%. Funding is allocated from the provincial equitable share with the exception of R81 million from the Health Professions Training and Development Grant, which addresses the cost to the service for training health professionals and R5.5 million from the National Health Insurance Grant for general specialist posts in the NHI pilot district.

The general specialist or regional hospitals receive R1.214 billion or 52.5% of the Programme four budget, which is a nominal increase of R56.216 million or 4.86%. Regional hospitals will treat approximately 110 778 patient admissions in 1 375 beds and manage 565 286 patient day equivalents (PDE) at an estimated cost of R1 842 per patient day equivalent during 2012/2013.

The six tuberculosis hospitals in the province are allocated R214 million or 9.3%. This is a nominal increase of R17.598 million or 8.95% of the programme four budget. Approximately 4 235 admissions and 306 830 patient day equivalents will be managed in 1 040 beds at a cost of R 611 per patient day equivalent. A pilot infectious diseases palliative centre was opened in December 2011 at Nelspoort Hospital in the Central Karoo District to manage patients with extreme drug resistant tuberculosis treatment failure.

The four psychiatric hospitals are allocated R631 million or 27.3% of the Programme four budget. This is a nominal increase of R60.181 million or 10.6%. These hospitals will treat approximately 5 860 admissions and 557 370 patient day equivalents in 1 698 beds at a cost of R1 037 per patient day equivalent during this period. In addition to this, the psychiatric hospitals will manage 145 step-down beds for the treatment of less acute psychiatric patients.

The revitalisation of Valkenberg Hospital is now a priority project for this Department on the grounds of the need to provide a facility capable of providing a forensic psychiatric assessment service to the Department of Justice. For some years now normal judicial processes have been seriously delayed because the current Valkenberg Hospital does not have the capacity to assess awaiting trial persons who have committed crimes as serious as murder. The R978 million rebuilding project is the largest capital project undertaken by this government. Construction will begin in January 2013 and will increase the bed capacity from 340 to 432 beds. Final construction is aimed to be complete by 2016.

The Western Cape Rehabilitation Centre (WCRC) is allocated R143 million or 6.2% of the Programme four budget. This amounts to a nominal increase of R5.763 million or 4.21%. The WCRC will manage approximately 885 admissions in 156 beds and 45 789 patient day equivalents at a cost of R2 163 per patient day equivalent.

The dental training hospitals are allocated R110 million to fund an oral health service that will provide approximately 120 000 oral health visits and manufacture 6 000 oral health prostheses.

Programme Five: Central Hospital Services
The central hospitals, Groote Schuur Hospital, Tygerberg Hospital and Red Cross Children's Hospital, provide highly specialised healthcare services and a platform for research and training of health workers by the universities. All three hospitals provide highly specialised services as national referral centres.

Central hospitals are allocated R4.212 billion or 28.8% of the vote in 2012/2013, which amounts to a nominal increase of R240.029 million or 6%.

The total National Tertiary Services Grant of R2.182 billion, R270 million of the Health Professions Training and Development Grant and R3 million of the National Health Insurance Grant constitute approximately 58% of the funding allocated to this programme. The balance of R1.757 billion allocated to the programme is derived from the provincial equitable share, which clearly illustrates the extent of the underfunding of highly specialised services by the national conditional grants. Personnel costs are especially high in these hospitals constituting approximately 69% of the expenditure of this programme.

The central hospitals will manage approximately 140 395 patient admissions in 2 545 beds and 1 123 389 patient day equivalents at a cost of R3 244 per patient day equivalent.

The picture archive communication system (PACS) which supports digital imaging equipment will be implemented in each central hospital and the pilot of the radiological imaging system (RIS) at Tygerberg Hospital will be completed and rolled out to the other central hospitals.

Programme Six: Health Sciences and Training
This programme funds training and development opportunities for employees and intending employees of the Department of Health and is allocated R255 million or 1.7% of the vote. Included in this amount is an earmarked allocation of R8.8 million for the purpose of the Social Sector Expanded Public Works Programme.

Counting 11 731 nurses out of 28 658 employees in the Western Cape Department of Health, our nurses constitute almost half of our workforce. The maintenance of their skills and competency levels in an ever-changing environment remains our challenge.

In the Western Cape we have now reached a point where we have the required number of professional nurses. We need to focus on the continuous training of nurses so that we have a readily available pool of nurses to provide sustainable nursing services. This means that our immediate requirement is to train approximately 450 professional nurses increasing by 50 for every academic year, notwithstanding the number of students already in training. The Cape Peninsula University of Technology does sterling work in this regard. At the end of last year 129 specialty nurses graduated here in Operating Theatre Nursing, Critical Care, Health Assessment Treatment and Care, Midwifery and Psychiatric Nursing Science.

The Integrated Nursing Education and Training Framework as part of the Provincial Nursing Strategy endorse the incorporation our six nursing schools at provincial hospitals into satellite campuses of the Western Cape College of Nursing. This means that the Worcester Hospital will become the Boland / Overberg satellite campus and George Hospital will become the Southern Cape / Karoo satellite campus and the same with the nursing schools at Beaufort West Hospital, Western Cape Rehab Centre, Groote Schuur Hospital and Tygerberg Hospital.

We are also in negotiation with the private sector to terminate the importation of nurses and to assist the private sector with the training of nurses. This will improve job creation and economic growth.

An amount of R58 million is allocated to the Western Cape College of Nursing and R74 million provides for bursaries, which are largely allocated to nurses at the Western Cape College of Nursing and the University of the Western Cape. It is anticipated that there will be an intake of 270 first year students during 2012/2013 and that 220 students will graduate from the nursing college during this period.

The department will train 2 000 home community-based carers to strengthen home-based care services, 140 data capturer interns, 110 pharmacy assistants, 120 assistant-to-artisan interns and 120 human resource and finance management interns. The training of interns not only enhances the quality of essential functions in the department but also contributes to increasing employment opportunity within the healthcare environment.

Programme Seven: Healthcare Support Services
This programme consists of laundry services, engineering services, forensic pathology services and the medicine trading account and is allocated R290 million or 2% of the vote in 2012/2013. This amounts to a nominal increase of R21.462 million or 8%.

The department annually launders approximately 20 million items of laundry of which approximately three quarters are laundered in-house and a quarter is outsourced. Increases in electricity and water tariffs have made it essential to improve the efficiency of laundry equipment. The Lentegeur Laundry will be upgraded and extended as part of the Mitchell's Plain Hospital revitalisation.

Engineering Services are allocated R95 million in 2012/2013, while the Forensic Pathology Services are allocated R106 million. The conditional grant previously allocated to Forensic Pathology Services was phased out as at the end of 2011/2012. Forensic Pathology Services will strive to respond to 80 % of cases within 40 minutes and to achieve a turnaround time of three days for forensic examinations. The Beaufort West Forensic Pathology Laboratory will reach the construction and handover phase during 2012/2013.

Programme Eight: Health Facilities Management
At this point in time we are project-managing the most capital projects ever in the history of this province, the total cost of capital projects exceeding R5 billion. A number of projects are in the feasibility, design and tender phase.

Projects in the construction and handover phase include:

Community day centres in Knysna (Witlokasie), Grabouw and Malmesbury (Wesbank).
Ambulance stations in Malmesbury, Tulbagh and Leeu Gamka.
Emergency centres at Swartland Hospital in Malmesbury and Ceres.
Hospital extensions and upgrading at the Hermanus and George Hospitals.
The new district hospital in Mitchell's Plain.

In addition we are looking into a district hospital for Du Noon and regional hospitals for the Helderberg Basin and for Mossel Bay. Another key project that is in the planning stage is the building of a new replacement hospital on the site of the current GF Jooste Hospital.

The new Tygerberg Hospital public private partnership project, which will be funded through the Hospital Revitalisation Grant, is a mega project that is in the identification and feasibility phase.

In 2012/2013, Programme eight is allocated 6% of the vote in 2012/2013, which translates into a nominal increase of R62.251 million or 7.6%.

73% of the programme's funding is from national conditional grants consisting of mainly:

R496 million from the Hospital Revitalisation Grant.
R131 million from the Health Infrastructure Grant.

The provincial equitable share funding has been allocated as follows:

R47 million for the purpose of maintaining current infrastructure.
R11 million for preventive maintenance.
R180 million for the purpose of maintenance and capital expenditure.
R12 million for Red Cross War Memorial Children's Hospital.

Other projects in planning are the redevelopment of the Brooklyn Chest TB Hospital in Rugby, a new Emergency Centre at Karl Bremer Hospital, ambulance stations at Knysna and Piketberg and forensic pathology laboratories for Beaufort West and Riversdale.

I am very proud of the health facilities that we are presenting to our patients. The Khayelitsha District Hospital, the Grassy Park and Kwanokuthula Community Day Centres - all of them are examples of international health design trends and I invite anyone in this house - in fact any delegate - to visit them.

Green Efficiency, Green Energy and Carbon Trading
In her State of the Province Address, the Premier spoke about our government's commitment to 10% energy and water savings, also in hospitals.

I am proud that our new hospitals - both the Khayelitsha Hospital and the Mitchell's Plain Hospital - and all current and future health facilities - are built in line with the latest international design trends for health facilities, featuring environment-friendly and power saving devices.

In line with this, a pilot study was undertaken at Groote Schuur Hospital by Schneider International to monitor electricity usage. A tender process will now be undertaken to obtain Green Efficiency interventions. This will include the administrative process to register for carbon credit trading. The department will also undertake research during this financial year to determine the options available to invest in Green Efficiency, as well as investing in Green Energy supply.

NHI
Healthcare in South Africa faces many challenges! In the private sector healthcare is becoming progressively more unaffordable for the average citizen. In the public sector healthcare delivery in many provinces is near collapse with critical services not being delivered due to a lack of critical skills, managerial incompetence, political interference, fraud and corruption. In response to these problems the National Government in addition to a raft of initiatives, many apparently uncoordinated, has released a green paper policy document proposing various initiatives under the umbrella of "National Health Insurance" (NHI).

Although the Western Cape does not support the National Health Insurance green paper in its current format, it does not mean that the province will not participate in the NHI pilot projects.

As an alternative solution, Western Cape Government proposes Universal Healthcare, built on a primary healthcare basis, similar to the structures implemented in the Western Cape at present, where patients are referred to regional and specialised facilities according to their medical needs, and government providing the transport infrastructure. The rest is governance-based on good business principles - financial discipline, efficiency, equality, modernisation, monitoring and evaluation.

The lesson we have learned in the Western Cape is that we can improve healthcare for everyone by strengthening the positive elements of the public sector and removing its deficiencies on a planned and sustained basis.

In the Western Cape, there is a significant private health sector presence that is on the whole well-managed and the public sector, despite challenges in some areas, as confirmed by outside evaluations and indeed the National Minister of Health himself, is functioning well.

The Western Cape Government is of the view that the key to any public sector health care reform in South Africa is a "well-functioning" health system, as currently exemplified by the Western Cape and as is set out in the discussion document released by the department on the proposed 2020 strategy for the future of healthcare in the province and the broader health reform as proposed by the Western Cape Government in the document Universal Health for All.

It is the view of this government that rather than coercion there should be a cooperative partnership between public and private sector to increase wellness and improve the health of the people. We encourage all South Africans to work with us to be better together!

In Closing
There is still much to be done to achieve the goal of the Western Cape Government of increasing wellness and significantly improving the quality of both the health services and the patient experience of the services that we provide. To promote openness and transparency a pamphlet highlighting key aspects of the annual performance plan for 2012/2013 has been published in a more reader friendly format that will be widely distributed to communicate the service priorities for the coming year.

The Western Cape Government continues to strive to provide the best possible health services within the available resources and I renew my undertaking with the Head of Department, Professor Craig Househam and the management team in this regard.

In the efforts to increase wellness by working together we can all be better together! If all those who work in the department work effectively and efficiently and make the best use of the available funds to provide the best service, we can be better together!

If government departments and other stakeholders all consider the impact of their activities on the health status of the people when evaluating their core business, we can be better together! An initiative that certainly demonstrates this is the draft legislation that my colleague, Robin Carlisle, is preparing to legislate the safety of children in transport. This will significantly reduce the number of children that we lose in motor vehicle accidents, and support the Safely Home project.

If the various spheres of government can work together to address health issues we can be better together! There is no better example of this in the manner in which the recent challenges related to health service delivery in Du Noon have been handled jointly by the Western Cape Department of Health and the City of Cape Town!

In the past few weeks we pulled out all the stops to deliver an improved health care service to the people of Du Noon. We acknowledged that the facility there was not up to standard and joined forces to create an interim solution by transporting select patients to nearby clinics. Then we negotiated a medium-term solution, renting a warehouse in Montagu Gardens to be converted into a clinic which will be ready at the end of July. In addition a mobile unit will be placed at the Table View clinic to assist with the patient load from Du Noon. Construction of the new R76 million Du Noon Community Health Centre will commence in September 2012. This building will be owned and operated by province. This is certainly a demonstration of being better together.

If the people who use our services take responsibility for their own health and health services and make use of the opportunities to work with the department through the various structures available such as facility boards, clinic committees, health forums and district health councils, we can be better together!

If our partnership with the universities of the Western Cape is strong and promotes the production of caring and competent health professionals and supports the delivery of world-class highly specialised healthcare, we can only be better together! On this topic I am happy to announce that in May this year the Premier will sign a multi-lateral agreement with our four partner universities. The agreement follows decades of legal processes to come to a mutual agreement about the status and compensation of employees working for the department and the university. It certainly is a highlight in my portfolio, and a historic event for this province.

Improving the health status and well-being of the people of the Western Cape can only be achieved through partnerships, put differently by working better together we can all live a better life!

Thank you!

Media Enquiries:

Helene Rossouw
Spokesperson for Minister Botha
Tel: 021 483 4426
Cell: 082 771 8834
E-mail: helene.rossouw@pgwc.gov.za