Health

Question by: 
Hon Rachel Windvogel
Answered by: 
Hon Nomafrench Mbombo
Question Number: 
9
Question Body: 

With regard to the ongoing challenges and severe service pressures experienced at the Khayelitsha District Hospital, the Mitchells Plain District Hospital and the Ceres Provincial Hospital:

  1. What are the causes of the challenges and service pressures at these hospitals;
  1. whether there are any shortage of (a) beds and (b) staff at each of these hospitals; if not, why not; if so, what are the relevant details;
  1. what are the details of all the interventions that have been put in place at each hospital to address the challenges and service pressures in (a) 2019, (b) 2020, (c) 2021 and (d) 2022 to date;
  1. what are the plans that have been put in place to address the challenges and service pressures at each hospital;
  1. whether her Department will make any additional budget allocations to these hospitals to address the ongoing challenges and service pressures; if not, why not; if so, what are the relevant details?
Answer Body: 
  1. The public health system remains under severe pressure across the board with increased mental health and COVID pressures added to the traditional quadruple burden of disease. Despite this, the quality of health care provided continues to be generally good. The social determinants facing communities, in particular violence and safety, drug abuse, unemployment, limited economic opportunity, and other factors and further contributes to the pressure on the health system. Trends of weekend violence such as gunshots and stab wounds, has now become prevalent during the week.

The hospitals continue to deliver good services despite the service pressures experiences through mental health and the COVID pandemic.

 

  1. The hospitals service an increased population with trauma cases continuing to burden our health system with interpersonal violence among the biggest contributors to the province’s quadruple burden of disease. While the Department of Health feels the effects of violence and injuries, addressing upstream factors must be a collaborative effort.  

KDH – 340 beds operating at 130+% capacity with a staff complement of 650 and a vacancy rate of 7%.

MPH – 395 beds operating above 120% capacity with a staff complement of 764 and a vacancy rate of 5.6%. Statiscally highest number of trauma related surgery. Highest number of EC presentations per month in the province. Medical Beds are at 120% while hospital average is 90% (due to paediatric and maternity ward occupancy).

Ceres - 100 beds operating at 93% capacity with a staff complement of 126  and a vacancy rate of 8.8%.

 

  1. Interventions at:

 

2019

2020

2021

2022

KDH

 

  1. new surgical was commissioned in 2018
  2. CT scan suite was commissioned
  3. new 32-bed 72-hour mental health unit
  1. blood bank established for quicker results
  1. intermediate care beds made available at the Zandvliet Intermediate Care facility
  1. of patients triaged with non-life-threatening conditions (green and yellow) from the EC to the Outpatients Department

A second orthopaedic surgeon has been appointed with a second surgeon post in the process of being filled

A Night Nursing Office initiated to address after hours concerns

MPH

 

Female mental health patients moved to separate 20 bedded ward on premises of Lentegeur Hospital, as numbers escalated.

Additional ward for 30 medical patients set up during COVID-19 is unable to be closed due to continued and sustained medical pressure post covid pandemic.

6 general wards, 4 medical and 2 surgical, 30 bedded wards in hospital have been increased to 32 beds each.

Hospital commissioned on 13 trolleys in EC Majors, now we work on 25 trolleys. In addition to that we take 10 wheelchairs and 10 chairs for mental health patients.

Hospital commissioned with 15 trolleys in EC Minors now up to 40 trolleys.

The following specialists and medical posts have been added to address the need: 2nd OBGYN, 2nd Paediatrician, Orthopaedic Surgeon (with 2nd slate from GSH), Additional District Psychiatrist, 2 additional Com Serve Drs in Surgery and Mental Health. With the addition of these doctors there has been no additional nursing, allied health or support service staff added.

Created moving team with agency nurse and porter to facilitate quicker movement out of EC.

Employ intermediate life support staff on each shift in EC to support doctors to see more patients without being called away.

Improved electronic communication between hospital and community-based care to simplify and speed process of patients moving.

Additional locum doctors given to deal with Paediatric surge in EC and extra Medical Officer to Medical team for mornings, distributed sessional posts between departments.

Nursing Agency exhausted by topping the extra wards, and busy units to ensure the service is sustained.

Ceres
  1. of vacancies at Ceres Hospital, including the appointment of a Family Physician.
  2. up a gate in a section of the hospital for patient safety.
  1. addition of a four-bed Mental Health Ward at Ceres Hospital is underway. Completion and utilisation should be at the end of 2022.
  1. system changes to improve the flow of patients from the Emergency Centre and throughout the hospital.
  1. commitment by staff to frequently share information and updates with patients in Ceres Hospital’s Emergency Centre.
  1. the current use of space at Ceres Hospital
  2. of the building previously called the Netcare Hospital. The building will be repurposed to support Primary Healthcare in the area (see more details below).
  3. the package of care at Ceres Clinic (previously Annie Brown Clinic).
  4. Aug 2022:

1. Ceres Clinic will become a satellite clinic deliver preventative

healthcare services.

2. Maintenance and renovation at Ceres Hospital.

3. Partnering with stakeholders to improve access to healthcare (e.g. the mobile unit sponsored by Perdekraal East Wind Farm).

4. Strengthening Public Private Partnerships.

 

  1. Improvement Plans:

KDH

We have done in depth analysis and evaluation of the challenges and efficiencies to be gained.

MPH

Longer Term plans for sustained pressure EC, Mental Health Care, Medical and Surgical Wards:

Work with PHC on COPC measures to ensure chronic illnesses are managed better in the community to decrease the load on EC and readmissions.

KMP Sub Structure to work with other Government Departments and NGO’s on the social determinants of health in MP community to reduce pressure on the EC.

Working with Sub Structure office to engage the MP community to use the appropriate ways and levels to access health care, from Clinic to Hospital.

Submission being made through our sub structure office for funding for the additional medical ward currently being used to manage the daily overflow of medical patients.

Motivations has been made for scrub RN’s and recovery nurses in theatre to match the increased number and complexity in our theatre, and to balance with the increase of surgeons.

In EC we have motivated for increased number of nurses and allied health which would reduce waiting time for triage and treatment in response to the higher number of patients being seen.

Previous requests for allied health practitioners such as social workers, psychologists, occupational therapists, in mental health as patients stay for much longer than 72hrs and need care.

We have made a submission for agency staff for support services such as porters, clerical and administrative support where the need is high.   

Ceres

Longer term plans:

1. Repurposing the former Netcare building to Ceres Community Day Centre Centre:

  • The Intermediate Care Facility currently at Ceres Hospital, moves to the new building, freeing up space for up to 14 additional beds at Ceres Hospital.
  • A section of the building to be used by rehab staff to see clients. They will also do outreaches from here.

2. Appointment of a sessional Psychiatrist for skills transfer to staff and support to staff.

3. Strengthening Area Based Teams to address challenges like violence, in collaboration with role-players like SAPS and Community Safety.

4. Continually reminding the public on the most appropriate ways to access healthcare (e.g. only people with emergencies to go to Ceres Hospital’s Emergency Centre)

5. Ongoing awareness drives about healthy living, prevention of diseases and the dangers of alcohol and substance abuse.

 

A whole of society response is needed to address the social determinants of health which are mostly upstream factors and its effects presenting at our health facilities. Currently the health system is experiencing mental health pressures at all levels and the department is putting plans in place to relieve pressures at district hospital level by strengthening specialised referral systems and community and PHC mental health services. This would include collaboration with other partners delivering mental health services including social development. These improvement plans are ongoing.

 

  1. Additional funding through the adjustment budget.

KDH

R26 613 000.00

MPH

R2 450 000.00

Ceres

R1 500 000.00
Date: 
Friday, November 4, 2022
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