Minister, Dr Aaron Motsoaledi, says he envisages a system where hospitals will have to pass a number of tests before they can be passed as being ready to provide services under the National Health Insurance (NHI) system. He says this can be done through the appointment of a standards regulatory body to monitor that hospitals satisfy criteria that has been set as requirements for NHI approval.

‘€œWe hope we can start the process of developing an Act of Parliament to establish the office of standards and accreditation. However, it is not yet decided that we’€™re going to establish a Quality Care Commission. This is what they have established in the UK. All we’€™re saying is that we believe there should be some office that checks standards, which inspects facilities, even one that can engage the public. The bottom line is that there must be consequences to everything and that is what is lacking in South Africa’€.

Motsoaledi says debates will be held around the country to establish what powers the body should be given. He says the public will be given a platform to have a say on whether or not a health facility deemed to be insufficient should be shut down. He cautioned, however, that consequences of the closure of inefficient hospitals could have an adverse impact on health care recipients.

‘€œAs a minister, I say I would prefer any institution that is not working to be shut down. However, there is a question there. The real question is: What if it is in a far rural area and the management is not performing?   The commission goes to inspect and decides that it should be closed down, who is going to lose? The people will want to know: Why punish them? So, I’€™m going to hear from the South Africans during the public hearings on what powers should be given to this body’€.

In the development of the NHI, the Health Department has identified six key issues as being critical in improving the quality of health care South Africans receive.

‘€œWe believe these 6 issues, which are basics, need to be looked at urgently. Issues of cleanliness, safety, long queues in hospitals, drug stock outs, etc; the lack of accountability, culture of mediocrity rather than excellence, staff feeling de-motivated and helpless, even an erosion of professional ethics. Those should all be basics in our field of work, but are all to blame. We really need to examine this erosion of ethics when we deal with quality of health services’€, says Motsoaledi.

The Department has roped in advice from other countries that have implemented the NHI system.

Former Chief Executive of the National Health System (NHS) in the United Kingdom, Lord Nigel Crisp, says the UK had to change a number of things to get the health system right.

‘€œWe used to get a number of complaints from people about having to sleep one night in hospital before receiving attention. So, we brought five hospitals together, we asked them to decide what one thing was needed to improve it. They all took little practical steps to change things around. Some changed staff, and some allowed nurses to order X-rays. To cut down the process, change the system a bit. The interesting thing is that the smallest hospital in England showed most change. A patient would be seen by a most senior nurse before being allowed further, as opposed to waiting in the line only to be passed down to another person’€, says Lord Crisp.

He says the proposals resulted in improved systems.

‘€œWaiting lists came down; one of our targets of reducing mortality from cancer, as opposed to HIV/AIDS came down; satisfaction came up; the patients were seen within four hours’€.

Minister Motsoaledi added that the attitudes of nursing staff will also have to change. He says far too many people are unhappy with the treatment given by nursing staff.