This is an unedited Statement by Gauteng MEC for Health, Dr Gwen Ramokgopa giving update on progress on Health Ombudsman Recommendations delivered on 22 February 2017
We made a commitment to keep the families and the public informed on the progress made in implementing the Health Ombuds recommendations on the de-institutionalization of mental health project that went horribly wrong resulting in over patients losing their lives. We believe transparency is an important step in demonstrating remorse over the incident, in committing to helping families to heal and in affirming our resolve to ensure that the Public Health Service remain accountable and involve citizens optimally as we all say never again should a tragedy of this magnitude occur .
I still do not fully comprehend how it was possible that the Constitution of our land, the National Health Act, the National Mental Health Act, the Health Professions Council Act, the South African Nursing Act, the Public Service Act as well as the plethora of policies and interventions like the Batho Pele Policy all failed the most vulnerable amongst us.
This is despite the voices and protests by their families over a protracted period including an out of court settlement entered into as an assurance that the project will offer the same, if not better services. I bemoan the fact that as a Medical Professional and an activist for a just society, together with millions other South Africans, could not foresee and thus intervene to prevent this tragedy as it unfolded. Some of the lessons that are emerging are that we must affirm the principle of participatory democracy; we must ensure the Public Health Service has more than adequate safeguards that are regularly tested for patient centred approach.
That all systems, policies, programs and persons are rigorously and regularly tested by experts for compliance with policy and law; that we strengthen partnership with the media in exposing challenges faced by ordinary citizens and that we respond optimally. We need to reflect on this experience, as difficult as it is and find ways to restore the confidence of our people in our health system. On the 18th February 2017, the Gauteng Provincial Government together with the bereaved families held a ‘Healing Session’ to reflect on the tragic passing away of patients.
It is in this context that extraordinary measures, in addition to implementing the recommendations of the Health Ombuds, are being taken to rebuild the reputation of the whole Gauteng Department of Health as a humane, caring, patient centred and competent public service. A dedicated team of managers and experts has been established to ensure that the relocation of patients from NGO’s to appropriate facilities is prioritized in consultation with families. We have invited the family committee to be involved. The safety and wellbeing of patients is our paramount importance. A dedicated line has been set up for families to call and we request the media to help popularise it.
Last week we insisted that Life Esidimeni Healthcare provide us with the database of all patients that were discharged from their facilities including their medical records. The team of experts who visited all the 27 NGO’s have provided a list of patients that are there. We have a record of all patients in public hospitals.
We also have a list of all patents that passed away, we also have a list of unclaimed bodies and those buried as unknowns. We are working with two experts from the Statistician General’s Office, the SAPS and Home Affairs to validate all records so that we account for all patients. To date 1398 patients were discharged from Life Esidimeni, 789 are in the remaining NGOs. There are patients who were discharged home. We appeal that the media and stakeholders work with us in a transparent manner to verify these figures.
The Ombudsman made 18 recommendations and additional six (6) were specifically directed to the Gauteng Department of Health. We can confirm that the deinstitutionalisation has been stopped. The HOD and the Director for Mental Health Services are on precautionary suspension, and the disciplinary process with regards to other implicated officials have begun.
The Gauteng Mental, Health Review Board, including the Chairperson is being dealt with in accordance with Mental Healthcare Act. We can also confirm that five of the NGOs have closed. The remaining 22 NGOs have been assessed last week and the process to transfer patients will begin next week. The transfer of patients will be done with the legislation and the procedures, advised by the team of experts that have assessed the patients and the competences of the receiving facilities that will take care of the specialised needs. We have consulted the family committee, and further details will be made avail to them. This so as to ensure all families are consulted with before the move, we have set up a dedicated team to contact each family. All patients will be examined, consider the extent of their severity, proximity to their homes, and consult with families before they are moved to appropriate facilities.
All logistical arrangements on the said transfer are in place. The transfer of patients will not be rushed and will be carried out properly. We also want to ensure that patients are brought closer to home and families must have access to visit their loved ones. We are also going to put in effective monitoring and evaluating systems to ensure that patients are not compromised during the transfers. Transparency is important in this matter.
We also intend to bring in medical experts in the field of mental healthcare to guide us moving forward. We are going to replenish the mental health team and change management.
The recommendations of the Health Ombuds include the following:
(i) The development of information systems with patient registers and a data base by which to make evidence-based decisions, monitor and evaluate health care delivery must be a priority for the Gauteng Department of Health; this recommendation is strongly endorsed by StatsSA;
On recommendation 1, we are currently working on a patients’ register in relation to the mental health users that were transferred from Life Esidimeni. We now have a master list of all patients. The team is supported by two officials from StatsSA. GDoH is also developing a proper health information system.
(ii) Exemplary adherence to the Mental Healthcare Act and its related regulations by the Gauteng Department of Health and the Metal Health Review Board;
Recommendation 2, we met with Mental Health Review Board to receive a high level report on the deinstitutionalisation process. GDoH will strengthen and capacitate the Mental Health Directorate as part of our efforts to restore quality mental healthcare in Gauteng.
(iii) District health services must be capacitated to ensure adherence to regulations and to provide clinical and rehabilitative support to the NGOs in each district. The strengthening of Primary Health Care Services and District Hospitals;
Recommendation 3, the team through District Health Services is currently assessing the capacity of facilities in all our five districts. We plan to strengthen primary healthcare. All primary healthcare facilities would have general practitioners. We are going to revisit cluster structures and break them down into sub-clusters to increase efficiency and effectiveness of the system.
(iv) If deinstitutionalisation of Mental Healthcare User is to be implemented in South Africa, it has to be done with the provision of structured community mental health care services, as recommended by the Mental Health Policy and articulated by Prof Freeman’s document, with the adequate planning and allocation of designated resources;
(v) Specialist run community / psychiatric services, as described in the MH Policy, must be included in the proposed NHI structure and funding in order to address the needs of people with severe psychiatric disability/ who require specialist level care close to their homes;
We will ensure that the recommendation is complied with.
(vi) GDoH must develop a capacity programme for all newly established NGOs within 45 days (submit such to the OHSC within 90 days).
We will ensure that the recommendation is complied with.
The Department has established a Rapid Intervention Team to look at the implementation of the six recommendations. The team will be supported by specialists in the mental health area. This team has already set-up an information centre where families can call to obtain information related to patients that were transferred from Life Esidimeni Healthcare to different facilities including NGOs. The Number is as follows: 011 564 2235/2215. Opens 24 hours from Monday to Sunday. We want to reach out to all affected families. The public can also use 082 809 0131 to SMS/WhatApp. We are also setting up a dedicated 0800 number.
The Rapid Intervention and Response Team will provide weekly updates on the progress made. We will work the 60 member group of experts appointed by the Minister of Health. I want to also announce that all vacant Hospital Boards positions and Clinic Committees will be filled and supported to be fully functional. We intend to give communities power to bring change in our facilities for the better of our quality health care.
The Gauteng Department of Health will together with the National Department to rapidly implement all the recommendations of the Ombudsman. We will also continue to work with family representatives and constantly update them on progress made with regards to the recommendations. Werecommit to make the health system more responsive to patients and families.