Budget cuts hit health service
• Western Cape forced to stop filling posts at public hospitals as national government fails to fund pay shortage
Unprecedented in-year budget cuts implemented by National Treasury in the medium-term budget policy statement (MTBPS) have put the brakes on filling posts at Cape Town’s biggest public hospitals, placing strain on staff and forcing patients to wait longer.
Several senior doctors who spoke to Business Day anonymously said vacant posts for key positions were not being filled timeously, agency nurses no longer filled gaps in crucial areas such as surgery and fewer registrars than usual were appointed at the start of the year. Registrars are specialists in training.
“Things are not great. We are accredited to train 60% to 70% more registrars than we have, we can’t fill nursing posts, and there is no nursing agency budget,” said a senior doctor at Groote Schuur Hospital. “The Western Cape is determined to stay within budget. It means patients are waiting longer, it is reducing the number of specialists we can train, and the load on staff has increased,” they said, noting the public health system had yet to recover from Covid disruption to services.
The conditions described by the doctor were corroborated by healthcare professionals at other hospitals who said demands on the health system were increasing while staffing levels shrank due to a growing population and an increasing burden of disease and trauma. The Western Cape health department said it was doing its best to protect direct service delivery positions but conceded it was employing fewer nurses than a year ago.
“We have approximately 820 nursing positions earmarked to be filled soon, as well as around 441 doctor positions. Due to the national directive to curb expenditure, restrictions have also been placed on the use of agency staff,” it said. The department’s records did not indicate a decline in the number of doctors employed year on year, it said.
Like all other provinces, Western Cape was forced to honour the higher-than-expected pay settlement reached by the government and unions after the Treasury finalised the 2023 budget. National government has not fully funded the shortage, leaving Western Cape with a R1.1bn shortfall for 2023-24, compounded by a R642m cut in its conditional grants announced in the MTBPS. Health and education bore the brunt of the budget cuts. The provincial education department said previously the budget cuts forced it to scale back plans to build new schools and classrooms.
“This government [Western Cape] has repeatedly and consistently raised formal objections to how centrally negotiated wage deals that impact the provinces are concluded by national government, and these objections and calls to engage for a constructive solution have gone unheeded,” said Western Cape finance MEC Mireille Wenger. The province expected worse was to come, she said.
“Due to technical adjustments to the Provincial Equitable Share as well as fiscal consolidation measures, a net reduction to the 2023 baseline of R6.7bn or 3.5% over the 2024 Medium-Term Expenditure Framework (MTEF) is expected,” she said. Western Cape expected R379.6m would be cut from the provincial equitable share along with a R6.4bn reduction due to fiscal consolidation measures imposed by Treasury.
“We are able to cushion this severe slashing of our budgets from the fiscal stabilisation reserve and from the Provincial Revenue Fund. But we are still confronted with a shortfall of R2.646bn over the MTEF that needs to be funded from our departments,” she said.