Critical: hospital budget cuts have
Health facilities countrywide have been negatively affected by the austerity measures, which have led to vacant
Health professionals in the Western Cape’s tertiary hospitals have sounded the alarm over the impact of nationally imposed budget cuts on the delivery of health services. Dire funding constraints have led the provincial Department of Health and Wellness to restrict the filling of vacant clinical posts, while also enacting various cost-saving measures across the region.
One of these measures involves the reduction of elective surgeries. Lydia Cairncross, head of the Department of Surgery at Groote Schuur Hospital, told Daily Maverick that the facility has had to cut about two theatre lists each day. These lists hold four or five surgical operations each, amounting to a loss of about 10 operations daily and about 100 in a month.
“These are lists which already have patients booked on them. Sometimes those patients are booked weeks or months in advance, and then we have to contact the patients and say we no longer have the list. We have to rebook them at another time and those waits get longer for individual patients,” explained Cairncross.
Over the past few years, the staff at Groote Schuur Hospital have worked hard to reduce the surgical backlogs caused by the disruption of health services during the Covid-19 pandemic. Just after the pandemic, the backlog stood at about 6,000 patients.
Since then, it has been brought down to between 3,000 and 4,000, according to Cairncross. However, as new patients are continually entering the system, the backlog only goes down when the hospital is able to increase its capacity to perform surgeries.
“If you decrease the capacity, that waiting list increases in size… I would say that every month that goes by in terms of these budget cuts at this level, we’re rolling back a month of surgical recovery… It’s really frustrating because we worked really hard to get that down,” said Cairncross.
The situation is affecting emergency theatre lists as well as scheduled operations, said Cairncross. “As our scheduled theatre lists decrease, it puts pressure on our emergency theatre lists because when patients wait
longer, they tend to have more advanced pathology and sometimes the conditions that they have complicate.
“We often see this in the ecosystem – that as the elective lists come under pressure, it spills over into the emergency list. Things that have started off as elective become urgent.”
Cairncross gave the example of a patient with a hernia, which is a weakness in the abdominal wall that causes chronic pain and discomfort. If treated immediately, while the defect in the abdominal wall is smaller, it requires a smaller and less expensive operation, and a shorter hospital stay.
“If you leave the hernia for a very long time … then the gap in the abdominal wall becomes bigger. You need a bigger operation, a bigger mesh implant to cover the defect and often a longer hospital stay, as well as a more complicated operation. The longer you wait to intervene … [to] reverse a condition, the more complicated it is, the more health resources it uses up and the greater the complexity for the patient in terms of their recovery,” she explained.
The reduced theatre lists at Groote Schuur Hospital are also affecting waiting times for oncology patients needing surgery, according to
Jeannette Parkes, head of the Division of
Clinical and Radiation Oncology. In many cases, surgery is required to determine the patient’s diagnosis or stage of cancer.
“Our breast cancer patients are affected, our GIT [gastrointestinal] cancers are affected, and even our smaller lists – for example, our plastic surgery lists for our patients with very advanced skin cancers – are affected,” she said.
Compounding the problem of the reduced theatre lists is the current shortage of surgical staff at the hospital. There are positions vacant in ophthalmology, plastic surgery, general surgery, ENT and paediatric surgery, according to Cairncross.
These budget cuts threaten
to undermine the huge gains that have been made not only in procuring these important services but also in improving the quality of
life of South Africans
Vacant posts
Vacant posts are currently a problem across all departments and tertiary hospitals in the Western Cape. Towards the end of 2023, the severe budget cuts led to concerns that the hospitals might run out of funds to pay salaries by mid-january 2024. As a result, hospital services were de-escalated and a freeze was put on filling both clinical and nonclinical posts.
Under normal circumstances, the hospitals would begin processes to fill posts as soon as they became vacant. However, Ntobeko Ntusi, head of Medicine at Groote Schuur Hospital, reported that there were currently nearly 300 clinical and non-clinical posts that had not been filled at the Groote Schuur and Red Cross hospitals.
“Between Red Cross and Groote Schuur, we’ve made some savings from the large number of posts that were frozen. So, in January, we were allowed to fill three posts at GSH and two at Red Cross. Then, in February, we were allowed to fill four posts, one at Red Cross and three at GSH,” he said.
Groote Schuur Hospital has seen a reduction in staff across most of its divisions. The problem has been particularly acute in emergency services, where 10 of the 20 medical officer posts are vacant, said Ntusi.
“Because it’s a constitutional mandate [that] we as a department have to provide emergency services to those who need them, we’ve actually diverted a significant amount of our resources in terms of personnel to the emergency services, which now means that if you need an appointment to be seen in many of our elective services, the waiting times are longer,” he explained.
At the beginning of February, the budget for agency nursing and overtime for nurses was frozen. This has led to a 15% nursing deficit in the surgical wards and other departments, according to Cairncross.
She added: “The nursing staff are extremely stretched in the wards and, in some cases, we are unable to get patients into beds in order to have their operations because … there are fewer beds than we had before, as you actually have to staff the beds.”
There is a large shortage of oncology nursing staff, said Parkes – a situation that will soon become a “limiting factor” for the number of chemotherapy treatments the department can provide per day.
“We’ve got a post frozen for one of our key medical officers who works in our very busy breast [cancer] clinic, which has more patients every year. And then we’ve got key radiographer planning and radiographer therapy technicians whose posts are frozen. We’ve got people acting in those positions but they’re actually not really qualified to take on that management role,” she said.
Parkes pointed out that, as more posts become vacant, the working conditions for those staff who remain become increasingly difficult. This drives more people to leave, seeking better working environments, and the number of vacant posts continues to grow – a vicious cycle.
“These are people who are on the scarce skill list of South Africa and are working in