Three top executives of the Health Professionals Council of SA have been found by the Health Minister Dr Aaron Motsoaledi’s ministerial task team unfit to hold their positions and is likely to be unbundled, separating the regulation of doctors and dentists from other health workers, reports MedicalBrief. The three had refused to co-operate with the MTT investigation or be interviewed.
The findings follows 15 years of’ multi-system organisational dysfunction’, R30m in tender irregularities, with its 12 boards and various sub-committees described as ‘lacking coherence and cohesion’, causing inter alia massive delays in the registration of health professionals and failing to act against unethical health professionals.
MTT conducted voluntary interviews of people with intimate knowledge of the HPCSA (i.e., current and past staff members of the HPCSA and members of the HPCSA Council). Practitioners and other stakeholders were invited through the HPCSA website to make written submissions to the MTT. In addition, the MTT collected and reviewed information from the available documents in the HPCSA such as reports on previous investigations and minutes of the various committee meetings. The CEO/Registrar, the COO and the General Manager Legal Services all declined repeated invitations to be interviewed by the MTT.
The MTT comprised Professor Bongani Mayosi (Chair) and Drs Mohamed Adam, Motodi Maserumule, Nkaki Matlala, Ralph, Mgijima, Luyanda Mtukushe, Molapane Cheue-Shabangu, and Professor Maila Matjila.
The complaints against the HPCSA culminated in the submission of more than 30 anonymous letters (apparently by HPCSA
staff) to the office of President of the HPCSA between November 2014 and January 2015, which alleged maladministration, irregularities, mismanagement and poor governance. The MTT conducted voluntary interviews of people with intimate knowledge of the HPCSA (i.e., current and past staff members of the HPCSA and members of the HPCSA Council). Practitioners and other stakeholders were invited through the HPCSA website to make written submissions to the MTT. In addition, the MTT collected and reviewed information from the available documents in the HPCSA such as reports on previous investigations and minutes of the various committee meetings. The CEO/Registrar, the COO and the General Manager Legal Services all declined repeated invitations to be interviewed by the MTT.
There were four major findings of the MTT:
1. First, there was evidence of administrative irregularities, mismanagement and poor governance at the HPCSA which was documented in the Forensic Investigation undertaken by KPMG in 2011, on the procurement procedures followed in the acquisition of the ORACLE information system, which eventually cost over R30m, instead of R14m. The Forensic Investigation had found that a former CEO/Registrar and Executive Committee of the Council of the HPCSA approved a contract and appointed a contract company in an irregular manner. The appointment of consultants by a former Acting CEO/Registrar and the current COO (in his previous capacity as Senior Manager Legal Services) was also not done according to the HPCSA’s procurement policies and procedures. These activities amounted to unauthorised, irregular, fruitless and wasteful expenditure. The Forensic Investigation Report made a number of recommendations, including possible disciplinary action against the officials involved, but nothing was done.
2. The veracity of allegations by whistleblowers that had specific reference to the inefficiency and the ineffectiveness of the HPCSA was supported in general by the findings of the oral interviews and the written submissions of the stakeholders. The key themes that emerged from the interviews and written submissions reflect the failure of the HPCSA to carry out its statutory mandate in its core five functions of (1) registration of health professionals, (2) examination and recognition of foreign qualifications of practitioners, (3) professional conduct enquiries, (4) approval of programmes in training schools, and (5) continued professional development. In addition, there was failure of management systems including (6) information communication technology, (7) data management, (8) space management, (9) human resource management and (10) overall risk management.
3. Regarding the fitness of the CEO/Registrar and COO to run the HPCSA:
3.1 Both internal and external stakeholders as well as the documents reviewed identify the failure of the CEO/Registrar to perform to the required standard in the majority of the key functions. These findings are not compatible with the CEO/Registrar who is fit to run the HPCSA. The refusal by the CEO/Registrar to appear before a MTT set up by the Minister and to provide information relevant to the investigation fly in the face of her ability to lead the organisation, instead it justifies the drawing of an adverse inference against her. In addition, her conduct possibly also amounts to an act of misconduct (insubordination).
3.2 Similarly, the internal and external stakeholders identify the failure of the COO to perform to the required standard. In addition, the COO was implicated in acts of unauthorised, irregular and/or fruitless and wasteful expenditure in a matter relating to the ORACLE information communication technology system which remain unresolved. Furthermore, the COO had taken the HPCSA to court in his pursuit of his failed application for the post of CEO/Registrar and lost the case with costs awarded against him. The MTT has not been placed in possession of any documents which prove that he has paid the costs due to the HPCSA.
3.3 Practitioners, professional associations and other organisations complained of mismanagement, maladministration, and irregularities in the system of professional conduct enquiries which is overseen by the General Manager: Legal Services. The key complaints relate to the turnaround period once a complaint has been lodged, with practitioners and complainants sometimes waiting for months to years for feedback from the Council. The delays prejudice practitioners, whilst at the same time leading to members of the public to lose confidence in the Council’s complaints system.
4. Additional insights gained by the MTT in this investigation:
4.1 The HPCSA (the Council, its professional boards and management structures) in its current form has failed to provide leadership and guidance to the health professions.
4.2 The HPCSA has severe structural deficits that contribute to its dysfunction.
4.3 There are institutional problems in relation to skills mix. The HPCSA employs more lawyers than health professionals. There is apparently not a single medical practitioner (or a member with a medical background) in the legal department that is responsible for professional conduct enquiries – most of which relate to the medical profession. The professional conduct enquiries are dominated by lawyers and proceedings adopt an adversarial legal approach rather than a professional conduct enquiry that is required by its mandate.
The MTT recommended:
1. Disciplinary and incapacity proceedings against the Registrar/CEO, COO and General Manager of Legal Services.
2. An interim executive management team.
3. The incoming and future Councils of the HPCSA should undergo a structured induction process to ensure an understanding and appreciation by all its members of their legal and governance obligations.
4. The recommendations of the KPMG Forensic Report of 2011 should be addressed.
5. A full organisational review and a proposal for a new governance and administrative structures for the future should be done.
‘The time has come to review the value of the HPCSA after 15 years of its establishment. This report reveals deep systemic dysfunction of the organisation which was extended from a single professional board (as the South African Medical and Dental Council for medical and dental practitioners) to a mega-organisation of 12 professional boards. There is a lack of coherence and cohesion in this large dysfunctional multi-professional organisation.
‘It is the view of the MTT that the best interests of the health system are not served by the current structure and organisation of the HPCSA. The MTT recommends that consideration be given to the unbundling of the HPCSA into at least two entities: the historic Medical and Dental Council (which constitutes a third of the current membership of the HPCSA) and a Health and Rehabilitation Council (for the rest of the professional membership of the HPCSA). These new Councils would join the South African Pharmacy Council, the South African Nursing Council and other autonomous councils in the Forum of Statutory Health Professions Councils.’
Health-e New reports that a new HPCSA board was appointed last week under the leadership of Dr Kgosi Letlape, the report says. Motsoaledi has given the board six months to report back on aspects of the task team’s findings, including how it will address irregularities uncovered by a forensic audit in 2011 that were never properly addressed.
HPCSA spokesperson Priscilla Sekhonyana said it was too early for a response to the task team report as the council’s board had only just received it and was still considering it.
The high-level task team was set to take 60 days but took six months due to the load of work. The Times reports that the task team became aware of a forensic investigation into the HPCSA by KMPG in 2011 that had uncovered tender irregularities in the awarding of a R30 million rand IT tender. The KMPG report had suggested that disciplinary procedures be implemented against individuals involved in the tender including the then head of legal services. But instead the head of legal services at the HPCSA was promoted to chief operating officer.
South Africa’s biggest doctor union, the South African Medical Association welcomed the task teams’ findings, reports Business Day. The union said it had lobbied for years to have a separate organisation for the medical and dental profession.