Thursday, 11 August, 2022
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Nursing Council resists training of new nurses, despite dire shortage, HASA conference told

Despite the chronic shortage of and desperate need for more qualified nurses, the SA Nursing Council (SANC) is stubbornly blocking the training of new candidates by preventing private hospitals from taking on more students, delegates at the annual Hospital Association of SA (HASA) conference heard on Tuesday.

HASA represents about 80% of South Africa’s more than 200 private hospitals, and counts JSE-listed Mediclinic, Life Healthcare and Netcare, as well as voluntary association the National Hospital Network, among its members.

The private hospitals are particularly frustrated by the obstacles to training nurses, as they are well placed to help fix the problem.

The SANC’s restriction on the number of training places offered by private hospitals undermines a HASA proposal tabled at the Presidential Jobs Summit in 2018 that the private sector train 50,000 nurses to help tackle SA’s critical shortage of healthcare professionals.

The proposal was endorsed by the presidential health social compact the next year, but is being held back by the SANC, which determines how many places may be offered by training institutions.

SA’s nine provincial colleges train about three-quarters of SA’s nurses, with the rest trained at universities, technikons and private nursing colleges.

Private hospital groups like Netcare previously played a significant role, but several years ago had their annual intake slashed by the SANC, with no rationale given for the change, said Netcare nursing education executive Toy Vermaak.

“We used to qualify for 500 (a year). Now if we do 80, it’s a lot,” she said. Netcare had received 23,000 applications for 130 training places, demonstrating the immense interest in pursuing a career in nursing, she said.

The SANC is a statutory council and operates independently from the Health Department, which has no direct influence over how it manages its affairs, said health deputy director-general for National Health Insurance (NHI) Nicholas Crisp. The shortage of nurses in public hospitals and clinics is largely due to budget constraints, which limit the number of posts provincial Health Departments can fill, he said.

The health budget is under immense pressure, and provinces have been unable to retain the 20,000 additional healthcare workers hired during the height of the COVID-19 pandemic, he added.

SA has a massive shortage of nurses, particularly in clinical specialities such as surgery and intensive care, said Netcare’s director for human resources and transformation, Nceba Ndzwayiba.

“COVID-19 exposed the magnitude of what we are dealing with in SA – the skills were just unavailable. We had to take workers from one province to another and try to follow the wave (of infections). This (showed) us the urgency to produce a pipeline to meet current and future demand, and ensure NHI will be adequately resourced,” he said.

The Health Department’s human resources strategy for 2030 projects that by 2025, there will be a shortage of 34,000 registered nurses in primary healthcare alone, while HASA estimated the nursing gap at between 21,000 and 61,000, he said.

The shortage of professionals is worsening, as the pool of healthcare workers per capita is shrinking even as the demand for services grows, said Shivani Ranchod, a co-founder of consultancy Percept.

The percentage of the population aged 50 or above is projected to rise from 18% in 2020 to 26% in 2040, accompanied by a growing prevalence in non-communicable
diseases.

Percept’s analysis of public and private sector records, including the government’s payroll system and medical scheme data, indicates there are fewer than 10,000 full-time equivalent specialists practising in SA, said Ranchod.

In March, MedicalBrief reported that the KZN High Court (Pietermaritzburg) had lambasted KwaZulu-Natal Health and directed it to authorise within 10 days a HASA application for the training accreditation of 230 nurses.

Judge Rishi Seegobin had rebuked the department for “acting unreasonably” and “reprehensible conduct”.

The court judgment, reported TimesLIVE, opened the door to the resumption of private training nursing training, stifled for three years by government and SANC resistance, and a spokesperson for HASA told MedicalBrief at the time that they wanted to continue to flag the “far more important matter of the general shortage of medical skills, in particular specialist medical skills, in the country”.

HASA had approached the court in October 2021 with an urgent application for an order reviewing a refusal by the KZN Health head of department to provide the letters of support for it to make an application to the SANC for accreditation to train 230 nurses at its own institutions.

KZN Health had said there was a three-year moratorium on nursing training because of a “surfeit” of nurses in the province who needed jobs and who should be employed in private hospitals. HASA said this was not true. The COVID-19 pandemic had put strain on the profession, many nurses had died, and research showed almost half of SAʼs nurses would retire in 15 years’.

The HOD and the MEC opposed the urgent application, which was finally heard in February this year.

Seegobin said HASAʼs lawyers had pointed out that the department had still not provided evidence of the so-called surfeit of nurses, and that HASA had been unable to train any new nurses since 2019, which was “chronically compromising access to healthcare”.

He added that HASA had assured the training would be done at its own cost and the graduates would be placed at its own institutions, so there would be no strain on government resources.

“It is deeply concerning that instead of owning up to its mistakes and taking responsibility for its failure to address the critical issues raised by HASA over such a long period of time, it chooses to sustain this rather reprehensible conduct by pegging its case on technical defences that have no merit whatsoever.

“HASA has conducted itself most appropriately throughout, regrettably the same cannot be said of the HoD and the department.

“It is clear the department is behaving unreasonably and limiting the publicʼs right to access to healthcare services. HASA has demonstrated, quite adequately, that there is a need for nurses in private healthcare institutions in KZN. Such an assessment is based solely on logic and demographics and requires no scientific or other expertise.”

Seegobin had set aside the HODʼs refusal to issue the letters of support, and ordered that they be issued within 10 days.

 

Business Day Pressreader article – Council ‘worsens shortage of nurses’ (Open access)

 

TimesLIVE article – Landmark decision: High Court orders ‘reprehensible’ KZN Health to allow private training of nurses (Open access)

 

See more from MedicalBrief archives:

 

Retirement boom and training drought — SA’s looming nursing crisis

 

Jobs summit to consider Netcare proposal for 50,000 new nurses

 

Gauteng Health admits to ‘critical’ shortage of nurses

 

New Critical Skills List records no shortage of medical skills in South Africa

 

 

 

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