The impact of national budget cuts on services has been flagged by the Western Cape’s tertiary hospitals, which have highlighted the restriction on filling vacant clinical posts, and the reduction of elective surgeries.
Lydia Cairncross, head of the Department of Surgery at Groote Schuur Hospital, told Daily Maverick the facility has had to cut two theatre lists daily. These lists hold four or five surgical operations each – a reduction of about 100 operations a month.
She said over the past few years, staff had worked hard to reduce the surgical backlogs caused by the disruption of health services during the pandemic. Just after the pandemic, the backlog stood at about 6 000 patients.
It has been brought down to between 3 000 and 4 000, but as new patients continually enter the system, the backlog only goes down when the hospital can increase its capacity to perform surgeries.
“If you decrease the capacity, that waiting list increases … every month, with these budget cuts at this level, we’re rolling back a month of surgical recovery …” Cairncross said.
The situation affects emergency theatre lists as well as scheduled operations. “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 their conditions complicate.
“We often see this – as the elective lists come under pressure, it spills over into the emergency list. Things that started off as elective become urgent.”
The reduced theatre lists also affects waiting times for oncology patients needing surgery, said Jeannette Parkes, head of the Division of Clinical and Radiation Oncology. Often, 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 reduced theatre list issue is the surgical staff shortage. There are positions vacant in ophthalmology, plastic surgery, general surgery, ENT and paediatric surgery.
Vacant positions
Vacancies are a problem across all departments and tertiary hospitals in the Western Cape.
Ntobeko Ntusi, head of Medicine at Groote Schuur, said there were nearly 300 unfilled clinical and non-clinical posts at 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. In February, we were allowed to fill four posts, one at Red Cross and three at GSH,” he said.
Groote Schuur has seen a reduction in staff across most divisions. The problem has been particularly acute in emergency services, where 10 of the 20 medical officer posts are vacant.
“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 personnel to emergency services, meaning if you need an appointment to be seen in many of our elective services, the waiting times are longer,” Ntusi said.
At the beginning of February, the budget for agency nursing and overtime for nurses was frozen, leading to a 15% nursing deficit in the surgical wards and other departments, said Cairncross.
There is also a large shortage of oncology nursing staff, said Parkes – which will soon become a “limiting factor” for the number of chemotherapy treatments the department can provide daily.
As more posts become vacant, working conditions for remaining staff become increasingly difficult, driving more people to leave, seeking better working environments, and the number of vacant posts then grows.
“These are people who are on the scarce skill list of South Africa and are working in the state sector, being pushed out into either the private sector or overseas, where they are actively recruiting for our very well-trained staff. These are not skills we will easily get back,” she warned.
Sean Chetty, executive head of the Department of Anaesthesiology and Critical Care at Tygerberg Hospital, said the facility had a large number of vacant clinical and non-clinical posts, and a backlog in the surgical department
“Patients presented to us for surgery are sicker … requiring more intensive care and higher resources … to just survive,” he said.
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