SUBMITTED TO: Parliamentary Portfolio Committee on Health

SUBMITTED BY: The Democratic Nursing Organisation of SA (DENOSA)

DATE: 10 October 2005

The Democratic Nursing Organisation of South Africa (DENOSA) appreciates the opportunity given to present its view on this important legislation for the nursing and midwifery professions. This Bill comes at a time when the health is in a flux as it responds to technological, demographic and epidemiological imperatives. Funders of health care strive to contain health care costs and more governments are entering into trade agreements with other countries.

In recent times we have seen a greater emphasis on patient safety and quality of care. The former is still the biggest challenge in our country whereas with the latter we have come up with some solutions to address it – to mention but a few is the Batho Pele Principles and the Patient’s Rights Charter that are applied in all government and many private hospitals. Shortages in the health care workforce are growing at the same time as national borders become more porous and workforce mobility grows. Consumers are demanding more transparency in the way care is delivered and in the manner in which health professionals are regulated.

In recognising the World Bank identifying nurses and midwives as the most cost effective resource for delivering high quality health care in both new and established economies, DENOSA has come up with detailed comments on all the chapters of the Bill. We have done so because we realize that the health care system of this country and many other countries is nurse centred and that this Bill is the one that defines who a nurse is and what a nurse can do and not do, i.e. defining the scope of a nurse.

The changing environment has implications for, interalia, the regulation of health professionals; the skill mix of nurses in various settings; boundaries of health professions that overlap; the definition of nursing roles; and the education and preparation of nurses to provide them with the necessary competencies to deliver care in a time of rapid change.

The purpose of health professional regulation is to protect the public and one way of fulfilling this mission is to ensure that health professionals being regulated are competent to practice. Defining health professional roles is an evolving process as they adapt to new technological environments which, in turn, create the need for new roles in health care. Linking competencies for nursing roles with education and regulation is essential if nurses are to provide care, which is competent and safe.

A series of documents have been released by the National Department of Health over the last few months that are interrelated in terms of the impact on health and nursing care, but for the profession the Nursing Bill is probably the most important piece of legislation and long awaited document. As with the other documents more time was required to consult with the profession on this Bill. The previous input was done 4 years ago. This Bill looks significantly different and therefore requires time and more consultation in order to provide comments on the Bill.

The general content of the Bill is supported and includes some of the amendments that DENOSA has been advocating for, the most important being the plea for a totally new Act. In particular the extensive provision on corporate governance is also appreciated. There is a clear distinction of the functions and roles of the Registrar and staff and that of the Council members, which will contribute to elimination of role confusion and interference in the operational day-to-day running of the Council. There are, however, areas that we do not support because we think it will compromise the profession and the services. Unfortunately the perceived underlying punitive approach towards professional regulation is pervasive, and as such the Bill does not give the reader a sense of Council’s, and indirectly that of public, confidence in nursing and its professional character. These are found in the clauses such as 2(i) licensing of private practitioners when no other health professional in this country is expected to do so; the full control of the Minister on the Council with no autonomy for the profession; and only those who have been absent from the Republic for more than 3 years gets taken of the register – what about those inside the country who has not practiced for reasons of their own?

It is noted that the Bill as it currently stands, gives all the power to the Minister to determine what should be happening to nurses and midwives. It is believed that more autonomy should be given to the Council so that nurses and midwives can monitor and improve themselves, and not at the whim of the Minister. The Nursing Council should not just become another avenue or method to punish nurses and midwives for a failing and unsupportive system.

The primary purpose of the council is stated in the memorandum as being to ‘increase the protection of the interests of the public and to promote greater accountability by members of the Council and the Registrar’. These sentiments are supported, but this document seems to alienate the professions rather than embracing them as key partners in achieving the stated purpose.

Given that the Council is established to protect the public and that the Minister will be appointing all members and controlling the Council, it seems reasonable to expect that public funding would be made available to finance the activities of the council. At present the funding is raised entirely from nurses and midwives in the form of license fees, and through other costs levied against nursing activities. While being a large professional group will serve to spread the cost, it also increases the volume of work undertaken by the council in its everyday operational functioning. It is not reasonable to burden the most impoverished professional group with carrying the entire burden of financing the council for the benefit of the public and not necessarily to the benefit of the professions.

In conclusion DENOSA wishes to thank the Portfolio Committee for the opportunity to comment on the Bill. The general thrust of the Bill as indicated, is supported and the areas that are not supported by the profession have been highlighted in the general and detailed comments summarized in the table attached.

DENOSA confirms its commitment to quality health care delivery and will be available to address or elaborate on any of the areas that may not be clearly covered in this correspondence to the Committee.