EDITORIAL: Health minister must intervene now to stop care catastrophe

The nursing crisis has been deepening for years, and not even the ANC’s ambitions for National Health Insurance (NHI) seem enough of an incentive to awaken a sense of urgency in health minister Joe Phaala. NHI, the government’s plan for universal health coverage, rests heavily on nurse-led care. Yet where these nurses will come from is a mystery.

The figures are horrifying. SA had 186,000 practising nurses in 2019 and was already short by as many as 62,000 nurses, according to a report by the Hospital Association of SA and McKinsey. By 2030, the gap was projected to widen to up to 178,000 nurses, as the supply of new nurses from training institutions failed to offset the effects of an ageing workforce and meet the demands of a growing population enduring a worsening burden of disease. Almost half the registered nurses are set to retire in the next 15 years, according to SA Nursing Council statistics.

Even private-sector patients, usually buffered from the worst of SA’s state-led crises, are feeling the effects of the nursing shortage. Thousands of specialist nursing posts in private hospitals stand empty, hobbling the sector’s ability to provide care. At best, the shortfall means patients wait longer for elective surgery and must travel further for routine procedures. At worst, it puts their lives at risk: when neonatal intensive care units are understaffed, babies die.

Nurses the world over are highly sought after, and the government cannot stand in the way of locally trained nurses seeking better paid jobs in wealthier countries. The government does, however, hold huge sway over the supply of nurses, since it controls how many are trained and determines the regulations governing foreign-qualified professionals who wish to work in SA.

The government is deleterious on both counts.

Nurse training has been disrupted severely by the ham-fisted implementation of new qualifications, which came into effect in 2000. Since then, institutions have been prohibited from enrolling students on the old qualifications. But despite the pressing need for new nurses, the various government agencies involved in approving education institutions and their training programmes created such a tortuous path to accreditation that they triggered a two-year hiatus in which no students could start training in specialist nursing fields such as theatre, ICU and midwifery, and only a handful will do so in 2023.

Universities and public nursing colleges have been given the green light to train just 70 nurses seeking postgraduate qualifications in emergency care, 200 in critical care, and a mere handful more for oncology, nephrology and midwifery. These are scandalous figures.

The new qualifications fail inexplicably to include postgraduate specialist training in neonatal ICU, and require all nurses who wish to specialise at postgraduate level to have a midwifery qualification, creating a barrier to thousands of nurses with non-university legacy qualifications, who must now do an extra course in midwifery before they specialise.

The crisis is amplified by the nursing council’s antipathy to the private sector. Without providing a coherent reason, it has spurned the efforts of private hospitals to train more nurses, undermining a hospital association proposal at the presidential jobs summit in 2019 that it train 50,000 nurses to help tackle the unemployment crisis. Private hospitals previously trained thousands of nurses a year, but SANC inexplicably slashed their numbers and they are now permitted to train a  fraction of what they once did. There is no shortage of interest: this newspaper previously reported that on one occasion Netcare said it had received more than 23,000 applications for 130 places.

To compound this appalling situation, the nursing council, which is accountable to the health minister, appears to have no interest in removing the obstacles private hospitals face in recruiting specialist nurses from overseas, despite their inclusion in the critical skills list published by the department of home affairs last August. The credentials required of nurses who wish to enter SA on a scarce-skills visa mean private hospitals can no longer readily recruit nurses from India, the key foreign market from which they have historically hired staff for their specialist units.  

The health minister is responsible for tackling the nursing crisis, but there is little sign of his being interested in the human tragedy his inaction will create. The underperformance of state hospitals is no doubt embarrassing, but that should not stop the minister from intervening to allow the private sector to train the nurses the country needs so desperately. Need we remind him that lives are at stake?