The Honourable Premier Hon. Speaker and Madam Deputy Speaker of the Legislature Hon. Members of the Executive Hon. Members of the Provincial Legislature Hon. Chairperson of the House of Traditional Leaders Hospital Boards and Clinic Committees Health and Medical Associations Leaders of the Organised Labour in the Health Sector Leaders of the Non-Governmental Sector and Organised Faith Based Organizations The Superintendent General and the Senior and Executive Management Team of the Department Fellow South Africans.
In the few months that I have been at the helm of the Eastern Cape Department of Health, I have experienced the following issues, which in their nature are not surmountable.
the management of the department has grown alarmingly over the years upstaging the clinicians and health professionals who deliver on the core business of the department.
the management structure that sits at head office and is disconnected from the institutions it is supposed to be servicing.
some hospitals in the eastern part of the Province are in a dilapidated state, walls are dirty, water pipes are leaking, roofs are leaking, and these conditions do not present themselves as places of healing, care and wellness.
under-spending on our infrastructure grant which really amazes me because we should be spending all our allocation that has been made available to the Department.
high levels of corruption and fraud, stealing of medicines at our health facilities.
Shortages of food, drugs as well as medicines are prevalent in some institutions.
Despite these conditions, the contrasting picture in some health facilities is commendable because doctors, nurses and general workers go about their business with zest. I was also impressed with the number of nurses that graduated from Lilitha College of Nursing, the pioneering Clinical Associates from Walter Sisulu University and the doctors from other Tertiary institutions.
Lately though the department has been embroiled once again in an unfortunate baby death episode. I would have thought that with all the advances in medicine and technology, something of this sort would be avoided. It is such a sad chapter and a blot in the life of the Health Department, more so when it occurs in the same complex not once and is a source of grave concern. My sincere condolences go to the families that lost their infants.
Hon. Speaker and Members of this august house, as I stand here, I am proud and confident to pronounce that winds of change are going to be sweeping at the Department of health. We are going to facilitate a new sense of purpose, responsibility and accountability throughout the entire Provincial Health Care System. A collective resolve and common vision for all of us at the Department of Health is to improve the health needs of the people of this Province. Those who are not prepared to work with us with urgency and speed, will have to give us the space to ensure that we deliver on the promise of the African National Congress which to make Health the Priority of this Government.
Taking cognizance of the available funding, for 2011/12 financial year, this Policy Speech has been developed and informed by Medium-Term Strategic Framework; the National Health System's 10-point plan; the recent ANC, NEC & PEC Lekgotla Resolutions; State of the Nation address by the President of the Republic; the recent Provincial Executive Council Lekgotla Resolutions on Service Delivery Improvements including the Provincial Government Programmme of Action as well as the Hon. Premier's State of the Province address.
In addition, the speech is informed and will direct the implementation of the department's strategic objectives and policy imperatives which are based on the primary healthcare (PHC) approach, with more emphasis on promotive and preventive instead of curative healthcare. It is important to note that decentralization of decision making processes to the lowest level is part of this PHC approach.
Reduce morbidity and mortality due to communicable diseases and noncommunicable illnesses and conditions by implementing high impact strategies to improve prevention, detection, management and support of communicable diseases and non-communicable illnesses and conditions at all levels of care.
Hon. Speaker and Hon. Members as I have alluded above, we are going to facilitate a new sense of purpose, responsibility and accountability and we have indeed presented a Turnaround Strategy of the Departments during the Exco Lekgotla. The key critical issues that we also presented centered around the following:a The Provincial Readiness of the Department to engage with all the Process of the NHI.
The Revitalization of the Provincial Health System including finalization of the Provincialization of Provincial State-Aided Hospitals and the Devolution of Environmental Health Services.
Finalization of Organizational Restructuring.
Clear focus on the Primary Health Care as a foundation for Provincial Health Care service delivery.
Correction of the HROPT outcomes.
Strengthening of intergovernmental cooperation.
Exploration of Revenue Generation and Retention.
These matters are further explained in the Policy Outlook for the coming financial year 2011/12.
Before we present our 2011/12 Policy Outlook, Hon. Speaker and members of the House, it is important to report that the department opened 5 clinics and 3 hospitals this year which is the commitment of the Ruling Party to improve access to health care, especially to our communities in rural areas. These projects are the Settlers Hospital in Grahamstown; the Revitalized Uitenhage Hospital; and the Accident & Emergency Unit in Port Elizabeth. The clinics are Mangalane in Mt Fletcher; Ngxasa clinic in Maclear; Agnes Rest in Lady Frere; Kotyana in Elliotdale; and Bengu clinic in Tsomo.
The Department procured 169 ambulances and 45 Patient Transport Vehicles, and these have been fitted with tracking computerized system to ensure effective use of these assets. This will indeed increase our response time to emergency scene to save the lives of our communities.
Following the President's Statement on the 1st December 2009, the government has put in place the HIV Counseling & Testing Campaign. On the 30th April 2010 we launched this campaign at Flagstaff, and soon after all the other districts followed with their own launches. Our Provincial target is 2 million for people to be tested by June 2011, and we are happy to report that a total of 764 000 people have tested in the province by the end of January 2011.
The fundamental thrust of this campaign is to ensure that all South Africans should know their status so that the scourge of the HIV and AIDS is managed from an informed base. The department has recorded 135 000 people who are on ARVs in the same period. We will engage the Hon. Speaker with a request to conduct the HCT campaign here at the Legislature, so that all the Hon. Members of this House are also counseled and tested accordingly, of course with their consent.
Hon. Speaker I will deal now with the Policy Imperatives for the oncoming financial year.
3.1 Implementation of Primary Health Care and Building Social Compact with communities through Health Promotion and Healthy Life Style living.
Hon. Speaker and Members of the House, the provision of primary health care services is the cornerstone and a fundamental philosophy of health service, especially the district health system. Our strategy to Revitalize the PHC is to strengthen PHC at community level and provide the necessary foundational basis for our future health system. The role of Community Health Workers will be re-visited to give them more scope and role to play in this initiative.
The Department will further develop multi-stakeholder participation processes to stimulate our communities to take greater responsibility for their own health, with the emphasis on prevention of ill-health. We shall further mobilize individuals, families and communities through community engagements and outreach programmes to take greater responsibility for their own health. Our communities will be encouraged to come up with practical projects to address their own health care without abdicating our responsibilities towards health access.
Hon. Speaker and Hon. Members of the House, we would like to report and indicate that the provincialization of 19 out of 26 municipalities have been done and the first phase of the exercise included the verification of Human Resources, Asset data collection and verification; the signing of transfer agreements and transfer of staff. The second phase of taking over of buildings and other equipment will be negotiated in 2011-12 financial year.
The Nelson Mandela Bay Municipality as a metro and Buffalo City Municipality are under negotiation to have Primary Health Care services assigned to them with a memorandum of agreement pending the final decision of the National Health Council. A budget amount of R2 963, 423m has been set aside for this policy imperative.
3.2 Implementation of Priority Health Programmes, HIV and AIDS, TB Control Programme; MCWH.
Hon. Speaker, our Life Expectancy is decreasing due to the HIV&AIDS and TB dual epidemics as well as emerging non-communicable diseases like Diabetes and hypertension. Lately these conditions are increasingly contributing to an increase in percentages of morbidity and mortality within the Province.
HIV and AIDS Programme.
With regards the HIV and AIDS, we are rolling out our HCT Campaign and building more capacity to achieve the set target of 2 million in the whole province by June 2011. Working closely with Eastern Cape Aids Council and other partners, the department seeks to increase testing sites as well as testing rate. In the new financial year additional nurse retirees will be recruited to conduct outreach campaign in the taxi ranks and other areas where people congregate in large numbers; 190 lay counselors will be trained for door-to-door coverage. Besides the HCT benefits (be responsible and know your status), the visit benefits include screening for TB, hypertension, diabetes and other non-communicable conditions.
In the ARV Program we will increase the sites from the current 264 to 420, and increase patients on ARVs from the current 135 000 to 215 000 in the new year. The plan includes training more nurses on Nurse Initiated Management of ART (NIMART) Program to achieve 2 nurses per site coverage. We will continue to sustain the current 98% coverage on the PMTCT Program. The Department has therefore budgeted an amount of R 884, 376m which has increased by 12.06% from the previous allocation of R 789,196m.
In terms of the TB Control Program the department is ensuring that the TB Infection Control measures are implemented in all the facilities to minimize cross-infection not only among other patients but also to our staff. The plan is to ensure 60% of our TB facilities have proper ventilation facilities. The Jose Pearson TB Hospital will be getting a 40 bedded unit and the Marjorie Parish TB Hospital 32 bedded unit to address crowding and infection control while Empilweni TB Hospital is being upgraded. These projects will be finalized in the new financial year.
A focus will be on the integration of services with HIV and AIDS to manage coinfection, the management of MDR/XDR TB to ensure better health outcomes. This will include improved early detection of the disease, and up-scaling of Directly Observed Treatment Short-course (DOTS). This is to ensure that patients complete their treatment and do not default, which can result in an escalation of their infection to MDR/XDR TB, which is harder and more expensive to treat.
It is crucial for Hon. Members of the House to understand that to treat a simple TB patient cost R 600, 00 per month, yet a MDR costs R 1 500, 00 per month, whilst an XDR Tb patient costs R 2 500 per month.
Hon. Speaker, the department is to implement the Community Based management for the MDR-TB and re-treatment of patients. This intervention will improve access to services as early diagnosis of patients and early initiation of treatment, will reduce the spread of disease to community members. The intervention is currently implemented at Amathole, Nelson Mandela Metro and O.R. Tambo Districts. Resources will be made available in the 2011/12 financial year to strengthen this intervention.
The department will implement this intervention in partnership with various NGO's like Italian Corporation;TB/HIV Care Association, USAID TB Project and others. Hon. Speaker and members of the House, the department will be commemorating the World Tb Day on the 24th of March 2010, which will be held at O.R. Tambo District.
handing over the GeneXpert, at OR Tambo District, which is a new machine that will reduce the turnaround time of the sputum results from 48hrs to 2 hours.
a press conference at OR Tambo to communicate the TB/HIV statistics.
Household visits by the top management of the Department.
All these endeavors, Hon. Speaker are to improve the Provincial Tb cure rate to achieve a target rate of 70% by the end of 2011/12 financial year from 65% in 2010/11. A budget amount of R361 204 000.00 has been set aside for this policy priority.
The Saving Mothers Saving Babies Program is one of our critical focal point to reduce maternal and baby deaths. This will be based on building a strong and functional Basic Antenatal Care (BANC), sustainable PMTCT Program, and a strong campaign to have mothers delivering in our facilities. To meet the needs of mothers with complicated pregnancies from distant and inaccessible areas, we have built maternal awaiting homes normally referred to as half-way houses.
We have put in place a drive to recruit specialists (for maternity, pediatrics, neonatal and anesthetist) to build and sustain the required capacity in our under resourced areas through the implementation of outreach and in-reach programmes. 72 school nurses for the school health services will be recruited this financial year in order to strengthen the implementation of School Health Services within the Province.
As part of strengthening accountability and reporting within this area, all our District Hospitals will be compelled to implement the National Committee on Confidential Enquiries into Maternal Death's10 recommendations and report on the progress they are making. Hon. Speaker and Members of the House, I cannot afford and allow seeing, nor hearing about the number of babies and mothers dying in our hospitals when we have ten clear recommendations to implement in order to mitigate these mortalities and morbidities.
A budget amount of R96, 513m inclusive of the integrated nutrition programme and the mother, child, and woman's health service has been set aside for this policy priority.
3.3 Investing in human resources for health to achieve the desired health outcomes.
Hon. Speaker, the provision of health care services requires a massive investment in the training and development of Health Professionals. This further requires increasing human resources capacity by recruiting the required personnel and increasing production of our nursing personnel. It is also our intention that we create the necessary balance between health professionals and administration personnel.
As previously indicated, the department is heightening its march towards the revitalization primary health care services. Considerable amounts of work including the planning of services, the referral system, re-organization of clinical support services e.g. the Pharmaceutical Benefit Plan, etc. will require a number of human resources to realize the strategy of revitalizing the primary health care services. The Department, Hon. Speaker is in the process of re-aligning the organization structure of the department so that form would follow function based on the 80 - 20 principle where 80% would be health professionals and 20% administration and support functions.
The challenges associated with the HROPT are going to be addressed as per the resolutions of the recent Exco Lekgotla. We have also noted the arrest of certain doctors who were allegedly not having the required qualifications to work, but are serving at our Health Facilities. The department will strengthen its systems of recruiting foreign doctors to ensure that they meet the required standards and protocols as set by the Government and Health Professional Council of South Africa.
Given the challenges that I have alluded above, it is our policy imperative to continue recruiting students from the disadvantaged communities for training as community health workers, nurses and emergency medical services recruits and other health professionals. Bursaries will be provided to assist with the recruitment of health professional staff including doctors, pharmacists and therapists. Part of the social compact we are developing with our communities, deserving students will be identified and selected by communities to receive a bursary from the department. Such students will sign a contract with their communities to service and work for a number of period as part of ploughing and contributing back to their communities. The department will fund a total of 305 bursaries to the value of R98 485, 321m for the new financial year.
We also have the responsibility of creating decent jobs for our people as the President has called upon on all of us and the department in this regard will the prioritize a total of 350 critical health professional posts to be filled by July 2011. In addition to this, with the implementation of our infrastructure programme driven by different agencies, we will monitor and report on the number of people employed by companies that are working behalf of the Department. A Job Register will be developed to record all employment opportunities created for our people in the province.
The Functionality and Effectiveness of all Health Facilities including Pharmaceutical Depots, EMS Metro Centres and Forensic Mortuaries.
Hon. Speaker, my experience during the interaction and visit to a number of Hospitals -suggest that these institutions of ours are not optimally functional and effective. Regardless of these challenges, most of the managers are trying their best; however, we do expect them to do more.
In order to address this lack of functionality of our institutions, the Department will implement a comprehensive programme to assist and make Health Facilities (District, Provincial and Specialized Hospitals), Pharmaceutical Depots, the EMS Metro Centers and Forensic Mortuaries functional and effective.
Our policy imperatives, Hon. Speaker is to ensure that all these institutions are managed and perform as functional and effective organizations that have a responsibility of providing health care to our communities and patients. We will urgently look at among other things, the leadership and administrative management of these institutions and decide whether sufficient capacity exist to lead, manage and supervise these institutions.
Hon. Speaker, the National Department of Health has developed a set of National Core Standards which provides guidance in order to improve the effective management of health facilities throughout the country. The main purpose of these National Core Standards is to develop a common definition of quality of care, which should be found in all health establishments in South Africa as a guide to the public and managers and staff at all levels.
The Department will facilitate the implementation and institutionalization of these Core Standards at all health facilities, with a special focus on the Patient Rights; Patient Safety, Clinical Governance and Clinical Care; Clinical Support Services; Public Health; Leadership and Governance; Operational Management; and Facilities and Infrastructure Management.
A budget amount of R36m has been made available for this exercise. At the end, Hon. Speaker, we should be able to point at a number of Health Facilities and conclude that such Health Facilities are functional and effective and are ready for the implementation of the National Health Insurance (NHI) by 2013/14.
Hon. Speaker, the Exco resolved that the matter of provincialization of provincial aided hospital be addressed as a matter of extreme urgency. To-date we are proud to announce that by the end of February 2011 thirteen Provincial Aided Hospitals have since joined the department with their formidable numbers and nineteen municipalities have relinquished their agency function of the primary health care. The exercise has been concluded with minor hiccups which were resolved without outside interference due to constant focus by the management and staff of the department.
It is important to note that even the outstanding Provincially Aided Hospitals and Municipalities are preparing for the transfer of the function before the end of March 2011.
A strategic and management decision has been arrived at to de-complex the current three hospital complexes of East London, Mthatha and Port Elizabeth. This decision is to allow for the hospitals within these institutions or complexes to be managed as individual hospitals that are supposed to be functional and effective. More specifically, is to ensure that clear leadership and management capability is available to manage the individual hospitals within these complexes and ensure that patient care is focused more than before.
Revamping our emergency medical care services capabilities.
The whole system of managing and co-ordinating our emergency response capability will be overhauled with a view of improving response times to save the lives of patients by transporting them to nearby health facilities with limited resources at our disposal.
Our aim Hon. Speaker is to provide adequate emergency care, transportation of victims of trauma and road traffic accident, obstetrics and other medical emergencies with the best care that we have. The Planned patient transport service, on the other hand, is to facilitate inter-hospital transfer, while indigent patients will be transported between clinics and hospitals.
The ambulances will come with installed tracking system in order to monitor all the ambulances when they are on the roads, especially to scenes where they are needed urgently.
We have also started building the fleet for the "beyond the contract" period. A due diligence has been done by the department and it will guide our activities associated with emergency medical services. The due diligence report will be presented to the Portfolio Committee of Health and Transport by the end of April 2011 to show our commitment to improving emergency medical services.
Hon Speaker, the department will decentralise this service by the end of the second quarter and new financial year, where each tertiary and district hospitals will be allocated an ambulance.
There are four metro centres that have been established in Mthatha, East London, Port Elizabeth, and Queenstown, and the EMS Base in Mount Ayliff will be finalized and officially opened in June 2011 and the Hon. Members of the House will be invited to the opening session. Two additional EMS Centres will be established at Joe Gqabi and Cacadu Districts in order ensure access of emergency vehicles to all communities in the Province.
For the new financial year, we have budgeted an amount of R 682, 580 m which is a 14, 71 % increase from the previous budget allocation of R 580, 703m.
3.6 Maintenance and Revitalisation of infrastructure and enhancing the productive capacity of the economy.
Hon Speaker, it is history now that South Africa received accolades for hosting the most successful 2010 FIFA Soccer World Cup and it must also be said that Eastern Cape Province received an award for the Best Logistics for the World Cup.
In the new financial year, the Department will implement a three-pronged strategy to accelerate infrastructure delivery. The first strategy entails accelerating the delivery of health infrastructure through Public Private Partnerships (PPPs) especially for the construction or refurbishment of the Nelson Mandela Academic Hospital which will be completed in 2014/15 financial year.
The second element of the strategy entails improving our primary healthcare facilities. This process will be informed by the outcomes of the audit of primary health care infrastructure and services. The third strategy consists of enhancing Health Technology and Information Communication Technology by conduct an audit of Essential Equipment in the Province, which will inform the finalization of the National Health Technology Strategy. Furthermore, prioritize the health technology maintenance, as a means to ensure safety of patients and employees at out health facilities.
Continuing with the upgrading of 09 hospitals namely, the Madwaleni, St. Patricks, Holy Cross, and Aliwal North District Hospitals, St. Elizabeth and Frontier Regional Hospitals; Cecilia Makiwane, Livingstone and Frere Hospitals which are levels two and three hospitals.
Hon. Speaker we are also going to be increasing our focus on the maintenance of our health facilities as un-maintained facilities contribute to infection spread and contamination.
Maintenance of 11 hospitals namely; Madzikane KaZulu, Midlands, Bhisho, Butterworth, Fort Beaufort, Mt.
Maintenance of 30 clinics namely; Cancele, Empilweni, Gcaleka, Gqunge, Grainvalley, Gura, High View, Macibe, Mnyibashe, Ndabakazi, Ngcizela, Ngqamakhwe CHC, Ntseshe, Zone 8 Zwelitsha Clinic, Qina, Qolora, Zihlaleni, Springs, Tutura, Tyali, Zazulwana, Bongweni, Joubertina, Lower Regu, Mqanduli, NU 1 Mdantsane, Thornhill and Zone 5 Zwelitsha Clinics.
Our Infrastructure Program has been allocated R1,138,492m from the Hospital Revitalization Project grant, Infrastructure Grant for Provinces and equitable share. This is a cut of R577m and has huge implications for the Department's ability to provide good support to the clinical services. Adequate maintenance of facilities and equipment will not be possible, neither, will the revitalization of most of the facilities be at the acceptable standards possible.
3.7 Clinical Support Services and the availability of drugs at health facilities.
The effective provision of health care support services is one of our strategic policy imperatives of the department. These services, Hon. Speaker are to compliment patient care at Health Facilities. We have resolved that during the next three years, the department will strengthen systems to ensure uninterrupted availability of essential medicines at health facilities at all times and ensure emergency blood availability at District Hospitals.
Hon. Speaker and Hon. Members of the House, I must hasten to indicate that for too long the Department has had major challenges around availability of essential medicines at our facilities. The Department is putting in place processes that will achieve better management capabilities at the two Depots, increased drug supply and demand capacity, and efficient distribution of drugs and medicine to our facilities.
Our main focus is zero stock-out levels for essential drugs at PHC level especially. The other spin-offs will be minimal drug shrinkage through theft, damage and the expiry date throughout our system. We have thus increased the budget by 3.10 % this year to an amount of R64, 320m from the previous allocation of R62, 387m to ensure improved pharmaceutical service delivery.
With regards the provision of assistive devices to our clients and patients, especially the indigent members of our communities, the Department has increased the budget allocation by 5.
provision of 3300 wheel chairs to deserving patients.
provision of 1700 hearing aids devices to deserving clients.
7000 orthoses to people with disabilities within the Province.
In terms of the Clinical Waste Management, an amount of R30m, which is an increase from the previous allocated amount of R25m in the previous financial year has been allocated for the Provincial Medical Waste contract as well as ensuring compliance with Occupational Health and Safety Regulations.A total budget amount for this policy imperative for the new financial year is R 97,339m which is an 8.98% increased compared to the previous allocation or R93, 572m.
Hon. Chairperson and Members of the House, the budget we are tabling to the House must be placed in the context of the significant budgetary pressures and cash flow woes facing the Eastern Cape Department of Health which have had a major impact on service delivery. We are effectively starting the new financial year from a negative position with expenditure expected to exceed budget by approximately R 978million, including accruals and carry through costs which will be carried over into the 2011/12 fiscal year. This shortfall will have to be funded from the 2011/12 budget, as a first claim against this budget.
The 2011/12 budget has been developed and aligned to the core business of the department, especially focusing on re-engineering the health system to one that is based on the primary healthcare (PHC) approach, with more emphasis on promotive and preventive instead of curative healthcare and the department's strategic objectives, to that effect 47, 4% of the budget is allocated to the District Health Services programme.
The appropriated budget of R14 237billion for 2011/12 increased by R395ml, 2.85% compared to the adjusted budget of the previous financial year. However, in real terms, the budget has had negative growth of 3.4% over the MTEF. This position has arisen substantially through baseline adjustments of net cuts to the Department's conditional grants of R82.9 million, national priority funding included of R197. 4 million and improvements in conditions of service R239.9 million allocated. An amount of R444.2 million has been top sliced to finance projected overspending.
Due to the impact of accruals carried forward to the next financial year as well as the amount top sliced, the department is concerned that care should be taken to ensure that it maintains a proper balance between personnel and non-personnel expenditure. The target is to reduce, from the levels we are at presently, the percentage of budget spent on personnel costs from 64% to 60% in the 2011/12 financial year. It is therefore our intention to continue to reprioritize spending to realign budgets to ensure targeted spending on frontline services, all programmes and spheres of the department have been required to assess their baseline budgets to ensure targeted spending as well as identify areas where savings and efficiencies can be derived.
Initiating income generation projects in identified hospitals to increase our generation and retention of revenue. This will not only increase our revenue base but will also build a nucleus of facilities towards readiness for NHI policy implementation. The accruing benefits include attraction of specialists to our public healthcare system, increasing and retaining revenue and forming the building of administrative capacity in readiness for the NHI implementation. We have already begun discussions with the Provincial Treasury on the modalities of this plan, particularly, the revenue retention component.
Reforming our Supply Chain Management system by building elements of transparency, efficiency, and decentralization. Aligned with the PHC revamping initiative, our procurement system will be geared towards strengthening Local Economic Development (LED) initiatives and exposing many people to economic opportunities.
Hon. Speaker, we must also mention that a multi-agency working group made up of the Special Investigation Unit, South African Revenue Services, National and Provincial Treasury and the Presidency has been established to reform the supply chain within the Department. The purpose of this team is among other things, to curb corruption and fraud in the Department. This team will also assist in the prosecution of corrupt suppliers and employees within the Department.
Hon. Speaker, I hereby table the Budget Vote, Vote No. 3 of the Eastern Cape Department of Health which is R 14,237,249 billion for 2011/12.
Health Administration 590,416 2. District Health Services 6,752,589 3. Emergency Medical Services 677,875 4. Provincial Hospital Services 3,761,539 5. Central Hospital Services 609,327 6. Health Sciences and Training 609,672 7. Health Care Support Services 97,339 8.
I also table the Service Delivery Improvement Programme of the Department which contains our Statement of Public Commitment towards the provision of health care as per the requirements of the Public Financial Management Act.
Hon. Speaker. I have indicated that we are going to facilitate a new sense of purpose, responsibility and accountability throughout the entire Provincial Health Care System. With the limited budget allocated to the Department, I believe the Department can do more. Peter Vail, an American geologist and geophysicist, describes a complex, turbulent, changing environment in which we have to operate as 'permanent white water' which is a reference to turbulent river rapids. He describes these conditions as living permanently outside our comfort zone.
Many surprises - These are characterized by the continual occurrence of problems that are not supposed to happen. b Never-before-seen problems: - These are complex systems that produce novel problems and conditions never before imagined. c High Costs: White water events that are often extremely costly, both in terms of money and effort to cope with the problem and deal with the damage. d Un-ending and recurring change: The anticipation cannot forestall the next surprising novel wave in the permanent white-water.
Working together in order to overcome these complex, turbulent, changing environments that we find ourselves in, we shall not fail the citizenry of the Province to provide them with health care services that they deserve. 'Collectively we can do more'.
I thank you all.
Fraud prevention line: 0800 701 701 24 hour Call Centre: 0800 032 364 Website: www.ecdoh.gov.