3 March 2017

TO:	Democratic Nursing Organisation of South Africa (DENOSA)
FROM:	South African Nursing Council (SANC)

 

RESPONSE TO THE MEMORANDUM OF DEMANDS FROM THE DEMOCRATIC NURSES ORGANISATION OF SOUTH AFRICA (DENOSA) TO THE SOUTH AFRICAN NURSING COUNCIL (SANC)
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PREAMBLE

The South African Nursing Council is a Statutory Health Professional Council and a juristic person, established in terms of the Nursing Act, 1978, (Act No 50 of 1978), and continues to exist under the Nursing Act, 2005 () Act No.33 of 2005.  Its main object is to serve and protect the public by regulating the education, practice and conduct of practitioners through the standards it sets.  Its highest decision-making body is the Council, composed of 25 members who must be and are appointed by the Minister of Health. The Council is charged with overall governance oversight in respect of the SANC. In terms of sections 10 (1) (a) and 18 (1), the Minister of Health, after consultation with the Council, appoints the Chairperson and the Registrar of the Council, respectively. The Council of the South African Nursing Council is accountable to the Minister of Health. The SANC recognises the content of the memorandum, including matters raised in both the preamble and the list of twenty two (22) demands by DENOSA to the SANC. It takes note of the concerns raised by DENOSA and will endeavour, in partnership with nurse trade unions such as DENOSA, to strive towards improving the services it renders to nurses and midwives of South Africa. In its preamble, DENOSA raises many issues/concerns, some of which appear below:

1. Sub-optimal governance, leadership and stewardship of the Council 

This concern cannot be responded to as it is unsubstantiated by any fact.

2. SANC database WAS found to be inadequate to assist with HRH planning

Although it is not clear which data is referred to herein, the SANC notes this expression and is open to engage with nurse trade unions such as DENOSA, in order to improve the type and quality of its data. Measures are being put in place to improve the database. 

3. No regulations to govern the nursing agency sector 

The South African Nursing Council is legally not responsible for the regulation of nursing agencies as there is no provision for this function in the Nursing Act, 2005. In fact there is no legal entity called a nursing agency since the repeal of the Nursing Act, 1978 (Act No. 50 of 1978).

The National Health Act, 2003, falling within the jurisdiction of the National Department of Health, does however provide for the regulation of health care agencies. 

4. Delay in accreditation of new nursing education institutions

SANC is unaware of which new Nursing Education Institutions are referred to herein.

5. Regulations to govern health care worker

The Nursing Act does not make provision for this category of worker.

6. Continuing Professional Development system for all nurses and midwives

There is good progress on this project, with the participation of all relevant stakeholders, including DENOSA, Technical Working Group and Stakeholder meetings that inform the stakeholders on progress. The SANC has just completed Provincial information sessions on the matter, with good feedback. A pilot study was conducted to determine the feasibility of implementing CPD.

7. Finalization of National Framework for education and training of nurse educators and managers

This concern is not understood by the SANC and makes it difficult to respond to. Clarity is therefore requested.

8. Fatalities experienced in December 2016

The SANC believes that DENOSA is misinformed on this. It further and categorically states that there has never been any fatality/ies at SANC in December 2016 or any other time. However, there was an incident in January 2017 where a nurse collapsed while she was being served. At the time of the incident she was not in the queue as there was no queue and she was not at the SANC to pay for her APC. SANC would be more than willing to engage DENOSA to share the facts if DENOSA considers it necessary to know the truth.

 

RESPONSES TO DEMANDS 

DEMAND 1

Decentralisation of SANC (opening of provincial offices urgently). The long queues and the unnecessary travelling encountered by Nurses are unprofessional and an unhealthy exercise. 

 

RESPONSE FROM THE SANC

The SANC is currently undertaking an on-line registration system that is aimed at creating effective and efficient business processes and systems, at the same time taking advantage of available technology in making services freely accessible to all stakeholders wherever they are.

In addition, the SANC is currently in discussions with the National Department of Health with regards to partnership on collection of annual fees from nurse practitioners who are employed in public service as a long-term measure to manage such collection.

As a short-term measure, Provincial Outreach Programme visits have been increased from three to five days. In the meantime, the SANC has recognized the need to increase capacity for on-site walk-in clients in Pretoria to service its members and this has hugely shortened the waiting time.

All access to and engagement with the SANC in future can be done through multiple electronic channels. The SANC will, however, keep assessing the need for strengthening off-site services.

 

DEMAND 2

We demand that there should not be interference by the department into the affairs of SANC once structures are appointed.

 

RESPONSE BY THE SANC

The SANC is not aware of interference by the department into the affairs of the Council, unless this is explained. 

The SANC is of an opinion that this demand is misplaced. If it is not, the context of the demand and the nature of interference should be clarified so that an appropriate response can be provided 

 

DEMAND 3

Opening of the registration period for payment of annual fees throughout the year, and not only from July to December of each year.

 

RESPONSE BY THE SANC

Currently, nurse practitioners are afforded a payment period of six months during which annual fees can be paid. Despite this, it has been noted over the years that the nurse practitioners do not utilise the first three months of the payment period, a clear indication that the number of months over which payments can be made is not a fundamental issue/ problem.

With this in mind, there is therefore no business case at this stage to extend the window period by a further six months.

 

DEMAND 4

Transparency on how the fees are increased and utilized by SANC. We demand an itemised billing and or statement 

 

RESPONSE BY THE SANC

The fee increase is normally inflation-linked. It should be noted that there was no fee increase for the annual fees of the 2016 calendar year. In its fee structure, the SANC currently offers 25% discount to nurse practitioners who are 60 to 64 years of age and 50% discount to nurse practitioners who are over 64 years of age.

The SANC makes every effort not to burden the nurse practitioners with high fees whenever possible. This is demonstrated by the fact that its fees remain the lowest in comparison with those of other Health Professional Councils.

In future, individual statements will be issued to nurses. Financial statements will be available as part of the annual report.

 

DEMAND 5

Allow nurses who work for government (who form majority nursing workforce in SA) to choose months that SANC can deduct annual fees from Persal, so that nurses don’t have to come to Pretoria.

 

RESPONSE BY THE SANC

The SANC has pro-actively identified this need and commenced discussions for a partnership with the Department of Health in 2016. The proposal is that annual fees are deducted by the employer from the practitioners employed in public service. The outcome of the discussions will govern how the collection is handled. The SANC appreciates that DENOSA supports this proposed partnership.

 

DEMAND 6

The punitive nature of SANC as seen in most cases outcomes (STRUCK OFF THE ROLL/PROLONGED SUSPENSION) is contrary to corrective discipline and is not complementing the current NURSE shortages in SA and is neither typical of a peer review body. We further demand the establishment of the investigating officers so as to avoid charging nurses prior to proper investigation.

 

RESPONSE BY THE SANC

All complaints received by the SANC must be investigated properly i.t.o section 4(1)(g) of the Nursing Act 33 of 2005 and this is done by the Preliminary Investigating Committee (a peer review committee appointed i.t.o. section 47(3) of the Act) i.t.o section 46 of the Act.

This Committee refers serious matters to the Professional Conduct Committee appointed i.t.o section 15(1) of the Act which will hold formal inquiries where parties can state their respective cases and sanctions are handed down in terms of section 47(1) of the Act. Also refer to the Rules Setting out the Acts and Omissions in Respect of Which the Council may Take Disciplinary Steps (R. 387).

Investigations are conducted by the officers of the Council, sometimes accompanied by the police, where the nature of the investigation warrants it.

In the period 2014 to 2016, which is the period of the 15th Council of the SANC, the statistics of the Professional Conduct Committee show that the following sanctions were handed down by the PCC:

1. Caution and Reprimand – 5 

2. Fines – 8 

3. Referral to the Impairment Committee – 2 

4. Suspended suspension – 60 

5. Effective suspension – 20

6. Effective removals– 5

 

The above figures may help bring context to your concern.

 

DEMAND 7

Financial accountability should be with the Health Ombudsman and demand audit of all finances as received and used in the last five years. We also demand annual report of the utilisation of all funds received by SANC.

 

RESPONSE BY THE SANC

Lines of financial accountability by the SANC are laid out in the Nursing Act, 2005. It is not clear whether DENOSA is suggesting that financial accountability for the SANC exclusively is to be moved from the Minister of Health to the Health Ombudsman, which suggestion, with sound rationale, will require an amendment of the Nursing Act. The SANC recognises the unavailability of financial reports from 2013/14 financial year onwards and is currently engaged in the process of correcting that. The annual report 2016/2017 will be made available in line with the timeframes set out in the Nursing Act.

 

DEMAND 8

Some fees paid to SANC e.g. restoration fee, fee for requesting academic records seems not to be a well and fairly calculated price. We demand to be taken through a process of information including accounting towards all amounts paid to SANC.

 

RESPONSE BY THE SANC

‘Fee for requesting an academic records’ is not clear and can therefore not be explained.

 

DEMAND 9

Further that exception should be made on merit upon removal of any person from the register due to non-payment of registration fees.

 

RESPONSE BY THE SANC

Restoration fees are payable by the nurse practitioners who apply to be restored to the Council register following removal of the practitioner’s name from the register, whether voluntarily or otherwise. 

The purpose of the restoration fee is to encourage practitioners to pay annual fees within the prescribed period. The nurse practitioners who adhere to payment of annual fees within the prescribed period will not be subject to any restoration fee. The SANC currently assist the nurse practitioners by allowing a window period of six months within which to pay the annual fees. 

A nurse practitioner who decides not to practice in a certain period can apply to be voluntarily removed from the Council register. In the case where a nurse practitioner was removed voluntarily and wishes to be restored to the Council register, only a nominal fee of R120.00 will be charged.  

With the SANC’s intended long-term measure of managing annual fee collection through partnering with the National Department of Health as well as via our new electronic system, it is envisaged that the percentage of restoration applications will be greatly reduced, if not eliminated. 

Fees and Fines are regulated in terms of the Regulations Regarding Fees and Fines Payable to the South African Nursing Council (R. 170). This is a fine to encourage nurse practitioners to pay in time and is like any other punishment for any other late payment of regulated (legislated) license fees in the country.  

DENOSA is implored to encourage its members to use the available time line for payment. The SANC will also strengthen its communication to practitioners.

 

DEMAND 10

Review all R212 qualifications to match the current trends and needs in the society and nursing education e.g. Forensic Nursing.

 

RESPONSE BY THE SANC

The R212 qualifications have in fact been reviewed for future offerings. In preparation for phase-in of non-legacy nursing qualifications, the SANC has developed competencies for nurse specialisations to be used to develop programmes towards the new qualifications (review for current trends and needs) so that the future Nurse /Midwife Specialists are trained for relevance. Forensic Nursing is one of them. This extensive review exercise was undertaken by the SANC with the participation of professional Societies, Professional Associations and nurse trade unions like DENOSA.

 

DEMAND 11

The parking space afforded to ourselves in an appalling condition is not near aesthetic to the human eye. We demand a revamping on this parking space.

 

RESPONSE BY THE SANC

The SANC acknowledges this and the matter is already receiving attention.

 

RESPONSE BY THE SANC

The SANC acknowledges this and the matter is already receiving attention.

 

DEMAND 12

The need for SANC to make the Nursing Act relevant and take out irrelevant nursing categories such as “Anciliary midwife” category, which is non- existent in SA.

 

RESPONSE BY THE SANC 

This demand is probably based on misinterpretation of the Nursing Act. The Act does not make any provision for a category named “Ancillary midwife” as this is not a nursing category and the SANC has never approved or accredited any NEI to offer any programme for professional registration in the said category. 

The Nursing Act is being reviewed/amended at the moment and any provision that needs to be amended will be duly amended. Discussions between the SANC and the Department of Health are currently underway.

 

DEMAND 13

 The urgent need to have provision for appeals procedures framework that the Appeals Committee must operate within.

 

RESPONSE BY THE SANC

The demand needs to be clarified as it may also be based on the interpretation oversight of the Act. The Nursing Act makes provisions for two appeal processes that are in operation already:

1. Appeals against decisions of the Council found in section 57 of the Nursing Act and the Committee responsible for this is appointed by the Minister of Health 

2. Appeals related to decisions of the Council in respect of unprofessional conduct. Section 15(4) of the Act, provides for an ad hoc disciplinary appeal committee dealing with appeals against sanctions invoked by PCC processes.

 

DEMAND 14

To relook at Section 56 of the Nursing Act and address the restriction on private nurses who, despite have done dispensing courses, can still not prescribe or dispense.

 

RESPONSE BY THE SANC

 The SANC appreciates this expression. The SANC has attended to and continues to attend to Section 56 of the Act. Discussions with the NDoH have been long underway. The Section 56 proposed amendment form part of the review of the Act (see point 12) that is currently underway. 

 

DEMAND 15

A turnaround should be developed with decentralisation in mind on ensuring that community service certificates and diploma/degree certificates are delivered to recipients within the first two months of commencements and not the more than six months we are experiencing 

 

RESPONSE BY THE SANC

In terms of R.195 of February 2008, the Registrar must issue the successful applicant with a certificate of registration within 60 days of receipt of the completed application.

The SANC is currently working within this deadline where Nursing Education Institutions submit complete, accurate and authentic documentation.

Unfortunately the NEIs do not always submit the completion documents within 30 days of completion of education and training as required by section 32(3) of the Nursing Act.

The SANC issues diplomas for the examinations it conducts in line with the prescripts of the Act. Degree certificates can only be and are issued by the HEIs.

Once the new IT system is in place, the efficiency of registration processes will be significantly improved and certificates will be distributed electronically in a fast, safe and secure manner.

 

DEMAND 16

An external audit should be conducted by the latest June 2017 on the high failure rate of external examination provided by SANC and the report be given out to the stakeholders and the public and remedial actions should be taken against those who will be found on the wrong side of the law. The audit should cover a period from January 2015 to December 2017 on all examinations provided by SANC.

 

RESPONSE BY THE SANC

There is no evidence, provided that there is a high failure rate with all examinations conducted by the SANC from 2015, including 2017 as at the time of receipt of this memo, there was no examination that had been conducted by the SANC for 2017.

The SANC has, however received a number of concerns relating to the examination conducted in May 2616. This was the examination for the Bridging course for Enrolled Nurses leading to Registration as a Nurse. An internal analysis of that examination is underway at Council.

 

DEMAND 17

Invigilation and marking on all examinations provided by SANC should be done by Nurse Educators who SANC should source their services and such services should never be provided by any person who does not hold Nursing Education qualification.

 

RESPONSE BY THE SANC

 All markers and moderators of the examinations conducted by the SANC, in line with the provisions of the Act, are qualified Nurse Educators who are registered with the SANC. 

The SANC will appreciate if evidence can be provided should there be an individual who is alleging to be a marker for the SANC and yet is not registered as a nurse educator. The SANC will immediately investigate the matter and duly mitigate.

Invigilators are not ordinarily nurse educators. This is a normal phenomenon in all educational institutions, including Quality Councils in general education.

 

DEMAND 18

SANC should lead a fight against bogus nursing schools and to involve all the relevant stakeholders including trade unions, communities, law enforcement agencies, etc.

 

RESPONSE BY SANC 

 

The SANC conducts inspection in loco each time when it becomes aware or is alerted about the existence of a bogus school that purports to offer nursing programmes. Whenever necessary, the law-enforcement agencies are involved. Support from trade unions like DENOSA will be beneficial in this regard.

 

DEMAND 19

The SANC academic rules and regulations should be given to all the students of all programs who are to write the council examinations.

 

RESPONSE BY THE SANC 

The SANC will look into the matter and provide critical information to students which will accompany the registration certificates.

 

DEMAND 20

The last 24 months have seen huge staff turnover at SANC, especially of senior personnel leading to break up in communication. SANC should explain the suspicious purging of senior personnel.

 

RESPONSE BY THE SANC

 DENOSA will have to assist the SANC and clarify the suspicions that the SANC purges senior personnel so that a proper response can be provided. All senior managers who left the organization in the mentioned period did so through natural attrition.

 

DEMAND 21

Stop mass retrenchments of staff, especially women and the youth. This goes against the spirit of nation building and alleviation of joblessness.

 

RESPONSE BY THE SANC

 The SANC has never embarked on any mass retrenchment of staff. DENOSA is requested to clarify this demand so that the SANC can provide an appropriate response.

 

DEMAND 22

SANC is an ivory tower, and makes it so difficult to communicate when seeking guidance. Telephones, emails and letters get no response. We demand that senior that personnel respond to request for meetings within 48 hours as delays cause damage to operations.

RESPONSE BY THE SANC

 The SANC acknowledges the current difficulties with its frontline services and is putting in place measures to improve this service. The SANC will continue to monitor the performance of the relevant sections.

The SANC is committed to improving its services to nurses and midwives in this country and continues to appreciate the support of all nurse formations and nurse trade unions such as DENOSA. 

 

 

The SANC is committed to improving its services to nurses and midwives in this country and continues to appreciate the support of all nurse formations and nurse trade unions such as DENOSA.