OVERVIEW OF THE LICENSING APPLICATION
AND INSPECTION PROCESS IN THE WESTERN CAPE
Mr Ndoda Mavela, Deputy Director: Licensing & Inspectorate
Public Private Health Forum (PPHF) Meeting | Friday, 2 June 2017
© Western Cape Government 2012 |
Objectives Of Regulation
To improve access, cost efficiency and quality of care
To promote public, staff and patient safety
To integrate the resources of public & private sectors
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© Western Cape Government 2012 |
Why PN 187?
Previous regulations (R158) outdated
New care patterns (step down, rehabilitation, sub-acute clinics & obstetrics units)
needed to be brought within the ambit of the regulations
Criteria be made more explicit & transparent
Allows for public comments on applications
Greater flexibility in re-location of facilities
Modernize the physical standards (Annexure B)
Create provisions for reporting of information
Built in efficiency standards in processing applications
Revised structures for adjudicating applications
Create provisions –application fees, penalties ++
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© Western Cape Government 2012 |
Criteria used in the Western Cape Adjudication Process
Consistent with health service planning and development
Equitable distribution and rationalization of health services
Mix public/private services. Mix of levels of care
Optimal use of spare capacity in public sector .
Bed-population ratios:-
Public : private pop. Split (80:20 Nat. norm)
Public: private split = 65:35 (Rural)
Public: private split = 75:25 (Metro)
3 beds / 1000 population
Need = actual beds: norm by drainage area
Availability of alternate services
Promotion of quality services
Advancement of persons (Employment Equity Act, 1998)
Perverse incentives
Geographical = Health district / appropriate drainage area
Spare capacity within the public sector
Any particular factors specific to the application was considered
Consistency in our approach is important
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© Western Cape Government 2012 |
Application Process
Formal application on prescribed form
HOD reviews application within 30 days of its receipt
Published in 2 newspapers and the provincial gazette
Public given 30 days to comment on the application
If comments are received, HOD must inform applicant within 10 days of lapse of
comment period, of such comments
Applicant entitled to respond to comments ( within 25 days of receipt of HODs
notice)
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© Western Cape Government 2012 |
Role of PHEAC & HOD
The committee must within 90 days of receiving and application
recommend:
Approve or reject ; or
Conditionally approve
HOD must within 10 days of receiving Committee’s decision either:
Confirm Committee’s decision;
If appropriate, reverse the Committee’s decision;
Amend the conditional approval ;
Refer an application back to the Committee if deemed necessary
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© Western Cape Government 2012 |
Right of Appeal
Applicant may appeal to the Minister within 7 days of receiving notification from
HOD.
Minister may appoint 3 person who are not departmental employees to advise
him on the appeal (Appeals Committee)
Appeal must be finalized within 90 days of its receipt.
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© Western Cape Government 2012 |
Inspection of Facilities
Approved facilities – must be inspected before a certificate of registration will be
issued
Existing facilities – annual inspections
Annexure B – structural and installation requirements
Adhoc inspections – complaints
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© Western Cape Government 2012 |
Current Fee Structure (Under Review)
R5000 per new application
R100 per bed / per annual inspection
R500 per major theatre
R300 per minor theatre, endoscopy suite, cardiac cath lab, delivery room etc.
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© Western Cape Government 2012 |
Challenges experienced within PN187:
10 WCG-PPT Slide Gallery-01112012.pptx
Applications submitted by property developers rather than healthcare operating
companies/PHE experienced applicants – lack of PHE management insight
Applicants who may be new service providers in WC not making use of DOH
assistance offered regarding interpretation of R187 application processes
(different to Reg. 158)
Late and /or non-submission of building plans, leading to lapse of approval by
operation of law
Lapse of approval due to visible building activities not commenced within 12
period as per PN 187 by operation of law
Health establishments not commissioned in full / in part once approved
Incorrect reference numbers on invoices/payments by PHEs post inspections
conducted
Licensing of Community Mental Health Facilities
© Western Cape Government 2012 |
Licensing of Community Mental Health Facilities
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Legislative Framework
Mental Health Care Act 17 of 2002 and Regulations 15 of 2004
Guidelines for the licensing of CMHF, 2008
Purpose
Licensing of community facilities which provide residential or day-care facilities to
5 and more people with mental disorders as provided in regulation 43 (1) of the
General Regulations to the Mental Health Care Act, (17 of 2002).
© Western Cape Government 2012 |
Application Process - 1
Head of Department – 90 days to adjudicate
If refused, Head of Department:
• Must provide written reasons
• Inform applicant of the right to appeal
Appeal to be submitted to the Minister of Health within 10
days of receipt of outcome
Minister has 60 days to consider application
© Western Cape Government 2012 |
Application Process - 2
Prior to the issuing of a license service to be inspected by a duly
authorised inspecting officer
Minimum requirements to be met in terms of Section 15 of the Guidelines:
• Governance
• Clinical Management
• Human Resources
• Physical Environment: Guiding principles for infrastructure requirements
• Specifications for design, layout and finishes
• Safety and Security
• Services
© Western Cape Government 2012 |
Registered and Operating Community Mental Health Services
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Status Total
Registered Facilities 146
Operating Facilities 139
Western Cape Ambulance Services Act
3, 2010
© Western Cape Government 2012 |
Purpose of the Act
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To improve patient centred care using norms and standards
To regulate ambulance services to ensure patient and public safety
Complaints received from the public regarding emergency medical services in
an unregulated fashion
‘Fly by night’ ambulance services operating - not adequately equipped to
provide safe pre-hospital emergency care to all members of the community
In the absence of National legislation the Western Cape drafted and
promulgated the Ambulance Service Act 3, 2010
© Western Cape Government 2012 |
Application Process
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On receipt of an apllication with the R10 000 license application fee
Advertised in two newspapers for public comment + sent to relevant local
municipalities – 30 days for comments .
The application will be considered by the Head of Department and upon
approval; the applicant may proceed to procure premises, vehicles, and
employ staff.
After an inspection – if compliant, a license certificate as well as tokens for the
vehicles will be issued.
If refused an appeal may be lodged with the Minister of Health within 14 days
© Western Cape Government 2012 |
Other provisions to note
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17(1) : An ambulance service must appoint a person who is qualified and
registered to at least intermediate life support level to manage and supervise the
service.
17(2) (f) ensure that no patient is ever refused care or transport by the ambulance
service on the basis of that person’s inability to pay for the care or transportation;
18. (1) The Head of Department must designate a staff member of the
Department to manage mass casualty incidents.
Current Situation : Ambulance Services
© Western Cape Government 2012 |
Licensed Ambulance Services in the Western Cape (May 2017)
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Public Sector Private Sector Combined Totals
Ambulance
bases
49 64 113
Ambulances 261 112 373
Response
vehicles
50 62 112
Rescue vehicles 41 1 42
Aircraft
3 0 3
Concluding Remarks
© Western Cape Government 2012 |
Concluding Remarks
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The WC has done well to put in place :
• An explicit regulatory framework
• Create an efficient administrative capacity
• Has a tried and tested machinery developed over more than a decade.
• The lessons from PHE have been applied to Ambulance Services.
It could be argued that the regulations have been effective in maintaining stds
but limited in achieving an equitable distribution of private hospital bed and
services
The future situation will be impacted by :
• The NHI proposes to contract both private and public accredited services and
will have major implications for the planning, configuration and utilization of
health services in all areas.
• The National Department is in the process of promulgating national EMS act and
regulations.
Tel: Fax:
www.westerncape.gov.za
Contact Us
Ndoda Mavela
Deputy Director: Licensing and Inspectorate
+27 (0)21 483 3303
