THE closure of a hospital is always sad. Hospitals are places of hope and their history is intricately woven into the communities they serve. This is particularly true of older hospitals.
The 140-bed McCord Hospital in Durban, established in 1909 but now facing closure, counts the training of thousands of medical staff and pioneering the treatment of HIV/AIDS among its milestones. The hospital, which has 400 staff, plans to shut due to cutbacks in the US government’s aid programme for HIV/AIDS, and a review by the KwaZulu-Natal Department of Health of an annual grant that amounted to R78m last year. The department is reviewing its grant because the hospital has ceased training interns and providing HIV/AIDS services to the poor, which were conditions of the grant. But the provincial government is also contemplating an offer for the facility.
The hospital needed huge capital investment to bring it up to licensing standards for private hospitals, and for the introduction of National Health Insurance.
Also facing the threat of closure is Durban’s second biggest, and oldest hospital, the 524-bed Addington Hospital on the beachfront. The department plans to meet affected parties, including its 2,200 staff, and talk about the future of the hospital, which is plagued by persistent complaints about crumbling infrastructure and declining levels of service.
The department initially ruled out buying McCord because the hospital is saddled with debt and it needs an upgrade. Also, McCord’s management apparently wants to keep the facility a "going concern", while the department can enter into such an agreement only if the hospital provides services for the poor (at very low prices). Clearly, the government cannot financially support a privately owned hospital with a failed business model.
It is likely that McCord will close, the government will buy it and offer free services, or it will become an acquisition opportunity for a private hospital group.
The future of Addington is more difficult to speculate about. Both hospitals undoubtedly provide valuable services to the city. But reports of infrastructure and service-delivery problems at Addington have become a regular feature in the city’s press.
Last year, the KwaZulu-Natal Legislature’s health committee members visited Addington and complained about linen and drug shortages and ageing infrastructure. A three-year revamp was started. Last week, some wards and operating theatres were closed due to air-conditioner problems.
If the department is contemplating closing the 16-storey Addington, it is likely to be mulling questions such as at what point is it more expensive to upgrade an old facility rather than build a new hospital? Is it still appropriate to have a large hospital in the middle of the city’s prime tourism destination? How much can the department afford to spend on Addington, or a new hospital, given that it also has other issues to deal with, such as a shortage of about 3,000 doctors? Are there other areas where a new hospital might be deemed a bigger priority? Is there sufficient capacity at other hospitals in the city to cope with Addington’s patients if it is closed while a new facility is built?
The last big hospital built in the city was the 846-bed Albert Luthuli Central Hospital, which opened in 2002.
My own view is that Addington is likely to remain open for many years yet, given the large number of indigent patients it cares for. But it is a good time to start planning a new big state hospital north of the city, where there is rapid growth.
A worrying aspect of McCord’s possible closure is the inexplicable view expressed by department head Dr Sibongile Zungu at a media briefing. Dr Zungu said that one of the reasons the government grant should be withheld is because McCord budgeted for a "R7m profit" in one of its financial years.
McCord is a nonprofit organisation, and such surpluses are typically reinvested in the operations as opposed to being returned to shareholders.
Perhaps she was reflecting the unhelpful ambivalence with which many left-leaning healthcare sector commentators in the government view the private healthcare sector these days.