DEAR South African healthcare professional, here’s a question for you: are you happy with the way the Health Professions Council of South Africa (HPCSA) is fulfilling its twin mandates, to protect the public and guide the professions?
Do you know who makes decisions on your behalf and how your money is spent? Are you comfortable that you can get an accounting for how and why those decisions are made?
I ask because I heard that the HPCSA is appealing the ruling in the Professor Tim Noakes case. For the purpose of this column, I am not interested in getting into the yeas and nays of low carb diets; I am only interested in finding out who made this decision and why.
Because, you see, “As an autonomous body the HPCSA receives no grants or subsidies from government or any other source. It is totally funded by the fees it receives from registered persons representing the professions under its jurisdiction. Each Professional Board, however, administers its own budget in a transparent manner from the funds allocated by the HPCSA, based on fees paid by various professions to Council.” Okay?
I am willing to bet that the long-running and very costly case against Noakes was not funded by a ring-fenced reserve of fees contributed by registered dietitians and nutritionists in South Africa (I tried to find out how many there are, but the Association of Dietetics doesn’t seem to know, and the HPCSA Professional Board concerned simply lets the phone ring).
The HPCSA must be using, not just the R1 525 paid this year by each registered dietitian or nutritionist, but all the fees paid by all of you to cover the enormous costs of this. (That’s anything from a few hundred rand a year for an anaesthetist's assistant to nearly R2 000 for a psychologist.)
The decision to appeal was unexpected, at least by me. I thought the HPCSA would be doing a little research on social media. Because the picture painted during the hearing was of a fumbling, bumbling set of HPCSA witnesses and legal team who were shown up as being very ignorant about digital media, how it works and how the rest of us use it.
My expectation was that they'd crawl home, lick their wounds – and then the council would set out to craft a policy on social media, to look closely at the wording of their ethics documents and ensure that all members have ethical guidance about using digital media.
In due course, say a year from now, all the professions would have received a link to a new set of guidelines for How To Be Ethical Online.
But no. The council is appealing the ruling. I could understand that, perhaps, if the Tweet That Caused All The Trouble (the one about how to wean babies) had actually caused any harm. You know, if someone had landed up in ICU as a result of reading Noakes’ 140-odd characters, then you could (sort of) understand what can only be read as a steely determination to skewer the man.
But as it stands, it would seem no baby – or any other living creature, not even an apoplectic dietitian – was hurt during the making of this legal soap opera.
How much will this second legal leg cost, more millions sunk in a seemingly pointless vendetta? And to what other uses could the council put that money, that would serve both the public and the healthcare professions better?
And by the way, I’ve yet to hear if a better job is being done by the newish HPCSA, following the disastrous report in 2015 by a ministerial task team, which “found the Health Professions Council of South Africa (HPCSA) to be ‘in a state of multi-system organisational dysfunction’ which has resulted in the body’s failure to function effectively”
That could be attested to by hundreds of healthcare practitioners who struggle to get simple assistance with repeated requests to the HPCSA (I remember a young friend’s titanic battle simply to register as a paramedic); by doctors returning to South Africa with loads of experience, willing and ready to help our strained public healthcare system, but who could not jump through enough hoops to satisfy the HPCSA (see this story for just one of many); by professional bodies who have begged the HPCSA for help in, for example, policing professions that overstep the scope of practice for which they have been trained… Have things improved much since the new regime was put in place?
Quizás, quizás, quizás, as the Song Otherwise Known as ‘Perhaps, perhaps, perhaps’ goes.
The HPCSA is a crucial custodian of healthcare in this country – but quis custodiet ipsos custodies? (Who watches the watchmen?) In this case those watchmen and women are unelected officials – chosen from a list of nominations by the professions, but appointed by the minister of health for five-year terms. So how transparent are they required to be, and who calls them to account?
If none of you healthcare practitioners wants to ask, then I do, as a member of the healthcare-using public (who pays the money to the registered practitioners which enables them to pay their fees, and therefore ultimately funds the HPCSA): who made the decision to appeal, and why?
Asking – once again – for a country that is getting just a little tired of our money being widdled away.
* Mandi Smallhorne is a versatile journalist and editor. Views expressed are her own. Follow her on Twitter.