RESTRUCTURING ACADEMIC HEALTH SERVICES IN THE WESTERN CAPE: A CRITICAL EVALUATION WITH EMPHASIS ON A RANGE OF FINANCIAL MODELS DEVELOPED TO ASSIST THE PROCESS

Zach de Beer Town

Dissertation submitted for the degree of Master of Medicine in Community Health, UniversityCape of Cape Town of

Summary

Various financialUniversity models were developed in the process of planning for the restructuring of academic health services in the W estem Cape. In an attempt to inform and assist this process, these models are described, critically analysed and in certain cases further developed. Since most of these models are dynamic and have been developed within computer spreadsheet applications, the relevant files are included here on computer disk and form an integral part of this submission. The background to restructuring is first explored, the models are examined, and then the implications for policy, resource allocation and academic health services are discussed.

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The copyright of this thesis vests in the author. No quotation from it or information derived from it is to be published without full acknowledgementTown of the source. The thesis is to be used for private study or non- commercial research purposes only. Cape Published by the University ofof Cape Town (UCT) in terms of the non-exclusive license granted to UCT by the author.

University MMed(Community Health) Part III University of Cape Town

DECLARATION

I, ZachariasJohannes de Beer, hereby declare that the work on which this thesis is based is my original work (except where acknowledgements indicate otherwise) and that neither the whole work nor anypart of it has been, is being, or is to be submitted for anotherdegree in thisor anyother University.

I empower the Universityto reproducefor the purpose of researcheither thewhole or anyportion of the contents in anymanner whatsoever.

Signature Signature removed

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CONTENTS ABBREVIATIONS ...... 4

SPREADSHEET FILES ON COMPUTER DISK ...... 4

BACKGROUND ...... 5

THE MODELS ...... 12 INTRODUCTION TO THE MODELS ...... 12 THE WORK UNITS MODEL ...... 13 Introduction ...... 13 Model input ...... 13 Model construction ...... 14 Strengths ofmodel ...... 17 Weaknesses of model ...... 18 Further comments and suggestions ...... 20 Staff and staff categories (and other useful information) ...... 20 THE OPTIMAL BED BASED (OBB) MODEL ...... 23 Introduction ...... 23 Model input ...... 23 Model construction ...... 23 Comments ...... 25 THE ACP-IC (UCT) SUBMISSION ...... 26 Introduction ...... 26 Discussion of the ACP-IC (UCT) submission ...... 27 Sources of data ...... 27 Methods of determining percentages of tertiary care ...... 28 Application of percentages to derive the cost of the tertiary component...... 28 Exclusion of costs ...... 29 Concluding remarks ...... 29 ESTIMATION OF THE COST OF TERTIARY AND SECONDARY LEVEL BEDS ...... 29 Introduction ...... 29 Sources ofdata ...... 29 Calculation ofcost estimates ...... 30 First estimate ...... 30 Second estimate ...... 31 Third estimate ...... 32 Fourth estimate ...... 3 3 Fifth estimate ...... 34 Summary and conclusion ...... 35 MODELS: GENERAL REMARKS ...... 35 DISCUSSION ...... 36 POLICY ...... 36 RESOURCE ALLOCATION ...... 38 ACADEMIC HEALTH SERVICES ...... 39

TABLES

Table I: Number of out-patient visits rated equal to one in-patient day ______14 Table II: Allocation ofspecialists 24 Table Ill: Allocation ofnurs es 24 Table IV: Number ofbeds per staff member 25 Table V: Deemed% of tertiary care at TBH, as a % oftertiary care at GSH 28 Table VI: Tertiary bed cost: second estimate 31 Table VII: GSH and TBH - Cost per Bed (R 'OOOs) 35 Table VIII: GSH - Cost per Bed (R 'OOOs) 35

3 MMed (Community Health) Part III University of Cape Town

ABBREVIATIONS

ACP-IC (UCT) Academic Complex Planning-Information Committee (University of Cape Town) ANC African National Congress APG Academic Priority Group DPHP Draft Provincial Health Plan FMS Financial Management Svstem GSH Groote Schuur Hospital MAP Management Accounting Process OBB Optimal Bed Based RCH Red Cross Children's Hospital SAMJ South African Medical Journal SMT Strategic Management Team TBH Tygerberg Hospital UCT University of Cape Town us University of Stellenbosch MOU Midwife Obstetric Unit OPD Out-patient Department

SPREADSHEET FILES ON COMPUTER DISK

WU-GSHR.XLS Work Units Model GSH Region WU-TBHRJCLS Work Units Model TBH Region WU-RCHR.XLS Work Units Model RCH Region WU-SUMR.XLS Work Units Model - Regional Summary WU-GSHI.XLS Work Units Model GSH Inner Core WU-TBHI.XLS Work Units Model TBH Inner Core WU-RCHI.XLS Work Units Model RCH Inner Core WU-SUMI.XLS Work Units Model - Inner Core Summary NEWMODEL.XLS Optimal Bed Based Model BEDCOST.XLS Appendix I (Tables 1-6) HOSPDB.XLS Annendices II-V

Please note: All spreadsheet files are "Excel" files.

4 MMed (Community Health) Part !II University of Cape Town

BACKGROUND

The central focus of this dissertation is the examination of a range of financial models which were developed in 1994/95 to facilitate the process of restructuring academic health services in the Western Cape. Historically resources in academic health care~ this province have been concentrated within three major hospitals and their regions. 1 The hospitals are associated with two universities and their respective medical faculties. These are Groote Schuur Hospital (GSH) and Red Cross War Memorial Children's Hospital (RCH) - both associated with the University of Cape Town (UCT) - and Tygerberg Hospital (TBH) which is associated with the University of Stellenbosch (US). These entities naturally feature prominently in the financial models and their development. However the process of restructuring academic health services is not confined to the Western Cape. It is a national phenomenon: the challenges facing Gauteng 1 are similar to those facing the Western Cape inasmuch as both provinces have been relatively financially "over-resourced" compared with other provinces2 and between them contain five of South Africa's eight medical schools (three in Gauteng and two in the Western Cape). 3

The forces which are driving and shaping health care restructuring have their roots in the political transformation which South Africa has undergone over the last decade. The elections of 1994 were historic in that they were the first truly democratic elections to be held in this country. Their occurrence was perhaps more remarkable and surprising in that this heralded peaceful political change in a country previously widely perceived to be heading irrevocably toward a violent and bloody confrontation between the racially divided proponents and opponents of apartheid. Heribert Adam has characterised this process as a "negotiated revolution". The peaceful nature of this change is generally acknowledged to have been a great achievement as evidenced by the joint award of the Nobel Peace Prize to Nelson Mandela and FW de Klerk in Oslo on December 10th 1993. However it also meant that many of the civil structures, systems and institutions existing within the old apartheid regime passed into the new dispensation little altered in the process. During 1994 the ANC published the Reconstruction and Development Programme5 and the ANC Health Plan. 6 These documents set out the respective development and health policies the ANC intended to pursue to effect widespread change within a society still bearing many of the hallmarks of apartheid. As the implementation of these policies has begun, enormous challenges have been posed, ( and continue to be posed), in the quest for 7 8 transformation, in what some regard as an unhelpful,3 even "neoliberal" • economic environment.

The historical development of the South African health care system, particularly with regard to academic and hospital medicine, as well as the interface between the public and private sectors, forms an important element in the context within which health care restructuring is taking place, and has recently been well described by Benatar. 3 The private sector developed strongly in the 1960s and 1970s during a period of vigorous economic growth. Approximately 40% of the country's doctors provided care to 20% of the population (mostly white and medically insured), in a private

; Each of the three major hospitals - GSH, TBH and RCH are part of a larger region. This is explained and discussed later in this section.

5 MMed (Community Health) Part III University of Cape Town sector consuming nearly one third of the 5% of gross national productii (GNP) devoted to health care. Many private sector doctors held part-time appointments in academic hospitals. During this period the public sector was strong. It employed 60% of the country's doctors and consumed 70% of health care resources (half of this going to academic institutions) in providing care to 80% of the population, albeit unevenly. The public sector was responsible for the training of health care professionals and enjoyed the respect of private practitioners, being the provider of last resort - both for those with complex disorders, and for those unable to pay.

During the 1980s the private sector continued to flourish and came to employ 60% of doctors while still only offering care to one fifth of the population. The private sector now consumed some 60% of health care resources which as a proportion of GNP had increased to 8%. Increasing salary disparities between the private and public sectors contributed to the drain of skilled personnel from the latter into the former. The private sector was now far less supportive of academic medicine3 and the problems which were increasingly evident within the public sector and academic medicine have been re~arded as a consequence, at least in part, of the expansion of the private sector.3' ,Jo

The relative strength of the public sector and academic medicine during the first two decades of Nationalist Party rule does not imply that the South African health care system, either then or later, was appropriate for the needs of its people (including those of the "homelands"). The public health sector was very much a child of British colonialism in the first instance and subsequently of its perverse extension - apartheid. Historically, emphasis has been placed on hospital-based, specialised and curative care. This is true both for the provision of care and for the education and training of health care professionals. This phenomenon is largely explained by the fact that health care in South Africa was developed by people of European descent to cater, in the main, for the needs of the white population. It was therefore modelled on the British system of training and health care provision3 and was subsequently also heavily influenced by developments in the United States of America. One consequence of this was that services became concentrated in the urban, more privileged areas. Until very recently the aim in the public sector was to emulate, in terms of research, training and the provision of care, the standards and norms found in Western Europe and North America. In the apartheid era there were as many as fourteen different departments of health. Moreover different components and functions of health were controlled at national, provincial and local government levels. This resulted in fragmentation, duplication, lack of co-ordination and waste. The provision of training and employment opportunities has historically been racially inequitable.

As was mentioned above, public sector academic hospitals were already beginning to suffer during the 1980s. While the expansion of the private health sector was undoubtedly one reason for this, other factors also contributed. The apartheid state had become a massive owner of the country's economically productive assets, (an irony in view of its professed hatred for socialist systems). The prolonged economic

ii GNP measures the value of goods and services owned by SA entities irrespective of location. GDP measures the total value of goods and services produced within the country irrespective of the origin of ownership. In SA GDP in 1994 was US$122 billion and 1994 GNP was US$125 billion (Source: A'frica Institute 1996 and World Development Report 1996).

6 MMed (Community Health) Part III University of Cape Town recession of the 1980s, (in a sanctions-bound economy), made it increasingly difficult to fund a vast public sector expenditure bill, and the public health sector could not escape the resulting funding squeeze. During its final days the apartheid regime increasingly embraced the policies of its opponents; in 1992 the then Director-General of Health of the Department of Health and Population Development, in an article in the South African Medical Journal essentially formally embraced the policy of Primary Health Care (PHC). 11 From about that time budgets at both provincial and national levels reflected the desire to shift resources away from tertiary care towards primary care. Out-dated, ineffective, unrepresentative and centralised governance, management and control of public sector hospitals meant that increasingly inadequate use was being made of the resources available. This fact was implicitly recognised in a policy framework developed for the Department of Health by the Hospital Strategy Project. 12 Emigration of highly trained health care personnel, particularly during the last decade of National Party rule, has also damaged public sector academic health services.3

In 1994 the ANC published its National Health Plan in which it explicitly stated that it would base its health policy on the PHC approach 13 as formulated and adopted in 1978 at a conference in Alma Ata in Kazakhstan, in what was then a part of the old Soviet Union. Given the grossly inadequate nature of primary and community health care services2 and a comparatively well resourced public hospital sector on the one hand, and an unwillingness on the part of the Department of Finance and the Government to contemplate fiscal indiscipline or dedicated health financing mechanisms 14 on the other, it became clear that in order to fulfil its pledge to deliver health care based on the PHC approach, a redistribution of existing resources within the health sector, particularly the public health sector, would be necessary. Moreover, since the Department of Health's approach to provincial resource allocation is largely 15 based on population indices , the historically "over-resourced" provinces of Gauteng and the Western Cape, home to most of the public sector academic hospitals, have become the major targets for budgetary reductions.

As Kale 16 has simply put it: "Restructuring South Africa's health care involves providing care to the majority who have so far been deprived of it without destroying the excellent tertiary health care facilities and the high standards of academic medicine that exist in the country." In 1992/3 South Africa spent approximately R30 billion, equivalent to 8.5% 17 of Gross Domestic Productii (GDP) on health care, which is more than the target set by the World Health Organisation (5% by the year 2000). 18 However, as alluded to previously, less than 40% of this was spent on public health services in the provision of care for only one fifth of the population. 17 Three quarters of public sector health expenditure was allocated to "acute hospitals" - 44% going to academic and other tertiary hospitals - while only 11 % was spent on non-hospital primary health care services. 17 These figures highlight the uneven deployment of health care funds and explain, given the PHC approach and national resource constraints, why the Minister of Health wishes to shift resources from public sector academic hospitals into primary health care.

While many senior academics and administrators associated with public sector academic hospitals are sympathetic and supportive of greater equity and the development of primary health care, they are also alarmed at the potential damage which may result from financial cuts. Professor Solly Benatar (UCT and GSH ):

7 MMed (Community Health) Part III University of Cape Town

"Their (the Western Cape) budgets, reduced by about 15% over recent years, will now be cut by a further 50% over the next 5 years, to expand primary services and bring per caput public health expenditure into line with that of other provinces. The danger in slashing the budgets of established institutions is that they become incapable of the clinical and development activities for which they exist."2 Professor Johan van Wyk (US and TBH): "Less funds means less care of patients, which in tum means less quality training, and probably less training altogether."19 Professor JP de V van Niekerk (UCT): "There is a threat to the educational institutions as funds may be diverted from medical colleges to finance primary health care ..... The danger is that the medical schools could have severe damage done to them. As medical schools generate the personnel needed for primary health care, taking funds away from them 16 is seen as a serious threat by me and my colleagues." Professor Ralph Kirsch (UCT and GSH): "Some of us in the larger hospitals will suffer and there is a danger we may get destroyed",16 and: "In the Western Cape cuts of as much as 25% are on the cards. While both central and provincial health departments are grappling with this problem a lack of the clearcut political will required to address the plight of the teaching hospitals may leave these irrevocably damaged and thus have far reaching long-term effects on the nation's health care."3 Professor John Terblanche (UCT and GSH), commenting on a possible failure to secure bridging funding for the Western 20 Cape: "I would be very pessimistic of the future of health care in South Africa." Professor Forder (UCT): "There will almost certainly be rationalisation of many of the tertiary teaching hospitals, with inevitable cut-backs in their budgets. This in tum could carry the risk of damage to the fabric of these institutions, which might be impossible to repair."21 Of course not all academics are concerned about the effects of financial cuts. Professor William Pick (Department of Community Health, University of Witwatersrand) was reportedly "not perturbed by any proposed cuts": "A 5% cut in the budget of academic institutions really means that we need to improve our 16 management, work efficiently, and save 5%."

There has been an ongoing exchange of views in the South African Medical Journal (SAMJ) surrounding restructuring and the funding squeeze in the Western Cape. This 22 was sparked by a mini-editorial entitled "The Western Cape bites the bullet", in which Daniel Ncayiyana writes: "For decades the Western Cape has enjoyed the extraordinary luxury of two tertiary academic hospitals located a stone's throw from each other. .... To stave off criticism, both wrapped themselves in the fashionable blanket of primary health care, which they provided at double what it would cost at a community hospital. To keep these health rand guzzlers in business, the province resorted to robbing Peter to pay Paul by engaging in deficit spending and in relative underfunding of peripheral facilities." These harsh words were written by way of introduction to a report in the same journal outlining proposals to restructure Western Cape Health Services.23 These proposals emerged from the Academic Priorities Groupiii (APG), for whom some of the models discussed below were developed. In terms of the proposals, the medical faculties of US and UCT would be uncoupled from their respective teaching hospitals to create a common teaching platform, with TBH becoming the main secondary hospital and the site of most undergraduate tuition for both universities, and GSH and RCH becoming purely tertiary institutions

iii The APG was appointed by the MEC for Health and Social Services in the Western Cape, Ebrahim Rasool, to investigate options for academic health services (chiefly downsizing and rationalisation). It was chaired by Professor Kay de Villiers, and included among others, academics, administrators and provincial health officials.

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responsible for most post-graduate trammg. The proposals were received with "cautious optimism" by JP de V van Niekerk (Dean of UCT), but not surprisingly, less enthusiastically by the then Acting Dean of US, Professor Wynand van der Merwe.23

The mini-editorial quoted from above provoked an angry response and five letters 24 25 26 27 28 reflecting this sentiment were published in the May edition of the SAMJ. • • • • The first of these,24 written on behalf of the Specialist Association of the Tygerberg Academic Complex, has this to say to Ncayiyana: "We suggest that you bite your tongue, Sir!". Four of these letters came from doctors working at TBH, and one of them,25 commenting on Ncayiyana's assertion that the proposals had already been agreed upon, pointed out that the recommendations of the National Committee on Academic Health Service Complexes, chaired by Professor Jack Moodley, and reported on in the same edition,29 were still under consideration. The storm of protest 31 was sufficient to elicit a near-apology from Ncayiyana.30 In a balanced reply to Ncayiyana's editorial in the June edition of the SAMJ, Kane-Berman draws a vital distinction between the major academic hospitals (GSH, TBH and RCH), and the larger "academic regions" of which they are but part. This distinction has frequently not been appreciated, even by some closely involved with the restructuring process. The regions comprise not only the hospitals, but also a range of other facilities, 31 colleges and services, and these are listed in the letter. Since the "regions" are the administrative and financial units of the academic health services, it is essential not to assume ( as some have done), that the resources allocated to them go solely to the three major academic hospitals. This distinction is incorporated into some of the models discussed below, where "core" or "inner core" refers to the hospital alone, and "region" refers to the larger entity including the core. Kane-Berman also pointed out that the three academic health service regions spend about half the provincial health budget (rather than the 70% claimed by Ncayiyana), and insisted that the regions were participating "creatively and constructively" in the process of resource redistribution. She writes: "Tygerberg, Groote Schuur and Red Cross Children's hospitals are not "super-specialist institutions", nor are they "health rand guzzlers". They are in fact components of the cost-effective and efficient, comprehensive academic health service in the Western Cape, which provides national, supraregional and provincial health care, teaching and research at all levels of care. In comparison with other countries, the extent and standards of service, teaching and research for each rand spent are remarkable. These institutions should be preserved and protected as valuable national assets."

If the title of the original mini-editorial was a rather bizarre mixture of cliche and metaphor, a further letter from Ruttman and others32 in the September edition was even more strangely titled: Restructuring of Health Services - the bullet bites back. The title aside, this letter refers to the Draft Provincial Health Plan33 (DPHP) and questions the validity of classifying hospitals and/or beds according to levels of care, (something which is assumed as valid in many of the models discussed below), as well as raising the issue of the National Increment for Teaching, Education and Research (NITER) and how this should be allocated. The Western Cape "bullet" makes a further appearance in the November 1996 edition of the SAMJ in an alarming report20 quoting Western Cape MEC for Health and Social Services, as saying that cuts would lead to the loss of 1600 posts and 500 beds at the academic hospitals (GSH, TBH and RCH) by March 1997.

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Groote Schuur Hospital is the oldest of the three major hospitals in the Western Cape (Somerset Hospital is the oldest in the country). Built on the northern end of the Groote Schuur Estate bequeathed by Cecil John Rhodes, it was officially opened on 31st January 193 8. 34 Rhodes had originally expressed the wish that the land be used for a "National Teaching University", and this was given effect when the University of Cape Town was established on a portion of the estate in 1918. Subsequently the University of Cape Town (Medical School) Act No. 33 of 1920 authorised the building of a "hospital for the sick", for which purposes the University agreed in 1926 to lease a part of the estate, next to the newly built Medical School, to the Cape Hospital Board for a "peppercorn rental" of£ 1 per annum. GSH was built as an 850 bed hospital although it only became fully functional during World War II. The "new" GSH was built in the latter part of the 1980s, more than doubling the bed capacity. While there may have been good reasons for a new and expanded GSH, many felt that the money could have been better spent elsewhere; in "progressive health circles" in the early 1990s the new GSH was often rather scathingly referred to as "the disease palace on the hill". The association between the University and the hospital was clearly present from the outset, and is central to the concept of an academic health service. This relationship set a precedent in the establishment of subsequent academic health service complexes in South Africa. Internationally GSH is best known for the first heart transplant. Certainly it has enjoyed a reputation for excellence, however in recent times it has been criticised as too expensive and remote from the true health care needs of ordinary South Africans.

Red Cross Children's Hospital is the only remaining free-standing children's hospital in southern Africa. 35 It was established in 1956 as a memorial to all South Africans who had fought and died in World War II, and has some 350 beds. Intended originally as a specialist in-patient facility, it has come to provide a range of ambulatory, primary, secondary and outreach facilities. The current vision is to transfer much of its service load to district level, and to become a truly specialist facility. 35 Like GSH, RCH has been associated with UCT and has enjoyed a reputation for excellence, although it has also attracted criticism by those who have wanted to see greater emphasis given to community paediatrics. A remarkable statistic, (although it may now be out of date), is that over 50% of the nursing staff have been with the hospital for over 20 years (personal communication- Superintendent's Office, undated). From a purely organisational perspective, this is a wonderful asset, and one which would be very difficult to replace once lost.

TBH, with some 1800 beds, probably carries a greater secondary load than GSH, but is in other respects similar in terms of perceived excellence. As de V van Niekerk has 3 pointed out , "medical schools were divided by language and colour". The history of the University of Stellenbosch Medical Faculty and Tygerberg Hospital bears this out. The following quotes are from documents provided by the Superintendent's Office, TBH (anonymous and undated).

"Die onstaan van die Tygerberg Hospitaal hang nou saam met die ontwikkeling van die Fakulteit van Geneeskunde van die Universiteit van Stellenbosch .... Historiese en kulturele oorwegings is in ag geneem en die mening was dat, aangesien Stellenbosch al so veel gedoen het om die Afrikaner sy regmatige plek in die beroepslewe te laat inneem, die stigting van so 'n fakulteit nie agterwee kon bly nie."

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"Dit (TBH) is egter 'n belegging in die gesondheid van die volk, wat ongeewenaard is in die geskiedenis van die wetenskap in hierdie land."

"Dit was ook die doel om 'n kompleks op te rig waarin beide die verskillende bevolkingsgroepe met 'n minimum van duplisering en personeel bedien kan word."

In 1953 when a young graduate ofUCT Medical School was about to take his place as a Member of Parliament, he was advised by the then Principal of UCT that one of his most important tasks was to ensure that Stellenbosch never got a medical school (personal communication - Z J de Beer, September 1997). As it was, TBH admitted its first inpatient in 1972, although the hospital was not officially opened until 1st October 1976. The linguistic and political divide between UCT and US, apparent all those years ago, has persisted, and although now attenuated, has still been clearly discernible in some of the working groups tasked with restructuring Western Cape academic health services.

As the dialogue and process surrounding restructuring has unfolded, it has become clear that although many of the concerns and interests of academics and administrators throughout the Western Cape academic health services are aligned, there has been an underlying conflict between the two universities and their respective teaching hospitals. This is seldom voiced or made explicit, but it arises from the inescapable conclusion that at the end of the day there will be less to go around. Bluntly put, the question is: who gets what and how much? These are "turf issues".

In 1994, following a directive from the Minister of Health, Zuma, the nine provincial governments appointed Strategic Management Teams (SMTs), tasked with managing the transformation process. The intention behind this directive was to mix political and technical inputs, thereby legitimising transformation recommendations.7 The specific mandates of the SMTs were to become "think tanks" for policy formulation, to advise on health administration integration, and to assist with the creation of the district health system. In the Western Cape, however, much of the attention of the SMT naturally fell onto the academic health services.

In July 1994 the minister for Health and Social Services in the Western Cape, Ebrahim Rasool, established his Strategic Management Team (SMT) and charged it with the task of drafting a health plan for the Province. He subsequently appointed an "Academic Priority Group (APG) Task Force" to address the need for rationalisation of academic health functions in the Western Cape. During the work of the SMT, the APG, their sub-structures and various other groups it became clear that it was impossible to meaningfully plan the down-sizing of the academic hospitals, and a shifting of resources from tertiary towards primary levels of care, without the development of some sort of framework or model within which the implications of resource allocation decisions could be considered. Accordingly a number of models were suggested and developed.

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THE MODELS

INTRODUCTION TO THE MODELS

To a lesser or greater degree, all the financial models discussed below have a narrow technical focus, and do not easily lend themselves to critical academic examination, particularly in a health related discipline. Moreover they were developed by their respective authors as working documents with all the associated time constraints, and are presented here "warts and all". Nevertheless an effort is made to describe them carefully so that they can be understood, and so that their critical evaluation and suggestions for further development are also understood. Footnotes are provided in the text where this is thought to be helpful. The understanding of those models which have been provided on computer disk is greatly enhanced by exploring them within a spreadsheet application. Indeed, it is submitted that to the extent that the computer spreadsheet files are the work of this author, they represent an original and significant component of this dissertation.

The cost data used in these models is 1994/95 rands. Insofar as global targets have been addressed the challenge was to reduce expenditure on the academic hospital regions from approximately Rl 000 million to levels considerably below this in the short to medium term.

This section of the dissertation was and is offered as a practical contribution to the process of planning and achieving changes in academic health services in the Western Cape. The models and approaches described and discussed below have been developed by a small number of individuals working either alone or in small groups. Most of the work has been done using computer applications and some of it maybe difficult to understand. However the output of this work has been tabled at a high level within provincial and academic health circles, and has been used to make important and potentially far-reaching decisions. The main intention of this exercise is as follows:

1. To make these models and approaches understandable and accessible:

Each model or approach is carefully described. Those models which have been developed within computer spreadsheet programmes are included with this document on computer disk. As stated above the models are much easier to understand when examined on computer, particularly in conjunction with their description in the text. Moreover the variables within the models, (and indeed the models themselves), can be altered within the spreadsheet applications to the extent that this is useful. The spreadsheet files included on computer disk are as provided by their respective authors, and queries relating to these files should be addressed to them.

2. To critically examine each model or approach:

12 MMed (Community Health) Part III University of Cape Town

Each model or approach is critically analysed and discussed. Recommendations are made where considered appropriate. In certain instances concrete steps have been taken to develop a model or approach further where this was thought to be useful.

Each model is introduced and separately examined below. The inputs to each model and the steps involved in its construction are described. Each model is then critically evaluated.

THE WORK UNITS MODEL

Introduction

This model was developed within a work-group of the Financial Sub-committee, Academic Priorities Group (APG). This work-group contained academics, administrators and financial experts with members from both the north and south academic complexes (US/TBH and UCT/GSH/RCH respectively). As such it was probably the most representative group in which any of the models were developed. While there were undoubtedly disagreements and tensions within the group, it was at least possible for these to be played out prior to the output being tabled at a higher level. The major architect of the model was Professor David Power, Department of Paediatrics and Child Health, University of Cape Town.

The model is applied to each of the three academic hospitals both as "regional entities" and as "core entities".iv This means that essentially 6 models are available for the purposes of making projections.

Model input

The following information provides input to the model:

• Estimated total expenditure and estimated total salary expenditure for each of the three academic hospitals using FMSv (the state Financial Management System) figures for the 1994/95 financial year • Numbers of filled posts within the following categories: Chief Specialist Principal Specialist iv For an explanation of"region entities" and "core entities", please refer to page 9. • FMS is a management accounting system used by the state. While detailed explanation is not possible here, the following points have relevance. FMS accounts on a cash flow basis rather than on the internationally more accepted basis of accrual. This makes it potentially very much more difficult to relate work activities to the costs and revenues with which they are associated. FMS accounts within expenditure categories rather than organisational units. This means, for example, that the system could tell you how much is being spent in a particular hospital on salaries, pharmaceuticals, telephones etc., but it could not tell you how much is being spent in the Departments of Medicine, Radiology or the Kitchen etc., nor could it break these costs down within these departments. The view of the Ernst & Young management consultants who were contracted by GSH, is that while FMS may have its uses at a higher level within the province or state, it cannot provide the management accounting information which is necessary to properly run an organisational unit such as a ward, a department or even a hospital. This is also the view of this author.

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Senior Specialist Specialist Medical Officer / Registrar Professional - remaindervi Nurse Auxiliary (Unclassified) vi i Technical Administrative General • Average current salary costs for each of the above categories • 1993/94 provincial statistics36 for the following: Out-patient visits In-patient days (IPD) Average length of stay (LOS) Occupancy (Bed numbers are then derived as follows: IPD/(365 x Occupancy) • Various adjustment and correction factors (alluded to below)

Model construction

1. Work Units are calculated

Work Units are derived from the numbers of in-patient days and the number of out­ patient visits. Each in-patient day is counted as one work unit. Clearly an out-patient visit should count for less than an in-patient day, the question is how much less? A previous convention was to equate 3 out-patient visits with one in-patient day. However this was felt to accord too high a value to out-patient visits, based partly on a study on the costs of the general out-patient service at RCH.37 (Subsequently Rex has used what he calls the "accepted conversion rate of six out-patient visits per in­ 38 patient day". ) Accordingly the following out-patient factors were used:

Table I: Number of out-patient visits rated equal to one in-patient day

Type of GSH GSH TBH TBH RCH RCH Visit Region Core Region Core Region Core Specialist 6 5 8 8 8 8 General 12 10 10 16 18 18

Using these values the number of work units expended in 1993/94 using each of the 6 models is calculated according to the formula:

In-patient days + Specialist OP visits / Specialist OP factor + General OP visits/ General OP factor

Note: The out-patient factors can be varied within the model.

vi . This refers to professional staff not included in other categories. v" These staff categories -"auxiliary" and "unclassified" - used at different institutions were similar but not identical.

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2. Work Unit to Staff ratios are set up

The Work Units calculated in each of the 6 models is divided by the number of staff in each category listed above. This is intended to provide an indirect measure of the average amount of work that can be performed by a given staff member within each category. This ratio or measure is the central feature of the Work Units Model, and is used to predict the staffing and cost implications of various scenarios.

An important assumption underlying the Work Units Model is that the current deployment of resources at GSH, TBH and RCH is sufficient, in general, for the provision of Level IIIviii care to existing patient numbers. That is, it is assumed that if all patients currently being serviced at these institutions are in need of Level III care, that this can be achieved using the currently deployed resources. It could be argued that since the patient load at all three institutions is demonstrably some mix of Level III and lower levels of care, that additional resources would be required were all patients in need of Level III care. However it was felt by David Power and others that given national resource constraints and the declared policy objective of developing Primary Health Care that it would be inappropriate and unrealistic to expect a greater concentration of resources in the tertiary sector, notwithstanding the fact that the absolute size of this sector would have to be reduced.

The calculated Work Unit to Staff ratios clearly differ between GSH, TBH and RCH. In an effort not to favour GSH or TBH unfairly, uniform sets of ratios were derived for GSH and TBH. The uniform GSH/TBH ratios are in fact not entirely uniform due to lack of comparability of certain staff categories at these institutions (Professional - remainder, Auxiliary and Technical). These uniform ratios are approximate means of the GSH and TBH figures. These uniform ratios, together with the calculated ratios for RCH, are then considered to be those required to staff a Level III facility.

An entirely fresh set of ratios were then created for GSH/TBH and RCH which were considered appropriate for staffing a Level II facility. These ratios were not derived, but were simply chosenix such that higher Work Unit to Staff ratios were used for viii In the restructuring debate terms such as Level II or III, and secondary or tertiary have been widely used without any universally accepted agreement on their meaning. The terms have also been applied to beds, implying that particular beds be designated for the provision of particular levels of care. Where these are mixed in a given institution, this gives rise to the so-called "layered cake" concept. The following are just one set of definitions which have been abstracted from the South African Health Review 1996:

Acute hospital care is provided in three categories of institutions:

Level I patients require treatment which may adequately and appropriately be provided at a district hospital (the first level of referral) by a generalist with access to basic diagnostic and therapeutic facilities. Level II patients require the use of equipment and facilities found at a regional or secondary hospital (which represents the second level of referral) and the expertise and care associated with the general specialties. Level III patients require the expertise and care associated with the sub-specialties and less common specialties, or require access to scarce, expensive and specialised therapeutic and diagnostic equipment found only at a central or tertiary hospital (the third level ofreferral). ix This may be criticised as arbitrary, but little objective basis existed for determining these ratios, and the model accommodates their alteration.

15 MMed (Community Health) Part III University of Cape Town medical and technical staff while the ratios for nursing, administrative and general staff were largely left unchanged. Clearly these ratios can be altered within the model.

The model therefore essentially provides two sets of Work Units to Staff ratios, one for Level III care and the other for Level II care. The Level III ratios represent the status quo at GSH, TBH and RCH, while the Level II ratios are created to describe a lower level of care. These ratios are then used to predict required staff numbers depending on the desired size of the facility, and the desired percentage composition of Level III and Level II care.

3. The ratios are used to predict staff requirements

For any facility (GSH, TBH, RCH) the model allows the number of beds at Level II and/or Level III to be chosen and varied. In-patient days (work unit equivalents) can then be calculated as follows:

annual in-patient days = number of beds x 365 x % occupancy

The figure for occupancy can be varied within the model, although David Power used the 1993/94 provincial occupancy statistics36 for predictive purposes.

The model allows the number of annual out-patient visits simply to be chosen. However in practice David Power chose numbers of visits which generally varied in direct proportion to the number of chosen beds, using the 1993/94 provincial statistics as a reference to determine the relative relationship between bed numbers and out­ patient visits. The exception to this was at RCH where a large number of Level II out­ patient visits are assumed to fall away even if bed numbers are not reduced.x

Having chosen the number of out-patient visits, the number of equivalent work units can be calculated by applying the appropriate out-patient factors described in (1) above.

By adding the work units derived from out-patient visits to those derived from in­ patient days the total number of work units at Level II and/or Level III at the facility being modelled can be calculated.

The Work Units Model incorporates a sophistication which recognises that when a hospital bed is closed something less than its full operating cost may be saved, at least in the short term. The reason for this is that the resources which support the existence of that bed may not be reduced by a commensurate amount. The model employs "residual value" factors (30% for in-patient beds, 20% for out-patient visits) to account for this phenomenon. These factors (which may be varied within the model) lead to a refinement of the total work unit numbers referred to in the above paragraph.

The numbers of work units finally derived for Level II and/or Level III are then divided by the respective work unit to staff ratios to predict the numbers of workers required in each category to staff the facility being modelled.

x This is under the assumption that a disproportionately large amount of Level II out-patient work has been done at RCH, much of which should in the future be done at district or primary level.

16 MMed (Community Health) Part III University of Cape Town

4. Annual operating costs are predicted

Once staff requirements are predicted it is a relatively simple matter to project total operating costs.

The average basic annual salary (plus 40% for bonus, overtime etc.t for each staff category is multiplied by the number of staff required in that category. These figures are all aggregated to project a total staff cost for the scenario being modelled. The model then employs a technical correction factor at each of the three hospitals to adjust for the difference between projected and observed staff costs.

It is generally held and observed that approximately 70% of hospital operating costs are staff costs. The observed percentages at each of the three institutions (ranging from 66% to 71 %) were used to calculate the "on-cost" or non-salary expenditure. This is then added to the staff costs to project total annual operating expenditure.

Streni:ths of model

1. The model is simple and robust. The principle on which the model is based is logical and easy to understand. Different service options are easily and readily tested. 2. The model is based on reality. The development of ratios of input (staff) to output (work units) which attempt to describe the current situation at GSH, TBH and RCH as a base from which to make projections anchors the model in reality. This means that the financial implications of modelled scenarios are likely to be reasonably close to the mark if public sector academic hospitals continue to function within broadly the same organisational and policy environment as at present. 3. The model makes good use of available information. There is a dearth of useful information for planning and management purposes in the public health sector. An examination of published statistics36 shows that there is little useful additional output data beyond that which is incorporated in this model. With respect to input, the state Financial Management System (FMS) is notoriously poor at accounting at an operational level where and on what public sector health resources are being consumed. This deficiency was being addressed at GSH with the implementation of the Management Accounting Processxii (MAP), but no such systems existed at TBH or RCH. However it was possible to obtain data on total salary and total hospital expenditure from FMS, as well as average salary information from the state salary system (PERSAL). This latter information provided the input to the Work Units Model. It should be noted that David Power would have been unable to separate the GSH Region from its core without information provided by this xi This is the historically observed percentage by which the basic salary must be inflated to arrive at the actual salary costs. xii MAP was a project launched in 1994 to design and implement a cost accounting and budgeting system at GSH. The project team included management consultants from Ernst & Young and employees of GSH (including for a time this author). The aim of the project was to supplement what was perceived as inadequate FMS data with a system to provide useful accrual based cost data which could effectively be used for management and budgeting purposes. An important parallel aim was to develop a more business-minded approach and culture in the organisation, particularly among senior academics.

17 MMed (Community Health) Part III University of Cape To wn

author which was abstracted from MAP. This problem, of not being able to separate GSH expenditure from the expenditure of its region had been recognised by Kane-Berman many years before.39 The model does not favour GSH or TBH or their associated universities. The use of mean uniform ratios for GSH/TBH allows any combination of Level III and/or Level II care to be modelled at either institution in a fair and comparable fashion. This observation is borne out by the major conclusions of the APG Finance Sub-committee Costing Working Party Report, that the important financial implications arise from the size and mix of the Level II/Level III service to be offered, and not from the site at which these services are to be offered.40 This neutrality in the model is an important asset, in that it is more likely to be acceptable to representatives from both GSH/UCT and TBH/US. The position of RCH is complicated by the fact that it is the only children's hospital in the country, and the fact that it is impossible to separate the paediatric component at TBH from the main body of the hospital because of the absence of meaningful accounting information. For these reasons RCH is treated in a "stand alone" fashion within the model. 4. The model accounts for the residual value of service reductions. This facility recognises that the closure of a given percentage of an institution's beds does not normally result in a similar percentage saving in operating costs due to the persistence of support services. The model uses a linear function to reflect this phenomenon, however a logarithmic function might be more appropriate and could easily be incorporated.

Weaknesses of model

1. The most important weakness of this model is the way in which staff categories have been formulated. (Note: This categorisation was furnished by the Medical Superintendents of the 3 hospitals.) In this regard the following comments are offered: • Of the 11 categories no less than 5 are for medical staff comprising only about 8% of total staff. Four of the 11 categories are for specialists making up little more than 2% of the total staff complement at any given institution. In contrast all nurses are lumped into a single category despite the fact that they make up a massive 40% or more of total staff at any given hospital. No separate category is recognised for management. Complex and highly heterogeneous support staff are hidden within large amorphous categories such as General and Technical. An examination of the different types of posts at GSH and the categories they are put into within the Work Units Model (Appendix II) bears witness to these observations. • The potential consequence of this skewed categorisation of staff is that any attempt to use these staff categories for the purposes of planning may lead to erroneous predictions. Technologists, pharmacists, managers, engineers etc. all have highly specific skills which need to be represented differently within different levels of care. Attention needs to be given to this fact if this model is to be used for "layering" and/or down-sizing, as this has both financial and human resource implications. • The doctor-centred nature of this categorisation is likely to be perceived (rightly or wrongly) as politically incorrect which may lead unnecessarily to the rejection of the model.

18 MMed (Community Health) Part III University of Cape Town

• The staff categories provided by GSH and TBH are in some respects different which leads to a lack of comparability in some of the data. • A solution to the problems resulting from the formulation of these staff categories is offered below (under "Further Comments and Suggestions"). 2. The fact that this model is based on reality is in one sense a strength ( alluded to above), but in another sense it is a weakness. Public sector academic hospitals in South Africa are beset with problems. They lack leadership, vision and strategic direction. They are highly bureaucratic and operate within a tangled web of policies, procedures rules and regulations. Authority is dispersed, and responsibility and accountability are seldom enforced or accepted. Anachronistic hierarchical staffing structures persist. These institutions are (almost literally) crying out for transformation. They need to be freed from excessive regulation. Organisational structures need to be flattened, and authority and responsibility pushed downwards and outwards. The whole way in which people work, and the processes which are performed need to be re-evaluated in a dynamic and flexible way. By using the modus operandi of the past as a basis for predicting staff requirements in the future there is a danger of entrenching out-moded organisational functions and structures. Conversely, if organisational transformation can be successfully effected, "real" work unit to staff ratios will rise significantly. 3. Level II staffing ratios are subjectively defined. 4. That which is assumed to be Level III care is in fact a mixture of Level III and Level II care. 5. The input and output measures in this model are not matched in terms of timing. Activity data is from 1993/94. Total expenditure and salary expenditure are estimates based on the 1994/95 financial year. The data on filled posts and average salaries is from early to mid-1995. This situation was to some extent a necessary consequence of the unavailability of information. However it is important to bear in mind that work that was done in a given year, is being measured against resources that were deployed a year, or even 2 years later. 6. No attempt is made to measure quality in this model. This may seem an unfair criticism as there are no readily available measures of quality in the academic hospitals. However it is important to realise that the numbers of in-patient days and numbers of out-patient visits say nothing about the quality of services being rendered. 7. No objective evidence (apart from a reference to a study on the costs of the general 37 out-patient department at RCH ) is furnished to support the numbers used as "out­ patient factors" to calculate work units from out-patient visits. It has since become possible using MAP data at GSH to meaningfully compare the resources required to fund an in-patient day and an out-patient visit, both globally and for every department. It is recommended that such an exercise be carried out in order to derive more valid "out-patient factors". 8. It is not clear that the volume and nature of out-patient visits will vary in a simple way with the size of the institution. However to the extent that such variations can be predicted, this can be built into the model. 9. The correction factors used to adjust projected salary costs are problematic. These correction factors are derived from the observed difference between actual salary costs (from FMS) and salary costs predicted by the model. In each scenario modelled, predicted salary costs are adjusted by the appropriate correction factor. Problems with these correction factors are:

19 MMed (Community Health) Part III University of Cape To wn

• There are individuals employed on the establishment of all 3 hospitals who spend some or all of their time working outside their respective institutions. Thus FMS will tend to overstate the true salary costs of running the institutions themselves. • The correction factors are sufficiently large (ranging from -7.5% to 10%) to make significant differences in predicted salary expenditure. Possible reasons for this include differences between theoretical and actual salary category means, and variations in the true "add on" costs which are estimated at 40%. At GSH actual individual month-on-month salary costs were captured through a PERSAL-MAP computer interface. Examination of this database would facilitate the solution of both these problems at GSH. A more laborious solution would be to sample actual individual salary data at all institutions. The problem of inaccurate category means can be addressed by the solution to salary category formulation alluded to in (1) above and discussed under "Further Comments and Suggestions" below. 10.The manner in which "on-cost" or non-salary costs are predicted. The model employs the observed relationship between salary and non-salary costs (from FMS) at each institution to predict non-salary costs in each modelled scenario. However the observed variation in the relationships between salary and non-salary costs at the three institutions is surely a consequence mainly of how well staffed one hospital is compared to another. It is no surprise that GSH (well known to have been better staffed than TBH) salary costs comprise 71 % of total operating costs compared with 67% at TBH. The aim is to model scenarios in which appropriate levels of human resources are matched with appropriate levels of other resources. It would therefore be better to use a standard "on-cost" (say 30% of total) or a mean of the "on-cost" at all 3 hospitals.

Further comments and su~~estions

The Work Units Model has been examined and criticised in some detail. However it must be pointed out that it was developed under pressure of time with a paucity of information in order to look at the "big picture". In this context it has been successful. Nevertheless it is possible that this model (and others) will be used in the future for more detailed scenario planning, as well as for monitoring and evaluating change as this takes place. In this event the criticisms offered above may prove useful.

In particular the way in which staff categories have been formulated within this model has been criticised. A solution to the problems associated with this formulation is now offered. Not only are suggestions made in this regard, but concrete steps have been taken to put this solution into effect.

Staff and staff categories {and other useful information)

It is possible to obtain print-outs from the PERSAL system for any given institution which show the description of each type of post, together with the number of individuals currently filling each type of post. Each type of post ( or "postclass" as it is called) is identified by a number and by a description. Print-outs were obtained for the following institutions:

1. GSH 2. TBH 3. Frere Hospital

20 MMed (Community Health) Part III University of Cape Town

4. Livingstone Hospital 5. RCH 6. Conradie/Jooste Hospitals 7. Somerset Hospital 8. Southern Peninsula Hospitals Group (SPHG) - this includes Victoria Hospital 9. Paarl Hospital 1O.Eben Donges Hospital 11.George Hospital

An examination of these print-outs shows that there were approximately 150 different postclasses filled by varying numbers of individuals at these hospitals. Using information from these print-outs, together with data from the 1993/94 provincial 36 statistics , a database has been manually constructed (Appendix III). For each institution the following information is given:

From the 1993/4 provincial statistics: 1. Actual beds 2. In-patient days 3. Length of stay 4. Occupancy 5. Head counts 6. Visits 7. Emergencies 8. Home visits

Derived ratios: 1. Visits/head counts - a measure of the mean number of out-patient visits per person per year 2. Emergencies/visits - an indication of the proportion of visits considered to be emergencies 3. Staff/bed - a measure of staffing levels 4. Work Units - a measure of work output calculated in the same way as in the Work Units Model except that an out-patient factor of 15 is used for all out-patient visits and a home visit factor of 5 is used at those institutions which undertake home visits. (These factors are easily changed).

From PERSAL: The postclass description and number of every type of filled post together with the number of individuals in each postclass (on the date shown).

Calculated measures: 1. The percentage of individuals in each postclass ( as a percentage of the total number of individuals employed at each hospital) 2. Work units/person - this measure is calculated for every different postclass by dividing the 1993/94 work units for that institution by the number of filled posts within each postclass. It is this measure which allows the problems related to the formulation of staff categories within the Work Units Model to be avoided. The measure allows every postclass to be treated as a separate staff category for the purposes of calculating work unit to staff ratios. Using these building blocks different postclasses may be aggregated into categories in different ways and to

21 MMed (Community Health) Part III University of Cape Town

varying degrees (or not at all) inasmuch as this is useful for particular modelling, planning or evaluation purposes (see below).

Category formulation: The addition of one or more "category" fields to the database allows the data to be sorted and aggregated in different ways. As an example the different postclasses have been categorised as follows:

1. Administration (ADM) 2. General (GEN) 3. Management (MAN) 4. Medical Officers (MOF) 5. Nursing Assistants (NAS) 6. Nurse Managers (NMA) 7. Professional Nurses (NPR) 8. Staff Nurses (NST) 9. Professions allied to Medicine (PAM) 1a.Pharmacists (PHA) 11.Registrars (REG) 12.Specialists (SPE) 13.Support Staff (SUP) 14.Technical Staff (TEC)

It is submitted that this categorisation is more rational, appropriate and accurate than the one used in the Work Units Model given the purpose for which the model was developed. However it is only an example, and different categories may be developed for different purposes. By collapsing the database into the above categories, the information contained within the database can be summarised (Appendix IV).

This database was constructed as a pilot project. It is hoped that the information contained in the database is of a nature that would assist policy makers, planners and managers in the health services. However the database had to be manually created and clearly the information relating to the number of filled posts will change with the passage of time. Computerised Information Systems (CIS) at the Provincial Administration of the Western Cape was therefore approached with a view to obtaining certain data as a computer download. After relevant discussions permission was obtained to write a programme within "MAGIC" which would access data from PERSAL in order to make this possible. (MAGIC is a computer application which is used to extract and manipulate information from databases.) A programme has therefore been writtenxiii which for any given institution(s) can generate a file containing the following information: 1. Each postclass number and description 2. The number of filled posts within each postclass 3. The average salary of each postclass Data within the file will be delimited so that it can be readily imported into any computer spreadsheet programme. It is hoped that information in this form will be xiii The programme was written by Mr. George Smit (Tel: Cape Town 483 3507) whose help is gratefully acknowledged and from whom further information may be obtained.

22 MMed (Community Health) Part III University of Cape Town useful to planners and managers. It could be combined with other information (such as provincial health activity statistics), and changes or additions can always be made to the programme in the future. It should be stressed that data can be obtained for any public sector facility, so that it has potential to be used for Level I hospitals, clinics and even non-health care public sector entities.

THE OPTIMAL BED BASED (OBB) MODEL

Introduction

This model was originally designed by Dr. Ann Brand, then Senior Medical Superintendent at GSH. It was also presented and discussed within the work-group of the Financial Sub-committee, Academic Priorities Group (APG) and forms part of the report of this group. 41 The model was also incorporated into the University of Cape Town Response to the Draft Provincial Health Plan.42

Model input

The following information provides input to the model:

• The mean salary (plus 40% for "add-ons") for each of the following staff categories: Chief Specialist Principal Specialist Specialist Registrar Medical Officer/Intern Professional Nurse StaffNurse Nurse Auxiliaries Paramedical Staff Technical Staff • The proposed number of beds at Level II and/or Level III • Proposed or ideal ratio of beds to staff for each of the above categories • Adjustment factors for "support" and equipment • Assumptions and factors related to activity or output

Model construction

1. The proposed numbers of staff in each of the above categories at Level II and Level III is calculated

This is a simple calculation based on the number of proposed beds at each level and the ideal ratios for each of the staff categories. The model is constructed such that total numbers of specialists and nurses are represented in the following proportions.

23 MMed (Community Health) Part III University of Cape Town

Table II: Allocation of specialists

Level 3 Level 2 Chief Specialist 5% 5% Principal Specialist 20% 20% Specialist 75% 75%

Table Ill: Allocation of nurses

Level 3 Level2 Professional Nurse 48% 43% Staff Nurse 27% 18% Nurse Auxiliary 25% 39%

2. Total salary costs for staff in the above categories are calculated

This is once again a simple calculation - the product of mean salary costs and the numbers of staff in each category. These amounts are then all aggregated.

3. A 30% "on-cost" is added

As discussed in the section on the Work Units Model, it is generally observed that salary costs comprise approximately 70% of total costs, so the rationale employed is to add on non-salary costs such that this relationship is satisfied. The correct formula to obtain total costs given salary costs is:

[(30/70) x salary costs]+ salary costs

Unfortunately the formula used in this model to obtain total costs is:

salary costs x 1.3

This latter formula, which is wrong, underestimates total costs by 9% (70 x 1.3 = 91 %) and implies that salary costs comprise 76.9% of total costs (70/91 = 0.769).

Although this error is easily corrected within the model, it is important it be recognised.

4. Support and equipment costs are added to give total costs

Thus far the model has calculated salary costs for the staff within the categories shown above, and added an "on-cost" for non-salary expenditure. However inspection of these staff categories reveals that "support" costs (both salary and non-salary) have not been taken into account. To allow for this further amounts are added for "support". The actual figures used are derived from examination of MAP data and the Financial Analysis performed by MAP/Ernst & Young in November 1994.43 The model allows these amounts to be adjusted.

Equipment costs are factored into the model as an additional 5% of total costs.

24 MMed (Community Health) Part III University of Cape To wn

The addition of support and equipment costs gives total projected costs for the "new" GSHand TBH.

5. Expected work outputs are calculated given predicted staff numbers and certain assumptions

Given assumptions with respect to occupancy and length of stay, (which may be varied), numbers of in-patients and in-patient days can be calculated.

Based on work done by Dr. D Smith (Medical Superintendent, GSH) in the early 1970s, factors are introduced which relate numbers of out-patient visits and operations (major and minor) to numbers and grades of medical staff. Using these factors the model predicts levels of activity given the modelled staffing levels.

Comments

The OBB Model is similar to the Work Units Model inasmuch as ratios are developed (beds to staff rather than work units to staff) which are used to predict staff requirements and then costs. It is simple and the different ratios and factors within the model are easily varied. However the OBB Model differs from the Work Units Model in one important respect. Whereas the Work Units Model is based on reality, the OBB model is based on proposed, or "optimal", bed to staff ratios. Using only information supplied within the OBB Model the following table has been compiled which shows GSH actual, and proposed Level III/Level II bed to staff ratios.

Table IV: Number of beds per staff member

Staff Cateeory GSH Actual Proposed L3 Proposed L2 Chief Specialist 770 140 400 Principal Specialist 39 35 100 Specialist 7.70 9.33 27 Registrar 4.89 5 10 Medical Officer/Intern 8.66 10 20 Professional Nurse 1.055 1.167 1.860 StaffNurse 2.723 2.074 4.444 Nurse Auxiliary 1.196 2.240 2.051 Paramedic 5.1 4.5 8 Technical 4.04 4 5.5

Since GSH is reckoned to be some mix of Level III and Level II care one might expect actual GSH bed to staff ratios to fall somewhere between those proposed for Level III and those proposed for Level II. However inspection of Table IV reveals that this is not always so. Specialists, Registrars, Medical Officers/Interns, Professional Nurses and Nurse Auxiliaries will all be expected to service more beds at both Level III and at Level II than is currently the case at GSH. It is therefore evident that significant changes are being proposed in staffing levels - mostly to spread resources more thinly. At the same time the creation of a largely tertiary service at GSH is being suggested. While it may be highly desirable that work processes and

25 MMed (Community Health) Part III University of Cape Town functions be radically revised in order to produce more effective and efficient hospital work-forces, this cannot simply be wished into existence. Until it can be shown how such changes can be successfully implemented given the current framework of the public health service, the proposals of the OBB Model may not be realistic.

To some degree the criticisms directed at the way in which staff categories were formulated within the Work Units Model apply also to the OBB Model. However the OBB Model is slightly less doctor-centred, breaks nursing staff into 3 categories and recognises Paramedics (Professions Allied to Medicine) as a separate staff category. Unfortunately management is not recognised as a staff category. General and support staff are not factored into the model proper, and the costs associated with them are added on afterwards. It is possible that this makes the estimation of these costs less reliable, particularly when other variables in the model are changed.

The error in the formula used to calculate "on-cost" is easily corrected. However it results in a sizeable underestimation of costs, and it is disturbing that two 41 2 documents ,4 containing these underestimates were tabled at a high level without the error being discovered.

This model explicitly tests the option contained within Chapter 13 of the DPHP33 to convert GSH into primarily a Level III hospital, and TBH into an exclusively Level II hospital. Moreover it has been included with UCT's response to the DPHP, which is supportive of this option. The OBB Model may therefore be construed as being supportive of this option. However it could just as easily have been used to model the reverse scenario (TBH mostly Level III, GSH all Level II). The real question is whether this model is realistic in its predictions, rather than at which hospitals those predictions are modelled.

One advantage of this model is that it makes provision for certain staff ratios which need to be maintained for training purposes - for example the Interim National Medical and Dental Council requires that the Registrar to Specialist ratio does not exceed 2.

Another positive aspect of this model is that it incorporates some additional measures of output based on the work of Dr. D Smith. Clearly in-patient days and out-patient visits on their own are a very crude measure of output. Further work in this area would be welcome.

Finally it should be remembered that this model (like the Work Units Model) was prepared in difficult circumstances in a short period of time.

THE ACP-IC (UCT) SUBMISSION

Introduction

Annexure C of the UCT response42 to the DPHP contains an estimate of the cost of tertiary care at GSH and TBH. This work emanated from the Academic Complex

26 MMed (Community Health) Part III University of Cape Town

Planning-Information Committee (ACP-IC) and was largely prepared by Professor Steve Louw. A copy of this estimate is appended (Appendix V).

This author was initially approached by the ACP-IC (UCT) group for suggestions as how to find a way of costing levels of care at GSH in a short space of time. The following simple approach was suggested:

1. Estimate the approximate proportions of Level III and Level II care in all clinical departments. 2. Find some way of allocating GSH costs using these proportions.

It was suggested that some form of standardised method be adopted to estimate proportions of different levels of care. Given the time constraints a suggested mechanism was to form some sort of "consensus group" containing representatives from major clinical areas, management, nursing etc., who could together agree on the figures. The rationale for this approach was that all clinical departments are cost centres represented within the MAP system. It was therefore possible to obtain the operational costs of these clinical departments. Using the cost accounting expertise within the MAP office it would then have been possible to meaningfully allocate these costs, together with all other hospital costs, in order to come up with estimates of Level III and Level II care, both within these departments, and in aggregate at GSH.

Perhaps unfortunately, these suggestions were only partially followed by the ACP-IC (UCT) group.

Discussion of the ACP-IC (UCT) submission

Sources of data

GSH cost centre data was obtained from the Management Accounting Process (MAP).xiv

TBH cost centre data is described as being obtained from Chapter 9 of the DPHP.33 Although this data is reproduced in the DPHP, the actual source of the data is the Financial Analysis of the Academic Hospitals43 which was tabled as a supplementary report to the main report44 prepared by the Academic Priority Group Task Force and presented to Minister E Rasool by Professor Kay de Villiers at Mon Villa in November 1994. It is therefore misleading to refer to "DPHP Cost Centres" as is done throughout this submission. Moreover the Financial Analysis referred to above was carried out over a very short period of time, and as noted in the report, the information "should only be used as a tool in determining areas for further investigation" and "no decisions be made to alter existing structures within the Academic Hospitals without further detailed investigation". This is particularly true for the TBH data; no system such as MAP existed within TBH and it was necessary to make some broad assumptions and adjustments in order to assimilate TBH cost data into cost centres. Unfortunately the cautions referred to in the report were not acknowledged.

xiv MAP is not the "Ernst and Young Management Accounting Procedure" as described in this submission, but a joint project between GSH and Ernst & Young.

27 MMed (Community Health) Part III University of Cape Town

Methods of determining percentages of tertiary care

It is stated that "each cost centre was individually considered in consultation with Heads of Divisions and hospital administration at GSH. A proportion of each cost centre's budget was apportioned as "tertiary" or "secondary"." However it is not clear how this process was carried out, nor is it clear if the process was consistent from one cost centre to another.

For TBH the "proportion of expenditure on tertiary work performed at TBH was adjusted relative to the estimates for GSH, taking into consideration factors such as number of specialists per Division; number of patients admitted, number of out­ patients, operations or deliveries". Once again it is not made clear precisely how these factors were taken into consideration.

Different methods have been employed to determine the percentages of tertiary care at GSH and TBH. Quite apart from the validity of the methods used, this inconsistency in the way in which the percentages are derived renders the figures incomparable. These figures are:

Table V: Deemed % of tertiary care at TBH, as a % of tertiary care at GSH

Deemed % of that done at GSH Medicine 50% Surgery 60% Obstetrics, Gynaecology, Neonatology 60% Radiotherapy 100% Anaesthetics 60% Radiology 70% Laboratory 70% Nursing 70% Professions Allied to Medicine 70%

While most objective observers would probably agree that the percentage of tertiary care at GSH exceeds that of TBH, the relative percentages shown above are most unlikely to find acceptance with representatives from TBH or the University of Stellenbosch Medical School.

Application of percentages to derive the cost of the tertiary component

An estimation is made of the tertiary component of the services provided by various cost centres. If this estimate was for example 50%, then 50% was applied to the cost of the cost centre to derive the cost of the tertiary component. This assumption however ignores the fact that the tertiary component will cost more than the secondary component. Consequently a percentage of greater than 50% in the example above should be used to derive a more accurate reflection of the tertiary component cost.

28 MMed (Community Health) Part III University of Cape Town

Exclusion of costs

This submission estimates the total cost of tertiary care at GSH and TBH to be approximately R280 million. However no financial provision is made for the management and support of these services. Since GSH and TBH together spent approximately R920 million in 1994/95, R640 million is unaccounted for in this analysis. It is simply not apparent from this submission how a single and integrated tertiary service at GSH will be financed given the requirement to reduce overall expenditure and still provide an acceptable level of secondary care.

Concludint: remarks

Given the observations above, the conclusion of the ACP-IC (UCT) group that "based on the findings of this investigation, it appears financially feasible to merge the current TBH and GSH tertiary services and accommodate these in GSH" is unsustainable. That is not to say that it is not financially feasible to amalgamate all tertiary services at GSH. It may be. But this cannot be concluded from the ACP-IC (UCT) submission.

Notwithstanding the m1sg1vmgs expressed above with regard to the deemed percentages of tertiary care, these percentages have been used in the following section to estimate "the cost per bed" at GSH. In doing so spreadsheets have been developed which explicitly take account of the costs excluded from the ACP-IC (UCT) submission. A further spreadsheet has been prepared which does the same thing for TBH (Appendix I, Table 6).

ESTIMATION OF THE COST OF TERTIARY AND SECONDARY LEVEL BEDS

Introduction

These costing estimates were prepared in the MAP office. They are the work of this author and of Mr. Mike Kane of Ernst & Young. The estimates were included with the UCT response42 to the DPHP, although without the authors' permission.

As part of the costing exercise being conducted for the academic hospitals an exercise was carried out to determine an estimate for the cost of a tertiary and a secondary bed. The accuracy of such an estimate was constrained by the availability of meaningful cost and patient data. Cost estimates were therefore calculated but these estimates should be interpreted in the light of the assumptions and constraints noted below. These estimates should be compared with other cost data which have been prepared for the academic hospitals.

Sources of data

The following sources of data were used:

29 MMed (Community Health) Part III University of Cape Town

• Cost centre costs, support costs and global costs as provided by the MAP system atGSH

• An exercise based on 1993 GSH patients which divides patients into tertiary and non-tertiary cases and calculates the relevant proportion of costs incurred by the two types of case. This exercise was conducted by Dr. Isaacs (Biometrician, GSH) and was based on the use of co-morbidity analysis and diagnosis related groups to arrive at weighted costs

• A preliminary analysis of Tygerberg Hospital cost centre costs conducted for the SMT43

• Estimates of the tertiary and non tertiary components of each cost centre as estimated by the ACP-IC (UCT) group.

Calculation of cost estimates

These calculations start at a simple level and then go through a number of revisions or iterations to try and refine the cost estimates by introducing additional variables and information.

Please note that all Tables referred to in this section are to be found in Appendix I.

First estimate

Cost estimates can be derived by taking the projected 1994/95 expenditure for GSH, adjusting this figure to take account of certain assumptionsxv (such as not funding the Midwife Obstetric Units - MOUs) and then comparing this with the number of beds. Table 1 reflects the data used for this exercise.

GSH: (from Tablel, Appendix I) R 'OOOs

Expected 1994/95 expenditure 500 000 Deduct services not to be funded by GSH 52 000 (e.g. MOU's, General out-patient department) Deduct support and global costs attributable to removal of services 12 000 (52 000/500 000 X 120 000) Total 436 000

Number of beds 1438

Cost per bed 303

xv The assumptions all relate to the removal of those services which would not be offered in a tertiary hospital.

30 MMed (Community Health) Part III University of Cape Town

This cost of R303 000 per bed obviously represents a mixture of level III and level II beds.

A similar exercise can be conducted for Tygerberg (TBH).

TBH: (from Table 6, Appendix I) R 'OOOs

Expected 1994/95 expenditure 420 080 Deduct services not to be funded by TBH 24 757 (e.g. Community Health, Paediatricstvi Deduct support and global costs attributable to removal of services 8 198

Total 387 125

Number of beds 1 815

Cost per bed 213

This cost per bed obviously represents a mixture of level III and level II beds.

Second estimate

A number of GSH cost centres are deemed to be 100% tertiary. These are Cardiac Clinic, Cardiothoracic Surgery, Liver Clinic, Neurology and Neonatology. The direct cost of each cost centre has been taken from the MAP accounts and a support cost and global cost has been added based on the number of beds. The source of this information is reflected in Table 1. (All figures are in thousands of rand):

Table VI: Tertiary bed cost: second estimate

Cost centre Direct cost Support Global Total cost No of beds Cardiac Clinic 10 770 2 630 403 13 803 29 Cardiothoracic 16 766 5 351 820 22 937 59 Liver Clinic 2 558 362 56 2 976 4 Neurology 2 616 2 177 333 5 126 24 Neonatology 5 322 6 530 1001 12 853 72 Total 57 695 188 Average 306/bed

This cost ofR306 000 per bed should probably be inflated by a small amount as there are certain tertiary cost centres which do not have beds as such, and to obtain a realistic overall cost per bed for a tertiary institution the cost of these cost centres should be allocated to beds. Examples of such cost centres are Radiology, Clinical Immunology and Medical Physics. The cost of these cost centres are not significant

xvi The same rationale applies as in the note above. In addition the paediatric service is assumed to be relocated elsewhere.

31 MMed (Community Health) Part Ill University of Cape Town when compared to most other cost centres and as a rough estimate another 10% could be added to the average ofR306 000 per bed to arrive at a cost ofR336 000 per bed.

Third estimate

The above estimate only looks at pure tertiary cost centres. An exercise was conducted to estimate the tertiary cost of all cost centres at GSH. Table 2 reflects the results of this exercise. The cost 1994/95 column reflects the adjusted MAP cost for the particular cost centre. The % tertiary column represents the existing tertiary component of each cost centres services as derived by the ACP-IC (UCT) group.

There is not necessarily a direct relationship between the percentage tertiary component and the percentage cost of each cost centre. The tertiary component presumably consumes more cost than the secondary component. This is borne out by an evaluation of 1993 GSH cases by Dr. S Isaacs (Biometrician, GSH) as depicted in Table 3. This shows the tertiary and non-tertiary cases for various cost centres and calculates the relevant proportion of costs incurred by the two types of case. Using this information as a base, rough adjustments have been made to the tertiary percentage as derived by ACP-IC (UCT) to arrive at the "Adjusted %" column in Table 2. Based on these percentages a tertiary cost was calculated for the whole hospital. As per Table 2 the total cost comes to R223 718 000.

The number of tertiary beds was derived by taking the total number of beds for each cost centre and applying the ACP-IC (UCT) tertiary component percentage to the total number of beds for that cost centre. It could be argued this method is not a correct basis for allocating beds but in the absence of other information it has been used and is unlikely to be significantly wrong.

The tertiary component cost of R223 718 000 should be increased to account for support and global costs. The basis for allocating these costs in this estimate is the number of tertiary beds.

R 'OOOs

Tertiary component cost (from Table 2, Appendix I) 223 718 Add support costs (815/1438 x 120 991) 68 573 Add global costs ( 815/1438 x 37 521) 21 265

Total 313 556

Number of beds 815

Cost per bed 385

This cost per bed of R385 000 should be compared with the R336 000 calculated in the second estimate above. The approximate mid-point of this range is R360 000 per bed.

32 MMed (Community Health) Part III University of Cape Town

A similar exercise can be conducted for the cost of a secondary level bed. With the same information used above the secondary level cost and the secondary level beds can be estimated. Table 4 reflects this information. R 'OOOs

Secondary component cost (from Table 4, Appendix I) 65 347 Add support costs (623/1438 x 120991) 52 418 Add global costs (623/1438 x 37 521) 16 256

Total 134 021

Number of beds 623

Cost per bed 215

The cost per secondary bed ofR215 000 at GSH compares with the TBH cost ofR213 000 per bed overall.

Fourth estimate

The estimates derived above assume a division of cost centres (or departments) into those which are deemed to deliver a service (at secondary and/or tertiary level), and those which are deemed to support these services (so-called support cost centres). The actual division used in the above estimates, ( as well as the percentage secondary/tertiary split), are those arrived at by the ACP-IC (UCT) group. This can be ascertained from inspection of Table 4. However, they are not necessarily correct. In particular, laboratory and imaging departments are considered to provide a direct service. It may be more correct to treat such departments as supporting the clinical service delivered by the true "coal face" clinical departments.

Accordingly, a revised division of cost centres into service departments and support departments is suggested. This may be ascertained by inspection of Table 5. The original percentage secondary/tertiary splits suggested by ACP-IC (UCT) have been left unchanged where these are applicable.

The overall effect of this approach is to increase total support costs, and to decrease secondary/tertiary service costs. This can be seen by comparing the totals in Table 4 with those in Table 5. The revised figures in Table 5 are then used to arrive at bed costs in exactly the same way as in Estimate 3 above.

Cost per tertiary bed

R ' OOOs

Tertiary component cost (from Table 5, Appendix I) 163 103 Add support costs (815/1438 x 195 608) 110 863 Add global costs (815/1438 x 37 521) 21 266

Total 295 232

33 MMed (Community Health) Part III University of Cape Town

Number of beds 815

Cost per bed 362

Cost per secondary bed

R 'OOOs

Secondary component cost (from Table 5, Appendix I) 51 344 Add support costs (623/1438 x 195 608) 84 746 Add global costs (623/1438 x 37 521) 16 256

Total 152 346

Number of beds 623

Cost per bed 245

Fifth estimate

Estimate 4 allocates support costs between secondary and tertiary beds under the assumption that every bed, whether secondary or tertiary, pulls with it the same quantum of support costs. This assumption, however, is unlikely to be justified. Although certain support costs ( e.g. cleaning) will vary little between a tertiary and secondary bed, many other more important support costs ( such as laboratory services, imaging etc.) will be significantly higher for a typical tertiary bed than for a typical secondary bed. For this reason it is suggested that support costs be allocated to secondary/tertiary beds on the basis of proportionate secondary/tertiary expenditure, rather than on the basis of proportionate secondary/tertiary beds.

Cost per tertiary bed

R 'OOOs

Tertiary component cost (from Table 5, Appendix I) 163 103 Add support costs (163 103/214 447 x 195 608) 148 775 Add global costs (815/1438 x 37 521) 21266

Total 333 144

Number of beds 815

Cost per bed 409

Cost per secondary bed

R 'OOOs

Secondary component cost (from Table 5, Appendix I) 51 344 Add support costs (51 344/214 447 x 195 608) 46 833

34 MMed (Community Health) Part III University of Cape To wn

Add global costs (623/1438 x 37 521) 16 256

Total 114 433

Number of beds 623

Cost per bed 184

Summary and conclusion

The results of all estimates are summarised in the tables below.

Table VII: GSH and TBH - Cost per Bed {R 'OOOs)

GSH overall TBH overall Estimate 1 303 213

Table VIII: GSH - Cost per Bed {R 'OOOs)

Tertiary Bed Secondary Bed Estimate 2 336 Estimate 3 385 215 Estimate 4 362 245 Estimate 5 409 184

This investigation was carried out over a short space of time. The estimates were built on a number of assumptions that need to be tested further. The cost data itself also had constraints the limits of which could only be tested once the full MAP data became available. The estimates therefore should be assessed after taking account of the above constraints. A cost of R370 000 per bed represents the mid-range of the estimates for the cost of a tertiary level bed determined above. An approximation of R215 000 as a secondary bed cost can be made from the limited estimates carried out above.

MODELS: GENERAL REMARKS

Each model has been discussed in detail above. This section deals with certain general considerations.

There is a temptation to assume that "rational decision making models" must of necessity be objective. However, they may obscure or excuse value judgements ( either innocently or deliberately), and should therefore be used and interpreted with caution.45

All the models dealt with above have strengths and weaknesses to differing degrees and in different ways. This suggests that no one model should be used to the exclusion of the others. A combination of approaches, together with a willingness to develop

35 MMed (Community Health) Part III University of Cape Town these models further, or even to introduce completely new approaches is likely to be most useful for the purposes of planning and implementation.

To date the planning for restructuring health services in the Western Cape has mostly been at a high level. Before extensive implementation of change can take place planning should occur on a much more detailed level. The models described above, or developments thereof, can be valuable tools in this process.

All the models in one way or another relate input (staff, money) to output (work units, beds). Data from the state salary system, PERSAL, can provide reasonable information with respect to staff inputs. However FMS financial data is generally poor in determining where and on what resources are being consumed. Systems such as MAP need to be urgently developed in public sector academic hospitals in order to provide more meaningful information on the deployment of resources. Leyenaar, original7 the Ernst & Young Project Director for MAP, in a recent article in the SAMJ, 4 outlines a generic approach based on the GSH MAP system, in which he stresses the need for good quality, appropriate and timeous management information 36 in hospitals. Information on measures of output (provincial statistics ) is crude and includes no measures of quality. Dyer,47 (writing about PHC programmes) has pointed out that although one might ideally wish to measure health status or outcome, it is generally more practical to focus on activities or processes. There is much information of this nature which could be collected in public sector hospitals. It is generally recognised that public health information systems need to be drastically improved, and it is encouraging that the Department of Health has embarked on a plan 48 for a National Health Information System for South Africa (NHIS/SA).

Whether information systems are good or bad, health service managers are increasingly faced with huge volumes of data which they are expected to assimilate and respond to. It is therefore essential that they find ways of identifying and deriving a manageable and limited set of information which can be used to make necessary decisions. Furthermore it is vital that the choice of such a set of information, or 49 "performance indicators", be informed by valid strategic goals and objectives. This is particularly true in the academic health services because of the scale and pace of change.

In planning for such change it is useful to think in terms of inputs, processes and outputs or outcomes,39 as alluded to above. Clearly the approach should be determined by individual circumstances, but there are examples in the literature of 50 51 restructuring strategies which can assist the process. •

DISCUSSION

POLICY

There are clearly a range of issues, many unresolved, which have the potential to influence the nature of academic health services in South Africa as we approach the new millennium. The country is surprisingly politically stable, given the stormy

36 MMed (Community Health) Part III University of Cape Town nature of our recent history, and has enjoyed real, if moderate, per capita economic growth since 1993. However, health care restructuring could fail miserably if the economy falters. 16 There is no national consensus on economic policy, or on how to translate economic policies into meaningful delivery of health and social services. The demise of communism has encouraged a widespread belief in much of the world that liberal democracy and free markets constitute the "best way of organising human societies", as epitomised by Fukuyama's writings on "the end of history". 52 The Congress of South African Trade Unions (COSATU) would not support this view, and have publicly differed with the government over its orthodox economic policy, GEAR (growth, employment and redistribution). Bond, Pillay and Sanders, 8 in a scathing attack on GEAR, refer to Trevor Manuel as "a black ANC leader and former community activist who once characterised himself as a socialist". They describe GEAR as a deeply flawed macroeconomic strategy, and refer to an "ever-deepening commitment to neoliberal economic philosophy" doing "serious, even irreparable harm to this country's political transformation".

While the greater economic fortunes of the country will undoubtedly impact on health services, there is also an unresolved debate regarding the distribution of existing health care resources. The inequitable distribution of these resources has been 9 53 well documented, particularly with respect to hospitals, hospital beds and clinics. ' Any consideration of this issue must take account of the private sector. As has already been pointed out, this sector consumes some 60% of health care resources in the provision of care to only 20% of the population. 17 Perhaps the ideal (some may say idealistic) solution to this problem would be the assimilation of all health facilities 54 55 and providers into a single national health service, and this has been advocated. , For those who believe that access to health services is a basic human right, and that the available resources should be fairly shared among all, the creation of a unitary health service makes good sense. Certainly this approach has the potential to ease the mounting pressures facing the public health sector, including of course the academic health services.

The creation of a national health service was doubtless easier in the heady days of Nye Bevan immediately after the second world war, when socialism was young and in the ascendant. To some extent the Gluckman Commission56 needs to be viewed in this historical context. It may now be impractical, and even undesirable to draw the private health sector wholly within a unitary service. Broomberg has previously argued for a national policy on private hospitals 10 in order to maximise their contribution to the health sector as a whole, and going further, has suggested the partial integration of private hospitals into the public health service through a "centrally financed system".57 These articles were published before the ANC came to power. Since then he co-chaired the "Committee of Inquiry into a National Health Insurance System", 58 the findings of which were controversial, and the recommendations have not yet been implemented. However a discussion document proposing revisions to the Medical Schemes Act has been released by the Department of Health, in which the issue of national health insurance in the provision of an essential minimum hospital package is revisited, and may be incorporated into legislation later this year. This document has attracted a lot of attention in the press, not all of it balanced, but Soderlund and van den Reever have provided a welcome review of the issues in a recent editorial in the SAMJ. 59 As was pointed out earlier, the Department of Finance has until now been seemingly unwilling to contemplate

37 MMed (Community Health) Part III University of Cape Town dedicated health care financing mechanisms outside of general tax revenue, which has 14 60 caused extreme concern among those who have advocated such mechanisms. · However, many economists dislike dedicated financing mechanisms for two reasons. Firstly, it means that the government relinquishes, to a degree, the control it normally exercises over state revenue and expenditure, which is the primary fiscal tool available for managing the economy. Secondly they create precedents for other interests (such as education), to also pursue earmarked revenue sources. Trevor Manuel has been reported in the press as having "not yet taken a position" on this issue; it will be interesting to watch developments.

RESOURCE ALLOCATION

The pursuit of equity in health care has not just involved an attempt to bring private sector resources into the public domain, but has taken place within the public sector itself. Provincial resource allocation is being guided primarily by population driven 15 indices. This issue has caused much debate in South Africa but is not new internationally. The Resource Allocation Working Party (RAWP) model developed in England, and its equivalents in Scotland and Wales, were used to allocate health care resources in the United Kingdom. This provoked a prolonged debate in the British medical literature, beginning in the late 1970s and persisting throughout the 1980s. The majority of the published articles were critical of RAWP, particularly with respect to the measurement of need. Between 1989 and 1991 a series of four papers emerged from the Department of Community Health, UCT, examining the British experience and advocating the adoption of a similar resource allocation mechanism in South Africa.61 ,62,63,64

Not all commentators support the principles embodied in population based resource 65 allocation formulae. Grant has argued that this approach confuses egalitarianism with humanitarianism, and does not necessarily help the poor. Forder has expressed the concern that this type of approach may conceal political motives: "in addressing the so-called lop-sided funding, it is vital that the good in the "old" health structures be preserved and not destroyed because of possible political agendas which stipulate that there can be nothing worthwhile in the previous system of medical care. This is 21 especially so of our large academic hospital."

Given that population based resource allocation adjustments are set to continue it is heartening to note that the Department of Health has recognised that these should 15 occur gradually , not only to avoid irreparable damage to the losers, but also to allow the winners to develop the capacity to spend their additional resources effectively. The importance of this gradualism, (the rule of thumb is to alter allocations by no more than 2.5% per annum), was first appreciated using the RAWP model in the 31 United Kingdom and has also been highlighted locally by both Kane-Berman and Rex.38

38 MMed (Community Health) Part III University of Cape Town

ACADEMIC HEALTH SERVICES

The academic health services in South Africa have been judged to be consuming a disproportionate and inappropriate share of the funds available to the public health sector. This is partly why the notion of "academic health complexes", which have as essential ingredients one or more teaching hospitals and a medical school or health science faculty, seem to have become less acceptable to national and provincial health policy makers. In the early 1990s increased independence for academic health complexes was being suggested as a means of empowering management to increase efficiency and effectiveness. This view is now being resisted. Cara Jeppe writes: "it is imperative that our academic health centres remain within and wholly accountable to the national health system and gain no degree of management autonomy. It should be their immediate task to train tens of thousands of doctors and nurses with the political will to implement the National Health Plan, particularly at the district level, as was done in Cuba after the triumph of their revolution."66

If academic health complexes are viewed in South Africa as one of the major causes of resource constraints within the public health services, it is ironic that they have been viewed elsewhere as a solution to health service problems arising from difficult financial circumstances. In an article67 entitled "The academic health centre: an idea whose time has come", Sinclair, writing in Canada, argues that such centres, because of the synergies that can be achieved, are greater than the sum of their parts, and can therefore deliver their "products" ( clinical service, teaching and research) more effectively and efficiently than would otherwise be possible. He also argues strongly in favour of "regionalization", or what we have called rationalisation in South Africa, which allows different institutions to focus on their particular strengths, while avoiding duplication. In Canada this includes increasing collaboration with all manner of community organisations. This positive approach, which focuses on solutions rather than problems, contrasts with the more negative and defensive view taken with respect to academic health complexes in South Africa. There may be valuable lessons to be learnt by examining the experiences and approaches which have been adopted elsewhere in the world.

It is generally accepted that hospitals such as GSH, TBH and RXH should be providing Level III care. At the same time it has been recognised that many patients who are serviced at these and other tertiary hospitals could be properly cared for at 68 69 lower levels of care, ' with the implication that this would be more cost-effective. This has led to much debate around levels of care, including the suggestion that differing levels of care could be offered within the same facility (the so-called "layered cake" proposal). This option has not yet been properly implemented and it remains to be seen how well it would work in practice. An additional complication in this debate arises because of the differing locations in which academic health service activity takes place. Myers and Pelteret70 have suggested a method of mapping services in terms of both level of care as well as location, which reveals the complexity of this issue as well as encouraging new and innovative ways of thinking about academic health services and the linkages between them.

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1 Nagtegaal J. Gauteng Provincial Administration Department of Health Budget Process. Pretoria: Gauteng Health Department, 1995: 1-3. 2 Harrison D, ed. South African Health Review 1996. Durban and Menlo Park: Health Systems Trust and Henry J. Kaiser Family Foundation, 1996: 76. 3 Benatar SR, Folb P, de V van Niekerk JP, et al. Country Profile: South Africa. Lancet 1997; 349: 1537-45. 4 Adam H, Moodley K. Th e Negotiated Revolution: Society and Politics in post-apartheid South Africa. Johannesburg: Jonathan Ball, 1993. 5 African National Congress. Th e Reconstruction and Development Programme. Johannesburg: ANC 1994. 6 African National Congress. A National Health Plan for South Africa. Johannesburg: ANC, 1994. 7 Pillay YG, Bond P. Health and social policies in the new South Africa. Int J H ealth Serv 1995; 25(4): 727-743. 8 Bond P, Pillay YG, Sanders D. The state ofneoliberalism in South Africa: economic, social, and health transformation in question. Int J H ealth Serv 1997; 27(1): 25-40. 9 Zwarenstein MF, Price MR. The 1983 distribution of hospitals and hospital beds in the RSA by area, race, ownership and type. S Afr Med J 1990; 77(9): 448-452. 10 Broomberg J, Chetty KS, Masobe P. The role of private hospitals in South Africa. Part I. Current Trends. S Afr Med J 1992; 82(5): 329 334. 11 Slabber CF. Health Policy Forum: A new South Africa - a new health care strategy. S Afr Med J 1992; 82(6): 388-391. 12 Hospital Strategy Project. A national policy framework on decentralisation of hospital management. Prepared by the Hospital Strategy Project for the Department of Health, April 1996. 13 African National Congress. A National Health Plan for South Africa. Johannesburg: ANC, 1994: 9. 14 Harrison D, ed. South African Health Review 1996. Durban and Menlo Park: Health Systems Trust and Henry J. Kaiser Family Foundation, 1996: 79. 15 Harrison D, ed. South African Health Review 1996. Durban and Menlo Park: Health Systems Trust and Henry J. Kaiser Family Foundation, 1996: 77. 16 Kale R. South Africa's Health. Restructuring South Africa's health care: dilemma for planners. BMJ 1995; 310(6991): 1397-1399. 17 McIntyre D, Bloom G, Doherty J, Brijlal P. Health Expenditure and Finance in South Africa. Durban, Health Systems Trust and the World Bank, 1995. 18 World Health organisation. Economic support for National Health for All Strategies. Geneva: WHO, 1988. 19 Izindaba. Medical education under threat. S Afr Med J 1996; (86)11: 1364. 20 Izindaba. Western Cape bites the bullet. S Afr Med J 1996; (86)11: 1362-1364. 21 Forder AA. How best to utilize limited resources. Journal ofHo spital Infection 1995; 30 (Supplement): 15-25. 22 Ncayiyana DJ. The Western Cape bites the bullet (Mini-editorial). S Afr Med J 1995; 85(3): 1. 23 Izindaba. Restructuring Western Cape Health Services. S Afr Med J 1995; 85(3): 32. 24 Loock JW. Restructuring of health services - the Western Cape bites the bullet (Letter). S Afr Med J 1995; (85)3: 385. 25 Warren BL. Restructuring of health services - the Western Cape bites the bullet (Letter). S Afr Med J 1995; (85)3: 385. 26 Van Zijl P, Beale B, van der Wal D, et al. Restructuring of health services - the Western Cape bites the bullet (Letter). S Afr Med J 1995; (85)3: 385-387. 27 Odendaal H, Durniny P, Steyn P, et al. Restructuring of health services - the Western Cape bites the bullet (Letter). S Afr Med J 1995; (85)3: 387. 28 Ruttman TG. Restructuring of health services - the Western Cape bites the bullet (Letter). S Afr Med J 1995; (85)3: 387. 29 Izindaba. Academic Health Service Complexes. S Afr Med J 1995; (85)3: 13-18. 30 Ncayiyana DJ. Restructuring of health services - the Western Cape bites the bullet. S Afr Med J 1995; (85)3: 388. 31 Kane-Berman J. Restructuring of health services - the Western Cape bites the bullet. S Afr Med J

40 1995; 85(5): 537-538. 32 Ruttman TG, Puterman A, Reitz D. Restructuring of Health Services - the bullet bites back (Letter). S Afr Med J 1995; (85)9: 923-924. 33 Strategic Management Team. Ministry of Health and Social Services. Draft Provincial Health Plan. Western Cape Province: February 1995. 34 Kane-Berman J. Groote Schuur Hospital: Historical Perspective. Hospital and Nursing Year Book of Southern Africa. Pretoria and Cape Town: Harold MacCarthy Publications/H Engelhardt, 1988. 35 Beatty DW, Henley L. Red Cross Children's Hospital- a valuable national resource (Editorial). S Afr Med J 1997; 87(8): 978-979. 36 Provincial Administration of the Cape of Good Hope. Statistics Report of the Deputy Director­ General Hospital and Health Services. 1993/94. 37 Academic Priorities Group. Financial Sub-committee. Draft Revised Report of the Costing Working Party. May 1995; 14. 38 Rex G. An answer to Gauteng's hospital financing crisis (Editorial). S Afr Med J 1995; 85(11): 1144-1146. 39 Kane-Berman JD, Taylor SP. Containing costs in public sector hospitals - a strategy for the future. Lessons from a large teaching hospital. S Afr Med J 1990; 78(3): 154-157. 40 Academic Priorities Group. Financial Sub-committee. Draft Revised Report of the Costing Working Party. May 1995; 11. 41 Academic Priorities Group. Financial Sub-committee. Draft Revised Report of the Costing Working Party. May 1995; 9. 42 University of Cape Town. Response to the Draft Provincial Health Plan. May 1995. 43 Financial Analysis of the Academic Hospitals Western Cape. November 1994. 44 Task Force of the Academic Priority Group. Report: Process of Rationalisation of Academic Health Services in the Western Cape Province. Cape Town: November 1994. 45 Green A, Barker C. Priority setting and economic appraisal: whose priorities - the community or the economist? Soc Sci M ed 1988; 26(9): 919-929. 46 Leyenaar H. Management accounting for hospitals (Special Article). S Afr Med J 1997; 87(10): 1349-1351. 47 Dyer JJ. Comparative costs of mobile and fixed-clinic primary health care services. S Afr Med J 1996; 86(5): 528-530. 48 Harrison D, ed. South African Health Review 1996. Durban and Menlo Park: Health Systems Trust and Henry J. Kaiser Family Foundation, 1996: 109. 49 Kane-Berman J. Performance indicators: adding value to hospital management. Medinfo 1995; 8 Pt 2: 1562-1565. 50 Kinneman MT, Hitchings KS, Bryan YE, et al. A pragmatic approach to measuring and evaluating hospital restructuring efforts. J Nurs Adm 1997; 27(7-8): 33-41. 51 Sovie MD. Tailoring Hospitals for Managed Care and Integrated Health Systems. Nursing Economics 1995; 13(2): 72-83. 52 Fukuyama F. "The End of History, Five Years Later". History and Theory 1995; 34(2): 27-43. 53 Chetty KS. An integrated analysis of health facilities in the nine provinces of South Africa. S Afr Med J 1995; 85(4): 245-250. 54 Benatar SR. A unitary health service for South Africa. S Afr Med J 1990; 77(9): 441-447. 55 Harrison D. The National Health Services Commission, 1942-1944- its origins and outcome. S Afr Med J 1993; 83(9): 679-684. 56 Union Government 30-1944. Report of the National Health Services Commission, 1942-44. Pretoria: Government Printer, 1944. 57 Broomberg J. The role of private hospitals in South Africa. Part IL Towards a national policy on private hospitals. S Afr Med J 1993; 83(5): 324-329. 58 Department of Health. Restructuring the national health system for universal primary health care: report of the committee of inquiry into a national health insurance system. Pretoria, 1995. 59 Soderlund N, van den Reever A. Regulation of the Medical Schemes Act - origins of the proposed reforms (Editorial). S Afr Med J 1997; 87(8): 983-984. 60 Doherty J, McIntyre D, Bloom G. Value for money in South African health care: findings ofa review of health expenditure and finance. Cent Afr J Med 1996; 42(1): 21-42. 61 Klopper JM, Bourne DE, McIntyre DE, et al. A methodology for resource allocation in health care for South Africa. Part I. Rationale and prerequisites. S Afr Med J 1989; 76: 209-211. 62 McIntyre DE, Taylor SP, Pick WM, et al. A methodology for resource allocation in health care for South Africa. Part II. The British experience and its relevance to South Africa. S Afr Med J 1990;

41 77(9): 453-455. 63 Bourne DE, Pick WM, Taylor SP, et al. A methodology for resource allocation in health care for South Africa. Part III. A South African health resource allocation formula. S Afr Med J 1990; 77(9): 456-459. 64 McIntyre DE, Bourne DE, Klopper JM, et al. A methodology for resource allocation in health care for South Africa. Part IV. Application of South African Health Resource Allocation Formula. S Afr MedJ1991; 80(3): 139-145. 65 Grant RJ. Equity vesus humanity in health care. S Afr Med J 1993; 83(5): 330-332. 66 Jeppe C. Who promotes primary health care and why? (Editorial). S Afr Med J 1995; 85(7): 634- 636. 67 Sinclair DG. The academic health centre: an idea whose time has come. Can Med Assoc J 1993; 148(9): 1543-1545. 68 Bachmann OM, Zwarenstein MF, Benatar SR, Blignaut R. Levels of Care needed by medical inpatients in a teaching hospital. S Afr Med J 1991 ; 80(10): 477-480. 69 Vallabhjee KN, Jinabhai CC, Gouws E, et al. Levels of health care at academic and regional hospitals in KwaZulu-Natal. S Afr Med J 1997; 87(10): 1355-1359. 70 Myers JE, Peteret R. Conceptualising health services in terms oflevel and location of care - a view from the academic health complex. S Afr Med J 1995; 85(5): 347-351 .

42

-

-

4 4

3 3

4 4

-

-

14 14 -

97 97

63 63

33 33

48 48

25 25

59 59

-

29 29

124 124

190 190

-

--

-

·---

-

·--

-

Beds Beds

---· ---·

-

·--

---

-· -·

--

-----

-

--

-

------

-

-

-----

. .

·--

-----· -----·

-----

.

-----

--

------

-

. .

--·---

Total Total

-

-

-

--

--

--

-

722 722

·

338 338

-

2 2

-

-

-

-

--

--·--

' '

--

----

-

----

-

-----

-----

·--

Exclusions Exclusions

-

-

----·---

----

-·--·---

------

------·-

-

--· --·

-

08 08

-

68 68

(ROOOs) (ROOOs)

578 578

214 214

9

207 207

772 772

289 289

659 659

819 819

212 212

588 588

645 645

860 860

353 353

262 262

-

-

1 1

7 7

3 3

4 4

8 8

1 1

2 2

1 1

---

4 4

5 5

4 4

1 1

------

-

17 17

10 10

·---

--

·--

-

-

-

-

-

--· --·

- Suppor:!_ Suppor:!_

COSTS COSTS

------

-

--·--·-

-· -·

--

--

-

-----

-- --

-

--

-

-

---

--~-----

90 90

--

-

68 68

214 214

113 113

578 578

558 558

908 908

264 264

891 891

207 207

379 379

772 772 289 289

333 333

323 323

153 153

996 996

296 296

659 659

?_~~ ?_~~

819 819

264 264

873 873

729 729

984 984

717 717 212 212

338 338

736 736

·-- 746 746

-- 363 363

588 588

645 645 438 438 353 353

860 860

766 766

770 770

262 262

916 916 916

891 891

764 764

1 1

7 7

2 2

1 1

4 4

3 3

2 2

8 8

1 1 1 1

6 6

5 5

5 5

1 1

1 1

1 1

2 2

2 2

9 9

4 4

5 5

4 4

1 1

6 6

_ _

12 12

11 11

17 17

25164 25164

20 20

10 10

10 10

16 16

10 10

1994/95 1994/95

-· -·

1994/95 1994/95

-

-

--

-

-

-

-----

GSH GSH

---

-

·-

-

-

-

1. 1.

-

--

·

Cost Cost

----

-

-

-

-

--

-

-

TABLE TABLE

---

----

Services Services

______

Department Department

s s

Schools Schools

Disease Disease

College College

Surgery Surgery

Unit Unit

_ _

uite

Diabetes Diabetes

Centre Centre

cs cs

Secretariat Secretariat

Clinic Clinic

S

Hygiene Hygiene

ndling ndling

Unit Unit

ources ources

Health Health

a

Pathology Pathology

nt nt

Engineering Engineering

Heart Heart

s

and and

cs cs

ees ees

e

H

Pathology Pathology

Unit Unit

Nursery Nursery

F

Engineering Engineering

di

Surgery

Medicine Medicine

Graphics Graphics

Cost Cost

m

s s

Nursing Nursing

Clinic Clinic

Re i Genet

nsion nsion

Science Science

Pharmac_ology Pharmac_ology

Immunology Immunology

ology ology

Engineering Engineering

-

Processing Processing

e

Practice Practice

House House

Thoracic Thoracic

e

e

c

-

g

Clinic Clinic

Clinic Clinic

rial

a

Clinic Clinic

pital pital

e

t

n

gopa

a

a

o

Medical Medical

M Lipid Lipid

lschaemic lschaemic

M

L Hypert

Liver Liver

Human Human

Human Human

os H

Finance Finance

Hospital Hospital

General General Family Family

Gynae Haematology Haematology General General Enviromental Enviromental

GIT GIT ENT ENT

Geriatric Geriatric Endocrine Endocrine

Emergency Emergency

Dietetics Dietetics

Dermatology Dermatology

Creche Creche Clinical Clinical

Community Community

Clinical Clinical

Clinical Clinical

Clinical Clinical

Chemical Chemical

Central Central

Catering Catering

Carinus Carinus Biomedical Biomedical

Cardio

Cardiac Cardiac

Animal Animal

Anatomical Anatomical

Anaesthetics Anaesthetics

Administration Administration

I I Appendix Appendix

, ,

5 5

-

39 39

27 27

15 15

20 20

82 82

27 27

23 23

52

94 94 24 24

72 72

438 438

---

108 108

! !

. .

1 1

Beds Beds

--·--

-~ -~

-

-

---

Total Total

1

j

1-

f f

425 425

330 330

~

---+--

52 52

44 44

± ±

------1-· ------1-·

_

-

Exclusions Exclusions

=--

'-

I I

J

it

56 56

(ROOOs) (ROOOs)

991 991

270 270

093 093

718 718

216 216

863 863

769 769

142 142

163 163

2 2

2 2

~

2 2

15~~ 15~~

12 12

120 120

Support Support

COSTS COSTS

~-=-~

_ _

-

f------

,

-

r

I

I I

6

~

56 56

-

521 521

481 481

842 842

242 242

834 834

270 270

353 353

035 035

093 093

885 885

718 718

68

292 292 664 664

216 216

684 684 890 890

330 330 465 465

544 544

565 565

863 863

769 769

732 732

616 616 405 405

142 142 322 322

137 137

244 244

163 163

-

2 2

3 3

2 2

8 8

2 2

2 2

8 8

8 8

3 3

4 4

2 2

1 1

i~!

2 2

2 2 6 6

5 5

2 2

2 2

5 5

-

37 37

15 15

13 13

026 026 16

,~?s:

44 44 11 11

12 12

500002 500002

1994/95 1994/95

462 462

---

1994/95 1994/95

GSH GSH

1. 1.

Cost Cost

j j

TABLE TABLE

Unit Unit

Expenses Expenses

Nursing Nursing

Centre Centre

Health Health

Therapy Therapy

of of

Total Total

Clinic Clinic

Other Other

Disease Disease

House House

Radiography Radiography

nd nd

Unit Unit

Cost Cost

EXPENDITURE EXPENDITURE

Medicine Medicine

Administration Administration

Physics Physics

Microbiology Microbiology

Informatics Informatics

s s

of of

Surgery Surgery

a

Work Work

Relations Relations

Unit Unit

e

Hospitals Hospitals

Centre Centre

(General) (General)

School School

Global Global

Urology Urology

Cost Cost

UCT UCT Suppli TOTAL TOTAL

Social Social

Services Services

Renal Renal School School

Trauma Trauma

Radiotherapy Radiotherapy

Radiology Radiology

Virology Virology

Rochester Rochester Public Public

Rheumatic Rheumatic

Psychiatry Psychiatry

Respiratory Respiratory

Plastic Plastic

Physiotherapy Physiotherapy

Pharmacy Pharmacy

PCU PCU

Paediatrics Paediatrics

Other Other

Orthopaedics Orthopaedics

Ophthalmology Ophthalmology

Nursing Nursing

OPD OPD

Nuclear Nuclear

Occupational Occupational

Neurosurgery Neurosurgery

Occupational Occupational

Neurology Neurology

Obstetrics Obstetrics

Neonatology Neonatology

Medico-legal Medico-legal

Medical Medical

Medical Medical

Medical Medical

I I Appendix Appendix

3 3

4 4

4 4

14 14

33 33

25 25 59 59

97 97

63 63

48 48

29 29

--

124 124

190 190

------

---

----

Beds Beds

--· --·

-

-·-

Total Total

-

----

-

-

3 3

6 6

9 9

0 0

8 8

4 4

-

62 62

76 76

44 44

24 24

49 49

29 29

59 59

-

--

-

-

-

-

--

-· -·

·----

-

·-

--

· ·

Beds Beds

-

-

---

-

-

--·--

-

--

-

---

-

-· -·

-----

--

-

--

-

-

---

-

----

~--

--

----

---

·------

-

--

---

---

-

_!erti'!_ry _!erti'!_ry

----

------

--

----

--

-

I---

~------

----

-

-

------

-

·- -

--

--

---

-

-· -·

722 722

338 338

-~ -~

--

~~ ~~

-

-

--

2 2

-

-

-

--

Cost Cost

--

-

----

-- ---

-----

-

---

--

-

-

-

----

----

---·-

-----

-

-

-

------

--

---· ---·

-

-

-

---

. .

----

--

-

----· ----·

-

-·-

-

-

. .

-

-

-

-

-----

-

-

---

--· --·

-

·-

-

. .

--

·--

-

--

Excluded Excluded

-----

-

--

-----·--

------·-

-

-

------

e------

---

-

-

-

-

--

68 68

---

-

578 578

214 214

908 908

207 207

772 772

659 659

-

212 212

-

588 588

645 645

860 860

353 353

-

262 262

916 916

1 1

3 3

7 7

2 2

4 4

8289 8289

1 1

1 1

---

1819 1819

4 4

4 4

5 5

1 1

--

--

---

-

10 10

Cos~

1

·

-

-

-

-·-

-

--

. .

-

--·-

·-

--

-

--

.. ..

---

-

-

-

-

-

---

. .

-

Sup_por:!_ Sup_por:!_

--

-

-

---

-

--

·-

---

---

------

-

------

-

(ROOOs) (ROOOs)

68 68

34 34

-

-

113 113

558 558

780 780

264 264

379 379

325 325

352 352

873 873

598 598

148 148

492 492

948 948

648 648

369 369

736 736

426 426

746 746

363 363

135 135

766 766

494 494

-

770 770

326 326

-

----

1 1

2 2

1 1

8 8

8 8

5 5

1 1 3 3

1 1

2 2

1 1

8 8

8 8

4 4

18 18

12 12

----

. .

Cost Cost

-·-··--

16 16

10 10

-

-

--

---

-----· -----·

-

-

-

- COSTS COSTS

-

-

-

----

-

-

-

-

--

-

-

--

-

--

-

-

-

-----

-

-

-

------

-

-

----

-

-- -

----

----

------·-

-

-

Tertiary Tertiary

---

----

1994/95 1994/95

% %

% %

% %

% %

% %

-

88% 88%

75

68% 68%

23% 23%

75% 75%

85% 85%

60% 60%

75% 75%

75% 75% 88% 88%

38% 38%

38% 38%

53

90% 90%

GSH GSH

60% 60%

77

100

100% 100%

100

100% 100%

100% 100%

100% 100%

100% 100%

100% 100%

100% 100%

. .

2

-

-

TABLE TABLE

Adjusted% Adjusted%

% %

% %

% %

% %

% %

% %

% %

% %

% %

% %

% %

15

50% 50%

50% 50%

70% 70%

75 50% 50%

45

50% 50%

25% 25%

35% 35%

40

25% 25%

76% 76%

80% 80%

55% 55%

40

100% 100%

100

100

100% 100%

100

100

100

100

100% 100%

Tertiary Tertiary

% %

' '

1 1

1 1

1 1

: :

14 14

90 90

68

153 153

164 164

113 113 578 578

558 558

379 379

2

333 333

323 323

908 908

891 891

659 659

264 264

207 207

264 264

289 289

772

296 296

996 996

819 819 722

873 873

729 729 984 984

212 212

717

338 338

736 736

746 746 363 363

588 588

353 353

766 766

438 438

645 645

860 860

262 262

770 770

916 916

891 891

764

1 1

1 1

7 7 1 1

1 1

3 3

2 2

1 1 4 4

8 8

1 1

6 6

2 2

5 5

5 5

2 2

1 1

2 2

5 5

4 4

9 9

1 1

4 4

6 6

11 11

12 12

17 17

25 25

20 20

10 10

16 16

10 10

10 10

1994/95 1994/95

Cost Cost

I I

I I

I I

I I

I I

I I

I I ; ;

i i

I I I I

I I ! !

I I

I I

! !

I I

, ,

I I

I I

I I

I I

I I

1 1

I I

I I

Services Services

ry ry

riat riat

partment partment

e

e

D

Schools Schools

creta

Disease Disease

College College

Surg

Unit Unit

Centre Centre

Diabetes Diabetes

Se

Clinic Clinic

Hygiene Hygiene

Suites Suites

unology unology

Health Health

Unit Unit

-

Pathology Pathology

Engineering Engineering

_

Heart Heart

and and

Pathology Pathology

Handling Handling

-

Unit Unit

Nursery Nursery

Engineering Engineering

Medicine Medicine

Cost Cost

Graphics Graphics

Nursing Nursing

Clinic Clinic

surgery surgery

Science Science

lmm

Pharmacology Pharmacology

Genetics Genetics

Engineering Engineering

Resources Resources

Processing Processing

=-

House House

Practice Practice

Clinic Clinic

Clinic Clinic

Clinic

Family Family

Dermatology Dermatology

General General

Finance Finance

Enviromental Enviromental

Human Human ENT ENT

Gynaecology Gynaecology Endocrine Endocrine

Hospital Hospital GIT GIT

Emergency

Medical Medical

Community Community

Haematology Haematology Geriatric Geriatric Dietetics Dietetics

General General

Clinical Clinical

lschaemic lschaemic

Lipid Lipid

Chemical Chemical

Central Central

Catering Catering Hypertension Hypertension

Human Human Carinus Carinus

~?~~ials ~?~~ials Cardio-Thoracic Cardio-Thoracic

Cardiac Cardiac

Clinical Clinical

Manag~i:nent Manag~i:nent

Clinical Clinical L~gC>paedics L~gC>paedics Biomedical Biomedical

Liver Liver

Clinical Clinical

Animal Animal

Anaesthetics Anaesthetics

Administration Administration

Creche Creche

----

Anatomical Anatomical

----

Hospi~alFees Hospi~alFees

----

----

I I Appendix Appendix

5 5

-

15 15

39 39

27 27

52 52 27 27

20 20

23 23 82 82

49 49

94 94

24 24

72 72

108 108

108 108 438 438

1 1

--

Beds Beds

-

---

. .

·

-

-

......

-

-

-

---

-

-· -·

Total Total

-

-

-

5 5

5 5

9 9

- 4 4

_ _

--

-

·--

14 14

12 12

11 11

82 82

59 59

25 25

54 54

66 66 24 24

72 72

--

815 815

-

--

-

----

·-

-

--

Beds

-

-

-

--

-·--

-

-----

-

-·-

----

----·· ----··

-

-

--· --·

~ ~

-

---

---

- -

-

----

-

-

-

---

-

-

-

-

----· ----·

-

-

· ·

-

--~ --~

-

.. ..

·-

-

-·-

--

-

·-

----

--·-· --·-·

-

---

-

--

-

--

-

--· --·

Tertiary Tertiary

--

-

- --

----·-

--· --·

----· ----·

--- -

---

---

--- I--

-·-

----

-

-

. . . .

--

-~ -~

-

--

·-

---

425 425

-

152 152

330 330

883 883

-

-

--

-

-

4 4

52 52

--

44 44

--

Cost Cost

---

----

·-

·-

-----

-

-

- --·--

----

-

·--

-

--

----· ----·

-

---

-

-

---

-----

---· ---·

--

·-- ·--· ·--·

-

·---

------

Excluded Excluded

- --

------

-

------

f- -

f-·--

-

I--· I--·

~·

56 56

-

-

-

991 991

270 270

885 885 093 093

718 718

216 216 --

255 255

211 211

863 863

769 769

142 142

--··-

163 163

--· --·

2 2

2 2

1 1

6 6

2 2

15 15

-

12 12

-

Cost Cost

-

---

120 120

---

-

-~----. -~----.

-

-

-

-

-

, ,

·

--

-· -·

-

-

-

·-

-

--·-

------

-

------

-

-

-

Support Support

-

-

-·---·-

-

-

---

------

-

------

----

~ ~

-

----· ----·

-

-

{ROOOs) {ROOOs)

-

20 20

608 608

682 682 653 653

725 725

526 526

100 100

364 364

617 617

622 622

292 292

210 210

467 467

105 105

135 135

274 274

554 554

722 722

616 616

437 437

110 110

322 322

244 244

1 1

1 1

1 1

2 2

1 1

-

7 7

7 7

2 2

5 5

1 1

5 5

8 8

2 2

5 5

2 2

2 2

4 4

13 13

13 13

10 10

Cost Cost

-

-

223 223

21

-

----

COSTS COSTS

·-

- . .

--·--· --·--·

--

----

-----

----

-

-----

-----

-

------

·-

-

-

-

--

------

-·----

-----

--

-

-

-

-

-· -·

Tertiary Tertiary

·-· ·-·

-

1994/95 1994/95

% %

% %

% %

% %

--

-

75% 75% 30% 30%

75% 75%

45% 45%

85% 85%

90% 90%

85% 85% 85% 85%

30% 30%

60% 60%

86% 86%

78% 78%

75

83% 83%

75% 75%

95% 95% GSH GSH

85% 85%

80% 80%

100

100

100

100% 100%

2. 2.

TABLE TABLE

Adjusted% Adjusted%

% %

% %

50% 50%

30% 30%

50% 50%

20% 20%

70% 70%

70% 70%

80% 80%

70% 70%

72% 72%

20% 20%

40% 40%

55

50% 50%

50% 50%

65% 65%

70

90% 90%

60% 60%

100% 100%

100% 100%

100% 100%

100% 100%

- Tertiary Tertiary

% %

I I

1 1

1 1

1 1

' '

56 56

521 521

002 002

270 270

834 834

035 035

242 242

481 481

842 842

885 885 093 093 353

152 152

718 718

664

292 292 686

890 890 026 026

684 684

216 216

255 255

330 330

211 211

039 039

465 465

847 847

883 883

544 544

142 142 863 863

769 769

322 322 405 405 565 565

163 163

732 732

616 616

137 137

244 244

3 3

2 2

2 2 8 8

2 2

2 2

1 1

3 3

8 8 2 2

4 4

8 8

6 6

1 1

4 4

6 6

2 2

5 5

6 6

2 2

5 5 2 2

2 2

37 37

15 15

16 16

13 13

13 13

11 11 44 44

12 12

500 500

462 462

1994/95

Cost Cost

I I

I I

I I

I I

I I i i

I I

I I

I I I I

I I

Unit Unit

xpenses xpenses

E

Nursing Nursing

Centre Centre

Health Health

Therapy Therapy

of of

Clinic Clinic

adiography adiography

Other Other

~ ~

_

Disease Disease

House House

-

R

_ _

__ __

y_ y_

Cost Cost

Unit Unit

EXPENDITURE EXPENDITURE

Medicine Medicine Microbiology Microbiology

Informatics Informatics

Physics Physics

Administration Administration

of of

Surg~ry Surg~ry

and and

______

Relations Relations

Work Work

Unit Unit

Hospitals Hospitals

~

CentreTotal CentreTotal

(Gen~ral) (Gen~ral)

Schoo

---

ba

_

-

Supplies Supplies

Gl9 Social Social TOTAL TOTAL

Rochester Rochester UCT UCT Renal Renal Services Services Public Public Physiotherapy Physiotherapy

Rheumatic Rheumatic Cost Cost School School Psychiatry Psychiatry Radiothe~py Radiothe~py Pharmacy

Virology Virology

Respiratory Respiratory Radiolo~ Plastic Plastic PCU PCU

Paediatrics Paediatrics

Other Other

Ortho~~<:li_

Trauma Trauma

Nuclear Nuclear OPD OPD Obstetrics Obstetrics

Neurosurgery Neurosurgery Occupational Occupational

Nursing Nursing Neurology Neurology Occupalion_al Occupalion_al

Neonatology Neonatology Medical Medical _9phthaJmology _9phthaJmology

----- Medico-legal Medico-legal Medical Medical

Medical Medical

~_!~ogy__ ~_!~ogy__

-

---

I I Appendix Appendix

71 71

62 62

70 70

74 74

70 70

97 97

50 50

60 60

41 41

59 59

40 40

73 73

67 67

74 74

95 95

45 45 74 74

75 75

73 73

77 77

47 47

77 77

88 88

77 77

GSH) GSH)

Cost Cost

% %

(1993 (1993

-

GSH) GSH)

(ROOOs) (ROOOs)

40 40 34 34

17 17

15 15

26 26

16 16

89 89

45 45

21 21

43 43

33 33

12 12

38 38

13 13

40 40

83 83

42 42

42 42

37 37

47 47

62 62

47 47

40 40

47 47

Cost Cost

Cases Cases

and and

COSTS COSTS

-

-

(Biometrician (Biometrician

available available

available available

available available

available available

available available

Tertiary Tertiary

Patients Patients

1994/95 1994/95

not not % %

not not

not not

not not

not not

I I

I I

I I

I I

I I

r r

Isaacs Isaacs

S S

GSH GSH

Dr Dr

. .

3

: :

Tertiary Tertiary

of of

Source

TABLE TABLE

Surgery Surgery

Medicine Medicine

Discipline Discipline

Clinic Clinic

Surgery Surgery

Percentage Percentage

Urology Urology

Rheumatology Rheumatology

Respiratory Respiratory Average Average

Renal Renal

Radiotherapy Radiotherapy Paediatrics Paediatrics

Radiology Radiology Neurology Neurology

Trauma Trauma Psychiatry Psychiatry

Obstetrics Obstetrics Neonatology Neonatology

Plastic Plastic Haematology Haematology

Orthopaedics Orthopaedics GIT GIT Neurosurgery Neurosurgery

Ophthalmology Ophthalmology Geriatrics Geriatrics

Gynaecology Gynaecology

ENT ENT

General General Endocrine Endocrine

General General Emergency Emergency

Dermatology Dermatology

Cardiothoracic Cardiothoracic

Cardiac Cardiac

I I Appendix Appendix

-

3 3 4 4

-

-

4 4

- -

-

- -

--

14 14

97 97

63 63

33 33

25 25

48 48

59 59

29 29

.

190 190

124 124

-

.. ..

---

--

-· -·

-·-

--

~--· ~--·

---

Beds Beds

-

._ ._

__ __

-

---

--

-

-----

--

--

----

-·-

------

------

----

-

------

. .

·----· ·----·

------

------

. .

--

Total Total

-----

8 8

3 3

1 1

-

19 19

48 48

62 62

24 24

16 16

25 25

---

-

- -

-

-

-

114 114

---

--

--

---

--

--

-

-

-

Beds Beds

-

--

-

----

-

-----

---

---

---· ---·

---

-

---

-----· -----·

------

------

-

·-

-·----

----

-·---·-

----·--

-----

-

--

-

-

-

-----

-

---

--

-

-

-

-

-

- -

-

-

-

------

-· -·

-

--

---

-·--

------

--

-

--

---

-··------

--

-

econdary econdary

-

--

-

·-

-

-----

---

-· -·

-

-

-

-

-

-

--· --·

-

·---

-~ -~

-~---

~

---

-

-

722 722

338 338

-

2 2

- -

-

-

Cost Cost

---

---

-

-----

---

----

-----

-

-

--

-

------

--

-

-

----

-

-

---

----

-

--·--

--

----·--

-----

-----

---

-

------

-----

-

--

-

• •

·------

-

--

-

-

---

-

Excluded Excluded

--

------

------

-

-

-

----

-

-

--

-

-

68 68

578 578

214 214

908 908

207 207

772 772

289 289

-

659 659

819 819

212 212

645 645

588 588

860 860

353 353

262 262

916 916

-

-

-

-

1 1

-

7 7 4 4

3 3

2 2

8 8

1 1

1 1

5 5

4 4 4 4

1 1 (ROOOs) (ROOOs)

-

-

17 17

-

10 10

Cost Cost

. .

----·-

-· -·

-

----

----

- -

-

-

-

-

-

--· --· -

--· --·

-

-

-

----

-

-

-

-----

-

COSTS COSTS

---

--

-

--

-

-

-

-

-

Support Support

-

-

-

- -

---

-

-

----

-

-

-

-

23 23

111 111

1994/95 1994/95

119 119 008 008

831 831

944 944

398 398

291 291

316 316

225 225

-

581 581

615 615

291 291

944 944

756 756 438 438

-

2 2

6 6

4 4

8 8

1 1

1 1

3 3

-

2 2

2 2

-

-

---

Cost Cost

----

-

GSH GSH

-

-

-

-

-

4. 4.

-- -

-

-

TABLE TABLE

Secondary Secondary

14 14

90 90

68 68

578 578

113 113

2

891 891

558 558

379 379 908 908 264 264

153 153

333 333

207 207

772 772

323 323 289 289

659 659

296 296

722 722 996 996

873 873

819 819

264 264 729 729

984 984

338 338

717 717

736 736 212 212

746 746

363 363

588 588 645 645

860 860

353 353

438 438

766 766

770 770

262 262

764 764 916 916

891 891

1 1

1 1

3 3

7 7 4 4

2 2

1 1

2 2 8 8

6 6 1 1

1 1

5 5

1 1

5 5

1 1

2 2

2 2

5 5

9 9

1 1 4 4

4 4

6 6

12 12

11 11

17 17

20 20

25164 25164

16 16

10 10

10 10

10 10

1994/95 1994/95

-

Cost Cost

I I

I I

I I

I I I I

I I

' ' I I

' '

nt nt

e

Research Research

s s

l

Services Services

gery gery

Department Department

Developm

r

ogy ogy

l

Schoo

es es

Disease Disease

Centre Centre

it

College College

Su

Unit Unit

Diabetes Diabetes

Secretariat Secretariat

Clinic Clinic

Su

Hygiene Hygiene

ng ng

i

eart eart

Unit Unit

Health Health

acic acic

Pathology Pathology

Engineering Engineering

r

H

and and

l l

Cost Cost

Pathology Pathology

Handling Handling

Nursery Nursery

Unit Unit

Fees Fees

Engineering Engineering

e e

Medicine Medicine

Surgery Surgery

ic ic

Graphics Graphics

Nurs

Clinic Clinic

etics etics

ca

Resources Resources

Science Science Genetics Genetics

Immunology Immunology

Engineering Engineering

Pharmaco

-

Processing Processing

ical ical

House House

l l

Practice Practice

g g

l l

al al -Tho

cal cal rin

cs cs

aedics aedics

istration istration

ric ric

a atology atology

ce ce

Clinic Clinic

atology atology

Clinic Clinic al al

ti

c

us us

an an

an an

Clinic Clinic

ical ical

ica

terin

n

~

iete

l

ardio

lschaem

GIT GIT Finan

~a~ily ~a~ily

Hum

ENT ENT Medic Hypertension Hypertension General General

Haem Geriat

Logop Hospit

Gynaecology Gynaecology

Endo Hum

Enviromental Enviromental

Derm Liver Liver Hospital Hospital

E_!!lergency E_!!lergency

~aterials ~aterials

Community Community D

Clin

Clinical Clinical

Central Central

Clinic

Bi~medi

Chemi

Cardiac Cardiac

~anagement ~anagement

Carin

~reche ~reche

~ipid ~ipid

~

Ca

Anatom

Anaesth

Animal Animal

Admin

~

~e~eral ~e~eral

I I Appendix Appendix

-

5 5

7 7

-

-

-

15 15 39 39

27 27

82 82

20 20

52 52

2

23 23

·-

49 49

72 72

94 94

24 24

-

--

----

438 438 -

-

108 108

-

108 108

-

--

--

1 1

-

--

- -

---

-----·--

. .

-

Beds Beds

----

-· -· ------

--

-

--

-

----

---

-

---

-

----·-

------

-----

-

-----

-

------

-

------

--·------

-

-

---

------

--

~------e------

------

---

Total Total

--·-----

------

----·--

-----

-

-

1 1

6 6

4 4

-

-

----

--

-

-

22 22

27 27

14 14

---

22 22

52 52

49 49

24 24

54 54

28 28

623 623

----

--

--

-

-

-

--

---

-

-

-

---

----

-

Beds Beds

-

-

-

------

------

-

-----·--

--

·---

------

------

-

----

-

-

-----

-----

----

-

-

--

-

--

-

-

· ·

-

-

-

--·-· --·-·

·-

-

---

--

--

-

-

--

-

-·--

-

--

------

--

-----

--

----

---

----

-----

----

-

------

----

·----

--

Secondary Secondary

--·--· --·--·

-· -·

--

--

-

- -

-

-· -·

-· -·

---·-

--

--

-

·-

-· -·

----

----

-

-

-

·--

-

-

--

-

425 425

---

152 152

330 330

883 883

--

--

-

4 4

-

-

--

--

---

52 52

44 44

---

Cost Cost

-

-

-

--

-

-

-·-

--

--

-·-· -·-·

----

------

-

----

---

--

-

-

--

-

-----

-

--

-

--

------

, ,

·

,,_ ,,_

---

-

-----

-

--

-

-

------

---

-----

Excluded Excluded

-

-

------·-

----

---

------

-----

56 56

-

991 991

270 270

885 885

093 093

718 718

-

216 216

255 255

211 211

--

-

863 863

769 769

142 142

163 163

-

--

--

~~ ~~

-

-

2 2 2 2

1 1

6 6

-

(ROOOs) (ROOOs)

-

2 2

-

-

-

15 15

-

12 12

C

-

-

120 120

-

·--

· ·

-·

-

-

-

-

-

-·--· -·--·

.!:!_

-

-

-

·-

--

----

--

-· -·

----

----

~ ~

-----

-

-

-

-

COSTS COSTS

-----· -----·

--

-

-----

-

-

-

·-

. .

--·-----

-----·--

----

-

------

Suppo

--

-

-

!_ !_

69 69

-

1994/95 1994/95

189 189

109 109

561 561

509 509

457 457

300 300

253 253

-

404 404

423 423 345 345

474 474

712 712

128 128 934 934

270 270

851 851

010 010

027 027

6 6 1 1

2 2 1 1

1 1

3 3

2 2

1 1

2 2

1 1

2 2

1 1

65 65

Co~

GSH GSH

-

-

. .

-

4

-

-

TABLE TABLE

Secondary Secondary

1 1

I I

1 1

1 1

1 1

56 56

521

002 002

834 834

035 035

242 242

885 885 842 842 481 481

093 270 270

353 353

664 664 718 718

292 292

686 686 890 890

684 026 026 152 152

216 216

255 255

330 330

211 211

465 465 039 039

847 847

883 883

544 544

863 863 565 565 142 142

137 137 769 769

322 322 163 163 405 405

732 732

616 616

244 244

3 3

2 2

8 8

2 2

2 2

2 2

8 8

1 1

8 8 3 3

2 2

4 4

6 6 1 1

4 4

6 6

2 2

5 5

6 6

2 2

5 5

2 2

2 2

15 15

37 37

13 13

16 16

13 13

12 12

11 11

44 44

500 500

462 462

1994/95 1994/95

Cost Cost

I I

I I

I I

I I

I I I I

I I

I I

I I

I I

I I I I

I I

I I

g g

Unit Unit

Expenses Expenses

cs cs

Centre Centre

r r

Nursin

Health Health

Therapy Therapy

of of

Total Total

Clinic Clinic

Othe

Disease Disease

House House

Cost Cost

Radiography Radiography

onal onal ogy ogy

erapy erapy

Unit Unit

l

Informati

Physics Physics

Medicine Medicine

Microbiology Microbiology EXPENDITURE EXPENDITURE

Administration Administration

legal legal

ti

of of

Surgery Surgery

and and

-

Relations Relations

Work Work

Unit Unit

ogy ogy

Hospitals Hospitals

gy gy

Centre Centre

(General) (General)

School School

ces ces iatrics iatrics

c c

al al

co

cal cal

etrics etrics

ear ear

lo

cupational cupational

urol

ccupa

edical edical

~

-

-

Supplies Supplies

Social Social Glob

Rochester Rochester

UCT UCT Renal Renal Servi Publi Physioth Paed

~chool ~chool Cost Cost Rheumatic Rheumatic

TOTAL TOTAL

PCU PCU Trauma Trauma

Nucl Other Other

~lastic ~lastic

Nursing Nursing O

~sychiatry ~sychiatry

~PD ~PD

Obst ~rology ~rology

~adiology ~adiology

Medi

Medical Medical Yiro

Medi

~harmacy ~harmacy

_Qphthalmology _Qphthalmology

~adiotherapy ~adiotherapy

~eurosurgery ~eurosurgery

~espiratory ~espiratory

9

!::Je

.Q_rthopaedics .Q_rthopaedics

~eonato

~

I I Appendix Appendix

722 722

338 338

2 2

Costs Costs

-----

·-

Excluded Excluded

14 14

68 68

142 142

244 244

2

891 891

578 578

908 908 207 207

167 167

289 289

. .

819 819 659 659

736 736

212 212

746 746

984 984

363 363

588 588

645 645 438 438

860 860

262 262 353 353

916 916

891 891

764 764

1 1

2 2

7 7 5137 5137

2163 2163

1379 1379

4 4

3 3

-- 8 8

2772 2772

1 1

6 6

1 1

1 1

1 1

-

-

9 9

4

5 5 1 1

4 4

6 6

17 17

10 10

10 10

--

Costs Costs

---

-

-

-

-· -·

·

-

---

-

-

-·--

--

--

-

---

---

--·-

--

--

-· -·

---

----

-

-----

-----

-----

---

Support Support

------

--·-

--

----

4 4

-

3 3

4 4

5 5

-

24 24

72 72

14 14

97 97

63 63

33 33 48 48

- 2

59 59

29 29

124 124

190 190

--

--

---

---

-

beds beds

-

-

-----

-

-

-

-

-

~ ~

--

------

-

--

----

---

-

---· ---·

----

-

------

-

------

-

-----

------

Total Total

->------

8 8

3 3

1 1

-

~-----

--

-

19 19

--

49 49

62 62

24 24

16 16

25 25

--

-

--

114 114

-

-

--

--

~ ~

-

-

--

--

Be

-

-

--

-----

-

-·-

-

-

--

--

·-

-

--

·-

-

-

---

------· ------·

------

-

-

------

--

------

--

----

--

-

-

·

-----

econda__ry econda__ry

-·-----

--· --·

-·------

-

-

-

-

·-

-

------· ------· -----

-

-

-

-

-

~

-

4 4

6 6

0 0

-

3 3

8 8

9 9

-

-

72 72

24 24

76 76

49 49

44 44 62 62

24 24

29 29

59 59 -

- -

-

---

. .

~ds ~ds

-

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119 119

291 291 -

831 831

944 944

398 398

316 316

225 225

581 581

29

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-

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2004 2004

1 1 8 8

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--

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Cos

COSTS COSTS

-

-

-

-

-

-

-

· ·

-

-

-

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-·-· -·-·

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-

-

-

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1994

------

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--

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-

-

-

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------

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Seco_ndary Seco_ndary

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. .

6 6

8 8

5

-

1

-

68 68

34 34

322 322

113 113

264 264

558 558

161 161

352 352

492 492

873 873

14

598 598

948 948

648 648

426 426

770 770

766 766

---

2 2 6

5 5 -

2 2

4 4

8 8

5 5

1 1

3 3

1 1

2 2

6 6

18 18

12 12

1

10 10

Cost Cost

TABLE TABLE

-

-

-

-

--

. .

-

-

!ertiary !ertiary

--

-

--

I I

. .

% % .

% %

75% 75%

00% 00%

75% 75%

75% 75%

68% 68%

85% 85% 23% 23%

60% 60%

75% 75%

88% 88% 53% 53%

38% 38%

100% 100%

100% 100%

1

100% 100%

100% 100%

100

100

Adjusted% Adjusted%

l l

I I

1 1

I I

; ;

J J

% %

% %

% %

% %

J J

%

00

50% 50%

15% 15%

45 50% 50%

50% 50%

70% 70%

50% 50%

40 76% 76%

25% 25%

35% 35%

1UO'Yo

1

100

100

100

100% 100%

100

Tertiary

% %

1 1

1 1

1 1

• •

1 1

I I

1 1

6 6 1 1 3 3

1

37 37

90 90

53 53

67 67

64 64

68

1

142 142

163 163

11

322 322

1

244 244

207 207 214 214

165 165

379 379

264 264 578 578

558 558 1

772 772

908 908

289

1

323 323

89 722 722 296 296

729 729

264 264 659 659

717 717

996 996 873 873 736 736

212 212

819 819

746 746

984 984

338 338

363 363 588

645 645

438 438

860 860

353

766 766

770 770

262 262

764

916 916

891 891

5 5

2 2 6

1 1 2 2

1 1

5 5 7 7 2 2

2 2

3 3

1 1

4 4 2 2

1 1

6 6

8 8

5 5

1 1 6 6

6 6

1 1

1 1

5 5

2 2

2 2

4 4

4 4 9 9

5 5

1 1

6 6

11 11

17 17 20 20

25 25

10 10

16 16

10 10

10 10

1994/95 1994/95

Cost Cost

I I

s s

nt nt

-

-

-

e

·-

-

s s

ories ories

-

Service

__ __

ool

-

--

rat

~

· ·

__ __

ID' ID'

Departm ne ne

--

y y

y y

ie

Sc

Disease Disease

College College

abo

Surgery Surgery ng ng

-

Unit Unit

i

Centre Centre

Other Other

L

Diabetes Diabetes

Secretariat Secretariat

-

Clinic Clinic -

ery ery

----·-

Hyg

Suites

ng ng

ery ery

i

unolog

Unit Unit

Health Health

Pathology Pathology

Engineering Engineering

Heart Heart

ctice ctice

and and

l l

~

icrobiology

Patholog

Handling Handling

Unit Unit Nurs

ogy ogy

Fees

Engineering Engineering

Medicine Medicine

Surg

Cost Cost

M

Informatics Informatics Graphics Graphics Physics Physics

Nurs

Clinic Clinic

I I

Resources Resources

Genetics Genetics

Engineering Engineering

lm

Science Science

-

Pharmacolo

Process

House House

Pra

Thoracic Thoracic

l l tol

tal tal

ral ral Clinic Clinic

Clinic Clinic

rgency rgency

nce nce

Clinic Clinic

na

mical mical

-

e

aematology aematology

ina

iomedical iomedical

Human Human

Hypertension Hypertension

Hospi

Em

ENT ENT

Human Human

F Hospital Hospital

Medical Medical

GIT GIT

Materials Materials

Family Family Liver Liver General General

Medico-legal Medico-legal

Endocrine Endocrine

Medical Medical

Geriatric Geriatric

Neuroloov Neuroloov

Management Management

Enviromental Enviromental Lipid Lipid

Medicai Medicai

G_ynaecology G_ynaecology

Medical Medical

Logopaedics Logopaedics Neo Community Community

Dietetics Dietetics

Clinical Clinical

Dermatology Dermatology Clinical Clinical

Catering Catering

ghe !:laematology !:laematology

Clinical Clinical

Gene

lschaemic lschaemic Carinus Carinus

Clinical Clinical !:!._

B

Cardio-

~re~he ~re~he

Cardiac Cardiac

Animal Animal

Anatomica

Anaesthetics Anaesthetics

~entra Administration Administration Appendix Appendix

I I

I I

I I

I I I I

I I

I I I I

I I

-

~I ~I

52425 52425

·:;:: ·:;::

Costs Costs

Excluded Excluded

I I

-----

I I

5~ 5~

. .

608 608

718 718

885 885

093 093

026 026

2161 2161

211 211

465 465

544 544

863 863

56

2270 2270

20351 20351

-- 2 2

,,::I ,,::I

1 1

2 2

6255 6255

1 1

2 2

15 15

16 16

---! ---!

12769 12769

195 195

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o_!:!~osts o_!:!~osts

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623 623

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Tertiary Tertiary

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0 0

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344 344

2~~ 2~~

934 934

712 712

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851 851

010 010

1 1

1474 1474

342

1 1

2 2

1 1 2 2

51 51

i i =:j-=--~-=-

;r ;r

Cost

130

COSTS COSTS

Costs Costs

--

_ _

-

-

--

--- --

---

_ _

1994/95 1994/95

------

__ __

447 447

-

-

______

--

Seconda_ry Seconda_ry

GSH GSH

--

Secondary Secondary

i-

1

J J

. .

214 214

5

103 103

725 725

1oo

617 617

364 364

292 292 467 467

105 105

554 554

722 722

1 1

2653 2653

7 7

7 7

1 1

2210 2210

5135 5135 -

plus plus

8 8

5 5

13 13

10 10

Cost Cost

163 163

TABLE TABLE

Tertiary Tertiary

Tertiary Tertiary

J J

% %

% %

% %

% %

30 45

90% 90%

30% 30%

85% 85% 60% 60%

85% 85%

78% 78%

75% 75%

75

85% 85%

100

Adjusted% Adjusted%

I I

1 1

I I

% %

% %

% % % %

% %

% %

%

% %

30% 30%

20% 20%

70

70% 70%

20

80

40

55

50% 50%

70 50

100

Tertiary Tertiary

% %

1 1

1 1

1 1

56 56

521

242 242

718 718

152 152

842 842

270 270

885 885

834 834

093 093

001

353 353

035 035

211 211

216 216

664 664

292 292

686 686

255 255

890 890

330 330 026 026

684 684

465 465 039 039

769 769 544 544

847 847

405 405 863 863 565 565

883 883 732 732

2 2

2 2

3 3 2 2

1 1 2 2

2 2

8 8

6 6

8 8 3 3 1 1

4 4 8 8

4 4

2 2

6 6

6 6

15 15

16 16

13 13

37 37

13 13

12 12

44 44 11 11

500 500

462 480 480 462

1994/95

Cost Cost

_ _

_ _

Unit Unit

-

-

--

_ _

Expenses Expenses

!:_

_

Centre Centre

Nursing Nursing

s s

______

_

y y

Health Health

n

Therapy Therapy

_

inistration inistration

of of

Total Total

o

,-

O)he

ti

Diseases Diseases

-:,

_

la

,,..

Cost Cost

e

Unit Unit

Medicine Medicine

Adm

EXPENDITURE EXPENDITURE

I I

-

lmolog

Surgery Surgery

and

Work Work

=R

Unit Unit

Hos.e.itals Hos.e.itals

Centre Centre

(~enerall (~enerall

School School

.

~atry ~atry

UCT UCT

Radiolo.9.y Radiolo.9.y

Services Services

Cost Cost

RochesterHouse RochesterHouse Res~Clinic Res~Clinic PCU PCU

Renal Renal

Supplies Supplies

Physiothera.e.y Physiothera.e.y UrolQID'_ School_9~a~~raphy School_9~a~~raphy

Rheumatic Rheumatic

Occu.e.ational Occu.e.ational

Paediatrics Paediatrics

Radiotherap Radiotherap

Ps

Other Other Social Social O~.l?

Trauma Trauma

Pharmacy Pharmacy

Nuclear Nuclear Obstetrics Obstetrics Ortho.e.aedics Ortho.e.aedics

Plastic Plastic

Occupational Occupational

TOTAL TOTAL

Neurosurgery Neurosurgery

Global Global Virolo_9 Virolo_9 Public Public

Nursing Nursing

Qphtha Appendix Appendix

-

-

-

. .

50 50

-

·--

347 347

638 638

365 365

212 212

123 123

858 858

. .

654 654

993 993

311 311

678 678

197 197

294 294

756 756

246 246

427 427

2 2

1 1

4 4

1 1

3 3

2 2

1 1

6 6

--

--

11 11

13 13

-

--

12 12

14 14

~ ~

-----

-

- ----

Support Support

------

----

-· -·

----

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-----

I I ----

------

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----

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------

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--

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663 663

501 501

-

-

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3 3

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------

---

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---

------

-

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-

62 62

89 89

531 531

156 156

246 246

134 134

932 932

299 299

295 295

198 198

---

297 297

206 206

650 650

363 363

078 078

297 297

790 790

541 541

854 854

157 157 051 051

289 289

089 089

395 395

--

--

-

·-· ·-·

2 2

2 2

-

3 3

9 9

1 1

5 5

1 1

1 1

1 1

1 1

----

3 3

4 4

-

-·-

-

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11 11

----

Cost Cost

-

-

--

-

--

-

-

-

---

------

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--

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------

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--

·------

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----· ----· ------

-·-· -·-·

-----

-

-

---

--

---

-

-

341 341

825 825

468 468

727 727

898 898

633 633

673 673

201 201

329 329

532 532 629 629

993 993

172 172

115 115

118 118

462 462

281 281

623 623

574 574

202 202

868 868

305 305

237 237

256 256

--

3 3

2 2

3 3

3 3

1 1

1 1

1 1

7 7

1 1

4 4

, ,

1 1

·

-

6 6

3 3

4 4

2 2

4 4

-

-

-----

---

-·-· -·-·

Cost Cost

-

-

--

----

- -

------

-

--

------· ------·

. .

-

-

--

--

-

-

-

--·--

-

--

-

-

-

-

- ·----

. .

-

-----

-

--

-

(ROOOs) (ROOOs)

. . -

-

-

-· -·

-

·--

-

Tertiary Tertiary

-

- -

-----

-

-

--

. .

-

-

-

-

-

% %

-

-

--

-

-

-

----

82% 82%

75% 75%

80% 80%

63% 63%

-

75% 75%

63% 63%

85% 85%

76% 76%

34% 34%

30% 30%

53% 53%

19% 19% 45% 45%

57% 57%

45% 45%

26% 26%

-

26% 26%

75% 75%

78% 78%

COSTS COSTS

80% 80%

75% 75%

66% 66%

42

49% 49%

---

-

-

--

-

--

--

--

--

-

-

--

---

------

-

-

-

·-

-

-

-

-----

----

-

---

-

1994/95 1994/95

-

-~

-

-

--

------

-· -·

--

-

-

-

- -

Adjusted% Adjusted%

. .

-

-

TBH TBH

% %

% %

% %

% %

% %

% %

% %

. .

6

50% 50%

63% 63%

42% 42% 60% 60%

50% 50%

70

42

53% 53%

23% 23%

35% 35% 13

30% 30%

18% 18%

30% 30%

20

18% 18% 38

50% 50%

56

60% 60%

50% 50%

33% 33%

28% 28%

44

-

-

Tertiary Tertiary

TABLE TABLE

% %

50 50

27 27

198 198

347 347

873 873

071 071

624 624 365 365

638 638 766 766

659 659 212 212

123 123

968 968

858 858

654 654

993 993 263 263

539 539

738 738 828 828

642 642

626 626

311 311

663 663

206 206 759 759

164 164 071 071 250 250 478 478

678 678

501 501

157 157

294 294

428 428

756 756

253 253

246 246

325 325

462 462

651 651

4

2 2

1 1

1 1

6 6 2 2

1 1 5 5

3 3

1 1

4 4

4 4

2 2

4 4

1 1

1 1

6 6 2 2

3 3

1 1

8 8 2 2

6197 6197

5 5

5 5

5 5

8 8

11 11

16 16

16 16

13 13

12 12

14 14

1994/95 1994/95

Cost Cost

I I

I I

I I

I I

! !

i i

I I

I I I I I I

I I

I I

I I

I I

I I

I I I I I I

I I

! !

Physiology Physiology

Services Services

& &

es es

t

Transcription Transcription

e

Department Department

ne ne

tion tion

e

Biology Biology

a

Schools Schools

& &

cs cs

Centre Centre

Surgery Surgery

Diab

Suites Suites

Hygi

Cell Cell

Grounds Grounds

Unit Unit

Health Health

dicine dicine

Pathology Pathology

and and

Cost Cost

e

Handling Handling

Pathology Pathology

and and

Nursery Nursery

Fees Fees

Engineering Engineering

Surgery Surgery

Medicine Medicine

Administr

Microbiology Microbiology M

Records Records Biochemistry Biochemistry

Informati Physics Physics Graphics Graphics

Clinic Clinic

and and

Engineering Engineering

Pharmacology Pharmacology

Processing Processing

-

Unit Unit

Planning Planning

Clinic Clinic

Neurosurgery Neurosurgery

Nursing Nursing

J'.'leonatology J'.'leonatology

Nuclear Nuclear

Medical Medical

M!Jdical M!Jdical

Materials Materials

Medical Medical

Medical Medical

M~nagement M~nagement

Medical Medical

~ortuary ~ortuary

Logopaedics Logopaedics

Haematology Haematology General General

GIT GIT

Endocrine Endocrine

Garden Garden

Enviromental Enviromental General General ~eurology ~eurology

lj_ospital lj_ospital ENT ENT

~dical ~dical

Dietetics Dietetics

!:Jospital !:Jospital Dermatology Dermatology

Creche Creche

-

Clinical Clinical

fommunity fommunity

Central Central ~linical ~linical

Catering Catering

Cardio-Thoracic Cardio-Thoracic

_§_[!lergency _§_[!lergency

Animal Animal .!=:amily .!=:amily Cardiac Cardiac

Admissions Admissions _<2hemical _<2hemical

~~atomical ~~atomical Anaesthetics Anaesthetics

~n~omy ~n~omy

I I Appendix Appendix -

-

-

-

_

-

--

- 71

-

-

__

-

113

123

564

968 652

386

234

889

011

025

-

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--

---

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-

--

·--

1

1

1

5 5 3

2

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-

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37

·

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139104

-

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Support

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016 847

731

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7

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12

--

24757

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-

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---

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Exclusions

-

---

--

-

-

-

- -

-

-

---·

_

1

2

-

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--

4

·-

536

246

235 810 554 014 128 1 920 087

434

020

017

841

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----

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.

1

3 1

2257

4

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15

98109

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S~c~~~ry~!_

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179

289

3()2

706 571 006 522

588 772

895

-

387

689

746

035

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1191

1

4 3

6259 8 2

3

1315 4

2

---

Cost

-

12

~

-

--.-

-

112637

-

-

-

-

-----

-

-

--

·--

(ROOOs)

--

-

-

-

Tertiary

--

·

------

____

--

-

-·

----

--

__

% o/;;-

'%

-

%

-

--

COSTS

Jo

15%

68o/o

75%

50%

75% 45% 36%

74

53% 53

53%

18

85%

45%

27%

53%

100%

-

-

-

--

.

~

-

---

-

-

-

--

-

-

----

-

--

- -

1994/95

-

--

-·

-

--

Adjus!ed

-

TBH

/o

.

%

%

%

%

6

2%

30%

50%

30% 33%

10 50% 46°

--

24%

35% 35%

49%

35%

1

30%

70

18

35%

100

Tertiary

TABLE

__

-

%

-

I

71

309 745

731

490 941

092 025 016 222 847

193 889 159 749 838

968

522

123

279

234 833

564 113

704

011 652

386

__,

750

854 830

763

877

4 7 4 7 4

080

1

3 2 8

1

7 1 4

5

8516

8 1 5 6 1

2 1

1

5 3

9

3

2

3

27

12

37

45

20

374606

_

4

1994/95

Cost

____

J

I

I

I

1

/

I

I

I

....._

rsonnel

e

Centre

e

P

Gynaecology

Therapy

Total

ncies

Clinic

and

Cost

and

Surgery

Medicin

e Parking

Colleges

Other

c

e

&

&

ic

Unit

Transport

Surgery

EXPENDITURE

Relations

Work

Unit

Expenses

a

(General)

Resid

gy

Office

Centre

Transport

sychiatry

Obstetrics _

Occupational

Oncology OPD

PA

Ophthalmology Orthopaedics

Paediatri Paediatr Patient

Pharmacy Physiotherapy Plastic

Public Radiology

Portering

Radiotherapy Registry Renal

P

Respiratory

Schools Security

Staff

Social

Staff Supplies

Services

Telephon

Theatre

Toxicology Traum

Urology

Virolo

Cost

Global

TOTAL

______

I

Appendix Appendix II

GROOTE SCHUUR HOSPITAL % OF TOTAL POST CLASS (NUMBER/DESCRIPTION) STAFF CATEGORY POSTS(2/8/95)

646 8.33% 29212 ADMINISTRATION CLERK ADMINISTRATION 28 0.36% 28959 ADMINISTRATIVE OFFICER ADMINISTRATION 6 0.08% 28967 ASD: ADMINISTRATION ADMINISTRATION 19 0.24% 29168 CHIEF ADMINISTRATION CLERK ADMINISTRATION 0.01% 28971 DD: ADMINISTRATION ADMINISTRATION 11 1 0 .01% 3846 IDD: INFORMATION TECHNOLOGY ADMINISTRATION 1 0.01% 10540 DD: MEDICAL TECHNOLOGY ADMINISTRATION 8 0.10% 3730 PROGRAMMER . ADMINISTRATION 64 0.83% 11558 IREGISTRY CLERK ADMINISTRATION I 13 1 0.17% 28963 \SENIOR ADMINISTRATIVE OFFICER ADMINISTRATION I ADMINISTRATION Total 787 1 10.15% ' 722 \ 9.31% 30169 ,CLEANER I AUXILIARY (UNCLASSIFIED) I 75 1 0.97% 30170 •CLEANER II AUXILIARY (UNCLASSIFIED) 133[ 1.71% 30190 1FOOD SERVICES AID I AUXILIARY (UNCLASSIFIED) 17 1 0.22% 30191 FOOD SERVICES AID II AUXILIARY (UNCLASSIFIED) 9 0.12% 30178 GENERAL STORES ASSISTANT I AUXILIARY (UNCLASSIFIED) I I 88 1 1.13% 30179 GENERAL STORES ASSISTANT II AUXILIARY (UNCLASSIFIED) 13 0.17% 30181 GROUNDSMAN I AUXILIARY (UNCLASSIFIED) 2 0 .03% 30182 GROUNDSMAN II 1AUXILIARY (UNCLASSIFIED) I 3 0 .04% 30184 LABOURER I !AUXILIARY (UNCLASSIFIED) I 4 0.05% 30185 LABOURER II AUXILIARY (UNCLASSIFIED) I 2 0 .03% 30199 LINEN STORES ASSISTANT I AUXILIARY (UNCLASSIFIED) 0.05% 30200 •LINEN STORES ASSISTANT II AUXILIARY (UNCLASSIFIED) 4 ! 0.45% 30204 MESSENGER AUXILIARY (UNCLASSIFIED) 35 1 28 [ 0.36% 18618 ,SENIOR MESSENGER AUXILIARY (UNCLASSIFIED) 0.03% 30187 :TRADESMAN AID I AUXILIARY (UNCLASSIFIED) 2 i 47 0.61 % 30188 TRADESMAN AID II AUXILIARY (UNCLASSIFIED) . AUXILIARY (UNCLASSIFIED) Total 1184 15.27% 1 0.01 % 30121 CHIEF DIRECTOR ICHIEF SPECIALIST I I 0.01 % 2776 CHIEF MEDICAUDENTAL SUPERINTENDENT CHIEF SPECIALIST 1, 1 0.01% 2513 CHIEF SPECIALIST/PROFESSOR !CHIEF SPECIALIST ! ICHIEF SPECIALIST Total I 3 0.04% 0.80% 10092 ARTISAN (A GROUP) GENERAL i 62 0.01 % 10123 ARTISAN (B GROUP) 1GENERAL 1 0.06% 10199 ARTISAN FOREMAN :GENERAL 5 10220 ARTISAN SUPERINTENDENT 'GENERAL 1 0.01 % 30212 'CHIEF SPECIALISED AUXILIARY SERVICES OFFICER !GENERAL 6 0.08% 961 DATA TYPIST GENERAL 8 0.10% 2765 DICTAPHONE TYPIST GENERAL 26 0.34% 21009 DRIVER GENERAL 51 0.66% 8825 FOOD SERVICES MANAGER GENERAL 9 0.12% 8828 FOOD SERVICES MANAGER. CHIEF GENERAL 1 0.01 % 8827 FOOD SERVICES MANAGER, PRINCIPAL GENERAL 1 0.01 % 3449 FOOD SERVICES SUPERVISOR GENERAL 48 0.62% 28043 GENERAL FOREMAN GENERAL 29 0.37% 30340 HOUSEKEEPING SUPERVISOR GENERAL 158 2.04% 825 LINEN SUPERVISOR GENERAL 4 0.05% 91866 LINEN SUPERVISOR, PRINCIPAL GENERAL 1 0.01°/, 90272 LINEN SUPERVISOR, SENIOR GENERAL 3 004% 28075 OPERATOR· GENERAL 29 0.37% 914 OPERATOR, SENIOR GENERAL 1 0.01 % 28079 OPERATOR. SENIOR' GENERAL 4 0.05% 90271 PORTER GENERAL 158 2.04~, 90231 PORTER. SENIOR GENERAL 16 ~ 28051 PRINCIPAL GENERAL FOREMAN GENERAL 3 0.04~·, 960 PRINCIPAL PORTER GENERAL 8 - 0.10~·, 874 SEAMSTRESS GENERAL 8 0.10% 876 SEAMSTRESS. SENIOR GENERAL 2 0.03~·, 2764 SECRETARY GENERAL 1 0.01 % 1361 SECURITY OFFICER GRADE I GENERAL 48 0.62o/c 2299 SECURITY OFFICER, PRINCIPAL GENERAL 1 0.01 % 1362 SECURITY OFFICER, SENIOR GENERAL 6 0.08% 24066 SECURITYGUARD GRADE I GENERAL 36 0.46°, 10230 SENIOR ARTISAN SUPERINTENDENT GENERAL 1 0.01 % 28047 SENIOR GENERAL FOREMAN GENERAL 33 0.43% 30343 SENIOR HOUSEKEEPING SUPERVISOR ,GENERAL 16 0.21% 30206 SPECIALISED AUXILIARY SERVICES OFFICER GENERAL I 199 2.57% 29701 SPECIALISED AUXILIARY SERVICES, ASSISTANT GENERAL I 631 0.81% 11382 STOREKEEPER GENERAL I 421 0.54% 28030 TELEKOM OPERATOR GENERAL I 23 0.30% 28038 TELEKOM OPERATOR, PRINCIPAL GENERAL I 1 0.01% 28034 TELEKOM OPERATOR, SENIOR GENERAL I 4 ' 0.05% 1320 TYPIST GENERAL I 64 0.83%

Page 1 Appendix II

0.03% 1319 TYPIST, CHIEF GENERAL I 21 GENERAL Total 11831 15.25% 145 1.87% 1113 MEDICAL OFFICER MEDICAL OFFICER 2 0 .03% 23825 MEDICAL OFFICER, CHIEF MEDICAL OFFICER 5 0.06% 1114 MEDICAL OFFICER, PRINCIPAL MEDICAL OFFICER 2 0 .03% 851 MEDICAUDENTAL SUPERINTENDENT j MEDICAL OFFICER I 21 0.03% 852 MEDICAUDENTAL SUPERINTENDENT, SENIOR MEDICAL OFFICER 305 3.93% 478 REGISTRAR MEDICAL OFFICER MEDICAL OFFICER Total 461 , 5.94% 1 0.01% 6289 \DIRECTOR: NURSING SERVICES, DEPUTY NURSING 11131 14.35% 6206 NURSING ASSISTANT NURSING 147 1.90% 6218 iNURSING ASSISTANT, SENIOR NURSING 15 0.19% 6278 NURSING SERVICE MANAGER !NURSING 1 , 0.01% 6287 NURSING SERVICE MANAGER. CHIEF NURSING 6 0.08% 6259 NURSING SERVICE MANAGER, SENIOR NURSING I I 1001 12.91% 6242 PROFESSIONAL NURSE !NURSING 86 1.11 % 6266 PROFESSIONAL NURSE, CHIEF NURSING 301 3.88% 62541PROFESSIONAL NURSE, SENIOR jNURSING 417 5.38% 6226 STAFF NURSE NURSING 142 1.83% 6234 STAFF NURSE, SENIOR !NURSING I NURSING Total 3230 41 .65% 29 0.37% 23880 PRINCIPAL SPECIALIST !PRINCIPAL SPECIALIST I PRINCIPAL SPECIALIST Total 29 0.37% .06% 4416 BIOMETRICIAN PROFESSIONAL REMAINDER .. 5 0 .15% 9305 DIRECTOR: MEDICAL NATURAL SCIENCE, ASSISTANT I PROFESSIONAL REMAINDER 12 0 0.06% 6441 ENGINEER PROFESSIONAL REMAINDER 5 I .01% 18483,ENGINEER, DEPUTY CHIEF PROFESSIONAL REMAINDER 1 0 0.30% 287831MEDICAL NATURAL SCIENTIST PROFESSIONAL REMAINDER 23 .09% 94591MEDICAL PHYSICIST PROFESSIONAL REMAINDER I 7 0 01% 9461 MEDICAL PHYSICIST, CONTROL ,PROFESSIONAL REMAINDER 1 0 . 2280 PHARMACIST PROFESSIONAL REMAINDER 31 0.40% 5 PRINCIPAL PHARMACIST jPROFESSIONAL REMAINDER I 1 0.01% 4 ,SENIOR PHARMACIST !PROFESSIONAL REMAINDER 3 0.04% I !PROFESSIONAL REMAINDER Total 89 1.15% 2514 SENIOR SPECIALIST SENIOR SPECIALIST 40 0.52% SENIOR SPECIALIST Total ' 40 0.52% 1781 SPECIALIST ,SPECIALIST 105 1.35% SPECIALIST Total 105 1.35% 8521 ANIMAL HOUSE TECHNICIAN TECHNICAL 1 0.01 % TECHNICIAN, CHIEF TECHNICAL 1 0.01% 85231ANIMAL HOUSE 30237 CHIEF HEALTH THERAPIST TECHNICAL 28 0.36 % 6583 CHIROPODIST TECHNICAL 1 0.01% 91669 CLINICAL PHOTOGRAPHER TECHNICAL 5 0.06% 10556 CLINICAL TECHNOLOGIST TECHNICAL 24 0.31% 10558 CLINICAL TECHNOLOGIST, CHIEF TECHNICAL 5 0.06% 29293 CLINICAL TECHNOLOGIST, CONTROL TECHNICAL 4 0.05% 30239 CONTROL HEALTH THERAPIST TECHNICAL 6 0.08% 9514 DIETICIAN ----- TECHNICAL 10 0.13% TECHNICAL 2 0 03% 9516 DIETICIAN. PRINCIPAL ------10345 DIRECTOR: SOCIAL SERVICES. ASSISTANT ---TECHNICAL ·------1 0--.01% 30233 HEAL TH THERAPIST TECHNICAL 158 2 04% ------· ------31 '% 7812 INDUSTRIAL TECHNICIAN TECHNICAL ------24 -o 13 0.17%, 7836 INDUSTRIAL TECHNICIAN. CHIEF TECHNICAL - 7837 INDUSTRIAL TECHNICIAN, CONTROL --- TECHNICAL 4 005% TECHNICAL 3 0.04% 10967 LIASON OFFICER -·----· 8585 MEDICAL TECHNICAL OFFICER TECHNICAL 56 0.72% 8588 MEDICAL TECHNICAL OFFICER, CHIEF TECHNICAL 5 0.06% 10536 MEDICAL TECHNOLOGIST TECHNICAL 159 205% _?9309 MEDICAL TECHNOLOGIST, CHIEF TECHNICAL 17 0.22% 29317 MEDICAL TECHNOLOGIST. CONTROL TECHNICAL 7 0.09% 10342 SOCIAL WORKER TECHNICAL 29 0.37% 30231 STUDENT HEALTH THERAPIST TECHNICAL 82 1.06% !TECHNICAL Total I 645 8.32% Grand Total I 7756 \ 100.00%

Page 2

1 1

I I 1 1

I I

I I

_ _

,1 ,1

5751 5751

4821 4821

8J7 8J7

BS3 BS3

~~ ~~

193 193

965 965

942 942

930 930

944 944

937 937

8SO 8SO

829 829

990 990

4621 4621

930 930

386 386

596 596

5 5

8 8 1298 1298

1 1

6 6

2 2

~ ~

604821 604821

80 80

1~ 1~

53655

16 16

40241 40241

32 32

18 18

134141 134141

80 80

45 45

29266

84 84

180965 180965

1073101 1073101

160 160 321930 321930

101310 101310

321 321

321 321

WU/PERSON WU/PERSON

______

I I

r----

I I

14%1 14%1

19%) 19%)

09% 09% 19% 19%

03%1 03%1

05% 05%

56% 56%

28% 28%

19% 19%

14% 14%

37% 37%

09% 09%

18% 18% 88% 88% 67% 67%

05% 05%

46% 46%

53% 53%

19%1 19%1

79% 79% 12%1 12%1 .

.

.

.

33%1 33%1

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. .

.

05% 05%

51% 51%

23% 23%

76% 76%

.

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----+----~ ----+----~

·~0FTOTAL ·~0FTOTAL

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1 1

1 1

1 1

2 2

41 41 I I

4 4

ii ii

1 1

8 8 2 2

t t

3 3

7 7 1 1

4_ 4_

-

5 5

21 21

25 25

55 55

-+-

10 10

~ ~

36 36

19 19

47 47

-

24

560

248 248

176 176

17 17 124

930 930

1

-

,Tl ,Tl

,-:ftl ,-:ftl

JO% JO%

7.171 7.171

-

:;@ :;@

182~1 182~1

-

321 321

~~!~, ~~!~,

2366~ 2366~

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1 1

1 1

1 1

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1-

t

t

378, 378,

043 043

880 880

348 348

317 317

736 736 174 174

579 579

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220 220

554 554

715 715

372 372 889 889

978 978

909 909

736 736

510

233 233

290 290

6 6

4 4

7 7

t t 9298 9298

t t

5 5

6 6 0290 0290

7798 7798

:~~ :~~

4

48 48

40290 40290

14 14

24 24 80 80

21 21

10 10

ao579 ao579

2~~9

80579

JQ~17 JQ~17

40 40

120 120

_

241736 241736

241738

120 120

241 241

15801 15801 120889 120889

1

24 24

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I I

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6% 6%

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~7% ~7%

26% 26%

00%, 00%,

22% 22%

46

13% 13%

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14% 14%

75% 75% 04% 04%

44% 44%

13% 13%

40% 40%

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.

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56% 56%

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71% 71%

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3

6 6

6 6

40 40

58 58

17 17

10 10

f: f: t t

-

32 32 26 26

36 36

45 45

31 31

% %

44 44

640 640

e

196 196 .

T91 266 266

_

153 153

_

738 738

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313 313 . .

895 895

oJ6 oJ6

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241 241

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1 1 -- I I

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373 373

391 391

365 365

927 927

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927 927

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693 693

155 155

577 577

834 834

111 111

044 044

719 719

340 340 044 044

736 736

927 927

881 881

770 770

991 991

464 464

1 1

7 7

2748, 2748,

-

8821 8821

5 5

4240 4240

5 5

18 18

9

30385

30 30

54 54

45 45 12 12

28 28

13 13

91 91 26 26

60 60

36462 36462

49721 30365

109 109

546 546

273464

546 546

109365 109365

109385

546 546

5~:~~;1 5~:~~;1

273 273

--· --·

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4

4

10% 10%

19% 19% 19%

16 53% 53%

08

02% 02%

19% 19% 0!% 0!%

02%' 02%'

29% 29%

10% 10%

53% 53%

34% 34%

08% 08%

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72% 72% .

oe% oe% .

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61 61

1 1

1

5 5

2 2

1 1

5 5

6 6 0

5 5

9 9

2 2

18 18

74 18 18

0 0 10 10

30 30

12 12

21 21

62 62

2, 2,

43 43

11 11

41 41

_t _t

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93 93 15 15

16 16

39 39

43 43

199 199

43 43

BS6 BS6 129 129

107 107

.

741 741

552 552

1468 1468

027 027

23

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--

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M! M!

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1.

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1815

546 546

112

681436 681436

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POSTS(116/115)1 POSTS(116/115)1

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Page Page

f---· f---·

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1----

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L

!

1 1

1

2 2

1 1

63 63

76 76

38 38

~ 91 91

168 168

1

691 691

449 449

346 346

354 354

053 053

29 336 336

359 359 082 082

897 897

691 691

346 346

673 673

897 897 346 346

300 300 2 8

217 217

735 735

- 990

560 560

609 609

346 346

Appendix Appendix

292 292

411 411 691 691

953 953

622

-

3 3

6031 6031 6 6

3

.J:

8 8

8_1!)2 8_1!)2

8 8

--

18 18

11 11

15 15 16 16

88 88

33 33

68 68

18 18

40 40

31 31

58966 58966

40822 40822

16 16

2793

20 20

66336 66336

176 176

132673 132673 530 530

132 132

17

265 265

530 530

265 265

100

2BS 2BS

-

51Q6

265 265 530 530

--= --=

-

~

~

- _

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--

-

-

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-

WU/PERSON WU/PERSON

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---

---

=--

---

1-

I I

% %

% %

-

-

1% 1%

10

36% 36%

43 61% 61%

08% 08%

03% 03%

01% 01% 21% 21%

17% 17%

04% 04% 13% 13%

12% 12%

05% 05%

03% 03%

05% 05% 17% 17%

04% 04%

03% 03% 31% 31%

71% 71%

97% 97%

22% 22% 23% 23%

0

01%

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. 00% 00% 83% 83%

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83% 83%

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.

37% 37% 34% 34% .

.

.

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.

24% 24% .

. .

. 36% 36%

.

.

.

.

.

. . . .

.

.

.

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.

.

.

.

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.

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.

.

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0

0

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0 0

0 0

0

0

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0

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0

0

1935% 1935%

11

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-

-

--

Y.OFTOTAL Y.OFTOTAL

-

1 1

6 6 3 3 2 2

t t

8 8

t t

2 2

4 4 1 1

5 5

2 2

9 9

2 2

8 8

16 16

26 26

13 13

47 47

33 33 17 17

35 35

29 29

13 13

75 75 19 19 66 66

62 62 64 64

26 26

64 64

26 26

30 30

59 59

156 156

133 133

722 722

. 9% 9%

871 871

846 846

691 691

330 330

633 633

436 436 531 531

743 743

1501 1501

802 802

1.53 1.53

4 4

8

01% 01%

1 1

75 75

530 530

852 852

558 558

473 473

GSH GSH

POSTS(2/6/115) POSTS(2/6/115)

; ;

~

1993/94 1993/94

~~~~I

CATEGORY CATEGORY

STAY STAY

S S

DAYS DAYS

REPORT REPORT

OF OF

BEDS BEDS

UNIT

VISITS VISITS

COUNTS COUNTS

STAFF STAFF

Total Total Total Total

CPA CPA

ITS ITS

PATIENT PATIENT

MAN MAN

MAN MAN

MAN MAN

GEN GEN

GEN GEN

GEN GEN GEN GEN

GEN GEN

GEN GEN

GEN GEN

GEN GEN

GEN GEN

GEN GEN GEN GEN

GEN GEN

GEN GEN

GEN GEN GEN GEN

GEN GEN

GEN GEN

GEN GEN GEN GEN

GEN GEN GEN GEN

GEN GEN GEN GEN

GEN GEN

GEN GEN GEN GEN

GEN GEN GEN GEN GEN GEN

GEN GEN

GEN GEN

ADM ADM

GEN GEN

ADM ADM

ADM ADM

ADM ADM

ADM ADM

ADM ADM

ADM ADM

ADM ADM

ADM ADM

WORK WORK ADM ADM

ADM ADM

~~~~S~~~~~E ADM ADM STAFF/BED STAFF/BED

EMERGENCIES EMERGENCIES

VIS

HOME HOME

HEAD HEAD

IN IN

0CCUPANCY 0CCUPANCY

LENGTH LENGTH

ACTUAL ACTUAL

)

1

II II I I

C:;T:;::O:;::R------, C:;T:;::O:;::R------,

II II

1 1

OLOGY OLOGY

OFFICER OFFICER

DATABASE DATABASE

CLERK CLERK

-

VISITS VISITS

(DOCTORS/NURSES) (DOCTORS/NURSES)

-

II II I I

FOREMAN FOREMAN

I I

il il

-

-

-

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ASSISTANT ASSISTANT

--

CHIEF CHIEF

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SUPERINTENDENT SUPERINTENDENT

CLERK CLERK

-

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AID AID

VISITS VISITS

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TYPIST TYPIST

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II II

PORTER PORTER

GENERAL GENERAL

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HOSPITAL HOSPITAL

CLERK CLERK

STORESASSISTANT STORESASSISTANT

STORES STORES FOREMAN

ASSI I I

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11 11 ESSENGER ESSENGER

SENIOR SENIOR

CLAS!iN\JMBER/DESCRIPTION) CLAS!iN\JMBER/DESCRIPTION)

IB IB

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SUPERINTENDENT SUPERINTENDENT FOREMAN FOREMAN

, ,

M

GENERAL GENERAL

ARTISAN ARTISAN

ADMINISTRATIVE ADMINISTRATIVE

CHIEF CHIEF

-

, ,

DIRECTOR DIRECTOR

STORES STORES

SERVICES SERVICES

ADMINISTRATION ADMINISTRATION

TYPIST TYPIST

INFQRW.TION INFQRW.TION

ADMINISTRATION ADMINISTRATION

-----

: :

: :

POST POST

--

CHIEF CHIEF

PRINCIPAL PRINCIPAL

SENIOR SENIOR

PRINCIPAL PRINCIPAL

MESSENGER MESSENGER

SENIOR SENIOR TRADESMAN TRADESMAN

LAUNDRY LAUNDRY

PORTER

LABOURER!

ASO LINEN LINEN

SENIOR SENIOR

LAUNDRY LAUNDRY

FOOD FOOD PORTER

ARTISAN ARTISAN

~~~~~g::g:1 ~~~~~g::g:1 GROUNDSMAN GROUNDSMAN

GENERAL GENERAL

ARTISAN ARTISAN -----::0,:-U~T"'.P"Ac;T:;;IEC:N~T"'F"'A-;: CLEANER CLEANER

SECRETARY SECRETARY REGITTRYcii

GENERAL GENERAL

DATA DATA

GROUNDSMAN GROUNDSMAN

ARTISAN ARTISAN

CLEANER CLEANER

REGISTRY REGISTRY GENERAL GENERAL

ARTISAN ARTISAN CHIEF CHIEF

FOODSEiivicesA1o ADMINISTRATION ADMINISTRATION

~NAIDII

LINENSTORESASSISTANT LINENSTORESASSISTANT

ADMiNisTRATIVEOFFICER ADMiNisTRATIVEOFFICER

------

1 1

-

;----

7 7

5 5

5 5

-

......

,

960 960

961 961

-

1580 1580

1319ITYPIST

3845 3845

i32o]TYPIST i32o]TYPIST

2784 2784

27BSIDICTAPHONE 27BSIDICTAPHONE

18818 18818

- 10230

-

10220 10220

10092 10092

10199 10199

30187 30187 30204 30204

10123 10123 11558 11558

30121 30121 30197 30197

90231 90231

30184 30184

30182 30182

30189 30189

30196 30196

30178 30178

30190 30190 ~1]!8 ~1]!8 90271 90271

1 28967,ASD

28051 28051 30181 30181 28043 28043

301BSILABOURER 301BSILABOURER

30170 30170

-

2804

28959 28959

-

--

~SENIOR ~SENIOR

29168 29168

29212 29212

30191 30191

--

30200 30200

30179 30179

30199 30199

--

--

-

I!~::: I!~:::

t-- I I •

1 1

I I

I I

1 1

1 1

I I

I I

I I

930

= =

627 627

110 110

366 366

330 330

462 462

930 930

366 366

930

965 965

671 671

220 220

961 961

930 930

310 310

540 540

930 930

8472 8472

5 5

91961 91961

1769 1769

6998 6998

2367 2367

2 2

~: ~:

169441 169441

1 1

134141 134141

2421 2421

60462 60462

26 26

40241 40241 2421 2421

15 15

16944 16944 64 64

21 21

64 64

15330 15330

1~

20121 20121

321 321

160965, 160965,

3219301 3219301

64366 64366

321930 321930

321 321

160 160

321 321

107 107

321 321

321930 321930

321930 321930

321930 321930

321 321

WU/PERSON_ WU/PERSON_

1 1

I I

% %

% %

77% 77% 05%1 05%1

= =

05% 05%

19% 19%

12% 12%

56% 56%

37% 37%

96% 96%

23% 23%

05% 05%

70% 70%

. 93% 93%

66% 66% .

05% 05%

. 23% 23%

-

14% 14% 05% 05%

.

09%1 09%1

.

.

.

32% 32%

. 32% 32%

. 46% 46%

74% 74%

. 14% 14%

.

.

.

57% 57%

.

G8% G8%

.

05% 05%

05% 05%

18

.

16% 16% .

72% 72%

.

.

.

.

.

23% 23%

05% 05%

.

05% 05%

.

.

1

.

.

~

05

0

1 0

.

.

066%

.

.

0

.

009%1 009%1 0

.

0

0

0

0

0 .

1.63%1 1.63%1 2

0

0

0

0

0

a

2

6

6

O

0.74% 0.74%

0

0

0

9

6

6

0

0

0

0

15

22

1!:: 1!::

TOTAL TOTAL

----1------

OF OF

-

.,,. .,,.

1 1

--

1 1

1

+

4 4 8 8

1 1

5 5

1 1

5 5

1 1

21 21

1 1

1 1 1 1

38 38

3 3

12 12

1 1

2• 2• 1 1

15 15

5 5

21 21

19 19

1 1

63 63

351 351

46 46

16 16

2

,~ ,~

182 182

136 136

145 145

480 480

335 335

133 133

2:! 2:!

133 133

209 209

--

-

-

.::::_::_

-

--==21 --==21

--

~

-

__ __

• •

-----

~~~ ~~~

~ ~

-

-

-

--

os

--

-

______

I I

1 1

1

!-

r

r

-----·

.=--. .=--.

I I

-----· -----·

=---==-

,

34 34

~~

4

738

;!! ;!!

860 860

430 430

434 434

595 595

777 777

738 738

348 348

11. 11.

738 738

669 669

738 738

~ ~

669 669

-

490 490

831 831

670 670 736 736

434 434

;~~ ;~~

_

955 955

4740 4740

3430 3430

3 3

7798 7798

1

1439 1439

1 1

0 0

4933 4933

14220

60 60

1

13 13 3

80579 80579

26 26

16 16

40200 40200 3139 3139

11511 11511

60 60

-

48 48

-

2

10510 10510

14220 14220

60 60 241 241

60579 60579

241738

241 241

120 120

_l._~ _l._~

1

241 241

241 241

241738 241738

241 241

_ _

241138 241138

241738 241738

241_7

--

_

-·-

PERSON

/

-

----

----

· ·

-

______

__

WU

~~

-

1

______

·--

, ,

t=

-~_

-

~

-----

>---

---1 ---1

-

•

1

_i

-

I I

% %

-+

-

% %

_ _

3% 3%

%

-

% %

18% 18%

-

24%

04

39% 39%

0% 0%

26% 26%

16% 16%

3% 3%

79% 79% .

.

81% 81%

92% 92% .

04% 04%

22% 22%

36% 36%

· ·

04% 04%

.

15% 15% 09% 09%

04% 04%

.

09% 09%

37% 37% .

.

.

79% 79% M% M%

18

.

63% 63%

.

.

75

04

1 .

04% 04%

.

.

1

.

38% 38%

.

04% 04% .

.

.

.

04% 04%

.

0

. 2

. ~~:

.

04% 04%

075%

0

.

.

o]_~ o]_~ 0

0

.

O

0

1 0

.

0

0

0

2

0

0

0

1.01% 1.01% 9T2% 9T2%

__ __

7

0

2

5

- 0

0

1

0

0

~~ ~~

34_2%

0

· ·

0

o

15

1

21.62% 21.62%

1

~-

_

_()

......

o:i TOTAL TOTAL

__3_

--

-· -·

__ __

~~ ~~

OF OF

---

______-

--

-

-

-

---

.,,. .,,.

,

,

L L

, ,

-· -·

-

---

--

_ _

-= -=

______-

11

,_

,_

3 3

1 1

g g

4 4

1 1

3 3

I I 1 1

5 5

2 2

2 2

1 1

1~

3 3 1 1

51 51 18 18

11

4 4

1 1

1

·-

16 16

3 3

1 1

1

1 1

64 64

21 21

31 31

,1

49 49

_

2

FJ

_ _

78

77

_

-

132 132

2

493 493

381 381

2~ 2~

1

~ 3~

--

--

__ __

··--

__ __

---

--

__ __

---

316/•S) 316/•S)

--

-·-·-

--· --·

______

-

--

·-~ ·-~

--

-

----

------

-

POSTS(l POSTS(l

______

______

-:..-:..-_-_-~_-

1 1

-

t-== t-== ----· ----·

--

L

-·--- ______

~-

~~------

,_. ,_.

7

~ ~

2 2

2 2

2

!

796 796

091 091

044 044

071 071

927 927

927 927

636 636

~ ~

556 556

732 732

556 556

346 346

036 036

927 927

860 860

464 464

677 677

309 309

46

770 770

625 625

735 735

610 610

319 319

46

552 552 ~7 ~7

:

46

309 309

-

927 927

3 -

927 927

2 2

_305 _305

6927 3679 3679

5 5

~ ~

1 1

1 1

2 2 _

2 2

6434 6434 3695 3695

6 6

1

2 2

11 11

7703 7703

26 26

11162

_

4

4

3

3652 3652

22769 22769

27346 27346

6

2 2

3464 3464 21 21

27 27

2

3

91155 91155

60 60

49721 49721

_

7

36 36

~~+~ ~~+~

5469

546 546

3

136 136

46 46 546 546

546927 546927

182 182 273 273

1212

546927 546927

-

546927 546927

16

5~27

5

546 546

-

54

2

182309

-

__3

---io

---

. .

__ __

-

-

WU/PERSON WU/PERSON

I I

,

0 0

______

---

1 1

1

______

---

__ __ --

______

-

--

---

--4

______

. .

% %

% %

% %

4

-

~ ~

"'5 "'5

3

31%

51% 51%

21% 21%

02%

02%

79%J 79%J

02% 02%

02% 02%

56% 56%

39% 39%

32% 32%

26% 26%

43% 43%

42% 42% 32% 32%

06% 06%

72% 72%

02% 02%

36% 36%

.

40% 40% .

02% 02% .

10% 10% .

.

36% 36%

14% 14% 03% 03% .

.

18% 18% .

.

.

05% 05%

.

02% 02%

7

.

1

21% 21%

.

.

.

04% 04%

.

.

. 83% 83%

.

. 85

03 .

02% 02%

. 24% 24%

.

5~°'! 5~°'!

.

90% 90%

.

.

.

26% 26%

. 24°'! 24°'!

02% 02%

.

05% 05%

.

05% 05%

.

.

02% 02%

. 02% 02%

.

.

.

2

.

0 .

o . 1 0

0

. 0

.

0

.

0

.

0

.

0

2 .

1

H3% H3%

3

0

4 0

0

0

0

2

. . 0

0

0,24% 0,24%

0

0

0

0

e'.oo% 3

0

a

0

0

0

0

5

2

2

0

0

0

0

l~:~

14

_o

10

~ ~

1

-

TOTAL TOTAL __!l.

_J)

-

--

_2

-

-

-

_ _

--

______

OF OF

---

-

--

-

----· ----·

__ __

______

-_-=--:::-

% %

______

L L

_ _

-· -·

--

~

_

1 1

1 1

1 1

91

1 1

1 1

4 4

4 4

1 1

2 2

3 3

6 6

9 9

1 1 I I

1 1

2 2

I I

21 21

32 32

~ ~

,-3 ,-3

4 1 1

41 41 3 3

97 97

24 24

20 20

26 26

~ ~

65 65

25 25

20 20

11 11

_

15 15

71 71

53 53 144 144

1

15 15

214 214

146 146 294 294

875 875 3 3

419 419

200 200

675 675

-_·

99

--

-

_!!

-

_1

~! ~!

-

6/05) 6/05)

__ __

~2

/

_ _

~

~ ~

_ _

-·-

---

---

--

-

-

2 2

Ill Ill

----

-

-

-

-

______

-==-

---

--

______

--

--· --·

---

POSTS(l

-

-

-

1 1

1 1

1

______

Paoc Paoc

------

--

~

b

~---~ ~---~

_ _

-

1 1

2 2

9 9

1 1

6 6

1

3 3

1 1

9 9

38 38

36 36

06 06

36 36

-

4

73 73

1 11

1

9

1

691 691

966

69

4

44

163 163

6

054 054

119 119

740 740

740 740

691 691

897 897

674 674

300 300

3

69 Appendix Appendix

069 069

449

ti!::tl ti!::tl

~~ ~~

~~

7

408 408

44

530 530

379 379

~!~ ~!~

477 477

4

~!: ~!:

346 346

691 691

691 691

691 691

691 691

3359

1 1

3033 3033 1 1

5 5

3267 3267

1 1

83001 83001

6472 6472

-

3~9 3~9

3737 3737

1 1

~86~ ~86~

6171 6171

11056 11056

3

3

10 10

22 22 3~

1

58 58

06 06

1

88 88

06 06

06 06

17 17

15 15

16 16

-

16 16

-

53 53

68 68

88 88

35 35

1

1

35379 35379

-

1

530 530

530691

530 530

176 176

530 530

530691 530691

530 530 265 265

-

530 530

_

530691 530691

53069

~: ~:

_

265 265

530 530 265346 265346

530 530

530 530

530 530

-

~

-

_

--

--

-

_ _

-

-

-

-

WU/PERSON WU/PERSON

-

__ __

----

-_-=.. -_-=..

--

1 1

1 1

-

1=--. 1=--.

1

% %

% %

% %

%

1

1% 1%

1

% %

1

1

3% 3%

1

12% 12%

9% 9%

3

04% 04%

62% 62%

0

01% 01%

06% 06%

0 66% 66%

37% 37%

26% 26%

06% 06% 35% 35%

93%

93% 93%

1

0

00%

09% 09%

. 01% 01%

.

03% 03%

. 36% 36% .

.

06% 06%

.

.

11% 11% 01% 01%

HI% HI%

38% .

79% 79% .

2

.

. .

.

06% 06%

88% 88%

.

91% 91%

01% 01%

41% 41%

1

.

01% 01%

25% 25%

.

90% 90%

35% 35%

.

96% 96%

06% 06%

03% 03%

.

87% .

.

03% 03% .

03% 03% .

.

. 0

01% 01%

01% 01% .

.

.

.

.

.

.

. .

.

.

.

.

.

.

.

.

.

.

.

.

1

.

0

2

0

0

0

0

0

0

0 0

008% 008%

006% 006%

2

052% 052%

3

0

3 3

0.45% 0.45%

0

4

004% 004%

1.83% 1.83%

001% 001%

040% 040%

037% 037%

204~

0

0

1 0

0

1

0 1

0

3

5

1

0

0

1

0 0

0

1

0

0

0

0

0

0

0

0

001% 001%

1

16

12

16

14

TOTAL TOTAL

-

--

--

-

_-:_-_

OF OF

=--

--

.,,. .,,.

·-

1 1

1

I I

I I

1 1

1 1

4 4 1 1

I I

1 1

9 9

5 5

5 5

6 6

5 5

3 3

1 1

2 2

1 1 0 0

6 6

1

1 1

7 7

5 5 3 3

5 5 2 2

2 2 1 1 2 2

2

58 58

48 48

5

05 05

40 40

29 29

31 31

35 35 1

62 62

58 58

1

28 28

) )

09 09

02 02

86 86

15 15

1

175 175

1

1

305 305

305 305

317 317

142 142

14

559 559 1

30

00

417 417

260 260

145 145

29 29

13

1

111

1

152

2/6195

POSTS(

I I

GORY GORY

ATE

C

otal otal

STAFF STAFF

Total Total

To1al To1al

To!al To!al

Tolal Tolal

Total Total

T

Tolal Tolal

Total Total

Total Total

Total Total

A A

A A

T T

UP UP

UP UP EG EG

S

AN AN

AS AS

SUP SUP

SUP SUP

SUP SUP

SUP SUP

SUP SUP

SUP SUP

SUP SUP

SUP SUP

SUP SUP

SPE SPE SUP SUP

SUP SUP

SUP SUP

SPE SPE SPE SPE

S

S

SPE SPE

SUP SUP

SPE SPE

SPE SPE PHA PHA

R

REG REG PHA PHA

PAM PAM

PHA PHA

PAM PAM

PHA PHA

PHA PHA

PAM PAM

PAM PAM

PAM PAM PAM PAM

PAM PAM

PAM PAM

PAM PAM

PAM PAM

PAM PAM

PAM PAM

N NPR NPR

NST NST NST NST

NM

NMA NMA

NPR NPR

NMA NMA NM

NPR NPR

NMA NMA NAS NAS

NMA NMA N NAS NAS

MOF MOF MOF MOF

MOF MOF

MOF MOF

MAN MAN

MAN MAN

MAN MAN MAN MAN

MAN MAN MAN MAN

M MAN MAN

'

I

OFFICER OFFICER

AL AL

IP

SENIOR SENIOR

ICES ICES

C

, ,

V

R

DEPUTY DEPUTY

PRIN

SE

. .

ASSISTANT ASSISTANT

, ,

SENIOR SENIOR CHIEF CHIEF

S

, ,

, ,

PRINCIPAL PRINCIPAL

CHIEF CHIEF

. .

OR OR

OGY OGY

HIEF HIEF

SSOR SSOR

--

ICES. ICES.

ER. ER.

SUPERINTENDENT SUPERINTENDENT SENIOR SENIOR

. .

CER CER

NOL

SENI

HIEF HIEF

e:C:

SERVICE

, ,

C

L L

AUXILIARY AUXILIARY

_

-

SERV

OLOGIST OLOGIST

CHIEF CHIEF

A

MANAGER MANAGER

MANAGER

MANAGER

_

THERAPIST THERAPIST

THERAPIST THERAPIST

D D

TE

-

, ,

OFFI

CHIEF CHIEF

P

SUPERINTENDENT

SUPERINTENDENT SUPERINTENDENT

C

SUPERVISOR SUPERVISOR

_ _ _ MANAGER

MANAGER MANAGER

, ,

SUPERVISOR SUPERVISOR

(N~MBER/OESCRIPTION) (N~MBER/OESCRIPTION)

NURS

NURSE

NURSE NURSE

CI

-

TH TH

ER.PruNCIPAL ER.PruNCIPAL

SENIOR SENIOR

THERAPIST THERAPIST

ISE

N

_

I

TECHNOLOGY TECHNOLOGY

_

TECHNICIAN TECHNICIAN

R

---

JCESMANAG

TH TH

SOCIAL SOCIAL

NURSING NURSING

SPECIALIST SPECIALIST

_

P

: :

PROGRAMMER PROGRAMMER

HEAL HEAL

: :

HEALTH HEALTH

-:-DEF'IJTYC

. .

SERVICE SERVICE

-

SERVICE SERVICE

ASSISTANT PHOTOGRAPHER PHOTOGRAPHER

ASSISTANT ASSISTANT

CLASS CLASS

OFFIC

OFFICER

OFFICER OFFICER

-

N

THERAPIST THERAPIST

SPECL'.LIST

~

WORKER

WORKER WORKER

______

A

NURSE, NURSE,

NURSE NURSE

~

SPECIALIST/PROFE

SPECIAL

HEAL HEAL

l

SERVICES SERVICES

SERVICES SERVICES

ALPHARMA

SERVICES SERVICES

SERV

MEOICAL/OENTAL MEOICAL/OENTAL

-

~

INFORMATION INFORMATION

MEDICAL MEDICAL

ADMINISTRATION ADMINISTRATION

POST POST

: :

: :

: :

INIC

IETIC

-~~ -~~

INDUSTRIAL INDUSTRIAL

HOUSEKEEPING HOUSEKEEPING

FOOD FOOD

FOOOSERVICESSUPERVISOR

FOOD FOOD SPECIALIST SPECIALIST

FOOD FOOD PRINCIPAL PRINCIPAL CONTROL CONTROL

REGISTRAR REGISTRAR SENIOR SENIOR ENGINE£R e10METRICIAN e10METRICIAN

COMMUNJCATioN COMMUNJCATioN FOOD

STUDENT STUDENT DIRECTOR ENGINEER ENGINEER

CLINic:AL

SOCIAL SOCIAL

CHIEF CHIEF D

DRIVER DRIVER

CHIEF

SOCIAL SOCIAL DIETICIAN DIETICIAN OPTOMETRIST OPTOMETRIST

HEALTH HEALTH

CONTROL CONTROL

NURSING NURSING

CHIROPODIST CHIROPODIST STAFF STAFF

CHIEF CHIEF PROFESSIONAL PROFESSIONAL

STAFF STAFF

DIRECTOR

PROFESSIONAL PROFESSIONAL

NURSING NURSING

NURSING NURSING

MEDICAL MEDICAL

PROFESSIONAL PROFESSIONAL

MEDICALJOENTAL MEDICALJOENTAL

CL

NURSING NURSING MEDICAL MEDICAL

MEDICALJOENTAL MEDICALJOENTAL

MEDICAL MEDICAL

DIRECTOR DIRECTOR

OD ·

OD

00 NURSINGSERVICE NURSINGSERVICE

CHIEF CHIEF

I

I

I

I

1

1

1 1

2 2

1 1

91 91

40 40

476

851 851

652 652

1H9 1H9

176

7612 7612

6625 6625

3766 3766

3449 3449

6627 6627

644 2513 2513

6628 6628 2514 2514

4416 4416 6560 6560

9514 9514

1113

8234 8234

6583 6583

6226 6226

9518 9518

6269 6269

8266 8266 ~ ~ 6254 6254

8259 8259

6242

6287 6287 6216

6206

0

3646 3646

2776 2776

16463 16463

10344 10344 166 10345 10345

1034

91669 91669

30340 30340

21009 21009

30212 30212

-

23680 23680

30231 30231

28155 28155 30233 30233

-

105 30237 30237

30120 30120

23625 23625

26971 26971

-

6278 6278

~~,

-

-

-t-

-· -· 1

1 1

I I

I I

I I

I I

I I

l l

I I

1 1

I I

150 150

368 368

930 930

655 655

930 930

930 930

930 930

16771 16771

64386 64386 11101 11101

45990 45990

128771 128771

64 64

53 53

--

292681 292681

32193

80462 80462

26621! 26621!

321 321

3219301 3219301

321 321

321 321

321 321

WU/PERSON WU/PERSON

I I

I I

I I

-i----

00% 00%

. 23% 23%

33% 33%

16% 16%

23% 23%

05% 05%

28% 28%

51%1 51%1

.

05% 05% 19% 19%

.

48%1 48%1

.

56% 56%

05% 05%

.

.

.

05% 05%

.

.

.

.

.

.

.

893%1 893%1 1.35% 1.35%

0

0

1

0

005%1 005%1

0

0

0

o

o

0

0

100

TOTAL TOTAL

---+-----

OF OF

-

% %

1

' '

1 1

1 1

1 1

I I

7 7

5 5

5 5 0

11 11 1 1

6 6 0

1 1

1 1 4 4

29 29

-

25 25

10

E E

215

--

---+ ---+

--1----

--

~=---

------

~ ~

~ ~

--

==:D:l ==:D:l

---

_ _

-

-

-

-

---

-

--

--

::-

-

~-=---=--·- ~

-

-

~ 1-

!-

1

1

.J'OST~S) .J'OST~S)

1 1

"

-

4

~ ~

i i

10

25 25

106 106

~ 109 109

:1 :1

• • 381 381

~~

---

739

348 348

5

~'! 290 290

1 - ~3

~

689 689

--

8

73

0

15 15

~~

;~ ;~

41738 41738 ~

068

1

48 48

80579 80579

40 40

1

2

80579

80579 80579

2 ,.,,~ ,.,,~

24: 24:

241738 241738

~

241 241

120869 120869

18595 18595

1

120 120

--

-

~

241

---

--

--

-··

-

_ _

-_-_-

Wt.yPER~ON Wt.yPER~ON

' '

~

-

-

-

--

--

===

r r

1

~

·

I I

-

:: ::

--

~

% %

7%

-

70%

09%' 09%'

00% 00% 26% 26%

.

.

.

.

22 5

13% 13%

04% 04%

22% 22%

01

04% 04%

26% 26%

04% 04%

31%

.

~ ~ .

.

13% 13%

.

.

.

09% 09%

. -

.

. 09% 09%

09% 09%

0

- 0

0

~:;

.

.

. .

~:

1.45%

1 0

0

0 0

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0

0

0

o

0

0

0

o

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--

TOTA__l: TOTA__l:

QF QF

~=----::~

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----

! !

1

1----.Q

6 6

~ 2 2

I I

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1 1

5 5

1 1 0

5 5

3 3

6 6

1 1

16 16

7

2 2

2 2 -

2 2

-

"5 "5

13 13

33 33

23 23

-

19;

~l---

-

2280 2280

__!

_ _

__ __

----

----=---

-

---

----

-

-----

______

POSTS(1316/115) POSTS(1316/115)

---·-:-_

------

·=------==---=

1------

______

-

------

~ ~

+---

t t

I I

,

=

88 88

I.j

2

-

"'

n

921 921

782 782

9

927 927

e

732 732

036 036

927 927

927 927

927 927

577 577

'-'

1829 1829

-

5

-· -·

2309 2309 14 14 'c

32172 32172

78132 78132

~m ~m

80770 80770

10518 10518

21

21 21

54693 54693

23779 23779

68368 68368

20257 20257

73464 73464

138732 138732 ---

45 45

54

54~~~; 546 546

136 136

546 546

546 546

546 546 2734~

546 546

2

15

7 54s92

109365 109365

~6 ~6

--

-

-

-

--

. .

-----

. .

WU/PERSON WU/PERSON

---

_

______

--

__ __

% %

%

% %

: :

2%

0% 0%

2% 2%

~-

00% 00%

80% 80%

11% 11%

14% 14%

06%

59% 59%

27% 27%

02% 02%

~

4 .

.

.. ..

16

02% 02%

06% 06%

83 4

02% 02%

37 .

. 02% 02%

02% 02% .

.

.

08% 08%

03% 03%

4 .

:

03%1 03%1

19% 19% .

.

. .

.

. .

.

05% 05%

.

.

.

.

.

.

-

4

.

.

~~% ~~%

_ 0

0 M~ M~

0

~ 0

0

0

0

0

0

0

0

0

o. o.

0

0 0

0

o

0

0

0

100

--

TOTAL TOTAL

--

~ ~

-

~l

-

-

__ __

-

-

-

•/.OF •/.OF

-

---

~

_ _

-

______

)_ )_

, ,

i

1 1

1 1

1 1

4 4

7 7 0

9 9

1 1

6 1 1

1 1

0 0

4 4 0

6 6

2 5 5

,_

~ ~

17 17

2 2

/' /'

37 37 v v

'i'j_:"__J>

52 52

23 23

1

299 299

25

1

_ -

4

623 _2

-

_ _

2

--

--

. .

-

-

---

~ ~

----

--

:=--

--- 3 3

ltl ltl

·--

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---

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---

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POSTS(116/115) POSTS(116/115)

______

--

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=--..:_

. .

-

·-

-

-

-

-

f--

Page Page

, ,

I I

1 1

c

-r -r

1 1

8 8 4 4 1 1

7 7

1 1

J J

9 9

66 66

73 73

38

13

1

813 813 648 648

217

112 112

338 338

22

69

69

Appendix Appendix

741 741

424 424

44 336 336

346 346

69

673 673

897 897

673 673

873 873

822 822

-

-

I I

-t -t 3 3

2 2 6

2

2636 2636

4 4 4

266

8

75 75

31 31

756

06 06

4

u~ u~

1

06

2

11056 11056 8 8

23074 23074

8

33168 33168

66

1 66336

32 32

32 32

1 ~3oo

40 40

1

13

-

13~:;; 13~:;;

530691 530691

s30 s30 530 530

1

530691 530691

265 265

1

176697

176 176

530 530

132 132

530691

PERSON PERSON

-

/

-

WU

-

, ,

% %

% %

% %

% %

% %

% %

% %

% %

% %

1

1

1

1

1

5% 5%

6% 6%

1

0% 0%

1

22% 22%

05% 05%

0

30% 30%

74% 74%

1

57% 57%

21% 21% 54% 54%

10

06% 06%

62% 62%

01% 01% 03% 03%

.

37% 37% .

.

.

0

17 .

05% 05%

04% 04%

04,-o 04,-o

.

.

.

.

.

05% 05%

.

.4

.

.

.

.

.

.

.

.

,

.

.

415

2

009% 009%

0

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0

0

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0

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0

0

0

0

0

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0

0

0

0

0

0

0000% 0000%

10

1

TOTAL TOTAL

OF OF

. .

-;

-

·

1 1

1 1

7 7

5 5

1 1 1 1

7 7

2 2

5 5 4 4

4 4

1 1

8 8 2 2

1 1

2

8 8

4 4

4 4

17 17 1

16 16 56 56

23 23

24 24

4

23 23

63 63 36 36

48 48

13 13

29 29

159 159

-

322 322

199 199

833 833

7756 7756

POSTS(2/6/115) POSTS(2/6/115)

I I

I I

I I

I I

CATEGORY CATEGORY

Tot.11 Tot.11

STAFF STAFF

Tot.11 Tot.11

Tot.11 Tot.11

C C

c c

C C P P

P P

ec ec

EC EC

UP UP

r

TE

Gro1nd Gro1nd

TEC TEC

T

TEC TEC rec rec

TEC TEC

re rec rec

TEC TEC

rec rec

TEC TEC

rec rec SUP SUP TE

TEC TEC

TEC TEC

TEC TEC TEC TEC

TEC TEC SUP SUP

SUP SUP

SUP SUP TEC TEC

suP suP TEC TEC

SUP SUP

SUP SUP

SUP SUP

SUP SUP SUP SUP

SUP SUP SUP SUP

SUP SUP

SUP SUP

SU

SUP SUP

SUP SUP

SUP SUP

S

SU

SUP SUP

SUP SUP

SUP SUP

SUP SUP

SUP SUP

SUP SUP

SUP SUP

SUP SUP

SUP SUP

SUP SUP

SUP SUP

SUP SUP

1

T T

S

THETI

S

ASSISTANT ASSISTANT

, ,

T T

S

PRO

CE

ASSISTANT ASSISTANT

N

OFFICER OFFICER

. .

PROSTHETIST PROSTHETIST

AND AND

HIEF HIEF

THETIST THETIST

IEF IEF

C

SCIE

S

, ,

CH

R VICES

AND AND

, ,

I I

SUPERVISOR SUPERVISOR

PAL PAL

PAL PAL

CONTROL CONTROL

CHIEF CHIEF

CHIEF CHIEF

PROSTHETI CHIEF CHIEF

PRO

CONTROL CONTROL

CE

CONTROL CONTROL

CHIEF CHIEF

, ,

, ,

, ,

CI CI

~UPERVISOR ~UPERVISOR

SER

SERVICES SERVICES

, ,

• •

SENIOR SENIOR

:-

AND AND

AND AND

OFFICER OFFICER

OFFI

CONTROL CONTROL

CHIEF CHIEF

CONTROL CONTROL

NATURAL NATURAL

MANAGER MANAGER

. .

-

SENIOR SENIOR PRIN

ORTHOTIST ORTHOTIST CHIEF CHIEF

SENIOR SENIOR

, ,

, ,

GRADE GRADE

, ,

L L

, ,

, ,

SCIENTIST SCIENTIST

ORTHOTIST ORTHOTIST

TECHNICIAN

TECHNICIAN TECHNICIAN

SENIOR SENIOR

, ,

AUXILIARY AUXILIARY

AUXILIARY AUXILIARY

SENIOR' SENIOR'

SENIOR

TECHNICIAN, TECHNICIAN,

TECHNICIAN

MEDICAL MEDICAL

-

, ,

, ,

MEDICAL MEDICAL

LAUNDRY LAUNDRY

HOUSEKEEPING HOUSEKEEPING

CONTROLLER CONTROLLER

OFFICER, OFFICER,

OFFICER

OFFICER, OFFICER,

OFFICER OFFICER

: :

SUPERVISOR

SUPERVISOR SUPERVISOR MANAGER

TECHNOLOGIST TECHNOLOGIST

TECHNOLOGIST, TECHNOLOGIST, CLASS~UMBER/OESCRIPTION) CLASS~UMBER/OESCRIPTION)

TECHNOlOGIST

NATURAL NATURAL TECHNOlOGIST TECHNOlOGIST TECHNOLOGIST

PHYSICIST

TECHNOLOGIST. TECHNOLOGIST.

TECHNICA

PHYSICIST

TECHNOLOGIST

TECHNICAL TECHNICAL

PHYSICIST PHYSICIST ORTHOTIST ORTHOTIST

HOUSE HOUSE

HOUSE HOUSE

L

TOR" TOR"

TOR

MEDICAL MEDICAL

AL AL

SUPERVISOR

SUPERVISORYRIN

ICAL ICAL

POST POST

SPECIALISED SPECIALISED MEDICAL MEDICAL

MEDICA

SECURITY SECURITY

CLINICAL CLINICAL MEDICAL MEDICAL

SPECIALISED SPECIALISED SEAMSTRESS SEAMSTRESS MEDICAL MEDICAL

MEOICAL MEOICAL CLINICAL CLINICAL

PROGRAMMER PROGRAMMER

~~~~R~:~;~E~:;"!E ~~~~R~:~;~E~:;"!E

SECURITY SECURITY

NETWORK NETWORK

MEDICAL MEDICAL

ANIMAL ANIMAL

SECURITY SECURITY STOREKEEPER STOREKEEPER CLINICAL CLINICAL

MEDICAL MEDICAL

~:~~~~i::~:OR ~:~~~~i::~:OR

DIRECTOR MEDICAL MEDICAL CHIEF CHIEF

PRINCIPAL PRINCIPAL

INOUSmlAL INOUSmlAL

SECURITY SECURITY

PRINCiPAL PRINCiPAL

MEDICAL MEDICAL

ANIMAL ANIMAL SEAMSTRESS

LAUNDRY LAUNDRY

OPERATOR LINEN LINEN PRINCIPAL PRINCIPAL

LAUNDRY LAUNDRY

OPERA OPERA

LINEN LINEN

LAUNDRY LAUNDRY OPERA OPERA

CLINIC

3 3

82 82

874 874

878 878

585 585 914 914

1361 1361

1382 1382

3730 3730

0578 0578 8568 8568

8521 8521

9461 9461

2299 2299 7837 7837

':~ ':~

9'59MED

78361NOUSTRIAL

10558 10558

10558 10558

10578 10578

10536 10536

105991,AEDICALORTHOTIST 105991,AEDICALORTHOTIST

1

29293 29293 30206 30206

29285 29285

28079 28079

211701 211701 28687 28687 -

29693 29693 29309 29309

29257 29257

29527 29527

90272 90272

28075 28075 29555 29555 29317 29317 28783 28783

29531 29531 91886 91886

24070 24070

!~: !~: 1

-

~

-

9305 9305

0

~ ~ 8

113

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1 1

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, ,

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1 1

1 1

27 27

417 417

810 810

· ·

-· -·

716 716

873 873

336 336

873 873

455 455

3 3

-·--1 -·--1

8155 8155

5 5

11

1 1

18004 18004

40009 40009

80019 80019

80010 80010

eoo19 eoo19

40009 40009

20005 20005

8001g 8001g

18004 18004

20873 20873 26 26

--

80019 80019

13 13

28 28

40009 40009

~ ~

~ ~ ~ ~

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27% 27%

: : 88% 88%

14'719

85% 85%

27% 27%

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54% 54% ...... 14 14

14% 14%

77% 77%

41% 41% --·· --··

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82%1 82%1 41%1 41%1

.

. .

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. ~;-.;.I ~;-.;.I

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47%1 47%1 .

.

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.

0 0.14% 0.14%

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11J 11J

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178 178

271 271

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267 267

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813 813

358 358

267 267

390 390

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7 7

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3633 8118

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16 16

27 27

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15581 15581

36 36

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21281 21281

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12115 12115

108 108

216 216

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POSTS(2111419SJ POSTS(2111419SJ

----

-_ -_

-=-

--

1 1

i i

i

1 1

1 1

! !

Appendix Appendix

67 67

9 9

709 709

382 382

4 382 382

691 691

A46 A46

564 564

1170 1170

846

382 382

564 564

8461 8461

362

217

891 891

564 564

564 564

8171 8171

338 338

726 726

255 255

691 691

709 709

258 258

217 217

-111/11 -111/11

-1:",', -1:",',

4 4

125

7 7

13 13

23 23

20 20 JO JO

74 74

30 30 l

61 61

11 11

23 23

20 20

30 30 20 20

61 61

20 20

11 11

13 13

61 61

1

123 123

1

30846 30846

123 123

12 12

--

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1 1

1 1

1 1

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1 1

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:

59% 59%

39% 39%

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18% 18%

72% 72%

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0

6

0

0

17

11

TOTAL TOTAL

%OF %OF

, ,

J J

~ ~

1 1

9 9

·

11 11

6 6

6 6

9 9

7 7

:•

11 11

10 10

. 17 17 11 11

29 29

98 98

31 31

264 264

170 170

. 151 151

4

382 382

256 256

471 471

837 837

353 353

1.30 1.30

4

28% 28%

84% 84%

23 23

62 62

69 69

1

1

108684

220 220

RXCH RXCH

POSTS(11619S) POSTS(11619S)

S S

1993/94 1993/94

COUNTS COUNTS

CATEGORY CATEGORY

STAY STAY

DAYS DAYS

REPORT REPORT

OF OF

BEDS BEDS

HEAD HEAD

UNITS UNITS

VISITS VISITS

/

COUNTS COUNTS

STAFF STAFF

Tolal Tolal

Tolal Tolal

CPA CPA

N N

N N

ITS

PATIENT PATIENT

IN IN

S

I

MAN MAN

GEN GEN MAN MAN

GEN GEN

MAN MAN

GEN GEN

GEN GEN

GEN GEN

GEN GEN

l:t l:t

GEN GEN GEN GEN

GEN GEN

C

GEN GEN

GLN GLN

GEN GEN

GEN GEN GEN GEN

GEN GEN GEN GEN

GEN GEN GEN GEN

GEN GEN

GEN GEN GEN GEN

GEN GEN

GEN GEN

GEN GEN GEN GEN

GE

GEN GEN

ADM ADM GEN GEN

GEN GEN

ADM ADM GEN GEN

ADM ADM

ADM ADM

ADM ADM

ADM ADM

ADM ADM

ADM ADM

ADM ADM

ADM ADM

ADM ADM

ADM ADM

STAFF/BED STAFF/BED

EMERGENCIES/VISIT

EMERGENCIES EMERGENCIES WORK WORK

HOME HOME

HEAD HEAD

IN IN

V

VISITS VISITS

LENGTH LENGTH

OCCUPANCY OCCUPANCY ACTUAL ACTUAL

,

--i --i

______

I I II II

T0RS1NURSES) T0RS1NURSES)

II II I I

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DATABASE DATABASE

OFFICER OFFICER

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CLERK CLERK

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FOREMAN FOREMAN

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TECHNOLOGY TECHNOLOGY

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ASSISTANT ASSISTANT

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I I I I

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11 11

ASSISTANT ASSISTANT

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MESSENGER MESSENGER

GENERAL GENERAL

ARTISAN ARTISAN

CHIEF CHIEF

DIRECTOR DIRECTOR

STORES

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SERVICES SERVICES

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ADMINISTRATION ADMINISTRATION

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TYPIST TYPIST

INFORMATION INFORMATION

ADMINISTRATION ADMINISTRATION

N N

: :

: :

POST POST

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MESSENGER MESSENGER

SENIOR SENIOR

PORTER

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LINE

SENIOR SENIOR ASD

PRINCIPA

LAUNDRY LAUNDRY

FOOD FOOD PORTER PORTER

SENIOR SENIOR

TRADESW.NAIDtt TRADESW.NAIDtt

LINEN LINEN

ASD

PRINCIPAL PRINCIPAL

GROUNDSMAN GROUNDSMAN

LABOURER LABOURER

HOUSEHOLD HOUSEHOLD GENERAL GENERAL TRADESMAN TRADESMAN

LAUNDRY LAUNDRY

FOOD FOOD GENERALSTORES GENERALSTORES

LABOURER LABOURER

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ARTISAN(B ARTISAN(B GROUNDSMAN GROUNDSMAN

REGISTRY REGISTRY

CLEANER CLEANER GENERAL GENERAL

TYPIST, TYPIST, ARTISAN ARTISAN

DICTAPHONE DICTAPHONE

TYPIST TYPIST

REGISTRYCLERK CLEANER CLEANER

DATA DATA

CHIEF CHIEF

ADMINISTRATIVE ADMINISTRATIVE

ADMINISTRATION ADMINISTRATION

HOUSEHOLD HOUSEHOLD

I I

I I

ct-----

5

15 15

194 194

193 193

181 181

960 960

~ii ~ii

-,

,

3845 3845 1320 1320

2785 2785

8959 8959

ll61 ll61

18618 18618

10220 10220

10092IARTISAN 10092IARTISAN

11560 11560 10199IART1SAN 10199IART1SAN

30187 30187

30204 30204 10123 10123

00231 00231

30184 30184

30182 30182 30200 30200

30189 30189 :io1:i1 :io1:i1

30178 30178

30196 30196

30188 30188 28047 28047

30

301m 301m

28051 28051 28967 28967

30199 30199 28043 28043 30181 30181

JO JO

30185 30185

1111271 1111271

11558 11558

30170 30170 30179 30179

29212 29212

2!~~ 2!~~

29168 29168

2

.

- 10230 10230

2!) 30187 30187

-

I I 1--~-----,,D-U 1--~-----,,D-U

I I

I I

I I 1 1

019 019

338 338

078 078

810 810

078 078 861 861

640 640

952 952

953 953

759 759

3

019 019

3 3

3 3

1177 1177

1 1

1111 1111

8002 8002

1 1

13 13 60 60

600191 600191

20005 20005

2 2

16004 16004

18004 18004

-

40009 40009

40009 40009

20005 20005

60019 60019

40009 40009

60019 60019

60 60

~ ~

~ ~

~ ~

~ ~

~ ~

~ ~

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26 26

21 21

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68

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10 10

72 72

43

41 41

64 64

3~1 3~1

29 29

11

125 125

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78 78

7 7

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178

797 797

067 067 1

907 907

416 416

267 267

533 533

......

915 915

' ' 633 633

00

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067 067

039 039

593 593

604 604

940 940

069 069

633 633

067 067

356 356

732 732

060 060

636 636

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49 49

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105 105

164 164

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524 524

607 607

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305 305

524 524

262

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183 183

504 504

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867 867

311 311

232 232

177 177

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303 303

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262 262

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27066 27066 8524 8524

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6186 6186

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8368 8368

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2 72 72

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218 218

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108 108

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216 216

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1 45 45

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183 183

116 116

184 184

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POS!S(28/4/05)

-- -·-----

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----

1 1

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---

1 1

1

1

1 1

2 2

2 2

7 7

9 9

1 1

Appendix Appendix

1 1

07 07

17 17

1

17 17

2

43

29 29

27 27

382 382 07 07

4

38

626 626

382 382

38

382 382

382 382

676 676

382 382

419 419

~ 338 338

626 626

2

~:~ ~:~ 2

2

382 382

2

1

382 382

69

127 127

542 542

062 062

577 577 629

817 817 382

364 364

494 494 36

113 113

393 393

127 127

4

564 564

427 427

382

3

3 3

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3 6 3

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3709 3709

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2

11 11 23 23 1

24 24

23 23

2 41 41

61 61

1

123 123

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1

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1

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41 41

41 41

~~~ ~~~

23382 23382

123 123

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123 123 t23 t23

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37% 37%

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TOTAL TOTAL

OF OF

% %

1 1

1 1

1 1

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1 1

I I

6 6

7 7

0 0

1 1

3 3

2

3 3

6 6

1 II II

2

t1 t1

11 11

14 34 34

St St

55 55

34

19 19

34 34

14 14

60 60

5

2

63 63

28 28

36 36

30

114 114

1

214 214

342 342

3

POSTS(1/6195) POSTS(1/6195)

CATEGORY CATEGORY

l l

a

lal lal

o

STAFF STAFF

Total Total

T

To1al To1al

Total Total

Total Total

Total Total

Total Total Total Total

To1

Total Total

A A

E E

S S

UP UP

PE PE

ST ST

S

SUP SUP

SUP SUP

SUP SUP

SUP SUP SUP SUP

SUP SUP

SUP SUP

SUP SUP

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SUP SUP

SP SUP SUP

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SPE SPE

S

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SPE SPE

SPE SPE

SPE SPE REG REG

REG REG

PHA PHA

PHA PHA

PMA PMA

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PAM PAM

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PAM PAM

PAM PAM

PAM PAM

PAM PAM

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PAM PAM

PAM PAM

PAM PAM

PAM PAM

PAM PAM

PAM PAM

NST NST

NPR NPR

N

NST NST

NPR NPR

NM

NMA NMA

NMA NMA

NAS NAS NPR NPR

MOF MOF NMA NMA

NMA NMA

NA

NMA NMA MOF MOF

NAS NAS

MOF MOF

MOF MOF

MAN MAN

MAN MAN

MAN MAN

MAN MAN

MAN MAN

MAN MAN

MAN MAN

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OFFICER OFFICER

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SERVICE

_ _

CH1EF CH1EF

SERVICES

PRINCIPAL PRINCIPAL

CHIEF CHIEF

MANAGER

MANAGER MANAGER

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= THERAPIST THERAPIST

TECNOLOGY TECNOLOGY

OFFICER OFFICER

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SUPERINTEN

SUPERINTEN

SUPERVIS

SUPERVISOR

rv MANAGER, MANAGER,

MANAG

MANAGER =

SUPERVISOR SUPERVISOR

(NUMBER/DESCRIPTION) (NUMBER/DESCRIPTION)

NURSE

NURSE NURSE

NURSE

u

~

TH TH

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SENIOR SENIOR

THERAPIST THERAPIST

P

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TECHNOLOGY TECHNOLOGY

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TECHNICIAN TECHNICIAN

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NURSING NURSING

SPECIALIST SPECIALIST

PHARMACIST PHARMACIST

~

PRINCIPAL PRINCIPAL

.

PROGRAMMER PROGRAMMER : :

: : R R

HEAL HEAL

_

~ SERVICE SERVICE

SERVICE SERVICE

PHARMACOLOGIST PHARMACOLOGIST SERVICE SERVICE

PHOTOGRAPHER PHOTOGRAPHER

ASSl~NIOR ASSl~NIOR

ASSISTANT ASSISTANT

CLASS CLASS

OFFICER OFFICER

OFFICER, OFFICER,

OFFICER RVICES RVICES

-

THERAPIST THERAPIST

SPECIALIST SPECIALIST

PHARMACIST PHARMACIST

WORKER WORKER

-

NURSE NURSE

SPECIALISEDAUXi

SPECIALIST/PROFESS

SERVICES SERVICES

SERVICES SERVICES

SERVICES SERVICES

SERVICES SERVICES

HEALTH HEALTH

MEDICAL/DENTAL MEDICAL/DENTAL

TH TH

INFORMATION INFORMATION

MEDICAL MEDICAL

ADMINISTRATION ADMINISTRATION

POST POST

: :

: :

: :

ROFESSIONAL ROFESSIONAL

INDUSTRIAL INDUSTRIAL FOOD FOOD SENIOR

HOUSEKEEPING HOUSEKEEPING SOCIAL SOCIAL

FOOD FOOD

CONTROL CONTROL

CHIEF CHIEF

PRINCIPAL PRINCIPAL

SENIQR SENIQR SPECIALIST SPECIALIST FOOD FOOD

FOOD FOOD CLINICAL CLINICAL

COMMUNICATION COMMUNICATION

ENGINEER ENGINEER

DIETICIA~ DIETICIA~

BIOMETRICIAN BIOMETRICIAN

CHIEF CHIEF

CLINICAL CLINICAL PRINCIPAL PRINCIPAL

HEAL HEAL DRIVER DRIVER

DIETICIAN DIETICIAN

DIRECTOR

CONTROL CONTROL OPTOMETRIST OPTOMETRIST

CHIROPODIST CHIROPODIST

STAFFNURSE, STAFFNURSE,

CHIEF CHIEF

R~ ENG1NEER

NURSING NURSING

DIRECTOR

NURSING NURSING

NURSING NURSING

PROFESSIONAL PROFESSIONAL

NURSING NURSING

MEDICAL MEDICAL

DIRECTOR DIRECTOR

MEDICAL MEDICAL

MEDICAL/DENTAL MEDICAL/DENTAL

DD

MEDICAL/OENTAL MEDICAL/OENTAL

DD

00

CHIEF CHIEF

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338 338

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POSTS(1/6/95)

CATEGORY CATEGORY

Total Total

STAFF STAFF

Total Total

Total Total

C C

C C

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P P

C C

P P C C

C C C C

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I

N

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S S

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CHIEF CHIEF

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C

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CHIEF CHIEF

I

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OR OR

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CHIEF CHIEF

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CHIEF CHIEF

-

I I

. . CHIEF CHIEF

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CONTROL CONTROL

CHIEF CHIEF

NATURAL NATURAL

MANAGER MANAGER

CONTROL CONTROL

ORTHOTIST ORTHOTIST

SENIOR SENIOR

PRINCIP

CHIEF CHIEF

SENIOR SENIOR

PRINCIPAL PRINCIPAL

, ,

, ,

, ,

, , , ,

, ,

SCIENTI

GRADE GRADE

TOR, TOR,

jNUM!!ERIDESCRIPTION) jNUM!!ERIDESCRIPTION)

EEPING EEPING

CHIEF CHIEF

ORTHOTIST ORTHOTIST

fECHNICIAN fECHNICIAN

TECHNICIAN

, ,

K

SENIOR SENIOR

, ,

AUXILIARY AUXILIARY

SENIOR SENIOR

SENIOR" SENIOR"

TECHNICIAN

TECHNICIAN

CHNOLOOIST

MEDICAL MEDICAL

MEDICAL MEDICAL

HOUSEKEEPING HOUSEKEEPING

LAUNDRY LAUNDRY

OFFICER

OFFICER, OFFICER,

CONTROLLER CONTROLLER

OFFICER

: :

OPERA OPERA

OPERATOR OPERATOR

OPERATOR

SUPERVISOR SUPERVISOR

MANAGER SUPERVISOR

OUSE

TECHNOLOGIST, TECHNOLOGIST,

TECHNOLOGIST TECHNOLOGIST

TECHNOLOGISf TECHNOLOGISf

TECHNOLOGIST

TECHNOLOGIST, TECHNOLOGIST,

PHYSICIST, PHYSICIST,

TECHNOLOGIST TECHNOLOGIST ORTHOTIST ORTHOTIST

PHYSICIST PHYSICIST

ORTHOTIST ORTHOTIST

TECHNICAL TECHNICAL

PHYSICIST

NATURAL NATURAL

TECHNICAL TECHNICAL

CLASS CLASS

.

TE

HOUSE HOUSE

HOUSE HOUSE

L

OFFICER OFFICER

H

TOR" TOR"

MEDICAL MEDICAL

AL

SUPERVISOR SUPERVISOR

SUPERVISOR

SUPERVISOR

POST POST

PRINCIPAL PRINCIPAL

MEDICAL MEDICAL

MEDICAL MEDICAL

MEDICAL MEDICAL MEDICAL MEDICAL

MEDICAL MEDICAL MEDICAL

CHIEF CHIEF

SECURITYGUARD SECURITYGUARD

MEDICAL MEDICAL

CLINICAL CLINICAL STOREKEEPER

MEDICA DIRECTOR

SPECIALISEOAUXILIARY SPECIALISEOAUXILIARY

MEDICAL MEDICAL

CLINICAL CLINICAL SECURITY SECURITY

MEDIC

CLINICAL CLINICAL SECURITYOFFICERGRADE SECURITYOFFICERGRADE

STOREKEEPER STOREKEEPER ANIMAL ANIMAL

SENIOR SENIOR

CLINICAL CLINICAL

SECURITY SECURITY

TELEKOM TELEKOM SPECIALISED SPECIALISED SEAMSTRESS

ANIMAL ANIMAL

SECURITY SECURITY

TELEKOM TELEKOM SEAMSTRESS SEAMSTRESS

PROGRAMMER PROGRAMMER

NETWORK NETWORK

OPERATOR, OPERATOR, LINEN LINEN PRINCIPAL PRINCIPAL

LINEN LINEN

OPERA OPERA LIASON LIASON PRINCIPAL PRINCIPAL

OPERATOR, OPERATOR, LINEN LINEN

LAUNDRY LAUNDRY

INDUSTRIAL INDUSTRIAL

LAUNDRY LAUNDRY

INOUSTRIAL INOUSTRIAL

LAUNDRY LAUNDRY

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Appendix Appendix

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PAARL PAARL

PosTs128/4/951 PosTs128/4/951

I I

1993194 1993194

COUNTS COUNTS

CATEGORY CATEGORY

STAY STAY

IESNISITS IESNISITS

DAYS DAYS

C

REPORT REPORT

OF OF

BEDS BEDS

BED BED

UNITS UNITS

VISITS VISITS

/

COUNTS COUNTS

STAFF STAFF

Total Total

Total Total

CPA CPA

N N

PATIENT PATIENT

EN EN

EN EN EN EN

EN EN EN EN

OME OME

GEN GEN

MAN MAN

GEN GEN MAN MAN

GEN GEN

MAN MAN GEN GEN

GEN GEN

GEN GEN

GEN GEN

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G

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GC

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GEN GEN

GEN GEN

GEN GEN

GEN GEN

GEN GEN

GEN GEN

GEN GEN

ADM ADM GEN GEN

ADM ADM GEN GEN

ADM ADM

GEN GEN

ADM ADM

ADM ADM

ADM ADM

ADM ADM

ADM ADM

ADM ADM

ADM ADM ~~~ ~~~

STAFF

WORK WORK

VISITS/HEAD VISITS/HEAD EMERGENCIES EMERGENCIES

EMERGEN

HEAD HEAD

VISITS VISITS

LENGTH LENGTH

IN IN

OCCUPANCY OCCUPANCY

ACTUAL ACTUAL

/

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I I

S

TANT TANT

FOREMAN FOREMAN

II II

I I

TECHNOLOGY TECHNOLOGY

S

I

ASSISTANT ASSISTANT

AS

FOREMAN FOREMAN

SUPERINTENDENT SUPERINTENDENT

CLERK CLERK

II II

I I

II II

I I

AID AID

AID AID

(NUMBER/DESCRIPTION) (NUMBER/DESCRIPTION)

SS

VISITS VISITS

-P-AT_I_E_N_T_F_A_C~TO-R------,1 -P-AT_I_E_N_T_F_A_C~TO-R------,1

A

ASSISTANT ASSISTANT

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TION TION

AID AID

AID AID AID AID

AID AID

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MA MA

II II

I I

PORTER PORTER

GENERAL GENERAL

HOSPITAL HOSPITAL

STORES STORES

STORES STORES

ASSISTANT ASSISTANT

FOREMAN FOREMAN ASSISTANT ASSISTANT

11 11

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SENIOR SENIOR

CLASS CLASS

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(B (B

(A (A

HOME HOME

OR OR

. .

MESSENGER MESSENGER ARTISAN ARTISAN

GENERAL GENERAL

DIRECTOR DIRECTOR

STORES STORES

STORES STORES

SERVICES SERVICES

SERVICES SERVICES

INF INF

ADMINISTRATION ADMINISTRATION

SAN SAN

: :

: :

POST POST

-

SENIOR SENIOR

SENIOR SENIOR

CHIEF CHIEF ASD

SENIOR SENIOR

TRADESMAN TRADESMAN

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PRINCIPAL PRINCIPAL

MESSENGER MESSENGER

-

LAUNDRY LAUNDRY

PRINCIPAL PRINCIPAL

LINEN LINEN

GROUNDSMAN GROUNDSMAN LABOURER LABOURER

LINEN LINEN

LABOURER LABOURER

LAUNDRY LAUNDRY

FOOD FOOD

GENERAL GENERAL AR_II HOUSEHOLD HOUSEHOLD

GENERAL GENERAL ARTISAN ARTISAN CLEANER CLEANER HOUSEHOlD HOUSEHOlD

CLEANER CLEANER

ARTISAN ARTISAN

FOOD FOOD

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0194 0194

186_!8 186_!8

10230 10230

10220 10220 10199 10199

30121 30121

30187 30187 10123 10123

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30204 30204

30196 30196

10092 10092 28051 28051

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30178 30178

26047 26047

30170 30170 30185 30185

30182 30182

90231 90231

30199 30199

30168 30168

30169 30169 30184 30184

30181 30181 90271 90271

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POSTS(28/4195) POSTS(28/4195)

-

' '

I

-

ATEGORY ATEGORY

C

STAFF STAFF

Total Total

Total Total

Total Total

Total Total

Total Total

Tolal Tolal

Total Total

Total Total

Total Total

Total Total

P P

P P

A A

M M

UP UP

UP UP

UP UP

ST ST

SUP SUP

SUP SUP

SUP SUP

S

SUP SUP

SUP SUP

S

SU

SU

SUP SUP

SUP SUP

SUP SUP

SUP SUP

S

SPE SPE

SUP SUP

SPE SPE SPE SPE

SPE SPE

PHA PHA

SPE SPE SPE SPE

REG REG

REG REG PHA PHA

PHA PHA

PAM PAM

PHA PHA

PAM PAM

PHA PHA

PAM PAM

PAM PAM PAM PAM

PAM PAM

PA

PAM PAM

PAM PAM

PAM PAM

PAM PAM

PAM PAM

N

NST NST NST NST

NMA NMA NPR NPR

NMA NMA

NMA NMA NPR NPR NPR NPR

NM

NAS NAS

NAS NAS

NMA NMA

NAS NAS

NMA NMA

MOF MOF

MOF MOF

MOF MOF

MOF MOF

MAN MAN MAN MAN

MAN MAN

MAN MAN

MAN MAN

MAN MAN

MAN MAN

MAN MAN

CER CER

I

OFF

AL AL

IP

CES CES

SENIOR SENIOR

I

iEN~T iEN~T

1

C

, ,

N

OR OR

NI

DEPUTY DEPUTY

PRI

SERV

, ,

, ,

SE

CHIEF CHIEF

, ,

PRINCIPAL PRINCIPAL

CHIEF CHIEF

ENDENT ENDENT

, ,

CES

I

SOR

SOR SOR

I I

GER, GER,

ER: ER:

NIOR NIOR

INTENDENT

INT

V

CHIEF CHIEF

, ,

SE

AG

T T

SERV

, ,

HIEF HIEF ANAGER ANAGER

CHIEF CHIEF

AUXILIARY AUXILIARY

SE

S

N N

PRINCIPAL PRINCIPAL

C

G G MANA

MANAGER

M

ST ST

UPER

LI

I

TECNOLOGY TECNOLOGY

OFFICER OFFICER

, ,

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SUPER

SUPER

SUPERV

MANAGER S

MAN

MANAGER MANAGER

IN

;i;A~Es~~~!~:;:~

SUPERVISOR SUPERVISOR C

1

N N

NUR

S

LIST LIST

A

CIA

CIST CIST

ICE ICE

G G

E

IA

N

TECHNOLOGY TECHNOLOGY

TECHNICIAN TECHNICIAN

T T

DEPUTY DEPUTY

NUR

SP

PHARMACIST PHARMACIST

, ,

S

PROGRAMMER PROGRAMMER

I

EPI

ONAL ONAL

CIAN CIAN

PHARMACOLOGIST PHARMACOLOGIST

SERV PHOTOGRAPHER PHOTOGRAPHER

SERVICE SERVICE

SERVICE SERVICE

ASSISTANT

ASSISTANT ASSISTANT

I

OFFICER

OFFICER

ST ST

OFFICER OFFICER

AR AR

C

SPEC

PHARM

UDENTAL UDENTAL

G G

G G

G G

OR: OR:

SS

SPECIALISED SPECIALISED

SPECIALIST/PROFESSOR SPECIALIST/PROFESSOR

PHARMA

SERVICES SERVICES SERVICES SERVICES

SERVICES SERVICES

SERVICES SERVICES

SERVICES SERVICES

IPAL IPAL

IPAL IPAL

FORMATIO

C

CAL CAL

CAL CAL

C

CAL CAL CAUDENTAL CAUDENTAL

ISTR

N

SING SING

I

MEDICAL MEDICAL

ADMINISTRATI

USTRIAL USTRIAL

EF EF

I

:

: :

: :

EDI

HOUSEKE IND

FOOD FOOD

BIOMETRI

PRIN

SENIOR SENIOR FOOD FOOD ENGINEER

CLINICAL CLINICAL

DRIVER DRIVER

CHIEF CHIEF

SPECIALI

CHIEF CHIEF

PRIN

SENIOR SENIOR

FOOD FOOD CONTROL CONTROL

PHARMA

COMMUNICATION COMMUNICATION

ENGINEER ENGINEER CLINICAL CLINICAL

CH

NURSIN

FOOD FOOD

FOOD FOOD

NURSIN

NURSIN

PROFE

DIRECT

NURSING NURSING

NUR

MEDI

MEDI

MEDI MEDICA

DD

DD

DD

DIRECTOR DIRECTOR

CHl:~~~~1~:5cD

M

4 4

5 5

4 4

9 9

009 009

!152 !152

-

1660 1660 1749 1749

17~1 17~1

7812 7812

8828 8828

3449 3449

3788 3788 8825 8825

6-441 6-441

8827 8827 8891 8891 3585 3585 2513 2513

11~~ 11~~

6287 6287

6218 6218

6269 6269

3646 3646

0120 0120 2776 2776

16-463 16-463

30340 30340

30212 30212

28155 28155

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26971 26971

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6200 6200

251

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6278 6278

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111 111

246 246

616 616

082 082

232 232

4 4

1232 1232

12 12

30 30

30618 30618

122481 122481

81232 81232

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81 81

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Appendix Appendix

-

---

1',0FTOTAL 1',0FTOTAL

[ [

1

1

1

8 8

11 11

-

6

732 732

_J_~ _J_~

e

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POSTS(28/4195) POSTS(28/4195)

CATEGORY CATEGORY

Total Total

STAFF STAFF

Total Total

Total Total

C C

C C

C C

TEC TEC

TEC TEC TEC TEC

TEC TEC TEC TEC

TEC TEC

Grand Grand TEC TEC

TEC TEC

TEC TEC TEC TEC TEC TEC

TEC TEC TEC TEC

TE SUP SUP TEC TEC

TE

TEC TEC TEC TEC SUP SUP

TE SUP SUP

TEC TEC

SUP SUP SUP SUP

SUP SUP TEC TEC

SUP SUP SUP SUP

SUP SUP SUP SUP

SUP SUP SUP SUP

SUP SUP

SUP SUP

SUP SUP

SUP SUP

SUP SUP SUP SUP

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SUP SUP SUP SUP

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SUP SUP SUP SUP

;~: ;~:

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i

ASSISTANT ASSISTANT

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S

ST ST

PROSTHETIST PROSTHETIST

STHETIST STHETIST I

OR OR

ASSISTANT ASSISTANT

OFFICER OFFICER

PRO

AND AND

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CHIEF CHIEF

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SCIENCE

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CONTROL CONTROL

CONTROL CONTROL

CHIEF CHIEF

CHIEF CHIEF

CHIEF CHIEF

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ENIOR ENIOR

SUPERVISOR SUPERVISOR

SERVICES, SERVICES,

SERV

T

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, ,

SENIOR SENIOR

PRINCIPAL PRINCIPAL

AND AND

AND AND

OFFICER. OFFICER. , ,

OFFICER OFFICER

CONTROL CONTROL

CHIEF CHIEF

NATURAL NATURAL

MANAGER MANAGER

CONTROL CONTROL

ORTHOTIST ORTHOTIST

SENIOR SENIOR

PRINCIPAL PRINCIPAL

CHIEF CHIEF

SENIOR SENIOR

PRINCIPAL PRINCIPAL

. .

ARY ARY

GRADE GRADE

. .

SCIENTIST SCIENTIST

, ,

, ,

, ,

ST ST

I

KEEPING KEEPING

GRADE GRADE

TOR

ER

(NUMBER/DESCRIPTION) (NUMBER/DESCRIPTION)

XILI

ORTHOTIST ORTHOTIST CHIEF CHIEF

DRY DRY

TECHNI

TECHNICIAN TECHNICIAN

SE

C

CER CER

, ,

NIOR NIOR

SENIOR SENIOR

I

AUXILIARY AUXILIARY

AU

, ,

SENIOR" SENIOR"

SE

FFI

TECHNICIAN

TECHNICIAN

MEDICAL MEDICAL

MEDICAL MEDICAL

. .

, ,

LAUN

HOU

: :

OFFICER, OFFICER,

OFFICER

OFF

CONTROLLER CONTROLLER O

OPERA OPERA

OPERATOR OPERATOR

OPERATOR. OPERATOR.

SUPERVISOR SUPERVISOR

SUPERVISOR

TECHNOLOGI

TECHNOLOGIST

TECHNOLOGIST TECHNOLOGIST

TECHNOLOGIST

ORTHOTIST ORTHOTIST

MANAGER PHYSICIST

TECHNICAL TECHNICAL

TECHNOLOGIST

TECHNOLOGIST TECHNOLOGIST

TECHNOLOGIST

ORTHOT PHYSICIST. PHYSICIST. TECHNICAL TECHNICAL

PHYSICIST PHYSICIST

NATURAL NATURAL

CLASS CLASS

HOUSEKEEPING HOUSEKEEPING

HOUSE HOUSE

HOUSE HOUSE

OFFICER OFFICER

MEDICAL MEDICAL

TOR" TOR"

OM OM

SUPERVISOR

SUPERVISOR. SUPERVISOR.

SUPERVISOR SUPERVISOR

RATOR

-

POST POST

MEDICAL MEDICAL PRINCIPAL PRINCIPAL

MEDICAL MEDICAL MEDICAL MEDICAL

MEDICAL MEDICAL

CHIEF CHIEF

MEDICAL MEDICAL MEDICAL MEDICAL

MEDICAL MEDICAL

DIRECTOR MEDICAL MEDICAL

CLINICAL CLINICAL

MEDICAL MEDICAL

ANIMAL ANIMAL CLINICAL CLINICAL

MEDICAL MEDICAL STOREKEEPER STOREKEEPER

CLINICAL CLINICAL

TELEK

SECURITYGUARO SECURITYGUARO

SPECIALISED SPECIALISED

CLINICAL CLINICAL

A~IMAL A~IMAL

TELEKOM TELEKOM

SECURITY SECURITY SPECIALISED SPECIALISED t.AEDICAL t.AEDICAL ~,:PREKEEPER

SENIOR SENIOR

SEAMSTRESS TELEKOM gcuRITY gcuRITY

SECURITY SECURITY

PROGRAMMER PROGRAMMER

SEAMSTRESS SEAMSTRESS

SECURITY SECURITY OPERA OPERA

LINEN LINEN PRINCIPAL PRINCIPAL

OPERATOR

LINEN LINEN NETWORK NETWORK

OPE

LIASON LIASON LINEN LINEN

LAUNDRY LAUNDRY IN_t)USTRIAL IN_t)USTRIAL

LAUNDRY LAUNDRY INDUSTRIAL INDUSTRIAL

LAUNDRY LAUNDRY

!'RINCIPAL !'RINCIPAL

7 7

14 14

81 81

874 874

825 825

8588 8588

8585 8585

8523 8523

1362 1362 8521 8521

3730 3730

2299 2299

7838 7838

9459 9459

10538 10538

10558 10558

29317 29317

11382 11382

ig309 ig309

29293 29293

28038 28038

28030 28030

28034 28034 302oii 302oii

30343 30343

24088 24088

29701 29701

24070 24070 10987 10987

29547 29547 90272 90272

28075 28075 91868 91868

29693 29693 28079 28079

29531 29531

29527 29527

29555 29555

28687 28687

-

-

29257 29257

10578 10578

- """ios78 """ios78

10599 10599

10558 10558

29285 29285 28783 28783

-

~05 ~05

-

9

,

303« 303« __!!!_98 __!!!_98

13

~ ~

783

I I

~ ~ )

1

1 1

; ;

1 I I 1

• •

1 1

1 1

I I

I I

150 150

877 877 414 414

330 330

671 671 366 366

330 330

421 421

575 575

1 1

1095 1095

1789 1789

5110 5110

1829 1829

2 2

13 13

15 15

15 15

84 84

---

WU/PERSON WU/PERSON

I I

I I

1------

----J--

12% 12%

00% 00%

93% 93%

32% 32%

98% 98%

98% 98% 18% 18%

93% 93%

46% 46%

87% 87%

18% 18%

23% 23%

03% 03%

.

.

.

.

.

.

.

.

.

.

.

.

.

1

8

0

2

8

0

6

0

8

13

22

26

100

TOTAL TOTAL

---1------

OF OF

% %

______

--

j j

f------

1 1

1 1

~ ~

5 5

0

1

1 1

24 24

21 21

21 21

63 63

83 83

192 192

.

=

18

133 133

480 480

178 178

294 294

500 500

405 405

83

566 566

306 306

1

1.71 1.71

2151 2151

36% 36%

.:

193

1176 1176

6

_

18284 18284

,,:

···-

3

~ ~

146 146

32

:c,

404 404

2

291 291

·--~ ·--~

--

_c

OSTSJ.!!!'9_5

-

-

=-_

----

-

__ __

LMNGST0NE LMNGST0NE

==

I I

1

1

-

09 09

-

--

N_j_!'

106 106

114 114

227 227

490 490

777 777

783 783

099 099

378 378

-

233 233

J....

-

1 1

1 1

3 3

3430 3430

3 3

1 1

--

tS

13430 13430

10510 10510

80579 80579

_1

···

_ _

--

·-

--

-==--=-

-=-==--

WUIP~R~D

______

______

-

-

---

-----

j

c c

1=.

I I

J J

% %

· ·

2% 2%

9% 9%

~% ~%

70% 70%

79% 79%

00% 00%

7

84% 84% 1

5

81% 81%

62 ~ ~

90%

07% 07%

80% 80%

.

.

.

.

.

.

.

.

.

.

.

8

: 1

0

2

0

li:

0

3.42% 3.42%

8

0

__ __

OTAl-

13

21

28

100

,:

__ __

--

OF OF

----1-----

______

% %

-·--

_ _

---

---== -=.

----

--

______

______

_ _

.._. .._.

·-

I I

1 1

.._____ .._____

1 1

, ,

3 3

5 5

18 18

18 18

11 11

) )

84 84

18 18

93 93

2~ 2~

78 78

_

44

9

22 22

.

197 197

. 217 217

4

196 196

840 840

167 167

8

313 313

370 370

661 661

936,

1.29 1.29

2280 2280

2

38% 38%

7

3

65% 65%

14 14

41736 41736

98 98

198 198

2

256 256

______

221 221

--=---

~

__ __

FR

2_STS{13181V5

-

P

_

_ _

c----

------

--· --·

,

I I

88 88

829 829

879 879

625 625

036 036

703 703

545 545

397 397

373 373

738 738

1 1

1107 1107

1272 1272

3 3

1660 1660

2558 2558

7 7

3 3

21 21 36462 36462

RSON RSON

----= ----=

!"E

----

. .

WU

-

1

I I

% %

00% 00%

80% 80%

93% 93% 72% 72%

28% 28%

90% 90% 43

42% 42%

58% 58%

04% 04% 24% 24%

53% 53%

69% 69%

11% 11%

.

.

.

.

.

.

.

.

.

.

.

.

.

.

4

7

3

0

4

2

6

2

0

14

00

16

11

23

TOTAL TOTAL

1

_ _

--

<;)F <;)F

~ ~

---r-

% %

-

----

---

_ _

---

------

~ ~ 1 1

I I

26 26 75 75

71 71

15 15

61 61

% %

141 141

299 299

494 494

214 214

294 294

004 004 430 430

741 741

230 230

436 436

084 084

498 498

815 815

1.43

16% 16%

3.43

. .

6231 6231

1466 1466

76

- 8

_i;.29 _i;.29

1

1

_1_

46921 46921

-

-

_ _

112 112

5

681 681

477 477

501 501

______

_ _

---

TBH TBH

--

1 1

IV IV

ix ix

--

-

POSTS(1/M15! POSTS(1/M15!

-

__ __

-

---

---

=-

Paue Paue

I I

1 1

1--

l l

1

88 88

83 83

1

848 848

637 637

033 033

740 740

421 421 869 869

674 674

491 491

949 949

406 406

379 379

354 354

609 609

--

Append

1 1

1 1

3 3

4 4

5 5

3 3

1

1

-

-

35

PERSON PERSON

/

--

=-----

WU

--=-~

I I

·

% %

% %

% %

1% 1%

5% 5%

9%1 9%1

--l --l

9% 9%

1

74

1

28% 28%

2

7

93% 93%

45

41

35% 35%

09% 09% 25,.o 25,.o

96% 96%

23% 23%

.

.

.

.

.

.

.

.

.

1

1

3 3 4

2

7

6 6

0

4

6 6

0

1

10

1

19

0000% 0000%

11

1

TOTAL TOTAL

OF OF

% %

I I

3 3

1 1

1 1

5 5

5 5

17 17

1

35 35

52 52

09 09

30 30

0

38 38

17

1

1

9% 9%

322 322

3 83

305 305

280 280

559 559

871 871

69

531 531 330 330

633 633

4

1.53 1.53

4 4

1302 1302

7756 7756

1

6.59 6.59

15

91% 91%

1_802 1_802

75 75

530 530

852 852

558 558

473743 473743

GSH GSH

POSTS(2/6/95) POSTS(2/6/95)

ITS ITS

1993194 1993194

S

YS YS

S S

COUNTS COUNTS

CATEGORY CATEGORY

STAY STAY

IES IES

DA

F F

C

UNT

REPORT REPORT

O

BEDS BEDS

UNITS UNITS

Total Total

VISITS VISITS

L L

CO

STAFF STAFF

Total Total

Total Total

Total Total

Total Total

Total Total

Total Total

Total Total

Tolal Tolal

Total Total

Total Total

Tolal Tolal

Total Total

Total Total

Total Total

CPA CPA

UA

PATIENT PATIENT

ORK ORK

TAFF/BED TAFF/BED

CT

SUP SUP

SPE SPE

Grand Grand

TEC TEC

REG REG

PHA PHA

NMA NMA

PAM PAM

NAS NAS

NST NST

MOF MOF

NPR NPR

MAN MAN

ADM ADM GEN GEN

S

W EMERGENCIESNI

HOME HOME VISITS VISITS

VISITS/HEAD VISITS/HEAD EMERGEN LENGTH LENGTH

IN IN

OCCUPANCY OCCUPANCY HEAD HEAD

A

! I I

I I

DATABASE DATABASE

FACTOR FACTOR

VISITS VISITS

(DOCTORS/NURSES) (DOCTORS/NURSES)

VISITS VISITS

OUT-PATIENT OUT-PATIENT

HOSPITAL HOSPITAL

HOME HOME

I I

-I -I

15 15

--"-----,------~------,

I I

r I I

I I

I I

I I

I I

I I

J J

109 109

=2 =2

941 941

078 078

696 696

00

840 840

353 353

009 009

417 417

~

1177 1177

3 3

1127 1127

8

2 2

16004 16004

26673 26673

40 40

WU/PERSON WU/PERSON

--~

----===

-----

1-

,

I I

c.

:c.,%

~

55% 55% 41% 41%

00% 00%

86% 86%

53% 53%

36

98% 98% 24% 24%

82% 82%

83% 83%

09% 09%

65% 65%

27% 27%

.,.

.

.

.

.

.

.

.

. .

. . .

.

.

1 1

3

o

9

0

4

0

9

11

15

18

26

100

TOTAL TOTAL

OF OF

"/, "/,

--~c'

-----

1---- ! !

! !

-

::-i

3 3

5 5

o

.

2 2

2 2

65 65

1

26 26

68 68

34 34

19~

71 71

35 35

~

.

738 738

115 115

125 125

19

751 751

125 125

313 313

2

~~ ~~

-

);] );]

60=0

18404

46 46

62881 62881

72 72

1

SPHG SPHG

---·-

~..!f~(2~5) ~..!f~(2~5)

-

------

_-_::::::=~~----..,c

---...:

--

-

------

,

,

1

9

_

~ ~

110 110

965 965

742 742

039 039

305 305

593 593

08

732 732

533 533

442 442

_

1 1

1113 1113 9915 9915

4 4

J J

9

54 54

--

-

~ ~

===

-

W~R~O

----·

-

---= ---=

______

-----

• •

-

% %

% %

-

11

00% 00%

99% 99%

32% 32%

51% 51%

21% 21%

86% 86%

20% 20%

65% 65%

.

.

.

.

. .

.

.

---;----·-l ---;----·-l

ui'i'

1

0:56% 0:56%

3

0

9

. .

..!.c.

11.37% 11.37%

18

1 1 1

14

.

24

100

TOT~L

_ _

-

_ _

~

OF OF

--

··-

% %

-

--

--

--==-

-:-_:--=:-·:-~----

_

1 1

2 2

1

11 11

11 11

1~ 1~

23 23

33 33

98 98

2J, 2J,

24 24

~ ~

4

113 113

.

994 994

.

105 105

184 184

149 149

1

247 247

067 067

435 435

043 043

1

18% 18% 2

}

~

- 6531 6531

26 26

99464 99464

109 109

-

144 144

11

·--

SOMERSET SOMERSET

P_9STS(2SW9S) P_9STS(2SW9S)

-

-

_

---· ---·

170 170

733 733

504 504

779 779

262 262

684 684

518 518

186 186 -

. .

1746 1746

1183 1183

1 1

3 3

8

2 2

30932 30932

10311 10311

30932 30932

106 106

---

. .

---

~ON ~ON

====-=-:-=-

I I

I I

FF:--

% %

% %

------

7% 7%

76

55% 55%

56% 56% 16

33% 33%

40% 40%

65% 65%

8

65% 65%

77% 77%

.

.

.

.

.

.

.

.

- .

.

9

i>:55%... i>:55%...

1

1

0

4

2.75% 2.75%

0

6

11

14

25

10000% 10000%

2

--

-

%0F!(>TAL %0F!(>TAL

---:-

1 1

1 1

2 2

58 58

35 35

78 78

88 88

78 78

68 68

.

.

183 183

144 144

32_6 32_6

2

524 524

t:

015 015

610 610

950 950 757 757

1

1271 1271

15% 15%

2

~

i

ffl5) ffl5)

31 31 ~ ~

73228 73228

STE STE

~ ~

216 216

203 203

202 202

--

--

-

OO OO

J

IV IV

· ·

--· --·

______

CON/

. .

--

POSTS(28/

1---'~02 1---'~02

---

--

-= -=

----~_ ----~_

·-

e-

I I

I

I I

1 1

3 3

Appendix Appendix

81 81

4

sos sos

857 857 127 127

2

36

082 082

577 577

467 467

726 726

-'--

1 1

_ _ 1217 1217

1 1

2419 2419

3427 3427

5384 5384

-

2 2

11217 11217

41 41

-

1

---

-· -·

_-

WU/PERSON WU/PERSON

--

I I

I I

% %

39% 39%

47% 47%

36% 36%

00% 00%

16% 16%

62% 62%

50% 50%

37% 37%

06% 06% 20% 20%

37% 37%

50% 50%

.

.

.

:

.

.

.

.

~

151% 151%

3

5

9 3

7

072

072% 072%

2 2

14 14

17

11

22

100

TOTAL TOTAL

-

OF OF

% %

, ,

3 3 0

2 2

7 7

11 11

11 11

.

5

82 82

55 55

JO JO

23 23

31 31

30 30

.

.

144 144

4 114 114

170 170

342 342

214 214

284 284

38

256 256

471 471

837 837

353 353

684 684

1

4

1520 1520

28% 28%

84% 84%

2 2

0 0

6

123 123

169 169

106 106

22

RXCH RXCH

POSTS(1/6/9S) POSTS(1/6/9S)

1993/114 1993/114

ATEGORY ATEGORY

S S

COUNTS COUNTS

C

STAY STAY

IES IES

DAYS DAYS

C

.al .al

REPORT REPORT

OF OF

SEO SEO

UNITS UNITS

Tot

v1s1Ts v1s1Ts

/

OUNT C

STAFF STAFF

Tot.al Tot.al

Tot.al Tot.al

Tot.al Tot.al

Tot.al Tot.al

Toi.al Toi.al

Toi.al Toi.al

S S

Tot.al Tot.al

Total Total

Tot.al Tot.al

Toi.al Toi.al

Tot.al Tot.al

Total Total

Toi.al Toi.al

Tot.al Tot.al

CPA CPA

IT

PATIENT PATIENT

EAD EAD

OME OME

SUP SUP

SPE SPE

Gr.and Gr.and

TEC TEC

REG REG

PHA PHA

PAM PAM

NAS NAS

NST NST

MOF MOF

NPR NPR

MAN MAN

GEN GEN

ADM ADM EMERGENCIESNISITS EMERGENCIESNISITS STAFF NMA NMA

WORK WORK

VIS

EMERGEN

VISITS/HEAD VISITS/HEAD

IN IN

0CCUPANCY 0CCUPANCY

LENGTH LENGTH

ACTUALBEOS ACTUALBEOS

'

1

!H

1 1

NuRsEs

1

DATABASE DATABASE

ISITS ISITS

(OOCTORS

_Y

_ _

v1s1Ts v1s1Ts

""P""A""T1-=E-N--T""F-A"'"c""ro'"R------;1H

·

HOSPITAL HOSPITAL

ttOME ttOME

----,,,o'"'uT"'

~=-=-=--· ~=-=-=--·

51 51

......

15J 15J

j j 11--

I I

I I

I I

, ,

, , ' '

7 7

-

-

11

-

246 246

785 785

827 827

582 582

331 331

480 480

854 854 7

1 1

3 3

-- 10205 10205

12 12

20411 20411

--

--;-m --;-m

~ ~

~ ~

-

-

-===

WU/PERSON WU/PERSON

-

----

--

~-

----

~

---

t-

1 1

1

~

I-=

1 1

% %

% %

% %

-

sic. sic.

!_% !_%

--

,

00% 00%

07% 07%

43% 43%

96% 96%

88

72% 72%

- 53% 53%

33% 33%

57% 57%

81

0

48

.

.

.

.

. .

.

.

.

.

.

.

.

1

1

2

0

3

0

8

0

,

--

1

-

15

2

25

-

-

100

-

TOTAL TOTAL

8

--

---

--

OF OF

-

--

-

I'. I'.

---

______

---

-

--

---

-----

-

==-

I I

------+-----

5 5

8 8 4 4

3 3

9 9

, ,

4

-

80 80

48 48

11 11

72 72

6 6

.

109 109

133 133

-

624 624

E:ii

2

52% 52%

4

64% 64% 522 522

irn

-

~ ~

__J!! __J!!

~~21

-

27581 27581

52 52 47985 47985

sf

---1-----· ---1-----·

_!J_C> _!J_C> -

~

--

--·--

_____, _____,

-

______

----·

---

GEO~E GEO~E

----

______

______

-

P0STS(2a/4/ll5) P0STS(2a/4/ll5)

---

__ __

---~ ---~

-

--

-= -=

-----

---· ---·

~-----

--

'--

_ _

-

-

I I

1 1

2 2

27 27

202 202

230 230

831 831

14 210 210

419 419

.-19 .-19

808 808 4

257 257

696 696

-

-

-

~_Q_3

1 1

2 2 1 1

6

8 8

2 2

-

15 15

18 18

3

109 109

----

-

-

--

U/PERSON U/PERSON

-

----

---

---

--

---

---· ---·

~---

--

% %

-

% %

~

06% 06%

11% 11% 00% 00%

55% 55% 14

18

38% 38%

59% 59%

29% 29%

23% 23%

02% 02%

43% 43%

.

.

.

.

.

.

.

. .

.

.

.

--

1

9

1

0

2

3

0

9

1

19

14

29

100

TOTA

--=-

----

----

OF OF

-

--

-----

----

. .

I'

-

-

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7 7

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8

49 49

17 17

67 67

77 77

51 51

70 70

69 69

_

541 541

106 106

157 157

222 222

31

1

216 216

85% 85%

41

48 48

67153 67153

9_1!.;~!

~% ~%

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-

109257 109257

144786 144786

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=-= =-=

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1

-

- 111 111

158 158

118 118

007 007

790 790

583 583

597 597

609 609

885 885

395 395

481 481

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1185 1185 9085 9085

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1

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7

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27% 27%

00% 00% 18% 18%

82% 82%

31% 31%

97% 97%

81% 81% 23% 23%

58% 58%

55% 55%

.

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.

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Appendix Appendix

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1

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581 581

1

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30

298 298

100 100

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1 1

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256% 256%

13 13 8

33625 33625

13 13

80 80

PAARL PAARL

P0STS(28/4/95) P0STS(28/4/95)

TS TS

1993/94 1993/94

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STAY STAY

S S

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REPORT REPORT

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BEDS BEDS

BED BED

UNITS UNITS

Total Total

VIS

/

COU

STAFF STAFF

Total Total

Total Total

Total Total

Total Total

Total Total

Total Total

Tola

Total Total

Total Total

Total Total

Total Total

Total Total

Total Total

Total Total

CPA CPA

ITS/HEAD ITS/HEAD

ITS ITS

ME ME

PATIENT PATIENT

TAFF

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Grand Grand

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NST NST

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NMA NMA

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S

ADM ADM

EMERGENCIESNISITS EMERGENCIESNISITS WORK WORK

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ACTUAL ACTUAL

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, t-- Appendix V

and cost o! tertiary care at Groote Schuur Hospital The clinical Tygerberg Hospital : based on esti~ates o! tertiary service!l

t..~e current To esti~ate the cost-i:mplications of consolidating GSH te=-=iary TSH tertiary service component with the cur::-ent service component.

De!in.i tions

se:?:""v:i.ce w·as defined as clinical care that cou:!.d Secondary (physician satisfac~orily be per=or:ned by a general specialist or surgeon), or-~~opaedic surgeon, obstetrician/gynaecologis~, at a #e l ~­ radiologist t anaesthetist or paediatrician etc. functic~ing L~vel 2 hospital, eg. Frere Hospital. ·of t.."le foLI.or.,:i ng '=ertizi.ry servJ..ce ,,;as dc::fined by combinations ~~p ~ r-s~~ ~~a l i ~ ~ r-~~e-;~ ( ~ ~ ~SC8~d ing order cf =eli2~ility): equipment, (organ, system, disease, technique); complex in ce::-':ain investigations, monitoring; a recognised "expe=-=" referral fro~ disorders; multidisciplinary specialist clir.ics; wit..~out t..~e region. t~e Level 2 Hospital: A hospital serving a region of province in which se:?:""vi~es up to ar.d r including those provided by specialists are available - Draft Prov; ~cial 3ealc~ Plan (DPH?), plJl. :!.evel i ~ Level 3 Hospital.: A hospital ' located at prov~~cial ,,;hich ser~ices up to and ~nc:!.~d~ng t..~cse provided by a subspecialist are available o··u 1, 1) (D- :!- I P-~ .

Data Sou::-ces

0 You~g ~ana~e=enc bv cost centr : The Er.1st ar.d Ex:Jendit~=e GSE Procedure (M.-:\2) data for all cost cen~=es at Ac~ountancy data ~ere 31 March 1995 were used for GS~. ~c.en t::J.ese as at :cu.,~ wit.:l t.~e data in C..~aoter 9 of t.::e D?~~' i t ~as comoared i~ t~e DP~?. t..~ac costs had gone up by 19%-over these =epor::ed sted by an T~e cost-centre ~ased data :or TSH ~ere adju on data ~ade i,c=e~ent of 1 0% - t..~is inc=ement was based ?ir.ance Co=::it~ee. a v ailabe to Er~st and Youns t~rough t.~e S?1T Appendix V

l.l Identi=ving t~e existinc te?:'"":iarv conoonent at GSF.: The H..?...? data idencified cost cenc=es which, on the ~hole, cor=esponded ~ith individual Units, Depar=~ents and, in some cases, wards. However, wit.~in a specific Unit (eg ~espiratory Unit) a service ~ay be wholly secondarJ (95% of acate ast.h:natics), ~holly tercia.=y (eg investigation of lyi:iphangiomyomacosis) er partly tertiary (eg an episode of pul~onary shadows in a pacienc on c:.rtotoxics). ~ach cost cent=e ~as individually considered in consultation ~ith Heads of Divisions and hospital ad.::linist=acion at GSn. A proportion of each cost: cent=e' s budgec ·.ras appo~ioned as "tertiar.1" o:­ "secondar.1".

l. 2 Costine ':he exist inc te~iarv ccmooner1t at GSF. : The estimated propor:ion of t.~e budget expended ~y eac~ cost cent=e on tert:iary ser~ices ~as calcalated. The results of t...~ese calcalations are eX:Jressed as percentage of Total Ser~ice by Division in Tableland detailed in Tables 2 - 10.

l.J Est i ~atinc th~ existincr te:rtiarv comoonent at T3F. The p::-opor:ion of expeD.ditu::-e on t:e=-::iary w·or.lc per:::o~ed at T3H was adjusted relative to the estimates for GSH, taking into cons ide:::-a tion fa.:::tcrs s 1J.C!".1. ".'.~ mrn:::.bP.-i: · of sp1:,cia 1.:. :::t.:; p2:::- Divis ion; nm::tbe::- of patients admit-:ed,· number of out-:;iatients, operations or deliveries; heavier ~eighting ~as given to incices of postgraduate activity including nm:ilier of =egist=-ars, interns and publications on tb.e g::-ounds t..~at tertiary activity in a teaching hospital necessa=ily involves regist=a=s and researc~. (Tables 2-10 see footnotes to tables) .

The i~oact of off-site li~ited private practice has not ~een taken lnto account.

The data comparing t.~e t~o institutions are show-r. in Ta.ble 11 (Situation a.nalysis) (NOTE; The esti~ated adjus~ents =er T3H are provisional, pending the future availability a:: ac:::urate data.)

1.4 The cost of t 0 :-ti ary ser";i ces : using ~e ~=ocedures outlined in 1. 1 and 1. 2 above, t..1.e ex;,enc.i tu=e on "te::::-:ia=-.! 11 services ~as calculated for GSF. and TBE (Table: ) . (NOT~: TT.e amounts quoted have been considerably re=ined oy subsequent ~cdelling - see A..nne~~=es 3 and~- )

Note: T~e pla.:i asslll:les that GSZ belongs to neit~er US no= we~; therefore, in order to render adec:uate tert~a_~ ser7ices a...:id to prov~de a =~tional base to= tedching, savi=;s ~ade at T3E have been tr~sfer=ed to GSE.

CONC!,ITS::ONS: l. Based on the findincs of this investigation, it appears financially feasibl; to merge the current TBH and GSF. ter=iarv services and acco!Il.!!lodate t~ese in GSF.. Fu:::""ther investigation of t..~is model is justified.

2. If a tertiary bed cost RJSO 000 pa is asst.m.ed (see Annexure 3), t..~en R280,064m (the est1~ated c~rrent costs of tert~ary se:::-vices fa~ GSE and T3H - see Table l) represents app r-oxinately 8 0 0 te::-tiar1 bees. Appendix V 21.4.1995

Ta.ble 1

ESTL'!.AT~D COST O? TERT~Y SZRVICES AT GSH :um TBH

Based on DPSP Cost Cent=e Forecast of R905 487 ooo (Red c=oss Hospital excluded).

3 LZVEL 3 I GSH I TBH X 10 TOT.AL Medici:ie 59 517 16 488 ' Surgery 49 JS4 22 070 0 & G 16 687 10 606 Radiot!lerapy lJ 292 a 226 Anaest.,.etics 5 SJ6 l 939 7--,- Radial & Nucl Med lJ 527 5 / :> Labs ,-=> - 723 ll 549 i N~:::-sing (M&A) 12 769 l 586 i' PAM 4 711 2 62] I I I 191 116 80 862 ! J + 10% inflation 8 08 6 191 116 88 948

NOT!::: T~e cost of support services has not been L~cluced eithe::- institut:ion (t...,.ese costs a.,.. 0 inc.2..uced ~odels show'TI i~ An.nexures Band~).

~otal: R.2&0,06~m

.:. Appendix V

21 • .,(.1995 Table 2

MEDICINE

; DPS:P COST C~NTRES E3t. Tertiu-y Component GSE: I T:SH Cardiac Clinic (100%) 10 770 4 978 :::m.ergency (25%) l 448 1 507 Clin !!illllunol (100%) J 63 ' Cli:i Phar:!1 (100%) 1 746 2 089 .I Clin Science (100%) 1 7J6 - Der::iatol (JS%) 951 362 1 -, Endoc::- & Diab (76%) l 423 _.:,_ ; Gen Med (40%) 8 399 6 425 ' Geriat::-ics (15%) 23 GIT (70%) 4 407 423 Hae~ (45%) 5 549 2 097 j G-2:1etics (100%) 1 379 I HT c.:inic (100%) 264 IE..D (50%). , 90 J Li.pia (100%) .. 113 Live= (100%) 2 558 1 Med Physics ( 100-%') 2 244 1 156 Neu=ology (100%) 2 616 602 Oncology 4 769 Renal (70%) 0 064 J 567 Resp (70%) 5 847 4 618 Rh Dis (80%) 549 ?sych (20%) 978 230 !

59 517 32 976

T3E esti~ated cu_--::-ent tertiary co~ponent = 50% of t:lat done at Gsc· 50 = JJ 259 X / 100 = Rl6, 629

*ratior.ale: T:SH has 5-<>-:) .... of GSH full-t.::..:ne specialists but 80% of G-··;::, :=. in-patients .:. and 57% of Gs:;: out-patients and 49% of GSE regist=ars and 43% of GSn inter.1s and 28% of GSE publications Appendix V 21.4.1995

Ta.bl e 3

SURGERY:

i ~3t. Tertiary Component I S DPID.' COST CZ.'iT::RE I I GSH T:BH I 5 070 ! Cardiot.'1oracic (100%) 16 766 i ( 50%) 361 l 196 ' ENT 8 078 I Gen Surgery (50%} 12 582 ., ! ( 70%} 4 712 ... 102 i Neurosurgery 1 685 i ( 50%} 3 424 I Ophthalmol i (55%) 7 171 4 296 I Ort..'1opaed.ics 324 ' ( 4 0%} 1 474 !j ?lastics 740 Tram:ia ( 20%) 1 768 a 1 150 800 i urology ( 3 0%) I ,Cl • ..,o 1 -1""'!, 4 705 'j !t 'T' __ ,., ,., t_ e lt \~~~, - """ ------"---.--4_9_3_5_4______3_6_7_8;--~1 3 TOTAL X 10

component T3H esti.:nated current tertiarv4 = 60% of t.~at at Gsa· = 36 783 X 60% = R22.069.8

*rationale : T:9H has 70% of GSH full-t.D!!e specialis"':s has 71% of GSH .:L"'l-patients has 90% of GSa out-patients (GSF. PAOH) -has 74% of GSH registrars has 18% of GSH publications Appendix V

21.4.1995

Ta..ble -4

Obstetrics• Gynaecology and Neonatology

~st. Ter""=ia..-ry Component DPK? COST CZNTRES GBH I T3H Obstets & Gynae (50%) 11 365 13 130 Neonatology (100%) I 5 322 4 ~97 3 ,- 677 TOTAL X 10 I 16 637 - I

· · T3.n estbnated cur:::-ent tertiary component = 60% of that at GSH*

*"?:"ationale T3H estimated c~::::-=ent tertiary component TBH has more consultants 19 (GSE = 13) has 63% of GSE =egistrars has 62% of GSH in-patients in Gvnae has 159% of GSE out-patients in.Gynae has 61% of GSE publications has (est) 55% of GSH's Level 3 deliver.::.es Appendix V

21. 4. l995 Table 5.

RADIOT2RAPY

Component i DPlG' COST CENTRE Est. Tertiary I GSH I TEH I 292 a 226 i rtadiotherapy (100%) lJ I .. a 226 TOTAL X l.03 lJ 292 I !/

Radiotherapy at TBH est at 100% tertiary saving of 10% T~ansfer of service to GSH may result in

::. Appendix V

21.4.1995

Table 6.

I I Est. Tertiary Co1:1ponent . ! r D1?!G> COST CZNTIU: I I I GSH I ~H ! 10 764 8 JSO -: Dist:=ilmtion of Surger.1 L.J : L2 J.6:3.4 2.4:2.8 I TOT~ ..... 103 5 535.8 3 2 3 2.2 I .. I - ' ------~- I -·

TBH tertiary .Anaesthetics = 60% of t!lat estimated for GSE* = J 232.2 X 60% = Rl ,939 .. J based on Surgery esti.1Ilates.

-- Appendix V Ta.ble 7

RADIOLOGY

es~. Tertia.:.·y Component TBH DPRJ? Cost Centre GSH I Radial (70%) l.l 213 5 754 Nuclear Med (90~) 2 309 2 496 I TOTAL x 103 lJ 527 8 250 I T3H Te~ia=Y Radiology services = 70% of the estimate for GSH, based en esti.::iates for clinical services = 70%' X 8250 = RS 775

Table 8

I est. Ter:.:::.a=Y Cooponent I I DPHP Cost Centre GSH I T3H l diem Path ( 80%) 7 550 6 508 l 900 Med B i c C..'1. e.1!l (100%) 1 214 I Med Mic::-o (60%) 3 932 3 340 Toxicology (100%) 824 I Virology (50%) l l2l J.. 871 Anat Path ( 4 0%) 2 756 2 056 I

3 ,_.::i - I 16 499 I TOTAL X 10 I 723 I T3H Tertiary Laboratory services = 70%' of:t...'i.e esti:nate for GSn, based on est::..::iates for cli nica_ services :::: 70% X 16 499 = :< 11 549 Appendix. V

T2Wle 9

NURSING

est. Tertiary Co!!!ponem:. GSH [°pP:r:P cost_ce~t=e (M, A) 100% 12 769 2 265

TEH Tert:iary Related Nursing = 70% of t!le esti:o.ate for GSn, based on estimates fa-::- :nec..::..c:.:: . and su:=gery = 70i X 2 265 =:?.1 535.~

Table 10

PR.OF~SSIOF°ALB ALLIED TO MEDICINE

est. Tertiary Componem::. '

I DP!il' Cost Cent=e GSH I T13H I i Pb.ysiotherapy (72%) l 775 l 21-_:i I Occ..1pa tional Therapy (65%) l 004 1 095 I' Logopaedics i (75%) 668 :91 I Dietet:.cs ( 25%) 246 425 i I Social Work ( 50%) l 018 323 I i I 4 711 I J 7~9 I TBE est.::..1nated tertiar1 ?.~ services = 70%' of the estbate for GS:a:, based on -~-..:-­ Medicine and Su:=gery = 70% X J 749 = ,.2 623.6