Blowing up the bridges

Like a defeated army in retreat, our minister of magic seems intent on leaving behind nothing but ruins for her successor. In what appears to be a frenetic dash to the finish line, the final stage of her marathon of misconduct, Dr Beet and her department are churning out a flurry of ill-conceived regulations and draft Bills. Notice and comment periods are kept to a bare minimum; sham consultations are hastily arranged.

Consider her latest two draft Bills, arguably the worst she has proposed in her decade of destruction. The ostensible purpose of each draft Bill is clearly justifiable. In the case of the National Health Amendment Bill, it’s the regulation of pricing in the private health sector. For the Medicines Amendment Bill, it’s the transformation of the Medicines Control Council (MCC) into an efficient and effective body.

But, as is always the case with the sister of Satan, the devil is in the detail. Under the guise of discharging a constitutionally mandated obligation — the regulation of healthcare services to ensure that they are accessible — we find a not-so-hidden agenda. Put simply, both draft Bills are primarily about the centralisation of unbridled power in the minister and the undermining of institutional independence.

This is, sadly, nothing new. Not a single piece of health legislation processed since 1999 has failed to do the same. Among other things, for example, the 2002 amendment to the Medicines Act weakened the MCC. It also limited the legal options of anyone adversely affected by one of its decisions, overturning a specific amendment enacted during the previous minister’s tenure.

Worse still, it repealed a 1998 statute that had taken the MCC’s transformation seriously. That law, which was unfortunately brought into operation too soon and consequently put on ice by the Constitutional Court, would have provided real solutions to what the 2008 Medicines Amendment Bill only pretends to address. Today, an independent medicines regulatory authority is not even on the agenda.

Other areas of healthcare have not escaped the minister’s wrath. Both the 2005 Nursing Act and the 2007 Health Professions Amendment Act provide further examples. They seek to put two key statutory bodies — the Nursing Council and the Health Professions Council respectively — firmly under ministerial control. Control the councils and you control the professions.

According to the proposed amendment to the National Health Act, the minister’s lackeys would be responsible for effecting direct price controls in the private health sector. Those who support appropriate price regulation are horrified. They recognise the need for an independent institution — working within the bounds of a clearly defined statutory mandate — to deal with vested interests in the healthcare industry.

The draft Medicines Amendment Bill is even worse. It proposes that the MCC be dissolved in its entirety. Instead, an internal department — reporting directly to the minister — would take over its functions. Without having to worry about council oversight, the proposed health-products regulatory authority would be free to take direct orders. In any event, the final decision on registration would lie with the boss.

If they were to become law, the two Bills would ensure that the madness of the Mbeki era extends well into the future. Luckily — but largely for the wrong reasons — the hospital industry is unlikely to let the price controls survive. Its anticipated legal action, if and when launched, will effectively leave the market largely unregulated. At this stage, it’s unclear if the drug industry will step in to save the MCC.

For its part, civil society is ready and willing to act. High on the agenda is for both of the draft Bills to be withdrawn at this stage. Then key stakeholders would be able to sit down and start discussing an appropriate regulatory framework. Rushing legislation through a dying Parliament is no way to move into the post-Mbeki future, especially not if it carries the smell of a moribund ministry.