The shocking findings of the Health minister on his impromptu visit at Candos Hospital should get everybody thinking: one duty nurse on time at 9 a.m. in the whole hospital; the administrator not aware of how many nurses should be on duty. How has such a state been reached in our administrative and professional nursing responsibilities? The diagnosis is clear-cut: our health services are sick. The prognosis is very poor unless radical surgery is rapidly performed. What can the ministry of Health (MOH) do after this discovery? Will the administration be reshaped?

The history of our National Health Service (NHS) has been a chequered one. It has served the limited purpose and expectations of a colonial island and a population unaware of the possibilities of Mauritius. Now that Mauritians are more informed and more quality-oriented, demands have increased and will continue to do so. The hospitals, management systems, administration, philosophy of care, education strategy and other services are no longer equipped to serve a modern population. The MOH is flogging a Morris Oxford to speed up to a BMW performance. Logic dictates that this is impossible. The MOH must realise that temporary patchwork will not solve the problem. A total new approach is needed to address the chronic sickness that has plagued and beleaguered us.

There is a clear and unambiguous problem with low morale. When only one nurse turns up on time on duty and the administrator is not aware of how many should be on duty, this speaks volume about staff interest (or rather lack of) in their work, self-esteem, professionalism and efficient management and organisation. When this type of anarchy reigns, nothing short of total reorganisation is needed. But first, heads must roll.

Disciplinary action and dismissal should be the order of the day. Has the Candos administrator been sacked? Have the nurses and most importantly charge nurses and managers been disciplined? Nobody knows. It is the responsibility of the minister, the permanent secretary and senior officers to act, and act vigorously, because of this totally unacceptable situation. Why have not we heard from the MOH? Are the senior officers guilty themselves of not upholding a competent management system? If so, they must go first.

In any other country, the discovery of such disorganisation would be a cause for the minister and his senior officers to hand in their resignation. These officers must ask themselves: how have we allowed such a situation to develop when sick people are waiting and relying on so-called professionals to care for them? This is a clear failure of the ?duty to care?. This is also a clear case for deregistration of nurses, who have neglected their duty. If Candos had been a private enterprise, the chief executive would have been sacked. Why did this not happen? Through the taxation system, we pay for the NHS, the wages of nurses, managers and administrators. We must have a say in what happens in our hospitals and the minister, as our political representative, must act and sack. If this situation is not made an example, then the Mauritian people is being cheated. We want the minister to act or resign.

If the MOH does not act, then the population must. It is regrettable that opposition parties have not made this abominable situation a substantial political issue. Why? Public services should be the cornerstone of all political manifesto and we urge Dr Navin Ramgoolam as opposition leader to show that he cares as an ex-medical practitioner and as a human being. There is no need to make political capital but enforce some of the basic Mauritian instincts that we respect, like serving the sick, the needy and the vulnerable. It reminds me of the young child who stared at his grandma sick in bed and said: ?Nani, there may be silver in your hair but you have a heart of gold.? This is the people Candos has let down. When this state of affairs prevails, there must be no cover up. There must be actions to remedy the situation in the short and long term.

? Long-term solutions

The main issue, which should be addressed is the low morale within the NHS. Obviously, there are qualified people interested in caring but they have been demotivated by the current circumstances. The NHS has not been modernised and thousands of nurses have made representations at the MOH only to be told that ?developments are in the pipeline.? It appears that the latter is very furry, possibly rusty and scaly, because there has been no genuine move to improve the working conditions and offer new opportunities to graduate nurses. Such delays are unacceptable and undermine their motivation. It is sad that people who have been trained for a job are denied opportunities of providing service. The NHS is moving too slowly and the ultimate casualty is the patient, as the minister discovered at Candos. Candos is perceived as an important hospital with specialist services and yet the staff is not motivated. It is no good blaming anybody but the ultimate responsibility to see that hospitals function effectively lies fairly and squarely with the MOH.

At the moment, there is huge emphasis on bureaucracy and too many layers of management at regional and local level. The structure must be simplified and clear lines of accountability established. We should have a hospital manager in charge of all the entire services of a hospital - a chief operating officer (COO). He/She must be empowered to hire and fire staff, including doctors and nurses. This aspect of management is central to maintaining a motivated workforce and providing local opportunities for development.

The MOH must realise that throwing money into our NHS is not the answer. Money is important but its management is critical for getting value for that money. This means good and efficient managers and management systems. The administrators in post have probably been promoted by an antiquated promotion system based on seniority. They may not have the expertise and proficiency for the jobs they are holding. The result is ?Peter?s principle: promoting people to their level of incompetence.? The boogie at Candos needs new blood to serve the needs of an increasingly developed population. The MOH knows it. Inject new blood or suffer the consequences of haemorrhaging services. So far, the MOH has chosen the latter.

For example, if the COO at Flacq hospital decides to put a matron in charge of all services, he/she should be allowed to do so as long as he/she justifies the structure with the Ministry. On the other hand, if SSR Hospital decides to put a medical director in charge of all services, he/she should be allowed to go ahead after justification. A local hospital should respond with a structure suited to local needs. This kind of flexible approach would give local hospitals autonomy to serve the public. Failure to have a flexible management system will lead to the present malignancy spreading to other parts of our health services. The MOH has no option but to be brave and devolve.

At the moment, a centralised approach is too cumbersome and time-consuming. The MOH is able to repeat only one message: ?there is something in the pipeline?. This is totally unacceptable and proof that the MOH cannot respond quickly. It may have ideas and new strategies but the centralised and top-down approach makes it impossible to react effectively. For example, it is criminal to encourage nurses to study up to degree level and not provide them opportunities to use that knowledge. The local COO could use graduates more effectively because of his/her local knowledge and local strategy to serve patients. It makes sense to give the COO such powers with a delegated budget to meet local needs. It does not matter how long the MOH resists these ideas, it knows that there is no alternative but to delegate these responsibilities locally. If it cares, it will delegate sooner rather than later.

Furthermore, there should be a health ombudsperson to receive public concerns and complaints, investigate them and prosecute those failing in their jobs. There must be a greater awareness of patients? rights. A new charter for patients? rights should be developed urgently to have the right of redress and compensation. This will bring some professional response from nurses and doctors. Self-regulation is not effective. The Medical and Nursing Councils should be empowered to be rigorous and ruthless to bring about a satisfactory level of professionalism.

? A plea to Paul Bérenger

It is becoming increasingly obvious that nothing of significance is emerging. We urge the prime minister to look into the reasons why everything is still stuck ?in a pipeline? and to send in ?drain busters? to the MOH. This might mean a change of personnel to provide a better healthcare system and new opportunities to staff.

Has the time come for a cabinet reshuffling? Does the MOH need a minister of Steve Obeegadoo?s calibre and the enthusiasm he has shown in the education reform? Is it also time to for a permanent secretary with vision to take the NHS into the 21st century?

The PM should realise that the health of the nation is as precious as its economic success. He is accountable to the population for a better health system. The time is right for him to intervene after the evidence uncovered at Candos. Is he happy to preside over a system, which is proving foul and inefficient? Come on PM, it?s time to act and, act now, to save the health of the nation. It is time to show to people why you wanted to be PM? Because you care? Because you believe in a social cause embodied by healthy living? Good health for all and not only for the rich who can afford private healthcare? The challenge is yours, PM!