The prime function of the NHS is to provide the highest standards of services to the public. This is the new culture that our hospitals need. The focus must be on quality. The HPC must be relentless on this issue and think creatively and laterally how to improve quality of all services. The HPC must use its powers to urge the PM to:

• Benchmark all services against a series of national standards. This means setting up a framework for grading and measuring public services. Thus, national public services standards (NPSS) criteria are overdue specifically for health services.

• The NPSS must state clearly the level of performance expected from health professionals. For example, if a complaint is lodged verbally or in writing, a written response from the Regional Health Board must be made within 5 days. If a patient turns up at the casualty department of a hospital, he/she should be seen within one hour. All patients must be told their rights in hospital by the ward managers who should carry out exit interviews with patients being discharged from the hospital. This will help make health services patient-friendly.

• Hospitals and health centres must undergo the same scrutiny as the private sector by health inspectors, health and safety assessors and water and sewerage examiners. The role of the ‘bureau sanitaire’ must be extended to local hospitals and health centres. This means giving additional powers to local health inspectors to access hospitals and health centres at any time just as they do any restaurant or bakery at the moment. All hospitals and health centres must have at least two announced and two unannounced formal inspections per year. These inspections must focus on cleanliness, hygiene facilities, food preparation and kitchen management. We all know our hospitals are not clean and the food unworthy of human consumption. This is unacceptable and HPC must recommend imposition of the strictest level of hygiene. Cooks, kitchen attendants, ward housekeepers and anybody handling food must undergo systematic training in Food Handling and Hygiene Management. This must be followed up in the wards by the ward managers. Ward management is not only roster management but it includes maintenance of hygiene and cleanliness.

• The conduct of public services must be regulated and those working in hospitals and health centres must be of sound character. Thus, local police must be given powers to interview and build a dossier on all health workers who must undergo Criminal Records Check annually. There is a lot of verbal and physical abuse in hospitals where patients are smacked, beaten and robbed. There is a real and genuine need to protect human rights in hospitals. Patients come to hospitals to be treated kindly and sympathetically but they end up losing their money and belongings. We know alcoholism is rife in Mauritius and public servants abusing alcohol must not be allowed to come in contact with patients. We must have a legal framework, which protects vulnerable adults in hospitals and health centres. Healthcare workers found guilty of abusing patients must be put on a Register of Protection of Vulnerable Adults (ROPOVA). This ROPOVA must be kept in the local police station and those on the list must be monitored and updated on a regular basis to prevent further abuse. The HPC must do this to protect women, the elderly, the sick and children.

<B>Structure</B>

If the HPC is genuinely interested in improving services, then it must come up with a structure to deliver expected standards. This means scrapping the present unworkable structure on the wards and health centres. A radical reorganisation is well overdue.

The overwhelming evidence is that the ward manager is the most influential employee responsible for standards. This post is critical, must be strengthened and new vibrant managers must be appointed to forge ahead new NPSS. In practice, this means all present ward managers should reapply for a new ward manager post. Certainly, those losing their jobs will be compensated financially but must not stand in the way of progress. HPC must bite the bullet and, more importantly, the MOH must manage a rocky but necessary transition to a better standard of care.

The new ward manager with an expanded role must be supported by deputies and qualified staff to ensure the NPSS is met. The manager must be more patient orientated, quality conscious, inspection management and research-based. To this end, each hospital should have a Research and Development Unit (RDU) staffed by nurses holding a BSc in Nursing Practice, health inspectors with a degree in public health and other research graduates. The primary function of the RDU is to work closely with ward/departmental managers to investigate and evaluate practices in wards, kitchens, clinics, administration and environment. RDU is not there to blame people but to study the impact of practices on quality of services and to recommend better practices that can only be enforced by the ward/departmental manager. This is the simplest and most effective way of raising levels of awareness about what healthcare professionals are doing, discovering gaps in their practices, skills and knowledge, and becoming inspired. It is a proven fact that quality improves not by having draconian measures but by being quality conscious, having a mental disposition to quality enhancement at every stage of the patients stay in hospital or contact at health centres. Education

The longer the PM delays shifting education of healthcare professionals to the MOE and the university, the poorer will the people of Mauritius be. The MOH is incapable of initiating, developing and managing a modern structured accredited form of continuing professional development for all workers in the NHS. This approach needs the university, adult pedagogy, and the skills of higher education. HPC must assert in no uncertain terms that the future of healthcare education rests with the university.

Mauritius should develop its own undergraduate and postgraduate diplomas and degrees in healthcare practices. This is what is needed to bring healthcare practice under greater scientific scrutiny and improvement. As Mauritius forges ahead to become an education hub under the jurisdiction of the Tertiary Education Commission, healthcare education should be a leading Faculty at UoM, which will attract our African neighbours to study in Mauritius. Let Mauritius be not only an economic and multicultural model but a pioneer in healthcare education worthy of admiration from Africa, Asia and the EU. The HPC has the opportunity now and it should grab it and cast it in tablets of stone. The new foundation must be laid now.

<B>Public transparency</B>

Mauritius is in desperate need of transparency in its decision-making process. Permanent Secretaries (PS) govern departments as well as stifle progress. The PS and his/her deputies must come under greater scrutiny and be cross-examined by Select Committees on TV. Healthcare professionals have been promised ‘developments in the pipeline’ by the PS at the MOH at every encounter. Nobody knows what development, when, where and which tail is wagging the dog. How ‘development’ decisions are reached and who stifles them. Decision-makers at the MOH must be accountable to the people of Mauritius. The people must be given a chance to see, listen and know who is working for the country. Greater public accountability is healthy and will help a greater cooperation between unions and the MOH.

The HPC must make this ground breaking recommendation that the PS at the MOH (or any Ministry for that matter) come under cross-examination. Thus, HPC must develop Ground Rules For Public Transparency. This can become a model that our PM can adopt for other ministries as well.

So, come on Mr Ganoo and co-members of the HPC. This is the moment and it has arrived. Rise to the challenge and make the most significant contribution to national development. Let our children remember you for the unwavering tower of strength that you can be by being brave and visionary. Don’t fail them!

<B>Taleb DURGAHEE</B>