Cancer patients lose R250m

Health department forfeits funds after a year of failing to use any of them for desperate sufferers

● The Gauteng health department has had to pay back R250m provided by the provincial treasury for potentially life-saving treatment for cancer patients — because it did not spend a cent of it.

This startling admission is contained in the department’s latest court documents filed in the Johannesburg high court and comes as a massive blow to thousands of desperate cancer patients waiting for treatment.

The R250m was the first tranche of a special R784m commitment from the Gauteng treasury to help clear the backlog by outsourcing treatment to the private sector. It was paid out in March 2023 and was forfeited at the end of the financial year on March 31 this year.

The treasury has subsequently paid the second tranche, R261m, which the department must use or lose by March 31 next year.

The department is in a legal battle with Cancer Alliance and Section 27, who have asked the court to compel the department to spend the money and clear the backlog of patients waiting for treatment.

They define “backlog patients” as cancer sufferers who have been waiting for treatment for between 18 months and three years. There are about 3,000 state patients waiting for treatment at Charlotte Maxeke Johannesburg Academic Hospital and Steve Biko Academic Hospital in Pretoria.

Amid the legal bickering, a frustrated oncologist at Charlotte Maxeke this week told the Sunday Times that there was some hesitation among state doctors regarding outsourcing cancer treatment.

“I am not a fan of government and its bureaucratic processes and bungling, but there are huge complications in this situation. I myself had misgivings about outsourcing services because of the danger that private service providers could see us as this massive cash cow.

“The cost of an average patient’s treatment at Charlotte Maxeke would be around R15,000 to R20,000. Then you get these guys in private health care telling us they can provide that treatment, but for a cost of around R150,000,” he said.

“Charlotte treats about 4,000 cancer patients a year, so if you want to do that privately you’re looking at a cost of about half a billion,” he said. “That’s something we could do ourselves if there was budget. For two linac accelerator machines [for radiation] with 10-year maintenance contracts, you’re looking at R200m.

“The biggest frustration is that if you gave me about R100m I could fix the problem fast, the backlog would be gone and we could get down to our real work and start focusing on research and driving cancer treatment forward,” he said.

Other challenges included the fact that radiographers at public hospitals in Gauteng were paid less than those based in every other province, and far less than radiographers at private hospitals.

“We have 20 radiographers at the moment, and we need 40. If someone could just approve pay increases, we could resolve that situation quickly.”

He said other problems included equipment breaking down and the bureaucratic process necessary to get it repaired, and non-functioning air conditioning resulting in the need to shut down linac accelerator radiation machines as they had to be kept cool.

In the legal battle, Cancer Alliance also wants the court to declare that the Gauteng health department acted unlawfully and unconstitutionally by failing to devise and implement a plan to provide radiation and oncology services to patients on the backlog list.

It has asked the court to order the department to outsource radiation and oncology services, interdictory relief

aimed at preserving the forfeited R250m and supervisory relief requiring the department to deliver updated progress reports and their long-term plan regarding the allocation of treatment to patients at Maxeke and Biko hospitals. The admission by the department about the forfeiture appears to contradict its early claims in court papers filed in July and again in October, in which it said the process of outsourcing treatment to private health-care providers was under way.

The Cancer Alliance questioned why the department did not mention the forfeiture in its earlier papers. “It is evident that GDoH [Gauteng department of health] has failed to take the court into its confidence,” the alliance said. “The department chose not to disclose this, even four months after the money was forfeited. The department told the court the money was to be used to provide services, knowing that the money had already been forfeited.

“Irreparable harm will occur if the department continues to fail to act expediently. There is already a danger that they will have to return some of this year’s funding.”

The alliance said that as of October 15 the Gauteng health department had not spent any of the total of R511m paid out for the provision of urgent services to cancer patients on the backlog list, budgeted for the 2023/24 and 2024/25 financial years.

But the department claims the situation is “not as urgent” as the Cancer Alliance makes it out to be. It says it has a solution that is being implemented and that the organisation’s legal action is an attempt to “run the department from the outside”.

“It is not up to [Cancer Alliance] to determine how such treatment is to be administered, when and by who,” said head of department Lesiba Malotana in court papers.

Malotana admits: “The entire R250m was unspent and returned to the provincial treasury. There is no R250m that is in the possession of the department at this stage.”

He said the money had not been spent because the department was still busy with tender processes relating to the outsourcing of services — and that during this time, patients would continue to be treated internally “as determined by the clinicians on site every day”.

The second tranche of money would therefore be spent “as long as the department is able to have commitments in the form of purchasing orders before the end of the 2024/25 financial year ” .

He said appointments had already been made but that “details will be thrashed out in the service level agreements that are being negotiated and concluded as we speak”.

In July, Malotana told the high court the department had advertised tenders for three different categories of cancer treatment. Two had been withdrawn, and the third — for “planning services” to the value of R17.48m — had been awarded to Siemens, for 2,000 plans at R8,740 per plan to be carried out from May this year to next April.

He said Siemens was to invoice the department for planning in batches of 100, but because 100 patients had not yet been treated, no invoice had been received.

Judgment in the matter has been reserved. Health department spokesperson

Motalatale Modiba told the Sunday Times this week the legal challenge was a “deliberate and

The entire R250m was unspent and returned to the provincial treasury. There is no R250m that is in the possession of the department at this stage

Lesiba Malotana, above

desperate attempt to conduct a trial in the court of public opinion on a matter that is under consideration by the court”.

“The department will not be engaging in media debates regarding the merits of the application or the issues before court until the matter has been concluded.”

Cancer patient Lydia Staats, of Boksburg, said the latest revelations were “disappointing”.

“I can’t believe it. I am one of the lucky ones because I got my treatment in time, but we are still fighting for those who are waiting,” said Staats, whose case study featured in the Cancer Alliance’s court submissions.

“I know what it is like to be on that waiting list — the fear you experience with every little ache or pain, terrified that the cancer has come back, or that it has spread,” she said.

She was diagnosed with breast cancer, underwent chemotherapy and surgery and was waiting for radiation — ideally to be administered within 90 days of surgery according to Gauteng health protocols — only to discover that her wait had been too long and her cancer had returned. She then had to go back for more chemotherapy and more surgery and was placed back on the waiting list for radiation — which she received in July this year and is now clear.

Another patient featuring in the case is Thato Moncho, a single mother and fitness instructor whose breast cancer returned three times while she waited for radiation. She has since been taken off the list because when she was finally called for radiation it was discovered that the cancer had spread to her lungs and progressed too far for radiation to be effective. She is now on palliative oncology treatment as nothing more can be done for her.