Unsafe and substandard. Is that what public healthcare in SA looks like?
'Unsupervised, unstructured, non-standardised, unsafe and altogether substandard.'
This is how the
Two later died and one was left with permanent brain damage.
In the same week as the ombud's report, politicians' comments about the 'alarming number' of patients who
Mention the
This is where the
The basic idea is that inspectors visit clinics and hospitals, run through a long list of requirements that have to be met, award a score for each one and then write up a report to say whether quality is up to scratch. If so, a certificate of compliance — valid for four years — is issued; if not, the facility is re-inspected later and, if still not in the clear, it gets a written warning.
But, says Susan Cleary, a health economist and head of the School of Public Health at the University of Cape Town, the measures defined in these scorecards make it 'almost impossible' for an establishment to pass the test. Scoring a facility's service quality according to measures they have little control over is unfair, she says. 'The last thing you want to do is give people a job that's impossible to do.'
Yet, given the way the inspection system tests whether a facility complies with each of the
'Is it then really a question of what the quality of service is,' she asks, 'or is it a question of what is being measured?'
In a series of analyses, we're diving into the OHSC's inspection reports to get a sense of what the benchmarks are — and what they say about the state of affairs at clinics, community health centres (CHCs) and hospitals.
In this first story, we're looking only at the public health sector — not because we think things are perfect in private establishments, but because with
And as with getting universal health coverage in place, we have to start somewhere. Come with us as we look at the numbers.
The lay of the land
South Africa has 3 741 public health facilities, of which about 90% are clinics and CHCs. Hospitals make up the remaining 10%.
Because the different facilities offer different services, the detailed list of requirements they have to meet doesn't look the same for each place — although they all have to adhere to the same broad set of 23 standards.
For example, four
For this reason, one day is budgeted for
Counting and compliance
Between 2019 and 2023, the OHSC inspected 3 093 public health facilities — about 83% of the total to be assessed. Scores for the last 17% — 648 facilities — are still outstanding. (The latest inspection results
Getting to every health facility in the country is a mammoth task. For example, 734 inspections in 2023 works out to two a day — and with
But the task seems even more overwhelming when the compliance rate is added into the mix. In 2022 (the latest year for which results are available), only four out of 10 public facilities passed the test and so have to be re-inspected later, meaning that the backlog builds.
To be rated as compliant, a facility has to get full marks for a set of so-called non-negotiable measures — things the
It's an unfeasible system, Cleary says. 'I think that's a large part of what's happened to our public sectors. [People] get given unfunded mandates all the time. But just because a standard has been set unrealistically high, it doesn't mean that [service] quality is terrible; it may simply mean that hitting the bar is unaffordable given the money or staff available.'
Star struck or star stuck?
If we convert public health facilities' compliance rates to a star rating — like you'd give a service provider on an online review — no province got more than three stars in 2022.
Looking at these results, it seems that, at best, three out of five facilities would make the cut — and it happens only in Gauteng. In KwaZulu-Natal and the Western Cape, chances are that every second facility might meet the OHSC's list of requirements, with the other provinces struggling to get more than one out of five facilities compliant. In fact, in the Northern Cape and Limpopo, so few of the inspected facilities could pass the assessments that their scores wouldn't even translate to a single star.
But these are the results on paper — and likely give a warped picture of what is happening in practice because of the way performance is measured.
A trimmed list of requirements — 'something that 90–95% of facilities can actually meet' — could give a more realistic view, says Cleary. This doesn't mean compromising on quality, but rather that decision-makers have to think more carefully about what the priorities really are.
'It's partly a matter of 'cutting your coat according to your cloth',' she says and working from there to improve step by step — with the money to make it happen.
Says Cleary: 'We have to let go of this idea that we can have everything and that it all has to be perfect otherwise it's not good enough.'
Stats that are shocking
Something like the non-negotiable measures in the OHSC's scorecards could give a fairer idea of what healthcare quality really looks like.
These are three things a clinic has to have in place to make the grade; the same three things in the emergency, obstetrics and clinical services units of a CHC and eight things in a hospital. They cover only statements related to handling a medical emergency, having a system in place for supplying lifesaving medical gas (like oxygen) to patients and getting patients' consent the right way.
Viewing the quality of public healthcare from this angle really does paint a shocking picture — and could give decision-makers a concrete place to start to get to grips with claims of inadequate service.
In 2022, only two provinces — Gauteng and the Western Cape — managed to have these minimum lifesaving measures in place in at least seven out of 10 clinics and CHCs and half the district hospitals inspected. (We didn't include regional hospitals in our analysis because at most two of these were assessed in a province. A score of, say, 50% would therefore not have been a fair reflection of reality.)
In two other provinces — Mpumalanga and North West — half of either clinics or CHCs met these minimum requirements. The other provinces didn't come close.
The health ombud's investigation
Looking only at these measures, the
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Mail & Guardian
4 hours ago
- Mail & Guardian
Pharmaceuticals found in Hout Bay mussels
Hout Bay's marine environment is threatened by pharmaceutical and personal care product compounds that have accumulated in marine life, even kilometres from pollution sources, University of Cape Town researchers have found. Hout Bay's marine environment is threatened by The authors said the findings of their Environments, raise urgent questions about sewage management, environmental monitoring and public health in one of Cape Town's popular coastal areas. The research team, led by These compounds — residues from common medications and products such as shampoo, soap, toothpaste and moisturisers — enter the marine environment through human excretion, wastewater discharge and improper disposal. The presence of these compounds in mussels is a 'red flag', Ojemaye warned. 'Mussels are sentinel organisms; they filter the water and accumulate pollutants, which means they are telling us a story about the health of the entire marine ecosystem.' The pollution from Hout Bay's sewage discharge extends far beyond the immediate outfall area, contradicting previous assumptions that contaminants disperse quickly and harmlessly. This is not a case of 'dilution is the solution to pollution', Ojemaye said. 'These contaminants don't just disappear. They spread, settle, and accumulate in marine life, creating an extensive and ongoing impact zone.' Sewage contamination The researchers used chemical analyses to quantify the presence of pollutants such as personal care product compounds in sentinel marine organisms such as mussels, as well as microbial indicators of faecal contamination in river water and seawater, for estimating the extent of affected zones in the coastal environment of Hout Bay. They also investigated the pharmaceuticals found in wastewater effluent samples in Hout Bay, examining whether these substances were also detectable in marine biota, specifically mussels. The findings revealed significant levels of sewage-related pollutants in the sampled environments. 'These results highlight persistent PPCP contamination in marine organisms, with increasing concentrations observed over time, suggesting a rise in population and pharmaceutical use,' the study said. Microbial analysis also found 'These findings underscore the significant impact of untreated sewage on the environment,' the study noted. It concluded that sewage treatment is insufficient to mitigate pollution, urging the implementation of more effective wastewater management practices and long-term monitoring of pharmaceutical levels in marine biota to protect both the environment and public health. In addition, municipal decisions regarding sewage disposal options in Hout Bay have played a significant role in the pollution by sewage of the coastal area. The lack of control of serviced land invasion has exacerbated things. 'The city has not provided Imizamo Yethu with adequate sanitation infrastructure for decades, leading to exceptionally high faecal content in the Disa River,' said The authors fully support the argument by lawyers involved in Significant source of pollution They say the sewage outlet services about half of Hout Bay's population, making it a significant source of chemical and microbial contamination. The Hout Bay River also carries pollutants into the bay, but the design and operation of the sewage outlet itself contribute heavily to the problem. The situation poses both ecological and potential human health risks if contaminated mussels and other shellfish are eaten. That the bay lies in a marine protected area makes the findings particularly concerning for conservation efforts. Beyond environmental damage, the research points to wider public health implications, including the possible spread of antimicrobial resistance through contaminated marine environments. 'We urgently need to understand whether faecal coliforms in Hout Bay are carrying antimicrobial resistance genes,' Ojemaye said. 'If so, this could have consequences for human health that extend far beyond our coastlines.' The study calls for a multi-pronged response, including investment in upgraded wastewater treatment, reduction of harmful chemical usage and stronger regulations on pollutant discharge. This is especially critical in light of issues such as the Covid-19 pandemic, which saw increased chemical use, and the ongoing energy crisis, which affects wastewater management. Outdated, harmful Globally, marine outlets are increasingly recognised as outdated and environmentally harmful, the scientists said, and replacing them with land-based treatment facilities should be a priority. Such systems can remove pollutants more effectively as well as produce renewable energy and recover valuable resources from wastewater. 'Hout Bay's pollution problem is not unique, but it is urgent,' Green said. 'This is an opportunity for innovation and collaboration. With the right technologies and political will, we can turn wastewater from a hazard into a resource.' The research team emphasised that although further studies are needed to map the pollution zone's full extent and understand the risks of consuming contaminated seafood, mitigation measures should begin without delay. 'This is not just about science; it's about protecting livelihoods, ecosystems and the health of our communities. If we wait until the damage is irreversible, it will be too late.' The study is a wake-up call for Cape Town, Green said, urging policymakers and the public to face the uncomfortable truth that the city's marine environment is absorbing the cost of inadequate wastewater management. 'Without urgent intervention, the toxic tide will keep rising.' City of Cape Town's response The difficulty of the removal of PPCPs from wastewater is not unique to Hout Bay or to Cape Town, said 'Advanced treatment technologies such as ozonation, reverse osmosis and membrane filtration can be used to remove some CECs [contaminants of emerging concern], but implementation of these technologies can be expensive and energy intensive and is not always a practical option at scale. Even our most sophisticated newly upgraded wastewater treatment works cannot treat wastewater in a manner that removes all traces of pharmaceuticals and other contaminants of emerging concern.' The city recently undertook a feasibility study to explore the options for replacing its marine sewage pipelines with new wastewater treatment works, but no decision has yet been made on when this will happen. 'We must acknowledge though that Cape Town has many underserviced areas requiring the provision and upgrading of basic services, and must weigh up the prioritisation of limited funding in this context. Marine outfalls In 2024, the city commissioned independent experts for its The findings are presented quarterly to a publicly accessible permit advisory forum established by the city in April last year, Andrews said. The first annual report on these studies is expected towards the end of the year. 'This programme builds on decades of monitoring by the city of the environmental impacts of the outfalls, all of which is comprehensively reported on in documentation available on the city's 'Respectfully, the authors of the study appear to be doing no more than speculating when they state that the marine outfall does not achieve the dilution and dispersal of contaminants of emerging concern. Their work did not include an analysis of PPCPs in effluent, river water or in coastal waters and analysed only mussels found in situ in the coastal environment.' Andrews said the UCT study 'cannot draw conclusions' about the source of the contaminants or the extent of the impact zone of the sewage outlet, nor the effectiveness of its design, based on the methods and results presented. 'What we do know is that the impacts of wastewater discharge, whether it occurs intentionally or due to spills, are far more acute in freshwater systems with very small volumes, than they are in the highly dynamic offshore environment when dispersion and dilution take place after discharge through an outfall diffuser,' he said. 'We have commissioned extensive research that we hope will provide greater insight into the questions raised here about the long-term impacts of marine wastewater disposal.' The city will 'act on reliable data and findings', he said. 'To date, the extensive scientific work undertaken has not demonstrated a significant negative impact. The 2024 marine outfalls environmental monitoring programme is very comprehensive and incorporates the assessment of hundreds of parameters, including several new components not previously forming part of routine assessments.' Very poor state The city acknowledges that the Hout Bay River is in a very poor state because of pollution from a variety of sources, Andrews said. It receives flows from a catchment of about 37 square kilometres, which includes natural upper slopes in the Table Mountain National Park, formal residential areas and smallholdings on both sides of the Hout Bay River, formal housing with backyard dwellers in Imizamo Yethu and Hangberg areas, and informal dwellings in Imizamo Yethu, which includes a fairly large informal settlement with limited services. The potential health risks associated with swimming in the sea near river mouths or stormwater outflows, even in summer and especially after rainfall, are signposted on the Hout Bay Beach and communicated to the public and beach users. The city concurs with the study's authors that further research into the accumulation of pharmaceutical compounds by bivalves in a marine protected area is needed, and note its environmental monitoring programme for the sewage outlets includes such monitoring. 'Unfortunately the authors of the study made no effort to assess the risks posed by the pharmaceutical concentrations they determined, but simply stated that exposure would be 'harmful'. To determine the actual risk to consumers it is necessary to establish the amount of seafood that would have to be consumed to cause an exposure in excess of safe levels, Andrews said. 'As this was not undertaken and only the absolute concentrations are presented, it is simply not responsible or scientifically sound to conclude that this may result in harm.' 'It is also of some concern that the authors do not appear to have accounted for the age or size of the mussels sampled in their study — the rates of accumulation of these compounds may vary with age.' The city does not dispute the presence of CECs in mussels but 'requests that, and based on the sweeping claims and conclusions made — especially those made in relation to public health — the authors take more responsibility in their application and improvement of scientific rigour in terms of their analysis and interpretation of the results of the study'. The MMC for water and sanitation, These include unplanned densification in informal areas, leading to a significant increase in wastewater volumes beyond the original sewer system's capacity; illegal informal dwelling connections to the sewer network, which compromise the integrity of the infrastructure and stormwater-to-sewer cross-connections, implemented historically to reduce river pollution, which now also contribute to system overloading. The disposal of building rubble and general waste that cause blockages and spills, as well as structures built over sewers make routine maintenance difficult. The water and sanitation directorate has a regional team that focuses on sewer reticulation problems in Hout Bay, Badroodien said. This team has implemented a range of short, medium and long-term interventions. 'As part of a broader R1.25 billion investment in sanitation infrastructure this financial year, R355 million has been allocated for sewer pipe replacements and R241 million for pump station upgrades across Cape Town,' he said. 'Through this combined infrastructure and behaviour-change approach, the city aims to significantly reduce sewer spills and associated pollution into the Hout Bay River and adjacent marine environment.'
Mail & Guardian
20 hours ago
- Mail & Guardian
Unsafe and substandard. Is that what public healthcare in SA looks like?
'Unsupervised, unstructured, non-standardised, unsafe and altogether substandard.' This is what was said about the care at two public hospitals in the Northern Cape last year. But is the way quality is measured a fair test? (Delwyn Verasamy) 'Unsupervised, unstructured, non-standardised, unsafe and altogether substandard.' This is how the Two later died and one was left with permanent brain damage. In the same week as the ombud's report, politicians' comments about the 'alarming number' of patients who Mention the This is where the The basic idea is that inspectors visit clinics and hospitals, run through a long list of requirements that have to be met, award a score for each one and then write up a report to say whether quality is up to scratch. If so, a certificate of compliance — valid for four years — is issued; if not, the facility is re-inspected later and, if still not in the clear, it gets a written warning. But, says Susan Cleary, a health economist and head of the School of Public Health at the University of Cape Town, the measures defined in these scorecards make it 'almost impossible' for an establishment to pass the test. Scoring a facility's service quality according to measures they have little control over is unfair, she says. 'The last thing you want to do is give people a job that's impossible to do.' Yet, given the way the inspection system tests whether a facility complies with each of the 'Is it then really a question of what the quality of service is,' she asks, 'or is it a question of what is being measured?' In a series of analyses, we're diving into the OHSC's inspection reports to get a sense of what the benchmarks are — and what they say about the state of affairs at clinics, community health centres (CHCs) and hospitals. In this first story, we're looking only at the public health sector — not because we think things are perfect in private establishments, but because with And as with getting universal health coverage in place, we have to start somewhere. Come with us as we look at the numbers. The lay of the land South Africa has 3 741 public health facilities, of which about 90% are clinics and CHCs. Hospitals make up the remaining 10%. Because the different facilities offer different services, the detailed list of requirements they have to meet doesn't look the same for each place — although they all have to adhere to the same broad set of 23 standards. For example, four For this reason, one day is budgeted for Counting and compliance Between 2019 and 2023, the OHSC inspected 3 093 public health facilities — about 83% of the total to be assessed. Scores for the last 17% — 648 facilities — are still outstanding. (The latest inspection results Getting to every health facility in the country is a mammoth task. For example, 734 inspections in 2023 works out to two a day — and with But the task seems even more overwhelming when the compliance rate is added into the mix. In 2022 (the latest year for which results are available), only four out of 10 public facilities passed the test and so have to be re-inspected later, meaning that the backlog builds. To be rated as compliant, a facility has to get full marks for a set of so-called non-negotiable measures — things the It's an unfeasible system, Cleary says. 'I think that's a large part of what's happened to our public sectors. [People] get given unfunded mandates all the time. But just because a standard has been set unrealistically high, it doesn't mean that [service] quality is terrible; it may simply mean that hitting the bar is unaffordable given the money or staff available.' Star struck or star stuck? If we convert public health facilities' compliance rates to a star rating — like you'd give a service provider on an online review — no province got more than three stars in 2022. Looking at these results, it seems that, at best, three out of five facilities would make the cut — and it happens only in Gauteng. In KwaZulu-Natal and the Western Cape, chances are that every second facility might meet the OHSC's list of requirements, with the other provinces struggling to get more than one out of five facilities compliant. In fact, in the Northern Cape and Limpopo, so few of the inspected facilities could pass the assessments that their scores wouldn't even translate to a single star. But these are the results on paper — and likely give a warped picture of what is happening in practice because of the way performance is measured. A trimmed list of requirements — 'something that 90–95% of facilities can actually meet' — could give a more realistic view, says Cleary. This doesn't mean compromising on quality, but rather that decision-makers have to think more carefully about what the priorities really are. 'It's partly a matter of 'cutting your coat according to your cloth',' she says and working from there to improve step by step — with the money to make it happen. Says Cleary: 'We have to let go of this idea that we can have everything and that it all has to be perfect otherwise it's not good enough.' Stats that are shocking Something like the non-negotiable measures in the OHSC's scorecards could give a fairer idea of what healthcare quality really looks like. These are three things a clinic has to have in place to make the grade; the same three things in the emergency, obstetrics and clinical services units of a CHC and eight things in a hospital. They cover only statements related to handling a medical emergency, having a system in place for supplying lifesaving medical gas (like oxygen) to patients and getting patients' consent the right way. Viewing the quality of public healthcare from this angle really does paint a shocking picture — and could give decision-makers a concrete place to start to get to grips with claims of inadequate service. In 2022, only two provinces — Gauteng and the Western Cape — managed to have these minimum lifesaving measures in place in at least seven out of 10 clinics and CHCs and half the district hospitals inspected. (We didn't include regional hospitals in our analysis because at most two of these were assessed in a province. A score of, say, 50% would therefore not have been a fair reflection of reality.) In two other provinces — Mpumalanga and North West — half of either clinics or CHCs met these minimum requirements. The other provinces didn't come close. The health ombud's investigation Looking only at these measures, the This story was produced by the . Sign up for the .
TimesLIVE
4 days ago
- TimesLIVE
Unsafe and substandard. Is that what public health care in SA looks like?
MEASURED Image: Delwyn Verasamy 'Unsupervised, unstructured, non-standardised, unsafe and altogether substandard.' This is how the health ombud's report at the end of July described the care four patients received at the Robert Mangaliso Sobukwe and Northern Cape Mental Health hospitals in Kimberley last year. Two later died and one was left with permanent brain damage. In the same week as the ombud's report, politicians' comments about the 'alarming number' of patients who pick up infections in Gauteng hospitals and a news headline alleging that duct tape was used to close an Eastern Cape mom's C-section wound raised questions — and hackles — about the standard at which health facilities in South Africa operate. Mention the National Health Insurance scheme — the government's plan for rolling out universal health coverage — in the same conversation and debates become explosive. The basic idea is that inspectors visit clinics and hospitals, run through a long list of requirements that have to be met, award a score for each one, and then later write up a report to say whether quality is up to scratch. If so, a certificate of compliance — valid for four years — is issued; if not, the facility is re-inspected later and if still not in the clear, it gets a written warning. But, says Susan Cleary, a health economist and head of the School of Public Health at the University of Cape Town, the measures defined in these scorecards make it 'almost impossible' for an establishment to pass the test. Scoring a facility's service quality according to measures they have little control over is unfair, she says. 'The last thing you want to do is give people a job that's impossible to do.' Yet given the way the inspection system tests whether a facility complies with each of the 23 standards defined by the National Health Act, it's 'almost as if we set them up for failure', says Cleary. 'Is it then really a question of what the quality of service is,' she asks, 'or is it a question of what is being measured?' In a series of analyses, we're diving into the OHSC's inspection reports to get a sense of what the benchmarks are — and what they say about the state of affairs at clinics, community health centres (CHCs) and hospitals. In this first story, we're looking only at the public health sector — not because we think things are perfect in private establishments, but because with roughly 85% of South Africans using government facilities, it seems like the best place to start. And like with getting universal health coverage in place, we have to start somewhere. Come with us as we look at the numbers. The lay of the land South Africa has 3,741 public health facilities, of which about 90% are clinics and CHCs. Hospitals make up the remaining 10%. Facilities differ in their size and types of service, with clinics and CHCs being smaller and offering primary health care, while hospitals (including district, regional or central hospitals) can handle many patients, have them stay a day or more and deliver more specialised treatment. Because the different facilities offer different services, the detailed list of requirements they have to meet doesn't look the same for each place — though they all have to adhere to the same broad set of 23 standards. For example, four inspection tools (almost like a questionnaire) have to be completed for a clinic, totalling about 90 pages of checklists. For a regional hospital though, we counted 38 tools to be filled in across its different departments — a total of roughly 500 pages of checklists. For this reason, one day is budgeted for doing a standards audit at a clinic, but up to five days for a hospital, depending on its size. Counting and compliance Between 2019 and 2023, the OHSC inspected 3,093 public health facilities — about 83% of the total to be assessed. Scores for the last 17% — 648 facilities — are still outstanding. (The latest inspection results available are for the 2022/23 financial year, and though the OHSC has published its annual performance report for 2023/24, the inspection results for the last two years have not been released yet. The OHSC did not respond to our questions about the reason for the delay.) Getting to each health facility in the country is a mammoth task though. For example, 734 inspections in 2023 work out to two a day — and with only 53 people in the OHSC's auditing unit at the time and the extent of the checklists, it's not surprising that things take way longer than planned. But the task seems even more overwhelming when the compliance rate is added into the mix. In 2022 (the latest year for which results are available), only four out of 10 public facilities passed the test and so have to be re-inspected later, meaning the backlog builds. To be rated as compliant, a facility has to get full marks for a set of so-called non-negotiable measures — things the standards documents say can lead to 'severe harm or death' if not in place, then at least 60% for a set of vital measures — requirements that are critical to keep staff and patients safe — and 50% on essential items, 'necessary for safe, decent and quality care'. It's an unfeasible system, says Cleary. 'I think that's a large part of what's happened to our public sectors. [People] get given unfunded mandates all the time. But just because a standard has been set unrealistically high, it doesn't mean that [service] quality is terrible; it may simply mean that hitting the bar is unaffordable given the money or staff available.' Star struck or star stuck? If we convert public health facilities' compliance rates to a star rating — like what you'd give a service provider on an online review — no province got more than three stars in 2022. Looking at these results, it seems that, at best, three out of five facilities would make the cut — and it happens only in Gauteng. In KwaZulu-Natal and the Western Cape chances are that every second facility may meet the OHSC's list of requirements, with the other provinces struggling to get more than one out of five facilities compliant. In fact, in the Northern Cape and Limpopo so few of the inspected facilities could pass the assessments that their scores won't even translate to a single star. But these are the results on paper — and likely give a warped picture of what is happening in practice because of the way performance is measured. A trimmed list of requirements — 'something that 90—95% of facilities can actually meet' — could give a more realistic view, says Cleary. This doesn't mean compromising on quality, but rather that decisionmakers have to think more carefully about what the priorities really are. 'It's partly a matter of 'cutting your coat according to your cloth',' she says, and then working from there to improve step by step — with the money to make it happen. Says Cleary: 'We have to let go of this idea that we can have everything and that it all has to be perfect otherwise it's not good enough.' Stats that really are shocking Something like the non-negotiable measures in the OHSC's scorecards could give a fairer idea of what healthcare quality really looks like. These are three things a clinic has to have in place to make the grade; the same three things in the emergency, obstetrics and clinical services units of a CHC; and eight things in a hospital. They cover only statements related to handling a medical emergency, having a system in place for supplying lifesaving medical gas (like oxygen) to patients, and getting patients' consent the right way. Viewing the quality of public health care from this angle really does paint a shocking picture — and could give decisionmakers a concrete place to start to get to grips with claims of inadequate service. In 2022, only two provinces — Gauteng and the Western Cape — managed to have these minimum life-saving measures in place in at least seven out of 10 clinics and CHCs and half the district hospitals inspected. (We didn't include regional hospitals in our analysis because at most two of these were assessed in a province. A score of, say, 50% would therefore not have been a fair reflection of reality.) In two other provinces — Mpumalanga and North West — half of either clinics or CHCs met these minimum requirements. The other provinces don't come close. The health ombud's investigation revealed that in the two Northern Cape hospitals under the spotlight, emergency power supply was non-existent and that resuscitation equipment did not work. Looking only at these measures then, the assessment that the care available to patients at these facilities was 'substandard, and [that] patients were not attended to in a manner consistent with the nature and severity of their health condition' would be fair — and something that leadership should be held accountable for.
