At the Life Esidimeni inquest on Wednesday, advocate William Mokhare put it to former Gauteng premier David Makhura that former Gauteng health MEC Qedani Mahlangu had told the inquest the decision to cancel the Life Esidimeni contract came from the Premier’s Budget Council (PBC). 

“The PBC would be in no position to make a decision over a contract … it would completely be unlawful,” Makhura retorted. 

Makhura told the inquest he became aware that patients had died following the contract’s termination when Mahlangu announced it in the provincial legislature in 2016. At a subsequent meeting with the former MEC and department officials, he asked officials how and why patients were dying at NGOs. 

According to Makhura, the officials said the deaths “are normal” and this shocked him. “I asked the MEC: ‘Why do you bring such a big delegation?’ She answered that these are the people that can answer my questions.” 

He said after he was initially told that 36 patients had died, the number kept changing and it was clear that more than 36 had died.  

Representing SECTION27 and the patients who died after being transferred from Life Esidimeni, a private healthcare provider, to NGOs, advocate Adila Hassim asked Makhura if he had asked officials why patients were moved to NGOs when there was no mention of this in the PBC meeting. 

“The core question for me is, how did people end up in NGOs [where] they died?” replied Makhura. “That’s when a whole host of officials introduced the National Mental Health Policy Framework and Strategic Plan 2013-2030 which they referred to as deinstitutionalisation, saying that actually they were implementing national legislation.” 

Makhura said it was at this point that he felt he had to speak to the national minister of health, and the minister made it clear to him that what the officials were implementing was not in line with national policy. 

Hassim asked Makhura if he thought that there should not be individual responsibility for the deaths of the patients, as department officials had testified that the termination was a collective decision. 

Makhura answered: “Every member of the executive is individually and collectively responsible for those things that are in their line of sight and area of responsibility. The notion that we are collectively responsible and nobody is individually [reponsible] is absurd.” 

On Tuesday former Gauteng finance MEC Barbara Creecy also testified at the inquest following Mahlangu’s testimony that Creecy and Makhura were central to the decision to terminate the Gauteng Department of Health’s (GDoH’s) contract with Life Esidimeni. 

Creecy referred the inquest to a 2015 Treasury practice note which explained where government entities were to cut costs, and pointed out that there was nowhere in the practice note that gave an instruction “to cut core services”. 

Mahlangu has throughout her testimony maintained that the termination of the Life Esidimeni contract was due to pressure to cut spending. However, Creecy testified that the GDoH had been underspending on its budget for the period 2014/2015 and 2015/2016 before the Marathon Project to move patients from Life Esidimeni to the ill-equipped and under-capacitated NGOs. 

“There was no cut in the health budget between [those] financial years,” Creecy said. She said that of the R1-billion allocated to mental health services in 2013/2014 the department had underspent by R62-million. Creecy told the inquest that the 2015/2016 budget was increased to R1.35-billion, of which the GDoH only spent R1.27-billion.  

Creecy told the inquest that the GDoH’s 2014/2015 cost containment proposal to the PBC flagged Life Esidimeni and said “final notice to be given in December to begin the termination of use of beds”. It indicated that this would lead to a potential savings of R50-million in the budget, but also noted that “departmental institutions may not have capacity to absorb patients from Life Esidimeni”.  

The inquest continues. DM