The building of the new facility is underway

The WCRC interfaces with, and receives referrals from, all levels of acute and sub-acute services (tertiary, secondary, district and primary -including step-down services and home-based care). Clients can also self-refer to the WCRC. Efficient referral pathways between the WCRC and all the other service points is essential, to ensure fast, appropriate referral to rehabilitation.

Due to pressure on acute beds, the average length of stay at tertiary-, secondary- and district hospitals is only 3 - 3.5 days. This results in many patients being discharged home prematurely. The major responsibility for relieving the Departments' long-term health care burden, therefore rests with rehabilitation services.

Failure by other health services providers to quickly refer appropriate clients to the WCRC, frequently results in disabled clients falling through the safety net. Secondary complications frequently develop, resulting in rehabilitation that is both more costly, lengthier, and has poorer outcomes.

The primary patient target groups referred to the WCRC include persons with spinal cord- and head injury, stroke, amputation, neurological disease, HIV/AIDS sequelae, TB complications (e.g. TB spine / TB meningitis) and cerebral palsy (amongst others).

Wheelchair ballroom dancing

Integral to the rehabilitation programme is the training and skills development of family- and caregivers, to ensure optimal health maintenance following a return home. Skills transference also helps in reducing the burden on caregivers (and ultimately also on the Department of Health).

The WCRC also provides a unique training- and research platform for a wide variety of under- and post-graduate health professionals from the tertiary institutions. Elective students from other provinces and from overseas are also regularly accommodated.

Construction of the new Centre

The Conardie Acute services relocated to the new Eerste River Hospital, and the St Luke"s HIV/AIDS hospice relocated to newly refurbished wards on the LG site.

Building (phase 3) and refurbishment of the new WCRC facility in Mitchell's Plain is in the final stages, with relocation earmarked for August 2004.

The new WCRC facility is custom-built for a physical rehabilitation service and will be a "flagship" for both the province and the country.. The facility is disability-friendly throughout, largely due to the active involvement of the disability sector throughout the planning and building stages.

Urban Renewal "spin-offs":
Mitchell's Plain has been earmarked by President Mbeki as one of the priority nodes of urban renewal in the W Cape. The relocation of the WCRC to the site in Mitchell's Plain has further contributed to this process, through many related "spin offs": for example upgrading of pavements to ensure wheelchair accessibility to the nearest shopping centre; the introduction of traffic-calming measures to increase the safety of this vulnerable population; upgrading of the Lentegeur and Mandalay stations to achieve universal accessibility standards.

The Infrastructure Plan for the WCRC complies with the four (4) key elements of infrastructure planning as outlined in 2010 in respect of its buildings, equipment and maintenance.

The relocation to previously under-utilized wards on the LG hospital site ensures that capital infrastructure will now be optimally utilized. In addition, the relocation to Mitchell's Plain addresses geographic inequality.

The new facility is well designed and will be accessible and secure. With a view to protecting this "new asset" in the long-term, the Department is proposing a PPP (in the form of Facility Management).

In providing the physically disabled population of the W. Cape with this wonderful facility, we are not only celebrating 10 years of democracy, but also the realization of a 10-year dream! In the same way, Health Care 2010 can become a reality!

The WCRC provides a specialized, high intensity rehabilitation service to the Western-, Northern- and Eastern Cape provinces. As a specialized facility, the WCRC also fulfils an additional responsibility in providing outreach & support to primary-, secondary & tertiary level services.

Promoting & facilitating the development of community-based rehabilitation services remains a high priority. Discussions with a view to future partnership building and adding value to the services on offer in the Mitchell's Plain Sub-District, have already been initiated with the Mitchell's Plain District Health Manager & various NGO's.

Disability Prevention and -Awareness-raising programmes will continue as a high priority, particularly in respect of rugby- and diving injuries, as well as the management of hypertension and diabetes mellitus.

The therapy area of the new Centre

Various OPD specialist clinics are also provided. These include scoliosis-, urology-, plastic surgery- and wheelchair- and buggy seating clinics.

The WCRC also provides post-operative management of complications in the spinal cord injured e.g. orthopaedic-, plastic- and urological surgery. A service level agreement has been signed with Eerste River hospital in respect of utilization of their theatres. (The WCRC utilizes its own sessional medical specialists.)

Health Care 2010 aspires to having "the right people with the right skills in the right place". In this respect the WCRC is well on track, as the organizational development study has been completed. The draft report (including the implications of Facility Management) should soon be released for comment.

Due to the unique nature of the facility and the manner in which services are provided, the re-structured staff establishment reflects many innovative approaches. For example, staff has been re-organized into interdisciplinary , functional teams or "clusters", rather than in the traditional departmental "silo" model. (The former is more efficient and effective.)

A generic post of Assistant Director Health has been developed, providing a career path into rehabilitation management for any one of the allied health professionals.

A post of Development Officer has also been created to monitor, co-ordinate, facilitate and evaluate the many capacity-building, training and research initiatives provided by this specialized hospital.

The ongoing constraint of critical shortages of key personnel remains a challenge: i.e. 50% vacancy rate for medical officers and more than 70 nursing posts vacant.

The decommissioning of Conradie, the amalgamation of the Rehabilitation services as well as the development of a new organizational structure and culture has placed ongoing high demands on all levels of Management.

Effective Change Management can be regarded as the key point in facilitating a move in the direction of 2010. Successful change management has also been experienced as being one of the areas currently providing the greatest job satisfaction!

Amongst the key strategies for 2004/5 will be the utilization of standardized, rehabilitation-specific performance indicators for the monitoring of effectiveness, such as the Re-integration to Normal Living Index, Caregiver strain Index, Outcome Levels (Landrum et al) and the Prosthetic Ambulatory scale (Volpicelli et al- modified).

Integral to the financial implementation plan for the WCRC has been a strong move to participative management, extending to clinician level. Consensus was reached in respect of posts prioritised for filling (within the affordability framework) and the key performance targets against which teams / clusters will be measured. Various performance targets (to be achieved by 01/04/05) have been agreed to. For example, the first 3 target priorities are: Duration of rehabilitation per admission will be less than 3 months in 95 % of all clients, 85% bed occupancy, and reduced cost /admission and PDE.

Various challenges remain. The inability to commission all 8 wards on the LG site due to a serious nursing-/doctor shortage, could be overcome by utilizing one ward as a transitional living area (best practice model used in SCI Units overseas), and the other for Work Rehabilitation (dependent on filling 2 x OT posts).

Serious inefficiencies in Orthotic & Prosthetic services make the outsourcing of this service for the WCRC in 2005/2006 the highest priority.

Finally, the financial demands resulting from the implementation of the policy of Free Health Care for Persons with Disabilities will have to be offset by increased revenue-generation. Goals in this regard include concluding Preferred Provider Agreements with the Workmen's' Compensation Commissioner, the RAF and various Medical Benefit Schemes (serving blue collar workers).

The WCRC is embracing Change and Transformation and we look forward to our relocation to our new facility in the near future !

In addition, the WCRC can, and will, play a key role in the further development of rehabilitation services at all levels, and assist in breaking the vicious cycle of poverty and disablement.

Within the social model framework of disability, continuous awareness raising of the needs of the physically disabled, and advocacy on their behalf, will remain an ongoing priority for the Western Cape Rehabilitation Centre.