Prevention of and Treatment for Substance Abuse Bill [B12-2008]: Deliberations on inputs by other departments

Meeting report

Prevention of and Treatment for Substance Abuse Bill (the Bill): Deliberations
The Chairperson reminded the Committee that discussion of the public submissions on the Bill should be completed at this meeting, as the Bill must be completed by the following Friday. He noted that the Committee had been through the Bill up to Chapter 4.

Mr Puseletso Loselo, Chief Director, Legal Services, Department of Social Development, hoped that there would be sufficient time to look at all the proposed amendments, so that the next meeting would be productive.

Ms J Semple (DA) wanted to place on record her deep unhappiness on the way the Bill was being rushed through. She asked if it was necessary to did this so quickly.

The Chairperson then reminded the Committee that there was less time for discussing Bills this year as Parliament as having a shortened session, so the process would have to be speeded up.

Chapter 5: Centre-Based and Outpatient Services
Clause 11: Establishment and abolishment of public treatment centres
Mr Loselo noted that a submission was received from the Central Drug Authority (CDA) , requesting that the term “training” be replaced by “development” throughout the Chapter. The Department of Education supported the clauses in principle, but requested that the requirements for registration of a treatment centre include the condition that children be cared for separately from adults. The Department of Trade and Industry submitted that Clause 11 should specify the strategic location of treatment centres to ensure accessibility to users, that conditions should be laid out for when the Minister may abolish a public treatment center, and that the Chapter should also provide information on the role of the Minister, the Director-General, nurses, social workers, and other Departments. Provision should also be made for the collection of data for statistical purposes, and information on specific cases of substance abuse. This would include the number of substance abusers, and information from the SAPS, to enable government to track the progress of the prevalence of substance abuse. The Department of Social Development (DSD) should also keep a register of the structures and programmes in place for substance abuse across the provinces.

The Chairperson asked the representatives from the Department if they had any reaction to the inputs from the public, and from other departments; and whether they agreed or disagreed with the submissions.

Ms Nomathemba Kela, Chief Director, DSD, wondered if certain wording could be substituted “Training” was intended to be aimed at the acquisition of a particular skill, while “development” as very broad, encompassing far more, and she believed that “skills development” would be a better term.

The Chairperson agreed that the training could be part of a larger process, rather than the primary objective of the centres.

Ms Kela stated that the Department of Social Development supported the proposal of the Department of Education for children to be treated separately from adults, but believed that this should fall under the “Norms and Standards” section of the Bill.

The Chairperson asked whether this was an issue relating to categorization and standards for centres, and whether this should then be dealt with in the Registration provisions. The Norms and Standards would come in later, but those wanting to register centres would needed to be able to find all the relevant requirements in the registration section. 

Mr Pierre Viviers, Deputy Director: Substance Abuse, Department of Social Development, noted that, when registering a facility for children, this facility would also have to adhere to the requirements in the Children’s Act, and the Minimum Standards of Childcare.

The Chairperson stated that the centres would needed to focus on the schooling of children, and their education would needed to continue during their treatment.

Ms Semple pointed out that one of the recommendations from the Department of Education, in relation to Chapter 2, was that centres would needed to cater for the educational needed of children.

The Chairperson replied that chapter 2 would be re-written. He then asked whether treatment centres currently provided education to children receiving treatment.

Mr Viviers replied that it currently was not a requirement for registration. However, some centres did provide distance education, and assisted children in completing their schooling. Normally, however, when a child would start rehabilitation, he or she would be so occupied with recovery that they were effectively unable to focus on schooling. Some centres also provided the option of children going to school during school hours, and returning to the centre later, but this could negatively impact on treatment. In meetings last week, the Department of Education promised to try to put together a new system to help children continue with education while receiving treatment.

Mr B Solo (ANC) said that the concern was that children would be denied the opportunity to get an education, and provision therefore needed to be made to ensure that this did not happen. Children in a difficult situation must be given education. The issue must be flagged so that the Departments of Social Development and Education could work out an arrangement that was acceptable to both.

The Chairperson noted that it was a complex situation, as children could not carry on with normal education during treatment while they were recuperating. However, he suggested that once a child had gone through the intensive detoxification stage and had stabilised, the focus needed to be on longer-term treatment. He questioned whether the Committee should require that treatment programmes should take account of the child’s educational needs. This would provide some degree of flexibility, but the obligation would be on the treatment centre to take steps to provide elements of education. This education would also need to be accredited, as the child must be able to return to school after the period of treatment. This Bill could not simply be reduced to issues relating to social development, but would have to have a multi-sectoral approach, including education.

Ms Kela stated that the Bill did not deal with education extensively, although Clause 6 mentioned coordinating the educational needed of children with the relevant department. The Department of Education would therefore take responsibility for providing the educational needed of children. The list of norms and standards in the Bill should not become too long, but as it stood, conditions relating to education were not included in the requirements for education. She also questioned whether this was not already included under Clause 13(3)(b)(ii), with the words “the prescribed requirements”.

The Chairperson said that Parliament would disagree, as this would be a case of the Department leading the Committee. The Committee would therefore rather give specific guidelines, and spell out the requirements now.

Ms Kela pointed out that the difficulty would lie with regulating for one aspect of treatment, and not others. The Bill would then have to focus on other aspects as well.

The Chairperson agreed, and stated that the Committee could not pass a vague law.

Ms Kela then raised the issue of what was going to be included in norms and standards. At the moment it was a “shopping list”. In the case of children, clause 6(f) should be either a guiding principle, or a norm and standard. A book containing norms and standards for In-patient treatment centres already existed.

The Chairperson answered that the Bill may end up with norms and standards for each area, as different facilities would needed to be registered for different purposes. All issues of a multi-sectoral nature in out-patient treatment would have to match those of in-patient treatment. For example, a child could continue with schooling during out-patient treatment, but during in-patient treatment, where patients were not allowed to leave the center, some other form of education would be required.

Mr Solo agreed that specifics needed to be brought in from the start.

Mr Loselo stated that the challenge would be finding an appropriate space in the Bill to include this. He pondered if the Bill could require the Minister to prescribe conditions for the admission of children into treatment care. Perhaps all the factors and conditions must be mentioned upfront. He also noted that this issue highlighted the fact that it was necessary to have an agreement with the Department of Education. This issue would apply to both public and private centres. Further, he questioned whether the Committee would be comfortable making the need for consultation with other departments a part of the Bill.

The Chairperson answered that the first problem was trying to deal with both public and private in centres in one chapter. He asked if it was possible to have an over-arching provision relating to both. Drafting choices would need to be made. He also said that children and adults were service users, but this Bill was not only dealing with their welfare aspects, but with a multiplicity of needs, including health, psycho-social, and educational needs. The Committee must look at all the needed of the person, and must indeed provide for multi-sectoral collaboration in the legislation.

Ms Kela stated that the Department was trying to understand what the Committee was saying, and how it was recommending that the Bill should be drafted. She asked if parts of other Acts, Bills, and booklets should be included in this Bill too.

The Chairperson responded that the Booklet on Standards for In-patient Treatment Centres did not have legal authority, and so the relevant sections needed to be included in the Bill. The Bill did not need to specify what education was required, but just needed to note that education was a requirement. He then asked Legal Services to re-draft the provision by next week Friday.

Ms Kela then turned to the submission from the Department of Trade and Industry.

The Chairperson raised the issue of past substance users who claimed to be rehabilitated, and who then tried to trade off other substance users. He asked if it was possible to provide a register of past substance abusers, similar to the registration of sex offenders provided for in the Children’s Act. He suggested that past substance users would not be able to run treatment centres.

Ms Kela responded that it was impossible to “blacklist” people coming out of substance abuse programmes. She said that this would require consideration of how this would be regulated, and that effectively this might result in no recovering addicts being allowed to work in any treatment facilities. She pointed out that the Bill must look at restorative processes, including behaviour management. Past substance abusers were not in the same category as known sex offenders.

The Chairperson asked whether it was true that there was a standard in the field of substance abuse treatment, where a person must have abstained for a certain length of time, and wondered if this could not be used. 

Ms Kela noted that most treatment centres, especially private centres, were being run by recovering substance abusers. The process could not cut off all practitioners who had once used or abused substances, and she queried whether it was being suggested that this be extended to other centres of employment as well. The Department of Trade and Industry also asked that the Bill provide detail on the roles of the Minister, Director-General, nurses, social workers and so forth. She agreed that there should be clarity on the roles of those based in parliament, to enhance accountability. It would also be good to maintain a database for statistical purposes, but not to provide a register or blacklist of former or current substance abusers. 

Mr Loselo noted that the Department of Trade and Industry was also asking for clarity on the conditions under which the Minister may abolish a treatment centre. This would be determined by how carefully the requirements were laid out for registration of centres. If the conditions for establishing a centre were comprehensive, then the Minister could be empowered to abolish a centre that was not meeting those requirements, in both the public and private sectors.

The Chairperson agreed that it again went back to the issue of specificity. The Bill needed to set out what a centre must did in order to register, and to maintain their registration. If centres did not comply with the norms and standards, they could be de-registered. However, not all of these could be included in the Norms and Standards section. Thus, perhaps a separate section would need to outline which aspects were non-negotiable.

Mr Mogotsi Kalaeamodimo, Director Substance Abuse, Department of Social Development, agreed with the submission of the Department of Trade and Industry, that there was a need to ensure that centres were accessible, but wondered whether this should be included under the conditions of establishment.

Ms Kela also agreed with that proposition, but believed that it should be looked at more broadly. The services needed to be accessible, rather than the facilities. Users needed access to the services, programmes, and treatment, but did not necessarily need to be going to a centre.

The Chairperson recommended looking at the provisions of the Children’s Act on the establishment of early childhood development centres, as these would provide guidelines on how substance abuse centres should be established, and whether this was to be done nationally or by provinces. The issue of ensuring equitable access to services should be a general focus by all the different departments. Good guidelines also needed to be given for when a Minister could de-register a centre, otherwise numerous court cases would arise. The coordination of statistics and a database was more an administrative issue.

Clause 12
Mr Loselo noted that a submission was received from Substance Misuse Advocacy Research and Treatment (SMART), stating that Clause 12 lacked clarity and had a clumsy use of language. The term “for a substance use disorder” should be inserted in line 41.

Mr Viviers noted that SMART used more specific terminology, but that the Department did not want to use medical model terminology such as the term “disorder”. This Bill needed to use broader terminology.

Mr Kalaeamodimo suggested that, instead of saying “substance abuse disorder”, the Bill should read “for treatment and rehabilitation”.

Ms Semple pointed out that the Bill contained no definition of “treatment”, although it did contain a definition of rehabilitation.

The Chairperson asked for clarity on whether the definitions of “treatment” and “rehabilitation”. were included in the Bill.

Mr Viviers answered that “treatment” included medical treatment and detoxification, and would begin when a person reported to a centre. It was a multi-disciplinary process. It would end when the person went back to the community. However, rehabilitation focused more on going back into the community, and integrating into it. 

The Chairperson pointed out that the definition in the Bill did not mention this, and he thought that “treatment” and “rehabilitation” needed to be re-defined. He asked where the concept of s health would fit into the “treatment” process. The Department of Health wanted “health” to be provided by health-care centres, as this was their responsibility, and therefore it must be mentioned in the Bill.

Mr Viviers raised the issue of detoxification facilities at treatment centres and at state institutions, and questioned whether this should only be provided by the Department of Health at hospitals and health-clinics. It was often difficult to get a patient into a hospital for detoxification, as hospitals were reluctant to take on patients who were disruptive. Thus, it might be a practical solution to send these patients to treatment centres instead.

The Chairperson asked whether providing detoxification facilities needed to be specified in the registration conditions.

Mr Viviers answered that very few centres made provision for detoxification, and in the past ten years, the Department of Social Development had not given any registration for this. Only older and more established centres provided these facilities.

The Chairperson asked if the Department of Health was involved in this registration.

Mr Viviers replied that the Department of Health (DoH) was always involved in helping with registration.

Ms Kela noted that the DoH had claimed responsibility, so detoxification must happen in hospitals, as the necessary facilities were available. It was not only the Department of Social Development that would be involved in this process. Other departments would also needed to be involved in inspections for the registration of facilities.

The Chairperson asked whether detoxification was going to be banned at treatment centres.

Ms Semple further asked if the detoxification facilities in the larger treatment centres were approved by the DoH and whether this process would stop in the future. She asked if DoH were able to handle the numbers of people requiring detoxification, and whether the Department would be able to prioritise this process within the health-care system.

Ms Kela reiterated that newer centres generally did not provide detoxification, as it was expensive and specialised, and would now require some form of accreditation from the DoH.  Usually those people who could pay for this service would get it in private treatment centres. However, it was a problem to get people admitted, as not all hospitals could handle detoxification. If people came into hospitals under the influence of drugs or alcohol, hospitals would often not admit them as patients until they were no longer under the influence. Also, “treatment” was a broader concept, including social services, psycho-social support, and a medical model of care.

The Chairperson noted that the disability sector had rejected the concept of “treatment” as form of social intervention. However, this sector was more comfortable with defining the intervention as “treatment”. He asked if this was the acceptable terminology for both users and service providers.

A Member noted that the Bill went in three phases of treatment, rehabilitation, and education. HE asked if all three phases would be included in one centre.

The Chairperson asked for clarity on the core phases that a patient would go through.

Ms Kela answered that the first stage was detoxification, as this enabled the patient to function normally again, after withdrawal symptoms had been controlled. Then there would be assessment. Once detoxification had taken place, an individualised treatment programme would be developed for the patient. It may vary according to time, the substance used, and the needs of the patients. A normal programme was six to twelve weeks, but this could be extended. This programme would deal with all aspects of the treatment, including rehabilitation, and skills development. Thus, by the time the patient returned to the community, the patient would have some skills. The phases followed on from each other, and no separation was necessary.

The Chairperson reiterated the need for concrete definitions of both “treatment” and “rehabilitation”.

Ms Semple then noted that the Department of Correctional Services (DCS) had indicated that they had certain facilities for dealing with detoxification and treatment, and she asked whether these facilities were run by DCS or DoH; if the former then she asked why this Department could run them without involvement from the health sector. She agreed that clear definitions were needed for each of the different phases.

Mr Loselo responded that the issue of detoxification in correctional facilities was raised in earlier meetings. The Department of Correctional Services stated that they were unable to manage their own health facilities, and had asked the DoH to take over. Clarity was still needed on the definition as to whether treatment or rehabilitation definitions should include references to detoxification.

The Chairperson agreed that it would be helpful, and the Committee would need to put it to the DoH to see if they were happy with the idea of detoxification being taken out of treatment centres, and becoming their responsibility. If so, then it should be included in the legislation.

Substance Misuse Advocacy Research and Treatment (SMART): Briefing
Ms Sarah Fisher, representative, SMART, gave a brief presentation outlining some important norms, standards, policies, implementation guidelines, and definitions used in substance use treatment. This included identification of some internationally used terms, as well as some alternative treatments, including replacement therapy, for substance abuse disorders. The issue of detoxification at hospitals and treatment centres was also discussed. She noted that her document would give information to anybody needing it. SMART drew up the document in consultation with numerous other departments, service providers, academic and international institutions. The document also looked at who was responsible for what during the different stages of the process. A comparative study of substance abuse in different Southern African countries was also outlined.

The Chairperson questioned the use of the term “disorders”, as it could lead to stigmatisation, and asked whether this was the correct term to use.

Ms Fisher responded that, internationally, there was reference made to a “drug use” or “alcohol use” disorder. There were three levels: use, abuse, and addiction. In order not to stigmatise people, the term “disorder” was used in preference to other terms.  The disorder related to how the substance was used.

The Chairperson noted that, in South Africa, the term used was “substance abuse”. This was because substance abuse could be a consequence of a disorder, but could also be more encompassing than just a “disorder”. “Disorder” would, to his mind, apply to a strictly medical condition. However, “substance abuse” was not just medical, but also behavioural and physical.

Ms Fisher replied that it would depend on the context. For example, detoxification was often the first step of treatment, which then allowed the patient to engage in the second stage of treatment, called “relapse prevention”. Detoxification was a medical process, and medical professionals were trying to find the best way of achieving “uncomplicated detoxifications”.

The Chairperson said that this Committee wanted the DoH to take responsibility for detoxification. However, if it was to be provided in treatment centres, it would have to be in line with the regulation framework.

Ms Fisher outlined “desirable features” of detoxification services. These could be supplied to the Department of Health, to allow them to discuss it. She also noted that the types of treatment models available varied widely. This could contribute to perceptions that treatment was ineffective. Treatment needed to be regulated better; and more uniformly. The definition of a “treatment centre” needed to include something like “substance abuse treatment” or “treatment for drug and alcohol problems”. There was a need for regulation of all the different forms of treatment, and how these would be approached. Issues like education, and the need for patients to be isolated from their normal lives for the duration of treatment would also need to be regulated, to ensure that there would not be a major disadvantage to the patient. She also outlined some of the main principles of effective treatment, which included the fact that no single treatment was appropriate for all individuals; and that treatment must look at all the different aspects of the problem, not just substance abuse. Patients also had to remain in centres for a sufficient length of time, called the stabilisation period.

The Chairperson noted that much of this would be going into the “norms and standards” section. Although the Bill might not go into the complete and detailed specifics of what was required, general outlines would needed to be provided. The document must be accessible to ordinary people as well as professionals.

Ms Fisher asked that terms such as statutory services, and diversion programmes be properly defined. The Bill would also have to outline the difference between voluntary and criminal patients; who was allowed to run treatment centres; who was legally accountable for the process; and who should be allowed to work in these centres. Criminal background checks would be necessary, as well as tightening of regulation across the country. The comparative study also looked at some potential harm-reduction process, although perhaps the better focus would be risk-reduction. Sometimes innovative solutions would needed to be used, focusing on stopping not only the drug use, but also other risk behaviours, including sexual risk behaviour, risk to families, and the risk of becoming involved in the criminal justice system. There was also a need to liaise with neighbouring countries, in terms of drug trade, drug use, and how each government responded to these.

The Chairperson asked if the Committee would need to use this document while re-drafting the Bill.

Mr Viviers responded that the Department had already been working closely with SMART, and had used the document before, but that it would be useful to look at it again.

Ms Kela noted that the document could be used in re-drawing parts of the Bill, including highlighting the issue of harm-reduction. There was also a need to look at people who did not necessarily require extensive treatment, but could be dealt with in the community, rather than being sent to treatment centres.  Replacement therapy also needed to be used carefully, as it could also be addictive. It must be administered by medical professionals. The position was taken in Cabinet that harm-reduction was recognised as part of the treatment programme.

Ms Semple asked where detoxification would fall in the process, and she repeated her questions whether it should be dealt with by the Department of Health, or whether it could be included in other centres.

Ms Fisher replied that detoxification could not be split from treatment. Unless it was a particularly complicated detoxification, the process was fairly easy and could be run on an out-patient basis. Nurses could also do home detoxifications, and outreach workers could run medically-monitored detoxifications.

The Chairperson noted that diagnosis would need to happen before treatment, otherwise the person may end up in an ineffective treatment programme. Both physical and mental health would need to be addressed. Certain concepts therefore needed greater clarity and specificity. The Bill also needed to provide details around what the centres were registering for, and what services they were permitted to provide. This included both the category of services, and the type of client for whom they could provide services  - such as adults, children, and different types of substances. This should apply to both public and private institutions. The Bill would also need to outline what each programme would provide. The registration requirements must therefore be clear.

Some aspects were clear in terms of service delivery, including respect for privacy of the individual, and ensuring their dignity. However, broad principles should be placed in the appropriate location. Other aspects should be placed in the norms and standards section, which would be included at the end. He asked whether there should be a general norms and standards clause at the end of the Bill, or a specific one for each Chapter, to provide for different types of services. The Department of Social Development must make recommendations. He also asked how specific the Committee should be in setting norms and standards. He asked if there were already other Acts that adequately deal with certain issues; or whether this Bill needed to fill a gap. Standards relating to the health and security of a facility would have to be set out. There would also need to be a specific statement as to where other departments would need to be involved.

Ms Fisher noted that treatment for substance abuse problems must be confidential. The mere fact of having had drug and alcohol problems would not qualify every person to treat substance abuse disorders, and a person wishing to treat would need to get qualifications like everyone else. A list should be drawn up of people working in the field who did not have qualifications, to help centre users access good treatment.

Clause 13
Mr Loselo noted that the Central Drug Authority (CDA), which was a government institution, had proposed that the Clause 13(3) include a subsection (c) which would allow the Minister to delegate authority when it came to maintaining a register of centres. The Department of Health submitted that period of a registration certificate was very long. The Bill must provide for audits on a more frequent basis, and licences should be re-issued based on audited reports.

Mr Loselo agreed that both the Minister and the Director-General should be allowed to delegate responsibility, and that the job of registration of treatment centres should be delegated to officials in the Department. With regard to the comments on the duration of the registration certificate, he asked whether the Department could realistically re-audit all centres on an annual basis, and suggested that perhaps a different time-frame was necessary.

Mr Viviers also agreed with the idea of a register. He thought also that there was a problem with the current five year period of registration. 

The Chairperson asked whether inserting a new subclause (c) into Clause 13(3) would be most appropriate, or whether it should be inserted in under sub-clause (7), which looked at the granting of certification by the Director-General.

Clause 14
Mr Loselo read out the Aids and Rights Alliance for Southern Africa (ARASA) and the Central Drug Authority (CDA) submissions to the Committee.

Mr Loselo indicated that the Department would add more flesh to Clause 14(3), which dealt with illnesses or other diseases, so as to make clear the links between AIDS and these other diseases.

The Chairperson stated that the CDA was asking the Committee to write into law the harms associated with substance abuse.

Ms Kela said that the Department would expand on what the CDA was saying, and look into the link between Aids and substance abuse.

The Chairperson asked if there was a reason to mention all the Aids related diseases, like  hepatitis and viral hepatitis.

Ms H Bogopane-Zulu (ANC) said that the link between HIV and substance abuse needed to be very clearly stated in the legislation.

Ms H Weber (DA) asked if it would be advisable to put hepatitis in the Bill, as it was spread by the use of needles.

The Chairperson stated that there would be no harm in mentioning it as there was a need to highlight the most severe illness linked to AIDS.

The Chairperson added that the underlying purpose of the clause was to deal with communication about the dangers of substance abuse and communicable diseases.

Ms Bogopane-Zulu stated that the clause talked about establishing halfway houses, but in the midst of this was also talking about the establishment of programmes and halfway houses. She said there was a need to outline what was required and suggested that this could be done under the conditions of registration, so it would be clear whether public institutions, private institutions or programmes were being referred to.

Ms Bogopane-Zulu added that there was a need also to show the two different kinds of registration for public and private institutions separately, so that the Bill could also indicate what happened when there was conditional registration.

Ms Bogopane-Zulu asked if there was a definition for a halfway house.

Mr Loselo responded that Clause 14 made provision for the establishment of a public halfway house, and Clause 15 for a private halfway house.

Ms Bogopane-Zulu understood that a halfway house was a bridge between the treatment centre and the outside world. She added that there was some difficulty in making halfway houses complementary to the next step of the process of rehabilitation and reunification. There was also a need to look at how long a person should stay at a halfway house.

The Chairperson said that there was no reference made to service users in the clause. He stated that concepts were being mixed, and clarity was required on re-integration into society and preparing the community for the return of persons who had undergone treatment.

Ms Direko said that she viewed halfway houses as safety valves in society.

The Chairperson stated that this clause should be talking to the need to identify affected communities and prepare them for the return of persons from treatment centres.

Mr Kalaeamodimo agreed with Ms Direko’s comment regarding halfway houses, stating that the main focus was to ensure reintegration. He added that the process of educating people had to be continuous.

Ms Kela stated the needed to retain Clause 14(3)(c) to emphasise education as a continuous process. There was also a need to rephrase the clause to indicate that halfway houses did do outreach programmes for communities.

Ms Bogopane-Zulu said that the legislation was too ambitious, and requested that the Department inform the Committee what it had in mind in terms of community services, out-patient services, and treatment centres.

Ms Bogopane-Zulu added that Clause 14 should be deferred until clarity was received from the Department.

The Chairperson agreed that the issue would be flagged.

Mr Viviers informed the Committee that halfway houses were seen as a way to assist persons affected by substance abuse to re-integrate into society. He said that there were only private halfway houses in the country – one of which was in Woodstock, Cape Town.

The Chairperson asked if, in the costing of the implementation of this Bill, the Department had determined how many halfway houses it was going to create and at what cost?

He asked further what was currently being spent on the five treatment centres and how the Department planned to progressively increase the figures.

Ms Kela responded that Mr Viviers had indicated that there were no public halfway houses in the country. She said that the Committee should look at the costing report that was submitted to the Committee, as figures were not available at this meeting. Ms Kela said that the current budget did not reflect costs, as deliberations on the Bill were still in progress, but she would submit available figures the following day.

Ms Bogopane-Zulu noted that before this Bill would be passed, a letter from National Treasury was required.

The Chairperson stated that it would have to be established from Treasury whether the costings submitted were concretely reflected in the budget.

The Chairperson said that a decision needed to made regarding whether to have a set of norms and standards that must be complied with, irrespective of whether the institution was private or public, or whether different types of norms and standards should be made for different types of facilities. He asked if it was possible to have a list of areas to which norms and standards must relate, across the full range of services and facilities, or whether there was a need for separate types per service facility or programme. The important challenge would be to consider what corrective measures would be taken if the norms and standards were not complied, including the issue of deregistration.

The Chairperson said that Chapter 2 of the Bill was set apart from the rest, and would be a mirror of the Chapter on the Central Drug Authority, but would show an integrated response for the Bill. The Chapter on the CDA would provide the co-ordination aspect.

Clause 15
Mr Loselo noted that there was only one submission on this clause, from the CDA.

Ms Bogopane-Zulu noted the inconsistencies between Clauses 14 and 15 and stressed the need to sort out the differences between public halfway houses and private halfway houses.

Mr Loselo agreed with Ms Bogopane-Zulu, and said the Department could rephrase Clause 15 to state the requirements for registration of private halfway houses, because there was a need to indicate that a private halfway house could not be managed unless there was an application for registration to the Director-General, and acceptance of that application. Only when the Director-General had registered the private halfway house, could it start to operate and be managed.

Mr Loselo added that Clauses 6 and 7 were the same.

The Chairperson addressed the State Law Advisors and asked why the Bill had gone through in its current state, with so many glaring errors present.

Ms Bogopane-Zulu said that the Department should work on Clauses 14, 15 and 16, as treatment centres and halfway houses could not be lumped together.

The Chairperson said that the procedure for registration, deregistration and temporary registration would be different for private and public institutions in relation to compliance. However, the content of their programmes, and the types and norms and standards adhered to would apply in the same way to both private and public.

Ms Bogopane-Zulu emphasised that cross-referencing should be carefully looked at when reviewing those clauses. She pointed out that the punitive measures for the offences were indicated but there was no indication that the offences amounted to crimes that warranted these punitive measures.

Clause 17
The Civil Society Prison Reform Initiative (CSPRI), South African Human Rights Commission (SAHRC), and Department of Health (DoH) submissions were presented. With regard to the comments by SAHRC and CSPRI around the prohibition of torture, Mr Loselo stated that there was agreement to include a clause that indicated that inhuman and degrading treatment would be prohibited.

The DoH had raised a comment around the giving of notice before an inspection, but he said that the general view was that people could stage- manage inspections, and the Department could remove any reference to giving notice before an inspections.

The Chairperson asked if provision could be made for both.

Mr Loselo responded that Clause 17 did provide for instances where notice did not have to be given before an inspection.

Ms Bogopane-Zulu asked for clarity on what kind of monitoring and evaluation unit was being referred to in the clause.

The Chairperson suggested that specificity was not required about social workers or nurses in the clause. When looking at the facility itself, in regard to issues of compliance and services rendered, there may be overlap into areas of requirements governing physical structures.

Mr Loselo said that the proposed rephrasing would be suitable, as the Department would then not be challenged on the people who would constitute the team for inspection.

Ms Bogopane-Zulu noted the need to sort out whether monitoring and assessment related to  compliance structurally, or whether to considerations on how the programmes were being implemented. She asked where the role of the social worker fitted, in evaluating a service or a programme. She stressed the need for clarity about what the team would be inspecting and the reason for service users to be subjected to what was being prescribed.

Ms Kela said the Department would separate out the clauses and rework them. She added that the minimum requirements for a core team for a basic inspection, based on the history of Departmental practice, were that a nurse and a social worker must be present.

The Chairperson asked if nurses and social workers satisfied the competencies required for inspections. Social workers especially were a scarce resource and might not always be available for these inspections.

Ms Kela replied that these assessments were not only administrative, but routine inspections and the practice currently needed trained personnel like social workers who knew and understood the issues. She stated that the assertion about the shortage of social workers was not being disputed, but these inspections were undertaken once a year and were not the same as other inspections.

Ms Kela added that the proposal by the SAHRC regarding an independent body to do monitoring was positive, as there were social workers in private practice who could be sourced for these purposes.

The Chairperson asked if the drafters of the Report by the Committee could record that this clause was passed at the insistence of the Department, with the Committee’s reservation about human resource capacity shortages.

Clause 18
Mr Loselo read out, and indicated that he agreed with the submission from the CDA.

Ms Bogopane-Zulu asked if the listing of personnel in clause 18(1) was really required to staff public treatment centres and public halfway houses.

Mr Loselo asked if specific people were needed to run treatment centres.

The Chairperson stated that it had more to do with management skills than qualifications.

Mr David Bayever, Deputy Chairperson, CDA, responded that one could take the example from hospitals at the moment. A CEO at a hospital did not have to be a qualified medical doctor, but rather one who could manage the hospital in a professional way.

Ms Bogopane-Zulu reiterated that halfway houses could not be lumped together with treatment centres. Regarding the wording of Clause 18(1), she suggested that the operative words should be ‘suitably qualified’ persons with training and accreditation. The word “public” should also be removed from the clause.

The Chairperson stated that public and private institutions should be treated equally in this context. 

Ms Kela expressed the need to ensure that a medical practitioner was part of the staff complement in public institutions.

Ms Suraya Williams, Principal State Law Advisor, responded that if norms and standards were available they could set the framework for practice of the law.

Mr Loselo said that in terms of the current Clause 4, the norms and standards would be prescribed by the regulations.

Mr Frank Jenkins, Parliamentary Legal Advisor, stated that a distinction should be made between norms and standards, and principles. Principles were not necessarily justiceable, as they intended to guide people who must implement the Act. Norms and standards were justiceable and could talk to suitable qualifications.

The Chairperson stated that a lot of detail relating to professional management of a treatment centre would be prescribed in the regulations. Accreditation would take place through relevant accreditation bodies.

Ms Bogopane-Zulu said that there was still as need to indicate that if persons were interested in working with substance abuse clients they would have to be properly trained.

The Chairperson said that accreditation could not be regulated. “Suitably qualified” would mean appropriately accredited with the relevant body.

Ms Bogopane-Zulu stated that she would be comfortable if training on substance abuse could be provided to personnel at treatment centres, and that this could be stipulated in the Bill.

Ms Direko stated that the words ‘suitably qualified’ could be misinterpreted, although she agreed that there was a need for a degree of specificity to provide guidelines.

Mr Bayever stated that the qualifications should be registered with the skills and qualifications Authority, SAQA.

Ms Bogopane-Zulu noted that there were two points. The first was that there must be acknowledgement of qualifications and accreditation by the respective bodies, and the second was accreditation of the ability to provide skilled service.

Mr Loselo stated that there seemed to be confusion regarding Clauses 18 and 3. Clause 3 dealt with accreditation of employees involved with substance abuse. He stated further that it was his opinion that only staff were being looked at, and wondered if they should be accredited as well.

Ms Bogopane-Zulu pointed out that this matter had already been cleared up since Clause 3 had been removed.

The Chairperson said that Clause 3 was being imported to this part of the Bill.

The Chairperson explained that the point at issue was the content of the service rendered, and the fact that the person who rendered the service had to be properly accredited in terms of applicable laws. He added that if someone who was a rehabilitated drug or alcohol user, who then became involved in the profession, in any capacity, then there must be standards to state what this person had to comply with in order to enter this field.

Ms Kela stated that the Department was aware of the possible risks of allowing a rehabilitated substance abuser to manage a treatment centre, and would not allow this to be a door to bad practice.

Ms Bogopane-Zulu asserted that all the issues that were worrying Ms Kela had already been sorted out by the Department, such as the conditions of registrations, where one would check for compliance before the issuance of a certificate.

Mr Bayever voiced his agreement with Ms Kela’s views on regulation of management of centres, for the protection of the public.  He added that the point that was made earlier about registration of facilities would equally apply to conditions. The person managing the centre should be suitably qualified.

Mr Viviers felt that checks and balances should be in place to prohibit people who had been addicted to substances from opening treatment centres. Caution needed to be exercised.

Ms Bogopane-Zulu said that this matter could not be legislated. She stated that if someone were to act incorrectly, then the professional body that accredited that person would deal with the matter. Secondly there would be norms and standards were in place to deal with management.

Clause 19
Mr Viviers said that there were issues about remuneration for volunteers.

Ms Bogopane-Zulu stated that there were guidelines for the hiring and remuneration of volunteers in government.

Ms Bogopane-Zulu stated that, since the conditions of registration and applications were being restructured, she wanted to add an Appeals process. There were clauses in the Bill that spoke to the opening and closing of establishments, and if people did not agree with the decision of the Director-General or the Minister then there must be provision for recourse.

Ms Williams stated that this was provided for in the Promotion of Administrative Justice Act.

The Chairperson believed that a special clause in the Bill was required for this purpose.

Members agreed to the removal of Clause 19.

Clause 20
Mr Loselo read out the submissions of SAHRC, and the South African Police Services (SAPS). He stated that a meeting was held with the SAPS, at which was agreed that death from unnatural causes need not be reported to SAPS.

Ms Bogopane-Zulu asked for the clause to be read out of the Children’s Act that illustrated how this matter was dealt with. She asked further if this would assist the Department in redrafting this section of the Bill.

Ms Kela stated that this would assist the Department to redraft Section 20 of the Bill.

Clause 21
Mr Loselo read out the SAHRC submission.

Ms Kela stated that the Department had had a lengthy discussion on this matter, and the DSD and DoH had understood that a service provided in a clinic could not be said to an out-patient service, otherwise it was a community-based service which was a different service altogether.

Ms Bogopane-Zulu did not understand this explanation. She stated that clinics were referred to as primary healthcare providers. She asked what the difference was between the two.

Ms Kela responded that there were certain health conditions that could only be dealt with at a hospital level - for instance, oncology was such a service, as it was not found in a clinic. In the case of substance abuse what was referred to was a service provided at the treatment centre. Where there were no such treatment centres a community-based centre would provide the service.

Ms Bogopane-Zulu stated that those very people would be called out-patients because they would leave the centre where assessment took place. A clinic referred to the person in the hospital or treatment centre as an out-patient. A service at a clinic was referred to as an out-patient service. The section and the community-based section must be re-looked at to obtain clarity for drafting purposes.

Ms Kela asked if Ms Bogopane-Zulu saw out-patient services as part of community-based services, and received confirmation that she did see them in this way.

Mr Loselo stated that the SAHRC had a point, as out-patient services did not provide an overnight stay.

Ms Bogopane-Zulu stated that the definition must be looked at again. Out-patient and community-based services would be assessed for overlaps. The revised wording would not have a Clause 21 but a reworked Clause 22 taking into consideration community-based services. The references to the Minister would be removed from Clause 21.

The meeting was adjourned.