Sustainability review - Social – Workplace

Human resources

The quality of Netcare people is central to the running of a patient-centred organisation. The Group's ability to attract, motivate and retain key skills is therefore core to its sustainability, and identifying, developing, advancing and retaining high-calibre employees and managers is a top priority. Netcare has implemented long-term strategies to ensure a readily available pool of clinical skills, while continuing efforts to ensure the workplace reflects the demographics of the countries in which it operates.

Netcare South Africa was awarded sixth place in the large company category of the Deloitte’s “Best Companies to Work For” survey, and tenth in the Corporate Research Foundation’s Employer of Choice awards. This is the second year Netcare was placed in the top ten and is testament to the quality of Netcare’s human resource practices.

Netcare employs over 27 000 people across two continents, South Africa and the United Kingdom.

Number of employees by region

Netcare's South African employees increased by 6,5% to 18 877 employees and an additional 1 071 agency staff were employed at 30 September 2007. The increase in headcount was due to the commissioning of two new hospitals, increased activity in the hospitals and a reduced nursing vacancy rate.

GHG employees remained relatively flat at 8 853 employees at 30 September 2007. The permanent headcount was reduced by 440 during the year as a result of restructuring. This was offset by the acquisition of Mount Alvernia Hospital and changing the staffing mix to move to a more flexible resourcing structure using bank staff that enables staffing to be closely matched to patient volumes.

Diversity

Netcare encourages a diverse workforce and ensures that the Group's values are included in all policies and procedures. During the year 2 720 employees in South Africa underwent diversity training. The diversity resilience programme for 2008 will focus on creating a culture of appreciation, inquiry and engagement.

Employment equity

Netcare has implemented a five-year Employment Equity (EE) plan with EE targets agreed at executive level and included in management's balanced scorecards. Performance against EE targets therefore impact executive and managerial incentives.

Netcare's national transformation forum meets three times a year with a mandate to monitor company compliance with legislation and transformation policy. In addition, each workplace has a transformation forum comprising employees that are elected to office. The forums consult on EE, employee development and training, and any other employee issues. Stewardship of transformation lies with executive management to facilitate consistent national implementation.

Employee type by number of employees

The annual Netcare ‘Night of the Stars’ is an event that recognises extraordinary members of staff who have gone beyond and above the call of duty. It recognises the many heroes that reside within Netcare and the many facilities throughout the Group bringing praise to ordinary employees showing an extraordinary level of care, dignity, participation, truth and passion. Many of the nominees are nominated not because they themselves have acted selflessly to better the life of another, but because they have inspired other to do selfless acts of kindness. One such person is Michelle Koen, a Credit Manager at Netcare N1 City Hospital who received the National Caregiver of the Year 2006 as well as the Coastal Region award.

Michelle Koen, Credit Manager, Netcare N1 City Hospital

At 30 September 2007, 61,4% of South African employees were Asian, Black and Coloured (ABC) compared to 57,6% in the prior year. The ABC representation improved across all employee levels; however Netcare's employment equity strategy is mainly focused on the management level given good representation at lower levels. ABC representation in management increased from 22% in 2006 to 26% in 2007.

Employee type by race (South Africa)

At 30 September 2007

Executive	Management	Professional	Enrolled nursing and support

In the year 37,3% (2006: 28,5%) of management promotions and 52,0% (2006: 32,3%) of new management recruitments were ABC. Netcare's strategy for the coming year will remain focused on transforming the management level. The 2008 target for ABC representation in management is set at 29% compared to this year's actual achievement of 26%, ahead of the target of 21%.

The following table reflects the demographics of the employee base in Netcare South Africa as extracted from the most recent submission to the Department of Labour at 30 September 2007.

Gender diversity

Netcare's diversity programme is structured to identify senior women with potential and fast track their development. There are also specific accelerated programmes in place to attract women to the paramedic profession in South Africa.

In 2007, 78,4% of the South African employees were female compared to 79,5% in the prior year. Female representationof 26,3% (2006: 26,7%) in the management level remained relatively constant compared to the prior year.

In 2007, 82,4% of the UK employees were female compared to 82,8% in the prior year. Female representation of 75,4% in the management level improved from 72,9% in the prior year.

Employee type by gender profile

Employee gender profile

at 30 September 2007

Age diversity

Netcare monitors age diversity across the business to ensure business continuity and skills transfer. Analysing age dynamics is also a requirement for understanding values and drivers of certain age groups to ensure appropriate communication and remuneration approaches.

In 2007, 62,2% (2006: 63,3%) of South African employees were aged between 26 and 45. The number of employees aged under 25 has increased slightly to 11,9% (2006: 10,8%) and the number of employees over the age of 55 has remained constant at 6,7% of employees (2006: 6,6%).

Employee age profile

at 30 September 2007

In 2007, 45,3% (2006: 46,1%) of UK employees were aged between 26 and 45. The number of employees aged under 25 has decreased slightly to 4,4% (2006: 4,7%) and the number of employees over the age of 55 has remained constant at 18,1% of employees (2006: 18,1%).

Employee retention

Employee turnover remains high in Netcare South Africa and in the sector as a result of the national skills shortage. In the year ended 30 September 2007, employee turnover was 19,4% (2006: 18,4%).

A key component of Netcare's retention strategy is the ongoing development of employees and providing opportunities for further learning. In addition, performance-based remuneration and share incentive schemes are in place. In January 2008, a retention programme will be initiated, aimed at retaining employees in core skill areas based on performance and tenure, reducing the employee turnover rate and promoting employee engagement.

Placements and employee movements within the Group's operations in the UK and South Africa show skilled South Africans returning to the country from the UK. Netcare attracted 40 employees back to South Africa in 2007, with 26 taking positions in the UK.

Reconciliation of SA employee numbers

The Rwandan genocide left many people wishing they could do something to help. At Netcare, we put those thoughts into action by helping Rwandan genocide victim Jean Tuyisenge. Jean’s plight was highlighted by Radio 702’s birthday wish list initiative in June 2006. A brutal attack left Jean with a facial injury which made talking and eating difficult. Maxillo-facial surgeons from our Rosebank and Milpark hospitals reconstructed his face in two operations. Inspired by the doctors who helped him, this extraordinary young man is determined to give back. An exceptional student, he was provisionally accepted at Wits Medical School and is currently working as a porter at Netcare Rosebank Hospital while he upgrades his maths and science skills.

Jean Tuyisenge, porter at Netcare Rosebank Hospital

Reconciliation of UK employee numbers

Employee reward and recognition

Remuneration and benefits are annually benchmarked to ensure that Netcare compensates its employees above the industry average and remains competitive on remuneration and general benefits such as annual leave.

Executive and management performance remuneration can vary as a percentage of basic remuneration (cost to company less company contributions) depending on seniority. Performance incentives are based on individual targets agreed at the beginning of the year in Balanced Scorecards. Balanced Scorecards are linked directly to the Group's six strategic themes and related objectives.

Individuals are required to score a minimum of 60% of their scorecard to qualify for performance incentives. Performance targets are aligned to seniority in the business where managers' performance targets are weighted more for operational unit performance and executives weighted more for overall company and/or group performance.

Incentives are self-funding based on the company's performance. The size of the pool available for incentives is determined by headline earnings per share or CFROI^c targets coupled with profitability growth targets for individual business units. In 2007, the base targets for South Africa were set at a maximum of 15% growth in core headline earnings per share and 13% CFROI^c. In 2007 the performance achieved was 75% of the maximum. The performance achieved against this target is then factored against individual balance scorecard achievements.

For other employees, organisationally aligned performance measurement mechanisms are linked to their annual increases, as agreed with unions. Netcare's unique "Goldcare" recognition model provides for "trophy" type awards by rewarding employees with points on an ad-hoc basis for achievements.

Length of service

at 30 September 2007

The Nightingales 2007 winners from the Cardiac Intensive Care Unit at Netcare Union Hospital, Karien Meyer, Iren Maifala, Busi Cele, Anna Letsoalo, Sylvia Phakoe, Sanna Molala, Sinah Pako and Georgie Mohale, are an inspiration to all with whom they come into contact. With their incredible spirit they have unified not only their own diverse team, but also that of the hospital and all who work within it. With their music and spirit of giving they have brought colour and light to the lives of patients and colleagues alike.

Sisters from Cardiac Intensive Care Unit, Netcare Union Hospital

The annual Netcare 'Night of the Stars' recognises extraordinary employees who demonstrate outstanding compassion and go way beyond their duties. Employees are nominated in each region by their peers.

Length of service

As a result of the high employee turnover in the industry, 59,1% (2006: 57,7%) of employees have been with Netcare South Africa for less than five years. In the UK, 48,7% (2006: 51,5%) of employees have been with GHG for less than five years.

Employee engagement

In 2007, over 13 500 South African employees (over 70% of the workforce) took part in the annual employee satisfaction survey. The results were encouraging with a clear improvement on the 2006 performance. The greatest improvements were in employee's understanding of the Group's vision and goals, organisation identification and organisational diversity. The lowest scores were in relation to reward and change leadership. The rollout of the Leadership Competency programme is aimed at addressing the latter and improving conflict and diversity management.

Industrial relations

Netcare recognises three labour unions in South Africa Health and other Service Personnel Trade Union of South Africa (HOSPERSA), Democratic Nursing Organisation of South Africa (DENOSA) and National Education Health Allied Workers' Union (NEHAWU).

Union membership

Netcare is the most unionised private hospital group in the sector (39,0% unionised), but had zero industrial action in 2007, due to an entrenched culture of respect and involvement of the unions in all major interventions. Netcare funds full time shop stewards for each of the unions to assist in maintaining good relations, in addition to the executive and operational interaction with unions that takes place on an ongoing basis.

Training and development

Netcare has embraced a pro-active skills development strategy that aims to nurture and further develop its employees and address the critical skills shortage in the industry.

The significant shortage of registered nurses in South Africa continues to pose a significant challenge to both the private and public healthcare sectors. The public sector cut nursing training of professional nurses from 2 629 in 1996 to 1 058 in 2005.

Against this backdrop, Netcare South Africa has increased its training expenditure to R100 million this year, a 16,3% increase over last year, and implemented a five-year training programme to address the shortage, which aims to increase the number of registered nurses qualifying from 181 in 2008 to 500 in 2011. In 2007, 3 700 nurses and paramedics were trained, at a total cost (direct and indirect costs) of R100 million, before Skills Education Training Authorities (SETA) levies and tax concessions received of R36 million.

Furthermore, seen only as an interim measure to alleviate nursing skills shortage until such time as the country has sufficient skills of its own, Netcare has applied for a corporate permit for around 800 foreign registered nurses. The Department of Trade and Industry has recommended to Immigration that such a permit be granted.

Netcare is also working to develop non-nurse categories of employees to perform non-nursing tasks that are currently carried out by nurses, thereby freeing up critical nursing skills. These include surgical technologists, clinical engineers and caregivers.

SA employees trained

Ten years ago, Nokuthula Mahlangu was working as a cleaner at Netcare Rehabilitation Hospital. Today, she is the Acting Unit Manager for the Paediatrics Unit and Ward 4 at the same hospital. Just five months after starting work as a cleaner, Nokuthula’s potential was noticed by the housekeeper, who suggested she become a care giver. This was the start of a career path that eventually saw her becoming a registered nurse and taking up her current position. Her career exemplifies Netcare’s commitment to helping people develop their full potential and is evidence that Netcare’s aim of becoming a learning organisation is being realised at every level.

Sister Nokuthula Mahlangu, Acting Unit Manager, Netcare Rehabilitation Hospital

The main aim of the Netcare Education division is to ensure that employees will be able to improve their job performance while enjoying individual growth opportunities. The education division is currently only responsible for training in South Africa.

Technical skills training

Netcare Education oversees the activities of educational facilities focused on developing skills in specific fields. These include:

• Netcare Training Academy, which offers standard nursing training courses that cover the basic and post-basic programmes, and a number of three- and five-day short programmes that focus on specific areas of care (such as HIV/Aids and Infection Control Principles).
• Netcare 911 School of Emergency and Critical Care (SECC), which is one of the largest private Emergency Medical Services (EMS) training facilities in Africa, and offers a variety of short courses, undergraduate and postgraduate programmes to members of the general public and healthcare professionals, at basic, intermediate and advanced levels.
• The Netcare Pharmacy Division has embarked on a multi-pronged strategy to counter the shortage of skills in the pharmaceutical industry. Initiatives include accommodating larger numbers of pharmacy interns at Netcare’s pharmacies, pharmacy assistant training (both basic and post-basic courses are offered) and continuing medical education opportunities for practising pharmacists.
• Catering training, which includes courses such as healthy eating habits, menu planning, the essentials of food and sanitation, hospitality law and food legislation, and chef training programmes (basic and advanced). Netcare hosts the Chef of the Year competition, and a two-year chef apprenticeship programme (resulting in a City and Guilds qualification).

Management and leadership development training

Netcare Education is actively developing the Group's management capacity, firstly through the development of internal management programmes, and secondly, in cooperation with selected universities and business schools.

Netcare has been accredited by the South African Institute of Chartered Accountants (SAICA) as an Approved Training Organisation (ATO). The Netcare TOPP (Training Outside Public Practice) programme offers trainees an opportunity to become Chartered Accountants through a three-year training contract. The first TOPP intake achieved a 100% pass rate in Part I of the Qualifying Examination.

During 2007 Netcare Education trained 840 managers and implemented 10 new customised management development programmes, including the Healthshare's Nursing Leadership Programme, Clinical Facilitation Development Programme and Unit Management Programme.

General skills training

Netcare Education has identified several skills development priorities and implemented appropriate training interventions to meet current and future skills needs of the organisation. In addition to formal technical skills training (for nurses, emergency medical personnel and pharmacists), and developing management and leadership competence, these include: diversity management; finance for non-financial employees; HIV/Aids; and continued professional development.

Creating a knowledge organisation

Netcare's Research Committee published its first Annual Research Publication in 2006. The publication comprises a collection of both medical and healthcare management research, published by doctors in practice at Netcare hospitals and by delegates who attend the management and leadership development programmes offered by Netcare Education's Corporate Institute for Healthcare and Business Leadership. This year's publication contains some 78 abstracts of healthcare management research written by Netcare's shift leaders, covering a diverse range of topics on innovations applied within Netcare hospitals, from customer and patient services, to equipment management, infection control, stock control and staff management. The publication also contains medical research papers written in fields such as biochemistry, cancer, cardiology, child neurology, clinical pathology, genetics, plastic and reconstructive surgery, orthopaedics, ophthalmology, traditional medicine and trauma.

Employee development

Netcare has an employee development programme in South Africa that has identified four pools of talented employees who have high potential with good emotional intelligence, problem solving abilities and the propensity for risk. Targeted development programmes are provided for these employees and ongoing assessments are undertaken. These employees are assigned a line coach and a mentor.

Alpheous Dube, Head Chef at Netcare St Augustine’s Hospital started his career in the hospital’s kitchen as a cleaner in 1992. After receiving extensive training he was promoted to Head Chef. Alpheous attributes his success to the many wonderful training programmes and opportunities afforded to him to grow and develop. Alpheous has won several categories over the years in Netcare’s “Chef of the Year” competition. He is currently working towards the City of Guilds Diploma which trains chefs to become Catering Managers.

Alpheous Dube, Head Chef at Netcare St Augustine’s Hospital

Safe working conditions

Netcare complies with local laws and regulations relating to occupational health and safety and endeavours to minimise, if not eradicate, work-related health hazards. All occupational health and safety risks have been identified and evaluated, allowing the development of appropriate mitigating processes. Health and safety committees at all operations use the Occupational Health and Safety Act as a benchmark minimum for their performance. Management of health and safety risks of the Group consists of regular audits, identification of material risks and managing these appropriately, pursuing accreditation against local and/or internationally recognised standards, and ongoing communication of health and safety matters to all employees.

The major occupational health risks facing employees and the mitigating initiatives are:

• Exposure to infectious diseases through needlestick injury, infected body fluids and patients with contagious infections – an infection control programme is in place at all of our hospitals and all nursing sisters were trained in infection control through the NTA during the year;
• Back, shoulder and knee injuries arising from lifting and handling patients – practical training is provided to instruct nurses how to move patients with the minimum stress on the spine and major joints; and
• Exposure to medical waste and other hazardous substances – Netcare complies with statutory healthcare waste management requirements and has been an active participant in the development of the Gauteng Healthcare Risk Waste Regulations.

Appropriate Personal Protective Equipment (PPE) is issued to employees, relative to their occupations and duties. This includes surgical gloves, masks, theatre coats and aprons all of which also contribute to infection control.

Nursing employees are encouraged to report occupational health-related incidents which are then recorded and analysed, prompting suitable preventative interventions. Employees whose health is compromised in any way while on duty receive comprehensive care.

Occupational safety-related incidents in South Africa increased by 8,2% to 1 413 (2006: 1 306) during the year ended 30 September 2007, largely due to the increased reporting of such incidents. An analysis of injuries by type and hospital has

allowed the implementation of improved management of injury risks. Sero-conversion tracking is done on all staff who sustain a needle stick injury. No cases of HIV-transmission due to needle stick injuries have been reported.

Netcare is equally concerned about the safety of the public who visit our facilities to access the healthcare services offered by the medical practitioners, whether as out-patients or during hospitalisation. In addition to infection control measures, every effort is made to optimise the safety of all public access areas.

SA staff injuries

30 September 2007

Hospital emergency planning guidelines

Guidelines to deal with a range of internal or external emergencies are in place at all Netcare facilities. Procedures for dealing with external incidents such as medical mass casualties resulting from food poisoning, nuclear incidents with contamination and irradiation, poisonous gas effects and biological incidents, natural or terrorist related, and the required actions under these circumstances are well documented.

In the unlikely event of an internal emergency such as fire, internal emergency planning is focused in the first instance on protecting patients from illness, injury or death as a result of the emergency and secondly to continue the treatment for which the patients were originally hospitalised. Netcare's Hospital Operations Centre together with external services such as the fire service, emergency medical service and police, head office or regional staff will, as appropriate implement documented policies and procedures to ensure emergencies are effectively managed.

Eileen Brannigan, Group Nursing Director was one of the 1 820 volunteers for HIV/Aids testing during Netcare’s voluntary counselling and testing (VCT) programme ‘Choose life today’ in August 2007. The programme, which was outsourced to ensure confidentiality, led to more than 60% of Netcare’s employees coming forward for testing. The VCT programme is viewed as an opportunity to engage in a meaningful way in raising awareness and highlighting the availability of potential assistance to our staff members and their families.

Eileen Brannigan, Group Nursing Director with sister from Aid for Aids

Accreditation

Since 2005, five of Netcare's Hospitals (Unitas, Milpark, N1 City, Sunninghill and St Augustine's hospitals) have been accredited by Health Accreditation and Quality Unit (HAQU) in the UK. In addition to the healthcare accreditation, Netcare has also acquired ISO9001:2000 certification in these five hospitals. Eleven hospitals are currently in the process of accreditation through the same body, namely Christiaan Barnard Memorial, Greenacres, Parklands, Umhlanga, The Bay Hospital, Linksfield, Union, Clinton, Pretoria East, Krugersdorp and Garden City hospitals.

Promoting employee health and wellness

Netcare has a targeted and integrated employee wellbeing strategy. All employees have access to ICAS (Independent Counselling and Advisory Services). This service is confidential and 25% of employees have accessed this service.

Netcare has a formal non-punitive absenteeism management programme that treats cases and ensures management's ability to change behaviours of an absenting employee.

SA lost hours

UK lost hours

Medical Scheme participation

Membership of the Netcare Medical Scheme increased by 12,1% to 13 206 members (2006: 11 784). Netcare's in-house medical aid scheme, following the restructuring of the contribution tables in June 2006, agreed to waive any underwriting fees to enable lower income employees to access medical cover and 15% of the 1 368 eligible employees took this option.

HIV/Aids

Netcare's strategy to manage HIV/Aids in the workplace focuses on employees, business partners, communities and the role of leadership. A policy to guide managers and employees in managing HIV/Aids in the workplace has been communicated in a structured manner to employees, so as to drive awareness. Netcare invested R4 million in HIV/Aids awareness and education, and Voluntary Counselling and Testing during the year under review.

In total, 85 peer educators in various hospitals have been trained on HIV/Aids and additional educators will be trained in the new financial year. These educators play an integral role in creating awareness of HIV/Aids. Managing HIV/Aids in the workplace training has been piloted for managers in the Gauteng North East region and a rollout plan is being discussed at present. Representatives of Aid For Aids, Netcare's partners in managing HIV/Aids in the workplace, conduct HIV/Aids awareness sessions for employees during induction process and at regular intervals. Condom dispensers have been placed in all hospitals.

During the year under review, Netcare launched its Voluntary Counselling and Testing (VCT) programme at five sites with 1 820 out of 2 800 employees volunteering for testing at a cost of R4 million. High levels of pre-sensitisation and awareness within the selected sites are created through briefing sessions and training, allowing VCT to be conducted within a positive and constructive environment. Participation at the sites ranged from 50% 65% and prevalence rates were recorded well within single digits. The VCT programme will be rolled out to at least another 15 sites in the forthcoming year, with 7 200 employees budgeted for at a national level. The final sites will be completed by 2009.

Employees who are infected with HIV have several benefits such as medical aid, which provides an HIV benefit of R25 000 for each participant, as well as a wellness programme that provides counselling services for employees and family members. The latter service is completely anonymous and offers comprehensive telephonic and face to face counselling as well as other forms of support.

The story of little Seiso Ratsoane who at the age of 18-months survived extensive torture at the hands of minors shocked the nation. With burns covering more than 20% of his body, Seiso is undergoing operations and medical care at Netcare Milpark Hospital on an ongoing basis. Doctors and staff at the hospital have provided exemplary pro-deo treatment for the little boy. Photographed with Seiso is anaesthetist Dr Peter Bettings who together with plastic surgeon Dr Gareth Edwards has been responsible for restoring Seiso’s health.

Dr Peter Bettings with Seiso Ratsoane at Netcare Milpark Hospital