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Public hearings held by government's Portfolio Committee on Labour about a potential labour broking ban have left at least one service provider uncertain of the country's future ability to provide adequate and critical healthcare services.

Werner Laubscher, MD of nursing labour broker, Charisma, says that attendees at several of the hearings, held in various locations around the country, were not receptive to the message that the nursing labour broking industry should be exempt from a ban.

"We heard many horror stories at the public hearings of bad practices in the labour broking industry at large and there is clear need for regulation either by the industry or government but nursing is a critical service and faces crippling shortages of employees if the ban is enforced, which will force state hospitals to ultimately close wards and turn patients away," says Laubscher. "We understand that in some cases people are being taken advantage of but in the nursing industry between 80% and 85% of all nurses in the labour broking pool already have permanent employment and use additional shifts obtained through brokers to supplement their incomes."

He says that the potential healthcare crisis stems from the fact that there are simply too few nurses to go round.

There are 203 000 registered nurses in South Africa but at least 19 500 of them are not active. Vacancy rates - nursing posts not filled - are extremely high: 40% in state hospitals and 25% in private hospitals. Each year around 10 000 people enter nursing academies but only a third of that number graduate.

"There is an enormous shortfall of trained, skilled and experienced nurses in South Africa," he says, "that is currently being filled by the labour broking industry. In the vast majority of cases labour brokers are using nurses already permanently employed by the hospitals, both state and private, to fill in additional shifts and take up the slack. If labour broking is banned then there will not be enough nurses to manoeuvre between the various hospitals as their changing needs required.

"Their needs change on a daily basis. A pregnancy ward in one hospital today may require 10 nurses because they expect many new births but only require three the following day. If we are not allowed, through labour broking, to shift resources from one area to another, then we will exacerbate the shortfall in certain areas while oversupplying in others.

"Labour broking, only in the nursing industry, gives the country's state and private healthcare facilities the flexibility to bring a hard pressed resource to bear when and where it is needed."

Laubscher says that the Gauteng Department of Health has already issued an instruction to state hospitals in the province to phase out labour broking of nurses but warns that the shortfall in the industry will ultimately lead to wards closing and will reduce nurses' incomes.