Trade union Solidarity has sent a legal letter to the deputy director general of the National Health Insurance (NHI), Nicholas Crisp, demanding that he cease hiring activity for the state-run health scheme – because it doesn’t yet exist.

The Department of Health has started advertising positions specifically for the NHI, with 44 jobs listed in an August newsletter. This, despite the fact that the NHI bill is still in parliament being processed and is nowhere near being finalised, Solidarity said.

The union is threatening legal action if Crisp does not withdraw the advertisements.

“Dr Crisp’s own statement on the NHI is that no official announcements can be made regarding its rollout or implementation as the bill has yet to go before parliament. Solidarity, therefore, finds it worrying that Dr Crisp is voicing conflicting opinions and apparently is persisting with the implementation process,” the union said.

“It is unacceptable that senior government officials voice conflicting statements regarding legislation and the implementation of laws that will have serious consequences for all of us, because it indicates contempt for the legal process.

“The same person who has promised to establish a health insurance that will supposedly make the world a better place because it will be watertight against corruption and unlawfulness, is trying to steamroller the implementation of the NHI despite ongoing parliamentary processes, and that cannot be tolerated.”

Solidarity said that the lawfulness of the appointments and the financial impact of such posts on the fiscus should be questioned.

The positions that are being advertised are far more involved than requiring mere technical skills as the advertisements are for senior management positions, the remuneration of which amounts to millions per year.

“Without heeding the impact further expenditure would have on the already ailing state coffers, Dr Crisp is rolling out his NHI. This he does under the guise of efficiency and reinforcing capacity, but how does one want to strengthen the capacity of something that does not yet exist?”

The union said that the job advertisements clearly indicate that the government is determined to implement its plans without regard for established democratic processes.

“Solidarity is trying to participate in the process by consistent communication that highlights the importance of rationality and reasonableness, but that seems to be impossible. The courts will therefore be the only way to get this government to think reasonably about this unaffordable law that they are trying to push through the legislator,” it said.

Earlier this week, the health department indicated that it will proceed with the rollout of the NHI despite court challenges against it.

A High Court ruling in June found that sections 36 to 40 of the NHA – relating to “certificates of need” – were unconstitutional. The sections are vital to the rollout of NHI, as they underpin the government’s ability to force doctors and other health professionals to work where it desires.

In a written parliamentary Q&A this past week, Phaahla said that, while the department is appealing the ruling, it will not wait for a legal outcome and will continue laying the groundwork for the NHI.

The government’s pursuit of the NHI continues despite criticism from the private health sector, medical aids, and warnings from Treasury and the department of health itself.

Private healthcare groups believe the scheme is unsustainable and unmanageable, given the scale of what the government wants to achieve against the backdrop of how it has already failed in the public healthcare space.

There are also concerns over an exodus of healthcare professionals who refuse to be subject to the scheme’s harsh conditions, as evidenced by the court ruling the department is appealing.

Medical aids have been fighting for their continued existence, given that the NHI scheme envisions a healthcare system with the state entirely in control and little to no room for private healthcare funding.

Treasury’s warnings come from a financing standpoint – there is simply no money to feed into the scheme without raising taxes.

Finally, the Department of Health has raised red flags over the scheme’s administration, conceding that it is vulnerable to maladministration and mismanagement.

Read: Court ruling won’t stop NHI plans for South Africa: minister