Replies to LegCo questions
LCQ22: Redevelopment project of Prince of Wales Hospital
Following is a question by the Dr Hon Elizabeth Quat and a written reply by the
Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today
(May 22):
Question:
A survey conducted by a political party has found that the waiting time for
consultation in the Accident and Emergency (A&E) Department of the Prince of
Wales Hospital (PWH) in the New Territories East (NTE) Cluster is much longer
than the average waiting time in the A&E Departments of other public hospitals
(101 minutes) and it is the longest in Hong Kong. Over half of the respondents
have indicated that there were occasions on which they had waited for over five
hours for consultation, while 20% of the respondents had the experience of
waiting for up to eight to 12 hours. According to information of the Hospital
Authority (HA), the average daily attendance of the A&E Department of PWH
exceeds 410, and its attendance last year was 160 000, representing a
year-on-year increase of 7.1% which was higher than the average rate of increase
of 4.4% across HA. Meanwhile, the residents have been continuously complaining
about the prolonged waiting time for consultation at various specialist
outpatient clinics in PWH and the shortage of hospital beds. It has been
reported that as the bed occupancy rate of the medical wards in PWH in January
this year was as high as 130%, temporary beds accounting for 30% of the total
number of beds had to be placed in the corridors. Faced with the ageing
population in Shatin and the pressure of rapid population growth brought about
by the completion of a number of new housing estates in Ma On Shan, the demand
for PWH's healthcare services has far exceeded its capacity for a long period of
time. As a result, members of the public are concerned that PWH's epidemic
prevention and infection control capabilities have been hampered. On the other
hand, the Sha Tin District Council endorsed the Phase Two expansion project for
PWH (the expansion project) in 2006 and PWH finalised the proposal for the
expansion project in June 2010. However, up to now, funds have not yet been
allocated for the implementation of the project and there is no timetable for
its completion. In this connection, will the Government inform this Council if
it knows:
(a) the progress as well as the expected commencement and completion dates of
the expansion project; if there is no timetable, of the reasons for that;
(b) whether the authorities have formulated any short, medium and long term
measures to tackle the problem of prolonged waiting time for consultation for
various specialties of PWH; if they have, of the details; if not, the reasons
for that;
(c) the details of the expansion project; how the expansion project will
strengthen the services provided by various specialties of PWH, especially those
specialties with longer waiting time for consultation (e.g. mental health
services for young people, medicine and A&E services), including by how long the
waiting time for consultation for various specialties may be shortened;
(d) the respective bed-to-population ratios for the various specialties in each
cluster at present, and the relevant ratios in the NTE Cluster upon completion
of the expansion project; and
(e) given that the population of Shatin and Ma On Shan will continue to grow in
the coming few years, whether the authorities have assessed if the NTE Cluster
will, upon completion of the expansion project, meet the proposed standards in
relation to healthcare services as set out in the Hong Kong Planning Standards
and Guidelines, and the results of comparison of the NTE Cluster with other
clusters regarding the relevant standards of services?
Reply:
President,
Apart from being the largest acute hospital serving the New Territories East (NTE),
the Prince of Wales Hospital (PWH) is also the teaching hospital of the Faculty
of Medicine of the Chinese University of Hong Kong, as well as a referral centre
for various specialties in the territory, including adult and paediatric
oncology, cardiothoracic surgery, paediatric surgery, neurosurgery and major
trauma. In addition to the 1.3 million population in the NTE including Sha Tin,
its service users also include cross-district patients.
In recent years, the NTE Cluster, which includes PWH, is facing an increasing
demand on healthcare services from local elderly population (including the large
number of residents in elderly homes within the district) and cross-boundary
patients. The elders are mainly in need of medicine in-patient service whereas
the cross-boundary patients mainly require trauma treatment and paediatric
service. As for PWH, the hospitalisation rate of patients attending the Accident
and Emergency (A&E) Department has been on the rise. The occupancy rate of acute
medical beds saw an increase of over 6% in the past two years. The hospital has
to open more wards and add beds to meet the demand.
My reply to various parts of the question is as follows:
(a) PWH was planned in the 1970s and opened in 1984. It is the largest hospital
in the NTE Cluster, providing acute and tertiary healthcare services. It is also
the teaching hospital of the Faculty of Medicine of the Chinese University of
Hong Kong. In order to provide adequate space to meet the long-term health care
needs of the district and health care training, the Government and the Hospital
Authority (HA) carried out the Phase 1 Redevelopment of PWH in 2007. The
fourteen-storey new building, the Main Clinical Block and Trauma Centre,
provides in-patient services including intensive care unit and intensive care
center, operating theatres and day services. The new building, with a total
gross floor area of 71,500 square meters to provide a better hospital
environment for patients, was opened in late 2010.
The original proposal for the phase two redevelopment project of PWH was to
demolish Staff Blocks A, C and D and the lecture hall of the nursing school for
the construction of a new block and provision of sufficient clinical space and
facilities in compliance with the current design and standards. Provision of
additional beds was not included in the original plan. In light of the relevant
government departments' latest projection of population growth and expected
changes in demographic structure in NTE, HA is reviewing the phase two
redevelopment project, with considerations given to increasing the number of
beds and expanding the inpatient services so as to meet the long-term medical
service demand of the NTE Cluster, including Sha Tin. Upon completion of the
review, HA will conduct a technical feasibility study on the new proposal and
draw up an overall development plan for PWH. As the review is in progress and
will take some time to complete, the estimated timetable for the commencement
and completion of the phase two redevelopment project is not yet available for
the time being.
(b) and (c) Although there has been a shortage of manpower in recent years, to
cater for the increasing demand for medical services, PWH has implemented
various measures to improve its A&E service, specialist outpatient (SOP)
services and the waiting time for hospital beds, with a view to enhancing the
overall service quality.
As for SOP services, the NTE Cluster will improve the management of SOP waiting
lists in 2013/14. Additional consultation sessions for Ophthalmology will be
conducted to manage a total of 4 000 new cases. Moreover, anti-vascular
endothelial growth factor treatment will be provided to 60 new age-related
macular degeneration cases and 500 new cases of diabetic related eye diseases,
including sight threatening diabetic retinopathy.
Additional resources are allocated to the NTE Cluster for granting special
honorarium to doctors who work overtime voluntarily to speed up the handling of
routine cases in Surgery, Gynaecology and Psychiatry. New patients who are
considered to be in suitable condition after assessment may be given an earlier
appointment.
HA has implemented a new initiative since August 2012 to facilitate patients in
certain specialties with stable condition to seek earlier SOP appointment
through cross cluster arrangements. HA is now exploring a similar arrangement to
transfer some gynaecological patients in NTE Cluster to Hong Kong East Cluster
for consultation.
There is an established mechanism in PWH for referral of patients in SOP clinics
who are in stable and simple medical condition to Family Medicine Training
Centre or general out-patient clinics for follow-up treatment, so as to spare
places in SOP clinics for handling new patients.
PWH has also been improving the environment of specialist clinics as well as the
consultation procedures and comfort of patients. For instances, the new Eye
Centre opened last year has an increase in area by 60% as compared with the old
clinic, the expansion of the psychiatric clinic has also been completed.
As regards A&E service, PWH will continue to actively recruit doctors to fill
the vacancies in the A&E Department. At present, staff have been deployed from
other departments (such as the Department of Family Medicine) to the A&E
Department, part-time doctors have been recruited and support has been sought
from doctors who are willing to work extra shifts or sessions through the
Special Honorarium Scheme. As for nursing manpower, nine additional nurses were
deployed to the A&E Department of PWH in April 2013 to relieve the work pressure
of frontline staff. Other contingency measures include increasing the A&E Nurse
Clinic sessions from two days a week to seven days a week, subject to the
manpower situation. Non-emergency and mild trauma cases will be treated by nurse
specialists so that doctors could attend to patients in critical condition.
PWH plans to launch a mobile phone application this year, providing real time
information on the number of semi-urgent and non-urgent patients waiting in the
A&E Department as well as the waiting time needed. Information on local private
doctors available for services will also be provided for reference of the public
so that they can make their own choices on the suitable consultation channels.
To cater for the increasing demand for in-patient services, PWH will provide 30
day beds at the Medical Ambulatory Care Centre in 2013/14 to divert the
non-emergency cases of acute wards and alleviate the access block at A&E.
Besides, three High Dependency Unit (HDU) beds will be added, 1 500 psychiatric
consultation liaison attendances will be provided at the A&E department for
patients with probable mental health problems to facilitate timely assessment
and early intervention and reduce unnecessary admissions.
In-patient wards of PWH have speeded up the workflow of discharge and transfer
of patients to rehabilitation hospitals with a view to vacating beds and
receiving in-patients as soon as possible. Beds will be added where necessary to
receive patients from other specialties who are in stable condition. During the
peak seasons of influenza, the community outreach nursing team will extend
service to seven days a week, and strengthen visits to local residential care
homes for the elderly so as to reduce the need for hospitalisation of their
residents. Direct admission to Shatin Hospital (without going through the A&E
Department) will be arranged for the elderly as necessary to alleviate the
burden on the A&E Department.
To relieve the work pressure on the frontline staff, an additional 31 nursing
graduates will be deployed to the Department of Medicine in August this year.
PWH is drafting its work plan for 2014/15 to apply for funds for adding several
dozens of medical beds and enhancing the ambulatory services so as to reduce the
admission needs of patients.
In the long run, the phase two expansion project of PWH will be implemented to
alleviate the shortage of acute beds in the district and shorten the waiting
time for in-patient admission.
(d) The Annex sets out the number of general beds in HA per 1 000 population by
hospital cluster in 2012-13 (excluding infirmary, mentally ill and mentally
handicapped beds).
PWH is revising its phase two redevelopment plan to ensure that the services to
be provided upon the completion of the phase two project could better tie in
with the demand of the community.
(e) The Hong Kong Planning Standards and Guidelines provide a general indication
of the sites reserved by the Government for medical and healthcare services such
as public and private hospitals, infirmaries and elderly homes. HA will take
into account a number of factors in planning for the provision of public
healthcare services, so as to formulate service development guidelines which
better tie in with the demand of the community. For instance, it will project
the demand for medical and healthcare services by the public in the short,
medium and long term having regard to demographic changes, population growth,
the rate of patients seeking cross-district medical treatment, the growth rate
of services of individual specialties and changes in healthcare services
utilisation pattern.
Ends/Wednesday, May 22, 2013
Issued at HKT 18:32
NNNN
LCQ22 Annex