Replies to LegCo questions
LCQ13: Services of Hospital Authority's New Territories East Cluster
Following is a question by the Hon James Tien Pei-chun and a written
reply by the Secretary for Food and Health, Dr Ko Wing-man, in the
Legislative Council today (November 6):
Question:
According to media reports, the waiting time of new cases for specialist
out-patient services on gynaecology in the New Territories East Cluster
(NTEC) of the Hospital Authority (HA) is as long as 127 weeks (i.e.
almost two and a half years), which is the longest among all hospital
clusters. Besides, the waiting time of new cases for specialist
out-patient services on ophthalmology of NTEC even stands at 160 weeks
(i.e. about three years). Moreover, in March this year, some semi-urgent
patients at the accident and emergency (A&E) department of the Prince of
Wales Hospital of NTEC in Sha Tin needed to wait for more than 12 hours
before they were treated. In this connection, will the Government inform
this Council whether it knows:
(a) the average waiting time of new cases for various specialist
out-patient services provided by the public hospitals of NTEC since
April 2013 (set out in Annex 1);
(b) the respective waiting time for the services of various A&E
departments in NTEC since April 2013 (set out in table form); whether HA
has reviewed the latest situation of the waiting time for A&E services
in NTEC so as to implement improvement measures; if it has, of the
details; if not, the reasons for that;
(c) given that HA launched, on a pilot basis, a cross-cluster referral
arrangement for specialist out-patient services in August 2012, the
total number of patients that NTEC has referred to other clusters for
medical treatment so far and, among them, the respective percentages of
the number of patients of various specialties in the total numbers of
patients of the specialties concerned in NTEC (set out by specialty and
cluster in table form); the criteria adopted by HA for deciding the
specialties for which such a cross-cluster referral arrangement should
be implemented on a pilot basis;
(d) if HA has assessed the effectiveness of the cross-cluster referral
arrangement mentioned in (c), including the resultant reduction in the
waiting time for various specialist services, and whether it has plans
to extend such arrangement; if so, of the details; if not, the reasons
for that; and
(e) if the authorities have assessed the impact of the trend of the
rising number of cross-boundary children coming to study or live in Hong
Kong on local medical services (particularly on the services of the
public hospitals of NTEC), and accordingly conducted a comprehensive
review of the staffing and resource allocation of the public hospitals
of NTEC; if they have, of the details; if not, the reasons for that?
Reply:
President,
The Hospital Authority (HA) has implemented a triage system for all new
specialist outpatient (SOP) cases to ensure that patients with urgent
conditions requiring early intervention are treated with priority. Under
the current triage system, new cases are usually first screened by a
nurse and then by a specialist doctor of the relevant specialty for
classification into priority 1 (urgent), priority 2 (semi-urgent) and
routine categories. The HA's target is to maintain the median waiting
time for cases under priority 1 and priority 2 within two weeks and
eight weeks respectively. HA has all along been able to keep this
performance pledge so far.
As regards Accident and Emergency (A&E) services, HA has adopted a
triage system which classifies patients attending the A&E departments
into five categories according to their clinical conditions, namely
critical (Category I), emergency (Category II), urgent (Category III),
semi-urgent (Category IV) and non-urgent (Category V), so as to ensure
that patients with more serious conditions are accorded higher priority
in medical treatment.
In 2012-13, the average waiting time for patients triaged as critical
and emergency was 0 minute and 7 minutes respectively. All patients
triaged as critical and 97 per cent of patients triaged as emergency
were treated within the time stated in the HA's performance pledge for
the two categories, i.e. immediately and 15 minutes. This shows that the
majority of patients with pressing medical needs were able to receive
timely medical treatment.
My reply to the various parts of the questions is as follows:
(a) The waiting time for new cases of SOP clinics in the New Territories
East (NTE) Cluster (Note) by priority set according to patients'
conditions from April to September 2013 (provisional figures) is set out
in Annex 2;
(b) The average waiting time in A&E departments of the NTE Cluster from
April to September 2013 (provisional figures) is set out in Annex 3;
In tandem with community development, the population of the NTE
(including Sha Tin, Tai Po and North District) has increased from 1.2
million in 2007 to 1.25 million in 2013 and there is a particular surge
in the proportion of elderly population. Moreover, there is a
cross-boundary demand for medical services. Hence, hospitals in the NTE
Cluster are under a certain level of pressure. Apart from meeting the
increasing demand of the NTE including Sha Tin for its A&E services and
facing the pressure of ageing patients, the Prince of Wales Hospital
(PWH) also needs to fulfill its role as a university teaching hospital
and a referral centre for major trauma involving more complicated cases.
PWH has kept the utilisation of its A&E service under close watch and
has taken a number of short-term and long-term measures to strengthen
its healthcare manpower. In addition to deploying doctors from other
hospitals or departments (such as the Department of Family Medicine),
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. Continuous active efforts are also made to
recruit full-time doctors, including overseas doctors. As for nursing
manpower, PWH recruited five additional nurses for its A&E department in
August 2013 and increased the number of day beds for medical ambulatory
care to 30 in a bid to relieve the work pressure of frontline staff and
divert non-emergency cases of acute wards.
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. In-patient wards have also speeded up the workflow
of discharge and transfer to rehabilitation hospitals, and added beds
where necessary, with a view to vacating beds and admitting A&E patients
as soon as possible to further relieve the pressure on the department.
(c) HA provides different kinds of public healthcare services throughout
the territory to give patients convenient access to these services
according to their needs. In general, HA encourages patients to seek
medical treatment from SOP clinics of the hospital cluster to which
their districts of residence belong so as to facilitate the follow-up
treatment of any of their conditions and the provision of community
support.
To manage the waiting time of SOP services (particularly for routine
cases) in an effective manner, HA has established a centrally
co-ordinated mechanism to enhance cross-cluster collaboration and
launched a pilot run of cross-cluster referrals. The mechanism provides
suitable patients in clusters of longer waiting time with an option to
seek medical treatment in clusters of shorter waiting time. In choosing
specialties for the pilot run, HA mainly considers the conditions (such
as those with shorter treatment duration) and appropriateness of the
patients concerned (such as those with greater mobility).
The pilot run of cross-cluster referral arrangement started in the Ear,
Nose and Throat departments of the Kowloon East Cluster and the Kowloon
Central Cluster in August 2012. In April 2013, the arrangement was
extended to referral of suitable new gynaecological cases in the NTE
Cluster to the Hong Kong East Cluster. As at September 30, 2013, about
142 patients in the NTE Cluster benefited from the arrangement. HA
further extended the service in October 2013 by referring new ophthalmic
cases in the NTE Cluster to the Hong Kong West Cluster.
(d) Regarding the cross-cluster referral services in the NTE Cluster,
the waiting time of gynaecological patients accepting the referral
arrangement has been reduced from over 100 weeks to 20-odd weeks. As for
ophthalmology, HA has yet to compile statistics about the changes in
waiting time because the pilot run of cross-cluster referral only
started in October 2013.
HA will consider extending the scope of cross-cluster referral
arrangement under the centrally co-ordinated matching system in the
light of the needs as well as suitability of the diseases and patients.
In the long run, HA will identify service areas in various specialties
and clusters which are under greater pressure and exercise more
effective management of waiting time through resources allocation
according to the HA's annual plan and other appropriate measures.
(e) HA has conducted surveys on the demand for healthcare services from
cross-boundary children who are eligible persons. According to its
latest estimation, there are some 151 000 children who were born in Hong
Kong to Mainland women and are now living in the vicinity of Guangdong
Province. This figure is projected to increase to 187 000 in 2017.
To cater for the needs of cross-boundary children and cope with the
overall demand for paediatric services, HA has been implementing various
measures and programmes to keep pace with service requirements. In
recent years, targeted resources were allocated to enhance the
paediatric services of the NTE Cluster, including recruitment of
additional healthcare staff and procurement of medical equipment in
2013-14, setting up of a paediatric day ward with 10 beds in the Alice
Ho Miu Ling Nethersole Hospital and establishment of a day care unit
with eight beds in the Children's Cancer Centre of PWH for patients to
undergo procedures such as chemotherapy, blood transfusion and
antibiotic injection. Additional healthcare staff have been recruited
and medical equipment procured to cope with such service development. As
regards in-patient service, an additional neonatal intensive care unit
bed and three more children high dependency beds with breathing
apparatus were provided in PWH in 2012-13.
The need to cope with the service requirements of cross-boundary
children and overall demand for paediatric services are understandably
not limited to NTE. As such, HA has added a total of 10 neonatal
intensive care beds in the Pamela Youde Nethersole Eastern Hospital,
Kwong Wah Hospital, Queen Elizabeth Hospital and Tuen Mun Hospital in
recent years. Services of paediatric intensive care and high dependency
units have also been enhanced in the Queen Mary Hospital. To enhance the
quality of paediatric services, the Duchess of Kent Children's Hospital
will provide three additional beds for the provision of
inter-disciplinary care for children who have to rely on respiratory
equipment. Pharmacy support services have also been introduced in
paediatric wards of various clusters to ensure the quality and safety of
medication.
In the long term, HA will continue to monitor the situation and make
appropriate service planning and manpower deployment in order to meet
service needs.
Note: As there is co-ordination among clinics for the same specialty
within clusters, the waiting time for SOP services is thus reported by
cluster (not by hospital).
Ends/Wednesday, November 6, 2013
Issued at HKT 16:35
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