Replies to LegCo questions
LCQ11: Nursing manpower in public hospitals
Following is a
question by the Professor Hon Joseph Lee and a written reply by the
Secretary for Food and Health, Dr Ko Wing-man, in the Legislative
Council today (December 4):
Question:
Some nurses have relayed to me that the Hospital Authority (HA) has
all along not drawn up any targeted nurse-to-patient ratios for public
hospitals, resulting in its failure to set reasonable nursing manpower
establishments for public hospitals. A survey report published in August
this year by the Association of Hong Kong Nursing Staff (AHKNS) shows
that the current average nurse-to-patient ratios in public hospitals for
the three shifts of morning, afternoon and night are 1:11, 1:12 and 1:24
respectively. Such ratios are a far cry from the statutory ratios (1:4
to 1:6) in foreign countries. AHKNS has also pointed out that HA has
all along told the public that it has gradually recruited more nursing
staff, but in fact the shortage of nursing staff is serious. In this
connection, will the Government inform this Council if it knows:
(a) whether HA has compiled statistics on the current nurse-to-patient
ratios in various clinical departments of public hospitals in Hong Kong;
if it has, of a breakdown of such figures by clinical department; if
not, the reasons for that and whether HA will consider compiling such
statistics;
(b) as HA is considering the feasibility of introducing the "Ward
Workload Index" (WWI), i.e. calculating the required manpower ratios
based on workload, whether HA has calculated the appropriate
nurse-to-patient ratios for various clinical departments according to
WWI; if it has, of such ratios, the shortfall in nursing staff and the
reasons for the shortage, broken down by clinical department; if not,
the reasons for that and whether it will consider making such
calculation expeditiously; and
(c) the number of new medical service programmes launched by HA in the
past three years, and set out the nursing staff required and whether
there is any shortfall in nursing staff at present (if so, of the
shortfall) in respect of each of these programmes?
Reply:
President,
With an ageing population, advances in medical technology, and an
increasing demand for healthcare services in the community, the manpower
requirement for healthcare personnel grows commensurately. Over the past
few years, the Hospital Authority (HA) was all along concerned about the
problem of manpower supply, including the shortage of frontline nursing
manpower in public hospitals. The HA has recruited additional nurses in
the past three years and the overall manpower has increased from 19 866
to 21 816 (on full-time equivalent basis), representing a net growth of
1 950 in number and an increase of 10%. In 2013, the HA will recruit 2
100 nurses to make up for staff turnover and relieve the work pressure
of frontline nurses.
My reply to the various parts of the question is as follows:
(a) The HA provides different types and levels of services to patients
according to the condition and needs of each patient at different
specialties. Hence, the HA does not use nurse-to-patient ratio for
assessing healthcare manpower requirement. The HA has no plan to compile
statistics on the nurse-to-patient ratios in various clinical
departments of public hospitals in Hong Kong for the time being.
(b) In recent years, the HA is developing a ward workload assessment
model for estimating nursing manpower requirement. In addition to the
prevailing number of patients, the model also takes into account the
dependency level of patients for nursing care.
There are four dependency categories under the model, deriving from
patients' needs for direct nursing care. The higher the dependency, the
more nursing time is required. The model also incorporates other
workload factors, such as the working time for providing patient
education, counselling and care planning as well as non-bedside nursing
work such as coordination and liaison. Other factors like patient
turnover (including admission, discharge and transfer of patients) which
have impact on nursing workload are also taken into consideration.
The ward workload assessment model is a dynamic tool used to
calculate long-term healthcare manpower requirement according to the
number of patients and the distribution of dependency categories. Since
HA is still developing the ward workload index, figures of individual
clinical departments are not yet available.
The HA mainly considers additional requirements generated by
projected service growth, and replacement requirements generated by
staff turnover (including retirement) in projecting its nursing manpower
requirement. The projection of service demand ranges from in-patient,
day-patient to outpatient, ambulatory and community services as well as
clinical supporting specialties services. The service demand projection
uses the age-specific and specialty-specific service utilisation rates
in a given year as the base, and takes into account anticipated changes
resulting from various factors including population growth and ageing,
and changes in healthcare services utilisation pattern. The HA estimated
that there was a shortfall of about 850 nurses in 2012.
(c) The targeted number of additional nurses to be recruited each year
by the HA is set having regard to the turnover rate and the manpower
required for providing new services. On the operational front, the HA
will flexibly deploy nursing staff to provide existing and new medical
services. Therefore, the HA has not maintained statistics on the vacancy
of nursing staff in respect of each medical service programme.
In general, the HA has strengthened the recruitment of nurses in
recent years to relieve the nursing manpower pressure. The increase in
the number of nurses is mainly for the provision of new medical services
by the HA. The net increase in the number of nurses each year is listed
in the following table:
Year Number of nurses Net increase
(full-time equivalent)
2009-10 19 866 --
2010-11 20 102 236
2011-12 20 901 799
2012-13 21 816 915
Total number of additional nurses 1 950
(Note: Including 700 additional nurses recruited through additional
Government funding to the HA. )
As mentioned in the reply to part (b), HA estimated that there was
a shortfall of about 850 nurses in 2012.
The HA has implemented various measures, including strengthening
recruitment, enhancing promotion prospects and supporting career
development of enrolled nurses, with a view to relieving the manpower
shortage of nurses. The HA will continue to monitor the manpower
situation and make appropriate arrangements in manpower planning in
order to cope with the service demand.
Ends/Wednesday, December 4, 2013
Issued at HKT 15:36
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