Replies to LegCo questions
LCQ2: Supply of healthcare services in the New Territories East Cluster of the Hospital Authority
Following is a question by the Hon Chan Hak-kan and a reply by the Secretary for
Food and Health, Dr Ko Wing-man, in the Legislative Council today (June 29):
Question:
Some residents of New Territories East have relayed to me the short supply of
healthcare services in the New Territories East Cluster. The projected number of
general hospital beds per 1 000 persons in the cluster in 2021, calculated on
the basis of geographical population of catchment districts, is 2.7, which is
lower than the overall 3.1 beds of the Hospital Authority (HA). In 2015-2016,
the inpatient bed occupancy rates of North District Hospital and Alice Ho Miu
Ling Nethersole Hospital (Nethersole Hospital) under the cluster were as high as
92 per cent and 84 per cent respectively. The respective numbers of doctors in
the Accident and Emergency (A&E) departments of the two hospitals only remained
at 20 and 24 in the past three years, and such manpower was tighter than that of
the A&E departments of the hospitals under other clusters. In this connection,
will the Government inform this Council:
(1) given that the obstetrics and gynaecology (O&G) department and the
paediatrics and adolescent medicine department in North District Hospital
currently provide only midwifery clinic service and outpatient service
respectively but not inpatient service, and Nethersole Hospital does not provide
O&G service at present, whether the authorities have assessed the existing
situation of residents of the North and Tai Po Districts seeking medical
consultation at hospitals in other districts in respect of the services not
provided by these two hospitals; if they have, of the number of persons
concerned;
(2) whether it knows if HA has considered expanding the staffing establishment
of doctors in the A&E departments of North District Hospital and Nethersole
Hospital; if HA has, of the details; if not, the reasons for that; and
(3) given that HA has included the expansion of North District Hospital into its
10-year hospital development plan, of the latest progress and implementation
timetable of the expansion plan; whether it knows if HA has currently adopted
any short, medium and long term measures to lower the inpatient bed occupancy
rate in North District Hospital; if HA has, of the details; if HA has not, the
reasons for that; whether the authorities will consider expanding Nethersole
Hospital; if they will, of the details; if not, the reasons for that?
Reply:
President,
My reply to the Hon Chan Hak-kan's question on the supply of healthcare services
in the New Territories East Cluster (NTEC) of the Hospital Authority (HA) is as
follows:
(1) HA plans its services on a cluster basis. To ensure that resources can be
used effectively, and the service volume of individual specialties in a hospital
can help the healthcare personnel accumulate sufficient clinical experience so
as to guarantee service quality, the types of services provided by hospitals in
individual cluster vary and complement each other. This arrangement serves to
provide comprehensive and appropriate services for the residents in the cluster.
As for NTEC, the three acute hospitals in the cluster, namely the Prince of
Wales Hospital (PWH), North District Hospital (NDH) and Alice Ho Miu Ling
Nethersole Hospital (AHNH), collaborate with other extended care hospitals in
the cluster to provide comprehensive services for the residents of New
Territories east.
As for obstetric services, the provision of obstetric inpatient and outpatient
services of NTEC are concentrated at PWH. HA's Expert Committee on Obstetrics
and Gynaecology (O&G) Services has drawn up a planning reference to ensure that
healthcare personnel can accumulate sufficient clinical experience to handle the
possible complications of pregnant women. In general, a public hospital will
only provide obstetric inpatient service when the number of births reaches 3 000
per year. The number of live births in public hospitals by pregnant women
residing in North District and Tai Po District was around 1 900 and 1 700
respectively in 2015-16, and has not yet reached the above benchmark. As such,
NTEC does not have plan to provide obstetric inpatient service at NDH and AHNH
at present.
However, we will review the demand for obstetrics inpatient service from time to
time, and explore whether and how we can meet the increasing service demand
through hospital redevelopment projects currently under planning, including the
expansion of NDH. Paediatrics service across clusters will also be adjusted and
realigned with the Hong Kong Children's Hospital coming into operation in 2018.
Annex 1 sets out the number of O&G and paediatrics patient days by residents in
the New Territories east (including Sha Tin, Tai Po and North Districts) in
2015-16. Annex 2 sets out the number of O&G and paediatrics specialist
outpatient attendances (clinical) by these residents in the same year. The data
in the Annexes indicate that among the residents in Sha Tin, Tai Po and North
Districts who received obstetrics and paediatrics services in public hospitals,
over 84 per cent of the number of patient days and 82 per cent of the number of
specialist outpatient attendances (clinical) were recorded in NTEC hospitals.
(2) HA implements the triage system in all accident and emergency (A&E)
departments of its hospitals, including NDH and AHNH, to ensure that priority
and timely treatment are given to patients in need of emergency services.
As the population in the North District and Tai Po District continues to grow
and age, the demand for A&E service in NDH and AHNH has been increasing in
recent years. In 2015-16, the number of A&E attendances in these two hospitals
were around 108 200 and 137 500 respectively. The average waiting time for A&E
service for Category III (i.e. urgent) cases, for example, was 22 minutes in NDH
and 12 minutes in AHNH, both of which were better than the HA overall average
waiting time (i.e. 24 minutes).
There are currently 20 and 24 doctors working in the A&E departments of NDH and
AHNH respectively. HA estimates that as about 420 medical graduates will
complete their internship in 2018-19, the problem of shortage of doctors will be
relieved. HA will increase the number of A&E doctors in NDH and AHNH as
necessary.
In fact, HA has all along been allocating additional resources to various
hospitals on a need basis in order to meet service demand and enhance service
provision. In 2013, NDH changed 20 beds in observation wards to A&E beds and
recruited one additional A&E doctor. In 2015, AHNH provided eight additional A&E
beds and recruited one additional A&E doctor. Moreover, both hospitals provide
over-time allowances for doctors through the special honorarium scheme to
increase manpower. During the period of December 2015 to April 2016, A&E doctors
in NDH and AHNH undertook over-time work for more than 970 hours and more than
320 hours respectively.
The general outpatient clinics in North District and Tai Po District had also
provided corresponding supporting services during the winter surge of influenza
this year by increasing each of their weekly consultation quotas by 70 to serve
the public.
(3) In light of the projected population growth and expected changes in
demographic structure in New Territories east as well as the rising demand for
services in the cluster, HA has completed the formulation of the Clinical
Services Plan (CSP) for NTEC. The CSP maps out the cluster's clinical strategies
and future service directions for meeting the long-term healthcare needs of the
community, including examining the roles and positioning of NDH and AHNH in the
cluster, and the expansion projects and service scopes of the two hospitals etc.
HA will, having regard to the CSP, formulate and take forward the development
projects for NDH and AHNH, and implement other appropriate measures to ensure
that their services can meet public demand.
To meet the future healthcare needs of the population of North District and to
serve the keen service demand of the public, the Government has reserved a site
of about 30 000 square metres adjacent to NDH for expansion of the hospital to
provide additional beds and increase service capacity. HA is formulating the
overall planning strategy for the future development of NDH, and is working with
the relevant departments to set a timetable for the implementation of the work
projects. According to the preliminary estimate, the expansion of NDH will be
completed by 2026.
Before the completion of the expansion project, NDH will also strengthen its
services in all aspects. These include the addition of 30 beds in the medical
ward in August 2015 and the introduction of 24-hour dispensary service in March
this year. Moreover, the hospital is embarking on a plan to build additional
wards, with a view to setting up two wards within next few years and providing
around 80 additional beds to meet the service demand and shorten the waiting
time. The outreaching team has increased its service capacity to conduct more
visits to the residential care homes in the district with a view to reducing
hospital admission of the residents and further relieving the burden of the A&E
department and inpatient services.
Separately, we understand that the demand of Tai Po residents for healthcare
services is keen. In this connection, HA is committed to enhancing the service
capacity of AHNH to enable patients to receive the necessary services more
quickly. HA will, in accordance with the recommendations of the CSP of NTEC and
through its annual planning exercise, progressively enhance the A&E service
capacity of AHNH, including the provision of emergency operation service,
improve surgical service, and provide additional clinical supporting facilities
and inpatient services. To provide the necessary support to tie in with the
launch of surgical service, AHNH has started providing magnetic resonance
imaging service since April this year. Moreover, improvement works for operating
theatres are being conducted to upgrade the facilities for performing general
anaesthesia operations in the future. To shorten the waiting time for joint
replacement, AHNH set up the fourth joint replacement centre in the territory in
October last year to perform extra joint replacement operations. As for surgical
service, AHNH plans to strengthen its emergency surgical and anaesthesia
services in the first quarter of 2017. It will provide five more emergency
operation sessions so as to get prepared for the launch of emergency surgical
service by phases.
Apart from implementing the projects under the 10-year hospital development
plan, HA will also study and plan for projects for the next stage of hospital
development, which include converting the existing parking space between AHNH
and Tai Po Hospital for an expansion project to increase the number of beds and
service capacity of the AHNH to meet future healthcare demand.
Ends/Wednesday, June 29, 2016
Issued at HKT 16:20
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LCQ2 Annex 1
LCQ2 Annex 2