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Following is a question by the Dr Hon Joseph Lee and a written reply by the Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council today (June 14):
Question:
It has been reported that the Hospital Authority (HA) will employ additional community nurses next year. In this connection, will the Government inform this Council:
(a) of the expenditure on community nursing services in each of the past three years;
(b) whether it has assessed the effectiveness of community nursing services over the past three years; if it has, of the assessment results;
(c) of the respective numbers of community nurses in the general and psychiatric streams and the ratio of community nurses to patients in each hospital cluster at present;
(d) of the criteria adopted by HA for working out the demand for community nursing services, and whether HA has set a target ratio of community nurses to patients and regularly reviews the ratio;
(e) of the expenditure involved in HA's plan to employ additional community nurses; and
(f) whether it has made any prediction on how the quality and development of community nursing services will be enhanced as a result of employing additional community nurses?
Reply :
Madam President,
The Hospital Authority (HA) provides a range of inpatient and ambulatory care services to meet the health care needs of the community. The provision of community nursing service is part of the community-based health care delivery approach to support the care of those who need such services in the community. The aim is to empower such persons in self-care, improve health and reduce hospital dependency. Provision of community nurses and community nursing service in a particular geographical area or hospital cluster depends on a number of factors such as the care delivery model, the make up of a health care team, the availability of local community resources such as volunteer carers, non-governmental organisations and primary care providers, as well as provision of old age homes in the area.
My answers to the questions asked are as follows -
(a) Expenditure on community nursing service in each of the past three years is shown in Table 1.
The reduction in the expenditure between 2003-04 and 2005-06 was due to the pay cut exercise in line with that in the civil service.
(b) In line with the strategy for a community-based health care delivery approach, the HA hospital clusters assess the need for community-based services based on specific patient needs and programmes. A range of outcome indicators are being used and continuously refined for measuring the effectiveness of community-based services, such as early discharge of patients, as well as reduction in hospital readmission and accident and emergency attendance. An example illustrating the effectiveness of the services is that the average length of stay for mastectomy patients in some hospitals has been shortened from 8-9 days to 4-5 days.
(c) & (d) The total numbers of community nurses and community psychiatric nurses in the HA as at the end of March 2006 are 385 and 110 respectively. Breakdown of their numbers in each hospital cluster is shown in Table 2.
Community nurses in the HA have made a total of 792 810 homes visits in 2005-06 to provide services to those in need in the community. Since the community psychiatric nursing service has been integrated with the community psychiatric team to form the community psychiatric service, there are no separate visit statistics for community psychiatric nurses.
The community nursing service in the HA provides care to an average of some 10 000 persons in need of such service in the community at any one time. These persons have diverse needs. The service volume, service location, care complexity and intensity for these persons vary because of their health conditions, nature of their social background and availability of family support and community resources. It would not be meaningful to interpret or devise any target ratio of nurses to patients on its own without reference to the aforementioned factors. The assessment of demand for community nursing service is an evolving and dynamic process. As such, the HA has empowered the hospital clusters to flexibly deploy resources to serve those in need of such service in the community based on the different social environment and to encourage the use of available community services in the local community.
(e) The HA estimates that $242 million will be allocated for running community nursing service in 2006-07, representing an additional provision of $2 million as compared with that of the 2005-06. Hospital clusters may employ additional community nurses taking into account the availability of resources and relevant services within their catchment areas as well as the service needs.
(f) The HA values the contributions of community nurses in empowering patients in self-care, improving health and reducing hospital dependency. Additional community nurses will further enhance the quality and service volume of the community nursing service, which has a definite role in the community-based health care service model, particularly in addressing the ageing population problem.
Ends/Wednesday, June 14, 2006
Issued at HKT 15:21
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