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Following is a question by the Hon Albert Chan and a reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (December 17):
Question:
In reply to my question in June last year, the Government said that the Hospital Authority had taken certain measures to shorten the waiting time for patients with non-urgent conditions for specialist out-patient (SOP) services. Yet, I recently still received complaints from members of the public about the long waiting time for SOP services, and the waiting time of some cases was even as long as six years. They are worried that their clinical conditions will worsen due to the lack of timely treatment over a prolonged period of time. In this connection, will the Government inform this Council if it knows:
(a) last year's average waiting time for each SOP service, together with a breakdown of the number of cases as at the end of last year by their waiting time (i.e. less than one year, one year to less than two years, two years to less than three years, and three years or above);
(b) the longest waiting time among existing cases for each SOP service; and
(c) whether the Hospital Authority will take further measures to alleviate the problem of excessively long waiting time for SOP services; if it will, of the details; if not, the reasons for that?
Reply:
President,
Currently, under the triage system under the Hospital Authority (HA), specialist out-patient (SOP) clinics will arrange the date of medical appointment for new SOP patients on the basis of the urgency of their clinical conditions at the time of referral, taking into account various factors including the patients' clinical history, the presenting symptoms and the findings of physical examination and investigations. Referrals of new patients are usually first screened by a nurse and then by a specialist of the relevant specialty for classification into priority 1 (urgent), priority 2 (semi-urgent) and routine categories. To ensure that no cases with urgent medical conditions are overlooked at the initial triage, all referrals that have been classified as routine cases would be reviewed by a senior doctor of the relevant specialty within seven working days of the initial triage. In addition, if a patient's condition deteriorates before the appointment, he or she may contact the SOP clinic concerned and request for an earlier appointment. If the condition is acute, the patient could also seek immediate treatment at the Accident and Emergency (A&E) departments. The patients would be arranged to receive earlier treatment as necessary.
The HA's targets are to maintain the median waiting time for cases in the priority 1 and 2 categories within two weeks and eight weeks respectively, to ensure that patients with urgent healthcare needs are given medical attention within a reasonable time. In 2007-08, all clusters under HA were able to meet the targets. Information related to various parts of the question is provided as follows.
(a) & (b) For first appointment of new cases in 2007-08, a breakdown by major specialties of the median waiting time and the waiting time at the 99th percentile is set out in Table 1. The overall median waiting time for first appointment of SOP cases is about seven weeks. In terms of median waiting time, the three specialties with the longest waiting time in descending order are Surgery, Gynaecology and Medicine.
For new cases for major specialties in 2007-08, a breakdown of the number of cases by the waiting time (i.e. less than a year, one to two years, two to three years and over three years) is set out in Table 2. As shown in Table 2, of the total of more than 680,000 new cases in 2007-08, the waiting time was less than one year in nearly 590,000 cases (or 86% of the total number of new cases). Among these cases, the waiting time for more than 230,000 cases (or 34% of the total number of new cases) was less than two weeks, and for about 150,000 other cases (or 23% of the total number of new cases), the waiting time was between three to eight weeks. It is evident from the above figures that for about 57% of all the new cases, the first appointment could be arranged within eight weeks. This shows that the triage system is effective in facilitating the provision of appropriate medical services for patients with urgent medical conditions in a timely manner.
(c) In addition, HA has taken the following measures to further improve the waiting time at SOP clinics: (i) setting up 24 family medicine specialist clinics as gatekeeper for SOP clinics and for follow up on patients triaged as routine cases; (ii) updating clinical protocols for referring medically stable patients to receive follow-up primary healthcare services; (iii) collaborating with private practitioners and non-governmental organisations (NGOs) to launch shared care programmes for the private sector and NGOs to follow up on medically stable patients and (iv) disseminating referral guidelines to clinicians to reduce unnecessary referrals.
At the same time, HA has set up a multi-specialty and cross-cluster working group to regularly examine the data and operation of SOP services, study the common causes for referral and make recommendations on improvement strategies in light of its findings, which include: (i) drawing up referral guidelines targeted at the sources of SOP referrals for major specialties and improving the referral arrangements so as to reduce unnecessary SOP referrals; (ii) allowing greater flexibility for the general out-patient (GOP) service in the areas of diagnosis, examination and prescription of drugs, with a view to enhancing diagnosis and service of primary care and reducing public demand for SOP services; and (iii) enhancing the service of nurse and allied health clinics for provision of early assessment and referral.
Based on the above strategies, a number programmes have been implemented in various clusters to improve the SOP services. While it will take time to see the effect of some of these programmes, the waiting time for most SOP services (except for some individual specialties) has improved slightly in the first six months (April to September) of 2008-09 in comparison with that for the whole year of 2007-08. HA will continue to monitor the utilisation and operation of SOP services and to devise and implement further improvement programmes.
HA currently offers a wide spectrum of services. More than 90% of in-patient and specialist services are provided through its 41 hospitals and institutions, 48 SOP clinics, and 74 GOP clinics. For 2007-08, the number of in-patient and day patient discharges was estimated to reach 1.2 million while attendances at A&E departments, SOP clinics, GOP clinics were estimated at 2.15 million, 7.95 million and 4.81 million respectively. However, the number of doctors working in public hospitals only account for 42% of the total number of doctors in Hong Kong. In the circumstances, the rising service demand has put great pressure on our public healthcare system. Public hospitals must therefore target the use of their resources on patients with acute or serious conditions.
In addition to the ongoing formulation and implementation of measures to improve the SOP service including the waiting time, amidst the ageing population and the rising demand for healthcare services from the public, in order to ensure the long-term sustainability of the healthcare system to provide quality healthcare services to meet the increasing needs of the community in future, we must embark on reforms to both the service delivery and financing arrangements of our healthcare system to fully solve the problem in the long run.
Ends/Wednesday, December 17, 2008
Issued at HKT 14:15
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