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LCQ13: Services of Hospital Authority's New Territories East Cluster
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     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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