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Following is a question by the Hon Lau Wai-hing and a written reply by the Secretary for Health and Welfare, Dr E K Yeoh, in the Legislative Council today (March 6):

Question:

In August last year, the Hospital Authority (HA) conducted a follow-up audit survey on the working hours of public hospital doctors. The findings of the survey revealed that only 60 per cent of the 90 departments audited could grant one rest day every week to doctors. In this connection, will the Executive Authorities inform this Council whether they:

(a) have assessed if the HA has violated the provision of the Employment Ordinance (Cap. 57) that employers shall grant not less than one rest day in every period of seven days to their employees;

(b) have evaluated the adverse effects of excessively long working hours of public hospital doctors on their ability to properly diagnose and treat patients; and

(c) have reviewed and examined the measures that should be taken to change the current situation in which the majority of health care services are provided by the public health care system, with a view to alleviating the workload of public hospital doctors; if so, of the details?

Reply:

Madam President,

(a) Long working hours of doctors is a longstanding problem encountered not just in Hong Kong but in many health systems worldwide. Due to the nature of hospital operation which requires provision of round-the-clock services for patients 365 days a year and the organisation of medical work, hospital doctors adopt work schedules that extend beyond normal working hours in order to provide continual medical attention to inpatients and patients admitted on emergency basis. The work arrangements can be broadly divided in the following three categories:

a) departments which operate in a mode where the workload is relatively constant in a 24-hour period (such as the Accident & Emergency Department which receives patients with medical emergencies on a 24-hour basis), necessitating doctors to work in shifts;

b) "support" clinical departments, such as pathology or radiology, where the main work load is encountered during office hours. To cater for the work load during the night and "non-work" days, doctors are scheduled to work during "off hours" on an on-call basis; and

c) "direct patient-care" clinical departments, such as medicine, surgery, and orthopaedics, which operate during day time and continue into the night to provide continuity of care to patients. The work load of these departments during the night varies considerably depending on whether the department is admitting emergency patients, and on the medical conditions of the in-patients already under their care. To meet the medical work needs during "off hours", doctors are rostered to be on-call and are required to be either "on-site" or are available to be accessed. Most of the hospital departments are under this category.

Working hours of doctors will also be affected by the wastage of doctors, the need to train specialists, and increased specialisation due to advancement in medical technology resulting in on-call needs for the respective subspecialties.

To address the problem of the high wastage rates of public hospital doctors and the conditions of work of doctors, a number of initiatives have been implemented. On the recommendation of the Standing Commission on Civil Service Salaries and Conditions of Service in 1990, we have increased the starting pay of the medical officer rank by one point and the maximum pay by two points in recognition of the special characteristics of the medical services, the requirement to work irregular and unsocial hours and the problem of retaining experienced staff in the public service. When HA was set up in 1991, in order to address the very high wastage rate, the terms of doctors working in the then subvented hospitals had also been enhanced to bring them on par with those working in the civil service. Since 1989, a fixed-rate honorarium has also been granted to doctors who are consistently required to work unusually long hours to attend on-call duties to compensate for the substantial amount of overtime work performed by them.

While the Employment Ordinance provides an employee employed under a continuous contract with not less than one rest day in every period of seven days, it also allows an employee to work voluntarily for his employer on a rest day. Whereas at present some doctors working in HA may not have weekly rest days, their duty schedules are worked out by the clinical departments of hospitals in discussion with the doctors. In so doing, a balance is struck between improved working conditions against the need for patient care, professional standards and adequacy of supervision of doctors undergoing training for specialisation. In this connection, we fully appreciate the fine tradition and culture of the medical profession, the devotion of public doctors and the sacrifices they have made in giving up their leisure time for the provision of quality health care service to the public, and amid increasing demand and public expectations of public hospital services. We recognise that improved working conditions of doctors, including adequate rest, is essential for the provision of quality patient care. In this regard, HA is making active efforts to provide doctors with one rest day per week.

(b) We fully recognise that improved working conditions, such as adequate rest, is essential for the provision of quality patient care. The physical well being of its employees, including doctors, is always the prime concern of HA. In this connection, HA is committed to tackling the problem of long working hours of public doctors. To prevent doctors from working excessively long hours, HA has issued guidelines to all public hospitals on the work hour arrangements of doctors and conducts regular audit reviews on doctors' working hours. HA has also taken the following specific measures to address the problem of long working hours of public hospital doctors:

(i) HA has pledged in its 2001/02 Annual Plan to reduce frontline doctors' work hours by recruiting more doctors to relieve the work of busy departments, better arrangement of on-call duties and provision of rest periods after long hours of work;

(ii) Hospital management is required to report on the call frequency, statutory holiday and rest day arrangements, as well as the post-call compensatory off arrangement in regular management meetings;

(iii) Individual hospitals have made continuous efforts to enhance the communication process between supervisors and frontline doctors to come up with mutually agreed arrangements on the provision of weekly rest days, and appropriate rest to doctors who have worked a stretch of excessively long working hours; and

(iv) HA recruited 312 doctors in 2000/01 and another 303 doctors in 2001/02 to alleviate the workload of doctors. The total number of doctors in HA has increased by around 12 per cent since March 2000. In 2002/03, HA will recruit at least 270 doctors to further address pressure areas in different hospitals.

(c) We have, in our consultation document on health care reform, set out reform proposals for the system of health care service delivery and the fee restructuring option. These proposals, when implemented, will not only improve the health system, but will also have an impact on the workload of the public system and of doctors working in the system. For the delivery of health care service, we shall strengthen preventive care, re-organise primary medical care, develop a community-focused, patient centred and knowledge based integrated health care service, and improve public/private interface. These proposals should facilitate a more efficient and effective distribution of work between the different levels and sectors of health care provision. As for fee restructuring, we shall carry out a full-scale review of our fee structure so as to better target our subsidy to lower income groups and to medical services which carry major financial risks to individuals, as well as to influence appropriate use of medical services.

It has always been our policy to maintain a viable private medical sector to complement the public sector. A dual system will provide patients with more choices of care. At present, the private sector provides 85 per cent of the primary medical care and a substantial amount of outpatient specialist care, while the public sector provides for 94 per cent of the inpatient services in Hong Kong. We believe the private sector can contribute more in the provision of hospital service. The fee differential between the public and private sectors is one of the factors affecting the equilibrium between the public sector and private sector. In the context of the health care reform, we are working on solutions to address the issue through improvement of the public/private interface. We aim to come up with solutions which can influence the distribution of workflow between the public and private sectors. In this connection, the Administration has set up two dedicated working groups with representatives of private medical practitioners and private hospitals respectively to explore proposals to achieve better collaboration between the public and private sectors. In parallel, HA has developed referral protocols and shared patient information with private practitioners to facilitate an effective transfer of patients between the public and private sectors.

End/Wednesday, March 6, 2002

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