LCQ2: Accident and emergency and emergency ambulance services

     Following is a question by the Hon Mrs Sophie Leung and a reply by the Acting Secretary for Food and Health, Professor Gabriel Leung, in the Legislative Council today (May 4):


     At present, unless patients can prove that they must be taken to designated hospitals for treatment because of special medical needs, emergency ambulances managed by the Fire Services Department in general will take them to the Accident and Emergency (A&E) department of the nearest public hospital.  In this connection, will the Government inform this Council:

(a) whether it knows the current number of private hospitals offering A&E services and 24-hour out-patient service in Hong Kong; whether the Government has any plan to encourage private hospitals to provide A&E services; of the Government's estimation, in view of the expansion of services by private hospitals, of the division of work between public and private hospitals and their respective positioning in the provision of A&E services;

(b) whether the Government will study amending the guidelines for conveyance of patients by emergency ambulances, such as setting up a mechanism under which ambulances may take patients, who are in semi-urgent condition, to private hospitals for treatment according to their requests even if they cannot prove that they have special medical needs; if it will, of the details; if not, the reasons for that; and

(c) whether the authorities have tried to collaborate with the trade and charity organisations to develop the market for paid semi-urgent and non-urgent ambulances services, or even cross-boundary patients conveyance service, so as to facilitate patients who are financially better-off to switch to private healthcare services, thus alleviating the burden on public healthcare services; if they have, of the details; if not, the reasons for that?



     At present, accident and emergency (A&E) services in Hong Kong are mainly provided by the Hospital Authority (HA).  HA has set up A&E departments in 16 public hospitals under its seven clusters to provide service to the public in different districts across the territory.  Generally, hospitals provided with A&E departments must be specially designed and be able to provide other specialist services at the same time and be equipped with appropriate staff and facilities, in order that comprehensive support and treatment could be provided to patients in critical conditions.  Having regard to the needs of the patients conveyed to A&E departments, hospitals may transfer these patients to other departments for further diagnosis or arrange them to receive suitable specialist surgery.  My reply to the various parts of the question is as follows:

(a) Services provided by private hospitals are subject to regulation by the Department of Health (DH).  The existing Code of Practice for Private Hospitals, Nursing Homes and Maternity Homes (the Code of Practice) issued by DH sets out the requirements for implementation by private hospitals as well as requirements for various types of clinical and supporting services.  As for A&E services, the Code of Practice specifies that hospitals operating A&E services must provide, on a 24-hour basis, an adequate range of pathology service, radiology service, operating theatre service, pharmacy and dispensing services, intensive care service, cardiac service and other related supporting services appropriate to the needs of patients in emergency. On staffing and skills training, private hospitals are required to appoint a specialist in emergency medicine to assume overall responsibility of the A&E services, and arrange medical practitioners who are competent in emergency medicine and nurses and staff who have received relevant specialist training for duty at the A&E department for provision of services.  In addition, private hospitals are required to have a policy in place to mobilise additional personnel to attend to emergency situations.  They should also review regularly their facilities, equipment and staff training in relation to A&E service.  DH will inspect the private hospitals from time to time to ensure that their service standard, equipment and staffing are in compliance with the requirements.

     With a view to enhancing the overall service capacity and service quality of our local healthcare system to cope with increasing service demand, the Government has been proactively promoting and facilitating development of private hospitals.  We encourage private hospitals to provide a wide range of services to cope with the demand of the community.  In determining whether to provide a specific kind of service, private hospitals will take into account service demand as well as availability of supporting services, staffing arrangement and ancillary facilities in their hospitals.  Since the provision of A&E service requires the support of other facilities and specialist services, in general private hospitals may not be able to provide A&E service.  At present, 24-hour outpatient services are available in seven of the 12 private hospitals, with one of them providing A&E service as well.

(b) At present, emergency ambulance services in Hong Kong are provided by the Fire Services Department (FSD).  FSD is committed to providing prompt and effective emergency ambulance services for people in need.  To ensure timely medical treatment of patients and prudent use of public resources, ambulances convey emergency patients to the nearest A&E department/clinic under HA.  The A&E service currently provided by HA serves different districts across the territory.  The relevant hospitals are also able to provide the required supporting facilities and services.  Patients requiring urgent medical care are therefore mainly transferred to A&E departments/clinics in public hospitals for treatment.

     In addition, to prevent the abuse of public resources and the negative impact on the use of ambulances by other patients in emergency, a patient who requests for conveyance to a designated private hospital must produce a valid certificate endorsed by the private hospital or a private doctor.  The certificate, on one hand, is meant to prove that there is a need for the patient to be conveyed by ambulance for treatment at a designated hospital.  On the other hand, it is also required to confirm that the private hospital concerned will admit the patient.  The conditions of the patient must also be stable for possibly longer journey.   We note that the Security Bureau has liaised with the Hong Kong Medical Association and the Hong Kong Private Hospitals Association on the abovementioned arrangement.

(c) The existing A&E and emergency ambulance services provided by HA and FSD respectively can cope with the demand in general.  Currently, no private ambulance service or cross-boundary patient transfer service is provided in Hong Kong.  As exchanges between the Mainland and Hong Kong have become more frequent, the Government has been maintaining communication with the relevant Mainland authorities to explore how to facilitate referral of Hong Kong residents from the Mainland to Hong Kong for treatment.  HA has reached an agreement with the relevant authorities of Shenzhen to implement the transfer of patient records of Hong Kong residents on a pilot basis starting from the first quarter of 2011.  Designated hospitals in Shenzhen and Hong Kong will work in co-ordination under the arrangement.  When a Hong Kong resident who has received treatment in a designated hospital in Shenzhen is transferred to Hong Kong for treatment, the hospital can pass the patient's clinical record to the designated hospital in Hong Kong to facilitate direct liaison between the hospitals in the two places after the patient has been transferred back to Hong Kong.  The arrangement is only applicable to patients who participate on a voluntary basis and are in stable condition.

     As regards the provision of cross-boundary ambulance service and non-emergency patient transfer service, it involves the key issue of patient safety and also other complicated issues relating to regulation, such as qualifications and training of the healthcare personnel providing the services, vehicle specifications of the ambulance and road safety, regulation of equipment for emergency services and service quality, etc.  The Government will continue to closely monitor the demand for cross-boundary patient transfer service and explore in detail any feasible model and arrangements for the provision of such service.

Ends/Wednesday, May 4, 2011
Issued at HKT 16:15