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Following is a question by the Dr Hon Elizabeth Quat and a written reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (May 22):
Question:
A survey conducted by a political party has found that the waiting time for consultation in the Accident and Emergency (A&E) Department of the Prince of Wales Hospital (PWH) in the New Territories East (NTE) Cluster is much longer than the average waiting time in the A&E Departments of other public hospitals (101 minutes) and it is the longest in Hong Kong. Over half of the respondents have indicated that there were occasions on which they had waited for over five hours for consultation, while 20% of the respondents had the experience of waiting for up to eight to 12 hours. According to information of the Hospital Authority (HA), the average daily attendance of the A&E Department of PWH exceeds 410, and its attendance last year was 160 000, representing a year-on-year increase of 7.1% which was higher than the average rate of increase of 4.4% across HA. Meanwhile, the residents have been continuously complaining about the prolonged waiting time for consultation at various specialist outpatient clinics in PWH and the shortage of hospital beds. It has been reported that as the bed occupancy rate of the medical wards in PWH in January this year was as high as 130%, temporary beds accounting for 30% of the total number of beds had to be placed in the corridors. Faced with the ageing population in Shatin and the pressure of rapid population growth brought about by the completion of a number of new housing estates in Ma On Shan, the demand for PWH's healthcare services has far exceeded its capacity for a long period of time. As a result, members of the public are concerned that PWH's epidemic prevention and infection control capabilities have been hampered. On the other hand, the Sha Tin District Council endorsed the Phase Two expansion project for PWH (the expansion project) in 2006 and PWH finalised the proposal for the expansion project in June 2010. However, up to now, funds have not yet been allocated for the implementation of the project and there is no timetable for its completion. In this connection, will the Government inform this Council if it knows:
(a) the progress as well as the expected commencement and completion dates of the expansion project; if there is no timetable, of the reasons for that;
(b) whether the authorities have formulated any short, medium and long term measures to tackle the problem of prolonged waiting time for consultation for various specialties of PWH; if they have, of the details; if not, the reasons for that;
(c) the details of the expansion project; how the expansion project will strengthen the services provided by various specialties of PWH, especially those specialties with longer waiting time for consultation (e.g. mental health services for young people, medicine and A&E services), including by how long the waiting time for consultation for various specialties may be shortened;
(d) the respective bed-to-population ratios for the various specialties in each cluster at present, and the relevant ratios in the NTE Cluster upon completion of the expansion project; and
(e) given that the population of Shatin and Ma On Shan will continue to grow in the coming few years, whether the authorities have assessed if the NTE Cluster will, upon completion of the expansion project, meet the proposed standards in relation to healthcare services as set out in the Hong Kong Planning Standards and Guidelines, and the results of comparison of the NTE Cluster with other clusters regarding the relevant standards of services?
Reply:
President,
Apart from being the largest acute hospital serving the New Territories East (NTE), the Prince of Wales Hospital (PWH) is also the teaching hospital of the Faculty of Medicine of the Chinese University of Hong Kong, as well as a referral centre for various specialties in the territory, including adult and paediatric oncology, cardiothoracic surgery, paediatric surgery, neurosurgery and major trauma. In addition to the 1.3 million population in the NTE including Sha Tin, its service users also include cross-district patients.
In recent years, the NTE Cluster, which includes PWH, is facing an increasing demand on healthcare services from local elderly population (including the large number of residents in elderly homes within the district) and cross-boundary patients. The elders are mainly in need of medicine in-patient service whereas the cross-boundary patients mainly require trauma treatment and paediatric service. As for PWH, the hospitalisation rate of patients attending the Accident and Emergency (A&E) Department has been on the rise. The occupancy rate of acute medical beds saw an increase of over 6% in the past two years. The hospital has to open more wards and add beds to meet the demand.
My reply to various parts of the question is as follows:
(a) PWH was planned in the 1970s and opened in 1984. It is the largest hospital in the NTE Cluster, providing acute and tertiary healthcare services. It is also the teaching hospital of the Faculty of Medicine of the Chinese University of Hong Kong. In order to provide adequate space to meet the long-term health care needs of the district and health care training, the Government and the Hospital Authority (HA) carried out the Phase 1 Redevelopment of PWH in 2007. The fourteen-storey new building, the Main Clinical Block and Trauma Centre, provides in-patient services including intensive care unit and intensive care center, operating theatres and day services. The new building, with a total gross floor area of 71,500 square meters to provide a better hospital environment for patients, was opened in late 2010.
The original proposal for the phase two redevelopment project of PWH was to demolish Staff Blocks A, C and D and the lecture hall of the nursing school for the construction of a new block and provision of sufficient clinical space and facilities in compliance with the current design and standards. Provision of additional beds was not included in the original plan. In light of the relevant government departments' latest projection of population growth and expected changes in demographic structure in NTE, HA is reviewing the phase two redevelopment project, with considerations given to increasing the number of beds and expanding the inpatient services so as to meet the long-term medical service demand of the NTE Cluster, including Sha Tin. Upon completion of the review, HA will conduct a technical feasibility study on the new proposal and draw up an overall development plan for PWH. As the review is in progress and will take some time to complete, the estimated timetable for the commencement and completion of the phase two redevelopment project is not yet available for the time being.
(b) and (c) Although there has been a shortage of manpower in recent years, to cater for the increasing demand for medical services, PWH has implemented various measures to improve its A&E service, specialist outpatient (SOP) services and the waiting time for hospital beds, with a view to enhancing the overall service quality.
As for SOP services, the NTE Cluster will improve the management of SOP waiting lists in 2013/14. Additional consultation sessions for Ophthalmology will be conducted to manage a total of 4 000 new cases. Moreover, anti-vascular endothelial growth factor treatment will be provided to 60 new age-related macular degeneration cases and 500 new cases of diabetic related eye diseases, including sight threatening diabetic retinopathy.
Additional resources are allocated to the NTE Cluster for granting special honorarium to doctors who work overtime voluntarily to speed up the handling of routine cases in Surgery, Gynaecology and Psychiatry. New patients who are considered to be in suitable condition after assessment may be given an earlier appointment.
HA has implemented a new initiative since August 2012 to facilitate patients in certain specialties with stable condition to seek earlier SOP appointment through cross cluster arrangements. HA is now exploring a similar arrangement to transfer some gynaecological patients in NTE Cluster to Hong Kong East Cluster for consultation.
There is an established mechanism in PWH for referral of patients in SOP clinics who are in stable and simple medical condition to Family Medicine Training Centre or general out-patient clinics for follow-up treatment, so as to spare places in SOP clinics for handling new patients.
PWH has also been improving the environment of specialist clinics as well as the consultation procedures and comfort of patients. For instances, the new Eye Centre opened last year has an increase in area by 60% as compared with the old clinic, the expansion of the psychiatric clinic has also been completed.
As regards A&E service, PWH will continue to actively recruit doctors to fill the vacancies in the A&E Department. At present, staff have been deployed from other departments (such as the Department of Family Medicine) to the A&E Department, 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. As for nursing manpower, nine additional nurses were deployed to the A&E Department of PWH in April 2013 to relieve the work pressure of frontline staff. 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.
PWH plans to launch a mobile phone application this year, providing real time information on the number of semi-urgent and non-urgent patients waiting in the A&E Department as well as the waiting time needed. Information on local private doctors available for services will also be provided for reference of the public so that they can make their own choices on the suitable consultation channels.
To cater for the increasing demand for in-patient services, PWH will provide 30 day beds at the Medical Ambulatory Care Centre in 2013/14 to divert the non-emergency cases of acute wards and alleviate the access block at A&E. Besides, three High Dependency Unit (HDU) beds will be added, 1 500 psychiatric consultation liaison attendances will be provided at the A&E department for patients with probable mental health problems to facilitate timely assessment and early intervention and reduce unnecessary admissions.
In-patient wards of PWH have speeded up the workflow of discharge and transfer of patients to rehabilitation hospitals with a view to vacating beds and receiving in-patients as soon as possible. Beds will be added where necessary to receive patients from other specialties who are in stable condition. During the peak seasons of influenza, the community outreach nursing team will extend service to seven days a week, and strengthen visits to local residential care homes for the elderly so as to reduce the need for hospitalisation of their residents. Direct admission to Shatin Hospital (without going through the A&E Department) will be arranged for the elderly as necessary to alleviate the burden on the A&E Department.
To relieve the work pressure on the frontline staff, an additional 31 nursing graduates will be deployed to the Department of Medicine in August this year. PWH is drafting its work plan for 2014/15 to apply for funds for adding several dozens of medical beds and enhancing the ambulatory services so as to reduce the admission needs of patients.
In the long run, the phase two expansion project of PWH will be implemented to alleviate the shortage of acute beds in the district and shorten the waiting time for in-patient admission.
(d) The Annex sets out the number of general beds in HA per 1 000 population by hospital cluster in 2012-13 (excluding infirmary, mentally ill and mentally handicapped beds).
PWH is revising its phase two redevelopment plan to ensure that the services to be provided upon the completion of the phase two project could better tie in with the demand of the community.
(e) The Hong Kong Planning Standards and Guidelines provide a general indication of the sites reserved by the Government for medical and healthcare services such as public and private hospitals, infirmaries and elderly homes. HA will take into account a number of factors in planning for the provision of public healthcare services, so as to formulate service development guidelines which better tie in with the demand of the community. For instance, it will project the demand for medical and healthcare services by the public in the short, medium and long term having regard to demographic changes, population growth, the rate of patients seeking cross-district medical treatment, the growth rate of services of individual specialties and changes in healthcare services utilisation pattern.
Ends/Wednesday, May 22, 2013
Issued at HKT 18:32
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