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LCQ11: Nursing manpower in public hospitals
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     Following is a question by the Professor Hon Joseph Lee and a written reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (December 4):

Question:

     Some nurses have relayed to me that the Hospital Authority (HA) has all along not drawn up any targeted nurse-to-patient ratios for public hospitals, resulting in its failure to set reasonable nursing manpower establishments for public hospitals. A survey report published in August this year by the Association of Hong Kong Nursing Staff (AHKNS) shows that the current average nurse-to-patient ratios in public hospitals for the three shifts of morning, afternoon and night are 1:11, 1:12 and 1:24 respectively. Such ratios are a far cry from the statutory ratios (1:4 to 1:6) in foreign countries.  AHKNS has also pointed out that HA has all along told the public that it has gradually recruited more nursing staff, but in fact the shortage of nursing staff is serious. In this connection, will the Government inform this Council if it knows:

(a) whether HA has compiled statistics on the current nurse-to-patient ratios in various clinical departments of public hospitals in Hong Kong; if it has, of a breakdown of such figures by clinical department; if not, the reasons for that and whether HA will consider compiling such statistics;

(b) as HA is considering the feasibility of introducing the "Ward Workload Index" (WWI), i.e. calculating the required manpower ratios based on workload, whether HA has calculated the appropriate nurse-to-patient ratios for various clinical departments according to WWI; if it has, of such ratios, the shortfall in nursing staff and the reasons for the shortage, broken down by clinical department; if not, the reasons for that and whether it will consider making such calculation expeditiously; and

(c) the number of new medical service programmes launched by HA in the past three years, and set out the nursing staff required and whether there is any shortfall in nursing staff at present (if so, of the shortfall) in respect of each of these programmes?
 
Reply:

President,

     With an ageing population, advances in medical technology, and an increasing demand for healthcare services in the community, the manpower requirement for healthcare personnel grows commensurately. Over the past few years, the Hospital Authority (HA) was all along concerned about the problem of manpower supply, including the shortage of frontline nursing manpower in public hospitals. The HA has recruited additional nurses in the past three years and the overall manpower has increased from 19 866 to 21 816 (on full-time equivalent basis), representing a net growth of 1 950 in number and an increase of 10%. In 2013, the HA will recruit 2 100 nurses to make up for staff turnover and relieve the work pressure of frontline nurses.

     My reply to the various parts of the question is as follows:  

(a) The HA provides different types and levels of services to patients according to the condition and needs of each patient at different specialties. Hence, the HA does not use nurse-to-patient ratio for assessing healthcare manpower requirement. The HA has no plan to compile statistics on the nurse-to-patient ratios in various clinical departments of public hospitals in Hong Kong for the time being.

(b) In recent years, the HA is developing a ward workload assessment model for estimating nursing manpower requirement. In addition to the prevailing number of patients, the model also takes into account the dependency level of patients for nursing care.  

     There are four dependency categories under the model, deriving from patients' needs for direct nursing care. The higher the dependency, the more nursing time is required. The model also incorporates other workload factors, such as the working time for providing patient education, counselling and care planning as well as non-bedside nursing work such as coordination and liaison. Other factors like patient turnover (including admission, discharge and transfer of patients) which have impact on nursing workload are also taken into consideration.

     The ward workload assessment model is a dynamic tool used to calculate long-term healthcare manpower requirement according to the number of patients and the distribution of dependency categories. Since HA is still developing the ward workload index, figures of individual clinical departments are not yet available.

     The HA mainly considers additional requirements generated by projected service growth, and replacement requirements generated by staff turnover (including retirement) in projecting its nursing manpower requirement. The projection of service demand ranges from in-patient, day-patient to outpatient, ambulatory and community services as well as clinical supporting specialties services. The service demand projection uses the age-specific and specialty-specific service utilisation rates in a given year as the base, and takes into account anticipated changes resulting from various factors including population growth and ageing, and changes in healthcare services utilisation pattern. The HA estimated that there was a shortfall of about 850 nurses in 2012.

 (c) The targeted number of additional nurses to be recruited each year by the HA is set having regard to the turnover rate and the manpower required for providing new services. On the operational front, the HA will flexibly deploy nursing staff to provide existing and new medical services. Therefore, the HA has not maintained statistics on the vacancy of nursing staff in respect of each medical service programme.

     In general, the HA has strengthened the recruitment of nurses in recent years to relieve the nursing manpower pressure. The increase in the number of nurses is mainly for the provision of new medical services by the HA. The net increase in the number of nurses each year is listed in the following table:  

Year         Number of nurses    Net increase
          (full-time equivalent)
2009-10           19 866              --
2010-11           20 102              236
2011-12           20 901              799
2012-13           21 816              915
Total number of additional nurses 1 950
(Note: Including 700 additional nurses recruited through additional Government funding to the HA. )@

     As mentioned in the reply to part (b), HA estimated that there was a shortfall of about 850 nurses in 2012.

     The HA has implemented various measures, including strengthening recruitment, enhancing promotion prospects and supporting career development of enrolled nurses, with a view to relieving the manpower shortage of nurses. The HA will continue to monitor the manpower situation and make appropriate arrangements in manpower planning in order to cope with the service demand.

Ends/Wednesday, December 4, 2013
Issued at HKT 15:36

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