LCQ2: Supply of healthcare services in the New Territories East Cluster of the Hospital Authority

     Following is a question by the Hon Chan Hak-kan and a reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (June 29):


     Some residents of New Territories East have relayed to me the short supply of healthcare services in the New Territories East Cluster.  The projected number of general hospital beds per 1 000 persons in the cluster in 2021, calculated on the basis of geographical population of catchment districts, is 2.7, which is lower than the overall 3.1 beds of the Hospital Authority (HA).  In 2015-2016, the inpatient bed occupancy rates of North District Hospital and Alice Ho Miu Ling Nethersole Hospital (Nethersole Hospital) under the cluster were as high as 92 per cent and 84 per cent respectively.  The respective numbers of doctors in the Accident and Emergency (A&E) departments of the two hospitals only remained at 20 and 24 in the past three years, and such manpower was tighter than that of the A&E departments of the hospitals under other clusters.  In this connection, will the Government inform this Council:

(1) given that the obstetrics and gynaecology (O&G) department and the paediatrics and adolescent medicine department in North District Hospital currently provide only midwifery clinic service and outpatient service respectively but not inpatient service, and Nethersole Hospital does not provide O&G service at present, whether the authorities have assessed the existing situation of residents of the North and Tai Po Districts seeking medical consultation at hospitals in other districts in respect of the services not provided by these two hospitals; if they have, of the number of persons concerned;

(2) whether it knows if HA has considered expanding the staffing establishment of doctors in the A&E departments of North District Hospital and Nethersole Hospital; if HA has, of the details; if not, the reasons for that; and

(3) given that HA has included the expansion of North District Hospital into its 10-year hospital development plan, of the latest progress and implementation timetable of the expansion plan; whether it knows if HA has currently adopted any short, medium and long term measures to lower the inpatient bed occupancy rate in North District Hospital; if HA has, of the details; if HA has not, the reasons for that; whether the authorities will consider expanding Nethersole Hospital; if they will, of the details; if not, the reasons for that?



     My reply to the Hon Chan Hak-kan's question on the supply of healthcare services in the New Territories East Cluster (NTEC) of the Hospital Authority (HA) is as follows:

(1) HA plans its services on a cluster basis.  To ensure that resources can be used effectively, and the service volume of individual specialties in a hospital can help the healthcare personnel accumulate sufficient clinical experience so as to guarantee service quality, the types of services provided by hospitals in individual cluster vary and complement each other.  This arrangement serves to provide comprehensive and appropriate services for the residents in the cluster.

     As for NTEC, the three acute hospitals in the cluster, namely the Prince of Wales Hospital (PWH), North District Hospital (NDH) and Alice Ho Miu Ling Nethersole Hospital (AHNH), collaborate with other extended care hospitals in the cluster to provide comprehensive services for the residents of New Territories east.  

     As for obstetric services, the provision of obstetric inpatient and outpatient services of NTEC are concentrated at PWH.  HA's Expert Committee on Obstetrics and Gynaecology (O&G) Services has drawn up a planning reference to ensure that healthcare personnel can accumulate sufficient clinical experience to handle the possible complications of pregnant women.  In general, a public hospital will only provide obstetric inpatient service when the number of births reaches 3 000 per year.  The number of live births in public hospitals by pregnant women residing in North District and Tai Po District was around 1 900 and 1 700 respectively in 2015-16, and has not yet reached the above benchmark.  As such, NTEC does not have plan to provide obstetric inpatient service at NDH and AHNH at present.  

     However, we will review the demand for obstetrics inpatient service from time to time, and explore whether and how we can meet the increasing service demand through hospital redevelopment projects currently under planning, including the expansion of NDH.  Paediatrics service across clusters will also be adjusted and realigned with the Hong Kong Children's Hospital coming into operation in 2018.

     Annex 1 sets out the number of O&G and paediatrics patient days by residents in the New Territories east (including Sha Tin, Tai Po and North Districts) in 2015-16.  Annex 2 sets out the number of O&G and paediatrics specialist outpatient attendances (clinical) by these residents in the same year.  The data in the Annexes indicate that among the residents in Sha Tin, Tai Po and North Districts who received obstetrics and paediatrics services in public hospitals, over 84 per cent of the number of patient days and 82 per cent of the number of specialist outpatient attendances (clinical) were recorded in NTEC hospitals.  

(2) HA implements the triage system in all accident and emergency (A&E) departments of its hospitals, including NDH and AHNH, to ensure that priority and timely treatment are given to patients in need of emergency services.  

     As the population in the North District and Tai Po District continues to grow and age, the demand for A&E service in NDH and AHNH has been increasing in recent years.  In 2015-16, the number of A&E attendances in these two hospitals were around 108 200 and 137 500 respectively.  The average waiting time for A&E service for Category III (i.e. urgent) cases, for example, was 22 minutes in NDH and 12 minutes in AHNH, both of which were better than the HA overall average waiting time (i.e. 24 minutes).  

     There are currently 20 and 24 doctors working in the A&E departments of NDH and AHNH respectively.  HA estimates that as about 420 medical graduates will complete their internship in 2018-19, the problem of shortage of doctors will be relieved.  HA will increase the number of A&E doctors in NDH and AHNH as necessary.  

     In fact, HA has all along been allocating additional resources to various hospitals on a need basis in order to meet service demand and enhance service provision.  In 2013, NDH changed 20 beds in observation wards to A&E beds and recruited one additional A&E doctor.  In 2015, AHNH provided eight additional A&E beds and recruited one additional A&E doctor.  Moreover, both hospitals provide over-time allowances for doctors through the special honorarium scheme to increase manpower.  During the period of December 2015 to April 2016, A&E doctors in NDH and AHNH undertook over-time work for more than 970 hours and more than 320 hours respectively.

     The general outpatient clinics in North District and Tai Po District had also provided corresponding supporting services during the winter surge of influenza this year by increasing each of their weekly consultation quotas by 70 to serve the public.

(3) In light of the projected population growth and expected changes in demographic structure in New Territories east as well as the rising demand for services in the cluster, HA has completed the formulation of the Clinical Services Plan (CSP) for NTEC.  The CSP maps out the cluster's clinical strategies and future service directions for meeting the long-term healthcare needs of the community, including examining the roles and positioning of NDH and AHNH in the cluster, and the expansion projects and service scopes of the two hospitals etc.  HA will, having regard to the CSP, formulate and take forward the development projects for NDH and AHNH, and implement other appropriate measures to ensure that their services can meet public demand.

     To meet the future healthcare needs of the population of North District and to serve the keen service demand of the public, the Government has reserved a site of about 30 000 square metres adjacent to NDH for expansion of the hospital to provide additional beds and increase service capacity.  HA is formulating the overall planning strategy for the future development of NDH, and is working with the relevant departments to set a timetable for the implementation of the work projects.  According to the preliminary estimate, the expansion of NDH will be completed by 2026.

     Before the completion of the expansion project, NDH will also strengthen its services in all aspects.  These include the addition of 30 beds in the medical ward in August 2015 and the introduction of 24-hour dispensary service in March this year.  Moreover, the hospital is embarking on a plan to build additional wards, with a view to setting up two wards within next few years and providing around 80 additional beds to meet the service demand and shorten the waiting time. The outreaching team has increased its service capacity to conduct more visits to the residential care homes in the district with a view to reducing hospital admission of the residents and further relieving the burden of the A&E department and inpatient services.  

     Separately, we understand that the demand of Tai Po residents for healthcare services is keen.  In this connection, HA is committed to enhancing the service capacity of AHNH to enable patients to receive the necessary services more quickly.  HA will, in accordance with the recommendations of the CSP of NTEC and through its annual planning exercise, progressively enhance the A&E service capacity of AHNH, including the provision of emergency operation service, improve surgical service, and provide additional clinical supporting facilities and inpatient services.  To provide the necessary support to tie in with the launch of surgical service, AHNH has started providing magnetic resonance imaging service since April this year.  Moreover, improvement works for operating theatres are being conducted to upgrade the facilities for performing general anaesthesia operations in the future.  To shorten the waiting time for joint replacement, AHNH set up the fourth joint replacement centre in the territory in October last year to perform extra joint replacement operations.  As for surgical service, AHNH plans to strengthen its emergency surgical and anaesthesia services in the first quarter of 2017.  It will provide five more emergency operation sessions so as to get prepared for the launch of emergency surgical service by phases.

     Apart from implementing the projects under the 10-year hospital development plan, HA will also study and plan for projects for the next stage of hospital development, which include converting the existing parking space between AHNH and Tai Po Hospital for an expansion project to increase the number of beds and service capacity of the AHNH to meet future healthcare demand.

Ends/Wednesday, June 29, 2016
Issued at HKT 16:20