LCQ17: Manpower of healthcare professionals
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Question:
The Report of Strategic Review on Healthcare Manpower Planning and Professional Development released earlier by the Government has pointed out that the problem of manpower shortage of the healthcare professions in Hong Kong is aggravating. For example, it is projected that by 2030, there will be shortfalls of over 1 000 doctors and 1 600 nurses. There have been public comments that with the problem of population ageing in Hong Kong worsening, it is imperative for the authorities to expeditiously adopt effective measures to increase the manpower of the healthcare professions, so as to avoid a collapse of the healthcare system. In this connection, will the Government inform this Council:
(1) whether it knows the respective numbers of vacancies of doctors, nurses and various allied health professionals in various hospital clusters under) in each of the past five years;
(2) whether it knows (i) the measures adopted by HA to address the manpower shortages of various healthcare professions, (ii) the difficulties encountered by HA in implementing such measures, and (iii) if HA assessed the effectiveness of such measures, in the past five years; if HA made such an assessment, of the outcome;
(3) whether it knows the number of local medical graduates and, among them, the number employed by HA, in each of the past five years;
(4) whether it will consider substantially increasing the resources allocated to the local medical schools for boosting the number of undergraduate places in the medical discipline, so as to ensure that there will be an adequate number of doctors to cope with service demand; if so, of the details; if not, the reasons for that; and
(5) whether it will consider mapping out a long-term development strategy for primary healthcare services and alleviate the pressure on the healthcare system by reducing the number of patients at source through measures such as improving the triage system for patients in the public healthcare system and strengthening community care services; if so, of the details and timetable; if not, the reasons for that?
Reply:
President,
My reply to the five questions raised by the Hon Alice Mak is as follows:
(1) The Hospital Authority (HA) has been proactively conducting recruitment to fill the vacancies of healthcare professionals and increase manpower to meet service demand. The number of vacancies may vary because of service development, natural wastage and turnover and manpower supply.
The shortage of doctors, nurses and allied health staff in HA from 2012-13 to 2016-17 is set out in the table below:
| Year | 2012-13 | 2013-14 | 2014-15 | 2015-16 | 2016-17 |
| Doctor | 250 | 310 | 340 | 300 | 300 |
| Nurse | 800 | 600 | 500 | 780 | 600 |
| Allied health professionals | 220 | 160 | 200 | 60 | 0 |
HA deploys manpower flexibly among hospital clusters and departments from time to time having regard to service demand, and hence HA does not keep information on manpower shortage by hospital cluster and department.
(2) Taking into account the manpower shortage of healthcare professionals and the development needs of healthcare services, HA has implemented a series of measures to increase manpower.
As a general measure, HA has raised the retirement age of new recruits from 60 to 65 since June 1, 2015. In order to retain experienced healthcare professionals for the purposes of training and knowledge transfer, alleviating manpower pressure, and meeting service needs, HA implemented the Special Retired and Rehire Scheme (SRRS) in 2015-16 to rehire doctors, nurses, allied health professionals and supporting grades staff reaching their normal retirement age or leaving the service upon completion of contract in 2015-16 and 2016-17. As at end June 2017, HA had arranged to rehire 61 doctors, 46 nurses, eight allied health professionals and 884 supporting staff after their retirement in 2015-16 and 2016-17. Considering that there is an imminent demand for experienced healthcare professionals and supporting staff due to service development, HA continues to implement SRRS in 2017-18 and is conducting recruitment exercise to rehire suitable retirees to meet its service needs.
Regarding doctors, locally trained medical graduates are the most important source of doctors serving in the public sector. HA employs the vast majority of local medical graduates as Resident Trainees. In 2018-19, 420 medical graduates will complete internship training, an increase by 100 as compared with 320 in 2017-18. It is expected that the manpower shortage of doctors will then be alleviated.
Although HA has employed most of the local medical graduates and other qualified doctors, there was still a shortage of about 300 doctors as at end 2016. To address manpower shortage in the short term, HA has employed non-locally trained doctors with limited registration to practise in Hong Kong. In view of the restriction under the Medical Registration Ordinance, the Medical Council of Hong Kong (MCHK) can only approve limited registration for a period of up to one year. This would deter some non-locally trained doctors from practising in Hong Kong. At present, only 15 non-locally trained doctors with limited registration are employed as Service Residents by HA to work in the departments of anaesthesiology, emergency medicine, family medicine, internal medicine, obstetrics and gynaecology, paediatrics and radiology in public hospitals, to relieve the manpower pressure of the specialties concerned. In addition, two doctors with limited registration have been employed to work in cardiothoracic anaesthesia and pathology and clinical biochemistry departments since 1997 and 1998 respectively.
In order to retain talent, HA has made sustained efforts to improve the working conditions of doctors. Additional Associate Consultant posts have been created in all specialties besides those for normal replacement and planned new services to enhance promotion opportunities of specialists. Better remuneration packages are also provided. For example, pregnant doctors are exempted from overnight duties, arrangements for full-pay examination leave and examination fee reimbursement are improved, the fixed-rate honorarium is increased and the Special Honorarium Scheme is enhanced.
As for nurses, hospitals will continue to recruit full-time and part-time nurses to increase the flexibility in staff deployment, thereby easing the workload of frontline nurses. HA plans to recruit 2 130 nurses in 2017-18 to alleviate manpower shortage, maintain current services and roll out service improvement measures. HA will continue to implement measures for the retention of nursing staff and review the effectiveness of the above measures. It will also formulate more staff attraction and retention measures when necessary.
To retain nurses, HA has implemented measures to enhance career advancement opportunities for experienced nurses. A total of 106 additional Nurse Consultant posts have been created to promote the development of the nursing profession. During the past three years, about 1 400 nurses were promoted. In addition, the Institute of Advanced Nursing Studies of HA offers 26 nursing specialist training courses per year so that nurses can pursue further studies after graduation. Subsidies are also provided each year for over 100 experienced nurses to undergo further studies and training overseas.
Under the Preceptorship Programme, experienced nurses are recruited to provide guidance for newly recruited nurses in an actual clinical setting, thereby familiarising them with ward procedures and environment as well as alleviating the work pressure of other experienced nursing staff in coaching new nurses. HA also provides simulation training for newly recruited nurses to enhance their first aid and emergency handling skills.
Moreover, HA has installed 6 000 additional electrically-operated beds and over 500 ceiling hoist systems to facilitate the lifting and transfer of patients. This helps simplify the burdensome work process of ward staff and improve the work environment and facilities, thereby relieving the work pressure of frontline nurses. Additional ward clerks and ward assistants are recruited to assist in clerical work and patient care, with a view to easing the workload of nurses.
As for allied health professionals, measures taken by HA in the past few years include strengthening allied health teams, enhancing the training and development of allied health professionals, implementing an overseas degree course subsidy scheme for individual grades where local training places are insufficient to meet manpower needs (e.g. podiatrists), re-engineering work processes and recruiting additional patient care assistants.
HA will continue to monitor the manpower situation in public hospitals and make suitable arrangements for manpower planning and deployment to cope with service needs.
(3) In the past five years (from 2012 to 2016), the average number of doctors who possessed qualifications awarded by the two medical schools and newly granted full registration was about 280 each year. From 2011-12 to 2015-16, the average number of doctors with full registration who graduated from the two local medical schools and joined HA was about 258 each year. Detailed figures are set out at Annex.
(4) In view of an ageing population and the general shortage of healthcare manpower in the past years, the Government has substantially increased the number of University Grants Committee-funded places for doctors over the past 10 years from 250 in the 2005/06 academic year to 320 in the 2009/10 academic year and 420 in the 2012/13 academic year, and further to 470 in the 2016/17 academic year.
According to the Report of Strategic Review on Healthcare Manpower Planning and Professional Development, with ageing population and increasing demand for healthcare services, it is projected that there will be manpower shortage of doctors in the short to medium term. Local graduates are the predominant source of doctors serving in the public sector. The Government will, having regard to the supply of and demand for doctors, consider further increasing the medical training places.
(5) The Government has been committed to the promotion of primary care. The Primary Care Development in Hong Kong: Strategy Document published in 2010 sets out the major strategies and pathways of action that will help the Government deliver high quality primary care in Hong Kong. One of the major strategies is to support professional development and quality improvement. Reference frameworks for primary care are formulated for the care of diabetes mellitus and hypertension (the two most common chronic diseases), and the care for children and the elderly in primary care settings. These frameworks aim to provide suitable reference for healthcare professionals in primary care settings so as to facilitate the provision of continuous, comprehensive and evidence-based care in the community. The reference frameworks also intend to enhance self-management or care capability of patients and their carers and to raise public awareness of the importance of proper prevention and management of chronic diseases, thereby performing health promotion and disease prevention work among different population groups.
With regard to the triage system for patients, the Department of Health (DH) suggests that members of the public should choose an appropriate family doctor according to their needs so as to obtain comprehensive and continuous healthcare services and minimise the risk of unexpected doctor visits.
The sub-directories of doctors and dentists under the Primary Care Directory were launched in 2011 while that of Chinese medicine practitioners was launched in 2012. The Primary Care Directory is equipped with a search function which facilitates public search for the required information. Posters and leaflets on the Primary Care Directory are available at the waiting area of the Accident and Emergency (A&E) Departments in public hospitals under HA for public information. Access to the mobile website of the Primary Care Directory with QR code is available at the waiting area of some A&E departments to facilitate public search for family doctors and encourage patients not in urgent need of medical treatment and with mild conditions to turn to family doctors for medical consultation. DH will continue to promote the Primary Care Directory to the public on a regular basis through different channels including mass transit carriers, smartphones and Internet platforms to help them find appropriate family doctors.
On the enhancement of community care, HA provides a wide range of services in the community through general out-patient (GOP) clinics, community geriatric assessment teams (CGATs), Community Nursing Services, and the General Outpatient Clinic Public-Private Partnership Programme (GOPC PPP). As for GOP services, HA is committed to providing community-based primary care services. Patients under the care of GOP clinics can be broadly divided into two main categories, namely chronic disease patients with stable conditions (e.g. diabetes mellitus and hypertension), and episodic disease patients with relatively mild symptoms (e.g. influenza, colds and gastroenteritis). In line with the Government's policy to enhance primary care services, HA has implemented different measures, including the enhancement of primary care support to patients with chronic diseases (e.g. diabetes mellitus and hypertension). The projects launched, including the Risk Factor Assessment and Management Programme, Nurse and Allied Health Clinics, and Patient Empowerment Programme, aim at supporting patients to stay in the community and reduce unnecessary hospitalisation. Besides, the capacity of GOP clinics has been increased through various measures to cope with service demand and reduce the burden at hospital level. These measures will be continued if resources are available.
The CGATs provide comprehensive multi-disciplinary treatment and care services for frail residents in Residential Care Homes for the Elderly (RCHEs) through regular visits. The target patients are primarily frail residents with complex health problems, poor functional and mobility status. The services provided by the CGATs include medical consultation, nursing assessment and care, as well as community rehabilitation service by allied health professionals. Moreover, the CGATs provide carer training to enhance their capability in taking care of elderly patients living in RCHEs. Community Nursing Services mainly cover comprehensive and continuous home nursing care for discharged patients. Through home visits, community nurses administer appropriate nursing care to patients and at the same time, imbue patients and their carers with knowledge of health promotion and disease prevention to facilitate recovery of patients in their home environment.
Besides, under the GOPC PPP, which was launched in mid-2014 in Kwun Tong, Wong Tai Sin and Tuen Mun, patients of HA GOP clinics with specific chronic diseases and in stable clinical condition are given a choice to receive treatment provided by private doctors. The programme was subsequently rolled out in 13 more districts and will be further extended to cover all the 18 districts in 2018-19.
On the other hand, DH has endeavoured over the years to encourage, through a life-course and setting-based approach, people to live a healthy lifestyle, including promotion of a balanced and healthy diet with regular exercise, call for avoidance of smoking and alcohol, and support for breastfeeding, with a view to reducing the risk of contracting non-infectious disease, preventing diseases from their sources and reducing the number of patients.
Hong Kong is facing a challenge of continuously ageing population and changes in health risks, which have brought about increasing burden of non-communicable diseases (NCD). In 2008, DH launched a strategic framework, namely A Strategic Framework for Prevention and Control of Non-communicable Diseases, which set out the directions on the control and prevention of NCD. A high-level steering committee chaired by the Secretary for Food and Health was established to oversee the development and progress of implementation of the strategy. Three working groups were formed under the steering committee and three action plans on the relevant themes were published in 2010, 2011 and 2015 respectively to promote healthy diet and engagement in physical activities, reduce alcohol-related harm and strengthen the prevention of unintentional injuries. DH has also partnered with various sectors of the community to prevent and control NCD.
The Family Health Service of DH provides a comprehensive range of health promotion and disease prevention services for children from birth to five years old and women at or below 64 years of age. Child health services comprise immunisation, growth and developmental surveillance as well as health education for parents. Services for women include antenatal and postnatal care, family planning, cervical screening and women health services. DH promotes the "StartSmart@school.hk" Campaign among pre-school children while promoting the EatSmart@school.hk Campaign among nurseries, kindergartens, primary and secondary schools.
The Student Health Service introduced by DH aims to safeguard both the physical and psychological health of school children through health promotion and disease prevention services. Currently, there are 12 Student Health Service Centres and three Special Assessment Centres in the territory providing annual health assessment services appropriate to the age and development of enrolled primary and secondary students. These services include physical examination, screening for health problems related to vision, hearing and psychological health and behaviour, individual health counselling and health education. Students found to have health problems upon examination at Student Health Service Centres will be referred to the Special Assessment Centres or specialist clinics of HA for detailed assessment and follow-up. In the 2015/16 academic year, a total of 629 000 primary and secondary students enrolled in the Student Health Service. DH will continue to provide health promotion and disease prevention services for students.
DH has also launched the Joyful@Healthy Workplace Programme in workplaces, the EatSmart@restaurant.hk Campaign in restaurants, and the I'm So Smart Community Health Promotion Programme in the community.
In addition, DH implements cancer screening programmes which have been proven to be effective in achieving better prognosis through early detection and treatment. For examples, a territory-wide Cervical Screening Programme was launched in 2004 in collaboration with public and private healthcare providers. With the support of the Community Care Fund, a three-year pilot scheme will be launched in December 2017 to subsidise eligible low-income women to receive cervical cancer screening and preventive education. On top of the above, the Colorectal Cancer Screening Pilot Programme was launched in September 2016 to provide subsidised colorectal cancer screening tests for asymptomatic Hong Kong residents born in the years 1946 to 1955 in phases over a period of three years for the prevention of colorectal cancer.
Ends/Wednesday, July 12, 2017
Issued at HKT 18:00
Issued at HKT 18:00
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