LCQ19: Healthcare manpower
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Question:
According to the information published by the Association of Hong Kong Nursing Staff in August 2013, the nurse-to-patient ratio of night-shifts in public hospitals in that year was 1:24, i.e. each nurse needed to take care of 24 patients on average, and such ratio was far worse than the ratio of international standard at 1:6. Some nurses of public hospitals have relayed that their workload has increased continuously in the past few years and their work pressure has therefore become greater. In addition, the Hospital Authority (HA) has all along been facing shortages of various types of healthcare staff. In this connection, will the Government inform this Council:
(1) whether it knows (i) the average doctor-to-patient ratio and (ii) the average nurse-to-patient ratio, in each public hospital for each of the morning, afternoon and night shifts in each of the past five years (set out in a table);
(2) whether it knows the respective average rates of pay increases for staff of various ranks in each healthcare grade in public and private hospitals in each of the past five years (set out in a table);
(3) whether it will consider drawing up a target nurse-to-patient ratio to ensure the quality of nursing care services, alleviate the work pressure on nurses and reduce nurse wastage;
(4) as the Chief Executive announced on January 30 this year that an additional one-off allocation of $500 million would be provided immediately to HA to alleviate the tremendous work pressure faced by frontline healthcare staff during the winter surge in service demand, whether the Government knows if HA will use the funding to implement new measures for retaining healthcare professionals; if HA will, of the details; and
(5) as some frontline healthcare staff members have pointed out that the use of the $500 million funding by HA to reduce nurses' clerical work in the wards is not conducive to solving the long-term manpower shortage problem, and coupled with the fact that the influenza summer surge is forthcoming, whether the Government will expeditiously and comprehensively review if the nursing manpower in public hospitals is sufficient to meet the ever increasing service demand, and formulate new short and medium term measures to solve the problem; if so, of the details; if not, the reasons for that?
Reply:
President,
My reply to the various parts of the question raised by Hon Jimmy Ng is as follows:
(1) The Hospital Authority (HA) adopts an integrated and multi-disciplinary approach in the delivery of various kinds of services to the public, including day in-patient, accident and emergency, specialist out-patient and primary healthcare services. The doctor-to-patient and nurse-to-patient ratios by cluster in the HA in the past five years are set out in the Annex. As the clinical duties of healthcare staff are determined flexibly having regard to the actual operational needs, a statistical breakdown of the requested information by AM, PM and night shifts is not available.
(2) The respective rates of pay increases for staff of the HA in the past five years are set out in the table below:
| Effective date | April 1, 2013 | April 1, 2014 |
October 1, 2014 |
April 1, 2015 |
April 1, 2016 |
April 1, 2017 |
|---|---|---|---|---|---|---|
| HA General Pay Scale point 45 or above or equivalent | 2.55% | 5.96% | 3% | 3.96% | 4.19% | 1.88% |
| Above HA General Pay Scale point 33 or equivalent | - | |||||
| HA General Pay Scale point 33 or below or equivalent | 3.92% | 4.71% | - | 4.62% | 4.68% | 2.94% |
Notes:
(a) Examples of the ranks at the HA General Pay Scale point 33 or below or equivalent are as follows:
Resident (at the HA General Pay Scale point 30 to 44B)/Enrolled Nurse/Registered Nurse/ Advanced Practice Nurse/Physiotherapist II/Physiotherapist I
(b) Examples of the ranks above the HA General Pay Scale point 33 or equivalent are as follows:
Resident (at HA General Pay Scale point 30 to 44B)/Associate Consultant/Consultant/ Department Operation Manager/Senior Physiotherapist
The Government does not have information on the salaries and respective rates of pay increases of healthcare professionals by ranks in private hospitals.
(3) The HA provides various types and levels of healthcare services to patients having regard to the conditions and needs of each patient. To meet the operational needs, the HA deploys nursing manpower flexibly and does not prescribe rigid nurse-to-patient ratios. The HA has also developed a workload assessment model to assess the nursing workload and staffing requirement according to factors such as the number of patients, patient dependency and nursing activities. The HA will make reference to the manpower requirement as assessed by this model when planning new services.
Given the increasing demand for healthcare services, the Government has substantially increased the number of University Grants Committee (UGC)-funded healthcare training places by about 60 per cent (from about 1 150 to about 1 800) over the past 10 years. The Government is discussing with UGC to further increase the publicly-funded training places for healthcare professionals (including nurses) in the 2019/2020 to 2021/2022 triennium.
Besides, the Government also encourages self-financing institutions to provide more training places for healthcare professionals under the Study Subsidy Scheme for Designated Professions/Sectors (SSSDP) to help meet part of the manpower demand. Under the SSSDP, the Government subsidises 860 students studying in qualified self-financing healthcare training programmes (including 765 places for nursing programmes) in the 2018/19 academic year.
(4) The Government had announced the allocation of an additional one-off provision of $500 million for the HA to meet the service needs during the winter surge. Apart from strengthening HA's response plan for the winter surge in 2017/18, the provision has also been used to implement a series of additional measures from February 12 to May 31, 2018 to alleviate the manpower shortage and work pressure of staff.
Insofar as the overall human resources policy is concerned, the HA has been implementing various manpower measures proactively to retain staff and alleviate the tight manpower situation of frontline nursing staff. Key measures are as follows:
(a) Continuous recruitment of full-time, part-time and agency nurses: Hospitals will continue to recruit full-time, part-time and agency nurses to enhance the flexibility in staff deployment, thereby easing the workload of frontline staff;
(b) Special Retired and Rehire Scheme (SRRS): The HA has implemented the SRRS since 2015/16 to rehire appropriate healthcare professionals after their retirement, so as to retain professionals to provide training, impart knowledge and alleviate the manpower shortage in the HA;
(c) Enhancement of promotion opportunities: In 2008/09, the HA created the post of Nurse Consultant to enhance the development prospects of the nursing profession, thereby improving the healthcare services of the HA. There are currently 113 Nurse Consultant posts. A total of 1 476 nurses were promoted in the past three years;
(d) Provision of more training opportunities: The Institute of Advanced Nursing Studies of the HA offers 26 nursing specialist training courses each year for nurses to continuously pursue further studies after graduation. The HA also provides subsidies for over 100 senior nurses to pursue further studies and training overseas each year;
(e) Enhancement of preceptorship support: Under the HA's preceptorship programme, experienced nurses are recruited through formats such as special allowance and part-time employment to serve as preceptors 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. The HA also provides simulation training for newly recruited nurses to enhance their first aid and emergency handling skills;
(f) Improvement of work environment: The HA has installed 6 000 additional electrically-operated beds and 523 ceiling hoist systems to facilitate the lifting and transfer of patients. This can help simplify the burdensome work processes of ward staff and improve the work environment and facilities, thereby relieving the work pressure of frontline nurses;
(g) Recruitment of additional ward clerks and ward assistants: The HA recruits additional ward clerks and ward assistants to assist nurses in carrying out clerical work and providing patient care, thereby easing the workload of nurses; and
(h) Reinstating the annual increment mechanism: To further boost staff morale and retain staff, the HA has reinstated the annual increment mechanism for all serving staff who joined the HA on or after June 15, 2002, as well as new recruits, with effect from April 1, 2018. This arrangement is expected to be applicable to about 17 000 eligible staff.
With the various enhancement measures to improve manpower supply, the number of nurses in the HA has been on the rise over the past few years. Calculated on a full-time equivalent basis, the number of nurses increased from 24 587 on March 31, 2016 to 26 103 on March 31, 2018. The HA plans to recruit about 2 230 nurses in 2018/19, and the number of nurses is expected to reach 26 560 by March 31, 2019.
(5) The HA is actively reviewing the nursing manpower and recruiting more healthcare staff, having regard to factors such as service needs and service development needs, staff wastage and market supply. The HA will continue to make appropriate arrangements for manpower planning and deployment, including implementing the staff retaining measures mentioned in part (4) of the reply, to cope with the service needs.
Ends/Wednesday, April 25, 2018
Issued at HKT 19:20
Issued at HKT 19:20
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