LCQ9: Public healthcare services in Hong Kong East
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Question:
The Hospital Authority (HA) has earlier on announced its plan to merge the Hong Kong East Cluster (HKEC) and the Hong Kong West Cluster in anticipation of a decline in the demand for healthcare services due to a reduction in the catchment population in the two clusters to about one million in future. It has also indicated that it is necessary to re-examine the plan to expand the Ambulatory Care Block of the Pamela Youde Nethersole Eastern Hospital (PYNEH) under the Second Ten-year Hospital Development Plan. However, there are views that population is not the only indicator of service demand, and if the decline in population is accompanied by an increase in the proportion of the elderly population, this may lead to an increase in the demand for chronic disease treatment, long-term care and services of the accident and emergency departments, etc, and there are concerns about whether the suspension of the expansion project of PYNEH will adversely affect the local community. In this connection, will the Government inform this Council:
(1) in respect of the population projections for the Eastern District, whether the authorities have taken into account the population growth brought about by new housing projects and redevelopment projects in the district (e.g. the newly constructed Home Ownership Scheme court in North Point, namely, Kei Wah Court, and the redevelopment project of Yue Wan Estate); if so, of the projected increase in the population brought about by such projects, and the age distribution of the additional population; if not, the reasons for that;
(2) given that according to the projection of the Planning Department, the population aged 65 or above will account for 35 per cent of the total population of the Eastern District in 2031, and according to the data of the Census and Statistics Department, the median monthly household income of households in the Eastern District in 2023 will be $33,800 which will be lower than that of other districts on Hong Kong Island, whether the Government has assessed the demand for public healthcare services in respect of the current and future number and proportion of the elderly population, as well as the distribution of the grass-root population; if so, of the details, including the catchment population of HKEC (set out in the table below); if not, the reasons for that;
| The catchment population of HKEC in 2024 | The catchment population of HKEC in 2031 | ||
| Total population | Population aged 65 and above | Total population | Population aged 65 and above |
(3) whether it knows the following information on the services provided by PYNEH in the past three years: (i) the numbers of beds for ambulatory services and beds for inpatient services and (ii) their utilisation rates, (iii) the ratio of the use of these two types of beds by elderly people aged 65 and above to the total number of people using such beds, (iv) the average waiting time for patients to be admitted to wards and (v) the average inpatient days;
(4) given that HA has proposed in the Hospital Authority Strategic Plan 2022-2027 to re-orientate service models to reduce the reliance on inpatient care by promoting ambulatory care to cut down on unnecessary hospital stay and enhance the efficiency of bed usage, whether the Government knows if HA has assessed the impact of suspending the expansion project of the Ambulatory Care Block of PYNEH on the efficiency of bed usage and patients' waiting time for admission to wards, and of the relevant corresponding measures; and
(5) whether it has formulated a specific timetable for re-examining the expansion project of the Ambulatory Care Block of PYNEH?
Reply:
President,
Clustering is an administrative arrangement for hospital management involving the delineation of medical facilities and clinical services according to their geographical locations to facilitate planning and service rationalisation. The Hospital Authority (HA) plans to merge the Hong Kong East Cluster (HKEC) and Hong Kong West Cluster (HKWC) to achieve rationalisation of administration and management, streamlining of administrative procedures, sharing of resources for better cost-effectiveness and enhancement of operational and management efficiency. The plan also has the objectives of improving the overall quality of healthcare services, optimising treatment procedures, as well as enhancing the cost-effectiveness of the utilisation of resources through consolidating the governance structure and enhancing the complementary co-ordination of professional resources of the two existing clusters. After the merger, the existing acute and critical care hospitals, including the Pamela Youde Nethersole Eastern Hospital (PYNEH), the Ruttonjee Hospital, the Queen Mary Hospital (QMH), the Grantham Hospital and the St John Hospital will continue to provide acute and critical care services, with general healthcare services and facilities being available to local residents within a reasonable geographical distance to ensure accessibility and convenience, in order that patients may receive a continuum of treatment under the same geographical setting.
During the planning of services of varying complexity, the HA has all along followed the principle of "localising where possible, centralising where necessary" in designing the system and service networks inside and outside the clusters. It is anticipated that after the merger of the clusters, the majority of the existing patients will be able to continue receiving services in hospitals in the vicinity, including those using the Accident and Emergency (A&E) services, the general out-patient services and general specialty services with high volume and relatively lower complexity (including medicine, geriatric, general surgery, orthopaedics and traumatology, paediatrics and allied health services) on the Hong Kong Island. Besides, the clusters have non-acute hospitals which render rehabilitation and convalescent in-patient services, psychiatric in-patient services, as well as day surgery services. Following the consolidation, the existing facilities of each hospital will continue to perform their current key functions and uphold their expertise while complementing the strengths of other hospitals within the cluster, thereby providing comprehensive healthcare services in a more effective manner.
There are some specialty services with a relatively lower demand the operation of which involves personnel with specialised clinical techniques and qualifications, or require sophisticated equipment and advanced technology (such as the organ transplant services and the first chest pain centre established in accordance with national accreditation standards at QMH, and the hyperbaric oxygen treatment at PYNEH). For these services, centralisation of specialists, specialised equipment and complicated cases for handling at designated hospitals will be arranged, with due consideration given to the accessibility of the designated hospitals. The teams of medical experts can accumulate techniques and experiences through an extensive period in treating different complex cases of the same disease, facilitating their acquisition of the most up-to-date medical knowledge to bring about the best treatment outcomes for patients, and hence enhancing the clinical quality indicators and minimising the risk of complications. Currently, the major hospitals on the Hong Kong Island have their respective expertise in specialty services. The professional medical teams of the merged cluster will be able to further focus on developing the strengths of their respective specialty services. In addition, by collaborating with various service provision points of the relevant specialty services within the cluster, healthcare services with even better quality will be provided to those of complex medical cases which constitute only a small number of the patients.
It is anticipated that the service consolidation will achieve comprehensive enhancement of the set-up of medical teams of the clusters, strengthen the co-ordination and flexibility of deployment of manpower and other resources of clinical and non-clinical departments, as well as minimise duplication of resources. As a result, the quality of clinical services provided in the cluster will be enhanced in the long run, facilitating the development of specialist services and providing more opportunities for staff training and their accumulation of experiences. To dovetail with the consolidation of cluster services, the HA will, in accordance with the prevailing mechanism, consider and deliberate the major direction(s), work plans and targets of the cluster, through the formulation of the annual plan, with a view to allocating additional resources to services which are newly introduced and with pressing needs.
The HA commenced the preparatory and engagement work for the consolidation of the hospital cluster services on Hong Kong Island early this year. Such work includes seven staff forums and three workshop sessions which aim at briefing HA employees on the considerations of the cluster services consolidation and the future development of service provision, as well as listening to staff's views. The consolidation of services is currently still at the stage of planning and deliberation. Regarding clinical services consolidation, the HA will set up task forces for particular specialties, initially to review existing services on the basis of facilitating the development of specialties and strengthening the existing service delivery models, while the next step will be to consider how to enhance the treatment procedures of patients as well as the efficiency and quality of the healthcare services. After the review, the HA will continue to communicate with stakeholders and service users on the overall direction of the development of the consolidation.
In consultation with the HA and the Planning Department, the consolidated reply to the various parts of the question raised by the Hon Stanley Ng is as follows:
(1) and (2) The HA plans and develops public healthcare services on a hospital cluster basis. For planning of various future public healthcare services on the Hong Kong Island, the HA mainly makes reference to the information prepared by the relevant government departments, including the planning and development of the Hong Kong Island and the relevant population projection figures. The forecast housing supply data, from which the population projection figures derive, have already taken into account of all planning information of housing development proposals that were known. Meanwhile, the HA will project the service demand by taking into consideration a number of factors, including the rising prevalence of chronic diseases, technology advancement, manpower supply, arrangements of the cluster services delineation, roles and positioning of the hospitals as well as the number of hospital beds. The HA also monitors the utilisation of various healthcare services to rationalise its plans for future services provision.
According to the latest population projections, the catchment population in the HKEC and the HKWC will reduce to around one million in total in future. On the other hand, while the catchment area of the HKEC and the HKEC will register growth in elderly population (aged 65 or above) against the backdrop of Hong Kong's aging population, the elderly population and its projected growth rate will not exceed those of the catchment areas of other clusters. As mentioned above, apart from population projections, the HA will continue to take into account a number of factors to project the service needs of respective clusters. It is anticipated that the service consolidation of the HKEC and the HKWC will achieve comprehensive enhancement of the set-up of medical teams of the clusters, strengthen the co-ordination and flexibility of deployment of manpower and other resources of clinical and non-clinical departments, as well as minimise duplication of resources, thereby enhancing the quality of clinical services provided in the cluster in the long run and facilitating the development of specialist services. To dovetail with the consolidation of cluster services, the HA will also consider and deliberate the major direction(s), work plans and targets of the cluster through the formulation of the annual plan, and allocate additional resources to services which are newly introduced and with pressing needs.
The catchment area population of the HA clusters (including the HKEC) in 2024 and 2031 are set out in the table below (Note 1 and 2):
| Hospital clusters and the catchment area | Population in 2024 (as at mid-2024) | Projected population in 2031 (as at mid-2031) | ||
| Overall | Aged 65 or above | Overall | Aged 65 or above | |
| Hong Kong East Cluster Eastern, Wan Chai, Islands (excluding Lantau Island) |
710 400 | 182 700 | 642 400 | 211 500 |
| Hong Kong West Cluster Central & Western, Southern |
494 100 | 113 800 | 489 800 | 136 700 |
| Hong Kong Island Cluster after the merger (For reference) |
1 204 500 | 296 500 | 1 132 200 | 348 200 |
| Kowloon Central Cluster Kowloon City, Yau Tsim Mong, Wong Tai Sin |
1 135 500 | 263 400 | 1 123 800 | 325 600 |
| Kowloon East Cluster Kwun Tong, Sai Kung |
1 171 600 | 258 200 | 1 229 500 | 342 700 |
| Kowloon West Cluster Sham Shui Po, Kwai Tsing, Tsuen Wan, Lantau Island |
1 415 800 | 318 900 | 1 540 200 | 410 400 |
| New Territories East Cluster Sha Tin, Tai Po, North |
1 379 500 | 314 200 | 1 446 500 | 421 200 |
| New Territories West Cluster Tuen Mun, Yuen Long |
1 218 900 | 250 400 | 1 346 800 | 357 300 |
| Overall Hong Kong | 7 526 800 | 1 702 000 | 7 820 200 | 2 205 300 |
Note 1: The above population figures are based on the latest projections by the Planning Department as published in the Projections of Population Distribution 2023-2031. Cluster catchment areas of the HA are largely delineated based on District Council Districts, while the Islands District is further divided into (a) Lantau Island and (b) Islands (excluding Lantau Island).
Note 2: Individual figures may not add up to the total due to rounding and inclusion of marine population.
(3) The statistics related to the number of hospital beds and in-patient services at the PYNEH from 2022-23 to 2024-25 are set out below (Note 3):
(i) The number of beds and their usage at PYNEH
| Year | Number of hospital beds (Note 4) (General (acute and convalescent)) (as at March 31 of respective year) |
In-patient bed occupancy rate (Note 5) (General (acute and convalescent)) |
Number of patient days of in-patients and number of discharges and deaths of day in-patients (General (acute and convalescent)) |
Percentage of patients aged 65 or above who had used the in-patient services (Note 6) | In-patient average length of stay (Note 5) (days) (General (acute and convalescent)) |
||
| Aged 0-64 | Aged 65 or above | Overall (including cases of unknown age) |
|||||
| 2022-23 | 1 503 | 86 per cent | 164 548 | 310 717 | 475 296 | 65 per cent | 6.0 |
| 2023-24 | 1 529 | 92 per cent | 178 855 | 335 491 | 514 347 | 65 per cent | 5.5 |
| 2024-25 | 1 529 | 86 per cent | 177 223 | 323 834 | 501 289 | 65 per cent | 5.2 |
(ii) Number of patients referred by the A&E for admission to the hospital wards of PYNEH and the average waiting time:
| Year | Number of patients | Average waiting time (minutes) |
| 2022-23 | 47 689 | 84 |
| 2023-24 | 55 242 | 74 |
| 2024-25 | 54 783 | 65 |
Note 3: The HA had adjusted its services to cope with the outbreak of COVID-19 in Hong Kong in early 2020. The above situation should be taken into consideration of when comparing the volume of services provided by the HA in the relevant years. As the COVID-19 epidemic situation in Hong Kong gradually subsided and various epidemic control measures were lifted in early 2023, the HA had been dovetailing with the Government's measures in resumption of normalcy and gradually resuming its public healthcare services.
Note 4: Bed information covers only the general beds in the HA. Infirmary, mentally-ill and mentally-handicapped beds are special in nature and the 400 mentally-ill beds at PYNEH are hence not included herein. As the public hospitals will deploy the hospital beds flexibly having regard to service needs, the number of beds for in-patients and day in-patients are combined in the compilation.
Note 5: Day in-patients refer to those who are admitted to hospitals for non-emergency treatment and discharged within the same day, while in-patients refer to those who are admitted to hospitals via the A&E departments or those who have stayed for more than one day. The number of day in-patients are not included in the calculation of the in-patient average length of stay and in-patient bed occupancy rate.
Note 6: Including the number patient days of in-patients and number of discharges and deaths (general (acute and convalescent)) of day in-patients.
(4) and (5) The Government announced under the 2018 Policy Address that it has invited the HA to commence planning for the Second Hospital Development Plan (HDP) to meet the expected service demand up to 2036. With the changes in the planning and development situation of Hong Kong, the Health Bureau (HHB) and the HA are currently reviewing the Second HDP. Amongst others, in view of the city-wide and regional planning and development strategies as announced by the Planning Department, including the "Hong Kong 2030+: Towards a Planning Vision and Strategy Transcending 2030" and the Northern Metropolis Development Strategy, as well as the corresponding population projections of Hong Kong including the latest changes in overall population, its distribution and demographics, and the population policy and talent attraction initiatives of the Government, the HHB and the HA have to adopt a planning horizon of up to 2040 and beyond for the Second HDP, and to project healthcare services demand and consider the supply and conditions of the land required, etc, for optimising the Second HDP. The Government will also consider factors such as the needs for and cost-effectiveness of renovation, refurbishment, redevelopment or addition of facilities for individual hospitals, and the convenience of public access to healthcare services under various major transport infrastructure development plans for determining the distribution, scale and priority, etc, of various hospital development projects (including the expansion of PYNEH and the use of the Chai Wan Laundry site after its relocation).
In projecting the healthcare services needs, the HA will also thoroughly consider the latest service delivery models, including review and plan the delineation of cluster services in a timely manner in accordance with changes in delivery models of healthcare services brought forth by the development of primary healthcare and the ambulatory care services. Such review will cover the roles and positioning of hospitals and the arrangements of the necessary facilities for the delivery of ambulatory care services, with a view to providing appropriate service delivery models and facilities and enhancing the efficiency of the service provision of the clusters.
In carrying out the above reviews, the hospital development projects of the Hong Kong Island will also be reviewed in one go. Upon completion of the reviews, the Government will announce the details in due course.
Ends/Wednesday, May 7, 2025
Issued at HKT 17:51
Issued at HKT 17:51
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