LCQ14: Manpower of doctors and consultation efficiency
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Question:
According to the data of the Hospital Authority (HA), the number of full-time doctors increased from 5 695 in 2013-2014 to 7 350 in 2023-2024, representing an increase of 29 per cent. During the same period, the number of HA's specialist outpatient attendances increased by only 18.9 per cent while the relevant increase rate in the number of its general outpatient attendances was 3.34 per cent, and the number of accident and emergency (A&E) attendances even recorded a drop of 4.4 per cent. In this connection, will the Government inform this Council:
(1) whether it knows the respective numbers of HA doctors providing general outpatient clinic (GOPC) services and specialist outpatient clinic (SOPC) services in 2013-2014 and 2023-2024, as well as the respective percentages of such numbers in the total number of HA doctors (set out in a table);
(2) whether it knows the respective average waiting time for HA's SOPC new cases, GOPC services and A&E services, the average consultation time per patient, as well as the average number of consultations per doctor in 2013-2014 and 2023-2024 (set out in a table);
(3) whether it knows if the HA has compared the average number of consultations per doctor between the HA and medical institutions in other places; if the HA has not, how the HA assesses the efficiency in the use of doctor manpower and the consultation efficiency; and
(4) as there are views that the aforesaid data show a significant increase in the number of HA doctors from 2013-2014 to 2023-2024, but there is no significant rise in the number of attendances for various outpatient services, whether the Government knows if the HA has examined the reasons for that, and whether the HA will consider providing additional evening consultation services, so as to enhance the efficiency in the use of manpower and the service coverage while alleviating the pressure on the daytime services?
Reply:
President,
In consultation with the Hospital Authority (HA), the consolidated reply to the question raised by Dr the Hon Chan Han-pan, is as follows:
With the ageing population and the increasing prevalence of chronic diseases, the demand for various types of services provided by the HA has continued to rise over the past decade. While coping with the ever-rising service demand, the HA is also committed to enhancing the quality and efficiency of public healthcare services, while adopting an integrated and multi-disciplinary team approach in the delivery of various healthcare services, with a view to providing optimal treatment and care to patients.
Apart from providing general out-patient (GOP), specialist out-patient (SOP) and Accident and Emergency (A&E) services as mentioned in the question, doctors of the HA are also tasked with providing a comprehensive range of services including in-patient, out-patient, and day services, as part of the overall healthcare team. The table below sets out the number of hospital beds and the number of attendances for each of the major service categories of the HA in 2013-14 and 2023-24, which show an increase in the utilisation of each of the services over the 11-year period mentioned in the question. In particular, the HA has been gradually promoting ambulatory care and community-based care in recent years to replace the traditional hospital-centric service model, with a particularly significant rise in the demand for day in-patient services.
| 2013-14 | 2023-24 | Increase | |
| Number of hospital beds (as at year-end) |
27 440 | 30 671 | 11.8% |
| Number of in-patient discharges and deaths | 1 026 998 | 1 146 494 | 11.6% |
| Number of patient days | 7 479 088 | 8 750 456 | 17.0% |
| Number of day in-patient discharges and deaths | 542 333 | 809 505 | 49.3% |
| Number of day hospital attendances (Note 1) | 477 553 | 508 961 | 6.6% |
| Number of SOP (Clinical) attendances | 7 040 883 | 8 368 107 | 18.9% |
| Number of Family Medicine out-patient (including Family Medicine Specialist Clinic and GOP clinic) attendances | 6 100 888 | 6 359 781 | 4.2% |
As far as day in-patient services are concerned, day surgery brings significant benefits to patients, the public and the HA. For patients, day surgery has the benefits of causing less disruption to daily lives, reducing the risk of cross-infection and relieving psychological stress. In addition, day surgery is less costly and more efficient as it reduces the need for patients to stay in the hospital overnight, thereby releasing beds for more critical cases. Studies have also shown that the efficacy of day surgery is similar to that of in-patient surgery. For ambulatory palliative care services, the HA provides medical, nursing, rehabilitation, psychosocial and bereavement services through a one-stop multi-disciplinary team to alleviate patients' symptoms and improve their quality of life, as well as reducing unnecessary hospitalisation. Day rehabilitation services include geriatric day hospitals, day rehabilitation services and allied health rehabilitation services. The HA provides specialty-oriented rehabilitation programmes, such as thoracic rehabilitation, orthopaedic rehabilitation, geriatric rehabilitation and cardiac rehabilitation, in its ambulatory care facilities to cater for the needs of individual types of patients. This development strategy can effectively shorten unnecessary hospitalisation time, help patients return to the community and enhance their ability to take care of their own health.
Moreover, the HA has actively increased the number of endoscopic sessions to meet the public demand for endoscopic examination. The table below sets out the number of common endoscopic procedures performed in 2014-15 and 2023-24.
| 2014-15 | 2023-24 | |
| Common endoscopic procedures (Note 2 and 3) | 184 789 | 218 476 |
The HA will review and plan the role and positioning of its hospitals in each cluster to reflect the changes in healthcare needs brought about by changes in population in various districts over time, and will review from time to time and ensure that hospitals in the clusters can complement each other in the continual provision of A&E and in-patient, ambulatory care, extended care as well as community care services, so as to ensure that patients will continue to receive optimal treatment and services at appropriate locations.
Please refer to Annex 1 for the number of doctors in each major specialty providing GOP or SOP services and their respective proportions in the total number of doctors in the HA in 2013-14 and 2023-24 as mentioned in the question. However, as mentioned above, since the HA adopts an integrated and multi-disciplinary approach in service provision, and flexibly deploys its staff to meet service and operational needs from time to time, the number of doctors in the above table only reflects the number of doctors providing GOP and SOP services, and the doctors concerned may also be tasked with providing other services including in-patient, A&E and ambulatory services, etc.
The HA has also been implementing various measures over the years to enhance consultation efficiency and improve waiting time.
In respect of SOP services, the HA has implemented a triage system to determine the priority of patients attending SOP clinics (SOPCs) based on their clinical condition. In addition, the HA has also adopted the strategy of "narrowing upstream, collaborating downstream, diverting midstream". The HA has introduced doctor-led multi-disciplinary integrated clinics, and allocated more resources for new cases, rationalised referral arrangements for cross-specialty cases, set up more integrated clinics to provide multi-disciplinary support, and enhanced primary healthcare to follow up on patients in stable conditions. With the implementation of various measures, the waiting time for SOPCs has improved notably in the past few years. The data shows that the number of new SOP cases in 2023-24 has increased by 18 per cent compared to a decade ago, with the number of stable new cases (i.e. routine cases) increasing from 448 545 in 2013-14 to 577 191 in 2023-24, an increase of 28 per cent. Please refer to the Annex 2 for the number of new cases and waiting time for SOP services in 2013-14 and 2023-24.
In addition, the HA has also rationalised the waiting procedures for SOP services to reduce the waiting time for patients to see doctors, with more than 75 per cent of SOP patients completing the process from registration to doctor consultation within 60 minutes in 2022-23 to 2023-24. The table below shows the percentage of the HA SOP patients who have completed the process from registration to doctor consultation within 60 minutes in 2022-23 and 2023-24:
| Year 2022-23 (Since November 2022) |
Year 2023-24 |
| 76.5% | 83.6% |
Regarding A&E services, to ensure that citizens with urgent needs can receive timely services, A&E departments implement a patient triage system under which patients are classified into five triages, namely critical, emergency, urgent, semi-urgent and non-urgent based on their clinical condition, and will receive treatment as prioritised by their urgency category. The HA's performance targets specify that all critical patients (i.e. 100 per cent) will receive immediate treatment, and emergency and urgent patients will be prioritised for treatment upon arrival at A&E departments, with the targets being that most emergency patients (95 per cent) and urgent patients (90 per cent) will be treated within 15 and 30 minutes. The table below sets out the number of attendances and average waiting time for each triage category of A&E services in the HA in 2013-14 and 2023-24 respectively:
| No. of A&E attendances | |||||
| Triage 1(Critical) | Triage 2 (Emergency) | Triage 3 (Urgent) | Triage 4 (Semi- urgent) |
Triage 5 (Non- urgent) |
|
| Year 2013-14 |
19 358 | 41 136 | 674 841 | 1 288 359 | 145 406 |
| Year 2023-24 |
28 138 | 56 566 | 820 353 | 1 126 207 | 58 965 |
The above attendances for A&E services under various triage categories in various hospitals under the HA exclude (i) first-time visits without triage categories, and (ii) follow-up visits to the A&E departments.
| Average waiting time (in minutes) for A&E services | |||||
| Triage 1 (Critical) | Triage 2 (Emergency) | Triage 3 (Urgent) | Triage 4 (Semi- urgent) |
Triage 5 (Non- urgent) |
|
| Year 2013-14 |
0 | 7 | 27 | 106 | 124 |
| Year 2023-24 |
0 | 8 | 29 | 180 | 205 |
The data show that, over the past decade, the number of A&E attendances for patients in Triage 1 to Triage 3 has increased by 23 per cent from more than 730 000 to more than 900 000. In particular, attendances for patients in Triage 1 and Triage 2, who are the primary service targets of the A&E departments, have increased by 45 per cent and 38 per cent respectively. That said, patients in these two categories are treated promptly and the relevant average waiting times continue to meet the service targets specified by the HA.
Regarding GOP services, the HA provides public primary healthcare services through its 74 GOP clinics (GOPCs) (including community health centres), providing more than five million out-patient attendances annually. Of these, a total of 23 GOPCs in all districts of Hong Kong provide evening out-patient services until 10pm. Patients under the care of the GOPCs comprise two major categories: patients with chronic diseases in stable medical condition, such as patients with diabetes mellitus or hypertension; and episodic disease patients with relatively mild symptoms, such as those suffering from cold or gastroenteritis. As for patients with chronic diseases requiring follow-up consultations, they will be assigned a time slot for follow-up by the GOPCs after each consultation and do not need to make separate appointments by phone. Episodic disease patients can make appointments for the next 24 hours through the HA GOPC telephone appointment system and "Book GOPC" function in the HA's one-stop mobile app "HA Go". There is no waiting time for GOP services.
The HA has been closely monitoring the operation and utilisation of different services with a view to deploying manpower and service resources flexibly. Since 2008, the HA has adopted a set of Key Performance Indicators (KPIs) to measure its service performance, covering clinical services, human resources and finance, with a view to establishing a mechanism for monitoring service performance and identifying service areas for continuous improvement. The HA conducts regular reviews of the KPIs annually and will enhance and refine them in accordance with its service strategies. Progress reports on KPIs are submitted to the HA Board and the Health Bureau on a regular basis, through quarterly progress review reports for the latter, to keep track of the HA's performance in key service areas. Trend analyses within and across hospital clusters can be conducted to help identify areas for deliberation and formulation of enhancement measures, and to provide reference on service planning and resource allocation.
Moreover, the HA has set up the Governance and Structure Reform Committee to provide strategic guidance, oversight, and reform advice on implementing governance and structure reforms. The work of the Committee includes examining the introduction of KPIs to measure the service performance of the HA.
In recent years, the HA has also endeavoured to enhance public healthcare services through various measures, including enhancing primary healthcare services, shortening the waiting time for cataract surgery, making good use of the Central Government-Aided Emergency Hospital to alleviate the pressure on the radiology services in public hospitals, and establishing centres for major illnesses, with a view to improving the quality and efficiency of treatment. Regarding evening out-patient services, the HA and the Primary Healthcare Commission will also review the demand and supply of evening out-patient services in different districts as well as the utilisation of such services by members of the public in various districts, with emphasis on districts where private evening out-patient services are scanty, with a view to further increasing the number of quotas of evening out-patient services through flexible deployment of manpower and resources, as well as exploring the feasibility of setting up additional evening out-patient clinics.
Note 1: The above figure includes attendances at Geriatric Day Hospitals, Psychiatric Day Hospitals, Day Rehabilitation Services, and Ambulatory Palliative Care Services. Of these, the number of attendances at Geriatric Day Hospitals includes those participating in the Integrated Discharge Support Programme for Elderly Patients.
Note 2: The HA has maintained the relevant statistics since 2014-15.
Note 3: The above endoscopic procedures include bronchoscopy, colonoscopy, colposcopy, endoscopic retrograde cholangiopancreatography, flexible cystoscopy, oesophagogastroduodenoscopy, sigmoidoscopy and endoscopic ultrasonography. Of these, endoscopic ultrasonography covers upper gastrointestinal tract, lower gastrointestinal tract, as well as bronchus and mediastinum.
Ends/Wednesday, July 23, 2025
Issued at HKT 17:20
Issued at HKT 17:20
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