EMILY.TSANG@SCMP.COM
UPDATED : Saturday, 26 March, 2016, 10:54pm
Due to overcapacity, some patients need to stay in beds in corridors, such as this one at Queen Elizabeth Hospital in Jordan. Photo: Sam Tsang
Patients lying in hospital emergency wards waiting to be moved into a room. Temporary beds filling up the corridors and every available space. Nurses navigating congested accident and emergency units, bearing the brunt of anger from patients left waiting hours at times for treatment. Doctors so busy that consultations are limited to three minutes and a 30-hour shift is not uncommon.
This is not a portrait of an underfunded hospital in a developing economy, but instead is a typical scene this winter in Hong Kong, one of the world’s wealthiest cities, where public hospitals are being stretched to the limit during the peak demand period.
The root of the problem, according to experts, is Hong Kong’s overreliance on the publicly-funded sector when it comes to health care service. Public hospitals, heavily funded by the government, provide comprehensive and “near-free” service to local residents.
The sector is taking care of 90 per cent of the city’s patients, while employing only 40 per cent of the doctors; whereas the lucrative private sector is taking care of only 10 per cent of patients while employing 60 per cent of doctors.
Public hospitals, according to the Hospital Authority, operate even on normal days with a shortage of 700 nurses and 250 doctors. New recruits to the industry are routinely lost to the more lucrative and relaxed private sector.
Which means when there is unprecedented demand, as with this year marked by extreme cold spells and a particularly busy flu season, public hospitals and their staff can be stretched almost to breaking point.
The number of patients attending accident and emergency units this season has soared above 7,000, compared with about 5,000, on normal days. The authority was expecting another surge in patients this long weekend that began with the coldest Good Friday in 38 years.
Bed occupancy rates in medical wards have been as high as 130 per cent – meaning regular beds were at capacity and temporary beds were being laid out between them or in hospital corridors.
Dr Cheung Wai-lun, the authority’s director of cluster services, conceded there was always a capacity shortfall in the city’s public hospitals, especially in terms of manpower, and it was exacerbated this winter.
“The capacity of public hospitals has been struggling and pushed to the edge for a long time,” he said. “Even normal days, the buffering capacity is too low.”
“So when an unusually high demand season hits us, it is difficult to cope.”
Nurses are on the front lines in bearing the brunt of the overcrowding crisis. In a sign of how serious the issue has become, the city’s largest nurses’ group placed an open letter in local Chinese newspapers on March 16 calling for extra resources and manpower to help overstretched public hospitals during the flu season.
Some patients need to stay at the hallway outside the wards at Queen Elizabeth Hospital in Jordan, as overcrowding situation is severe. Photo: Sam Tsang
In a full-page letter addressed to Chief Executive Leung Chun-ying, the Association of Hong Kong Nursing Staff urged Leung to come up with a special arrangement to add resources and manpower to maintain service quality in the public health sector and ease frontline nurses’ workload.
“When the medical ward kept admitting patients and laid out more beds, all the burden went to the nurses at the ward,” said Dr Joseph Lee Kok-long, lawmaker for the health service sector.
“No matter how many patients there are, the nurses have to take care of them,” he added.
According to the association, the average ratio of nurses per public patients was 1 to 11 in public hospitals, but the ratio could go as high as 1 to 24 at night. The international standard is 1 to 6.
Lee said the ratio was likely to worsen during this year’s crisis, but there was no way to quantify the situation as many medical wards were adding extra beds.
For doctors, the workload means some of them work up to 80 hours per week rather than the usual 44 hours, with very little time between shifts or for meal breaks while on duty.
Hours for internal medicine specialists were particularly intense, and their workload was often far greater than official figures.
“The doctors have been used to [being] busy even on normal days as the manpower of public hospitals has always been very stretched,” said Pierre Chan Pui-yin, president of the Public Doctors’ Association.
The government has been attempting to remedy the situation.
Among measures to address the current staffing crisis in public hospitals, the government is increasing the number of medical graduates each year: from 250 to 320 last year, and to 420 in 2018.
Public hospitals have also recruited retired doctors to work on a contract basis and private doctors to work on a part-time basis.
But only 11 overseas specialists were currently hired by the authority, on a one- to three-year contract basis, to ease the burden.
A suggestion to relax the license examination for foreign practitioners has faced fierce opposition from the local doctors’ union, which said the move would affect the quality of their work and endanger public health.
Chan said he believed overseas labour was not a long-term solution to the overcrowding problem. He said the real issue was the inequitable resource allocation between the private and public sectors, and among different public hospitals.
He suggested efforts to ease the strain during the cold weather spell should focus on two or three of the most overburdened public hospitals.
While the labour shortage was not yet being felt by the private sector, the president of the Private Hospitals Association feared a fierce fight for talent could ensue.
“More new hospitals will be built in the next few years which means we could expect some of our manpower will be [lured] away,” said Dr Anthony Lee Kai-yui, chief hospital manager and medical director of the private Union Hospital.
He said the hospital in Sha Tin had already seen management staff being recruited by the new Gleneagles Hospital in Wong Chuk Hang, which was expected to begin operation next year.
“I believe it will start recruiting frontline staff soon and push the salaries [of medical professionals] higher,” Lee said. “It will make business more difficult.”
The government believed the imbalance of the burden between the public and private health care sector could also be addressed by encouraging a higher take-up rate of private health insurance.
Fewer than 40 per cent of local residents were covered by health insurance policies. Of them, many had complained that schemes did not cover expenses to treat many common diseases when they were sick, according to the Food and Health Bureau.
In the end, many such individuals had to resort to the public sector when they were unable to take out private insurance or suffered from serious illnesses that were costly to treat.
The Leung administration has offered a remedy to correct the imbalance: regulating the quality of health insurance policies.
In a proposal, it suggested imposing 12 minimum requirements on all health insurance policies, to be regulated by a government board. The revamp is meant to attract more middle-class and young people to stay away from public hospitals by taking up the voluntary insurance scheme.
It is understood the government is now going through details of the reform with the insurance industry, but a legislative proposal would only be submitted to Legco in the next government term, namely after next year.
But Lee of the private hospitals association urged reform be enacted “as soon as possible”.
“The government lacks determination,” he said.
http://m.scmp.com/news/hong-kong/health-environment/article/1931049/medical-professionals-argue-public-hospitals-are
