How are you doing? A fairly warm weather with the chilly spell is
expected to last for few more days so remember to bundle up yourself
while going to work!
Since last December, Hong Kong has been overwhelmed by a strong outbreak
of seasonal influenza and the surge has been continued till now. To
prevent community outbreak, kindergartens and primary schools had to
take an early term break.
Bed occupancy of most public hospitals has been reaching
their new height to more than 120 percent.
The waiting time of most Accident and Emergency Departments
has been stretched to a breaking point of up to more than 8 hours.
It is therefore not surprising to see that both patients and nurses are
extremely disturbed and disappointed by the Hospital Authority’s
reactive approach in managing this year’s winter surge crisis.
Some nurses shared their current work situation with me in the past
weeks, saying that they were not able to finish their daily work
even if they skipped their meal time, or going to toilet. Some of
their wards were overloaded with 20 more patients than their
original capacity of 44, yet the manpower of nurses was never
increased. They also added that night shifts were even worse with
only 2 nurses taking care of over 50 patients. In addition, they
were requested to settle piles of unnecessary non-clinical
documentations which had stretched them further to their limit.
Obviously, the Hospital Authority has never learnt from experience.
Since flu outbreaks have already become a predictable
episodic health crisis, the Hospital Authority should be able to
instigate proactive and precautionary strategies to stop such
catastrophe from repeatedly challenging our public hospital systems.
However, the Hospital Authority, once again, could only deal with
the crisis in a passive and reactive manner, and in such a way to
further expose the administration’s ineffectiveness and inadequacy.
Looking back, in the last summer, an endemic of flu outbreak has also
flooded the public health system.
At that time, the Association of Hong Kong Nursing Staff
forwarded a series of recommendations to the Government requesting
the Government to earmark additional resources and contrive
exceptional measures to support the already overloaded frontline
nurses so as to resolve the crisis and help to address staffs’
recommendations include flexible allocation of internal resources,
speeding up the recruitment of part-time staff, streamlining of the
Special Honorarium Scheme, reducing unnecessary clinical
documentations, suspension of all the hospital accreditation
activities, expanding service capacity of the General Outpatient
Clinics, and triaging non-urgent patients to General Practitioners
in the community.
Disappointingly, apart from paying lip-service, the Hospital
Authority had adopted none of these suggestions to alleviate the
manpower pressure. This
inertia has put the operations of public hospitals on the verge of
In an attempt to help resolving such pressing situation in this winter
surge crisis, the Association of Hong Kong Nursing Staff, once
again, ran a full-page newspaper advertisement in late January
making an appeal to the public to support the Association’s campaign
on “Helpless, Yet Caring!”. Besides, a letter was also sent to the
Chief Executive, Mrs. Carrie Lam, appealing to her that our
frontline nurses were in distress and were very vulnerable with the
ever increasing number of beds but not staffing increase. The front
liners further pointed out that, under such circumstances, both
nurses and patients were being exploited from reasonable standard of
care. They urged the Government to allocate additional resources and
implement exceptional strategies to tackle the flu crisis. Over the
past few weeks, patients, the public and the LegCo members have
shown their overwhelming support to the campaign.
Prompted by the campaign, the Chief Executive, unexpectedly, announced a
special measure of earmarking a 500 million funding to the Hospital
Authority for instituting distinctive strategies to address the
pressing issue of nursing manpower shortage that is further
exacerbated by the deluge of flu surge, and, hopefully, in such a
way, could also boost the morale of frontline nurses.
The Association is, indeed, pleased with the positive
response from the Chief Executive. Nevertheless, it is hoped that
such additional resources should be allotted properly in order to
ease the heavy workload of frontline nurses.
To utilize the funding effectively, in our view, a number of short-term
“down-to-earth” measures should be implemented, which, include,
first, establishing and regularizing a staffing replacement pool to
alleviate manpower shortage due to staff day-off & additional beds;
second, revising the rate and flexibility of the Special Honorarium
Scheme to encourage staff participation; third, relaxing the
threshold of the Continuous Night Shift Scheme to elastic staff
deployment; last, but not least, enhancing clinical supervision to
ward staff during night shift by reducing the night supervision
With regard to the Hospital Accreditation Scheme, frontline nurses have
all along filed complaints to us saying that they have been
requested to handle piles of unnecessary clinical paperwork that are
Dragged by such burden, many of them are being pushed to the
breaking point amid direct patient care and laborious documentations
especially in the crisis of winter surge.
Obviously, quality patient care is the priority of all
Therefore, the Hospital Authority should focus its nursing manpower
on taking care of patients instead of dwelling onto the processes of
hospital accreditation activities should be suspended immediately.
In early February, the Association had a meeting with the Hospital
Authority to discuss the details on how the funding should be spent.
The above-mentioned recommended strategies had been tabled during
the meeting. Recently,
it is noted that the Hospital Authority, in respond to our request,
announced a couple of short-term measures that are mostly in line
with our proposal to relief the pressure of our frontline nurses.
Hopefully, when these strategies are being translated into actions,
the middle managers will execute the proposal prudently without
abusing their power.
Apart from that, I am wondering if you could still remember that the
Chief Executive has also pointed out that the Hospital Authority
have to abolish an unreasonable personnel policy which has been
adopted for the past 15 years.
That is, all new recruits are banned from the adjustment of a
pay point for their first two years of employment. It is indeed an
unfair personnel practice which is not only inconsistent with the
remuneration policy of the civil services but has also resulted in
the brain-drain of junior nurses. In fact, the Association has been
demanding the Hospital Authority to abolish this practice over the
last decade. During the
February meeting, the Association has again reiterated our request
to urge the Hospital Authority to not only rectify this unfair
situation, but also reimburse those affected colleagues with an
retrospective effect. In
this connection, the Hospital Authority showed a positive response,
and has agreed to review the related policy, work on the possible
financial implications and propose some specific arrangements
accordingly. The Association will continue our discussions with the
Hospital Authority to follow up this issue, and will take the lead
to seek financial support from the Government in the coming Budget.
In the long-run, to help easing the flu crisis, the Hospital Authority
has to concentrate its human resources in the provision and delivery
of healthcare services instead of overloading frontline staff with
excessive documentation and endless procedural activities that are
related to Hospital Accreditation exercise.
The nurse to patient ratio should be rectified in accordance
with the international standard of 1 to 6. Besides, establishing
Nurse-led Clinics in the General Out-patient Clinics can increase
its service capacity and, in turn, help triaging some of the
non-emergency attendees of the Accident and Emergency Departments.
Looking forward, the government should not only review the ineffective
organizational and bureaucratic structure of the Hospital Authority
but also have the determination to reposition the health policy of
Hong Kong, i.e. to shift from a treatment-focused model to a
health-centred model, and to balance the resources allocation
between primary, secondary & tertiary level care. To retain talents,
remuneration package, working conditions and training of nurses and
other allied health professional staff should be constantly reviewed
in order to ease the problem of manpower shortage.
Have a great year of the dog ahead !