Letter to Hong Kong



Dear Sophronia,

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’ frustrations.  These 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 collapse.

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 ratio.

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 accreditation-related.  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 frontline nurses.  Therefore, the Hospital Authority should focus its nursing manpower on taking care of patients instead of dwelling onto the processes of accreditation.  All 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 !


Uncle Joe


更新日期: 2018-02-20