Letter to Hong Kong



Dear Sophronia,

On the 6th day of the Year of the Pig, may I take this opportunity to wish you all the very best in pursuing your master’s degree.

Can you still recall the letter that I have sent to you about the seasonal influenza outbreak in Hong Kong last February.

Last November, I also wrote a column in one of the local newspapers urging the Government to ascertain the extra 500 million dollars which has been allocated to the Hospital Authority to help instigating proactive and precautionary strategies to prevent repeating the catastrophe of public hospitals as a result of winter surge.

Yet, apart from playing lip-service, the Government has remained passive and reserve over the past months.  Ironically, it is also noticed that the Hospital Authority had only spend half of that extra 500 million on measures which were related to assisting nurses to combat the challenge as a result of the flu surge.

Earlier this year, the chaos is back again.  Public hospitals are, as usual, heavily overloaded and in crisis.  Bed occupancy is, once again, in record-high.  Most of the wards are over 100%, and some of them, such as pediatric and medical wards, are even over 120%. 

However, sources from the frontline have reported that the official statistics have pretty much played down the real number of patients in the wards; simply because such reported occupancy rate has only made reference to the total number of patients at midnight.  That means the actual number of patients during day time should be much higher. 

Besides, it is also noted that, most of the time, the standard bed stat of wards, i.e. the original planned number of beds, has become very volatile as a result of the unpredictable number of extra beds. Thus, additional manpower to help shouldering up the actual workload has become mostly impossible.  Therefore, it is reported that one nurse has to take care of more than twelve patients.  Obviously, the workload and pressure of frontline nurses is much worse than you could image.

Disappointingly, taking advantage of nurses’ moral obligation to take care of their patients, and neglecting the fact that most of the nurses have, indeed, scarified their precious time spending with their children and family, or even taking care of their own parents; the Government and the Hospital Authority, instead of implementing solid and “down-to-earth” measures to relief the pressure, have only responded to the crisis with symbolic measures, such as releasing pampering statements and cheer up videos, or, even, passing around snacks and hand creams.

Obviously, these measures could neither assuage the discontent nor boost up morale of the front liners, but, on the contrary, only serve to expose the futile mentality of the administration, and, worse still, further widening the gap between the frontline and the management.

In an attempt to voice out their discontent and demand the Government to resolve the chaos of nursing manpower shortage, the Association of Hong Kong Nursing Staff took nurses onto the street and staged a protest to the Chief Executive of the HKSAR on 20th January 2019.

During the rally, many nurses shared their work situations, saying that they have to always skip meals and even toilets to take care of the influx of patients every day.  Some told us that each of them has to take care of up to 20 patients every shift which is far higher than the expected standard of 1 to 6.  Not to mention that, most of the time, 1 or 2 nurses have to take care of over 50 patients during night shifts.

The wards are indeed overcrowded with extra beds.  Patients’ basic needs, such as changing of diapers, or feeding with a cup of water, may have to wait for a few hours.

Though making every attempt to maintain the service quality and care standards, nurses are frustrated of being not able to optimize their professionalism and, even worse, they also anticipated that the risk of making mistakes are becoming higher and higher.

Obviously, the endless queue of extra beds without additional nursing manpower, has rendered both nurses and patients extremely disturbed and disappointed by the reactive approach of the administration in managing the winter surge crisis without learning from experience.

On behalf of the front liners, the Association of Hong Kong Nursing Staff has made an appeal the Chief Executive, Mrs Carrie Lam, urging her to rectify the core problematic issues that nurses in public hospitals are facing, namely, adding extra beds without additional nursing manpower, the fluidity of standard bed stat, unreasonable nurse to patient ratio, defective clinical supervision, uncompensated overtime, voluminous paper work, redundant administrative red-tapes, and dysfunctional clinical equipment & appliances.

To alleviate the situation and to boost the morale of nurses, the Association maintains that the Government should make every attempt to guard against patient care quality, and tender full support to sustain nursing care standard.  On that note, the Association has also advocated a series of “down-to-earth” recommendations to the Chief Executive, which included:-

First, maintaining sufficient nursing workforce to alleviate the shortage by introducing the Casual & Locum Appointment, enhancing the Special Honorarium Scheme and the Long-night Scheme, bench marking the nurse-to-patient ratio at a reasonable standard, and budgeting satisfactory resources to fill up nursing vacancies. 

Second, strengthening clinical supervision by retaining talent and acknowledging experience, i.e. raise the number of Advanced Practice Nurses and Nurse Consultants, set up clinical supervision ratio, and add an extra pay point to nurses with specialist training.

Third, rectifying management red-tapes and administrative bureaucracies by solidifying standard bed stat and occupancy rate, simplifying overtime and overwork reimbursements, reducing unnecessary clinical documentations, and  abandoning hospital accreditation & auditing activities.

Last, but not least, modernizing clinical equipment and appliances by allocating appropriate funding to source updated clinical care equipment and appliances to optimize the effectiveness of care delivery.

Prompted by the voices and noises of nurses, the Chief Executive, once again, before the Chinese New Year, earmarks another 500 million as addition to the Hospital Authority to help implementing measures to relieve the crisis of public hospitals.

Though it is delighted to see the timely response from the Chief Executive, frontline nurses, learning from their past experiences, do express concerns and hesitations on whether the “new money” could be eventually being effectively utilized by the Hospital Authority to deal with the crux of the matter.

It is because, in last July, the Association has conducted a survey to evaluate the effectiveness of the extra 500 million allocated to the Hospital Authority to resolve flu surge in 2018.

It is astonished to see that out of the 3,300 returned questionnaires, over 70% of the nurses considered that the Hospital Authority had not utilized the money effectively to relief their work pressure.  Regarding the effect of some specific strategies that had been implemented, over 80% indicated that there was no increase in clerical support in the wards, more than 65% reported that no enhancement of manpower, in any form, was apparent, and only 50% concurred that the red-tapes on reimbursement of overtime had been simplified.

With that, the Hospital Authority should learn from the past experience, and not to repeatedly engage in those ineffective administrative measures again. 

In order to effectively utilize this new money, it is therefore expected that the Hospital Authority has to consolidate a detailed action plan with clear road map and definite timeline on the ways to materialize appropriate strategies that are effective in helping to resolve the flu crisis in a “down-to-earth” manner.

Besides, the Food and Health Bureau should also shoulder up the responsibility of monitoring the implementation process, and, above all, evaluating the effectiveness of using the new money so as to report to the Chief Executive on time. 

In addition, the Association will continue to take up the role of being a check and balance agent in ensuring that the use of this extra funding is probably directed to resolve the work pressure of the frontline nurses.

Looking forward, the Government should have the determination to resolve the manpower shortage of healthcare professionals by retaining talents, revising remuneration package, improving working conditions and, most of all, training sufficient healthcare professionals.  Furthermore, she also has to have the courage to not only review the ineffective organizational and bureaucratic structure of the Hospital Authority again but also to drive a paradigmatic shift of the health policy from a treatment-focused model to a health-centred model, and to balance the resources allocation among primary, secondary & tertiary level care.

Do take good care of yourself.


Uncle Joe


更新日期: 2019-2-11