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
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
Public hospitals are, as usual,
heavily overloaded and in crisis.
Bed occupancy is, once again, in
Most of the wards are over 100%,
and some of them, such as pediatric and medical wards, are even over
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.
means the actual number of patients during day time should be much
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
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
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
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
The wards are indeed overcrowded with
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
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
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
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
Third, rectifying management red-tapes and administrative
by solidifying standard bed stat and
occupancy rate, simplifying overtime and overwork reimbursements,
reducing unnecessary clinical documentations, and
hospital accreditation & auditing activities.
Last, but not least, modernizing clinical equipment and appliances
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
Do take good care of yourself.