Manpower of community nurses and community psychiatric nurses

24/5/2017
Following is a question by the Professor Hon Joseph Lee and a written reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (May 24):

Question:

     Recently, quite a number of community nurses and community psychiatric nurses who are employed by the Hospital Authority (HA) have relayed to me that the ageing population of Hong Kong in recent years has led to a rising demand for outreach services, and both the number of cases they handle and the time taken to handle such cases have increased. Given the long-standing manpower shortage of these two types of nurses, it has become increasingly frequent for them to work overtime, thereby affecting both the quality of their services and staff morale. In this connection, will the Government inform this Council if it knows:

(1) the following information regarding each type of the aforesaid nurses in each of the past three years, set out by hospital cluster and service unit:
(i) the number of nurses,
(ii) the respective numbers of nurses leaving and joining the service,
(iii) the number of person-times using their services,
(iv) the average number of cases handled by each nurse,
(v) the average duration of time taken for each instance of outreach services, and
(vi) the average daily number of hours spent on the provision of outreach services by each nurse;

(2) the details of the outreach services;

(3) whether the aforesaid nurses generally need to work overtime to handle paperwork; if so, whether HA disburses overtime allowances to them; if HA does not, of the reasons for that; and

(4) whether HA, in response to the rising demand for outreach services, expanded the staffing establishment of the two types of nurses in the past three years; if so, of the details and the additional manpower that HA plans to provide in next three years; if not, the reasons for that?

Reply:

President,

     My reply to the questions concerning the manpower of community nurses and community psychiatric nurses of the Hospital Authority (HA) raised by the Professor Hon Joseph Lee is as follows:

(1) The tables below set out the numbers of community nurses (note 1) in HA and the number of home visits made by them in the past three years (from 2014-15 to 2016-17) by cluster:
 
Cluster Number of community nurses (note 1)
2014-15
(as at March 31, 2015)
2015-16
(as at March 31, 2016)
2016-17
(as at March 31, 2017)
[provisional figures]
Hong Kong East (HKE) 55 53 57
Hong Kong West (HKW) 28 28 29
Kowloon Central (KC) # 36 38 38
Kowloon East (KE) 96 95 95
Kowloon West (KW) # 143 145 145
New Territories East (NTE) 56 61 62
New Territories West (NTW) 54 56 56
Total 468 477 482

Note 1: The manpower figures of community nurses are calculated on a full-time equivalent basis, including permanent, contract and temporary staff in the HA. The numbers of community nurses leaving and joining the service in the respective year are also reflected in the above figures. Individual figures may not add up to the totals due to rounding. 
 
Cluster Number of home visits by community nurses
2014-15 2015-16 2016-17
[provisional figures]
HKE 107 715 104 068 99 343
HKW 58 172 55 097 56 685
KC# 68 767 75 537 80 927
KE 166 510 164 298 168 585
KW# 254 257 251 393 253 278
NTE 123 685 121 360 126 483
NTW 82 855 83 696 81 925
Total 861 961 855 449 867 226

     The number of cases handled by each community nurse varies, and the number and duration of visits of each case also differ. The influencing factors include, among others, the complexity of the cases, and the needs, risks and self-care abilities of the patients. Generally speaking, about eight to 10 home visits are conducted on average for each case, while the duration of each visit is 20 to 52 minutes. Each community nurse takes care of about 27 to 29 cases at any one time.

     As regards community psychiatric nurses, patients in need of community psychiatric services are currently followed up by the multi-disciplinary community psychiatric teams in various HA clusters. The teams, which comprise healthcare professionals such as psychiatric doctors, psychiatric nurses (including community psychiatric nurses), clinical psychologists, occupational therapists, medical social workers and peer support workers, etc, provide necessary community support services for patients with mental health needs residing in the community.

     The number of cases handled by a healthcare professional in community psychiatric services (including community psychiatric nurses) varies, depending on a number of factors such as patients' conditions and clinical needs as well as experience of the staff. The number and duration of visits also vary from case to case. On average, each takes care of about 40 to 60 patients at any one time on average.

     The table below sets out the numbers of community psychiatric nurses working in the psychiatric stream of each HA cluster in the past three years (from 2014-15 to 2016-17):
 
Cluster Number of community psychiatric nurses (note 2) (note 3)
2014-15
(as at March 31, 2015)
2015-16
(as at March 31, 2016)
2016-17
(as at March 31, 2017)
[provisional figures]
HKE 9 10 11
HKW 8 9 8
KC# 12 12 11
KE 16 16 16
KW# 21 21 23
NTE 21 17 21
NTW 43 45 48
Total 129 130 137

Note 2: The manpower figures above are calculated on a full-time equivalent basis, including permanent, contract and temporary staff in all HA clusters but excluding those in HA Head Office. The numbers of community psychiatric nurses leaving and joining the service in the respective year are also reflected in the above figures. Individual figures may not add up to the totals due to rounding.
Note 3: Psychiatric nurses include all nurses working in psychiatric hospitals (i.e. Kwai Chung Hospital, Castle Peak Hospital and Siu Lam Hospital), nurses working in psychiatric departments of non-psychiatric hospitals, as well as all other nurses in the psychiatric stream.

     The table below sets out the numbers of psychiatric outreach attendances of each HA cluster from 2014-15 to 2016-17:
 
Cluster 2014-15
 
2015-16
 
2016-17
[provisional figures]
HKE 23 896 22 587 23 118
HKW 19 381 19 414 19 756
KC# 19 743 19 296 19 166
KE 30 152 30 460 31 726
KW# 85 130 87 560 88 126
NTE 41 998 41 647 44 015
NTW 59 820 61 771 64 123
Total 280 120 282 735 290 030

# Wong Tai Sin District and Mong Kok area have been re-delineated from KW Cluster (KWC) to KC Cluster (KCC) since December 1, 2016. The service units in the communities concerned have therefore been re-delineated from the KWC to the KCC to support the new KCC catchment districts with effect from the same date. As a transitional arrangement, reports on services/manpower statistics and financial information continued to be made based on the previous clustering arrangement (i.e. the service units grouped under the KWC) until March 31, 2017. Reports have been made in accordance with the new clustering arrangement (i.e. the service units grouped under the KCC) since April 1, 2017.

(2) The primary goal of community nursing services is to provide nursing care for discharged patients in their own homes. The provision of continuous care for patients would facilitate them to recover in their home environment. Community nurses administer comprehensive and continuous nursing care to patients through home visits and at the same time, imbue patients and their carers with knowledge of health promotion and disease prevention.

     The healthcare professionals in community psychiatric services (including community psychiatric nurses) mainly provide necessary community support services, including, among others, mental health assessment, disease management training and crisis intervention, to patients with mental illness residing in the community to facilitate their re-integration into the community. They also offer support and advice to patients' carers and families as appropriate and promote mental health in the community.

(3) In general, the average working hours of outreach and in-house nurses are both 44 hours per week (including lunch break), which have covered the time for conducting home visits and performing other duties not related to patient care (e.g. time for travelling and handling paperwork). The provision of overtime compensation for community nurses and community psychiatric nurses is governed by the HA's existing policy and mechanism.

(4) The HA deploys nursing manpower flexibly among specialties according to service demands. In 2015-16 and 2016-17, the numbers of community nurses increased by 1.92% and 1.05% respectively, while those of community psychiatric nurses increased by 0.78% and 5.38% respectively. In planning for the provision of services, the HA takes into account a number of factors, including population growth and demographic changes, advancement in medical technology, manpower provision, organisation of services of clusters and hospitals, and service demands in each district. HA is currently conducting a comprehensive review on the planning of community psychiatric services, and will conduct reviews regularly to assess the workload of community nurses as well as service demands.

 

Last Updated 2017-5-25