New blood needed
The Hospital Authority was born in December 1990 and, in the last 21 years, we have changed Hong Kong's public hospital services from one that was criticised by many people to one that we are all proud of.
At a cost of less than 3per cent of Hong Kong's gross domestic product, we have a public health system that is the envy of many governments and health ministers around the world, and one that is appreciated by our patients and respected by the people of Hong Kong. We have indeed made very significant improvements in the last 21 years, but we must not be complacent. We must continue to improve ourselves.
No doubt I will be accused of being biased in making these statements. Of course I am. I am biased because I know how good a service we are providing to the people of Hong Kong with our limited resources; because I respect and appreciate the selfless contributions of our colleagues; and because our patient satisfaction survey conducted by the Chinese University of Hong Kong showed very encouraging results, with 80per cent of patients rating the care they had received as excellent, very good or good, while close to 90per cent of patients told us they have confidence and trust in our doctors and nurses.
When the Hospital Authority came into being, we had about 2,000 doctors and 16,000 nurses. Now we have over 5,000 doctors and 21,000 nurses. The government's funding has more than doubled over this period, to around HK$40billion this year.
Why then, you are going to ask, with the increase in the number of doctors and nurses and government funding, have you not been able to reduce some of the waiting time significantly? Why does the Hospital Authority still have a manpower shortage problem?
Why ... because we have 10 new hospitals and major extensions put into service in the last 21 years; because we have taken over the general out-patient services from the government since 2003; and, because we have an ageing population. Our population of those 65 years and above has jumped from about half a million in 1991 to almost a million today, and this figure will reach 1.2million in 2017. In Hong Kong, the number of elderly people seeking treatment in hospital is four times that of the non-elderly. The illnesses of elderly people are also more complex.
Let me give you some figures. In 2010, 1.3 beds were required for every 1,000 people under 65, whereas for those over 65, 11.8 beds were needed - nine times more. Last year, half our hospital bed-days were for the elderly.
Our throughput has increased substantially and we have introduced an array of new services over the years. Our inpatient care attendance, for example, has doubled from the figure in 1992/1993; our general outpatient attendances have gone up fivefold; and the number of major and ultra-major operations has gone up almost threefold.
Let's look at some of the services we have launched. Various forms of outreach health-care services have been introduced since the early 1990s. The volume of home visits by our community nurses has grown to 834,000 a year; visiting doctor attendances are now 115,000; and geriatric outreach attendances 620,000.
Most importantly, patients are receiving better services from us. Advances in medical technologies, which consume a lot of resources, improve the quality of care. Let me give you two examples.
First, robotic surgery for prostate cancer is a modern surgery that allows for more precision and smaller incisions, and leads to less blood loss during the operation, reducing blood transfusion. The average post-operation hospital stay is reduced from 18 days to seven. However, the total operation time is doubled, not counting the preparation time, and the consumable cost is 10 times that of the conventional method.
Now, let's take colorectal surgery as another example. Nowadays, the laparoscopic approach is adopted for over 60per cent of such operations in our hospitals. Compared to open surgery, this approach significantly reduces post-operative pain and surgical infection, speeds up recovery and shortens the hospital stay. But it costs three times more in consumables and takes up more of our colleagues' time. Last year, we performed 2,150 such surgeries, while the figure was only 430 in 2002. Simply put, patients are receiving much higher quality services, but that means more work for colleagues and more expenses for the authority.
All these 'whys' draw us to the crux of the challenges - the need for more health-care staff - doctors, nurses and allied health professionals. In serving a population of over 7million in Hong Kong, when around 90per cent of secondary and tertiary care are provided by the authority, we are facing a serious manpower shortage problem - for example, our total demand for doctors this year is over 500, against a supply of only 300 local doctors.
These challenges require our utmost attention. We are doing everything we can to retain our colleagues and we are trying our best in our recruitment efforts. We will continue to look for ways to improve the working conditions for our staff but, in the long run, we need to increase the supply of health-care professionals. At the same time, we must continue to explore ways to streamline our services and procedures and do our best to enhance quality and safety. We must also continue to explore and bring in more public-private partnerships and co-operation.
Anthony T.Y.Wu is chairman of the Hospital Authority. This is an edited version of his speech yesterday at the Hospital Authority Convention