Greater urgency needed to reform health system

PUBLISHED : Monday, 28 March, 2011, 12:00am
UPDATED : Monday, 28 March, 2011, 12:00am

Health secretary Dr York Chow Yat-ngok has offended public doctors by calling them petty-minded for wanting standard working hours, and then rubbed it in with a qualified apology if he hurt their feelings. Chow says patients often need round-the-clock care and many 'professional' doctors would not care what time they went off duty. That may be in the best traditions of the profession, but the latest spat in a long-running dispute leaves the public none the wiser about what really matters - whether doctors are being expected to work for too long for their own good and that of their patients.

There is no question that there is a real issue - otherwise the government would not have come up with a HK$172 million package earlier this month to tackle a record high medical staff turnover in public hospitals, following a rare threat by doctors to resort to industrial action.

The Frontline Doctors Union and the Public Doctors Association welcomed some of the measures, but rejected those to address overwork and promotion prospects as short-term fixes lacking in vision. Now they have formed an action group on working hours to take their campaign directly to the public by putting up posters in the city's 40-odd hospitals and in the streets, and have not ruled out further action such as sit-in protests.

The problem stems from 10 to 20 per cent staff shortfalls in some hospital areas because of high turnover. Factors such as pay, conditions and promotion prospects are employer-employee issues. But claims that as a result of high turnover some doctors work up to 100 hours a week and 24 hours in one shift, go to the heart of quality of care and patient safety - a public interest issue.

As Chow implied with his little dig about professionalism, which seemed to be targeted at younger doctors, long hours and dedication to patient care come with the territory of public hospital doctors. Indeed, some older doctors may have limited sympathy for the new generation. The question is where to draw the line in the interests of both doctor and patient. If doctors make personal sacrifices occasionally for the sake of patients, that is not a bad thing. If the government and the Hospital Authority are relying increasingly on that sense of duty to contain costs, that is not a good thing.

The government, understandably, is concerned to extract the best value for money from one of its biggest budget items, as an ageing population makes increasing demands on the health system. The long-term solution lies in a greater sense of urgency about introducing health reforms that shift more of the burden for primary care to the private sector, relieving pressure on the heavily subsidised public system and more costs onto people who can afford to pay more. Sooner, rather than later, that will call for leadership without waiting for elusive community consensus on the way forward.

Another issue is a plan by the authority to tackle the manpower shortage in the short term by recruiting plastic and heart, lung and chest surgeons from overseas, without requiring them to pass Hong Kong examinations. At first it would target overseas-trained, Cantonese speakers who have not practised in Hong Kong. Sceptical doctors' unions are naturally concerned about the potential for overseas recruits for weakening their bargaining power with the government, but that is less of a concern for the hospital-going public than the quality of their credentials and qualifications. We need to ensure the recruitment process is transparent in order to safeguard standards.