Overworked and understaffed: Can pressure on Hong Kong public hospitals be relieved?

Long-standing issues of understaffing at public hospitals

Hong Kong’s public hospitals have long been facing chronic shortages of nurses and hospitals over the last several years. Figures from 2016 show that despite only employing about 40% of doctors in Hong Kong, the public healthcare system provides nearly 90% of in-patient services (by bed-days).

Despite having increased the number of registered doctors by 17% between 2008 and 2017, the doctors-to-population ratio only edged up from 1.8 to 1.9 doctors per 1,000 population, with the Hospital Authority reporting an annual shortfall of 300 doctors in the public healthcare system between 2013-2014 and 2017-2018. The shortfall has been exacerbated by growing attrition rates for full-time doctors in the public system, growing from 3.7% in 2013 to 5.9% in 2017.

The number of registered nurses growing by 45% during the same 2008-2017 period did have an impact on the nurse-to-population ratio, from 5.4 to 7.3 nurses per 1,000 population. However, the percentage of nurses working for the Hospital Authority, declined from 50% to 46%, leaving public hospitals short of 400 nurses during the 2017-2018 period.

These issues, compounded by a growing and ageing population, have led to consistent rises in waiting times at public hospitals, with the overall average waiting times for semi-urgent patients going from 1 hour and 16 minutes in 2011-2012, to 1 hour 54 minutes in 2017-2018. Average waiting time for non-urgent patients also rose from 1 hour and 43 minutes in 2011-2012, to 2 hours and 7 minutes in 2017-2018.

Rising discontent among public healthcare staff

A heavy flu season in January 2019 caused a surge in admissions at public hospitals, pushing the overall admission rate over 100%, with some hospitals reaching well over 120%, leading to reports of extra hospital beds being put in corners and hallways to provide extra capacity. The explosion in workload led to a protest by off-duty nurses as well as a forum by doctors, both of which called for additional staffing.

Aside from the understaffing and complaints about poor compensation, one of frontline medical staff’s major complaints is the amount of red tape involved. On March 12th, 17 representatives from the Frontline Doctors’ Union and the Public Doctors’ Association met with Chief Executive Carrie Lam to voice their concerns and demands which included a cap on working hours and a simplification of the Hospital Authority’s management structure to cut down on administrative bureaucracy.

Indeed, the South China Morning Post has reported that many academics familiar with the public healthcare system, including the head of Hong Kong University’s medical school and Polytechnic University’s former associate dean of health and social services, have criticised the amount of paperwork and the fact that doctors are increasingly pushed to take up administrative work instead of practicing medicine.

Hospital Authority puts forth plans to address problems in the public healthcare system

In efforts to address these growing problems the Hospital Authority (HA) has put forth plans to hire 520 doctors and 2,270 nurses in 2019-2020 in their paper to the Legislative Council’s health services panel. However, even the Authority recognises that this “literally include[s] almost all supply of doctors and nurses in Hong Kong and available to HA”, covering both fresh graduates and existing registered doctors and nurses willing to work for the HA.

While the Authority’s budget has been expanded by 8.5% to HK$ 69.9 billion (US$ 8.9 billion) which should help it meet these hiring goals, it remains to be seen whether or not they will successfully tackle the issue of excessive administrative red tape, paperwork and meetings that seem to be the major sticking point for nurses’ and doctors’ groups alike.

Even health services panel members have pointed out that if they cannot tackle the issues of workloads and working environments, then the public healthcare system will continue to face troubles retaining medical staff.

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