Source: Hong Kong Government special administrative region
Following is a question of the Hon Mrs Regina Ip and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (April 30):
Question:
It has been reported that according to the population projections, the catchment population in the Hong Kong East Cluster and the Hong Kong West Cluster will be reduced to around one million in future, and that the authorities plan to merge the two clusters (the cluster merger) and will review afresh the second ten-year Hospital Development Plan (HDP), including the plan to expand the Pamela Youde Nethersole Eastern Hospital (PYNEH) to provide 500 additional beds. In addition, the Secretary for Health indicated at the special meeting of the Panel on Health Services of this Council on February 21 this year that some specialty services would be adjusted after the cluster merger. In this connection, will the Government inform this Council:
(1) whether it knows the specific details of the cluster merger, including the arrangements for resource allocation and healthcare services of various hospitals after the merger, as well as the specialty services to be adjusted or merged;
(2) as it is learnt that after the cluster merger, chest pain treatment services will be centralised at the chest pain centre of Queen Mary Hospital (QMH), whereas the travelling time from Eastern District to QMH is long, and the roads are congested from time to time, how the authorities will ensure that after the merger, patients with acute heart diseases in Eastern District can be transferred in time to the chest pain centre of QMH for treatment within the “golden treatment time”;
(3) whether it knows if the emergency medical services (e.g. treatment of acute stroke, head trauma, etc.) and obstetric services of PYNEH will be cancelled after the cluster merger; if such services will be cancelled, how the authorities will ensure that emergency patients and pregnant women originally at PYNEH can receive timely and appropriate treatment or services;
(4) of the expected completion time for the review of the second ten-year HDP; whether it will consider commencing the expansion project of PYNEH upon the cessation of the operation of Chai Wan Laundry at the end of this year; if so, of the timetable of the project; if not, the reasons for that; and
(5) whether it will consult the staff of PYNEH and representatives of the residents in Eastern District on the detailed arrangements for the cluster merger; if so, of the details; if not, the reasons for that?
Reply:
President,
In consultation with the Hospital Authority (HA), the consolidated reply to the question raised by the Hon Mrs Regina Ip is as follows:
(1), (2) and (3) Clustering is an administrative arrangement for hospital management involving the delineation of medical facilities and clinical services according to their geographical locations to facilitate planning and service rationalisation. The HA plans to merge the Hong Kong East Cluster (HKEC) and Hong Kong West Cluster (HKWC) to achieve rationalisation of administration and management, streamlining of administrative procedures, sharing of resources for better cost-effectiveness and enhancement of operational and management efficiency. The plan also has the objectives of improving the overall quality of healthcare services, optimising treatment procedures, as well as enhancing the cost-effectiveness of the utilisation of resources through consolidating the governance structure and enhancing the complementary co-ordination of professional resources of the two clusters. After the merger, the existing acute and critical care hospitals, including the Pamela Youde Nethersole Eastern Hospital (PYNEH), the Ruttonjee Hospital, the Queen Mary Hospital (QMH), the Grantham Hospital and the St. John Hospital will continue to provide acute and critical care services, with general healthcare services and facilities being available to local residents within a reasonable geographical distance to ensure accessibility and convenience, in order that patients may receive a continuum of treatment under the same geographical setting.
During the planning of services of varying complexity, the HA has all along followed the principle of “localising where possible, centralising where necessary” in designing the system and service networks inside and outside the clusters. It is anticipated that after the merger of the clusters, the majority of the existing patients will be able to continue receiving services in hospitals in the vicinity, including those using the Accident and Emergency services, the general out-patient services and general specialty services with high volume and relatively lower complexity (including medicine, geriatric, general surgery, orthopaedics and traumatology, paediatrics and allied health services) on the Hong Kong Island. Besides, the clusters have non-acute hospitals which render rehabilitation and convalescent in-patient services, psychiatric in-patient services, as well as day surgery services. Following the consolidation, the existing facilities of each hospital will continue to perform their current key functions and uphold their expertise while complementing the strengths of the other hospitals within the cluster, thereby providing comprehensive healthcare services in a more effective manner.
There are some specialty services with a relatively lower demand whose operation involves personnel with specialised clinical techniques and qualifications, or require sophisticated equipment and advanced technology (such as the organ transplant services and the first chest pain centre established in accordance with national accreditation standards at QMH, and the hyperbaric oxygen treatment at PYNEH). For these services, centralisation of specialists, specialised equipment and complicated cases for handling at designated hospitals will be arranged, with due consideration given to the accessibility of the designated hospitals. The teams of medical experts can accumulate techniques and experiences through an extensive period in treating different complex cases of the same disease, facilitating their acquisition of the most up-to-date medical knowledge to bring about the best treatment outcomes for patients and hence enhancing the clinical quality indicators and minimising the risk of complications. Currently, the major hospitals on the Hong Kong Island have their respective expertise in specialty services. The professional medical teams of the merged cluster will be able to further focus on developing the strengths of their respective specialty services. In addition, by collaborating with various service provision points of the relevant specialty services within the cluster, healthcare services with even better quality will be provided to those of complex medical cases which constitutes only a small number of the patients.
It is anticipated that the service consolidation will achieve comprehensive enhancement of the set-up of medical teams, strengthen the co-ordination and flexibility of deployment of manpower and other resources of clinical and non-clinical departments, as well as minimise duplication of resources. As a result, the quality of clinical services provided in the cluster will be enhanced in the long run, facilitating the development of specialist services and providing more opportunities for staff training and their accumulation of experiences. To dovetail with the consolidation of cluster services, the HA will, in accordance with the prevailing mechanism, consider and deliberate the major direction(s), work plans and targets of the cluster, through the formulation of the annual plan, with a view to allocating additional resources to services which are newly introduced and with pressing needs.
Regarding the emergency healthcare services provided by PYNEH, such services would not cease after the merger of the clusters. The hospital will, as mentioned above, continue to provide services to the acute and critical care services after the consolidation of the clusters. Acute and critically ill patients residing in the Eastern District will therefore continue to receive timely and appropriate treatments at the PYNEH which is in the vicinity.
On cardiology services, apart from the chest pain centre established in accordance with national accreditation standards, the Department of Cardiothoracic Surgery (CTS) at QMH provides Coronary Artery Bypass Graft Surgery (CABG) and supports the treatment of severe complications related to acute coronary heart diseases. In collaboration with the Cardiology and Anesthesia departments, it forms a multidisciplinary heart team that manages complex cases and utilises advanced technology to deliver optimal treatment to patients. In addition, QMH and the Grantham Hospital also offer treatment for end-stage heart failure patients, including the implantation of ventricular assist devices and heart transplantation. The consolidation of HKEC and HKWC would further facilitate the development of the specialist strengths and provide patients with cardiology services of better quality.
(4) The Government announced under the 2018 Policy Address that it has invited the HA to commence planning for the Second Hospital Development Plan (HDP) to meet the expected service demand up to 2036. With the changes in the planning and development situation of Hong Kong, the Health Bureau (HHB) and the HA are currently reviewing the Second HDP. Amongst others, in view of the city-wide and regional planning and development strategies as announced by the Planning Department, including the “Hong Kong 2030+: Towards a Planning Vision and Strategy Transcending 2030” and the Northern Metropolis Development Strategy, as well as the corresponding population projections of Hong Kong including the latest changes in overall population, its distribution and demographics, and the population policy and talent attraction initiatives of the Government, the HHB and the HA have to adopt a planning horizon of up to 2040 and beyond for the Second HDP, and to project healthcare services demand and consider the supply and conditions of the land required, for optimising the Second HDP. The Government also considers factors such as the needs for and cost-effectiveness of renovation, refurbishment, redevelopment or addition of facilities for individual hospitals, and the convenience of public access to healthcare services under various major transport infrastructure development plans for determining the distribution, scale and priority, etc. of various hospital development projects (including the expansion of PYNEH and the use of the Chai Wan Laundry site after its relocation). Upon completion of the review, the Government will announce the details of the Second HDP in due course.
(5) The HA commenced the preparatory and engagement work for the consolidation of the hospital cluster services on Hong Kong Island early this year. Such work include seven staff forums and three workshop sessions which aim at briefing HA employees on the considerations of the cluster services consolidation and the future development of service provision, as well as listening to employees’ views. The consolidation of services is currently still at the stage of planning and deliberation. Regarding clinical services consolidation, the HA will set up task forces for particular specialties, initially to review existing services on the basis of facilitating the development of specialties and strengthening the existing service delivery models, while the next step will be to consider how to enhance the treatment procedures of patients as well as the efficiency and quality of the healthcare services. After the review, the HA will continue to communicate with stakeholders and service users on the overall direction of the development of the consolidation.