Hong Kong’s nursing shortage remains a chronic problem

By Alfred Romann

During flu season, which typically begins in January, Hong Kong hospitals tend to be overcrowded and operating well beyond their capacity. It can be difficult to find one in which beds are not haphazardly placed in halls ways and corridors.

With flu outbreaks and now the spread of a superbug (known as carbapenemase-producing enterobacteriaceae or CPE) medical professionals in general and nurses in particular have their work cut out for them.

This is on top of the usual demands on a health care system in a city of 8 million that is aging and where trust in private hospitals is limited, according to a new survey.

It is up to nurses to find a place for anyone that needs one and, as a result, nurses are overworked and stretched too thin. Their calls for the government to act are growing.

Nurses, the lifeblood of any healthcare system, are overworked, underpaid and generally feel unappreciated. The government has a plan to hire another 2,500 over the next year but, at that rate, it will take several years for Hong Kong to meet OECD-recommended standards.

“In recent years, the shortage of medical and nursing manpower in the public healthcare system has been acute,” said legislator Dr. Helena Wong speaking during a session of the Legislative Council in February.

A projection done as part of the Report of Strategic Review on Healthcare Manpower Planning and Professional Development of 2017 noted that at the current rate of hiring, Hong Kong will be short 1,600 nurses by 2030 and 1,000 doctors.

The issues that medical staff in Hong Kong are hoping to address are myriad and range from the qualification of local and foreign staff, to concerns over red tape, disease outbreaks and immigration (currently, 150 people are allowed to move into Hong Kong every day and to meet OECD standards the Hospital Authority should be hiring nine new nurses every seven days just to keep up). Low pay is also an issue.

The problems have not gone unnoticed.

One key concern for patients and professional groups, such as the Association of Hong Kong Nursing Staff (AHKNS), is that the city’s overly bureaucratic approach to health care – with lots of paperwork and too many meetings not to mention licensing requirements that make it difficult to bring in more foreign professionals – is a key drag on the system.

As if keen to underline the point, in April the Medical Council voted down four options to open the door for more foreign doctors.  A study in 2017 found at least 300 more doctors were needed in Hong Kong but only 30 overseas professionals were allowed in. In May, the Medical Council moved to waive some internship requirements for professionals that are already working, but the measures were generally seen as too little to do much good and followed a month after the overly bureaucratic council rejected four other proposals. (See Harbour Times, 24 April 2019 – https://harbourtimes.com/tag/overseas-trained-doctors/)

Hong Kong has about 1.9 physicians for every 1,000 people, lower than just about all other developed economies. Singapore, for instance, has 2.3 doctors for every thousand people and Australia 3.6. (This number does not cover Chinese medicine doctors and there is little data on how the two system work together to meet outcomes.)

The city has 44 public hospitals and 12 private ones that are much more expensive for patients. Over the decade to 2016, the number of people covered by private insurance has risen by 78 percent to more than 2.4 million. But the Consumer Council found that 43 percent of them still relied on public hospitals.

This simple preference, coupled with Hong Kong’s aging demographics, occasional disease outbreaks, immigration from mainland China and growing medical needs are putting great strain on the system.

And most of this strain falls on nurses, the lifeblood of any health care system.

Experienced nurses may know more medicine than new interns. They are the first to spot problems with patients, administer tests and ongoing care. They look after the well-being of patients and generally ensure health outcomes are met. A patient at a hospital in Hong Kong might see a doctor a few minutes a day but will probably be in virtually constant contact with nurses in the ward.

For months now, the AHKNS has stepped up its calls for Hong Kong to increase hiring and implement an accreditation system for specialized nurses, saying it would be better than a voluntary registration scheme suggested by the government.

The AHKNS started its latest push to boost manpower in January, when about 100 members staged a protest outside the government offices. They called for a nurse-to-patient ratio to be set at 1 to 6, compared to the current 1 to 10 on average.

Secretary for Food and Health Sophia Chan met the protesters but stopped short of making any commitments. Chan did says that the nurses demands were reasonable and solutions should be implemented. She was booed. The nurses still remembered Chan’s comments that they should be “charitable” and simply deal with the workload and extra hours.

As the protest was happening outside the government offices, bed occupancy at Hong Kong hospitals was above 113 percent.

The shortages have been around for decades and were exacerbated in the year 2000 when the government shut down 20 nursing schools to cut down on government deficits. Universities did not significantly ramp up their nursing programs, so the number of new nurses that graduate every year fell by three quarters from about 2,500 to less than 600. The government reopened some nursing schools in 2008, five years after the outbreak of SARS that stretched the health care system to its limits and beyond.

The HA has a budget of HK$69.9 billion (US$8.9 billion) this year, up 8.5 percent from last year. The health care spend adds up to about 2.5 percent of Hong Kong’s total GDP of US$354 billion. Singapore spent almost 4.5 percent of its GDP on healthcare in 2016, mainland China almost 5 percent and Canada 10.5 percent, according to the World Bank, which does not have numbers for Hong Kong.

The HA employs a little more than 26,500 nurses. OECD standards call for nine qualified nurses for every thousand people. Hong Kong has seven. This means that the HA will need to hire another 10,000 nurses just to make up the shortfall.

In March, the HA said it would hire another 2,270 nurses and 520 doctors over the next year and to cut some of the red tape that is a heavy burden on working nurses and medical staff. The commitments were outlined in a paper prepared by the HA and the Food and Health Bureau.

These efforts by the government to boost spending should be welcome by nurses but are not likely to be enough.