公營醫療瀕爆煲 絕望真相須正視

<轉載自2017年7月19日 明報 社評>

夏季流感高峰期來臨，公立醫院不勝負荷人仰馬翻，有醫生告急形容「公營醫療系統快要崩潰」，感到「很絕望和無奈」。醫管局提出多項短期應對措施，能否稍紓公立醫院困境，仍是未知之數。本港公營醫療系統瀕臨「爆煲」，軟硬件配套嚴重滯後，政府難辭其咎；醫生業界部分既得利益者出於保護主義心態，不願正視醫生不足問題，亦有份埋下今天的苦果。當局必須亡羊補牢，一邊協助公立醫院應付眼前危機，一邊謀劃未來，增建「龍頭」級大型醫院，引入更多合資格海外醫生，改善基層醫療服務。

廿年未建大型醫院 政府短線難辭其咎

過去數天，公立醫院內科病房紛紛迫爆，病牀使用率普遍超過110%，院方需臨時安放病牀在走廊，各大急症室亦大排長龍，不少前線醫護疲於奔命，工作壓力沉重，有人更萌生去意，士氣低落勢必影響服務質素，加劇人手流失，形成惡性循環，情况令人憂慮。醫管局聲稱，今年夏季流感高峰期情况異常，過去兩周有較多長者因流感併發症入院，內科病房入住人數逾千持續10多天，超出承受容量。不過值得留意的是，近年每逢流感高峰，公院急症室和內科「爆棚」已成為常態，這次流感潮令多間公院「淪陷」，只是再次暴露了公營醫療系統瀕臨「爆煲」的絕望真相。公營醫療系統聘用本港約六成醫護人員，卻要照顧近九成病人，面對人口老化壓力，處理牀位短缺和醫生不足的問題，已是刻不容緩。

近日行政長官林鄭月娥視察伊利沙伯醫院，希望醫管局提出短期紓緩措施，應付燃眉之急。醫管局為此拋出多項構思，包括邀請衛生署醫生公餘時間拔刀相助，處理門診及急症服務，以及尋求私家醫院支援，提供牀位。醫生業界對相關構思意見紛紜，有人認為構思可取，有助短期內紓緩急症室、門診和病房人滿之患，也有人擔心衛生署醫生本已工作繁忙，未必有太多人願意下班後給醫管局兼職賣力，至於向私院借牀的運作模式和是否可行，亦存在不少疑問，質疑措施杯水車薪。誠然，根據多間私院提供的數字，目前內科和兒科病牀使用率普遍達到八成，能夠借予醫管局的牀位有限，可是公營醫療系統無論是牀位還是醫生人手都嚴重短缺，任何權宜之計都應好好考慮。建立借牀和借人機制，對於增加公營醫療系統運作彈性，始終是一件好事。

過去政府對醫院欠缺長遠規劃，是目前本港公營醫療系統不勝負荷的一大原因。自從1990年代初東區醫院投入服務以來，香港再未有「龍頭」級大型醫院落成，回歸後病牀總數一直維持在3.1萬張左右，未見長進，完全無法滿足社會實際需要。政府坐擁龐大財政儲備，卻不知進取，直至上屆政府才開始急起直追，包括興建「超級醫院」啟德醫院，以及擴建威爾斯親王醫院和瑪麗醫院等，然而投入服務還需多等數年。隨着人口老化，新醫院和擴建項目是否足以應付與日俱增的醫療服務需求，也是一個疑問。政府必須汲取教訓，及早謀劃興建更多大型全科醫院，勿再低估市民需要。

前線醫護人手不足 業界須棄鴕鳥心態

當然，徒有醫院硬件並不足夠，還必須有足夠的醫生。今年初天水圍醫院正式啟用，惟因人手不足，急症室只能提供8小時有限服務，今年內能否實現24小時服務，仍難預料。雖然近年政府已增加醫科學額，但是早前政府發表醫護人力規劃研究報告，估計2030年全港公私營醫療系統醫生短缺將逾千人。單靠栽培新血和挽留退休醫生，恐怕不足以長遠紓緩人手壓力，引入更多合資格海外醫生，實乃大勢所趨，不少國家如新加坡、加拿大和澳洲等都向海外醫生招手，可是本港卻面對相當大的保護主義阻力。部分醫生業界代表抗拒外國畢業醫科生來港執業，負笈海外的港人子弟也未能倖免。有業界代表便揚言，政府的研究報告「誇大」了醫生人手短缺；就算今次公院「淪陷」，前線醫護叫苦連天，可是仍然有醫生業界代表認為公眾「不應將矛頭指向前線人手不足」，鴕鳥心態令人驚訝。

為了減輕公營醫療系統壓力，政府必須增建醫院和增加醫生人手，同時亦應投入資源加強基層醫療服務。其實不少非緊急病症可由家庭醫生、普通科門診等基層醫療醫生處理，然而近年政府在推動基層醫療方面有欠積極，普通科門診難以預約，夜診服務亦太少，導致不少病人索性直接前往急症室。政府應根據地區需要，加強普通科門診和夜診服務，疏導非緊急及半緊急的病人到社區診所，紓緩急症室壓力。

Public healthcare system is about to collapse

BECAUSE the incidence of influenza has peaked in Hong Kong this summer, its public hospitals are insupportably overloaded. Their doctors and nurses are utterly exhausted. In describing the critical situation, some doctors have said "the public healthcare system is about to collapse" and they feel terribly desperate and helpless. The Hospital Authority has come up with some short-term countermeasures, but it remains to be seen whether they will slightly ease our public hospitals' difficulties.

The government failed to make any long-term plan for building hospitals. That is a main reason why Hong Kong's public healthcare system is insupportably overloaded. Since Pamela Youde Nethersole Eastern Hospital was brought into operation in the early 1990s, no big "flagship" hospital has been completed in the territory. The number of hospital beds in Hong Kong has remained in the neighbourhood of 31,000 ever since the handover. The number has hardly increased. Therefore, society's real needs cannot possibly be met. Despite its huge fiscal reserves, the government was not keen on making progress. Not until the last administration was assembled did it begin to rouse itself to catch up. It decided, for example, that a super hospital (Kai Tak Hospital) be built and Prince of Wales Hospital and Queen Mary Hospital be expanded. However, a few years will elapse before those new facilities can be put into operation. The population ageing, it is doubtful that those hospital construction and extension projects will meet society's ever-increasing demand for healthcare services. The government should learn a lesson and promptly come up with a plan for building a gigantic general hospital.

It is of course not enough for there to be just hospital hardware. There ought to be enough doctors. Tin Shui Wai Hospital, which came into operation early this year, now offers only limited (8-hour) casualty services because it is short-handed. As yet it is hard to tell whether it can begin to offer 24-hour casualty services later this year. The government has in recent years increased the number of medical school places. However, according to the report of a study on healthcare manpower planning (which the government has made public), it is estimated that, in 2030, Hong Kong's public and private providers of healthcare services will lack over 1,000 doctors. It is hardly possible in the long term to alleviate the manpower pressure just by bringing up new blood and retaining doctors who are over retirement age. There is indeed a general trend towards bringing in qualified overseas doctors. Many countries like Singapore, Canada and Australia have beckoned to overseas doctors. But Hong Kong is faced with considerable resistance of protectionism. Some representatives of the medical profession are against allowing graduates of foreign medical schools to practise in Hong Kong, and they make no exception for those born of Hong Kong parents. Others have asserted the lack of doctors is "exaggerated" in the report. Though public hospitals have now "fallen" and front-line doctors and nurses are bitterly complaining about their heavy workloads, there are representatives of the medical profession that do not think the public "should focus on the lack of front-line manpower". Their ostrichism is astonishing.

To ease the pressure on our healthcare system, the government ought to see that there will be more hospitals and doctors. It should at the same time devote resources to improving basic healthcare services. Many cases that are not acute can in fact be dealt with by family doctors or medical practitioners working at general outpatient clinics. However, because the government has not proactively developed basic healthcare services, it is hard to make appointments at general outpatient clinics, and night-time healthcare services are scarce. Therefore, many who are unwell just go to casualty directly. The government should step up general outpatient and night-time healthcare services in the light of local needs so as to direct non-acute and semi-acute cases to community clinics, thereby alleviating the pressure on casualty.

公營醫療瀕爆煲 絕望真相須正視

夏季流感高峰期來臨，公立醫院不勝負荷人仰馬翻，有醫生告急形容「公營醫療系統快要崩潰」，感到「很絕望和無奈」。醫管局提出多項短期應對措施，能否稍紓公立醫院困境，仍是未知之數。

過去政府對醫院欠缺長遠規劃，是目前本港公營醫療系統不勝負荷的一大原因。自從1990年代初東區醫院投入服務以來，香港再未有「龍頭」級大型醫院落成，回歸後病牀總數一直維持在3.1萬張左右，未見長進，完全無法滿足社會實際需要。政府坐擁龐大財政儲備，卻不知進取，直至上屆政府才開始急起直追，包括興建「超級醫院」啟德醫院，以及擴建威爾斯親王醫院和瑪麗醫院等，然而投入服務還需多等數年。隨着人口老化，新醫院和擴建項目是否足以應付與日俱增的醫療服務需求，也是一個疑問。政府必須汲取教訓，及早謀劃興建更多大型全科醫院。

當然，徒有醫院硬件並不足夠，還必須有足夠的醫生。今年初天水圍醫院正式啟用，惟因人手不足，急症室只能提供8小時有限服務，今年內能否實現24小時服務，仍難預料。雖然近年政府已增加醫科學額，但是早前政府發表醫護人力規劃研究報告，估計2030年全港公私營醫療系統醫生短缺將逾千人。單靠栽培新血和挽留退休醫生，恐怕不足以長遠紓緩人手壓力，引入更多合資格海外醫生，實乃大勢所趨，不少國家如新加坡、加拿大和澳洲等都向海外醫生招手，可是本港卻面對相當大的保護主義阻力。部分醫生業界代表抗拒外國畢業醫科生來港執業，負笈海外的港人子弟也未能倖免。有業界代表便揚言，政府的研究報告「誇大」了醫生人手短缺；就算今次公院「淪陷」，前線醫護叫苦連天，可是仍然有醫生業界代表認為公眾「不應將矛頭指向前線人手不足」，鴕鳥心態令人驚訝。

為了減輕公營醫療系統壓力，政府必須增建醫院和增加醫生人手，同時亦應投入資源加強基層醫療服務。其實不少非緊急病症可由家庭醫生、普通科門診等基層醫療醫生處理，然而近年政府在推動基層醫療方面有欠積極，普通科門診難以預約，夜診服務亦太少，導致不少病人索性直接前往急症室。政府應根據地區需要，加強普通科門診和夜診服務，疏導非緊急及半緊急的病人到社區診所，紓緩急症室壓力。