有醫院沒有醫生 硬件一流又如何

<轉載自2017年11月24日 明報 社評>

審計署發現，北大嶼山醫院（下稱「北嶼醫院」）投入服務4年，迄今仍有兩成面積空置，部分專科服務遲遲仍未展開，醫院近在咫尺，可是部分北大嶼山居民仍然要長途跋涉，前往瑪嘉烈醫院求醫，情况荒謬。本港公立醫院人手短缺，醫生不足，縱有一流硬件，也無法充分發揮服務市民，「北嶼醫院」的情况，只是一個具體反映，今年初投入服務的天水圍醫院會否步其後塵，令人憂慮。長遠增加醫護人員培訓，短期引入更多合資格外地醫生，實有迫切需要，業界不應囿於保護主義而阻撓。

北大嶼醫院未似預期 天水圍醫院未許樂觀

2009年，政府斥資25億元興建「北嶼醫院」，第一期於4年後正式啟用，除了急症及門診，還有外科、婦科、骨科等專科。東涌居民望穿秋水，以為區內終於有較為全面的公營醫療服務，可惜「北嶼醫院」徒有優良硬件，卻因為沒有足夠人手，未能充分發揮，部分服務不知何時才能啟用。東涌居民慨嘆「得物無所用」、「有醫院等於沒醫院」，無奈心情可以理解。

審計署報告提到，「北嶼醫院」未充分使用大樓，住院服務亦不足，10項主要醫療設備，有7項使用量低於預期，使用率不足60%，部分醫療設備購入至今未曾使用；婦科及兒科服務比預期遲了3年，迄今仍未開展，區內千計婦孺要老遠到瑪嘉烈醫院預約專科門診。根據第一期發展計劃，「北嶼醫院」原定2016年全面啟用，提供180張病牀，可是現今仍有近八成病牀未啟用，究竟「北嶼醫院」何時才能全面服務市民，仍是未知之數。

9年前，政府官員聲言，「北嶼醫院」服務足以滿足區內十多萬人口需要，現在回看，予人觀感是誇誇其談，有心無力。政府為了配合大嶼山長遠發展，正積極籌備「北嶼醫院」第二期計劃。本港醫院不足，政府願意投入更多資源增建醫院，本是好事，然而當「北嶼醫院」第一期發展未能地盡其利、物盡其用，試問市民又怎能相信第二期不會重蹈覆轍。

「北嶼醫院」的問題，說到底是公院醫護人手嚴重不足，醫管局左支右絀，調配無從。審計署提到，「北嶼醫院」現有員工數目，僅及全面運作所需的61%。雖說新醫院服務需要循序漸進擴展，然而一日不解決人手短缺，都難以好好服務市民。

醫管局長期受人手荒困擾，「北嶼醫院」未能高效運作，只是一個具體寫照，天水圍醫院情况同樣糟糕。天水圍醫院今年初啟用，惟因人手不足，目前只能提供8小時急症室服務。「北嶼醫院」投入服務一年後開展24小時急症，可是天水圍醫院隨時要等到2019年初，才能提供相關服務。屯門醫院作為新界西龍頭醫院，診治病人眾多，早已自顧不暇，政府寄望天水圍醫院各項服務陸續啟用後，成為區內主要公營醫療機構，減少跨區求診，紓減屯門醫院壓力，可是「北嶼醫院」的經驗，令人擔心政府這個如意算盤，何時才能打響。

醫生人口比例太低 引入外援不應阻撓

本港醫生與人口比例，與其他發達地區相比，可說低得可憐，每1000人只有1.7名醫生，相比之下，澳洲是4.0、美國是3.3、英國是3.7、日本是2.3，公院情况尤其嚴峻，由於工作壓力大，加上私營市場「錢途光明」，公院醫生流失嚴重。政府估計，2030年全港將欠缺逾千醫生。

公院醫護人手短缺，原因不一而足。十多年前政府因為財赤壓力大削醫管局開支，又錯估醫護人力供求需要，大減醫科學位，大批醫科生畢業後未獲聘用，到後來發現醫護人手不足，才亡羊補牢，政策短視搖擺，難辭其咎，然而醫生業界傾向保護主義，反對增加引入海外合資格醫生，亦導致問題短期無法紓緩。

醫生團體堅稱本港並非醫生不足，只是公私營醫療系統失衡，公院醫生太少病人太多。誠然，目前私院專科醫生相對人口的比例，遠比公院專科醫生為高，政府有必要加強公私營醫療機構合作，可是除了專科醫生，本港普通科醫生同樣缺乏。醫生業界強調專業自主，同時亦應以市民整體利益為依歸。回歸後，醫生業界不再承認英聯邦國家醫生的執業資格，執業試過關者20年間顯著減少，保護主義傾向並不健康。

增加引入合資格海外醫生，不僅可以紓緩人手荒，也可縮短目前醫生的超長工時，提升服務質素，對醫生和病人都是好事。醫生團體聲稱，本港醫生與人口比例「看似嚴重」，惟與2002年相比，「今天醫生比例已高了」。有關說法匪夷所思，實際是拿最差的數字來做比較，試圖「印證」現在情况未算最壞，可是社會大眾期望的，是合理和高質素醫療服務，沒理由強迫市民忍受現時醫生不足嚴重影響服務的情况。業界應該以社會利益為重，放下保護主義心態。

Hospitals lacking doctors

THE Audit Commission has revealed a ridiculous picture of service delays at North Lantau Hospital. More than a fifth of its floor area was still vacant and some medical services had not yet been commissioned even after four years of operation. Despite the proximity of this hospital to residents in northern Lantau Island, some of them still have to travel a long way to Princess Margaret Hospital for specialist services. But the story of North Lantau Hospital is just another concrete example showing the problem of a labour shortfall faced by public hospitals in Hong Kong. As long as the shortage of doctors persists, the sector can never provide services to the full scope of their capacity even if it has first-class hardware installed.

Aside from the underutilisation of the hospital building, the Director of Audit's report has also mentioned its shortfalls in delivering inpatient services. Of the 10 major medical equipment items at North Lantau Hospital, 7 items had a utilisation rate of below 60 per cent, way lower than expectations. Some medical equipment had never been put into use. The provision of gynaecology and paediatric services is three years overdue and even now the two clinics have not been commissioned yet. As a result, thousands of women and children in the district have to travel afar to Princess Margaret Hospital for specialist outpatient care. According to its Phase 1 development plan, the North Lantau Hospital was supposed to be fully open in 2016 and provide 180 inpatient beds, but up to now nearly 80 per cent of all beds have still been left idle. When the hospital can be fully operational remains a question mark.

The report noted that the number of staff in the hospital was only 61 per cent of the headcount needed for its full operations. In fact, the failure of North Lantau Hospital to have an efficient output is only a reflection of the manpower shortage that has plagued the Hospital Authority for long. Another hospital facing similar difficulties is Tin Shui Wai Hospital. It began operation early this year but because of staff shortage so far it can only provide eight hours of Accident and Emergency (A&E) services every day. North Lantau Hospital commenced its 24-hour A&E services after one year of operation, but in the case of Tin Shui Wai Hospital, it may have to wait till 2019 before it can extend the service to the whole day.

Many factors have contributed to the shortage of health care professionals in public hospitals. More than ten years ago, the government slashed the Hospital Authority spendings under the looming pressure of budget deficits. At the same time, it wrongly assessed the demand and supply of health care professionals and cut the number of medical school places hugely while many medical graduates failed to find a job as a practitioner. Only when the workforce crisis began to unfold did the government realise it had to remedy the situation. There is no doubt that the government should take the blame for its short-sightedness and policy swings. But on the other hand, the protectionist attitude shown by local medics in opposing the recruitment of overseas qualified practitioners is not helping to ease the problem either.

Local associations of doctors have argued that Hong Kong is not really suffering from a shortage of doctors but an imbalance between the public and private sectors in terms of manpower distribution, with the public sector having too few doctors but too many patients. To be fair, the private medical specialist to population ratio now is much higher than that in the public sector. The government must play its part to strengthen the collaboration between the public and private medical institutions. However, apart from specialists, general practitioners are also under shortage. After the handover, doctors from Commonwealth countries are no longer automatically awarded the qualification to practise in Hong Kong, and the number of those who passed the licensing exam has been decreasing significantly over the past twenty years. Protectionism is by no means a healthy tendency. Importing more qualified overseas doctors can not only help alleviate the workforce shortage, but it also shortens the current notoriously long working hours of doctors, in the end improving the quality of their service. This is in the interests of both doctors and patients.

有醫院沒有醫生 硬件一流又如何

審計署發現，北大嶼山醫院（下稱「北嶼醫院」）投入服務4年，迄今仍有兩成面積空置，部分專科服務遲遲仍未展開，醫院近在咫尺，可是部分北大嶼山居民仍然要長途跋涉，前往瑪嘉烈醫院求醫，情况荒謬。本港公立醫院人手短缺，醫生不足，縱有一流硬件，也無法充分發揮服務市民，「北嶼醫院」的情况，只是一個具體反映。

審計署報告提到，「北嶼醫院」未充分使用大樓，住院服務亦不足，10項主要醫療設備，有7項使用量低於預期，使用率不足60%，部分醫療設備購入至今未曾使用；婦科及兒科服務比預期遲了3年，迄今仍未開展，區內千計婦孺要老遠到瑪嘉烈醫院預約專科門診。根據第一期發展計劃，「北嶼醫院」原定2016年全面啟用，提供180張病牀，可是現今仍有近八成病牀未啟用，究竟「北嶼醫院」何時才能全面服務市民，仍是未知之數。

審計署提到，「北嶼醫院」現有員工數目，僅及全面運作所需的61%。醫管局長期受人手荒困擾，「北嶼醫院」未能高效運作，只是一個具體寫照，天水圍醫院情况同樣糟糕。天水圍醫院今年初啟用，惟因人手不足，目前只能提供8小時急症室服務。「北嶼醫院」投入服務一年後開展24小時急症，可是天水圍醫院隨時要等到2019年初，才能提供相關服務。

公院醫護人手短缺，原因不一而足。十多年前政府因為財赤壓力大削醫管局開支，又錯估醫護人力供求需要，大減醫科學位，大批醫科生畢業後未獲聘用，到後來發現醫護人手不足，才亡羊補牢，政策短視搖擺，難辭其咎，然而醫生業界傾向保護主義，反對增加引入海外合資格醫生，亦導致問題短期無法紓緩。

醫生團體堅稱本港並非醫生不足，只是公私營醫療系統失衡，公院醫生太少病人太多。誠然，目前私院專科醫生相對人口的比例，遠比公院專科醫生為高，政府有必要加強公私營醫療機構合作，可是除了專科醫生，本港普通科醫生同樣缺乏。回歸後，醫生業界不再承認英聯邦國家醫生的執業資格，執業試過關者20年間顯著減少，保護主義傾向並不健康。增加引入合資格海外醫生，不僅可以紓緩人手荒，也可縮短目前醫生的超長工時，提升服務質素，對醫生和病人都是好事。