公營醫療死結難解 急擲5億紓困有限

<轉載自2018年1月31日 明報 社評>

流感高峰期來臨，公立醫院護士疲於奔命，護士協會向政府求救，事隔數天，行政長官林鄭月娥迅即回應，急撥5億元予醫管局，希望紓緩近期公院服務緊張情况。今次政府急事急辦，反應敏捷，對於提振公院護士士氣，或有一定幫助，然而是否足以紓緩人手壓力，仍屬疑問。本港公營醫療系統千瘡百孔，護士人手不足只是「病徵」之一，私院高薪挖角，更令公院「護士荒」雪上加霜。政府必須做好長遠規劃，始能逐步解開本港公營醫療系統的死結。

短期提振護士士氣 紓困還看醫局措施

特區政府財力雄厚，林鄭提出理財新哲學，強調應花則花，由上台初期的50億元教育新資源方案，到今次急撥5億元為公院紓困減壓，反映現屆政府在運用公帑改善民生方面，算是較為積極進取。以今次增撥5億元為例，如果先等待立法會通過，難免要花較長時間，現在由政府先指示醫管局動用儲備墊支，之後再在財政預算案「補數」，做法無疑較具彈性。

當然，對於其他同樣渴望政府投放資源的不同界別來說，難免有人私下嘀咕，政府這次果斷出手，會否是因為「朝中有人好辦事」，主事的食衛局長陳肇始出身護士，深知業界疾苦，與代表護士發聲的護協主席李國麟，較易「搭通天地線」，然而無論如何，林鄭對公院護士困境迅速反應，始終是好事，不過5億元能救多少「近火」，仍是未知之數，究竟這個金額如何釐定出來，外界也不清楚，情况一如林鄭提出增加50億元教育經常開支，又或建議向政府各部門劃一增撥3％資源，到底具體數字指標是怎樣得出，予人觀感有點隨意，未夠縝密。林鄭的理財新哲學，在實際操作層面仍有完善空間。

政府今次急事急辦，總算讓市民和前線護士看到，當局關注刻下公院病牀迫爆的問題，願意投入資源，對於短期提升前線護士士氣，相信有一定幫助，至於能否成為前線人員真正的及時雨，還得看醫管局能否善用撥款。醫管局一年所得恆常撥款超過500億元，5億元可謂杯水車薪，指望新撥款能一下子起死回生，並不切實際，何况現時最大的問題是「有硬件缺軟件」，全港護士不足，醫管局就算有錢，短期內也難望增聘人手，就算想即時多聘兼職護士紓困，也不容易。醫管局短期內應採取措施，盡量減少現職護士文書方面的工作、改善超時津貼待遇，以及先重點加強支援夜更護士，減輕前線護士壓力。

近年公院護士人手流失一年比一年嚴重，流失率由2014/15年度的4.7％，升至前年約5.4％，部分公院內科護士流失率直逼一成，內部原因是公院工作壓力過大，外部原因是私院銀彈挖角，歸根究柢是公私營醫療系統失衡的問題。本港公營醫療系統聘用本地六成醫護人員，卻要負責照顧九成住院病人，系統不勝負荷，人人疲於奔命；相比之下，私營醫療系統聘用四成醫護人員，卻只需照顧一成市民。更甚的是，私院可以開出遠勝公院的薪酬待遇挖角，反觀公院護士卻要面對入職首兩年沒有增薪點的安排。

公私營醫療系統失衡 雙管齊下解決人手荒

「兩年零增薪」安排源於2002年，當時政府財政困難，需要削減開支，時移世易，現今政府財源滾滾，這種緊縮時期措施竟然一直持續至今。目前公院註冊護士起薪點約為2.8萬元，與私院護士新人的薪酬未算相差太遠，可是考慮到私院年年加薪、公院護士首兩年卻「凍薪」，一名有3年資歷的護士，在私院的月薪，可以比公院護士高出近1萬元。私院無論在薪酬待遇、工作環境和培訓都較為優勝，長期影響公院護士士氣，亦導致公院很難挽留人才。林鄭提出廢除「兩年零增薪」安排，總算是釜底抽薪的處理，然而現時取消凍薪點，主要只針對少數新入職員工，數年前入職的護士看在眼裏，未必覺得公道，當局需要慎重處理。

今次政府急撥5億元為公院護士紓困，短期挽回士氣的作用，多於即時實質改善公院人手不足。政府必須做好長遠規劃，投入更多資源，雙管齊下，一邊培訓更多人手，一邊改善公院護士待遇和工作環境。若不拉近公私營醫療系統醫護待遇，培訓再多人手，也只會流向私院；若不解決全港「護士荒」，就算公院改善護士待遇，私院大可開出更優厚條件挖人，當前公院困局只會持續下去。

Public healthcare knot

AMID the onset of a seasonal flu surge that has exhausted public hospital nurses, Chief Executive (CE) Carrie Lam Cheng Yuet-ngor has responded quickly to the Association of Hong Kong Nursing Staff's cry for the government's help. She did so a few days after it had made the call. She has announced an urgent funding of $500 million to the Hospital Authority (HA) in the hope that the strain that has recently been put on public hospital services can be eased. The government's posture in dealing with the issue urgently as a matter of urgency and its swift handling of the case may go some way towards boosting public hospital nurses' morale. But it remains questionable whether it is enough to alleviate the manpower pressure. The government must make a good job of long-term planning before it can untie the public healthcare system tight knot step by step.

Heading a financially sound SAR government, Mrs Lam has put forward a "new fiscal philosophy", emphasising the government ought to spend what it should spend. She proposed a $5-billion "new resources for education" plan soon after she had taken office. She has now urgently provided $500 million to ease the strain on public hospitals. Such measures show one may say this administration is relatively proactive in using public money to improve citizens' lives. Will the funding become front-line people's real timely help? That depends on whether the HA can use it properly.

The recurrent funding the HA receives tops $50 billion a year. One may well say that, compared to that, $500 million is utterly inadequate. What's more, the biggest problem now is that, "while there is hardware, software is lacking". Given the shortage of nurses in the whole territory, even if the HA has money, it is hard to hire part-time nurses, let alone to recruit new blood quickly. In the short run, the HA should take steps to ease front-line nurses' stress. For example, it should minimise their paper work, raise their overtime allowances and give priority to giving night-shift nurses greater support.

The turnover of public hospital nurses has recently become more and more serious year after year. While the huge work pressure at public hospitals is an internal cause, private hospitals' nurse poaching is an external cause. In the final analysis, the problem lies in the imbalance between the public healthcare system and the private. The public healthcare system employs 60% of the SAR's doctors and nurses but takes care of 90% of its in-patients. The system is overburdened, and everyone is kept constantly on the run. In contrast, the private system employs 40% of the SAR's doctors and nurses but takes care of just 10% of its citizens. Furthermore, private hospitals can lure nurses by offering them much better remuneration than they receive at public hospitals. On the contrary, a new public hospital nurse has to face a two-year increment freeze.

A nurse of three years' standing is paid nearly $10,000 more a month at a private hospital than at a public one. Private hospitals are better in terms of remuneration, working conditions and training. That has long affected public hospital nurses' morale, making it hard for public hospitals to retain talents. Mrs Lam has called for the abolition of the "two-year pay freeze". One may say she has tried to take away the firewood from under the cauldron. However, scrapping the increment freeze will only benefit new nurses, who are in the minority. That may not seem fair to nurses recruited several years ago. The authorities must handle the matter with great caution.

The urgent allocation of $500 million to ease nurses' stress is effective more in restoring morale in the short term than in immediately and really easing public hospital's manpower shortage. The government must make a good job of long-term planning and put in more resources. It should take a two-pronged approach. It should, on the one hand, train up more healthcare workers and, on the other, raise public hospital nurses' remuneration and improve their working conditions.

公營醫療死結難解 急擲5億紓困有限

流感高峰期來臨，公立醫院護士疲於奔命，護士協會向政府求救，事隔數天，行政長官林鄭月娥迅即回應，急撥5億元予醫管局，希望紓緩近期公院服務緊張情况。今次政府急事急辦，反應敏捷，對於提振公院護士士氣，或有一定幫助，然而是否足以紓緩人手壓力，仍屬疑問。政府必須做好長遠規劃，始能逐步解開本港公營醫療系統的死結。

特區政府財力雄厚，林鄭提出理財新哲學，強調應花則花，由上台初期的50億元教育新資源方案，到今次急撥5億元為公院紓困減壓，反映現屆政府在運用公帑改善民生方面，算是較為積極進取。至於能否成為前線人員真正的及時雨，還得看醫管局能否善用撥款。

醫管局一年所得恆常撥款超過500億元，5億元可謂杯水車薪，何况現時最大的問題是「有硬件缺軟件」，全港護士不足，醫管局就算有錢，短期內也難望增聘人手，就算想即時多聘兼職護士紓困，也不容易。醫管局短期內應採取措施，盡量減少現職護士文書方面的工作、改善超時津貼待遇，以及先重點加強支援夜更護士，減輕前線護士壓力。

近年公院護士人手流失一年比一年嚴重，內部原因是公院工作壓力過大，外部原因是私院銀彈挖角，歸根究柢是公私營醫療系統失衡的問題。本港公營醫療系統聘用本地六成醫護人員，卻要負責照顧九成住院病人，系統不勝負荷，人人疲於奔命；相比之下，私營醫療系統聘用四成醫護人員，卻只需照顧一成市民。更甚的是，私院可以開出遠勝公院的薪酬待遇挖角，反觀公院護士卻要面對入職首兩年沒有增薪點的安排。

一名有3年資歷的護士，在私院的月薪，可以比公院護士高出近1萬元。私院無論在薪酬待遇、工作環境和培訓都較為優勝，長期影響公院護士士氣，亦導致公院很難挽留人才。林鄭提出廢除「兩年零增薪」安排，總算是釜底抽薪的處理，然而現時取消凍薪點，主要只針對少數新入職員工，數年前入職的護士看在眼裏，未必覺得公道，當局需要慎重處理。

今次政府急撥5億元為公院護士紓困，短期挽回士氣的作用，多於即時實質改善公院人手不足。政府必須做好長遠規劃，投入更多資源，雙管齊下，一邊培訓更多人手，一邊改善公院護士待遇和工作環境。