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2019年3月11日 星期一

(東方) 港#MeToo落後 性暴力受害人延遲求助 最長啞忍58年

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(明報) 視光師收醫療券額4年增19倍 業界:反映私營服務需求 反對設限

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(東方) 促公院設危機支援中心 助姦案事主

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(蘋果) 受害人1歲起遭親人性侵 啞忍20年 向風雨蘭求助

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.(公教報) 規劃錯誤下的代罪羔羊

歷年冬季流感高峰期政府醫護人士,都面臨醫院求診者逼爆的困境,政府均未有加以正視,直至去年歲末終迫使醫護人員聯合一些社運人士上街,矛頭直指新移民不斷增加而構成醫療壓力,促源頭減人。

政府的回應,沒有在內地人移居來港的單程證審批權上作出明確表示,但二○一九至二○二○年財政預算案上增撥七億,用作:(一)上調醫生當值、醫護人員特別酬金計劃津貼及病房支援人員薪酬;(二)增加資深護士,加強病房夜間服務;(三)增加專職醫療人員職位,改善晉升前景;(四)增撥資源,繼續推行特別退休後重聘計劃。
無疑,這相較早前找演藝名人拍廣告片及向醫護人員奉送魚蛋小食打氣等舉措沒那麼搞笑,但觀乎對解決醫療壓力的思路卻如出一徹,只是這七億在醫護人員看來比較實惠,但卻沒顯出解決問題的決心。政府看逼爆的問題,會不會就看作是醫護沒士氣呢?這七億費用反而令人覺得是對一班在困境中發聲抗議的醫護的一種侮辱,認為他們要利益激勵而已。

周永新教授、立法會議員陳沛然醫生、社區組織協會幹事彭鴻昌均指出逼爆是規劃失誤所至。一九七四年的《香港醫療及衛生服務的進一步發展》白皮書訂立每一千人有五張病床,現醫管局只有二萬八千張,香港七百五十萬人口,床位與人口的比例只是三點七張。現在病床已逼爆走廊,病人甚至要睡在洗潔盆下,如床位比例達標,病床增加了,將往那裡放呢?

為逼爆而新增的人手,反而更要在如在鼠窟的非常有限空間中鑽動。陳沛然醫生指出,要興建新醫院,由籌劃至落成使用估計要十年,在今次的財政預算中,我們只見政府賣地,卻未見為建新醫院的撥地,可見將來逼爆的情況只會有增無減。這樣,莫非真要源頭減人?

要求取回審批權,港府失敗多次,似乎是中央政府的禁忌,比向特區政府爭撥資源還難。一百五十個單程證來港人士背景及新來港人士使用醫療服務,政府沒有資料數字,這是另一項規劃弊陋。但根據彭鴻昌指出,使用公共醫療服務的佔六成多是六十五歲以上長者,而新來港人士多是三、四十歲的青壯人士,設若他們用公共醫療服務,最多是餘下三、四成的一半。民粹反應的一個共通點,就是不理客觀數據,只信看到「事實」的片面。我絕對體會醫護受壓迫者的感受和他們所處的困境,但就是政府將資料諱莫如深,又沒有相應對策,為大家做就民粹陷阱。

一如政府增撥七億回應逼爆問題,偏離了增撥足夠資源以徹底解決醫療問題這個重心,醫護和社運人士又何嘗不是偏離了這問題的重心,卻在問題旁端發難,效果是使新來港人士成為規劃錯誤下的代罪羔羊,加深社會人士對他們歧視,實在不必。

「每一個人,尤其是基督徒,均有義務設法樹立普遍的弟兄關係, 這是真正的正義及持久和平不可或缺的基礎。如果我們拒絕對待某些同樣依上主肖像而受造的人為弟兄,我們便不能真心呼求天主,全人類的天父。人與天主的父子關係以及與他人的弟兄關係如此相互扣連,就如聖經所說:『那不愛的,亦不認識天主。』(若一:四,8)」(《八十週年》通諭#17)•天主教正義和平委員會www.hkjp.org

(成報) 陳沛然:立會推動設一站式危機支援中心

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(香港01) 醫管局加薪變點火 軍心未穩何以護民康

繼今年年初醫護人手壓力爆煲,接連集會控訴醫院管理局後,公營醫療體系前線員工的怒火蔓延至基層的支援職系。上周,相關工會因不滿局方的加薪方案加幅不一,「重新人輕舊人」,一度在與局方談判破裂後宣布發動靜坐。雖然後來勞資雙方達成劃一加薪的初步共識,工業行動暫時擱置,但本應皆大歡喜的加薪措施,為何反惹員工怨聲載道?從妥協方案來看,勞方的訴求並不難滿足,醫管局何以在前線水深火熱之際自招管理危機?是相關決策人員能力不足,還是體制內溝通失效?

在公營醫療體系前線服務的,除了醫生與護士以外,還有一群默默耕耘的支援職系員工,包括俗稱「病房阿姐」的病人服務助理、運作支援助理及文員等。他們主要負責看護與清潔等工作,但近年前線醫護人手短缺,又要應付繁重行政工作,導致病房助理需要兼顧量血壓等技術工作。當公立醫院不勝負荷,基層員工「做到無停手」成為常態,但支援職系起薪低、晉升慢、易勞損,故工會不斷要求改善薪酬待遇。

前線醫療爆煲的問題近期再在社會引起極大迴響,迫使醫管局正視。然而,醫管局回應員工訴求時,卻鬧出風波。醫管局委託的顧問公司建議先解決支援職系「無人入職」的問題,故局方提出先增加新入職的三A及三B級助理起薪點,加幅達9%至14%,舊員工則加薪2.5% 並且按年資調整。工會不滿這個方案,認為它變相拉近不同職級新舊員工的薪酬距離,質疑局方漠視資深員工。
上周二(5 日),工會宣布與資方談判破裂,要求劃一加薪12%,並計劃在上周四(7日)到醫管局總部靜坐抗議。醫管局行政總裁梁栢賢在上周三緊急與工會代表斡旋,傍晚達成所有支援職系員工劃一加薪8%的初步共識,涵蓋約2.5萬人,涉及經常開支4億至5億元。若醫管局董事局同意,相關措施最快於4月1日生效。工會代表隨後宣布擱置靜坐。

參與談判的醫管局支援職系員工協會主席吳偉玲在公立醫療體系服務十五年,現為二級病人服務助理,也是最受舊方案影響的一批基層員工。她直言,從談判可見,管理層缺乏敏銳度,任由資深員工流失:「員工是醫管局的資產,為何他們沒有意識到要把人留在體制內?」重新輕舊 管理層本末倒置吳偉玲說,多年來一直爭取改善支援職工的待遇,只因基層員工在前線服務中是「被遺忘的一群」,五勞七傷不在話下,「爆肝(即勞累)」程度亦不亞於醫護:「如果病房人手不足,很多時要『PPAA』追更,睡得很少。有時姑娘(護士晚上)10時收工,我們要善後,11 時才能走,但第二日繼續返早。」支援職系員工付出辛勞,但回報卻「跑輸個市」。以吳偉玲為例,她任職二級病人服務助理已五年,現時薪酬在16,000元左右,雖然該職級頂薪近 20,000元,但支援職系「跳point 慢」卻是人所共知。她指出,相比之下私人市場護理員的待遇更吸引,「坊間老人院、尤其津院的起薪都萬八九起跳,而且確保不用追更,怎麼比也好做過(公院)病房啦!」公營醫療的支援職系人手每年流失率平均14%。吳偉玲稱,流失人手的資歷由一兩個月到兩三年不等,離開原因不外乎環境辛苦。她比較道,年輕人多以支援職系作為投考護士的跳板,老一輩員工反而抱着「做生不如做熟」的心態,所以資深前線員工的人手相對穩定。

但她批評,醫管局管理層正是利用了資深員工這項特點來輕視他們的貢獻:「他們『睇死』這群員工讀書少、議價能力低,怎麼都不會走,所以才夠膽開原有的加薪方案!」局方最初的薪酬調整方案以「希望多個人做嘢」為由,提出先加新人起薪點吸引入行,年資三年或以上的員工暫不獲加薪。即使方案已被撤銷,吳偉玲談起時仍然氣難下:「這樣擺明是要趕人走。病房已經不夠人,即使夠,新人都需要老手帶;而且上房、入手術室的緊急情況很多時都是資深員工快速協助醫護人員。為什麼局方不是考慮好好留人?」溝通機制如黑洞 下情難上達回顧今次事件,支援職工在原方案一出已向局方表達不滿,認為對資深員工不公,但醫管局調整後的方案依然厚此薄彼,觸發工會發動靜坐抗議,最後要由梁栢賢親上火線「拆彈」,但每事靠高層出馬擺平,並非良好體制應有的管理模式。比起醫生與護士,今次支援職系的訴求相對簡單,但員工仍要透過社會輿論等外力,才能讓管理層改變決策,讓人質疑醫管局的內部溝通機制是否出現問題,中層無法發揮下情上達的功能。

立法會醫學界議員陳沛然曾以「七八判」來形容醫管局的管治架構,他上月接受《香港01》訪問時便指出,高層與基層之間的資訊傳遞,極可能因層層架構而令原意變形走樣,導致高層縱然有好的政策原意,亦難以有效、良好地落地;反之亦然,基層的聲音難以透過內部有效上達,溝通機制儼如吸聲黑洞。

吳偉玲在爭取加薪的過程中,深深體會龐大體制下的溝通斷層。她說,曾有醫院管理層私下表達支持,但他們的說話卻叫其啼笑皆非——「如果(談判)有任何進展記得告訴我,因為我們是不會從上頭知道消息的!」管治核心無人駕駛 政府難辭其咎總結支援職工的加薪風波,醫管局本可輕鬆解決,而內部溝通失靈,問題根源離不開醫管局老大難的管治問題。近年醫管局的表現強差人意,前線醫護怒火難平,劍劍直指管理高層。醫管局1990 年成立,本意是要讓公營醫療服務脫離傳統官僚體系,使運作更靈活具彈性,但時至今日,醫管局不僅發展成另一個龐大的「官僚」,而且缺乏有效的問責機制,儼如獨立王國。

曾為醫管局成員的立法會議員郭家麒認為,醫管局的管理造成今日局面,政府有不可推卸責任,因為根據《醫院管理局條例》,醫管局大會成員由特首任命,但特首在委任這些成員時沒有任何準則依循。郭家麒指出,若特首以親疏喜好來安排任命,便會令大會在討論醫管局決策方針時「塘水滾塘魚」。
郭家麒在2004 年擔任醫學界立法會議員時,與代表衞生服務界的李國麟一起獲委任為醫管局成員,是當時局內的兩名立法會民意代表。郭家麒在2006 年任期屆滿前夕,不獲續約,當時有聲音指這或與他經常發言挑戰醫管局管治有關。郭家麒之後的醫學界議員,沒有再被委任為醫管局成員,現時醫管局大會成員名單中,更沒有任何一名立法會醫護界別的議員。

郭家麒不諱言,今時今日醫管局屢見管治危機、高層被批「堅離地」,與成員中缺少了「諫官」,以及公眾缺乏渠道監察有很大關係:「以前在大會中仍然能容納一些不同聲音,現在卻是一堆辨識度低的人在『飲茶食飯』、蕭規曹隨;要不就是一堆人坐定定感覺良好,要不便是『閂埋房門傾』,自然撞板啦!」他形容,在這個情況下,醫管局管理層變相成為「無人駕駛」,前線醫護卻要因為上頭管治混亂而被迫「自動波」,雖然能夠提供基本有效的醫療服務,但長遠無助醫管局的管理重回正軌。
「無論用商業模式、管理方針、創新思維、聆聽意見的準則去衡量,醫管局可謂無一達標。」郭家麒強調,縱然醫管局是一座龐然大山,但政府並非全然束手無策,單是透過委任成員已能為改變管治氛圍打開一道缺口:「正如當時李柱銘被委任做消費者委員會主席(編按:1988年至1991年),是不是代表英國人喜歡他?不是的,但至少代表當時的政府願意在機構中接納不同的聲音。」護理人員更期主要分早更(A)、晚更(P)及通宵(N),早更時間大約由早上7 時到下午3 時; 晚更時間大約由下午2 時到下午10 時。「PPAA」則是連續兩天晚更,再當值兩天早更。
現在的醫管局大會缺少諫官只是一班「堅離地」在蕭規曹隨高層成為「無人駕駛」前線被迫「自動波」亦令醫管局愈行愈差—— 前醫管局成員、立法會議員郭家麒

2019年2月28日 星期四

(星島) 建制派評「四平八穩」新意不多 泛民指有盈餘 應每人派三千元

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(蘋果) 額外派發$1,000醫療券

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(蘋果) 隔牆有耳:波嫂種「生機」立會撐老公

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(成報) 預算案撥逾7億醫療救火 前線醫生:改革醫管局方可挽留人才

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(SCMP) HK$80b boost for health sector

Highlights include HK$10 billion stabilisation fund, more money for prescription drugs and higher allowances for doctors and support staff
Hong Kong's overloaded health sector emerged as one of the biggest winners in the budget yesterday, receiving morale-boosting measures worth a total of HK$80.6 billion in recurrent expenditure - a sharp rise of more than 10 per cent from last year.
One move that won praise was the creation of a new HK$10 billion stabilisation fund to help the Hospital Authority weather financial storms.
The sum was equivalent to about two months of spending by the authority, which runs the city's public hospitals.
A government source said it set up a safety net for the health care sector in the event the government was unable to provide sufficient funding, for example during an economic downturn.
Delivering his budget speech yesterday, Financial Secretary Paul Chan Mo-po said: "I have noticed many people from the public and private medical sectors, even university professors, have expressed worries about future resources. Creating the fund is meant to give everyone an assurance."
He said the public health sector would be able to tap the fund immediately, should the government face a funding shortfall because of any unexpected circumstances.
The government source would not say whether the idea stemmed from a similar proposal made by University of Hong Kong Professor Yuen Kwok-yung, who had called for a HK$50 billion safety net.
But the source stressed various suggestions for some kind of stabilisation fund had been tossed around during the consultation period for this year's budget.
Yuen, a top microbiologist, said he was not disappointed about the stabilisation fund being smaller than what he had suggested. "I think HK$10 billion is already pretty good," Yuen said. "The Hospital Authority has been treated very well this time."
The Society for Community Organisation, a non-governmental organisation, welcomed the move, but a spokesman expressed doubt on whether the fund could really help the most pressing areas in the system.
He suggested the authority be allowed to use the HK$10 billion to develop health services that responded to changes in demand.
The stabilisation fund was among a raft of measures aimed at soothing the city's manpower-starved public medical sector, which has resulted in overworked doctors, nurses and other staff protesting strenuously at being overwhelmed by the large number of patients during the recent peak flu season.
Praising their professionalism and passion in serving the community, Chan set aside HK$80.6 billion for the public health system - 10.9 per cent more than last year and accounting for 18.3 per cent of the government's total recurrent expenditure.
The Hospital Authority's usual annual subvention would also rise to HK$68.8 billion, up more than 8 per cent from the previous year. The authority would also get additional recurrent funding of more than HK$700 million to implement measures to help retain staff. The source expected allowances for doctors on call to rise by 55 per cent, while working staff could look forward to a higher overtime rate. Some 16,000 support staff could expect pay increases, and more than 200 posts for senior nurses would be added.
A doctor from Tuen Mun Hospital's department of medicine and geriatrics welcomed the increased allowances and overtime pay, but said they would not completely solve the staffing problem.
What was needed, he said, was more staff to share the heavy workload.
Medical sector lawmaker Dr Pierre Chan said the financial secretary did not address the issue of long working hours faced by frontline staff and he was unimpressed by the potential increase in allowances for on-call doctors.
To improve the provision of medicines in public hospitals, the authority would get HK$400 million in additional recurrent funding to expand the list of prescription drugs available.
Another HK$5 billion was earmarked to hasten the upgrading of critical medical equipment such as PET scan devices and new technology for cancer treatments.
Beyond the public hospitals, Chan also announced an allocation of HK$1.2 billion to implement the Hong Kong Genome Project. He also earmarked over HK$150 million to set up the first primary health care centre in Kwai Tsing before expanding to other districts.
A note of dismay came from the Hong Kong Academy of Medicine, which said it was regrettable that the government did not highlight any measure to improve the training of medical specialists.
The Hospital Authority chairman, Professor John Leong Chi-yan, meanwhile, welcomed the budget, expressing gratitude to the government.
He said the authority was planning a series of measures to boost morale, ranging from increments for nurses who obtained specialist qualifications to adding more positions for pharmacists.

(晴報) 泵水$160億 支援公營醫療 $7億改善待遇 $50億添設備

公營醫院人手緊張致怨聲載道,昨公布的財政預算案中,建議增撥至少161億元予醫管局解決人手及設備等問題,當中包括提供逾7億元提升醫管局醫護人員津貼,另增加150億元作添置儀器及應付突發情況,藉此提升士氣、挽留人才。但有前綫醫生和立法會議員認為措施屬小恩小惠,要解決問題必須改善整體規劃。

  最新一份財政預算案提出,額外提供逾7億元經常資助,供醫管局增加員工津貼及薪酬,及增加專職醫療人員及資深護師職位,改善晉升前景。消息指,當局計劃調升各級醫生當值時的候召補償金55%、增加醫護特別酬金(SHS)20%,並會調高第3級支援職系人員起薪點及現職薪酬,稍後完成檢討再調升第1、2級薪酬,冀多項措施有助挽留人手。

$100億撥款穩定基金 應對突發情況
  預算案亦會額外預留50億元更新及添置醫管局器材;及預留100億元作公營醫療撥款穩定基金,助醫管局面對突發情況;另增撥4億元經常資助擴闊藥物名冊,以納入更多藥物。醫管局主席梁智仁表示歡迎,並會繼續以不同措施紓緩前綫的工作壓力。

  黃任匡為公立醫院心臟科專科醫生,平均每周連同候命工時長達60多小時,他指SHS要求醫生放假時再當值,被形容為「賣血」。他說,流感高峰期不少同事已表示不要津貼、只想休息,質疑措施成效,認為整體措施只屬「小恩小惠」。

公院醫生指小恩小惠 議員稱有誠意
  醫學界立法會議員陳沛然指措施顯示出誠意,但問題根源在於規劃,促政府鞭策醫管局改善人手編制。衞生服務界立法會議員李國麟認為,措施有助留住富經驗的護士。香港病人政策連線主席林志釉稱,擴闊藥物名冊可增加醫生用藥的選擇。

$12億設基因中心 助及早診斷罕見病
  政府去年宣布將推行大型基因組測序計劃,預算案提出撥12億元成立香港基因組中心,未來6年可進行4至5萬個全基因組檢測。消息指,新中心由政府全資擁有,料今年內落成,日後有懷疑罕見病患可轉介作基因測序,及早診斷。

  記者︰李明佑
  編輯:林子豐
  美術:陳超雄

(Standard) Big shot in the arm for health-care services

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(明報) 設百億醫療「穩定基金」 議員:缺人未解 望梅止渴

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(東方) 政情:中環出更:財爺齋噏兩粒鐘 議員玩手機搵周公

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(明報) 醫療券開支42億升1/3 足建天水圍醫院未交代防濫用措施 續加碼1000元

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(信報) 醫療經常開支806億大升10.9% 設百億基金應急抗疫 50億添先進設備

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(蘋果)擲7億挽人才 百億救醫療

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(經濟) 百億設醫療穩定基金 7億振士氣

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(信報) 陳沛然新民黨支持通過撥款

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2019年2月27日 星期三

(SCMP) Will doctors hear the call?

Will doctors hear the call?   
More Hong Kong doctors may well be heading to the mainland if plans to develop better health care services in the "Greater Bay Area" take off.
Pioneers who have already made the move to Guangdong in recent years say the prospects are exciting, and city doctors will gain not only from business opportunities, but also knowledge and experience if they get to treat a much larger pool of patients there.
Ophthalmologist Dr Dennis Lam Shun-chiu, who openedhis first mainland eye hospital in Shenzhen in 2013, said there was great demand for quality services across the border, including from Hong Kong retirees living there.
"They would be interested in health care services provided by Hongkongers," he said.
The greater demand for Hong Kong care could also lead to an enlargement of capacity in the city itself, added Lam, who has hospitals in Beijing and Kunming too. It might even provide the impetus to open a third medical school in the city, he said.
However, others warn Hong Kong's manpower-starved public health sector faces further strain under an even greater number of patients.
Finance minister Paul Chan Mo-po will today unveil his 2019-2020 budget, and all eyes will be on whether he dishes out more resources for struggling medical professionals, to help prevent any possible brain drain.
But doctors in private practice say there are important unresolved issues stopping more doctors from working over the border, ranging from insurance coverage to the availability of medicines.
"We are not familiar with the regulations involved in opening a clinic on the mainland," said Dr Ho Chun-ping, president of the Hong Kong Medical Association, which represents more than 10,000 doctors.
For now, he does not think many private practitioners will be keen to move.
The recently unveiled blueprint for the development of the Greater Bay Area, which will bring together Hong Kong, Macau and nine other Pearl River Delta cities, calls for closer cooperation in health care services.
It sees medical service providers from Hong Kong and Macau setting up facilities in the nine mainland cities, and encourages health care professionals from the two special administrative regions to cross the border for academic exchanges and short-term private practice.
It also says authorities will look into transferring non-emergency and non-critically ill patients across the border and explore a pilot scheme to refer patients between designated public hospitals on either side.
The blueprint does not spell out which patients stand to benefit, but Hong Kong Chief Executive Carrie Lam Cheng Yuet-ngor has said it will be only Hongkongers.
The Food and Health Bureau has said the main purpose is to help Hongkongers living in Guangdong province to return for treatment or recuperation.
According to the Census and Statistics Department, more than 525,000 Hongkongers were living in Guangdong at the end of 2017. They included more than 79,000 people aged 65 or older, as well as those working there and Hong Kong children born to mainland parents.
The Greater Bay Area spans 56,000 sq km and has a population of about 70 million. Beijing envisions turning it into a global innovation and financial powerhouse to rival Silicon Valley and Japan's Tokyo Bay area.
However, the health care services proposals come at a time when Hong Kong is facing a medical manpower shortage and frontline doctors in overburdened public hospitals are concerned about the impact.
The city has more than 14,000 doctors, about 40 per cent of them work in public hospitals, which provide more than 90 per cent of all inpatient care.
Dr Alfred Wong Yam-hong, a spokesman for doctors' concern group M\u00e9decins Inspir\u00e9s, is worried more patients will turn up at public hospitals if non-emergency patients from the mainland are transferred to Hong Kong hospitals.
He works at Tuen Mun Hospital, near the mainland border, and said even now, it was not uncommon to see Hongkongers living on the mainland crossing the border for medical treatment. Many have serious illnesses.
"More patients can be expected if non-critically ill ones are sent in too," he said. "The burden on public hospitals all over Hong Kong would increase."
For now, doctors in private practice appear lukewarm to the Greater Bay Area plans because of the different medical system in place on the mainland, as well as barriers to crossing the border to work.
The Medical Association's Ho said there were day-to-day issues too, including the fact medicines prescribed in Hong Kong might not be available across the border due to different regimes for introducing drugs.
"It will be troublesome if a doctor cannot prescribe a medication he has previously been using for patients," Ho said.
Mainland health authorities had told him they were looking into this matter.
Ho said medical insurance protecting against lawsuits and negligence claims was also an issue, because the professional indemnity scheme used by many doctors in Hong Kong did not cover the mainland.
The plans outlined in the Greater Bay Area blueprint are not the first initiative to encourage Hong Kong doctors to work on the mainland.
Under the Closer Economic Partnership Arrangement (Cepa), signed between the governments of Hong Kong and the mainland more than a decade ago, local doctors without mainland qualifications can work for up to three years over the border with a renewable licence.
The arrangement also allows Hong Kong health care providers to open medical facilities such as hospitals on the mainland through wholly owned, joint equity or contractual joint ventures.
As of the end of last month however, only 49 certificates had been issued under Cepa to local service suppliers to provide medical or dental services across the border.
Medical sector lawmaker Dr Pierre Chan said the relatively small number of doctors working on the mainland suggested there would not be a rush north even with the bay area plan.
However, doctors with experience there point to a number of advantages, not least having access to more patients with a wider variety of conditions than those seen in Hong Kong.
Doctors Union president Dr Henry Yeung Chiu-fat, a paediatrician in private practice, referred to visits he and other doctors had made to patients on the mainland.
"Some of the cases we saw in Guangdong province were cases none of us had seen before," he said. Recalling patients with Marfan syndrome, a genetic disorder that results in elongated arms, legs and fingers and heart problems, he said it was helpful to deal with such cases.
"Doctors are able to widen their knowledge, and will be able to identify a patient's condition more quickly," he said.
Yeung, who obtained a qualification to practise on the mainland in 2009, said his union was opening a clinic later this year in Guangzhou's Nanfang Hospital, a public facility with more than 2,000 beds, and Hong Kong doctors would provide short-term services there.
More than 20 private practitioners, including paediatricians and ophthalmologists, have signed up to work at the clinic on an appointment basis, and the union has obtained medical insurance to cover them.
It is in talks with mainland officials on whether the doctors will be able to prescribe drugs not yet available across the border.
Thoracic surgeon Dr Alan Sihoe Dart-loon is equally convinced that working on the mainland will give Hong Kong doctors an opportunity to improve their skills.
He has been performing operations at Shanghai Pulmonary Hospital since 2013 and helped develop thoracic surgery services at the University of Hong Kong-Shenzhen Hospital over the past five years. "If you have the numbers, you can advance and make progress in the medicine you practise," he said.
To give an idea of the difference in scale on either side of the border, he said a major Hong Kong public hospital carried out about 200 lung cancer operations a year, whereas Shanghai Pulmonary Hospital did 15,000.
"By treating mainland patients, we can learn and develop techniques which could then benefit Hong Kong patients as well," he said.
What remains to be seen is how patients would respond if the Greater Bay Area plans became reality.
Hongkonger Tam Kwok-yuen, a 76-year-old retiree who moved to Guangzhou about five years ago, said having more Hong Kong health care professionals practising on the mainland would benefit him only if he could use their services on a subsidised basis.
Currently, Hongkongers aged 65 or above are entitled to annual vouchers worth HK$2,000 for private health care services, including visits to general practitioners or dentists.
Tam said the Hong Kong government could allow seniors to use the vouchers at mainland health care institutions too. At present, they can do so only at the University of Hong Kong-Shenzhen Hospital.
A diabetes patient, he spends about 10 days each month in Hong Kong, and goes to a public hospital there every three months to undergo regular check-ups and collect his medicines.
"If there were more Hong Kong doctors on the mainland, but I could not enjoy any medical benefits, why would I see them?" he asked.
In 2011, Hong Kong and Shenzhen launched a pilot scheme for Hongkongers admitted to two public hospitals in Shenzhen.
Once their condition was stable, they could be transferred to two Hong Kong hospitals close to the border, namely Tuen Mun Hospital and North District Hospital, if they wished to move.
So far, however, only three patients have been sent to the Hong Kong hospitals under this arrangement.
A Hospital Authority source said this was because of conditions stipulating patients had to be admitted to one of two designated hospitals in Shenzhen, and could be moved only to the two in Hong Kong.
It may be early days yet, but a patients' advocacy group in Hong Kong is concerned about the impact on the city's stressed health care system if doctors have more choices of where to work.
"They might move elsewhere, or practise on both sides of the border, but end up spending less time in Hong Kong," said Alex Lam Chi-yau, chairman of Hong Kong Patients' Voices.
Even if private doctors are the ones drawn there, the group is worried more public sector practitioners will then be lured to fill gaps in the private sector.
An integration plan without measures to protect Hong-kongers' interests risked further diluting resources available for Hong Kong patients, especially those in the public sector, he said.
Lam suggested authorities consider transferring Hong Kong patients who need long-term rehabilitation care to facilities on the mainland, where space was more readily available.
"We need to look at give-and-take in this Greater Bay Area plan," he said. "If we are only giving without receiving anything, I can't see a future."
Financial Secretary Paul Chan Mo-po today delivers his third budget for Hong Kong. All eyes are on whether he will give more aid to the public health care sector to help prevent a possible brain drain to the mainland. In the last of a three-part series, Elizabeth Cheung examines city fears over losing its doctors amid plans to link health care services in the "Greater Bay Area"

2019年2月21日 星期四

2019年2月18日 星期一

(信報) 醫護申訴無改善 李國麟失望

醫護申訴無改善 李國麟失望
流感高峰期期間公立醫院床位「逼爆」,工作量大增令不少醫護人員不滿,專業議政6名立法會議員聯同醫學界議員陳沛然致函特首辦,約見行政長官林鄭月娥,商討醫療政策及資源問題。本身代表衞生服務界的李國麟表示,對於食物及衞生局局長陳肇始上月聽畢醫護人員申訴後仍未回應,感到十分失望。

要求當局監管醫管局
專業議政成員的李國麟指出,政府雖增撥5億元予醫管局,但前線醫護人員仍處於水深火熱中,處境未有改善,希望可與特首商討除撥款外的解決方法。專業議政認為,應趁流感高峰期稍退,探討醫療政策及資源的長遠解決及改善方法。

他接受民主黨前主席劉慧卿訪問時又指醫管局管治架構臃腫,要求「解剖」醫管局查看問題所在,並促當局好好監管醫管局。

胡定旭倡吸名醫學院畢業生
醫管局前主席胡定旭周五早上於電台上明言,香港醫生與市民的比例較其他地區低,加上公私營醫生各佔一半,公營醫療系統人手確實不足,故建議全球排名最高的50間醫學院的港人醫科畢業生可免試回港執業,紓緩人手不足。
對於有醫生提到不少求診者為新移民,建議收緊單程證申請的配額,胡定旭說,6年前他仍任醫管局主席時,單程證人士使用醫管局的資源不多,更有不少新移民來港應徵作醫護人員,故認為不用收緊單程證政策。
#政情 - 醫護申訴無改善 李國麟失望

(星島)審議國歌法委會 最少60議員報名加入

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(明報)建制泛民「冧人」爭奪正副主席職 63議員加入國歌法委會

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(東方)政情:中環出更:斥陳肇始逃避 李國麟促解剖醫管局

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(東方) 政Whats噏:國歌法委員會冧友 白鴿黨唔認轉軚

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(東方) 政情:國歌法委員會再多四議員加入

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(香港01)走出醫管困局 手術刻不容緩

走出醫管困局 手術刻不容緩
醫院管理局自1990 年成立至今,是本地公營醫療服務的最大提供者,統領逾百間公立醫院、專科或普通科門診,掌管7.6 萬員工和每年數百億元計的公帑。當年政府下放管治權力給醫管局,由醫生為主的業界自主提供服務,目標是根治病床爆滿等醫療缺失。

如今醫管局自身難保,政府和公眾要認真思考,如何為醫管局動手術,清除各項管理病灶。
港英政府成立醫管局,源自1985 年發表的《史葛報告書》。顧問建議政府下放權力到新的醫療管理機構,並脫離公務員體系,期望管理更有效率。為何要推行這項改革?1980 年代的公營醫院一樣塞爆病人,醫護界批評行政程序繁複冗長,醫療開支也不斷上升。

當時的公共醫院區分政府醫院及由慈善機構營運的補助醫院,兩者在環境、員工待遇和管理的差異愈趨明顯。報告書提出多個改善目標,主要包括:重整政府醫院及補助醫院架構、人手及資源使用;減少醫院擁擠,提升服務水平;改善醫療融資及成本控制。報告認為,獨立成局並脫離公務員系統有以下好處:一、透過任免員工,加強醫院層面的問責能力;二、加入更多專業及民間代表以對公眾問責;三、政府可透過撥款和董事局,確保醫管局緊跟政府政策,尤其肩負照顧病人的重任;四、提升補助醫院認受性,統一政府及補助醫院員工待遇。
另一方面,根據公共行政學者張炳良研究,政務官和醫生趁機釐清管理權責。當時由政務官主導的衞生福利司,以及由醫生主導的醫務衞生署不咬弦,政務官在醫務衞生署受制於醫生,醫生則不願意由外行人參與醫療管理工作。兩者均有意調整架構,醫生掌資源調撥,政務官掌政策。

不可不提,港府整個醫療體系改革也受着當時英國公營部門改革牽動,醫管局可算是先行者。至於減少過分擁擠,報告書建議增設醫院急症室做好守門員角色,避免病房接收非嚴重病人,重新調配醫院之間及醫院內部的病床,加強病人轉換病房的效率等。政府也落實《史葛報告書》建議,把住院費與成本掛鈎,逐步收回成本。
醫管局在1990 年成立至九七回歸前可以說是蜜月期。醫護掌握行政權力,政府只有委任及指派最多三名公務員為醫管局大會成員的權力,主要是向醫管局購買醫療服務的採購者。員工—尤其補助醫院員工—的薪酬待遇及晉升階梯顯著改善,醫院人手和病床數目上升。舉例說,由1992年底至1997年底,醫管局醫生和護士人數分別增加近四成和兩成多(見表一);同期病床量增加約兩成,兩者在管理模式方面,研究本地公共行政制度的學者黃兆輝分析,醫管局成立後,高層強調機構管理和控制,例如不斷加強管理職位,以前的顧問醫生或護士長都改稱經理,行政工作的比重日增。總的來說,醫管局的開局不錯,很多資深醫護人員回憶,那場改革終結帆布床滿布的日子,令人欣慰。
供需失衡 醫院亂象重現報告書估計成立醫管局有助控制政府撥款,例如透過提升現有服務,延緩建設新醫院,抵消轉制的額外開支,結果事與願違,政府的醫療投入飛漲。究其原因,除了薪酬開支增長外,公立醫院服務提升,尤其是大力發展專科,吸引更多市民使用專科門診及急症室,抵消了增加人手的好處。政府在1993 年建議提高公立醫院收費但遭市民反對,無法減輕醫療開支承擔。幸而政府財政收入大漲小回,撥款飛漲並未弄垮公營醫療系統。

醫管局的考驗,在成立第二個十年出現。
亞洲金融風暴重創香港經濟,政府及公共部門落實資源增值計劃減少財赤,醫管局遂在1999/2000年度起節省開支。即使本地經濟在沙士之後回穩,政府仍於2003/04 至2005/06 年度縮減醫管局撥款預算,先前提及的任免權力,體現於那幾年的節流措施,例如減少新聘醫護,削減新人薪酬待遇,以「肥雞餐」鼓勵資深人員離職。更糟糕的是,政府認為醫護人手過剩,削減大學醫科生學額和關閉護士學校,而醫管局以增設日間手術及復康等服務為由,在2003 年起連續幾年削減住院病床。但是,其間住院病人數目沒有下降,專科門診和急症室的求診人次上升,日間住院服務疏導病床使用的能力有限,公營醫療體系的供求嚴重失衡(見表二)。
醫管局治下開初,醫生和病人比例其實並未真正令人滿意,金融風暴則令問題惡化。政府近年撥款大學和醫管局比較鬆手,但由於增加醫護學額和培訓專科人手,動輒十年八載,輸入非本地醫生應急也受阻撓,新增醫管局醫生僅屬追落後。最諷刺的例子莫過於運作中的病房經常爆滿,但近年新落成的醫院,部分病房缺乏醫護團隊,唯有丟空。
政府多次推動醫療融資改革,以期減輕政府負擔及分流公營醫院病人到私營市場,但成效不彰,預計今年實施的自願醫療保險也需時間驗證效用。基層醫療及公私營協作計劃也口惠而實不至,未能大幅分擔專科門診壓力。前線醫護油盡燈枯,不少被私家醫院和醫療集團挖角或者自立門戶。
工作繁重山頭主義 燃改革之火公營醫療供求失衡,除了人手問題,當中的資源調配及人事管理衝突變得尖銳。香港大學醫學院院長梁卓偉日前炮轟醫管局醫生不斷開會和埋首行政工作;前線醫生和護士也抱怨,用作評審醫院質素、加強病人安全的醫院認證計劃,運作十年衍生大量文書工作和考核,佔去診症時間,無助病人復康之餘,更累積對管理層的怨氣。雖然醫管局在去年7月中止認證計劃,但隨後宣布明年復推類似計劃,前線同事紛紛擔憂噩夢再來。

好一段時間,聯網制度常被炮轟助長山頭主義。地區聯網制度在1992 年設立,並於2001 年發展至現時七個聯網,原意是促進各個聯網內醫院的合作,善用資源,病人可在一個聯網得到全面治療。如果聯網執行順利,還可促成內部市場在競爭中求進步。然而,現實是聯網之間充斥人事鬥爭,病人利益亦受影響。
多位醫生代表批評聯網擁兵自重。香港大學感染及傳染病中心總監、香港公共醫療醫生協會時任會董何柏良在2013 年的電視訪問直斥每個聯網「有如獨立王國」,醫院爆發惡菌也沒有通報醫管局及衞生防護中心。同期,協會時任會長佘達明指,醫管局本有中央統籌委員會為總部監察專科的服務質素,但委員會成員關係密切,有如「同門師兄弟」,容易包庇過錯,總部無法駕馭聯網的資源不均。

山頭主義也體現於漫長的專科門診輪候時間。最近兩任醫學界立法會議員梁家騮與陳沛然均曾批評,輪候時間長的專科門診,會獲得更多資源和人手,意味着聯網和醫生有很大誘因留住病人,任由新症長期輪候。宏觀來看,聯網的撥款準則扭曲醫生行為,所以聯網資源分配需要改革。無怪乎梁家騮曾提出解散醫管局議案,主張廢除聯網制度。

要求解散醫管局或是噱頭,或是一時之氣,議案一如所料被否決,但社會不會就此放過醫管局。政府在2015 年發表檢討督導委員會報告,承認醫管局有山頭主義以及其他資源調配和溝通問題。醫管局接納建議,陸續推出改善措施,主調是收回聯網權力,加強中央統籌,以確保提供一致服務,又加強高級管理人員和臨床人員的輪調。
陳沛然上周向《香港01》表示,上述措施有效打擊山頭主義,例如致力確保各個聯網獲得同等資源。但他不諱言,中央統籌也有缺點,包括醫護被不斷召到醫管局總部開會。這就正正回到梁卓偉的批評,即開會擠壓了診症時間。就此,局方須積極尋找平衡點,謹記開會只是過程,服務病患才是目的。

解藥變沉疴 政府須推動醫管局革新回望過去,政府和醫護界曾經寄望醫管局成為解決醫療體系沉疴之道。成立之初,醫護人手待遇提升,病人滿意服務。可惜,醫管局今天已由良方逐漸變成問題的根源,病房重現放滿病床的日子,士氣低落。既然醫管局現況有違當初《史葛報告書》加強問責能力的期望,政府須檢討與醫管局的委託關係,例如修改法例,增加醫管局大會的官方代表和社會服務、病人組織的參與,強化制衡及監督角色。
至於醫管局內部,當聯網制度是主要矛盾,管理層必須持續消除地區聯網的撥款和管理差異,不斷改善撥款模式,重修與前線員工的關係,減少人手流失。就上述例子而言,在縮短專科門診範疇,醫管局適宜探討在不損害現有診症質素的前提下,鼓勵醫院多勞多得,增加縮減輪候人龍的誘因;新輪調及升遷制度要更公開透明,避免偏袒。此外,管理層必須改良評估績效管理模式,避免異化成無意義評核,阻礙日常醫治病人工作。
1985 年,政府委託顧問公司研究醫療改革,用五年時間,集各界之力誕生醫管局。政府能否再次鼓起勇氣,用五年甚至更短的時間,清除醫管局的瘀血?

(香港01)公營醫療爆煲經年 醫管局須跳出管治怪圈

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