WTSDC Paper No. 21/2016 (22.3.2016)

Hospital Authority’s Plan for Re-delineation of Cluster Boundary for Kowloon Central and Kowloon West Clusters

Introduction

This paper aims to brief the Wong Tai Sin District Council on the implementation plan of the Hospital Authority (HA) with regard to the recommendation of the Steering Committee (SC) on Review of HA on the re-delineation of cluster boundary for the Kowloon clusters.

Background

2. On 14 July 2015, the SC released 10 recommendations to drive for improvements in HA to meet future challenges. Review of cluster boundary was the first among the recommendations made. The SC also made the following related recommendations on the review of cluster boundary:

(a) The existing arrangement of having seven clusters should be maintained.

(b) The delineation of cluster boundary, particularly those of the Kowloon clusters, should be refined having regard to the supply and demand for healthcare services as well as the hospital development/redevelopment plans in the respective cluster; and

(c) In reviewing the cluster boundary, opportunities should be taken to maximise coherence on vertical integration of services to ensure continuity of care for patients within the same cluster.

The Clustering Concept

3. A cluster in the context of the HA is a network of medical facilities and services grouped together to help ensure continuity of high quality care within the same geographical setting throughout a patient’s episode of illness. This can be achieved through vertical integration of care from acute phase to extended, primary and community after-care. The clustering concept aims to achieve integration and collaboration among various clinical services in the cluster to ensure the most cost-effective use of resources within and among clusters.

5(2)_DC[P21](21-2016)-e 1 Issues to be Addressed

Cross-cluster Service Utilization

4. Cross-cluster service utilization is most noticeable among the three Kowloon Clusters particularly in Kowloon Central Cluster (KCC), with 62% of its inpatient services having been provided for patients residing outside its catchment districts in 2013/14 as shown in Table 1.

Table 1 Inpatient Service Utilisation Statistics for Kowloon Clusters in 2013/14

Proportion of Cluster’s Inpatient Cluster Discharge Episodes Utilised by Patients Catchment Districts Living Outside Catchment Districts

Kowloon Central 62% Kowloon City, Yau Tsim Kowloon East 10% Kwun Tong, Sai Kung Kowloon West 13% Mongkok, Wong Tai Sin, Sham Shui Po, Kwai Tsing, Tsuen Wan, Lantau Island

5. Of these 62%, patients from the Wong Tai Sin (WTS) District took up 31% with the remaining 31% distributed among Kwun Tong, Mongkok, Sham Shui Po and other districts. On the other hand, only 32% of the inpatient discharge episodes from patients of the WTS District which is under the Kowloon West Cluster (KWC) were provided by KWC’s cluster hospitals as shown in Table 2 below. The remaining 68% were provided by other clusters, especially KCC, which took up 54%. Such cross-cluster service utilization has called for attention for a number of service alignment issues.

Table 2 Inpatient Service Utilisation Statistics of Patients Residing in Wong Tai Sin District in 2013/14

Cluster Hospitals Distribution of Inpatient Discharge Episodes

Kowloon West (Cluster for Wong Tai Sin District) 32% Kowloon Central 54% Kowloon East 8% Other clusters 6% Overall 100%

5(2)_DC[P21](21-2016)-e 2 Misalignment of Services

6. One of the aims of the clustering arrangement is to cater for the different needs of patients throughout the course of their illness through vertical integration of services from acute, extended, primary to community care. As mentioned in the preceding paragraph, residents in the WTS District often seek medical care from KCC hospitals, namely the Queen Elizabeth Hospital (QEH) in the case of acute medical care. However, he / she will be followed up upon discharge by the community care team and primary care team (General Outpatient Clinics) of his / her own residential cluster, which is KWC. Such separation of care by two clusters is not conducive to the continuity of care. Another district calling for attention is Yau Tsim Mong (YTM). While the catchment districts of most of the clusters in HA are in line with the district boundaries under the District Administration Scheme, the YTM District is covered by two clusters. Despite the physical proximity of these three areas, residents in Mongkok are served by KWC while those in Yau Ma Tei and Tsim Sha Tsui by KCC. This has negative impact on the provision of continuous care to the residents of the above districts.

7. There is also service misalignment for extended care between KWC and KCC. Due to the current cluster networking arrangement, patients from the WTS District, after having been stabilized in QEH, are frequently transferred to the Kowloon Hospital (KH), the network hospital of QEH, for extended care. Vice versa, patients from the YTM District often received rehabilitation services in the Wong Tai Sin Hospital (WTSH) after receiving acute care in the Kwong Wah Hospital (KWH) in view of WTSH’s association with KWH under KWC. As the length of stay for extended care is relatively long, such arrangement often poses inconvenience on patients, their families and carers as the extended care hospital concerned is comparatively far away from the patients’ district of residence.

Action

8. To address the above issues, HA will regroup the WTS District and Mong Kok area from KWC to KCC. With such regrouping, KWH, WTSH and Our Lady of Maryknoll Hospital (OLMH) will be re-delineated from KWC to KCC to support the new KCC catchment districts which will cover Kowloon City, YTM and WTS Districts. It is anticipated that the above regrouping will have the following impact on service:

(a) Cross-cluster service utilization will be reduced with KCC’s inpatient services being provided for patients residing outside its catchment districts to be reduced from 62% to 30% (cross-cluster service utilization cannot be totally avoided due to a number of reasons e.g. patient choice, availability of highly specialized services in a few designated centres only, etc);

5(2)_DC[P21](21-2016)-e 3 (b) Proportion of WTS residents receiving inpatient services in other clusters will drop from 68% to 18%; and

(c) More patients (about 87%) from YTM District can receive inpatient services in its designated cluster viz. KCC.

On top of the above benefits, there will be a better balance in terms of population distribution and number of hospital beds per 1 000 geographical population of catchment districts among the three Kowloon clusters after the regrouping exercise. Overall speaking, there will be a positive impact on patients’ access to service in these three clusters.

Implementation Plan

9. The administrative arrangement for the regrouping exercise will take effect by late 2016. By administrative arrangement, it will mean the change of line accountability, viz the change of reporting line of Hospital Chief Executive of the affected hospitals to the Cluster Chief Executive of the receiving cluster, and the associated line management arrangement at senior level. Patient service will not be affected. Any change to service organization will only be implemented when the relevant supporting structures and functions are ready, with overall plan and key action steps mapped out to ensure smooth transition during the change.

10. To steer the project, HA has set up a steering group chaired by Director (Cluster Services) to lead and coordinate the whole process with relevant stakeholders involved. Sub-groups on the key functional / support areas have been formed to identify issues and work out solutions for the regrouping exercise. The major milestones with time-lines for the whole regrouping project are summarized in the ensuing paragraphs.

Reorganization of Healthcare Services within the New KCC and KWC

11. The regrouping exercise will need to be supported by a number of service reorganization initiatives in order that effective service integration, collaboration and networking can be achieved. Such reorganization must be carried out with great care so that continuity of patient care will not be jeopardized during the service reorganization period when new networks for different services are being put in place. The reorganization of care will take into consideration the supporting network across healthcare services at acute care, extended care, primary care and community care levels for patients from different catchment districts in the two affected clusters. This will be a complex process involving not only reorganization of service networks and realignment of services, but also redeployment of staff and reallocation of financial resources. There will also be infrastructural issues to be resolved. In this connection, the various

5(2)_DC[P21](21-2016)-e 4 sub-groups under the Steering Group have been tasked to formulate the detailed implementation plan for different functional / support areas. A preliminary implementation plan for the whole regrouping exercise, consolidating input from the sub-groups and relevant stakeholders, will be submitted to the HA Board for comments in end 2Q2016 while the final plan will be submitted to the HA Board for endorsement in 3Q2016. Implementation will take place by phases from 4Q2016 onwards, taking into account the redevelopment of KWH and the commissioning of the new acute hospital in the Kai Tak area.

Demand and Capacity Evaluation of Kowloon Clusters

12. On top of the re-delineation of cluster boundary between KWC and KCC to improve the continuity of care for patient management, HA will re-evaluate the demand and capacity gaps within the individual clusters of KCC, KWC and Kowloon East Cluster (KEC), taking into consideration the impact of cluster boundary realignment, and taking reference to the service demand projection up to 2026. The result of analysis, expected to be ready by 3Q2016, will serve as a guide for facility planning, workforce building, as well as future resource planning and allocation. Any subsequent development will be addressed through the annual planning and resource allocation exercises.

Stakeholder’s Interests and Engagement Plan

13. Full engagement and consultation of various internal and external stakeholders including staff, governing bodies of the affected hospitals, District Councils, patient groups and community are in progress. This will be an on-going exercise with feedback received during the process to be incorporated into the implementation plan, where appropriate.

Interim Measures

Rationalization of Acute-rehabilitation Service Arrangement

14. A pilot project to provide same district medical rehabilitation service for target patients residing in the WTS and YTM Districts after they have stabilized in acute hospitals was launched in August 2015. This is a new acute-rehabilitation patient-flow arrangement for QEH/WTSH and KWH/KH where WTSH and KH have each designated medical rehabilitation beds for cases referred by QEH and KWH respectively. This pilot project will help identify and iron out issues arising from change of network hospital for acute-rehabilitation services provided for patients in WTS and YTM Districts, and facilitate smooth provision of acute- rehabilitation services in the same geographical setting upon re-delineation of cluster boundary.

5(2)_DC[P21](21-2016)-e 5 Review of Geographical Boundary for Ambulance Brought-in Patients

15. HA will continue to work with the Fire Services Department to conduct regular review on the Kowloon ambulance catchment areas with a view to exploring improvement opportunities for refinement to enable more speedy access to patient care in the districts.

Benefits

16. A summary of the implementation plan is in the Appendix. In the long run, this regrouping exercise will have the following benefits on patient services:

(a) With such re-delineation, more effective vertical integration of care from acute phase to extended, primary and community after-care can be achieved. This facilitates the provision of continuous care to patients through the network of medical facilities in the vicinity throughout the patient’s episode of illness.

(b) For WTS residents, they can be transferred to WTSH near their residence for extended care after they have been stabilized in QEH.

(c) For YTM patients, rehabilitation services can be continued in the nearby KH after they received acute care in KWH.

(d) After the cluster boundary re-delineation exercise, demand and supply on non-emergency services across clusters will be better aligned. This will help achieve better parity in waiting time for non-emergency services, irrespective of the patient’s district of residence. The issue of waiting time is being addressed separately under the implementation plan for another recommendation of the SC.

Follow-up

17. HA will continue to engage and consult the various internal and external stakeholders including staff, governing bodies of the affected hospitals, District Councils, patient groups and community, with feedback received during the process to be incorporated into the implementation plan, where appropriate. Furthermore, the HA Board, together with its functional committees and the governing board of the concerned hospitals, will actively monitor the progress of planning and implementation of the above initiatives to ensure that they will progress as planned. As part of HA’s accountability to the Government and to the public, regular reports will be submitted to

5(2)_DC[P21](21-2016)-e 6 FHB, the legislature and District Councils for progress updates, feedback and comments. The above plan is only a preliminary proposal. HA will improve the plan taking into account feedbacks and comments received, with updates to be provided to District Councils at appropriate times.

Advice Sought

18. Members are invited to note and comment on the plan for re-delineation of cluster boundary as detailed in paras 8 - 17 above.

Hospital Authority Ref: HAD WTSDC 13-5/5/53 Pt.42 March 2016

5(2)_DC[P21](21-2016)-e 7 Appendix

Summary of the Implementation Plan

Strategic Goal and Target Action Timeline Re-grouping of WTS 1. Consult stakeholders, both internal 2015/16 district and MK area (KWH, (staff, governing bodies of WTSH and OLMH) from concerned hospitals, etc.) and KWC to KCC external (District Councils, patient groups, community, etc.) 2. Effect administrative arrangement Late 2016 for the re-grouping exercise 3. Re-organise care provision within Seek HA Board’s comments the new KCC and implement on preliminary plan in 2Q associated changes in KWC, 2016 having regard to  service planning and Seek HA Board’s coordination, taking into endorsement on detailed consideration supporting implementation plan in 3Q network across healthcare 2016 services at acute care, extended care, primary care Implement by phases from and community care levels 4Q 2016 onwards, taking into  service alignment with account KWH redevelopment partners beyond HA, e.g. FSD (target 2023) and the new and NGOs acute hospital in Kai Tak area  associated staff arrangement, (Phase 1 target 2021) relocation of resources  infrastructure issues 4. Evaluate demand and capacity gap Result of analysis for Board’s in KCC, KWC and KEC, taking endorsement in 3Q 2016; and reference to service demand implementation through projection up to 2026 subsequent annual planning exercises Interim measures for quick 5. Pilot project to drive for better August 2015 launched enhancement vertical integration between acute (a) Rationalise and rehabilitation service for target acute-rehabilitation patients residing in WTS and YTM service arrangement Districts (b) Refine geographical 6. Fine-tune the Kowloon ambulance Ongoing boundaries for catchment areas to enable more ambulance catchment speedy access to patient care in the areas districts

5(2)_DC[P21](21-2016)-e 8