HOSPITAL AUTHORITY ANNUAL PLAN 2005/06 Table of Contents EXECUTIVE SUMMARY 1 PLANNING BACKGROUND 1. Introduction 10 2. Review of Progress 13 3. Planning Environment 14 4. Budget Allocation 17 MAJOR DIRECTIONS AND PROGRAMME INITIATIVES FOR 2005/06 HA ANNUAL PLAN 5. Major Directions for HA Annual Plan 2005/06 20 6. Improving Population Health 22 7. Enhancing Organisational Performance 25 8. Enhancing Healthcare System Sustainability 30 9. Improving Service Quality and Clinical Governance 34 10. Building Human Resources Capability 40 CLUSTER PLANS 11. Hong Kong East Cluster 45 12. Hong Kong West Cluster 50 13. Kowloon East Cluster 54 14. Kowloon Central Cluster 58 15. Kowloon West Cluster 62 16. New Territories East Cluster 66 17. New Territories West Cluster 70 Hospital Authority Annual Plan 2005/06 i Table of Contents APPENDICES Appendix 1: List of Public Hospitals and Institutions 74 Appendix 2: List of Ambulatory Care Facilities 75 Appendix 3: Background Information on Hospital Authority 79 Appendix 4: Statistics of the Controlling Officer’s Report 81 ii Hospital Authority Annual Plan 2005/06 Executive Summary OVERVIEW 1. The Hospital Authority (HA) is responsible for delivering a comprehensive range of hospital, outpatient and community-based services through its network of healthcare facilities. As part of its commitment to enhance accountability and transparency to the community, it has been publishing its Annual Plan since 1992/93, which provides a structured mechanism for the organisation to turn its corporate vision and directions into strategies, goals and operational targets. 2. There are a number of major changes in the external and internal environment of HA that shape the major directions adopted and presented in this Annual Plan for 2005/06: (a) Key people changes after the SARS epidemic could have important bearings on the healthcare environment as well as the work of HA. These included succession for the positions of the Secretary for Health, Welfare and Food (SHWF), the HA Chairman and the former Director (Professional Services & Human Resources). There were also succession of the Director of Health, Deputy SHWF (Health), Dean of the Medical School of the Chinese University of Hong Kong, and new legislators representing the medical and health services constituencies respectively; all five had been appointed to the HA Board, together with other new members. At the senior executive level, there were new recruitments and reshuffling of portfolios involving Directors, Deputy Directors, Heads of divisions, and three of the seven Cluster Chief Executives. Meanwhile, the HA Board decided that for stability sake, the seven cluster management structure would remain unchanged for three years. (b) It has been almost two years after the SARS epidemic, yet the organisation still needs to invest very significant resources into tackling the aftermath of SARS. These include continuous multi-disciplinary care for the SARS victims some of whom still suffer complications of this new disease the natural course of which is not completely known, continuous processing of injury-on-duty claims under the Employees Compensation Ordinance together with HA’s insurer on more than 300 cases, providing assistance to the Labour Department in ascertaining the degree of disabilities in some, and managing other legal claims. Other work includes continuous vigilance and response to hospital infectious disease outbreaks and those in neighbouring countries/areas, construction of an Infectious Disease Block in Princess Margaret Hospital, preparing for possible influenza pandemics, continuous effort to strengthen workforce capabilities in infectious diseases management, intensive care and microbiology, enhancing occupational safety and health, and changing practices in hospitals regarding infection control. (c) Meanwhile, the organisation is facing increasing financial difficulties because of continuous budget cuts year on year. Despite very stringent savings measures, across-the-board salary reductions, lowering of staff packages for new recruits, voluntary retirement schemes to promote staff turnover, and because of the need to continuously absorb new healthcare graduates into the Hospital Authority Annual Plan 2005/06 1 Executive Summary workforce to provide training and fill service needs, reduction in overall cost of running the service could not catch up with the reduction in Government funding. Budgetary deficits since 2001/02 have gradually depleted the general reserve of the HA. Major measures are urgently called for both in terms of improving HA’s financial allocation/revenues and cutting cost. (d) HA is also facing morale problems of staff, who had suffered multiple blows in terms of the SARS epidemic itself, further stress related to the SARS aftermath, yearly budget cuts, and pressure from rising service demands of a growing and ageing population. In addition, there is the sentiment over equal work-unequal pay among new recruits brought on by budgetary realities, lack of promotion prospect and even job security. Workplace violence from hospital users has also been a growing concern. Frontline staff have been stretched to their limits both in terms of numbers and in terms of psychological stress. (e) As regards quality of services, there is also genuine concern on the impact of the budgetary and manpower problems. With limitation of resources in the face of growing demand, HA has embarked on triaging of cases based on clinical parameters to ensure that those with more urgent conditions are identified and given priority treatment. But this will inevitably be at the expense of those with less urgent conditions. The waiting time for the latter had therefore lengthened very considerably during the past year, to an extent that quality started to be compromised. While HA will double its effort to continuously maximise resource use, such worrying trend is expected to worsen until more effective measures are put in place to reverse the impossible situation imposed on the HA. (f) Lastly it is recognised after SARS that there is a need to rebuild the organisation’s image. Internally, staff members have pent up frustrations while not seeing how the public healthcare system is going to be sustainable. Externally, the HA has been described as being not transparent enough in its policy making. The direction is set to involve staff more in working towards solutions and steps have been taken to improve external communication. The perception issue over the incentive award system of senior executives also needs to be addressed. MAJOR DIRECTIONS FOR 2005/06 HA ANNUAL PLANNING New Government Policy Directions 3. The new SHWF, Dr York Chow, had set forth clear policy directions in public healthcare. These include the following: (a) There is a need to re-position the public healthcare services. For the HA, the four priority areas are: 2 Hospital Authority Annual Plan 2005/06 Executive Summary (i) Acute and emergency care; (ii) Services for the low income group and the underprivileged; (iii) Illnesses that entail high cost, advanced technology and multi-disciplinary professional team work in their treatment; and (iv) Training of healthcare professionals. (b) For population health, the Government will forge ahead with anti-smoking legislation, promote Family Medicine practice, and enhance district-based collaboration across departments and agencies. There will be additional Chinese Medicine clinics established through the HA. (c) It is anticipated that there will be a new round of fees revision for public healthcare services to inculcate cost-consciousness and narrow the gap between the public and private sectors. Financial measures will be taken to address the adverse health service seeking behaviour by Non-eligible Person users. In relation to the public private interface, contribution of the private sector in the specialist training of doctors is to be explored. (d) The Health and Medical Development Advisory Committee is to be revived, and Government aims to formulate long-term healthcare financing strategies within the year. Directions Endorsed by the HA Board 4. Together with the emphases expressed by the new HA Chairman and in accordance with discussions of the HA Board at its planning workshop and committee meetings, the key areas of consensus in HA are as follows: (a) Stability is the overriding concern of the HA after the organisation had undergone so much trauma in the last few years especially after SARS. (b) Staff is our greatest asset and to that extent the staff morale issue needs to be urgently addressed. (c) Despite the fiscal constraints, HA cannot sacrifice the pursuit of quality of service, which is the raison d’etre of the organisation. (d) HA will improve the transparency of policy decision-making and implementation, both in terms of staff involvement as well as communication to the public. We will share our achievements and our limitations. (e) Macro measures are required to tackle the severe budgetary problems facing the organisation. Hospital Authority Annual Plan 2005/06 3 Executive Summary MAJOR DIRECTIONS FOR 2005/06 5. Taking the above-mentioned environmental factors and organisational positions into consideration, HA has formulated its 2005/06 Annual Plan along the following five strategic directions: (a) Improving population health (b) Enhancing organisational performance (c) Enhancing healthcare system sustainability (d) Improving service quality and clinical governance (e) Building human resources capability 2005/06 ANNUAL