29 February 2020
Bradbury Hospice in Sha Tin, one of the 16 hospitals under the Hospital Authority that provide palliative care services. Photo: HKEJ
Bradbury Hospice in Sha Tin, one of the 16 hospitals under the Hospital Authority that provide palliative care services. Photo: HKEJ

Time for government to boost palliative care services

The Food and Health Bureau recently launched a public consultation on end-of-life care legislative proposals regarding advance directives and dying in place.

Over the years, I have been advocating at-home hospice care in Hong Kong, and I am glad to see that the government is finally aiming to formulate a legal framework under which conflicting laws and policies regarding this issue are either revoked or amended in order to clear the legal hurdles for promoting hospice care at home.

Thanks to advances in modern medicine, there is now a wide variety of medical therapies to extend a person’s life.

However, when a patient is already terminally ill, and stands no chance of recovery, “positive” therapies may no longer have any practical meaning for them.

Instead, palliative care may prove more efficacious when it comes to improving the quality of life, alleviating the physical pain and allaying the edginess of terminally ill patients.

Although the government has begun to divert more resources into enhancing the development of palliative care services in recent years, the coverage remains very low.

According to the Census and Statistics Department, over the past five years, the average number of deaths in Hong Kong stood between 43,400 and 46,900 every year, with 79 percent of them being elderly people aged 65 and above.

Among these deaths, some 40,000, or 90 percent, took place in hospitals. Yet only less than 10,000 of these deceased patients had received palliative care during their hospitalization.

The Hospital Authority (HA) published the Strategic Service Framework for Palliative Care in 2017, which laid down solid guidelines on the service model and development of systematic infrastructure for palliative care. However, the document didn’t go into any detail about manpower needs and talent training involved.

In other words, as far as both hardware and software are concerned, including the number of hospital beds allocated for palliative care and human resources required, there are quite a number of unresolved problems.

Take the number of hospital beds as an example. Based on the information submitted by the authorities to the Legislative Council, as of Dec. 31, 2018, the HA provided 360 palliative care beds, which only accounted for merely 1.2 percent of the 28,000 inpatient beds available in our public hospitals.

Worse still, according to some healthcare professionals, these 360 beds indeed aren’t allocated exclusively for terminally ill patients, but are available to other patients who also need palliative care, such as those suffering from dementia, emphysema and heart failure.

Due to the acute shortage of hospital beds in our public healthcare institutions, it isn’t uncommon for some of the palliative beds to be allocated for patients with emergency medical conditions.

As we can see, the palliative care inpatient service provided by our public hospitals is likely to be affected by bed shortages.

And then there is the problem of human resources. At present, there are only 40 doctors, 300 nurses and 60 allied health professionals under the HA providing palliative care services.

Apart from inpatient treatment, they are also responsible for providing out-patient service, daytime care, home visits and grief counseling.

The workload of palliative care staff has continued to mount over the past five years. For instance, the number of home visits which they paid jumped significantly from 33,199 in 2014/15 to 44,082 in 2018/19.

The fact that the authorities couldn’t even provide the exact figures on how many home visit cases each nurse is actually handling at present and how many additional healthcare workers it is going to recruit to meet the growing public demand indicates that the government simply doesn’t have any long-term planning in terms of manpower and talent training for the future development of palliative care services in our city.

This got me into thinking: since there is such a huge demand for palliative and at-home hospice care services, which is undoubtedly an urgent issue that involves huge public interests, then why didn’t Chief Executive Carrie Lam Cheung Yuet-ngor invoke the Emergency Regulations Ordinance and pass new laws on advance medical directives and at-home hospice as well?

This article appeared in the Hong Kong Economic Journal on Oct 9

Translation by Alan Lee

[Chinese version 中文版]

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Legislative councilor and head of nursing and health studies in the Open University of Hong Kong