Replies to LegCo questions
LCQ10: Nursing care in elderly services
Following is a question by the Dr Hon David Li and a written reply by the
Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council
today (June 22):
Question :
I have learned that the leading elderly care services providers in the welfare
sector are facing an extreme shortage of enrolled nurses to provide basic
nursing services for elderly patients. Some positions remain vacant, while
others have to be filled by registered nurses who are overqualified for the
posts. This results in higher cost for welfare agencies and problems of frequent
staff turnover as registered nurses seek employment which is more suitable to
their qualifications. In this connection, will the Government inform this
Council:
(a) whether it has conducted any survey on providers of day and residential care
services for the elderly and rehabilitation services to assess their current and
future nursing establishment needs, the current and projected vacancy rates, as
well as the current and projected rates of employment of registered nurses in
posts designated for enrolled nurses; if so, of the survey results;
(b) whether the rising need for elderly and rehabilitation services to cope with
the aging population was considered by the authorities when they decided to stop
providing training of enrolled nurses in 2000;
(c) whether it will consider reviewing the code of practice for health workers,
in order to enhance their training to the level required to provide simple
nursing care in residential and community settings; and
(d) whether it will consider facilitating the provision of training to
registered nurses working in the welfare sector to enhance their managerial and
supervisory skill?
Answer:
Madam President,
All residential care homes for the elderly (RCHEs) have to be licensed under the
Residential Care Homes (Elderly Persons) Ordinance and are required to maintain
a certain minimum ratio of care staff to residents. There is already a built-in
flexibility in the statutory staffing requirements so that RCHEs are allowed to
employ either health workers or nurses (whether registered or enrolled nurses)
to meet their operational needs. Under the Lump Sum Grant mode, subvented NGOs
are no longer bound by a fixed staff establishment but are free to deploy a mix
of staff to maintain the required care level for elders.
Having said that, we are aware of the difficulties of some NGOs serving the
elderly and people with disabilities in recruiting and retaining nursing staff.
The shortage of nursing manpower experienced by some of them may pose
operational difficulties. In response, the Social Welfare Department (SWD), in
cooperation with the Hospital Authority (HA) and NGOs, has recently organised
two sessions of career talk to students of Higher Diploma in Nursing of Queen
Elizabeth Hospital to familiarise them with the working environment in RHCE and
encourage them to join the welfare sector. We are also actively looking into
other feasible and practical ways to deal with the situation, including the
possibility of providing a one-off training programme of enrolled nurses to
address the specific needs of the welfare sector.
Our replies to the specific questions raised by Dr Hon David Li are as below:
(a) As RCHEs are given staff employment flexibility, we have not conducted
surveys specifically on the nursing staff needs of NGOs providing services to
the elderly or people with disabilities. However, we are monitoring the
situation closely and are keeping in touch with the welfare sector on this.
Looking ahead, the long term requirement for additional nurses, including the
requirement of the public medical sector, the private medical sector and the
welfare sector, is estimated to be about 600 a year. Since the estimated overall
supply of new nursing graduates is expected to increase from 516 in 2005-06 to
567 in 2006-07 and around 600 in subsequent years, there may still be an
undersupply of nursing graduates for a couple more years, but the situation
should improve by 2007-08.
(b) The decision to cease student intake to the enrolled nurses training
programmes run by the HA in July 1999 was in line with the policy of upgrading
basic nursing education to degree level for enhancing the quality of health care
services. One of the main rationales for upgrading basic nursing education to
degree level was to ensure that nurses would be able to work more independently
and better equipped with the necessary skills and knowledge for providing
medical services inside and outside the hospital setting, including in the
welfare setting. We are currently reviewing with the nursing profession and HA
on possible short-term measures to alleviate the shortage of enrolled nurses,
particularly for RCHEs and NGOs.
(c) There were 6,126 health workers in SWD's registry as at mid-June 2005. More
than 73 per cent of them have completed the revamped Health Worker Training
Course introduced in 1999. In comparison with the previous curriculum, the
training hours, number of field visits and practical sessions of the revamped
Course were substantially beefed up. Health workers are already properly trained
to play a supplementary role to nurses in caring for elders in RCHEs.
To enhance vigilance against infectious diseases, each RCHE is now required to
have a designated Infection Control Officer (ICO). With the training jointly
provided by SWD and Department of Health, many health workers are now qualified
to act as ICOs at the RCHEs they are working. SWD will regularly review and
further enhance the contents of Health Worker Training Course in view of the
changing needs of elderly care.
To encourage health workers to engage in skill upgrading, we also provide
financial subsidy for their training. For example, a subsidy of 70 per cent of
the course fees is provided to the trainees of a number of advanced courses on
specific topics, such as "Care Plan and Psychological Health for Elders",
"Management of an Elderly Home", etc., that are tailor-made for health workers
under the Skills Upgrading Scheme (SUS) on Elderly Care organised by the
Education and Manpower Bureau.
(d) As regards training to registered nurses, a number of training institutes
are currently providing self-financing courses for staff of RCHEs, including
registered nurses, to enhance their managerial and supervisory skills. Some
relevant courses are also available under the SUS where 70 per cent of the
course fees is subsidised by the Government. Moreover, NGOs are increasingly
committed to effective human resources development. Some agencies have taken the
proactive step in organising on-the-job training for their staff and put in
place reward systems to encourage staff to seek further training on management
or attend advanced courses in relation to their professional fields.
Ends/Wednesday, June 22, 2005
Issued at HKT 13:59
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