CHAPTER 6
SECURING A MORE EVEN USE OF HOSPITAL BEDS
6.1 The introduction of a regional approach to medical and health services and the establishment of regional administrative offices will make it possible to secure a more even use of the general beds available in Government and Government-assisted hospitals.
6.2 While there is overcrowding in Government hospitals, the occupancy rates in the majority of Government-assisted hospitals are lower than is desirable. This involves an uneconomic use of expensive resources. Not only should the fullest use be made of all beds and equipment but, given the very high cost of acute beds in particular, it is necessary to ensure that patients are treated with the level of staff and facilities which are appropriate to their ailments. A patient is in need of the more specialized facilities for only part of his stay in hospital. Depending on the course of treatment required, therefore, he should continue the remainder of his in-patient treatment in a bed with appropriate but simpler services.
6.3 The maximum use of beds would mean that a patient should usually first attend a general out-patient clinic, or a hospital casualty department in the case of an emergency. Where treatment can be continued on an out-patient basis, but specialist attention is required, the patient would normally be referred to a specialist clinic serving the region and within reasonable travelling distance of his home. If the doctor at a general or specialist clinic considers that in-patient treatment is necessary, the patient will be referred to a district hospital serving the region or to the regional hospital, depending on the treatment required. Subsequently, when his con- dition permits, he would be transferred to a non-acute bed for convalescence, in a district hospital or infirmary. Thus a patient not considered to require highly specialized treatment would not normally be referred to a regional hospital; one whose treatment requires a stay in an acute hospital bed would be transferred to a non-acute bed for convalescence.
6.4 Such, however, is the distribution of hospital beds that to secure these results it is necessary first to improve the adminis-
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trative and organizational integration between hospitals and clinics in the Government and aided sectors that exists at the present time.
6.5 Initially it is proposed that the new integrated arrange- ments will apply only to third class general beds. All Government hospitals will participate and it is proposed to invite in addition the Tung Wah Group of Hospitals, the United Christian Hospital, the Buddhist Hospital and the Caritas Medical Centre to take part from the outset. As experience of the scheme is gained, consideration will be given to the inclusion of other assisted hos- pitals. It is proposed that these new arrangements should take effect on 1st April 1975.
6.6 With the establishment of this integrated structure it will Accident be possible to undertake a detailed investigation of the accident Service. and casualty services. Before the MDAC report was submitted, advice had been received on a number of improvements to these services. It may be that these services should be reorganized into a two-tier system of Designated Accident Centres and Accident Centres***. A reorganisation on these lines could be effected on a regional basis. When the establishment of the new regional structure permits, proposals will be worked out in detail.
Advantages of the
6.7 The introduction of the regional approach should-- (a) ensure that patients are treated with facilities more appro- integrated
priate to their ailments;
hospital structure.
(b) ensure at a time when there is increasing pressure on hos-
pital beds, that the maximum use is made of them; and
(c) improve the accident service.
6.8 To secure the fullest benefits from the proposed scheme, Capital improvements should be carried out to existing hospitals, as Improve- resources permit. The proposals would involve—
(a) raising Kwong Wah to regional hospital capability, adding a new clinical pathology unit, developing the hospital's physiotherapy and medical social services and establishing an occupational therapy unit and 40 additional orthopaedic beds;
*** A Designated Accident Centre would be one equipped and staffed to enable every necessary investigation and treatment of any case of trauma of any part of the body at any time of the day or night.
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ments.