LegCo Paper No. CB(2) 380/95-96
[These minutes have been seen by
the Administration]
Ref: CB2/PL/HS/1

LegCo Panel on Health Services

Minutes of Meeting held on Monday, 9 September 1996 at 8:30 a.m. in Conference Room B of the Legislative Council Building

Members Present :

Members Absent :

Public Officers Attending :
Health and Welfare Branch

Mr Derek B GOULD: Deputy Secretary for Health & Welfare (Acting)
Miss Helen TANG: Principal Assistant Secretary for Health & Welfare (Acting)
Mr Daniel CHENG: Assistant Secretary for Health & Welfare
Miss WONG Yuet-wah: Assistant Secretary for Health & Welfare
Department of Health: Dr S P MAK
Deputy Director of Health (Acting): Dr Constance CHAN
Principal Medical & Health Officer

Hospital Authority

Dr W M KO: Deputy Director, Hospital Authority

Government Supplies Department

Mr Nigel SHIPMAN, JP: Director of Government Supplies

Education and Manpower Branch

Mr A M REYNALDS: Principal Assistant Secretary for Education and Manpower
Mr Brian L COAK: Deputy Secretary General, University Grants Committee
Mr WU Kam-yin: Assistant Secretary General (Policy), University Grants Committee
Miss Angelina FUNG: Assistant Secretary for Education and Manpower

Attendance By Invitation : Hong Kong Medical Association

Clerk in Attendance :

Ms Doris CHAN: Chief Assistant Secretary (2)4

Staff in Attendance :

Mr Alfred CHAU: Senior Assistant Secretary (2)4

Closed Meeting

Open Meeting

I. Confirmation of minutes of meeting held on 10 and 18 June 1996

Matters arising from the minutes of meeting on 18 June 1996

II. Renewal of contract of medical gas supply to HA

III. Private practice by university medical consultants and specialists

IV. Follow-up on role and governance of Prince Philip Dental Hospital (PPDH)

V. Consultation Paper on the Draft Reproductive Technology (RT) Bill

IV. Disclosure of identity and qualifications of locums

Date of Next Meeting

Closed Meeting

1. Dr LEONG Che-hung outlined his main concerns in respect of agenda items II and IV for members' information.

2. The Chairman suggested and members agreed to swop the order of agenda items III and IV.

Open Meeting

I. Confirmation of minutes of meeting held on 10 and 18 June 1996

(LegCo Paper Nos. CB(2) 2036 and 1979/95-96)

3. The minutes of meetings held on 10 and 18 June 1996 were confirmed.

Matters arising from the minutes of meeting on 18 June 1996

4. Dr LEONG Che-hung reminded the Administration to provide the requested information on the implementation of recommendations of the Expert Working Group on Occupational Health Services. The Clerk said that the English version of the Administration's response was already received and would be circulated to members as soon as the Chinese version was available

II. Renewal of contract of medical gas supply to HA

(Appendix I of LegCo No. CB(2) 2079/95-96)

5. Mr Nigel SHIPMAN highlighted the main points in the information paper. He pointed out that the Hong Kong Oxygen and Acetylene Co. Ltd. (HKO) was the only supplier able to meet the conditions and the contract was renewed with sufficient flexibility for Government and HA to try out other acceptable alternative sources during the five-year contract period.

6. Mr Howard YOUNG inquired about the present status of the break clause mentioned in paragraph 7 of the paper. Mr SHIPMAN said that Government would have preferred three years but from the point of view of HKO, it would require higher prices if the contract was for three years. He pointed out that the five-year contract allowed a wide quantity variation and Government could obtain up to 50% of the total requirement by the end of 1997/98 from other sources, if suitable alternatives could be found.

7. Dr LEONG referred to paragraph 3 of the information paper and said that since the VIE tanks installed within the hospitals were not to be used by other suppliers, Government would have to rely on HKO infinitely and asked why the Administration had allowed itself to be held to ransom. Mr SHIPMAN explained that when the tanks came up for replacement, HA would acquire ownership of the new tanks. He added that HKO was the only local producer of oxygen, which allowed the Administration to carry out full inspection and validation. For suppliers from outside Hong Kong, there was a need to ensure that they were up to standard. Dr LEONG said that he could not accept Mr SHIPMAN's argument. He declared that he was a member of HA and asked how long it would take for the 42 existing hospitals to have their VIE tanks replaced. He pointed out that HKO had repeatedly produced wrong supply of gas and opined that introducing competition was the only way to improve the present situation.

8. Dr LAW Chi-kwong referred to paragraph 6(b) of the information paper which indicated an estimated 50% of the total requirement could be obtained from other sources by the end of 1997/98 and said that he was confused by the arithmetic. Based on his own calculation only 35% was possible. Mr SHIPMAN replied that it was a theoretical possibility subject to satisfactory sources of supply, an estimated annual growth of 10% and other assumptions.

9. Referring to paragraphs 4(a) and (b), Dr LEONG asked the Administration to elaborate what the required standards were when assessing suppliers. He pointed out that it was ironical to learn that while assessment of suppliers was in progress, the Administration signed a five year contract with HKO under secret negotiations without an open tender about eight months before the expiry of the existing contract. It would not be fair to those suppliers who planned to improve in order to meet the required standards before February 1997. Mr SHIPMAN said that high standards were laid down in the five-year contract with HKO, such as quality standards at ISO 9002 which no other supplier could meet. Other quality assurance measures included a requirement to supply cylinders with British pharmaceutical standard labelling and bar code identifications and back-up storage for medical oxygen. The Administration would gradually bring in new suppliers meeting the required standards, possibly by putting them on a trial scheme first.

10. Dr LEONG asked the Administration to explain why the contract renewal date had been advanced and what guarantees were provided in the contract to ensure safety which was more important than costs. Mr SHIPMAN explained that the new contract with retrospective effect from March 1996 was brought in after considering the price offered which was 4.2% lower than the current price for oxygen. He pointed out that it was assessed by the Central Tender Board to be in the interests of Government. As regards safety measures, he said that since 1989, HKO had reviewed production procedures as recommended by an external consultant from the United Kingdom and had met the requirements for "Good Manufacturing Practice" in European Union and ISO9002 standards.

11. Referring to paragraph 6(c) of the information paper, Mr Howard YOUNG asked for information on the prices of medical gas supplies from overseas and in China. Mr SHIPMAN replied that those factories in Guangdong Province in China met Chinese National Standards and the acceptability of medical gas suppliers in PRC was being studied by the relevant experts after a visit in June. As regards prices, they were difficult to obtain and evaluate due to differences in quality levels, volume requirements and container sizes. However, in response to an open tender for the supply of a VIE tank and medical oxygen to the North District Hospital (NDH), four bids were received which would enable them to evaluate prices from other sources.

12. Mr MOK Ying-fan requested Mr SHIPMAN to answer Dr LEONG's question on why the Administration had entered into a contract with HKO about eight months before the expiry date of the current contract. He opined that patients' safety outweighed financial savings and asked when bar coding of the cylinders would be completed. Mr SHIPMAN said that the contract was deliberated by the Central Tender Board and was judged to be in the long term interest of the Government and HA. On Safety Standards, HKO met the ISO9002 standards and was required to install bar-coding devices for cylinders in the new agreement. Dr W M KO added that from HA's point of view, the need to introduce competition was agreed. In the process of renewal of contract, they did not only look at costs but quality assurances as well. One of the main reasons for renewing the contract with HKO was to ensure continuity of supply as it would not be possible to switch to a new supplier overnight. He agreed with Mr SHIPMAN that the new contract allowed HA to put new suppliers on a pilot scheme while maintaining a good supply of medical gases.

13. Dr LEONG asked the Administration to elaborate on the safety provisions in the new contract, and to indicate when legislation on the control of medical oxygen would be introduced. In reply, Mr SHIPMAN referred to paragraph 6(a) of the information paper which described the improvements including bar-coding of the cylinders and provision of back-up storage of medical oxygen for hospitals on Hong Kong Island. In addition HKO would also be required to provide quality assurance certificates for liquefied gases. As regards legislation, Mr Derek GOULD said the Health and Welfare Branch would bid for a legislative slot to amend the Pharmaceutical Ordinance in the second half of 1996/97. Dr LEONG commented that those improvements mentioned in Mr SHIPMAN's reply were items which HKO promised to improve after the incident in 1989 , and therefore he could not accept them as new initiatives to improve its standards.

14. Dr LAW Chi-kwong inquired whether a feasibility study had been carried out to determine the sales volumes and the market share for competitors to survive. He further asked whether the VIE tank at NDH would be owned by HA or HKO.

15. Mr MOK Ying-fan observed that despite the incident in 1989 the Administration had done little to improve the situation and had allowed the monopoly to continue.

16. In reply to Dr LAW's questions, Mr SHIPMAN said that the VIE tank at NDH would be owned by HA. He pointed out that although there was no feasibility study on market share, other bidders in the open tender had factories in China and had an existing level of business in supplying medical gases to hospitals in the region.

17. The Chairman asked whether the introduction of new medical gas suppliers must wait until the existing VIE tanks were replaced and whether there could be any technical difficulties in changing to other suppliers. He further enquired whether HKO would continue to be the sole supplier in the event that prices of HKO's supplies and service rocketed in the fourth and fifth year under the new contract. Mr SHIPMAN replied that there were price control measures specified in the new contract to regulate the prices so that they would not increase drastically. Dr KO added that HKO owned the VIE tanks, but there were plans to purchase VIE tanks subject to availability of funds. As regards the life span and cost of VIE tanks, Dr KO undertook to provide relevant figures to the Panel. He added that HA was considering the feasibility of using the Pressure Swing Absorber technology to supplement the supply of medical oxygen in hospitals.

Adm

18. The Chairman pointed out that the ownership of VIE tanks had enabled HKO to monopolize the supply of medical gases and requested the Administration to provide the following information:

Adm

the average life span of a VIE tank;
the price of purchasing a VIE tank; and
the number and the remaining life span of existing VIE tanks in each hospital; and
what steps were being taken to ensure that HKO could not monopolize.

19. Dr LEONG requested the Administration to furnish the Panel with relevant excerpts relating to the following matters in the new contract;

Adm

the safety clauses; and
price increases and price control measures.

Mr Howard YOUNG pointed out that the replacement cost of VIE tanks should be provided.	Adm
20. Mr SHIPMAN agreed to provide to the Panel extracts of the safety clauses in the new contract and provided the unit prices for VIE oxygen as follows:	Adm

Unit price per cubic meter of oxygen
(a) first three years	$6.8
(b)the fourth year	$7.1
(c) the fifth year	$7.4

III. Private practice by university medical consultants and specialists

(Appendix III of LegCo Paper No. CB(2) 2053/95-96)

21. The Chairman informed representatives of the Administration agenda item IV would be discussed first to be followed by item III.

22. Dr LAW Chi-kwong declared interest as an employee of the University of Hong Kong and Dr LEONG Che-hung also declared interest as a private medical practitioner.

23. Referring to paragraph 2 of the information paper, Dr LEONG Che-hung questioned the need to encourage university academic staff to undertake outside work in order to keep in practice in their profession and keep abreast of the latest practice. He considered that the same objectives could be achieved by attending public patients. He pointed out that possible abuses of the system would arise and it was not right for those full-time staff receiving salaries paid by tax-payers' money to utilize their time and university facilities for private practice and keep some of the income. It would also cause unfair competition among medical practitioners in private practice. Mr Brian COAK pointed out that both he and Mr WU Kam-yin were new to their posts. He explained that as the University Grants Committee (UGC)'s role was to discuss strategic matters, it would be difficult to answer questions on how the institutions were run as they took care of their own administrative matters. The common principle of all institutions was to advance learning by teaching, research and scholarship and the teachers were encouraged to take up outside work requiring specialised skills. Dr LEONG said that his questions were not answered and that he could not understand why only private practice could advance learning. He reiterated that it was not right to use public money and time to increase their income.

24. Mr Brian COAK said that the tertiary institutions received recurrent block grant allocation for each triennium and capital projects on an annual basis and research grants through the UGC and the Research Grants Council. The UGC avoids undue intervention in the affairs of the institutions or macro - manage them. He also expressed that it was "totally taboo" for them to say to universities on what they should do. He opined that university staff would be in a better position to answer the questions and would invite them upon request. The Chairman then invited comments from the Education and Manpower Branch (EMB). Mr A M REYNALDS said that he would provide a written response. Dr LEONG commented that it was very unsatisfactory to have meetings with representatives who were unable to provide answers. Referring to the taboo, he asked how the universities were controlled to avoid possible abuses of public funds. Mr COAK stated that in terms of regulations, university staff eligible to take-up private practice should obtain approval from their department heads before taking up private practice. Any income derived from private practice had to be reported and split according to the guidelines made by the Councils of respective universities.

Adm

25. Dr LEONG Che-hung requested UGC to produce figures on the income generated by private practices and how the incomes were disposed of. He also asked for a comparison of private practice earnings and the salary of the staff concerned. Mr COAK agreed to obtain those figures and commented that the regulations were quite sound and strict compared with those of the Administration.

Adm

26. Dr LEONG referred to a complaint letter in the press which showed that there was a possible lack of control and asked whether there was a monitoring system. Mr COAK said that it would be a matter for the universities to answer.

27. Mr Howard YOUNG asked for more information on the checks and balances governing private practice, and on how to ensure that the objective of keeping abreast of the latest practice was being achieved. Mr COAK said that the universities were in a position to ensure that the system was monitored satisfactorily and that the procedures were adequate.

28. The Chairman asked EMB as the vote controller to explain what mechanism existed to ensure that the funds were well spent. Mr COAK pointed out that as far as funds for the universities were concerned, the Secretary General of UGC was the controller, but the universities had autonomy over the use of such funds. As far as accountability was concerned, the universities were accountable to the community. He added UGC Secretariat released the funds and kept records of accounting matters. However, within the institutions, the vice-chancellors decided the allocation of funds. As regards mechanism for monitoring the proper use of funds, Mr COAK said that Members of the LegCo were in a position to monitor how the grants were used and agreed to direct views and concerns in this regard to UGC. He reiterated that the administration of the institutions was not a matter for UGC. UGC was a non-statutory body advising the Government on tertiary education strategies on the development and funding needs of higher education. The Secretary General of the UGC monitored and released the funds as agreed but once released, the universities were responsible for how the funds were spent.

29. Dr LEONG Che-hung requested the Chairman to ensure that there would be representatives able to answer members' questions in future. He further asked the Administration whether there was a policy that if there were insufficient funds for research projects, academic staff of the universities could go outside to make money.

Adm

30. Mr REYNALDS said that he was not aware of any policy to cut back research funds. He informed the Panel that a Research Grant Council (RGC) was set up in 1991 and it was keen to spend more money on researches. The Chairman then requested EMB or UGC to confirm whether the deans of faculties concerned had reflected their views to EMB or UGC about insufficient funds for research. Mr COAK said that as regard research funds provided by the UGC/RGC the projects were supported by direct allocation, and by grants awarded via a process of external peer review through competitive bids and from the UGC Central Allocation Vote. Government also provided funding for research projects in addition to those allocated by UGC/RGC. Mr COAK agreed to provide the Panel with the numbers of applications and amount of research funds. The Chairman asked whether the institutions were encouraged by UGC to seek more funds for their research projects. Mr COAK said that UGC wanted to improve the research culture and the quality of research in HK and RGC was satisfied with the present direction in respect of the amount and the quality of research. UGC would therefore support more funds for researches.

Adm

31. Dr LEONG Che-hung asked whether it was the policy of the Administration to encourage the institutions to make more money through private practice to complete more researches. Mr COAK said that over 1000 applications were received this year and a good proportion of them was approved. He stated that the universities with their own incomes could spend them on researches not funded by UGC. Miss Angelina FUNG added that the amounts for researches and the number of research applications had been increasing during the past three years. Regarding private practices, She pointed out universities encouraged staff to engage in private practice to keep abreast of the latest practice. Those applications solely based on financial gain would not be approved. Members agreed that further discussion would be necessary.

IV. Follow-up on role and governance of Prince Philip Dental Hospital (PPDH)

(Appendix II of LegCo Paper No. CB(2) 2053/95-96)

32. In response to the Chairman's question on whether there were representatives from PPDH, Mr COAK said that the Administration had held discussions with PPDH and did not invite representatives to attend on this occasion as the UGC members were in session and the UGC Secretariat was totally committed in supporting UGC members at the time. Mr COAK agreed that UGC would answer questions as far as possible.

33. Referring to the table in Annex A which showed that a professor and a reader each spent 98% of their time on clinical work on private patients, Dr LAW Chi-kwong asked the Administration to explain why they spent a large proportion of their time on private practice. Mr WU Kam-yin clarified that the university's regulations provided for two sessions on clinical work out of ten sessions in an average week and it was within the university limits. Dr LAW pointed out that clinical work was different from private practice, and asked why UGC did not require PPDH to provide clarification. Mr WU said that PPDH carried out monitoring activities and would recover all direct costs related to private patients. Each department head was required to prepare an annual report to the Faculty Board and the Director of Finance of the University.

The report was placed before the University Council. He added that this included information on clinical private practice.

34. Dr LEONG Che-hung queried whether it was acceptable to the Administration that a full-time PPDH staff spent 98% of his time on private practice, and commented on the "black-box operation" of the Faculty Outside Practice Committee (FOPC). He further asked how the checks and balances worked at PPDH. Mr COAK replied that the dean of the faculty would be responsible and accountable for this.

35. In view of the high proportion of time spent by full-time staff on private patients, Dr LEONG Che-hung asked whether it was possible that teaching was done by part-time staff. For student contact hours, Dr LEONG asked for information on the proportion of time offered by full-time staff and by part-time staff. Dr LEONG also asked whether there was a referral system at PPDH and whether patients not classified as teaching patients might subsequently be referred to staff of PPDH as private patients.

Adm

36. Mr COAK said that representatives from the faculty concerned should answer such questions on practices. The Chairman asked the Administration to provide written replies to members' questions and would advise the Administration whether representatives from the faculties concerned should be invited when the subject was next discussed by the Panel.

Adm

V. Consultation Paper on the Draft Reproductive Technology (RT) Bill

(Appendix IV of LegCo Paper No. CB(2) 2053/95-96)

37. Dr LEONG Che-hung declared that he was a member of the Provisional Council on Reproductive Technology. Dr Constance CHAN sought members' views on the three major issues in the paper, namely, sex selection achieved by means of RT procedures, use of fetal ovarian/testicular tissues in infertility treatment or in research, and licensing system. The Chairman pointed out that the Panel needed more time to discuss the paper.

38. Dr LAW Chi-kwong agreed with the Chairman and found that there had not been sufficient public discussion on the paper. It would be difficult to express views at this meeting before knowing how the public had reacted to the ethical issues. Dr LEONG Che-hung asked the Administration how the paper was promoted to the public and how their views and comments were collected. Mr GOULD said that because of the technical nature of the subject, a general community response was not expected. Ethical implications of RT were being examined by a subcommittee of the Provisional Council. Dr Constance CHAN said that a press conference on the consultation paper was held in July this year and more than 2000 copies were distributed through the District Offices of the Home Affairs Department. Copies were also sent to medical associations, nurses associations, the health sector, the social welfare sector, religious bodies, District Boards and interested parties. The paper was also available on the Internet. It was planned to issue a press release inviting response to the paper next week.

39. The Chairman asked how the Administration would approach those interested parties such as religious bodies and ethical associations which did not respond to the topic at an earlier stage. Dr Constance CHAN said that with the assistance of different organizations, the Administration had obtained lists of interested parties and had sent out copies of the paper to invite them to comment. Letters were also sent to remind interested parties of the deadline of the consultation period. Nine responses had been received so far

40. Mr GOULD said that the Bill would be introduced into LegCo in mid January 1997.

IV. Disclosure of identity and qualifications of locums

41. Dr KWOK Tin-fook of the Hong Kong Medical Association (HKMA) attended for this item .

42. The Chairman briefed members on the background of the item. There had been complaints about not having notices of substitute doctors displayed and that some locums did not disclose their identities and qualifications even upon requests. The Chairman opined that the patients, who were also consumers, had the right to consult doctors with the expected qualifications, and asked the Administration which government departments would handle such complaints. Dr S P MAK replied that complaints of that nature should be forwarded to the Hong Kong Medical Council which would investigate them. Dr MAK said that the Medical Council had issued code of practice to medical practitioners. Dr LEONG Che-hung said that there were grey areas in the code of practice of the Medical Council and requested Dr MAK to bring the matter to the attention of the Medical Council.

Adm

43. In reply to the Chairman's question on the difference between registered doctors and registered clinics, Dr S P MAK clarified that registered clinics referred to non-profit making clinics registered under Cap. 343 of the Laws of Hong Kong which would be monitored by Department of Health (DH).

44. From a consumer's point of view, the Chairman said that it was not fair to a patient to go to see a doctor of his choice but was instead seen by another doctor in whom he might have not confidence. He asked whether there were regulations on this matter apart from professional ethics. Dr MAK said although it was a matter of patients' rights, professional ethics were also involved. She agreed to reflect members' views to the Medical Council. Dr LEONG Che-hung suggested to include in the professional guideline a simple practice of showing the name and qualification of the locum. Dr MAK agreed to reflect his suggestions to the Medical Council. She pointed out that the rights and responsibilities of patients could also be promoted through various bodies such as the HKMA, the Consumer Council and Hospital Authority.

Adm
Adm

45. Dr KWOK Tin-fook commented that the incident was an isolated case and from his contacts and experience, problems like those seldomly occurred. It would be a common sense and good professional practice to advise the patients about any change in the doctors they were consulting. In response to the Chairman's questions, he clarified that he agreed that locums should disclose their identities and qualifications. He added that as far as he was aware, the medical profession had maintained a high standard in this regard. He agreed to reflect the matter to their members in their newsletters.

45.Dr KWOK

Date of Next Meeting

46. The Chairman reminded members that the next meeting would be held on 3 October 1996 at 12:30 p.m.

47. The meeting ended at 12:00 noon.
LegCo Secretariat
7 November 1996

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Last Updated on 19 Aug, 1998