LegCo Panel on Health Services

Closed Meeting

I. Fukang tablets

Action

The Chairman introduced a note from the President requesting the Panel to consider the policy aspects of the registration and clinical trial of Fukang tablets Members agreed that clinical trial of medicine should be carried out by the manufacturers themselves. They also noted that the regulation of Chinese Medicine in the long term would be considered by the Preparatory Committee for Chinese Medicine.

II. Items for discussion at the next meeting scheduled for 8 July 1996

2. Members agreed to discuss the following items at the meeting scheduled for 8 July 1996:

1. Charging policy in respect of privately purchased medical items;
2. Report on matters considered by the HMDAC; and
3. Follow-up on role and governance of Prince Philip Dental Hospital (PPDH).

3. It was agreed that the Administration should provide the Panel with information on proposals made by the HMDAC and on the Administration’s conclusions and follow-up action.

4. On the topic of PPDH, Dr LEONG Che-hung invited members’ attention to an article in the South China Morning Post dated 9 June 1996 concerning private practice of some university clinicians. Members agreed to complete the discussion on PPDH first and to deal with private practice of clinicians later.

5. Regarding the review of health care system, the Chairman suggested and members agreed that the discussion should focus on the process of the review.

Open meeting

I. Confirmation of minutes of meeting and matters arising

(LegCo Paper No. CB(2) 1526/95-96

6. The minutes of the meeting held on 6 May 1996 were confirmed.

7. In connection with the role and governance of Prince Philip Dental Hospital, the Chairman and Dr LEONG requested the Administration to furnish the information requested. Mr Donald NG responded that the Administration was collating the relevant information and would forward them to the Panel after receiving the minutes of the meeting on 20 May 1996.

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II. Items for discussion at the next regular meeting scheduled for 8 July 1996

8. The Chairman suggested and Mrs Doris HO agreed that the following items would be discussed at the meeting on 8 July 1996:

1. Charging policy in respect of privately purchased medical items; and
2. Report on matters considered by the HMDAC.

For (b), HWB agreed to provide an information paper on views and recommendations and follow-up actions.

9. Dr LEONG referred to the article in the South China Morning Post concerning the private practice of clinicians from the universities on a regular basis. He queried whether unfair competition might be created and requested information on monitoring such private practice and the changes over the years. It was agreed that the subject would be discussed on 12 August 1996 and the Administration should provide the information requested as soon as possible.

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10. It was agreed that the basis for long-term planning of health and medical services would also be discussed on 12 August 96. The Chairman requested and Mrs HO agreed to provide the Panel with relevant information on the item including demographic characteristics and their projected changes.

[Post-meeting note: The meeting on 12 August 96 was rescheduled to 9 September 96]

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III. Review of the Health Care System - A Tentative Timetable

(Appendix I of LegCo Paper No. CB(2) 1538/95-96)

11. The Chairman stated that the discussion should be focused on the review process as a whole.

12. Dr LEONG requested the Administration to clarify the time-frame of the review in paragraph 2 of the paper, and queried the rationale behind the two models, “Medicare” and “Medisave”. Mrs HO explained that HWB allowed time to consult different parties including doctors and the Hong Kong Medical Association regarding the feasibility of those measures. As to the models, she said there were three schemes on the list and welcomed other suggestions. Dr LEONG agreed that consultation with different parties was necessary and queried why the funding issues were scheduled for discussion in the fourth quarter of 1997. Mrs HO clarified that the exploration of those items did not follow a chronological sequence as indicated by the estimated time for completion and some items were considered concurrently.

13. Mr Howard YOUNG queried the rationale of the pegging of public health care expenditure to GDP or total public expenditure. Mr Derek GOULD explained that HWB adopted a mixed scanning approach to the review where the examination of issues and goals changed from time to time and in this review, the approach considered philosophical and fundamental issues first followed by practical issues on how the system should be designed and developed. However, Mr YOUNG argued that public health care expenditure was just one item of the total health services and did not understand the reason for the pegging. He suggested the review should be oriented towards a need basis and the Financial Branch should decide how the resources should be allocated.

14. Dr HUANG Chen-ya asked whether there was a pre-determined scheme for public health care system when the paper was prepared and detailed his observations to support his views. In reply, Mrs HO said that there were no preconceived ideas about the review and that was why HWB identified and examined many related issues. The Chairman and Dr HUANG then suggested that a public consultation exercise on the review of the health care system be carried out. Mr GOULD pointed out that if a public consultation without meaningful options was conducted, the responses would be fragmented and disjointed, and suggested that feasible options and ranges of the health care system with pros and cons for each one be presented to the public for a meaningful consultation. Dr HUANG remarked that the feasible options and ranges of the health care system in the paper reflected the predetermined schemes of the Administration. He further observed from the information note that a model adopting the “users pay” principle was introduced and queried why other options such as models for preventive medicine, models for cure-oriented medicine, were not examined. The Chairman put a further question to the Administration on how a meaningful and systematic public consultation could be effected. In reply, Mr GOULD pointed out the importance of having a focus in a public consultation without which the general public might criticise the existing system, and the need to consider two issues, namely, service delivery and funding. On a meaningful and systematic public consultation, Mr GOULD stated that different packages would be identified and presented together with their advantages and disadvantages, and public opinions would be solicited on their preferences. Mrs HO added that DH and HA would be involved in the public consultation process. Different options and models would be considered such as gatekeeper’s role, and the roles of primary and tertiary medical care would also be examined.

15. Miss CHAN Yuen-han agreed with members’ observations that there was a pre-determined scheme when the information paper was prepared, and stressed that a public consultation on various options would be necessary which could be held in phases if the subject matter was a complex one. She asked the Administration to detail a plan on how public consultation would be carried out and should the Administration fail to produce the plan, she suggested an overhaul of the review. Mrs HO stressed that the review consisted of different interlocking parts and involved different parties including DH, HA, the insurance sector, and private doctors. Miss CHAN noted that there had been public discussions about the change in the health care system in the past few years and should there be a pre-determined scheme, public consultation was recommended to avoid potential confrontation. Mrs HO reiterated that public views were collected from time to time, for instance in 1993 when objections to on fee-paying schemes were reflected to the Administration. It was those views on which the present review of the health care system was based.

16. Dr LAW Chi-kwong pointed out that the three following important aspects were not dealt with in the review:

1. the relationship between individuals, families, the community, and the Administration;
2. the role and responsibilities of the public and the private sectors in the health care system; and
3. the cooperation and competition between the public and the private sectors.

He further recommended that the Administration should publicize a time-frame for different stages of the review, to invite submissions from the public and to encourage public discussions to synchronise with those stages. Mrs HO explained that a working group on the review had been set up comprising members of HWB, HA and other organizations so that different activities might be initiated and views would be gathered through different channels. Regarding items (b) and (c) above, Mrs HO said that those issues were considered and grouped under items 2 and 3 of the Broad Issues. In reply to Mr MOK Ying-fan’s question on whether there would be a white or green paper for public consultation after the 2-year review, Mrs HO said that no firm plans had been drawn up yet and further plans would be made as the review continued.

17. Dr LEONG Che-hung commented that an action plan (such as a white paper) should be part of the review and recommended that an interim report should be published. He further pointed out that a preventive medical care system should be included in the review in addition to the provision of cure services. Mrs HO replied that the Administration was open to suggestions and there were also reviews and discussions in DH on preventive medical care and health education.

18. In conclusion, the Chairman asked the Administration to focus on the entire process of the review and to improve on the time-table by including the following:

1. the recommendations of the Panel;
2. the different means and alternatives of controlling the growth in the medical costs such as the gatekeeper approach, the preventive approach and so on;
3. the provision of relevant information and papers to the Panel and the public in the event that external consultants on models of medical system were considered; and
4. the public consultations to be made with the general public, professional bodies and organizations; and
5. the stages for publishing interim reports about the progress of the review.

Mrs HO said that the HWB would consider the various suggestions made by the Panel. The Chairman agreed to follow-up the issue in due course.

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IV. Primary Health Care

(Appendix II of LegCo Paper No. CB(2) 1538/95/96)

19. In response to Mr Howard YOUNG’s query on the $2 million recurrent costs for District Health System (DHS), Dr P Y LAM replied that it was mainly for the remuneration of the staff and about 10% of the aforesaid costs was for promotion activities. Upon reallocation of existing resources, three teams were set up without additional funding.

20. Dr LEONG Che-hung was disappointed about the progress of DHS since its introduction in 1992, and expressed the following concerns:

1. Why it took four years to establish a Patient Liaison Group;
2. What special features were about information sharing between clinics of DH and hospitals of HA, and at what stage the programme of information sharing was;
3. In terms of health education and promotion, why DHS was repeating what the Central Health Education Unit was commissioned to do, and what other activities were planned; and
4. On the collaboration with the private sector, apart from the morbidity survey, what other achievements had been made.

He further asked for the main reasons for the slow progress and little achievements of DHS.

21. In reply, Dr LAM agreed that DH should proceed with DHS in a more expeditious manner and said that DH would request more fundings for extending DHS to other districts. In additional to those activities described, he explained that most new initiatives from DHS were developed and then extended to all clinics for implementation as far as possible. DHS would aim at strengthening the participation in the districts.

22. Dr LEONG inquired about the achievable targets of DHS established at three levels, namely, the Working Group on DHS, DH, and DHS in respective districts. Dr LAM revealed that an interim review on DHS was completed and agreed to provide the relevant information by August, 1996.

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23. Dr HUANG Chen-ya commented that he was very disappointed with the paper as the contribution of DHS to the delivery of primary health care and its effectiveness and achievement were not clearly described. He requested a detailed report on the Kwun Tong DHS (KTDHS) showing what results had been achieved, the criteria used in measuring such results, and the methods used in assessing the cost effectiveness. Dr LAM agreed to provide the requested information as far as possible.

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24. Mr MOK Ying-fan asked about the plan for the extension of DHS to Hong Kong Island and the timeframe for the development of DHS. Dr LAM replied that subject to obtaining the necessary funds, DH planned to expand DHS in the coming financial year.

25. Dr LAM also agreed to provide information on the following items requested by the Chairman:

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1. the compositions and operations of the two committees formed under KTDHS;
2. the health needs in each district with DHS and the services to be furnished by DH to meet those needs; and
3. the article on morbidity survey which was published in a local medical journal.

V. Manpower Shortage of Nurses

26. Dr LEONG Che-hung noted that the Administration did not furnish the Panel with a complete response to the Survey on Medical and Nursing Staff’s Opinion on Nursing Manpower in Public Hospitals which the Administration had undertaken to provide. Responding to Dr LEONG’s remarks, Mr Clement CHEUNG said that although the Administration’s response focused mainly on staffing requirements and manpower indicators, various measures had been introduced to improve the working conditions, training opportunities and career prospect of nurses.

27. In response to Dr LEONG’s question on the discrepancy in figures between two reports on additional nursing manpower requirements, (last report indicated about 100 additional nurses required and now, 530), Dr W M KO explained that two different approaches were employed in assessing nursing manpower. While the last report focused on the nursing activities, the present assessment was based on the needs of patients. He further pointed out that the present figure showed the requirement in the 4 specialities of the 9 major acute hospitals, and thus did not present an overall picture. As regards the choice of an appropriate approach for assessment and the time-frame for improving the manpower shortage of nurses, Dr KO indicated that the present approach based on the needs of patients was preferable and that the manpower indictors for nursing staff would be refined accordingly. Consultations with individual hospitals on this subject was under way.

28. Miss CHAN Yuen-han emphasized that in the preparation of manpower indicators for nursing staff, the inputs from front-line medical and nursing staff should be incorporated. In the process of promoting the quality of medical services by administrative means alone, the front-line medical and nursing staff would feel an increase in work pressure which would cause increased staff turnover. Dr KO said that HA was equally concerned about the recruitment and retention of nursing staff and would monitor the situation closely. While administrative means alone might not be able to provide a complete solution, streamlining of work procedures and elimination of non-professional duties had been helpful in relieving the workload borne by front-line nursing staff.

29. Mr Howard YOUNG agreed that the approach for manpower indicators for nursing staff should be based on the needs of patients but worried that the extent of their needs could be infinite. Since the resources of Hospital Authority (HA) were limited, it was advisable to determine the services HA planned to provide and to calculate the manning level. Mr YOUNG was also concerned about the supply of nurses. In reply, Dr KO agreed that manpower requirements should be driven by the needs of patients, and that this approach had already been adopted in the present assessment exercise. As regards the supply of nurses, Dr KO said that apart from trainees graduating from nursing schools, HA had also been successful in attracting some qualified nurses through direct recruitment conducted both locally and overseas. Improvement in the work-flow in different wards could enhance cost effectiveness. As regards the supply of nurses, Dr KO said that HA depended heavily on the students and graduates of nursing schools. Yet, recruitment of local experienced nurse to rejoin the profession and of overseas nurses were actively pursued to alleviate the manpower shortage problem. Ms Susie LUM added that the recruitment of student nurses would be strengthened, and a think-tank was formed with front-line medical and nursing staff to improve the retention of nursing staff. In addition, Ms LUM said that part-time nurses were employed to alleviate the manpower shortage problem.

30. Mr MOK Ying-fan expressed his concern about shortage of nurses for night shifts and asked for concrete plans on how to improve the situation. Dr KO agreed to provide a written response on existing methods as well as planned approaches in this respect.

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31. Dr KO also agreed to furnish the Panel with a written response to Dr HUANG Chen-ya’s inquiry about the proportion of full-time equivalent of student nurses in wards and about improvements in releasing nurses from duties that could be handled by clerical staff or other professionals.

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32. Concerning the recent performance of HA resulting in an expansion of its market share, Miss CHAN Yuen-han said that as the workload of hospitals increased due to the expansion, the price would be higher staff turnover, and urged HA to assess whether the workload in hospitals, especially those of the front-line medical and nursing staff, was reasonable. Dr KO agreed that a written response would be submitted regarding recruitment, retention and improvement in workload of nursing staff.

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33. In response to the Chairman’s enquiry about the 530 additional nurses required in 9 hospitals, Dr KO stated that those were preliminary figures based on operational needs and experience, and action plans would be formulated after the discussion on nursing manpower indicators had been finalised with individual hospitals.

34. As regards the Chairman’s query about an annual growth of 500 nurses in HA, Dr KO clarified that the growth referred to the actual increase in nurses annually while figure of 530 additional nurses was an indication of the demand for nurses in 4 specialities of the 9 hospitals.

35. In conclusion, the Chairman urged and Dr KO agreed that HA would continue to assess the nursing manpower situations in other hospitals, particularly in psychiatric hospitals.

36. The meeting ended at 10:50 a.m.

LegCo Secretariat
29 August 1996