LegCo Panel on Health Services

Closed Meeting

I. Manpower problem in Siu Lam Psychiatric Centre (SLPC)

(LegCo Paper No. CB(2) 1615/95-96 and a comparison of nursing manpower on 14 July 1993 and 17 June 1996 tabled at the meeting)

Referring to the comparison prepared by his Office, the Chairman commented that little progress was made in the last 3 years in connection with SLPC. He was surprised to find that in the Report on SLPC, HA stated that the existing night nursing staff was adequate, and would like members to request the Administration to increase the establishment of SLPC. Dr LEONG Che-hung observed that SLPC was not only a prison but also a hospital, and the special nature should be taken into account by the Administration in the management and operation of SLPC.

II. Progress on the implementation of recommendations of Expert Working Group on Occupational Health Services

(Appendix III of LegCo Paper No. CB(2) 1589/95-96)

2. Dr LEONG briefed members on the background of the issue and quoted a few examples to support his remarks about the superficial treatment of the recommendations, such as the training of “Appointed Medical Practitioners” and the re-organisation of Occupational Health Services Division.

Open Meeting

I. Manpower problem of Siu Lam Psychiatric Centre

3. Mr YEUNG Sum requested the Administration to explain why there was an increase of only one psychiatric nurse over a period of almost 3 years, and wards were closed due to a shortage of nursing staff. In reply, Mr Kelvin PANG stated that since December 1995, there were staff turnovers and 3 Registered Nurses (RN) (Psy) and 1 Enrolled Nurse (EN) (Psy) were recruited. 5 RN (Psy) and 25 EN(Psy) were under training at Hospital Authority (HA) and there were plans to send 11 more staff to undergo nurse training. As for the Rehabilitation Ward, it was not closed and inmates were sent to workshops for occupational rehabilitation in the day time and would return in the evening. The General Ward was not closed. In response to the Chairman’s request, Mr PANG agreed to provide a breakdown of the number of staff retired, the number of staff resigned and the number of staff transferred to other posts.

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4. Dr LAW Chi-kwong asked why there was no information on occupational rehabilitation, and why only ratios of nursing staff were given instead of an assessment of the needs for manpower requirement in the HA report. In reply, Dr W M KO pointed out that the inmates at SLPC required both psychiatric care and custodial supervision, but professional medical advice only covered the former aspect. The HA report focused on the ratios between RN and EN since it was based upon findings of the review conducted by Correctional Services Department (CSD) in December 1994.

5. Referring to the information paper by the Security Branch (SB), Dr LAW queried why the target of 97 posts would only be achieved by 2001. On comparing the two papers, it seemed that the suggestions by SB were not reflected in the report by HA, and that there was no coordination between CSD and HA. In reply, Mr Andrew KLUTH indicated that the major reason was the identification of suitable employees for training and the training time required. He added that the Administration would continue to explore ways to improve the situation.

6. Responding to Dr LEONG’s question on what role HA performed in SLPC, Mr Clement CHEUNG agreed that employees in SLPC were unique in that they possessed nursing qualifications as well as correctional services experience. Though there was no direct deployment of RN and EN to SLPC, HWB and HA provided psychiatric services and supported the training of SLPC employees in attaining nursing qualifications. In reply to Dr LEONG’s question, Dr KO said that indicators being developed by HA would be a useful tool in assessing the staffing requirement at SLPC. Mr KLUTH added that the previous working group report identified 97 nursing posts and that the recent study had been made to assess the nursing element and qualifications needed for those posts.

7. The Chairman pointed out that it was the Panel’s decision to ask HWB to assess the number of nursing staff needed in SLPC but from HA’s report, only the ratios of RN to EN were shown. Mr KLUTH replied that the assessment of the number of nurses was not repeated in the report because it was done in the last review. The Chairman indicated that the Panel never accepted the number of 97 nursing staff as a reasonable figure and inquired what message was conveyed to HA for a report on nursing staff of SLPC. Mr CHEUNG explained that HA could not estimate the number of nursing staff by treating SLPC in the same way as an ordinary hospital. With constraints arising from the operational needs of CSD, HA could only play a supportive role in the assessment. In reply to the Chairman’s question, Dr KO reiterated that the recommendation of 97 posts was determined with professional input from CSD in the last review, while HA advised on the ratios between RN to EN. As SLPC was also a hospital, Dr LEONG argued that HA should be able to assess and advise CSD on the nursing manpower requirement in SLPC and queried again the role played by HWB. Mr CHEUNG delineated the role of HWB in SLPC as follows:

1. to provide psychiatric service to meet the clinical need of inmates detained in SLPC;
2. to advise CSD on the appropriate staff mix in SLPC based on the existing level and scope of activities; and
3. to provide training for CSD staff in pursuance of the target staff level.

8. The Chairman asked whether HWB/HA would assess and advise CSD on the number of nursing staff required in SLPC from a medical perspective. Dr KO emphasized that such as assessment could not be completed satisfactorily without the cooperation of the two professional services. Dr YEUNG requested HA to complete an independent and professional assessment of the manpower requirement for nursing staff. Dr KO agreed that HA could contribute in this exercise on a cooperative basis with CSD. Mr KLUTH stated that SB had no objection to HA conducting an independent study of the manpower requirement for nursing staff at SLPC. In previous studies on staffing at SLPC, SB had had no input and had simply received the reports prepared by the professionals. It was happy to do so again. Dr LEONG requested the report to be completed from a medical profession’s point of view as soon as possible. Dr LAW expressed his concerns about the methodology used in the report where the assessment of activities and distribution of work of each post were made with insufficient manpower. The outcome would be different when the same was carried out with a manning level at full strength. In reply to Dr LAW’s queries about counselling service in the evening, Mr PANG told the Panel that telephone counselling with inmates’ relatives was offered.

Adm

9. Referring to paragraph 18 of the report, the Chairman quoted that “the existing night nursing staff at SLPC is adequate provided that an emergency back-up is being maintained”, and challenged this recommendation. He understood that there was not a single nurse to attend the wards at SLPC at night, and there were only two nurses for the patrol of the whole centre. If his understanding was true, the Chairman considered that HA had made an irresponsible recommendation and would send the report to international nursing organizations and World Health Organization. In reply, Mr PANG said that the recommendation was based on a full strength of 97 professional nursing staff on duty and not on existing manpower level with a shortage of professionals. In the event that 97 professional nursing staff were in place, every ward would be manned by either a RN or an EN. However, the Chairman stressed that the report was clearly dated November 1995 and the description, “the existing night nursing staff at SLPC is adequate” referred obviously to the situation in November 1995 with a manning level of 45 nurses and queried whether this manning level was acceptable to HA. The Chairman quoted a further section, “We noted from our site visit that all inmates were locked up in their cells during the night shift. There were no direct nursing activities being carried out at night time apart from emergencies”. (Paragraph 15 of the report). Knowing that there was no nursing staff in the wards of SLPC at night, the Chairman observed that no direct nursing activities were apparently a direct consequence and challenged whether it was acceptable to HA that inmates were left in their cells behind locks because of the unavailability of nursing staff at night. Dr LAW agreed with the Chairman’s statements and made reference to the methodology of the survey to support the Chairman’s observation. In response to the Chairman’s request to comment on whether the existing nursing staff was adequate and whether the lock-up of inmates at night was acceptable from a medical profession’s point of view, Dr KO did not consider the recommendations irresponsible but acknowledged that they had been made under the prevailing operational constraints:

1. Rehabilitation activities for inmates were held in the day time; and
2. There were no planned medical treatment at night.

10. The Chairman pointed out that there was no planned medical treatment because there were no nursing staff on duty at night and it was unacceptable to the Panel that inmates who might need medical treatments were ignored and locked up in their cells suffering in isolation. In conclusion, the Chairman requested and HWB agreed to compile an independent assessment of the nursing manpower requirement in SLPC from a medical perspective. Dr YEUNG suggested and Mr CHEUNG agreed that the exercise would involve reassessment of the 97 posts recommended by CSD in its last review. Dr YEUNG sought the agreement that HWB would compile the manpower assessment and HWB would advise the Panel on details of the assessment including the methodology and the completion date of the report.

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II. Proposed new medical and health policy for new immigrants from China

(Appendix II of LegCo Paper No. CB(2) 1589/95-96)

11. Dr LAW observed that new immigrants from China came from different provinces with different health conditions, particularly in their medical examinations and immunization injections, and their understanding of health education varied vastly. He urged the Administration to assess and improve the health conditions of new immigrants from China and to provide health education to them.

12. In reply, Dr SAW stated that new immigrants from China and ordinary people in Hong Kong had equal access to our medical services. He also elaborated on the current services provided to children of new immigrants, particularly on immunization for children provided through Family Health Service and regional offices of DH. Dr SAW told the Panel that information from World Health Organization (WHO) indicated that most of the children from China in the vicinity of Hong Kong received immunization injections. Furthermore, when children were at school, the Student Health Service would assist in the follow-up of immunization of school children. He pointed out pre-entry medical examination was not advisable as a condition for entry and would give rise to a false sense of security. It was preferable to enhance the surveillance system now in Hong Kong. For health education, DH acted as an advisory organization, a resource centre and an agent to promote and educate new immigrants and people of Hong Kong, and contributed to the information booklets for new immigrants made available at the Immigration Department.

13. Dr LAW observed that Dr SAW’s remarks focused on children and did not mention adult immigrants which made up about 50% of the total number of immigrants. He criticised that data collection of the surveillance system detailed facts only but did not indicate any preventive measures. Dr LAW clarified that the proposed pre-entry medical examination aimed at helping new immigrants and not at imposing a condition for entry to Hong Kong. He believed that prevention would be better than cure and quoted tuberculosis as an example. In reply, Dr SAW stated that for most diseases medical examination might not be able to detect them at their incubation periods, and the examination would only be useful for certain diseases. Under the existing surveillance system, DH could cope with them. Dr SAW did not support a pre-entry medical examination because it would put additional stress on new immigrants who had to adopt the new environment. Family health services and general out-patient clinics were accessible to those new adult immigrants. An information booklet containing health information would be distributed to new immigrants at Lo Wu in the following month.

14. Dr LEONG pointed out that means and channels should be established for obtaining information about the health status of new immigrants and for compiling medical indicators for them. Those information and indicators could affect our policy-making and resources allocation. He commented that the collection of health information on locals needed a lot of improvements and urged the Administration to put more effort in data collection and analysis, for instance, by separating new immigrants and locals. Dr SAW replied that data collection was under way at Student Health Service for children and at some clinics. The former was computerized so that the data could be analysed. The data collected from clinics would not distinguish new immigrants from locals. Dr YEUNG agreed that requiring a pre-entry medical examination would turn out to be a sensitive issue and establishing means and channels for data collection and analysis was important. Dr LEONG stressed that it was not enough to collecting medical data for children alone, and medical data for adults should be included. The Chairman requested DH to provide existing data and information on health status of new immigrants so as to convince the Panel that the present approach was appropriate.

Adm

15. Miss CHAN Yuen-han stated that people of Hong Kong who stayed in China for a period of three months or longer were required to pass a medical examination, and she enquired what the arrangements were between Hong Kong and China in this respect. Dr SAW said that it was the prerogative of China to stipulate those measures and Hong Kong was not planning to introduce similar measures in the near future. In response to Miss CHAN’s suggestion to request new immigrants to submit medical information, Dr SAW maintained that the present arrangements for control and monitor were adequate.

16. Dr HUANG Chen-ya asked whether active TB cases were high among new immigrants from China and requested DH to provide the Panel with the information booklet containing medical information to new immigrants. In reply, Dr SAW stated that information from World Health Organization indicated that active TB cases in Southern China were lower than that in Hong Kong. At the request of the Chairman, Dr SAW agreed to provide information about TB cases in China and Hong Kong to the Panel.

[Post meeting note: information about TB cases in China and Hong Kong and information booklets were sent to members on 1.7. 96]

Adm

III. Progress on the implementation of recommendations of the Expert Working Group on Occupational Health Services

(Appendix III of LegCo Paper No. CB(2) 1589/95-96)

17. Dr W K LO briefed members on the salient points of the progress report.

18. Dr LEONG opined that the implementation of those recommendations by the Expert Working Group since 1992, were either superficial or ineffective, and quoted examples of delay in implementing certain recommendations to support his observations:

1. Review of the organisation of the Occupational Health Services (OHS) Division which now has medical practitioners seconded to the Labour Department (LD);
2. Statutory requirement for “Appointed medical Practitioners” to conduct medical examination for certain occupations;
3. Statutory pre-entry and in-service health checks for certain occupations; and
4. Recommendations 15 to 22.

19. In response, Dr LO said the OHS Division would remain in LD with newly created posts such as 1 Deputy Director of Occupational Safety and Occupational Health and 1 Senior Occupational Hygienist, and the training of about 10 “Appointed Medical Practitioners” was under way at the Chinese University of Hong Kong (CUHK) and the first batch would complete their training in June 1996. Mr S Y MAK added that there were 11 recommendations related to legislative changes which were either being considered by Education and Manpower Branch or new legislation was being drafted by the Legal Department. The Chairman requested Mr MAK to submit the list of the 11 recommendations related to legislative changes and their progress.

Adm

20. Dr LEONG asked about the training course for “Appointed Medical Practitioners” at CUHK including the duration of the course, the reasons of delaying the training from 1992 to 1996, the expected number of “Appointed Medical Practitioners” and the career prospect, of those medical practitioners. In reply, Dr LO explained that an attempt to offer a similar training course in 1994/95 failed because of the low enrolment rate. The training course was a Diploma Course lasting for 9 months with meetings held once a week for a half-day. Dr LO expected that more medical practitioners might be interested in this career after the legislation became effective.

21. Miss CHAN inquired about the current status of the implementation of environment hygiene assessment reports and extension of the Factories and Industrial Undertaking Ordinance to cover all establishments. In reply, Mr MAK said that the environment hygiene assessment proposal would be included in the proposed Occupational Safety and Health (Dangerous Substances) Regulation which would be submitted to Labour Advisory Board in October for advice and if endorsed, it would be forwarded to Education and Manpower Branch. The Bill to extend the coverage of safety and health legislation to all employees was now at its final stage in the Legal Department and would be submitted to Legislative Council once completed.

22. In conclusion, the Chairman requested LD to provide:

Adm

1. information on problems encountered in the implementation of the recommendations;
2. a time-table for the implementation of the 11 recommendations related to legislative changes; and
3. a report on the review of the organization of Occupational Health Division (Recommendations 3)

Close of Meeting

23. The meeting ended at 10:40 p.m.

LegCo Secretariat
9 August 1996