LegCo Panel on Health Services

Action

I. Confirmation of the Minutes of Meeting and Matters Arising

(LegCo Paper No. CB(2) 1176/95-96)

The minutes of the joint meeting with the Security Panel on 15 April 1996 were confirmed.

2.Research on Emergency Ambulance Service (EAS)

(Appendix I of LegCo Paper No. CB(2) 1314/95-96)

The Chairman briefed members on the scope of the study of EAS. Dr LEONG Che-hung proposed to add the following items:

(a) to provide motor cycle emergency service for fast on site attention before the arrival of Ambulances;

(b) to review what savings have been achieved with non-emergency service to the HA and whether the system is satisfactory; and

(c) to consider whether Emergency Ambulance Service should remain under the Fire Services Department (FSD).

3. He further suggested and members agreed that the scope of study be referred to the Security Panel for comments. Dr YEUNG Sum said that he fully supported prehospital treatment being a part of the study and shared Dr LEONG's concern whether it was appropriate for the EAS to remain part of the FSD.

Clerk

II. Items for discussion at the next meeting scheduled for 10 June 1996

(Papers tabled at the meeting)

4. Members agreed to discuss the following three subjects at the next meeting scheduled for 10 June 1996:

(a) Review of Health Care System - Tentative Timetable;

(b) Primary Health Care - phased implementation of the District Health System; and

(c) Follow-up on manpower shortage of nurses

III. Items for discussion at an additional meeting scheduled for 18 June 1996

5. To expedite the discussion of the following outstanding items, the Chairman proposed and members agreed to hold an additional meeting on 18 June 1996 at 8:30 a.m.:

(a) Manpower problem of Siu Lam Psychiatric Centre;

(b) Progress Report on the Implementation of the recommendations of the Expert Workings Group on Occupational Health Services; and

(c) Medical Services for New Immigrants from China.

6. Referring to the outstanding item on relationship with the Health and Medical Development Advisory Committee (HMDAC), Dr LEONG requested that the Administration should be asked to provide the agendas of the HMDAC for the Panel's reference. The Chairman suggested and members agreed to discuss the item at the meeting scheduled for 8 July 1996.

Clerk

IV. The Role and Governance of Prince Philip Dental Hospital (PPDH)

(Appendices II and III of LegCo Paper No. CB(2) 1314/95-96)

7. Dr LEONG Che-hung pointed out that the data provided by the Administration did not cover all the information that he requested. He would like to have details on the number of full-time clinical staff (including professors and others who were involved in teaching and clinical practice) and the number of part-time clinical staff and whether they were engaged in teaching or other activities.

8. Dr T A SAW replied that he would provide the figure on the number of full-time clinical staff while the number of part-time clinical staff was 64 or 8.5% of the full-time equivalent.

Adm

9. Referring to paragraphs (5) and (6) of the response, Dr LEONG asked for clarification on the number of patients being screened by PPDH from January to March 1996 (totalling 2,433), and the service load of the different dental subspecialties and general dentistry in term of the number of cases (totalling 24,003). Dr SAW pointed out that the latter figure referred to patient-visits. To understand the relationship between these two figures, Dr LEONG asked whether it was true that on the average, there were about 10 visits per patient. In reply, Mrs Doris HO explained that the figure of 24,003 cases included old cases as well as new cases. Dr LEONG said that he was surprised at the large number of cases dealt with by the subspecialties, e.g. Oral & Maxillofacial Surgery which dealt with 5056 cases in 3 months.

10. Dr LEONG then referred to a figure obtained from the Faculty of Dentistry, University of Hong Kong (HKU) that 975 private patients were treated in the year 1 April, 1994 to 31 March 1995. However, based on the figure of 3 patients provided in para.(5)(c), Dr LEONG projected a figure of 12 private patients for 1996 only. Dr SAW explained that the number of patients referred by PPDH to private dentists and subsequently referred back to PPDH was 3. He added that the number of patients referred by private dentists to PPDH was 120 for the first quarter of 1996 and the number of new private patients was 551 in 1995.

11. The Chairman noted that full-time clinical staff in PPDH could spend a maximum of 20% of their teaching time in clinical work including treatment of private patients and enquired whether a similar practice existed in the Faculty of Medicine, HKU and the Chinese University of Hong Kong (CUHK). He further asked how the mechanism worked in PPDH to monitor the time allocation of these staff.

12. In response, Mr K Y WU indicated that the University Grants Committee was expecting a reply from the university on the time spent by staff of the Dental Faculty on clinical activities related directly or indirectly to teaching.

UGC

13. As requested by the Chairman, Dr Iris BUDGE-REID elaborated the following principles applicable to private practice of university staff:

(a) There was a need for the staff to keep their hands in their profession; and

(b) It was necessary for the staff to keep abreast of the latest practice.

She added that the treatment of private patients in PPDH was regarded as indirectly teaching-related activities. EMB was also assured by UGC and the Universities that there were rules to ensure that the teaching function was not compromised.

14. Dr LEONG noted from the information paper the establishment of a new Faculty Outside Practice Committee (FOPC) to advise the University Council and to monitor all matters relating to the policy governing outside practice activities, and queried the need for the FOPC if rules already existed to advise and monitor these activities.

15. Dr BUDGE-REID explained that this was an additional approach to execute the monitoring function by a Committee outside the Faculty.

16. Dr LEONG sought information on the composition of FOPC, whether its meetings were held in public or in private, when the FOPC commenced work, and whether the deliberations and decisions of FOPC were accessible by the public. Dr BUDGE-REID agreed to provide the information requested.

EMB

17. In response to a question from Dr LEONG on the monitoring of private practice, Mr WU pointed out that University Council issued clear guidelines and instructions to monitor private practices and would submit relevant documents in this regard to the Panel.

UGC

18. As regards the waiting time for the 120 private patients referred by private dentists, Dr SAW explained that of the total number of patients screened during the first quarter of 1996, 1,564 were accepted for teaching purpose and 869 who were not suitable for teaching were referred to private dentists. Of the latter group, 3 were subsequently referred by these dentists in the private sector back to PPDH as private patients.

19. Dr LEONG noted the shorter waiting time for fee-paying patients compared with patients for teaching purposes and enquired whether it was a basic policy of the Administration to subsidize fee-paying patients. Mrs Doris HO clarified that it was not the Administration's intention to give fee-paying patients a priority. Mr WU indicated that he would seek more information from the Faculty of Dentistry in this regard and would report to the Panel in due course.

UGC

20. Dr LEONG understood that PPDH staff had to attend private patients because there was not enough expertise in the private sector. Dr LEONG asked the Administration to confirm whether that was the case and to provide the number of dental specialists in the private sector. Should that be the case, Dr LEONG enquired why PPDH had not been able to train up sufficient dental specialists since its establishment 10 year ago. He further requested the Administration to confirm whether that was the Administration's policy to use public funding for providing specialist dental service while leaving ordinary dental service to the private sector.

21. In reply, Dr SAW explained that the aim of the private patient scheme was to maintain and advance professional skills of the teaching staff and should not be treated as professional referral centre It allowed the teaching staff to keep in line with other dental faculties overseas. He pointed out that there were adequate specialists in both the public and private sectors to provide specialist dental care. Responding to the Chairman's inquiry, Mr WU stated the objective of funding universities was for teaching and research purposes and not to subsidize private practice offered by university staff.

22. In response to a question from the Chairman regarding the number of specialists trained in the 5 dental subspecialties in the last 10 years and the future training plans for specialists, Mr WU agreed to provide the Panel with relevant information.

UGC

23. Regarding the request for (funding) recognition of the clinical services not incidental to teaching by PPDH (Section C of para. 11 of Appendix II referred), Mr WU said that the UGC was still awaiting a response from the HKU Dental Faculty on specific examples of dental services provided by PPDH, unrelated to teaching, which were in fact essential to the community and not otherwise available in private or public hospitals/clinics.

UGC

24. After declaring his position as Head of Department of Social Work and Social Administration, HKU, Dr LAW Chi-kwong considered that the policy of private patients scheme should be reviewed, based on the figures and information available to the Panel. He observed that the private patients scheme might promote the skills of professional staff in the University. To his knowledge, University staff taking up private practice would involve time beyond normal working hours. He further stressed that the overall policy of private patients scheme should be scrutinised.

25. The Chairman asked the Administration to provide the Panel with the outstanding information before the next meeting. He also urged the Administration to submit papers to the Panel as soon as possible, preferably one week before the meeting to allow members sufficient time to study the papers. He quoted a recent example of papers not being provided until Friday afternoon for the Panel meeting scheduled for the following Monday morning.

Adm

V. Medical Consultant Posts in Hospital Authority

(Appendix IV and V of LegCo Paper No. CB(2) 1314/95-96)

26. Dr E K YEOH briefed members on the basis for the creation of consultant positions in the Hospital Authority (HA).

27. Dr LAW Chi-kwong said that his concerns were not totally addressed by the explanation provided by Dr YEOH. Based on his analysis of figures provided by HA (Appendix IV of LegCo Paper No. CB(2) 1314/95-96 referred), the number of beds was decreasing, the number of front-line staff stayed stagnant and yet the number of managerial staff as well as the number of medical consultants increased substantially. Without actual figures from HA, it was estimated that the increase in financial terms might be in the region of hundreds of million of dollars annually. Dr LAW asked whether the increase was reasonable. He further inquired why the increase took place in recent years and wondered if the increase in the number of medical consultant positions would continue at the same rate as shown in his analysis in the coming years.

28. In response, Dr YEOH pointed out that the decentralisation of authority from HA Head Office accounted for the increase in managerial staff in hospitals. It was a planned transfer of managerial staff originally stationed at HA Head Office to hospitals and should not be interpreted as an expansion of staff at the managerial level. He further explained that prior to 1993, the Hospital Pathology Service was provided by the University of Hong Kong and Consultants Doctors of the Queen Mary Hospital Pathology Service are part of the staff of the University of Hong Kong. Upon transfer of the Hospital Pathology service to the HA, Consultants Doctors of the service became staff of HA and accounted for part of the increase. As for Prince of Wales Hospital (PWH), the increase was due to an under-provision in the past, and was required for a high quality of secondary and tertiary level medical services. The increase in medical consultants in Queen Elizabeth Hospital (QEH) partly reflected a recent transfer of cardio-thoracic surgical services from Kowloon Hospital to QEH.

29. Although the explanation regarding the increase in PWH and QMH was understandable, Dr LAW was not convinced of those increases in other hospitals. Quoting QEH as an example, he queried why there was a more than 20% increase in senior medical officers (SMO) in QEH, despite the fact that there was a decrease of about 5% in the category of medical officers (MO) and an increase of only about 4% in beds.

30. In response, Dr YEOH reiterated that medical consultants were regarded as front-line staff and together with SMOs, provided the trained specialists required for high quality medical service to the community. MOs were specialists in training. He pointed out that the four major hospitals provided a high standard of complex tertiary level medical services. In keeping with the tertiary roles, supporting medical services such as medical laboratory service would also need to be developed and manned by specialists.

31. Regarding the trend of the increase of medical consultants, Dr LAW worried whether an increase of about 20% would be the trend and asked whether there were indicators to control the increase. DrYEOH stated that the HA Medical Services Development Committee (MSDC) had adopted an indicator of 1 consultant per 34 to 68 beds. Proposed increases would be reviewed by the MSDC based on the changing roles of SMOs and consultants, the need for medical services and annual work plans.

32. Dr LAW asked whether it was true that after approval had been given by HA Head Office for a hospital to convert a SMO post to a consultant post, the hospital could create a SMO post internally without HA Head Office's approval and how HA would monitor situations like this. Dr YEOH replied that with the delegation of power to hospitals, HA monitored hospitals by requiring them to report on their staffing positions and by checking whether the inputs were reasonable.

33. In reply to the Chairman's question on what mechanisms existed in HA to control the delegation of power, Dr YEOH stated that HA employed a budgetary control for each hospital. Depending on the demand of a hospital, funds would be allocated to new services and the number of posts required would be reviewed by a Staffing Level Committee in the hospital. Any changes in the budget would be reported to HA Head Office which would check and discuss with the hospital chief executives on any queries.

34. Miss CHAN Yuen-han regretted that the figures provided by HA matched the complaints which she had received from staff of HA, and pointed out that based on her calculations, she found that the number of posts of SMO and medical consultant was on the rise while the number of posts of other front-line staff was decreasing. It seemed that channels of communication were not effective and views of front-line staff were not reflected to the management. Miss CHAN would like to know how the complaints from front-line staff were handled through different channels, such as meetings.

35. In reply, Dr YEOH stressed that SMOs and medical consultants were front-line staff and that MO was a training grade. As a result, major medical services were provided by SMOs and medical consultants were also responsible for training and monitoring MOs. In most cases, patients were treated by MOs first and checked by SMOs and consultants. Dr YEOH further pointed out that by comparing with international standards, the local number of medical consultants were on the low side. Quoting Singapore as an example, he remarked that the numbers of SMOs and medical consultants in HA were about half of that of our counterpart.

36. To provide figures in support of her arguments, Miss CHAN showed her calculations of nurses and Health Care Assistants (HCAs) at PMH being 2200 in 1994 and 1823 in 1995 representing 95% and 94% of the total number of staff respectively. Similar trends were found in QMH, QEH and PWH indicating that the number of SMOs and consultants were increasing while the number of nurses and HCAs were decreasing. Complaints about heavy work load and pressure were received and though channels of communication existed in HA, it seemed these views and complaints were not properly dealt with. In response, Dr YEOH reminded the Panel that the number of registered nurses in QMH increased from 749 in 1992 to 833 in 1995 and showed figures of similar increases in QEH and PWH. He also pointed out vacancies for registered nurses existed in hospitals and recruitment exercises continued. The situation was also affected by a 10% turn-over rate of the grade. The number of HCAs had also increased significantly in the last 6 months.

37. Miss CHAN further requested HA to pay more attention to the views and comments of their front-line staff and to the changes over the years. Dr YEOH said that HA would review the situation and the manpower indicators and would follow up on this matter.

HA

38. Dr LEONG declared his role as a member of HA and the Chairman of the MSDC of HA. He shared DR LAW's observations concerning a decrease in the number of beds and an increase in the number of SMOs and medical consultants. He suggested HA to provide the Panel with a breakdown of the increases in medical consultants by specialties and a projection of the number of posts of medical consultants in the coming years. He further raised his concerns regarding the service benchmarks of Accident and Emergency (A&E) and Ophthalmology. With A&E being most patients' first point of contact with hospitals and a very important diagnostic and screening process with serious implications, he enquired whether the benchmark at 1 per 80,000 was on the low side. Similarly, he worried whether the benchmark for Ophthalmology at 1 to 2 per cluster was enough. Dr YEOH admitted that relatively less attention was given to A&E and Ophthalnodogy in previous decade resulting in less than desirable quality of services in those two specialties. However, recently more emphasis was put on training of specialists for Ophthalmology and more MOs and SMOs in Ophthalmology would be recruited initially. As to A&E, he remarked that the service was improving and thus attracted new MOs to join. Coupled with the establishment of a speciality in A&E in the Hong Kong Academy of Medicine, more specialists would be available and as a result it was expected that the service would be improved. He could provide information on the increase in the two specialties in the past few years.

Adm

HA

39. After declaring his role as a member of HA, the Chairman said that in the past few years due to changes in the staffing arrangement of teaching hospitals, increases were necessary to meet previous deficiencies. He would like to know which specialties had already achieved the targets on the number of medical consultant posts. As funding from the Government would be allocated mainly on new services and HA was able to improve existing services with additional manpower, the Chairman wondered where the money came from. In response, Dr YEOH stated that the increase in medical consultants was from about 250 before HA was set up to about 380 over a four-year period. Most increases were in rehabilitation services and in subvented hospitals. He envisaged that in major hospitals, the level of medical consultants would be stable and in ex-subvented hospitals, a moderate increase was expected. Regarding the funding for hospitals, Dr YEOH invited members' attention to the annual budget of HA which allocated the fundings to hospitals. As regards the Chairman's question on the composition of the Staffing Level Committee, Dr YEOH said that it was mainly chaired by the hospital chief executive with general managers of the hospital as members. The Chairman requested Dr YEOH to provide more information on the above items.

HA

40. The Chairman observed that the development of Yan Chai Hospital (YCH) in the vicinity of PMH alleviated some of the workload of PMH. On the one hand, he found that there was a decrease in registered nurses (RN) in PMH, presumably due to some RNs being transferred from PMH to YCH. On the other hand, he was aware that there was an increase in medical consultants over the same period. In response, Dr YEOH invited members' attention to the special services provided by PMH, and the shift to day care services. Without knowing the full impact of YCH on the workload of PMH, the budget for PMH in 1995 was not revised substantially. Upon obtaining more information on the impact, it was expected that the budget for PMH in coming years would be adjusted. The Chairman urged HA to carry out the adjustment on the budget for PMH without delay.

41. The Chairman noted that renovations were under way in PMH, QMH, QEH and worried whether an expansion would follow upon the completion of these projects. Dr YEOH replied he did not expect any expansions as the number of beds in these hospitals would remain more or less the same and certain demands for medical services would be transferred to day care services which experienced a substantial increase recently.

42. Referring to the service benchmarks, Dr LAW inquired if there were data to indicate the gaps between the existing service levels and the service benchmarks and when the gaps could be closed. In reply, Dr YEOH said that although the service benchmarks were presented in ranges, HA would be able to show these gaps by comparing existing services levels and the service benchmarks. The service benchmarks would be employed flexibly in hospitals depending mainly on the quality of service and the complexity of the situation. Dr YEOH, quoted PMH and YCH as examples by positioning YCH as a hospital handling less complicated cases and with PMH dealing with the more complicated ones. Thus the number of medical consultants in PMH would be higher and those in YCH lower.

43. Concerning the creation of a post of medical consultant, the Chairman inquired what mechanism would be applicable and what personnel would be involved. In response, Dr YEOH pointed out that at the policy level, the MSDC would review the plans, the services and the manpower requirements annually. At the implementation level, the hospital requiring additional medical consultants would submit relevant applications for manpower to HA Head Office, which would examine the needs before approval.

44. Dr YEOH further explained that the MSDC would be responsible for review and approval of manpower needs both for developing new services and improving the quality of existing services. Reports would be sent to the MSDC concerning the implementation and manning of those services. The Chairman opined that HA should consider setting up a separate committee to focus on prioritising and monitoring human resources matters.

HA

45. There being no other business, the meeting ended at 10:30 a.m.

LegCo Secretariat
4 July 1996