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Action
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Mr Michael HO was elected Chairman of the Joint Panel meeting.
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Declaration of interest
2. Dr LEONG Che-hung declared his interest as a member of the Hong Kong Action Committee Against Narcotics.
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Briefing by Head of the LegCo Secretariat Research and Library Services Division (RLSD)
3. Mrs Donna SHUM briefed members on the report prepared by the RLSD on "Methadone Treatment Programmes in Hong Kong and Selected Countries" (RP 12/95-96). She highlighted the history, cost and effectiveness of the methadone treatment programme and, other drug treatment programmes available in Hong Kong, methadone treatment programmes in other countries and substitutes for methadone.
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4. Members expressed their appreciation of the report prepared by the RLSD which they considered a useful reference to facilitate their understanding of the objectives and effectiveness of the methadone treatment programme.
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Briefing by the Administration
5. Mrs Sarah KWOK drew members' attention to the information paper on "Methadone Treatment Programme" prepared by the Administration (LegCo Paper No. CB(2) 987/95-96). She also briefed members on the letter dated 13 April 1996 from the Administration, commenting on the report prepared by the RLSD.
(Post-meeting note : The Administration's letter dated 13 April 1996 was circulated to absent members after the meeting under LegCo Paper No. CB(2) 1020/95-96.)
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Discussion
6. As urine analysis was the tool for testing drug addicts' relapse for opiates, Mr Fred LI considered it very important for the Administration to provide statistics on the relevant urine tests results. Dr W M CHAN advised that urine tests were taken on all new and readmitted patients before dispensing methadone. Regular urine tests were also conducted on existing patients. However, statistics on these urine tests results were not readily available. Dr LEONG Che-hung queried what was the purpose of conducting the tests if the results were not available for analysis. In order to address members' concern, Dr CHAN undertook to collect the relevant statistics and report back to the Joint Panel in due course.
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Adm
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7. Mr Fred LI noted from the report prepared by the RLSD that in the past few years, there had been about 9,000 drop-out cases and 9,000 readmissions to the methadone treatment programme every year. He wondered whether the Administration had followed up these cases by ascertaining the reasons of the drop-outs and readmissions and, offering counselling services to the drug abusers concerned. Dr W M CHAN pointed out that the large number of drop-outs and readmissions suggested on the one hand that some of the patients were not stable and highly mobile, and on the other hand, that the methadone treatment programme was able to attract patients as some of them did return after dropping out. Upon their readmissions, the patients would be given counselling services which aimed at keeping them in the programme. However, due to resource constraints, it was impossible to follow up each and every case of drop-outs.
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8. Members were concerned about the gathering of drug traffickers near methadone clinics to induce methadone patients to take drugs, which caused environmental nuisance and security problems to the nearby residents. Dr W M CHAN advised that only some of the methadone clinics had such problems. All along, the Royal Hong Kong Police Force (RHKPF) had been most co-operative and at times would undertake regular law enforcement action against drug trafficking activities near methadone clinics. Mrs Selina CHOW asked for the relevant statistics showing the number of such enforcement action taken by the RHKPF in the past few years and, the number of people arrested and prosecuted accordingly. Dr W M CHAN agreed to seek clarification with the RHKPF and provide the relevant information to the Joint Panel.
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Adm
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9. Mr IP Kwok-him asked whether the Administration had any concrete measures/plans to tackle the problem. Dr W M CHAN replied in the affirmative, quoting two examples where the situation near Robert Black Methadone Clinic was improved after enforcement action taken by the RHKPF and, the relocation of the entrance of the Lady Trench Methadone Clinic in Tsuen Wan had resulted in less drug traffickers and abusers gathering around the clinic.
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10. In response to Dr LEONG Che-hung's enquiry, Dr W M CHAN confirmed that methadone should only be consumed in methadone clinics and not to be taken away. However, there could be incidents where patients left the clinics with methadone in their mouths. Dr CHAN considered this problem not serious as any drug abusers could apply to join the methadone treatment programme and therefore, there should not be a black market for methadone.
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11. In response to Dr LEONG Che-hung's enquiry, Dr W M CHAN advised that for young patients aged under 18 to join the methadone treatment programme, parental or guardian's consent would always be sought as parental involvement was beneficial in the patient's overall treatment plan. Under circumstances where parental consent could not be obtained ( e.g. when the parent was out of Hong Kong or could not be reached), and the young patient concerned was capable of understanding the programme and of expressing his or her wish to receive treatment, treatment would still be provided on the basis of the patient's consent alone.
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12. Members were very concerned about the objectives and effectiveness of the methadone treatment programme. They noted that since the start of the programme in 1972, methadone had mainly been used for maintenance, not detoxification, of drug abusers and that only a total of 233 patients had been detoxified. The large number of drop-outs and readmissions suggested that the programme had been serving only as a typhoon shelter for the drug abusers so that they could take methadone as a substitute for heroin whenever there was an increase in price of the latter. They considered that the programme could not help solve the problem of drug abuse in Hong Kong and could not achieve its objectives. They therefore urged the Administration to review the effectiveness and, to set long term objectives of the programme.
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13. Dr W M CHAN pointed out that drug abuse was a chronic relapsing condition affected by complex socio-psychological factors. It was impractical to aim at total detoxification for all drug abusers. The out-patient methadone treatment programme provided an alternative to those drug abusers who were not receptive to residential treatment. Mrs Sarah KWOK advised that international and local experiences had shown that most abusers attending out-patient methadone clinics opted for the maintenance programme which was a more realistic objective for them. Under the local maintenance programme, patients were given an appropriate daily dose to relieve their craving for opiates. This stabilized the drug abusers and enabled them to continue to work and lead a normal life. In addition, counselling services were provided for the patients with an aim to encourage them to participate in the out-patient detoxification programme or to refer them to residential treatment programmes if found suitable and acceptable to them.
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14. Mr TSANG Kin-shing considered that there was a need to strengthen the provision of counselling services to the patients. He therefore asked for the provision of additional social workers in each methadone clinic for the purpose. Dr W M CHAN advised that additional provision had been made so that at present, there was one full time social worker stationed in each methadone clinic. Starting from October 1995, in addition to providing counselling services to patients undergoing treatment, the Society for the Aid and Rehabilitation of Drug Abusers (SARDA) had been offering aftercare service for 18 months to those patients who had been detoxified under the programme.
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15. Mrs Selina CHOW noted from para. 11 of the Administration's information paper that a Treatment and Rehabilitation Policy Review Committee had been formed in 1992 to review, inter alia, the methadone treatment programme. One of the main observations of the review was that "networking and referrals between the programmes of SARDA and the methadone treatment programme should be strengthened". Mrs CHOW wondered what action had been taken so far by the Administration towards that direction and whether the patients benefited from such action. Dr W M CHAN advised that as a result of that review, SARDA took over from the Social Welfare Department in 1993 as the provider of counselling services at methadone clinics. They had successfully referred a total of 1,946, 1,881 and 1,828 patients to other treatment programmes in 1993, 1994 and 1995 respectively.
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16. Mr James TO considered that the methadone treatment programme had its own merits and demerits and that, the Administration should explore different options for improving the programme so as to enhance its effectiveness. Dr HUANG Chen-ya and Dr John TSE shared his views. Dr LEONG Che-hung suggested the Administration to consider providing methadone treatment by a mobile clinic, such as adopting the practice of "methadone by bus" in Amsterdam where two buses drove through the city everyday and dispensed methadone to heroin abusers. Dr W M CHAN said that the Administration had looked into the proposal. However, as methadone bus did not have sufficient space to accommodate doctors, social workers, patients' files etc, it could not provide comprehensive services to the patients. As such, this practice was not applicable to Hong Kong. Moreover, it might cause further problems such as the gathering of drug abusers in the bus stop and therefore, nuisance to the districts.
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17. After discussion, the Chairman suggested the Administration to review the objectives and operation of the methadone treatment programme and, to set long term objectives of the detoxification programme. Dr John TSE also suggested the Administration to set an explicit objective in terms of percentage, such as the success rate of detoxification of patients. Mrs Sarah KWOK advised that in November 1995, the Administration had commissioned the Hong Kong Council of Social Service (HKCSS) to undertake a research study to review the objectives and outcomes of various drug treatment modalities adopted in Hong Kong, including the methadone treatment programme. After the study, the Administration would, based on the research results, review the existing services provided to drug abusers with an aim to enhance the effectiveness of the services. The Chairman proposed and Mrs KWOK agreed to consider and plan a timetable for the review and to advise the Joint Panel accordingly.
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Adm
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18. Dr LEONG Che-hung noted from the report prepared by the RLSD that the methadone treatment programme in the United States was more comprehensive than the one in Hong Kong. In response to Dr LEONG's request, Mrs Donna SHUM agreed to compare the rates of drop-outs, detoxification and readmission of patients between the two programmes.
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RLSD
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19. Members noted the joint submission from the Hong Kong Fire Services Department (HKFSD) Ambulance Officers Association and the HKFSD Ambulancemen's Union (LegCo Paper No. CB(2) 999/95-96).
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20. Mr CHAN Kai-ming tabled at the meeting a copy of his speech expressing the main concerns of the two staff associations. In brief, they requested the Administration to use response time as the performance target, to address the problem of manpower shortage and to set long term objectives of the emergency ambulance service (EAS).
(Post-meeting note : A copy of Mr CHAN Kai-ming's speech was circulated to absent members after the meeting under LegCo Paper No. CB(2) 1020/95-96.)
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21. Mr CHIU Kwok-fan added that the freezing of resources for the EAS since 1991 had caused the following problems :
(a) actual operational problems in ambulance deployments to cope with the increasing demand for EAS ;
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(b) ageing problem of the ambulance crews as there had been no new recruits in the past 5 years ;
(c) due to manpower shortage, the current establishment manning formula did not allow for relief for staff absences, including leave and sickness ; and
(d) due to manpower shortage, ambulance crews were required to undertake frequent overtime work which had resulted in most of them suffering from occupational diseases such as back pain.
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22. Mr Andrew KLUTH advised that in 1986, a consultancy study was conducted on the provision of ambulance services in Hong Kong. A second consultancy study was commissioned in 1995 to update the findings of the 1986 study and to provide advice on how to improve the delivery of EAS in a cost-effective manner. The Administration's response to the points raised in the two staff associations' joint submission was summarized as follows :
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(a) Performance target - "10-minute travel time"
The 1986 consultancy study had recommended a 10-minute travel time target to be achieved for 95% of emergency calls. Based on the then projections of the development of Hong Kong as a whole, it was anticipated that the target could be achieved within 5 years. However, those projections turned out to be very conservative when compared with the actual pace of Hong Kong's development over that period. In recent years, the 10-minute travel time target could only be achieved for 92% of all emergency calls. Last year, it dropped down to just below 90% and was now back up to over 90%. In order to achieve the most efficient deployment of ambulances, it was decided that the non-emergency ambulance services should be hived off to other agencies so that the EAS could concentrate on their core priority to answer emergency calls within the 10-minute travel time. In 1994/95, the Hospital Authority had taken over the majority of the non-emergency ambulance services. With effect from 1 April 1996, the Auxiliary Medical Services had begun taking over the remaining non-emergency ambulance services. These services represented about 6 to 7 % of the total number of calls dealt with by the EAS. The Administration would continue working towards the 10-minute travel time target. It would try to bid additional resources for the purpose in the 1997/98 Resource Allocation Exercise.
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(b) Response time
The Administration had been looking into the possibility of using response time as the performance target for the EAS. However, the existing computer system for the EAS did not allow for the retrieval of the response time data. It was expected that accurate figures on response time would be available after the upgrading of the computer system in mid-1996.
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(c) Comparison with the fire services
For the EAS, the 10-minute travel time target applied as a standard throughout Hong Kong irrespective of the location of the caller. For fire services, however, a graded response time target was adopted. It varied from 6 minutes in a densely crowded urban area up to a maximum of 23 minutes in the remote areas. A comparison between the two could not be valid because of the different nature of the services.
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Discussion
23. In response to Mr Fred LI's enquiry, Mr Andrew KLUTH clarified that the Administration did not disagree that response time would be a desirable target for the EAS. The Administration had accepted the 1986 consultancy study's recommendation to pursue the 10-minute travel time target. This target was reaffirmed by the 1995 consultancy study. The consultant had pointed out that the first priority should be to make the best use of available resources to meet the current 10-minute travel time target. However, the Administration had also accepted the consultant's recommendation that the ultimate aim was to use response time as the performance target. In order to achieve that aim, a reliable baseline for response time was required. At the moment, the baseline was not available and it would be premature for the Administration to choose a response time as the target.
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24. Dr LEONG Che-hung requested the Administration to clarify whether the 10-minute travel time target covered only the travelling time of the ambulance, but not the activation time which might take much more time. Mr Andrew KLUTH advised that from the figures on response time for January 1996 collected by the Administration manually, it was revealed that the ambulances were able to respond to 90.7% of all calls in 12 to 13 minutes. This suggested that the activation time was very short, not more than about 2 minutes. The Administration would further look into more detailed figures when they were available and consider the use of response time as the performance target.
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25. Dr HUANG Chen-ya pointed out that a person whose heart stopped beating would have a minimal chance of survival if no advanced medical support was provided to him within 12 minutes. In the circumstances, he considered that the Administration should use response time as the performance target which might be set at 12 minutes, i.e. 2-minute activation time plus 10-minute travel time.
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26. Mr IP Kwok-him supported the views of the two staff associations and considered that the Administration had misled the public by using "travel time" instead of "response time" as the target. He considered that the Administration should not only take into account the recommendations of the consultants, but also the views of the LegCo Members. Mr Andrew KLUTH pointed out that the Administration had not ignored the views expressed by any quarter. It had had several discussions with the LegCo Panels and the staff associations respectively. The Administration had taken into account all the views expressed in deciding on the best way forward.
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27. Miss CHAN Yuen-han shared Mr IP's views. She considered that while the Administration did not disagree to use response time as the performance target, it did not have any plans for achieving that. She requested the Administration to provide a clear indication on when that could be achieved. Mr Andrew KLUTH advised that the exact timing would depend on the availability of resources, which would be sought in the forthcoming Resource Allocation Exercise. He assured members that the Administration would accord priority to this subject.
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28. Mr Zachary WONG also supported to use response time as the performance target. He was concerned that from the Administration's advice at para. 24 above, about 90% of all calls were responded in 12 to 13 minutes. He wondered whether the remaining 10% originated from remote areas in the New Territories North West. He requested the Administration to make concrete plans and measures for the EAS to respond to all emergency calls, including those from remote areas, within a reasonable response time period.
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29. Mr LEE Cheuk-yan pointed out that the public was mainly concerned about the response time, not the travel time of ambulances. He indicated his strong dissatisfaction on the Administration's adoption of travel time as the performance target. He suggested the Joint Panel to pass a resolution to urge the Administration to use the response time target.
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30. Members considered that travel time was not a meaningful performance target for the EAS. They passed a resolution that the Administration should use response time as the performance target.
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Adm
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31. Dr LEONG Che-hung wondered why the hiving-off of non-emergency ambulance services had not helped improve the efficiency of the EAS. Mr Andrew KLUTH advised that the hiving-off exercises had improved the efficiency of the EAS. However, as the demand for ambulance services in the same period had been increasing, it was difficult to identify specifically the efficiency improvement arising from the hiving-off process itself. It was found that when each section had been hived off, there had been a general improvement in the efficiency of the EAS but the long term effect would be more difficult to tell because of other factors interfering.
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32. In response to Dr LEONG Che-hung's request, Mr Andrew KLUTH agreed to provide information on the percentage decrease in work of the ambulance services after hiving-off of non-emergency ambulance services.
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Adm
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33. In response to some members' enquiries, Mr Andrew KLUTH advised that the Administration had been taking very positive steps to improve the efficiency of the EAS, such as :
Short term measures
(a) Ambulances and their crews were redeployed from stations with relatively adequate manning to those where manning was inadequate to meet local demand ;
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(b) Ambulances were stationed in some of the fire stations, in addition to ambulance depots, to extend the coverage of the EAS ; and
(c) The Fire Services Communication Centre had streamlined its operational procedures for ambulance deployments to achieve more effective mobilization.
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Long term measures
(a) To provide 31 additional ambulances ;
(b) To plan for new ambulance depots at North Point, Sheung Wan, Kwai Chung and Kowloon Tong ; and
(c) To extend paramedic services to all ambulances.
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34. Mr Andrew KLUTH assured members that the Administration had been doing everything it could to improve the efficiency of the EAS. So far, the EAS had been able to achieve a survival rate of 99.3% in all emergency ambulance calls.
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35. Dr LEONG Che-hung noted from the staff associations' presentation that there had been no new recruits for the past few years. He considered that replacement should have been provided to cover those vacancies caused by natural wastage such as resignation or retirement. Mr MAK Kwai-pui advised that no replacement had been provided because of the hiving-off of non-emergency ambulance services.
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36. Mr IP Kwok-him noted from the joint submission of the two staff associations that the staffing ratio between ambulance officers and ambulancemen was 1:32. He requested the Administration to clarify whether this was the highest ratio among the disciplinary services as claimed by the two staff associations. Mr Andrew KLUTH advised that the staffing ratio of the EAS might not be so favourable as compared to those in the other disciplinary services. At the moment, FSD was coordinating studies on the management of the EAS and the Administration was awaiting the outcome.
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Adm
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37. In response to Mr Fred LI's enquiry, Mr Andrew KLUTH advised that the Administration had accepted the recommendation of the 1995 consultancy study that more ambulances should be provided to meet the current travel time target. The Administration's intention was to seek the necessary resources. When those resources were available, the Administration would be in a position to start recruiting on a regular basis.
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38. Mr MAK Kwai-pui considered that at present, the ageing problem in the ambulance crews was not serious because over 70% of them were below the age of 40. However, such problem might occur in future if no additional resources would be provided to the FSD for recruitment of new crews.
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39. Dr LEONG Che-hung pointed out that at present, the EAS was under the purview and control of the FSD while the basic user of the service was the Hospital Authority. He requested the Administration to clarify the rationale behind and, consider whether this was an appropriate arrangement. Mr Andrew KLUTH advised that the EAS was placed under the FSD because the latter provided emergency response services in Hong Kong. The Administration would continue its ongoing work with the FSD and the Hospital Authority to seek regular improvements in the coordination between emergency service units.
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Adm
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40. The meeting ended at 11 : 00 a.m.
LegCo Secretariat
6 May 1996
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Hon Michael HO Mun-ka (Chairman of the Joint Panel)
