LegCo Paper No. CB(2) 2558/96-97
(These minutes have been seen
by the Administration)
Ref: CB2/PL/HS

LegCo Panel on Health Services

Minutes of Meeting held on Monday, 14 April 1997 at 8:30 a.m. in Conference Room B of the Legislative Council

Members present :

Members absent :

Member attending :

Public officers attending :

Health and Welfare Branch
Mr Gregory LEUNG, JP: Deputy Secretary for Health & Welfare
Mrs Maureen CHAN: Principal Assistant Secretary for Health & Welfare
Ms Jennifer CHAN: Principal Assistant Secretary for Health & Welfare
Mr Edward LAW: Assistant Secretary for Health & Welfare
Mr Donald NG: Assistant Secretary for Health & Welfare
Item III
Education and Manpower Branch
Ms Michelle LI: Principal Assistant Secretary (Education and Manpower)
University Grants Committee Secretariat
Mr Nigel FRENCH, JP: Secretary General
Mr K Y WU: Assistant Secretary General (General)
Hospital Authority
Dr W M KO: Deputy Director (Operations)
Item IV
Security Branch
Mr Jack CHAN: Principal Assistant Secretary for Security
Correctional Services Department
Mr Peter PI: Assistant Commissioner (Operations)
Mr W M WONG: Senior Superintendent
Hospital Authority
Dr W M KO: Deputy Director (Operations)
Ms Susie LUM: Senior Executive Manager/Nursing
Item V
Department of Health
Dr T A SAW: Deputy Director of Health
Dr T H LEUNG: Assistant Director of Health
Item III - Deputations
University of Hong Kong
Prof. Rosie YOUNG
Pro-Vice Chancellor
Prof. W R DAVIES
Pro-Vice Chancellor
Chinese University of Hong Kong
Prof. Joseph LEE: Dean of Faculty of Medicine
Mr Andrew CHAN: Planning Officer, Faculty of Medicine

Clerk in attendance :

Mrs Mary TANG: Chief Assistant Secretary (2) 4

Staff in attendance :

Mr Stanley MA: Senior Assistant Secretary (2) 9

Closed Meeting

I. Confirmation of minutes of meeting and matters arising

II. Items for discussion at the next meeting

III. Private practice of university medical consultants and specialists

IV. Manpower problem of Siu Lam Psychiatric Centre

V. Primary health care for diabetic patients

VI. Any Other Business

Closed Meeting

1. Members went through the agenda items III to V and agreed on the approaches and main questions to be raised under each item.

2. Members also agreed on the topics to be discussed at the next regular meeting.

I. Confirmation of minutes of meeting and matters arising

(LegCo Paper Nos. CB(2)1596 and 1769/96-97)

3. The minutes of meeting held on 17 February and 21 March 1997 were confirmed.

II.Items for discussion at the next meeting

(Paper No. CB(2)1790/96-97 (01))

4. The Chairman informed the Administration that the Panel wished to discuss the following items at the next meeting to be held on 12 May 1997 -

the Nurses Registration (Amendment) Bill 1997;
the manpower shortage of nurses; and
the implementation of the Optometrists Regulation.

III. Private practice of university medical consultants and specialists

(Paper Nos. CB(2)1790/96-97 (02), (03), CB(2)1264 and 1205/96-97)

5. Dr YEUNG Sum and Dr LAW Chi-kwong declared interest as employees of the University of Hong Kong (HKU) and Dr LEONG Che-hung also declared interest as a private medical practitioner.

6. The Chairman briefed the meeting on the Panels concern on the proper use of public money in connection with the issue of private practice of university medical consultants and specialists in HKU and the Chinese University of Hong Kong (CUHK). He enquired whether the University Grants Committee (UGC) and the Education and Manpower Branch (EMB) had exercised appropriate control measures to ensure that such private practice were allowed to take place for the benefits of the community and without affecting the quality of teaching in the departments of the two Universities concerned.

7. In response, Mr Nigel FRENCH, Secretary General of the University Grants Committee (SG/UGC), briefed members on the monitoring role of UGC. He emphasized that UGC-funded institutions such as HKU and CUHK were statutorily autonomous legal entities who were required to manage their internal affairs, including terms and conditions of staff appointments and rules governing outside practice by such staff, efficiently, responsibly and accountably. UGC monitored these aspects of the two Universities activities in accordance with its "Notes on Procedures" and Government subvention rules to ensure that public funds, provided as recurrent subventions for the two Universities activities, were properly spent and accounted for. From time to time, UGC would also advise the two Universities on international best practice relevant to the two Universities activities.

8. While agreeing that HKUs regulations and guidelines governing private clinical practice by their clinical academic staff were more comprehensive, members enquired on the measures which UGC had taken and would be taking to ensure that similar approach could be adopted by CUHK. SG/UGC replied that UGC had already encouraged HKU and CUHK to jointly review their current guidelines on private practice, taking into account prevailing international best practice, with the aim of standardising the rules and regulations for academic staff in both universities. In reply to a members follow up question, SG/UGC acknowledged that private practice carried out within the campus of the university or the designated hospitals for clinical practice were essentially different from that rendered in private clinics. In this connection, he agreed that the existing guidelines of CUHK could be made more comprehensive.

9. Mr Howard YOUNG enquired on the jurisdiction of UGC over the internal administrative matters of HKU and CUHK. SG/UGC replied that UGC is a non-statutory body established to advise the Government in the allocation of public funds to local tertiary institutions. He reiterated that HKU and CUHK were statutorily autonomous organizations and were publicly accountable on their policy and procedures governing outside practice.

10. The Principal Assistant Secretary for Education and Manpower branch (PAS/EMB) supplemented that the Government respected the autonomy of tertiary institutions which were statutorily independent bodies. UGC was established as an independent body between the Government and the institutions. EMB was not involved in the day-to-day management of internal affairs of tertiary institutions including HKU and CUHK. As far as the use of public funds was concerned, EMB had seen that the two Universities had in place a set of established administrative systems and procedures to monitor their financial affairs. As part of an on-going monitoring process, EMB would review and examine, in consultation with UGC, the financial requirements of local tertiary institutions every three years. She added that UGC, through its role of making recommendations to the Government on the allocation of public funds to local tertiary institutions, could set some guiding principles in the proper disbursement of public funds by the two Universities and other UGC-funded institutions. When necessary, investigation would be conducted into cases involving misuse of public funds.

11. The Chairman asked UGC to elaborate on the mechanisms which were in force to ensure the proper use of public money by the two Universities. SG/UGC explained that UGC would thoroughly examine the financial reports which the two Universities were required to submit at regular intervals. When UGC considered that additional information on a particular item was necessary, the university concerned would be requested to provide further details in writing. He added that other monitoring mechanisms, including observation of the requirements setting out in the "Notes on Procedures" and Government subvention rules and examination of the annual accounts of the two Universities by the Director of Audit, had been in force to ensure that public funds were spent in a cost-effective manner. As part of an on-going process of review, the UGC was planning to undertake management reviews by the end of this year. These reviews would look into the management of resources and financial allocation of all the UGC-funded institutions.

12. A member enquired whether UGC did advise HKU and CUHK on the international best practice governing private clinical engagements by university medical consultants and specialists. PAS/EMB pointed out that as a Committee consisting of reputable members having connections with overseas institutions, UGCs recommendations in this regard were always taken into account by the two Universities.

13. Professor Rosie YOUNG, Pro-Vice Chancellor of HKU, supplemented that there were control mechanisms established at department, faculty and University committee levels for the monitoring of private practice by their teaching staff. If the quality of work of a clinical teacher engaging in private practice was adversely affected, the Head of the Department or the Dean of the Faculty would look into the case and take appropriate action as necessary to rectify the situation. In addition, HKU had recently set up a working party to review the current regulations and policies with the aim of ensuring cost-effectiveness as well as maintaining quality of teaching and research.

14. Professor Joseph LEE, Dean of Faculty of Medicine of CUHK, added that internal regulations and guidelines governing private clinical practice had been submitted to UGC for comments and a review of these regulations and guidelines in collaboration with HKU was underway. He added that as Dean of the Faculty of Medicine, he would monitor the list of senior clinical teachers who were allowed to undertake private clinical practice and their earnings therefrom and would make regular reports on outside practice to the University Council.

15. Quoting from reported cases of outside private practice by university medical consultants and specialists, members had reservation on the adequacy and effectiveness of the existing mechanisms governing outside private practice by eligible and approved clinical staff in the two Universities. They demanded that an overall review on Governments policies on the issue should be made. PAS/EMB stated that while there was at present no indication of an urgent need for a radical change in the related policies, the Administration was prepared to examine the situation to see if further improvements could be made. As for the two cases of outside private practice by clinical staff in CUHK, SG/UGC briefed members on the investigation findings and assured members that UGC was prepared to look into the details of every such case reported to its office.

16. The Chairman reiterated the concern of the Panel on the proper use of public funds in relation to the issue and requested the Administration to provide the Panel with a report on the review of the policy governing private practice by university medical consultants and specialists.

Adm

IV.Manpower problem of Siu Lam Psychiatric Centre

(Paper No. CB(2)1790/96-97 (04))

17. Referring to the report of the Hospital Authority (HA) on the nursing manpower requirements at Siu Lam Psychiatric Centre (SLPC) from a medical perspective, Dr YEUNG Sum asked how the Administration would tackle the problem of nursing manpower shortage at SLPC. The Principal Assistant Secretary for Security replied that as both the Security Branch (SB) and the Correctional Services Department (CSD) were not involved in HAs study which did not take into account that SLPC was primarily a correctional institution and that the implementation of CSDs proposals in the 1994 study was underway, the Administration would not consider the recommendations of HAs report at this stage. However, if there was a review following the full implementation of the CSDs proposals, it would not be ruled out that the Administration might use HAs report as a reference.

18. In response to members enquiries on the progress of implementation of the recommendations in CSDs report, the Assistant Commissioner (Operations) of CSD replied that 39 Correctional Services Officers (CSOs) at SLPC had been sent to receive psychiatric nursing training. Towards the end of the year, some 25 to 30 CSOs would also be arranged to attend the training. In respect of additional manpower required, four posts at Officer (Registered Nurse Psychiatric) level, one post of Dispenser and one post of Occupational Therapist I had been created. Another 16 new posts would be created as training reserve in the 1997/98 year.

19. The Deputy Director (Operations) of HA (DD(O)/HA) supplemented that the need to involve CSD was fully recognised, having regard to the unique nature of SLPC as an institution providing both correctional and psychiatric services. However, HA also understood the Administrations intention to go ahead with implementing CSDs proposals in 1994 before considering any other review. It therefore agreed to the Panels request and made the present assessment basing on operational experience of medical professionals in a medical setting.

20. In conclusion, the Chairman expressed that the Panel was not satisfied with the existing level of nursing care provided to inmates at SLPC. He urged SB and CSD to continue to coordinate their efforts in upgrading the nursing services at SLPC based on the additional resources made available in 1997/98.

V. Primary health care for diabetic patients

(Paper No. CB(2)1790/96-97 (05) and (06))

21. In view of the many subjects falling within the scope of primary health care, the Chairman stressed that the discussion would focus mainly on the issue of primary health care for diabetic patients.

22. Dr YEUNG Sum asked whether diabetic patients were receiving the same level of health care in general out-patient (GOP) clinics of the Department of Health (DH) and special clinics of HA. The Deputy Director of Health (DD/DH) replied that the services rendered at GOP clinics and specialist clinics for stabilised diabetic patients were basically similar. In addition to regular follow-up in accordance with an agreed protocol, there were regular health education programmes, individual counselling and support groups organized for these clients. He pointed out that doctors and nurses in GOP clinics had actively invited diabetic patients to make use of these services and in many instances had requested individual diabetic patients to return for medical checks as well as to join support groups. He emphasized that the primary objective of these health education activities was to promote patients compliance with treatment to prevent complications and to promote patients self reliance and self care in the prevention of illness and the maintenance of their health.

23. DD/DH added that a shared care programme coordinated jointly by GOP and specialist clinics had been implemented to look after the diabetic patients. In accordance with the agreed clinical protocol designed in consultation with the clinicians in the hospitals, doctors working at GOP clinics could arrange early transfer to specialist clinics for diabetic patients whose conditions required adjustment in management regime.

24. Dr YEUNG Sum enquired about the problems identified by the Concern Group on Diabetes Education in the General Out-patient Clinics (Paper No. CB(2) 1790/96-97 (06)). DD/DH replied that all doctors and nurses at GOP clinics had received training to look after chronic disease patients including diabetic patients. In addition, the following measures had been underway and would be further enhanced -

vocational training and continuing medical education in family medicine for doctors;
programme of continuing nursing education for nurses in all relevant aspects of nursing including training in conducting health education and giving dietary advice to special need groups;
the "Customer Service Improvement Project" had been launched in some GOP clinics with emphasis on procedural and attitude changes, as well as upgrading of equipment and improvements of clinic environment to inculcate a client-oriented culture among the staff. The project would be extended to all GOP clinics by the end of 1997;
recruitment of specialists including dietitian and chiropodist to help in the continuing education programme for nurses;
further training on communication and interpersonal skills for doctors and nurses; and
more innovative publicity programmes on health education.

25. In response to the Chairmans concern about the inadequacy of health education programmes for diabetic patients, DD/DH pointed out that health talks and meeting of support groups were organized throughout the year and were well received and attended. He stated that a total of 55,065 individual counselling, 660 health talks and 129 support groups for diabetic patients had been organized in 1996. The Chairman pointed out that in 1992, DH had launched the District Health System with the aim of promoting primary health care programmes at district level, but so far achievements had not been noteworthy. DD/DH replied that DH had been trying their best to improve primary health care services in all aspects. He believed that, as more and more in-service doctors and nurses were trained in their own roles, the overall quality of primary health care provided to the community had continuously been upgraded. He also assured members that DH had been provided with the necessary funds to proceed with the planned courses of actions to upgrade services in primary health care in 1997/98.

26. Miss CHAN Yuen-han was concerned that some diabetic patients had to suffer from the trauma of having to amputate their legs as a result of a lack of proper care. In response, DD/DH believed that not withstanding the natural course of the disease in some persons, better publicity on the variety of services available in GOP clinics as well as the promotion of patients compliance with treatment regime and maintenance of their health could facilitate more timely intervention and thus could help reduce the number of such cases. He also pointed out that for some reasons some diabetic patients did not turn up for medical checks arranged for them at GOP clinics. For diabetic patients showing signs of such inclination or having such record of attendance, doctors and nurses in GOP clinics would advise them of the possible consequences arising from the lack of proper health care at individual counselling sessions and over telephone conversations. The Chairman responded that DH should endeavor to ensure that all diabetic patients were well informed of their individual states of health and the range of services available in GOP clinics for the maintenance of their health.

27. Dr LAW Chi-kwong expressed concern about the waiting time for diabetic patients who were referred to specialist clinics under the shared care programme. DD(O)/HA replied that HA had initiated a list of remedial actions and had reduced the waiting time to an acceptable level. He added that agreements had been reached between DH and HA on the conditions of diabetic patients which justified transfer from GOP to specialist clinics and vice versa. DD/DH supplemented that the shared care programme for patients suffering from hypertension, tuberculosis and chronic heart diseases also had the same arrangement.

28. Regarding the provision of dietary and chiropodic services, DD(O)/HA pointed out that given the large population of diabetic patients in Hong Kong, it would be impractical to arrange direct service by specialists (some 60 dietitians and 16 chiropodists in HA) to diabetic patients. In such circumstances, DD/DH reiterated that special training for nurses in GOP clinics on dietary and chiropodic care would be a workable solution. At the request of the Chairman, DD/DH agreed to provide the Panel with details on the arrangements and programmes which DH would coordinate with HA to train up nurses and other concerned staff in GOP clinics with the necessary skills and knowledge for such purpose.

Adm

29. Members stated that some diabetic patients, after being transferred from specialist to GOP clinics, were not provided by GOP clinics with the same drugs which they received from specialist clinics. DD(O)/HA clarified that under the shared care programme, HA and DH had agreed on a common set of drugs to be used in both specialist and GOP clinics for diabetic patients. DD/DH supplemented that the liaison group consisting of representatives from HA and DH had been conducting an on-going review on the list of drugs available in both specialist and GOP clinics for such purpose. He however did not rule out the possibility of a few isolated cases which might involve the use of new or special drugs for diabetic patients in specialist clinics. In this connection, the Chairman requested DH and HA to follow up the matter.

VI. Any Other Business

30. In response to members concerns about the recent outbreaks of tuberculosis cases at a kindergarten and a nursery in Tsuen Wan district, DD/DH pointed out that DH had a well-developed tuberculosis control programme consisting of vaccination, disease surveillance, contact tracing, health education etc. which had effectively kept tuberculosis under control in Hong Kong. He added that the children were suffering from non-infectious tuberculosis and even with an infectious tuberculosis, proper medical treatment for one to two weeks could normally change the state of the patient from infectious to non-infectious. He also explained that DH had been handling the recent tuberculosis cases with a low profile in order to strike a right balance between the publics right to information and the patients right to confidentiality, to avoid unwarranted intrusion and discrimination. In the present circumstances, DD/DH said there was absolutely no need for panic. He urged that it was, instead, a time for support and understanding of those in need of care.

31. Members were also concerned whether swine fever would occur and infect people in Hong Kong. In response, DD/DH stated that it was a viral disease which was not communicable to human beings and that the virus concerned could not survive at normal cooking temperature He added that he did not see at this stage the need to introduce special measures on the prevention of the disease in Hong Kong.

32. There being no other business, the meeting ended at 11:15 am.

Legislative Council Secretariat
4 June 1997

Last Updated on 19 August 1998