LegCo Paper No. CB(2) 603/96-97
Ref: CB2/PL/HS/1

LegCo Panel on Health Services

Minutes of Meeting held on Monday, 14 October 1996 at 8:30 a.m. in Conference Room B of the Legislative Council Building

Members Present :

Members Absent :

Public Officers Attending :
Health and Welfare Branch

Mr Clement CHEUNG: Deputy Secretary for Health and Welfare (Acting)
Mrs Maureen CHAN: Principal Assistant Secretary for Health and Welfare (Medical)1
Mr Daniel CHENG: Assistant Secretary for Health and Welfare (Medical)3 Department of Health
Dr S P MAK: Deputy Director of Health (Acting)
Dr Elizabeth L KWAN: Consultant i/c Dental Service (Acting) Hospital Authority
Dr Lawrence LAI: Chief Executive (Acting)
Dr K K LAI: Senior Executive Manager (Professional Services)

Clerk in Attendance:

Ms Doris CHAN: Chief Assistant Secretary (2)4

Staff in Attendance :

Mr Alfred CHAU: Senior Assistant Secretary (2)4

I. Items for discussion at the next meeting

II. Accident and Emergency (A&E) Services in Public Hospitals

III. Dental service in public hospitals

I. Items for discussion at the next meeting

1. Members noted that private practice by medical clinicians of the University of Hong Kong and the Chinese University of Hong Kong and by clinical teachers of the Faculty of Dentistry of the University of Hong Kong would be discussed at the next meeting on 11 November 1996 with representatives from the two universities concerned attending.

II. Accident and Emergency (A&E) Services in Public Hospitals

(LegCo Paper No. CB(2) 116/96-97 (01))

2. The Chairman referred to the paper provided by the Hospital Authority (HA) and said that discussions should be centred on the following two areas of concern -

how to relieve the pressure on A&E services in public hospitals; and
press reports of complaints of non-admission and early discharge of patients.

3. Dr Lawrence LAI said that as outlined in the first paragraph of the paper, a series of improvement measures had been introduced to meet increasing public demand and to improve the quality of emergency services. He pointed out that there had been a 16% increase in patient attendance which rose from 1,600,000 to 1,900,000 and resulted in an upsurge of workload in some hospitals. A Triage system had been introduced to accord priority to patients requiring urgent treatment and the physical layout of A&E departments had been improved to facilitate better work and patient flow. As regards the second concern, he said that every A&E doctor made his/her decision based on the conditions of the patient.

4. Dr LEONG Che-hung queried the Administrations claim that the waiting time for treatment in A&E departments had been reduced to less than 30 minutes. He pointed out that in Tuen Mun Hospital, where the daily attendance had increased from 394 in January 1994 to the present figure of 518, the average waiting time was 45 minutes or above. He asked apart from increase of manpower, what else could be done by the Department of Health (DH), HA and medical practitioners in private practice, especially at night and during holidays.

5. Mr Clement CHEUNG admitted that for certain hospitals, the 30 minutes target time could not be achieved at all times. He said that those requiring urgent treatment would be given priority and that efforts had been made to educate the public and to improve the coordination between DH and HA. Dr Lawrence LAI stressed the importance of educating the public on the appropriate use of accident and emergency services, including an understanding on what sort of cases should attend the A&E departments, knowledge on treatment of minor ailments and as well as the availability of alternative service providers. Posters and pamphlets for the purpose had been printed and he undertook to provide some samples for members information.

6. Dr S P MAK informed the Panel that eight DH clinics offered services during long public holidays. Utilization rate of the services was around 60%. Various publicity measures had been implemented including display of posters at clinics, issuing of press release to newspapers and broadcast messages to radios, as well as publication in local district newspapers. In addition, there was the Medilink Service provided by the Hong Kong Medical Association on services available from doctors in both public and private practice.

7. The Chairman observed that the low utilization rate could be due to the inconvenient locations of the clinics. In reply to members question, Dr MAK said that the clinics were located as follows -

Hong Kong Island : Violet Peel Health Centre, Wanchai and Shau Kei Wan Jockey Club Clinic (JCC)

Kowloon : Yau Ma Tei JCC, Robert Black Health Centre, and Kwun Tong Jockey Club Health Centre

NT West : Lady Trench Polyclinic, Tsuen Wan and Yuen Long Jockey Club Health Centre

NT East : Shek Wu Hui JCC, Sheung Shui

She said that the public clinics were large clinics conveniently located and easily accessible. She added that the clinics in Shek Wu Hui and Yuen Long had the highest utilization rate while those in Yau Ma Tei and Kwun Tong had the lowest utilization rate.

8. Miss CHAN Yuen-han opined that the clinics were not evenly located and more clinics should be opened in the southern district of Hong Kong Island and in Tuen Mun.

9. The Chairman pointed out that the low utilization rate in Kwun Tong was closely related to the number of A&E attendances in the United Christian Hospital (UCH) where there had been a 50% increase. Dr LEONG Che-hung said that the DH should find out the reason why patients preferred waiting at the very busy A&E department of UCH instead of going to the Kwun Tong Clinic. He asked the Administration to inform the Panel of the opening hours of the eight DH clinics and the peak hours of the A&E departments of public hospitals.

10. Mr Clement CHEUNG said that some patients might prefer the A&E service in public hospitals because of the perception that a higher level of service could be provided. He also pointed out that for primary health care, the bulk of services should be provided by medical practitioners in the private sector.

11. Dr LEONG Che-hung remarked that the DH should help to relieve the burden on the HA. Miss CHAN Yuen-han considered that there was a lack of co-ordination between the DH and HA. She pointed out that in Tuen Mun, the waiting time could be up to three to four hours. She said that many private medical practitioners were not in service during public holidays and it was not a matter of preferring a higher level of service. The Chairman commented that the Administration must explore ways to alleviate the problem.

12. Referring to Dr LEONGs question, Dr Lawrence LAI said that the busiest hours of A&E departments were as follows -

9:00 - 10:00 a.m.
2:00 - 3:00 p.m.
9:00 p.m. - 12 midnight

Dr MAK said that the eight DH clinics opened from 9:00 a.m. to 1:00 p.m. on public holidays.

13. Dr LAW Chi-kwong said that in order to seriously consider the problem, the following information was necessary -

the utilization of the DH clinics, i.e. the number of attendances, on ordinary days;
the population of the catchment area of each clinic;
the distance of the clinics from other hospitals in the vicinity;
whether there had been any increase in the utilization rate, e.g. from 40% to 60%, since the opening of the clinics on holidays; and
for the A&E departments in HA hospitals, the waiting time for different periods of the day in order to establish patients utilization pattern.

Refe Referring to the complaints of refusing to refer patients for admission to hospitals, Dr LAW said that he would like to have information on the following -

the admission rates for the different wards;
the average length of stay in the various wards; and
the admission rates at A&E departments during different periods.

He said that the above information would enable members to see whether there was a relationship between the two. He further pointed out that the average waiting time of 30 minutes was meaningless as some patients had to wait for hours during peak periods while others were attended by doctors after only a few minutes at other times. He asked for the different waiting times for different periods at the various hospitals to be provided.

14. Dr MAK said that the eight DH clinics had a high utilization rate of over 90% on ordinary days and they were conveniently located for patients access. She agreed to provide the remaining information in respect of DH clinics in writing. The Chairman suggested that there might be a need to review the practice of private medical practitioners e.g. to require those practising in public housing estates through terms of lease of premises to open by rotation during publlic holidays. Mr Clement CHEUNG said that HWB would discuss the matter with the Housing Department and the Hong Kong Estate Doctors Association.

15. Miss CHAN Yuen-han said that instead of turning to private medical practitioners, the Administration should make use of the 60 DH clinics to relieve the workload of the 14 A&E departments in HA hospitals. She urged the Administration to draw up a comprehensive plan to solve the problem which must target at the busy hours and population centres.

Adm

16. Referring to Dr LAWs comments, Dr Lawerence LAI said that the HA already had some statistics available and would provide the information requested in writing. As regards patients behavioural pattern, he said that there would be more public education on the alternative arrangements for non-emergency treatment.

17. Dr LEONG Che-hung pointed out that educating the public alone was not enough when no alternatives were available. He suggested that private medical practitioners should also provide some service during holidays, in particular in areas like Kwun Tong and Tuen Mun and that the Administration should discuss the matter with leaders of the profession in those areas.

18. In reply to the Chairmans question, Dr Lawrence LAI said that the proposal to set up clinics for private medical practitioners in the Queen Elizabeth Hospital had not been discussed by the Hospital Governing Committee and therefore there was no decision yet.

19. As regards refusal of admission to hospitals, Dr Lawrence LAI said that there were no such occurrences. He pointed out that the medical staff in A&E departments would not base their admission decisions on the vacancy position in wards but on patients needs. For patients with borderline conditions, the current arrangement would be to place them in observation wards before deciding on admission. In response to Dr LEONGs question, Dr K K LAI said that in the larger A&E departments there were two consultants and six to eight SMOs. For smaller A&E departments e.g. Fanling Hospital, the number of senior staff would be fewer. Dr LAI pointed out that patients conditions changed over time e.g. for head injuries, symptoms might not initially be evident and patients attention would be drawn to the need to observe the onset of such symptoms. With emerging symptoms, doctors might need to vary their decisions and consider admission as necessary. To safeguard the best interest of patients, special arrangements could also be made for the patients with borderline conditions to return to the A&E department within 24 or 48 hours and to be seen by more experienced doctors.

20. Dr HUANG Chen-ya agreed with Dr LAIs comments and suggested that on the second visit, the doctor concerned should review the earlier decision and to provide an explanation to the patient. Dr LAI agree to the importance of educating doctors and nurses on the need to provide explanations to patients.

21. It was agreed that the Health and Welfare Branch would provide a progress report in two months.

Adm

III. Dental service in public hospitals

(LegCo Paper No. CB(2) 116/96-97 (02) )

22. Dr LAW Chi-kwong referred to some complaints that dentists in public hospitals, in handling patients who had undergone radiotherapy, generally only offered extraction of teeth, the simplest and easiest way of treatment. He enquired whether such complaints indicated that there was shortage of manpower and resources in the public hospitals forcing the dentists to handle patients hastily. He also wanted to know the division of work between the HA and the DH in the provision of dental service as he noted that there were both HA and DH dentists in public hospitals.

23. Addressing the first question raised by Dr Law, Dr Elizabeth KWAN said the type of treatment including, for example, extraction of teeth depended on the professional judgment and clinical conditions of the patients. There were established clinical protocols such as that for patients who had undergone radiotherapy. Dr LEONG Che-hung supported that the kind of treatment for patients was a matter of professional judgment which should be respected. He opined that there might be communication problem between the dentists and the patients who had not been clearly informed of their conditions and why extraction of teeth was necessary. However, if there was really such a tendency as pointed out by Dr LAW Chi-kwong, Dr LEONG considered that the Dental Council should step in to investigate. Mr Clement CHEUNG said he would be happy to look into these cases if further details were available.

Dr LAW

24. As regards the staffing situation, Dr KWAN informed the Panel that there was no manpower shortage in both the hospital oral maxillofacial and dental units. She said at least 10% of the total number of their dental professionals were based at these units. Mr Clement CHEUNG said the Administration could provide members with information on the present staffing situation and caseload.

Adm

25. In response to the second question raised by Dr LAW Chi-kwong, Mr Clement CHEUNG explained the background why there were both HA and DH dental staff providing the service to the public. He said that in ex-government hospitals, dental service was provided by DH staff stationed at the hospitals while some ex-subvented hospitals had their own dental service. He stressed that there was no difference in the standard of services provided by a HA or DH dentist.

Adm

26. Dr LEONG Che-hung suggested that HA should take over the management and provision of dental services in public hospitals. Mr Clement CHEUNG answered that the whole government dental service with the various expertise was under DH. The dental officers of the dental units located in public hospitals only constituted about 10% of the dental manpower of DH. The present arrangement was considered appropriate and more cost-effective. He agreed to review, if necessary, the existing standard of dental services and the co-ordination between HA and DH to see whether there was room for improvement. However, he did not see any need to change the present service arrangement. Mr CHEUNG further quoted the example of the new North District Hospital where a dental unit would be established to meet projected service demands. However, Dr LEONG pointed out that there were individual cases showing the lack of co-ordination between HA and DH in the deployment of resources. He mentioned that the oral maxillofacial unit at the Queen Mary Hospital and the dental unit at the Prince Philip Dental Hospital had been lacking in support from HA in the provision of resources.

27. Responding to the Chairman s questions on post-extraction service, Dr Elizabeth KWAN said that such service would be provided if it was considered part and parcel of the treatment. As regards service after discharge from public hospitals, Dr KWAN said that these patients had to obtain curative service from the private sector unless they were civil servants.

28. Dr LEONG Che-hung referred to the Governors Policy Address of 1993 whereby the Government committed to provide dental services to "special needs groups". Dr LEONG asked for the definitions of these groups and progress of the implementation of the policy.

29. Dr Elizabeth KWAN said that the definitions of the three main groups who were considered "patients with special needs" covered by the scheme were as follows -

. patients with serious and disabling oral diseases;
patients who were severely handicapped mentally or physically; and
individuals with specific medical diseases.

Dr S P MAK said it was estimated that about 11,000 patients belonged to these three categories; 1,900 of them had been covered by the scheme already and it was estimated that a total of 3,000 would be covered by 1996/97. She reported that the programme started off with the Tuen Mun Hospital in 1993 and had been extended to Pamela Youde Nethersole Eastern Hospital. It would be extended, by phases, to the remaining regional hospitals. The next target would be the Prince of Wales Hospital. Dr MAK, however, could not yet indicate when the service would be extended to all the six targeted hospitals. Members were not satisfied with the pace of progress and the Administration agreed to report progress to the Panel with a rough indication of the timing for the completion of the programme.

30. Dr LEONG Che-hung asked whether the definition spelled out in para. 29 included the elderly. Dr MAK explained that the special needs group were categorized according to clinical conditions, and therefore the elderly age group was not included as such. However, she knew that the Social Welfare Department had designated some private dental clinics to provide dental services to the Comprehensive Social Security Assistance (CSSA) recipients who were in need of such service. The Administration would provide information on the number of CSSA recipients who were receiving this free dental service. Dr MAK said that promotive and preventive dental service was provided to the public, in particular school children, so that they could start good habits in dental care.

Adm

31. Dr LEONG criticised that the existing government policy on dental service which mainly focused on the promotion of oral hygiene was too narrow in scope. It had neglected the poor who could not afford to obtain proper oral care services. He urged the Administration to review the existing services and to consider the need to extend the services to the elderly and the increasing number of new immigrants from China.

Adm

32. In response to Dr LEONG Che-hungs enquiry, Dr S P MAK reported that six-month attachment training on oral maxillofacial surgery was being provided to the dentists at the six government oral maxillofacial surgery and dental units (OMS&DUs) of public hospitals. She said draft training plans had also been submitted to the College of Dental Surgeons for consideration.

33. The Chairman asked whether the provision of dental service could be included in the review of health care financing. Mr Clement CHEUNG clarified that the review only focused on existing financing structure of the health care system and options for reform. Dr LEONG reiterated that dental services constituted a part of health services and the Administration should explore every possible means to improve the provision of the dental services.

34. The meeting ended at 10:40 a.m.
Legislative Council Secretariat
2 December 1996

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Last Updated on 19 August 1998