EC(97-98)44
For discussion
on on 14 January 1998


ITEM FOR ESTABLISHMENT SUBCOMMITTEE OF
FINANCE COMMITTEE

HEAD 37 - DEPARTMENT OF HEALTH
Subhead 001 Salaries

Members are invited to recommend to Finance Committee the creation of the following permanent posts -

2 Assistant Directors of Health

(D2) ($110,000 - $116,800)

1 Consultant

(D4/D3/D2)

($145,150 - $149,600 / $127,900 - $135,550/

$110,000 - $116,800)

(in the overall promotion ratio of 2:3:6)

PROBLEM

The Department of Health (DH) requires additional directorate support to plan and deliver a revised Elderly Health Services (EHS) programme and to establish a regulatory framework to control the practice, use and trading of Traditional Chinese Medicine (TCM).

PROPOSAL

2. We propose creation of the following permanent posts -

  1. one Assistant Director of Health (D2) post with effect from 1 March 1998 to assume overall responsibility for the delivery of an integrated EHS which aims to provide comprehensive and quality primary health care service for the elderly;

  2. one Consultant (D4/D3/D2) post with effect from April 1998 to provide specialist clinical support to EHS; and

  3. one Assistant Director of Health (D2) post with effect from 1 April 1998 for establishing and implementing a regulatory framework to control the practice, use and trading of TCM.

JUSTIFICATION

Elderly Health Services

3. DH now operates pledged to develop seven elderly health centres to provide comprehensive preventive and promotive health services for the elderly. These seven such centres provide health screening service and health education to the elderly. DH's operational experience has shown that such a health care programme has room for improvement to meet the overall health needs of the elderly. In particular, we should improve family support for the sick elderly and encourage the elderly to age in place with dignity and maximal independence. Having reviewed the scope and content of the present service, the Director of Health proposes to provide the service with a new integrated approach.

4. Under the new approach, DH will expand the current network of elderly health centres, and enhance the service to include, in addition to preventive and promotive, curative care for the elderly. At the same time, out-reaching visiting health teams will be established to provide preventive and promotive care services to the elderly living in the community as well as professional support to their carers. DH's target is to set up 18 elderly health centres and visiting health teams in the next two years, with 12 centres and teams operating in 1998-99, followed by another six centres and teams in 1999-2000. The aim is to provide, in a holistic manner, comprehensive and quality integrated primary healthcare services with a multi-disciplinary approach.

5. DH will organise the enhanced service under two components: the Public Health & Outreaching Service and the Clinic Service. The Public Health & Outreaching Service focuses on identifying, assessing and meeting demands for service, planning and development of strategy and programme in promoting community health, operating outreaching visiting health teams and administration of the new integrated elderly health service as a whole. The Clinic Service provides centre-based integrated healthcare to address individual health needs of the elderly. Because of their distinctive nature of work, the two services require different expertise. The Director considers it necessary to have an Assistant Director of Health to assume the responsibility of taking charge of the EHS and to head the Public Health & Outreaching Service, and a Consultant to head the Clinic Service for the clinical care for the elderly.

One Assistant Director of Health for the Public Health & Outreaching Service

6. The Director considers that the Public Health & Outreaching Service should be headed by a very experienced public health administrator. The officer will be responsible for planning, steering and developing elderly health services, to ensure that they fulfil the Chief Executive's strategic policy objectives on care for the elderly, and to ensure that they meet the changing needs of the elderly. In this connection, he will be responsible for monitoring the public health dimensions of the elderly, including health data and trend analysis, assessment of health needs of the elderly, as well as planning, development and review of multi-dimensional health programmes. He will also be responsible for the resources management of the integrated elderly health services to ensure that they are operating cost-effectively. To this end, he will set performance targets, monitor the progress of programmed activities and assess them against the targets. He will ensure consistency in the quality and standard of service provided and their proper interface with the services provided by the welfare sector, community groups, the Hospital Authority and other relevant parties so as to deliver a service package that best meets the needs of the elderly. The Assistant Director will be responsible for promotion of the new service, including the formulation and implementation of publicity strategies to encourage participation in the programme. In addition, he will take charge of the outreaching service provided by the visiting health teams. The visiting health teams are to provide, on an outreaching basis, on-site preventive and promotive health care services to the elderly and their carers, and also provide vaccination to institutionalised elderly. The Assistant Director will supervise the operation of the visiting health teams, review the effectiveness of the mode of operation and scope of service, and, where appropriate, adjust the service to best meet the needs of the elderly.

7. The comprehensive service planning and effective monitoring of the implementation the new EHS will require a professional officer of good medical knowledge and extensive health administration experience. Having regard to the level of responsibility, importance and complexity of the job, the Director considers that the post should be pitched at the Assistant Director level.

8. To facilitate the planning of the expanded services, the Director created under delegated authority a supernumerary post of Assistant Director of Health on 1 September 1997 for six months to accommodate an officer for the purpose. As the development of the integrated elderly health services has indicated a need for a permanent Assistant Director post, the Director proposes to create the post on a permanent basis with effect from 1 March 1998. The post will be designated as Assistant Director (Elderly Health Services).

One Consultant post for the Clinic Service

9. The Clinic Service will consist of Elderly Health Centres with related para-medical support. Elderly Health Centres advocate self-care, independent living and peer support. Adopting a family medicine approach, Elderly Health Centres offer holistic care including preventive, curative and para-medical services to clients aged 65 and above. Major activities include health education to promote healthy living, counselling to improve self-care ability, screening for early diseases and their treatment. The Director estimates that, when in full operation, the annual attendance at these centres would reach 300 000. The Clinic Service will also offer training to family members to support home care for the elderly, and interface with other health care sectors for clinical management of chronic cases.

10. Having regard to the nature of the service, we consider that a specialist in family medicine is required for heading the Clinic Service. The officer will supervise the Elderly Health Centres which aim to provide holistically preventive, promotive and curative health care to the elderly. He will attend to the more complicated cases that require the expertise and experience of a Consultant. He will develop and implement clinical protocols for the integrated elderly health services, as well as training and educational programmes in family medicine for the centres. This calls for an officer with medical expertise and experience in family medicine. Having regard to the duties and responsibilities involved, the Director considers it appropriate to rank the post at the Consultant level.

11. Job descriptions of the proposed Assistant Director (Elderly Health Services) and the Consultant (Family Medicine) (Elderly Health Services) posts are at Enclosures 1 and 2. A proposed organisation chart of the Elderly Health Services is at Enclosure 3.

Traditional Chinese Medicine

12. TCM is widely used in the community but we do not have a specific mechanism to assess and ensure standards of practice or to regulate the safe use of Chinese medicines. In March 1995, the Secretary for Health and Welfare appointed a Preparatory Committee on Chinese Medicine to advise on the promotion, development and regulation of TCM. The Preparatory Committee submitted its recommendations in March 1997 which, inter alia, include the establishment of a statutory body to regulate the practice, use and trading of TCM, of a system of accreditation, involving examination, registration and discipline for TCM practitioners, and of a control mechanism, through registration, licensing and labelling, to regulate the manufacture, distribution, retail and import/export of TCM.

13. In the 1997 Policy Address, the Chief Executive announced that we would establish a statutory framework to regulate TCM. The framework will enable us to assess and ensure acceptable standards of TCM practice, and to regulate the use, manufacture and sale of Chinese medicines. A sound regulatory system will provide Hong Kong with a firm basis to develop into an international centre for the manufacturing and trading of Chinese medicine and for promoting the use of TCM. As a first step, the Government plans to introduce a bill in
1998-99 to establish such a statutory framework.

One Assistant Director of Health post for the Traditional Chinese Medicine Division

14. In view of the scale and the importance of the tasks concerned, DH needs to set up a dedicated team to develop and administer the implementation of the new control framework. The TCM Division will comprise two sections -

  1. the Public Health Administration Section to deal with the administration and planning, law enforcement, public health investigation, and promotion of and education on TCM; and

  2. TCM Administration Section with a TCM Practice Unit to direct and supervise registration, discipline, licensing and examination of TCM practitioners and to handle accreditation of institutions, and a Chinese Medicine Unit responsible for matters relating to the control of the use and trading of Chinese medicines.

15. The immediate task of the Assistant Director is to establish the TCM Council and the framework for regulating the practice, use and trading of TCM. He needs to establish a system of accreditation and registration for practitioners, and set up a control mechanism through registration, licensing and labelling, to regulate the manufacture, distribution, retail and import/export of TCM.

16. He will set up an infrastructure for implementing the regulation of TCM. He will draw up a database for TCM, set standards for and monitor the quality and safety of Chinese medicines. He will also advise on the publicity and promotion strategy, provide health education on the appropriate use of Chinese medicines, and investigate into incidents of herbal poisoning.

17. Upon enactment of the related legislation, the Assistant Director will oversee the regulation of the TCM practice in accordance with the legislative requirements and supervise the necessary enforcement action. He will review the related legislation regularly to ensure that it serves the regulatory purpose and meets the community's changing needs.

18. The effective discharge of the above responsibilities requires an officer with broad experience in public health administration. Having regard to the importance and complexity of the task, the Director considers that the post should be ranked at Assistant Director level.

19. To accommodate an officer to start planning for the setting up of a statutory body and framework for regulating TCM, the Director of Health created under delegated authority one supernumerary Assistant Director of Health post on 1 October 1997 for six months. Given the long term requirement of the post, the Director proposes that the post should be created on a permanent basis with effect from 1 April 1998. The post will be designated as AD(TCM). Job description of the proposed post is at Enclosure 4and a proposed organisation chart for the TCM Division is at Enclosure 5.

20. Proposed organisation chart of the Department of Health is at Enclosure 6.

FINANCIAL IMPLICATIONS

21. The additional notional annual salary cost of the proposals at MID-POINT is -

$No. of Post
New permanent posts4,221,2733

The full annual average staff cost of the proposed posts, including salaries and staff on-costs, is $7,021,259. We will include sufficient provision in the 1998-99 draft Estimates to meet the cost of this proposal.

BACKGROUND INFORMATION

22. To provide adequate support to deliver the elderly health services with a new integrated approach, the Director of Health advises that she will require in addition to the existing 51 non-directorate posts established for the seven Elderly Health Centres, creation of 163 and 107 non-directorate posts in 1998-99 and 1999-2000 respectively. For regulating TCM, another 23 non-directorate posts will be required in 1998-99 and nine in 1999-2000. The creation of these posts will be effected through the normal Departmental Establishment Committee machinery under delegated authority.

CIVIL SERVICE BUREAU COMMENTS

23. The grading and ranking of the proposed posts are appropriate having regard to their duties and responsibilities.

ADVICE OF THE STANDING COMMITTEE ON DIRECTORATE SALARIES AND CONDITIONS OF SERVICE

24. The Standing Committee on Directorate Salaries and Conditions of Service has advised that the grading proposed for the posts would be appropriate if the posts were to be created.

Health and Welfare Bureau

January 1998

Enclosure 1 to EC(97-98)44

Duty list of the proposed Assistant Director of Health post
for the Public Health & Outreaching Service
of the Integrated Elderly Health Services

  1. To assist the Deputy Director of Health (1) in the overall administration of the Integrated Elderly Health Services including resources management, training, general administration, clinic administration and nursing administration.

  2. To provide strategic direction to the Integrated Elderly Health Services to ensure they meet the changing needs of the elderly and fulfil the Chief Executive's strategic policy objectives.

  3. To develop, implement and review multi-dimensional health programmes for the elderly.

  4. To supervise Visiting Health Teams to provide outreaching preventive and promotive health care services for the elderly.

  5. To oversee health data collection, analysis and dissemination as well as health services research with regard to the elderly.

  6. To monitor the overall health status of the elderly and changing trends.

  7. To collaborate and strengthen liaison with the welfare sectors, community groups and the Hospital Authority in order to promote intersectoral coordination and direct appropriate service to the elderly.

  8. To develop, implement and review publicity and promotion strategies for the Integrated Elderly Health Services.

Enclosure 2 to EC(97-98)44

Duty list of the proposed Consultant post
for the Clinic Service of the Integrated Elderly Health Services

  1. To supervise Elderly Health Centres to provide primary preventive, promotive and curative health care to the elderly through family medicine approach.

  2. To attend to complicated cases where the expertise and experience of a Consultant is required.

  3. To develop and implement clinical protocols for the Integrated Elderly Health Services.

  4. To develop and implement training and educational programmes in family medicine for Elderly Health Centres.

  5. To collaborate with Assistant Director (Elderly Health Services) in developing public health programmes for the elderly.

  6. To liaise with local and international medical and non-medical bodies on recent advances of clinical management of the elderly.

Enclosure 4 to EC(97-98)44

Duty list of the proposed Assistant Director of Health post for
the Traditional Chinese Medicine Division

  1. To oversee the overall administration of the Traditional Chinese Medicine (TCM) Division including general administration, planning and resources management.

  2. To develop a framework for regulation of TCM, including its practice, use and trading, and to oversee its implementation.

  3. To provide professional support for the drafting and review of legislation for the accreditation of TCM practitioners and regulation of Chinese medicines.

  4. To devise and monitor standards for quality and safety of Chinese medicine.

  5. To organise necessary law enforcement action and to supervise public health investigation.

  6. To oversee the build-up and development of a database for TCM.

  7. To steer the conduct of health education programmes in TCM.

  8. To advise on the publicity and promotion strategy for TCM.