EC(97-98)35
For discussion
on 19 November 1997

ITEM FOR ESTABLISHMENT SUBCOMMITTEE OF
FINANCE COMMITTEE

HEAD 37- DEPARTMENT OF HEALTH
Subhead 001 Salaries

Members are invited to recommend to Finance Committee -

1. the revision of the salary scale of the X-ray Assistant grade with retrospective effect from 1 November 1996, as follows -

   Rank	Salary Scale (Master Pay Scale)
   X-ray Assistant	Point 7 - 15 ($11,905 - $18,915)
   Senior X-ray Assistant	Point 16 - 21 ($19,860 - $25,340)

   
   

2. to retitle the grade as " Radiographic Technician " .

PROBLEM

We need to upgrade the entry qualification of the X-ray Assistant (XRA) grade to comply with the registration requirements arising from the legislative control over the practice of radiography from 1 November 1996.

PROPOSAL

2.We propose to upgrade the entry qualification of the XRA grade to Technician level and to correspondingly revise its pay scale with retrospective effect from 1 November 1996 as follows -

Rank	Salary Scale (Master Pay Scale (MPS))
	Existing	Proposed
X-ray Assistant (XRA)	Point 3 - 12 ($9,245 - $16,165)	Point 7 - 15 ($11,905 - $18,915)
Senior X-ray Assistant (SXRA)	Point 13 - 17 ($17,145 - $20,865)	Point 16 - 21 ($19,860 - $25,340)

We also propose to retitle the grade as " Radiographic Technician " .

JUSTIFICATION

3.We employ XRAs to perform chest radiography duties in the Department of Health. Since the creation of the grade in 1965, we have set the basic entry qualification at Form IV level. Without formal training in radiography, these XRAs were trained on-the-job to operate X-ray machines and take plain X-ray of chests under the supervision of SXRA and Senior Radiographer. To qualify for promotion, XRAs are required to possess either a Diploma issued by the Hong Kong Radiological Technician Association or a Certificate issued by the Hong Kong Polytechnic and have at least five years' satisfactory service in the rank.

Legislative Requirements

4.With effect from 1 November 1996, only persons registered with the Radiographers Board are permitted to practise radiography. The registration is required pursuant to the Radiographers (Registration and Disciplinary Procedure) Regulation made under the Supplementary Medical Professions Ordinance (Cap. 359). This new legislative requirement was introduced to raise the standard of the practice of radiography and for the better protection of the public. Only persons meeting the professional standard, either by acquiring qualification through formal training or by passing examinations held by the Radiographers Board, can be registered as radiographers and only registered persons are allowed to operate radiographic equipment on the human body. This spells the end of the career of XRAs and SXRAs who are ineligible for registration. The registration system imposed a de facto change to the entry requirement to the basic rank of XRA because an XRA has to be registered as a diagnostic radiographer in the appropriate part of the Register under the Regulation if he wishes to practice radiography. As a result of this change, the Form IV standard is no longer an acceptable entry qualification for appointment to the XRA rank.

5.The criteria for registration as a radiographer are based on academic qualifications, post qualification experience and examinations conducted by the Radiographers Board. Persons with the recognised qualifications and experience as listed in Enclosure 1can be registered in either Part I, II or III of the Register as appropriate. Persons who have no recognised qualification but are practising radiography before 1 July 1995 can apply for provisional registration not later than 30 December 1995. They have three chances to sit for an examination conducted by the Radiographers Board leading to provisional registration in Part IV starting from August 1996. Failure to pass the examination after three attempts within 21 months will render the individuals ineligible to undertake diagnostic radiography.

6.As at 1 November 1996 (the date on which legislative control over the practice of radiography came into force), 27 SXRAs/XRAs who were accepted for registration could remain in the service. These include 12 SXRAs and nine XRAs who have acquired the qualifications; and six XRAs who were without any qualifications but were accepted to apply for provisional registration in Part IV by virtue of their experience. Another five officers were made redundant as they did not register and hence were prohibited from practising radiography under the law.

Enhanced Responsibility of the XRA Grade

7.To cope with the Department's service plan for more and better radiographic services and in compliance with the code of practice regarding the proper procedures for performing radiographic examinations, the duties and responsibilities of the XRA grade have been enhanced since 1 November 1996. In addition to carrying out the routine procedures of taking X-ray, XRAs have been given additional duties to ensure proper management and care of patients with varying disabilities and illnesses, and proper radiation protection for all patients. XRAs have also gradually taken up the new radiographic duties of taking plain X-ray of heads, limbs, shoulders and other parts of the body hitherto assumed by staff in the Radiographer grade. The existing and new job descriptions for XRAs and SXRAs are at Enclosures 2 and 3.

Recommendation

8.In the light of the change in entry requirement and having regard to the enhanced responsibilities of staff, we propose to upgrade the XRA grade to the technician level with the entry requirement set at a pass in the examination held by the Radiographers Board leading to provisional registration in Part IV of the Register; and to revise the pay scales of the XRA grade. Promotion to the senior rank requires a registration in Part III in the Register of the Radiographers Board, plus at least five years of satisfactory service in the grade. To reflect more accurately the changed status and enhanced duties, we propose that the XRA grade be retitled as the " Radiographic Technician " grade. Accordingly, XRA will be retitled as " Radiographic Technician " and SXRA as 'senior Radiographic Technician " .

9.We propose that the new " Radiographic Technician " grade be classified under Group I of the " Technician, Supervisory and Related Grades' which consists of grades requiring a Certificate from a Polytechnic (or equivalent) or completion of a recognised apprenticeship on the grounds that -

1. the examination syllabus for Part IV registration covers a comprehensive range of topics similar to a Certificate course in Diagnostic Radiography; and

2. the present arrangement whereby XRAs are placed to work under Senior Radiographers who provide them with on-the-job training and supervision is akin to an apprenticeship scheme, successful completion of which is attained through XRAs passing the Part IV examination.

10.The existing pay scales of the XRA grade were set at two points above the group norm in recognition of the nature of work, the skills required and the hardship inherent in working in remote areas with the mobile X-ray units.

After upgrading, we propose to set the new pay scales for the Radiographic Technician (RT) and Senior Radiographic Technician (SRT) ranks at one point above the group norm to continuously recognise the job factor of constant exposure to secondary ionizing radiation, as follows -

Rank	Existing Pay Scale for XRA Grade (MPS)	Pay Norm for Group I of the Technician, Supervisory and Related Grades (MPS)	Proposed Pay Scale (MPS)
XRA (to be retitled as RT)	3 -12	Second tier 6 - 10 Third tier 11 - 14	7 - 15
SXRA (to be retitled as SRT)	13 - 17	Fourth tier 15 - 20	16 - 21

11.The pay of registered XRAs will be converted in accordance with the established arrangements recommended by the Standing Commission on Civil Service Salaries and Conditions of Service. Officers will convert to the new pay scale on 1 November 1996 or the date of passing the relevant examination, whichever is the later. Officers who have served on the old maximum point for one or more years will convert to two points above their existing pay and others will convert to the next point on the pay scale or the new minimum as appropriate. A chart showing the conversion arrangements is at Enclosure 4.

Effective Date Of Implementation

12.Members of the XRA grade feel strongly that the upgrading proposal which introduces new pay scales should be implemented with effect from 1 November 1996 because the new registration requirement came into force on that date. In view of the higher qualification required for registration, they argued that the pay scales of the XRA grade should be adjusted with effect from the same date. Given that those XRAs who did not register were made redundant on 1 November 1996 due to the legislative requirement, we consider that it is reasonable that XRAs who register and remain in service should receive the revised pay with effect from 1 November 1996, or the date of passing the relevant examination, whichever is the later.

13.Ideally the upgrading proposal should have been submitted before 1 November 1996, but time has been spent on consulting staff and exploring alternative arrangements which included a proposal to appoint all XRA officers to Radiographer II posts. As some of the XRA staff were found not suitable for appointment as Radiographer II and that there is a service need to retain the XRA grade for simpler radiography functions, that option has been abandoned and the current upgrading proposal submitted. While it is the established practice that any upgrading or revision of pay scale of civil service posts should take effect from a current date unless it is a major service-wide pay review exercise, the case of XRA grade is unique in that the revision in the entry qualification was consequent to a statutory requirement which took effect on 1 November 1996. We support the proposal that the new pay scales should take effect from the same date.

FINANCIAL IMPLICATIONS

14.The estimated additional annual salary cost of the proposal is $510,000. We have included sufficient provision in the 1997-98 Estimates to meet the cost of this proposal for the period from November 1996 to March 1998, which is estimated at $702,000. The proposal has no other additional financial implications.

ADVICE OF THE STANDING COMMISSION ON CIVIL SERVICE SALARIES AND CONDITIONS OF SERVICE

15.The Standing Commission on Civil Service Salaries and Conditions of Service has examined the upgrading proposal in detail and advised that the proposed pay scales, the revised title of the grade, the conversion arrangements and the backdating proposal are appropriate. The Commission noted the de facto change brought upon the XRA grade by virtue of the new legislative requirements. This is a unique situation and staff of the grade do have a legitimate expectation of the new pay scales being implemented upon the coming into effect of the registration requirement on 1 November 1996, the date upon which the career of XRAs who could not qualify for registration were curtailed. The Commission, however, has reaffirmed that the established practice of implementing new pay scales from a current date should be continuously enforced, except in unique circumstances, on which the Commission's advice must first be sought.

Civil Service Bureau
November 1997

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Enclosure 1 to EC(97-98)35

Qualifications eligible for registrationunder the Supplementary Medical Professions Ordinance Radio graphers Regulation

* These qualifications are awarded by the Hong Kong Polytechnic University or the then Hong Kong Polytechnic.

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Enclosure 2 to EC(97-98)35

Existing Job DescriptionX-Ray Assistant

1. To check patient's name against name on X-ray request form and select correct film size.

2. To make up patient identification number for display on X-ray film.

3. To measure patient's chest size.

4. To give preliminary instruction to patient on correct breathing procedure during film exposure.

5. To position patient according to film projection requested by physician/ radiologist.

6. To position X-ray tube to ensure correct alignment and distance.

7. To position patient's radiation protection device.

8. To select exposure factors according to patient's chest measurement, subject type, age, clinical condition; and instruct patient to hold breath.

9. To operate X-ray generator to activate exposure of film.

10. To send film to darkroom for processing.

11. To have an understanding of office routine and patient identification systems practised at his/her place of work.

Existing Job Description
Senior X-ray Assistant

1. To perform all the duties carried out by X-ray Assistants.

2. To supervise staff in the unit and ensure that all staff exhibit good manners, courtesy, tact at all times to the general public.

3. To liaise with all persons concerned in the efficient running of the unit.

4. To initiate appointments, preparation, instruction to patients prior to chest radiography.

5. To supervise X-ray Assistant in chest positioning. Responsible for maintaining high standard in chest radiography.

6. To ensure radiation protection for patients and staff.

7. To ensure that all equipment under control is clean and serviceable including X-ray and processing equipment.

8. To keep record of maintenance of the equipment.

9. To keep inventory of all equipment and furniture in the unit.

10. To initiate monthly supply of films and chemicals.

11. To supervise the compilation of monthly, quarterly, yearly statistical returns.

12. To liaise with Senior Radiographer on matters relating to problems of staff discipline, breakdowns of equipment, administration and request authority to prepare memos outside of the unit.

Mobile X-ray Van Senior X-ray Assistant

13. To supervise X-ray Van driver, in relation to traffic accidents, vehicle repair and daily locations for X-ray.

14. To liaise with driver, X-ray workshops and Senior Radiographer during repair of X-ray equipment.

15. To liaise with staff at the location for X-ray, over marshaling of examinees, parking of the van, provision of power supplies.

16. To organise and collect staff on a daily basis to go to X-ray location.

17. To monitor weather conditions when necessary and request cancellation of day's work through Senior Radiographer.

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Enclosure 3 to EC(97-98)35

Proposed Job Description
Radiographic Technician

1. To check patient's name against name on X-ray request form and select correct film size.

2. To make up patient identification number for display on X-ray film.

3. To estimate patient's size.

4. To give preliminary instruction to patient on correct posture and/or breathing procedure during film exposure.

5. To take necessary procedures for the proper management and care of patients with varying disabilities and illnesses.

6. To position patient according to film projection requested by medical practitioner.

7. To position X-ray tube to ensure correct alignment and distance.

8. To take all necessary procedures, including positioning patient's radiation protection device, to ensure appropriate protection against radiation during X-ray examination.

9. To select exposure factors according to patient's size, subject type, age, and clinical condition and to instruct patient to hold the posture and/or breath.

10. To operate X-ray generator to active exposure of film.

11. To send films to darkroom for processing.

Radiographic Technicians are required to register in the Diagnostic Radiographer's Register under the Radiographers (Registration and Disciplinary Procedures) Regulation. Radiographic Technicians registered under Part IV of the Register should work under the personal supervision of a medical practitioner, a Part I diagnostic radiographer, or a Part II/III diagnostic radiographer acting subject to the direction of a medical practitioner or a Part I diagnostic radiographer.

Proposed Job Description
Senior Radiographic Technician

1. To take plain X-ray, including chest and other parts of a body, and send films to darkroom for processing in a X-ray room or mobile X-ray unit.

2. To arrange appointments, and to prepare and give instruction to patients prior to X-ray examination.

3. To supervise Radiographic Technicians in all radiographic and patient handling procedures and be responsible for maintaining a high standard of radiography service.

4. To supervise junior staff in a X-ray unit and to ensure that all staff exhibit good manners, courtesy and tact at all times in dealing with members of the general public.

5. To ensure radiation protection for patients and staff.

6. To liaise with all persons concerned to ensure efficient running of the X-ray unit.

7. To ensure that all equipment under control, including X-ray and processing equipment, is clean and serviceable.

8. To keep record on repair and maintenance of equipment.

9. To keep inventory of all equipment and furniture in the X-ray unit.

10. To initiate monthly supply of films and chemicals.

11. To compile monthly, quarterly and yearly statistical returns.

12. To report to Senior Radiographer on staff discipline problems, breakdowns of equipment, and other important administration matters.

Additional duties in a Mobile X-ray Van

13. To supervise X-ray van driver in daily operation and to give instruction in cases of traffic accidents and vehicle repair.

14. To liaise with staff of clinic or other organisation at site on queue control, parking and electricity supply.

15. To liaise with driver, X-ray workshops and Senior Radiographer for repair of X-ray equipment.

16. To organise and collect staff on a daily basis to the site.

17. To observe weather conditions and to seek approval for cancellation of mobile X-ray service from Senior Radiographer.

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Enclosure 4 to EC(97-98)35

Proposed Pay Conversion Arrangement for X-ray Assistants

Officer whose pay is less than the minimum of the revised scale should receive the new minimum.

Officer whose pay is equivalent to or above the new minimum should advance to the next point on the scale.

Officer who has served on the old maximum for one or more years should convert to two points above his existing pay point.

SXRA (To be retitled as Senior Radiographic Technician)

		Proposed
		21 ($25,340)
		20 ($24,135)
		19 ($22,990)
Existing		18 ($21,900)
17 ($20,865)		17 ($20,865)
16 ($19,860)		16 ($19,860)
15 ($18,915)
14 ($18,010)
13 ($17,145)

XRA (To be retitled as Radiographic Technician)

		Proposed
		15 ($18,915)
		14 ($18,010)
Existing		13 ($17,145)
12 ($16,165)		12 ($16,165)
11 ($15,215)		11 ($15,215)
10 ($14,330)		10 ($14,330)
9 ($13,515)		9 ($13,515)
8 ($12,690)		8 ($12,690)
7 ($11,905)		7 ($11,905)
6 ($11,170)
5 ($10,505)
4 ($9,845)
3 ($9,245)