Provisional Legislative Council

PLC Paper No. CB(2)576
(These minutes have been
seen by the Administration)

Ref : CB2/PL/HS

Provisional Legislative Council
Panel on Health Services

Minutes of Meeting held on Monday, 13 October 1997 at 8:30 am in the Chamber of the Legislative Council Building

Members present :

Dr Hon TANG Siu-tong, JP (Chairman)
Dr Hon LEONG Che-hung, JP (Deputy Chairman)
Hon WONG Siu-yee
Hon Henry WU
Hon MOK Ying-fan

Members absent :

Hon CHEUNG Hon-chung
Hon CHAN Yuen-han
Hon Howard YOUNG, JP

Public Officers attending :

For all items

Mrs Maureen CHAN

Deputy Secretary for Health and Welfare (Acting)

Ms Jennifer CHAN

Principal Assistant Secretary for Health and Welfare

Mr Derek B GOULD

Principal Assistant Secretary for Health and Welfare

Miss Winnie TSE

Assistant Secretary for Health and Welfare

For item III

Dr W M KO

Deputy Director (Operation)

Hospital Authority

For item IV

Mrs Sarah KWOK

Principal Assistant Secretary for Security, Security Bureau

Mr C C LOK

Chief Staff Officer, Auxiliary Medical Service

Mr M K LAU

Senior Operation and Training Officer, Auxiliary Medical Service

Mr K P MAK

Chief Ambulance Officer, Fire Services Department

For item VI

Dr P Y LAM

Deputy Director of Health,Department of Health

Dr Gloria TAM

Assistant Director of Health (Hygiene) Department of Health

Clerk in attendance :

Ms Doris CHAN

Chief Assistant Secretary (2) 4

Staff in attendance :

Miss Eva LIU

Head (Research & Library Services)

Mr Stanley MA

Senior Assistant Secretary (2)7

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Closed meeting

Members agreed to distribute the report on " Long Term Health Care Policy " prepared by the Research and Library Services Division to non-Panel members for reference and to invite them to join the discussion of the report at the next regular meeting. Members also went through the agenda and agreed on the approaches and major issues to be discussed under each agenda item.

2.To better understand the operation and facilities available in an elderly health centre and the new North District Hospital (NDH), members agreed to request the Administration to arrange a site visit to an elderly health centre and NDH in early November 1997. Members also agreed on the items to be discussed at the next regular meeting.

Open meeting

I.Confirmation of minutes of meeting and matters arising

3.The minutes of meeting held on 19 August 1997 were confirmed.

Student Health Service

4.Dr LEONG Che-hung asked about the follow-up for students who had joined the Student Health Service (SHS) and were found to have behavioural problems during the annual medical check up. In response, Deputy Director of Health (DDH) said that the Department of Health (DH) would, in collaboration with the Hospital Authority (HA), continue to look after the health and psychological developments of all students who were referred to specialist clinics of HA. Members commented that in order to enable medical staff at Student Assessment Centres to better understand the health and behavioural problems of students, it would be beneficial to have the presence of their parents during the whole medical check-up process. DDH undertook to relay members' views to staff of the Student Health Service.

II.Date of next meeting and items for discussion

5.The Chairman informed the Administration that the Panel would like to discuss the following items at the next meeting to be held on 10 November 1997 -

1. Elderly Health Centres; and

2. The Secretariat's report on " Long Term Health Care Policy " .

6.The Chairman requested and the Administration agreed to arrange a visit to an elderly health centre and the North District Hospital in early November 1997.

7.Members were dissatisfied with the Administration's delay in providing information papers for Panel meetings. In order to allow members sufficient time to study the papers before the meeting, the Chairman urged the Administration to provide papers at least one week before the date of the meeting in future.

III.Assessment criteria for the Samaritan Fund
(Paper No. CB(2)410(01))

8.At Chairman's request, Deputy Director (Operation) of the Hospital Authority (DD(O)/HA) briefed members on the salient points of the Administration's paper on Samaritan Fund (the Fund) as follows -

1. the Fund was established as a trust in 1950 by resolution of the Legislative Council. Administration of the Fund was transferred from the Hospital Services Department to HA on 1 December 1991 upon the vesting of management and control of public hospitals to HA pursuant to the Hospital Authority Ordinance;

2. the Fund was set up to provide emergency and temporary financial assistance to needy patients and their families in meeting medical expenses which were not covered by hospital maintenance fees or out-patient consultation fees in public hospitals and clinics;

3. In 1995 the Administration undertook a review of the charging arrangements in public hospitals with the aim of rationalizing the different charging practices amongst public hospitals. As a result, charges for a number of privately purchased items were abolished and only 10 items remained on the list of privately purchases items as at 1 December 1995;

4. A set of revised applications procedures and relaxed assessment criteria was also adopted on 1 December 1995. The Median Monthly Domestic Household Income (MMDHI) as well as the total family savings had since then be an used as the two major factors for the assessment of applications for assistance from the Fund. In exceptional circumstances, HA had discretion to approve an application upon the advice of medical social workers, disregarding the total monthly income and savings of the family concerned;

5. Upon the introduction of new assessment criteria, and during the period of 1 December 1995 to 30 November 1996, a total of 1 349 patients, involving HK$20 million and of whom 712 were comprehensive social security assistance beneficiaries, received financial assistance through the Fund. The corresponding figure in 1994/95 was 290 patients involving around HK$4 million. The number of successful applications had increased significantly; and

6. A review of the revised assessment criteria and applications procedures was underway. The review would take into account feedback from hospitals and patients groups as well as the operational data gathered through administering the Fund and was expected to be completed in two months' time. In particular, HA was considering the proposal to update the MMDHI figures on a quarterly basis, subject to availability of information from the Census and Statistics Department.

9.In response to Dr LEONG Che-hung's enquiries, DD(O)/HA explained that full assistance from the Fund would be given to patients whose family income was equal to or below the MMDHI, and whose family savings were equal to or below two times the cost of the item concerned. Patients whose family savings were below three times but above two times of the cost of the item would be provided with partial assistance. HA would flexibly consider the application of patients whose situation justified special consideration. For instance, an elderly patient who had just received a retirement fund which was three times or more higher than the cost of the item or whose family savings was three times more than the cost of the item but the family member(s) who owned the savings refused to fund the item might, with the support of the medical social worker concerned, still be provided with certain level of assistance from the Fund. In urgent cases where verbal approval was given by HA to use the Fund to assist the patient, HA would follow up with the recovery of the cost of the item from the patient or his family members, if necessary. But there would be no guarantee on partial or full recovery of the cost of the item. As for the sources of funding for the Fund, DD(O)/HA said HA, apart from receiving donations of the Hong Kong Jockey Club, the Sir Robert Ho Tung Charitable Fund and the Li Po Chun Charitable Trust Fund and the Tung Wah Group of Hospitals and the Chinese Permanent Cemetery Fund, would take initiatives in securing new sources of charitable donations. He stressed that the Administration had taken the lead in making two injections of $20 and $4.68 million to the Fund. He pointed out that HA had a mechanism to evaluate the effectiveness of new medical equipment. However, as new medical equipment and technologies would continue to be developed, it is possible that some new medical items, which were recognized as effective may not initially be funded due to limited resource constraint and competing priorities. The current policy of limiting the list of privately purchased items applicable to all public hospitals may restrict the flexibility of individual hospitals to fund new medical items. In response to the Chairman's concern about the current financial situation of the Fund, he said HA had been able to strike a balance between income and expenses in recent years.

10.Responding to Mr MOK Ying-fan's concerns, DD(O)/HA said the review would be completed in about two months' time and HA would carefully consider each application for assistance from the Fund in accordance with the laid-down criteria. The need of the medical item for the patient concerned would be confirmed by doctors and re-checked by HA. As patients had expressed their view that approval of applications should not involve a lengthy process of administrative procedures such as the requirement of a declaration and the thorough checking of the bank accounts of the patient and his/her family members, HA had hitherto relied on the information provided by the patients as well as the advice of medical social workers in considering applications for assistance from the Fund. Mr MOK agreed that too many hurdles in the process of approving an application should be avoided but pointed out that a monitoring mechanism such as random checking of the information stated in applications to ensure the proper use of available resources was necessary.

11.Dr LEONG Che-hung accused the Government of shovelling the responsibility of shouldering medical costs for the needy to the HA. He was concerned about the long-term financial strength of the Fund and opined that it should be the Government's responsibility to ensure that sufficient funding would be available in case the Fund was run in deficit. DD(O)/HA responded that while it could not be assured that the Fund would have sufficient money to assist needy patients in purchasing new and advanced medical items in the distant future, the Fund would be able to meet the needs of the community in the next few years. Deputy Secretary for Health and Welfare (Acting) reassured members that the Administration's basic philosophy was to ensure that no one would be prevented from obtaining adequate medical treatment through lack of means. Ways and means would be found to assist the needy patients. She added that the review outcome would be reported to the Panel for comments. In response to members' further enquiry, DD(O)/HA said the Administration would collaborate with HA on providing adequate resources to the Fund and it was unlikely that the operation of the Fund would be disrupted due to lack of financial resources. Dr LEONG reiterated his concern about the long term sources of income for the Fund.

12.The Chairman reminded HA to provide the Panel with an interim report on its comprehensive reviews on clinical audit and monitoring for discussion at the next meeting and reiterated the need to provide information papers at least one week in advance of the date of the meeting concerned. Another member suggested that the House Committee should follow up with the Administration on the issue of late provision of papers to PLC Panels and committees.

IV .Non-emergency ambulance transfer service (NEATS)
(Paper No. CB(2)410(03))

13.At Chairman's request, Principal Assistant Secretary of Security Bureau (PAS/SB) briefed the meeting on the salient points of the Administration's paper on the subject as follows -

1. As part of the Administration's efforts to improve the emergency ambulance service (EAS) provided by the Fire Services Department (FSD), NEATS for HA institutions was transferred to HA during 1994 to 1995 together with the necessary resources;

2. A consultancy study commissioned by FSD in 1995 on " Emergency Ambulance Cover in Hong Kong " recommended, inter alia, that the residual (non-HA) NEATS be taken up by another agency. As a result, the Auxiliary Medical Service (AMS) started on 1 April 1996 to provide NEATS to cases referred by DH, Social Welfare Department (SWD) and private hospitals for the Kowloon region and its service had been extended to cover the whole territory on 1 July 1997. The necessary resources had been transferred from FSD to AMS accordingly;

3. The transfer of NEATS from FSD to AMS had been publicized through a number of channels as detailed in the Annex of the PLC Paper No. CB(2)410(03);

4. The service of NEATS was provided on an advance booking and first-come-first-served basis rather than on an on-call basis. AMS had a fleet of six ambulances and operated from 8:00 am to 6:00 pm Monday to Saturday excluding public holidays. From April to September 1997, AMS had received an average of 1 233 requests per month and on average appointments could be fixed within seven working days of the time of request. It had tried its best to meet requests from private hospitals with short notices. Since July 1997, there had been a total of 31 requests which AMS could not entertain due to their short notices ranging from three hours to a day; and

5. AMS had responded to the concerns raised by private hospitals by -
   1. extending its service to cover Sundays and public holidays from 19 August 1997 as a trial scheme for three months;

   2. extending the FSD's supplementary service to NEATS on weekdays for a further and final period of three months; and

   3. arranging with DH to schedule medical appointments of DH clinics in the vicinity to fall on the same day of a week so that more time slots could be made available to entertain other requests for NEATS.

14.PAS/SB stressed that the transfer of NEATS from FSD to HA and AMS was implemented to enable FSD to concentrate on improving the performance of EAS and that AMS had been provided with the level of resources commensurate with that used by FSD previously in providing NEATS. Given the non-emergency nature of NEATS, AMS should continue to provide NEATS service on an advance booking and first-come-first-served basis.

15.Dr LEONG Che-hung pointed out that some patients of private hospitals were in genuine need of NEATS as they could not use other means of transportation even if they were willing to pay, such as those on large plaster cast, on oxygen inhalation or on drip. He thanked the Security Bureau for arranging a further three months of supplementary NEATS service by FSD. Given an average of 1 233 requests a month, he queried how AMS, with a total fleet of six ambulances, could handle some 14 800 requests a year. PAS/SB agreed that if the number of NEATS requests increased from the original estimate of 9 000 to around 14 800 a year it could put pressure on AMS. However it remained to be seen whether the increase over the past few months would become a trend. She emphasized that AMS did not give priority to requests from DH and would continue to respond to requests from private hospitals as soon as practicable. She explained that the case in which the patient had to wait for 10 days was an individual case, due in part to the intervening five-day public holidays in late June/early July 1997. She reiterated that the arrangement with DH from November 1997 onwards on scheduling of medical appointments of DH clinics would facilitate AMS's deployment of resources. She said the Administration would monitor the situation closely and if the demand for NEATS remained at the present high level, appropriate follow up measures would be considered.

16.Responding to Dr LEONG's further enquiry, PAS/SB explained that bookings for NEATS from DH and SWD were normally made well in advance. According to available data, she pointed out that 28 out of the 59 requests for NEATS from private hospitals in the month of September 1997 required the service within the day of request and AMS had been able to entertain all these 28 requests. At the request of members, she assured members that the Administration's objective after November 1997 would still be to fix appointments for NEATS on average within seven working days of the time requested. Chief Staff Officer of Auxiliary Medical Service (CSO/AMS) supplemented that NEATS had been provided within seven working days to all 59 requests from private hospitals in September 1997 and 38 of them were provided within three working days. As regards the acceptable time for the provision of NEATS to private hospitals, PAS/SB expressed that SB, in collaboration with DH and SWD, had been working on improvement measures to shorten the response time. She said that additional allocation of resources for NEATS was not justifiable because there were on average only about 70 - 80 requests from private hospitals per month. Dr LEONG stressed that waiting for seven working days was totally unacceptable as a patient would have to pay the "unnecessary" hospitalisation fees for every day's wait. He asked the Administration to consider shortening the waiting to two days and to examine the feasibility of supplementary NEATS to be taken up by other agencies such as the St. John's Ambulance Service and HA's NEATS after November 1997.

17.Mr MOK Ying-fan was also not satisfied that patients in private hospitals might have to wait up to seven working days for NEATS and asked how the first-come-first-served policy was implemented. PAS/SB reiterated that the Administration would continue to follow up with AMS, DH and SWD for the most effective use of existing resources for NEATS. CSO/AMS supplemented that bookings for NEATS could be made by fax, post or telephone and DH normally made its bookings one month in advance.

18.Dr LEONG enquired whether the emergency ambulance service (EAS) could be provided to a patient who requested to be taken to private hospitals. Chief Ambulance Officer of Fire Services Department (CAO/FSD) responded that EAS would normally take an emergency patient requiring immediate medical attention to the nearest public hospital which operated an emergency and accident service. In case the patient requested to be taken to a private hospital, he/she would be advised to receive emergency service at a public hospital first and when conditions allowed, a transfer service for the patient would be arranged. If the patient insisted, he/she would be asked to sign an undertaking to confirm his/her wish and would then be taken to the requested private hospital. He added that relevant instructions had been given to staff of EAS concerned.

V.Any other business

Contaminated imported ice cream and beef

19.DDH briefed members on the follow up actions taken by the DH in respect of ice-cream bars produced by the Dreyer's plant in Dallas, USA which were found to contain Listeria monocytogenes bacteria and a consignment of beef imported from USA to South Korea, which was said to be infected with E-coli O157. As an interim measure, all consignments of the said ice cream produced by the said plant were recalled by the importer from the market and all future consignments of the brand would have to be tested for the bacteria by DH before they could be put to the retail outlets. The beef imported from the factory of Iowa Beef Packers in Nebrasaka had all been taken off the market pending the results of laboratory tests which would be available in one to two weeks' time.

20.In response to Mr WONG Siu-yee's enquiry, DDH said DH would conduct laboratory tests of samples of all imported ice-cream products and check other relevant details such as its production process before they were allowed to be put on sale in Hong Kong. The Regional Services Department (RSD) and the Urban Services Council (USD) also helped to monitor the hygiene standards of food products available in the market. As for the recall of contaminated products on the market, DDH said the current practice which had been adopted by developed countries overseas was to ask the importers/producers concerned to supervise and implement the recall as they were more familiar with the distribution and location of the retail outlets. As regards the institution of legal action against the company which produced the contaminated ice-cream, DDH replied that this would be considered when a full picture of the case was in hand and the advice of the Department of Justice would be sought in due course.

21.In reply to Mr Henry WU's concern, DDH said, according to the Food Recall Guidlines issued by Department of Health the ice-cream importer should produce an interim report in one month's time. A final report should also be submitted to DH within two months. He added that the concerned authority in America had been advised of the incident through the America Consulate in Hong Kong.

22.Mr MOK Ying-fan opined that apart from relying on the importer to recall the infected products from the market, the Administration should review the existing mechanism of informing the public to stop buying the products and the retail outlets to remove the products. DDH responded that in addition to the recall action initiated by the importer, health inspectors of the Regional Services Department and the Urban Services Department also carried out checks on the availability of the infected products in retail outlets. He added that media report was an effective mechanism in informing the public of any infected products. Mr MOK commented that DH should work out a more effective means to immediately inform the public in the future. In response to Mr WONG Siu-yee's further enquiry on the standards of health monitoring system in Hong Kong, DDH said DH had followed international standard adopted by World Health Organization and other authorities and highlighted that in the infected ice-cream incident, Hong Kong was the first to discover such contamination.

Report on " Long Term Health Care Policy "

23.At Chairman's request, Miss Eva LIU of the Research and Library Services Division briefed the meeting on the contents of the report. Members agreed to discuss the report in more detail at the next meeting.

24.The meeting ended at 11:15 a.m.

Provisional Legislative Council Secretariat
18 November 1997