Panel on Health Services (Minutes) 17 Nov 97

Provisional Legislative Council

PLC Paper No. CB(2)766
(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, 17 November 1997 at 8:30 am
in Conference Room B 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

Members absent :

Hon Henry WU
Hon CHEUNG Hon-chung
Hon MOK Ying-fan
Hon CHAN Yuen-han
Hon Howard YOUNG, JP

Members attending :

Hon LEE Kai-ming
Hon CHAN Choi-hi

Public officers attending :

Mr Gregory LEUNG, JP: Deputy Secretary for Health and Welfare
Ms Jennifer CHAN: Principal Assistant Secretary for Health and Welfare
Dr Vivian CHAN: Acting Principal Assistant Secretary for Health and Welfare
Miss Winnie TSE: Assistant Secretary for Health and Welfare

Department of Health

Dr LAM Ping-yan: Deputy Director of Health
Dr LEUNG Pak-yin: Assistant Director (Elderly Health Services)

Hospital Authority

Dr Dickson CHANG: Deputy Director (Operations & Service Development)

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

Closed Meeting

Dr LEONG Che-hung tabled a list of three proposed amendments to the minutes of the meeting held on 13 October 1997 for members' consideration under agenda item I.

2.Members decided to re-schedule the next meeting to 9 December 1997 at 2:30 pm and agreed on the items for discussion at the meeting.

Open Meeting

I. Confirmation of minutes of meetings held on 8 September 1997 and 13 October 1997 and matters arising
(PLC Paper Nos. CB(2)604 and 576)

3.The minutes of meeting held on 8 September 1997 were confirmed. The minutes of meeting held on 13 October 1997 were confirmed with three amendments proposed by Dr LEONG and tabled at the meeting.

Contaminated imported ice cream

4.Deputy Director of Health (DDH) said that the independent consultant employed by Dreyer's had completed its investigation into the causes of the contamination and Dreyer's had submitted its final report to Department of Health (DH) on 3 November 1997. The report stated that the ice-cream bars produced by the plant in Dallas, USA was most probably contaminated by the drip of condensate into the ice-cream during the production process. The factory had taken steps to clean up and disinfect the whole production line. The relevant health authorities in Texas and other US authorities concerned were satisfied with the recommendations of the report. Dreyer's was now following up the contractual issues with the manufacturer concerned and production at the plant had been suspended. DDH assured members that when similar ice-cream products of Dreyer's were imported into Hong Kong in the future, DH would arrange to conduct more stringent sample tests on these products before they were allowed to be put on sale. As for legal action against Dreyer's, DDH said that details of the case would be referred to the Department of Justice for consideration. In reply to Dr LEONG's enquiry, DDH confirmed that so far no report of people infected with the Listeria monocytogenes as a result of eating the ice-cream had been received.

Non-emergency ambulance transfer service (NEATS)

5.Dr LEONG informed the meeting that the Fire Services Department's supplementary service to NEATS would soon expire. Whilst awaiting a reply from the Security Bureau on the future arrangement of NEATS for private hospitals, Dr LEONG said the feasibility of employing private companies to provide the service was being explored. The initial finding was that the one-off capital and the recurrent expenditure for the operation of NEATS was high and it would be unfair for patients concerned to bear the additional costs. The St John's Ambulance Service had been requested to provide NEATS for private hospitals and a reply was awaited. Given that the supplementary NEATS service would end soon, Dr LEONG requested and the Administration agreed to liaise with the Security Bureau for an appropriate alternative arrangement.

II. Date of next meeting and items for discussion

6.The Chairman informed the Administration that the next meeting would be held on 9 December 1997 at 2:30 pm and that the Panel would like to discuss the following items at the meeting -

medical rehabilitation service for ex-mental patients;
Regulation 26 of the Radiation (Control of Irradiating Apparatus) Regulations; and
implementation of the Smoking (Public Health) (Amendment) (No.2) Ordinance 1997;

III. Elderly Health Centres (EHCs)
[Paper No. CB(2)522(01)]

7.At the Chairman's request, DDH briefed members on the salient points of the Administration's paper on EHCs as follows -

Based on the recommendations of the Working Party on Primary Health Care in 1990, seven EHCs were established in seven districts between 1994 and 1997 to provide preventive and promotive health services for elderly people;
Under the elderly health service scheme, community and centre-based health promotion activities were organized to enrich the elderly's knowledge of their own health and enhance their ability to adopt a healthy lifestyle and practise self-care. So far around 10 000 elderly people had enrolled in the service, with over 300 000 attendances at various health promotion activities. 99 participants had completed the Senior Health Ambassador programmes run by the DH's Central Health Education Unit;
Cases of cataract, hypertension, diabetes, depression and cancer had been detected through the annual physical check-up and the elderly concerned had been referred to appropriate private or public clinics for treatment. Over 90% of the respondents in the Clients' Satisfaction Survey conducted in August 1996 had expressed that the overall performance of EHCs was " good " or " very good " ;
Despite efforts to recruit new members, enrollment rate at EHCs remained low for some time and was slow to take off. The possible causes of the unfavourable take-up rate were -
1. inconvenient locations for some users;
2. the elderly needed curative services more than preventive services;
3. lack of curative and other paramedical services such as that of dietitian was not conducive to assuring comprehensiveness and continuity of care; and
4. the annual enrollment fee of $220 could be a financial burden to some elderly people.
To enhance primary health care to elderly people living in the community, improve their self-care ability, encourage healthy living and strengthen family support so as to minimize illness and disability, the Chief Executive had announced in his Policy Address on 8 October 1997 the establishment of 12 EHCs (including the existing seven EHCs) and 12 visiting teams in 1998-1999 and another six EHCs and six teams in 1999-2000. These EHCs together with the visiting health teams would provide a comprehensive and more effective primary health care programme to the elderly; and
The health visiting teams would share their experience, knowledge and skills with staff working in social centres, elderly homes and home help service as well as other carers to better take care of the elderly in the community.

8.Mr WONG Siu-yee opined that welfare and health care services were interrelated and to make the best use of social resources, these services should be coordinated in collaboration with the departments concerned. He was worried that without a well-coordinated programme of implementation, the improved health care services at EHCs might be overlooked and interpreted by the elderly as an alternative option of general out-patient (GOP) service provided by DH. DDH agreed and pointed out that DH had appointed an Assistant Director (Elderly Health Services) (AD(EHS)) to oversee the coordination of efforts among other welfare and health care services providers with the aim of promoting EHC's improved services for the elderly. The long term objective of EHCs was to provide primary integrated health services to the elderly in conjunction with other elderly welfare and health services providers as well as to ease the demand for GOP service. Due to time constraint, the existing seven EHCs would be improved to provide the elderly with primary preventive and promotive health care services. Five other locations for new EHCs would be carefully selected to ensure that they could, along with other services providers in the neighbourhood, serve the elderly living in the communities in a cost-effective manner. Deputy Secretary of Health and Welfare (DS/H&W) supplemented that welfare and health care services for the elderly would also be looked after by designated officers of the Health and Welfare Bureau (HWB). The curative services provided by future EHCs would be based on the findings of the annual physical check-up for individual elderly enrollees. Supplemented by the services of the corresponding 18 visiting health teams and the various community services providers such as the Social Welfare Department (SWD) and subvented non-governmental organizations (NGOs), it was anticipated that a better social networking for the elderly people and community participation in health care could be achieved. In reply to the Chairman's and Mr LEE Kai-ming's follow-up enquiries, DDH said the services of the 18 visiting health teams would cover private elderly homes and would be different from that of the psychogeriatric out-reach service, domiciliary physiotherapy service, community geriatric assessment service etc provided to the elderly through public hospitals of the Hospital Authority (HA). He stressed that the visiting health teams were targetted at providing preventive and promotive care services to the elderly living in the community and support services to their carers.

9.Responding to Dr LEONG's enquiries, DDH said the existing EHC aimed at serving 2 300 elderly people in a year. The low utilization of the services available at existing EHCs could be attributed to the fact that the culture of visiting doctors for prevention of disease was still new among the elderly in Hong Kong. While it was likely that during the initial operation of new EHCs there would be an overlapping of curative services provided by GOP clinics and EHCs, it was anticipated that through providing curative care from a family medicine perspective using a multi-disciplinary team approach with the support of paramedical staff including dietitians, clinical psychologists, physiotherapists and occupational therapists, the elderly clients would later develop a sense of belonging to these EHCs. As for duplication of efforts with other agencies, DH would collaborate with HA closely to supplement each other's services for the elderly so as to ensure the effective use of health care resources.

10.The Chairman enquired about the development plan for the future five new EHCs. He was concerned that around two-third of the elderly enrolled in the previous year had not continued to use the elderly health services of existing EHCs in the following year. DDH reiterated that the existing seven EHCs would be improved to provide the range of services which would be available in new EHCs. Where possible, purpose-built regional centres would be built to make available adequate accommodation for the elderly and staff. AD(EHS) supplemented that due to time constraint, the additional five EHCs would also be developed inside or in close proximity to GOP clinics to expedite the provision of integrated elderly health service to elderly people. He acknowledged that these new EHCs might not be able to achieve in full the merits of the proposed new EHCs but stressed that the ultimate target was to accommodate an EHC, its supplementary visiting health team and GOP service together within the same purpose-built premises so that family members of the elderly clients could conveniently access these services and be taught to assist in enhancing the elderly's knowledge of healthy lifestyle and self-care. As regards the high dropout rate of elderly enrollees, DDH pointed out that many elderly clients of the existing EHCs, who had been found to be without any health problems during the physical check-up, would cease to use the elderly health service in the following year. Nevertheless, about one-third of the elderly clients recognized the importance of preventive health care by continuing their enrollment.

11.Mr WONG Siu-yee invited DDH to send representatives to the Welfare Services Panel members' coming meeting with the Secretary for Health and Welfare so that the future developments of EHCs could also be discussed. DDH agreed. Dr LEONG requested that the Panel be briefed on the contents of the discussion.

12.Dr LEONG was concerned about the on-schedule development of the 18 EHCs, the provision of sufficient resources to support their efficient operation, and the charges for using the service of EHCs. DDH confirmed that there would be altogether 18 EHCs, with 12 to be established in 1998/1999 and six in 1999/2000. He added that the budget proposals for establishment of the new EHCs would be submitted to the Finance Committee in 1998-99 session. As for the one-off charge of $220 for enrollment in the elderly health services, he acknowledged that some elderly people might find it a financial burden and said that DH was reviewing the fees structure and level of charging, taking into consideration the client's ability to pay. The Chairman requested the Administration to provide further details on the operations of the future EHCs and in particular their relationship with the various other elderly community and health care services provided by HA, SWD, NGOs and other private carers. DDH replied that the package of health care services available at future EHCs and the associated operational arrangements were now at the planning stage. He agreed to provide further information to the Panel for comments in due course. DS/H&W supplemented that the Elderly Commission was considering the proposals on future EHCs. As its membership comprised representatives from HWB, Housing Bureau, HA, SWD, DH and Housing Department, DS/H&W was confident that the final proposals on EHCs would have considered both the welfare and health care needs of the elderly and would include a list of existing and new health services with detailed implementation programmes to ensure that the future EHCs could achieve the desired results and supplement the services provided by other departments.

IV.Report on the comprehensive reviews conducted by the Hospital Authority to assure quality of care and enhance professional accountability
[Paper No. CB(2)522(02)]

13.Deputy Director (Operations & Service Development) of HA (DD/O&SD) stressed that the mission of HA was to provide quality patient-centre care through the provision of responsive, effective and value for money services which met the health care needs of the community. He informed the meeting that a Special Committee comprising HA members had been set up to conduct a comprehensive review on clinical audit, risk management, clinical supervision, staff workload and professional accountability within the public hospital system with a view to ensuring quality of patient care and enhancing professional accountability. He drew members' attention to the following -

Review on clinical supervision and workload

HA Head Office had held a series of discussions and consultation sessions/forums with all Hospital Chief Executives, Chiefs of Services, Department Operations Managers and front-line clinical staff and agreed the following initiatives for ensuring quality of care -
1. all hospitals had reviewed their system of clinical supervision and identified ways to enhance clinical supervision over trainees and less experienced staff;
2. the administrative workload of clinical staff would be re-prioritized or re-engineered and time-off would be flexibly considered and granted to staff who had worked for long and continuous hours; and
3. business support to departments and wards would be reviewed and strengthened. Clinical managers would be assisted in financial and resource management matters.
Review on clinical audit and professional accountability
HA had an infrastructure in place in every hospital to coordinate and facilitate activities in continuous quality improvement. A Clinical Audit Committee was established in HA's Head Office to coordinate the work of the existing 14 Expert Specialty Coordinating Committees in their share of clinical experiences and success quality initiatives. Clinical guidelines and outcome standards were regularly updated and issued to hospitals for reference as well as to upgrade staff's professional knowledge and accountability in their respective clinical areas. To keep in pace with the continuous advance of medical science and technology, HA had developed a sophisticated library information system which incorporated an update database of electronic reference materials ranging from professional health care knowledge to management reference. Through its connection to the Internet, the library information system provided HA's staff with an access to the latest medical research findings, knowledge and scientific evidence in medicine and medical operations developed in advanced countries.
Review on complaints/incidents management
HA was considering the results of the review on complaints management. In addition to efforts aiming to make the existing three-tier system of receiving public complaints more transparent and accountable, i.e. the work and role of Patients Relations Officer at public hospitals, the Complaint Officer in HA Head Office and the Public Complaints Committee of HA, special committees comprising medical and non-medical professionals would be set up on a case-by-case basis to investigate the causes of major medical incidents and proposed appropriate remedial actions.

14.Dr LEONG declared interest as a member of HA Board and the Special Committee. He commented that the information paper on the progress of HA's comprehensive review was too brief for members to have a clear understanding of what remedial actions had been taken and would be taken. Given that the comprehensive review was underway, he asked for information on the solid actions and programmes which HA had taken to restore public confidence in the public health care system as well as the morale of its staff. Referring to the total expenditure of around 750 million which had been spent on information technology projects, he queried the cost-effectiveness of HA's developed information systems and communication networks in the context of providing quality health care needs to the community. DD/O&SD replied that HA had in fact prepared a set of directives consisting of 28 major items to address issues affecting different levels of hospital operations. In particular clinical guidelines and procedures were prepared to ensure standards of practice and professional accountability in public hospitals. This set of directives had been issued to all public hospitals for reference and for immediate follow-up actions on some items. He anticipated that the guidelines on release of clinical staff from administrative work would assist in promoting the morale of clinical staff. He added that due to time constraint, the decisions of the Special Committee reached at the meeting on 11 November 1997 had not been included in the Administration's information paper. He said that additional information would be provided to the Panel upon members' request. On the development of information systems in HA, he explained that the initial developments were focused on human resources, financial management, inventory control and assets management systems and in the years ahead, efforts would be directed towards the development of clinical management and clinical department systems. The ultimate objective was to maintain a database of all patients of public hospitals and clinics to facilitate the provision of continuous efficient and effective health care services to individual patients. With a full picture on diseases and treatment records of all patients, HA would be able to identify areas for conducting medical researches and areas for improving hospital operations The HA's Medical Services Development Committee chaired by Dr LEONG would further discuss the development and utilization of computer systems in HA at its next meeting on 12 December 1997. He added that HA had developed a territory-wide health information infrastructures across hospitals. All public hospitals were now electronically connected and staff could conduct researches and bookings on the collections and information available at the library's electronic database and records. All public hospitals were also connected to the Internet which enabled medical staff to access up-to-date medical information available on the World Wide Web.

15.Referring to the review on complaints management which had been completed, Mr WONG Siu-yee asked whether the report of the review and the implementation of its recommendations could be made available to the Panel. DD/O&SD said the report would be considered by HA Board at its meeting on 2 December 1997. He agreed to provide the Panel with an information paper incorporating the comments of the HA Board members on the report for discussion at the next regular meeting. He stressed that HA would continue to review its complaints management and would not end the process by any single review. At the Chairman's request, DD/O&SD undertook to provide the Panel with further progress report on the review at a suitable time. In reply to Mr LEE Kai-ming's follow-up question, he assured members that HA would follow up medical incidents and take remedial measures as soon as practicable. He reiterated that HA's review on various areas of hospital operations was a continuous process.

16.Referring to paragraphs 2(b) and 5 of the Administration's paper, Mr CHAN Choi-hi commented that no proposals to solve the manpower shortage problem in public hospitals and to improve the operation of the complaints mechanism were presented in the paper. DD/O&SD responded that HA had taken a series of measures to reduce the workload of medical and nursing staff. Many non-technical tasks and administrative duties had now been taken up by non-medical staff wherever possible. The number of administrative meetings had been reduced and professional duties were now prioritized in accordance with commonly accepted practice. As far as the grant of time off to medical staff who had worked long and continuous hours, there was now clearer guidelines for Chiefs of Services to follow. As a result, medical and nursing staff could now concentrate more on clinical duties and were more conscious of the important areas of clinical performance. To enhance the effectiveness of the first level complaint mechanism in public hospitals and clinics, HA had decided to deploy senior nursing staff to take up the posts of Patient Relations Officer. These senior nurses were familiar with the hospital operations and were more skillful in oral communications which could enhance effective communications with the complainants. To promote public awareness of the three levels of complaint mechanisms, HA had prepared an information sheet to illustrate their role and inter-relationship. DD/O&SD highlighted that these were examples of the many follow-up measures which HA had taken in response to the recent series of medical incidents. He added that HA was working towards establishing a corporate culture of viewing complaints as one of the essential driving force for continuous organizational development. Dr LEONG reiterated members' request for a full picture on measures which HA had implemented and planned to implement for preventing recurrence of similar medical incidents. The Chairman requested that a conclusive report on remedial measures for the recent medical incidents should be ready for discussion at the meeting in January 1998.

V. Long Term Health Care Policy
(Research report RP01/PLC)

17.Referring to paragraph 16 of the research report, Mr CHAN Choi-hi suggested that the Administration should conduct a review of the roles and functions of Regional Council, Urban Council, DH, Regional Services Department and Urban Services Department and their relationship in the delivery of health care services. The review should aim at exploring the feasibility of coordinating their efforts in the provision of health care services. DS/H&W agreed to look into the matter.

18.Dr LEONG expressed appreciation of the efforts of the Research and Library Services Division in completing the report. He drew the Administration's attention to three issues, namely, the early completion of the review on health care financing which would determine the future developments in various areas of the health care system, the provision of dental services to the community in the future and lastly the role of Chinese medicine practitioners in the public health care system after the completion of their statutory registration in 2000 and the associated financial implications. DS/H&W responded that the Government was now providing dental services to primary school students and dental health education to the public.

19.Mr CHAN Choi-hi said he had received negative feedback from parents on the operation of Student Health Service (SHS) and asked the Administration to re-consider bringing back the Student Medical Service (SMS). DDH pointed out that SHS was introduced upon the recommendation of the Working Party on Primary Health Care in 1990 after wide public consultation conducted in 1991. It replaced the former SMS with the aim of providing integrated health promotion and preventive care to the student population through regular screening and health education. He pointed out that with the establishment of the 18 EHCs by 2000, the existing GOP clinics should have sufficient resources to look after the primary health care needs of the student population. DS/H&W supplemented that given the then available resources, SHS was adopted to safeguard both the physical and psychological development of students through comprehensive promotive and preventive health programmes. He added that the capacity of DH's GOP service had been expanded in recent years and could well cope with the demand of students. Dr LEONG commented that the policy decision of replacing SMS by SHS was correct from a long term perspective. The health data collected would be an important source of information on the general health standards and needs of the youth and could facilitate the planning of public health services to cater for their specific needs. He added that the role and share of DH in the provision of primary health care services to the community should be reviewed to explore new areas of service such as conducting researches on infectious diseases with the purpose of identifying suitable precautionary measures, establishing a centre for the collection of data on infections diseases in Asian countries and providing dental service to the community.

20.Mr CHAN Choi-hi opined that purpose-built premises should be constructed at each district to provide a full range of welfare and health care services at the community level. DDH responded that the existing capacity of GOP clinics were able to provide an adequate level of GOP service to the community and for new premises to be constructed for the operation of GOP clinics in the future, multistorey buildings which could accommodate a wide range of welfare and health care services would be carefully considered.

21.Dr LEONG opined that the number of public hospitals should be increased to match the increase in demand for health care services as a result of population growth. Also, to keep in pace with advances in medical science and technology, he said the range of medical services provided by public hospitals should also be reviewed to meet the changing needs of the community.

22.In response to the Chairman's request, DS/H&W responded that the Administration would consider members' comments in their review on health care financing. He agreed to report to the Panel on the progress of the review at an appropriate time.

23.The meeting ended at 10:40 am.

Provisional Legislative Council Secretariat
19 December 1997

Provisional Legislative Council

Provisional Legislative Council Panel on Health Services

Provisional Legislative Council
Panel on Health Services