Panel on Health Services (Minutes) 8 Feb 99

Legislative Council

LC Paper No. CB(2) 2133/98-99
(These minutes have been
seen by the Administration)

Ref : CB2/PL/HS

LegCo Panel on Health Services

Minutes of meeting
held on Monday, 8 February 1999 at 8:30 am
in the Chamber of the Legislative Council Building
Members Present:

Hon Michael HO Mun-ka (Chairman)
Dr Hon LEONG Che-hung, JP (Deputy Chairman)
Hon HO Sai-chu, JP
Hon Cyd HO Sau-lan
Hon CHAN Yuen-han
Hon Mrs Sophie LEUNG LAU Yau-fun, JP
Dr Hon YEUNG Sum
Hon YEUNG Yiu-chung
Dr Hon TANG Siu-tong, JP
Hon LAW Chi-kwong, JP

Public Officers Attending :

For All Items
Mr Gregory LEUNG: Deputy Secretary for Health and Welfare
Miss Ada CHAN: Assistant Secretary for Health and Welfare
For Agenda Item III only
Ms Jennifer CHAN: Principal Assistant Secretary for Health and Welfare
Miss Ophelia CHAN: Assistant Director for Social Welfare (Rehabilitation and Medical Social Welfare)
Dr Lawrence LAI: Deputy Director (Corporate Affairs), Hospital Authority
Dr YIP Ka-chee: Chief of Service (Psychiatry), Kowloon Hospital
For Agenda Item IV only
Miss Eliza YAU: Principal Assistant Secretary for Health and Welfare
Dr S P MAK: Deputy Director of Health (Ag)
Mr Anthony CHAN: Chief Pharmacist, Department of Health
Dr Lawrence LAI: Deputy Director (Corporate Affairs), Hospital Authority

Deputation by Invitation :

The Hong Kong Association of the Pharmaceutical Industry: Mr Tom CURTISS; Mr Rentao Dell ORTO; Mr Perry SIT; Ms Joy OTTWAY; Dr Kenneth LEE

Clerk in Attendance :

Ms Doris CHAN: Chief Assistant Secretary (2) 4

Staff in Attendance :

Mrs Eleanor CHOW: Senior Assistant Secretary (2) 4

I. Confirmation of minutes of meeting held on 12 October 1998
(LC Paper No. CB(2)1172/98-99)

The minutes of the meeting held on 12 October 1998 were confirmed.

II. Date of next meeting and items for discussion
(LC Paper No. CB(2)1246/98-99(01))

2. Members agreed to discuss the following items at the next meeting to be held on 8 March 1999 at 8:30 am -

Medical registration - meeting with representatives of the Hong Kong China Medical Association;
Chiropractors registration - meeting with representatives of the Chiropractors Registration Ordinance Concern Group; and
Implementation of Enhanced Productivity Programme in the Hospital Authority (HA) and the Department of Health (DH).

III. Mental Health Services
(LC Papers Nos. CB(2)1146/98-99(01) and (02))

3. The Chairman said that as he had a meeting with the DH at 9:30 am, Dr LEONG Che-hung, Deputy Chairman, would chair the meeting during his temporary absence. Members noted that the subject of mental health services was raised by the Chairman in his paper (01) and the Administration's response was provided in paper (02).

4. At the invitation of the Chairman, Deputy Director (Corporate Affairs) of the HA (DDHA) informed members of the latest position regarding the attendance in psychiatric specialist outpatient clinics (SOPCs). The total attendance was about 390 000 in the first three quarters of 1998/99. This represented a 9% increase over 1997/98 as compared to only 6% in 1997/98 over 1996/97. The increase was in line with the overall increase in specialist outpatient clinics which was averaged at 10%. There were a total of 18 SOPCs and the consultation hours had increased by 15% in the past two years from 6 000 in 1995/96 to 6 800 in 1997/98. To improve efficiency, the HA operated a triage system. Those who had serious mental illness were hospitalised. For the less seriously ill patients who required psychiatric outpatients service, priority would be given to those requiring immediate medical care. The average waiting time for first appointment at SOPCs was 10 weeks. The HA would strive to reduce the waiting time to nine weeks or below by redeploying resources.

5. Dr YEUNG Sum said that the proposed reduction to nine weeks was still a long time for mental patients, as any delay in giving them proper treatment might result in undesirable consequences which would stigmatise them further. He asked whether the 9% increase in first attendance was normal and whether the economic downturn had aggravated the problem.

6. In reply, DDHA said that he agreed with Dr YEUNG that nine weeks' waiting time was not good enough. He assured members that the HA would continue to work towards a shorter waiting time. He said that the increase of first attendance for SPOCs usually did not exceed 10%. Although the increase in 1998/99 was relatively higher, it was still lower than the increase of other specialist outpatient services which was averaged at 10%. The recent increase could be due to various reasons. The HA's psychiatrists were planning to conduct a longitudinal prospective study to look at the types and frequency of psychiatric illness presenting at the outpatient clinics, hoping to find out the causes of the recent increase in attendance.

7. Dr YEUNG Sum enquired when the target of reducing the waiting time for first attendance to nine weeks could be achieved and when the longitudinal study would be completed. DDHA replied that the HA aimed to reduce the waiting time for first attendance to nine weeks by 1999/2000 and gradually to five weeks in the longer term. Chief of Service (Psychiatry) of Kowloon Hospital (CSP) supplemented that it would take about 6 months to do such a study. The Administration undertook to report on the findings of the study to the Panel in due course.

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8. Miss CHAN Yuen-han expressed concern over the short consultation time for each patient. DDHA assured members that adequate time would be spent on patients especially new patients, on whom a long observation would be made at first attendance. Even for follow-up cases, a doctor would handle 13 to 14 cases a session.

9. The Chairman asked whether the HA would redeploy resources internally to meet a sudden surge of demand and if so, whether the demand would level off after awhile. DDHA replied that the HA already had such an arrangement in place as it was very concerned about the waiting time for first attendance. Each speciality in the HA had its own co-ordinating committee to deal with waiting time for first attendance.

10. Mr HO Sai-chu asked whether there was a triage system during consultation in general outpatient clinics (OPC) and if so, what was the percentage for acute mental cases. DDHA replied that he did not have that figure. He confirmed that psychiatric patients were usually diagnosed and referred to SOPCs by doctors of OPCs. Serious psychiatric patients usually displayed acute symptoms and were referred to hospitals for treatment as required under the Mental Health Ordinance. CSP supplemented that SOPCs had special sessions for urgent cases. A doctor at the SOPC would take into account the recommendation of the referral letter from the doctor at OPC, the condition of the patient as observed by an experienced nurse, and the information supplied by the patient's family members when deciding whether or not a patient should be given priority treatment. For a patient who did not require immediate medical care, he would be told that in the event his condition deteriorated drastically, he could go to the SOPC or the accident and emergency department.

11. Dr TANG Siu-tong doubted whether nurses were in the best position to observe the behaviour of mental patients. Noting that the waiting list for first attendance in October 1998 was 3657 which represented an increase of some 80% over 1995/96's figure of 2002, he asked whether the manpower in the HA had a corresponding increase in order to cope with the workload.

12. DDHA reiterated that the HA would be conducting a study to analyse the type of psychiatric illnesses presenting at the outpatient clinics. The HA had provided additional manpower to cope with the increase in workload. The number of doctors and psychiatric nurses had increased from 169 and 2037 in 1996/97 to 188 and 2160 in 1998/99 respectively. He explained that the increase in workload would require a marginal increase in manpower, because a core number of staff had to be provided for mental services irrespective of the demand. The HA would review the patient throughput and manpower ratio on a yearly basis. It would redeploy and increase resources as and when necessary.

13. Dr LEONG Che-hung raised the following questions -

What was the long-term policy for mental health services;
Why were there be fewer wards after a hospital was refurbished. For instance, the number of beds in Kwai Chung Hospital (KCH) would be reduced after refurbishment;
Whether patients at the SPOCs were attended by psychiatrists or doctors under training and how much time did they spend on a patient. He considered that Hong Kong did not have sufficient psychiatrists, as they represented only one-fiftieth of that in the UK;
Whether the HA had the budget to procure new drugs which had been found to be effective in treating mental patients, given that they were quite expensive; and
What rehabilitation and support services were available to discharged mental patients.

14. DDHA replied with the following points -

Mental health was one of the major and priority services of the HA. At present the HA was working out the service direction and development plans for different specialities including psychiatric services. Care for mental patients was not restricted to mental hospitals, community and outreach services were also provided to help mental patients to re-integrate into society;
There were about 5 000 beds for psychiatric patients as compared to only 4 400 beds when the HA was first established. The ratio of 0.8 bed per 1 000 patients compared favourably with other countries;
Patients at SOPCs were attended by qualified psychiatrists or psychiatrists in training. The HA was concerned about providing professional service to patients attending SOPCs the first time. Therefore, the service was led by qualified specialists. It was inappropriate to draw a direct comparison between the UK and Hong Kong because the two places had different health care policies and demographics. The population in the UK was about 10 times that of Hong Kong with over one million staff involved in health care;
The HA had budgeted for new psychiatric drugs with better efficacy; and
There were community psychiatric teams, community psychogeriatric teams and the outreaching teams providing rehabilitation services for discharged mental patients. There were also resource centres providing information and assistance to the patients and their family members.

15. Noting that there were increases in the number of beds, enhanced outreaching and community services, Dr LEONG Che-hung asked whether there was sufficient manpower to cope with the workload. He further asked whether there were enough new drugs for all patients who needed them, or whether the HA would consider existing drugs good enough for patients as long as they had taken their medications regularly. He stressed that mental patients relied on drugs and it was important that new drugs, although expensive, should be available to all those who were in need.

16. DDHA replied that the increase in manpower in the HA was averaged at 3% a year. Psychiatric services had the same percentage of increase in manpower. Although the increase in manpower might not be proportional to the increase in the demand for medical services, the HA had adopted various cost-effectiveness measures to fully utilise the additional resources to meet the increasing demand in the past few years. As regards new drugs, the HA would have regard to scientific evidence in medical literature. By adopting this evidence-based approach, HA would introduce new drugs on a pilot basis to assess their effectiveness before introducing them on full scale.

17. The Chairman made the following comments -

The ward to patients ratio had regressed to those of the 1960's. In the 1960's, the ward to patients ratio was 1:100. In the 1980's, the ratio dropped to 1:50. In recent years with the refurbishment of wards, the ratio was increased to 1:70/80. The ratio in the Pamela Youde Nethersole Eastern Hospital (PYNEH) had reached 1:90 now and the HA had advised in paper (02) that the wards in the KCH 'might' reopen upon completion of the refurbishment project. He asked whether it was the plan of the HA to enlarge wards to accommodate more patients, if so, what was the targeted ward to patients ratio. Noting that the funding for the Castle Peak Hospital(CPH) and the PYNEH was $200,000/bed and $330,000/bed respectively, he asked how the fund was used;
The waiting time for patients to receive psychiatric community nursing (CPN) and outreaching services varied from hospital to hospital. In the CPH, the waiting time ranged from half a year to one year while the response time in KCH after referral ranged from two days to seven days. He asked the reasons for the differences and the measures taken by the HA to improve the situation;
New drugs were usually expensive because apart from costs of drugs, suppliers also provided guarantee and support services such as blood tests for patients. The fact in Hong Kong was, if patients were in hospitals or attending outpatient clinics, the provision of supporting services and assessment of the effectiveness of the drugs were done with the resources of the HA and not of the suppliers. The HA should review whether it should pay for the add-on costs of drugs; and
The admission criteria for long-stay care homes and half-way houses were too harsh, given that patients who could not take care of themselves would not be admitted. He criticised that these institutions were not really taking care of those in need. He doubted whether it was right to allow them to selectively admit patients.

18. DDHA replied with the following points -

The PYNEH had nine psychiatric wards with 540 beds. The wards were spacious, the floor area of two of them exceeded 880 square metres and were able be accommodate some 65 patients each. The other five wards were more than 650 square metres each. In 1997 the two gazetted wards which received patients under the Mental Health Ordinance were merged with a total area of 1 300 square metres. One of the wards was converted into a day activity area to offer a wide variety of daytime rehabilitative activities for psychiatric patients while the other ward was used as a dormitory area for some 80 patients. Both the patients and their families were satisfied with the arrangement. He added that the number of patients in the ward exceeded the limit of 80 in 1997 mainly because the patients were admitted under the Mental Health Ordinance and the PYNEH could not turn them away. As regards KCH, he assured members that the reduction in the number of wards was a temporary measure during refurbishment;
In 1997/98, CPH had 12 community psychiatric nurses handling 490 referrals for CPN services while KCH had 21 nurses handling 696 referrals. Most of the patients referred to the CPH received CPN service within a relatively short waiting time. In the last quarter of 1998, two additional psychiatric nurses were provided for the CPH to relieve the workload; and
The HA would not contribute to the development costs of new drugs introduced by the pharmaceutical industry. The HA was concerned about the efficacy of new drugs. If they were proven to be efficacious and cost-effective, the HA would make available resources for the patients who needed such medication to be given appropriate treatment.

Dr LEONG Che-hung took the chair at this juncture.

19. Addressing members' concern on the policy of mental health care, Deputy Secretary for Health and Welfare (DSHW) said that after-care and rehabilitation services for mental patients were as important as in-patient service, given that the ultimate aim was to help discharged mental patients to re-integrate into the community. The long-term policy would be to reduce in-patient service and enhance community psychiatric services. The Administration considered it necessary to improve the interface between various psychiatric services. To this end, the Health and Welfare Bureau (HWB) was working closely with the HA and the Social Welfare Department (SWD) to improve co-ordination to ensure continuity of medical treatment and aftercare services for discharged mental patients. He hoped that the HA would put more emphasis on the co-operation between hospitals and community services during its review on mental care services.

20. Assistant Director of Social Welfare (Rehabilitation and Medical Social Services) (ADSW) explained that long stay care homes (LSCH) and half-way houses were meant for patients with different mental conditions. Half-way houses were for stable rehabilitated patients who needed hostels after being discharged from the hospitals. The eligibility criteria for admission was that the discharged patients must have work volition. Counselling and training programmes were provided to help them to develop work habits and to be independent. Arrangement would be made for them to work in sheltered workshop which provided opportunities for work adjustment and advancement with the ultimate objective of moving on to open employment whenever possible. As regards LSCH, it was a facility for chronic mental patients who were in stable or controlled medical and mental conditions, who required no active medical treatment but who needed long term residence and some nursing care. Therefore their training programmes were focused on activities of daily living and self-care. For admission to LSCH, patients had to be referred by medical social workers and psychiatrists. Details of the admission procedure were set out in Item (4) of paper (02).

21. ADSW further explained that non-government organisations (NGOs) running half-way houses and LSCH would discuss with the patient and his family members to understand the condition of the patient and the type of services suitable for him. Since there were different assessment tools adopted by the HA and NGOs to assess the rehabilitation progress of mental patients, the SWD had set up a working group comprising representatives from the HA and NGO operators to streamline referral procedures. The study on half-way houses had been completed and some of these recommendations were already implemented. For instance, some NGO operators had agreed to admit discharged mental patients to half-way houses based on the recommendation of the psychiatrist of a hospital or a SOPC. As regards LSCH, the working group had yet to draw up standard admission criteria and a set of assessment tools to facilitate discharged mental patients to receive rehabilitation services as early as possible. There was a long waiting list for LSCH as there were only 570 places available. Of the 570 places, 65% were taken up by patients referred by hospitals and 20% by SOPCs. As regards places for half-way houses, 60% of the patients were admitted directly from hospitals. Several LSCHs were now under construction and were expected to be commissioned in 2003, providing 800 additional places.

22. Dr LEONG Che-hung said that the question raised by the Chairman regarding the long-term policy for the provision of beds in each ward was not yet answered. Dr LEONG also enquired about the timetable for the review of mental health care services.

23. DDHA said that during the planning stage of a hospital, the physical need and the activity area required by mental patients would be considered. The HA would also have regard to the mode of operation and efficiency in the design of a ward. He said that both the patients and their families liked the design in PYNEH because there was ample space for day activities and medical treatment could also be carried out in the ward.

24. DSHW supplemented that it was the HA's long term plan that the environment in hospitals should be improved. For instance, the number of mental patients in CPH was targeted at 1 900 in 1997 and the target was revised to 1 700 at present. After refurbishment, the number would be further reduced to 1 500. As to the timetable, he was not able to give a date because the HA was currently conducting an internal review and assessment of their service. He undertook to give more information to members in due course.

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25. Noting that the attendance for weekend depot injection service in the PYNEH and KCH was quite low, Dr YEUNG Sum enquired about the measures for improving utilisation and suggested that the HA should make reference to the operation of the United Christian Hospital . DDHA explained that weekend depot service was provided to patients who had difficulty in attending psychiatric clinic for injection during week days. The United Christian Hospital had been offering Sunday depot injection for over 10 years and had therefore accumulated a larger number of patients. Given that the service in KCH and PYNEH only started at the end of 1997, a gradual accumulation of patients was expected.

26. Mr YEUNG Yiu-chung opined that prevention might not be better than cure in the case of mental patients. He pointed out that after acquiring more understanding of mental illness through public education, some people might overreact and seek medical treatment for mental illness. He asked about the number of such cases received by the HA and whether the treatment programme for new mental patients was shorter. DDHA said that the HA considered that public education on mental health played an important part in the social rehabilitation of mental patients. With the public becoming more aware of the importance of mental health and acquiring more understanding about mental illness, it was hoped that discharged mental patients could be more easily accepted by the community, and relapse of discharged mental patients could be prevented or identified at an early stage. As to whether public education programmes had resulted in a surge in the number of first attendance, he did not have a ready answer. Nevertheless, he pointed out that it was always better to seek early treatment if a person suspected that he was suffering from mental illness.

27. Referring to a recent survey conducted by the Chinese University of Hong Kong which revealed that one out of five mental patients would have relapses, Dr LEONG Che-hung asked whether the problem had arisen because of shortage of resources. DDHA responded that he had to read that report before making any comment.

28. Mr LAW Chi-kwong enquired about the movement of discharged mental patients; the type of after-care services they received; and the number of discharged patients receiving such services. He opined that a flow chart depicting the movement and development of discharged mental patients would help to review mental health services and identify areas for improvement.

29. DDHA replied that the figures in paper (02) could not show the progress of individual cases because the figures so provided were in response to paper (01) prepared by the Chairman. He said that it would be difficult for the HA to chart the flow or outcome of discharged mental patients and provide the corresponding number of patients under each category of services. Should members wish to know the effectiveness of mental health services, he could provide figures on the unplanned readmission rate of discharged mental patients.

30. Mr LAW Chi-kwong said that he could draw up a flowchart for the HA to fill in the figures. If the HA was still unable to provide such information, he considered that the HA should try to improve its follow-up service. Dr LEONG Che-hung supported his view.

31. In response to a question from Dr TANG Siu-tong on the central registration system, DDHA explained that with the decentralisation of the psychiatric services in recent years, it was no longer necessary for the central register to be maintained. Each psychiatric institution or SOPC kept a local register of the priority follow-up patients in the system and monitored the conditions locally.

32. In concluding the discussion, Dr LEONG Che-hung said that the Panel noted that a longitudinal prospective study of the types and frequency of psychiatric illnesses presenting at the outpatient clinics would be conducted by the HA to find out the causes of the recent increase in attendance. He considered that the subject should be discussed again at a later date.

IV. Control of unregistered pharmaceuticals and blood/blood products in Hong Kong
(LC Papers Nos. 981/98-99(01), 1246/98-99(03) - (06))

33. Dr LEONG Che-hung welcomed representatives of the Hong Kong Association of the Pharmaceutical Industry (HKAPI) to the meeting.

34. The President of the HKAPI made a brief presentation. He expressed concern about the risks of unregistered pharmaceutical products (UPP) on public health and safety. He explained the channels through which UPPs were illegally entering Hong Kong and urged the various government departments to work closely with the pharmaceutical industry with a view to closing the regulatory loopholes that presently existed. (A copy of his speech was issued to members vide LC Paper CB(2) 1308/98-99.)

35. At the invitation of Dr LEONG Che-hung, Chief Pharmacist of the Department of Health (CPDH) briefed members on the existing control mechanism of UPPs. He said that the Administration was concerned about the safety, efficacy and quality of pharmaceuticals sold in Hong Kong. Under the Pharmacy and Poisons Ordinance (PPO), pharmaceutical products must be registered before they were imported for sale in Hong Kong. The importers were required to provide relevant information regarding the imported pharmaceuticals to ensure that they met the required standards. The sale of a UPP was an offence. DH staff would carry out both regular and surprise inspections of pharmaceutical wholesalers and retailers, and investigate complaints to enforce the law. He further informed members that the Pharmacy and Poisons Board (the Board) was currently conducting a review of the existing mechanism with a view to tightening the import of pharmaceuticals.

36. Dr YEUNG sum asked the Administration the following questions -

whether the problem of smuggled pharmaceuticals was getting more serious and what were the control measures to stamp out pharmaceuticals brought in through illegal channels;
How to ensure that pharmaceuticals entering the territory for re-export would not be sold in Hong Kong; and
How would the Administration handle inadequate labelling and instruction literature of pharmaceuticals.

37. DSHW replied that one of the reasons for an increase in the number of prosecutions for selling UPPs was that more manpower had been allocated to the DH to carry out inspections. As the Board was consulting the industry on tightening the controlled measures, substantial information in this respect was therefore not yet provided in the paper. He expected that the Board would be able to come up with some recommendations after its meeting on 10 February 1999. He stressed that while it was important to step up enforcement action against the importation of pharmaceuticals through illegal channels, the measures taken for this purpose should not hamper normal re-export trading activities.

38. Dr LEONG Che-hung said that as the problem of UPPs had been a long-standing one, he did not understand why consultation with the industry was conducted long after the PPO was introduced. He also doubted the effectiveness of the consultation. He pointed out that some controlled pharmaceuticals could be purchased by the public without the need for a doctor's prescription. As there was a large volume of such transactions, he doubted whether the industry would be willing to co-operate and propose measures to jeopardise their business.

39. Dr YEUNG Sum enquired about the size of the problem in respect of invalid imports, i.e. re-export pharmaceuticals actually sold in Hong Kong. DSHW said that the number of prosecutions for such an offence might be able to give a rough picture of the problem. CPDH supplemented that there was an increase in the number of such prosecutions in recent years. He believed that merchants were lured into bringing in UPPs because currency devaluation in Asian countries had made their pharmaceuticals much cheaper than that of Hong Kong. To tackle the problem, the DH had enforced the relevant regulation on the sale of UPPs by paying more inspection visits, and the Custom and Excise Department had stepped up action to stamp out the inflow of UPPs through illegal channels. He explained that under the Import and Export Ordinance (Cap. 60), a pharmaceutical product could only be imported if an import licence had been granted. An import licence would only be granted for UPPs if the importer declared that the product was imported solely for re-export. In addition, the Board would be consulted first before the import licence was issued. As the number of prosecutions for false declaration and import without a licence had surged since 1997, enforcement action had been stepped up at the entry points. There was also a more vigilant approach to ensure that the imported pharmaceuticals had the proper documentation.

40. Dr YEUNG Sum said that the Administration had answered the part on UPPs, but had not addressed the part relating to registered pharmaceuticals purported to be for re-export but were sold in the local market. Dr LEONG Che-hung said that it appeared that the Administration could not ascertain the size of the problem. He asked whether the HKAPI had such information.

41. The President of the HKAPI responded that it did share information with the DH about products brought into the domestic market, but it had no knowledge on the size of the problem. He emphasised that his concern was on public safety, and to this end pharmaceutical products should be handled through proper channels.

42. Addressing Dr YEUNG's question, DSHW explained that for law enforcers, irrespective of whether the pharmaceuticals were registered or unregistered, as long as the imported products were brought into the domestic market through illegal means, enforcement action would be taken against the persons concerned. The increase of prosecution cases indicated that the problem of invalid imports was more serious than before. Therefore, the Board was consulting the pharmaceutical industry to explore measures which were more effective without unduly upsetting the normal business transactions of the industry. He said that the Administration could not provide an answer on the exact size of the problem. If the Administration was able to do so, it would have stamped out such illegal activities entirely.

43. In response to Dr LEONG Che-hung , DSHW said that the HWB and the DH were the co-ordinator for the control mechanism of UPPs, and the Trade and Industry Bureau and the Custom and Excise Department were also involved. As regards Miss CHAN Yuen-han's question on the number of successful prosecutions against selling UPPs, making false declaration or importing pharmaceutical products without a licence, the Administration would provide the figure after the meeting. At the request of the Chairman who had re-joined the meeting at this point, DSHW undertook to provide a supplementary paper to incorporate the recommendations of the Board at its meeting to be held on 10 February 1999.

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44. Mr LAW Chi-kwong enquired about the use of UPPs in private hospitals and by private practitioners; the control measures to ensure that they would not use UPPs; and whether adequate support had been provided to enable them to distinguish between registered and unregistered products.

45. CPDH replied that the DH had distributed a pamphlet to all registered doctors, pharmacies and medicine companies in 1998 to remind them that all pharmaceutical products were required to be registered and using UPPs was an offence. It also advised them on how to determine whether a product was registered or not. The simplest way was to look for the registration number on the package. If a doctor was in doubt of a product, he could call the enquiry number in the pamphlet. The information of the pamphlet had been uploaded onto the Internet for public access.

46. In response to a further question from Mr LAW Chi-kwong, CPDH said that the DH had only found one case in a private hospital using a UPP. The case was found accidentally. The drug in question had to be used together with other radioactive drugs. The hospital realised that it had to meet the requirement in the radioactive legislation, but had overlooked the requirement of the other drug under the PPO.

47. Noting that UPPs were sometimes sold by those inside the pharmaceutical trade, the Chairman asked the Administration how it would treat the views of these people. CPDH replied that these people usually operated under a licence. During regular inspections, staff of the DH would remind them of the need to register drugs sold in Hong Kong. The consultation exercise would cover all licensed importers. He believed that there was only a handful of licensees selling UPPs, as there were only some 1 300 pharmaceutical traders.

48. Given that an importer operating under a licence would have the facilities to meet the requirement for storage and other handling procedures, the Chairman asked why the importer had not registered the drugs. CPDH explained that the source of UPPs could be dubious, it might have changed hands many times or improperly stored in the process.

49. DSHW remarked that for UPPs, it was definitely a question of law enforcement. He said that there were two aspects for enforcement, one was at the entry points and the other at the retail level. It was more difficult to tackle the purported re-export products because they entered Hong Kong legally but were subsequently sold in the black market. He had considered the scenario whereby re-export products would be required to attach import certificate from the third country. He would seek views from the trade regarding the implication of his proposal on their business. Having regard to the fact UPPs would eventually be sold at retail level, he said that enforcement action was focused on regular and surprise inspections of pharmacies. The use of UPPs by private practitioners and hospitals was not so much a problem because they were regulated by their code of practice.

50. Dr LEONG asked about the size of the workforce in carrying out inspections and its operation. CPDH said that there were 28 inspectors in the DH responsible for enforcing the PPO. They would visit each pharmacy at least twice a year. Pharmacies which had a poorer track record would be visited more frequently. During inspection, the inspectors would check the expiry dates and registration numbers of the pharmaceuticals stocked. If they were in doubt, they would verify the number with the DH. If a drug was proven to be unregistered, investigation would be carried out and followed by prosecution if necessary.

51. Mr LAW Chi-kwong asked the Administration to consider adopting standard procedures for imports and re-exports, in order that the movement of imported drugs could be traced. On law enforcement, he asked whether there was a blacklist system whereby convicted importers would not be allowed to import pharmaceuticals any more. DSHW said that if the same standard was adopted for imports and re-exports, it was tantamount to applying the procedure of registered drugs to re-export. This would impose burden on re-export activities, given that some drugs were not intended to be registered in Hong Kong and some might not be qualified for registration. It was imperative to strike a right balance.

52. The Chairman asked that if an importer had bought a product at a very cheap price in another country and was able to meet the storage and other handling requirements, how the Administration would handle these products. He asked the Administration to address his question in the supplementary paper to be provided.	Adm

V. Any Other Business

Government clinics providing service during the Chinese new year holidays

53. Dr LEONG Che-hung asked the Government/DH to announce as soon as possible the government outpatient clinics which would be open during the Chinese new year and to discuss with the Hong Kong Medical Association regarding a list of private clinics which would be open. DSHW said that 11 government clinics would be open and early publicity on the matter would be made.

54. The meeting ended at 10:45 am.

Legislative Council Secretariat
1 June 1999