Panel on Health Services (Minutes) 8 Mar 99

Legislative Council

LC Paper No. CB(2) 2590/98-99
(These minutes have been
seen by the Administration)

Ref : CB2/PL/HS

LegCo Panel on Health Services

Minutes of meeting
held on Monday, 8 March 1998 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 Cyd HO Sau-lan
Hon CHAN Yuen-han
Dr Hon TANG Siu-tong, JP
Hon LAW Chi-kwong, JP

Members Absent :

Hon HO Sai-chu, JP
Hon Mrs Sophie LEUNG LAU Yau-fun, JP
Dr Hon YEUNG Sum
Hon YEUNG Yiu-chung

Public Officers Attending :

For All Items
Mr Gregory LEUNG: Deputy Secretary for Health and Welfare 1
Miss Ada CHAN: Assistant Secretary for Health and Welfare
For Agenda Items III & IV only
Miss Eliza YAU: Principal Assistant Secretary for Health and Welfare (Medical) 1
Mr Fletch CHAN: Assistant Secretary for Health and Welfare
Dr Constance CHAN: Assistant Director of Health (Health Administration and Planning)
Mr TSE Man-shing: Head of Boards & Councils Office, Department of Health
For Agenda Item V only
Miss Eliza YAU: Principal Assistant Secretary for Health and Welfare (Medical) 1
Ms Jennifer CHAN: Principal Assistant Secretary for Health and Welfare
Mrs Kathryn WONG: Assistant Director of Health (Administration)
Dr W M KO: Deputy Director (Operations), Hospital Authority

Attendance by Invitation :

For Agenda Item III
Hong Kong China Medicine Association
Mr WONG Dai-tim: President
Mr TSE Wing-kwan: Vice President
Mr WU Foo-cham: Vice President
Mr TSUI Sin-kwok: Vice President
For Agenda Item IV
Hong Kong Chiropractors' Association
Mr Edward LEE: President, HKCA
Mr William YAM: Vice-President, HKCA
Mr David COSMAN: Chairman, HKCA Sports and Injury Committee
Mr Stanley LUM: Chairman, HKCA Education Committee
Mr Alex SHIU: Member
Mr Bruce VAUGHAN: Member
Chiropractors Legislation Concern Group: Mr FONG Hang; Mr Russell WILLIAMS; Mr Thomas WILTSE

Clerk in Attendance :

Ms Doris CHAN: Chief Assistant Secretary (2) 4

Staff in Attendance :

Mr LEE Yu-sung: Senior Assistant Legal Adviser
Ms Joanne MAK: Senior Assistant Secretary (2) 4

I. Confirmation of minutes of meeting held on 14 December 1998 and matters arising
(LC Paper No. CB(2) 1348/98-99)

The minutes of the meeting held on 14 December 1998 were confirmed.

II. Date of next meeting and items for discussion
(LC Paper No. CB(2) 1413/98-99(01))

Consultancy report on Hong Kong's health care system (the consultancy report)

2. Deputy Secretary for Health and Welfare 1 (DS(HW)1) informed members that the consultancy report prepared by Professor William HSIAO of the Harvard University's School of Public Health was largely ready. It would be provided to members when the Chinese translation of its executive summary was available. Subject to further arrangements Professor HSIAO might return to Hong Kong to brief the Panel on the report at its next meeting on 12 April 1999. The Administration would invite the public to give views on the recommendations of the report. At the Chairman's request, DS(HW)1 agreed to provide a work schedule in respect of the review of health care financing at the next meeting. Items for discussion at the meeting scheduled for 19 April 1999 at 8:30 am

Adm

3. Members agreed to hold an additional meeting on 19 April 1999 at 8:30 am to discuss the following items -

Monitoring of private hospitals; and
Visiting health teams for the elderly of the Department of Health (DH) and outreaching services provided by the Hospital Authority (HA).

Members noted that the Health and Medical Development Advisory Committee (HMDAC) had discussed the monitoring of private hospitals and DS(HW)1 agreed to provide the relevant information to members.	Adm

Items for discussion at the meeting scheduled for 10 May 1999

4. Members agreed to discuss the following items at the meeting to be held on 10 May 1999 -

Investigation report on the kidney dialysis incident at the Hong Kong & Sanatorium and Hospital if the relevant death inquiry was completed before the meeting;
Dental policy and review of oral health goals; and
Registration of ancillary dental personnel.

In connection with item (b), Principal Assistant Secretary for Health and Welfare (Medical) 1 (PAS(HW)(M)1) reported that the Dental Sub-committee of HMDAC should receive the report submitted by the Working Group on Revision of Oral Health Goals and it might discuss the report at its meeting in April 1999.

5. DS(HW)1 informed members that the Administration was preparing a consultation paper on the registration of ancillary dental personnel which would be issued to the sector concerned. He would inform members of the outcome of the consultation at a future meeting.	Adm

III. Medical Registration
(LC Papers Nos. CB(2) 1413/98-99(02) and (03))

6. At the invitation of the Chairman, the President of the Hong Kong China Medicine Association (HKCMA) made the following points -

The Licensing Examination (LE) (formerly the Licentiate Examination) held by the Medical Council of Hong Kong (HKMC) for non-local medical graduates was a continuation of the Government's policy of discrimination against medical practitioners trained in the Mainland and to prevent them from practising in Hong Kong.
Legislation should be passed to make provisions for exemption of those who had completed at least five years' medical training in the Mainland and were now residing in Hong Kong so that they could practise medicine in Hong Kong without having to sit for the LE.
They should be given the same treatment as those British Commonwealth medical graduates covered by the Medical Registration (Transitional Provisions) Ordinance 1997 i.e. to be exempted from the LE, since they had the same resident status as those graduates and had completed a five-year medical training.

7. Miss Cyd HO noted that most of the medical graduates from the Mainland had not practised medicine since taking up residence in Hong Kong. She asked the representatives whether after having not practised for 10-20 years, they would need to receive some training and acquire some clinical experience first before they could practise medicine in Hong Kong if they were not required to sit for the LE. In response, a representative of HKCMA agreed that it would be desirable if the government could arrange seminars for them to help them to understand local practice. The Chairman requested HKCMA to provide to the Panel details of their proposals in this regard after the meeting.

8. Miss Cyd HO further enquired whether HKCMA would accept that, after attending the refresher training course if such was provided, the medical graduates trained in the Mainland would have to pass a qualifying examination in order to practise medicine in Hong Kong. In response, the President of HKCMA stressed that they had an absolute right to practise in Hong Kong. They therefore would only accept, after registration, to attend a training course of not more than 30 hours to familiarize themselves with the local health care system. However, they would in no way accept any means to evaluate their professional standards.

9. The Chairman referred to the Basic Law which provided that the Government of the Hong Kong Special Administrative Region (HKSAR) could formulate provisions on its own for assessing the qualifications for practice in the various professions and asked the representatives' views on this. In response, the President of HKCMA said that while they recognized that the Government of HKSAR enjoyed legislative power, they considered that the registration system for medical practitioners should reflect the fact that Hong Kong was now part and partial of the People's Republic of China.

10. Dr LEONG Che-hung pointed out that in the past the granting of exemptions to the medical graduates from 38 Commonwealth universities from taking LE was not a preferential treatment. He explained that the exemptions were granted because the standards of the universities concerned were recognized by the General Medical Council (GMC) which had conducted assessments of the universities. He said that in 1987, when GMC removed some of the universities from its list of recognized universities due to their failures to meet the required standards or for other reasons, HKMC also followed suit and no longer granted exemptions to the medical graduates from those universities. Dr LEONG further took the view that the standard of medical care in Hong Kong should be maintained after the reunification.

11. The representatives of HKCMA pointed out that all medical graduates in the Mainland were subject to a unified standard evaluation for the whole country. They urged the Administration to spend time to understand the medical training system in the Mainland and to recognize the qualifications of the medical graduates for registration in Hong Kong.

12. Dr TANG Siu-tong referred to the principle of "one country two systems" and also pointed out that even in the United States (US), there were some differences in the registration systems for medical practitioners between various states. In response to Dr TANG's question on their views on this, a representative of the Association said that the cases of the US and Hong Kong were basically different. For example, he understood that a registered medical practitioner in the US had to re-apply for a practising licence if he had stopped practising medicine for seven years or more.

13. Summing up the discussion, the Chairman said that members had taken note of HKCMA's views and proposals. He suggested that the HKCMA could further provide members with supplementary information, if any, to facilitate members' deliberations of the matter.

IV. Chiropractors Registration
(LC Paper No. CB(2) 1413/98-99(04), (05), (06) and (07))

14. Representatives of the Chiropractic Legislation Concern Group (CLCG) said that CLCG was concerned about the following problems -

Qualifications for registration of chiropractors

The Chiropractors Registration Ordinance did not provide well defined requirements for registration as a chiropractor. CLCG recommended that a recognized chiropractic degree with internship served should be set as the minimum requirements for registration.
Chiropractors Council

CLCG was concerned that members of the chiropractic profession who sat upon the Chiropractors Council were exclusively members of a professional organization. CLCG demanded that the membership of the Chiropractors Council should be open to chiropractors in general.
The draft Code of Practice (COP)

CLCG suggested that the COP should be finalized as soon as possible. In the finalization of the COP, all chiropractors in Hong Kong should have an opportunity to participate in a meaningful way and so far that had not happened.

15. At the invitation of the Chairman, the President of the Hong Kong Chiropractors' Association (HKCA) said that HKCA represented 43 out of the 48 chiropractors practising in Hong Kong. He pointed out that matters including the code of practice of HKCA, membership requirements and so on were voted on the basis of one-member-one-vote. He further informed members that HKCA had adopted the draft COP issued by the Chiropractors Council as its own code of practice and agreed to abide by it. As regards the membership requirements of HKCA, he explained that members were required to have met the requirements for practising chiropractic stipulated by the country where the member received his/her Chiropractic degree. For example, in the case of the US, most of the states (42 states) accepted completion of the National Board of Chiropractic Examiners (NBCE) Part IV as the requirement for application of a practising licence in the country. Therefore HKCA required an applicant graduating from the US to present the NBCE Part IV certificate in applying to be members of HKCA.

16. In response to the views expressed by CLCG, Head of Boards & Councils Office (HBCO) pointed out that the COP was only at the drafting stage and it had yet to be implemented. He further informed members that the Chiropractors Council, in considering the academic criteria for registration, would draw reference to the qualifications awarded by chiropractic colleges accredited with the overseas Councils on Chiropractic Education in the US, Canada, Australia and the United Kingdom. In this connection, DS(HW)1 said that the Administration supported this policy of the Chiropractors Council since Hong Kong did not have its own mechanism for providing chiropractic training.

17. A representative of CLCG said that he had heard that the Chiropractors Council would impose different requirements for registration on individual applicants depending on the country where he/she had received his/her Chiropractic degree. He considered that this arrangement was far from satisfactory for the lack of a uniformed standard for all applicants for registration. Moreover, he said that this might result in students choosing to study Chiropractic in a particular country just because the qualification requirements for registration in that country were considered less stringent.

18. Miss CHAN Yuen-han asked whether the Administration had listened to the views of other professional organizations in the chiropractic sector in setting the registration criteria and in preparing the draft Chiropractors (Registration and Disciplinary Procedure) Rules (the Rules). In response, DS(HW)1 said that the Administration respected the autonomy enjoyed by professions especially in the setting of their registration criteria. In view of the small number of chiropractors practising in Hong Kong, DS(HW)1 considered that there should be little problem in collecting their views for consideration by the Chiropractors Council and the Administration. He reiterated that there was no intention to rely on membership requirement of a particular association as a precondition for registration in the chiropractic profession. The Chairman said that since there were allegations that the views of some members of the profession had been neglected by the Chiropractors Council, he suggested that the Health and Welfare Bureau (HWB) should follow up the matter. In response, DS(HW)1 agreed to look into the matter and follow up where necessary. In response to a member's enquiry, a representative of HKCA clarified that two of the five chiropractors sitting on the Chiropractors Council were not members of HKCA.

19. A representative of CLCG considered that all chiropractors should be given an equal opportunity to voice their opinions to the Chiropractors Council. He believed that only by providing such an opportunity for an open exchange of opinions that Hong Kong could be an ideal place for chiropractors to practise.

20. Dr LEONG Che-hung referred to a letter provided by representatives of CLCG during the LegCo Duty Roster Members' meeting held with them on 3 February 1999. The letter was issued by HKCA to a member of CLCG dated 14 November 1998 which stated that if the member of CLCG continued failing to comply with the requirements imposed by HKCA, his standing with the HKCA would be jeopardized and "this would definitely compromise his eligibility to register with the Hong Kong Chiropractors Council in the upcoming full implementation of the registration" of chiropractors in Hong Kong. Dr LEONG pointed out that during the same meeting, the representatives of CLCG also told members that the Administration had only consulted HKCA during the preparation of the Rules while other chiropractors in practice who were not HKCA members had not been consulted. In response, HBCO pointed out that the quoted letter was issued by HKCA and it did not represent the stance of the Chiropractors Council. He confirmed that the Chiropractors Council, in considering whether an applicant met the requirement contained in clause 9(1)(d) of the Chiropractors Registration Ordinance (CRO), would make reference to the recommendations made by a professional body such as HKCA on the suitability of the applicant for the registration. However, he stressed that it was not a mandatory requirement for the applicants to be members of any professional bodies. He said that the Chiropractors Council would also accept references submitted by other people related such as the applicant's teachers.

21. As regards the consultation process of the Rules, HBCO pointed out that the Chiropractors Council had discussed and made recommendations on the Rules, which were submitted to HWB. He stressed that there was no intention to exclude any members of the profession from the consultation. DS(HW)1 assured members that the Administration would try to reach as many members of the profession as possible. He undertook to follow up the issue in collaboration with the Chiropractors Council.

Adm

22. Dr LEONG Che-hung enquired what arrangements would be made for those chiropractors who had practised in Hong Kong for a long time and were not able to meet the requirements for registration to be imposed by the Chiropractors Council. In response, HBCO explained that for such cases, the Chiropractors Council would take into account the training and practical experiences accumulated by the chiropractors concerned and further decide on the cases. The Chairman requested the Administration to follow up the "grandparent" issue.

Adm

23. Miss CHAN Yuen-han and Dr LEONG Che-hung urged the Administration to expedite the preparation of the subsidiary legislation under the CRO. They also requested the Administration to widen its scope of consultation in the sector as far as possible.

24. The Chairman requested the deputations to forward their views or any concrete proposals concerning the academic requirements for registration and the draft COP to HWB, which would follow up the matter with the Chiropractors Council.

V. Follow-up on implementation of the Enhanced Productivity Programme (EPP) in the Hospital Authority and the Department of Health
(LC Paper No. CB(2) 1413/98-99(08))

25. Assistant Director of Health (Administration) (AD(H)(Adm)) informed members that the Administration's proposals on implementation of EPP in DH was drawn up after careful review of work procedures and consultations conducted with the front-line staff to ensure that the proposals were feasible and realistic. Miss CHAN Yuen-han was concerned about the pressure exerted on the front-line staff due to heavy workload. She doubted whether the staff could cope if EPP resulted in additional workload. In response, AD(H)(Adm) explained that some of the measures would not actually cause additional workload as they would enhance services by improving the working procedures and administrative arrangements.

26. Deputy Director of Hospital Authority (Operations) (DD(O)) said that in HA, achievement of productivity gains was made possible by means of re-deployment of resources to meet service needs and by exploring room for improvement in the use of the existing resources to enhance services. In determining which areas where service enhancement was necessary, DD(O) said that it was based on professional advices and public opinions.

27. Miss Cyd HO referred to paragraph 9(c) of the paper and commented that the proposed increase in the number of annual assessment provided to diabetic patients from 25,000 to 45,000 was quite substantial. She asked DH and HA to explain the basis for deciding on the scope of EPP and the various proposed new initiatives. In reply, AD(H)(Adm) said that these service areas were identified for implementation of the new initiatives after taking into account their high service demands and the feasibility of implementing the proposed new initiatives in these areas.

28. DH(HW)1 informed members that in 1999-2000 HA and DH would implement the new initiatives within the allocation for that year. Thereafter, they would be required to achieve productivity gains amounting to 5% of their respective operating expenditures between now and the year 2002-03. Dr LEONG Che-hung questioned how DH and HA could manage to achieve productivity gains and introduce the new services as detailed in paragraphs 5 to 9 in spite of the cut in public expenditures under EPP. He referred to some of the initiatives of DH such as the proposed increase in the number of plain X-ray to be taken in 1999-2000 from 19,700 to 48,700 and was concerned whether the target set would psychologically create much pressure on the front-line staff. In response, DH(HW)1 said that the Administration shared members' concern about the workload of the front-line staff and it would try to enhance productivity by improving the administrative procedures. AD(H)(Adm) said that the initiatives introduced in paragraph 9 would be achieved by re-deployment of manpower and resources from service areas with lower service demands and also by improving administrative and work procedures. As regards HA, DD(O) explained that with more adequate allocation of resources from the Government four to five years ago, HA had actually already achieved productivity gains. Moreover, HA would redeploy 1% of hospitals' baseline budgets as "seed money" for funding one-off expenditure initiatives which could achieve future real money savings. The Chairman requested HA and DH to provide more detailed information to explain how they would achieve the targets as set out in paragraph 5(a) to (e) and in paragraph 9(a) to (e).

Adm & HA

29. Miss CHAN Yuen-han held the view that DH could further explore ways to achieve better use of its existing resources for enhancement of service and quoted the example that DH should encourage the public to use the general out-patient clinics of DH in order to ease the workload of the Accident and Emergency Departments of public hospitals during public holidays. In response, DS(HW)1 said that DH had been working on this target and HWB had been coordinating with DH and HA to work towards this end. He reiterated that the purpose of EPP was to achieve enhancement of services by measures like streamlining procedures. He said that services would be rationalized to ensure that there were no duplications of services and waste of resources. AD(H)(Adm) said that DH had been keeping a close watch on the front-line staff's working conditions and it would try to achieve enhancement of services by improving the administrative procedures and re-deployment of staff. She explained that EPP was a long-term plan and more implementation plans would be worked out and introduced in the next few years.

30. DD(O) concurred with Miss CHAN Yuen-han's comments that the HA's front-line staff were under heavy pressure of work and pointed out that HA would focus on areas like management structure, supporting service and energy conservation to identify ways to achieve savings and productivity gains. He confirmed that resources allocated to the Head Office of HA would be reduced and redeployed to hospitals. In addition, HA would carry out reviews of the clinical services in collaboration with each clinical unit to seek improvements on their mode of operations with a view to increasing the number of consultations. He pointed out that there would be re-deployment of resources from areas where the service demands had decreased.

31. The Chairman and Mr LAW Chi-kwong requested DH and HA to provide the following information by April 1999 -	Adm & HA

service areas where reduction of resources had been made and the justifications;
service areas from which resources had been redeployed and justifications for the re-deployment; and
details of how each public hospital managed to identify 1% of its baseline budget for re-deployment in 1999-2000 as "seed money".

DS(HW)1 said that he would discuss with HA and DH to see whether the service areas could be identified. DD(O) pointed out that it might not be possible to provide details for each hospital in respect of the 1% seed money by April but he would try his best to provide the requested information.

32. The meeting ended at 10:45 am.

Legislative Council Secretariat
16 July 1999