Panel on Health Services (Minutes) 11 Jan 99

Legislative Council

LC Paper No. CB(2) 1847/98-99
(These minutes have been
seen by the Administration)

Ref : CB2/PL/HS

LegCo Panel on Health Services

Minutes of meeting
held on Monday, 11 January 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 CHAN Yuen-han
Dr Hon YEUNG Sum
Dr Hon TANG Siu-tong, JP
Hon LAW Chi-kwong, JP

Members Absent :

Hon Cyd HO Sau-lan
Hon Mrs Sophie LEUNG LAU Yau-fun, JP
Hon YEUNG Yiu-chung

Public Officers Attending :

For All Items
Mr Gregory LEUNG, JP: Deputy Secretary for Health and Welfare
Dr P Y LAM: Deputy Director of Health
Miss Eliza YAU: Principal Assistant Secretary for Health and Welfare
Miss Joyce HO: Assistant Secretary for Health and Welfare
Mr Fletch CHAN: Assistant Secretary for Health and Welfare
For Agenda Item I only
Mrs Katherine FOK, JP: Secretary for Health and Welfare
For Agenda Items II and III only
Mr M S TSE: Head of Boards & Councils Office
For Agenda Items III and IV only
Dr Elizabeth KWAN: Consultant in charge Dental Service, Department of Health
For Agenda Item IV only
Mrs Philomena LEUNG: Principal Assistant Secretary for the Civil Service

Clerk in Attendance :

Ms Doris CHAN: Chief Assistant Secretary (2) 4

Staff in Attendance :

Mr LEE Yu-sung: Senior Assistant Legal Adviser
Mrs Eleanor CHOW: Senior Assistant Secretary (2) 4

I. Date of next meeting and items for discussion

Members agreed to hold an additional meeting on 27 January 1999 to discuss the following subjects -

Implementation of the Enhanced Productivity Programme in the Hospital Authority (HA) and the Department of Health;
Government's proposal to deduct $114 million from the HA budget; and
Undesirable medical advertisements.

2. Members agreed to discuss the following items at the next regular meeting on 8 February 1999 -

Mental Health Service; and
Control of unregistered pharmaceuticals and blood/blood products in Hong Kong.

Consultancy Study on Hong Kong's Health Care System

3. The Chairman said that although the consultant's report had not yet been released, various aspects of the study had been reported in the press quoting a variety of sources. He therefore considered it necessary for the Administration to brief the Panel on the up-to-date position of the study.

4. The Secretary for Health and Welfare (SHW) said that the Consultant was preparing the final report and finalizing the attachments to the report for submission to the Government at the end of January. Thereafter the Government would study the report in detail. The present plan was to prepare a consultation document for public comment in the middle of the year. She said that she understood the public's interest in the matter and would allow sufficient time for the public to understand and digest the contents of the report. SHW also briefed members on the scope of the consultancy study which was as follows -

to analyze the strengths and weaknesses of the existing health care system in Hong Kong and the problems facing the system;
to establish a Domestic Health Account to indicate how health care spending was funded and expended;
to project future service demand and health care costs, and determine Government's and the community's ability to meet the costs;
based on an analysis of Hong Kong's actual situation and taking into reference experience of other countries, to propose options for a future health care system; and
to conduct in-depth analyses of the financial implications and the cost-effectiveness of the proposed options.

In response to a question from the Chairman, SHW clarified that the study was a comprehensive review of the entire health care system including both the public and private sectors and covered both health care financing and provision of services.

5. Dr YEUNG Sum asked when the document would be made available to the Legislative Council and how long the consultation period would be. SHW said that it would be made available in the middle of the year and there would be quite a long period of consultation.

6. Dr LEONG Che-hung pointed out that some contents of the report had been revealed on various occasions and asked the Administration to clarify whether it was normal practice for the consultant to reveal parts of the report before it was submitted to the Government. He considered the fragmented nature of release of such information unsatisfactory and asked whether the full report would be released.

7. SHW said while the consultant had referred to his findings on two different occasions, he had not mentioned about any recommendations. She confirmed that the whole report on the consultancy study carried out by the Harvard University would be released together with a consultation document stating the Government's stance. The way forward and the final recommendations would only be decided after the consultation period.

8. Mr LAW Chi-kwong pointed out that as there was already much press coverage of the subject even before the report was released, there would be even more reporting after the full report had been submitted to the Government. He therefore asked the Administration to consider releasing the report for public comments as soon as possible without having to wait for the consultation document. SHW agreed to consider Mr LAW's proposal.

Adm

9. The Chairman and Dr LEONG Che-hung also considered that the report should be released as soon as possible. As regards the timing for the release of the report, SHW said that the Government had not yet decided on how to release the report. As both the report and the executive summary were in English, the Government had to consider whether the report should be released in English only or with a translated version.

10. Mr LAW Chi-kwong suggested to ask the consultant to provide a soft copy for the Internet. The Chairman said that the suggestion should be considered to facilitate the process of public consultation. He asked SHW to report again on the position, including any technical problems, in February.	Adm

II. Subsidiary legislation under the Chiropractors Registration Ordinance (Cap. 428)
(LC Papers Nos. CB(2) 860/98-99(01) and 1011/98-99(02))

11. The Chairman referred to the second paper provided by the Administration and commented that it failed to set out clearly the problems holding up progress of the matter.

12. The Deputy Secretary for Health and Welfare (DSHW) said that he shared members' concern over the time taken for the preparation of the subsidiary legislation under the Chiropractors Registration Ordinance (CRO). He pointed out that the main problem was caused by the difficulty in preparing the proposed subsidiary legislation, the drafting of which was nevertheless at a final stage and he hoped to submit the subsidiary legislation to the Chiropractors Council (the Council) in February 1999. He then asked Head, Boards & Councils Office (HBCO) to provide more details on the outstanding issues.

13. HBCO explained that the first issue to be resolved concerned application for registration. He pointed out that the CRO provided for the establishment of a Registration Committee (RC) to assist the Council to consider applications for registration. The CRO also empowered the Council to refuse to register a person as a registered chiropractor if he/she had been convicted of a criminal offence or had committed misconduct or neglect in a professional respect. On making reference to the practice in other registration ordinances such as that for medical practitioners and nurses, it was found that this provision was dissimilar. In determining how this power should be exercised, it was considered that the standards for handling disciplinary complaints against registered chiropractors should be adopted and therefore the RC should consult the Council's Preliminary Investigation Committee (PIC) in respect of such cases. However, legal opinion was that such referrals should be made by the Council instead of the RC. Therefore the application procedures in the draft subsidiary legislation might need to be revised to set out in more detail how such referrals should be made. HBCO said that it might be required to avoid duplication of membership between RC and the Council and the matter had now been resolved.

14. The second outstanding issue concerned hearing of an application for registration. Section 9(1)(c) and (d) of the CRO required that an applicant for registration should be competent to practise in chiropractic and be a fit and proper person to be registered. There was a suggestion that a full hearing should be held to determine whether the application should be accepted if the Council was in doubt whether the applicant fulfilled these requirements. Such an arrangement was not included in the Council's original legislative proposal but the suggestion was being studied in detail before a recommendation was made to the Council.

15. Section 17(7) of the CRO provided for the Council to make rules for the rehearing of an inquiry by an enquiry committee. No rules had been proposed for this purpose. Since the appeal mechanism should be the Court of Appeal, the rehearing of an inquiry would not be appropriate. The last issue to be resolved was how to implement the provision in section 12(8) of the CRO on extension of time for renewal of practising certificates. Such a provision was not found in registration legislation of other medical professions but had been included in the CRO. Whether and what procedures should be provided for such extension were being considered.

16. Dr LEONG Che-hung commented that since the CRO was passed over six years ago and there were only some 30 chiropractors, he could not understand why it had taken so long to resolve the technical matters holding up the subsidiary legislation. He considered the delay in completing the legislative scheme for the registration and discipline of the profession unacceptable. In response, HBCO pointed out that since Hong Kong did not have any mechanism for providing chiropractic training, the Council had to obtain information on qualifications for registration from overseas countries for reference. As regards Dr LEONG's suggestion that applicants should be required to submit a Certificate of No Criminal Conviction similar to the practice of the Medical Council, HBCO said that it could be considered for the applicants to make a similar declaration. He informed members that the code of practice was at the translation stage. In response to a further question from Dr LEONG, HBCO clarified that there was no intention to rely on membership of a particular association as a pre-condition for chiropractic registration.

17. Mr LAW Chi-kwong shared the view that the process had taken too long. He considered that section 13(5) of the CRO which read "The Council may delegate any of its functions relating to registration and the renewal of registration to the registration committee." was unclear and suggested that it should be amended to specify the functions. HBCO said that he would reflect the suggestion to the Council but pointed out that it had already been resolved that the RC would consider the qualifications while the Council would make referrals to the PIC which would make recommendations for consideration and decision by the Council. The proposed procedures would be referred to the Council for consideration and agreement.

Adm

18. Dr LEONG Che-hung asked the Administration to consider tidying up the provisions in the CRO in order to solve the problem once and for all. Dr YEUNG Sum said that consideration of amendments to the CRO and finalizing the subsidiary legislation could proceed simultaneously. In response, HBCO confirmed that the subsidiary legislation would soon be introduced to enable registration of chiropractors to proceed first. It should not be held up by the suggested amendments to the CRO.

III. Proposal for registration of ancillary dental personnel
(LC Paper No. CB(2) 860/98-99(02)

19. Referring to the Administration's paper on the subject, the Chairman pointed out that the matter had been dragging on for seven to eight years now and invited the Administration to brief members on the present position.

20. DSHW said that the Administration would conduct further consultation with those who might be affected. He highlighted the differences between the four groups of ancillary dental personnel (ADP) by pointing out that while dental therapists (DTs) and dental hygienists (DHs) had direct contact with patients and therefore required tighter control, dental technicians (DTechs) had little contact with patients and dental surgery assistants (DSAs) worked directly under dentists. He said that it was necessary to assess whether there was a need for registration because of the administrative costs involved and the concerns expressed in the consultation exercises conducted in 1993 and 1996.

21. Dr LEONG Che-hung said that since the four groups were different, the Administration should consider whether they should be split up for individual consideration. DSHW said that dealing with each group separately would involve higher administration costs. Members noted that all the four groups had to work under registered dentists and could not practise on their own.

22. In response to Mr LAW Chi-kwong's question regarding the membership of the Working Group on the Registration of Ancillary Dental Personnel, Consultant in charge Dental Service, Department of Health said that each ADP group had two representatives in the Working Group. The Chairman asked the Administration to provide the membership list for members' information.	Adm

(Post-meeting note : The membership list was circulated to members on 13 January 1999.)

23. The Chairman questioned the need for further consultation as all questions should have already been asked before. DSHW said the affected groups should be informed of their rights and responsibilities should the proposal of registration be adopted. He added that because of the work done previously, less time was required for the coming consultation exercise. Dr YEUNG Sum urged the Administration to proceed with the consultation without any further delay.

24. Summing up the discussion, the Chairman said that the Panel agreed that the four ADP groups could be dealt with separately. Of the four, he considered that DSAs should be dealt with first in view of the large number in this group and their distribution in numerous dental offices. He pointed out that there was great variation in their training and standards and if disinfecting procedures were not properly carried out, it could lead to spread of diseases such as Hepatitis B. He considered that there was a need to follow up the need for basic training for this group. He did not envisage that there would be any problems with registration of DHs and DTs. As regards DTechs, he said that unless they were registered, there was no control of their standards. He concluded his comments by pointing out that there would always be dissenting views but the Government must consider the matter from the angle of the dental profession's interest and the well-being of patients.

25. DSHW expressed his agreement to the views expressed and said that the Administration would proceed with the consultation and report back to the Panel in two to three months' time.	Adm

IV. Director of Audit's Report on dental services provided by the Department of Health
(LC Paper No. CB(2) 1011/98-99(03))

26. The Deputy Director of Health (DDH) introduced the Administration's paper which provided a summary of the Audit Report's recommendations and the developments to date.

27. Dr LEONG Che-hung observed that the public in general had limited knowledge of oral health. He referred to Table 1 of the Audit Report and pointed out that whereas one of the World Health Organization global health goals for the year 2010 for 65 to 74-year-olds was 75% with a minimum of 20 functional teeth, the latest known conditions for over 60-year-olds in Hong Kong (1991) was 40% with a minimum of 20 functional teeth. He considered that the Government had not provided sufficient information to the public on how to take care of their oral health. He noted that whilst the Government did not provide a general dental service to the public, some special services were available and he wished to know whether there would be an extension of such services. In reply, DSHW said that oral health was a matter of personal hygiene, the habit of which should be developed from an early age. For this reason, work was done through the School Dental Care Services and promotion of oral health awareness in the community. Apart from providing an emergency dental extraction service to the general public, the Government also provided oral health services in special circumstances, e.g. dental surgeons from the Department of Health provided specialist and emergency dental services to patients in public hospitals. He said that present resources did not permit provision of a general dental service to adults. In reply to a further question from Dr LEONG, DDH said that specialist dental services were provided in seven public hospitals to patients suffering from hare-lips, cancer, etc. and patients with mental disability. Such services were provided to some 7 000 patients and the figure could go up to some 9 000 patients when all the seven public hospitals were in full operation, meeting 80% of the present requirement.

28. Referring to paragraph 25 of the Audit Report, Dr LEONG asked for further information on the review of oral health goals. DDH said that the review conducted by the Working Group on Revision of Oral Health Goals was at the completion stage and the Working Group would soon report to the Dental Subcommittee of the Health and Medical Development Advisory Committee. Both Dr LEONG and Miss CHAN Yuen-han asked for a copy of the report to be provided to the Panel. DDH agreed to convey the request to the chairman of the Working Group.

Adm

29. As regards comparison with private sector dental services, DDH explained that the cost of government dental services was shown to be higher than that of the private sector mainly because of the method of calculation. A more refined breakdown was now used for comparison which showed that the cost of government dental service compared favourably with that of the private sector. The Chairman asked whether the costs of oral maxillofacial surgery and dental cases in public hospitals had been taken out. DDH replied in the affirmative and added that since such cases were very expensive, the cost of government dental services now presented more accurately reflected the true picture.

30. Dr LEONG referred to paragraph 26 of the Audit Report regarding the lack of comprehensive and up-to-date oral health data for evaluation of the oral health conditions of the different age groups in Hong Kong and wished to know how the Government planned for provision of dental services in Hong Kong without such information. Turning to dentist manpower planning, he noted that in 1973 the Medical Development Advisory Committee set a ratio of one dentist to 6 000 population but recent surveys showed that there was an under-utilization of the existing dental manpower in the private sector. As it was expensive to train a dentist, he considered that the dentist-to-population ratio should be reviewed as soon as possible to determine how many dentists should be trained in future. DDH explained that the Department of Health had no mechanism to measure the oral health conditions of the population because the Government did not provide a general dental service to the public. He informed members that the Dental Subcommittee would discuss in February/March 1999 how to establish a monitoring system to conduct regular surveys on the oral health conditions of the population. The data from such surveys would be very useful for planning preventive measures to promote oral health. The Chairman asked whether the relevant information would be released on a regular basis and requested the Administration to set out in writing the type of information and data to be collected in the surveys. DDH said that the monitoring proposal could be made available to the Panel for further discussion after it had been discussed and agreed by the Dental Subcommittee.

Adm

31. The Chairman asked whether it was Government policy that scaling and polishing of teeth would be performed by dental hygienists. DDH clarified that it was not policy but if more dental hygienists were recruited, they could take over some of the work of dental officers. He also informed members that under the supervision of dental officers, dental therapists could provide dental services to patients below the age of 18.

32. Dr LEONG commented that in addition to promoting dental awareness, there was a need to consider how dental services should be provided to those who could not afford regular dental examinations by dentists in the private sector. He pointed out that DDH had not responded to his comment on the need for a review of dentist manpower. He referred to Table 3 of the Audit Report which showed that there was 27% unproductive clinical time of private dentists in 1994 and reiterated that the supply of dentist manpower should be reviewed. DDH said that the Government would closely monitor the matter. In reply to a further question from Dr LEONG, he explained that whether there was an over-supply of dentists depended on the public's utilization of the dentist manpower and the Dental Subcommittee was of the view that there were insufficient indications at present to support a reduction in the annual intake of students to the Faculty of Dentistry of the University of Hong Kong.

33. Dr LEONG urged the Government to consider providing more dental services to the general public which would require more dentists and help to ease the over-supply situation. DDH said that it was not the Government's oral health policy to provide such service at present. The Chairman asked the Administration to provide a more detailed information paper setting out clearly the Government's oral health policy. DDH explained that the Department of Health provided dental services to civil servants and their dependents and also provided an emergency dental extraction service to the general public at 11 government dental clinics. In addition, the Government invested in children through the School Dental Care Services which provided basic preventive and restorative dental care for primary school children. The main aim was to promote oral hygiene from an early age. The Chairman said that he would like to know what follow-up measures would be taken to safeguard the oral health of children upon leaving primary schools. Dr YEUNG Sum commented that while there was no objection to investing in the next generation, if resources allowed, the Government should consider providing more dental services to the general public in addition to emergency dental services.

Adm

34. The meeting ended at 10:43 am.

Legislative Council Secretariat
27 April 1999