Panel on Health Services (Minutes) 21 May 99

Legislative Council

LC Paper No. CB(2)305/99-00
(These minutes have been
seen by the Administration)

Ref : CB2/PL/HS

LegCo Panel on Health Services

Minutes of meeting
held on Friday, 21 May 1999 at 8:30 am
in Conference Room A of the Legislative Council Building
Members Present:

Hon Michael HO Mun-ka (Chairman)
Dr Hon LEONG Che-hung, JP (Deputy Chairman)
Hon CHAN Yuen-han
Hon HO Sai-chu, JP
Hon Mrs Sophie LEUNG LAU Yau-fun, JP
Dr Hon TANG Siu-tong, JP

Members Absent :

Dr Hon YEUNG SUM
Hon Cyd HO Sau-lan
Hon YEUNG Yiu-chung
Hon LAW Chi-kwong, JP

Public Officers Attending :

For All Items
Mr Gregory LEUNG, JP: Deputy Secretary for Health and Welfare 1
Dr S P MAK: Deputy Director of Health 2 (Acting)
Miss Eliza YAU: Principal Assistant Secretary for Health and Welfare (Medical) 1
Mr Clement LAU: Assistant Secretary for Health and Welfare (Medical) 6
For Agenda Item III only
Ms Jennifer CHAN: Principal Assistant Secretary for Health and Welfare (Medical) 2
Dr KO Wing Man: Deputy Director of Operations, Hospital Authority (HA)
Dr Albert C Y LO: Executive Manager (Professional Services), HA
Mr Michael FUNG Tat Shing: Senior System Manager, HA
Mr Albert POON: Engineering Services Manager, Electrical and Mechanical Services Department (EMSD)
Dr Y S WONG: Senior Government Chemist, Government Laboratory
For Agenda Item IV only
Dr KO Wing Man: Deputy Director of Operations, HA
For Agenda Item V only
Dr Elizabeth KWAN: Consultant i/c Dental Service
For Agenda Item VI only
Dr Gloria TAM: Assistant Director of Health (Hygiene)
Mr K K LIU: Assistant Director of Agriculture and Fisheries

Clerk in Attendance :

Ms Doris CHAN: Chief Assistant Secretary (2) 4

Staff in Attendance :

Ms Joanne MAK: Senior Assistant Secretary (2) 4

I. Confirmation of minutes of meeting held on 11 January 1999 and matters arising
(LC Paper No. CB(2)1847/98-99)

The minutes of the meeting held on 11 January 1999 were confirmed.

II. Date of next meeting and items for discussion
(LC Paper No. CB(2) 1876/98-99(01))

2. The Chairman proposed to discuss the following items at the next regular meeting on 14 June 1999 -

Investigation report on the kidney dialysis incident at the Hong Kong Sanatorium and Hospital;
Proposed amendments to the Human Organ Transplant Ordinance; and
The Harvard Report on Improving Hong Kong's Health Care System.

3. Referring to item (a), Deputy Secretary for Health and Welfare 1 (DSHW) said that although the coroner's report came out the day before, it was not known at the present time whether there would be civil proceedings. He would obtain legal advice on the matter and confirm whether the item could be discussed at the next meeting. Dr LEONG Che-hung asked whether copies of the coroner's report and the Government's investigation report could be provided to the Panel. Deputy Director of Health 2 (Acting) (DDH2(Atg)) said that there should be no problem with providing a copy of the coroner's report. She would seek legal opinion regarding the release of the Government's report and the Hong Kong Sanatorium and Hospital's report.

Adm

4. Members also agreed to hold additional meetings at the end of June and in July to discuss the following items -

Registration of ancillary dental personnel; and
The Harvard Report on Improving Hong Kong's Health Care System.

Regarding item (b) above, the Chairman suggested to select some topics in the Harvard Report for discussion and invite representatives of concerned organizations to present their views. Since private and public hospitals were included in the Harvard Report, he considered that the monitoring of private hospitals could also be discussed at these meetings. Dr LEONG Che-hung said that the Panel should address the Harvard Report on the aspects of policy, structure and financing and invite academics and specialists, to attend for each topic. The Chairman asked the Clerk to make arrangements for the meetings.

Clerk

III. Year 2000 compliance in public and private health sectors
(LC Papers Nos. CB(2) 1876/98-99(02) and 1884/98-99(01))

5. At the invitation of the Chairman, Deputy Director (Operations) (DD(O)) of the Hospital Authority (HA) explained that the Y2K problem was a very serious matter, affecting not only computers but also medical equipment. The HA had established a steering committee at Head Office level to closely monitor Y2K compliance progress in the health sector. The HA would categorize its systems and equipment into administrative (information) systems, and non-administrative (computer-embedded) systems and equipment, and would take stock of all equipment and systems and find out how many items of what systems and equipment were at risk.

6. DD(O) further explained that medical equipment would be classified into four levels of risk as a consequence of the Y2K problem. These were: Level 1 (fatal) - life threatening; Level 2 (critical) - problems would affect treatment decisions for patients; Level 3 (marginal) - problems would cause a minor inconvenience or annoyance, mainly recording errors; and Level 4 (no impact) - there should be no problems. Medical equipment was very difficult to test for Y2K problem as the computer chips were often deeply embedded in the equipment. The HA had asked other government departments, including the Electrical and Mechanical Services Department (EMSD), to assist with the programme of testing, and had contacted the original suppliers and manufacturers of the equipment in order to determine if the equipment had any micro-software imbedded in the system, and whether or not this would pose a problem.

7. DD(O) reported that in the early stages of this project, the progress to rectify Y2K problem was not very quick but the rate of progress became much more satisfactory in the past year. As of April 1999, most of the equipment that had Y2K problem had, to a large extent, been rectified. The HA would aim to complete the testing of all equipment by the end of June 1999. The safety margin of timings was quite wide, so that even if the testing of individual pieces of equipment was not yet completed, this work could be carried out in the third quarter of the year. The HA could test the facilities at the moment by inputting the date etc. However, as some of the facilities could not be tested; there was still a need to consider other options.

8. In case problems might occur at the Y2K rollover, there was a need for a contingency plan. At the HA Head Office (HAHO) level, the HA had a steering committee to provide guidance to the hospitals. Hospitals had been required to prepare their contingency plans, which would include operational plans. DD(O) said that the HA understood that while its own facilities could survive the turn of the Millennium, there might be problems in the wider community, which might have an impact on the demand for hospital services. Hence, on top of normal plans, the HA would be alert for extra demand for services.

9. DD(O) then explained the operational contingency plans. For Y2K problem within the HA, there was a need to coordinate the contingency plans within the HA network, as several hospitals had similar specialties. The HA's requirement was that the hospitals would have completed their contingency plans in June 1999 and then HAHO would interface these plans with external organizations. Therefore in the third quarter these plans would be finalized. The HA was confident that it could successfully overcome the millennium bug problem. He also noted that publicity and education were very important in preparing for the Y2K rollover. The HA had organized seminars on the Y2K problem, some of which were very technical in nature and others for promoting general understanding amongst HA staff so that they were aware of several critical dates. With such a sense of crisis and preparation and with the contingency plans ready, the millennium bug should not affect the level of service provided to patients.

10. Dr LEONG Che-heung asked questions on the following areas -

the reason why the actual costs incurred were smaller than original estimates made by the HA for tackling the Y2K problem;
the preparation work done by the smaller organizations and private clinics in addressing the millennium bug;
the safeguard measures for patients with pacemakers in their bodies, and other patients using equipment at home; and
the co-ordination efforts on 1 January 2000.

11. In response to Dr LEONG's first question, DD(O) said that the required resources estimated for completing this project were originally far greater than the resources actually used. Much of the equipment used within the HA was non-computer equipment with embedded chips and these could not be removed for separate testing, therefore the HA liaised with the manufacturers to check whether the equipment had Y2K problem. In the early stage of this project, the HA was unable to accurately estimate the costs of the project. They had had to assume that if no contact could be made with the manufacturers, or if no answer was forthcoming, it would be necessary to replace the equipment. However, with the assistance of the EMSD and the manufacturers, the HA had been able to establish a clearer picture of the situation and so the actual costs incurred had been smaller than original estimates.

12. As regards question (b), DD(O) explained that private hospitals fell under the jurisdiction of the Department of Health (DH). However, the HA had also been trying to help them find solutions to their Y2K problem. The HA invited staff of private hospitals to attend seminars, provided references through the Internet, helped private hospitals check their equipment, and offered assistance for the preparation of the contingency plans. Networks would also be established to exchange information and offer support. The HA had taken a proactive role in disseminating information regarding the Y2K problem to the private sector and was engaged in a series of meetings with private sector health care professionals.

13. Regarding the issue of pacemakers and home-use equipment, DD(O) said that according to HA records, there were approximately 500 items for home use by patients. Following a detailed study, only one item was found to be affected. The item in question was the haemodialysis machine, but this would only be a date display problem.

14. As to question (d), DD(O) said that the HA had been working to ensure its contingency plans were incorporated into the wider plans of the Hong Kong Government.

15. Dr TANG Siu-tong asked the HA what forms of compensation would be made for equipment that was found not to be compliant, and what tests, if any, had been carried out on X-ray equipment. DD(O) responded that the HA had used the most cost-effective way of solving the Y2K problem. In most cases the suppliers did not charge any fees to make their systems compliant. The HA's first priority was patients' safety, therefore the issue of compensation had not been a major objective. However, if negligence was involved, the HA would seek compensation from the manufacturers and suppliers of incompliant equipment.

16. DSHW1 said that the DH and HA were by no means simplifying the Y2K problem, and assured members that very rigorous controls were in place to protect patient welfare. Engineering Services Manager (ESM) of the EMSD added that they would seek assurance from manufacturers in supplying compliant equipment. The equipment was required to undergo a series of nine tests to ensure it was compliant. However, in case of any problems that might arise, they would formulate contingency plans and set up a special repairing centre for the equipment. They would also seek compensation from the suppliers of incompliant equipment under the contractual terms. At the time, they found that less than 5% of the equipment was unable to pass the Y2K test.

17. The Chairman asked how the HA would ensure the pacemakers were Y2K compliant. DD(O) replied that pacemakers were very sophisticated pieces of equipment, with only four to five manufacturers worldwide. The HA had liaised with the United States Food and Drug Administration, which had very stringent controls, and found that the pacemakers were Y2K compliant.

18. The Chairman asked DDH2(Atg) to highlight the progress of Y2K compliance in private hospitals. DDH2(Atg) explained that the DH had liaised with private hospitals in assuring Y2K compliance and required them to prepare and submit a list of equipment that might encounter Y2K problem. The management staff of private hospitals had been asked to contact the manufacturers to ensure the equipment was Y2K compliant. The DH had also required private hospitals to submit regular progress reports. Since January 1999, monthly reports outlining their Y2K status and contingency plans were submitted to DH. The position in April was that rectification/replacement was 88% completed. In the monthly report for May, this figure rose to 91%. For the remaining 9%, rectification/replacement work was being actively pursued.

19. Mrs Sophie LEUNG LAU Yau-fan asked what plans were being made in relation to nursing homes and elderly homes. DDH2(Atg) replied that there were 12 private hospitals and 21 nursing homes registered under the Hospitals, Nursing Homes and Maternity Homes Registration Ordinance (Cap. 165). DH had asked these 21 nursing homes to check whether or not their equipment were Y2K compliant and had asked them to submit their contingency plans. DSHW added that the Social Welfare Department (SWD) had also been assisting elderly homes in solving the Y2K problem. The Chairman asked the HA and DH to present a progress report on the Y2K issue in August this year.

Adm

20. Dr LEONG Che-hung expressed his concern over the following areas -

whether or not small-scale establishments such as X-ray laboratories and dental clinics were able to tackle the Y2K problem;
whether or not the DH had instructed the hospitals to avoid doing any non-emergency operations on 1 January 2000; and
whether or not the Administration would follow up with haemodialysis machines and nebulizers used by patients at home and smaller centres.

21. In addressing Dr LEONG's first concern, DDH2(Atg) said that the licensing body had already issued letters to all licensed establishments to alert them of the problems, and to ask them to check with the manufacturers to see if their equipment was Y2K compliant. As regards item (b), DDH2(Atg) pointed out that all private hospitals had been asked to address this issue in their contingency plans and provide their visiting doctors with up-to-date information on the progress of the Y2K compliance work. Regarding item (c), DD(O) said that towards the end of June, work would begin to disseminate the message so that private doctors and patients would receive the required information. The HA would also provide detailed information on specific areas to specialists through the Internet.

22. Dr LEONG was concerned that while the dissemination of information was important, the Administration should be careful not to raise undue fears among the public. In addition, doctors should ensure the equipment being used by their patients was Y2K compliant.

23. The Chairman asked how the licensing authority would ensure the equipment used in X-ray laboratories was Y2K compliant. DSHW said that at the end of 1998 and early 1999, they had written to doctors and other health care professionals reminding them of the Y2K issue, and would have another round of this exercise in July this year. The Administration would render assistance to the licensed establishments if required. Principal Assistant Secretary for Health and Welfare (Medical)1 (PASHW1) added that the Administration had sent letters to the licensees reminding them of the problem and had invited them to browse the Website of the HA for further information. The Chairman suggested that if the licensees could not solve the problems, the Radiology Board should be able to help by providing information on whether the machines in the laboratories were compliant or not.

24. In response to Dr TANG Siu-tong's concern, DDH2 said that in June this year, the Y2K Task Force set up by Information Technology and Broadcasting Bureau (ITBB), comprising members from EMSD, Office of the Telecommunications Authority, ITSD and ITBB, DH and Health and Welfare Bureau would visit some private hospitals together with representatives to check on their Y2K compliance progress. As regards whether the EMSD would offer such assistance to the X-ray laboratories in the private sector, DSHW said that the EMSD could only offer general advice to the privately-operated laboratories and therefore the private operators would have to rely on their own resources to carry out the actual rectification work.

25. Mrs Sophie LEUNG suggested that the Administration should work with the Consumer Council to disseminate additional information on home-use equipment. DSHW1 agreed to give as much information as possible in the pamphlets to be issued and on the Internet.

26. The Chairman asked about the current status of the network of mutual support among the private hospitals and the role of DH in this regard. DDH2(Atg) responded that while the DH had regular meetings with private hospitals, the latter also had regular meetings among themselves. The DH had required them to submit reports on a regular basis and would follow up on their contingency plans. The Chairman asked DDH2(Atg) to provide a detailed status report of the network of mutual support arrangement in two months.

Adm

IV. Progress report on the Enhanced Productivity Programme (EPP) in the Hospital Authority

27. At the invitation of the Chairman, DD(O) explained that in the financial year 1999-2000 the HA had withheld 1% of each hospital's budget in order to fund a new scheme to enhance productivity throughout the HA. Hospitals would be required to submit applications for granting funds from the EPP, and funding would be provided from the 1% budget. He explained that a high level committee had been established to deal with the first batch of applications from hospitals. An example of how productivity would be enhanced was a proposed scheme to invest in new energy efficiency technology in order to fund future savings in electricity and other fuels.

28. Miss CHAN Yuen-Han asked if hospitals were also trying to make savings on manpower, thereby placing extra pressure on frontline staff such as nurses and doctors. DD(O) replied that the EPP might involve savings in manpower, for example, laboratories of smaller hospitals with only one or two staff would be closed if they were in the vicinity of a larger hospital. This would be a more cost-effective and efficient use of resources. The guideline was that manpower changes would be in accordance with workload. Miss CHAN Yuen-han enquired whether mechanisms were in place to deal with staff complaints and grievances arising from the implementation of the EPP. DD(O) replied that major changes in human resources policies would need the HA's approval and there were a number of channels to deal with such complaints, including staff consultative committees at various levels. In addition, the Chief Executive of the HA also had a timetable to visit each hospital's management and had forums to exchange ideas with staff.

29. The Chairman asked how the HA would cope with just 99% of their original budget in the financial year 1999-2000, and what plans had been put in place to deal with this. DD(O) replied that it would be very difficult for him to explain the details of how these savings were being made, as each hospital was responsible for its own budget. The HA was responsible for approving any major changes in budgetary use; hence, the savings would be achieved through proper means.

30. The Chairman was not satisfied with this explanation and asked for some clearer examples of how savings were being made within the hospitals under the HA's control. DD(O) explained that no clear details would be available until the end of the current financial year, but said that he would try to compile the plans and examples of what the hospitals were aiming to achieve for members' reference. He said that hospitals were operated in a complicated manner and that it was not simply a matter of looking at the previous year's accounts to forecast where potential savings could be made. Budgetary decisions were a matter for individual hospitals. Each hospital would still have to achieve its patient welfare requirements within the budget available. It was the responsibility of Hospital Chief Executives to make savings in the way that best suited their hospitals.

Adm

31. The Chairman asked DD(O) to confirm if the 5% savings in coming years under the EPP would be clearly accounted for. DD(O) replied that the HA would endeavour to present the figures in a comprehensible manner, but reiterated the point that he would not be able to specify exact details.

32. Mrs Sophie LEUNG said that the HA was trying to empower the different hospitals to take responsibility for their own budgets. The hospitals might be making savings in the wrong areas, which could result in improper use of resources, such as excessive staff cuts. The Panel did not require exact breakdown of how savings had been made, but there was a need to identify the general areas where savings had been made and would be made in the future. The Chairman asked DSHW to revert to the Panel in a month with a clearer picture of how the EPP was going to be achieved.

Adm

33. Dr LEONG asked whether the Administration would take back savings from the HA. DSHW replied that the 1% saved this year would be used to fund future saving schemes, however, the 5% saved in future years would be returned to the central treasury. He said that the Administration had been considering an alternative way of working out HA's budget, which had historically been based on the number of beds, and was awaiting a proposal from the HA. The Chairman pointed out that this was a separate issue from the EPP.

V. Dental policy and the review of oral health goals
(LC Papers Nos. CB(2) 1876/98-99(03) and 2009/98-99(01))

34. Dr LEONG referred to paragraph 28 of the minutes of meeting held on 11 January discussing the Director of Audit's Report on dental services provided by the DH. He said that he had asked for a copy of the report on the review of oral health goals conducted by the Working Group on Revision of Oral Health Goals (the Working Group) under the Dental Subcommittee (DSC) of the Health and Medical Development Advisory Committee at the meeting but he had not yet received it. In reply, DDH2(Atg) referred members to paragraph 5 of the Administration's paper for this meeting, which stated that a report had been submitted to the DSC. After discussion, the DSC was of the opinion that the Working Group should establish a framework to coordinate the work and collect more data before setting out oral health goals. As the DSC was still scrutinizing the report, the final report had not yet been sent to the DH. The Chairman asked DDH2(Atg) to provide a copy of the report when available.

Adm

35. Consultant-in-charge Dental Service, DH explained that the report, which was presented to the DSC at its meeting in February 1999, was discussed at great length and was still under consideration. The reason for the delay was that the DSC felt that it was inappropriate to base revisions of oral health goals on data collected in 1991. It considered that more up-to-date oral health surveillance data of the various age groups should be collected before recommendations could be made for revising oral health goals.

36. Dr LEONG questioned whether the current government policy of promoting preventive services was effective, because according to the Director of Audit's Report, it fell far short of World Health Organisation (WHO) expectations. Referring to paragraph 30 of the minutes of meeting held on 11 January 1999, he pointed out that the DH 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 queried how the Administration was able to monitor oral health without relevant data. Dr LEONG then expressed his dissatisfaction that the Harvard Report did not cover dental services. He considered that the omission of dental services meant that it was not a review of the entire health system.

37. In response to the first question raised by Dr LEONG, DDH2(Atg) said that currently, government, academic institutions and the private sector had been collecting and collating various oral health data. She referred to paragraph 6 of the Administration's paper which stated that a Liaison Group on Oral Health Surveillance in Hong Kong had been formed. The Liaison Group, headed by the DH, and with membership comprising representatives from the Faculty of Dentistry of the University of Hong Kong and the Hong Kong Dental Association, was tasked with the responsibility of enhancing coordination of oral health surveillance efforts among the various parties.

38. As regards the Harvard Report, DSHW pointed out that it covered primary health education and primary health care. The Harvard team had suggested that the Government should do more in these areas. He explained that oral health was part of primary health care and stated that the Administration would certainly consider doing more in this area. Dr LEONG commented that the Administration should review oral health policy without any further delays. DSHW reiterated that oral health was part of primary health care and in the coming six months, the Administration would look at how they could expand primary health care in the context of the current health care review. Regarding long-term oral health goals, the Administration would wait until the Liaison Group finished its work. The Chairman asked DDH2(Atg) to provide to the Panel a progress report on the work of the Liaison Group in two months.

Adm

39. Dr LEONG queried why the question of manpower in relation to oral health care was not mentioned in the Administration's paper, despite the Director of Audit's Report's observation of a surplus of manpower in the dental profession. The Chairman asked DSHW to follow up this issue	Adm

VI. Food safety in relation to cholera

40. Miss CHAN Yuen-han said that earlier in the year freshwater turtles were banned in Macau due to cholera inflection but a similar ban was not imposed in Hong Kong. She asked the Administration to explain the reason for the different way of dealing with the matter.

41. Assistant Director of Agriculture and Fisheries, Agriculture and Fisheries Department (AD(AFD)) said that the AFD was the licensing authority for the sale of freshwater turtles. The AFD had conducted tests on freshwater turtles on sale in Hong Kong but they had not found any traces of cholera infection. The AFD had also been in contact with veterinarians on the Mainland to monitor freshwater turtle farms across the border.

42. In reply to a further question from Miss CHAN Yuen-han, AD(AFD) explained that while freshwater turtles sold in Macau primarily came from Western Guangdong, Hong Kong's supply mainly came from Eastern Guangdong. He said that the AFD would continue to monitor the situation and if any problems were detected, they would work closely with the authorities on the Mainland.

43. Miss CHAN Yuen-han then asked for the details of monitoring process. AD(AFD) said that in places where freshwater turtiles were sold, the AFD took samples for testing on a bi-weekly basis. Under the Public Health (Animals and Birds) Ordinance (Cap. 139), the AFD was empowered to control the sale of freshwater turtles.

44. Miss CHAN Yuen-han was concerned about the effectiveness of the monitoring system as the private sale of fish was not controlled by the Administration. AD(AFD) replied that live fish was not covered by the Public Health and Municipal Services Ordinance (Cap. 132).

45. The Chairman remarked that as the issue of private sale of fish was outside the scope of the present agenda item, discussion should be deferred to a later date.

46. The meeting ended at 10:55 am.

Legislative Council Secretariat
5 November 1999