E X T R A C T

LegCo Paper No. CB(2) 1312/95-96
[These minutes have been seen
by the Administration]

Ref: CB2/PL/HS/1

LegCo Panel on Health Services and
LegCo Panel on Security

Minutes of Joint Meeting
held on Monday, 15 April 1996 at 8:30 a.m.
in the Legislative Council Chamber

III. Emergency Ambulance Service
Briefing by the two staff associations

19. Members noted the joint submission from the Hong Kong Fire Services Department (HKFSD) Ambulance Officers Association and the HKFSD Ambulancemen's Union (LegCo Paper No. CB(2) 999/95-96).

20. Mr CHAN Kai-ming tabled at the meeting a copy of his speech expressing the main concerns of the two staff associations. In brief, they requested the Administration to use response time as the performance target, to address the problem of manpower shortage and to set long term objectives of the emergency ambulance service (EAS).(Post-meeting note : A copy of Mr CHAN Kai-ming's speech was circulated to absent members after the meeting under LegCo Paper No. CB(2) 1020/95-96.)

21. Mr CHIU Kwok-fan added that the freezing of resources for the EAS since 1991 had caused the following problems :

1. actual operational problems in ambulance deployments to cope with the increasing demand for EAS ;
   
   
2. ageing problem of the ambulance crews as there had been no new recruits in the past 5 years ;
   
   
3. due to manpower shortage, the current establishment manning formula did not allow for relief for staff absences, including leave and sickness ; and
   
   
4. due to manpower shortage, ambulance crews were required to undertake frequent overtime work which had resulted in most of them suffering from occupational diseases such as back pain.

The Administration's response

22. Mr Andrew KLUTH advised that in 1986, a consultancy study was conducted on the provision of ambulance services in Hong Kong. A second consultancy study was commissioned in 1995 to update the findings of the 1986 study and to provide advice on how to improve the delivery of EAS in a cost-effective manner. The Administration's response to the points raised in the two staff associations' joint submission was summarized as follows :

1. Performance target - "10-minute travel time" The 1986 consultancy study had recommended a 10-minute travel time target to be achieved for 95% of emergency calls. Based on the then projections of the development of Hong Kong as a whole, it was anticipated that the target could be achieved within 5 years. However, those projections turned out to be very conservative when compared with the actual pace of Hong Kong's development over that period. In recent years, the 10-minute travel time target could only be achieved for 92% of all emergency calls. Last year, it dropped down to just below 90% and was now back up to over 90%. In order to achieve the most efficient deployment of ambulances, it was decided that the non-emergency ambulance services should be hived off to other agencies so that the EAS could concentrate on their core priority to answer emergency calls within the 10-minute travel time. In 1994/95, the Hospital Authority had taken over the majority of the non-emergency ambulance services. With effect from 1 April 1996, the Auxiliary Medical Services had begun taking over the remaining non-emergency ambulance services. These services represented about 6 to 7 % of the total number of calls dealt with by the EAS. The Administration would continue working towards the 10-minute travel time target. It would try to bid additional resources for the purpose in the 1997/98 Resource Allocation Exercise.
   
   
2. Response time - The Administration had been looking into the possibility of using response time as the performance target for the EAS. However, the existing computer system for the EAS did not allow for the retrieval of the response time data. It was expected that accurate figures on response time would be available after the upgrading of the computer system in mid-1996.
   
   
3. Comparison with the fire services - For the EAS, the 10-minute travel time target applied as a standard throughout Hong Kong irrespective of the location of the caller. For fire services, however, a graded response time target was adopted. It varied from 6 minutes in a densely crowded urban area up to a maximum of 23 minutes in the remote areas. A comparison between the two could not be valid because of the different nature of the services.

DiscussionPerformance target for the EAS : "travel time" Vs "response time"

23. In response to Mr Fred LI's enquiry, Mr Andrew KLUTH clarified that the Administration did not disagree that response time would be a desirable target for the EAS. The Administration had accepted the 1986 consultancy study's recommendation to pursue the 10-minute travel time target. This target was reaffirmed by the 1995 consultancy study. The consultant had pointed out that the first priority should be to make the best use of available resources to meet the current 10-minute travel time target. However, the Administration had also accepted the consultant's recommendation that the ultimate aim was to use response time as the performance target. In order to achieve that aim, a reliable baseline for response time was required. At the moment, the baseline was not available and it would be premature for the Administration to choose a response time as the target.

24. Dr LEONG Che-hung requested the Administration to clarify whether the 10-minute travel time target covered only the travelling time of the ambulance, but not the activation time which might take much more time. Mr Andrew KLUTH advised that from the figures on response time for January 1996 collected by the Administration manually, it was revealed that the ambulances were able to respond to 90.7% of all calls in 12 to 13 minutes. This suggested that the activation time was very short, not more than about 2 minutes. The Administration would further look into more detailed figures when they were available and consider the use of response time as the performance target.

25. Dr HUANG Chen-ya pointed out that a person whose heart stopped beating would have a minimal chance of survival if no advanced medical support was provided to him within 12 minutes. In the circumstances, he considered that the Administration should use response time as the performance target which might be set at 12 minutes, i.e. 2-minute activation time plus 10-minute travel time.

26. Mr IP Kwok-him supported the views of the two staff associations and considered that the Administration had misled the public by using "travel time" instead of "response time" as the target. He considered that the Administration should not only take into account the recommendations of the consultants, but also the views of the LegCo Members. Mr Andrew KLUTH pointed out that the Administration had not ignored the views expressed by any quarter. It had had several discussions with the LegCo Panels and the staff associations respectively. The Administration had taken into account all the views expressed in deciding on the best way forward.

27. Miss CHAN Yuen-han shared Mr IP's views. She considered that while the Administration did not disagree to use response time as the performance target, it did not have any plans for achieving that. She requested the Administration to provide a clear indication on when that could be achieved. Mr Andrew KLUTH advised that the exact timing would depend on the availability of resources, which would be sought in the forthcoming Resource Allocation Exercise. He assured members that the Administration would accord priority to this subject.

28. Mr Zachary WONG also supported to use response time as the performance target. He was concerned that from the Administration's advice at para. 24 above, about 90% of all calls were responded in 12 to 13 minutes. He wondered whether the remaining 10% originated from remote areas in the New Territories North West. He requested the Administration to make concrete plans and measures for the EAS to respond to all emergency calls, including those from remote areas, within a reasonable response time period.

29. Mr LEE Cheuk-yan pointed out that the public was mainly concerned about the response time, not the travel time of ambulances. He indicated his strong dissatisfaction on the Administration's adoption of travel time as the performance target. He suggested the Joint Panel to pass a resolution to urge the Administration to use the response time target.

30.Members considered that travel time was not a meaningful performance target for the EAS. They passed a resolution that the Administration should use response time as the performance target.

Adm

Improving the efficiency of the EAS

31. Dr LEONG Che-hung wondered why the hiving-off of non-emergency ambulance services had not helped improve the efficiency of the EAS. Mr Andrew KLUTH advised that the hiving-off exercises had improved the efficiency of the EAS. However, as the demand for ambulance services in the same period had been increasing, it was difficult to identify specifically the efficiency improvement arising from the hiving-off process itself. It was found that when each section had been hived off, there had been a general improvement in the efficiency of the EAS but the long term effect would be more difficult to tell because of other factors interfering.

32.In response to Dr LEONG Che-hung's request, Mr Andrew KLUTH agreed to provide information on the percentage decrease in work of the ambulance services after hiving-off of non-emergency ambulance services.

Adm

33. In response to some members' enquiries, Mr Andrew KLUTH advised that the Administration had been taking very positive steps to improve the efficiency of the EAS, such as :

Short term measures

1. Ambulances and their crews were redeployed from stations with relatively adequate manning to those where manning was inadequate to meet local demand ;
   
   
2. Ambulances were stationed in some of the fire stations, in addition to ambulance depots, to extend the coverage of the EAS ; and (c) The Fire Services Communication Centre had streamlined its operational procedures for ambulance deployments to achieve more effective mobilization.

Long term measures

1. To provide 31 additional ambulances ;
   
   
2. To plan for new ambulance depots at North Point, Sheung Wan, Kwai Chung and Kowloon Tong ; and
   
   
3. To extend paramedic services to all ambulances.

34. Mr Andrew KLUTH assured members that the Administration had been doing everything it could to improve the efficiency of the EAS. So far, the EAS had been able to achieve a survival rate of 99.3% in all emergency ambulance calls.

Manpower shortage in the EAS35.

35.Dr LEONG Che-hung noted from the staff associations' presentation that there had been no new recruits for the past few years. He considered that replacement should have been provided to cover those vacancies caused by natural wastage such as resignation or retirement. Mr MAK Kwai-pui advised that no replacement had been provided because of the hiving-off of non-emergency ambulance services.

36.Mr IP Kwok-him noted from the joint submission of the two staff associations that the staffing ratio between ambulance officers and ambulancemen was 1:32. He requested the Administration to clarify whether this was the highest ratio among the disciplinary services as claimed by the two staff associations. Mr Andrew KLUTH advised that the staffing ratio of the EAS might not be so favourable as compared to those in the other disciplinary services. At the moment, FSD was coordinating studies on the management of the EAS and the Administration was awaiting the outcome.

Adm

Ageing problem of the ambulance crews

37.In response to Mr Fred LI's enquiry, Mr Andrew KLUTH advised that the Administration had accepted the recommendation of the 1995 consultancy study that more ambulances should be provided to meet the current travel time target. The Administration's intention was to seek the necessary resources. When those resources were available, the Administration would be in a position to start recruiting on a regular basis.

38. Mr MAK Kwai-pui considered that at present, the ageing problem in the ambulance crews was not serious because over 70% of them were below the age of 40. However, such problem might occur in future if no additional resources would be provided to the FSD for recruitment of new crews.

Control over the EAS39.

Dr LEONG Che-hung pointed out that at present, the EAS was under the purview and control of the FSD while the basic user of the service was the Hospital Authority. He requested the Administration to clarify the rationale behind and, consider whether this was an appropriate arrangement. Mr Andrew KLUTH advised that the EAS was placed under the FSD because the latter provided emergency response services in Hong Kong. The Administration would continue its ongoing work with the FSD and the Hospital Authority to seek regular improvements in the coordination between emergency service units.

Adm

X X X X X X

LegCo Secretariat
6 May 1996