Panel on Welfare Services(Minutes) 11 January 1999

LC Paper No. CB(2) 2257/98-99
(These minutes have been seen by the Administration)

Ref : CB2/PL/WS

LegCo Panel on Welfare Services

Minutes of meeting held on Monday, 11 January 1999 at 10:45 amin the Chamber of the Legislative Council Building

Members Present:

Hon CHAN Yuen-han (Chairman)
Hon HO Sai-chu, JP (Deputy Chairman)
Hon David CHU Yu-lin
Hon Cyd HO Sau-lan
Hon LEE Cheuk-yan
Hon Eric LI Ka-cheung, JP
Hon LEE Kai-ming, JP
Hon Fred LI Wah-ming
Dr Hon YEUNG Sum
Hon CHOY So-yuk
Hon LAW Chi-kwong, JP

Members Absent:

Hon Ronald ARCULLI, JP
Hon YEUNG Yiu-chung

Public Officers:

Item III - Elderly Commission Ad Hoc Committee Report on Attending Housing and Residential Services

Mr HO Wing-him

Deputy Secretary for Health and Welfare 2

Mrs Patricia CHU

Deputy Director of Social Welfare (Services)

Mrs Eliza LEUNG

Assistant Director of Social Welfare (Elderly)

Mr S S DILLON

Assistant Director of Social Welfare (Project Planning)

Miss Monica CHEN

Principal Assistant Secretary for Health and Welfare
(Elderly Service 1)

Mr CHENG Yao-kong

Assistant Director of Housing/Application and Home Ownership

Item IV - Supplementary Provision for Comprehensive Social Security Assistance and Social Security Allowance Schemes

Mr Andrew K P LEUNG

Director of Social Welfare

Mr HO Wing-him

Deputy Secretary for Health and Welfare 2

Mrs Rachel CARTLAND

Assistant Director of Social Welfare (Social Security)

Miss Lilian FUNG

Senior Statistician/Social Welfare Department

Item V - Proposed Amendment to Volunteer and Naval Volunteer Pension Ordinance

Mr Robin GILL

Deputy Secretary for Health and Welfare 3

Miss Victoria TANG

Principal Assistant Secretary for Health & Welfare (Welfare 2)

Item VI - Outcome of Subvention Review

Mr Robin GILL

Deputy Secretary for Health and Welfare 3

Mrs Louise WONG

Deputy Director of Social Welfare (Administration)

Mrs June SHERRY

Assistant Director of Social Welfare (Subvention)

Miss Victoria TANG

Principal Assistant Secretary for Health & Welfare (Welfare 2)

Item VII - Any Other Business

Mrs Louise WONG

Deputy Director of Social Welfare (Administration)

Clerk in Attendance:

Ms Doris CHAN: Chief Assistant Secretary (2) 4

Staff in Attendance:

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

I. Confirmation of minutes of meeting held on 19 October 1998

The minutes of the meeting held on 19 October 1998 were confirmed.

II. Date of next meeting and items for discussion

(LC Paper No. CB(2) 985/98-99(01))

2. Members noted the Administration's reply to questions raised by members at the meetings on 9 and 14 December 1998 on the Comprehensive Social Security Assistance Scheme (CSSA) (tabled at the meeting and issued vide LC Paper No. CB(2) 1128/98-99). In order to consider the result of public consultation on the Review of CSSA at an earlier date so that any further views of members could be considered by the Administration, members agreed that the next meeting originally scheduled for 8 February 1999 should be advanced to 25 January 1999 at 10:45 am to discuss -

review of Comprehensive Social Security Assistance Scheme - result of public consultation;
funding problems faced by non-government organizations (NGOs) with reduced subsidy from the Community Chest;
report on Consultancy Study on the Social Networking for the Elderly Project; and
Hong Kong War Memorial Pensions (Amendment) Bill - Independent Battalion.

(Post-meeting note : the meeting was subsequently further rescheduled to 1 February 1999 at the request of the Administration.)

Members also agreed to discuss the subject of CSSA inflationary adjustment in June.

III. Elderly Commission's Ad Hoc Committee Report on Housing and Residential Services
(LC Paper No. CB(2) 985/98-99(02))

3. Principal Assistant Secretary for Health & Welfare (Elderly Service 1) (PAS(HW)(ES1)) briefly introduced the above paper which provided an outline of the Report of the Ad Hoc Committee on Housing and Residential Care (the report). Deputy Secretary for Health and Welfare 2 (DSHW2) pointed out that the construction of a purpose-built residential care home took a very long time. The report recommended the provision of more sites and premises for residential care homes through the inclusion of suitable conditions in land sale programmes and granting building concessions to require developers to provide accommodation for care homes.

4. Mr LAW Chi-kwong asked whether assistance would be provided by the Administration for conversion of shopping arcades and private domestic flats into residential care homes. PAS(HW)(ES1) said that the report suggested relaxing the relevant regulations when examining applications for such conversion. Consideration was being given to amending the relevant legislation to override relevant provisions in the Deeds of Mutual Covenant so as to permit the operation of residential care homes in private residential buildings.

5. On the question of whether property developers had been consulted on the inclusion of suitable conditions in land sale programmes, DSHW2 said that consultation had been made with major property developers. Although the initial response in 1997, when the property market was booming, was not very encouraging, the response had become more positive following the downturn of the property market. Some developers had even appointed consultants to examine the viability of providing residential care homes in their property development.

6. As regards the difference between provision of purpose-built premises to self-financing homes and private residential care homes, DSHW2 explained that private residential care homes had to pay market rent for the premises, while subvented or self-financing homes were only required to pay very low or nominal rent.

Continuum of care

7. Referring to the policy of continuum of care, Mr LAW Chi-kwong commented that the paper did not put enough emphasis on the provision of suitable hardware. Assistant Director of Social Welfare (Elderly) (ADSW(E)) responded that the Administration considered both hardware and software to be important for the implementation of continuum of care. On the software side, the Administration was calculating the staffing requirement for the implementation of continuum of care. On the hardware side, the design of recently constructed residential care homes had reached the standard required of C & A homes. Where necessary, existing homes for the aged would also be upgraded to the standard of C & A homes.

8. Miss Cyd HO expressed support for the policy of continuum of care. She added that a research conducted by the City University forecast that by 2030, the elderly population would account for 30% of the total population in Hong Kong. SWD should therefore take steps to prepare for the ageing of the population. She stated that according to the report, the concept of continuum of care had been realized in private and self-financing residential care homes. In view of this, the Administration could study the experience of these homes instead of launching a two-year pilot scheme at two C & A homes. In response, DSHW2 advised that the implementation of continuum of care in private and self-financing care homes was different in that different levels of care services were provided at different charges. The subvented care homes however imposed the same charge on all residents irrespective of the level of service provided. A pilot test was therefore necessary to assess accurately the needs of the elderly and the implementation difficulties. Nevertheless, the experience of private and self-financing care homes would also be examined.

Demand for residential care homes

9. Mr LEE Cheuk-yan said that according to the report, the forecast genuine demand on the waiting list as at the end of 2001/2 was 8 400 places. This reflected that the residential care home shortage problem would still be unresolved by that time. DSHW2 replied that with the ageing of the population, demand for residential care homes would increase. The 8 400 elderly persons would be mostly new applicants additional to the 13 000 persons already on the list. The addition of about 8 000 places by 2001/02, as pledged in the CE's policy address, would be a substantial increase. A reduction of the waiting list from 13 000 to about 8 400 was a substantial achievement, especially given that the overall supply in the last year was only 8 000 to 9 000 places. The waiting time had been shortened from 30 months at the beginning of 1998 to 24 months in the last quarter of 1998. It was expected to be further shortened with the addition of more residential care places towards 2001/02.

10. Mr HO Sai-chu was concerned that in view of the anticipated increase in elderly population, the demand for residential care service might be higher than what the Administration had projected. Deputy Director of Social Welfare (Services) said that by adopting a standardized assessment tool, assessment would be more objective and efficient. The Administration would continue to monitor the waiting list to assess demand and take these into account in service planning. DSHW2 added that with the rapid increase in elderly population, demand for C & A homes and nursing homes would increase rapidly. Even with the addition of about 8 000 places in the coming four years, the problem would not be totally resolved. To address the problem, the Administration would provide more sites and premises for residential care homes.

11. Noting that 13 000 out of 27 000 elderly persons on the waiting list of residential care homes met the admission criteria, Mr Fred LI was concerned that the Administration might impose stringent admission criteria to contain the length of the waiting list. DSHW2 responded that services for the elderly should be provided to those genuinely in need. Objective assessments indicated that out of the 27 000 applicants, only 13 000 met the admission criteria. He added that some elderly people applied for such services to safeguard themselves against any possible future need arising from deterioration of their health condition. For this reason, some applicants had not taken up the places allocated to them simply because their health condition had not reached a stage requiring such a service.

Upgrading of homes for the aged to care and attention homes

12. DSHW2 pointed out that the process of upgrading homes for the aged to C & A homes would not be completed within a short time. As this would result in an increased demand of able-bodied elderly people for public housing units, discussions were being held with the Housing Department (HD) to address the issue. In addition, consideration was being given to strengthening home help service. He undertook to report to the Panel when discussions with relevant departments were completed.

Adm

13. As regards the timetable for the rehousing of the elderly in housing units provided by the HD, DSHW2 said that the matter was still under consideration and there was not yet a timetable. New applicants were still put on the waiting list for homes for the aged. He added that even with the existing supply, the turnover of elderly persons in existing care homes should help to meet some of the demand.

Employment of local labour in residential care homes

14. Mr LEE Cheuk-yan was dissatisfied that while the Administration was working hard to create jobs and to solve the unemployment problem, there was no measure to encourage the employment of local labour in residential care homes. DSHW2 responded that the matter had been discussed by the Panel and the Elderly Commission. There were divergent views on the issue of whether private residential care homes participating in the Bought Place Scheme should be prohibited from employing imported labour. The importation of labour was subject to a number of criteria and procedures as required under the Labour Importation Scheme. From a elderly policy point of view, if a residential care home could not employ suitable staff from the local market, the importation of labour in accordance with the required process and procedures would be to the benefits of the elderly. It would not be in the interests of the elderly to totally prohibit importation of labour. He assured that the Administration would monitor the situation and follow up if necessary. In response to Mr LEE Cheuk-yan, he said that the subvention for a residential care home was the same regardless of whether it employed imported or local labour.

Manpower training for care workers

15. ADSW(E) advised that the Social Welfare Department (SWD) had trained about 1 100 care workers in the past two years but some of them had already left the industry. A survey conducted in December 1998 revealed that about 3 000 out of 3 200 care worker vacancies had been filled, which represented a shortage of about 200 care workers, indicating a vast improvement over the past two years. She added that a further 850 care workers would be trained within 1999. 140 of them had already completed training and the training of the remainder would be completed within this year. The fact that these 140 people had been chosen from more than 400 applicants reflected that these courses were well received and the Administration would continue to organize such in-service training for care workers.

16. Mr Fred LI considered that in offering more financial support under the Enhanced Bought Place Scheme, the Administration should take steps to ensure that the additional financial resources provided would be used for paying higher wages to the staff.

17. The Chairman requested the Administration to take into account members' view in the implementation of the recommendations in the report and to brief the Panel again on the progress in due course.

Adm

IV. Supplementary Provision for Comprehensive Social Security Assistance and Social Security Allowance Schemes
(LC Paper No. CB(2) 985/98-99(03))

18. In explaining the supplementary provision for Social Security Assistance (SSA), Director of Social Welfare stated that the additional provision to be sought would be used to meet an across-the-board increase of 4.8% in the rates payment with effect from 1 April 1998 to take account of the forecast inflation, and an increased expenditure arising from the number of SSA recipients being slightly above the SWD's projection.

19. In response to Mr Fred LI's question on the actual amount of the requested additional provision for SSA, Senior Statistician/Social Welfare Department (SS/SWD) said that the additional provision for the 4.8% increase in rates payment amounted to $211 million, while that for the increased number of SSA recipients was $33 million. She added that the number of SSA recipients was only less than one percent above the projected figure.

20. As regards Mr HO Sai-chu's question on the forecast inflation in the original estimates, SS/SWD explained that there was no inflation element in the original estimates which were prepared on the basis of 1997/98 prices.

21. Members noted that the request for supplementary provision would be submitted to the Finance Committee for consideration at its meeting on 16 January 1999.

V. Proposed amendments to the Volunteer and Naval Volunteer Pensions Ordinance
(LC Paper No. CB(2) 985/98-99(04))

22. At the invitation of the Chairman, Deputy Secretary for Health & Welfare 3 (DSHW3) briefed members on the paper and explained that while the Ordinance had provided for the pensions payable to be adjusted at a rate consistent with that of the civil service pension increase, it required a separate legislative process for the adjustment. The bill, which involved straightforward technical amendments, sought to simplify current procedures by establishing a formal link between adjustments to the Volunteer and Naval Volunteer pensions and the civil service pension increase, and to provide for the increase to take retrospective effect from 1 April of each year.

23. Senior Assistant Legal Adviser informed members that as the drafting of the bill was not yet completed, the Legal Service Division would carry out the usual scrutiny for newly introduced bills once the bill was gazetted. Members attention would be drawn to any matters requiring examination.

24. Mr LAW Chi-kwong expressed support in principle for the bill.

VI. Outcome of Subvention Review
(LC Paper No. CB(2) 985/98-99(05))

25. DSHW3 presented the paper and informed members that the Administration had completed the Review of the Social Welfare Subvention System, which sought to identify improvements to the current administratively complex subvention system. The Administration also intended to promote a quality-oriented culture among NGOs and increase their accountability for services delivered through a new subvention mode. The service quality standards and the funding and service agreements, which form part of the service performance monitoring system, would be introduced in phases starting from the current financial year. The service performance monitoring measures would apply to both SWD as well as NGO service units. The service quality standards were objective standards which defined the procedures for managing and controlling service quality. The Administration had already formulated 19 service quality standards, which would be introduced over the next three years. To assist NGOs to enter this system, the Administration would provide training programmes for practitioners at all levels, including NGO executive board members, departmental and NGO managerial and front line supervisory staff. The Administration had decided that in view of the concerns expressed on the fixed funding approach, it would not be implemented for the time being. Instead, consideration would be given to adopting a more integrated mode in service delivery in the allocation of new welfare services. This would be beneficial to the long term development of welfare services since it would ultimately help to enhance the quality of these services to the benefit of the community at large.

26. Mr LAW Chi-kwong commented that the wording of the paper on the pilot project introduced in the Tung Chung Complex gave the impression that the seven agencies responses to the new funding arrangement were positive. In fact, the positive response of the seven agencies which submitted bids for the project only reflected their interest in the project. Deputy Director of Social Welfare (Administration) (DDSW(A)) responded that the successful bidder had actually expressed its view that the new funding model was effective in providing flexibility in the use of resources, thereby improving the overall quality of service. She added that the welfare sector's reluctance to accept the fixed funding formula was probably due to the concern that the mid-point salary provision and provident fund contribution would be insufficient for meeting their expenditure, particularly as the welfare sector matured and more staff were paid above the mid-point salary. Such a concern however was not associated with the lump sum model currently adopted in the integrated service project. DSHW3 added that participation in the pilot project was voluntary. The seven bids received for the project indicated a certain amount of interest in the way of funding that project. He said that the current subvention system had focused on "input-control", while the Administration was very keen to move towards "output control", which was generally favoured by the Administration and the welfare sector.

27. Dr YEUNG Sum said that the paper seemed contradictory in stating that the Administration would not implement the fixed funding approach, yet the lump sum grant model was introduced in 1997 in the Tung Chung pilot project. DDSW(A) explained that the proposed fixed funding formula, which was not accepted by the sector, applied to the entire organization, while the lump sum grant model applied to individual projects or units.

28. Mr LEE Cheuk-yan enquired about the result of the Administration's study on the feasibility of contracting out selected services through open bidding. He was concerned that if the service contract was awarded to a private service provider, the service quality and staff salary might be lowered to allow for a profit. DDSW(A) replied that the Administration was examining the feasibility of contracting out, through open tender, some home-help service such as the provision of meals on a pilot basis in 1999/2000, in order to improve the cost effectiveness of such services. Subvented NGOs were welcome to bid for the contract. She assured members that the Administration would take steps to ensure that the service to be provided by the successful bidder would be the same as that currently provided by home-help teams.

29. On the question of whether the Administration had already decided to contract out home-help service in 1999/2000, DDSW(A) said that the proposal had yet to be submitted to the Elderly Commission and Social Welfare Advisory Committee. She undertook to brief the Panel again when more details were available.

Adm

30. As regards whether the fixed funding formula would be introduced again if the Tung Chung pilot project was successful, DDSW(A) said that the Administration would examine the feedback on the lump sum grant model, which had been applied to individual projects. However, if any organization requested to switch to the a fixed funding approach, the Administration could consider such a request.

31. Mr LAW Chi-kwong considered that the proposed open tender exercise should only be open to non-profit organizations in order to prevent abuse. He referred to the registration of private residential care homes and pointed that despite the legislation which came into force in 1995 requiring all private care homes to be registered by 1996, a number of private care homes were still not yet able to meet the standard for registration even in early 1999. As home-help service was very difficult to monitor and the service recipients who were mainly elderly people were unable to play a monitoring role, he was opposed to allowing profit-making companies to bid for the service. Other members generally shared the same view. DDSW(A) assured members that the Administration was aware of the importance of monitoring the service provided and that their views would be given thorough consideration. She pointed out that while the service would be open to bidding by all sectors, the project cost would not be the only determinant in the assessment of bids.

32. Mr Eric LI said that the Administration should consider the impact on the employment of NGO employees if an NGO had to wind up when a contract was not renewed. DDSW(A) advised that the spirit of a contract was to let both parties entering into the contract know their obligations. The Administration would examine the issue and, where necessary, lay down requirements on this aspect in the contract.

33. Mr LEE Cheuk-yan commented that the use of the words "cultural change" in the paper was inappropriate as it gave the impression that there was a problem with the existing culture. DDSW(A) explained that "cultural change" was only used to describe a change from controlling input to controlling output.

34. Responding to Mr LEE Cheuk-yan's question on the proposal to allow subvented bodies to use any surplus capped at 30% of their annual expenditure, DSHW3 said that since it was part of the fixed funding package which had not been supported by the sector, it would not be implemented. Individual elements in the package could not be implemented separately.

Adm35. The Chairman requested the Administration to report back to the Panel when there were more concrete plans.

VII. Any other business
(LC Paper Nos. CB(2) 985/98-99(06) & (07))

Expenses incurred by elderly CSSA recipients on private medical treatment

36. Commenting on the points raised in the submission regarding expenses incurred by elderly CSSA recipients on private medical treatment, DDSW(A) said that there was no special grant to cover such expenses because CSSA recipients were entitled to free medical treatment at government hospitals and clinics. As pointed out in paragraph 3 of the Administration's paper, the standard rates for elderly CSSA recipients were substantially increased in April 1998 following a survey conducted in 1996/97 and at the same time two annual special grants for the elderly, namely the Chinese New Year Grant and the Social and Recreational Activities Grant, were merged into their standard rates to make up an increase of $380 a month. The elderly people could therefore use the increase in their monthly CSSA payments to pay for private medical expenses incurred.

37. On the question of whether a further increase would be considered, DDSW(A) said that there was no plan for a review as a major review on the elderly people had just been completed.

38. Miss Cyd HO and Mr Eric LI requested the Administration to employ Chinese medicine practitioners in Government clinics. DDSW(A) agreed to refer the request to the Health & Welfare Bureau and other relevant departments for consideration.

39. The meeting ended at 12:45 pm.

Legislative Council Secretariat

10 June 1999