Panel on Welfare Services(Minutes) 12 Apr 99

Legislative Council

LC Paper No. CB(2)155/99-00
(These minutes have been
seen by the Administration)

Ref : CB2/PL/WS

LegCo Panel on Welfare Services

Minutes of meeting
held on Monday, 12 April 1999 at 11:15 am
in Conference Room A of the Legislative Council Building

Members Present:

Hon CHAN Yuen-han (Chairman)
Hon HO Sai-chu, JP (Deputy Chairman)
Hon Cyd HO Sau-lan
Hon LEE Cheuk-yan
Hon LEE Kai-ming, JP
Hon Ronald ARCULLI, JP
Dr Hon YEUNG Sum
Hon YEUNG Yiu-chung
Hon CHOY So-yuk
Hon LAW Chi-kwong, JP

Members Absent :

Hon David CHU Yu-lin
Hon Eric LI Ka-cheung, JP
Hon Fred LI Wah-ming

Public Officers Attending :

Item III - Services for demented elderly
Miss Monica CHEN: Principal Assistant Secretary for Health and Welfare (Elderly Service) 1
Mrs Eliza LEUNG: Assistant Director of Social Welfare (Elderly)
Item IV - Active Employment Assistance Programme
Mr Andrew K P LEUNG: Director of Social Welfare
Mrs Marion LAI: Deputy Director of Social Welfare (Administration)
Mr Laurie LO: Principal Assistant Secretary for Health and Welfare (Welfare) 1
Mr CHENG Chok-man: Acting Assistant Director of Social Welfare (Social Security)
Mr T S CHOW: Assistant Commissioner for Labour (Employment Services)
Mr M C LEUNG: Senior Labour Officer (Employment Services)
Mr K K WONG: Acting Executive Director, Employees Retraining Board
Item V - Strengthening of social security field units and the Special Investigation Team
Mrs Marion LAI: Deputy Director of Social Welfare (Administration)
Mr Laurie LO: Principal Assistant Secretary for Health and Welfare (Welfare) 1
Mr LI Kok-ming: Chief Social Security Officer, Social Welfare Department
Item VI - Creation of one Chief Clinical Psychologist post in the Social Welfare Department
Mr Robin GILL: Deputy Secretary for Health and Welfare 3
Mrs Patricia CHU: Deputy Director of Social Welfare (Services)
Mrs Cecilia TONG: Assistant Director of Social Welfare (Family and Child Welfare)

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 9 December 1998 and 24 February 1999 and matters arising
LC Papers Nos. CB(2) 1664 and 1665/98-99

The minutes of the above meetings were confirmed.

II. Date of next meeting and items for discussion
LC Paper No. CB(2) 1663/98-99(01) - list of outstanding issues

2. Members agreed that the following items should be discussed at the next regular meeting to be held on 10 May 1999 at 10:45 am -

Progress of Year 2000 (Y2K) compliance exercise in social welfare oganizations;
Contracting out the meal service of Community Care Services;
Community Rehabilitation Network; and
Honoraria and allowances for Guardianship Board members and witnesses.

3. Principal Assistant Secretary for Health and Welfare (Elderly Service) 1 (PAS(HW)(ES)1) informed members that the Administration was not yet in a position to brief the Panel on the "Hong Kong Red Cross Report on the Operation of the PCSSA Scheme and Recommendation for the Review of the Scheme" because of the complexity of the issues involved. The Chairman pointed out that discussion of the Report had been pending for quite some time since the Report was released a few months ago and she suggested that the item should be discussed at the regular meeting in June.

III. Services for demented elderly
LC Paper No. CB(2) 1136/98-99(06)

4. At the invitation of the Chairman, PAS(HW)(ES)1 took members through the salient points of the Administration's proposal to provide dedicated services for demented elderly as follows -

A community-based, multi-disciplinary approach was essential in tackling the complex problem of dementia. To cater for the special needs of the demented, the Social Welfare Department (SWD) would conduct pilot projects to set up dementia units in subvented residential care homes and day care centres in 1999-2000 to provide dedicated services for the care of dementia in either residential or day care settings;
These dementia units would provide tailor-made training to the demented to enhance their functioning and independence in daily activities and defer deterioration of the disease. Specialized programmes and facilities included, inter alia, wandering paths, padded walls and orientation signs in corridors and rooms, reminiscence activities to help recall happy experience and build up self-image, memory training as well as other rehabilitation activities. Training and support services were also provided to care-givers to improve their understanding of the disease and problem solving approach. Residential respite services were available to give temporary relief to family carers of the elderly with dementia.
Six dementia units in five subvented residential care homes and two day care centres would initially be set up under the pilot projects. The capacity of each unit in residential care homes was 24 to 28 clients and that of each day care centre was 20. Based on the particular condition of individual clients, the inmates would be discharged after receiving training, and referrals for other services would be arranged if necessary; and
The pilot projects were scheduled to commence in April 1999 for three years. In the three-year period, SWD would conduct mid-term and final evaluations to examine the cost-effectiveness of the projects and to determine the way forward.

The Administration further advised that a new Dementia Supplement at about $40,000 per elderly per year had been provided to subvented care and attention homes since November 1998 to employ additional staff to provide better care for 200 demented. Resources to benefit more demented elderly would be secured in 1999-2000. In addition, a special grant had been obtained under the Lotteries Fund to support the implementation of the pilot projects mentioned above.

Questions raised by members

5. Mr HO Sai-chu enquired whether SWD would conduct evaluations of the pilot projects at an earlier stage so that more demented elderly in need might benefit from the services before end of the three-year period. Echoing Mr HO's point, Mr YEUNG Sum said that as the population was rapidly ageing, it might be necessary for the Administration to maintain a central register of demented elderly persons in order that future services could be effectively planned.

6. Assistant Director for Social Welfare (Elderly) (ADSW(E)) responded that SWD intended to carry out a mid-term evaluation in 18 months' time after the implementation of the pilot projects. The Department did not rule out the possibility that the projects would be launched on a full-scale basis ahead of schedule if the results were proved to be satisfactory. She added that under the pilot projects, the number of day care centres with dementia units would ultimately be increased to four, bringing the total number of available places under this pilot scheme to 228.

7. ADSW(E) further advised that the typical clinical course in dementia was progressive decline in mental function which underwent a number of stages, ranging from mild memory impairment and subtle personality changes to deterioration in self-control and eventually might become bed-bound. Medical findings showed that about 4% of those aged 65 or above were prone to suffering from dementia. On this basis, the number of people who were exposed to such risk in Hong Kong was about 25 000. According to a study conducted by Professor Helen CHIU of the Chinese University of Hong Kong in 1995, 17% of those admitted to residential care homes were demented elderly, putting the figure of such persons at about 2 800 at current level. A survey conducted by the Hong Kong Council of Social Service suggested that about 40%, or 1 200 in absolute number, of those demented elderly in residential care homes required specialized attention. On the other hand, according to a survey done by SWD itself last year, it was estimated that about 400 demented elderly in subvented residential care homes required the kind of dedicated services as contemplated in the pilot projects. ADSW(E) said that the number was not as alarming as one might have been led to believe.

8. Mr YEUNG Sum said that he did not agree with the view expressed in paragraph 5 of the Administration's paper that stand-alone residential care homes and day care centres for the demented were not recommended to avoid stigmatization. He considered that the Administration should further examine the merits of setting up stand-alone units to cater for the special needs of those persons.

9. ADSW(E) replied that the dedicated services provided under the pilot projects were new to Hong Kong. In working out the approach, the Administration had studied the systems in other overseas countries like the US, Canada, Australia and New Zealand. The Administration was of the view that at the initial stage of implementation, Hong Kong should follow the lead of these countries that the operation of the dedicated service units should not be detached from the normal residential or day care settings. Whether or not the mode of service provision should be changed would be reviewed at a later stage.

10. Ms Cyd HO opined that it might not be a correct approach to assess the number of demented elderly based on the number of inmates in existing residential care homes, without taking into consideration those who were waiting in the queue for admission. She also pointed out that there had been medical reports saying that the onset age for dementia had been lowering.

11. ADSW(E) responded that the statistics she had quoted were results of actual findings available from recent studies. Whereas it was established fact that the rate of dementia increased with age, there had yet to be convincing evidence to show that the onset of dementia occurred much earlier than the age of 65.

12. In reply to the Chairman's comment that better training should be provided to care-givers to enhance their knowledge and understanding of dementia, ADSW(E) said that the Administration was conscious of such need and had pledged to offer 800 training places in 1999-2000 to carers and other staff members on the job so that the pilot projects could be pushed smoothly ahead. In addition, the grant secured under the Lotteries Fund, which totalled $22 million, would mostly be spent on providing additional manpower resources to subvented residential care homes and day care centres taking part in the projects.

13. PAS(HW)(ES)1 supplemented that the Administration took a forward-looking approach in the provision of dedicated services for demented elderly. A Working Group comprising medical and social work professionals and academics had been set up to review existing services and to recommend areas for improvement. The Working Group would submit its Report to the Administration in mid 1999. The Chairman suggested to discuss the matter again when the Report was available.

IV. Active Employment Assistance Programme
LC Paper No. CB(2) 1663/98-99(02)

14. At the invitation of the Chairman, Director of Social Welfare (DSW) briefed members on the major features of the Active Employment Assistance (AEA) Programme under the Support for Self-reliance (SFS) Scheme, which was due to be implemented on 1 June 1999 together with other recommendations in the Review of the Comprehensive Social Security Assistance (CSSA) Scheme. (Relevant extract from the Report on the Review of the CSSA Scheme on the AEA Programme was attached in Appendix I to the Administration's paper). He said that rather than being a scheme for full employment, the AEA Programme focused mainly on developing a co-ordinated programme of employment-related services for CSSA recipients as a stepping stone off welfare dependency, ranging from counselling and retraining to employment services provided by SWD, the Labour Department (LD), the Employees Retraining Board (ERB) and the Education Department (ED) working in close link with each other and with non-Government organizations (NGOs) in the relevant fields.

Questions raised by members

15. In response to Mr LEE Cheuk-yan's question, DSW said that CSSA might be terminated for those unemployed CSSA recipients with working ability but who persistently refused to seek work without valid reasons.

16. Mr LEE Cheuk-yan expressed the view that there appeared to be a role confusion for the Administration to assume both the function of "tempting with a carrot" by offering employment assistance to CSSA recipients on the one hand, and "wielding a big stick" by the threat of stopping CSSA payments on the other. He cautioned that the Government should guard against unscrupulous employers taking advantage of the AEA Programme to suppress wage levels by offering low wages to CSSA job-seekers.

17. In reply, DSW assured members that CSSA payments would only be terminated on valid grounds and that there were appropriate appeal channels for the aggrieved. He said that the Administration would not force an unemployed CSSA recipient to accept a job if the wages offered were unreasonably low, in which case LD would follow up the matter with the employer concerned. There was no evidence to substantiate that employers in general were forcing wages below the market rate in the case of CSSA job-seekers. When making referrals, the Local Employment Service of LD (LES(LD)) would not reveal the status of the job-seekers as CSSA recipients to the prospective employers. He added that CSSA job applicants tended to have a lower motivation for work than their non-CSSA counterparts. Therefore, the measures adopted for the AEA Programme would also aim at addressing the motivational issues, such as providing counselling to CSSA recipients on the value of active employment and self-reliance.

18. Mr LEE Cheuk-yan pointed out that some able-bodied unemployed CSSA recipients had been subject to severe psychological trauma arising from their destitute state such that they might practically have given up all hopes in life. For these people, the stopping of CSSA payment would only add hardship to their families rather than motivate them to work. He opined that special assistance should be provided to them on a personalized basis as if they were people suffering from disabilities. DSW noted the view and responded that whether special services should be provided to particular clients would depend on the individual circumstances of the case.

19. Mr LEE Kai-ming said that an unemployed CSSA recipient would simply not consider a job offer if the wages he/she could earn from it were less than the CSSA payment. He considered that additional incentives should be provided in such cases to encourage the person to accept the job.

20. DSW replied that the rate of CSSA was worked out on the basis of recognized needs of the household. A family with total earnings falling short of that level would be eligible for assistance under the category of low-income families. He advised that under the existing system, $1,805 of the wage that a CSSA recipient received from work would be disregarded in the calculation of recognized income. He added that the Administration had proposed to extend this provision to cover the whole of the first-month salary irrespective of its amount for unemployed recipients returning to work.

Adm

21. The Chairman enquired about the success rates of job-referrals made by LES(LD) in respect of CSSA and non-CSSA applicants. Assistant Commissioner for Labour (Employment Services) advised that during the period from January to March 1999, out of 20 332 CSSA recipients registered with LES(LD), 0.9% of them succeeded in securing employment. The corresponding figures for non-CSSA job applicants were 34 909 and 19.2% respectively. The perception of LES(LD) was that CSSA recipients in general tended to demand a higher pay than non-CSSA applicants with similar qualifications and backgrounds.

22. In reply to Ms Cyd HO's question on how ERB provided retraining facilities to unemployed CSSA recipients, Acting Executive Director, ERB advised that since April 1997, ERB had organized tailor-made, market-driven retraining courses for 3 600-plus unemployed CSSA recipients to help them regain employment through upgrading their working skills or acquiring new skills. Placement assistance was offered by training bodies to retrainees on completion of full-time courses. In 1998, the success rate of able-bodied CSSA retrainees in finding employment was 54%, as compared with 66% for all the retrainees taken together. He anticipated that the success rate would improve with the implementation of the SFS Scheme.

23. DSW added that the success rate in finding jobs was not the only yardstick to measure the effectiveness of the AEA Scheme. Other indicators included the creation of a positive attitude toward work/self-reliance and a readiness for accepting changes and developing job skills among the unemployed.

24. Mr LEE Kai-ming considered that the success rate of 0.9% for CSSA job-seekers registered with LES(LD) was disappointingly low. He requested the Administration to explain the factors accounting for this. Regarding those CSSA recipients who succeeded in finding employment after retraining, Mr LEE requested and the Administration agreed to provide information on how long they had been staying on the job.	Adm

25. Mr YEUNG Yiu-chung asked how effective were ED's measures, as mentioned in points (c) and (d) in page 5 of the Administration's paper, in accommodating students from CSSA families who needed to stay behind after school hours. DSW undertook to revert back on this point after seeking advice from ED.	Adm

26. The Chairman held the view that the proposals promulgated in the AEA Programme represented only a piece-meal approach in dealing with the problem of unemployed CSSA recipients. In her opinion, the Scheme would merely force people out of the CSSA net without providing a long-term solution to the core issues. She called upon the Administration to take into consideration the concerns expressed by members and requested the Administration to report to the Panel on the progress of implementation of the Scheme when the Panel resumed its business after the summer recess.	Adm

V. Strengthening of social security field units and the Special Investigation Team
LC Paper No. CB(2) 1663/98-99(03)

27. Deputy Director of Social Welfare (Administration) (DDSW(A)) briefed members on the Administration's proposal to strengthen the establishment of social security field units (SSFUs) and the Special Investigation Teams (SITs) in the Social Security Branch of SWD. She said that at present, there were 33 SSFUs and two SITs with an approved staff establishment of 1 349 and 18 respectively. In 1999-2000, this would be increased to 1 537 for SSFUs and 34 for SITs. The increase in staff in SSFUs was required to implement the SFS Scheme, handle increased number of applications and reviews due to increase in social security caseloads and strengthened investigation. The additional staff proposed for SITs was required to step up investigation to detect and prevent fraudulent CSSA cases.

Questions raised by members

28. Mr HO Sai-chu pointed out that as overcrowding had been a common problem for SSFUs, the Administration should ensure that there would be suitable accommodation for the additional staff so that the operation of the units would not be adversely affected. The Administration noted his view.

29. Mr LEE Cheuk-yan and Ms Cyd HO opined that for SWD to assume the dual role of providing counselling and performing enforcement/investigation duties would not be conducive to developing a sense of trust in the Department's staff in the minds of CSSA recipients. They considered that it might be desirable to separate the two roles.

30. DDSW(A) replied that a major objective of the SFS Scheme was to encourage and assist able-bodied unemployed CSSA recipients to regain employment through a proactive, customized service intervention. Efforts to investigate and prevent possible abuses in CSSA cases, on the other hand, was to ensure that public money was properly spent and that CSSA was only made available to those genuinely in need. She said that there was no conflict of roles for SWD to act in both areas. She added that as far as SITs were concerned, the team members were not responsible for providing counselling services to CSSA recipients, apart from investigation-related duties.

31. Ms Cyd HO noted from the Administration's paper that to step up investigation into "high risk" CSSA cases, 10 000 cases would be selected for investigation in 1999-2000. She considered that the spending of significant manpower to investigate such a large number of cases might be out of proportion with the severity of the problem of CSSA frauds.

32. Chief Social Security Officer, SWD responded that "high risk" cases referred largely to those CSSA cases which would experience changes in financial conditions more frequently, such as those involving low-income families, single parents and the prolonged unemployed. Many CSSA fraud cases fell within these categories and the number of such cases was on the rise. He advised that the number of fraud cases detected in 1996-97 and 1997-98 was 17 and 57 respectively. In 1998-99, up to end of February 1999, there were 88 cases. Therefore, there was a need for stepping up investigation to crack down on abuses.

VI. Creation of one Chief Clinical Psychologist post in the Social Welfare Department
LC Paper No. CB(2) 1663/98-99(04)

33. At the invitation of the Chairman, Deputy Director of Social Welfare (Services) (DDSW(S)) introduced the Administration's paper, which explained the need for creating a permanent post in the new rank of Chief Clinical Psychologist (CCP) at Directorate level (D1) in SWD to enhance professional management of the clinical psychological services which had become increasingly complex and demanding.

Questions raised by members

34. In reply to the Chairman and Ms Cyd HO's queries about the justifications for creating the proposed CCP post at D1 level, DDSW(S) advised that, against the background of a growing establishment of Clinical Psychologists (CPs) from 22 to 41 over the past five years and a strong demand for the CP service, there was a need to create a senior CP post to head the CP service in SWD. At present, there were four CP Units in the territory and each Unit was headed by a Senior Clinical Psychologist reporting to the Regional Social Welfare Officer. At the headquarters, CP service was under the purview of the Assistant Director (Family & Child Welfare). As those persons in charge were social workers by profession, they did not possess the necessary professional skills to meet the growing requirements to oversee the performance of CPs and to improve the productivity and efficiency in the delivery of CP services. Furthermore, CP services were also rapidly developing in the NGO sector and in a broad range of welfare programmes covering, for example, family and child welfare, elderly services, services for young people and rehabilitation services for people with disabilities. The proposed CCP, with the required managerial experience as well as professional expertise and connections in the field, would be able to co-ordinate the increasing demand from the wide spectrum of service areas, and to ensure effective interfacing with related professionals including social workers, the police, teachers, medical and legal personnel. The CCP would also commit himself/herself to the strategic planning and development of CP services in a changing environment with a view to further improving the service. Therefore, the Administration was satisfied that a level pitched at D1 was appropriate for the proposed CCP post.

35. Ms Cyd HO said that she supported measures to improve the provision of CP services. However, she cautioned that the Administration should learn from the experience of the Hospital Authority where the professional expertise of a large number of senior medical personnel had not been fully utilized for the reason that they had been heavily engaged in policy matters and other general administrative duties. She said that the qualifications and experience required of the person who filled the proposed CCP post must be fully commensurate with the nature of duties of the post.

36. The meeting ended at 12:45 pm.

Legislative Council Secretariat
21 October 1999