LegCo Paper No. CB(2)1459/96-97
(These minutes have been seen
by the Administration)
LegCo Panel on Health Services
Minutes of Meeting held on Monday, 13 January 1997 at 8:30 a.m. in Conference Room B of the Legislative Council Building
Members present :
Hon Michael HO Mun-ka (Chairman)Member attending :
Dr Hon Edward LEONG Che-hung, OBE, JP (Deputy Chairman)
Dr Hon HUANG Chen-ya, MBE
Dr Hon YEUNG Sum
Hon Howard YOUNG, JP
Hon CHAN Yuen-han
Dr Hon LAW Chi-kwong
Hon MOK Ying-fan
Hon LEE Kai-mingPublic officers attending :
Clerk in attendance :
Staff in attendance :
- Ms Doris CHAN
- Chief Assistant Secretary (2)4
- Miss Joanne MAK
- Senior Assistant Secretary (2)4
1. Members agreed to re-schedule the next meeting to 17 February 1997 as many members would be away from Hong Kong on 14 February 1997.
2. Members agreed to discuss the following at the next meeting on 17 February 1997 -
- Follow-up on private practice by university medical consultants and specialists;
- Control of sushimi, sushi, oyster and meat to be eaten in their raw state; and
- Medical Registration (Transitional Provisions) Bill 1997 - Members bill proposed by Hon Mrs Selina CHOW.
I.Confirmation of minutes of meeting held on 11 November 1996 and matters arising
(LegCo Paper No. CB(2) 822/96-97)
3. The minutes of the meeting held on 11 November 1996 were confirmed subject to the following amendment proposed by Dr LEONG Che-hung -
To add at the end of para. 31 : "In response to Dr LEONGs comment that the Committee was not transparent enough with no outsider, Professor YOUNG said that it was a peer monitoring mechanism."
Manpower problem at Siu Lam Psychiatric Centre (SLPC)
(LegCo Paper No. CB(2) 910/96-97)
4. The Administration presented a paper setting out the proposed methodology to be adopted in assessing the nursing manpower requirements at SLPC from a medical perspective based on its existing mode of operation, physical configuration and patient profile. Members noted that the outcome of this exercise would need to be modified taking into account the element of custodian duties. The Panel accepted the proposal of the Administration.
|5. The Administration informed members that responsibilities must be shared between the Health and Welfare Branch (HWB) and the Security Branch (SB) to formulate plans for the improvement of nursing care at SLPC. HWB would keep SB informed of the progress and outcome of this assessment exercise, as well as to advise on the possible way forward. The Chairman referred to the "Statement of Establishment" of SLPC as at 15 May 1996 showing that the staff had been divided into two groups specialising in custodian and non-custodian duties and requested HWB to clarify this with SB.||Adm|
|6. The Deputy Director of the Hospital Authority (DDHA) informed members that the initial findings of the assessment exercise would be worked out by March 1997.||HA|
II. Manpower shortages of nurses
(LegCo Paper No. CB(2) 900/96-97 (02)
7. DDHA reported that the latest manpower review undertaken by HA had concluded that an additional 580 nurses were required in a number of clinical specialties. In response to members request for a concrete implementation plan to recruit the required additional manpower, the Administration explained that it could be achieved in the following ways -
- Acquisition of new resources from the Government;
- Internal re-distribution of resources of HA; and
- small-scale redeployment of nurses to areas where intensive nursing care was required.
Members considered that option (c) would not be of much help in improving the situation and requested the Administration to disclose more details in relation to options (a) and (b). In response, the Administration and HA committed that the issue under discussion would be given high priority in their acquisition of new resources and internal redeployment of resources respectively.
8. In reply to members inquiry, DDHA revealed that the recruitment and retention of nurses had improved over the past few years, with the wastage rate lowered from 10% to less than 9%. He agreed with a member that priority setting was required in allocation of resources amongst the specialties suffering from shortage of nurses, and indicated that the psychiatric and critical care specialties should gain higher priority.
|9. A member criticized the Administration for addressing the problem of nurse shortage only from the perspective of HA without taking into account the needs of the private sector and the Department of Health (DH). In response, the Administration reported that the staffing requirement of all service providers in the public sector had been taken into account in the global planning process, and that DH was not experiencing any nursing manpower shortage. A representative of DH supplemented that the Department was conducting a comprehensive survey with both the public and private sector to gauge information on the manpower situation in respect of doctors, nurses, dental and allied health personnel. The preliminary results of the survey would be available by May 1997 and would be submitted to members for information.||DH|
|10. In reply to a members inquiry, a representative of HA explained that the latest review on nursing manpower involved participation of various staff groups and front-line nurses. The Nursing Manpower Indicators developed by the HA were used in that exercise as the basis to work out the manpower requirement. At members request, HA would provide information explaining the basis upon which the requirement of 580 additional nurses was concluded.||HA
|11. Members requested HA to closely monitor the nursing manpower situation of the public hospitals and conduct regular reviews to see what improvements were made. Members stressed that HA must not stop conducting this kind of manpower review after completing the latest one covering the period from October 1995 to September 1996 .||HA|
III. Review of the healthcare system (the review)
(LegCo Paper No. CB(2) 900/96-97 (03) )
12. The Administration informed that since the issue was last discussed at this Panel, an analysis had been conducted on the healthcare financing system of several countries including New Zealand, United Kingdom (UK), Singapore and Korea. The Administration reported that it had identified many good features of other systems and would continue to research other countries to see if more useful ideas could be gained to assist Hong Kong in devising its own long-term financing strategy. In addition, the Administration was reviewing the respective roles of the public and private sectors in the provision of healthcare services, and organizing a workshop among the major service providers (such as HA, DH, Social Welfare Department, non-governmental organisations and the private sector) to see how improvements could be made.
|13. The Administration further reported that it had set up a task force to undertake the review and was currently examining two fundamental issues relating to the healthcare system as outlined in its paper. The Administration said that its current stage of work focussed on information gathering. On the composition of the task force, a member considered that representatives of the private sector should be invited to reflect the views of the sector in respect of the interface problem. The Administration replied that private sector representatives would be invited when it came to discussion of some concrete issues relating to the private sector and the interface problem.||Adm|
14. A member raised that the existing healthcare system in Hong Kong which offered universal coverage of comprehensive public healthcare services at a highly subsidised rate within a framework of a low taxation should be preserved. He was worried that the Administration would change to adopt privatisation of the healthcare system. The Administration assured that it would not embark on any drastic changes without careful deliberation and public consultation.
|15. Members criticized the Administration for repeating its effort to study similar information as they noted that the "country analysis" had been already studied some years ago by HWB. A member asked why the Administration had not responded to the publics feedback on issues such as the excessively high management cost of public hospitals and the provision of semi-private rooms in public hospitals. In reply, the Administration reported that it was reviewing the semi-private room pilot scheme and account would be taken of this in the overall review of the healthcare financing system. As regards the criticism of the excessively high management cost, the Administration replied that the need to achieve better cost-effectiveness and efficiency was an issue of common concern for both Government and HA.||Adm|
|16. In response to a members inquiry, the Administration confirmed that it would study the healthcare system of the United States as well. At the suggestion of a member, the Administration would welcome the opportunity of examining the situation in Taiwan and some major cities in China if information on these could be made available.||Adm|
17. A member criticized that the review had not included measures to safeguard health by preventing disease, which was very important given the rising cost of medical treatment. He also queried the basis of the Administrations argument that it was overspending on healthcare service as he noted that the Governments expenditure on this aspect was much lower than foreign countries. In response, the Administration explained that there was need to examine the long-term sustainability of the current system in Hong Kong, having regard to population growth, an ageing population and increasing costs. The Hong Kong Government accounted for only 17% of Hong Kongs GDP but was already paying for nearly half of the healthcare. Other countries with a higher tax rate could have the resources available to render a greater proportion of the service. Furthermore, since primary care and preventive medicine in Hong Kong were largely provided by private practitioners, it might be a more pragmatic approach to encourage the private sector to play a greater role. The study of the "interface" was aimed at reducing the financial expenses of the public sector in curative care and to mobilise the private sector to play a greater role in preventive care.
18. In reply to a members inquiry, the Administration pointed out that the current review was only targetted at the financing strategy for the long-term development of the healthcare system. The scope of discussion would not include the dental service as the governments policy on the latter was confined to the provision of preventive and educational services only.
IV. Registration of ancillary dental personnel (ADP)
(LegCo Paper No. CB(2) 900/96-97 (04) )
|19. The Administration reported that it had conducted two consultation exercises and the last one was done in 1996 during which objections to the compulsory registration of the ADP were raised by the dental practitioners. The Hong Kong Dental Association had commissioned an independent consultant firm to conduct a survey to solicit the views of its members and their dental surgery assistants (DSA). The findings of the survey were not yet available. The Administration was trying to contact DSAs in the private sector who had also expressed reservation on the proposed registration system during the latest consultation exercise.||Adm
|20. The Administration explained that the Working Group on the Registration of Ancillary Dental Personnel to be set up under the Dental Subcommittee of the Health and Medical Development Advisory Committee sought to reconcile the views and concerns among the ADPs and dentists. The Working Group had scheduled to complete its work in six months time.||Adm
|21. A member noted that many ADPs especially DSAs were not immediately qualified for registration. He requested the Administration to take note of the fact in devising the statutory registration system and to avoid causing unemployment to such ADPs as a result of the registration.||Adm
|22. A member raised his concern about the availability of ADP manpower supply consequential to registration; and requested the Administration to re-examine the issue from the perspective of the financial and operational implications which had to be borne by the employers.||Adm|
23. In response to a members inquiry, the Administration said that most of the 50 dental hygienists (DHs) had received the relevant formal training. It pointed out that the inadequacy of training was mainly found amongst DSAs and dental technicians.
|24. The Chairman reiterated the importance to take into account the concerns of the affected parties of the proposed registration system and to provide assistance as far possible.|| Adm|
V. Proposed amendments to the Nurses Registration Ordinance and the Midwives Registration Ordinance
(LegCo Paper No. CB(2) 900/96-97(05))
|25. Due to running out of time for discussion, members agreed to defer this item to the next meeting. Meanwhile, members were requested to forward any questions they wanted to raise regarding this matter before the next meeting.||members|
26. The meeting ended at 11 am.
7 March 1997
Last Updated on 19 August 1998