Provisional Legislative Council
PLC Paper No. CB(2)604
(These minutes have been
seen by the Administration)
Ref : CB2/PL/HS
Provisional Legislative Council
Panel on Health Services
Minutes of Meeting held on Monday, 8 September 1997 at 8:30 am in Conference Room B of the Legislative Council Building
Members present :
Dr Hon TANG Siu-tong, JP (Chairman)
Dr Hon LEONG Che-hung, JP (Deputy Chairman)
Hon WONG Siu-yee
Hon Henry WU
Hon CHEUNG Hon-chung
Hon Howard YOUNG, JP
Members Absent :
Hon MOK Ying-fan
Hon CHAN Yuen-han
Member Attending :
Hon CHAN Choi-hi
Public Officers Attending :
For all items
For item II only
- Mr Gregory LEUNG, JP
- Secretary for Health and Welfare (Acting)
- Mr Derek B GOULD
- Deputy Secretary for Health and Welfare (Acting)
- Mrs Maureen CHAN
- Principal Assistant Secretary for Health and Welfare
- Ms Jennifer CHAN
- Principal Assistant Secretary for Health and Welfare
- Mr Edwin LAU
- Assistant Secretary for Health and Welfare
For item III only
- Dr Lawrence LAI, JP
- Deputy Director of Hospital Authority
Clerk in Attendance :
- Dr T A SAW, JP
- Deputy Director of Health
- Dr TSE Lai-yin
- Consultant, Community Medicine
- (Student Health Service)
Staff in Attendance :
- Ms Doris CHAN
- Chief Assistant Secretary (2) 4
- Mr Stanley MA
- Senior Assistant Secretary (2) 7
Dr LEONG Che-hung briefed members on the operation of the previous Student Medical Scheme (SMS) and its shortcomings. Members considered that some of the arrangements under the Student Health Service (SHS) should be improved and agreed on issues to be raised for discussion.
2.Dr LEONG proposed and members agreed to enquire about the work progress of the special Task Force on the investigation into the H5N1 virus.
3.The Chairman informed the meeting that Mr Allen LEE had resigned his membership of the Panel.
I.Date of next meeting and items for discussion
4.The Chairman informed members that a joint meeting with the Panel on Environmental Services had been tentatively scheduled for 24 October 1997 at 8:30 am to discuss the subject of Centralised Incineration Facility.
5.Members proposed and the Administration agreed to provide relevant information papers on the following items for discussion at the next meeting on 13 October 1997 -
- assessment criteria for application of the Samaritan Fund; and
- non-emergency ambulance service.
6.Dr LEONG briefed members on the current situation of non-emergency ambulance service provided to private hospitals by the Auxiliary Medical Service (AMS). Given that AMS had only a total of six ambulances and its clients included the Department of Health (DH) which generated about 9 000 calls for its service a year, AMS was in practice incapable of responding readily to requests for service from private hospitals. He pointed out that at present patients who for some reasons had to be taken to a private hospital by an ambulance would have to wait for about 10 days for service to be provided by AMS. As a result, many patients who originally intended to receive medical treatment at private hospitals might instead make use of the emergency ambulance service which would only take them to public hospitals. At members' request, the Administration undertook to invite representatives from the Security Bureau and Fire Services Department for discussion of the issue at the next meeting. The Security Bureau would also be requested to provide an information paper incorporating relevant statistics on the utilization of the service by DH and private hospitals. Dr LEONG also undertook to collect data on the utilization of the service by private hospitals.
II.Review on clinical audit and monitoring
(Paper No. CB(2)241(01))
7.At the Chairman's request, Deputy Director of Hospital Authority (DD/HA) stressed that HA was committed to providing quality health care services to the community. It had established a number of systems and mechanisms to ensure proper monitoring of clinical services and safeguard professional standards, practices and accountability. He briefed members on HA's established clinical audit and quality assurance systems which were detailed in part A of the Administration's paper on the subject -
- HA had a number of systems and mechanisms in the clinical departments of all hospitals to ensure professional standards of practice and accountability. Compliance with these systems had been documented in the annual plans of respective hospitals. In particular, the participation of peers and colleagues of the same discipline in clinical audit reviews formed an integral part in the evaluation of clinical performance and outcomes, having regard to the prevailing good medical practice based on internationally accepted scientific evidence;
- a critical incident reporting system was in place to ensure the reporting of all incidents relating to patient care with medico-legal implications. All reported incidents would be investigated and followed up, and where appropriate referred to the coroner for an inquest. Staff disciplinary action would be initiated if warranted by investigation findings;
- to ensure the professional competence and codes of practice of its professional staff, HA arranged post-graduate training and development programmes for doctors, nurses and allied medical personnel on a continuous basis;
- a well-developed and structured system of supervision of junior medical and nursing staff was in place. Qualified senior clinicians were available to supervise the work of junior clinical staff in public hospitals and ambulatory service settings during daytime and off hours; and
- a range of channels were available for patients and their family members, and members of the public to lodge complaints, air grievances and make suggestions on patient care and hospital services. Staff at HA Head Office and each public hospital were designated to deal with public complaints. The Public Complaints Committee of HA, comprising members from the HA Board and members of the public, would ensure the proper handling of all complaints and appeals referred to it. In fact, HA had always striven to proactively monitor and improve its services through proper complaint management.
8.As regards the review of clinical audit and monitoring, DD/HA said HA had regularly reviewed these systems to ensure that they were in step with advances in technology and the increasing complexity of clinical procedures and treatment. In the light of the recently reported clinical incidents, HA had decided to conduct comprehensive reviews on the following with a veiw to assuring quality of care and enhancing professional accountability -
- a review of the existing clinical audit systems to examine methods of enhancing its effectiveness. The advice of a member of the HA Expert Panel as well as local experts would be sought;
- a study by two overseas experts on risk management in public hospitals was underway. Phase I of the study had been completed and after the completion of phase II, proposals to minimize and manage clinical and other risks in the health care setting would be recommended to HA for consideration;
- a review had been initiated to examine how clinical supervision of junior doctors and nurses including trainees could be better enhanced. Meetings with Chiefs of Service and Nursing Managers were in progress. The involvement of clinical staff in management and administrative duties would also be reviewed with the aim of determining the optimal contribution of clinicians in clinical supervision and patient services;
- a review of the workload of front-line staff and work processes in clinical service areas with the most acute pressure to ensure quality patient care services; and
- a review of the existing mechanisms in handling patient complaints and clinical incidents to enhance accountability of professional staff.
DD/HA added that results of the above reviews would be reported to the Panel and made available to the public in due course.
9.The Chairman enquired about HA's short-term and long-term measures to prevent recurrence of similar adverse events at public hospitals. DD/HA responded that HA would look into the causes of each clinical accident and adopt appropriate remedial actions to prevent recurrence. He quoted the recent alleged wrong blood transfusion case at Queen Mary Hospital (QMH) as an example to illustrate that HA would follow up all clinical incidents promptly and impartially. He pointed out that for cases which had been referred to the coroner, it would be inappropriate for HA to release details and comment on the case before the judgment had been made.
10.In response to Mr CHAN Choi-hi's enquiries, DD/HA reiterated that HA had since its establishment in 1991 progressively developed a clinical monitoring framework which incorporated a number of systems and mechanisms such as clinical auditing and reporting system to ensure the provision of efficient and effective health care services to the community. He explained that there were disease, treatment and equipment-related risks, and administrative and human factors contributing to the occurrence of clinical incidents. While clinical mishaps caused by human carelessness were undesirable, it was understandable that some human errors were preventable while others unavoidable in real-life situations. Nevertheless HA had developed a range of clinical auditing systems and guidelines to prevent and minimise mishaps. Given that HA had to service a total of around 10 million patients in 1997, it was inevitable that some clinical mishaps would occur. He anticipated that ideas and insights would emerge from the current comprehensive review to minimize the number of clinical incidents. As for the allegations that doctors would not criticize the performance of their colleagues, peers and the profession as a whole, DD/HA pointed out that independent investigations into clinical incidents by both local and overseas medical experts as well as non-medical professionals were common. He also stated the names of members of the special committee set up to monitor HA's implementation of the recommendations of the above reviews to illustrate that HA was always and would continue to be an open, transparent and accountable organization. He added that the reviews would be completed in three to six months' time and finding of the reviews would be made public. In reply to a member's further enquiry, DD/HA pointed out that HA had established a Public Complaints Committee (PCC) comprising members from various medical and non-medical sectors of the community to receive public complaints. Although the decision of PCC would be final for HA, DD/HA added that there were a number of other channels for lodging complaints of a clinical nature available to the general public, including the Hong Kong Medical Council, the Provisional Legislative Council, the Ombudsman and the judicial system etc.
11.Referring to the recent case of alleged wrong blood transfusion at QMH, the Chairman asked how HA could ensure staff's adherence to laid-down guidelines and procedures. DD/HA explained that the revised guidelines on blood transfusion issued to all public hospitals on 1 August 1997 was an updating version. He added that every public hospital, especially those admitting accident and emergency patients, should now have established a Blood Transfusion Committee (BTC) to oversee procedures relating to blood transfusion and any incidents should be reported to BTC as soon as practicable. He added that since all medical staff in HA were qualified and had attained a sufficient level of job-related skills and knowledge, the guidelines primarily served to enhance conformance of hospital arrangements for blood transfusion operations.
12.Noting that HA had since its establishment in 1991 been striving towards the provision of quality patient-centred health care services within available resources, Mr Henry WU was concerned about the increasing administrative workload which front-line senior clinical staff had to tackle. He enquired about the long-term strategic plan of HA on its provision of public health care services to the community. In response, DD/HA said that in line with the established policy objectives, HA had been trying to optimize the use of both human and financial resources available to public hospitals with the aim of improving and upgrading the quality of public health care services. In view of the increased patient load taken on by public hospitals in recent years, HA had also reviewed the administrative procedures in public hospitals. In a recent study, HA estimated that as much as 20 - 40 % of the work of front-line nurses were consumed in administrative and clerical duties and had subsequently taken appropriate steps to reduce their administrative workload. In particular, DD/HA pointed out that HA had cultivated the concept of resources management in public hospitals among staff to ensure the cost-effectiveness of various health care programmes. He added that HA was aware that both clinical and executive managerial roles were important for the long-term success of hospital operations and for this purpose a thorough review on the involvement of clinicians in management and administrative duties was underway. In its 1998/99 annual plan, HA would concentrate on the optimum use of available resources to consolidate and imporve existing basic health care services in public hospitals. Members in principle welcomed such a direction for improving public health care services.
13.Dr LEONG Che-hung declared interest as a member of the Hospital Authority Board. He expressed concerns on the following issues -
- the effectiveness of HA's existing mechanisms for receiving complaints from patients and members of the public;
- the balance of attention and efforts on administrative and clinical management in public hospitals in the light of the recent series of clinical incidents;
- the setting up of a large number of monitoring committees and the issue of a large number of clinical procedures and guidelines for staff to follow;
- the impacts of the recent adverse events on staff morale; and
- the manpower shortage problem in public hospitals and the target market share of HA in the overall health care expenditure.
14.In response, DD/HA said -
- in addition to the independent Public Complaints Committee, Patient Relations Officers were available at every public hospital to receive complaints. He assured members that HA would handle each complaint in an impartial manner. Besides, patients and members of the public could also lodge their complaints to HA through its hotline service available on 2882-4866;
- HA would in collaboration with the Hospital Chief Executives and Chiefs of Service adopt a balanced approach to reducing the proportion of time spent by senior clinicians in managerial roles with the aim of improving the overall quality of public health care services;
- HA would continue to regularly review the effectiveness of its various management systems and committees as well as the formulation of relevant guidelines. To ensure staff's professional competence, it would also continue to enhance training and development opportunities for in-service medical staff;
- HA would keep in view staff morale within public hospitals and staff would be given appropriate support and informed of the results of the investigations into the recent medical accidents; and
- HA was constantly reviewing its manpower requirement and staff redeployment arrangements to cope with the demands and expectations of the community for quality health care.
15.In response to members' follow-up enquiries, DD/HA said that investigations into recent medical incidents which had not been referred to the coroners' court would be completed soon. As regards the future role and targets of HA in the provision of public health care services, the Medical Services Development Committee of HA would continue to follow up the issue and make recommendations to HA for consideration. While HA provided some 93 percent of the total secondary and tertiary health care services, private practitioners did play a significant part particularly in the provision of primary health care services to the community. Secretary for Health and Welfare (Acting) (SH&W(Atg)) supplemented that a comprehensive review on health care financing was underway. Once the review had been completed, proposals would be submitted to the Panel for scrutiny.
16.The Chairman summed up discussion and urged the Administration to keep in view the progress of the issue. Mr CHAN Choi-hi reiterated his view that an additional independent mechanism to handle complaints on clinical accidents should be considered.
III.Student Health Service
(Paper No. CB(2)241(02))
17.Dr TSE Lai-yin of DH briefed members on the salient points of the Administration's paper as follows -
- the School Medical Service (SMS) was established in 1964 through contracted service and provided only curative service. Its scope of service was considered appropriate for the Sixties when social resources were not so abundant as it was today;
- the Student Health Service (SHS) was introduced to all primary students in 1995/96 (Phase I) and to all secondary students in 1996/97 (Phase II). It replaced SMS and provided a comprehensive range of promotive and preventive health programmes and services to look after the physical and psychological development of students. Enrolled students would be given an annual appointment to attend to a SHS centre for a series of health services designed to cater for the health needs at various stages of their development. Students found to have health problems would be referred to the Special Assessment Centres (SACs) or specialist clinics of HA for detailed assessment and follow-up;
- a total of 1 445 schools had joined the scheme which covered 75 % of all students. 40 % of these students were found having one or more health problems and more than 20% of them had been referred to specialist clinics;
- SHS would help parents and teachers have a better understanding of the physical, psychological and behavioural problems of students;
- SHS would provide DH with valuable information and baseline data on the health status and needs of the school children for the development of long-term health policies for the young generation; and
- DH would continue to improve and publicize the services of SHS with the aim of promoting the service to all primary and secondary students. DH would also monitor the service of general out-patient clinics to meet the needs of students.
18.In response to Dr LEONG's enquiries, Dr TSE supplemented that students found to have health problems at SHS Centres would be referred to SACs for a thorough medical check-up. They would be advised by medical personnel at SAC on appropriate preventive and curative measures to be adopted to improve their health. If necessary, they would be referred to specialist clinics for further treatment. She reiterated that enrolled students would receive a series of health services in their annual check-up. Under the SHS scheme, the health development of all students would be monitored from primary one to form seven and the overall general health of the community would be improved in the long run.
19.In reply to Dr LEONG's follow up enquiry, Dr TSE explained that the low enrollment rate of secondary students could be attributed to the fact that many secondary students were psychologically reluctant to undergo the medical check-up conducted at SHS Centre. She assured members that DH would coordinate with parents and school teachers to reduce secondary students' anxiety in this respect. As for the number of referrals, she said around 40 students were referred to the specialist clinics of HA daily and they had been attended to within a reasonable time. She reiterated that SHS emphasized health promotion, disease prevention and continuity of care which was different from SMS in essence. She added that DH had plans to improve the level of GOP service and would continue to monitor the situation closely to ensure the provision of prompt GOP service to all students. Deputy Director of the Department of Health (DD/DH) supplemented that all GOP clinics had been directed to service every student who arrived at the clinics within the consultation hours and so far no student had been turned away for service. Depending on the demand for service at individual clinics, the deployment of additional doctors, provision of additional consultation hours by way of evening sessions and even the development of new clinics in vicinity would be considered. Members welcomed these improvement plans for GOP service and urged the Administration to follow up the allocation of additional resources, if necessary, to DH.
(Post-meeting note : Information obtained from the Hospital Authority showed that the average waiting time was currently 11.5, 6.1 and 5.5 weeks for the surgical, paediatrics and ENT specialist clinic respectively. However, the actual waiting time may vary depending on the urgency of the referral as recommended by the referring doctor.)
20.Responding to Dr LEONG's query on the adoption of the centre-based approach for assessment of student's health under SHS, DD/DH explained the following -
- the operational costs of SHS Centres were much lower than that of the school visiting teams of SMS;
- the health services available under SHS which included physical examination, screening for health problems, individual counselling and health education were better conducted at purpose-built SHS Centres. The available space and environment at individual schools might not be suitable for carrying out these health services;
- the estimated resources required for about 920 000 students to complete the annual check-up by school teams within a school year of around 140 school days would be fourfold as that required under the centre-based programme; and
- parents accompanying their children to SHS Centres would have the opportunity to witness the various health services provided and be educated to look after the health of their children.
21.Members enquired about the arrangement for referrals and the increased workload of GOP clinics. Dr TSE responded that since the introduction of SHS to replace SMS in 1995/96, the utilization of GOP clinics by children aged between 6 to 14 had remained stationary within the range of 7 to 8 % of the total number of patients. She agreed that SMS and SHS were different in nature. Given the available resources, the provision of SHS to school students was considered more cost-effective. SH&W(Atg) supplemented that improvement of GOP service to school children would depend on the total expenditure on public health care services which the community would be ready to accept.
22.Mr CHAN Choi-hi was concerned whether additional manpower would be required for the provision of health care services to children newly arrived from the mainland. DD/DH responded that the provision of SHS and GOP services could well accommodate their needs. He added that DH would arrange additional manpower for GOP clinics and had planned to open additional SHS Centres to meet increase in demand for service. On the question of arranging compulsory health care services for new arrivals from the mainland, he opined that the community in general would prefer to adopt a voluntary approach. With the implementation of more publicity programmes and the parents' and teachers' better understanding of the merits of SHS, he anticipated that these children would join SHS and their health would be properly looked after.
IV.Any Other Business
23.DD/DH said that following the death of a three-year old boy who had been infected with the influenza A (H5N1) virus, a special Task Force comprising four experts from the Centres for Disease Control (CDC) in Atlanta, USA, two local microbiologists (one from the University of Hong Kong (HKU) and one from the Chinese University of Hong Kong), and officials of the Department of Agriculture and Fisheries (DAF) and DH had been established to conduct an in-depth investigation into the incident. In its extensive field visits and investigation over the last two weeks, the Force had collected over 460 samples of blood from the victim's home, school and neighbourhood contacts and a total of 1 500 samples from corresponding population groups for control purposes. These blood samples were divided into two equal halves and would be independently tested at laboratories in Hong Kong and CDC using a new technique being developed by CDC. Another set of 2 100 samples collected from animals and birds were tested by DAF and HKU. Based on the investigation results so far, the Force ruled out the possibility of contamination and confirmed that no another clinical case of H5N1 viral illness had been found so far. The Force had concluded that the confirmed case of viral illness found in the victim was an isolated incident. He assured members that the influenza H5N1 did not pose a significant public health risk and no special measures were needed. He added that experts at CDC were working at full to develop a new laboratory test for detection of H5N1 viral infection. When the laboratory investigation results using this test were available, DH would work with CDC and the World Health Organization to analyse and interpret the data, to monitor the situation closely and to devise new plans on the way forward, if necessary.
24.Responding to Dr LEONG's enquiries, DD/DH said that based on the information available so far and the fact that no other clinical case of H5N1 illness had been detected, the Task Force had good reasons to believe that the H5N1 virus had a very low transmissibility and its ability to cause illness to man was also low.
25.The meeting ended at 11:00 am.
Provisional Legislative Council Secretariat
14 November 1997