For discussion
on 16 December 1998
PWSC(98-99)52
ITEM FOR PUBLIC WORKS SUBCOMMITTEE
OF FINANCE COMMITTEE
HEAD 703 - BUILDINGS
Health - Clinics
59MC - Fanling primary health care centre in area 11B, Fanling
Members are invited to recommend to Finance Committee the upgrading of 59MC to Category A at an estimated cost of $392.9 million in money-of-the-day prices for the construction of the Fanling Primary Health Care Centre in area 11B, Fanling.
PROBLEM
There are insufficient clinic facilities in the Fanling/Sheung Shui area to meet the growing demand for primary health care services.
PROPOSAL
2. The Director of Architectural Services (D Arch S), with the support of the Secretary for Health and Welfare, proposes to upgrade 59MC to Category A at an estimated cost of $392.9 million in money-of-the-day (MOD) prices for the construction of a primary health care centre in area 11B, Fanling.
PROJECT SCOPE AND NATURE
3. The project comprises the construction of a nine-storey building on a reserved site of 3 019 square metres to provide -
- a general out-patient clinic with four consultation rooms;
- a school dental clinic with three dental surgeries and 30 treatment cubicles;
- a dental clinic for civil servants, their dependants and pensioners, which will also provide emergency services to the public;
- a maternal and child health centre with four consultation rooms;
- a child assessment centre with three assessment rooms;
- a general radiography centre;
- an integrated treatment centre for skin diseases and sexually transmitted diseases including Human Immunodeficiency Virus infection with a day ward with ten beds, and seven consultation rooms;
- training facilities and seven consultation rooms for the Department of Community and Family Medicine, the Chinese University of Hong Kong (CUHK); and
- other ancillary facilities, including a central dispensary, and 28 carparking spaces on the ground floor.
The Department of Health (DH) will operate all the above services except for item (h) which will be operated by CUHK.
JUSTIFICATION
General out-patient clinic (GOPC)
4. The Fanling/Sheung Shui area is currently served by a Government GOPC with 3 consultation rooms at Shek Wu Hui. This was designed to cater for a population of around 100 000. With the rapid development of the Fanling/Sheung Shui New Town, the demand for GOPC services from the existing population has outgrown the level of service provision provided at the GOPC in Shek Wu Hui which is operating at full capacity. Furthermore, by the year 2006, the New Town population will increase from the current level of 214 800 to 236 200, representing a further 10% increase. We need to provide another GOPC in the area to ameliorate the under-provision at present and meet the increasing demand for services in future.
School dental clinic (SDC)
5. An SDC provides basic and preventive dental care to primary school children between the ages of 6 and 12. In 1994, DH conducted a territory-wide survey to assess the treatment needs of students participating in the School Dental Care Service. The survey revealed that each participant needed on average two appointments per school year to complete the required dental treatment. At present, children in the New Territories East (NTE) patronise the Sha Tin SDC, the only clinic in the region. Statistics show that NTE participants of the scheme can only receive 1.2 appointments per school year on average. This is considered unsatisfactory. With a view to providing two appointments per school year to NTE participants of the School Dental Care Service, we propose to set up one additional SDC in Fanling.
Dental clinic
6. The proposed dental clinic will provide dental treatment for civil servants, their dependants and civil service pensioners. In addition, emergency services will be provided for members of the general public. As at 1 October 1998, the average waiting time for appointments for non-emergency dental treatment in dental clinics in NTE was 7.81 months, which far exceeds the territory-wide average waiting time of 5.98 months. We plan to reprovision eight
dental chairs from three clinics in NTE and an existing clinic in Kowloon to the new clinic. By pooling of resources after reprovisioning, DH will be able to enhance productivity through streamlining workflow, shared use of manpower, facilities and equipment, and enhanced professional support and supervision.
Maternal and child health centre (MCHC)
7. An MCHC provides a comprehensive range of promotive and preventive health services for women of child bearing age and children from birth to the age of five. Presently, the Fanling MCHC with two consultation rooms, which was intended to serve a population of 100 000, is the only full-time MCHC in the Fanling /Sheung Shui New Town. Against the rapid population expansion in this area, the annual attendance statistics of the Fanling MCHC between 1993 and 1997 showed an upsurge of 38% in child health sessions, 22% in post-natal sessions and 11% in family planning sessions. In view of further population growth projected in the Fanling/Sheung Shui area by the year 2006, we need to enhance maternal and child health services provided to the local community. A MCHC with four consultation rooms is therefore required. Upon completion of this project, we will close down the existing Fanling MCHC and release the space for other requirements.
Child assessment centre (CAC)
8. A CAC provides comprehensive physical, psychological and social assessment services for children from birth to the age of 11 who have developmental abnormalities. DH is now operating five CACs at Sha Tin, Tuen Mun, Kwai Ching, Kwun Tong and Mong Kok. By early 1999, a sixth CAC, located in Central Kowloon will come into operation. During the last decade, the population for the age group 0 - 11 years in NTE has increased by 33%. NTE based children in need of CAC services can only patronise the centre in Sha Tin which has an average waiting time of 8 months for new cases. We consider that an additional CAC in the NTE is required to ease the regional demand, and to provide timely attention to children with developmental problems. We anticipate that the proposed CAC together with the new CAC in Central Kowloon will help to reduce the overall average waiting time for new cases from 8 months to about 5 months on a territory-wide basis.
General Radiography Centre
9. The general radiography centre will provide a dedicated X-ray service to patients attending DH clinics. Under existing arrangements, patients in need of certain types of radiological examinations are referred to the Hospital Authority (HA) for the service. There were about 37 000 cases of referrals in 1992 which have grown to 49 000 cases in 1997. Patients requiring special forms of radiological examinations have to be seen in HA specialist clinics for the examinations as well as treatment. Such referrals have overloaded HA clinics which are meant to provide secondary medical care. This approach has resulted in long waiting times for radiological services (up to six months in some cases) and delays in treatment, which are not conducive to patient convenience and effective service delivery. As a first step in addressing this problem, we are building a new radiography centre in Kowloon Bay. This centre will become operational in 1999. To further improve service delivery, DH proposes to set up a second radiography centre in the Fanling/Sheung Shui area in 2002. This centre will provide X-ray examinations and ultrasound studies. With the two new dedicated radiography centres in full operation, we can relieve the specialist clinics from handling some 12 000 radiography requests referred from DH.
Integrated treatment centre cum day ward for skin diseases and sexually transmitted diseases (STD) including Human Immunodeficiency Virus (HIV) infection
10. The proposed centre is needed to enhance existing services for STD and skin diseases provided in the Fanling/Sheung Shui area. In NTE, such services are presently available only on a part-time basis (one afternoon session every Friday) at the Shek Wu Hui Jockey Club Clinic. There is only one clinic, the Lek Yuen Social Hygiene Clinic in Sha Tin, providing such services on a full-time basis in NTE. The waiting time for new skin cases in NTE is over 100 days and in some cases over 200 days, falling much behind the territory-wide target waiting time of 56 days. For STD cases including HIV and AIDS, service is provided on a walk-in basis. The attendance figures for STDs and skin diseases in NTE in 1995, 1996 and 1997 were about 12 100, 22 100 and 27 600 respectively. This has grossly overstretched the existing facilities.
11. With regard to AIDS specifically, the Yaumatei Jockey Club Clinic is the only clinic currently providing dedicated out-patient-based treatment
services. By 1999, additional clinical services for AIDS patients will be provided in the Kowloon Bay Health Care Centre. As regards HIV cases, the territory-wide attendance figures in 1995, 1996 and 1997 were about 1 200, 1 700 and 2 200 respectively. We estimate that the attendance will further increase to over 10 000 in the year 2002 because HIV positive patients will have a longer life expectancy and will continue to live in the community even in the late stages of disease due to more effective and sophisticated treatment modalities. By the same year, we anticipate the three clinic facilities at the Yaumatei Jockey Club Clinic, the Kowloon Bay Health Care Centre and the new Fanling Primary Health Care Centre will be able to meet the demand for services.
12. To shorten the waiting time for dermatology services and to provide readily available service for the control and treatment of STDs and HIV cases, we propose to set up an integrated treatment centre in Fanling. With this centre, we will be able to address the growing number of STD and HIV cases in the NTE region and we anticipate that the waiting time for dermatology services can be shortened by fifty percent.
13. The proposed day ward in the treatment centre will provide ambulatory care for patients with skin diseases, STDs or HIV who require meticulous, supervised management and who cannot be adequately treated in an out-patient specialist clinic. Statistics show that about 1% of the patients attending dermatology clinics have severe skin conditions which require day treatment in a hospital setting. The day ward facilities of the integrated treatment centre will also help to relieve existing hospitals in providing in-patient treatment to these patients.
Training facilities for the Department of Community and Family Medicine, the Chinese University of Hong Kong (CUHK)
14. Training facilities for the Department of Community and Family Medicine, CUHK are currently provided at the Lek Yuen Health Centre in Sha Tin. The centre which provides training for undergraduate and postgraduate students was set up in 1981 with a total net floor area of about 660 square metres. During the past decade, there have been substantial increases in student intakes at the CUHK, from 80 in the early 1980s to 140 and 160 in 1992 and 1998 respectively. The number of teaching and support staff has also increased
correspondingly. Due to the growing number of medical students and staff, the existing accommodation at Lek Yuen is unable to cope with the teaching needs. We therefore intend to reprovision these training facilities to the proposed new building, expanding the net floor area from 660 square metres to 1 400 square metres. The expanded accommodation and training facilities will not only enhance the quality of the teaching environment for Community and Family Medicine students, but will also provide additional quality medical care to the public.
FINANCIAL IMPLICATIONS
15. We estimate the capital cost of the project to be $392.9 million in MOD prices (see paragraph 17 below), made up as follows -
| $ million
|
|---|
| (a) Piling | 17.1
|
| (b) Drainage and external works | 6.0
|
| (c) Building | 156.0
|
| (d) Building services | 72.8
|
| (e) Furniture and equipment | 37.0
|
| (f) Trading fund charges | 0.9
|
| (g) Contingencies | 23.5
|
| ______
|
| Sub-total | 313.3 | (at December
1997 prices)
|
| (h) Provision for price adjustment | 79.6
|
| ______
|
| Total | 392.9 | (in MOD prices)
|
| ______
|
A breakdown of the estimate for the trading fund charges is at the Enclosure.
16. The construction floor area (CFA) of 59MC is 17 550 square metres. The construction unit cost of the superstructure, represented by building and building services costs, is $13,037 per square metre at December 1997 prices. We consider this reasonable compared with similar projects built by Government.
17. Subject to approval, we will phase the expenditure as follows -
| Year | $ million
(Dec 1997)
| Price
adjustment
factor
| $ million
(MOD)
|
|---|
| 1999 - 2000 | 29.4 | 1.12890 | 33.2
|
| 2000 - 01 | 98.0 | 1.19663 | 117.3
|
| 2001 - 02 | 118.0 | 1.26843 | 149.7
|
| 2002 - 03 | 50.0 | 1.344546 | 7.2
|
| 2003 - 041 | 7.9 | 1.425212 | 5.5
|
| ______ | | ______
|
| 313.3 | | 392.9
|
| ______ | | ______
|
18. We derived the MOD estimates on the basis of Government's latest forecast of trend labour and construction prices for the period 1999 to 2004. To speed up the works programme, we will separately tender the project under a fixed-price lump-sum contract for piling and a lump-sum contract without provision for inflation for the superstructure, drainage and external works.
19. We estimate the additional annually recurrent expenditure for the project to be $124.26 million.
ENVIRONMENTAL IMPLICATIONS
20. D Arch S completed a Preliminary Environmental Review (PER) in March 1995 which concluded that an Environmental Impact Assessment was not required. We will provide a central air-conditioning system to alleviate traffic noise impact and we will take steps to dispose of clinical wastes in an appropriate manner as recommended by the PER.
21. We will control noise, dust and site run-off nuisance during construction through the implementation of mitigation measures in relevant works contracts.
PUBLIC CONSULTATION
22. We consulted the North District Board on 12 December 1996. Members of the Board supported the project.
23. We also held meetings with the people in the immediate area who will be most affected by the project. Whilst local residents were happy with the provision of a new primary health care centre in North District, they queried the location of the centre at the chosen site. In addition, they were concerned about possible odour nuisance in the locality of the centre and the possible transmission of skin diseases or STDs from patients visiting the proposed centre. With regard to location, we explained that the site was considered by Government to be the most suitable and practicable option having regard to the overall planning intention, land uses and transportation infrastructural provision for the Fanling/Sheung Shui New Town. In response to their other concerns, DH assured residents that the installation of central air-conditioning at the centre would minimise potential odour nuisance and that sexually transmitted diseases and skin diseases cannot be transmitted through casual contact.
LAND ACQUISITION
24. On 30 June 1998, the Chief Executive in Council approved the resumption of the private lot within the site for the construction of the proposed primary health care centre. We gazetted the resumption notice on 17 July 1998 and no objections were received. The subject land reverted to Government on 29 October 1998.
Background INFORMATION
25. We upgraded 59MC to Category B in September 1995. D Arch S has completed the majority of the pre-contract works including detailed design and tender preparation using in-house staff resources and has engaged a contractor to carry out site investigation works for the project at an estimated cost of $0.4 million. We charged this amount to the block allocation Subhead 3100GX "Project feasibility studies, minor investigations and consultants fees for items in Category D of the Public Works Programme". The site investigation works were completed in June 1998. We plan to start the construction works in April 1999 for completion in January 2002.
26. The present proposal has achieved a plot ratio of 4.45 and has reached the maximum height restriction of 9 storeys. We consider that the project has fully utilised the development potential of the site.
--------------------------------------
Health and Welfare Bureau
December 1998
(PWSC0033/WIN2)
Enclosure to PWSC(98-99)52
59MC - Fanling Primary Health Care Centre in area 11B, Fanling
Details of Trading Fund Charges
Breakdown of estimates for trading fund charges
| Item
| Estimated
fee
($ million)
|
|---|
(A) Charges by EMSD
(fees for advisory services on installation, testing, commissioning and monitoring services during maintenance period)
| 0.5
|
(B) Charges by the Office of the Telecommunication Authority Trading Fund (OFTATF)
(fees for advisory services on planning, design and installation of telecommunication system) | 0.4
|
| _____
|
| Tota | l0.9
|
| _____
|
Notes
1. Since the establishment of EMSTF on 1 August 1996 under the Trading Funds Ordinance, government departments are charged for design and technical consultancy services for electrical and mechanical installations provided by the Electrical and Mechanical Services Department (EMSD). The figures above are based on estimates prepared by D Arch S. The actual cost for the service charges is subject to further discussion between the Government and the EMSD.
2. Since the establishment of the OFTATF on 1 June 1995 under the Trading Funds Ordinance, government departments are charged for design and technical consultancy services for telecommunication system installations provided by the Office of the Telecommunication Authority (OFTA). The figures above are based on estimates prepared by D Arch S. The actual cost for the service charges is subject to further discussion between the Government and the OFTA.
(PWSC0033/WIN2)
18 December 1998.]
