Provisional Legislative Council

PLC Paper No. CB(2)1280
(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, 12 January 1998 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 MOK Ying-fan
Hon CHAN Yuen-han
Hon Howard YOUNG, JP

Member absent :

Hon CHEUNG Hon-chung

Member attending :

Hon CHAN Choi-hi

Public officers attending :

For all items

Health and Welfare Bureau

Mr Gregory LEUNG, JP
Deputy Secretary for Health and Welfare

Miss Eliza YAU
Principal Assistant Secretary for Health and Welfare (Medical) 1

Ms Jennifer CHAN
Principal Assistant Secretary for Health and Welfare (Medical) 2

Miss Candy LEUNG
Assistant Secretary for Health and Welfare (Medical) 1

For item III

Department of Health

Deputy Director of Health

Assistant Director of Health

Consultant (Community Medicine)

For item IV and V

Hospital Authority

Deputy Director (Operations) 4

For item V

Agriculture and Fisheries Department

Mr LIU Kwei-kin
Assistant Director (Agriculture and Regulation)

Environmental Protection Department

Mr Alex Y W NG
Principal Environmental Protection Officer (Acting)

Urban Services Department

Assistant Director (Environmental Health)

Regional Services Department

Assistant Director (Environment Health Policy)

Clerk in attendance :

Ms Doris CHAN
Chief Assistant Secretary (2) 4

Staff in attendance :

Mr Stanley MA
Senior Assistant Secretary (2) 7

Closed Meeting

Members agreed on items to be discussed at the next meeting.

2. Dr LEONG Che-hung briefed members on the non-emergency ambulance transfer service provided to private hospitals by the St. John's Ambulance Service (SJAS). He also pointed out that in line with the increase in population in the years to come, the Administration should ensure the provision of sufficient beds in public hospitals. The Chairman agreed to include the subject in the Panel's list of outstanding items for discussion at a future meeting.

3. Dr LEONG was not satisfied with the slow progress of implementation of the Smoking (Public Health) (Amendment) Ordinance 1997 (the Amendment Ordinance). Members were also disappointed that the Administration had not provided the Panel with the contingency plan in the form of flow-chart in case of an epidemic of H5N1 as agreed at the special meeting held on 31 December 1997. Members concurred that the Panel should express strong views against the Administration's slow response towards the request of the Panel.

Open Meeting

I. Confirmation of minutes of meetings held on 17 November and 9 December 1997 and matters arising

4. The minutes of meetings held on 17 November and 9 December 1997 were confirmed.

5. Dr LEONG informed the Administration that since 1 January 1998 SJAS had started to provide non-emergency ambulance transfer service (NEATS) to patients of private hospitals on the condition that requests for emergency ambulance service received by SJAS should always be handled first. However, SJAS's service was not available on horse racing days, Saturday afternoons, Sundays and days on which a major public event was held. In view of the fact that the Auxiliary Medical Service (AMS), which was now providing NEATS to the Department of Health, Social Work Department and private hospitals, had only a fleet of six ambulances, Dr LEONG was concerned about the overall adequacy of NEATS available to private hospitals in the long run. As patients of private hospitals suffering from some illnesses such as bone disjoints had a genuine need of the service, he opined that the Administration should arrange to provide a sufficient level of NEATS to these patients. In this connection, Dr LEONG suggested that the Administration should explore the feasibility of extending the NEATS of Hospital Authority (HA), which was now serving the existing 44 public hospitals, to cover the 10 private hospitals. Deputy Secretary for Health and Welfare (DS/HW) responded that the Administration would review the efficiency of NEATS available to private hospitals by the AMS and the SJAS on a continuous basis.

6. The Chairman enquired about the latest development of the proposed Elderly Health Centres. Deputy Director of Health (DDH) agreed to provide the Panel with an update on the subject as soon as practicable.

7. Responding to Dr LEONG's enquiry about the provision of adequate beds in public hospitals, the requirement of which might increase as a result of advances in medical science and technology, Deputy Director (Operations) of the Hospital Authority (DD(O)/HA) said that the HA conducted comprehensive reviews on the provision of public health care service on a regular basis. These reviews covered researches on latest advances in medical science as well as the provision of adequate number of hospitals with respect to increase in population and its changing geographical distribution. He added that two such reviews had been conducted since the HA was established and another one was in progress.

8. Regarding the roles and functions of the Regional Council, Urban Council, Department of Health, Regional Services Department and Urban Services Department in the delivery of health care services to the public, the Administration agreed to bring up the subject for discussion at a future meeting when a review on the subject had been completed.

II. Date of next meeting and items for discussion

9. The Chairman informed the Administration that the next meeting would be held on 9 February 1998 at 8:30 am and the Panel would like to discuss the following subjects at the meeting -

  1. prevention of Hepatitis A;

  2. infectious disease surveillance and data collection/management; and

  3. update on H5N1 virus.

III. Implementation of the Smoking (Public Health) (Amendment) (No.2) Ordinance 1997
[Paper No. CB(2)821(01)]

10. At the Chairman's request, DS/HW briefed members on the salient points of the Administration's paper on the subject.

11. Dr LEONG was concerned about the enforcement arrangements for the new requirements introduced by the Smoking (Public Health) (Amendment) Ordinance 1997 (the Amendment Ordinance). Given the enactment of the Amendment Ordinance on 26 June 1997, he said that he was surprised that the implementation of the requirements had yet to start. He questioned whether the tobacco companies had exerted a lot of pressure on the Administration in this regard. DS/HW explained that as a result of the many Committee stage amendments proposed and endorsed by members of the former Legislative Council, the Administration had to draft the consequential amendments to the subsidiary legislation which had to be in place before the Amendment Ordinance could be brought into effect. He anticipated that the Smoking (Public Health) (Amendment) Regulation 1998 could be introduced to the PLC for negative vetting by the end of January 1998. He pointed out that different commencement dates would be set for different provisions of the Amendment Ordinance so as to allow sufficient time for the industry and affected traders to comply with the new requirements. In this connection, the Administration would set grace periods ranging from three to 12 months for implementation of individual measures.

12. In reply to Mr Howard YOUNG's enquiries, DS/HW said that as listed in paragraph 4 of the Administration's paper, the ban of display of tobacco advertisements, with some exemptions, and of tobacco advertisements in printed publications would take effect from 26 June and 31 December 1999 respectively. Together with the prohibition of placing tobacco advertisements on the Internet, Hong Kong would be able to meet, with a few exemptions, the target of the World Health Organization to become a tobacco-advertising free community by the year 2000. Responding to Mr YOUNG's further question, he added that in some public entertainment events such as car racing, occasional and accidental shots of tobacco brand names and related promotion materials appearing on television screens as a result of live broadcasting or reporting of the event, which were not intended for the purpose of promoting the tobacco brands, were understandable. Dr LEONG supplemented that the enforcement of the provisions of the Amendment Ordinance would not be able to completely forbid the advertising of tobacco products. He urged the Administration to review the legislation from time to time and proposed appropriate amendments, taking into account of world trends and local views, with the aim of improving the general health of the community as well as to ensuring a completely tobacco-advertising free community by the year 2000.

13. Mr MOK Ying-fan commented that the Administration should set a clear time frame for implementing the new requirements brought about by the Amendment Ordinance. DS/HW reiterated that with the enactment of the relevant subsidiary legislation, grace periods ranging from three to 12 months in maximum would be provided for the tobacco traders to make preparations for compliance with the new requirements. Members generally agreed that the Administration should set out the targeted dates for the new requirements to come into operation when it presented the related subsidiary legislation to the PLC for approval.

14. Noting that under the Amendment Ordinance, restaurants with over 200 seats would be required to designate no-smoking areas, Mr Henry WU commented that the associated operational arrangements should be conveyed to restaurant operators as early as practicable. DS/HW replied that the Administration understood that there were operational difficulties for individual restaurant operators to comply with this requirement, He assured members that the Administration would consult the Urban Services Department, Regional Services Department and restaurant operators to ensure full understanding of the requirement.

IV. Report by the Hospital Authority on remedial measures for medical incidents and review of complaints management
[Paper No. CB(2)821(02)]

15. DD(O)/HA briefed members on the remedial measures taken up by the HA after the recent series of medical incidents and its review of complaints management.

16. Responding to Mr Howard YOUNG's enquiry about the progress of implementation of the remedial measures, DD(O)/HA highlighted the following developments -

  1. a two-tier professional accountability structure where experienced clinicians were responsible for supervising and monitoring of junior doctors had been in place;

  2. administrative workloads of clinical staff had been reprioritized and reduced;

  3. a Central HA Clinical Audit Committee had been established to proactively safeguard professional standard and improve its service. Experience sharing sessions on clinical audit were organized and would continue to be undertaken by all hospitals and staff. A reference manual on clinical audit was being produced to help clinicians conduct clinical audit in a systematic manner;

  4. the report of the review on risk management in four selected hospitals was being compiled;

  5. senior nurses had been assigned to take up patient advocate/patient relations functions in hospitals to help resolve complaints at the front line at the earliest opportunity. Experience sharing sessions would also be organized for staff serving these functions; and

  6. the role of the Public Complaint Committee (PCC) was being expanded with the aim of enhancing its effectiveness on complaint management. The nomination of members for the supporting expert panel which would comprise HA and non-HA medical and nursing experts was under consideration.

17. In response to Miss CHAN Yuen-han's enquiries, DD(O)/HA replied that in reducing administrative workload of senior medical and nursing staff, the HA had now, apart from reprioritizing works and procedures, arranged to send only appropriate circulars to relevant grades of staff and strengthen business support to departments and wards in hospitals. Where appropriate, the HA would provide support and assistance to clinicians on financial and resource management matters. The Central HA Clinical Audit Committee (HACAC) would be established to define the scope of clinical audit activities to be conducted in public hospitals and co-ordinate territory-wide clinical audit activities across various specialties, disciplines and hospitals. While clinical supervision in public hospitals was the responsibility of the relevant Hospital Governing Committees, Hospital Chief Executives and senior clinical staff, the HACAC as an external assessor could carry out a monitoring role to ensure that consistent clinical procedures and standards were maintained in these hospitals. As to the availability of the manual on clinical audit and the expanded membership of the PCC, DD(O)/HA undertook to provide the Panel with updated information as soon as practicable. Responding to Miss CHAN's follow-up question, DD(O)/HA said that according to feedback from medical staff, some senior clinicians used to spend around 50% of their time in administrative tasks and the HA was now aiming to reduce it to 25% in general. He added that some administrative duties which were relatively unimportant would be discontinued.

18. While appreciating the HA's efforts in improving clinical procedures and reinforcing supervision on clinical work, Mr MOK Ying-fan highlighted the importance of staff morale in organizational development. DD(O)/HA said that the 75% principle was a general guideline and was not intended to be strictly followed without any flexibility. As far as the two-tier professional accountability structure was concerned, Chiefs of Services, Department Operations Managers and Ward Managers in hospitals could exercise discretion in their supervision and follow-up of individual junior staff to ensure the best use of available resources. He agreed that the overall working attitude of staff played an essential role in improving clinical performance and in this regard the HA was proactively taking steps to develop among staff a positive attitude towards patients?complaints as well as to intensify efforts to promote the patient-centred culture and provision of good customer services. Since the formation of a corporate culture in a large organization was a long and continuous process, the HA would continue to adopt a balanced approach in promoting the patient-centred culture among HA staff and educating patients to look after themselves. He highlighted that despite the recent series of medical incidents and the complaints received, the community as a whole had agreed that clinical performance and staff working attitude in public hospitals had improved substantially since the establishment of the HA. Responding to Mr MOK's further comments, DD(O)/HA added that a television production on hospital operation was in progress and it was anticipated that through staff participation, a more positive and enthusiastic spirit in the care of patients could be developed among staff working in hospitals.

19. In reply to Mr Henry WU's enquiries, DD(O)/HA said that four large public hospitals having an accident and emergency department were selected for phase I stages 2 and 3 of the review on risk management. As regards clinicians' duties in financial and resource management matters, he said that these included the very important task of identifying areas of improving resources management in preparing the annual departmental work plan. He added that flexible targets rather than a fixed 2% saving in departmental annual budgets were now allowed for clinicians to make the best use of available resources.

20. Mr CHAN Choi-hi was concerned about the manpower shortage problem and its impacts on the delivery of public health care services. He opined that the work of the PCC should be open to public surveillance and its regular reports on complaints cases and improvement measures should be made available to members of the public. He also commented that human factor played a crucial part in clinical performance. DD(O)/HA reiterated that the HA had since its establishment been working towards developing a favourable corporate culture in parallel with an effective clinical audit system to ensure a consistent professional performance and standard in the health care setting. Before an administrative instruction relating to clinical management and operation was implemented, the HA must have considered the pros and cons of possible alternatives and consulted the affected clinicians and staff thoroughly. Preparation work for improving public surveillance on the HA's complaints handling and management by expanding the power and membership of the PCC was underway. The proposed expert panel which would comprise experts from a wide variety of specialties could enhance the efficiency of the PCC in complaints case handling. While it was indisputable that adequate manpower played an essential part in reducing risks in hospital operation, there were other factors such as a positive corporate culture, an efficient system of clinical audit for clinical management and an impartial complaints handling system, etc., which were equally important in ensuring continuous improvement of clinical performance and standards. He stressed that the HA recognized that staff were the most valuable asset of the organization and had undertaken a series of initiatives to improve the staffing situation with particular focus on nursing manpower planning.

21. Dr LEONG Che-hung declared interest as a member of the Hospital Authority Board. He opined that the HA, rather than its staff, should be held responsible for the recent series of medical incidents. Given the responsibility to look after the public health care services since its establishment on 1 December 1991, he asked whether the HA had expanded its existing services and developed new services at a pace faster than its available resources and savings could cope with. He said that the time had come for the HA to review its future direction of development. He supported using publicity channels to enhance public knowledge of health related issues and understanding of the work of the HA as well as the rights and responsibility of patients. In reply to Dr LEONG's enquiries, DD(O)/HA said that one of the principal tasks of the HA since it was inaugurated was to improve the management of public hospitals to ensure optimal use of resources available. Hospital Chief Executives and Chiefs of Services in public hospitals were required to ensure the provision of responsive, effective and value-for-money health care services to the community. In the light of the recent series of medical incidents, the HA had initiated a series of remedial measures to ensure the continuous delivery of quality health care services as well as to reduce the administrative workload of senior clinicians. As regards the practice of the two-tier professional accountability structure in a health care setting, DD(O)/HA pointed out that as the modes and process of supervision and monitoring of junior doctors by experienced clinicians varied from specialties to specialties, the responsible clinicians had to exercise discretion in their assessment of the capabilities of individual junior doctors in respect of different medical diagnosis and operation. As regards complaints which were directed to public media, he pointed out that the HA had been proactive in approaching those media and responding to those complaints.

22. Miss CHAN Yuen-han commented that the HA's emphasis on effective resources management had created heavy psychological and operational pressure on staff members which could jeopardize staff morale. Dr LEONG echoed that the Administration should carefully consider the level of public expenditure which could be allocated to public health care services through the comprehensive review on health care system in progress. DS/HW supplemented that the appointed consultant had started the review on 13 November 1997 and would complete the whole project in 12 months. At members?request, he undertook to provide an interim report to the PLC in April 1998. DD(O)/HA supplemented that staff morale issues as a result of quality improvement drive would be addressed by the HA. The HA Management was always vigilant in resolving staffing morale issues.

V. H5N1 Virus
[Paper No. CB(2)821(03)]

23. At the Chairman's request, DS/HW briefed members on the main points of the Administration's paper on Influenza A H5N1 virus. DDH supplemented that there were a total of 1 826 poultry workers attending the health check at the 14 designated evening clinics which provided such service for two weeks ending on 10 January 1998. The results of antibody tests on their blood samples would be available in about a month. As a result of enhanced general out-patient (GOP) services within the same two weeks, the Department of Health had recorded increases of around 2 500 and 500 consultations in its day and evening clinics respectively. Adequate GOP service had therefore been provided to the community.

24. The Chairman asked for the simple flow-chart which could illustrate the Administration's contingency plans and procedures in the event of an epidemic of H5N1. DS/HW replied that in the absence of a better understanding of the virus and its genetical structure, the Administration would prefer to withhold the release of such a flow-chart which might run the risk of being too simplistic. He pointed out that there were now a total of about 9 000 registered medical practitioners and 30 000 beds in public and private hospitals which should be able to accommodate any emergency situation arising from an outbreak of H5N1 Influenza A.

25. Responding to Mr Howard YOUNG's questions, DDH explained that since conflicting test results of the sample were recorded by the two collaborating test centres of the World Health Organization, further tests would have to be arranged before the remaining suspected case could be confirmed as a genuine case of H5N1 or otherwise. As regards the 3 000 blood samples collected from close contacts of confirmed H5N1 patients, DDH said that they were taken from different groups of people with the purpose of assessing the various characteristics of the virus including its incubation period, modes of transmission, the efficiency of man-to-man transmission, the period of exposure, the risks of transmission etc. He added that the grouping of samples had been deliberately planned to ensure that the forthcoming test results would satisfy standards recognized by the scientific community.

26. Dr LEONG was disappointed that the Administration had not provided the Panel with the requested flow-chart on contingency procedures which the Administration would adopt and follow in the case of an epidemic of H5N1. In response, DS/HW elaborated on the envisaged difficulties and uncertainties involved in preparing such a flow-chart. Members in general did not accept the Administration's explanation and as a consolidated view of the Panel, the Chairman moved and members passed the following motion :

"That the Panel strongly urges the Administration to prepare a set of contingency procedure flow-charts to enhance public confidence in the Administration's ability to tackle an epidemic of the Influenza A H5N1 virus.?

27. Mr WONG Siu-yee queried why representatives of the Inter-Departmental Working Group (IDWG) on H5N1 were not invited to the meeting and asked about its work progress. DS/HW replied that the IDWG should now be progressing in accordance with its work schedule. As regards ducks bred in local poultry farms, Assistant Director (Agriculture and Regulation) (AD(AR)) said that the results of sample tests conducted by the Agriculture and Fisheries Department (AFD) would be available in the following week. While import of ducks had been temporarily suspended since 24 December 1997, the AFD would continue to conduct sample tests for poultry bred in local farms to keep close surveillance on the development of the virus. In response to Mr CHAN Choi-hi's follow-up enquiry, AD(AR) said that before the resumption of import of live chickens from the Mainland, an effective quarantine system, the operation of which had been well explained and publicized in the media, would be put in place. In reply to Dr LEONG's follow-up question, AD(AR) explained that in examining and validating the preliminary test results of the samples collected from ducks in local farms and retail outlets, the AFD would need to conduct further tests to eliminate, verify or confirm all possible and potential causes leading to the preliminary test results. He reiterated that the AFD would be able to announce the results of these tests in the next week.

28. Members unanimously agreed that the IDWG on H5N1 should proactively and regularly inform the public of the latest development of H5N1 and its work progress. DS/HW replied that the IDWG was actively co-ordinating departmental efforts to tackle a wide variety of issues in relation to Influenza A H5N1 virus. The virus was a new strain of Influenza A and the available methods of test for the virus were also new. In ensuring the accuracy of test results, the AFD often have to arrange repeated and further tests for the samples collected. As for the existence of H5N1 in chicken eggs, DS/HW stressed that the virus would be killed by proper cooking at a temperature of 56 degree centigrade or above.

VI. Any other business

Investigation report on incident of wrongly dispensed medicine in Cheung Sha Wan Jockey Club Clinic Dispensary (CSWJCCD)
[Paper No. CB(2)821(04)]

29. Assistant Director of Health (ADH) briefed members on the major findings and follow-up actions as detailed in the Administration's paper on the subject.

30. Dr LEONG was concerned that some dispensing staff in CSWJCCD had provided misleading information to some of the parents whose children were provided with the contaminated medicine, i.e., a mixture of Thumol Gargle and Paracetamol Elixir. ADH said that preliminary finding had suggested that the staff concerned, in an attempt to retrieve the contaminated medicine without creating fear and anxiety among parents of the affected children, had committed such a mistake. She assured members that the DH would follow up the necessary disciplinary actions against the dispensing staff involved in accordance with civil service procedures. Mr WONG Siu-yee pointed out that in the light of the incident, the Administration should be more responsive and proactive in handling similar medical incidents in the future. ADH agreed that the community had the right to know at the earliest opportunity but pointed out that prompt notices to the affected patients should be given higher priority. Furthermore, the DH could only be in a position to brief the press on the incident after it had checked that the dispensaries in other public clinics had not made any similar error in dispensing medicine.

31. There being no other business, the meeting ended at 11:30 am.

The Provisional Legislative Council Secretariat
23 March 1998.