Legislative Council

LC Paper No. CB(2)237/99-00
(These minutes have been
seen by the Administration)

Ref : CB2/PL/HS

LegCo Panel on Health Services

Minutes of meeting
held on Monday, 19 April 1999 at 8:30 am
in Conference Room B of the Legislative Council Building
Members Present:

Hon Michael HO Mun-ka (Chairman)
Dr Hon LEONG Che-hung, JP (Deputy Chairman)
Hon HO Sai-chu, JP
Hon Cyd HO Sau-lan
Hon CHAN Yuen-han
Hon Mrs Sophie LEUNG LAU Yau-fun, JP
Dr Hon YEUNG Sum
Hon YEUNG Yiu-chung
Dr Hon TANG Siu-tong, JP

Member Absent :

Hon LAW Chi-kwong, JP

Public Officers Attending :

Mr Gregory LEUNG, JP
Deputy Secretary for Health and Welfare 1

Mr Clement LAU
Assistant Secretary for Health and Welfare (Medical) 6

Deputy Director of Health 1

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

Consultant (Community Medicine), Department of Health

Mr Eddie POON
Principal Assistant Secretary for Health and Welfare (Medical) 3

Mr Laurie LO
Principal Assistant Secretary for Health and Welfare (Welfare)1

Miss Monica CHEN
Principal Assistant Secretary for Health and Welfare (Elderly Services) 1

Dr Regina CHING
Assistant Director of Health (Elderly Health Services)(Acting)

Senior Executive Manager (Operations & Service Development), Hospital Authority

Attendance by Invitation :

Society for Community Organization and the Patients' Rights Association
Miss LAU Sau-han
Mr LAI Shou-cheng
Miss WONG Pui-yuen

Clerk in Attendance :

Ms Doris CHAN Chief Assistant Secretary (2) 4

Staff in Attendance :

Ms Eva LIU
Head, Research & Library Services

Ms YUE Sin-yui
Research Officer 2

Ms Joanne MAK
Senior Assistant Secretary (2) 4

I. Confirmation of minutes of meeting held on 9 November 1998 and matters arising
(LC Paper No. CB(2)1653/98-99 and CB(2)1728/98-99(01))

The minutes of the meeting held on 9 November 1998 were confirmed.

Research studies to be conducted by the Research and Library Services Divisions
(Paper No. CB(2)1728/98-99(01))

2. At the invitation of the Chairman, Head, Research and Library Services (H(RL)) presented to members draft outlines of two proposed studies, namely, A Comparison Between the "Harvard Proposal" and Other Health Care Financing Models ("Harvard Proposal") and Health Care Expenditure and Financing in Singapore ("Singapore Model"). The two studies would be completed by mid/late July 1999.

3. Dr LEONG Che-hung suggested that the research on the "Harvard Proposal" should include a comparison of the Harvard Proposal with the health care system in Germany, Canada and China. There should also be a cost and benefit analysis of the Harvard Proposal. Regarding the research on the "Singapore Model", Dr LEONG suggested that the research should also look into the sustainability of the Singapore's health care system.

4. The Chairman proposed that shortcomings of the current health care delivery system in Hong Kong and Singapore should also be included in the two studies.

Consultancy Report on Hong Kong's Health Care System - follow-up action

5. Members noted that there would be a motion debate on the subject at a coming Council meeting. The Chairman suggested and members agreed to convene a special meeting in June 1999 to discuss the Harvard Report.

II. Date of Next Meeting and Items for Discussion

6. The next regular meeting was scheduled for Monday, 10 May 1999.

7. The Chairman sought the views of the Administration and members on discussion of the following items at the next regular meeting -

  1. Registration of ancillary dental personnel; and

  2. Investigation report on the kidney dialysis incident at the Hong Kong Sanatorium & Hospital;

  3. Year 2000 compliance in the public and private health sectors;

  4. Dental policy and review of oral health goals.

8. Deputy Secretary for Health and Welfare 1 (DSHW) suggested and the Chairman agreed that discussion of item (a) be deferred to June as the consultation exercise in respect of the matter had just completed and the results of the consultation were not yet ready.

9. DSHW informed members that with regard to item (c), about 10% of equipment installed in the Hospital Authority required rectification work in order to meet the Year 2000 compliance. As half of the work had already been completed, it was estimated that compliance could be achieved by the end of June 1999. As requested by the Chairman, DSHW agreed to provide a paper on the subject by the end of April. The paper would include progress made in the private health sector and details of the contingency plans. Adm

10. Members agreed not to discuss item (b) until after the completion of the inquest which only commenced the week before.

11. DSHW said that the Administration would like to consult the Panel at the next meeting on the second stage proposed amendments to the Human Organ Transplant Ordinance before the drafting commenced. The Chairman asked the Administration to provide a paper on the subject as soon as possible for members' consideration.Adm

III. Briefing on H9N2

12. The Consultant (Community Medicine), Department of Health (C(CM)), reported that as of to date, Influenza A H9N2 was found to have infected two children. Both of them recovered fully without any complication. It was known that one of the two children had history of exposure to live poultry while the other had not. The Department of Health (DH) was working with local and overseas experts to ascertain the mode of transmission of the virus and determine its public health impact.

13. C(CM) informed members that an investigation team had been set up and it had made a visit to the kindergarten of one of the infected children in the previous week. He assured members that the school environment was clean and there were no animals kept at the school. Parents were also given questionnaires and invited to have blood tests.

14. In response to the Chairman's enquiry, C(CM) said that the overseas experts were satisfied with the current mechanism of influenza surveillance adopted in Hong Kong. However, they suggested that DH should investigate into the mode of transmission of influenza viruses and the possibility of person-to-person transmission and bird-to-human transmission of the H9N2 virus.

15. In response to Miss Chan Yuen-han's enquiry, C(CM) explained that the Department of Education had already advised to schools that they should use videos or models to replace live poultry as teaching aids and they should teach children the importance of proper personal hygiene. The above guidelines were also available on the Internet and had been issued to primary schools and kindergartens in Hong Kong.

16. The Chairman enquired whether DH would advise families against keeping birds or live poultry at home. C(CM) explained that keeping live poultry in schools was different from keeping them at home. As it was more difficult to ensure personal hygiene among students, in particular primary school and kindergarten students, there was a higher possibility of virus transmission in school than at home.

17. In response to Dr LEONG's enquiry, C(CM) explained the differences in symptoms of infection of H5N1 virus from that of H9N2 virus. Both the clinical presentations were similar to those of typical influenza, with fever of acute onset. However, H5N1 virus was more malicious and could cause serious complications like respiratory failure and so on. Patients would also suffer from being short of breath. All this information could be found on the Internet and they had been disseminated to general practitioners. At the moment, 63 Government out-patient clinics and 28 private clinics were involved in close monitor of the situation and they would report to DH incidents of influenza infection.

18. Mrs Sophie LEUNG was concerned whether the Administration would need to slaughter all live poultry again so as to prevent the spread of H9N2 virus. C(CM) assured that this would not be necessary as H9N2 virus had been isolated in birds for many years and it only caused mild illness in birds. Although it was isolated for the first time in human beings, both of the two infected children had no complications and recovered fully.

IV. Monitoring of Private Hospitals
(LC Papers Nos. CB(2)1714/98-99(02) and CB(2)1714/98-99(03))

19. The Chairman welcomed representatives of the Society for Community Organization (SOCO) and the Patients' Rights Association to the meeting.

20. Miss LAU Sau-han, one of the representatives, pointed out that the current legislation did not sufficiently cover the quality of the services provided by private hospitals. The monitoring of private hospitals carried out by DH was inadequate and she had received a number of complaints regarding private hospitals. Similar views had been made by the Harvard Team in its recently published report.

21. Mr LAI Shou-cheng, a patient representative, remarked that there was neither a mechanism to control the charges of private hospitals nor a channel for the general public to air their grievances against the services provided by private hospitals. Mr LAI then referred to his personal experience in his mother's case. In an attempt to lodge a complaint against the charges made by a private hospital, he had approached the Consumer Council, the Hospital Authority, the Office of the Ombudsman, two Members of LegCo, the Complaints Division of the Legislative Council Secretariat and DH but to no avail as he found that none of the above authorities had jurisdiction over charges for services provided in private hospitals. In particular, the staff of DH told him that the role of DH was to issue licences to private hospitals and not to control charges or interfere in their administration. He therefore wished to know why there was no mechanism to monitor the charges of private hospitals.

22. Miss WONG Pui-yuen, representative of Patients' Rights Association, pointed out that it was very difficult for the general public to have access to the medical records of private hospitals. The general public did not know what information was available to them. This posed great difficulty in negotiating compensation with the private hospitals. To illustrate her point, she referred to a case of a patient who died whilst under intensive care several years before and the difficulty in obtaining information from the hospital. After a long lapse of time, the patients' family had no choice but to receive payment from the hospital for agreeing not to follow-up the matter. She highlighted the lack of transparency of the operation of private hospitals in Hong Kong which showed little regard for patients' rights.

23. At the invitation of the Chairman, Miss LAU Sau-han made the following proposals on behalf of the deputation -

  1. to allow the general public access to their medical records;

  2. to make annual reports and charges of private hospitals open documents for public scrutiny; and

  3. to establish an independent complaints committee.

24. Miss CHAN Yuen-han was concerned about the response made by DH as reported by Mr LAI Shou-cheng. Deputy Director of Health 1 (DDH1) undertook to look into the matter and report to the Panel. He explained the current practice was that DH would follow up and investigate any complaints received on services provided in private hospitals. On the avenue of complaint, he pointed out the relatives of a patient or any client had the right to complain to the management of the hospital. When it involved an attending visiting doctor, the doctor might be asked to explain his action also. On issues relating to professional misconduct, the clients had the right to report them to the Medical Council which would look into the professional aspects of the complaints. Adm

25. As regards the role of DH in registration, DDH1 said that the department required hospitals to complete a questionnaire covering various aspects of their operation in the annual registration. DH also carried out ad hoc inspections if necessary.

26. Miss CHAN Yuen-han then enquired about the details of accreditation of private hospitals. DDH1 said that the accreditation process would involve various aspects of procedures and systems in the hospitals. It would be prepared taking into regard local conditions and cultural constraints. It would be adapted from international standards appropriate for local conditions. The system would be set by a panel comprising professionals, Government officials and consumers.

27. Dr YEUNG Sum asked whether a list of charges was available to safeguard patients' rights. DDH1 said that in general on admission patients were shown a range of charges including charges of visiting doctors. He pointed out that most of the disputes had arisen over the charges of consumables in the final bill on discharge of the patients from private hospitals. As some hospitals had very comprehensive charges list while other did not, DH would ask the private hospitals to prepare a more comprehensive list of charges for distribution to patients.

28. Mr YEUNG Yiu-chung enquired about the 20 complaints received by DH. He also wished to know whether there was any requirement for the private hospitals to report medical incidents to DH. DDH1 replied that private hospitals would report to DH medical incidents relating to patient care. However, complaints about staff manners, staff performance or administrative procedures would be handled by the private hospitals themselves. As regards the 20 complaints received by DH, DDH1 said that nine of them were substantiated, out of which four involved staff performance, one was about staff manners and four were in regard to services.

29. Mr YEUNG Yiu-chung further enquired whether any guidelines on incidents to be reported had been issued to the private hospitals. DDH1 explained that there existed an understanding between private hospitals and DH. If the incident resulted in injury to or death of a patient or if the scope was covered by the Coroners' Ordinance, the private hospital concerned would need to report the incident to DH. As requested by Mr YEUNG, DDH1 agreed to provide a written reply on the number of reports received last year.Adm

30. Referring to the earlier discussion on charges for services, Dr LEONG Che-hung opined that private doctors could not possibly explain the charge of every consumable. He considered that there should be a standard list of fees and charges and DH should provide clearer guidelines on the need to display a list of comprehensive charges for patients' information. He pointed out that he had first raised the matter of monitoring of private hospitals in 1989 but no action had been taken by the Administration. He said that he was disappointed with the Administration's paper as it had only provided general information without any details of the private hospitals' self-regulatory mechanism mentioned in paragraph 2. Furthermore, he found the brief information given in the paragraph confusing.

31. DDH1 clarified that doctors of private hospitals would only explain to their patients the procedures they would be undertaking and the charges for these procedures. They would not be expected to explain the charges of consumables to the patients.

32. As regards the Quality Assurance Programmes (QAP) mentioned in paragraph 2 of the paper, DDH1 said that at the moment, six private hospitals had joined the QAP and were accredited. They would be inspected by a team from the Hong Kong College of Obstetricians and Gynaecologists who would confirm their facilities were adequate and the equipment and manpower appropriate for maternity services. The certificate of accreditation was valid for five years. The accreditation under the College of Pathologists was undertaken jointly with the Hong Kong Medical Technologists' Association and the Hong Kong Red Cross Blood Transfusion Service. At present, there were seven hospitals with such accreditation. The College of Pathologists provided QAP in various sub-specialties of pathology such as anatomical pathology, microbiology and chemical pathology, haematology and blood transfusion service. Similar to the programme undertaken by the Hong Kong College of Obstetricians and Gynaecologists, there was a programme of assessment to assess and maintain the professional skills of the people involved in providing such services.

33. Dr LEONG raised three questions -

  1. when DH would require private hospitals to produce a comprehensive charges list;

  2. whether DH would disclose the names of private hospitals which had obtained accreditation of maternity or pathology services or other specialties; and

  3. when DH would establish benchmark for the quality of hospital services.

34. DDH1 agreed to follow up (a) above immediately. As regards accreditation, he pointed out that a voluntary scheme was proposed in the paper.

35. Dr LEONG agreed that participation should be voluntary but considered that DH should establish some benchmark to measure the quality of hospital services. He was disappointed that no action had been taken on the matter since it was first raised in 1989.

36. DSHW explained that as there was no established agency to accredit hospital services in Hong Kong, they must rely on the overseas accreditation agencies. However, overseas standards might not be applicable here. It took time for the overseas agencies to understand our local circumstances before our own benchmark could be established. The accreditation charge per hospital per year might involve some HK$200,000 to HK$1million. This would pose great financial burden to the small private hospitals and these costs might also be transferred ultimately to patients.

37. Referring to the case quoted by Miss WONG Pui-yuen, Dr LEONG asked whether she had lodged a complaint to the Medical Council. Miss WONG answered in the negative as the patient concerned had no confidence in the Medical Council. She criticized that the Medical Council was not representative as its members were mainly doctors and there was only one non-medical personnel represented in the Medical Council.

38. The Chairman enquired about the Government's role in monitoring the charges of private hospitals and the Government official responsible for dealing with complaints about private hospitals. DDH1 replied that the general public could contact Dr Monica WONG of DH on 2961 8894 regarding such complaints. In response to the Chairman's question regarding problems relating to clinical matters of visiting doctors, DDH1 clarified that visiting doctors at the private hospitals might be asked to explain allegations on clinical issues.

39. Miss Cyd HO opined that in dealing with such complaints, the Administration should act as an arbitrator between private hospitals and the complainants. The Administration should also issue pamphlets or guidelines to the general public on the procedures for making grievances. Families of the patients should be given opportunities to be present during the treatment procedures and attend any hearings or meetings of the investigation team.

40. The Chairman suggested and the Administration agreed that this subject should be discussed again in two to three months' time.

V. Visiting Health Teams for the Elderly
(LC Paper No. CB(2) 1714/98-99(04)

41. Senior Executive Manager (Operations & Service Department), Hospital Authority (SEM), briefed members on the services provided by the Community Geriatric Assessment Teams (CGATs) and said that their services would be extended to private care homes for the elderly. Assistant Director of Health (Elderly Health Services) (Acting) (AD(EHS)(Atg)) then briefed members on the services provided by the Visiting Health Team (VHT).

42. Dr TANG Siu-tong enquired whether there was wastage of resources as both the Hospital Authority (HA) and DH had set up their own teams for the elderly. AD(EHS)(Atg) said that there was virtually no overlap between the two teams as their target clients were different. The CGATs were responsible for taking care of the frail elderly whereas the VHTs focused on enhancing primary health care for the elderly in general and would not give any medical treatment to the elderly. SEM pointed out that liaison had been established between the CGATs and the VHTs on a geographical basis.

43. In response to Dr TANG and Miss Cyd HO's enquiries, AD(EHS)(Atg) clarified that it was not mandatory for the elderly homes to receive services of VHTs. If they had difficulties in accommodating the services of VHTs due to staff constraint, they could ask the VHTs to make other arrangements.

44. Dr TANG further enquired about the reasons for not putting CGATs and VHTs under one roof. DSHW explained that the two teams were designed for meeting the needs of two different target groups of the elderly. While CGATs provided treatment of medical conditions of high risk elderly persons, VHTs provided outreaching health services of a preventive nature.

45. Mrs Sophie LEUNG pointed out that the elderly might not want to be visited by different groups of doctors or nurses and expressed concern about the cost effectiveness of having two different teams. Miss Cyd HO voiced similar concern.

46. In response to the concern expressed by Mrs Sophie LEUNG and Miss Cyd HO, Principal Assistant Secretary for Health and Welfare (Welfare)1 (PAS(HW)1) further elaborated the differences between the two teams. She pointed out that unlike the CGATs, most of the work of VHTs was carried out by nurses, and doctors were mainly involved in the planning of work or drafting of the guidelines.

47. The Chairman said that whilst he agreed that there were some differences between the services provided by the two types of teams, he considered that a review of their cost effectiveness should be carried out. PAS(HW)1 replied that as six more VHTs had yet to be established, they planned to conduct the review after all the 18 VHTs had been set up.

48. The Chairman objected to the proposed timetable. He considered that there was no need to wait until all the 18 VHTs were established since 12 were already operating and initially there was already some duplication of services seen. He therefore suggested that the review should be conducted as soon as possible. Miss Cyd HO observed that very often pilot projects were introduced first to assess the result first and she could not see the need for full implementation of VHTs before a review could be conducted.

49. DSHW reiterated the manpower and services provided by the two types of teams were different even though some overlap of services was unavoidable. In view of members' concern about the cost effectiveness of having two different teams, he agreed to conduct a review as soon as possible. Adm

50. The meeting ended at 10:55 am.

Legislative Council Secretariat
29 October 1999