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Following is a question by the Hon Cheung Man-kwong and a written reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (June 1):
Question:
Regarding the installation and replacement of medical equipment in various hospitals within the Hospital Authority (HA)'s clusters and the relevant mechanism, will the Government inform this Council:
(a) whether it knows an inventory of the commonly used and essential items of medical equipment which are important and sizable and must be installed in both acute and non-acute hospitals, and the names of those hospitals which have not installed all such equipment; the important and sizable medical equipment which had been installed or replaced in each hospital within a cluster in the past five years, the expenditure incurred, the number of additional staff thus employed, the utilisation rates of such medical equipment and the numbers of patients who had used such equipment, with a breakdown of the above by hospital cluster;
(b) as some healthcare staff have pointed out that Magnetic Resonance Imaging (MRI) scanners are important items of equipment which are commonly used in hospitals and important to patients in acute hospitals in particular, but some acute hospitals still have not yet installed such equipment, whether it knows the reasons for that; the factors to be considered by various clusters in determining whether individual hospitals need to procure MRI scanners, and a breakdown by cluster of the names of the acute hospitals which have not installed MRI scanners, the names of the acute hospitals which have installed MRI scanners, as well as the number of scanners installed and the respective years of installation; the names of the acute hospitals which will replace old MRI scanners with new ones, or those acute hospitals which will install the scanners and the timetable concerned, the utilisation rates of the MRI scanners in various hospitals, the numbers of acute patients in various acute hospitals who were referred to other public or private hospitals to receive MRI services in 2010-2011, and the median waiting time of patients for receiving MRI services;
(c) whether it knows the factors to be considered by various clusters in determining whether individual hospitals need to procure Computerised Tomography (CT) scanners, and a breakdown by cluster of the names of the hospitals which have not installed CT scanners, the names of the hospitals which have installed CT scanners, the number of scanners installed and the respective years of installation, the names of the hospitals which will replace old CT scanners with new ones, or those hospitals which will install the scanners and the timetable concerned, the utilisation rates of the CT scanners in various hospitals, the numbers of in-patients in various hospitals who were referred to other hospitals to receive CT scanning services in 2010-2011, and the median waiting time of patients for receiving CT scanning services; whether doctors in general outpatient clinics can directly refer patients to receive CT scanning services; if not, the reasons for that; and
(d) the mechanism through which various clusters discuss and decide on matters relating to the procurement or replacement of medical equipment in various hospitals within a cluster; given that the Hospital Chief Executive of the major acute hospital in a cluster will concurrently serve as the Cluster Chief Executive and controls the deployment of manpower, allocation of resources and development of services in all the hospitals within the cluster, what channels are available for other hospitals to participate in discussing and monitoring the allocation of resources within the cluster and to achieve checks and balances, how HA monitors and ensures that the allocation of resources will not be tilted in favour of major acute hospitals and other hospitals are able to install and replace the medical equipment they need and develop their services in a timely manner?
Reply:
President,
The Hospital Authority (HA) has medical equipment of a total value of more than $8 billion. The equipment is allocated to individual hospitals according to their service scope and capacity. All hospitals therefore have medical equipment required for provision of their services, such as blood pressure monitors, defibrillators, ventilators, electrocardiographs, physiological monitors, ultrasonic devices, endoscopes, resuscitators and sterilisers. Medical laboratories, intensive care units, cardiac catheterisation laboratories and operating theatres, which cater for specific services, are provided with the relevant medical equipment.
For effective utilisation of healthcare resources, seven hospital clusters have been established under HA to coordinate the services of hospitals within the respective clusters. This cluster service model enables HA to provide quality and efficient public hospital services on a sustainable basis. HA's healthcare services are categorised into primary, secondary, tertiary and quaternary services according to the prevailing conditions of the relevant diseases, the number of patients seeking treatment and the complexity of the services. The major considerations for provision of tertiary and quaternary healthcare services include: (i) technology centralisation; (ii) availability of a sufficient number of patients seeking treatment for maintaining the relevant technology and capability; (iii) the economy of scale for provision of 24-hour service and manpower planning; and (iv) the greater need for monitoring and ensuring the service quality of more complicated medical procedures. Thus, more complicated healthcare services such as organ transplant and cardiac surgery are conducted in a few designated hospitals. The medical equipment required for these complicated healthcare services is therefore only available in the designated hospitals.
Nevertheless, individual hospitals in each cluster are equipped with basic medical equipment to cope with their needs. With regard to laboratory services, for instance, major acute hospitals in each cluster have set up advanced laboratories for provision of comprehensive laboratory services for the whole cluster while individual hospitals in the cluster are equipped with basic laboratories to cope with their operational needs.
Modern healthcare is heavily technology driven. Advancement in medical technology contributes to better patient care through faster and more accurate diagnosis. It also enables less invasive or more precise new treatments for better clinical outcome that benefits patients direct. HA has attached great importance to modernisation and upgrading of its medical equipment and have been continuously modernising its medical equipment in order to provide quality services to patients. Regarding the four parts of the question, the reply is as follows:
(a) and (d) HA has maintained a central record to keep track of the relevant information of its medical equipment items such as their age profile, locations and maintenance records, which enables HA to assess supply of equipment to hospitals and its service areas as well as to plan for equipment allocation and replacement. The allocation and supply of medical equipment is considered mainly based on the following factors:
(1) The areas, nature and level of services of hospitals: that is whether the medical equipment concerned must be centrally installed to enable the centralisation of technical staff and economy of scale to be achieved;
(2) The age profile and service conditions of the existing equipment;
(3) Whether alternative technologies are available for elimination of obsolete equipment and lowering of the risks;
(4) Whether new technologies can be adopted for provision of modernised medical services based on the principles of evidence-based medical practice: HA has set up a clinical co-ordinating committee for each specialty, under which a technology committee is established and tasked to advise HA on the current level and strategy of technology application as well as the merits, risk and maturity of the relevant technologies;
(5) Medical equipment required to be allocated and acquired for new service plans adopted under HA's annual work plan; and
(6) Interface issues such as deployment or recruitment of relevant professional and technical staff and capital works planning for sites where the equipment is to be located.
Requests for procurement of medical equipment items with a unit cost over $150,000 are centrally coordinated by HA and the expenditure is met by a block vote. Individual hospitals may lodge requests for allocation and replacement of medical equipment according to their needs. Requests from hospitals are considered by HA mainly according to the priority of service needs and the following principles:
(1) Risk level;
(2) Importance to clinical service outcome;
(3) Equipment safety and their regulation compliance;
(4) Service level;
(5) Utilisation rate;
(6) Reliability;
(7) Availability of backup equipment; and
(8) Occupational safety and health considerations.
Requests for procurement of other medical equipment items (with a unit cost less than $150,000) are considered by individual hospitals and the expenditure is met by their own budget allocations. A technology advisory committee has been set up in each hospital cluster to monitor any need for medical equipment and advise the hospital management on the priority of replacement and procurement of medical equipment items. Hospitals also process donation of medical equipment from other organisations or individuals on the basis of the above principles.
In planning for procurement of additional equipment items, especially for the major equipment, HA has taken into consideration the corresponding manpower deployment or recruitment plans to ensure that there will be adequate technicians, doctors, nurses and supporting staff to cope with the procurement plan and the operational needs. The relevant expenditure is met by the hospitals' own budget allocations.
A list of medical equipment procured with funding from the block vote from 2007/08 to 2010/2011 is at Annex 1.
(b) and (c) HA provides computerised tomography (CT) and magnetic resonance imaging (MRI) scanning services based on the hospital cluster model. All acute hospitals with 24-hour accident and emergency (A&E) services are provided with CT scanners while each cluster is equipped with MRI scanner. Up to April 1, 2011, HA has a total of 26 CT scanners and 13 MRI scanners. The distribution of these scanners is at Annex 2. Besides, HA plans to provide a number of additional CT and MRI scanners in various hospitals in the coming two years from 2011/12 to 2012/13, which includes provision of an additional CT scanner in Our Lady of Maryknoll Hospital and provision of a total of three additional MRI scanners in Tseung Kwan O Hospital, Caritas Medical Centre and Ruttonjee Hospital. The number of people provided with CT and MRI scanning services in 2010/11 and the median waiting time for the services are at Annexes 3 and 4 respectively.
Patients taken care of by general out-patient clinics (GOPCs) can be divided into two main categories, namely chronic disease patients with stable conditions (e.g. patients with diabetes mellitus, hypertension, etc.) and episodic disease patients with relatively mild symptoms (e.g. patients who suffer from influenza, cold, fever, gastroenteritis, etc). These patients receive primary healthcare services in GOPCs and they are less likely to have a need for receiving CT or MRI scanning services when compared with patients of the specialist out-patient clinics (SOPCs). For this reason, doctors in GOPCs normally do not refer patients direct to receive CT or MRI scanning services. If such scanning is considered necessary, doctors of GOPCs will refer patients to family medicine clinics or SOPCs for follow-up and further treatment.
Ends/Wednesday, June 1, 2011
Issued at HKT 19:05
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