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Following is the speech by the Chief Secretary for Administration, Mrs Carrie Lam, at the Hong Kong Association of Gerontology 19th Annual Congress of Gerontology this morning (November 24):
President Dr Leung, distinguished speakers, ladies and gentlemen,
Well, first of all, it gives me really great pleasure to come back to the welfare sector and in particularly in the elderly care, which has been very close to my heart.
I wish to take this opportunity really to first extend my deep appreciation to the Hong Kong Association of Gerontology. The Association was set up by a group of people back in 1986, well before ageing population has become such a topical issue in Hong Kong. This group of geriatricians, psychologists, social workers, nurses and all professionals who are so passionate and caring about our elderly in Hong Kong. And throughout the last 26 years, the Association has done some wonderful things, which Edward (the Association's president Dr Edward Leung) has just outlined to you. So I was very pleased to come back not only to speak to you but also to express to you my personal appreciation and of course that on behalf of the Hong Kong Special Administrative Region Government.
I was particularly excited because after I have spoken, I will be invited to present certificates of recognition to organisations which have all their elderly homes participating in the accreditation scheme. As Edward has mentioned, this idea of doing accreditation was very much well conceived in Social Welfare Department (SWD) when I was the Director of Social Welfare (DSW), so I am very pleased to hear of the progress made, although, as Edward said, more could be made in this particular respect, and I’ll come back to you in a moment.
Now, since I am speaking to an audience who are all very concerned about elders, I don't think I need to remind you of the scale of the issue. At the moment, people who are 65 years and over account for about 13 per cent of our population, slightly less than 1 million. In 30 years' time, that is by 2039, the same percentage will rise to 28 per cent, accounting for 2.56 million of our population. So what does that mean for us? That means that there are a lot challenges in front of us, and these challenges can only be overcome by all sectors of Hong Kong pooling their efforts together.
Recently, we have heard more about this sort of ageing population, this challenge, because of a very topical issue. Unfortunately, it's still being discussed in the Legislative Council. That is the introduction of an Old Age Living Allowance at $2,200 per month to assist the elders in need. I was supposed, hopefully, to tell you the good news this morning that the proposal has been approved. But unfortunately that did not happen last evening. Earlier in the week, upon completion of my European visit - I came back to office on Monday this week - I took that courage to give a phone call to the Honourable(Legislative Council Member) Leung Kwok-hung. Of course, I tried to persuade him to give up this filibustering so that the estimated 400 000 elders could benefit as soon as possible. But I did also impress upon him that I had this occasion on a Saturday morning, so if he could allow the proposal to go through, then I would have this good news to disclose to you all who are very concerned about Hong Kong's elders, but unfortunately I could not bring you that good news. However, I truly believe that as long as we are determined to get it through, we will get it through.
Now, facing this challenge, of course the Government has been doing a lot of things in the last couple of decades, to the extent that by now over half of today's welfare expenditure, that is the operating expenditure of about $44 billion, over half of that goes to elderly cash assistance as well as elderly care services. This is not a small sum and that has been growing on an annual basis. But in my opinion, money is not the only solution to the problem that we are facing and that’s why I am very pleased that the 19th Annual Congress of the Hong Kong Association of Gerontology has taken this theme, which unfortunately was not in your backdrop. I was told that the theme of this Annual Congress is "Promoting Choices and Frontiers in Elder Care". In fact, if I may just suggest a word, I think it should be "Promoting Choices and Extending Frontiers in Elders' Care". Now, I'll come to in a moment why I have this very modest suggestion.
Now, let me start my recounting what I felt about nine years ago when I left my job as the Director of Social Welfare. It was almost exactly nine years ago in November 2003, after having spent three and a half very fruitful, very comforting years in that particular position I left Social Welfare Department. I said in public on that point of departure that there were two main unfinished businesses for me. One is to review with a view to improve the CSSA, that is the Comprehensive Social Security Assistance scheme. Because after having worked as the Director for three years, I acknowledged and recognised that there are deficiencies in the current social safety net in Hong Kong. The second unfinished business is that I did not have the time or maybe the ability to put in place what I call "Money Following the Elders" (錢跟老人走) in particular in residential care services for the elders. I am very pleased that I will now have an opportunity in the next five years to complete this unfinished business.
As you know, the Chief Secretary for Adminisration, of course, she has to look after a wide range of portfolios, but welfare and related matters are part of the CS' oversight. And in particular, I have already set up two very high-level committees to look at two important aspects. One is the Commission on Poverty, the other is the Steering Committee on Population Policy. So you could be assured that in both committees’ work, the issue of elders' care or elderly needs will feature very prominently in the future deliberations. And this will also provide a very good platform for many of the issues that you are concerned with to be tackled. So I hope that you will continue to take a very keen interest in the work of these two committees, and I believe some of you will actually join me in working on these two committees.
Now coming back to choices, I mentioned that money is not the only solution. Similarly, providing more care, while at this moment in time I think it is very well justified because we don’t have enough quality health-care homes, we do not have enough, maybe, health-care workers and community care and premises and so on. So I'm not suggesting that we have enough hardware but at the same time I think it is time for us to really focus on providing more choices for elders. Particularly, as you can imagine, in time to come we are talking elders like myself who do have certain aspirations, who do want to have more choices as a consumer. So the current provision of elderly care products may not be able to satisfy the next generation of elders in Hong Kong.
In this particular respect, I am actually quite pleased to know that in the last eight years or so, that is since I had left my job as DSW, certain products have been moving in that direction. Previously, there was only a portable scheme for CSSA. This was actually introduced before the reunification with our Mainland. Now it has been extended to Fujian Province, so we have a portable CSSA scheme in both Guangdong Province and Fujian Province. And very shortly, we will have a Guangdong scheme for allowing recipients of Old Age Allowance, to take their benefits to Guangdong. In other words, the living requirement in Hong Kong will be waived. And we have a medical voucher scheme which is also providing choices for elders over 70 years of age. From a pilot of $250, this voucher value has been increased to $500 a year and from January 1 next year will be increased to $1,000 a year in fulfilment of the Chief Executive's promise in his manifesto. And also within 2013, SWD will introduce these community care vouchers so to allow elders actually to procure both home care and community care services on their own.
Now, beyond the provision in terms of the Government policies and practices, in the Community Care Fund (CCF), which has been operating for the last two years, there are also projects or items which embrace this element of providing choices, so at the moment under the CCF we are providing elders in need who are living in private accommodation with a subsidy so their choice has been respected. Somehow if, for whatever reason, these elders prefer, for maybe they couldn't really get into public rental housing immediately, CCF is able to help them, though I have to confess that the extent of subsidy may not be considered as adequate. And we also provide a home care and escort service subsidy for elders who are waiting for the enhanced home care. So you can see that in fact certain things have been moving in that direction. But I think the time has come for really policy changes.
One thing that I notice coming back to the job of welfare is over these years, there have been a lot of pilots, under the Lotteries Fund, the Hong Kong Jockey Club, foundations and so on. But pilots are pilots. I think the time has come for some real policies to be made so that these become important and integral features of Hong Kong's elderly care policy. So I am inclined, or actually I have started work, for us to take a systematic and holistic look at the various pilots that had been undertaken over the years to provide greater social innovation in the way that we help our elders to meet their needs. But "choice" is one of the most important areas in Hong Kong's residential care services. Because that is the place where our elders will spend a lot of time, and that is a place where elders need to be assured that they will be visited by their families, so they need to have this choice to decide where they want to go to in terms of residential care services.
And here I have a little story to tell, because when I went into the job of DSW, Eliza Leung (the then Assistant Director of Social Welfare Department (Elderly)) and I, we told ourselves that this is a very important area that we must grapple with within our, sort of, term. So we started off by completing or speeding up the licensing. You remember that back in 2000, we even did not have completed the licensing, which is a very basic standard in terms of safety and space of Hong Kong's private as well as, of course, subvented homes. So we spent a couple of years to speed up the licensing of Hong Kong's RCHEs, residential care homes for the elders. And at the same time, we introduce what we called a premises-led approach to provide the hardware, because even at that time, well before the property market has become so overheated, we acknowledged that land and premises are just too valuable in Hong Kong for them to be readily devoted for the use of residential care homes. So with the permission and the support of the various bureaus and departments, we actually managed to get what we call a premises-led strategy in the provision of residential care homes. And that is, we will provide as much as possible, through collaboration with the Housing Authority, through private-sector participation, through development of our own GIC (Government, Institution or Community) sites, to provide purpose-built residential care homes in order to increase the supply of these valuable premises.
And then we introduced competitive bidding, although I know some of you may not like bidding at all. But in order to make sure that we get value for money and also to ensure we have quality in our homes, we introduced competitive bidding into these homes or these premises that were purpose-built for residential care. And these are now called contract homes. And in order to prepare for some sort of choices for elders, most of these contract homes are operating on what I call a mixed mode - in other words, of the number of beds provided in these contract homes, some are subvented by SWD, but some are operated on a self-financing basis, but with quality assured and with prices being controlled. In fact, I was telling my colleagues when we had a discussion on Hong Kong's Statutory Minimum Wage, I told them that actually some form of mandatory minimum wage was first introduced in these contract homes, for which we specified that the successful bidder should pay their care workers at a prescribed level so as to ensure that the elders will receive the needed care from the carers who are not aggrieved with the wages that they were being paid.
And then I invited the Hong Kong Association of Gerontology to develop accreditation. Because once elders are asked to exercise their choice, they need to tell one from the other, they need to distinguish which is the better home. And the relatives have to be assured that they are getting value for money. Just like when we are getting into a hotel, we need to tell whether this is a five-star, four-star or three-star hotel - it doesn't mean that three-star hotel is bad because we are talking about, really, value for money. If you are prepared to pay more, get a more spacious environment and more privacy, then perhaps you will have to go into a higher grade home.
So it is all this work that has been prepared in anticipation of providing choice care for elders in residential care, although at the moment, Edward told me that only one in seven of Hong Kong's homes has received accreditation. But I am quite confident that with the right policy - it could be a stick, it could be a carrot, but apparently it seems that it would be a carrot. I think incentives are more powerful in this particular aspect - with the right policy and incentives, I am sure that this extent of accreditation will pick up very, very fast. This is something that only the Government can do, so I don't blame the 600 other homes who have not come forward for accreditation. There could also all sorts of practical difficulties. But once the policy regime is there, then I am sure that more will come forward.
So this is promotion of choices that I would like to see in the further development of Hong Kong's elderly care services. But we have to make a hard choice when we promote choices for elders, and that is who is paying. I'm sure you are by now fully aware that unless we significantly change Hong Kong's fiscal system, to the extent of maybe deviating from this living-within-our-means fiscal principle, otherwise there is absolutely no way that we could shoulder all these challenges from an ageing population from taxpayers' source of revenue. So this hard choice is: Should we target the limited resources to only those in need, which will then require some form of means testing or economic assessment before we make available the care for the elders? But at the same time, with the provision of choice care and perhaps with the provision of co-payment, then we could still ensure that elders will get varying degrees of help from taxpayers. So as a result of which, those who are most in need, for example elders who are now living in homes not in the context of residential care home, but under the CSSA - I am sure you agree with me, these are perhaps the elders most in need - they will be properly catered for in an elderly care service system.
Another ingredient that I would really emphasise in providing choice care in taking forward some of the work that I outlined to you is that we must respect and cater for both the private and the NGO sector. In this sector of elderly care homes, although there have been complaints from time to time about the quality or the diversity in the quality of care between private homes, I think that private homes have actually done a great service to Hong Kong in providing the needed volume of service, also because under our current system they are not entirely on a level paying field, so I hope that in developing this particular area further that we should not just keep on expanding the NGO or the subvented sector. We should respect the need for the existence of the private sector in Hong Kong.
Now I come to the second theme of this conference, which is about "frontiers". I mentioned that perhaps I would like to call this "Extending Frontiers in Elders' Care" because I see there's actually no frontier in elder care - everybody could chip in to provide better, higher quality service for a growing elderly population. We need cross-sector collaboration to provide the needed diversity and seamless care for the elders in all policy areas like medical and health, like social welfare, including even education, because more and more we are seeing elders who are still very healthy, who still aspire to learn, life-long learning and so on. We need also the support of city planners as well as transport engineers, as well as financial people in respect of providing a more universally accessible city, a safe city, and also in terms of how elders with more means in future would require some financial advice in their retirement protection, just like what the Hong Kong Mortgage Corporation has started in terms of providing reverse mortgage for some of the elderly owners of residential units.
Yesterday evening, I was at the award ceremony of the CIIF (Community Investment and Inclusion Fund), and I was very impressed by this project which exactly has successfully extended the frontiers in elder care, and they call this 「醫福社」 project. That is combining efforts of the medical sector, the social welfare sector and the community in the Kwai Tsing area to provide a safe city environment for the elders, which has demonstrated to be able to reduce the admissions into the Accident and Emergency Units of the public hospitals.
Now, I mentioned about my unfinished business about nine years ago when I left the job. At the moment I don't know whether I would still have some unfinished business after completing my five-year term in 2017, but nonetheless I remain very confident that under the steer of the Chief Executive, Mr C Y Leung, and with the team of colleagues that I am now working with, we will be able to bring some of my unfinished business to fruition. But I have to look to all of you for your support, for your advice and for your encouragement. But meanwhile, I wish you all to have a very fruitful conference today. So thank you very much.
Ends/Saturday, November 24, 2012
Issued at HKT 18:32
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