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Following is a question by the Hon Chan Chi-chuen and a written reply by the Acting Secretary for Food and Health, Professor Sophia Chan, in the Legislative Council today (December 9):
Question:
At present, transgender people who wish to receive partial or full sex reassignment surgery must first be assessed by the specialists and experts of the various specialties concerned (including plastic surgery, psychiatry, endocrinology, clinical psychology, etc.) to ascertain if they are suitable for undergoing the surgery. The New Territories East Cluster under the Hospital Authority (HA) announced earlier that from the current fiscal year onwards, the Prince of Wales Hospital (PWH) under the cluster would provide one-stop medical services for people with Gender Identity Disorder and those with Gender Dysphoria (collectively known as "transgender medical services"). Starting from October this year, PWH would reserve three operating theatre sessions for sex reassignment surgery each month and would provide the relevant psychiatric and endocrinology services later on. It is learnt that in the past, sex reassignment surgery used to be performed mainly by a surgeon at the Ruttonjee Hospital, but the surgeon retired in October this year. PWH has therefore arranged overseas training for the doctors who will be responsible for performing this type of surgery. Some transgender people have relayed to me that as there is a lack of doctors with experience and qualifications in the relevant diagnoses in public hospitals at present, and such medical services provided by PWH are still at their early stage, they are worried that the waiting time for transgender medical services will be rather long. In this connection, will the Government inform this Council:
(1) whether it knows the number of attendances for transgender medical services in public hospitals as well as the respective numbers of people who underwent partial and full sex reassignment surgeries, in each of the past five years, together with a tabular breakdown of the figures by hospital cluster and type of sex reassignment (i.e. male to female conversion or vice versa);
(2) whether it knows the longest, shortest and average waiting times of new cases for the various transgender medical services provided in public hospitals at present (set out in a table);
(3) whether it knows the estimated number of patients to whom PWH can provide transgender medical services in each of the coming five years; whether PWH will provide medical services to the transgender people referred by public hospitals in clusters other than the New Territories East;
(4) whether it knows the current number of healthcare personnel (with a breakdown by specialty such as plastic surgery, psychiatry, endocrinology and clinical psychology) in public hospitals with experience or qualifications in transgender diagnoses; among such healthcare personnel, the number of doctors working at PWH, and the number of those who will reach retirement age in the coming five years;
(5) whether it knows the current number of healthcare personnel (with a breakdown by specialty such as plastic surgery, psychiatry, endocrinology and clinical psychology) in public hospitals who have received overseas training in transgender medical services, and among them, the number of doctors working at PWH; the number of healthcare personnel whom HA plans to send overseas to receive training in this respect in the coming five years;
(6) given that pre-sex reassignment surgery psychiatric assessment services are separately provided in various hospital clusters at present, whether it knows if HA has any plans to centralise resources by designating PWH as the sole provider of psychiatric assessment services for such type of cases across the territory; if HA does, of the projected implementation time; if not, whether HA will undertake to rationalise the assessment services in the coming year and put forward feasible proposals; and
(7) as some transgender people have relayed to me that since they have given up receiving sex reassignment surgery due to heath, family and personal reasons, they are not permitted to change the sex entries on their identity cards, and such situation has caused inconvenience to their lives, of the measures to be formulated to help these people by the Inter-departmental Working Group on Gender Recognition set up by the Government; the work progress of the Working Group so far and its next course of action?
Reply:
President,
At present, the Hospital Authority (HA) provides preliminary assessment and medical services for people with Gender Identity Disorder (GID) through its psychiatric specialist out-patient (SOP) clinics in various clusters. In general, psychological counselling services and drug treatment will be arranged for GID patients according to their individual conditions, and some of these patients may need to receive sex reassignment surgery (SRS) (commonly known as "transsexual operation"). The Prince of Wales Hospital (PWH) started to receive SRS (including male-to-female and female-to-male conversion) cases upon referral in 2015/16, while the Ruttonjee Hospital (RH) continues to provide male-to-female SRS service. The HA is planning to centralise the provision of GID-related services at the PWH, and expects to commence the services in 2016/17.
My reply to the Hon Chan Chi-chuen's question is as follows:
(1) The breakdowns of the number of GID patients being followed up by psychiatric specialist services and the respective number of persons who underwent partial or full SRS in each of the past five years are at Annex 1 and Annex 2 respectively.
(2) The HA has put in place an established triage system for new cases at the psychiatric SOP clinics to ensure that patients with urgent healthcare needs are given medical attention within a reasonable time. New cases received at the psychiatric SOP clinics will be triaged into priority 1 (urgent), priority 2 (semi-urgent) and routine (stable) cases according to their severity and urgency to ensure that more urgent and severe cases are followed up promptly.
The HA seeks to keep the median waiting time for first appointment at the psychiatric SOP clinics for priority 1 and priority 2 cases within two and eight weeks respectively. This performance pledge has been fulfilled. The waiting time for new cases in non-urgent and stable condition is relatively longer as more patients are under this category. The psychiatric SOP clinics under the HA do not maintain a breakdown of the average waiting time of new cases of specific diseases. In 2014/15, the median waiting time for first appointment at the psychiatric SOP clinics for cases in stable condition was 22 weeks. If a patient's mental condition changes before the appointment, he or she may request the psychiatric SOP clinic concerned for re-assessment to determine whether his/her original appointment should be advanced. Patients whose condition drastically deteriorates or who require urgent medical attention may consider seeking medical treatment from the accident and emergency department, and the HA will provide suitable services for them according to their needs.
(3) As mentioned above, preliminary assessment and medical services are provided for GID patients by the psychiatric SOP clinics in various HA clusters, while SRSs are conducted at the PWH and the RH. The HA is planning to centralise the provision of such services at the PWH, and expects to commence the services in 2016/17. In line with the service planning, the HA will ensure that sufficient manpower is available at the PWH to cater for the needs of GID patients. Appropriate adjustments will also be considered in the future taking into account the changes in service needs.
(4) The treatment of GID patients requires the involvement of a multi-disciplinary team which comprises professionals including psychiatrists, surgeons, endocrinologists, clinical psychologists and other allied health professionals. Since the healthcare personnel of the multi-disciplinary team provide medical services not only for GID patients, but also for patients suffering from other diseases, the HA does not maintain statistics on the number of healthcare personnel who provide treatment specifically for GID patients.
(5) The HA regularly arranges for the healthcare personnel to receive local and overseas training in respect of the medical services they provide. With commencement of the SRS service at the PWH in 2015/16, the HA also arranged relevant local and overseas training for the healthcare personnel. For example, arrangement was made for three surgeons of the PWH to receive overseas training in SRS in 2015/16. The HA will continue to arrange such training in the light of service development.
(6) As mentioned above, the HA is planning to centralise the provision of GID-related services at the PWH, and expects to commence the services in 2016/17.
(7) The Government set up an Inter-departmental Working Group on Gender Recognition (IWG), chaired by the Secretary for Justice, in mid-January 2014 to consider legislation and incidental administrative measures that may be required to protect the rights of transsexual persons in Hong Kong in all legal contexts, and to make recommendations for reform as appropriate.
The IWG's remit covers a consideration of both recognition and post-recognition issues. As regards recognition issues, the IWG is reviewing issues such as various options for a gender recognition scheme, the qualification criteria and the application procedure. As for post-recognition issues, the IWG is reviewing all the existing legislative provisions and administrative measures in Hong Kong which may be affected by legal gender recognition, so that any required legislative or procedural reform can be followed-up by the Government.
The IWG has been meeting on a regular basis and is currently focusing on the completion of a first-stage consultation paper to seek the views of the Hong Kong public on recognition issues. This work includes a comparative study of relevant laws in over 100 jurisdictions.
Ends/Wednesday, December 9, 2015
Issued at HKT 12:25
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