Following is the speech by the Secretary for Health and Welfare, Dr E K Yeoh, in the motion debate on the 2001 Policy Address in the Legislative Council today (October 19):
Madam President, Honorable Members,
I would like to thank Honorable Members for their very valuable opinions and comments. I shall respond to them in the course of the next 30 minutes.
The incipient downturn of the global economy following so closely on, from the challenges and pain we are encountering in adjusting to the Asian financial turmoil and our own economic structuring process presents unprecedented challenges to us as a community. In his policy address, the Chief Executive had spoken on the strategies and initiatives which will not only reap socio-economic benefits in the longer term but also provide short term relief for the hardship and anguish the community is suffering. My colleagues have already spoken on the measures which we will be taking to stimulate the economy, how we will strengthen our efforts to net new economic opportunities, the infrastructures which will be developed to compliment the new socio-economic environment and the investments we will be making in human capital. I would now like to speak on an equally important components of our strategy, in the context of our social policies.
I would like to highlight 4 pillars of our social policies.
(i) We will invest in the different domains of human development of each person, provide opportunities for each person to develop his or her potential and enable every person to participate in and contribute to economic and social life.
(ii) We will fulfill our special social responsibilities to the disabled, disadvantaged and vulnerable members of our community, by providing specific programmes, additional support and targetted assistance to enable them develop their potential and participate fully in community.
(iii) For individuals who are economically inactive because of age, illness or disability, and for individuals who are in need of financial assistance because of unemployment, we will ensure that our social security schemes provide a safety net of income support.
(iv) We will strengthen the social fabric of the community by fostering mutual care and support, and building the social networks necessary for individuals and families to flourish.
In his Policy Address, the Chief Executive said that in face of the challenges of economic restructuring, we have to respond to new demands on social services and this is exactly what we will do.
Over the years, we have made substantial investments in social services. Our programmes in health and social welfare have risen from $28 billion and $21.7 billion in 1997-98 to $33.9 billion and $31.4 billion respectively in 2001-02. At an annual expenditure of $1.7 billion, our family and child welfare programme provides a comprehensive range of services, including family casework, family life education, family aide service, family activities and resource centres and various support services for special family groups (such as single parents, new arrivals etc.) and it still appears insufficient. At an annual expenditure of $1.2 billion, our youth welfare programmes provides a full range of developmental, preventive, supportive and remedial services to assist our young people to reach their potential and become responsible and contributing members of our society. Our spending on elderly welfare programmes is $3.2 billion every year and we provide an extensive range of residential, home and community care and support services. At an annual expenditure of over $2.6 billion, our rehabilitation welfare programmes for the disabled ranges from education and training to, employment, transport, community and residential care. And finally, at an annual expenditure of $20.7 billion, our social security system provides a basic safety net for those in need. To respond to the new demands in the coming year, we will continue our investments in various social services to enable the strength and ability of each individual in the community, flourish and grow. We will also strengthen the role of the family in nurturing and supporting its members and will work to foster mutual care and support in the community and enhance the social networks needed for families to thrive.
Additional resources have been ear-marked for a plethora of initiatives and programmes, and we estimate 3,300 new positions will be created in the process.
Health and welfare services are being re-organised to strengthen the district set-ups in order to improve responsiveness to local needs and to achieve better co-ordination in the interface of services. Our services are also being re-engineered for greater efficiency and re-created for greater effectiveness. Emphasis has been given to training and development to ensure that our colleagues in the frontline will be equipped with new knowledge and better skills to address specific problems with a more holistic approach. We will enhance our networking and outreaching services to ensure that those that need help receive help. We will also innovate one-stop services to ensure that the help that is received is the help that is needed.
The strength of Hong Kong has always been its people. Our creativeness, adaptability and resilience are precisely the qualities required in the new economic order which places a high premium on knowledge and ingenuity. There is great strength in the diversity of our community, as each member is endowed with different talents and equipped with different abilities. I see it as our mission to provide every opportunity for individuals to develop their potential, with a view to not only coping with the changes, but also emerging from them much stronger.
It is therefore important that we continue to invest in the human development of each person and in each stage of human development, provide each person opportunities for developing their full potential and enable every person to participate in and contribute to Hong Kong's economic and social life and share in Hong Kong's success. We recognize that individuals are not starting on the same footing and the situation of each person is different. Multiple and different, but complementary programmes and approaches are required to enable the strength and ability of each person to flourish and grow.
Hong Kong is a caring and compassionate society underpinned by important pillars such as the family and the community. We are obviously very sensitive to the feelings of individuals in the community who face adversities in the new economic order through, for example, the loss of jobs or relationship problems. However, families are resources of first resort for the individual. The warm and stability of relationships within families however constituted, is what counts in nurturing and supporting its members. There is no substitute for an effective functioning family. The family and the community's social network play a vital role in providing the necessary support and help to individuals to ride out the difficulties and challenges faced. Government' role is merely supportive. I very much see it as our responsibility to strengthen family solidarity, enhance partnerships amongst various sectors and foster mutual care and help in the community so that individuals are embedded in a network of care, trust, support and reciprocity. All must work together to ensure that no individual is left alone to face adversity. And every member of society should be cohesive during these trying times and offer mutual help and support to each other.
Community Investment and Inclusion Fund
The CE announced in his Policy Address, the establishment of a Community Investment and Inclusion Fund. The purpose of this is to provide resources and a vehicle to harness the beneficence, to prevalent in the community and to mobilize community action in supporting individuals and families particularly, the more vulnerable. The objectives of the Fund, which will initially benefit from a $300M capital injection, are three-fold. Firstly, to sponsor local community-based projects which support children, young people, the family, women, people with disabilities, the elderly and others with a view to strengthening the role of the community in supporting their individual functioning and development. Secondly, to encourage and facilitate cross-sectoral co-operation including working with the private sector in social networking and community support projects. And thirdly, to commission and fund research on community support issues such as, how best to strengthen the linkages between individuals, the families and the community. The programmes that been envisaged in this Fund will be complementary to the funding that I available from other sources and we are obviously evaluating the effectiveness of how the funds are used.
The Fund will be open to applications from all non-profit making organizations or groups in the community who wish to pursue at least one of these objectives. We intend to give priority to projects in receipt of some private sector funding and/or participation; to new types of service; and to those which have an investment rather than short-term consumption focus and have long-term impact. Many operational details will have yet to be worked out and we will work closely with our advisory committees and commissions in the Welfare Sector and the community in this regards.
Turning to new specific initiatives to achieve the goals that we have set out in the Policy Objectives in the coming financial year, we will strengthen and support the family in a more comprehensive, effective and client oriented manner. Under the direction of a child-centred, family-focused and community-based approach, our traditional family service centres will be re-modelled into integrated family centres to address different needs of different families. In the re-modelled centers, there will be a resource unit which will provide open and universal services to all families, a support unit for disadvantaged families and a counseling unit which will provide intensive counseling and support to families in crisis. These 3 units will provide services in a continuum. Family services will be made more accessible to families in need, have the ability to better identify problems early and intervene appropriately, and will enable us better identify and meet the needs of different families, such as families of single parents, minority groups and new immigrants.
The details of other initiatives are in our Policy Objectives booklet and I should not refer to them here.
Turning to youth, in early childhood, nurturing has a substantial effect on the child' subsequent ability to learn, the development of language skills and the development of emotions and the ability to have healthy relations with others. Our child care centres are engaging parents in the development of their young children. Many parents however, do not send their children to child care centres. To ensure the best start for our children in the pre-school period, our maternity and child health clinics will be reorientated and resourced to provide support for parenting choices and parenting knowledge and skills. The health, welfare and educational sectors will work closely with parents and families to ensure that children are provided with the best environment for their development.
As children grow into adolescence, they enter an essential formative state of life, adolescence is a time of opportunity, but it is also a period where there are many risks when taking on the challenges of this transition to adulthood. Warm supportive relationship and a conducive environment are needed to seize this window of opportunity for the healthy development of our youth. A collaborative approach of the education, health and welfare sectors working alongside families and the community is necessary. Our educational sector will develop and nurture the cognitive skills of our young people and will work towards attaining all-round development. The health and welfare sectors will develop complementary and collaborative programmes to nurture the healthy bio-social and psycho-social development of our youth. The health sector will refocus the school health services and enhance the adolescent health programmes. Health education on growth and development and changes experienced physically, psychologically and socially during maturation, and the specific areas of health and health risks, such as skills and life skills, and build new access points for adolescents to seek further advice and help.
For young people who have not encountered a conducive environment appropriate to their needs, or who have not been able to enjoy supportive relationships in the family or in the community, different interventions and additional support is required. Youth welfare service providers work closely with schools and families to provide different entry points at different stages in their lives. Together, they aim to work through problems, rebuild confidence, foster resilience and help them acquire self-care capabilities and life skills which facilitate their psychosocial development. A wide range of services is currently available to help young people in need and to handle specific problems such as drug abuse, delinquency, family discord etc. However, the complexity of these problems is on the increase and we must be prepared to adjust our programmes to ensure that we truly meet the current day needs of young people.
In addition to the programmes in the health sector, we will also be enhancing our programmes in the welfare sector. And in total we have earmarked resourses of 200M for the programmes involving the health and welfare sectors. We will extend the Understanding the Adolescent Project to all secondary schools in the next 3 years, to identify young people with poor family and social support, who are in need of guidance and to support to build up psychosocial competencies. We will provide an additional 16 Integrated Teams and will also be introducing youth peer counsellors which will be part of the Integrated Teams to provide an additional and alternative channels for youth to access help.
The Government provides a social safety net to ensure that assistance is available to the financially vulnerable. Our spending on the Comprehensive Social Security Assistance (CSSA) Scheme has increased by 54% from $9.44 billion in 1997-98 to $14.50 billion in 2001-02. Our spending on Social Security Allowance (SSA) Scheme has increased by 26% from $4.42 billion to $5.57 billion over the same period. There are over 900,000 people in Hong Kong who are receiving benefits from our social safety net. This is really quite in contrast to the comments Members have raised relating to the reluctance of people to apply for the scheme.
Many of the able-bodied unemployed recipients of CSSA in fact do not wish to rely on social assistance and are seeking opportunities for self-reliance and self-betterment. We will continue to assist those who are capable of work to find employment so as for them to become self-reliant and independent under the Support for Self-Reliance Strategy. The programme has been strengthened with the recruitment of Employment Assistance Co-ordinators who provide tailor-made assistance to able-bodied recipients of CSSA. We have had encouraging success in rebuilding confidence, rekindling self-motivation and in supporting and assisting CSSA recipients to regain employment and move towards self-reliance. A package of supportive measures will also be introduced to encourage and help single parent CSSA recipients to participate in more social and economic activities so as to prevent them from social exclusion. Having given you this discouse on CSSA, I accept the criticisms from members that there are still rooms for improvement in the administration of our scheme and certainly we will be very happy to review how the scheme is administered and how we can better meet the needs of the recipients of CSSA and those who apply for assistance.
For people with disabilities, our objective is to provide suitable rehabilitation services, support and assistance to enable them to develop their full potential and participate in the life of the community. The range of programmes is comprehensive ranging from pre-school education, to skills training, employment opportunities, transport, IT provision and training and other extensive day and residential care. Much has been achieved in this regard in recent years and we are continuing with our efforts tand the details are in the Policy booklets and I do not intend to go to them at this stage.
Care for Elders
We shall pursue a three-pronged strategy to improve the quality of life of our elderly, ensuring that they will enjoy a sense of security, a sense of belonging, and a feeling of health and worthiness.
To improve the community's understanding of ageing as a natural, continuous and positive process. The Elderly Commission will continue its efforts in promoting active and healthy ageing, with emphasis on both physical and psychosocial well-being.
We also develop a sustainable financial support system for older persons, that provides cash allowance to needy elders to meet their basic and essential needs. I shall elaborate on this issue later.
We also provide quality long-term care services in a comprehensive, client-centred and integrated manner to frail elderly. We will strengthen home and community care and support services to meet our elders' preference to age at home and to provide support to family carers. Training will be provided to carers to equip them with the knowledge and skills to care for the elderly. We will also further increase the number of subsidized residential care places and improve the service quality of private care homes.
Financial Support for Older Persons
In his Policy Address last year, the Chief Executive stated the Government's intention to provide additional financial assistance to those elderly who have meagre savings and lack family support and who depend backing on the old age allowance for a living. Since then, we have reviewed the Old Age Allowance Scheme. We have examined the financial disposition of the current and the next generation of older persons in Hong Kong and studied the arrangements for providing financial support for older persons in other countries. We have shared our findings with the Elderly Commission and the LegCo Panel on Welfare Services in June and July this year respectively.
To put the issue in perspective, I wish to point out that we have been examining our retirement income protection schemes in the context of the "three-pillar approach" recommended by the World Bank. That is, a publicly administered, privately managed mandatory provident fund; second, private savings, investments and annuities; and third, a social safety net to provide needy elderly with financial assistance to meet their basic needs. At present, over 600,000 older persons are receiving either CSSA or OAA, accounting for 60% of the population aged 60 or above, at an estimated expenditure of $11 billion in 2001-02, compared to $7.9 billion five years ago. For the population aged over 65, this accounts for 75% of the population. We need to develop a sustainable social safety net to provide financial assistance to needy older persons to meet their basic needs.
There are many complex issues involved. We need to provide additional financial assistance to those older persons who currently are relying on the OAA as their main source of income. At the same time, we have to bear in mind that there will be a group of older persons in the next generation who are currently on low income or have little family support when they grow old, who are likely to require financial support from our safety net after their retirement. Overseas experience suggests that the old age allowance could not be turned into a universal basic pension, funded from general revenue, to all older persons. Our currently low and simple taxation system could not sustain such a scheme. Even countries with higher tax rates and the Social Insurance Scheme find that such an approach increasingly difficult to sustain.
The Government will be spending more money in future years to provide direct financial assistance to needy older persons. The demand for it will be increasing given the growth of our ageing population. The Social Security Schemes currently accounts for 9% of total public recurrent expenditure. How to achieve our objectives of providing additional financial assistance to older persons in need and at the same time ensuring that we have a sustainable safety net for that purpose is a very complex issue. We will undertake a further review of our schemes and hope to be able to consult the community at a later stage.
Our policy objective is to develop and maintain in Hong Kong a health care system which protects and promotes the health of the population, which provides lifelong holistic care to each citizen at affordable prices, and which is financially sustainable in the long term. The provision of such a system will achieve the aim of enhancing the quality of life of the population and enabling individuals to develop their full human potential.
It was with this fundamental objective in mind that we issued in December 2000 for public consultation the document on health care reform entitled "Lifelong Investment in Health". The document set out 11 strategic reform proposals and 33 initiatives for the three main components of our health care system - organization and provision of health services, mechanisms for assuring the quality of care and the funding and financing of health services. The consultation period had ended and we reported the responses received to the public in July 2001 and to this Council. For the reform proposals that have received general support from the community, particularly those relating to health services delivery and quality assurance, we are working out and taking forward implementation plans so that the public can see for themselves quickly the tangible benefits of the reforms. For proposals which need further consideration, in particular those relating to the long-term financial sustainability of the health care system, we are having further deliberations and in-depth studies and will be consulting the public at a later date.
Specifically on the issue raised by the Hon Emily Lau on the health care financing, in fact, the three strategic directions set out in the consultation document are:
- to reduce cost and enhance productivity;
- to revamp public fees structure;
- to establish Health Protection Account.
On the issue of reducing cost and enhancing productivity, the Hon Dr Lo Wing-lok spoke on the measures that the Hospital Authority are currently taking to improve its productivity. I think all those are appropriate and as a member of health care expert, I think Dr Lo should also recognize that there are many issues in the application of technology and the use of drugs which really need to be managed appropriately. In fact, the worldwide literature shows that drugs are not taken by 50 per cent of the patients to whom that they are prescribed. So there is a need for mechanism to ensure drug compliance. Medical technology has led to many benefits but medical technology has also led to many risks. And if it is used inappropriately, it can drive up unnecessarily the cost. So all these technologies have to be managed appropriately and there is nothing wrong in terms of having appropriate mechanisms to look at the effective and appropriate use of medical technology and drugs. And I do not apologize for that.
There is certainly no policy currently in the public sector to increase the portfolio of private medical services. Currently in the Hospital Authority, one per cent of the hospital beds are designated for private use. This has all been the percentage and we have not increased this percentage in the last decade. There is no policy at the moment to increase that sector of private hospital services in the public sector.
Our proposed legislative amendments to the Smoking (Public Health) Ordinance aim at further protecting members of the public against the harmful effect of passive smoking in public indoor premises and further restricting the promotion of tobacco products.
Impact on the Catering Industry
As regards the concerns expressed by the Honorable Tommy Cheung over the potential impact on the catering industry, I would like to re-assure all Honorable Members that the Government will consider the potential economic impact of our proposals. A study performed by the Hong Kong Council on Smoking and Health, on the impact of smoke-free policies on the patronage of restaurants in Hong Kong concluded that 97% of respondents either would not change their eating-out patterns (77%) or would go to eat out more often (20%). Only 3% declared they would eat out less often. The increased business generated by the smoking ban is likely to exceed any loss of business by a considerable margin. It is estimated that, at a minimum, about 450,000 additional meals would be sold per week.
COSH also reviewed 34 studies in the United States of America and Canada which examined the impact of smoking restrictions on restaurant and bar sales. The investigators used taxable sales receipts, number of restaurants, employment rates, proprietor estimations of changes in sales, consumer estimates of patronage, patron estimates of changes in number of customers, estimates of gratuities received and costs of regulating smoking to assess the effect on restaurant and bar businesses. 31 out of the 34 studies demonstrated an absence of any negative impact on sales. 11 of these actually found a positive effect with revenues increasing. Of the 3 remaining studies, all were based on expectations of future behaviour and two of them were associated with the tobacco industry. We have engaged an independent consultant company to conduct a comprehensive Regulatory Impact Assessment (RIA) Study to evaluate the potential economic impacts on different industry sectors, including the catering industry. The report is being finalized by the consultant and should be ready for release in the coming weeks. We will examine the findings carefully together with the findings all relevant studies conducted on this subject, including the report done by the Honorable Tommy Cheung.
We should also bear in mind that the economic consideration apart, the Government and employers are duty bound to protect restaurant employees and customers from exposure to passive smoking, the hazard of which is well proven and documented. But I just wish to give you some figures here. It is estimated that 50 per cent of people smoke eventually die from a smoking-related disease. And for every eight persons who die for smoking, one person who does not smoke dies with them. And this is from the effects of passive smoking. It is also well known that there are carcinogen of cancer-causing substances in smoke and this is even more prevalent I the sideline of passive smoking as it is not filtered. And it is also very well known that for people who are in rooms of other people smoke that you find cancer-causing substances in the blood and urine. So are these things we should just neglect? There is a 25 per cent increase risk of cancer and of heart disease of people who are exposed to second hand smoking. So these are just things and figures that this Council may wish to consider when we come back to you later the year to report back the outcome of the public consultation and our proposed final legislative recommendations. The Honourable Dr Lo Wing-lok has also written in some of the newspapers. It is likely that the legislative timetable is not going to be looking at our proposals until the year 2002/2003. And we have already stated in our consultation document that we also provide a grace period for the industry to adjust. So we are really talking about the year 2004 before any of these proposals will in effect.
Members have talked about the response to the increase in the number of deaths resulting from suicide. The causes of suicide are complex, normally multi-faceted in nature and unique to each individual. Effectively preventing and reducing suicide requires the concerted efforts of everyone in the community.
For its part, the Government continues to attach considerable importance to handling this issue. The inter-departmental task group has met to review our strategies and programmes. Our inter-sectoral and multi-disciplinary approach provides a wide range of preventive, supportive and remedial services. Considerable efforts are made in public education and publicity and in the training of our frontline professionals.
However, the Administration is sensitive to the need to do more to help those with suicidal tendencies. And in our Policy Objectives this year, we will be introducing additional suicide-prevention programmes, especially on preventing elderly suicide and we have earmarked additional resources for the public sector to launch its programmes.
Let me reassure Hon. Members that we remain committed to preventing and reducing suicide in our community, as far as possible and will continue our search for new ways to achieve this aim.
Madam Chairman, I would like to assure Members that the Government is acutely aware of the hardship an anquished community is suffering. And our social policies are designed to do all we can to support members of the community ride through this period of hardship and hope that members of the community will work with us and Members of this Council will cooperate with us in achieving those objectives. Thank you.
End/Friday, October 19, 2001