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LCQ20: Demand for public medical services

     Following is a question by the Hon James To Kun-sun and a written reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (May 30):


     The statistics of the 2011 Population Census reveal that the population of Hong Kong continued to grow older during the last 10 years, and the number of people aged 65 and over had exceeded 940 000, representing approximately 13% of Hong Kong's total population. With a growing elderly population, the demand for healthcare services will increase.  In this connection, will the Government inform this Council:

(a) given that in reply to a question from a Member of this Council on January 11, this year, the authorities indicated that having considered the information submitted by the Hospital Authority (HA), the Government had accepted in principle the proposals on the redevelopment of Kwong Wah Hospital and Queen Mary Hospital, and the redevelopment plans of Yan Chai Hospital and Caritas Medial Centre had also been initiated, whether the authorities have any plan at present to redevelop other hospitals; if so, of the plan;

(b) given that the Chief Executive announced in the 2008-2009 Policy Address that the Government would explore the concept of Community Health Centres (CHCs) as one of the policy initiatives on enhancing primary care, and the first CHC was set up in Tin Shui Wai in the first half of 2012, when the Government will review this policy initiative and set up CHCs in other districts; of the relevant details;

(c) whether the Government will, in the coming five years, construct additional general or specialist outpatient clinics for use by the grassroots; if so, of the breakdown by year and district;

(d) given that the public housing estates in the Kai Tak Development Area are expected to accommodate approximately 34 000 residents, and the first batch of units will be available for occupation in 2013, whether the Government will, in response to the growing population of the district, establish additional public clinics or public hospitals in the district, or strengthen the connections between hospital clusters, so as to cater for the healthcare needs of additional residents in Kowloon East; if so, of the details;

(e) given that there will be an upsurge in the demand for healthcare personnel, the Chief Executive stated in the 2011-2012 Policy Address that $200 million would be allocated to increase the number of first-year first-degree places in medicine by 100, nursing by 40 and allied health professions by 146, but, with the redevelopment of the hospitals referred to in (a), whether the Government needs to train additional healthcare personnel, so as to meet the manpower needs after the completion of redevelopment; if so, of the details; and

(f) given that the Chief Executive-elect stated in his policy platform that in order to respond to changes in society such as an expected ageing population, HA should embark on an overall review of its management and staff systems, working hours, cost benefits and service levels in accordance with its own positioning, whether it knows if HA is conducting similar studies at present, so as to enhance the cost-effectiveness in using resources; if HA is conducting such studies, of the details?



(a) The Hospital Authority (HA) reviews the conditions of the structures and facilities of its 41 public hospitals annually in order to prioritise and allocate resources for the implementation of various maintenance and improvement works.  In planning for the redevelopment of existing hospitals as necessary, HA will take into account the future population growth and demographic changes in different regions, the demand for healthcare services, the overall provision of healthcare services in the various clusters under HA, the conditions of the hospitals' structures and facilities, HA's long-term objectives and strategies for its overall service development, as well as the development of public and private healthcare services.  Before the implementation of any redevelopment project, HA has to carry out preliminary planning work, including various preliminary technical assessments to ascertain the project's technical feasibility.

     In the past years, we have obtained funding approval from the Legislative Council (LegCo) for various capital works projects, including expansion, redevelopment, relocation and renovation of existing hospitals, improvement of various hospital facilities and equipment, and constructions of new hospitals.  For the existing term of the Government, the LegCo Finance Committee has approved a funding of over $9.7 billion for implementation of seven capital works projects on hospital facilities.  The capital works projects which will be completed in the next five years include Phase I of the North Lantau Hospital, the Redevelopment of Caritas Medical Centre Phase 2, the Redevelopment of Yan Chai Hospital and the Tin Shui Wai Hospital.  Moreover, HA will soon commence the necessary detailed planning and design for taking forward the redevelopment of Kwong Wah Hospital and Queen Mary Hospital and the expansion of United Christian Hospital.

(b) In the face of challenges posed by ageing population, rising medical costs and increasing demand for healthcare services, the Government is now making efforts to take forward the healthcare reform with enhancement of primary care being the first and foremost task.  We have formulated a development strategy for implementation through various fronts to enhance the primary care in Hong Kong, including exploration of different feasible models for delivery of primary care services as well as devising and launching appropriate pilot projects such as setting up of community health centre (CHC) and networks to promote the provision of community-based primary care services through collaboration among various sectors.  The first CHC in Hong Kong based on this model will commence operation in Tin Shui Wai in June 2012.  We will review the effectiveness of this service delivery model with reference to the operational experience of the CHC in Tin Shui Wai and further explore ways to extend similar services to other districts in need of enhanced primary care services having regard to the planning of other services.

(c) Public general out-patient (GOP) services mainly target at low-income individuals, the elders and chronic disease patients.  Patients taken care of by GOP clinics can be mainly divided into chronic disease patients with stable conditions and episodic disease patients with relatively mild symptoms.  In order to improve public primary care services, to provide enhanced support to chronic disease patients and to raise the public's awareness about their health, the Government has rolled out a series of chronic diseases management programmes through HA.  These include the provision of health risk assessments and specific care for patients with diabetes mellitus or hypertension by multi-disciplinary teams of healthcare professionals so as to reduce the risk of complications among these patients and the number of their attendances at clinics so that more quota can be made available in GOP clinics for episodic disease patients.  Besides, HA is also implementing a series of measures, including renovation and facilities upgrading at existing GOP clinics, actively hiring more staff and improving the workflow in the clinics etc., in order to enhance its services and service capability.

     In addition, a number of HA hospital construction/redevelopment projects are now underway for provision of additional/enhanced specialist out-patient services in the next five years.  These include the North Lantau Hospital Phase 1, the Redevelopment of Caritas Medical Centre Phase 2, the Redevelopment of Yan Chai Hospital and the Tin Shui Wai Hospital.  We will continue to monitor the demand for primary care services in each district and make flexible deployment of manpower and other resources having regard to the relevant factors, so as to provide the local community with appropriate public primary care services.

(d) In planning for provision of public healthcare services, HA takes into account a number of factors, including the projected demand for healthcare services having regard to population growth and demographic changes, the growth rate of services of individual specialties and the possible changes in healthcare services utilisation pattern etc. To cope with the increasing service demand in the Kai Tak Development Area, HA has allocated additional resources to the Kowloon East (KE) Cluster and Kowloon Central (KC) Cluster for provision of additional services in the past few years.

     For KE Cluster, the expansion of Tseung Kwan O Hospital (TKOH) will be completed in 2013. By then, 178 additional beds will be provided and the number of consultation rooms in the specialist out-patient department will increase to 70. Other services and facilities of TKOH will also be expanded accordingly to meet its increased service capacity.  The United Christian Hospital will also be expanded.  Its expansion is expected to be completed in 2021. New facilities and services to be provided under the expansion project include a cancer centre for the KE Cluster, an ambulatory centre and rehabilitation/convalescent beds.  Facilities such as the accident and emergency department, intensive care unit, operation theatres and specialist out-patient clinic will also be expanded.  Other additional or enhanced services provided in the past few years include setting up a new cataract centre in TKOH, enhancement of clinical oncology services, and introduction of palliative care for patients with end stage renal disease etc.

     Services of various departments will also be strengthened under HA's KC Cluster, including more long-term dialysis treatment for end-stage nephrosis patients, extension of the service hours of the primary Percutaneous Coronary Interventions service, enhancement of the service of the diabetic care centre, implementation of a new mode of service delivery for positive emission tomography scan and computerised tomography scan services etc.  HA will also open additional beds in the cardiac care unit and the neonatal intensive care unit and establish a new adult blood donor centre at Queen Elizabeth Hospital (QEH), and plan for the reprovisioning of Yaumatei Specialist Clinic at QEH so as to meet the growing demand.

(e) In view of the manpower requirements for healthcare professionals, for the three years starting from 2012, the Government will allocate an addition of $200 million to increase the number of first-year first degree places in medicine by 100 to 420 per year, nursing by 40 and allied health professional by 146.

     In addition, based on the outcome of the Second Stage Public Consultation on Healthcare Reform, the Government has set up a high-level steering committee, chaired by the Secretary for Food and Health, to conduct a strategic review on healthcare manpower planning and professional development in Hong Kong. It has also invited the University of Hong Kong to conduct, by scientific and objective methods, a comprehensive manpower projection for healthcare professions covered in the strategic review. In making the projection, we will take into account the increase in demand for healthcare arising from the ageing population, changes in the delivery model of healthcare services, and the new and the additional demand brought by the service reform in the healthcare sector etc.

(f) HA constantly keeps its management structure under review in an effort to ensure that overall it can provide quality healthcare services to the public in a more effective manner.

     In 2007, HA conducted a review on the cluster management structure which was formally implemented in 2001. In early 2011, HA further followed up on the cluster structure review conducted in 2007.  After thorough consultation, HA made further improvements on the cluster management structure by streamlining and standardising the existing roles of the management positions in all clusters, service re-engineering, as well as appointment of Deputy Hospital Chief Executives and designated Specialist Clinical Co-ordinators and Cluster Service Directors in order to define more clearly the powers and responsibilities of all hospitals and departments under each cluster and facilitate efficient delivery of appropriate and holistic services to the public.

     The HA Head Office also conducts review on its structure and related issues from time to time. After a review on its structure in 2006, the HA Head Office re-shuffled the business areas of its various divisions and established a Quality and Safety Division, a Strategy and Planning Division, and a Cluster Services Division.  In 2011, HA commissioned a consultant to conduct a follow-up review on the structure of the HA Head Office which was reorganised in 2006.  HA is now implementing the consultant's recommendations step by step to further strengthen the HA Head Office's functions in cluster co-ordination, corporate communications, staff communications and grade management.  In addition, subsequent to the review, HA has proceeded to set up a consolidated corporate risk management framework to identify and handle the potential risks faced by HA in its various business areas.

     To ensure the best use of resources for delivery of quality services to the public, HA has been adopting an approach that integrates its service planning and resource allocation through a structured framework and defined process.  As for service planning, the drawing up of the annual plans at hospital and cluster levels is guided by the overall direction and priority service planning at the corporate level.  Both the HA budget and the resource allocation among hospital clusters are put to the Finance Committee and the Administrative and Operational Meeting of the HA Board for consideration and endorsement.  The allocation of resources within each cluster is essentially based on the service programmes and targets as defined in the process of drawing up the annual plan.

     HA has also put in place a resource management framework, under which resource inputs are linked up with service outputs, targets and quality standard, enabling the HA Head Office to monitor and evaluate the use of resources at cluster level in an objective manner through a financial and performance reporting system. The clusters are requested to submit regular reports to the HA Head Office to show its performance indicators in regard to its service activities, manpower and financial situation, clinical outcome and progress of its annual plan.  HA will examine closely any variations from the pre-determined targets and where appropriate, take remedial actions with corresponding adjustment in resource allocation.

     Generally speaking, HA will continue to keep its structure and operation under review taking into account such relevant factors as demographic changes, the trend of diseases and public expectations.  It will also keep abreast of the latest developments to enable appropriate adjustments to be made in an effort to provide quality services to the community.

     As a matter of fact, HA has already implemented an array of new services in New Territories West and Kowloon East in response to changes in service demand. For example, the New Territories West Cluster has increased 150 beds since 2010, opened additional beds in the neonatal intensive care unit and an Autologous Haemopoietic Stem Cell Transplant centre in the Tuen Mun Hospital; and newly opened a CHC in Tin Shui Wai for provision of primary care services.  For Kowloon East Cluster, apart from the expansion on TKOH and United Christian Hospital, other additional or enhanced services provided in the past few years include the addition of about 100 beds, setting up a new cataract centre in TKOH, opening of blood transfusion centre for adult thalassaemia patients in UCH, enhancement of clinical oncology services, and introduction of palliative care for patients with end stage renal disease etc.  This demonstrates that HA has the determination and ability to advance with the times and provide the public with quality services.

Ends/Wednesday, May 30, 2012
Issued at HKT 17:01


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