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Following is a question by Dr Hon Joseph Lee Kok-long and a reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (July 4):
Question:
During the term of the last Government, a number of medical incidents and drug safety problems occurred and the manpower shortage of nurses and allied health staff became more acute. Moreover, quite a number of health policy initiatives (including enhancing primary care services, promoting public-private partnership (PPP) in healthcare and implementing subsidy schemes which embody the "money follows patient" concept) introduced by the last Government are still underway, and how the manpower of healthcare and allied health staff will be affected by the direction of development of such initiatives in the future is of public concern. With the formal inauguration of the Government of the new term, in respect of issues such as the manpower planning of healthcare and allied health staff and their professional development in the future, will the Government inform this Council:
(a) whether the authorities will increase the manpower of nurses and allied health staff, so as to reduce the chance of occurrence of medical incidents; if they will, of the details; if not, the reasons for that;
(b) whether the Steering Committee on Strategic Review on Healthcare Manpower Planning and Professional Development will conduct any review of or make any strategic recommendation (e.g. setting a minimum nurse-to-patient ratio) on the manpower planning of nurses and allied health staff; if it will, of the timetable and details; if not, the reasons for that; regarding the professional development of allied health staff, as no legislation is in place at present to regulate the practising qualifications of some of these staff, whether the authorities have drawn up any target or strategic recommendation, so as to complete as early as possible legislating for the regulation of such qualifications; if they have, of the details; if not, the reasons for that; and
(c) regarding the promotion of primary care services and PPP programmes in healthcare, of the latest direction and target of the long-term development set by the authorities; whether they have any plan to enhance the roles of nurses and allied health staff in these two aspects; if they have, of the details; if not, the reasons for that; whether the authorities will consider extending subsidy schemes which embody the "money follows patient" concept, etc; if they will, of the details and whether the manpower planning of nurses and allied health staff will be affected; if not, the reasons for that?
Reply:
President,
A healthcare system of high quality and efficiency is the cornerstone of social development. Over the years, Hong Kong has developed a healthcare system that provides quality services for the community. We have made outstanding achievements on healthcare, and healthcare professions have upheld high professional and ethical standards. At the same time, the system is facing many challenges arising from an ageing population, an increasing occurrence of lifestyle-related diseases and the need to keep pace with rapid development in medical technology. In the face of these challenges, we have to improve the existing healthcare system, focusing on the fundamentals including enhancing primary care services, strengthening the public healthcare safety net, promoting the development of healthcare services and public-private partnership (PPP) so as to balance the roles of public and private sectors in the healthcare system, as well as formulating a long-term strategy on healthcare manpower planning and professional development, with a view to facilitating the healthy and sustainable development of our healthcare system.
My reply to the various parts of the question is as follows:
(a) Every medical procedure involves a certain degree of risk. With the innovation and advancement of medical technology, treatment procedures have become more sophisticated, and the risks involved have also increased. The occurrence of medical incidents is attributable to varying causes. The change of a patient's conditions and the efficacy of treatment can also be affected by a number of factors, including the emergence and development of symptoms, the stability or otherwise of a patient's condition, whether the patient is suffering from multiple diseases, as well as the known risks of the treatment procedures, side-effects of drugs and emergence of complications, etc. It is therefore necessary to conduct detailed analysis before any conclusion can be made about whether a medical incident is caused by known risks, complications, clinical conditions of the patient or human factors.
While we cannot rule out the possibility of medical incidents, we can minimise their occurrence by improving the existing mechanism and staffing arrangement. The Hospital Authority (HA) and the Department of Health have always attached great importance to the quality of healthcare services and patient safety. They have established mechanisms and promulgated guidelines for the reporting and handling of medical incidents by public and private hospitals respectively. They also seek to enhance the efficiency of the reporting mechanisms from time to time, investigate each and every serious medical incident carefully and put forth improvement measures, with a view to preventing the recurrence of similar incidents.
Improving clinical governance system is imperative to reducing medical incidents. In view of this, HA seeks to ensure service standards and continues to improve service quality through implementation of various schemes on hospital accreditation, clinical audit, monitoring and improving the effectiveness of surgical services, as well as mechanisms for introducing new medical technology and handling drugs, etc. HA has also engaged overseas experts to conduct a review on its clinical governance system with reference to international standards. HA will study and follow up on the improvement recommendations as appropriate upon completion of the review. Meanwhile, we are working on a review of the Hospitals, Nursing Homes and Maternity Homes Registration Ordinance, particularly in respect of the service standards of private hospitals and transparency of the fees they charge, with a view to further improving the service quality of private hospitals and safeguarding patients' right to know.
HA will recruit additional staff as and when necessary to enhance its service capacity and quality, and to alleviate pressure on staff. HA plans to recruit an addition of about 290 full-time doctors, 2 000 nurses and 550 allied health professionals in 2012-13.
(b) 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. The review covers healthcare professionals from 13 professions which are subject to statutory regulation, including medical practitioners, nurses and allied health practitioners covered under the Supplementary Medical Professions Ordinance. The Steering Committee will assess manpower needs in the various healthcare professions and put forward recommendations on how to cope with anticipated demand for healthcare manpower, strengthen professional training and facilitate professional development having regard to the findings of the strategic review, with a view to ensuring the healthy and sustainable development of Hong Kong's healthcare system.
Given the complexity and diversity of the issues involved in the review, and as the healthcare industry engages a considerable number of personnel coming from a wide range of disciplines, for the purpose of the present review we will focus on the 13 healthcare professions which are subject to statutory regulation. As for disciplines currently not subject to statutory regulation, the views on future development of the relevant professions can be suitably reflected through the relevant consultative sub-group formed under the Steering Committee. The review is in progress and expected to be completed by 2013.
(c) To promote primary care services, the Government has formulated the overall strategy for primary care development in Hong Kong and been implementing the strategy in three major areas through a step-by-step approach, including developing primary care reference frameworks for different chronic diseases and age groups, setting up a Primary Care Directory, and drawing up feasible service delivery models including community health centres and networks. In addition, we have rolled out a series of chronic disease management programmes through HA. This includes the provision of various healthcare services by multi-disciplinary teams of healthcare professionals, such as the provision of health risk assessments and follow-up care for patients with diabetes mellitus and hypertension by nurses and allied health professionals in General Out-patient Clinics, and targeted treatment services for high-risk chronic patients by multi-disciplinary teams comprising nurses, physiotherapists, occupational therapists and pharmacists, with a view to providing the most comprehensive and appropriate primary care services.
We also hope to enhance primary care services through the implementation of various pilot projects, such as the Elderly Health Care Voucher Pilot Scheme (the EHCV Scheme) and the Pilot Project on Outreach Primary Dental Care Services for the Elderly. The EHCV Scheme is one of the subsidy schemes where we put the "money-follows-patient" concept to test. It enables elders aged 70 or above to choose primary care services from the private sector. Since the implementation of the EHCV Scheme in 2009, the annual voucher amount of each eligible elderly person has been increased to $500, which can be used for services provided by western medical practitioners, Chinese medicine practitioners, dentists, nurses, chiropractors and allied health professionals including optometrists, occupational therapists and physiotherapists. As for the way forward of the EHCV Scheme, we will continue to listen to the views of the community and actively examine the feasibility of further fine-tuning other details of the Scheme.
Apart from enhancing primary care services, promoting PPP in hospital services is also an important attempt in improving the healthcare system. To this end, the Government has implemented a number of pilot PPP projects through HA, including subsidising eligible patients to receive cataract surgeries, haemodialysis services and radiological imaging services for designated cancers in the private sector. HA will consolidate the experience gained from the implementation of these pilot projects and map out their way forward, and make recommendations on how to improve the design and arrangements of future PPP initiatives. Looking ahead, we will continue to make good use of the resources of the private healthcare market and ease the pressure on the public healthcare system through PPP collaboration.
When delivering healthcare services, we will closely monitor the manpower situation of various healthcare professions and respond accordingly in resource allocation, manpower training and planning so as to facilitate the sustainable development of our healthcare system.
Thank you, President.
Ends/Wednesday, July 4, 2012
Issued at HKT 13:24
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