LCQ3: Regulation on healthcare professionals
At present, the practitioners of 26 healthcare professions are eligible to be registered as voters in the Health Services Subsector of the Election Committee. Given that 16 of those professions have not yet been included in any statutory registration system, the services provided by the practitioners of such professions (e.g. clinical psychologists, speech therapists and dietitians) lack adequate regulation, resulting in their service quality varying greatly and the public health not safeguarded. On the other hand, among the healthcare professions which have been included in a statutory registration system and are subject to regulation, the authorities have established boards for only five of them in accordance with the Supplementary Medical Professions Ordinance (SMPO). Some practitioners of those five professions have pointed out that all members of their boards are to be appointed by the Government and the incumbent chairmen are medical practitioners or dentists rather than practitioners of the respective professions. Such arrangements have resulted in a situation of professional autonomy lacking and are ineffective in promoting the development of their professions. Regarding the regulation and development of various healthcare professions, will the Government inform this Council:
(1) whether it will set up a statutory registration system for those healthcare professions which have not yet been included in any of such systems, to ensure that their practitioners provide services of professional standards, thereby safeguarding the public health;
(2) whether it will, by making reference to the composition of the Medical Council of Hong Kong, amend section 5 of SMPO to stipulate that half of the members of the board of each supplementary medical profession are to be elected by practitioners of that profession and the chairman is to be elected from among such board members who are practitioners of the profession, so as to achieve professional autonomy; and
(3) whether the Government will introduce an "Open Access" mechanism, which allows patients who need to receive healthcare services such as physiotherapy, occupational therapy and clinical psychological treatment to choose to get the services either upon referrals by medical practitioners or by approaching the professionals concerned directly, and under which practitioners of the various healthcare professions may refer patients to each other, so as to establish a healthcare system with greater flexibility?
Many developed countries or regions adopt both statutory and non-statutory mechanisms to regulate healthcare professionals. The Hong Kong SAR Government, in line with the international practice, also adopts a risk-based approach in the regulation of our healthcare professionals.
Healthcare professionals who are currently not subject to statutory registration in Hong Kong are mostly self-regulated through voluntary society-based registration. Under the society-based registration, a healthcare professional body administers a registration system and promulgates a list of its members by which the public can make reference when choosing certain type of healthcare services. The professional bodies usually formulate relevant codes of practice and develop quality assurance and disciplinary mechanisms to uphold the professional standards of their members.
My reply to the three parts of the question raised by the Hon Mrs Regina Ip is as follows:
(1) In 2013, the Ombudsman released a report on the Government's control of healthcare professions not subject to statutory registration. In brief, the Ombudsman opined that while not all healthcare professions needed statutory regulation, the Government should enhance communication with relevant professional bodies and societies, conduct regular risk assessments and provide guidance for such bodies in respect of monitoring and service standards.
The Government recognised the importance and effectiveness of the voluntary society-based registration and has decided to launch the Pilot Scheme of the Accredited Registers for Healthcare Professions (the Scheme). The Scheme aims to enhance the current society-based registration arrangements under the principle of professional autonomy, with a view to ensuring the professional competency of healthcare personnel and providing more information for the public to make informed decisions.
The Scheme operates under the principle of "one profession, one professional body, one register". As the independent Accreditation Agent of the Scheme, the Jockey Club School of Public Health and Primary Care of the Chinese University of Hong Kong sets out six major accreditation standards, including governance, operational effectiveness, risk management and quality improvement, standards for registrants, educational and training requirements, and management of the register of the professional body. Individual healthcare professional bodies will only be recognised as "accredited healthcare professional bodies" (accredited bodies) should they meet the requirements and criteria set by the Accreditation Agent.
Accredited bodies should demonstrate a broad representation of their professions and maintain a well-established operation. They should administer the register of their own professions and take appropriate actions to ensure the professional competency of their members. The public can look up the registers of healthcare professionals through the accredited bodies, which will be permitted to use an accreditation mark on their websites and on the Certificates of Registration issued to their members for the public's easy identification. Members of the accredited bodies can use a specific title on their name cards. If the public make complaints against individual healthcare professionals, the accredited bodies will take action according to their complaints handling and disciplinary inquiry mechanisms and make public the outcomes of the disciplinary actions.
(2) Healthcare professional regulatory bodies are statutory bodies responsible for regulating healthcare professions. Their composition should reflect their missions of safeguarding public health and interests. In considering the composition of the regulatory body, consideration should also be given to their functions, circumstances of individual professions and views of stakeholders. In addition to professional autonomy, we need to consider whether increasing the number of elected members can help the regulatory body achieve its mission and balance the interests of different stakeholders.
Section 5 of the Supplementary Medical Professions Ordinance (Cap. 359) (the Ordinance) provides that the Chairman of each of the five boards under the Supplementary Medical Professions Council (the Council), namely the Occupational Therapists Board, Physiotherapists Board, Medical Laboratory Technologists Board, Optometrists Board and Radiographers Board, should be appointed from among the members of the Council. Section 3 of the Ordinance provides that the Council shall consist of not more than 18 members, including a Chairman, a Deputy Chairman, not more than four public officers, three persons nominated by universities (from the University of Hong Kong, the Chinese University of Hong Kong and the Hong Kong Polytechnic University respectively), five practitioners (one each from the five supplementary medical professions), and four other persons who are not public officers.
Section 5 of the Ordinance provides that the Board Chairman, to be appointed by the Government, shall not be the person appointed from each supplementary medical profession. The current legislation allows the chairmanship of the five boards to be assumed by a member of the relevant professions or one from other sectors. The appointment of the Board Chairman is made on an personal basis taking into consideration the candidates' abilities, expertise, experience, integrity and commitment to public service. The professional background of the candidates could be one of the considerations, but the decision of appointment is made after balancing all factors. At present, the Government has no plan to amend the legislation to prescribe any specific requirement on the professional background of the Chairman.
The Government has conducted a strategic review on healthcare manpower planning and professional development in Hong Kong (the Review). The Review aims to formulate recommendations that will enable our society to meet the projected demand for healthcare manpower and foster professional development, with a view to ensuring the sustainable development of our healthcare system. The Review covers the professions which are subject to regulation under the Ordinance, namely occupational therapists, physiotherapists, medical laboratory technologists, optometrists and radiographers.
On regulatory regimes for healthcare professions, the Review covers the composition of the statutory regulatory bodies, including that of the Council and its boards. We will soon publish the review report and take forward the recommendations therein upon consultation with the stakeholders, including the Council and its boards, and the profession.
(3) Under the principle of professional autonomy, the Council and its boards currently set out practical operational procedures and referral mechanisms for their respective professions by issuing codes of practice. According to the current codes of practice or legislation applicable to the relevant supplementary healthcare professions, under normal circumstances, patients should be referred to the supplementary healthcare professions (except optometrists) for examination or treatment by prescribed persons such as doctors so as to ensure the presence of valid causes for referral based on diagnosis made through legal medical services. Otherwise, the practitioners concerned will be deemed to be in breach of the established codes of practice and subject to disciplinary actions taken by the Council and the boards concerned.
Nevertheless, the referral mechanism adopted by each profession allows a certain degree of flexibility. For example, for emergencies and under certain circumstances, a physiotherapist may be obliged to undertake some treatment without such previous referral. In such an eventuality the physiotherapist should ensure that such assessment and treatment is strictly limited to what the practitioner of physiotherapy has been trained to do.
We note that some healthcare professions have examined their respective referral mechanisms. A case in point is the dedicated working group set up by the Physiotherapists Board to review the current requirements on patient referrals.
The Government respects the decisions taken by the Council and its boards to uphold their professional standards, and will provide appropriate assistance where necessary.
Ends/Wednesday, June 7, 2017
Issued at HKT 16:10
Issued at HKT 16:10