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LCQ1: Development in elderly healthcare services to cope with population change
     Following is a question by the Hon Alvin Yeung and a reply by the Secretary for Food and Health, Professor Sophia Chan, in the Legislative Council today (December 13):


     According to the population projections released by the Census and Statistics Department in September this year, the number of elderly persons aged 65 and above will rise from over 1.16 million at present to 2.37 million by 2036 (accounting for about 30 per cent of the total population across the territory at that time), and the number of elderly persons is projected to be over 2.3 million for at least 30 years afterwards. There are views that the existing manpower of medical practitioners in the elderly-related specialties has already been stretched to the limit, and the elderly population doubling in future will aggravate the situation. With regard to coping with the forthcoming silver tsunami, will the Government inform this Council:

(1) given that there are only 21 and 160 locally registered medical practitioners specialised in palliative medicine and geriatric medicine respectively, of the details of the authorities' plan to train these two types of specialists in Hong Kong in the next five years, including the estimated expenditure and the manpower target;

(2) whether it will discuss with the two faculties of medicine the designation of palliative treatment as a compulsory subject in the specialty of family medicine, and subsidise the existing 433 registered medical practitioners specialised in family medicine to attend courses on palliative medicine; if so, of the details; if not, the reasons for that; and

(3) as the Government proposed in the Policy Agenda released in October this year that it would conduct public consultation on the implementation of the Law Reform Commission's recommendations on enacting legislation to extend the scope of an enduring power of attorney to include matters relating to the personal care of the donor, of the latest progress of such work, as well as the respective timetables for conducting public consultation and enacting legislation?



     My reply to the various parts of the Hon Alvin Yeung's question is as follows:

(1) The Hospital Authority (HA) provides palliative care and elderly healthcare services through multi-disciplinary teams comprising doctors, nurses, allied health professionals and supporting grade staff. As at November 2017, there are more than 40 doctors, 300 nurses and 60 allied health professionals (on a full-time equivalent basis) providing palliative care service under the HA. In order to plan and further enhance the quality and sustainability of its palliative care service as well as to cope with the increasing demand, the HA developed the Strategic Service Framework for Palliative Care this year, so as to guide the development of palliative care service for the coming five to ten years. Strategies and directions for improving adult and paediatric palliative care were also formulated. 

     Geriatrics is a subspecialty under the specialty of medicine, of which elderly patients are the major service users. As at the end of 2016, there were 1 292 doctors working in the specialty of medicine under the HA.

     The HA will regularly review the demand for various medical services (including palliative care and geriatric services) and plan for the development of such services according to factors such as population growth and changes, advancement of medical technology and healthcare manpower, and collaborate with community partners to better meet the needs of patients.

(2) Currently, there are two colleges in Hong Kong, i.e. the Hong Kong College of Physicians and the Hong Kong College of Radiologists, that provide specialist training and award specialist qualification on palliative care to doctors who aspire to obtain such qualification. These two colleges are under the Hong Kong Academy of Medicine (HKAM). Operating under the principle of professional autonomy, HKAM is an independent statutory body established under the Hong Kong Academy of Medicine Ordinance (Cap 419). HKAM and its colleges have statutory power to organise, monitor, assess and accredit all medical specialist training and to oversee the provision of continuing medical education.

     The specialist training of family medicine is currently provided by the Hong Kong College of Family Physicians (also one of the colleges under the HKAM), featuring comprehensive, continuing, whole-person and preventive care for individuals and families so as to ensure their physical, psychological and social well-being. By providing continuing and comprehensive healthcare services with focus on individual- (or patient-) centred care, family doctors are well-positioned to tackle various acute and chronic diseases and provide appropriate palliative care for the needy patients in primary care settings. In addition, family doctors will, in accordance with clinical assessment, refer patients to palliative care service for treatment as and when appropriate. As for the designation of palliative medicine as a compulsory subject in the specialty of family medicine, it is the prerogative of the Hong Kong College of Family Physicians.

     Under the new Strategic Service Framework for Palliative Care, the HA will enhance training in three aspects to cover the staff of different specialties, settings and grades. Firstly, basic training on palliative care will be enhanced to give all healthcare colleagues an understanding of the concepts and principles of palliative care. Secondly, training will be arranged for non-palliative care teams working directly with patients who are suffering from life-threatening or life-limiting illnesses. Thirdly, apart from taking care of patients with complex palliative care needs, the palliative care team also offers consultative service and support to teams of other specialties. As such, the palliative care team needs continuous specialist training to consolidate the provision of specialist palliative care service. Meanwhile, they will also acquire knowledge of other specialties, such as nephrology, cardiology and pulmonary, in treating terminal diseases so as to strengthen cross-specialties co-operation and communication.

(3) The Law Reform Commission of Hong Kong (LRC) published the Report on Enduring Powers of Attorney: Personal Care (the Report) in July 2011. The Report recommended that the scope of an enduring power of attorney be extended to cover not only the decisions on a donor's property and financial affairs, but also decisions on the donor's personal care.

     The Department of Justice (DoJ) has convened an inter-departmental working group (IWG) to examine the Report. Representatives from the Labour and Welfare Bureau, the Food and Health Bureau and the Social Welfare Department are members of the IWG. After careful consideration of the views and recommendations of the LRC and those provided by members of the IWG, the DoJ has prepared the proposed Continuing Powers of Attorney Bill with a view to implementing the recommendations made in the Report.

     The Bill proposes to formulate a new piece of legislation titled the Continuing Powers of Attorney Ordinance. The purpose of the Bill is to replace the existing scheme of enduring power of attorney (EPA) with a new regime known as the continuing power of attorney (CPA) so as to distinguish it from an EPA created under the existing Enduring Powers of Attorney Ordinance (Cap 501). More specifically, the Bill aims to provide for a statutory framework for the creation of CPAs, under which the donor confers on the attorney authority to act for (including making decisions for) the donor in relation to the personal care (note), property and financial affairs of the donor. As in the case of an EPA, a CPA will survive the subsequent mental incapacity of the donor. Whilst new EPAs may no longer be created after the commencement of the Continuing Powers of Attorney Ordinance, EPAs executed prior to that date would continue to be governed by the Enduring Powers of Attorney Ordinance. 

     The Government plans to launch a public consultation exercise on the above matters by the end of December 2017. Subject to the results of the public consultation, the Continuing Powers of Attorney Bill is expected to be introduced into the Legislative Council in the second quarter of 2018. 

Note: Under the new CPA regime, (1) the Chinese rendition of "attorney" is "承權人", instead of "受權人" under the existing EPA regime; and (2) the Chinese rendition of "personal care" is "個人照護", instead of "個人照顧" used in the Report. "照護" has the meanings of "taking care of" and "providing nursing care", which can more accurately reflect the matters to be covered by this term in the draft Bill.
Ends/Wednesday, December 13, 2017
Issued at HKT 17:42
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