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LCQ14: Elective total joint replacement surgery of public hospitals
     Following is a question by the Hon Lam So-wai and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (December 14):
     According to the Report on Key Performance Indicators published by the Hospital Authority (HA) in September this year, the waiting time at 90th percentile for elective total joint replacement surgery for the year from July 2021 to June 2022 was 72 months, which was lengthened by 16 months when compared with 56 months for the year before that. This situation has caused patients affected by knee osteoarthritis and associated pains to have to wait as long as six years before they can receive the surgery. As a result, they have to suffer from joint pains for a longer period of time. In this connection, will the Government inform this Council:
(1) whether it knows the reasons for the increase in the waiting time for the aforesaid type of surgery;
(2) whether it knows if the HA will take further measures to alleviate the problem of excessively long waiting time for the aforesaid type of surgery; if the HA will, of the details; if not, the reasons for that; and
(3) whether it will consider launching a public-private partnership programme for the aforesaid type of surgery; if so, of the details; if not, the reasons for that?
     In response to the question raised by the Hon Lam So-wai, my consolidated reply in consultation with the Hospital Authority (HA) is as follows:
     In view of the ageing population in Hong Kong coupled with the rising risk of degenerative joint conditions with age, the number of patients requiring joint replacement surgery in HA hospitals has continued to increase in the past few years. In addition, the HA has been making adjustments to non-emergency and non-essential healthcare services from time to time including some of the total knee joint replacement surgeries, in response to the development of the COVID-19 epidemic in Hong Kong, so as to focus the deployment of manpower, resources, and beds for coping with the epidemic situation. As a consequence, the waiting time for total knee joint replacement surgery has increased recently.
     At present, prioritisation of the waiting list takes into account patients' clinical conditions and needs, arrangements are made having regard to the urgency of patients' conditions. The HA has been closely monitoring the service demand, patients' waiting time and changes in the epidemic situation, as well as taking active measures to manage the waiting time of patients for joint replacement surgery, in order to cope with the increasing service demand more effectively while minimising the impact on patients. Apart from gradual resumption of elective surgery, increasing the provision of total joint replacement surgery from 3 057 cases in 2019 to 3 522 cases in 2022, the HA has also introduced a series of measures, including:
(i) Adopt high volume surgical model
     The HA has successively adopted the high volume surgical model in each cluster, streamlining the diagnosis and pre-operation investigation workflow to increase service capacity. Subject to available resources, the HA will consider extending the model to suitable hospitals in due course.
(ii) Promote non-surgical treatment
     The HA has introduced some non-surgical treatment that are clinically proven to be effective, such as systematic non-interventional treatment plan that provides additional physiotherapy out-patient services for patients who are waiting for joint replacement surgery to help them relieve the symptoms of osteoarthritis and improve their physical functioning. The HA commenced non-surgical treatment in clusters progressively and systematically from 2021-21. As at October 2022, over 5 500 patients benefitted from this service.
(iii) Triage and prioritisation
     The Orthopaedics Coordinating Committee of the HA has formulated the triage and prioritisation system for elective surgeries such as joint replacement surgery to ensure patients whose conditions require early intervention are treated with priority.
(iv) Increase transparency
     The HA has uploaded to its website the waiting time for joint replacement surgery to help patients understand the waiting time for HA services and make appropriate decisions on treatment options and plans.
     As for the launch of Public-Private Partnership (PPP) Programme for joint replacement surgery, the HA will carefully consider relevant factors when exploring a new PPP Programme, including the service needs of the HA, suitable patient categories, potential complexity of the programme, the capacity and adaptability of the private market, and whether the programme may affect the turnover of specialist doctors in public hospitals.
     The HA will continue to communicate with the public and patient organisations and work closely with stakeholders to explore the feasibility of implementing other PPP Programmes to meet public demand for healthcare services.
Ends/Wednesday, December 14, 2022
Issued at HKT 15:45
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