Replies to LegCo questions
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):
Question:
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?
Reply:
President,
(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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