Replies to LegCo questions
LCQ3: Regulation on healthcare professionals
Following is a question by the Hon Mrs Regina Ip and a reply by the Secretary
for Food and Health, Dr Ko Wing-man, in the Legislative Council today (June 7):
Question:
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?
Reply:
President,
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
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