2017 was a rather tough year for healthcare professionals in Hong Kong. In addition to the summer flu outbreak, release of the healthcare manpower report and numerous medical malpractices, the issue of manpower shortages across medical professions was once again put under the spotlight. However, aside from these controversial topics, 2017 was undoubtedly another big year for public health, as policies for primary healthcare and reform of the Medical Council were introduced throughout the year. Here’s a roundup of 2017’s #Top10 key highlights from the local health industry.

1. Summer flu outbreak

Hong Kong witnessed one of its worst bouts of seasonal influenza earlier this year, which lasted from mid-May until the end of August, resulting in a total of 428 deaths and an additional three deaths from paediatric cases. During this period, many mainland tourists cancelled their visits to the city as a precaution, which prompted Secretary for Food and Health, Professor Sophia Chan, to explain that the mortality rate was comparable to previous figures, and that the government had already clarified the state of summer influenza to the corresponding department in mainland China.

19 cases of severe influenza-associated complication or death (three deaths) were detected.
19 cases of severe influenza-associated complication or death (three deaths) were detected.

At the height of the summer flu outbreak, the Hospital Authority (HA) announced the suspension of all hospital accreditation activities until June 2018 to alleviate non-clinical duties and additional pressure of healthcare staff. A few days later, HA also revealed that it had reached an agreement with St Teresa’s Hospital to receive patients from public hospitals. In addition, a total of 48 beds would be made available to transfer patients with stipulated conditions. The day after the Centre for Health Protection announced the end of the summer influenza season, HA declared that an additional 500 beds would be added to prepare for the winter influenza peak season, and that most of the beds would be added to public hospitals in Kowloon and New Territories.

2. Healthcare manpower report

The Strategic Review on Healthcare Manpower Planning and Professional Development report was released to the public in June – highlighting 10 key recommendations regarding manpower supply, professional development and regulation to address the increasing trend of manpower shortages across medical professions, among others.

The report predicted a shortage of doctors, dentists, dental hygienists, general nurses, occupational therapists, physiotherapists, medical laboratory technologists, optometrists and radiographers. Recommendations included further increases in the number of subsidised training places, retaining manpower by attracting retired professionals to work part-time, recruiting non-locally trained professionals, making continuing professional education and development a mandatory requirement, as well as regulating healthcare professions not subject to statutory registration.

Dr Pierre Chan responded to the government’s healthcare manpower report in the Legislative Council’s meeting.
Dr Pierre Chan responded to the government’s healthcare manpower report in the Legislative Council’s meeting.

Critics stated that the report failed to make accurate predictions regarding the shortages – with some saying it exaggerated the issue as it failed to estimate the capacity provided by private doctors that were less responsive to the government's study, while others suggested that the report underestimated the demand for doctors and nurses and did not accurately reflect the manpower needs that the city, with a growing ageing population, would require in the near future.

3. United Christian Hospital’s liver failure blunder

The United Christian Hospital is often said to be allocated with far less resources than hospitals in other clusters. Photo credit: Baycrest
The United Christian Hospital is often said to be allocated with far less resources than hospitals in other clusters. Photo credit: Baycrest

Two renal specialists at the United Christian Hospital failed to prescribe an anti-viral drug whilst treating a Hong Kong mother, Tang Kwai-sze, with high dosage steroids for a kidney condition in January. Tang, a hepatitis B carrier, subsequently suffered from acute liver failure, required two liver transplants, and eventually succumbed to infection in late August. The hospital was heavily criticised by the public and lawmakers for delaying communication with the patient’s family and delaying the announcement of the medical mistake to the public.

HA formed an investigative panel to probe into the reasons for the medical blunder, and revealed that the doctors displayed an insufficient level of vigilance, and that a heavy workload was also a contributing factor. The panel refused to comment whether the two doctors would be suspended from their duties or disciplined by the hospital. This raised concerns regarding the evading of responsibilities from both senior management and the doctors, and whether this would lead to the public losing faith in HA and even the organ donation scheme.

4. Rare disease patients

Earlier this year, the death of a young mother, Chi Yin-lan, suffering from a rare genetic disease, tuberous sclerosis complex (TSC) characterised by the growth of benign tumors in vital organs, has put a spotlight on the lack of rare disease policies in Hong Kong and ignited a public debate on whether the government should subsidise expensive medication for rare disease patients. Chi couldn’t afford the medicine that could have saved her life, and left behind her 13-year-old daughter who also suffers from the same condition.

In response to an open letter penned by 23-year-old spinal muscular atrophy (SMA) patient, Josy Chow, in early October, Chief Executive Carrie Lam made a personal pledge to ensure that the best efforts would be made into ensuring quick access of treatment for SMA, a genetic disease characterised by the loss of muscle mass and motor neurons. Under Secretary for Food and Health, Dr Chui Tak-yi also announced that the government has been working closely with the pharmaceutical company to accelerate the access of the newly approved drug, Spinraza, to SMA patients.

Currently, Hong Kong has no clear definition of rare diseases, no accurate count of local incidences and no formulated funding policy to support rare disease patients. According to the Hong Kong Alliance for Rare Diseases (HKARD), it is estimated that here are around 7,500 patients living with rare diseases in the city. Out of an estimated 85 SMA patients, 20 of them suffer from the most severe form of the condition.

5. New Secretary and Under Secretary for Food and Health announced

Newly elected Chief Executive Carrie Lam appointed Professor Sophia Chan as the new Secretary of Food and Health in mid-2017 – making Chan the only woman to serve in Lam’s cabinet. Chan has previously worked as the Under Secretary for Food and Health under the leadership of Dr Ko Wing-man for five years. She has also worked in academia and research prior to working with the government, where she was the Head of the School of Nursing and Director of Research at the University of Hong Kong.

Two months later, it was announced that Dr Chui Tak-yi, previously the Cluster Chief Executive of Kowloon East Cluster and Hospital Chief Executive of United Christian Hospital (since July 2014), would be appointed as the Under Secretary for Food and Health. Chan referenced Chui’s experience in working with elderly, in hospital care and with the community as being an asset in assisting her to push forward future policies.

6. Primary healthcare committee set-up

The government announced the establishment of the Steering Committee on Primary Healthcare Development in late November, to review the existing planning of primary healthcare services in the city and formulate a blueprint for sustainable development of such services – including devising service models to provide primary healthcare services via district-based medical-social collaboration in the community.

The establishment of the committee is aimed to reduce the demand for hospitalisation.
The establishment of the committee is aimed to reduce the demand for hospitalisation.

With support from the Working Group on District Health Centre Pilot Project in Kwai Tsing, the committee will take on the role of establishing a pilot district health centre in that district, with the aims of boosting public awareness on disease prevention and health self-management, while also providing support for the chronically ill. The government will subsequently use the experiences gained from the pilot project to set up additional district health centers around the city.

7. Increase in public accident and emergency fees: from HKD100 to HKD180

In view of both rising costs and demand for services as well as public concerns of increased financial burden after the HA proposed a fee increase to HKD220, the Hong Kong government increased the fees for public accident and emergency (A&E) – from HKD100 to HKD180 – to offset healthcare costs.

The fee hike to HKD180 aims to encourage the appropriate use of public healthcare services and relieve the burden on emergency departments, while concurrently addressing the public’s concerns of increased medical costs.

There was an 18% drop in the number of non-critical patients that sought medical attention at A&E services in August compared to May, before the fee increase. Additional data analysis would be needed to make any conclusions on the effectiveness of the fee increase. In addition, there are concerns regarding whether the increase in A&E fees in public hospitals would result in reduced access to emergency healthcare among the poor and underprivileged – since there was a significant price difference of at least HKD200 between A&E services in public hospitals compared to private clinics.

8. Revised proposal for composition of Medical Council

In October, the government announced the formulation of a revised proposal for the composition of the Medical Council, which is in charge of the licensing and discipline of medical practitioners and the regulation of professional practice and conduct. Under the new plan, the Hong Kong Academy of Medicine, which represents specialist doctors, would have an additional two seats added to their existing two – in which two seats would be appointed by the government while two would be elected by academy board members. The total number of seats in the Council would remain at 32, with HA and the Department of Health (DH) both losing a seat and having just one representative each.

This move was made in an attempt to boost the council’s accountability and to expedite the handling of medical complaints, as the council has long been criticised for operating as a ‘closed shop’ and taking too long to discipline doctors. Two additional members from the academy could help ensuring medical standards and level of professionalism in the council, while also addressing relevant issues in the council.

9. HA runs into deficit, but seniors receive pay raise

HA reported a deficit of HKD1.52 billion this year, their first financial deficit in eight years since 2009 – 2010. Healthcare expenditure increased by HKD3.2 billion this year, totaling to HKD62 billion. In response to the rising demand for hospital services and increases in annual public health spending, Chief Executive Carrie Lam announced the allocation of an additional HKD2 billion of annual funding for the authority, which manages 42 public hospitals and institutions in the city.

Secretary for Food and Health, Sophia Chan further emphasised the need to strengthen primary health care services at the district level to prevent overcrowding at public hospitals.

However, most of the healthcare expenditure from last year was spent on staff payrolls, which increased by almost 7%. The top five highest-paid executives were paid a total of HKD27.1 million, with the Chief Executive of the Authority, Leung Pak-yin, gaining a 4.3% pay raise and pocketed HKD6 million.

10. Five healthcare professions preliminarily assessed to meet criteria for accreditation process of accredited registers

Dr Charles Pau (first from right, back row) and Dr Kitty Wu (first from left, front row) from Division of Clinical Psychology (DCP) at Hong Kong Psychological Society (HKPS) shared with MIMS the significance of AR Scheme to clinical psychologists and allied health professionals.
Dr Charles Pau (first from right, back row) and Dr Kitty Wu (first from left, front row) from Division of Clinical Psychology (DCP) at Hong Kong Psychological Society (HKPS) shared with MIMS the significance of AR Scheme to clinical psychologists and allied health professionals.

The Jockey Club School of Public Health and Primary Care of the Chinese University of Hong Kong (JCSPHPC) was appointed as the independent accreditation agent for the government’s Pilot Scheme of the Accredited Registers for Healthcare Professions, in which five healthcare professions including speech therapists, clinical psychologists, educational psychologists, audiologists and dietitians were preliminary assessed to meet accreditation criteria under the first phase of the scheme. Once the professional body is accredited, it will be responsible for administering the register of its profession.

Accredited professional bodies would be permitted by Department of Health (DH) to use an accreditation mark on their websites and on the Certificate of Registration issued to their members, which would allow for easy identification by the public and help them make informed decisions about healthcare services. The first profession of the five to be accredited were speech therapists, with the accreditation process estimated to be completed by the fourth quarter of 2017.

Aside from doctors, nurses and pharmacists, other healthcare professions are not subjected to statutory regulation. Therefore, any individual can claim to be a clinical psychologist and the public wouldn’t have any reliable information to check their qualifications. The accreditation scheme spearheaded by DH will attempt to address this issue and help protect the public’s interests. MIMS

Read more:
More than just manpower shortage: Why does HA fail to address overburden over the years?
CUHK Nursing's Director shares her take on manpower and maximising the role of nurses in Hong Kong
Public interest priority: Hong Kong clinical psychologists geared up for Accredited Registers (AR) Scheme