1 HONG KONG LEGISLATIVE COUNCIL -- 3 July 1991 HONG KONG LEGISLATIVE COUNCIL -- 3 July 1991 1
OFFICIAL REPORT OF PROCEEDINGS
Wednesday, 3 July 1991
The Council met at half-past Two o'clock
PRESENT
HIS EXCELLENCY THE GOVERNOR (PRESIDENT)
SIR DAVID CLIVE WILSON, G.C.M.G.
THE CHIEF SECRETARY
THE HONOURABLE SIR DAVID ROBERT FORD, K.B.E., L.V.O., J.P.
THE FINANCIAL SECRETARY
THE HONOURABLE SIR PIERS JACOBS, K.B.E., J.P.
THE ATTORNEY GENERAL
THE HONOURABLE JEREMY FELL MATHEWS, C.M.G., J.P. THE HONOURABLE ALLEN LEE PENG-FEI, C.B.E., J.P. THE HONOURABLE CHEUNG YAN-LUNG, C.B.E., J.P.
THE HONOURABLE MRS SELINA CHOW LIANG SHUK-YEE, O.B.E., J.P. THE HONOURABLE MARIA TAM WAI-CHU, C.B.E., J.P. DR THE HONOURABLE HENRIETTA IP MAN-HING, O.B.E., J.P.
THE HONOURABLE CHAN YING-LUN, O.B.E., J.P. THE HONOURABLE MRS RITA FAN HSU LAI-TAI, O.B.E., J.P. THE HONOURABLE PETER POON WING-CHEUNG, O.B.E., J.P. THE HONOURABLE CHENG HON-KWAN, O.B.E., J.P. THE HONOURABLE CHUNG PUI-LAM, O.B.E., J.P. THE HONOURABLE MARTIN LEE CHU-MING, Q.C., J.P. THE HONOURABLE DAVID LI KWOK-PO, O.B.E., J.P. THE HONOURABLE NGAI SHIU-KIT, O.B.E., J.P.
THE HONOURABLE PANG CHUN-HOI, M.B.E.
THE HONOURABLE POON CHI-FAI, J.P.
PROF. THE HONOURABLE POON CHUNG-KWONG, J.P. THE HONOURABLE SZETO WAH
THE HONOURABLE TAM YIU-CHUNG
DR THE HONOURABLE DANIEL TSE, C.B.E., J.P. THE HONOURABLE ANDREW WONG WANG-FAT, O.B.E., J.P. THE HONOURABLE LAU WONG-FAT, O.B.E., J.P.
THE HONOURABLE GRAHAM BARNES, C.B.E., J.P. SECRETARY FOR PLANNING, ENVIRONMENT AND LANDS
THE HONOURABLE MICHAEL LEUNG MAN-KIN, J.P. SECRETARY FOR TRANSPORT
THE HONOURABLE EDWARD HO SING-TIN, J.P.
THE HONOURABLE MARTIN GILBERT BARROW, O.B.E. THE HONOURABLE MICHAEL CHENG TAK-KIN, J.P.
THE HONOURABLE DAVID CHEUNG CHI-KONG, J.P.
THE HONOURABLE RONALD CHOW MEI-TAK
THE HONOURABLE MRS NELLIE FONG WONG KUT-MAN, J.P. THE HONOURABLE MRS PEGGY LAM, M.B.E., J.P.
THE HONOURABLE DANIEL LAM WAI-KEUNG, J.P.
THE HONOURABLE MRS MIRIAM LAU KIN-YEE
THE HONOURABLE LAU WAH-SUM, O.B.E., J.P.
DR THE HONOURABLE LEONG CHE-HUNG
THE HONOURABLE LEUNG WAI-TUNG, J.P.
THE HONOURABLE JAMES DAVID McGREGOR, O.B.E., I.S.O., J.P. THE HONOURABLE KINGSLEY SIT HO-YIN
THE HONOURABLE MRS SO CHAU YIM-PING, J.P.
THE HONOURABLE JAMES TIEN PEI-CHUN, J.P.
THE HONOURABLE MRS ELSIE TU, C.B.E.
THE HONOURABLE PETER WONG HONG-YUEN, J.P.
THE HONOURABLE MRS ANSON CHAN, J.P.
SECRETARY FOR ECONOMIC SERVICES
THE HONOURABLE MRS ELIZABETH WONG CHIEN CHI-LIEN, I.S.O., J.P. SECRETARY FOR HEALTH AND WELFARE
THE HONOURABLE ALISTAIR PETER ASPREY, O.B.E., A.E., J.P. SECRETARY FOR SECURITY
THE HONOURABLE JOHN CHAN CHO-CHAK, L.V.O., O.B.E., J.P. SECRETARY FOR EDUCATION AND MANPOWER
THE HONOURABLE ALBERT LAM CHI-CHIU, J.P.
SECRETARY FOR HOME AFFAIRS
ABSENT
THE HONOURABLE STEPHEN CHEONG KAM-CHUEN, C.B.E., J.P. THE HONOURABLE HO SAI-CHU, O.B.E., J.P.
THE HONOURABLE HUI YIN-FAT, O.B.E., J.P.
THE HONOURABLE TAI CHIN-WAH, J.P.
THE HONOURABLE MRS ROSANNA TAM WONG YICK-MING, O.B.E., J.P. THE HONOURABLE RONALD JOSEPH ARCULLI, J.P.
THE HONOURABLE PAUL CHENG MING-FUN
IN ATTENDANCE
THE CLERK TO THE LEGISLATIVE COUNCIL
MR LAW KAM-SANG
Papers
The following papers were laid on the table pursuant to Standing Order 14(2): Subject
Subsidiary Legislation L.N. No.
Registration of Persons (Application for New Identity Cards) (No. 10) Order 1991.......................... 238/91
Employees Compensation Assistance Ordinance 1991 (Commencement) Notice 1991........................... 239/91
Tax Reserve Certificates (Rate of Interest) (No. 3) Notice 1991.................................................. 240/91
Sessional Paper 1990-91
No. 79 -- Report of changes to the approved Estimates of Expenditure approved during the final quarter of 1990-91
Public Finance Ordinance: Section 8
No. 80 -- 1990 Annual Report by the Commissioner of the Independent Commission Against Corruption
No. 81 -- Annual Report 1990-91
Securities and Futures Commission
Addresses by Members
Report of changes to the approved Estimates of Expenditure approved during the final quarter of 1990-91
Public Finance Ordinance: Section 8
FINANCIAL SECRETARY: Sir, in accordance with section 8(8)(b) of the Public Finance Ordinance, I now table for Members' information a summary of all changes made to the approved estimates of expenditure for the final quarter of the financial year 1990-91.
Supplementary provision of $6,672.9 million was approved. This included $4,966.6 million for the implementation of the 1990 pay adjustment, the restructuring of directorate salary scales, the second and third reports of non-directorate salary structure review and the recommendations of the Standing Committee on Disciplined
Services Salaries and Conditions of Service in respect of the Civil Service and government subvented organizations. Of the amount of $6,672.9 million, $6,282.9 million was offset by savings under the same or other heads of expenditure or by the deletion of funds under the Additional Commitments subheads. The remaining $390.0 million was net supplementary provision.
Approved non-recurrent commitments were increased by $31.8 million during the period, and new non-recurrent commitments of $895.0 million were also approved.
In the same period, a net decrease of 206 posts was approved.
Items in the summary have been approved either by Finance Committee or under delegated authority. The latter has been reported to the Finance Committee in accordance with section 8(8)(a) of the Public Finance Ordinance.
1990 Annual Report by the Commissioner of the Independent Commission Aganist Corruption
DR TSE: Sir, as Chairman of the Advisory Committee on Corruption, I am pleased to introduce the 1990 Annual Report by the Commissioner of the Independent Commission Against Corruption, which is tabled today in this Council.
The Operations Department of the Commission meets its obligations by investigating all allegations of corruption, regardless of their origin. In 1990 the number of reports to the Commission alleging corruption was 2 400, a
decrease of 1% on the figure for 1989.
Two points of particular significance were first that 1 390 of these reports were capable of investigation, the third highest number in any one year since the Commission was established in 1974. One important factor was that the proportion of persons prepared to identify themselves when reporting alleged corruption was as high as 66%. As a result of this development, during the year the Operations Department had the largest case-load it has had since 1974.
Second, although corruption allegations involving the public service increased by 9% compared with 1989 and allegations in respect of the private sector decreased by 9%, the private sector at 1 205 still accounted for more than half of the total. The main reason for the decline in reports involving the private sector was that whereas there had been elections to district boards in 1989 there were no elections in 1990. In practice the complexity of the private sector cases continued to increase,
largely because the investigation of such corruption so often leads to investigations of complicated commercial fraud facilitated by corruption.
As a result of the number of allegations capable of investigation, the number of persons prosecuted and cautioned in 1990 was 402, the fifth highest so far. At 73% the conviction rate remained most satisfactory.
One consequence of the high proportion of allegations involving the private sector has been that the Corruption Prevention Department has still been receiving a fair number of requests from private sector organizations to advise them on methods to prevent corruption and fraud. The Department assisted 154 organizations in this way during the year.
At the same time, the Corruption Prevention Department was able to complete 13% more studies for Government and public bodies than it did in 1989. It also gave extensive advice to government departments and public bodies formulating new policies and adjusting existing ones, so as to keep opportunities for corruption to the
absolute minimum.
Another reason for the number of allegations capable of investigation, for the high proportion of allegations involving the private sector and for the requests for advice from the private sector on measures to prevent corruption and fraud, was the appropriate publicity the Community Relations Department has been giving through
direct contacts with the public and through the mass media. The Department has put much effort into getting the anti-corruption message across to the private sector.
Another object on which the Community Relations Department concentrated was to encourage the public to come forward with any suspicions of corruption they may have. This work is particularly important. Once more the results indicate the Department's success. The Commission's surveys of public opinion confirm this view.
Another important target for the Community Relations Department is young people. The Department's role here is to educate the young against corruption. It has had much valuable support in this direction from teachers.
Sir, in his review chapter the Commissioner has expressed his thanks to members of the four advisory committees for their invaluable advice on the Commission's work they have given during the year. He has also paid a warm tribute to the staff of the Commission who put so much devoted effort into tackling corruption during the year. I am well aware that, overall, corruption is becoming increasingly
sophisticated and its investigation more difficult and time consuming. Additional challenges facing the Commission are the Bill of Rights and the investigation of offences deriving from all the elections this year. I am confident that the Commissioner and his staff will meet these challenges with dedication and resolve.
Oral answers to questions
Anti-inflationary measures
1. MRS FONG asked: In addition to the announcement made by the Government in this Council on 29 May 1991 that it would freeze for the next nine months all planned increases in departmental fees and charges which had not been announced by 1 June 1991, can the Administration demonstrate its intention to curb inflation by taking the following measures:
(a) to announce that it will instruct all departments to embark on efficiency reviews and cost reduction programmes;
(b) to implement an anti-inflationary budget in 1992-93;
(c) to appeal to the municipal councils to freeze fees and charges for nine months;
and
(d) to appeal to the private sector to seek ways to increase their efficiency and to maintain fees and charges at their existing levels?
FINANCIAL SECRETARY: Sir, in answer to the first part of Mrs FONG's question, the Finance Branch constantly reminds different departments of the Administration of the need to improve efficiency and seek cost savings. Top down reviews and value for money studies have been employed in the Administration for much of the past decade. I gave in my 1991-92 Budget earlier this year some details of a number of initiatives designed to achieve a reduction in the overall cost of Government expenditure.
As to part (b) of Mrs FONG's question, she will be well aware that inflation is only one of the factors that has to be taken into account in framing budgetary proposals. Any Budget should be appropriate to the overall fiscal and economic circumstances of the day. I will not seek to commit my successor to any specific budgetary policies or initiatives. Next year's Budget is for him, not for me. However, I have no doubt that he will wish to keep a firm control on public expenditure.
Incidentally, the last five Budgets that I have presented have consistently been based on the strategy of running a Budget surplus, an entirely appropriate strategy in times of rising inflation. Furthermore, Members may recollect that in my last Budget I indicated our intention to introduce a programme of government borrowing, again an appropriate measure in relation to our policy of reducing inflationary
pressures.
As to part (c) of Mrs FONG's question, Members will be aware that the Municipal Councils are autonomous in their financial affairs. And, to be fair, they are more reliant on fee income than is the Government in meeting their expenditure needs. It would, in my view, be more meaningful, as an anti-inflationary measure, to consider ways of reducing expenditure growth.
The Regional Council has little room to manoeuvre given the need to provide services to the growing population in the new towns. However, I am sure the Regional Council fully recognizes the need to exercise restraint. The Urban Council, to its credit, has undertaken not to increase the existing strength of the Urban Services Department for the next three years. Any freeze in the levels of fees and charges
should be left to the individual Municipal Councils to decide.
As regards the private sector, Sir, I repeat what I said in the motion debate on 29 May this year. The Administration through its restraint is pointing the way. But if we are to attack inflation successfully, the community as a whole must play its part.
MRS FONG: Sir, I would like to pursue the Financial Secretary's answer by asking a question relating to the private sector. Has the Government been in discussion with the private sector regarding joint efforts to curb inflation? And what assistance and encouragement has the Administration considered providing to the private sector in this respect?
FINANCIAL SECRETARY: Sir, there have been no formal discussions with the private sector but the Government's views have certainly been conveyed to various influential people in the private sector. As far as assistance to the private sector is concerned it is difficult to imagine what sort of assistance would be appropriate. Certainly, I would not imagine that financial assistance would be at all the right thing to give.
MR DAVID CHEUNG: Sir, in his answer the Financial Secretary mentioned that top down reviews and value for money studies have been employed by the Administration for much of the past decade. Would the Financial Secretary kindly inform this Council how many departments have actually done that, as a result of which how much money has been saved?
FINANCIAL SECRETARY: Sir, we have had major studies in a number of departments: in the Registrar General's Department, the Government Property Agency, the Legal Department, the City and New Territories Administration, the Electrical and Mechanical Services Department, the Labour Department, and the Water Supplies Department. Overall, as far as top down studies and value for money studies are concerned, over the last four years more than 2 500 posts have been deleted with annual recurrent savings of some $500 million.
MR TIEN: Sir, regarding the part of the Financial Secretary's reply on the private sector's effort to tackle inflation, would the Administration please inform this Council whether the importation of labour programme will be further expanded with a view to containing excessive wage increases which contribute to high inflation?
FINANCIAL SECRETARY: Sir, we have from time to time indicated that there is a case for the selective importation of labour; we continue to examine this question and we do indeed have some proposals under consideration.
MR PETER WONG: Sir, it is all very well for the Finance Branch to continuously send reminders to departments to improve their efficiency. Would the Secretary advise what concrete action the Finance Branch takes in respect of those departments which either refuse to respond or move very slowly?
FINANCIAL SECRETARY: Sir, I discussed this question in the Budget debate at some length and Members may recollect that I referred to the Star Chamber, the body chaired by the Chief Secretary involving myself and policy branch Secretaries. This body, the Star Chamber, is intimately and deeply involved in the resource allocation
exercise. Great restraint is exercised over departments; very often their cases for new staff or new initiatives are cut down or disallowed altogether.
MR BARROW: Sir, could the Financial Secretary advise if the top down reviews include consideration of further privatization and corporatization? And if not, could he explain the reasons?
FINANCIAL SECRETARY: Sir, we do indeed consider at all times the possibility of privatization or corporatization but we look for the benefits; we do not want to get caught up in privatization and corporatization exercises just for their own sake.
MR POON CHI-FAI (in Cantonese): Can the Government inform this Council whether in addition to rallying the support of the private sector in tackling inflation, it will set an example by playing a leading role in freezing the rent of public housing at
its present level? This not only can curb inflation but also relieve the middle to lower income group from their predicament as their living standard, due to price spiral, has dropped with life becoming very difficult.
FINANCIAL SECRETARY: Sir, we have indeed approached the Chairman of the Housing Authority and suggested to him that there should be some restraint. But of course the Housing Authority has its own programmes to meet and its own Budget to manage.
MRS FAN: Sir, in relation to the private sector, does the Government intend to make it clear to public transport and utility companies that any application for increase in fees, charges and fares in the next nine months will not be viewed with sympathy by the public and the Government will have to take that view into account?
FINANCIAL SECRETARY: I think that message, Sir, is well understood by the chairmen of the two railway corporations and also no doubt by the bus companies.
MRS FONG: I would like to follow up on the answer regarding the municipal councils. Even though they have financial autonomy, they do derive their income from rates and fees and charges. Has the Government talked to the municipal councils regarding the freezing of fees and charges for the nine months?
FINANCIAL SECRETARY: Yes, Sir.
MR EDWARD HO: Sir, a large element of inflation is due to the high housing costs recently, and this is directly attributable to the shortage of land supply for residential development. Will the Administration consider releasing more land for residential development?
FINANCIAL SECRETARY: Sir, as Mr HO knows, we have some constraints in relation to the releasing of more land under the terms of the Joint Declaration. In any event, if we were to release a great deal of extra land, I very much doubt whether there
is the capacity in the economy to form the land and produce the buildings. The supply of land is certainly something that we keep under constant review.
Tree planting in old urban areas
2. MRS LAM asked (in Cantonese): In view of the vigorous launching of environmental protection campaigns in Hong Kong in recent years, will Government inform this Council whether any policy on tree planting on streets in old urban areas has been drawn up? If not, what are the reasons?
SECRETARY FOR PLANNING, ENVIRONMENT AND LANDS: Sir, our policy statement about tree planting in streets, such as it is, is very simple. It is included in Hong Kong Planning Standards and Guidelines and states "wherever possible footways, median strips and roadside areas should be designed to accommodate planting". Simple and limited it may be, but it and the perseverance of the municipal councils, the Highways Department and some district boards have ensured that we do in fact have trees in most footways, median strips and roadside areas where they are possible and in Wan Chai in some places where they are seemingly impossible.
Sir, although it may be hard to trace an obvious policy umbrella for provision and planting of trees, in practice we have a policy -- for want of a better word -- of making financial provision for tree and amenity planting on all our new streets, and I am pleased to say that as far as I know the Finance Committee of this Council has never quibbled about any provision for these purposes. The municipal councils too provide generously for trees all over their respective areas. We may have started systematic provision of trees later than Singapore and our streets are undoubtedly more crowded than they are there, but we are still doing pretty well.
With that said, Sir, the departments concerned have been discussing the tree planting problem together recently and they agreed that a more comprehensive policy would help them in their efforts to plant more trees, particularly where there is competition for pavement space which is in almost all the older areas. An
interdepartmental working group on urban trees has been formed, and is expected to propose more detailed standards for tree provision.
MRS LAM (in Cantonese): Sir, thank for the Secretary's reply. May I know whether the Government has conducted a survey on streets in old urban areas so that we can find out where we can plant trees and where we cannot? If not, will such a survey be conducted in the future?
SECRETARY FOR PLANNING, ENVIRONMENT AND LANDS: Sir, something of that kind is under consideration by the working party.
MR McGREGOR: Sir, has Government given thought to the possibility of the private sector assisting in the planting of trees by donating the funds required, because I notice that in some districts funds are running short for this purpose?
SECRETARY FOR PLANNING, ENVIRONMENT AND LANDS: Sir, many tree planting schemes, both great and small, have been fostered and encouraged with the private sector providing for trees. The most notable recent one was a very large scheme in Central. MR PETER WONG: Sir, will the Secretary please confirm that when the interdepartmental working group meet to consider it, there will be a policy to facilitate private concern groups to plant trees in our urban and other open spaces?
SECRETARY FOR PLANNING, ENVIRONMENT AND LANDS: Sir, I can certainly ensure that the interdepartmental working group consider that possibility.
MR LAM (in Cantonese): Environmental protection campaigns in Hong Kong are now in full swing. Can the Government inform this Council of the role the 19 district boards and the two municipal councils play in them?
SECRETARY FOR PLANNING, ENVIRONMENT AND LANDS: Sir, that question sounded slightly wider than the one on tree planting. But if I may narrow it down to what the boards and councils can do about tree planting, I think that the Wan Chai District Board has already set an example in that they have organized tree surveys in the area and obtained advice which has resulted in a tree planting programme. Some of the trees may not be faring so well now, judging from this morning's paper, but the bulk of
them in fact are doing very well.
MRS LAM (in Cantonese): Sir, can the Government inform this Council whether the Highways Department will follow Singapore's example and consider reserving spaces for tree and amenity planting at the sides of newly built footbridges and flyovers in future?
SECRETARY FOR PLANNING, ENVIRONMENT AND LANDS: Sir, Members will in fact have seen that several of our flyovers do in fact incorporate this. However there is always the consideration as to whether this is suitable. This may be ruled out for lack of room, and planting strips may not be suitable and they may not be able to be cared for. All these are taken into consideration but the Highways Department is very conscious of the need to "green up" their roads and also their flyovers.
MRS LAM (in Cantonese): Sir, I know that we cannot plant trees on some streets, but will the Government consider placing some green or potted plants in those streets so as to "green up" the old urban areas?
SECRETARY FOR PLANNING, ENVIRONMENT AND LANDS: Sir, this is certainly done. I mean in many different areas one can see that there are concrete "planters", as they are called, and they are all over the urban area. I think it is simply a question of the Urban Council putting more plants into these planters, and the Urban Council has steady provision for more greening of the urban area and I have no doubt that these planters will increase.
Physical fitness test scheme
3. DR IP asked: Will Government inform this Council whether it will consider introducing a physical fitness test scheme for adults in Hong Kong to promote physical fitness and setting an example by encouraging all civil servants to undergo such tests on an annual basis?
SECRETARY FOR HOME AFFAIRS: Sir, in a report by the then Council for Recreation and Sport in August 1989, a recommendation was made to establish a physical fitness scheme. However, consideration of this recommendation was deferred pending the formulation of an overall strategy by the Hong Kong Sports Development Board for the future
development of sports and physical recreation in Hong Kong.
The Hong Kong Sports Development Board has now produced a strategic plan for actions for the period 1991-95. The main emphasis of this plan is on the development of sporting excellence to international standards, the nurturing and training of young athletes, and the strengthening of major sports organizations. The extension of sporting facilities and opportunities for young people through a network of
community sports clubs will also receive priority attention.
In the light of this plan, and given the limited resources available, there is no plan in the foreseeable future to introduce a physical fitness test scheme generally for adults on the lines suggested by the Honourable Member.
However, that is not to say that physical fitness does not receive proper attention in Hong Kong. The two municipal councils do organize a varied and substantive programme of courses and activities to promote physical fitness ranging from multi-gym fitness course, tai chi, aerobic dance, judo and roller skating to canoeing, fencing, athletic training and many others. Furthermore, physical fitness facilities, including some first-class gymnasia under professional supervision, are readily available and easily accessible to members of the public in indoor games halls, indoor recreation centres and sports centres operated by the two municipal councils.
As regards civil servants, physical fitness tests are conducted for staff of the disciplined services regularly and annually to ensure that they are fit to perform their duties. Similar tests do not apply to civilian grades for whom physical stamina, although desirable, is not a primary job requirement.
However, civil servants may arrange medical examinations with government hospitals and clinics on a need basis.
MR DAVID CHEUNG: Sir, will the Government inform this Council whether it will consider, as a long-term measure, requiring students to produce annually or biannually a certificate of physical fitness before they can be officially enrolled or re-enrolled
in schools?
SECRETARY FOR HOME AFFAIRS: Sir, that is really a matter for my colleague, the Secretary for Education and Manpower. But I do know that in the Education Department they have introduced a Physical Fitness Award Scheme for primary students some two years ago, and for secondary students since this year.
MR PETER WONG: Sir, is there a case to mandate all Legislative Council candidates to pass fitness tests to make them eligible for election to this demanding Council? And in a lighter vein, should there be a "wakefulness test" for long Legislative Council sessions? (Laughter)
SECRETARY FOR HOME AFFAIRS: Sir, the present provisions in the Electoral Provisions Ordinance do not contain such requirements but that is a matter for future consideration.
MR CHEUNG YAN-LUNG (in Cantonese): Sir, will Government inform this Council if there is any research paper that shows the fitter a person is, the better his work performance will be? If yes, what will the Government do to improve the physical fitness of civil servants?
SECRETARY FOR HOME AFFAIRS: Sir, as I said earlier, disciplined services staff are required to be examined medically every year and if it is found that they do not meet the requirements, they will have to undergo remedial training or fitness courses. As regards other civil servants, that is perhaps something for the long term, but for the time being there are no such plans and it is difficult to allocate resources for the sole, specific purpose of improving the physical fitness of civil servants.
MR McGREGOR: Sir, I have the same kind of thinking as Mr Peter WONG. Will Government consider, on a short-term basis, extending any approved adult fitness programme to this Council and using the results as an indication of what can be done with the vim, vigour and vitality of willing participants?
SECRETARY FOR HOME AFFAIRS: Sir, I think that is a matter for the In-House of OMELCO.
MR MARTIN LEE: Sir, in the absence of any plan to introduce any physical fitness test scheme for our senior civil servants, I wonder whether you, Sir, can take them with you when you go up hill or down dale during the weekends, to keep your senior civil servants perhaps a little more wakeful during some of our boring speeches?
HIS EXCELLENCY THE PRESIDENT: Sadly, however much the President would like to answer that question himself, he has to pass it to the Secretary for Home Affairs. (Laughter)
SECRETARY FOR HOME AFFAIRS: Sir, I think the ventilation of this Chamber has considerably improved in recent years and as a result the state of alertness of Members has increased.
DR IP: Sir, will Government inform this Council who is physically fitter, our Governor who is a keen jogger or our Chief Secretary who is a keen tennis player?
SECRETARY FOR HOME AFFAIRS: Sir, I am not medically qualified to answer that question.
MRS LAM (in Cantonese): Does the Government have any plan to encourage or compel all employees in the public or private sector to set aside a period everyday in the midst of their working hours for physical training?
SECRETARY FOR HOME AFFAIRS: Sir, it is of course Government's policy to ensure that civil servants enjoy good health. But this must be seen in the context of resource availability. Civil servants are no more than ordinary members of the public and should not therefore receive any special treatment in terms of attention to their physical well-being.
HIS EXCELLENCY THE PRESIDENT: Dr C.H. LEONG, last question; I would not like Members to exhaust themselves on this one topic.
DR LEONG: Sir, does the Administration have any statistics concerning civil servants failing medical examinations during their terms of office?
SECRETARY FOR HOME AFFAIRS: Sir, I do not have the figures with me but I can certainly obtain the figures from the Civil Service Branch. (Annex I)
Written answers to questions
Job security measures against unfair dismissal
4. MR TAM asked: Will the Government inform this Council:
(i) of the total number of complaint cases over the past five years in which employees claimed that they were dismissed by their employers in retaliation for their reports about the employers' breach of legislation;
(ii) under the existing legislation, what measures can be taken by the Government to ensure job security for those employees who are victimized for their actions described in (i); and
(iii) whether the Government will introduce legislation to ensure that employees will not be dismissed by their employers in retaliation for their reports about the employers' alleged breach of legislation?
SECRETARY FOR EDUCATION AND MANPOWER: Sir, complaints from employees that they have been dismissed in retaliation for reporting the employer's breach of legislation are rare. The Labour Department has recorded only one such complaint in the past five years.
Under section 72B of the Employment Ordinance, it is an offence for an employer to terminate, or threaten to terminate, the employment of any of his employees for giving evidence in court or giving information to a public officer in connection with the enforcement of the Ordinance. The penalty for the offence is a fine of $20,000.
Section 6 of the Factories and Industrial Undertakings Ordinance provides similar protection to employees in respect of the enforcement of that Ordinance.
We consider the present statutory protection in this area to be adequate, except that there is at present no sanction for breaching section 6 of the Factories and Industrial Undertakings Ordinance. We intend to introduce a penalty along the same lines as section 72B of the Employment Ordinance and hope to bring the relevant
legislation to this Council during the next Session.
PADS-related infrastructural developments
5. MR LAM asked: In view of the fact that the Chek Lap Kok new airport project has not yet been implemented, will Government inform this Council: (a) whether it is really necessary to construct the Tsing Ma Bridge in line with the new airport project;
(b) whether the works progress of Route 3 linking Kowloon and the northwestern part of the New Territories will be affected by the airport project; and
(c) whether the third cross-harbour tunnel between Kowloon and the Western district of Hong Kong Island will be built as scheduled?
CHIEF SECRETARY: Sir, the Lantau Fixed Crossing, comprising the Tsing Ma Bridge and the Kap Shui Mun Bridge, is a critical component of the PADS strategy. It serves as the initial link to the new airport at Chek Lap Kok and the supporting community of Tung Chung as well as serving the future port peninsula at northeast Lantau. It is clearly important that the Lantau Fixed Crossing is built in time to meet these needs.
Route 3 stretching from the Western Harbour Crossing to the northwest New Territories and the border has been identified in the Second Comprehensive Transport Study as the major northsouth route for the territory which should be in place by the late 1990s to cater for the anticipated growth of traffic. It is divided into the following sections: Western Harbour Crossing, West Kowloon Expressway, Kwai Chung and Tsing Yi Sections and the Country Park Section. To serve the new airport at Chek Lap Kok, the Western Harbour Crossing, West Kowloon Expressway and Kwai Chung and
Tsing Yi Sections will need to be completed just before airport opening date, leaving the Country Park Section to be subsequently completed in the late 1990s depending on forecast traffic demand. Planning and design work for those sections serving the new airport, including the Western Harbour Crossing, are in progress and will
continue.
Sports facilities for Islands District
6. MR LAM asked: In view of the continuous growth of the population in the Islands District in recent years and the keen demand for sports facilities by students and youths, will Government inform this Council when it will construct the first standard sports ground in the district, so as to solve the problem concerning the lack of a standard track and field ground for training and competition purposes?
SECRETARY FOR HOME AFFAIRS: Sir, a standard sports ground in Mui Wo is under planning by the Regional Council. The proposed project is in Category IV of the Regional Council Capital Works Programme. Part of the 2.5 hectare site falls on government land. The rest is private agricultural land and building land requiring resumption.
Site formation is necessary before construction can be started. Due to competing priorities, site formation for the sports ground is scheduled to start in 1995, and subject to availability of funds, is expected to be completed by the end of 1996. Construction of the sports ground would probably start in 1997 and be completed in 1998-99.
Hong Kong's autonomy over the Vietnamese boat people problem
7. MR POON CHI-FAI asked: In view of the fact that it may be derogatory to the autonomy and integrity of the Hong Kong Government for the United Kingdom Government, which has always been insistent on maintaining its effective administration over the territory before 1997, to consult the official responsible for refugee matters in Washington when dealing with problems concerning Vietnamese boat people who have been screened out as non-refugees, will the Government approach the United Kingdom Government as soon as possible for a clear understanding of the situation and explain to the people of Hong Kong the reason for the United Kingdom Government, the sovereign state of Hong Kong until 1997, to seek the endorsement of the United States before
commencing bilateral negotiations with the Vietnamese Government and inform this Council what measures will be taken to maintain Hong Kong's autonomy and integrity?
SECRETARY FOR SECURITY: Both the United Kingdom and the Hong Kong Governments are endeavouring to find additional means, within the context of the Comprehensive Plan of Action (CPA) to return to Vietnam those asylum seekers who have been determined not to be refugees. This will require the agreement and co-operation of the
Vietnamese Government; and it is very clear from our discussions of this subject over more than two years that the attitude of the Vietnamese Government will be influenced by that of other countries who are parties to the CPA including the United States Government. We are seeking arrangements which are acceptable to all parties to the CPA. There is no derogation from the autonomy and integrity of the Hong Kong
Government.
First Reading of Bill
SUPPLEMENTARY APPROPRIATION (1990-91) BILL 1991
Bill read the First time and ordered to be set down for Second Reading pursuant to Standing Order 41(3).
Second Reading of Bills
SUPPLEMENTARY APPROPRIATION (1990-91) BILL 1991
THE FINANCIAL SECRETARY moved the Second Reading of: "A Bill to approve a supplementary appropriation to the service of the financial year which ended on 31 March 1991".
He said: Sir, I move that the Supplementary Appropriation (1990-91) Bill 1991 be read the Second time.
Section 9 of the Public Finance Ordinance states that "If at the close of account for any financial year it is found that expenditure charged to any head is in excess of the sum appropriated for that head by an Appropriation Ordinance, the excess shall
be included in a Supplementary Appropriation Bill which shall be introduced into the Legislative Council as soon as practicable after the close of the financial year to which the excess expenditure relates".
The accounts for the financial year 1990-91 have been finalized by the Director of Accounting Services. The expenditure charged to 64 heads out of a total of 75 heads is in excess of the sum appropriated for those heads by the Appropriation Ordinance 1990. This is because sufficient offsetting savings could not be found within the heads concerned. In accordance with section 9 of the Public Finance Ordinance, this excess has been included in the Supplementary Appropriation (1990-91) Bill 1991 now before Members. The Bill seeks to give final legislative authority for the amount of supplementary provision approved in respect of particular heads of expenditure by the Finance Committee or under powers delegated by it.
The total net supplementary appropriation required in respect of the 64 heads of expenditure is $6,118.5 million. As I indicated in my earlier statement this afternoon, this excess is largely attributable to the implementation of the 1990 pay adjustment, the restructuring of directorate salary scales, the second and third reports of non-directorate salary structure review and the recommendations of the Standing Committee on Disciplined Services Salaries and Conditions of Service in respect of the Civil Service ($3,224.9 million) and government subvented
organizations ($2,163.8 million). Other major contributing factors include the payment of the revised home purchase allowance and the special allowance to officers eligible for assistance under the Home Purchase Scheme and the introduction of a new Home Financing Scheme ($366.3 million) and the establishment of a new Student Financial Assistance Agency on 1 August 1990 ($349.3 million).
Sir, the cost of the 1990 pay adjustment and salary restructuring had been anticipated in the 1990-91 estimates under the "Additional Commitments" subhead. Savings were also made in other subheads through continued tight control over public expenditure, and I would like to thank the controlling officers and others who have contributed to restraint. Because of these savings and the provision made for additional commitments, total expenditure for the year is within the sum appropriated in the Appropriation Ordinance 1990.
Sir, I move that the debate on this motion be now adjourned.
Question on the adjournment proposed, put and agreed to.
PRIVATE BILLS BILL 1990
Resumption of debate on Second Reading which was moved on 21 March 1990 Question on the Second Reading of the Bill proposed, put and agreed to. Bill read the Second time.
Bill committed to a Committee of the whole Council pursuant to Standing Order 43(1).
OATHS AND DECLARATIONS (AMENDMENT) BILL 1991
Resumption of debate on Second Reading which was moved on 5 June 1991 Question on the Second Reading of the Bill proposed, put and agreed to. Bill read the Second time.
Bill committed to a Committee of the whole Council pursuant to Standing Order 43(1).
COMPANIES (AMENDMENT) (NO. 2) BILL 1991
Resumption of debate on Second Reading which was moved on 1 May 1991 Question on Second Reading proposed.
MR LAU WAH-SUM: Sir, three years ago after the October 1987 market crisis, the Securities Review Committee recommended that companies in Hong Kong should be allowed to purchase their own shares. In a moment's time, the Committee's recommendation will bear fruit if the majority of honourable Members voted "aye" to the Companies (Amendment) (No. 2) Bill 1991 after the Third Reading.
As a member of the Securities Review Committee making the recommendation, and now the Convenor of the ad hoc group charged with the responsibility of examining the Bill, I fully appreciate, and would like to commend wholeheartedly, the untiring
effort of the Administration in bringing this and other related legislation into force within a relatively short period of time.
Turning now to the Bill proper, Sir, I would like to report to honourable Members that there are three issues which are of particular concern to the ad hoc group.
The first one relates to the proposed authority and procedures for share repurchases by listed companies. Under the proposed new section 49B(1), listed companies wishing to purchase their own shares are required to comply with the Share Repurchase Code which is a non-statutory code issued by the Securities and Futures Commission.
According to the Administration, such approach is intended to give the necessary flexibility to listed companies in times of market crises. As a matter of fact, experience in the United States has shown that the ability of United States corporations to take quick actions to purchase their own shares in the worldwide market crash in October 1987 has contributed substantially to the steadying of the United States market.
The Law Society has, however, observed that while the Share Repurchase Code is non-statutory, breach of it will constitute a criminal offence under existing section 58(1A) of the Ordinance and the proposed new section 58(1B). The Society is of the strong view that it is wholly inappropriate that non-observance of a non-statutory code should result in criminal liability on the part of directors of companies
concerned and others. Another undesirable effect of linking the Share Repurchase Code with the legislation is that the Code, being non-statutory, can be amended by the Securities and Futures Commission without having to go through the normal legislative route. Yet the Code, in actual fact, has legislative effect.
The view of the Law Society is also shared by the Securities and Futures Commission which has advised that although the Share Repurchase Code is published by the Commission in pursuance of its functions stipulated in the Securities and Futures Commission Ordinance, the concept of giving statutory backing to the Code is not recommended by the Commission.
To address the Law Society's concern while maintaining the necessary flexibility sought by the Administration's approach, the Securities and Futures Commission has come up with the following alternate proposal --
(a) all references to the Share Repurchase Code in the Bill should be deleted; and
(b) provisions should be introduced in the Bill to require prior shareholder approval of the various forms of share repurchases and to grant the Securites and Futures Commission a general power to waive such requirement.
The points made by the Law Society and the Securities and Futures Commission were readily accepted by the Administration who have effectively come up with a new procedure for listed companies to purchase their own shares along the line proposed by the Securities and Futures Commission.
Having had a series of meetings with the Administration to scrutinize this new procedure and to improve the drafting of the relevant provisions, the ad hoc group is satisfied that the new procedure, which will be proposed later by the Financial Secretary during the Committee stage, has satisfactorily addressed the concern of the Law Society while maintaining the necessary flexibility to meet market crisis. And I can, with full confidence, commend the Bill to honourable Members this
afternoon.
The other two issues of concern to us relate to the definition of distributable profits and the operation of the Bill in the Hong Kong situation.
Regarding the definition of profit, the ad hoc group would like to see that once statutory provisions allowing share repurchases are in place, consideration would be given to widen the definition to include up to 50% of any unrealized property revaluation reserves of a company so as to reflect the prevalence of property
companies in Hong Kong.
As for the operation of the Bill, the ad hoc group has noted that most of the proposed amendments in the Bill follow closely the corresponding provisions in the United Kingdom Companies Act 1985, and would like therefore to see that the legislation will be reviewed in the light of experience of the Ordinance in operation to see if they totally suit Hong Kong's situation.
I have been given to understand that in his speech this afternoon, the Financial Secretary will, on behalf of the Administration, positively respond to these two points raised by the ad hoc group.
Sir, in concluding, I would like to sincerely thank the organizations which submitted their views to this Council and whose representatives took part in many hours of detailed discussion with the ad hoc group. Let me also thank the OMELCO Secretariat and the Legal Unit for the support and hard work they have given to the ad hoc group for without their help this piece of legislation could not have been ready today.
With these remarks, Sir, I support the motion.
FINANCIAL SECRETARY: Sir, I am grateful to Mr LAU Wah-sum and members of the ad hoc group for their careful consideration of and support for the Bill.
For the reasons given by Mr LAU, we accept that the Share Repurchase Code should not have any statutory backing. I shall move amendments at the Committee stage to address this concern. At the same time, I shall move a number of technical amendments to tidy up and clarify selected provisions of the Bill.
In place of statutory backing for the Code, we propose that the Bill should contain minimum requirements for disclosure and prior shareholder approval of repurchases to be made by listed companies. The requirements vary according to the type of repurchase proposed and constitute an important safeguard against abuse.
At the same time, we recognize the need for flexibility. We propose, therefore, that the Securities and Futures Commission should be given a broad discretion to waive these requirements in exceptional circumstances. The Commission will exercise this discretion sparingly, and in doing so, the Commission will always have due regard to the interests of non-selling shareholders.
In order that the main criteria in relation to the exercise of its discretion should be known the Commission will publish guidelines in the Gazette before the proposed legislation comes into force. In broad terms, the Commission envisages three categories of waiver: a blanket waiver for all companies wishing to make
purchases on the Stock Exchange in times of abnormal market activity; a specific waiver for a particular company wishing to make a purchase, whether on or off the Stock Exchange, where it would be unreasonable to require compliance; and a specific waiver for a particular company wishing to make an off-market purchase, where the
cost of compliance would outweigh the benefits to shareholders.
The definition of distributable profits follows closely the corresponding provisions of the United Kingdom Companies Act 1985. On the advice of the Standing Committee on Company Law Reform, we have not accepted a proposal to widen the definition, for the purpose of share repurchases, to include up to 50% of any unrealized property revaluation reserves of a company. Such purchases are not allowed in the United Kingdom. We believe it prudent to have experience of the legislation in operation before considering such a departure. In answer to Mr LAU's request for an assurance, the Standing Committee will review the question and the operation of the provisions of this Bill generally after the statutory provisions on share repurchases are in place.
Sir, as I stated during the passage of the Securities (Insider Dealing) Ordinance 1991, I propose that the Companies (Amendment) (No. 2) Bill 1991, if enacted, should come into operation on 1 September this year. A lead time of two months is necessary to allow companies to become familiar with the new provisions, and to enable the Society of Accountants to prepare guidelines on the definition of distributable
profits.
Sir, I beg to move.
Question on the Second Reading of the Bill put and agreed to. Bill read the Second time.
Bill committed to a Committee of the whole Council pursuant to Standing Order 43(1).
BANKRUPTCY (AMENDMENT) BILL 1991
Resumption of debate on Second Reading which was moved on 12 June 1991 Question on the Second Reading of the Bill proposed, put and agreed to. Bill read the Second time.
Bill committed to a Committee of the whole Council pursuant to Standing Order 43(1).
FIXED PENALTY (TRAFFIC CONTRAVENTIONS) (AMENDMENT) (NO. 2) BILL 1991 Resumption of debate on Second Reading which was moved on 12 June 1991 Question on the Second Reading of the Bill proposed, put and agreed to. Bill read the Second time.
Bill committed to a Committee of the whole Council pursuant to Standing Order 43(1).
ROAD TRAFFIC (AMENDMENT) (NO. 4) BILL 1991
Resumption of debate on Second Reading which was moved on 12 June 1991 Question on the Second Reading of the Bill proposed, put and agreed to. Bill read the Second time.
Bill committed to a Committee of the whole Council pursuant to Standing Order 43(1).
EMPLOYMENT (AMENDMENT) (NO. 2) BILL 1991
Resumption of debate on Second Reading which was moved on 12 June 1991 Question on the Second Reading of the Bill proposed, put and agreed to. Bill read the Second time.
Bill committed to a Committee of the whole Council pursuant to Standing Order 43(1).
EMPLOYEES' COMPENSATION (AMENDMENT) BILL 1991
Resumption of debate on Second Reading which was moved on 12 June 1991
Question on the Second Reading of the Bill proposed, put and agreed to. Bill read the Second time.
Bill committed to a Committee of the whole Council pursuant to Standing Order 43(1).
PNEUMOCONIOSIS (COMPENSATION) (AMENDMENT) BILL 1991
Resumption of debate on Second Reading which was moved on 12 June 1991 Question on the Second Reading of the Bill proposed, put and agreed to. Bill read the Second time.
Bill committed to a Committee of the whole Council pursuant to Standing Order 43(1).
Committee stage of Bills
Council went into Committee.
PRIVATE BILLS BILL 1990
Clauses 1 to 3
MR MARTIN LEE: Sir, I move that clauses 1, 2 and 3(2) be amended as set out under my name in the paper circulated to Members.
Clause 2 provides for the definition of the term "private bill". The ad hoc group considers the original definition far from satisfactory since all Bills, be they government or private, affect some particular persons, associations or body corporate. The new clause 2 gives a better definition as it distinguishes the interests and benefit of an individual, association or body corporate from the interest and benefit of the public.
Clause 3(2) provides for the criteria under which an organization may be exempted
from the payment of the prescribed fee. Some organizations which are required to promote a private Bill so as to facilitate a government measure may have difficulty in raising sufficient funds. Having regard to the difficulties of these organizations, the new clause 3(2) extends the Chief Secretary's discretion to exempt these
organizations from paying the prescribed fee to cover Bills which are promoted to facilitate a government measure.
Sir, I so move.
Proposed amendments
Clause 1
That clause 1 be amended by deleting "1990" and substituting "1991". Clause 2
That clause 2 be amended by deleting the definition of "private bill" and substituting -
""private bill" means a bill which -
(a) provides primarily for the particular interest or benefit of any individual, association or body corporate rather than the interest or benefit of the public; and
(b) is not a Government measure.".
Clause 3(2)
That clause 3(2) be amended by deleting "that the bill is for a charitable purpose within the meaning of section 2 of the Registered Trustees Incorporation Ordinance (Cap. 306)" and substituting -
"that the bill -
(a) is for a charitable purpose within the meaning of section 2 of the Registered Trustees Incorporation Ordinance (Cap. 306); or
(b) facilitates a Government measure.".
Question on the amendments proposed, put and agreed to.
Question on clauses 1 to 3, as amended, proposed put and agreed to.
Clause 4 was agreed to.
Schedule
MR MARTIN LEE: Sir, I move that the schedule be amended as set out under my name in the paper circulated to Members. The schedule sets out the level of fees payable for private Bills. The ad hoc group considers it wrong in principle to double the fee for a bilingual Bill; we feel that no matter whether the Bill is drafted in one or both official languages, it is still one Bill rather than two Bills; hence there should be only one set of fees. Having said this, the ad hoc group accepts that a private Bill for a principal Ordinance is essentially different from a private Bill which amends an existing Ordinance. As a result, it is more appropriate to set
different levels of fees for the two types of private Bills. The new schedule gives effect to such a decision.
Sir, I beg to move.
Proposed amendment
Schedule
That schedule be amended by deleting items 1 and 2 and substituting -
"1. A bill to amend an existing
Ordinance, in one or both
official languages........................................... 25,000
2. A bill for a principal Ordinance
(whether or not the bill also amends
an existing Ordinance), in one or both
official languages........................................... 50,000".
Question on the amendment proposed, put and agreed to.
Question on schedule, as amended, proposed put and agreed to. OATHS AND DECLARATIONS (AMENDMENT) BILL 1991
Clauses 1 to 3 were agreed to.
COMPANIES (AMENDMENT) (NO. 2) BILL 1991
Clauses 1, 2, 4 to 6 and 9
FINANCIAL SECRETARY: Sir, I move that the clauses specified be amended as set out in the paper circulated to Members.
Clause 4 is amended to delete reference to the Share Repurchase Code in new section 49B(1). This seeks to remove statutory backing for the Code. The clause is further amended to insert new section 49BA which sets out the requirements of disclosure and prior shareholder approval for listed companies, and grants the Securities and
Futures Commission a general power of waiver from any of the requirements.
Clause 4 is also amended to apply new sections 49E, 49F and 49G to listed and unlisted companies, where appropriate. These sections relate to authority for a contingent purchase contract, assignment or release of a company's right to repurchase shares and disclosure by a company of share repurchases.
Clauses 5 and 9 are amended to delete references to "substantial shareholder" and "acting in concert", to avoid possible confusion with the use of similar terms in the different context of the Takeovers and Mergers Code issued by the Securities and Futures Commission and the Listing Rules of the Stock Exchange.
A new clause 10 is added to introduce a consequential amendment to section 54(1)(a) of the Securities and Futures Commission Ordinance to enable the Commission to charge fees to recover the cost of administering the Share Repurchase Code and processing applications for waiver under new section 49BA.
Sir, I beg to move.
Proposed amendments
Clause 1(1)
That clause 1(1) be amended by deleting "(No. 2)".
Clause 2
That clause 2 be amended by deleting paragraph (c).
Clause 4
That clause 4 be amended --
(a) In proposed section 49B(1) --
(i) by adding "49BA," after "49A,"; "49E, 49F," after "49C,"; and ", 49R" after "49Q";
(ii) by deleting "in accordance with the Share Repurchase Code".
(b) In proposed section 49B(4) by deleting "In addition to acquiring shares from funds specified in section 49A, a company may acquire its own shares" and substituting --
"Notwithstanding subsections (1) and (2) but subject to sections 49, 49A, 49F, 49G, 49H, 49I(4) and (5), 49P, 49Q, 49R and 49S, except that such purchases may be made either out of or otherwise than out of its distributable profits or the proceeds of a fresh issue of shares, a listed company and an unlisted company limited by shares or limited by guarantee and having a share capital may, if authorized to do so by its articles, purchase its own shares (including any redeemable shares)".
(c) By adding after proposed section 49B --
"49BA. Requirements for listed company
to purchase own shares
(1) A listed company may purchase its own shares --
(a) subject to subsections (2), (3) and (7), under a general offer;
(b) subject to subsections (2), (3) and (4), on the Unified Exchange or on a recognized stock exchange;
(c) subject to subsections (5) and (6), otherwise than on the Unified Exchange or on a recognized stock exchange, and otherwise than under a general offer referred to in paragraph (a).
(2) A listed company shall not --
(a) make a general offer under subsection (1)(a) unless the proposed general offer is authorized by the company in general meeting; or
(b) purchase any of its own shares on the Unified Exchange or on a recognized stock exchange under subsection (1)(b), unless the proposed purchase is authorized by the company in general meeting.
(3) A listed company shall include together with the notice of any general meeting called for the purpose of subsection (2) --
(a) in the case of a general offer under subsection (1)(a) -- (i) a copy of the document containing the proposed general offer; and
(ii) a statement, signed by the directors of the company, containing such particulars as would enable a reasonable person to form as a result thereof a valid and justifiable opinion as to the merits of the proposed general offer; and
(b) in the case of a purchase under subsection (1)(b), a memorandum of the terms of the proposed purchase.
(4) An authorization given by a company in general meeting under subsection (2)(b) shall be valid for the period expiring on the date of the next annual general meeting of the company and such period may be extended by the company at such annual general meeting until the date of the next annual general meeting of the company.
(5) A listed company shall not make a purchase of any of its shares under subsection (1)(c) unless the proposed purchase has been authorized by a special resolution of the company and section 49D(4) shall apply to such a resolution as it applies to a resolution under that subsection.
(6) A listed company shall include together with the notice of any meeting called for the purpose of subsection (5) --
(a) where the proposed purchase agreement is in writing, a copy of the proposed purchase agreement; or
(b) where the proposed purchase agreement is not in writing, a memorandum of the terms of the proposed purchase agreement; and
(c) a statement, signed by the directors of the company, after having made due and diligent inquiry of the members of the company holding the shares to which the proposed purchase agreement relates, containing such particulars as would enable a reasonable person to form as a result thereof a valid and justifiable opinion as to the merits of the proposed purchase agreement.
(7) If, in the case of a general offer under subsection (1)(a), a member of the company may be compelled to dispose of his shares under section 168B --
(a) the company shall appoint an independent investment adviser to advise members who may be affected by the compulsory disposal on the merits of the proposed general offer; and
(b) the proposed general offer shall be authorized by a special resolution of the company, on which no relevant shareholder votes and for this purpose --
(i) a relevant shareholder shall be regarded as voting not only if he votes on a poll on the question whether the resolution shall be passed, but also if he votes on the resolution otherwise than on a poll;
(ii) notwithstanding anything in the company's articles, any member of the company may demand a poll on that question; and
(iii) a vote and a demand for a poll by a person as proxy for a relevant shareholder are the same (respectively) as a vote and demand by a relevant shareholder.
(8) A person shall not be appointed as an investment adviser under subsection (7) unless he is a registered or exempt investment adviser within the meaning of the Securities Ordinance (Cap. 333) and is neither --
(a) a member, officer or employee of the company making the general offer or of a related company thereof; nor
(b) a related company of the company making the general offer. (9) For the purposes of this section --
"Exchange Company" means the Exchange Company as defined in section 2(1) of the Stock Exchanges Unification Ordinance (Cap. 361);
"general offer" means an offer to all members of a company or to all members holding shares of a particular class in a company, other than any members residing in a jurisdiction where such an offer is contrary to the laws of that jurisdiction, on terms which are the same in relation to all such shares or in relation to the shares of each class;
"recognized stock exchange" means a stock exchange recognized for the purposes of this section by the Securities and Futures Commission and the Exchange Company by notice published in the Gazette;
"related company" in relation to a company, means any company that is the company's subsidiary or holding company or a subsidiary of that company's holding company;
"relevant shareholder" means a person to whom the description "relevant shareholder" in the Thirteenth Schedule applies.
(10) In the application of the definition of "officer" in section 2(1) to subsection (8), "director" includes --
(a) any person occupying the position of director, by whatever name called; and
(b) any person in accordance with whose directions or instructions the directors of the company are accustomed to act.
(11) The Securities and Futures Commission may exempt any listed company from any of the provisions of this section, subject to such conditions as it thinks fit.
(12) The Securities and Futures Commission may --
(a) suspend or withdraw an exemption granted under subsection (11) on the ground that the conditions subject to which the exemption was granted have not been complied with or on such other ground as the Commission thinks fit; or
(b) vary any condition imposed under subsection (11).".
(d) By deleting proposed section 49C(2).
(e) In proposed section 49E --
(i) by renumbering subsection (2) as subsection (3); and
(ii) by adding after subsection (1) --
"(2) A listed company may only make a purchase of its own shares in pursuance of a contingent purchase contract if the proposed contingent purchase contract is authorized in advance by a special resolution of the company before the contract is entered into, and section 49BA(5) and (6) applies to authorization for a proposed contingent purchase contract as to authorization for a proposed purchase agreement under section 49BA(1)(c).".
(f) In proposed section 49F --
(i) by deleting "unlisted" in the heading; and
(ii) in subsection (1) --
(A) by deleting "an unlisted company" and substituting "a company";
(B) by adding "or authorized under section 49BA or 49E" after "section 49D or 49E";
(iii) by adding after subsection (2) --
"(3) An agreement by a listed company to release its rights under a contract authorized under section 49BA(1)(a) or (c) or under section 49E is void unless the terms of the release agreement are authorized in advance by a special resolution of the company before the agreement is entered into; and section 49BA(5) and (6) applies to authorization for a proposed release agreement as to authorization for a proposed purchase agreement under section 49BA(1)(c).".
(g) In proposed section 49G --
(i) in subsection (1) by deleting "Part" and substituting "Ordinance"; (ii) in subsection (4) by adding "49BA(1)(c)," before "49D".
(h) In proposed sections 49H(1), 49I(3) and 49N(1) by deleting "Part" wherever it occurs and substituting "Ordinance".
(i) In proposed section 49P(1) by deleting "(No. 2)".
(j) In proposed section 49R --
(i) by deleting "(No. 2)" wherever it occurs;
(ii) in subsections (1) and (2) by deleting "Part" wherever it occurs and substituting "Ordinance as amended by that Ordinance".
Clause 5
That clause 5 be amended --
(a) In proposed subsection (1B)(c) by deleting "substantial" and substituting "relevant".
(b) In proposed subsection (1C) by adding "and subsection (1D)" after "section 168A".
(c) By adding after proposed subsection (1C) --
"(1D) Notwithstanding subsection (1C), a purchase which contravenes section 49B(6) is void.".
Clause 6
That clause 6 be amended, in proposed section 79A(1) in the definition of "appointed day", by deleting "(No. 2)".
Clause 9
That clause 9 be amended --
(a) In proposed Thirteenth Schedule between the square brackets at the beginning by adding "49BA," before "58".
(b) In proposed Thirteenth Schedule by deleting "substantial" wherever it occurs and substituting "relevant".
(c) In paragraph 1 of Part 1 of proposed Thirteenth Schedule -- (i) by deleting "acting in concert with the repurchasing company,";
(ii) by deleting "at the time of the offer" and substituting "not later than the date that notice of the meeting called for the purpose of authorizing the proposed offer is given".
Question on the amendments proposed, put and agreed to.
Question on clauses 1, 2, 4 to 6 and 9, as amended, proposed, put and agreed to. Clauses 3, 7 and 8 were agreed to.
New clause 10 Consequential Amendment
Securities and Futures Commodities Ordinance
Fees and other charges
Clause read the First time and ordered to be set down for Second Reading pursuant to Standing Order 46(6).
Question on the Second Reading of the new clause proposed, put and agreed to. Clause read the Second time.
Proposed addition
New clause 10
That the Bill be amended by adding after clause 9 --
"Consequential Amendment
Securities and Futures Commission Ordinance
10. Fees and other charges
Section 54(1)(a) of the Securities and Futures Commission Ordinance (Cap. 24) is amended --
(a) by adding --
(i) "the Commission or" before "a committee"; and
(ii) " " before " "; and
(b) by adding --
(i) "share repurchases," before "takeovers and mergers"; and
(ii) " " before " ".".
Question on the addition of the new clause proposed, put and agreed to.
Long title
FINANCIAL SECRETARY: Sir, I move that the long title be amended as set out in the paper circulated to Members.
Proposed amendment
Title
That title be amended by adding "and consequentially to amend the Securities and Futures Commission Ordinance" after "Ordinance".
Question on the amendment proposed, put and agreed to.
Question on title, as amended, proposed, put and agreed to.
BANKRUPTCY (AMENDMENT) BILL 1991
Clauses 1 to 4 were agreed to.
FIXED PENALTY (TRAFFIC CONTRAVENTIONS) (AMENDMENT) (NO. 2) BILL 1991 Clauses 1 and 2 were agreed to.
ROAD TRAFFIC (AMENDMENT) (NO. 4) BILL 1991
Clauses 1 and 2 were agreed to.
EMPLOYMENT (AMENDMENT) (NO. 2) BILL 1991
Clause 1
SECRETARY FOR HEALTH AND WELFARE: Sir, I move that clause 1 be amended as set out in the paper circulated to Members. The Bill has to be re-numbered because the proposed
amendment to the Ordinance is expected to be the first to be enacted this year. Sir, I beg to move.
Proposed amendment
Clause 1
That clause 1 be amended by deleting "(No.2)".
Question on the amendment proposed, put and agreed to.
Question on clause 1, as amended, proposed, put and agreed to. Clause 2 was ageed to.
EMPLOYEES' COMPENSATION (AMENDMENT) BILL 1991
Clauses 1 and 2 were agreed to.
PNEUMOCONIOSIS (COMPENSATION) (AMENDMENT) BILL 1991
Clauses 1 and 2 were agreed to.
Council then resumed.
Third Reading of Bills
THE ATTORNEY GENERAL reported that the
OATHS AND DECLARATIONS (AMENDMENT) BILL 1991
BANKRUPTCY (AMENDMENT) BILL 1991
FIXED PENALTY (TRAFFIC CONTRAVENTIONS) (AMENDMENT) (NO. 2) BILL 1991
ROAD TRAFFIC (AMENDMENT) (NO. 4) BILL 1991
EMPLOYEES' COMPENSATION (AMENDMENT) BILL 1991
PNEUMOCONIOSIS (COMPENSATION) (AMENDMENT) BILL 1991
had passed through Committee without amendment and the
PRIVATE BILLS BILL 1991, the original short title of which is PRIVATE BILLS BILL 1990
COMPANIES (AMENDMENT) BILL 1991, the original short title of which is COMPANIES (AMENDMENT) (NO. 2) BILL 1991 and
EMPLOYMENT (AMENDMENT) BILL 1991, the original short title of which is EMPLOYMENT (AMENDMENT) (NO. 2) BILL 1991
had passed through Committee with amendments. He moved the Third Reading of the Bills.
Question on the Third Reading of the Bills proposed, put and agreed to. Bills read the Third time and passed.
Member's motion
PRIMARY HEALTH CARE
MR LAU WAH-SUM moved the following motion:
"That this Council supports the development of quality primary health care services in Hong Kong to meet the World Health Organization's target of "Health For All by the Year 2000", and urges Government to take early steps to implement those improvement measures as recommended by the Working Party on Primary Health Care, having regard to the views expressed by the public before the expiry of the consultation period on 31 July 1991."
MR LAU WAH-SUM: Sir, I move the motion standing in my name on the Order Paper.
On 24 April this year, the Report of the Working Party on Primary Health Care entitled Health for All: The Way Ahead was tabled before this Council and published for public consultation thereafter. Since then, there have been many comments and viewpoints expressed. I am sure more will be forthcoming before the expiry of the consultation period by the end of this month.
As convener of the OMELCO Standing Panel on Health Services, I welcome wholeheartedly the timely publication of this report. Better provision of primary health care services will improve the health standard of the community. Most important of all, the development of quality primary health care services, in the words of the working party, will lay a firm foundation for the future health care system. It will achieve a better and more appropriate balance between primary health care and hospital treatment.
According to the World Health Organization: "Primary Health Care is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost that the community and country can afford". It includes many essential and basic services that we have often taken for granted, like childhood immunization, health education and the control of communicable diseases. It also includes first-line medical care for the treatment of diseases and injuries.
It would therefore be erroneous to equate primary health care with primitive care, or services that are less important. Primary health care is also certainly not second-rate care for the underprivileged. In fact it should be the opposite. We learn from the working party report that primary health care provides basic, comprehensive services and continuity of care to an individual. It is the base upon which the rest of the health care system should be built. It is a strategy of health care advocated by the World Health Organization to enable the best use of resources to benefit the entire population.
For those who are impressed by Hong Kong's low infant mortality rates, longevity of our men and women and our successful control of communicable diseases, the obvious questions are: What has gone wrong with our health services? Why do we need to develop primary health care?
The answer to these questions lies in finding the most cost-effective means to achieve the goal of "Health for All". In the past decades, technological developments have made the provision of medical care increasingly expensive. Everyone of us knows that hospitals are expensive to build, but even more costly to run. The escalating costs of life-saving surgical procedures and medical technology are the realities we have to face. Containing health costs while providing quality care -- these two apparently conflicting objectives -- are our major tasks ahead.
As illustrated by what has taken place in countries like Canada, Australia and those in Europe, a shift in emphasis to primary health care is the only feasible way to improve the health of the community and promote the best use of resources. The history of poliomyelitis and tuberculosis control in Hong Kong has taught us that expensive treatment facilities and manpower resources can be saved if the preventive health programmes are successful. More than three decades ago, immunization against these two deadly diseases was introduced. And today, we see hospitals purposely built to treat these diseases changing their use because they have out-served their original purpose. More importantly, we no longer see children crippled from
poliomyelitis affecting the lower limbs or tuberculosis affecting the spine. Seed sown long ago have borne fruit. In the language of the Hong Kong investors, the investment made years ago has produced continuous high return.
The emphasis in promotion of health and prevention of disease is certainly the right direction to follow. For too long we have been dazzled by the glamour and drama of high technology curative medical care. This is high time we re-orientate the entire health care delivery system towards a better balance between primary health care and hospital care. The way I see it, the best cure to disease and disability should lie much earlier than when the condition presents itself -- prevention: action even before the condition exists. The aim should be to minimize all sufferings rather than to remedy them.
It is my firm belief that for the more modern diseases that afflict mankind, we should take the same approach. Health education is a very effective means to involve individuals in taking care of their health. Work towards prevention and early detection, and channel resources to enable these health maintenance activities to take place. For the reduction of human suffering is in itself priceless.
Turning to the issue of early detection and treatment of illnesses. I notice that the working party has advocated the provision of a framework for the delivery
of continuing, comprehensive and whole-person care. I am in complete agreement with this approach. In this modern age of medical specialties, one is often overwhelmed and at times confused by the many specialists dealing with different organs of the body. It is most heartening to see the proposal for the development of family
medicine in the government out-patient clinics and in private practices: a doctor who offers total care, taking into account the physical, social as well as psychological aspects of illnesses, who has good understanding of his patients, and who co-ordinates the care provided to his patient by other health care workers. This revival of the "family doctor" who knows the patient and takes good care of him brings back the human touch to the art of cure, and is another effective means to enable better utilization of resources. For with a pool of quality family doctors in the community, hospital admissions could be reduced. This is because more patients could be taken care of in the community by their family doctors rather than by specialists in the hospitals. This "gate-keeper" function has led many governments in other parts of the world to place greater emphasis on the training of doctors in family medicine. And I urge the Hong Kong Government to do the same.
And it is not just for the sole reason of cost that I am advocating for more training opportunities. Manpower development is the basis of quality service and for this reason, the working party has attached the utmost importance to the training of health care personnel. The doctors engaging in primary health care, adequate training in family medicine and community medicine is long overdue and need to be recognized as a top priority. Such training is essential because it can help doctors in giving more accurate diagnoses and referrals to specialties, which will save the manpower and resources wasted in incorrect diagnoses and also reduce the possible sufferings and danger caused to the patients.
Likewise, training opportunities for nurses are equally important. With the increased incidence of chronic diseases nowadays, the role of nurses in out-patient clinics should be expanded to include health education, screening and counselling, while the less technical work could be carried out by clinic assistants. This would be a more cost-effective means of utilizing the nursing manpower resources and the nurses could derive greater job satisfaction from better use of their skills. I support the working party's recommendation that the training capacity of the Government Public Health Nursing School be expanded as a matter of urgency. Nurses from mainland China can also be re-trained or at least be recruited to serve as clinic assistants. In addition, we should offer better terms of employment to attract more part-time nurses to assist the full-time nurses to ease the present staff shortage.
We should also not forget the importance of staff development. That is, a good career structure and an attractive reward together with job satisfaction have to be developed alongside training for the purpose of retaining capable staff and boosting their morale. This applies both to doctors and nurses.
I would now touch on two proposals of the working party which have generated some controversy -- the setting up of a Primary Health Care Authority and the review of fee structure at general out-patient clinics. I urge that public views expressed on these issues be taken into full account in the Administration's subsequent
deliberations.
On the proposed Primary Health Care Authority, I am in support of the underlying principle of allowing community participation at the decision-making level. However, the working mechanics and the relationship of the Authority to Government and to the Hospital Authority would need to be carefully examined. In any case, with the basic infrastructure on health care provisions currently in place, I do not see the need to hold back improvement measures whilst we spend time on examining the setting up of a Primary Health Care Authority. The working party has spent a considerable period of time and made a very comprehensive review of the present primary health care system and it has come up with a total of 102 practical proposals for changes and improvements. I strongly urge that these valuable recommendations be implemented quickly before the establishment of the Primary Health Care Authority.
On fees and charges, I welcome the working party's recommendation that the Government should continue to provide preventive and promotive services free of charge for all. Contrary to this, some of the public feedback so far is that Government is going to shirk its responsibility in primary health and ask the public to pay from their own pocket in accordance with the "user-pay" concept. In fact, the recommendation of a "target group approach" applies only to clinical services at government general out-patient clinics. Under this approach, young children, elderly, disability allowances recipients and public assistance recipients will fall within the target group and will be provided subsidized general out-patient clinical services at half fee or even free of charge, leaving only those who can afford to pay the fee. According to statistics, government general out-patient clinics take care of only about 15% of all the out-patient medical consultations in Hong Kong while the remainder goes to private clinics. Some of the 15% group patients already fall within the target group. In any case, there will be a fee-waiving mechanism for those
who cannot afford to pay and I am sure that these measures will fulfil Government's pledge that "no one should be prevented, through lack of means, from obtaining adequate medical treatment". As an accountant by training, I must admit that the "target group approach" has its merits in being administratively simple.
There is therefore no need for the public to be over-worried about the review on fees and charges at the government general out-patient clinics. The Secretary for Health and Welfare has already promised us a Green Paper on medical and health services that will specifically review the overall health financing policy and address the fee issue together with the fee-waiving mechanism.
Before we take sight of this Green Paper, which I understand will not be ready until early 1992, I believe the time is ripe for the Government to commit itself to develop quality primary health care services in Hong Kong. The sum of $186 million estimated for implementing the improvement measures is relatively small in comparison with the many tasks mentioned in the report and the objective of achieving "Health for All by the Year 2000".
Finally, I hope the public will spend time to consider these recommendations in the Report and express their views to the Government. In any case, we still have four weeks available before the end of the public consultation period. I am sure the views expressed in this Chamber today and by the public during the public consultation period will be taken into account by the Government. I wish to reiterate that with the basic infrastructure of health care provisions currently in place and with the ample time available for public consultation, that is, more than three months from 24 April to the end of July this year, we should quickly implement the improvement measures before the setting up of the Primary Health Care Authority. I do not support an extension of the consultation period since it will only delay the implementation of the many overdue improvement measures to our primary health care services.
Sir, I beg to move.
HIS EXCELLENCY THE PRESIDENT: I have received notices from Mr Ronald CHOW and Miss LEUNG Wai-tung to move amendments to the motion. Their amendments have been printed in the Order Paper and circulated to Members. I will call upon them to move the amendments when it comes to their turns to speak.
Question on the motion proposed.
MR CHAN (in Cantonese): Sir, what is praiseworthy of the Report of the Working Party on Primary Health Care is that many of its recommendations are aimed at tackling problems of the times. However, inadequacies can still be found in the report given the constraints of the working party's terms of reference. For example, the review was confined to the delivery of primary health care in the government sector and covered only 15% of all patients throughout the territory. Private practitioners who catered for 70% of the medical consultations fell outside the scope of the review. If the report needs to achieve the goal of Health for All, the Government must review the health care system in its entirety.
I am particularly concerned about the many problems which remain to be solved in respect of public clinic services. For example, patients using government out-patient service often have to wait five to six hours, but consultation duration is no longer than one minute; and appointments with specialist doctors sometimes take as long as two years to fix. With demand outstripping supply, people seeking medical treatment are just like beggars. Whenever people seeking urgent treatment turn to me for help, I am always willing to beg on their behalf, but this will affect other patients queuing up for medical treatment. Elderly people often have minor troubles such as headache and sore foot, but are forced to endure pain over a long period of time because the Government cannot provide the care and guidance they need. To achieve the goal of Health for All, the Government must introduce reforms and improve existing services. I fully support the report's recommendations for improving clinic service, providing community health services and developing the concept of a District Health System. Nevertheless, there must not be any lack of commitment of financial resources on the part of the Government, or else they will be nothing but empty talk.
Therefore, I have reservations, in particular, about the proposal to contract out the operation of public clinics to doctors in the non-government sector. There is much doubt whether this scheme can enhance effectiveness both in the quality of service and deployment of resources. The arrangement to have clinics contracted to private practitioners to ensure better quality of service appears to be a well
intentioned proposal, but can it achieve the desired effect? The crux of the matter is whether similar resources will be allocated. If the same contract-out arrangements as the School Medical Service Scheme are adopted whereby patients are given a fixed amount of subsidy by the Government, there will certainly be a decline in the quality of service and the scheme is bound to fail. A better alternative is
to allow the patients to choose their own private doctors while those who cannot afford to pay will be fully subsidized by the Government. While this mode of operation will ensure quality of service, there will no doubt be a substantial increase in public expenditure and the Government may find it difficult to regulate this expenditure.
Therefore, I have come to the conclusion that the Government should in the first instance improve out-patient service in the public sector rather than seek better quality assurance by adopting the contract-out approach. Provided that additional public resources are deployed to reduce a doctor's workload from 100 to 60 patients per day, that is by increasing the number of doctors, quality service can definitely be assured. Priority must be given to promptly improving the quality of government out-patient service because users of this service are mainly from the lower classes. The out-patient service has a vital role to play in health maintenance and disease control. Furthermore, as the Government has a duty to look after patients who cannot afford to pay (though they do not constitute a significant proportion of our
population, they are numerous in number), there can be no reduction in the provision of out-patient service in the public sector. Consideration should therefore be given to the provision of quality service, instead of implementing an arrangement to contract out the operation of public clinics to private practitioners.
Sir, with these remarks, I support the Honourable LAU Wah-sum's motion.
MR PANG (in Cantonese): Sir, it is to be appreciated that the Government is firmly committed to the development of primary health care to achieve the goal of Health for All. In the past, there has been much dissatisfaction among the public over Hong Kong's system and level of medical care services. With the release of the Report of the Working Party on Primary Health Care, one may say that the Government is
beginning to pay serious attention to health care in Hong Kong. When I first looked at the report, I got an impression that the Government was finally trying to improve medical care services. However, after more detailed reading, I noticed that the Government first put forward a fine proposal and then asked the public to pay for the costs. I shall now briefly give my views on the report.
First, quoting from paragraph 4.9 of the report, I cannot agree that "Government should not and need not aim to become the sole or main provider of such services." I should like to ask: Who should be responsible for providing primary health care if not the Government? In fact, who wants to be a person affected with favus on the
head if one has hair on it? Those who can afford to pay will seek medical consultations from private practitioners as no sick person wants to queue up for public out-patient services. Therefore, as stated in paragraph 3.20, the private practitioners catered for 70% of the medical consultations.
Second, paragraph 4.5 has this to say: With rising public expectations for better service, a "public assistance" approach for all in the delivery of personal medical care services seems no longer appropriate. Sir, as it is only reasonable for the public to expect better services, any government department should do all it can to provide the best possible services for members of the public. Moreover, I cannot agree that our existing medical services can be branded as adopting a "public
assistance" approach.
Third, on the question of occupational health, staff in the Occupational Health Division of the Labour Department currently comprise nursing officers seconded from the Department of Health. At present, a major responsibility of the division is to investigate "notified" occupational diseases and potential health hazards reported by the Factory Inspectorate and to determine preventive action. As this is an
entirely passive approach and action taken can only be remedial, there can be no adequate safeguard against occupational diseases.
Also, the report briefly mentions that "trade unions and employers associations also play an important role in occupational health matters". I have in this Council urged the Labour Department to promote occupational health and strengthen ties with the trade unions so that they can help educate workers on occupational health.
Since the report contains more than 200 pages with over 100 proposals, I think sufficient time should be allowed for making an in-depth study into many of the aspects covered and a three-month consultation period will not be adequate for the purpose. In this connexion, I support the Honourable Ronald CHOW's amended motion which urges Government to extend the consultation period so as to give the public more time to study the report and express their views.
PROF. POON: Sir, it is indeed commendable for the Secretary for Health and Welfare and her predecessor to have completed three substantial reports within a span of five years: two being on hospital care and one on primary health care. I understand that the Secretary for Health and Welfare is going to provide this Council with yet another important report on health care which aims at a much broader view of our health care
system, taking into serious consideration the health insurance issue as well as the Chinese medicine issue and it will be ready for consideration by this Council early next year.
That being so, I think what is before us today is to consider ways to make sure that these reports are not just aspirations, but are plans for action that are to be implemented eventually with resources and commitments. However, before I go into specific comments of the report, I think it is important both for myself and this Council to make clear what we are trying to achieve and why it is necessary to do so.
Broadly speaking there are at present two models of health service delivery in modern society, namely, the hospital-base model and the community-base model. Amongst these two models there are a few common domains: curative care in hospitals and clinics; health prevention; health maintenance and medical rehabilitation. Both models will involve a combination of these domains. Hong Kong thus far has a largely hospital-base system and such system had demonstrated to be both inefficient and inappropriate as far as meeting the health needs of the population is concerned. It is my understanding that the report is trying to suggest that there should be a fundamental shift in our health care delivery philosophy. It is now a world trend that health systems should be moving towards a community-base model emphasizing primary health care: a system whereby essential health care is made universally accessible to individuals and families in the community at an affordable cost, the rationale being, as stated clearly in the report, a hospital-base model is no longer possible to serve the needs of the people because it is expensive, unnecessary and somewhat wasteful. Nonetheless, I must point out at the outset to this Council that: since all the domains appear in both models and it is the combinations, the emphasis, and the unique approach that matter, I think this Council must recognize that mere incrementalistic changes in our current health care system do not live up to the spirit of this report. It is only through a substantial breakthrough in our resources deployment could we be able to achieve the ultimate purpose of this Paper.
Sir, it is on such spirit and understanding that I shall comment on the following four areas: (1) primary medical care; (2) community health service; (3) health information and health screening and (4) some neglected areas in the report.
Primary medical care
Sir, amongst the 16 chapters of this report touching on various facets of our existing health system, I think the most substantial and most reflective chapter is the one on Primary Medical Care. As defined, primary medical care refers to the point of first contact between the patient and the curative medical services. It is
different from primary health care in that the latter includes a wide spectrum of health activities which include health promotion, prevention, maintenance and rehabilitation.
Sir, although I can understand that current government out-patient clinics is not one of the best utilized services over the year, I am still surprised to find out that it only constitutes 15% of the whole primary medical care while the private sector serves around 70% of all needs. I am surprised to learn that with an average workload of 100 patients per day and an average 3.3 minutes per patient consultation time, many government out-patient clinic doctors can still manage to see all patients well before the closing time. The problems of the government out-patient clinics in the provision of primary health service cannot be better summarized than page 139 of the report, that it lacks quality medical care, lacks morale among doctors, lacks patient information and most important lacks objectives for primary medical care.
In order to cure the "illness" of the government out-patient clinics, the working party broadly suggested the following measures: namely (1) better training in family medicine; (2) improved promotion prospects; (3) establish a patient information base; (4) possible reduction in patient load by not allowing civil servants to use
privileged service in government out-patient clinics and so on.
Sir, without going into their details, I think all these proposals have their relative merits. What I am worrying about is their aggregate effects on the health care system. It is now an accepted fact worldwide that primary health care at the community level is not cheap, particularly during its early phase of establishment. If we are going to reduce workload, improve the conditions of service for government out-patient clinic doctors and to establish a sound database, the average costs per patient will inevitably go up. If it is already estimated that the average cost per patient is $56 now, it does not take a mathematician to know how much it would cost us in the future. All these being done, we are still not sure whether or not
government out-patient clinics could compete with the private sector, because one of the important reasons for the popularity of private medical care is that they are convenient and accessible. If this is going to be the case, why do we not simply subsidize the private sector by a simple voucher system?
Sir, I am all for a better public primary medical service. I think the greatest problem with our current system is that individuals are being treated as "objects needing cure" rather that "a person within a family needing personal medical attention". What I must remind this Council is that we are not necessarily opting for a more cost-efficient system as many may have thought. A successful primary health care system necessitates a much greater resource commitment on the part of the Government. We must also ensure increased costs do not go to burden the public because we know full well that those depending on the public health system are usually from the lower income strata. I am proposing that we must be much more cautious in pondering our ways to implement the new system. More innovations in care delivery seems to be needed.
Community health service
Sir, I recognize that in drafting the report, one of the primary concern of the working party is how to reduce the public's dependence on the hospital system. Hence we must look for ways to induce health care to be provided either in families or community institutions. To do so, the Government reviewed the Community Nursing Service, the Domestic Occupational Therapy Service, and Elderly Care Service. In sum what the report proposed was that all these community-base services must be
strengthened and the Government should continue to encourage voluntary agencies to assume responsibility for such kind of community care. I can also understand that in this deliberation cost-efficiency was also high on the agenda of the Administration because survey had indicated that more than 20% of out-patient care went to very dependent elderly cases.
While I am in full agreement with the idea of keeping patients outside the hospitals and involving the community to participate in the caring process, I wish to draw the Council's attention to the controversial debate of the issue of community care in the United Kingdom and elsewhere. The question focus was that those people who have to depend on community care are usually those in the lower economic strata who could not afford to have home care or being looked after by their own family members. If the Government do not provide sufficient support services within the community (which again might not be cost efficient), community care would easily become lip service.
The other crucial thing that I wish to comment on concerns community participation.
Chapter 9 only touches on reviews of specific community type health services that seemed to have paid less attention to how to involve the community. Does community health service merely mean a strengthening of the role of voluntary organization? Or does it mean actual involvement of local leaders in health decision-making? If we are really going to involve the community, how are we going to prepare the community for this? How would health care planning at the community level be organized and what is the relationship with central health planning? Sir, I can think of an endless array of questions for community involvement. The simple point I wish to put forth is that: community participation in health delivery needs careful planning, are we going to do it?
Health information and health screening
Sir, one of the most emphasized part of the report is that the health care system in Hong Kong lacks adequate information. It is lacking in both the macro level where the concern is more on epidemiological and demographic data as well as the micro level where the concern is more on individual health data. According to World Health
Organization consultants, the lack of data at the micro level seemed more pertinent. To remedy, the report suggested the development of health indicators on the macro level and the establishment of a health information unit in the Department of Health. On the macro level, the suggestion seems to be more vague. But as far as this is concerned, I think there exists great opportunity for local tertiary educational institutions to contribute. Research teams could be established with the minimal encouragement from the Government. What I am concerned more is still with
information at the individual level. In the chapter on Screening Service, it was suggested that a district/community level of information collection targeted at individual diseases or subgroups is more preferred to territory-wide screening service. So it seems that we are heading towards an individual/community level of information base.
Sir, while I am all for the development of an individual information base for diagnostic/management purposes we must make sure that it is for the purpose of maintaining continuity of care for individuals. Such information must be handy and accessible for both the doctor and the patient and yet be kept in a confidential manner. In an era of information explosion, I should like to see individual health data be treated with respect and privacy.
Some neglected areas in the report
Sir, while I fully appreciate the comprehensiveness of this report, there are two areas which to some extent, I think, might not have received sufficient attention namely: (1) the role of supplementary health care professionals, such as physiotherapist, occupational therapist and so on, as well as (2) the role of non-medical first contact health professionals such as optometrists and social workers. I think these health professionals are also playing a very important primary health care role and therefore, their roles should be properly studied within the context of the report.
Sir, it is with the above remarks that I support my honourable colleague Mr LAU's motion and urge the Administration to take early steps to implement those improvement measures as recommended by the working party. I do not, however, support the proposed extension of the consultation period as this would cause undue delay to the early implementation of the recommendations.
MR TAM (in Cantonese): Sir, yesterday I was so engrossed in preparing my speech for the primary health care debate that I forgot to take care of myself and as a result got a cold. I therefore regret to say that Honourable Members today have to endure my voice, which may perhaps sound a bit sexy though. The slogan "Health for all, the way ahead" reflects one of the goals that should be pursuited by every society. The Report of the Working Party on Primary Health Care redresses the medical policy in the past which placed too much emphasis on treatment but overlooked primary health care. It also establishes a correct objective and direction for the medical services in future, namely, to perfect mental and physical health of the public through health promotion, disease prevention and continuity of care. Undoubtedly, the report
should be welcome and supported. However, to set forth the correct objective and direction is one thing, whether improvement measures can be taken in the light of the actual situation in Hong Kong is another. Regrettably, the report has failed to put forward such measures despite its good intention. And I am afraid the wrong prescriptions have been given in some cases. I would like to put forward the
following comments and suggestions on certain issues discussed in the report which are of public concern.
Failure to make comprehensive improvements to the existing primary medical services in Hong Kong
The report points out that only 15% of the existing primary health care is provided by government clinics compared to 70% by private practitioners. However, having reviewed the overall primary medical services in Hong Kong and identified the establishment of family physicians and district health systems as the solution to the problem, the report proposes some practical improvement measures such as the development of medical records and appointment system which concern with government clinics only. Obviously, it can do nothing with private physicians who are responsible for 70% of primary medical care. No matter how effective these improvement measures may be, they can hardly perfect primary medical services when the major supplier of such services is not included. The so-called family physicians system, district health system as well as health education for patients are but empty talks.
In order to make substantial improvements to primary medical services, private physicians must also be covered. Suitable control of private physicians is important to perfect primary medical services.
Failure to formulate a suitable strategy for health education and screening services in the light of the actual situation in Hong Kong
In order to promote health and prevent diseases, it is very important to promote health education and screening programme. However, the report has failed to give a comprehensive assessment of the existing services in this aspect and the sickness pattern of the public, resulting in the absence of a health education and screening strategy tailored for the actual situation in Hong Kong.
I am of the view that in promoting health education and screening services, the Government must take into account the sickness pattern and morbidity of the public. According to the information provided by the Hospital Services Department, the most popular diseases in Hong Kong are hepatitis, heart diseases and cancer. Other
surveys also show that the morbidity of elderly people is higher than that of other age groups. The Government must fully comprehend these information and cater for the needs of most of the patients and the public in devising health education and screening programmes, so as to make the most effective use of resources. However, it seems that the Government has implemented its health education policy in response to the international trend (as in the case of AIDS) rather than the needs of the Hong Kong society.
The problem of occupational health
The fact that less than three pages of the report have been devoted to occupational health reflects that the working party has taken the subject lightly. But on the contrary, occupational safety is presently a pressing problem in Hong Kong. In 1990, there were approximately 100 000 cases of industrial accidents. On average, one worker died in an industrial accident every four and a half days. As regards
occupational diseases, there were over 400 cases. Since the statutory list of occupational diseases are too narrow in scope and physicians generally lacks knowledge of occupational diseases, the actual number of cases should be far greater than the above figure. For instance, the white petroleum spirit, which has aroused extensive concern recently was discovered by accident. And it is significant that all these industrial accidents and occupational diseases can definitely be prevented. However, judging from the fact that the report, which attaches great importance to primary health services and aims at health promotion and diseases prevention, touches on the significant and preventable problem of occupational diseases lightly, one can see that not only the Government has overlooked the danger of occupational diseases, professionals have also failed to make accurate assessment of the subject.
As the report fails to make a comprehensive review of occupational health and the relevant preventive measures, there are two deficiencies in respect of its recommendations: (i) the measures recommended are not mandatory in nature and it is difficult to expect that they will be vigorously implemented, and (ii) too much emphasis has been placed on the scope of medical services. As far as occupational health is concerned, medical service is only one of the measures in the prevention of occupational diseases or industrial accidents. The following measures may be more important:
(1) To extend the safety officer system to cover the manufacturing industry on a mandatory basis and medium-small size undertakings may employ consultants instead;
(2) To stipulate in law that a safety committee be set up for an enterprise or industry in the manufacturing and construction sectors, so as to step up monitoring measures with regard to the hygiene and safety of the working environment;
(3) To stipulate in law that workers who have to contact dangerous substances must receive pre-service check-up and on-the-job screening on a regular basis;
(4) To review the existing statutory list of occupational diseases and incorporate those which have been identified as being caused by contacts with certain dangerous substances into the statutory list of occupational diseases;
(5) To review the existing legislation governing the use of dangerous substances and establish the safety standards in relation to the use of such substances;
(6) To set up a Central Occupational Health Records System, so as to collect and maintain information on occupational health;
(7) To set up clinics in major industrial areas which are to be manned by physicians having professional knowledge of occupational health.
The charging policy
The report has the following comments on the charging policy in the Chapter on Funding and Implementation: "Basic preventive care services aiming to safeguard and promote public health should continue to be provided free or virtually free for all. In the case of primary medical care providing curative treatment, we feel that the principle of individual contribution should be applied more critically having regard to the individual's actual needs and ability to pay." (page 265) "..... Those who choose Government services and can afford to pay should not continue to be heavily subsidized."(page 268) "Charging non-target group patients at cost should be the eventual aim. This should be achieved gradually with visible improvements in the quality of service." (page 272) These arguments involve two issues. One is the role played by the Government. The other is the charging principle adopted by the
Government, that is, those who can afford should pay and charges should be related to costs.
(1) The role of the Government
Regarding the role of the Government in the provision of medical services, many people share the views put forward in the report. They feel that the Government should be responsible for safeguarding and promoting the general public health of the community while personal health should be taken care of by individuals. Such argument is based, to a certain extent, on the assumption that one should be personally responsible for the conditions of his health which has nothing to do with society.
However, if a member of the public contracts hepatitis after eating polluted seafood or suffers from respiratory disease caused by air pollution, or in case an elderly person breaks down because of constant overwork in his younger days, who should be held responsible, the society or the individual? As diseases are often regarded as a kind of social cost in modern society and such cost should be borne by the community as a whole, the Government is in duty bound to make commitments to medical services.
Actually, the Government took up full responsibility in providing medical services in the past decade because it had to maintain Hong Kong's low wage system as well as to ensure that Hong Kong had a highly productive labour force. Therefore, a free-of-charge medical system is, to a certain extent, a compensation for the uneven distribution of wealth in our society.
It will be short-sighted to consider the existing medical system as the Government's financial burden which must be got rid of quickly, without regard to the social, economic and historical background of Hong Kong. In the meantime, Hong Kong's low wage system still exists and no substantial improvement has been made to rectify the uneven distribution of wealth. It will lead to social unstability and unrest if the Government withdraw its commitment in medical services.
(2) The principle that "those who can afford should pay"
In recent years, the Administration has spared no efforts in promoting the principle that "those who can afford should pay", whether this principle is desirable or not, we must first of all review if the primary care services of Hong Kong has been abused by "those who can afford".
According to a survey conducted by the Department of Community Medicine of the University of Hong Kong on health and medical services, those who visit government out-patient clinics mainly come from the low income group and their educational level is lower than average. The report also points out that among those who visit
government clinics, 30% suffer from chronic diseases, 20% are elderly people, 20% are children and another 20% are civil servants. All information clearly indicates that those attending government clinics are mainly from the lowest stratum and need medical services most. If charges of government clinics are related to costs, it will still be a heavy burden for the target group patients who have to pay half the charges, not to mention those who fall outside the target group.
It is doubtful whether the principle that "those who can afford should pay" is applicable to the provision of medical services. In Western countries, most of their people are in the middle class and have a higher income. But still, they cannot on their own shoulder the huge medical expenses and have to take up various medical insurance schemes. As for the local working population, half of them earn about $5,000 a month. In view of the living standard nowadays, how can they be classified as "those who can afford"? How can they shoulder by themselves the hefty medical expenses? I hope those who are in a position to formulate such policy will stand in the shoes of these people and will not make excuse for reducing government
commitment by indiscriminately putting forward proposals such as "those who can afford should pay" and "charges should be related to costs".
Sir, what I have mentioned are some criticisms on the report, but all in all, I support its objectives and overall direction. As a matter of fact, the report covers a lot of issues, many of which require better discussion. A three-month consultation period is not adequate for the general public to study the report in detail. Therefore, I am in favour of extending the consultation period as proposed in the amendment. But I hope that some indisputable improvement measures can be given a go-head first so that they will not be delayed because of the amendment. Sir, these are my remarks.
4.31 pm
HIS EXCELLENCY THE PRESIDENT: Before we get on to debating amendments to the motion, Members might like a short break.
4.55 pm
HIS EXCELLENCY THE PRESIDENT: Council will resume. Mr Ronald CHOW, you may now speak to the question and also move your amendment as well if you wish.
Mr Ronald CHOW moved an amendment to the motion:
That Mr LAU Wah-sum motion's be amended by deleting all the words following the word "and" and substituting the following:
"in view of the importance of primary health care, urges Government to extend the consultation period of the Report of the Working Party on Primary Health Care to 31 October 1991 and take early steps to improve primary health care services, having regard to the views expressed by the public before the expiry of the consultation period."
MR CHOW (in Cantonese): Sir, I rise to move an amendment to the Honourable LAU Wah-sum's motion. My motion would, as stated in the Order Paper, delete all the words following the word "and" in that motion and substitute therefor the following words:
"in view of the importance of primary health care, urges Government to extend the consultation period of the Report of the Working Party on Primary Health Care to 31 October 1991 and take early steps to improve primary health care services, having regard to the views expressed by the public before the expiry of the consultation period."
Sir, the motion states that this Council supports the development of quality primary health care services in Hong Kong to meet the World Health Organization's target of "Health for All by the Year 2000." This is a target worth supporting. However, the second half of the motion, that is, the part that urges Government to take early steps to implement those improvement measures as recommended by the Working Party on Primary Health Care, raises a point that is quite debatable. If the motion is passed in its original form, Government would be urged to act as recommended by the working party in its report.
Then, should some of the recommendations of the Report of the Working Party conflict with the development of an overall medical policy or have a major impact on public interests, the result would really be very bad for the development of the overall medical policy for the future, and government actions on primary health care services, which affect the success or failure of the entire medical services system, would have huge repercussions for the entire medical services system. How many people in the entire community would be affected? People, irrespective of age or sex, including high officials, the rich, hawkers and messengers, would all be affected. In both English and Chinese, "primary" in "primary health care" refers to the primary column of support for the overall medical services system. Primary health care services are very important. Any undesirable change made in them could bring about the collapse of the entire medical services system. The public consultation period is three months. It is not enough even for the professional organizations in the
health professions, for they, too, need time for analysis, much less for members of the public and organizations outside those professions. I therefore hope that, if Government is really to obtain the full views of all sectors of the community, it will consider extending the consultation period. Would it not be rushing to make a decision if it hastens in this way to pass the 102 improvement measures recommended by the Working Party on Primary Health Care?
Although the report adopts the WHO's definition of, and target for, primary health care, its substance is far different from the WHO's target. It focuses on paving the way for a phased pull-out by the Government from primary health care services and it would turn the existing fee policy into "gilding the lily" for Hong Kong's private doctors, about whom a public debate has just begun. They would become
"favorites among God's favorites." True, every profession should receive satisfactory and reasonable remuneration. Unfortunately, however, the report's recommendation that Government contracts out out-patient care to private practitioners at the present time when a system of controls is lacking is contrary to "the idea of distribution of wealth from those who can afford to those who cannot". On the contrary, it will cause a massive flow of wealth into "pockets that become fatter and fatter". In the medical profession, the prevailing thinking is that "practising medicine in Hong Kong for one year is better than doing the same in a foreign country for 10 years". The implementation of the particular recommendation of the report will change "10 years" to "15 or 20 years". The report is indeed a "show case" report. It has a "facade" but pays scant attention to substance. It is a case not much different from that in which "a vendor of dog meat displays the head of a lamb". The following are some of my comments on the Report of the Working Party on Primary Health Care.
I will not comment at length here on the views that some Members have just expressed.
(1) The making of a policy that puts the cart before the horse
For the past 14 years, there has never been an overall review of Hong Kong's medical policy. Developments in recent years have been particularly unsatisfactory. First of all, Government in 1985 proposed the establishment of a Hospital Authority. This year, it is proposing the establishment of a Primary Health Care Authority. It will wait until next year before issuing a Green Paper on Medical Policy, proposing a reform of medical service charges and a medical insurance system. Reforming the
administrative system before proposing improvements in policy is simply a case of putting the cart before the horse. Its intention is to create a fait accompli and then discuss retrospectively the question of direction. The entire process of so-called "consultation" from 1985 until now has simply been a political game.
(2) The trilogy of privatization
Government intends to phase in privatization in the area of medical services. The establishment of independent authorities is one of the principal ways of accomplishing privatization. The Hospital Authority was set up last year. Now the establishment of a Primary Health Care Authority is being proposed. An additional fact is that a medical insurance system is being promoted even though Government would not directly address the improvement of a situation where there is no control over the private practitioners' charging. All these are signs of Government's gradual backing out of its direct commitment to the provision of medical services.
Because the independent authorities will have considerable autonomy in administrative and financial matters, they will be able to decide charging policies themselves. This will directly affect people's everyday life. What method and system will Government use for monitoring the situation? The Hospital Authority already has great power for deciding the charges for hospital beds. The future Primary Health Care Authority will do likewise. In particular, the charges for medical and health care will be linked to costs. The fees charged by professional providers of private medical services will directly affect these costs and bring about endless increases in the inflation rate of the costs for medical care. This, too, will deal a heavy blow to people's livelihood. What system will Government be able to use for restraining such inflation? What department of Government will in future be able to make policy decisions conducive to the improvement of medical services? How will the Health and Welfare Branch of the Government Secretariat be able to play its role in the planning and co-ordination of a macro medical policy? After these authorities are established, will the Health and Welfare Branch be abolished as the Housing Branch already has been? Many policies today are detached from Government. The endless increases in public housing rents are precisely a consequence of Government's inability to interfere with the policy making of the Housing Authority after the authority became autonomous.
(3) Inconsistency between concept and substance
Although the report treats primary health care and primary medical care as separate concepts, yet its principal substance is devoted to one element of primary health care services, namely, primary medical services, and it particularly emphasizes the role of government clinics. The report emphasizes the fees to be charged by government clinics and the conversion of such clinics into semi-private clinics, but it overlooks the importance of primary health care services, nor does it provide a long-term development strategy for long-term primary health care services. In name, the report is a report on primary health care services. In substance, its emphasis is on primary medical services. That is, it puts an equal sign between the role of government clinics and primary health care services as a whole. Such a ploy to confuse readers and listeners is really disappointing. I hope that Members will not be confused by the mix-up of primary health care services and primary medical services.
If one ponders over the question more deeply, one will see that no serious blame can be laid. Because primary medical services (where an equal sign is put between the role of government clinics and primary medical services) in fact account for a very large portion of the Department of Health's budget, introducing initial
privatization here is understandable. However, one must not forget that health education and counselling is the most effective when conducted at the stage of out-patient care. It can be imagined that, after privatization, preventive education and counselling will suffer.
(4) Disadvantages of semi-private clinics
I have referred earlier to the disadvantages of semi-private clinics. The report recommends contracting out government clinics to private medical practitioners. The thinking that this will safeguard the quality of services is very tenuous. As everybody knows, in the final analysis, the quality of private medical practitioners can only be determined by the medical profession itself. Government has never exercised supervision. Now the wish is to use a piece of paper -- the contract -- to accomplish the effect of supervision, thus raising the professional quality of the private medical practitioners. One doubts very much this will be effective. In addition, because the private medical practitioners vary in service quality, and because the report gives no explanation as to the form of Government-private co operation, management, distribution of resources, operating methods and powers and responsibilities, one wonders what the basis is for the argument that the quality of service will be improved in this way.
(5) Is the purpose of the subject group system to facilitate Government's charging of high fees?
The report stresses that, to cope with the huge expenses on primary health care services incurred because of the improvement of services, Government must charge higher fees from some non-subject groups. The rule is that the fee standard is based on "letting those who have the means pay". However, has Government considered the fact that the "letting those who have the means pay" charging mode is contrary to citizens' basic civil right to primary health care services?
In many advanced countries, the governments have a direct commitment to the provision of primary health care services. I remember especially well that in 1986, when the Scott Panel of Australia was debating the issue of privatization of hospital services versus "letting those who have the means pay", the Government stressed that there would be no change to its direct commitment to the provision of primary health care services. If it is argued that Hong Kong's low tax system makes "letting those who have the means pay" necessary, then, in view of the present lack of effective controls over the private medical practitioners' fees and quality of service, can the above idea of redistribution of resources be realized? This is rather doubtful. Nor will medical insurance, even if enforced in future, be the panacea, because the insurance premium will rise at a rate that will be directly influenced by the private medical practitioners' fees. We must boldly confront and solve the problem of the "black hand" of medical cost inflation. It has also been argued that, in a free economy, the market mechanism will produce the effect of imposing self-discipline on the profession. I find this argument even less commendable. We must know that the medical services market is unique and quite different from the ordinary commodity market, where there are choices and comparisons and available information. In Hong Kong's abnormal social setting, the providers of medical services enjoy a unique semi-monopoly. The public does not have the right to know. They have no effective channel for asking who is responsible. I believe that Members here, who are citizens' mouth-pieces, have had such experiences and been unable to do anything about them. Government must never be allowed to use the improvement of services as the excuse for reducing its direct commitment to the provision of primary health care services.
In addition, allowing separate fees to be set for different subject groups undoubtedly gives Government too much discretionary power in deciding which group of people should pay through their noses. The charges for out-patient care would be greatly raised. The report recommends that the charges be cut by half for children
between the ages of six and 15, for full-time students of 18 or below, for old people of 65 or above and for recipients of disability allowances and be waived only for recipients of public assistance. At the same time, what is Government to do about the borderline cases between subject groups and non-subject groups? The report says nothing about any of these. The most obvious example of omission is: Will fees be waived for those out-patient cases who are victims of industrial accidents? In fact, to the law-abiding and ethical members of the medical profession, setting up an
effective system of controls will be most fair, since it will keep them from being harmed by the blackguards through association.
The report provides no clear guidance concerning the definition of subject groups. Nor is its fee exemption system satisfactory. One feels very disgusted with its service charge standards according to subject groups.
(6) Overlooking of other medical groups' professional evaluations of developments and services
The success or failure of primary health care services in fact depends on co-ordination among all professional medical, health and nursing ranks. Regrettably, the report totally ignores the professional roles of other health professions such as optometrists, dietitians, pharmacists, clinical psychologists, family visiting
nurses and physiotherapists. Besides, the report fails to assign positions to their roles in preventive education and counselling in the primary health care services. As a result, the report becomes one that emphasizes disease treatment but overlooks the related services such as disease prevention and health education.
In order to provide primary health care services, we must do more than look at out-patient care alone. This fact is beyond dispute. However, how does one involve all the ranks of the medical, health and nursing professions in primary health care services? This may be done through the establishment of a medical team that crosses professional lines. Such a team will co-ordinate the roles played by the different professions in primary health care services, thus enabling primary health care
services to grow healthily and comprehensively. Regrettably, the report fails to mention this. What are receiving lop-sided emphasis are the private medical practitioners and out-patient care. Government must immediately correct such an unhealthy idea about development.
Sir, primary health care services are like "piling" in a building project. They
are indeed the main columns of support for medical services as a whole. You make a slight mistake, and the result surely will affect everything else, just as pulling someone by the hair will cause his entire body to move. In 1985, Government began studying the establishment of a Hospital Authority. A six-month consultation period followed in March to August 1986. The Hospital Authority was not established until the end of 1990. Before that, countless interested people were consulted. Three years were spent on consulting the affected employees about their job changes. To this day, many problems are still pending solution. It is thus clear that to act is harder than to know. I believe that the establishment of a Primary Health Care Authority will certainly not be less complex than that of the Hospital Authority. It will involve a broader range of things. It will similarly involve the
reorganization of the Department of Health, the conversion of its employees to non-civil servant status, its power after the reorganization relative to the Administration, its accountability and so forth. Besides, during last year's debate on the question of the Hospital Authority, Government did not actively take the view that the existing system of primary health care services must be changed in a hurry. Why then the hurry to pass the recommendations of the report today? There are people who emphasize that an extension of the consultation period may cause a delay in the appropriation of funds and consequently prevent the recommended reform from being implemented. Similar views were expressed at the time of the establishment of the Hospital Authority. Is it the intention to say that "using a knife to cut quickly through a skein of hemp" is better than "making a fine product in a time-consuming process," that what can be grabbed quickly must be grabbed quickly?
In addition, the report's recommendations that non-subject groups be charged higher out-patient care fees by way of "letting those who have the means pay" and that government clinics be run as semi-private clinics will have major repercussions for the out-patient care services which each year take care of more than 4 000 000 patients. Most recipients of out-patient care services are lower middle income
groups. How can Government be wishy-washy about a policy that would have far reaching effects on people's livelihood? Besides, it took the working party nearly two years to finish drafting the report containing an unprecedented 102 recommendations. How can the public be expected to understand and express views on the report's recommendations within the three short months of the consultation period? Up to now, many district boards have not yet discussed the report. Some did not discuss it until yesterday. The consultation period will expire in 20-plus days. Must the matter be rushed in this manner? Up to yesterday, the working party had received only seven position papers. Does this have to do with the lack of government
publicity or the difficulty with which one may obtain the full text of the report? In view of the above, Sir, I hope that Government will extend the consultation period of the report from the original three months to six months and that, during the period, Government will conduct a more effective public information campaign on the report's recommendations, will take the initiative in gathering the views of the professional organizations and the public on the report and will not take the arbitrary action of adopting the report's recommendations in their entirety. As the saying goes, "Make one wrong move and you become trapped for the entire chess game." I urge
Government not to take primary health care services lightly. The Honourable LAU Wah-sum mentioned training China mainland nurses. That will involve the whole of Hong Kong's nurse development and training system, the licensing system, the system of evaluation standards and other complex questions. The issue is like the one we discussed last year: Western doctors are better trained than China mainland doctors; so the latter's coming to Hong Kong to practise will cause complex problems. I
believe that Government understands that it must not lightly consider this issue.
Sir, with these remarks, I beg to move. I hope that Members will truly appreciate the importance of primary health care. "Primary" refers to the primary level. Hospitals provide services only at the "secondary" level. Something wrong at the primary level means something wrong for the whole system. I hope that Members will support my motion for amendment and allow more people to make comments on the report. Thank you.
Question on Mr Ronald CHOW's amendment proposed.
HIS EXCELLENCY THE PRESIDENT: Members by now, I think, will be familiar with the procedural gymnastics which are necessary on occasions like this, but I will repeat them. Those who have already spoken in the debate may speak again on the amendment, but they should confine their remarks solely to the amendment and its purpose. If there are Members who have not yet spoken and now wish to speak, it will be taken that they are speaking both to the amendment and the original motion. So, they will not get a chance to speak again after the amendment has been disposed of. Now, in addition to Members who have already spoken on the main question, I have the names of the following Members, which I will read out, who have said that they want to take part in the debate: Mr Martin LEE, Mrs Peggy LAM, Miss LEUNG Wai-tung, Mr Peter WONG and the Secretary for Health and Welfare. Are there any other Members who also wish to speak? Would you just hold up your hands for a moment please? Mr POON Chi-fai.
Thank you very much.
Now, a further piece of procedural gymnastics. In the case of Miss LEUNG Wai-tung, she has also given notice to move an amendment but the amendment relates to the original motion; so if Mr Ronald CHOW's amendment is approved, then she would have nothing on which to base the amendment. So I will not call her now. She will have a chance to speak again after the amendment by Mr Ronald CHOW has been disposed of one way or the other.
MR MARTIN LEE: Sir, I have listened with care to the salient points mentioned by the Honourable Ronald CHOW in his well prepared speech and I agree with the contents in his speech. Sir, I just wish to take one more point and that is the advantage of extending the consultation period to the end of October this year. The extension will make it possible for the incoming legislature to have the benefit of additional view expressed between now and then. Therefore for these reasons I would support the amendment moved by the Honourable Ronald CHOW. But in case his amendment is defeated and Miss LEUNG Wai-tung will then move her amendment, I would support her because at least the limitation contained in the original motion would be removed by her amendment.
MR POON CHI-FAI (in Cantonese): Sir, I had the opportunity of knowing before the debate the Honourable Ronald CHOW's position and views on the Report of the Working Party on Primary Health Care. Since we share more or less the same views, I am not going to repeat them here except to reaffirm my acceptance of and support for his position on the motion.
Sir, the Report of the Working Party on Primary Health Care will have far-reaching effects on the medical services available to the general public. We agree that the report, which is well-conceived and is heading towards the right direction in the area of provision of medical services, should deserve our support. But to make it more substantial and perfect, public opinion is necessary to enrich the content of the report so that the recommendations contained therein will be more acceptable to the public and therefore easier to implement. Most unfortunately, the Government has failed to give full attention to promoting and publicizing the report since its publication. This lack of publicity, coupled with the fact that the news headlines had within that period been dominated by crucial domestic and world events, explains
why the report has failed to attract public attention and hence extensive debate. So the proposal of extending the consultation period is in fact worthy of consideration and support as better results will surely be obtained if the period can be extended for two or three months and greater publicity be given to the report. Based on the above reasons, if I were to choose among the motion by the Honourable LAU Wah-sum and the amended motions by the Honourable Ronald CHOW and the Honourable LEUNG Wai-tung, I would prefer Mr CHOW's amendment motion, namely, to extend the consultation period of the Report of the Working Party on Primary Health Care to 31 October 1991. Sir, with these remarks, I support the Honourable Ronald CHOW's amended motion. Thank you.
MRS LAM (in Cantonese): Sir, the health care system in Hong Kong has all along been emphasizing on hospital services while health services outside the scope of a hospital have not been given their due attention. Fortunately, the Government has made zealous efforts in recent years to develop primary health care services. A working party has also been set up to conduct an overall review on the subject. This is indeed praiseworthy.
After two years of hard work, the Working Party on Primary Health Care has now come up with 102 recommendations. These recommendations cover matters big and small, ranging from broad principles such as the objectives of developing primary health care services to minute details such as the labelling of medicine for patients.
The Report of the Working Party on Primary Health Care is a comprehensive and concrete one. This can demonstrate the sincerity of the working party in addressing the problem. The working party further recommends that preventive and promotive health care services should continue to be provided free of charge, while general out-patient services should be provided to children, senior citizens and disability allowances recipients at half fee, and provided free of charge to public assistance recipients. To the general public, however, the major point of concern in this
voluminous report is probably the concept of "payment by those who can afford", which means recovering the costs of providing health care services from non-target group patients. If this broad principle is not accepted by the public, it would be meaningless to go on with the consultation on the details of the recommendations.
I would, therefore, first of all comment on the "payment by those who can afford" principle.
Sir, I recall that in your policy address delivered in October last year, you pointed out that people in the 1990s "are no longer content simply with a basic level of provision. In an increasingly prosperous and educated Hong Kong, they expect a higher quality of service and more opportunities for the individual to choose
particular types of service. Greater choice and higher incomes mean that families must increasingly pay for services which go beyond the basic level".
This concept is applicable to the medical service system. In face of our budgetary constraints and the need to maintain the existing taxation system, it is becoming more and more difficult for the Government to make provision for any substantial increase in medical expenditures. The improvement of our medical services will thus only be achieved through higher efficiency and the development of new resources. Strengthening management and minimizing waste of resources are the basic means to enhance efficiency. And it is for these purposes that the Hospital Authority and Primary Health Care Authority are established. As for the development of new resources, the charging principle of "payment by those who can afford" will have to be adopted in order to recover the ever increasing costs in providing medical services. But this must be carried out in phase to cushion the effect any abrupt change may have on patients.
Primary health care is essential health care made universally assessable to individuals and families in the community by means acceptable to them, through their full participation and at a cost that the community can afford. Primary Health Care services include disease prevention, health education and promotion, curative services and rehabilitative services. To pay to see a doctor is one form of participation in primary health care services. It also serves as an economic incentive for disease prevention and the promotion of health education.
The working party has laid down certain principles for the provision of primary health care services, which include:
(1) public health matters should primarily remain Government's responsibility, but the public sector should not become the only or main provider of clinic or curative services;
(2) no one should be prevented, through lack of means, from obtaining adequate medical treatment; and
(3) quality health care services should be provided by both the public and private sectors.
I fully support these principles.
It is true to say that under the present system, no one will be prevented from obtaining adequate medical treatment due to the lack of means. But the problem is that government hospitals do not have the necessary resources to improve the quality of service because they have been charging only nominal fees for the services they provide. Take for example the general out-patient (GOP) clinics, as the quota is 70 to 100 patients per day, this accounts for the unreasonably long waiting time and unimaginably short consultation time which have long been the subject of public
complaints. If we want to improve the quality of service at these out-patient clinics, higher fees must be charged. However, service such as disease prevention, control of communicable diseases and health promotion should continue to be provided free of charge or at a nominal fee because prevention is better than cure. Good preventive services will effectively reduce the chances for the contraction of diseases.
The working party recommends that young children, the elderly and people on disability allowances should be eligible for general out-patient services at half fee while people on public assistance should be eligible for the services free of charge. The eventual aim should be to charge non-target group patients at cost. The working party has also made similar recommendations concerning screening services.
I accept that in the long term, charging at cost would be the solution for the resources problem. But this charging policy must be implemented step by step so as to minimize its impact on the general public. On the other hand, in order to ensure that no one will be deprived of medical services due to financial reasons, there should be arrangements for the waiving of fee for those who cannot afford to pay. The problem is that substantial administration costs will be required for identifying those who are in genuine difficulties. Now that the working party has suggested a method for classifying target groups for subsidized medical services, I think it is a reasonable and practicable approach.
Some people may say that at present, most of the patients visiting government GOP clinics are those who cannot afford the fees, otherwise, they would not have to queue up for service at these government clinics and would have switched to private sector clinics instead. Under the circumstances, the policy to charge at cost may
not be able to achieve its desired result as most of the patients will have their consultation fees waived. Given such an argument, I wonder if the Government can provide relevant statistics for our reference. Nevertheless, I personally believe that the majority of people visiting government GOP clinics are elderly citizens. They prefer government clinics to private clinics not simply because they cannot afford higher fees, but also because they have more spare time to queue up for the less expensive GOP services. Although this group of elderly citizens will only be paying half-fee according to the proposed charging policy, their contributions will, to a certain extent, help relieve the financial stringency of GOP clinics. Moreover, with an improved financial situation made possible by the implementation of the new charging policy, GOP clinics would be able to gradually upgrade their quality of service. Hopefully, we can have patients of private sector clinics switching over to government clinics one day.
Doubtlessly, under the charging policy of "payment by those who can afford", the public will inevitably have to shoulder a heavier burden in respect of medical expenses. It is therefore important that a medical insurance scheme should be introduced simultaneously. It is understood that the Medical Insurance Working Group set up by the Government has already made initial progress in their studies, and has suggested three models, namely: the insurance company model, the health care organization model and the sickness fund association model for further considerations. Should our future medical insurance scheme be centralized, should it be compulsory or voluntary, which parties should contribute, should it be profit-making or non-profit-making, should it cover both primary health care and hospital services or only one of the two? All these would require thorough considerations by parties concerned.
Sir, just now I mentioned about the problem of old people seeking medical service. In this regard, I would like to bring up once again the concept of multi-service elderly centres. It should be an ideal arrangement for the elderly if medical, social work and recreational services can all be available at one location.
Finally, I would like to talk about the screening services.
I agree in principle to the working party's recommendations that (1) screening programmes should be targeted towards diseases or population sub-groups instead of introducing mass screening programme for all; (2) opportunistic screening should be introduced on a pilot basis for the elderly aged 65 and above attending general
out-patient clinics; (3) screening and other preventive services should be introduced on a pilot basis to women attending the proposed well-woman clinics; and (4) public clinics screening services should be provided at a charge to recover the costs.
The experience of the Family Planning Association of Hong Kong in providing screening services may rate a mention here. The problem of funds has all along been a big headache for voluntary agencies. It was in the late 1970s when the Family Planning Association was running into deficits that I proposed to introduce a new premarital screening service for couples before getting married. This screening service can on the one hand provide preventive health care whereby promoting the health of the population, and on the other hand secure a considerable income for the Association.
When I first put forward this proposal to the Board of Directors, the response had not been encouraging. Some directors even voted against it though in the end it was agreed that the proposal could be given a try. Nevertheless, the pilot scheme turned out to be a great success. People did not refrain from taking this screening service just because it was charged. On the contrary, they gave full support to the scheme and took it more seriously as they had to pay for the service. Of course, the success or otherwise of a scheme hinges on its promotion and publicity work. Sir, I agree with the Honourable LAU Wah-sum's motion which urges Government to take early steps to implement those improvement measures as recommended by the Working Party on Primary Health Care after the expiry of the consultation period on 31 July 1991. With these remarks, I support Mr LAU Wah-sum's motion.
DR LEONG: Sir, the medical profession would like to pay tribute to the Working Party on Primary Health Care for their tremendous effort in producing the report titled Health for All, the Way Ahead. Not only did they identify the shortcomings of the current system, but also pave the way for reform of primary health care so vital to the development of a proper health system in Hong Kong. Let me first quote from the editorial of the official publication of the Hong Kong Medical Association:
"Throughout the report, the many themes have been spelled out loud and clear -- that Primary Health Care is vital to the well-being of our society and that in order to improve our health care system, a lot has to be done. In fact a radical change in concept with its practical application has been put forward in many areas. The report is the first one ever in Hong Kong which gives such a very comprehensive review of
the present Primary Health Care system, its shortcomings and the reasons underlying, and the possible means of remedy within the theoretical basis for such changes. All medical colleagues who are interested in the development of our health care system should read the original report".
Similarly, the medical profession is grateful to the Administration for recognizing the importance of primary health care after so many years. We are stimulated by the fact that the Administration has the vision of throwing the report open for public consultation, hopefully with a view to implementing the recommendations without delay having regard to the views of the public. This, Sir, the profession so urges.
Sir, we have heard from the Members who have spoken today many points praising the recommendations of this report. But are there any flaws, are there any areas which are not completely covered? Are there any possibilities to make any reform of primary health care even more effective and efficient? Sir, I would like to dwell on some nine points in this proper direction:
1. Incompleteness of the report
Statistics have shown that only some 15% of the patients who need primary health care are being taken care of by the public out-patient clinics whilst the remaining 85% of the people of Hong Kong are being cared by private practitioners, Chinese herbalists and other practitioners of health care. This report, regrettably,
limited by its terms of reference, has concentrated mainly on reform of the public primary health care service. Ironically, any reform will therefore be directed to improvement in the service to benefit only some 15% of the population. It is therefore time that an even wider review be taken on board to improve the private sector and also to streamline the practice of Chinese traditional practitioners and those alternative health care practices.
2. Inadequate guidance in the implementation of integrated services
One of the main thrust of this report is an attempt to provide an integrated service between the primary health care and the hospital and between the public sector and the private sector of providers of services taking into consideration the input from the community. Such, Sir, is easier said than done. Two aspects are simply missing and perhaps should be taken on board to provide proper implementation and
integration:
(1) Some regular channels of dialogue on operational matters must be devised between the providers of care in the primary health care and hospitals and between private and public;
(2) Ways and means must be introduced so that patient records will be available to the different segments of the health care teams at the point of contact with the patients.
3. Inadequate vision in the reform of the school medical service
Whilst the cancellation of the school medical service is to be hailed, the report is not brave enough to cancel the special service to school children completely and to leave the care of these children to the improved public general out-patient clinics.
Instead, a school health services system is introduced to screen school children. Is this cost-effective? What are the funding requirements? How extensive would be the screening? Furthermore are there adequate manpower and financial resources to tackle the problems identified in the screening process? Is it then just an exercise or is it just something for the Administration to tell the public that something is in store still for school children?
4. Inadequacy in the details of the proposed screening services
Whilst it is commendable to introduce screening service for specific groups such as well-women clinics, screening for the elderly and so on, the same problems in relation to screening of school children apply. Are there enough provisions both in manpower and resources to bring about treatment of problems so identified?
Furthermore, there is a lack of details of purposes and objectives of screening these groups and why these groups are singled out as targets.
5. What are the side-effects from improvements of out-patient department service?
It is commendable again to upgrade our existing sorrowful state in the general out-patient services. It is indeed good news for our suffering public that they now do not have to wait for many hours queuing up in the heat of summer sun but can now
arrange for an appointment to come at a specific time. But with improvement in service, we would expect increase in attendance.
Are there provisions again in manpower and finance to effectively care for the increase in number or are we again introducing a disguised quota system to prevent our frontline workers from overloading their work and thereby affecting the standards?
Are we again setting the vicious cycle in motion again?
6. Inadequate protection of the private practitioners' interest
In as much as a proper service is needed for the public, considerations must also be given to protecting the segment of health care providers who look after some 70% of the primary health care in Hong Kong, that is the private practitioners. Will the improvement of the general out-patient clinics which are heavily government
subsidized interfere with the practice of the private practitioners? Are the training programme proposed by this report made available to private and public practitioners alike? These problems, Sir, must be addressed. Furthermore, it would be farcical if patients were initially channelled to general out-patient department service and finally had to go back to private practitioners because the general out-patient clinics were not able to deliver the "goods", as it were, due to overload of work!
Sir, this is in contradiction to what my honourable colleague, Mr Ronald CHOW, predicts. Mr CHOW has repeatedly confused the issue of charging by private practitioners with the spirit of the Report of the Working Party. But, Sir, I do not intend to dwell on this particular subject any more as the intention of this debate is to debate the improvement on ways or means of improving primary health care services in the public sector, not a battlefield between one profession against the other.
7. Careful consideration must be made for contracting out clinics to private practitioners
Recommendations are being made in the report to contract out general out-patient clinics in completely new towns to private practitioners. Government will subsidize the target groups and there will be no government-run general out-patient clinics there. Whilst such will have the advantages of more flexibility and greater
cost-effective management, special considerations must be given in two directions:
(1) The criteria for contracting out to doctors must be water-proof and fairness must be the order of the day in awarding these contracts.
(2) Provisions must be made to ensure that residents of these new towns will not fall victim to the absence of choice to attend an almost free, heavily subsidized government out-patient clinics as in other parts of Hong Kong.
8. Misconceptions in the funding of primary health care
Whilst, Sir, it is true that improvement in primary health care will probably decrease the need for hospital care, and it is equally true that primary health care is by and large cheaper than hospital care, the Administration must be advised in no uncertain terms that improvement of primary health care should not be done at the expense of hospital care. Robbing Peter to pay Paul will not do. Hospital service budget cannot, and should not, be cut but more funding should be allocated to primary health care so as to curb the increasing need of hospital care.
9. The lack of a detailed integration of dental service
It is regrettable that this report did not incorporate any details of the provision of dental care. It should be realized that a healthy set of teeth is as important to the total health of a person as any other part of his/her anatomy. Fortunately, as if by coincidence, the dental sub-committee of the Medical Development Advisory Committee has provided a report on the future direction of dental service in Hong Kong at the same time. Whilst I am glad that a synopsis of the dental report is incorporated into the synopsis of the working party's report, I am disappointed that the detailed dental report is not out for public consultation.
Policy issues
Sir, there are a few issues relating to the policy matters which are being touched on by the Working Party's Report on which I would like to say a few words:
(1) The proposal to reorganize the Department of Health
It is very important that the Department be restructured to take the onslaught
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