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HONG KONG URBAN COUNCIL
fully qualified doctor for every 1,000 persons as is the case in the United Kingdom, we should need a total of 4,000 doctors or 2,400 more than the present total of some 1,600. At the present rate of output of medical graduates, even when the number increases to 120 a year on the completion of the expansion programme of the Medical Faculty in the University of Hong Kong by 1971, it will take another twenty years to achieve our aim provided that doctors at present registered not be permitted to die or to emigrate and that the whole population be sterilized during this period. Otherwise, the natural growth rate of over 100,000 per annum will absorb most of the additional doctors' services. In other words, unless some bold measures are taken the problem of shortage threatens to remain with us for ever.
In His Excellency the Governor's speech it was also stated that "In fact we probably have the most nearly genuinely free health service of major proportions, for those who wish to use it, in the world; and one which provides a very good standard of treatment and care." Mr. Chairman, having regard to the low rate chargeable to the public in clinics and hospitals and to the hard work put in by medical officers and other staff, to whom all credit is due, I am in perfect agreement with this statement. However, I must point out that in Government institutions the dignity of the individual is unfortunately often disregarded. I refer of course mainly to the less privileged class who form the great majority of those using the services. Because of the shortage of medical personnel, as I have pointed out before, out-patient work has to a great extent deteriorated into a sort of perfunctory relief with much detriment to patients' dignity, emergency cases often have to wait in casualty reception for hours before the necessary urgent care is accorded to them, specialist attention can hardly be obtained in less than a number of weeks and it is common for a general surgical case to wait for several months before admission. Thus, no matter how low the rate and how high the standard of medical service, the number of people who can benefit from it is very much reduced.
I wish to reiterate my previous proposal first made in 1964 to establish an additional medical school in the Chinese University of Hong Kong as a radical solution to this grave and pressing problem. This proposal is based upon the following grounds:
(i) The graduates of Chinese middle schools, whose parents are also taxpayers, should be given equal opportunity to receive professional training at university level.
In view of the fact that the great majority of the population here are Chinese it would be very unwise to overlook the importance of Chinese education.
(ii) Healthy competition between medical schools will help to raise our standards and improve our services.
HONG KONG URBAN COUNCIL
323
(iii) The teaching facilities of the existing medical school are located on Hong Kong island, which houses slightly over one million people. On the other side of the harbour live double that number and there are situated the two largest hospitals in the Colony, the Queen Elizabeth Hospital and the Kwong Wah Hospital, which could serve admirably as teaching institutions.
It is also generally agreed by medical educators that a smaller class is always more desirable than a larger one.
In connection with my proposal I wish to emphasise that having more doctors does not necessarily mean keener competition among medical practitioners to earn a decent living. Apart from Government departments and a few modern firms and factories, employees in industry and commerce and their families have not been provided by their employers with medical facilities. The medical profession has the duty to see that the whole community is receiving proper modern medical service and only when we have sufficient personnel to staff the project can we press the authorities concerned to draw up legislation along this line.
It may be claimed that the proposal, while sound, involves heavy expenditure, while others may say that the Chinese University needs time to consolidate its present achievements before expanding further. Neither of these appears to me a convincing argument. As I suggested last year, the authorities should set up a special committee to investigate the feasibility of realising this project. While Government has the responsibility to shoulder the necessary expenditure, I am personally convinced that many organizations and individuals, local and overseas, would be willing to contribute towards this end. As for the other argument, it is beyond dispute that many outstanding universities in the world, especially in China and including the University of Hong Kong, first came into existence as medical schools.
II.
Education
Education is the direct concern of us all and although to my deep regret I have failed in the past to convince the officials in our Education Department, nevertheless I here renew my attempts in the hope of some tangible results.
(i) In spite of strong opposition from educational circles the Department's decision to encourage primary VI students to be instructed in English still stands and has in many schools been implemented.
The authorities neglect the fact that less than 3% of our primary school graduates will have the opportunity to undergo university training while the great majority will seek
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322
HONG KONG URBAN COUNCIL
fully qualified doctor for every 1,000 persons as is the case in the United Kingdom, we should need a total of 4,000 doctors or 2,400 more than the present total of some 1,600. At the present rate of output of medical graduates, even when the number increases to 120 a year on the completion of the expansion programme of the Medical Faculty in the University of Hong Kong by 1971, it will take another twenty years to achieve our aim provided that doctors at present registered not be permitted to die or to emigrate and that the whole population be sterilized during this period. Otherwise, the natural growth rate of over 100,000 per annum will absorb most of the additional doctors' services. In other words, unless some bold measures are taken the problem of shortage threatens to remain with us for ever.
In His Excellency the Governor's speech it was also stated that "In fact we probably have the most nearly genuinely free health service of major proportions, for those who wish to use it, in the world; and one which provides a very good standard of treatment and care." Mr. Chairman, having regard to the low rate chargeable to the public in clinics and hospitals and to the hard work put in by medical officers and other staff, to whom all credit is due, I am in perfect agreement with this statement. However, I must point out that in Government institutions the dignity of the individual is unfortunately often dis- regarded. I refer of course mainly to the less privileged class who form the great majority of those using the services. Because of the shortage of medical personnel, as I have pointed out before, out-patient work has to a great extent deteriorated into a sort of perfunctory relief with much detriment to patients' dignity, emergency cases often have to wait in casualty reception for hours before the necessary urgent care is accorded to them, specialist attention can hardly be obtained in less than a number of weeks and it is common for a general surgical case to wait for several months before admission. Thus, no matter how low the rate and how high the standard of medical service, the number of people who can benefit from it is very much reduced.
I wish to reiterate my previous proposal first made in 1964 to establish an additional medical school in the Chinese University of Hong Kong as a radical solution to this grave and pressing problem. This proposal is based upon the following grounds:
(i) The graduates of Chinese middle schools, whose parents are also taxpayers, should be given equal opportunity to receive professional training at university level.
In view of the fact that the great majority of the popula- tion here are Chinese it would be very unwise to overlook the importance of Chinese education.
(ii) Healthy competition between medical schools will help to
raise our standards and improve our services.
HONG KONG URBAN COUNCIL
323
(iii) The teaching facilities of the existing medical school are located on Hong Kong island, which houses slightly over one million people. On the other side of the harbour live double that number and there are situated the two largest hospitals in the Colony, the Queen Elizabeth Hospital and the Kwong Wah Hospital, which could serve admirably as teaching institu- tions.
It is also generally agreed by medical educators that a smaller class is always more desirable than a larger one.
In connection with my proposal I wish to emphasise that having more doctors does not necessarily mean keener competition among medical practitioners to earn a decent living. Apart from Government departments and a few modern firms and factories, employees in industry and commerce and their families have not been provided by their employers with medical facilities. The medical profession has the duty to see that the whole community is receiving proper modern medical service and only when we have sufficient personnel to staff the project can we press the authorities concerned to draw up legislation along this line.
It may be claimed that the proposal, while sound, involves heavy expenditure, while others may say that the Chinese University needs time to consolidate its present achievements before expanding further. Neither of these appears to me a convincing argument. As I suggested last year, the authorities should set up a special committee to investigate the feasibility of realising this project. While Government has the responsibility to shoulder the necessary expenditure, I am personally convinced that many organizations and individuals, local and overseas, would be willing to contribute towards this end. As for the other argument, it is beyond dispute that many outstanding universities in the world, especially in China and including the University of Hong Kong, first came into existence as medical schools.
II.
Education
Education is the direct concern of us all and although to my deep regret I have failed in the past to convince the officials in our Education Department, nevertheless I here renew my attempts in the hope of some tangible results.
(i) In spite of strong opposition from educational circles the Department's decision to encourage primary VI students to be instructed in English still stands and has in many schools been implemented.
The authorities neglect the fact that less than 3% of our primary school graduates will have the opportunity to under- go university training while the great majority will seek
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