LCQ22: Improving children’s healthcare services

     Following is a question by Dr the Hon Ngan Man-yu and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (November 27):
 
Question:
 
     Regarding improving children's healthcare services, will the Government inform this Council:
 
(1) as it has been reported that the authorities plan to transfer some of the services previously provided by the Department of Health (DH) to the Hospital Authority or the Primary Healthcare Commission, whereas DH is dedicated to properly fulfilling its roles in disease prevention, health promotion, drug regulation, etc., of the details concerning the repositioning of the three healthcare departments/organisations and the impact on children's healthcare services after the repositioning;
 
(2) as it is learnt that the seven Child Assessment Centres (CACs) under DH will be restructured in the light of the 2024 Policy Address's proposal to deepen reform of the healthcare system, of the relevant details (including which government department or organisation will be responsible for the operation of such CACs upon their restructuring); whether it has assessed if the waiting time for child assessment can be effectively shortened after the restructuring of such CACs;
 
(3) as the 2024 Policy Address proposes to launch the Primary Dental Co-Care Pilot Scheme for Adolescents to encourage the prevention of dental diseases and to provide oral check-ups and preventive dental services for pre-school children, of the details of the Scheme and the services (including the contents of the Scheme/services, co-‍ordination bodies, eligibility criteria, and target beneficiaries);
 
(4) as the 2024 Policy Address proposes to support Hong Kong Children's Hospital in further developing more advanced healthcare services, of the relevant details;
 
(5) as the 2024 Policy Address proposes to revamp maternal and child health and family-planning services to promote healthy fertility, of the relevant detailed plans; whether it has considered gradually diverting the demand of expectant mothers and newborn babies for healthcare services from Maternal and Child Health Centres to private healthcare facilities, and then redeploying resources to set up dedicated "Children's Clinics" in order to provide more convenient paediatric services;
 
(6) whether it has studied providing full subsidies for infants and young children eligible for the Hong Kong Childhood Immunisation Programme to receive vaccinations at private healthcare facilities, thus allowing flexible vaccination arrangements to be made while ensuring, by means of the eHealth System, that children receive all necessary vaccinations, thereby maintaining the high vaccination coverage rate of Hong Kong; if so, of the details; if not, the reasons for that; and
 
(7) whether it has considered, by drawing reference from the model of the Chronic Disease Co-Care Pilot Scheme, setting up a "Children's Healthcare Co-Care Scheme" to monitor the health and growth of children through medical public-private partnership programmes for early detection and treatment of health problems, thereby improving the health of children in general; if so, of the details; if not, the reasons for that?
 
Reply:
 
President,
 
     The Government attaches great importance to children's health, and is committed to providing children with quality medical and health services. The 28 Maternal and Child Health Centres (MCHCs) under the Department of Health (DH) are set up in all 18 districts in Hong Kong, providing health promotion and disease prevention services for newborn babies and children up to five years old, including free vaccination services and continuous monitoring of children's growth and development. In addition, the 13 Student Health Service Centres of the DH have been providing a range of health services to all students and adolescents in Hong Kong to cater for their needs at different stages of development, including screenings for health problems related to growth, vision, hearing and scoliosis; physical examinations; health behaviours and psychosocial health. If students are found to have health problems, they will be referred to the Special Assessment Centres of the Student Health Service, specialist clinics under the Hospital Authority (HA) or other organisations as appropriate for further assessment and treatment. As for paediatric services, the HA operates its paediatric services under a hub-and-spoke model. The Hong Kong Children's Hospital (HKCH) serves as a tertiary referral centre for severe, complex and uncommon paediatric cases requiring multi-disciplinary management. As for the paediatric departments in public hospitals in different regions, they are mainly responsible for secondary, emergency and community care services. Under this hub-and-spoke model, HKCH and regional hospitals work together as a co-ordinated and coherent paediatric service network. The paediatrics departments under the HA also provide paediatric out-patient, in-patient services, acute care as well as rehabilitation services. In addition, the paediatrics, paediatric surgery and child psychiatric service departments provide clinical services. Meanwhile, there are multi-disciplinary teams in the HA providing children with appropriate supporting services.
 
     In consultation with the DH, the HA and the Primary Healthcare Commission (PHC Commission), the consolidated reply to the relevant questions, which are mainly on "The Chief Executive's 2024 Policy Address", as raised by Dr the Hon Ngan Man-yu is as follows:
 
(1) and (2) It is announced in "The Chief Executive's 2024 Policy Address" that the Health Bureau (HHB) will conduct a comprehensive review on the positioning and objectives of the healthcare system, reform the functions and division of work among the HA, the DH and the PHC Commission, strengthen health promotion and disease prevention in primary healthcare, and improve public healthcare services. In parallel, the HHB will push forward reform in private healthcare services in terms of their quality, cost-effectiveness and price transparency, providing the public with high-quality, cost-effective and affordable healthcare service options.
 
     The PHC Commission has been actively expanding its work since its official establishment in July this year to strengthen the primary healthcare service network in the community. The DH will gradually transfer its specialist and primary clinical services to the HA and the PHC Commission respectively, so as to concentrate its resources on improving public health, disease prevention and health education, as well as its functions in respect of medical professions, regulation of healthcare organisations and approval for drugs and medical devices.
 
     According to the abovementioned direction of consolidation, the Government is planning to transfer the Child Assessment Service of the DH to the HA for management, with a view to consolidating public paediatrics services to facilitate collaboration among various specialties and streamline service delivery. This will ensure that children suspected of having developmental or behavioural problems can receive the necessary integrated and multi-disciplinary assessment, treatment and rehabilitation services in a timely manner, while the referral arrangements and services for patients can be optimised. Relevant details will be announced at an appropriate juncture.
 
(3) The Working Group on Oral Health and Dental Care (Working Group) was established by the HHB in 2022 and released its interim report at the end of 2023. Pursuant to the recommendations of the Working Group, the Government will launch the Primary Dental Co-Care Pilot Scheme for Adolescents (Pilot Scheme) and introduce preventive dental care service for pre-school children.
 
     The Pilot Scheme will be launched in 2025 to interface with the School Dental Care Service. The Scheme will provide a partial subsidy for adolescents aged 13 to 17 for private dental check-up services, and foster the establishment of long-term partnership between adolescents and dentists in the private sector or non-governmental organisations (NGOs), so as to promote their life-long habit of regular oral check-ups to prevent oral diseases. The oral check-up items to be provided under Government subsidies should include oral health risk assessments, scaling, personalised oral hygiene instructions and fluoride applications based on the assessed risk level.
 
     Moreover, since June 2023, the DH has piloted the Bright Smiles Baby Programme 2023-24 – Pilot Outreaching Oral Health Care and Promotion Programme for Prekindergarten Children for children aged from birth to three who attend in Child Care Centres (CCCs). It provides children with free oral check-ups for assessing condition of tooth decay and application of topical fluoride for preventing tooth decay depending on the child's age and need. The DH will, by making use of the existing primary healthcare system (MCHCs, CCCs and kindergartens), gradually expand the programme in phases to cover children aged from birth to three using MCHC services, as well as those aged from three to six attending kindergartens so as to provide oral disease prevention-oriented primary oral health care services to the children and educational promotion to the parents.
 
     Details of the above two programmes will be announced at an appropriate juncture.
 
(4) It was announced in "The Chief Executive's 2024 Policy Address" that HKCH will fully integrate the paediatric services of various clusters and develop more advanced healthcare services to make the best use of HKCH. In this connection, the HA is exploring the expansion of paediatric services at HKCH, including increasing the scope of newborn screening; collaborating with foetal medicine teams to perform magnetic resonance imaging of the brain and the central nervous system of foetuses and newborns; developing advanced and complex neurosurgical procedures; establishing an evidence-based therapeutic centre targeted for patients with rare neurological diseases, including introducing advanced gene therapy and maintaining case directories of neuromuscular disorders. In addition, the HA is exploring more service models including private services with a view to meeting public expectation, while providing support to other healthcare organisations in the region on the management of complex cases that they find difficult to handle.
 
     The HA and the Hong Kong Genome Institute (HKGI) have now established a partnering centre at HKCH to conduct whole genome sequencing for suitable patients and family members with their informed consent. By analysing the sequencing results, especially on rare, hereditary and undiagnosed diseases, clinicians can more easily make precise diagnosis to provide personalised and appropriate treatment and preventive options. Both parties will enhance collaboration through formulating a directory for inherited and rare diseases by using the HKGI's genomic data, thereby facilitating early diagnosis and treatment by clinical teams while supporting relevant research and clinical trials to promote precision medicine.
 
     Details of the above measures will be announced at an appropriate juncture.
 
(5) and (7) It is announced in "The Chief Executive's 2024 Policy Address" that the DH will revamp maternal and child health and family planning services to strengthen pre-pregnancy counselling and parental education and promote healthy fertility. The DH will provide the new pre-pregnancy health services to reproductive age group women at the MCHCs in phases, support women in preparing for pregnancy through early health assessments, arrangement of blood tests and other investigations, and provide nutritional dietary and lifestyle health advice with a view to aligning with the Government's policy of encouraging and promoting healthy fertility as well as protecting and advancing maternal and child health. In addition, the DH will review and adjust the scope of the subsidised family planning service currently provided by the NGOs, so as to dovetail with the Government's policy of encouraging and promoting healthy fertility.
 
     The Government will gradually re-position the general out-patient clinics and actively plan to introduce prevention-oriented concepts and programmes into the treatment-oriented public primary healthcare system, with a view to providing comprehensive primary healthcare services for the underprivileged, including children and adolescents from low-income families.
 
     The current public healthcare system (including services provided by the DH and the HA) already caters for children's health needs at different stages. Considering that the Government has already devoted a significant amount of resources to the promotion of children's health, the further establishment of the "Children's Healthcare Co-Care Scheme" may render the whole funding model too fragmented and complicated. The Government understands that people of different age groups have needs for primary healthcare. However, compared with the existing public healthcare services of various types for children, the "Children's Healthcare Co-Care Scheme" does not provide targeted support to the health and developmental needs of children, and hence its effectiveness is relatively limited. It may not be able to best meet the needs of the community in terms of the allocation of public and healthcare resources. Therefore, the Government has no plan to set up a "Children's Healthcare Co-Care Scheme" at present.
 
     The Government will take into account a number of factors when planning for public healthcare services, including the population forecast parameters of each district in Hong Kong, the development plans of the Government, the utilisation patterns of healthcare services as well as the corresponding healthcare needs, technological development and manpower supply. The Government will continue to closely monitor the above factors and adjust the public healthcare services for children in a timely manner.
 
(6) The Hong Kong Childhood Immunisation Programme (HKCIP) of the DH provides free vaccination services to eligible children for the prevention of 11 types of infectious diseases, including tuberculosis, hepatitis B, poliomyelitis, tetanus, pertussis, measles, diphtheria, mumps, rubella, chickenpox and pneumococcal disease. Over 90 per cent of locally born babies visit MCHCs for services including immunisation every year. Data also shows that the overall coverage rate for relevant vaccines among locally born pre-school children has all along been maintained at a very high level of above 98 per cent. In the long run, the Government will progressively consolidate certain existing primary healthcare services under the DH (including maternal and child health service and student health service) in the primary healthcare system in order to enhance children's healthcare services in Hong Kong and create a better environment for receiving healthcare services and healthy growth. In respect of vaccination, the Government will ensure the very high coverage rate be maintained and the provision of convenient services.
 
     Insofar as electronic health record is concerned, the Government will continue to encourage and facilitate parents to register their children with eHealth through various measures, enabling them to build a lifelong personal electronic health record from an early age and ensure that they receive continuous care as they grow up. Currently, under the HKCIP, the record of all vaccines administered to children at the MCHCs (since 2007) and at primary schools across Hong Kong (since 2013) are deposited in the eHealth system. The Government is exploring to impose a mandatory requirement for students participating in the HKCIP in the future to register with eHealth, with a view to facilitating the establishment of more comprehensive vaccination records and ensuring that infants and children receive all immunisation recommended by the DH at different stages of development.