LCQ9: Children’s healthcare services
Following is a question by the Hon Nixie Lam and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (November 6):
Question:
The Opinions on Advancing the High-quality Development of Children's Medical and Healthcare Services issued by 10 Mainland authorities including the National Health Commission on January 10 this year put forward the objective of enhancing the system of children's medical and healthcare services with clear division of functions, reasonable arrangements, appropriate scale and high efficiency by 2025, so as to achieve the target of 0.87 licensed (assistant) paediatric doctors and 2.5 hospital beds per 1 000 children. On the other hand, there are views that notwithstanding the relatively robust healthcare resources for children in Hong Kong in general, the waiting time for children's healthcare services in the public sector is still relatively long. In this connection, will the Government inform this Council:
(1) whether it has reviewed (i) the allocation of resources (including the respective ratios of practising doctors and nurses per 1 000 children, the ratio of hospital beds per 1 000 children, and the average waiting time for paediatric patients referred to various specialist services before receiving treatment), (ii) the scope of services, (iii) the equipment and technology, and (iv) the quality and safety levels, in respect of children's healthcare in Hong Kong at present;
(2) whether it has reviewed the regional distribution and balance of children's healthcare resources in Hong Kong at present, including (i) the distribution of children's healthcare institutions among the 18 districts in Hong Kong, (ii) the average waiting time for paediatric patients in various districts referred to various specialist services before receiving treatment, (iii) whether there are relatively large disparities in terms of medical equipment, technology and healthcare quality among various districts, and (iv) whether children in various districts can enjoy comparatively equal healthcare services; and
(3) whether the Government has formulated development planning specifically on the allocation of children's healthcare resources, e.g. whether it will consider providing more children's healthcare services in the next five years to meet the demand of members of the public, and whether measures are in place to create a better environment for children to seek medical treatment; if so, of the plans; if not, the reasons for that?
Reply:
President,
In consultation with the Department of Health (DH) and Hospital Authority (HA), the consolidated reply to the question raised by the Hon Nixie Lam is as follows:
(1) and (2) The Government attaches great importance to children’s health and devotes significant resources to public health and the healthcare system to provide a wide range of quality health and healthcare services for the public including children.
According to the latest figures from the Census and Statistics Department, the Hong Kong population of minors aged under 18 in 2021 was 967 679, among whom 281 796 were aged 0 to 5, 352 521 aged 6 to 11 and 333 362 aged 12 to 17. The healthcare need of minors is mainly on primary healthcare including health checks and out-patient services, and less on secondary/ tertiary healthcare including specialist and in-patient services. In 2023, there were overall one million attendances at the health services provided by the DH for children (including maternal and child health as well as student health services). According to the HA’s statistics, from 2023 to 2024, the total attendance of Specialist Out-patient Clinics (SOPCs) (clinical) for patients aged 0 to 17 is 566 243, while the number of in-patient discharges and deaths and that of in-patient bed days are 125 627 and 546 551 respectively.
Currently, there are 16 528 doctors in Hong Kong, among whom 7 802 work in public hospitals. For other practising doctors, most of them work in the private sector providing various healthcare services including those of primary healthcare. Family doctors and doctors of different specialties also provide healthcare services for children as necessary. As for specialist services, there are 746 paediatricians in Hong Kong. As at August 31, 2024, there are 455 doctors and 1 572 nurses (full-time equivalent) working in the HA’s paediatric departments. Besides, there are 1 500 paediatric beds in Hong Kong, including 1 126 beds in public hospitals and 374 beds in private hospitals. Despite the overall tight healthcare manpower situation in Hong Kong, the healthcare services of different levels provided to children by the healthcare system have been adequate in general amidst the steady decline in the population and proportion of minors for the past decade or so.
The Government is committed to promoting child health services. The 28 Maternal and Child Health Centres (MCHCs) under the 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 5 years old, including free vaccination services and continuous monitoring of children’s growth and development. There were about 325 000 service attendances at MCHCs in 2023. Children with health or developmental problems will be referred to specialists or the Child Assessment Service (CAS) for follow-up as necessary, including comprehensive assessments and diagnoses, formulation of rehabilitation plans and support for parents. In 2023, the DH's Family Health Service referred about 28 000 cases and the CAS referred about 9 300 cases. In addition, the 13 Student Health Service Centres (SHSCs) 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. In the 2022/23 school year, a total of about 460 000 students from 1 185 primary and secondary schools were enrolled in the Student Health Service (SHS). If students are found to have health problems, they will be referred to the Special Assessment Centres of the SHS, specialist clinics under the HA or other organisations as appropriate for further assessment and treatment. In the 2022/23 school year, a total of about 114 000 students were referred.
In addition, the Government set up District Health Centres (DHCs) and interim DHC Expresses of a smaller scale (hereafter collectively referred to as DHCs) in all 18 districts across the city by the end of 2022. DHCs draw up personalised health plans for the public, including children, according to factors such as their age, gender and lifestyle. As at September 2024, there are 4 100 members aged 18 or below in DHCs across the 18 districts.
DHCs provide information on the vaccinations required by children as well as prevention of infectious diseases, cancers and chronic diseases so as to achieve “prevention is better than cure”. DHCs also provide children-targeted services, such as emotion management, weight management and healthy diet classes. In addition, DHCs collaborate with schools to provide outreach health education, health risk factors assessment, low salt and sugar diet education and promotion activities, etc.
The HA plans and develops various public healthcare services on a cluster basis while taking into account a number of factors, including the population forecast parameters of each district, the development plans of the Government, and the utilisation patterns of healthcare services. As for paediatric services, the HA operates its paediatric services under a hub-and-spoke model since the Hong Kong Children’s Hospital (HKCH) commenced its service by phases starting from December 2018. HKCH serves as a tertiary referral centre for severe, complex and uncommon paediatric cases requiring multi-disciplinary management, providing diagnosis, treatment and rehabilitation services for patients from birth to 18 years of age with relevant clinical needs from the whole city. 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, with a view to providing appropriate hospital and nursing care services for children in all districts of Hong Kong. In the last 12 months (October 1, 2023 to September 30, 2024), the total SOPC (clinical) attendances of the HA’s paediatric departments is 278 466. The number of in-patient discharges and deaths and that of in-patient bed days are 94 259 and 400 352 respectively. The median waiting time of new cases triaged as urgent and semi-urgent is less than one week and less than six weeks respectively while that of stable new cases is about 16 weeks.
The HA’s paediatric services cover a wide range of services. Its paediatrics departments provide paediatric out-patient, in-patient services, acute care as well as rehabilitation services depending on the healthcare needs of neonates, children and adolescents. In addition, the paediatrics, paediatric surgery and child psychiatric service departments provide clinical services. Meanwhile, there are multi-disciplinary teams (including physiotherapists, speech therapists, occupational therapists, social workers and clinical psychologists) in the HA providing children with appropriate supporting services. Considering factors such as the distribution of the population and the corresponding healthcare needs, technological development and manpower supply, the numbers of paediatric beds and waiting time of paediatric SOPC services in each public hospital cluster are different, with details set out at the Annex. The Government and the HA have always attached great importance to the quality and safety of paediatric services, and will continue to closely monitor the above factors and adjust the public healthcare services for children in a timely manner.
(3) The Government will continue to provide quality healthcare and health services to children. The Government has put forward measures in the 2023 and 2024 Policy Address to enhance children’s healthcare services in Hong Kong and create a better environment for receiving healthcare services and healthy growth. The planned measures include:
(i) Devising health promotion strategies by adopting a life-course framework to formulate health management plans for the public according to their age and health conditions;
(ii) Revamping maternal and child health and family-planning services to strengthen pre-pregnancy counselling and parental education and promote healthy fertility; also strengthening the Whole School Health Programme to recommend targeted school-based measures for physical activities, meals and other matters for schools to improve children’s physical and psychological wellbeing;
(iii) Progressively strengthening the role of DHCs as co-ordinators of community primary healthcare services and case managers to support primary healthcare doctors, as well as district healthcare services and resource hubs that connect public and private healthcare professionals and different sectors in the community. In the long run, some primary healthcare services under the DH, including the MCHCs and SHSCs, will be migrated to the primary healthcare system in an orderly manner;
(iv) Fully integrating the paediatric services of various clusters with HKCH as the hub under the hub-and-spoke model to enable HKCH to fulfil its function as the Centre of Excellence in Paediatrics, thereby enhancing the quality of paediatric care in Hong Kong and providing a platform conducive to research development and professional training;
(v) Establishing a breastmilk bank in HKCH and formulating the related mechanism for breastmilk donation in 2025 to provide breastmilk for infants and young children who cannot be breastfed by their biological mothers, and especially to minimise the chance of serious illness in premature or severely ill babies; and
(vi) Exploring the expansion of paediatric services including increasing the scope of newborn screening; collaborating with foetal medicine teams to perform magnetic resonance imaging diagnoses of the brain and the central nervous system of foetuses and newborns; initiating and developing complex neurosurgical procedures, establishing evidence-based therapeutic centres and clinical research centres; as well as maintaining case directories for diseases such as neuromuscular disorders, and establishing an advanced gene therapy centre.