Following is a question by the Hon Ip Kin-yuen and a written reply by the Secretary for Education, Mr Kevin Yeung, in the Legislative Council today (November 20):
Question:
Regarding the demand and supply situation of speech therapists, will the Government inform this Council:
(1) whether it knows the current number of speech therapists and, among them, the respective numbers of those (i) who are qualified for registration and (ii) who have been registered under the Accredited Registers Scheme for Healthcare Professions;
(2) of the respective numbers and percentages of speech therapists employed by the Government and subvented organisations, in each of the financial years from 2016-2017 to 2018-2019;
(3) of the respective staffing establishments of speech therapists in (i) the Government, (ii) the Hospital Authority, (iii) subvented organisations and (iv) the academia, in each of the financial years from 2016-2017 to 2018-2019, with a breakdown by the unit in which they serviced (e.g. various types of schools, social welfare organisations and allied health departments); the average number of cases handled by each speech therapist each year;
(4) of the number of degree programmes related to speech therapy offered by tertiary institutions in each of the academic years from 2017-2018 to 2019-2020, and set out by year (i) the number of places, (ii) the funding mode and (iii) the duration of each programme;
(5) as the Government indicated in the Policy Addresses delivered in the past two years and the Budget delivered last year respectively that it would introduce measures to enhance speech therapy services, of the respective manpower requirements of various policy bureaux/government departments for speech therapists in each of the coming three years;
(6) given that starting from this school year, the Education Bureau (EDB) will implement the Enhanced School-based Speech Therapy Service (SBSTS) and create school-based speech therapist posts in public sector ordinary primary and secondary schools by phases in three years to allow schools to form clusters to employ school-based speech therapists to support students with speech and language impairment,
(i) of the number of speech therapists to be employed, the number of schools implementing SBSTS, the number of students benefitting from SBSTS and the recurrent expenditure to be incurred, in this and each of the coming two school years;
(ii) of the respective to-date numbers of school clusters which have and have not recruited speech therapists, and the respective numbers of posts involved;
(iii) whether it will enquire with the school clusters which have recruited speech therapists about whether the appointees have reported for duty; of the measures in place to assist the school clusters which have not recruited speech therapists;
(iv) of the measures in place to assist the school clusters concerned in retaining speech therapists, so as to avoid the relevant services being affected by their resignation; and
(v) as quite a number of schools have indicated that they have encountered difficulties in recruiting speech therapists, whether EDB will adjust the implementation timetable of SBSTS; and
(7) as some members of the education sector and the social welfare sector have indicated that they have encountered difficulties in recruiting speech therapists, whether the Government will enhance the coordination among departments and communication with the stakeholders, so as to ensure that the training and career progression pathways for speech therapists will be commensurate with the professional development and service needs of the trade; if so, of the details; if not, the reasons for that?
Reply:
President,
Speech therapists (STs) provide professional services for people in need in various aspects to improve their abilities in language, communication, swallowing, etc. so as to strengthen their social and learning skills, and enhance their quality of life and daily life functioning.
Healthcare, social welfare and education sectors, based on the needs of various individuals, develop respective speech therapy services. Local tertiary institutions organise different speech therapy programmes to train relevant professionals to respond appropriately to the demand for STs in different sectors.
Regarding Hon Ip Kin-yuen's question, our reply is as follows:
(1) and (2) The Department of Health (DH) conducts Health Manpower Surveys (HMS) on a regular basis to obtain up-to-date information on the characteristics and employment status of healthcare professionals practising in Hong Kong. According to the 2014 HMS on the 16 types of healthcare professionals included in the health services functional constituency, with employment institutions as the unit of enumeration, it is estimated that about 640 STs were practising in Hong Kong, with 40.4 per cent employed by the subvented sector, 35.4 per cent by the private sector, 12.8 per cent by the Hospital Authority (HA), 8.0 per cent by the academic sector and 3.4 per cent by the Government. In this survey, ST denotes a person with a Bachelor's Degree or above in Speech and Hearing Sciences from a Hong Kong university, or equivalent.
At present, STs are not among the healthcare professionals that are subject to statutory registration. In April 2018, full accreditation status was granted to the Hong Kong Institute of Speech Therapists under the Pilot Accredited Registers Scheme for Healthcare Professions as the accredited healthcare professional body responsible for administering a register for the speech therapy profession. STs may voluntarily register under the Pilot Accredited Registers Scheme for Healthcare Professions. As at May 2019, there were 216 voluntarily registered STs on the register.
For government departments, from the 2016-17 to 2018-19 financial years, 15 STs were employed by the DH in the posts of Speech Therapy Officers. From the 2016/17 to 2018/19 school years, nine, nine and 12 STs were employed by the Education Bureau (EDB) respectively as Specialists (Speech Therapy). The HA, as a statutory body, employed 110, 115 and 119 STs from the 2016-17 to 2018-19 financial years respectively. As for aided special schools, about 145, 156 and 160 STs were employed from the 2016/17 to 2018/19 school years respectively.
Besides, in the 2016-2017 to 2018-2019 financial years, the Social Welfare Department (SWD) subvented a total of 170 non-governmental organisations (NGOs) to run welfare services, of which 165 received Lump Sum Grant subventions. Under the Lump Sum Grant Subvention System, the SWD's subvented NGOs have the flexibility to deploy the subvention obtained (excluding the part for Provident Fund) and arrange suitable staffing, as long as the essential service requirements, service output and outcome standards, as well as service quality standards as set out in the respective Funding and Service Agreements are achieved. The SWD has no information on the number of ST employed by these NGOs. As for the remaining five NGOs subvented by the SWD under conventional modes, one of them has employed a ST.
(3) The number of STs working in the healthcare sector from 2016-17 to 2018-19 are tabulated below:
| 2016-17 financial year |
2017-18 financial year |
2018-19 financial year |
|
| Speech therapists under Family Health Service of the Department of Health (Note 1) | 2 | 2 | 2 |
| Speech therapists under Child Assessment Service of the Department of Health (Note 1) | 13 | 13 | 13 |
| Department Manager (Speech Therapy)/Senior Speech Therapists of Hospital Authority (Note 2) | 7 | 7 | 7 |
| Speech Therapists of Hospital Authority (Note 2) | 103 | 108 | 112 |
Note 1: This figure was the the approved establishment in the respective year.
Note 2: The HA manpower figures are calculated on full-time equivalent basis including permanent, contract and temporary staff in the HA.
The STs under Family Health Service provide articulation assessment to preschool children with articulation problems in Maternal and Child Health Centres and provide interim support to their parents. The average number of assessment/interim support provided is about 3 400 per year. The STs under Child Assessment Service assess the child's communication skills and provide interim support to their parents. The average number of assessment/interim support provided is about 6 700 per year. The above-mentioned service units will make referral to appropriate service providers and the specialty clinics of Hospital Authority for training, education support as well as medical treatment.
STs of the HA provide assessment, testing, treatment and counselling to patients with communication or swallowing disorders, with a view to helping them prevent, reduce and overcome barriers to communication and swallowing, and enhancing their quality of life.
Having regard to patients' clinical needs, the HA flexibly deploys its staff to provide speech therapy service to patients with rehabilitation needs. Therefore, the HA is not able to provide the number of cases handled per ST. The attendances for speech therapy in the HA in the past three financial years are set out in the table below:
| Speech therapy attendances | 2016-17 financial year (as at March 31, 2017) |
2017-18 financial year (as at March 31, 2018) |
2018-19 financial year (as at March 31, 2019) |
| Number of inpatient and day inpatient attendances | 219 458 | 235 077 | 243 180 |
| Number of allied health outpatient attendances | 58 304 | 56 929 | 57 697 |
In each of the 2016-17 to 2018-19 financial years, the notional staffing establishments for STs of the SWD's subvented NGOs providing elderly and rehabilitation services are as follows:
| 2016-17 financial year | 2017-18 financial year | 2018-19 financial year | |
| Subvented Elderly Service Unit (Note 1) | 0 | 0 | About 200 (Note 2) |
| Subvented Rehabilitation Service Unit | About 100 (Note 3) | About 100 (Note 3) | About 180 (Note 4) |
Note 1: Including Integrated Home Care Services (Frail Cases), Day Care Centres/Units for the Elderly, Enhanced Home and Community Care Services, Subvented Residential Care Homes for the Elderly, and the Pilot Scheme on Multi-disciplinary Outreaching Support Teams for the Elderly.
Note 2: Since 2018-19 financial year, the SWD has been making additional provision to provide speech therapy services for the service users of elderly service units with swallowing difficulties or speech impairment.
Note 3: Including Early Education and Training Centres, Special Child Care Centres (including Residential Special Child Care Centres), District-based Speech Therapy Teams and Multi-Service Centres for the Hearing Impaired Persons.
Note 4: Including Residential Care Homes for Persons with Disabilities, Support Centres for Persons with Autism, Pilot Scheme on Professional Outreaching Teams for Private Residential Care Homes for Persons with Disabilities, On-site Pre-school Rehabilitation Services, Early Education and Training Centres, Special Child Care Centres (including Residential Special Child Care Centres), District-based Speech Therapy Teams and Multi-service Centres for the Hearing Impaired Persons.
Apart from direct hiring of STs, subvented NGOs may also make use of the allocated resources to purchase services for service users with speech impairment and swallowing difficulties. The SWD does not have information on the average number of cases or the headcount of service users handled by each ST post.
The EDB does not have record on the staffing establishment of STs for the tertiary institutions. From the 2016/17 to 2018/19 school years, the staffing establishment of STs for the public sector schools and the EDB are listed in the table below:
| 2016/17 school year | 2017/18 school year | 2018/19 school year | |
| Aided special schools | 145 | 155.5 | 159.5 |
| Public sector ordinary schools (Note 1) | – | – | – |
| Education Bureau (Note 2) | 9 | 9 | 12 |
Note 1: Enhanced School-Based Speech Therapy Service is implemented in the public sector ordinary schools starting from the 2019/20 school year. Before that, schools did not have school-based speech therapist permanent posts.
Note 2: The EDB has specialist (speech therapy) posts which require the qualification of ST.
All along, the EDB provides additional resources for public sector ordinary schools to procure School-based Speech Therapy Service (SBSTS). The school-based speech therapists (SBSTs) implementing SBSTS will provide assessment and treatment for students with speech and language impairment (SLI) to reduce the impacts on their communication, learning and social aspects. They will also arrange and organise activities and programmes for enhancing language learning, incorporate language learning strategies into instructional elements and integrate the strategies into classroom learning, so as to enhance the language abilities of all students in school. Therefore, SBSTS benefits not only the students with SLI but also other students in school. From the 2016/17 to 2018/19 school years, the number of students with SLI (including students with other types of special educational needs comorbid with SLI) in public sector ordinary schools are 23 580, 24 410 and 25 510 respectively.
(4) Programmes organised by the tertiary institutions in speech therapy in Hong Kong include: (i) Bachelor of Science in Speech and Hearing Sciences by the Human Communication, Development, and Information Sciences Unit under the Faculty of Education of The University of Hong Kong, (ii) Master of Science in Educational Speech-Language Pathology and Learning Disabilities by the Department of Special Education and Counselling under the Faculty of Education and Human Development of The Education University of Hong Kong, (iii) Master of Speech Therapy by the Department of Chinese and Bilingual Studies under the Faculty of Humanities of The Hong Kong Polytechnic University, and (iv) Master of Science in Speech-Language Pathology by the Department of Otorhinolaryngology, Head and Neck Surgery under the Faculty of Medicine of The Chinese University of Hong Kong. The number of places, funding mode and duration of each programme are in Table 1 and Table 2:
Table 1: Number of Places of Programmes in Speech Therapy
| School year | The University of Hong Kong | The Education University of Hong Kong | The Hong Kong Polytechnic University | The Chinese University of Hong Kong | Total |
| 2017/18 | 55 | 42 | 40 | – | 137 |
| 2018/19 | 40 | 49 | 40 | 33 | 162 |
| 2019/20 | 48 | 39 | 36 | NA (Note) | 123 |
Note: The Chinese University of Hong Kong started running the programme in the 2018/19 school year. It did not have student intake in the 2019/20 school year.
Table 2: Background Information of Programmes in Speech Therapy
| Tertiary institutions | Funding mode | Duration |
| The University of Hong Kong | University Grants Committee-funded | 5 years |
| The Education University of Hong Kong | Self-financed | 2 years |
| The Hong Kong Polytechnic University | Self-financed | 2.5 years |
| The Chinese University of Hong Kong | Self-financed | 2 years |
(5) In education, starting from the 2017/18 school year, the EDB provides one ST each to the school for children with visual impairment and every school for social development to better cater for students with SLI in the schools. This initiative involved 9 schools and 9 SBST posts in total. Together with the STs working in other types of special schools, the aided special schools require about 160 STs each school year.
Besides, it was announced in the 2018 Policy Address that SBST posts would be created in all public sector ordinary schools. Starting from the 2019/20 school year, the EDB will implement the Enhanced SBSTS in three school years. The EDB will form clusters of schools according to the number of approved classes of schools, the number of students with SLI and their severity of SLI, previous experience of schools in employing SBSTs and the preference of schools. Most school clusters will be formed by two schools. One school in each cluster will be the base school. The permanent posts of SBST will be created in the base schools. Upon full implementation of the Enhanced SBSTS, it is estimated that about 420 SBST posts will be created in the public sector ordinary schools.
When all public sector ordinary schools employ about 420 SBSTs, together with about 160 ST posts in the aided special schools, schools in total will need about 580 STs. By then, the public sector ordinary schools in principle will not need to procure ST services. Although the public sector ordinary schools will create 420 new SBST posts, part of the work was performed by the STs of the service providers and these STs could be employed as SBSTs. Taking the 2019/20 school year as an example, about one-third of the newly employed SBSTs were previously employed as STs by the service providers. Therefore, the net increase in demand from the creation of SBST posts in the public sector ordinary schools will be lower than the number of posts created. The EDB adopts a pragmatic approach to implement the Enhanced SBSTS by phases so as to meet the needs of schools and the supply of STs.
As regards elderly and rehabilitation services, in each of the 2019-20 to 2021-22 financial years, the notional staffing establishments for STs of SWD's subvented NGOs providing elderly and rehabilitation services are estimated as follows:
| 2019-20 financial year | 2020-21 financial year | 2021-22 financial year | |
| SWD | About 520 | About 530 | About 530 |
(6) (i) & (v) In the 2019/20 school year, the EDB has created 118 SBST posts in 223 public sector ordinary secondary and primary schools. The EDB will create about 300 SBST posts for the remaining 300 secondary schools and 321 primary schools in the coming two school years. The EDB will keep in view the recruitment of SBSTs by schools and the operational experience in implementing the SBSTS. When necessary, the EDB will adjust the pace of the implementation of the service according to the preference of schools and actual progress so as to assist all public sector ordinary schools to fully implement the Enhanced SBSTS in an orderly manner. After full implementation of the Enhanced SBSTS, the estimated recurrent annual expenditure will be about $320 million.
(ii) & (iii) In the 2019/20 school year (as at October 2019), among the 223 public sector ordinary secondary and primary schools, 165 schools constituting 88 school clusters have employed 89 SBSTs. The remaining 58 public sector ordinary schools (29 secondary and 29 primary schools) constituting 29 school clusters have not yet recruited suitable SBSTs. There are still 29 SBST vacancies.
To assist those schools that have not yet employed their SBSTs, the EDB provides them with transitional SBSTS arrangement. Primary schools will be disbursed with the Enhanced Speech Therapy Grant of the whole school year, and secondary schools will continue to be provided with the Learning Support Grant according to the number of students with SLI and the severity level, so as to allow schools to procure the service to support the students with SLI in school. The EDB has been maintaining close liaison with the schools to understand the progress of recruitment of those schools which are still intending to recruit SBSTs, and to assist the schools in providing appropriate support for the students.
(iv) To assist schools to implement the Enhanced SBSTS, Specialists (Speech Therapy) of the Bureau will visit the schools regularly to offer professional advice and assist the SBSTs to implement the service from professional perspectives. Apart from providing regular on-site support on case consultation and professional advice, the EDB organises different training for SBSTs, including arranging induction programmes, organising thematic talks, seminars and workshops, and conducting professional learning community meetings to promote professional development, hence to support students with SLI and implement SBSTS more effectively.
Besides, the EDB will organise workshops for the school clusters which are going to implement the Enhanced SBSTS to let them understand the details of implementation and to let schools having already employed SBST share their good experience.
The EDB will continue to review the implementation of the Enhanced SBSTS and the work performance of SBSTs with a view to ensuring that the service could help the students with SLI effectively and the SBSTs could work in their schools smoothly to support the students in need.
(7) When implementing relevant policies, the policy Bureaux will take into consideration the manpower requirement collaboratively to ensure smooth implementation. At this stage, the training and related development of STs are progressing well. The Government will continue to maintain close liaison with stakeholders and there is no plan to change the current mode of operation.
In respect of the Pilot Accredited Registers Scheme for Healthcare Professions, the accredited healthcare professional organisation will require its registrants to meet its educational standards which define a set of minimum clinical knowledge and skills for all registrants. The accredited professional organisation will also require its registrants to keep abreast of professional knowledge.
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