LCQ21: District Health Centres
29.3.2023

Following is a question by the Hon Edward Leung and a written reply by the Acting Secretary for Health, Dr Libby Lee, in the Legislative Council today (March 29): Question: The Secretary for Health has pointed out earlier on that the establishment of District Health Centres (DHCs) in all 18 districts across Hong Kong is a new move to optimise the healthcare system in the city. In addition, in its Primary Healthcare Blueprint released last year, the Government has proposed to reinforce the role of DHCs in co-ordinating primary healthcare services in the community in stages. In this connection, will the Government inform this Council: (1) as the task of co-ordinating primary healthcare services in 11 of the 18 districts across the territory is still undertaken by interim DHC Expresses, how the Government will upgrade such DHC Expresses into DHCs in stages; (2) whether the report on the "Monitoring and Evaluation Study of Kwai Tsing District Health Centre" conducted by the Chinese University of Hong Kong, which was commissioned by the Government, has been completed; if so, of the conclusion regarding the effectiveness of such DHC; (3) of the following information of various DHCs since their commencement of operation: (i) the service attendance, (ii) the number of referrals received from public hospitals, and (iii) the types of such referrals; (4) as the Government's interim goal of "having all 18 districts in Hong Kong covered" by DHCs was already attained by the end of last year, whether the Government will enhance the services of various DHCs and DHC Expresses, and how it will formulate key performance indicators for their services provided; and (5) as there are views pointing out that DHCs are already having difficulties in hiring nursing staff due to the shortage of healthcare personnel across the territory, how the Government ensures that DHCs have sufficient manpower to provide close follow-up services to chronic disease patients following the implementation of the Chronic Disease Co-Care Pilot Scheme? Reply: President, In face of the pressure brought about by an ageing population and the increasing prevalence of chronic diseases, the Government released the Primary Healthcare Blueprint in December 2022, setting out a series of reform initiatives to strengthen primary healthcare services in Hong Kong. Through prevention-oriented, community-based and family-centric strategies which focus on early detection and intervention, the vision is to improve the overall health status of the population, provide accessible and coherent healthcare services, and establish a sustainable healthcare system. Among the recommendations in the Blueprint, it is proposed to further develop a district-based family-centric community healthcare system based on the District Health Centre (DHC) model, with an emphasis on horizontal integration and co-ordination of district-based primary healthcare services through service co-ordination, strategic purchasing and medical-social collaboration; as well as vertical integration and interfacing with secondary/tertiary healthcare services through protocol-driven care pathway for specified chronic diseases and well-trained primary healthcare family doctors. Against the above, DHCs will progressively strengthen their role as the co-ordinators of community primary healthcare services and case managers to support primary healthcare doctors on one hand, and their role as a district's healthcare services and resource hub that connect the public and private services provided by different sectors in the community on the other, thereby re-defining the relationship among public and private healthcare services; as well as that among primary healthcare and social service providers. Regarding the enquiries raised by the Hon Edward Leung, the reply is provided as follows: (1) To build up a critical mass of district-based primary healthcare services throughout the city as soon as possible, with a view to maintaining the momentum in promoting primary healthcare and setting a solid foundation for the establishment of a prevention-focused primary healthcare system in the long term, the Government has set up interim DHC Expresses in 11 districts where full-fledged DHCs are yet to be set up. DHC Express provides key district-based primary healthcare services subsidised by the Government, including health promotion, health risk factors assessment and chronic disease management. The service scope of DHC Express is similar to that of DHC but in a smaller scale. Similar to DHC, DHC Express facilitates community medical-social support for the public through identification of healthcare and social welfare resources, as well as early engagement of community service partners in the districts. All DHC Expresses have commenced services within 2021. The Government has planned and is reserving appropriate sites for setting up DHCs. For the concrete tender invitation schedule for operators of future DHCs, the Government will consider the overall implementation and make announcement in due course with a view to establishing DHCs in all districts in Hong Kong as soon as possible. By then, the DHC Express services will migrate to the local DHC. (2) The Government commissioned the Chinese University of Hong Kong to conduct a monitoring and evaluation study on the DHCs. The research team will submit the final report by end 2023. The Health Bureau (HHB) will study the report and follow the direction as stipulated in the Blueprint to enhance and review the services of the DHCs for continuous improvement of primary healthcare services in Hong Kong. (3) The number of attendances of the seven DHCs (namely Kwai Tsing (K&T), Sham Shui Po (SSP), Tuen Mun (TM), Wong Tai Sin (WTS), Southern (S), Yuen Long (YL) and Tsuen Wan (TW) District) are set out below: DHC Service commencement date Number of attendances in accumulation (up to December 2022) (Provisional figures) (Note 1 and 2) Health promotion/ Patient empowerment activities/ Vaccination Basic health risk factors assessment/ Screening for diabetes mellitus and hypertension Chronic disease management/ Community rehabilitation programme (Note 3) Total K&T September 2019 140 900 57 600 60 700 259 200 SSP June 2021 29 700 14 500 8 200 52 400 TM May 2022 17 000 12 700 9 600 39 300 WTS June 2022 7 700 6 100 1 100 14 900 S October 2022 2 000 1 900 < 50 3 800 YL October 2022 2 700 3 700 1 300 7 600 TW December 2022 0 100 0 100 Note 1: Figures are rounded to the nearest hundred and may not add up to the total due to rounding. Note 2: Service figures are captured from the DHC information system, excluding medical laboratory tests. Note 3: Cases referred by Hospital Authority are included. HHB does not maintain other separate breakdown mentioned in the question. (4) As mentioned above, in accordance with the recommendations as stipulated in the Blueprint, DHCs will be repositioned to strengthen their role as the co-ordinators and case managers of community disease-prevention services and chronic disease management on the basis of the existing services. DHCs will also optimise the community service resources to develop multi-disciplinary public-private partnership services and establish networks for medical and social collaboration. As announced in the 2022 Policy Address, the Government would introduce a three-year "Chronic Disease Co-Care Pilot Scheme" (CDCC Scheme) in the third quarter of 2023, with a view to enhancing public awareness of chronic disease prevention and management, empowering citizens to identify risk through screening. DHCs will co-ordinate and promote the CDCC Scheme to support citizens to manage their own health, conduct health planning for targeted citizens with high risk of hypertension or diabetes mellitus, and provide further follow-up, suggestions, examination as well as appropriate preventive and curative services in collaboration with the community network, private professional service providers, including family doctors. In terms of subsidy, the Government will subsidise about half of the examination and treatment fees. With the implementation of the CDCC Scheme, the Primary Healthcare Office (PHO) will review the performance assessment indicators of DHCs. The need for service enhancement and relevant indicators for future DHC operation contracts is currently being reviewed by the PHO. In the long run, as recommended in the Blueprint, the Government will progressively transform the PHO currently under the HHB into the Primary Healthcare Commission empowered to oversee primary healthcare service delivery, standard setting, quality assurance and training of primary healthcare professionals under one roof. Other quality assurance measures such as review and evaluation of clinical practice, as well as the performance indicators for primary healthcare services (including DHCs) will also be explored by the Government. Currently, the Government is preparing for the reorganisation of the Primary Healthcare Commission. (5) All along, the Government has been adopting a multi-pronged strategy to enhance the supply and training of healthcare manpower to ensure sufficient healthcare manpower for provision of various healthcare services (including DHCs) required by the public. On strengthening local training of healthcare manpower, the Government has been allocating substantial resources to increase the number of local healthcare training places. Currently, the healthcare manpower planning and projection exercise is conducted by the HHB once every three years to consider appropriate adjustments to the University Grants Committee-funded healthcare training places in the light of the latest manpower demand and supply situation. The results of the Healthcare Manpower Projection 2020 was released in March 2021. A new round of manpower projection exercise has been launched by the HHB and is expected to be completed by the end of 2023. On the introduction of qualified non-locally trained healthcare manpower, following the passage of the relevant legislative amendments by the Legislative Council in October 2021 to admit qualified non-locally trained doctors to serve in the public healthcare institutions in Hong Kong, the HHB plans to propose legislative amendments to the Legislative Council within 2023 to admit qualified non-locally trained nurses, and has commenced consultation with relevant stakeholders on the proposal in the first quarter of 2023. The supply and attrition of healthcare professional manpower is a city-wide issue. As for DHCs, the respective DHC operators have been making efforts by adopting different contingency measures on talent recruitment and retention, including enhancing staff training opportunities and improving employees' benefits such as providing short-term rewards, etc. DHCs would also adopt service purchasing in order to maintain service level. In the long run, to ensure an adequate supply of primary healthcare-related professionals, the Government will review the manpower projection model and formulate strategies to systematically project the demand for primary healthcare professionals, taking into account healthcare demands of the population as a whole, the recommendations in the Blueprint, and provision of primary healthcare services in both public and private sectors, with a view to ensuring a sufficient supply of primary healthcare professionals through subsidised local training places as well as attraction of non-locally trained professionals.