Speak on the 2013-14 Budget (Translation):

　　I think I had better focus my speech on healthcare issues as Secretary Dr KO Wing-man just happens to be in the Chamber and the Financial Secretary has also returned. I have compared this year's Budget with the one of last year, only to find that they are more or less the same as the problems existed last year have not yet been solved. Perhaps, I should repeat these healthcare problems, just in case the Financial Secretary has forgotten about them or some new Members have not heard about them before. Also, some Members might not be in their seats when these problems were raised last year.

　　First of all, should healthcare problems be solved by the Financial Secretary? Given that the Financial Secretary is the one who makes the provision to the Hospital Authority (HA), should he just let the HA use the provision at its own will, or should he learn about the details of its spending? I find that, in this Budget, the Financial Secretary has actually mentioned some of the details. For example, he has stated that a significant sum of money will be used to build new hospitals and redevelop existing hospitals like Queen Mary Hospital, Kwong Wah Hospital, United Christian Hospital and Kwai Chung Hospital. Also, he has said that more than 200 beds will be added. Therefore, the Budget has indeed mentioned quite a lot of details. However, I hope all the more that the Financial Secretary can consider exercising his influence over the HA in the utilization of funds to solve our healthcare problems.

　　Year after year, Members keep on asking why the Government does not spend more on healthcare or social welfare when its reserve is increasing. On this issue, I have checked the relevant accounts. Last year, the Government allocated $41 billion to the HA, excluding the one-off injection into the Samaritan Fund. This year, the provision increases by $4 billion to $45 billion, representing an increase of 9.5%. This increase is quite impressive indeed. Nevertheless, while the Government has increased its healthcare expenditure over the years, the general public do not seem to perceive any significant improvement in the HA's services. They are still very discontented with the services. Now, I am going to remind the Financial Secretary once again of where the problems lie.

　　In my view, the poor public perception of the HA's services mainly comes from the long waiting time. Patients always have to wait for years for its services, say, three years for cataract surgery, and five years for colonoscopy. I would like to show you a chart. According to this chart, in the period between 2006-2007 and 2011-2012, the annual provision rose by nearly 40% from $28 billion to more than $36 billion in six years' time. The staff size of the HA also increased by 16% from 53 000 to 61 000. Then, did the service output increase at a faster pace than the provision amount and staff size? During the same period, the population only rose by 3.1%. Meanwhile, the number of bed days for general in-patient services (that is, the total number of bed days of patients in Hong Kong) just increased by 5.2%, and the number of attendances at Accident and Emergency Departments 9.2%. These figures suggest that the provision amount and staff size actually had a greater and faster rate of increase than the demand for healthcare services. Then, why are the people still discontented? As I have just said, the people care more about the waiting time. Let us now look at the waiting time.

　　There are various specialties under the HA. Yet, I find that the waiting times for the same specialty vary greatly among different hospital clusters. Here is an example I had given before: The waiting time for the Ear, Nose and Throat Department is 92 weeks in the New Territories West Cluster but one week in the Central Kowloon Cluster. Last year, some improvement was seen in the situation. The waiting time in the New Territories West Cluster was suddenly shortened to 26 weeks. Yet, the waiting time in the New Territories East Cluster was lengthened to 54 weeks and the Central Kowloon Cluster three weeks. There are still vast differences in the waiting times among different clusters. But which cluster has the longest waiting time? Among the eight specialties, the longest waiting times for the departments of Gynaecology, Orthopaedics and Traumatology, Paediatrics and Surgery are all found in the East Kowloon Cluster. From this, we can see that when many members of the public or Members often complain about the long waiting time, they may be only referring to one or two specific clusters, which are likely to be the East Kowloon Cluster, the New Territories West Cluster and New Territories East Cluster.

　　Why is there this situation? Let us look at how the HA allocates its funding to various clusters. In 2011-2012, the HA provided the East Kowloon Cluster with a funding of $4 million for every 1 000 people. In comparison, the New Territories West Cluster and New Territories East Cluster received more funding, with each of them getting more than $4 million for every 1 000 people. As for the Central Kowloon Cluster, it was given a funding of $11 million for every 1 000 people. In other words, the Central Kowloon Cluster had a funding which was more than double that of the respective amounts received by the East Kowloon Cluster, the New Territories East Cluster and the New Territories West Cluster. In terms of corresponding manpower, the doctor-population ratio of the East Kowloon Cluster and the New Territories West Cluster was 0.6:1 000 as they had less funding. In contrast, this ratio reached 1.3:1 000 in the Central Kowloon Cluster. It was a much higher ratio. While the provision for the HA increases every year …… the Financial Secretary has left the Chamber. I may have to repeat all this again later or next year.

　　While the provision for the HA has increased considerably over the years, why does the HA not allocate more funds to the clusters which used to have less funding? Let us review the percentages of resources received by various clusters from the HA between 2006-2007 and 2011-2012. I will use the East Kowloon Cluster as an example. This cluster has to serve some 14% of the population of Hong Kong. In 2006-2007, $28 billion was provided to the HA, and 10% of this sum was allocated to this cluster. In 2011-2012, the Government increased its provision for the HA to $38 billion; yet, the HA continued to allocate only 10% of its funding to this cluster. In other words, although the Government had given more funding to the HA, the HA did not allocate a greater percentage of its provision to the cluster which has the longest waiting times and is the most short of hands.

Why did the HA allocate its provision in this way? In response, the HA said that it was due to a historical factor, which means this cluster has received the smallest proportion of funding since the very beginning. Therefore, the cluster will continue to receive the smallest proportion of funding in future. If the Financial Secretary does not address the HA's problems in resource allocation, the public and Members will never stop pressing the Government to provide more funding and manpower to the HA. Well, it may be a piece of good news to the management of the HA as they can have additional funding and manpower without doing anything or by worsening the services intentionally or unintentionally. Some colleagues have said that it is weird for the positions of stick and carrot to have switched. What they mean to say is that the stick is now used to hit the donkey's head while the carrot is tied to its tail. In this case, how can the donkey be motivated to move forward? Is there any solution to improve this situation? Some scholars suggest taking the approach of "money follows the patient" plus "more pay for more work".

　　The private-sector market is actually operating on this mode. How does the private-sector market operate? I have to mention my wife and daughter again. A few months ago, my wife gave birth to our daughter and she wanted her to do an ultrasound scan. The hospital, which is a private one, then arranged for the scan to be done at 4 pm on the day of their discharge. Yet, my wife wanted to leave the hospital in the morning and did not want to wait till 4 pm. So, she was thinking of giving up the ultrasound scan and leaving the hospital then. The hospital immediately arranged for our daughter to do an ultrasound scan at 10 am on that day before discharge. The reason why the hospital made such a prompt arrangement was not that I am a Member of this Council. It was simply because "money followed the patient". In other words, the hospital would not let go any chance to provide services and make money. It made an immediate arrangement to earn the service fees. If they did not do so, the patient might go to see another doctor after discharge from the hospital. In that event, the money would have really followed the patient and gone to the pocket of another doctor.

　　Does the private sector have the problem of reaching its maximum capacity? This problem is rarely heard. Have private doctors complained about long working hours? In my memory, I have never heard of such complaints. Has the private sector complained about staff shortage? This kind of complaints is never heard of. Therefore, if we wish to shorten the waiting times in public healthcare organizations to satisfy our patients, we must start with improving the existing mechanism as this problem cannot simply be solved by additional resources. To put it simply, we should first consider the workloads and service outputs of various healthcare organizations. To those which have a high service output, we should give them more funding. Only by this can we offer an incentive to encourage the hospital clusters to shorten their waiting times. If the waiting time is too long, patients can then go to another cluster to seek medical consultation.

　　Perhaps, it is because lots of views were given last year that the Financial Secretary has stated in this year's Budget that the HA will refine the waiting list management to shorten the waiting time of patients. Unfortunately, the measure is only piecemeal. Why do I say so? Let me take the waiting time of new cases as a benchmark. Regarding the specialist out-patient services provided by the HA, new cases account for only 10%, taking up a very small portion of the HA's services. While there are 600 000 new cases in a year, there are 6 million old cases. All of them have to be taken care of by the Specialist Out-patient Department. If we do not provide them with any incentive …… I suppose the wording of "refine the waiting list management" means transferring patients of the East Kowloon Cluster (where the waiting time is the longest) to the Central Kowloon Cluster (where the waiting time is the shortest). As the waiting time in the Central Kowloon Cluster is so short, it seems right to make this cluster take up some cases for the East Kowloon Cluster. However, colleagues of the Central Kowloon Cluster will then complain that this measure is penalizing them. They will say that they have a short waiting time because their working performance is good. When they have worked so hard to minimize the waiting time, they are now forced to receive the patients transferred by the HA. They will consider it stupid to work so hard. Then, come next year, the Central Kowloon Cluster can simply increase its proportion of old cases and receive fewer new cases. The waiting time in the Central Kowloon Cluster will then be lengthened immediately. In that case, the comments I made in the previous year will lengthen the waiting times in all hospital clusters over the territory. Sorry, I would have done a disservice out of good intentions.

　　Therefore, if the Government refines the waiting list management by simply transferring patients to other clusters, it will just achieve a short-term effect and soon lose its impact. It must be supported by a proper allocation of resources. For clusters receiving more patients, they should be given more resources to shorten the waiting time. If it is impossible to transfer some of the patients to other clusters, a system which gives "more pay for more work" should be introduced. By then, even if some patients refuse to leave the East Kowloon Cluster, there will be no problem since the doctors of East Kowloon will work very hard to benefit under the system of "money follows the patient" and "more pay for more work".

　　There is also another option. If we all agree that the poor services of the HA are caused by staff shortage, it means we cannot hold the HA management responsible as there is not much they can do right now. However, after considering the above figures, we should indeed hold the management accountable for the poor services. What does it mean by "holding the management accountable"? As a matter of fact, the Government has allocated provision to the HA. Yet, its management fails to make a fair allocation of the funds received. If the management cannot fix this problem in two years, the relevant management staff should be fired. This is how they are held accountable. We must hold the management accountable; otherwise, they will not have any incentive to figure out how to shorten the waiting time by improving every part of the work process. Is that right?

　　I do not wish to speak too much. It is enough to give a short speech. President, I so submit.