Quota cuts loom for mainland mothers

The issue of children born of mainland parents in Hong Kong (i.e. when neither parent is a Hong Kong permanent resident at the time their children are born) has plagued the city for almost a decade.

In recent years, the number of children born in Hong Kong who fall into this category has escalated. They number some 176,300 in the years spanning 2000 and 2011. That's 22 percent of the total number of children born in Hong Kong hospitals during the period. The trend, which has continued to grow over the last decade, is almost certainly connected to a ruling by the Court of Final Appeal in 2001, that any child born in Hong Kong automatically attains to the right of permanent residency, regardless of the status of their parents.

In 2011 alone, the fathers of about 80 percent of newborns were not permanent residents of Hong Kong. Of the 46,964 births and births by appointment at public hospitals, 10,110 of the new mothers were non-local women. At private hospitals, the proportion of non-local women giving birth shoots up to about 70 percent of the 48,000 births and births by appointment.

Last year, over 45,300 babies were born in public hospitals and 48,900 in private hospitals. Nearly 47 percent were born of non-local women, PY Leung, chief executive of Hospital Authority, told China Daily in an exclusive interview.

The increase in the number of mainland women has risen to drastic proportion, creating serious pressure on the city's obstetrics service, the public healthcare system in general, and has affected accessibility of services for local mothers. The government came under great pressure to solve the problem.

Last year, for the first time, the government set a quota on the number of mainland mothers to be given access to services, after consultation with the HA and private hospitals. The quota was cut back again for 2012, to 35,000. Maternity care will be made available at public hospital to only 3,400 non-local women. The remaining 31,000 beds were allocated to private hospitals.

With priority of services mandated to local women, coupled with an expected increase in pregnancies during the Year of the Dragon, Leung does not rule out the possibility of a zero quota for mainland women in the coming year. The HA will announce its 2013 quotas sometime this month.

"Over 95,000 babies were born in Hong Kong last year and about half of them were born of non-local women," he said.

"Even though some mainland women give birth in private hospitals, related laboratory services and neonatal intensive care services (for newborns whose conditions are not good) in public hospitals are also affected (because private hospitals lack facilities for treating neonatal intensive care cases). As the question of 'doubly unqualified' children from the mainland has sparked widespread concerns in the community, we must come up with solutions in the long term."

At the end of 2011, the government introduced administrative measures to control the influx of pregnant mainlanders. A pregnant woman was required to provide proof that she has a confirmed booking at a local hospital before being admitted to the SAR. Boundary control officers are carrying out enhanced checks on pregnant women at boundary control points. There's a crackdown on illegal agents, who had carried on a lucrative business of transporting mainland women across borders. There's been an additional move against unlicensed guesthouses.

The HA is studying additional measures. The quota system sparked a flurry of cases of mainland mothers to be coming to Hong Kong, waiting until they go into labor, then rush to hospital emergency wards. The HA is considering a sharp increase in fees to deter women from obtaining services in that way, he said. The existing charge for three-day package plus examination is HK$39,000 for women who have prior bookings. Women who appear for emergency care at the last moment of pregnancy pay HK$48,000.

"Last year, there were over 1,600 mainland pregnant women without appointments rushing to our emergency wards at the last minute," Leung said. "Deliveries in emergency wards are very hazardous for both the mums and babies. For humanitarian reasons, we provided them delivery services whether they were able to pay or not."

The administrative measures have worked so far, with the number of deliveries in emergency wards dropping from 204 in December 2011 to 118 in February this year. "But whether such measures will continue to work remains to be seen," he remarked.

As the HA chief, Leung is happy to note that Chief Executive-elect CY Leung has attached great importance to the population policy and the problem of ineligible mainland women giving birth in Hong Kong.

Emphasizing priority services for local mothers, CY Leung suggested in his election platform that public hospitals stop admitting mainland women in 2013 and the government should delay negotiation of quotas with private hospitals.

"We welcome his position on this matter, as what he advocates is in line with what we have been thinking and doing," said the HA chief.

Moving up or final job?

PY Leung is just half way through his three-year contract as chief executive of the Hospital Authority. At 53, he muses that he could begin planning for retirement and has not thought about moving up the career ladder any further, though some have tipped him as a possible candidate for the post of Secretary for Food and Health in the next-term government.

"I am not too young now and I can start planning for retirement," he said happily. Asked if he would be willing to become a policy secretary, he responded: "My job with the HA is a very challenging one. The job as a policy secretary is more challenging but I will not think about it."

When Leung attended a TV interview several months ago, he said he has reached the summit of his career as becoming CEO of the Hospital Authority.

"To me, every stage is a summit and I have nothing to regret," he said.

"I am very glad that the government has given me so many chances to take up various positions. So far, I am the only one who has involvement in public health, food safety and worked in the Labour Department, Food and Environmental Hygiene Department and the Department of Health."

He was special assistant to then secretary for health and welfare Libby Wong (before 1997), with responsibility for healthcare financing and policy on Chinese medicine. He also played a part in handling the avian flu outbreak in 2000, which necessitated the slaughter of millions of live chicken.

"I have come across almost every aspect of the public healthcare system. To me, this is a perfect ending if you call it an ending. I don't think it is necessarily an upward move to become a policy secretary," he said with a big laugh.

Management by consensus removes ‘independent empires’

When PY Leung took over the post of Chief Executive of the Hong Kong Hospital Authority in late 2010, he found himself confronted with what he terms "warlordism" within the hospital clusters.

He found conditions which he said depressed staff morale, which in consequence exacerbate the manpower shortage, further contributing to overworked medical care staff working excessive hours.

The Hospital Authority is a large organization, with an annual budget of over HK$40 billion and 6,000 staff in its employ.

Though a doctor by training, Leung has had little experience as a hospital practitioner.

As director of quality and safety, he visited the hospitals frequently and handled medical incidents. He was also acting chief executive of Queen Mary Hospital and head of the Island West cluster for four months in 2010, during which time familiarized himself with hospital operations and earned a reputation for communicating well with frontline staff.

As head of HA, Leung pursues an open management style, counting on collaboration, cooperation and teamwork, with the benefit of patients in mind.

"If we discuss matters by laying them on the table and don't get too personal, warlordism will dilute gradually," he explained.

"At senior management meetings, we often discuss how resources can best be utilized. When there is no consensus, we set the matter aside for further discussion, or use the resources for other purposes. We strive for consensus and transparency with a problem-solving approach. We also encourage a speak-up culture, without fear of reprisals."

He took robotic surgery as a case in point. There are only four robotic devices within the HA, insufficient for all seven clusters. If a cluster chief wants one of the four, he is asked if he has sufficient budget to absorb operating costs without cutting other services.

"He will be asked at the budget committee meeting if he can maintain a balanced budget after absorbing the costs," said Leung. "If not, will he accept a salary cut as a penalty? One definitely dares not to say yes if he doesn't have enough funds to back the new services, and so empire-building cannot succeed."

Leung recalls that during his first days in the post, staff workload and poor morale had reached the bursting point. "So it was very important to first address the manpower and morale problems," he said. "We introduced new initiatives, thanks to our Chairman Anthony Wu for his striving for additional resources from the government and the solid support of Secretary for Food and Health York Chow."

To ease the manpower shortage and workload, retired and doctors who had resigned from HA, and private doctors were employed on a part-time basis. As a result, weekly working hours of most doctors were reduced to below 65 hours, except for those in a few under-manned specialist units.

Advancement prospects are also offered, he added. Specialist doctors with five years' experience who perform well, may be promoted to deputy consultant doctors, while consultant doctors are open to promotion to the directorate grade. Besides, fixed duty allowances are provided, while unnecessary non-clinical duties are reduced as far as possible.

For nurses, more posts and promotion opportunities were created. Apart from reimbursement of examination fees, which were in the past borne by the staff, medical personnel who are at the later stage of pregnancy are relieved of overnight duty.

Since the changes were put in place, medical personnel have more time for training, whether locally or overseas.

When Leung visited the hospitals last year, staff were disgruntled and had many complaints. They are happier today and show appreciation for the improvements.

"It is important to listen and take onboard their suggestions as far as possible. The trust between management and staff will be enhanced if the new measures work out right," he said.

He cited stark examples from the past: when staff got together for lunch, usually it was at a farewell party for people leaving. "Now there are more celebrations for promotions of the colleagues," he said enthusiastically.