Speech by CS at the 194th Congregation and Prize Presentation Ceremony of Li Ka Shing Faculty of Medicine of University of Hong Kong (English only)

Following is the speech by the Chief Secretary for Administration, Mrs Carrie Lam,at the 194th Congregation and Prize Presentation Ceremony of Li Ka Shing Faculty of Medicine of the University of Hong today (November 21):

Professor Peter Mathieson (President and Vice-Chancellor of The University of Hong Kong), Professor Gabriel Leung (Dean of the Li Ka Shing Faculty of Medicine), faculty members, graduates, parents, ladies and gentlemen,

Good morning.

I am delighted to join you all at the 194th Congregation and Prize Presentation Ceremony of the Li Ka Shing Faculty of Medicine of The University of Hong Kong. To me, this is both an honour and a challenge.

As an alumna of this distinguished university, it is indeed an honour to be invited back to attend and speak at the congregation of her premium faculty, which is also the longest established institution in higher education in Hong Kong.

As the senior government official in charge of some 20 months of heated discussion on Hong Kong's constitutional development which had given rise to 79 days of "Occupy Movement", the challenge lies in whether my presence would lead to unnecessary disruptions to the solemn proceedings of a graduation ceremony, an experience I have had at my appearance at the graduation ceremony of the Hong Kong Academy of Performing Arts last year. What bothers me is not embarrassment at a personal level, but annoyance to students and parents to whom the graduation ceremony is a big and memorable occasion.

Nonetheless, I have decided to take up the challenge for two reasons. First, your Dean, as you know, is my former colleague : a very likable one who in my view possesses the rare combined talents of an academic, an administrator and a politician. I have observed what he has introduced to the Faculty of Medicine since taking over the helm, including a new set of admissions rules and the Springboard Scholarships. I endorse these initiatives and would like to come here to give him my support. Secondly, newly graduated medical professionals are our future in ensuring the high quality of Hong Kong's medical and health services and I would like to take this opportunity to share with them a few observations and messages.

You will think that I am speaking to you just as a senior government official, in my capacity as the Chief Secretary for Administration. The reality is : I know the subject well as almost one-third of my 35 years of public service was closely related to Hong Kong's medical services. In the early 1980s, I started my career as a young Administrative Officer in the then Medical and Health Services Department responsible for project planning. And one of the pressure demands in those days was whether we should build an Eastern District Hospital. In 1991, I took up the position of a Principal Assistant Secretary in the then Health and Welfare Branch, serving as secretary to the Medical Development Advisory Committee and secretary to a high level committee to review Hong Kong's primary health care chaired by a very distinguished alumna of this faculty, Professor Rosie Young. During those two years, I also brought into effect the Supplementary Medical Professions Ordinance, embarked upon policy work on the promotion and regulation of Traditional Chinese Medicine and reviewed the Pharmacy and Poisons Ordinance. I even went to Singapore to study the feasibility of a statutory opt-out scheme in promoting organ donation, a topic that has caught some public attention recently. I was then posted to the Department of Health as its Assistant Director of Administration, tasked to implement those recommendations in the Primary Health Care Report entitled Health For All by the Year 2000. They included new services like the Student Health Service and the Well Women Clinics and a new discipline in Family Medicine with the appointment of the first government consultant. Between 1997 and 2000, I sat on the Hospital Authority (HA) Board as representative of the Financial Secretary. My interest in HA went beyond its finances and I voluntarily served as a member of HA's Patients' Complaints Committee. As the Director of Social Welfare between 2000 and 2003, I worked closely with my medical counterparts in elderly and rehabilitation services where there is a very strong interface between health and welfare.

With my extensive experience, I have come to the unwavering conclusion that Hong Kong is blessed with a high quality, reliable and cost-effective medical and health system which we should preserve and enhance for the people of Hong Kong. Medical personnel are the foundation of the system and thus our graduates today - doctors, nurses, pharmacists - all command my greatest respect. After today, you will carry the burden to maintain this system for Hong Kong and to better the care for our people.

My first and foremost message to you is that the Government is committed to ensuring a robust medical and health system in Hong Kong. This is much valued by the Hong Kong people. In the current fiscal year, total recurrent expenditure on health amounts to $54.5 billion, representing 16.8% of total government recurrent expenditure. Subventions to the HA have increased from $34 billion in 2010-11 to $50 billion in 2015-16. On top of that, $10 billion was injected into the Samaritan Fund in September 2012 to pay for privately purchased medical items for needy patients; $13 billion was granted to HA in December 2013 to improve the condition and environment of HA's ageing facilities and another $10 billion, subject to the Legislative Council's approval on 4 December, will be made available to HA to extend the General Outpatient Clinic Public-Private Partnership Programmes to 18 districts. On the infrastructure side, $25 billion of works are under construction including the Redevelopment of Queen Mary Hospital Phase 1 and a Children's Hospital at Kai Tak. More are in the pipeline. These are no small sums, especially given the competing priorities for additional government spending from other pressing areas like education and social welfare.

But these significant investments will pale into insignificance if we look at the demographic challenges that Hong Kong is facing. Our population is ageing, and ageing fast. According to the latest 50-year projections released by the Census & Statistics Department in September, the proportion of persons aged 65 and over will increase from 15% in 2014 to 30% in 2034, that is 20 years from now, and the number of persons aged 75 and over is projected to surge from about 530,000 to more than 1.17 million over the same period. With elderly patients' much higher risk of hospitalisation and considerably longer stay (respectively four times higher than that of a non-elderly and an average of 14.2 days per year in the general specialties), the pressure on the public hospital system is huge. According to a study on Hong Kong's long term fiscal planning released by Government in March 2014, recurrent health expenditure as a percentage of nominal GDP would increase from 2.4% in 2014-15 to 4% in 2041-42; or in dollar terms, from $52.4 billion to $285 billion over the same period, even when no service enhancement were to be contemplated. Sustainability is a big issue.

My second message to you is therefore we must innovate and find more effective ways to treat patients. As prevention is better than cure, the Department of Health is ensuring comprehensive coverage under the Childhood Immunisation Programme in respect of 11 diseases and pressing ahead with the Government Vaccination Programme in respect of seasonal influenza and pneumococcal infection. Another area is the wider use of technology and advance procedures. In this respect, I wish to commend the HA for adopting the ambulatory care model in providing sophisticated health services in ambulatory settings. As you are aware, the Government has finally established a new Innovation and Technology Bureau yesterday. I expect this will bring about wider application of innovation and technology in medical services to improve livelihood.

My third message is to highlight the importance of team work and cross-sector collaboration. As leader of the medical team, doctors must work closely with nurses and other supplementary medical professions to deliver whole-person integrated care to the patient. Young doctors like graduates today would benefit from learning from other members of the medical team who have years of practical experience. At present, multi-disciplinary and cross-sector mental health services are provided to persons with mental health problems through collaboration amongst HA, the Labour and Welfare Bureau, Social Welfare Department, Department of Health, NGOs and other stakeholders in the community. We are exploring a pilot under the Community Care Fund to resource District Elderly Community Centres to help take care of dementia patients, thereby relieving HA's geriatric and psychiatric services to provide early screening to elderly persons. In respect of children with special needs, we have recently launched an on-site pre-school rehabilitation services pilot at kindergartens through the concerted efforts of Labour and Welfare Bureau, Education Bureau and Food and Health Bureau. These are some good examples of cross-sector collaboration which are also more oriented towards the needs of the patients. I believe there is still a great potential in such collaboration waiting to be tapped and I look to the medical fraternity taking a lead.

My fourth message is on manpower. In the face of challenges posed by a rapidly ageing population and increasing demand for health care services, we will need more doctors, nurses, physiotherapists, occupational therapists, etc. Actually, if not because of the shortage of some of these healthcare professionals, the on-site pre-school rehabilitation services pilot I just mentioned could go further in providing more places for children now queuing for services. While a comprehensive review covering both the projected demand for healthcare manpower and the regulatory framework governing healthcare professions in Hong Kong is under way, I wish to make an appeal to our medical professionals, particularly doctors, that a more liberal and open-door approach should be adopted in admitting overseas-trained personnel to register and practise in Hong Kong. In my view, the admission of non-locally trained medical professionals has the dual advantages of meeting our manpower demand and facilitating cross-fertilisation of ideas, experience and expertise. These timely moves will in my view help enhance Hong Kong people's trust and confidence in the Medical Council.

My final message is to encourage our young graduates to serve with compassion and empathy. Beyond doubt, medical practitioners are highly-respected people in any society. This is particularly true in Hong Kong, given the reputation of our world-class health care services. Hong Kong enjoys one of the lowest infant mortality rates and longest life expectancy in the world. The professionalism of our medical practitioners, together with our advanced infrastructure, contributes to Hong Kong's position as a centre of excellence in medical services. People respect and trust our doctors, including each of you as you take off your black graduation gown and put on your white coat. All patients, regardless of their age, their identity and their social standing, take your words seriously. They submit to your authority and expertise. You are the last straw of hope to people who confront death, as well as to their desperate families. You are in the frontline on matters of life and death.

I fully understand that when you go into the real working environment, the sheer volume of caseload may not enable you to spend enough time with each patient. But I hope this would not prevent you from patiently listening to their worries, explaining to them their conditions and addressing their anxieties. What I have referred to is "empathy", not "sympathy" because my decades of public service experience tell me that whether in drawing up new policies or dealing with individual cases, the most practical and rewarding approach is to put yourself into the shoes of those you are serving and trying to see things from their perspective.

With those remarks, let me send my warmest congratulations to all graduates and your parents. It is gratifying to witness this moment when you are about to harvest what you have sowed in sweat and tears all the years through. It is also gratifying for the Government and the taxpayers that the heavy investment in medical training is bearing fruit. Our society will benefit from a new batch of well trained and competent doctors, nurses and pharmacists.

Graduates, I am sure the "Declaration of Geneva", stated in the Code of Professional Conduct of the Medical Council, is not unfamiliar to you. Let me quote part of it: "At the time of being admitted as a member of the medical profession, I solemnly pledge to consecrate my life to the service of humanity. ...The health of my patient will be my first consideration. ... I will practise my profession with conscience and dignity." I have trust in you to uphold your profession and practise your expertise with a sense of mission and compassion. Our society would be glad to have you upholding your professional knowledge and devoting nothing less than the very best of you. This is the biggest contribution you can make for our society and for humanity.

Ladies and Gentlemen, let us together wish all graduates today every success as they embark on their careers. Let me also congratulate the parents, family members, friends and teachers of the graduates in the audience. For your unyielding support to the graduates during their tough student life, you deserve a good portion of today's glory.

Thank you very much.