Annex 1

Progress Report for the Southern District Signature Project – Eye Examination Scheme ( From 01/10/2020 to 31/12/2020 )

1. Purpose

This document aims to report on the progress of the Eye Examination Scheme during the period from October 2020 to December 2020.

2. Background

In 2013, the Government introduced the Signature Project Scheme (“SPS”) through which $100 million has been earmarked for each District Council to undertake large-scale and sustainable project(s) that would address the needs of the district.

The Southern District Council (SDC) decided to adopt the Eye Examination Scheme (“the Project”) as one of its two SPS projects and endorsed the proposal for engaging The University of Hong Kong (“HKU”) as the partner organisation for the Project in November 2017. On 1 June 2018, the Finance Committee of the Legislative Council approved the funding application of HK$49,700,000 for the purpose of implementing the Project.

The Department of Ophthalmology of The University of Hong Kong has established an ophthalmic examination centre (“the Centre”) at Southern District Office (“SDO”)’s Wah Kwai Sub-office to provide free and comprehensive ophthalmic examination services for Southern District residents aged 50 or above. The Eye Examination Scheme was officially launched on 20 May 2019.

3. Service Summary As of 31 December 2020, a total of 4774 qualified Southern District residents have received ophthalmological examination under the scheme. The overall attendance rate was 88.67%. Out of the total, 1131, 531 and 543 participants were diagnosed with cataract (23.69%), glaucoma or suspected glaucoma (11.12%), and macular and retinal diseases (11.37%), respectively. A summary is shown below:

Aged 50-59 Aged 60-69 Aged 70-79 Aged 80 or Above Total Types of eye disease No. of No. of No. of No. of No. of % % % % % Participants Participants Participants Participants Participants

Cataract 208 13.79% 586 26.58% 275 32.86% 62 27.68% 1131 23.69%

Glaucoma 166 11.01% 245 11.11% 90 10.75% 30 13.39% 531 11.12%

Macular & retinal 134 8.89% 244 11.07% 130 15.53% 35 15.63% 543 11.37% diseases Other ocular diseases 149 9.88% 285 12.93% 153 18.28% 46 20.54% 633 13.26% Table1: Summary of Common Eye Disease among the participants

1 978 of the residents (20.49%) were referred to ophthalmologists for further management of eye disease and 12 referrals (0.25%) were made to other medical specialists for non-ophthalmological conditions. A summary of the reasons of referral is shown below:

No. of referred % out of a total of Types of eye disease participants 4774 participants Cataract 339 7.10 Suspected glaucoma 370 7.75 Macular diseases 228 4.78 Other ocular diseases 110 2.30 Others 12 0.25

Table 2: Summary for the reason of referral

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The following table shows the summary of attendance rate for sub-districts of Southern District. Currently, 4.28% of all eligible residents have undergone eye screening through our programme. As at 31 December 2020, the highest participation rates were observed in (D05) Lei Tung II, (D07) South Horizons West and (D08) Wah Kwai among all the sub-districts, with all being > 7% of their eligible population.

Population of % out of 4774 qualified resident % of Resident Sub-District No. of Participants participants aged 50 or above received eye check from Census 2016 (D01) Aberdeen 413 8.65% 7401 5.58%

(D02) Ap Lei Chau Estate 246 5.15% 7834 3.14%

(D03) Ap Lei Chau North 245 5.13% 4477 5.47%

(D04) Lei Tung I 373 7.81% 6881 5.42%

(D05) Lei Tung II 484 10.14% 5888 8.22%

(D06) South Horizons East 314 6.58% 5330 5.89%

(D07) South Horizons West 432 9.05% 6036 7.16%

(D08) Wah Kwai 603 12.63% 6689 9.01%

(D09) Wah Fu South 309 6.47% 6252 4.94%

(D10) Wah Fu North 262 5.49% 5989 4.37%

(D11) Pokfulam 34 0.71% 5879 0.58%

(D12) Chi Fu 322 6.74% 6427 5.01%

(D13) Tin Wan 200 4.19% 6996 2.86%

(D14) Shek Yue 227 4.75% 8086 2.81%

(D15) Wong Chuk Hang 205 4.29% 8992 2.28%

(D16) Bays Area 1 0.02% 5924 0.02%

(D17) Stanley & Shek O 104 2.18% 6504 1.60%

Grand Total 4774 100.00% 111585 4.28%

Table 4: Attendance rate for the different sub-districts of Southern District

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4. Human Resource Plan

The following table shows the number of staff employed for the implementation of the Project:

Position Number Major job duties

 Perform ophthalmological examination Ophthalmologist 2  Provide medical advice to participants during consultation  Perform the role of team leader on site

 Perform vision testing and investigations Optometrist 2  Provide supervision and training for other supporting staff

 Handle medical related treatment issues (e.g. handling of medication, instruments, and/or blood taking) Enrolled Nurse* 1  Serve as the infection control officer for the project  Conduct training and risk assessment

Project Manager 1  Coordinate various logistics of the Project

 Provide assistance to Ophthalmologists during consultation Technical Assistant 3  Coordinate participants during the actual visit  Record the data and assessment results gathered

 Provide clerical support Secretariat assistant 3  Coordinate participants during the actual visit Total 12

*Remark: We experienced difficulties in the employment of Registered Nurse due to very competitive offers in the market. Under this circumstance, an Enrolled Nurse was hired in Mar 2020 to fill the vacancy. After the recruitment of nurse and the streamlining of examination procedures, it is expected the service capacity will reach 28-30 per day.

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5. Measurements in Response to the Risks of Coronavirus Disease 2019 (COVID-19)

5.1 Suspension of service

Suspension Period: 29 Jan 2020 to 22 May 2020

On the 26 Jan 2020, with the increasing risk of a COVID-19 outbreak in the community, the HKSAR Government raised the response level under the "Preparedness and Response Plan for Novel Infectious Disease of Public Health Significance" (“the Preparedness and Response Plan”) to Emergency Response Level with immediate effect. In view of this and the general situation in Hong Kong at the time, the Centre was closed from the 25 Jan 2020. A total of 504 participants had registered during the suspension period.

As the COVID-19 pandemic eased, service resumption was sought and approved by HKU Health System and the Southern District Council (SDC), and service resumed on 25 May 2020. Priority booking service was given to the affected participants during the suspension period. Among those, 493 appointments were re-scheduled and completed in Jun 2020, while 11 participants cancelled their booking. Online and phone booking service resumed on 10 Jul 2020.

Suspension Period: 20 Jul 2020 to 28 Aug 2020

In light of the community outbreaks of COVID-19 in July reported by the HKSAR Government, HKU Health System, in consultation with SDC, decided to re-suspend the operations of the Centre from 20 July 2020. After the situation became relatively stable again in mid-August, service resumed on 31 August 2020. A total of 340 participants were affected during this period, and all of their appointments were rescheduled. Among them, 230 completed their eye check in Sep 2020. Online and phone booking service resumed on 9 Oct 2020.

5.2 Ongoing monitoring of the outbreak and plans for resumption of service

With the unpredictable COVID-19 pandemic situation, the following criteria were adopted as indicator for service suspension:

i. Special work arrangement announced by the HKSAR Government. ii. Confirmed COVID-19 cases visited the Centre in the past 14 days. iii. Service suspension for 3 days for cleaning of Centre when confirmed COVID-19 infection of staff. iv. If HKU Health System, HKU Department of Ophthalmology, and the SDC all agree that the COVID-19 community transmission risk is too high to continue service.

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The following actions will be taken immediately to implement the service suspension:

i. Immediately suspend online and phone booking for new appointments. ii. A notice of service suspension (in Chinese and English) to be placed at the Centre entrance on the same day. iii. Participants with existing bookings are promptly informed via telephone regarding the cancellation of their appointment. iv. Affected participants with cancelled bookings will be informed that they would be given choice of priority booking once service is resumed. Each of these participants would be offered one of two dates set in two different months for their rescheduled appointment. The participants would be informed that should they decline the offer, they would have to make a new booking without priority in the future. v. The hotline will be attended to as usual during regular office hours to address any questions from the public.

HKU Health System will conduct bi-weekly review to decide whether to continue service suspension during the suspension period. The following criteria for resumption of service were adopted to reduce the risk of COVID-19 transmission among participants at the Centre:

i. The HKSAR Government downgrade the response level under the Preparedness and Response Plan; or ii. No new COVID-19 cases with confirmed or suspected community transmission in Hong Kong for the last 14 days; or iii. If HKU Health System, HKU Department of Ophthalmology and the SDC all agree that the COVID-19 community transmission risk is low enough to safely resume service.

5.3 Risk Assessment and Infection Control Implementation

Our aim is to continue the service when the risk of community transmission is acceptably low, and as an additional safeguard, a designated infection control coordinator will ensure all medical and technical staff of the Centre is well versed in the upgraded infection control measures. Although the upgraded evidence-based infection control measures can help ensure that the risk of COVID-19 transmission at the Centre will be kept to a minimum, the ultimate aim is still to provide service only when the local outbreak is controlled, with the safety of the residents of the Southern District being our priority. In reviewing the space, setup, and nature of the service, the daily quota of participants will be set to 20 participants or lower according to the latest social distancing measures from the HKSAR Government.

The bookings will be spread out across the whole day in four timeslots:

i. 9:00 AM – 10:30 AM ii. 10:30 AM – 12:30 PM iii. 1:30 PM – 3:00 PM iv. 3:00 PM – 5:00 PM

With improved workflow efficiency as a result of the questionnaire being conducted entirely by telephone, the participants would be able to complete all assessments and ophthalmology consultation within the assigned time slot. This minimises the contact time between participants and staff at the Centre.

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5.4 Service after 1-Dec-2020

Although special work arrangement was announced by the HKSAR Government on 2 Dec 2020, with the consent of SDC and HKU Health System, the service continued. After infection risk assessment, the daily booking was limited to 20 participants, with maximum 5 participants per timeslot. The daily service quota was reviewed regularly depends on the COVID-19 community transmission risk.

During the service period, the following infection control measurements were applied:

Proper Triage

1. Designated area was marked at the waiting area to maintain social distancing among the participants. 2. Health declaration was done by phone prior to the examination to minimise the risk at the waiting area. 3. Participants with fever and respiratory symptoms were not allowed to enter the centre and priority booking was provided after recovery. 4. Participants having close contact with a confirmed case of COVID-19 in the past 14 days were rescheduled. 5. Participants living in the building with COVID-19 confirmed case in the past 14 days was rescheduled. 6. All participants had to perform hand hygiene and temperature check before entering the centre.

Strength cleansing

1. All eye check equipment should be disinfected with alcohol tower after using. 2. Environmental cleansing with 1:99 bleach should be performed at least twice per day.

Infection control and policy

1. Regular infection control audit and risk assessment. 2. Provide training for staff on infection control measurements. 3. Setup protocol for staff sick leave, disinfection procedures and stock check. 4. Setup proper cleansing and evacuation policies for the possible visit of COVID-19 confirmed case.

Strength Communication

1. Install “LeaveHomeSafe” QR code for tracing of the COVID-19 confirmed case. 2. Notes / pamphlets given to participants of what to do in case participant is unwell after a consultation. 3. Poster of proper hand washing, mask wearing and cough procedures were placed around clinic.

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5.5 HR arrangement in Response to the Risks of COVID-19

Three divisions have been set up to enhance the quality of our service and to minimise the risk of COVID-19. Each division is led by the Ophthalmologists and consists of secretarial staff, clinical staff or technical staff according to the nature of the division. The functions and duties of each division are shown below:

Division Functions and Duties General Enquiries  Handle email and phone enquiries from general public during office hours  Handle online booking during the suspension period  Reschedule booking for the affected participants once the service resumed  Perform ad-hoc tasks at the Centre Routine Secretarial task  Source suppliers for clinical consumables (e.g. face masks and alcohol swabs)  Prepare service reports to SDC, HKU Faculty of Medicine, ethic committee and other managing authorities  Arrange annual maintenance for the equipment  Prepare financial reports and handle reimbursements  Provide support to procurement and HR related matters  Manage medical records and clinical database Infection Control and Quality Assurance  Oversee quality assurance matters  Perform risk assessment  Establish and implement the infection control guidelines  Review and streamline the current clinical procedures  Handle complaints and report to the corresponding managing authorities  Arrange infection control training for staff of the Centre

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6. Financial Position

The following table summarises the expenditures incurred for implementing the Project:

Approved budget Expenditure incurred Items (HK$) (HK$) as at 31 Dec 2020 (I) Start-up Cost

a) Procurement of essential equipment and 5,871,000 5,872,582 computer system b) Procurement of furniture 45,000 43,157

c) Initial public promotional activities 325,000 297,329

Sub-total 6,241,000 6,213,068

(II) Operating expenses

a) Employment of staff for delivery of the 40,829,000 11,641,665 Project b) Maintenance, rental for examination venue, 1,900,000 312,307 insurance, administrative expenses, etc. c) Community Promotion 730,000.00 0

Sub-total 43,459,000 11,953,972

Total 49,700,000 18,167,040

Department of Ophthalmology Li Ka Shing Faculty of Medicine The University of Hong Kong

December 2020

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