Annex

Progress Report for the Southern District Signature Project – Eye Examination Scheme ( From 01/04/2020 to 30/09/2020 )

1. Purpose

This document aims to report on the progress of the Eye Examination Scheme during the first half year of 2020/21 financial year.

2. Background

In 2013, the Government introduced the Signature Project Scheme (“SPS”) under 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 Sub-office to provide free and comprehensive ophthalmic examination services for Southern District residents aged 50 or above. The Eye Examination Scheme has been officially launched on 20 May 2019.

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3. Service Summary By 30 September 2020, a total of 3669 qualified Southern District residents have received ophthalmological examination under the scheme. The overall attendance rate was 83.3%. Out of the total, 671, 354, and 259 participants were diagnosed with cataract (18.29%), glaucoma or suspected glaucoma (9.65%), and macular and retinal diseases (7.06%), respectively. A summary is shown below:

Types of Aged 50-59 Aged 60-69 Aged 70-79 Aged 80 or Above Total eye No. of No. of No. of No. of No. of % % % % % disease Participants Participants Participants Participants Participants Cataract 109 9.43 342 20.30 182 27.70 38 22.22 671 18.29 Glaucoma 114 9.86 154 9.14 66 10.05 20 11.70 354 9.65 Macular & retinal 66 5.71 112 6.65 68 10.35 13 7.60 259 7.06 diseases Other ocular 28 2.42 33 1.96 24 3.65 6 3.51 91 2.48 diseases Non- Ocular 0 0.00 2 0.12 0 0.00 0 0.00 2 0.05 disease

Table1: Summary of Common Eye Disease among the participants

There were 578 referrals (15.75%) to ophthalmologists for further management of eye disease and 2 referrals (0.05%) 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 3669 participants Cataract 235 6.41 Suspected glaucoma 256 6.98 Macular diseases 152 4.14 Other ocular diseases 73 1.99 Others 2 0.05

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, 3.29% of all eligible residents have undergone eye screening through our programme. Among the sub-districts, (D05) Lei Tung II, (D07) South Horizons West, and (D08) Wah Kwai have the highest participation rates so far, all being over 5% of their eligible population.

Population of % of Resident No. of % out of 3669 qualified resident Sub-District received eye Participants participants aged 50 or above check from Census 2016 (D01) 317 8.64% 7401 4.28% (D02) Ap Lei Chau Estate 175 4.77% 7834 2.23% (D03) Ap Lei Chau North 144 3.92% 4477 3.22% (D04) 314 8.56% 6881 4.56% (D05) Lei Tung II 373 10.17% 5888 6.33% (D06) South Horizons East 248 6.76% 5330 4.65% (D07) South Horizons West 341 9.29% 6036 5.65% (D08) Wah Kwai 453 12.35% 6689 6.77% (D09) Wah Fu South 225 6.13% 6252 3.60% (D10) Wah Fu North 214 5.83% 5989 3.57% (D11) 31 0.84% 5879 0.53% (D12) Chi Fu 269 7.33% 6427 4.19% (D13) 155 4.22% 6996 2.22% (D14) 170 4.63% 8086 2.10% (D15) Wong Chuk Hang 156 4.25% 8992 1.73% (D16) 1 0.03% 5924 0.02% (D17) Stanley & Shek O 83 2.26% 6504 1.28% Grand Total 3669 100.00% 111585 3.29%

Table 3: 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 • Provide medical advice to participants during Ophthalmologist 2 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 Technical consultation 3 Assistant • Coordinate participants during the actual visit • Record the data and assessment results gathered Secretariat • Provide clerical support 3 Assistant • Coordinate participants during the actual visit Total 12

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5. Service Suspension 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 26 Jan 2020, with increasing threat 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. Coinciding with this and the general situation in Hong Kong at the time, the Centre was closed from 25 Jan 2020. A total of 504 participants had registered during the suspension period.

With the adoption of social distancing and widespread use of face-masks, there were initially few new COVID-19 cases with confirmed or suspected community transmission. Therefore, service resumption was sought and approved by HKU Health System and Southern District Council (SDC), and the service resumed on 25 May 2020. Priority booking service was given to the affected participants during the suspension period. Among those, 493 participants were re-scheduled and completed their eye check 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 confirmed community outbreaks of COVID-19 in late July 2020 reported by the HKSAR Government, HKU Health System, in consultation with Southern District Council, decided to re-suspend the operation of the Centre from 20 July 2020. After the situation became relatively stable again in mid-August 2020, the Centre resumed service on 31 August 2020 after discussing with HKU Health System and Southern District Council. A total of 340 participants were affected during this period, and all were successively rescheduled. Among them, 230 have completed their eye check in Sep 2020. Online and phone booking service will resume on 9 Oct 2020.

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

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

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

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

i. Immediately suspending 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 personally 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. A lack of 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 agreed that the COVID-19 community transmission risk is low enough to safely resume service.

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5.3 Risk Assessment and Infection Control Implementation

Our aim is to continue or resume 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 are 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 resume service only when the local outbreak is controlled, with the safety of the residents of the Southern District being our first priority. In reviewing the space, setup, and nature of the service, the daily quota of participants will be set to reflect 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 will complete all assessments and ophthalmology consultation within the assigned time slot. This minimises the contact time between participants and staff at the Centre.

In accordance with the current social distancing measures, the daily booking is limited to 16 participants, with 4 participants per timeslots. We plan to increase the daily service quota when the Government further relaxes these measures, so that we can provide as many opportunities as possible for the residents of the Southern District to undergo eye screening without compromising their safety and overall satisfaction with the Project.

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5.4 Manpower Deployment During the Service Suspension Period

During the suspension period, job duties of the on-site staff have been rearranged into 3 divisions. Each division is led by the ophthalmologists and consists of secretarial staff, clinical staff and 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 • Oversee quality assurance matters Assurance • 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 30 Sep 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 9,787,458 Project b) Maintenance, rental for examination venue, 1,900,000 217,952 insurance, administrative expenses, etc. c) Community Promotion 730,000.00 0

Sub-total 43,459,000 10,005,410

Total 49,700,000 16,218,478

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

Oct 2020

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