Hospital Authority Convention 2021 Keynote Address by Dr Tony Ko Pat-sing, Chief Executive of Authority 3 May 2021

Embracing the Past, Reaching Out for a Sustainable Future

Chief Executive (The Honourable Mrs Carrie Lam Cheng Yuet-ngor, GBM, GBS, Chief Executive of HKSARG), Professor Chan (Professor Sophia Chan Siu-chee, Secretary for Food and Health), Mr Fan (Mr Henry Fan Hung-ling, HA Chairman), distinguished guests, colleagues, ladies and gentlemen – good morning.

1. It is my greatest pleasure to welcome you all to the 2021 (HA) Convention.

2. Last year, we reluctantly cancelled the HA Convention in the wake of the COVID-19 pandemic. This year, thanks to technology advancement and our dedicated support team, we are proud to launch this annual flagship event using a hybrid mode. Despite the limitations on cross-border travel, we are glad to have more than 50 eminent local and non-local speakers, joining us either in person or via virtual platform. I would also like to thank our Mainland and Macau counterparts who are joining us online today. My heartfelt gratitude in particular goes to Minister Ma of the National Health Commission for his thoughtful arrangement in delivering his congratulatory message to us via video.

3. This is the first HA Convention that I join after assuming the role of HA Chief Executive in 2019. I am excited to see that the Convention continues to

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provide an excellent opportunity for colleagues and leading healthcare experts to share on a diverse array of knowledge and new ideas.

4. This year, HA is celebrating its 30th anniversary. Confucius once said that a person is able to establish himself at the age of thirty (三十而立). HA’s 30th Anniversary is indeed an opportune time for us to consolidate our past experience and prepare ourselves for the challenges ahead.

5. Today at this special occasion, I would like to quickly travel with you through the past, take a snapshot of the present, and offer a glimpse into our future.

The First Three Decades of HA

6. As we stroll down the memory lane, I am sure many of us can recall the days in the 70’s and 80’s when ’s public hospital service was under immense pressure due to increasing demand and community expectations. It was against this backdrop that HA was inaugurated on 1 December 1990 under the Hospital Authority Ordinance, and formally took over the management and control of all government and subvented in 1991.

7. Our Chairman Mr Henry Fan pointed out the critical challenge of escalating service demand in his welcome address. To illustrate this, our Accidents & Emergency (A&E) attendances have increased by more than 150% 1 from 1.25 million thirty years ago to over 2 million last year. Similarly, over the same period, our specialist outpatient attendances have more than doubled from 3.7 million to 7.6 million2. Adding to the challenge of the significant growth of service volume is the increasing complexity of disease management as a result of advances in technology and treatment. Taking ischaemic stroke as an example, there were not much effective acute treatments available in the 70’s and 80’s. Mainstay of treatment was aspirin, rehabilitation was less organised, and many patients have to suffer significant disability. Today, patients are provided with a full range of complex clinical services from ultra- urgent imaging, time sensitive hyper-acute therapies for reperfusion,

1 Number of A&E attendances: 1.25 million (1990-91, Annual Report); 2.05 million (HA Website) 2 Number of specialist outpatient attendances: 3.7 million (1990-91, Annual Report); 7.6 million (HA Website) 2

dedicated acute multidisciplinary team support, to professional rehabilitation and assistive aid, etc.

8. Over the past three decades, HA holds steadfast to its mission to provide high quality patient-centred healthcare services to the Hong Kong community. We have put in place many initiatives and service developments in terms of hardware and software. Believe it or not, I still sometimes dream about the days when I was a junior doctor, working in a hot and humid hospital ward without air-conditioning on a summer day, digging through piles of paper records to find the laboratory results for the patients! As we are now moving on with the development of Smart Care and Smart Hospital Projects for the coming years, I wish to take this opportunity to thank our predecessors who dared to dream big and pioneer a lot of great initiatives. I am really glad to see that this pioneer spirit continues to grow in HA and many more innovative ideas are budding. And many of our dreams today, I believe, will also come true very soon.

Snapshot of the Current Dual Challenge in HA

9. Throughout the history of HA, we have been facing profound impacts of the escalating service demand arising from the growing and ageing population, and the high and increasing number of patients with chronic diseases.

10. If we take a look at the latest government projections, we can see that Hong Kong’s population will increase by around 7% from 7.5 million in 2020 to more than 8 million in 2036, with significant growth in the elderly population, with the percentage of elderly sharply rising from 18% to 30%.

11. Elderly people generally require more healthcare services. They have attributed to around half of our total patient days and A&E admissions, and one-third of our General Outpatient Clinic and Specialist Outpatient Clinic attendances.

12. The escalating service demand is also affected by an increasing prevalence of chronic diseases. Parallel to the ageing population and higher longevity is the rising occurrence of chronic illnesses, not only for the elderly population but also for middle-age citizens aged 40 to 64. According to the latest 3

projection, the number of patients with chronic diseases will increase by 50% from 2 million by end of 2019 to 3 million by end of 2039.

13. Through various measures implemented over the years, we managed to bring down the utilisation per capita of HA’s elderly inpatients and day patients by around 12% in the past ten years. However, the alarming fact is that the utilisation per capita of the middle-age group is on a sharp rising trend, with nearly 21% increase over the same period. We foresee that this increasing chronic disease prevalence in the middle-age group will cause a big impact on Hong Kong’s healthcare system.

14. Apart from the sharp rising trend of service demand in the coming decades, another huge challenge for HA is of course the unprecedented global pandemic of COVID-19.

15. Following the outbreak of the pandemic last year and activation of Emergency Response Level in all public hospitals, many of our non-emergency services were suspended or postponed in order to reserve HA’s manpower and hospital facilities for treatment of COVID patients.

16. We have been hard hit by waves of COVID-19 outbreak since last year. Thanks to the support from the government and our dedicated teams in fighting against the virus, our services have by now largely resumed to our usual level. Nonetheless, the previous service suspensions have inevitably created additional burdens to the already long waiting lists for our hospital services.

17. To a certain extent, HA has gained much experiences in managing major infection threats over the last three decades, including the bird flu, Human Swine Flu and notably SARS in 2003.

18. After the SARS experience, we have reinforced closer collaboration with the Department of Health and its Centre for Health Protection, and have further enhanced HA’s infection control facilities and emergency response systems.

19. On top of this foundation, and with special thanks to the strong support of the Central Government and the Hong Kong SAR Government, we have, in 4

response to the COVID-19 challenges, established the Community Treatment Facility at AsiaWorld-Expo in 2020 and the Hong Kong Infection Control Centre earlier this year. With the concerted efforts of our colleagues, we are able to operate these additional facilities within short timeframe which have no doubt bolstered Hong Kong’s capacity to fight against COVID-19.

Support from the Government

20. The staunch support of the Government is always the most reliable backer in our public healthcare service and its sustainable development. I would like to take this opportunity to express our most sincere gratitude to the Government for according high priority to healthcare services in its funding and policy initiatives over the years. In particular, we have the Government’s strong commitment of two 10-year Hospital Development Plans involving around HK$470 billion (roughly equivalent to US$60.5 billion) in total, additional funding allocations for the COVID-19 expenditures, the progressive triennial funding arrangement and the substantial increase in the annual subvention to HK$82.4 billion (about US$10.6 billion) to HA in 2021-223.

Reaching Out for a Sustainable Future in HA

21. Looking ahead, the rapidly growing demand will quickly further outstrip the supply, and we foresee a major sustainability challenge to HA.

22. I am truly grateful that under the guidance of the HA Board, a special Task Group was established in December 2019 and led by our Chairman himself to critically examine major sustainability challenges facing HA, for formulating strategic directions for HA to cope with the challenges ahead.

23. I believe you already have an overview of our plan on HA’s sustainability from the video just now. The implementation of measures to achieve sustainable future is indeed a mammoth task. But we know if we change nothing, nothing will change. Just by doing more of the same is not going

3 Annual subvention to HA: HK$82.4 billion (~US$10.6 billion) in 2021-22 vs HK$78.7 billion (~US$10 billion) in 2020-21, i.e. a 4.7% growth. 5

to work. Here, I would like to share with you some of the major initiatives among the various key priority areas which the Task Group has looked into, namely on provision of Smart Care, development of Smart Hospitals and building of Smart and Happy Workforce.

Smart Care

24. The essence of sustainability is to balance demand and supply. To address this, HA is adopting a three-pronged strategy through narrowing upstream, collaborating downstream, and diverting midstream. One of the key directions is to change the service models towards the provision of “Smart Care” to keep patients healthy in the community and reduce their need for hospitalisation.

25. We have four major strategies in driving for this change of service model: adopting data-driven care, developing personalised care, promoting ambulatory care, and enhancing community-based care.

Adopt data-driven care & Develop personalised care

26. To narrow upstream demand, it is of utmost importance to strengthen disease prevention. With our strong in-house developed Clinical Management System (CMS) and the myriad clinical data in HA, we have great opportunities to leverage on big data to provide predictive and proactive care to patients.

27. One of our previous success in predictive risk modelling is the Hospital Admission Risk Reduction Programme for the Elderly (HARRPE) which was developed by our clinicians and statisticians more than ten years ago to identify elderly patients with high risk of readmission for targeted support.

28. Riding on this success, we are now building various types of predictive risk models, such as the e-Frailty Index (eFI), to identify high risk elderly patients with frailty impacts on clinical management. It aims to stratify elderly patients for appropriate intervention, care plans and care settings. With data on selected clinical characteristics and socioeconomic factors in the CMS, the

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e-Frailty Index would be developed as part of the clinical care where individualised care plan and interventions could be formulated.

29. Based on risk prediction and stratification of individual patients, we will be able to tailor personalised treatment options according to their specific healthcare needs. Using elderly care as an example, for the majority of elderly patients with stable chronic conditions who are living in the community, “supported self-care” will be the focus; for patients with comorbidities or requiring rehabilitation to prevent further deterioration, “chronic disease management” will be arranged; and for the relatively small proportion of elderly patients with high risk and complex conditions, “case management” will be provided to reduce avoidable hospitalisation.

30. On Diabetes Mellitus (DM) management, I believe many of you are familiar with the Risk Assessment and Management Programme (RAMP) first started more than a decade ago. Every year, more than 200,000 patients are given comprehensive risk assessment and stratification for complications identification and receive targeted interventions from multi-disciplinary teams for better control of disease progression. The Programme has achieved significant improvements in patients’ key clinical parameters including glycated haemoglobin (HbA1c), blood pressure (BP) and Low Density Lipid Protein-Cholesterol (LDL-C) levels.

31. We are now developing a DM Risk Engine built from a machine learning model. Based on demographics, comorbidity and clinical data, the probability of developing selected adverse outcomes (e.g. mortality, Chronic Kidney Disease Stage 3A to 5, etc.) in 5 years’ time could be predicted for individual DM patients. We will pilot this DM Risk Engine in our Patient Support Call Centre Chronic Disease Management programme. Patients will be prioritised according to the risk prediction from the DM Risk Engine for early intervention, provision of personalised care and patient empowerment.

Promote ambulatory care & Enhance community-based care

32. To collaborate downstream, we will re-orientate HA’s service delivery models to be less reliant on inpatient care, by promoting ambulatory care. For instance, by concentrating the diagnostic imaging services in ambulatory

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centres and by enabling tele-radiology and off-site reporting, suitable patients can be diverted to day services for radiology procedures. This will in turn decongest the inpatient services and increase the efficiency of the diagnostic imaging services.

33. To divert midstream, empowerment of patients for self-care and keeping them healthy in the community is another key direction. With the advancement of technology, there are more options for patient empowerment. For instance, we can now use the mobile app “HA Go” to record self-monitoring health data including body weight, BMI, blood glucose, blood pressure, body temperature, and even pain symptoms and peritoneal dialysis. Patient education information can also be prescribed in forms of e-pamphlets, videos and soundtracks to patients through HA Go MyHealth App on an individualised approach.

34. We will also continue to strengthen medico-social collaboration with community partners to reduce the need for hospital care. Examples include delivering rehabilitation programmes in the District Health Centres, and providing End-of-Life care to terminally ill patients living in elderly homes.

35. In a nutshell, our future plan on Smart Care is to further adopt risk prediction tools and incorporate them into the mobile app “HA Go” to further empower patients for personalised self-care, while at the same time promote ambulatory care and enhance community-based care services so as to reduce the need for hospitalisation.

Smart Hospitals

36. Facing vigorous growth in demand and costs as well as shortage of key manpower resources, HA is working towards the strategic direction of developing smart hospitals, aiming to achieve digital innovations in meeting future sustainability challenges.

37. HA has developed extensive digital health capabilities over the last 30 years, including a world class CMS which provides a massive lateral coverage of clinical data of all our 43 public hospitals and 79 general outpatient clinics, with clinical modules covering the entire range of clinical care processes. 8

CMS was developed by clinicians, for clinicians, to support care delivery for all the clinical specialties and disciplines of HA. Leveraging on this solid foundation, we are now actively developing the Smart Hospital strategy to take digital health in HA to the next level.

38. In essence, our Smart Hospital strategy aims to enhance HA’s digital capabilities to develop new models of healthcare delivery including tele- medicine; improve patient experience and engage them better in their own care; and provide more efficient support for both clinical and non-clinical staff in the workplace.

39. Technology is at the heart of HA’s Smart Hospital Strategy. With more technology access and enablement, more services can be provided through digital platforms with much more automation. New technologies being piloted include artificial intelligence (AI), robotics, telecare, smart ward and clinic applications, and command centre solutions.

40. Delivering Smart Hospital is a wide-ranging transformation process, with changes to service delivery and workflows in many key areas that require the participation of all staff across HA. To take this forward, we have designated three hospitals, namely , Tseung Kwan O Hospital and Queen Elizabeth Hospital as pilots to develop and deploy a comprehensive suite of Smart Hospital products at an early stage, so that these products can be further enhanced and fine-tuned for deployment across HA in future.

41. I am sure you will be hearing more about HA’s Smart Hospital projects later today and tomorrow. Here, I would like to just briefly share with you a few examples of our smart initiatives.

42. On the clinical service front, we have adopted AI applications for highlighting chest x-ray abnormalities. We have also developed multiple tele-care applications including tele-consultation in wards and special outpatient clinics; tele-drug counselling services; tele-rehabilitation, tele-monitoring and tele-consultation for patients. Our one-stop patient mobile app, “HA Go”, provides easy electronic access to various HA services and important health information on personal basis to our patients and their carers.

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43. We have set up a Hospital Command Centre which brings together key operative information to a single location so that colleagues can review and manage their bed capacity through dashboards and real time reports. We have also started using robot applications including Cleansing Robots, Ward Assistant Robots and Delivery Robots in daily hospital operations.

44. As we learn from these pilots and refine the Smart Hospital product portfolio, I trust that we will be able to seamlessly incorporate them into our care delivery to improve patient and staff experience.

Smart and Happy Workforce

45. In enabling the direction towards the provision of Smart Care and Smart Hospital, we also strive to build a Smart and Happy Workforce.

46. HA currently has almost 90,000 staff. Human capital is always our greatest asset, and is also one of the focus areas studied by the Task Group on Sustainability.

47. We are developing a digital workplace that is more personalised, easy to access and with connected IT capabilities. The development mainly focuses on the key themes of “Paperless”, “Personalised” and “Peer Friendly”. In fact, I believe many of you may have already experienced a few of these digital workplace initiatives such as the HA staff mobile app – “My HR App” that is now joined and used by over 80,000 staff members and equipped with capabilities covering many day-to-day staff needs like leave application and approval; as well as the recently added feature of HA Chatbot for assisting staff on COVID-related matters such as FAQ, booking of vaccination appointment and making vaccination records. More initiatives down the pipeline will include mobile apps that target on specific work areas to ease administrative work, communication, ordering services and providing alerts.

48. We also target to explore more innovative measures to transform HA’s human resource (HR) strategies to better meet the needs and expectations of the new generations. Traditionally, our healthcare workforce is primarily built for performing highly specialised and unique roles on a full-time basis. To

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optimise agility and flexibility, we are going to explore new career options through empowerment and training for multiple talents and multiple roles.

49. Staff well-being and effective communication are always important keys to building a happy workforce. We will continue to enhance effective communication with staff to strengthen staff engagement on all fronts and to launch different staff well-being programmes that meet the prevailing needs of our staff. That include, among others, developing strategies to build a harmonious working environment and reinforce a caring and respect culture in HA.

Moving Forward

50. HA has been facing huge challenges in the past, and now we have to fight against the unprecedented global pandemic of COVID-19. While we may not have magical solutions to all challenges ahead, we have strong resolve to provide the best care to our patients. With the strong support of the Government and the guidance of the HA Board, a dedicated healthcare workforce as well as close partnership with other stakeholders, I trust that we together will successfully move forward to provide a sustainable healthcare service to help people live healthier and happier.

51. Thank you.

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