(蘋果) 額外派發$1,000醫療券

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【本報訊】長者醫療券是少數獲加碼的紓困措施，政府將連續第二年額外發放多1,000元，涉10.42億元，連同恒常每年發放的2,000元，即今年長者獲發3,000元醫療券。

(星島) 建制派評「四平八穩」新意不多 泛民指有盈餘 應每人派三千元

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(蘋果) 隔牆有耳：波嫂種「生機」立會撐老公

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財政司司長陳茂波噚日去立法會宣讀任內第二份財政預算案，太太許步明都有到場支持，仲好有心思咁着咗件綠色衫襯返老公嘅心血結晶，即係嗰本寓意香港係充滿生機嘅土壤嘅粉綠色封面預算案，不過波波嘅手足就似唔太撐場，13位局長到齊，但得八位副局長包括陳帥夫、區志光、徐德義、蔡若蓮、陳浩濂等，同埋兩位政助及兩位行會成員包括周松崗同葉國謙喺觀眾席旁聽，身兼行會成員嘅經民聯議員劉業強仲遲到一粒鐘，成12點先施施然走入會議廳。

(成報) 預算案撥逾7億醫療救火 前線醫生：改革醫管局方可挽留人才

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(SCMP) HK$80b boost for health sector

Highlights include HK$10 billion stabilisation fund, more money for prescription drugs and higher allowances for doctors and support staff

Hong Kong's overloaded health sector emerged as one of the biggest winners in the budget yesterday, receiving morale-boosting measures worth a total of HK$80.6 billion in recurrent expenditure - a sharp rise of more than 10 per cent from last year.

One move that won praise was the creation of a new HK$10 billion stabilisation fund to help the Hospital Authority weather financial storms.

The sum was equivalent to about two months of spending by the authority, which runs the city's public hospitals.

A government source said it set up a safety net for the health care sector in the event the government was unable to provide sufficient funding, for example during an economic downturn.

Delivering his budget speech yesterday, Financial Secretary Paul Chan Mo-po said: "I have noticed many people from the public and private medical sectors, even university professors, have expressed worries about future resources. Creating the fund is meant to give everyone an assurance."

He said the public health sector would be able to tap the fund immediately, should the government face a funding shortfall because of any unexpected circumstances.

The government source would not say whether the idea stemmed from a similar proposal made by University of Hong Kong Professor Yuen Kwok-yung, who had called for a HK$50 billion safety net.

But the source stressed various suggestions for some kind of stabilisation fund had been tossed around during the consultation period for this year's budget.

Yuen, a top microbiologist, said he was not disappointed about the stabilisation fund being smaller than what he had suggested. "I think HK$10 billion is already pretty good," Yuen said. "The Hospital Authority has been treated very well this time."

The Society for Community Organisation, a non-governmental organisation, welcomed the move, but a spokesman expressed doubt on whether the fund could really help the most pressing areas in the system.

He suggested the authority be allowed to use the HK$10 billion to develop health services that responded to changes in demand.

The stabilisation fund was among a raft of measures aimed at soothing the city's manpower-starved public medical sector, which has resulted in overworked doctors, nurses and other staff protesting strenuously at being overwhelmed by the large number of patients during the recent peak flu season.

Praising their professionalism and passion in serving the community, Chan set aside HK$80.6 billion for the public health system - 10.9 per cent more than last year and accounting for 18.3 per cent of the government's total recurrent expenditure.

The Hospital Authority's usual annual subvention would also rise to HK$68.8 billion, up more than 8 per cent from the previous year. The authority would also get additional recurrent funding of more than HK$700 million to implement measures to help retain staff. The source expected allowances for doctors on call to rise by 55 per cent, while working staff could look forward to a higher overtime rate. Some 16,000 support staff could expect pay increases, and more than 200 posts for senior nurses would be added.

A doctor from Tuen Mun Hospital's department of medicine and geriatrics welcomed the increased allowances and overtime pay, but said they would not completely solve the staffing problem.

What was needed, he said, was more staff to share the heavy workload.

Medical sector lawmaker Dr Pierre Chan said the financial secretary did not address the issue of long working hours faced by frontline staff and he was unimpressed by the potential increase in allowances for on-call doctors.

To improve the provision of medicines in public hospitals, the authority would get HK$400 million in additional recurrent funding to expand the list of prescription drugs available.

Another HK$5 billion was earmarked to hasten the upgrading of critical medical equipment such as PET scan devices and new technology for cancer treatments.

Beyond the public hospitals, Chan also announced an allocation of HK$1.2 billion to implement the Hong Kong Genome Project. He also earmarked over HK$150 million to set up the first primary health care centre in Kwai Tsing before expanding to other districts.

A note of dismay came from the Hong Kong Academy of Medicine, which said it was regrettable that the government did not highlight any measure to improve the training of medical specialists.

The Hospital Authority chairman, Professor John Leong Chi-yan, meanwhile, welcomed the budget, expressing gratitude to the government.

He said the authority was planning a series of measures to boost morale, ranging from increments for nurses who obtained specialist qualifications to adding more positions for pharmacists.

(晴報) 泵水$160億 支援公營醫療 $7億改善待遇 $50億添設備

公營醫院人手緊張致怨聲載道，昨公布的財政預算案中，建議增撥至少161億元予醫管局解決人手及設備等問題，當中包括提供逾7億元提升醫管局醫護人員津貼，另增加150億元作添置儀器及應付突發情況，藉此提升士氣、挽留人才。但有前綫醫生和立法會議員認為措施屬小恩小惠，要解決問題必須改善整體規劃。

　　最新一份財政預算案提出，額外提供逾7億元經常資助，供醫管局增加員工津貼及薪酬，及增加專職醫療人員及資深護師職位，改善晉升前景。消息指，當局計劃調升各級醫生當值時的候召補償金55%、增加醫護特別酬金（SHS）20%，並會調高第3級支援職系人員起薪點及現職薪酬，稍後完成檢討再調升第1、2級薪酬，冀多項措施有助挽留人手。

$100億撥款穩定基金 應對突發情況

　　預算案亦會額外預留50億元更新及添置醫管局器材；及預留100億元作公營醫療撥款穩定基金，助醫管局面對突發情況；另增撥4億元經常資助擴闊藥物名冊，以納入更多藥物。醫管局主席梁智仁表示歡迎，並會繼續以不同措施紓緩前綫的工作壓力。

　　黃任匡為公立醫院心臟科專科醫生，平均每周連同候命工時長達60多小時，他指SHS要求醫生放假時再當值，被形容為「賣血」。他說，流感高峰期不少同事已表示不要津貼、只想休息，質疑措施成效，認為整體措施只屬「小恩小惠」。

公院醫生指小恩小惠 議員稱有誠意

　　醫學界立法會議員陳沛然指措施顯示出誠意，但問題根源在於規劃，促政府鞭策醫管局改善人手編制。衞生服務界立法會議員李國麟認為，措施有助留住富經驗的護士。香港病人政策連線主席林志釉稱，擴闊藥物名冊可增加醫生用藥的選擇。

$12億設基因中心 助及早診斷罕見病

　　政府去年宣布將推行大型基因組測序計劃，預算案提出撥12億元成立香港基因組中心，未來6年可進行4至5萬個全基因組檢測。消息指，新中心由政府全資擁有，料今年內落成，日後有懷疑罕見病患可轉介作基因測序，及早診斷。

　　記者︰李明佑

　　編輯：林子豐

　　美術：陳超雄

(Standard) Big shot in the arm for health-care services

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(明報) 設百億醫療「穩定基金」 議員：缺人未解 望梅止渴

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(東方) 政情：中環出更：財爺齋噏兩粒鐘 議員玩手機搵周公

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(明報) 醫療券開支42億升1/3 足建天水圍醫院未交代防濫用措施 續加碼1000元

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(信報) 醫療經常開支806億大升10.9% 設百億基金應急抗疫 50億添先進設備

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(蘋果)擲7億挽人才 百億救醫療

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【2019－20財政預算案　公院爆廠】
【本報訊】公營醫療體系瀕臨爆煲，財政預算案大灑金錢，包括設100億公營醫療撥款穩定基金，若政府未來因經濟下行等原因未能向醫管局提供足夠撥款，該局可運用該基金，令服務不受影響。2019/20年度醫管局經常性撥款688億元，較2018/19年度增加53億元，當中逾7億元用於挽留人才。
記者：陳沛冰　于健民

(經濟) 百億設醫療穩定基金 7億振士氣

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(信報) 陳沛然新民黨支持通過撥款

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(SCMP) Will doctors hear the call?

Will doctors hear the call?

More Hong Kong doctors may well be heading to the mainland if plans to develop better health care services in the "Greater Bay Area" take off. Pioneers who have already made the move to Guangdong in recent years say the prospects are exciting, and city doctors will gain not only from business opportunities, but also knowledge and experience if they get to treat a much larger pool of patients there. Ophthalmologist Dr Dennis Lam Shun-chiu, who openedhis first mainland eye hospital in Shenzhen in 2013, said there was great demand for quality services across the border, including from Hong Kong retirees living there. "They would be interested in health care services provided by Hongkongers," he said. The greater demand for Hong Kong care could also lead to an enlargement of capacity in the city itself, added Lam, who has hospitals in Beijing and Kunming too. It might even provide the impetus to open a third medical school in the city, he said. However, others warn Hong Kong's manpower-starved public health sector faces further strain under an even greater number of patients. Finance minister Paul Chan Mo-po will today unveil his 2019-2020 budget, and all eyes will be on whether he dishes out more resources for struggling medical professionals, to help prevent any possible brain drain. But doctors in private practice say there are important unresolved issues stopping more doctors from working over the border, ranging from insurance coverage to the availability of medicines. "We are not familiar with the regulations involved in opening a clinic on the mainland," said Dr Ho Chun-ping, president of the Hong Kong Medical Association, which represents more than 10,000 doctors. For now, he does not think many private practitioners will be keen to move. The recently unveiled blueprint for the development of the Greater Bay Area, which will bring together Hong Kong, Macau and nine other Pearl River Delta cities, calls for closer cooperation in health care services. It sees medical service providers from Hong Kong and Macau setting up facilities in the nine mainland cities, and encourages health care professionals from the two special administrative regions to cross the border for academic exchanges and short-term private practice. It also says authorities will look into transferring non-emergency and non-critically ill patients across the border and explore a pilot scheme to refer patients between designated public hospitals on either side. The blueprint does not spell out which patients stand to benefit, but Hong Kong Chief Executive Carrie Lam Cheng Yuet-ngor has said it will be only Hongkongers. The Food and Health Bureau has said the main purpose is to help Hongkongers living in Guangdong province to return for treatment or recuperation. According to the Census and Statistics Department, more than 525,000 Hongkongers were living in Guangdong at the end of 2017. They included more than 79,000 people aged 65 or older, as well as those working there and Hong Kong children born to mainland parents. The Greater Bay Area spans 56,000 sq km and has a population of about 70 million. Beijing envisions turning it into a global innovation and financial powerhouse to rival Silicon Valley and Japan's Tokyo Bay area. However, the health care services proposals come at a time when Hong Kong is facing a medical manpower shortage and frontline doctors in overburdened public hospitals are concerned about the impact. The city has more than 14,000 doctors, about 40 per cent of them work in public hospitals, which provide more than 90 per cent of all inpatient care. Dr Alfred Wong Yam-hong, a spokesman for doctors' concern group M\u00e9decins Inspir\u00e9s, is worried more patients will turn up at public hospitals if non-emergency patients from the mainland are transferred to Hong Kong hospitals. He works at Tuen Mun Hospital, near the mainland border, and said even now, it was not uncommon to see Hongkongers living on the mainland crossing the border for medical treatment. Many have serious illnesses. "More patients can be expected if non-critically ill ones are sent in too," he said. "The burden on public hospitals all over Hong Kong would increase." For now, doctors in private practice appear lukewarm to the Greater Bay Area plans because of the different medical system in place on the mainland, as well as barriers to crossing the border to work. The Medical Association's Ho said there were day-to-day issues too, including the fact medicines prescribed in Hong Kong might not be available across the border due to different regimes for introducing drugs. "It will be troublesome if a doctor cannot prescribe a medication he has previously been using for patients," Ho said. Mainland health authorities had told him they were looking into this matter. Ho said medical insurance protecting against lawsuits and negligence claims was also an issue, because the professional indemnity scheme used by many doctors in Hong Kong did not cover the mainland. The plans outlined in the Greater Bay Area blueprint are not the first initiative to encourage Hong Kong doctors to work on the mainland. Under the Closer Economic Partnership Arrangement (Cepa), signed between the governments of Hong Kong and the mainland more than a decade ago, local doctors without mainland qualifications can work for up to three years over the border with a renewable licence. The arrangement also allows Hong Kong health care providers to open medical facilities such as hospitals on the mainland through wholly owned, joint equity or contractual joint ventures. As of the end of last month however, only 49 certificates had been issued under Cepa to local service suppliers to provide medical or dental services across the border. Medical sector lawmaker Dr Pierre Chan said the relatively small number of doctors working on the mainland suggested there would not be a rush north even with the bay area plan. However, doctors with experience there point to a number of advantages, not least having access to more patients with a wider variety of conditions than those seen in Hong Kong. Doctors Union president Dr Henry Yeung Chiu-fat, a paediatrician in private practice, referred to visits he and other doctors had made to patients on the mainland. "Some of the cases we saw in Guangdong province were cases none of us had seen before," he said. Recalling patients with Marfan syndrome, a genetic disorder that results in elongated arms, legs and fingers and heart problems, he said it was helpful to deal with such cases. "Doctors are able to widen their knowledge, and will be able to identify a patient's condition more quickly," he said. Yeung, who obtained a qualification to practise on the mainland in 2009, said his union was opening a clinic later this year in Guangzhou's Nanfang Hospital, a public facility with more than 2,000 beds, and Hong Kong doctors would provide short-term services there. More than 20 private practitioners, including paediatricians and ophthalmologists, have signed up to work at the clinic on an appointment basis, and the union has obtained medical insurance to cover them. It is in talks with mainland officials on whether the doctors will be able to prescribe drugs not yet available across the border. Thoracic surgeon Dr Alan Sihoe Dart-loon is equally convinced that working on the mainland will give Hong Kong doctors an opportunity to improve their skills. He has been performing operations at Shanghai Pulmonary Hospital since 2013 and helped develop thoracic surgery services at the University of Hong Kong-Shenzhen Hospital over the past five years. "If you have the numbers, you can advance and make progress in the medicine you practise," he said. To give an idea of the difference in scale on either side of the border, he said a major Hong Kong public hospital carried out about 200 lung cancer operations a year, whereas Shanghai Pulmonary Hospital did 15,000. "By treating mainland patients, we can learn and develop techniques which could then benefit Hong Kong patients as well," he said. What remains to be seen is how patients would respond if the Greater Bay Area plans became reality. Hongkonger Tam Kwok-yuen, a 76-year-old retiree who moved to Guangzhou about five years ago, said having more Hong Kong health care professionals practising on the mainland would benefit him only if he could use their services on a subsidised basis. Currently, Hongkongers aged 65 or above are entitled to annual vouchers worth HK$2,000 for private health care services, including visits to general practitioners or dentists. Tam said the Hong Kong government could allow seniors to use the vouchers at mainland health care institutions too. At present, they can do so only at the University of Hong Kong-Shenzhen Hospital. A diabetes patient, he spends about 10 days each month in Hong Kong, and goes to a public hospital there every three months to undergo regular check-ups and collect his medicines. "If there were more Hong Kong doctors on the mainland, but I could not enjoy any medical benefits, why would I see them?" he asked. In 2011, Hong Kong and Shenzhen launched a pilot scheme for Hongkongers admitted to two public hospitals in Shenzhen. Once their condition was stable, they could be transferred to two Hong Kong hospitals close to the border, namely Tuen Mun Hospital and North District Hospital, if they wished to move. So far, however, only three patients have been sent to the Hong Kong hospitals under this arrangement. A Hospital Authority source said this was because of conditions stipulating patients had to be admitted to one of two designated hospitals in Shenzhen, and could be moved only to the two in Hong Kong. It may be early days yet, but a patients' advocacy group in Hong Kong is concerned about the impact on the city's stressed health care system if doctors have more choices of where to work. "They might move elsewhere, or practise on both sides of the border, but end up spending less time in Hong Kong," said Alex Lam Chi-yau, chairman of Hong Kong Patients' Voices. Even if private doctors are the ones drawn there, the group is worried more public sector practitioners will then be lured to fill gaps in the private sector. An integration plan without measures to protect Hong-kongers' interests risked further diluting resources available for Hong Kong patients, especially those in the public sector, he said. Lam suggested authorities consider transferring Hong Kong patients who need long-term rehabilitation care to facilities on the mainland, where space was more readily available. "We need to look at give-and-take in this Greater Bay Area plan," he said. "If we are only giving without receiving anything, I can't see a future." Financial Secretary Paul Chan Mo-po today delivers his third budget for Hong Kong. All eyes are on whether he will give more aid to the public health care sector to help prevent a possible brain drain to the mainland. In the last of a three-part series, Elizabeth Cheung examines city fears over losing its doctors amid plans to link health care services in the "Greater Bay Area"

(明報) 特權法查沙中線第四度否決

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(頭條)「活化強積金」議案遭否決

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(東方) 議員倡允提取強積金置業 財庫局：隨時取款違原意

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(星島) 立會否決特權法查沙中綫

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(明報) 民主黨擬約特首談逃犯

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(AM730) 民主派杯葛春茗 王志民：港勿成 國家法外之地

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(信報) 醫護申訴無改善 李國麟失望

醫護申訴無改善 李國麟失望

流感高峰期期間公立醫院床位「逼爆」，工作量大增令不少醫護人員不滿，專業議政6名立法會議員聯同醫學界議員陳沛然致函特首辦，約見行政長官林鄭月娥，商討醫療政策及資源問題。本身代表衞生服務界的李國麟表示，對於食物及衞生局局長陳肇始上月聽畢醫護人員申訴後仍未回應，感到十分失望。 要求當局監管醫管局 專業議政成員的李國麟指出，政府雖增撥5億元予醫管局，但前線醫護人員仍處於水深火熱中，處境未有改善，希望可與特首商討除撥款外的解決方法。專業議政認為，應趁流感高峰期稍退，探討醫療政策及資源的長遠解決及改善方法。 他接受民主黨前主席劉慧卿訪問時又指醫管局管治架構臃腫，要求「解剖」醫管局查看問題所在，並促當局好好監管醫管局。 胡定旭倡吸名醫學院畢業生 醫管局前主席胡定旭周五早上於電台上明言，香港醫生與市民的比例較其他地區低，加上公私營醫生各佔一半，公營醫療系統人手確實不足，故建議全球排名最高的50間醫學院的港人醫科畢業生可免試回港執業，紓緩人手不足。 對於有醫生提到不少求診者為新移民，建議收緊單程證申請的配額，胡定旭說，6年前他仍任醫管局主席時，單程證人士使用醫管局的資源不多，更有不少新移民來港應徵作醫護人員，故認為不用收緊單程證政策。 #政情 - 醫護申訴無改善 李國麟失望

(星島)審議國歌法委會 最少60議員報名加入

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(明報)建制泛民「冧人」爭奪正副主席職 63議員加入國歌法委會

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(東方)政情：中環出更：斥陳肇始逃避 李國麟促解剖醫管局

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(東方) 政Whats噏：國歌法委員會冧友 白鴿黨唔認轉軚

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(東方) 政情：國歌法委員會再多四議員加入

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(香港01)走出醫管困局 手術刻不容緩

走出醫管困局 手術刻不容緩

醫院管理局自1990 年成立至今，是本地公營醫療服務的最大提供者，統領逾百間公立醫院、專科或普通科門診，掌管7.6 萬員工和每年數百億元計的公帑。當年政府下放管治權力給醫管局，由醫生為主的業界自主提供服務，目標是根治病床爆滿等醫療缺失。 如今醫管局自身難保，政府和公眾要認真思考，如何為醫管局動手術，清除各項管理病灶。 港英政府成立醫管局，源自1985 年發表的《史葛報告書》。顧問建議政府下放權力到新的醫療管理機構，並脫離公務員體系，期望管理更有效率。為何要推行這項改革？1980 年代的公營醫院一樣塞爆病人，醫護界批評行政程序繁複冗長，醫療開支也不斷上升。 當時的公共醫院區分政府醫院及由慈善機構營運的補助醫院，兩者在環境、員工待遇和管理的差異愈趨明顯。報告書提出多個改善目標，主要包括：重整政府醫院及補助醫院架構、人手及資源使用；減少醫院擁擠，提升服務水平；改善醫療融資及成本控制。報告認為，獨立成局並脫離公務員系統有以下好處：一、透過任免員工，加強醫院層面的問責能力；二、加入更多專業及民間代表以對公眾問責；三、政府可透過撥款和董事局，確保醫管局緊跟政府政策，尤其肩負照顧病人的重任；四、提升補助醫院認受性，統一政府及補助醫院員工待遇。 另一方面，根據公共行政學者張炳良研究，政務官和醫生趁機釐清管理權責。當時由政務官主導的衞生福利司，以及由醫生主導的醫務衞生署不咬弦，政務官在醫務衞生署受制於醫生，醫生則不願意由外行人參與醫療管理工作。兩者均有意調整架構，醫生掌資源調撥，政務官掌政策。 不可不提，港府整個醫療體系改革也受着當時英國公營部門改革牽動，醫管局可算是先行者。至於減少過分擁擠，報告書建議增設醫院急症室做好守門員角色，避免病房接收非嚴重病人，重新調配醫院之間及醫院內部的病床，加強病人轉換病房的效率等。政府也落實《史葛報告書》建議，把住院費與成本掛鈎，逐步收回成本。 醫管局在1990 年成立至九七回歸前可以說是蜜月期。醫護掌握行政權力，政府只有委任及指派最多三名公務員為醫管局大會成員的權力，主要是向醫管局購買醫療服務的採購者。員工—尤其補助醫院員工—的薪酬待遇及晉升階梯顯著改善，醫院人手和病床數目上升。舉例說，由1992年底至1997年底，醫管局醫生和護士人數分別增加近四成和兩成多（見表一）；同期病床量增加約兩成，兩者在管理模式方面，研究本地公共行政制度的學者黃兆輝分析，醫管局成立後，高層強調機構管理和控制，例如不斷加強管理職位，以前的顧問醫生或護士長都改稱經理，行政工作的比重日增。總的來說，醫管局的開局不錯，很多資深醫護人員回憶，那場改革終結帆布床滿布的日子，令人欣慰。 供需失衡　醫院亂象重現報告書估計成立醫管局有助控制政府撥款，例如透過提升現有服務，延緩建設新醫院，抵消轉制的額外開支，結果事與願違，政府的醫療投入飛漲。究其原因，除了薪酬開支增長外，公立醫院服務提升，尤其是大力發展專科，吸引更多市民使用專科門診及急症室，抵消了增加人手的好處。政府在1993 年建議提高公立醫院收費但遭市民反對，無法減輕醫療開支承擔。幸而政府財政收入大漲小回，撥款飛漲並未弄垮公營醫療系統。 醫管局的考驗，在成立第二個十年出現。 亞洲金融風暴重創香港經濟，政府及公共部門落實資源增值計劃減少財赤，醫管局遂在1999/2000年度起節省開支。即使本地經濟在沙士之後回穩，政府仍於2003/04 至2005/06 年度縮減醫管局撥款預算，先前提及的任免權力，體現於那幾年的節流措施，例如減少新聘醫護，削減新人薪酬待遇，以「肥雞餐」鼓勵資深人員離職。更糟糕的是，政府認為醫護人手過剩，削減大學醫科生學額和關閉護士學校，而醫管局以增設日間手術及復康等服務為由，在2003 年起連續幾年削減住院病床。但是，其間住院病人數目沒有下降，專科門診和急症室的求診人次上升，日間住院服務疏導病床使用的能力有限，公營醫療體系的供求嚴重失衡（見表二）。 醫管局治下開初，醫生和病人比例其實並未真正令人滿意，金融風暴則令問題惡化。政府近年撥款大學和醫管局比較鬆手，但由於增加醫護學額和培訓專科人手，動輒十年八載，輸入非本地醫生應急也受阻撓，新增醫管局醫生僅屬追落後。最諷刺的例子莫過於運作中的病房經常爆滿，但近年新落成的醫院，部分病房缺乏醫護團隊，唯有丟空。 政府多次推動醫療融資改革，以期減輕政府負擔及分流公營醫院病人到私營市場，但成效不彰，預計今年實施的自願醫療保險也需時間驗證效用。基層醫療及公私營協作計劃也口惠而實不至，未能大幅分擔專科門診壓力。前線醫護油盡燈枯，不少被私家醫院和醫療集團挖角或者自立門戶。 工作繁重山頭主義　燃改革之火公營醫療供求失衡，除了人手問題，當中的資源調配及人事管理衝突變得尖銳。香港大學醫學院院長梁卓偉日前炮轟醫管局醫生不斷開會和埋首行政工作；前線醫生和護士也抱怨，用作評審醫院質素、加強病人安全的醫院認證計劃，運作十年衍生大量文書工作和考核，佔去診症時間，無助病人復康之餘，更累積對管理層的怨氣。雖然醫管局在去年7月中止認證計劃，但隨後宣布明年復推類似計劃，前線同事紛紛擔憂噩夢再來。 好一段時間，聯網制度常被炮轟助長山頭主義。地區聯網制度在1992 年設立，並於2001 年發展至現時七個聯網，原意是促進各個聯網內醫院的合作，善用資源，病人可在一個聯網得到全面治療。如果聯網執行順利，還可促成內部市場在競爭中求進步。然而，現實是聯網之間充斥人事鬥爭，病人利益亦受影響。 多位醫生代表批評聯網擁兵自重。香港大學感染及傳染病中心總監、香港公共醫療醫生協會時任會董何柏良在2013 年的電視訪問直斥每個聯網「有如獨立王國」，醫院爆發惡菌也沒有通報醫管局及衞生防護中心。同期，協會時任會長佘達明指，醫管局本有中央統籌委員會為總部監察專科的服務質素，但委員會成員關係密切，有如「同門師兄弟」，容易包庇過錯，總部無法駕馭聯網的資源不均。 山頭主義也體現於漫長的專科門診輪候時間。最近兩任醫學界立法會議員梁家騮與陳沛然均曾批評，輪候時間長的專科門診，會獲得更多資源和人手，意味着聯網和醫生有很大誘因留住病人，任由新症長期輪候。宏觀來看，聯網的撥款準則扭曲醫生行為，所以聯網資源分配需要改革。無怪乎梁家騮曾提出解散醫管局議案，主張廢除聯網制度。 要求解散醫管局或是噱頭，或是一時之氣，議案一如所料被否決，但社會不會就此放過醫管局。政府在2015 年發表檢討督導委員會報告，承認醫管局有山頭主義以及其他資源調配和溝通問題。醫管局接納建議，陸續推出改善措施，主調是收回聯網權力，加強中央統籌，以確保提供一致服務，又加強高級管理人員和臨床人員的輪調。 陳沛然上周向《香港01》表示，上述措施有效打擊山頭主義，例如致力確保各個聯網獲得同等資源。但他不諱言，中央統籌也有缺點，包括醫護被不斷召到醫管局總部開會。這就正正回到梁卓偉的批評，即開會擠壓了診症時間。就此，局方須積極尋找平衡點，謹記開會只是過程，服務病患才是目的。 解藥變沉疴　政府須推動醫管局革新回望過去，政府和醫護界曾經寄望醫管局成為解決醫療體系沉疴之道。成立之初，醫護人手待遇提升，病人滿意服務。可惜，醫管局今天已由良方逐漸變成問題的根源，病房重現放滿病床的日子，士氣低落。既然醫管局現況有違當初《史葛報告書》加強問責能力的期望，政府須檢討與醫管局的委託關係，例如修改法例，增加醫管局大會的官方代表和社會服務、病人組織的參與，強化制衡及監督角色。 至於醫管局內部，當聯網制度是主要矛盾，管理層必須持續消除地區聯網的撥款和管理差異，不斷改善撥款模式，重修與前線員工的關係，減少人手流失。就上述例子而言，在縮短專科門診範疇，醫管局適宜探討在不損害現有診症質素的前提下，鼓勵醫院多勞多得，增加縮減輪候人龍的誘因；新輪調及升遷制度要更公開透明，避免偏袒。此外，管理層必須改良評估績效管理模式，避免異化成無意義評核，阻礙日常醫治病人工作。 1985 年，政府委託顧問公司研究醫療改革，用五年時間，集各界之力誕生醫管局。政府能否再次鼓起勇氣，用五年甚至更短的時間，清除醫管局的瘀血？

(香港01)公營醫療爆煲經年 醫管局須跳出管治怪圈

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(明報)拒出席立會與特首宴會 專業議政約林鄭談政策

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(都市)專業議政公開「劏豬」 諷官監工差！

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(星島)專業議政拒「齋食飯」 願與中聯辦商正經事 對春茗邀約 持開放態度

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(蘋果) 隔牆有耳： 政團劏黑豬盼林鄭謙卑

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專業議政六名成員聯同醫學界議員陳沛然噚日舉辦新春傳媒茶敍，自稱「最溫和」嘅專業議政成員仲好慷慨，齊齊將新年願望送畀娥特；各人自創揮春贈林鄭，大部份人都係叫娥特改改佢自視過高嘅脾性。法律界郭榮鏗、教育界葉建源同社福界邵家臻分別祝娥特「學會謙卑」、「虛懷若谷」，同埋要有「豬般智慧」。

(明報) 專業議政多次招手 陳沛然享受拍拖

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(星島)陳沛然 拒入專業議政

泛民專業人士組成的專業議政昨日舉行傳媒新春團拜，仲叫埋無黨派的醫學界陳沛然（Pierre）出席。Pierre與專業議政向來有不少交集，不過他說暫時未有打算加入，話感受到大家的誠意，但都係維持現狀比較好。

　　會計界梁繼昌（Kenneth）形容同Pierre的關係是「穩定的男女朋友關係」，有好多合作空間，但又毋須時時走在一起，未去到談婚論嫁階段。Kenneth話，專業議政處於Open relationship（開放式關係），不單止Pierre，所有理念相同的議員都可以加入。資訊科技界莫乃光就話，「成日約Pierre食飯，拖佢手仔」，但就唔知點解遲遲不願接受邀請。

(東方) 政情：拒應承加入關係立立亂 專業議政箍唔實陳沛然

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(信報) 專業議政夥陳沛然 函約特首商討政事

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(經濟) 陳沛然倡 監管醫局資源分配

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(SCMP) Doctors and managers join call to cut red tape

Hospital Authority is 'bloated' and held back by paperwork and meetings, experts say

A senior Hong Kong health care official and a board member at the authority that manages the city's public hospitals have added their voices to calls for the organisation to slash red tape.

Hospital Authority board member Charlie Yip Wing-tong yesterday threw his support behind Professor Gabriel Leung, dean of the University of Hong Kong's faculty of medicine and a former undersecretary for food and health, who a day earlier warned that bureaucracy was going too far.

Leung, another Hospital Authority board member, questioned whether repeated meetings on the same issues were benefiting patients. This culture had resulted in a bloated structure and warranted reflection by management, he said.

His concerns were echoed yesterday by Yip: "If Gabriel Leung, who is familiar with the system and also head of a medical school, also thinks meetings are excessive, the Hospital Authority should really think about it."

Frontline clinical doctors should be involved less in meetings, Yip said.

A top public hospital manager who spoke on condition of anonymity said meetings on three topics had occupied a great deal of time for health care staff. One was preparing an annual plan setting out targets for a group of hospitals.

The manager, who has more than 10 years' experience at a senior level, said hospitals often failed to secure the necessary resources for proposed projects, meaning much preparation work and time spent in meetings went to waste.

Quality control and safety issues, as well as internal audits, also ate up a lot of time, he added.

"There is room to reduce the number of meetings on these [issues]," the manager said.

He described the process for buying new equipment or launching a project as akin to collecting stamps. "Each stamp is like a meeting Eight to 10 are unavoidable," he said.

Meetings often involved staff from a multitude of areas, including a specific department, hospital, several hospitals or a medical discipline across all public hospitals.

Lawmaker Dr Pierre Chan, who represents the medical sector in the legislature and also works in a public hospital, said it had taken two years for one doctor to install an icon on a computer system. At least three meetings were involved, he added.

Chan also criticised the hospital accreditation programme, which he said had burdened staff with paperwork. Nurses needed to fill in 10 forms for newly admitted patients, he said. The requirements were excessive, and a single form would suffice, Chan said.

(Standard) Pan-dems thumb down Liaison Office's banquet invite

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(信報) 泛民絕大多數拒赴中聯辦春茗

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(明報) 自編自導自演的醫療爆煲

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(明報) 何時公立醫療人員的申訴才會停止？

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(成報) 工會斥梁智仁「轉院論」離地 復康醫院1護士照顧48病人

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(明報) 前線醫生比例22年新低 四成半中高層 知情者稱開會文化攤薄臨牀人力

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(明報) 前線醫生氣從何來 醫管局須探究紓解

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