The Hong Kong College of Community Medicine is pleased to present a special edition of a series of articles written by Dr William Ho JP,1 our Honorary Fellow and former Chief Executive of the Hong Kong Hospital Authority (HA), on the HA’s early history as well as his insightful reflections. More than three decades have passed since the inception of the HA in December 1990. At the time, the HA reform was hailed as an unprecedented successful management transformation exercise, galvanising the energy of healthcare professionals to improve service quality by leaps and bounds. Upon leaving the HA in 2005, Dr Ho began writing about this part of Hong Kong’s health system’s history, from the unique angle and vantage point of a frontline clinician in the pre-HA era, a doctors’ union leader involved in negotiations with the Government during the transition period, and subsequently as a medical administrator in the newly formed HA, working all the way to the top position of Chief Executive. His focus was not so much on the detailed chronology of events, but on the socio-economic, political, managerial and philosophical underpinnings that shaped the trajectory of the HA reform.

Today, the organisation is once again approaching a critical point, facing challenges of increasing demand, long waiting times, and staff shortages. Last year, the Government called upon the HA to conduct ‘a comprehensive review of the systemic issues and the need for reform with regard to the management of public hospitals.’2 It is noteworthy that many of the problems currently encountered are not dissimilar to those Dr Ho described in the pre-HA era. Given the passage of time and changes in the environment, many of the original ideas and concepts should be reinstalled in the organisation’s memory and laid down as a foundation for future faculty development in healthcare management. From the perspective of our Administrative Medicine subspecialty, such historical material is most valuable for sharing and learning, particularly for Fellows in healthcare leadership roles. We also believe it will have a wider impact on the medical community and even the lay public. Hence, we have discussed with Dr Ho, who has kindly reviewed and suitably revised what he wrote back then, culminating in a trilogy of articles for the Hong Kong Medical Journal. We are also grateful to the journal’s Editorial Board for facilitating the publication as a special series.

This article series, comprising three parts (Part 1 to Part 3), attempts to describe and analyse the early history of the Hong Kong Hospital Authority (HA) reform, from its inception to around the year 2000.

The HA is a huge organisation, second only to the Civil Service in staff size, shouldering the lion’s share of healthcare services in Hong Kong. The process of its establishment and the extensive reforms of the public hospital system were most transformational and quite unique in the international scene. Apart from the dramatic service improvements achieved, the underlying management concepts, philosophy and methods were exemplary. Yet, there appears to be little in-depth study on this epic journey, either within or outside the organisation. As time has passed and circumstances have changed, there is a feeling of ‘lost organisational memory’ in how the HA came about and the underlying spirit of its systems and processes, as reflected to the author by executives and clinicians.

Public health services in Hong Kong traditionally were under the purview of the Health and Welfare Branch of the Hong Kong Government Secretariat, and provided through the Medical and Health Department (M&HD). The Director of Medical and Health Services was in charge of the public health functions and operation of the Government hospitals. In 1985, 47% of all hospital beds were in Government hospitals,3 while another 41% were in Subvented hospitals4 run by charitable organisations such as the Tung Wah Group of Hospitals, Caritas Hong Kong, and so on. The remainder were in private hospitals. While the parent organisations of Subvented hospitals owned the land and buildings, as well as managed these hospitals’ operations and staff, the operating costs were increasingly subsidised by the Government, hence the term ‘Subvented’. In general, their hospital equipment, staff terms and training opportunities were inferior compared with Government hospitals. Public hospital services were highly subsidised and fees were nominal compared with the actual cost.

Health services provision in the late 1970s and early 1980s generally followed the 1974 White Paper of the Hong Kong Government entitled The Further Development of Medical and Health Services in Hong Kong. The main proposals included organising services on a regional basis, building new facilities to cater for the needs of the growing population, particularly in new towns, to achieve a target of 5.5 hospital beds per 1000 population, and starting a new medical school, a new nursing school and a dental school.5 By the mid-1980s, the system was evidently not coping. One reason was the rapid increase in the population, which grew by 24.18% in the 10-year period after 1974, particularly due to legal and illegal immigrants from Chinese Mainland, and Vietnamese refugees.6 Serious overcrowding, particularly in the Government hospitals, with the infamous ‘camp beds’ lining hospital corridors, was a public eye sore. Staff discontent, both in terms of the poor working environment and low morale, resulted not only in a brain drain to the lucrative private sector, but also in waves of union actions.7

Vivid accounts of the public hospital scenes at that time can be found in the book entitled Bedside Manner: Hospitals and Health Care in Hong Kong by Robin Hutcheon.8 Observations from people in the system whom he interviewed could be summarised as a severe lack of proper management in public hospitals, poor quality of care, inefficiency in using Subvented hospitals in the system, jealousy over unequal staff terms, and hospital Medical Superintendents being poorly trained for their jobs.8

It is to be noted that Hong Kong was not unique in having a poorly run public healthcare service. In the United Kingdom, the government-commissioned Griffiths Report of 19839 severely criticised its National Health Service (NHS), and recommended wholesale management reform. This was quickly embraced and implemented by the Thatcher government. The United Kingdom’s experience then influenced other Commonwealth countries such as Australia, New Zealand and Singapore, where similar reforms were planned for their public health systems. Indeed, managerial reform of public entities to improve performance was the trend of the period in many countries. This ranged from internal management strengthening, corporatisation ‘hiving off’ Civil Service functions to be run by corporate entities, to outright privatisation. An example in Hong Kong would be the formation of the Housing Authority in 1973 to introduce professional housing management.10

Facing increasing public discontent over the quality of the public hospital services, several legislators pressed for change, including Dr Harry Fang 方心讓, Dr Henrietta Ip 葉文慶, and Ms Lydia Dunn 鄧蓮如. The Secretary for Health and Welfare Mr Henry Ching 程慶禮 proposed calling in consultants to conduct an overall review, which was approved by the Executive Council. The job was eventually awarded to Coopers & Lybrand, WD Scott from Australia, who published their report in December 1985 (the Scott Report) [Table 1]. A key recommendation was to take the whole public hospital system away from the M&HD, to be managed by an independent Hospital Authority, free from the constraints of the Civil Service.

At the outset, however, the consultancy study was criticised for its limited scope, which even the consultants themselves admitted in their report. As the pressure at the time was over public hospital services, the consultants’ brief was merely to look at how the public hospital system could be improved.11 This approach of excluding the public health and primary care sides of the healthcare system from the reform proposal sowed the seed for eventual over-reliance on hospital systems and fragmentation.

Such weakness was particularly felt much later during the SARS (severe acute respiratory syndrome) epidemic of 2003 when coordination between the hospital and public health sides was most vital for the success of control.

The Government conducted public consultation on the Scott Report in 1986. Public opinion welcomed proposals on enhancing community participation and the overall objective of management reform in public hospitals, but vehemently objected to the suggestion of linking service fees to a percentage of the cost. Staff working in Subvented hospitals welcomed the proposals, as they expected better pay and a more equitable allocation of resources to their hospitals, even though the directors of the parent organisations feared a loss of autonomy. Civil Servants working in Government hospitals, however, opposed to the proposal, which threatened to cut their existing benefits in order to equalise terms with Subvented hospital staff, and possibly reduce job stability compared with Civil Servants. Nursing unions also opposed the proposed change that would place nurses under the doctors’ management in the new clinical departmental structure.

The OMELCO (Office of Members of the Executive and Legislative Councils) Standing Panel on Health Services, as presented by the then medical constituency representative Dr Hin-kwong Chiu 招顯洸 was generally in favour of the HA proposal.12 The Governor-in-Council Sir David Wilson 港督衛奕信 announced in his Policy Speech on 7 October 1987 the decision to proceed with the establishment of an HA to integrate the management of all Government and Subvented hospitals into a single system, and to introduce the necessary management reform. To prepare for the change, the original M&HD was to be split into a Department of Health and a Hospital Services Department. The latter would eventually be abolished upon the management takeover by the HA. Meanwhile, a Provisional Hospital Authority (PHA) was to be set up to plan and prepare for the establishment of the HA.

Meanwhile, the public hospital system continued to deteriorate with severe overcrowding, poor environment, long queues, and overworked staff with low morale. The exodus of doctors into the private sector reached a historical high of around 13% for Government hospitals and exceeded 20% for some Subvented hospitals in 1988. Sentiments among members of the Government Doctors’ Association (GDA)13 culminated in a call for industrial action, which was echoed by the The Joint Council of Subvented Hospitals of Hong Kong, and nursing unions. The plight of overworked doctors gained the support of some legislators, such as Dr Che-hung Leong 梁智鴻 and Mr Martin Lee 李柱銘.14 In a symbolic strike that lasted for 10 days from 1 March 1989,15 the GDA was able to win over public sympathy and succeeded in pressing the Government to agree to their demand for setting up a high-level committee, comprising representatives of relevant Government branches and departments, as well as GDA representatives. Chaired by the then Secretary for Health and Welfare Mr Brian Tak-hay Chau 周德熙, the committee provided a platform for negotiation and for monitoring progress on promised improvements, without deferring to the yet-to-be-established HA. These included plans to eliminate camp beds, reduce patients’ waiting times in specialist clinics, improve linen supply for patients, as well as significantly enhance the salary structure and promotion opportunities for both doctors and nurses. The scale of these improvements within such a short time was unprecedented in the history of the M&HD (Table 2).

The PHA was established on 1 October 1988, chaired by Sir Sze-yuen Chung 鍾士元爵士, a veteran Executive and Legislative Councillor. The PHA adopted most of the recommendations of the Scott Report and developed detailed plans. The Government published the PHA Report on 1 April 1990. Legislative processes ensued, and the HA Ordinance was enacted on 1 December 1990, when the HA was formally established, with Sir Sze-yuen Chung at the helm. Most proposed changes were planned for phased implementation, except the proposal to link fees and charges to costs. Indeed, it was written into the HA Ordinance: “the principle that no person should be prevented, through lack of means, from obtaining adequate medical treatment”.16

Negotiations with the Government on funding and administrative arrangements turned out to be complex, as more than 20 other Government departments had previously served the public hospitals as part and parcel of their work. Examples included the Architectural Services Department looking after hospital buildings and capital projects; the Electrical and Mechanical Services Department overseeing building services and hospital equipment; the Government Supplies Department handling procurement and inventories; and the Department of Health with its intricate involvement in hospital operations. Once the HA was established, however, it was envisaged that either the HA would have to take over the work or be cross-charged.

Another dimension was the additional resources incurred simply because the HA became a separate legal entity. In the past, Government departments were deemed exempt from many pieces of legislation. However, the HA would not enjoy such exemptions and would incur additional resources to comply with the myriad requirements of various ordinances. The Government agreed to allocate additional resources for the HA to purchase necessary insurance policies, licences and registration fees. Nevertheless, the full implications of these requirements could not be easily appreciated from day one.17

There were also negotiations with staff unions on new HA terms of employment and ‘bridging-over terms’, as well as with the boards of directors of Subvented hospitals, which proceeded in earnest. For the latter, it was agreed that ownership of land, properties, and equipment would continue to belong to the parent organisations, including any subsequent Government investment in hardware upgrades. It was also agreed that nominations from the parent bodies would constitute the majority in future Hospital Governing Committees.18 Formal contract signing with all 15 Subvented organisations that governed 23 hospitals in the system took place on 24 May 1991.19 In a ‘big bang’ approach, the HA took over the management of all 38 public hospitals and 37 000 staff overnight on 1 December 1991.20

Thus, it took merely around 6 years from the conception of an independent HA, to 1 December 1990, when the HA was formally established, and another 12 months for the HA to take over all operations of public hospitals. Given the scale of public hospital services and the enormity of major changes to be implemented, this was a most successful feat, even by international standards. Such a result could be attributed to congruence with prevailing societal values and concerns, as well as major stakeholders’ interests. An attempt to explain these factors is made below.

Hong Kong as a predominantly Chinese society first and foremost embodied the traditional values of communitarianism and the Confucian care-based ideology of good government, particularly in healthcare.21 At the same time, Hong Kong, as a British colony for more than a century, had inherited much of the British system in its social structure. The public healthcare system was similar to the British NHS, with centralised bureaucratic control, funded entirely through general taxation, and with all doctors employed as salaried staff. The ideology was similarly one of egalitarianism, where the stated Government policy was that every citizen had the right to appropriate public healthcare when sick. This spirit was eventually written into law, as mentioned above, namely “no person should be prevented, through lack of means, from obtaining adequate medical treatment”.16

However, unlike the NHS with its framework of General Practitioner gatekeeping, Hong Kong did not have a well-developed public primary care system. Instead, there existed a large private sector in which patients typically paid out of pocket for treatment. Under such a ‘dual system’, people could afford private care for minor illnesses, while most depended on the public system for hospital services.

Such a value system explains:

a. The vehement community opposition to even a hint of linking public hospital charges to a percentage of the cost.

b. The relative tolerance of the Government’s decision to focus reform efforts solely on public hospitals, rather than clinics, even though no one would consider the services in Government General Out-Patient Clinics to be any better.

c. The general sympathy for overworked hospital staff, given that patients’ lives were at stake.

Any major reform has to address the interests of key societal stakeholders. The state of affairs at the time can be summarised as follows:

a. Public: While the majority of patients with severe illnesses depended on the public sector for the highly subsidised care, there was widespread discontent over the poor state of public hospitals in the early 1980s. Change for the better was, in fact, long overdue.

b. Staff: Doctors and nurses in the system were increasingly frustrated by overcrowding and poor working environment. They deeply felt the constraints of stifling bureaucracies, where obvious problems were left unaddressed. Manpower shortages worsened as experienced staff left for the private sector in growing numbers.

c. Government: There was evidence that the Government was equally concerned about system-wide inefficiencies and the limited management capabilities in the M&HD. At the same time, while the Government was increasingly funding the Subvented hospitals, it felt it lacked a commensurate level of control over their operations.

d. Subvented organisations: There was a strong sense of second-class treatment among Subvented hospitals, particularly in terms of staff conditions, equipment, and funding compared to Government hospitals. Any reform aimed at levelling these disparities would be welcomed. Although the respective boards of directors feared losing autonomy under the new HA, such concerns were outweighed by overwhelming staff support for change.

e. Politicians: The interests of Legislative Councillors largely coincided with those of the public. Moreover, there were ‘functional constituency’ legislators at the time, including one seat for the Medical constituency (elected by registered medical practitioners) and another for the Health constituency (elected by other healthcare professionals). There were also appointed members with medical backgrounds. Their expertise in the healthcare field often gave them considerable influence in related debates.

f. Professional bodies: The Hong Kong Medical Association was all along supportive of public hospital reform, in light of the plight of public doctors who formed a considerable part of its membership.22 The same applied to nurses’ unions, particularly The Hong Kong Association of Nursing Staff and the Nurses Branch of the Hong Kong Chinese Civil Servants’ Association, as well as other bodies such as the Association of Hospital Administrators, Hong Kong.

g. Business sector: The business sector generally welcomed any Government initiative to improve public hospital services, viewing it as beneficial for societal stability, economic development and the health of the workforce. Moreover, a high-quality, heavily subsidised public hospital service would also indirectly benefit private businesses by helping lower the premium of health insurance they needed to provide for employees.

h. Private hospitals: Private hospitals only constituted a small portion of the market share for hospital services, as most people could not afford private care and fewer than half of the population had any meaningful private health insurance cover at the time. These hospitals also operated as separate entities without a united front and thus did not exert much political influence.23

As described above, the 6 years from the initial conception to the formal establishment of the HA were by no means straightforward and guaranteed. Political determination by the Government was paramount, while leadership from legislators, community organisations and staff bodies was also instrumental. Equally important, the buoyant economy of Hong Kong at the time helped support such bold reform, which predictably had major resource implications. Be that as it may, this was only the first step in the journey. Part 2 will describe how the HA undertook the mammoth task of reforming the public hospital system in its initial years, based on the blueprint established thus far.

The author declares full responsibility for the accuracy of the content, which does not represent the views of the Hospital Authority. Given the scale of the reform, not all aspects can be covered in detail. Interested readers and scholars are encouraged to consult the Hospital Authority’s publications for further information.

This article series is based on an unfinished project from the author’s time as a visiting fellow at the Harvard School of Public Health, aiming to document both the history and philosophy of the reform. The author is grateful to two successive Presidents of the Hong Kong College of Community Medicine, Dr Libby Lee and Dr Fei-chau Pang, for encouraging its revival.

1. The author was Chief Executive of the HA from 1999 to 2005. He was initially trained as a specialist in general surgery and worked in the former M&HD. Upon the establishment of the HA in 1991, he joined the HA Head Office to assist in the management transformation process, and thereafter worked in the operations team in various positions. He was appointed Hospital Chief Executive of Kwong Wah Hospital from 1995 to 1999, before being further promoted to head the entire organisation as Chief Executive.
2. Hong Kong SAR Government. Secretary for Health deeply concerned about management of public healthcare system [press release]. 21 Jun 2024. Available from: https://www.info.gov.hk/gia/general/202406/21/P2024062100808.htm. Accessed 1 Sep 2025.
3. Coopers & Lybrand WD Scott. The Delivery of Medical Services in Hospitals—A Report for the Hong Kong Government. Hong Kong: Hong Kong Government Printer; December 1985. Section 3.1.
4. These hospitals, originally established as private institutions, became increasingly dependent on Government subvention for financial sustainability over time, hence the term ‘Subvented hospitals’.
5. Coopers & Lybrand WD Scott. The Delivery of Medical Services in Hospitals—A Report for the Hong Kong Government. Hong Kong: Hong Kong Government Printer; December 1985. Appendix 3A.
6. Coopers & Lybrand WD Scott. The Delivery of Medical Services in Hospitals—A Report for the Hong Kong Government. Hong Kong: Hong Kong Government Printer; December 1985. Appendix 3B.
7. Ng A. Medical and health. In: Tsim TL, Luk BH, editors. The Other Hong Kong Report. Hong Kong: The Chinese University of Hong Kong Press; 1989.
8. Hutcheon R. Bedside Manner: Hospital and Health Care in Hong Kong. Hong Kong: The Chinese University of Hong Kong Press; 1999: 34-42.
9. National Health Service Management Inquiry. Griffiths Report. London: Department of Health and Social Security; 1983.
10. Hutcheon R. Bedside Manner: Hospital and Health Care in Hong Kong. Hong Kong: The Chinese University of Hong Kong Press; 1999.
11. Coopers & Lybrand WD Scott. The Delivery of Medical Services in Hospitals—A Report for the Hong Kong Government. Hong Kong: Hong Kong Government Printer; December 1985. Section 1.1.
12. Official Report of Proceedings of the Hong Kong Legislative Council. Session held on 15 October 1986. Hong Kong: Legislative Council; 1986.
13. The author was Vice Chairman of the Government Doctors’ Association in 1989 and actively took part in negotiations with the Government. He became Chairman in 1990-1991.
14. Official Report of Proceedings of the Hong Kong Legislative Council. Session held on 8 March 1989. Hong Kong: Legislative Council; 1989.
15. The main action that achieved the aim of embarrassing the Government without adversely affecting patient care was the refusal of public doctors to sign the payment slips for discharged patients, who were discharged anyway but without the need to pay up. The other actions—refusing to teach nursing students, attend non-urgent medical boards, and write non-urgent medical reports “because the doctors were too busy”—were essentially cosmetic, with little real impact during the short period.
16. Hong Kong SAR Government. Hospital Authority Ordinance (Cap 113), Section 4(d). Hong Kong: Hong Kong Government Printer; 1990.
17. Indeed, the HA was haunted years later by stipulations in the Employment Ordinance that certain staff unions claimed the organisation had violated, due to the long working hours of doctors—the subject of a lawsuit that lingered until 2006 over matters dating back to before 2000.
18. The HA also promised to honour the traditions and philosophies of the parent organisations. Examples included service restrictions (such as abortion) in some religious hospitals, and the traditional Free Medical Service provided by the Tung Wah Group of Hospitals (TWGHs) for out-patients. With these concessions, the HA was able to reach agreement first with the TWGHs, which owned five hospitals. Once this was accomplished, the other subvented organisations soon followed suit.
19. Following enactment of the HA Ordinance, these hospitals became known as Schedule 2 hospitals. Schedule 1 hospitals comprised all former Government hospitals previously under M&HD.
20. Such a feat was rarely seen elsewhere. Singapore, for example, reformed its public hospitals one at a time.
21. Tao J. Confucian care-based philosophical foundation of health care, In: Leung GM, Bacon-Shone J, editors. Hong Kong’s Health System: Reflections, Perspectives and Visions. Hong Kong: Hong Kong University Press; 2006: 41-60.
22. The Association’s stance changed considerably a few years later, due to concerns that a “too successful” HA posed a threat to the business of its private sector members. It complained of an “unequal playing field” as the HA was able to offer services that were equal to, if not better than, those of the private sector, while being heavily subsidised by the Government. However, this was not foreseen at the time.
23. The Hong Kong Private Hospitals Association was not established until as late as 2000.

When disaster strikes, the resilience of a community is often measured by the dedication of those who step forward to help. Among them are healthcare professionals who extend their expertise beyond the confines of hospitals and clinics, venturing into the most challenging environments to provide humanitarian aid. One such individual is Dr Cecilia Fan, a consultant in family medicine with over 30 years of experience working in the Department of Health. She then served in the Professional Development and Quality Assurance Service, overseeing families clinic services for government employees and correctional medical services, and operating quarantine centre medical posts during major infectious disease outbreaks such as SARS, swine flu, and coronavirus disease 2019. Dr Fan’s unwavering dedication to humanitarian efforts culminated in her leading the Department of Health medical support team of the Hong Kong SAR Search and Rescue Team to Türkiye in response to the 2023 Türkiye–Syria earthquake.

The Department of Health medical support team, comprising two doctors and two nursing officers, was deployed with the core mission of supporting the health of frontline rescue workers. Although many might assume such missions focus on direct victim care, it is equally essential to ensure that firefighters and rescue personnel remain physically and mentally fit during their lifesaving operations. Healthcare professionals in these settings act as the backbone of operations, ensuring that those risking their lives to save others are well cared for.

Their journey began with an arduous deployment process, as flights could only be confirmed at the last minute, requiring multiple transfers before arriving in Hatay. Once on the ground, the team travelled through damaged and unlit roads, navigating a disaster-ravaged landscape with limited supplies. Dr Kinson Lau, the other doctor on the team, recalls, “It was pitch black, the roads had no lights, and the driver had been driving through the small hours without rest. Our commander kept talking to him to keep him awake.” Upon arrival, the team set up a tent as a medical post on open ground riddled with cracks, to serve the rescue forces. They conducted daily health checks, monitoring vital signs and psychological well-being. The nonstop travel and race-against-time operation schedule led to fatigue among team members, whereas the wide temperature range and cold nights caused respiratory symptoms. Minor injuries and skin conditions were common, and the psychological stress of witnessing destruction and death was immense. When one team member fell ill with a high fever, the team had to assess the need to isolate him to prevent the spread of infection. It was decided that it would be more suitable to treat him while ensuring his tent-mate wore a mask. Mr CF Kwok, nursing officer of the team, stated, “He might feel deserted if being isolated. Instead, we ensured his tent-mate, who is caring and supportive, wore a mask and took precautions.”

Another major challenge was maintaining mental well-being. The emotional weight of witnessing destruction and loss took a toll on everyone. There were shocking moments when the team recovered deceased victims. Psychological debriefing became an essential part of their routine, allowing them to process their experiences and support one another. “We saw families sitting in front of collapsed buildings, waiting for news of their loved ones, overflowing with a sense of helplessness.” Despite this, the team found strength in each other and in the moments when their work led to a successful rescue.

Every deployment brings unique lessons, and the mission in Türkiye was no exception. The extreme cold posed unexpected difficulties, with temperatures dropping below freezing at night. With limited supplies, the team had to improvise ways to stay warm, including using cardboard as insulation and huddling around makeshift fires. Clean water was scarce, making hygiene a challenge. The team had to ration bottled water and adopted innovative methods for sanitation, such as using small amounts of disinfectant wipes for personal hygiene. Mr Stephen Ngai, another nursing officer on the team, mentioned, “Food, simply, was also a concern.” Initially, the team relied on military ration packs, which were practical but monotonous. However, through collaboration with the China Search and Rescue team, they were able to secure hot meals, substantially boosting morale. Looking ahead, Dr Fan advocates for better preparedness and training programmes for medical support teams, emphasising the need for psychological resilience training and logistical pre-planning to enhance efficiency in future deployments.

Amid these challenges, the team found profound moments of impact, especially when the first survivor was found on the fifth day. For Dr Fan, it was incredibly rewarding to see the team’s efforts come to fruition: “Eighty percent of the buildings in the city collapsed. We walked through ruins, knowing that buried beneath were people in dire need of being found. The golden time for survival might have been missed, but the team never gave up. Pulling someone out alive after several days was a feeling I will never forget.”

Dr Fan and her team embody the spirit of selfless service, demonstrating that healthcare professionals are not confined to hospitals and clinics—they are essential pillars in disaster response and humanitarian relief. Their work in Türkiye serves as an inspiring example of how medical expertise, adaptability, and teamwork can make a life-saving difference in the most challenging environments. As crises continue to arise worldwide, their efforts remind us that the true essence of medicine lies in its ability to serve humanity, regardless of borders. The mission of medical support teams is never just about treating injuries; it is about preserving the health, safety, and dignity of those who put themselves at risk for the sake of others.

The team’s efforts have led to lasting institutional and societal impacts. Their experience served as a catalyst for the formation of a dedicated medical team within the Hospital Authority to support the Fire Services Department’s Disaster Response and Rescue Team in its efforts to obtain accreditation from the International Search and Rescue Advisory Group. This medical team, comprising orthopaedic and emergency specialists and nurses, underwent humanitarian training and exchange in Beijing, equipping them with essential skills such as mass casualty management, field amputations, and high-stress resuscitation. Their contributions have fortified Hong Kong’s capacity to respond to future crises, while inspiring a broader cultural shift towards valuing humanitarian medicine as a professional imperative.

For Dr Fan, the motivation to engage in high-risk humanitarian work transcends professional duty—it is a reaffirmation of medicine’s foundational ethos: to serve where the need is greatest. She candidly reflects on the medical, logistical, and emotional challenges faced in Türkiye, from confronting the limits of intervention in catastrophic settings to navigating psychological stress. Yet, despite these difficulties, Dr Fan and the team emphasised the profound fulfilment of such missions. Their vision for the future is clear: to help cultivate a generation of medically trained humanitarians who are technically proficient, psychologically prepared, and ethically grounded. “When the call comes, answer it,” she urges, framing humanitarian service not as an extraordinary sacrifice but as a natural extension of medical vocation—one that enriches both the provider and the profession.

Dr Fan and the team’s story is one of extraordinary resilience and commitment. Their experiences in Türkiye reinforce the message that humanitarian medical work is not just an act of service—it is a duty that bridges borders and uplifts humanity in its darkest hours.

Professor Eric Wai-choi Tse is a distinguished physician-scientist specialising in clinical haematology and experimental oncology at The University of Hong Kong (HKU). Renowned for his exemplary and unwavering dedication both to community service and scientific research, Prof Tse has built a remarkable career marked by both excellence and compassion.

Prof Tse discovered his interests in haematology and oncology early on during medical school. He took a year out of the then 5-year medical curriculum at HKU to pursue an intercalated bachelor’s degree in biomedical sciences in the Department of Pathology. Under the mentorship of the late Prof LC Chan, he studied the clonality of haematological malignancies using molecular biology techniques. This year was pivotal in solidifying his passion for research and inspired him to pursue a career in academia. Fuelled by an insatiable quest for knowledge and guided by the late Sir David Todd, he embarked on his doctoral studies under Prof Terry Rabbitts at the prestigious MRC Laboratory of Molecular Biology at the University of Cambridge following the completion of his medical degree at HKU. During this time, he honed and expanded his repertoire of molecular biology techniques, laying a robust foundation that would later prove invaluable in his career. He then returned to Hong Kong to complete his postgraduate medical training and rejoined HKU as an assistant professor. Prof Tse remains deeply grateful to his mentors, including Sir David Todd and Professors LC Chan, Terry Rabbitts, TK Chan, Raymond Liang, and YL Kwong for their unwavering support and guidance.

When discussing his current research interests, Prof Tse radiates an infectious enthusiasm for his work. He has a particular interest in PIN1 (peptidylprolyl cis/trans isomerase), an intracellular enzyme, and its role in the pathogenesis of hepatocellular carcinoma. Throughout the interview, he maintains the importance of being open-minded and being receptive to new ideas. He believes one can uncover fresh perspectives and applications from exploring beyond one’s own area of expertise. For instance, he co-authored an original research article exploring the connections between PIN1 and neurodegeneration alongside other PIN1 researchers whom he met at a neuroscience conference—an exciting and rewarding experience that would have been impossible had he confined himself to his own areas of expertise. Prof Tse is also investigating the use of arsenic trioxide in treating acute promyelocytic leukaemia, a highly treatable form of blood cancer. His work is shedding light on the different mechanisms through which arsenic trioxide potentially combats other cancers and its synergistic effects when combined with all-trans retinoic acid, another drug often used for treating promyelocytic leukaemia.

Prof Tse’s approach to patient care is rooted in honesty, empathy, and clear communication. He emphasises the importance of being frank with patients about their conditions, explaining the nature of the disease and its treatment in simple, relatable terms, often using analogies to aid understanding. Prof Tse believes in empowering patients to make decisions about their own treatment, tailoring his communication to their concerns and level of understanding. He recognises his role as a team player and the importance of collaboration in achieving better outcomes for his patients. Despite being a leading physician in his field, Prof Tse deeply values the insights and experiences he gains from working with his junior colleagues and views learning as a two-way process. Many of his juniors share novel approaches to patient care acquired from their training at other institutions, thereby fostering a collaborative environment where everyone works together towards a common goal of improving patient care. His humility and openness to new ideas serve as testaments to his open-mindedness and commitment to continuous growth.

Being a physician-scientist, Prof Tse occupies a unique place in the healthcare system. He believes that his roles as both a doctor and a researcher complement each other in many ways. His training in basic science has provided him with the skills needed to approach problems methodically and ‘get to the bottom of the question’. On the other hand, his work in clinical trials has offered him firsthand experience with using new drugs, thereby equipping him with the expertise to use them effectively in his own practice. However, the combination of clinical demand and maintaining research output requires endless time, effort, and dedication. When asked how he manages such a hectic schedule, Prof Tse talks about the heartfelt experiences he has had in clinical practice and the appreciation expressed by both patients and their family members, some of whom still send him Christmas cards many years later. Prof Tse is also passionate about his research and views it more as a hobby, in the same way that some people might play tennis or golf. As a hobby, his research is both something that he actively enjoys and also an indulgence, which means that the long hours spent both as a clinician and a scientist do not feel tiresome.

As a highly successful researcher, Prof Tse also shared some of the challenges he faced to get where he is today. Reflecting on his career, he believes that budding researchers must have the mental preparation and fortitude to deal with frustration at times. He believes that when one is faced with negative feedback, this should be viewed as constructive criticism and used as an opportunity to improve one’s work.

Looking ahead, Prof Tse has a positive outlook on the advancements of haemato-oncological research. He is a firm believer that ongoing research in the field will continue to greatly benefit blood cancer patients, citing the adoption of oral drugs such as tyrosine kinase inhibitors over the use of haematopoietic stem cell transplantation in the treatment of chronic myeloid leukaemia to show the translational impacts of haematological research. He also mentions how modern laboratory techniques, coupled with the advent of gene and cell therapy, will remove previous barriers to research in the field and revolutionise blood cancer treatments. Prof Tse also predicts that in the coming decade haematooncological research will lead to safer drugs that avoid the ‘toxic’ chemotherapy approach, allowing patients to recover from malignancies without the massive toll on their own health.

Dr Fei-chau Pang is the Commissioner of Primary Healthcare at the Health Bureau in the Hong Kong SAR Government. He is the current President of the Hong Kong College of Community Medicine and was a Clinical Associate Professor at the School of Public Health of The University of Hong Kong until 2022.

As we began our interview with a question about his past achievements, Dr Pang humbly redirected the conversation and said, ‘Let’s not focus on achievements; let’s chat more about Hong Kong’s primary healthcare system instead’. Throughout the interview, his passion for improving our healthcare system through system-level changes was evident, reflecting the drive that has persisted throughout his career.

This conversation raised important questions about our primary care system, such as, ‘What committed role should primary care doctors take in Hong Kong?’ and ‘How effective is our healthcare system in improving the general health of our population?’ Our dialogue with Dr Pang prompted deep reflection on the importance of developing strong primary healthcare in Hong Kong and how we, as a community of healthcare professionals, can collectively improve the accessibility and sustainability of our healthcare amid increasing fiscal pressure and disease burden.

Dr Pang’s involvement in primary healthcare began early in his life. During secondary school, he volunteered as a student health leader for the Department of Health, raising public awareness about smoking cessation. His advocacy continued in medical school as a council member of the medical society by organising community exhibitions for cancer screening. As he pursued specialty training in geriatrics, he developed a deeper appreciation for providing holistic care for patients. These experiences inspired him to further his training in medical administration, which led him to pursue various impactful projects over the years.

In 2004, Dr Pang was actively involved in setting up Hong Kong’s first batch of public Chinese medicine clinics, focusing on quality assurance and information system development. This initiative operated under a tripartite collaboration model involving the Hospital Authority, a non-governmental organisation, and a local university to provide research-oriented care to the public. This administrative model was an innovative approach at the time, though was proven successful, with over 18 service centres in Hong Kong as of 2024. Later, Dr Pang became the Chief Manager of the Hospital Authority’s Quality and Safety Division, where he led the hospital accreditation programme in both the private and public sectors and successfully assisted in the accreditation of five public hospitals by the Australian Council on Healthcare Standards (ACHS). The aim was to create a quality improvement system for public hospitals and develop Hong Kong’s first set of hospital standards based on the Evaluation and Quality Improvement Program (EQuIP 4) standards adopted in Australia. Dr Pang also led the redevelopment project of the Grantham Hospital, which involved the planning of the design, facilities, and services. Subsequently, Dr Pang was transferred to the Head Office of the Hospital Authority and spearheaded the development of the myHR App to enable direct electronic communication with all staff across over 40 hospitals.

When asked about his motivation for pursuing systemic change, Dr Pang responded, ‘Often, it is easy to go on with your day-to-day work without making much effort in improving the current workflow. However, is there indeed nothing we can improve within our existing system? I find purpose in identifying and addressing pressing issues by building major, system-level changes in our healthcare system. Though developing holistic solutions involving multiple stakeholders is not without challenges, my guiding principles in life motivate and drive my work.’

Since 2022, having come full circle, Dr Pang has combined his passion for community care and administration in his new role as the Commissioner for Primary Healthcare in the Health Bureau.

One major problem in Hong Kong’s healthcare system is the lack of sustainability in its specialist-led model. Many chronic diseases are managed under the Hospital Authority with limited primary care services and there is a reduction of focus on disease prevention and a lack of continuous care. As a result, patients with chronic diseases may not be well-managed and present with complications as their first encounter with the healthcare system. For instance, many conditions being treated in the hospital currently, such as myocardial infarction, end-stage renal failure, and vision loss in adults, are linked to modifiable risk factors, including poorly managed hypertension and diabetes mellitus. This healthcare model increases reliance on specialist care and exacerbates waiting times for all.

Currently, healthcare expenditure accounts for approximately 19% of the government’s total spending in 2024/25, and this figure is expected to rise if the system remains unchanged. Such a trajectory renders Hong Kong’s healthcare system unsustainable. Recognising that the lack of emphasis on primary healthcare is closely linked to issues of accessibility, quality of care, and the overall sustainability of the healthcare system, Dr Pang is committed to supporting the government in reforming Hong Kong’s primary healthcare system.

Dr Pang explained that the main reason for these healthcare challenges stems from limited public understanding of primary healthcare and guidance of its role among healthcare workers. Many patients seek care only when symptoms arise and may be reluctant to undergo preventative screenings suggested by doctors due to high cost and a lack of understanding about their benefits. Some patients might seek primary care at the emergency department instead of primary care clinics, while others might engage in ‘doctor shopping’. These behaviours hinder the development of the continuous doctor–patient relationship that is important for comprehensive care.

In both primary healthcare and specialist doctors, consultations often focus on the patient’s chief complaint rather than the health of the whole person. For instance, during a primary care consultation for an upper respiratory tract infection, the primary care doctors may not, in their routine practice, advise on screenings for colorectal cancer or chronic diseases like diabetes and hypertension. On the other hand, specialists may only focus on diseases related to their expertise and may not think about referring patients to primary care for long-term follow-up and management of chronic diseases. These issues reflect just a few of the ‘hotspots’ in the current healthcare system, as noted by Dr Pang. He emphasises the need for change, ‘We need to promulgate and encourage our professionals to take up new commitments on continuity of care and responsibilities on chronic disease management, especially in the private sector.’

To address the main challenges, Dr Pang, as the Commissioner for Primary Healthcare, is leading the Primary Healthcare Commission in its implementation of the measures set out in the Primary Healthcare Blueprint, which was unveiled in the Chief Executive’s 2022 and 2024 policy addresses. The team has spearheaded the development of District Health Centres (DHCs) in all 18 districts, which aim to develop a community-based service network and serve as a pivotal hub for primary healthcare services, providing health promotion, health assessments, and chronic disease management, whilst also bridging the gap with secondary care through development of the eHealth system.

Among the initiatives coordinated by the DHCs is the Chronic Disease Co-Care Pilot Scheme. This scheme provides subsidies for diagnosing and managing hypertension and diabetes mellitus in the private sector. It includes subsidised laboratory tests, a specialised drug list at significantly discounted prices, and multidisciplinary care. The DHCs assist citizens in pairing with family doctors and provide multidisciplinary support in managing patients. They also empower people to manage their own health by providing blood pressure monitoring, weight management, and health promotion.

Another initiative is the development of the Life Course Preventive Care Plan, which is a set of guidelines for both public and primary healthcare professionals on the recommended preventative care measures based on an individual’s age and sex. It includes guidelines on immunisation, women’s health, mental health support, cancer screening, chronic disease management, and more. Ultimately, this initiative hopes to better guide family doctors in providing care to patients and improve the public’s understanding of the role of primary care whenever they encounter their family doctors.

Our conversation with Dr Pang encourages us to be courageous in bringing about meaningful changes, whether big or small, and he inspires us to focus on what truly matters to us rather than seeking validation from others. By the end of our interview, despite Dr Pang’s modesty in acknowledging his work as an accomplishment, it is undoubtedly clear to us that he is passionate about reform and hopes that it will have a substantial impact on our society.

On Dr Gary Ng’s 14th birthday, he was greeted with an unpleasant surprise: he had malignant osteosarcoma in his left leg, which required immediate chemotherapy and eventual amputation. However, he was undaunted by the subsequent mobility restrictions—this situation inspired him to devote his life to medicine and volunteering to help others in need. In recognition of his effort and perseverance, he has been a proud recipient of multiple awards, such as the Ten Outstanding Young Persons in 2020, the 8th Hong Kong Volunteer Award 2020, the Outstanding Disabled Persons Award 2002, the Ten Warriors of Regeneration Selection 1996, and many others. In addition, he is the current chairperson of the Hong Kong Federation of Handicapped Youth (HKFHY).

The Hong Kong Federation of Handicapped Youth, established in 1970, aims to promote the spirit of self-help among handicapped young people and allow smooth societal integration of underprivileged groups. It strives to achieve these objectives by providing services to disabled individuals and advocating for policy changes to create a barrier-free society. The HKFHY also collaborates with other organisations to arrange improvements in public facilities, with the goal of allowing handicapped individuals to regain a sense of independence and self-sufficiency while raising public awareness.

Dr Ng’s volunteer work began just after his graduation from secondary school, long before he joined the HKFHY. He was invited to give talks at secondary schools and to share his extraordinary experiences with cancer patients who were facing the same challenges as he had. Believing in the balance between quantity and quality, he was determined to motivate others with his story with different delivery methods. When asked about the effectiveness of his talks, Dr Ng replied, ‘If even one person remembers my message after my talk and takes my lessons to heart, I have already succeeded.’ He recalled one memorable story involving a tour guide who had osteosarcoma. The guide adamantly refused to undergo leg amputation, concerned that impaired mobility would severely affect his livelihood. In desperation, a volunteer organisation contacted Dr Ng, asking him to persuade the guide to undergo the amputation surgery. After hearing Dr Ng’s story, the guide was sufficiently moved by the doctor’s cancer journey that he chose to undergo the amputation procedure—this decision both saved his life and improved his long-term quality of life. Dr Ng believes that his volunteer work has provided an opportunity for self-reflection because his unique perspective as both a cancer survivor and doctor makes his stories compelling and relatable to the general public. His journey inspires others to accept themselves, instead of dwelling on their misfortunes, and to face the challenges ahead with vigour and enthusiasm.

Years later, as chairperson of the HKFHY, Dr Ng’s outreach has extended beyond the youth population. Notable initiatives include the establishment of social enterprises such as ‘First Sense Design’ and ‘Flower Workshop’. These enterprises offer job opportunities for disabled individuals and provide them with a sense of fulfilment. Recognising that disabled individuals have limited physical mobility and lacks sporting habit, Dr Ng is enthusiastic to promote ‘Sports of All’ which encourages disabled individuals to participate and develop an interest in sport. Furthermore, Dr Ng has been an active member of various sub-committees, providing insights from the perspective of disabled users and advocating for practical follow-up measures in areas such as malls and the transportation sector. These include increasing the availability of elevators at malls, or installation of mirrors inside of the elevators for wheelchair user’s easy access. Dr Ng’s work encompasses a broad range of activities, from serving individual users to persistently advocating for policy changes.

Over the years, although Dr Ng has transitioned from patient to doctor, his unwavering commitment to serving the handicapped community has never faded. While studying medicine, Dr Ng coincidentally discovered that the survival rate for the type of surgery he had undergone is alarmingly low: approximately 3% after 3 years. This finding reinforced his firm belief in giving back to society. Engagement in volunteer services has provided Dr Ng with continuous opportunities for reflection, reminding him of how fortunate he is to have recovered, to have encountered compassionate medical professionals, and to now serve as a beacon of hope for others. Thus, volunteering benefits the individuals receiving services while serving as a means of self-improvement and self-reflection.

Dr Ng’s work has not been free of challenges and setbacks, particularly in terms of facilitating employment opportunities for disabled individuals during Hong Kong’s economic recessions. Although handicapped individuals exhibit a higher level of loyalty and dedication to their work, as Dr Ng has suggested, some complex considerations and obstacles persist. For instance, employers often express hesitation regarding the termination of handicapped employees who do not meet the required job standards because this termination may be perceived as a violation of anti-discrimination laws. Businesses have also raised concerns about the financial implications of office space renovation to include necessary facilities, such as barrierfree washrooms and elevators. It is particularly challenging for Dr Ng to act as a bridge between the disabled community and the business sector—seeking opportunities for the disabled yet balancing the concerns from the business field at the same time.

With deep gratitude and humility, Dr Ng pledges to lead the HKFHY to new heights, with the goal of increasing disabled community involvement in community planning and design. During visits to explore infrastructures in other countries, Dr Ng was especially impressed to see disabled individuals actively participating in the design process, which resulted in truly inclusive facilities such as lowered check-in counters that can accommodate wheelchair users. Dr Ng has placed great emphasis on the importance of providing disabled individuals with abundant opportunities to broaden their horizons and increase their knowledge through field trips and continuous visits. By enabling disabled individuals to ‘see more’ and ‘hear more’, this approach allows them to acquire valuable insights and experiences that can be effectively applied within Hong Kong. The organisation also aspires to work to closely with other regions, such as helping mainland China to develop barrier-free tourism.

Throughout our chat with Dr Ng, he consistently emphasised the importance of inclusivity. As someone who is both disabled and a volunteer, Dr Ng firmly believes that true inclusivity extends beyond merely assisting disabled individuals—it is the mutual respect between different disabled and the society, and the understanding that everyone could play an important role in society that matters the most. ‘When you have the opportunity to work with someone who is disabled, express gratitude by saying, “Thank you for providing me with the opportunity to better understand you”, instead of “Thank you for giving me a chance to help you,” ’ advises Dr Ng. Ultimately, the deepest motivation arises from a genuine and sincere desire to serve, along with a firm belief in making our beloved city, Hong Kong, a better place.