Appendix III Environmental Scan Background To facilitate the review of the Hong Kong Rehabilitation Programme Plan (RPP), the Working Group responsible for the review has taken stock of the number of rehabilitation service users and examined the factors affecting the service development. A summary of the data/factors examined by the Working Group is set out in this annex. Summary (a) Number and Prevalence Rate of Service Users 2. A territory-wide survey on persons with disabilities and chronic diseases was conducted by the Census and Statistic Department (C&SD) throughout the entire year of 2000 to gauge the total number and prevalence rate of persons with selected types of disability and chronic diseases. The data from this survey have been published in the Special Topics Report No. 28 on Persons with Disabilities and Chronic Diseases. 3. At the time of enumeration, it was estimated that there were 269 500 persons with disabilities. The overall prevalence rate of persons with disabilities was 4 %. For the number of persons with individual types of disability, please refer to Table 1. The survey also estimated that the total number of mentally handicapped persons in Hong Kong was about 62 000 to 87 000, representing a prevalence rate of some 0.9% to 1.3%. 1 Table 1: Number and Prevalence Rate of Service Users Types of Disability Number of Persons Restriction in body movement As % of the total population of Hong Kong 103 500 1.5 Seeing difficulty 73 900 1.1 Hearing difficulty 69 700 1.0 Mental illness 50 500 0.7 Speech difficulty 18 500 0.3 Autism 3 000 Total: <0.05 269 500 4.0 Note: (1) Classification and definitions of disabilities adopted by the Special Topics Report No. 28 on Persons with Disabilities and Chronic Diseases are as follows: “Persons with restriction in body movement” were defined as those who had been diagnosed as being physically handicapped under medical assessment tests (such as spasm, paraplegia and quadriplegia, and loss of limbs) or perceived themselves as having long-term difficulty in movement of upper/lower limb or other parts of the body; “Persons with seeing difficulty” referred to those who had been diagnosed as being blind or having low vision under medical assessment tests or perceived themselves as having long-term difficulty in seeing with one eye or both eyes whether with or without correcting glasses/contact lenses. Nevertheless, nearsightedness, farsightedness, astigmatism and presbyopia were excluded; “Persons with hearing difficulty” were defined as those who had been diagnosed as having hearing impairment under medical assessment tests or perceived themselves as having long-term difficulty in hearing. Based on the information collected in the survey, they were classified into three categories: (i) unable to hear at all; (ii) required a specialised hearing aid in order to be able to hear well; and (iii) not required a specialised hearing aid; “Persons with speech difficulty” referred to those who had been diagnosed as having 2 speech impairment under medical assessment tests or perceived themselves as having long-term difficulty in speaking and being understood by others. They were classified into three categories in the survey: (i) unable to speak at all; (ii) required a specialised aid in order to be able to speak and be understood by others; and (iii) not required a specialised aid; “Mentally ill persons” were defined as those who had been diagnosed as being mentally ill under medical assessment tests (including ex-mentally ill) or had been/were being treated by psychiatrists or had received/were receiving some form of rehabilitation services provided for ex-mentally ill persons (such as psychiatric clinics, private psychiatrists, halfway houses and community psychiatric nursing services) at the time of enumeration; “Autistic persons” referred to those who had been diagnosed as being autistic under medical assessment tests; and “Mentally handicapped persons” referred to those who had been diagnosed as being mentally handicapped (or with intellectual disabilities) under medical assessment tests. Down's syndrome was included. (2) A service user may have more than one type of disability and hence the overall number of persons with disabilities is smaller than the sum of the number of persons with individual types of disability. (3) The survey also collected information on persons with intellectual disabilities residing in institutions and in domestic households. However, there was strong indication of under-estimation in respect of the number of persons with intellectual disabilities in domestic households as derived from the survey findings. Hence, the analysis of survey findings pertaining to the persons with intellectual disabilities has been separated from that of persons with other types of disability in this report. A crude statistical assessment indicated that the total number of persons with intellectual disabilities in Hong Kong was likely to be in the region of 62 000 – 87 000, representing a prevalence rate of some 0.9%-1.3% for persons with intellectual disabilities in Hong Kong. (4) Statistical data on persons with visceral disability in Hong Kong is not available for the time being. However, the survey estimated that there were some 882 700 persons reporting their requirement for long-term (i.e. lasting at least six months) medical treatment, consultation or medication (referred to as “persons with chronic diseases”). The prevalence rate of persons with chronic diseases was 13.0%. Among these 882 700 persons, 731 600 indicated that 3 they did not have any selected type of disability as shown in Table 1. (5) The C&SD will conduct another survey in 2007/08 with a view to updating the related figures and information. (b) Social Factors Affecting the Number of Service Users (i) Elderly Population 4. Hong Kong has the lowest birth rate among the 225 countries and places in the world, with only 7.63 new births per 1 000 population. The fertility rate is only 0.91 birth per woman. This, coupled with the increase in average life expectancy, means that the ageing of our population will become more pronounced. According to the Hong Kong Population Projections 2004-2033 published by the C&SD in 2004, it is estimated that people aged 65 and above will account for 26.8% of the territory’s total population by 2033, representing a remarkable growth as compared with 7% in 1983 (Table 2). It is also estimated that the number of service users with mobility difficulty, visual impairment and hearing impairment will be on the rise as such disabilities are common to the aged. Table 2: Elderly Population population percentage 26.8% 2 500 000 30% 2 243 100 2 000 000 25% 19.4% 1 548 500 20% 1 500 000 13.2% 978 000 11.7% 1 000 000 9.3% 7.0% 500 000 15% 795 500 10% 546 000 374 600 5% 0 year 0% 1983 1993 2003 2013 no. of elderly aged over 65 4 2023 2033 as percentage of the total population (ii) Median Age at First Childbirth 5. Infants with congenital defects are often born to older mothers. According to the findings of a survey conducted by the C&SD in 2004, there was a rising trend in the median age of Hong Kong women at first childbirth (Table 3), from the age of 26.2 in 1985 to 29.4 in 2004. Nevertheless, with the increasing popularity of premarital/antenatal check-ups, the rising trend in the median age of these mothers does not necessarily translate into a higher birth rate of infants with congenital defects. Table 3: Number of Births and the Median Age at First Childbirth no. of births 80000 age 76126 30 67731 70000 68637 28.7 60000 29.3 29 54134 47892 27.8 50000 29.4 40000 30000 28 27 26.2 26 20000 25 10000 0 year 24 1985 1990 no. of births (iii) 1995 2000 2004 median age at first childbirth Number of Cases Receiving Child Assessment Service (for Children Aged 0-11) and Student Health Service (for Students from Primary 1 to Form 7) from the Department of Health 6. With the enhancement of child assessment service and student health service under the Department of Health (DH), the continuous improvement in impairment/disease detection and prevention technologies, as well as the increased awareness of the importance of early intervention among parents, there is a general rising trend in the number of cases receiving child assessment service and student health service from the DH (Table 4). This will facilitate 5 early prevention and intervention, thereby preventing the development of impairments/diseases into disabilities and helping to reduce the prevalence rate of rehabilitation service users. Table 4: Total Number of Cases Receiving Child Assessment Service (for Children Aged 0-11) and Student Health Service (for Students from Primary 1 to Form 7) from the Department of Health no. of cases 2500 2212 2000 1650 in 2000 1500 in 2005 1089 897 1000 500 490 352 1007 870 473 218 405 217 145 178 4681 0 it fic de di y li t t m r/e l ty de cu ffi r so en m di t en m ir pa n io nt im al ir pa g in rn t y li t en m bi is a im lea d al m ic ys te at su vi ph tis c ifi g in ec ar au he sp ir pa bi is a d al im tu ec ch ee ll te sp in na io ot la nd ha be r ou vi al lem ob pr s (iv) Number of Injuries Caused by Occupational, Industrial and Traffic Accidents 7. With the sustained improvement in the occupational, industrial and traffic safety legislation and measures, a downward trend in the number of injury cases caused by occupational, industrial and traffic accidents is detected as shown in Tables 5 to 8. This will help reduce the number of adults using rehabilitation service. 6 Table 5: Number of Occupational Injury Cases non-fatal cases fatal cases 70000 300 60000 250 50000 200 40000 150 30000 100 20000 50 10000 0 year 0 1998 1999 2000 2001 2002 non-fatal cases Table 6: 2003 2004 2005 fatal cases Number of Industrial Accidents accident rate per 1 000 workers no. of accidents 50000 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 year 70 60 50 40 30 20 10 0 1998 1999 2000 2001 2002 non-fatal cases 2003 2004 2005 accident rate per 1 000 workers 7 Table 7: Number of Cases Assessed as Permanent Loss of Earning Capacity under the Employees’ Compensation Ordinance no.of cases 20000 18000 16000 14000 12000 10000 8000 6000 4000 2000 0 year Table 8: 1998 1999 2000 2001 2002 2003 2004 2005 Number of Injuries/Deaths Caused by Traffic Accidents no. of severely injured no.of deaths 4000 250 3500 200 3000 2500 150 2000 100 1500 1000 50 500 0 year 0 1998 1999 2000 2001 2002 severely injured 8 2003 deaths 2004 2005 (v) Mental Health Problem 8. Tables 9 to 11 show an increase in the number of psychiatric inpatient, outpatient and day attendances at hospitals under the Hospital Authority in 2005/06 as compared with 2001/02, and in particular, there is a marked rising trend in the number of young service users aged below 18. Table 9: Number of Discharges and Deaths of Psychiatric Inpatients and Day Patients of the Hospital Authority no. ofpatients patients no. of 18000 16000 14000 12000 aged 65 or above 10000 aged 18-64 8000 aged below 18 6000 4000 2000 0 financial year 2001/02 2002/03 2003/04 2004/05 2005/06 aged 65 or above 1793 1822 1606 1837 1800 aged 18-64 11317 11531 11240 12212 12577 438 579 691 987 954 aged below 18 Note: Age refers to mid-year age Patients whose ages are not identified are not included in the above data 9 Table 10: Number of Psychiatric Outpatient Attendances at Hospitals under the Hospital Authority no. of attendance 700000 600000 aged 65 or above 500000 400000 aged 18-64 300000 aged below 18 200000 100000 0 2001/02 2002/03 2003/04 2004/05 2005/06 aged 65 or above 100011 109229 102683 108659 115693 aged 18-64 389051 414824 415284 440725 460746 aged below 18 22039 25060 25456 27363 29496 financial year Note: Age refers to mid-year age Patients whose ages are not identified are not included in the above data Table 11: Number of Psychiatric Day Attendances at Hospitals under the Hospital Authority no. of attendance 200000 180000 160000 140000 aged 65 or above 120000 100000 aged 18-64 80000 60000 aged below 18 40000 20000 0 2001/02 2002/03 2003/04 2004/05 2005/06 aged 65 or above 18853 28093 20425 25544 27236 aged 18-64 151041 137716 116689 128693 136338 aged below 18 10870 17520 17515 18986 19913 Note: Age refers to mid-year age 10 financial year (c) Education Services 9. The Working Group has also taken stock of the numbers of students with disabilities enrolled in special and ordinary schools respectively as well as the number of students referred from ordinary schools to special schools in the past few years. The number of students in special schools, the number of students with disabilities in ordinary schools, as well as the number of students referred from ordinary schools to special schools from 2001 to 2005 are shown in Tables 12, 13 and 14 respectively. Table 12: Number of Students in Special Schools 2001/02 2002/03 5107 5178 Visual Impairment 164 Hearing Impairment Physical Disability Intellectual Disability Total 2003/04 2004/05 2005/06 5235 5111 5135 154 164 160 157 427 394 362 332 292 732 754 762 778 796 6430 6480 6523 6381 6380 Table 13: Number of Students with Disabilities in Ordinary Schools* 2001/02 2002/03 2003/04 2004/05 2005/06 Intellectual Disability 619 722 926 1012 974 Hearing Impairment 715 783 872 902 932 Visual Impairment 110 64 55 69 117 Physical Disability 220 209 200 214 205 Autism 202 318 509 601 662 # 1109 1159 1133 1356 1866 3205 3721 3931 4246 Speech Impairment Total Note: * In September 2006, the numbers of students with specific learning difficulties and attention deficit/hyperactivity disorder were 5 960 and 431 respectively. # data not available 11 Table 14: Number of Students Referred by Ordinary Schools to Special Schools 2001/02 2002/03 2003/04 2004/05 2005/06 95 97 129 11 9 123 Visual Impairment 1 1 1 7 0 Hearing Impairment 8 1 4 1 0 Physical Disability 15 9 13 12 13 11 9 108 147 139 136 Intellectual Disability Total (d) Vocational Training and Rehabilitation 10. The Working Group has also reviewed the vocational training and rehabilitation service provided by the Labour Department (LD), Vocational Training Council (VTC) and Social Welfare Department (SWD). Table 15 shows that the number of people who successfully secured employment with the assistance of the LD’s Selective Placement Division increased from 2 007 in 2000 to 2 459 in 2005. Among those who successfully secured employment, most of them are persons with intellectual disabilities and hearing impairment, while the employment level for those with visual impairment has persistently been on the low end. Table 15: Number of People Securing Job Placement with the Assistance of the Selective Placement Division of the Labour Department no. of people 3000 no. of hearing imparied persons 2 572 2 348 2 442 2 391 2 459 no. of visually impaired persons 2500 2 007 648 1500 58 271 1000 500 663 540 652 794 72 203 64 199 293 277 426 428 864 745 697 2003 2004 2005 646 2000 90 319 357 229 350 57 262 87 208 356 352 477 391 757 2002 356 451 580 2000 2001 0 year 口 12 no. of persons with physical disabilities no. of persons with chonic diseases no. of persons with psychiatric disabilities no. of persons with intellectual disabilities 11. Table 16 shows the employment situation of graduates from the VTC’s skills centres. The number of graduates pursuing full-time education is on a downward trend while the number of those seeking employment is on a rising trend. Table 16: Employment Situation of Graduates from Skills Centres no. of people 450 390 400 no. of graduates in employment 366 325 340 350 309 417 300 219 222 250 213 216 194 200 100 50 0 year 38 7 40 37 7 47 41 7 66 6 no. of graduates waiting to report for duty no. of graduates pursuing full-time education 165 150 no. of graduates seeking employment 54 55 56 40 3 12 3 19 24 36 41 43 32 39 2000 2001 2002 2003 2004 2005 no. of graduates not seeking employment 12. Regarding its vocational rehabilitation services, the SWD has initiated the process of reengineering some of its resources for sheltered workshops (SW) and supported employment (SE) since 2005 to provide one-stop vocational rehabilitation and training for PWDs through integrated vocational rehabilitation services (IVRS). Overall speaking, as shown in Table 17, the number of places for the SWD’s vocational rehabilitation services, including SW, SE and IVRS centres, has increased from 8 275 in 2001 to 9 647 in 2005. 13. Tables 18 and 19 show a rising trend in the number of people waitlisted for SW and the waiting time involved. The number of people waitlisted for SE generally remains below 250, whereas the average waiting time is less than 2.5 months. 13 Table 17: Vocational Rehabilitation Services of the Social Welfare Department no. of places 12,000 8,000 integrated vocational rehabilitation services centre (IVRSC) 6,000 supported employment (SE) 10,000 4,000 sheltered workshop (SW) 2,000 0 year 2001 2002 2003 2004 2005 口 Table 18: Waiting Time and Number of People Waitlisted for Sheltered Workshop (SW) no. of people time (month) 2500 14 12 2000 10 1500 8 1000 6 4 500 0 year 2 0 2001 2002 2003 2004 2005 口 no. of people waitlisted for SW average waiting time (month) 14 Table 19: Waiting Time and Number of People Waitlisted for Supported Employment (SE) no. of people time (month) 300 3 250 2.5 200 2 150 1.5 100 1 50 0.5 0 year 口 0 2001 2002 2003 no. of people waitlisted for SE - END - 15 2004 2005 average waiting time (month)