President, I submit the report in my capacity as the Chairman of the Bills Committee on Dentists Registration (Amendment) Bill 2024 (“the Bills Committee”). The Dentists Registration (Amendment) Bill 2024 (“the Bill”) seeks to amend the Dentists Registration Ordinance (“the Ordinance”) and its subsidiary legislation to revise the regulatory framework in respect of the practice of dentistry, and to make consequential amendments.

The Bills Committee has held 12 meetings with the Administration, including 1 meeting to receive views from members of the public. Members in general support the Bill and hope that it will address the shortage of dentists in the public sector and allow more dental care professionals (“DenCPs”) to provide services in a more independent manner, thereby helping to increase manpower.

Regarding the Bill’s requirement for students of the Bachelor of Dental Surgery (“BDS”) programme to undergo a one-year internship after their graduation, which will apply to local dental graduates in class of 2025 at the earliest, some members have queried the urgency of implementing the internship arrangement, and considered that it will disrupt the future plans of current students of the BDS programme and contravene the principle of informed consent. 

The Administration has emphasized that the proposed internship arrangement aims to enhance the clinical experience of local dental graduates through on-job training, so as to address the concerns raised by the Dental Council of Hong Kong (“DCHK”) on multiple occasions over the severe lack of clinical experience among the graduates of the BDS programme of the University of Hong Kong (“HKU”) in its accreditation exercises. This serves to uphold the standard of dental services in Hong Kong and safeguard the well-being of patients. However, as it may not be possible to arrange placement for fresh graduates in view of the time needed for the legislative exercise as well as planning of internship details, coupled with the impact on fresh graduates who are currently seeking jobs, the internship arrangement will only apply to local dental graduates in class of 2025 and thereafter. 

Some members have pointed out that some of the world’s top dentistry programmes overseas already include clinical internship and last for about five to six years. In this connection, it has been suggested that the existing six-year BDS programme should be shortened so that BDS students can complete both the programme and the internship within six years. There has also been a suggestion that transitional arrangements should be made for current BDS students to allow them to undertake internship after school hours or during holidays in lieu of undergoing a one-year internship after their graduation.

 DCHK has pointed out that with regard to the registration of dentists, no restriction is imposed under the Bill on the duration of any programme pertaining to a qualified degree in dentistry. The design and study duration of dentistry programmes vary among different places, and unlike the practice in Hong Kong, students of some overseas programmes are required to pass the local licensing examinations upon graduation before they are allowed to practise. As a regulatory body, DCHK may give advice to the HKU Faculty of Dentistry, but its curriculum design is a matter of the university. DCHK will respect its academic autonomy and continue to carry out accreditation work. 

The Administration has reiterated that local dental graduates are to be treated under the Bill as registered dentists when they are undergoing the internship. The internship arrangement is by no means an extension of the BDS programme. It is impractical to require students to undergo internship on a full-time basis while studying an undergraduate programme at the same time. DCHK has pointed out that it is inappropriate to allow BDS students, who are still in the learning and practising process without having yet fully mastered various clinical skills for dental treatment, to prematurely undergo internship as registered dentists and independently perform various dental procedures on patients. It is of no benefit to both students and patients.

There has been a view that the discussion generated by the current legislative amendments has affected public confidence in the professionalism of recent dental graduates, and has also brought current students of the BDS programme under pressure. Members have asked how the Administration will address the sentiment of students, and some have urged the Administration to further explain its policies and communicate with BDS students so as to allay their concerns and misunderstandings about the internship arrangement. 

The Administration has explained that it met with student representatives in the company of teaching staff of the HKU Faculty of Dentistry in March last year to explain the considerations for introducing the internship arrangement after the consultation on the proposed legislative amendments began last year. Following the introduction of the Bill to the Legislative Council (“LegCo”) this year, it met with students in the company of teaching staff of the HKU Faculty of Dentistry again in April this year to explain the specific contents of the Bill and listen to their views. The Administration has undertaken to continue to communicate with students on the internship arrangement. In fact, it has informed the HKU Faculty of Dentistry of its intention to obtain further views from students and is willing to arrange for them to visit internship venues. DCHK, the Department of Health and the HKU Faculty of Dentistry have set up a task force to discuss details of the internship arrangement, with the involvement of a BDS student representative, and the relevant discussion will continue.

 The Bills Committee has also discussed a number of issues, such as the new pathways for the admission of non-locally trained dentists, i.e. limited registration and special registration, the establishment of a statutory registration system for DenCPs, and the changes to the composition and structure of DCHK. The Administration will propose amendments to address the views of members and the Legal Adviser to the Bills Committee as well as to make the necessary technical and textual amendments. Members support the amendments. The Bills Committee will not propose any amendment to the Bill.

The Bills Committee has completed its work. Details of the deliberations of the Bills Committee are set out in its report to the Council.

 President, the following are my views on the Bill. 

First of all, this is a bill that has been long awaited by the general public. At present, there is a serious shortage of public dental services in Hong Kong, while the fees charged for private dental services are grossly exorbitant, discouraging people from seeking such services. Many people have no choice but to seek dental treatment in the Mainland instead, but this has led to all sorts of complicated problems.

 According to government figures, as of the end of December 2023, there were only 2 876 registered dentists in Hong Kong, of whom more than 45% were aged 50 or above and are now approaching retirement or semi-retirement age. In the register maintained by DCHK, a surprising 8% to 10% of the dentists live outside Hong Kong, which is tantamount to having no such dentists in the eyes of the general public. It is evident that there is a serious shortage and succession problem of manpower for dental services in Hong Kong.

 This all boils down to the fact that Hong Kong’s healthcare services market (including dental services) has always been protectionist and closed to the outside world since our return to the motherland in 1997, and that the number of dental training places in Hong Kong is extremely limited. Currently, only the HKU Faculty of Dentistry offers a dental training programme in Hong Kong. Even with the increase in the number of school places from the 2022-2023 academic year, it only admits 90 students per year, which is radically a drop in the bucket in the actual context of Hong Kong. The number of school places for locally trained dentists is acutely inadequate and, due to protectionism, there are even very few non-locally trained dentists who have successfully passed the licensing examination to practise in Hong Kong.

President, Hong Kong’s serious lag in dental services is evident in the existing Ordinance too. The existing Ordinance is an old piece of legislation with a history of 65 years, the passage of which can be traced back to 1959, a time when I believe three quarters of the Honourable Members were not even born yet. Despite constant patchy fixes over the years, the Ordinance can only provide a very rudimentary legal framework for the registration and regulation of dentists. President, “toothache is worse than a major illness”, and Hong Kong’s dental services are indeed “suffering from a major illness” and are therefore in urgent need of reform.

 The Bill is intended to “perform a major operation” on the existing Ordinance by “converting in-situ” the existing Ordinance with 53 sections and 1 Schedule into a regulatory framework divided into a total of 17 Parts and containing 124 sections and 11 Schedules. Only five of the original sections are left untouched and retained, while most of the rest are amended beyond recognition. One can easily imagine the complexity of “converting” a rudimentary, old piece of legislation into a well-structured regulatory framework that meets practical needs. The Bill was gazetted on 10 April 2024, and it is a miracle that the Second Reading debate can be resumed today, only three months later, before the LegCo recess.

Here, as the Chairman of the Bills Committee, I would like to express my heartfelt gratitude to the colleagues of the Health Bureau and the Department of Justice, as well as Honourable colleagues of the Bills Committee, for addressing people’s pressing needs despite the pressure of working overtime. I would also like to thank the LegCo Secretariat and the Legal Adviser for completing the processing of the marked-up copy of some 310 pages for our consideration two weeks earlier than I expected. The parties concerned have demonstrated their accountability to the general public by completing the deliberations on this Ordinance in a professional and expeditious manner.

President, the Bill has made reference to the Medical Registration Ordinance and allows examination-free admission of non-locally trained dentists to serve in Hong Kong through special registration and limited registration systems for Hong Kong’s public dental services. Although this cannot be described as a drastic reform, it is an important step in opening up Hong Kong’s dental services market. In addition, the Bill also introduces a statutory registration system for the numerous ancillary dental workers who have been working hard in silence for many years, with a view to establishing their status as DenCPs and providing a legal basis for the training of additional manpower offering simple dental services. At the same time, the Bill requires dentists and DenCPs to participate in mandatory continuing professional development in order to afford continuous protection to the general public.

During the deliberations on the Bill, the controversy over whether the current students of the HKU Faculty of Dentistry should be required to participate in the statutory one-year internship has distracted public attention, and some people have even questioned the need for a statutory one-year internship. In my view, the Bill stands firmly on the side of patients’ rights and interests, so it is only right to require the introduction of a one-year internship. Over the years, while DCHK has exercised its professional autonomy to request for an additional year of internship, the HKU Faculty of Dentistry has, under the guise of academic autonomy, dragged its feet in responding to DCHK’s legitimate concern and request. This situation really makes me think. While we often say that we should respect both professional autonomy and academic autonomy, I find this to be highly ironic in this case. In fact, the HKU Faculty of Dentistry has failed not only its students, but also the community. Should it be publicly condemned?

President, the Bill changes the composition and structure of DCHK in the light of its new functions. The number of members of DCHK will double from 12 to 24, and the ratio of dental practitioner members to lay members will be reduced from more than 2:1 before the amendment to less than 2:1 after the amendment. This is indeed an improvement in the governance of DCHK. At the same time, the Bill upholds the conventional practice of having all DCHK members appointed by the Chief Executive. The general public has a reasonable expectation that DCHK will be able to implement its policies and discharge its duties in a more practical manner.

President, I so submit. The Liberal Party supports the Second Reading and passage of the Bill.