Few institutions will be affected by the ageing of the population as much as the city's public hospitals. Older people and their needs will shape the balance of community expectations. It is good that a government-led panel is to review hospital performance to ensure the public health care service can meet changing demands. This will likely result in a call for reform of the authority - another chapter in 30 years of debate on the financing and delivery of health services that has yet to result in any basic change. Numerous consultations have been held, only for proposals to be shelved for want of consensus or political will. This cannot continue without affecting services, which must be rationed by queues or cost. The introduction soon of voluntary health insurance is a step in the right direction of requiring people who can afford it to pay more.

The pressure on hospital resources and the government's budget is set to continue rising, as people who live longer demand access to ever more expensive advances in treatment and medical technology. Signs of system stress rear their heads. For example, an authority panel recently blamed a bungled heart transplant in which a patient was given a mismatched organ on lack of manpower, specialist training, and communication and information. Happily the patient has apparently come to no harm.

One member of the new panel, Patients' Rights Association spokesman Tim Pang Hung-cheong, said it would need to come up with measures to quickly address a lack of doctors, since it will be years before an expanded medical school intake helps to address a shortage of 200 doctors in public hospitals. In that respect it is a concern that the Medical Association, the Public Doctors' Association and three other groups complain that the panel lacks representation from frontline practitioners. They have a stake and an important role to play in proposed health care reforms, including the development of a public-private partnership in primary and preventive health care that reins in the growing burden on the public system.