Hong Kong is renowned for its high medical standards. The excellence in health care is reflected in our boasting the world's second highest life expectancy rates and the fourth lowest level of infant mortality. Our surgeons pioneered liver transplants and scientists have put us at the forefront of influenza research. It therefore comes as a shock to learn that one of our hospitals is in a shabby state and is so poorly equipped that the chairman of its governing board has described its situation as 'shameful'. Our Lady of Maryknoll Hospital in Wong Tai Sin serves 430,000 people, yet lacks commonplace equipment and facilities. Residents needing computer scans for strokes or breathing difficulties or out-of-hours X-rays have to go to other hospitals in the Hospital Authority's Kowloon West cluster. Its chairman, Conrad Lam Kui-shing, rightly contends that such resources should be basic for a community hospital such as his. But a patient would not even need to know about the absence of these things to agree with his assertion that the hospital is substandard - a visit to the wards is all that is needed. As the photographs we publish today show, the hospital bucks the image we have in our minds of high standards and excellence. Paint peeling off walls, broken blinds and buckets placed to catch water from leaking pipes are not what we expect. Anecdotal accounts from staff of water dripping from a roof in an operating theatre last year amplify the impression that Hong Kong's health care reputation is overblown. It would be wrong to jump to such a conclusion based on the state of a single hospital. The staff and management are not at fault; they can do nothing about services and maintenance if the Hospital Authority does not give them adequate funding. Blame is being directed at the cluster system, under which bigger hospitals are said to get funding precedence in the name of cost-effectiveness. It is unclear whether this is the reason Our Lady of Maryknoll finds it difficult to provide a basic level of service for some patients - and even the ability to repair leaking pipes. Hong Kong without doubt has a good public hospital system - the health statistics amply back this up. Fees for residents are low and the service is generally efficient. But as our population increasingly ages, cost-effectiveness becomes correspondingly more important. The cluster model, with smaller hospitals serving catchment areas and based around one or more bigger hospitals, aims to ensure that resources are not replicated and are strategically distributed. A Hospital Authority spokeswoman told us that the role of Our Lady of Maryknoll in the Kowloon West cluster was being reviewed. She said HK$10 million had been allocated to repair and repaint the hospital's main block this year, and work on other blocks would be carried out next year. This is well and good, but a hospital catering to so many people should never be allowed to get into such a state. A basic level of medical service is necessary to ensure the health of residents. Questions have to be raised about how the authority allocates funding. Resources have to be provided with cost in mind, but lives, reputation and image should not be put at risk in doing so.