Of all the grand projects for integrating the Pearl River Delta as a single economy, medical services may be among the most difficult. While goodwill is there on both sides, profound differences in culture and professional standards stand in the way. An example is an ambitious project by the University of Hong Kong to open a teaching hospital in Shenzhen. With only 17 months to go before a scheduled soft opening, it appears basic decisions have yet to be finalised. Such questions include who will run the hospital, what their responsibilities will be, how many staff need to be hired for different departments and when to launch recruitment exercises. Such elementary issues should have been dealt with long ago. At this late stage, it is worrying. The 2,000-bed hospital is expected to be fully operational by 2013. It aims to be a vehicle for the mainland's best medical services. Paid for by the Shenzhen government, it has the full backing of the Ministry of Health and is to be a showcase of medical reforms on the mainland. But, perhaps for that very reason, some local officials have been less than enthusiastic about the project. They apparently consider it a slight to have to invite outsiders to run a top local hospital. HKU medical staff members have complained about being ignored. Some have warned the university is risking its reputation on a project over which it has an undetermined level of control. They have good reason to be concerned. Practices that are common in many mainland hospitals are considered unethical or even criminal in Hong Kong. Some medical procedures practised across the border may not be acceptable in Hong Kong. For example, patients handing out red packets - effectively offering small bribes - to medical staff to speed up or improve services is commonplace in mainland hospitals. Also, there are few effective channels to seek redress in case of medical mishaps or malpractice. With so much at stake for the university, it may be better for its senior doctors and administrators to insist on resolving all outstanding issues before opening the hospital. It is better to be late but have everything properly in place than to open on time and then fail to deliver.