Aline K. Wong
Singapore
“The ENABLE (Encouraging Achievement and Better Learning) programme gives additional support to those who are not achieving their potential. Our curriculum has given more emphasis to critical and creative thinking skills.”
“Can I just take one more second on the waiting list because Mr Ahmad Magad mentioned that the waiting list is long? There are 18 SPED schools now which cater to about 4,000 children. Of the 18 SPED schools, eight have waiting lists.”
“Sir, I am sure the Member in his meet-the-people sessions has also encountered cases where some families pleaded for priority to be admitted on grounds of, say, the child's sickness, or that the mother is working and is unable to bring the child to school, or that the grandparent cannot manage to take care of so many grandchildren.”
“I think he did not hear what I say. For both of these families, someone who lives within one kilometre or next door and someone who lives right on the border of this one kilometre, or of any delineation you choose to draw, my point is that for both of them, this is their nearest school.”
“Principals, as part of their duties, are always alert to what is happening in the school. They have also been given guidelines, in the Principals' Handbook, on discipline and the code of conduct which is expected of the teachers and staff members. But having said that, all these things are not foolproof.”
“It will continue to stagger the rental increase to market levels for assignment of tenancies, subletting cases and for tenants who are renewing their tenancies for the third time. Shop lessees can also apply to convert to shorter leases to reduce the cost of servicing their mortgage loans.”
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“In fact, the feedback in the past, and even today, has been that our system has been overly cautious and stringent. Nonetheless, the BCA was asked to carry out precautionary checks on other similar structures in schools to make sure that they are absolutely safe. The BCA will continue to review the current system to further minimise the possibility of accidents like Compassvale occurring ever again. The BCA will also work with the various professional bodies and other parties in the construction industry to safeguard the integrity of our system. This being the case, the Ministry does not see the need to convene a Commission of Inquiry.”
“The question should best be answered by the Minister for National Development because it is under the purview of the BCA. COMPASSVALE PRIMARY SCHOOL ACCIDENT (Setting up of Commission of Inquiry) 6. Mdm Claire Chiang See Ngoh asked the Minister for National Development if he will consider setting up a Commission of Inquiry to investigate the Compassvale Primary School accident. The Senior Parliamentary Secretary to the Minister for National Development (Assoc. Prof. Koo Tsai Kee) (for the Minister for National Development): Mr Speaker, Sir, since the collapse of the roof of the uncompleted school hall on 15th June this year, the Building and Construction Authority (BCA) has conducted an investigation, and many other investigations. Their preliminary findings show that the collapse of the roof was most likely the result of a design error. BCA has conducted precautionary checks on buildings designed or checked by the same individuals responsible for the Compassvale Primary School. These checks include physical inspection of the buildings for signs of defects. The BCA is satisfied that all existing schools designed or checked by the same individuals are safe for occupation. In other words, the individuals responsible for designing Compassvale Primary School did not commit the same error elsewhere. I am also pleased to report that as of today the BCA has visually inspected all the 362 schools in Singapore, both Government-aided and Government schools, and has found them to be structurally sound. We are confident that the present system of building control and checks has created and will continue to ensure a safe built environment. The record speaks for itself.”
“Sir, since the case of Compassvale is still under investigation, it is not advisable to disclose the names of the consultants or the engineers who are the checkers at this point.”
“We had to seek the support of the Police because it was done in unlicensed premises. I think I have covered most of the points that she has raised, Sir. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill. - [Dr Aline Wong]. Bill considered in Committee, reported without amendment; read a Third time and passed. ADMINISTRATION OF MUSLIM LAW (AMENDMENT) BILL (As reported from Select Committee) Order for Third Reading read. 3.47 pm”
“At present, traditional medicine, whether it is of the Chinese, Malay or Indian tradition, is exempted from the Private Hospitals and Medical Clinics Act, just as these practitioners are exempted from the Medical Registration Act. But as I have informed the House in the Budget debate last year, we are already going into the area of registering acupuncture within the near future. With the registration of acupuncturists, we would go into the registration of acupuncture clinics and then maybe we would move on to other areas of traditional Chinese medicine. As for other kinds of complementary medicine, I think we have to tread with great care. We have to be very cautious. The boundaries are vague and the claims are also very difficult for us to evaluate. We have to tread very slowly. But the Amendment Bill will precisely enable us to go into regulating them, if there is a need. At the moment, health or wellness centres and health spas do not carry out the kind of diagnosis, treatment and care of people with disease, injury or disabilities in the same way as medical practitioners do. So they are not under the purview of this Act. I think we have to be very careful about going into the area of regulating slimming centres, beauty salons and so on. We have already gone into regulation of cosmetics. The Amendment Bill will allow us the flexibility of regulating these other kinds of so-called healthcare establishments, if there is a need to. On her point about colonic irrigation clinics, the case we know was an unlicensed clinic, and it is precisely because of this incident that we need to enhance our powers to go and search premises, and seize evidence because we had difficulty in getting evidence to prosecute this case.”
“This Advisory Committee would be a panel of experts, depending on the type of healthcare establishments you are talking about. Obviously, a dental clinic would be under a panel of dentists. A medical clinic would be referred to a panel of medical professionals who are in that specialty. We are talking about having panels of experts to assist the Minister in Advisory Committees. This appeal process is in place. Why should they be protected in the same way for their opinions? As I explained, both the QA committee and members of the Advisory Committees are to give their opinions to the hospitals, the healthcare establishments or to the Minister in good faith. They can express their opinion very frankly in such committees and they give their opinion in good faith. But they are only given qualified privilege. If there is any reason to doubt that they are trying to cover up any mistakes done by the hospital or to protect another colleague, then there is a process whereby their evidence could still be discovered. As for alternative medicine, I share her concern that there is a proliferation of so-called alternative medicine, complementary medicine or alternative healthcare practices springing up in Singapore. This is a world-wide trend and I think many countries in the world are still grappling with how to regulate and recognise them. I would not want to give my opinion on whether these alternative practices are more holistic than western medicine. I would not want to give an opinion on whether they are holistic or not. But definitely, they exist. Some have long traditions, like traditional Chinese medicine. Some have sprung up recently, like the revival of customary healing practices and so on.”
“I would like to assure her that the visits would be coordinated by the various sections of the Ministry and my officers would make sure that the data collection and submission will not place an undue demand on healthcare establishments at the expense of their productivity. Finally, she asked that the term "healthcare establishment" should be put in the preamble of the Act. I can look into that. I think there is no problem with putting back the term "healthcare establishment" into the preamble of the Act. On Mdm Claire Chiang's concerns, I find her reference to the Director of Medical Services as being comparable to the director of a company rather puzzling. I think we are talking about two different things. The Director of Medical Services is charged with the responsibility to oversee the professional standards of the entire health sector. I find that it is not really a comparable issue. As far as appeals are concerned and on safeguards, if the licensee commits a certain breach of the licensing requirement, this would be under the purview of our Ministry's regulations. The Act already provides for the composition of fines, instead of bringing the licensee to court. If it is a matter of medical ethics or a professional lapse, then the person would be brought before the Medical Council. So it is a matter of professional judgment and the Council is an independent body. I can assure her that various bodies are in place to regulate the healthcare establishments and to ensure that they perform to certain standards within the purview of this appeal process. If a licensee is aggrieved, he can appeal to the Minister and the Minister can appoint an Advisory Committee.”
“Also, this licence allows a clinic to have up to five doctors or dentists. The onus on a single or individual doctor or dentist is not that heavy in terms of financial burden. I take her point that doctors have to pay for their practising certificate, clinic licence fee and also some charges or fees for equipment such as ultrasound, laser, x-rays and so on. These are meant to cover only administrative expenses for enforcing the regulations under the various requirements. I have actually thought about this and I asked for some comparative figures on what lawyers have to pay to stay in the practice. They pay much more, in fact. For example, a practising certificate for lawyers can vary between $450 and $750 per year. All of them have also to pay for an indemnity policy, on an average of $4,000 for every million dollar revenue collected, as compared to the doctor's medical defence insurance which is just between $1,000 and $2,000. But this is for the good of lawyers and doctors. They should cover themselves with such funds. On top of that, if lawyers want to be a notary public or a Commissioner of Oaths, they have to pay an additional registration fee of $1,000. I should say that lawyers are comparable to doctors as professionals, but the fees they pay are higher than what doctors are paying under our present schedule. I take her point that these fees should not be too onerous and her point that the requirement for licensees of healthcare establishments to furnish information on their practice, procedures, and so on, should not be too onerous.”
“I would discuss her point about whether traditional Chinese medicine or acupuncture clinics can be considered as healthcare establishments under this Bill, and other kinds of healthcare establishments that we might want to regulate, later on. She was concerned also about new sub-section 10(4) which states that "the minutes of meetings can be made available for any proceedings" and whether it would erode the protection of the said members in any proceedings. Under sub-section 10(3) of the Bill, a person who is a member of a QA committee is not compelled to disclose the proceedings of the committee. However, sub-section 10(4) would only apply if the Ministry has adequate reason to believe that this person has not acted in good faith and there is some deliberate cover-up of wrongdoings by the doctor under investigation. The Director can then require that the relevant information or minutes of meetings be made available for review. This is the same question that Mdm Claire Chiang has asked about qualified privilege. In other words, a member of a QC committee is protected by this Bill and is not compelled to divulge any proceedings, but if there is reason for the Ministry to suspect that there is some wrongdoing or that the QC member did not act in good faith, the minutes of evidence could still be called for. The Ministry can still look into this evidence and an aggrieved patient or doctor would still have recourse to the normal process of the law to sue, because if the QC member was found not to have acted in good faith, then what he said and his opinions in the QC committee would still be open to legal judgment. As for the high fees that Dr Lily Neo talked about, I would like to clarify that the $600 clinic licence fee is actually for two years. It is not for one year.”
“Mr Speaker, Sir, I will attempt to answer the points raised by Dr Lily Neo first. In general, she supports the Bill but she has raised a couple of issues. First, the issue of quality versus quantity. She asked whether the main objective of the Bill is to regulate quality, that is, the standard of the professional services or control the quantity, that is, the number of healthcare establishments that will be set up. Let me reiterate that the main objective of the Bill is to give my Ministry more effective means to ensure that hospitals, clinics and nursing homes maintain a good quality of care and that there are provisions within the establishments for the QA activities. So the Act primarily seeks to enforce the parameters that the hospitals, nursing homes and clinics must work under in order that the health services given to the public are of a high standard. The new section 5(3) of the Bill defines the parameters for the Director to issue or refuse to issue a licence but none of these parameters refer to the distribution or the number of hospitals, clinics or nursing homes. In other words, the Bill does not control the number or distribution of such premises. She was correct in pointing out that one sometimes finds in HDB estates a concentration of five or six medical clinics. But this is the result of the tendering process where the doctors make a decision to locate their clinics in a certain locality. We have, in the past, left it to market forces and I think we should still leave it to market forces to decide on the number and distribution of healthcare establishments. The Bill is not intended at all to cover this aspect of her concern.”
“Under clause 10 of the Amendment Bill, a new section 11 provides the Director of Medical Services and authorised officers with additional powers to seize evidence, make copies or take extracts from relevant records or require the persons in charge of licensed establishments to do so when enforcing the Act. Under clause 13 of the Amendment Bill, a new section 16D is enacted to allow for the composition of offences up to a maximum of $2,000. Finally, the Bill updates the penalties for various offences under the Act, and proposes a couple of new offences, such as the failure of an unlicensed healthcare establishment to comply with an order to close the establishment; and failure to comply with an order to stop using an equipment or to stop carrying out a practice deemed dangerous or unsuitable. Sir, medical knowledge, medical technology and medical practice have changed and advanced tremendously in the last two decades and will continue to evolve into the new millennium. New diseases pose new challenges that will present new modalities of treatment and new approaches to patient care. In the midst of these changes, there will always be a need to ensure that a high level of professional standard is upheld in healthcare establishments. The amendments proposed in this Bill will strengthen the regulatory framework so that we can meet these challenges with confidence and achieve our goal of providing good quality health care to Singaporeans that is appropriate to their needs. Sir, I beg to move. Question proposed.”
“It provides an essential balance to the provision which allows access to patients' medical records by authorised officers. The new section 12 only allows for disclosure of medical information for specific statutory purposes such as for disciplinary proceedings under the Medical Registration Act or the Dentists Act. The maximum penalty for wrongful disclosure of information under the Act has been increased from a fine of $2,000 to $5,000. Under clause 3 of the Amendment Bill, a new section 2A is enacted to allow the Director of Medical Services to authorise any person to assist in the administration of the Act. This section also provides for the Minister to establish one or more advisory committees to advise on matters pertaining to the administration of the Act. Under clause 13 of the Amendment Bill, a new section 16B is enacted to protect all authorised officers and members of advisory committees from legal liability for anything which is done in good faith in the performance of their duties under the Act. These amendments ensure that the appointed medical experts are adequately protected from any personal or professional liability in the exercise of their responsibility and judgement. Under clause 2 of the Amendment Bill, section 2 of the Act is amended to include the definition of a healthcare establishment as any premises or conveyance which is declared by the Minister to be an establishment that requires licensing under this Act. This will give my Ministry the flexibility to license new types of healthcare establishments as and when required.”
“These two countries have also drawn up legislation to prevent forced legal disclosure of QA matters in hospitals and other healthcare establishments. They have also enacted legislation to protect members of QA committees from personal liability when they act in good faith. Clause 14 of the Amendment Bill also amends section 17 of the Act to allow the Minister to make regulations on the composition, procedures, duties and responsibilities of QA committees of healthcare establishments. Under clause 10 of the Amendment Bill, another new section 11 is enacted which provides for the access to medical records of patients notwithstanding that the prior consent of the patient has not been obtained in order to: (a) investigate whether this Act or any regulations made thereunder has been or is being contravened; or (b) to assess the quality and appropriateness of the services provided and the practices and procedures being carried out at the healthcare establishment. Section 12 of the existing Act which requires the patient's consent for access to medical records is therefore repealed. The new section 11 stipulates that the access to medical records without consent is allowed only for medical audit purposes. Access to medical records is also strictly confined to officers authorised by the Director of Medical Services. Under clause 10 of the Amendment Bill, a third new section, section 12, is enacted to prevent the disclosure of any information contained in a patient's medical record which has come to the knowledge of the Director of Medical Services or an authorised officer in the course of performing any duty under this Act. This provision safeguards the need for doctors to maintain confidentiality of medical information.”
“The revision of the Private Hospitals and Medical Clinics Act will facilitate the enforcement work of my Ministry by allowing the seizure of evidence during raids especially on unlicensed premises. Presently, we have to rely on the police to exercise such powers. This is an unnecessary burden on the police and can be removed by enhancing the investigative powers of the officers acting under the authority of the Act. Currently, all offences under the Act require prosecution in court before any penalty can be imposed. For greater flexibility in enforcement, there is a need to provide for composition of offences especially for the more minor ones. The penalties for offences under the Act also need to be updated. Sir, I will now brief the House on the main provisions of the Bill which will address the concerns I have listed earlier. Under clause 10 of the Amendment Bill, a new section 10 is enacted to require the setting up of quality assurance committees in hospitals. To facilitate the conduct of effective quality assurance programmes in hospitals and health care establishments, the section provides that: (a) Documents arising from the deliberations of quality assurance committees cannot be compelled to be divulged to any court, tribunal, board or person; (b) Findings and recommendations made by quality assurance committees on changes to be made to practices, in particular healthcare establishments, shall not be used as evidence that the service or practice was inadequate or inappropriate; and (c) Members of quality assurance committees are protected from personal liability when they exercise their duties in good faith. These provisions are similar to legislation which has been enacted in the United States and in Australia to support QA programmes in health care.”
“Examples of areas being audited are caesarean sections, hysterectomies, endoscopies, arthroscopies and balloon angioplasties. Most of the audits done so far have shown that there is a very high degree of conformity with acceptable "best practice". This is to the great credit of our medical profession. Where `deviations' are found, for example, with indications for performing caesarean sections, the doctors or professional bodies are given feedback to enable corrective action and improvement of practices. Sir, the manner in which healthcare is delivered is evolving rapidly. The second objective of the Bill is to provide for greater flexibility in licensing of healthcare establishments. The Act currently provides for only three types of licences: (1) Hospital licences for hospitals, nursing homes and maternity homes; (2) Medical clinic licences for medical and dental clinics; and (3) Clinical laboratory licences. Since the Act was passed, new types of health care establishments have emerged, for example, ambulatory surgical treatment centres, renal dialysis clinics and MRI centres. I have no doubt that this trend of new types of healthcare establishments being set up will continue. There is therefore a need to build greater flexibility into the Act for the licensing of new health care establishments which can then be better controlled through their own specific regulations. The third objective of the Bill is to enhance my Ministry's power of enforcement. The existing Act only allows my Ministry to inspect health care establishments but does not allow for the seizure of evidence which is frequently necessary for prosecution.”
“Medical audits are conducted mostly on common medical conditions, and this should be done before any conclusion is reached on the quality of care. Obtaining the patient's consent at this stage will potentially cause undue alarm to the patient, and may raise doubts that some error in medical management has occurred, where none may have been made at all. The need for the patient's consent is also not practical when a large number of a particular type of patients is studied. For example, when we audited the appropriateness and outcome of caesarean sections performed for pregnant women under different clinical situations, we took a random sample of 10%. In 1997, out of 46,000 deliveries, some 12,600 or 27% were by caesarian section. A 10% sample for 1997 therefore entailed a study of 1,200 cases of caesarian sections. It is obviously impractical to ask each and every patient chosen in the sample for her consent to have her medical record examined. It will be more practical to allow access to medical records specifically and only for the purpose of statutory medical audit, while at the same time safeguarding the principle of medical confidentiality. I want to emphasise that the objective of having access to the medical records is for the purpose of studying the pattern of management of a particular group of patients and not for identification of the individual patient. The identity of the individual is protected and safeguarded under new provisions of the Bill (clause 10, section 12), which I will elaborate on later. My Ministry is selectively auditing areas of clinical practice where there is a large number of patients or high volume, where the cost is high, and where there may be a potential for `errant practice'.”
“Secondly, QA committee members are exposed to personal liability for the opinions they have expressed and to legal suits for defamation by aggrieved doctors. But QA programmes must have the active involvement of doctors to be effective. There is therefore a need to formally recognise the roles and functions of QA committees and to provide the necessary safeguards for the hospital and members of the QA committees that will facilitate the conduct of effective QA programmes. Countries like Australia and the United States have also recognised the importance of effective quality assurance programmes in health care and have enacted legislation to address these legal issues. The Bill lays down more definitive requirements for hospital QA programmes. It will also enable the Minister to make regulations on the composition, procedures, duties and responsibilities of QA committees in hospitals and other health care establishments. The Bill will, secondly, enable my Ministry to conduct more effective medical audit programmes. To ensure that high standards of professional practice are maintained, it is necessary for my Ministry to conduct medical audits to evaluate the medical treatment that has been given to patients. To do so effectively, my Ministry must have access to the patient's medical records so that the clinical data, investigations performed, treatment prescribed and the outcomes of clinical management can be objectively reviewed and assessed for their quality and appropriateness. However, section 12(3) of the existing Act prohibits access to a patient's medical records except with the patient's consent. This prohibition is unduly restrictive for the purposes of statutory medical audit.”
“The Bill will help to ensure a high level of professional standard by providing, firstly, for : (a) more effective quality assurance (QA) programmes at health care establishments; and, (b) more effective medical audits carried out by my Ministry. QA programmes comprise a range of activities directed at ensuring the quality of patient care through objective and systematic monitoring, evaluation, identification of problems and action to improve the level and appropriateness of care. The programmes are by and large institutional activities for self-monitoring purposes. These have been established in all hospitals as a requirement for licensing since the implementation of the Private Hospitals and Medical Clinics Act in 1991. My Ministry monitors closely these activities by requiring hospitals to submit regular six monthly returns on clinical performance indicators such as unexpected deaths; perioperative deaths; unplanned re-admissions to hospitals; and unplanned returns to the operating theatres, and so on. We also require six monthly returns on any report of Committees of Inquiry into medical incidents as well as the results of tissue audit. The results of these returns are then closely scrutinised by my Ministry and in-depth medical audits are conducted if necessary. While it is important to retain the self-monitoring element in QA programmes, they are, however, based on a peer review process which requires doctors to evaluate and pass judgement on each other's professional performance. Understandably, many doctors have been reluctant to participate in QA committees because firstly, the findings of a QA committee under the current provision of the law are open to legal discovery and could provide the basis for legal action against the hospital.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time". The Private Hospitals and Medical Clinics Act (Chapter 248 of the 1985 Revised Edition) was passed in 1980 to provide for the control, licensing and inspection of private hospitals, medical clinics and clinical laboratories and to prohibit trading in human blood. The Act came into operation when its regulations were gazetted in 1991. The Act was passed in 1980 when most hospitals were run by the Government and the Act did not apply to them. With the restructuring of Government hospitals, the conversion of homes for the aged into nursing homes and the increasing number of private hospitals, clinics and clinical laboratories being set up, it was necessary to implement the law to oversee the operation of these healthcare institutions and uphold the high standard of medical care in Singapore. Regulations to the Act were finalised and the Act came into operation in 1991. My Ministry then established the Medical Audit and Accreditation Unit (MAAU) to license all private healthcare institutions, including the restructured hospitals, to regulate their professional standards and to audit their clinical activities. With recent changes in medical practice and rapid advance in medical technologies, there is need for some amendments to the legislative framework under which MAAU works. Before I brief the House on the amendments to the Bill in detail, let me present the three main objectives that my Ministry intends to achieve with these amendments. They are: (i) to ensure a high level of professional standard practised at health care establishments; (ii) to provide for greater flexibility in licensing the establishments; and (iii) to enhance our capability for regulatory enforcement.”
“Even though this question is not related to the Question asked, I would like to assure the Member that my Ministry has been promoting breast feeding among mothers who deliver in our restructured hospitals and Government hospitals. PUBLIC TRANSPORT SYSTEM SERVING TEMASEK POLYTECHNIC (Improvement) 17. Mr Ong Kian Min asked the Minister for Communications whether there are any plans to improve the public transportation system serving Temasek Polytechnic to cater to the large number of people attending full-time courses as well as part-time skills redevelopment and upgrading courses at the Polytechnic.”
“We hope to have a more balanced system, a system which is more aligned with achieving the Desired Outcomes of Education, and a system which recognises effort, discipline, content knowledge via the `A' levels; which recognises reasoning ability and a more general ability of the student to cope with university education, via SAT1 even though he may not have As for his `A' levels. ECA, where we have EQ, leadership, tenacity, the ability to face difficult and unusual circumstances; project work, where again things like EQ, application of knowledge, team work and so on. So, what we are looking for is a broad range of attributes which we want our students to have. If we do not change our university admission system, nothing else that we are trying to do in the education system is going to work.”
“They would go out to do experiments in the garden and things like that. So I was a little puzzled. I asked him, "How do you reconcile this with preparing your students for the Tokyo University entrance examinations system?" And his reply surprised me. He said, "Ah, for the students who are preparing for the university entrance examinations system, we have a more traditional syllabus. This is for the students who are not going to university." That really took me aback. I discovered later that some three-quarters of the students in the school were girls. It is a very new school, innovative curriculum, and he explained to me that for the girls, it is OK. For the boys, they have to prepare them seriously for the university entrance examination. So it is too much of a risk to send them through this kind of system. What is the moral of the story, Sir? The moral of the story is that if we stick to our present university admission system, which is based solely on the 'A' levels, one throw of the dice on the 'A' levels, nothing else that we do in the education system makes a difference. Parents and the students will continue to focus their efforts on getting that extra mark in the 'A' levels. ECA and all the other things do not matter. What do we hope to see with the new university admission system, which I stress again, goes beyond adding in the SAT1? It includes adding in ECA and project work. What do we hope to see?”
“The children in the pre-school years will develop language use, understanding of numbers, learn some good social and personal habits, and learn to appreciate music and to gain confidence through basic skills, simple sports and so on. My Ministry is looking into spelling out the desired entry level competencies for formal schooling, with special attention being paid to language development and social and affective goals. These entry level competencies will be realistic and will not require pupils to be able to do at the pre-school stage what they will be taught at primary one. Sir, with this, we will be looking into guiding the kindergartens further in matters of curriculum, teacher training, quality and so on. RAdm Teo Chee Hean: Sir, thank you for your indulgence. I thought it will be useful to address the point that Mr Low Thia Khiang brought up earlier. He basically asked that with the university admission system, what do we expect parents and students to change? What values do we expect? Sir, I will begin with a little story. I went to Japan in August 1997, to pay a visit and to understand the Japanese education system. They brought me to a high school, a very, very modern high school, one of the newest high schools in Japan - aluminum finishing, glass walls and so on. They have wonderful computer facilities, enough to make any of our schools, which are already very well equipped by world standards, enough to make their mouths water. They have wonderful student to computer ratio. They brought me around the school. They showed me the laboratories, wonderful facilities. I spoke to the physics teacher and he explained to me how he is using experiential learning and so forth to teach his students science, physics and all that.”
“He talked about giving awards and so on. Indeed, we do have teachers' awards. We have the Caring Teachers award every year. For Chinese teachers, we have the Inspiring Chinese Teacher award. And do not forget, we have initiated last year, the President's Award for Teachers, which is the highest kind of recognition we can give to a teacher for his or her contribution and performance. Literally, there were thousands of nominations submitted for this President's Award, and this is a reflection of our teachers' efforts, as well as the fact that a lot of people out there, in spite of Mr Zulkifli's perception that there seems to be a declining respect for teachers, who want to give due recognition to teachers who have made a difference to their lives. As far as the parent/community relations are concerned, I think later on in the debate, we would have an opportunity to talk about the Ministry's latest initiative, ie, COMPASS (Community and Parents in Support of Schools). Let me respond to Mr Hawazi briefly on early childhood education. My Ministry regulates the private kindergartens by registering them, setting curriculum guidelines and accrediting teacher training. The kindergartens plan their curriculum based on our guidelines, which are focused on the developmental milestones of children at the ages 3 to 5. MOE believes that kindergartens should prepare children for learning, and we will be revising the guidelines for early childhood education to ensure that early childhood - the period that the child spends in kindergarten - should be a time when the child learns and develops through various activities.”
“Sir, as time is running out, allow me to very briefly respond to the three Members who just spoke. Mr Peh Chin Hua said that the Ministry should not stifle the creativity of teachers by requiring its teachers to seek prior approval before they engage in part-time work. I must stress that teaching is a very demanding profession. When people choose to serve as teachers with MOE, we would like them to give full attention, energies and commitment to the job. My Ministry currently allows part-time work on a selective basis, and only on the condition that the teacher's performance is not affected. Mr Peh said that there is a civil service rule requiring all civil servants to return the money that they earn from their part-time work to their departments. There is no such so-called rule. The Public Service Division's circular that he referred to says that where a civil servant uses official material, knowledge, time or resources to help him engage in outside work - say, as an author writing a book - he would then have to pay the royalties and the fees earned to his Government department. But if a civil servant is involved in publications done in his private capacity, eg, work related to his personal hobby or interest that involves no official material, knowledge, time or resources, he is allowed to retain the fees or remuneration arising from such work. Mr Zulkifli Bin Baharudin spoke about the need for parents and the wider community to accord more respect and more appreciation to teachers. I cannot agree with him more. I think the parents and the wider community need to have appropriate appreciation for the heavy responsibilities of the teachers. We have, over the last few years especially, done quite a lot to raise the image and the morale of teachers.”
“So this additional Medisave that is paid into the salary of the doctors, including the junior doctors on MSO, is meant to cover his medical expenses through insurance or through out-of-pocket payments. In addition, the doctors or the civil servants in general on MSO are subsidised up to $350 a year for outpatient expenses. In the Ministry of Health, all the new junior doctors are briefed on their eligibility for medical benefits and are advised to purchase medical insurance coverage, using the 1% additional Medisave contribution. However, I agree with Dr Neo that the hospitals where the doctors work should look after the junior doctors well, especially those who require medical treatment either as inpatient or outpatient, and extend appropriate courtesy to them. This has been emphasised by my Ministry to the hospitals from time to time. Where the junior doctors contract illnesses which arise out of their work and require medical treatment, the Ministry is prepared to bear the cost if it can be shown that the illness is related to the work. I would therefore request Dr Neo to let me have the details of the two cases cited by her. If my officers ascertain that their illnesses were work related, we will ask the hospitals concerned to look into bearing the cost of the medical treatment. Finally, on the subject of hair transplant, hair loss is one of those things in life associated with the aging process or otherwise, which I think we all have to take a bit philosophically, although this seems to afflict one sex more than the other. For those who would like to seek treatment, the way is open to them. Singapore does not ban hair transplant at all.”
“So, I think the Spastic Association can learn from the experience of the Margaret Drive Special School on how they can run this kind of dental clinic for spastic children. Dr Lily Neo made a very emotional appeal for the medical benefits of junior doctors. I must say that I was taken aback by her description of the Ministry of Health as almost a heartless organisation. I take strong objection to that. My Ministry is concerned about the welfare and the morale of our staff. In fact, only recently, we have revised the medical scheme of service and implemented several measures to improve the working conditions of medical doctors, including the junior doctors, and these measures have been described in the House. I would not dwell on them. Dr Lily Neo talked more specifically about the medical benefits for the junior doctors. Medical benefits have all along been provided for doctors in the civil service, which include our junior doctors. These were revised when changes were made to the civil service medical benefit in 1994, in line with our national objective of encouraging personal responsibility for one's own healthcare. 4.15 pm When the Deputy Prime Minister introduced this scheme in the House at the end of 1993, he gave a very full explanation of why we made a switch over from the old scheme to the new Medisave-cum-subsidised outpatient (MSO) scheme. Under the 1994 MSO Scheme, the Government contributes an additional 1% of the officer's total monthly salary into his Medisave account. This additional Medisave contribution is meant to cover hospitalisation expenses should they be incurred or to buy approved medical insurance, including MediShield, MediShield Plus, for costly serious illness.”
“I think she recognises that children with certain types of disabilities, such as spastic children, are difficult to manage at times, because there are uncontrollable movements and they are not able to function as normal children in terms of bodily control. It is a complex problem. For children who need sedation for their dental treatment, they are presently being catered to by the National Dental Centre. Those who are spastic, children who are particularly fidgety, can seek treatment there. Mdm Chiang spoke about the need for specially trained dentists who are willing and able to handle the spastic children. The stand of the Dental Faculty at NUH is that the Dental Centre at NUH provides dental care to disabled persons, including the spastic children or children with cerebral palsy. In fact, the dental students now are given exposure under the supervision of their academic staff to treat these children. But it is not possible for every dental student to be trained well enough to be able to handle these children on their own. It requires some further special training. I think the best solution for the spastic children is for the Spastic Children Association to run a dental clinic on its own, which, in fact, I hear they have plans to do so, when they move to the new premises. Then they can gather a group of dentists, whether they are paid or volunteers, who would be helped by their own paramedics who would prepare the children for dental treatment. By and by, they would accumulate some expertise in this area. There is another association, the Margaret Drive Special School which will be running a dental clinic at its premises, and it will be manned completely by volunteers from the Dental Health Foundation.”
“Mr Gerard Ee advocates compulsory deduction from Medisave of family members if a patient is unable to pay for his medical expenses, particularly if the family can afford to do so. From our experience, there are actually very few cases where the immediate family members refuse to pay for the healthcare cost of a patient, particularly the parent, who is unable to pay for himself. This shows that family links or relationships in Singapore are still very strong, and in matters of the heart, like family relationships, filial piety, I think the Government should not interfere as much as possible. We already have the Maintenance of Parents Act which allows an elderly person to claim maintenance from the children who are able to contribute but refuse to do so. We should not press for the medical maintenance of parents further. At least the problem is not significant enough to warrant legislation. As for dental care for the disabled, Mdm Claire Chiang raised the special case of the spastics. Let me inform her that MOH provides dental service to the pupils of all the special education schools, including the spastics. We do it either by sending a mobile dental clinic to the school grounds, park there for a couple of months, and let the children have a regular check-up and be treated. Or we give them access to the school's dental clinics at nearby schools so that the volunteers or teachers can bring the children over for their regular dental check-ups and treatment. The children from these special schools, as well as children from MOH approved welfare homes, get free treatment. The other disabled children, if they visit our polyclinics, our dental clinics, are charged at the same concessionary rate as children without disabilities, that is, 50% of the adult rate.”
“Sir, I would like to address the points raised by Mr Yeo Guat Kwang. I think he made a case for the Ministry to encourage more workplace health promotion programmes. Indeed, we put quite a bit of emphasis on promoting healthy lifestyle programmes at the workplace. As early as 1988, we already formed a Workplace Health Promotion Unit within the Ministry and we went out to various organisations and ministries to help them organise comprehensive workplace health promotion programmes. We also train facilitators at the workplace so that they can carry on those programmes after we have done the initial kick-off for them. Come September this year, in order to highlight the importance of our emphasis on workplace health promotion programmes, we are going to present a special award, the acronym of which is HEALTH, which stands for "Helping Employees Achieve Lifetime Health", to those employers who have commendable workplace health promotion programmes. I would like to show our appreciation here to NTUC for launching the NTUC Workplace Health Promotion Programme in August last year which had quite a widespread participation rate among the various organisations. Mr Yeo asked what kind of incentives we should provide to employers to promote health at the workplace. But as he himself said, increase in productivity, decrease in absenteeism, increase in worker's morale, all these will reward the organisation many times over the amount that they spent on health promotion activities. So I think there is really no need for additional incentives, such as tax incentives to be given to these organisations. But I applaud and agree with him that it is important to promote health at the workplace.”
“I think I have addressed all the points. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill. - [Dr Aline Wong]. Bill considered in Committee; Bill reported without amendment; read a Third time and passed. RECLAMATION (Pulau Pesek Kechil/Ayer Chawan/Sakra)”
“Of course, we will inform all the medical practitioners and health care workers of the new provisions and keep them updated. Finally, let me come to Mr Shriniwas Rai's point about the severity of the penalty. I think he agrees with the new section 10A, that is, for people who give false information when they give blood donation, the penalty will be raised to $20,000 or to imprisonment of two years or both. But he does not quite agree with section 20C that raises the present penalty for a person who knows that he is HIV-infected but he still insists on giving blood at our blood bank. Mr Rai does not agree with raising the penalty from $10,000 to $50,000. He said that it is too severe. I think the heavy penalty underscores the seriousness of the crime. This person has already been counselled against giving blood. He knows about his own HIV status. He knows it himself and he still persists in donating blood. When he goes to the blood centre, he is made to understand the consequences. He is given the blood donor's health assessment form where he has to sign a declaration about his blood donation. If he knows that he is HIV infected, he is supposed to refrain from donating blood and there are legal penalties involved and he knows. He is supposed to read this form, and be counselled before signing the form. But he still does it. It is very dangerous because this could cause the death of the person who receives his blood. Of course, if the the blood is infected, we are able to detect it because of our stringent tests. But in the extreme case, if it escapes detection, the consequences would be too heavy. If he does it wilfully, with his eyes open, then I must question what is the motive. We must guard ourselves against such irresponsible behaviour.”
“Counselling is crucial because it will help the patient cope with the situation and help him change his risk behaviour and lifestyle to prevent further spreading of the disease. Under the law, it is necessary in all circumstances to obtain consent of the person before taking his blood for laboratory testing. This includes testing the blood for HIV. This act, if done without the patient's consent, constitutes a battery of tort and an offence of voluntarily causing hurt under section 323 of the Penal Code. From the medical ethical point of view, when a patient seeks medical attention, doctors have a duty to inform him what tests are being done and what is the nature of this test. So this is in the spirit of a good doctor-patient relationship. In the case of HIV testing, informed consent is required to also protect the doctor in case there is a denial by the patient later. HIV testing is put on par with a surgical operation as it has serious implications should a positive result turn out. Finally, on her point about the need for more stringent and radical steps to control the spread of AIDS in Singapore, we should not be complacent about the situation but it is a fact that the extent of the AIDS epidemic in Singapore is comparatively smaller than many other countries in the region, because we took steps to control the situation very early, from the day go in 1985, shortly after AIDS itself was identified. So, we have taken the necessary AIDS control measures and we have been reviewing and fine-tuning the strategies based on the changing trends of the HIV infection over the years. I am confident that with this amendment Bill, we would be able to further tighten the AIDS control situation for public health purposes in Singapore.”
“We will update our Donor's Health Assessment Questionnaire to include the new penalties and so on, that we have amended today. HIV patients at the Communicable Disease Centre (CDC) are always warned during the counselling sessions that it is an offence to carry out any act that may transmit HIV infection to others, such as sexual intercourse, without first informing their partner of the status, or to donate blood. Again, in our counselling at the CDC, we would make sure the counsellers, doctors and nurses will inform the patients of the new provisions in this Bill. In the event of a HIV patient who behaves carelessly and most irresponsibly, then this amendment Bill allows the Minister for Health to disclose the identity of the HIV infected person to relevant persons, including the public, so as to ensure that public health and safety is preserved. It is a preventive measure to publish information which leads to the identification of the person but it will call for the Minister's authorisation and it would be done only under extreme circumstances when the person behaves carelessly and most irresponsibly. On Dr Neo's comment that there is no need for specific consent for HIV testing when a person seeks medical or surgical treatment, I would like to emphasise that HIV infection is different from any other infectious diseases in that there is at present no cure and that it carries a very strong social stigma. Therefore, HIV testing and its outcome have a very traumatic impact on the person. It is almost like a pronouncement of a death sentence, as some Members have put it. Persons undergoing such tests should therefore be fully aware of the nature of the test and be counselled before and after the HIV test is carried out.”
“But, in practice, as Dr Tan mentioned, in the Notification of Infectious Diseases form, which is gazetted and which every medical doctor receives, it is clearly stated that for the other sexually transmitted diseases, such as gonorrhoea, syphilis, non-gonococco urethritis and so on, there is no need to disclose the full name, the identity card or passport number, address, etc, of the patient. The only exception for full information is on HIV. I am not sure about the STD that Dr Tan mentioned. I could ask my officers to look into this and whether it is specifically mentioned in the form. There is no need to add the word "designated" before "sexually transmitted diseases" in this amendment or in the law itself because it is fully understood that the list of diseases will be gazetted and that the law will apply to these gazetted conditions. Two Members have complained about the language of this Bill. I will feedback this to the Attorney-General's Chambers. In fact, I also spent quite a lot of time trying to read through this Bill. May I address some of Dr Lily Neo's points. Again, I thank her for supporting this Bill. As for her point about the severity of the new penalties on blood donors who give false information or wilfully donate blood even though they know of their own HIV status, my Ministry will revise the Donor's Health Assessment questionnaire to include the new provisions of the amended Act. Even in the existing blood Donor Health Assessment Questionnaire, we have already warned them about the danger of donating contaminated blood which is not suitable for transfusion and if they do so, they would be liable to prosecution and would face serious consequences.”
“I would like to thank the Members of the House who spoke in such strong support of this Bill. We all realise that Singapore is open to the world trend of increase in AIDS/HIV infection, and therefore we must do our utmost to try to contain the problem, to prevent its spread among the population and to educate people to avoid the risk of infection. I agree completely with Mr Bernard Chen, Dr Lily Neo and also Mr Shriniwas Rai that public education is very, very important. We will do our best in this respect to help prevent the disease and its spread. Now, let me address some of the specific points brought up by my colleagues here. Dr Tan Cheng Bock talked about the Explanatory Statement where "any other sexually transmitted disease" is mentioned. He said that he could not find this phrase in this Amendment Bill and he was concerned that this is too blanket a statement which would seem to allow the disclosure of a whole range of sexually transmitted diseases on the same ground or at par with HIV infection. Actually this Amendment Bill is an extension of the 1992 Amendment Act where, in section 20D, it is mentioned "or is suffering from a sexually transmitted disease" which is any other STD. I would like to point out that there is a reason for this. By inserting "any other sexually transmitted disease" is to cater for a situation when, apart from HIV, some time in the future, we may discover another very deadly disease that we have to control on the same ground and use the same measures as we control HIV. So that is a contingency.”
“At the same time, we will continue and step up our public education on AIDS, so that all Singaporeans will become fully aware of the danger of the infection and take preventive measures to avoid the risk of being infected. Sir, the proposed amendments to the Infectious Diseases Act will enable my Ministry to step up the public health control of AIDS in Singapore. It will help to prevent further transmission of the infection among the population, and allow those who may be innocently infected to seek screening and early treatment. It will also enhance further the safety of our national blood supply. Sir, I beg to move. Question proposed.”
“Under the Amendment Bill, the Minister is empowered to authorise the publication of information which may identify the HIV infected person in instances where the health or safety of the public is threatened. I would like to assure the House that this provision would only be evoked under extreme circumstances, such as when an infected person wilfully continues to place others at risk of contracting the infection, and the disclosure can only be done with the Minister's approval. Re-disclosure of information To ensure that there is no abuse despite the increase in the categories of persons to whom information on the HIV infected person can be disclosed to, the Bill has included a provision under clause 7, subsection 9, in which no person to whom any information on a HIV infected person has been disclosed, shall re-disclose such information to anyone except to persons stipulated in the Act. Unauthorised re-disclosure will be dealt with seriously. The penalty is a fine of $10,000 or imprisonment for a term not exceeding three months or both. In conclusion, with the increasing incidence and changing pattern of HIV infection in Singapore, the amendments to the Infectious Diseases Act are necessary to ensure that the health of our people is not compromised. All of us, doctors, neighbours and friends, members of the public, should continue to empathise with HIV patients and their families. AIDS is a dreadful disease that causes great suffering and social stigma to the victims and their loved ones. We must continue to help them and treat them humanely and with great compassion. My Ministry will ensure that the new provisions under the Infectious Diseases Act will not be abused and the rights and confidentiality of the infected person are protected as far as possible.”
“My Ministry strongly views that the spouse or contact who has been exposed to the risk of infection has a right to know so that they can be counselled and screened for the infection. Those who are not infected can take the necessary precautions to protect themselves against any further exposure to the HIV while those who may be infected will have a chance to undergo anti-retroviral therapy while they are in the early stages of the infection and make the relevant choices. For example, for infected wives who are pregnant, early diagnosis will allow a choice to abort the pregnancy or to take prophylactic measures to prevent transmission of HIV to the baby. My Ministry will continue to counsel those who are infected on the importance of disclosure so that they inform their spouses and contacts themselves and to bring them forward for counselling and screening. However, we will need to apply this legal provision if the counselling fails. Clause 7(d) of the Amendment Bill also enables the disclosure of the identity of a HIV infected person to the health care workers who have previously treated him/her, or to any other person who, in the act of rendering emergency assistance to a HIV infected person, has therefore been exposed to the risk of infection with the HIV. Other new provisions under clause 7(c) of the Amendment Bill would allow my Ministry to disclose the identity of HIV infected foreigners to the Controller of Immigration for the purposes of the Immigration Act, and the disclosure to the next of kin of the HIV infected person in the event of death, because special burial arrangements have to be made to ensure that public health is safeguarded.”
“Exceptions to Medical Confidentiality The identity of the person with AIDS/HIV infection is protected under section 20D of the existing Act, where disclosure of identity and HIV status is allowed only to specified categories of persons. To address the public health issues that have arisen over recent years which I have described just now, my Ministry proposes that new exceptions to medical confidentiality be included. The main objective of such new exceptions is to prevent transmission of the infection through irresponsible behaviour by persons who are infected and to allow those who have been exposed to the risk of the infection to be informed early, counselled and tested. With the availability of newer anti-retroviral drugs, early diagnosis will allow such victims to be treated to delay the progress to full blown AIDS. The treatment will also allow for a better quality of life on the part of the patients. Under clause 7(d) of the Amendment Bill, new provisions have been provided to allow the disclosure of the HIV status and the identity of the HIV infected person to his/her spouse and contacts. This amendment is to cater to the increasing incidence of HIV infection among married persons. From our experience, the infected person is sometimes reluctant to inform the spouse or contact despite numerous counselling sessions and advice from the doctors. Some have even refused to do so. Under the existing Act, my Ministry is unable to take any further action should the patient refuse to inform his or her spouse or contact. The new provision will allow the doctor to disclose the HIV status of the patient to the spouse or contact if the patient refuses to do so despite repeated counselling by the doctor.”
“Provisions have also been made for disclosure to health care providers and other personnel who had come in contact with blood or body fluids of an infected person, and to the next of kin upon death of the infected person as well as in the interest of public health if it is threatened. Even in the United States where there were earlier laws to protect the civil liberties of HIV infected persons, new legislation has been introduced more recently to identify, notify and make it an offence for those who intentionally place others at risk of contracting the infection. Infectious Diseases (Amendment) Bill Sir, I will now deal with the main provisions of the Bill. Currently, a person who furnishes false information at the Blood Bank is charged under section 182 of the Penal Code. This carries a maximum penalty of $1,000 and/or a maximum jail sentence of six months. My Ministry proposes to make this an offence under the Infectious Diseases Act so that the appropriate penalty commensurate with the severity of the offence can be meted out. In the Amendment Bill, under a new section 10A, it is an offence to furnish false or misleading information in relation to the donation of blood. The maximum penalty under this section is a fine of $20,000 or a term of imprisonment not exceeding two years or both. Consequent to such a new provision, section 20C of the principal Act is amended to raise the penalty for a person who knows that he is HIV infected and yet donates blood or does any act that is likely to result in the spread of the disease from $10,000 to $50,000.”
“This is despite the stringent measures taken by the Singapore Blood Transfusion Services (SBTS) to exclude donors with risk factors because the donor had lied in this case. The HIV infected donor admitted to a total of six offences under section 182 of the Penal Code. He was charged in court early last year and given a sentence of 12 months. This penalty is hardly commensurate with the harm the donor had caused to the two recipients who received his blood. In 1997, my Ministry was also notified of a health care worker who was HIV infected. All the health care worker's patients, who were exposed to the risk of acquiring the infection through clinical procedures that were carried out on them, were informed, counselled and offered HIV screening. This look back programme to trace the contacts of the health care worker cost my Ministry $400,000. Fortunately, none was infected. Sir, with the changing pattern of transmission of HIV infection in Singapore, we have to address these new and emerging issues pertaining to the HIV infection here. My Ministry has reviewed the law and put up new strategies to ensure that the health of our people is not compromised. Timely actions need to be taken to prevent further spread of the disease within the population. My Ministry has studied the existing Infectious Diseases Act and has proposed several amendments to the existing Act to tighten the control of HIV infection in Singapore. Several countries responding to the AIDS epidemic, like the United States, Britain and Australia, have legislation to protect the public. Legislation in these countries has been enacted to allow for the disclosure of the HIV status of a patient to the spouse, sexual partner or contact.”
“In addition, a total of 2,813 foreigners had been tested to be HIV positive while they were in Singapore. About 80% of such foreigners were work permit holders and applicants. They have already left Singapore. The pattern of transmission of the HIV infection has changed over the years, from a predominantly homosexual infection to one that is mostly spread by heterosexual transmission. Over the last three years, heterosexual transmission accounted for an average of 78% of all new cases. Most of these cases had unprotected sex with prostitutes and casual acquaintances in Singapore or abroad. The pattern of heterosexual infection itself has also changed. The proportion of married men among new cases of HIV infection among male Singaporeans has increased from 10% in 1991 to 30% in 1998. With this shift of the infection to the married population, infected men are bringing the infection home to their wives. A further tragic consequence is that there are more reports recently of children with HIV infection. The first HIV infected child was reported in 1991. Since then, eight more cases have been reported between 1997 and l998. All of them have been infected perinatally. Families have been devastated by the HIV infection. We have had at least two families where all members were infected. This emerging trend needs to be addressed. Another major concern that has arisen recently is HIV transmission through blood transfusion. In 1997, my Ministry reported the first case of HIV transmission through blood transfusion. Two persons became infected after they received blood from a donor who was in the window period of the HIV infection.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." This Bill seeks to amend the Infectious Diseases Act (Chapter 137 of the 1985 Revised Edition) and the Infectious Diseases (Amendment) Act 1992, to strengthen the public health control of Acquired Immune Deficiency Syndrome (AIDS) in Singapore. The Infectious Diseases Act was passed in 1976 to prevent the introduction and spread of all infectious diseases in Singapore. AIDS, which is caused by the Human Immunodeficiency Virus (HIV), became a notifiable disease under the Infectious Diseases Act in 1985. In 1992, the Act was amended to include provisions to tighten the control of AIDS and to provide for the confidentiality of infected persons. However, changing trends of HIV infection in recent years require us to make further amendments to the Act in order to strengthen the public health control of AIDS in Singapore. Before I go into the details about the Bill, let me brief the House on these trends and therefore the need for changes to the existing law. HIV/AIDS situation in Singapore The number of HIV infected Singaporeans has been increasing over the years since 1985 when the first case was reported. Between 1985 and 1990, a total of 61 cases were reported. The rate of increase has accelerated since then. In 1991 alone, 42 new cases of HIV/AIDS were reported, as against the total of 61 cases between 1985-1990. Over the last four years, the number of cases shot up to more than 100 per year. Last year, 1998, the number climbed to nearly 200. The exact number was 199. In total, there were 930 Singapore residents notified to be HIV infected between 1985 and 1998, of whom 423 had asymptomatic infection, 196 had full blown AIDS and 311 had passed away.”
“This is the best way to cut down the burden of his own healthcare costs, the burden to his family, to the community and, eventually, also to the Government, because the Government heavily subsidises healthcare. I would like to conclude by saying that we are committed to ensuring that the elderly have access to affordable long-term care, but health is also very much in our own hands. Question put, and agreed to. Resolved, That Parliament do now adjourn. Adjourned accordingly at Nineteen Minutes past Eight o'clock pm to Friday, 26th February, 1999. WRITTEN ANSWERS TO QUESTIONS FOR ORAL ANSWER NOT ANSWERED BY 1.30 PM HOSPITALISATION AND MEDICAL EXPENSES FOR PERSONS ABOVE 55 YEARS 14. Mdm Claire Chiang See Ngoh asked the Minister for Health, from 1994 to 1998, (a) how many persons above 55 years old without savings in the Central Provident Fund were admitted to hospitals; (b) how many in this age category with Medisave accounts were unable to meet their medical expenses; and (c) how the hospitals handled these cases.”
“I would also like to say that MOH is not only concerned with the availability of long-term care services. These services must meet certain standards set by my Ministry for obvious reasons, like physical standards and quality of care provided for patients. We have drawn up guidelines on physical facilities and the staffing ratio already. Guidelines on care standards are also being developed. Once these are developed, they would apply to all the nursing homes and other long-term care facilities. It is important to ensure that individuals are able to finance their own long-term care needs, especially during old age, and this is apart from Government subsidies and the subsidies provided by the VWOs through their fund-raising efforts. We recognise and appreciate the efforts put in by the VWOs in raising funds, in providing the services, in running the homes and community hospitals. In fact, we are deliberating on how we can help them to reduce their load of fund-raising. We are also considering how individuals and families could be helped, apart from Medisave and MediShield, to finance their share of long-term care. The Inter-Ministerial Committee on Healthcare for the Elderly has considered the suggestions which have been put forward by its members and by members of the community. Its report and recommendations will be released soon. So I would not disclose further details on these financing aspects. Finally, I agree with Dr Lily Neo, I agree very much indeed - and this has been the emphasis of my work in the Ministry in the past years - that everybody, whether young or old, must put emphasis on leading a healthy lifestyle.”
“By the year 2003, there would be an increase of 800 community hospital beds and chronic sick beds. Currently, there is no shortage of places at the day rehabilitation centres. However, there is a need to provide home care services. As the Member so rightly pointed out, some patients could be taken care of at home and it might be better for them to be cared for by family members or care-givers. So MOH is encouraging more VWOs to provide home-care services for the elderly sick. The Government will continue to provide financial assistance to VWOs for the development of facilities and services for the elderly sick. I would like to stress that funds provided by the Ministry of Finance have not been reduced, despite the economic downturn. Between 1996 and 1998, we have provided $33.4 million to nursing home projects. Between 1999 and the year 2001, we will be providing $131 million. If you take into consideration the other long-term care facilities, such as community hospitals and chronic sick hospitals, then, from now till the year 2003, MOH expects to spend $235 million to assist the VWOs to build these long-term facilities. The case of the Kwong Wai Shiu Hospital, as we explained in the written answer to the Member already, is that originally, they had a very grand plan of building a 1,500-bed convalescent hospital cum nursing home. We went back to them and asked them to reconsider the plan. We asked them whether this was realistic in terms of the resources and so on. The redevelopment plan is now still at the concept stage and is being revised. Once the details are firmed up, we will be able to work out the funding details. So we are asking them to revise the plan and to be more realistic and more effective so as to meet with our requirements.”
“When this is compared to the projected requirement of 6,750 beds, the shortfall will be reduced very significantly to only 350 beds in two years. With more nursing home projects coming on-stream between the year 2002 and 2003, there will be another 1,000 beds added to the stock, and this will, in fact, wipe out the shortfall. There will be no shortfall by the year 2003. The total supply of available beds by the year 2003 will be 7,400, which is in contrast to an earlier estimate we made in 1997, that only 6,600 nursing beds would be available. The revised figure is made possible because last year, we reviewed the nursing home building programme and re-prioritised the projects to ensure that those that could be moved ahead faster would receive higher priority for funding. New nursing homes that would add more nursing home beds compared with replacement or upgrading projects and those that could be put up at a lower cost received priority funding. As a result of our re-prioritisation exercise, we were able to increase the number of nursing home beds available by the year 2003 from 6,600 to 7,400. As I have said, by the year 2003, we do not expect any shortfall and we would maintain this balance. Furthermore, we have begun to work with other VWOs on planning for nursing homes to come on-stream beyond the year 2003. The Member mentioned that there would be a requirement of 22,000 nursing home beds by the year 2030. But this is more than 30 years down the road. With the new momentum that we have created, we are confident that by that time, we would be amply prepared to meet the projected demand. I would like to say that besides nursing homes, we are also stepping up the provision of other long-term care facilities, such as community hospital beds and chronic sick beds.”
“So, much time has to be spent at meetings with the VWOs and their architects to assist them to revise the plans until they meet the MOH's requirements. The other reasons for the delays include delay in identifying suitable sites, the time required to assess community reaction, the formal allocation of site and the need to coordinate with various other agencies on the plans, such as with the URA, Land Office, PWD, LTA, and so on. The construction itself takes another 1.5 to two years. So under the present procedures, the minimum time required is 3.5 to four years for a development project to be completed. We have reviewed the process with a view to expediting the time required for project approval. It is true that presently we have a shortfall of nursing home beds. However, according to our latest projections, we should be able to correct this shortfall within the next five years. Let me elaborate. At the end of 1998, there were around 4,600 available nursing home beds. The shortfall was 1,600 beds. This shortfall is higher than the 1,300 beds quoted by Dr Neo, because she was referring to 1997 figures. The background is that between 1996 and 1998, there were only four nursing home projects (two were new homes and two were replacement homes) which were completed. And this added only 450 beds to our supply of beds. So there was a slight increase in the shortfall. We are stepping up our assistance to the VWOs. And we are currently working with 12 VWOs to build nursing homes to meet this shortfall. These projects are already in various advanced stages of development. Between 1999 and 2001, there will be nine new and replacement projects which will be completed, adding another 2,000 beds. This would give a total supply of around 6,400 beds.”
“Mr Deputy Speaker, Sir, my Ministry is not shelving the development of nursing homes. On the contrary, we are expediting and building more nursing homes. Let me explain. My Ministry is fully aware of the need to plan for the long-term care facilities for the elderly sick. Not every sick elderly person requires institutionalisation. According to a study done by the Ministry of Health a few years back, our estimate is that only about 3% of the total elderly population aged 65 years and above need some form of institutional care. MOH has been actively working with the Voluntary Welfare Organisations (VWOs) to build nursing homes and help those who are interested in doing so. Indeed, I agree with the Member, Dr Lily Neo, that nursing homes by far are a cheaper alternative to having patients staying unnecessarily long in our acute hospitals. Irrespective of the Casemix formula of funding hospitals, which is actually still at the trial stage, there is need for us to provide the cheaper alternative, that is, in terms of nursing homes for the elderly patients. However, many VWOs have problems implementing their projects on time. The length of time taken for a project to be approved for funding is dependent on the VWO's proposal meeting MOH's guideline on the setting up of nursing homes and also the obtaining of the necessary approvals from various Government departments. The average time taken for a project plan to be finalised is around two years. But there are often delays in the planning and design phase carried out by the VWOs, and these are due to several factors. Firstly, the VWOs tend to far exceed the space norms for approved facilities and they often want to include facilities which turn out to be not eligible for Government funding.”