Amy Khor Lean Suan
Singapore
“Sir, NEA does conduct inspections of these premises from time to time. For this particular premises, they actually did six inspections since 2021.”
“The Land Transport Authority (LTA) conducts enforcement actions against drivers who are found to have provided illegal car-pooling services. An individual who provides an illegal car-pooling service may face a fine of up to $3,000, up to six months' imprisonment, or both.”
“We will also provide the first 500 private heavy vehicle chargers co-funding of up to 50% of the charger installation cost, capped at $30,000 per charger. These measures will narrow the lifecycle cost gap between an electric and internal combustion engine heavy vehicle and spur adoption of electric heavy vehicles.”
“With regard to the extension of the lower speed limit to school zones for full day, we will work with the relevant agencies on the enhanced enforcements.”
“They will provide a certain amount of protection to the pedestrians because, as I have said, the bollards will absorb the impact of the collision from the vehicles. So, there is a protection. But ultimately, of course, road safety really depends on a multitude of factors, including road user behaviour.”
“The bollards installed at pedestrian crossings by the Land Transport Authority (LTA) are not of the K4, K8 or K12 standards stated by the Member. Bollards of these standards are typically security bollards. They are installed to protect critical infrastructure or at high security areas, such as Changi Airport, to be unyielding.”
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“30 pm I will now move on to hawker centres. Our hawker centres serve important social objectives of providing affordable food in a hygienic environment for patrons, enabling hawkers to earn a decent livelihood and creating vibrant social spaces to bond our communities. However, hawkers face many challenges today, from changing demographics and customer preferences to new models of competition, such as central kitchens and food delivery services. It can be even more difficult for hawkers in new hawker centres. They face competition from other F&B options in the vicinity and need time to build up their clientele. This is why my Ministry piloted the SEHC model to help hawkers compete better as a Centre. As Mr Liang Eng Hwa said, last year, NEA addressed concerns on contractual terms, such as opening hours and termination notice periods. I visited all seven SEHCs to get feedback from the stallholders on the changes made and am pleased that the majority of stallholders have welcomed them. We will continue to improve the model based on feedback from hawkers and other stakeholders. One area of concern is attracting and supporting new entrants into the hawker trade. Without new hawkers, future generations would not be able to enjoy hawker food. It is, therefore, critical that we imbue new hawkers with key skills to succeed. This is why NEA set up the Incubation Stall Programme (ISP) and worked with the People's Association and ITE to set up hawker training programmes that cover business management and operation, marketing and culinary skills. Mr Gan Thiam Poh asked for an update on ISP. I am pleased that six new stallholders will be joining NEA's ISP, bringing the total number of incubation stalls in operation to 10.”
“Mr Low Thia Khiang asked for an update on the provision of the Inland Ash Scattering (IAS) facilities and the proposed post-death rites facility at Tanah Merah. IAS services are on track to be available at Choa Chu Kang Cemetery by 2020 and Mandai Crematorium and Columbarium Complex by 2021. NEA is working on the designs to incorporate suggestions from consultations with funeral service providers, religious leaders and members of the public. When completed, these secular facilities will be an additional option for bereaved families to lay their loved ones to rest in a dignified and respectful environment. The Environmental Impact Study commissioned for the proposed post-death rites facility at Tanah Merah is in progress. We will consider the results of the study and public feedback before arriving at a final decision. Mr Dennis Tan asked about actions taken against the contractor who had provided quartz instead of marble plaques when relocating niches from Mount Vernon Columbarium Complex. There was no evidence from NEA’s investigation to suggest that the contractor had deliberately provided a different material with the intention to cheat. NEA’s checks also showed that the marble and quartz plaque prices were comparable. NEA has required the contractor to remedy the breach of contractual requirements. The contractor has undertaken remedial measures to replace the quartz plaques with new marble ones and will be bearing all additional costs incurred. As a further penalty, the contractor will also bear additional manpower costs incurred by NEA to oversee the niche replacement works. NEA will continue to monitor the replacement works closely. So far, there have been no anomalies detected during laboratory tests and visual inspections. 6.”
“Since September last year, disposables are also no longer permitted for dine-in when new cooked food stallholders operate at existing NEA-managed centres, that means for new stallholders, new tenancies. NEA will continue to work with existing stallholders to not use disposables for dine-in. Assoc Prof Daniel Goh asked about promoting the reuse of construction and demolition (C&D) waste. Singapore recycles 99% of our C&D waste. For instance, waste concrete is mostly processed to produce recycled aggregates. This is a good example of the circular economy in action! BCA has published a Sustainable Construction Guide with useful information on recycled construction materials and their applications. Ms Irene Quay raised the issue of medication waste. I agree it is important to curb over-prescription of medicine. By not over-buying medication that will be wasted, patients also save money. Some hospitals limit prescriptions to no more than three months’ supply of normal medicine and no more than six months’ supply for chronic illnesses. Certain pharmacies put additional labelling on drug packaging to inform patients to return unused drugs. Pharmacists also counsel patients and review their medication supply to ensure that patients do not take more medication than needed. Generally, household drugs can be safely disposed of together with household waste. All our household waste is collected and safely incinerated before the ash is landfilled in Semakau Landfill. Some people may not know this, but my Ministry also oversees the planning of after-death facilities and services, which some may view as a morbid endeavour. Nonetheless, someone has to do it. And, indeed, it is – pardon the pun – a deadly serious matter that has to be handled sensitively.”
“My Ministry will also work with owners of large public sector buildings with F&B outlets to segregate food waste for treatment from 2021. We are exploring doing so under the Public Sector Taking the Lead in Environmental Sustainability (PSTLES) initiative. PSTLES already builds environmental sustainability into our Government procurement, which Mr Louis Ng asked about. Public sector agencies must purchase Energy Star-certified ICT equipment, eco-labelled printing paper and energy-efficient appliances. Er Dr Lee Bee Wah asked if we proactively identify companies with greater potential to reduce waste. Since 2014, owners and managers of large hotels and malls have been reporting their general waste data and waste reduction plans to NEA. This focuses attention on waste generation by premises and the potential for reduction and recycling. More than 90% of hotels and malls covered have now adopted recycling programmes. From 2020, we will extend the mandatory waste reporting scheme to other large waste generators. These are factories, warehouses and convention and exhibition centres above a certain gross floor area. Er Dr Lee Bee Wah also spoke about the dilemma of replacing disposables with reusables which require washing. NEA's lifecycle assessment on the environmental impact of carrier bags and food containers showed that reusables had a lower overall environmental impact than disposables. Hence, opting for reusables is better for the environment. Mr Louis Ng asked about the use of disposables for dining-in at hawker centres, which is already disallowed in new hawker centres.”
“The residents were delighted to receive packets of the fertiliser, a very tangible symbol of their efforts in closing the food waste loop. The pilot, which was due to end in October last year, has been extended at the request of the residents. We are encouraged by their enthusiasm and are working with Zero Waste SG to explore how we can enhance involvement and ownership by the community. I am also glad that with the support of NEA's 3R Fund, onsite food waste treatment systems have been installed in 23 premises. We are now ready to expand food waste segregation, starting with larger food waste generators. NEA has started consulting the industry on requirements for food waste segregation for treatment. From 2024, we will require commercial and industrial premises that generate large amounts of food waste to segregate it for treatment. Premises include hotels and malls, and industrial developments housing food manufacturers, caterers and food storage warehouses. Existing premises can choose the treatment solution that best suits their operations, including offsite treatment at the upcoming Tuas Nexus. Unlike existing premises, new premises can plan for onsite food waste treatment in their building design. We will require developers of new developments where large amounts of food waste are expected to be generated to cater for onsite food waste treatment to be implemented. These must be included in the building plans submitted from 2021. We will continue to provide support for premises and invite interested parties to implement onsite food waste treatment before the mandatory requirements take effect. Premises can tap on funding support, such as the 3R Fund.”
“An EPR framework would incentivise upstream reductions in packaging, an outcome similar to what Mr Louis Ng envisaged through setting mandatory reduction targets. EPR is a more holistic way of addressing packaging waste, including single-use plastics. For example, by voluntarily changing the packaging design and optimising production practices, Nestlé Singapore has saved 2,000 tonnes of packaging used for its MILO® products. This is not only good for the environment; it also reduces business costs. We will continue to engage the 3P sector as we develop this EPR framework. Even as we study EPR, we are working with the industry on new initiatives to collect back packaging waste, such as PET bottles and aluminium cans. For instance, we are collaborating with partners to tap on the Towards Zero Waste Grant to roll out 50 reverse vending machines in major malls and the community later this year. Assoc Prof Daniel Goh suggested a need to address packaging due to the rise in online shopping and home delivery. Supermarkets, which usually offer online retail services and home deliveries, will be covered under the mandatory packaging reporting requirements. Mr Liang Eng Hwa asked about the current state of food waste and our measures to manage this. In 2018, we generated 763,000 tonnes of food waste. Of this, only 17% was recycled. We conducted a food waste segregation pilot at Tampines Greenlace estate in August last year. The residents participated actively, with one in three households depositing food waste in dedicated bins at least once a week. Over three months, more than 4,000 kg of food waste from Tampines Greenlace were recycled into fertilisers.”
“The framework will include new recycling requirements to ensure that all collected e-waste is properly treated to facilitate the recovery of resources, such as gold, and the removal of harmful substances. We note Mr Louis Ng's suggestion on the recovery of coltan. We are still consulting the industry on the recycling requirements. To support this framework, NEA will actively develop the e-waste industry, such as the skills and capabilities of our local recyclers. This will create more good job opportunities for Singaporeans, including opportunities in the PRO, supply chain management and e-waste recycling. Packaging waste, including plastics, is another priority for my Ministry. Packaging waste comprised one-third of domestic waste disposed of in 2018. Mr Louis Ng asked for more details on the mandatory packaging reporting framework for businesses to be introduced in 2020. We will require producers of packaging and packaged products to report to NEA how much packaging they put-to-market annually. They must also submit their plans to reduce, reuse or recycle packaging waste. For a start, we will exempt micro and small enterprises with an annual turnover of $10 million or less. NEA will monitor the companies’ packaging data and 3R plans over the next few years and explore with them ways to reduce packaging waste. NEA will also engage companies to simplify reporting procedures and minimise compliance costs. Mandatory reporting is the first step in our plan to introduce an EPR framework for managing packaging waste, including plastics, by 2025. Similar to e-waste, we are studying how producers can assume responsibility in collecting and treating packaging waste.”
“All producers of non-consumer EEE will be required to take back all end-of-life products for free upon request. This covers commercial and industrial equipment, such as solar panels and data servers. We will not require them to finance a PRO, as they have existing take-back processes. Retailers must also offer free one-to-one takeback services during delivery; for example, to take away the old refrigerator when delivering a new one. Further, retailers with an EEE sales area of more than 300 square metres must provide in-store collection points. This provides consumers with convenient avenues for recycling e-waste. Many retailers and partners already provide such collection points voluntarily. For example, NEA partnered StarHub, DHL and TES to bring the RENEW programme to Best Denki, Courts, Gain City and Harvey Norman. They have collected more than 3,200 kilogrammes (kg) of e-waste across 20 outlets since June last year. Altogether, there are currently about 500 e-waste recycling bins island-wide, which can be located via myENV app. I encourage everyone to take advantage of these convenient channels to recycle your e-waste, including rechargeable lithium-ion batteries from our mobile phones. Mr Chairman, with your permission, I would like to show some slides.”
“It is critical that we manage our e-waste properly: first, to avoid contaminating our landfill and water catchment with toxic substances; second, to protect the health of workers who handle these discarded products; and third, to extract valuable materials that can be recycled into new products. We will do so through the Extended Producer Responsibility (EPR) framework, which makes producers financially and physically responsible for the end-of-life collection and treatment of their products. Mr Louis Ng and Miss Cheng Li Hui asked for details of the framework, which will come into effect in 2021. We have no plans to bring the start date forward. Industry feedback has highlighted that both producers and recyclers need sufficient time to adjust. The framework will apply to electrical and electronic equipment, or what we call "triple E" (EEE), which are categorised as Information and Communications Technology (ICT) equipment, batteries, lamps, solar panels and large appliances. Large appliances will now include electric mobility devices like e-scooters and power-assisted bicycles. Almost 90% of e-waste in Singapore will be covered. 6.15 pm Arising from industry feedback, NEA will appoint a single Producer Responsibility Organisation (PRO) to reap economies of scale. Producers of EEE for the consumer market, such as laptops and mobile phones, will be required to finance the PRO. We will exempt small producers from financing the PRO to avoid imposing disproportionately high costs on them. PRO will collect and send the e-waste for recycling. NEA will impose collection targets on the PRO. But as a transitional measure, penalties for missing collection targets will not be enforced in the first three years.”
“Mr Chairman, in 2018, which was designated the Year of Climate Action, we rallied individuals and organisations and received more than 340,000 climate action pledges. Collectively, our people, public and private (3P) partners initiated and organised more than 800 climate action events. That is more than two events a day! It shows the far-reaching impact of consultation and partnership. To build on this momentum, we designated 2019 as the Year Towards Zero Waste. We will adopt a circular economy approach to conserve resources for a sustainable Singapore. We will release the inaugural Zero Waste Master Plan later this year. The Master Plan will cover our three priority waste streams of e-waste, packaging waste, including plastics and food waste. We hope that it will align the 3P sectors and the research and development community towards a common vision of a Zero Waste Nation. The Master Plan brings together our collective efforts over several years. Last year alone, NEA consulted more than 250 companies on measures to address our priority waste streams. NEA has also approved two Environmental Services Regulatory Sandbox applications since it was launched in July 2018. These efforts help us to co-create our regulations with the industry, ensuring we minimise business costs and enhance sustainable economic growth. To effect our plans, we will be introducing the Resource Sustainability Bill this year to cover management of the three priority waste streams. The Bill also aims to support economic opportunities in innovative circular business models and the rising demand for resource recovery in Singapore and the region. I will speak on e-waste first.”
“Since 2015, we have been significantly increasing aged care capacity in terms of nursing homes as well as community care, home and centre-based care facilities. In fact, we have added 2,700 daycare places since 2015 so that seniors can access daycare services near their homes. We have also added another 2,300 homecare places over the same period. In fact, the supply of home and daycare places has actually stabilised. We see sufficient capacity at the national level. So, in fact, at the national level, there are more vacancies than waitlisted seniors, except that there could be an imbalance in demand and supply within certain local areas because of patient or family preferences and so on. So, in those areas where there is an imbalance, we are actually ramping up capacity in terms of new centres, as well as building new centres. Our focus now is on the quality and variety of aged care services available. Earlier on in my speech, I said that we are actually looking at better integration of social and health services and, therefore, because the SACs have now come under MOH, together with the SCCs, we are now looking at a range of services that all these Senior Centres can offer within the community and, therefore, increasing access and availability of services for our seniors.”
“I thank the Member for reminding me about his cut. My apologies. In response to the cut, the current cut-off of 24 gestational weeks for abortion was based on scientific evidence of foetal viability outside the womb. According to local experts as well as based on our hospitals' experience, foetal viability below 24 weeks remains low. Furthermore, morbidities, such as neuro-developmental disabilities, are very high among the premature babies who survived. International studies and professional bodies also largely support the low foetal viability below 24 gestational weeks. In addition, in 2018, it is worthwhile to note that about 1% of all abortions performed were performed between 22 and 24 gestational weeks, of which more than half of these abortions were performed due to foetal anomalies and other medical reasons. So, essentially, the number of abortions below 24 but between 22 to 24 is already very low, and quite a large percentage is really due to medical reasons. So, what we have done, really, is also to work together with MSF to strengthen pre-abortion counselling and to raise awareness among these women with unplanned pregnancies of the options available to them, including adoptions. MOH will continue to monitor and review this issue as new evidence emerges.”
“To facilitate this, NNA will articulate the skills and competencies needed for nurses' evolving roles as part of the larger Skills Framework for Healthcare. We will deepen this framework, starting with the Community Nursing Competency Framework, which will be completed by May this year. This will be followed by frameworks for palliative and gerontology care in 2020. NNA’s efforts will benefit all nurses and healthcare providers in the public, private and community sectors. Mr Chairman, in conclusion, as MOH continues to empower all Singaporeans to take charge of our health, I invite everyone to work with us to add more life to years.”
“In line with the SkillsFuture movement, we worked with Nanyang and Ngee Ann Polytechnics to create a new, faster progression pathway for Enrolled Nurses who did well during their Institute of Technical Education (ITE) training, to upskill to a Registered Nurse. We now have a 2+2 Diploma in Nursing which will allow ITE upgraders to complete the Diploma in Nursing course in two years instead of the current 2.5 years. We will strengthen and better recognise workplace-based learning, to achieve the twin objectives of better care for our patients and professional growth for our healthcare staff. Assuring our staff of continued opportunities for professional development is key to retaining them in the healthcare workforce. I am pleased to announce that we will set up the National Nursing Academy (NNA) to coordinate and support lifelong learning across healthcare institutions, schools and training providers. NNA will oversee Continuing Education and Training efforts to develop future-ready nurses with the requisite skills and competencies to meet evolving healthcare needs. In line with the push towards digitalisation, the NNA platform will allow nurses and healthcare leaders to access a comprehensive suite of high-quality courses and learning opportunities online. Today, many healthcare providers have inhouse training programmes which are often not recognised and transferable across different institutions. The NNA will accredit and strengthen the quality of workplace-based training and develop a system to recognise the skills and competencies attained by a nurse at the workplace. This will make the skills portable and stackable to advance nurses’ careers and professional practice across healthcare institutions and settings.”
“They will be automatically eligible for subsidised cardiovascular risk screening under the Screen for Life programme, and will no longer need to take the online diabetes risk assessment tool to qualify. For women intending to enrol in in vitro fertilisation, Mr Louis Ng will be pleased to know that we will lift the requirement for purchase of Assisted Reproduction Programme insurance from 1 April 2019. This is because MediShield Life and MediSave now provide basic healthcare coverage for all Singaporeans from birth. Mr Christopher de Souza and Mr Dennis Tan asked about attracting more Singaporeans to nursing and supporting continuing development and career progression of healthcare professionals. 3.00 pm Over the last five years, we increased nursing intakes by around 30%. In 2018, we admitted more than 2,100 students, our highest intake to date, up from 1,600 in 2013. But it will be challenging to continually increase student intakes in view of falling cohort sizes. So, we need to look at mid-careerists, too, beyond supplementing our local workforce with foreigners. For those looking for a second career in healthcare, our Professional Conversion Programmes (PCPs) provide sponsorship for course fees and an allowance. In 2018, about 130 mid-career individuals embarked on our nursing PCPs, our highest intake in 10 years. MOH will continue to work with healthcare employers to improve retention, provide meaningful job opportunities, and enhance careers through multiple progression pathways and entry points to ensure we maintain a strong local core of the nursing workforce.”
“One focus area is cervical cancer. From 2011 to 2015, about 200 new cases were diagnosed annually and around 70 die of the disease every year. This cancer, which is caused by infection with the Human Papilloma Virus (HPV), can be prevented with vaccination and screening. To bring about more comprehensive coverage of HPV vaccination for cervical cancer prevention, MOH will offer fully subsidised HPV vaccination from April 2019 as part of our national school-based health programme similar to countries, such as the United Kingdom and Brunei. Current and future cohorts of Secondary 1 female students will be offered the HPV vaccination, and a one-time catch-up programme will be progressively provided for current cohorts of secondary school female students. All other female Singapore Citizens and Permanent Residents (PRs) from the same age-equivalent cohorts, including those studying in private education institutions, will also be eligible. The vaccination will be fully subsidised, as part of an opt-in scheme. For women aged 30 and above, we are introducing a more accurate HPV screening test for cervical cancer, which only needs to be done every five years, compared to the current recommended protocol involving Pap smear test which needs to be done once every three years. The better test will cost more, but the Government will provide more subsidies, so the cost to women will be the same in the long run. We will also make early screening more convenient for women with an history of gestational diabetes, who are at higher risk of diabetes later in life and need to start regular screening soon after pregnancy.”
“Also, eligible MG seniors will pay only $2 for screenings recommended under the Screen for Life programme, compared to up to $5 today. Finally, in 2021, when CareShield Life becomes available for existing cohorts, we will give an additional participation incentive of $1,500 to each MG senior who joins the scheme, on top of the $2,500 previously announced. MG seniors who join CareShield Life will hence receive participation incentives totalling $4,000 each, which will offset annual premiums for 10 years. Eligible seniors will receive a notification letter for the MGP by April 2019. From the same month, SGO will start to proactively reach out to 500,000 MG seniors to share details of the MGP. To Dr Chia Shi-Lu's query, beyond home visits, SGO will employ new approaches, such as group engagements at workplaces, which may be preferred by MG seniors, among whom one in two are working. SGO will also conduct engagements at community locations frequented by MG seniors, like hawker centres. It will connect MG seniors to volunteering and learning opportunities, such as the Retire with a Purpose (RWAP) programme under the Organisation of Senior Volunteers (RSVP) and National Silver Academy courses. As mentioned by Minister Gan Kim Yong, Senior Minister of State Sim Ann and I will co-chair an MG Communications and Engagement Taskforce to ensure effective communications and outreach to our MGs and their family members. The taskforce comprises 23 members from the public, private and people sectors, which had its first meeting two weeks ago. Ms Tin Pei Ling noted that women are living longer and we must address their healthcare needs. The Women's Health Committee will continue to champion good health among Singaporean women at all stages of their life.”
“Two, additional MediShield Life premium subsidies for MG seniors will take effect. MG seniors will receive subsidies starting from 5% of their MediShield Life annual premiums and increasing to 10% after reaching 75 years old. Although system changes to automatically apply the additional subsidies will be ready only towards the end of this year, we will backdate the subsidies to 1 July, to allow more MG seniors to enjoy them. MG seniors with policy renewals between 1 July and 31 October this year will pay the full premium first and receive the additional subsidies as a refund automatically by the end December 2019. Three, the one-time $100 top-up to their PAssion Silver cards, we will share more details on how to redeem the top-up when ready. As they will have till 31 December next year to do so, and the credits do not expire, we would like to assure all our MG seniors that there is no need to rush. Come 1 November 2019, MG seniors will receive additional subsidies for outpatient care, for life. Implementing the outpatient subsidies involves many healthcare partners, who need to train frontline staff and make necessary system changes. We need time to do this properly and correctly so that implementation can be as smooth as possible. When MG seniors visit polyclinics and public specialist outpatient clinics from 1 November 2019 onwards, they will automatically receive an additional 25% off their subsidised bills. MG seniors can also bring their MG cards when they visit CHAS GP and dental clinics, to enjoy special subsidies of up to $23.50 per visit for common illnesses, $520 in annual chronic subsidies and $261.50 per procedure for dental procedures.”
“The Community Health Assessment Team (CHAT) operates a mental health wellness centre for youths, which has reached out and provided mental health assessment to more than 3,100 at-risk youths as of December last year. As social and mental health issues are interlinked, we will take a more holistic approach for at-risk youths. MOH will develop a new integrated youth service, together with community youth partners, IMH, AIC, NCSS and HPB. We will expand on the success of the CHAT model to increase outreach and educate youths on resilience and mental well-being. Those who need help will be referred to social and health services for assistance and intervention in an integrated manner. MOH will update the enhanced Community Mental Health Masterplan and rally a whole-of-society effort to build communities of care around mental health patients and their caregivers. MGP is a major fiscal undertaking and is our show of appreciation and support for the MG in their silver years. After the Prime Minister announced the MGP at the National Day Rally last year, many of my MG cohort friends excitedly asked me "What, what, what are the benefits?" Following Minister Heng Swee Keat's Budget speech, the constant refrain became "When, when, when, when will I get these benefits?" We want our MG seniors to benefit from the package as soon as possible. Implementing the MGP is a major effort involving multiple Government agencies and partners, and we are working closely to roll out the benefits quickly. The bulk of the MGP benefits will be available in two tranches, in July and November 2019. From July 2019, MG seniors will receive three benefits. One, their MediSave accounts will be automatically credited with their first $200 top-up, which they will continue to get once every year until 2023.”
“Over 2,700 individuals have been supported with medical care or social support according to their needs. We will continue to work with agencies like the Ministry of Home Affairs and HDB, grassroots leaders and VWOs to identify and provide social and medical support for those in need, including persons who exhibit behavioural challenges in the community. Addressing the stigma associated with mental health conditions is also a collective effort. NCSS and IMH launched the "Beyond the Label" campaign in September 2018. We hope this will catalyse more conversations about mental health and encourage those facing such challenges to seek help. To strengthen care and support in the community, we increased access to mental health and dementia services in 12 polyclinics, up from eight in 2018 and also at our GP clinics. As of December 2018, over 190 GPs have been trained to diagnose and support persons with mental health conditions. Twenty allied health-led community intervention teams were established to support GPs and community organisations in managing persons with mental health conditions. Beyond building on existing efforts and scaling up programmes, we are developing new initiatives to better address emerging areas. Following the NurtureSG Taskforce's recommendation to better support youths, the Ministry of Education (MOE) and HPB have been establishing peer support structures in mainstream schools and Institutes of Higher Learning to equip students to look out for signs of mental stress among peers, and support and encourage them to seek help when needed. Since 2007, about 2,400 Allied Educators have received training to identify and support students who require referrals to mental health services. We will train more moving forward.”
“I agree with Mr Christopher de Souza and Mr Melvin Yong as well as Ms Anthea Ong that we must support persons with mental health conditions and their caregivers. In 2017, arising from the recommendations of the Inter-agency Committee on Community Mental Health, MOH launched the enhanced Community Mental Health Masterplan to further strengthen mental healthcare. We have made good progress since in increasing outreach, early detection and providing care and support in the community. Through a multi-pronged approach strategy, we bring the community together to raise awareness and support for seniors with or are at-risk of dementia and depression. Thirty-nine community outreach teams have been set up and have reached out to over 210,000 people. We are on track to meet our 2021 target of 50 teams. We established eight Dementia-Friendly Communities, building networks of support around those with dementia and their caregivers. Our Dementia Friends Mobile App has encouraged more than 4,100 people to sign up as Dementia Friends and assisted over 50 persons since its launch in October 2018. Our Community Network for Seniors (CNS) has been expanded nationwide to anchor a strong community care system for seniors, including those with mental health conditions. Under CNS, SGAs proactively reach out to seniors, referring those with possible mental health conditions to support services. Community befrienders visit lonely seniors regularly, providing them with emotional support to keep social isolation and depression at bay. Furthermore, AIC has trained over 14,000 frontline staff from Government agencies and community partners to identify and respond to persons with mental health conditions.”
“For instance, healthy seniors could buy into basic services, such as light housekeeping. Additional services, like care coordination, can be layered on as their needs change. We have identified a possible location, and MND will share more on this. The development could comprise flats with senior-friendly features, complemented by communal spaces like recreation-cum-dining rooms with light programming to encourage interaction. MOH and MND will start Focus Group Discussions over the next few months to better understand Singaporeans' aspirations and finetune this new option for ageing-in-place before going to market. As Ms Tin Pei Ling suggested, we are tapping on technology to benefit seniors, starting with MG seniors who are more IT-literate. MOH is partnering the Smart Nation and Digital Government Office and the Public Service Division to include a new module under the existing Moments of Life app to support active ageing. I have seen a prototype and found it useful. The app will include an Active Ageing Programme finder that can show seniors programmes near their homes. Seniors can also use the app to check their eligibility for Government benefits like the MGP and the Goods and Services Tax Voucher scheme. In a later phase, we will explore features, such as allowing bookings for active ageing programmes. The app will be piloted later this year, and I look forward to using and sharing it. An ageing population raises demand for community mental health services. Someone once jokingly said to me, "The nice thing about ageing and losing your memory is that you make new friends every day!" Jokes aside, in reality, dementia can be debilitating not just to patients but also caregivers.”
“In response to Ms Joan Pereira and Dr Lily Neo, we aspire towards more age-friendly neighbourhoods, with accessible care and amenities. We are expanding aged care services capacity but must do so sustainably. MOH will partner our operators to enhance the scope and reach of services in our Senior Centres. For example, those currently providing daycare services may offer additional wellness programmes. Services will be made available to all seniors, not just those living in studio apartments and rental flats. We will work with operators, enhancing their capacity and capabilities, to implement this common vision of SACs, SCCs and AAHs as places where seniors can access a range of services from fiscal year 2020. 2.45 pm In relation to Mr Leon Perera's question, since 2012, we introduced the Build-Own-Lease framework to support efforts to increase capacity, encourage improvements in care quality while keeping fees affordable. Our tender process covers quality, including innovative care models, and affordable fees. The Agency for Integrated Care (AIC) supports providers in capability development, including leadership development, manpower recruitment and quality improvement programmes. To support preventive health, we grew the number of Community Health Posts to around 150. We will now expand the number of areas covered by Community Nursing teams from 18 to 29 areas around Singapore. We will also partner more Senior Centres to make community nursing services accessible to more seniors by 2020. Members, such as Ms Rahayu Mahzam, have called for Assisted Living options. MOH and the Ministry of National Development (MND) plan to launch a pilot where seniors buy a home bundled with a package of programmes and services that can be customised to suit their needs and preferences.”
“MOH works closely with our community care providers and healthcare professionals to deliver quality care, ensuring good governance over our services, while allowing room for the sector to evolve. To Ms Anthea Ong's query, in 2015, MOH developed developmental guidelines for home and daycare providers to work towards quality care. Healthcare professionals providing these services, such as doctors, nurses and therapists, must also be licensed by their professional bodies. Looking ahead, MOH will review the need for more formal regulation, including licensing under the proposed Healthcare Services Bill, as Mr Louis Ng has also asked in a PQ. We will adopt a risk-based approach, and subject services with higher patient risks to higher levels of regulation. Hence, we will start with licensing home medical services, and review the need to license other services as the sector evolves. Second, we will strengthen integration by providing places and programmes to address the social and healthcare needs of our seniors. Following the transfer of functions from MSF, as of end 2018, MOH oversees 127 SACs providing wellness programmes to seniors living in studio apartments and rental flats; 118 Senior Care Centres (SCCs) providing daycare and community rehabilitation services, and five Active Ageing Hubs (AAHs) serving seniors across a spectrum of needs. Chairman, may I display some slides?”
“This House recently saw a lively debate on ageing. I was encouraged by the support for the Action Plan for Successful Ageing launched in 2015, when I shared about its progress. As Minister Gan Kim Yong shared, our Life Expectancy and Healthy Life Expectancy are good. Nonetheless, through the Action Plan, we want to further help Singaporeans add more life to years, not just years to life. As we provide for seniors today, we will do more for seniors of tomorrow, who will live longer, be better educated and have different aspirations. MOH will conduct a public consultation later this year with stakeholders, including seniors, community and business partners, to develop an updated Action Plan. A study by the Duke-National University of Singapore (NUS) Centre for Ageing Research and Education showed that seniors who are supported by social networks and befriending can better manage their chronic diseases. Strengthening integration between social and healthcare is key to successful ageing. Let me elaborate on our efforts, which I call the "3 Ps" – People, Places and Programmes. First, we want to further enable people in the social and health sectors to integrate care for our seniors. Since the beginning of 2018, about 3,000 Silver Generation Ambassadors (SGAs) have engaged around 280,000 seniors, identifying seniors with needs and working with stakeholders to link them to active ageing, befriending and care services. Seniors can have their social and healthcare needs managed jointly by the Silver Generation Office (SGO) and Social Service Offices (SSOs). More of these offices will be co-located where possible. SGO is recruiting more SGAs to reach out to seniors, including the MG. I encourage Singaporeans to come forward and join this endeavour.”
“I thank the Member for the supplementary questions, as well as for his suggestions. First, as I have said earlier, any member of the public who actually observes such spillage on the road can report it to NEA. As I had also noted, NEA does stakeouts as well as deploy portable cameras for surveillance of such acts. Very often, our portable cameras are installed at hotspots where we have received quite a number of feedback cases and tip-offs about such spillage, for instance, near large construction sites or concrete batching plants where these vehicles often ply, in order to enforce against such vehicles and the drivers. I just wish to make a note that between 2016 and 2018, we received more than 300 instances of feedback on spillage on the roads from such trucks and lorries, and these numbers have been declining. So, the Member could follow up with NEA on the area that he is talking about. As regards the responsibility, as I have also said, upstream, we work with the commercial transport operators as well as the sand suppliers and remind them to inspect their lorry fleets frequently while making sure that their flap covers are operational. The drivers are responsible for ensuring that the flap covers properly cover the building materials before they drive off the site. That is why our Act makes them responsible, but we work with the vehicle owners to identify who the particular drivers are. As I have said, we will continue to see how we can engage with the commercial transport operators as well as the sand and building material suppliers upstream. 11.09 am”
“I thank the Member for the supplementary question. NEA employs portable surveillance cameras to detect vehicles that spill sand or other materials on public roads. They deploy such devices at hotspots to spot and identify errant vehicles and their drivers for further investigation and enforcement. In addition, NEA does stakeouts along public roads to spot and act against such errant vehicles and drivers. The Land Transport Authority (LTA), on the other hand, conducts routine patrols and operations to enforce against overloaded vehicles. Offenders who are caught with their trucks or lorries exceeding the maximum laden weight limit can be fined up to $1,000 upon conviction, jailed for up to three months or both.”
“As announced at the Committee of Supply last year, MOH is working closely with MND to develop new AL options that include care services. More details will be shared at the Committee of Supply this year. Longevity is not a curse but a blessing and offers us possibilities to live more meaningful and productive lives. As future cohorts of seniors are more educated and skilled, there is no better time to take advantage of our longer life years than now. Mr Speaker, I am a proud member of the Merdeka Generation and wish to end my speech by encouraging my fellow Merdeka Generation seniors to embrace our longer life years, be positive and proactive, so that we can age successfully. I personally believe that there is no better investment to make than that in good health. As the Chinese saying goes, "Health is Wealth" or "健康是财富". Just as the Pioneer and Merdeka Generations have each played key roles in shaping Singapore's early years, we all have a responsibility today to shape our communities to build successive generations of successful agers. On this note, Mr Speaker, I support both Motions. [Applause.]”
“Our tenders allow providers to propose how much they intend to charge patients based on what is sustainable to them, and the price competition helps keep nursing home fees affordable for elderly residents. We also regularly review our funding for nursing homes, separately from the providers' fee bids, to ensure providers are adequately funded for the services provided to subsidised residents. In fact, we recently reviewed and increased funding for nursing homes in 2018. We will continue to review our BOL framework to ensure that nursing home residents can access good and appropriate care at affordable fees. We continue to find innovative ways to mobilise community resources to better support our seniors, such as in the area of transport raised by Miss Cheryl Chan. AIC had worked with private-hire companies, such as Grab, to train their drivers to help seniors who have limited mobility or are in wheelchairs, get into or out of the car safely to bring them to their medical appointments or to senior centres. The GrabAssist service is also available for those who wish to book a ride from the over 1,000 drivers that have been trained to date. Another area we are looking to evolve new typologies of ageing in place is in the staging of assisted living (AL) services within housing estates. In 2014, we piloted "in situ" care precincts by staging care services and AL support out of SACs within rental precincts through our Care Close to Home (C2H) programme. C2H is currently offered at 15 sites across Singapore, including in Dr Lily Neo's ward, serving more than 3,500 clients. We are reviewing how we can develop new options of AL for seniors to facilitate ageing in place, as suggested also by Mr Henry Kwek, Ms Joan Pereira and Ms Rahayu Mahzam.”
“Under the Action Plan for Successful Ageing, we are also co-locating childcare and eldercare facilities, such as those in Mr Christopher de Souza's ward, to facilitate intergenerational programming. Third, we want to continue to evolve our typologies of ageing in place to meet the needs and aspirations of future generations of seniors. In recent years, the Government has announced efforts to ensure that our current and upcoming cohorts of seniors, such as the Merdeka Generation, have greater assurance for issues of concern to them, such as coping with healthcare expenses. More details on the Merdeka Generation Package will be shared at Budget. I will also share more about how we will reach out to the Merdeka Generation seniors at the Committee of Supply this year. We need to anticipate what future generations of seniors might deem important to age in place gracefully and confidently, and be prepared to evolve our models of care, or experiment with new ones. Mr Melvin Yong has suggested a review of the current Build-Own-Lease (BOL) funding model for nursing homes. We do regularly review our nursing home development costs and nursing home development models. Our BOL framework introduced in 2012 has allowed us to ramp up our nursing home capacity to meet the needs of our frail seniors. Under this framework, the Government pays for the capital costs of development and tenders out the operating rights to both private and VWO operators so that these operators do not have to bear the upfront capital costs. This model also allowed us to encourage quality care as providers are evaluated on the quality of their proposals, which includes aspects like model of care and community integration plans.”
“The suicide rates amongst Singapore residents aged 60 and above fell from 22.4 per 100,000 residents in 2007 to 16.4 in 2017. Nonetheless, each suicide is one too many. Hence, we will further strengthen our efforts to prevent suicides by proactively reaching out to pre-empt social isolation and provide support for those at risk. For example, our SG Ambassadors today are trained to identify seniors at risk of social isolation when they make their home visits and will proactively link them up to community befrienders in their neighbourhood who can check in on them regularly. Care Line, a 24-hour senior helpline, which will be expanded nationwide, also calls seniors regularly to check whether they are well and provides urgent assistance if seniors call in, distressed. Our community outreach teams managed by community service providers also reach out to seniors with or at-risk of dementia and depression. Er Dr Lee Bee Wah shared examples of how the senior residents in her constituency help other seniors. Indeed, seniors find it easier to relate to and befriend other seniors, for example, by being able to communicate in their native dialect and mother tongue. They are a valuable volunteer resource pool to tap on, as highlighted by Ms Joan Pereira. In fact, four in five community befrienders and one in four of our SG Ambassadors are senior volunteers. Building communities of care involves our younger generation as well, and I am heartened to hear of the intergenerational initiatives shared by Mr Mohamed Irshad. The Council for Third Age (C3A) organises intergenerational learning programmes which provide opportunities for seniors and students to interact and learn from each other. More than 20,000 students have participated in such programmes to date.”
“Second, we want to enable strong and cohesive networks of care that support all seniors, especially vulnerable seniors, to age in place with dignity. Senior Minister of State Edwin Tong has talked about how we can strengthen support for family caregivers. The community plays a key role in supplementing and complementing the care and support provided by families to build a robust community care ecosystem for our seniors. We envision such an ecosystem to be underpinned by four key layers of support. First, through the "preventive health home visits" which I talked about earlier. Second, by providing a systematic and comprehensive range of preventive health and active ageing programmes, such as chronic disease screening and nutrition classes, in the community. Third, building up a network of befrienders in the community. And fourth, linking them up with the necessary care and support services. Mr Henry Kwek talked about the importance of local coordination. Our Community Networks for Seniors (CNS) initiative, which I am pleased to report has been expanded nationwide now to 89 neighbourhoods and areas, brings together stakeholders on the ground, including Government agencies, care providers and community organisations, to close the last-mile delivery of active ageing programmes and care services, and provide timely and coordinated care for our seniors when needed. We agree with Miss Cheng Li Hui that more support should be extended to vulnerable seniors who are at high risk of social isolation and loneliness. Mr Faisal Manap also raised the issue of elderly suicide. To clarify, while the number of elderly suicides has increased in recent years, along with our ageing population, the suicide death rates among our elderly have, in fact, declined over the past decade.”
“We will continue to grow the senior learning opportunities under the NSA, including in areas, such as IT and digital literacy, as suggested by Ms Joan Pereira and Ms Tin Pei Ling, and make them even more accessible by bringing more of these courses into the community. Seniors can also utilise their SkillsFuture Credits for many of the NSA courses to learn new skills that can help them find freelance work opportunities, as suggested by Mr Henry Kwek. We recognise that seniors are invaluable assets to the community, and we want to empower them to contribute their knowledge and wisdom by volunteering. One example is 68-year-old Mr Chia Shih Thow who started volunteering with Montfort Care 10 years ago after he attended their Young At Heart (YAH!) programme. Mr Chia was inspired to hear of other senior volunteers through the programme and signed up as a Health Ambassador first, before taking on other roles, such as medical escort, befriender and games facilitator. He is now back at where he discovered his passion for volunteering, inspiring others as a group facilitator in the YAH! programme. To help others like Mr Chia give back to the community, we have set up the Silver Volunteer Fund (SVF) to provide funding by community-based organisations that create volunteering opportunities for our seniors. We have other sources of funding to support good ground-up initiatives, such as the Tote Board Community Healthcare Fund (TBCHF) and the Community Silver Trust (CST) dollar-for-dollar matching grant which was extended to active ageing programmes in 2017. We will continue to review the funding for such programmes, including the suggestion by Dr Teo Ho Pin to set up a Healthy Living Endowment fund.”
“So, where have all the men gone? We agree with Mr Ang Wei Neng that there is scope to increase male participation in our active ageing programmes and are determined to do so. The example he shared of the Men's Shed movement in Australia is interesting, as it recognises that men find it easier to make friends through work-based activities, such as carpentry. We may not have backyards or sheds like in Australia, but we have our void decks and common spaces, where we can see our men at work. For example, in Kampung Senang, male senior volunteers under the "Silver Mobility Aiders" programme help to maintain and service wheelchairs for their fellow seniors. In Yishun, the "Repair Kakis", a group made up of about 15 men who used to be technicians, electricians and engineers, get together weekly to help repair, assemble and fix various electrical appliances brought in by their fellow residents. I am encouraged to hear that Mr Henry Kwek is planning to bring in more communal sports for the senior men in Kebun Baru. Indeed, we need a concerted effort to find meaningful activities and innovative ways to bring the male seniors together and create local versions of these men's sheds. For a start, MOH welcomes suggestions from all the men in this House on new active ageing approaches to get men not just to talk, but also to learn and play "shoulder to shoulder". We also want to support our seniors' aspirations to continue learning. Today, the National Silver Academy (NSA) offers over 1,000 courses for seniors to pursue their interests in a wide range of areas, such as art, wellness and life skills. These courses have attracted some 26,000 participants thus far.”
“The taskforce, chaired by Senior Parliamentary Secretary Amrin Amin, is in the process of gathering feedback and ideas and we look forward to the public’s contributions. Ms Joan Pereira and Dr Lily Neo suggested building more SACs to promote wellness activities close to where seniors live. Besides SACs, we have also been siting such programmes in eldercare facilities to provide a continuum of active ageing and care services to seniors in the community. One example, as shared by Ms Joan Pereira, is the “Wellness Kampung” initiative in Yishun. Piloted in 2016 as a partnership between Yishun Health, St Luke's ElderCare and the Nee Soon grassroots organisations, the network of three wellness and care centres provide wellness activities, such as healthy cooking demonstrations and recreational activities, as well as day care and rehabilitation services for frail seniors. MOH is also building larger day care centres called "Active Ageing Hubs" which offer a range of active ageing and care services, similar to the "Wellness Kampung". We have opened five such hubs to date and expect another five by 2020. Going forward, we will work closely with community partners to provide a good range of customised active ageing programmes to suit different profiles of seniors in their neighbourhoods. While the gender diversity debate in the corporate world has been cast as a shortage of women directors in listed and non-listed companies, it is interesting that the problem is reversed for our seniors in these programmes – men are scarce in this space! Anecdotally, our community partners share the same observation as Mr Ang Wei Neng that only about one in five or 20% of their participants are men. Even for senior learning courses, only about 30% of the participants are men.”
“We have expanded the reach of preventive health services to seniors in the community in recent years. Last year, we rolled out Project Silver Screen, in partnership with Temasek Foundation Cares, to check seniors' vision, hearing and oral health, at low or no cost, and follow-up on abnormal results if needed. About 45,000 seniors have benefited from this nationwide functional screening programme since January 2018. We are also leveraging our network of about 3,000 Silver Generation (SG) Ambassadors to proactively assess seniors' health status when they visit them at home and encourage them to participate in the preventive health and active ageing programmes in their neighbourhoods. Beginning with the Pioneers in 2014, our SG Ambassadors have made more than one million home visits and engaged about 450,000 seniors aged 65 and above. As noted by Dr Lily Neo, we are also extending active ageing programmes to more communities. By 2020, two in three RCs nationwide will host active ageing programmes. We agree with Mr Darryl David that efforts to inculcate healthy living habits among seniors should start early. One of the ways we do this is by targeting mature workers aged 40 and above through HPB's workplace health programmes. Over 60,000 mature workers in seven sectors, including transport and security, have participated in such programmes which have been customised to each sector’s workplace environment. In line with his suggestion for a multi-agency approach, we formed the HealthySG Taskforce in November last year to coordinate an integrated approach across public agencies to encourage Singaporeans to adopt a healthy lifestyle.”
“Mr Speaker, MOH supports both Motions. Healthy longevity presents opportunities for us to transform ageing into a positive force. We are second in the world for healthy life expectancy at birth, after Japan and ahead of South Korea. Japan has already started challenging the notion of what "old" means. The Japan Gerontological Society shared a report in 2017 which recognised how their current seniors are much fitter than past generations, and suggested redefining "old" as those “over 75". We can redefine ageing and turn it into a positive force if we embrace longevity and its opportunities. In 2015, we set out to do this with the Action Plan for Successful Ageing, a $3 billion plan with more than 70 initiatives across 12 areas to make Singapore a Nation for All Ages. We have made good progress on these initiatives, including on senior-friendly designs, as raised by Ms Tin Pei Ling. As we continue to make progress on these initiatives, we need to plan ahead for successive generations of seniors who have different needs and aspirations. The Merdeka Generation seniors, for example, are living longer and healthier and are more educated, skilled and IT-savvy, compared to our Pioneers. MOH is strengthening efforts in three areas to enable Singaporeans to look forward to their senior years with confidence and grace. We call it the "3Es" framework – one, Empowering good health and active ageing; two, Enabling communities of care; and three, Evolving new models of ageing in place. First, we want to empower seniors to stay healthy and active and provide opportunities for personal development and community participation so that they can continue to find purpose and meaning in their senior years. Good health is a life asset that we must continue to invest in.”
“I thank the Member for his supplementary question. First, let me say that in housing estates, for the large metal cage burners, they are normally used during specific events, such as during the seventh month festival as well as funerals. In order to be able to place those large metal cage burners in housing estates, you need the approval of the Town Council. Normally, the Town Council will allow this on a temporary occupation licence basis for a fixed period. We work very closely with the stakeholders, including the Town Councils. Our advice is for the Town Councils to ensure that these large metal cage burners are not located very close to dense residential areas, away from the residential areas. We do also have educational materials that we share with the Town Councils so that they can give them to the residents as well as to religious organisations and other stakeholders in the industry, to ensure that they burn it within the large metal containers and in small quantities to mitigate or reduce the emission of smoke. Of course, we also encourage the industry to look into improving the design of these large metal cage burners, including, for example, containing the smoke coming out. Indeed, we have worked with industry and other stakeholders to look at the trials of such eco-friendly burners and we will continue to assist in such trials to facilitate the adoption of technology, to mitigate smoke and fly ash emissions from burning, as long as there are parties who are willing to work with us.”
“] (proc text)] [(proc text) Bill considered in Committee; reported without amendment; read a Third time and passed. (proc text)]”
“To Mr Gan Thiam Poh's query on the accreditation of "Tie Da" (跌打) practitioners, "Tie Da" is considered a form of traditional folk medicine passed down from master to apprentice and, hence, Tie Da practitioners are not registered under the Act. There is also no requirement for the registration of Chinese herbal dispensers, although herbal dispensers with the relevant qualifications can choose to be listed with the Board. There has been a decline in the use of Chinese herbs which are mainly available from Chinese medical halls, compared to the use of Chinese Proprietary Medicines, that is, Chinese medicines in the prepared form, due to the latter's convenience and ease of use. Notwithstanding this, MOH supports the continuing education of herbal dispensers as part of the upskilling of the TCM industry. Herbal dispensers listed with the Board are also eligible for funding support provided under the Development Grant. MOH will continue to support and promote the professionalism of TCMPs and ensure consistency and safety of TCM use. Mr Deputy Speaker, Sir, a robust and efficient disciplinary framework and the upholding of practice standards are important for the safeguard of public safety as the TCM profession matures in Singapore. We are, indeed, heartened by the support of the TCM community and the public during our consultation and engagement sessions, as well as the support of Members of this House. Mr Deputy Speaker, Sir, I beg to move. [(proc text) Question put, and agreed to. (proc text)] [(proc text) Bill accordingly read a Second time and committed to a Committee of the whole House. (proc text)] [(proc text) The House immediately resolved itself into a Committee on the Bill. – [Dr Amy Khor Lean Suan.”
“For example, based on the latest literature on safety of use, MOH has lifted the ban on raw herbs containing berberine (黄连), to allow practitioners more options in the use of TCM in their practice and service to the public. Since 2005, acupuncture has also been allowed in our public hospitals. We are also happy to note that the research project, supported by the TCM Research Grant, on dry eyes undertaken by the Singapore Eye Research Institute and Singapore Chung Hwa Medical Institution, has shown encouraging results. We hope that this will foster greater research collaborations between Western Medicine and TCM. Prof Fatimah Lateef asked about the possible standardisation of charges for TCM services and recognition of MCs issued by TCMPs. As TCM plays a complementary role to mainstream medicine in Singapore's healthcare system, MOH will leave it to the employers and companies to decide if they wish to recognise the MCs issued by TCMPs. Prof Fatimah Lateef also pointed out that there is a range of charges for TCM services. This is due to a correspondingly diverse range of TCM practices and services offered, from charity TCM clinics operated by Voluntary Welfare Organisations to large industry players with chain clinics, catering to all segments of the population. Hence, the charges will continue to be left to market forces. In response to Prof Fatimah Lateef's request for clarification on the classes of registration, we would like to note that there are currently two classes of registration – practitioners registered as TCM Physicians are able to provide the full range of TCM practice, including acupuncture, while practitioners registered as acupuncturists can only practise acupuncture.”
“We think this would suffice as, since its inception, the Board has comprised the maximum number of members allowed under the Act. Mr Louis Ng sought clarifications on the differences in the use of the term "mental or physical disability" in section 6 of the Act which sets out the criteria for disqualification of Board members and "mental or physical condition" in section 19 of the amended Act, which allows the Board to take certain action against the TCMP concerned. The amendment Bill revises the language in section 19(1)(k) from the term "disability" to "condition" so as to broaden the scope of mental and physical conditions that may render a TCMP unable to practise TCM safely. This will better safeguard patients' interests as the TCMPs are directly responsible for the care of their patients. On the other hand, we recognise that a person may still be able to contribute effectively as a member of the Board even if he was afflicted by a mental or physical condition, like a mild stroke, that does not affect his daily activities and mental capacity. However, this same condition may affect a practising TCMP's ability to provide safe and effective care. The Inquiry Committee for conducting a health inquiry relating to a TCMP's fitness to practise should consist of members who have the relevant expertise to inquire into the matter of which it is appointed, for example, a member who is a medical practitioner in a relevant field. Mr Chen Show Mao may also like to note that MOH regularly reviews the regulations and policies on TCM, taking into consideration the advancements in medical science and evolving standards of TCM.”
“We have, on balance, decided on the $50,000 maximum quantum as TCMPs provide direct outpatient care to patients, similar to the allied health professionals and dentists in general. To Mr Louis Ng's query on whether the Board informs the complainant of the findings of the inquiry and if it communicates with former patients of the TCMP if the TCMP is found guilty of misconduct, the Board will promptly inform both the complainant and TCMP involved of the Board's findings and decisions in writing once the inquiry process has been completed. Furthermore, upon the conclusion of the case, a press release will typically be issued and published on the Board's website for public access. I thank Dr Chia Shi-Lu for his comments on having clear guidelines for the penalties to be meted out by the Board. The Board has put in place a sentencing framework based on the degree of harm and culpability to assess the seriousness of the offence and to guide the appropriate sentencing. As deemed necessary, the Board will update the framework. In addition, the Board also engages the Academy of Chinese Medicine Singapore for expert advice on TCM professional matters. Prof Fatimah Lateef and Dr Chia Shi-Lu commented on the representation of the Board. We agree that the Board should consist of experienced and well-versed TCMPs who are conversant with various aspects of TCM practice. Hence, the current composition of the Board requires Board members who are TCMPs to have at least 10 years' experience in the practice of TCM. Taking into account feedback from the public consultation, the size of the Board will be increased from nine to 11 so that more TCMPs can be included on the Board.”
“Prof Fatimah Lateef and Mr Gan Thiam Poh asked for information on the number of complaints received, disciplinary action taken and the trend over the years. The number of complaints received by the Board each year since 2013 has remained relatively constant at less than 10 per year, with about half of these cases requiring disciplinary action against the TCMPs involved. The cases can be broadly categorised into professional misconduct, negligence, use of western medicines and criminal conviction. The actions the Board can take against a TCMP is dependent on the gravity of the matter the TCMP is guilty of and range from issuing a letter of advice, censure or the suspension or cancellation of registration. While the number of cases is relatively low, we need to continue to ensure that the disciplinary framework remains relevant and effective in safeguarding public interest and safety. This will be effected through the proposed three-pronged approach mentioned in my opening speech, namely, to enhance the disciplinary framework to improve efficiency, increase maximum financial penalty to provide sufficient deterrence and enhance investigative powers. The proposed increase in maximum financial penalty from $10,000 to $50,000 is to provide sufficient deterrence and punishment for misconduct so as to protect the safety and interests of the public. This quantum is similar to the maximum financial penalty applicable for dentists, pharmacists and allied health professionals in the Dental Registration Act, Pharmacists Registration Act and Allied Health Professions Act, but lower than the maximum penalty of $100,000 for doctors under the Medical Registration Act (MRA).”
“Dr Chia Shi-Lu also asked how MOH will ensure the availability and quality of accredited CPE courses upon the implementation of compulsory CPE. On the availability of CPE courses, the Board has been engaging the course providers to organise more courses in anticipation of the implementation of compulsory CPE. To further ensure that there are adequate courses, the CPE course providers will be required to fulfil a minimum number of course-hours per year to maintain their accreditation status. The Board has established guidelines for the accreditation of CPE providers and courses, such as the credentials of the speakers or instructors, to ensure that they are of an acceptable standard. Prof Fatimah Lateef may be pleased to note that with the online CPE system, TCMPs may log on via the Board's website to search for CPE activities they wish to attend and monitor their CPE points. The system will be enhanced to send reminders at appropriate junctures to TCMPs who are at risk of not satisfying their CPE points requirement to help them fulfil these requirements. We note Mr Gan Thiam Poh's suggestion to integrate records of patients receiving treatment from both mainstream and TCM service providers for more coordinated management of care. However, as TCM is complementary to mainstream treatment and there are clinical and technical challenges that make it difficult to integrate the records, we will continue to work with the TCM community in order to provide a holistic approach towards patient management through other avenues. For example, the TCM Development Grant supports the TCM service providers to strengthen their operating capabilities, including the adoption of information technology (IT) solutions and enhancement of clinic facilities for TCM clinics.”
“Let me first explain that we introduced voluntary CPE some five years ago and have also undertaken extensive consultations with the industry on the implementation of compulsory CPE. Hence, the TCMPs should be familiar with the CPE framework and guidelines on points accumulation. Nonetheless, the accumulation of compulsory CPE points will take effect from 2020 after the Bill has been passed. For new registered TCMPs, they will be issued PCs valid until June 2020 and will be required to accumulate 50 CPE points in order to renew their PCs in June 2022. So, they start accumulating points after June 2020 and then, in June 2022, they will be required to have the requisite 50 CPE points for the PC renewal. Of the 2,800 existing TCMPs holding valid PCs, half of them will have their PCs expiring in June this year and the other half in June next year. For those with PCs expiring in June this year, their PCs will be renewed until June 2020. This exercise is to align the existing cohort so that the CPE requirement can start at the same time for all existing TCMPs. Between now till June 2020, the Board will engage the TCMPs and CPE course providers to update them on the revised CPE assessment framework. We strongly urge all TCMPs to actively participate in CPE and familiarise themselves with the online CPE system. Dr Chia Shi-Lu asked how TCMPs who are not currently in active practice will be impacted with the passing of this Bill. As the CPE requirement is uniformly applied to all TCMPs who wish to practise, those who do not currently hold a valid PC will have to fulfil the CPE points requirement before they can apply to resume their practice.”
“I thank Members for speaking in support of the Bill. Prof Fatimah Lateef, Mr Gan Thiam Poh, Dr Chia Shi-Lu and Mr Louis Ng highlighted the increasing popularity of TCM and the growing number of registered TCMPs in Singapore, and hence the need for a robust regulatory and disciplinary framework and a code of conduct, etiquette and practice guidelines for TCMPs to provide greater assurance and confidence to the public. Members have also expressed support for the implementation of compulsory CPE to raise the standards of the profession. Let me now respond to the queries and suggestions made by Members in respect of this Bill. Prof Fatimah Lateef asked if subsidies could be offered to TCMPs to defray the costs of attending CPE courses. As mentioned in my opening speech, individual TCMPs can already apply for the TCM Development Grant launched last year, capped at $200 per year, to help defray the cost of attending CPE courses. I am pleased to share that as at the end of last year, over 400 individual TCMPs have benefited from the Grant, with claims of more than $71,000 made. This is in addition to the $90,000 granted to accredited TCM training providers for the organisation of TCM conferences and seminars. We will continue to monitor the utilisation of this Grant by individual TCMPs to defray the cost of attending CPE courses and make adjustments if necessary. As Prof Fatimah Lateef rightly pointed out, TCMPs can also make claims under SkillsFuture funding for their courses. We will continue to encourage CPE course providers to get their courses accredited by SkillsFuture Singapore so that more TCMPs can benefit. Prof Fatimah Lateef also asked whether there could be some flexibility given to the TCMPs during the first two years of implementation of compulsory CPE.”
“Besides CPE, MOH also hopes to enhance the regulatory regime by amending the Bill to further strengthen the disciplinary framework for greater efficiency and to maintain public and patient safety more effectively. (In English): With this, I seek Members' support for this Bill. Mr Deputy Speaker, I beg to move. [(proc text) Question proposed. (proc text)]”
“Clause 8 amends section 20 to clarify the types of costs and expenses that the Board may require a TCMP who is the subject of disciplinary proceedings under Part IVA to pay. This includes the cost and expenses of any assessor or advocate and solicitor appointed by the Board for any proceedings before an Inquiry Committee, and reasonable expenses the Board may pay to witnesses. Clause 14 inserts a new section 34A to provide that the Board may compound any offence under the Act that is prescribed as a compoundable offence. The maximum composition sum is the lower of one half of the amount of the maximum fine that is prescribed for the offence, and $2,000. This empowers the Board to compound such offences without having to rely on section 243 of the Criminal Procedure Code. Mr Deputy Speaker, Sir, please allow me to conclude in Mandarin. (In Mandarin): [Please refer to Vernacular Speech.] The upholding of practice standards of TCMPs is important as the TCM profession matures and develops in Singapore. Therefore, MOH values and encourages the continuing education of TCMPs. We have successfully introduced voluntary CPEs in 2013 and received positive feedback. After the passage of this Bill, it will, indeed, be a milestone for the TCM community as we implement compulsory CPE. We are grateful for the feedback from the community on the implementation of CPE and have also taken in their feedback, such as expanding the learning platforms to include accredited online courses, and to award more points for instructors and self-learners. To support TCMPs in their continual learning, TCMPs can tap on the TCM Development Grant, capped at $200 per year, as well as SkillsFuture funding, to defray their costs for attending CPE courses.”
“However, if the investigator is investigating into a disciplinary complaint under the new Part IVA, these powers of entry, search and seizure can be exercised only if (a) a Court warrant has been obtained; (b) the occupier of the place consents; or (c) the investigator believes on reasonable grounds that there is an imminent or immediate danger of serious bodily injury or death to any individual who is receiving or who is about to receive any treatment at the place. The new section 30 makes it an offence for a person to (a) provide any document or give information that is false or misleading in a material particular; (b) knowingly obstruct or prevent an investigator in the discharge of the investigator's powers or duties; (c) intentionally alter, suppress or destroy any document or information which the person is required to provide; or (d) fail, without reasonable excuse, to provide any information the person is required to provide. Finally, the new section 30A provides for the disposal and forfeiture of items seized by an investigator under the amended Act. Next, I will turn to the other amendments in the Bill, which are mostly of a housekeeping nature. Taking in feedback from the TCM community, clause 3 of the Bill amends section 3(2) of the Act to increase the maximum size of the Board from nine to 11 members, which allows for a broader representation of the TCM profession on the Board. Clause 6 repeals and re-enacts section 18 so that the Registrar of the Board is not constrained in publishing a list containing information about all registered TCMPs with a valid practising certificate in the Gazette. Instead, the amendment will allow the list to be published on the Board's website or by other means.”