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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“In some places – for instance, the Central region, mature estates, ageing profile – it is not easy to find sites for new senior care centres. Sometimes, it is also because of patients' preferences. For instance, they want a day care centre in a certain location for convenience's sake. So, there is some wait time. Of course, there has also been increasing demand for day care places. But let me assure Members that we are working very hard to ramp up our supply of home and day care places, and we are on track to meet our target for 2020. In the meantime, for those who are waiting for day care places, AIC works with the patient as well as the families for interim care arrangements. They can get on either to the home care services available or they can avail themselves of the Interim Caregiver Service (ICS). When the senior is discharged from hospital, we can offer ICS whilst they are waiting for longer-term care arrangements. ICS can be for a period of two weeks, in the first instance, and up to three months while they are waiting for longer-term care arrangements.”
“I thank the Member for the supplementary questions. Let me explain that the capacity required, which I have noted in my earlier answer, is smaller than the referral numbers for three reasons. First, not all referrals, as I have said, eventually choose to take up the service. Some could be because they have got alternative care arrangements, domestic helpers; some because the seniors are re-admitted to hospitals; in fact, there are also some where the seniors are concurrently referred to multiple services, both home and community care service, while they actually only need one. In 2015, of the referrals received, about 5,600 home care referrals and slightly more than 3,000 daycare referrals were admitted into service. Secondly, the difference in numbers is also because whilst we have a flow of referrals during the year, we also have a flow of discharges. During the year, there may be patients who are discharged from home care or day care because they no longer need the service, because the conditions have improved, they have alternative care arrangements, or they have passed away. In 2015, about 3,800 home care clients and 1,200 daycare clients did not continue with the service, which frees up capacity for others who need the places. Thirdly, for day care services, seniors may not need to have the service every day. They may take up the service three days a week. Therefore, one day care place can serve more than one senior. Taking all these into consideration as well as the fact that we have been ramping up capacity, there is no wait time for home care. We have sufficient capacity for home care. There is some wait time for day care. The median waiting time is about 20 days. The reason, really, is because of geographical imbalance between supply and demand.”
“Is there a waiting list and is there a criterion in which those put on the waiting list can be bumped up if there is an urgent need?”
“The Ministry of Health (MOH) has been working to expand home and centre-based care capacity to better support our seniors to age-in-place among their family and friends. We currently have a capacity of 6,900 home care and 3,500 centre-based day care places. This is an increase of 80% from the 3,800 home care places, and a 67% increase from the 2,100 daycare places, in 2011. We are on track to meet our target of 10,000 home care places and 6,200 daycare places by 2020. We have also been working to increase awareness of home- and centre-based care so that seniors and their families can consider these services for their care arrangements. In 2015, the Agency for Integrated Care (AIC) received home care referrals for about 8,500 seniors, and day care referrals for about 7,800 seniors. AIC does not turn down referrals. Its role is to facilitate the placement of seniors needing home or community care services or other appropriate aged care services. Once a referral is received, AIC works with the seniors and their families to find the most appropriate service to meet their needs. Not all referrals for home or centre-based care services translate into actual take-up for a variety of reasons. Of the referrals that did not result in services being taken up, about half were because families opted for alternative care arrangements such as hiring a domestic helper. Another reason for not taking up the service is seniors being readmitted to the hospital as their conditions were not stable. Assoc Prof Daniel Goh Pei Siong (Non-Constituency Member): I thank the Senior Minister of State for the detailed answer. Is there a waiting list, therefore, for those people who are not going to change the referral, because the spaces and the type of care that they want are not available?”
“Indeed, there can be exceptions to such bills. For such instances, patients could approach the social worker to apply for additional assistance under MediFund or Medication Assistance Fund. Let me assure the Member that no patient will be denied the appropriate care that he or she needs due to inability to pay. When we receive appeals, for instance, for more usage of MediSave, we will consider these on a case-by-case basis and work out the patient's healthcare needs as well as affordability issues with the patient and the family members.”
“Care options for patients with terminal illnesses and end-stage diseases include palliative treatment at home or in a hospice. Palliative care is subsidised and patients can tap on MediSave to pay for the remaining copayment. The Ministry of Health (MOH) recently raised the MediSave limits so that patients can tap on more MediSave for palliative care needs. In January 2015, the MediSave withdrawal limit for inpatient hospices was increased from $160 per day to $200 per day. There are no daily limits for home palliative care but there is a lifetime MediSave withdrawal limit which was increased from $1,500 to $2,500. Patients can use their own or their immediate family members' MediSave. However, if the patient passes away in the hospice, he may use all the available balance in his own MediSave account for the final inpatient hospice bill without any daily limit. Similarly, for a home palliative patient with terminal cancer or end-stage organ failure, he can also use all the available balance in his own MediSave account for the bills and will not be subject to the lifetime limit. Bills may be covered by Government subsidies, MediSave or charity dollars from voluntary welfare organisations. Overall, about eight out of 10 inpatient hospice bills did not have out-of-pocket payments while about nine in 10 home palliative care patients did not have to make out-of-pocket payment for their bills. MOH will continue to ensure that the MediSave withdrawal limits for end-of-life care remain sufficient, along with subsidy coverage to keep these services affordable.”
“The grant is given if the frail elderly is a Permanent Resident and aged above 65. Having said that, this is one of the many available schemes we have to support elderly with caregiving needs.”
“If the elderly parent is aged 65 and above and is a Permanent Resident, they can still get the grant as long as the caregiver is a Singaporean.”
“The FDW concessionary levy for those with caregiving needs was just reduced from $120 a month to $60 a month in May 2015, which was less than a year ago. And as I said earlier in my reply, this is significantly lower than the regular FDW levy of $265. This will benefit families with children aged below 16, elderly aged 65 and above or disabled family members. With the lowered concessionary levy of $60, families who need to hire FDWs to care for their frail elderly or persons with moderate disabilities will receive a net subsidy of $60, taking into account the monthly FDW Grant of $120. In addition, if these frail elderly are aged 80 or above, the likelihood would be that they would belong to the Pioneer Generation, so they will also be able to receive cash payouts of $1,200 a year under the Pioneer Generation Disability Assistance Scheme. In view of that, we currently do not have plans to further reduce the FDW concessionary levy or to tier it based on an age criterion. Having said that, we will continue to review the schemes to better support families with care-giving needs, including those with elderly dependants.”
“The Foreign Domestic Worker (FDW) Grant was introduced in 2012. It provides a monthly grant of $120 to support households who need to hire FDWs to care for seniors and persons with moderate disabilities. We do not have plans to increase the grant quantum at the moment, as the current grant quantum is generally adequate. Besides the FDW Grant, these households are also eligible for FDW concessionary levy. The concessionary levy was lowered from $120 to $60 per month from May 2015, compared to the normal levy of $265 per month. Pioneers can get additional cash payouts to help with their expenses through the Pioneer Generation-Disability Assistance Scheme. We also have other financial schemes to help defray the cost of caring for the elderly with more severe disabilities. Examples include the Interim Disability Assistance Programme for the Elderly (IDAPE) and ElderShield, which is a disability insurance scheme. As of December 2015, about 6,200 households are receiving the grant, with the Government providing a total grant amount of $8.4 million in 2015. Since 2012, at least 10,400 households have benefited from this grant, with the Government grant totalling $20.6 million. We will continue to monitor the utilisation and adequacy of the FDW Grant.”
“I thank her for her active efforts to promote a smoke-free environment for her constituents. MEWR and NEA are currently studying the progress of Project DSP: Cool to be Considerate, to gauge the public's response to these DSPs. We also need to better understand the impact of having such DSPs in our HDB heartlands, including their effectiveness, prior to committing to any expansion of such a programme. Mdm Speaker, the Members who are physicians have pointed out how harmful tobacco can be to the human body. With the recent increase in the popularity of Electronic Nicotine Delivery System (ENDS) worldwide and their targeted marketing to youths, we need to strengthen our regulatory measures. It is also imperative that we decrease exposure of non-smokers, especially youths, to the advertising effect of point-of-sale tobacco product displays. The aim is to ultimately de-normalise tobacco use. We also need to update and streamline our regulatory framework to ensure that our enforcement efforts remain effective and robust, yet fair. These changes are needed as part of a bigger community-wide effort towards creating a tobacco-free Singapore and we are, indeed, heartened by the support of the public received during our consultations as well as the support of Members of this House. Mdm Speaker, 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]. (proc text)] [(proc text) Bill considered in Committee; reported without amendment; read a Third time and passed. (proc text)]”
“In order to effectively ban cross-border Internet advertising, there should be control at its origin in every country. Regardless of developments elsewhere, we will play our part as a responsible member of the global public health community by making it clear that our prohibition on advertising will cover online advertising and promotion that originate from Singapore or from Singapore-connected persons. Mr Louis Ng raised concerns regarding HSA's enforcement powers under the amended Act. These powers are essential to enable HSA to effectively conduct enforcement activities and investigations under the Act. The amendments seek to update and, where appropriate, clarify the scope of these powers. Mr Louis Ng asked about the powers to search premises and vehicles without a warrant. I would like to clarify that the power to enter and search premises is not new. It is in the existing Act. The amendments simply clarify that no warrant is required to exercise such powers because authorised officers need to be able to act on reasonable suspicion and in a timely manner to search premises and vehicles for evidence in connection with a possible offence, before the suspect can dispose of the evidence. The same approach has been used for the Health Products Act. The existing search powers are being extended to cover vehicles because there have been several cases of illegal peddling of tobacco through the use of vehicles. Let me assure Members that a vehicle will be searched only if authorised officers have reasonable cause to suspect that the vehicle in question is associated with a potential offence under the Act. Er Dr Lee Bee Wah also proposed that we expand the number of designated smoking points (DSPs), like the ones in her Nee Soon South constituency.”
“We agree with Er Dr Lee Bee Wah on the need to build a conducive environment that encourages smokers to quit the habit. HPB has been expanding its outreach and support network for smoking cessation. Over the past year, HPB has added over 130 new smoking cessation touch-points, including healthcare institutions and retail pharmacies, bringing the total to over 280. By 2020, the aim is to double the number to 600 nationwide. These "I Quit" touch-points offer free smoking cessation counselling to smokers on the "I Quit 28-Day Countdown" programme. Smokers can also call in to Quitline or access online resources for additional support to quit smoking. In addition, we have been educating the public on the harms of environmental tobacco smoke and its impact on loved ones, to nudge smokers to contemplate quitting. Assoc Prof Fatimah Lateef had expressed concern that the number of Malay smokers remained high, though there was a slight decrease in prevalence in 2013. Please be assured that we are monitoring these trends closely. Like Assoc Prof Fatimah Lateef has pointed out, we can use culturally significant moments to nudge our fellow Singaporeans to live a healthier life. HPB has held the "I Quit" Ramadan roadshows since 2012. They will host another edition for the upcoming Ramadan in June 2016 and hope to encourage 2,000 Malay smokers to sign up to quit and I hope that the community will support HPB in their efforts. Assoc Prof Fatimah Lateef has also asked how the amendment would be applicable to online advertising. And Er Dr Lee Bee Wah commented that there could be limitations to the effectiveness of banning Internet advertising. I recognise that limiting access to online advertisements is not easy.”
“We are still studying raising the minimum legal age as part of the on-going public consultation on further amendments of our tobacco control measures, which include standardised packaging and larger graphic health warnings. This public consultation is due to end on 29 March 2016. Raising the minimum legal age to 21 years is a relatively new measure in jurisdictions that have implemented it, such as Hawaii and New York City. Hence, we would need to carefully study their experiences and see if this would be appropriate in our local context. MOH agrees with Assoc Prof Fatimah Lateef, Mr Louis Ng and Er Dr Lee Bee Wah that public education efforts and support for smokers to quit smoking complement legislative measures. They are key elements of our multi-pronged approach towards tobacco control. Mr Louis Ng made a call to intensify efforts to encourage more smokers to quit. Quitting can be perceived as a rather challenging journey by smokers. Hence, HPB introduced the "I Quit 28 Day Countdown" in 2013, to get smokers to quit by breaking down the quit journey into daily, small actionable steps. So, as Er Dr Lee Bee Wah said, by the end of 28 days, the body will be back to normal as before they started smoking. It is based on findings that smokers who stay smoke-free for 28 days are five times more likely to quit smoking for good. Like the "Tips from Former Smokers" campaign mentioned by Mr Louis Ng, "I Quit" adopts a community-based, but personalised, approach to build a network of support to help smokers quit. The campaign has seen about 10,000 sign-ups each year since 2014. Its Facebook page has more than 40,000 members, with daily exchanges by ex-smokers sharing their personal stories, smokers seeking advice on quitting and non-smokers penning words of encouragement.”
“I also applaud efforts by passionate volunteers to get our youths to pledge to be a tobacco-free generation. Going beyond promotional measures, both Dr Tan Wu Meng and Assoc Prof Fatimah Lateef had proposed that we could also introduce a cohort ban on smoking, by banning sales of tobacco to Singaporeans born from the year 2000 or another specified year onwards. MOH is familiar with this proposal and has given it a lot of thought. Our concerns are the significant practical difficulties and risks in implementing and enforcing such a ban and it may not result in the desired reduction in smoking rates. Such a cohort ban would be easy to circumvent and enforcement is going to be challenging and likely to be resource-intensive. An effective ban would also require laws to penalise persons not subject to the ban who supply tobacco products to the affected cohort. For example, a person affected by the ban could buy cigarettes overseas, or get an older relative or friend unaffected by the ban to buy cigarettes for them. In such a situation, we would have to penalise the person providing the cigarettes. Furthermore, enforcing such a cohort ban can be very challenging as age differences between close cohorts become less apparent physically as they grow into adults. Hence, MOH will not pursue such a cohort ban for now. But we are aware that this idea is being pursued in Tasmania, Australia, through a Private Member's Bill and we will monitor its development. Mr Louis Ng has asked why MOH had not included raising the minimum legal age for buying tobacco and smoking in this current set of amendments. Dr Chia Shi-Lu and Er Dr Lee Bee Wah made a similar call for MOH to raise the minimum legal age.”
“Members have suggested additional ways to enhance tobacco control, especially measures to prevent youths from picking up smoking and to help smokers quit. I am heartened by their enthusiasm. Let me assure Members that MOH is open to ideas and best practices from around the world and we closely monitor such developments. Dr Chia Shi-Lu had suggested that we follow in Australia's footsteps and quickly move to introduce standardised packaging. Emerging data from Australia shows that standardised packaging reduces the attractiveness of the tobacco products and makes the health warnings more prominent and effective. There are early indications that it reduces smoking prevalence. We have been studying and are closely monitoring international developments on standardised packaging. In May this year, France, the UK and the Republic of Ireland will start to implement standardised packaging as well. The decision on whether or not to proceed with standardised packaging will be based on public health considerations and we will also ensure that any measure, if introduced, will be designed in a manner consistent with our international obligations, including those relating to intellectual property rights. I fully agree with Dr Tan Wu Meng, Er Dr Lee Bee Wah and Assoc Prof Fatimah Lateef that tobacco control is best managed upstream – that is, we win the hearts and minds of our children and youths to prevent them from getting addicted in the first place. That is why Health Promotion Board (HPB) works with MOE and Institutes of Higher Learning to incorporate anti-tobacco messages into the curriculum, so as to raise awareness about the benefits of a tobacco-free lifestyle, dispel the misconceptions about smoking and equip youths with life skills to refuse cigarette offers.”
“We will also control the font size. As not all customers are literate in English, we will permit the price list to be published in each of the four official languages. But this is limited to one price list per official language. Mdm Speaker, this is a sample of what the price list is going to look like and there will be four official languages – one in each. Assoc Prof Fatimah Lateef recommends that we shorten the grace period of one year. I am pleased to see her enthusiastic support for the ban. Much as it would be ideal to implement the ban as soon as possible, the reality is that tobacco retailers, especially the smaller shops, will need time to make the necessary adjustments to their existing store set-up. The grace period also gives them time to diversify their business models away from the sale of tobacco products. As such, we think a grace period of one year is reasonable. However, MOH certainly encourages retailers to comply early with the requirements of the ban. Er Dr Lee Bee Wah expressed concern that tobacco retailers, especially the smaller businesses, would be affected financially by this ban. We have conducted engagement sessions with small retailers since 2014 to help them prepare for the ban. The ban applies to all general tobacco retailers. As such, no tobacco retailer will lose out to another. Like all our tobacco control measures, the intended effect is to decrease the overall demand for cigarettes. But as this will likely not be an immediate development, small retailers can use this grace period and beyond to start shifting their business models away from dependence on selling tobacco products. They may also consider changing their business practices to increase their productivity.”
“I also said that specialist tobacconists are required to keep tobacco products out of sight from outside their premises because these specialist tobacconists usually sell mainly cigars and, perhaps, alcohol. To do this, they can completely make their store windows opaque, use curtains or any other method that achieves the same effect. Presently, there are about 17 such specialist tobacconists – in fact, five of the outlets are from the same company. Assoc Prof Fatimah Lateef asked about duty-free retailers. Unlike general tobacco retailers, duty-free retailers at Changi Airport serve mostly tourists and overseas passengers who are departing Singapore. Given this, the point-of-sale display ban will not be implemented at duty-free retailers at Changi Airport for now, although we will continue to review the position. Duty-free retailers at seaports will be required to comply with the point-of-sale display ban. Like specialist tobacconists, the requirements will be slightly different from those for general tobacco retailers. Duty-free retailers at seaports may place their tobacco products within a specified "tobacco area" of the premises, but the tobacco products should not be visible from outside this area. Alternatively, they may follow the requirements for general tobacco retailers. DFS Galleria at Scotts is classified as a general tobacco retailer and will be required to comply with the requirements for general tobacco retailers. Assoc Prof Fatimah Lateef asked what the price list will look like. The appearance of the price list will be prescribed by MOH. It should be in text, printed on white A4 paper and contain only the necessary information on the product, such as brand and variant, price barcode and stock number. There should be no pictures or logos.”
“Mdm Speaker, I thank Members for speaking up in support of the Bill. Clearly, all of us have been touched by the issue of smoking at some point in our lives, either personally or professionally. Dr Tan Wu Meng has shared how, as a medical oncologist, he had witnessed first-hand the damage wrought on his patients by tobacco. Assoc Prof Fatimah Lateef has pointed out the diseases caused by tobacco – it seems as if almost every organ in the body can be affected by tobacco use! Mr Louis Ng provided personal insights on how difficult it can be to quit smoking and how he tried to avoid point-of-sale displays of cigarettes while quitting. I must commend him for being creative in quitting smoking by going "cold turkey" in Disneyland. During my engagement session with tobacco retailers in December 2015, one comment made stayed with me for a long time. A retailer told me that even though he sold tobacco, he did not want his own children to smoke! He acknowledged that tobacco could cause addiction among his customers. This is why we need to continue to strengthen our tobacco control measures and provide a supportive environment for smokers to quit. We need to make sure that our youth do not pick up the habit. We want to bring smoking rates down even more. The point-of-sale display ban plays a part in fulfilling these objectives. Let me now respond to the queries and suggestions made by Members in respect of this Bill. With regard to the point-of-sale display ban, I had earlier described the requirements for general tobacco retailers to keep their tobacco products out of sight of customers and the public within their premises.”
“(In Mandarin): [Please refer to Vernacular Speech.] Singapore has been actively bringing down the smoking rate. Prohibiting shops from displaying tobacco products and banning online tobacco advertisements will minimise the temptation to the young and, hopefully, can reduce the smoking rate effectively. However, the effect of these measures can still be limited as young people can easily see or smell adult smoking on the street. This may even give them the impression that smoking is a sign of adulthood, enticing them to try smoking. Hence, I suggest that we should build more Designated Smoking Points that are far away from schools and crowded areas so as to reduce the temptation to youngsters. At the same time, we must pay more attention to encouraging and helping smokers to quit smoking. On the other hand, many small retailers are already affected by the restrictions on selling alcohol; now, with tobacco sales also falling, they may face financial difficulties. I hope the authorities can look into how to help these small shops transform. I support this amendment Bill. 3.47 pm”
“And she says that one day she saw a flyer from HPB to show them that if you were to stop smoking for a certain number of days – she told me 17 days but when I go and check the website, it has various pages – she says that if she stops smoking for 17 days, her lungs will be free of most toxins. That gave her the hope and the desire and the motivation to quit smoking. So, she started to quit smoking but she said she failed many times. Eventually, she managed to quit at the age of 27. And now I ask her how old she is now, she said she is 32, happily married with a daughter. So, I would like to ask for more such encouragement for those smokers. Of course, we need to have more educational talks in schools to deter people from even starting to smoke and perhaps show them how to do so, how to have stress management because many of them say that they picked up smoking because of the stress in school. Perhaps, introduce to them meditation, introduce them to sports and, for those already smoking, there is another set of education – to give them hope and chance to reverse their lungs. Having said much on the hazards of tobacco smoking, I would like to briefly wrap up by asking for help to small retailers who sell cigarettes. For them, cigarette sale is good revenue. It would be impractical to expect these small business owners to change their focus to something else in a short period of time. This is especially so since their other major source of revenue, alcohol sales, has been restricted already. How can we help them adapt? What substitute can they sell in place of cigarettes to generate income? As part of our commitment to help small businesses, I hope the Ministry will be able to look into the situations of these small shops. Mdm Speaker, in Mandarin, please.”
“In Nee Soon South, we have piloted designated smoking points at one zone. There are smokers who use them though there are still some smokers who smoke outside them, but I believe that, through social conditioning, we can eventually be like Japan, where most smokers voluntarily smoke at designated spaces. Following residents' requests, we are now expanding them to the whole Nee Soon South. Certainly, I hope to see a wider adoption of Designated Smoking Points to minimise exposure of non-smokers to second-hand smoke that causes cancer, heart disease, lung disease and childhood illnesses, including cot death and asthma. We must also create an environment that is more supportive and encouraging for potential quitters. When we piloted the Designated Smoking Points in my constituency, we also had Blue Ribbon Ambassadors. These ambassadors would not only encourage smokers to smoke in the designated smoking points, but also advise them on how to quit smoking. I hope that we can eventually pool together more resources to turn it into a nation-wide effort. We are striving to be a more compassionate society and, in our good intentions to combat the harmful effects of smoking, we must not make smokers feel alienated and criminalised. I posted on my Facebook page about me speaking on this tobacco Bill and one of my residents messaged me, she told me that she started smoking at age 15. And she says that you can increase the price of cigarettes, you can put it in different packaging, you can show all the eerie, ugly pictures of the smokers; it will not deter them from smoking. Because she says that, "Since my lungs are already so black, it does not matter".”
“I pledge my full support for the ban on tobacco displays. By the same logic, it seems ideal to prohibit Internet advertising, especially as our youths spend more and more time on the Internet. Online shopping is fast growing and last year, a news report indicated that people were hawking banned e-smoking devices online. But I have to caution against the possible limitations of this. Firstly, forcefully limiting exposure could be a double-edged sword. When there is too little of something, it becomes a novelty, a taboo, an object of curiosity. Consider drugs and marijuana, they are never openly sold, yet people fall prey to it. Just recently, "Ah Boys to Men" actor Noah Yap was sentenced to nine months detention for taking cannabis. Second, the World Wide Web is too extensive to police. There are numerous online groups advocating smoking. Just do a search and you will find a number of smoking and drug-use advocacy pages on Facebook with thousands of followers. There are even web articles dedicated to paparazzi shots of celebrities smoking, glamorising smoking in a perfectly legal way. Ultimately, there is a limit to the effect of banning point-of-sale displays and Internet advertising. I recall a news report that interviewed a smoker who had been smoking since he was 15. He said, "I do not need to see the pack to crave a cigarette. What matters most is the smell." When adults smoke, children and teens see them. They walk by and they whiff the smoke. They probably even associate smoking with adulthood. Thus, we must invest more resources in continued public awareness and outreach efforts, both for youths and adults. Smoke-free zones in public spaces can also reduce the visual and nasal temptation of cigarettes.”
“In several countries, the UK, Canada, Thailand, Australia, New Zealand among others, such displays are banned. The Centre for Tobacco Control Research at the University of Stirling said 46% of UK teenagers were aware of the displays and those who intended to smoke were more likely to recall brands they had seen at the point of sale. Research by the Centre for Behavioural Research in Cancer in Australia and Stanford University in the US confirmed this. A study of 25,000 young people in New Zealand found that children exposed to displays were almost three times more likely to smoke. Research in Australia and the US shed light on the rationale: point-of-sale-display advertising of cigarettes normalises tobacco use for children and creates a perception that tobacco is easily obtainable. To further drive home the point, RAND Corporation did a one-of-a-kind laboratory replica of a convenience store to examine whether limiting displays of tobacco products in retail outlets could reduce the intention of young people to begin smoking. The results, published in November last year, showed that there was an 11% reduction in smoking intention when the display of tobacco products was hidden, compared to when it was visible behind the cashier. Point-of-sale display is a common sales promotion tactic. I believe many of us can recount a time when we bought something on impulse at the cashier, simply because seeing it stimulated a desire for it. There is already a blanket ban on advertising and promotion of tobacco products in Singapore. It only makes sense to extend the ban to point-of-sale displays. In conjunction with the proposed increase in the minimum age to purchase cigarettes in the near future, this measure is expected to reduce temptation and impulsive cigarette buys.”
“33 pm Er Dr Lee Bee Wah (Nee Soon): Mdm Speaker, the enhancements to the Bill are evident indicators of the Government's unrelenting determination to create a smoke-free living environment in Singapore. In Singapore, tobacco kills about 2,500 smokers and 250 non-smokers each year, said the Health Promotion Board (HPB) statistics in May 2015 and that is seven and a half people killed each day. From a social viewpoint, tobacco use impinges on other peoples' lives. From an economic standpoint, the health problems created impose a financial burden on all taxpayers – you, me and everybody. This does not include the emotional and mental suffering of the victims and families who lose their loved ones due to smoking. We have, as part of our anti-smoking campaign, required cigarette packs to carry graphic images and warnings since 2004. This was recommended as part of WHO's Tobacco Free Initiative. Such graphic warnings were found to be generally effective in creating awareness and motivating people to quit smoking, according to a study by the Harvard School of Public Health. Yet, a survey done in 2013 showed that many smokers in Singapore were undeterred by the graphic warnings. A similar sentiment was echoed by a British study held in the same year. Differing demographics worldwide can lead to inconsistencies. Therefore, we need to review policies regularly and explore new solutions. Many tobacco companies and retailers rely on point-of-sale displays to compensate for the inability to advertise tobacco sales in many countries. Tobacco companies are great marketers. In some local convenience stores, cigarette packages dominate the most eye-catching display wall. The display takes a premium spot, for example, next to the cashier's counter.”
“Clause 26 amends section 26 to empower the Chief Executive and authorised officers to inspect and seize electronic documents and materials, computers or other relevant equipment in which evidence may be stored and to request that access codes or passwords be provided. The clause also extends existing search powers of premises to include conveyances. It will be an offence to wilfully fail to comply with a requirement made under the amended section 26. Clauses 28 and 29 extend the scope of powers of forfeiture to include any imitation tobacco product, document, material or article and empower the Chief Executive to give directions on the disposal of forfeited items seized under the Act. I would like to clarify that the powers of forfeiture are not new to the Act. The amendments here take into account the other changes in this Bill, as well as the changing enforcement landscape, and are scoped to allow HSA to continue exercising its functions under the Act effectively. Similar powers of seizure are provided for in the Health Products Act and the Sale of Food Act. Mdm Speaker, smoking is the primary cause of premature death in Singapore. Though we are fortunate that smoking prevalence in Singapore has remained relatively low compared to many other countries, we must not be complacent. We also know the industry aggressively markets their products to youth, so as to hook them from an early age. As such, we must continue and, in fact, step up our efforts to protect the public from the advertising effects of tobacco and introduce new measures to enable us to keep pace with the rapid changes in the industry. I seek Members' support for this Bill. Mdm Speaker, I beg to move. [(proc text) Question proposed. (proc text)] 3.”
“Clause 16 repeals the current section 14. The existing ban on sale of tobacco products via vending machines will now be covered under the amended section 18. Clause 20 repeals and re-enacts section 18 to clarify the licensing requirements for the wholesale or retail of tobacco products in Singapore. It will limit the sale of tobacco products to a single point of sale specified in the tobacco retail licence, to limit access to tobacco products. For example, a supermarket may only have one point of sale for tobacco products, which is already the current practice. The Minister will be empowered to make regulations to give effect to these licensing requirements, as provided for in clause 31. For example, the Minister will be able to make regulations to specify the fees to be paid by tobacco wholesalers and retailers and the length of time for which the licences are granted. Clause 24 provides that Police officers and authorised officers are empowered to ask a suspect to produce identification, search his bags and require him to reveal the contents of his pockets. This is necessary to prevent suspects from concealing evidence in their bags or pockets from enforcement officers. As a safeguard, enforcement officers have been trained to follow standard operating procedures strictly and regularly undergo refresher training. No physical search of the body is involved. Clause 25 enhances the powers of investigations, by allowing the Chief Executive, HSA, and authorised officers to require relevant information to be furnished in writing, for the purposes of investigation.”
“This is in compliance with the World Health Organization's Framework Convention on Tobacco Control, to which Singapore is a signatory. Clause 4 of the Bill amends section 3 of the Act such that our ban on tobacco product advertisements extends to advertisements that are published electronically in Singapore. These include advertisements originating from Singapore, even if targeted at a foreign audience, as well as advertisements originating from outside Singapore that are accessible by persons physically in Singapore and published by a Singapore-connected person. A "Singapore-connected person" is defined in clause 2 of the Bill. The amended section 3 also prohibits Internet advertisements that provide a facility to the person accessing these advertisements to buy tobacco products or imitation tobacco products. Clause 9 amends section 9 to prohibit tobacco product sales promotions that originate from Singapore, even if targeted at persons outside Singapore. Sales promotional schemes have evolved over the years. The new section 9A in clause 10 of the Bill makes it explicit that customer loyalty programmes involving tobacco products, such as the redemption of reward points for tobacco products, and other promotional schemes are disallowed. Besides the changes outlined above, we also took the opportunity to make a number of additional amendments to the Act to be in line with the latest legal policy developments, improve clarity, and enhance its implementation. Some of these are as follows: Clause 12 amends the wording of section 11 to improve clarity. Authorised officers may seize the tobacco products if an offence is committed under section 11(1). Clause 15 allows the Health Sciences Authority to specify the visual characteristics of the "No sale to minors" sign used.”
“ENDS are banned under the existing Act as imitation tobacco products that are designed to resemble existing tobacco products. Earlier models of ENDS looked like traditional cigarettes, to appeal to smokers or would-be smokers. However, newer varieties of ENDS do not necessarily look like cigarettes. They are sleek, colourful and deliberately attention-grabbing. They target not just current smokers, but also seek to expand market demand, especially among youth and women. Please let me show you. This is ENDS 1.0, an earlier version. And these are the newer ENDS products. Clause 18 of the Bill repeals and re-enacts section 16 of the Act to make it clear that the existing ban on the importation, distribution and sale of imitation tobacco products also includes products that may be used in such a way as to mimic the act of smoking, even though they may not necessarily physically resemble cigarettes or other tobacco products. The ban will also extend to the components of such products, to prevent such products from being imported in parts and re-assembled thereafter. With the increasing popularity of ENDS, there is a need to control the advertising of such products. Clause 4 extends the existing prohibition on advertisements for tobacco products to imitation tobacco products and corresponding amendments will be made to sections 6, 7 and 8 of the Act. With expansion of online access, there is increasing use of the Internet for tobacco advertising and commerce. As part of the global public health community, Singapore should ensure that our existing prohibitions on tobacco advertising and promotion are comprehensive and cover online advertising and promotion originating from Singapore.”
“Options include using gravity flaps, vertical blinds, curtains or automated sliding/closing doors. As per current requirements, the storage unit has to be plain and without design, sound or lighting decorations, as these could draw attention to the storage units and be used as a form of advertising. Specialist tobacconists serve a niche market, as they sell primarily cigars. Unlike customers of general retailers, who may be shopping for other products, most customers who step into a specialist tobacconist shop have already made up their mind to buy tobacco products. Hence, for such shops, we will focus on limiting the advertising impact from outside the shops. Regulations will be crafted to allow specialist tobacconists to display their products within their premises, so long as the products are not visible from outside the premises. Following feedback and appeals, general tobacco retailers will be allowed to use a text-only price list to facilitate communications with customers. Display of the price list is allowed only upon customers' request and its appearance will be prescribed by MOH. This is provided for in the new section 3(1A) in clause 4 of the Bill. We have engaged tobacco retailers extensively since 2014 and briefed them on the requirements. Tobacco retailers will be given a one-year grace period before the point-of-sale display ban takes effect. Globally, there has been a marked increase in the popularity of electronic nicotine delivery systems (ENDS), also known as e-cigarettes, especially among young people. ENDS vapour contains cancer-causing agents. Studies show that high school students who use ENDS are more likely to move on to smoke cigarettes. To protect public health, Singapore has pre-emptively banned the import, distribution and sale of ENDS.”
“In December last year, we banned emerging tobacco products not currently in the Singapore market, such as smokeless cigarettes. On 1 August this year, the ban will be extended to products available here, such as snuff and gutkha. The Tobacco (Control of Advertisements and Sale) (Amendment) Bill seeks to amend the current Tobacco (Control of Advertisements and Sale) Act to introduce the point-of-sale display ban. In addition, MOH will be using the opportunity to further streamline our tobacco control measures and address new regulatory challenges posed by the tobacco industry. Mdm Speaker, please allow me to highlight the major provisions being introduced in the Bill. First, let me elaborate on the point-of-sale display ban. The ban on point-of-sale display of tobacco products is a continuation of our tobacco control efforts. Firstly, we want to reduce exposure of non-smokers, especially youths, to the advertising effect of point-of-sale tobacco product displays. The aim is to, ultimately, de-normalise tobacco use. Secondly, we want to decrease impulse purchases of tobacco products, thereby helping smokers who are trying to quit. Other countries, such as Australia, Canada, Iceland, New Zealand, Thailand and the UK, have successfully introduced a point-of-sale display ban. The new section 12A in clause 14 of the Bill will introduce the prohibition on the display of tobacco products. This will apply to all tobacco products, including cigars, beedies, "ang hoon" and others, in addition to cigarettes. General tobacco retailers will be required to use storage devices to keep tobacco products out of the direct line of sight of customers and the public within their premises. They may choose different methods to comply with the ban, so long as the storage unit is self-closing.”
“Mdm Speaker, I beg to move, "That the Bill be now read a Second time." The adverse health effects caused by smoking tobacco are well-known. Smoking is the primary cause of lung cancer and is also a risk factor for other types of cancer, such as cancers of the mouth, upper throat, oesophagus, bowel and bladder. Smoking is also a risk factor for many major chronic diseases, such as high blood pressure, chronic lung diseases, heart disease and stroke. Tobacco itself contains more than 60 chemicals, including nicotine. Nicotine is the substance that causes addiction. Once addiction sets in, many smokers find it difficult to quit even though they might want to. Worldwide, tobacco is the cause of approximately six million deaths annually. More than five million of those deaths are a result of direct tobacco use, while more than 600,000 are the result of exposure to second-hand smoke. Many deaths due to tobacco use are preventable. Smoking is the second highest risk factor that contributes to the burden of disease in Singapore. About six Singaporeans die prematurely from smoking-related diseases each day. In Singapore, we have brought down smoking rates over the years, from 18.3% in 1992, to an all-time low of 12.6% in 2004. We did this by being aggressive in our tobacco control measures. We introduced progressively stricter restrictions on smoking advertisements, banned the use and possession of tobacco by minors under 18, introduced mandatory graphic health warnings and banned misleading descriptors, such as "mild" or "light". Nonetheless, our smoking prevalence has, in recent years, crept up somewhat, to reach 13.3% in 2013. We have tightened up our tobacco control measures in the past two years. In November 2014, we introduced the ban on shisha or water pipe tobacco.”
“We are monitoring and also looking into an extension of some of these smoking areas. So, as soon as we have made the decision, we will make the announcements.”
“As mentioned in my earlier reply, we will take into account the Member's suggestion to extend the smoking prohibited area to within a five-metre radius from the outer edge of the playground and exercise areas. There are jurisdictions in other countries that have implemented this. As I have noted earlier, the smoking prohibited areas have been extended to all sidewalks and these areas could already be well within the suggested five-metre radius. At the end of the day, all stakeholders have to play their part and exercise civic-mindedness and social responsibility. I would like to urge all smokers not to smoke near the playgrounds and smoking prohibited areas. Should there be actual cases, perhaps a gentle and polite reminder asking the smoker to move away may well do the trick.”
“I think I have answered those questions. I said that based on the information I have − and I have actually made the effort to check through the records of flash floods that occurred over recent times − I do not have any information of access being blocked. It could be that there might be some ambulances which decided, because of the warnings that we had, to take a different route. But I do not have the information. As far as I am concerned, there was no blockage to access to hospitals. I do not have such information. As I have said, we have advance warnings to the public and we also work very closely with SCDF, LTA and all the other agencies.”
“Yes, I think I have answered that. Actually, the flood monitoring operations kick in and there is an operations centre. In fact, the public can also use our PUB-One hotline to inform us of any flash flood incidents that they may be aware of and, in the spirit of the Minister of State Mr Sam Tan, let me publicise PUB-One's hotline, too. In fact, it is very easy. It is just "1800 Call PUB" or 1800 2255782.”
“I thank the Member for his three supplementary questions. Firstly, let me say that flash floods are a result of rainwater overwhelming the drainage system. I have gone through the records of the recent flash floods in the last couple of years and most of the flash floods receded within 30 minutes. Obviously, that is not to say that we do not acknowledge the inconvenience and delay that might be caused. But generally, whilst there might be delays or some cars might be stranded, public transport had not been affected – that means, buses and all that. Even though there is a Standard Operating Procedure (SOP) for diversion, we have not had to do this for the incidents involved. As to the question about known cases where emergency vehicles were delayed or diverted, I do not have information with regard to that. As I have said, I have checked and essential services had not been disrupted, including public transport. Whether there is a protocol, PUB works very closely with LTA, SCDF and all the other agencies. In fact, once the Meteorological Services of Singapore (MSS) puts out an alert of a heavy storm, PUB's flood monitoring operations will kick in. As I have said, we have got water sensors as well as CCTVs. We also have access to LTA's CCTVs to monitor the situation and to give alerts in advance through social media websites, mobile apps, as well as on our PUB website. There is also a free SMS alert system. SCDF services would also utilise this to make sure that if there are any issues about flash floods in various areas, they will be aware of it. Can the hon Member remind me what was the third question?”
“We agree with Members that high-rise littering is an anti-social act and it is something that we must not condone and will not tolerate as it poses a threat to public health and safety. At the end of the day, I think all of us need to play our part to cultivate social graciousness, good habits, as well as a sense of shared responsibility. Deploying more and more cameras really is not sustainable and it is also not desirable. But having said that, we take every high-rise littering feedback seriously and, where there is a need to deploy the camera, we will do so. Regarding the success rate of the cameras in identifying perpetrators, on the whole, based on the number of camera deployments, it is about one-third. The reason is that, very often, when we put up a camera, it may actually deter the litterbug from littering if he is aware that there is a camera focused on him or the unit. In some instances, it could also be because of intelligence or understanding of the ground, the camera could be focused at the wrong column of flat units, or on the wrong column and then we will have to redeploy it. Regarding a "name-and-shame" tactic, I think it is something we will continue to monitor and consider.”
“In response to the rising number of high-rise littering feedback, we have done a number of things. Firstly, of course, we have stepped up our outreach and education efforts. Secondly, we have increased the number of camera deployments since the adoption of this method to catch persistent high-rise litterbugs in 2012. We have increased the number of camera deployments by more than four times to close to 3,000 over the last three years. In fact, just last year alone, there were more than 1,000 camera deployments. We will continue to monitor the situation on the ground to see if we need to deploy more cameras. But let me assure the Member that we will deploy a surveillance camera when it is assessed that there is a need to do so when our outreach and education efforts do not resolve the problem, notwithstanding the fact that resources are ultimately finite and, like everybody else, we do experience resource constraints. But having said that, if there is a need and it is feasible to deploy the camera, we will do so. With regard to the time required to deploy a camera, normally, upon confirmation of the need to deploy a camera, we can install it as soon as four days from the date of confirmation. We need the time to do a detailed site assessment to determine the feasibility of the installation of the camera, as well as to further study where is the best position or the vantage point to deploy the camera to increase the success rate of catching the high-rise littering act, whilst safeguarding the privacy of residents around.”
“The reason I ask is that there are many near-miss cases. Residents show me their clothes that were burnt by cigarette butts. But whenever I asked for action, NEA officers would merely set up ambush and then they would give me the update that they did not catch anyone. So, I have the impression that NEA does not have sufficient surveillance cameras and it takes a long time for them to deploy the cameras.”
“I want to thank the Member for her suggestions as well as her questions. Firstly, for recalcitrant high-rise litterbugs, to consider if we should cap the limit for the fine imposed. First of all, for high-rise litterbugs, the fine is not compounded. They have to attend Court and the Court will decide on the fines to be imposed. But certainly, this is something that we can follow up on. Regarding the acquisition of a property, we need to carefully consider this. In most instances, in fact, since we started the implementation of surveillance cameras, as I have noted earlier, we have been able to effectively enforce on a significant number of litterbugs. Last year, for instance, more than 800 enforcement actions were taken and we hope that this will be a deterrence. Before we even deploy surveillance cameras, we undertake education and outreach efforts, including house-to-house visits. In most cases, the littering would stop or improve. Therefore, implementing the surveillance cameras acts as a deterrence. Having said that, for recalcitrant offenders, we also have to look at the facts of each case. In cases where it may be due to mental issues, we work closely with the grassroots, as well as with the family members, to see what assistance can be rendered, as well as to implement measures to prevent this littering from happening, for instance, even installing wire mesh across the grills of the windows to prevent the littering offence. We need to look at each case separately and be mindful that some of these may be due to specific issues. Er Dr Lee Bee Wah (Nee Soon): Mdm Speaker, I would like to ask the Senior Minister of State how many surveillance cameras does NEA have and how long do they take to deploy surveillance cameras.”
“SARS and Zika viruses are spread through different modes of transmission. SARS is spread from person to person, while Zika is spread by mosquitoes. Containment measures like isolation of cases, contact tracing and quarantine of close contacts are important for SARS. For Zika, vector control remains paramount. MOH will isolate confirmed cases Page: 28 of Zika infection to reduce the risk of transmission in the community. But once there is community spread – that is, if the Zika virus takes root and infection takes root in the community – then we will move from containment to mitigation measures. Measures to admit a confirmed case, isolate him until he recovers and the history of the virus will not work anymore. So, we will move to containment and mitigation measures and this means that we will take measures similar to dengue prevention and control – that is, source reduction.”
“MOH has set up a clinical advisory group to provide assessment and advice on the clinical management of pregnant women with confirmed or suspected Zika virus infection. The clinical advisory group has just met and is still discussing their recommendations on the clinical management of pregnant women with confirmed or suspected Zika virus infection. MOH will issue guidelines and recommendations to doctors based on the recommendations of the advisory group. Notwithstanding this, it is noted that in Singapore, in fact, all pregnant women are already recommended to undergo routine ultrasound scans as part of antenatal check-ups. Any abnormal foetal development, including microcephaly, that is picked up during these scans will be followed up by their doctors. The doctor is in the best place to provide advice to the individual cases. Termination of pregnancy is a personal choice made by the parents in consultation with their doctor. With regard to ultrasound scans and whether they will be given free, just let me say that, currently, subsidised patients in public hospitals will be able to receive subsidised ultrasound screening. In fact, if patients have any financial difficulties, they will be referred to the medical social worker proactively and financial assistance will be given after means testing. MediFund also covers obstetrics care to ensure good antenatal care for all pregnancies and to optimise pregnancy outcomes. We will consider this and other issues after the clinical advisory group has made its recommendations.”
“NEA has stepped up its vector control efforts, in partnership with the community, agencies and stakeholders, to control the mosquito population. NEA has also brought forward the annual "Do the Mozzie Wipeout" campaign this year − in fact, it was held yesterday − as part of its community outreach efforts to raise awareness of the "5-Step Mozzie Wipeout" and urge the community to take immediate action to prevent mosquito breeding. All of us can do our part by taking the appropriate precautions to prevent mosquito breeding.”
“If they have such symptoms after coming back from areas with Zika transmission, blood samples will be taken for Zika testing. In the light of WHO's declaration, MOH and NEA have worked together to introduce additional measures. MOH is expanding Zika virus testing capability to more public hospital laboratories. NEA has also stepped up the testing of blood samples from patients with fever and rash and suspected dengue for Zika as part of its Zika virus surveillance efforts. Given the suspected link between Zika virus infection during pregnancy and microcephaly in newborns, MOH has also set up a Clinical Advisory Group on Zika virus infection and pregnancy to provide expert advice on the management of pregnant women with Zika virus infection. In addition, the Health Sciences Authority (HSA) has also required that donors with a history of travel to outbreak areas be deferred from donating blood for 28 days upon return. As recommended by WHO, surveillance for microcephaly and Guillain-Barre Syndrome (GBS) has been enhanced to pick up any unusual trends. MOH is also looking at potential areas for collaboration and research with the relevant institutions on Zika virus diagnostics, transmission and the association with microcephaly and GBS. In addition, if a case is detected here, NEA and other agencies under the Inter-Agency Dengue Task Force, such as the Ministry of Manpower (MOM) and the Public Utilities Board (PUB), will intensify search and destroy efforts to control the Aedes mosquito population at the implicated sites to contain any potential spread. Page: 27 As Zika is transmitted through the same Aedes mosquito that transmits dengue, vector control remains the mainstay to prevent transmission of the Zika virus.”
“Thank you. On 1 February 2016, the World Health Organization (WHO) declared the recent cluster of microcephaly cases and other neurological disorders reported in Brazil a Public Health Emergency of International Concern (PHEIC). WHO further noted that there was strong association of the PHEIC with Zika virus transmission in the affected areas. The National Environment Agency (NEA) has an ongoing surveillance programme for Zika virus since 2014. Prior to the WHO's declaration, the Ministry of Health (MOH) and NEA had already enhanced the surveillance, as well as stepped up measures, to reduce the risk of the Zika virus taking root in Singapore. Since 26 January this year, Zika virus infection has been added to the List of Notifiable Infectious Diseases under the Infectious Diseases Act. All doctors have been advised to stay vigilant against possible cases of Zika virus infection and on the protocols for testing and managing of suspect and confirmed cases. So far, there has not been any reported case of Zika virus infection in Singapore. To reduce the risk of Zika becoming entrenched in Singapore, all confirmed cases will be admitted to Tan Tock Seng Hospital until they recover and test negative for the virus. MOH will also screen people in the vicinity of the home and workplace of confirmed cases for Zika virus infection. In addition, we have issued advisories to travellers to and from Zika-affected countries on how to protect themselves against mosquito bites. We have also reminded travellers who have returned to Singapore from affected areas to monitor their health and consult a doctor if they have symptoms of Zika, such as fever, skin rashes, joint and muscle pains, headaches and red eyes, and to reveal their travel history to their doctor.”
“Madam, with your permission, may I take Question Nos 18 and 19 together?”
“Nursing home should only be for those with higher care needs, as well as those with very low or no family and social support.”
“Our subsidy policies will need to take into account the scalability and the resource sustainability of the care models at the system levels, beyond any single-pilot project. Let me say at this point that we are not clear that single rooms or twin-bedded room facilities can be cost-effectively implemented across the entire aged care sector. But having said that, as I have said, we do want to support innovative new models of care because we do want to experiment and learn and find better care models. Because of this, actually, we are still in discussion with Peacehaven Nursing Home and the funders to look at how the project can be adjusted so that it can proceed. Then, we can learn lessons from this model and see if we can apply it to the rest of the sector. With regard to funding, as I have said, we need to ensure that the care models are sustainable because, at the end of the day, we know that ageing needs are going to grow and we do have limited resources, as well as manpower and space constraints, so we need to look at the different models of care and ensure that these are sustainable models and are cost-effective. The subvention will be given to the different care models, depending on the projects, as well as, of course, the programmes. And there are actually subvention or subsidy to the individual patient, which is Page: 17 portable because it depends on which nursing home or which care they take up. I also want to add that, at the end of the day, if you ask the elderly, their preferred option is to be cared for at home, not in an institution. What we are doing is ramping up home care and community care and we want to encourage and support more home care for as long as the elderly is able to be cared for at home.”
“Let me take this opportunity to explain briefly with regard to the Jade Circle project. First of all, let me say that MOH supports innovation on new models of care that will enhance care outcomes for the patients. But we need to balance this against the need to ensure the long-term sustainability of the care models because our aged care needs will grow and, ultimately, subsidies come from taxes. Due to the reduced ability of dementia patients to adapt to environmental stresses, smaller scale layouts which provide personal space and privacy would actually help the patients in terms of calming them and ensuring that they are not aggressive and there are no other negative social reactions. But single beds, which is Jade Circle's proposal, do have their downsides. For instance, there will be patients who would feel more isolated if they do not come out of their rooms. And there are issues with safety, surveillance, monitoring because of line of sight by the care staff and, particularly so for patients with functional deficits, leading to limited independence or because of behavioural and psychological problems. So, there will be challenges not just with space constraints, but also manpower constraints. Single rooms are not necessarily the magic pill to good quality dementia care. As I have pointed out, good quality dementia care does not depend just on the physical attributes of the facility – of which layout of the bedroom is one aspect – but it also depends on the quality of the care delivery. Having said that, we note that there will be instances where single rooms or twin-bedded rooms are needed for patients, say, with some behavioural issues. These are provided in our purpose-built nursing homes.”