Balaji Sadasivan
Singapore
“The issue is, of course, not good publicity for ASEAN. In fact, it is bad publicity for ASEAN. However, the fact that the ASEAN leaders have met and agreed to deal with the issue and ensure that we try and solve the problem at source, and the fact that ASEAN has tasked the Secretary-General to look into the issue and report to the various…”
“Thus far, the authorities here have not encountered any Rohingya refugees seeking to enter Singapore waters. Given our limited land and natural resources, Singapore is not in a position to accept persons seeking political asylum or refugee status. This has been our policy for decades.”
“I would like to conclude by noting that by resolving this dispute through third party adjudication, both countries have demonstrated our respect for international law and our commitment to settle disputes in an amicable manner.”
“Yes, we shall continue with those efforts. In fact, with the Youth Olympics and the F1, it is a great opportunity for all Singaporeans to think about their behaviour and whether they can improve it – whether they can be more polite and more gracious.”
“Sir, currently, the guideline for the Vasantham Channel is that a minimum of 75% of the programming must be in Tamil and 25% can be in other non-Tamil Indian languages. The number of hours is increasing, from 29 hours per week to 65 hours per week. But the guideline will still remain the same.”
“Sir, our branding is what we are and part of our branding is the law and order that we have and the safety that we have in our city and the fact that everybody has to comply with the law. This is part of our reputation and part of our branding, and it is not a bad part of our brand value.”
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“To address these challenges, MDA already has in place a light touch class licence regulatory framework that ensures the industry maintains some minimum standards with regard to the Internet, SMS, MMS, and other forms of new media services. We also have deterrent legislation like the Computer Misuse Act and the Penal Code to prevent the illegal use or abuse of such technologies. MICA also intends to introduce a legislation to control spam this year. But there is a limit to what legislation could do in an environment where information travels across borders in bits and bytes. We need to educate parents and children to become more discerning and responsible end-users. We also need to educate organisations to pay more attention to security and the use of the same default passwords on the SDU website was a contributing factor to the lapse in security at that site. So MDA is working with companies and volunteer groups like Parents Advisory Group for the Internet (PAGi) and Touch Community Services. To help the community deal with Internet security, MDA has provided over $2.3 million in funding support for activities and programmes that help the community deal with dangers on the Internet. Sir, the infocomm and media sectors offer great opportunities for our economy and new exciting lifestyles for our young. With the light regulatory touch, MICA's goal is to maximise these opportunities and minimise the downside. I have presented an overview. In our digital age, for more information, Members could log on to www.mica.gov.sg. I thank the Members for their cuts. Media Development Authority Programme”
“But the shake-up will provide opportunities for those who are innovative. For the consumers, convergence holds exciting promises. Some time in this exciting future, on a mobile one could talk to another person in New York at a fraction of the cost today because the voice information would be digitalised and sent across the Internet using VOIP technology. Or, one could watch the news or a movie on one's handphone or plug one's handphone on a plasma screen to watch a movie - a service that could be provided by one's telecoms operator. Or one could have wireless broadband through WIMAX, a service provided by one's broadcaster. The infocomm, media, and broadcast sectors are overlapping and merging. To promote growth in this new merged sector, MICA and its statutory boards, the IDA and the MDA have adopted a multi-pronged strategy. IDA has been actively facilitating the deployment of infrastructure that will enable Singapore to employ these new technologies. Sir, young people today could look forward to an exciting world that technology is creating for them. Sir, some Members may remember the excitement we enjoyed during our National Service days playing "Space Invaders" at the canteen in SAFTI. Young people today have not heard of "Space Invaders". They play computer games on Playstation 2 in near virtual reality with movie screen quality images. Members in this House communicate with email. The young talk to the world on blog sites. We think in terms of SDU to meet new people. They link up to the Third Degree on Friendster. It is a really cool world for young people. While these technological advances are exciting, we must protect the vulnerable young from being exploited and prevent technology from being used for illegal purposes.”
“Last year, the infocomm and media cluster was the second strongest contributor to investment commitments in the service industry, with $647 million in business spending, generating $1.3 billion in total value-add and 3,000 professional and skilled jobs. Revenues from the infocomm sector are expected to grow by 6% in 2004 to $34.7 billion and to grow by 7.4% this year to $37.3 billion. The number of infocomm professionals employed is expected to grow by 3% to more than 108,000 in the coming year. There are new growth opportunities in the infocomm sector, as pointed out by Mr Loh. Business process outsourcing (BPO) is a growth area and we have enjoyed success in this area. As pointed out by Mr Loh, Singapore is ranked No. 1 in the world for offshore projects per million population and ranked 6th globally in absolute numbers. Our high quality telecoms infrastructure, conducive regulatory environment, and well-educated workforce make us a very competitive location for higher-end outsourcing processes and services. These include business continuity, disaster recovery, IT strategy and security implementation. The use of infocomm technologies is pervasive in Singapore. Singapore's Internet penetration rate is one of the highest in the world, with two out of every three households and three out of every four companies, having access to the Internet. More than 42% of households have a broadband connection. Mr Zainudin has pointed out that the technologies IT and media sectors are converging and asked what MICA is doing about that. The next few years will be exciting ones, with opportunities for the innovative as the telecoms, broadcast and media and IT sectors converged. Convergence could very well shake up all the sectors.”
“The idea is to give them an opportunity to get a start, so that Singaporeans with the talent of Dan Brown, the author of the Da Vinci Code, would have an opportunity to emerge and take their place on the regional and global literary scene. MICA supports the local literary arts scene through programmes managed by the National Arts Council (NAC). The NAC provides financial assistance to writers through publishing grants, training and travel grants, as well as project grants for literary arts events and projects. In FY 2004, financial assistance to writers through these grants increased by 16%. So in reply to Dr Ong's request for aid to writers, I am happy to let him know that last year, $325,000 was given to literary artists to support their work. In addition, we are also helping them with housing. The NAC supports the literary arts, through the Arts Housing Scheme, which subsidises arts premises to literary arts groups, such as the Sin Sheng Poet Society and the Association of Singapore Tamil Writers. Dr Ong also suggested a literature award for writers. I am pleased to inform the House that last year, NAC supported the National Book Development Council in organising the annual Singapore literature prize. In addition, NAC organises the biennial NAC-SPH Golden Point Award, which provides a national platform by identifying literary arts talent in the four official languages. Sir, Mr Loh Meng See was concerned about the health of the infocomm sector and asked if Singapore's IT sector could grow when there was near stagnation in global IT spending. I am happy to say that our IT sector is healthy. Singapore's infocomm industry remains one of the key engines of growth for the economy. The pipeline for investments remains strong.”
“A few weeks ago, at a function, I was urged by a well-meaning Singaporean that we should do more for our Chinese literary artists. So I asked him when was the last time he bought a book of Chinese fiction written by a local author. He was stumped by the question and he said he read the Chinese newspapers but was too busy to read Chinese fiction. Our literary artists, whether writing in English, Chinese, Malay or Tamil, need people to buy their books. That is the real support they need. In a globalised world, this is a difficult challenge. Chinese writers compete in the market with writers from China and Taiwan, Malay writers with those from Malaysia and Indonesia. Tamil writers from those in Tamil Nadu. And those who write in the English language, they have to compete with everybody, with writers from the whole world, because famous authors who write their works in a non-English language would have their works translated into English. Writers now serve a global market, and the same book, the Da Vinci Code, is the best seller in Singapore and many countries around the world, including non-English speaking countries. Singapore literary artists must write for the regional and global audience. Some Singapore writers have succeeded in doing this. Eugene and Yen Puay Noi in the Chinese language, Abdul Ghani and Masuri in the Malay language, J M Sali in the Tamil language, are well-known overseas. Tan Tee Hwee's second novel, Memo Inc, was internationally acclaimed and was on the W H Smith's top 20 Best Sellers list in Asia for more than two months. MICA has schemes to help and encourage Singapore literary talent.”
“The new National Library will incorporate a new and major research institution - the Lee Kong Chian Reference Library. The establishment of the Lee Kong Chian Reference Library was made possible by the generous contribution of the Lee Foundation of $60 million to the NLB. The LKC Reference Library will occupy most of the space in one of the blocks at the new National Library. It will offer a collection of 500,000 items. This reference collection will focus on a wide range of topics from business to the arts. It will have a Singapore and Southeast Asian collection, a point that Mr Loh noted, the importance of collecting books on our local heritage. Mr Loh Meng See also asked about the connectivity and networking of the library to complement the printed material collection. NLB would be increasing its electronic material collection from 36 databases, almost double the 19 databases, it offered in 2004, to provide users with more information resource through its digital library services. Over the past three years, NLB has signed MOUs with several libraries overseas, allowing it to widen its access to collections outside Singapore. 4.00 pm Finally, Mr Loh Meng See also asked if the role of the existing regional libraries will change. I would like to reassure him that our regional libraries will continue to play their important role. The libraries in NLB's network complement one another and are located in different parts of Singapore to reach out to the community, thereby making it more convenient for Singaporeans to access the knowledge of the world. Ms Irene Ng and Dr Ong Seh Hong were concerned about another aspect of books, namely, the writers of books, the literary artists.”
“Sir, I want to thank the hon. Members, Dr Ong Seh Hong, Mr Loh Meng See and Mr Zainudin Nordin for their cuts. 2005 will be an exciting year for book-lovers because a new National Library building will open its doors to the public. Mr Loh Meng See has noted the importance of reading and the pivotal role of the library and asked how the library will serve the public. The new National Library building will have something for everyone. It will offer a greater access to printed and digital collections, and a wide variety of reading materials and learning programmes which will cater to young and old Singaporeans. To answer Mr Loh, there will be audio materials. The new library building is hardware to serve the reading public. It needs a new energised management to serve as software. I am pleased to inform the House that the NLB has just completed its five-year strategic plan or L2010. Under this plan, the National Library will offer users access to knowledge, help users build up their ability to assimilate knowledge, be it to satisfy their curiosities for personal development or for research. As NLB continues to inculcate a reading culture amongst Singaporeans, it would also help users of our libraries to actively deploy the acquired knowledge for personal, social or economic benefit. That is why the new NLB building will also house facilities like the new Drama Centre of the National Arts Council and facilities that will inspire learning and knowledge application such as an observatory pod, a programming zone, exhibition spaces, living gallery and an events plaza. Over time, I expect the new NLB building to become an icon of learning and knowledge in Singapore. I am also happy to report on a major development within the National Library building.”
“Mr Deputy Speaker, Sir, this is a question of legal drafting. Under subsection (4) that he mentioned, you cannot question the validity of a spectrum grant but you can appeal to the Minister if you think that the decision should be reconsidered. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill. - [Dr Balaji Sadasivan]. Bill considered in Committee. [Mr Deputy Speaker in the Chair]”
“We agree with the Member on the need for transparency and consultation with the industry. IDA will consult members of the public and the industry on major changes to the codes of practice. As an example, IDA conducted two public consultations on the proposed amendments to the Telecom Competition Code last year. Exemptions may be granted for licensees or persons to be exempted from some provisions in the codes of practice. IDA will assess each exemption request to determine if the exemption can be granted in line with IDA's regulatory principles. Where exemptions have significant impact on the sector, IDA will generally consult on the proposed exemptions before reaching a final decision. For example, licensees classified as dominant may apply to be exempted from certain dominant licensee obligations imposed on them under the Telecom Competition Code. IDA will undertake a vigorous study and assess the exemption application as well as the state of competition in the market. IDA will base its decision on its assessment as well as comments received from the industry through public consultation. Codes of practice and exemptions will be published appropriately, such as on the IDA's website or in Government Gazette. Mr Deputy Speaker, Sir, I thank the Members for the points raised. Sir, the amendments to the Act are fairly technical, but they are needed in order to keep the Act relevant to the fast changing telecommunications sector. It also keeps pace with the convergence of technology between the telecommunications and the broadcasting sectors.”
“Because of changes in technology, what is a necessity today may not be a necessity tomorrow. As a safeguard, however, any decision of the Authority as to the necessity of providing telecommunication services under the revised section 21 can be appealed to the Minister. This is already provided for in the revised section 69. On the second issue, the location of installation of equipment, the Authority has issued a Code of Practice for Info-communication Facilities in buildings (COPIF). The COPIF dictates, among other things, the specifications of the space and facilities to be provided by building owners for the installation of telecommunication equipment within their buildings, as well as the use of such space and facilities. The Authority is currently reviewing the COPIF, and will shortly carry out a separate public consultation on its proposed revisions of the COPIF. On the third issue, the ability of the Authority to set rental limits, the revised section 21 already provides that the Authority can direct that the telecommunication licensee contributes to the cost and expense of the provision of the space or facilities in question as well as any other requirement that the Authority may specify. This would include the setting of rentals for the use of the space where appropriate. If the Authority sees fit to set such rentals, then it would, as a matter of course, take into account appropriate factors for determining the quantum of the rental, including the current market rental for similar space in similar buildings. The hon. Member's next point was with regard to section 26, the codes of practice and standards of performance, and in particular, the granting of exemptions. He asked for transparency of the process.”
“The effect of section 17(3) is that it would be reasonable, as a starting point, for the licensee to require that the property owner or developer bear the full cost of alteration or relocation of the installation or plant in the absence of factors dictating otherwise. Beyond that, the reasonableness of the terms and conditions imposed by the licensee would depend on the facts of each case. What is ultimately deemed to be reasonable in each case is again a matter best left to the court to decide upon, if the parties cannot agree on their own. The hon. Member's next point concerns section 21(1), the provision of space or facility or installation, plant or system by direction of the Authority. There are three issues raised with regard to this section: (1) When would it be considered necessary for telecommunication services to be provided to any building or land; (2) The location where telecommunication equipment should be installed; and (3) The ability of the Authority to set rental limits. On the first issue, whether it is necessary for any given telecommunication service to be provided to any particular land or building would very much depend on the regulatory policies in force at that time. For example, it is currently a regulatory policy that basic voice services are available to all who request them. As such, if there is currently insufficient space set aside in a particular building for the installation of equipment to provide basic voice services, then the Authority may require that the owner of that building provides the necessary space. However, as regulatory policies would change from time to time in order to cater for the changing telecommunication environment, it is neither desirable nor feasible to legislate strict criteria for the assessment of necessity.”
“Mr Deputy Speaker, Sir, section 8 does not prevent a licensee from selling or transferring his licence, if it is allowed under the terms of the licence and subject to IDA's approval. The expanded scope for which IDA can suspend or cancel a licence is for situations where the licensee has gone into liquidation, is no longer in a position to comply with his licence, or it is in the public interest. The hon. Member's next point was with regard to section 17(2), which was the relocation of telecommunication equipment. He wanted clarification on what were considered reasonable alterations, and on guidelines for the terms and conditions that could be imposed in a dispute between a property owner and the telecommunication licensee. What is reasonable in a dispute must depend on the facts of each case. For example, there may be a case where the property owner or developer may desire the relocation of an installation simply because he feels that it is more aesthetically pleasing to him. In another case, the owner or developer may want to relocate the installation in order to be able to redevelop the land into usable housing space. It may probably be reasonable for the licensee to relocate the installation in the latter case, but not the former. As it is not possible to prescribe and cater for each and every possible circumstance in legislation, what would be considered reasonable in each case would be a matter best left to the court to decide upon, if the parties are unable to agree on their own. As for what would be considered reasonable terms and conditions, some form of guidance is already provided for in section 17(3).”
“I thank the hon. Members, Mr Zainudin Nordin and Mr Low Thia Khiang, for the points that they have raised with regard to the amendments of the Telecommunications Act. The first point raised by both Members was with regard to new section 5A, which is the power to grant spectrum rights. Mr Zainudin had expressed the view that any use of section 5 be subject to appeal under section 69, and Mr Low Thia Khiang had asked whether anyone can question the Minister. Mr Deputy Speaker, Sir, first of all, the powers for the IDA to grant, vary, suspend or cancel spectrum rights exist today in the Telecommunications (Radio Communications) Regulations. So, section 5A provides express powers in the Telecommunications Act for legislative neatness. It is not a new power that IDA is acquiring as a result of amendments to the Act. Frequency spectrum is a national asset and, therefore, IDA has a right to grant spectrum in a manner that protects national interests. However, that does not mean that a person cannot appeal against any decision that the IDA makes because, with regard to appeal, under section 69, telecommunication licensees may appeal against any of IDA's decisions, including IDA's decisions to change or vary their spectrum rights. Non-licensees, such as those applying for spectrum rights, may also appeal against IDA's decisions under section 5A. These appeal channels are provided for in section 69(1) and (2). So, section 5A should be read in conjunction with section 69. Mr Zainudin's second point was with regard to section 8, ie, the suspension or cancellation of licences. He proposed that this section be amended to allow licensees to dispose of or sell the licence to another party.”
“This suggests that many singles are able to get together and share a rental flat. We have no plans to change the requirement for singles to pair up to rent a flat.”
“With regard to resources, currently, 95% of the resources given to CDC is used on the clinical side, that is, looking after patients who have got HIV/AIDS, and only 5% of the resources of the budget is being used in public health measures in trying to control AIDS. We are going to give more resources to build the public health arm. With that, I think they will be more effective in contact tracing and doing all the other things that are necessary to try and reduce the number of new HIV cases. HDB RENTAL FLATS (Review of policy) 2. Dr Lily Neo asked the Minister for National Development (a) how many applications for HDB rental flats have failed because of the two sharing policy in the past years; and (b) will his Ministry review this policy especially for those single elderly with no family member to share with. The Minister of State for National Development (Mr Cedric Foo Chee Keng) (for the Minister for National Development): Sir, under the Joint Singles Scheme (JSS) for HDB rental housing, two singles who are at least 35 years old and who have a combined monthly income of not more than $1,500 can apply jointly to rent a one-room flat from HDB. HDB requires singles to pair up to rent a flat because HDB has a limited stock of rental flats, whose rents are heavily subsidised. This pairing arrangement also facilitates mutual care and support between the tenants, which is especially important for elderly singles. HDB maintains a list of single persons who are looking for a flatmate. HDB does not track the number of applicants who are ineligible because he or she cannot find another person to pair up with. Nevertheless, there are currently 9,400 rental flats let out under the Joint Singles Scheme.”
“The first issue of sex tourists is a very complicated issue. We do not know why they choose to go to Batam and have unsafe sex. If the issue is one of not being educated about the precaution that they can take, then this is something that the Ministry can try and correct. Pamphlets have now been distributed to these travellers about AIDS prevention. But there has been another feedback that we have got from members of the community. It is hard to verify how true this is. It is that most of the people who get HIV/AIDS, whether they are gays or heterosexual men who are having casual sex, know there is a risk of HIV and they know what they need to do to protect themselves. But they think that it will not be them who are going to get the disease. They always think it is someone else. The reason for this may be that, so far, the incidence of HIV has been quite low and they have not seen their friends, colleagues and partners die of HIV. So there is still this denial that it is a problem that is going to affect them and that is why they are not taking the necessary precaution. It is very hard to understand what goes on in the minds of these people. Nevertheless, my Ministry will try our best to reach out to these people and get this message across to them that they have to protect themselves. My Ministry will work with the unions and others in the tripartite partnership and businesses, and to further our education efforts in the business community. We hope the unions will also work with us in getting this message across.”
“With regard to the first question, my Ministry is reviewing this question of screening of mothers with HIV, especially since if we treat a mother who has HIV with medication, the child can be born without HIV. The risk of HIV transmission is reduced from 25% to 2%, and that is a significant drop in the risk. So the Ministry is currently reviewing this and will announce changes shortly. With regard to the second question on helping HIV patients, currently, we treat HIV patients in our hospitals like all other patients. We should not discriminate against HIV patients either positively or negatively. So HIV patients are entitled to the same subsidies as patients who suffer from other illness. Like other patients, if they have financial difficulty, they can apply to the medical social worker for help.”
“The Health Promotion Board and the Ministry of Health have frequent dialogue sessions with the community groups, including AFA. In fact, last week, there was one such session and all the groups from the community agree on the four messages, although there was no total agreement on how much emphasis should be given to each individual message.”
“Mr Deputy Speaker, Sir, I beg to move, "That the Bill be now read a Second time." Sir, this Bill seeks to amend the Broadcasting Act to strengthen the legal control measures against the trade and use of unauthorised decoders. An unauthorised decoder is one which enables an encrypted programme to be viewed in decoded form, without authorisation from the broadcasting service provider. Such decoders are currently available for sale in Singapore and are being used to decode the broadcast signals of StarHub Cable Vision's cable television programmes without paying for the subscription. The number of such cases is not significant at the moment, when compared to other countries. However, the enactment of this Bill is expected to provide further deterrence by criminalising the acts of export, assembly, modification or distribution of unauthorised decoders. In addition, the Bill will criminalise the wilful receipt and further distribution of signals decoded without the authorisation of the lawful broadcasting service provider. Lawful broadcasting service providers and owners of copyright will also be able to bring a civil action against persons who have committed any of the abovementioned acts, if they have suffered any loss or damage. To conclude, Sir, this Bill will allow for more effective control over the trade and use of unauthorised decoders in Singapore. Sir, I beg to move. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill. - [DrBalaji Sadasivan]. Bill considered in Committee; reported without amendment; read a Third time and passed. MERCHANT SHIPPING (AMENDMENT) BILL Order for Second Reading read.”
“Consequently, the only defences that will be available to a Network Service Provider in respect of any such liability will be the defences in the Copyright Act which wasintroduced under the Copyright (Amendment) Bill 2004. This will obviate any inconsistency in Singapore's laws. Sir, I beg to move. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill. - [DrBalaji Sadasivan]. Bill considered in Committee; reported without amendment; read a Third time and passed. BROADCASTING (AMENDMENT) BILL Order for Second Reading read.”
“Mr Deputy Speaker, Sir, I beg to move, "That the Bill be now read a Second time". Sir, this Bill seeks to amend the Electronics Transactions Act (ETA) to ensure that the liabilities of Network Service Providers pertaining to copyright are limited by provisions in the Copyright Act. The Copyright Act is being amended to ensure that Singapore's copyright laws remain relevant in the digital age and strengthen Singapore's position as an attractive location for copyright-based activities. The proposed amendments to the Copyright Act provide that Network Service Providers will not be liable for infringement of copyright for the making available or storage of material provided they fulfill certain conditions, such as taking reasonable steps to remove such material upon receipt of formal notice. The current ETA exempts a Network Service Provider from civil or criminal liability in respect of third-party material in the form of electronic records for which he merely provides access, if such liability is founded on infringement of any rights subsisting in or in relation to such material. As such, the ETA provides a wider defence to a Network Service Provider than the Copyright Act for liabilities pertaining to copyright. Section 10 of the ETA is being amended to address this inconsistency so that the defence available to a Network Service Provider under the ETA does not apply to any liability of the Network Service Provider under the Copyright Act in respect of €” (a) the infringement of copyright in any work or other subject-matter in which copyright subsists; or (b) the unauthorised use of any performance, the protection period of which has not expired.”
“Dr Teo Ho Pin asked the Minister for Trade and Industry (a) whether his Ministry has taken measures to ensure that fair trading is being practised in the sale of chicken and eggs between traders and consumers; and (b) what enforcement measures are being taken to check against profiteering.”
“Sir, we encourage our clusters and the hospitals to move as many services as possible to the outpatient level. For example, there is going to be a pilot project to bring chemotherapy to the outpatient level. It is a pilot project because we do not know whether it is the best thing to do. Chemotherapy involves giving very strong drugs. There may be complications from it. There may be a need for other special services that the patient needs suddenly because he is getting chemotherapy. On paper, it looks like it is a project that could work and be tried out. But suppose we have chemotherapy services in the polyclinics and patients do not want the polyclinic chemotherapy because, every time there is a problem that they have to, besides going to the polyclinic, get referred to the hospital. And let us say, it happens once in three times, the patients may decide to have their treatment at a hospital setting than in a polyclinic setting. So to see whether such things would happen, we would run a pilot project. When you run a pilot project, you must run it with an open mind, not on the basis that if I start a pilot project, its conclusion must be what I have decided at the start of the pilot project. So with podiatry service, it was a pilot project and the conclusion that was decided at the end of the pilot project was that it was not a good way of providing the service. So they have reverted to the previous way that they ran it. They may relook at it and see if they can better reorganise the foot services for diabetics, and we would encourage it. As a philosophy, we encourage our hospitals and clusters to bring as many services as possible as close to the polyclinic level and as close to the patients as possible. SALE OF CHICKENS AND EGGS (Measures against profiteering) 11.”
“And in the whole scheme of things, it appeared that the general practitioners and the other polyclinic doctors did not see the need for it, that is, if they thought a problem was going to be a little bit more complicated than what they usually look after, they would rather send him to an orthopaedic surgeon to look at the foot and have the podiatrist see with the orthopaedic surgeon, rather than sending the patient to the podiatrists. So these are the details of medical practice that are best managed by people on the ground who know these things and will decide how to site these services better so that the patients get the best care, and ensure that is also provided in the most cost efficient manner. And this is something that is better done at that level than at the Ministry's level with the Ministry dictating that resources be placed at a physical location based on a theoretical model.”
“I do not think that is the mental thinking of our practitioners. But what you have to understand is that there is a gradation of care. Things that are complicated are often seen by an orthopaedic surgeon. Things that are simple are often seen by the general practitioner. And in the same way, in the nursing care, nurses trained to look at diabetic feet take care of a lot of simple problems. When something is very complicated, like if there is a diabetic ulcer, then an orthopaedic surgeon would see it and would often get a podiatrist to look at the foot. And this is how care has been provided for many, many years. The innovation is taking the podiatrist who usually looks after complex problems and putting the podiatrist in a position where there are common problems, that means, normal uncomplicated feet are being seen. So, although 9% of adult Singaporeans may be diabetics, it does not mean that 9% of Singaporeans are walking round with a diabetic ulcer. So should we take someone with this additional skill and put him in a polyclinic setting to look at problems that may not require that degree of expertise? Because the skills of podiatry are between the skills of an orthopaedic surgeon and that of a trained nurse who looks after diabetic foot problems, the exact definition of where their skill should start and where their skill should end is not clearly defined. So in providing this service, trying to define where the podiatry service should be, is a new idea. It is a new innovation. So that is why it is a pilot project.”
“The hon. Member may be mistaken. It is not a decision by the Ministry to centralise services. We are open to the clusters should they want to provide a service in the polyclinics if they think it makes economic sense for them to provide that service, if the numbers are there to justify it. So, should NHG again look at these numbers and want to try some other pilot projects where it can move services down to the polyclinic level, at Ministry level we will support it. And as a philosophy, we believe, as far as possible, we should bring services to as close to the patients as possible. But this was a pilot project. A pilot project is a project that tries out new ideas to see if it works. In this particular case, NHG reported that the idea did not work. They have, therefore, stopped the project. They can review the project again. And if they think that there need to be changes before they introduce it, we will not stop them. But we do not micro-manage these services at the cluster or the hospital level. We leave it to our clusters and hospitals to decide how and when to best place services.”
“Sir, we allow our clusters and hospitals to decide where to place services so that they can provide the services as efficiently as possible. For a podiatry service to function, it requires a certain critical mass of patients to come to that centre so that the service can be provided efficiently. When NHG decided to start podiatry service in one of its polyclinics as a pilot project, they made an assumption that there would be a majority of patients coming from general practitioners and others who referred their cases to their polyclinics. But it turned out that less than 1% of the patients seen at the podiatry clinics were cases referred to the polyclinics. This was despite the fact that they charged $8 for the podiatry service to try to popularise their service while other centres, like the NKF prevention centres, charged $25. They originally had planned to charge $20 for the service. But they brought it down to $8 to see if there was a demand for the service. So, if a service is not efficient and cannot be provided efficiently because the numbers are not there, then we allow our clusters to organise them in such a way that a critical number of patients are there. Currently, the podiatry services are in the restructured hospitals and if patients need these specialised services, they are referred to the hospitals. However, all our polyclinics still have nurses who are trained in foot care, which means that routine foot care for most diabetic patients would be looked after in the polyclinics. Only the specialised cases would go to the hospitals.”
“Mr Speaker, Sir, diabetes is a common problem among Singaporeans. About 9% of our adult population is diabetic. To prevent foot complications, the blood sugar level must first be controlled. Doctors treating diabetics need to advise their patients to look after their feet carefully and take any complaints related to the feet seriously. The diabetics must then learn proper daily foot care. Foot screening and assessments are currently provided by trained nurses at our polyclinic. These trained nurses are able to assess and educate on preventive measures, as well as provide treatment for our diabetic patients. Sometimes, patients develop complex ulcers and would require more specialised foot care. A podiatrist would then be needed. At other times, the problem may be even more complicated, and would need the expertise of an orthopaedic surgeon. Hospitals have podiatry and orthopaedic services. The National Healthcare Group started a pilot project two years ago for podiatry service to be provided at its polyclinics. NHG polyclinics believed that the service would be cost-effective because they believed that they could market such services to the general practitioners. To introduce and popularise the service, they decided to charge the service at less than what it actually cost. However, despite this, the response was poor. The project ended in September 2004. Podiatry services will continue to be available in the hospitals. Our hospitals and polyclinics will continue to pilot projects that try out new ideas.”
“The Bio-advisory Committee had been formed in 2000, and a special sub-committee to deal with this was formed in 2001, and this committee wrote to all the religious groups and professional bodies, including the Law Society - this is for Mr Chandra Mohan's information - to get their feedback. All this feedback was collated and published in its report. So, the opinions of everyone is in that report and a proper public consultation was done.”
“Basically, stem cells are cells that have the potential to divide into any kind of tissue. Adult stem cells can do it, and embryonic stem cells can do it. Most scientists feel that research on all types of stem cells is necessary, but they believe that the potential for a cure is going to come from embryonic stem cells. This Bill has not mentioned therapeutic cloning, and therapeutic cloning is not being done in Singapore at this time. Why may therapeutic cloning be necessary in stem cell research? Sir,how stem cells would be used to treat diseases is that the stem cells would be used to create cells that a person has a deficit in. These cells would then be given to that person. For example, a person who suffers from diabetes does not have the cells that produce insulin. Therefore, if we were to give him stem cells that convert into cells that can produce insulin, then his diabetes can be cured. But one of the problems would be that these cells may be rejected by the body. But if the make-up of the cell could be altered so that it is genetically similar to that of the recipient, then those stem cells, when given to the patient, will not be rejected by the patient. So, although the stem cell may originally have come from an embryo with a different DNA make-up, the stem cell that went into the patient has the genetic make-up of the patient himself. This process of changing the nucleus of the stem cells would constitute therapeutic cloning. And because it can be an essential part in the cure for many diseases, therapeutic cloning has not been banned in many countries. Questions were asked whether there wereadequate consultations.”
“Mr Speaker, Sir, I thank the hon. Members, Dr Lily Neo, Dr Amy Khor, Dr Chong Weng Chiew, Mr Ahmad Khalis, Mr Ang Mong Seng, Mr Iswaran, Mr Chandra Mohan and Dr Ong Seh Hong for their comments and for their support for this Bill. Many Members were concerned that because we have not specifically banned therapeutic cloning, this maybe the thin wedge that leads to human cloning. Some members of the public also share this concern, especially because of the many sensational media reports about cloning. Dr Amy Khor mentioned a report about Dr Panos Zavos who claimed a few days ago that he had successfully cloned two dead people using cow embryos. There areothers who have made equally sensational claims. First, there was a Richard Seed, a physicist who volunteered himself for cloning and was going to clone himself. Then, there was an Italian doctor who was mentioned who has travelled around Europe with plans to clone a human, and announced that he intended to clone a person in the UK. The UK then passed emergency legislation to prohibit human cloning. Then, there is a journalist called Rael who started a religious cult and formed the company called Clonaid. He claims he met clones when an UFO landed in Canada and they had given him instructions to clone humans. Clonaid has announced that it has cloned a human called Eve, and there were even local media reports that Clonaid may clone Singaporeans and my Ministry was queried. This Bill will unequivocally make it clear that we prohibit reproductive human cloning and that these self-promoters who want to promote human cloning are not welcome in Singapore for any activity that is related to human cloning. There were questions asked about adult and embryonic stem cell research.”
“Mr Speaker, Sir, I agree with the Member that we must constantly try to improve our healthcare services andreduce mortality rates from heart diseases, and we should constantly review all measures and see if improvements can be made. But if you look at it globally, in terms of health care, our life expectancy is now reaching into one of the top 10 in the world and our mortality rate from cardiac disease is also going downcompared tothe developed countries. So the Heart Centre and all the cardiology units in Singapore are making progress. And, of course, we will urge them to continue to improve their services. MEDICAL INSURANCE 6. Dr Lily Neo asked the Minister for Health (a) how will he address the concerns of Singaporeans on the affordability of healthcare costs, especially hospitalisation costs; (b) does he agree that "risk-pooling insurance" is a good consideration compared to "save and pay as we go" in financing healthcare; (c) if so, what are his action plans; and (d) will he ensure that any insurance plans implemented will be adequate for hospital needs of the majority and one that can also cater for the long term future medical needs. 7. Mr Zainudin Nordin asked the Minister for Health (a) what is the maximum limit for any person to buy a medical insurance policy under MediShield for protection in his old age; and (b) if a person can afford to invest in an additional insurance policy, will he be allowed to buy it under MediShield.”
“We do recognise that there may be situations where researchers may not be in a position to check or control the nature and age of the embryo being imported and so only those who knowingly import prohibited embryos will be liable to prosecution under this Bill. (f) Prohibition of commercial trading in egg, sperm and embryo. The Bill also prohibits commercial trading in human eggs, sperms and embryos. This is prevented by outlawing the giving or receiving of valuable consideration for the supply of such items. Valuable consideration includes any inducement, such as money or gifts, as well as any discount or priority in the provision of a service to the donor. It does not include the payment of reasonable reimbursement, such as expenses incurred or the provision of services during the collection, storage or transport of the tissue. (g)Penalties. The maximum penalty for offences under this Bill is a fine of $100,000, a 10-year jail term, or both. This is in line with the penalties in the UK legislation. Conclusion Mr Deputy Speaker, Sir, this Bill prohibits what is considered unethical by everyone, that is, activities leading to the development of a human clone. I hope all Members will show their support for this Human Cloning and Other Prohibited Practices Bill as this will clearly demonstrate Singapore's commitment towards ethical and responsible biomedical research. Sir, I beg to move. Question proposed.”
“In order to prevent individuals from circumventing the first provision by developing human clones outside the human body, this Bill includes a provision that prohibits embryos created by any means from being developed outside of a woman's body for more than 14 days. This cut-off point of 14 days was recommended by the Bioethics Advisory Committee because it is at this time that the cells in the embryo begin to differentiate and start forming tissues. This 14-day rule is found in similar cloning legislation from countries such as Australia, Belgium, Japan and the UK. (c)Prohibitions on certain uses of embryos. This provision is to ensure that no one would be allowed to undertake such abhorrent experiments as placing of human embryos into animals or placing animal embryos into the body of a human being. (d) Prohibited embryos. This provision complements the earlier provision by ensuring that embryos that have been developed for more than 14 days outside the body of a woman should not be implanted into a womb. This does not include any period of time during which the embryo's development has been suspended, for example, when an embryo is frozen. The prohibition against implantation also extends to embryos that have been deliberately removed from a woman's body with the intention of collecting a viable embryo. (e) Prohibition against import and export of prohibited embryos. This Bill also prohibits the import and export of prohibited embryos so that researchers cannot collaborate with overseas parties in unethical cloning research activities.”
“This was supported by the feedback obtained by my Ministry during its public consultations on the draft version of this Bill. Scope of Bill This Bill prohibits human reproductive cloning. I think no one will disagree with this and so I hope that all Members, including those whomay be opposed to other aspects of human embryonic stem cell research, IVF or any kind of researchdealing with embryos, would agree to support this Bill which bans human reproductive cloning. As issues that relate to stem cell research touch on the fundamental moral and religious beliefs of Members, I would like to ask for the Whip to be raised so that Members can vote for this Bill according to their conscience. Provisions Mr Deputy Speaker, Sir, the overall intent of this Bill is very straightforward, that is, to ban the cloning of a human being. However, the provisions in the Bill are technically complex as it is necessary to ensure that this Bill adequately addresses all the scenarios in which human reproductive cloning activities might take place. At the same time, we also need to make sure that the provisions do not inadvertently interfere with couples who are making use of Assisted Reproduction services and In-vitro fertilisation (IVF) programmes to have children. I will now proceed to describe the main provisions in the Human Cloning and Other Prohibited Practices Bill: (a) Prohibition of implantation of any human clone. The key provision of this Bill is that it bans the placing of a human embryo clone into the body of a woman. This effectively prevents anyone from developing an embryo clone inside a human womb and delivering it after nine months as a live baby. (b) Prohibition against developing embryos outside the body for more than 14 days.”
“Secondly, the cloning of identical copies of humans raises ethical and moral concerns that trouble most people. In December 2000, the Bioethics Advisory Committee (BAC) was appointed by Cabinet to examine the ethical, legal and social issues arising from biomedical research and development in Singapore, and to recommend policies to the Ministerial Committee for Life Sciences on these issues. In February 2001, the Human Stem Cell Research Sub-committee was formed under BAC to specifically deal with the ethical, legal and social issues arising from human stem cell research. The BAC made its recommendations on how stem cell research should be conducted in its report which was accepted by Cabinet in May 2002. The BAC recommended that there should be a complete ban on the implantation of a human embryo created by the application of cloning technology into a womb, or any treatment of a human embryo intended to result in its development into a viable infant. In other words, it recommended banning human reproductive cloning. This Bill will ban human reproductive cloning without stopping stem cell research that may provide cures for millions of people with diseases like diabetes and stroke. Stem cell research Mr Deputy Speaker, Sir, there is a spectrum of views on stem cell research and therapeutic cloning. There will be no unanimous view on this subject and my Ministry recognises and respects the diversity of views. But in the area of human reproductive cloning, there is almost unanimous agreement from the international community, local scientific and religious groups as well as our general public that reproductive cloning of human beings is abhorrent and should not be allowed under any circumstances.”
“Mr Deputy Speaker, Sir, I beg to move, "That the Bill be now read a Second time." Concerns about cloning and stem cell research Sir, stem cells are unspecialised cells. They are able to renew, proliferate or reproduce themselves. They are also able to specialise and differentiate into other type of cells with specialised functions. Because of this potential to become specialised cells, stem cell research may provide a cure for diseases like diabetes, dementia, Parkinson's disease, stroke, spinal cord injury and heart failure. When the stem cells are obtained from an embryo, they are known as embryonic stem cells. The embryonic stem cells may be obtained from human embryos created by in vitro fertilisation (IVF), by cloning techniques or from existing embryonic stem cell lines. Cloning techniques used to produce stem cells are referred to as therapeutic cloning techniques. In 1997, the first successfully cloned mammal, Dolly the sheep, was born. This was not an easy feat: Prof Ian Wilmut and his team had to make more than 270 attempts before they finally succeeded in cloning Dolly. Since then, scientists have cloned a number of other animal species but no one has yet managed to successfully clone a human being. But the potential to create a human clone exists. This form of cloning is called reproductive human cloning. Almost everyone believes human reproductive cloning should not be attempted for two reasons. Firstly, the attempt to clone a human is very likely to give rise to many malformed babies before a seemingly normal baby is cloned. Dolly the sheep had premature ageing and died early. So even if a normal looking baby was successfully created by cloning, such a baby may have many defects.”
“Sir, in short, we give a 65% subsidy for all diseases, whether it is stroke, heart disease or cancer. We do not discriminate between sick patients based on their diseases. 3.00 pm”
“Sir, our systems for subsidies for inpatient and outpatient are different. What we have done for inpatient is to take all parts of the treatment - medicines, implants, surgery, ward care - together, and we provide a 65% subsidy. For outpatient, our subsidy is up to 50%. At this point in time, I think we will continue with these subsidy levels. In the past, we tried to differentiate - 65% subsidy for different parts of the inpatient treatment - and patients suffered. Because when they needed an implant, they did not get any subsidy and they had to pay for these implants out of their own pockets. With the MSP, what we are doing is that we are rationalising the treatment for inpatient care and ensuring that they get this overall 65% subsidy.”
“We will monitor closely the utilisation of cardiac services and the quality of care provided. The development of the MSP for the other specialties will involve defining the list of services and evaluating the benefits to patients. It will also involve making the necessary changes to the hospitals' billing and IT systems. MOH will be monitoring closely the impact of the MSP on cardiac services over the next three to six months. Based on the results of this pilot, MOH will take a phased approach in extending the MSP to other specialties. With the subsidies under the MSP, healthcare services for heart diseases, which are expensive services to provide, will remain affordable for Singaporeans.”
“MOH has recently reviewed the inpatient subsidy system and introduced the Medical Service Package (MSP) for heart diseases on 5th July 2004. The main objective of the MSP is to ensure that patients receive the appropriate subsidies for all cardiac services according to their ward class. The need for services is strictly based on medical indication. Under the MSP, medical services are classified into basic and extended. Basic medical services refer to treatments where the treatment indications are standard. These services will not be subject to peer review. Extended medical services refer to treatments where treatment indications are still evolving or controversial. Doctors will conduct peer reviews on the use of extended medical services to ensure that the most appropriate treatment is provided to their patients. This will serve as a form of quality control where the cardiology profession monitors the work of the individual cardiologist. This is to ensure that neither under-treatment of patients nor over-provision of services occurs. Experimental treatments like placement of an artificial heart or stem cell therapy will be considered as excluded services and will require MOH's approval before doctors can proceed with such treatments. Previously, there was minimal subsidy for implants like stents, pace-makers and defibrillators. Stents can cost between $1,800 and $5,000. Defibrillators can cost about $25,000. With the introduction of the MSP, patients who need these implants will receive a subsidy of 65% for the implants if they are in B2 class and 80% if they are in C class. The MSP has also added nine new cardiac drugs to the list of drugs on the standard list and these drugs will be subsidised at 65% for B2 patients and 80% for C class patients.”
“They include: (a) Ensuring that drugs are prescribed appropriately: MOH has been working with the relevant specialists to develop clinical practice guidelines for various common diseases to help doctors provide the appropriate treatments that are evidence based. (b) Using cheaper alternatives where available: With the introduction of electronic prescription systems, doctors are now kept informed about the costs of drugs and available alternatives. Doctors are encouraged, where possible, to use generic instead of patented drugs. (c) Central procurement through the Group Purchasing Office: The Group Purchasing Office (GPO) was set up in the year 2000 to support the institutions under the two clusters to perform central procurement. The GPO obtains competitive prices through purchasing tools such as open tenders for bulk purchases. Savings obtained by this economy of scale are passed directly to patients. To succeed in our efforts to keep healthcare costs affordable, we need the support of both the doctors and the public. Medical care in Singapore can remain affordable if we ensure that we spend our healthcare dollars in a sensible manner. Many older medicines, which are generic, are effective and have a well proven track record of curing or controlling a disease. It does not always mean that a newer patented drug is better than an older generic drug. Often, the latest medical treatments only provide a theoretical benefit but at a significantly higher cost. The long-term benefits and risks of these new treatments are often unknown. Doctors therefore need to look at medical treatments objectively and not be swayed by the subjective influences of advertising and marketing efforts. The public should also not think that expensive or newer medicine is always better.”
“Sir, healthcare is an expensive service to provide because it involves resources such as trained professionals, high technology equipment, and medical implants and pharmaceuticals. Of these, pharmaceuticals form 10-15% of healthcare cost. We do not control the price of these resources. Nevertheless, the Ministry is working to keep healthcare affordable. In 1979, the Ministry developed a list of standard and non-standard drugs with the help of expert physicians. The Standard Drug List (SDL) was modelled after the WHO Essential Drug List, with modifications to suit local disease profiles and practice. It consists of drugs assessed by the MOH Drug Advisory Committee to be cost-effective and essential to the provision of medical care to all Singaporeans. The SDL is further categorised into lists 1 and 2. SDL 1 consists of mainly first-line drugs required for the treatment of common diseases of mild to moderate severity. SDL 2 was established in 1992 to allow essential but more expensive drugs (eg, cancer drugs) to be included. MOH reviews the SDL regularly to take into account changes in clinical practice and advances in medical science. Revisions to the SDL are made with the input of the MOH Drug Advisory Committee and the respective national specialty committees. Evidence from the medical literature and comments from medical practitioners of the respective specialties are also taken into consideration. Where necessary, new drugs are added to the SDL. To ensure that the cost of medicines remains affordable, our hospitals and polyclinics have taken the following measures.”
“When the appointments are made, yes, the appointments are made for a specific doctor, and you can do that in our public hospitals. With regard to whether there is a specific remuneration for subsidised patients seen in the clinics, I do not think so. But I can check on that and give the system of remuneration to the Member. SINGAPORE LABOUR FOUNDATION (Funding of new programmes) 15. Mdm Ho Geok Choo asked the Acting Minister for Manpower following the announcement in May 2004 that the Singapore Labour Foundation (SLF) is giving up its charity status to focus on funding new programmes that will benefit workers, (a) what are these new programmes; (b) how will these programmes benefit workers in general; and (c) how will SLF be classified henceforth.”
“So, to ensure that when you go to a clinic, the doctor at the clinic is able to read the writing that was written before and the doctor remembers all the complaints over the last 10 visits, really, a lot of patients who are currently going to our specialist clinics and trying to make use of our specialists as their primary physician, should switch their focus and think of the general practitioner as their primary physician, the one who is going to be their friend, confidant and help them navigate through the complex system in modern healthcare.”
“That is a whole series of questions, but I will try and answer them in general. Firstly, hospital care is a very complex organism, with so many different people involved and with specialists in different areas. In the hospital, the doctors are also involved in multiple functions. They not only look after patients, they also teach and present papers at international meetings. So, although a patient is under the care of a certain consultant, quite often the patient does not see the consultant. He goes to the clinic, but the consultant may be presenting a paper at a meeting or he may be doing an emergency operation. But what the patient wants, very often, is a familiar face. They very much like to see the same person time after time, so that they know this doctor remembers the complaint that they had eight, nine or 10 visits ago. Really, that is a function of primary care. So, what a patient should do is that he should have a general practitioner, someone whom he can see all the time and who understands all the complaints. What too many patients do, is that they go to a specialist clinic, once they have a problem, say, a heart problem. They try and make use of the specialist as their primary physician and expect that every time they go to the clinic, he will be there. This is very hard for a hospital to provide, because of the very nature and complexity of hospital care.”
“Mr Speaker, Sir, in public hospitals, the care for all patients, whether paying or subsidised, involves team work. Every patient is under the care of a medical team led by a consultant. The consultant is ultimately responsible for the patient's care although other doctors in the team may also be involved in treating the patient. In the case of a seriously ill patient, the medical team may be quite large and often involves doctors from several specialities. This is the result of specialisation and it ensures the high standard of care for the patients. Even so, there will always be one department and one consultant who take primary responsibility for care. Consultants are assigned to the subsidised patients, based on the medical condition and specific needs of the patients. Every speciality has a roster of consultants to ensure optimum distribution of patient load. Upon discharge, the patients continue to be cared for by the medical team in the hospital specialist clinic.”
“Sir, he assumes wrongly! Twenty companies purchased the tender documents. Companies such as Satyam Computer Services, Hewlett Packard, Microsoft (Singapore), etc, bought the tender documents. Two companies finally submitted their tenders. Of the two, Green Dot submitted the lower tender. ILLEGAL IMMIGRANTS The following Question stood in the name of Ms Indranee Rajah - 6. To ask the Minister for Home Affairs (a) what is the total number of illegal immigrants caught trying to enter Singapore through the various checkpoints over the past two years and (b) what are the measures being taken to deal with the problem of persons trying to enter Singapore illegally.”
“In addition, integrating the three portals into one will make it more convenient for motorists, the motoring industry and members of the public, as they only need to go to one single site for a whole range of comprehensive motoring and traffic information.”
“Sir, Mr Steve Chia asked about the cost for revamping the One Motoring website. First, let me clarify that the new One Motoring portal is a merger of three separate existing portals, namely, the One.motoring, Traffic.smart and OnePay Hub portals. These portals provide useful services such as information on COE bids and car numbers available for bidding, road tax renewal, real-time traffic information and electronic payment options for fines and administrative fees. Collectively, they have more than two million page views and handle more than 300,000 online transactions per month. As the contracts for the hosting and operation of these three portals will expire this year, LTA took the opportunity to consolidate them for greater synergy and, at the same time, derive possible commercial benefits by outsourcing them to the private sector. A tender was called by LTA, and Green Dot Internet Services Pte Ltd (GDIS) won the contract. Today, LTA incurs a cost of $6.3 million for hosting, operating and maintaining the three portals separately for a period of five years. The new 5-year contract will cost a total of $3.9 million or $780,000 annually. This represents a cost saving of about 40% for LTA, or about $500,000 annually. The remaining $1.1 million is a budget set aside under the contract for future enhancements that may be needed. It will only be payable as and when the enhancements are identified and implemented. Hence, the new contract amount represents a significant cost saving over the current cost of running the three portals separately.”