Chia Shi-Lu
Singapore
“Chairman, I wish to thank all Members who have taken part in this debate and, of course, Minister Gan, Senior Ministers of State Amy Khor and Dr Lam Pin Min and Mr Edwin Tong and also Senior Parliamentary Secretary Amrin Amin, together with all the staff at MOH for their replies and the work they have put in for the healthcare system for…”
“Nonetheless, I believe that a united society will be a key piece to this puzzle, and I look forward to the Ministry of Health's stewardship in this regard. May we all live long, live well and grow old together as one people. Thank you, and I beg to move. [(proc text) Question proposed.”
“Mr Chairman, high usage of air-conditioning and refrigerators contributes to global warming, and none more so than in Singapore where we love our climate control and air-conditioning. But as a responsible member of the global community, we should do our best to reduce our carbon footprint.”
“Management of E-waste Last cut. With the introduction of the Resource Sustainability Act last year, the EPR scheme will commence and a PRS operator I alluded to earlier will be appointed to collect and ensure proper disposal of electrical and electronic consumer products.”
“I thank the Minister for the update. I just have two clarifications about the Disease Outbreak Response System Condition (DORSCON) level – the acronym of the year, so far! First, some clarification about how this DORSCON is arrived at. Is it by independent committee that makes this decision and recommends to the Minister?”
“I just want to echo and express my thanks to Minister Gan Kim Yong for his statement of thanks and support for healthcare workers. Two short but slightly technical questions, I apologise. The first, the Minister touched about it earlier.”
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“The amendments which are specified in Part V of the Bill to empower SCDF to go upstream to punish suppliers which provide non-compliant products and building materials and ban their use is certainly a step in the right direction. Such a move would enhance the fire safety of materials used in new buildings. However, in the meanwhile, what about downstream consequences? Would the Ministry consider conducting from now, spot checks and audits on existing buildings and require replacements should there be deficiencies due to less stringent fire safety standards applied in the past or perhaps because of deterioration over time? I would like to conclude with my support for the Bill and look forward to the clarifications on these issues.”
“The Ministry has indicated that it is prepared to be flexible and may accept alternative solutions for buildings which encounter technical problems installing such features. I appeal to SCDF to adhere to its high standards. Understandably, owners will be concerned with costs. But alternatives which compromise on safety should not be permitted. I have a question regarding the evacuation of persons with mobility problems. The new regulations require at least two compartmented rooms for horizontal evacuation, but only for healthcare buildings primarily. What about other buildings? With our rapidly ageing population and integration of persons with disabilities into our workforce, we can expect more persons with mobility issues in our workplaces as well as other buildings, including residences. What provisions do we have in the protected stairways to enable the safe evacuation of the less abled or the disabled? Let me move on to fire safety products which many other Members have already brought up. Fire safety products used in buildings do play a very important role and we are all aware of the examples of the Toh Guan Road industrial complex fire in May 2017 and London's Grenfell Tower inferno just one month later. The external cladding in both cases accelerated the spread of the fire. I and including others, have raised this concern in this House previously. Grenfell Tower also had similar deficiencies as the Kyoto Animation building in lacking a fire sprinkler system and having only one stairway, which the survivors later reported were blocked and full of smoke, an indication that the fire doors had failed.”
“Deputy Speaker, Sir, fire is a horrific event and the amendments to this Act are timely and will strike a balance between empowering SCDF, which has always been working tirelessly to keep us all safe from the scourge of fire, to continue upholding high fire safety standards and ensuring public safety as well as managing the costs for building owners and industry stakeholders. In Singapore, most fires are the results of accidents and, in some cases, negligence. But we should also be on guard against sabotage and attacks, including those related to criminal and terrorist activities. We can draw lessons from fire incidents in other countries. First, allow me to comment on the need for critical fire safety features for all buildings. Last month, the Kyoto Animation arson attack in Japan tragically took 35 lives, all employees in their 20s and 30s. The building had just passed a fire safety inspection in October last year, but as it was designated a small office building, it was exempted from installing fire sprinklers, indoor fire hose reels and protected staircases leading to external areas, all safety features which could have helped reduce the number of lives lost and which are, thankfully, included in this Bill. Hence, I fully support the proposal to require owners of older buildings to upgrade and install critical fire safety features to keep up with the latest Fire Code. In particular, I hope to see wider adoption of smoke detection and sprinkler systems in all buildings by owners. Such features are necessary, regardless of the size or the designated building use. As the Kyoto Animation fire had shown, regulators should not make exemptions, as precious lives are at stake and fires consume buildings both big and small.”
“Just two supplementary questions for the Senior Minister of State. I just wanted to ask whether the Ministry has any ideas to perhaps increase either subsidies or further funding support for patients with diabetes. Just to give an example, diabetes is part of the Chronic Disease Management Programme (CDMP) but not all of the chronic diseases are created equal. So, I was wondering since we have this war against diabetes, whether we could look at some package where there could be additional funding liberated either from patients' MediSave or, perhaps from other targeted subsidies for patients with diabetes, because this would probably help to increase compliance. The second supplementary question is related to my later question, but I think I will just ask it here. We are all concerned to see that the sugar intake per day of Singaporeans, as of a survey last year, is still at 60 grammes, and the World Health Organization's (WHO's) standard is 25 grammes every day. It is quite a big jump. So, I was wondering whether MOH has any targets. Have we set any targets for the sugar intake per day for Singaporeans, and do we have any timeline to try and reach these targets?”
“In addition, we should make it mandatory for motorists to install and maintain approved models of car cameras. And these cameras can help to moderate driving behavior and detect other irresponsible motorists. Finally, we should be paying attention to the growing segment of elderly drivers as our population is ageing rapidly. Adjustments to infrastructure and additional training will help keep our senior drivers safe on our roads. We should take heed of the experiences of other countries with significant elderly populations. In June, the Lianhe Zaobao reported on an NHK article about the severe problems caused by elderly Japanese motorists. The traffic accidents they are involved in have the highest death rates. The main cause for the group aged 75 and above who are involved in fatal accidents was "inappropriate vehicle operation". Therefore, I urge the Ministry to consider implementing perhaps more stringent and frequent cognitive tests and health checks for all elderly motorists. These assessments should be annual or perhaps bi-annual for those aged 75 and above, as functional health can potentially decline steeply from this age. Efforts would have to be made to persuade older drivers of the benefits of these assessments as they will enhance their own and other road users' safety. I would like to conclude by voicing my support for this Bill.”
“They should not be allowed to transfer to anyone without a driving licence, of course. And while this is an unpalatable measure, such a punishment may be a more effective deterrent and much easier to enforce. I note that, already in this Bill, there is a range of offences which can result in the forfeiture of vehicles, for example, dangerous driving causing death or grievous hurt. However, I am not sure if these offenders would be prevented from acquiring another vehicle and I would like to seek some clarifications on this. In addition, anyone, such as family members and friends, who willingly or unwittingly provide access to vehicles should also be made to bear varying loads of penalties, so that they will be more vigilant in keeping these offenders out of the driver's seat. The Ministry should also provide car leasing companies with greater support and tools to ensure that they lease vehicles to only motorists with valid licences. And I do applaud the move to make the licences virtual. These companies should be able to perform cross-checking in real time and be provided updated data. Next, I would like to request that the Ministry consider following the measures by the EU to install speed limiters in all new cars. These devices automatically prevent drivers from exceeding the speed limit. It might be even better if we could take it one step further and require all vehicles to be fitted or retrofitted with such devices. The EU will also be introducing other safety measures which will be mandatory by 2022. These include automated emergency braking, electronic data recorders and features to be built into bigger and heavier vehicles like lorries to improve visibility of cyclists and pedestrians around them. We should consider incorporating these ideas as well.”
“Mr Deputy Speaker, Sir, road safety is as much about user behaviour as it is about good infrastructure and design. We have conducted decades of public education and made continuous investments in road networks and technology to enhance safety of all users. However, the most important component of road safety is still the behaviour of our motorists. Unfortunately, many motorists still have some way to go in terms of safety awareness and etiquette. In recent years, the number of summonses issued for traffic offences and feedback letters sent to the Traffic Police have been increasing. More worryingly, we are seeing a jump in the number of drink-driving accidents. With lives and limbs at stake, heavier penalties, as proposed in this Bill, are necessary to serve as stronger deterrents to motorists who drive irresponsibly and dangerously. Longer jail terms and disqualification periods (DQ) from driving will certainly help to keep such hazardous drivers off the roads. My concern is that quite a number of disqualified drivers are not compliant. The Traffic Police have been catching more motorists driving without valid licences in the last few years, from 921 in 2014, to 1,435 in 2018, and there are probably quite a number who got away, considering the difficulty of detection. As a result, the effectiveness of DQ, as a deterrent and punishment, could be undermined. Hence, I would like to propose that the Ministry also consider restricting offenders' access to vehicles. This can be partly achieved by prohibiting vehicle ownership for various durations, depending on the severity of their offences. This would mean that offenders might even have to transfer or sell their vehicles, resulting in potential inconveniences and, perhaps, financial losses.”
“For example, if I were to take some data that had been rejected by all of the highly regarded and respected medical journals, and decided to take it in my own hands and publish it online, and many people could read it, there is actually very little recourse for the scientific community or for various agencies to be able to correct such falsehood. Sir, in closing, I would like to end by expressing my thanks to the SC on Deliberate Online Falsehoods for their work and for their contributions towards the formulation of this Bill, and I support it.”
“For example, there is news circulating online about how a promising young person was reduced to a cripple some weeks after receiving a vaccine, and how the vaccine was responsible for her horrific condition. Imagine if we were just to post alongside this untrue article the links to the many scientific papers showing it to be untrue, I wonder how many would think otherwise or have their opinions changed as a result of this corrective posting. Way back during the Severe Acute Respiratory Syndrome (SARS) epidemic, for instance, what if there was fake news online that going to a quarantined area or to a hospital would lead to loss of life, or maybe things like eating white salt would be able to cure you of SARS? If this was allowed to spread unchecked on the Internet, how many lives would have been lost? I am going to end by just making a little bit of a small comment. I actually have a contrarian view that perhaps this law may, in fact, be a little bit too narrow. In fact, it is very far from the nuclear option that hon Member Mr Png Eng Huat just spoke about. From the perspective of an academic, which I think in some areas of my job roles I do consider myself as an academic, it has always been the case that when we do research or publish papers about various aspects of science or research, these are already subject to many rules and regulations. And the veracity of such publications, if there are erroneous conclusions or problems with the data, this is subject to very real scrutiny and there is already a due process for corrections or even retractions. However, such avenues do not exist if such papers are published online, which is one of the criticisms for the emerging breadth of so-called research articles that are sprouting online.”
“Laws still need to be in place to safeguard the public interest and for public safety. Hence, I agree that domain Ministers are best placed to decide if the falsehood concerning their area impacts public interest, as the correction of online medical falsehoods, for example, constitutes a public health urgency, and demands to be expedited, and speed here is indeed necessary. If there is a physical threat to public security or public health, an Executive decision needs to be made as to how to counter this threat, and certainly decision by committee or by prior application to the Courts would not work. Imminent or existing threats, either physical or in the online space, must be dealt with expediently, though I do agree that for the falsehoods, there should still be an appeals process, and the Courts should have the final say on what is false. Here, I do seek a clarification from the Minister as to the process through which an online falsehood will be dealt with in terms of the action or the corrective action taken: how will it be decided if a simple corrective rebuttal is all that would be required, or if a takedown is needed? This is because like most situations in healthcare, prevention is always better than cure. Once a medical lie has entered the public domain, it takes root very quickly and becomes very hard to eradicate, if not impossible. Posting the real facts alongside the falsehood will probably be of little use. It is so much more powerful and engaging to read a snippet of alarmist fake medical news, and believe it to be true due to the strong human element, than to believe the reams of boring but rigorous scientific and medical evidence that can be posted alongside it.”
“The problem we have now is that in the online arena, those that shout the loudest, trumpet that which is sensationalist, novel or frightening regardless of its veracity, will garner the most attention and drown out other voices, leading to an imbalance which actually prevents equitable and meaningful discussion. A lie is a lie, no matter how much you may wish it to be true, and no matter how you paint it, and the distinction between truth and falsehood is simple where it counts, in matters of life and death, and of sickness and health. Particularly in issues of healthcare, there is really no need for committee after committee, council after council, or for the Courts to decide what is true and what is not. This yardstick does not apply to truth in advertising or standards in claims about medical treatments offline, so why should offline or online untruths be spared? Therefore, I feel that the same should apply to online information and also misinformation about healthcare. Make no mistake about it. Much of this information online is deliberate and carefully crafted and cultivated. This new disease on online space, as hon Member Ms Sun Xueling has so eloquently put in her speech yesterday, needs a targeted yet calibrated response with legislation, such as the one we are debating today, or these bad actors of the social media space will gain the upper hand to the detriment of us all. It is, of course, important that we continue to invest in public education, but the general public cannot be always relied on to tell what is fake news and what is not. In fact, in a recent study by the Massachusetts Institute of Technology, it showed that people are 70% more likely to share online falsehoods rather than facts.”
“(In English): The consequences of fake medical news are clear to see. It is startling that we are now seeing measles epidemics around the world, with very real loss of life that could have been entirely preventable through vaccination, vaccination that increasing numbers are choosing to refuse partly due to untrue information available online. Closer to home, the timely decision by the Ministry of Health to introduce anti-human papillomavirus (HPV) vaccination for female schoolchildren, which will save the lives of many of our future wives and mothers, has been greeted with the rise of online falsehoods regarding the vaccine, which seek to derail this very important and life-preserving programme. Online falsehoods have very real consequences. Misleading information spread by the anti-vaccine movement using social media can cause parents to reconsider vaccinating their children, exposing them to significant health risks. Prof Heidi Larson, who is a public health expert at the London School of Hygiene and Tropical Medicine, wrote in the journal Nature that: "The next major outbreak of a fatal strain of influenza or something else will not be due to a lack of preventive technologies. Instead, emotional contagion, digitally enabled, could erode trust in vaccines so much as to render them moot. This deluge of conflicting and manipulated information on social media should be recognised as a global public health threat." Like other Members before me, I do not think that this Bill will be an impediment to free speech, nor should it have any chilling effect on public discourse or creativity. I believe it will actually accomplish the opposite.”
“But fake medical news threatens our lives”, he notes that and, I quote, “While misinformation has been the object of great attention in politics, medical misinformation might have an even greater body count. As is true with fake news in general, medical lies tend to spread further than truths on the Internet – and they have very real repercussions”. Mr Deputy Speaker, in Mandarin, please. (In Mandarin): [Please refer to Vernacular Speech.] I am sure that Members of this House are aware of the many examples of fake health news online that have led to very real harm. False information about statins, which are cholesterol-lowering medicines, has led to many people choosing not to go on these medicines and, so, significantly raising their risk of heart attacks. Fake claims about cancer treatments have led many to forgo lifesaving treatment for curable tumours, in favour of treatments that have no known efficacy and which can even be dangerous. There is also a lot of false information online about the dangers of various types of vaccines. In recent months, some residents have approached me with their concerns about the safety of vaccination programmes that we have been advocating for public health reasons. Some expressed their belief that vaccination could lead to serious mental or neurological damage, others were convinced that many vaccines contain poisons. When asked about the source of this information, they all indicated articles they had read on the Internet, or information circulated via WhatsApp or short message services (SMS). This is unsurprising, because such untruths cannot be circulated in print or other physical media as there are regulations against the promulgation of such false information.”
“Mr Deputy Speaker, I rise in support of the Bill, which I believe to be necessary for the welfare of all Singaporeans. I would like to speak on the importance of this new Bill, from the perspective of healthcare, and specifically from the viewpoint of the pernicious and harmful effects of deliberate online falsehoods and malicious misrepresentations in regard to medical and health information. And I hope that this also illustrates why I feel that the approach this Bill takes is, indeed, the right approach to protecting us all from online falsehoods. It was not too long ago that healthcare professionals and ordinary citizens alike hailed the Internet as the great equaliser by helping to reduce information asymmetry between healthcare providers and their patients. While many doctors were initially apprehensive when their patients became so much better informed due to the amount of medical information available online, healthcare professionals gradually learnt to welcome this and appreciate how this made the doctor-patient relationship more equal and more participative. But it soon became apparent that the Internet, like any powerful tool, can be a double-edged sword. Medical misinformation and outright falsehoods began gaining a larger and larger footprint in the datasphere, and it was exasperating to many healthcare providers that such falsehoods online were significantly impacting the health-seeking behaviour and ultimately the health of their patients, so much so that life and limb were at risk. In an op ed piece earlier this year by Dr Haider Warraich, with the byline “Fake news threatens our democracy.”
“Just a quick clarification for the Senior Minister of State. I was wondering if the Senior Minister of State could share with the House for those appeals for IVF, what are some of the considerations that the Ministry takes into account when evaluating the appeals?”
“As it has often been said, not only should justice be done, it must be seen to be done. I support the Bill.”
“Some of these acts of online "vigilantism", such as to expose the couple who harassed an old man at a hawker centre, inconsiderate and dangerous drivers, voyeurs and Peeping Toms, may seem warranted but, in fact, undermines the very foundation of our justice system. Administering justice is not an activity which can be done part-time, remotely nor casually. Thorough investigations of the facts of the events are necessary, in fairness to all parties involved. In fact, there have been many cases where false or misleading information had been shared, causing hurt and damage to innocent parties. I urge the Ministry to step up awareness of what constitutes the illegal act of doxxing through public education programmes as well as the appropriate measures the man in the street can take to address bad social behaviours. A number of netizens resort to doxxing because they lack confidence in Government institutions to rectify certain situations and social behaviours, leading them to take matters into their own hands. It is important that public institutions concerned show their awareness of these incidents and prove that the Government takes a serious view of their feedback through comprehensive measures and consistent enforcement. Public education to increase their awareness of the appropriate forums to share such information is essential. For example, they should be encouraged to post and share videos of, for example, dangerous driving with the Traffic Police, forward information on disputes to the relevant authorities and share information with emergency services. In order to reduce the incidents of doxxing, public institutions must be prepared to step up to address public concerns expeditiously and provide updates on actions taken.”
“Although I do not have the full information about the case, it was clear that they felt that this son was not behaving rationally and they were in constant fear of being attacked or harassed by this son, despite the existence of POs. And there was very little, in terms of immediate recourse, that they could turn to. So, is it possible to introduce stronger deterrent measures to enforce the POs and can more be done to prevent subsequent harassments or attacks? Would the Ministry also share recent data on the effectiveness of POs, including the number of cases of repeated breaches or subsequent injuries or perhaps even deaths? Next, like many Members before me, I do welcome the amendments to counter the unfortunate new social trend of doxxing, where people’s personal information, such as names, photographs, contact details, home and work addresses, are shared online in order to facilitate harassment, issue threats or cause physical harm. Many examples have been shared in this House over the past hour. I myself have also encountered such examples, maybe not of such degree or this nature. For example, several months ago, I came across a cleaner in one of the hawker centres who had a little bit of disagreement with one of his customers. It so transpired that the details about the cleaner were then posted on social media which led to a lot of consternation to this cleaner. Of course, notwithstanding the merits or the lack thereof of the case, I think these are very unfortunate developments in the social media arena.”
“Mr Speaker, Sir, I rise in support of this Bill which will further strengthen the current legislation to provide protection against harassment. One of the key amendments of this Bill is the establishment of the specialist Court, the PHC, which will provide a one-stop centre for all matters relating to protection from harassment. This arrangement will certainly facilitate the provision of holistic and effective interventions for victims. Two of the main concerns of harassment victims are the time required and also difficulties faced in getting POs. I am heartened to note that PHC will adopt simplified procedures and expedite the hearings for certain applications, for example, within 48 to 72 hours for EPOs, and where there is risk of violence or violence had already occurred, within 24 hours. The decision to permit the PHC not to be bounded by the rules of evidence in the conduct of civil proceedings will also be very helpful for victims. I would like, however, to seek some clarifications on the enforcement of POs once issued. The Bill indicates that remedies and recourse for breaches of POs and EPOs will be strengthened. The measures include the issuance of community orders and, in the cases of causing hurt or continued harassment, making such breaches arrestable offences. My concern is that these are implemented after the breaches, by which time the victims would have suffered another round of psychological or physical trauma. In cases where the accused may be unable to think rationally nor behave with restraint, there seems little to prevent them from causing more trouble. I have encountered some of these cases in my dealings as a Member of Parliament. For example, we had a daughter and her mother who felt they were threatened by one of their sons.”
“I would like to thank the Minister for the very comprehensive response. I have a few supplementary questions. The first is with regard to the measles cases that were reported recently, that is, the increase to 43 cases. Could I just maybe have an understanding of the type of cases? Were they adults, children? Were they imported cases? Just to get a feel of how these cases arose. The second question is with regard to vaccination rates. I note the answer on the vaccination rates with regard to children. I was wondering whether we have data on the overall vaccination rate for the resident population in Singapore. This is because if we look at the outbreaks overseas, a lot of cases arose in adults and so on, not just in the paediatric community. The third supplementary question: I was wondering whether we have some ideas or some knowledge about what are the reasons that certain children or adults refuse to be vaccinated. I think this maybe comes with the next Parliamentary Question. Does the Ministry think that the anti-vaccination movement and the online misinformation have an important impact on the reason why parents, or maybe adults even, are refusing the vaccination? The last supplementary question is regarding whether MOH foresees that in the event of an outbreak or even pre-emptively, actions might be taken against unvaccinated individuals? We have seen in other countries there are restrictions on children who are unvaccinated from attending preschool or even going to school. The German Minister for Health has just proposed that there might be financial penalties for people who are unvaccinated.”
“How many and where are these works being done and what are the expected dates of completion? I understand that last year alone, the Ministry received about 500 submissions for plans to build retention tanks. But as of February 2018, only 158 have been completed. What is the status now for these projects? Besides these constructions, the maintenance of our drains is equally important. From the regular inspections, what common problems were detected and how can members of the public assist to keep obstructions out of the drains? And lastly, as I also called for last year, would the Ministry be considering the use of innovative porous materials, such as durable permeable concrete on our roads and walkways to facilitate drainage? Water Demand Management”
“Thank you, Chairman. The formation of the Singapore Food Agency (SFA) will bring together the food-related functions of the Agri-Food and Veterinary Authority (AVA), NEA and HSA. Without a doubt, this consolidation of regulatory oversight for food safety and security under a single agency will be more efficient. The streamlining of processes and the sharing of facilities and technology will enable all the various teams to communicate more effectively, reduce red tape, avoid duplication and work more productively. But for all the work behind the scenes, what are the benefits for Singaporeans and companies from this consolidation? Would the Minister share some examples of how these changes translate to, for example, the ability to conduct more accurate tests and frequent checks, or shorten approval times for certain applications, among others? As with any transition, there will be unexpected issues which will crop up. With less than a month to go before the start of SFA on 1 April, what are some of the challenges, if any, which the agencies involved encounter and how are these problems being solved? Rising temperatures pose a particular threat to food safety in Singapore, for example, as our wet markets and hawker centres are not air-conditioned, exposing all food to higher risks of spoilage. What is the Ministry's view on this problem? Flooding and Drainage With climate change, we can expect more unpredictable and intense rainfall. What are some of PUB's plans to mitigate flood risks in the face of this challenge? Would the Ministry share some updates, starting with the progress of the various drainage improvement works, canals, retention and any new detention tanks around our island?”
“Mr Chairman, as always, I would like to thank all Members for their active participation and for the very healthy debate and, of course, to Minister Gan Kim Yong, Senior Ministers of State Amy Khor, Lam Pin Min and Edwin Tong and Senior Parliamentary Secretary Amrin Amin and all the staff of MOH for the care they have given because you get explanations and the surgical precision of their responses. May we all live long and prosper. With that, I beg leave to withdraw my amendment. [(proc text) Amendment, by leave, withdrawn. (proc text)] [(proc text) The sum of $10,023,750,700 for Head O ordered to stand part of the Main Estimates. (proc text)] [(proc text) The sum of $1,698,806,800 for Head O ordered to stand part of the Development Estimates. (proc text)]”
“Just two clarifications. One is concerning the Agency for Care Effectiveness (ACE). I have been very supportive of it because it gives guidelines on what are the best practices. So, I was hoping that MOH could perhaps share with the House the achievements of ACE thus far. The second clarification is regarding MediShield Life. Earlier this year, there were some concerns about inadequate payouts for certain patients. I understand from previous replies that the MediShield Life Review Committee is looking at claims limits. But in the meanwhile, to give better assurance to Singaporeans, is there any mechanism by which we can appeal for higher payouts from MediShield Life in certain of these bills?”
“Chairman, MOH has introduced a series of tobacco measures to make it harder for smokers and to deter new ones. These include excise taxes, restrictions on smoking areas, a ban on point-of-sale display and a gradual increase in the minimum legal age. Very soon, cigarette packaging will also have to be plain and standardised, with bigger graphic health warnings. Can the Ministry take one step further and reconsider a ban on flavored and, particularly, menthol cigarettes, such as what Canada has recently done and which the US is considering once again? Such products are particularly appealing to new smokers, especially youths. WHO has also recently introduced the concept of a "best buy" policy. How aligned is Singapore with WHO's recommended, cost-effective policy action for smoking? For example, should we increase the minimum legal age beyond 21 and is our tobacco tax sufficiently prohibitive? Can more be done to help smokers, particularly young ones?”
“Chairman, besides doctors and nurses, Allied Health Professionals and Traditional Chinese Medicine (TCM) practitioners make significant contributions to our healthcare ecosystem. In a rapidly ageing country like ours, there will be greater demand for their services, particularly for therapists, psychologists, audiologists, dietitians and medical social workers, just to name a few. They are an integral part of a healthcare system which delivers comprehensive and seamless care. Sir, I have four questions. One, how is MOH ensuring that we will have a steady pipeline of Allied Health Professionals, given the need for holistic care? Two, will there be measures to upskill and better empower nurses to take on a greater role in our healthcare system, given our tight labour market and the heavy work burdens of our nurses? Three, in addition to the training and development of these professionals through the traditional career progression pathways, would the Ministry elaborate on measures to attract those interested in making a mid-career change to these professions? Lastly, how would the Ministry ensure that the remunerations of those in the public sector remain competitive? Engaging VWOs in Intermediate and Long-term Care (ILTC)”
“Chairman, the Merdeka Generation Package (MGP) is a wide-ranging and comprehensive package of measures that addresses concerns that the Merdeka Generation (MG) would have regarding healthcare affordability. What are MOH's plans to reach out to the MG seniors to let them know about the MGP and support their aspirations for active ageing? In particular, I note that the package includes a participation incentive of $1,500 to join CareShield Life on top of the previously announced $2,500. The total incentive of $4,000, together with the higher lifelong payouts, should be highlighted to the seniors during outreach activities, as they may be concerned about the higher monthly premiums. With longer lifespans, the risk of more seniors facing severe disability in their later years is higher. We can see for ourselves today, within our communities, many of the old-old, as we move from an aged society to a super-aged society, and with the old-old defined as those aged 85 and above, needing help with at least three out of six Activities of Daily Living (ADLs) of washing, dressing, feeding, transferring, toileting and walking. This proportion is growing higher day by day. Affected seniors covered under CareShield Life will qualify for lifelong payouts, compared to only six years for the previous ElderShield400 system, and this will be very useful for paying for care assistance or necessary consumables. Singapore Medical Council (SMC) Complaints Procedures”
“Mr Chairman, the Community Health Assist Scheme (CHAS) programme, I am happy to note, has progressed significantly since its inception. Today, the majority of general practitioner (GP) clinics support it. A new CHAS card for chronic disease management was announced by the Prime Minister last year and I would like to ask for more details about this new card. As the new card will cover all Singaporeans for chronic conditions, regardless of income, we can expect greater demand for the services of participating GPs. Does the Ministry expect more GP clinics to join the network and can we look forward to a 100% participation rate? What are the obstacles that still prevent clinics from joining? What plans does MOH have to help them? Given the rise in median household incomes over the years, I would also like to ask if the qualifying income criteria for the Blue and Orange CHAS cards will be revised and also if the benefits can be revised upwards, in addition to the new benefits announced, that is, the increased subsidies for complex chronic conditions and the extension of subsidies for common illnesses to Orange cardholders. MOH has also stated that it aims to strengthen the private primary healthcare sector. MOH started the Primary Care Network (PCN) scheme in January 2018, where GPs come together to provide holistic team-based care for their patients. Would MOH please provide an update on this scheme? It was announced during the Budget Statement that the Ministry "will be looking at how to help CHAS clinics better track their patients' progress and outcomes". Can this tracking process also be enabled at the PCN level? Personalised Medicine”
“What about efforts to increase participation in regular exercise and sports? Finally, let me touch on health screenings and immunisations. The Screen for Life (SFL) programme is a landmark initiative as early disease detection typically supersedes any medical treatment for established diseases. I would like to ask how we can encourage more Singaporeans to take up the SFL programme for health screenings and post-screening follow-ups. Although heavily subsidised, many older Singaporeans, and many of them live in my constituency of Queenstown, still maintain the attitude that it is better not to know about their health conditions, or are concerned that screening examinations are too inconvenient, too difficult or too onerous for them. Since November 2017, adult Singaporeans can now use their MediSave to pay for vaccinations which MOH is recommending depending on their age and health status. It is the latest step in the push to encourage preventive care. The new National Adult Immunisation Schedule, which lists who should be vaccinated and when, includes immunisation for diseases, such as the flu and hepatitis B. How has the response been? What is the proportion of adults who have had vaccinations since? Are we still seeing 100% coverage for children under the National Childhood Immunisation Programme? I know that there have been cases of parents who have refused due to misconceptions about potential side effects of vaccinations for the children. How can MOH reach out to them and convince them of the benefits? Finally, I would like to ask: are there more diseases of public health importance that can be addressed by a nationwide programme of immunisation? Thank you and I beg to move. [(proc text) Question proposed. (proc text)]”
“A systematic analysis of scientific evidence that was published about alcohol in the Lancet in September last year, concluded that: "Alcohol use is a leading risk factor for disease burden worldwide, accounting for nearly 10% of global deaths among populations aged 15 to 49 years", very young, "and poses dire ramifications for future population health in the absence of policy action today. The widely held view of the health benefits of alcohol needs revising, particularly as improved methods and analyses continue to show how much alcohol use contributes to global death and disability. Our results show that the safest level of drinking is none. This level is in conflict with most health guidelines, which espouse health benefits associated with consuming up to two drinks a day". Regarding dementia, I note that there have been cuts filed on mental health. But I would like to ask about our national strategy to deal with dementia. With longer lifespans and an ageing population, comes an increase in the number of patients with dementia. I would like to ask how we can prevent or delay its onset, increase diagnosis rates and provide the necessary support and long-term care for patients with dementia. What is the progress on the expansion of dementia-friendly communities? Let me now move on to obesity. How are we tackling obesity? In Singapore, the percentages of overweight men and women are expected to increase to 36.5% and 21.7% respectively by 2025, according to the World Obesity Federation. In 2017, MOH figures showed that 36.2% of Singaporeans aged 18 to 69 years and 13% of children in mainstream schools are overweight. In addition to measures to curb sugar intake that are alluded to earlier, are there also efforts to reduce fat intake in our diet?”
“With regard to diabetes, we are now in the third year of a long and bruising campaign against diabetes. What milestones in our war on diabetes have been achieved? Sugar is, indeed, the enemy. From December last year till January this year, MOH sought views on four proposals: (a) a total ban on prepacked high-sugar drinks; (b) single or tiered taxes on high-sugar drinks; (c) mandatory front-of-pack labelling on sugar/nutrition content; and finally, perhaps even (d) a ban on advertisements for high-sugar drinks on all platforms. Has a decision been reached following the public consultation on possible measures for prepackaged sugar-sweetened beverages? Is the Ministry still considering a tax on sugar? Singapore also hosted the inaugural Ministerial Conference on Diabetes in November of last year. The conference brought together more than 300 international and local delegates, including health ministers, senior government officials, academics and thought leaders from 18 countries. What are the takeaways from the inaugural Ministerial Conference on Diabetes in November last year? Moving on to alcohol, concerning alcohol intake, I would like to follow up on a recent Parliamentary Question (PQ) I filed concerning recommendations about alcohol consumption. MOH’s current recommended limit for regular alcohol consumption is two standard drinks a day for men and one standard drink a day for women. We should review this recommendation in view of the latest findings that there is, in fact, no safe level of alcohol consumption.”
“Some years ago, I was proud to mention that Singapore was the Healthiest Country in the World. Disappointingly, this year, we have dropped to eighth position from fourth position a year before. In terms of healthcare, the system in Singapore remains affordable and accessible, and of very high quality. But rightly, over the past few years, Singapore has shifted more and more resources towards health promotion and maintenance, rather than to costly medical services. Part of the three key shifts are espoused by the Ministry of Health (MOH). I believe that choosing and maintaining healthy lifestyle choices can only be achieved if there is a community and whole-of-society approach, a support structure that positively reinforces such behavior. Just like recidivism among ex-offenders can only be drastically reduced by strong family and community support, many studies show that if we encourage one another at every opportunity, then we will find it easy to live healthily. Hence, we have to be healthy together, as it is difficult to stay the course alone. We often go for health screenings on the encouragement of friends and loved ones, maintain our diets with the support of friends and family, and quit smoking when we want to do it for the betterment of both ourselves and our families. It is vitally important that the Government supports this whole-of-society effort. I was very happy to learn of the new multi-agency task force that has been set up to drive health promotion. I understand that “it will coordinate and synergise efforts across multiple public agencies, to nudge Singaporeans towards adopting a healthy lifestyle”. Can the Ministry provide an update on the progress of this task force?”
“Chairman, I beg to move, "That the total sum to be allocated for Head O of the Estimates be reduced by $100". I know of a man, now in his 70s, who had been smoking since his teens. No amount of persuasion, threats, nicotine patches or counseling could make him quit. And then, he was hospitalised for a minor heart attack a few years ago, and he has not smoked since. That man is my father. I know of a woman, also in her 70s, who cares about so many people around her, but despite her advancing years somehow never got around to going for health screening, despite the urging of her family, and although she herself would urge her family to go for regular health checks. And then, one day, her group of friends decided to go for a health check at the nearby polyclinic, and because it was their regular meet-up for lunch, she decided to just tag along, had the very first mammogram of her life, which detected very early stage breast cancer, which was then quickly and safely removed. That woman is my mother. Much has been written on how one’s attitudes to health and health seeking behavior can be changed. It can be due to some catastrophic event, such as the onset of disease, but in the absence of such event, what else can be done to nudge someone towards better health practices? You would think that any reasonable person would take the appropriate steps to stay healthy, but we smoke, we drink more than we should, we eat too much, exercise not too much, and so on. We emphasise health education, we try to "game-ify" healthy practices, such as the 10,000 step challenge. We penalise poor choices with sin taxes. Against tobacco, we have cornered the industry at every turn, short of an outright ban. But still, ill health in our society remains frustratingly, maddeningly sticky.”
“Mr Chairman, as a free and open economy, trade is critical to Singapore and we welcome new trading partners and investment opportunities. We had established trade and investment links with the major economies and have a wide network of bilateral and multilateral FTAs. These are all part of the soft infrastructure needed to support Singapore companies’ reach overseas to tap new opportunities and markets abroad. There are many emerging economies with vast markets and youthful populations. Would MFA provide an update on our engagement with these economies, specifically Africa, Latin America and the Middle East? Relations with Brunei”
“Mr Chairman, we observe a trend of more countries all over the world, including those in our region, becoming increasingly nationalistic and inward-looking. The recent elections and change in government in Malaysia had coincided with the emergence of prickly issues in Singapore-Malaysia relations. As our other close neighbour, Indonesia, will have its own national elections in April. What is MFA's view on the possible impact this could have on bilateral relations with Singapore? What are some of the issues which have been unresolved and could become potential points of contention? Which are the main areas of common interests which we can pursue to strengthen our relationship?”
“Besides skills, many caregivers have also shared that they often had difficulties finding about formal support services that could have facilitated their caregiving duties. In hospitals, we have patient or care navigators to assist patients in accessing the types of care and support that they need, and this has paid significant dividends in improving the standard of patient care and the overall care experience, and improved value while reducing costs. I am happy to learn that more efforts will be put into improving care navigation for caregivers, and the leveraging of Silver Generation Offices for this purpose has also been suggested by Miss Cheng Li Hui, Ms Denise Phua and Mr Murali Pillai. E-services, as suggested by Mr Melvin Yong, can also be used to push out information to caregivers and assist caregivers to procure services and equipment. On a similar note, Ms Denise Phua has also spoken about the special challenges facing caregivers of PWDs and a call for better case identification, individualisation and integration bears a closer look. All of us here are caregivers, either at present, in the past or in the future. Caring for others is an important determinant of who we are as individuals, and who we are as a society. It is a duty that is often not anticipated and often unprepared for, but there is no nobler duty, particularly when we are caring for the elderly who cared for us when we were little and similarly vulnerable. This Motion was raised to recognise this crucial role that caregivers play in society, particularly in regard to looking after our seniors, and we call upon the Government and all Singaporeans to continue our steadfast support for the caregivers amongst us. [Applause.] 7.06 pm”
“I welcome the announcements on the night respite care service for seniors with dementia and steps, such as pre-enrolment, to reduce onboarding times for respite services. The home-based respite service to support caregivers for cancer patients, as also announced by Senior Minister of State Edwin Tong, will also go a long way towards improving end-of-life care for Singaporeans. AIC’s pilot outreach teams to reach out to caregivers who are themselves at risk, and the moves towards growing caregiver support networks in our neighbourhoods, are all welcome moves to safeguard the well-being of caregivers and, in turn, those that they care for. I note, however, that the Survey on Informal Caregiving that was commissioned by MCYS and published in the early 2010s, noted that while recognising that support networks are likely to be important, the participation by caregivers in such networks was low and the overall experience reported was not particularly positive. I hope that we can learn from these past experiences such that the current incarnation of caregiver support networks will meet with greater acceptance and greater success. Informal caregiving means that caregivers are typically not formally trained in caregiving, and often have their roles thrust upon them when a loved one falls ill, often quite unexpectedly. Many caregivers have shared that one of the reasons they feel unable to cope is because they have little experience and little knowledge about how to look after someone else in a proper and efficient manner. In a similar vein, we recognise that, in Singapore, a high proportion of informal caregiving is provided by FDWs, who also often do not have such skills. Hence, the measures that were announced to broaden caregiver training are very welcome indeed.”
“The financial and, indeed, the physical and mental stress faced by caregivers is compounded by disruptions to their work due to their caregiving commitments. And, as noted, close to three-quarters of caregivers are employed. Mr Melvin Yong, Ms Joan Pereira, Ms Rahayu and myself have called for various means of workplace and workforce support. I am encouraged that MOM will be focusing on measures to facilitate flexible working hours and considering enhancements to the Work-Life Grant. Mr Melvin Yong has recommended a Progressive Wage Model (PWM) for professional caregivers and also asked for more to be done to support caregivers’ re-entry into the workforce. I believe that more can be done to leverage schemes, such as Adapt and Grow, to support their re-entry into the workforce. Like Mr Melvin Yong, Mr Christopher de Souza and Dr Lily Neo, I also hope that MOM will reconsider legislating caregiver or eldercare leave for workers. Today, in this House, we have heard many touching and inspirational stories of caring and being cared for, and Members' support for this Motion in this House today signifies Members' appreciation and recognition of the sacrifices and selflessness of all caregivers. And we have to do more to support caregivers, other than just financial support. Many caregivers feel isolated and overwhelmed at various points in their caregiving journey, and burnout and depression are all too common amongst caregivers. Respite care is a critical component of caring for caregivers and more has to be done to make respite care in Singapore more accessible and more affordable, as noted by Ms Tin Pei Ling, Dr Lily Neo, Er Dr Lee Bee Wah and Mr Christopher de Souza.”
“Mr Speaker, it has been a long time, and I would like to thank all hon Members who have participated in this debate and expressed their support for the Motion on Support for Caregivers, and also to the Government for their replies. Clearly, it is neither sustainable, practicable nor desirable for all caregiving to be relegated to the state or to delegated institutions. This twin Motion today is united by a focus on the elderly, and caring for our seniors is an issue of particular relevance in the context of our rapidly ageing society. All Members agree that a whole-of-society approach is needed. All of us – the Government, the community, families and individuals – need to work together to support our senior care recipients and also their caregivers, who are often elderly as well. Caregivers face many hurdles, as Members have elaborated in some detail. But the one key problem that most caregivers face, and which has been described by many studies on caregivers, is financial. Many Members – Dr Lily Neo, Mr Chen Show Mao, Mr Christopher de Souza, Ms Tin Pei Ling, Mr Murali Pillai and also Dr Intan Mokhtar – agreed with me that the Government should look into providing a Caregiver Allowance of some form, in line with countries like Sweden, the UK, Australia and Hong Kong. I am happy to hear that MOH will, indeed, be introducing such financial support in the form of a Home Caregiving Grant, as announced by Senior Minister of State Edwin Tong. I am also particularly happy that MOH will be allowing MediSave use to be extended to siblings, as this is not an uncommon appeal that I receive both as a doctor from my patients and also as a Member of Parliament from my residents. This would certainly help to alleviate the out-of-pocket expenditures of family caregivers.”
“All caregivers require easy access to information and training to enable them to provide care competently for their loved ones. As far as possible, the Government should simplify these chunks of information and provide them in mother tongues and dialects as well. Many caregivers are themselves elderly and it can be quite confusing for them to process so much information. Having more one-stop information centres at accessible locations island-wide would enable caregivers to obtain reliable and updated information more easily as not all of them are computer literate nor comfortable getting information online. We can also draw upon community resources, such as volunteers from neighbourhood groups, who can be trained to disseminate information and translation to support the one-stop centres. These volunteers can also be part of caregiver support groups which they can turn to for social and emotional support. Training should be accessible from multiple sources. Whether online or classroom training, sessions should be conducted in multiple languages so that everyone, including foreign domestic workers (FDWs), would be able to understand easily and learn in bite-size modules to accommodate different schedules. (In English): In conclusion, Mr Speaker, caring for a senior is a whole-of-society effort. Now is a timely opportunity for the Government, for our community and for individuals to come together and study ways to improve support for our caregivers and help our fellow Singaporeans age with dignity. Sir, I beg to move. [(proc text) Question proposed. (proc text)]”
“Finally, to ensure that the fees of these centres remain affordable, I would also like to propose that the Government take the lead in the ownership and operation of many of these centres to reap the benefits of economies of scale. Private companies and non-profit organisations can continue to run similar set-ups to provide a wider range of choices for families. In various surveys of caregiver concerns, the one issue that keeps on sticking out is financial stress. It is expensive to be a caregiver. Over the last few years, the idea of providing an allowance to family caregivers has surfaced episodically. While the Government provides subsidies for home and community care through schemes, such as Silver Support and the Senior Mobility and Enabling Fund (SMF), caregivers still have to incur out-of-pocket costs for consumables, medication, transportation and others. For those who have left their jobs to look after the elderly full-time, additional financial support would be helpful and is, in fact, needed. The concern here is over the long-term financial sustainability of paying family caregivers as the number of elderly increases even as the number of Singaporeans in the workforce shrinks. Countries which implement payouts, such as UK, Australia and Hong Kong, limit this benefit to lower-income caregivers or to caregivers with no other sources of income. The Government may wish to consider providing allowances to only full-time family caregivers who are in the lower-income groups and who look after seniors with long-term disabilities, a more calibrated approach. Mr Speaker, in Mandarin, please, on empowering caregivers. (In Mandarin): [Please refer to Vernacular Speech.] Now, I would like to talk about how we can improve our caregivers' capabilities.”
“Respite care schemes provide much-needed temporary breaks for caregivers. Although most families choose to take care of their elderly, there would be times when the emotional and physical demands of such caregiving take their toll, especially when the seniors suffer from poor health or mental issues. Planned respite care offers the opportunity for caregivers to rest and recharge. Research overseas have also shown that regular breaks from caregiving is beneficial to family caregivers' health and well-being and reduce conflict between spouses and also among family members. Respite care can also help to reduce abuse or neglect of the elderly and delay or prevent seniors from being sent to institutionalised care subsequently. While there is already a number of respite care services, both in-home and at day-care centres and nursing homes, I would like to suggest that we invest in more respite care facilities located strategically in every housing estate. Ideally, these centres should be located near Senior Activity or Residents' Centre and are, hence, both convenient and familiar to both care recipients and their families. We should also consider allowing families to pre-register and list essential health, medical, financial and payment details so that in the event of an emergency or an urgency, such as a hospitalisation or perhaps an overseas work trip or holiday, families can place their seniors in these centres with peace of mind. These centres should also be linked so that, if they have no vacancies, they may make referrals to the nearest centres. I understand that the United Kingdom (UK) and Australia already have such systems in place.”
“I understand that under the Enhanced Work-Life Grant, companies can already apply for grants and incentives to implement job sharing and FWAs, such as flexi-load, flexi-place and flexi-time. May I ask the Minister for Manpower how the take-up rate has been so far, and what plans are there to accelerate the implementation of FWA, particularly among small and medium enterprises (SMEs)? One of my concerns is that companies may be deterred by the amount of administrative work and changes to work processes in order to integrate FWA. Another obstacle would be the additional financial costs to the company. For example, for job sharing, a company would have to hire two instead of one worker. Due to the cap on CPF contributions, it may cost a company less to hire one full-time worker than to hire two, each with correspondingly lower salaries but which attract employer CPF contributions below the cap. Similarly, employers may have to pay double for employees' insurance premiums. It would be helpful for MOM to have dedicated liaison officers to examine all these potential roadblocks with interested or perhaps with targeted companies and work on overcoming these barriers together. So far, the implementation of FWA has been employer-centric. I wonder if it is possible for the FWA framework to become more employee-centric. For organisations which are not proactive, what can employees do? Would the Ministry consider setting up a channel to enable employees to appeal for FWA to MOM directly? Upon receipt of such a request, MOM may then send a liaison officer to discuss with the company the viability of FWA and share the successful experiences of other companies. Next, I would like to appeal for greater support for respite care, particularly emergency respite care.”
“The 2013 Ministry of Community Development, Youth and Sports (MCYS) Survey on Informal Caregiving also found that for working caregivers, in the period of six months prior to the survey, 29%, or close to one-third, had to leave work at least once for the care recipient's doctor's appointment and 10% indicated that they went late to work over the same period for caregiving commitments. Caregiving certainly had a negative impact on these working caregivers. How can we then help these caregivers in an increasingly competitive and demanding work environment? First, we can consider legislating a certain number of days for paid and unpaid caregiver or eldercare leave. The Nordic countries, Australia and Canada already offer paid leave for working caregivers. In Singapore, paid leave is only for childcare. Employees may also tap on six days of unpaid leave for infants. More importantly, we should focus on FWAs. I would think that compared to the occasional days of eldercare or caregiver leave, FWA has a greater impact on a caregiver's ability to continue working. In fact, a body of research in OECD countries have found this to be exactly the case. We must support those who would like to remain in the workforce. Otherwise, not only would our economy suffer from the loss of their skills and knowledge, their loss of income would have a negative impact on their families' finances and their own futures as seniors. The Ministry of Manpower (MOM) should consider committing additional resources to speed up the adoption of FWA and to increase awareness among jobseekers and employees of companies with FWA.”
“A majority of Singaporeans prefer to care for elderly family members themselves. This is the same whether you are Chinese, Malay, Indian or Eurasian. Fewer seniors are placed in institutional care, and this is only usually due to extenuating circumstances. Our seniors also prefer to stay in familiar surroundings near or surrounded by their children and grandchildren. The desire to experience "天伦之乐" or the joy of family ties, is universal. This arrangement is mutually beneficial for the young and old. As our children participate in the process of providing care for the elderly, they imbibe important values, such as filial piety, responsibility, respect, compassion and empathy. They learn most and they learn best from our personal examples. Our population is ageing rapidly. As our family sizes shrink and life expectancies increase, the task of caregiving for elderly members will become more challenging. The load on each caregiving party will become heavier and the last lap for each senior is expected to last longer. While we all aim to help our seniors stay healthy for as long as possible, we must also prepare for frailty, a growing chronic disease burden, and the prevalence of dementia. In view of the rising needs of family caregivers, it is timely for us to review areas of support for caregivers. We need a whole-of-society approach – the Government, the community, families and individuals. We all have a part to play in supporting caregivers and our seniors. According to the last available data on caregiving from the Department of Statistics, in 2010, close to three-quarters of our caregivers are working. This means that they have to juggle work commitments, family responsibilities and caregiving.”
“Mr Speaker, I beg to move* "That this House recognises, given our rapidly ageing population, the important role that caregivers play in helping our Singaporeans age with dignity, and calls on the Government and the community to continue strengthening support for caregivers." I do so with the support of fellow Members of the Government Parliamentary Committee (GPC) for Health, Dr Lily Neo, Mr Christopher de Souza, Mr Murali Pillai and Ms Tin Pei Ling. [(proc text) *The Motion also stood in the names of Mr Christopher de Souza, Mr Murali Pillai, Dr Lily Neo and Ms Tin Pei Ling. (proc text)] Why are we focusing on such family caregiving or informal caregiving? Over the course of the Chinese New Year festivities last week, as I made my way through rounds of family and constituency celebrations, I was heartened to observe strong family ties and the special care paid to the elderly. Gatherings are centred around the seniors, with extended family members coming together to pay their respects to their 长辈, or their seniors – grandparents, granduncles and grand-aunties: "恭喜发财, 身体健康". All of these were said with sincerity and with genuine well-meaning. Many seniors, thankfully, are still hale and hearty, but some have clear disabilities, which is not surprising, as it has been estimated that as many as one in three Singaporeans will suffer a period of significant disability in their lifetime. But in every situation, the infirm elderly were treated with care and respect, with love and concern, and quite naturally so, showing that such caregiving has already become part of the fabric of the tapestry that is family. Traditional values are still strongly held in our society and the family remains the first line of support.”
“I would like to ask how the Ministry will assist in ensuring the quality of accredited courses or programmes, and also to ensure that enough of such educational activities are available and accessible to practitioners. There are now over 3,000 TCMPs in Singapore, but I note that close to 20% of them are inactive. If these inactive practitioners do not participate in the CPE programme and do not practise, will this affect them if they decide to re-enter active practice in the future and reapply for a PC or licence? Third, I note also that the maximum number of members of the TCM Board will increase from nine to 11 under the proposed amendments. I would like to ask if the Ministry would consider also increasing the minimum number of members from five to seven and also mandating a higher minimum number of medical practitioners and, in particular, TCMPs to the Board. This would allow for a greater breadth of professional medical opinion on the Board. I support the Bill.”
“For instance, in the United States (US), there was a much discussed case or incident where a senior surgeon in his early 70s, while supervising a procedure, fell asleep during the surgery. This particular surgeon was not performing the surgery itself, but concerns were raised. And there were many discussions between the Board of the hospital and various communities. But the problem they faced was that it was difficult to prove fitness or unfitness from a mental or physical point of view. Just by going by normal physical and mental tests alone, he passed. The case was finally resolved by the voluntary withdrawal of the physician in question from clinical practice. But these are challenges that have no easy answers. I would just like to find out, with this Inquiry Committee, how will it deal with such cases? For other feedback, if there is a complaint to the Complaints Review Committee, for instance, about overcharging, how will such cases be investigated, given that there are no generally agreed guidelines and the spectrum of treatments within TCM is very wide? I have heard instances where the cost of TCM treatment could even reach six figures and maybe five figures in many cases. What would be considered an acceptable treatment modality and what would not be considered an acceptable treatment modality, considering that TCM embraces a wide range of treatment philosophies and modalities, some of which may be at odds with one another? I hope that the Ministry will be able to elaborate on how the procedural aspects of these disciplinary processes can be made more robust and better able to stand up to scrutiny, with these amendments. Second, the introduction of compulsory CPE is certainly a step in the right direction and will help to maintain professional standards.”
“Mr Deputy Speaker, Sir, TCM forms an integral and important part of our healthcare landscape. In recent years, both our Prime Minister and our Minister for Health have remarked on the critical role that TCM can play in improving the health of our citizens, particularly within the context of an ageing population. I, too, would like to put on record my appreciation to the TCM community for the contributions to Singapore's healthcare. Certainly, TCM remains a medical remedy of choice for many Singaporeans. Indeed, we are seeing a new generation of TCMPs, with more young Singaporeans choosing TCM as a career, particularly since the introduction of the Nanyang Technological University's (NTU's) double degree programme in Biomedical Science and Chinese Medicine in 2005. The amendments to this Act, which was first passed in 2000, are timely and vital for the TCM sector to grow and achieve its true potential in providing for the healthcare needs of Singaporeans. I have three comments and clarifications for the Minister. First, the clarifications to the disciplinary framework are welcome and will certainly improve self-regulation within the TCM sector and increase public trust. Nonetheless, I am concerned that the lack of a more formal disciplinary or inquiry process, and the absence of specific schedules on penalties, and clear definitions of physical and mental fitness for work, may lead to the same issues and criticisms facing disciplinary processes by the Singapore Medical Council today. For instance, how robust will the renamed Inquiry Committee's decision regarding a practitioner's physical or mental fitness to practise be? This is a challenge that western medicine is also facing.”
“Standard packaging is a measure that is endorsed by WHO which, in 2016, on World No Tobacco Day, exhorted all countries to prepare to introduce plain packaging for tobacco products. There are two concerns that have been raised about plain packaging or standard packaging that I would like to ask the Minister to address so as to reassure the House that these potential consequences will not come to bear. First, concerns have been raised that standard packaging of cigarettes and tobacco products could lead to the phenomenon of "down trading", where smokers will just switch to cheaper products as it would be harder to distinguish between various products. This could conversely lead to cheaper products increasing market share and may, in theory, lead to increased smoking due to cheaper products and more affordable products coming to the forefront. Second, concerns have also been raised that plain packaging could facilitate counterfeiting of cigarettes. Is there any evidence for this concern, and what are the measures to ensure that plain packaging does not play into the hands of counterfeiters? I look forward to the Ministry's responses on these points, and I support the Bill.”