Fatimah Lateef
Singapore
“Some cases or disputes put up for mediation may span a period of time, maybe even years, and agreement may not have been reached at the first sitting.”
“This is because I feel that this can be a potential area for abuse and also misinterpretation. Take, for example, the beauty and wellness industry. It is not within the scope of this Bill. Neither is Traditional Medicine and Complementary Medicine.”
“In this light, perhaps can MOM work with the Ministry of Health (MOH) on a framework or guideline to assist and advise medical practitioners on some kind of algorithmic process, so that there is actually some kind of a loose framework they can refer to?”
“Therefore, we had to conduct more dialogue sessions and discussions, such as case studies, where we can show our families, especially those from the low-income groups, how to obtain assistance from the good schemes made available by our Ministry.”
“Chairman, I have one clarification for the Minister. It is actually pertaining to single unwed mothers, and I know the principles and values we want to uphold in the society and all that.”
“In terms of innovation and productivity, healthcare, as I said, is labour-intensive and patient-centric. So, we need to review that appropriately as well. Fifth, it is data-driven healthcare which is really a must moving into the future. This will help us formulate guidelines and policies.”
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“While the situation has shown some improvement, we will continue to monitor the situation closely and, if necessary, we will introduce further measures to deal with the problem. But let me reiterate the point I made earlier in this House, which is that loansharking in general and harassment in particular are crimes that are not easy to solve. I know that Police presence is reassuring – I think Ms Lee makes that point – but by themselves they will not overcome this scourge. Indeed, she points to one avenue that I think we can do more on, which is getting the community involved. So CSSP programme – maybe installing CCTVs – being the eyes and ears of Police on the ground, forming Neighbourhood Watch Groups targeted for neighbours to help each other to detect and to deter loansharks would be helpful. I think everybody can play a part but, on MHA's part, on my part, we will continue to monitor as we have been doing. I have been taking PQs on this problem. Let us see whether working together we can improve the ground situation especially for our residents. I think Ms Lee talks about that. I also have residents who suffer like that. So, I think the authorities and the community can all work together to do more. But let us also monitor the impact of these amendments because, like I have said, these amendments, hopefully, will help divert some people who may turn to illegal loansharks, to turn to licensed moneylenders. Sir, I think I have covered the key points raised. I thank both Ms Lee and Dr Fatimah for sharing their thoughts. The Registrar of Moneylenders will certainly monitor the out-working of this new moneylending regime. Question put, and agreed to. Bill accordingly read a Second Time and committed to a Committee of the whole House.”
“Over time, the Registrar will review the types of moneylenders who apply for specific exemption and evaluate whether there is a need to grant class exemptions. One of the advantages of class exemption is the person exempted will no longer need to apply for exemption every three years. Sir, finally, let me say something on loansharking, on which both Dr Fatimah and Ms Lee have expressed concerns. I want to thank Ms Lee for supporting the proposal to extend caning to loansharks who use others to carry out harassment acts. It will remove the shield the loansharks have been using to carry out their clandestine activities. This addresses a key issue in tackling loansharking, that is, hitting at the core of the problem – the loansharks themselves. This amendment and the other one on expanding the presumption clause to cover use of handphones and pagers will strengthen the existing arsenal of weapons that was introduced since 2005 to counter the loansharking scourge. In this regard, penalties have been enhanced, loansharks have been detained under the Criminal Law Temporary Provisions Act, assets of the convicted loansharks confiscated and passports of loansharks cancelled. We also work with partners, such as HDB and SingPost, to tighten the procedures, deterring opportunities for exploitation by loansharks as well as the procedures for changing the address on one's identity card. So, we will press on. On our part, Police has kept up the pressure on loansharks through painstaking investigations, intelligence gathering and ground operations, as well as national level operations against syndicates.”
“Well, she will be happy to know that currently, ROM already briefs all newly-licensed moneylenders on their duties and responsibilities, including key provisions of the Moneylenders Act and also on the proper completion of the returns to ROM. In addition, ROM has been in touch with the Moneylenders Association to see if the Association can conduct courses to help moneylenders acquire skills on modern credit management. Next, Dr Fatimah asked how the list of licensed moneylenders would be published. This is actually already currently done. The Registry of Moneylenders publishes a list of licensed moneylenders in the Gazette as well as on its website. ROM will continue with this practice to facilitate easy public access and also the giving of information to those who may want to know. A point that Ms Lee makes is public education. I agree with her. That is important. Let us continue to do that. Some have been done currently by MoneySense, a national programme that gives talks and issues materials, but I think more can certainly be done. On the Minister's power to prescribe different classes of licences as well as make rules to exempt classes of persons from the Act – a query Dr Fatimah has – these are new provisions not found in the Act currently. We have inserted them to provide flexibility for future, not immediate use. While the Minister may prescribe different classes or description of licences bearing different fees, there is no intention at the present moment to do so. Similarly, whilst the Minister may make rules exempting different classes of persons from the Act, there are no immediate plans to do this. As I said, the power to exempt under the new regime is essentially a residual one.”
“So, like other financial institutions, I think we should let the market decide what is the appropriate interest rate for these higher value loans. Sir, these amendments will put the moneylending industry on a firmer footing, ensuring that moneylenders conduct themselves in a fair and transparent manner. But I think the point to note is that borrowers themselves have to act responsibly. First of all, they should not give a chance to loansharks to ruin their lives by borrowing from them. I hope that these amendments would tip the balance for some of them to borrow from licensed moneylenders, instead of turning to loansharks. Secondly, if they really need to borrow money, they should not overstretch themselves in doing so. Thirdly, when they do so, they should seek clarification if they do not understand the terms and conditions of the loan. And, finally, they should make every effort to repay their loan. So the point is, whilst lenders must exercise prudence and responsibility in lending, borrowers should exercise discipline and restraint in borrowing. I think this would put the relationship on the best balance. To further ensure prudent borrowing, MinLaw has been working, in consultation with MAS, to formulate rules that would provide that moneylenders who grant unsecured loans in excess of $3,000, do so only to persons who have sufficient means to repay them and to limit the quantum of the loan which they may extend, based on the borrower's income. Let me now deal quickly with the remaining points that have been raised. I think Dr Fatimah makes an interesting suggestion that moneylenders be given assistance on documentation processes, ie, paper work; indeed, suggesting even a startup course for new moneylenders.”
“So, in that sense, the Registrar will have greater powers to ensure that all lending is done properly. Now, also, there were concerns raised as to whether unwary borrowers would be taken advantage of. Well, as I have said in my speech, affording protection to borrowers is a key consideration of this Bill. I had mentioned some safeguards already in my speech which include upfront disclosure of the terms and conditions of the loan and also an issuance of a note of contract to the borrower, which is explained to him in a language that he understands. In fact, the note of contract will contain an advisory to the borrower that he is not to sign the note if the entries are not properly filled in and to repay the loan promptly in order to avoid incurring additional charges. Furthermore, the Registrar intends to require moneylenders to ask the borrower in a loan application form whether he has existing loans from other moneylenders, banks or other financial institutions. This would act as a check against borrowers over-extending themselves by taking multiple loans from different moneylenders and, on top of all these safeguards, moneylenders would also be prohibited from granting unsolicited loans. All these requirements will help ensure that the transactions between borrower and lender are properly entered into. On Dr Fatimah's suggestion to set out an acceptable range of interest, let me reassure her that borrowers of small amounts, like I have said, will continue to be protected as there will be an interest rate cap, which will be the current one, 18% per annum for loans $3,000 and below. Now, interest rates for loans above $3,000 will be lifted, which is a practice in line with the market.”
“Still, Sir, notwithstanding this opening up on advertisements, I do not expect that the smaller and more traditional moneylenders will want or need to advertise widely, as my understanding is that the business is generated mainly through word of mouth introductions. They take a conservative approach because they lend their own money. There may be the bigger ones who want to tap this modern setting and may want to advertise. As I have said, the Registry of Moneylenders (ROM) will monitor how this is carried out. So, how the advertisements are cast, I think that is important. On whether occasions will proliferate, whilst moneylenders will be able to set up branches, each branch will require a fresh deposit of $20,000. That is a new requirement under the Bill. This is a query Dr Fatimah has. Moreover, every place of business has to be approved by the Registrar. Hence, whilst there is some freeing up, it is not without restraints. As for existing moneylenders, they would only have to place a deposit which may take the form of a banker's guarantee when they next renew their licence. I think that is the point that Dr Fatimah made. This brings me to the next point, which is that the Registrar's powers have indeed been enhanced under the Act in other ways to ensure that licensed moneylenders conduct their business in a proper manner and also to safeguard borrowers' interest. So this should assure Ms Lee, who urges that the authorities keep close tabs on the lending activities of moneylenders. Indeed, as Dr Fatimah suggests, ROM officers can inspect the moneylenders' premises at any time without any prior notice or warning and, overall, as I have said, sentences for offences committed by licensed moneylenders have been revised upwards and brought up to date.”
“Indeed, it is my hope that by establishing the moneylending industry in a modern setting, less people will resort to borrowing from loansharks. Now, another point is that with the global credit crunch and economic uncertainty, moneylenders will be more risk-averse and cautious in their lending. Any increase and demand for loans from members of the public will therefore not necessarily be matched by an increase in supply of loans from licensed moneylenders. In other words, the prudent approach in lending on the part of licensed moneylenders, which is now already the case, will likely continue. What is important is that the borrowers must correspondingly exercise discipline in borrowing. Next, even with the relaxation on advertising and locations, let us be clear, I think Ms Lee said whether this may lead to perception that we are decontrolling the industry. This is not the case. Notwithstanding the relaxation on advertisements, there will still be restrictions. As I have said, the Registrar of Moneylenders would issue directions against advertisements and marketing materials which are false or misleading or which induce the public to borrow money for inappropriate purposes or to induce them using unethical or unscrupulous methods. In other words, to set out the rules and empower the Registrar to do more in this area. Indeed, in the Bill itself, as I mentioned in my speech, there would be provisions to prohibit moneylenders from publishing any marketing or advertising materials which are false or misleading. So I think this should address both Ms Lee and Dr Fatimah's concerns.”
“Sir, this Moneylenders Bill will certainly enhance the licensing and regulation of moneylenders providing all forms of services and loans to the public. It will serve to keep a check on the industry through the robust licensing and regulatory regime but, at the same time, relax certain current controls to facilitate the business in a modern credit economy. Let us hope that the very colourful moneylending business we have here achieves a more regulated approach with greater respect for all concerned. Assoc. Prof. Ho Peng Kee: Mr Deputy Speaker, Sir, I thank Ms Ellen Lee and Dr Fatimah Lateef for speaking in support of the Bill. They have concerns and queries which I will now address. Firstly, they focus on the impact these amendments will have on the moneylending industry as a whole; secondly, the proper regulating of moneylenders; thirdly, ensuring that borrowers would not be taken advantage of; and fourthly, our fight against illegal moneylending or loanshark activities. Dr Fatimah also has got some specific queries on the provisions themselves. Ms Lee is concerned that with these amendments, more people may let their guard down and borrow, perhaps, blindly from moneylenders. Sir, I do not expect this to happen as there are checks in place, which I will set out later. But, first, let me say that we should remember that people with no or low income will at certain points in time need cash quickly to meet an urgent and a genuine need. In other words, they too will need access to credit. Banks are not likely to lend to them. So some turn to moneylenders; others to pawnbrokers, others maybe to relatives and friends and, indeed, unfortunately, some also turn to unlicensed moneylenders or loansharks. Now, these amendments will help these people.”
“Will the owners be exempted from this payment for the existing businesses or shops, which may have already been given prior licence before this Bill is passed? Section 13: Publication of Lists - I support this move as it will provide a useful list of information for the public utilising the service. Of course regular interval updates will be relevant, and I would like to ask the Minister if the listing will be electronic or in the form of a hard copy register. On the use of advertising and marketing, with the more relaxed criteria that we are going to have now, I would like to suggest that the authorities come up with some guidelines or recommendations on the acceptable range of interest. This will certainly be useful to safeguard consumers. Section 21: On the required statements of accounts, loan documents and receipts, can I suggest the Ministry come up with a framework for submission and thus achieve standardisation of the submitted data? Section 25: Pertaining to the Power to inspect – I also would like to suggest that this should be done without prior information and warning, especially as we realise the potential for abuse and chances of "sliding down the slippery slope" with such businesses. Section 26(2): General Power to issue directions and service guide to assist moneylenders on the process of documentation, preparation of cautionary statements, drawing up of agreements and other relevant paperwork – perhaps the Ministry can even consider a startup course or workshop, which may be made a prerequisite for those applying for new licences. This can serve as a platform to share and ensure understanding of the rules, especially those stipulated in section 37.”
“Mr Deputy Speaker, Sir, I rise in support of the Bill. Many of us would have heard of some "horror" stories pertaining to illegal moneylending and loan sharks' activities, example, spray painting of indecent words, snipe remarks and threats of all forms, including to life and limb. This Bill is indeed timely and necessary especially in the face of the global credit crunch that we are facing today. It serves as a social legislation as it will help to put checks and balances in place to safeguard borrowers from unscrupulous moneylenders who charge exorbitant interest rates. It will also bring the business practices in line with the market practices of established financial institutions. Sir , I have some observations and a few issues to raise: Firstly, this Bill helps to define the term "moneylender" clearly. It excludes persons licensed, approved and regulated by the Monetary Authority of Singapore, persons who grant staff loans and corporation loans. These persons are governed by the Securities and Futures Act and this definition is important as it prevents misperception, in particular when it comes to substituting the term with more colloquial ones. Moreover, when dealing with the law, these definitions would certainly have to be very clear. Sir, I also am in support of the stiffer penalties, which is hoped to be a deterrence. I also note the allowances made for flexibility. Clarification on section 5(5)C: a deposit of $20,000 for each place of business to be licensed – does this mean that if a person has a current existing moneylending business and he hopes to open up a new one after this Bill is passed in Parliament, he would then have to pay $20,000 each for both the existing as well as the new premises?”
“Hence, some are suggesting that the Muslim community be given a chance to choose which fund they want to donate to. Even though the Islamic Religious Council of Singapore (MUIS) has explained that we must view the usage of the fund for religious education from a broader perspective, that is, to develop religious teachers for the benefit of the whole Malay/Muslim community in Singapore, it will be good if the method of using the Fund for that purpose is explained to the public. The account for using this Fund must be transparent, so that the community has no misgivings. If a small proportion want to opt out, what should they do? This way, we can avoid any dissatisfaction, if any. Ultimately, we can convince the whole community about the benefit of strengthening our religious education and obtain their full support. Mr Deputy Speaker, I support the Bill. *Cols. 871-872. 5.04 pm”
“On my many trips to the Middle East, I was asked how Muslims in Singapore, in particular women, deal with westernisation and globalisation and adapt to a rapidly changing world, yet at the same time keeping our Muslim identity. These are exactly the principles we could share through our MUIS' brothers and sisters. Finally, I would also like to reinforce that we must include women on these teams that we send abroad. I would, however, like to add a word of caution as these topics that we are going to discuss would certainly be sensitive, and our practices may be very "local" and have differences which may have to be handled with tact and diplomacy. I will continue the last part in Malay, Sir. This is on the MBMF. (In Malay): [For vernacular speech, please refer to Appendix A*.] Although our community generally supports the broadening of the MBMF’s usage, some are still querying its details. Most agree with the new ideas to use some of this money to upgrade present mosques. But on certain issues, they have some concerns. Many are still unsure on how this will be done and the form of education it will be used for. Is it for madrasah education under the JMS (Joint Madrasah System) or for other types of education as well? What will be the performance benchmark or KPI to be set? Will this money be given to the schools or madrasahs, or be given as a scholarship for its students? There are those who ask why they need to contribute towards supporting the madrasah education, even though it only benefits a small group of madrasah students. Furthermore, madrasah education is like private schools, and parents who choose to send their children to madrasah have to bear the cost of that education.”
“More importantly, the proposed new requirement is a move towards giving a clear signal to the community that minor marriages are not encouraged because they are more likely to end in divorces. However, these amendments must be coupled with targeted public education and awareness, education of families and teens, bridging the generation gap, correction of certain mindsets and attitudes, keeping youths in school and having a strong foundation in religious education and understanding. The multi-faceted and multi-targeted approach we have today needs to be reinforced, consolidated, and be made more practical and accessible. This is a positive move to streamline and cut a so-called "red tape" procedure as these cases can be managed in a secular fashion similar to the way they are handled for non-Muslims. [Mr Deputy Speaker (Mr Matthias Yao Chih) in the Chair] 5.00 pm Divorced Muslim women are already facing many problems as it is, so why do we need to add to their difficulties in order for them to get their errant ex-husbands to keep up with maintenance payments? The current process costs money and time, so cutting down on these additional steps will indeed be a welcome change. This will be in line with broadening the horizon of the Singapore Muslim, giving greater exposure to our officers on the global stage and widening our mindsets through networking and sharing of ideas. Many countries, including Muslim countries, Sir, have voiced interest to share our policies and approaches in a Muslim community embedded in a secular nation. These have been tried and tested to a certain extent and they are current, updated and practical when it comes to execution. After all, we in Singapore are known not just to talk but also with our follow-up actions as well.”
“Sir, the Administration of Muslim Law (Amendment) Bill is being debated yet again this year, following the 1999 and 2005 revisions. This shows that certain changes are, indeed, necessary if the AMLA is to evolve and remain relevant to the Muslims in Singapore in our journey towards the community of excellence. Furthermore, these proposed changes aim to strengthen some of the key pillars in our community, that is, family, religion and the mosque. Strengthening these pillars are necessary in our quest to build a community of excellence. I am glad to note that the community is generally supportive of the changes. Now, let us consider this real scenario: a 15-year old girl had dropped out from school as she was pregnant. Her boyfriend, 17 years of age, did odd jobs and did not complete his education either. After two years, she has two children and is now seeing another man as her first husband is in prison. By 20, she has four children, did not work and was essentially a single parent. Is this the result of minor marriages? Often, in cases like this, there is emotional immaturity, insecurity, lack of financial independence and stable jobs, and also a lack of educational qualification. These people face a major struggle with several young children as well as other competing needs and priorities. All these contribute towards the vicious cycle just described. In line with these observations, it seems in order to raise the minimum marriage age – whilst our community is not against building and forming families – it is important for us to help ensure marriages last and perhaps remain forever. It is something we have to do earlier rather than later. But will we see the positive changes we expect? Perhaps not so fast either.”
“Sir, can I ask the Minister if there are any plans to increase the number of training places for palliative care? Currently, we only have a handful of palliative care medicine specialists and with the ageing population, the needs are going to increase. Also, if we cannot meet the needs for palliative care specialists, can we consider running some courses for general practitioners who would be more suited to provide home care and palliative care, and it will be more on an ambulatory basis as well?”
“Sir, I thank the Minister for the response. I would like to find out if the Ministry of Health is considering doing some sessions to update doctors on the AMD because as we had feedback from some members of the public that the doctors were not aware or not comfortable with talking about the AMD and advising them accordingly. Secondly, I would like to ask the Minister whether there is a possibility to consider a kind of bridging of information into the health screening programme that we do quite extensively now because I think it is a comprehensive package we have for health screening. Perhaps broaching the idea during these sessions could be good as well.”
“We heard the CET Masterplan but it would not be good if we do not create the maximum positive impact it was created and set up to do. 6.07 pm”
“Mr Deputy Speaker, I support the Skills Development Levy (Amendment) Bill. I do, however, have four issues to raise. (1) How do we ensure that all employers with eligible employees or workers comply with the Act? Will there be certain guidelines that they can follow through? (2) It will be beneficial and helpful to have the employers list the development courses which the employees would qualify for. We heard from the Minister that there are various forms of funding available and including even Masters courses which are being funded. Of late, I have had many emails from individuals asking for clarification if they are applicable and eligible to study certain courses and to take up certain skills as well. Certainly, this would vary according to the jobs and nature of work. But, perhaps, there may be a category which covers general courses applicable to all general employees. So I think there needs to be a bit more clarification. (3) Companies should consider some form of awareness creation programme or education of their employees to enhance their understanding of the need and advantages of skills development, especially with our globalised economy. This would represent a more proactive approach by the companies and employers. (4) What would happen to the skills development levy for an employee when he leaves a company or have his services terminated? Will there be a possibility for the accumulated funds or amount to be carried forward with him as he moves to a new company, or would this have to be considered on a case-by-case basis and, if so, what are the criteria to be considered? This Amendment Bill is in line with the upgrading of our workers' skills and capabilities. It would take the triple partnership of the Government, employers and employees to make this work.”
“One of the new additions is for countries to notify WHO of all public health emergencies of international concern as it will help mount a response internationally. The amended Infectious Diseases Bill will have the opportunity to be fine-tuned and to take this new requirement into account.”
“However, I would like to caution that we do an extensive assessment of such cases, especially pertaining to the phrase "who has reason to believe that he has, or has been exposed to a significant risk of contracting AIDS or HIV". Firstly, people may not always be forthcoming and truthful; and, secondly, for those who have already reached an established state of the disease, they may not have a lifespan which reaches up to 10 years or more. So it may be beyond their lifespan! For public health emergencies, Singapore needs to be prepared to handle any outbreak more serious than SARS. In the event of a highly contagious infectious disease outbreak, we need to be able to ringfence areas, implement control measures and limit spread as much as possible, and this is especially so as we are an open country, with high international travellers traffic. In such an emergency, we must harness all resources, including those from the private sectors, private ambulances, doctors, nurses and other medical and paramedical staff. The Ministry will have the power to requisition these resources under the Requisition of Resources Act (RORA). This is the most important and appropriate action and the only way forward for us as a team, especially in a small nation like Singapore where resources are scarce and should be shared and coordinated effectively. On the International Health Regulation, which was drawn up by WHO and member states (which include Singapore), it is there to protect against and limit the international spread of diseases, including infectious diseases. This rule requires countries to improve international surveillance and reporting mechanisms by member countries, strengthening their own national surveillances and response capabilities.”
“It is not uncommon that we get outbreaks of chicken pox/varicella, even dengue, in these overcrowded rooms and apartments where they live in rather unhygienic circumstances. To wait for an index case to surface may be too late as the spread can be rampant during the incubation phase itself, especially in such close proximity. Anyway, the emphasis should be on preventive measures. Section 19 on the closure and disinfection of premises becomes a reality for us all when the Prima Deli incident happened. Even in Clean Singapore, this is still a real possibility for us and we must never take this for granted. Hence, I support this enforcement proposed by the Bill. Next, let us consider this scenario: a known HIV positive patient arrives at the hospital with fever and cough. As the paramedics are transferring him, he threatens the staff that he will contaminate them if he is not attended to immediately. He has a wound on his arm which is oozing blood. A very real scenario, and I have personally encountered such patients. This Bill mentions clearly about the sexual mode of transmission but does not mention the non-sexual aspects which can certainly happen. Can I ask the Minister if it will be possible to have some guidelines written in black and white to also cover these other circumstances because, certainly, we need to empathise with our healthcare workers who may encounter this in the course of their work. Sir, in principle, I also support the amendments made under clause 19 (section 24.2) whereby the term of imprisonment is extended from two to 10 years. This re-enforces the moral, ethical and public health responsibility of a person.”
“In fact, greater cooperation will also be in place as we saw during the SARS outbreak where home surveillance and monitoring, home isolation and strict enforcement all come hand in hand with the Ministry of Home Affairs, Ministry of Education, Ministry of Community Development, Youth and Sports as well as the Ministry of Health. We may need to invest a little more in training these personnel in epidemiological data collection and monitoring, contact tracing, infectious diseases, nursing, etc. In future, perhaps we can consider if our population is ready to take on the responsibility of perhaps self-reporting as and when they experience certain symptoms. This is useful especially when many self-medicate and do not present to any healthcare clinic or institution. This information can be used to track outbreaks very early. However, it would take a lot of discipline, compliance and cooperation on everyone's part for this to work. This Bill allows a health or police officer to enter premises and carry out the necessary checks where animals, food and water are handled. I see this responsibility as a necessary cooperation, again, with NEA and AVA as well. This will definitely come in useful with new and emerging infectious diseases such as in the recent avian flu outbreak. There was much controversy and discussion as to whether animal to human transmission was possible and of course strategies for the prevention. Section 18 empowers designated personnel to enter buildings and take measures to abate overcrowding or close the building in the event of non-compliance of the owner. Here, I would like to urge for greater efforts in looking at our foreign workers quarters.”
“Mr Speaker, Sir, it was 2003, in the midst of the SARS outbreak, a doctor walked into the hospital’s emergency room, the beginning of a 12-hour shift. A young lady just back from an overseas shopping trip, lay on a trolley, breathless and gasping for air. Her oxygen saturation was low and her chest X-ray showed patchy infiltrates suggesting pneumonia. What are the things that go through the doctor’s mind? How easily this lady got infected and caught an airborne infectious disease? What if he, as a doctor, got infected by it? And who will look after his aged parents and his family? And the list of questions goes on. It stresses the need to have an effective, rapidly implementable, robust as well as adaptable programme in place for approaching infectious diseases. That is why I strongly support the authority given to the Director to institute public health surveillance programmes and undertake investigations as necessary. In fact, consistent and continuous syndromic surveillance is the way to go and to be vigilant in identifying trends early. A good network of compliance cannot be over-emphasised. In fact, this is where I would like to reinforce and seek the Ministry's agreement on getting inputs from TCM or traditional practitioners because usually they are the first to see certain trends as a large segment of our population still seeks treatment from them at the first sign of any symptoms. In the same context, greater cooperation and sharing of information with NEA becomes necessary.”
“Madam, I am glad to hear the Minister of State mention that we will go all out to help the destitute in our community. I am wondering whether we have any estimates of the number of destitutes we have in Singapore. As a follow-up to last year's debate where I brought up the fact that the destitute hotline was not responded to throughout the whole weekend, I would like to update the Ministry that the response is extremely good now and they will come and pick up your destitute within one to two hours at any location upon calling the hotline, which is very well-manned today.”
“(In Malay): [For vernacular speech, please refer to Appendix A *. ] The Islamic Religious Council of Singapore has done an excellent job by providing the innovative Religious Teachers Development Programme. In 2006, more than $100,000 was channelled towards this effort. I would like to ask the Minister: firstly, what aspects of training are the focus of this programme, taking into account the fact that religious teachers come from various backgrounds, and their qualifications are obtained from various educational and training institutes? Secondly, what are the KPIs and targets set for this programme? Thirdly, does MUIS consider making the programme as part of a continuing and sustainable professional development plan? And, fourthly, due to many challenges, will MUIS consider publishing the names of religious teachers that have undergone this programme or training? *Cols. 2315-2316.”
“(In Malay): [For vernacular speech, please refer to Appendix A *. ] The number of divorces among young Malay/Muslim couples is still high even though there was much effort to overcome the problem. This is due to several factors and those trapped are in the vicious cycle of dysfunctional families. Usually, this problem is linked to many other issues like single mothers, individuals with multiple partners and teenage pregnancies. Furthermore, Malay teenagers form 55.1% of all births by teenage mothers in 2006. As a follow up to my question in the previous COS debates, are there any plans, and if so, what is the development in terms of increasing the minimum age limit for Muslim marriages, from 16 years old currently to 18 years old? *Cols. 2303-2304. Dysfunctional Families in the Malay/Muslim Community”
“Sir, with rapid development, globalisation, a fast ageing society and the coming up of the IRs, etc, those who cannot cope physically, psychologically and financially will be needing more assistance in the various forms in our community. One of the main and crucial approaches to these issues is counselling and case management. In this light, the demand for social workers and counsellors can also increase tremendously. Currently, there are only about 600 or so social workers in Singapore. Many have left the related sector and some did not even work in this area in which they qualified. We realise there are challenges related to the job, which include the low level of recognition, the relatively low remuneration and the very labour-intensive type of work. Are there plans to recruit and train more social workers and counsellors? Can their career path be made more comprehensive and exciting, in line with the need to retain and recruit more social workers? 2.00 pm”
“Sir, in 2007, we had seen the pilot of the FutureSchools@Singapore taking off. This is in line with our plans to develop an enabled nation through infocomm. How will MOE plan to extend this programme and how will the schools be selected? Will there be collaboration with IDA to evolve the programme for a tie-up with the Wireless@Singapore system? And will the selected schools be allocated additional funding and grants?”
“Sir, the Advance Medical Directive has been introduced in Singapore. Guidelines have been circulated. However, many are still not aware, not interested, as it may represent a rather taboo subject or are not taking any action, thinking that perhaps it is still too early to consider their last days. There exist skepticism and barriers to discussing such a subject and, of course, there are issues of religion and culture to be taken into account as well. Will the Ministry be doing any further publicity, roadshows, dialogues and so on to enhance awareness and understanding of this very important subject? We need to safeguard the rights of the sick, the aged and the dying with the same enthusiasm we show for the young and the healthy in our society. Treatment decisions can be difficult. We need to think about our wishes and expectations in advance to discuss with our family, friends and healthcare professionals and make plans for our future healthcare needs. I am sure, Sir, everyone will come to realise the positive impact such a period of reflection will have on us all. Skin Donation”
“Sir, under the Chronic Disease Management Programme (CDMP), which comprises diabetes, hypilipidemia, hypertension and stroke, the number of patients enrolled has increased from 7,000 when the programme was first implemented in October 2006, to 91,000 in December 2007. This resulted in the annual drawdown on Medisave of approximately $17 million in 2007. With the coming introduction of the CDMP for asthma and chronic obstructive lung diseases, what will be the additional draw down projected annually? Only about half of the general practitioners, ie, 734, have to date signed up and participated in the programme. What are the main concerns and the reasons for the rest not joining the programme? Finally, will there be future plans to include other chronic illnesses, which are confirmed by doctors, such as rheumatoid arthritis, SLE or lupus and long-term confirmed psychiatric illnesses into the programme? Health Policy”
“Finally, I would recommend that the holistic approach be adopted to ensure an integrated age-friendly health care system, looking at hardware and software that prevail in Singapore. Short-term gerontology training could be given to all staff in community-based agencies serving older people in the community. This would help them understand the needs of older people and appreciate their strength. With technology, such a training could be even done on a website, and GPs could be encouraged to also do this training.”
“They regretted that they did not have more time to spend with older patients due to the work load at polyclinics. The social workers and case managers voiced the lack of integration between health and social care services. An example: community health care providers could not access medical data of patients. Hence, the delay in helping clients in critical conditions. Some suggested solutions: (1) Assign older patients to a particular day in the week for polyclinics, eg, Fridays. I know that there is a pilot scheme in Delhi doing this, and realistically rostering their appointment times, such as 10 minutes or 15 minutes instead of the standard five minutes; and (2) Obtain the permission from patients to share their medical data with community-based health care providers for an added level of efficiency in meeting their needs. It would mean time saved and less frustration. I would like to ask the Health Minister whether MOH has any plans to promote age-friendly practices in the polyclinics. There are older persons who cannot keep an appointment because they have no one to escort them. I would like to suggest perhaps a resource help line to be maintained by polyclinics. If a patient calls, say, two days ahead of time that he or she needs such an escort, a health senior volunteer from a nearby senior activities centre could provide the service with a small transport allowance. In addition, not all polyclinics are accessible to wheelchair-bound patients, eg, Clementi Polyclinic. Can I request the Health Minister to look into this important issue? Addressing this barrier could lead to more elderly patients keeping their appointments as well as disabled patients.”
“Other players are the community-based day rehabilitation centres, mobile health clinics, senior activities centres and free clinics run by religious and ethnic-based organisations. The HPB has done many programmes, such as oral health promotion and so on. However, preventive education is a marathon task. Hence, it has to be undertaken by all the players in the primary health care system in a planned and systematic manner. Since MOH is the central policy making body, it is important for MOH to ensure that all the players move in a similar direction for preventive health care as we are facing an ageing population. Now, I move on to another study conducted in Singapore, and I would like to declare my interest here as a principal investigator of this research. Older people and care givers were asked about their views on the primary health care system, and their suggestions for improvements. This primary care study revealed barriers faced by older persons in accessing health services. These were: (1) distance - here, primary care partnership scheme helps but it has many conditions; (2) cost; and (3) physical access. The last was emphasised by frail, dependent and physically disabled elders. Recommendations included shorter waiting time, choice to see the same doctor on every visit to the polyclinic. The recent move by MOH to introduce the scheme of family physicians does meet the last recommendation to some extent. However, the increase in cost is a barrier to many. Sir, I wish to ask the reason for this extra charge. Is it really necessary? The doctors and nurses mentioned two main issues. Doctors who were interviewed expressed their focus on curative medicine rather than preventive medicine.”
“There are three major categories included in these general principles: (1) Information, education and training. All clinical staff should receive basic training in core competencies of elder care; (2) Community-based health care management. All relevant stakeholders, including older persons, should be part of participatory decision-making mechanisms regarding the organisation of committee-based care systems; and (3) Physical environment, safe and affordable transport to the health care centre should be available for all, including older persons whenever possible, by using a variety of community-based resources, including volunteers. The importance of primary health care in an ageing society today is an under discussed topic, especially at national levels. Global ageing has shown the prevalence of chronic diseases over infectious diseases. World wide, it is estimated that 60% of all deaths are attributed to chronic diseases, such as hypertension, diabetes, stroke and dementia. Compared to neighbouring countries, Singapore has a higher prevalence of diabetes. Sir, recently, an expert in geriatrics, Prof. Bergman, visited Singapore, and he said in one of his presentations that "the daunting challenges of adopting health care systems to the complexity of managing and tracking chronic diseases requires a multi-dimensional approach. More resources have to be pumped into primary health care as prevention is better than cure." His opinion was that the Singapore primary health care system is fragmented and could be strengthened. The primary health care system in Singapore consists of ageing polyclinics and GPs. The private GPs handle 80% of the bulk of primary care while polyclinics handle the rest.”
“Sir, with our rapidly ageing population, the incidence of dementia and psychological illnesses is bound to increase significantly, as we have heard the numbers. Given the finite number of community hospitals, acute hospitals, nursing homes and rehabilitative institution beds, it will become necessary to be able to manage many of these people on an ambulatory basis in the community. They may have to be cared for by their family members, their neighbours, the community around them, and certainly inputs from professionals offering auxiliary services in the community become very important. To be able to handle the caring of such persons, these people may require some training, empowerment and understanding of the nature of these illnesses. Would MOH be able to consider some form of care-giver support package, which may include subsidies, recognition, facilitation for domestic, which may have to be a tie-up with MCYS and MOM perhaps and, of course, simple training. Age-Friendly Primary Health Care Assoc. Prof. Kalyani K Mehta (Nominated Member): Mr Chairman, the concept of age-friendly primary health care was developed by the World Health Organisation in 2002. An international research was conducted using focus group methodology in the following countries - Australia, Canada, Jamaica, Malaysia and the Philippines. According to their report, which I have here, published in 2004, Active Ageing Towards Age-Friendly Primary Health Care, the general principles guiding the practice of age-friendly community-based practice were described in detail. Singapore participated in the second half of the study when doctors and nurses were interviewed for their views. The Tsao Foundation represented Singapore in this study.”
“Sir, the Policy Study Workgroup under REACH was revamped in October 2006 and re-launched in September 2007. There were five major areas that they had to look into and one of the focuses was actually health and ageing. The group allocated this topic was to brainstorm and design a health package for the different segments of society in Singapore and how they could stay healthy. Are there any updates on the reports and progress of the group? I do hope the programmes would include preventive health recommendations for the average Singaporean, suggestions for community and primary care screening, rehabilitative care and community integration of those affected by long-term illnesses, such as psychiatric illnesses. Ageing Population”
“Sir, currently, there are about 7,000 doctors or, to be exact, 6,931 from the 2006 statistics in Singapore. This will give us a doctor to patient ratio of 1:650 or we have 1.5 doctor per thousand population. As a comparison, Australia has 2.9 doctors per thousand population; USA has 3; Japan has 2.1; and New Zealand has 2.2 per thousand population. With the annual numbers of our medical school graduates from NUS and a small contribution from the Duke's Medical School, which is more of a research based education, how will Singapore plan to recruit more doctors, including some from foreign sources? I realise there are already efforts going on to bring back some of our own medical students and doctors trained overseas. These projected numbers of doctors will become important in the coming 10 to 20 years as we deal with a population that is ageing rapidly, living longer and with a higher incidence of chronic illnesses as well. Certainly, standards of care and performance will have to be maintained and upkept as well. Manpower Development”
“The literary arts appear to have less visibility compared to some other areas of the arts. The National Book Development Council of Singapore has received grants under the MICA budget. It has utilised part of its funds to set up the Singapore Writers Centre and publish the resource kit for writers. I would like to enquire what are the opportunities and options this can offer to the budding writers in Singapore. How many publications do we get annually? What is the language breakdown for the publications? What are the plans that the Ministry has to uplift this area of the literary arts to give it enhanced recognition? Creative Entrepreneur Development Programme The Creative Entrepreneur Development programme will be introduced to develop the entrepreneurial capacity in Singapore. I hope to see more creative collaborations and unique tie-ups between companies in various sectors to maintain the industry's presence. What will its programme comprise of and what targets and impact can we expect from it? I would also like to suggest that they work with Creative Community Singapore to help nurture and harness the creative potential here as well as work together in areas, such as branding and co-branding, marketing and co-funding.”
“Sir, the Geylang area offers a wide range of arts, culture and heritage, what with its numerous small galleries and studios, temples, religious associations, the Buddhist Library, and so on. It has a great potential to form another civic district in Singapore. Currently, many of the facilities are rundown and they pose serious challenges of congestion as well as vice. Can the Ministry consider improving and enhancing these facilities and helping in their preservation? Next, increasing the public's awareness of these places through some form of publicity programmes which sustain. Thirdly, medium term tie-ups with the STB to add and highlight these places in some of their packages, especially those pertaining to culture and heritage tours. As Singapore becomes more vibrant with all the exciting and stimulating developments around, certainly, the richness of Geylang cannot and should not be left out, left undeveloped and left unharnessed. Patrons of Art 12.30 pm”
“Following Singapore joining the UNESCO in October 2007, MICA has been assigned to lead the sub-committee on culture and information. What will be MICA's strategies and also how will we showcase and highlight our culture, communications and information sectors to the world, bearing in mind countries in the regions and around the world are also developing their creative industries, and competition as well as acknowledgement at all levels will also certainly be high? How will we showcase Singapore in the context of the evolution of an exciting, vibrant and transformed global nation positioned at the crossroads of Asia and, most importantly, our multi-racial and multi-cultural characteristics? Arts Outreach The arts community, MICA, the National Arts Council and specific arts groups are doing a lot in making Singapore a more vibrant global arts and culture city. In FY2006 alone, there were 158 free arts events to reach out to the populace and over 300 events in total. However, these only still attract those who are more interested and have an artistic flair. For the coming years, will the Ministry be planning more community outreach for the heartlander crowd? By this, I mean the lower-income, the average aunties and uncles who do not read the newspapers or do not speak English very well, so that they, too, can enhance their awareness of the arts and do not miss out on the finer things in life. Will there be centralised programmes to promote active enhancement and engagement as well as ownership of arts and culture by the community at large? These arts and heritage events will certainly help to put our innovative developments to foster an inclusive society, especially with the influx of new citizens as well as foreign talents amongst us. Cultural Heritage”
“Sir, with the rapidly ageing population, better technology and healthcare, there will be many more seniors amongst us in the coming years. More of these people will continue to be active and contributing to society. Many would like to remain independent and have accommodation of their own. We are already seeing this group coming forward to get rental flats and studio apartments. Rental flat application, however, requires strict criteria to be adhered to. I would like to enquire on the feasibility of setting up a kind of a retirement village or seniors' complex concept in Singapore. This will be a housing development specifically catered for the elderly to meet their needs. It is for supported independent living, which I feel is a good concept for HDB to explore. It would comprise of living units, facilities and, of course, have the relevant ethnic quota of integration. There can be economy of sharing costs, benefit of companionship and interaction and activities to keep the ageing minds stimulated. And, of course, we certainly will not just have old folks there but we will have people ranging from the age of 60 up to the end of their lives. User-friendly Environment”
“Sir, Singapore is known for her strict law pertaining to drug trafficking, distribution and use. Over the years, there have been effective measures to control the problem, using a multi-pronged as well as community-based approach. It has attracted much interest from other countries as well. In fact, in our DRCs now, there are days when we have more visitors than inmates. In managing the drug abuse problem, besides the individual, physical and psychological consequences related to the addiction, there are also social implications such as family disputes and disruption, non-performance and drop-out from schools, loss of jobs and source of employment. Over time, the nature and type of drug abuse has also evolved to Subutex, Dormicum, designer as well as lifestyle drugs. In fact, despite the fact that Subutex has been made a controlled drug, I am still seeing cases coming to the hospital with complications of recent abuse. What are the average numbers of drug related arrests currently? What are the numbers being entered into our DRCs and what are their ethnic breakdowns?”
“I thank the Minister of State for her response. The number of cases that she mentioned will probably be the tip of the iceberg. Are there any steps that the Ministry is undertaking to ensure that the numbers received will decrease and whether we can actually have some kind of campaigns or steps to help address this issue which is certainly of a concern to us? Certainly, counselling is the mainstay of managing issues like this. I was wondering whether there is any plan to recruit and also train more social workers in this area.”
“08 pm As human beings, we taste of the same pool of sufferings; perhaps the only thing that makes sorrow bearable is that there can be something redemptive about it, by blessing another out of a tragedy. This is no mere cliche but a fundamental principle and profound spiritual reality. Naked, we are born into this world and naked, we depart from it. We cannot take anything with us, except the legacy of how we lived our lives. The message behind HOTA is: don't take your organs with you - others have need of that which you cannot use anymore. To quote Peter Petrelli, a character from the TV show, Heroes: "Death is the one thing that connects us all. It reminds us that what's really important is who we've touched, how much we've given. It makes us realise that we have to be good to one another." Madam, I support the amendments.”
“Will or are separate registers kept for each organ, and will individuals who object, for example, to cornea transplant alone, nonetheless enjoy priority for kidneys? The reason why calls for further educative and publicity measures keep being reiterated is probably because the message is not getting through sufficiently. This was demonstrated starkly in February 2007 by the unfortunate incident where the relatives of a dead man pleaded with the Singapore General Hospital staff not to remove his organs. After the incident, I read press reports of a spike in the number of requests for opt-out forms such that hospitals ran out of it. Nothing like bad press to cure apathy. Adopting a presumed consent model places the Government under less pressure to conduct a public campaign to encourage organ donation, since that is the default position. If HOTA's chief purpose was mainly to increase the supply of human organs, the coercive force of the law would suffice to accomplish this. However, HOTA also has the noble purpose of promoting benevolence to others, in building a generous-hearted society. I hope the Minister can give some assurances that concerted efforts will continue to be made to inform the public about the medical benefits of organ donation and transplants to ensure that they actively support it. For example, could students be informed about these issues as part of their curriculum? Ultimately, HOTA reminds us that 'no man is an island entire of itself' as John Donne so eloquently put it. We all have the opportunity to demonstrate "compassion" by helping to bear the distress of the suffering, with whom we share a common humanity. [Mdm Deputy Speaker (Ms Indranee Rajah) in the Chair] 5.”
“From the "Fiqh of Organ Transplant and its Application in Singapore" on the MUIS website, it is clear that Muslim organs can be donated to non-Muslims, but does this work the other way round? Can a Muslim receive an organ from a non-Muslim? Practical matters Sir, on a more practical note, how can we ensure that the Muslim community at large, which includes non-Malays, is fully informed about the implications of these HOTA amendments? The issues must be explained clearly in the relevant languages, and the opting-out procedure must be simple and accessible. Presumably, they will be notified by mail in the same way those turning 21 are notified, but is this sufficient? The MOH website provides much relevant information. However, since HOTA is being applied to the Muslim community for the first time, not all of whom may be Internet-savvy, does the Government have plans to ensure that those with questions about organ donation, both medical and religious, have someone to talk to? I also note that the opt-out form is available on the MOH website but has to be posted - in the age of the Internet and e-filing, could we not allow those wanting to opt out to do so electronically, via the Internet? This ties in with the larger issue of the continuing need for public education, given that every year, the class of people subject to the HOTA regime changes as people turn 21 or 61, or assume citizenship. The perennial concern remains that Singaporeans still have not sufficiently grasped the implications of HOTA's presumed consent model, out of ignorance or apathy, such as the fact they can lodge objections for some but not other organs.”
“Ideological diversity in religion and philosophy is integral to a free society and rests on protecting the sanctity of a free conscience. Part of the freedom to believe in any faith includes the freedom to work out how that religious belief shapes our choices. This includes acting out of personal conviction with regard to how we discharge our duty towards the Creator, which may involve how we wish our bodies to be handled when we have shuffled off our mortal coil. As James Madison, the fourth US President opined, duties owed to God preceded the claims of Civil Society as "Before any man can be considered as a member of Civil Society, he must be considered as a subject of the Governor of the Universe." So, too, this round of HOTA amendments respects the principle of freedom of individual conscience which is central to religious liberty. Matters of conscience belong to the individual, not to any group or the State. Muslims who continue to feel unease towards the HOTA presumed consent scheme retain the option, like any other Singaporean, to opt out under section 9, whereupon their names will be entered into a register of objectors which the public cannot inspect. While HOTA operates on the basis of a default presumption of consent, the State cannot and does not take away our choice in this regard. Under HOTA, Muslims are able to participate in mainstream society in relation to organ transplants. This should strengthen the sense of solidarity in our common identity and destiny as Singaporeans. However, I am unclear about whether organs donated by Muslims will go into a common pool for all citizens or not.”
“This is consistent with the principle of secular limited government which recognises the co-existence of two distinct realms, the sacred and the secular, such that Caesar should not usurp the realm of God and vice versa. This speaks to the broader issue of religion-State relations and the model of secularism Singapore espouses. The Government has consistently and wisely rejected a militant form of secularism which is anti-theistic and regards religious faith with hostility. Our version of secularism views religion as a constructive social force and respects it as an important source of identity for the majority of Singaporeans professing a religious faith. The Government, in engaging with the Muslim community, through consultation and dialogue over the issue of organ transplants, displayed respect for the autonomy of religious communities. It did not ride roughshod over religious reservations but provided space for the community to determine the issue internally. Freedom of individual conscience Sir, it is highly unlikely that views within any one religious community are unanimous. While the Constitution enjoins the state to respect religious group autonomy, Article 15(1) also safeguards the religious freedom of each individual within a religious community. While the Government can regulate external manifestations of religious practice and propagation, it cannot invade the internal dimension of religious profession or belief. Indeed, the Court of Appeal in 1999 stated that Singapore practised a form of "accommodative secularism" which sought to remove restrictions to an individual's choice of religious belief, or unbelief, I might add.”
“Indeed, a Muslim MP in 1987 said it was proper to exclude Muslims from the HOTA presumed consent model as this was in accordance with Muslim law. Within the Muslim community, with MUIS as the chief representative organ, the issue of human organ procurement and transplants has been the subject of review. In 1973, a MUIS fatwa stated it was not permissible to donate one's kidneys to another kidney patient by will. Today, the jurisprudence has evolved, in the light of changing social needs and advanced medical technology that made organ transplant a viable form of medical treatment. It is now considered permissible because it serves a pressing, grave need and helps save lives. Organ donation blesses the donor, whose continuing donation will yield rewards in the afterlife, and the recipient, whose suffering is alleviated. It is good that the Muslim community and their religious leaders enjoyed the autonomy to work out the tenets of their belief system, to demonstrate the relevance of a living faith and how this applies to novel situations, without forsaking the integrity of basic beliefs. This is both prudent politics and shows fidelity to constitutional obligation under Article 152. Article 153 of the Constitution also recognises the right of religious groups to manage their own religious affairs. The relationship between State and religion Sir, while it is sometimes appropriate for the State and religion to co-operate, there are instances where the State must keep out of religion. In particular, the Government must recognise the limits of its jurisdiction and competence and not presume to interpret religious or theological questions. This would be an egregious violation of religious freedom as the State has no business determining religious orthodoxy.”
“First, it speaks to how the interests of a religious minority are safeguarded under the Singapore model of secular democracy; second, to the general inter-relationship between State and religion; and, third, to the relationship between a religious community and its individual members. Article 152 and racial and religious minorities Sir, human organ transplantation raises religious, cultural and personal concerns. The process by which the Muslim community was consulted in this regard indicates how the State treats a religious minority. It implicates the practical operation of Article 152 of the Constitution, which obliges the Government to constantly care for the interests of racial and religious minorities and especially, to safeguard the socio-cultural interests of Malays as the recognised indigenous people. Within a deliberative democracy, giving due attention to different interests is part of rational, responsible policy development. Thus, Muslims were originally exempted from HOTA out of deference to their religious teachings. This departure from the rule of law principle that the law applies to all citizens with equal force is justified as the Constitution mandates a limited degree of legal pluralism. Under Article 153, Parliament is authorised to enact law to regulate Muslim religious and personal affairs, and did so in the form of the Administration of Muslim Law Act. The Government has also sought to accommodate the concerns of the Muslim community in other matters like the Compulsory Education Act, for example. Sir, by not imposing a uniform "one size fits all" model on the Muslim community when HOTA was introduced in 1987, the Government showed that it does take religious sensitivities seriously in formulating law and policy.”