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.”
The complete record
Every one of 291 lines we hold for Fatimah Lateef, in date order, each linked to its source. Free to read, in full, without an account. Page 5 of 6.
“Practically, this placed Muslim donors on an equal standing with those who did not opt out of HOTA and who enjoyed priority over those who opted out. Thus, organ allocation under HOTA is not strictly based on need but on a principle of fairness and reciprocity, that those who give should be the first in line to receive. However, the Minister also noted in 1987 that the "active consent" model under MTERA had been a "dismal failure", which was why HOTA adopted a "presumed consent" approach. In July 2007, the MUIS Fatwa Committee issued a fatwa stating it was permissible for Muslims to come under HOTA, to ensure that Muslims suffering organ failure had enhanced access to donated organs. This is consistent with the principle of saving lives and the fatwa presumably played a crucial role in "green-lighting" the extension of HOTA to Muslims. Under the 2008 amendment, section 5(2)(f) of HOTA will be deleted. This is a religious exemption excluding Muslims from the operation of section 5 which provides for organ removal after death by designated hospital officers for transplant purposes. Muslims are now placed under the same general regime of presumed consent as every other citizen and PR. In addition to yielding more donor organs, the scheme increases the prospects of Muslim patients in receiving donor organs, by placing them in the top priority group, unless they opt out of HOTA. Sir, the extension of the HOTA regime to Muslims implicates matters relating to our constitutional order and more practical concerns. This amendment is a significant policy shift; how this was arrived at sheds lights on three aspects of constitutional practice in relation to the model of religious liberty and religious pluralism Singapore has adopted.”
“It adopted a gradualist approach towards extending HOTA, first, in terms of including other organs besides kidneys like the liver, heart and corneas, and, now, in broadening the class of persons HOTA applies to. From forbidden to permissible to encouraged It is apparent from the series of fatwas on human organ donation issued by the Islamic Religious Council or MUIS that what was once considered forbidden under Islamic law was later considered permissible to save life in cases of dire necessity and now even encouraged as an act of charity. The issue of ownership of the deceased's body as belonging to the guardians of the estate or waris and the need for their consent grounded religious objections against the presumed consent model. From the perspective of public health policy, the problem is that patient demand for organ transplants far exceeds donor supply. In particular, the mainly Muslim Malay community suffers a disproportionate incidence of organ failure. At its inception, the HOTA provisions relating to the removal of organs after death applied to all Singaporeans and Permanent Residents between 21 and 60. An exception was carved out for Muslims on the basis of religious objection. The then Minister of State for Health said in 1987 that the "Islamic religion specifically prohibits organ donation under the presumed consent system". Nonetheless, it was recognised that "Islam does permit donation of kidneys if it is to save lives". Individual Muslims had the liberty to opt in and actively pledge to donate their organs under the 1972 Medical (Therapy Education and Research) Act (MTERA) for the purposes of immediate transplant rather than storage, under certain MUIS stipulated conditions.”
“" Section 15(4) then says that such period of detention "shall not exceed 48 hours". Does 48 hours then represent the upper limit of a reasonable period of detention? If not, can an arrested person be further detained beyond the initial 48 hours and does the Minister consider that such further detention may be necessary? If detention beyond 48 hours is contemplated, who will authorise this, the executive or judicial branch? Article 9(4) of the Constitution provides that in such cases, there shall be no further detention in custody "without the Magistrate's authority." If HOTA does not envisage a period of detention beyond 48 hours, I hope the Minister can confirm this or otherwise clarify who will authorise further detention. Extension of HOTA regime to Muslim community Sir, the amendments to HOTA today have been called a "milestone" insofar as the HOTA "presumed consent" regime is extended to the Muslim community, who were previously exempt from it. I note that in the history of discussions surrounding HOTA, a host of bioethical and legal issues have been canvassed. The regulation of human organ transplantation provokes strong emotions as it compels us to face our own mortality and to grapple with a complex calculus of competing interests, such as the public interest in healing the sick, prolonging life and improving quality of living, as against the dignity of bodily integrity in life and death. This Bill makes us face the issue of how to formulate and renovate the most prudent and ethically responsible policy for procuring cadaveric organs. In treading carefully into these complex waters, the Government has taken pains to consult extensively.”
“Article 9(4) of the Constitution requires that an arrested person be produced before a magistrate "without unreasonable delay". I have two queries. First, is the use of the word "unnecessary" delay in HOTA meant to differ from the constitutional standard of "unreasonable" delay? If so, could the Minister elaborate? Second, Article 9(4) requires that an arrested person be produced before a Magistrate "in any case within 48 hours (excluding the time of any necessary journey)." This puts a ceiling or upper limit on what an "unreasonable delay" might be; a violation of the 48-hour rule could be challenged by judicial review. My question is, does the 48-hour rule also apply to arrests under section 15I clause (1), so as to qualify what an "unnecessary delay" might be under section 15(2), in relation to producing the arrested person before the Magistrate? In other words, should section 15I(2) be read with section 15I(4) which states persons arrested under section 15I(1)(a) may only be detained in custody for a period not exceeding "48 hours (excluding the time for any necessary journey to the Magistrate's Court)"? If this is the intent, it may be better for purposes of clarity to include an express reference to the 48-hour rule in section 15I(2), concerning the time period within which an arrested person must be produced before a Magistrate. Or, should section 15I(2) be read as a stand-alone provision? I hope the Minister can shed some light on this. Period of detention Sir, another issue I am unclear about is the length of the permissible period a person arrested under section 15I(1) may be detained in custody. Section 15I(3) says this should not be "for a longer period than is reasonable under the circumstances of the case.”
“World Health Organisation guidelines urge that human organ transplants not be commercialised. It is heartening that our domestic laws share this same ethical commitment. Under section 15A, the donation of organs by living persons must be as a gift free from duress, which affirms the vital principle of charity. It is an offence under HOTA to enter into these prohibited contracts (section 14) to make related advertisements (section 15) and to carry out unauthorised living donor organ transplants (sections 15A, 15C). Enforcement powers Sir, the amendment Bill seeks to give more "teeth" in the form of enforcement powers to the relevant actors in investigating these offences. Under the new Part IVB, inspectors are given broad powers of search and seizure to procure evidence relevant to HOTA offence proceedings. They are authorised under section 15I to arrest without warrant persons reasonably suspected of committing an offence. This entails a deprivation of personal liberty, which Article 9(1) of the Constitution safeguards. The rule of law demands that administrative actors be held accountable for their exercise of public powers, which should have clear legal limits. In all instances, statutory law should be consistent with constitutional standards, as the Constitution is the supreme law of the land. In this regard, I have some concerns over the meaning and scope of the powers of arrest under new section 15I, in relation to Article 9(4) of the Constitution which constitutionalises the common law writ of habeas corpus. Bringing before a Magistrate Section 15(2) states that arrested persons should be produced "without unnecessary delay" before a Magistrate. Standing by itself, no guidance on how to compute "unnecessary delay" is provided.”
“This rejects treating human organs, after the heart stops or upon "brain death", as a public resource for the State to harvest. This would clash with other human values like the right of individuals to make decisions about their bodies before and after death. Nonetheless, to more efficiently increase the supply of organs, HOTA rejected the "active consent" model, which removes the difficult task of asking family members for a deceased person's organs. While the presumed consent model may annoy those who prefer that donation be a positive and conscious act, we must remember that the procedure for opting out of HOTA is relatively straightforward, although it means being placed at the bottom of the recipient waiting list. Section 14 of HOTA correctly rejects the approach of allowing an individual unrestricted autonomy to contract to buy and sell organs at will. This would lead to the "commodification" of human organs, as anything has the potential, in a market economy, to become a saleable form of property, up for grabs by the highest bidder. A Japanese sociologist calls this treating of the human body as a menu of spare parts for prolonging life the "new cannibalism", which many consider dehumanising. It is important that HOTA's public health values limit the freedom of contract of living donors, as the poor and vulnerable are most likely to fall prey to perverse monetary incentives for self-mutilation and most in need of protection from economic exploitation. We hear horror stories about the black market trade in organs, like people in India selling kidneys to pay for dowries or how a British woman sold a kidney for $50,000 over the Internet to an American to pay off her legal debts.”
“These are the questions that have been raised by our community. Many of these have been answered during the dialogue sessions. However, it will be better for the Ministry of Health to explain to the public, so that more people, who are concerned and hesitant, will come forward. The rate of diabetes among the Muslim community in Singapore is high compared to the international standard. It is about 11%. Diabetes is the main cause of kidney disease and this continues to increase every day. And this is important, because if HOTA can include our Malay/Muslim community, it will be a concrete and positive step to resolve this kidney problem or the need for this organ. I suggest that MOH increase publicity on the projected statistics of the Malay/Muslim community's participation in more detail, so that more of them will understand the issues fully. It is expected that we can get five organs or donors every year with the inclusion of the Malay/Muslim community. This will produce about 10 kidneys, 10 corneas, five livers and five hearts. And think about it, this will save lives and will increase the quality of life for more patients. Lastly, I would like to express my gratitude to the staff of MOH and MUIS on their professionalism and sensitivity when they conducted these HOTA dialogues with the Malay/Muslim community. I am also happy with the support given when I was chairing some of these dialogues. I think many people in the community are now well-versed when debating the issue of Islamic law. *Cols. 187-188. 4.48 Prof. Thio Li-ann (Nominated Member): Sir, the premise underlying the "presumed consent" model adopted under section 5 of the Human Organ Transplant Act (HOTA) is that organ transplantation, for treating organ failure, be based on organ donation as a gift.”
“Sustained long-term education is indeed the way forward. The second point is that the handling of the situation itself has to be comprehensive and a complete package, which means we have to look into the medical and procedural aspects of organ donation as well as the emotional, social and other related issues on the matter; streamlining the process flow, making it a little easier for the grieving relatives, shortening the timing to the most minimum necessary. Sir, all these will help facilitate HOTA and, of course, we will get the buy-in. It will also instill full confidence amongst Singaporeans on HOTA. Sir, I would like to continue to speak in Malay. (In Malay): [For vernacular speech, please refer to Appendix A*. ] Many of the Malay/Muslim community fully support this Bill. This is because lives are saved and patients' suffering is alleviated. Every year, about 24 patients die while waiting for a new kidney. The Fatwa Committee of MUIS has clearly stated that our Muslim community can participate in HOTA. During the many dialogue sessions carried out, it was discovered that our community has a lot of feedback. A number of concerns have been raised, including, firstly, the issue of the surgery that must take place. Secondly, the time needed before the body of the donor is handed over to the next-of-kin. Thirdly, the confirmation of brain death. Fourthly, the condition of the body after the organ needed has been removed and how the body is stitched up before it is returned to the next-of-kin. This was questioned thoroughly during the dialogue sessions. Fifthly, the distribution system for patients who need the organ. Lastly, is the cost of removing the organs. Many of them asked whether they should pay this cost to the families concerned.”
“Part IVB, section 15G states that, "no women may be searched except in the presence of a woman officer". These guidelines on the protection of informers as well is also very necessary in addition to this new Amendment Bill. It will provide the reassurance to everyone with relevant information who would like to come forward. Sir, I would like to say a little bit about the consent age. Currently, the lower limit for HOTA is 21 years of age. Sir, I would like to ask the Ministry to review and consider whether it would be necessary to lower this to 18 years of age. I suggest this because our driving and riding cut-off age group is 18 years and most boys are in National Service at 18 years of age where they are legally allowed to make many decisions. Others would probably be in institutions of higher learning or would already have started working by 18. I would like to ask the Ministry if it has been doing any calculations or mathematics to see how many more organs we are likely to get with the lowering of the cut-off age. On the amendments for the Muslim community, including them under HOTA means more than just saving lives. It is a significant step forward indeed. It reflects just one of the many achievements and contributions of the community over the years. It also shows the willingness to change and adapt accordingly to circumstances with the objective of showing compassion to those in need, regardless of race, language, religion and background. In my opinion, there are two main factors which are essential in making everyone, not just the Muslims, understand and support HOTA even further. The first point is that we must not let up in promoting awareness and understanding. We must never slacken even after the initial hue and cry period is over.”
“Mr Speaker, Sir, I rise in support of the Bill. This Bill, Sir, is an essential Bill, first introduced in 1987 as a presumed consent law. Over the years, we have seen the need to evolve the Bill accordingly. This Amendment Bill will help finetune our framework for HOTA, making it more robust and compatible with the evolving trends and determinants of organ need and donation rate in Singapore. Currently, our organ donation rate still lags behind countries such as Spain, the United States and the United Kingdom. We still have a long way to go. Pertaining to the enforcement action of the Bill, the facts are clearly outlined for compliance. I support the strong signal it will send out to the public. It definitely has to be so, considering the seriousness of the offence if it does happen. Moreover, this deals with the human organs, ethics and the respect for the human body. For the appointed inspection officers, I hope the Ministry will brief and explain the sensitivity of the circumstances to them when they deal with the issues on the ground. The phrases and the terms as well as the non-verbal communications given out by these officers are very crucial and must not be seen to be offensive to any race, culture or religion. Whilst errant practitioners will be dealt with appropriately and, when necessary, all records must be shared, I do hope for the assurance that patient confidentiality issues will not be breached unnecessarily by the officers. This will thus make it important for the inspection officers and inspectors to be briefed on the patient-doctor relationship and what information can and cannot be disclosed under different circumstances. Despite the strict enforcements, I am also glad to see that allowances have been made for gender considerations.”
“It is aimed to facilitate research on disease prevention and control, and to make it mandatory for the health institutions to report new cases, and the information collected is used when making our national health policies. Mr Speaker, I strongly support this Bill. I would like to raise a few facts. I would like to suggest that there should be a committee to study the forms and website to be filled in for all four registries of diseases, which will be formulated soon. These forms, where patients’ facts, health and diagnosis are filled in, should not be so difficult and lengthy. It should be focused on the important information in brief. Second, only the data of Singaporeans should be collected and considered. Although, at present, hospitals and the health institutions in Singapore are widely handling patients from overseas, it is the facts on our indigenous people that will be important in this issue. Third, I would like to touch on the issue of consent from the patients. Explanations made should be firm and easily understood to them. They should be informed that their personal data will be handled with confidentiality and fairness. Therefore, any issue of ethical and moral conflict will not happen. Fourth, the four Registries are already being used by some of our institutions. For example, the Cancer Registry is organised successfully now. I have read that these Registries will be formalised in two years' time. I would like to suggest, Mr Speaker, that we should implement it as soon as possible when we are ready, because this is an important and good step. *Cols. 2625-2626. 4.42 pm”
“Sir, with reference to Part III, clause 6, on the use of the term "manager", different health institutions may define "manager" in different terms. I think we need to be a little bit more specific here as sometimes the duties and job description of the manager or certain officers, whether it is a divisional or general manager, or whether it is the chief operating officer who does the job, we need to be clear as to who has the ownership and responsibility of this very important process. And, certainly, I think it will be good if we can specify this a bit more. Finally, Sir, for the fees, there should also be some reasonable guidelines, and this should be kept as affordable as possible. In terms of research today, grants are highly competitive and are often quite quickly and rapidly utilised and consumed once they have been received for the many competing needs and requirements on the research projects which are ongoing. Thus, keeping the fees affordable will be very helpful. Let me now just say a few words in Malay, Sir. (In Malay): [For vernacular speech, please refer to Appendix A *. ] We should always adapt ourselves to the situations and needs in the field of medical research, which has made many developments. However, with regard to healthcare, care- ful planning is a very important factor to ensure its effectiveness. For effective planning, we should have sufficient data, which should be accurate, stable, balanced and bring about the desired benefits. In this matter, I laud this National Registry of Diseases Bill which I feel comes at the right time.”
“For security, Sir, the public will be reassured by the administrative safeguards and level of protection that will be put in place to prevent abuse and minimise errors. These will have to be emphasised to the user and also the applicant to ensure compliance. It would also be good to have the following in place: First, for applicants who wish to request data for a study, there must be support from the ethics committee or the institutional review board approval letter from their relevant institutions. A copy of the study protocol and questionnaire should also be forwarded to the secretariat. Second, all publications related to the application and use of these data must be sent to the secretariat. At the more preliminary stage, if there are controversial results which are seen, it is important that these must be highlighted to the secretariat as soon as possible. The authors may want to acknowledge the efforts of the Registry staff and secretariat as relevant. I would also like to suggest that applications be divided into at least two different categories. Firstly, the request for generic information and data where trends are important, eg, for policy formulation and guideline writing. Secondly, the request for more personal and individualised information data or report. This must be handled even more cautiously and be reviewed at different levels of staff in order to prevent abuse and protect confidentiality. More public education to explain that the rules being drawn up are watertight to prevent mishandling of information is also going to be beneficial. The public must be assured that the legislation is not meant to be intrusive of their personal medical information and is down with proper safeguards to their privacy.”
“Here, Sir, I would like to suggest perhaps that consideration be given for recruitment of retired nurses and healthcare workers, because their background and knowledge will be a bonus for this type of work and they are quite used to issues of confidentiality and will certainly serve us in an advantageous manner. Third, the need for a clear legal framework to protect data from abuse. The framework, when ready, should perhaps be made public on the website, so that everyone is aware of the requirements. Fourth, the consent acquisition process needs to be formal and clearly specified. This must also include the need to understand the reasons for request of data and its utilisation. Finally, it will also be optimal if we can follow a relatively similar or standardised structure format for all the registries, eg, the cancer registry, which started many years ago, was one where healthcare staff had to complete the form manually and then faxed or posted out. In this day and age, electronic submission would be most optimal and efficient, and it must certainly be the way to go forward. It is essential to ensure 100% compliance and participation, and that is why we have this legislation, and this will no doubt affect the quality of data that we get as well. The Ministry needs to set a timeline for entry and data submission. Perhaps this can be set at about 2-3 weeks after diagnosis or after discharge. Sir, safeguarding and protecting confidential information must go beyond just having a set of rules, because once improper disclosure of data and information happens, it is already too late, even as there is a hefty punishment for the offender.”
“Sir, I rise in support of the Bill. The practice of medicine and healthcare is changing and evolving. There is now a paradigm shift towards evidence-based practices. Basing our policies, healthcare and clinical guidelines on published Western figures and Caucasian population statistics is not acceptable anymore. We have to utilise our own local cohort results, figures, trends, etc, to formulate practice guidelines. Moreover, with our multi-racial and multi-ethnic representations, local figures become highly relevant. This Bill will facilitate the collection of medical and health data for research, disease prevention, planning and control. It will give us our very own unique data applicable for formulation of policies and intervention in our population. And as data collected will be ongoing, it will be a good example of the time motion trial. For the Disease Registry itself, the Bill will cover cancer, heart disease, renal disease and also stroke. I would like to propose other diseases to be included in the Registry in a staggered fashion over the years, as this will be gradually necessary. Some of the suggestions would be a registry for asthma, chronic obstructive lung disease and also perhaps a genetic diseases registry which will become highly relevant for information sharing, because these are highly specialised diseases in our small society. The setting up of these registries requires several key factors. First, the cooperation from all stakeholders in order to achieve the complete and comprehensive data we want. Second, a dedicated secretariat to run the system, handle administrative issues, requests, data extraction, etc.”
“A final suggestion I have, Sir, is to have it specifically written that designated customs officers or relevant authorities are given the power to access or detain property if they are found to have suspicious activities such as being relations to terrorists or terrorism. They should also be given authority to use tracking devices or some similar devices as deemed relevant and necessary for national security that would better protect Singapore against any asymmetric terrorist attacks, as we align with the requirements of the Convention. Sir, I support the Bill.”
“This is over and above the phrase, and I quote, "a place of public use which is currently mentioned in section 3". This is certainly a form that terrorist acts can take today and I feel it would be good to include this as well unless it is covered under any other Acts elsewhere. Moreover, there is now the emerging threat of chemical, biological and radiological attacks. Indeed, Sir, terrorist acts are usually criminal offences, such as intimidation, property damage or murder, but these offences are committed with an ideological, political or religious motive. The latter may not be known for sure until investigations have been carried out and completed. Singapore is acutely aware of the need for regional and international cooperation given the transnational character of modern terrorism. No country is immune. Being a member of the global community, we must also have our options for the treatment of international terrorists who commit offences on our shores, and vice versa. This is where the provision in the Bill which gives Singapore the extra-territorial jurisdiction over bombing offences is highly relevant. In the event where there is no extradition treaty between Singapore and the Convention country, or if the existing treaty does not have provisions for extradition of persons involved in a terrorist bombing attack, this Bill allows for notification to be made for the application of the Extradition Act. I would hope, Sir, that this will be executed expeditiously in a timely fashion, given the nature of the crime that we are considering. To eliminate terrorist acts, it is also important to eliminate supporters of terrorism. Terrorists operate where they are able to receive funds and information from supporters and sympathisers.”
“Sir, at this late hour, I will make my speech short, sharp and straight to the points that I would like to raise. Before that, I would like to first declare that I speak as someone who has been involved in the medical management of victims of terrorist attacks, namely in Pakistan, Iran, Iraq and in the Jakarta and Bali bomb blasts. This Bill, Sir, serves to remind us all of the potential ongoing threat to our safety and security. Terrorism is emerging as a most formidable challenge globally. Terrorists do not respect territorial boundaries, age, ethnicity, customs and traditions. This Bill strengthens the need for commitment at every level of society to combat this threat. It is also a further step by the Government to ensure we have in place a full and comprehensive range of measures to prevent and respond to any effort by terrorists who operate in our society. In the definition and interpretation sections, Sir, I would like to suggest the inclusion of the definition of "terrorist" or "terrorist groups". This would add weight to the list of terms defined and also it would be good to include some of the recognised terrorist groups in operation, especially in our region. This would help to enhance awareness as well as the spillover effects will be apparent in the form of growth of a transborder link between various extremists and terrorist groups. My next proposal is related to quite a larger picture of terrorism and terrorist acts. Under clause 3, with regard to the types of activities, can we also consider including something more specific, and I quote, "offences such as contamination of products such as food, water, vegetation intended for human consumption with the intent to harm persons or cause major economic disruption and damage"?”
“With regard to the amendment to section 9, I support the addition of the relevant phrases to make it clearer and certainly more specific. The concentration limits and types of chemicals must be prescribed by the regulations. The stiff penalties must be maintained as it is certainly a deterrent. The amendments in the Bill, Sir, ensure that practical steps are clearly defined and delineated in our quest towards preventing any chemical weapons threat. I support the amendments as we align ourselves with the international convention. 3.16 pm”
“Sir, I rise in support of the amendments to be made in the above Bill. Singapore's main focus has always and will continue to be the regulation and inspection of chemical facilities and operators. This would include all those companies and industries dealing with chemicals stipulated in Schedules I to IV. It is important to have frequent inspections, discussions and engagement of these vendors and companies. This is also because there is very rapid development in the area whereby partially related or so-called cousin chemical may be produced from R&D activities. Therefore, the new definition of the word "produce" is indeed appropriate. A register of all these companies and persons in charge should be maintained adequately. Also, if we do have foreign workers and foreign nationals working in these sensitive areas, it may be time to consider stricter monitoring. In these days and age where terrorist network can be extensive, we have to remain highly vigilant, in particular when dealing with areas such as this with a high potential for hazards. Can I also enquire if these premises dealing with such chemicals can be clearly demarcated and have signages? No doubt, many of these may already be sited away from residential and educational areas. Another query I have, Sir, is whether the inspections of these premises are conducted ad hoc or the owners are pre-informed beforehand so that they can prepare the premises adequately. I would like to suggest a kind of spot-check type approach, if this is not already being done, to increase the so-called surprise element and to see what really goes on on a day-to-day basis. Also, perhaps, the monitoring of accidents and incidents or the industrial injuries and explosions can be used as KPIs for these companies and industries.”
“If the business is registered under a person's name, he or she would have responsibility of the pharmacy business carried out on that premises. All pharmacy businesses must have a pharmacist name, either as the person in charge or as the adviser. The pharmacist may be the person under whose name the business is registered, or the pharmacist may be appointed by the person in charge of the premises to have overall responsibility of the pharmacy part of the business. The Ministry should also consider a register for retail pharmacy businesses to assist with the regulation process. Finally, this Bill, Mdm Deputy Speaker, is a step in the right direction as we move towards and strategise for greater professionalism and, certainly, in our moving towards the future of healthcare in Singapore. I support the Bill. 5.55 pm”
“We also know that often, these are the people who do the handing out of medications prescribed by a doctor in these practices. Whereas it would have not been right to subject them to the same regulations as a professional, such as a pharmacist, can I put forth the suggestion for them to have certain training and guidelines followed by certification upon completion of a training course? This would certainly go a long way in helping us move towards achieving 100% patient safety and safe prescribing. We have also heard of recent cases where physicians have been found to over-prescribe certain controlled drugs on a regular basis. Perhaps, with knowledge, training and empowerment of these clinic assistants, we can reduce the incidence of such cases. After all, one of the objectives of this Bill would be to enhance standards of patient safety and increase public confidence in pharmacy practice in a very structured and sustained way. About the appointment of advisers, besides the appointment of committees with general or special purposes, I would like to suggest the appointment of a legal adviser or advisers for particular proceedings of the Council. The Council will make the rules for the functions of these legal advisers who are appointed. Clinical advisers too would be very useful and they should be specialists or experts in particular fields and their inputs would come in useful in handling complaints, drawing up guidelines and inputs on team practices as pharmacists, Mdm Deputy Speaker, are indeed members of the holistic healthcare team. Finally, the pharmacy business. Pharmacists must have responsibility for the pharmacy business.”
“I would also like to suggest that the Bill has allowances for the following two points. Firstly, for a pharmacist who has been on an overseas attachment or posting for a certain period of time, what would be the criteria for having their full practising certification upon return? This needs to be clearly stated. Secondly, how about the non-practising pharmacists who wish to keep their certification? What requirements would they have to fulfil? This would probably have to be in terms of continuing education programme participation. And if they do decide to come back into active practice, it would indeed be necessary to have a short period of clinical supervision, depending on how long they have been out of clinical practice. Pertaining to continuing professional development, this should be planned along the same lines as those in existence for doctors, nurses and also, recently, the practice of optometry. As professionals, we cannot run away from the fact that our knowledge has to be updated all the time. In this Bill, there is reference to the regulation of the grant and renewal of practising certificates. This is indeed a step in the right direction to help step up professionalism. And I would urge the Ministry of Health to work closely with the School of Pharmacy and also with the practising pharmacists to get their inputs and feedback on this matter. As the public often is not able to differentiate between pharmacists, pharmacist assistants and the pharmacist technicians, I would also like to enquire as to whether there are plans to subject the pharmacist technicians to any form of regulation. Also, we know that many general practice and private clinics do not employ pharmacists, but instead, they have clinic assistants.”
“Mdm Deputy Speaker, I rise in support of the Bill. Gone are the days when doctors would register, treat, prescribe medication, prepare the concoction and elixir all by themselves. Healthcare has evolved to become a very specialised, and, in fact, even a sub-specialised area. The divide between dispensing and prescribing must be clearly defined. Here, I would like to clarify one of the Member's earlier query whether we actually break down costs into different types of treatment that are given. Currently, in our restructured hospitals, we have the bills being broken down into the cost for consultation, x-ray as well as prescription of medication. Pharmacists are now the recognised experts in drug use development, prescription and also monitoring. The Pharmacists Registration Bill will have a major role in ensuring that professional standards are maintained and it will also introduce what I would term the "fitness to practise" regime. In fact, pharmacists have now taken on a specialist role and they are involved in areas such as toxicology, poison centre management, psychiatry, oncology and also hazardous material handling. Thus, the relevance of the specialist register as the industry progresses and evolves, the guidelines for temporary, conditional and full registrations are stipulated very clearly in this Bill, and this is very timely indeed as we realise the need to recruit foreign trained pharmacists. With our current ratio of only 0.35 pharmacists per 1,000 population, we are indeed below first world standards. Our requirements are about 200 pharmacists per year. And we also have to take into account the fact that we have a turnover in the industry, knowing that the pharmacists actually do face job stresses and they have competing needs as well.”
“I would like to see more dialogue with the people to provide further explanation so that there will be no misconceptions on the schemes that will be implemented. Cols. 1979-1982. 2.07 pm”
“They have to be more positive and view these changes as a measure to protect their interest in old age. If you look at it closely, the changes to the scheme are a call for us to save early and to plan our budget and our family's budget in a better way. One of our responsibilities is to start investing from now, ie, long term investment for our children so that they will have good education. In this way, they will be able to earn a better income and may be able to contribute to our own old age later. If our younger generation is more successful, their parents will be able to use their CPF funds for their own use during retirement. For those who are having difficulties finding a job or are earning a low income, they should use this time to upgrade their skills. Moreover, the Government will also be amending the laws to enable us to work to a later age. For the Government, we have to take into account all these concerns of the Malay/Muslim community. There should be flexibility for them to make their own choices. Among the flexibilities that we can implement are issues such as life annuity or joint annuity which is very popular in countries such as Switzerland. This scheme enables one to receive monthly payouts and when he passes away, the money will be paid to his heirs. This annuity is normally for married men. At the same time, we also have to consider another group of the population, ie, the housewives and those who do not have permanent jobs to contribute to the CPF. Will they be allowed to take part in certain schemes? How will we assist this group of people? Finally, the understanding and acceptance of the people are very much needed so that these changes can be implemented more effectively.”
“The way to do it is by making preparations in terms of savings and the main form of savings for most Singaporeans is the CPF. So any change to the CPF scheme as a way of preparing ourselves is something that we must support. There are questions and concerns on this issue, but we have to change our mindsets for the sake of our own future comfort and old age. For the Malay/Muslim community, some of them may already be feeling the heat and impact of the move to delay the CPF draw-down age. This is especially so for those who earn a lower income and are without other savings. They will always be needing money as soon as possible. There are also those who may want to use the money to perform their pilgrimage and this is a common thing among the community. There are also others who may want to use the money to take care of financial problems due to debt burden or perhaps to help their children who are facing financial problems. Another group that may be affected are those who have lost their jobs during the economic crisis and are having difficulties finding a new job. They place high hopes on the withdrawal of their CPF funds. With regard to annuity, there are many who are concerned that they may not have sufficient money in their Minimum Sum to take part in the scheme. There are others who feel that the scheme may not be necessary because they feel that life and death are a question of fate and it is quite unlikely that they will reach 80 years of age. These concerns can be understood. Issues like one's hard-earned savings, livelihood, health, life and death are matters of serious concern that affect every one. However, the Malay community has to have a broader and more forward-looking view.”
“A fixed guaranteed stream of income throughout your retirement to cover your basic needs sounds very appealing. Again, why the unhappiness? Well, they want the flexibility as well. Those who already have purchased some form of retirement annuity should be given some exemption. Perhaps, there can be some consideration for a scheme with survivor benefits to make it more palatable. Most annuities that are offered now have relatively low payouts. The current range is from $474 to $599 for males, and $440 to $513 for females. Some may thus prefer to take part of their retirement funds to invest in a portfolio of safe instruments, such as Government bonds and Bills. They should be given this flexibility as well if they can afford it, and of course it will also cater to their lifestyle. How about those who cannot make the grade and meet the Minimum Sum requirements, such as the irregular workers, housewives and, now, perhaps even the house-husbands? Finally, it is a visionary Government that plans for all the sectors of its population. These CPF changes are coupled with issues of empowering the elderly, ensuring employment for all as long as one wishes to have work, handling the widening income gap which is a universal problem, and strengthening our economy. Sir, I am in favour of the changes and, as Minister Lim Swee Say said yesterday, with the right action, we are half way there. Well, I am going to say that with the right mindset, half the battle is won. Let me now just say a few words in Malay. (In Malay): [For vernacular speech, please refer to Appendix A *.] Appropriate measures must be made from now if we want to handle the issue of a growing ageing population.”
“They may not watch television and they may not come to our dialogues. They may not be computer literate. So they make their decisions based on the impressions that they form based on other's speeches. Flexibility in the scheme is essential for the disabled and the chronically ill elderly, the low-income and those who have gone into bankruptcy and are facing financial difficulties, the single elderly with no family support, those who are having difficulties getting a job or have been unemployed for reasons not due to their own doing. Those with ageing parents, who have chronic disabilities and illnesses, to take care of and those with long-term mental illnesses who are not fit to work at all. You may tell me that this list may be unending. But it is up to the board, the new committee and the Ministry to set up some clear stipulated guidelines to ensure that there is no abuse as well. It may not be easy but this is where we have to strike a balance. Singapore is very strong in job creation and re-creation. But can we consolidate this a bit further? The numbers that we see receiving rejection letters and negative responses week after week at our meet-the-people sessions and they keep coming back again and again pinning such high hopes on us, calls for this. The NTUC is actively looking into this and doing a lot as well. But, certainly, we need to see many more employers jumping on to the same wagon and speaking the same language. More coordination and sharing of databases of applicants may also be some useful steps to take. Having a secure job means a lot to the elderly, not just a stable source of income, but an active and healthy state of mind is so essential that the living well part of ageing is taken care of.”
“But somehow we manage to live longer than most people because of the nutritional diet, good healthcare system and a willingness to work longer.", so said Hideki Ito, Director of the Tokyo Metropolitan Gerontological Institute. All of us are concerned about how we will fend for ourselves in our golden years. It is a dream of every nation to have its greying generation self-sufficient, independent and, of course, financially independent as well, actively participating and, perhaps, still contributing to society in a multitude of ways. I pause at this juncture to share with you that in my constituency, I have a "Retirement Not Encouraged" policy for my community leaders. For those who wish to step down, they do not retire but they are channelled into a grassroots resource network where they will continue to contribute from their wealth of experience and ideas. With all the recent announcements, the combined effect of the Workfare Income Supplement scheme, people who are working longer and retiring later, the delayed draw-down age and, of course, the higher CPF returns will certainly help our older workers prepare for their retirement. When talking about the delayed draw-down age, this would be done very gradually from 62 to 65 years from 2012 to 2018. In fact, members would have more monies in their accounts, they will have the higher returns, they will have the D- and the V-Bonuses. So does not all that sound very good! Then what is all the discontent about? It is about the inaccurate perceptions and wanting to have more flexibility in the system. To ensure greater buy-in, we have to correct all the misperceptions going around in the coffeeshops, in the void decks and in the markets. These may be people who do not read the dailies.”
“Mr Speaker, Sir, I rise in support of the announced CPF reforms. For, indeed, we must never under estimate the power of an idea whose time has come, so said Victor Hugo. Mr Low Thia Khiang yesterday wanted a longevity fund to provide handouts for those over the age of 85. Mr Siew Kum Hong as well was wondering if we should, instead of the annuity, consider aid and funds for the elderly over the age of 85. Sir, let me share with them that, firstly, we already have the Public Assistance scheme for those who are in need, whether they are over or below 85 years of age. In fact, MCYS has outlined 39 different aid schemes for the needy, the low-income, the elderly and the destitute and they can tap on these no matter what age. Moreover, the golden generation may not always wish for us to provide them with handouts. They have their pride as well. Let me illustrate this. About a couple of months ago, I saw a patient in the Emergency Department - a 93-year-old Cantonese-speaking lady, we will call her LCS, she came in with a mild heart failure and, after treatment, she was well enough to speak in full sentences. She was advised on admission and, upon knowing that she had to be admitted, we told her that her children would probably make the choice on the class and also the payment, she straightaway sat up, lifted forward and exclaimed, "No. Don't take their money. I have money for my own care." And she pulled out her cloth purse from underneath her upper garment and inside were several thousands of dollars. I suppose it is her life savings. Indeed, there are elderly people like this. They too may have a mindset of their own. "It is very difficult to live long and live well, especially when the Japanese society is so stressful.”
“Sir, I would like to ask the MOS, with the introduction of the "Teach Less, Learn More" concept which was introduced by the Ministry, how has the reception in the schools been and what is the take-up like?”
“Let me share with you an example from country X, where the professional and ethical standards for practice states: "Foreign reciprocity: No foreigner shall be admitted to the Optometric Board Examinations unless he proves in a manner prescribed by the rules of court the country of which he is a citizen, subject or national either admits our citizens to the practice of optometry without restriction or allows them to practise after an examination on terms of absolute or strict equality with citizens, subjects and nationals of the said country." We may not be taking a course along these lines but it is certainly something for us to consider. On the issue of complaints, I hope there can be some design to facilitate the resolution of complaints at the lowest and most appropriate level possible and also to avoid duplication of complaint resolution processes. There must, however, be some flexibility in handling the complaints system. Options may include taking no action at all, a decision that an action is unnecessary or inappropriate, referral to an advocate or a provider for resolution, or calling a mediation conference without a need for formal investigations. Investigations will be reserved for more serious cases, certainly. Finally, of course, the stiffer penalties that are stipulated in these current guidelines are something which hopefully will serve as a deterrent. Mdm Deputy Speaker, I support the Bill. 4.20 pm”
“As we know, there are many so-called opticians and optical shops that are available widely in Singapore, and some of them are actually very old shops that have been passed down from generation to generation where many of the people who run these shops are performing refraction and also optical procedures are not highly qualified and do not have formal education. So we may have to give them a bit of time to adjust to this new regulation as well. The Board will also have to decide on the duration of validity for the certification of practice. Usually, for most other professions, this is stipulated at about two to three years, and there is a reason for that. This is because, beyond that, usually you would need to be upgraded and updated in terms of information. So, that is something for us to consider as well. Currently, the line between an optometrist and ophthalmologist with respect to detecting and treating eye diseases is also blurring. In places without therapeutic pharmaceutical agent law for optometrist, such as in Singapore, they must still refer patients to ophthalmologists for treatment where eye diseases are being detected or are present. With respect to contact lens dispensing, too, there is a need to define the job scope further for clarity. One more area for the Board to consider will be that of the recruitment of foreign-trained optometrists and opticians. As we see more foreigners in our midst, we must have an allowance for their recruitment as well. What will be the policy in terms of recognition of foreign certification or their entry criteria for a job in Singapore?”
“The setting up of the Optometrists and Opticians Board is essential and indeed very timely. However, I would suggest dialogues and sessions to meet up and reach out to those affected, to gather feedback and hear their inputs before formalisation. Perhaps, a team can be set up to randomly visit some of these existing optical and eyecare shops to assist with relevant explanation, get feedback and checks through engagement of these personnel. And, as we have heard, there are over 800 retail shops dealing with eyecare products and only about 40% have qualified personnel. That is a very low number indeed. I note with delight that there will at least be one person on the proposed Board who will not be a doctor, optician or optometrist, and this will usually be from the consumer. This is a positive step for the consumer to give feedback and also sit on the Board. I am also glad to hear that there will be allowance for the Board to set up an appropriate committee, when necessary, for special duties and projects. This is relevant, as those with valuable skills and inputs must be invited to come forward and contribute. Examples would be physicians, legal representatives and also consumers when necessary. The Board may also want to consider mandating display of certification. This is because with the current status, there are eyecare product shops a dime a dozen in most malls and also in heartland areas. Thus, for the public to know that the premises are registered and recognised, there must be some form of identification which the public can identify.”
“It would also help to specify permissible boundaries of practice as there is frequent overlap in the job description of the optometrists and the opticians. Regulation will help enhance professionalism as well. Professional ethics must be adhered to strictly. And with this, there must be a formalised programme of continuing professional development to help continuous enhancement of technical and practical proficiencies. This would require an appointed Secretariat working with the proposed Board to set minimum standards and required hours of attendances. For those in the profession, who are specialised or sub-specialised, there may have to be a separate requirement for that as well. And I note the details given by the MOS on this in his earlier speech. An example for us to consider would be, in Hong Kong, the register of optometrists is divided into two different parts. Part I is where the optometrist who is registered under this Part can practise without any restriction. And for Part II, certain stipulated restrictions are there but Part II registered optometrist can be registered as Part I, if he fulfils certain training and experiential requirements. Documentation and checking system, preferably electronic, would also be required for ourselves. There was a study in 1986 in the district of Columbia and it found that increasing the restrictiveness of optometrist's licensing examination had a positive and statistically significant impact on the price of eye examination and eye glasses but need not have a significant impact on the quality of eye examination measured by the thoroughness of the examination. We hope that the prices will certainly not be too much affected by the regulation that we are setting upon.”
“Mdm Deputy Speaker, the eyecare industry is undergoing rapid development and changes. With our open and global market economy, the industry will see more partnerships, joint ventures, international patrons and also cross border collaboration and interaction. One very recent example of this would be NeuroVision, a Singapore-based eyecare specialist partnership with Essilor International, a world leader in optical products. With more such opportunities, we have to be prepared and adapt as well as evolve. Our standards have to be on par with the rest of the First World. On 11th October 1953, a group of dispensing opticians met in Kentucky, USA, and the elected office bearers formed the society of dispensing opticians with a membership fee of only US$10 each. They formed it because, and I quote, "to promote increased efficiency and higher qualifications of dispensing opticians by state law providing licences only to properly qualified persons." That was in 1953. We are now in 2007. It is more than half a century, and it is indeed time for regulation. Economic theory suggests that in the absence of regulation, certain health personnel may provide lower quality service at higher quality prices to uninformed consumers. Thus, regulation will help to improve services and protect consumers and Singaporeans are indeed high consumers of eye services and products. What with four out of five young adults being myopic before the age of 21 years, where one-fifth of our young myopics have a high degree of myopia being of greater than 600 degrees and where the current trend shows a higher rate of myopia starting at the pre-school levels. Regulation will certainly set the minimum standards of education, qualification and experience.”
“We have programmes to raise students' awareness of potential discipline problems including bullying and to equip pupils with the knowledge and skills to handle challenging situations, such as help-seeking, self-management, relationship management and responsible decision-making. Schools also intervene to manage bullying and other forms of misbehaviour. Depending on the seriousness of the offence, schools use a combination of counselling, mediation and disciplinary measures to educate and correct offenders. We have full-time and part-time School Counsellors to complement the efforts of teachers to help both the bully and the bullied through counselling and mediation. Schools may also resort to disciplinary measures, which range from corrective work, detention, suspension to caning. Certainly, parents are important partners not only in this but in all aspects of education. The schools welcome and value the support of parents when dealing with disciplinary cases. Such parental support will help the children better learn from the experiences. It will also make the effort to prevent and resolve the cases more effective. In addition, for those bullied, we would encourage the parents to alert the school of such incidents as soon as possible so that the authorities can take necessary action to deal with them.”
“Sir, I would like to find out whether there are such programmes or whether staff in the preschool arena are being trained to identify such cases because we know that some of these cases actually surface very early on and the earlier the intervention is done, the better it is because the preschool area is one of the areas where these programmes are lacking. RAdm [NS] Lui Tuck Yew: Specifically on psychosis, international studies from countries like Australia and US indicate that the onset of psychosis occurs most commonly in late teenage and young adult years, from 16 years and onwards. At least, in reference to this particular area, I do not think we will want to be introducing any specific programmes into the preschool level at this point in time. INCIDENTS OF BULLYING IN SCHOOLS 4. Mr Seah Kian Peng asked the Minister for Education in light of the recent report where a girl was stripped and beaten by her friends in school, (a) how often do such incidents occur in schools and what is the Ministry doing about it; and (b) whether there is a way for parents to help. RAdm [NS] Lui Tuck Yew (for the Minister for Education): Mr Speaker, Sir, let me assure the House that MOE views such incidents seriously and that such incidents of extreme bullying are infrequent. We have provided schools with comprehensive guidelines to manage discipline in schools. Within these guidelines, each school formulates its own set of specific rules and measures taking into account the student profile. The focus is on ensuring a safe school environment for all pupils. Our schools manage discipline through a combination of proactive and intervention measures. The preferred approach is to prevent such incidents.”
“As the discipline is relatively small in Singapore still, we will have to ensure that there are enough such CME sessions in order that the dentists be given a fair chance and, of course, the choice as well. On complaints and disciplinary prosecution, with the new Bill, the complaints process is being made clearer with more structures in place and, of course, it is even more fair and effective. It is essential to ensure parties involved get a fair deal and understand early the course of action which is going to be involved. This can then ensure that they undertake a series of necessary systematic steps in pursuing the issues concerned. This will certainly contribute towards consistently high quality dental care and practice, aligning with the norms for professionals and perhaps even for everything else in Singapore, which is always to be whiter than white and shinier than shiny. Sir, I also strongly support the proposed formation of an Interim Orders Committee which will be making the decision whether to suspend or restrict the practice of a practitioner whilst he is still under investigation. Currently, such practitioners are allowed to carry out their work which is creating a bit of a sour feeling with a lot of people. Once again, this is consistent with our call for enhancement of patient and public safety. It is also very heartening to see that various safeguard measures have been in place and are clearly stipulated to preserve the rights of the dental practitioners. Finally, I concur with the change in name for the Act to the Dental Registration Act, certainly a more appropriate choice and an all-encompassing terminology. Sir, I support the Bill. 3.53 pm”
“Revalidation will now require them to demonstrate on a regular basis that they remain fit for continuing registration and thus worthy of their patients' trust. Acquisition of adequate CME activity points over a stipulated period will allow one to renew the professional practising certificate. This new regulation will promote self-motivation and thus compliance, just as it has done for the medical profession. Sir, I would like to highlight and suggest the following to be considered in the setting up of the dental continuing professional development programme and system in Singapore. First, a dialogue for the Dental Council, the Ministry of Health and the dentists to attend and discuss as well as finetune, taking into account their feedback and suggestions, as these are the people who work on the ground and they know the practicalities and issues on the ground. Second, the setting up of a secretariat to help in the management of the system. Third, the use of on-line submission to facilitate the management of the CME points. Fourth, the use of different categories with different point weightages given, something similar to the current medical CME system. And, finally, to have a system to pro-rate and manage those who have to be overseas for an extended period of training or practice. One word of caution I have is that there must be consideration before starting up a core versus a non-core points accumulating system which is used with the medical system today. Core points pertain to points obtained when attending CME sessions related to their area of specialisation, whereas non-core points or general points are for generic dental-related CME programmes.”
“This, Sir, may turn out to be very restrictive towards other institutions in future which may become engaged in training and education to serve the growing needs of our population. Sir, this new Bill must provide a leeway for future developments without having to propose a new amendment Bill every time to suit changes and evolution. So we hope that could be addressed. On oral health therapists, just as new fields in dental specialisation develops, the scope of work of oral health therapists should be expansive and not restrictive. The new Bill introduces two groups of oral health therapists, namely, the dental therapists and the dental hygienists, with a very narrow scope of work. Should not the scope of work for oral health therapists be allowed to expand, especially with a formal introduction of dental specialisation? Should not dental therapists be trained to complement, not just general dental works, but also specialised dental works as well? Dental therapists are currently trained in general dental restorative works, such as fillings and basic dentistry for minors up to the age of 18 years in school dental health service. If we are to support that expansion of services, how will they make the transition into practice that involves adult patients? There must, therefore, be some options and avenues for them to develop in order to make the transition and necessary adjustments. It is also unclear from the Bill as to whether dental hygienists and therapists can set up independent practice after a prescribed period of supervised practice with a Division I qualified dentist. On CME, Sir, revalidation of members of the dental team is a proactive approach to regulation.”
“For dentists dealing with medical-related devices, such as dentures, braces, bridges and so on, they should be subjected to the Medical Products Act which has just been recently discussed in Parliament. The payment of dental practice insurance may also differ from these different groups of dentists, just as we have doctors in the low, medium as well as high-risk disciplines paying different premiums. It is only fair for those performing more invasive and high-risk procedures to be more highly covered and insured as you can certainly say, "Your bite is only as big as your teeth." I am also very glad to see the introduction of registration and regulation for oral health therapists. This is a profession which has certainly not been given much focus and recognition despite the importance of their role. Many are today being sidelined still, except in the school dental health service where they play a very significant role even up to today. These are the group of people who can help with dental public education and creation of awareness, not just for children, but also for the public, and their knowledge and expertise are to be tapped in certainly a positive way. Sir, this wider range of a more robust regulatory mechanism will also be in the interest of public protection and certainly safety. On accreditation, the Bill stipulates that the Dental Council is to have one academic representative who is the Dean of the Faculty of Dentistry at NUS (section 3.2(b)) and the academic representative of the Oral Health Therapists Accreditation Board to be one member of the academic staff of the dental hygiene and therapy course offered by Nanyang Polytechnic.”
“Mr Speaker, Sir, dental practice and education are becoming more globalised today. Greater practitioner and patient mobility, the free flow of information, increasing global standards of care and new enhanced legal and economic frameworks are forcing countries to review dental licensure and specialisation as well as their continuing education programmes. These changes are to be expected and seen as a springboard of the future. Outdated concepts of regulation and the assumption that the profession alone knows best must be set aside in order to keep in step with the ever-increasing patient expectations and developments in healthcare provision and regulation. Dental care in Singapore is of world-class standard. The number of foreign patients seeking both general as well as specialised dental care here is certainly increasing. In line with all these changes, the introduction of these amendments is indeed timely and appropriate. On registration, Sir, I fully support the differentiation set out pertaining to full conditional as well as temporary registration. This will make the definition and delineation of roles so much more clearer and, of course, it is also very similar to what the medical practitioners are already practising today which is working very well. Making it comparable for both professions is a positive step. Doctors and dentists, who have been deemed not ready to practise independently, should be given the due supervision they require to mature and excel. It is also important to differentiate between the general dentists and those who are specialised as their scope of practice, the types of equipment, the state-of-art technology and also the risk involved are very different.”
“Thank you very much for the answer. I would just like to ask one supplementary question. Will there be a possibility to consider some kind of formal interactive programme or integration programme between uni-cultural schools, basically SAP schools, versus maybe perhaps madrasah schools? Because a kind of a long-term relationship between two types of schools would probably be good in developing tolerance and understanding of our multi-cultural and multi-racial society.”
“I would like to ask the Minister of State if she can clarify the numbers that she mentioned. Were they just the physical abuse of the elderly or do they also include things like financial abuse and psychological abuse of the elderly which we know happen in society as well? The second part is whether MCYS would like to consider embarking on an awareness campaign because, unlike child abuse and domestic violence, elderly abuse is something which is a bit quieter and needs a bit of enhancement and society as well.”
“Sir, I would like to ask the Minister if there are any plans by NEA to actually assist some of the stallholders in the older-generation hawker centres where business is really taking a downturn. They have problems and because of their lease they cannot return the stalls. I am referring to perhaps something like the RPS programme done by HDB or if there are any other options. Because lately, we have seen a lot of stallholders approaching us for assistance in terms of poor business. Assoc. Prof. Dr Yaacob Ibrahim: Sir, we look at this request on a case-by-case basis. There are people who decide to exit their business and, therefore, we can facilitate that. I would not want to give a definite answer but I would like to look into the case specifically. There may be an instance whereby we may want to give them an alternative site so that they can improve on their business. I think there are measures in place by NEA to help affected hawkers but, ultimately, we would leave to the hawker to decide what is the best outcome for him in terms of his business. ROAD HUMPS IN VICINITY OF SCHOOLS (Installation) 16. Mdm Ho Geok Choo asked the Minister for Transport whether his Ministry plans to install road humps in the vicinity of schools to slow down speeding vehicles and prevent accidents involving students and what is his Ministry's policy on the installation of road humps.”
“Sir, this is also for outpatient or SOC patient where the downgrading actually may take up to eight to 10 weeks. I have had several cases who had actually come to me to appeal because they need to make several appointments with the medical social worker and also to get approval of the doctor for the downgrading. So if this could be streamlined further, it would be so much helpful for the patient because, in the interim, they have to pay the non-subsidised rate while waiting to be downgraded for the eight to 10 weeks.”
“Two points, Sir. More and more Singapore NGOs are participating in humanitarian activities, both locally as well as overseas. We have heard MINDEF's response a couple of days ago about coordinating the efforts of local NGOs. I have seen smaller NGOs which are not so well coordinated on the ground overseas. They seem to be lost and rather uncoordinated. I would like to seek the Minister's advice or plans as to whether this is a possibility of MCYS being the umbrella body to coordinate some of these NGOs under a Singapore-incorporated effort in responding to such disasters. The second point is pertaining to hotlines and improving communication channels. I would like to cite an example. I actually tried to call the destitute hotline over one-and-a-half days over a Friday and a Saturday with no response. This was pertaining to an elderly man, 70 years of age, and his companion, a 40-year old woman, who were living in the void deck. I tried to secure them a shelter and I actually had to personally call several nursing homes, even SAGE as well as several VWOs and family service centres, to actually locate shelter for them over the weekend. Actually, if the hotline works over the Friday and Saturday, it would be a lot better and easier for all of us.”
“[For vernacular speech, please refer to Appendix A *.] A 24-year old Malay lady who is a single mother has six children whose age ranges from six months to seven years old. Two of them are her step children from her second husband and she is only 24 years old. When I was 24 years old, I had just completed my studies and was not ready to get married and had not started working. But for this lady, she has six children. The divorce rate within the Malay community is higher as compared to other communities in Singapore. There are various contributing factors, for example, financial problems, the couple being too young and not mature and ready to settle down to married life, and other external factors. Are the strategies that we have now adequate to tackle these problems? Is the Ministry considering to carry out other efforts to reduce the divorce rate? And how about the marriage preparation courses that have been conducted? Are they effective and do they produce the desired result? I also would like to recommend that, with regard to the Malay community, we consider increasing the minimum legal age for getting married. Religious Leadership”