Gan Kim Yong
Singapore
“Consumer complaints relating to the secondary resale market for tickets to major events and concerts have generally remained low. Nonetheless, to protect the public from scams on secondary ticket resale platforms, the Police have imposed Code of Practice requirements under the Online Criminal Harms Act to require designated online service…”
“Singapore does not condone the use of forced labour. We criminalise forced labour in Singapore under various laws. Relevant Government Ministries and agencies, such as the Ministry of Manpower, Ministry of Home Affairs and Singapore Police Force, play their part in investigating complaints of suspected breaches in domestic laws that relat…”
“The Association of Banks in Singapore (ABS) discontinued the PayNow nickname feature as scammers had been exploiting the use of nicknames to impersonate legitimate entities and trusted individuals.”
“As of end-2025, around 6,900 private residential buildings have registered their solar installations with SP Group for the export of excess solar-generated electricity to the grid. The installed solar capacity of these residential buildings is 115.3 megawatt-peak (MWp), or around 5.5% of all current installed solar capacity in Singapore.”
“The one-year pilot extension of liquor trading hours has seen strong interest from businesses. As of 31 May 2026, the Police have approved 88 applications for the extension of liquor trading hours from public entertainment outlets in these areas.”
“The Government does not make projections of domestic or regional demand for renewable diesel or sustainable aviation fuel. Demand depends on commercial considerations, evolving market conditions and regulatory developments across different jurisdictions.”
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“The primary focus of the Community Health Assist Scheme (CHAS) is to help the lower-income elderly Singaporeans, especially those with chronic conditions. The Ministry of Health enhanced CHAS in January 2012 to benefit more Singaporeans, by lowering the age criterion for Page: 159 the scheme from 65 to 40 years old and relaxing the income criteria. Currently, we have about 240,000 Singaporeans on the scheme. We are monitoring the impact of these enhancements and will review the scheme again in due course. Between January and November 2012, we have assessed around 530 appeals to join CHAS. Cases which do not meet the criteria but are deserving of help are reviewed carefully on a case-by-case basis. Mitigating factors, such as the severity of the appellants' medical condition, recent loss of job or pay cut, will be taken into consideration. Some 80% of the appeals are approved. For those not eligible for CHAS, they can still receive subsidised care at polyclinics.”
“Collectively, the three Sponsoring Institutions were able to provide backfill for 90% of the appointed teaching faculty. However, the situation may be uneven across institutions and specialties. MOH will continue to work with the Sponsoring Institutions to improve on this. Second, the Ministry also provides other resources to Sponsoring Institutions to support the residency programmes, including funding for key administrative staff. An additional 62 staff have been made available to Sponsoring Institutions so far. Third, MOH makes available funds for the acquisition of teaching aids, such as simulators and infrastructural improvement to existing educational facilities. Faculty development programmes and workshops are also offered, enabling teaching staff to be more efficient in their work. MOH will continue to work closely with the Sponsoring Institutions in the transition to the new system of specialist training, which will allow Singapore Page: 140 to benefit from better trained specialists.”
“The Residency postgraduate training system is a collaboration between the Ministry of Health (MOH) and the Accreditation Council for Graduate Medical Education-International (ACGME-I) in developing Page: 140 and implementing a structured training system that ensures that each doctor trainee consistently receives quality specialist training. To date, all residency training programmes offered in the three main training institutions (referred to as "Sponsoring Institutions"), namely the National Healthcare Group, the National University Health Systems and SingHealth, are accredited by ACGME-I. Training throughput had risen two-fold from 257 trainees in 2009 to 475 in 2012. Such an expansion entails the Sponsoring Institutions to ramp up their educational capabilities in terms of qualified clinical teachers and educational facilities in accordance with standards set by MOH and ACGME-I. For instance, Sponsoring Institutions must provide, among other things, a requisite number of dedicated teaching faculty who will devote 20% of their work week for educational activities. There are 219 doctors who are directly involved in teaching, representing 4% of the total number of doctors in the three Sponsoring Institutions. To help Sponsoring Institutions meet their teaching workload, MOH supports the Sponsoring Institutions in three ways. First, MOH provides funding for the employment of additional manpower commensurate with the number of work hours devoted by doctors to teaching. This service backfill arrangement is intended to assume the service obligations of these doctors so that they can devote some of their time to teaching. MOH has provided approximately $10 million to Sponsoring Institutions to fund this arrangement since the residency programmes started in 2010.”
“Plain packaging of tobacco products was introduced in Australia through a new legislation in December 2012. All tobacco products, including cigarette packs, are now required to be sold in plain, olive colour packaging, with large graphic health warnings and the brand printed in a standard font at the bottom of the pack. This move is intended to deny tobacco companies the use of attractive packaging to market cigarettes. The tobacco companies and several countries have challenged the legality of the measures. While the legal challenges in Australia’s domestic courts by the tobacco companies have failed, the question of whether the legislation infringes on intellectual property rights and violates global trade laws is pending dispute resolution between state parties at the World Trade Organisation. Australia has also been challenged by a tobacco company through the Hong Kong-Australia Bilateral Investment Treaty on grounds of unlawful expropriation of its investments and valuable intellectual property without compensation. My Ministry is closely monitoring the developments in Australia and around the world on this plain packaging, with regard to the legal issues as well as its effectiveness. Tobacco control is and continues to be a public health priority in Singapore. Any new control measure will be considered as part of a multi-pronged approach to reduce smoking prevalence.”
“We intend to develop more of such programmes and care options to enable our seniors to age-in-place in the Page: 133 community.”
“There are about 60 nursing homes in Singapore providing some 9,000 beds today for the elderly with high care needs. About 500 seniors are currently on the waiting list for a nursing home bed, and the average waiting time for admission to a nursing home is about four months. MOH is building more nursing homes to meet the increase in demand. Over 500 more nursing home beds will come on-stream in 2013. A further 3,300 beds will be added with the development of 10 new nursing homes by 2016. MOH is also working with MSF to provide other alternatives to nursing homes. We are developing a range of home- and community-based aged care services to support families to care for their loved ones at home. We target to double the capacity of home-based healthcare services, such as home nursing and home medical services, to serve up to 10,000 seniors, and more than triple the capacity of home-based social care, such as meals delivery, escort for medical appointments, and personal care services like cleaning and housekeeping, to serve up to 7,500 seniors by 2020. The Agency for Integrated Care (AIC) has also worked with various voluntary welfare organisations to develop the Singapore Programme for Integrated Care for the Elderly (SPICE), which provides care in the day time for dependent seniors who would otherwise need to be cared for in nursing homes. Seniors under this programme can go to a SPICE centre in the day time and receive nursing, medical, rehabilitative, personal as well as custodial care services. They can receive some of these services at home on days when they cannot visit the centres physically. The cost of SPICE is comparable to that of nursing home care. SPICE thus enables their caregivers to continue to work while caring for their seniors in the community.”
“As at end 2012, around 240,000 Singaporeans have signed up for the Community Health Assist Scheme (CHAS). Singaporeans who are not on the scheme continue to have access to subsidised care at the polyclinics. If the applications are in order, successful applicants will typically receive their Health Assist cards within 15 working days from the date that their applications are received. Sometimes, the process may be delayed due to incomplete application form. Applicants may call the CHAS Hotline3 to check on the status of their applications. Over the past year, the Agency for Integrated Care (AIC) and the Health Promotion Board (HPB) have been promoting and raising awareness of CHAS Page: 124 through the newspaper, radio and TV advertisements. We have also been working closely with grassroots organisations to extend our outreach into the community. In the coming year, AIC is focussing on more targeted engagement through the grassroots. Some of these planned initiatives include appointing and supporting CHAS "champions" at the grassroots level to encourage more residents to participate in the scheme. Other initiatives, such as direct mailers to potential beneficiaries and sign-up booths within the neighbourhood, are also in the pipeline. We will continue to find ways to reach out to and encourage more eligible Singaporeans to sign up and benefit from the scheme.”
“For community support, IMH will refer patients to partners, such as the Singapore Association for Mental Health, Silver Ribbon Singapore, and the Community Rehabilitation Support & Service Programme run by Singapore Anglican Community Services. Such support could include counselling, psycho-social rehabilitation, and assistance with housing or employment issues. Upon discharge, IMH patients are also given contacts for IMH’s contact centre, case managers, and community mental health team. Moving forward, the Agency for Integrated Care is working closely with IMH, RHs and social agencies to ensure that new services and existing programmes develop into an integrated mental health network so as to provide seamless and continuous care for patients with mental illness in the community, particularly for those with little or no family support.”
“This team covers the elderly with dementia and their caregivers in the northern region, comprising Yishun and Woodlands and the central region, comprising Ang Mo Kio, Toa Payoh and Kallang. Another COMIT team focusing on adults and caregivers has just been launched in Yishun in November this year to cover the northern region. The COMIT teams will be linking with GPs in these regions so that GPs can refer patients who need counselling and psychotherapy to the team. There are plans for 10 COMITs by 2016. We have also put in place a 24-hour mental health helpline through which community partners, such as FSCs and SACs, can be linked up with healthcare services when they encounter difficult situations. This is supported by mobile teams to provide home visits where further assistance or closer assessment is needed. We are extending this helpline to our community partners in stages. Currently, 12 FSCs have been linked up to this helpline. We intend to reach all SACs and FSCs by March 2013. For patients with psychosis, which is a more severe form of mental illness, IMH is developing an Integrated Patient Assessment and Continuous Engagement System (iPACE) to ensure that they are cared for appropriately and comply with treatment. Patients under iPACE are assessed to determine what follow-up care they require. Patients who require closer follow-up, such as those with a higher risk of relapsing, would then receive closer monitoring to Page: 123 ensure that they receive the care and treatment that they need. Community Mental Health Teams conduct home visits when necessary.”
“Earlier this year, we announced plans to develop community-based mental health services to complement those in our hospitals. As part of this, we are developing Assessment and Shared Care Teams (ASCAT) to provide specialised mental health care. People with mental conditions can be seen and managed by these teams, which are led by psychiatrists and consist of psychologists, occupational and physical therapists and case managers, at the clinics in the community instead of having to see Page: 122 psychiatrists in the hospital. To date, we have set up two ASCAT teams. One is temporarily sited in Khoo Teck Puat Hospital (KTPH) in Yishun and will eventually move to a location outside the hospital; the other is at Ang Mo Kio Polyclinic. These two teams have seen over 200 patients since commencing services this year in August and October respectively. The ASCATs are also working closely with the community partners in their area, such as Family Service Centres (FSCs), and Senior Activity Centres (SACs), by providing them with training in the care of the mentally ill. These community partners are also able to refer cases to ASCAT. If these pilots are successful, we will expand to six ASCATs by 2016. For those who require more basic support in mental healthcare, such as counselling and psychotherapy, we have set up two Community Mental Health Intervention Teams (COMIT) to support General Practitioners (GPs) in managing patients with mild to moderate mental conditions. The first team led by O'Joy Care Services, has been operating at Upper Boon Keng since January this year, helping over 80 patients to date.”
“For example, the Changi General Hospital and St Andrew's Community Hospital's Integrated Building will add 180 acute hospital beds and 100 community hospital beds when it is completed in end-2014. Where appropriate, our hospitals deploy transition beds to accommodate patients for up to a day until transfers to beds are available. In addition, hospitals also tap on the capacity in the private sector to meet their needs. For example, Changi General Hospital rents 26 beds in Parkway East Hospital to manage their clinically stable patients. Finally, I would like to reassure the public that my Ministry monitors the hospital bed situation closely and our hospitals work hard to deliver appropriate care in a timely manner to ensure that patient safety and care are not compromised.”
“Our public hospitals adopt a multi-pronged strategy to actively manage patient loads and bed occupancy. This includes right-siting care, active intervention to safeguard patient safety during the wait for admission, and optimising the use of resources. To right-site care, our hospitals actively review and discharge patients who are medically stable so as to release capacity and allow new patients to be admitted. This includes working closely with the Agency for Integrated Care to transfer stable patients to step-down care settings, such as community hospitals and nursing homes. Some hospitals also work with service providers Page: 106 to provide transitional support and training for care-givers, to help discharged patients recuperate in their own homes. For patients waiting at the emergency departments for admission, our hospitals have put in place measures to ensure the continued delivery of safe and timely care. These include deploying inpatient medical teams to initiate prompt medical assessment and definitive care at the emergency department. To optimise the use of resources, subsidised patients may be placed into private wards for a short duration if subsidised wards are full, and these patients continue to pay subsidised rates. As occupancy rates vary across hospitals, some stable patients are also transferred, with their consent, to hospitals with higher available capacity, such as Alexandra Hospital. This helps to spread the load across the system. While we are also building new capacity in the longer-term, such as the new Ng Teng Fong General Hospital, which is scheduled for completion by end-2014, MOH is also working with existing institutions to add capacity in the short term.”
“The cost of the pay increase will be funded fully by the Government in FY2012 and FY2013. Thereafter, it will be taken into account as part of the operating cost and the Government will provide funding to the service providers according to the normal subsidy framework. At the same time, we are working with the ILTC sector to raise productivity so that wage increases can be sustained over time. The Government has set aside $110 million from 2012 to 2016 on improving the productivity of the ILTC sector. The Government will continue to monitor the cost of ILTC services to ensure that they remain affordable and accessible to Singaporeans. Page: 1431”
“All Singaporeans, including families with babies who suffer from congenital conditions, can already benefit from significant Government subsidies of up to 80% when seeking subsidised healthcare treatment in our public hospitals. Those who still face difficulties managing their healthcare bills can apply for financial assistance from our medical institutions, such as via Medifund. We are mindful that the cumulative costs incurred by those with congenital conditions may be a burden even for middle or higher income families, and will take these into consideration when assessing the patients' eligibility for financial assistance. We understand that parents have concerns regarding healthcare costs for their children. To provide parents with greater peace of mind, we will be conducting a broader review on how to better support them in providing for their children’s healthcare needs. The extension of MediShield to congenital conditions is being considered, along with other ideas as part of the on-going deliberation on encouraging marriage and parenthood as well as the "Our Singapore Conversation" (OSC) taking place to shape a consensus on the future we want for Singapore. The Government will announce more details when ready. Page: 1304”
“I am happy to inform Ms Faizah that we have already been providing guidelines on the sugar content of drinks dispensed by vending machines in schools through the Healthy Eating in Schools Programme (HESP). HESP, introduced in 2003, provides schools with a set of healthier food service guidelines so that students and staff will have convenient access to healthier food and beverage choices. Commercially-prepared sweetened drinks offered in vending machines or sold in canteens in participating schools must have the Healthier Choice Symbol (HCS) logo. Drinks under the HCS programme contain less sugar than similar drinks. In addition, to discourage students from consuming sweetened drinks, participating schools are expected to have two drinking water coolers within the canteen area to provide an even healthier option. We intend to step up our efforts with schools to encourage students to consume water instead of sweetened drinks. Page: 1297 My Ministry will continue to study and implement a range of initiatives designed to encourage a healthier eating habit amongst our children and youth, and review existing practices, including the installation of vending machines offering sugared drinks in our schools, to ensure that our efforts remain effective and relevant. Page: 1297”
“Mr Speaker, I would like to inform the Member that we are, indeed, looking at adjusting the Medisave withdrawal limits to be in line with the adjustments in the premiums to make sure that adjustments in the premiums will continue to be affordable to Singaporeans. With regard to the congenital and neo-natal conditions coverage under MediShield, we have considered it at length and we feel that it is part and parcel of our efforts to provide healthcare protection for our children. It is also part of our overall effort to encourage marriage and parenthood. That is why we have surfaced this for discussion at Our Singapore Conversation, to allow Singaporeans to participate in the discussion on what kind of a healthcare system we want for the future, and what kind of protection we like for our children. We will also be discussing this as part and parcel of a debate on marriage and parenthood. In due course, at these various avenues, we will discuss the issue before we make a final decision. Page: 1204”
“The Member was asking why they were not insured. There are a variety of reasons. Some of them have their own insurance schemes and some of them may have pre-existing conditions where insurance may not be feasible or may not be the most efficient protection for them, because insurance, including MediShield, operates on a risk-pooling basis. When the total pool of the insured becomes smaller, especially those like the elderly group, the risk pooling may not be effective. Among those in the elderly group, a significant number of them may already have pre-existing conditions. Even if they are included in the MediShield, these existing conditions may be excluded from the coverage and, therefore, it may or may not be efficient for them. So, it is on an individual case-by-case basis. We make MediShield available for the elderly beyond 75 years old primarily because of the feedback that some of them may be healthy and they may want to opt in. We open up the scheme to allow them to opt in to MediShield but some of them may already have pre-existing conditions that make insurance not practical for them. We will look at how we can help these people who may not be covered by MediShield in a different way. As I mentioned, we provide assistance and generous subsidies in our public healthcare institutions for all patients, including the elderly. On top of that, we have introduced the Medifund Silver specifically targeted at these elderly, as we understand that they have specific needs, to help them with the medical expenses. Page: 1204 We help these elderly patients through a variety of ways – some through insurance; some through Government broad-based subsidy and some through specifically targeted programmes to help them.”
“Mr Speaker, Sir, we recently announced the lifting of the maximum entry age for MediShield, which will take effect from 1 March 2013, along with other MediShield enhancements. This change was in response to feedback received during the public consultation on the proposed MediShield changes. We will encourage eligible, uninsured Singaporeans to apply for MediShield coverage through public outreach efforts, such as the public talks run by the CPF Board. MOH will also be tapping on the Health Ambassadors' network of the HPB and other grassroots organisations to spread the message within the community about the benefits of MediShield through our various activities, including those targeted at our older citizens. We also encourage children to apply on their elderly parents' behalf. Beyond MediShield, the elderly can also receive help for their healthcare costs. All elderly Singaporeans will continue to enjoy Government subsidies of up to 80% for subsidised healthcare treatment at our public healthcare institutions, regardless of their insured status. Under the GST Voucher scheme, the Government will also provide annual Medisave top-ups for the majority of elderly Singaporeans to help with their medical expenses. Those who still face difficulties can approach the medical social workers at our public healthcare institutions for financial assistance, including through Medifund Silver, which is a targeted assistance scheme for the elderly. Since 2007, Medifund Silver provided about $61 million to help elderly patients with their healthcare expenses.”
“About 1,000 newborns, or less than 3% per cohort of newborns, were born with congenital anomalies each year, based on data from 2007 to 20095. It is common for newborn babies to develop mild neonatal conditions6, such as jaundice. On average, for the period 2007 to 2010, about 5,000 newborns each year had a more serious condition which required hospitalisation for more than three days during the neonatal period. All Singaporeans, including families with babies who require treatment for congenital and neonatal conditions, are eligible for significant Government subsidies of up to 80% when seeking subsidised medical treatment in our public hospitals. In addition, families who have difficulty paying for their children's healthcare costs can apply for financial assistance, such as Medifund, from public medical institutions. Medifund provided $5.0 million and $5.3 million in 2010 and 2011 respectively, to help patients aged 16 and below with their medical expenses. The specific expenditure on children with congenital and neonatal conditions is not available. Page: 1160”
“Government subsidies are currently not provided for the reversal of ligation. Page: 1160”
“Sir, let me clarify that there are two Medisave top-ups. The first is the one-time top-up which is meant to help our members pay for the increase in premiums. But there is an ongoing annual GST Voucher for Medisave, up to $450 a year. That is a yearly amount that would go toward paying ongoing cost deductibles as well as medical bills. On Medifund, as I had mentioned in my reply, we have announced a top-up earlier this year during the Budget, by $600 million. That would give us roughly about $15 million to $20 million a year, and this amount would be available for us to help the needy patients, including those who cannot afford to pay for the deductibles. Page: 1063”
“Sir, MediShield is a catastrophic insurance scheme designed to cover larger hospitalisation bills. It complements Medisave, which can be used to pay the annual deductible and co-insurance components under MediShield, and any remaining portion of the bill. MediShield will be enhanced on 1 March 2013 and will include an increase of the MediShield policy year claim limit and lifetime claim limit to $70,000 and $300,000 respectively, to enhance coverage of catastrophic expenses. To keep premiums affordable, the deductibles for Class B2 and Class C will be raised so that MediShield continues to focus on larger bills while smaller bills can be covered by Medisave or cash. We understand the concerns about the affordability of the higher deductibles, especially the lower income and elderly. Other than the one-off Medisave top-up of up to $400, eligible elderly also receive annual Medisave top-ups of up to $450 under the GST Voucher scheme, while low-wage workers who qualify for the Workfare Income Supplement (WIS) Scheme would receive part of their WIS payouts in their Medisave account. In addition, the Government provides ad hoc Medisave top-ups when the budget situation permits, which have totalled $2.2 billion since 2005. Page: 1063 The Medisave top-ups are part of the Government's targeted efforts to enhance Singaporeans' Medisave adequacy and help the more vulnerable with their healthcare expenses. Those who still face difficulty managing their healthcare bills can apply for financial assistance from the public healthcare institutions via Medifund. We have topped up Medifund by $600 million, as announced in this year's Budget, and this will provide more help for needy patients.”
“Sir, I do not have the number of appeals at hand, but if you do come across deserving cases – whether they are odd job labourers or because their income is irregular – if they have been penalised unfairly, do let us know. We will then look into the details on a case-by-case basis, and if they are indeed eligible and ought to be helped, we will extend the help to them. The purpose of this scheme is really to help them, so if they deserve it, we will extend the help to them. Page: 1061”
“Sir, there are a variety of reasons. We have been engaging them. Some of them were concerned that there would be a lot of administrative work to be carried out especially in an area where they see there are not likely to have many such patients. From their point of view, it may not make sense for them to participate in the scheme, put themselves on the system, and then find that they are able to service only one or two patients. Not all of them will be coming on board. From the numbers we have, we cover roughly a third of all the clinics in Singapore. This coverage is quite significant. This would work out to about 10 clinics for each constituency. The key now is distribution. The Ministry is looking at the distribution of these clinics. We have close to 800 CHAS clinics, but they are not spread evenly in all areas. In areas that are short of clinics, we try to reach out to them and engage them, and to encourage them to come on board so that we have a more even spread of clinics across Singapore. Page: 1061”
“Sir, CHAS is a Government subsidy scheme and, therefore, the primary target is still the lower income elderly group, is focused at chronic disease management. But I do take Ms Sylvia Lim's point. In fact, there are patients or residents who are living in inherited private houses who may not be of high income. We do consider on a case by case, especially for those who are at the borderline. If Members do come across cases that they think are deserving despite the fact that they live in private properties of annual value above $13,000, or if Members think these residents have big families or do not have high income and have difficulty meeting healthcare financial obligations, do come forward and let us know. We will review these on a case by case basis. At the end of the day, even if they are not eligible for CHAS, they will still be able to receive subsidised treatment at the polyclinics. That will always be the last resort for our patients who cannot afford private clinics. CHAS is meant for use at private clinics. If you are not eligible for CHAS, you can still be eligible to be treated in our polyclinics. Of course, the purpose of CHAS is that we will hopefully be able to facilitate our patients to seek treatment with a subsidy at the private clinics. So, we do take into account applicants on a case-by-case basis. Do let us know if Members do come across such cases, and we will review them.”
“As far as the number of patients is concerned, in the first six months of this year, we have seen about 31,000 patients who have made use of their CHAS cards in our various private clinics. That shows that these patients, who potentially could have been treated at the polyclinics, are now going to the private GP clinics. We hope to be able to reach out to more. Some of them have signed for the CHAS card but they have not used it because they are not due for medical review, and some of them may not have chronic diseases yet, but they want to have the card in order to be ready in case they need to use it. We see the trend growing. This is a significant increase. Every year, we try to estimate how many patients are likely to make use of the card and what is the potential financial commitment from the Government. To date, we have disbursed a total of about $8 million under this scheme to provide for the subsidies. We had budgeted for a little more, just in case more-than-expected number of people are making claims. If we do not have enough budget, I am sure we can go back to the Minister for Finance to ask for more allocation in time to come. As far as the timing is concerned, let us take this one step at a time. It has barely been one year, so let us review this in time to come. If need be, we will look at the various criteria and see whether we need to tweak them to keep the scheme effective and relevant. Page: 1060”
“Mr Speaker, Sir, we have just enhanced the Community Health Assist Scheme (CHAS) in January this year to benefit more Singaporeans, especially those with chronic conditions, by lowering the age criterion for the scheme from 65 to 40 years old and relaxing the income criteria. We are monitoring the impact of these enhancements and will review the scheme again in due course. Page: 1059 Since the enhancement of CHAS, we have seen about a 20% increase in the number of participating GP and Dental Clinics to the current 794 clinics. Over 220,000 Singaporeans are now CHAS cardholders, a seven-fold increase from about 34,000 a year ago. MOH, together with the Agency for Integrated Care (AIC) and Health Promotion Board (HPB), will continue to engage private clinics to encourage them to come on board the scheme. We are also reaching out to the community with the support of local Advisors and grassroots leaders to increase awareness and participation in CHAS through various events and activities. Other engagement efforts include clinic visits, island-wide media campaign as well as setting up sign-up booths at our public hospitals and polyclinics.”
“Under CHAS, lower and middle-income Singaporeans aged 40 and above can receive subsidised dental services, such as crowns, bridges, dentures and root canal treatments, at participating private dental clinics near their homes. My Ministry will continue to review the services in the primary care sector and ensure that Singaporeans from all walks of life, especially those who are less privileged and the elderly, will have access to good and affordable medical and dental care. Page: 1007”
“Polyclinics see patients through walk-ins or by appointment. For general medical services, patients are usually seen as walk-ins. Our polyclinics, however, encourage patients to make an appointment for services, such as health screenings, immunisations and visits for chronic conditions. Patients who make an appointment for these services for the first time will be seen within one to two weeks. Polyclinic dental services are provided only on an appointment basis, aside from emergency cases. The lead time for patients to see the dentists at the polyclinics depends on the type of conditions. Patients with dental emergencies, such as severe pain, swelling and bleeding, are typically seen on the same day. For simple dental services, such as dental fillings, patients are seen within one and a half months. Routine services, such as scaling and polishing, are typically planned in advance and generally performed during the routine yearly dental check-ups. Because the assignment of appointment date is by clinical needs and urgency, the polyclinics do not track appointment times according to 14, 21 or 30 days, as requested by Mr Baey. We have seen an increase of about 30% in the demand for basic dental services in the polyclinics over the past two to three years. The polyclinics have implemented measures to better manage appointment wait-times, including having a phone triaging system managed by trained personnel, so that patients needing more urgent treatments receive priority. Besides the polyclinics, Singaporeans can access subsidised services in 504 GP and 272 private dental clinics (figures as at September 2012) through the Community Health Assist Scheme (CHAS).”
“Page: 1003 I appreciate comments and suggestions by Members about providing education and support to the disabled and their caregivers. Although some of these comments do not relate directly to the amendments in the Bill, I am sure the relevant Ministries and agencies will follow up on them. MOH will continue to monitor the situation on the ground, work with key stakeholders to ensure smooth implementation. Sir, I look forward to Members of the House for their support on this voluntary sterilization amendment Bill. Mr Speaker, Sir, I beg to move. [(proc text) Question put, and agreed to. (proc text)] [(proc text) Bill accordingly read a Second time and committed to a Committee of the whole House. (proc text)] [(proc text) The House immediately resolved itself into a Committee on the Bill. – [Mr Gan Kim Yong]. (proc text)] [(proc text) Bill considered in Committee; reported without amendment; read a Third time and passed. (proc text)] Page: 1003”
“During the period from 2003 to 2011, there were only nine cases where the patient underwent the procedure because of a history of mental illness or hereditary diseases. The record showed that in eight out of these nine cases, the patients gave their own consent. There was only one case where consent was given by the person's parent. Dr Lam Pin Min had asked how MOH would check whether the law is being followed by the institutions. Under the regulations, every doctor who performs a sexual sterilization procedure on a minor is required to submit a report to MOH within 30 days of that treatment. MOH officers also routinely perform licensing checks for all healthcare institutions. During these inspections, officers will call up records and case files, including those of patients who have undergone voluntary sterilization in these institutions, to ensure that processes and requirements specified under the VSA have been complied with. Ms Denise Phua felt that the period for public consultation was perhaps too short. Our public consultation period of four weeks was within the norm. Feedback channels have always remained open, even after the consultation period was officially over. Nonetheless, we take Ms Denise Phua's feedback and we will see how we can further improve on our consultation process in the future. Mr Speaker, Sir, let me conclude. The amendments seek to better protect those who lack mental capacity in mandating that the parent, guardian or spouse apply to the court for an order allowing the procedure to be carried out. We also want to ensure that VSA remains relevant and reflect current medical practices. These amendments will also bring Singapore in line with the UN Convention on the rights of persons with disabilities.”
“MOH is working with the courts to make the process as streamlined as possible. Mental capacity assessments are also available as a subsidised service in our restructured hospitals and polyclinics. Several Members and Dr Chia Shi-Lu also suggested the inclusion of psychologists, counsellors and social welfare workers in this decision-making process. Understandably, since such cases can be complicated and involve social factors and family-related issues, the court may call for and take into account inputs from all relevant parties, if it deems appropriate to do so. Page: 1002 Ms Sylvia Lim cautioned that we ought to be mindful in determining what constitutes "best interests". I agree. It is indeed a very complex subject. It is often complicated by different factors and circumstances that are specific to the particular case. The MCA itself recognises this and it provides a framework that offers guidance on what constitutes best interests. And it is because the best interests of a person who lacks mental capacity is such a complex matter, we have decided that it should not be left solely in the hands of any one individual or caregiver, but should instead be decided by the court, taking into account the doctor's report and after considering all relevant medical, social, ethical aspects of the case. Assoc Prof Fatimah Lateef had asked who had been the decision maker in the sterilization cases over the last 10 years. In the vast majority of these cases – 98% of them – most people undergo the procedure because they have achieved their desired family size and decided not to have any more children. For these cases, the person himself or herself had decided and given their own consent to undergo sterilization.”
“Let me clarify the consent of the parent or guardian in this case will act as a safeguard and is required in addition to the young person's own consent. The consent of the parent or guardian does not replace the consent of the young person. In fact, should a parent or guardian refuse to give consent, doctor also cannot carry out the procedure. To enhance our safeguards further, all cases involving minors who are not mentally incapacitated seeking sterilization will be referred to the hospital ethics committee for review. The hospital ethics committee will independently deliberate on whether the minor should undergo sexual sterilization. It will take into account all clinical, psychological, social and ethical aspects of the case. Directives will be issued to the licensees of healthcare establishments under the PHMC Act, to all healthcare institutions, to mandate this. This is similar to the suggestions by several Members, including Assoc Prof Fatimah Lateef, Ms Denise Phua and Asst Prof Eugene Tan, to have independent committees to assist in the decision making process. I am confident that there is broad consensus within our medical community in Singapore that doctors will be very cautious to perform sexual sterilization on an otherwise healthy young person, in the absence of any strong medical grounds for justification. Dr Lam Pin Min had asked why the VSA did not impose parity requirements based on the number of children that a person has. I think it is best to leave the decision of family size to the couple. Dr Lam Pin Min and Assoc Prof Fatimah Lateef are concerned whether the court application process may become too complicated or too costly and pose an additional burden on families. I understand and appreciate these concerns.”
“In dealing with unmarried young persons, the doctor needs to, first of all, satisfy himself that this young person is able to understand matters relating to procreation and sterilization. If this person is too young, and not mature enough to understand the doctor's explanation on sterilization and its implications – a concern highlighted by Ms Faizah Jamal – the doctor cannot proceed any further. In such a case, there can be no informed consent and, without the young person's informed consent, the doctor cannot perform the sterilization. This is regardless of the wishes of the parents or guardian. For the young person who is mature enough to have sufficient understanding of the matter, the doctor will then need to assess if he or she really wants to undergo sterilization. Members have requested that such young persons who want to undergo sterilization be properly counselled to ensure that they appreciate the gravity of the procedure and its consequences. Page: 1001 The College of Obstetrics and Gynaecology of the Academy of Medicine Singapore has set out good practice principles from medical professionals in the taking of informed consent. In the case of informed consent for sexual sterilization, the doctor has to counsel the person and ascertain the motivation for sterilization, explore all other non-surgical alternatives and reversible procedures available and clearly outline all the risks, benefits and prognosis of the procedure. Only when the young person fully understands the implications and consequences of sterilization, can the doctor continue with the procedure. Ms Faizah Jamal expressed concern that only one parent or guardian is required to give consent.”
“Mr Speaker, Sir, let me thank all the Members who have given their views and voiced support for the Bill. Let me now address the comments and suggestions made by the various Members. Members, such as Dr Lam Pin Min, Asst Prof Eugene Tan, Ms Denise Phua and Ms Mary Liew expressed concerns about the protection accorded to minors or young persons below the age of 21. They have asked why we do not also require a court order for minors undergoing sterilization, or impose an age requirement. They have expressed concerns that these young people may not fully understand the consequences of such a procedure and would not be able to make an informed decision due to their young age. I agree with their concerns. First, let me clarify that a young person below the age of 21 years, who lacks mental capacity, is given the same protection as that for an adult who lacks mental capacity. A court order is needed before sterilization can be performed. In the case of an unmarried young person below the age of 21 years, who does not lack mental capacity, there are four levels of safeguards. First, the young person must give his or her own consent, unlike in the case of a person lacking in mental capacity. Second, his or her parent or a guardian must consent to having the young person undergo such a procedure. Thirdly, the amended section 3(3) of the Act requires the doctor to give a full and reasonable explanation as to the meaning and consequences of such a treatment, and obtain certification from such a person that he clearly understands the meaning and consequences of the treatment. Fourthly, cases involving such young persons will be required to be referred to the hospital ethics committee for review. There are sufficient safeguards. Let me elaborate.”
“We have also received valuable inputs from various quarters, through the formal consultation process, as well as through our other usual feedback channels even after the consultation period is over. We have taken such input into account in finalising the proposed amendments to the VSA. I would like to thank all those who have taken an interest in the Bill and provided their valuable input. In conclusion, Sir, this Bill will make the necessary amendments to update the VSA and ensure that it remains relevant to Singapore today. It will also amend the VSA to provide better protection for persons with disabilities and bring it in line with the United Nations Convention on the Rights of Persons with Disabilities. Sir, I beg to move. Page: 982 [(proc text) Question proposed. (proc text)] 3.24 pm”
“Page: 981 The amended VSA will allow registered medical practitioners in a PHMCA-licensed hospital or ambulatory surgical centre to carry out such procedures once they have been credentialed by their institution to do so. The respective institutions will be responsible for ensuring that they only allow medical practitioners who are adequately trained and possess the necessary skills, to carry out the procedures. In the smaller specialist medical clinics, which do not have such a credentialing system, the VSA will still require that such procedures be carried out by certain recognised specialists, such as surgeons, urologists, obstetricians and gynaecologists. These specialists are accredited as possessing the requisite qualifications and experience, and registered with the Singapore Medical Council. Patient confidentiality and consent are the fundamental tenets of good professional conduct and practice of healthcare professionals, and the penalties for breaching these obligations should reflect the severity of the offence. The penalties in the VSA for unauthorised disclosure of confidential information will be increased, to align them with similar provisions in other healthcare laws like the Infectious Diseases Act and the Human Organ Transplant Act. The maximum fine will be raised from $2,000 to $10,000. The maximum jail term of 12 months remains unchanged. The VSA will also be amended to raise the maximum fine for persons who coerce or intimidate another person to undergo sexual sterilization against his or her will from $5,000 to $10,000. The maximum jail term of five years remains unchanged. My Ministry conducted a public consultation on the proposed amendments on the VSA from 4 June 2012 to 2 July 2012. The feedback has been broadly supportive.”
“There was therefore a need for specific approval from the Minister, to ensure the safety and suitability of the institutions carrying out sexual sterilization. However, this requirement has been made obsolete with the licensing of healthcare institutions under the Private Hospitals and Medical Clinics Act (PHMCA), which came into force in 1993. Furthermore, sexual sterilization involving tubal ligation for females and vasectomy for males are today relatively simple procedures that do not require any complicated equipment or setup. With clause 4 of the Bill, we will amend the VSA such that these procedures can be carried out in institutions that are already licensed under the PHMCA, without the need for specific approval from the Minister. Under the current VSA, sexual sterilization procedures can only be carried out by registered medical practitioners who either have certain specialist qualifications or have acquired a certain amount of training or experience. These requirements are outdated and not reflective of the current practices. Previously, a medical practitioner is allowed to perform a surgical procedure, such as sexual sterilization, just based on the fact that he had previously undergone a certain amount of training or experience in that area. Today, in the larger healthcare institutions, such as hospitals, they now rely on well-established credentialing systems, whereby only those practitioners who can show that they have adequate training and have kept up-to-date in their practice, would be allowed to perform certain types of procedures in that institution. So, we will amend the VSA to reflect current practice norms in our healthcare institutions.”
“Others have cautioned that there may be instances where the spouse, parent or guardian may not act in the best interest of the person who lacks mental capacity, in giving consent for such a procedure to be carried out. Page: 980 My Ministry has weighed all the concerns and views that have been raised, taking into consideration the important role of the family in such decisions, as well as the need to protect the welfare of this vulnerable group of people. Clause 3 of the Bill will amend the VSA such that for persons who lack mental capacity, while the spouse, if the person is married, or the parent or guardian, if the person is unmarried, may be the one who first comes to a decision that the person should undergo such a procedure, as an additional safeguard, the spouse or guardian will need to apply to the Court for an order to proceed. Similar to the Court's role under the MCA, the Court may then make an order declaring that the treatment is necessary in the best interests of the person. This application will need to be supported by a doctor's report stating that the person lacks mental capacity to give his or her own consent to the procedure, and that the procedure is necessary in the person's best interests. Reference will be made to provisions in the MCA in determining whether a person lacks mental capacity, and whether the treatment for sexual sterilization is in the person's best interests. The current VSA requires healthcare institutions that can carry out sexual sterilization procedures to be first approved by the Minister for Health. This requirement is a historical one. When the VSA was first enacted, hospitals and clinics in Singapore were not yet licensed or regulated by the Ministry.”
“However, sections 3(2)(d) and 3(2)(e) of the current VSA provide that for persons who are "afflicted with any hereditary form of illness that is recurrent, mental illness, mental deficiency or epilepsy", the spouse, parent or guardian of such persons have the power to consent on their behalf, even though such persons may still be capable of giving their own consent despite their conditions. We need to change this. The amendment in clause 3 of the Bill will align the VSA with the approach taken in the Mental Capacity Act (MCA), which came into force on 1 March 2010. With the amendment, a person is presumed to have mental capacity as defined in the MCA to make decisions for himself or herself, and should therefore give his or her own consent to undergo sexual sterilization, unless it is shown that the person lacks mental capacity. In this way, we will return autonomy to those with mental or hereditary illnesses, but who still have the mental capacity to give their own consent. This amendment will also bring the VSA in line with the UN Convention to accord persons with hereditary illnesses or mental disabilities with the same legal rights as others. This will then enable Singapore to accede to the UN Convention, which we aim to do by the end of this year. We have also received various feedback from families, interest groups and the public, on the issue of safeguards for those who lack mental capacity. Some were of the view that the decision to have such a person undergo sexual sterilization should rest with the family, as they will be the ones who have to care for the person and live with the consequences of such a procedure.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." The Voluntary Sterilization Act (VSA) was first enacted in 1969 and came into force in 1970. It was introduced to provide legal certainty for sexual sterilization procedures performed by registered medical practitioners, for the purposes of family planning. Page: 979 As this was a relatively new policy then, the VSA included a number of safeguards and these were: (a) controls on institutions where such surgical procedures could be carried out; (b) professional qualifications of the medical practitioners who could carry out such procedures; (c) the requirement for consent to be obtained before a person undergoes such procedures; and (d) protection for the confidentiality of personal information of those who undergo such procedures, as this is a sensitive and private matter. Between 2003 and 2011, a total of 27,905 persons underwent voluntary sexual sterilization. The VSA was last reviewed nearly four decades ago in 1974. There have been many changes in Singapore since then, both in the healthcare landscape as well as in society in general. It is therefore timely for us to review and amend the VSA to ensure that it remains effective and relevant today. In addition, Singapore is working towards becoming a party to the United Nations Convention on the Rights of Persons with Disabilities (the UN Convention). We are therefore making amendments to the provisions in the VSA that may be viewed as potentially discriminatory against disabled persons. I will now elaborate on the proposed amendments to the VSA. Under the VSA, a person must give his or her consent before undergoing a sexual sterilization procedure.”
“As part of the multi-agency effort under the National Mental Health Blueprint, there have been enhanced efforts to increase public awareness of mental health and improve access to counselling and other support. For example, the Health Promotion Board (HPB) conducts various mental health promotion and education programmes to promote mental wellbeing among children, adults and seniors, enable them with coping skills, facilitate early detection and treatment, as well as share information on how to recognise the signs and symptoms of mental illness. In 2011, more than 40 initiatives and activities were organised in schools, workplaces and community settings, reaching out to some 170,000 students and members of the public. Page: 929 Access to mental health services in the community has also improved. For instance, IMH's community mental health teams (CMHTs) provide psycho-social rehabilitation for stable patients in the community. CMHT also operates a Mobile Crisis Team which comprises a 24-hour hotline giving information and advice, and a Home Visit team that can help to de-escalate stressful situations that patients face in their homes. The GP Partnership programme helps GPs better manage persons with mental illness in the community.”
“According to police records, the number of attempted suicide increased from 706 in 2007 to 992 in 2011, or an increase from 15.4 to 19.1 per 100,000 total population. The corresponding figures for completed suicides (based on death records) show a decline from 8.2 per 100,000 residents to 6.7 over the same period, after adjusting for the changing age distribution of the population over the years. The Government adopts a multi-pronged strategy to suicide prevention, which includes collaborative efforts from different agencies, such as MCYS, MOE, MHA, MOH and stakeholders in the social sectors. The broad approaches involve (a) building greater resilience in the population; (b) developing targeted interventions for high-risk individuals, and; (c) increasing public awareness of mental health issues. Students are taught to set realistic and achievable goals for themselves, build positive and healthy relationships with others, and to seek help when necessary. For the elderly, social support is a key element in the prevention of suicides, and this is provided through community services, such as counselling and befriending. Hospitals provide crisis interventions for patients who have attempted suicide. They aim to reduce the risk of identified suicide attempters through (i) elimination of acute suicide danger (for example, hospitalisation, sedation, crisis-intervention); (ii) adequate treatment (for example, pharmacotherapy, psychotherapy); (iii) provision of follow-up care of those with high suicide risk; and (iv) counselling and support groups for patients both within the hospital and community settings.”
“We are also working with the relevant Ministries to provide tailored programmes for full-time National Servicemen. Page: 929 Underlying our health promotion and smoking cessation efforts is the creation of a tobacco-free environment for youth. The Health Sciences Authority (HSA) takes firm action against retailers who supply minors with tobacco products, while the National Environment Agency (NEA) enforces the ban on smoking in public places, including the places where youth congregate, that come under the ban. Families and the community can also play a positive role providing good role models and support to our young people to live healthy, smoke-free lives. Page: 929”
“We have made progress in dissuading our youth from smoking through our tobacco control initiatives. National surveys of the youth population indicate that the proportion of Secondary 1 to 4 students who smoked at least one day in the last 30 days fell from 11% in 2000 to 9% in 2006, and 6% in 2009. Post-programme surveys also show that about 90% of youth are aware of the harmful effects of smoking which may deter them from experimenting with tobacco products11. Nevertheless, we are mindful that much more remains to be done. Recent studies indicate that the incidence rates of smoking among the youth are showing signs of an increase, similar to many countries in the world. Therefore, our efforts need to be sustained, especially for each new cohort of youth, and we also need to ensure that our youth remain smoke-free as they get older. Hence, we have adopted a multi-pronged, whole-of-Government approach. This comprises legislation, health promotion and education, and smoking cessation efforts involving multiple agencies that aim at denormalising tobacco use and establishing smoke-free living as the social norm in Singapore. For example, we have worked with the Ministry of Education (MOE) to incorporate messages on the harmful effects of smoking and ways to say "no" to smoking into the school curricula and co-"curricular activities. The "Live it Up Without Lighting Up" initiative engages young people outside of the school environment, and highlights the benefits of being tobacco-free in areas that appeal to youth. To help youth who are already smokers, we have increased the number of smoking cessation touch points in the community and in schools. The adolescent care clinics at our restructured hospitals also provide on-site, smoking cessation counselling to youth smokers.”
“Medisave is primarily meant to help pay for hospitalisation, but we have extended Medisave usage to outpatient treatment, such as diagnostic MRI and CT scans, if they form part of cancer treatment, up to the withdrawal limit of $600 per patient per year. Medisave withdrawal limits are generally set to be sufficient for the majority of patients in the Government hospitals and medical institutions. The current $600 limit is able to cover about 95% of the annual costs for Singaporean cancer patients at the Government hospitals and medical institutions. It was also adequate to fully cover the cost of scans for more than four in five such patients. We need to balance higher withdrawal limits with the risk of cost escalation or over-consumption, especially at the private hospitals and clinics, to avoid premature depletion of Medisave balances. Patients who face difficulty paying for medical bills for their treatment at the Government hospitals and institutions could apply for financial assistance, for example, through Medifund. Page: 928 We will continue to monitor the adequacy of Medisave withdrawal limits to help Singaporeans defray their healthcare bills.”
“The study published in July 2012 by the Mashhad University of Medical Sciences found that lung functions in shisha smokers were adversely affected to the same degree as deep-inhaling cigarette smokers. This is in line with the findings published by other institutions like the Dokuz Eylül University, Turkey; Tishreen University School of Medicine, Syria; and Kuwait University, Kuwait. There are a total of 43 tobacco retail outlets that sell shisha today. My Ministry will continue to promote a tobacco-free lifestyle in the population and has stepped up educational efforts to focus on the harm of shisha smoking. The Health Promotion Board embarked on a shisha education campaign in March 2012 targeted at young adults aged 18-25 years, using social media to correct the misconceptions youth might have regarding shisha smoking. We also had youth advocates on the ground distributing educational material and educating their peers regarding the dangers of shisha. NEA conducts routine checks of food and beverage establishments, including those that serve shisha, and enforces against any infringements. No distinction is made between shisha and other tobacco products with regard to smoking prohibitions. Between January last year and July this year, NEA issued more than 60 summonses against retail outlets that sell shisha for infringing smoking prohibition regulations. Page: 927”
“My Ministry regularly reviews whether to include other chronic conditions into CDMP so that treatment for chronic conditions remains affordable for Singaporeans, while at the same time ensuring that we do not deplete Medisave balances prematurely. Page: 903”
“Medisave was designed primarily to help patients pay for hospitalisation costs. However, we have extended Medisave usage to the outpatient treatment of the more common chronic diseases under the Medisave Chronic Disease Management Programme (CDMP) since 2006 to help lower the out-of-pocket payment by patients. Today, CDMP covers 10 common chronic diseases – diabetes, hypertension and lipid disorders, stroke, asthma, chronic obstructive pulmonary disease, schizophrenia and major depression, dementia and bi-polar disorder. We had extended Medisave use to these 10 conditions based on the following considerations: First, a significant number of Singaporeans are affected by these conditions; Second, the cumulative cost of treatment over long periods for these chronic conditions may pose a severe financial burden for the patients and their families. Some may forgo treatment until serious complications arise which may then require costly hospitalisations; Page: 903 Third, there are established structured disease management protocols, processes and indicators to track and achieve better patient outcomes for these 10 diseases. For serious prostate conditions like prostate cancer, treatment may require surgery or hormone therapy, for which Medisave can be used. The milder form of prostate conditions, such as the Benign Prostate Hyperplasia (BPH), can be treated effectively with medication and the commonly used medications are subsidised. Patients who have difficulty paying for their treatment may seek financial assistance at the polyclinics or restructured hospitals.”
“Between May and July 2012, my Ministry sought the inputs of the public and interested parties through both my Ministry's and the REACH's websites. The proposed amendments to the Voluntary Sterilization Act (VSA) and the public consultation were reported by the local media. We also met with various groups, including medical practitioners and other interested parties. Based on the feedback received, the stakeholders and the public were generally supportive of the proposed changes as they understood the rationale of the move to return the autonomy on decisions concerning voluntary sterilisation to persons who have mental capacity. We have received valuable inputs from the consultation, and used them to refine the proposed amendments to the VSA, including the strengthening of provisions for vulnerable members of our society. Moreover, feedback channels are always open for anyone with concerns. As such, we have not extended the period for this public consultation. Page: 787 I have introduced the Voluntary Sterilization (Amendment) Bill in Parliament, and I will elaborate on the proposed amendments at the Second Reading of the Bill. The proposed amendments to the VSA would also enable Singapore to accede to the United Nations Convention on the Rights of Persons with Disabilities.”