Heng Chee How
Singapore
“And in the case of overseas training, then there will be specific link-ups into the systems of our overseas partners, for example, if there is a need to further send the injured NSman to the local hospitals for more specialised treatment, that, too, was all planned in as well in terms of the protocols.”
“In addition to conducting regular exchanges with their professional counterparts, SAF personnel in our overseas training detachments participate actively in local community life and contribute back to the local communities, thus contributing to the strengthening of bilateral ties.”
“Mr Chairman, I thank Mr Giam for his question. The NS allowance, the nature of it, it is in a form of honorarium and for that, CPF is not payable. However, I just wanted to emphasise two points. One, within the NS journey, they are actually eligible for NS HOME Awards, which are paid out in the course of the NSmen's journey.”
“Mr Chairman, as we look forward, MINDEF/SAF’s commitment to NS and to our NSmen remains steadfast. We will continue to enhance the NS experience, maximise the contributions of our NSmen, and strengthen recognition for their service.”
“Mr Speaker, we have shown care for our older workers as a Government, as tripartite partners, not only in words but in deeds. As a result, we have made very substantial progress for our older workers, often bucking global trends. The environment we must deal with will be increasingly challenging.”
“Ultimately, fighting age discrimination is not only a legal matter nor is it just a moral imperative. It is also an economic necessity that will help sustain long-term prosperity for all.”
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Every one of 862 lines we hold for Heng Chee How, in date order, each linked to its source. Free to read, in full, without an account. Page 12 of 18.
“Mdm Deputy Speaker, thank you for allowing me to join in this debate. I wish to speak on two areas: the re-employment of workers beyond the age of 62 and longevity insurance. I think a key part of what the Minister has said is the re-timing of the CPF Minimum Sum draw-down age from 62 to 65 by the year 2018. This move means that CPF account-holders will start getting payouts from their Minimum Sum three years later. The challenge is therefore to help workers reaching 62 years of age extend their working years by three years. If this is done, and workers have income to support their living expenses and contribute further to their CPF nest-egg, the situation will be manageable. Conversely, if there is no work and no income from 62 to 65, we must expect a big social pressure. On this topic, I have a number of points to make. First, we must quickly amass examples of re-employment arrangements across different industries and job types, and put them into a database. Such a database of good practices will answer those who say it cannot be done, as well as provide concrete starting-points for those who wish to customise arrangements for their companies' use. Such a database should also be open for public use so as to facilitate adoption and adaptation. The growth of examples in this database will be one proxy indicator of how much and how fast re-employment of workers past age 62 is happening. There are already encouraging signs in certain quarters. Let me cite you some examples from the Food, Drinks and Allied Workers Union (FDAWU). At Goodwood Park Hotel, employees who reach retirement age and re-employed stay in the same job but at a different pay. The key re-employment criteria there include job knowledge, customer relations/service excellence and health.”
“Sir, I also thank the Member for giving this feedback about Tan Tock Seng Hospital. We will certainly relay this to the hospital for their review. As mentioned in my answer just now, we recognise that hospital complexes are becoming more complicated. There are multiple departments and so on. We do recognise that proper signages in understandable form and language that would service the users best are important. We will endeavour to make further improvements, and we will take into account this particular feedback. SPORTS AS A CHARITY (Update) 17. Mr Zainudin Nordin asked the Minister for Community Development, Youth and Sports with the recognition of sports as a charity (a) how has this classification benefited the community in general and the sports fraternity in particular; (b) whether he will provide an update on the number of applications by organisations and National Sports Associations for tax exemption for monies collected for sports; and (c) whether the procedure to obtain tax exemptions is onerous for them.”
“Sir, I thank the Member for her feedback. We will certainly endeavour to further improve our signage systems. And if there is a feedback about a particular hospital, eg, a particular experience, we welcome that feedback so that we can actually look into it. We will, on our part, continue to review our systems periodically, using internal processes, but we certainly welcome specific feedback that can help us improve.”
“Mdm Deputy Speaker, I thank Mdm Halimah for that clarification. What I wanted to say is that, internationally, optometrists are trained to do refraction, ours included. In our situation, which is unlike that in many other countries, we have some opticians in Singapore who do refraction. For a start, what we are saying is that provided they can demonstrate their competence, we will register them and allow them to continue to do this refraction component as opticians. Then we have the OOB set up under the Act. In a dynamic situation where the science is changing, the economics of practice amongst opticians, optometrists and ophthalmologists may also be shifting. So, in that situation, the Board, over time, would have to review and take into account all these factors and to see how best to balance between the needs of the three groups, and then balance that as against the needs of the population in terms of safety and standards. And, finally, how do we position that in favour of the development of the eyecare industry in Singapore? All that will take place and it is something that the OOB will certainly look at very carefully in its work. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill. - [Mr Heng Chee How]. Bill considered in Committee; reported without amendment; read a Third time and passed. NGEE ANN KONGSI (INCORPORATION) (AMENDMENT) BILL Order for Second Reading read. 4.55 pm”
“This is a process that will go on and, through time, people will be more aware of it. But the point is that when the Act comes into force, nobody walking into a shop of an optical service provider will be subjected to unsafe eyecare. That is the point.”
“Mdm Deputy Speaker, on the first question of having two Registers - one for optometrists and the other for opticians - that is correct, because we are not saying that they are the same. They are not the same. Yes, optometrists can definitely do refraction, but optometrists are not just opticians who can do refraction. They can do other things as well. So it is a spectrum. What we are saying here is that some opticians in Singapore over all these years are already doing refraction, and there are opticians who are just doing dispensing. Opticians who are doing refraction, subject to being tested and certified to demonstrate their competence, can carry on to do refraction. This does not make them optometrists. For opticians who can do refraction and want to become optometrists, they must then take on other skills in order to qualify for registration as optometrists. That is why we have two Registers. Even if an optician can do refraction, he is not an optometrist. That is number one. Her second question is whether we will further confuse the public when the Act comes into force, in the case of a person who walks into a shop and sees some opticians who can do refraction and some who cannot. The reality today is, with or without this Act, there are opticians in Singapore who are doing refraction and there are opticians who are not doing refraction. This is the current situation. What we are doing here is through a process of certification, and what Dr Fatimah Lateef has suggested, namely, the display of certificates, and through public education, ie, what types of eyecare professionals are there and what they do respectively. So it will take time, as the public gains more awareness of the different types of eyecare professionals and who they should see and for what.”
“I believe this will be taken up. Mr Zainudin Nordin has also asked for an update on the Health Promotion Board's National Myopia Prevention Programme. This programme was started in 2001 and it was done in partnership with the Ministry of Education and MCYS. The aim of the programme was to delay the onset and reduce the progression of myopia in children. The prevention strategies include public education targeted at parents, teachers and children to inculcate good eyecare habits, such as adopting correct posture when reading, ensuring adequate lighting and having regular outdoor activities. The HPB also introduced a vision screening programme in primary and secondary schools, and a Spectacles Fund to help children from needy families buy spectacles. On this, HPB works closely with kindergartens/childcare centres to extend the vision screening to pre-schoolers. The aim is to identify children with early myopia and the lazy eye problem. About one in seven pre-schoolers have defective vision and they are referred to refraction clinics in the polyclinics for further assessment and management. For children with the lazy eye condition, early treatment can prevent the development of functional blindness. These are serious ongoing efforts, but we also recognise that bringing down the myopia rate is an uphill task. We will continue to put in our efforts in this area to slow down the progression, even if we may not able to reverse the rate in the short term. Mr Zainudin has also suggested that the HPB work more closely with the different eyecare professionals to enlist their help in this programme. The HPB will consider how best to do this.”
“So I want to assure the House that every effort will be made to enable people with the competence to be so certified but they must demonstrate that competence. On the question of the respective roles and the synergies that can come out of the three groups - the ophthalmologists, optometrists and opticians, which Dr Lim Wee Kiak brought up - if we do it properly, we can indeed derive those synergies that he talked about and that must indeed be our aim. I am very sure that the OOB, in its establishment, will make that a priority. It will be aided by the fact that its composition would have representatives from all three groups and more. And Dr Lim Wee Kiak's suggestion that a particular nominee comes from the Chapter of Ophthalmologists is something that the OOB can take into account. There were inputs from Dr Fatimah as well as Dr Lam Pin Min on what we can do with regard to the conditional registration of foreign practitioners. Again, I thank them for their inputs and we will take this into consideration in drawing up the regulations. On the specialist eyedrops, which is that line between the optometrist and the ophthalmologist, I think the general response will be the same as that for refraction, which is between the opticians and optometrists which is that, ultimately, it is the science of it, the competence of it, that safety is of primary concern, and we will make sure that in regulating this, we will not subject our population to risks that they ought not be exposed to. There is a suggestion on the display of certificates so that a member of public, who does not know who is whom, can actually look at the certificate and feel confident that if he comes into the shop, he will get good standards and safe eyecare. This is a very good idea.”
“On the question of public education, including educating the public to go for regular eye screening and so on, we completely agree, and this is something that we have to step up and maintain our efforts simply because good vision is very important to our population. On the point of whether regulation would drive up business cost, we will put it this way. Obviously, if you do not have to comply with anything compared to if you have to comply with something, a certain amount of attention has now to be paid. As far as the Optometrists and Opticians Board (OOB) is concerned, I am very sure that it will not be in its interest nor will it be its intention to drive this cost up unnecessarily. I would say that it will regulate only as necessary and not make that an issue that would hamper the practitioners and, ultimately, have the cost passed on to customers and undermine one of the fundamental objectives, which is affordability. So it is a question of balancing. But the intention must be to keep it to the minimum. On the question of those practitioners, especially the opticians who have been doing so for many years but who may lack the language abilities or the formal education, under the implementation process, the idea is that for those with more than five years' experience, they will be put through a competency test. It is a practical test, so they are not placed at a disadvantage if, for example, they cannot speak English. And if they have experience and they know how to do it, that test will reveal their competency and they will be certified for it. Even for those who do not pass it the first time, there will be another attempt and there will be a course for those who have to go through upgrading.”
“Through this combination of efforts, I think we can send a very strong signal to the industry that, on the one hand, we provide upgrading paths as we want to ensure standards and, on the other hand, that those who do not comply with the regulations would have to face the music. By doing so, we would make sure that nobody in this industry goes off with the wrong impression that they can continue in any way to remain unprofessional and get by with it and, in a way, cheat the customer. I must also say that industry associations can play a very important role here. These associations have members who are opticians or optometrists and it is in their professional interest that they encourage their members to comply fully with those regulations as well as to take full advantage of all upgrading opportunities. Dr Fatimah raised the point that even as we enforce and there may be complaints, the flipside of it is how we resolve these complaints without making the process too cumbersome. If they are the simple ones, can they not be resolved as simply as possible at the lowest possible level? I think that is a good suggestion. We have to see it in the context of the entire mechanism of dealing with these complaints and investigations, to grade the different types of complaints. Those that are suitable for resolution at the lowest level, the simplest possible level, should be so resolved. But, at the same time, I think it should also be very clear to people that if there is wrongdoing, it will be fully investigated and there are regulations to provide for that.”
“So, therefore, in this process of regulating, what we are going for is not to say that whoever is an optician and decides to do refraction, that he can just carry on and do it, but that there will be a competency test. And those who want to do refraction as opticians will have to pass this test. And if they pass, they will be certified that they meet the standards and then they can do so safely for their customers. And if they do not pass, then they go through an upgrading programme in order to make sure that they are competent before they are certified to practise. Then, for opticians who do not want to practise refraction - they just want to do dispensing - they will be certified to do dispensing. In that way, we separate between the groups of opticians and make sure that only those who are competent and certified to do refraction do refraction. Mdm Halimah also asked how we intend to go about enforcing this Bill once it is passed. I think, as in all legislation, enforcement is key in order for it to be credible. Yes, there are many hundreds of optical shops out there and it will not be possible to station a checker or an inspector in every shop all the time to ensure that nothing goes wrong. But the same could be said of any other kind of business. In the end, it would be through a combination of opening up the channels for feedback, collecting information and intelligence of where sub-standard service, incompetent service or unlawful servicing might be going on as well as through regular and surprise inspections, and taking to task those who have been found to be in breach of the regulations.”
“Mdm Deputy Speaker, first, I thank the Members who have spoken - Mdm Halimah, Dr Fatimah Lateef, Dr Lam Pin Min, Dr Lim Wee Kiak as well as Mr Zainudin Nordin for their very constructive views and for their strong support for this Bill. I am very happy that we all agree and see very clearly the key intentions of this Bill which are that eyecare is a very important part of well-being and, as a country, we must do our utmost to safeguard and promote it and that optometrists and opticians play an integral and important role in this entire care spectrum. So the regulation of these two professions, properly done, will enhance the national objectives. What are these objectives? It would be that we want our population to have access to quality, high standard and safe eyecare at prices that are affordable, and doing so in a way that takes into account the market realities, without compromising safety and standards, to move forward with minimum disruptions. I have grouped some of the comments by the Members into several parts and I will take them in turn now. Mdm Halimah was of the opinion that we adopt the situation in many other countries where you draw a clear line in the area of refraction - let the optometrists do the refraction and do not let the opticians do it, because it is something that is specialised. Some of the other Members have mentioned that we ought to take into account the fact that there are already opticians in Singapore who have been doing refraction adequately, and for years. Dr Lim Wee Kiak has also pointed out to us that it is not a question of who gets to do it but whether or not the person who is doing it is competent to do it. And on this point, I agree with him, namely, it is a question of safety and standards.”
“In conclusion, we are ready now to regulate the practice of optometry and opticianry. The existing Contact Lens Practitioners Act has laid the ground for us to take this step, and years of training optometrists and opticians have created a sufficiently competitive market to support this move. I seek the House's support for this Bill to ensure that the public continues to enjoy high standards of eye care, in relation to the practice in optometry and opticianry in Singapore. Sir, I beg to move. Question proposed. 3.28 pm”
“For opticians, those with work experience of at least five years will be fully registered as opticians if they pass a competency test. Those with between two and five years of experience will need to undergo a part-time modular upgrading course. There may be some opticians who do not intend to do any refraction but wish to do only dispensing; they will need to undergo a competency test or failing which, an upgrading programme but without the refraction component. In this way, we will ensure that they can uphold safe standards in dispensing. Opticians with less than two years' experience and all new entrants to the profession will need to attend a certificate course in opticianry in order to qualify for registration. Singapore Polytechnic has organised a course to cater to these opticians. The course can be completed between nine and 24 months, depending on the frequency of attending the modules. Further details of the registration of optometrists and opticians will be spelt out in subsidiary legislation to be enacted at a later date. My Ministry will be reaching out to existing optometrists and opticians through the media, seminars and other efforts to inform the practitioners on the procedure for registration, including details on the competency tests and upgrading courses that are necessary for registration. In preparing this Bill, the Ministry has consulted persons who will be affected by this new legislation and, in particular, the key representative groups of the professions, such as the Singapore Optometric Association, the Singapore Opticianry Practitioners and the Singapore Polytechnic Optometry Centre. These stakeholders have been supportive of the Bill. We will continue to consult them as we develop the subsidiary legislation.”
“This is to ensure that the practitioners continue to maintain a high level of competence so as to provide quality and safe primary eye care to the public. Part IV provides for offences in regard to the unlawful engagement in optometry and opticianry and fraudulent registration. A person who practises optometry or opticianry without registration or a valid practising certificate will be liable on conviction to a fine not exceeding $25,000 and/or imprisonment for a term not exceeding six months for a first offence, and a fine not exceeding $50,000 and/or imprisonment for a term not exceeding 12 months for subsequent offences. Under clause 29, the Board may also compound any offence prescribed as a compoundable offence under the Act. Part V, clause 31, allows for the appointment of Inspectors to investigate into offences under the Act, and complaints against registered optometrists and opticians. Finally, under Part VI, clause 39, the Contact Lens Practitioners Act will be repealed. Implementation Let me now touch on implementation. To minimise the impact of regulation on contact lens practitioners licensed under the current Contact Lens Practitioners Act, licensed practitioners will be automatically registered as opticians and granted practising certificates in respect of opticianry when the Act comes into operation. Furthermore, contact lens practitioners with the appropriate qualifications and experience may also apply to be registered as optometrists. For optometrists, those with recognised qualifications and at least one year of optometry experience will be fully registered. Optometrists with less than one year of experience will be provisionally registered, and will have to work under supervision for one year before they become fully registered.”
“Based on this approach, we have drafted the Optometrists and Opticians Bill which is now before this House. Main features of Bill Let me now go through the main features of this Bill. First, we have defined the acts constituting optometry and opticianry in the Schedule. Only persons who are registered as optometrists or opticians are allowed to perform the respective activities listed in the Schedule. However, exemptions will be made in subsidiary legislation to allow health professionals, such as medical practitioners and orthoptists, to continue performing eye examination procedures which are part of their scopes of practice. Part II of the Bill establishes the Optometrists and Opticians Board. The Board will be represented by members from the optometry, opticianry and ophthalmology professions, public officers from the Ministry of Health and the Ministry of Education as well as some lay-persons. The main functions of the Board are to approve or reject applications for registration, accredit courses in optometry and opticianry, and determine guidelines for the professional conduct and practice of optometrists and opticians. Part III sets out the role of the Registrar in maintaining the registers of optometrists and opticians, and the powers of the Board to take disciplinary action against registered optometrists or opticians, including the cancellation or suspension of the registration of such persons, and the imposition of monetary penalties. It also provides for a right for any person aggrieved by the decision of the Board to appeal to the High Court. Part III also requires optometrists and opticians to apply for practising certificates, which will be made renewable, subject to mandatory continuing professional education to be specified in subsidiary legislation.”
“In developing our regulatory framework, our principal objective is to ensure that optometry and opticianry services are safe for our public. While we want to regulate the optometrists and opticians as two distinct professions, we want also to take into account market realities and to avoid unnecessary disruption to the way that the public uses the services of these professionals. Our legislation will therefore enable opticians to continue to perform refraction provided that they are properly trained. But we propose to exclude children under 8 from the persons whom an optician may refract. Young children are more difficult to refract and may have eye anomalies that opticians are not trained to detect. With our legislation, refraction services for such young children will require the higher skills of an optometrist. In addition, optometrists will be formally recognised for their ability to perform basic eye examination procedures and diagnose certain eye problems. We are mindful that regulation may cause some disruption to the practices of some existing optometrists and opticians, and we seek to minimise this as far as possible. Some opticians currently only perform dispensing and have no intention to learn refraction. We will register such opticians to perform only dispensing so as to allow them to continue their practice. Nonetheless, there is a competing need to ensure that opticians attain a reasonable level of competence. To achieve this balance, existing opticians will be registered under the Act according to their experience, qualifications and competence. Those who do not satisfy certain minimum requirements will be required to undergo upgrading courses in order to qualify for registration.”
“Our prevalence rate for myopia is high at 40% among Chinese adult Singaporeans over 40 years old, as compared to, say, 15% among Australians and 27% among Americans in the same age group. The problem will grow as our population ages. There are several reasons why we need to regulate the practice of optometry and opticianry. First, the public will then be better assured of high standards of primary eye care, refraction and optical aid dispensing. Second, practitioners will be required to maintain high standards in their professional practice through mandatory continuing professional education. Third, errant practitioners may be disciplined for, amongst other things, professional misconduct or negligence, or any improper act or conduct which brings disrepute to the profession, arising from a complaint brought by an aggrieved patient or client. Our approach to regulation The regulation of optometrists and opticians is, however, not straight-forward. In most other countries, there is a clear division of labour between optometrists and opticians, depending on their training. Optometrists are trained to perform refraction and basic eye examination procedures, such as examining eyeball pressure, visual field and retina. On the other hand, opticians are trained to prepare, adjust and fit optical aids and perform other retail duties. However, in Singapore, there is much overlap between the practices of these two groups of eye care professionals, with opticians doing refraction and optometrists dispensing optical aids. As a result, our public has become accustomed to having both refraction and dispensing provided by the same optical service provider rather than being served by separate providers, as is the case in many other countries.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." Background Like other countries, eye care in Singapore is provided by ophthalmologists, with auxiliary support from optometrists and opticians. Our ophthalmologists are highly trained and enjoy a good international reputation. In our situation, unlike many other countries, we have left the practice of optometry and opticianry unregulated. This has been historical. But several years ago, the Health Ministry decided that we should bring the practice of optometry and opticianry under regulation and started to prepare the industry for it. In 1994, we took the first major step when the Singapore Polytechnic launched a diploma course in optometry and certificate courses in ophthalmic dispensing. This was to provide the industry with well-trained optometrists and opticians to help raise the standard of eye care by these allied health professionals. Over the years, the Singapore Polytechnic has graduated about 600 optometrists and provided training for about 300 opticians. We now have an active market in such eye care practices with competitive prices. In 1995, we took the second major step when the Contact Lens Practitioners Act was introduced to regulate contact lens practice. This was a priority to ensure public safety by allowing only properly trained practitioners to fit and dispense contact lenses. We are now ready to take the third major step by bringing legislation to bear on the remaining practices of optometry and opticianry, which fall outside of the Contact Lens Practitioners Act. This is an important piece of legislation particularly because myopia is rather common in Singapore.”
“Mr Speaker, Sir, first of all, I would like to clarify that even though the vaccine is not included in the immunisation programme, it is available. So it is an option that parents who want to immunise their child can do so. But when you talk about mass immunisation, that is, without exception, every child that is born here, then we would have got to look at the cost-effectiveness of things and weigh it against how many people are likely to contract such a disease, and looking at the hospitalisation data to see whether or not that is the best course of trying to prevent some of the complications that Dr Lam mentioned. Certainly, in terms of the treatment of the cases that have surfaced, there would be every attention paid to it. We will continue to monitor the cost-effectiveness of it. We do not exclude this as a possibility but it is to look for a time where if the cost comes down to a level that can justify its inclusion, then we can consider it. OUTDOOR REFRESHMENT AREAS AT HDB ESTATES (Extension of operating hours) 18. Dr Muhammad Faishal Ibrahim asked the Minister for National Development if the Ministry will consider extending the operating hours of Outdoor Refreshment Areas at HDB premises in suburban HDB estates that were originally designed as eating houses to further enhance the vibrancy of these locations.”
“Mr Speaker, Sir, our feedback has been that, currently, patients who opt for B1, many prefer the air-conditioned comfort. But, in the same breath, I would say that we continue to take in the feedback. If the demography changes and the demand patterns change, we certainly would take that into account in the configuration of the amenities that we provide. JOB OPPORTUNITIES IN SINGAPORE (Assistance to foreigners to take up) 11. Mdm Ho Geok Choo asked the Minister for Manpower (a) what are the Ministry's plans to fill jobs with foreign and guest workers in light of the Singapore economy expecting to generate some 450,000 jobs in the next five years and the local workforce only filling half of these jobs; and (b) what efforts are being made to identify and help foreigners to come to Singapore to take up these jobs.”
“Mr Speaker, Sir, for B2 and C class wards, they are not air-conditioned. In the case of B1 wards, there are four beds in each room and they are air-conditioned. Not everybody is averse to air-conditioning. In fact, we have found out that the majority of people look for air-conditioned comfort as well. In the current setting, those who feel that they might need an extra blanket or so are certainly given one. For Class A1 wards, they are single-bedded and they are able to adjust the temperature in their own rooms according to the thermostat. With regard to the new hospital in the north, as my Minister has explained, new beds are certainly going to be made available there up to 550, most of which would be subsidised beds. In the B2 and C class wards, that would not be a problem.”
“Bill considered in Committee; reported without amendment; read a Third time and passed. LEGAL PROFESSION (AMENDMENT) BILL Order for Second Reading read. 4.42 pm”
“Mr Speaker, Sir, I agree with Dr Lily Neo that we should continue to do our best for our children's teeth. I propose a multi-pronged approach - many helping hands, so to speak - everybody participating, including the child himself or herself. In this regard, I would say that the quality of the dental screening provided by the School Dental Service is an integral part of that. I agree. So, whether or not that service provided over the years has yielded the intended positive results, improved results, or has that service over the years done harm and caused deteriorating results in the teeth of our children, as measured by internationally comparable indicators? Dr Neo has just quoted a different figure. I am afraid I do not have that particular chart with me. But for the figure that I have quoted in my speech, clearly between 1994 and 2003, that decay index has improved from one down to 0.54. It therefore conveys to us that we are on the right track, that the care that we are giving through that service to our children has led to further improvement in the dental health of our children. Yes, it also means that there are still teeth decaying in our children and there are still children losing their teeth. We must continue to persist and further improve on this. But the answer to a zero missing tooth challenge, I submit, lies in everybody who is involved in it - the child, the parents, the system working together - that will give us the best chance, rather than to say if I have a dentist checking it, the tooth will not be missing. I do not think that is so. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill. - [Mr Heng Chee How].”
“Parents should do their part, the school system does its part, the dental health screening service does its part, and together with daily participation of the children themselves, that kind of approach is the best approach, rather than to say that it is to be consigned to any one group to ensure it. Sir, I believe I have covered most of the points raised by the Members. I thank Members once again for supporting the Bill.”
“This will be an ongoing programme which should reach out to all dentists, oral health therapists and related healthcare professionals in Singapore. Mr Speaker, Sir, I would like now to address one final point by Dr Lily Neo with regard to the quality of care that we are providing to our school children and the parents' belief that with screening done in the school, they have completely outsourced the need to those school dental services and therefore there is no need to bring their children for regular dental checkups. First of all, on the quality of screening. At the end of it, I think we need not really look at whether or not it is done by a dentist or by what used to be called a dental staff nurse, or now called an oral health therapist. We look at it by way of the training they are provided, the curriculum, and the final test is really in the outcomes. And if you look at the outcomes that we have achieved so far by way of education, practice of oral hygiene and the decay indicators, and so on, I say the results point to one of confidence rather than one of concern. Therefore, I do not think we can say that because our dental staff nurses or oral health therapists have been the ones doing the screening for our children and, therefore, as Singapore develops, we are shortchanging our children or we are subjecting them to third-world care even in first-world Singapore. I disagree with that. The point about the parents - I would want to take this opportunity to urge parents to remember that it is important that our children have good teeth. I would agree totally with that view and it should be a partnership.”
“So, it is a constant monitoring of the developments and to see in what ways can we move that is sensible, and balancing the immediate and longer term needs. We are conscious that obviously when you allow Medisave to be used, then the outlay on the part of the patient could be reduced, and this is attractive to the patient. We have to conduct it in a balanced manner. On ageing population, I think Mdm Halimah mentioned in particular cost of dentures. I am told that, in general, dentures are not prohibitive in cost and at this moment we do not think this is something for which we want to make it claimable. But we will continue to monitor all such developments. In her speech on the orthodontal care needs of the elderly, Mdm Halimah believes that our dental education institutions should also provide topics on geriatric dental care and planning the curriculum. The NUS Dental Faculty and Nanyang Polytechnic have incorporated teaching modules on the management of geriatric patients. There is an on-going review of the courses with the intention of increasing instruction, contact time and exposure to elderly patients as well as patients with special needs. One of the primary roles of the soon-to-be regulated oral health therapists would indeed be the management of the elderly in the homes and hospices. We have also not forgotten the need to update and educate dentists on the changes and developments in the management of the elderly patients. In fact, a comprehensive health manpower development programme, or HMDP, on geriatric dentistry as well as the management of patients with special needs, organised by my Ministry, has been tentatively scheduled to be held in the first quarter of 2008.”
“We will certainly take all those ideas and suggestions into account in implementation planning. On the use of Medisave for dental services, Mdm Halimah suggested that MOH conduct a review of the dental procedures covered and also update the Medisave claimable amount. My Ministry is in the course of an internal review. But I would like to say that, as is already the case now, dental inpatient and some surgical procedures performed in day surgery are already Medisave claimable. We will certainly monitor the needs and developments in our population, in particular the ageing demography, and cross check that with respect to Medisave claims for dental procedures and, if necessary, we will make the adjustments when the need arises. However, I would like to say something about what Medisave is for. As we all know, Medisave is not something that we would want depleted prematurely. Therefore, for a long time, the Ministry of Health has advocated and stuck by the position that we should keep it for hospitalisation, ie, in-patient care. Only very recently have we made a very conscious and calculated deviation from it, and that is in the case of the Chronic Disease Management Programme. We do that for a purpose, but we have built in very good safeguards to make sure that we do not inadvertently cause this to be a slippery slope through which the Medisave of CPF members would be prematurely depleted and causing them other untold problems later on. Similarly, in considering whether or not certain scans relating to the treatment of cancer should be included to be Medisave claimable, we also took this into account very seriously. The point is that whatever we do, we must not end up depleting prematurely the member's CPF savings.”
“To promote dental fee transparency, MOH will be publishing the public dental institution fees for selected dental procedures on the MOH website. Mdm Halimah asked if the continuing professional education requirements to renew a practising certificate could be reduced for older or semi-retired dentists. Continuing professional education will be made a condition for the renewal of practising certificate under the regulations to be enacted after this Bill is brought into operation. A practising certificate allows a dentist to perform the full range of dental procedures on their patients. To safeguard the interest of the public, MOH is of the view that the continuing professional education requirements for older or semi-retired dentists should not be reduced. Incidentally, oral health therapists will also be required to renew their practising certificates biennially and obtain half the number of continuing professional education hours of the dentists, because of their different scope of work. Dentists and oral health therapists will be allowed to accumulate their continuing professional education points through various means, such as attending conferences, lectures, workshops, attempting online education programmes and self-reading of research journals. Seventy hours, which is the requirement, over two years for dentists work out to be about three hours a month. We feel that three hours a month is not excessive. In fact, it is probably conservative. By comparison, the dentists in the UK are required to chalk up 250 hours over five years, which is 50 hours per year, whereas what we are asking for is 70 hours over two years. I thank Dr Fatimah for her many suggestions on how to operationalise the system for continuing education.”
“The programmes will help improve the public's awareness of the various dental specialties and when and why they should seek treatment from these specialists. The Singapore Dental Council's website will include the list of dental specialists and their specialties. The oral health therapists' role in the provision of dental care and the scope of their work will also be highlighted through public awareness and education programmes. Are dental fees expected to increase because of the establishment of the Dental Specialists Register? I acknowledge that this can be a concern, but I would like to assure the House that the Dental Specialists Register is to formally recognise and make it more transparent to the public which dentists have upgraded and maintained their skills in specific areas of dentistry and who have not. Incidentally, the dentists who will be placed on the Specialists Register, I am told, are already charging appropriate fees for the higher level of specialised dental care that they are providing. So I take it that when they are doing the higher level of dental care, they would explain the difference to their patients and factor that into their charges. I would like to assure the House that this Register is unlikely to lead to a fee increase. The reverse, however, may be true as general dental practitioners, who had been performing these procedures and who may have called themselves specialists in some way, will now think twice before quoting or charging higher fees. There is also a relatively healthy referral culture amongst our dentists. The specialists will continue to refer the more basic and less complex cases to the general dental practitioners and vice versa; hence, ensuring right-siting, appropriate care and certainly appropriate charging.”
“I would say that there is no dispute over the merits of having a representative from the NUS Dental Faculty on the Council. If we look at the other provisions of appointment, then we are able to utilise the other limbs of the appointment provisions in order to augment the Council or to take suitable representatives to be on board. Sir, there are various ways of looking at this. Dr Fatimah, in her speech, in fact, cautioned against over specifying. She referred to another provision and said, "Why do you want to specify Nanyang Polytechnic and NUS Dental Faculty? There could be others who might come up." The answer, to balance all these concerns, would be to say that for the obvious ones, we put in and then we have other provisions within the appointment processes to allow us to appoint, because all of them would be registered dentists of various Divisions anyway. That gives us the flexibility to do what is necessary and sensible to achieve the purposes. So we have to strike a balance between not trying to specify every single one in nor to inadvertently over specify and ending up with either creating monopolies or actually restricting our own ability to manoeuvre when circumstances change. Mdm Halimah and Mr Zainudin highlighted the need for public awareness and education programmes and dental fee transparency, which will help the public make informed choices. Mdm Halimah also wondered if the establishment of the Dental Specialists Register could lead to higher dental fees. Public awareness and education programmes are indeed in the pipeline, and these programmes will focus on the various types of dental specialties as well as on the oral health therapists.”
“This is something that the Ministry will be monitoring and we will have to move in such a way that it balances between not only the interest of the therapists but also those of the dentists, while at every point of time ensuring standards and safety for the people who receive their services and treatment. Dr Lily Neo was also concerned that oral health therapists may be over represented in the new Dental Council. I just want to explain here that the new Dental Council comprise 11 dentists, of whom up to three may be oral health therapists. These oral health therapist representatives will be appointed by the Minister. The Ministry believes that the oral health therapists have to be sufficiently represented in the Council since they will be working closely with the dentists. The Chief Dental Officer of MOH will recommend to the Minister the actual number to be appointed after considering the total number in proportion to this group of dental professionals in Singapore. So I take Dr Lily Neo's point that we should actually look at the relative sizes in deciding how many oral health therapists ought to be appointed in any one term of the Dental Council, and this is something that the Chief Dental Officer will take into account in making his recommendations to the Minister. Within the amendments proposed, there is a cap of not more than three. Clearly, to have any representation at all, it cannot be less than one. So that is where it stands. Dr Lily Neo also alluded to why a representative from the NUS Dental Faculty was included in the new Singapore Dental Council but was not mentioned in the other board. She was saying whether or not there should also be a representative of the National Dental Centre on the Singapore Dental Council.”
“Because they were dealing within the school system, there was this specification in the regulations. As the scope of the oral health therapists' work is extended and as we consider the fact that they would be able, if they so choose, to practise after the five years on their own, no doubt under the supervision of dentists, one of the measures that has been taken to assist them in enhancing their employability and their job worth is to equip and certify them for the dental hygienist's work. That is step one. So, an oral health therapist, who also qualifies as a hygienist, can do the hygienist's work without limitation on the age. What about lifting the limitation for therapy work? On this, we would have to look at how things evolve and take concurrent steps. There are a few pieces that we have got to move and adjust in an interdependent way. As I mentioned earlier, the origin of the rule was because of the nature of the work for which they were trained to do. For the adult population beyond the age, that really comes under the realm of the dentists. Dr Lily Neo draws a very strict line as to what dentists can do and what oral health therapists cannot be trusted to do. But Mdm Halimah and Dr Fatimah hold the view that as they upgrade their skills and so on, why is it that we have a limitation of who they can provide services to? So there is an implication on the kind of training that we provide them, what they can be competent in, what kind of supervision they should be put through, as we consider whether or not they can then move beyond their current scope, in terms of oral therapy work.”
“The programme, among other things, trains them to screen school children and provide the necessary basic dental care. Currently, all primary school children and half of the secondary school children are screened and treated by qualified oral health therapists. Some secondary school children are being screened and treated by dental officers due to the shortage of oral health therapists who are fully qualified to do the screening. Once there are sufficient numbers of oral health therapists, all secondary school children will be screened and treated by oral health therapists for the basic care for which they have been trained and qualified to do. Oral health therapists are well qualified to carry out these screenings and provide basic dental care, eg, in scaling, polishing, filling and the extraction of milk or primary teeth. Students who need dental treatments that are beyond the scope of oral health therapists are referred to dental officers for consultation and management. The dental officers also supervise and conduct regular checks on the oral health therapists, not only on how they conduct the screenings but also on how they perform treatment. Here, I would like to address another issue which was brought up by Dr Fatimah as well as Mdm Halimah. This is with regard to the current rule of dealing with the teeth of those who are below 18 years of age by the therapists. This rule currently does not apply to hygienists. So hygienists can practise what they are trained to do in an age neutral way. They are not limited by this rule. As for therapists, this rule in the regulations started because of the way in which they were trained and deployed - in other words, the job that they were employed to do.”
“This actually puts us as one of the lowest in the world. So, it is a good result. It suggests that the education programme and the promotion of good habits, in terms of toothbrushing and so on, have yielded results. Mdm Halimah was also concerned about the job scope of the oral health therapists - and I think Dr Fatimah as well as Dr Lily Neo - and asked us to have some clarity about their job scope. Dr Neo was of the view that registered oral health therapists should not be allowed to work independently, but work under the supervision or fulfil the prescription of qualified dentists. The amended Dentists Regulations, pursuant to the Act, would clearly state the job scope of all oral health therapists as well as that they will work in collaboration with registered dentists. Specifically, they will only be allowed to perform dental procedures that they are qualified to do and will work under the direct supervision of dentists for at least five years. The five years that they spend under the direct supervision of dentists will help them gain sufficient clinical experience. After the five years, they may choose to work under a dentist in the same premises or provide the services in their own premises to patients referred to them by any dentist. They may not prescribe treatment or provide dental treatment independently. They may only treat patients referred to them by dentists and may only provide treatment which is prescribed by dentists. On Dr Lily Neo's concern that oral health therapists are not sufficiently qualified to perform dental screening of students on their own, I wish to inform the House that oral health therapists go through a 3-year diploma programme at Nanyang Polytechnic.”
“Mr Speaker, Sir, I thank the Members for speaking in support of the Bill. As pointed out, this Bill will raise the standards of dental care and dental professional practice in Singapore. Allow me now to respond to the Members' specific comments and concerns. Mdm Halimah wondered if our primary school children are still continuing with the after-recess toothbrushing drills which, as she correctly remembered, had increased dental awareness and instilled in school children good dental hygiene habits. What happened was that that practice actually continued right up to where SARS struck us. At that point, to minimise cross-contamination and possible transmission of unknown infections amongst students, that was scaled down. But, instead, the School Dental Service under the Health Promotion Board moved towards an individualised and enhanced oral health promotion programme which, by their indicator, has proven to be more effective. What happened is that all school children are now instructed, at the chair side during the free dental treatment visits, on how to brush their teeth effectively and regularly. In addition, the dental therapists in the schools have also increased the frequency of oral health promotion talks. Dental health education has also been incorporated into the health education curriculum in the primary schools. Currently, these measures continue to instil good dental hygiene habits amongst our school children. A 2003 survey has found that amongst 12-year-olds, there is 0.54 of decayed, missing or filled teeth. That is an internationally recognised comparable indicator. This number in 2003 of 0.54 was a decrease from the number of one (1) in the year 1994. In other words, there have been fewer decayed, missing or filled teeth in our children.”
“These enhancements to the disciplinary processes, including the amendments to allow the appointment of Interim Orders Committees, are modelled on the provisions in the Medical Registration Act. Composition of offences Amendments have also been proposed to allow the Dental Council, with the approval of the Minister, to prescribe offences which may be compounded and, where appropriate, compound such offences. Change in name of the Dentists Act To reflect the extension of the Act to cover dental specialists and oral health therapists, we further propose to change the name of the Act to the 'Dental Registration Act'. Conclusion In conclusion, Mr Speaker, Sir, Singapore has, over the years, seen quantum improvements in the provision of dental care and services. Our dental professionals' standards of competency and commitment have led to a general state of good dental health and treatment in Singapore. The proposed amendments will ensure that Singaporeans continue to enjoy access to dental care which is affordable and of consistently high standards. Sir, I beg to move. Question proposed.”
“This may not be entirely satisfactory in some situations as there may be compelling reasons to suspend such a dentist from practising, even before the outcome of his disciplinary inquiry, in the interest of public safety. We have therefore proposed a provision to allow the Dental Council to appoint an Interim Orders Committee with the power to suspend or restrict the practice of a registered dentist or a registered oral health therapist for the protection of members of the public or in the public interest, pending the completion of disciplinary proceedings against him. To safeguard the rights of dental professionals, however, provisions have been inserted: (a) to restrict a member of a Complaints Committee or Disciplinary Committee from participating as a member of an Interim Orders Committee inquiring into the same matter; (b) to provide that no interim order shall be made unless the dental professional in question has been given an opportunity to appear before the Interim Orders Committee and present his case (either in person or by a legal representative); (c) to grant a dental professional a right of appeal to the High Court; (d) to require the review of an interim order by an Interim Orders Committee after six months to determine if it should be revoked or amended and, following this first review, a further review every three months until the matter is settled, or until an Interim Orders Committee decides that the order is no longer necessary, or eighteen months after the initial issue of the order. An extension beyond eighteen months will require approval by the High Court.”
“In summary: (a) The Dental Council will be empowered to direct that an inquiry be continued even if the complainant withdraws his complaint before it is referred to a Complaints Committee, a Health Committee, a Disciplinary Committee or before the conclusion of the inquiry of the above-mentioned committees. (b) A Complaints Committee will be empowered to decide on its own motion to inquire into a matter when it receives information regarding the conduct or physical or mental fitness of a dentist or an oral health therapist which may give rise to proceedings against the dentist or the oral health therapist under the Act. (c) A Disciplinary Committee will be empowered to refer information to the relevant authorities for further investigation if there are reasons for the committee to believe that a criminal offence(s) has been committed. Furthermore: (a) The Chairmen of Disciplinary Committees will be selected from a panel of senior, well-respected dentists appointed by the Minister for Health. A disciplinary committee will also include non-Council members as well as a lay observer. (b) The maximum penalty that may be imposed by a Disciplinary Committee will be increased from $5,000 to $50,000. This increase in the maximum penalty will give a Disciplinary Committee the flexibility to impose a monetary penalty that is commensurate with the professional misconduct in question. Appointment of Interim Orders Committee Inquiries into disciplinary matters may take up to 24 months to complete and, presently, a dentist who is under investigation is still able to practise.”
“To enable the Registrar to carry out his duties effectively, he will be empowered to remove from the appropriate Registers the names of persons who have: (a) not renewed their practising certificates for a continuous period of five years and who cannot be contacted; or (b) requested and shown sufficient reason for his name to be removed from the register, unless an enquiry or proceedings have commenced against the person. Conditional and temporary registration The proposed amendments will allow, in addition to full registration, the conditional and temporary registration of dentists. The Dental Council will conditionally register a dentist if it is of the view that the person should work under the supervision of a fully registered dentist for a time. Such persons include those whose qualifications or experience do not allow them to be fully registered in the first instance, such as a foreign-trained graduate. In such cases, the Dental Council will explicitly state the conditions of registration. Temporary registration will be granted to a person who does not have a local degree and who, for instance, is in Singapore for the purpose of teaching, research or to pursue a postgraduate study in dentistry. This scheme of full, conditional and temporary registration is similar to that for medical practitioners under the Medical Registration Act. Enhanced disciplinary processes To enable the Dental Council to carry out its regulatory duties effectively, the proposed amendments will grant the Council and its committees enhanced powers in respect of disciplinary matters.”
“Compulsory continuing professional education for dentists Dental science is constantly improving. Therefore, there is a need for dentists to maintain the currency of their professional knowledge and to stay abreast of developments in dental science and practice. Continuing professional education is a well-accepted mechanism to achieve this. The amendment proposed under clause 14 will enable the Dental Council to prescribe conditions for the grant and renewal of practising certificates, including mandatory participation in continuing professional education. Only dentists who accumulate the minimum continuing professional education points specified by the Dental Council will be issued with practising certificates, or will have their certificates renewed. Continuing professional education for dentists is already a requirement in developed countries, such as the USA and UK. In Singapore, continuing medical education has been linked to the renewal of practising certificates for medical practitioners since 2003. Compulsory continuing professional education for dentists will help ensure that standards of dental care in Singapore remain high. Compulsory voting Voting of members for the Dental Council is currently compulsory for all registered dentists. The proposed amendments will make compulsory voting applicable only to registered dentists with current practising certificates. Registrar of the Dental Council Since 2001, the Chief Dental Officer, Ministry of Health, has been appointed as the Registrar of the Dental Council. The proposed amendments will formalise this practice.”
“Local and overseas general dental practitioners and medical practitioners will also be able to identify such dental specialists so that they can make referrals when necessary. By recognising and regulating dental specialists, we would also, firstly, motivate more dentists to aspire towards specialisation; secondly, encourage dental specialists to remain competent in their areas of specialisation; and, thirdly, protect the public by ensuring that only dentists with the appropriate qualifications may hold themselves out to be specialists in the appropriate areas of specialisation. Registration and regulation of oral health therapists Under the proposed amendments, a new division will be inserted to provide for the registration of oral health therapists. In countries such as the USA, UK, Australia, Germany and New Zealand, oral health therapists support a dentist's practice and provide basic dental care. In Singapore, oral health therapists have been providing basic dental care to primary school students for many years. Basic dental care includes procedures such as scaling and polishing of teeth. By allowing oral health therapists to provide cost-effective basic dental care, dentists will be motivated to improve on their skills and perform more complex dental procedures. The registration and regulation of oral health therapists will help assure the public that these therapists will be appropriately trained and accredited for the skilled provision of basic dental care. The registration and regulation of dental specialists and oral health therapists will create a continuum of skilled and affordable dental care that the public can choose from. Enhanced Dental Council Sir, let me move on to the amendments to enhance the role and processes of the Dental Council.”
“The registration and regulation of oral health therapists will ensure that these therapists, who would now be able to seek employment in the private sector as well, are adequately trained to provide basic dental care to the public. We need to update the Act to ensure that our laws continue to be relevant to the practice of dentistry today, by recognising and regulating the work of dental specialists and oral health therapists. The proposed amendments will also enhance the role and processes of the Dental Council to enable it to perform its regulatory functions more effectively, and allow for the introduction of compulsory continuing professional education so that the Council can raise and maintain professional standards of dental practice. Let me now elaborate on the amendments which I have just highlighted. Setting up of a Dental Specialists' Register The amendments proposed under clauses 12 and 25 provide for the setting up of a separate register for dental specialists, and the registration of such specialists. Dental specialists are recognised in countries like the USA, UK, Australia, Sweden and Switzerland, as I mentioned earlier. In the USA, a dentist is recognised as a specialist when he obtains his specialist board certification. UK, Australia, Sweden and Switzerland provide for the registration of dental specialists in a register that is separate from that for other dentists. In Singapore, we have a good number of dentists who have specialised in specific areas of dentistry. They provide a higher level of dental care to our patients. A Dental Specialists’ Register will list these dental specialists and their area of specialty. This will allow patients who require specialised dental treatment to easily identify an appropriate dental specialist.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." The Dentists (Amendment) Bill seeks to amend the Dentists Act (Chapter 76 of the 2000 Revised Edition). The proposed amendments will ensure that our laws are relevant to the practice of dentistry today. The amendments will also enhance the powers of the Dental Council so that it may perform its regulatory functions more effectively. Background Singaporeans enjoy a high standard of dental care that is easily accessible. Today, we have about 1,250 registered dentists working in the public and private sectors providing a wide range of dental care and services to our population. About 20% of our registered dentists have on their own volition upgraded their skills in specific areas of dentistry such as orthodontics, prosthodontics, oral and maxillofacial surgery, periodontics, endodontics and paediatric dentistry. These "dental specialists" provide a higher level of dental care to patients whose dental conditions require management by a dentist with specialised training. Although developed countries such as the USA, UK, Australia, Sweden and Switzerland already have a separate register for dental specialists, our specialists are neither recognised nor regulated under the present Dentists Act, other than as registered dentists. Oral health therapists, ie, dental therapists and dental hygienists, have been providing basic dental care in developed countries such as the USA, UK, Australia and Germany. In Singapore, such therapists, who have been allowed to be employed by the Health Promotion Board, have been providing basic dental care to our schoolchildren for many years.”
“Mr Chairman, Sir, I thank the Member for her comment. From the perspective of the Ministry, and certainly from IMH, supply adequacy will be a factor we will always bear in mind. In other words, it is not a question of defining a certain supply and then, once you reach that, you push everybody out even though they may need inpatient care. But neither do you want to then make every case an inpatient case unnecessarily, because the considerations must be the early re-integration of the person into wider society so that he or she might be able to function normally and live a full and fulfilling life. So there is the medical aspect of this, ie, the assessment by the doctors as to what might be the right thing to do for an individual case, and this is also ongoing. Certainly, as the population changes in profile, as it ages, and as more stress comes upon society, the demand patterns may shift and this is something that is also monitored by the Ministry as well as by IMH. Suitable resources will be directed to the improvement of the supply, if need be. 12.30 pm”
“Mr Chairman, Sir, my understanding is that the RAF form is used within the system. The form was introduced to enable a simple way to assess those needs. As I explained yesterday, the process of looking at the adequacy of the form is a continuous one, and we constantly look out for new methods, including the interRAI. The question on whether stakeholders are consulted as to the adequacy of the form and what might be its shortcomings, this would also be an important part of the ongoing communications. If there are inadequacies, then they can also be improved upon. Finally, on the possibly different criteria in means testing used in nursing homes versus the homes run by MCYS, I do not have the details with me here. But I would certainly take the Member's feedback and we would make a check of it, and if there is a need to synchronise and harmonise them, we will do so.”
“While there is limited scope of rotating this Tamiflu with clinics and hospitals because there is overall very low usage, my Ministry will, nonetheless, do our utmost and look at different ways to minimise the stocking cost of this anti-viral stockpile, but without compromising Singapore ’s pandemic preparedness.”
“Foreign practitioners currently form about 5% of the pool of registered TCM practitioners in Singapore and the total pool is about 2,000. Dr Lam Pin Min asked for an update on our pandemic plans. Effective surveillance is important in detecting disease outbreaks early. MOH does this through continuous monitoring of news reports of disease outbreaks overseas and assessing the risk of these occurrences to Singapore, keeping the hospitals and doctors informed of developments and providing guidelines for detecting and reporting suspect cases, and enhancing laboratory capabilities and capacities for disease detection. Beyond surveillance and detection, prompt and correct response is equally important to retard and limit the spread of the outbreaks. In the latest review of the Pandemic Plan, focus was placed on bringing in the participation of private GPs and private hospitals to expand the healthcare resources available nationally to cope with demand during a pandemic. MOH conducted exercises with public and private hospitals in April and May 2006 to test their preparedness for the avian and pandemic influenza. These were followed by a system-wide exercise in July 2006 that involved MOH, hospitals, polyclinics, GP clinics, nursing homes and relevant Government agencies. The lessons learnt from these exercises served to improve the design of the plans. Exercises will be conducted from time to time to ensure our continued preparedness. On our anti-viral stockpile, we have now stocked 1.05 million courses of Tamiflu. They will be used to treat infected persons during an avian flu pandemic. The stockpile of Tamiflu was delivered to us in batches and the first batch will expire in 2008.”
“We were told that the demand there has grown very quickly over the last two years, perhaps tripling, and the facilities to support the use of TCM in inpatient settings have also been expanded to cope. We saw both Singaporeans as well as foreign patients at that clinic. I believe that successfully developing TCM in Singapore will give the patients, both local and foreign, additional good options to choose from. Of course, in doing so, we must make sure that quality and safety are always maintained. The systematic training and qualifying of TCM practitioners will boost their credibility and give confidence to patients. Having foreign TCM practitioners of high standing come to practise in Singapore will also contribute positively to this capability building. In this regard, the two main local TCM schools, namely, the Singapore College of TCM and the Institute of Chinese Medical Studies, started TCM degree courses in 2006, with my Ministry's encouragement. These courses are carried out in collaboration with respected TCM universities in China. The TCM Practitioners Board, which is the industry regulator, currently allows TCM practitioners with Bachelor's degrees from six approved TCM universities in China to be registered here and practise. The TCM Practitioners Act also gives the TCM Board the means to allow practitioners, whose qualifications lie outside the approved list but who are assessed to have outstanding skills and expertise, to register and practise in Singapore. But I take note of Dr Ong's feedback just now pertaining to the specific criteria and requirements and we would take that into consideration in terms of reviewing whether or not it is too tight in allowing this kind of practitioners to come into Singapore.”
“We have decided to extend the convenience and benefit of the PCPS to the eligible disabled by the end of this year. Details will be announced in due course. On research into intervention methods for common special needs, the Child Development Units, or CDUs, currently monitor the incidence of child development problems in Singapore. They also conduct some amount of research on diagnostic and intervention methods. They have plans to research into the areas of skills training and mediated learning for persons with special needs in time to come. I also agree that more education and information provided to parents of the disabled children would be most helpful. As for disability medicine, rehabilitation services are currently available in various settings, including acute and community hospitals and day rehabilitation centres. The four community hospitals provide inpatient convalescent and rehabilitation care for patients after they have been discharged from the acute hospitals, while the day rehabilitation centres provide day programmes for persons with disabilities. There are about 30 of these day rehabilitation centres spread across the island. Now, I move on to TCM. I agree with Dr Ong Seh Hong that developing TCM would enhance our position as an international medical hub and would also help with the SingaporeMedicine initiative. Singapore is well placed to do this because of our recognised strengths in Western medicine and our proximity and close links to countries like China and India, which have strong roots in traditional medicine. Demand for complementary medicine is strong and growing. Just to give an example, I recently accompanied my Minister to visit the TCM clinic at Raffles Hospital.”