Irene Quay Siew Ching
Singapore
“Regardless of how much funding our Government pours in to subsidise drug treatments and improve access to medication, a patient's treatment cannot be optimised if he or she does not swallow a pill that is tailored to their needs.”
“Thank you, Chairman. Senior Minister of State Lam shared about this national antimicrobial surveillance report. I just wanted to ask if the results are ready and how are we faring in terms of our antibiotic utilisation in the community? What are our national targets and what are we doing about it?”
“As such, instead of a blanket policy to limit S Passes with minimal exceptions, I would still like to appeal for MOM to consider showing flexibility to employers trying to hire locally with failed attempts to turn to foreign workers.”
“I thank the Ministers. My question is: in the event if we need to step up to using N95 masks because there is wide community spread or for future viral outbreaks, how do you ensure that the public are fitted with the right model of N95 masks?”
“I seek clarification as to whether the overlapping of regulatory scopes might cause confusion and inefficiency in running these different services.”
“Next, IRO should be as inclusive as possible with the various faiths to ensure religious harmony. Finally, the Government should empower NSC to bring in faith groups together for a common cause and promote religious awareness education in Singapore.”
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Every one of 87 lines we hold for Irene Quay Siew Ching, in date order, each linked to its source. Free to read, in full, without an account. Page 1 of 2.
“I understand that MSF has implemented the Triple P Positive Parenting Programme nation-wide in schools and I would like to find out more about the attendance and success rates of these courses. I have attended such courses at my children's schools and a common remark from the teachers at the start of the course is that, often, the parents who do not make time or do not have the time for these programmes are the ones that the teachers need to reach out to. Sir, I believe that there are two extreme types of parents that we need to be mindful of – those that are ignorant or do not have enough time for their children, and the overly-concerned parents who subconsciously impart unnecessary stress to children, teachers and the people around them. This brings me to an enlightened quote from Dr Shefali Tsabary, a renowned clinical psychologist and writer of the award-winning New York Times bestselling book, "The Conscious Parent – Transforming Ourselves, Empowering our Children". Her revolutionary wisdom focuses on a parent-centric way of upbringing, rather than on the child. And I end with a quote, "To be an awakened parent who is aware that traditional paradigms of parenting, where parent is seen as greater than the child are obsolete in the modern world, producing dysfunction and disconnections in families. When parents are aware in the present moment, learning and growing alongside their children, the entire family thrives. Free to actualise their individual destiny, each family member lives unencumbered and unafraid. Empowered with self-awareness, boundless in self-belief, liberated in self-expression, each feels free to explore, discover and manifest their authentic being." Reforms in the Family Justice System”
“45 pm I am sure that all parents in this Chamber, myself included, will agree that parenting is one of the most complex jobs out there. There is a widely held and unfounded perception that parents should or naturally know what to do to parent their children and everything will be fine as long as we love them enough. But I am sorry to say that this is not always the case. As such, I find it quite perplexing that we are not using available science, expertise and valuable experiences from those who have gone through the journey to better prepare new parents. Parenting courses will be useful to help new parents eliminate unnecessary fears of unknowns while bringing awareness to what may be expected when raising a child. It will also help them understand and learn different parenting styles for different personalities and how to engage their kids to create a supportive family structure through mindfulness and conscious parenting. At the end of the day, we should prepare our kids for what lies ahead by providing them with a strong mental, emotional and moral foundation. We cannot just leave this to MOE or MSF alone because no one can be a better role model to our children than us, parents. As a working mother with four children, I can fully understand that this is not easy. We cannot be perfect but we must keep trying and keep working on it, using the right parenting skills – like speaking to my kids sitting in the Gallery today. [Laughter.] Coming back to my speech, sorry, Chairman. They are quite a distraction.”
“Mr Chairman, Sir, I would like to address the challenges of teenage health, both physical and emotional, and the necessary roles that parents can play in providing a nurturing and loving environment to secure a bright future for their offsprings. Teens in Singapore face a multitude of issues ranging from body image, struggles to find their place in society, peer influence, parental pressure, physical health changes, school-related stress, bullying, substance abuse, just to name a few. Healthcare professionals caring for school-aged children and adolescents are also seeing an increased cases of eating disorders, a form of psychiatric illness with significant, life-threatening medical complications as well as teenage suicide cases. Although there are many contributing factors to these problems, I believe that parents can do more to help and support their teenagers in this challenging journey. Parenting is a complex balancing act, which requires both making hard decisions between giving the child freedom to grow and being there for them when needed. I noticed, with regret, that data from MSF showed a gradual rise in the number of children referred to MSF for various forms of abuse. Hence, there is a need for us to work on and improve parenting skills of our adults in Singapore because I believe that all parents want the best for their children. However, we should acknowledge that not all parents may be equipped with the right skillset and mindset to raise the child. Hence, I would like to propose to MSF to consider making parenting courses mandatory for all new parents and incentivise parents to attend such courses by making it a prerequisite to receive their Baby Bonus entitlements. 5.”
“Thank you, Chairman. Senior Minister of State Lam shared about this national antimicrobial surveillance report. I just wanted to ask if the results are ready and how are we faring in terms of our antibiotic utilisation in the community? What are our national targets and what are we doing about it?”
“Mr Chairman, I refer to the nationwide curbing of antimicrobial resistance (AMR), an issue which I have also spoken on before on the need for us to curb AMR through legislative changes. AMR is a major global threat that persists and will continue to worsen if left unchecked. I do not speak this lightly, but the potential fatal consequences of AMR will surpass that of SARS, H1N1, Ebola, MERs-CoV and COVID-19 combined. A quote from England Chief Medical Officer, Dr Dame Sally Davies, "The threat of antibiotic resistance is as great as that from climate change." This imminent danger is a result of antibiotic overuse, misuse and the lack of regulation. A local study reporting a 10-year review of AMR in Singapore noted a marked difference in the community rectal carriage of ESBL-producing Enterobacteriaceae, that is, 6.3% in 2006 versus 26% in 2016 between two dissimilar surveys, appearing to signify an increasing trend despite the differences in methodology. It is therefore with all urgency that I ask if MOH has any data to share on antibiotic usage in the community? I understand that the antimicrobial stewardship programme has been well established in our public institutions. May I ask if MOH has considered funding for such antimicrobial surveillance programme in the community, where the majority of our primary healthcare is provided by private practices? I would also like to request for an update on the progress of the National Strategic Action Plan on AMR. 2.45 pm Prevention and Early Detection of Diseases”
“Regardless of how much funding our Government pours in to subsidise drug treatments and improve access to medication, a patient's treatment cannot be optimised if he or she does not swallow a pill that is tailored to their needs. Mr Chairman, I would like the Committee to consider my proposal to increase funding towards pharmacists with regard to the above-mentioned points. This will enable them to provide more individualised care for patients and at the same time, reduce medication-related problems and long-term healthcare cost in the community. Eldercare”
“These patients requiring multiple medications will most certainly be at high risk of polypharmacy and non-compliance. I would therefore like to propose to MOH to set aside and expedite funding to support pharmaceutical services, particularly in the areas of medication review and reconciliation, de-prescribing efforts and related health literacy education, medication delivery services to facilitate instalment collections to avoid medication hoarding and waste, subsidies for adherence toolkits such as pill boxes and medication packaging instructions to fill these pillboxes, and multi-dose drug sachet dispensaries to improve drug compliance. A recent report from the MOH Health Manpower Development Plan (HMDP) visiting expert, Dr Catriona Bradley, pointed out that the resources of the current community pharmacists are not optimised, and that there is an uneven spread of work leveraging on the capabilities that exist within primary care. She recommends increasing the deployment of community pharmacists in the areas of medication management and pharmaceutical care, which is in line with directives from the World Health Organization's (WHO) Patient Safety Challenge of "Medication Without Harm". I quote verbatim, "Where multiple prescribers treat the same patients across primary and secondary care, there is a need for a central point of review for medications". I understand that MOH is currently piloting studies to explore the benefits and cost effectiveness of such pharmaceutical services, but in view of the ageing tsunami, expedited efforts are necessary to galvanise our healthcare professionals to oversee this urgently.”
“For this year's committee hearing, I would like to highlight another grave medication-related problem in our healthcare system – medication non-adherence or compliance. This issue is especially prevalent among the elderly. In late 2017, researchers from the National Healthcare Group Health Services and Outcomes Research department reported that seven in 20 newly diagnosed diabetic patients do not adhere to prescribed medication. This makes up about 35% of newly diagnosed diabetes patients in Singapore. There are many reasons for medication non-adherence, which include a lack of understanding or knowledge of diabetic medicine, difficulty in managing their complex medication regimen, concerns about medication side-effects and cultural beliefs. Another study by the Saw Swee Hock School of Public Health and the Department of Pharmacy in NUS shows that pharmacists play an important role in educating patients on how their medication work. This can help to prevent long-term complications by explaining to patients the potential side-effects and how to manage them. However, to address the many concerns that patients may have is very time-consuming. Currently, pharmacists working in healthcare institutions are beset by high patient load on a daily basis. They are unable to tailor individualised care for the needs of each patient and to follow-up to ensure that their concerns are addressed. For instance, according to the Well-being of the Singapore Elderly (WiSE) study led by the Institute of Mental Health (IMH) in 2015, one in 10 persons aged 60 and above may have dementia. This translates to almost 82,000 people in 2018, and the number is expected to exceed 100,000 in a few years' time.”
“This can be piloted through a regulatory sandbox approach. Perhaps, Public services can also take the lead to recognise time sheets and reimbursement for minor ailments and medication from retail pharmacies to relieve our polyclinics from their heavy workload. In a similar vein, I understand that MOH has been attempting to right-site chronic disease patients to be cared for in the community by AHPs. Can the Minister provide an update on the success of this shift so far and the projected targets for the next five years? I am concerned that the current financial gradient may not be steep enough to facilitate this shift from acute to the community. May I ask if MOH is looking at porting more subsidies for AHPs in the community settings to facilitate this transition? If done right, I see potential to effect an even more efficient and financially sustainable healthcare system for our citizens. Combat Medication Adherence Mr Chairman, in this COS speech, I would like to address the need to direct support towards pharmacists in tackling medication-related issues within the community. One such issue is polypharmacy, which is the concurrent use of multiple medication. It is a growing and persistent issue in Singapore as our population rapidly ages alongside with an increase in the number of patients with chronic diseases. In the previous committee hearing, I talked about the different types of medication waste. Some examples include expired drugs, drug hoarding, drugs prescribed without indication, or duplication of drug therapy. I quoted a study from a local hospital on the estimated drug wastage cost detected during hospital pharmacist visits, at any time point, to be a staggering figure of $663 per patient.”
“Mr Chairman, I declare my interest as the President of the Pharmaceutical Society of Singapore and the Assistant Director of Allied Health Office at KK Women's and Children's Hospital. I would like to speak on how MOH can empower our allied health practitioners, AHPs in short, and collaborative prescribing practitioners, or CPPs in short, to combat chronic diseases in Singapore by giving them the right tools through specific policy changes. I spoke during the Employment (Amendment) Bill debate in 2018 on allowing AHPs and CPPs to issue recognised medical certificates (MCs). Currently under the Medical Registration Act, only qualified medical practitioners are able to issue medical certificates. As our ageing population increases along with the surge in chronic diseases, we need to change our approach towards long-term follow-up for chronic patients to ensure healthcare and financial sustainability. AHPs and CPPs need to have the right tools to step up in their roles to care for these patients. At the moment, it is reassuring to see more of them taking over follow-up appointments for chronic cases as well as being equipped to manage them. However, they are handicapped for reasons pertaining to regulatory restrictions. Patients often require MCs after consultation and they will have to be directed to medical doctors for issuances of MCs. This results in unnecessary delays to patients and is disruptive to the AHPs and CPPs as well as the doctor who might be seeing another patient. I request that MOH consider permitting this group of healthcare professionals to issue MCs which are limited to two days per patient visit, starting with restructured healthcare institutions where AHPs and CPPs are taking on more in the management of chronic disease patients.”
“As such, instead of a blanket policy to limit S Passes with minimal exceptions, I would still like to appeal for MOM to consider showing flexibility to employers trying to hire locally with failed attempts to turn to foreign workers. I believe that if we want to reserve jobs for Singaporeans, we should reserve jobs that they prefer – jobs with good career upside and work-life balance. And if the intent is to avoid over-reliance on foreign workers, then there is a need to ensure that the solutions provided to solve current problems are feasible, for example, if there is good headway with mid-career transition programmes, before we further cut S Pass quotas. Mr Deputy Speaker, notwithstanding the above, I stand to support the Budget.”
“Thirdly, Deputy Prime Minister Heng Swee Keat and Minister Josephine Teo spoke about foreign worker policy and the need to further restrict S Pass holders for the identified industries. While we agree that we should always put Singaporeans first and give them the best possible opportunities, but we know that there are jobs out there that are really challenging to find locals to take on. An example of healthcare-related jobs are pharmacy technicians, whose service is required 24/7, including public holidays and weekends. Although we have polytechnics that specialise in training and educating diploma holders to support this pipeline of pharmacy technicians, most of our youngsters aspire to take on higher qualifications after their graduation, leaving a constant vacuum in the system. I am concerned that if this persists, pharmaceutical care for our patients will be significantly impacted. To overcome this long drought, pharmacists are actually standing in to take on pharmacy technicians' duties. This is extremely cost-inefficient, especially in view of rising healthcare cost, as we are not fully utilising their advanced skills and knowledge to serve our patients. I believe that service industries in other fields are also facing similar problems. While the Government may advocate for automation to improve productivity, there are situations where automation, for various reasons, is not feasible. In healthcare, a lot of frontline patient care activities require healthcare professionals to display empathy and compassion to each individual patient. Such duty of care simply cannot just be easily replaced by machines, and I think similar sentiments can apply to many service industries.”
“While I understand that these courses are already highly subsidised, I am wondering if it would be more effective to further subsidise it, but add a limit to the number of courses each individual can take up per year, instead of mass distribution of these funds. This would allow interested citizens to reap the full benefits of the subsidy while we continue to encourage those who have not signed up. Secondly, while I support the financial assistance schemes, such as ComCare and MediFund top-ups, which aim to provide support for our needy families, I am concerned about the central checks and governance that ensure appropriate utilisation of these funds. At this juncture, I would like to declare my interest as the President of the Pharmaceutical Society of Singapore and the Head of Pharmacy at KK Women’s and Children’s Hospital. As a healthcare professional working in public over the past 20 years, I foresee potential loopholes. For example, what is in place to prevent a MediFund applicant from going to different healthcare institutions seeking more-than-required medical supplies, nutritional supplements and medications? Can the applicant ask for waiver from the National Electronic Medical Record sharing, quoting PDPA rights, to avoid detection? How can we tell if each claim is within reasonable limits and not excessive? And f there are excess claims, how are these rechannelled to help other needy patients and not inappropriately disposed of? There is a need to tighten how these funds are used to ensure that the taxpayers' money is spent appropriately. Without central audits and controls in place, there is a potential for misuse.”
“Mr Deputy Speaker, Sir, I thank Deputy Prime Minister Heng Swee Keat and his team for planning this comprehensive and strategic Budget, which aims to tackle a wide scope of upcoming challenges, such as the gloomy economic outlook, further complicated by COVID-19. This Budget aims to provide Singaporeans with new job opportunities as well as care and support for those in need of financial and social assistance. Just as important, I admire the foresightedness and proactiveness in safeguarding our future against the potential harm brought about by climate changes. The decisive move of providing financial assistance to help businesses, especially those heavily impacted by COVID-19, is also critical and timely. The Budget set aside to prepare our youths to be more globally ready through overseas exposure is also a step in the right direction. However, I would like to ask for the effectiveness of the SkillsFuture credit top-up of $500 scheme for adult Singaporeans aged 25 and above and the special SkillsFuture credit top-up scheme for Singaporeans aged 40 to 60. May I know what is the percentage of the originally allocated funds that have been used so far and what is the participation rate across the nation over the years, especially for the individual participants? For those who have utilised the SkillsFuture Credit, what percentage has actually resulted in successful career switches or career progression? I believe that a one-time funding of $500 may not be sufficient in paying for a fully effective, upskilling course as lifelong learning requires continuous, ongoing support. Furthermore, not everyone has the desire for upskilling and should there be much of these funds left unused, there will be misallocation and underutilisation of resources.”
“I thank the Ministers. My question is: in the event if we need to step up to using N95 masks because there is wide community spread or for future viral outbreaks, how do you ensure that the public are fitted with the right model of N95 masks? Because what is being done in the healthcare institutions is we actually go for mask fitting test to ensure that there is optimal protection, because different models fit different face shapes and the public may not be aware of this.”
“I seek clarification as to whether the overlapping of regulatory scopes might cause confusion and inefficiency in running these different services. Finally, I would like to ask how will the new HCS Bill impact pharmacy licensing for health screenings, telemedicine services and collaborative prescribing services in the community as they fall under the list of licensable services of this Bill. How will this impact future pharmaceutical services, such as pharmacists looking into providing vaccination service in the community? I look forward to the Minister’s response to the above-mentioned concerns. I support the Bill.”
“These recommendations are targeted to be implemented fully in three years' time and I applaud the committee for the extensive review. I thank the Government for taking full responsibility and accountability for the lapses and using these lessons as opportunities to strengthen our public data security. So, with these initiatives set in place, I seek clarification as to whether MOH has plans to introduce mandatory NEHR core data contribution by licensees and, if so, can the Minister provide a timeline so that private healthcare facilities may be better prepared in the eventuality that these recommendations are implemented? At this juncture, I would like to declare my interest as the President of the Pharmaceutical Society of Singapore. I have a few queries regarding the change from premises-based to service-based licensing for pharmacy services. How can MOH ensure that there are no overlapping scopes and standards across different regulations? Take, for example, hospital outpatient pharmacies which provide dispensary and medication delivery services for walk-in patients, as opposed to their own hospital patients. Although the type and level of services provided are similar, the same pharmacy is subjected to two different Acts, respectively, hospital patients which fall under the PHMCA, as compared to the walk-in patients which fall under the Health Product Act. Another example is the tele-pharmacy services provided in hospitals for hospital patients versus those provided by retail pharmacies for patients in the community. Although these services are similar, they are subjected to different Acts with different licensing requirements and standards.”
“Next, I refer to Part 1 of clause 5 of this Bill which states that the Bill does not apply to and is not related to any healthcare service provided by the Government. Can the Minister explain the rationale for this exclusion and how can we be assured that healthcare services not governed under this Bill will provide similar patient safety and governance standards, for example, ambulance services provided by SCDF and medical services provided by the Ministry of Defence? Would an inclusion instead enhance safety and align standards across the country, with MOH providing an independent oversight as a Ministry with expertise in healthcare? Also, Part 2 of clause 22 requires that the Director keep and maintain a register of licensees. May I ask if this list will be made public with their licensed scope of practice made known to patients? Part 3 of clause 28 in the Bill imposes restrictions on licensees who employ staff to work in healthcare services which cater for the frail and vulnerable patient groups. I would like to clarify if the existing staff currently working in these premises will be screened as well or if the Bill only refers to new hires? What is to be done if the existing staff do not meet the current requirements stated in the new Bill? I understand that the Public Sector Data Security Review Committee chaired by Senior Minister Teo Chee Hean has made five key recommendations to improve public sector data security, and these include enhancing technology and the relevant processes to protect public data, strengthening data detection and responsiveness to data incidents by building data security competencies across the Public Service, ensuring improved accountability and transparency and, lastly, sustainability of data security efforts.”
“Mr Deputy Speaker, Sir, I laud MOH's move to repeal the current PHMC Act and replace it with the upcoming Healthcare Services (HCS) Bill, which aims to transit from a premises-based licensing framework to a services-based one. This is a progressive move which will cater to new models of healthcare delivery, in tandem with medical technology advancement, the growing needs of an ageing population and increased chronic disease concerns. This augmented Bill will provide improved patient safety in the changing healthcare landscape through more efficient governance while allowing for new and innovative healthcare services to be deployed on online and mobile platforms. However, I do have some questions concerning the Bill. I understand that although Allied Health and Non-Physician Healthcare, Traditional, Complementary and Alternative medicine fall under the HCS Bill, they will not be licensed for the time being. I ask if the Minister will elaborate on the future plans and timeline as to when these aspects will be covered because it may affect healthcare professionals practising in these areas, or perhaps under what kind of circumstances will an actionable response be considered to include them in the Bill. Furthermore, I would like to ask how MOH plans to transit healthcare institutions from the PHMCA to the HCS Act. How will the existing services be mapped out and what will be the differences in standard requirements as well as the impact on healthcare institutions and professionals? How will the consequences affect licensed sites which are currently co-locating with the non-licensed services, such as Traditional, Complementary and Alternative medicines or Allied Health services?”
“Next, IRO should be as inclusive as possible with the various faiths to ensure religious harmony. Finally, the Government should empower NSC to bring in faith groups together for a common cause and promote religious awareness education in Singapore. I look forward to MHA’s response to my proposals and the concerns raised by some of our religious leaders.”
“With the growth of interfaith organisations in Singapore, perhaps NSC can be the central body to bring these interfaith groups together to discuss how each organisation can work in synergy and be aligned with the national strategy and direction. One of the potential areas of collaboration could be developing authentic religious educational materials for MOE to raise awareness in students. Currently, there is no syllabus in schools imparting knowledge about our various religions. This prevents citizens from having a stronger understanding of each religion so that they feel comfortable and safe to engage in discussion. A successful, harmonious society should be one where we understand one another’s religion and are able to openly share without causing tension, rather than one where people choose to be silent and harbour ignorant ideals of another’s religion. Mr Deputy Speaker, as we ended our conversation, Haniff also shared that there are still day-to-day challenges and that religious harmony efforts remain a work in progress. I quote Prime Minister Lee’s recent speech in New York that "Singapore is ranked the most religiously diverse country in the world, but its harmonious society did not come about by chance." His words remind me of the numerous unsung heroes in Singapore, committed to their vital roles to bring peace and harmony to our country. They include our inter-Ministerial colleagues, our Home Team, religious leaders, interfaith advocates, responsible media and a strong Singaporean community. Mr Deputy Speaker, I would like to summarise. Firstly, to form a conclave of official and religious mediators to strengthen community ownership regarding sensitive religious matters.”
“An elderly Muslim man lived alone and was neglected by his family. To stave off loneliness, he joined a Church, participated in Christian activities and, over the years, decided to embrace Christianity. However, he became very ill and one of his last wishes was to die as a Christian and be buried according to Christian rites. Subsequently, the family came to know of this and made a Court injunction to stop him from being buried with Christian rites. The Church countered this challenge and brought the matter to Court. For such a scenario, religious mediators are much needed by the authorities to step in and find an amicable solution. Greater emphasis should also be placed on intra-faith harmony. While the IRO Council promotes interfaith harmony, it is equally important for us to focus on intra-faith harmony. There are many examples of intra-faith conflicts all around the world for us to learn from, such as the Shia-Sunni conflict in the Middle East. Hence, it is important for us to follow the principle of "every Singaporean matters". Despite the occurrences of sensitive disputes, we are all Singaporeans, regardless of religion, and one has to acknowledge that all religions form part of our social fabric, too. So, perhaps the IRO can consider expanding its membership to include other faith sect representatives, so that we can work together towards a more inclusive society. I also understand that the National Steering Committee (NSC) on Racial and Religious Harmony is a national platform built to bring together top levels of community, the Government and faith leaders.”
“This way, if practices are breached, regardless of whether they are religious in nature or not, they can be dealt with similarly, instead of incorporating into this Bill and putting an unflattering spotlight on religion. Another concern is about leadership requirements placed on Singapore’s religious organisations. It is stipulated that their governing bodies and top leaders are required to be Singaporeans or Singapore PRs. All religious societies in Singapore have their origins overseas and it is not uncommon that their leaders are appointed from their head organisations overseas. I understand that MHA do have provisions for exemptions on a case-by-case basis. Can I ask if MHA can elaborate further on the criteria for exemptions, so that this process is more open and transparent? Can it provide assurance that this change will not compromise their leadership appointment process? MHA has been very vigilant in monitoring religious matters happening in Singapore. We all know the stakes are very high when it comes to maintaining racial and religious harmony and any imbalance can severely affect security, peace and stability. We can do more to strengthen community cohesion and engagement through forming a conclave of renowned, highly respectable community leaders, and empower them as spokesmen to front religious sensitive matters. Such an initiative is apparent to MUIS, but more can be done to extend this to other religious organisations. This can help to promote community ownership for sensitive matters related to religion. A select group of official, religious mediators can also support these leaders through mediation and cross religion practice awareness training, also coordinated and assisted by MHA. Allow me to posit a case where religious sensitivity was involved.”
“I was introduced to several religious leaders, educators and interfaith advocates through Haniff and while most of them are generally supportive of this Bill's amendments, they do have some concerns that they have laid out in the hope that the Government will consider them. First, I would like to talk about the introduction of mandatory declarations for foreign donations of $10,000 per transaction to safeguard against foreign influence. Mr Deputy Speaker, while they are supportive in principle of the mandatory declaration for foreign donations, they would like to find out how was this quantum decided, because the value seems modest in today's day and age. We must place trust in our respected and learned religious leaders to be accountable, and reduce the administrative burden on these organisations. Can MHA provide evidence or examples of past cases where foreign countries exerted influence and control over religious organisations through donations? How much were such donations? How is the proposed quantum compared with figures used, let us say, to monitor for money laundering activities or terrorism financing activities in Singapore? Some religious leaders are concerned that this requirement will add on more administrative work and may deter future donations needed to support their community work, as some donors may prefer to remain anonymous. As there are many ways for external influence to act on a country and disrupt societal harmony, would it not be possible to deal with these concerns as a whole through a Foreign Interference or Social Harmony Act?”
“Mr Deputy Speaker, Sir, we are witnessing a sharp increase in sectarian and religious violence in the world, and Singapore is not unsusceptible to such external influences. As such, we need to be mindful of the aspects which could pose challenges to religious harmony in our society. Immigration is one such aspect. New citizens and foreigners may not be familiar with living in a multicultural and multi-religious environment and there may be more diversity in the practice of faith, which can cause potential rifts and conflict among practitioners. While I was going through the Bill, I thought of Muhammed Haniff Abdul Razak, my long-time family friend, who has devoted a big part of his life to inter- and intra-faith harmony work. Haniff was previously serving on the Islamic Religious Council in Singapore and was tasked by MUIS President Encik Alami Musa to set up a Harmony Centre in Singapore. Together with Imam Habib Hassan and Ms Hairani Hassan, they came together to devise a concept and pioneered this initiative that provides inter-faith services in Singapore. This Singaporean concept of a Harmony Centre has deeply impressed many interfaith organisations across the world. And, with that, in 2010, Haniff was invited by the esteemed Prof Venerable Master Chin Kung and the Late Mr Ng Kim Suan to set up a similar centre in Australia, and since then, shared and replicated this model with many other countries, such as the UK, Taiwan, Hong Kong, Thailand, Sri Lanka, Bangladesh and many others. This clearly demonstrates how our little red dot can be an incubator for innovative models and influencing practices all across the world.”
“While I understand that MOH has appointed an actuarial consultancy to compute the premiums and in time to conduct an evaluation of the liability of the scheme, having an independent actuary on the CareShield Life Council can help by evaluating the robustness of the actuarial analyses and computation methodology in light of this scarcity of data, validating the conclusions drawn from the analyses, probing for the safeguards the consultant actuary has built in to avoid having to change premium rates too frequently. As the proposed Council member will be providing actuarial advice, a Fellow of SAS, who is governed by the standards and code of conduct of SAS, will be most appropriate for this role. Notwithstanding the clarifications and proposal above, I stand to support the Bill.”
“An actuary with a statutory role, such as the Appointed Actuary of a Life Assurance Company or the Certifying Actuary of a General Insurance Company, is also required to have a Practising Certificate awarded after attending relevant courses run by the SAS locally. Hence, with regard to section 37 of the Bill regarding the CareShield Life Council, I propose that when the Minister appoints the Council, can the Minister consider including a Fellow of SAS who is conversant with the financial management of long-term care insurance in the Council? The viability and sustainability of the CareShield Life Scheme are highly dependent on the appropriateness of the premiums and the adequacy of the assets in the CareShield Life and the ElderShield Fund to support the benefits promised under the scheme. CareShield Life is a long-term insurance programme. There may be uncertainties in how the experience will unfold and there is a lack of long-term care historical experience to guide an actuary in pricing and valuations. To carry out the work, the consulting actuary has to transfer and adapt experience from other countries and draw up assumptions of future experience such that the likelihood of having to adjust the premiums is kept at an acceptable level, keeping in mind frequent adjustments to premiums leads to loss of confidence by the public in the scheme.”
“Mr Deputy Speaker, Sir, I thank the Minister for this timely Bill as we prepare ourselves for the silver tsunami. The introduction of the new $5.1 billion CareShield Life as universal healthcare insurance to ensure lifetime coverage and higher monthly payouts is definitely moving in the right direction. While I understand that CareShield Life aids to subsidise the cost of long-term care for adults above age 30 with severe disability, what about patients below 30, such as paediatric patients with severe disability? Though I am aware that the topic of differential premium for men and women introduced for CareShield Life was widely debated previously, I would still like to state my stand and hope that MOH can review its position. The principle underpinning insurance is risk pooling. Hence, I do not agree that our society should go the route of differential premium by gender, causing gender divide. Otherwise, we may start the trend of potentially differentiating premiums in future by race or other genetic risk factors as we advance into precision medicine. Lastly, as the Nominated Member representing the professional bodies in Singapore, I hope to bring awareness to the House, the Singapore Actuarial Society, a governance body for the actuarial profession in Singapore. The Singapore Actuarial Society (SAS) was established in 1976. Fellows of SAS are in most cases Fellows of the Society of Actuaries in the US, the Canadian Institute of Actuaries, Institute and Faculty of Actuaries (UK) or Institute of Actuaries of Australia. Like other professional bodies, SAS requires Fellows to maintain and disclose annually a minimum level of continuing professional development.”
“Can I ask the Senior Minister of State when will be the timeline for implementation of this new audit system?”
“To continue with my proposition, a long-term plan would involve the execution of a five- to 10-year phase which will introduce new legislation, in view of increasing fire risks from an ageing population and from more extensive use of PMDs. The implementation process may be long, but we need to start with the first step. This new legislation shall include mandatory installation of fire alarms, both exterior along HDB corridors and interior in homes, while concurrently equipping all homes with a fire extinguisher or at least a fire blanket for economical reasons or practical maintenance. I hope my suggestions provide much needed insight and I look forward to having them considered seriously and implemented.”
“A short-term plan would be for SCDF to introduce a fire safety checklist to raise awareness and the level of fire safety standards in homes. Furthermore, the Government should ramp up educational efforts in the community and in shared spaces on fire safety. Perhaps, volunteers from the neighbourhood watch zone or Silver Generation Ambassadors can be engaged to expedite efforts to encourage the take-up of fire extinguisher or smoke detectors. Consequently, certified smoke detectors, fire extinguishers or fire blankets should be made more accessible and affordable within the community for purchase as they are the first lines of defence in the event of fire. For this purpose, a national procurement competition would be very suited to design and introduce a lightweight and all-purpose fire extinguisher easily used by the young and elderly. Residents may not be aware that water cannot put out grease fire, and also, fire extinguishers are loaded with different dousing agents to fight specific fires. Some extinguishers are ineffective against certain fires, while others could potentially worsen the situation. Having an easy to use and lightweight all-purpose extinguisher at hand will infinitely reduce the threat of a fire emergency. Supermarkets can then be involved with the sale of this extinguisher to make it more accessible. This way, residents will not need to worry if the fire extinguisher they purchase is certified, as there are many types of uncertified extinguishers available online. I then move on to ask if the revised Act will cover online sales of non-certified fire extinguishers and how do the authorities plan to regulate this?”
“In 2017, the President of the Fire Safety Managers' Association forewarned that "in many cases of home fires, there have been cases of injuries or death due to smoke inhalation, which could have happened while the occupants were asleep. A localised smoke alarm will alert residents so that they can react to the fire at an early stage." He also cautioned that the voluntary take-up rate of fire alarms and extinguishers in homes has been low, despite encouragement from the authorities. A fire safety expert from a fire safety solutions provider in Singapore clarified that often, the deadliest fires are small fires that quietly smoulder and cause smoke while people are sleeping or are in a different room. Without the early warning provided by an alarm, people can be overcome by smoke even before the fire is discovered. A 2015 report by the US National Fire Protection Association has found that the fatality rate from residential fires in homes with working alarms was 40% lower than in those without. Out of the 4,114 fire calls responded to in 2016 in Singapore, 68.5% were fires in residential areas, an increase of 62.9% compared to 2015. These fire incidents have resulted in three deaths and 60 injured in 2017, two deaths and 62 injured in 2016. The predominant reasons cited by SCDF for residential fires were materials set alight in rubbish chutes, bins or unattended cooking. Recently, we have observed an increase in PMD-related fire incidents. As we can see from the statistics I have cited, smoke detectors would be very effective as a preventive fire safety measure, as they would provide residents with an early warning sign. So, my proposition to improve fire safety for all residential areas are twofold.”
“Mr Deputy Speaker, I am in support of the Fire Safety Bill amendments, which include mandatory critical fire safety upgrades for existing buildings, and tightening regulations of fire safety products and materials sold in Singapore. MHA should be commended for their progressive and pre-emptive responses to install fire alarm devices, or smoke detectors in short, for new and existing residential premises carrying out fire safety works from 1 June 2018. SCDF, HDB and the People's Association (PA) have also been working together to install smoke alarms in flats let out under the HDB Public Rental scheme at no additional cost to tenants. More than 50,000 households will be covered by this assistance scheme, and installations implemented in phases to prioritise households with one member aged 60 and above. I understand that there are also ongoing efforts by grassroots leaders and Members of Parliament to educate residents on fire safety in their homes. It is, therefore, very regrettable that MHA is not insisting for smoke detector HFADs to be installed in all existing residential premises that are not carrying out fire safety works. This is in spite of the fact that existing homeowners are strongly encouraged to install smoke detectors for their own safety. I would like to express that encouraging homeowners to practise good fire safety habits is woefully insufficient and does not provide adequate coverage, compared to homeowners who already have the devices installed. Consequently, I would like to ask MHA the reasons for the differing treatment and if there are any long-term plans to make smoke detector installations mandatory for existing residential premises?”
“I thank the Senior Minister of State. I would like to congratulate the Ministry of Health for the excellent leadership and planning in this recall of losartan event, taking an open but calibrated approach to ensure that patients have sufficient, unaffected stocks and, at the same time, avoid panic on the ground such that patients stop taking their anti-hypertensives. I think this is something the world can learn from us. Just a question: when are we expecting the stock to be stabilised so that patients will not be inconvenienced by the current stock restriction policy?”
“We are not suggesting that the oversight committee take over this Executive decision, so we still maintain for Ministers to make the Executive decision. So, our stand of independent oversight Council is for review of the past cases to finetune future Bills. That is all.”
“Yes, I would like to make a correction that when I meant "independent council", I am not referring to a council that will make Executive decision. So, what we are proposing is a post review council for learning purposes.”
“I would like to receive the response to my questions and an honest discussion following.”
“The majority of Singaporeans support the vision and bravery of this Bill and trust the sitting Government to be honest and just in its implementation. As implicit in the asking of trust from the people, trust should also be paid forward to the people, that we are able to discern fake news as a highly educated populace. The Government will imperil itself if the people perceive that this Bill takes too much liberty with their freedom of speech. I appeal to the House to seriously consider lifting the Party Whip and allow Members to vote according to their conscience for tomorrow's voting. This Bill will have a huge impact on the average Singaporean's freedom of expression and possibly our nation's progress. Many civil groups harbour genuine concerns over this Bill, as evident by the 170 written representations from individuals and organisations who submitted to the SC, and this includes numerous open letters and joint statements published in protest of this Bill from both local and international fronts. Hence, I think it is our moral obligation to give constructive criticism and proposals to finetune this Bill in the best interests of Singapore. If left unrevised, this Bill may have long-term repercussions on freedom of expression and speech, impede the development of an engaged and intellectual public, and erode the trust in our Government. At the end of the day, it is our solemn duty to uphold the mandate by the people and justify their trust through uncompromising policymaking and rigorous debate. Undoubtedly, I certainly have strong reservations for the Bill in its current form. While I do see positive elements within the Bill, Mr Deputy Speaker, this Bill, in its current state, will need further clarifications before it is ready to be passed.”
“Though the final arbiter will be the High Court, what about cases that do not appear before the High Court? This is pertinent if actions will be taken against individuals or small groups of people compared to large tele-media companies, whose access to resources provides greater efficiency for recourse in Court. This oversight council is in line with the SC's Recommendation 10c: "Existing efforts should be reviewed, to consider whether they are adequate to achieve transparency, participation and communication and accountability". Having an independent oversight council to evaluate the effects of fake news will allow directives to be issued in an effective manner and ensure credibility in our governance. The proposed council is not meant to be at odds with Ministries or the Courts in any way, but to allow for transparency, accountability and synergy. It will clearly add much-needed integrity to our entire political system. Additionally, the case studies compiled from the council's annual report can be used for public media literacy education, and to establish consistency across Ministries in refining future Bills. The Minister has said that Parliament should be the final check and balance, and in this place, should we then not dissolve all the existing councils. I believe they are set up for a reason. The same rationale for our proposal. As the first country in the world to enact a Bill with such broad strokes to curb the volatility of fake news, a steep learning curve is to be expected. I believe that we will get it right, striking a balance between curbing fake news and ensuring freedom of speech. Central to the discussion is the element of trust in pursuit of truth.”
“Sir, this brings me to the next point to confer Ministers with executive powers to issue correction orders and takedown notices. How do we ensure consistency in approach across Ministries to determine between fact and opinion? How do we see to it that there is no "cherry picking" when it comes to acting against specific information not in favour of the Government? If fake news originates from the Ministry itself, who then decides to have that Ministry take it down? This is the characteristic dilemma of "Who watches the watchers?" In a democratic society, the rule of law should apply to everyone. I acknowledge Minister Shanmugan's assurance that members of the public have the recourse of appealing the Government's decision via the Court and he has also advised that the process will be relatively "fast and inexpensive". That said, there is no mention in clause 17 of the Bill for an expeditious recourse. The Bill does not specify the prompt access to recourse in the event of a wrongly executed takedown of supposed fake news. I would, therefore, like to propose a stipulation in the primary legislation for the Government to respond in a timely fashion for information clarification and facilitation of the appeal process. Although I understand a timeline for appeal will be stated in the subsidiary legislation, I strongly urge the need for an expeditious appeal process to be included in the primary legislation, for example, not more than how many days. This signals a stronger reassurance that prompt access to remedy is readily available and any future Government will have to go back to Parliament to have this amended. The next point of contention is the lack of an independent oversight council for checks and balances.”
“Our citizens will need to think twice if a view is a fact or an opinion before expressing it and be able to correctly interpret a view even if information is not readily available. This issue is compounded by the fact that Singapore does not have a Freedom of Information Act, where citizens can request for data from the Government instead of having to do their own fact-checking and analysis. Can we remedy this by providing information that the public seeks? Would the Minister consider implementing both Bills together as a counterbalancing approach? Citizens would also need to consider if the content they share or upload is targeting a person or the Government and take precautions to avoid legal consequences with laws, such as the Defamation Act or the Internal Security Act, amongst others. How would these Acts cooperate or conflict with one another, given their overlapping functions and how will they be handled? Depending on how this law is implemented, there will be heightened concerns with legal ramifications. Apprehension and over-cautiousness will arise from expressing views and uploading content for fear of swift legal reprisal. Citizens will feel inhibited to raise or discuss sensitive topics related to the issues close to their hearts. There is also concern of the legislation being used against citizens who criticise the Government or have views contrary to the ruling party. Law Minister Shanmugam has clarified in The Straits Times that opinions, criticisms, parody and satire will not be covered. However, these reassurances are not explicitly addressed in the Bill. Proactively including this language will go far to allay these concerns.”
“For example, Germany's Network Enforcement Act or the French anti-fake news law against the manipulation of information. In both instances, a "notice and takedown" order is issued against purveyors of fake news. The Minister has suggested that the Bill put forth offers a more calibrated approach wherein correction orders are possible. This allows for contents with correction notice to be still available for debates and, therefore, more informed decision-making and this is, indeed, progressive. However, one feature to note in our current Bill is that it applies to any person or organisation deemed to be spreading fake news. The aforementioned German and French legislation limit the scope of the law to only tele-media service providers operating Internet platforms. Large tele-media companies have the ability to counterbalance and respond to challenges from the Ministry. It is quite different for individuals or smaller organisations and, hence, the concerns about the impact on general freedom of speech. I would also like to highlight some concerns regarding the definitions listed in the Bill. The definition of what constitutes "statement of fact, public interest and diminution of public confidence" is very broad. Sir, I suggest that these definitions and terminologies be clarified and explicitly defined for the layman in the principles of the Act in the Bill, as what has been practised for POHA. This will help agencies effectively implement the Act and give the general public a general grasp of what it means. The law cannot be set up just to be understood by the Court, and citizens do not understand at all. The consequences of these overly broad definitions can lead to chilling effects on freedom of speech and expression for our country.”
“Mr Speaker, Sir, I will state from the outset that I am fully supportive of the legislative intent of this Bill. Fake news is extremely detrimental to society, and the severity of its effects cannot be understated. Its negative impacts range from the weakening of national security and public institutions to influencing election outcomes. It also influences the actions of people and affects trust, which, in turn, may lead to violence and loss of lives, warping social and public discourse. [Deputy Speaker (Mr Charles Chong) in the Chair] The speed with which online falsehoods spread and threaten public interest cannot be addressed effectively using the usual judicial process and require timely executive action. We also cannot rely solely on non-legislative measures, such as self-regulation of online platforms or only focusing on promoting media literacy. Countries that rely on such approaches have not found much success in tackling fake news. Battling fake news is similar to combating terrorism or fighting a war on drugs. There is no hard and fast answer. However, neither should a blanket policy be applied. Formulating a solution will require vigorous debate and consideration before executing a final calibrated response, much like a surgeon using a scalpel to remove necrotised tissue and not harming healthy cells. Minister Shanmugam shared that the current existing laws give the Government more powers and are broader. In view of the recent public concerns, should we not then seriously review this, rather than using existing laws as gold standards, because those are big hammers and I believe they are intended for a different purpose? Currently, I am aware of the following countries that have enacted laws against falsehood.”
“These free apps help women collect detailed evidence in order to obtain a protection order or prove a breach of one. They collect photographs, videos and recordings and save them off device to ensure that the evidence is protected and can be used in court later when victims are ready to lodge a report. The Daisy app in Australia provides information about support services within the vicinity and includes safety features to help protect the privacy of people using it. In the US, the Sojourner Peace app is available in multiple languages and provides resources for victims of domestic abuse in a quick and discreet way. It also provides links and phone numbers to places where survivors can seek help and access the Sojourner's 24-hour domestic violence hotline. To recap and emphasise, an app mentioned above would greatly benefit victims of domestic abuse and facilitate the ease of reporting for abuse cases. By adding features, such as discreet evidence gathering, a one-touch Police alert option and the central hotline number, we can ensure that every service is synergised to provide the best protection and survivor-centric help to all victims of domestic violence in Singapore. Notwithstanding my above points, I stand to support the Bill.”
“Victims can also be directed to websites, such as AWARE, through the app, where information on domestic violence education can be found. This is if they feel the need to consider their situation before taking further action. It is also vitally important that an algorithm be implemented in the app to separate the more urgent cases and triage victims who require immediate medical attention from abuse. Through these processes, victims will be able to chart their journey towards restitution and rehabilitation should they choose to lodge a formal report. They will also be educated on frequently asked questions and fully assured that there will be no backlash from their abusers. There have been many precedents where victims have successfully sought recourse through lodging a report, and these inspiring stories should be made aware through the app to encourage reporting. This central hotline and app can also be a platform for members of the public or bystanders to report abuse cases with anonymity, and an avenue where they can be taught how to help victims of abuse. However, while most do not report such cases to the authorities or hotlines, many may want to seek advice or information for family members or friends. Having a standalone app or a secondary municipal app feature will be useful in encouraging reporting or seek information on how to help abuse victims. Members of the public may be more comfortable making a report online compared to calling a hotline. There are many examples of such apps available overseas and their features which can be used as reference. The Smartsafe app, by the Domestic Violence Resource Centre in Australia or the Bright Sky app by the UK charity body are a few examples.”
“In the interest of reducing prolonged cases of domestic violence and abuse, I request that a central dedicated hotline be set up with trained personnel to handle all domestic violence calls. Concurrently, a standalone app or feature should be introduced like our current municipal app, such as OneService or SG Secure, to handle all social abuse ranging from child, spouse, elderly or other vulnerable groups and even include animal abuse to allow for a more coordinated response. This way, victims do not have to be routed to call various touchpoints and repeat their accounts. This dedicated hotline and app can be designed to offer all victims of domestic abuse immediate relief from their plight in three stages: firstly, through crisis intervention and counselling; next, indoctrination and action on the various channels of recourse; and consequently, a successful resolution and rehabilitation. Our current system requires victims to call various resources at different hotlines, which is confusing and can be a deterrent. The staff working at this central hotline and app can be trained in crisis intervention and be assigned to handle individual cases to build rapport with victims through counselling. They can then coordinate with local resources, such as the Police, hospitals, or pro bono legal aid for a more integrated, victim-centric care. The staff can then work out a personalised safety plan, which will include how to receive financial assistance and how to gather evidence of abuse if the case goes to Court. In the event that the victim cannot continue residing in their home for fear of continued abuse, coordinating staff will assist to put them up in a temporary shelter and seek protection order on their behalf with their consent.”
“Their endeavours have led to enhanced detection, reporting and management of child abuse cases, resulting in a very significant increase of 60% in reporting. However, there is always room for improvement. A quote from social workers from a Straits Times' article in 2017 has indicated a disparity where, "when a child is abused by a stranger, family members are quick to report; however, this is not so when the abuser is a family member." In recent years, there has been a trend of cases involving children dying or severely traumatised from brutal, chronic physical, psychological and sexual abuse in households. And to hear of this is absolutely heart-breaking. It is also very distressing that most child abuse cases in Singapore involve caregivers. In 2015, MSF was quoted by The New Paper stating that "in the 64 cases of alleged sexual abuse reported and investigated from January to September 2015, for every case, the alleged perpetrator was a family member or someone residing in the same household as the victim." These cases often go unreported as the victims are afraid that the family may be devastated. The victims, more often than not, are unable to fend for themselves or are too afraid to come forward to seek help. As such, it is of paramount importance that members of the public, such as the neighbours, relatives and friends, are encouraged to come forward to identify victims of family violence. In a similar vein, spouse abuse is the most common form of family violence in Singapore. A study by the organisation PAVE, based on 3,600 cases over the last 10 years, found that victims who are physically or psychologically abused by their spouse made up a disquieting 72% of new cases.”
“Mr Deputy Speaker, Sir, the Criminal Law Reform Bill could not have arrived in a timelier manner, especially in light of the changing crime environment in Singapore by virtue of the proliferation of social media and smartphone use. I would like to commend MinLaw, MHA and PCRC for working unceasingly over the past two years soliciting feedback from various sectors, both private and public; from judges and private practitioners to academics, the Police, as well as public consultations with selected groups and social organisations working with vulnerable victims. The outcome of the Bill is one that is relevant, practical and well-calibrated to ensure that the vulnerable are protected, and the resulting punishments accurately reflect moral culpability. I am very heartened to hear that the latest changes repeal marital immunity for rape and introduce higher penalties for offences knowingly committed against vulnerable victims. These also include charging members of the household guilty of offence for causing or allowing the death of a child under the age of 14. While we have a comprehensive, robust Bill to protect victims from criminal offenders, it is contingent upon us to constantly look for ways to facilitate the reporting of domestic violence. The reasons for not reporting can be complex as they range from social, psychological and financial considerations to the ease of reporting. I would like to take this opportunity to laud MSF for their considerable efforts over the years to introduce more rigorous screening tools, training more professionals in operating these tools, and creating more public awareness towards these issues.”
“I have some concern to raise to the Minister. I lodged a complaint to SMC recently. I was told that I needed to wait for three to four months to see a commissioner to make a statutory declaration. After that, I have to wait for another at least nine months for the CC to look into the case. So, in view of the huge backlog which I understand that SMC is trying very hard to clear, is there a current immediate plan to triage some of these complaints so that we do not have errant prescribers that continue to practise and affect the public's safety?”
“I am referring to the Public Sector (Governance) Act, Official Secrets Act, Income Tax Act and Infectious Diseases Act.”