Khaw Boon Wan
Singapore
“Motor vehicle dealerships and showrooms have been closed since the start of the circuit breaker. As COE bidding is done mostly by the motor vehicle dealers on behalf of prospective owners, the Land Transport Authority (LTA) suspended COE bidding for the months of April and May.”
“Though stressed by the financial pain, they press on with the immediate priority of fighting the virus and supporting essential services. Post-pandemic, we will see how public transport evolves. Will demand for public transport services simply return to the pre-pandemic level?”
“Under our rail financing framework, the Government fully pays for the cost of building new rail lines. In other words, we do not recover the cost of building the Cross Island Line (CRL) from commuters through fares. The CRL project is being implemented and the final costs will depend on tender bids.”
“There are around 5,000 private bus operators with a combined fleet of 13,500 private buses. As we do not track the number of private bus trips and passengers, we do not have data on their carbon emissions.”
“There are nursing rooms at 50% of our bus interchanges. We will provide nursing rooms at all new bus interchanges and integrated transport hubs. For the MRT network, we will provide nursing rooms at all new interchange stations. We will also explore providing such facilities when MRT stations undergo upgrading.”
“Over the last three years, Singapore carriers have reported a total of 20 incidents of food allergies on board their flights. None required the use of epinephrine or emergency flight diversions.”
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“The Totalisator Board will pool collections from the casino entry levies with their recurrent surpluses, which go towards funding activities benefiting the community. Just to recap, these range from educational and health programmes to sports and arts and culture. Some of Tote Board’s ongoing commitments include the Tote Board Social Service Fund, the Tote Board Community Healthcare Fund, the Yellow Ribbon Project and the Community Chest. The revenues collected by the Government from the IRs, like those from the rest of the gaming industry, flow into the Consolidated Fund. They are not earmarked for specific purposes, but go towards funding of the Government budget as a whole. This allows Government the flexibility to channel funds to areas with the greatest needs and strategic priority.”
“The answer is "yes". I totally agree with the approach as proposed by Dr Lam Pin Min. All surveys, whether in Singapore or outside Singapore, point in the same direction. All seniors do want to age at home. Our job is to try to facilitate that. Homecare is something that I have been looking at for the last couple of years. I think Members will hear a lot more about these during the next few years. GOVERNMENT REVENUE ATTRIBUTABLE TO INTEGRATED RESORTS (Breakdown and utilisation) 8. Ms Denise Phua Lay Peng asked the Minister for Finance (a) how much additional revenue will the Government be receiving as a result of the good financial performance of the two Integrated Resorts; (b) what is the breakdown of the revenue attributable to the casinos and other operational units; and (c) what are the likely ways in which this additional revenue will be utilised. The Second Minister for Finance (Mrs Lim Hwee Hua) (for the Minister for Finance): Sir, the two Integrated Resorts (IRs) collect casino entry levies on behalf of the Totalisator Board. They also pay betting taxes and GST on their business receipts to the Government. However, the entry of the IRs has also led to a restructuring of the gaming industry as a whole. Hence, while the IRs have brought in new revenues, collections from other gaming activities such as lotteries, horse and sports betting, and fruit machines operated by clubs have fallen. Taken together, the net increase in collections by the Totalisator Board with the entry of the IRs was about $130 million in the eight months between April and November 2010. Likewise, the net increase in revenues to the Government with the entry of the IRs was about $420 million over the same period.”
“By that, what I mean is when you work, do save in your Medisave. For employees, no problem, but the self-employed must be encouraged to save. And when you have enough money in Medisave, then do buy insurance. In the case of nursing homes, ElderShield is important. ElderShield today is still rather basic and I would like to further enhance the ElderShield programme so that they can play a more effective role. That is something that we would do in the next few years.”
“Sir, "49 days" is an average figure but I suppose it varies from nursing home to nursing home. Some nursing homes are more popular than others and if some patients insisted on going to those nursing homes, the waiting time can be longer. It was reported in today's newspaper on Nanyang Kindergarten. There are kindergartens and there are kindergartens. Likewise, there are nursing homes and there are nursing homes. At my level, I look at it from the macro point of view and we try to make sure that the average figure is manageable. "49 days" is a bit long. My own personal target is: I would like to shave off 20 days, so that it is within a month. But let me explain that whether it is 29 or 49 days, it does not mean that the patients are not being served. What it means is usually, they are kept waiting in an expensive setting, which usually means in an acute hospital. I have an interest to reduce the waiting time and we have been reducing it over time. Building more nursing homes will help but, at the same time, it is a balancing game. We also do not want to make nursing homes so accessible, so easily available that we encourage a different trend which is that children may be encouraged to refer their elderly to institutions which I think we do not want to see it happen. My personal view is if the waiting time is about a month, that will be a reasonable figure to target. Affordability of healthcare is always an issue and is always my priority. We try to make sure that healthcare, whether it is at a nursing home or at the hospitals, is affordable. My own view is: they are affordable but provided we all cooperate in this. For example, our 3M system is very good but you must be in it. If you choose to be out of 3M, then I think it is troublesome.”
“The waiting time for a subsidised nursing home bed is, on average, 49 days. Currently, 2% of our elderly population above 65 years requires nursing home care. The figure may grow in the future but we must try to keep it low as all seniors prefer to age at home, rather than in an institution. It is our priority to raise the standard of care in nursing homes. We have discussed these plans before in this House. Last month, we have also set up an Expert Panel on nursing homes to improve the rehabilitative capabilities of nursing homes so that patients can benefit from effective rehabilitation and be able to return home eventually. The Expert Panel will be advising the Ministry of Health on how we should go about achieving this objective. Meanwhile, we have started building six new nursing homes. They are at different stages of planning and construction. Three of them should be ready by early 2013. Of the three, two are in the west.”
“For patients with traumatic brain injury (TBI), our doctors' priority is to prevent any death, and to recover as much of pre-injury functionality as possible. Inpatient rehabilitation is provided by an interdisciplinary team, led by a rehabilitation physician, and includes therapists, social worker and clinical psychologist. It may take up to three months. This is followed by community rehabilitation which focuses on further training in household independence and community integration. Depending on the patient's severity of injury and residual disability, it may take up to a year or even longer. Most patients can achieve good recovery and can return to their previous jobs or lifestyle. A minority of the severely injured will face significant challenges. Some may require long-term institutional care such as in nursing homes. There are support groups and VWOs that can provide appropriate assistance. For example, TTSH has a support group of nurses, doctors and ex-TBI patients to provide emotional support and share useful experiences. VWOs such as the Singapore Society for the Physically Disabled and Bizlink Centre provide valuable assistance in life skills training, vocational assessments, vocational training in sheltered work environment, job placement and other job support. We welcome more employers to offer suitable job opportunities for these patients. UPDATES ON THE PRODUCTIVITY AND INNOVATION CREDIT SCHEME AND THE NATIONAL PRODUCTIVITY FUND 4. Mrs Mildred Tan asked the Minister for Finance whether he will provide an update on the Productivity and Innovation Credit Scheme and the National Productivity Fund that were introduced in 2010.”
“I scanned the range of allied health professions regulated in other countries and by and large, these are the 10 professions which are being regulated in Australia, the United Kingdom and United States. We will start with the three therapy professions in the first phase and then this will be followed by another three professions: clinical psychologists, diagnostic radiographers and radiation therapists. These are the six professions which we already have local education and training programmes. For the rest of the professions we will bring on board as well. My own estimate is that we should be able to complete the registration of the 10 professions within the next term of Government. Ms Ellen Lee and Dr Lam asked if chiropractors would be included in this Bill. My Ministry is studying the regulation of chiropractors in some countries. Where they are regulated, they are regulated as “complementary and alternative health practitioners”. We are studying the need for such a piece of legislation and it is an assignment which probably will be in our work plan during the next few years. Mr Speaker, Sir, the allied health professionals form an important pillar of our healthcare system. It is time for us to go beyond self-regulation. By setting and enforcing standards, the Bill will raise the quality of the allied health sector and, thus, serve the public better, and I seek the House full support of this Bill. 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 Khaw Boon Wan]. Bill considered in Committee. [Mr Speaker in the Chair]”
“The Bill will not affect the choices available to consumers and patients regarding the type of services they seek. Assoc. Prof. Paulin Tay Straughan wondered if regulation would impact reimbursement decisions by insurers. This is really something for the insurers to decide. Currently some insurance policies do reimburse for some allied health professional services. I suppose they will then price it into the premiums. Ms Ellen Lee was concerned with the burden on the allied health professionals if they are subject to costly indemnity insurance. I agree with her that it will be prudent for practitioners to have arrangements either through their employers for some sort of indemnity, or if they are self-employed, to have their own indemnity insurance. In the public healthcare sector, we employ quite a large number of the professionals and, we have that kind of arrangement. In our experience the cost of such insurance, while market determined, is not too prohibitive. Ms Ellen Lee asked how the quality of care provided over the Internet will be dealt with. This is an emerging issue and probably would be challenging as well. At the moment, for allied health services, by our observation, is not yet a significant issue. But I agree that the Internet will open up new possibilities and challenges. Some of the other regulatory councils are currently looking into this issue, and it will be appropriate to develop this as a policy across all healthcare professionals. Several Members asked about the implementation timeline. If the Bill is passed, we will set up the regulatory framework and get it operational for the three professions within a year. We have, as you see in the First Schedule, listed 10 groups.”
“This follows the practice in other health professional regulatory Councils. Dr Lam sought clarification on the different roles of the Performance Assessment Panel (PAP), Fitness Assessment Panel (FAP) and Interim Orders Committee (IOC). The Performance Assessment Panel will be appointed by the Complaints Committee if there is an issue of the quality of professional services provided by the professional. This is set out in clause 45. The FAP will be appointed where the professional’s fitness to practice is in doubt by reason of his physical or mental condition. This is in clause 46. The IOC will be invoked when immediate or urgent action is required for the protection of members of the public or it is otherwise in the public interest or in the interests of the allied health professional concerned. The IOC may order that his registration be suspended or be made subject to conditions or restrictions. Dr Lam asked if there would be guidelines on advertisements of practitioners. We will set these guidelines in the ethical codes for the allied health professions, similar to the medical profession. Assoc. Prof. Paulin Tay Straughan expressed concerns on the cost of regulation. Any regulation will come with a cost. The key is to minimise the cost of regulation. Indeed, one reason for taking an omnibus approach is to try to reduce the overhead cost, so that it will be minimised for the professions and the clients that they served. Our sense is that any cost impact will not be significant for as long as the market is sufficiently competitive. I think pricing is more of a function of how competitive the market is. This was our experience when we started regulating the optometrists and opticians.”
“When implemented, this will better assure the public that registered professionals will be up-to-date in their knowledge and practice. As Ms Ellen Lee pointed out, this will strengthen the quality of care provided. The Council will consider this after completing the registration of existing practitioners. Given the wide range of the professions, the Council will set up committees to set the policies, standards and requirements for continuing professional education. The committees will comprise the relevant allied health professionals. Continuing professional education activities will be co-ordinated by the professional bodies, healthcare institutions, and other education providers as is the case with other healthcare professions. Ms Ellen Lee asked if there were safeguards to protect registrants against frivolous complaints. These are provided for in the Bill. The complaint must be made in writing and supported by a statutory declaration. The professional will be given the opportunity to present his case. The Complaints Committee will review and investigate the complaints thoroughly, and only serious complaints will be directed for formal inquiries. Ms Ellen Lee asked who could represent the allied health professional when he is called to answer a case against him. When the complaint is reviewed by the Complaints Committee, the allied health professional will not generally be required to appear before the Committee. Instead, he may be asked to provide a written exculpatory statement. It is only when the complaint is directed for further inquiry at the Disciplinary Tribunal or Health Committee, would his attendance at the proceedings be required. And at this stage, he can engage a legal counsel to represent him if he wants to.”
“There will also be practitioners whose basic professional qualifications are not recognised, but have had good quality post-graduate training and practice experience in a particular area of the profession; or others who may have practised exclusively in a particular area of practice, such as sports physiotherapy, or paediatric occupational therapy, for a long period of time. Restricted registration may also be applicable to these individuals. Allied health professionals employed for the purpose of teaching, training or research, must also be registered. Competence and conduct issues remain relevant. When they are here for a short stint of a few weeks or months or do not have qualifications that are on the list of approved qualifications, temporary registration is needed. In areas of critical manpower shortages, temporary registration can also be applied as a stop-gap measure. Such a practitioner must work under supervision at all times. In this way, the tiered registration framework allows us flexibility to manage our manpower challenges and at the same time, protecting public safety and consumer interest. Dr Lam asked about the process for renewal of registration for practitioners whose registration has lapsed. The practitioner can apply, or the Council can restore the name to a register on its own motion. The name will be restored to the same register if there is no reason not to do so. Otherwise, the Council can place the person on conditional or restricted registration as well. The details are in clauses 27, 56, and 59. Dr Lam and Assoc. Prof. Fatimah Lateef asked if compulsory continuing professional education will be required. The Bill does provide for the Council to mandate continuing professional education to grant or renew practicing certificates.”
“We have adopted a tiered registration framework as we have found it useful in regulating the other health professions. A tiered system allows practitioners of diverse background and training continued access to our system for the provision of care without compromising public safety. Let me briefly explain how the registration framework will work. Full and conditional registration will apply to most practitioners. All practitioners who have approved qualifications or have passed the local qualifying examinations will be eligible for registration in either one of these two categories. For those who have been practising as an allied health professional in Singapore, they will be directly eligible for full registration. New graduates, or those who have little or no experience of practising in Singapore will first be conditionally registered and required to work under supervision. After completing their supervised practice period with no adverse performance reports, they will be able to convert to full registration. Dr Lam asked if supervised practice during conditional registration can be done in private institutions. The answer is "yes". We will allow it, provided the private organisations have the capabilities and standards to supervise such professionals. Among those who are currently practising in Singapore, there is a small number whose basic professional qualifications are not recognised. However, they have been serving patients for many years in their jobs. They should be allowed to continue in their practice, and serving the patient groups they are familiar with. Restricted registration will apply to this group of practitioners, where they will only be allowed to work with client groups they are familiar with, or only in specified employment or places of practice.”
“Ms Ellen Lee noted some overlap in the scope of practice between chiropractors and physiotherapists. She wondered if chiropractors would lose their right to practice what they are trained for. They will not. The Bill does not grant monopoly power to a particular profession. For example, both voice coaches and speech therapists provide voice training. If you are a teacher, and you want to control and project your voice better, a voice coach could well do the job. However, if you have just had a stroke and need help to regain your speech, you would need a speech therapist. Even amongst the allied health professions, there are overlapping areas of practice, as noted by Ms Ellen Lee. For example, hand therapy may be carried out by both physiotherapists and occupational therapists; and difficulties in swallowing may be managed by both occupational therapists and speech therapists. As healthcare becomes increasingly team-based and integrated, it is more important that a profession is allowed to practice what they have been trained to do so long as they can demonstrate competence in doing so. We do not want to reduce access to services, or choices for consumers because that will push up cost. However, it is important to help consumers make an informed choice. Therefore, we have to protect the titles and the practice of the profession under the title, and not the scope of practice. In so doing, when patients need an allied health professional’s expertise, the professional titles used will serve as a guide for them, as will the register of practitioners which will be readily accessible on the Internet. Assoc. Prof. Fatimah Lateef, Mdm Cynthia Phua and Ms Ellen Lee commented on the registration framework.”
“The first Council will start off with the Director of Medical Services or his representative; the Director-General of Education or his representative; the Registrar; one physiotherapist, one occupational therapist, and one speech therapist. We will make sure all of them would have at least 10 years of practical experience. We will add new members as needed. Dr Lam Pin Min asked if we would put a cap on the size of the Council. We are thinking of keeping it to 25 members so that it does not become too big. Let me add that the Allied Health Professions Council is, first and foremost, a regulator. Its primary duty is to ensure the safety and welfare of the public. It is not set up to promote or advocate the different professions’ interest. In regulating these professions, the Council needs to ensure that the standards and regulatory policies are relevant to the different groups, and can effectively address any regulatory issues unique to the profession. The Council will have to consult extensively with the different professions and stakeholders as it further develops and implements the regulatory policies and standards. It will be supported by advisory committees and boards, comprising experienced practitioners from the professions. It should also learn from other allied health regulators overseas. Assoc. Prof. Fatimah Lateef felt it is important to define clearly what each profession can and cannot do. We will define the knowledge, skills, and training required for each specific allied health profession. We will set standards on practice, conduct and ethics. But in defining what the professionals can or cannot do, we must be careful not to hinder other legitimate service providers from providing services which they are competent to do.”
“Mr Speaker, Sir, I thank the five Members who have spoken on the Bill for their strong support. Let me address their various comments and valuable suggestions. Dr Lam Pin Min noted that the Bill is quite different from the other health professional registration laws as the scope this time round is wide and varied. Assoc. Prof. Paulin Tay Straughan asked if we could draw useful lessons from the regulation of Traditional Chinese Medicine (TCM). The registration laws for the different healthcare professions are generally similar as they all seek to protect the public from unqualified practitioners or those who are unethical. Not surprisingly, there are similarities in approach. When drafting this Bill, we have taken references from several countries, including Australia, Canada and New Zealand. The omnibus approach to this Bill, resulting in it being therefore wide and varied, is for a practical consideration as noted by several Members, including Dr Lam. But the strategic intent of raising professional standard, safeguarding consumer interest and promoting high ethical practices is similar to how we regulate doctors, dentists, pharmacists or TCM physicians. However as the range is wide, adequate representation on the Council is therefore a valid concern. I have addressed this earlier in my second reading speech. Assoc. Prof. Fatimah Lateef suggested some sort of a proportionate representation of each profession on the Council. The Bill allows us to appoint more than one member of each profession on the Council. Where a profession has more than, say 500 registrants, I suppose we can appoint two Council members. But for now, we will start with one representative each, and see how it goes.”
“These powers are set out in clauses 42, 49 and 53. In addition, the Disciplinary Tribunal is empowered to impose a penalty of up to $50,000 on a registrant. Part VI provides for miscellaneous clauses to support the Council in meeting its mandate, such as setting out the powers of the investigators, appointment of legal and medical assessors and allowing for composition of offences. Lastly, the First Schedule sets out the occupational groups defined as allied health professions, and the Second Schedule lists and describes the allied health professions to which the Bill applies to. In preparing this Bill, the Ministry has consulted the public, allied health professionals and their associations as well as employers. There is strong support for the Bill. We will continue to consult them as we refine the implementation plans and subsidiary legislation that will follow. Mr Speaker, Sir, we need highly-skilled allied health professionals to beef up our healthcare teams so that Singaporeans can continue to enjoy a high level of health even as they grow old. Our allied health professionals have rendered a high level of care despite not being regulated. However, going forward, my Ministry believes that the allied health professionals can play an even larger and more effective role through statutory regulation as prescribed in this Bill. This will be good for the professions which have unanimously supported this Bill and this will be good for patients who can then be assured of competent and safe services. I seek the House's strong support for this Bill to ensure that the public continues to enjoy high standards of healthcare. Sir, I beg to move. Question proposed. 3.15 pm”
“Thus, clauses 29 and 30 make it an offence for a person who is not registered to imply that he is a qualified professional from the way he provides services, or use any title set out in the Second Schedule. Clauses 31 to 33 set out various offences to prohibit business owners and employers from making false claims that their employee is so qualified, and also holds the employee and his co-workers liable for such false claims. Part V of the Bill deals with disciplinary proceedings before a Complaints Committee, Disciplinary Tribunal, Health Committee and interim orders committee inquiries. It provides for the Council to take action against the registered allied health professional on conduct and fitness to practise issues set out in clause 39, and also has in place appeals mechanisms for aggrieved parties. The clauses in this Part are substantially similar to the new Part VII of the Medical Registration Act. To support professional self regulation, the Complaints Committee and Disciplinary Tribunal set out in clauses 40 and 50 will have a majority of members from the profession register index in the same profession as the person being complained against. As some of the smaller professions may not have members of sufficient experience and expertise, clause 50 also provides for the Minister to make exceptions to the Disciplinary Tribunal members' appointment where it is expedient to do so. Senior legal professionals may also be appointed to the Tribunal. The Complaints Committee and Disciplinary Tribunal are empowered to make a wide range of orders to deal with matters. These include dismissing frivolous complaints; issuing letters of advice or warning; ordering the registered person to undergo treatment, or suspending his practice.”
“The supervision requirement also ensures that new practitioners are adequately supported when they start working in Singapore. Temporary registration is set out in clause 19 and applies to an allied health professional who is in Singapore for the purpose of teaching, research or postgraduate study; or deemed to have knowledge, experience and skill of value to Singapore to function in any healthcare capacity, including the provision of health services, but is not otherwise entitled to be registered. To safeguard the public, a practitioner on temporary registration will require supervision at all times, and additional conditions and restrictions may also be imposed. Part IV of the Bill sets out the various offences and a penalty of a fine not exceeding $25,000 and/or prison term not exceeding six months for a first offence. This Part protects the public by prohibiting false representation of the regulated allied health professionals. There are inherent difficulties in regulating every aspect of practice in any profession as, naturally, overlaps occur in normal life and work. For example, both exercise trainers and physiotherapists prescribe exercises but for different purposes and to different types of clients. However, we recognise that allied health professionals are trained and qualified to deal with healthcare and patients, and the expectation from the public is with regard to such expertise and its expected treatment outcomes. With a register of such professionals and laws against false representation, patients are assured that they are receiving treatment from bona fide practitioners.”
“Clause 16 deals with full registration and requires an allied health professional to complete a period of supervised practice under conditional registration before being eligible for full registration. This allows the Council to make a more comprehensive assessment of the practitioner instead of relying only on his qualifications and credentials. Clause 16 also allows the Council to apply exceptions and give full registration directly to an individual who is clearly well-trained and competent. Where a person is not eligible for full registration, his application will be assessed for other registration categories. Clause 17 deals with restricted registration. A practitioner who does not have an approved qualification but has been practising in Singapore; or who may have a post-graduate qualification in specific area of professional practice but does not have an approved basic qualification, is among those who will be eligible for restricted registration. Like full registration, an allied health professional on restricted registration can practise independently. However, restrictions are imposed on his scope, place of practice, or employment because of his qualifications, practice experience, or health issues. Before an individual is granted restricted registration, his abilities may also have to be assessed through conditional registration. Clause 18 deals with conditional registration. Conditional registration will generally be applied to all new registrants who have approved qualifications or have passed the local qualifying examinations. While under conditional registration, the practitioner will be supervised and subject to performance review. This enables the Council to make an assessment on the ability to practise safely and competently.”
“Coupled with a representative Council, such a structure would ensure that each profession is adequately represented and the unique issues faced by specific professions can be addressed. However, for operational efficiency, the Council is expected to maintain oversight and management of the committees and boards, complaints, investigations and disciplinary processes. Part III of the Bill sets out the registration framework to recognise appropriately trained and qualified professionals for practice in Singapore, and empowers the Council to impose conditions and restrictions on registration, require mandatory continuing education, refuse registration, remove and restore names under specified circumstances. Clause 14 sets up the four registers, corresponding to the four types of registration and these are: Full, Restricted, Conditional, and Temporary registration. Clauses 16 to 19 set out the general criteria, conditions and restrictions that may be imposed in the four registration categories. The tiered registration framework enables the Council flexibility to register individuals according to their training and practice experience, whilst providing safeguards to protect the public. Let me now elaborate on the different tiers of registration. An allied health professional with full registration may practise generally and without supervision in the profession in which he is registered. There will be a list of approved qualifications. These qualifications will be determined by the Council and established for each regulated profession in the regulations. Anyone who holds an approved qualification or passes the local qualifying examination in a regulated profession would be eligible for full registration.”
“Instead, we recommend the more efficient option of an umbrella legislation that will allow for the regulation of many allied health groups, with subsidiary legislations covering individual professions. The United Kingdom, New Zealand and Hong Kong have taken such an approach and this is the approach which is incorporated in this Bill. Let me now elaborate on the key features. Main features of Bill Part I lays out the scope of application for the Bill where clause 4 clarifies that the Bill applies only to Allied Health Professions listed in the Second Schedule. As a start, only the occupational therapists, physiotherapists and speech therapists will be regulated. Clause 5 empowers the Minister for Health to amend the Schedule to regulate other allied health professions in future. Part II of the Bill sets up the Allied Health Professions Council, provides for members of the Council to be appointed by the Minister for Health, and to include representatives from each of the regulated allied health professions. The Council's functions are set out in clause 7, and include registration, issuing of practising certificates, and setting of standards for training, conduct and practice. There have been concerns raised regarding adequate representation of the different professions and the effectiveness of a single regulator regulating many different professions. Clause 12 empowers the Council to appoint committees and professional boards. These committees and professional boards play a key role in advising and making recommendations to the Council with regard to the standards and issues arising in particular professions, and will comprise mainly members of the specific professions.”
“For a long time, we have left the allied health professions to regulate themselves. This was somewhat adequate in the past as most of them worked in the public sector and the professional bodies had diligently taken on a voluntary regulatory role. However, as the demand for their services grows and as we try to build up the long-term care sector, the voluntary approach to regulation will become less effective. Voluntary self-regulation is also not the international norm. All developed countries have legislations to regulate their allied health professions and they have been doing so for years. Singapore is an outlier. I signalled this intent to regulate the allied health professions in 2007 when I came to this House to move the Optometrists and Opticians Bill. The experience to regulate the optometrists and opticians has been positive. We are now better assured that these eye-care practitioners have the competencies to provide safe and effective eye-care services. Since then, the Optometrists and Opticians Board has registered more than 2,300 optometrists and opticians and will be implementing mandatory continuing professional education. This is a significant improvement from the past where untrained persons could easily set up shop and provide optometry services with sometimes questionable standards. Our approach to regulation The next major group are the therapy professions: physiotherapists, occupational therapists and speech therapists. MOH could establish another legislation to target this group but there are many more allied health professions, like the dietitians, radiographers and psychologists. Such a piecemeal approach will take a long time.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." The Allied Health Professions Bill establishes a regulatory body, the Allied Health Professions Council, to register and regulate the allied health professionals, and prohibits false representation of these professionals. The Allied Health Professions comprise diverse groups of healthcare professionals providing a wide range of health services. They include radiographers, physiotherapists, occupational therapists, psychologists, speech therapists, and many others. With a rapidly ageing population, demand for healthcare will rise as the sick elderly are more likely to present with many diseases and more complex conditions. We are reforming our healthcare system to cope with the challenges in two major areas. First, we are strengthening the community and step-down care sector so that patients can be treated there competently instead of in costly acute hospitals. Second, doctors will increasingly be assisted by multi-disciplinary healthcare teams with allied health professionals as key partners. Success of these reforms relies on well-trained allied health professionals. These health professionals, with their specialised know-how, can contribute to better health outcomes and lower healthcare costs through effective rehabilitation, health promotion and prevention. For example, a physiotherapist is skilled in the physical rehabilitation of stroke patients or those who had undergone hip replacement, helping them to walk again. An occupational therapist is best placed to train the patient to perform self-care activities safely and independently, such as dressing himself, toileting and bathing. These rehabilitative activities are essential in helping the elderly regain an active and meaningful life.”
“The Quality of Death Index by the Economist Intelligence Unit tried to measure the level of end-of-life care services across 40 countries. It ranked Singapore as Number 18 among these countries, and Number 2 in Asia. I find it a fair assessment. We were deemed to have done particularly well in areas of end-of-life care policies, in recognition, training and accreditation of end-of-life care practitioners, and in the availability of volunteers in end-of-life care. The area where we could have done better was in the availability of end-of-life care facilities. We will, of course, continue to develop this sector. I began to pay some attention to this in the last five years. And I, myself, am satisfied with the progress that we have made but there is still much more that we have to do. In fact, I spoke about our plan in Parliament last month and I will not repeat it. The Quality of Death Index researchers felt that we should articulate our plan into a formal national strategy for palliative care and publish it. We are in the process of doing so and will formulate one in consultation with the palliative care community. We will consider including a code of ethics in the national strategy. Although no formal code exists at the moment, our informal assessment is that existing providers do provide palliative care of high ethical standards. Column No : 1844 EARLY INTERVENTION AT PRE-SCHOOLS 3. Ms Denise Phua Lay Peng asked the Minister for Community Development, Youth and Sports if he will commission a study on the efficacy of (i) early intervention for special-needs children; and (ii) general pre-school education for children before primary school age.”
“But if some of the recommended screening tests were to be rather expensive – for example, I expect colonoscopy may be included as one of those evidence-based and time-tested tests that should be done for those above 50 years old. There could be some problems with funding. We would then see whether current Medisave rules need to be tweaked to allow for this. Give me a few more weeks or months to settle this. Column No : 1843 QUALITY OF PALLIATIVE CARE IN SINGAPORE 2. Assoc. Prof. Paulin Tay Straughan asked the Minister for Health (a) whether he will comment on Singapore being ranked 18th in the Economist Intelligence Unit's report on Quality of Death that was released in 2010; (b) whether the Ministry has a national plan for palliative care given the growing significance of palliative care; and (c) whether the Ministry plans to set up a code of ethics that governs hospice care.”
“The tests in the ISP for the lower-income group are free. We have contracted more than 700 General Practitioners (GPs) to carry out the screening services. They are quite spread out across Singapore. The consumers only need to pay the consultation fees to the GP. It is not completely free. I think it is important that we do not make it completely free so that the consumer has to make some cash payment. But we pay for the tests on behalf of the lower-income group. Will Medisave be used for health screening? I raised this topic in response to some proposals by MPs, like Mdm Halimah, some time ago. We have been studying this. I see it as a two-stage approach: the first stage is to decide on the basic screening package for each age group that we should promote. There is a wide range of screening tests out there – some are very expensive and offer marginal benefits. If we blindly promote screening, we may end up with a lot of over servicing and abuses with little benefit or, sometimes, even with slight harm to the patients. We have to be careful how we do this. What we have done in the last few months is to task the Academy of Medicine to set up a Committee of Experts to help us sieve through all the available tests in the marketplace and then draw up a list of recommended screening packages, by age group and by gender. That process is about to be completed. When the Committee has completed its report, we will publicise it. We will then take a look at funding. If they are inexpensive tests – and Members know my philosophy – we should not touch Medisave for these tests. Anything less than $100, that costs $20 or $30: I would say let the consumers pay out of their pocket.”
“Purely empirical and based on what we observe, I would say that, generally, majority of Singaporeans do go for screening. Where is the evidence? In the latest National Health Survey, one of the questions posed to the targeted group – the elderly and those aged 40 years and above – was "Have you got yourself screened in the last three years for diabetes, blood cholesterol?" Majority said "yes". Relying on memory, I would say more than 60% or 70%. For basic health screening, I would say the outreach is not bad. However, at 70%, it still means that 30% out there have not been screened, at least in the last three years. They may have been screened before that. Hence, the efforts to reach out and educate the public must continue. There are other programmes organised jointly with, for example, Minister Lim Boon Heng's Committee on Ageing. It has started the "Wellness Programme" at the constituency level that targets Singaporeans above 50 years of age. Through the programme, we reach out to the elderly to get them screened. More importantly, we get those who are in the high risk groups to follow up when their risk factors have been picked up. In the pilot programme, we have injected resources to call up those with abnormal results and we nag at them to see the doctors. And many do. The following step, which is even more uphill, is to get them to change their lifestyle, "eat less, move more". That is trickier. We must continue to press on.”
“The National Integrated Screening Programme (ISP) started in June 2008, two years ago. It targets Singaporeans aged 40 years and above. More than 35,000 Singaporeans have benefited from this programme so far. As the recommended screening frequency for diabetes, high blood cholesterol and cervical cancer is once in every three years, it is too early to say if it has led to sustained screening behaviour. We plan to roll out a national colorectal screening next year. Assoc. Prof. Paulin Tay Straughan (Nominated Member): It was such a brief response I am not even prepared, Sir. One supplementary question. Could the Minister share with us if he has noticed a trend from those groups that have not attended the screening programme? And if so, what measures has MOH taken to encourage these Singaporeans to step forward for health screening?”
“Tribunal staff will also advise the elderly parents of the application process and legal effect of a PPO and assist them to approach social agencies specialising in elderly abuse for further intervention, if necessary. APPENDICES Section Name: ORAL ANSWERS TO QUESTIONS Title: GANG-RELATED CRIMES AND TEEN GANGSTERISM Filename : Table on Rioting Statistics (2005-2010) MP Name: The Minister for Home Affairs (Mr K Shanmugam)”
“Dr Vivian Balakrishnan: The Tribunal for the Maintenance of Parents was set up under the Maintenance of Parents Act to provide an avenue for needy elderly parents to obtain financial support from their children. The Act also provides for the setting up of the Office of the Commissioner for the Maintenance of Parents (CMP). The role of CMP is to facilitate conciliation and mediation between parents and children in order to resolve maintenance issues. If the parties cannot reach an agreement, the parent can commence legal action by filing an application at the Tribunal. MCYS supports the Maintenance of Parents (Amendment) Bill tabled by Mr Seah Kian Peng (Marine Parade GRC), which aims to enhance the effectiveness of the Act for its beneficiaries. Parents who wish to make applications for the first time will have their case referred to the CMP first. Cases that reach an agreement facilitated by the Commissioner may be independently endorsed by the President or a Deputy President of the Tribunal, and have the same force and effect as a maintenance order made by the Tribunal. To enhance its conciliation efforts, the amendment also proposes that the Commissioner be empowered to investigate the merits of the case through obtaining information and data from relevant Government agencies or statutory bodies. Such information will be used for the purposes of identifying and locating the children of the applicant, assessing the veracity of information supplied and assessing the means of each child to maintain the applicant. In cases where there is a risk of violence from the children, elderly parents may apply for a Personal Protection Order (PPO) with the Family Court.”
“For those who feel that the current payout is too low as compared to what they would need, they should top up their coverage with ElderShield Supplements provided by private insurers. About 14% of ElderShield policyholders currently do so but more Singaporeans should do likewise. Information on healthcare financing is readily available to the public and can be found from various sources. A good place to start would be the MOH and CPF Board websites. There, we have information on our 3Ms healthcare financing framework, including that on basic MediShield and ElderShield. There are also comparisons of the various Medisave-approved supplementary plans and the service performance of the insurers, eg, claims processing time. Information pamphlets are also available in the hospitals and polyclinics. We also work with various organisations to educate the public on health insurance. These include the MAS, the Life Insurance Association, the local media, the People's Association and its grassroots organisations. We will continue to reach out to Singaporeans to ensure that they are adequately insured against the financial risk of hospitalisation and severe disability. APPLICATIONS FOR MAINTENANCE OF PARENTS 3. Mdm Ho Geok Choo asked the Minister for Health (a) whether Singaporeans are under-insured in health insurance and whether their Medisave and MediShield covers need to be complemented with an enhanced insurance cover; (b) what measures will the Ministry take to educate Singaporeans on the need for health insurance; and (c) what percentage of Singaporeans have health insurance and of these, how many are under-insured.”
“There are two health insurance products which are essential: MediShield to cover hospitalisation expenses and ElderShield to protect against the financial risk of severe disability. For those who prefer higher ward classes and larger payouts, they should top up their basic MediShield and ElderShield with supplementary plans offered by private insurers. For MediShield, the coverage is not bad. Ninety percent of Singaporeans are protected with MediShield and the number is still growing. Among the MediShield policyholders, nearly 60% of them have topped up with a private supplementary plan which will enable them to seek treatment in Class A/B1 or private hospitals. As most inpatients are admitted to Class B2/C wards, the level of coverage looks good. However, we will continue to reach out to the uninsured to get them protected. The two major groups of the uninsured are the young and the housewives. We are making progress in getting them insured and we will press on with our efforts. As for ElderShield, this product is still less understood. Nevertheless, coverage has now exceeded 55%. At the per-cohort level, coverage is good at about 90%. We will continue to educate Singaporeans on ElderShield and encourage them to get themselves covered. We will also further enhance the ElderShield benefits. Basically, for those who choose Class B2/C wards, basic MediShield should suffice. But for those who prefer and can afford Class A/B1 or private hospital wards, they should top up with a private supplement. For ElderShield, the current payout of $400 per month for six years is just about adequate for the lower-income group who qualify for heavy subsidies in nursing homes.”
“Sir, we offer a DNA parentage testing service but whether we should offer it for free is a separate issue. LOANSHARKING ACTIVITIES (Update since implementation of new measures) 10. Mdm Halimah Yacob asked the Minister for Home Affairs (a) how effective are the new measures to curb the activities of loansharks; (b) whether the Ministry has observed any trends of loansharks resorting to more aggressive tactics to recover their loans; and (c) what more can be done to curb this nuisance. 11. Mr Liang Eng Hwa asked the Minister for Home Affairs (a) if he will provide an update on the number of loanshark harassment cases in HDB towns; and (b) whether the enhanced measures that were introduced had been effective in reducing loanshark cases.”
“We carry out regular audits on all Assisted Reproduction Centres, including Thomson Medical Centre. But should we go backwards in time and start checking every IVF baby to see whether there has been a mix-up in the past? Short of doing a DNA parentage test on every IVF baby, we will never know. I think we should do what is practical. Based on the information that we have, we are not aware of other mix-ups, certainly not in recent years.”
“Sir, there are nine IVF Centres in Singapore. We call them Assisted Reproduction Centres. After the incident, we re-checked all the nine Assisted Reproduction Centres. Two of them, besides TMC, did not comply with all the procedures. That means that there were six who fully complied. All the public sector Assisted Reproduction (AR) Centres fully complied with the SOP. What is the right of the unintended parent or father in this case? We consulted the National Medical Ethics Committee. We tasked it to convene a meeting to discuss this particular incident because many parties are involved here and there are obligations and ethical duties of the operator and the hospital towards each of these parties, and all have to be taken into account. They have given very sound advice; they said that TMC will have a duty towards each and everyone of those parties involved. However, in fulfilling all those duties, it may conflict or cause other problems to some of the parties involved, and their advice is that the baby's rights should take priority. In the case of this unintended father of the baby, their advice is if the donor asked, then TMC will have a duty to inform. But TMC need not volunteer the information, taking into account the impact it may have especially on the baby. We have shared the National Medical Ethics Committee's advice with TMC. As for the shortage of sperm donations, this is a global phenomenon. I think we are not alone in having a shortage of people coming forward to donate sperms.”
“My Ministry has also suspended the operation of the TMC IVF Centre. The incident has impacted the reputation of the TMC IVF Centre and indirectly affected Singapore’s reputation as a regional medical hub. TMC has been responsive and has cooperated fully with my Ministry in the investigation. They are determined to recover from this incident. The key is full disclosure of the facts and immediate correction of any systemic inadequacies to ensure that similar errors will not recur. This is the way to regain patients' confidence and trust.”
“Sir, my Ministry has completed the investigation into the IVF mix-up incident at Thomson Medical Centre (TMC). The investigators have concluded that the mix-up was due to lapses in procedures and human error. Assisted Reproduction Centres handle specimens from many couples. To eliminate the risk of any mix-up, they follow a number of procedures in accordance with international best practices. First, the embryologist will work on the specimens of only one individual or one couple at a workstation at a time. Second, he will carefully label all the receptacles and instruments with the couple’s or the individual’s name. Third, he will discard the disposable instruments such as pipettes after each use. This is to avoid any contamination. Fourth, at every critical step, a second operator will counter-check that the specimens are transferred to the correct receptacles. The investigators found that the TMC IVF Centre had deviated from some of these procedures. At the time of the incident, the embryologist was processing semen specimens of two individuals at the same workstation at the same time. The pipette used for transferring the specimen was reused instead of being discarded after each step. Even though it was reused only for handling the specimens from the same individual, it unnecessarily raised the risk of human error. This was particularly risky as there was no second person to counter-check that the specimens were transferred to the correct receptacles at every critical stage. These lapses in procedure contributed to the occurrence of a human error and both led to the IVF mix-up in this case. Following this incident, my Ministry has directed all Assisted Reproduction Centres to strictly follow the correct procedures, if they have not been doing so.”
“My Ministry has accepted the recommendation of the Expert Committee on Immunisation (ECI) to include the HPV vaccine in the National Childhood Immunisation Programme for girls aged nine and above. The ECI has further recommended that we encourage the parents to discuss the HPV vaccination with their family doctors, so that they can make an informed decision on whether to vaccinate their daughters. We will adopt the approach as recommended. Needy parents with financial difficulty can apply for subsidy at the polyclinics, if they find the cost unaffordable. PUBLIC ASSISTANCE SCHEME (Statistics) 5. Assoc. Prof. Fatimah Lateef asked the Minister for Community Development, Youth and Sports (a) how many people do we have on the Public Assistance scheme over the last three years; (b) on average, how many cases can be weaned off the list annually and how many new cases are added on; and (c) how many of them are chronic or long-term recipients.”
“My Ministry conducts regular audits on all nursing homes licensed under the Private Hospitals and Medical Clinics Act. Their licences are subject to renewal every two years. They will have to comply with all the audit requirements before their licence can be renewed. One audit requirement is that the nursing home must meet the minimum "care staff to patient ratio". The ratio will vary in accordance with the medical profile and hence the needs of the patients. For the majority of patients in our nursing homes, the ratio is for one care staff to between two to four patients. VACCINATION AGAINST HUMAN PAPILLOMA VIRUS (HPV) 4. Mdm Halimah Yacob asked the Minister for Health whether he will consider (i) implementing the recommendation of the Expert Committee for Immunisation to include the vaccination against the human papilloma virus (HPV) in the childhood immunisation programme; or (ii) subsidising the cost of the vaccine which is still too high for low-income families.”
“We should support these preferences as far as practicable by growing community support services for home palliative care. This is not just in medical and nursing care, but also in psychosocial support. This is particularly important for patients with young children or complicated family relationships as it helps the surviving family members come to terms with the patient's impending passing. We are working to support the efforts of the hospice care community in providing this vital service. We are also working with the hospice community to have more day facilities to meet the care needs of these patients. Some terminally ill patients end up in nursing homes. Tan Tock Seng Hospital and Dover Park Hospice have started a pilot programme to improve end-of-life care in nursing homes. As the outcomes are promising, we are expanding the programme progressively across more regions in Singapore. HEAVY VEHICLES 26. Mdm Cynthia Phua asked the Minister for Transport (a) in each of the last three years, what is the number of accidents that involved heavy vehicles being driven past speed limits; (b) whether the Ministry will look into speed-limiting devices and enforcing even more stringent speed limits on these heavy vehicles; and (c) what has the Ministry done to prevent heavy vehicles (lorries and buses) from parking in private housing estates.”
“End-of-life care is a delicate and complex issue. The challenges it throws up are many; addressing them is a preoccupation among healthcare providers in many societies. In Singapore, we have made a lot of progress, particularly in recent years and are now much better prepared. But much more still needs to be done. Supply side constraints are real, in terms of availability of skilled resources. We are expanding capacity and raising capabilities through greater investment in this area. My Ministry is committed to this. I have shared our plans on this before in this House and I will not repeat them. At the end of the day, resource constraints are easier to fix. More difficult to fix are attitudinal constraints: both of the patients, their family members, as well as of the doctors. Acknowledging the limits of medical science and human mortality is easier said than done, especially when it involves ourselves and our loved ones. Changing attitudes takes time and we should be patient. The key is greater dialogue, more sharing of experiences, raising awareness and empathy. Within the healthcare sector, we are promoting advance care planning (ACP) to facilitate greater dialogue between patients, families and the healthcare professionals on end-of-life care and treatment decisions. The aim is to empower patients and families to participate in decision making and express their wishes for treatment and care preferences, through facilitated discussions. My Ministry is also working to reinforce ACP to doctors, nurses and other healthcare professionals, through targeted training and awareness sessions. We know that many terminally-ill patients prefer to spend their last days at home, in familiar surroundings accompanied by their loved ones.”
“These serve to ensure that public agencies and officials, in carrying out their statutory functions, are subject to responsibilities to maintain confidentiality and limit the disclosure of personal information. We recognise that an effective data protection regime is a critical factor in building trust between consumers and businesses, and in strengthening Singapore's global competitiveness and position as a trusted IT hub. An inter-Ministry effort has been on-going to examine this issue in detail and determine the best data protection model for Singapore that would address consumers' data protection concerns, business considerations and national interests. Going forward, we will be working closely with the relevant stakeholders in the public, private and people sectors to address their data protection needs and concerns.”
“The Acting Minister for Information, Communications and the Arts (RAdm [NS] Lui Tuck Yew): Mr Speaker, Sir, Ms Denise Phua asked what measures are there to ensure organisations in the private, public and people sectors do not divulge personal particulars of individuals without their permission. Currently, we have in place provisions in our sectoral laws, such as the Banking Act and codes for medical professionals to protect sensitive financial and health information. There are also other industry codes of practice, such as in the telecommunications sector, that prevent the unauthorised use of personal information. To complement the sectoral laws, we have a Model Data Protection Code that was introduced in 2002 for voluntary adoption by any organisation in the private and people sectors. The principles of this Code have been adopted by many organisations, including those engaged in e-commerce under the TrustSg initiative. Some organisations, including charitable and non-profit organisations, that collect and use personal information, have also put in place their own data protection policies. Within the public sector, the Government takes protection of personal data very seriously. The public sector's data protection policy encompasses the principles of the Model Data Protection Code and is incorporated in the Government Instruction Manual. It requires that public agencies put in place processes and procedures to ensure that data acquired by the public sector is properly managed and protected. There are also statutory provisions in many of our Acts that regulate the collection, use and disclosure of information by the public sector. Some examples include the Census Act, Income Tax Act, IRAS Act and Official Secrets Act.”
“Offhand, I am not too familiar with the details, but Members know they have a very sympathetic Health Minister here. I have always been exploring how to help the seniors more, facilitate them more, whether it is through greater subsidy which needs regular adjustments, anyway, with inflation, or allowing greater use of Medisave or mobilising the community to chip in. My own sense is that money is not the key issue. The healthcare needs of an elderly today are being met, but often in the wrong place. If an elderly could be competently cared for at home, sometimes he may still get stuck in an acute hospital where the cost is very high. If they do not need the sophisticated services in the acute hospitals, their money could have been saved if they are, what we call, "right-sited": whether it is at home, at day care facilities, or being in a lower cost community hospital, or in a nursing home. I think right-siting is definitely the way to go. But I will be the first one to admit that the incentives are sometimes warped so that to a patient, he finds it cheaper to stay or over stay in an expensive Class C ward in an acute hospital when he should be, for example, in a community hospital. Trying to clean up these distortions that have been accumulated over the years has taken me quite a few years and would continue to take me many more months. But clean it up, we will. PERSONAL DATA PROTECTION 13. Ms Denise Phua Lay Peng asked the Acting Minister for Information, Communications and the Arts what measures are there to ensure organisations in the private, public and people sectors do not divulge personal particulars of individuals without their permission, for commercial or non-commercial purposes.”
“The community care to support the elderly at home can come from all sources. Community hospital is one good source where you can base the home care activities. Acute hospitals can play that role too, especially now that I have re-organised our acute hospitals for them to take a much more regional approach to healthcare needs. If I may give the north as an example again, the new Khoo Teck Puat Hospital's mission is not just to look after the services within the four walls of the hospital. My message to them is that they are a hospital without walls. The hospital is just a focal point of activities, perhaps to even provide the thought leadership because they have the specialists who would be able to give authoritative information, for example, on nutrition and physiotherapy. It can help organise these services which are not necessarily based in the hospital but outside it. A major part of their activities is to reach out beyond the four walls. That is the same mandate I am giving to the new hospital coming up in Jurong and likewise to the existing hospitals.”
“That is the sort of society and values which we should try to inculcate. At the end of it, prevention is still better. In other words, try to stay well for as long as you can which means keep slim, do not over eat, exercise and eat properly.”
“I am also expanding some others in the west as well as in the north-east. And we will continue to watch over this. Nursing home construction is simpler because the lead time is short, quite unlike a hospital. Hospital takes seven or eight years to plan. But nursing home takes only two or three years. I am quite sure two or three will come up within the next two or three years. But development is not just for institutional care. It is also for care at the community level. As the Member puts it, with more nuclear families looking after the seniors at home when there is nobody at home other than the seniors, is a big problem. I was doing my cardiac rehabilitation this morning and was chit-chatting with my physiotherapist. She has an elderly mother. She was sharing with me the challenges. As she is in the same generation as me, she has several siblings to share and take turns. As for the next generation, they will not have that luxury, and it is going to be a big problem. The western world is already experiencing this. Their solution is more institutional care which we, from the Oriental side, are not sure if that is the right decision. The Japanese are experimenting with more neighbourly help. That is why I am fully in support of MND's expansion of studio apartments. We group them together and, at the same time, there are also other non-studio apartments, allowing the young and old to be together. I think that provides a much more interesting lifestyle, with "buzz". And if people are neighbourly, they can help watch out for each other. The Japanese do that. Sometime ago, I visited some Japanese old towns and I was struck by how closely bonded the neighbours are. They are not relatives but they watch over each other because today, I help you, next week, you may help me.”
“Sir, clearly, the rising number of seniors is itself a good outcome because it means with better health and healthcare services, people are living longer. As that population increases, infrastructure has to keep pace. Infrastructure covers a whole range of facilities, part of it is within my Ministry's purview and part of it is outside my Ministry – under the Ministry of Community Development, Youth and Sports (MCYS), for example, for the elderly homes; and under the Ministry of National Development (MND), for more studio apartments. I will just comment on what is within my purview. Hospitals need to expand and that is why we are expanding them. A new hospital has just opened a few months ago, and a couple more will come about further downstream. There is a need for nursing homes as well. Waiting time has been lengthening, and we have been watching this. Two or three years back, we embarked on a programme to review all existing nursing homes, and we decided on two initiatives which we are now implementing to correct the deficiencies. One is the location of nursing homes. Many of these homes were founded many years ago. Overtime, they find their catchment population disappearing with re-siting of the housing estates. Secondly, they tend to be smaller and therefore do not have the economy of scale to provide many supportive programmes which we now found to be very important, for example, physiotherapy. We need a minimum size to reap certain economy of scale. The conclusion is that we should expand, rebuild and re-site them. We will be doing so, for example, in my constituency in the north, we will be building two brand new nursing homes. They will replace two existing nursing homes which are poorly located. But it is not just my area.”
“The National Heritage Board (NHB) also organised travelling exhibitions, such as "Project 3/12: A Nation Remembers" to commemorate 50 years of self-governance. The National Archives of Singapore (NAS) also curated "10 Years That Shaped a Nation: 1965-1975" (launched in 2007) and "The Second Decade – Nation Building In Progress: 1975-1985" (launched in 2009) which features Singapore's 20 years of growth after Independence. The "10 Years That Shaped a Nation" exhibition highlights some of the important contributions made by Members of the First Cabinet to the Republic. The National Library Board (NLB) also carried out a special project and event on the First Cabinet. To promote a greater understanding of Singapore's Founding Fathers, a publication titled "Singapore: The First Ten Years of Independence 1965-1975" was published in collaboration with NAS in 2008. The publication is a guide to resources available in NAS and NLB on the Members of the First Cabinet during the first decade. These are just some initiatives which have been implemented to recognise and honour the contributions of Singapore's founding fathers and leaders. More will be implemented. In addition, we also welcome ideas and initiatives from the community and grassroots organisations on how they would like to pay tribute to our pioneers. Ultimately, through these measures, we hope that present and future generations will be inspired by the deeds of these individuals and build on their efforts to make a better Singapore. GOODS AND SERVICES TAX CHEATS 22. Mdm Ho Geok Choo asked the Minister for Finance (a) whether the number of GST cheats has been increasing over the years; and (b) how much has the Government lost and how much has been recovered from these cheats over the past five years.”
“It is not just a matter of gratitude, but to stay true to the ideals that they fought for and to remind ourselves to continue striving to become "one united people, regardless of race, language or religion". The measures being taken to honour the founding fathers and leaders not only acknowledge their contributions during the early stages of Singapore's development but recognise that these contributions have a transformational role. They serve as the foundations upon which Singapore's success continues to be built. For example, Dr Goh Keng Swee was instrumental in building up the SAF. He built not just the hardware but a thinking SAF, with capable commanders and staff and soldiers who can outwit and out-manoeuvre the opponent. Dr Goh's emphasis on developing talent and on a thinking SAF endures. In recognition of this, the Singapore Command and Staff College, which is the highest institution for training senior officers in the SAF, will be renamed the "Goh Keng Swee Command and Staff College" in Dr Goh's honour. In addition, in recognition of Dr Goh's contributions in developing our education system, a new building which will house the Academy of Singapore Teachers will be named the "Goh Keng Swee Centre for Education". Other ways in which the contributions of Singapore's founding fathers and leaders are commemorated include exhibitions, publications, videos/ documentaries and other educational programmes to educate younger generations on the contributions of our forefathers and inculcate and strengthen national identity. The permanent exhibition on Singapore History at the National Museum of Singapore features our founding fathers, leaders and other important historical figures throughout Singapore's history.”