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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“On the point of 3%, we have to look at the overall bed occupancy. Last month – because I was preparing the answer for another parliamentary question – our hospitals' actual bed occupancy rate averaged 82% or 84%. There is enough slack. If our occupancy is 97% or 98%, then at 3%, you are really crowding out the locals. I think we have to look at it from that point of view. Secondly, about ensuring quality – yes, certainly. This is one of the reasons why, since the unionists' suggestions, it took me more than a year to look at this problem, because if you just suddenly open the floodgate, there could be problems. But even then, I can never guarantee the quality of a particular service overseas. I cannot guarantee a particular quality of service even for hospitals in Singapore, say, a particular transaction. We cannot guarantee it because there could be individual misconduct or negligence, or whatever. Consumers as always, whether seeking treatment locally or across-border, have to think carefully before they decide to cross the border, particularly if they get into complications. And if they want to pursue legal suits, they will know that cross-border claims will be that much more difficult. That is why, although I have opened up this scheme, I personally do not expect many to go over. But even for the few who are able to take advantage of it, it is great savings for them. They can then preserve their Medisave dollars longer. Is it not a good thing? FINANCIAL ASSISTANCE GIVEN UNDER HELP PROGRAMMES 13.”
“Obviously, they will not go there if the prices are the same or more expensive. In fact, they quoted me examples where if you go to a hospital in Malacca, the cost is less than half. The reason is because nurses' salaries and rentals there are substantially cheaper than in Singapore. I see this as offering choices for consumers. If you want competition, this is another factor in helping to promote the competition advantages in this sector. By keeping our borders open, it keeps our operators within Singapore more competitive because if, say, they are losing a lot of patients to Johor Baru, then they will have to figure out a way to bring their costs down so that they can cling on to the patient load. I think these are very good for consumers.”
“I look forward to receiving the poster or picture of a huge billboard, presumably by STB, under SingaporeMedicine. In recent years, we begin to get very interesting patients coming from very far away. Singapore has always been a regional medical hub. For 40 to 50 years, we have had many patients from Indonesia and Malaysia. But in the last five years especially, we are getting patients from very far away, and Russia is one growing market, Middle East is another. I think that is good for Singapore, good for our economic development and it is part and parcel of the sophisticated development of our tourism business. This way, people come here for treatment and not merely to gamble. But as I said, I will take a look at the poster. The doctors charge foreign patients slightly more, in fact the hospitals also charge foreign patients slightly more. Because as you know, for our Class A rates, we are just charging Singaporeans at cost. I see no reason why foreigners should merely be charged at cost. Because the alternative for them is to go to the Parkway group or some other private hospitals, where there will be a profit margin. So we leave it to the hospitals to decide how much premium they want to levy. But I think the key point is still that at the end of the day, fewer than 3% of our patients are foreigners. I do not think that is excessive. I mean if 30% of our patients or beds are occupied by foreigners, then obviously I got to sit down with the CEOs to see what is happening, or is it we have so many empty beds that we are able to cope with this extra load. The Medisave for overseas hospitals' use was my response to very strong suggestions from unionists. From the consumers' point of view, it is to stretch their Medisave dollars.”
“The public hospitals do not engage in overseas marketing. Their mission and priority are towards local residents, and especially those in the lower income group. Public hospitals do treat foreign patients, as there is no reason to reject them. Given our high standard of care and competitive prices, we attract a significant number of foreign patients who come here deliberately for treatment. But they form less than 3% of our total patient load. Singapore does strive to preserve its role as a regional medical hub, an initiative which we code-named "SingaporeMedicine", and it is spearheaded by the Singapore Tourism Board (STB). As a major provider of tertiary healthcare services, Ministry of Health lends its support to the promotion of SingaporeMedicine. This is because increasingly foreign patients come here for sophisticated treatment in such tertiary care disciplines. This is an area which Singapore, despite our higher cost, has an edge over our regional competitors. While we have many competent specialists in the private sector, many are in the public sector.”
“Sir, my purview does not extend beyond healthcare. But I was in the MTI for several years, so I understand how some of the competitive forces have played. The generic principles of competition and competition being the most rational form of organising economic activity applies to all sectors, but the conditions must be conducive, for perfect competition to take place. Even in some products, where seemingly there is perfect competition, there is actually no such thing as perfect competition. But each sector tries to reduce the imperfection, so that the advantages of competition can be exploited. As for transport and education, the Member will have to pose different PQs to the relevant Ministers. RESTRUCTURED HOSPITALS' PURSUIT OF FOREIGN PATIENTS 12. Mr Seah Kian Peng asked the Minister for Health (a) what is the amount incurred annually by restructured hospitals on overseas marketing from 2007 to 2009; (b) what is the rationale for this expenditure and does it prevent the crowding out of private healthcare providers; and (c) whether this augments a hospital's core mission of providing quality health care for Singaporeans.”
“Just a simple act, and within two or three months, the prices of lasik packages dropped by more than a thousand dollars per eye. Lasik is a fairly homogenous product, though there are complications for some. With information transparency, you can achieve competition. Unfortunately, the bulk of healthcare services do not lend itself to such a competitive environment. But we have to continue to make progress, and therefore I look at this as a really long journey. We have started the first few steps, I think it has been positive, and we will continue to push it. Does it mean the end of the two clusters? Yes, in a way, it has ended. We now have a third cluster coming up in NUH. We have the fourth cluster coming up with Khoo Teck Puat Hospital near my Constituency. And I think that is a positive development. Ms Denise Phua Lay Peng (Jalan Besar): Minister, I am still a little bit baffled by the logic. If there is real competition and real advantage in injecting competition for an essential service like healthcare, such that it will increase innovation and elevate service standards, then why not extend this logic to all essential services, such as education, transport, national security and utilities? How is it that the competition that we tried to inject in media, for example, did not really succeed as expected?”
“I thank the Member for his comment. Certainly, I believe competition is – to use his words – "useful, necessary and desirable". But as I explained in my reply, you have to be skilful in managing competition in this unique sector, called healthcare. Where the conditions are conducive, it can work and it works pretty well. My favourite example of demonstrating this is in the obstetrics service. Many friends who are obstetricians have always grumbled to me that for the last 15 years, their fees and the antenatal package charges remain the same, in nominal terms. What it means in real terms is their income have been dropping because the productivity remains the same – how many babies can they deliver per day? This is the result of competition. I mentioned "information asymmetry" in healthcare, but in obstetrics, there is less asymmetry, because 90-odd percent of pregnancies will be routine pregnancies: simple deliveries, the mother stays two or three days, and mother and child go home happy. Pregnant ladies, after nine months of antenatal care in the clinics, have a lot of things to share. They know which doctors are charging what etc. There is information transparency. Here is a classic example of where the conditions for competition exist and competition will prevail. That is why obstetrics service has been pretty competitive. Likewise, look at our GP services. The reason why primary healthcare in Singapore is of good standard and is relatively inexpensive, is because it has been a pretty competitive market. Members may remember a few years ago that I did an experiment by just simply publishing the prices charged by ophthalmologists, when they do lasik operation.”
“Healthcare delivery will continue to evolve as medical science continues to make progress and better educated patients demand higher levels of service. We have restructured the public healthcare sector since the '80s and the enhancement in service level is visible to our patients. But it is not perfect and we will continue to improve it in the light of experience.”
“Third, competition in healthcare is less intense between large systems, but is more likely to occur at the micro level, between individual doctors or the hospital clinical departments. For example, when a pregnant woman is looking for an obstetrician, her decision is less about whether she would go to the SingHealth Cluster or the NHG Cluster. If she has decided to use the public sector, then she would more likely pick from among the Obstetrics Department of KK Hospital or NUH or SGH. And if she is familiar with the healthcare sector, she may even pick a particular doctor by name, never mind where the obstetrician operates. With these insights, Ministry of Health has since brought the reorganisation further down the road. We have established regional clusters to build partnerships and seek synergies beyond the public healthcare sector. With an ageing population and increased prevalence of chronic diseases, we are strengthening community-based prevention, management and rehabilitation services, most of which are delivered by the private and charity sectors. There is a need for more proactive and coordinated joint management of patients by healthcare players from all the three sectors. These regional clusters will focus on providing integrated patient-centric care in partnership with other healthcare institutions within their respective geographical areas. For instance, the Changi General Hospital will anchor the eastern cluster, in partnership with St. Andrew’s Community Hospital next door, GPs, polyclinics, nursing homes and other healthcare providers in the east. We are doing the same in the other parts of Singapore.”
“First, integration has to be more comprehensive, going beyond the public sector, to also include the private and charity sectors. This is particularly so for the care of the elderly with chronic diseases. These patients will during the course of their sickness consult many healthcare professionals from any or all of the three sectors, including GPs and nursing homes, besides restructured hospitals and polyclinics. The reason why we need to better integrate the care rendered by public hospitals and polyclinics applies similarly to the care rendered by the healthcare professionals from the private and charity sectors. This does not mean that we should nationalise all healthcare services, but it does require a stronger level of coordination and sharing of information across the entire range of healthcare service providers. Second, competition in healthcare has to be better understood and more skillfully managed in a way that is mindful of the unique characteristics of this sector. Many economists have concluded that there is significant market failure in healthcare. Hence, "real competition" as observed by Mr Viswa Sadasivan in presumably other economic sectors, is not as prevalent as in the healthcare sector. One key obstacle to "real competition" is what economists refer to as "information asymmetry": the providers know much more than the consumers. But market does not inevitably fail in healthcare. If conditions conducive for competition exist, serious competition can take place. The generic principles of healthy competition, including greater information transparency, can be applied to healthcare. So we need to discern what is applicable and implement those which are relevant.”
“In 2000, MOH reorganised its restructured hospitals and polyclinics into two clusters. There were two objectives. First, Ministry of Health wanted to better integrate the hospitals and polyclinics to facilitate the referral of patients from polyclinics to hospitals and to coordinate the care of the patients with chronic diseases after their discharge from hospitals. There was also a desire for greater integration and coordination between hospitals and the national specialty centres. Second, Ministry of Health wanted the two clusters to compete more actively to provide better care at lower cost to their patients. The clustering experience has generally been positive. The clusters compete in a friendly manner, to innovate and pilot new ideas, especially in the area of greater service integration, IT applications and chronic disease management. Some ideas were started by one cluster and when confirmed useful, were adopted by the other cluster. Patients gained along the way. Where appropriate, the clusters also collaborate and synergise for mutual benefits. For example, they combined their supply needs through bulk tenders and purchases, reaping substantial cost savings for our patients. Other areas of efficiency gains include: cost savings through sharing centralised services, such as laboratory and imaging services; and sharing best clinical practices, such as the protocols to reduce hospital acquired infections. In the past three years, we have further reviewed the clustering experience and have progressively refined the healthcare delivery model to make it serve Singaporeans better. We have taken several significant steps, after factoring in our new insights.”
“Smokers know that cigarettes are harmful but they still smoke. We will continue to step up targeted education programmes and try out more effective ways to reach out to them. We will also continue to support those who want to quit smoking. NEIGHBOUR DISPUTES IN HDB ESTATES 28. Dr Lam Pin Min asked the Minister for National Development (a) what is the number of reported neighbour disputes in HDB estates over the past three years; (b) what are the resolution processes in place and their success rate; (c) what is the eventual outcome of such disputes; and (d) whether the new HDB Community Relations Department will take on the role of managing such disputes.”
“Singapore’s smoking prevalence is among the lowest in the world. Concerted efforts of our National Smoking Control Programme since the 1970s, have reduced our smoking prevalence from above 25% to below 14% currently. However, this still means that about 360,000 Singaporeans smoke. Our age-specific smoking prevalence exceeds 10% for all age groups, from 18 to 69, peaking at 17% for those aged 18 to 29 years. Men are six times more likely to smoke than women. The age-specific male smoking prevalence exceeds 20% for all age groups from 18 to 69. There is a significant racial difference. Malays’ smoking prevalence is more than double that of Chinese or Indians. Malay men aged 30–39 years, have the highest smoking prevalence of 49%, as compared to 19% for Chinese and 12% for Indians. Fortunately, our female smoking prevalence is low, at single digit percentage, except for young Malay ladies (14%). But more than half of women smokers are below 29 years old and their smoking rate has risen sharply from 5% in 1998 to 9% in 2007. Hence, we must not be complacent in our anti-smoking drive. Current measures include keeping tobacco taxation high, frequent review and timely update of tobacco control legislation, banning smoking in public places, providing effective smoking cessation services and actively educating Singaporeans on the dangers of smoking. In particular, our current campaign has targeted youth and young working adults, including young ladies, with messages disseminated through popular youth activities, like sports and music. We have also ongoing campaign targeting Malay men, which is in its sixth year, with reasonable success among its participants. Behavioural change, unfortunately, is never easy.”
“For those below 20, the rate is especially alarming, having more than doubled from 61 per 100,000 population in 2000 to 133 in 2008. MOH has worked with several organisations to put in place several programmes to address the rising trend of STIs among youths. The topic on STIs is included in the science syllabus and MOE has made it mandatory for schools to implement sexuality education. HPB conducts regular programmes for parents in work places, schools and community venues offering them information and tips on how to broach and discuss sexuality issues, including STIs, with their children. The safe sex messages in HPB’s educational campaigns for HIV also apply to the prevention of STIs in general. DISCOURAGING SMOKING (Campaigns and effectiveness) 27. Dr Lam Pin Min asked the Minister for Health (a) what is the number and demographic profile of smokers in Singapore; (b) what are the current campaigns against smoking and their effectiveness; and (c) whether there will be more measures in future to decrease the prevalence of smoking.”
“Sexually transmitted infections (STIs) are notifiable in Singapore. To protect patients’ confidentiality, STI notifications need not include personal particulars. A patient who consults several doctors will chalk up several notifications. Repeat visits to the same doctor for the same STI will however require only one notification by the doctor. Notifications of STIs, other than HIV, in the past three years suggest these trends. First, the numbers are on the rise, increasing from about 11,000 in 2006 to 12,300 in 2008. The three main STIs are gonorrhoea, non-gonococcal urethritis (NGU) and syphilis. Second, Singapore citizens accounted for about 62% of the number of infections. Based on the data in our STI Control Clinic, one-third of the attendances were new cases, with two-thirds as follow-up cases. We do not have the breakdown of the cases seen at private clinics. Third, 70% of the cases were young adults, in their twenties or thirties. The gender breakdown depends on the age group. For cases below 20, two-thirds were female. For those older than 20, two-thirds were male. Fourth, the overall rate of notifications per 100,000 population has remained quite stable, increasing only marginally from 250 in 2006 to 254 in 2008. However, while the rates have been relatively stable over the past three years, they are at a higher level than before. The overall rate of notifications per 100,000 population has increased about one and a half times from 155 in 2000 to 254 in 2008. Those aged between 10 and 39 years accounted for the largest increases in STI notification rates. For those in their twenties and thirties, the rate per 100,000 population has increased by 67%, from 270 in 2000 to 451 in 2008.”
“Chiropractic is currently not regulated in Singapore, as it is not widely used by Singaporeans. Our patients are well served by western trained doctors and TCM physicians. There are however a few chiropractic practitioners in Singapore, mostly foreigners on employment pass. MOH has provided MOM with a list of chiropractic qualifications which are registrable in Australia, Canada, UK and USA for their reference. MOH has regular dialogue sessions with the chiropractic community to gather feedback on the practice and to encourage them to self-regulate. WRITTEN ANSWERS TO QUESTIONS REDUCING NUMBERS OF ABANDONED PETS 1. Dr Lam Pin Min asked the Minister for National Development (a) what is the number of abandoned pets in Singapore over the past three years and how are they managed; (b) what efforts has AVA taken to control the abandoning of pets; and (c) how many cases of cruelty to animals were reported and their perpetrators persecuted over the past three years.”
“We also have targeted prevention programmes for high-risk groups, encouraging them to go for regular HIV testing and to practise safe sex. An important part of public education is to address misconceptions so as to help reduce stigma associated with HIV. But we need to do more and we are roping in other partners to help in this cause. The Singapore National Employers’ Federation (SNEF) is an important partner. It has produced a set of guidelines on the management of HIV at the workplace. They include a recommendation that employers should not terminate the services of employees just because of HIV. The fear of fellow employees contracting HIV infection at the workplace from an infected colleague is unfounded, unless they are sexual partners. A supportive and non-discriminatory work environment will go a long way to convince the high-risk employees to go for regular screening. We encourage all employers to adopt the SNEF guidelines and put their employees at ease. FAMILY AND ELDER CARE (Balance between family and state responsibility) 32. Mr Laurence Wee Yoke Thong asked the Prime Minister how does the Government strike a balance between supporting families in caregiving support while at the same time not taking over the family's role and making elderly care the responsibility of the community and state. 33. Mr Laurence Wee Yoke Thong asked the Prime Minister with the impending flood of older people who will require long-term care in the coming decade and the declining numbers of workers in this field, what is being done presently to prepare for the future and what are the plans and strategies for the scale needed to enhance caregiver support and reduce caregiver stress.”
“Human immunodeficiency virus (HIV) is a deadly disease, with no cure at the moment, but it is preventable. Hence, our emphasis is on prevention, including regular screening for the high-risk groups. Regular screening, leading to early detection of HIV-infected cases, has two advantages. First, this allows early treatment to commence, which can delay the progression of the disease and raise the patients’ quality of life. Second, the patients can then be counselled on safe sex, thus protecting their sexual partners and preventing new infections. Compared to last year, more people have been tested for HIV, nearly 14,500 per month. But this is not good enough. Among the 218 new HIV-positive cases detected in the first half of this year, only 11% were picked up during voluntary HIV testing. The majority were detected when they sought medical care. More than half of the new cases were at late-stage HIV infection. We need more high-risk groups to come forward for voluntary HIV testing and to do so regularly. To promote voluntary HIV testing, we have adopted a number of initiatives. First, rapid test kits using saliva or finger-prick blood samples are now available in GP clinics. These tests can give a result in about 20 minutes at the same clinic visit. Second, anonymous HIV testing is now available in seven clinics. We will increase the number of such clinics, when the demand grows further. Currently, the number of anonymous tests is below 850 per month. Third, HIV screening on an opt-out basis is now provided to all adult inpatients in acute public hospitals. Such opportunistic screening is convenient for the patients. Fourth, we have regular public education programmes to raise awareness, both for the general population and in schools and workplaces.”
“H1N1 vaccination is recommended, but it is voluntary, not unlike seasonal flu vaccination. Many employers have subsidised their employees for H1N1 vaccination, or even provided it for free. They take into account the need for business continuity and their existing employment medical benefits obligations. In the public sector, we have compiled a list of essential frontline staff and we offer them free H1N1 vaccination. They number some 200,000 persons. We leave it to taxi operators to work with the associations representing their taxi drivers on whether to offer subsidised H1N1 vaccination to them. For those who need to be vaccinated but who have financial difficulty, polyclinics will assist, subject to means-testing. ELECTORAL BOUNDARIES REVIEW COMMITTEE (Update) 25. Mr Chiam See Tong asked the Prime Minister (a) which electoral boundaries of the present constituencies will be changed; and (b) when will the Electoral Boundaries Review Committee’s report be published.”
“And we should not give Singaporeans the wrong impression that, "The state of medical malpractice may have reached an epidemic level warranting harsher measures". But like all professions, there are some black sheep and we need efficient, transparent and fair processes in place to ensure that misconduct is dealt with speedily so as to strengthen the good reputation that our medical profession enjoys. As Mdm Halimah put it, with the proposed amendments, "The law is now very clear. Its aim is to protect the health and safety of the public through mechanisms to ensure that doctors are competent, uphold the highest standards and maintain public confidence." On this note, I thank Members again for their 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 Deputy Speaker in the Chair]”
“Straughan touched on the Interim Orders Committee (IOC) and the issue of justice to the doctor. The need for the IOC and the safeguards were debated in this House when the previous amendment was introduced. I do not want to repeat the arguments. The facts, I hope, will be comforting to Prof. Straughan. In the last five years, there has only been one case when an IOC was convened. This was in a case of a recalcitrant doctor who had a prior conviction for the indiscriminate dispensing of addictive drugs. The IOC decided to curtail his practice. Mr Ang asked if there is a monitoring system in place to prevent drug addicts hopping from clinic to clinic, collecting drugs such as sleeping pills. Such a system exists for one highly addictive drug, methadone. Whether we should extend this system for sleeping pills will need to be carefully studied. Mr Ang also asked whether our hospitals are adequately equipped to detect medical errors. This is a big topic – as medical errors can come from many causes and no hospital has been able to eradicate medical errors as we are dealing with human beings and human errors do occur. Proper staff training and supervision are important. Systems must also be in place to monitor adverse events so that lessons are learnt and staff reminded. Where systemic inadequacy leads to the error, then systemic solutions have to be found and implemented. Mr Deputy Speaker, Sir, I believe I have addressed all the concerns raised. Singaporeans enjoy a high standard of healthcare services and our doctors are largely ethical, professional and competent. As Dr Lam put it, "There is really nothing seriously wrong with the medical profession here in Singapore".”
“We are injecting more resources, assigning dedicated clinical teaching and establishing a sustainable structure to improve the learning experience of our trainees. In other words, it is a modular approach and whether you progress to the next stage of training depends on what you have achieved and you must demonstrate that. So it is not purely based on: Have you done three years, five years or six years? Rather, we would progressively test, examine, assess and be confident that, yes, this trainee has imbibed what has been taught to him or her so that he can progress on to the next stage. The idea is to improve effectiveness and reduce attritions. Dr Lim is familiar with our current system which has been around for many years. It is a good system but in some specialties, it has led to huge attritions. The Americans look at such issues from a different point of view. To them, doctors are specially selected, so they ought to be capable of being trained properly. When there are huge attritions, they would blame the trainer: "What kind of training are you providing that, at the end, most of your students fail?" Therefore, what they believe more in is structured training so that at each step of the way I know what I am supposed to learn and what I should be capable of doing at the end of that stage, and if I do, then I progress on. It means objective assessment of outcomes so that both trainer and trainee are familiar with what to expect and along the way, they are able to reduce attritions. This is the approach that we hope we can incorporate into Singapore. What we intend to do is certainly to enhance training so that our specialists will be competent and properly trained. This is something that we have always been proud of and we will not lose that. Prof.”
“Finally, there were a number of comments which do not pertain to the proposed amendments in the current Bill. So let me address them briefly. Ms Ellen Lee noted a recent media report which suggested that Singapore-trained doctors as compared to foreign-trained doctors were more lenient to colleagues who misbehave. The media report was based on a survey done on a small sample of house offices. We had then discussed this subject in this House. We must certainly take issues on medical ethics and professionalism seriously. The teaching and learning start early in the medical school and extend to postgraduate medical education and throughout the medical career. Professionalism and communication skills are core competencies which our training authorities will strengthen through structured training processes and exposure to clinician mentors. We have started on this journey to reaffirm the importance of professionalism and ethics in medicine, and we will press on. Ms Sylvia Lim asked whether the postgraduate training at Duke NUS without the one year of requisite housemanship would be compromised. Under the Medical Registration Regulations, first year post-graduation is required to have broad-based training exposure. This applies to graduates from both medical schools. Dr Lim Wee Kiak referred to the enhanced postgraduate training programme and wondered if the reduced duration would compromise quality. For almost all specialties, there will be no reduction in the training duration. The intent of the enhancement is to ensure a more structured approach to training. Trainees will be assessed each step of the way so that we can raise training effectiveness and reduce attritions.”
“She felt that this may be seen by the public as less transparent. Let me clarify that this provision only pertains to situations where a formal complaint has never been received from the public. However, if the information received by the SMC pertains to a serious offence of professional misconduct, SMC will proceed to forward the information to the Chairman of the Complaints Panel and formal investigations will be initiated even though no formal complaint has yet been lodged. Sixth, Dr Lam asked why there is a need to raise the maximum financial penalty from $10,000 to $100,000. At the same time, I heard Mdm Halimah complaining about the $10,000 penalty on a recent case as just too low. The current quantum was set in 1997 when the financial penalty was first introduced. Prior to that, there was no financial penalty as part of the disciplinary orders available to SMC. Many years have passed since and we thought that the $100,000 penalty for medical misconduct is not excessive. Mr Ang asked about the number of doctors who have repeated similar offences in the past five years. There were 17 such doctors. Mdm Halimah asked whether most of the cases brought before the SMC were referred by MOH. This was not so. Three in four of the complaints received by the SMC during the last three years came from members of the public. Seventh, many Members have spoken in support of the establishment of a Family Physician Register. Dr Lam asked if existing family physicians would automatically be included in this register. There must be minimum requirements for registration as a family physician. The criteria and qualifying conditions were extensively discussed previously when I undertook another public consultation several years ago but, generally, we will take an inclusive approach.”
“I have noted the various suggestions and we will discuss with the medical community and the general public on whether the proceedings should continue to be held in private or with limited attendance and whether the proceedings should be published in full or in an abridged version while maintaining confidentiality of patients. So this is bound to be another subject of public consultation which I will undertake. We will have to find a balance which will serve the public interest best. I have also noted Mdm Halimah's suggestion about some schedule of penalties in order to improve transparency, and we will take a look at that as well. Related to this issue of transparency, Ms Ellen Lee and Mdm Halimah suggested that we publish and regularly update a list of errant doctors. I thank Prof. Paulin Straughan for expressing her views why she thinks this is not a good idea. It is a debatable idea – whether we should maintain an active public listing of the guilty – and we can argue about it. Would that not unduly stigmatise doctors whose offences may not be so serious and, if so, then what constitutes serious offence? Then, what about those who have genuinely turned over a new leaf? I am a champion of the Yellow Ribbon Movement. People make mistakes – they should be given a second chance. The key point is: do you realise your mistake and do you sincerely want to change? And if you do, I think society must support that. If you stigmatise them, you are forcing them down a different route, which I do not think is productive for the society. Ms Audrey Wong referred to the provision of the Bill which allows the SMC to deal directly with the medical practitioner without referring to the Chairman of the Complaints Panel.”
“There are provisions to limit the time taken by the Complaints Committee and the Disciplinary Tribunals. The authority to vary the time for the Complaints Committee and the Disciplinary Tribunal to complete the cases resides with the SMC. Prof. Straughan asked whether all complaints could be dealt with within the three-year limitation period so that complainants who may wish to pursue a civil lawsuit can rely on the outcome of the Disciplinary Tribunal to make an informed decision. SMC will make every effort to conclude the investigations of every complaint within a reasonable time. However, civil suits are best legally advised and considered independently from the Disciplinary Inquiry. Complainants who wish to commence civil proceedings should not wait for the outcome of SMC's investigation. If they intend to, they should instead file a civil suit within the limitation period to ensure that their right to sue is preserved. That said, SMC has assured me that most cases can be concluded within three years and, with the various amendments that I hope the House would pass this afternoon, we will now have greater ability to form Complaints Committee and Disciplinary Tribunals and get the proceedings off speedily. Fifth, Mdm Halimah, Prof. Straughan, Mr Ang and Mr Calvin Cheng commented on the need for more transparency in disciplinary inquiries. As noted by Mdm Halimah, this is a trend that we already see in the UK, US and Australia. Current proceedings are not completely opaque, neither are they fully transparent. What makes this subject complicated? It is the need to protect patient confidentiality. However, given rising level of interest in the issue of transparency, we will study this issue further.”
“The SMC conducts training sessions for all members of the Complaints Panel from which members of the Disciplinary Tribunals are drawn. The training sessions are conducted by SMC's lawyers and focus on legal issues, procedures and policies relating to the Medical Registration Act. Third, Prof. Paulin Straughan noted that investigators appointed by the SMC are potentially powerful agents, as she put it, with fairly extensive authority. Ms Sylvia Lim also noted that the investigator holds an important and pivotal role in the disciplinary process. Both wanted to know the qualifications these investigators are expected to hold. Our plan is to recruit officers with at least 10 years of experience in the Police or related enforcement agencies. They will be very much like the officers in my Ministry's Enforcement Branch. We would like to assure this House that investigators will be provided with all the necessary training to equip them with the appropriate skills to carry out the duties of an SMC investigator. Fourth, Prof. Paulin Straughan and Ms Audrey Wong commented on the time taken by the SMC to deal with each complaint. They are concerned about rising number of cases, resulting in delay and a backlog. I share similar concerns. In fact, one main objective of this Bill, as noted and welcomed by Mdm Halimah, is to help the SMC speed up the disciplinary processes. Mr Ang Mong Seng offered some suggestions. He proposed that we categorise cases as core or non-core and set a time limit for each category. For instance, complicated cases should be concluded within a year and if more time is needed, a formal request for extension should be made. I agree that all complaints should be dealt with speedily.”
“Of course, what is complex, I agree, is hard to codify or define, and that is why this is the question best left to the SMC. The SMC will have to consider each case differently and they are the ones who decide if this case is sufficiently complex in nature such that having a senior lawyer to chair will bring advantages to the proceedings. Mr Calvin Cheng suggested that we should allow laypersons to form the majority of the Tribunals. But unfortunately, this will defeat the whole purpose as pointed out by Dr Lim Wee Kiak. This will undermine the whole approach of self-regulation that we wanted the medical profession to follow. Dr Lam Pin Min also asked if the new provisions for SMC to lodge an appeal to the High Courts on behalf of a patient under section 55(2), constitutes a "double whammy" as this amounted to a doctor being prosecuted twice. This is not an issue unique to Singapore. In fact, there was a similar issue that was raised in the UK, where they have a Council for Healthcare Regulatory Excellence, which has the power to refer matters to the High Court that it considers to be "unduly lenient". Like the SMC, this UK Council can in effect, appeal on behalf of patients even where the doctor has been acquitted by the general medical council in UK. And when the issue was raised in the English Court of Appeal, the English Court accepted that this power creates an element of "double jeopardy", as they put it. But overall, they thought that such concerns were to take second place when this is necessary to protect the public. And in this instance, we have taken a similar approach in Singapore. Second, Dr Lam asked if Disciplinary Committee members receive any form of training. Yes, they do.”
“And as noted by Mr de Souza and Ms Audrey Wong, we have made some amendments to the original draft Bill, which I put out for public consultation. The current Bill, which is in front of the House, contains amendments to the original because I take public consultations seriously. It is not just a show. When I consult, I am really keen to see what are the comments and if there are valid points, we will incorporate them. This is one example where, because of the strong views expressed by certain segments of the medical community, I decided to hold back the whole tabling of this Bill by two or three months to allow me to consult the various people and along the way, we amend the original draft Bill, which is the version that Members see today. I think and as noted by Mdm Halimah, we have made sufficient and relevant compromise to finding this trade-off between preserving the interest of the public as well as making sure that the self-regulation approach to medical professionalism that we have in the medical profession, is not compromised. And Members can notice that just on this point, in this House this afternoon, there are strong views, different views and I hope Members can accept that the compromise that I have struck, is a fair one. Dr Lim Wee Kiak would like us to consider an alternative, which is to appoint a highly respected individual such as a Justice of the Peace, and not necessarily a legal professional to chair the Disciplinary Tribunal. Unfortunately, that cannot resolve the problem that we have identified, which is the legal complications which have been imposed on the Disciplinary Tribunal in dragging out unnecessarily the whole entire proceedings.”
“This is not an indictment of the medical professional, rather it is a progressive development where the medical practitioners collaborate "synergistically" to use Mr de Souza's words, with the legal professionals to do their best, to manage efficiently both questions or fact of medical practice and questions of law. This will help the Disciplinary Tribunal to make fair judgments in complex cases. Let me reiterate again that the SMC is not arrogating its responsibility. As noted by Mdm Halimah, "the amendments have taken into account doctors' concerns as their appointment of any legally qualified person, whether chairman or committee member is at the discretion of the SMC." The SMC will have the prerogative to include a senior lawyer to Disciplinary Tribunal, only when it deems appropriate. The Bills specify that there should be at least three voting members in a Tribunal, of which at least two, shall be medical practitioners and does not set an upper limit to the number of voting medical practitioners. The Medical Council may have two or more practitioners in addition to the legal professionals to constitute such Tribunals, so that when it comes to questions of facts pertaining to medical practice, the medical professionals' views will prevail. This amendment is to mitigate potential legal errors which may arise when dealing with complex issues of law which medical professionals are often either not familiar with or is aware of. After the Director of Medical Services has explained the background of this amendment to the entire medical community, as I highlighted during my speech a couple of hours ago, the vast majority of the medical community had no further objections on this particular amendment.”
“It seems to me that if the proceedings were chaired by an experienced legally trained chairman, or if there were present such a person as a member, not as a legal assessor, the proceedings could and indeed would have progressed more expeditiously." I spoke to the President and a couple of past presidents of the SMC, because when the reaction from a certain segment of the medical community emerged during the public consultation phase, I felt it necessary to get to the bottom of this, so I spent time with a few of these current and past presidents. All of them strongly recommended that we include this particular amendment. They have personal experience conducting the disciplinary proceedings and felt strongly that the presence of an experienced legal professional on the Disciplinary Tribunal will be a significant advantage. I note Mr de Souza's support for this amendment and also his very sound advice that SMC proceedings should not become overly legalistic, shifting the focus from what is medically professional and ethical to what is strictly legal. I agree with his call but the reality is that increasingly, senior lawyers are being engaged in high-profile cases saddling disciplinary committees with legal arguments and technicalities, the relevance of which does require legal training to discern. And that is why the SMC President and past presidents have made such a strong recommendation to allow them the option to appoint senior lawyers to chair some Disciplinary Tribunals, where circumstances may demand it.”
“During the public consultation on this amendment, one senior lawyer who has served many years as legal assessor for the SMC wrote in to express his observations that frequently the SMC's Disciplinary Committee wasted a lot of time on irrelevant matters but he was unable to intervene. I have his letter to the Ministry of Health here. I have not sought his permission to quote him – so I will not name him – but I would read an extract of what he said, because this is a real, personal experience of one who has helped out as legal assessor for many years. This is what he said: "As a legal assessor, my role in the disciplinary proceedings is limited to advising the Disciplinary Committee on questions of law arising in the course of the proceedings or informing the Disciplinary Committee of any irregularity in the conduct of the proceedings and advising the Disciplinary Committee when it appears to me that there is a possibility of a mistake of law being made. In that restricted role, I often felt inadequate and at times frustrated in being constrained from intervening when I noted counsel, either for the doctors concerned or for the SMC, spending a great deal of time in questioning witnesses on or dealing with irrelevant or peripheral matters arising. The doctors chairing the Disciplinary Committees were often too polite and indulgent to counsels and gave them a lot of leeway. Conducting hearings and dealing with contentious counsels, arguing with each other across the table and disputing on issues or points – sometimes serious and at other times frivolous – are not matters with which the doctors are familiar.”
“Mr Deputy Speaker, Sir, I thank Members who have spoken very passionately on this Bill – not always agreeing with one another – and generally in support of this Bill. Let me address their comments and suggestions. First, the proposal to allow senior lawyers to chair Disciplinary Tribunals. I am not surprised that this is one of the most heated issues this afternoon. Dr Lam noted that the practice was not unusual, having been done in Australia, Canada and elsewhere. However, he worried that it might be perceived as, "SMC lacking the moral courage and legitimacy to discipline high profile complex cases". In any case, he commented that "the definition of complex is subjective and can be ambiguous". In contrast, he and Ms Audrey Wong noted the Law Society going in the opposite direction, doing away with the appointment of laypersons in the Disciplinary Committees. Dr Lam asked whether the amendment would mean "the medical profession is regressing and arrogating responsibility". I do not know fully the circumstances that led to the amendment to the Legal Profession Act. But I recall the debate in this House which noted that formalised legal processes, like the legal disciplinary proceedings, would benefit from lawyers' participation. And the amendment to remove the layperson was to help speed up the proceedings. SMC's disciplinary proceedings are similarly formalised legal processes but currently without the advantage of having legal professionals on its Disciplinary Tribunal. Although there is a legal assessor present to assist the SMC's Disciplinary Committee, as noted by a number of Members, to address issues of law, the extent to which legal assessors can guide the proceedings is limited.”
“In any verdict passed, the influence of a legal professional will only come into being when the doctors on the Tribunal have different votes. Furthermore, only very senior and eminent legal professionals such as a former Supreme Court Judge or Judicial Commissioner, senior lawyers, or senior legal officers can be appointed to chair the Disciplinary Tribunal. After his explanation, the vast majority of the medical community have no objection to the provision. Mr Speaker, Sir, the standard of clinical and ethical practice of our doctors in Singapore is high. I believe Singaporeans are proud of our healthcare services. In addition, a large number of international patients come here annually to seek treatment, which is further evidence of their trust in our medical services. Our job is to maintain the high standard that our patients expect and make sure that professional medical regulation keeps up with continuing changes in the environment. I seek the Members' support for this Bill as we forge ahead in providing medical regulation that protects the interest of the general public and also the reputation of our good medical professionals. Sir, I beg to move. Question proposed.”
“The quality and pace of proceedings can be significantly improved by appointing appropriate chairpersons or members who will be legally empowered to control the proceedings and rein in prosecution and defence counsels. Sir, let me emphasise that the presence of legally-trained persons in the Tribunal is not intended to replace the medical profession's self-regulation. The reality is that the SMC can no longer hold any disciplinary inquiry without significant legal assistance and no inquiry can be conducted without legal inputs and extensive legal preparation and costs. No Disciplinary Committee wishes to risk submitting legal errors or judgements that can be subjected to challenges in a court of law. Even in the course of such extensive legal consultations, there have been cases in the past where the High Court had taken prosecuting lawyers or Disciplinary Committees to task for errors arising from failure to appreciate and comply with legal principles. Such situations may be reduced or avoided by allowing senior legal professionals to sit in the Tribunals where it is deemed expedient by the SMC. From the public consultations and discussions in the media and with the professional community, we believe that the changes will help to augment the processes and improve public confidence. As the provision was of great interest to the medical community, my Director of Medical Services (DMS) wrote to all the 8,000 registered doctors in Singapore, to explain fully the purpose of the provision and to seek their individual views. We assure our doctors that the decision to appoint a legal professional as chairman or a member of the Disciplinary Tribunal remains in the hands of the SMC – which is a body entirely made up of senior doctors.”
“Public consultations Mr Speaker, Sir, the Second Reading of this Bill today follows months of consultation that involved the general public, doctors and key professional groups. MOH had engaged the SMC and key leaders of various professional bodies, including the College of Family Physicians, Singapore Medical Association and the Academy of Medicine. I would like to thank all who have contributed their views to help shape the Bill. One proposed amendment has been the subject of much debate from a segment of the medical fraternity. It is the provision to allow the SMC to appoint legal professionals either as chairman or as a member of a Disciplinary Tribunal. Let me explain why such a change is not only necessary but will also add value to the current system. Disciplinary inquiries increasingly involve complex issues that are legally and procedurally challenging. In almost every inquiry, both the Council and the defendant are represented by legal teams. Thus, Disciplinary Committees always require the presence of a Legal Assessor to assist in the proceedings. For high profile cases, doctors have been known to engage top lawyers, including Senior Counsels. Disciplinary Committees are increasingly saddled with legal arguments, technicalities or materials that unnecessarily lengthen proceedings. Consequently, the legal costs of conducting inquiries have risen considerably. Senior lawyers appointed by the Medical Council as Legal Assessors are, by law, limited in their ability to direct the course of proceedings at the inquiry, to assess the weight of evidence, or to participate in the final decision of the Disciplinary Committee.”
“This Register will list the names of Family Physicians who have undergone a recognised formal training programme in family medicine. The new Board and Register will further enhance the level of healthcare in the community and raise the standard of family medicine practice in Singapore. If Singaporeans receive good and affordable healthcare in the community, they can avoid unnecessary visits to acute hospitals and therefore save money. Miscellaneous amendments Finally, we are taking the opportunity to introduce a number of miscellaneous amendments to enable the SMC to operate more effectively and efficiently. They include: (a) clause 5 which allows the SMC to provide administrative services to other bodies (whether corporate or unincorporate) responsible for the regulation of healthcare professionals; (b) clause 18 which removes the requirement for the SMC to publish a list of doctors in the Gazette, as such information is now already and regularly updated on the Council's Internet website; and (c) clause 31 which allows the SMC to compound offences in lieu of prosecution. Consequential amendments will also be made to the following Acts: (a) section 12 of the Private Hospitals and Medical Clinics Act (PHMCA) to widen its powers of investigation, and section 13 to allow authorised officers to disclose information obtained under the Act, if such disclosure is under or for the purpose of administering and enforcing the Medicines Act or the Health Products Act; and (b) section 14C of the Dental Registration Act and section 18 of the Pharmacists Registration Act to empower the Singapore Dental Council and Singapore Pharmacy Council to impose conditions and restrictions on specialist registration for dentists and pharmacists respectively.”
“This will enable the SMC to assess the applicants more thoroughly prior to registration and proactively deal with the registrant's condition. (d) Clause 22 allows the Specialists Accreditation Board to certify as specialists, persons who have the experience and meet the conditions for specialist registration even if they did not have recognised qualifications, and to define areas of sub-specialty. Clause 12 clarifies that conditions and restrictions can be imposed on a person's Specialist Registration. This will allow the SMC to register a foreign specialist, and limit the scope of his practice to only his field of specialisation or area of expertise where necessary. For example, hepatology is not defined as a specialty in Singapore. However, with the amendments, we can certify a hepatologist as a specialist in gastroenterology, which is a specialty here, but restrict his practice to hepatology. Hepatology is a sub-specialty of gastroenterology. I think it deals with liver diseases. This will help safeguard public interest and safety. Registering family physicians Fourth, we propose to set up a register of Family Physicians. With an ageing population and the rising prevalence of complex chronic illnesses, there is a need to have more well-trained family physicians to serve the healthcare needs of Singaporeans in the community. Every Singaporean should have a trusted Family Physician. If you do not have one, better look for one now. The Family Physician will be a valued physician who will coordinate care for the patient and his family competently and cost effectively. Clause 23 of the Bill will establish the Family Physicians Accreditation Board to accredit such practitioners and clause 13 provides for the Registration of Family Physicians with the SMC.”
“The following changes will better enable the Medical Council to scrutinise and, if necessary, limit the practice and conduct of new doctors entering the healthcare system and to act to maintain standards: (a) The current Act only allows the SMC to consider reports from the supervisor in monitoring and assessing the conditional registrant. This is not always adequate for assessing competencies in areas such as communication and teamwork. Clause 11 improves the current supervisory framework by enabling the SMC to seek feedback and reports from other healthcare professionals other than the supervisor to provide a fuller assessment of the doctor's competence and ability to work in our local environment. (b) Clause 14 allows the SMC to cancel the provisional registration of a medical practitioner if he was found to be underperforming. Under the current Act, the SMC does not have such powers and is not able to stop a house officer from practising even when there are serious issues with his performance. (c) Currently, the SMC can refuse to register an applicant only if he was not qualified to be registered; was not of good reputation and character; or had his name removed from a register of medical practitioners in another country. For fresh foreign-trained medical graduates, neither of these reasons would apply. However, they may have health conditions, such as Hepatitis B, HIV or psychiatric disorders, which may render them to be unsuitable for practice in some areas. Clause 16 allows the Council to refuse to register persons who are found incompetent or is unfit to practise medicine due to a physical or mental condition, or fails to submit to a medical examination, or comply with any condition or restriction of any previous registration.”
“However, this is still not enough to meet the rising healthcare needs of our larger population base, a significant segment of which is rapidly aging. We are actively recruiting competent foreign trained doctors and the enhanced registration framework will enable the SMC to cater to new issues that have arisen in view of these developments. Let me explain. The new GMS with its different model of education will require a different mechanism for assessing its graduates for registration as opposed to the graduates from the NUS Yong Loo Lin School of Medicine. This is generally not provided for under the current MRA. Clause 10 enables the Medical Council to prescribe different requirements for the different degrees in medicine and surgery specified in the First Schedule. This will allow the SMC to adopt requirements similar to the US system in assessing the NUS-Duke GMS graduates. Over the years, we have also increased the number of overseas medical schools recognised in Singapore from 24 to 160, to facilitate the entry of foreign-trained doctors from good medical schools. There is a sizeable influx of foreign-trained doctors, both foreigners and Singaporeans who studied overseas, into our medical workforce. Last year, two out of three new medical registrations were foreign-trained. In other words, for every local graduate, there were two graduates from foreign medical schools. Aside from medical qualifications, we also need to monitor the performance of these doctors, making sure that they are up to our standards and adapt well to the local environment.”
“Under the current Medical Registration Act, the Disciplinary Committee can impose a financial penalty not exceeding $10,000 on a medical practitioner who is convicted. The next level of penalty is a suspension of between three months and three years. There is, therefore, a significant gap in the range of penalties in the current Act. The new section 53 will allow the Tribunal to impose a fine of up to $100,000, thereby enabling the Tribunal to mete out a penalty that is appropriate to the severity of the case. This section will also allow the Disciplinary Tribunal to impose other orders, for example, changing his medical registration from one that is fully registered and unsupervised to one that is conditionally registered and supervised. The SMC, by so doing, can thus impose appropriate conditions or restrictions on the practitioner. The Disciplinary Tribunals will also be able to mete out the new range of orders available to the Complaints Committee. All this enhances the powers of the Tribunal by expanding the array of possible orders. Similarly, the new section 58 will enable the Health Committee to restrict a doctor's practice for a period exceeding the current three years where necessary. These changes, in conjunction with the expansion of orders available to the Complaints Committees, and Disciplinary Tribunals will allow appropriate rehabilitative or punitive actions to be taken that commensurate with the severity and circumstances of the cases. A more nuanced medical registration Third, we seek to enhance medical registration for both local and foreign-trained doctors. Mr Speaker, Sir, to cope with the rising demand for doctors in Singapore, we have increased the medical school intake at NUS, and started the NUS-Duke Graduate Medical School (GMS).”
“This enables SMC to resolve certain less serious health or performance issues with the mutual consent of the doctor instead of going through tedious, and formal disciplinary proceedings. However, this section will not apply if a complaint had been received against the doctor. Currently, the Complaints Committees are only empowered to issue letters of advice or warnings where no further inquiry is necessary, or order an inquiry to be held by a disciplinary committee or a health committee. We propose to widen the range of orders available to the Complaints Committees so that less serious complaints can be concluded expeditiously without the heavy legal involvement and time required for Disciplinary Tribunals. When the Complaints Committee deems that no formal inquiry is necessary, the new section 49 will allow the Committee to: (a) order that the registered medical practitioner seek and undergo medical or psychiatric treatment, or report on the status of his fitness to practise periodically to SMC; (b) order that the registered medical practitioner undergo further training, or seek and take advice in relation to the management of his practice; (c) refer complaints for external mediation to facilitate resolution amongst the parties concerned, for example, where miscommunication or compensation between the parties had been the key issue in the complaint; and (d) by agreement of the doctor, remove the name of a doctor from the register, suspend his practice for not more than three years, cancel or suspend his practising certificate, or impose restrictions and conditions on his practice. These changes also allow the SMC to deal with correctable behaviours more constructively.”
“Currently, where information is received regarding a doctor's practice, such as errant prescribing of addictive drugs, there are no provisions for SMC to conduct a thorough investigation. A Complaints Committee can only rely on exculpatory statements and medical records submitted by the doctor and expert opinions. These may not fully reflect the facts or severity of the case. These amendments will empower the appointed investigators to seize evidence without notice to the doctor, and conduct a thorough investigation. In this way, the Complaints Committees will be better able to make informed and impartial decisions, resulting in complaints being processed more quickly and with fairer outcomes. The new section 55 sets out the framework for the SMC or an aggrieved complainant to appeal to the High Court against the Disciplinary Tribunal's decisions. Currently, only the defendant doctor is allowed to appeal to the High Court on the decision of the Disciplinary Committee. This is not necessarily fair to the public or the complainant. This section allows the SMC to appeal when the Council is not in agreement with its independent Tribunal's orders. The framework also allows the complainant an avenue to initiate an appeal through a review committee appointed by the Minister. Expanding the range of orders Second, we propose to expand the range of orders for SMC, its Complaints Committees, Disciplinary Tribunals and Health Committees so as to grant them more powers to be able to deal more effectively and appropriately with errant doctors. The new section 37A provides for a doctor, who is aware of his performance difficulties to voluntarily request the SMC to remove his name from the register, suspend him, or impose conditions or restrictions to his practice.”
“Together with clause 4 which increases the number of Council members from the present 19 to 25 members, these changes will effectively increase the number of chairmen and committees that can be constituted to handle the larger number of complaints. (b) Further, the new section 40 will reduce the number of members of the Complaints Committees from the present four to three members, and all three members of the committee need to be present to constitute a quorum. With a smaller committee, this will make it easier and faster to coordinate members' schedules for meetings. (c) In addition, the new section 50 renames the Disciplinary Committees as Disciplinary Tribunals, a more appropriate term and changes the way they are constituted. With the amendments, the Disciplinary Tribunals will no longer specifically require the chair and one member to be Council member as is the case today. The Disciplinary Tribunal's Chairman and members will be constituted from a panel of Chairmen appointed by the Minister, and the Complaints Panel respectively. It will also allow the SMC the option of appointing members with experience in legal matters, such as a senior legal officer, senior lawyer, former Supreme Court Judge or Judicial Commissioner, to be a member or the chair of a Disciplinary Tribunal. I will speak more on this amendment later, but briefly these changes expand the Council's capacity and capability to deal with the increasing number and complexity of disciplinary cases by widening the pool of members that can be appointed to the Disciplinary Tribunals. The new section 42 and clause 28 will allow SMC's Complaints Committee to appoint and empower officers to investigate complaints against doctors.”
“This is partly because the number of doctors has also increased substantially, from 6,292 in 2003 to more than 9,000 in 2009. This works out to about 11 complaints per 1,000 doctor per year, which is not alarming. However, SMC's capacity to cope with the rising number of complaints has remained the same during this period. The result is a growing delay by the SMC in processing the cases, especially if they are complex. Last year, as an example, a simple complaint took about three months to conclude, and one complex case actually took more than five years. As a result of long delay, there have been instances where the complainant who was dissatisfied with the outcome of the disciplinary process, was unable to initiate civil proceedings against the doctor. The complainant also has no recourse for appeal against the Disciplinary Committee's decision under the current Act. This is unsatisfactory. Clause 26 repeals and re-enacts Part VII of the Act relating to inquiry and disciplinary proceedings. The changes in Part VII seek to achieve more expeditious and equitable management of complaints. SMC's Complaints and Disciplinary Committee members are all volunteers. With the increasing number of complaints, the existing members have been heavily burdened with disciplinary inquiries which could last up to 10 days, and requiring at least six hours each day. The frequent and heavy commitment required makes it difficult at times to constitute the committees, thus delaying the proceedings. To improve the situation, (a) the new section 38 will raise the cap on the number of lay persons and registered doctors in the Complaints Panel from the current 80 to 150, almost doubled.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." The Medical Registration Act (MRA) seeks to protect the health and safety of the public by creating mechanisms to ensure that medical practitioners are competent and fit to practise medicine. In this way, we uphold the standards of medical practice in Singapore, and so doing, maintain public confidence in the medical profession. The MRA was last amended in 2003. Since then, new issues in professional conduct and standards have arisen due to changing demands and expectations of patients and the public. This Bill seeks Members' support for several amendments to the MRA. The amendments will address four key objectives: (a) To strengthen and streamline the Singapore Medical Council (SMC)'s existing disciplinary processes to cope with the increase in the number and complexity of complaints and disciplinary proceedings; (b) To provide a wider range of orders and penalties which the SMC can impose, commensurate with the extent of a medical practitioner's wrongdoing and circumstances of the case; (c) To adopt a more nuanced approach to medical registration for both local and foreign-trained doctors; and (d) To set up a Register of Family Physicians. Let me elaborate on each of these objectives and explain how the proposed amendments would achieve them. SMC's disciplinary processes First, we see a need to strengthen and streamline the SMC's disciplinary processes, to cope with the rising number and complexity of complaints against doctors. Singaporeans enjoy high standard of medical care and largely have high confidence in our doctors. Nevertheless, the number of complaints has gone up from 66 in 2003 to 96 in 2009.”
“PUB drinking water is treated to a quality well within "WHO guidelines for Drinking Water Quality" and is safe for life-long consumption. The WHO Guideline Value for chlorine is 5 mg/litre while the residual chlorine in PUB’s water supply is typically less than 2 mg/litre. Column No : 1811 FOREIGN SPORTS TALENT SCHEME (Update) 6. Ms Joscelin Yeo asked the Minister for Community Development, Youth and Sports (a) what is the present ratio of local national athletes to athletes brought in through the Foreign Sports Talent (FST) scheme in each of the core sports; and (b) whether his Ministry sees a need to set a minimum ratio to ensure that local athletes are given an opportunity to develop and represent Singapore before the spot is taken by an athlete who comes through the FST scheme.”
“Compliance to proper disease management programme is key to avoiding future complications, like heart attack, stroke or organ failure. To ensure that Singaporeans have access to safe and healthy food, my Ministry works closely with other agencies such as the Agri-Food and Veterinary Authority of Singapore (AVA) and the Public Utilities Board (PUB) to keep abreast of new developments and to educate the public regarding food and water safety. The AVA takes the lead on food safety. It educates food traders and members of the public on the safety of food additives through seminars, workshops and dialogue sessions on a regular basis. All food additives permitted in Singapore have to pass international food safety standards. In addition, the AVA further regulates the maximum level of use of food additives by taking reference from levels permitted in other developed countries, while the HPB regularly monitors the dietary intake pattern in our local population. HSA’s Food Safety Laboratory also constantly evaluates innovative new testing methodologies for food additives, food packaging contaminants etc. As for trans fat, HPB has conducted local studies which show that three in 10 adults, particularly those aged 18 to 39, have exceeded the World Health Organisation (WHO) recommended daily limit. We will step up public education on the harms of excessive consumption of trans fat, and work in close partnership with AVA to review the trans fat levels in the food supply. Finally, the WHO supports the use of chlorine for disinfection of drinking water. This is safe when applied below specified levels, effective against waterborne pathogens and is beneficial to public health.”
“In Singapore, the top five causes of deaths, in descending order of significance, are (a) cancer, (b) ischaemic heart disease, (c) pneumonia, (d) cerebrovascular diseases including stroke and (e) accidents, poisoning and violence. To combat these major killers, our focus is on prevention, early detection and chronic disease management. The risk factors are well-established: smoking, physical inactivity, unhealthy diet, obesity, and chronic conditions such as diabetes and hypertension. To help bring about behavioural change, we have a range of health promotion strategies, including public education, capacity building, and partnering with stakeholders in the school, community, workplace and healthcare settings, to create a supportive environment. For instance, this year’s National Healthy Lifestyle Campaign focuses on obesity and its prevention. A national weight-loss challenge "Lose to Win" was well supported by both employers and employees at the workplace. HPB also works closely with the food industry to offer a wider range of healthier food for consumers. Over the past three years, we have rolled out an Integrated Screening programme and launched a "Screening on Wheels" workplace programme to encourage early detection of chronic diseases and selected cancers through regular evidence-based screening. There are ongoing national screening programmes for breast and cervical cancers and a national colorectal cancer screening programme is being piloted. For those with a chronic condition such as diabetes, HPB has launched the Nurse Educator Programme to educate and motivate them to better manage their condition. This requires support by the primary healthcare providers and the patients’ families.”
“Mr Seah Kian Peng asked the Minister for Community Development, Youth and Sports (a) in each of the last three years, what is the amount that the Government spent year on sporting activities for the disabled and how does this compare with other countries; and (b) whether more can be done for the disabled who are non-athletes to help them lead a sporting and active life, as much as their disability will allow.”