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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“Sixth, HSA maintains an active international network of contacts amongst its overseas counterparts and other relevant scientific laboratories. In this way, we stay close to developments overseas and will be able to promptly follow up on any new risk factor that may have emerged elsewhere. Our screening and surveillance system is based on an objective scientific approach in line with international best practice. However, at the end of the day, we can only minimise risk but not eliminate it totally. Routine testing of products can only look for known and expected chemical contaminants. If new, unexpected chemicals are added by an unscrupulous trader, existing tests will not detect them. This risk is even higher for products sold from dubious sources like back alley shops or the Internet. People who choose to buy and use such products are exposing themselves to high and unnecessary risks that endanger their own health and safety. We strongly advise Singaporeans against doing so. STRATEGIC INDUSTRIES IN SINGAPORE 29. Mr Gautam Banerjee asked the Minister for Trade and Industry whether his Ministry regards any industry in Singapore as strategic for national defence, competitiveness and long-term sustainability and, if so, how does Singapore retain control over such strategic industries.”
“There are prescribed limits for these substances which CPM products should not exceed. Additional attention is paid to higher-risk products that are more likely to be adulterated, for example, those with claims of sexual enhancement or slimming properties. For these products, the dealer must submit additional test reports to show that the product does not contain any adulterant or other prohibited substance. Third, after initial approval, each time a batch of CPM products is brought in and before they can be sold, the importer must submit a letter of undertaking to HSA, confirming that the batch does not contain (a) any synthetic chemical or other prohibited substance, and (b) excessive toxic heavy metals and microbial contents. The appropriate laboratory test reports must accompany the letter of undertaking. Fourth, an active post-market surveillance programme is carried out after all registered products enter the market. HSA carries out ongoing post-market surveillance to check on the safety and quality of products being sold. It has a system for picking up adverse event signals from doctors and hospitals if their patients experience side effects after taking the health products. This is an important part of post-market surveillance and allows HSA to take quick action to warn the public, investigate and, in severe cases, recall products that may be causing unexpected side effects. Fifth, HSA carries out sampling and testing of higher-risk products to check that they meet specified requirements. If testing shows any deviation – for example, if a supposedly herbal medicine is found to be adulterated with a synthetic drug – HSA will mandate recall of the product from the market, and can take punitive action against the dealer.”
“It is not practical for the Health Sciences Authority (HSA) to test all medicinal or herbal products imported from China or for that matter, any other country. Indeed, no country takes such an approach. Instead, like other leading regulators, HSA adopts an objective, risk-based approach, grounded on latest available scientific evidence. HSA regulates a number of products but imposes the most stringent controls on the two highest-risk categories of products – 'Western' pharmaceutical medicines and herbal Chinese proprietary medicines (CPM). Its risk-based approach comprises six key elements. First, all importers and wholesale dealers of these products have to be licensed by HSA. As part of the licensing requirements, they must comply with internationally established Good Distribution Practice (GDP). In this way, the licensees are fully reminded of their responsibilities and what they need to do to ensure the safety and quality of the products that they are dealing with. Currently, there are more than 360 importers on its register. Second, a rigorous pre-market assessment is made before a product is registered and allowed to enter the Singapore market. HSA will require the submission of the necessary documents and laboratory testing reports and review them. There are currently more than 5,000 western medicines and more than 8,000 CPM products on its register. Any importer who intends to introduce a CPM product into Singapore must submit two sets of documents: (a) the full formula of the product, which will help reveal the possible presence of any synthetic chemical or other prohibited substance, and (b) laboratory test reports on the level of any toxic heavy metal, such as mercury and lead, and the microbial content in the product.”
“From next year, all subsidised healthcare services used by Class B2 and C patients during their hospital stay will have the bills adjusted by the appropriate subsidy levels. This would include standard drugs. Non-standard drugs will continue to be charged at cost to patients, as is the practice today. MEDICINAL IMPORTS FROM CHINA (Screening and testing) 28. Ms Ellen Lee asked the Minister for Health whether the Health Sciences Authority screens and tests all medicinal, herbal or related items that are imported from China.”
“I think the reply to the first query is more "DIE-logues". You just got to keep on talking and there is no short-cut to this. The more we talk about death and the dying trajectories, we will develop a more mature attitude towards this. And if we can overcome this squeamishness, I certainly hope to be able to amend the AMD so that doctors and providers of care can discuss end-of-life issues much more openly with their patients. As for caregivers, I am aware of the pain and sufferings they go through. Indeed, in many areas of palliative care, attention is now extended to care for the caregivers too because, often, they themselves end up ill, either in parallel with the terminally ill or soon after death. So that is a level of sophistication in palliative care that I think we are still under-developed which we should begin to build into our palliative care programme. ENERGY MARKET AUTHORITY (Review of tariff-setting mechanism) 9. Mr Seah Kian Peng asked the Minister for Trade and Industry whether the Energy Market Authority will be reviewing the tariff-setting mechanism in determining the electricity tariffs to better reflect prevailing fuel prices in the market.”
“Third, we are working with nursing homes to consider providing palliative care and to help their residents with proper end-of-life planning. Death is a certainty and while it is not welcomed, a good death, I assume, is the aspiration of all. A good death may not come naturally and proper advance planning is more likely to deliver one.”
“Sir, euthanasia is only allowed in Belgium and the Netherlands. In Switzerland and the US states of Oregon and Washington, doctor-assisted suicide is permissible, but not euthanasia. Both involve performing an act that leads to death. The difference is that while euthanasia allows for the doctor to perform the act, in doctor-assisted suicide, the patient performs the act himself and the doctor only provides the lethal prescription. My Ministry is promoting Advance Medical Directive (AMD) and palliative care. AMD is about letting nature take its course for the terminally ill at the last stage of their lives. AMD is about not mindlessly postponing death through futile medical interventions. AMD is not euthanasia or doctor-assisted suicide. I do not think that Singaporeans are ready to accept euthanasia. Instead, we should focus on providing good palliative care for the dying and getting people to think about and plan for the kind of care they want at the end of their lives. Death should not be a taboo subject. There must be more public discussion about death and end-of-life matters. I therefore welcome the recent public debate about euthanasia. It has raised public awareness about palliative care and the frustrations of some terminally ill and their caregivers. My Ministry will help the terminally ill cope better with end-of-life issues. First, we are working with the hospice and palliative care community to expand their capacity and to extend their reach. We will provide greater support to the dying persons and their caregivers, while managing their needs sensitively. Second, we are getting more doctors and nurses to train in palliative care. Palliative care is now a medical sub-specialty and we will offer more training opportunities in it.”
“Sir, the lack of well-trained doctors and nurses in this area is a constraint globally. We are aware of this limitation and we certainly would ramp up training of such specialists and nurses. The problem, sometimes, is a lack of interest. It is a specialty that does not make a lot of money and, unfortunately, some trainees are motivated by that, and it is not unique to Singapore. I have just read the US Institute of Medicine Report (IOM) on geriatric and palliative care and it describes this whole ageing of US as a "silver tsunami" – I supposed they were inspired by the current financial tsunami from Wall Street – and their conclusion is that in the US, they can see this tsunami coming but the US is not prepared to deal with it. That is a good summation of this huge problem that the whole world would be facing in the next one or two decades. I think we have to take practical approaches which are: exposing as many doctors and nurses to different aspects of geriatric care and palliative care so that along the way whichever department, or specialty they are in, that extra knowledge that they have picked up will be useful and be translated into better care for their patients. And GPs certainly play a big role, and so long as they are interested, we are ever-ready to train them up so that they can bring benefit to their patients. EUTHANASIA 8. Mdm Halimah Yacob asked the Minister for Health (a) how many countries in the world have practised euthanasia; (b) whether euthanasia is being considered in Singapore; and (c) instead of euthanasia, what more can be done to help Singaporeans better cope with end-of-life issues.”
“If cost is a major constraint towards access, I would look into it. But, off-hand, my feedback is that because of heavy subsidies that we provide to inpatient hospices, as well as through VWOs to home hospices, cost may not be a major obstacle but lack of awareness is. I think there is lack of understanding of what palliative care is all about and how it can benefit the patient and the family. There is that lack of awareness in the marketplace which we must try to overcome.”
“Sir, last year, about 5,400 patients received hospice and palliative care services. Of these, about 4,200 patients were cared for at home, while 1,200 stayed at inpatient hospices. Hospice care is affordable as it is subsidised by up to 75% of cost for low-income patients. Inpatients are able to tap on Medisave to pay for their bills. Medifund is also available for those with additional financial needs. Care is accessible, and no patient who needs hospice care will be turned away. The main obstacle to access is awareness. There is a need for more discussions about death between patients, their families and their doctors. As death is inevitable, everyone should have an end-of-life care plan, including the kind of care that is preferred and share it with the family. For some, this may include signing the Advance Medical Directive.”
“In addition, the Town Councils Financial Rules require that the type of investments placed by a fund manager appointed by the TC and the market value of such investments be disclosed in the annual accounts. MND will continue to monitor closely for compliance with its financial guidelines.”
“MND has imposed an investment cap of 35% on TCs' investments in stocks, funds or securities that are not issued by the Singapore Government or any statutory board, or not guaranteed by the Singapore Government. In other words, of the total funds that they can invest in, only 35% can invest in such stocks, funds or securities that are not issued by the Singapore Government, statutory board or guaranteed by the Singapore Government. The investment guidelines for TCs seek to achieve an optimal balance between reasonable returns and financial prudence. Based on the TCs' financial statements for FY2007, which ended 31st March 2008, and additional investment details recently submitted to MND, about $12 million, or about 0.6% of the TCs' total funds available for investment are invested in Lehman Minibond notes and other credit-linked notes for which early redemption has been triggered. The latter refers to DBS High Notes 5, Merrill Lynch's Jubilee Series 3 and Pinnacle Notes Series 9 and 10. Of the 16 TCs, only two have invested some of their funds in the said products. Holland Bukit-Panjang and Pasir Ris-Punggol TCs have invested about 6.7% and 2.6% of their total funds available for investment in them. Within the investment guidelines that MND has put in place, TCs are in the best position to determine the balance that suits their respective financial requirement and risk tolerance. It is neither practical nor desirable for MND to be overly prescriptive. MND has no intention to amend the investment guidelines. TCs' financial statements are audited and published annually. These financial statements are prepared in accordance with the Financial Reporting Standards, which prescribe disclosure requirements for investments.”
“Long-term or cyclical expenditure needs generally involve more expensive works. There are lifts, pumps and pipes to be replaced, roofs to be re-roofed and repairs and redecorations to blocks to be done. TCs also use their sinking funds to fund their co-payment of lift upgrading, so that residents pay an even smaller percentage of the total lift upgrading cost. The funding for these large expenditures is collected over time as part of the monthly service and conservancy charges. This way, residents do not have to fork out a large sum every time one of these works needs to be done. The larger the number of flats under a TC's management, the larger the funds need to be accumulated to cater to such works. The Town Councils Act governs the use of sinking funds. In other words, the Town Council could not just use sinking funds for any other purpose but what has been prescribed in the Town Councils Act. To ensure that the Town Council funds are not eroded by inflation as they are being accumulated, TCs need to invest their funds prudently. Therefore, MND has guidelines in the Town Councils Financial Rules that regulate what TCs can invest in. TCs are allowed to invest funds that are not required for immediate use in Singapore denominated fixed deposits, stocks, funds and securities. Investments in stocks, funds or securities must be on the advice of a qualified person. Examples of qualified persons are an investment adviser holding a licence under the Securities and Futures Act and an approved bank or a merchant bank approved as a financial institution under the Monetary Authority of Singapore Act.”
“Sir, the short answer is yes. I agree with Ms Ellen Lee that it is really a mouthful, and rather inconvenient when I have to discuss it with the public in Mandarin. That is why I suppose the translators wander into this "an le shi" as an euphemism. But even "an le shi" causes problem because I have had feedback from some of the readers that it is misleading. It has misled many to think that AMD is euthanasia. Some of the Zaobao's forum letters on this topic suggests to me that many of them have confused euthanasia with assisted suicide and AMD. These are three very different things. As there are a couple of other PQs on this subject, we can discuss this very interesting subject further. INVESTMENTS BY TOWN COUNCILS (Guidelines) 6. Ms Eunice Elizabeth Olsen asked the Minister for National Development (a) what are the investment guidelines that Town Councils use, especially with regard to complex and risky financial instruments; (b) whether the Ministry will further cap the proportion of Town Council investments that are allowed to be made in non-government securities and bonds; and (c) whether the Ministry will consider requiring Town Councils to publish a breakdown of the types of investments which they make. The Senior Minister of State for National Development (Ms Grace Fu Hai Yien) (for the Minister for National Development): Mr Speaker, Sir, before I discuss the investment guidelines that Ms Olsen has asked for, we should first understand the nature of the funds for which the investment guidelines were adopted for. Town Councils (TCs) maintain two funds: an operating fund for short-term expenditure needs, and a sinking fund to cater to the long-term maintenance expenditure needs of the common property in HDB estates.”
“Sir, I agree with Dr Fatimah that we need more sessions both with the public as well as with the doctors. I have mentioned this point in one sitting before that some of our focus group discussions revealed that even among doctors there were some, I hope not the majority, who themselves are uncomfortable about discussing AMD and end-of-life issues with their patients. So you can see we are in a bit of an uphill task here. But there is no shortcut to overcoming this problem, and we just need more "DIElogues" with Singaporeans. On the second part about health screening and incorporating AMD questions into it, we are bound by the current law. As I said just now, we are not supposed to ask the question, "Have you signed up AMD?" or "Do you intend to sign up AMD?" If we ask such a question, we will be sent to jail. So it is these restrictions which we have imposed into the Act, maybe for a good reason 11 years ago but, honestly, I feel that it is outdated and, in any case, no other countries do that. So I am keen to remove these restrictions but let me do more sounding with the public first.”
“Sir, I think AMD should never be a number game whereby we set KPIs and then we chase the numbers. I think that would be totally wrong. In any case, even if you look at the States, where I mentioned the figure of 20% among adults having signed up AMD, there is a wide variation across the States. Some states have single digit percentage of AMD rate and this is after more than 20 years of a much more open attitude towards discussing death and end-of-life matters. To me, the key issue is not so much about AMDs or how many people sign up, but about advance planning, particularly among the terminally ill. When a patient picks up a terminal illness, for example cancer, then at a suitable point, as health care providers, we really would need to engage the patients and their families so as to mentally prepare them about the possibility of end-of-life issues. There are many personal preferences and decisions that we need to know ahead of time and the earlier it is discussed in an open manner, I think it should help the terminally ill as well as their family members cope better. So that is the attitude I am bringing to the table on this subject.”
“Sir, I suppose the small number of six AMDs being put into effect in a way reflects that the pool of AMD's signatories is small, to begin with. As I said, we now have 10,000 – I am one of the 10,000 – but the vast majority of them only signed up in the last two to four years and for a long time there were just a couple of hundreds per year. Now we are signing up about 2,000 to 3,000 per year, and it is growing. And we will certainly do our best to promote this more. But I think the underlying difficulty is this general squeamishness among the people, whether justified or not, and I think that change will take time. I certainly agree that the people sector is a major partner of ours in this exercise, and that is why I welcome the Lien Centre for Palliative Care pushing more "DIE-logues" about death. That is why for several weeks when Zaobao kept up the debate on euthanasia, and despite some misunderstanding among the forum letters, I let the debate continue. Let this topic be discussed more. In a way, the discussions surprised me because I had thought that Asians would find death taboo and would not want to talk about it. I was pleasantly surprised by the great interest the public have on this topic and I consider it positive. It is our job to continue this discussion and help direct it in a positive manner. As to the reasons why the 16 revoked their AMDs, we could not ask why do they revoke just as we do ask why they sign up. Hence, I do not have the breakdown. But whatever it is, the number is small.”
“Meanwhile, we will ensure that written materials on AMDs will be made easily accessible to the public, at the clinics, in the hospitals and nursing homes. The recent public debate on euthanasia, hospice and palliative care has been useful to get more Singaporeans to think about and discuss end-of-life issues. My Ministry will also encourage hospitals and nursing homes to engage their patients and their families in general discussions on advance care planning, including AMD.”
“We are quite unique in the world in imposing such restrictions. Reading the Hansard records of the debate in the House on AMD, I gather that these restrictions were put in as there were concerns by some Singaporeans that a doctor may be less forthcoming in his treatment if he knows that his patient has already signed an AMD. I am confident that our doctors are ethical and will do what is necessary for their patients, regardless of their AMD status. Unfortunately, such fear, though groundless, remains among some Singaporeans. The restrictions have inadvertently become counterproductive to the intent of the AMD by making discussions on AMD taboo. This is a major reason for the lack of awareness and apathy among the public and even healthcare professionals on the AMD. It is my view that we should change this attitude and help Singaporeans cope with end-of-life issues in a much more scientific and mature manner. Death is a certainty and must not be a taboo subject. For the terminally ill, we do need to engage them and their family members early to understand their concerns and their preferences. I am inclined to amend the AMD Act in two ways. First, make it simpler to sign up for an AMD. The requirement that the form must be witnessed by a doctor has deterred many as they find it a hassle and costly. Many have asked me to drop this requirement. Second, drop the restrictionsthat have made AMD a taboo subject between doctors and their patients. We must promote greater openness the way the Americans have done. However, I do not know if Singaporeans are ready for these amendments. I will do more sounding and I certainly welcome Members' advice on this.”
“More than 10,100 Singaporeans have signed Advance Medical Directives (AMDs). Three-quarter of them did so in the past four years. Over the years, 19 AMDs have been revoked and six have been put into effect. As signatories are not required to disclose their medical conditions when making an AMD, I do not have the breakdown as requested by Dr Fatimah Lateef. Our AMD rate of 0.4% is low. But this is the experience in many other countries too. For example, in Australia, the sign-up rate is even lower, at 0.2%. The US is unique in having a much higher sign-up rate compared to the rest of the world. Their rate is around 20%. One major reason for the higher sign-up rate in the US is the openness in which the patients and the doctors there are able to actively engage in discussions on advance directives and end-of-life issues. In fact, the Americans have a Patient Self-Determination Act which requires Government-funded hospitals, hospices and nursing homes to ask all adult patients, at the time of admission, if they have made an advance directive, and if not, to inform them about their right to do so. Such information is then required to be documented in the patient's medical records. In sharp contrast, our society remains rather squeamish about discussions on AMDs. Our AMD Act specifically prohibits doctors and nurses involved in the care of a patient from asking whether or not the patient has made or intends to make an AMD. It will be a criminal offence if they do and there are severe penalties including a fine and jail term. Our AMD Act further requires the AMD Register to be kept strictly confidential. So a doctor may request for a search of the AMD Register only when his patient is terminally ill, unconscious, and would require extraordinary life-sustaining treatment.”
“Sir, may I take Question Nos. 3, 4 and 5 together, please.”
“There would be no liability if it has done all it could to prevent such a transmission. Nevertheless, each case will have to be assessed on its own merit. Column No : 647 PRIVATE EDUCATION INSTITUTIONS (Regulation and supervision) 22. Dr Lily Neo asked the Minister for Education in view of the study undertaken by the Ministry to enhance the regulation and supervision of the private education sector, (a) whether he can ascertain how many private schools are offering unrecognised degrees from unaccredited universities; (b) how many Singaporeans are in these schools; and (c) what plans does the Ministry have to better protect the interest of students in private schools. 23. Mdm Cynthia Phua asked the Minister for Education in light of the recent reports on private schools offering dubious university courses, (a) what is the Ministry doing to weed out such school operators; (b) will the Ministry take on a stricter role in processing applicants before granting them approval to run a school; and (c) whether there is any restriction on schools using the phrase "licensed by MOE" on their collaterals and publicity materials. 24. Mr Lim Biow Chuan asked the Minister for Education if he will provide an update on the status on the implementation of the EduTrust Scheme for private education organisations.”
“The risk of contracting an infection through blood transfusion is inherent in such a procedure. It has to be weighed against the life-saving benefits of blood transfusion. The only practical approach is to reduce the risk of transmission to its absolute minimum. This is done through a comprehensive series of measures based on international best practices to assure the safety of the national blood supply. First, we ban commercial blood-banking, as it tends to attract the wrong type of donors. Instead, blood-banking in Singapore is purely based on voluntary non-remunerated blood donation. This allows us to select the blood donors, focusing on low-risk donors. Second, we test all donated blood for HIV, Hepatitis B, Hepatitis C and syphilis using the latest available screening tests. There have been no reported cases of transfusion transmitted infections in the last 12 months. However, blood transfusion still carries a risk. This is because there is a window period in the early stage of infections such as HIV or Hepatitis when the virus cannot be detected by existing tests. There are also diseases such as dengue, where there is no licensed test available to screen the blood supply. Hence, we also rely on potential blood donors to do their part. They must answer truthfully on the donor health assessment questionnaire and during the medical screening process. If they have already donated blood, but think that their blood is not suitable for transfusion, they should immediately contact the blood bank to stop the usage of the blood. In the unlikely event of an infection through blood transfusion, the liability of the blood bank will depend on the circumstances leading to the infection. Patients will be compensated if there has been negligence involved.”
“The higher inflation rate in 2008 has not dampened the demand for inpatient services. Both public and private hospitals reported an increase in their admission rate by 1.3% and 4.0% respectively. For the first half of this year, the private hospitals' market share has remained stable at 23.2% (22.7% in 1H2007). We are unable to make similar comparisons for polyclinics as we do not have detailed statistics on private sector outpatient attendances. DEFERMENT OF PUBLIC PROJECTS (Update of plans on construction of Indoor Sports Hall in schools) 7. Dr Fatimah Lateef asked the Minister for Education following the announcement that the Government had deferred public projects due to the high cost of construction and inflation rate, if he will provide an update and details of subsequent plans for construction of Indoor Sports Hall in schools.”
“Our obesity rate of 7% is also among the lowest in the world. But much more need to be done. One in seven Singaporeans still smoke. One in three Singaporeans need to reduce their waistline. Three in four Singaporeans do not exercise regularly. We must intensify our efforts to get all Singaporeans to embrace healthy lifestyle as a way of life. To succeed, every Singaporean must join in this effort, and from young. WOMEN'S CHARTER (Protection for foreign wives of Singaporean men) 47. Dr Fatimah Lateef asked the Minister for Community Development, Youth and Sports (a) under the Women's Charter, what kind of protection is offered to foreign wives of Singaporean men; and (b) in the last three years, how many complaints had been received from such wives whose ex-husbands are not paying their monthly maintenance.”
“Three diseases, cancer, coronary heart disease and stroke, caused more than 60% of all deaths in Singapore. This has been the pattern for 20 years and is also observed in other developed countries. These are described as "lifestyle diseases", as they are often due to modern lifestyle, in contrast with infectious diseases which were the main killers 40 years ago. Besides causing death, they are also the main causes for morbidity or ill-health. Together with diabetes and mental disorders, these five diseases account for more than 70% of disease burden, contributing to the bulk of our patients in the clinics and the hospitals. The key control strategy is prevention: keeping Singaporeans healthy through healthy lifestyle, and managing the chronic diseases to avoid future complications. This is particularly urgent as the continued ageing of our population will only worsen the problem. My Ministry will ramp up the preventive effort and allocate more resources to support the increased emphasis. There are two main programmes: public education through the Health Promotion Board (HPB) and a systematic disease management programme through hospitals and clinics. The budget for HPB has increased by 40% since its establishment in 2001, to around $100 million this year. But HPB can only be a catalyst, working through partners like the schools, sports council, employers and the community organizations. The total national budget on health promotion is, therefore, much bigger than what is reflected on HPB's financial statements. But this is money worth spending if we can get more Singaporeans to adopt a healthy lifestyle: eat less, exercise more and do not smoke. Our efforts have had some success. Our smoking rate of 14% is among the lowest in the world.”
“Mr Ong Ah Heng asked the Minister for Health (a) whether there has been any change in the list of causes of deaths in Singapore; (b) which chronic illnesses should Singaporeans be on guard against; (c) in light of the ageing population and preventive healthcare becoming more critical, whether the Ministry will allocate more resources towards this end; and (d) what is the success of programmes to educate the public on major illnesses like cancer, diabetics and heart diseases.”
“I have set out the Ministry's position on kidney transplant when I spoke in this House on 21st July. First, we will focus on prevention, especially on diabetes management to reduce the incidence of kidney failure. This means getting all diabetic patients to adopt a healthy lifestyle. Second, we will focus on raising kidney transplant rate through promoting and supporting altruistic kidney donation by both cadavers and related living donors. We have some way to go, as compared to, say, Spain and Norway. These must be the main sources of kidneys for transplantation. Specifically, I will come back to this House to amend the Human Organ Transplant Act (HOTA) in 3 areas: (a) lift the HOTA age limit, (b) allow pair-matched transplants by living donors, (c) support the welfare of donors, including financial reimbursement to cover the additional expenses that they have to incur as a result of their kidney donation. These would include costs such as for additional medical care, loss of income and higher insurance premiums. Such reimbursement is best done by a voluntary welfare organisation, which will need to raise funds from the public to support such a mission. Reimbursement to kidney donors is to help protect donor welfare and reduce the barriers against kidney donation. I believe our society should readily acknowledge the contribution of these donors who have given a kidney to save someone's life. An adequate financial reimbursement will be a practical gesture. The National Kidney Foundation has come forward to help in this effort and my Ministry is working out the details with them. DISEASES AND CHRONIC ILLNESSES (Public education programme) 42.”
“HPB also works with Family Service Centres and other youth organisations to reach out to other youths to provide them with knowledge and skills to protect themselves against STIs. Parents play an important role in the sexuality education of their children. HPB conducts regular "Love Them. Talk about Sex." programmes in work places, schools and community venues. These offer parents information and tips on how to broach and discuss sexuality issues, including STIs, with their children. A toolkit, helpline and website (www.letstalkaboutsex.sg/parents) have also been developed. Through these programmes, we aim to reduce the incidence of STIs among youths over time. We will repeat the Students' Health Survey every three years to monitor the effectiveness of these programmes. NEW BRIDGE ROAD, EU TONG SEN STREET AND SOUTH BRIDGE ROAD (Data on traffic speeds before imposition of ERP) 2. Mr Lim Biow Chuan asked the Minister for Transport if he will provide data on traffic speeds that had occurred for the three-month period prior to the imposition of ERP at New Bridge Road, Eu Tong Sen Street and South Bridge Road.”
“The incidence of sexually transmitted infections (STIs) among youths aged between 15 and 24 years has increased from 231 per 100,000 population in 1998 to 418 per 100,000 in 2007: Age-gender-specific STI incidence per 100,000 population Year 15 – 24 years Male Female All 1998 219 242 231 1999 228 226 227 2000 248 172 210 2001 259 189 224 2002 253 202 227 2003 331 338 334 2004 416 457 437 2005 422 469 446 2006 390 468 428 2007 362 479 418 A 2006 Students' Health Survey, jointly conducted by the Health Promotion Board (HPB) and the Ministry of Education (MOE), found that 4% of Secondary 3 and 4 students have had sexual intercourse. Of these, 24% were sexually active (more than five times in the past 12 months). Another study by NUS is currently underway to examine the correlation factors, including socio-economic and educational background. Several programmes are in place 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 complements it with its "Breaking Down Barriers" (BDB) programme, an STI/AIDS prevention programme targeted at Secondary 3 students. The BDB programme covers protective measures like abstinence and condom use, and life-skills such as decision-making, assertiveness and negotiation. STI/AIDS awareness and education programmes are also conducted for students in post-secondary and tertiary institutions. These programmes help the students to recognise the signs and symptoms of STIs and advise them on the appropriate medical follow-up. Those who are diagnosed with STIs are treated and counselled individually.”
“But for a small minority of these mentally ill, their psychiatric problems necessitate their involuntary admission, care and treatment in a psychiatric institution. This is to ensure their personal safety, health and to protect other persons in the community. Hence, we need this Bill and, once again, I thank the House for their strong support. 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; reported without amendment; read a Third time and passed. MENTAL CAPACITY BILL Order for Second Reading read. 5.21 pm”
“While I agree that the California case threw up an important issue, I doubt this is the occasion to debate it. I do not think it is appropriate to legislate on a psychiatrist's duty of care towards third parties in this Bill. Without detracting too much from the debate on this Bill, let me just say that the doctor-patient confidentiality is fundamentally important but it is not absolute. There may be very compelling situations where countervailing public interests may justify disclosure. This is also recognised in the Singapore Medical Council's ethical code and ethical guidelines. Mr Speaker, Sir, my Ministry will continue to work with other ministries and agencies on this nation-wide mental healthcare programme. My Ministry cannot do this alone. Under this programme, we will pro-actively care for patients across a wide spectrum of mental health conditions. The focus is prevention, early treatment for those who suffer from mental health conditions, get them back on their feet with continuing care in the community wherever possible. While the Government will work hard on this, the society at large has to work even harder on changing mindset, ie, employers, fellow employees, fellow Singaporeans, family members, neighbours. The mentally ill need our help, our sympathy, our empathy. Try to put ourselves in their shoes. If you continue to stigmatise mental illness, treat all of them like psychopaths, we will only make their conditions worse and their recovery more difficult. I, therefore, join Mdm Halimah, Dr Ong, Mdm Cynthia Phua and all the Members who have spoken, to appeal to all Singaporeans to join us to help these unfortunate patients.”
“Mr Ang Mong Seng asked if the police can be more proactive in getting patients, behaving strangely before they become violent or dangerous, to seek treatment early. We certainly should try, whenever we come across such cases, to alert the medical officers and hospitals so that we can start early treatment or diagnosis. But I hope we can do it in a way which will not reinforce the flawed stereotyping of the mentally ill. Some of this social nuisance does not equate to dangerous behaviour. It simply means that the person is unwell and we should find the root cause to it. Is he getting enough support and care from his family, compliant with his treatment or experiencing a relapse? Let us all, as family members, neighbours and fellow Singaporeans, lend a listening ear and a helping hand. Society can play a greater role in supporting the needs of the mentally ill. Police assistance can be sought, however, if the public thinks that the nuisance is persistent and it poses a danger to himself or others. I thank Dr Lam for expressing concerns about the welfare of healthcare givers working in psychiatric institutions but we are used to dealing with such occupational hazards. The IMH has a framework in place to deal with cases of assault on staff. Clause 15(5) of the Bill allows the transfer of detained patients to another hospital for treatment of non-mental related illness. Dr Lam was concerned that the receiving hospital's facility might not be adequate. We will work with the hospitals to ensure that they have the necessary capacity and capability to manage these patients. Dr Ong highlighted the 1976 California Supreme Court ruling of Tarasoff vs Regents of the University of California and asked for a debate on this issue.”
“On the other hand, if the investigation turns out that the family members have ill-treated their mentally ill relatives – a scenario painted by Dr Lam just now – they would have committed an offence, not under this Bill but under the Penal Code, and will be taken to task. In any case, each case will have to be looked at individually and we should not jump to any hasty conclusion or moral judgment. It is easy for outsiders to criticise a family member living with a mentally ill 24 hours a day, seven days a week. As Mdm Halimah, Mdm Cynthia Phua and Prof. Kalyani Mehta have noted, sometimes the family members will need strong support and treatment too. Mdm Halimah asked what constitutes dangerous behaviour, whether police officers are trained to handle persons with mental disorders and how they assess that a mentally disordered person is indeed dangerous to himself or others. Dangerous behaviour may include arming oneself with a knife or other sharp object, threatening others, or putting oneself in a precarious position, for example, climbing out of the window to stand on the parapet. In dealing with such situations, the police will bring the mentally disordered person into safe custody first before referring them to medical assessment and treatment. The police have proper procedures in place to handle such persons. These procedures will guide officers on the course of actions to take, to assure, to pacify and to persuade the person to go for medical treatment. Where force is required as a last resort, to disarm the person or to bring him into custody safely, these procedures further specify that such force shall only be sufficient to overcome the threat or resistance. In short, police officers do receive training in handling persons with mental disorders.”
“But, meanwhile, we step up and strengthen the community services. There is a gap and let us plug the gap first. We will think about the law later. Mdm Halimah asked for MediShield to cover mental illness, while Dr Ong suggested that treatment be free. With Medifund, some mentally ill do not pay anything. So, it is free for them. But they have to be properly means-tested to avoid any abuse. MediShield does not cover mental illness because its premiums have not factored in such a liability. If MediShield is to cover mental illness, these premiums will have to be raised. But I have mentioned before that I keep an open mind on this particular idea. At some stage, when we are going to revise MediShield again, we can think about this particular idea. Mdm Halimah was concerned that increasing the maximum penalty in clause 8 of the Bill will cause hardship for caregivers. Under clause 8(3), a police officer is empowered to visit and inspect a mentally disordered person to ascertain whether or not he is properly cared for or whether he is being ill-treated or neglected. A caregiver commits an offence only if he refuses to allow the police officer access. I believe it is necessary to enhance the penalty for such an offence so as to protect the patients in the community. Mr Ang Mong Seng was worried that family members may abuse the elderly with dementia by complaining to the police so that these elderly persons can be arrested and removed from their homes. If so, this will indeed be a very sad development for our society. The police will not detain any person indiscriminately based solely on complaints. They will conduct a thorough investigation and assessment of the situation.”
“The first is an in-patient order which is similar to our Bill, when detention and in-patient treatment are considered absolutely necessary. The second is community treatment order, where a patient can be adequately and safely treated on an outpatient basis and he is ordered to undergo treatment in the community. Mandatory community treatment is therefore a complement to compulsory in-patient treatment and an extension of legal coverage. It is not an alternative. My Ministry is committed to ensuring that patients with mental disorders are treated in the least restrictive way possible. Like any other illnesses, such patients and their families should be encouraged to seek help, whether in the community or in a hospital. Detention is really a last resort, when a patient poses a risk to himself or to others. Even when detention is necessary, there is a provision in the Bill to grant the patient leave from the institution. This is one mechanism to transit patients back to the community even before formal discharge, when the risk to themselves or the community is reduced. Our intent is clear. It is to shift the focus of caring for the mentally ill from the institution to the community. If a patient does not need to be detained, then we think it is best to emphasise voluntary treatment and community self-help, rather than resort to legal compulsion. That is why we promote voluntary community mental health treatment programmes rather than extend the law to make community treatment compulsory. Nevertheless, I keep an open mind. We will closely monitor the progress, outcomes and the effectiveness of our own programmes and compare them with the experience in New Zealand and elsewhere. We can then decide if we need to extend the law to provide for community treatment orders.”
“The visitors can also make surprise random checks at any time. The visitors have a comprehensive list of tasks to perform whenever they conduct an inspection. Besides inspecting the institution, they also have to carefully review the overall well-being of the detained patients through observations and interviews. In addition, they need to evaluate patients detained by court order under the Criminal Procedure Code, make recommendations on patients' fitness for discharge from detention or from a remand to an open ward. Mdm Halimah and Mdm Cynthia Phua spoke on continuing care for psychiatric patients after their discharge from hospitals, and this is clearly necessary. Last year, my Ministry provided about $7 million of subsidies to support such long-term care for psychiatric patients. This will not be sufficient, going forward. Our approach is to ensure that a wide range of community-based services are available to help these patients. We will invest more resources to expand the sector as demand increases. Mdm Halimah and Dr Ong have asked us to study the feasibility of supervised community treatments. Mdm Phua also called on MOH to support the management of these patients in a much more aggressive way in the community, and we will try to be aggressive. Mdm Halimah referred this House to the New Zealand Mental Health Compulsory Assessment and Treatment Act. If a patient can be treated in a community and does not pose a danger, then he cannot be detained. Detention is a major step and that is why we set the threshold high. But countries, such as New Zealand, have gone further. Under the New Zealand scheme, two kinds of compulsory orders may be made.”
“As an added safeguard, applications for detention of up to 12 months at a time can only be made by these external visitors, after reviewing the institution's report and personally inspecting the patient. The visitors' application is then carefully scrutinised by the Magistrate who then decides whether to make such a detention order. Apart from these safeguards, applications may be made to the High Court for a review of any detention to challenge the lawfulness of a detention. Once a patient is assessed as no longer posing a danger, he will be discharged from detention immediately. As this is not a new power, let us see what has been our actual experience. Last year, for example, IMH had more than 3,000 admissions under the Mental Disorders and Treatment Act. But of these, only five cases required further detention beyond one month. In fact, only 5% of these cases require detention beyond three days. So, the bulk of the detentions are for less than 72 hours. A Magistrate's Order for extended detention is also rare. I believe the current measures are adequate, based on actual experience. We will study best practices overseas to see whether additional safety nets, such as the tribunal that Members mentioned about, should also be put in place. I will keep an open mind on this particular issue. Mdm Halimah expressed concern that a reduction in the minimum frequency of visitor inspections might affect the protection of patients. Let me assure this House that the protection for detained patients will not be compromised. The amendment refers to the minimum frequency of visits. So it does not prevent visitors from conducting more frequent checks. We have added a provision which allows the Director of Medical Services to order additional visits if he deems necessary.”
“Clause 2 of the Bill states that only a doctor working in a psychiatric institution and who is designated in writing by my Ministry may sign such an order. And, obviously, we would only authorise doctors who are competent and have been properly trained. Several Members were concerned about patients being subjected to unnecessary or prolonged detention. This is a valid concern. Mdm Halimah and Dr Ong called for a Mental Health Review Tribunal to hear appeals by patients and their families. Mdm Halimah asked for stronger protection of a patient from the arbitrary exercise of the power of detention, now that it has been increased. Dr Lam asked if there is a maximum period of which a Magistrate may order a patient's detention. Let me clarify that, as compared to the current Act, this Bill does not increase the power of detention or the length of time for which a patient may be detained. On the contrary, this Bill is to reduce the power of detention. The maximum period of detention, for example, is now halved. Let me stress that not all mentally ill patients can be detained by us. We must fulfil two conditions: (1) That his condition requires in-patient treatment. If he does not require in-patient treatment, there is no reason to exercise this Act; and (2) That detention is necessary in the interest of his own health and safety or for the protection of other persons. So, both criteria must be valid before we can exercise this power. And there are checks and balances in place to ensure there is no abuse. For instance, the need for detention is reviewed regularly by a multi-disciplinary team treating the patient, as well as by the Visitors Board. The Visitors Board comprises lay persons and doctors who are not working at a psychiatric institution.”
“GPs can do more, as our key partners in managing patients with more stable and less severe mental illness in the community. Hospitals are training our GPs and engaging them in close working partnership to deliver continuing mental healthcare in the community. A new graduate diploma in psychiatry for GPs will also be launched. The family medicine training programme which prepares our young doctors to become GPs now includes a core posting in psychiatry. That probably helps explain the big increase in the number of trainees in psychiatry. There are nearly 500 nurses who have specialised training in mental health today. We will support more nurses for skills upgrading. This year, 35 nurses have been awarded scholarships to do so. And from this year, 15 new fellowships will be offered annually for allied health professionals to pursue skills upgrading or postgraduate training in clinical psychology, occupational therapy, medical social work and other mental health areas. Prof. Kalyani Mehta asked about clinical research. Yes, this is also an area of emphasis. Out of the five-year programme funding, a small though significant sum is set aside for research, to particularly pay attention to applied research; how we can reduce hospitalisation stay, how we can avoid re-admissions to hospitals, and other related areas. Over all, my Ministry will continue to review these measures, study the experience elsewhere, whether it is Australia or New Zealand, and improve ours so as to enhance the care and treatment of the mentally ill here. Let me now address some specific queries on the Bill. Dr Lam asked whether non-psychiatrists, including potentially untrained junior doctors, may sign the orders to detain patients for care and treatment. The answer is no.”
“Through these initiatives, we seek to train more GPs to better manage their mentally ill patients, avoid hospitalisation, reduce length of hospital stay, increase public awareness of the importance of public mental health and knowledge of coping strategies as well as improve the level of functioning of the mentally ill patients. I agree with Mdm Halimah and Prof. Mehta that we need to ramp up our manpower in a big way to support mental healthcare. We need many more trained professionals who can manage persons with mental illness effectively. Mental health or psychiatry has now been incorporated into the basic training of medical doctors, nurses and therapists. We support post-graduate training and specialisation in mental health for healthcare professionals through training awards and scholarships. As Members noted, there are now 116 registered psychiatrists in Singapore. Too few! We have to ramp up the number. I am quite glad to note, just before coming here, that right now, we have 50 trainees in the pipeline. We are definitely going to increase the number to at least 200 by . It can be done. If we need to augment with foreign recruits, we would do so. This would raise the psychiatric population ratio to about 4:100,000 – still low compared to many other countries, but a significant improvement compared to today. But we have to take a multi-disciplinary team approach, relying not merely on psychiatrists. $15 million has been set aside to develop mental health manpower through the training of nurses, clinical psychologists, occupational therapists, medical social workers and many more, as noted by Mdm Cynthia Phua. Mental health scholarships, awards and other skills development opportunities are also being offered.”
“Like all things, a preventive approach is best. If we wait until it is too late, it is really too late. We can try to remedy and rectify, but it is never satisfactory and full recovery is almost impossible. The Health Promotion Board will implement its health promotion activities across a variety of settings, such as schools and workplaces, targeting Singaporeans at various stages of life. I agree with Mdm Halimah and Dr Ong that society needs to help the mentally ill in many areas, including trying to secure employment. IMH has a job club programme to facilitate the employment of persons whose mental disorders have stabilised by providing rehabilitation and skills training. I believe strongly in this, but I know how uphill the task is. I have looked at the "Yellow Ribbon" programme which tries to help the ex-convicts secure jobs. It started off difficult, as usual. But after 10 years, it had achieved quite good results. I challenged our people in IMH and the Ministry of Health to try to do something similar, though knowing that getting employers to accept ex-convicts is probably easier than the ex-mentally ill; a lot has to do with social stigma, which many Members have talked about. Society tends to generalise that all mentally ill are identically of the extreme, when in fact these are the small minority. Many can be stabilised and rehabilitated and can function like you and me. So we need the support of many to make this work, ie, employers, fellow employees, family members, community rehabilitation organisations as well as agencies like the Workforce Development Agency (WDA) and CDCs.”
“Last year, my Ministry launched a five-year programme to help enhanced mental health. So we are now into year two. There are four key thrusts – improve public education on mental health, develop community-based mental healthcare services, increase manpower and enhance research capabilities in mental health. I think we are all on the same wavelength here, based on what Members have spoken. Two-thirds of the fund would seek to expand the community's resources for persons with mental illness. This includes developing partnership with GPs, community mental health teams and integrated medical psychological teams. The community mental health teams target four significant groups - school-going children, adolescents, adults and the elderly. They provide clinical services which include diagnosis, treatment and support to persons with mental health conditions in the community. They also provide training to front-line staff in a community agency as well as carers, a point raised by Mdm Cynthia Phua. The targeted agencies include eldercare services, VWOs, grassroots organisations and schools to teach them to detect possible mental health problems in their clients and educate them on the follow-up steps that they should take. Early detection and intervention programmes ensure that persons who have just developed mental disorder can reintegrate into the community as soon as possible. With good clinical care and strong support in the community to ensure good compliance with follow-up treatment and rehabilitation, the mentally ill in the community can be managed much more effectively. About $18 million is set aside for public education to increase awareness of Singaporeans about the importance of mental wellness and what they can do to maintain it.”
“Unfortunately, society's perception of the mentally ill remains largely archaic. As noted by Dr Ong Seh Hong, a recent study by IMH found that more than one in three Singaporeans believed mentally ill patients to be dangerous. About half of the respondents felt that the public should be better protected from people with mental health problems. The stigma runs deep, as noted by several Members. The majority of the respondents believed that mental health problems could afflict anyone, including themselves. But about half would not want anyone to know about it, if they were to suffer mental health problems, and that is why many continue to delay treatment to the detriment of their own health. And this is not unique to Singapore. Dr Ong quoted a similar study in the United Kingdom. So, clearly, we have much to do. We have to work harder to correct the misperceptions, destigmatise mental illness, promote mental health and ensure that the patients receive prompt care in the appropriate setting, whether it is in a hospital or in a community. Mdm Halimah, Mdm Cynthia Phua and Dr Ong highlighted the benefits of educating the public about mental health. I totally agree. Early treatment and detection aid recovery and prevent the illness from getting worse. These are the issues we need to address through community-based mental healthcare programmes. Medical experts agree that community-based care is the way forward in improving the standards of care for the mentally ill by focusing on rehabilitation and integration of the patient into society as far as possible. There is evidence to suggest that aggressive community management of persons with mental illness can result in improvements in the quality of life, greater acceptance of treatment and reduction in hospital readmissions.”
“Mr Speaker, Sir, let me thank Members for rendering their support to this Bill. Members have spoken very passionately on this subject and I have noted all their feedback and suggestions. As noted by Members, mental disorder covers a very wide range of mental illnesses, and that is why most legislation, including ours, have to define "mental disorder" very widely. Mdm Halimah, Dr Ong Seh Hong and, just a while ago, Mr Ang Mong Seng seem to prefer a clearer, presumably, tighter definition. But the objective of this Bill is to ensure that those mentally ill patients who require institutionalised psychiatric care are accorded prompt treatment. Not all mentally ill need to be institutionalised. In fact, only a small minority do. Mdm Halimah and Dr Lam highlighted this point a while ago. So all patients have to be assessed and a medical judgement made. We think this is best achieved by allowing the attending doctor to make such an assessment rather than trying to hard-wire the various possible mental disabilities into the legal definition. But because mental disorder covers a wide range of mental illnesses, the stereotype image of the mentally ill is most unfortunate, incorrect, unfair and unhelpful. A senior doctor once commented, probably half in jest, that to different degrees, we are all mentally ill. In fact, he probably meant it quite seriously. The fact is that most mentally ill patients can carry on a productive life, especially if they comply with the doctor's medical prescription. They do not need to be institutionalised. Even for the small minority who require institutionalisation, extended institutionalisation is now the exception rather than the rule. This is the result of better medical knowledge and advancement in mental healthcare.”
“(b) Second, the penalty for having sexual intercourse with a patient will be increased from a fine of up to $1,000 or imprisonment for up to two years or both, to a maximum fine of $20,000 or imprisonment for up to 10 years or both. (c) Third, the penalty for improperly receiving or detaining a patient will be increased from a maximum fine of $2,000 or imprisonment for up to two years or both, to a maximum fine of $5,000 or imprisonment for up to three years or both. (d) Fourth, a police officer is empowered to visit and inspect a mentally disordered person under the care of a person to ascertain whether or not that mentally disordered person is under proper care and control or is ill-treated or neglected. The Bill enhances the maximum fine for refusing to produce the mentally disordered person for inspection from $1,000 to $4,000. (e) Lastly, the maximum amount for which a minor offence under the Bill may be compounded will be raised from $500 to $2,000. Mr Speaker, Sir, the care and treatment of the mentally ill has evolved over the years and it will continue to evolve, in the light of experience and medical knowledge. Increasingly, care and treatment for most mentally ill is best done in the community setting. But it is sometimes necessary to detain some mentally disordered persons in a psychiatric institution, to safeguard the health and safety of the patients and to protect the others in the community. In such cases, we have to ensure that the power to detain is not abused. This Bill updates and strengthens the safeguards for the detained patients under such circumstances. I hope to get the support of all Members for this Bill. Sir, I beg to move. Question proposed. 3.15 pm”
“Strengthening safeguards Fourth, after the first month of detention, any further detention, if ordered by two designated doctors, will be capped at a maximum of six months. This is half of the current provision. For detention beyond six months, a Magistrate's order will be required. These safeguards are to ensure that patients are not detained beyond what is medically required. Fifth, a detained patient who requires treatment for an acute medical condition other than his mental disorder may now be transferred to another hospital, and be temporarily detained there. This arrangement is necessary, as psychiatric institutions may not have the necessary facilities for managing these acute medical conditions. There is currently no such provision in the Mental Disorders and Treatment Act. Penalties Finally, we are updating the penalties for certain offences to ensure that they have a deterrent effect and to be on par with equivalent legislation. We are increasing the maximum penalties of fines and imprisonment for offences committed against patients who have to be detained for treatment. These patients are in a vulnerable situation and we need to send a clear message that abuse of such patients will not be tolerated. (a) First, the maximum penalties for ill treating a patient will be raised. Ill-treatment includes physical or sexual abuse, as well as wilful or unreasonable endangerment or neglect of a patient. Currently, the maximum penalty is a fine not exceeding $500 or imprisonment for up to two years or both. The Bill increases this to a maximum fine of $5,000 or imprisonment for up to four years or both. If death is caused to the patient, the penalty will be a maximum fine of $20,000 or imprisonment for up to seven years or both.”
“The improper detention of a person, or wilful neglect or ill-treatment of a patient, will be an offence under the Bill. Mr Speaker, Sir, let me elaborate on each of the proposed amendments. Definitions First, we will replace the term 'mental hospitals' with 'psychiatric institutions'. A part of a hospital (for example, a ward or a department) may now be designated as a 'psychiatric institution' for the reception and treatment of the mentally ill, instead of an entire hospital. This will give us greater flexibility to alter the capacity to meet changing demand in the future. Procedures Second, a patient who has voluntarily admitted himself to a psychiatric institution may now be detained pursuant to an order of a designated medical practitioner, if he is assessed to be a danger to himself or others. This is to facilitate prompt treatment. Currently, a detention order may only be made in respect of a person who has not yet been admitted into the mental hospital. Third, we are reducing the minimum frequency of inspections by visitors appointed by the Minister for Health from once a month to once every three months. This will enable us to set the frequency in accordance with needs. For example, where a psychiatric institution has not had adverse reports for a long period, a reduced frequency may be justified. This is a practical step to reduce the load on the visitors. The visitors are, however, required to submit a report to the Director of Medical Services after every inspection. Based on these reports, the Director of Medical Services may then direct the visitors to conduct further inspections as necessary.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." This Bill is prompted by the Mental Capacity Bill which the Minister for Community Development, Youth and Sports will shortly take the House through. The Mental Capacity Bill aims to empower individuals to voluntarily plan in advance and appoint a proxy decision-maker for a time when they may lack mental capacity. It will also allow parents to apply to the court for the appointment of a proxy decision-maker for their intellectually disabled children. The Mental Capacity Bill will replace and update Part I of the existing Mental Disorders and Treatment Act. The Mental Health (Care and Treatment) Bill will in turn replace Parts II and III of the Mental Disorders and Treatment Act. It aims to regulate the involuntary detention of a person in a psychiatric institution for treatment if: (a) he is suffering from a mental disorder which warrants the detention for treatment; and (b) it is necessary in the interests of the health or safety of the person or for the protection of other persons that the person be detained. Many other countries, including the United Kingdom and Australia, have similar provisions for involuntary treatment for persons suffering from mental disorders whose ability to make decisions about medical treatment is significantly impaired and who are likely to suffer mental, behavioural or physical deterioration without prompt and adequate treatment. Our Bill will maintain parity with modern best practices to strengthen the safeguards to protect the patients who are involuntarily detained for treatment. For example, regular inspections have to be conducted by visitors appointed by the Minister and a Magistrate's order is required for the detention of a patient beyond a certain period.”
“On the first question, the answer is "no" because, as I have explained, we do not subsidise care in private hospitals unless there are specific circumstances. I am ideologically not against having subsidies in private hospitals where, for example, we are not able to cope with the volume or we lack such expertise. For example, there was once when we subsidised a liver transplant in the private hospital. So, I have no problem subsidising private hospitals but there must be a purpose for it. In this case, there is no need as such capabilities and capacity are available in the public hospitals. For the second question, the answer is "yes". 3.00 pm”