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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“We are now about 50% sufficient, which is not bad as compared to many other countries. This is a result of our adopting the Human Organ Transplant Act (HOTA) based on presumed consent in 1987, 21 years ago, and our more recent efforts to promote living donor organ transplants. HOTA now contributes about 50 kidneys a year and living-related kidneys another 30, for a total of 80 kidneys a year. Another 20 Singaporeans go overseas for kidney transplant annually. We can expect our kidney transplant rate to continue to grow. First, from next month, HOTA will be extended to cover Muslims. Second, the living-related kidney transplant rate has been rising and with greater awareness and understanding, should go up further. There is scope to raise both cadaveric and living donor transplant rates, and this is what we will do. Currently, HOTA sets an age limit of 60 years on cadaveric donors. This is an arbitrary limit and has unnecessarily put many organs to waste. Many countries, including Spain, do not set such an age limit. The suitability of the organ depends on its condition, rather than the age of the donor. The condition of the kidney can be determined by the transplant doctor and that should be the criterion for determining if an organ is suitable. We shall remove the HOTA age limit to help save many more lives. We will need to amend HOTA and when I bring the Bill to this House, I hope to get the full support of Members for this initiative. For living-related kidney donation, there are often family members who wish to donate to their loved ones but their tissues do not match well. Some hospitals in the US and Europe have shown that with proactive coordination, "pair-matched donations" can be done.”
“Sir, both questions pertain to alleged illegal organ trading transactions in Singapore. As the case is before the courts and further investigations are still on-going, I should not comment on them. After the case has been fully wrapped up, my Ministry will review existing measures and fix any inadequacy. Let me instead discuss this subject generally to outline the extent of the problem, our current approach and our strategy going forward. End stage renal disease (ESRD) or kidney failure is a dreadful disease. Every year, about 1,000 new cases are diagnosed here. 38% of the patients will not survive the first year given the severity of their illness. For the remaining 600 patients, the treatment options are limited: either a kidney transplant or life-long kidney dialysis. Kidney transplant is the preferred option as patients’ life expectancy is longer and their quality of life is better as the transplanted patients do not have to be hooked on to a dialysis machine for a significant portion of their life. But kidney transplant is a major operation with its attendant risk. Old age and other co-morbidity of the patient can significantly increase the surgical risk to the patient and reduce the chance of a successful transplant. That is why only about a third of the 600 new patients, ie, 200, are suitable for kidney transplant and can potentially benefit from the transplant option. The other 400 new patients will have to depend on kidney dialysis. Donated kidneys come from two sources: deceased donors and live donors. Like the rest of the world, we have worked to increase the kidney transplant rate. While we are not yet getting 200 kidney transplants a year, we have raised our transplant rate quite significantly.”
“Mr Speaker, Sir, may I have your permission to take Question Nos. 1 and 2 together?”
“We are supportive of families who want to care for their sick elderly at home. A wide range of community-based long-term care services, such as day rehabilitation and dementia day care, are available. Depending on their household income, the patients may qualify for varying levels of subsidies for such care. In addition, we are engaging General Practitioners to provide subsidised outpatient medical services to the needy elderly. We have also made subsidies available for home medical and nursing services for needy patients who are unable to leave their homes because of their disabilities. However, these services are very costly to provide. Long-term care will grow and its funding will pose significant burden to both families and society. That is why we introduced ElderShield and its Supplements and we encourage Singaporeans to subscribe to them. With payouts in cash, patients can then decide if they want their care to be at home or in an appropriate institution. The former may be preferred by some families but it will be more expensive. Government subsidy for the needy will have to bias towards the less costly option. But this is an evolving issue and regular reviews are necessary as we understand the subject and the needs of the patients better. We will do more where practical, but we need to ensure that it is sustainable. GROWTH DIVIDENDS 4. Mr Siew Kum Hong asked the Minister for Finance in view of the $407 million of Growth Dividends paid out on 30th April 2008, how much, in absolute figures and as a percentage of the total, was received by each decile of households in Singapore as arranged by household income.”
“Parents have an important role to play: set personal example of good hygiene standard, teach the children to do the same, and keep them at home should they fall sick. SINGAPORE AS AN EDUCATION HUB (Update) 18. Mr Zainudin Nordin asked the Minister for Trade and Industry (a) if he will provide an update on the vision of making Singapore an education hub; (b) whether there exists a conducive eco-system that allows education services in Singapore to flourish; (c) whether the recent rise in property prices and operational costs has affected efforts to attract reputable institutions to locate in Singapore; (d) what is the present total number of foreign students in Singapore and the long term target of this number; and (e) whether the current immigration policy is in line with and "friendly" towards the objectives set for the education hub. 19. Mr Ang Mong Seng asked the Minister for Trade and Industry in view of our plans to be an international education hub (a) how many foreign students his Ministry intends to attract over the next three years; and (b) what are the plans to provide sufficient affordable accommodation for these students.”
“Hand Foot Mouth Disease (HFMD) is a notifiable disease. By law, a doctor is required to report all cases of HFMD to my Ministry, including information such as the childcare centre or the school the child is attending. We investigate all clusters of HFMD cases to determine the extent of disease transmission and whether the institutions should be closed to contain the infection. If a cluster were reported in a school run by a private or a religious provider as described by Ms Ellen Lee, we will investigate. In practice, given the longer exposure time and greater intensity of interaction, transmission risk is higher in the following institutions and they have therefore administrative arrangements to report their HFMD clusters to my Ministry: (a) All childcare centres under the Ministry of Community Development, Youth and Sports; (b) All playgroups under the People's Association; and (c) All kindergartens, special education schools, primary schools, secondary schools, junior colleges, religious schools, private regular schools and foreign system schools under the Ministry of Education. This arrangement will cover almost all of the children who are cared for outside of their homes. HFMD is spread through direct contact with the bodily secretions of an infected person or indirectly through contact with contaminated items. Children may be infectious before they show any symptoms. A significant proportion of infected children remain asymptomatic, but they are also infectious. The risk of transmission will therefore exist whenever children congregate and if good hygiene is not practised. The only way to prevent transmission is to maintain a high standard of personal and environmental hygiene.”
“Thio used the words – I am always happy but I am not 'trigger happy' – and I cry wolf every now and then, I lose credibility. And when the real wolf appears, nobody believes me; I may declare social distancing and people still go out to restaurants and elsewhere, and it defeats the whole purpose, because I have lost credibility. That, to me, is the single most important safeguard against any abuse of these very harsh measures and powers which we are asking the House to provide us. 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. Column No : 2712 ADJOURNMENT Resolved, "That Parliament do now adjourn to a date to be fixed." – [Mr Mah Bow Tan]. Adjourned accordingly at Eighteen Minutes to Five o'clock pm to a date to be fixed. APPENDICES”
“Sorry, I forgot this particular query on Whip. It is not for me to decide whether the Whip will be lifted. But all I know is our MPs, Whip or no Whip, will have the full interest of the public at heart, and I am sure they will vote according to what is needed to protect them. The key point of making such a declaration is not straightforward. It is not one of politics. It is about accessing information which almost certainly will be limited and incomplete, and to make a judgment call – do you declare or not to declare? Let us see the current outbreak of hand, foot and mouth disease where the number of cases has exceeded last year's. I have received many emails. Many have asked me to close down all primary schools and nurseries, to break the transmission. But how to do so? Because hand, foot and mouth disease has been around for years, and it will continue to be around for years. If each time there is a cluster, we were to close down nurseries, we will end up not having any nursery open at all throughout the year, because it is one of those infections that spread throughout the year. People will vary according to their risk appetite. So it is not easy to make a call. A couple of months ago, you may remember, Hong Kong declared a closure of all their schools because of the flu outbreak. After the event, it is easy to comment whether that decision was premature, necessary or correct. But while you are in the midst of the outbreak, having to judge what is likely to happen next and what you should do now is not an easy decision to take. That is why, in my speech, I emphasised that this is a heavy responsibility and a decision which we will take very carefully, after weighing the options. Because if I were 'trigger happy', I think Prof.”
“That has diminished the risk to a tiny risk, and that is part of the reason too why, globally, we have not heard of any HIV transmission from doctor to patient for many years. Mr Speaker, Sir, I thank the House once again for their support of the Bill.”
“Their legal liability and their own ethical oath would then determine their behaviour. The reason why not all participated in screening, based on our focus group discussions, is because many have done the screening before. For instance, some of them are regular blood donors, so they would have known their HIV status. They would also know their sexual activities. These are knowledgeable people and they will know what is the likelihood of them being HIV-positive. Not participating in this particular round of health screening does not mean that they will not take part in future health screening. So I was not surprised that the participation rate is not 100% or close to 100%. Mdm Halimah asked about the expert committee which I mentioned in my written reply to her yesterday. Supposing we discover a hospital worker who turns out to be HIV-positive, then we will have to decide whether we go back to all previous cases treated by him. Let us say he is a surgeon and he has operated on some patients. Do we need to go back and trace the patients and then get them to come forward to be HIV-screened, in case there was an infection in the past? To help us make that kind of decision, we will convene, as and when a case crops up, an expert committee to look into this. I would add that, over the years, the need to convene, what we call, a look-back study has become less and less. In fact, I have not read of any such look-back studies in the world in recent years. The reasons are several. One is better awareness of how HIV may be transmitted during exposure-prone procedures and therefore enhanced infection control procedures. Staff are serious in compliance.”
“However, from the point of view of patient care, HIV testing is but only the first step. The patient needs to be properly followed up for treatment and counselling. Therefore, we encourage at-risk individuals to come forward to be tested in a normal clinic testing so that the appropriate clinical management, counselling and contact tracing can be carried out. Nearly 100 medical clinics now offer HIV testing using the new rapid HIV test kits that can produce results in about 20 minutes. We will do our best to combat HIV, but the Government alone cannot stop the transmission of HIV in Singapore. We need at-risk individuals to practise safer sex and regularly test themselves. That is the spirit of the new legislation. Before I end, let me address Mdm Halimah's additional queries. She asked about HIV testing of doctors in hospitals, which we introduced recently. She noted that not 100% of doctors took part in the HIV screening. First, let me clarify that, globally, nobody prescribes mandatory HIV testing, whether of healthcare workers or of patients. But the recommendation is to go for one. In the case of doctors, as we discussed yesterday, they operate within their medical ethical framework, and one major ethical rule is: "do no harm". So if you are engaged in exposure-prone activities and you know that there is a risk, even though the risk is low or minimal, you should ascertain your HIV status. This way, you can then better decide if you should engage in such exposure-prone activities. This is the ethical framework which they operate under. Let us say they are a high-risk group and yet refuse to be screened for HIV and if one day, one of their patients is infected, they would have to answer to the law.”
“Once a person has been informed of the risk, we leave it to the person to decide whether to accept that risk and to take whatever precautions to reduce the risk of transmission. I am not saying that we are unconcerned about HIV transmission where the risk is known. Our public education efforts have always been to encourage those who choose to engage in casual sex to use condoms to avoid HIV infection. However, we do not think it appropriate to legislate how people should have sex. In this connection, I thank Prof. Thio for her comment on our definition of "sexual activity". Maybe, we were not creative enough. Her comment is fair, but I think the present definition does sufficiently capture the range of activities which present a risk of HIV transmission. But if we are proven wrong, then we can always amend it in due course. Prof. Thio also asked how a high-risk person who donates blood while waiting for his HIV test results and who therefore does not know he may be HIV-positive will be treated by the law. If he does not disclose his high-risk history and he is subsequently found to be HIV-positive, then he will be committing an offence for making a false declaration. I have noted Dr Fatimah's comment that the extended imprisonment term for HIV-related offences may exceed the life expectancy of some. But I believe it is necessary to raise the maximum penalty so that it is commensurate with the severity of these offences. We should not look upon the offence lightly just because the offender may have a shortened lifespan. That said, it is up to the courts to have the final say on the penalty meted out in each case. Mdm Halimah asked for more anonymous test sites to get more people to voluntarily go for HIV testing. We can take a look at this suggestion.”
“However, there must be victims who are prepared to testify against their sexual partners before an investigation is likely to uncover anything. But we do follow up on every new case of HIV infection which is reported to us for contact tracing. This way, every known sexual partner who has been put at risk can be traced for counselling and HIV screening. Dr Lam asked about the window period and the validity period of HIV-negative tests. Current evidence suggests that up to 97% of the newly-infected patients have a window period of three months, although the majority would have detectable antibodies within two to eight weeks after infection. The standard practice for the doctors today is to advise anyone, who has a negative test within three months of last exposure to the risk of HIV infection, to be retested more than three months after that exposure to ascertain that, indeed, he does not have HIV or its infection. In order not to be liable for an offence, the person must have a negative result outside the window period. The negative result would be valid, so long as the individual does not have a new exposure to the risk of infection. As to whether section 23 of the Bill will apply to both males and females, the answer is yes. Prof. Thio queried why the Act does not require a known HIV-infected person to take reasonable precautions, for example, using condoms, to protect his partner, whereas the new provision would seem to apply to those who are at risk but are not aware of their HIV status. As I clarified earlier, under the new provision, if an at-risk individual informs his partner of the risk of contracting HIV infection from him, his partner may still consent to unprotected sex with him.”
“Thio had asked what constitutes informing a partner of the risk of contracting HIV and raises the possibility of conflicting evidence. Let us return to the spirit of this provision. The intention is for a person who knows that he is HIV-positive or that he has been exposed to a significant risk of contracting HIV to act responsibly and inform his sexual partner of the risk of contracting HIV from him. How such information will be communicated between partners will be different in every relationship and in every sexual encounter. We can expect that some will be more truthful and direct, while others may try and hide the extent of their indiscretions. We do not intend to prescribe a consent form to be signed or some standard words to be uttered. In a prosecution, the courts will look at the unique circumstances of the case and decide whether there has been sufficient disclosure of the risk. As for the possibility of conflicting evidence, this is to be expected. Sometimes, complainants may embellish their evidence for reasons of anger or jealousy, witnesses may be uncooperative because of embarrassment or because they have feelings for the accused. We will be sensitive to these dynamics when investigating a complaint. If, after careful investigation and evaluation, we conclude that there is an offence, our findings will be submitted to the Attorney-General who will again assess if there is evidence to support the prosecution. If the Attorney-General decides that there is, we would then leave it to the courts to weigh the evidence given by the accused, his complainant and other witnesses, and decide on the case. Mdm Halimah suggested that we investigate every new HIV case for possible breach of the new section 23.”
“Thio asked what constitutes "reasonable precautions to prevent transmission". In the current state of medical science, this means the correct and consistent use of condoms each time a person has sex. For the purpose of this Bill, a promiscuous person who practises safer sex, by using condoms every time he engages in sexual activity, is not considered at high risk of contracting HIV/AIDS. This is for the purpose of this Bill. If you ask me, from the public health point of view, I think he is still at risk by being promiscuous. Dr Lam asked me to define "promiscuity" by giving a number. It is really not possible to put a number to this. But what is clear is that having unprotected sex with people with unknown HIV status, meaning strangers, eg, one who is not your wife, simply increases the risk. And, honestly, you do not need many encounters to get HIV. Sometimes, it is one unfortunate encounter and your life is ruined. So please do not do it. I agree with Mdm Halimah's observation that in the dynamics of a marital relationship, the husband is unlikely to be truthful about his infidelities and the wife is unlikely to testify against her husband. Such complexities in human relationship cannot be avoided. But this new legislation will offer an innocent spouse, who is infected, the possibility of redress from the reckless behaviour of her husband. Here, I would add that our experience in working with HIV-positive individuals is that the majority do inform their sexual partners voluntarily. That has been our experience. However, that is only after they have discovered they are HIV-positive, by which time, they would have been engaging in high-risk behaviour for a while. Prof.”
“But what can they do in the circumstances? So these are real situations on the ground and are not theoretical. Members have asked what amounts to "reason to believe", what is high-risk behaviour and who are high-risk individuals. I think they are quite straightforward. Let me give an illustration. A man who has unprotected sex with prostitutes or with other men, or a man who has unprotected sex with multiple partners, or a man who shares injection needles with other drug addicts would clearly be aware of his activities and he should have reason to believe that he has been exposed to a significant risk of contracting HIV. Ms Sylvia Lim has suggested that we hardwire these illustrations into the Act. But we think this is not necessary, firstly, because the examples will never be exhaustive; secondly, because our public health education programmes will clearly emphasise what activities put a person at risk of contracting HIV/AIDS and the necessary precautions to be taken to reduce that risk. Let me clarify that the new provision does not ban such a person from sex. It merely requires him to take any one of the following three measures before he has sex with another person: (1) Inform his partner of the risk and then allow the partner to make an informed decision as to whether to accept the risk and have sex with him; (2) Undergo regular HIV testing to determine that he is not HIV-infected at the time of the sexual intercourse; or (3) Take reasonable precautions to protect the partner, eg, by using the condom. Any one of these procedures would then protect him legally. While we encourage such a person to take all three steps to protect his partner, he is legally protected if he takes any one of the three steps. Prof.”
“I agree with Mdm Halimah that the law alone is not sufficient to deal with the problem of HIV. As there is no cure for HIV, the only viable solution is prevention, and in HIV prevention public education remains the key strategy. But the mode of public education should take into account the nature of our society. The ABC campaign against HIV - Abstinence, Be faithful and Condom usage - cannot be broadcast nationwide with equal intensity. Many parents would be upset with such a campaign and we will be accused of promoting promiscuity. So the general broadcast will have to be ABC with a small "c". On the other hand, the ABC campaign targeted at high risk groups will have a huge "C", enlarged "C", as the main theme. I agree with Mdm Halimah that we should pay special attention to vulnerable groups such as the young and women. We are also building capacity for NGOs and healthcare institutions to care and support for people living with HIV/AIDS. We will address stigma and discrimination more aggressively. We have set aside an additional $10 million over the next two years to expand on these efforts. As for the new provision under section 23 to tighten the control of HIV, let me repeat here that it is not our intention to discriminate against or to criminalise HIV-infected patients. What we want to do is to push them to act more responsibly and not to hide behind the ignorance of their HIV status to go on exposing their sexual partners to the risk of HIV infection. Such behaviour is most unacceptable, particularly, in relation to the innocent wives of men who visit prostitutes. In my job, I have come across a handful of such innocent victims, totally unaware that their husbands had gone to different places, had fun and then passed on the HIV to them.”
“Thio asked what we would do if a person refuses to be examined. In that case, we will have to quarantine him until we are sure that he no longer poses a threat to public health. As I said, the key objective is public health. It is not so much prosecution and seeing that he be penalised in some way or the other. Prof. Thio also asked what practical steps to ensure that affected persons will receive the actual notice of the orders under the new section 17A. We will make full use of the media extensively to disseminate such information. Singapore, being so small, I think disseminating such information should not be too difficult. In addition, where appropriate, we will work with the licensing agencies to inform their licensees of such orders and, on the ground, our officers will also assist in disseminating such information when directing the movement of persons in the restricted zones. Dr Fatimah Lateef highlighted the potential public health problems of unhygienic, overcrowded quarters housing foreign workers. We are equally concerned and are working with other Ministries on this issue. Prof. Thio has a couple of drafting recommendations on section 8 which I have noted for future reference. Let me now address the comments on HIV/AIDS. Dr Fatimah asked whether the law provides protection against transmission of HIV through non-sexual means. She gave a personal account of how a HIV-infected patient threatening to infect the healthcare workers if he did not receive immediate attention. Existing law does confer such protection for our staff. For instance, a patient as described may be liable for criminal intimidation under section 503 of the Penal Code. The hospital should have taken up the case and pressed charges.”
“However, in the larger interests of public health, we do need the power of section 7 to examine the affected patients promptly so that there is no delay and the results will not be skewed by patients who may refuse examination. I agree with Mdm Halimah on the importance of regular training of our healthcare workers, whether they are in the public or private sectors, on how to deal with an emergency, and that is why we have regular exercises to test and finetune our emergency plans and we will continue to reach out to the doctors in the private sector. My Ministry has to work with all parties in our fight against outbreaks and a good example is the recent Chikungunya outbreak in Little India where the public, private and people sectors came together and worked as one Singapore. It was a success story which we can be proud of. Epidemiological investigation does require a medical examination of an infected person during which a body sample may have to be taken. Prof. Thio asked what might constitute body samples. These typically refer to saliva, urine, faeces, swabs of the throat and blood. I foresee that the most invasive sample that will be required will be a blood sample. Prof. Thio asked what might constitute "reasonable excuse" for rejecting a medical examination. I think this will depend on the circumstances. For example, I think it will be a reasonable excuse for a haemophiliac to refuse to give a blood sample. However, the claim of a right to privacy would not be a reasonable excuse. We are dealing here with infectious diseases which may have serious public health implications, if uncontrolled. As I said earlier, some privacy will have to be ceded in return for the collective protection from infection. Prof.”
“In particular, we have modelled our safeguards against similar provisions found in the foreign legislation. Ms Sylvia Lim has asked whether Parliament, instead of the Minister, should make the decision to declare a public health emergency. Foreign legislations that we have studied do not require the legislature to be convened to decide on whether public health emergency should be declared. This is because of the urgency of the situation, as pointed out by Dr Lam. We have taken heed of this foreign legislation provision and also make it a ministerial executive decision subject to Parliamentary oversight, and we believe that this strikes a good balance between acting speedily to protect public health while ensuring public accountability. At the same time, we are mindful of the heavy responsibility. How do we recognise and when do we declare a public health emergency? This calls for sound judgment and decisive action. In the absence of complete information, a delay in sounding the alarm will cause many lives. Dr Lam gave us a good account of what a worst case scenario may look like. To enhance our ability to make the right call, we need to strengthen our surveillance capabilities. This is the public health equivalent of intelligence work in anti-terrorism. We need to investigate relevant signs and signals and pursue them aggressively when a plausible trend appears. Signals will come from clinics, whether they are western or eastern. So I agree with Dr Fatimah Lateef that we should tap on the TCM practitioners for this purpose of surveillance. Surveillance data will be treated in the strictest confidentiality.”
“Mr Speaker, Sir, I thank the Members who have spoken in support of the Bill. SARS has come and gone, but SARS or a new virus may appear again. If the outbreak is similar to SARS, we know now how to combat it effectively. But nature will always surprise us. While we hope for the best, we must within practical limits prepare for the worst, and this Bill will help us better prepare for an attack that is worse than SARS. The two additional powers that we seek – to requisition private sector resources and a new section 17A to prohibit mass gathering in the event of a public health emergency – will expand our capacity and capability considerably. We know that these are drastic measures and we will use them only when absolutely necessary. As noted by Mdm Halimah, these measures will cause major disruptions to the daily lives of Singaporeans and would be a major cost to businesses. Hence, I agree that they must only be invoked in very grave situations where alternatives are not workable. The law has therefore built in safeguards to ensure that the powers are exercised appropriately. We need to strike a balance between individual liberty and the protection of the community at large. We are not alone in grappling with this very difficult problem. After SARS in 2003, many countries have implemented new legislation to enable the government agencies to prevent, control and manage a severe outbreak. The UK introduced the Civil Contingencies Act in 2004; Western Australia introduced the Emergency Management Act in 2005; New Zealand introduced the Epidemic Preparedness Act in 2006, and others are seriously considering similar legislation. In drafting the Bill, we have in fact drawn useful provisions from such legislation.”
“The more we assume that we will be hit and actively prepare for one, the more likely that we can minimise the number of casualties when a crisis strikes. This Bill is part of our preparation for such an eventuality. I hope to get the support of all Members for this Bill. Sir, I beg to move. Question proposed. 2.50 pm”
“Otherwise, he must inform his partner of the risk of contracting HIV from him, leaving the partner to voluntarily accept the risk, if he or she so wishes. The objective of this amendment is therefore to help promote condom use and regular HIV testing, while sending a strong message that no one has a right to put others at risk through his irresponsible behaviour. It is not our intention to go after every HIV infected person. We will only act if there is a complaint from an aggrieved victim, and only after a thorough investigation to establish the facts. The Bill will also amend the Act to raise the penalty for HIV/AIDS related offences. The increase in the penalty reflects the seriousness with which society views such offences and, we hope, would deter potential offenders. 2005 WHO International Health Regulations The final set of proposed amendments is technical in nature, to update our legislation to be in line with the 2005 WHO International Health Regulations. Under the regulations, Singapore may be required to disclose the identity of an infected person to the World Health Organisation or a member-state. Clause 31 amends the Act to allow for this. Disclosure of the identity of an infected person in other cases, and which are not governed by other laws, will be subject to strict requirements in order to protect patient confidentiality without compromising the public interest. Clauses 21 to 27 amend the vaccination requirements in the Act to comply with the WHO International Health Regulations. Mr Speaker, Sir, no country would welcome a disease outbreak. But, unfortunately, globalisation and jet travel have combined to raise the risk of such a crisis. We hope that it will never happen in Singapore but mere wishful thinking will not protect our people.”
“Enhanced measures to prevent and control HIV/AIDS Mr Speaker, Sir, let me now discuss the third set of proposed amendments concerning HIV/AIDS. HIV remains a problem in Singapore. The number of new cases continues to grow. In 2001, there were 237 newly notified HIV cases. Last year, that number has almost doubled to 422. The main mode of transmission of HIV in Singapore is through unprotected sex with a HIV-infected person. Section 23 of the current Act states that before sexual intercourse, a person who knows of his HIV status is required to inform his sexual partner of the risk of contracting HIV from him. If the partner willingly accepts the risk, no offence is committed. Doctors regularly inform HIV patients about this law at the point of diagnosis. This law, however, is effective only when a person knows that he is HIV positive. Despite the easy access to testing in Singapore, it is estimated that for every known HIV case, there could be another one to two cases who are infected but remain undiagnosed, until the symptoms appear. The latter group may continue transmitting HIV unknowingly to their partners for many years during the asymptomatic period. Clause 18 amends section 23 of the Act to shift greater responsibility to individuals whose sexual behaviour, for example, puts their spouses and partners at risk of contracting HIV/AIDS. A person who has reason to believe that he has or has been exposed to a significant risk of contracting HIV/AIDS must take reasonable precautions to protect his sexual partner, such as by using condoms, even if he is ignorant of his HIV positive status. Alternatively, he can go for a HIV test to confirm that he is HIV-negative.”
“This will enable the Ministry to appoint the healthcare staff in public restructured healthcare institutions such as the Communicable Disease Centre for this purpose. These officers perform important public health duties, such as contact tracing, patient counselling and epidemiological investigations, as part of their course of work. The intent is to designate the public restructured healthcare institutions as the “prescribed institutions” under subsidiary legislation, which operate with MOH oversight. Powers of investigation and arrest To ensure compliance with the Act, clauses 29 and 30 will introduce provisions to empower my Ministry to investigate offences under the Act. These include powers to record statements, enter and search premises, and seize evidence. It will also allow Health Officers to arrest a suspect without warrant for certain offences under the Act. National public health research When faced with a new infectious disease threat, it may be necessary for us to expedite research into more effective control measures or new diagnostic tests or treatment. Clause 32 of the Bill will amend the Act to empower the Director of Medical Services to acquire information or existing samples from patients, or order a doctor to obtain, with consent, additional samples from patients under his care, to facilitate such national public health research. The information and samples will be anonymised to protect medical confidentiality. In deciding whether to invoke this power, the Director must first consider the public health risk of the disease and the potential benefits of the research to Singapore. MOH will work with the relevant clinicians, researchers and other stakeholders to carry out such research.”
“Compliance by minors and those mentally or physically incapacitated Clauses 5, 9 and 10 of the Bill amend the Act so that the Director of Medical Services may require the parent or guardian of a minor to ensure his compliance with an order to undergo medical examination, treatment, surveillance or quarantine in order to control the spread of an infectious disease. These provisions will only be invoked if it is assessed that the minor will not be able to understand and comply with an Order given to him. Furthermore, clause 30 amends the Act so that a police or Health Officer may take necessary measures to give effect to an Order for the medical examination, treatment, surveillance or quarantine of a person who is mentally or physically incapacitated. Enforcement of orders issued under the IDA Currently, to prevent or limit the spread of an infectious disease, the Director of Medical Services may order an overcrowded building, food establishment or a business to be closed, or to prohibit a meeting, gathering or public entertainment. Clauses 13 to 16 of the Bill will amend the Act to empower the Director to enter premises to enforce such an order. As a safeguard, any person aggrieved by such an order may appeal to the Minister within seven days of the order. As an additional safeguard, an order to prohibit gatherings or close premises will expire after 14 days unless it is renewed. Appointment of Health Officers The Act provides for Health Officers to be appointed with extensive powers to effect the prevention and control of infectious diseases. Clause 3 of the Bill will amend section 4 of the Act, so that an employee of an institution which the Minister must prescribe in subsidiary legislation may be appointed as a Health Officer.”
“Specifically, when a public health emergency has been declared under the Infectious Diseases Act, the Minister may order Part III of the Requisition of Resources Act to be brought into operation if additional land, property and services are needed to secure public safety. Owners of these assets will be suitably compensated in accordance with the Requisition of Resources Act. Strengthening existing powers Mr Speaker, Sir, let me now discuss the second set of proposed amendments to strengthen the management and control of infectious diseases under normal circumstances. Enhanced powers for infectious disease surveillance To respond to an infectious disease, we need sensitive and robust disease surveillance, to alert us to any outbreaks or imminent outbreaks. Currently, we monitor the local infectious disease situation through a system of mandatory disease notification by doctors and laboratories, and studies to measure population immunity against various infectious diseases. Clause 4 of the Bill will enhance our disease surveillance powers, by amending section 7 of the Act to empower the Director of Medical Services to obtain residual blood or body samples in the healthcare institutions to determine the level of immunity within the population or to monitor and track infectious diseases trends. The primary focus of this additional measure will be the pooled statistical data. However, if there is a need to contact a patient from whom a sample was obtained, such as for the purposes of contact tracing or to provide urgent medical treatment, we may invoke our powers to do so under the Act.”
“Invoking such a provision has serious implications as it will cause major disruptions to the businesses and the daily lives of Singaporeans. Such a decision will not be taken lightly. We have therefore put in safeguards. First, every declaration of a public health emergency and restricted zone will expire after 14 days unless it is renewed. Second, the Minister must ensure that such orders are published through appropriate media so that the public will have notice of it. Third, every order must be presented to Parliament as soon as possible after it is made. The Minister will have to argue his case and justify the declaration of such an order. Parliament may annul the order if it does not agree. Requisition of resources Fighting a disease outbreak requires the participation of many sectors. The Ministry of Health and its resources alone will not be sufficient. For example, during SARS, we had to use holiday chalets and hostels as quarantine facilities. Auxiliary police officers were called upon to deliver quarantine orders and monitor those who were quarantined. From the SARS experience, we can anticipate that in the event of a more serious outbreak, massive resources, both from the Government as well as from the private sector, will need to be mobilised. To effect this, clause 36 of the Bill makes consequential amendments to the Requisition of Resources Act so that civil resources and services, including those found in the private sector, such as private hospitals, ambulances, doctors, nurses and other paramedical personnel, may be mobilised to help combat the outbreak.”
“This is the main purpose of this Bill, to provide my Ministry with the necessary powers to impose social distancing measures speedily in response to a potential severe public health emergency as described. At the same time, I am taking the opportunity to do three things: (a) to refine the existing legislation, (b) tighten one aspect of HIV/AIDS control measures, and (c) to update our laws to conform with the 2005 WHO International Health Regulations. Mr Speaker, Sir, let me elaborate on each set of the proposed amendments. Public health emergencies First, the amended Act authorises the Minister to declare a public health emergency if he is satisfied that an outbreak or an imminent outbreak of an infectious disease poses a substantial risk for significant deaths and disabilities in the population. Once such a declaration has been made, my Ministry will be able to take measures necessary to (a) prevent the spread of disease through social distancing measures, and (b) mobilise civil resources to help fight the outbreak. Restricted zones Clause 12 of the Bill inserts provision in the Act under which the Minister may establish restricted zones, after a public health emergency is declared. The entry and stay of persons in any premises or the holding of public gatherings in such restricted zones may then be restricted or prohibited, in order to minimise opportunities for disease transmission through person-to-person contact or contact with the contaminated environment. This can be quickly and effectively implemented by allowing the blanket prohibition of all or selected gatherings, meetings or public entertainment or closure of all or selected premises island-wide. Police and other authorised officers will be empowered to enforce compliance in a restricted zone.”
“Influenza spreads rapidly because its incubation period is short, about two days, and it is highly transmissible. Unlike SARS, those infected may develop no or very mild symptoms, yet they are infectious. So contact tracing and quarantine may not be totally effective. In such a scenario, what we can do is to restrict and reduce social interactions through “social distancing” measures – this is a technical term and it just means prohibiting mass gathering – in order to slow the spread of the disease in the community. For instance, schools can be closed. Cinemas and shopping centres may have to be closed too. This will buy us valuable time until an effective vaccine becomes available. Social distancing will also reduce the peak of the pandemic, in other words, reduce the maximum number of casualties, thus minimising the burden on our hospitals and healthcare institutions. To be effective, social distancing measures have to be implemented soon after the first local cases appear, before the outbreak has become widespread. But we would need to have the powers to effect social distancing measures swiftly. The current IDA allows the Ministry to prohibit specific meetings, gatherings and public entertainments when the holding of such events is judged to increase the spread of any infectious disease. But it requires us to issue individual prohibition order to prohibit each meeting or each gathering. This will be too slow in a major crisis like the flu pandemic. Valuable time and scarce public health resources will be wasted to bring all the premises under control. This gap in our legislation will need to be closed.”
“They have created many more isolation rooms and built up a stockpile of essential medical supplies and drugs. We conduct regular exercises among Government agencies and healthcare institutions to test our response. Internationally, we also work closely with the World Health Organisation and other countries to reduce the threat of the spread of infectious diseases across international border. Nevertheless, we have to be prepared for new public health threats that could be a lot more severe than SARS. While SARS is infectious, it requires intimate intensive contact with a patient who is quite ill before transmission can succeed. That was why most of the SARS victims were doctors, nurses and other hospital staff and close relatives who cared for the patients. An exception was a minority of patients who for some reason ended up with very heavy virus load; they became highly infectious even for short encounters. Fortunately, their number was small. Moreover, only patients with clear symptoms such as fever were infectious. They could therefore be identified through temperature screening and can be promptly isolated. But what if a virus comes along which is a lot more contagious than SARS and not easily identifiable? For example, if it is air-borne, a patient in a cinema or a shopping centre can easily infect many others who happen to be in the same enclosed space. Or what if an infected person can be infectious yet without showing any physical signs? This is not theoretical. One such threat is that of a global influenza pandemic should the current bird flu mutate and become much more efficient in human-to-human transmission. It had happened before. The Spanish flu of 1918 was just one such example.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time.” Five years ago, SARS appeared suddenly and, for three months, caused havoc around the world. We lost 33 lives in Singapore. SARS taught us many lessons. First, infectious diseases are here to stay and new diseases will continue to surprise mankind. We cannot let our guard down. Second, in the fight against infectious diseases, being proactive is necessary to pre-empt the escalation. Reacting to the epidemic will grant the disease a headstart which can prove disastrous. Third, fighting infectious diseases requires a joint effort by all. The public, in particular, plays an important role. Mobilising and galvanising the people into action, in turn, require transparency and timely information. Prompt sharing of information with the people, what we know and what we do not yet know, helps to build trust, reduce speculation, fears and panic. Fourth, we need effective legislation to mount a successful war against an epidemic. The Infectious Diseases Act is our principal legislation for the control and prevention of infectious diseases. SARS exposed some gaps in our legislation which we promptly plugged. The House would recall that we met in the middle of the SARS crisis to make urgent amendments to the Act to provide the Health Ministry with additional powers to bring SARS under control. We have since significantly strengthened our capacity and capability to detect, prevent and control outbreaks of infectious diseases. For example, we have acquired stronger capability in disease surveillance, contact tracing and quarantine. Our hospitals have updated their infection control protocols to deal with potentially infectious patients.”
“Sir, as I have explained yesterday, aesthetic medicine covers a wide range of procedures. My Ministry will regulate the high-risk procedures in the interest of patient safety. Any operator who insists on providing such high-risk procedures illegally will be dealt with by the law. Patients can also protect themselves by not seeking the services of such illegal operators. As for the relatively low-risk procedures, we shall await the proposed guidelines being formulated by the professional bodies. We are also studying the regulatory regimes in other countries to see how best to regulate this business. By and large, we have competent and ethical doctors. We will do our best to safeguard the high standard of our healthcare services. Consumers have to play their part too. Do not be taken in by advertisements and, where possible, try to get additional opinions from other qualified medical practitioners. Certainly, do not follow the illegal operators underground. Column No : 2643 Column No : 2643 GOVERNMENT RESPONSIBILITY (Statement by the Prime Minister) 1.48 pm”
“Second, maintain a high standard of personal hygiene, including frequent hand washing with soap. Third, do not infect the others with your influenza. So please do not spread germs. Cover your month when coughing or sneezing, stay at home when you have flu and wear a mask if you have to leave home. As for the potential flu pandemic, we have discussed in this House our preparation plan. The world has so far avoided one but the risk of one coming remains real. We must not be complacent. We regularly exercise our pandemic plan and we work to strengthen it. The Infectious Diseases (Amendment) Bill which the House will shortly debate is one additional step in that direction and I look forward to the full support by the House. Column No : 2638 UNDISCHARGED BANKRUPTS IN SINGAPORE 5. Dr Lim Wee Kiak asked the Deputy Prime Minister and Minister for Law (a) how many undischarged bankrupts are there presently; (b) how many of them are Professionals, Managers, Executives and Technicians (PMETs); and (c) how many of them are unemployed.”
“Sir, last month's influenza outbreak in Hong Kong was similar to that of previous years. It involved the usual seasonal influenza virus subtypes: H1, H3 and B. Thankfully, there were no new virulent strains or the dreaded H5N1, which many scientists worry could spark a global flu pandemic. Influenza is a common infectious disease that affects all age-groups. It is usually mild and self-limiting. Complications such as pneumonia are rare, but when they occur, they can be fatal to children and the elderly. In Singapore, we experience two influenza seasons, from December to February, and again from June to August. We have a lower level of influenza activity for the rest of the year. So we are right now in between the two peak seasons. We have an active influenza surveillance programme to track the level of influenza activity. We monitor the number of attendances and hospital admissions for acute respiratory infections and pneumonia. We carry out tests on samples from patients with flu-like symptoms for influenza viruses to determine the circulating strains. Singapore is part of the influenza network of the World Health Organisation. We are in close contact with our international counterparts, especially in times of outbreaks. The current level of influenza activity is within the expected seasonal variation. But we need to remain vigilant as the influenza activity is expected to increase in the coming months. It is not possible to protect all from influenza. But there are several measures that Singaporeans can take to reduce the risk of an infection. First, an annual vaccination against influenza can be considered for the vulnerable group; that means children aged six months to five years, the elderly, patients with chronic diseases; and their caregivers.”
“Sir, we should not be surprised by the low claims number. There are two main reasons for it. One, it is still a new scheme, meaning the policy holders are largely young and, as we know, severe disability is likely to inflict the elderly rather than the young people. It does not mean that the young people may not get disabled. Some do, as some of the claims numbers show, but largely this is a problem of the future. So the collections in the first few years will build up reserves for possible claims in the future. That is one major reason. The second reason is that Members may remember that when we introduced ElderShield in 2002, we introduced a scheme called IDAPE. IDAPE was specifically aimed at those who already have disability and, therefore, not insurable, plus all Singaporeans who are above the age of 70, I think. IDAPE, therefore, has taken over the bulk of the risks for today. So if you look at IDAPE claims, relying on memory, I think it is about 8,000, which is almost three times the ElderShield claims of 3,000. I am therefore not surprised by the low claims ratio. I will be very surprised if the ratio remains low over the next 10 or 20 years. Column No : 2636 FLU OUTBREAK IN SINGAPORE (Measures to ensure safety of Singapore Children) The following Question stood in the name of Mdm Ho Geok Choo – 4. To ask the Minister for Health in light of the recent flu outbreak amongst children in Hong Kong, what measures does the Ministry have in place to ensure the safety of Singaporean children.”
“Sir, there are more than 790,000 ElderShield policyholders. More than 3,100 people have benefited from Eldershield since its establishment in 2002. The total ElderShield payout amounted to $17 million.”
“The hospital bills incurred by patients above 80 years old in public hospitals averaged $1,100 for Class C and $1,600 for Class B2. The claims by elderly patients from basic MediShield averaged $1,200 per Class C bill and $1,400 per Class B2 bill. In nine in 10 of these cases, the rest of the bill was settled fully via Medisave. SOCIAL MOBILITY THROUGH UNIVERSITY EDUCATION (Tracking and indicators) 4. Ms Sylvia Lim asked the Minister for Education (a) whether the Government tracks social mobility vis-a-vis access to local university education and what are the indicators used; and (b) of the students entering NUS, NTU and SMU in the last three years, how far does the distribution of household income of the undergraduate population in the three local universities mirror or differ from the household income distribution of the general population.”
“The Institute of Mental Health (IMH) operates the Child Guidance Clinic (CGC) at two locations: IMH and the Health Promotion Board. The Clinic provides clinical specialist services to children with mental health problems. We are expanding the Clinic to meet the rising demand. Last month, we increased the number of consultation rooms from 33 to 45. In parallel, the clinic staff has increased to 59. We will continue to match our capacity to demand. But not all the patients need to be served at the CGC. Indeed, children with mild problems are best supported and cared for in the community. MOH is piloting the Response, Early Intervention and Assessment in Community Mental Health (REACH) programme, to train and support school counsellors and General Practitioners in identifying and managing students with emotional and behavioural problems. The aim is to extend the programme nationwide in due course. The staff turnover rate was manageable, at 8% (2007). IMH has a strong culture of peer sharing and support. It actively trains the staff to cope with stresses and problems encountered at work. Rotating staff between the Clinic and the wards also helps to hone their skills in a variety of care settings, besides reducing staff burnout. HOSPITAL BILLS OF PATIENTS ABOVE 80 YEARS OLD 3. Mdm Halimah Yacob asked the Minister for Health in respect of 2007 (a) what was the average bill size incurred by patients above 80 years old who were hospitalised in our public hospitals; and (b) how much of this bill was covered by MediShield and how much was paid through their Medisave account.”
“All healthcare institutions must ensure that their staff practice such standard precautions. Voluntary HIV screening of doctors enhances the prevention strategy as we can then redeploy any HIV infected doctor away from exposure-prone procedures. If a doctor is found to be HIV-positive, there are several factors to consider when deciding whether his patients have been put at risk: (a) whether the doctor performs exposure-prone procedures, (b) whether there was compliance with infection control precautions, and (c) the clinical status and viral load of the infected doctor. In line with international best practice, the decision to contact trace and notify the patients of an infected doctor will have to be made on a case-by-case basis. An expert committee will be set up to assess the specific risk in each case. A decision will then be taken based on the committee’s assessment and recommendation. BICYCLE THEFTS 31. Ms Irene Ng Phek Hoong asked the Deputy Prime Minister and Minister for Home Affairs (a) how many bicycle thefts have been reported each year over the last five years; and (b) what action has been taken to prevent the thefts, especially at MRT stations and HDB void decks.”
“Our public hospitals are at different stages of starting voluntary HIV testing for doctors who perform exposure-prone procedures. These are invasive procedures in which injury to the healthcare worker may result in the worker’s blood contaminating a patient’s open tissues. Changi General Hospital was the first to do so when, in August 2007, they included voluntary HIV testing in their annual health screening exercise for all their staff. 57% of their doctors underwent HIV screening. KK Hospital followed suit in October 2007. 30% of their doctors participated. The other hospitals are beginning to implement a similar policy. The policy is based on the principle that healthcare workers have an ethical obligation to protect the health and safety of their patients. Although the risk of HIV transmission to patients from doctors is tiny, and the risk can be further reduced through stringent infection control measures, we recommend that those who perform exposure-prone procedures should know their HIV status. The risk has been estimated as in the order of two to 24 per million. In more than 25 years of the HIV epidemic, there have only been three reported cases worldwide of infected healthcare workers transmitting HIV to their patients. In contrast, the risk of transmission from an infected patient to a healthcare worker during an invasive procedure is many times higher, at three per 1000. Regardless of the source of transmission, the most effective way to prevent HIV transmission in the healthcare setting is to strictly adhere to appropriate infection control measures. This would reduce the opportunity of direct exposure to blood and body fluids for both healthcare workers and patients.”
“But we should remain vigilant because our region has high TB incidence and drug-resistant TB has become a major global problem. GOVERNMENT PENSIONERS (Cost of living allowance) 23. Mr Lim Biow Chuan asked the Prime Minister, in light of the rising cost of living especially with respect to food and other daily necessities, whether the Ministry will consider giving a cost of living allowance to all Government pen- sioners who have contributed in the past to the growth of the country.”
“Sir, our tuberculosis (TB) incidence rate of 35 per 100,000 residents is indeed higher than the corresponding rates of less than 20 in other developed countries. This is largely for historical reason. TB has a long incubation period. A person can be infected and only become ill many years later. Up till the 1960s, TB was common in Singapore. In 1960, for example, our TB incidence rate was 307 per 100,000 residents. This was nearly ten-fold the current rate. Some elderly Singapore residents who were living then are now manifesting the illness and contributing to the current high incidence rate. Last year, for example, the TB incidence rate among our residents aged 60 years and above was 106 per 100,000. The corresponding figure for Singapore residents below 20 years, for instance, was only six per 100,000. In other words, in terms of TB incidence, our population is a mixture of both the first world and the third world people. In time, our incidence rate would match those in the other developed countries, although unlike these countries, we will continue to have a more challenging task as we have a large foreign worker population who come from countries with high TB incidence. Meanwhile, we will press on with our TB control strategy of early detection, aggressive contact-tracing and prompt treatment and complete cure for the adults. As a preventive step, we also extend treatment to contacts of TB patients who have latent infection so as to arrest the progress of the disease. I do not think our TB incidence rate will tarnish our reputation as an international economic, financial and healthcare hub. Indeed, our success in tackling TB within one generation is often quoted as a reference for many developing countries. We can be proud of this achievement.”
“Dr Fatimah Lateef asked the Minister for Health, with the high incidence of pulmonary tuberculosis for a first world nation and a third of the cases being amongst foreigners and work permit holders (a) what are the Ministry's course of action and strategies to reduce the current 35.1 per 100,000 population incidence to less than 20 per 100,000 population as in other first world nations; and (b) whether this figure will have a bearing on our reputation as an international economic, financial and healthcare hub.”
“I do not think it is possible to have a comprehensive list and a clear classification of what is high risk and what is low risk or medium risk. But internally, as regulators, we must be clear which are the commonly provided procedures in Singapore which belong to the high-risk group, which we will regulate. I think it could be a shortlist which probably will grow in time as new procedures are being provided, which may prove to be of high risk and which may cause severe complications. Until the regulations are in place, are the procedures being prohibited? As I said, for procedures which are provided by doctors, they operate under the SMC Ethical Rules. Doctors know that they operate within that framework. If they go beyond their competence, they can get into serious trouble. As for non-doctors (beauticians), for practically all these procedures, I doubt they are allowed to practise, to begin with. You cannot be performing surgery, for example, if you are not a surgeon. The last point about what if all doctors start going into aesthetic medicine and nobody wants to look after the patients, I hope that will not happen. I doubt it will happen because I think the doctors went into this profession for a purpose and took their oaths seriously. This is the season for admissions to medical schools, and hearing from the doctors who do the interviews, we know the students are passionate in expressing their wish to save the world and help relieve sufferings and save lives. So, I will be very sad if, having given that kind of interview answers and then got into medical school and graduated, a vast majority of them decide to go into aesthetic medicine, only to peel skin or to contour body. PULMONARY TUBERCULOSIS (Strategies to reduce incidence) 22.”
“If those procedures are done by beauticians, that is fine with them, because these are not medical procedures. So among the guidelines that we have to look at is also labelling. The other day I took a walk in a shopping centre and I saw a signboard outside a shop which looked like a medical clinic but when I looked closer, there were no doctors listed on the signboard. But they call themselves "medical clinic". So we should see whether non-doctors are abusing, for example, the use of "medical clinics" label. "Health clinics" may be harder to define, but "medical clinics" should, I think, be restricted to doctors' clinics. This way, we avoid consumers walking in thinking that they are going to get their skin "peeled" by doctors, only to end up being served by beauticians instead.”
“I have been watching this trend on the growth of aesthetic medicine for quite some time. It is one of those activities that is correlated with GDP because these are discretionary consumption and unless you have extra money in the pocket, you may prefer a particular body contour but you may not be able to afford it. So as people become richer, this demand is bound to grow, whether they are provided by doctors or non-doctors. As for "impetus", I have been watching with concern over the complication rates elsewhere of high-risk procedures like liposuction and there have been deaths associated with it. Even in our neighbouring region, there have been severe complications. At least there is one case of a patient in her 40s, I think, who went in to reduce her waistline but ended up now in coma for almost two months. So serious complications can occur and so I asked former Minister of State Heng Chee How to give a statement here during the Budget Debate highlighting our intention to regulate this area. That was how it started, but as things went, other procedures got into the picture like mesotherapy that I did not even fully understand. I look at it from the risk angle. If it is high risk, we must understand it and we must know how to regulate it. For those which are low risk, they may be of questionable value, but I think we leave it to the profession to decide whether they should provide such procedures at all. That is why I use the word "so-called aesthetic medicine" because, to many traditional doctors, they regard many of these procedures that are being provided by beauticians as not medicine and they reacted violently to classifying those procedures as aesthetic "medicine".”
“There are two key safeguards here. One is the doctors themselves. The doctors are under oath and under the SMC's ethical rulings. They have to perform under that kind of framework and if they misbehave and go beyond what ethical practice demands, they have to answer to their peers in due course if a complaint were to crop up and an accident occurs. So that is one level of safeguard. The second level of safeguard will fall on the consumers themselves. Yes, I take the Member's point that there is asymmetry of information, ie, the doctors know more than the consumers. And that is why I promote "one Singaporean, one family GP". Every Singaporean should have his own GP whom he trusts, whom he has relationship for many years, who understands his problems and the needs of his family. And whenever in doubt, get a second opinion and the best second opinion will be from this family GP whom he has developed years of trust.”
“Sir, I will interpret "low risk" as what the English word means. It means it is low risk. Is it safe? Nothing is completely safe. So there is a range of risks. As regulators, worldwide, it is not just Singapore, we have to be practical and focus on where the regulatory measures can be most effective. Where maximum damage can be done, this is where we really must focus on high-risk procedures. This is what we will do. But for low-risk procedures, I think consumers will have to also play their part. We will of course educate as much as we can. But at the end of the day, they have to decide. The best advice the Ministry of Health can give to them is to get a second opinion. If you do not even understand what the procedure is, all the more do not part with the money until you are clear what you are getting into. If you are getting the service from a doctor, he is obliged by his ethical standards to provide the full information of the risks and the benefits. You may get better looks but there could be other harm that may be incurred as a result of it. So I think getting informed consent for the kind of procedure is important. As for beauticians, we should not get the impression they are operating in a cowboy town where it is unregulated. There are regulations. For example, if beauticians were to make use of lasers and there is a wide range of lasers being made use of, the powerful lasers are highly regulated. Likewise, if they want to offer liposuction, that will not be allowed. And only doctors and pharmacists can make use of prescription drugs. So if non-doctors and non-pharmacists proceed to do so, the law will go after them.”
“I will find it difficult to implement such an idea.”