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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“Medisave can now be used to help pay the premiums for ElderShield Supplements, on top of basic ElderShield. Dr Fatimah also asked about waiting time for placement in these step-down care institutions. For community hospitals, there is hardly any waiting time. For nursing homes, the waiting time now is about one to two weeks. This is a considerable improvement from the past, but I will see how we can shorten this further as any delay means the patients are unnecessarily occupying costly acute hospital beds. But we will need the co-operation and understanding of the patients and their families, to agree to speedy transfer from acute hospitals to nursing homes. Column No : 2297 HOME IMPROVEMENT PROGRAMME AT TOA PAYOH LORONG 8 29. Mr Chiam See Tong asked the Minister for National Development why were the flats at Blocks 213 to 224 of Lorong 8 Toa Payoh not selected for the Home Improvement Programme if the age of the buildings is the main criterion.”
“Dr Fatimah Lateef asked about nursing homes and community hospitals. Together with the other entities in the step-down care sector, such as chronic sick hospitals, hospices and day rehabilitation centres, they cater to the diverse needs of Singaporeans who cannot be adequately looked after at home, but require some sort of medical, nursing or other professional services. The degree of professional intervention depends on the state of a patient which in turn determines the cost of providing the service. Typically, a nursing home or day centre cost much less to run than, say, a community hospital. The cost of running the step-down care sector has been largely borne by the Government, through direct operating subsidies to the entities and initial capital development grants. Last year, my Ministry provided more than $100 million in direct subsidies. With ageing of the population, we can expect this to grow. But patients also co-pay and are means-tested to determine the level of subsidy that they receive. In addition, various charities chip in to help lower-income patients pay their bills. Medisave was designed to help pay acute hospitalisation. However, over the years, we have gradually extended its use to cover other medical services, provided such extension does not undermine the primary objective of Medisave. For the step-down care sector, Medisave can now be used to help pay for services in community hospitals, chronic sick hospitals and hospices. For nursing home care, Medisave can be used, but in an indirect manner via ElderShield, as many patients in nursing homes are the target beneficiaries of ElderShield. With the recent ElderShield reform, the role of Medisave to help fund care in nursing homes has been expanded.”
“I would like to thank them once again for supporting the Bill. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill. - [Mr Khaw Boon Wan]. Bill considered in Committee; reported without amendment; read a Third time and passed. ADJOURNMENT Resolved, "That Parliament do now adjourn to a date to be fixed." - [Dr Ng Eng Hen]. Adjourned accordingly at Fourteen Minutes past Six o'clock pm to a date to be fixed. APPENDICES”
“And if the patients decide to buy the prescriptions from the medical specialists, then the cost of the medicine should be clearly printed on the clinic bill as a separate item from the doctor's consultation fee. We should expect such a level of transparency of all our doctors in Singapore. Our patients should demand such a standard of transparency. The public sector has demonstrated that it can be done and I hope the private sector will follow suit, beginning with the medical specialists. One suggestion that I recently received from a creative pharmacist is that, since our current regime does not separate the two functions, why not start by looking at those medicines which are particularly addictive, for example, Subutex or Dormicum, and restrict dispensing right to only pharmacists for that kind of addictive drugs. That is an interesting idea from this pharmacist. But when I think it over, there is no guarantee that the black sheep that we find amongst some doctors would not also appear in the pharmacist profession. However, it raised a different suggestion in my own mind: perhaps we can consider this as one of the penalties or disciplinary actions that the Singapore Medical Council can impose on those GPs who are found to be flouting this rule, who are wrongly or unethically prescribing drugs like Dormicum. Currently, in the tool box of SMC is suspension from clinic practice. I am going to suggest to them that we consider, in addition to this penalty, one of the penalties could be to suspend this errant GP for a certain period of no dispensing right of addictive medicines. That is probably something worthwhile for us to think about. Mdm Deputy Speaker, I believe I have addressed all the comments raised by the Members.”
“She noted that this is already the case in public institutions but not yet in the private sector. While a case could be made to grant pharmacists the monopoly in dispensing medicine, our current system is not without its benefits. First, as noted by Mdm Halimah, patients have the convenience of consulting a doctor and getting their prescriptions filled in one place without having to visit two places. Secondly, the system of separating the two functions may end up more costly for the patients. When we prevent doctors from dispensing, then we are restricting supply. I doubt it will enhance consumer interest. The key is whether the providers are competent in dispensing, and I think there is no doubt that the doctors are as competent as the pharmacists in doing so. My natural instinct is to expand supply rather than restrict supply of providers. My preference is not to replace our current system but I will work to enhance it. The key is to give our patients the choice to fill the prescriptions at wherever they wish, be it at the doctor's clinic, in a private pharmacy or even across the Causeway. To achieve such an outcome, doctors should provide each patient with a clearly written, preferably computer printed, prescription. This is already the case in public hospitals and polyclinics. So Mdm Halimah's proposed first step that we should do, which I totally support, is that doctors in the private sector should do the same. And given the high cost of medications prescribed by the specialists, the private medical specialists, in particular, should set the example and pave the way for this change in practice. They should automatically issue prescriptions to all their patients without their patients having to ask for them.”
“Dr Lam suggested that we list the pharmacy degrees that we recognise for the benefit of students who plan to study overseas, and we will do so. Mr Seah asked if we can allow pharmacists from countries like the Philippines or India to work in retail pharmacies under conditional registration. This can potentially be allowed, but the Council will have to assess the specific pharmacy qualifications to ensure that they are of sufficiently high standard. Mdm Halimah mentioned the important topic of drug cost and making sure that they are affordable, particularly for the poor. This is a continuing concern for me. We review drug prices regularly and, in particular, the composition of drugs on the standard drug list is something that we review at least once a year. I have an expert committee advising me. They have to look at cost benefits, cost effectiveness and make their recommendations to the Ministry. And we do periodically add to the list so as to ensure that drugs will always remain affordable to our people. I have looked at the composition of the national gross health expenditure, particularly the breakdown in the various items. Singapore is the lowest among the developed countries in terms of drugs as a percentage of the gross health expenditure. Finally, Mdm Halimah asked if my Ministry would rethink the current policy of allowing doctors to both prescribe and dispense medicine. As noted by her, in many countries, the two functions are kept separate, with doctors not allowed to dispense medicine, and in so doing, granting the pharmacists the sole dispensing right. Mdm Halimah felt that such a system might be safer from the patients' point of view, as there would then be a proper check and balance.”
“This is permissible if there are approved provisions, such as video or tele-pharmacy facilities, in the retail outlet to enable the cluster pharmacist to exercise adequate supervision, even though remote. Some pharmacies have already been approved for such a purpose. Mr Seah suggested that the Singapore Pharmacy Council should include wide representation, including at least one representative from the retail trade. We will bear in mind this recommendation when we form the Council. Members have all supported the strengthening of the Pharmacy Council so as to maintain high professional conduct and standard. As black sheep cannot be completely eliminated, some disciplinary actions will have to be exercised as needed. Dr Fatimah suggested that the Singapore Pharmacy Council appoint legal and clinical advisers to help the Council in some of their proceedings. This is a sound suggestion for the Council to consider. Dr Fatimah also made some suggestions for the regulation of pharmacy business. The Medicines Act and its regulations cover all matters pertaining to the regulation of pharmacy business. These are currently being reviewed and my Ministry will study her suggestions. Dr Lam noted the shortage in pharmacists and supported the need to train more locally. I understand that the NUS Pharmacy Department has plans to raise its student intake. We will also recruit from abroad to augment local training. But in so doing, I agree with Dr Lam that we must not compromise on quality. Foreign-trained pharmacists will have to meet the same minimum criteria as our locally-trained pharmacists, and they will need to work under supervisory framework before they can apply to be fully registered.”
“Dr Lam asked whether specialist pharmacists will require special CPE requirements through participating in CPE activities that will be relevant to their specialty, and the answer is yes. Dr Fatimah asked if we plan to regulate pharmacy technicians. We now have about 450 pharmacy technicians in our healthcare institutions. They are either diploma holders in pharmaceutical science and technology, or they have successfully completed the certified pharmacy technician course. Pharmacy technicians play a supporting role and they are under the direct supervision of pharmacists. As the pharmacist takes full responsibility for the actions of the pharmacy technician, I think the current arrangement is satisfactory, and my Ministry has no plan to regulate pharmacy technicians for now. Dr Fatimah suggested that the clinic assistants working in private medical clinics without pharmacists should have proper skills training followed by certification. The Singapore Medical Association currently runs such a certification programme in partnership with ITE. The general practitioners should encourage their clinic assistants to attend such a programme so as to upgrade their skills. As clinic assistants come under the direct supervision of doctors who are ultimately responsible for their work, it is in the interest of the doctors that their clinic assistants are properly trained. Mr Seah Kian Peng asked if trained pharmacy technicians can work in retail pharmacies. The answer is yes, but they must be supervised by pharmacists who will be responsible for their actions. Mr Seah also enquired if pharmacy technicians can be allowed to dispense non-prescription drugs, such as pharmacy only medicines (POM) in a retail pharmacy under the supervision of an off-site cluster pharmacist.”
“Mdm Deputy Speaker, first, let me thank the Members who have spoken in support of the Pharmacists Registration Bill. As noted by the four Members, pharmacists now play a very important role in our healthcare system. Pharmacists are the experts in drug use, development, prescription and monitoring, and they are no longer mere dispensers of medications, but have taken on many specialist roles. Dr Lam Pin Min commented that specialist pharmacists are especially needed to support Singapore's vision to be a medical and biomedical sciences hub. It is therefore timely to set up this specialist register for pharmacists. Mdm Halimah suggested that we publish the specialist register and make it accessible to the public, and I agree. The Singapore Pharmacy Council will do so. Members also supported the need for continuing professional education. Dr Fatimah asked about the CPE requirements for pharmacists who were on overseas attachments or postings and the non-practising pharmacists who wish to return to active practice. The new pharmacist registration regulations will spell out such CPE requirements. Briefly, pharmacists who have been away from Singapore for more than 90 consecutive days will have their CPE requirements prorated. Non-practising pharmacists can keep their names on the Register for up to five years without a practising certificate. But when they wish to return to active practice, they would have to meet at least half of the required number of CPE points during the preceding 12 months in order to qualify for a practising certificate. And it is certainly advisable for such pharmacists to undergo a period of clinical supervision to ensure competency. Our institutions will provide the necessary support for such pharmacists.”
“Its role is to inquire into the physical or mental fitness of a pharmacist to practise pharmacy, when concerns about the health of pharmacists are received by the Council. The Health Committee will be empowered under clause 51 to suspend a pharmacist, restrict his practice, or, in cases of serious impairment, remove him from the register. Sixth: Interim Orders Committee Inquiries into disciplinary and health matters may take some time to complete and, presently, a pharmacist who is under investigation is still able to practise. This may not be entirely satisfactory in some situations as there may be compelling reasons to suspend such a pharmacist from practising, even before the outcome of his inquiry, either for the protection of the public, or in the interests of the pharmacist. Clause 53 allows the Council to appoint an Interim Orders Committee with the power to suspend or restrict the practice of a registered pharmacist for these reasons, pending the completion of disciplinary proceedings against him. To safeguard the interests of the pharmacist, measures have been put in place in the Bill. Composition of offences Finally, clause 69 allows the Council, with the approval of the Minister, to prescribe offences which may be compounded and, where appropriate, to compound such offences. Conclusion Mdm Deputy Speaker, our pharmaceutical services have seen many improvements over the years. But as medical science continues to develop, the pharmacy profession must be given the support and backing of this House to enable it to keep pace with the rest of the healthcare professions. Mdm Deputy Speaker, I beg to move. Question proposed. 5.36 pm”
“Clause 5 of the Bill will strengthen the Council's ability to regulate standards of pharmacy practice and direct the development of the pharmacy profession. The Council will now be able to make recommendations for the undergraduate courses of instruction, pre-registration training and compulsory continuing professional education for pharmacists. Fifth: Enhanced disciplinary and health inquiry framework Currently, complaints made against pharmacists are dealt with by the Singapore Pharmacy Board. The Board is empowered to discipline a pharmacist, after conducting an inquiry or after giving the pharmacist concerned an opportunity to explain himself. The pharmacist may be issued a warning. In more serious cases, he may be struck off the register. Part VI of the Bill establishes a more robust disciplinary and health inquiry framework for pharmacists, modelled after the medical and dental professions. Under this system, complaints that the Singapore Pharmacy Council receives will be referred to the Complaints Panel. From this Panel, a Complaints Committee will be instituted to inquire into the complaint. After doing so, the Complaints Committee may either dismiss the complaint or refer the matter for a full hearing before a Disciplinary Committee. Clause 42 of the Bill sets out the composition of the Disciplinary Committee. It is empowered to take a variety of disciplinary actions against errant pharmacists. For instance, under clause 46, it may strike him off the register or suspend him for up to three years. It may impose conditions to restrict his practice, or to impose a penalty of up to $50,000. The pharmacist or the complainant aggrieved by the decision of the Committee may appeal to the High Court. Clause 50 of the Bill establishes a Health Committee.”
“Such specialist pharmacists will enable cost-effective drug prescribing, optimal dosing of drugs, reduction in medication errors and fewer drug-therapy related complications. With the advent of molecular medicine, there will also be a need for targeted therapy, to deliver the right dose of the right drug to the right patient at the right time. Specialist pharmacists in pharmacogenomics and nanotechnology will support such advancements in disease management from research to pharmaceutical manufacturing and clinical service. Responding to this sophisticated demand, we observe a growing number of pharmacists with such specialist qualifications. They are mostly American Board-certified specialist pharmacists and they are providing an excellent level of pharmaceutical care to our patients. But we need more. The establishment of a Register of Specialists will encourage more pharmacists to pursue postgraduate education in their chosen field. Besides enhancing patient care, this will also make the professional environment here more attractive to well-trained foreign pharmacists and encourage their inflow into Singapore. Fourth: Singapore Pharmacy Council The Bill will establish a new statutory board, the Singapore Pharmacy Council. Currently, the profession is regulated by the Pharmacy Board which is a department of the Ministry of Health. Our proposal is to convert the Pharmacy Board into a statutory board and to enhance its regulatory powers. The Council will comprise 11 members, nine of whom will be appointed by the Minister, with the Chief Pharmacist and the Head of the NUS Pharmacy Department (or designate) as ex-officio members. This is provided for in clauses 3 and 4. The Chief Pharmacist will function as the Registrar.”
“While NUS will consider expanding the intake, we will also have to recruit from abroad to augment our local supply. The Bill will make provisions to facilitate foreign recruitment. Clauses 17 and 19 will allow, in addition to full registration, the conditional and temporary registration of pharmacists. The Bill will enable the Pharmacy Council to conditionally register a pharmacist who holds a prescribed qualification in pharmacy conferred by a tertiary institution outside Singapore, or any other relevant qualification which, in the Council's opinion, is not lower in standing than the prescribed qualifications. These pharmacists will work under the supervision of a fully registered pharmacist for a certain period of time. On successfully completing the period of supervision, the pharmacist may apply to the Council to be fully registered. Temporary registration will be granted to pharmacy experts or pharmacists whose qualifications are deemed adequate by the Council, and who are temporarily in Singapore for the purpose of teaching, research or postgraduate study in pharmacy. This scheme, comprising full, conditional and temporary registration, is modelled against that of the medical and dental professions. Third: Register of Specialists Clauses 15 and 18 of the Bill provide for the setting up of a separate register for specialist pharmacists and the registration of such specialists. Clauses 36 and 37 establish a Specialist Accreditation Board to define specialities and to determine the requirements for specialist registration. Pharmacists with specialised expertise are increasingly required, particularly in areas, such as oncology, cardiology, critical care and geriatrics, to ensure safe, evidence-based and cost-effective use of medicines for better patient outcomes.”
“Our proposal is to establish a new statutory body, the Singapore Pharmacy Council, with enhanced regulatory powers to help maintain good professional conduct of pharmacists and raise the standard of pharmacy practice. The Bill will repeal the existing Pharmacists Registration Act but most of the current provisions which remain relevant will be re-enacted. But several key amendments are proposed, which I will now elaborate. First: Compulsory continuing professional education Like doctors and dentists, pharmacists need to keep up with the latest developments in the field of pharmacy in order to provide up-to-date, high quality and cost-effective pharmaceutical care. Many countries, including the UK and Canada, have therefore introduced compulsory continuing professional education for their pharmacists. We should do the same. Clause 74 of the Bill will enable the new Pharmacy Council to prescribe conditions for the grant and renewal of practising certificates. One of these conditions will be mandatory participation in continuing professional education. Only pharmacists who accumulate the requisite number of points specified by the Council will be issued with practising certificates, or have their certificates renewed. Second: Conditional and temporary registration The growth in the healthcare and biomedical sciences sectors will push up the demand for more pharmacists. We will continue to ramp up our supply. The National University of Singapore (NUS) has increased its Pharmacy student intake over the years, from 41 in 1996 to 115 in 2006. This is a tripling in number over 10 years. But we need to do more. We project a need for 200 additional pharmacists every year for the next 10 years.”
“While they still provide the check-and-balance in the drug dispensing process, pharmacists today also tailor drug therapy according to the patients' needs, for example, the titration of antibiotic dosages for individual patients. Pharmacists must therefore update their knowledge and skills through continuing education in order to provide pharmaceutical care of the highest standard. This Bill seeks to mandate continuing professional education for all pharmacists. The pharmacy profession has undergone many changes. With continuing discovery of new drugs and novel drug delivery systems, there will be new demands on pharmacists. They will play an increasingly important role as domain experts in drug evaluation, drug use and surveillance. Patients today have access to better and more potent medicines. But these medicines are not without side effects or risks. Patient medication management has therefore become more complex due to a wider range of drugs and treatment regimes. Poly-pharmacy amongst the elderly and patients with multiple illnesses are situations in which the expertise of pharmacists can be called upon. We need better trained pharmacists with postgraduate training and specialised knowledge, skills and experience to manage these complex drug therapies. Through this Bill, we seek to establish a "Register of Specialists" for specialist pharmacists who are capable of providing advanced medication management. The current Pharmacists Registration Act was enacted in 1981, more than 25 years ago. We need to bring it up to date with the modern practice of pharmacy. We also seek to enhance the regulatory role of the current Pharmacy Board for it to function more effectively.”
“Mdm Deputy Speaker, I beg to move, "That the Bill be now read a Second time." The Pharmacists Registration Bill seeks to repeal the Pharmacists Registration Act (Chapter 230 of the 1985 Revised Edition) and to re-enact it with amendments. The Bill aims to achieve two main objectives. First, it is to help raise the practice standards of pharmacists. Second, it is to ensure that our laws remain relevant to the practice of pharmacy today. In so doing, the Bill will establish a new statutory body, the Singapore Pharmacy Council, and enhance its powers to enable it to perform its regulatory functions more effectively. Background There are almost 1,500 registered pharmacists in Singapore. After nurses and doctors, pharmacists form the third largest healthcare professional group. The demand for pharmacists will continue to increase to meet the rising healthcare needs of Singaporeans and also to support the growth in the biomedical sciences and pharmaceutical research sectors. We will step up local training of pharmacists but we will also need to augment it by recruiting trained pharmacists from abroad. The Bill will make provisions to facilitate such foreign recruitment. Pharmacists work in a wide range of jobs in both the public and private sectors. Traditionally, pharmacists' role as custodians of drugs is to ensure the passage of safe and good quality drugs to our patients through proper distribution and dispensing, protecting the patients from counterfeit and sub-standard drugs. Over the years, the profession has progressed from a mere drug focus to a patient focus.”
“Sir, it is always of concern to me when CPF members do not have enough savings, whether in CPF, Medisave or some other savings account. So, the 15,800 Singaporeans with zero Medisave balance is certainly of concern to me. I hope that the majority of them could depend on their family members' Medisave accounts, such as housewives whose husbands would have Medisave accounts or have children or parents who have Medisave accounts. We look at Medisave as a family account, and not so much an individual account. If somebody is without family members and without anything in their Medisave, then that is where the third leg of the 3M system - Medifund - comes in to specifically assist those who, despite all their efforts, are still unable to pay for their medical bills. On the second question whether I find Medisave balances sufficient, I have expressed a view before that with increasing healthcare cost, due to rising wages and also new technology, we should always try to build up as much Medisave as we can. That is the reason why we adjust the Medisave Minimum Sum every year for medical inflation, so that we preserve the purchasing power of the savings that we have in our Medisave. But I think the key approach, in the spirit of the discussion these few days, is to keep healthy and continue to work for as long as we can and save up as much money as we can, whether by legislation through the CPF route or our own savings, and do not forget to buy insurance. SIGNAGES IN PUBLIC HOSPITALS (In four official languages) 16. Ms Sylvia Lim asked the Minister for Health whether the Government will consider mandating that signages in public hospitals be in the four official languages so as to make public hospitals more navigable to those not literate in English.”
“Sir, a breakdown of the Medisave balances of CPF members by age and income level is tabulated on Ministry of Health's website. The Clerk of Parliament will now circulate the statistical table to Members, as it will be time-consuming for me to read out those data. [Copies of table distributed to Members.] Table: Average Medisave Balances of CPF Members (as at December 2006) Age group (years) Monthly Salary ($) 1,500 & below 1,501-2,000 2,001-3,000 3,001-4,000 4,001-4,500 Above 4,500 0 – 20 200 1,000 1,200 1,200 2,900 1,400 21 – 30 2,500 4,400 6,100 8,200 9,600 11,400 31 – 40 9,300 13,900 17,900 21,500 24,000 27,400 41 – 50 13,800 22,700 27,800 30,600 31,800 32,600 51 – 60 15,800 25,900 29,700 31,200 32,100 32,600 61 – 65 14,800 24,700 27,600 28,500 30,000 30,600 Above 65 13,000 24,200 25,900 28,500 29,900 29,900 Overall 10,200 15,200 19,100 22,800 26,200 27,500 As expected, the average Medisave balance would increase with income level. Likewise, it would also increase with the age of the members, but up to the age of 60. Generally, members above the age of 40 and earning more than $1,500 per month would have an average balance exceeding $20,000. This will generally be sufficient to cover 16 episodes of hospitalisation in a Class B2 ward. Members above the age of 40 and earning above $3,000 per month would have an average Medisave balance of at least the Medisave Minimum Sum of $28,000. Among the 2.7 million CPF members, ie, both active as well as inactive members, 606,000 or 22% of CPF members have Medisave balances exceeding the Medisave Minimum Sum. On the other hand, 15,800 or 0.6% have no Medisave savings at all.”
“There is indeed such a protocol and, in fact, we centralise the follow-up action. The requirement is that all doctors, whether in public or private hospital, GP or specialist, once they identify and diagnose a HIV-positive case, they have to inform our CDC, and then we will follow up. Notification to spouse is one of those follow-up actions which we will do. We would follow up with the spouse, inform the spouse and also test the spouse so that we know the HIV status. If the spouse has already been infected, likely by the husband, then we can begin treatment. Or if the spouse is not yet infected or is not positive, we can advise the couple on proper precautions in order to hopefully avoid the infection. PUBLIC LECTURE BY PROFESSOR EMERITUS DOUGLAS SANDERS (Reasons for cancellation of public entertainment licence) 6. Mr Baey Yam Keng asked the Deputy Prime Minister and Minister for Home Affairs (a) what are the reasons for the change in assessment of the permit for Prof. Emeritus Douglas Sanders' public lecture after the permit was previously approved; and (b) what is the number of similar cancellations of approved permits in the past five years and what are the main reasons for their cancellation. 7. Mr Siew Kum Hong asked the Deputy Prime Minister and Minister for Home Affairs (a) why was a public entertainment licence initially granted for a public lecture on 7th August 2007 by Prof. Emeritus Douglas Sanders; and (b) what circumstances had changed to result in the cancellation of the licence. The Senior Minister of State for Home Affairs (Assoc. Prof. Ho Peng Kee) (for the Deputy Prime Minister and Minister for Home Affairs): Sir, may I take Question Nos. 6 and 7 together?”
“The number of women infected by HIV was 28 in 2002, 30 in 2003, 21 in 2004, 30 in 2005 and 32 in 2006. While the number is quite stable, we should not be complacent for reasons which I have given in my earlier reply to Dr Lim Wee Kiak. The vast majority of these cases, 91% (nine in 10), were infected through sexual transmission. So, the most effective way to protect the women is through public education and direct counselling of HIV-positive patients. That is why it is so important for us to do more HIV screening so that we can pick up the carriers early and to track down their sexual partners for counselling.”
“This is an evolving field and so everyone is learning from one another. I propose that we take a step-by-step approach. In US, because their numbers are higher, they have been studying this for a longer period. That is why we look to the US CDC recommendations and also other regimes to see whether we can learn from them. That is part of the reason why Dr Balaji led a delegation to Australia recently. To take the measures that I mentioned just now with hospitals offering screening to our own healthcare workers as well as beginning to offer the screening for adult males will be a big step forward. Let us go through this step first and learn from that experience. With better data, we can then decide whether we need to be more aggressive or just hold it at that level. Compulsory HIV screening - no country has done it yet. I think that is something for us to think about, whether we want to be ahead of the curve, especially when our prevalence is not as high as in the rest of the world. WOMEN INFECTED BY HIV 5. Mdm Halimah Yacob asked the Minister for Health with the record increase in HIV cases last year (a) whether there is concern that women are now more exposed to HIV infection compared to the past; (b) what is the number of women infected by HIV in each of the last five years; (c) what are the most common causes of their infection; and (d) what measures are being taken to educate and protect women from infection by their spouses.”
“This is not a new issue because another disease that has a longer history is Hepatitis B. In fact, empirical data globally has shown that the transmission of Hepatitis B is even more common than HIV transmission. We can apply the same model or approach. And that is why in the US CDC recommendations when they suggest routine screening for healthcare workers who are engaged in EPP (exposure prone procedures), such as surgery, it is to re-deploy those infected, to put them in other work areas which are less or non-exposure prone. Those are standard ways that institutions will adopt. As for compensation, you have to take into account and establish if indeed there is infection from a patient to a healthcare worker. You also have to establish that the healthcare worker was not himself careless because as healthcare workers, we know there are occupational hazards in this chosen profession. That is why we are taught and we learn how to protect ourselves. If you are careless, then you have yourself to blame. But, like all things, better get to the basic approach, which is to pick up as many HIV-infected patients as possible so that we can treat them and counsel them, and in that way we can protect the rest of the society.”
“For population-wide screening or test, there is a trade-off that we have to make because there is a cost to screening and also we do not want to cause unnecessary inconvenience to the vast majority. That is why if you study the US CDC recommendations, they were careful to say that even in a hospital setting, they recommend a voluntary routine screening only if the prevalence is above a certain level. In our case, our adult male prevalence would have exceeded that threshold, but not the female. That is why the first step that we will be doing before the end of this year is to start offering this HIV testing to adult males. With the benefit of better data, we can then revise our strategy going forward. If we do it well and keep the prevalence low, hopefully we do not have to cross the threshold to have to do population-wide screening. Let us continue to review this because, as I said, it has to do with cost-benefit. Fortunately, the cost of HIV testing is coming down. As it becomes cheaper to do so, we may then decide to make it more accessible, much like routine blood pressure or simple blood test. At some stage, HIV may become one of the routine checklist of tests to be done.”
“The Infectious Diseases Act makes it an offence for someone who is HIV-positive if he has sex without informing his sexual partner of his HIV status. I will soon come to this House to amend the Act to clarify that ignorance of one's HIV status will not be a defence for those who engage in such high-risk sexual behaviour. In parallel, we will strengthen other prevention efforts. Last July, Senior Minister of State Dr Balaji Sadasivan, who chairs the National HIV/AIDS Policy Committee, led a delegation from my Ministry and three NGOs involved in HIV prevention to Sydney to study their prevention efforts. A key learning point was the strong collaboration among the stakeholders, ie, Government, NGOs and academia to create an enabling environment that allows people at risk to take personal responsibility to reduce risky behaviours and go for regular testing. My Ministry has formed a working group involving the NGOs to apply what they have learnt in Sydney to further enhance our HIV prevention strategy.”
“If the hospital study is representative, then one dozen unknown HIV patients come into close contact with healthcare workers every day. The risk of accidental transmission is not trivial. That is why the US CDC (Centers for Disease Control and Prevention) has issued recommendations that require (a) certain categories of healthcare workers, eg, surgeons, to know their HIV status, and (b) adult patients to be offered HIV screening. The first measure is to avoid infected healthcare workers from participating in procedures which are prone to accidental transmission, what we call "exposure prone procedures (EPP)". The second measure is to pick up the infected patients for early treatment and counselling. Our public hospitals are progressively implementing the US CDC recommendations. HIV testing will be included in the regular health screening of healthcare workers, on a voluntary basis. Changi General Hospital has started doing so. As for screening of patients, we have begun doing so for all pregnant women and have saved 30 babies from unnecessary HIV transmission in the last two years. Later this year, we will also start offering HIV testing to adult male inpatients on a voluntary basis. A simple HIV test is all that is needed to diagnose the infection. HIV testing is now widely available in GP clinics and hospitals and my Ministry has just allowed the use of rapid HIV test kits in medical clinics. In trained hands, the kit can give accurate and reliable results in 20 minutes. We should take advantage of this to promote regular HIV screening among the population. It is an important measure in HIV prevention. In particular, all individuals who engage in high-risk sexual behaviour must go for regular HIV testing.”
“Based on this study, we estimated that one in 350 hospital patients was HIV-positive, giving an undiagnosed prevalence of 0.28%. As patients are not representative of the general population, we should not extrapolate the hospital prevalence nation-wide. Nevertheless, it would suggest that the number of undiagnosed HIV-positive patients is more than the number of known carriers of this virus. Our experience is not unique. This is a common problem all over the world. There are many HIV-positive patients out there who are not aware of their infection. While some of these patients may choose to be ignorant of their infection, we have to be concerned about the significant number of undiagnosed HIV cases. From the public health point of view, all persons who are HIV-infected should know their status. First, they can then receive early treatment. Second, they then can be counselled on how they can avoid infecting their loved ones. For example, a HIV-infected pregnant woman can protect her child if the obstetrician is aware of her infection. Likewise, a HIV-infected man can reduce the risk of infecting his sexual partner if he takes proper precautions. Furthermore, in a hospital or a clinic, being aware of one's HIV status can reduce accidental transmission of the virus, for example, through a needle prick or cut during a surgical operation. The transmission can go from an infected healthcare worker to a patient but much more likely, from an infected patient to a healthy healthcare worker. While all healthcare workers will routinely take proper infection control measures, being alerted to the HIV status of the patient will be extremely helpful to all. Every day, we treat about 4,500 inpatients in public hospitals alone.”
“Sir, the World Health Organisation (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) classify HIV epidemics into three categories: low-level, concentrated and generalised, in ascending order of severity. Singapore's HIV epidemic is classified as a low-level epidemic. But we are at risk of shifting into the concentrated category, where the prevalence in the general population is low (below 1%) but among a specific high-risk population, the prevalence is high (above 5%). Hence, we must not be complacent, particularly because our region has high HIV prevalence. I am sure Members are aware of the disastrous HIV prevalence in Africa. And in parts of South East Asia, like Papua New Guinea and Irian Jaya, their HIV rates are almost at African rates. Let me provide some local statistics. Up till the end of last year, 3,060 HIV-positive cases had been diagnosed, of which one-third or 1,048 had died. In the first eight months of this year, 278 Singaporeans were newly diagnosed, bringing the total number of known HIV-infected Singaporeans to 3,338. Our prevalence of known HIV cases among the resident population above 15 years of age is 0.07%. This is low, but 10 years ago, it was only 0.02%. So it has been rising. What is, however, not known is the prevalence of undiagnosed HIV. There have been various estimates. UNAIDS, in 2005, estimated our total adult prevalence, diagnosed plus undiagnosed, at 0.3%. This is higher than their estimates for countries like Australia, New Zealand, Japan or Korea which were all below 0.1%. Early this year, my Ministry did a survey to determine the HIV prevalence among the patients in our public hospitals. Discarded blood samples of all patients who were not known to be HIV-positive were tested anonymously for HIV.”
“The Singapore Cord Blood Bank (SCBB) was launched in September 2005 as a public cord blood bank. It has collected about 2,000 cord blood units (CBUs) with high number of cells ready for use. The target is to add about 2,000 units to the bank each year for a significant inventory of at least 10,000 useable CBUs. There have been two successful cord blood transplantations using the CBUs from SCBB. A CBU has just been issued to a local transplant centre for transplantation. For the two cord blood transplantations, the retrieval fees were around $25,000 each. This is about half the rate in the US as the SCBB is partly subsidised. The patients were also able to access various charity funds. Unlike the SCBB, the private cord blood banks collect and store cells for the donors' personal use in the future. Given the different objectives, their performances are not comparable. SINGAPORE YOUTH FESTIVAL (Annual budget, success and achievements) 5. Mr Baey Yam Keng asked the Minister for Education (a) what is the annual budget for the Singapore Youth Festival (SYF) for the last five years, with a breakdown into the categories of performing arts, sports and uniformed groups; (b) how the success of the SYF is measured; and (c) what are some examples of its key achievements.”
“Ms Sylvia Lim asked the Minister for Transport whether the report by the consultants for the land transport review has been submitted to the Government and when the report will be made public.”
“From FY01 to FY06, the cost of treating subsidised patients in our public hospitals increased from $1.45 billion to $1.96 billion. The corresponding total Government subsidy grew from $0.90 billion to $1.27 billion over the same period. Public hospitals provide a wide range of subsidised services, from Class C to Class B1 in wards, and from Emergency Department to Specialist Outpatient Clinics at the outpatient level. Providing the detailed breakdown as requested will require many statistical tables, resulting in a huge amount of figures which may not illuminate. As an illustration, the tables below provide the requested details for one public hospital: Table 1: Cost of Treating Subsidised Inpatients in TanTockSengHospital(TTSH) ($'million) FY01 FY02 FY03 FY04 FY05 FY06 Class B1 13.3 17.8 12.0 17.3 17.9 22.1 Class B2 43.0 56.5 45.6 63.3 72.6 79.8 Class C 74.4 84.2 95.4 114.8 124.4 127.8 Table 2: Subsidies to Subsidised Inpatients in TTSH ($'million) FY01 FY02 FY03 FY04 FY05 FY06 Class B1 3.0 4.3 2.3 3.9 4.2 4.5 Class B2 30.0 39.9 28.1 43.0 49.5 51.4 Class C 63.9 73.3 69.5 96.3 103.4 104.4 Table 3: Cost of Treating Subsidised Outpatients in TTSH ($'million) FY01 FY02 FY03 FY04 FY05 FY06 Day Surgery 13.2 17.7 17.9 24.2 20.3 22.6 SOC 35.6 41.2 42.6 54.7 63.7 70.9 Emergency Department 15.9 17.0 17.1 19.0 20.9 21.7 Table 4: Subsidies to Subsidised Outpatients in TTSH ($'million) FY01 FY02 FY03 FY04 FY05 FY06 Day Surgery 9.4 12.4 11.3 16.3 13.8 15.5 SOC 20.0 24.7 24.7 34.2 37.6 41.2 Emergency Department 8.8 9.4 8.9 10.9 12.0 12.8 The Ministry will provide further statistics if necessary. LAND TRANSPORT REVIEW (Report) 8.”
“The vast majority of our patients are able to settle their hospital bills. Last year, less than 1% of patient cases were not completely paid due to patients not being able to pay their bills in full. Only a tiny minority could not pay even any portion at all. Debt recovery generally follows this procedure. A patient who does not pay up within a month will receive a reminder from the hospital. There will be a second reminder, if necessary, during the following month. When there is still no response, some hospitals may refer the case to a debt collection agency to collect the arrears on their behalf. For patients who have expressed problems paying the hospital bills, the hospital would explore with them options for financial assistance, such as payment by instalments. Singaporeans who have genuine financial difficulties will be assisted through Medifund. Last year, Medifund provided about $40 million to help low-income Singaporeans with their medical bills. ADMISSION TO JUNIOR COLLEGES OR POLYTECHNICS 32. Ms Ellen Lee asked the Minister for Education (a) in 2007, how many 'O' level students with perfect scores could not be admitted to junior colleges or polytechnics of their choice; and (b) what steps will the Ministry take to avoid such situations.”
“Over the last five years, our Government health expenditure for Singaporeans has increased from $1.53 billion in FY2002, to $1.93 billion in FY2006. This was an average growth rate of 6% per annum. On a per-capita basis, the Government's expenditure has increased from $453 to $535 over the same period. As a percentage of total Government expenditure, it has gone up from 6.7% to 7.5% over the same period. This was not a straight-line growth because there was a sharp spike in health expenditure in FY2003, to counter the immediate challenges from the Severe Acute Respiratory Syndrome (SARS). There was also some post-SARS expenditure in subsequent years to prepare for possible re-emergence of SARS and similar threats. The trend in Government health expenditure is clearly upwards as our population continues to age and patients' expectation continues to rise. Going forward, the Government will spend a lot more on healthcare, but patients' co-payment will inevitably go up in quantum even as we maintain the same subsidy rate. We therefore have a collective interest to look for more effective ways to deliver services without compromising standards, make health insurance work more efficiently, and manage rising expectations. EMPLOYMENT PASSES (Figures) 27. Mr Siew Kum Hong asked the Minister for Manpower (a) why is a breakdown of P1, P2, Q, R and S passes not available for the last 10 years; and (b) how is the total foreign employment level calculated if the breakdown is not available.”
“Dr Fatimah Lateef asked the Minister for Education with the recent announcement of having special needs officers in primary and secondary schools, whether there will be plans to have these officers available for assessment of preschool and kindergarten students, as many manifestations such as attention deficit disorder, autism and dyslexia are detectable during the preschool years.”
“Patients in public hospitals receive subsidies, ranging from 20% of cost in Class B1 to 65% in Class B2 and 80% in Class C. Class A patients are charged at cost. The table below shows the average bill sizes after Government subsidies, by ward class from 2001 to 2006. This is the amount to be borne by the patients. Pre-subsidy costs can be computed from the table. Table: Average Bill Size Average Bill Size ($) Year 2001 2002 2003 2004 2005 2006 Class A AH 2,206 2,550 3,112 2,299 2,849 3,328 CGH 2,938 2,961 3,178 2,705 2,980 3,250 KKH 1,958 2,058 2,237 2,287 2,201 2,205 NUH 3,671 3,794 3,961 3,891 4,226 4,717 SGH 3,528 3,466 3,811 3,753 4,069 4,393 TTSH 3,837 3,338 3,609 4,599 3,914 3,917 Class B1 AH 1,712 1,827 1,840 1,872 1,695 1,901 CGH 2,325 2,409 2,466 2,125 2,277 2,665 KKH 1,498 1,520 1,680 1,698 1,804 1,930 NUH 2,797 3,145 3,346 3,298 3,741 4,066 SGH 2,751 2,946 3,181 3,175 3,525 3,950 TTSH 2,884 2,852 3,030 3,046 3,305 4,114 Class B2 AH 803 806 849 776 847 897 CGH 1,035 964 1,101 863 950 1,061 KKH 657 710 707 783 780 796 NUH 1,210 1,159 1,174 1,142 1,217 1,337 SGH 1,333 1,158 1,296 1,270 1,289 1,424 TTSH 958 934 1,127 1,127 1,145 1,168 Class C AH 571 603 675 615 566 637 CGH 746 712 795 640 711 816 KKH 618 657 779 749 832 913 NUH 827 985 921 927 1,007 1,069 SGH 820 1,043 1,164 1,162 1,206 1,327 TTSH 702 672 860 856 991 1,092 *AH -- Alexandra Hospital, CGH -- Changi General Hospital, KKH -- Kandang Kerbau Hospital, NUH -- National University Hospital, SGH -- Singapore General Hospital, TTSH -- Tan Tock Seng Hospital SPECIAL NEEDS OFFICERS IN PRIMARY AND SECONDARY SCHOOLS 5.”
“Kalyani K Mehta asked the Minister for Manpower in view of the majority of the working population observing a five-day work week, whether his Ministry will consider replacing a public holiday that falls on a Saturday with the following Monday and, if not, what are the valid reasons for maintaining the current status quo. Dr Ng Eng Hen: As companies within Singapore need to respond to different business environments, the 5-day week is not uniformly applied. In 2006, approximately 40% of full-time employees in the private sector worked five days a week. The share of employees who were on the 5.5-day and 6-day workweek arrangement constituted 15% and 16% respectively, while the remaining worked on shift work or with alternate Saturdays off. So a large proportion of workers would still enjoy a public holiday which falls on a Saturday. Workers covered under the Employment Act are already entitled to claim a day off or compensation in lieu, if a public holiday falls on a non-working day for their company. The current provisions are adequate to ensure that workers receive sufficient rest days and there is no need to impose the rule to replace a public holiday that falls on a Saturday with the following Monday. FIRES IN HOUSEHOLDS AND FOOD PREMISES 53. Dr Fatimah Lateef asked the Deputy Prime Minister and Minister for Home Affairs (a) if he can provide the number of households and food premises over the last three years which had fires that were caused by problems relating to liquefied petroleum gas (LPG) canisters or their hoses; and (b) what are the improvements and active measures undertaken to reduce these incidents.”
“Myopia is a major public health problem here. The prevalence rate seems to have stabilised in the last five years, but it is high in absolute terms. About 30% of our Primary 1 students and two in three Primary 6 students have myopia. By the time they are 18, 80% of them are myopic. Myopia usually develops and progresses in childhood, but stabilises when one enters adulthood. Our preventive efforts therefore focus on children. In 2001, the Health Promotion Board (HPB) spearheaded the National Myopia Prevention Programme, in partnership with MOE and MCYS. The aim is to delay the onset and reduce the progression of myopia in children. The prevention strategies include public education targeted at parents, teachers and children to inculcate good eye care habits such as adopting correct posture when reading, ensuring adequate lighting and having regular outdoor activity. We also introduced a vision screening programme in primary and secondary schools and a spectacles fund for needy children. HPB works closely with kindergartens and childcare centres to extend vision screening to pre-schoolers. The aim is to identify children with early myopia and "lazy eye" (ambylopia). About one in seven pre-schoolers has defective vision. They are referred to refraction clinics in our polyclinics for further assessment and management. For children with "lazy eye" condition, early treatment can prevent the development of functional blindness. While we will press on with our preventive efforts, we recognise that bringing down myopia rates will not be easy. Thus far, we are not aware of any country that has succeeded in reducing its myopia prevalence rate. PUBLIC HOLIDAYS FALLING ON SATURDAYS (Replacement) 52. Assoc. Prof.”
“So far, 60,000 patients have benefited from the scheme. The statistics are summarised in Table 4 below. Table 4: Patients who have claimed from the Medisave for Chronic Disease Management Programme Disease Type Number (up to end April 2007) Diabetes(2) 47,035 Hypertension 11,635 Lipids disorder 1,020 Stroke 199 Total 59,889 (1) Refers to survey respondents who answered 'Yes' to the question "Have you ever been told by a doctor that you had a stroke?" (2) Patients who suffer from diabetes and one or more of the other three diseases are classified as diabetes patients. ACCOMMODATION FOR FOREIGN WORKERS (Guidelines) 7. Dr Fatimah Lateef asked the Minister for Manpower whether there are guidelines for (i) the accommodation of foreign workers in industries such as the construction industry; and (ii) the use of properties in residential areas for such accommodation.”
“Table 1: Estimated Number of Singaporeans with Diabetes, 2004 Age Group Total Chinese Malay Indian Total Male Female Total Male Female Total Male Female Total Male Female Total 273,300 137,100 136,200 191,600 90,400 101,200 41,400 22,300 19,100 40,200 24,400 15,800 18-39 17,000 8,500 8,500 8,100 4,700 3,400 4,400 1,900 2,500 4,500 1,900 2,600 40-59 120,300 68,100 52,200 80,400 46,100 34,300 20,000 11,300 8,700 19,800 10,700 9,100 60 & above 136,000 60,500 75,500 103,100 39,600 63,500 17,000 9,100 7,900 15,900 11,800 4,100 Source: National Health Survey 2004 Table 2: Estimated Number of Singaporeans with Hypertension, 2004 Age Group Total Chinese Malay Indian Total Male Female Total Male Female Total Male Female Total Male Female Total 613,700 344,800 268,900 507,800 287,000 220,800 67,500 35,200 32,300 38,400 22,600 15,800 18-39 74,000 57,600 16,400 55,700 43,500 12,200 10,400 7,700 2,700 7,900 6,400 1,500 40-59 287,800 171,600 116,200 237,100 146,700 90,400 32,400 14,900 17,500 18,300 10,000 8,300 60 & above 251,900 115,600 136,300 215,000 96,800 118,200 24,700 12,600 12,100 12,200 6,200 6,000 Source: National Health Survey 2004 Table 3: Estimated Number of Singaporeans with Stroke (self-reported)(1), 2004 Age Group Total Chinese Malay Indian Total Male Female Total Male Female Total Male Female Total Male Female Total 35,200 22,900 12,300 29,900 19,900 10,000 3,500 1,800 1,700 1,800 1,200 600 18-39 0 0 0 0 0 0 0 0 0 0 0 0 40-59 16,200 12,100 4,100 14,400 11,500 2,900 600 0 600 1,200 600 600 60 & above 19,000 10,800 8,200 15,500 8,400 7,100 2,900 1,800 1,100 600 600 0 Source: National Health Survey 2004 The Medisave for Chronic Disease Management Scheme was launched for diabetes in October 2006 and extended to hypertension, lipid disorder and stroke in January 2007.”
“We do not have precise figures and can only estimate the breakdown by age, gender and ethnicity of Singapore citizens who suffer from diabetes, hypertension and stroke based on the latest national health survey in 2004. The estimates are summarised in Tables 1-3 below.”
“The most recent profile study was done in 2004, which captured some income data. Based on this study, the profile of the Class C patients in acute hospitals is tabulated below: Breakdown by Per Capita Household Income Population Profile by Per Capita Household Income % of Class C Patients Lowest 20th Percentile 33% 20th - 40th Percentile 25% 40th - 60th Percentile 19% 60th - 80th Percentile 14% Highest 20th Percentile 9% For instance, 9% of Class C patients were from the top 20th income households, while 33% were from the lowest 20th income households. CHRONIC DISEASES (Figures) 6. Assoc. Prof. Kalyani K Mehta asked the Minister for Health (a) if he can provide a breakdown according to age, gender and ethnicity of Singapore residents and citizens suffering from (i) Diabetes type-1 and Diabetes type-2; (ii) Hypertension; and (iii) stroke or post-stroke; and (b) if he can provide statistics on the total numbers who have applied under the Chronic Disease Management scheme for each of the above diseases since its launch last year.”
“Mr Siew Kum Hong asked the Minister for Manpower (a) whether the Ministry has begun to collect statistics on the income of re-employed Professionals, Managers, Executives and Technicians compared to their previous income; (b) if it has not, whether the Ministry intends to do so and when; and (c) if the Ministry does not intend to do so, what is the reason for it, given that CPF records were used for the Ministry's recent paper "Retrenchment and Re-employment 2006" and can be used to derive this data for most income-earners.”
“Nursing homes are regulated under the Private Hospitals and Medical Clinics Act. The Act stipulates the minimum standards required of these nursing homes. These include the minimum qualifications of staff and the staff to patient ratios. For instance, we require all nursing homes to be supervised by registered nurses at all times. While a resident doctor is not a requirement, nursing homes must ensure that its patients receive prompt and appropriate medical care when needed. We also specify the minimum staff to patient ratios, based on the nursing care needs of the patients. This may be one care staff to eight patients for those with lower care needs or one care staff to two patients for those with greater needs. All nurses are regulated by the Singapore Nursing Board and they are encouraged to participate in continuing education to maintain and upgrade their professional competencies. Besides meeting the minimum staff to patient ratio, nursing homes must also ensure that their care staff have the necessary skills and knowledge to serve the types of patients admitted. Our key considerations are patient safety and quality of nursing care. The objective is to allow nursing homes to provide optimal care in a cost-effective manner. We will continue to review all regulations and guidelines to ensure that they remain relevant. RE-EMPLOYED PROFESSIONALS, MANAGERS, EXECUTIVES AND TECHNICIANS (Statistics on income) 41.”
“About 25,500 non-Muslim Singaporeans and Permanent Residents between the ages of 21 and 60 years are HOTA objectors. They make up 1% of potential HOTA population. While the opt-out rate is low, every objector is a potential loss of a donor and is therefore of some concern. But overall, I am grateful that the vast majority of Singaporeans support the HOTA legislation. We will continue with our public education programme to persuade Singaporeans to stay within HOTA. This includes the use of mass media, public lectures and direct correspondence with all Singaporeans who turn 21. NURSING HOMES FROM PRIVATE AND GOVERNMENT SECTORS (Review of guidelines and standards) 39. Dr Fatimah Lateef asked the Minister for Health whether there are plans to review the guidelines and standards of nursing homes from both the private and government sectors including areas such as employment of staff with different skills grade, patient to staff ratio and training requirements such as training in dementia care, in order to come up with a set of criteria which can be applied to all nursing homes.”
“The number of patients staying more than a week in our acute public hospitals has increased annually. In 2005, there were 48,376 such patients, and in 2006, 49,271 patients. This was an increase of 1.9%. The increase was expected as our population expands and ages. The increase was observed in all classes of wards, although it varied from 0.1% in Class C, 1.9% in Class B2, 7.0% in Class B1 to 8.1% in Class A. However, over a longer period, say between 2001 and 2006, while the overall increase was only +4%, the changes were much more varied among classes, at respectively +55% for Class C, -15% for Class B2, -31% for Class B1 and +19% for Class A. In other words, Class C accounted for the largest share of the expansion. WORKMEN'S COMPENSATION (Claims and violations) 31. Mdm Halimah Yacob asked the Minister for Manpower for the year 2006 (a) how many workmen's compensation claims did the Ministry receive and how long did it take to process the claims; (b) how many of these claims involved foreign workers; and (c) how many employers were prosecuted for violations of the Act.”
“This includes proper hand washing, covering the mouth and nose when coughing or sneezing; and not sharing soiled toys. Seek medical attention early if the child is unwell. And if the child is infected, please keep the child at home and away from other children. HOSPITAL ADMISSIONS (Trends in classes of wards) 30. Ms Jessica Tan Soon Neo asked the Minister for Health in the last two years (a) what is the trend in the volume of patients in the various classes of wards staying for more than one week; and (b) whether there is an increasing trend in any of these classes of wards and, if so, what are the profiles of the patients contributing to this increase.”
“Hand, Foot and Mouth disease (HFMD) is a common infection among young children. It is caused by over 60 types of viruses and the effects are usually mild. Only one particular virus, EV-71, can occasionally cause severe complications, including death. Up to 5th May, 6,004 HFMD cases have been notified so far this year. This is an increase of 4% over last year (5,746 cases). There is a seasonal pattern to HFMD outbreak. Not surprisingly, it peaks during the school terms and declines during the school holidays. The current outbreak is largely caused by the Coxsackie A16 virus. There was one case of EV-71 infection; fortunately the child did not have any complications. Almost all the affected children were treated as outpatients. Nevertheless, it causes much anxiety and inconvenience to the parents, besides adding to our patient load. We should try to minimise this infection. There are two main strategies to reduce the incidence of HFMD. First, we must break the chain of transmission by keeping the infected child away from other children. Parents should keep them at home and not bring them to schools or childcare centres. Second, we must maintain high standards of personal hygiene among our children. Parents should set personal good examples. My Ministry will continue to work with MCYS and MOE, to get all childcare, kindergarten and preschool operators to adopt sound public health measures, including early identification and isolation of sick children. Meanwhile, we have stepped up public education on HFMD. MCYS and MOE officers have also stepped up their health inspections of all preschools. All of us, as parents and caregivers, have an important role to play, by inculcating good hygiene habits in children.”
“Mdm Cynthia Phua asked the Minister for Health (a) whether the Ministry will consider providing non-air-conditioned Class B1 wards in public hospitals as many elderly patients are uncomfortable with air-conditioning and there is a shortage of beds in Class B2 and C wards; and (b) what is the Ministry's plan to solve the shortage of beds in Class B2 and C wards of our public hospitals.”
“Sir, for us in this business of healthcare, our instinct is always to save life and not to do harm. So I do not think doctors would be discharging patients before they are ready to be discharged. A lot of times, the pressure is on where we know we have done all we can for the patients in an acute hospital setting, and the patients can be competently handled in a community hospital or nursing home. That is where the discharge is all about, where we are worried about "abuse" - if I may use that word - of expensive acute hospital. When the acute episode is over and we have done what we can, say after surgery and the patient may need a few more days of recovery but can be adequately managed in a community hospital, our preference is to move that patient from a very expensive acute hospital - expensive both to the patient as well as to society at large - to a nursing home or community hospital. But, currently, the pricing sometimes skews the outcome, because they may find that SGH is so cheap and the consultants are there, even though they know they could be adequately handled, say, in Ang Mo Kio Community Hospital. But they say, "Please, can we stay one, two or three more days?" But each time we allow that, there are patients waiting in the emergency department, new patients with acute medical conditions, who can benefit from the use of that bed. That is the sort of trade-off which we have to do, and we hope patients will continue to be cooperative. But, I think if we price it rightly, they can be more readily cooperative. CLASS B2 AND C WARDS IN PUBLIC HOSPITALS (Shortage of beds) 10.”
“Sir, means testing is always a topic at the top of my head, and it will continue to be at the top of my head. But I have also many other urgent matters to attend to. So, in due course, we would address this issue. The concept is simple: those who can afford less ought to be subsidised more than those who can afford more. But translating it is not so simple. Over the weekend, I have read Mdm Halimah's comments on this issue and we will take those into consideration when I am ready to explore this subject in greater detail. But, meanwhile, I have still got many things to do - ElderShield reform, MediShield reform, etc. We will come to it in due course.”
“Sir, as I said, the plan is to add in incrementally because patient demand does not increase suddenly to 500 beds in a few years' time. It increased gradually, just as population ages gradually every day. So the rough projection of between 60 and 100 new beds per year should be adequate. And I think the plan that we have added this year and next year should be able to meet the demand. But let me make a word of caution here that for public hospitals, as I have explained in this House before, we try to run it on high occupancy because that is the only way to keep costs as low as it is feasible. The easiest thing is to keep on adding beds but demand will simply swell to meet up. By keeping beds a bit tight, it forces the administration to look out for areas of possible wastages, and eliminate them. If I may give a simple example of day surgery - I remember introducing day surgery in public hospitals over 20 years ago when I was running NUH. At that time, it was a new concept and habits had to change. So the take-up was slow. I am quite glad that more than 20 years later, today more surgeries are done as day surgeries than as inpatients. That is a dramatic achievement. But we have probably hit the maximum of what is possible for day surgeries. In recent months, we begin to study what other medical treatments which may not require surgeries but which can be done on an outpatient basis. And each time we push the frontier, if we can save X% of hospitalisation, then we save a lot of costs both for the patient as well as for the society. This is an important effort that we must continue to push on.”