Koh Poh Koon
Singapore
“In 2025, for walk-in patients, the median and 95th percentile doctor consultation waiting times were eight minutes and 72 minutes respectively. However, the Ministry of Health (MOH) does not track waiting times by peak versus off-peak hours, but it is likely that 95th percentile waiting times happened during peak hours.”
“The offences and penalties for importing, supplying or abusing SPS products are similar to those in the MDA, to ensure similar level of deterrence. Mr Speaker, with your permission, may I ask the Clerks to distribute a handout that summarises the changes in legislative penalties for key offences.”
“So, if you are a Singaporean student, you will expect that there will be some subsidies to the fees. The third question on how can the public, who may want to seek psychological care, know who is legitimate.”
“Sir, I thank the Member for his question on audiologists. In general, a qualified audiologist in Singapore needs a higher level of certification because a diploma level may not be quite enough to perform the task. So, we will look and see whether there is a way to actually find an in-between.”
“We are starting with registration to give formal recognition to those who are practising in higher risk sub-sectors in psychology and making sure that the quality, the standards and the support is given to them to deliver the care that the clients and the patients need.”
“It takes a bit of, not just system change in the providers, in the doctors and the care teams, but also, a gradual shift in the mindset of our population as well. So, it is something that we have to continue to do. There is no magic bullet to this and it is not something we can achieve overnight. 12.15 pm”
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“Sir, the law protects employees against dismissals without just cause or excuse. This covers situations in which a person is dismissed because he or she reported workplace discrimination. The Tripartite Guidelines on Fair Employment Practices (TGFEP) also require employers to treat all employees based on merit at all phases of employment. Hence, if an employee reported discrimination and is subsequently treated differently by their employer, they can approach TAFEP for advice and assistance. As previously announced, the Tripartite Committee on Workplace Fairness is examining the scope of possible legislation. The Committee will also examine the issue of protection for whistle-blowers. I hope we will give the Committee some time to deliberate on this and we will share more information when the deliberations are completed.”
“Sir, I thank the Member for his comments. Indeed, HR practitioners and employment agencies are areas of engagement that MOM would want to focus on because they form the link between the employers and the hiring practices of the companies. So, we will increase our engagement with these intermediaries such as HR practitioners.”
“Sir, I thank the Member for his idea to actually name and shame some of these employers who may have adopted discriminatory practices. Currently, firms that may have some degree of discriminatory practices may be put on a Fair Consideration Framework, or FCF, watch list. Firms that are on this watch list, technically, they have not flouted any rules yet but, perhaps, some of their practices may be veering on the grey margins. It is through putting them on the watch list that we use it as a way to engage the firms and signal to them that their practices have to be improved. In most instances, employers who are on this FCF watch list have been responsive to TAFEP's engagement efforts and expanded the employment of local employees. In this instance, such engagement is also an educational effort for companies or firms that may not be aware, upfront, of the nuancing of the guidelines on fair employment. I think we want to take a very educational approach because not every firm that may on prima facie seems to have infringed on some of the regulations, could be doing it in a very deliberate way. Sometimes, through these efforts, firms do change their practices for the better. Naming firms, sometimes, could also end up having a negative consequence because it would then frustrate their efforts to recruit and hire people. It may then have the negative consequence of impeding some of the business functions that these firms have as well. We would want to probably go on the more educational approach. As I said, for firms that, despite our efforts to engage them, refuse or have persisted in their discriminatory actions, we will take enforcement actions against them.”
“Sir, indeed, one approach that we want to emphasise is education of both employers and employees on what constitutes workplace discrimination. So, we will take the Member's suggestions and study how we can better do this at workplaces by actively correcting stereotypes and changing employers' mindsets through more promotional efforts.”
“Sir, the Ministry of Manpower (MOM) and the Tripartite Alliance for Fair and Progressive Employment Practices (TAFEP) takes a serious view of workplace discrimination, including the use of age or race as a selection criterion. Other than requiring employers to attend corrective workshops conducted by TAFEP, employers can be advised to rectify lapses in their HR processes. MOM will not hesitate to take enforcement actions against discriminatory employers such as curtailing their work pass privileges in more serious cases. We urge employee who experience any workplace discrimination to approach MOM or TAFEP for assistance.”
“Sir, I thank the Member for his two questions. Indeed, workplace injuries and the kind of compensation that gig workers may need to have are something that we will ask the committee to study further, relating to workplace injury compensation, for example. This is something which, today, under the Employment Act, other employees would have enjoyed. So, I think this is a serious issue, because these drivers do go around many places, sometimes many trips a day as well. They are constantly exposed to the risk on the road. Looking at how we can actually better protect them from workplace injuries and also compensation would be something that the committee would want to deliberate on. On the second question, of those cases of fatality as a result of gig work, whether they do enjoy the same level of compensation, I am afraid I do not have information for that. Suffice to say that, today, they are not treated as employees. So, I would imagine the amount of compensation, if there is, would not be commensurate with what employees would probably get under the Employment Act as well. So, again, these are issues that we will want to study further with the committee and in engagement with the platform companies as well, to see how they can also continue to function as a good employer, to be able to make their business sustainable, while ensuring a safer place but also attracting good workers to continue with them for the longer term.”
“Sir, I think these are important considerations and stressors that our workers face. I am sure the committee would take that feedback from the Member into account and deliberate on this, striking a good balance between maintaining flexibility of work while ensuring some degree of protection and stability for their longer-term needs, whether it is housing or retirement. The committee has not quite really begun its work, so, I do not want to prejudge their deliberations. But I think the Member's feedback will be useful. I do know that the Member is going to be on the committee. So, I hope she will bring this up as a point of discussion as well. We can deliberate on this further.”
“This is a concern as more people take up such work and some at a young age as well. To look into strengthening protections for platform workers, specifically delivery workers, private-hire car drivers and taxi drivers, and ensuring a more balanced relationship between platforms and platform workers, an Advisory Committee will be convened. The committee will need time to consult widely with stakeholders and study these issues carefully before making its recommendations. The points raised by Members will be shared with the Advisory Committee, so that they can take them into account when studying the issues.”
“Sir, I thank Members for their questions following the Prime Minister's announcement at the National Day Rally that MOM will be studying the issue of self-employed persons and their relationship with the platform companies. In 2020, about 190,000 persons were engaged in self-employment as their main source of income, of which about 79,000 worked with matching platform companies. Among such platform workers, about half are private-hire car drivers and one-third are taxi drivers. The rest are mostly car and light goods vehicle drivers who use delivery service platforms to obtain delivery work. From 2018 to 2020, the median monthly income of full-time employed residents in these three occupations ranged between $1,500 and $2,000. To Mr Melvin Yong's question on the number of injuries and fatalities suffered by food and goods delivery riders, the number of fatalities has remained low. In 2019 and 2020, there were two fatalities each year. In 2018, the first year we started tracking this, there were zero fatalities. We do not currently have data on traffic-related injuries suffered by these delivery riders. The work arrangements of platform workers can resemble those of employees. The platform companies set the price of their product, determine which jobs are assigned to which workers and manage how the workers perform, including imposing penalties and suspensions. Most platform workers earn a modest income, even before the impact of COVID-19, and may find it harder to afford housing, healthcare and retirement. Because their contracts with platform companies are not employment contracts, they do not have basic job protections that most employees enjoy, such as work injury compensation, union representation and employer CPF.”
“Mr Speaker, with your permission, I would like to take Question Nos 23 to 27 together, please.”
“Several Members asked about how the Tripartite Committee will gather and balance the views of different stakeholders. The Tripartite Committee comprises a diverse group of business, union, Government and HR practitioners. It intends to conduct wider consultations and engagements with these groups as well as the general public to ensure its deliberations and eventual recommendations are well-balanced. The Tripartite Committee aims to complete its work in the first half of 2022. The Government will then consider its recommendations and, if accepted, start work to prepare legislation. In the meantime, I would like to reiterate that TAFEP and MOM will ensure the Tripartite Guidelines continue to be practised and upheld. As fair and merit-based HR practices have already been promoted for so many years, even SMEs would be familiar with the requirements. TAFEP will continue to step up education and outreach, even as the Tripartite Committee continues its work.”
“For employers, curtailment of their work pass privileges, which has a significant impact on their overall business operations, can, in some cases, be disproportionate to the breach. Even if there is some mitigating factor, there are no alternative penalties that could provide for a more calibrated approach. Legislation will also send a strong signal that society does not condone discrimination at the workplace and further entrench the fair employment standards that we have built up over the years. The Tripartite Committee on Workplace Fairness has not completed its work yet. It will continue the next stage of its deliberations, to define the scope of future legislation and design a legal framework that is balanced and in the best interest of Singapore and Singaporeans. This includes looking into how we can avoid the unintended consequence of fostering a litigious workplace culture, something Mr Desmond Choo and Mr Sharael Taha are also concerned about. We should have a claims process where mediation is the first and necessary step, with appearances before the Tribunal as a last resort. This has worked well for the handling of salary-related and wrongful dismissal cases. To Mr Patrick Tay's question, in the case of unionised employees, the union is involved in the mediation process today. This is something the Tripartite Committee should also consider and study for the new claims process. Anxieties about workplace discrimination can also be driven by perceptions. Not every complaint means that the employer has done something wrong. The process must be fair to both the worker and the employer. By adopting an even-handed approach, we can avoid a situation where employers are deterred by excessive legal compliance to further expand their businesses.”
“Therefore, the process of mediation is, in itself, an opportunity for employers and employees to close the gaps in their understanding of the requirements. We will continue to maintain the strong emphasis on mediation even as we strengthen the legislation. Ms Yeo Wan Ling asked specifically about gender discrimination. Over the last three years, about one in seven reported cases each year fell into this category. Most related to employers specifying their preference for a particular gender in their recruitment advertisements. In about 30% of these cases, discrimination was substantiated after further investigation and the errant employers had their work pass privileges curtailed. The Tripartite Committee on Workplace Fairness, co-chaired by the Minister for Manpower Dr Tan See Leng, NTUC Secretary-General Mr Ng Chee Meng and Singapore National Employers Federation (SNEF) President Dr Robert Yap, convened last month and took stock of the progress made. We recognised the calls made by Members in this House previously, including Mr Patrick Tay, Mr Saktiandi Supaat and Mr Louis Ng, for the Tripartite Guidelines to be legislated. We concluded that legislation could be a helpful next step to take and updated the Prime Minister on our assessment. Mr Liang Eng Hwa asked how legislation will achieve better outcomes. Legislation builds on the progress made with our current approach. With legislation, we can broaden the range of remedies available. This can benefit both workers and employers. For workers, the remedies could give them direct redress, rather than indirectly through enforcement action against the employer. For example, such redress is available for wrongful dismissals today. Employees can claim for compensation or for reinstatement to their former employment.”
“Sir, Members have filed numerous questions on the topic of workplace fairness and I thank them for their interest in this very important topic. The tripartite partners' approach to enhancing workplace fairness has been a successful journey. Compared to the year 2006, when the Tripartite Alliance for Fair and Progressive Employment Practices (TAFEP) was first formed, the HR practices of firms have improved significantly. This was the right approach. Rather than rush to legislate, the tripartite partners recognised that education to cultivate the right workplace norms and values was the foremost and more fundamental task. We did not want the process to become legalistic or confrontational. It is better if disputes can be resolved amicably. Year by year, we have progressively stepped up our efforts, including coupling education with enforcement against discriminatory employers, thus advancing the cause of fair and merit-based HR practices. Today, we have a set of Tripartite Guidelines on Fair Employment Practices, which is familiar and well-accepted by employers and workers alike. The vast majority of employers comply with the Guidelines. If there is a complaint, TAFEP uses these Guidelines to evaluate and advise the parties concerned. About two-thirds of reported cases are not substantiated. The majority are misunderstandings which are clarified and where both parties do not pursue the matter further. Where TAFEP finds gaps in the employer's HR practices, TAFEP would counsel the employer. Most employers accept and make amends. Very rarely does the employer dispute the assessment and refuse to correct their actions. In cases where discrimination is substantiated, TAFEP would refer the employer to MOM, which can restrict it from hiring foreign workers.”
“Mr Speaker, Sir, with your permission, may I take Question Nos 17 to 22 together, please.”
“If we take a very legalistic approach and only wait to act when there is guidance given, then I think we may be behind the curve in trying to deal with workplace transmission. This is something that we hope that we will continue to be able to convince employers to do so. And if any employee feels that they are unfairly victimised or unfairly treated or discriminated as a result of their need to care for their child or their family, do highlight to MOM or the Tripartite Alliance for Fair and Progressive Employment Practices and we will take a look and engage the employer accordingly.”
“Sir, I thank the Member for highlighting some of the practical challenges that working parents face, especially in the situation of the pandemic where some childcare centres may have to be affected and the child may have to be kept at home as a result of some clusters that may have developed in the childcare centres. I must say that in the international space, at least as of this moment, not many countries that I know of would have introduced any additional leave or parental leave entitlement as a result of the pandemic. More often than not, there is a dependence more on flexible work arrangements because the situation evolves rapidly and also, different work arrangements may already be possible. We must bear in mind that in the background, as of this point in time, about 93% of employers already have adopted some form of flexible work arrangements as a way to ensure business continuity, as part of the pandemic preparedness response. In the context of many employers already having some form of flexible work arrangements, it really is about having that thinking to work together to get past this particular hurdle. It is also in the employers' interests to make sure that any employee who may have a family member, even if it is a child, who may be at risk of transmitting or be in contact with a COVID-19 case, to also keep the employee away from work to make sure that he or she does not bring any potential infection into the workplace. And that is part of business continuity planning as well. So, I do urge employers to adopt that flexible attitude to be enlightened, as the Member has said, that this is really a hump that we all got to get through together.”
“Sir, we recognise that working parents may have additional challenges when childcare centres or schools have to close temporarily due to links to COVID-19 cases. Today, each working parent of a Singaporean child is eligible for up to six days of paid childcare leave if their child is under the age of seven years, or two days of paid extended childcare leave if their child is between seven and 12 years old. In addition, almost half of all employees in Singapore have more than 14 days of annual leave. Parents may wish to tap on these leave entitlements to cope with closures. Any enhancements to leave, even if time-limited, will need to take into account the manpower and operational needs of the employers. A more sustainable way to support parents would be through providing more flexible work arrangements. Together with our tripartite partners, we have introduced Tripartite Standards on Flexible Work Arrangements, on Work-Life Harmony and on Unpaid Leave for Unexpected Care Needs, to encourage and guide employers in creating a work environment that helps parents manage their work and family responsibilities. In the past year, more employers have also adopted flexible work arrangements such as flexible hours or remote work. These go a long way in helping parents and we encourage more employers to do so.”
“Sir, I thank the Member for his question. I think it is quite clear that we all desire to make sure that we help the vulnerable amongst us, whether it is a person on kidney dialysis or a person with physical disability, to continue to remain in the workforce. But I think we do understand that there are very diverse workplace arrangements and different job roles and requirements . Legislating a requirement like this would probably be challenging to implement because different businesses and operating models may have different needs. What we should do though is to continue to engage with our employers through the Singapore National Employers Federation as well as our Labour Movement, to continue that conversation and helping employers to look at redesigning their jobs, so that more people with disability, or even those who need flexible arrangement for dialysis treatment, can continue to be meaningfully engaged and contribute to the workforce and also to the companies' operations as well. This is an ongoing effort. We will continue to engage our stakeholders.”
“Sir, I think going upstream to prevent consequences of disease is something that we do in a very broad-based manner at MOH. I think if the Member remembers, we do have a War on Diabetes and the Diabetic Task Force has been formed a couple of years back, at least to really look at comprehensively engaging people through lifestyle changes, through exercise, through stakeholders in the community as well as in the medical fraternity, to make sure we target the management and treatment of diabetes to prevent the downstream consequences of renal impairment and kidney failure. So, engaging employers and employees at the workplace to continue to adopt healthy lifestyle is part of the work of educating the public and we will continue to do so through many of our partners and stakeholders as well as through the Labour Movement.”
“Employees who feel that they have encountered workplace discrimination should lodge a complaint with TAFEP.”
“Sir, the tripartite partners support all employees, including those requiring dialysis treatment, to enter and remain in the workforce while managing their personal responsibilities and circumstances. We do so by promoting the adoption of flexible work arrangements (FWAs) and work-life strategies as well as ensuring that such employees are not discriminated against at the workplace. In 2020, 93% of firms offered some form of formal or ad hoc FWAs to employees. To further entrench the implementation of such work arrangements, the Tripartite Alliance for Fair and Progressive Employment Practices (TAFEP) actively promotes the Tripartite Standard on FWAs to companies through its publicity campaigns, briefings to members of trade associations and chambers (TACs) and also, conduct workshops. Progressive employers who adopt this Standard are required to inform their employees of the types of FWAs available, such as "flexi-time" and "flexi-load" which allow employees, including those with medical conditions, to vary their working hours and job functions to manage their work and personal responsibilities. To ensure greater success in the implementation of FWAs, employees are also encouraged to proactively engage their supervisors on their personal responsibilities and circumstances. This allows employers and employees to discuss and explore varied FWAs that meet employers' business needs while enabling employees to manage their personal responsibilities. Employees requiring dialysis treatment, or having any other medical conditions, are protected against discrimination through the Tripartite Guidelines on Fair Employment Practices (TGFEP) which is based on the principles of fair and merit-based employment practices at the workplace.”
“Sir, MOH does have regular touchpoints with partners and stakeholders in the care sector and also within the engagement platforms with many focus groups, residents through our grassroots networks and all. I am not sure the Member's suggestion of doing a regular survey itself would achieve the intended purpose because caregiving can be quite different, where there are different needs for different segments. I think it is more important to be targeted in terms of reaching out to those who have direct nexus with caregiving and curate some of those insights in a more focused and deep way where it makes it easier for us to implement some of these measures in a more meaningful way, rather than do a broad survey that gathers broad insights, which may not exactly be applied to each different care setting. But we will continue to engage different partners and stakeholders to gain the insights as suggested by the Member.”
“Following the national Survey on Informal Caregiving in 2012, the Government continues to monitor the evolving trends of caregiving through research studies, such as the Retirement and Health Study by the Central Provident Fund Board and partner agencies, the Quality of Life of Caregivers study by the National Council of Social Service, and findings from social service agencies and other institutions such as Duke-NUS' Centre for Ageing Research and Education. We also conduct regular engagements with partners and stakeholders. In 2018, the Ministry of Health (MOH) consulted over 200 caregivers, service providers, stakeholders and grassroots leaders on the needs of caregivers. Following this, MOH launched the Caregiver Support Action Plan in 2019 to address caregiving needs in the community. We will continue to collect insights from studies and engage caregiving platforms to review the senior caregiving support landscape as they evolve.”
“So, we should devote a lot more resources in helping them to be able to be cared for close to their families, especially in areas like home nursing and home care.”
“Sir, the case that the Member has described, I would think it is rather unusual for a wait to extend to so many years. So, perhaps, if there are special circumstances and situations that he might want to highlight, he can actually send the information to us, we can take a look. It would be quite unusual for someone to have to wait years just to get into a nursing home. That is not my experience working in the hospitals as well, so I think that is quite unusual. While the number of nursing homes may have increased somewhat, the key is not about the number of nursing homes but the number of beds available. Each nursing home can come in different sizes, so just because the increase in the number of homes may not be exponential does not mean that the number of beds available is not increasing significantly. But what we want to do is to make sure that we do not entrench our elderly in institutions as they age. It is more important to make sure that they age in place and also, have good health to be able to carry on a meaningful life in their golden years. So, it is important to make sure that the intervention is about keeping them healthy, making sure that if they do have care needs, try and localise them within the community, so that they do have a social support network around them to promote emotional, physical well-being as well, such as keeping active and having engagements, rather than think about institutionalising them in nursing homes. That, in my mind, as a doctor, should be the very last resort for our elderly to be in. If you speak to enough elderly, that is one of the things they fear a lot as well, to be kept in a home, away from their family.”
“Annual statistics on nursing homes are published by the Ministry of Health (MOH) on its website. The number of nursing homes has increased from 69 in 2016 to 77 in 2020, comprising 24 public, 22 not-for-profit and 31 private nursing homes in 2020. The number of licensed nursing home beds has also increased from around 13,000 to 16,300 in the same time period, where there were 6,400 public, 6,000 not-for-profit and 3,900 private nursing home beds in 2020. The number of available beds differs based on operational considerations. Bed occupancy rate has generally remained stable over the past five years at around 90%.”
“Sir, I thank the Member for raising this clarification. I think what he has described are genuine real challenges on the ground. Not every job description or job role is amenable to full flexible work arrangements because it depends on the roles the person has to perform and also the nature of the work. Indeed, many outsourced workers undertake work that could present challenges for their employers to implement flexible work arrangements. These include shift workers, workers in frontline or client-facing roles, such as cleaners, manufacturing operators and service workers. It is quite a challenge to do flexible work arrangements when the worker is required to man a production line, for example. But having said that, there is a tripartite effort to encourage outsourced companies to do a lot more flexible work arrangements where possible. There is also an Alliance for Action on Work Life Harmony, which is a good example of how the partners can come together to look at ways in which they can encourage, not just companies, but also workers, to adopt new skills, so that there is a lot more upgrading and redesign of the jobs. Ultimately, it is about working together, seeing how we can transform the job into something that is, perhaps, much more automated and productive, and this makes it open to possibilities of flexible work arrangements through the use of technology. I hope that is something that employers, workers and unions can work together on, to make it possible for all job roles to eventually explore some degree of flexible work arrangements.”
“Sir, the Work-Life Grant was introduced in July 2013 to incentivise companies to enhance and sustain the provision of flexible work arrangements (FWAs) for their employees. Contractors that performed outsourced work for their clients could apply for the Work-Life Grant. Since the start of the COVID-19 pandemic, many forms of FWAs, such as telecommuting and staggered working hours, have become more common. With FWAs becoming increasingly prevalent, the Work-Life Grant was ceased in August 2020. FWAs enable employees to continue working while meeting their personal and family needs, and are especially important for those who have to take care of young children or elderly family members at home. Employers that provide the option of FWAs are more likely to attract and retain talent in the long run. That must be the biggest incentive for employers to extend FWAs to their employees.”
“I would like to thank Miss Cheryl Chan for calling on both the community and the Government and even the pharmaceutical companies to provide stronger support towards patients with rare diseases. I would like to reiterate the Government’s commitment towards supporting these patients with rare diseases. I encourage everyone to donate generously, so that more can benefit from the RDF. [(proc text) Question put, and agreed to. (proc text)] [(proc text) Resolved, "That Parliament do now adjourn." (proc text)] Adjourned accordingly at 7.41 pm.”
“Miss Cheryl Chan also suggested going beyond the RDF and leveraging more on insurance. I note that Miss Cheryl Chan is familiar with the practice among private insurers of not covering pre-existing illnesses. Where coverage of pre-existing illnesses is provided, it comes with the loading of the insurance premium, which can be significant. The benefits and premiums of private insurance products, such as Integrated Shield Plans (IPs), are determined by insurers, based on their own commercial and actuarial considerations. In doing so, insurers have to strike a balance between providing more comprehensive coverage and ensuring the affordability of premiums, as well as the sustainability of their insurance fund. As private insurance is optional, the insurers also need to guard against adverse selection that can affect sustainability. Miss Cheryl Chan may, however, be pleased to know that some insurance products, such as IPs, do not set exclusions for rare diseases, unless these are pre-existing conditions. In addition, our universal national medical insurance, MediShield Life, covers all Singaporeans from birth, with no disease exclusions, including all rare diseases, subject to the relevant claims limit. Where there are claims limits to payouts such that there remains an out-of-pocket payment for the patient, the RDF would consider an application to support this remaining out-of-pocket payment. In conclusion, establishing the RDF was but a first step in assisting patients with rare diseases. The task remains ahead of us, as a community, to muster all the necessary resources and assistance that we all agree are needed for this group of fellow Singaporeans.”
“It also stands ready to collaborate with organisations to help raise funds for the RDF, as it has done so on a few occasions in the past. It is also exploring how it can develop a base of supporters who can reach out to their networks to fundraise. The RDF Committee will appreciate all the help that it can get. If Members of this House would like to help raise funds for the RDF, please let me know and I will gladly put you in touch with the RDF Committee. Let me now turn to a few other proposals made in Miss Cheryl Chan’s speech. First, Miss Cheryl Chan proposed to include two specific rare diseases: neuroblastoma and Krabbe Disease. Neuroblastoma is a form of cancer. Treatments for cancer, including neuroblastoma, are not covered under the RDF as mainstream financing is available through MediShield Life currently. Those who need further assistance can apply for MediFund. As for Krabbe Disease, there are, unfortunately, no treatments available to slow disease progression today, with most patients succumbing by age two. The current available medicines are for palliative and supportive care only, which would not fulfil the inclusion criteria for RDF of being able to substantially extend a patient’s lifespan. Patients who require additional assistance for palliative care are already supported via mainstream financing schemes, such as subsidies and our 3M of MediSave, MediShield Life and MediFund. I would like to assure Miss Cheryl Chan that the RDF Committee is well advised by the Rare Disease Expert Group on the rare disease drugs that should be prioritised for coverage. Currently, the RDF Committee has a pipeline of five other medicines for three more rare diseases that stand ready to be added to the RDF list once sufficient funds are raised.”
“We have to cater for these increases with age when we decide how many patients the RDF can sustain, in order that the supported patients can be assured that they can continue to afford their medications once they are started on treatment. The reality is that this is a large sum for a very small number of patients. But that is how expensive rare diseases medicine costs and why we need all of us – the Government, the community – to work together to help this group. Without more donations, it will be very difficult for the RDF to list more medicines or to support new patients. This, therefore, brings me to the crux of what will allow RDF to help more patients with rare diseases – raising more donations. Miss Cheryl Chan has also recognised this in her speech. It is not easy raising funds for patients with rare diseases. It was in recognition of this difficulty that the Government decided to match donations $3-to-$1, so that every donation dollar is stretched further and also to help encourage donors to come forward. In addition, all donations to the RDF are also eligible for a generous level of tax deduction at 250% and the Government also funds all administrative costs of the RDF so that donors are assured that every single cent of their donation goes to the patients. This also applies to all donations made by corporations and family offices. Fully aware of the importance of raising more funds, the RDF Committee, together with its secretariat at KK Hospital, is doubling up their efforts to raise funds. It has and will continue to approach high networth individuals, foundations as well as corporate sponsors, as suggested by Miss Cheryl Chan.”
“However, the majority of these patients have conditions where no treatments are available to correct the genetic deficiency and life expectancy may be limited with poor quality of life; or where treatments were relatively low cost and, hence, can already be supported under current funding sources. We had, therefore, anticipated there could be up to 15 medicines that needed RDF support, based on experiences of equivalent rare disease funds from overseas. In two years, we have covered six medicines. We need to do more, but it is tangible progress in a short time of two years. I would like to thank the RDF Committee for what has been achieved and for the work that is to come to bring support to more patients. Third, Miss Cheryl Chan also proposed to list more rare diseases and medicines on the RDF. We should only do so if the rare diseases have effective treatments that can meaningfully extend the life expectancy. But adding more medicines does not, in itself, enable more patients to be helped, especially if the RDF does not have sufficient funds to support more patients for the entire lifetime of their treatment costs. In the last financial year alone, the RDF made grant payouts of around $1 million. Many of the beneficiaries are children. They will grow and increase in body weight, which means that the medication dosage required, along with the cost of treatment, will go up commensurately. For example, in this financial year, RDF is projecting to make grant payouts of around $1.5 million, which is 50% more than the last financial year for the same group of patients. In the coming years, the annual sum in grant payouts required would increase significantly just to support these same patients.”
“Because these treatments tend to be lifelong, the RDF is structured as an endowment fund to ensure that only the interest income generated is used to fund the treatment and the capital sum continues to generate a sustainable stream of income to ensure patients enrolled into the programme will have assured support. While welcoming the set-up of the RDF, Miss Cheryl Chan has highlighted that the number of patients, conditions and medicines covered by the RDF is low, potentially leaving some rare diseases patients unassisted. Let me, first, clarify three common misconceptions. First, this is not a situation in which eligible patients are not applying for the RDF due to a lack of awareness. In fact, as the costs are high, patients with rare diseases, generally, seek care in the public sector. We can, therefore, easily identify patients with rare diseases covered by the RDF and invite those who require financial assistance to apply. Furthermore, many of the public sector specialists who treat genetic disorders are on the expert panel that advises the RDF Committee on the rare disease medicines that should be considered for coverage by the RDF. Some patients with rare diseases have insurance coverage or alternative financial means and need not apply for RDF grants. For those who are in financial need, medical social workers in the public healthcare institution and the patient’s specialist will assist the patient to apply for RDF assistance. Second, when we first set up the RDF, it was established that there were up to 2,000 patients with rare diseases in Singapore.”
“Mr Deputy Speaker, Sir, having a child born with a rare disease can be a life-changing event for an entire family. In addition to the suffering that the child goes through, it also creates a lot of emotional distress, uncertainties and anxieties for the parents and can impose greater financial as well as physical demands in caring for the needs of the child. The high cost of treatment adds to the overall burden. As a doctor, I have walked this difficult journey with many patients and their families before, especially when they had an unexpected diagnosis being revealed to them. So, I would like to thank Miss Cheryl Chan for her passionate speech and proposals relating to the Rare Disease Fund (RDF) in support of these families. The Government shares her concern for individuals with rare diseases where medication is very costly and required for life. This was why, in 2019, the Government provided a generous matching of $3 for every $1 of public donation to establish the RDF as a charity fund to support Singapore Citizens diagnosed with rare genetic diseases. The RDF supports high-cost, life-saving treatments for very rare genetic conditions where the medicines, firstly, have a proven therapeutic efficacy; secondly, are able to substantially extend a patient's lifespan and maintain a quality of life as a direct consequence of its use and; thirdly, be reasonably priced as when compared to its price in other countries. Rare diseases with onset in childhood are prioritised initially as these patients with conditions, such as rare diseases, can often go on to lead full and meaningful lives if they are diagnosed early in the course of their disease and receive the required treatment promptly.”
“(proc text)] [(proc text) Bill accordingly read a Second time and committed to a Committee of the whole House. (proc text)] [(proc text) The House immediately resolved itself into a Committee on the Bill. – [Dr Koh Poh Koon]. (proc text)] [(proc text) Bill considered in Committee; reported without amendment; read a Third time and passed. (proc text)]”
“Sir, I thank the Member for her questions. On the review for the DRA Schedule, yes, I think we can review it periodically. But I think that the key is in the fact that dentistry is more of a practice where you actually do things with your hands, whereas the ranking of dental schools is not necessarily in conjunction with the quality of the practice of the person but more so depending on citations, research outputs, which does not necessarily translate into actual dental practice. So, the reputation of the school itself could well be more biased towards academia and research. What we want to do then is to put in place a qualifying examination where we can ascertain the actual quality, in terms of competency, skills and ability to perform a procedure, for example, of a foreign-trained graduate. So, that leads me to the Member's second question, which is, when will SDC be the one that takes a case-by-case approach. In fact, actually, if the graduates are from the Schedule list after this amendment and they can secure employment, they will all, automatically, be eligible for the qualifying examination, the difference being, if you are a Singaporean/PR, you can take it many times. But if you are a non-Singapore/PR, you may only take it with a cap of two times within a 12-month period. For those that SDC needs to make a decision, those are graduates who are not within the list itself, that means, if you take a degree that is outside the Schedule list, then you will need to have SDC look upon your application on a case-by-case basis, before the person can be allowed to take the qualifying examination. I hope that clarifies the Member's questions. [(proc text) Question put, and agreed to.”
“And in the context of our local practice, we also have upstream basic care given to students in the schools. So, it is to be seen in the context of a holistic dental care ecosystem and not just at the primary care level, when the person has become an adult. MOH monitors and reviews primary care dental capacity provided by private CHAS dental clinics and public polyclinics, both of which provide subsidised dental services. There are, currently, over 800 CHAS dental clinics islandwide. Pioneer Generation, Merdeka Generation, as well as Community Health Assist Scheme (CHAS) Blue and Orange card holders, enjoy subsidies for selected basic dental services at private CHAS dental clinics. Singaporeans can also look forward to dental services in the upcoming polyclinics, such as Bukit Panjang and Eunos Polyclinic, which are scheduled to open this year. Sir, I would like to assure Singaporeans that MOH will ensure that dental care will remain accessible, affordable and of good quality by competent dentists. Mr Deputy Speaker, I would like to express my gratitude to the Members who have spoken on this Bill. Their questions and comments have provided valuable insight on the areas that we should focus on when implementing these measures. I am heartened at their support. I should reiterate that, as I have mentioned in my speech earlier, for these proposed measures to ensure the continued quality of foreign-trained dentists seeking to practise in Singapore, we will need the support of the dental community to help implement and operationalise these amendments. I am confident that these amendments will go a long way to ensure the continued high quality of foreign-trained dentists to complement our dental workforce in Singapore.”
“And as Dr Shahira Abdullah has pointed out, the QE is, in fact, present in many overseas jurisdictions and, with these amendments, Singapore would be in alignment with the rest of the world. Additionally, SDC has reviewed the international rankings of the 89 universities in the DRA Schedule. Most of the top-ranked schools in the latest international rankings, which are primarily based on academic/employer reputation and research citations, are not in the DRA Schedule. Together with the variation in dental practices and training across overseas universities, international rankings would, therefore, be less relevant for the purpose of removing universities that may not produce foreign dental graduates on par with local graduates. Given that the majority of our foreign-trained dentists have graduated from a selected number of foreign dental schools, SDC will curate a more concise list of recognised basic dental qualifications to ensure the relevance of the Schedule. We will remove 27 schools that SDC has not received any registration over the past 12 years. The list of overseas dental schools and universities in the Schedule will be reduced from the current 89 to 62. SDC will make available the revised Schedule by end 2021. Sir, I would like to conclude by addressing Mr Ang Wei Neng's query on making dental services affordable, especially for our ageing population. I must clarify that, in contrast to what Mr Ang Wei Neng has said earlier, MOH actually has no guidance for a twice-a-year visit to a dentist. In fact, we are already moving to a risk-based approach, which is what is practised in the UK as well. For example, those who are deemed to have low dental risks actually may only need to see the dentist once every two years. So, this is more of a risk-based approach.”
“But I want to reassure Members that there will be a transition period of seven years whereby foreign-trained dentists will still be able to apply for conditional registration under the existing regime under the current DRA, as the implementation of the qualifying examination is intended to only be effective from 1 January 2029. This means that students who are currently enrolled in or have secured places in dentistry courses overseas and will graduate before 1 January 2029, as well as foreign-trained dental graduates who already hold basic dental qualifications from universities on the DRA Schedule will not be affected by this change and will be considered for conditional registration to practise dentistry in Singapore if they fulfil the requirements under the current DRA. Mr Yip Hong Weng has asked for clarification on why the Ministry does not just refine the current DRA Schedule by removing universities that do not produce graduates on par with local graduates, instead of imposing this qualifying examination. In relation to the DRA Schedule, the SDC has reviewed local and overseas practices to assess the clinical competence and eligibility of a dentist for registration. Jurisdictions, such as Canada, Hong Kong SAR and Thailand have adopted a national examination regime for foreign-trained dentists. Countries, such as Norway and Germany, use a Schedule of schools with exemptions on a case-by-case basis for non-citizens. Countries, such as Denmark, Ireland, Sweden, United Kingdom, United States of America, Australia and New Zealand have adopted a hybrid of Schedule and national examination, based on citizenship, location of dental training or licence.”
“For foreign-trained dentists, irrespective of nationality, who pursue dental qualifications not found in the DRA Schedule and wish to practise in Singapore, SDC will review their applications on a case-by-case basis and allow dentists of good repute who meet the requirements to take the qualifying examination to assess their competency to practise in the local context. Dr Shahira Abdullah asked how SDC assesses the eligibility of foreign-trained dentists who do not hold a Singapore degree or a degree from a university specified in the DRA Schedule, to sit for the qualifying examination. As stated in the DRA, this is left to SDC's discretion. SDC has, generally, allowed foreign-trained dentists to take the qualifying examination so long as the university from which they attained their basic dental degree is recognised by the respective dental regulatory body of the country. The teaching medium is in English, failing which, the dentist must take and pass an English Language proficiency test. And thirdly, if they meet other requirements, like having an offer of employment and whether the foreign-trained dentist has a connection to Singapore, such as being a Singaporean/Permanent Resident (PR) or married to a Singaporean/PR or children of PRs, for example, as published on SDC's website. Mr Yip Hon Weng was concerned about the timeline for the implementation of the qualifying examination requirement as this may affect existing overseas Singaporean dentistry students. I think it is a fair concern.”
“The qualifying examination, which is administered by the NUS Faculty of Dentistry, is benchmarked to the final-year professional dental examination that locally-trained dentists are required to pass before they can obtain their Bachelor of Dental Surgery degree from NUS. As such, the qualifying examination should be required for foreign-trained dentists applying for conditional registration, irrespective of their nationality. I turn now to address Dr Shahira Abdullah's and Mr Louis Ng's queries on the number of attempts allowed for the qualifying examination. To recap, the qualifying examination comprises three parts and the candidates will be provided with the qualifying examination syllabus and related preparatory materials. For foreign-trained Singapore Citizens and Permanent Residents who pursue dental qualifications found in the DRA Schedule and wish to practise in Singapore, there will be no cap on the number of attempts to pass each part of the qualifying examination. For other foreign-trained dentists who pursue dental qualifications found in the DRA Schedule and who wish to practise in Singapore, there will be a cap of two attempts to pass each part of the QE, with each second attempt having to be within 12 months of the first attempt. This has been the practice currently and there will be no change to this. Historically, in the final Bachelor of Dental Surgery degree examination here in NUS, over 90% of local students passed on their first attempt and close to 100% passed by the second attempt. Hence, a two-attempt cap for non-residents, which is the current practice, is a reasonable benchmark for ensuring the standards of those taking the qualifying examination is on par with our local graduates.”
“We project an increase to one visit to the dentist per capita per year by 2030 and, with that, we will require a ratio of one dentist to 2,200 population by 2030. The annual intake into the NUS Faculty of Dentistry has increased by 36% from 44 in 2008, to 60 in 2018. Based on our service planning parameters, with the increased dental student intake of 80 this year, we expect to be on track to reach a target dentist-to-population ratio of one to 2,200 by 2030. And we will, of course, continue to look at the evolving needs and to adjust the NUS Faculty intake where necessary. As pointed out by Mr Yip Hon Weng, it is important to have competent and well-trained dentists in Singapore. I could not agree more. All of us who ever see a dentist will want the dentist to be competent. Currently, foreign-trained dentists who have graduated from the universities on the DRA Schedule can apply to register to practise in Singapore, if they fulfil the requirement to secure employment with a dental clinic or a healthcare institution, which is largely driven by market forces. This employment requirement will still be applicable when the new measures come into force. Given the high degree of variability in overseas clinical practices and the dental curriculum of overseas universities, based either on the DRA Schedule or otherwise, the qualifying examination is, therefore, an important assessment to determine the clinical skills and competencies of a dentist, which are fundamental to the practice of dentistry and thus would ensure that the quality and competencies of foreign-trained dental graduates who are eligible to register and practise in Singapore remain high.”
“Mr Deputy Speaker, Sir, I thank the Members who have spoken for their support of this Bill. I will address the queries that they have raised in their speeches. In my opening speech, I outlined the need for a steady supply of dentists each year to meet the expected demand for dental services by Singaporeans. Mr Yip Hon Weng expressed concern that we need to increase our number of dentists in Singapore. Singapore, indeed, has a lower ratio of dental professionals per capita, as compared to the Organisation for Economic Co-operation and Development (OECD) countries. Hence, the DRA Schedule was revised comprehensively in 2008 to allow for the registration of a wider range of foreign dental qualifications. The dental workforce has experienced a 3% to 5% year-on-year growth since then. Let me now come to the issue of the present status of the dental workforce raised by Mr Ang Wei Neng, Mr Louis Ng and Mr Yip Hon Weng. To ensure adequate supply and continuity of dental care for Singaporeans, we have also increased our dental training pipeline to meet the growing dental care needs of our ageing population and to ensure a target ratio of one dentist to 2,200 people or 0.45 dentist per1,000 population by 2030. The student intake into the NUS Faculty of Dentistry has, historically, been derived based on targeted dentist-to-population ratios. Predicting how many dentists we will need in the future is actually not a very easy task. There are factors to consider, including population demographics that evolves over time, the different dental awareness amongst the population and also the health-seeking behaviour of our people. Singapore currently, has 0.84 visits to the dentist per capita per year. This is low, compared to the average of 1.3 in the OECD nations.”
“Once passed, the Ministry of Health (MOH) and SDC will work closely with the dental community and other stakeholders to implement and operationalise these requirements. At present, the introduction of the requirement for the qualifying examination is planned for 1 January 2029. In the coming months, SDC will engage dental students who will be affected by these changes, to ensure that they understand the new requirements and to address any concerns that they may have. I seek Members’ support for this Bill. Mr Deputy Speaker, I beg to move. [(proc text) Question proposed. (proc text)]”
“As mentioned earlier, foreign dental graduates who have a degree listed in the DRA Schedule will automatically be eligible to take the qualifying examination, unlike the foreign graduates with degrees not listed in the Schedule. Alongside these amendments introduced by the Bill, we will be revising the Schedule to ensure that the list continues to reflect degrees in dentistry from foreign universities that give their holders this automatic eligibility to take the qualifying examination. The last revision of the Schedule was in 2008 and a review is timely to ensure the continued quality of foreign-trained dental graduates who practise as dentists in Singapore. This revision will be done by way of subsidiary legislation and is actually not part of the Bill per se. But I have highlighted this as it complements the introduction of the mandatory qualifying examination that foreign-trained dental graduates must pass to be eligible for conditional registration. There will be a transitional period after the revision of the Schedule, where qualifications in the current Schedule will continue to be recognised and, their holders, as well as students who are already enrolled or have secured places in courses leading to such qualifications, may apply for conditional registration under the DRA. The Bill also makes a number of miscellaneous amendments, which are to provide for payment of penalties and composition sums into the Consolidated Fund, as well as for better administration of the Act. Mr Deputy Speaker, this Bill will ensure the continued quality of foreign-trained dental graduates and that their clinical skills and competencies are aligned with those of locally trained dental graduates, so that they can effectively meet the dental needs of our population.”
“This new requirement of a qualifying examination will also ensure that foreign dental graduates are familiar with the requirements for clinical practice here in Singapore. For example, the local dental curriculum has, in recent times, sharpened its focus on core clinical general dentistry skills and more emphasis has been placed on geriatric dentistry, considering the trends in Singapore’s demographics. Under the current DRA, any foreign dental graduate with a degree listed in the Schedule is entitled to be registered as a dentist with conditional registration, if he has secured employment with a local dental practice. With the proposed amendment, the qualifying examination will be applicable to graduates with degrees listed in the Schedule as well. To be clear, there is no change to the regime for dental graduates with a Singapore degree. They continue to be eligible to apply for full registration directly. There is no requirement of a qualifying examination for locally trained dental graduates. I now move on to the second measure which we will be implementing to ensure the continued quality of foreign-trained dental graduates who practise in Singapore. This will be a revision of the DRA Schedule, which contains the list of foreign degrees in dentistry that are recognised by the Singapore Dental Council (SDC) for the purposes of conditional registration. This list is curated based on a review of dentistry degrees from foreign universities which the SDC deems prima facie to meet the standards for practice in Singapore, subject to the individual dental graduate’s proof of his skills, knowledge and competencies through the qualifying examination.”
“This qualifying examination, which is currently already taken by foreign-trained dental graduates who do not have dentistry degrees in the Schedule, is administered by the National University of Singapore (NUS) Faculty of Dentistry and overseen by SDC. It assesses a dental graduate’s clinical knowledge and procedural skills which are fundamental to the practice of dentistry. This is similar in scope and benchmarked to the standards of the final-year examination of the NUS Faculty of Dentistry. Section 14A, when amended, will make it a requirement for foreign dental graduates, regardless of whether their qualifications are contained in the DRA Schedule, to pass a qualifying examination to be eligible for conditional registration. Foreign graduates who have a degree in dentistry listed in the DRA Schedule will automatically be eligible to take the qualifying examination. Those not listed in the DRA Schedule are not automatically eligible to take the qualifying examination, but the SDC may permit them to do so on a case-by-case basis if the circumstances set out in section 14A(2) apply. The treatment of foreign graduates with degrees in dentistry not listed in the DRA Schedule will not be so different from that under the current DRA in that they already have to pass an examination to be eligible for conditional registration. This amendment will ensure that the competency standards of foreign dental graduates who are granted conditional registration in Singapore, whether or not their degrees are listed in the DRA Schedule, are aligned with those of dental graduates who have a Singapore degree, which means someone who has obtained a degree in dentistry from NUS.”
“The second measure, which I will touch on briefly later, will be affected by way of subsidiary legislation. Under the current DRA, dental graduates from foreign universities looking to practise in Singapore will, typically, have to apply for conditional registration first. This means that they have to complete a period of supervised work, usually around two years, and be assessed to be competent, before they can apply to be fully registered dentists. For the purposes of an application for conditional registration, the SDC recognises dental degrees from universities in Australia, Canada, the Hong Kong Special Administrative Region, New Zealand, the Republic of Ireland, the United Kingdom and the United States of America, which are listed in the Schedule of the DRA. If an applicant has a degree in dentistry from a foreign university listed in the Schedule and also meets the other prevailing criteria for conditional registration, the SDC may grant the applicant conditional registration. These criteria do not currently include a requirement to pass a qualifying examination. The SDC may also grant conditional registration to applicants who have degrees in dentistry from other foreign universities that are not listed in the Schedule. The SDC evaluates such applications on a case-by-case basis and may require that such applicants pass an examination, to ascertain that they have the minimum skills and knowledge to practise and treat patients safely and competently in our local context. Clause 4 of the Bill amends section 14A of the DRA to introduce a requirement that foreign-trained dental graduates must take and pass a qualifying examination to be eligible for conditional registration.”