Lam Pin Min
Singapore
“Mr Speaker, on behalf of the Minister for Transport, I beg to move, "That the Bill be now read a Second Time". This Bill, together with the Active Mobility (Amendment No.”
“It is timely for us to put in place a regulatory framework to ensure that active mobility devices being brought into and used in Singapore are safe. This is a key step in helping us put in place a safe and sustainable active mobility landscape in Singapore. Mr Speaker, I beg to move. [(proc text) Question proposed. (proc text)] 1.55 pm”
“Clause 6 facilitates the transfer to and vesting in the financial security provider of a seafarer's rights against a shipowner as a result of any liability arising from the shipowner's obligation to repatriate the seafarer. For example, the liability to pay the seafarer's wages and entitlements.”
“Mr Speaker, to ensure a safe and high-quality blood supply for our patients in Singapore, pre-donation interviews are conducted to screen blood donors for risk factors and blood donations are also tested for blood-borne infections. However, infections can only be detected some time after the blood donors have been infected.”
“I thank the Member for that clarification. As far as I know, not all mental conditions will be excluded from blood donation. In fact, we have checked with HSA. There is a wide spectrum of mental illnesses – from very mild mental conditions to very severe conditions.”
“I think we must be cognisant that the reason why they are inmates is because of certain things that have happened, prior to that. That actually pre-disposes them to some high-risk behaviours.”
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“But it is important for doctors to have the enhanced awareness that should the patient develop other symptoms or signs that point towards Kawasaki disease, further investigation would be warranted. I also understand that there are many doctors who are concerned with the verdict and judgement of this case. My advice to doctors is that they should stay calm and not overreact. Secondly, do read and understand the proceedings of the DT and appreciate the rationale and considerations of the judgement. Because, very often, when doctors read the headlines, they will jump to the conclusion that, "Oh, if I miss a fever and therefore miss a Kawasaki disease diagnosis, I will be suspended for three months". That is actually not the case. One of the common questions that Dr Lim had alluded to is: "Should I investigate every child who presents with fever or a rash for Kawasaki disease?" Of course, like I mentioned previously, the answer is no. That would actually be tantamount to very poor clinical judgement and defensive medicine. The advice to doctors is that we should fall back on basics first. Getting a good history and a thorough and proper clinical examination is critical in the practice of medicine. Consider any international guidelines available in the evaluation and management of the condition at hand. In the case of Kawasaki disease, the international guidelines on the evaluation of suspected incomplete Kawasaki disease and the diagnosis of management of Kawasaki disease from the American Heart Association is internationally well-known and accepted and has been there since 2004. If the doctor is unsure or if the case is complex, please do not hesitate to discuss with other more experienced colleagues on the most appropriate management of the case.”
“I would like to thank Dr Lim for the also very long and comprehensive comment, and the many supplementary questions. With regard to the first question, which is on the type of blood test that can be used in the diagnosis of Kawasaki disease, we are referring to C-reactive protein which is the inflammatory marker for any form of inflammation. Though non-specific for Kawasaki disease, it is a supportive investigation that helps in the diagnosis of Kawasaki disease. And, of course, in cases where Kawasaki disease is highly suspected, there is also a need to order echo-cardiogram to assess the coronary vessels to look for any aneurysms or dilatation. The American Heart Association has come up with international guidelines in the management of Kawasaki disease as well as the evaluation of incomplete Kawasaki disease. If you look at the literature, incomplete Kawasaki disease is more common in children who are of a very young age, which was what this child had in this case − incomplete Kawasaki disease. If doctors were to follow the international guidelines issued by the American Heart Association, the definition of incomplete Kawasaki disease is defined as persistent fever with at least two signs that are suggestive of Kawasaki disease. So, in this case, the patient does have persistent fever, the patient has skin rash, bilateral sore eyes as well as cracked lips. So, this patient actually had more than two signs; he had three signs. Based on the international guidelines, supportive tests, such as C-reactive protein and echo-cardiogram, should have been ordered. As to the Member's second comment on whether every child with fever or rash should therefore be investigated for Kawasaki disease, the answer is obviously no.”
“For cases which are complex or for which the treating doctors are unsure, they can also discuss with other colleagues on the most appropriate management of the case. In addition, medical knowledge is constantly evolving. It is important for doctors to keep abreast of medical knowledge and international guidelines based on the recommendations of medical experts. Hence, SMC requires all doctors in the public and private sectors to have mandatory continuing medical education. Our hospitals and institutions also have teaching, training and peer review to enable doctors to maintain and upgrade their skills.”
“The appeal was then dismissed by the High Court. Dr Lim asked if MOH advocates doctors to send all cases for detailed diagnostic tests to avoid misdiagnosing rare medical conditions. The answer is no. Such defensive medicine practice deviates from good clinical practice. It will also unnecessarily increase healthcare costs. Dr Lim also asked if the Ministry should issue standard practice guidelines on diagnosis for all potentially rare illnesses. It is neither possible nor practical for MOH to issue guidelines for all rare diseases. Doctors would have to exercise their clinical judgement in such situations. However, in this particular case, there were already existing international guidelines which warranted further investigations to diagnose Kawasaki disease, given the symptoms and signs of persistent fever, red eyes, red cracked lips and a rash. Ms Tin asked if there have been international studies on defensive medicine, which is defined as a deviation of sound medical practice that is induced mainly by a fear of medical malpractice action. There have been a few international studies, mainly comprising surveys of doctors, which noted the high prevalence of defensive medicine practices overseas, resulting in unnecessary increases in healthcare costs. Other international studies have also suggested that a substantial fraction of malpractice claims are a result of failure of doctor-patient communication. There has been no local studies on defensive medicine. As part of their work, doctors are expected to exercise good clinical judgement to manage patients appropriately. Clinical judgement is dependent on the seniority of the doctor, the area of practice and experience, clinical presentation of each patient and the facts and circumstances surrounding each case.”
“During its inquiry, the DT also considered the opinions of two expert witnesses. The DT noted that there were already well accepted international guidelines for the diagnosis of Kawasaki disease since 2004. Based on these international guidelines, the child presented with signs and symptoms which should be investigated further for Kawasaki disease. The DT concluded that Dr Chia fell short of the reasonable standard expected of a senior paediatrician by not ordering tests to support the diagnosis or discussing with the parents about this possible diagnosis which she had considered. The DT judged that this amounted to professional misconduct on her part. In deciding on the sentence, the DT considered eight precedents relating to doctors who had missed or given a wrong diagnosis, failed to provide adequate advice and/or failed to provide adequate and timely treatment to patients. The DT noted that six of the precedents were dealt with by a suspension instead of a fine. The DT also took into account the seniority of Dr Chia and that she was an experienced paediatrician of 23 years' standing. After considering all the relevant facts and circumstances, including the aggravating and mitigating factors, such as Dr Chia's unblemished record, the many testimonials and character references and her contribution to society, the DT ordered a three-month suspension, which is the shortest suspension under the Medical Registration Act. Dr Chia appealed to the High Court against the DT's decision. The High Court noted that Dr Chia had not pleaded guilty to the charge and that the disease faced was not uncommon. Taking these factors, as well as the precedents into consideration, the High Court found the order of three months' suspension to be appropriate.”
“On 3 March, which was the ninth day of the child's fever, the child was reviewed by Dr Chia as an outpatient at her clinic. Dr Chia was informed by the parents that the fever had continued in the two days after discharge although, according to Dr Chia, the red eyes and the rashes had resolved and the child's lips had improved. The history of the progression of the child's symptoms and signs, including prolonged fever, red eye, rash and red lips were suggestive of Kawasaki disease which should have prompted Dr Chia to carry out supportive tests, but Dr Chia still maintained that it was viral fever and did not order any supportive tests. The next day, on 4 March, the child's parents decided to seek a second opinion and went to consult another paediatrician as the child continued to have high fever. On examination, she noted that the child was irritable and had a rash on the upper body. The second paediatrician also noted redness in the child's palms and soles, prominent lymph nodes on the right neck and discovered a heart murmur. All these were signs suggestive of Kawasaki disease. She ordered the blood tests which supported the diagnosis of Kawasaki disease and an echocardiogram which showed that the blood vessels of the heart was already affected. Fortunately, the child responded well from the treatment for Kawasaki disease and the fever settled. The child's mother then filed a complaint with the Singapore Medical Council (SMC). In accordance with the Medical Registration Act, the SMC convened a Complaints Committee. After conducting its own investigations, the Complaints Committee concluded that a formal inquiry by a Disciplinary Tribunal (DT) was necessary. A DT was convened comprising two senior doctors and a lawyer.”
“Mdm Speaker, Kawasaki disease is a childhood disorder affecting the blood vessels with an incidence of approximately 32.5 per 100,000 children less than five years old per year. KK Women and Children's Hospital and NUHS see about 160 to 190 Kawasaki disease cases per year. Kawasaki disease is also the most common cause of acquired heart disease in children in developed countries. If left untreated, about 15%-20% of cases develop coronary aneurysms and ectasia, and the risk of ischemic heart disease and sudden death. The background facts to the case are as follows. On 25 February 2013, the patient, a one-year-old child, was hospitalised at Gleneagles hospital with high fever for three days and red eyes, besides other symptoms. The paediatrician who was on call at the hospital, Dr Chia Foong Lin, attended to the child and diagnosed the case as a viral infection. Two days later, on 27 February, or the fifth day of the child's fever, the child was noted to be fretful, had red lips and developed a rash. On 28 February, the following day, he had a spike of fever in the morning and red and cracked lips. Dr Chia considered the possibility of Kawasaki disease and looked for the full features of Kawasaki disease. However, she did not conduct any supportive tests for Kawasaki disease and did not share this with the parents. Dr Chia's diagnosis remained as viral infection as there were no full features of Kawasaki disease. On 1 March, the fifth day in the hospital and the seventh day of the child's fever, the child was discharged by Dr Chia as the fever appeared to have settled. According to Dr Chia, the red eyes improved and no rashes were seen but his lips were still slightly red and cracked. The diagnosis by Dr Chia was again viral infection.”
“Mdm Speaker, may I have your permission to take Question Nos 11 to 14 together?”
“I thank Mr Seah for the suggestion and I agree that some of these factors are important to be considered in the evaluation of the bid. Indeed, the PQM guidelines have been dictated by BCA. LTA does review the guidelines and make necessary changes and amendments according to its needs. If we do need to make any significant changes, we will need to get the approval from BCA as well. I thank Mr Seah for those comments and we will take them seriously.”
“I thank the Member for the questions. The investigation is likely to be completed sometime in October. Once the investigation has been completed, we will make public the report as soon as possible. With regard to how soon we can resume work, we will resume as soon as possible, without compromising safety.”
“I would like to thank Miss Cheryl Chan for the supplementary questions. For all projects, ultimately, the main contractor will be held responsible for any safety lapses that may occur as a result of the work that has been sublet to other smaller subcontractors.”
“I would like to thank the Member for the comment as well as the two supplementary questions. LTA is working with MOM as well as BCA to investigate the cause of the collapse. I would like to urge all Members to be patient, not to speculate what the cause is and let the investigation take its due course. Of course, the delay of the project after the issuance of the Stop Work Order will depend on the investigation process and the cause of the accident. Once that has been determined, all necessary precautions, as well as, if there is a need in re-qualifying the design and so on, will be taken into consideration before work can resume.”
“I would like to thank the Member for the question. LTA does not bar contractors which have safety lapses or are blacklisted by MOM from participating in the tenders. In fact, their quality envelopes will still be opened and assessed objectively. Any safety lapses will then be penalised under the safety component accordingly. However, those with very low-quality scores may be disqualified and their price envelopes left unopened. In fact, from 15 July 2015 onwards, LTA has put in place a new policy where the LTA Board can veto bidders on the basis of very poor safety performance alone. For such cases, the price envelopes will be returned unopened. Since then, I would like to inform the Member that LTA Board has vetoed 16 bids from 10 companies for this very reason. Er Dr Lee Bee Wah (Nee Soon): Mdm Speaker, it is important for LTA to have a thorough investigation, so that the root cause of the collapse can be identified and measures taken. On the other hand, I also hope that LTA will not overdo it and have knee-jerk reaction. I have two supplementary questions. Since the Stop Work Order is already issued, how much of a delay will this cause to the project? The second question is, will the Ministry work with MOM to let the contractor resume work at other areas except the viaduct construction, because the project is a big project and now the Stop Work Order is for the whole project?”
“I would like to thank Dr Tan Wu Meng for the two supplementary questions. On the first, where two bidders were eventually successful out of the 69 bidders who had a serious safety lapse, I do not have the details of the kind of projects and works that they have been involved in. I will be able to provide the information separately to him. As to the impact of safety records on quality performance, yes, I have indicated in my previous reply that safety forms a significant proportion of the quality score. In the case of LTA projects, it forms about 25%. While safety lapses may have happened, we also need to be cognisant of the fact that we need to go into the details of the accident − what caused the accident − before deciding on the score under the quality framework. At the end of the day, we need to look into all different factors and considerations and apply the PQM in determining who the eventual winner of the bid will be. Assoc Prof Daniel Goh Pei Siong (Non-Constituency Member): I thank the Senior Minister of State. I was just wondering whether there is a vicious cycle that is going on here in the sense that contractors, knowing that they will be scoring low for quality due to poor safety record, will be lowering their price bid in the next contract to an unrealistic level and, therefore, risking further safety lapses; and whether, therefore, a review of the PQM framework is on the cards after this accident.”
“As to the Member's question on the reasons and the cause of the accident, the investigation is ongoing; it is still premature to judge what is the exact cause. I think it is unfair to make any judgement at this point in time. Suffice to say that based on our preliminary investigation, it is the design of the corbels that could have resulted in the accident. LTA, together with BCA and MOM, has already done whatever possible to put proppings around the structure to ensure that the existing structure remains safe for any ongoing investigation and works.”
“I would like to thank the Member for her supplementary questions. First, allow me to run through with Members our tender evaluation framework with regard to price, as well as the quality. As I have mentioned in my reply, all public agencies adhere to the price-quality method (PQM) published by BCA, which evaluates both the price as well as the quality attributes for all tenderers. For build-only projects, agencies generally adopt a price-quality weightage of 80:20. In this case, which is a design-and-build project, agencies can consider price-quality ratios between 60:40 and 70:30, depending on the complexity. In this case, for the TPE-PIE project, a 70:30 ratio was considered, similar to other projects of similar complexity and nature. BCA guidelines make it mandatory for safety performance to make up at least 15% of the quality score. However, LTA, in its internal guidelines, assigned 25%, so they are actually more stringent than BCA. So, 25% of the quality score must be attributed to safety performance. In addition, LTA evaluates four sub-components for safety performance, namely, the safety records of the past two years, the robustness of the safety management systems, the safety and health performance in ongoing LTA projects and whether the company had won any safety awards. Other components of the quality evaluation include project-specific proposals which actually form the bulk of the evaluation − project performance, dispute resolution approach and favourable adjudication result. In this case, LTA had done the due diligence in ensuring that the award had been given to the tenderer who actually performed best in the PQM.”
“I would like to thank Mr Seah for the supplementary questions. Let me explain why OKP was actually given the contract, in spite of the Yio Chu Kang Flyover accident. OKP was awarded the contract after emerging with the highest price-quality score amongst the four tenderers. The tender submissions were evaluated objectively and fairly, based on the price-quality weightages and tender specifications made known to all the tenderers. While I understand that there are concerns with regard to the safety records of companies who are tendering for such projects, and although OKP has one fatality and some injuries at the Yio Chu Kang Flyover in September 2015, at the point in time when the tender was evaluated, like I mentioned in my reply, investigations were still ongoing. We did not really know what the exact cause was and what OKP's liabilities were. This was, in fact, taken into consideration when we evaluated the tender, and, as a result, OKP scored the lowest for quality, which includes safety performance, in the tender submission. However, we do look at other factors. OKP had a good track record over the past 10 years for completing many similar projects and, prior to the Yio Chu Kang Flyover accident, OKP had achieved an accident-free record of more than 25,000 man-hours. Following the fatal accident at the Yio Chu Kang Flyover, OKP had also improved their safety standards with visible improvements. Since 2015, OKP did not have any work-site accidents, MOM fines or demerit points until the collapse of the current PIE-TPE viaduct. We hear the Member's concern. We do take into consideration the safety records and safety performances of companies when they bid for projects.”
“Over the past three years, LTA has called a total of 175 tenders for construction works, which received over 1,100 submissions. Out of these submissions, 69 were from contractors who had serious workplace safety lapses. Of these 69, only two bids were successful. Both these bidders had submitted the lowest price bid and received the highest overall price-quality score. For these two cases, the winning price bids were 27% and 6% lower than the second lowest bids. As for Mr Ang Wei Neng's query on project delays, out of 67 major rail and road projects that LTA has completed in the past five years, only seven exceeded the project timelines by more than three months. In this particular case, the main contractor, Or Kim Peow Pte Ltd (OKP) had a fatal workplace incident at Yio Chu Kang Flyover in 2015. MOM's investigations were still ongoing at the time LTA was evaluating OKP's bid for the construction of this viaduct in question and, hence, LTA did not disqualify OKP outright. Nevertheless, LTA gave OKP a low safety performance score in the evaluation of its bid. On the other hand, OKP offered the lowest tender price and also had a good track record in completing many similar infrastructural projects over the past 10 years. Overall, it obtained the highest score and was awarded the project. Following the incident, LTA conducted a half-day safety timeout for all ongoing road and rail construction projects to review on-site safety practices and measures. MOM inspected all active OKP worksites and other projects with ongoing viaduct works, and will step up inspection of other worksites performing formwork and concreting works. We will undertake all possible measures to prevent similar accidents.”
“Mdm Speaker, I am deeply saddened by the loss of life and injuries in the collapse of the viaduct. I would like to extend my deepest condolences to the family of Mr Chen Yinchuan, the worker who passed away, and pray for the recovery of the four workers still receiving treatment in the hospital. LTA is working with MOM and BCA to investigate the cause of the collapse. Preliminary investigations suggest that the corbels, or fork-like structures, supporting the deck slab gave way. However, we will have to wait till the investigations are completed to understand why they gave way. Members have asked about LTA's procurement process for construction projects. LTA adheres to the guidelines issued by BCA, which consider both the price and quality of bids. BCA's guidelines for the price-quality ratio range from 60:40 for more complex projects, to 80:20 for simpler ones. For the construction of this viaduct, LTA adopted a ratio of 70:30, commonly used for projects of this complexity. As part of the overall quality score, LTA assesses the safety practices of the bidders, based on their past safety records, such as their demerit points from MOM, the safety performance of their ongoing projects and the robustness of their safety management systems. Tenderers who have had workplace safety lapses in the past would receive lower quality scores. If a bidder does not meet minimum overall quality requirements, his price envelope will not even be opened, and his bid will be disqualified. Two years ago, LTA further tightened the evaluation process, so that poor safety performance alone can lead to disqualification. Since then, 16 bids from 10 contractors have been disqualified for this reason.”
“Mdm Speaker, may I have your permission to take Question Nos 2 to 8 together?”
“I would like to thank Mr Png for the supplementary question. In fact, this has been raised in previous Parliamentary sittings. But let me reiterate that motorcycles currently are in a separate COE category so that motorcycle buyers need not compete with car buyers for COEs. I think this is quite well understood. However, splitting Category D further would result in a much smaller quota available in each sub-category and this may lead to more volatility in the quota as well as the prices.”
“Mdm Speaker, LTA's engagement with motorcycle dealers was part of its efforts to better understand recent Category D price trends. The feedback was that the market is still in a state of flux and will take some time to stabilise following the recent Additional Registration Fee (ARF) changes. These ARF changes will make higher end motorcycles more expensive. However, lower end motorcycles, which constitute more than 60% of the market, are unaffected and continue to attract an ARF of only 15% of the Open Market Value. Furthermore, we had stopped the contribution of COEs from Category D to the Open Category since May, which will result in a larger supply of motorcycle COEs.”
“Mdm Speaker, I would like to thank Mr Ang for the supplementary question. LTA inspects roads at regular intervals − weekly for expressways, every two weeks for major roads and every eight weeks for minor roads. During inspections, if LTA detects road defects, such as faded signs and signs blocked by trees or shrubs, LTA will rectify the defects and also alert NParks should there be any trees that obstruct the road signs.”
“Mdm Speaker, LTA stipulates that trees cannot be planted within 75 metres in front of advance directional signs on expressways, or 45 metres on all other roads. No-planting zones are also established around pedestrian crossings to ensure that motorists have a clear view of pedestrians. The size of these no-planting zones depends on the site conditions, such as the geometry of the road and the speed limit. In addition, NParks conducts inspections at least once a month to make sure that greenery does not block the visibility of crossings and signs.”
“Mdm Speaker, there are currently no new entrants of bike-sharing operators. We do foresee that there may be a potential for new entrants in the future. We are also working with the bike-sharing operators to encourage them to come up with some form of incentive and penalty system so that they can modify or mould the behaviour of users, so that indiscriminate parking will be discouraged, just as the Member had mentioned, in his Town Council.”
“Mdm Speaker, I would like to thank Mr Zaqy Mohamad for the supplementary questions. The Member is right and I agree with his suggestion that we need to have a whole-of-Government approach. Currently, we have about 130,700 rack and dockless bicycle parking spaces. LTA will work with Government agencies, including Town Councils, to allow shared bicycles to be parked in all public bicycle parking areas. We are looking into increasing the number of parking places as well. LTA will also coordinate and strengthen enforcement approaches across these various agencies against indiscriminate bicycle parking. Last but not least, as part of the whole-of-Government approach, LTA will work with all agencies to harmonise the active mobility infrastructure to make it more convenient and seamless for users.”
“I would like to thank Mr Ang for the supplementary questions. At this point in time, there are a total of about 29,000 to 30,000 shared bicycles available in the market. LTA is engaging the bike-sharing operators to deploy their fleet in a responsible manner to prevent excessive, indiscriminate parking as well as disamenities to the public. As to the Member's last question on geo-fencing, LTA is also working with the various bike-sharing companies to look into some of these innovative and technological solutions so that the prevalence of indiscriminate parking will also be minimised.”
“The Land Transport Authority (LTA) has been coordinating with fellow Government agencies and Town Councils to align the approach against indiscriminate parking of shared bicycles. There are three elements in our approach. First, ensure an adequate supply of parking spaces. LTA is working with the National Parks Board (NParks), the Housing and Development Board (HDB) and Town Councils to increase bicycle parking capacity within their premises. On LTA's part, it has implemented 34 bicycle parking zones, which can accommodate 1,400 bicycles at Mass Rapid Transit (MRT) stations. These are quicker to implement than bicycle racks and LTA will be providing more, including near bus stops. At the same time, LTA will continue with its ongoing plans to add 6,000 more bicycle lots at various MRT stations, and another 500 lots in the city area by 2019. Second, ensure the cooperation of the bicycle-sharing companies. LTA requires them to promptly remove the bicycles which are indiscriminately parked. It is in their interest to cooperate with the authorities. Any public backlash may make the business model unsustainable. Third, strict enforcement against errant behaviour. If the indiscriminately parked bicycles are not removed within half a day, LTA will impound them, levy a fee on the bicycle-sharing companies for the resources used for the impounding, and fine the companies. LTA has received about 70 complaints of indiscriminate parking since the beginning of this year. This does not include the many comments on forum pages and social media. LTA has served around 1,000 notices for indiscriminately parked bicycles, of which 200 bicycles have been impounded, and about half of the impounded bicycles have been collected by the companies.”
“Mdm Speaker, may I have your permission to take Question Nos 1 to 2 together?”
“Mdm Speaker, I would like to thank the hon Member for the two supplementary questions. The answer to the first supplementary question is yes, the polyclinics do publish a list of minor surgical procedures that they are able to perform in the polyclinics and this information is available on the SingHealth polyclinics' as well as the National Healthcare Group polyclinics' websites. However, I would like to qualify that these minor surgical procedures may not be available in every polyclinic every day due to infrastructure and manpower constraints. Moving forward, all the new polyclinics that will be developed will have dedicated space catered for minor surgical procedures. As to Miss Cheryl Chan's second supplementary question, today, polyclinics would conduct the necessary triage and assessment process to ensure that only urgent cases are referred to A&E. In fact, we do not encourage polyclinic doctors to refer non-urgent cases to A&E. Non-urgent cases should preferably be referred to the Specialist Outpatient Clinics instead. We have noted Miss Cheryl Chan's feedback and will continue to work with the polyclinics to ensure that patients are referred appropriately to the right care settings, taking into consideration accessibility and affordability for the patients.”
“Mdm Speaker, the numbers of cases referred from polyclinics to Accident and Emergency (A&E) departments at public hospitals were 55,000 in 2014, 57,000 in 2015 and 64,000 in 2016. Comparable figures for 2013 are not readily available. The proportion of such referrals to total polyclinic attendances has been fairly small and constant at about 1% in each of the three years. Likewise, the proportion of such cases to total A&E attendances has been quite small and stable at about 4% over the same period. We do not have statistics on how many of such referrals are for procedures that cannot be performed at the polyclinics. Today, polyclinics are able to attend to patients requiring minor procedures if the condition can be appropriately managed at a primary care setting. Patients with high-risk factors, or patients presenting with conditions that require more specialised assessments, treatments or monitoring would, however, need to be referred to a hospital's specialist outpatient clinic. Patients who require such services on an immediate basis may be referred to the hospital's A&E. The Ministry of Health will continue to work with the polyclinics to build up capabilities to offer more treatments and procedures to Singaporeans at primary care settings.”
“In fact, all dental services in other hospitals other than what I have described are to provide private dental specialty services to patients. I have mentioned the reasons: to consolidate manpower resources at the three designated centres and, at the same time, provide opportunities for training of our dental specialists.”
“I would like to thank Er Dr Lee Bee Wah for the supplementary questions. Only dental conditions that require specialist dental care will be referred for management at the national specialty centres. With regard to the long waiting time at the Dental Centre Singapore, we are currently expanding and upgrading our specialty centres. The new National Dental Centre Singapore will be expanded as part of the overall Outram campus plan which will be redeveloped in phases. In addition, the National University Hospital (NUH) Dental Centre has also started accepting specialty referrals. So, not only just the National Dental Centre, the NUH Dental Centre does accept specialty referrals as well. In addition, the NUH National University Centre for Oral Health will be completed in 2019 and this will also increase the capacity of managing these patients. Since 2011, the Ministry of Health (MOH) has put in place measures to offer root canal treatments, dentures, crowns and bridges at Khoo Teck Puat Hospital at subsidised rates limited to polyclinic referrals only. Er Dr Lee also mentioned about whether such subsidised cases can be provided at the other hospitals. In fact, MOH takes reference from recommendations on national dental services strategy, and subsidised specialist dental care is only provided at designated national dental specialty centres, which include the National Dental Centre Singapore, NUH Dental Centre and some in Khoo Teck Puat Hospital. The reason for this is that it allows consolidation of manpower as well as specialty resources for the provision of these specialty services. At the same time, we also provide training opportunities for dental students as well as specialist training.”
“Mdm Speaker, dental attendances in our polyclinics have been growing, from 149,000 in 2013 to 179,000 in 2016. Our polyclinics have expanded dental capacity, reviewed work processes and introduced measures to improve waiting times. We will continue to expand capacity to address the increasing demand for dental services. This includes building more dental facilities in the upcoming new polyclinics, such as Punggol Polyclinic, as well as expanding existing polyclinic dental facilities. The introduction of the Community Health Assist Scheme (CHAS) in 2012 has also improved the accessibility of subsidised primary dental care through private dental clinics. Today, there are over 700 private dental clinics participating in CHAS, an increase from 290 in 2012. In 2016, there were over 500,000 subsidised dental attendances at CHAS dental clinics. Polyclinics also inform patients about availability of CHAS dental clinics, where eligible patients can also access primary dental care if they choose to do so. Patients assessed to require immediate treatment can be attended to immediately. Most dental conditions are diagnosed and treated at the same sitting. However, a minority of patients require additional appointments for more extensive treatments. In such cases, when the next appointment is scheduled will depend on the urgency of the situation. We will continue to monitor and meet the primary dental care needs of Singaporeans through both our polyclinics and CHAS dental clinics.”
“On egg freezing, licensed Assisted Reproduction (AR) centres in Singapore are allowed to do this when there are medical needs. For example, egg freezing can be performed on women who need to undergo medical treatment, such as chemotherapy or radiotherapy, that may adversely affect their fertility. We would also like to highlight that egg freezing carries some risks to the woman. The process of stimulating production and collecting a woman's eggs for freezing can result in complications, such as over-stimulation of the ovaries, bleeding and infection. In addition, the issue of allowing egg freezing for non-medical or social reasons is a complex one due to various ethical and social implications. First, egg freezing is not a guaranteed solution to delaying parenthood. Second, the risks of developing certain age-related complications during pregnancies are not mitigated by egg freezing. For this reason, the Government still encourages couples to have more children when they are relatively young and healthy. Nevertheless, we are currently studying the feasibility of allowing social egg freezing. We are weighing the social, ethical and religious concerns very carefully. Should social egg freezing be allowed, we will need to build a robust regulatory framework with adequate controls not just to ensure the safety and welfare of the women undergoing social egg freezing, but to also mitigate the potential social, ethical and religious considerations. Mr Deputy Speaker, we recognise the many important roles women play in our lives. Through various measures, we hope that women can be better supported to fulfil their aspirations as well as their many essential roles in our society. With that, I support the Motion.”
“It can also send automated notifications if the system detects an anomaly in the seniors' behaviour, such as lack of movement over a prolonged duration. Ultimately, supporting our caregivers is a collective responsibility. We need to build a community support system where our seniors and their caregivers are supported and cared for. Under the Community Networks for Seniors pilot programme, we are partnering community stakeholders to reach out, befriend and support seniors living in each community. We are also promoting dementia-friendly communities by encouraging the community-at-large to be trained to help seniors with dementia. In these "dementia-friendly communities", seniors with dementia can stay active and caregivers do not have to be afraid of them going out, because there will be people around to help them home. Together, we hope to foster a more inclusive and compassionate society where caregivers are well-supported in their caregiving roles. The Government will also continue to study new ways to support our caregivers. We agree with Mr Desmond Choo that we need to support women's aspiration to raise healthy children. He suggested measures, such as extending subsidies for ART, and allowing egg freezing. We have no plans to extend ART subsidies to private centres at this point in time. There is sufficient capacity at ART facilities in our public hospitals. Clinical data in Singapore also shows that public and private centres' success rates are comparable. From 2011 to 2015, the average live birth rate from ART was 20.7% at public centres, compared to 19.8% at private centres. Nevertheless, couples seeking treatment at private ART centres may tap on their MediSave to defray the cost of ART treatment.”
“We are not ready to legislate eldercare leave at this time because we need to strike a balance between employers' concern on business costs and manpower constraints, and caregivers' need for more leave for eldercare purposes. Existing leave provisions can be used for this purpose today. We encourage more employers to provide family-related leave benefits which can be used for different purposes, as well as FWAs, such as time-off to look after their elderly parents. Public Service agencies currently provide two days of parent care leave annually. Some private companies have also done so. For example, the Overseas-Chinese Banking Corporation (OCBC) offers two days of family leave for employees who are not entitled to childcare leave. This would include caregivers who are singles and taking care of their elderly parents. We encourage more employers to do likewise. We will continue to review the need to legislate eldercare leave as our socio-economic circumstances change over time. Ms Tin Pei Ling suggested to leverage technology for remote monitoring of our seniors while caregivers are at work. I am happy to share with Ms Tin that we are piloting the use of technology to find an effective and sustainable model which can be scaled up. As part of HDB's Smart Homes Trial, we are testing elderly monitoring systems which can send out alerts to their caregivers if the seniors are in distress. This will allow caregivers greater peace of mind. For example, in Yuhua, residents can install solutions, such as the Smart Elderly Monitoring and Alert System (SEMAS). The system can provide alerts to caregivers when the seniors trigger the distress buttons.”
“In 2014, we launched the Singapore Silver Line which is a one-stop call centre to help seniors and their caregivers with information on care services and schemes in the community. The Agency for Integrated Care (AIC) has also set up AICareLinks centres at five hospitals and at its office in Maxwell Road. These are one-stop counters where caregivers can receive advice on services and schemes. To facilitate easier access to information, AIC will set up information booths at selected polyclinics. We now have booths in three polyclinics at Chua Chu Kang, Marine Parade and Yishun. AIC will roll this out to another six polyclinics by early next year. Many Members suggested that employers provide FWAs to allow employees to better manage work demands with family and caregiving needs. Today, more employers are adopting FWAs. In 2016, about 67% of the employees worked in firms that offer formal FWAs, up from 56% in 2011. More than eight in 10 employees worked in firms that offer unplanned time-off or ad hoc teleworking for their employees to attend to personal matters, up from seven in 10 in 2011. Miss Cheryl Chan has suggested that the public sector take the lead in enabling FWAs. We agree with the suggestion and would like to update the House that all our public healthcare clusters have done so to help staff balance work and personal demands. For instance, more than 4,200 nurses are benefiting from FWAs, such as having more flexible rosters enabled by e-scheduling systems. Miss Cheryl Chan and Ms Joan Pereira also suggested to provide more eldercare leave for working caregivers to take care of the seniors. We have been studying the issue in consultation with unions and employers.”
“We also have Professional Conversion Programmes to attract mid-career Singaporeans to be trained as nurses and allied health professionals and organise job fairs as well as put in place the Community Care Traineeship Programme to attract Singaporeans to be trained as support care staff for the aged care sector. Second, we are expanding our respite services so that caregivers can rest and recharge and working caregivers can travel for overseas trips. Other than weekend respite services at our eldercare centres, more than 40 nursing homes now provide residential respite services ranging from a few days to a month. Caregivers of seniors with dementia can also tap on the Eldersit and Home-Based Intervention Programme which offers home-based respite aimed at keeping the seniors engaged in activities in a familiar environment while their caregivers take a break. Third, we are equipping our caregivers to provide better care for their loved ones. We currently provide subsidies of up to $200 per annum from the Caregivers' Training Grant (CTG) for caregivers who are caring for seniors or those with a disability, including foreign domestic workers (FDWs), to attend training courses on caregiving or self-care skills. Caregivers co-pay as little as $10 after taking into account training subsidies. To date, more than 35,000 caregivers have utilised the grant. In October last year, we started piloting an eldercare training scheme for our FDWs to better care for seniors. These FDWs undergo a comprehensive training before deployment. As of last month, about 60 FDWs have been trained, of which 50 have been placed with families. Fourth, we are increasing the touchpoints in the community to help caregivers navigate the social and healthcare systems.”
“Mr Deputy Speaker, thank you for allowing me to join in the debate. First and foremost, I would like to thank Ms Tin Pei Ling and the Members for raising the need to recognise and support Singapore women, many of whom have made personal sacrifices to care for their loved ones. Caregiving is no easy feat. It is an important responsibility, which will only grow heavier with Singapore's ageing population. The Government is strengthening efforts in a number of areas so that caregivers feel more supported in caring for their loved ones. First, we are enhancing accessibility to eldercare services in the community. Ms Tin Pei Ling and Ms Joan Pereira asked that we provide more eldercare services and locate them in convenient locations. We have expanded our home care capacity from 3,800 places in 2011 to around 7,500 home care places today. We have also increased our day care places from 2,100 in 2011 to 4,000 today. We are on target to grow this to 10,000 home care and 6,200 day care places by 2020. We are building our eldercare centres across Singapore and ramping up transport services so that it is more convenient for seniors to travel to the centres. New centres will operate minimally from 7.00 am to 7.00 pm so that it is more convenient for working caregivers. Some centres now operate on weekends. We are also encouraging more centres to extend their operating hours and establishing home care services at their centres to make care more accessible. We will need more manpower to support this expansion and are enhancing schemes, such as the Return to Nursing scheme, which aims to attract retired and home practising nurses to return to work in the healthcare sector.”
“Mdm Speaker, I beg to move, "That the Bill be now read a Third time." Madam, at the Second Reading in January this year, the House committed The Kwong-Wai-Shiu Free Hospital (Transfer of Undertaking and Dissolution) Bill to a Select Committee. The Select Committee received one written representation, which was assessed not to directly concern the subject matter of the Bill. The Kwong-Wai-Shiu Free Hospital has also expressed its support for the Bill. The Select Committee has considered the Bill and has only made textual alterations to the Bill to reflect the change in citation year from 2016 to 2017. The Committee's Report was presented to Members of the House on 15 February 2017. In conclusion, the passing of the Bill will enable Kwong Wai Shiu to modernise its corporate structure and place the hospital in a stronger position, with greater flexibility to provide quality healthcare services to Singaporeans while ensuring transparency and accountability. Mdm Speaker, I beg to move. [(proc text) Question put, and agreed to. (proc text)] [(proc text) Bill accordingly read a Third time and passed. (proc text)]”
“Mdm Speaker, under the Private Hospitals and Medical Clinics Act (PHMCA), the Ministry regulates clinics to ensure that they provide a safe and good standard of care to their patients. This includes the continuity of care for patients. Where a licensed operator intends to cease operating, or let, sell or in any way dispose of its medical clinic, it is required to notify the Ministry of Health (MOH) of its intention in writing not less than 30 days before he takes such an action. In order to ensure continuity of care for the clinic's patients, the operator must properly transfer its patients' medical information to another licensed clinic of the patients' choice. Third Party Administrators (TPAs) provide a range of intermediary services to healthcare providers, such as helping them participate in employer medical benefit programmes, processing of medical claims and concierge services. These are private contractual arrangements between the TPA and healthcare providers which MOH does not directly intervene in. However, the Singapore Medical Council (SMC) has provided guidance to doctors on appropriate fee arrangements through its Ethical Code and Ethical Guidelines (ECEG) that emphasise on the ethical practice and appropriate care so that the well-being of the patients will not be compromised. 1.30 pm”
“I would like to thank Ms Tin Pei Ling for the clarification. I recall Ms Tin asked about the "Trim and Fit" (TAF) programme last year and I appreciate her passion on this issue. While the obesity rate amongst our children is not alarming compared to the western countries, the proportion of overweight and severely overweight students in our mainstream schools has crept up from 10% to 12% in 2016. Under NurtureSG, a new programme for students will be implemented to provide more support to them. Unlike the old TAF programme which actually focused very much on losing weight and, as a result, caused some forms of stigmatisation among the students, this new programme will focus on lifestyle as well as behavioural changes to cultivate healthy eating habits and regular exercise among the children. More importantly, we have to focus on the active involvement of parents as well to make it successful.”
“I thank Dr Tan for the clarifications. First of all, just let me say that for any expansion plans, we do take into consideration the demographic profile as well as the type of diseases, especially chronic diseases, that are being seen at those polyclinics. For example, in the case of Clementi Polyclinic, definitely, we will have child-related services, such as immunisation as well as child development assessment, because I understand that there are young family members there, and also chronic care management services which cover things like diabetic food screening as well as retinopathy. We hear the Member's suggestions about the future needs of his residents and we will take those suggestions into consideration in our expansion plans, not just only in Clementi Polyclinic, but in other polyclinics as well Last but not least, I do agree that we really need to thank all the healthcare workers, not just in Clementi Polyclinic, but in the whole of Singapore, that they have been doing a good job, the hard work to our patients.”
“I would like to thank Mr Low for the clarifications. At this moment, we do not have any plans for a new polyclinic in Hougang but I would like to reassure the Member that MOH does look at the utilisation of polyclinics all around Singapore. If needed, we will look into expanding or even building new polyclinics. We also want to encourage patients to utilise the CHAS GPs because we believe that there is spare capacity in the CHAS GP clinics that residents can utilise using their CHAS card. Also, as I mentioned in my speech, MOH is also looking at Primary Care Networks (PCNs) and, hopefully, with this pilot programme, we are able to reach out to even more patients in the Hougang area.”
“Madam, let me address Dr Chia Shi-Lu's last clarification on primary care. As I have mentioned in my speech earlier, primary care is the bedrock of our healthcare system and we envisage that our primary care landscape will transform into one integrated primary care system, linking vertically with the hospitals as well as horizontally with our community partners. And more importantly, we believe in the central role of the family doctor. Thus, our vision of one Singaporean, one family doctor. I just want to reassure Dr Chia that MOH is working very closely with our polyclinics, GPs and community partners to drive this transformation so that we can better anchor patients in the community.”
“I urge all Singaporeans and healthcare providers to partner us in our initiatives to build a healthier future for Singapore.”
“Requirements to increase the accountability of healthcare providers and clinical oversight over more complex services have been generally positive. Various providers and members of the public gave useful suggestions on how we can enhance continuity of care for patients through an integrated NEHR. One of our Focus Group Discussion participants, Dr Theresa Yap, commended NEHR as she felt that it not only enabled her to make better treatment decisions but also provided patients with greater continuity of care when they visited multiple healthcare checkpoints. Members of the public who were consulted were also supportive of NEHR as they felt that it would make healthcare less costly by preventing duplication of diagnostic tests and chances of erroneous prescription or drug interactions. However, we are also aware of the concerns raised with regard to ensuring security of patient records, confidentiality of patient information and costs to providers. There are currently security measures in place and my Ministry will continue to strengthen the measures to address these concerns. The draft Bill will be put up for public consultation this year. We welcome all healthcare service providers and members of the public to review the Bill and provide us with more feedback and suggestions. 2.15 pm Mdm Chair, our country's journey for better care and better health starts from a commitment and understanding of how to stay healthy in every individual. Healthy lifestyle habits keep chronic diseases at bay. Staying connected to a regular doctor with improved access to healthcare services within the community will allow for better care management. MOH will continue to review our system and ensure that it evolves to ensure a safe delivery of appropriate care to patients.”
“Dr Tan Wu Meng had asked if Clementi Polyclinic can be expanded. I have good news for Dr Tan. Expansion plans are already being planned for Clementi Polytechnic and are expected to be completed by next year. My Ministry is also looking into partner arrangements to better care for patients. Since June 2014, Clementi Polyclinic has worked with NUHS-Frontier FMC to transfer over 6,700 patients from Clementi Polyclinic to Frontier FMC for primary care needs. Finally, to future-ready our healthcare system, we will also be revising the PHMCA which was enacted in the 1980s. Dr Chia Shi-Lu asked for the progress of the review of PHMCA. While PHMCA has served us well in ensuring the delivery of safe and quality care, more IT-enabled interventions and mobile services have emerged in recent years. We need to ensure adequate standards for these services. It is important that our healthcare laws stay current and flexible to allow for these shifts in models of care. I announced the revision of PHMCA in October 2016. Since then, we have actively engaged stakeholders, including hospitals and clinics, in focus group discussions. We have also engaged patient groups and members of the public to see how we can better ensure patient safety, welfare and continuity of care through the new Healthcare Services Act. To date, we have held 11 Advisory Panel Discussion sessions and 34 Focus Group Discussion sessions. The feedback has been constructive and helpful. Both providers and the public have welcomed changes to license healthcare providers by services rather than by premises. They have also been supportive of changes aimed at making healthcare costs more transparent through the display of fees, more targeted financial counselling and bill itemisation.”
“I would like to share a story about Mr Mohd Bin Sahat who has been seeing his regular family physician, Dr Chong Chin Kwang, for about eight years to manage his chronic medical conditions. Since 2012, he has been utilising the PCN services at Dr Chong's clinic, which gives him access to ancillary services, such as diabetic foot and eye screenings. I would like to quote Mr Mohd and he said, "I have received timely reminders on my appointments and follow-ups from the (PCN) staff…the (PCN) nurses also gave advice and recommended tips on diet and exercise. I really appreciate them." I am happy to note that Mr Mohd's efforts in leading a healthy lifestyle, coupled with holistic chronic disease management by the PCN team, have helped him to manage his chronic conditions optimally. Beyond PCNs, MOH will also continue to renew our primary care infrastructure. As announced last year, two new FMCs in Keat Hong and Tampines will be operational early this year. In particular, Tampines FMC will be located at the integrated complex, Our Tampines Hub, together with a Community Health Centre (CHC) and an SCC, providing our patients with a range of comprehensive community care options. Residents in Jurong West and Punggol can also look forward to the opening of Pioneer and Punggol polyclinics this year. We are on track to operationalise new polyclinics in Bukit Panjang, Eunos and Sembawang by 2020. I am also pleased to announce that we will build a new polyclinic in the Kallang/Balestier area which is expected to be operational by 2020. We are also working with the polyclinic groups to refresh the existing polyclinics, to evolve the polyclinics according to changing care needs. Polyclinics have progressively been renovated and expanded over the years.”