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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“In doing so, we can facilitate the continual growth of electronic commerce (e-commerce), electronic communications and electronic transactions, hence strengthening Singapore’s position as a trusted global infocomm hub. This is of strategic importance given the increasing use of the electronic medium for communications and transactions, and substantial growth in global e-commerce trade. According to comScore, a global market research company, US e-commerce trade reached a total of US$130 billion in 2009 and is expected to grow by almost 7% this year. Closer to home, Singaporeans increasingly go online to purchase goods, procure services and transact with the Government. As an example, based on the annual e-Government perception survey conducted in 2009, almost nine out of 10 users who transacted with the Government did so electronically, at least once a year. For the ETA to effectively play its role, we will need to ensure that it remains aligned with global developments on the rules of conducting electronic transactions, and be capable of adapting to constant technological change. A comprehensive review of the ETA was therefore conducted to identify aspects of the legislation which required amendments. Mr Speaker, Sir, the review had identified three sets of amendments to the ETA, which are presented in this Bill. They are: first, amendments to align the ETA with the UN Convention on the Use of Electronic Communications in International Contracts (UN Electronic Communications Convention); second, amendments to the ETA to facilitate more effective delivery of e-Government services in Singapore; and third, amendments to the Certification Authority regulatory framework enshrined in the ETA to enhance the technology neutrality of the legislation.”
“As to when an autopsy is required, yes, I believe there are factors to be considered on this. The key point is, really, the purpose of an autopsy is to determine the cause of death. The Coroner taking professional advice from the forensic pathologists will decide if a reported case can be signed off without the need for an autopsy. Finally, Sir, as to whether the Coroners' findings are appealable: the Coroners' findings are not subject to appeal or criminal revision. But a person with sufficient standing, such as an immediate family member, may apply for judicial view. The Public Prosecutor may, at any time, direct the Coroner to reopen a concluded enquiry or if an enquiry was not held in the first place, to conduct one. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill. – [Assoc. Prof. Ho Peng Kee]. Bill considered in Committee; reported without amendment; read a Third time and passed. ELECTRONIC TRANSACTIONS BILL Order for Second Reading read. 5.06 pm The Acting Minister for Information, Communications and the Arts (RAdm [NS] Lui Tuck Yew): Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." This Bill seeks to repeal and re-enact with amendments the existing Electronic Transactions Act (ETA) to maintain its relevancy in a rapidly changing digital world. It ensures that, going forward, the ETA will continue to fulfil its fundamental role of providing a conducive legal framework for electronic transactions to take place in Singapore.”
“This will expedite the release of the body to the next-of-kin after the Coroner has viewed and identified it. But let me assure Dr Lam that the norm will still be the current practice of the Coroner going down physically, right to the mortuary every morning to view and identify the body, and that includes weekends and public holidays. I should add that the decision, whether or not to hold an inquiry, is actually not determined by the viewing or identification of the body, but really by the factors that I have set out earlier under clause 25. Now, let me quickly address two other concerns that have been raised. Dr Lam asked if all Sentinel events resulting in deaths would be classified as Coroners' cases. For those of us who are not doctors, I understand that Sentinel events refer to unexpected deaths or major injuries in healthcare institutions that are associated with the treatment, lack of treatment or delay in treatment. Sir, indeed, there will be instances where a death occurring in a hospital will trigger both a Sentinel event report as well as a report to the Coroner. On the other hand, a major injury arising may be a Sentinel event but need not be reported as a Coroner's case, as there is no death. In any case, the point is that these two reporting systems serve different purposes, and are reviewed and managed separately. Sentinel event reports are made by the hospital's quality assurance committees to the Ministry of Health for the principal purpose of identifying and addressing any systemic issues. On the other hand, when a death is reported as a Coroner's case, this triggers a Police investigation that may eventually lead to criminal charges being preferred. As such, there are separate guidelines for reporting Coroners' cases and Sentinel events.”
“By way of comparison, the destruction of documents or electronic records, which may be required as evidence in Court, under section 204 of the Penal Code, is punishable with imprisonment of up to two years or with fine, or with both. The law takes a serious view of such offences. This explains the disparity in the maximum penalties, in terms of the equivalence in the Penal Code. But, of course, I think the point to note is that in any given case, the Court has the discretion to impose an appropriate sentence according to the facts of the case and the level of culpability involved. Will criminalising the failure to report result in an increase in the number of Coroners' cases involving medical-related deaths? First, I should say that as of now, the failure to report is already an offence. This Bill does not change the position, although as Dr Lam rightly points out, the instances of reporting are now made clearer, as set out in the Second Schedule. So, essentially, it should not lead to an increase in the number of Coroners' cases involving medical-related deaths. As to the current workload for Coroners and forensic pathologists: every year, approximately 4,000 Coroners' cases are handled and about 50% of these undergo autopsies. Dr Lam asked if it is acceptable for the Coroner to view and identify a body by a "live" video-link or any other such means, as the State Coroner may approve, in order to make the important decision of whether to hold an inquiry. Sir, this provision will enable the Coroner to harness technology in appropriate cases, where the Coroner may be indisposed to be physically present to view the body, without having to cause unnecessary delay to the progress of time-sensitive investigations.”
“Sir, as I have said in my speech, the provision in the Coroners Bill is based on those in the Subordinate Courts Act and the Supreme Court of Judicature Act. Essentially, the Courts will have to provide for the assessors' remuneration in their budget submissions to Parliament. Then, next, Dr Lam asks why the penalties for failing to report a reportable death to the Police and failing to preserve medical records are different. First, just to clarify that there is a general duty to report a reportable death in clause 5 by any member of the public for which the penalty for non-compliance is a maximum fine of $1,500 or imprisonment not exceeding one month or both. The penalty for failing to report a reportable death to the police under clause 5 is in line with the penalty in section 176 of the Penal Code which is an offence of intentionally omitting to furnish information on any subject to a public servant when one is legally bound to do so. This obligation applies to the public at large. Now, the intention is to ensure that the police receives information on reportable deaths so that they can conduct investigations. Then next, there is a specific duty to report deaths that occur in official custody in clause 6 which I think Dr Lam points to. The penalty for this is stiffer, and rightly so, because this reflects the public interest in ensuring the investigation of any death that occurs in official custody. Finally, there is an even stiffer penalty for failing to preserve medical records. The preservation of medical records is vital as it helps the forensic pathologist determine whether a death is medical-related. To fail to preserve the medical records for the requisite period is tantamount to disposal of evidence.”
“This is necessary because in the UK, forensic pathologists can operate out of private practice or a variety of institutions. Indeed, some Coroners in the UK may also outsource the work to hospital pathologists. So their historical development is quite different. In Singapore, all forensic pathologists must register with the Medical Council's Register of Specialists under the specialty of pathology. Forensic medical services are provided by the forensic pathologists employed by HSA which maintain professional standards through an internal peer review system and the performance appraisal that includes a professional component that is evaluated annually. HSA's Forensic Medicine Division is also fully accredited with the US National Association of Medical Examiners which requires its forensic pathologists to comply with certain performance standards. Next, what are the skills and experience required of assessors and how they are paid. Sir, essentially, an assessor advises the Coroner at an inquiry which involves technical, scientific or highly specialised matters so that the Coroner is better informed in making his determination. The value of an assessor lies in the fact that he is a non-partisan expert assisting the Coroner. The types of skills and experience required of an assessor will really depend on the facts of the case. For instance, whilst medical experts may be required in medical-related deaths, engineers will be useful. Their input will be useful for inquiries into workplace-related deaths. As for the remuneration of assessors, this is to compensate them to some extent for their time and expertise. The law currently already provides for the remuneration of assessors who assist the Courts in other proceedings.”
“On whether we should specify the requisite seniority or experience before a person may be appointed a forensic pathologist, currently the task of examining Coroner cases is carried out by qualified and trained forensic pathologists from the Health Science Authority (HSA) who hold post-graduate qualifications in this specialised field. The Bill essentially formalises this arrangement. All practising forensic pathologists in Singapore are presently employed by HSA. I think currently there are six, which require that such practitioners are not only registered as pathologists under the Singapore Medical Council's Register of Specialists but also hold relevant post-graduate qualifications in forensic pathology. By the time a medical practitioner attains the necessary qualifications and completes specialist training to qualify as a forensic pathologist, he or she would have had at least five to six years of supervised training and on-the-job experience. But Dr Lam also asks why forensic pathologists are appointed by the Chief Executive of HSA under the Bill, and not the Minister or the Attorney-General. Sir, the short answer to that is that HSA is a public authority charged, among other roles, with providing professional, investigative, analytical and other services in health sciences to the Government. It is therefore appropriate for the Chief Executive of HSA to appoint forensic pathologists to carry out functions under the Act. Unlike the UK, there is no need to keep a Register of Pathologists from which forensic pathologists can be appointed. The UK Home Office Register was established to ensure that forensic pathologists who provide services to Coroners and the police maintain professional standards.”
“While a State Coroner must be a District Judge, the other Coroners may be District Judges or Magistrates who as judicial officers, hearing civil and criminal cases in the Subordinate Courts on a daily basis, are well placed to perform the role of Coroners. This leads me to the next point that Dr Lam makes which is whether other professionals such as doctors can be appointed as Coroners. Sir, I note what the Member shares that in the UK, a Coroner can be either a lawyer or doctor of at least five years' standing. On this point, our view is that as functionaries of the State, judicial officers are in the best position to conduct independent fact-finding inquiries. But, we recognise that the circumstances of death in each case can be varied and may involve medical technicalities, that is why we have provided in the Bill for the appointment of forensic pathologists to assist in investigations and also of assessors from any technical field, including the medical field to provide expert input when required during an inquiry. So this will enhance the quality of investigations and also ensure that inquiries are not hampered by the lack of medical or other technical expertise. So, essentially, what we have done is to keep the basic approach of having Judges as Coroners who will be in-charge of the inquiry and, if necessary, complement his legal oversight with the relevant professional expertise, including medical expertise. Dr Lam makes a few points about the appointing authority and qualifications of forensic pathologists.”
“In the United Kingdom, appeals against the local Coroner’s decision can be made to the Chief Coroner. What avenues are available to relatives should they disagree with the decision of the Coroner? It is often asked, "What is the difference between Coroner’s case and Sentinel events?" It is important that clear guidelines be made available as non- reporting of supposedly Coroner’s case can result in persecution. Can the Minister clarify whether all sentinel events resulting in death will be classified as a Coroner’s case? In addition, will all Sentinel events leading to death be subjected to autopsies so that the actual cause of death can be determined? Are there clear guidelines for Coroner to decide if the case be signed off without autopsy or otherwise? Sir, the introduction of this Bill is certainly welcome as it clearly clarifies the Coroner’s jurisdiction, refocuses the role of Coroner to that of fact-finding, increases its effectiveness and enhances public confidence. With that, I support the Bill. Assoc. Prof. Ho Peng Kee: Sir, I thank Dr Lam Pin Min for speaking in support of the Bill. He raises a number of queries on selected aspects of the Bill which I will now address. Sir, on the appointment of Coroners, Dr Lam observes that the Bill does not specify the requisite seniority in terms of years of experience. As I have said in my speech, the seniority requirements are tied to the appointment of District Judges or Magistrates as Coroners who under the Subordinate Courts Act must be qualified persons of not less than five years and one year's standing respectively.”
“I would like to clarify with the Minister the rationale for the difference as it gives the impression of one offence being more severe than the other. With the criminalisation of non-reporting, it is likely that there will be a surge in the number of medical Coroner’s cases. What is the current workload of Coroners and forensic pathologists? Will the anticipated increase overwhelm our Coroner’s system? Clause 12 sets out the procedure for the Coroner to view the body and make preliminary investigations. It allows the Coroner to view and identify body by a live video link or any other such means as the State Coroner may approve, to make an important decision of whether an inquiry is needed. Will this provision trivialise the investigative process? What safeguards are there to ensure that proper identification and investigations are carried out and that important information will not be missed if the Coroner is not at the scene to view the body? Clause 32 provides for the appointment by the Coroner of not more than two assessors with skill and experience to assist in the hearing of any inquiry. However, the Bill seemed ambiguous with regard to the exact role and function of the assessor and the skills and experience required. Clause 32(3) also states that the remuneration of the assessor sitting in the inquiry shall be payable out of moneys provided by Parliament. Can the Minister elaborate on the remuneration procedure and its source, and how the rate will be determined? Will it be payable through the Parliament’s budget or from a budget to be nominated by Parliament? The Bill provides no provision for appeals against a decision made by the Coroner.”
“However, can a non-judicial officer, such as a medical doctor or other professionals, be appointed? If not, what are the considerations for deciding otherwise? In England and Wales, the Coroner must be a lawyer or doctor of at least five years standing. In addition, the UK also regulates the training requirements of appointed Coroners. Clause 4 of the Bill stipulates that the CEO of the Health Science Authority can appoint any pathologist as a forensic pathologist. Similarly, there is no mention of the seniority and experience required. Is there currently a pre-approved list of accredited pathologists from which the forensic pathologist can be appointed from? In the UK, there is a home office pathologist register from which the forensic pathologist can be appointed. What is the rationale for the provision for this appointment by the CEO of Health Science Authority? Why not the Minister or the Attorney-General? Clause 6 imposes a duty to report all deaths which occur in the course of arrest or detention or while the deceased is in official custody, except in cases of lawful execution of a death sentence. This duty is on the person effecting the arrest or detention or the person in whose custody the deceased was, to report the death. Failure to do so is an offence. Clause 8 imposes a duty on persons in-charge of hospitals, medical clinics or places of custody to preserve all medical records and healthcare records pertaining to the deceased. The penalties for failure to report death and preserve medical records respectively are fines not exceeding $10,000 for both and/or to imprisonment for a term not exceeding six months and 12 months respectively.”
“Mr Speaker, Sir, thank you for allowing me to speak on this Bill. This Bill is good and timely as it defines clearly the work and jurisdiction of the Coroner, shifts its focus to fact-finding rather than fault-finding, and for the first time, schedules that define reportable deaths and Coroner’s cases are clearly spelt out. The Coronial system was established in England in Medieval times. The duties of Coroners then included investigating sudden and unnatural deaths and also inquiries into treasure troves. The Coronial system underwent numerous changes in England and local Coroners are often medically qualified. The English Coronial system was introduced to many of its colonies, including Singapore. Whilst the system may differ in different countries depending on when they were introduced, the basic features of being a quasi-criminal proceeding, focussing on whether criminal conduct caused the death remained. The first Coroner of Singapore appointed was Mr Andrew Farquhar in December 1827. The laws on coroners remained largely unchanged and the processes were prescribed by the Criminal Procedure Code. This Bill is therefore a by-product of the Ministry’s review of the Criminal Procedure Code. Allow me to highlight some of my concerns on the Bill and to seek clarifications from the Minister on certain issues. This Bill defines the appointment of the State Coroner and Coroners and sets out their qualifications and functions. Clause 3 of the Bill stipulates that the Coroner must be a judicial officer appointed under the Subordinate Courts Act and in the case of the State Coroner, a District Judge appointed under the same Act. This Bill makes no mention of the seniority and experience of the Coroner.”
“It involves discussions with both companies and banks, as well as with Export-Import (EXIM) banks and Export Credit Agencies (ECAs) of other countries who can give us a detailed understanding of how they operate in the marketplace. We would like to find an approach that is commercially sustainable, and which also stays relevant through business cycles, not only at times of crises. Sir, we should also not rush into duplicating models elsewhere but instead explore solutions that meet the needs of our companies and address the gaps in our financial market. In the meantime, IE Singapore continues to support cross-border financing through existing schemes like the Loan Insurance Scheme (LIS) and LIS Plus, the Export Coverage Scheme (ECS) and the Internationalisation Finance Scheme (IFS).”
“Question No. 4, Sir. Assoc. Prof. Ho Peng Kee: Sir, the Insolvency & Public Trustee’s Office (IPTO) collects the statistics on bankruptcies that are due to use of excessive credit, the causes of which may include not only credit card debts but also bank overdrafts and hire-purchase spending. These are based on declarations made by bankrupts in their Statements of Affairs. Sir, last year, there were 2,058 bankrupts, of which 1,845 cases have filed their Statements of Affairs. Amongst these, 852 or about 46% declared that their insolvency arose from excessive use of credit. By gender, about 80% were male and 20% were female. By age group, 12.9% were between 21 and 30 years old, 38.2% were between 31 and 40 years old, 33.1% were between 40 and 50 years old, while the remaining 15.8% were above 51 years old. In terms of the breakdown by income, 18.7% earned no income, 20.4% earned $1,000 or less, 39.9% earned between $1,000 and $2,000, 13.3% earned between $2,000 and $3,000, while the remaining 7.7% earned more than $3,000. SPECIALISED FINANCIAL INSTITUTION FOR CROSS-BORDER SME FINANCING 5. Mr Teo Siong Seng asked the Minister for Finance whether he will provide an update on the study of a specialised financial institution to handle cross-border financing for local SMEs as proposed by the Economic Strategies Committee. The Second Minister for Finance (Mrs Lim Hwee Hua) (for the Minister for Finance): Sir, the study that the Member has asked about is still underway. The Government is evaluating how best we can realise the development of a market-based institution to support and catalyse cross-border financing for Singapore-based companies. The study includes an assessment of the various possible business models for such an institution.”
“I would like to thank the Senior Minister of State for the comprehensive answer. I would like to ask: what are the common and acceptable methods used by these licensed moneylenders to collect their debts? How does the Ministry ensure that these licensed moneylenders do not metamorphosise into licensed loansharks? Assoc. Prof. Ho Peng Kee: Sir, we are monitoring the situation carefully. We know that there is a surge in the number of moneylenders. Therefore, background checks are important to ensure that those who come on board as licensed moneylenders are not in fact migrating from the tough actions and the pressure we have put on illegal moneylenders. Let me assure Dr Lam and the House that no such migration has been detected. But the point I am making is that even though there is an increase in the number of moneylenders, they are put on notice. If there are complaints, the registry will check. Eighteen complaints were received last year and warning letters had been issued. As far as I know, three licences have not been renewed. A licence has to be renewed annually, so that any moneylender who does wrong can be checked easily. BANKRUPTCY DUE TO CREDIT CARD DEBTS The following Question stood in the name of Mdm Halimah Yacob – 4. To ask the Minister for Law in 2009 (i) what number of bankruptcy cases were due to credit card debts; (b) what percentage does this constitute in relation to the total number of bankruptcy cases; and (c) what are the profiles of these credit card debtors with respect to age, gender and income level.”
“Just a short question for the Minister. May I ask the Minister whether there is a quota imposed on the number of international students at the Duke medical programme. What is the maximum capacity that the programme can take in a year?”
“I would like to thank the Minister for the reply. Whilst vaccination may not completely eliminate the cervical cancer incidence, we understand that the vaccine actually provides a 100% protection against the two commonest HPV that causes 70% of cervical cancer. If the vaccination can be extended to the national immunisation programme, then that will be a great boost in terms of the mortality rate and the incidence of cervical cancer. I understand that the cost of the vaccine is about $200 per dose and we require about three doses. This can be prohibiting to many low-income families and I wonder if some form of subsidy or even the use of Medisave can be considered for this vaccination programme.”
“Mr Chairman, Sir, on behalf of the GPC and Members of the House who have spoken so passionately on various health issues, I would like to thank the Minister and Senior Parliamentary Secretary for their comprehensive, yet emotional, and at times moving responses. There is a Chinese saying, "医者父母心 (Yi zhe fu mu xin )", which basically means, as doctors, we treat patients with the heart and good-intent of a loving parent. Similarly, the Minister and his team shoulder a heavy responsibility of looking after the health needs of four million Singaporeans. This is by no means an easy feat and requires a even bigger heart than that of a parent. I am optimistic and confident that with a big compassionate heart and astute leadership, our healthcare system will undergo this quiet healthcare revolution successfully to remain relevant to the needs of all Singaporeans. On that note, I beg leave to withdraw the amendment. Amendment, by leave, withdrawn. The sum of $3,537,809,800 for Head O ordered to stand part of the Main Estimates. The sum of $643,606,300 for Head O ordered to stand part of the Development Estimates.”
“Mr Chairman, I have three clarifications for the Minister. First and foremost, I would like to ask the Minister while waiting for the new Jurong General Hospital to be ready, what is the plan for the old Alexandra Hospital and whether it can be made fully operational to help relieve the current shortage of beds. Secondly, I am happy to note that MOH is investing another $57 million for mental health programme. I would like to ask the Minister what are the deliverables and KPIs to help determine if this money will be well spent. Last but, most importantly, the Minister mentioned in his speech just now that although he is 58 years old this year, his residents commented that he looks much younger. Sir, I would like to clarify with the Minister whether he has found an elixir for youthfulness and whether he can share with us his secret recipe for staying young.”
“Mr Chairman, children with special needs have an array of different diagnoses – from learning disabilities like dyslexia to profound mental developmental delay; behavioural issues like autism, attention deficit hyperactivity disorder (ADHD) to psychiatric problems. Early detection of children with special needs will allow early intervention, leading to better outcome for these children. Currently, there is a lack of awareness amongst parents about these conditions and also a severe shortage of medical screening services for these children. This is aggravated by a shortage of professionals to provide such services. Does the Ministry have plans to raise awareness of these conditions amongst the public and also to grow this sector to cater to the increasing demand in Singapore? Health promotion and a healthy nation”
“Mr Chairman, Sir, over the years, Medisave has been liberalised progressively for payment of medical-related insurances, outpatient treatments and investigations. An example would be the Chronic Diseases Management Programme (CDMP) where Medisave is allowed to be used for the cost of outpatient treatment up to a cap of $300 per Medisave Account per year. However, we know that early detection and subsequent prompt treatment of diseases can improve the prognosis and outcome. I would like to urge the Minister to consider allowing the use of Medisave for health screening but still subject to similar restriction of capping the maximum withdrawal of $300 per account per year and strict guidelines on the types of screening allowable. This would prevent premature depletion and potential abuse of the Medisave savings of Singaporeans. Health screening”
“Mr Chairman, Sir, as more people are living longer, the incidence of age-related degenerative diseases of the brain, such as Alzheimer's and senile dementia, is expected to rise. Other mental illnesses, such as schizophrenia, depression and addiction are also on the rise. Unfortunately, the stigma attached to mental illness is still very apparent and people tend to shun mental patients due to lack of knowledge and understanding of mental conditions. More should be done to educate the public on mental health and diseases so as to help de-stigmatise this problem. There should also be better support from MOH in the form of mental health promotion and caregivers support. There is also an urgent need for the better integration of the services provided by VWOs and the Government agencies in the areas of social integration and community rehabilitation of patients with mental illness. I will, therefore, like to ask the Minister for an update on MOH's strategy in managing mental health and illness in Singapore.”
“Each Singaporean should also have a family physician to look after his physical and mental health. It is through self-discipline and responsibility that wastages can be minimised, and the limited healthcare resources be channelled to areas which need it most. May I ask the Minister for an update on the Ministry's "One Singaporean, One Family Physician, One Electronic Medical Record" strategic thrust? In conclusion, I am glad that the MOH has already taken steps to make our healthcare system more integrated and seamless through the Electronic Medical Records Exchange (EMRX) initiative, and the new regional cluster model where regional hospitals will be given more autonomy in day-to-day operations, manage polyclinics and their own network of general practitioners and a step-down care facility in their respective zones. However, more must be done to further integrate the public and the private healthcare sectors. I am sure, with determination and visionary leadership, Singapore can strive to have the best healthcare system in the world.”
“Without meeting the basic infrastructural requirements of a world-class healthcare system, we can never attain the goal of achieving a seamless healthcare system. I would like to ask the Minister for an update on the infrastructural development in the next 5-10 years, and whether these facilities will be able to cope with the increasing population, both residents, non-residents as well as medical tourists in Singapore. Third, building our medical manpower resources. The health workforce faces the challenges of a greying population as well as new technologies, lifestyle medicine and higher expectation, and demand for good medical care. There are shortages of healthcare providers in certain medical disciplines that will have to be filled. At the same time, the growth of the private sector may lead to higher attrition from the public sector. High quality care will be delivered by healthcare professionals who are trained in a holistic way to meet the standards of care in a changing, more sophisticated population. The challenge is to ensure adequate numbers of such healthcare professionals trained in different disciplines, especially in those healthcare disciplines that are currently under-subscribed, such as geriatric medicine, occupational speech and physiotherapy, just to name a few. Can the Minister elaborate on the Ministry's medical manpower build-up strategy to cope with the current shortfall and to address our long-term needs? Fourth, patient responsibility. The patient forms an important part of the equation of achieving a seamless healthcare system. Patients must actively manage their own health, taking personal responsibility in staying healthy by exercising and watching their diet.”
“Your entire medical history, from the time you are born till you reach a ripe old age, is available to any healthcare provider, with just a push of the button or just reading the microchip in a national medical identity card. The cornerstone of a seamless healthcare is an efficient, effective IT infrastructure. There should be a national healthcare IT network to integrate all healthcare entities in the country. Beyond just simple connectivity, it demands a system that inter-operates seamlessly to reduce duplication, errors, waiting times and management overhead or costs, resulting in cheaper, safe and faster healthcare services. Second, physical infrastructural development. The provision of physical healthcare infrastructure, such as hospitals, step-down care, nursing homes and primary healthcare facilities must be adequate to meet the increasing demand from the increased population and ageing population. The recent newspaper reports of shortages of hospital beds, patients waiting for prolonged periods at the Emergency Department before admission and the "alleged" premature discharge of unwell patients from hospital to free up beds are consequences of the inadequacy of healthcare infrastructure and, to a certain extent, a mismatch in the demand and the provision of medical services. We can have the best surgeons, best physicians, best nurses and the most conducive clinics. But if patients are made to wait long hours to be admitted, with long periods for their medical records to be traced and investigations repeated due to lack of integration with other healthcare entities, the whole patient experience of a seamless and efficient healthcare system will not be realised.”
“Our 3Ms, namely, Medisave, MediShield and Medifund, as well as our 3Es framework, namely, Eldersave, ElderShield and ElderFund, have ensured that our healthcare services remain affordable and that no Singaporeans will be deprived of the medical care that he or she needs. However, while Singaporeans enjoy a world-class healthcare system, we should not rest on our laurels, as there are still many areas that require further improvement. Our healthcare system must continue to evolve with the times to stay relevant to the changing needs of Singaporeans. So, what constitutes an ideal healthcare system? In my opinion, the characteristics of an ideal healthcare system can be illustrated by the acronym SAFE – S for Seamless, A for Affordable, F for Fast and E for Efficient. When all the key qualities are achieved, the result is a safe and high quality healthcare system for all Singaporeans. Much has been debated in the past about affordability and the provision of timely, quality medical services. I would like to take this opportunity to discuss how we can work towards propelling our healthcare system to the next level of excellence. The recipe for a seamless healthcare system will include the following ingredients: (i) information technology (IT) infrastructural support; (ii) physical infrastructural development; (iii) building our medical manpower resources; and last but not least (iv) patient responsibility. First, IT infrastructural support. Imagine walking into any healthcare institution in Singapore, whether it is a public or private hospital, polyclinic or GP clinic, step-down care or nursing home, pharmacy or blood test laboratory.”
“Sir, I beg to move, That the total sum allocated for Head O of the Estimates be reduced by $100. Sir, there are many different types of healthcare models, ranging from those completely operated by the Government to others based entirely on private enterprises. Some offer free national healthcare coverage, some rely on health insurance, and others require patients to pay all bills out-of-pocket at the time of service. There is no one size fits all solutions. Our system of healthcare when transplanted into another country such as the United States or United Kingdom, may not yield the same results and satisfaction for the Americans and the British respectively, as it does in Singapore. Singapore has come a long way from a very basic healthcare system half a century ago to one of sophistication and envy of many nations. I was reading this article in the Straits Times last Friday, extracted from an article published in the Washington Post. The title of the article reads: "US can get pointers from Singapore's healthcare system". Let me quote from the article: "Singapore, a poor country a few decades ago, now boasts a higher per capita income than the United States. And here's the astonishing fact: Singapore spends less than 4% of its gross domestic product on healthcare. The US spends 17%. Singapore achieves world-class results, thanks to a bold, unconventional synthesis of liberal and conservative approaches. The island's real ideology is pragmatic problem-solving." 7.00 pm Indeed, Singapore's healthcare system has been rated by the World Health Organization as the best in Asia and the sixth best in the world in year 2000.”
“There are more than 400 nuclear plants worldwide generating 16% of the world's electricity. While many governments are highly ambivalent about this energy source, especially its safety concerns, technological advances and stringent requirements since the Chernobyl accident have made nuclear energy a much safer option. In addition, it is friendlier to the environment as it produces very little carbon dioxide emission. Fossil fuels like coal account for half of electricity production costs while for nuclear energy, only about 3% to 4% of total production costs is due to the raw uranium. Volatile and rising oil prices have meanwhile made the relatively lower costs of nuclear energy more appealing but I understand there are challenges to making it a reality in Singapore. The Economic Strategies Committee (ESC) has recommended that Singapore should look into tapping on nuclear energy for this long-term energy requirements. I would, therefore, like to ask the Minister what is the feasibility of Singapore achieving this, considering the potential problems associated with nuclear energy generation and the geographical location and size of Singapore.”
“Mr Chairman, China and Japan are key strategic partners in ensuring economic and political security in the region. China's growing influence, both economically and militarily, has also raised some eyebrows amongst some major powers. Singapore enjoys good relations with China and is one of the few countries whose citizens enjoy visa-free access to China. China had also announced last year that a pair of endangered giant pandas will be delivered to Singapore as a sign of Singapore-Sino relations reaching a "new high". Similarly, Singapore and Japan also enjoy warm and cordial relations since 1966. There is also continuous exchange of visits at the highest levels. However, the elections last year ended 50 years of rule by the Liberal Democratic Party (LDP), with the Democratic Party of Japan (DPJ) led by Japanese Prime Minister Yukio Hatoyama, taking over as Japan's new government. I would like to ask the Minister for an update on the bilateral relations with both China and Japan, especially with the new DPJ government in Japan. How will the proposal of an East Asian community by the new Japanese Premier affect the Singapore-Japan relations and the centrality of ASEAN in the region? Japan-Singapore relations”
“Sir, the Individual Physical Proficiency Test (IPPT) used by the SAF to assess the physical fitness of our soldiers has been around since the mid 1970s. Over the years, new methods and equipment for fitness training as well as a better understanding of exercise physiology have evolved. Although it has been useful over the past two to three decades, I believe it is due for a review to examine its relevance to our 3G SAF servicemen. I would like to ask the Minister: (a) What are the objectives of the various exercise stations in IPPT and how effective and relevant are they in measuring the overall fitness of our servicemen; and (b) With the 3G SAF, what physical attributes in servicemen are deemed important and how can these attributes be assessed appropriately? Operationally ready National Service liability and tertiary education”
“The transformation to a 3G SAF fighting force involves hardware, software and liveware improvements. I would like to ask the Minister: (a) How much is MINDEF investing in defence research and development to enhance the capabilities of our 3G SAF; (b) What areas is MINDEF focusing on; (c) How have these investment paid off, and (d) What are the tangible benefits to the SAF servicemen on the ground? Basic military training”
“Mr Chairman, Sir, the Chinese have an ancient saying, "(In Mandarin ) 养兵千日, 用在一朝 (Yang bing qian ri, yong zai yi zhao)". In essence, it means that the maintenance of a military force, although costly and tedious, is vital to the survival of a nation, as we may one day need it to fend off our enemies. Singapore is fortunate to have enjoyed peace and harmony for the past four decades. In addition to training for conventional warfare, our SAF has also taken other roles such as battling terrorism, low-intensity conflict, peacekeeping and humanitarian and disaster relief missions. Of course, the SAF is also instrumental in organising the many wonderful National Day parades we have enjoyed for so many years. However, on a backdrop of a global economic crisis that has affected many countries worldwide, including Singapore and our regional neighbours, I would like to ask the Minister the following: (a) Has MINDEF's policy on defence spending changed following this economic crisis; (b) What is MINDEF's defence capability and built-up strategy over the mid- and long- term, taking into consideration the geo-political climate and development in the region? Defence research and development The technological advancement in warfare and weaponry is vital in gaining a superior edge over one's potential adversary. This is also in line with Sun Tzu's military strategy of overcoming the enemy with as little resources as possible. Being a small country, it is imperative that our armed forces be strong enough to act as deterrent to any potential enemy. However, technological advancement and military superiority can only be achieved with prudent investment in research and development.”
“Mr Chairman, may I have your permission to take the two cuts together?”
“Mr Chairmain, Sir, Singapore's involvement in international humanitarian and peace-keeping missions has increased over the years. Since the 1980s, the SAF had participated in many humanitarian and United Nation's peace-keeping missions. These include places like Aceh and central Java, Taiwan, East Timor, Iraq and Afghanistan, just to name a few. Whilst I understand the need for Singapore to play its part as a global citizen, such missions are not without risk to the lives of our servicemen. I would, therefore, like to ask the Minister the following questions: (a) What is the rationale for Singapore's involvement in missions situated far way such as in the Middle East and beyond; (b) Are our servicemen adequately trained and equipped to operate in these hostile conditions; (c) Are risk analysis performed before a decision is made to proceed with a particular mission; (d) and lastly, will Singapore ever take part in peace enforcement missions in the future? Fight against terrorism”
“Thank you, Sir. I have two supplementary questions. One is with regard to the utilisation of the different classes of wards. Does the Minister think there is any shift in the utilisation of the different classes after the implementation of means testing? Are we pushing Singaporeans to use Class B2 and C wards, rather than Class B1 and A because of the decreased subsidies? Secondly, with regard to the bad debt issue, is there a mechanism whereby the hospitals can advise Singaporeans, especially those from the low to middle-income groups, not to opt for the higher classes of wards because, at the end of the day, the bill may be quite substantial?”
“An investment in "green" energy means a future of low energy cost and a greener sustainable environment. Just late last year, the Inter-Ministerial Committee on Climate Change, chaired by Senior Minister Jayakumar, have laid firm targets to cut carbon emissions growth, ahead of the Copenhagen climate change summit. Under the Sustainable Singapore Blueprint, the Government has committed $1 billion over five years to improve the energy efficiency of our economy in industry, transport, households and buildings. Singapore has also pledged to voluntarily work towards cutting projected "business as usual" emission levels in 2020 by 16%, contingent on a global agreement being reached. I certainly hope this resolution will be the catalyst for the explosion of green industry in Singapore. Sir, on that note, I support the Budget. ADJOURNMENT OF DEBATE”
“Alternative energy market is an emerging industry potentially worth billions of dollars. Singapore should take the bold step of investing in this industry, not only to stay ahead in the "power" curve, but also to create employment in alternative energy jobs. With this expertise, Singapore can subsequently develop products and services that we can export to the international market. We live in a world where the need for energy is continually growing. But how will we be able to meet the ever-growing demands if we primarily depend on non-renewable resources? Today, fossil fuels supply more than 85% of the world's energy. Sooner or later, we will have to look for alternatives. It is always better sooner than later. So what can we do? The future is definitely not in fossil fuels, we know that. It belongs to renewable energy. Solar power, wind power and hydro power are the leading renewable energy technologies of today. Our overly dependence on fossil fuels is not a good thing and we should start making serious efforts to decrease it. Being dependent on something that will soon run out is not very healthy. The main objection against green energy is the cost. That is true. Renewable energy is generally more expensive, but for how long? When fossil fuels start to run out, the price will climb and we would not have a viable replacement. Green and renewable energy should be our main focus in the coming decades. The sooner we become free of our fossil fuel addiction, the better. Mr Deputy Speaker, Sir, global climate change with its profound global impacts is one of the most daunting challenges faced by policymakers. In addition, much of the traditional sources of energy are becoming unsustainable, making new greener sources of energy the wave of the future.”
“This overuse of air-conditioning indoors persists and the Government should step in to incentivise or penalise so that suitable temperatures can be adhered to. Many of us carelessly leave doors to air-conditioned spaces open, at the expense of the building management. We design buildings without effective mechanisms to reduce the amount of cold air escaping. The Government can further enhance the existing Energy Efficiency schemes in the form of public education, subsidies, tax rebates, grants, seed fundings and incentives, to make it a lot more appealing for individuals and companies to embrace the green movement. In the United States, families are given home tax credits of up to US$1,500 for energy efficiency improvement works in the homes. Maybe the Government can also consider this to encourage all Singaporeans to do their part. At the moment, the general perception of green technology is costly and requires a high start-up investment. But many people are not aware that green technologies and solutions can save so much energy that they pay for themselves, and therefore it makes sense to implement them. The Government can inject more grants and tax rebates into the Green Mark Incentive Scheme so that more developers and building owners will retrofit old buildings, instead of tearing them down and building new ones, to make them more energy efficient. The number of green vehicles on the road is less than ideal. The existing green vehicle rebate can be increased further to make it irresistible and more economical for car owners to switch to green vehicles. Or perhaps the Government can start a different COE category just for green vehicles to encourage the growth of these types of vehicles.”
“There is no place like home to start cutting emissions. A significant amount of greenhouse gas emissions come from our homes. Air-conditioning is one of the biggest energy users in Singapore homes. Installing timers on air-condition systems and setting the temperature at 24-25 degrees Celsius can help save energy. Appliances use electricity when on stand-by mode. Do turn off the TV or computer when not in use. Rather than use a screen saver, which uses just as much energy as a normal screen, simply set your computer to turn monitor off, say, after 5-10 minutes of inaction. Lighting makes up about 15% of our home's energy use. We can cut that by half in dark-coloured rooms simply by painting the walls white. Inefficient incandescent globes, invented in 1875, convert only about 5% of the energy they use into useful light, the rest being lost as heat. Switching to compact fluorescent lamps or LED lamps can save energy. LED lamps also last much longer and emit less greenhouse gas than compact fluorescent lamps. Singaporeans must be encouraged to reduce, reuse and recycle for general sustainability, and it also contributes to greenhouse gas reductions. Companies can do their part in improving their energy efficiency and reducing energy wastage. This will not only reduce their carbon footprint but also enhance their long-term business competitiveness. NEA's industry-focused Energy Efficiency National Partnership programme also provides the necessary help to companies who are keen to take the green initiative. Singapore is a paradox when it comes to temperatures. Many foreigners from temperate countries often remark how we are "summer outside, winter inside".”
“They have known for decades that all the waste gases we dump into the air would change our climate. They have been warning of the risk since the 1980s. Unfortunately, few people have listened. There was the Kyoto Protocol initiated back in 1997. World leaders patted each other on the back and then headed home and pretty much, everyone has overshot their targeted emissions commitments, a bit like a new year's resolution. Almost everyday, new information confirms that our environment has changed. In fact, our environment is changing even at this very moment as I speak. The recently concluded Copenhagen Summit did not bring much consolation to environmentalists lobbying for more concrete actions to be taken. It is too easy to be fatalistic and say that the challenge is just too enormous and that efforts by a small tiny nation like Singapore will not have made much of a difference. But that is incorrect. Every little effort counts and I believe sooner or later, tackling climate change would be an important agenda for all governments. We have reached a level of technological advancement that puts us in a powerful position to harness non-polluting sources of energy. Given the right technology and commitment of governments, it would be possible for solar, hydro and wind energy to power the whole planet on their own. Each of us can make a real difference to the amount of greenhouse gases released to the air. Do nothing and we consign the planet to a temperature rise of 6 degrees Celsius or more by 2100, and almost unimaginable changes to our climate, planet and lives. The changes we can make at home, at work and at school are not extreme. Simple adjustments that we can all make can stop millions of tonnes of emissions. Everyone of us can make a difference!”
“Mr Deputy Speaker, Sir, I rise in support of the forward-looking Budget announced by the Finance Minister. 2009 has been a difficult year for many Singaporeans. Whilst the current signs point towards a possibly strong recovery for Singapore and the region, the United States and the Euro zone are still facing high unemployment rates and uncertainties in their economic future. Economic survivability and long-term sustainability seem to be taking centrestage in this year's Budget. The Government has also announced many measures and schemes to help up-skill and raise the productivity of our workers. These are no doubt important initiatives as they affect the livelihood of many Singaporeans. However, we need to look beyond just economic growth and the competitiveness of Singapore. We need to have a big picture perspective of ensuring the survivability of mankind and its environment. The constant damages done to our fragile environment are irreversible and Singapore must do its part in saving the environment, even in our pursuit for economic growth. Despite inconclusive climate change talks at the Copenhagen Climate Summit in December, I am heartened that the Government is nonetheless pushing ahead with more spending for a greener Singapore. However, more should be dedicated to fight climate change, invest in green technology and incentivise companies and individuals to go green. Sir, we often hear people complaining about the weather. This is indeed a succinct and accurate statement about what is possibly the number one issue of our times. The world has been experiencing erratic weather and natural disasters. Many scientists have attributed the severe floods and droughts faced by many nations in the world to climate change.”
“Thank you, Mr de Souza for that clarification. I would like to point out that in the current system there is already a provision for the legal assessor to be in the DT. But to allow a doctor to sit in a legal DT and to be the Chairman, I think it is a different story altogether. So, there is no comparison between the two although we understand that doctors and lawyers can collaborate and work closely together for the benefit of the complainant.”
“Mr Deputy Speaker, Sir, in moving the Amendment to the Medical Registration Act, it is important that the Ministry gives an unequivocal signal to the greater public that there is really nothing seriously wrong with the medical profession here in Singapore. This amendment comes amidst many adverse media reports of medical glitches and, instinctively, Singaporeans may have the wrong perception that the state of medical malpractice may have reached an epidemic level, warranting harsher measures to be introduced. In the practice of medicine, the patient's confidence and ultimate trust in the doctor is vital. Hence, if the integrity of the medical profession is placed in doubt, good medical services can never be delivered as doctors may put up a self-protective shield by practising defensive medicine. On that note, I support the Bill. 4.39 pm”
“Neither is it about doctors refusing to countenance judicially controlled disciplining of the profession. It is about the principle and the spirit of self-regulation. The entire rationale of the existence of the SMC is to have a self-regulatory body, and that having non-doctors as the Chairman of the DT completely defeats this purpose. Hence, I hope that the Minister can clarify the impetus and rationale for this change. The new section 53 allows the Disciplinary Tribunal to impose a fine of up to $100,000, which is a ten-fold increase from the previous amount of $10,000. Many medical practitioners have expressed that this steep increase is alarming. I hope the Minister can also elaborate on the reasons for the need to raise it by so much. The proposal to set up a register of family physicians is indeed welcome as it serves to raise the overall standard of family medicine practice. Family physicians play an important role in the provision of healthcare to the general public. Family physicians deliver over 80% of the primary healthcare in Singapore and will play a pivotal function in the delivery of quality primary healthcare in the face of the changing landscape of a greying population. The newly established Family Physicians Accreditation Board will determine the qualifications, experience and other conditions for registration as a family physician under this Act. However, will existing family physicians be automatically included in this register? Or do they have to go through an arduous accreditation process, over and above the experience they have accumulated over the years of practice? I hope the Minister can clarify this.”
“However, before we undertake to go in that direction, it is also important to understand the background and rationale for the inclusion in these countries. In addition, the Law Society has decided to do away with appointing layman in their Disciplinary Tribunal (DT). If the Law Society is going in the opposite direction, how is it that the medical profession is regressing and arrogating responsibility? The new section 55 dealing with Appeals against orders by the DT allows SMC or an aggrieved complainant to appeal to the High Court against the decisions of the DT. The current system only allows doctors unhappy with the disciplinary decision against them to appeal. This is reasonable as the complainant must be extended the same privilege that is accorded to the doctor who is being complained against. However, section 55(2) states that this appeal to the High Court will be conducted by the SMC on behalf of the complainant. If the DT was appointed by the SMC in the first instance, would not this be seen as a "double whammy" where the doctor is being persecuted twice by the SMC? Will it also lead to a situation where almost every dissatisfied complainant will, by default, file an appeal without giving due consideration. I hope the Minister can elaborate on this. Mr Deputy Speaker, Sir, most professions rightly cherish the concept and privilege of self-regulation. This ideal is upheld if those who err are made accountable in the requisite measure and the quickest time. The proposed amendment to the MRA might suggest to some that it is not possible to find respectable, impartial, effective and legally well-advised senior medical doctors to chair a SMC DT. Sir, this debate is not about doctors protecting doctors.”
“In fact, a senior medical chairperson who has trodden the marathon of doctoring would have a deeper understanding of the nuances of a complex medical case in question. But if it is legally complex, then maybe such cases should be referred by SMC to the Courts, where it can be dealt with more fittingly. Whilst appointing a lawyer in the DT can be argued to increase the transparency of the disciplinary processes, it may be perceived as SMC lacking the moral courage and legitimacy to discipline high profile complex cases. As it is, the Disciplinary Committees already have lawyers as legal assessors, and also lay people sitting in ensuring transparency, the SMC can have the option of appointing more than one lawyer to observe the proceedings. Getting a lawyer to chair the Disciplinary Tribunal can be counterproductive as it may give the negative impression that SMC is arrogating responsibility. In a landmark case in which Singapore's ex-Chief Justice stated in his judgment: "We often enough tell doctors not to play god; it seems only fair that, similarly, judges and lawyers should not play at being doctors. A judge, unschooled and unskilled in the art of medicine, has no business adjudicating matters over which medical experts themselves cannot come to agreement." I understand the intent of the new proposal is to ensure fair outcomes for the public, the complainant and the doctor, and engenders greater general public trust in the profession. The inclusion of non-medical practitioners such as senior lawyers as chairmen in such tribunals is not unusual. It is practised in New Zealand and Victoria in Australia, Canada and Britain.”
“I would therefore like to ask the Minister what sort of training do the Disciplinary Committee chairpersons and members receive currently and if this training would be refined further in light of the latest amendments. Under the proposed amendments in the new section 50, the new Disciplinary Tribunal could be chaired by a senior doctor, or the Medical Council could exercise its discretion to appoint a senior lawyer, legal officer or retired judge for certain cases, in which case the Disciplinary Tribunal (DT) need not have lay person. This proposed change has led to a significant amount of unease and apprehension in the medical fraternity as the provision to allow the appointment of a lawyer to chair a medical Disciplinary Tribunal may send the wrong signal to the public that the medical profession lacks the integrity and ability to self-regulate. As highlighted by the Singapore Medical Association President in the Straits Times Forum page on 24th June 2009, one of the main concerns of having a lawyer to chair the DT is that "it may bring about the legal-ethics convergence, leading to a more legalistic SMC and a deterioration of ethics." The Minister has also mentioned in his speech that disciplinary inquiries increasingly involve complex issues that are legally and procedurally challenging and that in high profile cases, doctors have been known to engage top lawyers. However, the definition of "complex" is subjective and can be ambiguous. There are possibly three sources of complexity in any disciplinary case – it can be scientifically complex, in which a doctor is better than a lawyer to chair the DT; or if it is ethically complex, then a doctor will be no worse than a lawyer or could even be more appropriate.”
“As a consequence of this delay, complainants could be deprived of the option to initiate civil proceedings against the doctor. I am glad to know that one of the provisions of the amendment to the MRA is to address this shortcoming. Sir, I would like to touch on three key areas in the Amendment Bill, namely, the Singapore Medical Council's disciplinary processes, the financial penalty and the new Family Physician register. Under the current system, complaints of professional misconduct against any medical practitioners are handled by the Singapore Medical Council (SMC) which comprises entirely of medical doctors. When a complaint is lodged, the Chairman of the Complaints Panel will appoint a Complaints Committee comprising three doctors and a lay person, who will then be tasked to investigate the complaint and debate if a formal inquiry is necessary. The Disciplinary Committee (which this Amendment Bill proposes to rename "Tribunal"), comprises of three doctors (two of whom must be Council members), and a non-voting fourth lay person. The Disciplinary Committee must be chaired by a member of the Medical Council. Clause 26 repeals and re-enacts Part VII of the Act, with the changes to facilitate a more expeditious management of complaints by the SMC. These changes include the new section 38 and section 40 which enlarges the pool of the Complaints Panel and decreases the number of members in the Complaints Committee respectively. However, one of my concerns would be the availability of training to ensure that the appointed members of the Complaints Panel will be equipped with the appropriate knowledge to act effectively in their various roles.”
“Secondly, patients are also more educated and better informed these days. Many would have read all about their medical illnesses and treatment options through the Internet even before stepping into the consultation room. As a result, patients demand and expect more from their doctors and any deviation from the expected ideal can be perceived as unacceptable or worse – negligence. Gone are the days when doctors' words were taken as the "gospel truth" and their medical advice as "orders". Patients nowadays will demand the treatment they want to receive and would have no qualms questioning the doctors' treatment plans. I believe, and I hope I am right, that we have not deteriorated to the extent of being highly litigious, whereby doctors practise defensive medicine to protect their own interest rather than the interest of patients. Undoubtedly the cost of healthcare will escalate if we do go the way of the western countries. The practice of good medicine is a combination of both science and art. Doctors must exercise proper clinical acumen and professional judgment when treating patients as each patient is unique. There is no "one size fits all" in medicine. The doctor-patient relationship is also critical and proper communication and trusts are keys to minimising misunderstanding and unhappiness which can lead to potential legal actions. Unfortunately and coincidentally, there have been a few high profile cases of medical negligence reported in the media of late. It has also been highlighted by the Minister that as a result of the limited capacity of SMC in processing complaint cases, certain complex cases actually took more than five years to conclude.”
“Mr Deputy Speaker, Sir, thank you for giving me this opportunity to speak on the Medical Registration (Amendment) Bill. First and foremost, I would like to declare my interest as a practising medical professional. The Medical Registration Act (MRA) governs the registration of medical practitioners and regulates the conduct and ethics of doctors. It was last amended in 2003. It is therefore apt to amend the MRA to keep abreast the rapid changes in the medical profession. There is a rising trend in the number of complaints and claims against medical practitioners. This rising trend is a reflection of two major contributing factors. Firstly, the practice of medicine is becoming increasingly more sophisticated and complex. The advent of new medical technologies, surgical techniques, pharmaceuticals and emerging diseases has resulted in more treatment options for many medical illnesses. Many diseases that may have been deemed untreatable in the past can now be treated, albeit with more new modalities that can carry with it potential adverse effects and inherent risks. In addition, with more doctors and more procedures being performed, many of which are technically more difficult, the number of complications will inevitably increase. A good analogy that could be drawn is the rising number of road traffic accidents in recent years compared to 20 to 30 years ago where the number of road users and vehicles was much fewer. More cars, higher performance vehicles and higher speed limits on our highways all contribute to the rising trend. However, this does not mean that the drivers today are worse off in terms of their driving skills compared to those of yesteryears. Similarly, one should not conclude that doctors today are more reckless or less capable compared to the past.”