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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“There is a poem that best illustrates this sentiment, and I read: "Some say I am disabled but you know that it isn't true. I simply have a challenge a little different from you. My slight inconvenience has taught me things they could not know. Each obstacle is a victory enabling me to grow. There're really not many differences. I cry, I laugh, I snore. I do not want to be treated as if I am not a person anymore." Mr Speaker, the Government has emphasised the need to spend on R&D to spur Singapore's economy to the next phase of growth. However, many of these R&D spendings are on products with high economic value such as pharmaceutical, life sciences and technology. What is lacking is the R&D spending on products with high social value, such as assistive technology. The Government should seriously consider investing in this area to address the current and future needs of the elderly and the handicapped. Another vulnerable group that may have fallen through the cracks is the single-parent family. This year's generous Budget fails to give this group a boost, especially in difficult times like this. Mr Speaker, in Mandarin, please. (In Mandarin): [For vernacular speech, please refer to Appendix A*. ] Singapore's social policies espouse on strong Asian or Confucian values and place great emphasis on traditional family structures and self-reliance. Under this system, the society's overall good generally takes precedence over an individual's rights. The position of the Singapore Government is premised on the belief that specific social security programmes for single-parent families will create a potential moral dilemma that encourages dependency on the State as well as the promulgation of undesired alternative households resulting from divorces and pregnancy out of wedlock.”
“As Singapore ages, care services are being dominated more and more by diseases and injuries that affect the elderly, such as dementia, impaired mobility, impaired vision, impaired hearing and "general frailness". Therefore, the demand for rehabilitation and assistive devices will increase, particularly among extremely elderly people. In Singapore, there is currently no centralised agency that specifically addresses the assistive technological needs and requirements of the elderly and the handicapped. Available services, such as those provided by SPD and SAVH are generally very fragmented and there is very little knowledge and awareness of the availability of assistive technology. The assistive technological support offered is generally very basic, compared to what is currently available and commonly prescribed in the western countries, such as in Europe and the United States. Just take, for example, the Swedish Handicap Institute (HI) is a national resource centre on assistive technology and accessibility for people with disabilities. The Swedish Handicap Institute works to promote full participation and equality for people with disabilities by ensuring access to high quality assistive technology, effective provision of assistive devices and an accessible environment. It encourages research and development, tests and procures assistive devices, assists with the development of knowledge and methods and provides information and training. Many elderly and the handicapped want to live their lives independently and with dignity. Some may need a little basic assistance whilst others will request technological ingenuity to overcome their physical challenges.”
“More funding should be allocated to the provision and research and development of assistive technology for the elderly and handicapped. The use of assistive technology to improve the lives of the elderly and the disabled seems to take the back seat in Singapore compared to many of our first-world counterparts, such as the Nordic countries. The provision of assistive technology to people with disabilities is among the cornerstones of policy on disabilities in the Nordic countries. In countries such as Sweden and Finland, disability policies strive to bring about a society which makes it possible for people with disabilities to be fully active members of society. The fact that all people are equal is a basic starting point with regard to how society should be formulated, and people with disabilities are citizens with exactly the same rights and obligations as everyone else. Assistive devices are products which people with disabilities need in order to prevent future losses of function or ability and to compensate for impaired or lost function ability to cope with day-to-day life. Assistive devices can assist individuals to carry out the many simple and basic tasks (many of which we normal people take for granted) themselves or with the help of someone else. These would include getting dressed, eating, moving around, communicating with society, finding their way around and to taking part in normal leisure and recreation activities. As disabilities become more common as people age, the elderly will inevitably use assistive technology to a great extent. One reason why assistive devices are becoming more important is the fact that the number of elderly people has risen, as has the number of extremely elderly people, ie, those above the age of 80.”
“Unfortunately, there are a few blind spots which I would like to highlight. Some of the less fortunate and vulnerable groups of society have often been left out of the radar screen, left to fend for themselves, both in good times and in bad times. I would like to bring up the predicaments of two such groups – the handicapped (many from old age and sicknesses) and the single parents. They are are often sidelined as our country strives towards economic growth and prosperity. Indeed, these vulnerable groups are likened to the remnants of burnt rice stuck at the bottom of the rice cooker, often avoided because of its bitter taste and rough texture, even though it has similar beginnings as the much appreciated fragrant rice. Being one of the fastest ageing populations in Asia, Singapore faces the continuous challenge of developing public policies to accommodate this shift in the population demographics. As a result of improvements in sanitation, medical technology, and public health awareness, life expectancy has risen in Singapore to 78 years old for men and 81 years old for women; and this is expected to increase further in the next few decades. The Government has done a wonderful job in addressing the potential issues of financial security, employment, housing and affordable healthcare for the elderly. MOH is also stepping up infrastructural development such as building more rehabilitation centres, nursing homes and step-down care. However, what is severely lacking is the emphasis on social independence and improving the quality of lives of the handicapped and the sick and aged who want to contribute to the society and continue to stay in their own homes respectively.”
“Mr Speaker, Sir, I rise in support of the generous Budget announced by the Minister for Finance. It is indeed a challenge for me to speak as the last speaker, as I will be effectively scraping the barrel for pertinent, yet uncovered issues after having heard 52 other speeches before me. Nonetheless, as the Chinese saying goes, hao xi zai hou tou (好戏在后头) or , literally translated, "The best is yet to be ". 2008 has been a tumultuous year. The world economy has gone through a roller-coaster ride, starting from a high point of booming trade, skyrocketing stock indices and property prices to one of doom and gloom towards the second half of the year. What started as a sub-prime crisis in the US has swiftly cascaded to the rest of the world, to one of global financial meltdown and sinking into a deep recession – likely the worst since the last Depression in the 1930s. Many economists and analysts have coined this crisis, financial tsunami or economic Pearl Harbour, aptly reflecting the true severity of the current situation. I certainly hope that the world economy will not deteriorate into an economic Hiroshima. Our Government has done an appropriate thing in bringing forward the Budget Statement and announcing a generous Budget totalling $20.5 billion to help the Singapore economy and Singaporeans pull through this unprecedented time of difficulty. Previous speakers have already eloquently articulated and argued the salient features of this year's Budget. I will not attempt to repeat the points already so well put forward in this House over the past two days. But suffice to say, in all, the Budget is generally an all-encompassing one, with the sole objective of saving jobs and helping the low-income families.”
“Minister, I would like to highlight that I remember quite a number of these drownings actually happened at night and I was just wondering if the poor lightings along the banks of the river could have contributed to these fatal drownings, as any accidental falls into the river may be missed due to the poor visibility and, as such, whether the Ministry would consider improving the lighting conditions along the Singapore River. Assoc. Prof. Dr Yaacob Ibrahim: Sir, the lighting along the Singapore River is done in conjunction with the URA. But the point is noted that we can continue to review whether or not the lighting is adequate, especially in areas where there are crowds. But at the end of the day, it is also important for people who use the facilities along the river to take the necessary precautions. CONTRIBUTIONS TO NOT-FOR-PROFIT SECTORS (Measures to encourage donations) 15. Miss Penny Low asked the Minister for Finance what measures and tax incentives can be introduced to encourage contributions to the not-for-profit sectors, in view of the current economic conditions and the anticipated fall in such contributions. Miss Penny Low (Pasir Ris-Punggol): I declare my interest in the not-for-profit sector.”
“I would like to ask the Minister, whether he has a breakdown of the medical tourists statistics, into those seen at the private sectors as well as those at the restructured medical institutions and whether the Ministry has a process in place to monitor if the medical care to local Singaporeans has been compromised, especially in the restructured hospitals, as a result of the channeling of resources to service the medical tourists.”
“I have two supplementary questions for the Senior Minister of State. Will MOE consider including in its annual workplan a specific segment on students with special needs who are in mainstream schools? MOE runs schools like Northlight and Assumption Pathway, and there are 21 special schools run by charities. The reason is because this will ensure that these students are not forgotten in the MOE's key thrust and good work. The second question is: can MOE, as administrator of education in the charity sector, work with MCYS and its agency (NCSS) to develop one single integrated quality assurance, performance, evaluation and reporting system so that special schools, like mainstream schools, report to only one system and not to several systems from several agencies?”
“Mr Ong Ah Heng asked the Minister for Education in view of the single intake in January 2009 for students of Junior Colleges (JCs) and Millennia Institute (a) whether the JCs and Millennia Institute are ready for the students; (b) what differences will the single intake have on the students' curriculum; and (c) whether the five polytechnics will also be similarly ready to admit students earlier. The Senior Parliamentary Secretary to the Minister for Education (Mr Masagos Zulkifli B M M) (for the Minister for Education): Mr Speaker, we wish to assure our hon. Member, Mr Ong, that the Ministry of Education has been working closely with the Junior Colleges (JCs) and Millennia Institute (MI) to ensure that they are ready for the single intake in February 2009. The move to a single intake will not affect the curriculum. The duration of the new academic calendar is comparable to the existing one, and will provide teachers with sufficient time to cover the same curriculum. Unlike the JCs and Millennia Institute, the academic year of the polytechnics currently commences in April. We have no immediate plans to change this as the current arrangement allows the polytechnics to conduct several smaller admissions exercises after the main Joint Admissions Exercise (JAE) so that they can cater to other groups of applicants, including ITE upgraders. SPECIAL EDUCATION SCHOOLS (Inclusion in MOE's IT Masterplans) The following Question stood in the name of Ms Denise Phua Lay Peng – 9. To ask the Minister for Education whether staff and students from special schools are being considered and included in the formulation of the Ministry's annual work plans and initiatives such as the Ministry's IT Masterplans.”
“Mr Speaker, the senseless loss of 59 innocent lives in Bangkok's nightclub fire is a stark reminder that fire safety is paramount and should never be trivialised. The incident is not the first and will not be the last. I would like to ask the Senior Minister of State if the penalty will be increased to reflect the potential catastrophic outcome associated with the infringement of fire safety regulations, and also to send a strong signal to night entertainment club owners. Assoc. Prof. Ho Peng Kee: Sir, the penalties currently are stiff enough because a person who breaches the requirements of the Fire Code can, in fact, be imprisoned up to six months and fined up to $10,000. Of course, a composition fine can also be imposed. But that is only the deterrence part. What I have really painted is a comprehensive and holistic approach in Singapore, starting from the time when the premises are structured and also, on the part of the operators, the sense of responsibility exercised by them. So they are very aware that there is a need to comply with the requirements. Also, in terms of the enforcement being carried out, there is a process of issuing fire notices. And so far, as the figures have indicated, most, in fact, have complied. Let us work this system. Of course, I take Dr Lam's point that we cannot take things for granted just because the record has been good. We must ensure that the big fire that happened in Bangkok should not and must not happen here. JUNIOR COLLEGES AND MILLENNIA INSTITUTE (Single intake of students in 2009) 8.”
“I would like to ask the Minister what is the projection for the demand for hospice and palliative services with our rapidly ageing population and whether we are able to meet this demand in the short term and, if not, are there temporary or alternative measures in place to tackle this growing need. Mr Khaw Boon Wan: Sir, clearly, the demand for this will grow for two reasons, one is because of ageing, and second, is because I do intend to promote greater awareness of this need. I feel strongly about it. They are part and parcel of what end-of-life care requires. In many cases of the terminally ill, a good level of palliative care is available. As for the current supply, I think we are able to meet that demand. When I look at the inpatient hospice figures, the occupancy rate is not too high; we still have vacancies to take patients in. Hence, for the short term, we are all right, but for the medium to long term, I would like to see growth in this sector. I would say that all the terminally ill cancer patients ought to have a good level of palliative care. Today, I think more than half, maybe 60%, have access to that. What about the other 40%? Is it because of ignorance or what is it? We will try to find out why. But beyond terminally ill cancer patients, there are also other terminal illnesses which can benefit from palliative care – organ failure is just one of them. So I think it is a topic which I would like to encourage greater awareness among the patients as well as the carers.”
“Sir, whilst I appreciate the Ministry's effort to raise awareness and to simplify the processes, I like to ask the Minister: how are we going to measure this "awareness" amongst Singaporeans, because not every person who discusses about end-of-life issues will ultimately sign up for the AMD. What implications are there should the sign-up rate be high or low? Let us say, for example, if the AMD sign-up rate is high, does it reflect the fact that maybe health care cost is too high and they think that it is not affordable to maintain or sustain life any longer?”
“If not, can the designated medical practitioner who has the power to sign the order to detain up to one month be a non-specialist and potentially a trainee or junior doctor? Sir, in closing, let me quote from an American writer, Renata Adler, best known for articles in The New Yorker magazine: "Nothing defines the quality of life in a community more clearly than people who regard themselves, or whom the consensus chooses to regard, as mentally unwell." Sir, with that, I support the Bill. 3.41 pm”
“Perhaps, family members who ill-treat mental patients, like Mr Sujit Kumar from Fiji, known to millions around the world as the Chicken Boy, who was confined in a chicken-coop by his family for almost 20 years. It is equally culpable. I understand the need to be sensitive and not to over-burden family members who are caregivers, but it is imperative to send the right signals that we do not condone any ill-treatment of mental patients by anyone. And the Bill needs to be fair in prosecuting any wrong-doers, whether they are healthcare givers, family members or anyone else. Sir, I would also like to seek clarifications from the Minister on the following issues: (1) The Bill amends the maximum detention period of mental patients from 12 to six months, with further extensions requiring Magistrate approval. However, the Bill does not state if there is maximum period for this Magistrate's imposition. I would think that the maximum period is necessary as it mandates a thorough review of the patient's status before a further extension is allowed. Thus, preventing unnecessary prolonged detention of any mental patients. (2) Clause 15(5) allows a transfer to another hospital for treatment of non mental-related illness. This initiative is good as it allows prompt treatment of the non-medical condition in a better equipped facility. However, one concern is that when deciding on the medical facility for such a transfer, it should ideally be equipped in terms of physical infrastructure to handle such mental patients, especially if they are violent or suicidal. In clause 10 of the Bill, what is the definition of the designated medical practitioner? Must they be specialists, ie, psychiatrists?”
“Having said that, Sir, let me declare my interest as a member of the healthcare profession. I am a little concerned over the possibility of wrongful prosecution of mental healthcare givers. Mental healthcare providers are exposed to a wide range of patients with mental illnesses, many of whom are of the violent type. For instance, healthcare providers taking care of patients suffering from paranoid schizophrenia are susceptible to violent manipulation. In addition, given their mental state, the injury and ill-treatment may be self-inflicted, leading to the wrongful prosecution of healthcare givers. I hope the Ministry can recognise this possibility, no matter how remote, when investigating alleged claims of abuse by mental patients. Similarly, in the prosecution of ill-treatment, the same predicament faced by family caregivers needs to be taken into consideration, and judicious enforcement necessary. Usually, seemingly innocent problems are quite common for the elderly with mental illness. Hence, the issue of ill-treatment to people with mental illness, especially family members who are caregivers, needs to be enforced with greater care and sensitivity. For instance, the demented person may complain to others for being ill-treated by not being fed, while in actual fact they had been fed but could not recall recent events because of the nature of their sickness. Family members are already quite stressed out taking care of one of their members with mental disturbances, and may just keel over when confronted with unnecessary investigations into allegations of ill-treatment. I would like to clarify with the Minister the reason for not stating the penalty for family members guilty of ill-treating mental patients in clause 8 of the Bill.”
“Asians also have a tendency of somaticising psychological distress as physical pain. Experts in the field are in general agreement that early treatment of mental illnesses is crucial. Hence, I would like to urge the Ministry to engage and train primary healthcare givers, such as GPs, to help identify and provide early treatment, and to refer them to a specialist before the illness deteriorates. In Hong Kong, mental healthcare faces critical manpower shortage problem resulting in compromised quality of care, as well as physical and mental burnout of the caregivers. The situation in Hong Kong is likened to having five lids for 10 boiling teapots. Comparatively, in Singapore, as our population grows, the number of mental healthcare givers needs to correspondingly grow with it. The question to ask thus is, "Do we have an adequate number of mental healthcare professionals?" In the US and Canada, the ratio of professional psychiatric caregiver to the population is about 1:8,000. Whereas WHO recommends that the ratio should be about 1:19,000. According to the Singapore Medical Council's annual report, there are currently about 114 psychiatrists practising in Singapore. Based on WHO's recommendation, we should, therefore, have 210 doctors specialising in psychiatry. We need to act now, given the length of time needed to train the necessary medical professionals to meet these rising demands. Sir, it is a fact that mental patients are more vulnerable to abuse than their perceived image of "danger". Mental patients, because of the nature of their ailments, are prone to abuse with possibly little recourse. In that respect, I support the harsher penalty imposed for the ill-treatment of patients by healthcare givers as it serves as an effective deterrent against such acts.”
“In a highly stressful urban society like Singapore, we do expect to see more people suffering from some form of mental illnesses. In addition, as more people are living longer, the incidence of the elderly developing age-related degenerative diseases of the brain, such as Parkinson's, Alzheimer and senile dementia, is expected to rise as well. By the year 2050, Singapore would have the world's fourth oldest population. The introduction of the Mental Health (Care and Treatment) Bill is not only timely but also an important step in the right direction. Mental illnesses, such as depression, anxiety, schizophrenia or dementia, are growing problems plaguing many developed countries. In the United States, the Alzheimer's Association estimated that the direct and indirect cost of Alzheimer's disease and other forms of dementia amounts to about US$145 billion annually. A study on Singapore in 2004 estimated that about 5.6% of our adult population suffers from some form of depression. This figure works out to more than 200,000 based on our current population size of four million. This is indeed an alarming figure for our healthcare delivery system to tackle. If not managed properly, the cost overrun could be catastrophic to our national health budget. Notwithstanding the estimated number of 200,000 people suffering from depression, our Institute of Mental Health only treated a total of 33,000 patients last year, as alluded to by Mdm Halimah. This disparity in number of afflicted and those who sought treatment can be attributed to our Asians' perception of mental illness. Because of the stigma attached to mental illnesses, Asians are reluctant to seek treatment early when confronted with mental illnesses.”
“Mr Speaker, Sir, allow me to begin by quoting Dr Johann Christian Reil, one of the most progressive psychiatrists of his era, in the late 18th century. He said: "It is difficult to understand the incredible inhumanity with which mentally-sick citizens were treated. We incarcerate these miserable creatures as if they were criminals in abandoned jails, near to the lairs of owls in barren canyons beyond the city gates, or in damp dungeons of prisons, where never a pitying look of a humanitarian penetrates; and we let them, in chains, rot in their own excrement. Their fetters have eaten off the flesh of their bones, and their emaciated pale faces look expectantly toward the graves which will end their misery and cover up our shamefulness. Excited patients were locked naked into narrow closets and fed through holes from copperware attached to chains. Beatings were common and defended by shallow rationalisations. Strait jackets and chains attached to walls or beds were used to restrain patients, since the theory was that the more painful the restraint, the better the results, particularly with obstinate psychotics. The unsanitary conditions, lack of nourishment, wounds inflicted by the chains, and application of drastic skin irritants to increase the torment killed a large number of these patients." Mr Speaker, Sir, what I just recounted were not just fictional stories that could possibly be made into box-office movies, such as the likes of Hannibals or the Silence of the Lambs. Such stories still exist in this day and age, though not to such horrific extent all over the world in mental institutions and homes, whose raison d'etre is to provide the very refuge, protection and care for these vulnerable human beings suffering from mental illnesses.”
“The PUB is committed to finding new ways and means to improve our water supply but the solution lies in technology because Singapore is such a small space. We do not have enough catchments and, therefore we have to find some other ways of using technology to harvest all the rainwater that falls onto our land.”
“I would like to ask the Minister, in addition to the current available water technologies, what other R&D project is the Government investing towards water self-sufficiency and maybe even more affordable modalities of fresh water generation? And the second question is: are there plans to continue importing water beyond the said agreement? Assoc. Prof. Dr Yaacob Ibrahim: Sir, let me reply to the second question first. We have two agreements with Malaysia, one is expiring in 2011, the other one in 2061. The previous Minister and myself have mentioned in Parliament that we will not renew the 2011 agreement and we have communicated this to the Malaysians. For the 2061 agreement, it is still a long way to go. We will continue with that until the time comes for us to review it whether we want to prolong that or not. On the first question as to whether we are exploring other means, the answer is yes. We are exploring all other available technological solutions to harvest as much water as possible from Singapore's land area. NEWater has been our great success but we are not being complacent. For example, we have put a request for research proposal in which Simens has been awarded the contract to investigate how best we can reduce the energy costs for desalination. So we will try our very best to provide affordable water to Singaporeans and use technology to improve our water harvesting. Another example would be the Variability Salinity Plant, which is a water plant which can take both brackish water and river water at the same time. So we can change between slightly desalinated water and slightly fresh water and clean the water up. This allows us to put these plants at the various mouths of the canals across Singapore and thereby increasing the water harvesting in Singapore.”
“I would like to thank the Minister of State for the comprehensive answer. While I understand that the PA recipients receive a lot of assistance in kind, my question is actually about the PA allowance alone. I would like to ask if the Ministry could have a system whereby the PA allowance quantum be automatically reviewed on a regular basis, taking into consideration any appropriate indices deemed necessary for a fair and timely computation of the amount to address the basic needs of the PA recipients.”
“I would like to ask the Minister whether LTA has studied the effect of escalating fuel prices which have increased by almost 100% over the past year on the road traffic congestion problem and the mode of travel pattern of Singaporeans, especially those who own private vehicles. And if indeed the traffic condition has improved, should the Ministry not withhold the ERP increases for the time being?”
“Sir, I would like to thank the Minister for the comprehensive reply. I have three supplementary questions. (1) Under the current HOTA for altruistic living organ donations, is there a provision for employers to provide the necessary support to the donors in terms of paid leave or even extended medical leave? If not, would it not be useful to mandate donor-employer support so as to minimise the sufferings and sacrifices of these living donors? (2) By increasing the age limit of donor organ above the age of 60, is there any study to indicate the survivability of such organs; and (3) What is the cost of dialysis per patient per year? Will the legalisation of a kidney white market result in significant cost savings and better usage of limited medical resources, in addition to the alleviation of pain and sufferings among kidney-failure patients?”
“I would like to thank the DPM for the comprehensive answer. Personally, I am very satisfied with the honest and candid answers provided by the DPM in his Ministerial Statement during the last sitting and I have received many feedback affirming this. Notwithstanding this and the fact that the COI has ascertained that there are no criminal activities or negligence in any individual, the escape of Mas Selamat is indeed an unfortunate incident that can be attributed to several grave lapses. I would, therefore, like to seek the following two clarifications from DPM. We know that there are basically two main groups of culpable parties, those who did not conform to the existing SOPs and those that did not exercise due diligence in fulfilling their duties of ensuring the operational functionality as well as the physical security of the facility. I would like to ask the DPM: (1) Are the blame and disciplinary actions apportioned commensurate with the level of responsibilities and culpabilities of each individual officer? (2) Are there avenues and processes in place to allow these officers involved to seek redress or clarification on the disciplinary actions meted out and, if so, are the officers satisfied that the outcome is fair and just, and whether there are any appeals lodged by any of these officers?”
“The Bill requires the person who has reason to believe that he has or has been exposed to a significant risk of contracting HIV/AIDS to take reasonable precautions to protect his sexual partner, such as by using condoms. If a promiscuous person practises safe sex by using the condoms every time he engages in sexual activities, is he considered as high risk of contracting HIV/AIDS? Will he be considered safe and therefore be absolved of contravening section 23 of the Act? Section 23 also states that the person can go for a HIV test to confirm that he is HIV negative. Otherwise he must inform his partner of the risk of contracting HIV from him, leaving the partner to voluntarily accept the risk. Unfortunately, there is a window period for which an infected person can still be tested negative since it takes about three to six months to seroconvert to test positive. Will there be a validity period of the HIV negative results after which the high risk person will not be granted immunity from the law? What about intravenous drug abusers, especially those who share contaminated needles? Should they also be covered under this Act when they engaged in sexual activities with their spouses or partners? Last but not least, I would like to clarify with the Minister that section 23 of the Act is gender neutral and that it applies to both, the males and the females. Sir, on that note, I support the Bill.”
“It was during this period that my wife and I actually talked about plans for our then 2-year-old daughter should anything untoward happen to either or both of us. I can understand the public's apprehension of empowering the Ministry with so much power to limit the movements of people, closure of public areas to contain the outbreak of the disease and the seizure and arrest of properties and suspects respectively. However, these measures are absolutely necessary from a public health, safety and infectious disease control standpoint as any unnecessary delay may result in the rapid spread of the disease with unimaginable magnitude of potential lives lost. In this context, I disagree with Ms Sylvia Lim's suggestion that urgent Parliament be convened instead of investing the necessary powers to the Minister to handle such an emergency. Next, I would like to applaud the Ministry for enhancing measures to prevent and control HIV/AIDS. HIV/AIDS is presently a pandemic, with an estimated 33 million people infected worldwide and having claimed about 2.1 million lives. Tough actions to curb the spread of the disease are needed to prevent further escalation in Singapore. However, the proposed amendments to the Bill have cast some doubts on the intent and the practicality of enforcing section 23 of the Act. Clause 18 amends section 23 of the Act to shift greater responsibility to individuals whose sexual behaviour puts their spouses and partners at risk of contracting HIV/AIDS. What then is the definition of "high risk groups"? What is the definition of "promiscuity"? Is it more than one, two or three partners?”
“More recently, SARS infected a total of 8,096 persons between November 2002 and July 2003, with 774 reported deaths. This works out to a mortality rate of 9.6%. To date, the number of confirmed H5N1 human cases stands at 369, with 234 deaths so far. This works out to a mortality rate of 63%. With the world population today having more than tripled since a century ago, coupled with the ease of air travel and the potential high virulence of the H5N1 virus, what is to stop a modern flu pandemic from claiming upwards a hundred million lives? This is no science fiction story but a highly possible scenario that every nation must be cognisant of in their planning and preparation against any worst case scenario infectious disease outbreak. Fighting such an infectious disease is like fighting a war with an invisible enemy. As alluded by the Minister, SARS was a wake-up call to the nation and the world to the real threat of infectious diseases in this globalised world. Speaking as a medical professional who was at the forefront in the battle against SARS and having witnessed the unexpected loss of fellow friends, colleagues and their loved ones, I strongly support MOH's move to further strengthen its capabilities to detect, prevent and control the outbreaks of infectious diseases. SARS has taught us an important lesson – to be prepared for all eventualities. During that dark period, as a precaution, my wife and I shifted out of our family home so as to minimise the potential exposure of the disease to our parents and child since we were both healthcare workers and were considered high risk personnel for contracting SARS. The SARS episode has also taught us the vulnerability of human lives.”
“Mr Speaker, Sir, I rise in support of the Infectious Diseases (Amendment) Bill. Throughout history, the movement of infectious diseases across the globe has been intimately associated with the movement of man himself. The most spectacular example of this was the spread of bubonic plague throughout Europe during the 14th Century, which closely mirrored the migration of the civilian population in advance of the Monguls' invasion from the East. This indirectly led to the first attempt at control of communicable diseases related to travel. In England, several small communities attempted to isolate themselves by preventing all contact with outsiders. The most famous of these was the village of Ian in Derbyshire which now has a museum dedicated to the disease. The impact of commercial airliners on communicable diseases cannot be underestimated. The profile of the traveller has changed from someone moving through necessity, such as businessmen, immigrants or soldier, to someone travelling through choice, ie, the holiday-maker. As a consequence, many people are exposed to an increasingly diverse array of infectious diseases. Air travel and globalisation have brought a whole new dimension to the epidemiology, surveillance, spread and control of infectious diseases. The world has shrunk literally and diseases can spread from one end of the world to the other within a short span of one to two days. Many experts have warned of the possibility of another influenza pandemic occurring. It is not about the certainty of it happening but rather the question of when and how soon. During the Spanish flu pandemic in the early 20th Century, the mortality rate of the disease was 2%-5%, with the number of deaths estimated between 20 and 40 million worldwide.”
“I would like to ask the Minister what was the impetus behind this aesthetic medicine debacle recently. Was it because there was an alarming increase in the number of complaints with regard to the complications arising from such procedures to SMC or to the Ministry of Health?”
“I would like to ask MOS, with the liberalisation of air rights as well as the advent of more ultra long-haul aircraft, such as the A345 and many more that will come up, how would this impact on the air traffic volume to Singapore, and whether MOT has taken these changes into consideration in their strategy to maintain Changi Airport as an aviation hub?”
“Sir, competition in the aviation industry is fierce, and getting hotter by the day. Singapore's Changi Airport may enjoy pole position today but the competition from the region remains very keen. Hot on our heels are KLIA, Bangkok Suwannaphum Airport, Dubai International, and Hong Kong's Chek Lap Kok Airport - probably counted as the strongest rival to our Changi Airport. In fact, a new airport being built by the Chinese Government in time for the 2008 Beijing Olympics will be the world's biggest and can be truly awesome, according to its British architect, Lord Foster. We have done a whole lot in recent years to improve and transform the landscape of Singapore that will result in significantly more tourist arrivals. The staging of the inaugural Formula 1 night race this year, completion of the two Integrated Resorts in 2009 and 2010 respectively, and our recent success in our bid to host the Youth Olympics in 2010 will inadvertently put Singapore in the world map once again. We should continually look into improving our infrastructure and our connectivity to keep our competitive edge as a regional aviation hub. I would like to ask the Minister the following: what are our strategies to maintain Singapore as an aviation hub amidst the rising competition from regional players? How would the recent developments towards air liberalisation place additional challenges on our status as an aviation hub? And lastly, with the introduction of many more ultra long haul planes, such as the A345 and Boeing 777 extended range, would our strength of high connectivity and being a transit hub become irrelevant? Changi Airport”
“Whilst many understood the rationale for pricing the taxi charges higher, the majority found the ERP charges imposed on public transport, in this case, tax, is unfair. I would like to urge the Minister to consider the following suggestions to alleviate the financial burden on the less well-off Singaporeans and the retirees: (1) Consider concessionary fares for the senior citizens and retirees to be extended to the whole day rather than during the specified periods only; (2) Extend free rides to all children of ages four and below, rather than using the height criterion of less than 0.9 metres; (3) Waive ERP charges for taxi; and (4) Issue special concession cards to the low-income families, especially the Public Assistance recipients so that they can be entitled to subsidised public transport. This is somewhat similar to the concept of the medical and education assistance under the Public Assistance scheme. Transport for the Elderly”
“Sir, I had a dialogue session with my residents on Singapore's land transport system recently, and one of the feedback that resonates so frequently was the affordability of our public transport system. Many, especially the low and middle-income residents, are worried that the rising costs of public transport, aggravated by the steep rise in food prices, will add to their burden of high cost of living in Singapore. Not surprisingly, those from the lower-income families have no choice but to rely solely on public transport while the higher-income households can enjoy the luxury and convenience of private cars and the occasional novelty of riding on buses and MRTs. Paradoxically, the majority of the lower- and middle-income households reside in the suburbs, such as Yishun, Sengkang, Punggol and Jurong, incurring higher costs on their public transportation due to the longer distance needed to travel from their residence to the city area and vice versa. The recent announcement on the land transport review is viewed by many Singaporeans with mixed feelings and skepticism. We can expect more comfortable bus and train rides, less crowding, shorter waiting and travelling times. These are positive outcomes that the majority, if not all, Singaporeans would welcome. However, many are concerned that the cost of improving the public transport services would inevitably be passed on to the commuters, resulting in the cost of bus and train rides to be increased significantly. This comes at a time when inflation is set to worsen, adding to the financial burden of low- and middle-income Singaporeans. Another pet peeve experienced by those who utilise the taxi services would be the higher surcharges imposed during peak hours and the mounting ERP charges.”
“I would like to thank Minister Lim for his response to our call for a caregiver's allowance. In fact, I was quite heartened by his response when he said that the Government is not ready to provide the allowance yet, compared to what the response was last year when I brought this up. It was a flat no. I agree with the Minister that we must not monetise the duty and responsibility of providing care for our loved ones. In fact, we should not place a price tag to filial piety because it is priceless. However, for the low income family, this additional financial assistance goes a long way in alleviating the financial burden faced by them and many of these families are actually living from hand to mouth. Therefore, I would like to urge the Ministry to study this closely and hopefully, next year, we will have a positive reply.”
“In anticipation of such demographic trends, I hope that MCYS will study how to better support caregivers, both financially and psychologically. (In English ): Often times, caregivers have to quit their jobs to care for their loved ones at home. Home-based care not only provides the ideal cost-effective long-term care of the elderly frail and disabled in the family, it also helps free up limited vacancies in daycare centres and old folks' homes for families who genuinely requires such services. Having said that, it is ultimately the responsibility of family members to provide the necessary love and care, and such fundamental values of filial piety should never be eroded with time. I hope that MCYS and PA would also continue to inculcate and promote such family values and virtues among Singaporeans. I am not advocating that caregivers be given an exorbitant amount of allowances but rather token amounts to help alleviate the financial burden faced by such families. Another alternative would be to register bona fide caregivers as part of the workforce, thus qualifying them for workfare bonuses under the Workfare Incentive Scheme. One might argue about the practicality and difficulty in defining a bona fide caregiver. But I believe such semantics and administrative hurdle should not be a road-block to providing the financial support such deserving caregivers so desperately need. I would therefore like to urge the Minister to consider providing allowance to caregivers in Singapore or even extending the Workfare Incentive Scheme to them so that their sacrifices and hard work will not be left unrecognised. *Cols. 2293-2294.”
“The caregiver's role for a family with persons with disability or mental disorders can be very demanding and could be a lifelong responsibility. Without adequate support. caregivers are prone to exhaustion, emotional stress, financial and other care-related strains, resulting in burn-out of the caregivers and premature or unnecessary institutionalisation of persons who can otherwise benefit from home care. Yes, the Ministry would argue that there are already existing programmes, incentives and services, such as caregiver training grant, foreign domestic worker levy concession, family or caregiver support group, etc. However, the common feedback from caregivers is that whilst they are appreciative of the efforts put in by the Ministries and the VWOs to support them, they felt that many of these efforts are ad-hoc and there was a need to ensure continuity. In Mandarin, Sir. (In Mandarin): [For vernacular speech, please refer to Appendix A *. ] With the high standard and cost of living in Singapore, most of us would require a regular paying job to support our families and ourselves. However, there are many families among us with elderly sick or disabled family members who require special attention and care. The care of a disabled family member and the elderly sick can be emotionally, physically and financially draining. Often times, caregivers have to quit their job to care for their dependent loved ones at home. Many countries have already embarked on providing caregivers with monetary allowances designed to compensate family caregivers for their unpaid effort and stress. In Singapore, our increasingly ageing population with one in five expected to be above the age of 65 in 2030, we will all be receivers or givers of care at some point in our lives.”
“Sir, allow me to relate this story published in the Straits Times Forum page last year by a fellow Singaporean, Mr Raymond Anthony Fernando. He wrote: "As a sole caregiver to my wife who was stricken with schizophrenia 17 years ago, my journey with her has been extremely painful. With hardly any support from family members, I have been burnt out several times - physically, mentally and financially. It is a very real struggle for me to provide a safe haven for her in a world that is filled with prejudice and discrimination against people with mental illness. I am often helpless, laughing on the outside, crying on the inside. There is no one to provide even a listening ear in my weakest moments." He went on to say: "The structural support for caregivers in Singapore is very weak; many a time, it is just not there. This is why I have been relentless in speaking up for both the mentally ill and their caregivers. I raised the issue of a caregiver's allowance last year because caregiving is a full time job, especially with those stricken with mental disorders. I urge the Government to help in our very difficult journey. Do not neglect citizens who need support badly." This story is real and it is not unique. There are many Singaporeans out there who are facing the same predicament, many not knowing where to turn to for help, suffering in silence. It very much sums up what I have to say. There are basically two fundamental issues at hand: Caregivers' support and allowance and social support for patients with mental disorders. However, my cut will only touch on the former. Caregiving is a challenging task that can impact a caregiver emotionally and physically.”
“Thank you, Madam, for giving me this opportunity to ask two clarifications. One is with regard to retaining medical health professionals in the public sector. We understand that there is always an efflux of top surgeons or specialists into the private sector because it is always more lucrative in terms of monetary factors. I remember the last time we had a pay revision in the public sector, it was probably umpteen years ago. I want to ask the Minister whether there is a feasibility of benchmarking the pay of public healthcare workers to those in the private sector. The second question is with regard to incentives to stay trim. One of my suggestions is whether we could incentivise by lowering the medical premium for health insurance for people who keep trim and fit. We can actually use the BMI as a standard to measure health, maybe even a lucky draw for people who remain healthy or thin for that matter.”
“I would like to ask the Minister: (1) What are the plans and strategies to cope with this increased demand? (2) What assurance can MOH give to the average Singaporeans that they would not be unduly disadvantaged or sidelined as a consequence of medical tourism?”
“Sir, more and more people the world over are seeing the attraction and benefit of seeking medical treatment overseas. The figures are staggering and, to illustrate this clearly, it has been estimated that the amount generated by medical tourism worldwide will amount to about US$92 billion by 2012. Every practitioner in the private medical industry wants a slice of this growing pie. Singapore is no exception. Singapore Medicine was launched five years ago with the goal to attract one million medical tourists by 2012. Our share of the medical tourism market has been steadily climbing too. Achieving our target by 2012 would generate about S$2.4 billion in healthcare expenditure as well as 13,000 jobs. This is good for Singapore in more ways than one. It is also a goal that we can achieve, given the good reputation of the Singapore medical profession, both in the public and private sectors. However, as it is, the world is facing a shortage of medical professionals. This has resulted in a brain drain not only between countries but also between the public and private healthcare sectors. Singapore is not spared of this phenomenon as well. It is common knowledge that our professional healthcare givers in the restructured hospitals and polyclinics are usually overworked and some may even conclude that they are under-remunerated. It is thus not surprising to see an exodus of healthcare professionals from the public to private healthcare sector. For the average Singaporean, with the increased arrival of tourists competing for medical services, they fear that they may be sidelined. As it is, the current long waiting time in restructured hospitals would be worsened if the infrastructure is unable to cope with this increased demand.”
“However, I understand that times have changed and the society and younger Singaporeans take a more liberal view about sex. It is, therefore, more important to educate teenagers on the importance of safe sex. I would like to ask the Minister what additional efforts will be put in place to address the issues of teenage abortions in Singapore, and what indicators or targets will be used to monitor the effectiveness of such initiatives. The Living Will”
“(3) Can the Ministry implement incentives to encourage Singaporeans to stay trim, such as lower premiums for health insurances, something to the likes of no claim bonus in motor insurance? Let me switch from fat to sex now. Teenage Abortion Sir, our teenagers' cavalier attitude towards pre-marital sex is a cause for concern. According to some of the surveys conducted, it is a matter requiring immediate attention. "It just happened," said one teenage girl who engaged in unprotected sex after one drink too many with a casual friend. Teenagers are adopting a more liberal attitude towards sex. A poll of youngsters between 16 and 23 years found 13% of them were sexually active. A survey conducted by pharmaceutical company Bayer Schering, Pharma Singapore and Youth.sg, an online portal, revealed 23% did not use any form of contraception. In the first nine months of last year, 657 young people sought help for sexually-transmitted diseases. In addition, the rising number of teenage abortions strongly suggests that sex education amongst our teenagers is inadequate. Of the 12,000 abortions in 2006, teenage abortion accounts for 11%, with 19 cases performed on girls under the age of 15. Abortion should not be used as a form of contraceptive. Frequent abortions can result in possible medical complications, such as womb infection, bleeding problems and even sub-fertility. Not surprisingly, the increasing number of young people engaging in pre-marital sex has resulted in more teenage abortions, teenage pregnancies and sexually-transmitted diseases. Sex education has been shown to be effective to correct the ills of pre-marital sex and teenage pregnancies and abortions. Teenagers should be educated on the moral values and virtues of abstinence from pre-marital sex.”
“Sir, obesity has reached epidemic proportions in some countries like the US. While the prevalence of obesity in Singapore has not reached such alarming levels, it is still a matter of concern, as statistics have shown that the prevalence of primary school children with obesity is about 12%-14%. A 32-year study published in the New England Journal of Medicine reports that obesity spreads within social circles. Interestingly, we base our idea of appropriate body size on people we trust. We have a 100% increase in our risk of obesity if we have an obese best friend, 44% if our brother is obese, and 37% if our wife is obese. Therefore, the latest doctor's advice is - choose your friends carefully! In our looks-obsessed society, lots of people think that being overweight is only an appearance or aesthetic issue. But being overweight is actually a medical concern because it can seriously affect a person's health, both physically and psychologically. The association between obesity and cardiovascular diseases is well established. Other health problems that can affect obese individuals include arthritis, diabetes, depression and lower self-esteem. In addition, European researchers report in a recent study also link obesity with certain cancers, such as thyroid and kidney, among others. Prevention is one of the best strategies to address the long-term effects and high costs of treating the co-morbidities of obesity. I would like to ask the Minister the following questions: (1) What measures or programmes are put in place to educate Singaporeans the ill effects of obesity? (2) Is the Ministry working closely with MOE and MCYS to prevent obesity at its early stage, in the childcare centre and in the schools?”
“What strategy is the Ministry taking to ramp up the supply of medical professionals to cope with our rapidly ageing population? Lastly, I would like to urge the Ministry to embark on research programmes in the prevention of age-related mental degenerative diseases. Ageing Society and Ambulatory Community Care and Support”
“Sir, the filial daughter-in-law looking after her demented father-in-law made the mistake of leaving him alone at home while she went downstairs to run some errands. She was only going for no longer than 10 minutes. What harm can possibly happen? She did not bring the keys to the flat and spent the next three hours trying to coax her father-in-law to open the door to let her back into the flat. Welcome to the world of reality and dementia. The risk of developing degenerative mental problems such as dementia and Alzheimer's disease increases with age, doubling every five years after the age of 65. Given that 20% of Singapore's population will be 65 and older in 2030, we will be facing a potentially serious problem in the future. If our current population remains constant by 2030, that is four million, we are likely to have 800,000 above the age of 65 and a significant proportion is likely to be suffering from some forms of mental degenerative diseases. The number of people suffering from dementia and Alzheimer disease is set to grow, as our population greys. Medical science can help slow down the degeneration but it cannot cure. More programmes must be put in place to get us ready to deal with this disease. It can be overwhelming for family members confronted with a member suffering from dementia. Yet, family members, as carers, are the most cost effective and conducive. Towards this line, I would like to ask if the Ministry of Health is prepared to step up its programme for families of demented patients. 4.00 pm Secondly, the ratio of medical professionals, especially in the fields of geriatric medicine, psychological medicine and allied health, such as physiotherapists and occupational therapists, to the population appears inadequate.”
“This is especially imperative for solo medical practitioners who do not have the luxury of manpower to submit the reports. Sir, in the area of mandatory registering of diseases, many countries, such as the United States, Canada, Australia and New Zealand, had done more and are way ahead of Singapore. The introduction of the National Registry of Diseases Bill is, therefore, timely and would aid the Ministry in the formulation of sound healthcare policies and public health programmes that would benefit Singaporeans. On that note, Sir, I support the Bill. 4.12 pm”
“In certain countries, these cancers are exempted from reporting, as they are rarely fatal and usually do not require hospitalisation. In addition, I would also like to ask the Minister if benign tumours with the potential to cause fatality, such as meningioma of the brain and nervous system, be considered in the definition of cancer in the Schedule? The Bill is certainly designed with the intent to expand the scope of reportable diseases in the future. The inclusion of other common diseases that afflict Singaporeans, such as stroke, diabetes mellitus, heart and renal diseases, into the Schedule will be useful, and I urge the Ministry to seriously consider doing this sooner than later. This would enable relevant medical information to be collected, analysed and researched to support formulation of effective public health policies on possible prevention and control of these common diseases. In the process of reporting and data collection, the issue of patient confidentiality is an important one. Well-trained staff and strict procedures must be put in place to protect patients' privacy and medical confidentiality. The data in the Registry must not be released to any other parties, such as employers and insurance companies, without the prior consent of the patient. The use of International Classification of Disease (ICD) codes in the reporting should be considered as it provides, to a certain extent, a "masking effect" on the disease conditions to untrained personnel. In order to enhance compliance and to minimise inconvenience to the healthcare institutions and medical practitioners, I am glad to know that the Ministry is considering different modes of submissions, either electronically or paper reports. The entire process should also be made simple and seamless.”
“The introduction of the National Registry of Diseases Bill is therefore important for the following reasons: (1) The information collected will provide significant contributions to efforts to find causes of diseases; (2) It is the most accurate way to determine the number of people with a particular disease and to identify trends in disease rates; (3) It can determine whether demographic factors, such as race, ethnicity, gender, age and place of residence, influence the likelihood of developing the disease; (4) It provides systematic ways to link diseases to environmental risk factors, by linking with environmental health databases; and, lastly, and most importantly, (5) The identification of factors causing the disease is the first step towards the prevention of the disease. The Singapore Cancer Registry was the first to be set up in 1968. With its well-established processes, it is therefore natural and understandable to make cancer the first reportable disease to be included in the Schedule. Cancer is the leading cause of death in Singapore. It accounts for 28.5% of total deaths in 2006, with ischemic heart disease tailing behind at 18.5%. In order to position Singapore as the centre for cancer research, the Singapore Cancer Syndicate was formed to enhance cancer research and to bring it to the next higher plane. The data collected under this new Act would definitely go a long way to bolster the efforts in enhancing cancer research in Singapore. However, I would like to seek clarification from the Minister if the definition of cancer in the Schedule encompasses only malignant tumours. Will there be exclusions, for example, for selected skin cancers, namely, basal and squamous cell carcinoma of the skin?”
“Mr Speaker, Sir, I rise in support of the National Registry of Diseases Bill. The healthcare services in Singapore have a reputation of being world-class, reliable and efficient. The combination of excellent healthcare infrastructure, availability of skilled medical professionals and the latest medical technology has made Singapore the convincing healthcare services hub in the region. However, in order for Singaporeans to benefit from the excellent medical services available, rational and well-thought through healthcare policies are necessary, and I fully agree with the Minister's comment that good healthcare policies are underpinned by accurate and timely information. There are currently a few disease registries for the common medical conditions, such as cancer, heart disease, renal disease and, most recently, stroke. Unfortunately, there is currently no law to make the reporting of these diseases mandatory and, as such, the data collected is largely from the public healthcare institutions, which submit it on a voluntary basis. This has inevitably resulted in incomplete collection of data with limited usefulness for national level policy planning and research. In fact, inaccurate or incomplete information may in turn give false correlations and become useless for research and disease prevention.”
“As evident from past reports of unexpected adverse events and drug interactions of certain medications, up-to-date knowledge of such events is crucial to the pharmacists so that they can advise the patients accordingly when dispensing the drugs. With the setting up of the Register of Specialists, it will be apt to classify the continuing professional education requirements to core and non-core, where registered pharmacists must clock sufficient points in their core area of specialty while the remaining points from non-core educational programmes. This is similar to that of the medical professional specialist CME requirement. Singapore Pharmacy Council The replacement of the current Pharmacy Board with a new statutory body, the Singapore Pharmacy Council, serves to broaden the role and enhance the regulatory function of the regulatory body. The establishment of the Singapore Pharmacy Council is therefore essential to uphold the professional conduct of pharmacists, set required standards and disciplinary actions, and to provide an avenue for redress and complaints from patients on errant practitioners. Conclusion Madam, for a country as modern and developed as Singapore, we lag behind the United States, Japan, United Kingdom and Australia in regulating the practice of pharmacy. Given the importance of pharmacy practice and the effects of pharmaceutical products on a human body, the introduction of this Bill is necessary and timely. On that note, I support the Bill. 5.49 pm”