Lim Hng Kiang
Singapore
“The company has made commitments to recycle the ash, and as for renewable energy, the gasification project is not an energy project, it is not a generation company (genco). It is to produce hydrogen and carbon monoxide or, essentially, carbon. Because as feedstock to the petrochemical sector, you need more C and more H2.”
“The Government will continue to recover the IIA awarded if the company fails any conditions or breaches the legislative amendments. I would like to highlight that there are no errant cases in the last five years for IIA and the current amendments are, therefore, not reactionary in nature, but are being made for legislative clarity.”
“In addition, the IIA scheme will be extended till 31 December 2022. Clauses 10 to 13 give legislative effect to this change. The remaining legislative changes arising from our periodic review of the income tax system are either administrative or technical in nature.”
“Data on household and individual savings rates by income groups are not available. However, data on the aggregate level of household financial assets can be obtained from the Household Sector balance sheet compiled by the Department of Statistics.”
“The aggregate level of financial assets owned by Singapore’s household sector6 in each of the past five years is provided in Table 1 below. Data on the amount of financial assets owned by households and individuals in the different income percentiles is not available.”
“The Second Review of the Comprehensive Economic Cooperation Agreement (Second CECA Review) is ongoing. The review is taking some time as both countries have our respective interests to work through, such as in the area of labour mobility. Our agencies regularly engage Indian counterparts to work through issues collaboratively.”
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“Therefore, we kept the spirit of that scheme to cater for such people who do not fall into the main segments that would benefit from the GST package. The intention of designing this scheme is good. It is intended to target at that group of people. As it turns out, that group is far fewer than we expect. We have raised expectations. People thought that it was a free handout. They came and tried their luck. We cannot turn them away, so we used that as an educational exercise. SINGAPORE'S OVERSEAS INVESTMENTS (Losses) 10. Mr Steve Chia Kiah Hong asked the Deputy Prime Minister and Minister for Finance whether Singapore has suffered big losses from its overseas investments.”
“Mr Speaker, Sir, we must understand the objective of the scheme. We started off by saying that when we increased the GST, all Singaporeans would be expected to pay a higher GST component when they buy things. At the same time, we have a GST package which will help them offset this additional GST component. And because of the ERS, we make sure that everybody is better off with the GST package. That is the intention of having this scheme. Because the design of our ERS is by household type and therefore there may be those people, for example, who stay in private property but at the lower end of the private property, who have high income levels, who may not be a national serviceman, and do not get the extra GST. So there may be a segment of people in that situation whose income level may be around $3,000 or $2,000 and because they are not staying in an HDB flat, they may not be the head of the household and therefore do not get the benefit through the Utilities Save and the S&C grant, they do not benefit fully from the offset package. So these are the cases that we want to cater for. When we made this announcement, we have set aside a few million dollars. We did not make it a very big programme to cater for this group. We know from our calculations that such families ought to be very few, but from 1994 till now, the household formations and the type of housing in Singapore have changed. I think Members would remember that when Dr Richard Hu proposed this scheme in 1994, he was very concerned about many of the families staying in the Chinatown area which are not HDB flats. They are not heads of households, so they would not benefit from the S&C grant, the Utilities Save and schemes like these.”
“Mr Speaker, Sir, I have explained the background to the scheme. If, when we introduced this scheme, we told this House that we were removing this scheme, I am sure MPs like Mr Tan Soo Khoon would have stood up and said that the Government should keep this scheme in case our offset package was not comprehensive enough and, therefore, we should have this safety net to catch these people. I think our intentions are quite clear. We have designed a comprehensive GST package but the society has different segments and we provide this safety net in case people feel that they have not benefited from the offset package. We have run the scheme. People have turned up. They were unsuccessful. There are some costs to us in having to explain to them. But, personally, I think this is worthwhile because when you sit down with the person and go through the calculations with him, you convince him that, in fact, the additional GST expenditure that he has incurred is not very significant and the GST offset that he has got from the Government is significant enough to offset it. So it may seem a very costly and laborious way of convincing individuals but, personally, I think it is worth it and, therefore, I do not think we should stop in the middle of the exercise. The numbers are coming down, so I do not think that it will incur too much administration from now on.”
“The reason why I did not answer the question is because I do not have the data. We have not estimated the cost to run this scheme because this scheme is run by the CCC. So it is not easy to ascribe the specific cost to this system. But I think it is useful, psychologically and politically, for us to have this scheme so that whoever falls through the net knows that there is this scheme that they can come forward and avail themselves. It is good for us and although we may have designed the offset package comprehensively, we never know which sector we may have missed out. I think it is right for us to include the scheme. We did not expect that many applicants would turn up and that it would be costly for us to administer this scheme. But the perception on the ground is that this is a free grant and everybody tries their luck. So now, we have to take actions to make sure that people understand the scheme properly. I think it is a worthwhile scheme to run. It will run its course and, at the end of the exercise, people who felt that they have been disadvantaged or they did not benefit from the GST package know that there is a recourse that they can turn to. And those who tried their luck had been given a hearing. We calculated for them to show specifically that the GST offset package that they get more than pays for the additional GST expenditure. I think we also win a convert to the GST scheme. It is good for us to keep the scheme and not close it and divert the cost of running it to other schemes.”
“But because we had this scheme in 1994, we thought we should not remove the scheme and still keep this safety net even though we know that having improved on the offset package, the number of applicants would be very, very few and indeed it turns out that actually the number of applicants who were eligible would be very small. But this GST change comes amidst the economic downturn, so more people are in financial difficulties. It comes about after we have run the EDRS scheme which unfortunately may have given the impression to some Singaporeans that there can be handouts if they come to the CCC and apply for it. As a result, it generated this big increase in the number of applications. That is the reason why PA and MOF took action to explain this. I think we are getting this message across and the number of applications has come down.”
“The way the scheme is run, each applicant would have to list out his income and his expected GST expenditure and also the expected offset package that he has received. We would then analyse and see what is the difference. And if indeed the offset package he has received is less than the GST expenditure which he is likely to incur, then we would give him the additional assistance. In the first family, the amount of grant approved is about $105. In the second family, it is about $72. Let me explain that the CCC Assistance Scheme is not a new scheme introduced by us. We put in place this scheme when we introduced GST in 1994. If Members remember, Dr Richard Hu explained why such a scheme was necessary. I think he put it very cogently. Basically, we have the various assistance schemes for Singaporeans which provide a safety net. All of us have tried to be as comprehensive as possible in designing these safety nets. But just in case people are not protected by these safety nets, then we have this "mother of all schemes" called the CCC Assistance Scheme where they just come forward, explain how it has affected them and if indeed they have been adversely affected, we will provide them the assistance. And that worked out quite well in 1994. This time round when we raised the GST, we have, of course, had the experience of the previous GST arrangement and we have improved the offset package. The most important change that we have made this time round is the ERS which really hands out cash grants to Singaporeans and we are very confident that every Singaporean has got an offset package that more than offsets the GST expenditure.”
“Members should note that all these violations have occurred well after the Malaysians first made their claim on Pedra Branca in 1979. We have protested all these violations, and sought the cooperation of the Malaysian Government to stop the violations. As Members of this House know, Singapore and Malaysia signed a Special Agreement three weeks ago, on 6th February 2003, to refer the Pedra Branca dispute to the International Court of Justice. Unfortunately, Malaysian naval vessels have continued to violate our territorial waters around Pedra Branca even after that. Sir, under international law, what disputing parties do to advance their case after the dispute has arisen will not be given credence by the court. Violations of our territorial waters around Pedra Branca by Malaysian state vessels therefore do not strengthen Malaysia's case in any way. Such violations can only lead to a tense situation on the ground and increase the risk of unintended incidents.”
“However, the lifting of the limits does mean that Singaporeans must take charge of their own finances when making car purchases and determine the level of financing that is appropriate for their circumstances, bearing in mind their repayment ability over the longer term. At the same time, financial institutions are expected to act prudently and decide on the quantum of financing and repayment period, based on their assessment of the repayment ability of their borrowers. PEDRA BRANCA (Patrols by Royal Malaysian Navy vessels) 8. Mr Ahmad Mohd Magad asked the Deputy Prime Minister and Minister for Defence whether the Royal Malaysian Navy vessels have been conducting patrol operations around Pedra Branca since 1964 and, if so, were these patrols conducted on a regular basis. The Second Minister for Defence (RAdm Teo Chee Hean) (for the Deputy Prime Minister and Minister for Defence): Mr Speaker, Sir, Malaysian leaders and their media have claimed that their Navy has been patrolling Pedra Branca waters for decades. This is simply not true. Malaysian state vessels - Navy and Marine Police - came into Pedra Branca waters for the first time in June 1989, a good 10 years after the Malaysian claim surfaced in 1979. This first spate of violations by Malaysian vessels took place over a 3-week period in 1989. After that, there was a lull before a second spate of violations in 1992, and then another lull, then in May 2002 there was a third spate before the current episode from the end of last year. In between these spates, over the decade between 1992 and 2002, we recorded eight other violations of our sovereignty at Pedra Branca by Malaysian state vessels. Hon.”
“Miss Penny Low and Dr Wang Kai Yuen have sought clarification on MAS' rationale for the lifting of the financial limits on car loans. This decision is the consequence of a general shift in MAS' supervisory philosophy from prescriptive regulation to a risk-based approach, where MAS avoids micro managing decisions by financial institutions and consumers, and applies supervisory limits only where necessary. From a risk perspective, the financial limits on car loans were unnecessary, because such loans form a small proportion of total loans in the financial system, and the proportion of car loans that are non-performing is low. From a consumer perspective, car loans are no different from other forms of hire purchase. Dr Wang has asked whether this sets a precedent for the removal of other rules on consumer loans, such as housing loans. This is not the case. Housing loans are significant from a risk perspective because they form a large proportion of total loans in the financial system. Unsecured loans and credit card facilities are smaller than housing loans, but MAS regulates them for prudential and social reasons. Many other regulators around the world are likewise concerned with the risks posed by rapid growth in property and consumer loans to the health of their financial systems. Hence, MAS has no plans to remove these necessary safeguards. Miss Low noted that there has been a rise in bankruptcies and unemployment rates and questioned the appropriateness of the timing of this announcement. The lifting of the car financing limits does not in any way imply that the Government is less concerned about Singaporeans facing financial difficulties as a result of excessive borrowing for consumption.”
“Sir, I would like to assure the House that all the agencies operating at the Checkpoints are committed to minimising traffic congestion without compromising on security and safety.”
“This allows for easier traffic management. However, if motorcyclists were allowed to weave in and out of traffic, they could obstruct cars, lorries and other vehicles from entering the Checkpoints and even slow traffic down further, as had happened in the past. They would also pose safety problems and even endanger their own lives. Mr Chia has suggested adding more staff and opening up more immigration counters during the peak period. SIR monitors traffic conditions at the Tuas and Woodlands Checkpoints very closely and has undertaken measures to alleviate the traffic congestion. During the morning and evening peak periods when motorcycle traffic is particularly heavy, as many motorcycle clearance counters are open at the two Checkpoints as possible. All available manpower is deployed to clear all modes of transport during the peak hours, with more being deployed to the critical areas. For example, if there are more motorcycles, more officers will be deployed to clear motorcycles. SIR has also staggered their shifts and has a system to call upon off-duty officers to help with very heavy volumes of travellers. Traffic congestion, however, is inevitable whenever a large number of motorcyclists and other travellers try to pass through the Checkpoints at the same time. We urge all travellers, wherever possible, to adjust their travelling times to avoid the peak periods. They can call the traffic information hotlines or listen in to TrafficWatch on our radio stations to find out the latest traffic conditions at the Woodlands and Tuas Checkpoints. In some cases, they should consider to car pool or even use public transport.”
“When the time is necessary to make the change, we will have some transitional measures so that the changes would be made as light as possible for those who have to pay more. TUAS AND WOODLANDS CHECKPOINTS (Use of car lanes by motorcyclists) 13. Mr Steve Chia Kiah Hong asked the Minister for Home Affairs if his Ministry will consider (i) allowing motorcyclists holding Singapore passports to use the less jammed car lanes at the Tuas and Woodlands Checkpoints, so as to alleviate the long jams caused by Malaysian motorcyclists returning home after work and (ii) adding more staff and opening up more immigration Checkpoint counters during peak hours so as to reduce the time taken for Malaysian motorcyclists to clear Singapore immigration. The Senior Parliamentary Secretary to the Minister for Home Affairs (Encik Mohamad Maidin B P M) (for the Minister for Home Affairs): Sir, our Checkpoints are our first line of defence in safeguarding Singapore's security and safety. Since September 11 2001, security checks at all our Checkpoints have been stepped up to prevent the entry of undesirable persons, weapons, explosives, etc. Whilst SIR, Customs and other agencies manning the Checkpoints try to clear travellers as quickly as possible, security cannot be compromised. Hence, travellers may, at times, have to put up with slightly longer clearance times. Mr Chia has suggested that we should allow motorcyclists holding Singapore passports to be cleared at car counter during peak periods. Sir, we have found that this idea is not very practical. I will explain why. Currently, the land Checkpoints adopt a sound practice of segregating the different forms of various types of traffic: motorcycles, cars, lorries, buses, etc, as they enter or leave the Checkpoints.”
“I think the Member meant the "ceiling" and going over the roof and not "bottomless". That is the reason why we have been taking some time in considering this review. As I explained earlier, in the polyclinics, we have a very simple system, a standard $1.40. So for those drugs which are cheaper to buy, cheaper in cost, then you pay slightly more. For those drugs, especially for patients who have chronic conditions, they come to the polyclinic very regularly, this ceiling of $1.40 helps them. This system has been in place for a long time. It has served us well. We are quite reluctant to change it. But then it gives rise to this anomaly that for those drugs which are very lowly priced, you are charged $1.40, whereas if you go to the hospital, it could be 60 or 70 cents. Then, people may raise problems. If we go by charging actual cost, then, of course, the cost will be harmonised across all institutions. But as Mr Low Thia Khiang says, those chronic patients, who have been paying the low standard price of $1.40, may now have to pay higher prices because the cost is actually much higher. We considered this last year and we wanted to make a change. In the end, we decided not to change for two reasons: first, to make the change requires us to spend money on IT, which will then cause the charges to be higher also. And, secondly, some people will pay less, but some will have to pay more. So, in the light of last year's economic conditions, we decided to keep the change in view. But a lot of questions were raised by Members and also in the press. We cannot keep this standard charge forever. At some point, we have to move to proper charging by cost.”
“On the second question about ensuring that patients get the best deal in drug prices, I would like to inform the House that the two healthcare clusters have set up a central agency, called the Group Purchasing Office (GPO), to purchase drugs for all the public healthcare institutions, including the polyclinics. The Group Purchasing Office has started with bulk purchasing of high volume standard drugs and would, over time, extend it to all the other drugs. Currently, both clusters purchase around 90% of their standard drugs, which is around 400 items, through the Group Purchasing Office. Central purchasing by the Group Purchasing Office helps to standardise the price of drugs and also achieve savings, which can then be passed on to patients. Mr Low Thia Khiang: Sir, I am worried about this review on the drug charging system. Would the Minister tell us more about this review and whether or not there will be a cap on the charging of drugs, as in the existing charging system for polyclinics, which is at $1.40? Will the cap remain at $1.40 or is it going to be bottomless?”
“Mr Speaker, Sir, the Member asked why the prices of some drugs in polyclinics are higher than those of restructured hospitals. This anomaly arose because historically we charge drugs in the polyclinics under a system which is different from the way we charge drugs in the restructured hospitals. The charging system for Standard Drug List (SDL) medication at the polyclinics is set at a fixed rate of $1.40 for one week's prescription. It has been so for many years. The reason is because we want it to be simple and easy to administer. So in such cases some patients will pay more than the cost of drugs, if the cost of drugs is lower than $1.40, whereas other patients will pay less than the cost of drugs, if the cost of drug is more than $1.40 per week's supply. So there is a cross-subsidy in the polyclinic system. In the restructured hospitals, being corporatised, they charge the drugs based on the cost of the drugs. So, as a result, you will find that some drugs cost more in the polyclinics than in the hospitals. Although this charging system has served us well in the polyclinics, my Ministry is reviewing this system, together with the clusters, to explore ways to improve the charging system and harmonise the drug charges across the different public sector institutions. We have to take into account constraints, such as IT infrastructure and also how to educate Singaporeans to adjust to these changes in the pricing system. The results of this review will be made known in due course.”
“Dr Amy Khor Lean Suan asked the Minister for Education (a) how many students, by levels, were expelled from schools for each year from 2000 to 2002; (b) whether these numbers had been increasing over the years; (c) what are the current guidelines provided by the Ministry to school principals regarding the expulsion of students; (d) what help and counselling these students are given or can turn to before and after expulsion; and (e) whether the Ministry can provide clear guidelines and assistance for their re-admission to schools, instead of asking the students and their parents to apply directly to the schools.”
“I agree entirely with the Member. I think home medical and home nursing are critical components of our step-down care infrastructure. Over the last two years, for example, we have put in place what we designate as approved providers - nursing homes, community hospitals - who can extend home medical and home nursing services. We are trying to build up such services, not just by specialised home medical and home nursing services like the Home Nursing Foundation, but also extend the provision by other groups - nursing homes, community hospitals - so that these become more readily available. Recently, I announced that the Ministry is extending training grants for step-down care, not just professionals in the community hospitals and nursing homes, but also people extending home medical and home nursing services. So, we recognise that this is a very important area. It is a very manpower intensive area, despite Singapore being a small island. If we have a nurse visiting homes, there is a very limited number of visits she can make every day. So it is a very expensive service. But we recognise that this is an important service because it helps to keep the elderly in the community, in the home, and we intend to build this up. EXPULSION OF STUDENTS (Statistics and guidelines) 9.”
“As I have explained earlier, medical treatments are very expensive. We are asking Singaporeans to save 6% of their income in Medisave and therefore we have to make use of our Medisave correctly. The policy of Medisave is to target this saving at the more expensive medical treatments, which is largely the inpatient care. Over the years, we have extended it to some outpatient care which is very expensive too. But so far, we have not allowed Medisave to be used for GP care, for step-down care, home medical and home nursing care. And I think these are very sensible reasons. Because if we allow Medisave to be used for GP care, for home nursing and home medical, very soon you will not have very much Medisave left for your hospitalisation care. Last year, we made an exception. We recognised that home medical and home nursing care for the very severely disabled will cost a lot of money, and that is the reason why we introduced ElderShield and allowed Singaporeans to use up to 1% of their Medisave if they insure themselves under ElderShield. And if they are severely disabled, the group insurance that they participate in will help pay for their home medical and home nursing. So we are already making an extension of using the Medisave for the severely disabled who need home medical, home nursing or institutional nursing care. But if we extend Medisave to all kinds of home medical and home nursing, then your 6% Medisave contribution will not be enough. If the Member can convince other Members of this House to raise the Medisave contribution from 6% to 8%, then I am prepared to consider extending it.”
“Mr Speaker, Sir, first, I wish to reiterate that Medisave is primarily intended for inpatient hospitalisations. However, over the years, the Ministry of Health has allowed the use of Medisave for day surgeries and certain expensive treatments, which were originally inpatient treatment but are now carried out more effectively as outpatient treatments, such as renal dialysis and chemotherapy for cancer patients. However, the Ministry does not intend to allow Medisave to be used for dormiciliary medical and nursing care, so that individuals can preserve their Medisave for the more expensive medical treatments. From 1st October 2002, the Ministry of Health has extended Government subsidies to eligible elderly Singaporeans who require home medical and home nursing services so that they can afford such services. Out-of-pocket expenditure is kept low, at between $30-$60 per home medical visit and $13-$28 per home nursing visit, after the 50% to 75% subsidy from the Government. Those who are severely disabled and covered under ElderShield or IDAPE Scheme can also receive cash payments of $300 per month from ElderShield, or up to $150 per month from IDAPE Scheme. These would further help them pay for their home medical and home nursing services.”
“Since clustering, NHG and SingHealth have been given the autonomy to manage their resources to maximise performance and minimise wastage. In line with this, they now have autonomy to decide on salary matters, including bonuses, using well-established market principles to reward performance. NHG currently pays an institution bonus to incentivise all round performance of the individual institutions, besides paying individual performance bonuses and a cluster bonus. This is paid in the month of July to staff of institutions that showed improvement in a set of performance factors covering financial, operational, service, quality, care, teaching and research. The decision on institution bonus is taken at the cluster management level, and approved by the NHG Board Human Resource Committee. Since this is a performance-based bonus and not an entitlement, the actual payout will depend on whether and the extent to which an institution has improved in its performance. Nonetheless, all staff in an institution will receive the same quantum of payment when institution bonus is granted to the institution. CENTRAL PROVIDENT FUND ACCOUNTS 3. Ms Braema Mathiaparanam asked the Minister for Manpower (a) how many (i) individuals do not have Central Provident Fund (CPF) accounts (ii) women do not have any CPF accounts and (iii) CPF accounts are inactive; and (b) if he will provide details of these inactive account holders by age group, sex and occupation type.”
“Mr Speaker, Sir, as I have said earlier, ElderShield was launched only very recently. The immediate task of the Ministry and the ElderShield insurers is to ensure the smooth operation of the scheme. But notwithstanding what I have said, we will ask the two ElderShield insurers to consider doing such a survey, and to review the scheme if it is necessary to do so. SUPREME COURT (Operating costs) 13. Mr Low Thia Khiang asked the Minister for Law (a) whether the cost of operating the Supreme Court increased significantly in the 1990s; and (b) if so, which items were responsible for the increase and the amounts involved.”
“When the doctor comes up for the renewal of his practising certificate, he must demonstrate that he has at least 50 points over the last preceding two years. If they do not want to practise and they are not seeking a renewal of their practising certificates, they are temporarily exempted from doing the CME. But if they want to practise at some point in time, if they want to renew, then they must take the CME. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill. - [Mr Lim Hng Kiang]. Bill considered in Committee; reported without amendment; read a Third time and passed. ADJOURNMENT Resolved, "That Parliament do now adjourn to a date to be fixed. " - [Mr Mah Bow Tan]. Adjourned accordingly at Twenty-seven minutes to Five o'clock pm to a date to be fixed. Annex - GST Offset Package”
“As long as they make the assessment that these doctors meet the quality standards and these doctors practise under close supervision, they add to our capability. And many of these doctors may later on continue to take up specialist courses and join our system. Why do we want to restrict ourselves and restrict recruitment from some of these good universities, even though they may not appear on the schedule? They come, work for us for two years, we assess them and, if they are good, we encourage them to go for specialist training. They add to our talent pool. I do not see why we should cut them off. Dr Lily Neo: Now that the Minister condones such a practice, I am sure our public community hospitals and even the private hospitals will take in more doctors from the cheaper non-traditional sources for the benefit of saving costs, but not necessarily to the benefit of the patients and the nation. Mr Speaker, Sir, I just want to register one more point to my disappointment over this response from the Minister, because I feel that this is definitely a soft option and not preserving the prestige of medical excellence in Singapore, and changing the position of our healthcare service.”
“If the doctor is immobilised for two years, then I am sure the SMC would take that into account. On recourse by junior doctors for the housemanship, this is the usual process: we have interviews with the housemen, they go through three supervisors and are supervised by the Dean. So, there are a lot of feedback channels for the housemen, if they think that they have not been properly assessed. The Director of Medical Services takes a very personal interest in all the housemen. This year, for example, one houseman came to my office and asked to see me, and I saw her. We keep a fairly open-office policy in the Ministry of Health. So, I think there is enough recourse. Of course, if they find all these unsatisfactory, they will make a beeline to see her! On the quality of doctors, I think we are still maintaining the very high quality of our doctors. The main strategy is really our Health Manpower Development Programme (HMDP). This has been on for many years. Our doctors go to the best and most reputable centres around the world, funded by the Government. This is how we keep up with the latest. The HMDP programme is our key in keeping this quality. At the same time, we do face a shortage of doctors. With the expansion of the schedule, we will be able to recruit both Singaporean as well as foreign doctors from the foreign universities. After 1993, when the list was restricted to 28 and then, now 24, our avenues of recruitment were limited. So, with the expansion of the schedule, obviously we have more choices. But I would not rule out completely and insist that our clusters are not allowed to recruit from universities not on the list. Why do we want to constrain them?”
“Mr Speaker, Sir, as I mentioned just now, 50 points over two years should not be such a difficult hurdle to cross. Many of these points are accumulated just by self-reading, answering questions. We are talking about 50 CME points over two years. I do not see that being difficult to achieve.”
“In a few of these cases, the panel of assessors and the Dean would rather that the doctors not go solo in the HDB heartlands, but that they spend another three months, six months or another year under supervision. Then, I think, we will be more confident that the doctor can fly solo in the HDB heartland clinics. This provision is to allow the panel of assessors and the Dean to have this flexibility of awarding conditional registration, so that the doctor still continues to practise, but practise under supervision. Then, after a period of review, when the panel is confident, then the doctor is given full registration. Again, I will assure the House that when we implement this, there will be proper checks and balances, as we do whenever we assess the capabilities of the doctors. On the representation of the SMC, the Act allows for the SMC to be constituted, some appointed by the Minister, for which we have certain criteria to make sure we have a cross-section from the private and public sectors, people from different specialties. But the bulk is elected by the doctors themselves. This is the essence of self-regulation by the SMC. Here, I think, we would expect the doctors to exercise good judgement in electing a professional body to look after their professional interests and who will be in charge of regulating them. So far it has worked well. We will continue to monitor the SMC. Over the years, it has built up a strong reputation. It has the support of all the doctors and I am confident it will continue to do so.”
“On the points made on the Interim Orders Committee, as I explained in my speech, we know this is a very delicate balance. We need to protect public safety. At the same time, we need to recognise the rights of the doctors. Therefore, if we ever have this order to suspend a doctor's practice, I can assure the House that this would be done very, very selectively and, when there are compelling reasons in order to protect public safety. We have modelled this after the UK. Let us try this out. We have put in all the safeguards that we have researched on. But I think we need to strike a balance. We cannot just give the doctors a blank cheque to say they must practise, whatever the circumstances. At the same time, there are issues of public safety involved, especially if the doctor is a very severe alcoholic or has a drug addiction problem or a very severe mental illness problem. So, I assure the House we will do this very selectively, and only when there are compelling reasons. On the registration of housemen, today graduates from our local universities go for housemanship and, at the end of housemanship, they are given full registration. But in one, two or three cases every year, the panel of assessors and the Dean would have been happier if the doctor underwent a longer period of supervision. The system here is that we allow the doctor, after the one-year housemanship, to go and practise solo. This is a very high burden. If I may use the analogy of a private pilot's licence. You may know the theory of how to fly a plane. You may be able to fly a plane with the instructor next to you, to land and to take off. But to fly solo, you need a certain exposure to the different circumstances that may arise. You need experience and judgement.”
“I recognise that those working in the restructured hospitals or institutions will find it easier, whereas those who are operating solo practices out in the heartlands will find it more difficult. And that is the reason why we have worked very closely with the College of Family Physicians and the Singapore Medical Association to work out mechanisms, whether it is online or self-directed, to make sure that the private sector general practitioner can have access to CME. Both the clusters have extended schemes to the private sector general practitioner under the partnership scheme, where GPs actually work with the clusters as partners, referring to the specialist clinics and vice versa. Therefore, this link-up will allow the private-sector GPs to attend the CME classes run by the clusters. But I must say that in the end the private-sector GP must make an effort. We do run these classes in the evenings and on weekends, but they must make the effort. My view is that 50 CME points over two years is not that big an effort to make. But I take the comments of Dr Lily Neo and Dr Tan Cheng Bock that we should make sure that this is flexible, realistic and achievable, and that we will work together with the various professional organisations to make sure that this is so. In the end, the professional organisations must run CME on their own budget. The Ministry of Health has given them a transitional budget to help set up the online processes, working out the curriculum. But it is not our intention that this fiscal support should be in the long term. So, beyond the transitional grant that the Ministry of Health has given them, our intention is that the medical profession must stand on its own feet.”
“In the past, our hospitals and clinics had got used to using junior medical doctors, because they were bonded to us for a number of years and, when the numbers fluctuate, then the establishment is not filled. We have asked the hospitals to actually look at the processes and to look at employing experienced medical officers and not just use these people who are with us for the period of the bond, but use experienced doctors who may not want to go on to a specialty but who are quite happy to have a career working in the hospitals as very experienced medical officers. So, they have done so and they have a resident physician scheme and it is becoming quite attractive. In the meantime, the hospitals have recruited doctors from some non-traditional sources. They have been very careful to make sure that these doctors are of very high quality, and all these doctors are practising in an institutional set-up. They are closely supervised and monitored, and they add value to our healthcare system. So, it is not just a matter of cost and lowering cost. I know Dr Lily Neo says we must preserve quality at all costs. But I am sure the next time I come here and ask for a fee increase, she would be the first to jump up and argue against a fee increase. So, we have to be quite clear. It is not just a matter of lowering cost; it is complementing the range of expertise and experience that we have in the hospitals. On CME, I take both Dr Lily Neo and Dr Tan Cheng Bock's comments. We have tried this on a voluntary basis. Other countries and jurisdictions have gone on to make it compulsory. I think we should follow suit. Our requirements are not that stringent. 50 points over two years is not an overly difficult hurdle to cross.”
“Mr Speaker, Sir, I thank the Members for their comments. Let me respond to them. First, on the schedule for recognising the universities and the medical colleges. Dr Lily Neo asked why not just recognise all 176 universities in the pre-1993 list. It is already 10 years since 1993, and we have asked SMC to take a look at all the universities from a fresh approach and recommend to the Ministry which universities and medical colleges should be put into the schedule for recognition. There are two aspects to it. One is the quality of the medical schools and the universities. And secondly is the compatibility of their training and curriculum to our practice here. So not being on the list does not mean that the universities are not good. They could be good, but we also want the way they teach their students and the way they organise their curriculum to be reasonably compatible to ours. There is really no need to have such a long list, because our projection is that we would need to supplement our local output of doctors by between 50-80 doctors who are foreign-trained, whether Singaporeans or foreigners. We really do not need such a long list of universities. If we look at the pre-1993 list, the bulk in the list are American universities. We do not really get many graduates from the American universities. SMC should look at the list and identify those universities and medical colleges that we are likely to have Singaporeans or where we are likely to be able to recruit foreign talent. So, it is with a clearer objective in mind. On the shortage of junior doctors, I agree with Dr Lily Neo that we should look at the root causes of the shortage of junior doctors. I think the way to approach it is really to restructure the whole process in the hospitals and in our clinics.”
“This will help ensure that Singaporeans will continue to enjoy a good quality of medical care and to continue to have full confidence and trust in the doctors whom they consult. Sir, I beg to move. Question proposed.”
“The SMC will also be allowed to impose conditions on the restoration of a doctor who has been struck off the register, such as placing him under conditional registration rather than restoring him to full registration right away. Another amendment is to allow the SMC to release information to prescribed persons or Government organisations for policy planning and other purposes. Such information includes names and biodata, information on professional qualifications, as well as employment data. This is consistent with the provisions made in the Private Hospitals and Medical Clinics Act. Before closing, Mr Speaker, Sir, I would like to take this opportunity to touch on two related matters: Firstly, the Schedule of the Medical Registration Act, which lists the basic medical degrees recognised for registration in Singapore, and secondly, the one-third quota placed on the female medical student intake into the National University of Singapore. Several Members have asked for these two policies to be reviewed. I am happy to announce that the Ministry of Health has decided to expand the Schedule, which lists the foreign universities and medical schools whose medical degrees are recognised for registration in Singapore. Also, the one-third quota on the intake of female medical students into NUS will also be lifted with effect from academic year 2003. I would like to thank Members who have raised this, including Mrs Lim Hwee Hua and Dr Lily Neo, and to thank them also for their patience when raising these two issues for review. Good things come to those who wait. In conclusion, Mr Speaker, Sir, the proposed amendments to the Medical Registration Act would allow the Singapore Medical Council to maintain the high professional standards of the doctors practising in Singapore.”
“Mr Speaker, Sir, as I was saying, we will allow the SMC to refer any information regarding the criminal conviction of a registered medical practitioner to the SMC's Complaints Panel, without first having to receive a formal complaint regarding the practitioner. This will ensure that doctors who have been convicted of offences in the criminal court are also reviewed by the SMC to determine if there had also been breaches in professional conduct. The title of a specialist is currently not protected by law. A new amendment will allow the SMC to institute disciplinary proceedings against doctors who falsely hold themselves out to be specialists. Mr Speaker, Sir, let me now highlight the amendments in this Bill that seek to streamline the registration processes of the SMC. First, currently, any Singapore medical degree holder is entitled to full registration. A proposed amendment will ensure that only those who have completed their housemanship satisfactorily can progress to full registration. If the SMC is of the view that a particular doctor has not fulfilled the requirements for full registration but is safe to practise under supervision, the SMC will be given the discretion to award conditional registration for such cases. Singapore degree holders who complete their housemanship overseas would also be granted conditional registration in the first instance. Second, foreign degree holders seeking registration will be required to either complete their housemanship locally or produce a certificate of experience that is recognised by the SMC as evidence that they have satisfactorily completed their housemanship overseas.”
“These amendments to establish the IOC and to provide safeguards for the rights of the doctors are closely modelled on the current legislation and system in the UK. Let me now highlight some other amendments to the Act that are intended to strengthen the current disciplinary process. We will empower the Complaints Committee to inquire into matters of professional conduct that were discovered in the course of investigations, but did not form part of the original complaint. The Complaints Committee will also be allowed to continue an investigation even if a complaint had been withdrawn. This is consistent with the powers vested in the Inquiry Committees under the Legal Profession Act. The SMC will be authorised to refer, by its own volition, any information regarding the criminal conviction of a registered medical practitioner to the SMC's Complaints Panel, without first having to receive a formal complaint against this practitioner.”
“I would like to assure the House that cases will only be referred to the IOC when there is compelling evidence that the doctor's continued practice poses a threat to public safety. Such evidence could include psychiatric reports and court convictions. Based on the experience of the IOC in the UK, examples of cases that could be referred to the IOC would include cases like failures of care that indicate a serious lack of basic medical knowledge or skills; or doctors with serious health problems that would affect their ability to practise medicine, such as severe mental illness, alcoholism or drug addiction. I would like to highlight that a number of provisions have been built into the Act to safeguard the rights of the doctor who has been referred to the IOC. For example: (1) The members of the IOC will not participate as members of any other committee that is involved in looking into the complaint against that doctor. (2) No interim order shall be made by the IOC unless the doctor in question has been given the opportunity to appear before the IOC and be heard as to whether such an order should be made in his case. The doctor also has the right to be represented by legal counsel. (3) Any doctor whose registration has been suspended or made subject to conditions by the IOC will have a right of appeal to the High Court. (4) The IOC is required to review its interim order after 6 months to determine if it should be revoked or amended. After this first review, the order is subject to further review every three months until the matter is settled, or the IOC decides that the order is no longer necessary, or 18 months after the initial issue of the order. Any extension of the order beyond 18 months will require approval by the High Court.”
“SMC has established an Ethical Code and Ethical Guidelines that set the standards of professionalism expected of all doctors in Singapore. SMC also has a well-established disciplinary procedure to assess and to deal with doctors who have been referred to the SMC. In the main, these procedures are working well and have allowed the SMC to maintain high standards of medical professionalism in Singapore. However, there are a number of limitations that the SMC faces in its current disciplinary processes. These will be addressed in the amendments to this Act so that SMC will be able to carry out its regulatory duties more efficiently and effectively. Interim Orders Committee (IOC) Because of the complexities of medical practice issues and the time required to gather and review all the relevant evidence, inquiries into disciplinary matters may take up to two years to complete. During that time, the doctor under investigation is still able to practise. In some situations, there may be compelling reasons to suspend a doctor from practising, even before the outcome of his disciplinary enquiry is known, in the interests of public safety. We therefore propose that a new provision be created to allow for the establishment of an Interim Orders Committee (IOC). The IOC will be vested with the power to summarily suspend or restrict a doctor's practice before the outcome of an inquiry is known. This inquiry could be held either by the Disciplinary Committee (DC) which looks into the professional conduct of the doctor or the Health Committee (HC) which considers the physical and mental fitness of the doctor to practise.”
“Two years ago, the SMC launched an on-line CME system for all registered medical practitioners and worked with the College of Family Physicians, the Academy of Medicine and the Singapore Medical Association, to establish a voluntary national CME system so as to better meet the needs of the different groups of medical practitioners through the provision of a diverse variety of accredited CME activities. However, not all doctors have demonstrated participation to a satisfactory level of CME. Notifications by medical practitioners to the SMC's voluntary CME system showed that only 39% fulfilled the minimum CME requirements of 25 points per year in 2000. The situation improved to 49.5% participation rate in the year 2001. It is likely that there were some doctors who participated in CME but failed to notify. Nonetheless, the voluntary participation rate is far from satisfactory. Many developed countries, in fact, have made CME compulsory in their jurisdictions, eg, most states in the USA, some states in Australia, New Zealand, the Netherlands and Hong Kong. Canada and the UK are actively looking into doing so as well. We have therefore decided to make CME compulsory for all medical practitioners from 2003. This Bill proposes an amendment that allows the SMC to prescribe conditions for the grant and renewal of a doctor's practising certificate, including mandatory participation in CME. The SMC has decided that doctors should accumulate at least 50 CME points within a 2-year cycle before they can renew their practising certificates. Strengthening of SMC's Disciplinary Procedures Mr Speaker, Sir, the SMC plays a critical role in the regulation of medical professionals and medical practice in Singapore.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time." This Bill seeks to make amendments to the Medical Registration Act (Chapter 174 of the 1998 Revised Edition). Background The Medical Registration Act provides for the establishment of the Singapore Medical Council (SMC) to register and regulate medical practitioners. The amendments to the Act are needed to set the requirements for continuing medical education when doctors renew their practising certificates, to address the limitations that the SMC faces in its disciplinary processes and to keep pace with international developments in professional regulation. Mr Speaker, Sir, let me now highlight the major amendments that are being introduced in this Bill. Compulsory Continuing Medical Education (CME) The pace of change in the practice of medicine is rapid, driven mainly by the dramatic advances in biomedical research and technology. At the same time, there is greater acceptance of evidence-based medicine, ie, medical practices that are supported by rigorous and comprehensive analyses of the relevant body of clinical research or trial data. This helps doctors to ensure that the care given to patients is necessary, beneficial and of good quality. Our patients and the general public also have high, and rising, expectations of the quality of healthcare that they receive. It is imperative, therefore, for all doctors to maintain the currency of their professional knowledge and to stay abreast of developments in medical science and practice. Continuing Medical Education (CME) is a well-accepted mechanism to achieve this. There is a long history and tradition of CME within our local medical community.”
“Yes, if you are married, you get the extra relief. So if you want to get the relief, get married. LAW ON PUBLIC SPEAKING 7. Mr Steve Chia Kiah Hong asked the Minister for Home Affairs in view of Singapore becoming a more open society, if the law on public speaking will be relaxed.”
“Sir, we look at such cases and we try to be as sympathetic as possible.”
“Sir, as I said in my reply, if the singles need to look after handicapped parents, there are other forms of reliefs. It is not that these reliefs are not available to singles. If the single person wants to work, she can claim relief under handicapped parent relief. Or if she has to look after siblings, she can claim relief under handicapped siblings. But this maid relief is a misnomer. It should be called married woman's relief. Then things will be clear.”
“Sir, as I said, the foreign maid tax relief is to encourage women to continue working. As long as the person is married and is working, she can claim the relief. Whether the maid is used to look after parents, children or family, we do not really bother. The criteria are that the person must be married and must continue working, and the relief will be granted.”
“This is to ensure that the public will take the necessary precautions to minimise the chance of infection. However, the best precaution is not to undergo a tattooing itself. At this point we feel that it is not necessary to regulate tattooing, nor require those below 18 to get parental consent. However, we will continue to monitor the practice and we will review the situation regularly. LITERATURE AS A COMPULSORY SUBJECT IN SCHOOLS 3. Ms Braema Mathiaparanam asked the Minister for Education based on the merits of Literature as endorsed by the Ministry and the Economic Review Committee, if he will (i) consider making Literature a compulsory subject for all students at the upper primary and lower secondary school levels using a range of books to manage the different linguistic abilities of children; and (ii) introduce a compulsory module of Literature for all polytechnic students to give them an all-rounded education.”
“Mr Speaker, Sir, tattoo practitioners do not come under the purview of the Ministry of Health, as they are not medical practitioners. Services provided by these practitioners, which are non-medical, are therefore not required to be licensed under the Private Hospitals and Medical Clinics Act. Nonetheless, if they carry out practices or procedures that are considered medical treatments, ie, they use harmful medical products or they prescribe poisons or controlled drugs, or use unlicensed equipment such as lasers, then they will be in contravention of a number of legislation. The Ministry of Health will then investigate into these tattoo practitioners, if they contravened any of these acts. Tattooing procedures carry the risk of transmitting blood-borne diseases, like Hepatitis B, C and HIV. If sterilised needles and other hygiene measures are used, of course, the risk of infection is small. Investigations into all the notified cases of blood-borne diseases in Singapore, including HIV, have indicated that none of these reported cases from 1985 to date have acquired the infection from tattooing procedures in Singapore. Under the Infectious Diseases Act, the Ministry of Health has the power to prohibit any person from carrying out any occupation, trade or business if these are conducted in such a manner as is likely to cause the spread of any infectious diseases. If there is any evidence that the practice at any establishment is likely to have caused the spread of an infectious disease, these establishments can be closed down under this Act. The Ministry of Health so far has also put in place health education programmes mainly through health education pamphlets, etc, to advise the public on the prevention of transmission of infectious diseases during tattooing.”
“As I have explained in my answer, we have a team of cardiac surgeons and cardiologists who regularly reviews these procedures and makes sure that our list of standard procedures covers all the cost-effective procedures that we want to subvent and that we allow Medisave to be used for. The problem arises because there are claims by manufacturers that if you use this latest stent, it will give you additional benefits. But this is not assessed by our team of experts to be a cost-effective procedure that we want to include under our Medisave list based on proper evidence, but it is available on the market. So, do we allow this choice, or do we say, "If you go to a restructured hospital, we will only do those cases which are recommended and assessed by our team of experts"? TATTOOING PROCEDURES (Regulation) 2. Mdm Halimah Yacob asked the Minister for Health, in view of the high risk of infection of unregulated tattooing procedures now freely conducted by untrained persons without any health or safety guidelines will his Ministry (i) regulate the conduct of this procedure; and (ii) consider banning those below 18 years from tattooing themselves unless they have parental consent as is the practice in some countries.”
“On the use of Medisave, we have to be very clear. There has to be some restraint and discipline and, therefore, there will be some maximum withdrawal limits imposed. I am not prepared to say that everybody is allowed to use his Medisave in whatever way he likes. We can use our cash in whatever way we like but, for Medisave, its purpose is forced savings intended to last us a lifetime and, therefore, it cannot be a free-for-all. Whether or not we allow you to spend your cash freely in the restructured hospitals, that is something that we want to consider. Even if it is your cash, we may not allow you to spend freely in the hospital. We may say, "If you want to spend your cash freely in the hospital, please go to the private hospitals." This is something that we are considering.”
“Mr Speaker, Sir, I am no doctor. I leave this to the professionals. If the professionals feel that in a particular condition stents can be done in a day surgery, we encourage them to do so in a day surgery. If the professionals say that this is safer done in an in-patient setting, then we will do it in an in-patient setting.”
“Stent is almost used as a standard device nowadays, and if you are admitted as a B2 patient and the average stay perhaps is four days, the average B2 patient bill for such a procedure is $4,600. The total amount that can be withdrawn from Medisave and MediShield is about $4,000 or 86%. So, you pay the balance in cash. If you go for a standard procedure involving standard stents, our current rules allow the withdrawal which is about 86%. The problem arises when the patient chooses a top-of-the-market stent which costs $6,000, as is the case which I understood from Mdm Halimah. In that case, he had two stents, which cost $12,000. This is obviously way beyond the Medisave limit. This is a non-standard procedure and, therefore, he was asked to pay cash. How do we address this? As I have said in my answer, we could say that such things are not allowed in the restructured hospitals. If somebody wants to go for these top-of-the-range stents, then please go to the private hospitals. We will then not have such problems in the restructured hospitals. Or we can take a more liberal approach and say, "These are non-standard. If you want them, please be sure you know the financial repercussions", and we make sure we have financial counselling. But I can assure Members that out of the 1,000 cases, there will be lapses or claims of lapses, and we will face these problems. So, this is something that we will have to review and we will decide next year whether or not we take a more stringent approach or we still allow this choice in our restructured hospitals.”
“If a patient wants a more expensive stent, Medisave and MediShield will not fully cover the patient's bill.”
“Mr Speaker, Sir, I wish to clarify that Medisave can be used to pay for stents in an angioplasty procedure. Surgical implants, including stents, are eligible for Medisave claims as part of the total hospital bill, subject to the daily withdrawal limit of $300. Implants can also be claimed under MediShield and Medisave-approved insurance schemes, where the maximum amount claimable ranges from $1,500 to $3,500, in addition to other claims such as room and board and surgery procedures. Together, Medisave and MediShield can cover more than 80% of the average B2 patient bill for a coronary angioplasty procedure involving stent implants. The Ministry of Health, however, recognises that the costs of implants vary considerably, depending on the type of medical condition treated. Therefore, the current Medisave withdrawal limits and MediShield claimable limits may not fully cater for the wide range in costs between treatments for different medical conditions. To address this, the Ministry will reset the Medisave withdrawal limits and MediShield Claimable limits for inpatient and day surgery cases to be based on Diagnosis-Related-Groups (DRGs) next year. This will better reflect the resources needed to treat the different medical conditions, and will allow patients to withdraw or claim more from Medisave or MediShield, for medical conditions that are on the average more expensive to treat. Under this new structure, Medisave and MediShield would be able to fully cover the bills for most subsidised patients undergoing coronary angioplasty procedures with stent implants. The price of medical technology like stents can vary greatly and equally effective stents can be priced differently by manufacturers.”