Rahayu Mahzam
Singapore
“We engage the insurance providers quite regularly, but we are very mindful about where we intervene, especially because they need to be competitive and there is a commercial dimension to it, which we feel that we should respect. So, how we intervene is via the conditions that are put in place vis-a-vis the consumers.”
“So, that is not something they can worry about. There is already the S+3M framework that is already in place, so we know that MediShield Life is one, they have their MediSave and if all else fails, there is MediFund.”
“Should there be disputes over specific claims, policyholders can take it to the Financial Industry Disputes Resolution Centre (FIDReC), an independent and impartial institution that assists with insurance-related disputes.”
“It is just a symptom, so the underlying cost pressures still need to be addressed. The description that we had put earlier in the past is that it is a knot that we need to untangle; and that is something we are doing with a multi-pronged, with engagements with different parties and stakeholders.”
“I appreciate the Member's feedback. As I said earlier, this is something that we will continue to consider. But we do also have to appreciate that the information that we get is live, in terms of waiting times and all that.”
“But I do take the point and we are actually reviewing to see what is a meaningful way to put out this information so that the public can understand, so that we can all track properly whether the good health outcomes are a result of the efforts that we are making. I will take the feedback back and we will continue to review this.”
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“As a result, lower-sodium alternatives are now more accessible. Today, the wholesale price of most lower-sodium salt, sauces and seasonings supplied to food operators are comparable to that of regular versions. To date, HPB has garnered the commitment of 15 major manufacturers and food operators, representing over 30% of the retail market for sauces and seasonings and 10% of the F&B market share, to increase the variety and demand of lower-sodium ingredients. The other stakeholder to engage are food operators such as hawkers, restaurants, caterers and chefs to promote the adoption of lower-sodium ingredients. We will have to explain to them the need to cut our sodium intake, introduce them to lower-sodium ingredients, as well as provide them with samples that they can try out so that we can get them to use these products. We also hope that they will help us explain to the public that salt is an acquired taste and that if we over-consume it over some time, our taste buds will get accustomed to it and fail to taste other natural ingredients. We are planning a series of engagement sessions with them, including with the industry and professional associations. Finally, HPB will also be stepping up its public education campaign. In Singapore, less salt often means more taste as it allows us to appreciate the natural flavours of the herbs, spices and other ingredients typically used in local cuisine. HPB will continue to educate Singaporeans on the need to cut sodium, increase their receptiveness to using lower-sodium ingredients and change the perception that we need more salt and sauces for flavourful dishes. It will conduct more activities, such as food sampling activities at supermarkets.”
“Mr Speaker, the Health Promotion Board (HPB)'s National Nutrition Survey 2022 showed that our intake of sodium is excessively high, which significantly increases the risk for hypertension, which can lead to diseases such as heart attack, stroke and kidney failure. We need to cut down on our consumption of sodium urgently. Other countries have faced similar challenges and the Ministry of Health (MOH) has studied what they have done. Chile has implemented regulations in 2016 to require food and drinks high in sugar, salt and saturated fat to have a warning label. You can find such warning labels on soft drinks, sauces, processed meats and so on, in Chile. Finland has also successfully used food labelling laws to reduce salt consumption over the past three decades. Hungary went further, as beyond identifying food items which have unhealthy levels of salt and sugar, it imposes a tax on it. These are useful practices for us to learn from, but we do not intend to emulate any of these systems. For example, our Nutri-grade labelling measures for pre-packaged beverages has been very effective in bringing down sugar consumption. We should likewise tackle excessive sodium consumption in a way that is suited to our context. In many European and Western countries, their main source of sodium is processed foods which households buy from shops or supermarkets. In Singapore, sodium comes mainly from added salt, sauces and seasonings, such as soya sauce, dark sauce, fish sauce and chili sauce, and we consume them most when we eat out. A key priority is therefore to work with the manufacturers of salt and sauces. Today, HPB offers grant support to salt and sauce suppliers to reformulate their products, through the Healthier Ingredient Development Scheme (HIDS).”
“If everybody had followed according to what they were supposed to have done, this situation could, indeed, have been prevented.”
“I thank Dr Tan for sharing his resident's situation and for raising the supplementary questions. I can appreciate his concern in this case. The Member had asked about the agency to refer to and the recourse available to the consumers. For disputes involving miscommunication between the patients and medical providers, the patients may consider writing in to MOH Holdings Healthcare Mediation Unit for mediation services, if they are not able to resolve the matter with the provider. And if they are then still not able to resolve that through mediation, the other possible avenues include recourse through the Consumers Association of Singapore as well as the Small Claims Tribunals. The case that Dr Tan has surfaced is, indeed, an unfortunate one. It is a situation where there was a misunderstanding on the doctor's part and also a miscommunication on the hospital's part. This is a good opportunity to remind all stakeholders to play their part in helping patients make informed decisions about their panel benefits. The hospitals that wish to inform patients of the doctor's panel status should ensure that information that they have provided is updated and the doctors should also inform patients of any changes in their panel status as soon as possible. The insurance company and their agents should also remind policyholders to first check the panel status of the doctor before going for the treatment and explain the implications of the insurance coverage. When everyone plays their part, situations like this could be avoided. So, I appreciate the Member's concerns. But in this case, it was really one of those few cases that we have seen where there was a misunderstanding and miscommunication.”
“Mr Speaker, the Ministry of Health (MOH) does not track such data. However, we are aware of a few cases where medical providers have conveyed information that may have led patients into thinking that their medical bill would qualify for panel benefits or be fully covered by insurance. Affected patients are encouraged to resolve their concerns directly with the medical provider first. Failing which, they may consider filing their dispute with the Clinical Claims Resolution Process (CCRP), which helps to resolve clinical matters pertaining to Integrated Shield Plan (IP) claims or seek mediation with the healthcare institutions facilitated by MOH Holdings' Healthcare Mediation Unit.”
“Mental health is integral to overall health and well-being. There are plans in the pipeline to address mental health issues holistically over the next few years. With the release of the National Mental Health and Well-being Strategy Report, we invite the members of public to go through the report, understand the strategy and plans and put up further ideas and suggestions for discussion. [(proc text) Question put, and agreed to. (proc text)] [(proc text) Resolved, "That Parliament do now adjourn." (proc text)]”
“Today, all Singaporeans are eligible for healthcare subsidies of up to 80% in the public health care institutions and all Singaporeans and permanent residents are also covered under MediShield Life, regardless of pre-existing conditions, including mental health conditions. Some individuals may wish to purchase private Integrated Shield Plans and other insurance plans beyond subsidies and MediShield Life. Private insurers selling these plans are expected to deal fairly with customers and not to indiscriminately reject an application solely based on declared personal information, such as occupation, income, disability or medical condition, including mental health conditions. The Monetary Authority of Singapore (MAS) will take action against insurers whose practices are in breach of MAS' regulations or guidance and individuals with concerns over the insurers' underwriting decision can make an appeal through your insurers' feedback channel or through MAS. Lastly, we recognise the importance of workplace and employment support for individuals with mental health needs. On this front, companies are encouraged to tap on the various initiative's available, such as the HPB's Workplace Outreach Wellness package, which supports companies in rolling out general workplace health programmes, including mental health workshops based on their employees' needs. The MOM, together with NCSS, is looking into improving the employment and employability of persons with mental health conditions and strengthening support for mental well-being at the workplace, such as better work life harmony strategies and more job opportunities for persons with mental health conditions. More details on these will be released in the National Mental Health and Well-being Strategy in the next few days.”
“Beyond literacy and awareness, it is also important to dispel stigma and misconceptions around the topic of mental health and well-being. The National Council of Social Services (NCSS), beyond the Labour Movement, addresses mental health stigma and promotes social inclusion of persons with mental health conditions. We hope that through these efforts we can build better awareness, improve understanding and normalise conversations around mental health of Singaporeans from all ethnic and religious groups. Beyond general public education efforts, we have been enhancing community resources to make it easier for Singaporeans to seek help. For instance, well-being circles have been set up to provide citizens the skills to care for their own mental well-being and that of others around them. In addition, community mental health teams supported by the Government and set up by social service agencies provide mental health assessment and psychosocial help for those in distress. Many of these services are provided without charge to their residents. Specifically for the Malay/Muslim community, I am leading a new focus area on community Health set up under M3, a collaborative effort between the Islamic Religious Council of Singapore, MENDAKI and madrasahs. The aim is to rally the Malay/Muslim community in promoting healthy living lifestyles and empowering them to organise and scale community-led initiatives. One of its priority areas include supporting the mental health and well-being of the residents, taking into account their cultural context. We will leverage on this effort to bring across more mental well-being initiatives to the residents through further collaborations. We note Dr Syed Harun's concerns on health insurance coverage for individuals with mental health conditions.”
“For these reasons, the Inter-agency Task Force on Mental Health and Well-being was established in July 2022 to oversee and coordinate mental health efforts across different sectors focusing on cross-cutting issues that require inter-agency collaborations. The Task Force is chaired by Senior Minister of State for Health Dr Janil Puthucheary and brings together members from over 30 public, private and people sector agencies, including colleagues from the education, social and workplace domains. Over the past two years, the Task Force has reviewed the landscape, studied gaps and challenges and consulted the public and stakeholders. We have since put together a comprehensive National Mental Health and Well-being Strategy that charts our way forward to improve the mental health of Singaporeans, and we will be releasing a full report of the strategy in the next few days. Ahead of the release of the strategy report, allow me to provide some responses to the issues raised by Dr Syed Harun. We fully agree with Dr Syed Harun on the importance of taking an active approach towards ensuring accessibility and timeliness of care, capacity and support structures around mental health. For this reason, we believe in preventing poor mental health upstream by equipping every Singaporean with basic awareness and literacy on mental health and well-being issues and encouraging those in distress to actively seek help when needed. Efforts in this space include the Health Promotion Boards (HPB), mysg portal and the "It's okay to reach out" campaign, which promotes self-help and provide guidance on maintaining good mental well-being, such as managing emotions and stress.”
“Mr Speaker, I thank the Member Dr Syed Harun Alhabsyi for his passion and concern for the mental health and well-being of all Singaporeans. I am also grateful that Dr Syed Harun has chosen to speak on this important topic in his maiden speech in this House. Mental health is indeed a pressing concern. The recent National Population Health Survey reported a rise in prevalence of poor mental health among Singapore citizens from 13% in 2020 to 17% in 2022. Younger adults aged 18 to 29 years old seem more affected with about a quarter of those surveyed reporting having poor mental health. The Singapore Youth Epidemiology and Resilience Study findings released earlier this year also showed that one in three youths reported mental health symptoms, such as sadness, anxiety and loneliness. Good mental health is essential in maintaining overall health. A person's mental health and well-being is influenced by many factors, such as pressures at work, school, poor relationships and so on. Addressing these issues will require a collaborative and integrated approach that involves multiple stakeholders from the health, social, education, workplace and community sectors. Therefore, beside expanding healthcare capacity and investing in training of our healthcare manpower, we need to go beyond curing mental health conditions to prevention and tackle upstream factors through a holistic and coherent strategy. This move upstream means we can avoid over-medicalising mental health conditions and instead invest our resources in the promotion of well-being and early intervention. This will help us to improve our overall health outcomes and reduce health inequalities across the population.”
“We recognise that requiring two Resident Assessment Forms six months apart is not very applicable to the patients in hospices. For patients in the inpatient hospice setting, the best assessment arrangement is to use the severe disability assessment, but we acknowledge the issue that Dr Tan's resident faced. In that particular case, the ElderShield application was eventually approved based on the doctor's memo. We thank Dr Tan for raising a very important issue so that we can enhance our claims processes for patients with limited life expectancy. In following up with Dr Tan's feedback, MOH is working with AIC to improve access to severe disability assessors. In particular, AIC will work with inpatient hospices to actively link them up with available severe disability assessors. More broadly, AIC will proactively look up for claims from patients with limited life expectancies and prioritise processing of their applications. To further enhance this, we are also looking at enhancing access to severe disability assessments at home for patients who may be less mobile. We will continue to expand our pool of house-call assessors who are currently in the number of about 230. We are also exploring the possibility of allowing tele-assessments to further improve accessibility of severe disability accessors. So, we hope that in doing all these efforts, the concerns raised by Dr Tan will be addressed. 1.01 pm”
“Mr Speaker, between January 2022 and June 2023, around 20 inpatient hospice patients have sought ElderShield claims, and all were approved, supported by severe disability assessments conducted by the Ministry of Health (MOH)-accredited severe disability assessors. The Resident Assessment Form is an assessment tool that is typically used in nursing homes and is not commonly used in inpatient hospices. Currently, the median time for processing all severe disability scheme claims applications is 10 working days. Payouts are disbursed in the month after application approval and will include payouts for prior months between date of disability assessment and approval date. The Agency for Integrated Care (AIC) proactively looks out for claims applications from patients with limited life expectancy and prioritises the processing of their claims applications.”
“I thank the Member for the questions. I appreciate his concerns in this matter. I had mentioned earlier that three in four of the appeals are successful. That is quite a large number. We do look into the specific circumstances on a case-by-case basis. As to the suggestion, as I mentioned, we do regularly review the income criteria. It is a constant practice. We note that things have evolved and changed, post pandemic. And so, we will take into account the suggestions and the inputs that the Member has given in our constant review in this matter. We do look at it holistically, including the circumstances of the matter and the inflation index in our assessment of the review.”
“Mr Speaker, the Ministry of Health (MOH) regularly reviews the income criteria and subsidy levels for our healthcare subsidy schemes. Both the Community Health Assist Scheme (CHAS) subsidy levels and income criteria were last reviewed in 2019. From early next year, CHAS cardholders can benefit from the Healthier SG Chronic Tier, if they enrol with a Healthier SG general practitioner (GP) clinic. In the last two years, MOH has received around 14,000 appeals for changes of CHAS card status. Three in four managed to upgrade their cards. MOH considers all appeals on a case-by-case basis to review applicants’ means and circumstances, beyond just applying eligibility criteria of per capita household income or the annual value of their homes.”
“Now, Sir, I beg to move, "That the Bill be now read a Third time."”
“As I have mentioned, the Minister will be able to use subsidiary legislation to prescribe specific requirements that must be satisfied. These requirements will be reviewed from time to time, to keep pace with technological developments and address new ways of committing fraud. Mr Speaker, I believe that I have answered all the questions posed by Members. Sir, with that, I beg to move. 5.18 pm”
“It is possible for the CFO or NP, client and interpreter to be at three separate physical locations. Mr Ng asked what steps the CFO or NP should take to ensure that the interpretation and communication is accurately done. Today, CFOs and NPs are already required to take steps to safeguard the integrity of the process when it is done in person. Similar requirements will continue to apply under the electronic framework. For example, CFOs and NPs may be required to ensure that they can hear and see both the client and the interpreter simultaneously. The specific steps CFOs and NP will be required to take will be set out in either subsidiary legislation or in the refreshed guidelines to be issued by the Singapore Academy of Law. Ultimately, however, it will be up to each individual CFO and NP to exercise their professional judgment and experience, to satisfy themselves that the contents of the relevant document have been properly interpreted. If the CFO or NP is, at any point in time, not satisfied with the integrity of the process, the CFO or NP should stop the process, and request that the statutory declaration or oath or affirmation, be made or taken physically in person instead. Finally, Mr Lim Biow Chuan asked if remote commissioning or remote notarisations can be enabled through the promulgation of subsidiary legislation by the Minister. In the present case, amendments to primary legislation are necessary because we are making changes to certain requirements currently found in primary legislation. Nonetheless, going forward, the Bills do provide the Minister with the necessary rule-making powers to adjust the electronic framework using subsidiary legislation.”
“There are also existing rules and requirements on this in the Evidence Act and the Criminal Procedure Code. Likewise, to Mr Dennis Tan's question on whether an oath may be administered en masse to polling or counting agents, this must also be determined with reference to the existing legislative provisions under the Parliamentary Elections Act and the Presidential Elections Act. The amendments under these Bills do not change the existing position under these Acts. The manner in which oaths are administered for polling and counting agents – including whether video link is used in the first place – is something that the Elections Department will decide, depending on their assessment of what is most appropriate, to ensure that the integrity of the election process, as a whole, is not undermined. Next, Mr Lim Biow Chuan asked whether consular officers may administer oaths and affirmations or perform notarial acts through virtual means. The powers of a consular officer to administer an oath or affirmation, take an affidavit or perform a notarial act are set out in the Diplomatic and Consular Officers (Oaths and Fees) Act 1968, or the DCOA. Today, consular officers only perform such functions in-person. These Bills do not affect the existing position under the DCOA. We are aware overseas Singaporeans sometimes face difficulties obtaining notarial services in-person at our overseas Missions. Together with the Ministry of Foreign Affairs (MFA), we are studying possible ways, including by electronic means, to address such difficulties. Next, Mr Louis Ng asked several queries relating to interpreters. Mr Ng asked whether an interpreter has to be present in person with the client. The Bills do not require this.”
“For statutory declarations and notarisations, both the service provider and the client must be in Singapore before they can rely on the electronic framework that is set out under the ODN Bill. This is consistent with the position under existing law. There is an existing framework providing various options for overseas Singaporeans who need to make a statutory declaration or who need a document to be notarised. For instance, they may approach a notary public in that country or seek assistance from a Singapore Overseas Mission. For oaths, I mentioned earlier that our laws provide for oaths to be taken in a wide range of different processes and circumstances. Requirements such as who must take an oath, who the oath must be taken before and the form of words that must be used are set out in those existing laws. What these amendments do, is to make clear that any witnessing requirement for an oath can also be satisfied through the use of electronic means of communication such as videoconferencing. So, apart from making clear that the use of the stipulated electronic modalities is acceptable, the Bills do not make changes to the frameworks under existing law. Therefore, to Mr Yip's question on whether any specific oath can be taken when one or more persons involved in the process is physically outside Singapore, this is context specific and must be determined with reference to the legislation governing the process in question. For example, in the case of a witness who is appearing before Court, it is possible under the rules governing court procedure for the witness to be overseas and to take his oath and give evidence to a Singapore Court through live video link. However, this will be subject to the grant of permission by the Court.”
“Mr Ng also asked whether there are any requirements as to the security of the permitted platforms and whether, for instance, they must be secured with end-to-end encryption. The Bills are not prescriptive of the specific electronic platform that parties must use or how fast, clear or secure the electronic link must be. Instead, the Bills set out broad outcomes that the electronic link must be capable of achieving. Specifically, the electronic link must enable the service provider to communicate with the client, confirm the client's identity and verify any document that is to be signed. An electronic link will not meet these minimum requirements if it is of such poor quality that the service provider is unable to properly make out the client's face, or if it keeps dropping such that parties are unable to communicate properly. In such cases, parties will have to try again with a better connection, or fall back to an in-person meeting. As for the security of the electronic platform, it is up to the client and service provider to agree on an electronic platform that both are comfortable with using and that will best safeguard the confidentiality of the transaction. The client may also request for an in-person meeting instead. I should add that even in the absence of technical difficulties or concerns about confidentiality, it will still be open to any party to end the remote session at any time and request for an in-person meeting. For instance, the service provider may do this if he or she feels that something is amiss. Next, Mr Yip asked whether an overseas live link is allowed – I understand this to mean a scenario where one or even both parties to the process are not physically present in Singapore.”
“Those who are entrusted with the responsibility to administer the oath or statutory declaration must continue to be vigilant and to take the necessary steps to satisfy themselves of the identity of the person taking the oath or making the statutory declaration and that the person is not under undue influence. With regard to Mr Dennis Tan's point on keeping to the existing standard of care, the revised requirements and guidelines are unlikely to result in significant additional burden to CFOs and NPs. Any specific requirements that are put in place will be those that are necessary to safeguard the integrity of the various processes. In a related vein, Mr Ng asked whether there are methods by which clients can verify if the video links for oaths, affirmations and notarisations are valid, rather than a scam. The best defence against scams is a vigilant and discerning public. Members of the public should take care to verify that the service provider they are engaging is legitimate and is not a scammer. In this regard, the public can visit the SAL's website today to check whether a person is indeed a CFO or NP. As with the use of any other online service, members of the public who wish to conduct transactions remotely should also keep a lookout for tell-tale signs of scams. For example, they should check that any links that they receive are sent from the email address of the CFO or NP that they have been communicating with, and that the links point to an established video conferencing platform. If in doubt, members of the public should verify the authenticity of any links received through a separate channel such as a phone call with the CFO or NP. Mr Yip asked about the reliability of the electronic link and what happens if the electronic link is disrupted.”
“It is probably easier for a person to exert undue pressure on a client in the same room without a CFO's or NP's knowledge when the CFO or NP is communicating with the client by video link instead of in-person. So, as mentioned earlier, the Bills set out some minimum requirements that the electronic link must satisfy. One requirement is that the electronic link must enable the person who is administering the oath or statutory declaration to confirm the identity of the client. Further requirements may also be prescribed in subsidiary legislation under the Oaths, Declarations and Notarisations (Remote Methods) Bill, or the ODN Bill. These requirements can be reviewed and updated from time to time to keep pace with technological developments and to address new ways of committing fraud. We will also work with the Singapore Academy of Law to update the existing guidelines for CFOs and NPs, so that the CFOs and NPs are equipped with the practical know-how to conduct transactions in a secure electronic environment. When formulating the revised guidelines, we will bear in mind the issues of fraud and impersonation which Mr Yip has raised. We will also bear in mind the need to guard against undue influence. With this in mind, CFOs and NPs will likely be required to verify whether there are any other persons in the room with the client, and if so, who they are – a step that Mr Ng had alluded to and a step which CFOs are required to take today when commissioning affidavits remotely. All this being said, laws and guidelines are not in themselves sufficient.”
“Sir, I thank Members who spoke in support of the Bills. Let me now address the questions that were raised. First, Mr Dennis Tan asked whether the amendments to section 11 apply to Commissioners for Oaths (CFOs), administering statutory declarations. The answer is yes – the section 11 amendments are intended to apply to CFOs administering statutory declarations. Next, Mr Yip Hon Weng asked how we can guard against fraud and impersonation. Mr Louis Ng asked what steps CFOs and Notary Publics (NPs) should take to ensure that the client is not under undue pressure over video link. Mr Dennis Tan commented that the use of electronic means of communication may come with some difficulties and asked that we do not increase the standard of care expected of CFOs and NPs. As I mentioned during my opening speech, the need to ensure the continuing integrity of the various processes was a key consideration when developing the electronic framework. The possibility of fraud, impersonation and undue pressure is not unique to the electronic space. Identity fraud and forgery can happen in the real world. To guard against this, the Singapore Academy of Law (SAL) has existing guidelines which advise CFOs and NPs to take steps to verify the identity of the person before them, for example, by requiring the person to produce a photo ID. Nonetheless, we recognise that the adoption of technology introduces new ways in which fraud can be carried out. Impersonation through deepfakes, which Mr Yip has mentioned, is one possibility that we need to be on our guard against. Technology also has its limitations.”
“The validation clauses under the Oaths, Declarations and Notarisations (Remote Methods) Bill apply only to those statutory declarations and notarial acts that were done using a live video or live television link. So, for example, a statutory declaration or notarial act that was done only by telephone will not be validated. The validation clauses also do not affect a person’s right to challenge the validity of a statutory declaration or notarial act on the basis that some other requirement, apart from the in-person witnessing requirement, was not met. The framework I have just outlined is crafted to strike a balance between convenience and efficiency on the one hand and safeguarding the integrity of the process on the other hand. The Bills have also been designed to be as technology neutral as possible, with details devolved to subsidiary legislation, so that the framework and its associated safeguards can be updated from time to time to keep pace with technological developments. Mr Speaker, Sir, I beg to move. [(proc text) Question proposed. (proc text)]”
“This means that the public can continue with their existing in-person and/or paper-based processes if they wish. It follows that the legislative framework does not oblige Government agencies, a Commissioner for Oath or a Notary Public to provide or adopt an electronic option. For example, public agencies administer or require the taking of statutory declarations or oaths in a wide variety of circumstances. There may be important, or simply practical, reasons for physical processes to continue. It may be that certain oaths of office or other Constitutional oaths continue to be taken in person as a general rule because of the gravity and solemnity associated with such oaths. In other cases, it may be that the agency in question has some specific policy or practical reason to require a person’s physical presence when taking a statutory declaration or oath. The second point relates to statutory declarations and notarial acts that have already been made in a process that involved remote witnessing. For example, this may have been done during the COVID-19 pandemic when movement restrictions were in place. Given the lack of clarity in the current law on whether these processes can be conducted remotely, the Oaths, Declarations and Notarisations (Remote Methods) Bill will make it clear that no statutory declaration or notarial act made or carried out prior to these amendments will be invalidated solely because video conferencing was used. This should address concerns around the validity of statutory declarations or notarial acts made in a process involving remote witnessing before this Bill.”
“In some cases, such as oaths of office that are taken by officeholders under the Constitution or other Acts, the Bills will make clarificatory amendments so as to provide for greater legal certainty. The second aspect is that of electronic signing. For statutory declarations, the Oaths, Declarations and Notarisations (Remote Methods) Bill will provide clearly that these instruments can be signed using an electronic signature. There are various types of electronic signatures. As a safeguard for statutory declarations, it will be necessary to only use the type of electronic signature that will be prescribed in subsidiary legislation. In deciding the type of electronic signature to prescribe in subsidiary legislation, we will consider factors, such as performance standards, security, reliability and ease of access for Singaporeans. For notarial acts or oaths that must be subscribed with a signature – such as oaths administered in the course of judicial proceedings, or oaths taken by officeholders under the Constitution – the Constitution (Amendment) Bill, and the Oaths, Declarations and Notarisations (Remote Methods) Bill do not change the position in relation to how these should be signed. Notarial acts or oaths arise in a variety of situations, with different needs and circumstances. We will, therefore, leave the precise signing requirements to be determined by the relevant sectorial agency. Before I conclude, Mr Speaker, let me touch on a couple of points. The first point is that the framework is enabling and not prescriptive. It provides individuals, businesses and service providers with an electronic option, for the various legal processes that I have spoken of. The framework does not require or mandate the use of such electronic options.”
“This is in line with the Government’s ongoing efforts to facilitate electronic transactions, by progressively reviewing and updating the relevant legal frameworks in place. Just to give a few recent examples, in 2021, this House enacted: (a) the Courts (Civil and Criminal Justice) Reform Act which empowered the Courts to conduct hearings remotely; (b) the Electronic Transactions (Amendment) Act, which enabled the creation and use of electronic bills of lading; and (c) the Mental Capacity (Amendment) Act, which enabled the creation and registration of electronic lasting powers of attorney. Let me now highlight two key aspects of the framework for Members. The first aspect is that of electronic meetings with authorised service providers. Where a client is currently required by law and practice to appear before an authorised service provider to make a statutory declaration, take an oath, or obtain a notarial act, the framework under the Oaths, Declarations and Notarisations (Remote Methods) Bill will make it clear that the client and authorised service provider are allowed to meet using stipulated electronic means of communication. The Bill sets out certain minimum requirements relating to the quality of such electronic means of communication. And we also intend to prescribe further procedural requirements or safeguards that parties must comply with, in subsidiary legislation. The Board of Commissioners for Oaths and Notaries Public under the Singapore Academy of Law also intends to issue refreshed guidelines that will assist CFOs and NPs in carrying out their functions under this framework. We understand that these guidelines will include guidance on the circumstances in which it may be inappropriate for a CFO or NP to provide their services remotely.”
“This mitigates the risk of forgery, safeguards the integrity of the process and provides foreign recipients with the assurance that they need in order to rely on documents that are notarised by a NP in Singapore. As Members will have gathered from the brief explanation that I have given, historically, and today, the process for making a statutory declaration; taking an oath or affirmation; or obtaining a notarial act, is stringent and subject to several requirements, including the need to, generally, appear in-person before an authorised service provider, such as a Commissioner for Oaths or a Notary Public. Further, the process is often paper-based, involving the use of wet ink signatures. These requirements all help to ensure the integrity of the process – for the reasons I have outlined earlier. Technology has improved drastically over the years. It is now possible with the touch of a button to see and hear, through video-conferencing software, a person who is on the other end of Singapore – something unthinkable when these requirements were first formulated centuries ago. Society is also increasingly comfortable with relying on digital processes. Where possible, it is important that the law does not hinder, but instead supports innovation and digitalisation of business processes whilst ensuring that necessary safeguards are maintained or strengthened. These Bills, therefore, seek to put in place a framework that will enable statutory declarations, oaths and affirmations, and notarisations to be done through electronic means, whilst ensuring the integrity of these processes and maintaining a high degree of security against fraud.”
“And it must also be made before an authorised person, such as a Commissioner for Oaths, or CFO for short, who will check the identity of the declarant and ensure that the declarant is aware of what he is doing and aware of the consequences of making a false declaration. Next, an oath or affirmation is a solemn declaration by which a person swears or affirms that what he says is the truth or that he will do as he has promised to do. There is a wide range of circumstances in which a person may be required to take an oath, but most oaths fall within two broad categories. First, a person, such as a witness, may be required to take an oath before giving evidence, for example, to a Court or tribunal. Second, a person may also be required to take an oath if he or she is appointed to an office, such as that of a Judge. For example, before assuming office, Supreme Court Judges are required under the Constitution to solemnly swear to faithfully discharge their judicial duties and do right without fear or favour. Last, I come to notarial functions that are performed by a Notary Public in Singapore, or NP for short. From time to time, individuals or businesses may need to obtain a notarial act from a NP. For example, an individual may need a certified true copy of an original document such as his identity card or academic certificate to apply to a foreign educational institution for further studies; or a business may need a NP to witness the due execution of a document that is meant for use overseas. The process of obtaining a notarial act is a stringent one. Notaries must keep a full and accurate record of the whole procedure. Further, each notarial certificate issued by the NP is serialised and must be presented to the Singapore Academy of Law for authentication.”
“Thank you, Sir. Sir, this Constitution (Amendment) Bill and the Oaths, Declarations and Notarisations (Remote Methods) Bill concern the way in which a statutory declaration, oath and affirmation, or notarial act is to be made or done in Singapore. Let me first briefly explain what a statutory declaration, oath and affirmation, and notarial act is before I take Members through the key aspects of these Bills. In brief, a statutory declaration is a written statement that a person signs and solemnly declares to be true. Making a false statutory declaration is a serious criminal offence. For example, producing a false statutory declaration to a Court can result in a jail term of up to seven years. Apart from use in Court proceedings, statutory declarations may also be taken for a myriad of commercial or regulatory purposes, such as registering a ship, declaring that a company is solvent, transferring a bill of sale or affirming that contractual obligations have been complied with. Some public agencies may also require certain applications to be supported by a statutory declaration. For instance, applications to the Registrar of Titles for a replacement Certificate of Title must be accompanied by a statutory declaration setting out the circumstances leading to the loss of the original Certificate. Given the weight that can be placed on facts set out in a sworn statutory declaration and the serious consequences associated with making a false statutory declaration, the law today requires a statutory declaration to be made in a specific form and manner. Therefore, a statutory declaration must take the form that is set out in the Oaths and Declarations Act.”
“Mr Speaker, on behalf of the Minister for Law, I beg to move, "That the Bill be now read a Second time". Sir, this Constitution (Amendment) Bill is linked to the next Bill on the Order Paper, the Oaths, Declarations and Notarisations (Remote Methods) Bill. May I therefore propose, with your permission, that the substantive debate on both Bills takes place now? Members are welcome to raise questions or express their views on both Bills during the debate. We will still have the formal Second Reading of the Oaths, Declarations and Notarisations (Remote Methods) Bill to ensure that the procedural requirements are satisfied.”
“I thank the Member for the questions. With regard to non-clinical genetic tests, these are typically those that do not address medical conditions or disorders and are usually used for general wellness or recreational purposes. So, they are assessed to be of lower risk and may be offered directly to consumers. Nonetheless, it is important for consumers of non-clinical genetic tests to be informed and take precautions for themselves in looking after their own interests. So, that is why we have developed the guidance document and enhanced consumer education to raise awareness on genetic testing. In contrast, the clinical genetic tests are used to assess, diagnose, prevent, alleviate and predict risks or treat a medical condition or disorder. So, they should be administered by medical practitioners with the appropriate knowledge and training. So, we make sure that the medical practitioner is involved in order to actually look at the test results properly and provide the necessary management to the individual. That responds to the first question. In respect of the second question, because of this difference with the DTC tests, we take a risk-based approach, as I had explained. We use a caveat emptor approach. It means that the consumer has to be responsible, has to be aware that they have to protect themselves. Having said that, as I mentioned, we have guidelines in place. Moving forward, we are also looking at the development of the Health Information Bill. And these are also ways in which we can enhance protection further. But we will watch and see whether there is any need for further regulatory enhancements in this space.”
“The Ministry of Health (MOH) takes a risk-based approach to the regulation of genetic testing. Aligned to this approach, we regulate clinical genetic testing but not direct-to-consumer (DTC) tests used for general wellness, ancestry and nutrigenomic purposes. Nevertheless, MOH has issued a guidance document in May 2021 which outlines good practices for providers offering non-clinical genetic testing and educates consumers on the risks of such testing. These risks include exaggerated claims, the possible sharing and commercial use of genetic data obtained from DTC tests by third parties and the lack of proper medical interpretation of test results. Consumers should exercise care to assess for themselves the suitability and quality of such non-clinical tests. Consumers need to read the test provider's terms and conditions carefully before using such tests and contact the provider or approach their doctors when in doubt. MOH will continue to monitor the development of DTC genetic testing and review our regulatory initiatives and consumer education efforts to ensure the safety, privacy and welfare of the public.”
“I think on the second question, there is going to be a cut-off somewhere. But how we apply it is really about trying to assess and see if they do have needs. I do not think it is done in a manner that is unfair and draconian to the recipients. On the first point, there are back-end processes that make sure that they are supported. But if there are appeals, they will definitely be looked at. If it is zero per capita household income, we will definitely provide the same subsidies as per the others.”
“There are quite a few questions. My response may not be in order. But I just wanted to confirm a few things. Firstly, the Member had asked about whether we are still using the AV as at 31 December 2022, I confirm that. But I note there may be applicants who are living in new residences which do not have an AV for 2022. So, the benchmark is 2023. But there are processes in place to ensure that they will not be shortchanged and all those HDB households with zero per capita household income will not be made worse off because of this discrepancy in the AV; they will continue to receive the same amount of subsidies. On the Member's point of considering to remove this, this is a broader point that we are looking at. The AV still remains a proxy of the means for the households and it is something that we still use to assess the support required. As the Member would know, actually, there are also other subsidies and support which we offer to others who may be asset-rich but cash-poor, including non-means tested support in other schemes. For instance, those who are aged 65 and above receive higher subsidies of 75% at polyclinics, regardless of means; and for those who are in the Pioneer Generation and Merdeka Generation, these seniors also receive benefits, regardless of their per capita household income or the AV of their residence, such as subsidies for MediShield Life premiums, MediSave top-ups and higher subsidies at outpatient care. So, these are things in place. And as I have mentioned earlier, if any of them are facing difficulties, they can always approach their healthcare providers and we will do our best to assist.”
“Mdm Deputy Speaker, as the Inland Revenue Authority of Singapore (IRAS) has just revised the annual values (AVs) of properties upwards from 1 January 2023, agencies, such as the Ministry of Health (MOH), continue to use AVs as at 31 December 2022 to conduct means-testing for healthcare subsidies in 2023. Given the 2023 increase in AVs, the Ministry of Finance (MOF) had previously informed that social support schemes, including the AV thresholds, will be reviewed. An update will be provided later this year. Individuals who face difficulties in paying for their healthcare expenses due to a change in their AV under such circumstances, may approach their respective healthcare institution or provider for assistance.”
“I thank the Member for her passion and interest in this. I know that this is an issue that has been raised, especially in our conversations on women's development, and it is of concern. However, when we talk about supporting, from the Ministry's perspective as to how we support the caregiving services, there are some considerations that we have to take into account. We see the family as the first line of defence and we need to ensure that we are advocating for the right behaviours and there are also concerns about the fiscal sustainability of the approaches that we take in this. As Members are aware, the Government is already providing a lot of support – and multiple tiers of support – for healthcare services and the support to caregivers. The caregivers can tap on their MediSave, they can tap on their subsidy schemes and their grants, and a lot of this is really targeted at those who actually need the help the most. So, we do need to think carefully about changing this model and approach. I think we remain open to reviewing the different approaches to support caregivers, but we have to look at this in the context of the whole support that we are giving to the family, in respect of caregiving. On the question in respect of the different models, under the refreshed action plan for successful ageing, we are already exploring with different models. We are developing the Active Ageing Centres within the communities. We are investing quite a bit in community care and we are also looking at how to enhance the support for home caregiving services.”
“There are various efforts that we are looking into. This is something that we can consider. Yesterday, I had explained to this House that we are also trying to look at how we can get more seniors to volunteer and these may be some avenues that we can explore.”
“Mr Deputy Speaker, based on the Ministry of Manpower's (MOM) 2022 Labour Force Survey, about 90,300 residents outside of the labour force cited caregiving responsibilities as the main reason for not working. Twelve thousand four hundred of these caregivers were looking after their aged, ill or disabled parents. As our population ages, more seniors will need care and there will be more caregivers who may need support. To prepare for this, we have strengthened support for caregivers, such as through the recent enhancement to the Home Caregiving Grant. The Government has also scaled up the capacity for aged care services, such as home and day care services, over the years to meet the needs of seniors. We are reviewing the aged care landscape to better anchor care in the community and support seniors to age well at home. These changes will help to relieve the burden on family caregivers. To enable these improvements, the Government will continue to build up the capacity and capability of care workers. The Ministry of Health (MOH) and the Agency for Integrated Care (AIC) have helped community care organisations attract and retain manpower through schemes to support local recruitment, branding of the sector and salary enhancements. Providers can also access manpower training initiatives under AIC, such as study awards and training courses offered by learning institutes.”
“I thank the Member for his interest in this matter. Indeed, this is something close to our hearts and it is of concern. We are trying to grow the manpower and we are on track on building the numbers. In respect of getting the numbers from the local institutions, we are doing a few things. We are facilitating this process. The numbers are small now, but we are encouraging movements from the different tracks. We are tracking the numbers from institutions to understand why there may be leakage or why people drop off from the courses and do not enter the profession. We are working with schools and the healthcare institutions to ensure smooth transition, so that after they graduate, they enter into the profession. To facilitate entry into the profession, we are also reviewing the remuneration framework to ensure that the profession remains attractive. There are various work streams to look into how we can improve the profession, increase its stature as well as improve the work environments, so that overall, there is attraction to this profession. We are doing different efforts on different fronts. Hopefully, in time, this will improve the manpower situation.”
“Mr Deputy Speaker, over the past three years, a total of 10 students from the International Baccalaureate Diploma Programme (IBDP) and Integrated Programme (IP) were admitted to the National University of Singapore (NUS)’s Nursing degree programme. There were five students from the IBDP and IP admitted to Nanyang Polytechnic (NYP)’s and Ngee Ann Polytechnic (NP)’s Nursing diploma programmes, where most entered after completing Year 4 of their IB or IP studies. Our Institutes of Higher Learning (IHLs) will assess all applicants for nursing courses holistically, taking into account both academic performance and course fit. For IBDP or IP students who are keen on nursing as a career, we encourage them to apply for admission to polytechnic Nursing diploma programmes on the basis of Year 4 grades, and the NUS Nursing degree programme on the basis of Year 6 grades. An overview of the various admission pathways into Nursing programmes at the IHLs is available on MOH Holdings’ Care to Go Beyond website. Information on each IHL’s admission processes and requirements can also be found on their respective websites.”
“I thank the Member for the question. This is a work-in-progress clearly. We do have very good partners on the ground who have been around for a long time and have built relationships with the seniors, so we will be tapping on that expertise. But capability will continue to be built and we need to do so, especially in light of Healthier SG as we reach out to more people. As mentioned, the effort is also in tapping on community volunteers and partners. That is why it is so important to work with grassroots, with partners on the ground and also to bring in seniors who are already connected and convert them to be volunteers themselves, so that they can also reach out. I think this is a whole-of-community effort and we will definitely have to reach out for different ideas. There are already engagements on the ground, there are already efforts to build capabilities, but this will continue to be a work-in-progress.”
“This is indeed the problem that many of us face. We do not have the monopoly on the ideas on this; in fact, that is why we are working very closely with partners, as well as with the different communities to understand what the different demographics or interest are. Perhaps, with this collaboration with partners on the ground, we will be able to come up with activities that will attract these seniors. We are also trying to bring in these seniors to bring out their other friends, so perhaps, that is also one way to enhance participation from those who have not traditionally included themselves in these activities.”
“Mdm Deputy Speaker, the RNs are intended to be satellites for the AACs to reach out to more seniors. We are already in communication with PA to open up the spaces. It will really depend on the different areas because we are looking at where there are gaps, and we are trying to fill in those gaps. We will be providing funding for the AACs to run the active ageing programmes. This is something that we will definitely keep track of. There will be key performance indicators (KPIs) to be achieved to see whether the AACs are keeping up with the outcomes that are targeted. We will definitely be working with PA and depending on the different areas, we will be working with the advisors. We look forward to Members' support on this. In respect of the volunteer opportunities, the Silver Volunteer Fund that I mentioned is intended to create a diverse range of senior-centric volunteering opportunities and this can include opportunities to do mentoring to high-risk youths from low-income families and also, to help caregivers of special needs children with art and music therapeutic programmes. AACs are also volunteering opportunities for the seniors to organise the active ageing programmes for fellow seniors and reach out to those seniors who are in isolation. We will continue to work with partners to ensure that there are a whole host of different types of volunteer activities that will be able to attract seniors with different abilities.”
“Mdm Deputy Speaker, over the past two months, the healthcare family has been discussing these key work streams that the Member has raised at our Work Plan seminar. As explained to the House before, we have three inter-related healthcare systems and the aged care system is a key one we are prioritising for review. Encouraging seniors to adopt active lifestyles and practice good health habits is the most sustainable and effective way to address the challenge of an ageing population with rapidly rising number of people with chronic and other illnesses. To do so, we need to strengthen our ageing infrastructure in the community. Many of our initiatives are laid out in a recent 2023 Action Plan for Successful Ageing. Further, we are expanding the number of the Active Ageing Centres (AACs) and transforming their operating model to support healthy ageing for seniors. But AACs cannot work alone, and close collaboration with other agencies, such as the Health Promotion Board (HPB) and the People's Association (PA) will be critical and we seek the support of all Advisors. For example, to outreach to seniors more effectively and extensively, we need to tap on all community volunteers, whether they are from the Agency for Integrated Care (AIC) or PA. To enable seniors to lead an active lifestyle, HPB and PA need to organise suitable activities, and be as inclusive as possible. Promoting senior volunteerism will be an important thrust. For example, the expansion of AACs will offer more volunteer roles such as buddying and befriending. The Ministry of Health (MOH) and the Council of Third Age will also roll out the enhanced Silver Volunteer Fund in the second half of 2023 to support the growing network of volunteer host organisations offering meaningful senior volunteer opportunities.”
“Meeting the health and healthcare needs of PwDs will require coordination of the efforts of different stakeholders. MOH and the Ministry of Social and Family Development will continue to study the gaps in service provision for PwDs and explore how to work with healthcare providers and community partners to strengthen support for them.”
“Mr Deputy Speaker, the Ministry of Health (MOH) will build on the Enabling Masterplan 2030 to enable Persons with Disabilities (PwDs), including those with intellectual disabilities, to live healthier lives. There are specific considerations in delivering care to PwDs and we are committed to working with partners on this journey. Our healthcare professionals may face challenges, such as when there are high medical and social needs involved which need detailed support. As part of the Master Plan, MOH has collaborated with the College of Family Physicians Singapore to offer a Family Practice Skills Course for general practitioners, which equips them in caring for persons with intellectual disabilities. We are also piloting a Community Integrated Health Team in partnership with a social service agency and a specialist outreach team from the Institute of Mental Health. These multidisciplinary teams offer home- or community-based care for persons with intellectual disabilities who have complex health needs. We will continue to build these capabilities in the community so as to support more caregivers and families of PwDs. In line with making healthy living more accessible under Healthier SG, we are also working with partners to bring a wider range of programmes and activities closer to all residents, regardless of their level of mobility. For example, the Singapore Physical Activity Guidelines, developed by the Health Promotion Board and SportSG, were updated in 2022 and expanded to be inclusive of PwDs, providing recommendations and tips for PwDs to stay active. SportSG has expanded sporting opportunities for PwDs through the Para Sports Academy programme and is also working with the Ministry of Culture, Community and Youth to update the Disability Sports Masterplan.”
“This is not change that will happen overnight, but I am confident that it is one which will gather pace in the coming years. In conclusion, end-of-life care is a key priority for the Ministry. We have gathered key partners to refresh our national strategy for palliative care and will share more in the coming months. But to ensure that Singaporeans live well and leave well, all of us have to play our roles as family members, caregivers and friends and have conversations about what a good death looks like. 6.06 pm”
“Medical advancement has given us the belief that all conditions can be treated and life extended. This has led to death becoming medicalised. Many end up dying in hospitals, having life-sustaining treatment up to their very last breath even though this might not have been how they wished to leave. We now know that health is, to a large extent, determined by social factors. Death is, in fact, also very much a social process. What matters to most is being with their loved ones in a familiar environment, having their final wishes fulfilled and regrets resolved. Bringing end-of-life conversations into our collective consciousness is similarly a social process. It builds on relationships and often evokes strong emotions. If we are successful in building up our preventive care system centred around family doctors and aged care system centred around AACs and community partners, we will be able to normalise end-of-life conversations amongst residents, their loved ones and care teams.”
“Terminally ill patients may also withdraw all their Central Provident Fund (CPF) savings in a lump sum under the CPF Reduced Life Expectancy scheme, subject to retaining a balance of $5,000 in their MediSave account. On top of the schemes and services, we, ourselves, play an important role in ensuring that we have a good death. We need to take charge of our own end-of-life journey, to be open to discussing with our loved ones what matters to us, what quality of life means and how we would want to live our last days. We will do more to normalise conversations about death and dying. MOH and the Public Service Division (PSD) set up the My Legacy portal in 2020 to serve as a one-stop resource to provide information on planning ahead, and tools, such as the LPA, ACP and the AMD. We are looking at further digitalising these processes to make it more convenient for the public to make these tools. MOH, MSF and PSD are also planning a three-year campaign to increase awareness and adoption of pre-planning instruments with a focus on LPA and ACP. This will be launched later this year and will involve a range of both in-person and digital activities. To complement the campaign's activities, a series of workshops will be held at AACs, as Ms Ng Ling Ling has suggested. We are also working with SHC to engage the community through the grassroots, corporates, faith-based organisations and schools to build a pool of advocates. Serving as a trusted source of information, these advocates can plant seeds of these important conversations amongst the wider community and spread awareness of palliative care. Many decades ago, people routinely spent the last days at home. They would deteriorate gradually and loved ones would gather as their activity levels drop.”