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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“Civil society and community organisations are well-placed to participate in this effort. They can play a critical role in providing support for women and creating platforms for the public in general to discuss and better understand issues surrounding menopause. MOH is supportive of such efforts. In addition, many women who are going through menopause are concurrently taking on caregiving responsibilities. We support caregivers to balance caregiving while pursuing their aspirations and caring for their own health. We are enhancing options to make childcare and eldercare more accessible, affordable and available, for example, by scaling up childcare and eldercare capacity, and providing multiple layers of financial support. These, in tandem with other moves to support women at work, will support women to better balance their responsibilities, and their own health and well-being. Assoc Prof Razwana also spoke about suggestions for MOE and MOM, touching on educating people about menopause in schools and workplace policies that better support women with menopause. In MOE's Sexuality Education and Science curriculum, students learn about menstrual health in women. Primary 5 students learn about the physiological changes that occur during puberty, such as menstruation. Students are also educated on human reproduction and issues related to menstrual health in Lower Secondary Science and Upper Secondary Biology. In Upper Secondary Biology, students will also learn about changes to the menstrual cycle as a female ages, leading to menopause. On workplace policies, women who experience severe menopausal symptoms can already seek subsidised medical treatment at Public Healthcare Institutions, and take sick leave to rest and recover, just like any other medical need.”
“Research into menopause would provide more insight into how it affects women's overall health and well-being, and enable better ways to manage menopause symptoms and its impact. The National University Hospital currently conducts the Integrated Women's Health Programme (IWHP) which is a cohort study looking at health issues experienced by Singaporean women. Issues studied include the associations between menopause and age-related health issues, such as osteoporosis and sleep disturbances. The research team plans to conduct follow-up studies and we look forward to further insights that the IWHP and other researchers can provide on women's health in general, as well as menopause specifically. Women should not feel ashamed, embarrassed or misunderstood to speak openly about menopause. As a society, we should work to remove the stigma surrounding menopause, and we are already taking steps to educate the public. Reliable information on menopause can be found on HealthHub and the websites of our public healthcare institutions. KKH has also launched the Women In all Stages Empowered, or WISE, Health Guide, which highlights important health advice for women, including advice on menopause. Education about menopause is important to help women understand what to expect and how to manage the changes to their body. We will continue to empower women to approach menopause with confidence and make informed decisions about their health and well-being. To truly enhance women's well-being during menopause, we must address not only the physical symptoms, but also the psychological and social impacts. This includes combating stigma, promoting open dialogue and ensuring that women have access to accurate information and supportive resources.”
“For significant symptoms impacting quality of life, women should see their doctor to explore suitable interventions to manage the impact on both physical and mental health. We agree that educating our medical students and medical practitioners on menopause is important and we have been doing so. In our three local medical schools, knowledge of symptoms, diagnosis and management of menstrual disorders, including menopause, is one of the core learning outcomes for the medical students. Postgraduate family medicine programmes, such as the Family Medicine residency programme and the Graduate Diploma in Family Medicine include training on common women's health conditions, including menopause, in the curriculum. Professional bodies, such as the College of Family Physicians Singapore also run skills courses on a variety of topics relevant to primary care practice. These efforts enable our primary care doctors to be a source of support to women in managing the health issues that may arise during this life transition. Under Healthier SG, the relationship between the primary care doctor and enrollee is central. Women who are experiencing menopausal symptoms can inform their primary care doctor, who would be well placed to assess the symptoms, the patient's needs and make recommendations on further management. The Member also mentioned KKH and the KK Menopause Centre. This multi-specialty practice comprising of gynaecology, family medicine, dermatology and mental health specialists, has been trained to support a range of needs of women with menopausal-related health issues. Mental health services are also available in various care settings to identify women who may be experiencing psychological symptoms and provide interventions when required.”
“Mr Deputy Speaker, the hon Member Assoc Prof Razwana spoke about enhancing the well-being of women going through perimenopause or menopause and gave suggestions that MOH, MOM and MOE could consider to better support women through this critical phase in their lives. I thank her for her speech and suggestions. I agree with many of the points raised by Assoc Prof Razwana. She shared about the health impact of menopause on women and how we can address this impact with training of healthcare providers, research into contributing factors and management, public education and social support. I will now address her points in my speech. Every woman's experience during menopause is different. Some may experience significant impact to their health and well-being, beyond the more common symptoms, such as hot flushes, night sweats and insomnia. For example, cardiovascular health may be affected. This is because as the protective effects of oestrogen on the heart diminish, this can potentially lead to an increased risk of heart disease and stroke. Changes in metabolism during menopause can also result in weight gain, particularly around the abdomen, which may increase the risk of diabetes and other metabolic disorders. Assoc Prof Razwana also highlighted that women undergoing menopause can experience changes in mood, which can impact their mental well-being. It is important to note that while these health impacts of concern, they can be managed. Regular check-ups, a healthy lifestyle, including exercise, eating well and finding ways to relax can help. Simple things like using moisturisers for dryness and choosing appropriate clothing to manage hot flushes can also make a difference.”
“I note the concern that the Member raised on the limitations of the SMF. I would say though that there are over 16,000 seniors since 2019, I believe, who have already applied for this fund and most of them will actually get subsidies; 99% of them are eligible and actually would get the subsidies. So, for those of them who cannot meet the eligibility requirement, they can go to AIC for any additional support. [Please refer to "Clarification by Minister of State for Health", Official Report, 16 October 2024, Vol 95, Issue 144, Correction By Written Statement section.] I note the Member's concerns, but I think it is a balancing exercise that we have to take note of. This is something that we will constantly review and assess because there is a need to also ensure that there are sufficient balances in MediSave. We take into account how we reserve this for the more severe situations and more costly items. And this is a principle that we adhere to. It is something that we will continue to assess. As I said, if there are situations where the seniors feel that they actually cannot afford it and do not meet the SMF eligibility requirements, they can approach AIC and we can see what are some of the other ways that we can support the seniors.”
“Mr Speaker, seniors who require hearing aids can tap on the Seniors’ Mobility and Enabling Fund (SMF), which provides eligible Singaporeans with means-tested subsidies of up to 90%. Those with severe hearing loss requiring hearing implants, such as bone conduction hearing or cochlear implants, can tap on subsidies, MediSave and MediShield Life. The Agency for Integrated Care (AIC) can also provide additional support. While it is understandable that many Singaporeans wish to use more of their MediSave, we also need to ensure that Singaporeans have adequate MediSave balances to support their medical expenses for major health episodes, which tend to happen when they are in an advanced age.”
“I appreciate the Member's question and concern in identifying certain groups which may not be as receptive or a bit more exposed to AI. She made specific references to two of the programmes that we are working on. The Code for Fun programme is something that we do in schools. That is something that the teachers roll out and we do, indeed, aim to encourage more students to participate in it. We definitely can always look at enhancing this and ensuring that students from all backgrounds get to benefit from this. Being in school allows for that accessibility to students from different backgrounds to have access and for teachers to identify those who, perhaps, need more support and more nudging. The NLB programme, indeed, is also with the same thinking. It is done in a platform that is accessible for all. I believe there should be tracking of some of this participation. This is something that I will need to look into. But it is something that we are cognisant of, that there are certain groups that may not be as receptive or maybe even groups we want to reach out to share these resources and we will continue with our efforts to do so. We continue to work also with partners through our Digital for Life programmes. Through these partners, who are working in the ground communities, they help us access different groups with different modalities. With the suite of all these efforts, we should be able to reach out to different groups. But if there are any groups that the Member has identified that needs further support, please let us know and we would be happy to reach out and extend some of these resources to them.”
“I thank the Member for the question and for constantly championing the needs of the healthcare workers. I know that he has also raised this question separately. We have not extended the ANGEL scheme, which was specifically meant for nurses, because we take different approaches. There are different considerations for different healthcare workers. We do not have the same scheme for nurses and doctors, for example. We do take into account factors, such as the strength of the recruitment pipeline, the global competition, the nature of the jobs and their career structure and looking at what is needed for that particular role and that particular healthcare group. Nurses make up a large number. There is a large number of healthcare workers. They make up a large proportion of the workforce in the public healthcare institution. Hence, it becomes necessary to have a scheme like ANGEL to retain them, very much like why teachers, when they have a whole group of workers who are in the public sector that needs to be retained. So, that scheme was specifically meant for them. We do consider the needs of all our healthcare workers and, indeed, the administrative and support healthcare workers are as important to us, but we do it in a different way. We regularly review the salaries of all the healthcare workers in the public healthcare institutions to ensure that their salaries are fair and competitive. And we will continue to look at various ways to attract and retain them, various measures to ensure that they are future-ready, that we are supporting mid-entry entrants, for example, into the sector, providing them with opportunities to have job redesign, career development and also ensuring that they have a conducive and age-appropriate work environment.”
“Mr Speaker, the Ministry of Health (MOH) actively works with the public healthcare clusters and community care organisations to ensure that they are able to recruit and retain sufficient staff to meet their needs. This includes ensuring competitive salaries, career development opportunities and safe working environments. For administrative and support healthcare workers, we pay special attention to redesign their roles and career pathways so that they have more development and career progression opportunities. MOH has worked with the clusters to develop the Care Support Associate (CSA) and Patient Service Associate (PSA) roles, which incorporate an expanded mix of patient caregiving, administrative and operational tasks. This is currently being rolled out, with training support available, to enable existing staff to take up the expanded roles.”
“The Ministry of Health (MOH) will work with our public healthcare institutions to ensure that there are good career prospects and development opportunities for pharmacy technicians. The Public Sector Pharmacy Technicians Career Development Pathway (PharmTech CDP) maps out the career progression pathway for pharmacy technicians where they will have the opportunity to take on expanded responsibilities across key areas, such as patient care, procurement, logistics management and medication safety. We will review the PharmTech CDP regularly and raise public awareness of the career and professional development opportunities for pharmacy technicians. The starting salaries of pharmacy technicians in the public healthcare clusters will increase by 9% in 2023 with additional funding support from MOH. Salaries are reviewed regularly to ensure that they remain competitive.”
“Mr Speaker, may I, with your permission, address Question Nos 7 and 8 together?”
“There is already training for our healthcare providers and clinicians to look out for signs and symptoms of ACEs. When the clinicians see these signs and symptoms, like distress and parental neglect, they can ask more questions and identify some of the issues and would already make the appropriate referrals. So, there is already that approach that we take to try and catch them early. But this takes a whole-of-Government, whole-of-society effort – and that is also why you have asked questions of all the different Ministries. We, indeed, work together because you see children at different touch points and you want to make sure that everyone who interacts with them will be able to identify and help and catch them early. So, that is the direction we are going. We try and go as upstream as possible with MSF and MOE taking care of building stronger families. We train the professionals to understand and identify this and we want to proliferate this to as many touch points as possible so that they can be caught early. We do acknowledge that there is a need to go upstream and we do need to have a broad-based approach involving many different partners in this effort.”
“Community mental health services, such as Youth Community Outreach Teams or CREST-Youth, and Youth Integrated Teams or YITs, also provide mental health support to youths with mental health needs arising from stressors, such as ACEs.”
“I thank Assoc Prof Razwana for raising three separate Parliamentary Questions to the Ministry of Health (MOH), Ministry of Education (MOE) and Ministry of Social and Family Development (MSF) in relation to adverse childhood experiences (ACEs). MOH will be addressing the question from the community health and healthcare angle. As stated in the MSF reply, actually the ACEs effect can be mitigated or prevented. Nevertheless, several programmes are in place to identify and offer support to those who have been exposed to ACEs. The Institute of Mental Health's (IMH's) programme on Forensic Rehabilitation, Intervention, Evaluation and Network Development Services, or FRIENDS for short, provides integrated multidisciplinary assessment and intervention for youth victims of abuse. IMH also conducts a Resilience Programme which enhances the well-being and resilience of children whose parents have mental illnesses, through family-based psycho-education workshops. Additionally, children with signs of exposure to ACEs may be identified when they present at the KK Women's and Children's Hospital (KKH). KKH has two programmes to support children with ACEs. Firstly, the Anchor Start programme provides timely and comprehensive screening for young children up to six years old with suspected abuse and neglect as well as counselling and psychoeducation for the affected children and their families. Secondly, KKH's Project RESTORE – REach the unreached, STrengthen Our community to support and REspond to families – trains community partners to provide psychological support and therapy to traumatised children and their caregivers.”
“I thank Member for the question. The issue of portability had previously been explained by Minister Ong in a different setting. Portability is a very complex matter and it may have unintended consequences. So, we are studying this very thoroughly. Because when each insurer is uncertain about the risk that they have to bear, premiums may actually go up and all in all this may not be helpful. So, we are really looking into this. And to answer the Member's question, we are intending to share our findings by the end of the year. 1.30 pm”
“Perhaps community partners can also step up to assist and support in enhancing the awareness of some of these resources available to the community.”
“I thank the Member for the supplementary questions raised and the hon Member makes very valid points. I acknowledge the concerns on the consumption of the public healthcare services, and the limitations and the capacity of the same. As Members are already aware, there are a lot of efforts that we are making in trying to improve the capacity in the public healthcare institutions. Firstly, there are several ongoing projects to increase bed capacities in the various public hospitals. Secondly, we have been working on the manpower to make sure it is augmented and there is support in this front. And thirdly, we are also looking at right-siting so that we do not tax the acute healthcare sector. All in all, there are multiple issues relating to the healthcare sector and there are a lot of issues people are concerned with and we are taking a multi-pronged approach, focusing various efforts on various fronts. So, I think the key thing is also related to the second point, it is in creating awareness and understanding of the choices for people to make because what we are seeing right now is that they are over-insuring and I think that is where the cost issue arises. So, it relates to the Member's second point in that we really do need to enhance consumer education. There are already platforms now and the exercise of CPF Board to provide information, comparison between different IPs. I think more can be done in the community also to create such awareness. I will take note of the feedback and point that the Member has suggested in the advisory committee, but I think the resources currently available are quite extensive and will actually help guide people in making decisions.”
“Today, the Central Provident Fund (CPF) website and MoneySense, Singapore’s national financial education programme, already have educational articles on what to consider before buying an IP. The Ministry of Health (MOH) also began publishing a comparison of indicative lifetime premiums across IPs this year. This is in addition to existing resources on MOH’s website which compare the benefits, features and premiums of IPs. We can support individuals in making more informed health insurance decisions and will be working with CPF Board and the Life Insurance Association Singapore to achieve this.”
“Mr Speaker, MediShield Life is our national health insurance scheme which protects Singaporeans against major healthcare episodes. It is designed to cover the vast majority – nine in 10 – of subsidised bills. The MediShield Life Council is currently undertaking a comprehensive review of the scheme. The key objective is to ensure that it continues to protect Singaporeans against large medical bills, amidst rising bill sizes and the evolving healthcare landscape. This means that coverage may broaden and claim limits may need to go up, to give Singaporeans greater peace of mind should they encounter a major health episode. More details will be available when the review is completed later this year. Notwithstanding the review of MediShield Life, many Singaporeans will still choose to buy additional private health insurance. These are called Integrated Shield Plans (IPs). IPs provide greater coverage on top of MediShield Life, mainly to cover expenses for unsubsidised care in public hospitals or in private hospitals. Some will also choose to buy riders, which can further reduce cash outlay. However, many people pay for protection that they do not use. To illustrate, about half of patients with IP and rider protection end up using subsidised public healthcare for hospitalisation or day surgery. These patients may not need IPs or riders, because MediShield Life is generally sufficient for such episodes and will be further enhanced after the major review this year. In addition, premiums for IPs and riders charged by private insurers are getting more and more expensive. We will do more to help consumers understand their needs and choose the right health insurance to buy.”
“We appreciate the support that existing cancer charities provide to patients, such as the support from the Singapore Cancer Society, Breast Cancer Foundation and Children's Cancer Foundation. But we also note that they may encounter difficulties in prioritising fertility treatments for these patients if it means diverting funds from other cancer patients. As for the suggestion of interest-free loans, like the Tuition Fee loans, we note that these are ultimately financed and subsidised by Government, similar to the co-funding support that is currently already available for AR treatments. We will, however, continue to review the adequacy of co-funding and other support to address the fertility treatments for these patients and welcome any additional support that charities can provide alongside, to address affordability issues. [(proc text) Question put, and agreed to. (proc text)] [(proc text) Resolved, "That Parliament do now adjourn." (proc text)]”
“For singles who want to undergo fertility preservation so that they can have children in future, we recognise these procedures can be quite expensive. For example, egg freezing alone can cost up to $10,000. Other fertility preservation procedures, like egg storage or ovarian tissue storage, can cost several thousand dollars over the course of five years. Today, young women can already tap on MediSave for egg freezing, if it is done on medical grounds, such as due to their cancer treatment. If they get married in the future and would like to use their eggs for AR treatments, they can also receive Government co-funding support and use MediSave for their treatments. MOH will study Dr Tan's proposals to extend Government co-funding and insurance, bearing in mind there may be other medically necessary treatments for conditions besides cancer that could affect fertility of young Singaporeans. I would also like to acknowledge Dr Tan's other recommendations, such as to support philanthropic initiatives in the fertility preservation sector and to collaborate with financial institutions to provide interest-free loans for fertility preservation. To bolster philanthropic efforts in the fertility preservation sector, Dr Tan has proposed enhancing the current 250% tax deduction rates for donations and introducing Government matching grants, similar to the approach taken for the Rare Disease Fund. Today, donations made to Institutions of a Public Character, or IPCs, that focus on supporting cancer patients, will qualify for a tax deduction of 250%. This is consistent with other IPCs in Singapore, which is high compared to other jurisdictions.”
“In 2020, we removed the statutory age limit of 45 years old which restricted when a woman may go for AR treatments. This allowed more couples to undergo procedures like IVF, as long as they were considered suitable for the procedure by their doctor. We also allowed couples to tap on up to two out of six co-funded AR treatments above the age of 40, as long as they had attempted AR before the age of 40. This was so that we do not inadvertently encourage couples to start their families too late, given the higher likelihood of clinical complexities associated with late pregnancies. Last July, we took a further step. Women between the ages of 21 to 37 are now able to undergo elective egg freezing. Prior to last July, women were only allowed to do so on medical grounds. This shift came after careful consideration, recognising that there may be women who desire to preserve their fertility because of personal circumstances, such as being unable to find a partner when they were younger. The policy shifts we have made over these years reflect the Government's ongoing commitment to support fertility and parenthood. This is an ongoing journey. We will continue to refine our policies to ensure that these continue to meet Singaporeans' aspirations and needs in the area. On this note, I thank Dr Tan for his recommendations on financing fertility preservation procedures among young cancer patients. We note that some young married couples are facing a situation where one of them is afflicted with cancer and will be receiving treatment. Yet, they are still currently trying to start a family. Today, these couples are eligible to tap on Government co-funding and their MediSave for embryo freezing as part of their AR treatments, to preserve the option of having children in the future.”
“Mr Speaker, Sir, I would first like to thank Dr Tan Wu Meng for raising the plight of young cancer patients who desire fertility preservation. These patients already suffer the misfortune of a cancer and the side effects of cancer treatment. We deeply empathise with the anxiety and emotional distress that they face. Mr Speaker, the Government has supported and remains committed to supporting the parenthood aspirations of all Singaporeans. In 2008, the Government introduced co-funding for Assisted Reproduction (AR) treatments, such as In-Vitro Fertilisation, or IVF, at public AR centres. Any couple where at least one spouse is a Singapore Citizen would be eligible for this co-funding. Over the years, we have made enhancements to further support couples requiring AR treatments. We raised the Government co-funding quantum in 2013 and again in 2018. We also increased the number of co-funded cycles. Today, a Singaporean citizen couple can enjoy up to 75% in Government co-funding for up to three fresh cycles and three frozen cycles. This is subject to a dollar cap of up to $7,700 for each fresh cycle and up to $2,200 for each frozen cycle. On top of co-funding, we allow MediSave use of up to $6,000 for the first cycle, $5,000 for the second cycle and $4,000 for the third and subsequent cycles, with a lifetime limit of $15,000. In 2020, we expanded our co-funding coverage to include Intra-Uterine Insemination, or IUI, to provide better support to couples who may prefer less invasive procedures. The Government would co-fund up to three IUI cycles, subject to a dollar cap of up to $1,000. We also recognised that couples who marry late also have parenthood aspirations and wanted to give them the best shot at it.”
“Mr Speaker, HSA is already doing upstream efforts in looking at the online space on sales and supplies of these e-vaporisers by monitoring illicit sales of e-vaporisers through social media, e-commerce and messaging platforms, and actually carries out operations regularly to target the sales of e-vaporisers on these platforms. We also have been engaging the larger platforms like Instagram, Facebook and Carousell to remove postings of illegal sales of such products. As it stands already, it is illegal. All advertisements and sales of e-vaporisers are prohibited under the Tobacco (Control of Advertisements and Sale) Act. Recently, MOH and HSA issued a letter of notice to 16 social media and e-commerce platforms in March this year to remind them that hosting vaping-related content is in breach of the Tobacco Act. The onus is on these platforms to exercise due diligence and proactively remove vaping-related content that are targeted at Singapore residents. Enforcement actions may be taken against these platforms if they are found to have inadequate processes to detect. We will continue to work with different agencies like MCI as well as IMDA. So, we are taking a multi-pronged approach on this. On the front, with the digital platforms, we are going upstream, we are trying to monitor, we are engaging with the platforms and we are also educating our people. So, I think this is something that we do need a whole-of-community support on, and we will do what we can to ensure that we will not let this take root in our community, but we do hope to get support from the community as well, to disseminate this message and to also extend the right information to the youths.”
“Mr Speaker, the Member raised a very valid point. Indeed, it is important for us to have an understanding and keep aware of the trends that are happening in the space. Which is why when we did the vape-free campaign in 2023, we did work with National Youth Council (NYC) and the youth organisations to understand and appreciate the nuances that would be helpful. We worked with social media influencers and the different platforms to make sure that the information that is given out there is curated and will be reaching the groups that we target. Indeed, this is going to be a work in progress. We have already ongoing relations with the youth organisations and we have plans to continue building on these efforts. And I hope that we will also continue to get support from Members in disseminating the information to the right target audience.”
“Yes, there is a lot of research and data surrounding this information, and we are keeping track of this. In fact, that is our concern because there is some misinformation also spreading among young people, even amongst adults, thinking that e-vaporisers are harmless; that, in fact, they could be cessation products. The truth is that there is a lot of data that suggests that they are gateway products to smoking as well as to drug use. So, these are things that we need to continue building knowledge on and also disseminating information on.”
“The Ministry of Health (MOH) and Health Sciences Authority (HSA) will continue to work closely with the Ministry of Communications and Information (MCI) and the Infocomm Media Development Authority (IMDA) to engage these platforms. Secondly, under the Code of Practice for Online Safety, the IMDA designated social media services with significant reach or impact to minimise users' exposure to harmful content. The designated social media services are Facebook, HardwareZone, Instagram, TikTok, X and YouTube. Thirdly, HSA has been monitoring illicit sales of e-vaporisers via social media, e-commerce and messaging platforms, and carrying out operations to remove e-vaporiser content. HSA is trying to expand its efforts and is reviewing the legal penalties to strengthen the deterrence against advertising, importation and distribution of e-vaporisers. Fourthly, even as we remove e-vaporisers content, we also try to increase pro-health content. The Health Promotion Board (HPB) also launched a vape-free campaign in 2023, including using social media, targeting youths and younger adults.”
“Mr Speaker, my response will also cover the matters raised in the written questions by Dr Wan Rizal, which are scheduled for today’s Sitting. There is a global rise in the use of e-vaporisers among youths. Marketing, including through social media and influencers, is largely targeted at youths, which contributed to its widespread usage amongst this age group. Many youths picked up the vaping habit, thinking it is harmless because it smells like fruits, and they make it a lifestyle habit among their friends. However, we all know that vaping is harmful. The fact that it is taking root among youths makes it even more harmful. Many countries allowed vaping, only to try to restrict its consumption now. Fortunately, Singapore saw its potential harm and banned it from the start. The Tobacco (Control of Advertisements and Sale) Act, or the Tobacco Act, also prohibits advertisement of e-vaporisers. As we all know, like all domestic laws, the Tobacco Act applies to vaping-related content published in Singapore and by Singapore-connected persons or entities. However, the Internet and social media is a global ecosystem and having domestic laws that ban harmful content or advertisements does not mean that these materials would not come in from a foreign source or a foreign influencer. That is the nature of online enforcement today. But we are not without agency and we have put in place several measures. For example, firstly, social media and e-commerce platforms are aware that under the Tobacco Act, they are expected to exercise due diligence and proactively remove vaping-related content that target Singapore residents. Enforcement actions may be taken against platforms that are found with inadequate processes to detect and remove vaping-related contents.”
“As I mentioned earlier in my answer, there are different touch points for these PMEs to reach out to. At the moment, we are also building those up. If the Member has any other suggestions as to how we can build on these further, we are happy to hear from you and we can see how we can make this more meaningful for the community.”
“I thank the Member for her question. In the work that we do, what we have realised that people come across our portals through very different situations; they are all at different phases of their lives. So, while it may be useful to have one touch point, but in terms of reaching out, it is meaningful to have many different people doing it in different manners. That is why we work with various partners. There are the key sources of information which we want citizens and residents to refer to, like Healthy 365 and HealthHub. These are the key touch points. In terms of outreach, it is more meaningful to have different permutations, different platforms, at workplaces especially for working adults, at the community for those who are a bit more elderly, and maybe in schools for children. While we do note that there needs to be a single resource, it might be helpful to have different touch points. If you are looking at it, though, from the perspective of partners who want to work with us, perhaps, I would suggest the Health Promotion Board (HPB) would be the one agency that maybe useful for you to start off with. But, as I said earlier, PA, SportSG also do different dimensions of the work. If you do want to try and tie up for certain efforts, you may refer it to me and perhaps we can connect you to HPB.”
“All agencies and organisations across the healthcare and sporting ecosystems have a role to play in upskilling staff, volunteers and partners, including health and well-being coaches, to support the delivery of better health.”
“Mr Speaker, we have made health planning affordable for Healthier SG (HSG) enrollees by fully subsidising their first Health Plan consultations with their enrolled family doctor. During these consultations, residents discuss follow-up actions to improve their health with their family doctors, such as health screening, and exercise and diet adjustments. More than half of HSG enrollees have consulted their chosen doctors to develop a personal Health Plan. On top of this, there are other types of planning and support available from community partners and healthcare clusters. For example, Sport Singapore’s Active Health Labs offer residents opportunities to have a guided fitness and health assessment, and recommendations on how to achieve fitness and health goals. Healthcare providers can prescribe Active Health's targeted programmes to residents who are medically at risk of lifestyle-related conditions such as Type 2 diabetes, obesity or hypertension. Some Community Health Posts provided by healthcare clusters at accessible locations, such as Active Ageing Centres, also provide support for individuals to make diet and lifestyle changes. Resources, such as informative articles recommended programmes, are also available on HealthHub and Healthy 365, to support residents in embracing a healthier lifestyle. Health planning and support covers a wide scope of activities involving different groups, including Government agencies like the Ministry of Health (MOH), People's Association (PA) and SportSG as well as the groups in the community like professional associations.”
“Mr Speaker, under the Healthcare Services Act 2020 (HCSA), all licensed healthcare institutions are required to report any incident or allegations of abuse involving a patient to their management. This includes cases of patient abuse by healthcare professionals. The licensees must take steps as soon as possible to manage the risk of recurrent abuse. This may include the reassignment of a healthcare professional to non-clinical duties or to require the healthcare professional to take a leave of absence to minimise further patient interactions while investigations are ongoing. The healthcare professional may be further referred to the Police if a criminal offence is likely to have been committed and to the relevant Professional Board for further disciplinary action. Since 2010, four healthcare professionals have been convicted of offences related to patient abuse. Disciplinary actions were taken in all these cases, including suspension and being struck off the appropriate professional register. Three are no longer practising and one returned to practice after serving a 15-month suspension.”
“We will continue to assess and monitor the situation. At this juncture, yes, HSA is the one that is doing the enforcement. When we are involving all these agencies, there is some thought to it. These are the agencies that are relevant in the problem. They are involved because, as I mentioned earlier, there are different aspects of the issue which we want to resolve, and their support and action is also necessary. We need to figure out what is the best approach. It is not just about bringing all different agencies in, but how can they meaningfully come on board to work together. We are looking at how we can ensure effective enforcement and deploy resources meaningfully. I guess that addresses his first question about whether there are other agencies coming on board. We will assess this. In terms of whether there will be guidelines and protocols in place, yes, that is something that is being looked at. At the moment, there is some understanding between the different agencies as to how to make this work meaningfully so that we are having an integrated approach that will help to address the whole problem.”
“I thank the Member for the feedback. If he has some specific issues that have arisen, please do let us know. This is something that we have also progressed over time. Initially, perhaps, there may have been some apprehension with regard to the other agencies getting involved in this, but we had recently announced the multi-agency effort, so, I think there is better coordination now between the agencies. We are looking at how we can make sure that the different aspects are dealt with. For example, if it is a complaint to schools, the schools will look at it with disciplinary proceedings as well. At the same time now, we are also making sure that HSA is kept apprised of this and the necessary compositions are issued. But I note your concerns about the enforcement measures all being handled by HSA. At this juncture, it comes under the Tobacco (Control of Advertisements and Sale) Act, and that is something that is under the purview of HSA. So, at this juncture, the enforcement bit of that, in terms of issuing of composition as well as any action taken in Court, is done by HSA. But actually, there are other aspects of the work – there is the catching, there is education, there is also checking at the borders, there is checking on the online space – which all need collective effort from different agencies.”
“And if there is a need, we can definitely size the manpower and adjust our manpower accordingly to address the problem. At this juncture, because it is something that happens in multi-facets of people's lives – I mean, we also have to consider things like at the borders when things get smuggled in – so, we do need to take that approach of working together with all these other agencies collectively, so that we can have a more effective response to the growing problem.”
“Mr Speaker, I appreciate the Member's concern about the size of the enforcement team at HSA to deal with this growing problem. We note the concern and the approach that we are taking is, as mentioned, that we are looking at a multi-agency approach. We do have to look at this issue from a multi-pronged perspective as well. We are taking the approach of outsourcing some of the enforcement measures. The agencies will cross enforce, meaning that if there are agencies that take up and pick up some of these cases of vaping, it is referred to HSA and HSA can then issue the necessary Notice of Composition. The Member had also asked whether the Police is also involved in this. Yes. If they go out and as they do their own work, and they do discover cases of vaping, they will refer these cases to HSA, and also at many different fronts, because this issue, as you know, is a big one. We are also looking at things upstream. At the front where it relates to the sale and the advertisement of the products online, we are working with the Ministry of Communications and Information (MCI) and the Infocomm Media Development Authority. This is where we are working with other agencies to track and stop the efforts of people selling all these products online. We are working with the agencies in the community, as I mentioned earlier, with NEA, NParks, the Police, in the community. When they catch these cases, these cases are referred to us and then we issue the Notice of Composition or do the necessary enforcement. We are also working with the schools. The schools work with us to look at education and informing the public about it. These are some of the various efforts of how this multi-agency collaboration effort works. We are continually monitoring this.”
“Mr Speaker, the Health Sciences Authority (HSA) received 1,700, 1,500 and 2,070 vaping-related feedback from the public and through other agencies in 2021, 2022 and 2023 respectively. We do not have readily available data on the breakdown of the feedback sources. We are taking a multi-agency collaborative approach to enforcement. Hence, while HSA is primarily a scientific agency with a modestly-sized enforcement team, it is supplemented by outsourcing and enforcement support from other agencies such as the National Environment Agency (NEA), National Parks Board (NParks) and Immigration and Checkpoints Authority (ICA). Our schools also take an active approach to prevent students from picking up the habit of vaping. There were about 7,600, 5,600 and 8,000 vaping-related offences in 2021, 2022 and 2023 respectively. Of the vaping-related offences, about 4,700, 5,000, 7,900 were purchase, use and possession offences in the same three years. Cases which require a Notice of Composition to be issued are handled by HSA.”
“So, we will not want to change our position completely on this because what we are doing is based on data, based on evidence, and requiring disclosure of the risk of acquiring HIV prior to sexual activity so as to allow the sexual partners to make an informed decision before engaging in sexual activities, and be able to then take the mitigating measures, such as medications, to protect themselves.”
“I thank Member for the question. In relation to her point, actually how this works is that when a complaint is made, the person investigated for the offence would then have to produce the necessary evidence or show undetectable viral load (UVL) that they have had. So, when at that juncture, the strongest evidence for adherence of medical treatment would be the UVL test result from a recognised laboratory at the next regular medical follow-up visit for HIV after the sexual activity in question because it will show that they have maintained their UVL, as this would not have been possible without treatment. There would be other circumstantial evidence for adherence to treatment that may include contemporaneous records at the next follow-up visit after the sexual activity in question, of documented treatment adherence, or documentation in past medical records of a consistent pattern of treatment adherence and consistent past UVL test results carried out by a recognised laboratory. These are the things that they would have to show in the event there is a complaint made and investigations follow. In as far as how they would conduct themselves, the reality is that this is a law, a provision that says you are not supposed to do it. So, if they then do this and there is a complaint made, investigations will follow, and these are the provisions and the evidence that they can rely on. On the second question on the criminalisation of non-disclosure, the amendments consider the established scientific evidence that transmission risk with an undetectable viral load is effectively zero. That is the premise upon which we are making this change. In contrast, other sexual activities, although lower risk, pose some transmission risk.”
“The proposed amendments will allow Singapore to respond more nimbly to future infectious diseases threats, by providing the flexibility to calibrate our measures in accordance with the public health situation. COVID-19 will not be the last pandemic that we encounter. The world remains vigilant against the next infectious disease threat; likewise, we must stand ready. I am confident that with these amendments, Singapore will be better equipped to tackle future outbreaks and pandemics and safeguard the health of our population. I thank Members for their support of this Bill.”
“Of the seven, four had undetectable viral loads at the time of their offences. All four convictions had aggravating circumstances, including simultaneous offences under the Misuse of Drugs Act; committing a second offence while under investigation for a first offence; one victim was a minor; and one deceived and exploited a victim by lying and posing as a police officer. The law at that time was that a person living with HIV was required to inform their sexual partners of the risk of getting HIV infection from them. This law was informed by the state of medical science and there have since been developments in this, and that is why we are updating the laws to align with these developments. Mr Speaker, to summarise, persons living with HIV do not need to disclose the risk of HIV transmission to their sexual partners if they have, first, maintained stable undetectable HIV viral load consistently below 200 copies per millilitre of blood, for at least six months, based on test results from a recognised laboratory. Second, their most recent undetectable viral load test result should be nine months or less before the sexual activity in question. Third, they had adhered to medical treatment for HIV infection up to the time of the sexual activity in question. Persons living with HIV who have met these criteria would have effectively zero risk of transmitting HIV to their sexual partner. We will set out the criteria in subsidiary legislation, to allow for timely and responsive adjustments should the state of medical science change in the future. Mr Speaker, the COVID-19 pandemic has greatly widened our perspectives on the management of infectious diseases.”
“During the COVID-19 pandemic and also in the context of other communicable diseases, the duration has always been based on public health considerations and grounded in medical science, typically until the individual is no longer infectious or potentially infectious. I note that Mr Louis Ng as well as Ms He Ting Ru welcomed the provisions in relation to HIV. Mr Ng asked about the definition of undetectable viral load, length of the prescribed period and whether these would be periodically updated. I would like to emphasise that the criteria for the maintenance of an undetectable viral load were rigorously determined based on latest scientific evidence and clinical knowledge after consultation with HIV and infectious diseases experts. Ms He Ting Ru has also raised some other questions. In response, I would say that section 23 remains relevant to reduce sexual transmission of HIV, by requiring persons living with HIV with a detectable viral load and persons who do not know of their status, but have reasons to believe that they have HIV, to disclose their risk of acquiring HIV to their sexual partners prior to sexual activity. This allows sexual partners to make an informed decision before engaging in sexual activities and to encourage responsible sexual behaviour by taking mitigating measures such as ensuring condom use to protect themselves. The intention of the HIV laws is not to criminalise persons living with HIV, but to deter irresponsible behaviour. She had also made reference to the high court judgment. The high court judgment will be superseded by the amendment. In relation to the queries on the prosecution, from 2015 to 2023, seven people were convicted under section 23(1) for failing to inform their sexual partners of the risk of getting HIV infection from them.”
“Data collected may not necessarily be anonymised. It may be necessary to match the samples collected to the data collected for the right patient. But where data can be used in anonymised form, such as to conduct trend analysis, MOH will do so. MOH treats the management and protection of personal data very seriously, regardless of whether the information is collected from individuals or a class of persons. Sensitive personal data is managed and protected in compliance with whole-of-Government standards. Disclosure of information under the IDA requires DGH’s authorisation and is only for public health purposes, including measures to prevent and control an outbreak and national public health research. DGH may also impose additional conditions on the receiving party to better protect the information. In relation to section 15 on the detection and isolation of persons, Mr Ng pointed out that while an individual may be ordered to be isolated in his own residence "for the protection of the public", this phrase is not used in relation to individuals being ordered to isolate in a hospital. The difference in language is not new and already exists in the current Act. Isolation of persons in a hospital protects other patients and hospital staff, whereas isolation of individuals in their residence is more directly for the protection of the public within the community. On whether MOH considered providing for a time limit for isolation orders under section 15, the duration of a section 15 isolation order is not open ended or arbitrary.”
“Thank you. Members have sought clarifications on the proposed amendments. Allow me to respond. Mr Louis Ng sought clarifications on how the guardian of an individual who lacks mental capacity should balance their responsibilities under the Infectious Diseases Act (IDA) and the principles under the Mental Capacity Act. I would like to clarify that the IDA does not limit the Mental Capacity Act. The principles under the Mental Capacity Act will therefore continue to apply. Under the new section 2A, the IDA notice must first be served on the minor or individual. Where the minor or individual is not able to fully understand and follow through with the requirements in the IDA notice, the same IDA notice is then served on the parent or guardian, requiring them to facilitate the minor or individual’s compliance. This is a reasonable expectation, that the parent or guardian should play a part. Section 2A allows the Ministry of Health (MOH) to take action in cases of irresponsible parents or guardians, who without reasonable excuse, fail to do so. Mr Ng asked about the safeguards for the management of information collected from classes of persons under section 7. The current section 7 already allows the Director-General of Health (DGH) to require any person to provide information for the purposes of public health surveillance, epidemiological investigations or surveys. The amendment is not an expansion of powers. Rather, it clarifies and makes explicit the manner in which DGH may exercise his power to require information from classes of persons. This facilitates operational efficiency. For example, a notice can be issued to the class of “persons who are in charge of a laboratory”, as opposed to multiple individual notices issued to each person in charge of a laboratory.”
“As experts have cautioned, the likelihood of another pathogen with even deadlier potential than COVID-19 remains. The intent behind these amendments is to better equip MOH and Singapore to tackle future outbreaks and pandemics, safeguard the lives of our people and the functioning of our healthcare system. I ask for the support of all Members for this Bill. Mdm Deputy Speaker, I beg to move.”
“More details will be set out in subsidiary legislation. This amendment aligns with medical advancements and our public health objective to curb transmission by shifting greater responsibility to individuals to get tested and treated for HIV in order to achieve and maintain a stable undetectable viral load. The objectives of the amendments are to encourage individuals who are at high risk of getting HIV to be tested regularly for HIV, and if possible, to get treated early, so that they can achieve undetectable viral load as early as possible. We urge persons living with HIV to adhere to HIV treatment and monitor their viral load closely with their doctors. In doing so, we aim to reduce the risk of HIV transmission. Singapore is not the first or only country to amend the law on this. Other jurisdictions such as Sweden, Taiwan, United States have removed the disclosure requirement for persons living with HIV who have no risk of transmitting HIV. I would like to emphasise that in proposing the amendments, we are not relaxing the public health safeguards against HIV transmission, but encouraging infected persons to come forward to be tested and treated, thereby better protecting their sexual partners. Irresponsible behaviour that can lead to the transmission of HIV remains an offence in Singapore and appropriate enforcement action will be taken as required. To conclude, I return to the primary aim behind the amendment Bill. We have sought to enhance the IDA to enable the swift prevention and control of infectious diseases, and the flexibility to calibrate our response according to the public health situation. We have ported over relevant provisions under the COVID-19 (Temporary Measures) Act, Part 7, which served us well and updated the existing IDA provisions.”
“Section 23(2) of the IDA similarly requires persons who do not know that they have HIV but have reason to believe that they may have HIV, to inform their sexual partners of the risk of infection. These safeguards remain and will continue to deter irresponsible behaviour, including from those who attempt to hide behind the ignorance of their HIV status. While the safeguards are in place to deter irresponsible behaviour, it is important also for our HIV legislation to be aligned with medical advancements in HIV treatment, in order to encourage early detection and treatment of HIV. HIV remains incurable. However, with medical advancements in HIV treatment, persons living with HIV who adhere to their HIV treatment as prescribed by their doctors are now able to reduce the amount of HIV in their bodies to an undetectable level. This is referred to as having an undetectable viral load. A person who maintains a stable undetectable viral load over time, as a result of a consistent adherence to their treatment, cannot transmit HIV to their sexual partner. The sexual partner therefore is not at risk of contracting HIV from these individuals. The amendment Bill introduces a provision which excludes persons living with HIV from the disclosure requirement under section 23(1), if the person has maintained an undetectable viral load for a certain period of time preceding the sexual activity in question. A person is presumed to have done so if certain conditions are met. These conditions are that the person living with HIV adhere to treatment, have stable and consistent undetectable viral load test results from a licensed laboratory in Singapore, and have an undetectable viral load test result within a specified period prior to sexual activity.”
“These powers include imposing requirements on healthcare professionals or institutions for the purposes of investigating or preventing the spread of an infectious disease; the declaration of isolation areas; and orders to disseminate health advisories. Finally, in addition to the amendments relating to outbreak response, we have also updated other sections of the IDA. MOH will be removing the requirement which circumscribes the group of persons who can perform vaccinations. The provision of vaccination, including the persons who may perform vaccinations, will be regulated under relevant levers that govern healthcare service delivery and the conduct of practitioners, such as the Healthcare Services Act 2020 and the Medical Registration Act 1997. Let me now discuss the proposed amendment concerning the human immunodeficiency virus (HIV). Section 23(1) of the IDA was introduced in 1992 as one of the public health measures to control and curb HIV transmission. It requires persons living with HIV to inform their sexual partners, prior to sexual activity, of the risk of contracting HIV from them and to obtain the partner’s consent to accept the risk of transmission. This allows the sexual partner to make an informed decision on whether to proceed with the sexual activity and take necessary precautions to minimise the risk of contracting HIV. In practice, doctors regularly inform patients about this legal obligation at the point of HIV diagnosis. The intention of this disclosure requirement was to control the spread of HIV and deter the irresponsible behaviour of those that put others at risk of contracting HIV. The disclosure requirement remains relevant as a public health safeguard to protect the sexual partners of persons living with HIV.”
“Clause 3 of the Bill introduces a new section 2A, which provides that, one, parents or guardians of minors and, two, guardians of persons with any intellectual disability or lacking in mental capacity, may be notified of any requirement, direction, notice or order that has been issued to the person under their care. Upon receipt of such notice, the parent or guardian will be personally required to ensure that the person under their care complies with the requirement, direction, notice or order, as the case may be. Currently, section 17 of the IDA requires the declaration of an isolation area to be published in the Gazette before it can take effect. Clause 14 of the Bill amends section 17 to provide that the declaration of an isolation area takes effect once it is brought to the notice of all persons who need to be aware of the declaration. This amendment will allow for the effective and timely isolation of persons within a particular area to prevent the spread of disease. For public awareness, MOH will continue to publish the declaration of an isolation area in the Gazette. The IDA will also be updated to account for the latest modalities and approaches to disease management. For example, the definition of "medical examination" in section 2 of the IDA will be expanded to include self-administered examinations such as antigen-rapid tests. Separately, for clarity, the service of orders and notices under the IDA using electronic means such as email and SMS will also be explicitly recognised. The powers under the IDA that involve public health assessment will now reside with the Director-General of Health instead of the Minister for Health. These amendments are in recognition that such decisions would be better suited to the professional expertise of the Director-General.”