1 Mr Darryl David asked the Minister for Education (a) in the last five years, how many international students have been accepted into local Universities under the Tuition Grant Scheme (TGS); (b) what are those numbers as a percentage of the total University student population; (c) whether this number of TGS international students will be reduced in light of the COVID-19 pandemic and, if so, whether this reduction will mean more places for Singaporean students; and (d) what will be the consequences for international students who cannot meet their TGS bond commitments in this present COVID-19 employment market.
2 Assoc Prof Jamus Jerome Lim asked the Minister for Education (a) what contingency plans are in place for foreign recipients of scholarships to serve out their bonds given the tightened restrictions on access to employment and other foreign-worker passes; (b) whether the Ministry will consider alternative mechanisms for recent graduates to serve out their commitments such as a deferral of the bond period or service of their bond periods with Singapore-owned or Singapore-affiliated companies abroad.
\tThe Minister for Education (Mr Lawrence Wong): Mr Speaker, beg your pardon. I would like to take Question Nos 1 and 2 together.
\tMr Speaker: Please proceed.
\tMr Lawrence Wong: The objective of our education system is to serve the needs of Singaporeans. Places in the Autonomous Universities or AUs are planned first and foremost for Singaporeans, in line with the cohort participation target of 40%. This year, we set aside more places at the AUs, to cater to Singaporean students whose overseas study plans were disrupted by the COVID-19 pandemic.
The AUs first admit Singaporean students who are able to meet their admission standards. They then raise the bar a few notches and admit a small number of international students, over and above the local students. As such, no Singaporean is displaced from an AU because of an international student.
Over the past five years, the number of international students who received tuition grant in each cohort averaged around 1,600, less than 10% of each intake. For Academic Year 2020, we are still finalising the numbers, but expect to see similar trends of less than 10%.
Having some international students adds to the diversity of the overall education experience and cultivates students’ global orientation and inter-cultural skills. It also better prepares them for the future workplace, where they may have to interact with different nationalities. We will continue to review and adjust the number of international students on tuition grant in the future, taking into consideration the quality of applicants and other factors.
We understand that recent graduates may face challenges finding employment in the current economic climate. Our priority remains to support locals in finding employment. However, we will also give fair treatment to tuition grant holders obliged to serve a three-year bond after graduation. These students can serve out their obligations in Singapore or overseas with Singapore-registered companies.
In particular, MOE works with the Universities and other public agencies to facilitate their applications for work pass arrangements here, while keeping to the Fair Consideration Framework. Flexibility is given when assessing these students’ work pass applications. The students are also given time to stay in Singapore to look for a job. Those who have genuine difficulties finding employment – be it here or abroad – may reach out to the Universities and MOE, and we will assess their situation and see how best to assist them on a case-by-case basis. We will continue to monitor the situation and adjust our approach appropriate to the economic situation and outlook.
\tMr Darryl David (Ang Mo Kio): Mr Speaker, I thank the Minister for the reply. It is very heartening to hear what Minister said, specifically that no Singaporean student will be displaced from a position in our AUs because of an international student. I just have two supplementary questions, Mr Speaker.
First is a question to the Minister that when we decide on the international students to admit into our AUs, do we consider or look at a ratio or a good balance of which countries these international students come from? And if we do, is this ratio periodically reviewed?
The second thing is when we determine which areas or field of study that we offer these international students places in our AUs for, would we also consider not only the needs of Singaporeans but whether or not the respective industries that these students could be graduating into are able to absorb these students into the workforce?
\tMr Lawrence Wong: Mr Speaker, I thank the Member for the questions. On both questions, the answer is that the Universities look at taking in students from a range of different sources. So, they are very mindful of having a variety of nationalities. As I had highlighted earlier, these international students come in over and above the local students.
When the Universities consider the applications from international students, they will look at them coming in from a range of different countries, bearing in mind that they do not want concentration from any single source and they will also look at them coming in to study in a range of different disciplines, different subjects, bearing in mind the desire for diversity across the student body and also taking into consideration the absorption capacity of the industry.
These are all considerations that the Universities would take into account.
\tAssoc Prof Jamus Jerome Lim (Sengkang): Mr Speaker, I thank the Minister for his response. I am just curious if he could clarify the typical career path of scholarship recipients, in this case, especially in terms of the ratio of students who end up taking up Singapore Permanent Residence or Citizenship after they have completed their studies.
\tMr Lawrence Wong: Mr Speaker, we are referring here to Tuition Grant holders, not to scholarship recipients. They are a different category. These Tuition Grant holders come in, they apply to the Universities; they do not need to apply for a Tuition Grant, but if they do so, they would have to serve a three-year bond. Quite separate from scholarship applicants. I do not have on hand the data on the percentage of Tuition Grant holders who go on to apply for Permanent Residence (PR) or Citizenship, for that matter. But just to make the point that Tuition Grant applicants and recipients are quite different from scholarship recipients.
\tAssoc Prof Jamus Jerome Lim: I thank the Minister for clarifying the distinction between the two and I apologise for the loose language. I am wondering, since he has brought up that distinction, whether it is possible to elaborate on the approximate ratio of Tuition Grant recipients versus scholarship recipients in terms of foreign students choosing to study here.
\tMr Lawrence Wong: Again, if the Member would like to file a separate question asking for those details – number of scholarship holders, number of Tuition Grant holders – these are data that from time to time, Members in this House have asked for and we have released those data. Likewise, if the Member would be interested in the proportion of scholarship holders who have gone on to take on Citizenship or PR, he may file a separate question and we would be happy to provide the information.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Plans to Help Aviation Sector Recover from COVID-19 Impact","subTitle":null,"sectionType":"OA","content":"3 Mr Gan Thiam Poh asked the Minister for Transport (a) what is the total number of passengers who have made transits through Singapore since Changi Airport was re-opened for transit passengers; and (b) whether there is a plan to open further for business travellers and leisure tourists without the need for Stay-Home Notices if effective and reliable measures such as the swab test can be relied on and faster clearances at designated areas in the airport.
4 Mr Saktiandi Supaat asked the Minister for Transport (a) what plans are in the pipeline to revive our aviation industry and promote safe air travel through Singapore; (b) how will these plans address the medium to long-term risks to our air hub status; and (c) whether the retrenchment exercise by SIA will affect these plans to revive our aviation industry and, if so, what is the impact.
5 Mr Melvin Yong Yik Chye asked the Minister for Transport which reciprocal travel arrangements with other countries are expected to be finalised within the next three months.
6 Mr Melvin Yong Yik Chye asked the Minister for Transport whether the Government has plans to aid the recovery of Singapore Airlines in the event of a prolonged COVID-19 pandemic situation and, if so, what are these.
7 Mr Liang Eng Hwa asked the Minister for Transport (a) how can the Government help the aviation industry and Singapore Airlines preserve their capabilities and pivot in the post-COVID-19 pandemic landscape; and (b) whether the medium-to long-term plans for the industry need to be revised including the building of Changi Airport Terminal 5.
8 Mr Dennis Tan Lip Fong asked the Minister for Transport what are the factors that the Ministry will consider before approving no-destination flights and how important will carbon emissions arising from such flights be a factor for approval.
\t\tThe Senior Parliamentary Secretary to the Minister for Transport (Mr Baey Yam Keng) (for the Minister for Transport): Mr Speaker, Sir, may I have your permission for the Minister for Transport to take Question No 3 through to Question No 8 in his Ministerial Statement later in the Sitting, please.
\tMr Speaker: Yes. Mr Ang Wei Neng.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Implications of Converting Johor Bahru-Singapore Rapid Transit into Light Rail Transit","subTitle":null,"sectionType":"OA","content":"9 Mr Ang Wei Neng asked the Minister for Transport whether he can provide an update on the Johor Bahru-Singapore Rapid Transit (RTS) Link including the implications of converting the RTS into a Light Rail Transit.
\tThe Senior Minister of State for Transport (Mr Chee Hong Tat) (for the Minister for Transport): Mr Speaker, Sir, on 30 July 2020, Singapore and Malaysia formally agreed to resume the Johor Bahru–Singapore Rapid Transit System Link or RTS Link Project, and held a ceremony witnessed by both Prime Ministers to mark the occasion.
Three agreements were signed to give effect to the resumption of the project – an agreement to amend the RTS Link Bilateral Agreement, a Joint Venture Agreement between Singapore’s SMRT and Malaysia’s Prasarana to constitute a joint venture Operating Company or OpCo, and a Concession Agreement for the Government of Malaysia and LTA to appoint this OpCo as the RTS Link Operator for the first 30-year concession period.
Both sides have agreed that the RTS Link will use an LRT system, instead of the Thomson-East Coast Line or TEL MRT system. The LRT system for the RTS Link is more similar to a medium capacity MRT system, such as the Jurong Region Line, with a peak hour capacity of 10,000 passengers per hour per direction.
The change from TEL to LRT system will not require any major changes to the original infrastructure design. The RTS Link station continues to be located next to the TEL Woodlands North Station to provide commuters with ease of transfer.
The RTS Link is an important bilateral project that will ease Causeway congestion, facilitate business and tourism, and bring our peoples closer together. Singapore looks forward to working closely with Malaysia to implement the RTS Link Project and to commence passenger service by end 2026.
\tMr Ang Wei Neng (West Coast): Mr Speaker, Sir, I thank the Senior Minister of State for the comprehensive reply. We understand there are a lot of changes in Malaysia recently and it might impact long-term projects between the two countries. So, given the context, I have three supplementary questions.
First, what are the safeguards in ensuring that the RTS Link project will be carried out even if there is a change in government in Malaysia over the next few years?
Second, what are the implications of having the switch of the RTS Link depot from the existing Thomson-East Coast Line's Mandai Depot, to a new depot in Wadi Hana, Johor Bahru? Does it mean that the maintenance of the RTS Link trains and system will lie primarily in Malaysia and what would be the impact on the reliability of RTS Link?
Mr Speaker: Mr Ang, can you keep it to two supplementary questions, please. Thank you.
Mr Ang Wei Neng: Last supplementary question. Thank you. Would MOT consider building a transfer line along the Causeway to supplement the RTS Link or replace the RTS Link if the RTS Link becomes not viable again?
\tMr Chee Hong Tat: Mr Speaker, Sir, a project of this nature is a bilateral project, something that requires both parties to sit down, negotiate, discuss and find a way forward. I think Mr Ang is aware that for the RTS Link project, it was suspended for a short while and we had to discuss together with Malaysia on what were the arrangements that were acceptable to both countries. In such negotiations and discussions, there will be some give and take, some changes made. And that is what we did with the RTS Link Project.
But the important thing is this – there are safeguards in the agreement to protect the interests of both countries and to ensure that the objectives of the project can still be achieved.
So, I mentioned earlier, and I stressed this point, 10,000 passengers per hour per direction. Because that was what we wanted; to make sure that continues to be the case. So, even though we switched from the TEL to LRT, we continue to be able to achieve this objective.
Mr Ang also asked about maintenance, and again, I mentioned this in my main reply. I said there is a OpCo that is being formed by companies from both sides. Both countries will have a shared interest to ensure that the trains are able to run reliably, safely and meet the needs of commuters from both sides.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Impact of COVID-19 Pandemic on SAF Operations and Training","subTitle":null,"sectionType":"OA","content":"10 Mr Dennis Tan Lip Fong asked the Minister for Defence (a) how has the COVID-19 crisis affected SAF operations and training in 2020 so far, (b) how has the SAF coped with the challenges to ensure that the operational readiness of SAF and the quality of all SAF training have remained uncompromised.
\tThe Minister for Defence (Dr Ng Eng Hen): Mr Speaker, the hon Member, Mr Dennis Tan has asked for the state of SAF readiness during this COVID-19 pandemic. It is a pertinent question, because despite the COVID-19 crisis being dubbed as the test of this generation, our other security threats are in no way diminished. So, let me elaborate.
The SAF operations that are deemed critical such as island defence, protection of key installations, maritime security, air defence and counter-terrorism, continue around the clock even in the midst of the COVID-19 pandemic. So, they never stop, whether we had circuit breaker or before that or even now. And it will not stop. Similarly, training schools that are essential to sustain our operational units have also continued, namely the Officer Cadet School, the Specialist Cadet School and essential In-Camp Training or ICT.
To be able to achieve that, to be able to continue to be Readiness Condition 1, REDCON 1, for these critical missions, the key aspect is manning. You have to plan for manning, in the face of the risk of infection. So, to minimise the risk of infection for these critical units, the SAF implemented strict health and safety measures. They include cohorting, safe distancing measures, reduction in training group size and testing regimes.
But, in order to make sure that you maintain REDCON 1 across the span of duties, some personnel performing critical operations had to isolate themselves in camps and bases for a period of time. Why? Because this is how it works. You have to make sure that you are ready and you are free from infection before you start your duty. And the only way they could do that was to stay in camp for two weeks away from their families as a cohort before they start their duties and during their operational duties.
For other SAF training, the disruptions caused by COVID-19 corresponded to restrictions and other measures placed on the general public for safety and health reasons. For example, during the circuit breaker period, Basic Military Training or BMT and large-scale overseas exercises were suspended as well as some ICTs were deferred.
Mr Tan asked how the SAF has coped. I think the SAF has coped well with these challenges brought about by COVID-19. In addition to maintaining its core functions and military training, the SAF strongly supported our nation's fight against COVID-19. More than 6,000 MINDEF/SAF personnel were mobilised and deployed across a wide range of national task forces and operations. They range from leading contact tracing, caring for migrant workers in dormitories, converting and managing SAF camps as community recovery facilities, and providing medical care to recovering patients.
With the easing up of restrictions on the public, the SAF has progressively resumed more training and exercises, while continuing to take health and safety precautions. More ICTs have been conducted and some overseas training have resumed. For example, the Navy has just safely completed a 67-day deployment for the Rim of the Pacific, RIMPAC, which is a multinational naval exercise held in Honolulu. It was SAF's first overseas exercise since the COVID-19 pandemic struck. And for this, the RSN had to plan, how do you ensure: one, that you can pick up detections while you are at sea; and two, care for infected servicemen or servicewomen while at sea, because you are out there and you may need ICU. It was an interesting exercise; it was an interesting challenge. They brought on a COVID-19 test kit, they put it on board and they converted their ship with ICU capabilities. I was quite proud of them for being able to do that. Thankfully, they did not have to use the ICU, none of them got infected and they successfully completed that exercise.
The RSAF pilots continue to hone their skills with regular local flying as well as overseas training and exercises. Later this month, the Air Force will be deploying about 200 personnel and 10 aircraft to train in Darwin, Australia for about two months. Our boys and women are there now, doing their two weeks of isolation before they start training.
In tandem with the increase in training activities, the SAF has also added measures to enhance the detection of COVID-19 infections to mitigate their spread. From October, some ICT units will have their NSmen undergo swab tests if proximity to other individuals cannot be avoided during training. That is an added measure on top of the measures that I talked about. For these swab tests, DSO is assisting the SAF to use other methods which are more suited for mass testing. For example, oropharyngeal mid-turbinate swabs or OP-MT, or saliva testing. Initial results of our trials on both these different applications have been promising with regard to the acceptability and accuracy of these newer methods.
While the SAF contributes to Singapore's fight against COVID-19, it will not be distracted from its core functions. The SAF recognises that Singapore's security challenges do not diminish during this COVID-19 pandemic. In fact, our assumption is that, would be aggressors can take advantage of the situation to do us harm. The SAF will therefore continue to be vigilant, maintain its level of operational readiness through realistic training and full-manning of critical units.
\tMr Speaker: Mr Dennis Tan.
\tMr Dennis Tan Lip Fong (Hougang): Mr Speaker, Sir, I thank the Minister for his comprehensive replies. I have one supplementary question. Picking on the experience in handling training and operational matters during the COVID-19 period this year, is the Minister able to share with this House whether the SAF has any plans to enhance its training programme locally or overseas in the coming year, especially if he considers that the COVID-19 situation may have improved as far as the training scenarios are concerned? Thank you – in the coming year, Sir.
\tDr Ng Eng Hen: Mr Speaker, again, very pertinent questions. Our assumption is, as I had said, on an operational level, critical functions cannot stop. And you do everything you can to make sure you are fully manned, all hands on deck, minimise infections; if there are infections, you get replacements. That is not negotiable and that will continue.
But, of course, a large part of the SAF operations are what we call – not critical real time, but you still need to maintain the operational readiness, the level of training, that tempo. As all of us know, more realistic training, some of it can be done locally to the extent possible. For example, pilots, you can do simulators, you can fly. Yesterday, we just had a question on RSAF pilots and I asked for the indulgence of the public and Members to understand why we have to train locally. We have done everything possible to train as much as we can overseas, but what remains, has to be done here, we have done it and we have made adjustments.
But for a lot of the army exercises, tanks, artilleries, our HIMARS operations, our infantry and so on and so forth, we have done that in overseas areas. That sometimes is subject to the other party. Let me just say that our attitude is not to take COVID-19 as a reason not to train. We keep knocking on doors to say we will take measures to protect your public and we will make sure that we are disciplined. We will make sure that we have testing but we want to start training. But, we can understand that it is subject to many factors. Be that as it may, where we can, we will continue and step up local training.
That is why, I mentioned that, in order for us to give us the confidence to be able to train at the tempo and at the pace that we want to, even locally, our assessment is that we will need mass testing.
If you ask your tank platoons to mount up and go into their tanks, they cannot practice safe distancing. And therefore, you have to test all of them. The way to do that is to have tests which are acceptable, which are accurate and that is why I mentioned saliva testing, I mentioned oropharyngeal mid-turbinate testing, which can be more readily applied to larger groups, as well as other innovative methods of testing that we are working on.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Expand Powers under Mental Health Act to Allow for Intervention when Relatives Do Not Allow Patients To Receive Treatment","subTitle":null,"sectionType":"OA","content":"11 Mr Murali Pillai asked the Minister for Health whether the powers under the Mental Health (Care and Treatment) Act may be expanded to provide intervention for the benefit of mentally disordered persons under the care of relatives who do not allow these persons to receive psychiatric treatment even though these relatives do not ill-treat or neglect such persons within the meaning of section 8(1) of the Act.
\tThe Parliamentary Secretary to the Minister for Health (Ms Rahayu Mahzam) (for the Minister for Health): The Mental Health (Care and Treatment) Act or MHCTA allows for the state to intervene for persons with or suspected of having mental health conditions and who may be a risk to self or pose a danger to others. The Police can apprehend the person and take him or her to a doctor for an assessment or bring the person to a psychiatric institution for treatment. The processes that are empowered under MHCTA apply, even if the person declines to seek treatment on his or her own accord, or relatives refuse to bring the person to receive psychiatric treatment.
Nonetheless, MOH's approach is to intervene early and reach out to the persons who are facing mental health issues and their families to encourage them to seek help voluntarily, before there is a need to enforce mandatory psychiatric evaluation and treatment. MOH has worked with Agency for Integrated Care (AIC) to develop services to support persons with mental health conditions under the Community Mental Health Masterplan. AIC acts as a \"first touchpoint\" for agencies, service providers and members of the public to refer persons suspected to have mental health conditions and not receiving the treatment they need for further support. AIC, with the support of relevant stakeholders, could refer such persons to the appropriate medical and social services.
To actively reach out to community to provide early identification and community support for persons with mental health needs, AIC has set up 43 community outreach teams and trained over 24,000 frontline staff from Government agencies and community partners across Singapore as of end 2019. These teams have reached out to over 300,000 persons and provided assistance to more than 23,000 persons who were at risk of developing mental health conditions or dementia.
\t
Nevertheless, MOH recognises that there is a need to better support persons with, or suspected with, mental health needs and displaying challenging behaviours in the community. MOH is currently reviewing the enablers for the community support required which include the current legislative levers.
We would like to urge Members and any member of the public that if they come across any person with mental health needs, to contact the Institute of Mental Health (IMH)’s 24-hour mental health helpline (6389 2222) or AIC’s Care-in-Mind (careinmind@aic.sg) for assistance.
\tMr Murali Pillai (Bukit Batok): Mr Speaker, Sir, I thank the hon Parliamentary Secretary Ms Rahayu Mahzam for her comprehensive answer to my question. With your indulgence, Mr Speaker, Sir, on a point of elucidation, I wish to state that I filed this Parliamentary Question arising from my tracking of a case involving my resident and attended to by the AIC's Community Mental Health Division, Fei Yue's Community Intervention Team (COMIT), MOH's Mobile Crisis Team (MCT) and Adult Neuro-developmental Disorder Service (ANDS), MSF's Adult Protective Services (APS), HDB as well as my community leaders. The case involved a mentally disordered young man whose parents refused to allow him to be treated by IMH as they believe in religious and spiritual intervention.
The final report from AIC was that if the family refuses to cooperate, there cannot be any intervention under the current legislative landscape because he is physically well taken care of and he does not pose a safety risk. I was advised to tell the neighbours to file a complaint with the Community Dispute Resolution Tribunal (CDRT) as the young man screams very loudly in the middle of the night from time to time. Respectfully, I do not think this advice, though well-meant, is useful.
I am glad to note the hon Parliamentary Secretary has indicated that MOH is willing to review the legislative landscape. While waiting for the review, would MOH be prepared to direct its agencies to engage and work collaboratively with the spiritual and religious healers? And in this regard, I would like to offer that the researchers at IMH, led by Prof Chong Siow Ann, in 2012 and 2016, opined that there is a significant treatment gap in Singapore, with more than three quarters of mentally disordered persons not seeking professional help and 24% of people who seek some form of help go to religious and spiritual healers.
\tMs Rahayu Mahzam: I thank the Member for the question as well as the extensive feedback and I am grateful for the acknowledgement given to all the different partners involved in resolving the particular issue that he was faced with. MOH is aware of the concerns that the Member has raised and, in particular, that case. We definitely need to look at how to better support persons with or suspected with mental health needs and displaying challenging behaviours in the community as well as the people around them.
Indeed, this is a work in progress. In 2012, MOH launched the Community Mental Health (CMH) Master Plan to further strengthen mental health care in the community and enable persons with mental health needs to be well supported. In 2017, we announced that the Government will be further enhancing and expanding mental health services over the next few years. So, it is work in progress.
AIC, as the Member has mentioned, has established Community Intervention Teams to support general practitioners, GP partners and service providers with allied health services, such as psychotherapy and counselling. As of end 2019, over 26,000 persons had been supported by these teams.
We have also started mental health and dementia services in more than half of our polyclinics and trained over 210 GP partners to diagnose and support persons with mental health conditions. So, a lot has been done and a lot will continue to have to be done. And it is, indeed, important to enhance these efforts.
I would just like to highlight that we have actually been working very closely with the health care institutions, community health partners, Government agencies like the Police, HDB and grassroots organisations to build up community networks to better support and manage persons with mental health conditions in the community.
So, the suggestion that the Member has raised about working with religious partners is something that we can definitely look into. And we definitely need to look into enhancing the awareness and support.
As I have mentioned, MOH is already reviewing the enablers for the community support. We will take the Member's feedback and input into consideration during this review and assess the appropriate approaches and recourse that we can take to address such cases in the community.
\tMs Carrie Tan (Nee Soon): I thank the Parliamentary Secretary Rahayu Mahzam. I have further questions for MOH. Does the Ministry have any data about the recovery rates and outcomes of mental health patients currently receiving existing types of treatment through the methods employed by IMH? Second, will MOH consider exploring or supporting research into alternative treatments or rehabilitative care methods for mental health patients, including, possibly, TCM or other alternative medicines?
\tMs Rahayu Mahzam: I thank the Member for the question. The details which the Member has asked for, I will need to check and, if the Member wishes, she can file another Parliamentary Question asking specifically for the data.
In respect of considering alternative treatment, this is work in progress. We are all still new at this and we are all looking at how to better address this situation as a community. With inputs from community partners and people in the sector, we can continue to build on this. I do not believe this is a closed option. But we definitely need to look and find out if the approaches that we are taking will actually meaningfully help address the situation. So, this is something that I can take back. But we hope to also get support from the community with the existing measures that we already have in place to help address the situation as we build towards strengthening the support that we are giving to the partners.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Support for Workers Suffering from Workplace-related Mental Health Issues","subTitle":null,"sectionType":"OA","content":"12 Mr Melvin Yong Yik Chye asked the Minister for Manpower (a) when will the Tripartite Advisory on Mental Health be published; and (b) whether the advisory can be expedited to provide better support to workers suffering from mental-health-related issues arising from the workplace.
\tThe Senior Minister of State for Manpower (Mr Zaqy Mohamad) (for the Minister for Manpower): Mr Speaker, we are on track to publish the Tripartite Advisory on Mental Health in the fourth quarter of this year.
Currently, the Advisory is undergoing consultation with employers, unions, mental health professionals and our civil society groups. In the meantime, the Inter-Agency Advisory on supporting mental well-being of workers under COVID-19 work arrangements that was published in April serves as a useful reference. It has a list of external resources that employers can consider engaging to provide support for their workers’ mental health.
Employers can also initiate support for their workers. For instance, supervisors can check in regularly with their workers, talk to them to find out if they are facing any problems and refer them to external help if needed.
\tMr Melvin Yong Yik Chye (Radin Mas): Mr Speaker, I thank the Senior Minister of State for his update. I have one supplementary question. The prolonged telecommuting arrangements have blurred boundaries between the home and the office for many of our workers, especially our PMETs. Many have told me that they now work increasingly long hours as emails, calls and WhatsApp messages have come in outside of their regular working hours. Some shared that they now have Zoom work meetings in the night, which they never had before COVID-19. In fact, they told me that they had not even heard of Zoom before COVID-19.
Could the Ministry, therefore, consider incorporating aspects of the right to disconnect legislation as part of the Tripartite Advisory on Mental Health so as to provide our workers with a guideline on how to start a conversation with their employers about commuting outside of work hours for non-critical work?
\tMr Zaqy Mohamad: Sir, I thank the Member for his clarification and questions. Certainly, the work from home arrangement today has changed the way we work and brought access to the office into the home. So, I fully recognise the challenges some of our workers are facing with regard to the blurred lines between work hours and personal time. Certainly, I can see where the Member is coming from, where clearer boundaries between work and personal time would be useful.
Sir, as we work on the Tripartite Advisory that we plan to announce later, it is important that we look at some of these aspects to see how we can use the space to work towards an understanding between employer and employee to see how we can better manage this work-life balance. But the same time as well, we have to also recognise that this is something new. I think it originated in France, if I am not mistaken – the El Khomri law. And many countries are still observing and seeing how this works out before we can consider it – whether it is feasible and open to legislation. The consideration that we must consider is whether something like this would be relevant or rigid in Singapore's context, given the fact that many of us, for example, do work for multinational firms or firms that work across time zones and you need to also pick up calls – and Zoom included – late at night to cater to a different work type of environment. But the same time as well, we also know that enforcing rigidity may also impede on some workers, too, because some prefer the flexibility that they can tend to their kids in the day, run errands, send the kids to pre-school, childcare and then come back, pick up the kids early and then work at night.
So, there are different modalities in terms of how we work and intermingle the work boundaries and personal life boundaries. I think these are important points for us to consider and perhaps something that the union could raise as part of our discussions on the Tripartite Advisory.
\tMr Louis Ng Kok Kwang (Nee Soon): Thank you, Sir. Can I ask the Minister whether he can confirm that the tripartite guidelines or advisory will make clear that employers should not request for information on a person's mental health condition unless the condition has a direct connection with their ability to perform the job role.
\tMr Zaqy Mohamad: I thank the Member. The Tripartite Advisory has not been announced and I cannot confirm. But we will certainly look into it. I think, today, the practice is already in place and something we encourage strongly. Where the job does not require it, the employee does not need to declare it as part of his employment application. So, this is something that we need to hold strong, too. But look out for the advisory once it is out. But rest assured that we are looking at various areas in which we want to make sure that the well-being of our workers is well protected, both from the physical health as well as mental health states.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Measures to Tackle Scam Crimes","subTitle":null,"sectionType":"OA","content":"13 Mr Ang Wei Neng asked the Minister for Home Affairs (a) what has been the trend of scam crimes in the past 10 years; and (b) what is the Police's strategy to reduce such scam crimes.
\tThe Minister of State for Home Affairs (Mr Desmond Tan) (for the Minister for Home Affairs): The Police started to track the number and types of scams from 2016 when it started to become a crime of concern. Since then, the number of scams reported has increased by 77%, from 5,383 cases in 2016 to 9,545 cases in 2019. There were 10,402 cases of scam reported in the first eight months of this year, which is a 100% increase over the 5,229 cases reported during the same period last year.
In terms of the total amount lost, it has also risen over the past years, from $89.7 million in 2016 to $170.8 million in 2019. In the first eight months of this year, the total amount cheated increased by almost 71% to $157 million, from $92 million in the same period in 2019.
\t
The Member asked about what the Singapore Police Force is doing about this. MHA adopts a multi-pronged approach to tackle scams. First, strengthening enforcement. The Police have set up specialised units to disrupt scammers’ operations. One of these units is the E-Commerce Fraud Enforcement and Coordination Team or E-FECT in short. Since its formation in November 2018, the E-FECT has arrested 101 e-commerce scammers and solved about 2,000 e-commerce scams. In June 2019, the Police set up the Anti-Scam Centre or ASC, which acts as a nerve centre for investigations into scam-related crimes. The ASC’s focus is to mitigate victims’ losses, through the swift interdiction of the proceeds of the crime. In its first year of operation, the ASC froze more than 6,100 bank accounts and recovered more than S$21.2 million.
Second, the Police have stepped up collaboration with foreign law enforcement agencies. The Police set up the Transnational Commercial Crime Task Force or TCTF in short, in October 2017 to investigate transnational scams such as China Officials Impersonation Scams, Internet Love Scams and Credit-for-Sex Scams. We have seen good results since. To date, the TCTF has conducted 12 joint operations with international counterparts, resulting in the arrests of over 120 suspects. Let me cite two examples.
First, in November 2019, the TCTF worked with the Royal Malaysia Police, Hong Kong Police Force and the Macau Judiciary Police to jointly cripple an Internet Love Scam syndicate based in Malaysia. The group is believed to have been involved in at least 139 cases in Singapore, Malaysia, Hong Kong and Macau, involving losses of about S$5.8 million.
Second, in May 2019, the TCTF successfully extradited two Nigerian men to Singapore for cheating Singapore-based victims in Internet Love Scams perpetrated from Malaysia.
The two accused persons were charged in court in May 2019, and the trial is still on-going.
Third, we work closely with public and private sector stakeholders. The Police regularly engage banks, remittance agencies and convenience stores to train their frontline staff to spot possible scam victims. In 2019, the Police commended 108 recipients from the community for preventing 91 instances of scams involving approximately S$5 million. Earlier this year, the Inter-Ministry Committee on Scams was set up to coordinate a whole-of-Government effort to combat scams and their roles include (a) to improve scam detection and disruption capabilities; (b) to develop measures to secure the digital space; (c) to enhance the loss recovery and remediation experience for scam victims; and (iv) to improve public education and outreach efforts against scams.
Fourth is public education. The Police and the National Crime Prevention Council have disseminated advisories through various media platforms, including messaging and social media platforms such as Facebook, Instagram and TikTok. In August 2020, an anti-scam public education campaign, \"Spot the Signs. Stop the Crimes\", was launched. This new campaign focuses on sharing real-life scam examples to educate and inform the public on how to spot the tell-tale signs of various scams.
Indeed, the key to fight against scams is a discerning public. They are urged to stay vigilant and report possible scams promptly to the Police.
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\tMr Ang Wei Neng (West Coast): Mr Speaker, I thank the Minister of State for the comprehensive reply. I have a few supplementary questions.
First, I heard a few types of scams mentioned by the Minister of State. Can the Minister of State advise us which is the most common scam and which is the one that has the biggest monetary loss in Singapore?
I understand that five major crimes which are often communicated to the communities have dropped significantly over the years, and the number of online scams has overtaken the five crimes. So, will the Minister of State consider providing the number or type of online crimes by constituency, on a monthly basis, so as to better alert the residents and garner their support to fight and prevent online scams.
Thirdly, I often receive WhatsApp messages asking me to take personal loans from moneylenders. I think it is mostly the works of the illegal moneylenders. I also receive phone calls to tell me that I have a parcel stuck at the custom and mostly this is a fraud case. I understand many Singaporeans also receive similar messages. Can the Police advise Singaporeans what to do when they receive such messages or phone calls? Can the Police consider setting up a hotline or an email account for Singaporeans to send such messages and details of the phone calls to the Police?
\tMr Desmond Tan: I thank the Member for the question. The first question with regard to the most popular scam crimes that we have tracked, the top three, in terms of number of incidents that has happened, will be first is the e-commerce scam. We can all understand why. With the prevalence of Internet and the e-commerce platform, this has become the number one, the most common scam that we see in our community.
The second one is social media, impersonation scam. The third one will be loan scam. These are in terms of the number of incidents that happened. If you would like to see more in terms of the top 10, you can go to our anti-scam website. We have listed the most common scams that have happened.
In terms of the amount, the highest levels of investment or financial losses will be for those related to investment scams.
The Member also asked in terms of breaking down online scams by constituency. I do not have the data right now. We will take it back. We have to bear in mind that online scams represent a very challenging area to deal with, in terms of how we look at the trans-borderless nature of this crime, as well as how anonymous some of these crime scammers can go about doing its operation. So, I am not so sure how this breakdown will help but we will certainly take a look at the Member's suggestions on how to break down the data. If it is useful, we will do that as well.
Finally, the Member talked about how the Police can allow our residents and our people to have a one-stop way to seek help when they need help, so I would like to inform Members of the House that the Anti-Scam Centre was set up for this purpose. Working with National Crime Prevention Council, since several years ago, we have already set up a hotline. This hotline is 1800-722-6688. Any member of the public who needs help, who is not sure, who needs advice on whether that is a scam, they can go to the hotline.
On top of that, we have also set up the scamalert.sg, which is a URL that allows members of the public to see what are the most common scams that have happened and also for members of the public to share their stories about how they have fallen prey to scams.
So, these are the efforts that we will continue to step up, in time to come.
\t
\tMr Ang Wei Neng: I thank the Minister of State for the reply. I just want to make two small clarifications about what I said. Firstly, we know that the Police communicated to the communities what are the five major crimes, very often, on a monthly basis, and engage the residents. So, I am suggesting that the Police can do the same for the number of online scams by constituency and let the residents know that these are the online crimes that happened in their neighbourhood, where their neighbour are victims, so that they are more aware, and they can help the Police to fight the online crime together.
The second one, I mentioned that we often receive a lot of messages. Is there some way or can we set up a website, and we can send those phone calls and messages to that one site, rather than just making phone call which is sometimes, not efficient because you need people to man the hotline.
\tMr Desmond Tan: I thank the Member for the clarification of the question. As I had mentioned, we will take his suggestions. Today, the Police work closely with the community to also highlight what are the top five crimes in the community. Scam is obviously one of those that are increasing in trend. So, we will take the Member's suggestions in mind.
The second one with regard to the website and a one-stop station for residents to post and also to submit the scam situation, as I had mentioned, the scamalert.sg would probably serve that purpose.
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\tMs Poh Li San (Sembawang): Thank you, Mr Speaker, Sir. I thank Minister of State Desmond Tan for his clarifications. May I ask Minister of State Desmond Tan what are the preventative strategies to protect specifically seniors from Internet scams, given the on-going efforts to increase the digital literacy amongst our seniors.
\tMr Desmond Tan: Indeed, the Member has highlighted a vulnerable group. We are also mindful that they are quite prone to scams. The Police and MHA have started, in terms of our public education, to be more targeted and focused on specific targets that are prone to certain different kinds of scams.
So, for the seniors group, other than the mainstream media, we also work very closely with the community networks through their events, through their house visits including the Agency for Integrated Care, to make sure that some of these messages are communicated to them. We also work with IMDA, in terms of the Seniors Go Digital Programme, to try and see whether we can highlight, in the process of teaching them how to use the smartphone, to be more mindful of the risk and the threat that can come their way.
So, these are the efforts that we are working on and we will continue to make sure that our seniors are protected in cyberspace. They are an important group for us.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Proposal to Conduct Skills Test in Singapore for Foreign Workers for Construction Sector","subTitle":null,"sectionType":"OA","content":"14 Miss Cheryl Chan Wei Ling asked the Minister for National Development to help the construction sector expedite the availability of overseas workers and restart projects post-COVID-19 (a) whether the Skills Evaluation Certificate (Knowledge) test can be conducted in Singapore upon the overseas workers' arrival instead of at overseas testing centres; and (b) whether there can be an exemption for workers with past experience in the same trade in Singapore.
\tThe Minister of State for National Development (Mr Tan Kiat How) (for the Minister for National Development): Mr Speaker, Sir, we require new foreign construction workers to pass the Skills Evaluation Certificate (Knowledge) test, or SEC(K) trade test, at our overseas testing centres to ensure that they are equipped with the necessary trade knowledge and skills competency before coming to Singapore to work. This way, employers and the workers themselves can be assured that the workers are able to meet the requirements before incurring expenses, such as airfare, to travel to Singapore.
For workers that have previously obtained the necessary SEC(K) qualifications in a particular trade, they do not need to retake the SEC(K) test before returning to Singapore to work in the same trade.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Complaints of Defects in New HDB BTO Flats","subTitle":null,"sectionType":"OA","content":"15 Mr Vikram Nair asked the Minister for National Development (a) in each of the last three years, what is the number of complaints made in relation to defects in HDB BTO flats within five years of their completion; (b) what is this figure as a percentage of the total number of HDB BTO flats completed in that year; and (c) whether HBD will consider extending the defects liability period with its contractors for a longer period of up to five years to ensure greater responsibility for workmanship.
\tThe Second Minister for National Development (Ms Indranee Rajah) (for the Minister for National Development): Mr Speaker, flat owners of newly completed BTO flats are provided with a one-year Defects Liability Period or DLP, where the building contractor will repair defects reported by flat owners.
Based on BTO flats completed over the past five years, about 90% of the feedback on defects was received during the DLP, with the remaining 10% received in the second to fifth year following the blocks’ completion. On average, during the DLP, the number of reported defects per BTO flat was around 2.6 and this dropped significantly to 0.2 after the first year, 0.1 after the second year and 0.05 after the third year.
The vast majority of reported defects involve issues such as scratches or cracks on timber surfaces, walls, tiles and sanitary fittings. These are easily rectified by the contractors and do not affect the structural integrity or safety of the building.
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As most defects are resolved within the first year, a one-year DLP is sufficient for the majority of new flat owners and is in line with the industry practice for private developments. In addition, HDB provides all new flat owners with a five-year warranty for external wall seepage or inter-floor seepages, and a 10-year warranty for spalling concrete.
\tMr Vikram Nair (Sembawang): I thank the Minister for her explanation which I think clearly shows this is not a widespread problem. But in certain BTOs I have had in my estate, Woodland Glen is one of them. There are about 888 units and we have had more than 200 complaints so far on defects; most of which HDB is trying to rectify but HDB has no recourse against the original developer legally.
So, I was just wondering whether HDB or MND has a way of keeping track of maybe individual developers that have significant issues like this, where more than a quarter of the units will have defects that have come up later. And these are not things to do with wear and tear; it is like windows panes melting, toilet seats breaking. So, it just sounds like quality is bad or workmanship is bad.
\tMs Indranee Rajah: I thank the Member for his question. I had earlier omitted in my answer to also mention that if any maintenance issues are reported after the DLP, HDB will investigate the likely cause and advise flat owners on the follow-up action accordingly. So, if the issue is assessed to be due to an inherent defect or quality issue, HDB will engage the building contractor to rectify it.
The Member raised the question of what happens when you have certain developments that may have more than the usual number of defects. And I think he referred in particular to Woodlands Glen. The BTO project at Woodlands Glen consists of five residential blocks with a total of 888 units and the flats in the MSCP were completed between March 2017 and June 2017. And I think that a number of the residents had appealed to Mr Nair with regard to the defects.
HDB met up with the building contractor, Precise Development Pte Ltd, and the contractor agreed to replace, in this case, I think a number of the defects related to the cracked toilet seat cover. So, they agreed to replace that – the bumpers and the window weather seal, upon the residents' feedback. And with regard to the other reported defects, for example, there was feedback about rusty gate and timber toilet door issues, HDB followed up to resolve the issues with the residents. So, HDB is working closely with the contractor.
In short therefore, I think the position is this. On DLP specifically and the length of it, the numbers show that one year would be sufficient because the vast majority of the defects appear within that period and those are generally fairly minor defects. We have provisions obviously for major things like wall seepage and spalling concrete.
So, when you do have outliers like this, HDB will work closely with the contractor to rectify the defects and to see how they can be made good because obviously people moving into new BTOs would want their premises to be nice to live in. And it is obviously upsetting when there are defects, because they mar your enjoyment of the premises.
\tMr Speaker: Mr Gerald Giam.
\tMr Gerald Giam Yean Song (Aljunied): Sir, I have two supplementary questions. Firstly, defects are sometimes reported before the end of the Defects Liability Period or DLP, but are not fully acted on by HDB or the developers, or not satisfactorily resolved by the end of the DLP. So, will HDB continue to act on these defects until they are fully resolved?
My second question – several residents in DBSS development in my constituency have reported a large number of similar defects soon after the DLP. What options are available to lessees who encounter defects after the DLP and will HDB consider co-payment arrangements, so that lessees do not have to bear the full cost of rectifications on their own?
\tMs Indranee Rajah: With respect to the first question, if the defects are reported within the DLP, then obviously, it is within the relevant time frame and they should be followed up upon. For the defects which come up after the DLP period, as mentioned earlier, HDB will investigate the cause and then decide on what the best course of action is.
The reason I say this – and I sort of cannot give a definitive answer that yes, automatically everything after the defects liability period will be attended to by HDB – is because it depends on the nature of the defect. It depends on what exactly the cause is and it also depends on the nature of the follow-up action that needs to be taken. So, I think the the assurance we can give is this. If there is a problem after the defects liability period, HDB will look into it and do its best to resolve it with the contractor. But obviously if it is something that crops up 10 years later, then that is a very different thing.
\tMr Speaker: Ms Carrie Tan.
\tMs Carrie Tan (Nee Soon): Thank you, Mr Speaker. In cases where the residents have encountered multiple repair attempts to water seepage and wall seepage problems due to shoddy waterproofing works done by the contractor, and despite multiple attempts by contractors to fix the same problem, the problem keeps coming back in intervals of two to three years for the past 10-15 years – what recourse do residents have from HDB in terms of the distress that they have had to live through for the many years in encountering these problems?
\tMs Indranee Rajah: Again, it goes back to a question of identifying the source or the cause of the problem. The question as framed by the Member was where the residents have multiple attempts at repairs and this continues over many years with respect to seepage, I understand. So, if it is seepage, then there is a five-year warranty. So, if it falls within the five-year warranty, it will be dealt with on the basis of that warranty.
But if the seepage arose, let us say, maybe in the sixth year and it was because of the unit above having done certain renovation works and therefore broken the waterproofing or done something, then, it really would not be correct to look to HDB for that because the owner above will also have to bear some responsibility.
Hence, it goes back to the approach that I said earlier. We would look at the cause, we would look at where the fault is or what the reason is. Sometimes, it is a diagnostic problem. All of us have encountered this. The residents will point to leakage, they think it comes from a certain place but actually it may come from somewhere else. You have got to trace it, you have got to find the cause. And whoever is responsible for having generated that cause or made that leakage happen, should generally be the one to deal with it.
But bearing in mind that for flats – and this is the same for HDB as well as for private developments – there is a defects liability period or DLP for a reason and there is a warranty period for a reason. Because it cannot be that a developer remains responsible for the entire lifetime of the building which is subject to fair wear and tear. So, if it is a new flat and there are defects, that will be followed up on, general rule – DLP; seepage, then the warranty for the seepage, spalling concrete, that is a 10-year warranty, which is a really long time. And the assurance you have is that they will be investigated and dealt with accordingly.
\tMr Speaker: Mr Leon Perera.
\tMr Leon Perera (Aljunied): Thank you, Mr Speaker, Sir. One supplementary question for the Minister. Does the HDB monitor the extent of BTO flat defects associated with particular contractors in particular developments? And is that information then, given consideration in the decision-making process to award future contracts to that particular contractor? Is that information set analysed and given some weight in the decision-making process to award tenders to contractors?
\tMs Indranee Rajah: I do not have that particular information with me at the moment and hence, I do not want to hazard an answer, and inadvertently, not give correct information. So, if the Member could just file a question on that, then we will be able to get back to him.
\tMr Speaker: Ms Mariam Jaafar.
Ms Mariam Jaafar (Sembawang): Good afternoon, Sir. I just have a question. For the defect liability period for both BTO and HIP projects, given the length of time of the circuit breaker and shortage in workers, will the Ministry consider an automatic six-month extension or some suitable period for the defect liability periods that have expired within this time frame?
\tMs Indranee Rajah: Can I just clarify with the Member, before she goes back to her seat. Because the defects liability period usually runs from a certain time. So, if the works have not been completed yet, the defects liability period does not run. So, I just wanted to clarify what time period she meant?
\tMs Mariam Jaafar: Yes, I think since the end of an HIP project that perhaps was completed at the end of last year or somewhere where during the COVID-19 period, we have had the liability periods come up.
\tMs Indranee Rajah: So, meaning it is already into the defects liability period, but because of the circuit breaker, the works could not be dealt with?
\tMs Mariam Jaafar: Yes.
\tMs Indranee Rajah: We will certainly look into that.
\tMs Mariam Jaafar: Thank you.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Attention to Employment Prospects for Persons with Special Needs amidst COVID-19 Pandemic","subTitle":null,"sectionType":"OA","content":"16 Mr Chong Kee Hiong asked the Minister for Social and Family Development what has been the impact of the COVID-19 pandemic on the employment prospects and status of those with special needs and persons with disabilities and how is the Ministry progressing with measures to raise inclusivity during this challenging period.
17 Dr Tan Wu Meng asked the Minister for Social and Family Development (a) whether the Ministry monitors (i) the retrenchment rates for persons with disabilities (PWDs) and (ii) the proportion later found to have been \"disguised retrenchments\"; (b) if so, how do these findings compare with employees who are not PWDs; and (c) what is the average duration before a retrenched PWD finds new employment.
\tThe Minister for Social and Family Development (Mr Masagos Zulkifli B M M): Mr Speaker, can I take Question Nos 16 and 17 together, please?
\tMr Speaker: Yes, please.
\tMr Masagos Zulkifli B M M: Thank you. Based on the latest available survey data from MOM, there were 4.9 residents retrenched per 1,000 resident employees in the first half of 2020. This is higher than the incidence rate for the same period a year ago, which was at 2.5 residents retrenched per 1,000 resident employees.
The re-entry rate of retrenched residents in the first half of 2020 was 61.4%, lower than that in the same period a year ago, which was at 63.2%. MOM does not have a further breakdown of these indicators by persons with disabilities and persons without disabilities. Similarly, we do not track statistics on complaints of \"disguised retrenchments\" from persons with disabilities, or PWDs. That said, I would like to assure Members that as the Minister for Manpower explained to this House on 4 June this year, MOM will take appropriate actions against employers who disguise retrenchment to avoid fulfilling their contractual obligations.
To help retrenched workers secure new jobs, the Taskforce for Responsible Retrenchment and Employment Facilitation proactively reaches out to them to provide timely employment support. This includes matching them to suitable jobs and training opportunities under the SGUnited Jobs and Skills Package. In the first half of 2020, the Taskforce reached out to about 8,200 affected workers. The Taskforce will continue to engage retrenching companies on responsible retrenchment practices.
SG Enable and its job placement and job support partners have implemented additional measures during this challenging period. SG Enable has reached out to PWDs who stopped working since the start of the year, to encourage them to sign up for employment support services. Job support initiatives are offered online as far as possible, while considering the accessibility needs of PWDs.
SG Enable's Virtual Career Fair held from April to May 2020 offered over 100 job opportunities, and another 150 job opportunities were advertised during their online Training and Career Fair in September. To facilitate e-learning, SG Enable helped training providers to convert lessons into online modules. Where training cannot be conducted virtually, SG Enable has put in place safe management practices to ensure that the health of clients and trainers are not compromised.
\t
These additional efforts to support PWDs come on top of existing training and job placement and job support services that SG Enable provides under the Open Door Programme. The Open Door Programme training grant was recently enhanced in July, with more course fee subsidies and training allowance, as well as a new training commitment award of $100 per completed eligible training course. We will replace the wage offsets for employers of PWDs under the Special Employment Credit or SEC and Additional SEC with the Enabling Employment Credit or EEC, when the former expires in December 2020.
The EEC will provide employers that hire Singaporean PWDs earning below $4,000 a month with wage offsets of up to 20% of the employee's monthly income. Employers hiring PWDs who have not been working for at least six months will receive an additional wage offset of up to 10% for the first six months of employment. This is in addition to the Jobs Growth Incentive or JGI announced by Deputy Prime Minister Heng Swee Keat yesterday. Under the JGI, employers will receive the highest tier of 50% wage support for additional new hires of PWDs from September 2020 to February 2021.
It is encouraging that despite the challenges of COVID-19, many employers are still committed to inclusive hiring and over 140 organisations have signed the President's Challenge Enabling Employment Pledge since it was launched in March this year. While many PWDs and their care-givers tell us that they are temporarily exiting the workforce due to concerns over contracting COVID-19, we will continue to engage them and strive to serve more jobseekers as the situation stabilises and more activities resume. We are also working through the National Jobs Council to provide further support for those who need it, and we will announce these plans when ready.
\tMr Speaker: Dr Tan Wu Meng.
\tDr Tan Wu Meng (Jurong): I thank the Minister for his answer and for his sharing about the efforts to continue shaping the market and to bend the arc of our society towards further inclusivity. I have got two supplementary questions for the Minister.
The first is on statistics. Would the Minister consider tracking the statistics mentioned in my Parliamentary Question more actively and more deliberately? I say this because sometimes, to understand the situation, we need to seek truth from data and seek truth from facts. And by having that data, we are in a better position to understand if certain companies or certain sectors may be disproportionately retrenching PWDs.
My second supplementary question is: what efforts are ongoing by the Ministry to help shape the awareness of employers, the awareness of what a PWD can bring to the workplace in an intangible way. For example, the power of having a PWD team mate inspire other colleagues?
And if I may just seek Mr Speaker's indulgence, I have a resident, a young lady, who survived a car crash. She moves around in a wheelchair but got back to work, started a family and has continued in work as a working mother. But recently, during COVID, she was retrenched by a company which has a significant presence in the Singapore private sector and that actually had an emotional impact on neighbours and fellow residents.
So, it is important, Mr Speaker, I would put to the Minister that we look at shaping that intangible element as well.
\tMr Masagos Zulkifli B M M: I thank the Member for the supplementary questions. For the first question, we will work with MOM to see whether it is something practical. Because to get the data on unemployment or employability, all these have certain angle of statistical reliability which, in the case of the PWD, is a very small segment. It is not like male and female – that is statistically significant. Therefore, we may need to customise how we get this data and how we report this data.
But nevertheless, as I had mentioned if there are any complaints that may arise from their parents or the disabled themselves that they were unfairly treated either through retrenchment or employment practices, MOM, as well as MSF will take action.
Secondly, on the efforts of building this spirit of inclusivity in our community, it is something that we will never stop getting this work done, we will never stop doing this work. I think for the longest time, we have been putting out awareness campaigns, but we also put in enabling courses that employers can get involved in. As an example, there is a training grant under SG Enable curated training courses where we support up to 90% of co-workers to build up their capabilities and confidence in hiring and integrating PWDs into the workplace. This is amongst a few incentives and framework with which we are putting to the employers to enable and encourage them to be inclusive in hiring PWDs.
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\tMr Chong Kee Hiong (Bishan-Toa Payoh): As persons with special needs or disabilities are more vulnerable, particularly during periods of crisis, does the Ministry have case managers to follow up with those who lose their jobs or who have been retrenched so that you can render direct assistance?
\tMr Masagos Zulkifli B M M: Certainly, for those who have come forward and ask for help, we will render the help. But if Members know of anyone in their wards who may not be coming forward to ask for help, we will be happy to hear from you.
\tMr Speaker: Ms Denise Phua.
\tMs Denise Phua Lay Peng (Jalan Besar): Speaker, I would like to thank MSF and the Ministers. They have been some of the strongest partners for the PWD community. I have some comments and to seek Minister's comments as well.
First of all, issues like employment, healthcare, education, mobility, transport and so forth, these are the basic essential rights that every citizen should have. So, when we grant these rights, it is not meant to inspire other people so that they become better persons although that is one of the desired outcomes. Basic rights are actually where we should start from, that persons with disabilities are equal members of our society and therefore, things like work, the right to be schooled, to be educated, to have healthcare and to work whenever possible, these are the basic rights. So, this is the starting point when we look at issues such as these.
The second thing is this. While the COVID-19 pandemic has really raised challenges, especially in the areas of technology and the fast pace of change that affect Singaporeans and especially the PWDs, there are other root issues like the unemployment and the under employment of PWDs that need to be looked at. There is already a work group, thanks to MSF – Minister Desmond and Mr Masagos and team. There is already a Workgroup looking at this. But because of the question —
\tMr Speaker: Ms Phua, is there a question there somewhere?
\tMs Denise Phua Lay Peng: — because of the GE and the changes, the results and the progress updates are still not there. Hence, I request the Ministry to speed up the work of this work group and get those things that can get going, get going first, so that those things that need discussion do not have to wait till the expiry of the Enabling Masterplan. I seek Minister's indulgence and support of that.
\tMr Masagos Zulkifli B M M: The Member has the Ministry's and the Minister's support. The answer is yes.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Profile of Employees Retrenched due to COVID-19 Pandemic","subTitle":null,"sectionType":"OA","content":"18 Mr Yip Hon Weng asked the Minister for Manpower (a) how many Singaporeans aged 60 and above have been retrenched, or did not have their contracts renewed, as fallout from the economic impact of COVID-19; (b) how will the Ministry address the challenges of ageism in the COVID-19 economy; and (c) whether the Ministry will provide additional assistance to help seniors who are seeking employment opportunities.
19 Ms Sylvia Lim asked the Minister for Manpower whether she can clarify how the national guidelines on managing excess manpower and responsible retrenchments and other related policies ensure that Singaporeans are better off compared to permanent residents and non-Singaporeans in terms of job and income security.
20 Mr Chua Kheng Wee Louis asked the Minister for Manpower of the total retrenchments of 11,350 workers in the first half of 2020, (a) what is (i) the number of workers with less than two years' service with the company versus at least two years' service and (ii) the median and range of the retrenchment benefit based on the number of months' of salary for every year of service; and (b) whether a baseline retrenchment benefit can be legislated.
\tThe Minister for Manpower (Mrs Josephine Teo): Mr Speaker, may I seek your permission to take Question Nos 18 to 20 together?
\tMr Speaker: Yes, please.
\tMrs Josephine Teo: Sir, Singaporeans are understandably concerned about retrenchments. Since the start of the COVID-19 pandemic, retrenchments have risen and exceeded the peak observed in the SARS outbreak of 2003 but are still lower than during the Global Financial Crisis of 2009. Nonetheless, MOM is monitoring closely.
In the first half of 2020, the incidence of local retrenchment was 4.9 per 1,000 local employees. To the question by Mr Yip Hon Weng, the incidence of local retrenchment for senior workers aged 60 and above was generally comparable, at 5.2 per 1,000 local employees.
As for employees on fixed-term contracts, they constitute about 8% of all employees in the workforce. The number of contracts not renewed in the first half of 2020 has remained stable compared to the second half of 2019. MOM does not have data on non-renewals of contracts by age groups.
To the question by Ms Sylvia Lim, the Tripartite Advisory on Managing Excess Manpower and Responsible Retrenchment – which I will henceforth refer to as the Tripartite Advisory – this emphasises retrenchment as a last resort, only after employers have exhausted non-wage-related and wage-related cost-savings measures. The advisory sets out expectations for employers when they have to retrench staff.
The main goal of the retrenchment must be to give the business the best chance of survival or continued long-term viability, without which both the employer and all employees are worse-off, even if they were not retrenched. Selection of employees to be retrenched should be based on objective criteria, with primary considerations given to employee merit and preserving skills to help the business keep going. In addition, the Tripartite Advisory calls on employers to maintain a strong Singaporean Core even as they retrench. So, let me say that again. The Tripartite Advisory calls on employers to maintain a strong Singaporean Core even as they retrench.
Based on MOM's investigation of retrenchment cases, businesses have generally taken heed of the advice and made serious efforts to retain Singaporeans in their workforce. Where retrenchments cannot be avoided, WSG will reach out to offer job assistance. In unionised companies, NTUC has sought to minimise their period of unemployment through its \"lift and place\" efforts, partnering with the Government. A good example is how Singapore crew members from SIA were helped to take up jobs in healthcare with funding support.
Beyond efforts to help them stay in work which I will say more about later, Singaporeans also get extra support in social policies, such as education, training and healthcare. Schemes like Workfare and Silver Support, which help to boost incomes during work and in retirement, apply only to citizens.
The Tripartite Advisory that Ms Lim asked about also stipulates that the prevailing norm is to pay a retrenchment benefit of between two weeks' and one month's salary per year of service, depending on the financial position of the company and industry practices.
To the questions by Mr Louis Chua, the requirement to submit retrenchment notifications to MOM covers about 90% of the workforce and provides a broadly representative view. Based on notifications received between April and September this year, about two-thirds of the employees affected by retrenchment had at least two years of service with their employers and were eligible for retrenchment benefits. About nine in 10 of these eligible employees received some retrenchment benefit, of which about 84% received at least two weeks' salary per year of service. Even amongst employees who were not eligible, almost half received some retrenchment payout.
The question of whether a baseline retrenchment benefit should be legislated is not new and has also been debated in Parliament. The tripartite consensus, after extensive deliberation, is that it does not guarantee better outcomes for retrenched employees.
The legislated baseline would likely become the default. Even when employers can afford to pay more, they would be unlikely to do so.
On the other hand, setting a high baseline retrenchment benefit would strain the financial health of businesses that are already struggling, and potentially jeopardise their survival and the jobs of the remaining employees.
With legislated retrenchment benefit, employers would also be less likely to offer long-term or permanent contracts to employees, and resort more to hiring employees on short-term contracts.
Hence, while recognising the usefulness of retrenchment benefit and encouraging employers to pay according to the prevailing norms, we are even more focused on helping retrenched workers return to the workforce. Besides heavy subsidies for skills programmes, we provide substantial training and wage support to employers while their new hires undergo conversion programmes.
During this period where hiring sentiments have weakened, we have significantly enhanced the support to local jobseekers.
We introduced the Jobs Growth Incentive to spur employers to expand local hiring, with double the support for new hires aged 40 and above.
We created the SGUnited Mid-Career Pathways Programme to help mid-career locals gain relevant work experience through attachments hosted by companies. This will position them to take up jobs later.
We have also expanded the SGUnited Skills programme which offers full-time training programmes ranging from six to 12 months.
Mr Yip asked about the additional help for seniors who wish to continue working. For many decades, we have recognised employers' concerns about the cost of hiring and retaining them. With encouragement from the tripartite partners, many employers have therefore moved away from a seniority-based wage system to competency- or performance-based wage systems. Senior workers aged above 55 years have lower employer CPF contribution rates. The Government further provides the Special Employment Credit to employers to offset wages of Singaporeans aged 55 and above. Employers who redesign jobs to be better suited for senior workers can tap on the Productivity Solutions Grant.
In more recent times, we observed that senior workers increasingly prefer to reduce their work intensity as they approach retirement. To encourage more employers to offer part-time opportunities for them and enable them to stay on in the workforce, we introduced the Part-time Re-employment Grant earlier this year that will provide up to $125,000 to companies that commit to a part-time re-employment policy.
Through these measures, we have made good gains in senior employment. Our employment rate for residents aged 60 and above has increased from 27.2% in 2009 to 38.5% in 2019. During this period of economic uncertainty, the unemployment rate for locals aged 60 and over remains comparable to that of the overall workforce.
Nonetheless, MOM recognises Mr Yip's concerns about ageism, especially in a slack job market. Singapore's employment laws protect employees against discriminatory employment practices, including wrongful dismissal on grounds of age. In January this year, we also strengthened the Fair Consideration Framework for greater deterrence against all forms of workplace discrimination by raising administrative penalties across the board.
Our seniors are important and are valued members of our workforce. We will continue to look out for them and support their employers' efforts to retain them.
Mr Speaker, I appreciate Members for raising these important questions on retrenchments. Until the economy recovers more fully, we will maintain the stance of heightened vigilance on the job situation.
Where retrenchment can be avoided through cost-cutting measures, we will keep a lookout for instances where the wage cuts cause excessive hardship to workers. In cases where MOM has intervened, employers that have the means have shown willingness to moderate their wage cuts. Where retrenchments cannot be avoided, we will watch out for Singaporeans, give full support to employers' efforts to retain them or to help them move into new jobs as quickly as possible.
\tMr Speaker: Order. End of Question Time. Ministerial Statement.
[Pursuant to Standing Order No 22(3), Written Answers to Question Nos 22-36 and 39-53 on the Order Paper are reproduced in the Appendix. Question Nos 21, 37 and 38 have been postponed to the sitting of Parliament on 14 October 2020.]
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Aviation Recovery","subTitle":"Statement by Minister for Transport","sectionType":"OS","content":"The Minister for Transport (Mr Ong Ye Kung): Mr Speaker, Sir, as the COVID-19 virus spread around the world earlier this year, many countries closed their borders. It was a drastic and unprecedented measure. But faced with an unknown and dangerous virus, governments around the world concluded that this was the best way to stave off a viral invasion. Singapore did the same on 24 March this year.
This has decimated air travel. Today, we have fewer passengers than when we first opened Changi Airport Terminal 1 in 1981 – we have gone back more than 40 years because of COVID-19.
It also affected many other sectors – aerospace, tourism, hospitality, entertainment, attractions, retail, our taxi and private hire car drivers. But what is most worrying is the longer term impact on our entire economy. Our aviation hub status is essential, even existential, to the health of the Singapore economy, to our jobs and to our future.
I have described our airport as a lung of Singapore. Just as a lung takes in oxygen and vitalises every part of the human body, the airport connects Singapore with the outside world and energises every sector of our economy.
When a company puts a significant investment in Singapore, one key reason for them to do that is our superior air connectivity, because that means their customers, suppliers, partners and key executives, can travel in and out of Singapore easily. They can come from any part of the world, come to Singapore and then connect on to another part of the world. Our status as an air hub makes that possible.
However, the longer our borders remain closed, the greater the risk of losing our air hub status and our attractiveness as a place to invest and to create jobs because of those investments.
The status quo is therefore not sustainable for us. We cannot just wait around for a vaccine, which may take a year or two before it becomes widely available. Even then, we do not know if the vaccine will work as expected.
We need to take proactive steps to revive the Changi Air Hub, as a top national priority. Mr Saktiandi and Mr Melvin Yong asked how we would achieve that. Mr Gan Thiam Poh asked a similar question for the next sitting which I will answer today.
Today, I will give first an update on the current situation in the aviation sector; second, I will explain what has changed from the time we closed our borders in March 2020 until now, what has changed; and third, finally, what are the steps we will take to try to revive our air hub.
So, let me first give the House an update of the current situation.
Compared to pre-COVID-19, Changi Airport is serving 1.5% of our usual passenger volume; and 6% of the usual number of passenger flights. The numbers are stark because Singapore has no domestic air travel.
If we include cargo flights, it is higher, at 17% of total flight volume. This is because we are flying more than two and a half times more cargo flights now, which partially offsets the reduction in passenger flights; so all the online buying of goods has contributed to cargo and allowed us to mount more cargo flights.
We now have direct flights to 49 cities in the world, compared to pre-COVID-19, 160.
We were the seventh busiest airport in the world for international passenger traffic. Today, we have dropped to 58th place.
Two key companies in the aviation sector are facing a deep crisis. They are Singapore Airlines (SIA) and Changi Airport Group (CAG).
SIA recorded its largest ever quarterly loss on record in the first quarter of Fiscal Year 2020. It is trying its best to reduce cash burn, preserve core capabilities and explore all ways to generate revenue.
Unfortunately, the SIA Group had to make the difficult decision to rationalise its workforce. One thousand nine hundred jobs have been rationalised through open vacancies that were not filled, early retirement and voluntary release scheme.
The recently concluded agreement with SIA’s pilot union for pilots to take deeper salary cuts, enabled the SIA Group to reduce the number of retrenchments from 2,400 to 2,000. So, all in all it is about 3,900 jobs rationalised either through non-filling of vacancies, early retirement or retrenchments in the SIA Group – 3,900 jobs.
Without the recent major recapitalisation exercise, there would not be an SIA today. It is far from being out of the woods.
One of the initiatives SIA considered recently to generate some revenue and get more pilots to do actual flying, was a flight to nowhere. Mr Dennis Tan and Assoc Prof Jamus Lim asked if MOT would support this. It has now become a moot point, because SIA has decided to scrap the idea.
Whichever way SIA had decided, MOT would always try our best to support our national carrier in times like this. But what I will not contemplate is to impose on them an environment tax at this time, as Assoc Prof Jamus Lim indicated in his question, because that will just worsen the crisis for SIA.
CAG too has lost its revenue streams. With low passenger volume and flights, the amount of service charges it is collecting from airlines and passengers is miniscule. Shops and restaurants at the airport are seeing far fewer customers; many shops have closed. CAG is also dipping into its reserves, while preserving cash and retaining its core capabilities.
Mr Liang Eng Hwa asked about the plan for Terminal 5. This is a very large-scale project undertaken by CAG. Given the current situation, we have decided to take a two-year pause, so that we have more clarity on the pace of air travel recovery, before deciding how to proceed with the project.
The Government will continue to support SIA, CAG and other companies in the aviation sector as much as we can. This includes the Jobs Support Scheme, where the aviation sector benefits from the highest level of support. We have also provided cost relief through the Enhanced Aviation Support Package and temporary redeployment programmes for workers affected.
But the most meaningful support we can give to our aviation companies is to restore passenger traffic and revive our air hub, in a safe and controlled manner. How do we do this? We must recognise that compared to six months ago, when we closed our borders, the situation has changed, in a few very significant ways.
First, the virus situation in Singapore – both in the community and in the foreign worker dormitories – is largely under control. The number of new cases in the community has remained stable at an average of one case per day in the last two weeks. Thanks to the hard work of our healthcare staff, we have had no fatalities resulting from complications due to COVID-19 infection since mid-July. Our fatality rate is also one of the lowest in the world. Thankfully, for many weeks now, we have not had any patients admitted to ICU due to COVID-19 infection or its complications.
Members have heard all these updates before, but I thought I would repeat them anyway because this track record matters greatly to countries and regions seeking partners to restore aviation links.
The second major thing that has changed is our testing capacity. COVID-19 testing capacity is no longer a major constraint. Back in March 2020, we could only conduct about 2,000 tests a day and they had to be reserved for critical public health purposes such as testing high-risk symptomatic individuals.
At that time, closing our borders was the only way to slow down the import of the virus and keep Singaporeans safe. For returning Singaporeans and residents, we subjected them to a lengthy 14-day Stay-Home Notice (SHN) – and usually \"Plus\". It means a Stay-Home Notice, plus you stay in a hotel and not at home. So, it is a lengthy 14-day \"SHN Plus\" invented by Minister Gan to ensure that they were free from the virus before allowing them to mingle with the rest of the community.
Today, we test more than 27,000 individuals daily – from 2,000 in March, to now, 27,000 daily today – using diagnostic polymerase chain reaction, or PCR, tests and we are on track to increase our testing capacity to 40,000 tests a day by November 2020. To give this a further boost, we will also be leveraging the private sector to develop commercial testing capacity.
At the same time, testing technology is advancing. There are now promising tests with quicker turnarounds while maintaining acceptable test sensitivity. For example, DSO and A*STAR have developed the Resolute test kit. It halves the time needed to process and analyse patient samples in the lab from two to two and a half hours to between one and one and a half hours.
There are also trials for less intrusive tests using deep throat saliva – but you must know how to spit – and efforts to develop rapid test kits such as antigen and breathalyser tests that can deliver results on the spot – in a few minutes – without having to send the samples to a laboratory for processing. We are watching this space very carefully and with great interest. And we will deploy these tests where practicable.
Part of this increased capacity will be allocated to test air passengers.
With high-sensitivity tests, we can now filter out the virus at the border – better still, before the traveller boards the plane – and significantly mitigate the risk of importing and spreading the virus in Singapore. In other words, on a selective basis, we can open up our border, do away with Stay-Home Notice, or SHN, which is a big deterrent to travel for anybody and replace SHN with tests.
Testing is therefore the key to unlock air travel.
With COVID-19 around for a while, the emerging international practice is to get tested before travel – not different from us going through security, having our bags checked before we board the plane. That is the emerging international practice. Changi Airport has already set up a facility to swab up to 10,000 passengers a day as a start and with some notice, it can ramp up the numbers quite readily. In the next few months, we plan to set up at Changi Airport a dedicated COVID-19 testing laboratory to support aviation recovery.
A third key change since March is tracing capability. We have scaled up our ability to quickly identify and isolate new cases and their close contacts. When we had our first COVID-19 case in January, we relied entirely on human contact tracers to manually retrace a patient's steps. Today, technologies such as SafeEntry, the TraceTogether app and tokens complement the work of human contact tracers. We can therefore quickly identify and isolate people who have come into contact with a confirmed patient. This helps to reduce the risk of any community outbreak.
Finally, because of all these developments, internationally, there is now a desire to cautiously and steadily open up air travel again. For example, the European Union has designated countries whose residents can visit Europe. The United Kingdom – the UK – has recently exempted travellers from Singapore from their 14-day quarantine when you arrive. Vietnam is restoring scheduled passenger flights to several cities. Hong Kong has announced its intention to negotiate travel bubble arrangements with several countries, including Singapore.
Mr Speaker, Sir, having described the situation – what has changed – let me now talk about the steps we will take to open up our borders and revive air travel.
The key is to make sure we stay safe – we can manage the risks while we open up aviation. We have gone through quite a bit – including a painful circuit breaker – to arrive at the stable situation we have today. We must not give that up. We have seen how a second wave has broken out in other countries and regions. In some cities, in some countries, they are going back to a lockdown again. And we should learn from those experiences.
Air hubs such as Dubai in the United Arab Emirates and Istanbul in Turkey have restored flights quite quickly. Now, they are at about 30% of pre-COVID-19 volumes. Earlier, I mentioned we are at 1.5%.
As of 5 October 2020, the United Arab Emirates had an infection incidence rate of about nine per 100,000 population per day and for Turkey, about two per 100,000 population per day. Singapore – we are at 0.1 per 100,000 population per day.
I think there is a recovery and risk trade-off and we can learn from each other in managing the risks of opening up. But as I just described, because conditions have changed over the past months, the trade-off is not as stark as before.
I need to manage expectations here. For Members who are hoping that I am about to announce some air travel resumption and possible December holiday destinations, I am sorry I will disappoint you. The fact is that borders are still closed for most parts of the world. Some countries such as Germany only allow business travellers from Singapore. And to the best of my knowledge, only a handful of countries – such as the US, the UK, Turkey, the Maldives – allow general travellers from Singapore.
We cannot control what other countries want to do with their borders but we can control ours – to welcome back visitors, bring back jobs, revive our air hub safely. How we do this safely can be a useful reference point for other countries and perhaps even catalyse some safe opening around the world.
The coming months will be crucial. It will be a difficult and gradual climb out of a very deep abyss. But climb we must, and we will do the following.
First, we will continue to pursue Reciprocal Green Lane arrangements with partner countries or regions. These are restricted to a small group of essential business and official travellers. They will be subject to pre-departure and on-arrival tests to ensure they do not carry the virus. Further, they will have controlled itineraries to minimise any residual risk of community spread.
MFA has led this inter-agency effort and concluded arrangements with Brunei, China, Japan, Malaysia and the Republic of Korea.
Secondly, we will continue to facilitate transfers at Changi Airport. As an air hub, about a quarter of our passenger volume at Changi are transfers, meaning the passengers do not clear immigration and are using Changi Airport as an interchange to get to their final destinations. Mr Gan Thiam Poh asked for the number of such transfer passengers at Changi Airport today. Since June, about 27,000 passengers transferred safely through Singapore. On a weekly basis, we are now serving about 2,500 transfer passengers and we expect the numbers to rise steadily. But this is still a small fraction of what we used to serve. We have put in place robust safeguards and no Singaporean has become ill as a result of these transfers.
The third thing we will do – we should be prepared to lift our border restrictions to countries and to regions with comprehensive public health surveillance systems and comparable incidence rates to Singapore. That means we are of the same risk profile, which is low. We already know who they are. At the same time, when we do so, we should also lift our travel advisory for Singapore residents travelling to these countries and regions.
Purely from an infection risk point of view, the risk of a traveller from these places carrying the virus when they arrive at Changi Airport is no higher than that of a Singaporean resident coming from Jurong or Sembawang because we are of the same incidence rate and same risk profile. But as a precaution, we will subject these travellers to a COVID-19 test to ensure they are free from the virus. In this way, we can safely lift our border restrictions for these countries and regions and welcome their travellers. Their governments will decide if and when to reciprocate for travellers from Singapore. Once they do that, aviation links between us would have been restored. There is no need for lengthy bilateral negotiations.
We have already taken the first steps. We opened up to travellers from Brunei and New Zealand last month, and more recently – in fact, last week – we opened up to Australia, ex-Victoria, and Vietnam. We do not expect big numbers in the short term because these countries currently discourage or restrict travel for their residents. Notwithstanding this, such unilateral opening is still meaningful because it is like a standing invitation. Although the other countries are not ready to lift their restrictions now, Singapore can be top of mind when they are ready eventually.
Let me give you an example – the UK. Recently, it unilaterally allowed Singaporeans to travel there without a quarantine. Many of our students actually went to their universities as a result.
At present, UK's incidence rate is quite high, so we still have a travel advisory against Singaporean residents travelling to the UK and we are also not ready to allow travellers from the UK to enter freely into Singapore. But we appreciate the UK's standing invitation. Once their infection rate falls and becomes comparable to ours, we will likely lift restrictions quickly, which will effectively restore air travel between our countries.
Remember – we are small. Our domestic market is not a big bargaining chip. Instead, what we need to have is a mindset of generosity required of a hub. It is why when we were building up Changi Airport in the 1980s, we opened up our skies unilaterally. It is also why decades ago, we removed tariffs unilaterally for all countries. Yet, many countries chose to negotiate with us for Air Services Agreements and Free Trade Agreements – because our partners know that by connecting to Singapore, they connect with the rest of the world. They chose to deal with Singapore because it is strategic to do so.
The fourth thing we will do, for these safe countries or regions, is that we will also negotiate Air Travel Bubbles or ATBs, or pursue such ATBs with them. Air Travel Bubbles are not the same as Reciprocal Green Lanes that I mentioned just now, which are for official and essential business travel only. Air Travel Bubbles are for general travellers and have no requirements for a controlled itinerary.
While we should establish ATBs only with safe countries and regions, we can further manage risks by setting a quota on the number of travellers per day and ensuring that everyone abides by a COVID-19 test protocols. We also require travellers to apply for an Air Travel Pass before their journeys, to allow us to plan for their arrivals, and if need be, throttle down the numbers, or reduce the quota if the epidemic situation changes. Hong Kong has publicly announced its intention to establish ATBs with several countries, including Singapore, and we have responded positively. We hope to commence discussions with Hong Kong and other partners soon.
Finally, we will not stop at these modes of opening up our borders, that I just talked about. The Multi-Ministry Task Force will explore other practical schemes. This is especially important for travellers from countries which are economically important to us, but with higher infection rates. There are ways to facilitate these travellers to come to Singapore while managing the risk of virus transmission. Many stakeholders and members of public have written to us with very well thought-through and sensible ideas and we are studying them carefully.
In particular, we recognise that the requirement of having to serve a full 14-day Stay Home Notice or SHN in a hotel, will deter most travellers from wanting to come to Singapore. So, we have to facilitate the visits without such an onerous restriction. For example, we can replace the 14-day SHN in a hotel with new requirements, such as a more stringent and repeated test protocol – on arrival, three days later, five days later, seven days later, we will study that. We can segregate them from the rest of the community, a process that we call \"bubble wrapping\", and we can closely track their movements while they are here.
This will benefit not just business travellers important to our economy, but a range of people who need to come to Singapore for various purposes, such as compassionate reasons or to re-unite with a long-separated partner. The message we want to send to the world is this – Singapore has started to re-open its borders. In the near future, if you have the virus under control and infection rates are as low as Singapore's, you are welcome to visit us, but travellers will be subject to a COVID-19 test, as a precaution. If you are from a place where infection rates are higher than Singapore, you can also visit us, so long as you agree to conditions such as testing, segregation and tracing. The Task Force will be studying these approaches and developing the schemes.
Mr Speaker, Sir, let me conclude. Earlier in the year, we had to close our borders to keep Singaporeans safe. But as we learn to control the virus and testing becomes much less of a constraint, the trade-off between health and economic needs, between lives and livelihoods, is no longer so stark, and the two do not have to be at odds. Eventually, when there is a widely available and effective vaccine, air travel will resume. But in the meantime, we will have to learn to live with the virus – taking sensible precautions, while earning a living, and keeping hopes for our future alive.
We have opened up safely before. We did that when we emerged from the circuit breaker in June and we have been bringing back our community and social life, step by step. We have been restoring school life for our children, activity by activity, and made sure throughout that process, that our children stay safe and they did not lose their school year. We did not rush, but neither did we baulk at what we need to do to regain our normal lives and livelihoods.
It will be the same with our international borders, to open up step-by-step, carefully, safely and steadily. What is at stake is not just hundreds of thousands of jobs, but our status as an air hub, Singapore's relevance to the world, our economic survival, and in turn, our ability to determine our own future.
When Terminal 1 opened in 1981, it opened up a whole new world and brought prosperity undreamt of in generations past. Today, the skies remain key to our economic survival. We must open up slowly, carefully, and holding each other accountable for our collective safety. But open up we must. I hope to have the support of all Members of this House, and all Singaporeans, for this critical endeavour, so as to take our place in the world once again and to start building our future as we once did. [Applause.]
Mr Speaker: Mr Saktiandi.
Mr Saktiandi Supaat (Bishan-Toa Payoh): Mr Speaker, I wish to thank Minister Ong for the very detailed answer to our colleagues' questions and my questions as well. I have three clarifications that I wish to seek from Minister. First of all, I do understand the recovery and risk trade-off that Minister mentioned. I think we all mindful of it, especially with the incidence risk that comes along with opening up the country.
My first question is, the Minister mentioned about the testing technology improving and there are plans for Air Travel Bubbles, ATBs. My first question is regarding bilateral and regional arrangements with ASEAN, for example. Can the Minister share with us how are the deliberations in the plans going ahead or the task force's deliberations with ASEAN for example, in opening up our regional air travel between ASEAN countries going forward, as testing technology improves?
The second question, Minister mentioned about the logistics and cargo volume that has improved two times – I think if I am not mistaken, I heard two times, it has ramped up two times. My question is in the interim, as we see more Scoot planes on the tarmac, as we drive past Changi, PIE and towards the end, we see Scoot planes there – is there is a possibility of ramping up our logistics and cargo volume even further, in the interim. Particularly, because you probably might want to get the core capabilities of our aviation sector built up in the interim, as we as we wait for some of these technologies to improve or for ATBs or arrangements with other countries.
My third question is in relation to my Parliamentary Question, in post-COVID, what are our plans for the medium and longer terms. Whether the Minister can share with us any infrastructure, strategies or plans to put us in a good stead post-COVID – I am not sure whether COVID-19 will end next year – beyond one year, two years or three, four, five years. How Singapore can take this opportunity to put us in a better stead beyond one year ahead?
Mr Ong Ye Kung: Mr Speaker, Sir, on ASEAN, I think we need to recognise first that ASEAN is quite different from the EU. EU has a Schengen treaty. So, between EU member states, they signed an agreement, they agreed for free movement between different citizens of EU member states.
Even so, between EU Schengen member states, they impose border restrictions on each other. So, Schengen means that you do not have to apply for a visa to travel from say France to Germany, but between the countries, they impose border measures. I asked some of my European friends, what are the border measures and they said, \"It is too complicated to explain. Here is the website\". I went to the website – EU member state has a separate border restriction.
I think practically this is what is happening – and in ASEAN, it will be the same. As of now, I would not say ASEAN is ready to discuss a regional plan but individual countries, member states, are doing our own assessment of what is safe, what is unsafe. Within ASEAN countries, as Members know, we have opened up to Vietnam, it has a very good track record and MOH recognises that, so we can have opened up unilaterally for Vietnam. Where possible, and we have RGLs or Reciprocal Green Lane arrangements such as with Malaysia or Indonesia. So, we will push in that direction, taking a country-by-country approach and bearing in mind ASEAN is an important market for us. So, that is where we are.
On cargo, yes, we will ramp up when there is demand and when demand justifies it. Therefore, today, because of the ramping up, cargo flights is 2.5 times more than COVID-19. So, that is one thing that went up in aviation despite COVID-19. But bear in mind, even during pre-COVID-19 times, cargo flights were only 4% of total flights. So, you cannot restore aviation just by banking on cargo. Further, cargo flights ferry non-living things, and in the end, aviation is about people-to-people linkages – Singaporeans connecting with people from around the world. Therefore, we still have to work on as hard as we can.
Finally, what infrastructure plans. As Members know, we have T5, and our terminals are going through upgrading as well, so we are not short of infrastructure plans. What we need now is not so much the hardware, but the software of being able to open up our borders, welcome travellers to and fro but do so safely. It will be in infrastructure such as testing capacity, such as people who can do the tests, such as adopting new, novel testing methods including rapid test kits that allow us to open up safely. This is what is critical now. If we succeed, if we can make the first moves, then when there is a vaccine, when air travel opens again internationally, we will find that Singapore is right up there, ahead of the curve and we can retain our air hub status.
Mr Speaker: A reminder – let us keep to two clarifications. Assoc Prof Jamus Lim.
Assoc Prof Jamus Jerome Lim (Sengkang): I thank the Minister. I am just wondering if he would be able to clarify the thinking behind why in his Statement, he mentioned that he would not consider an environmental tax because it would impose clear costs on the economic viability of SIA.
I mention this because, of course, the burden of the tax as economists understand it, really falls on either the consumer or the producer, depending in large part on the intensity with which the demand or supply responds to price – what economists call an elasticity. So, it is entirely possible that it does not impose an immediate concern on the viability, the economic viability, if SIA is able to pass on the cost.
The second question is, I wonder whether it is possible to consider mechanisms where the environmental needs of both the country and the world need not be a casualty to business considerations. By which I mean we can think of innovative ways, for example, if you have a flight to nowhere – of course as the Minister mentioned a moot point right now – it could well be the case that this tax could be funded by savings on berthing rights. And hence, ultimately the cost of a ticket need not actually rise. So, I am wondering if I could get clarifications on those.
Mr Ong Ye Kung: I think all these considerations can be done if there had been no COVID-19. There has been some discussion in ICAO, in the EU, in the international community. But I think the basic answer, the simple answer is this: we are in a crisis. SIA, as I mentioned, is ferrying 1.5% of its passenger volume, so it is not about passing the costs to passengers; it is that there are no passengers to pass the costs to now. And SIA is doing whatever it can to preserve cash. Because if you understand how a company is run – when a company runs out of cash, it is insolvent, it goes under. And SIA would have gone under if not for the massive recapitalisation exercise that happened.
And therefore, we need to help SIA preserve as much cash as it can. It itself is trying to generate as much revenue as it can. So, this is really not the time now to talk about an environmental tax on SIA. If I were to do that, I think there is a Chinese saying, \"落井下石\". I would have made the situation much worse for SIA. It means \"someone fell into the well and you throw a stone to make the situation worse\".
So, let us be very careful about that. When things resume, the international conversation will go on, on whether there should be an environmental tax.
Mr Speaker: Mr Liang Eng Hwa.
Mr Liang Eng Hwa (Bukit Panjang): Sir, I welcome the update and the various announcements by the Minister to open up our borders to resume flights. As I hear him describe some of the things that we need to do – to have the Reciprocal Green Lane, Controlled Itinerary, the various testings, the monitoring and surveillance as well – it gives me a sense that there would be a lot of costs to be added on as well, including for the airlines when they have to fly planes that are not as full, and not to mention that the air tickets that the airlines sell would not be cheap as well, may not be that affordable.
So, I want to ask the Minister from a cost-revenue standpoint, does it make sense, does it clear the break-even point for us to resume travel, given this environment? That is my first question.
The second question is, during this COVID-19 situation, there were quite a number of airlines that have actually moved out of Singapore. They hub somewhere else or they find a cheaper location. So, I want to ask the Minister whether when we resume, let us say, when the air travel comes back, are we confident of bringing these major airlines back to Singapore, to hub in Singapore again?
Mr Ong Ye Kung: Mr Speaker, Mr Liang is right that the cost of running per passenger service now is higher. If you have to do a test, you have to have extra segregation and all that, cost is higher. But, at the same time, be mindful too that supply has greatly been reduced. So, there are many passengers who are still prepared to pay a bit more, even go through the discomfort of being tested in order to travel, either for business, leisure or just visit relatives and other reasons.
I think the demand is there because the supply has totally been decimated. So, just to restore some demand, we believe there are passengers who are prepared to travel.
You can just speak to your friends – Singaporeans who have not travelled for the whole year and now you tell them, you can pay a bit more, you can visit XX country or region – I think they will be quite happy to try to do so. Some are getting cabin fever and Singaporeans love to travel. So, I think the latent demand is there. I think we need to unlock it through the methods I mentioned earlier.
As to whether major airlines will come back, that is why we need to start taking steps, as I had mentioned, to start signalling that we are determined to hold on to our status as an air hub. And we are taking active steps, as I had mentioned, to open up our borders and revive air travel again. And airlines are sensitive to this. We are in contact with the airline industry; many are still very keen to come back to Singapore. I just met a senior executive of a regional airline. He actually flew to Singapore, did his 14-day SHN Plus in order to meet some of us and he met me for half an hour with a clear message, \"Please open up aviation again because our airlines want to come back to Singapore\".
So, I think we are still top of mind for many of the airlines but we have to start taking steps to open up our borders.
Mr Speaker: Mr Gerald Giam.
Mr Gerald Giam Yean Song (Aljunied): Sir, I appreciate the work that the Minister and his Ministry are doing to safely open our airport. I have a few clarification questions.
First, why has Changi Airport's passenger rank dropped from seventh place to 58th place when the crisis is global and has affected other air hubs in US and Europe far more than in Singapore? So, how did these 51 cities overtake Singapore and what lessons are we drawing from them?
Secondly, I understand many incoming arrivals are currently placed on SHN for up to 12 to 14 days before their first PCR test. Why are they not all tested on arrival and is testing capacity a factor?
And lastly, regarding green lanes and pre-departure tests conducted in originating countries, how can we be sure that the test results are reliable, especially for countries where corruption is rife and cheating is commonplace?
Mr Ong Ye Kung: Sorry, can the Member repeat the second question? I missed it.
Mr Gerald Giam Yean Song: I understand that many incoming arrivals are currently placed on SHN up to 12 to 14 days before their first PCR test. So, why are they not all tested on arrival and is testing capacity a reason for this?
Mr Ong Ye Kung: I invite the Co-chairs of the Multi-Ministry Taskforce or MTF, to chime in, if necessary. Why is the drop in Singapore's passenger traffic so drastic? The key reason is the fact that we are small. We rely entirely on international traffic. We do not have domestic travel, like the US. The drop, I concede, is on international travel. But if you are a big country, China or US, you have a much bigger population who is flying out and not just flying within the country and that generates international traffic, which is why there is a certain cushion. For us, as a small domestic market, the numbers are more stark.
SHN, 14 days – the simple answer is this. For travellers that we open up to unilaterally, they have to be tested upon arrival. What the Member mentioned about SHN 14 days, they refer to other individuals and they are undergoing their 14-day SHN, then they get their test at the end of the service of the SHN. For travellers that we open up unilaterally to – travellers from Brunei, New Zealand, Vietnam, Australia – they will be tested upon arrival.
As for green lanes, perhaps I will ask Minister Gan or Mr Lawrence Wong to answer this.
Mr Speaker: Minister Gan.
The Minister for Health (Mr Gan Kim Yong): Mr Speaker, thank you for allowing me to chime in. Just to elaborate on Minister Ong's explanation, for travellers who come in that require SHN or SHN Plus, the reason they require SHN or SHN Plus is because of the incubation period. When they come in, they may have been infected and if we test them on the spot on arrival, it may not be detected. Because there is an incubation period. That is why we put them within the SHN or SHN Plus for the whole duration of the incubation period and we test them at the end.
And if they are still negative, that means they are past the incubation period and they are still negative, we can then allow them to go into the community. If we test them on the first day, the test is not going to be effective because he may still be within his incubation period. And you, nonetheless, have to test them again at the end of 14 days. And that is why instead of repeated testing, we decided that for those that require SHN because of whatever risk profile that we have decided on, they should be tested at the end of their SHN period.
Mr Speaker: Ms Poh Li San.
Ms Poh Li San (Sembawang): Thank you, Mr Speaker, Sir. I thank Minister Ong for sharing MOT's strategies for the aviation sector. I feel very heartened. I like to first declare my interest as an employee of the Changi Airport Group.
Currently, there are different travel schemes and swab and isolation protocol upon arrival for travellers – some 14 days' isolation, some seven days and some zero, for example, Australia and Brunei in the latest case. I would like to ask the Minister in the next three to six months, will MOT consider reducing the SHN duration for countries that are relatively successful, like China, Taiwan, for example – from the current seven days to, perhaps, three to five days, a shorter period following a negative swab results? Pre-COVID, I believe China has the highest travel volume into Singapore, so if we can actually reduce that number of days for SHN, that will reduce the deterrence for travellers to enter into Singapore.
Mr Ong Ye Kung: Mr Speaker, Sir, selectively, the MTF has been reducing SHN but backed by healthcare experts' advice and our findings and understanding of the virus – 14 days to seven days, for example, for some countries and regions with a safer track record.
But what I mentioned earlier about unilateral opening is better than reducing SHN from 14 days. In the case of Brunei, New Zealand, Vietnam and Australia, ex Victoria, we require zero days of SHN. Because these countries have incidence rates and risk profile that are similar to or better than Singapore. Like I had mentioned, when you have similar risk profiles, technically, there is actually no need for a test, because someone from those countries coming to Singapore – is not different from someone from Jurong or Sembawang or Bedok going to Changi Airport – same risk profile. But out of an abundance of caution, we still administer a post-arrival test and once negative, they are free to move about, there is no need for SHN.
So, I think right now it is not the time to simplify rules or reduce requirements and then apply generally. It is not the time to do that. Now, what we need to do is to understand every single country or region, understand the risk profile and customise our approach for travellers from each of these countries or region, which is what we are doing.
Mr Speaker: Mr Melvin Yong.
Mr Melvin Yong Yik Chye (Radin Mas): Thank you, Mr Speaker. I thank the Minister for his Ministerial Statement. It does provide us with a clearer overview of the challenges and our strategic directions towards systematic recovery of our aviation sector. I have two clarifications.
According to the latest flight schedules published by the SIA Group, SIA and SilkAir are gradually increasing the number of flights they operate. Flights to Brunei, Japan and the Maldives are scheduled to be reinstated by the end of the year. Flights for some existing routes which include Australia, France and the UK will also increase. I like to ask if these business decisions by the SIA Group are linked to the Government's on-going negotiations on Reciprocal Travel Arrangements. Residents have asked why SIA continues to operate flights to countries that we currently cannot travel to.
My follow-up question is whether the Government has plans to aid the recovery of SIA in the event of a prolonged COVID-19 pandemic situation. So, instead of, \"落井下石\", I would like to ask how we can remove as many rocks and pebbles so that our SIA can soar once again.
Mr Ong Ye Kung: This House has sat through many Budget speeches by Deputy Prime Minister Heng. And I recall him mentioning many, many times all the recovery packages and help that we are giving to the aviation sector; and companies such as SIA often benefit from the top tier of the support. So, indeed, we are doing whatever we can to help our national carrier.
As for increasing the number of flights, SIA make partly their own commercial decisions. I am sure they are listening to the Statement and they make their own assessment what are the flights they want to resume. They have announced they will resume up to 15% of their flights by the end of this year.
On the other hand, there are some flights, although the load factor is low, but they are flying anyway to maintain what they call Minimum Connectivity Network, because you have got to be present in those markets and be in touch with your customers. Even though demand is low, you just need to be there. It is just the nature of the business.
Also, from the Government's perspective, you will recall in March, Deputy Prime Minister Heng announced the Resilience Budget. And that includes the $350 million Enhanced Aviation Support Package and part of that package is to help SIA maintain this Minimum Connection Network because Singaporeans do need to go in and out – students, families and so on – and allow Singaporeans from overseas to come home.
So, even though load factor is low, we support SIA to continue these flights and also to mount cargo flights so that our supply chain is not affected. So, it is a combination – both because of Enhanced Aviation Support Package as well as SIA's own commercial decisions that it is increasing the number of flights.
Mr Speaker: The last clarification. Mr Sharael Taha.
Mr Sharael Taha (Pasir Ris-Punggol): Thank you, Speaker, Sir. I thank the Minister for making the Ministerial Statement.
Sir, I would like to stand in support of the controlled opening of air travel. And I just want to state that whatever that goes through air travel, that revenue goes through not only just SIA but goes through the ground-handling crew, goes through the guys at Changi Airport, goes through the taxi drivers, the Grab drivers and all the way till the monkeys at the Zoo, when we are looking at that revenue spend.
So, I agree that there is still air travel demand. In fact, in the industry – and I would like to declare that I work in the aerospace industry – as we are commissioning new equipment and new machinery, we are still asking from engineers from overseas to commission the machine and we need them to travel here to Singapore.
As for the environmental tax that was mooted earlier, I just want to declare that SIA has invested very heavily on new aircraft, such as the A350s and the 787 Dreamliner that by itself, contribute about 25% less CO2 emissions and the fuel consumption is only three to four litres per hundred kilometre travel of passengers.
So, with that, Minister, I just wanted to ask a supplementary question on this. Between SIA and CAG, is there any leverage that the two can have to reduce the cost for SIA's planes parking on the tarmac?
Mr Ong Ye Kung: Mr Speaker, Sir, I thank the Member for some useful information, although those are not questions.
CAG, SIA, CAAS and MOT will work closely together. I do not have the details but some of the fees and charges have been waived for this period in order to reduce costs. But it is not a lot and not significant compared to all the costs of operating an airline because the planes are involved, huge number of workforce and we want to retain them as much as we can to maintain core capabilities.
So, the overall fixed cost of maintaining SIA as a going concern, even when business is so far down, the cost is quite tremendous.
But we have a plan. We do what we can and this is a crucial period in the next few months. We hope by taking such steps, comprehensive, clear steps, no doubt there is a lot of uncertainty but the direction we want to go towards, what we can control and what we cannot control, we have a good sense of it. We will do our best to revive the air hub. We want to ensure that when there is a vaccine, when air travel recovers again, we are right there and we are able to hold on to our position as an aviation hub.
Mr Speaker: Order. End of Ministerial Statement. Introduction of Government Bill. Second Minister for Finance.
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[(proc text) recommendation of President signified; presented by the Second Minister for Finance (Mr Lawrence Wong); read the First time; to be read a Second time on the next available Sitting of Parliament, and to be printed. (proc text)]
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Time Limit for Minister's Speech","subTitle":"Suspension of Standing Orders","sectionType":"OS","content":"The Leader of the House (Ms Indranee Rajah): Mr Speaker, may I seek your consent and the general assent of Members present to move that the proceedings on the item under discussion be exempted from the provisions of Standing Order No 48(8) to remove the time limit in respect of Minister Edwin Tong's speech?
Mr Speaker: I give my consent. Does the Leader of the House have the general assent of the hon Members present to so move?
[(proc text) Hon Members indicated assent. (proc text)]
[(proc text) With the consent of Mr Speaker and the general assent of Members present, question put, and agreed to. (proc text)]
[(proc text) Resolved, that the proceedings on the item under discussion be exempted from the provisions of Standing Order 48(8) in respect of Minister Edwin Tong's speech. – [Ms Indranee Rajah.] (proc text)]
Mr Speaker: Second Minister for Law.
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The Second Minister for Law (Mr Edwin Tong Chun Fai): Mr Speaker, I beg to move, \"That the Bill be now read a Second time\".
Sir, this Bill is linked to the next Bill on our Order Paper, the Medical Registration (Amendment) Bill or the MRA Bill. With your permission, may I propose that the substantive debate on both these Bills takes place now. Members would be welcome to raise questions or express their views on both Bills during this debate and we will still have the formal Second Reading of the MRA Bill to ensure that procedural requirements are dealt with. However, this proposal is to allow for the substantive debate on both Bills to take place at the same time to allow for concerns on the related subject matter to be captured cogently in a single debate. Sir, with your leave.
Mr Speaker: Please proceed.
Mr Edwin Tong Chun Fai: Thank you. Mr Speaker, the practice of medicine revolves around the patient-doctor relationship. It is not exactly an equal relationship because the doctor has far more information and expertise than the patient. We call this information asymmetry in favour of the doctor. And that is why the patient-doctor relationship must be undergirded, supported and have its foundations in trust – trust between the patient and the doctor.
The patient has to be able to trust that the doctor is doing his best for him; and to the doctor, the interests of the patient must be paramount at all times.
Unfortunately, there will be instances where a doctor might fall short of what is expected of him and the doctor's conduct has to be looked at, and if necessary, sanctions might be imposed on the doctor.
In such a situation, a doctor has to be able to trust the system that regulates the medical profession. He has to be certain as to the standards by which he is to be judged, able to put faith in a system that will be fair, transparent and also produce consistent outcomes.
On this point, I would like to reiterate that we are in full agreement with the High Court Judges on several occasions who have pronounced the three main aims of a disciplinary system that regulates the ethical and professional behaviour of the medical profession. And they are: to uphold public interest – I think there really can be no doubt; second, to preserve and protect public confidence in the health system and the medical profession; and third, to achieve general deterrence in disciplinary outcomes such that other doctors are deterred from adopting unethical practices.
The importance of trust in both contexts cannot be overstated.
For patients, the quality of the doctor-patient relationship really has a direct impact on the quality of care and, of course, the outcome of care. Where that relationship is strong, then patients are more willing and more open to confide in the doctors, and that itself enhances the quality of the diagnosis and the quality of the outcomes. This in turn also allows the doctor freely to focus on the patient's needs, communicate information about the disease or condition and options for treatment honestly, openly and really without the spectre of having to look over his shoulders each time a patient walks into his clinic. This, in my view, enhances decision-making and outcomes for the patient.
For doctors, where the disciplinary system does not effectively and also consistently enforce the profession's standards, they face uncertainty and unnecessary stress. To cope with this, doctors may feel pressured to adopt defensive practices that they think will best protect themselves, not enhance the patient's outcome but protect themselves. And even in doing so, they might become less effective in serving the needs of their patients. We have seen and I will show later on in my speech some examples, both here in Singapore as well as elsewhere in the world of such practices proceeding and then undermining the quality of care given to patients.
Over time, these practices erode the trust of the patient and of course undermine the doctor-patient relationship.
Sir, to be clear, our medical profession is, and has been built on and is steeped in the finest tradition of looking after the patient first, doing what is best for the patient, putting their interests as paramount. That has not changed, and the high ethical standards that are found within the medical profession must be maintained and the patient must know that he receives the best possible treatment, each time and every time.
In recent years, however, the relationships of trust that underpin our healthcare eco-system has been called into question, following several well publicised medico-legal cases from the Singapore Medical Council or SMC Disciplinary Tribunals or DTs.
To give one example, Members will recall the case of Dr Lim Lian Arn, where the SMC DT had found Dr Lim guilty of failing to obtain informed consent from his patient. This was on the basis that he had failed to advise the patient on the risk of possible complications of a steroid injection, some of which subsequently manifested in the patient at hand. Dr Lim pleaded guilty to the charge and was fined the maximum of $100,000 by the DT.
Many doctors took the view that the sentence and conviction by the DT were unwarranted. It set an unreasonable standard as to how much information should be given to a patient in order to meet the standard and what that standard might itself be. And many doctors felt that even if there was a lapse in standard in this case, whether it was of sufficient gravamen so as to amount to professional misconduct.
Dr Lim's conviction was subsequently overturned on appeal to the Court of Three Judges, primarily on the basis that the disciplinary threshold of professional misconduct was not satisfied in that case. And in my view, rightly so. Questions arose as to whether this case ought even have gone to the DT in the first place, let alone result in a conviction with a sentence that attracted the highest possible fine under our legislation.
The Court observed that in Dr Lim's case, it was a \"one-off failing committed in the course of a routine procedure\", labelling the conviction in fairly strong words, a \"miscarriage of justice\". And that is a very serious indictment on the system.
The Chief Justice's observations in Dr Lim's case were correct and timely, and served to restore some faith in the outcomes, and of course, also in the system.
But members will also recall that shortly after Dr Lim's case, another decision by the SMC DT – this time, in Dr Soo Shuenn Chiang's case – gave rise to some further disquiet amongst the medical profession. This case also had to be subsequently overturned by the Court of Three Judges.
In the wake of these cases, there was a significant disquiet within the medical fraternity. Many doctors grew uncertain as to what might be required of them when they saw a patient, advised the patient, took informed consent as well as they had also serious concerns as to whether the rigour of the SMC system was sufficient to see through the cases to get a clear, consistent and certain outcome.
And whenever disciplinary outcomes diverge from well-established practices by doctors on patient care within the medical community, uncertainty follows. Doctors start to question their own judgement as to how much information is going to be enough to care for the patient, and there is the constant worry of whether this patient will make a complaint, and what will happen to the adjudication of that complaint.
This has damaged the doctor-patient relationship. And I should add the fact that the cases, particularly in those two that I have mentioned and others, have taken an extraordinarily long period of time to be dealt with from the time a complaint was first made, to when the DT resolved the case, has also added frustration, not just for doctors, but also to complainants. And this issue has arisen several times on several occasions over the last, I believe, at least a decade, before the Courts, resulting in many cases where the Courts have felt that they had to intervene to reduce the sentence on otherwise recalcitrant doctors. And that is also an indictment on the system.
Sir, we are already seeing the negative effects of this uncertainty and worry in the medical profession.
Let me just cite a peer reviewed study commissioned by the Singapore Medical Association and the College of Family Physicians Singapore. This was done in the period just after Dr Lim Lian Arn's case, the DT's decision. Doing a survey on the number of doctors who gave the same steroid injection, it showed that the number of doctors who were prepared to and continued to give that same steroid injection, the H&L injection, came down – the number of doctors reduced, while the median cost of these same injections increased.
So, fewer doctors were prepared to offer the treatment, and when they did, it became more expensive for the patient.
That is something done in Singapore on a procedure which most doctors would tell you is fairly routine. This study has demonstrated how the uncertainty engendered by these uncertainties, the medico-legal cases, the outcomes, has affected practice behaviour to the detriment of patients.
In addition, there are also accounts from the ground, from the doctors themselves, doctors whom we met – myself with my colleagues at MOH when I was there – with the work group that was appointed by MOH. We heard, for example, anecdotal accounts of doctors seeking to give patients voluminous amounts of information about all forms of possible risks from the textbooks and alternatives for the procedure, resulting in what the Courts regard as an \"information dump\" on the patient – a lot more information but really with a lot less understanding.
When the work group – that was appointed by MOH to review the taking of informed consent and to study the SMC disciplinary procedure – discussed the issue at many town halls – and there were many open town halls that took place, both in the private hospitals and in the public hospitals – there was a very clear, palpable sense that doctors grew uncertain of the standards that were expected of them. Many of them turned inwards. They were spending less time on patient-focused information and instead, providing information in a manner that they themselves judged would best absolve themselves of liability should the patient complain. The focus became very different.
The Court has – and the lawyers amongst us will know – on numerous occasions said that a doctor does not discharge his obligation to the patient by simply giving information without really trying to solicit understanding. That is not the way to take informed consent, but yet, we have seen numerous accounts of this take place.
Beyond our shores, the experiences of other jurisdictions also serve as a warning to what might come if we do not take steps to address these issues.
A 2017 study published in the British Medical Journal found that protracted disciplinary proceedings were associated with an increase in defensive medicine in the form of avoidance behaviour – the kind of behaviour that one might have seen after Lim Lian Arn's case, when fewer doctors were prepared to offer that treatment. This journal was published, taking sensing and surveying statistics from the same jurisdiction where the Montgomery test on informed consent was framed.
Sir, I should add also that these issues that we have just talked about are not novel issues. In 2001, Minister Shanmugam – at that time when he was a practising lawyer – gave the Singapore Medical Association or SMA Lecture that year entitled \"Testing the Bolam Test\". It was given at a time when there was a discussion after a landmark decision in the High Court about what the relevant standard of care ought to be when taking informed consent. That was in 2001. At that time, like now, the issue arose because of a judicial decision on how informed consent ought to be assessed.
In that lecture, it was assessed that an increase in the practice of defensive medicine leads to far poorer outcomes, with some of the negative effects being: (a) a rise in medical procedures which are not in the best interests of the patient – more investigation and more checks just to ensure that there could not be a suggestion that perhaps some other test ought to have been done for this patient; (b) rising insurance and hence medical costs – overall, an increase in cost to the detriment of patients and to society; (c) stress for doctors, which we have heard articulated to the work group on several occasions; and (d) finally, critically, an erosion of trust in the doctor-patient relationship.
These issues, almost two decades ago, are quite the same and also about what to do with the legal standard for informed consent. These are also the issues identified by the work group today and it is clear that there is an urgent need to now address these issues swiftly and also decisively.
Minister Gan Kim Yong made a Ministerial Statement in April last year outlining the steps that MOH would take to address these issues and one of them was to appoint a work group. He gave them a clean canvas and told them in these terms: to leave no stone unturned. Start from a blank canvas, go out and consult with as many as you can, take the time, study it, understand the concerns and make the recommendations.
The work group was appointed in March 2019. It comprised doctors from various disciplines and also looking at having the composition, came from across a spectrum of different seniority of doctors. It also included the heads of the major medical professional bodies. It also comprised lawyers with significant medico-legal experience as well as laypersons with expertise in various fields. It was chaired by a medical director of a national specialty centre as well as a senior counsel.
In formulating its recommendations, the work group consulted extensively with relevant stakeholders. They held about 40 town halls and engagement sessions. These engagements sought to understand the breadth and depth of concerns and issues with the taking of informed consent and with the SMC disciplinary procedure. They consulted more than 1,000 doctors of varying seniority from a range of diverse practices across the public and private healthcare settings. They went to see the SMC itself; past and present members of the Complaints Committee and the Disciplinary Tribunal; the medical professional bodies, of which there are three and they represent the vast majority of doctors in Singapore; patient advocacy groups to ensure that in scoping the test, one does not also ignore the interests of the patient, which is paramount, as I have mentioned; insurers, who have a relevant role to play in rising healthcare costs and in ensuring that we continue to maintain a cap on where these costs are going; and of course also the lawyers, both on the prosecution and on the defense side in medico-legal cases. It is a very, very broad and extensive range of sessions that they had.
The sessions were a very effective platform for the work group to listen to a wide range of views. What was obvious was that there was a consistent theme in the call for change, not just in relation to the prevailing legal and ethical requirements but really also in the manner in which the disciplinary process was being conducted. It was quite clear that there was an urgent need to restore trust in the system.
I would say to Members that the broad range and depth of the consultation itself by the work group lends weight to the observations and recommendations which they have made.
Starting from a clean canvas, the work group formulated preliminary recommendations from the early feedback they received. These were then re-presented back to the doctors in different town halls, the medical professional bodies and other groups, and the stakeholders for further views, fine-tuning and testing before they finalise those recommendations.
On 28 November 2019, the work group released its 100-page report setting out its final recommendations and also the background thinking to its recommendations and what it was proposing to do. The Government subsequently accepted the recommendations and the contents of the work group's report ought to be considered by Members when debating these two Bills that are before us.
Sir, before moving on from this topic, I would just like to thank the work group members, the many organisers of the engagement sessions and all of whom who have provided views and suggestions voluntarily. They really kept coming at town halls, meetings, through emails and even on social media. If you talk to the work group members, they will tell you that they really lived and breathed the topic for a good nine months before they produced the report.
Since accepting the work group's recommendations in December 2019, what have we done?
Before coming to the Parliament with these two Bills, we have already implemented some of the changes. Let me just quickly outline a few of them. Those that do not require legislative change – for example,\tthe enhanced training to ensure that there is quality of personnel across the spectrum of tribunals – has started. Internally, the SMC has devoted separate and additional resources to clear the existing backlog because Members will know that if and when this Bill is passed, this process and procedure will apply to new cases but not to the existing ones, which are to be resolved under the old regime.
In other aspects, such as the enhanced use of meditation, that has also been promoted to the extent possible, even within the current framework and rubric. For other changes, we have needed to come to the Parliament for legislative changes to provide for the establishment of the required structures and to reform the process and procedures. Sir, these changes are now reflected by way of amendments in the Civil Law Act and the Medical Registration Act.
We will also – apart from what the work group has recommended – propose to include some additional amendments, some related and some fresher ones, to enhance the workflow and to streamline and strengthen the disciplinary process. Some of these amendments arise from an earlier review of the SMC process that the SMC had itself commissioned independent of the commencement of the work by the work group.
Sir, the amendments to the Civil Law Act and the Medical Registration Act aim to achieve two broad objectives.
The first is to set a clear standard for healthcare professionals' duty in giving medical advice to their patients. On this, Members will note what I have said earlier about there being a lack of clarity. If the doctors themselves have that uncertainty, that lends itself to an outcome that is uncertain and in the longer term, leading to defensive practices. Secondly, to strengthen the medical disciplinary system through more effective enforcement of professional standards, more expeditious resolution of complaints and an increased transparency overall in the disciplinary process.
Clarity, certainty and consistency will be driving principles behind these amendments.
Sir, I will now highlight the key features of the Bill, starting with the Civil Law (Amendment) Bill.
This Bill seeks to legislate the standard of care that healthcare professionals have to meet in giving medical advice to their patients. For brevity, I will in this speech refer to this as the \"duty to advise\".
To understand the background and context to these amendments, it would be useful to quickly set out the current legal standard.
Prior to 2017, whether a doctor had met the requisite standard of care in the duty to advise or not was assessed by reference to the practices and opinions of a responsible body of his peers. This is called the \"responsible body of medical opinion\". Some might know it as the Bolam-Bolitho Test.
In 2017, the Court of Appeal pronounced the current legal standard for the doctor's duty to advise in the case of Hii Chii Kok v Ooi Peng Jin London Lucien. I will refer to this 2017 decision as the \"Hii Chii Kok test\".
Under the Hii Chii Kok test, a doctor's duty to advise requires that he disclose to a patient information that is relevant and material when giving the patient medical advice. The Court assesses what is relevant and material information from the perspective of the particular patient. The Hii Chii Kok Test was borne out of the observation that the Bolam-Bolitho Test did not sufficiently give effect to the principle of patient autonomy and that the previous test was regarded as too \"doctor-centric\".
While undoubtedly well-intentioned, this test in Hii Chii Kok has led to some uncertainty amongst doctors. The work group, in particular, found that many doctors perceived the Hii Chii Kok test as bringing in an element of variability and hence uncertainty as to what each patient might want to know, since what is relevant and material is said to be assessed from the patient's perspective.
Sir, I hasten to add that this is not necessarily an accurate reading of the test in Hii Chii Kok. The test in Hii Chii Kok seeks to strike a balance but the way in which it is articulated has given rise to these uncertainties.
At paragraph 13 of its report, the work group stated, \"While some doctors understand how the test is to be applied, many others have expressed confusion and anxiety about what exactly they are now required to do. Some doctors have even candidly admitted that they now practice defensively just to be sure.\"
The work group found that doctors became unsure of how to advise patients in a manner that meets the standard of care, especially so given the realities of practice where doctors see a large number of patients across a wide spectrum on a given day.
I would add that much of this is likely to be a perceived uncertainty, as I said earlier and as the work group has also found, but perceived or otherwise, this leads to a course of conduct to guard against that perception.
In the face of this perceived uncertainty, some doctors have started to adopt defensive practices. I mentioned some of these engagements earlier. In one such engagement, a senior consultant specialist in private practice shared that this doctor took as long as 30 minutes to explain a procedure to patients, not necessarily with the end outcome of ensuring that the patients would come away with it with more information or more understanding but really out of an abundance of caution. This doctor presented this view in a town hall that had close to 250 doctors present. It was quite a startling admission.
As the work group put it in their report, \"Patients are not necessarily better informed. On the contrary, we have received feedback that they are now increasingly inundated with information and are none the wiser.\"
Some doctors have become more reluctant to guide their patients’ decision-making, worrying that they may be accused of paternalism in doing so. Others, such as general practitioners – and we have heard one example earlier in the statistics – have decided not to offer certain treatments altogether. They opt to refer their patients to specialists instead, for fear of complaints being made against them.
All of these, as Members appreciate, are worrying developments. They threaten patient safety, they undermine the doctor-patient relationship, they make it less cost effective and overall, a weaker system for all.
Another subtle but perhaps understated state of affairs is that the current system is premised on a dichotomy that one has to choose: one has to be either patient-centric or doctor-centric, rendering the patient and doctor constantly pitted against one another in a zero-sum game.
Sir, it would be better to frame the legal test as one which coheres with a doctor and patient, jointly managing his or her medical outcome. One which acknowledges the reality that doctor and patient are, in fact, on the same side, working towards the same outcome: the good health and recovery of the patient. And striving to create an environment where doctors feel safe to give advice to allow a patient to make that judgement himself. But at the same time, creating an environment where the patient knows that he is entitled to ask any question he wants in that consultation, and the doctor has to give due regard to it.
After studying the work group’s recommendations, the Government accepted the recommendation to recalibrate the test for medical advice in the way in which I had outlined earlier.
On the one hand, this new test will strive to preserve the principle of patient autonomy as set out in Hii Chii Kok, by requiring healthcare professionals to give their patients the information they require to make an informed decision. So, for example, information about a procedure that a patient specifically asked for must be provided to the patient. And this is irrespective of whether some other patient might have wanted it or some other patient might have regarded it as material or otherwise.
This gives primacy to what might be of concern to the patient at hand – the patient in front of the doctor – recognising that no two patients and no two consultations are identical.
At the same time, however, the test will uphold the principle of self-regulation in the medical profession, by providing that regard should be had to what peer healthcare professionals say as to the appropriate standard of care in giving a patient information.
This is the peer review standard, which I had mentioned earlier. The Courts will continue to have oversight, by ensuring that the views of peer healthcare professionals pass muster when it comes to logic and reasonableness.
In concept, this is not a fundamental shift in direction – the underlying principles would be familiar to doctors, to lawyers alike and they are ones which are currently established in law.
However, we agree with the work group that the way in which the test is articulated best strikes the appropriate balance between the principles of self-regulation and patient autonomy.
Sir, before I go into the specific provisions, I would like to highlight that we are not alone in taking steps to codify the law in this area.
In Australia, the law of negligence, including its application to professionals such as healthcare professionals, had already departed from the English common law in some significant way in Rogers v Whitaker. It has been subsequently codified in various Australian states through legislation on civil liability, following a review on the law of negligence by an expert panel in 2002.
For example, Queensland’s Civil Liability Act and Victoria’s Victorian Wrongs Act prescribe a general standard of care for professionals. Section 21 of the Queensland statute, in particular, sets out the scope of a doctor’s duty to warn a patient of risks.
Sir, I will now take Members through the main features of the new statutory test.
The test provides that a healthcare professional will meet the standard of care in giving medical advice to a patient where two conditions are satisfied. This is set out in section 37(1). These two conditions are:
First, he acts in a manner which is accepted by the medical opinion of a respectable body of such healthcare professionals as reasonable professional practice in the circumstances. We call this, in short, the “peer professional opinion”.
Second, this peer professional opinion has to be logical, in that it has compared and weighed the risks and benefits of the conduct in question and arrived at a defensible conclusion that is internally consistent and does not ignore known medical facts – a formulation that I am sure that many in this House would be familiar with.
These two conditions incorporate the same legal principles that were used to assess healthcare professionals’ conduct using the Bolam-Bolitho Test.
To be clear, this does not change the burden of proof for civil claims in medical negligence. As before, a claimant patient continues to have the legal burden of proving that the healthcare professional has not met the standard of care in providing medical advice to him.
This statutory test also does not change the test for medical diagnosis and treatment, both of which continue to be governed by the existing legal test in the common law that is premised solely on peer professional opinion, that is, the Bolam-Bolitho test. This is since the principle of patient autonomy has a much smaller role to play in the arena of medical diagnosis and treatment, both of which remain largely within the domains of doctors.
The new test also prescribes the standard by which the peer professional opinion must assess the information given by healthcare professionals. To this, there are three limbs.
If Members can look at section 37(2), the first limb is set out in (2)(a)(i). The healthcare professional must give his patient information that a patient in the same circumstances, that is, a “typical” patient, would reasonably require to make an informed decision about whether to undergo a treatment or follow a particular piece of medical advice.
In the second limb, in section 37(2)(a)(ii), the healthcare professional must give his patient information that he knows or ought reasonably to know is material to that “specific” patient for the purpose of making the same informed decision as in the first limb.
So, section 37(2)(a)(i) provides for what you might do for a typical patient. That is judged by what the peers would regard as appropriate. The second limb requires the professional to also think about what might be material to this patient. Let me explain that a little bit more.
Material information falls into either of two categories, which are set out in section 37(3). First, if it relates to specific concerns or queries that the patient expressly communicates in relation to undergoing the treatment or on the medical advice. So, an express question or query or some discussion raised by the patient. That does not require any further elaboration. If a doctor is asked a specific question, that becomes something he has to explain.
Second, in the second limb in section 37(3)(b), where it relates to specific concerns or queries which the patient does not expressly communicate, but which ought to be apparent from the medical records of the patient which the healthcare professional has reasonable access to and ought reasonably to review. It is a bit of a mouthful, but let me explain why it is couched this way and to ensure that Members in this House understand it.
For the avoidance of doubt, any concerns expressly communicated by a patient have to be addressed. The work group was quite unanimous in the view that if it has been brought up expressly to the doctor, then the doctor has to address those queries.
In short, in that scenario, the patient can be assured that when he walks into a clinic and sees a doctor, there really are no “stupid questions”. Every question that this patient raises with this doctor, is a valid, relevant question that has to be addressed.
In relation to information that ought to be apparent from medical records, this is not intended to impose an obligation on healthcare professionals to review and go back into reviewing substantial volumes of medical records or voluminous medical history on the National Electronic Health Record or NEHR, in order to try and work out or ferret out what are the concerns or queries the patient might have. That is not the intention and clearly, that is not also provided for in the statute.
It is also not practical or feasible in practice. The litmus test is that of reasonableness – both in terms of what the healthcare professional has reasonable access to and also whether in the circumstance of the case, the discussion with the patient, the context in which the patient is seeing the doctor, whether that creates a scenario where the doctor ought to reasonably review these past records.
What is reasonable is a matter to be assessed in the context of each case and it is not possible to define upfront, at the start, all the categories, in a closed fashion, of information that will be regarded as reasonable or not reasonable. For instance, a factor that would go into the assessment of what is reasonable might well be the age of the medical records in question. So, it would not ordinarily appear to be reasonable for a healthcare professional to have to trawl through old microfilms and medical records going back 10 years, barring some exceptional circumstance.
And so, therefore, the older the medical records are, the less likely it would be that it would be reasonable to expect the healthcare professional to review them. But if there is an old medical record or an old investigation that is labelled, and you put a bright sticky tape on it and it is taped to the front of the file in an obvious way, and it makes some notes about this person's history from some years ago – perhaps an unusual investigation that has taken place or perhaps an allergy that would not be easily discerned from trawling through the files – then it would make it harder for that healthcare professional to say that that is something that he ought not look at in the context of this treatment.
Other relevant factors to the assessment would include what transpired during the discussion that the patient has had with the doctor and how the query or concern was characterised in the previous medical records. So, if something is mentioned in passing and does not feature prominently across the spectrum of the medical records, then it is less likely that it would be something that ought to be apparent to the doctor.
To enhance the understanding of how the provision operates, the Bill provides an illustration at section 37(3)(b) on when information that is not expressly communicated to the attending doctor will be considered material. The illustration of a patient undergoing a total knee reconstruction in that case is by no means intended to define or circumscribe what is “reasonable” in every case. It is just intended to give an example of what could or would satisfy the requirements of reasonableness in the illustration.
Sir, let me now move on to the third limb. The third limb, by contrast, addresses the other side of the equation; it asks whether there is reasonable justification on the part of the healthcare professional in situations where information is not given. This is in section 37(2)(b).
The Bill contains several illustrations in this regard. For example, there may be reasonable justification for not providing information in a situation of emergency or where a patient has waived his right of information by telling the healthcare professional that he does not want to be given information, and that can be established.
Whether there is a waiver is a matter of fact – sometimes of mixed fact and law – and the peer professional opinion can assist in the forensic analysis and weighing up of whether there has been such a waiver by the Judge or tribunal.
On the other hand, we are also making clear that a healthcare professional cannot simply refuse to provide information to his patient, merely because he thinks that providing a particular piece of medical advice or undergoing a treatment is in the best interests of his patient. In other words, you cannot make up your mind for the patient and then, decide, based on that end outcome, what information you will or will not tell the patient. That will not be reasonable justification.
Sir, if there are different peer professional opinions held by other respected healthcare professionals, then, each of these opinions can still be used, provided it satisfies that test of logic. If Members can look at section 37(4), this recognises that there may be diversity of views amongst healthcare professionals, all of which are in-principle equally valid for consideration. But, of course, for each of them to be logical, they have to cohere with the standards and pass the test of logic and reasonableness, in the manner which I have described earlier.
Finally, Sir, let me outline the scope of the new test.
Section 37(6) of the Bill provides that the test applies not only in respect of medical advice given to patients, but also medical advice given to a person who is responsible for making a decision about undergoing a treatment or following a particular piece of medical advice on behalf of someone else – that someone else being a patient who is otherwise, legally disabled.
A legally disabled person is someone who does not have the mental competence to make the decision for himself. For example, a parent would be responsible for making a decision on behalf of his infant child.
Second, the test applies to healthcare professionals. This is defined in section 37(7) of the Bill to mean an individual practicing a profession that provides medical advice. This includes doctors, dentists and oral health therapists, and is not an exhaustive list.
The scope is broad enough to include any individual who practices a profession that provides medical advice, or for which it can be shown that there exists peer professional opinion.
We appreciate, Sir, that, beyond the language and contours of the legislation itself, healthcare professionals will require detailed guidance on what is required from them under the new test in practice. We fully agree and we intend to provide such guidance, working with the professional bodies, also the SMC and the CMEP to do so.
For a start, we will be revising the Ethical Code and Ethical Guidelines or ECEG of both the Singapore Medical Council and Singapore Dental Council in respect of the issue of the taking of informed consent. That in fact, was something that the work group itself had proposed as a draft in its report and we will use that as a basis to start the revision of the ethical code and guidelines. There was in fact, a strong recommendation by the work group to do so to reduce the ECEG into basic core irreducible principles of professional conduct, and use that to gauge and guide doctors in terms of where that bright white line ought to be when it comes to the thresholds.
Steps will be taken to review and revise the SMC Ethical Code and Ethical Guidelines so that it is in-step with these latest proposed amendments both to the Civil Law Act as well as to the Medical Registration Act.
Sir, this new test for medical advice seeks to recalibrate, but not completely overhaul the standard of care for medical advice. We believe it endows it with more clarity and certainty. Healthcare professionals will also have the assurance that they will be evaluated on the basis of a peer who can assess and also contextualise the standard required to that of a clinical setting, which is important because as I have said, no two patients and no two consultations are identical.
At the same time, it maintains the high degree of patient autonomy that was present in the Hii Chii Kok test. And we strive to move away from a test that is described as patient-centric or a doctor-centric, but instead to one where we can say that it is really undergirded by patient empowerment. Patient autonomy and certainty in the medico-legal climate for doctors cannot be mutually exclusive ideals. They can exist in a virtuous cycle and in the process, build more trust into the patient-doctor relationship. And that ultimately, is the overriding objective of designing this test and adopting it in a way in which I have just outlined.
Sir, I will now move on to key features of the second Bill – the Medical Registration (Amendment) Bill, which amends the Medical Registration Act.
Broadly, these amendments seek to strengthen the system, make it more robust, and deal with as many of the problems that have been identified in the cases that I have outlined and also beyond that. This is the second slate of amendments that we are proposing, arising out also of the work group's recommendations.
Sir, I think it cannot be gain said that it is really of utmost importance that the medical disciplinary system functions efficiently, effectively and fairly. Both doctors and the public alike must trust in this outcome, know that it will be independent and transparent and also be able to enforce standards that are fair and consistent.
If this system falls short, it undermines confidence and in turn, will affect doctors’ practices and erode trust, in the way I have outlined.
The amendments in this Bill are quite substantial and I do not propose to cover every clause, probably to your relief, Sir. But I would add, Sir, that it is not a silver bullet. You cannot look at the provisions in and of itself, and so, we would like Members to look at these amendments as a collective whole. Because you cannot just change the process or you cannot just impose a time discipline or you cannot just say enhance training. They have got to be all taken into account together.
The amendments that we seek to introduce broadly strive towards four objectives, which I will organise my speech around and then highlight the salient clauses in relation to each of these objectives to Members. The four objectives are: firstly, to improve the quality and consistency of processes and outcomes in the system; second, to reduce delays and facilitate a more expeditious resolution of complaints; third, to protect patients more effectively; and fourth, to encourage as far as possible, the amicable resolution of complaints and facilitate a less adversarial disciplinary process in the appropriate cases between patients and doctors.
Sir, I will first address the change that we seek to make to improve the quality of the process and outcomes. When the disciplinary system does not effectively enforce the profession's standards, doctors are faced with uncertainty and unnecessary stress. In these cases, the patient-doctor relationship is sometimes supplanted by the plaintiff-doctor relationship.
We seek to introduce a number of changes to enhance the structure and to give more robustness to the disciplinary framework.
First, to further improve the quality of processes and outcomes, the new section 57 provides for the appointment by the Minister of an independent body to be known as the Disciplinary Commission or DC. This will be a body that is separate from the SMC, headed by a senior doctor as President.
It is envisaged that the President will be a full-time appointment. The DC will have a dedicated secretariat that will exclusively support its functions and it will have two key mandates. It will be responsible for constituting the DTs in each of the cases. It will set up the DTs and ensure the personnel is appropriate for the DTs. This is in place of the current SMC, which through its secretariat, assists in setting up the DT.
This addresses concerns about the independence of the DTs from the SMC. Currently, the DT is independent of the SMC which also acts on behalf of the complainant as the prosecutor. However, there is a continuing perception of the lack of independence simply because the SMC appoints the DT and also has a prosecution arm looking after the complaints of the complainant and framing the charges against the doctor.
This is ostensibly because as I said, they appoint the DT, but the reality is that it is not suggested that the DT is influenced in any way by the SMC. But nonetheless, this perception is a troubling one, with the potential to undermine confidence. We want the impartiality to be not just real but to be seen, to be obviously separate.
We are not starting from a clean slate as it were in this case as we looked at their practices in other countries, other jurisdictions, and the one that is fairly close to what we are proposing is found in the United Kingdom. In the UK, the General Medical Council, which is the equivalent of the SMC, established their Medical Practitioners Tribunal Service in 2012, and the purpose of this was, amongst other things, to provide a clear separation between a GMC's investigation functions and the adjudication of hearings, which is similar to what we are proposing here.
With the DC, it will be responsible for the setting up of the DTs to hear the cases as tribunal and the SMC will continue with the function of preferring the charges and prosecuting the charges on behalf of the complainants.
The DC’s second key mandate is to oversee the training of members of the Complaints Panel and the Health Committee, and ensure that they are appropriately trained to carry out their roles in the various committees. This addresses various feedback both from members of the CCs and DTs and also from doctors in the town halls that we need to increase and uphold the standards of doctors who sit in these tribunals. Many of them are experienced doctors, but sometimes marrying the experience as doctors to a process that has a fairly strong legal slant to it may not always make for a good match.
Other than providing for this, training, regular and systemic training will also help them to carry out their duties better. And that is something that the DC will oversee to ensure that the various disciplinary committees are staffed by well-trained, up-to-date and competent members.
As a step to ensuring consistency in processes and outcomes, we are proposing that a legal professional is required to sit on each DT. The new section 58(1) provides that individual DTs will now comprise two doctors and one legal professional. Previously, DTs were constituted in various permutations, and it was not obligatory to have a legal professional sit in one of these tribunals, but our view is that having an experienced legal professional on the DT will bring greater legal and forensic expertise to the DTs' deliberations and determinations.
In addition, the quasi-judicial nature of DT hearings means that they also invariably require the consideration and application of legal concepts and forensic analysis, such as the application of the standard of proof and assessing the weight and relevance of evidence.
In some of the more difficult cases, the key issues may also be more legal rather than medical in nature. In addition, having a legally trained member sit on the DT will assist the DT in preparing his decisions, ensuring that they are legally sound and structured and also ensure that there is a consistent body of decisions to guide future DTs in their decision making.
In some cases where the DC President might regard as being more complex or novel or perhaps raise novel issues of law, they may be more appropriately directed to a serving Judge or Judicial Commissioner of the Supreme Court. The new section 59 provides a mechanism for the President of the DC in those cases, to apply to the Chief Justice for permission for a Judge or a Judicial Commissioner of the Supreme Court to chair the DT in those cases.
So, there is an opening or option in section 59 for the President of the DC to decide on a case being more complex and inviting the Chief Justice to nominate a Judge or a JC to sit as a Chairman of that particular DT.
Sir, I should make it clear that with this proposal, we still continue to maintain the principle of self-regulation by the medical profession. The legal professional will not necessarily be the chairman of the DT and further, a serving Judge or JC will only chair cases where the President of the DC feels that it is appropriate to do so, and the decisions of the DT will still be determined by majority vote. Even in a case where a Judge or JC sits as a Chairman, that person cannot on his or her own override the opinion of two doctors if both doctors agree with each other.
Sir, on this note, I should also highlight that the SMC appointed a Sentencing Guidelines Committee in January 2019 to look at and to draw up sentencing guidelines for DTs to ensure uniformity, consistency and to ensure that the DTs pay sufficient regard to the relevant factors when deciding on an appropriate sentence.
The committee has completed its work and the SMC published these guidelines in July 2020. These will complement the current amendments to facilitate fair, consistent decision making by the DT.
The next change we are proposing is to introduce greater legal support throughout the system. This is to strive to improve the quality of decision making at every level of the process. For this purpose, the SMC will be establishing a legal advisory and prosecution unit. The advisory arm of this unit will advise the disciplinary committees in their disciplinary framework and ensure that they have access to legal support that they require to perform the functions, and this in turns facilitates clarity on the applicable standards, how the charges might be preferred, what kind of legal standards will apply and so on.
The prosecution arm of the new unit will undertake prosecutions for the SMC; a topic that I will return to later. While the creation of the new Legal Advisory and Prosecution Unit does not in itself require legislative amendment and will be effected by the SMC administratively, I thought to highlight this to Members as they reflect an important part of the structural changes being made. So later on, when I deal with the IC and the RC, Members should also recall that the legal unit does sit and is present to assist the IC at the outset.
The moment a case is referred to the IC, the IC gets legal support to assess the case, to assess whether it is vexatious or frivolous and whether or not it meets the required threshold for professional misconduct.
Next Sir, the amendment will also provide that it is the SMC rather than the CC which will determine whether a matter is referred to the DT or not. Currently, the MRA requires the SMC to appoint a DT if the CC determines that a formal inquiry by the DT is necessary. So, a typical CC will be appointed; it will be a three member CC and if the CC, after deciding that it needs to be sent to the DT, currently the SMC has got no role to play in that process and the matter goes to the DT.
And that is the case even if the SMC might otherwise disagree with the view of the CC.\tDuring the work group's consultations, both the SMC as well as the medical community felt that the SMC should play a more proactive role in ensuring that it is aware of the outcomes of complaints and that there is also a more consistent and uniform filter that the SMC can play before it goes to the DT.
The medical community feels that the SMC as a whole, has to take ownership and oversight of handling of complaints and not just delegate this to a CC. To this end, the SMC will be responsible for the ultimate decision as to whether a matter will be referred to the DT or not. And we believe that the collective wisdom of the SMC in reviewing the CC's decision will also act as a check to ensure that the threshold for professional misconduct is met or at least met in a prima facie way before the matter is referred to the DT.
The new section 46(6) provides that the CC will now make recommendations to the SMC as to whether there should be a formal inquiry by a DT. If a CC recommends a formal inquiry by the DT, it will also have to formulate the charges and give its reasons for recommending the referral of the complaint to a DT. This provides for a more seamless transition. At present, the moment the CC recommends that the matter should be heard by the DT, it finishes its functions. It passes the matter on and then a new team, almost, takes over. Here, once the CC has decided, it states its reasons and it will also at least formulate the charges, if not fully, as least in draft, so that the DT or the prosecution at that stage, will know the thinking of the CC and know what were the considerations by the CC in referring the matter to the DT.
On the other hand, if the SMC determines after the recommendation by the CC, that the case should not proceed to a formal inquiry then under section 46(7), it must inform the parties of its determination and the reasons for this. So, the fact that it has decided not to take up the CC's recommendation and also its reasons for not doing so. It may also take a range of alternative actions such as issuing letters of advice, or warning; or perhaps directing the doctor to seek and undergo medical or psychiatric treatment or counselling in the appropriate cases.
The decision of the SMC as to whether to refer a case to the DT will be final. This is also in line with what is currently the system with the Law Society, a similar system where the Council of the Law Society makes the final decision on whether to take further action in relation to a complaint after it receives the recommendations from the Inquiry Committee or IC in this case, which is the Law Society's equivalent of the CC.
Sir, in this regard, we are also making clear the standard for referral of a case to the DT, which is not currently provided for in the MRA. Section 46(2) provides that it must be a case where there is a cause of sufficient gravity for formal inquiry. We wanted to do this to ensure that there is at least a gate or a threshold before the matter is referred to the DT and the relevant members of both the CC and the SMC apply their minds to the standards that have to be established.
Sir, in assessing whether the threshold is satisfied, the CC and SMC should engage in the three-stage inquiry that the Court of Three Judges set out in Lim Lian Arn. I do not need to repeat that here, but those will be the criteria and we would require the SMC members to have regard to that pronouncement in making the assessment.
The amendments to provide for the SMC to determine if a DT to be appointed as well as prescribing the standards for referral, overall, we believe would allow for greater consistency of cases and also an overall uniformity of standards to be applied. So that as far as possible, whilst I have said, no two cases are alike, but the gravamen between the cases should result in a similar outcome in terms of the disciplinary process.
Sir, I move on next to look at the amendments to facilitate a more expeditious resolution of complaints. Sir, I think Members know that that has been one of the chief complaints about the system that has taken too long; that between the time a complaint is lodged until it is resolved, can be five, six, seven years in some cases; in the case where a doctor is found ultimately not liable, not guilty, it is a real strain on the doctor and a real stress on the doctor; in a case where the patient is successful and the doctor is found liable for professional misconduct, then the question will be – why is it that for the last six, seven years, this doctor has been practising and what has been done to protect the patient's interest.
All of these issues do arise and what we have done is to look at some very specific measures to ensure that it is more expeditious. Overall, Members will know from the Bill that there is an overarching timeline that applies to the conduct of the case. I am not going to go into the specific timelines, but at each stage there is a timeline, there is some provision for extensions beyond certain number of extensions, the relevant committees will have to go to the High Court to make a case for that extension. And we believe that that is the really the best way of driving this forward in a fair way. On our estimate, on an average case, it would take something like a year and a half, 18 to about 20, 22 months for a case to be resolved and we believe that that is sufficiently reasonable time for the cases to be adequately disposed of. But of course, in the cases, which are more complex, require more time and more investigations, parties can apply to Court and justify that.
I will just quickly outline the measures that we have set up in the Bill to address the delays.
They are first, an early notification to a doctor that a complaint has been filed. Currently, part of the problem is the doctors do not always know immediately and sometimes it takes months, if not a year, before the doctor is aware that a complaint has been made.
Second, we strive to increase the pool of Complaints Panel members because the Complaints Panel really is the bottleneck. If the Complaints Panel is more well resourced, better staffed, then these cases can proceed more expeditiously and they enable disciplinary committees to be constituted more quickly.
Third, introducing a time limit – time limitation period for complaints. This is also similar to what is done in the Law Society to ensure that very stale complains do not get refreshed, really to ensure that there is also fairness in terms of having the doctors maintain his or her notes and the evidence and the quality of the evidence does not diminish if the complaint is an old one. There are provisions for exceptions to be made in cases where patients are unable to or did not know they can still seek leave, justify that and complaints can still be brought despite the time bar.
Fourth, we have created, as I mentioned just now, levers to control both individual stages of the proceedings as well as the overall length of time that the complaint takes to be resolved.
There are just two areas which are relatively new and I just want to spend a bit more time on them, to explain this to Members. The first is the Inquiry Committee. We have proposed a new filter mechanism up front, to help to sieve out unmeritorious complaints at an early stage. To give Members some idea of the thinking behind this, I will just give you some of the numbers that we have.
Since 2010, in other words, for the past decade or so, the SMC has received an average of about 165 complaints every year. Quite a significant percentage of these complaints are eventually found to be of no merit, either because they did not pass muster in terms of the standards; or the facts were found to be of a different sort than what was advanced by the patient; or it was otherwise vexatious in a sense that it was a repeat complaint; or a complaint that has been dredged up when it has already been resolved and so on.
Each such complaint takes up considerable resources to manage, which will be better utilised for more deserving cases where the complaint actually has a good basis. And on our rough numbers, roughly about 10% of these complaints make it to the DT every year. So, roughly about 16 to 18 cases make it to the DT. There is a fair number of cases that do not end up in the DT. The thinking behind having the IC is to have more resources upfront to evaluate these cases better, early, and direct more attention to them and dispose of them where possible upfront. Because as one can imagine, if you have the full 165 cases travel through the system, it will create a lot more strain on the resources and it will take a lot more time for each of the cases to be resolved. So, having more specialised and dedicated resources upfront, will play in our view, a significant role in filtering out the cases appropriate either for resolution, early resolution, or perhaps channelling into mediation and then only allowing those that require investigation or have merit in the substance of the complaint to proceed.
Sir, some complainants may not necessarily have all the information at hand at the time they make the complaint. This rule is not designed to shut them out because we do know, on one hand, that making a complaint is a serious matter and complainants are expected to substantiate the allegations. At the same time, complaints will not be dismissed out of head simply because they do not have the requisite level of information or the level of detail that is needed. In the appropriate cases, the IC will also direct that this will be either investigated further, or for the complaints committee to take it up.
In any event, if the complaint is dismissed, the IC will be required to give its reasons for the decision. This is under the new section 43(3)(a). It is the SMC's practice currently to inform complainants of the outcome of the complaints. This will continue to be the case even after the amendments come into force and the complainants will of course be informed if an IC dismisses their complaint along with the reasons for that dismissal.
Sir, there are new powers in section 43(3)(b)(ii) and 43(3)(c), which give the IC the power to direct the investigations commence upon referral to the CC without having to wait for the CC to be appointed. Sir, this is really just to close the gap between the two committees, so that at the time when one is handed over, straightaway, the investigation unit is empowered to commence investigations, take statements, take documents and really be in a position to be ready, once the CC steps in and is constituted. Once the CC is appointed, it then takes over and assumes oversight of those investigations.
Similar to the Review Committee of the Legal Profession Act or LPA, which some Members might be familiar with, there is no right of appeal from the IC's decision to another committee in the disciplinary process or to a Court. However, this does not preclude judicial review which is present and that is governed by general law.
Sir, there was some feedback during the work groups consultations as to whether or not this additional layer was necessary. Some might think that the CC could play this function and do this filter role. For the reasons I have set out earlier, as to why allowing these cases to be resolved earlier rather than to have them channel through the system, take up committee time, investigation resources, it is for that reason that we propose to have a filter up front and staffed better, more resource and also in tandem with the legal advisory unit that I mentioned earlier.
I just want to also mention to Members that the creation of the IC also parallels the Legal Profession Act which has a similar filtering committee and I think it is called the Review Committee.
Next, let me talk about the Review Committee or RC. It is a new creation; that is why I will spend some time on this. The Review Committee reviews the decisions of the CC except decisions to refer the complaint for a formal inquiry. This replaces the current appeals process whereby appeals against such decisions of CCs are made to the Minister for Health.
There is some feedback that the existing process for appeals was either not transparent or was slow; and sometimes unclear as to what the considerations were; and sometimes new evidence was let in, in those cases which then led to the process being derailed. The new sections 54, 55 and 56 provide for the appointment of the RC to consider requests made by the complainant doctor or the SMC against the CC.
I hasten to add that this RC is not intended to be a second CC and so the scope will be limited to two specific instances: First, whether or not there has been due process. So, it looks at the CC and evaluates it from the position of whether due process has been complied with. Second, to assess whether any new evidence has been submitted to an RC and if so, why and it will consider whether the new evidence is material to the complaint or to the outcome, as the case may be. The RC proceeds by majority and can make the orders such as stating that the CC has compiled with the procedural requirements, or it may direct the CC to conduct further investigations or inquiry.
Sir, I move very quickly to the third broad basket of changes, that is to protect the patients more effectively and just very briefly set out some of the provisions in the interest of time for Members.
First, we seek to empower the IC and the CC to obtain relevant documents and information for the purposes of their inquiries. I think it can brook no dissent that the relevant investigative arms of this process must be clothed with the power to obtain documents, take information as quickly as possible. So, the new sections 43(2) and 45(5) provide for that.
Second, we seek to also provide that the investigator can look into wrongdoings not covered by the complaint. It is something that we considered for some time because there are two schools of thought. One, if it is not contained in the four corners of the complaint, then why should the investigation start to look into this? On the other hand, it may be a related matter, one which would be a matter of interest and in the current rules, you would have to restart the process just to look into that.
So, in the end, it was decided that, to the extent that it is in respect of the same doctor or another doctor, the mechanism that is set out is in section 50, subsection 6 and 7 will apply, and the SMC may, on the basis of the report made by the investigator who has looked into these matters, file a new complaint against the doctor. So, you can investigate it at the same time, file a new complaint and I believe this is an improvement over the current process.
Next, allowing for interim orders to be issued more expediently in appropriate cases. This is also a new provision. It seeks to introduce a framework for the Interim Orders Committee (IOC). We provided for the IOC to be constituted more expediently and to act more quickly in circumstances where there is an imminent threat to the health or safety of doctors' patients. Let me very quickly outline the main changes.
Under the current MRA, the referrals to the IOC are made by the Chairman of the Complaints Panel. The SMC does not have power to refer complaints to the IOC on its own accord and the effect of this is that where the SMC learns of matters which might warrant a referral to the IOC, it is reliant on the Chairman of the Complaints Panel to do so, and we regard this as less than ideal. The new section 59J(4) will, therefore, give the SMC power to do so on its own motion.
Under the current MRA, the doctor must be heard at an IOC hearing in all cases before the order is made. So, with the best of intentions, sometimes, these hearings will take place weeks, if not months, after the referral is first made, for a number of reasons, not necessarily because of an intention to delay. The new section 59K provides that an IOC can make an interim order immediately, without first giving the doctor the right to be heard in certain exceptional situations. And these situations are limited to two types.
First, where a Court of law in Singapore has found that a doctor has engaged in conduct alleged in the complaint or information and the conduct poses an imminent danger to the health or safety of any of the doctor's patients. So, a finding of this has been made by a Court in Singapore and the SMC is of the view that this doctor's continued practice would pose an imminent danger to his patients.
Second, where the SMC is of the opinion that such conduct poses an imminent danger to the health or safety of any of the doctor's patients. So, the thresholds are high, but we regard this as being in the interest of patient safety and public interest.
In situations where such an interim order is made, the IOC must then convene the hearing within one month where the doctor will then be heard on his position and the interim order can then either be revoked or it can be replaced, as the case may be.
If the hearing is not able to be convened within the month, then the immediate interim order will lapse. So, this also seeks to preserve the balance between the SMC and the doctor's livelihood.
Sir, let me now move on to some other related revisions and then wrap up this afternoon's speech.
Sir, we are also making changes to the composition of the SMC. This is to ensure a greater diversity of representation and views. The SMC is the paramount body that regulates and also represents the medical community, and it is important that its composition reflects the range of views amongst the different groups and also the different range of seniorities in the medical profession. So, the amended section 4 makes two key changes to the composition of the SMC.
First, the major medical professional bodies will now be represented on the SMC. So, these are the Academy of Medicine Singapore, the College of Family Physicians Singapore and the Singapore Medical Association. They will be represented by their respective Master or Presidents, as the case may be, or by a member of their respective councils, as nominated by the President or the Master.
Second, there will now be one instead of two representatives from each medical school in Singapore. This could be the Dean or his representative. As the leaders of the major medical professional bodies are elected into their roles, the elected membership in the SMC will, in effect, be increased from 12 up to 15 members whilst the appointed membership will be changed from 15 to 12 members. In the same vein, the amended section 8 reduces the minimum years of standing required for a doctor to serve on the SMC from 10 years to eight years and a similar amendment has been made to the years of standing to allow a doctor to serve as a member on the Complaints Panel. We hope that this will encourage younger and also more doctors to step forward and serve on the SMC and on the Complaints Panel.
Finally, I have mentioned the increased and enhanced use of mediation at the outset. We have set out some provisions which allow for this and, in the interest of time, I will not go into that but to ask members to look at section 47 which empowers the IC to refer a complaint to mediation during its inquiry; this section similarly empowers the CC also to do so.
If the parties are participating in the mediation, obviously, if you are in the middle of a mediation, you do not want to have also a disciplinary inquiry. So, the IC or the CC may, having regard to the progress of the mediation, suspend the inquiry. We will work with institutions, like the Singapore Mediation Centre, to provide the relevant expertise and also infrastructural settings to achieve better outcomes through the use of well-trained, highly qualified mediators.
There will be a reporting obligation for mediators who will report to the IC and CC to ensure that one keeps an even keel on the progress of the mediation and it is not used as an excuse to dislodge or disrupt the timetable for the conduct of the disciplinary proceedings.
Sir, before I conclude, I just want to go back to a point I made earlier about the Legal Advisory and Prosecution Unit. I talked about it earlier. To recap, it is the advisory arm of the new unit that will advise the various committees. But there will also be a prosecution arm of that new unit and this will conduct prosecutions on behalf of the SMC. When that work group canvassed views, particularly from doctors, there were some who expressed the concern that the use of private law firms for prosecution may sometimes result in a \"I must get a conviction at all costs\" kind of approach and that is not the case. But it is also not healthy that there is that impression.
On the other hand, a dedicated in-house prosecution team, residing within the SMC under the new unit, will help SMC to strengthen its own capabilities. It will aggregate the cases, build up experience to be able to handle prosecutions and to have, residing within the SMC, institutional knowledge and the collective wisdom of what it would take to prosecute these cases. This, itself, will lend consistency across the spectrum as to how a charge might be framed and the factors to be taken into account in mitigation or aggravation as the case may be.
Sir, I believe I have covered most of the key recommendations. As I have mentioned to Members, these have all to be taken together. You have to look at it in its totality and I have not gone through every clause in detail.
Mr Speaker: Thankfully.
Mr Edwin Tong Chun Fai: Yes, Sir. [Laughter.]
But I just want to end by saying that these reforms are significant. They reflect a very strong ground sentiment, both by doctors and patients, and the extensive work of the work group in consulting over so many months – the number of doctors they have seen, the number of patients the advocacy groups have seen. They have also touched on stakeholders – insurers, lawyers, practitioners. They represent a very strong sense of what the industry – the legal, medical fraternity – wants to see. And many of these amendments that we have made here reflect that sentiment.
It remains only for me to thank the work group members. I also want to record my appreciation to the members of the three professional bodies. They have been very supportive of our efforts. They also have people sitting on the work group and they have also recorded their agreement and support for the changes reflected in this Bill. Sir, with that, I beg to move. [Applause.]
[(proc text) Question proposed. (proc text)]
Mr Pritam Singh (Aljunied): Mr. Speaker, the Workers' Party supports both Bills. I will speak on the Civil Law (Amendment) Bill and my colleague, Mr Leon Perera, will speak on the amendments to the Medical Registration (Amendment) Bill.
For my speech, I will focus on the promulgation of the standard of care for medical advice in the proposed section 37, which I will refer to as the section 37 test, and the work group report on which the section 37 test is based.
I will speak on three points. First, there are many positives about the Bill and the work group report. Second, there remains some residual concerns about the section 37 test, which I will go into. Thirdly, I will make a point about the importance of an eye needing to be kept on the future.
Mr Speaker, first, the positives about the Bill and the work group report. I wish to thank the work group for its fine work and well-written report. The work group was set up in March 2019, as the Minister shared, and, by November, it had submitted its comprehensive report which contained 29 recommendations.
I have sought feedback from some doctors on the Bill. One consistent feedback that was shared almost unanimously was that the feedback from doctors on the systemic issues surrounding both informed consent and the SMC disciplinary process was taken very seriously by the work group and the Ministry respectively. As one doctor put it, and I quote: \"The work group report succinctly captures the sentiment of doctors.\" When I read the feedback given by doctors in the report, it was refreshing to read what came across in an unvarnished yet professional way. To this end, the doctors and others who came forward to give feedback are also to be acknowledged and thanked.
The section 37 test, which is the subject of the Bill, appears to be a deliberate clarification of the common law modified Montgomery test that it manifestly takes into account peer professional opinion. In that way, the section 37 test combines the previous Bolam-Bolitho test with the modified Montgomery test.
Some doctors have said that the amendment is well thought out and would be welcomed by the medical community. It would go some way towards mitigating defensive medicine which, as we know, increases healthcare costs without necessarily improving medical outcomes.
Overall, the work group report and the section 37 test are significant steps in the right direction. The work group itself recommends further steps, including Recommendation 3, the development of nationally agreed speciality specific and situational guidelines to deal with standard commonplace procedures in each speciality. I am sure this House and the public look forward to the speedy publication of those guidelines as well.
Mr Speaker, this brings me to my second point, which is the concerns that yet persist in view of the proposed section 37 test.
The first query concerns how the proposed section 37 will be applied in Singapore Medical Council or SMC disciplinary cases going forward. Its application to future civil proceedings covering medical negligence is not in doubt. However, in light of the work group report’s recommendations to amend the SMC Ethical Code and Ethical Guidelines or ECEG on informed consent, as detailed in Annex F of the work group’s report, how will the proposed section 37 interface with SMC disciplinary proceedings where a doctor is deemed to meet the threshold of the “serious negligence” limb of professional misconduct? Prima facie, it ought to follow that the section 37 test would apply. To this end, and in view of the High Court’s judgment in Lim Lian Arn on the correct understanding of the ECEG with respect to professional misconduct, clarification by the Minister on this point would be helpful.
Mr Speaker, a few doctors have shared the following concerns about their professional experience should the amendments come into force.
One is the difficulties faced by doctors who have a limited time with patients. The work group report in Annex C sets out the feedback received from doctors on informed consent. Among other points, doctors gave feedback that, and I quote: “Thorough consent-taking is not possible in every setting, especially in the polyclinics. Doctors may be burdened with other onerous administrative duties and have heavy caseloads. They are simply not afforded enough time to build a relationship with the patient.” This feedback was given in relation to the perceived impracticality of satisfying all the requirements of the Modified Montgomery test.
The concern with the section 37 test is that it does not seem to solve this issue raised in the feedback. As the section 37 test still requires the idiosyncrasies of patients to be taken into account, it may still remain very difficult to take consent thoroughly in a polyclinic setting.
Even as the Government is ramping up the building of new polyclinics in anticipation of higher caseloads and a growing population of seniors, my understanding is that there are potentially a large number of patients, and each outpatient consultation is ordinarily scheduled for around roughly 10 minutes. In that time, the doctor has to gather the patient's history, examine him or her, discuss treatment options and refer the matter to a specialist or as appropriate.
In addition, the doctor has to comply with the section 37 test when it comes into force. Not only does the doctor have to answer queries from the patient, as provided in sub-section 3(a) which can already take up time, sub-section 3(b) requires that even if the patient does not ask, the doctor must assess whether any information is material to the patient when reviewing the patient's medical records. And it is unclear from section 37 how far back the doctor should look, after all the records of an elderly patients can go back decades – although I note Minister's point about reasonableness in his Second Reading speech.
The only statutory illustration provided for in sub-section 3(b) concerns knee replacement surgery which is a major procedure done by orthopaedic specialists and for which a doctor will certainly have more time for consultation. But based on this sole illustration, a doctor working in a polyclinic and even a general practitioner in private practice may be hard pressed to know what is practically expected of them in dealing with large number of patients with short consultation times. Increasing the consultation time is not a practical solution because it comes with costs too, in terms of higher waiting times, higher consultation fees in proportion to the times spent and even stress on doctors.
Another concern that some doctors raised over the section 37 test to me is the difficulties that may arise when multiple doctors are involved in the patient's care, also known as team management, especially in large public hospitals. The patient may have many concerns documented by different doctors of varied specialties over a period of time. If a doctor who finally takes the consent inadvertently does not address one of the possible risks, especially one that is outside his or her speciality, would it be fair to hold this against him or her?
This is similar to one of the points raised by doctors to the work group and I quote, \"Practitioners face an inordinate number of challenges in getting proper informed consent in team settings. This is partly due to restrictions of time, exigencies of service, operational efficiency and the lack of familiarity with patients\". Although this concern was raised to the work group, there are no illustrations in section 37 to guide doctors in team settings.
May I ask the Minister for his response to these concerns. Also, may I request that the Minister consider more illustrations to interpret section 37 for better guidance, especially for doctors in polyclinic settings with limited consultation time and for doctors who work in team settings. Alternatively, or preferably in addition, could clear guidelines be issued by MOH as to how exactly doctors should practise in light of these constraints?
The section 37 test carries potentially serious consequences for doctors who are found not to be in compliance. It would not be ideal or helpful if the application of section 37 test raises doubts that can only be properly clarified in test cases. Because it is not only doctors who will suffer the consequences. All of us tend to lose if defensive medicine is practised due to uncertainty, whether in terms of over-treatment and the associated higher costs, longer waiting times, higher taxes or poorer healthcare outcomes.
Mr Speaker, my short third point is that we need to keep an eye on the future. In line with this, I would also make another suggestion which was given to me in feedback by a doctor and that is to have a mandatory review perhaps in two or three years' time on how the section 37 test and the new disciplinary process have worked in practice.
I would suggest that the Government review the issue of informed consent more frequently in light of the rapid changes in medicine, including the use of telemedicine and artificial intelligence-assisted medicine.
More fundamentally, regular reviews would be consistent with the evolution of medical care in Singapore, where individual rights and patient autonomy continue to move centre stage and reflect the current and future realities of medical practice.
The prospect of the doubling of the elderly population by 2030 and by extension more complicated or multiple medical conditions from a patient requiring overlapping advice and consultation may well be a harbinger for increased misunderstanding between patients and doctors. In our multicultural local setting, added complications could arise in view of potential language barriers in some cases.
Mr Speaker, those are my three points for today. First, the positives surrounding the work group Report and proposed Bill; second, the residual concerns about the section 37 test; and third, the need to keep an eye on the future. I support the Bill.
Mr Speaker: Dr Tan Wu Meng.
Dr Tan Wu Meng (Jurong): Mr Speaker, I start by declaring my interest as a medical doctor. I also declare my interest as the son of a cancer patient.
All of us have loved ones who have been through the journey of illness. All of us know of stories, whether family, friends, residents being diagnosed – wondering what the next step is on the treatment journey. Grappling with uncertainty – whether from the perspective of a patient, or being the loved one looking on wanting the best for the patient, our loved one. And for those of us who happen to be doctors as well, seeing it from the professional lens but, at the same time, having those thoughts go through our minds that the person we are caring for is someone's loved one – could be very much like our loved one; that humanity connecting us together.
I support the broad architecture of the legislative changes. The intent is to help patients, and to help doctors to help patients. But I have questions to ask, both on the detail and on the bigger picture and my questions fall into three sections: the law, the process and the big picture – making patient safety better, helping patients better.
On the law, I want to ask about this new statutory test. How often is a statutory test legislated so quickly to supersede case law after a high profile Court of Appeal judgment such as the case of Hii Chii Kok.
I understand the Minister has shared there was consultation with the legal profession. For the benefit of those of us in this debate who are non lawyers, we will be happy to hear more on what was the legal profession's view.
The Minister spoke about engaging patient advocacy groups. Can the Minister share in greater detail what patients think of this and whether patients across a broad range of socio-economic backgrounds were engaged as well? Because the informational needs and concerns and worries of the Ah Gong, the Ah Ma living in a 1-room, 2-room HDB flat, are very different from the very well informed professional going to see a doctor. It is something that every practitioner faces every day and having confidence that the Ministry has looked at that is going to be very much part of looking at these reforms.
The Minister also said that there were comparable legislative moves in other jurisdictions like Australia. Can the Minister confirm that these were recalibrations or codifications of case law?
On the proposed section 37, sub-section (4) can I ask the Minister what will be the approach when there are different peer professional opinions, each of them deemed reasonable and logical? How does the Ministry foresee Disciplinary Tribunals and the Courts adjudicating on this? And if a Disciplinary Tribunal or the Courts happens to prefer one particular body or peer opinion, does that shape the weight in which that body will be considered in subsequent Disciplinary Tribunals or Courts' decisions.
Sir, on the second point – the process. Mr Speaker, implementation is policy. And if the new structures are to deliver justice and outcomes well for patients and for doctors, there must be adequate resourcing and manpower – whether to support the Inquiry Committee, the revised Complaints Committee or the workings of the SMC.
We know that when justice is unduly delayed, it is unfair for the patients and families, who spend years wondering what the outcome will be. Delayed justice is also unjust to an accused who will go for years not knowing if he or she will be found guilty or innocent.
On the other hand, Mr Speaker, it would also be a disservice to patients and doctors together if strict, speedy timelines are pushed, but without sufficient resources to do the job thoroughly and fairly. Can the Minister confirm and assure us that there will be sufficient resourcing and how will the resourcing be budgeted for?
I want to speak about expert witnesses.
Allowing a Disciplinary Tribunal to appoint experts is an important reform because we know that in an adversarial system, there is always a risk, whether real, implied or subconscious, that an adversarial spirit will permeate the adversarial proceedings. The Disciplinary Tribunal's own expert witness can thus be a second opinion to each side’s expert opinions. You might say a third opinion or a third way: a moderating force, a stabiliser when there are differences in expert opinion. Indeed, some jurisdictions have explored having the experts convened together in a less structured way, they call it “hot tubbing”; and these current reforms introduce an aspect of that. Because the first duty of the expert witness is not the side that is hiring them, but to the truth. So, expert witnesses must continue seeking the truth together and not as adversaries.
Mr Speaker, I now want to talk about the big picture. Improving patient safety, improving patient outcomes. Beyond the changes to the law and the regulatory framework, we must also look at the bigger picture. How do we improve patient safety? How do we help doctors and healthcare workers to keep patients safe, to provide better care? It starts by touching the ground every day, all the time.
I want to speak about younger doctors because for the SMC, lowering the minimum years of standing from 10 to eight, it sends an important message of inclusion – inclusion of the views and experiences of our younger doctors. This is important for Complaints Panels too, which must draw people from a wide range of backgrounds and experiences. The new section 39 allows a doctor of eight years’ experience to be appointed to the Complaints Panel.
But, Sir, what is on paper and the actual extent of representation – the actual extent of representation matters too because when you speak with junior doctors, young doctors out on the ground; busy, running, doing everything they can to keep patients going, to keep patients alive, our junior doctors have that certain closeness to the ground, especially on the inpatient wards. Our junior doctors have that sense of the actual working experience, actual working conditions. Whether it is implementing the decisions of a senior, more experienced doctor, or caring for patients in the middle of the night on call, a 24-hour shift, 36-hour shift or in the old days – and I am starting to sound like an older doctor – even longer shifts by those seniors who came before some of us. But these views from the ground from our junior doctors, our younger doctors, they add important colour to the understanding of healthcare delivery every day on the ground.
Sir, implementation is policy. And on the ground, especially in healthcare, implementation is reality.
Indeed, Sir, over the years, in some hospitals, it is our younger doctors – working together with nurses, allied health, medical social workers, healthcare administrators, mentors – who help bring change and transformation, keeping open eyes, open minds and open hearts.
Seeing through the eyes of our people. Seeing through the eyes of patients to make the journey safer and better for all. Seeing through the eyes of healthcare workers so that our people can do their best – and do even better – to look after patients, keep patients safer, lower the risk of human error. Because when a human error happens, it is not always just about one human.
Sir, I want to talk about learning from a tragedy. I want to mention a case reported in the media. In referring to this case, I take reference from public domain media reports, in particular, a Straits Times article from 18 January 2006.
Mr Speaker, over 15 years ago, Mdm Grace Leong was the only staff nurse in a welfare home taking care of 180 residents. One hundred eighty residents. One nurse.
One of the 180 residents was a patient with a drug allergy, newly diagnosed during a hospital admission. Staff nurse Mdm Leong was the only one at the home who knew of the drug allergy but she omitted to inform the doctor who was going to see the patient at a subsequent hospital appointment. This drug was later given to the patient who had an allergy to it. The patient died.
The State Coroner found staff nurse Mdm Leong negligent because by the legal definition of neglience, there was a duty of care, that care was breached for whatever reason and harm ensued as a result. So, you might say the coroner was bound legally to find that there was neglience. But the coroner also noted the challenging circumstances she worked under.
The then-executive director of the Singapore Nurses Association was quoted as saying, \"This is a home with 180 elderly residents and they require a certain level of care. How can you expect a nurse who has to take care of all 180 residents to also provide the standard of care that is expected to be given to sick patients?\"
Sir, I still remember how troubled I was to read about what happened because as healthcare workers, we are all in this together. When a fellow doctor does not deliver that care to the patient, we feel for the patient and we ask, \"How can we help that doctor to do better?\" When a nurse has been put in a difficult situation and things have not gone well, we believe in standing by our fellow healthcare workers as well.
In a letter to the Straits Times that year in 2006, I wrote, \"It is true that nurses – while human and thus fallible – owe a duty of care to their patients. Yet care is not provided by individuals alone, but by organisations and the systems set up therein. When accidents occur, it is crucial to look not just at the individuals involved in making the error but also the system and organisation.\"
Nurses, doctors, healthcare workers – like everyone in this House, human and thus fallible. But we know healthcare is not provided by individuals alone but by organisations and systems.
Sir, Minister Ong Ye Kung spoke about aviation earlier today and indeed there are lessons we can learn from the aviation industry.
The airplane pilot has ultimate responsibility for operation and safety in-flight. But safety goes beyond the pilot and the airline industry recognises this deep truth. The International Civil Aviation Organization's or ICAO Safety Management Manual looks at the relationship between humans and workplace. They call it the \"SHELL\" model – software, hardware, environment and liveware. Liveware, as in people.
Software – the procedures, training and support; hardware – the machines and equipment; environment – the workplace in which everything and everyone functions; and liveware – humans, people who have to work with software, hardware and the working environment.
So, it is critical that MOH continues to touch the ground and look at systems factors as part of root cause analysis when mishaps occur. Healthcare workers being professionals must necessarily take responsibility, but our healthcare institutions also have a duty of care and a role to play in making safer workplaces and reducing the risk of human errors. Because nobody starts their day thinking of doing harm. No medical professional, no healthcare worker, no nurse starts their day intending to cause harm.
We need to continue making workplaces safer and reducing the risk of human error. We have to keep on improving because the day a belief sets in that improvement is not possible or not worth striving for, that is the day our system will ossify and begin to decay. We must stand against the belief that improvement is not possible. We must keep on improving.
Mr Speaker, in seeking improvement, good quality data is key. We have today discussed the duty to advise as part of informed consent. In Question Time earlier, I spoke about seeking truth from data, seeking truth from facts.
May I ask the Minister and MOH:\thave there been studies done on how much time is needed on average to adequately advise the average patient on a particular topic? How does this time compare with the average time slot provided for a patient consultation? How often do healthcare workers have to go the extra mile by finding time and doing these communications outside of official clinic working hours?
Sir, this data is fundamental for the planning of manpower, clinic timings, clinic sizes, both for today and for future hospitals, and especially in busy practice settings such as our public sector hospitals.
Mr Speaker, these legislative amendments are an important step forward in helping patients and helping doctors to help patients. But our healthcare institutions, processes and management have a critical role too. I stand in support of these two Bills.
Mr Speaker: Mr Murali Pillai.
Mr Murali Pillai (Bukit Batok): Mr Speaker, Sir, I first declare my interest as a lawyer in private practice. Before proceeding, I would like to refer to the revelation of my hon friend, Dr Tan Wu Meng, informing that his father is a cancer patient. I would like to take this opportunity to wish his father strength as he undergoes treatment and I want to wish my hon friend strength in taking care of him.
Sir, I wish to address the proposed section 37 in the Civil Law (Amendment) Bill, which introduces the standard of care based on what is accepted by a respectable body of medical opinion, which is assessed to be logical in relation to the provision of medical advice.
The key question is this: what is good advice from a doctor that is in keeping with the trust that the patient reposes in his or her doctor? That is advice that cannot be faulted by a patient for being incomplete, medically unsound or in any way that does not respect his autonomy and ability to make decisions for his own health.
A patient decides based on two things – first, what he knows and second, what he thinks the doctor is telling him.
The first is a function of metaphysics – what he feels he wants in life, his current state, his tolerance for uncertainty, suffering or more prosaic things such as personal finances, what he wants to leave behind, what he wants to use up in this life and his relationship with his family.
The second is less subjective. And it is this second part which I would like to speak on. I have two specific points to make: first, let us be clear on what balance we wish to strike between the recognition of medical expertise and patient autonomy. I do not find it useful to call the first \"paternalistic\" and the second \"patient-centric\" because of the negative overtones in the first and for the positive in the second.
I make this clarification at the start because there is some risk of doublespeak if we were to use these words without care as to their meaning.
Take for example the report from the work group to review the taking of informed consent and SMC disciplinary processes. The hon Minister referred to the stupendous work that this work group did and I join him in the laudatory remarks that he made.
In Annex E of the report, dealing with legal tests for the provision of medical advice, it spells out the motivation for the new test. It claims, \"This is a patient-centric test based on peer professional opinion which has regard to patient autonomy and choice and takes into account what is material to the patient.\"
This test is called a patient-centric test but in broad strokes, it moves the needle towards the weight of doctors. I do not say whether this is right or wrong but merely to point out where the needle is moving – and we ought not try and give it a veneer of political correctness by calling it \"patient-centric\".
A model that focuses on the patient means we regard the materiality and relevance of information from the perspective of the patient. The new test measures this by reference to opinion of a responsible body of doctors. Some critics may argue that this new test will in fact emasculate the \"patient-centric\" element. This is the first point on which I seek clarification.
Can the hon Minister please tell how the proposed calibration for medical advice in favour of peer professional opinion represents an improvement on the status quo?
Currently, in relation to disclosure of information that a healthcare professional knows or ought reasonably to know, the legal standard of care is measured from the perspective of a reasonable patient in the patient's situation. This is not an end by itself but to facilitate the patient to make an informed decision on the advice.
The work group in its report refers to confusion and anxiety amongst many doctors arising from the application of the \"reasonable patient\" standard who believe that this will give rise to defensive medicine and more litigation. The hon Minister, made a similar comment today as well and he referred to this as more of perceived uncertainty. I fully agree with the honourable Minister with his views. So, if that is the case, perhaps we could deal directly with the perception of the doctors instead of introducing a new standard of care.
Also, would it not be the case if a patient who is provided advice that is based on the standard of care requiring him to reasonably understand and expect it, that there should be a lesser chance of him suing his doctor?
I note that the Bill itself does not make the claim of being \"patient-centric\". Again, I recognise the role of professional expertise in any decision-making. Being a professional myself, I hope my clients concede that I do know the law in a manner that they do not. What I am asking for is a clear-eyed recognition of the limits of the role of the patient, the role of the doctor and the role of the Court in the finding of fact.
This leads me to the second point. Even with this new test, there remains instances when the body of medical opinion is irrelevant. For example, whether a patient has indeed given a waiver to know information relating to a certain decision – that is, when a patient has decided not to decide. These are findings of fact and a place should be reserved for the Court to determine this matter rather than relying on the professional opinion of doctors.
Here, may I seek clarification on whether there is still a role for the body of medical opinion to be the standard of care governing this area? As the Minister is aware, the evolution of peer professional advice standard in case law was due to the recognition that in the medical field, it may be impossible to identify a single professional consensus on a specific course of action. Hence, so long as it is a view of a group of competent members of a profession, it suffices. But when it comes to issues of what a reasonable patient has or has not decided, one can presumably arrive at a more specific finding.
Lastly, Mr Speaker, Sir, I have been speaking on the interests of doctors and those of the patients and speaking of the needle as if more for one is less for the other. But as the hon Minister said, the interests of both do coincide in very large areas. Indeed, it is never in the interest of doctors to violate their Hippocratic Oath and harm their patients.
Mr Speaker, Sir, I consider decision-making between a client and a professional a collaborative process. But the relationship between a patient and a doctor is an unequal one – a point made by the hon Minister. It is unequal in terms of expertise, experience and judgement. That is why the law regards the doctor as the patient's fiduciary.
The doctor, in the giving of advice, must take this asymmetry into account. At the same time, often, we need the doctor to help the patient.
I had an illuminating discussion with the hon Senior Minister of State for Health, Dr Koh Poh Koon at the Members' Room yesterday where he shared instances when he was in medical practice where he had to exercise therapeutic privilege, often at the instance of the patient's relatives and not provide his patients with information that may lead to this patient becoming paraylsed with fear and becoming unsure as to what to do. That would not be a good outcome for the patients. We therefore need to continue to support doctors who in good faith and with utmost competence and due diligence – act in the interests of patients. And this, in the words of the hon Minister, would enhance decision-making and better outcomes for patients.
I ask for the Minister to clarify how this is addressed by the new test, as well as to ask the hon Minister to spell out more clearly the limits of this test in matters of fact-finding vis-a-vis the patient.
Mr Leon Perera (Aljunied): Mr Speaker, Sir, the Medical Registration (Amendment) Bill represents the result of a process of review that was initiated in early 2019 and also saw the formation of the work group to review the taking of informed consent and SMC disciplinary process, which submitted its report in late 2019.
Taken as a whole, the Bill represents an important step in the right direction and I do not oppose the Bill. However, there are gaps and issues on which I shall speak to suggest further areas for review and Improvement going forward.
A furore on the medical community over the taking of informed consent emerged in early 2019 over the case of SMC vs Dr Lim Lian Arn. During the COS debates in 2019, I spoke about some of the issues raised by this and other recent cases in respect of the clarity around rules on consent taking and procedural issues with the SMC's disciplinary process, including the rules governing the composition of the SMC itself.
Why is the Bill before us today a step in the right direction? These include firstly, it will enable the SMC to issue immediate interim orders against medical practitioners if there is imminent danger to the public. Second, it specifies the statute of limitations which would tend to enhance clarity and confidence amongst the medical profession. Thirdly, it specifies timelines for investigation and disciplinary deliberations such as, for example, that for the complaints panel to appoint an Inquiry Committee and for the Inquiry Committee to perform its filtering role. This addresses the unsatisfactory situation of complaints being deliberated for years while during that time, a cloud hangs over the head of the medical practitioner who is the complainant. Fourthly, it provides for clear separation or clearer separation between the investigation and adjudication arms with the establishment of a new Disciplinary Commission or DC. Taking a step back and looking at the bigger picture, these clarifications would tend to advance confidence and certainty amongst medical practitioners which may lessen any drift towards defensive medicine.
Next, I will speak about potential gaps and issues in the Bills as it stands and make a number of suggestions. Before I begin, I declare my interest as the CEO of a research consultancy that there is some work in the healthcare services space.
While some have seen these amendments as lending greater weight in the disciplinary process towards doctors and away from lawyers and while, if true, that would have its merits, as the process would be more akin to discipline being meted out by a jury of one's peers, I wonder if there should be a role for patient advocates, so that the outcomes from the disciplinary process may better balance the interests of different stakeholder groups and will be seen to be performing that role.
This is not an idea that is without precedent. The Australian Health Practitioner Regulation Agency, for example, overseas a regulatory regime which includes performance and professional standards panels that consists of at least three members selected from a list of people approved by the national board. The panel will include at least half but no more than two-thirds of registered practitioners in the same profession as the practitioners subject to the panel, and at least one person representing the community.
Another interesting example to cite in this regard is Singapore's disciplinary process for accountants. The Public Accountants Oversight Committee or PAOC, operating under ACRA, is authorised to oversee all matters related to the registration of public accountants in Singapore. To ensure independence, a majority of PAOC members are not public accountants. They comprise experienced professionals from the Public Service, the business community and the audit profession. Providing some degree of representation to patient advocacy groups on such DCs while medical practitioners remain in the majority may be worth considering.
I would also suggest that legislation consider requiring that a public interest goal that encompasses a recognition of the need to balance all stakeholder interests, including those of patients, non-doctor medical staff and taxpayers be included in the mission statement of the SMC. After all, the SMA already exists as something akin to a union for medical practitioners and the SMC should be seen to reflect the broader interests and the greater good.
In the same vein, I would also like to ask: the 2019 work group report, which provided the critical inputs for these amendments, largely drew on feedback from doctors. The report did mention that the work group spoke to patient advocacy groups, but did not specify which ones. I would like to ask for details of which patient advocacy groups were consulted.
Next, Sir, I would like to ask if there will be a requirement for a minimum number of medical practitioners sitting on DCs from the same discipline as that of the medical practitioner who is the subject of a complaint or investigation. This would seem sensible, so as to inject relevant clinical expertise into the deliberative process.
Doctors come from an array of specialties and backgrounds and may not fully understand the intricacies of cases across the profession.
In Australia, for performance assessments, the national board selects an assessor whose scope of practice is similar to that of the practitioner being assessed. For example, a general practitioner who works in a rural and remote area might be assessed by a practitioner who is familiar with the particular challenges of rural practice. Moreover, in health and performance panels, at least one member must be a registered practitioner in the relevant or same health profession as the practitioners subject to the panel.
Next, Sir, while the introduction of a statute of limitations of six years for complaints is a good step to allow for the referral of a late complaint to the President of the Disciplinary Commission, section 41 (6)(3) may appear to negate the whole point of a statute of limitations. The President of the Disciplinary Commission will then decide if it is still \"in the public interest\" to pursue the case. It is possible that the threshold is set very low, in which case, many late cases will be pursued contrary to the reasonableness of the statute of limitations. Can the legislation or subsidiary legislation be more specific in describing the scenarios in which it would be permissible for a late complaint to be investigated?
Next, I raise the issue of ensuring sufficient training to members of the these DCs, in a way that is comprehensive and demonstrably. In the Lim Lian Arn and Soo Shuenn Chiang's cases, unjust outcomes were found by the Court of Three Judges to have arisen from ignorance of the Ethical Code and Ethical Guidelines or ECEG and of medical ethics in general. The Judges claimed that if the Complaints Committee members and the Disciplinary Tribunal members as well as both Prosecuting and Defence Counsel had all studied the ECEG properly as well as previous Court of Three Judges' judgments that were relevant, the unjust outcomes could have been avoided.
Beyond the medical aspects of the case, the members may not be familiar with legal concepts, such as rules of natural justice and due process, burden of proof, a minimum standard for professional misconduct, which is an issue of mixed fact and law and proportionate sentencing. For instance, in the Soo Shuenn Chiang's case, the DT wrongly accepted the guilty plea because of the failure to properly assess the facts of the case and whether the acts which Dr Soo admitted to, rose to the level of professional misconduct in the first place.
I would like to suggest the provision of certified training in the ECEG, medical ethics and relevant legal concepts for members of the named committees. Training of all members involved in the disciplinary process is key to ensuring justice. Section 57(2b) states that the Disciplinary Commission or DC is responsible for training members of the complaints panel or health committee.
For greater rigour, the amendments should include a requirement for certified training in the ECEG and medical law before someone can act in the disciplinary process. Such training would surely help raise confidence in the disciplinary processes among the medical community. I note that the 2019 work group report had recommended that such specialist training in legal matters be provided to members and that the DC should consider working together with the Singapore Judicial College, the Singapore Academy of Law and Singapore Medical Association on the provision of training. I understand that there are existing training courses provided for being an expert witness. But my suggestion here is for more comprehensive training to all relevant personnel with clear certifiable outcomes. I understand that Minister Edwin Tong did allude to the responsibility of the DC in ensuring that training is provided to DC members and would be grateful for more details on how this will be executed.
Next, the Bill seems to be silent on the question of who the SMC uses as its Prosecuting Counsel. The current practice of using commercial law firms may be unsustainable due to skyrocketing legal costs, sometimes, at the expense of fair judgments. I did note that, in his Second Reading speech, Minister Edwin Tong did allude to the creation of a legal unit within the SMC as part of the changes that will happen after the passage of this Bill if it is passed. I would be curious to know whether all legal work would be handled by this in-house legal unit and there would be no more reliance on outsourced lawyers, or would that be a hybrid model going forward.
The context for raising this question is as follows. The 2019 work group observed that commercial law firms appear to have an attitude of securing convictions at all costs, even at the expense of disregarding the ECEG and previous Court of Three Judges judgments in some cases.
Legal costs borne by the SMC have been known to be high, potentially posing a concern. This may result in doctors having to pay more in terms of their contribution to the SMC and medical indemnity insurance, in turn leading to rising healthcare costs borne by consumers.
In 2018, the SMC's net legal expenses for disciplinary proceedings – 880,000 – comprised a significant 10% of total operating expenses of $8.8 million. The 2019 work group report recommended the creation of in-house prosecution and legal advisory units to improve access to legal resources. This suggestion would also solve the issue of insufficient legal support provided to the CCs at present. Members of the legal and prosecution units may be drawn from the Attorney-General's Chambers or from the pool of Legal Services Officers to tap on their legal and prosecutorial experience.
However, it is unclear if having in-house counsel would help to save on legal costs compared to outsourcing, that begs the question of whether the SMC has done a cost-benefit analysis of having an in-house legal unit versus continued reliance on outsourcing to commercial law firms. I would urge the Government to work with the SMC to look into this question and act accordingly.
Next, I would like to raise the possibility of creating a parallel disciplinary process that departs from an adversarial system to an inquisitorial system so that witnesses, that are agreed to by both sides, may be questioned by the DT to form an opinion. Currently, the DT members may sit quietly for much of the proceedings while lawyers and witnesses duel in front of them. An inquisitorial system would remove the incentives and therefore the biases inherent in a \"conviction at all costs\" attitude on the part of the prosecution. It may also substantially lower legal costs. Moreover, an inquisitorial system for the SMC would give more power to the DT in directing the proceedings and offers the advantage of seeking the truth instead of taking sides. But the adversarial approach is perhaps most appropriate where the defendant needs to prove innocence in relation to a very serious charge. In fact, this point of feedback was raised during a review in 2014.
I would like to suggest that a separate non-adversarial track or parallel track for disciplinary proceedings be created which could be activated based on mutual consent among both parties or by an order from the DC, which may decide to order such proceedings in cases where, for example, one party is of lesser means and may thus be disadvantaged by the need to hire skilled legal counsel. For this to work, the DT members would need to be adequately trained, as alluded to earlier in my speech.
Next, I would like to speak on recognition and support for doctors serving in disciplinary committees or as expert witnesses. Currently, while a small honorarium is paid to some Complaints Panel members from the private sector, DT members are not reimbursed for the time spent on working on a case. The DT's two senior doctors would usually have to block out their clinical appointments for about a week for each DT case, representing a significant trade-off in respect of income. As a result, active private doctors who run busy practices often decline the invitation to be in the DT.
Yet, it is important to have full-time working doctors in DTs as it ensures its decisions are relevant, up-to-date and reflect ground realities.
One point I would make here in passing is that I suggest that the Government and the SMC analyse the current doctor composition on such committees to assess if senior and retired doctors are over-represented. One doctor in private practice I spoke to, had describe being in the SMC or serving in DTs as a \"thankless job\". Another doctor commented that a friend recently mentioned that you received 11-feet high stacks of notes to go through before a case, with little compensation and support to speak of.
Sir, I do not have a perfect solution to this. The stipend paid to doctors for their service could be increased, but there are of course limits to this as this may tend to raise the fees doctors need to pay for the SMC's costs which may pass through to consumers. One possibility is to automatically assign credit when doctors serve on disciplinary tribunals to count towards doctors' mandatory Continuing Medical Education or CME requirements to maintain good standing as medical practitioners. However, this would need further and consultation so as to be done in a manner that does not compromise CME goals.
My suggestion here would be for the Government to work with SMC to study this problem and consider better ways to incentivise and support doctors serving and Disciplinary Committees, including considering non-monetary forms of recognition and the provision of better supporting resources.
Next Sir, I would like to ask if the Minister could provide assurance that sufficient resources will be dedicated to allow adherence to stipulate the timelines under this new MRA. There is a perception that the SMC is stretched thinly on resources explaining the long timelines taken to resolve complaints and the existence of a significant backlog of cases. To meet these new stricter timelines, more resources would need to be made available. I would also like to ask if plans are being made for the SMC to handle the current backlog of cases to be in line with these new requirements.
Last but not least, I would like to raise the issue of the composition of the SMC returning to a subject I raised during the 2019 Committee of Supply debate.
Currently, the Government appoints a large number of SMC members. And in the past the majority of SMC members were not directly elected by the medical practitioner community. Anecdotally, it would appear that a perception still exists among the medical practitioner community that the SMC acts like a Government arm and as such the outcomes of disciplinary processes may reflect the Government's stance more than what is fair and agreeable to doctors.
The counter argument to that kind of perception is that an SMC, where the majority of members are elected from the medical profession, may become a body that tilts more towards the interests of doctors than patients or the wider society, in lieu of the hand of the Government to inject considerations of broader societal interest.
In considering this question and it is a big question, I would like to suggest that the Government considers regularly measuring the state of opinion among doctors towards the SMC to ensure that confidence is high. And in light of these findings, consider how best to tweak the balance between elected and appointed seats on the SMC, if at all. After all, an SMC which enjoys a high degree of confidence from the medical practitioner community would be a strong bulwark against any creep towards defensive medicine.
Mr Ang Wei Neng (West Coast): Mr Speaker, Sir, for our healthcare system to work well, trust is critical. It is important that patients can trust their doctors and know that their complaints against errant doctors can be heard fairly.
Last night, one of my residents, Mr Chua came to see me about his mother, who passed away after taking a straightforward liver test in the hospital. His mother was hospitalised for a skin condition. Understandably, Mr Chua was very upset. We wrote a few letters for him. It is in this context that I hope that the debate on the two amendment Bills today, would build trust between patients and doctors, and not less.
I know that it is equally important that doctors need to know of the practical, clear and consistent guidelines to inform their patients on treatment risks so that they can fully serve their patients without fear that patients will end up suing them. But this trust had been under \"serious threat of erosion\", according to a special work group which was formed in March 2019 to look into this. The report pointed out that controversial, high-profile cases of medical malpractice which seemed to go on for a long time with outcomes the doctors did not expect, had perhaps made doctors fearful and wonder, \"How can I care for my patient without getting into legal trouble?\"
The work group to review the taking of informed consent and SMC Disciplinary Process has put in a lot of effort into this report, engaging over 1,000 doctors. I would like to thank the work group for the great job. Arising from their recommendations, which were released in November 2019, we are now at the stage of legalising some of these recommendations through the amendments of the Medical Registration Act or MRA and the Civil Law Act.
These recommendations will hopefully go a long way in restoring trust. In a nutshell, the MRA amendments put more responsibility on the medical community to self-regulate, with the creation of new legal advisory unit, dedicated secretariat and new committees. Currently, many people not in the medical fraternity feedbacked that the Singapore Medical Council or SMC is taking too long to handle and investigate complaints against the doctors. For example, out of 138 complaints in 2018, SMC could only conclude 18 inquiries. The doctors are also complaining. For instance, a doctor's interview in a news report last year, said it took two and a half years for SMC to resolve what she termed as a \"frivolous\" complaint against her. Thus, we hope that the legal mechanisms will be able to speed up the process for resolving medical complaints.
I spoke to several doctors and they are general pleased with the amendment Bill. In particular, some senior doctors are glad that the avenue to appeal to the Minister is replaced by a Review Committee which would also include a lay person.
In the light of the new Review Committee, I would like to ask the Minister what will be the selection criteria of the lay person stated in section 2 of Medical Registration (Amendment) Bill. In most people's mind, we hope that these laymen should be experienced professionals who are older, as they are more likely to have the experience to avoid making radical judgements.
However, in tipping the balance toward doctors, I am concerned that this might disadvantage patients in some way, especially those who are lack of resources. Mr Speaker, Sir, let me continue my speech in Mandarin.
(In Mandarin): [Please refer to Vernacular Speech.] Mr Speaker, it is timely to amend the Medical Registration Act to allow the SMC to set up a new Inquiry Committee to improve the efficiency of handling complaints. The new Inquiry Committee will decide within three weeks whether the complaint is valid from a doctor's point of view; vexatious complaints will be rejected immediately. If the complaint merits empathy and is not complicated, it will be recommended that the dispute be resolved through mediation. Cases that merits further investigation will be referred to the Complaints Committee.
In general, Singaporeans are not very familiar with medical knowledge. If patients suspect that they have been misdiagnosed or given the wrong medicine, they often feel that there is no way to lodge a complaint. I would like to ask, while the Bill is reassuring to doctors, what about further safeguards for patients if they have complaints? I hope Minister can provide help to complainants in 3 areas.
First, if the complainant feels that the Inquiry Committee is too hasty in dismissing the complaint, can he appeal to MOH? Second, when the complainant is ordered to go through mediation, can he apply for third-party assistance if necessary? Third, if the complainant does not have the means to hire a lawyer when he needs to go to court or when he is sued for defamation by the doctor, can he apply for pro-bono legal services?
Overall, we do not want an honest complainant to be denied access to appeals because of a lack of resources.
(In English): Mr Speaker, Sir, the Civil Law and the Medical Registration (Amendment) Bills have given the doctors a better peace of mind and have also benefited the patients. Through the amendment Bills, SMC has created new legal entities, dedicated secretariat and a few more \"C\"s such as Inquiry Committee or IC, Disciplinary Commission or DC, Health Committee or HC, Review Committee or RC, Interim Orders Committee or IOC, just to name a few. However, all these \"C\"s will lead to a higher \"C\", that is, higher cost. I will like to ask the Minister who would fund the additional costs? Do we expect the patients who complain to pay? I hope not.
Based on the 2018 annual report of the SMC, it has an accumulated surplus of $4.9 million as of 31 March 2019. Yet, SMC received a grant of almost $1.9 million from MOH in 2019. Why is this so? Do we expect the taxpayer to pay for the additional costs of the SMC? I hope not.
As of 2018, there were 11,461 fully registered doctors in Singapore and almost of half of them were specialists. So, we have 11,461 doctors, half specialists. What I am going to suggest next will not go well with the doctors, including the physician that will examine me at my next medical report or medical check-up. However, in the larger interest of Singaporeans, I will like to suggest each of the doctors pay an additional $300 annual fee to the SMC. Three hundred dollars per year might be a small proportion of the doctor's annual income. But, it will contribute $3.4 million a year to SMC and that might cover the additional costs to better the complaints by the patients. I hope the doctors can understand and will not pass this additional fee to their patients. Mr Speaker, Sir, despite my above clarifications and suggestions, I support the Bill.
Mr Louis Ng Kok Kwang (Nee Soon): Sir, in recent years, the Singapore Medical Council or SMC has faced several questions about his disciplinary process. Some cases brought to the SMC has taken a long time to resolve. It has created agony for some patients and doctors who wait up to seven years for justice to see its day. For several doctors, they question whether justice is even on the table and some cases brought by SMC were misguide and ended up being overturned by the High Court.
The Medical Registration (Amendment) Bill is a step in the right direction. It helps the process produce fairer, quicker and more consistent outcomes. I support the Bill and I would like to thank MOH for convening the work group to review the taking of informed consent and SMC Disciplinary Process in March 2019. The work group engaged doctors, doctors' associations, patient advocacy groups, lawyers and members of the public, producing a rich report whose imprint is clear in this Bill. That is it. I have some points of clarification on this Bill.
My first point relates to manpower, as many have raised before me. This Bill adds several layers to the SMC's disciplinary process to reach its conclusion. A given case may not pass through as many as six committees, the Inquiry Committee, Complaints Committee, Review Committee, Health Committee, Interim Orders Committee and Disciplinary Tribunal. By my count, a case may require as many as 17 different committee members not including experts or lawyers. Some new measures will help with staffing, such as lifting the limits on the number of non-SMC members who can join the Complaints Panel. But, I worry that this is not enough, after all, we are talking about a status quo where lack of manpower has delayed the process by years.
As such, I have two questions. One, of the non-SMC members appointed to the Complaints Panel in 2019, how many were doctors and non doctors? I ask this because we are lifting the limits on these numbers, but the change will not help if each number is currently nowhere near its limit.
Two, how many Complaints Panel members does the Ministry aim for the Complaints Panel to have in 2021? What steps will the Ministry take to achieve this target?
My second point of clarification is on the purpose of the Inquiry Committee.
This Bill introduces the idea of the Inquiry Committee. Any time a case reaches the SMC, two doctors from the Inquiry Committee will decide whether the case is frivolous. If yes, they throw it out. If no, they pass it to the Complaints Committee to investigate.
But do we actually need it? According to the work group, only 7% of SMC complaints have been dismissed as frivolous or vexatious. For the other 93% of the cases, this new proposal adds five weeks and two doctors without actually changing the outcome.
This does not help SMC's manpower problems. Instead, it makes them worse. I have to agree with a group of doctors interviewed by the work group who has said that a new committee is not the solution.
The most elegant solution, in my view, is to skip the creation of the Inquiry Committee. We let the Complaints Committee determine whether a case is frivolous but set a deadline of three weeks for them to do so. If the case is not frivolous, they seamlessly continue their investigation. This way, we keep the committee sensitive to time and focused on tasks while avoiding the work of forming new committees and the friction of transferring investigations between them.
If we do decide to keep the Inquiry Committee, I have two questions for the Ministry. Firstly, how many cases does the Ministry forecast will reach the Inquiry Committee but not the Complaints Committee? Secondly, there is an existing problem of some Complaints Committee members avoiding risky decisions and passing the buck to the Disciplinary Tribunal to make a decision, according to the work group. What will be done to ensure Inquiry Committees avoid this same exact practice?
My third point of clarification relates to the dismissal of frivolous, vexatious, misconceived or non substantive complaints by the Inquiry Committee. The Minister had earlier addressed this point substantively and I just wanted to confirm that the Inquiry Committee will share its decisions and reasons with the complainant when it dismisses the complaint.
My next point was addressed by the Minister about the legal advisory unit and I will move on to my fifth point, which is about the avenues now available to the medical council in serious cases.
It can do two things currently. Firstly, escalate a complaint to the President of the Disciplinary Commission and it can do so when the doctor has a criminal conviction, caused the death of a patient, is the subject of an adverse finding by a coroner or is assessed to pose some other serious threat to patient health. Secondly, seek interim orders that can suspend a doctor or impose conditions on a doctor's work. It can do this when it determines that the order would protect members of the public or otherwise serve the public interest.
I have three questions on this point.
One, when is it appropriate for the medical council to choose not to escalate matters to the Disciplinary Commission? The existence of discretion suggests that it is sometimes acceptable to the medical council to avoid escalating the matter even when a doctor has caused the death of a patient or has been convicted of a serious criminal offense. What factors mitigate against the severity of such incidents?
Two, what are the envisaged cases where an interim order is required and it is deemed \"necessary for the protection of members of the public or otherwise in the public's interest\"? What factors or principles should guide the consideration of the Interim Orders Committee?
Three, when should the medical council escalate matters to the Disciplinary Commission as opposed to seeking interim orders? If a patient's health is being threatened, these two avenues are available to the medical council. Can the Ministry provide examples where it would be more appropriate to pursue an escalation to the Disciplinary Commission as opposed to seeking interim orders?
Sir, I believe that this Bill will lead to better outcomes for both patients and doctors and I stand in support of it.
Next, I also thank the Ministry for the direction taken in the Civil Law (Amendment) Bill towards a more patient-centric approach. This is consistent with the growing international consensus on the need for greater patient autonomy and informed consent.
My only concern on this Bill is again on manpower and time constraints doctors face.
I understand that doctors have significant concerns on how to meet the proposed patient care standards given the manpower and time constraints doctors face.
The current doctor-patient ratio in Singapore is one doctor for every 444 patients or 2.3 doctors for every 1,000 patients. In comparison, there are 2.8 doctors for every 1,000 patients in the UK. The European Union average ratio is 3.8 doctors for every 1,000 patients. The OECD average ratio is 3.5 doctors for every 1,000 patients.
At the same time, I understand that doctors have very limited consultation time with their patients due to their workload.
With a short amount of time, doctors are expected to assess needs, comb through a vast amount of medical history information that may be available on the National Electronic Healthcare System, explain the situation and assist patients to make informed clinical decisions. Due to consult time constraints and possible differences in language and levels of understanding, patients may not be able to convey their concerns well enough to their doctors as well. Doctors similarly may not be able to extract enough information to understand every aspect of the patient's concerns.
Time is also required to build understanding and to build confidence in the patient to undergo a recommended treatment. The stress of having to meet hospital KPIs measured in terms of consult time and manpower may also be overwhelming.
I understand some doctors fear what is reasonable to the court may in fact be humanly impossible to achieve. They also fear that such expectations can lead to further burnout amongst doctors. If the calibration is not done well, this may tilt the balance towards doctors practicing defensive medicine while simultaneously managing consultation time.
Can the Minister share what additional support will be given to our doctors to allow them to meet these enhanced standards of advice that is required to be given to our patients? For example, will the doctor-patient ratio and consultation time be increased in public hospitals?
Can the Minister also provide assurance that practical circumstances of doctors will be taken into account when assessing the reasonableness of such advice?
Sir, Minister Edwin Tong said himself in a speech in 2019 that doctors must be able to trust the system and that if it is not clear what standards are required of doctors, doctors may end up giving more information than necessary. He said, \"Ultimately, we can do more harm if we assume that simply giving more information means the patient has more understanding. Paradoxically, it is the complete opposite. Giving more information could lead to less understanding. Ultimately, no one benefits from this kind of defensive medicine because medical costs will go up and patients do not get the best advice from their doctors. Patient safety will be compromised.\"
I hope we will provide a framework for a system which doctors can trust and that would be fair to the circumstances they face. The system should take into account practical constraints, patient's preferences and the types of medical procedures.
Sir, notwithstanding these clarifications, I stand in support of both Bills.
Mr Speaker: Mr Vikram Nair.
Mr Vikram Nair (Sembawang): Mr Speaker, I rise in support of this amendment Bill. I declare my interest as a dispute resolution lawyer whose law firm advises on medical negligence cases.
I think many of the earlier speakers had focused on the Medical Registration (Amendment) Bill. I will discuss a little bit about the Civil Law (Amendment) Bill.
The Civil Law Act is an old piece of legislation dating to 1909 and it provides rules covering a very wide range of discrete civil law issues that were not otherwise clear in the common law or in the legislation. This includes provisions giving the Courts power to administer equity and law at the same time, rules on the calculation of limitation periods for actions, administration of insolvent estates, rules on enforceability of gaming contracts, assessment of damages and contracts by minors.
Each of these provisions addresses specific matters that were live issues at the time of legislation but have since become part of the rubric of our laws, co-existing with the other existing rules. Today, a very specific rule relating to the test for issuing medical advice is joining this tapestry of other rules that form part of the Civil Law Act.
In the slightly older days when I was studying law in school, the classic \"Bolam\" test applied to every stage of the medical process, whether it was diagnosis, giving advice or treatment. This test was first articulated in the English case of Bolam v Friern Hospital Management Committee in 1957. This was essentially a test that if the doctor's actions were supported by a reasonable body of medical opinion, he would not be liable.
This was subsequently modified by a test called Bolitho, which said a doctor's decision must also be logically arrived at. This test for medical negligence was commonly known as the Bolam-Bolitho test. Typically, claims against doctors would proceed with parties engaging expert witnesses to assist the court and determine what this reasonable body of medical opinion was in relation to the actions in question.
The Bolam test was devised under circumstances where it was assumed the doctor would play the most significant part in all decisions. However, modern medical practice has very sensibly developed to give patients more choices in this process and in particular, for doctors to actually advise patients on treatment options available and the risk of each, while empowering patients to make the decision.
This means significantly different considerations ought to apply when a doctor is giving advice as opposed to other matters such as diagnosis or treatment, where the patient may have no say. If a patient is being diagnosed, that is very much in the doctor's hands. If a patient is being treated, that is again in the doctor's hands. But where a decision is being made, that is in fact a joint effort.
For example, where a patient has severe knee pain and a knee replacement may be an option, a doctor would likely advise the patient on a range of alternatives from surgery, including other ways of living with and managing the pain. The patient will ultimately make the decision on whether he prefers to go for surgery or deal with one of the other options.
If he opts for surgery, then of course the surgical process itself will be entirely in the doctor's hands. The doctor would then be required to comply with the required test set out in \"Bolam\" to carry out that surgery. However, if the patient suffers from complications from that surgery even though the doctor took all steps that a reasonable body of medical opinion would support in the course of that surgery, then the doctor would not be liable. The decision for making that surgery, if made by a well-informed patient, would not be the doctor's fault.
This was, in fact, the way the current test as we understood it developed. In fact, this development of the test was relatively recent. In 2015, the English Court of Appeal articulated this modified test in a case called Montgomery, where it set out a doctor's duties in relation to giving patients advice was actually to properly inform patients of the treatment options and the risks involved.
In 2018, in the Hii Chii Kok case, which I think the Minister mentioned as well, the Singapore Court of Appeal was faced with a similar issue and again, it identified clearly the three different stages of the medical process – diagnosis, medical advice and treatment – and said that a different test ought to apply when we are talking about the giving of medical advice.
This is what brings us to where we are today. In the Civil Law Act, what we have now is an amendment proposed specifically to alter the common law test in relation to medical advice. It does not change the common law test in relation to diagnosis or treatment. To me, this amendment is not so revolutionary and in some ways, to me, it looks like it is very consistent with the development of the law, including the developments by the courts in both England and Singapore.
I note that the Civil Law Act is stated to replace the common law insofar as it is inconsistent but I think it may be helpful if the Minister could clarify how different this in fact is from the existing common law test, say, in Montgomery or Hii Chii Kok in relation to the giving of medical advice. Although I think it is helpful to have this test set out specifically in legislation and also to have specific limbs stating exactly when and how the doctor should give information, to me, I think this is not a revolutionary change but rather a clarification of the common law position.
There is always a challenge because in practical terms and I think many of my friends alluded to this. Doctors may get concerned about how much information they need to give and to what extent they have to advise patients of every single available option. In my understanding, case law is quite clear. You do not have to actually inform patients of inconceivable risks and you do not have to give every footnote in the textbook. But I think if there is indeed a concern that defensive medicine is going to develop, then it is necessary to prevent that.
Defensive medicine is of course a concern because if doctors prescribe a range of expensive diagnostic tests, most of which do not yield any results and feel compelled to give detailed pros and cons, this is definitely going to raise medical costs for the patients without necessarily giving better outcomes.
So, to me, the test put forward by the amendment to the Civil Law Act is a sensible and practical one. In my view, it is largely consistent with the common law and I think it places risk in the right places. So, risk for diagnosis and treatment is largely with doctors. In the making of medical decisions, the doctors' duty is to inform and give the patient enough information to make the right decision. But ultimately, the patient makes that decision. So, this is the called patient empowerment. And I think this legislation helps in that process. So, for that reason I stand behind it.
Mr Speaker: Before I call for a break, Senior Minister of State Koh Poh Koon, would you like to make a clarification?
The Senior Minister of State for Health (Dr Koh Poh Koon): Thank you, Mr Speaker. I was not preparing to make a speech during this debate, but Mr Murali made a reference to a sharing I had with him yesterday at the tea room. And I thought it is useful for me to take this opportunity to share a larger context of what the conversation was because I think it adds texture to the debate.
For many in the House who may not be practising doctors – and I think I am going to say this as a doctor who has been dealing with informed consent for many complicated procedures, performing abdominal surgery – in the context of sharing, it is about when sharing more information can sometimes lead to paralysis. I think Mr Murali made the point; situations where a doctor may use therapeutic privilege to withhold information from patients.
I share this story of many old patients who may be afraid of going for surgery. And I think many of us who deal with elder patients will recognise that there is a subgroup of patients who are afraid of hearing the big \"C\" word – the word cancer. Sometimes, the word \"cancer\" would then force them into denial. They will refuse treatment, to their own detriment. Many family members in this context in Singapore which is very much an Asian-centric population where the patient relies a lot on their family members for a lot of social support and family members naturally will come to the doctor and say, \"Please do not tell my mother or my father he has cancer\". Because they know their parents better, they know that if the parents were to hear about the \"C\" word, they will deny treatment, they will insist on going home, and I think the doctor also knows in this situation, that the patient will ultimately be harmed by refusing surgery, by going home where they have an acute abdominal situation.
I think in this situation, it is where the doctor spends time talking to the family instead of maybe just the patient alone, to help the family to understand the context in which the decision has been made and why a surgery is necessary.
There are times in which we withhold a lot of the details of informed consent with that particular patient who may be in denial but who needs surgery urgently to convince the person to go for life-saving surgery. I think it is in that context where the doctor himself may take on some professional risk as well. But ultimately as doctors, we take the Hippocratic Oath seriously. Our job is to first, be a patient advocate. I think if all of us here, with aged parents, put ourselves in the shoes of a son or a daughter knowing your parents will refuse surgery if they know about the full context of what they are going to go through for the next three hours under the anaesthesia, I think you understand what I mean by saying that there are situations in which the doctor must make a difficult decision to put himself, probably at professional risk for the sake of the patient.
And this is why in this Bill, the construct of a professional value of opinion is still important. Even as we try and shift some of the focus to become more patient-centric, we hope that doctors will not take a defensive approach, but will still continue to advocate the benefits of patients. Mr Speaker, thank you very much.
Mr Speaker: Order. I do need to take a break now. I suspend the Sitting and will take the Chair at 5:10 pm.
Sitting accordingly suspended
at 4.49 pm until 5.10 pm.
Sitting resumed at 5.10 pm.
[Mr Speaker in the Chair]
CIVIL LAW (AMENDMENT) BILL
[(proc text) Debate resumed. (proc text)]
Mr Yip Hon Weng (Yio Chu Kang): Mr Speaker, Sir, I rise to support the Bill. Prior to being a Member of Parliament, I spent many years working as a civil servant in MOH. I can attest to the fact that the practice of medicine is complex. And many aspects may not be easily understood by the general public. A comfortable and trusting relationship between a doctor and a patient is thus very important to bridge this knowledge gap.
Most people, especially the elderly, hold doctors in high regard. However, those who have elderly family members know how challenging it is to convince seniors to consult a doctor or even go for medical assessments. It is worse if the patient is in a state of denial or lack insight.
But in recent years, trust between doctors and patients has been somewhat eroded by a spate of high-profile cases of negligence and unethical practices. There have also been reports of near misses and errors in the prescription of medicine. Hence, the younger generation when accompanying the elderly would often read up on the Internet beforehand. Thereafter, they may ask probing questions often to the chagrin of the doctors. This may then create simmering tensions between parties if there are disparities in treatment goals.
Mr Speaker, Sir, one way to improve the doctor-patient relationship is through good communication. An important area is in the area of consent. I hope the Minister would look into how guidelines can be drawn up for doctors to obtain informed consent, especially in cases where language barriers can be a challenge. Of course, the dilemma is how to provide information that is relevant to the patient to allow an informed decision. This is particularly so for elderly patients.
Taking a step further, I hope the Ministry can support healthcare institutions, especially those frequently used by our seniors, to reduce communication barriers. Every clinic should have at least one person on duty who is trained to speak in the different dialects and local languages with a certain level of competency. This person must be able to facilitate the flow of information between the doctors and patients who can understand only dialects or local languages. When complex terms are delivered in one’s own language, it can reduce the unease the patient may face at a doctor’s consult. It also helps to improve the doctor-patient relationship. It is heartening to read that in Changi General Hospital they were experimenting with i-COMM, an AI to produce communication apps for dialects and mother tongues. We can surely leverage more on technology to help us in this endeavour.
Another crucial factor to improve good communication is for doctors to consider the patient’s profile when obtaining informed consent. The doctor should also consider if such a patient is well-informed, educated or able to understand what is being communicated. It should be emphasised in the Ethical Code and Ethical Guidelines on informed consent that a doctor should consider his patient’s profile when informing them about their medical condition and treatment options.
An example would be elderly patients who may not have completed their formal education. I see many of such seniors in Yio Chu Kang today. They may require an approach where doctors exercise professional judgement by taking into account the benefits, limitations and risks relevant to them and translating that into recommendations. On the other hand, a younger, educated and well-informed patient may prefer a more detailed description of the benefits, limitations and risks to be explained to them. With this knowledge, they will then make their own decision and assessment.
Mr Speaker, Sir, allow me to address the question of complaints against errant doctors. In case of suspected misconduct, patients should not have to face unduly onerous rules to lodge a complaint or request an investigation. On the other hand, I am against families or patients who abuse the professional disciplinary process when their informed choice of treatment did not give the desired outcomes. A balance needs to be struck where a patient has access to justice under a robust system, yet does not abuse the process and take up resources that can be better deployed.
Can the Minister help the House to understand what is the estimated time for an investigation to be concluded at present? And how will this timeline affect any current backlog of cases? It will also be useful if the Minister can share with us plans to clear the backlog.
Next, how can we simplify the process so that it would not be so onerous that it would turn away a complainant from highlighting dangerous practice? I note that cost orders may be imposed if a complaint is found to be frivolous. This should be made known to a complainant, before he proceeds with his action.
Mr Speaker, Sir, anticipating and addressing potential challenges in mediation can make this a meaningful and useful option. I can personally attest to the benefits and advantages of mediation, having served as a mediator in the Community Mediation Centre at MinLaw. We should ideally keep the cost of mediation affordable for patients to take up this route. The ease and relative advantages of mediation should be emphasised. Often, medical disputes arise due to simple miscommunication. Mediation can help to avoid an ugly law suit.
Tapping on the Singapore Mediation Centre or SMC is a good option as the SMC already has expertise. Mediators from the SMC could benefit from training to equip them with knowledge and sensitivities to handle medical-related disputes. I understand that MOHH likewise has a Healthcare Mediation Scheme. Whilst the fractured relationship rarely fully heals, I know for a fact that mediation goes some way in allowing parties to talk face to face and rebuild trust.
In conclusion, I must put on record in Yio Chu Kang Single Member Constituency, we have many pleasant encounters with caring and dedicated healthcare professionals. I believe it is timely that we address all the above issues so that we can further grow the mutual respect between the patient and the doctor in our healthcare system.
Mr Xie Yao Quan (Jurong): Mr Speaker, Sir, I declare my interest as an administrator in a public healthcare institution.
Sir, as our population ages, the number of healthcare encounters in our system will only go up. And as more patients face not one, but multiple conditions interacting with each other in complex ways on the one hand and as therapies become more advanced on the other, the healthcare decisions that doctors have to make will only become more complex.
In other words, this debate about regulating the professional and ethical practice of medicine in our society is not taking place in a static context, but in an operating environment that will become more demanding and more complex going forward. It is therefore a timely debate and one that we must get right, because the stakes are high and will only get higher.
Against this backdrop, we must guard zealously against defensive medicine, because it is bad for everyone.
The US Congress' Office of Technology Assessment defines defensive medicine as occurring when, and I quote, \"doctors order tests, procedures or visits, or avoid high-risk patients or procedures, primarily to reduce their exposure to malpractice liability.\" This was published in 1994. And so, the problem of defensive medicine is a longstanding one. And as Minister Gan Kim Yong noted in this House last year, defensive medicine \"will not only affect doctors, but ultimately compromise the quality of medical care, raising medical costs and harming patient welfare.\"
In short, defensive medicine is bad – it is bad for the patient; it is bad for the healthcare professional and it is bad for the system.
Now, as an example of defensive medicine and this is anecdotal, in one hospital in Singapore, there is a large number of a certain scan that is ordered each year to look for a particular condition of the lungs. From my understanding, the pick-up rate from these scans at the hospital has been less than 10% compared to around 25% in the best centres worldwide. In other words, doctors at the hospital are frequently ordering the scan and a rather expensive one at that, but rarely, finding anything adverse.
This is a specific type of behaviour in defensive medicine known as assurance behaviour. The Minister, in his Second Reading speech just now spoke about a study showing avoidance behaviour, that is when doctors do not order a test when it is appropriate to do so. Assurance behaviour is the opposite, when doctors order tests when it is not entirely appropriate. And yes, it seems to be happening here in Singapore.
In 2017, a major paper published in the Lancet presents compelling evidence on the overuse of medical services around the world. First, there is overuse of medication, the best-documented example being the inappropriate use of antibiotics.
Second, there is overuse of screening tests, even for cervical and breast cancers, and screening colonoscopy. In one country, it is estimated that up to 99.9% of thyroid cancers detected there by way of the aggressive use of ultrasound screening represented over-diagnosis.
Third, there is overuse of treatment procedures. For certain cardiovascular procedures, up to 20% of the procedures ordered have been found to be inappropriate across various countries, despite clear and broadly accepted criteria for what is appropriate.
Now, the study observes that the harm to patients caused by overuse can be physical, in the form of side effects and complications, financial and psychological. The paper concludes that, and I quote, \"The provision of medical services that are more likely to cause harm than good is a global problem that afflicts rich and poor countries alike.\"
Sir, the amendments in these Bills have been made amidst a significant level of disquiet in the medical profession.
The high-profile decisions last year, around specific issues of informed consent and patient confidentiality, had brought this disquiet to the fore, but I think it stemmed from a broader uncertainty about standards of care and a general gap in confidence in the professional disciplinary process and its outcomes.
Members before me have spoken on the merits of specific amendments and I will not belabour these.
I think the amendments, as well as the non-legislative measures, as a whole, are decisive and better grounded in practice realities. I hope this would help restore trust between doctors and the regulatory system and arrest the risk of us sliding further towards defensive medicine, to the detriment of both patients and professionals.
As the hon Member Dr Tan Wu Meng puts it, we must help doctors to help patients, because this is the way to help both doctors and patients.
That said, we must avoid swinging to the other extreme, where patients without medical training or deep resources are left to feel like their access to justice in this system has been compromised. When something goes wrong, we must have a system that works for both patient and doctor.
So, for instance, while I welcome the proposal for an Inquiry Committee to act as a first and efficient level of triage for the merits of a complaint, prima facie, complete facts will become crucial for the Committee to effectively perform its intended function.
I therefore urge the Ministry to look into providing resources to guide lay complainants through the filing process, especially in providing supporting documents and other evidence. This is a key detail in implementation that would safeguard patient welfare.
But while we strike that fine balance at a system that works for both doctor and patient, ultimately, the panacea against defensive medicine cannot be about enhancing a system of recourse and justice for times when something goes wrong. Rather, our surest inoculation against defensive medicine must be that broad public confidence that in our system, things would by and large, and almost always, go right. More to the point, when I am the patient, I must feel that things would go right, for me.
Objectively, this must mean that our system has high standards of quality and safety. Dr Tan Wu Meng has spoken about the roles of both the individual and the system to achieve these. But more viscerally, this is also about the deep human-to-human relationship between patient and doctor. This is why we talk in terms of care, instead of just treating an illness. This is why we talk in terms of the experience, instead of just a consultation or a procedure. And this is why there is a whole emerging field on empathy in medical education – systematically teaching doctors about kindness and compassion. This is why a doctor's \"bedside manners\" matter so much to us.
Indeed, at the University of Texas at Austin, their Medical School and the College of Fine Arts have joined forces to form a Design Institute for Health. It is their way to deliberately bring design sensibilities into healthcare, because design is ultimately about addressing human needs, and they have recognised that healthcare is first and foremost about the human relationship. It goes well beyond a transaction, or a delivery of service.
And if we think about it, our healthcare system is essentially the sum of millions of these relationships, exchanging value on a daily basis and at a micro-level. And so, the system can only work effectively and sustainably when these relationships are thriving, on the basis of a high level of trust. So, when all is said and done, it is time to double down on trust. It is time to double down on both the human relationships and the professional quality in our system.
Amongst hospital management teams here, there is a common saying: we aspire to provide \"care that is good enough for my mother\". And then someone said, perhaps it should be care that is good enough for my mother-in-law. Well, I shall leave it to Members to mull over the material differences. But it is a case of differences but same same. The essential point is this. Beyond legislation and policy, institutions on the ground are working relentlessly at high quality and quality relationships, creating care that is good enough for our own loved ones.
Mr Speaker, Sir, let me conclude. The ultimate paradox for the enhancements in the Bills before us is that one hopes to never have to use these, for when these are invoked, it means a care relationship between doctor and patient has broken down. In such a situation, our structures and processes must become a back-stop, to serve justice efficiently and consistently.
In turn, this prevents the loss of trust in one relationship from spilling over into and eroding the larger system.
All stakeholders – doctors, patients, the professional self-regulatory system, healthcare institutions – all of us need to work hard to maintain and grow this trust, because it is our surest way to guard against a regression into defensive medicine.
Trust is our ballast for a sustainable and effective system to secure our healthcare future and meet the many complex challenges ahead. Sir, I support these Bills.
Dr Lim Wee Kiak (Sembawang): Mr Speaker, Sir, I rise in support of the Bill. I would like to assure the Member who spoke before me that we will provide care for all mothers, fathers, mothers-in-law and fathers-in-law as well.
First, let me just begin by declaring my interest as a member of the medical profession. The amendments are timely as there is a need to enhance the legislative processes to protect patients’ rights as well as to preserve the trust between the doctors and the patient. Currently in Singapore, there is a stable trend of medical complaints against doctors at an average of 214 cases per year over the last five years, range 161 to 259. This translates to 16 complaints per 1,000 medical practitioners. About 20 cases or about 10% of these complaints are categorised under “No/Inappropriate or Inadequate Informed consent”. While the trend is stable now, we are deeply concerned that cases may increase in light of the experience overseas.
Allow me just briefly to share with you what happened in UK, the National Health System or NHS has reported in 2015 that a study found that negligence claims against NHS doctors due to failure to inform patients before they consent to procedures have spiralled upwards since the landmark legal ruling in 2015.
This research was done by Queen Mary University of London, found that while the rate of other claims has remained steady, cases relating to consent have risen fourfold overall since March 2015 – where failure to inform was added as a contributory claim, the rise was nearly tenfold. As a background, let me share that this change follows a landmark Supreme Court judgment – known as Montgomery judgment – that changes the legal test for determining what is sufficient disclosure before consent is given to treatment, by moving away from asking what a reasonable doctor would warn and asking instead to what a reasonable patient would expect to know. It would be relevant to add to my understanding that even the wisdom in the Montgomery case now is an issue being debated in the legal circles.
The key is how is a doctor to strike a balance between an information overload for the patient versus too little information. With all due respect to all our patients, they are all different. Some may not understand the choices before them, especially where the choices are scientifically complex. And doctors would only be adding to emotional burden of the patients, causing alarm and confusion unnecessarily. Hence, the materiality of information is a real challenge.
Of course, the patient could have his family members or her family members to explain to him or her and hopefully there is no loss of critical information in the course of the communication. For many healthcare practitioners, working with seniors and foreign patients who do not speak any of our four national languages poses one of the greatest challenges. In a small clinical set-up, there is simply a shortage of resources with the necessary interpreting skills as well. And medical terms are complex. In cases of complications as a result of lack of informed consent, who would be liable? The doctor for failing to obtain the consent, or the interpreter for misinterpreting?
Apart from doctors, patients too would have a responsibility to share more about their personal health, for example, their health history and habits which in a consultation in the presence of family members the patient may not find it convenient to share their full disclosure to the doctors.
With increasing medical litigation, the medical indemnity insurance premium paid by doctors are also rising exponentially year after year. In US, the annual medical indemnity insurance premium paid by practising obstetricians last year can be as high as a quarter of US$1 million per year. Many of the US O&G specialists gave up practising obstetrics simply because they just find that their earnings are not enough to cover the premiums or the risk being sued is too high to bear. I hope in Singapore, we will not move in that direction. If we do, ultimately the consumers, our patients, will bear the cost.
In the last two years, I and a few Members of Parliament brought up in this Chamber the inappropriately harsh penalties given to doctors by Singapore Medical Council's Disciplinary Tribunal and we were concerned with the rising trend. This will lead to defensive medicine if left unchecked and a further escalation of medical costs to all of us. I would like to thank MOH, especially the work group on this amendment for their hard work meeting so many stakeholders and holding so many focus groups discussions to bring to this House today this amendment.
This amendment will affirm our patient’s rights and at the same time give some clarity and assurance to our medical fraternity on a fair and expeditious system that handles medical complaints by SMC.
I have three clarifications.
Number one, the increase in cost and resources to SMC. According to SMC annual report, SMC spent nearly $2 million in 2017 and $1.6 million in 2018 for legal expenses for disciplinary proceedings.
The setting up of more layers to handle public complaints will require more manpower and resources. What is the estimated increase in running cost of the SMC when this legislation takes effect? Can MOH give more grant to SMC to offset the increase in cost? The changes also call for more doctors to come forward to serve on SMC’s committees. Currently, how many doctors are serving on the SMC to handle public complaints? How many more doctors will be required with this new proposal? What are the plans? What plans do MOH have to increase the number of doctors serving in these committees and how do you attract them?
With increasing cost involved, will SMC consider levying a small administrative fee for public to file their complaint? Just like CASE or Small Claims Tribunal. By charging a small fee, it may also deter frivolous complaints too. I know for now MOH is not considering leveraging an administrative fee for public who file complaints but I hope MOH will consider this later?
Number two, on medical records. In one of examples cited in the legislation stated by the Minister just now, it states that the doctors need to go through old medical records to sieve out information which may be material to the case. In the example given, a patient with history of eczema had skin complications after undergoing an orthopaedic surgery. The orthopaedic surgeon is liable because the surgeon failed to look through the old notes which stated the patient had eczema recorded many years ago. I would like to seek clarification on this example as some of our patients with chronic diseases may have decades of medical history running into many volumes of clinical records. Is it the duty of the doctors to go through all old notes even stored in microfilm? I know as a medical practitioner we are required by law to keep our medical records for seven years. Is there a time bar for the medical records in this example?
Number three, mediation. I am supportive to have mediation as a mechanism to resolve some of these complaints before the case is being escalated to the Disciplinary Tribunal or the Courts. For mediation suggested in this amendment, is it mandatory? Is there additional cost involved in mediation? Currently, our medical indemnity insurance covers doctors for medico-legal claims but I understand from some of my medical colleagues, the insurance companies are not obliged to accept mediation and may not pay for any cost involved in mediation. Can this legislation make mediation mandatory and also make it mandatory for medical indemnity insurers to honour and cover the cost of mediation if mandated by SMC? Mr Speaker, I support the Bill.
Mr Zhulkarnain Abdul Rahim (Chua Chu Kang): Mr Speaker, Sir, I rise in support of these amendment Bills. I thank the Second Minister for Law for the explanations to the amendment Bills.
I note with interest in the Medical Registration (Amendment) Bill, the introduction of an Inquiry Committee in the proposed framework for the Singapore Medical Council’s Disciplinary Process as envisaged in the Bill. This new committee would sift through at first level, those frivolous and vexatious complaints before they even reach the Complaints Committee.
The Inquiry Committee would thus be able to either dismiss a complaint, issue a letter of advice or refer the matter to the Complaints Committee and also to refer for mediation. The Inquiry Committee would also be able to refer the matter to mediation before making these orders. To prevent the filing of frivolous and vexatious complaints, the Inquiry Committee and the Complaints Committee also have power to order costs against the complainant.
All of these measures are necessary and welcomed. They balance both the interests of the patient or the family, usually the complainant, and that of the doctor being complained of.
I draw parallels between this Inquiry Committee and that of the Review Committee of the Law Society of Singapore. We can draw lessons from similar amendments to the Legal Profession Act or LPA. Those amendments were back in 2001 which had introduced a Review Committee. The function of the Review Committee in the LPA is also to review each complaint and dismiss those that are \"frivolous, vexatious, misconceived or lacking in substance\".
In a 2018 Court of Appeal case Re Nalpon, Zero Geraldo [2018] SGCA 71, the decision of a Review Committee in the LPA was challenged by way of a judicial review. The case involved a complaint against lawyers by another lawyer. The complainant challenged the decision of the Review Committee, saying that it had made its decision in just seven days, provided only a brief statement of its decision and did not even call the complainant or the lawyers that was the subject of his complaint to provide any further information or clarification. Although the judicial review challenge ultimately failed before the Court, the case highlighted the risk of protracted litigation if the first stage of the Review Committee and, in this case, the Inquiry Committee does not sufficiently manage or meet with the complaint's expectations, especially in those cases involving lay persons and grieving families.
It will help to conclude the matter efficiently, but for complainants, especially the families, they need closure sooner rather than later.
A couple of weeks ago, a resident informed me that her pregnant sister-in-law suffered severe bleeding while under the care of a hospital. She delivered her baby prematurely and because of some complications, the baby now suffers from permanent brain damage. They are a young working couple and that was their firstborn. They are now questioning the standard of care that they were given.
In the past month, I attended a wake of a deceased elderly parent of a long-time resident of mine and volunteer. The daughter questioned whether early detection and intervention by a particular doctor would have saved her mother’s life. These are questions that families in grief are grappling with.
These families may or may not probe further or proceed on in their actions. But if they do, then this system of regulating the complaints against doctors and the medical profession must not only be efficient but it also must be humane in the way it explains the true situation and circumstances to the families in grief.
This Bill thus must be seen in the light of its true intentions. It is not intended to shield doctors against complaints but it is to balance all interests and ensure protection and adequate recourse for patients and families.
I say all this from personal experience. In 2011, a close relative suffered complications after surgery and passed away in the hospital. She was young. Her parents had not seen her graduate yet. She had a full life ahead of her. Naturally, in a time of tragedy and loss, the parents sought answers to explain their loss by questioning the system and the treating doctors and hospital. That process took more than two years, which ultimately found that there was no wrongdoing or negligence by the treating doctors. Although there was finality to the process, the sheer duration did not give the family any closure nor heal any wounds. Nothing can beguile parents from a loss of a child so overwhelming or assuage the anguish of their bereavement.
It is thus important to quicken the complaint process and disciplinary procedure, which is what this Bill aims to do so as well.
In this regard, I note that the first stage of the initial review and triage by the Inquiry Committee is envisaged to be completed within a general timeline of about five weeks. The second stage of the inquiry by the Complaints Committee would take another three to four months to ascertain if the complaint proceeds on to the Disciplinary Tribunal, which is the third stage.
I am heartened that a legal advisory unit will be set up to support and advise the Inquiry Committee. With greater medical knowledge and public awareness and increasingly complex medical situations, there would be more cases in which doctors may be faced with complaints. Perhaps legal aid access can also be extended and provided to laypersons who have legitimate complaints and require assistance to file complaints.
I am very grateful to Minister Edwin Tong for his clarifications and I seek the Ministry's assurance that adequate resources and manpower be provided upfront to the Inquiry Committee to cater and address these complaints filed by complainants or their families and their next-of-kin quickly, efficiently, satisfactorily, because although they are looking for a lifeline, they cannot be made to wait a lifetime. Mr Speaker, Sir, I support the amendments to these Bills.
Mr Speaker: Minister Edwin Tong.
Mr Edwin Tong Chun Fai: Thank you, Mr Speaker, and thank you to all the hon Members who have spoken on this Bill and in support of this Bill.
Let me just go straight into the heart of the Civil Law Act issues raised by Dr Tan Wu Meng, Mr Murali Pillai, Mr Vikram Nair, Dr Lim Wee Kiak, amongst others. Let me start by picking up on what Dr Koh Poh Koon said. I think he has given a very vivid explanation of why doctors need to feel that they are able to take some risk with the patient, able to advance the patient's interests in the best way that they know how to do. Knowing the information that they have, making the judgement that they do. And in some ways, trying to make the best decision and guide the patient towards that best decision sometimes does require the doctor to take a position – to exercise some degree of therapeutic privilege and to assess the kind of information that ought to be appropriate for not just this kind of injury and this kind of outcome but for this kind of patient and their family and overall, not losing sight of the end outcome.
I would dare say that the majority of doctors want to be in that position where they do not have to look over their shoulder, they do not have to worry about what the patient might say and worry first about whether or not they have given everything to the patient based on the textbook. I think that is really an illustration of why the practice of medicine is truly an art and is not a science. It is an inexact art to begin with. It is a judgement call in every sense of the word.
It is in that context that we start with the proposition that we do not want to place labels on the test. It should not be pro-doctor or pro-patient. That is why Mr Pillai is right that in this Bill, we have deliberately stayed away from putting that label on. Yes, it was discussed in the context of the previous decisions. That is the terminology that has been used. The work group has also used that terminology, but we have chosen to make sure that we stay away from it – as far as we can, to advance it as a common denominator of benefiting the patient and the doctor together.
Sir, Mr Pillai asked – why change the test? What do we see as the value of making this change?
Sir, I just want to make reference to one statistic.
Earlier on, Mr Xie, Dr Lim Wee Kiak had talked about what the position was in the UK post-Montgomery, and I think there is a lesson to be learned there as well – the number of cases not just post-Montgomery but in respect of informed consent post-Montgomery. But look at the position in Singapore based on cases filed with the SMC. On informed consent complaints, there was an average of one per year from the years 2010 to 2016. It became five per year in 2017 and 2018 – roughly around the period of time that Hii Chii Kok was decided. In 2019 alone last year, there were 17 cases – 17 cases filed in respect of alleged informed consent breaches and drop in standard. That was in the year around the period of time when the Lim Lian Arn DT or Disciplinary Tribunal was decided.
To Mr Pillai's point – and I get your point that perhaps if it is just a perception, why not we just deal with the perception. But the point I am making is that the perception actually results in there being tangible impact in the way the complaints are brought, in the way that damages have gone up over the years. And so, in Singapore, between 2017 and 2019, it is a threefold increase. That is a sign that we do need to do something about it.
We therefore look at the test as trying to give doctors that degree of assurance when they first walk into a consultation room. The test starts with, as a matter of philosophy, what would my peers do in that situation? A peer might be a peer like Dr Koh's peers, who would decide that in such a situation, there is something to be gained by exercising therapeutic privilege. It is not something that patients easily understand if you look at it from the patient's perspective.
I want to make one other observation, which is that in every single case where the patient's perspective is called into question and you have to assess what is the patient's perspective – whether it is a quasi-criminal case when it is before the Disciplinary Tribunal or DT, or whether it is a civil liability case – at that juncture, when you are assessing and talking about the patient's perspective, there is already an adverse issue between the patient and the doctor. The claim has already been made or the complaint has already been made. That is why you are looking at the patient's perspective. The patient's perspective is going to be very different.
So, if you are a doctor, you think about walking into a room. You think about the therapeutic privilege that perhaps Dr Koh might think about, and then worry about whether or not at some stage downstream – not in the light of this fairly amicable discussion in the consultation room today – but you think about what might happen if you start the inquiry as, \"What would that patient in that particular perspective want to know?\" Then, I think the outcome might well be very different or at least perceived to be very different. There is going to be a tangible impact on the way you conduct yourself as a doctor.
We therefore want philosophically to start with giving the doctors the assurance that when you walk into a room with a typical patient, average patient, this is what the practice of peer professionals would do. As long as you conform with that as a starting point, that is your baseline. As I mentioned earlier in my speech, it is the baseline standard.
How do we assist this? Well, we also want to work with the professional bodies like Academy of Medicine of Singapore or AMS. AMS has got several chapters. We want to work with them to ensure that as far as they are concerned, for some of these more standard procedures, there is a benchmark that can be used to educate and inform doctors.
Earlier on, a Member said: let us not wait until these cases are decided by the Court, because by that time, it is too late – at least for that case. We agree. We want to proactively look at what we can do, working with the fraternity to help the fraternity understand this better. We also want to amend the ECEG as I said earlier on to give better guidance to doctors on how these guidelines are to be applied.
We want to do training. Many of the Members have mentioned and we have made a commitment to training in perhaps the boldest possible way by setting up a separate body, the Disciplinary Commission (DC), to look specifically at training, to make sure that the members who sit on the Complaints Committees (CCs), on the Disciplinary Tribunals (DTs), on the Review Committees (RCs), on the many \"Cs\" that someone has spoken about, are all of sufficient standard and not just at one point in time but are continually refreshed.
To Mr Pritam Singh's point about Recommendation 3 in the work group's report – yes, that is something that we will continue to look at, put in place and with due course, to have sufficient level of guidance for the medical fraternity.
Going back to this test, we therefore start with, \"What would my peers do in a typical consultation like this?\" But we graft onto it what we regard as giving primacy to the patient's inquiries.
If you go in and you do not say anything, we have some rules that set out what a doctor has to reasonably ascertain. I will come back to that in a moment. But if a patient asks a question directly, expresses a view or a concern, then even if that view of concern might not be regarded by the peer professional test as being material in every consultation, that still has to be answered by the doctor. That still has to be addressed by the doctor to their satisfaction.
So, if I am a doctor and you ask me about a concern that is otherwise not within the radar of the peer professional opinion, I still have to address it, I still have to get my information to you correctly on what is the risk for this particular type of very small injury, which may not be material to many other people but to this patient, it is. This is my patient, I have to address it.
That is how we strike that balance between certain starting points for doctors, but also taking into account patient autonomy.
On this second question about what might be reasonably looked at and what is material. To Dr Lim's point, we do not need to look at all the medical records, all the microfiches, all the scans. That is not reasonable. If you ask me today, standing here, can we come up with a formula for what is reasonable, I think that is not possible. I think Members know why. Because it is very situational, very fact-specific, fact-dependent. I hesitate even to say but probably the longer, further back a medical record is, the scan is – 10, 12, 15 years ago – the less likely it is to be relevant. I would not rule it out but the less likely it is. It probably would have been superseded by something else. It is really designed with the illustrations to give some degree of fluidity and some flexibility to look at the particular situation.
With this framework, and I think Mr Vikram Nair also said, actually this is something that is very familiar territory. Not every detail needs to be given and within this framework, I think most doctors, if not, at least the lawyers would know, what is the peer opinion? Who are the peers? Who would qualify as a good, decent peer? What is an opinion that is logical, defensible, internally consistent? I think lawyers all know this. Then, you graft onto it – what did the patient ask or if the patient did not ask, what is reasonable to derive from the information before you?
That is how we see the test operating. In some ways, to answer Dr Tan's point, we had to put out legislation to deal with this partly because we saw this was how it was going. We looked at the numbers that have been cited by myself and Members. We looked at observations of the work group. We understand where this is going and we understand that it might be a perception and it might well even be wrong. But that is the way in which the industry is reacting to it and I think it behooves us to do something about it. That is why these amendments have been offered.
Sir, let me now move to a point that was raised by Mr Pritam Singh about the implication of a test like this for a busy polyclinic setting. That is a fair concern and the point is taken. Anything that has got to do with putting on more workload and the workload then perhaps undermining the quality of care is something that MOH would be concerned about. And I would like to assure Members about that.
But I would also like to say that we need to frame a test now which best promotes the doctor-patient relationship, gives that relationship the best chance of having a good interactive discourse that promotes the best outcomes. That has to be the starting point. Yes, there might be an increase in workload – although I do have something to say about that in a moment – but that ought not to be the starting point. That should not drive the way we define or formulate this test. We may have to find ways to work around it, to put better resources in public hospitals or polyclinics. But, as in designing the Civil Law Act test, I think we must first focus, and perhaps only focus, on what is good for the patient and doctor in that relationship.
Anecdotally, I also do not see this formulation adding more to the current status quo. It might add more to what might have been the old Bolam test. But on the current modified Montgomery test, I do not think this formulation would add more by way of the time that you take to consult. I have also had a quick look at the polyclinic caseload over the years and I believe the numbers have been relatively steady in the past three to five years in terms of the caseload, roughly per consultant per day. In fact, if anything, you take that back 10 to 15 years, the numbers actually have come down. But that said, I appreciate the point made by both Mr Pritam Singh as well as Dr Tan Wu Meng about looking after the systemic issues. We will do so.
Mr Louis Ng asked what might be an idiosyncratic reason. I think I have addressed this. But I will just briefly mention that an idiosyncratic reason is just a reason that is peculiar to that patient. It may not be relevant or material to many other patients or most other patients or, in fact, maybe even any other patient. But if to that patient it is, and he has asked the question about it, then the doctor is required to address those concerns.
Mr Pritam Singh also asked what do we do with a multi-disciplinary team setting. I would just like to say that, actually, in today's context, most care is given in that setting. If you go to a polyclinic, there is a team that looks after you. If you go to a PHI, a public hospital, there is also a team that looks after you. And the law actually takes that into account. The law does not require that only one doctor, the leading doctor, takes the consent. The law does accept that any member of the team can take the consent. But, obviously, the requirements of the consent-taking has to be fulfilled. You have got to give the right information, you got to ensure that the patient understands and so on. There have been several cases, the most recent of which is the case involving Dr Yeo Tseng Tsai, a decision decided last year where the Courts commented and I would just quote from a small portion of it at paragraph 50 of the Judgment where the Court says that \"...in a public hospital that practises team-based care, it is reasonable for other members of the operating surgeon's team to explain the risks of the proposed treatment and to obtain the patient's consent on the surgeon's behalf.\" And that is a point that is quite consistent across several other decisions in the High Court in Singapore.
To Mr Pritam Singh's point that we must look at this more frequently and regularly, we agree. That is actually quite a baseline consideration, given that medical technology innovation is changing, evolving, and we do want to ensure that our system that looks after discipline has the public interest of the patients at heart, is constantly updated and kept updated with technological progress.
Mr Louis Ng asked several questions, one of which was in relation to the cases that can go directly to a DT. He asked why the SMC was allowed to retain some discretion in doing that. The answer to that is that it depends on the nature of the case and it gives the SMC some degree of latitude in terms of assessing the case. The SMC themselves will then play a more proactive role in reviewing and determining whether these cases ought to be directed to the DT straightaway.
Mr Louis Ng also asked about the interim orders and the fact that the interim orders committees have a wide remit to determine what is necessary for the protection of members of the public or otherwise in the public interest. That is put in that form so that it can allow the IOC to take into account a broad spectrum of matters, including how it affects public interest, when it might affect public interest and the kind of occasions or risk factors that a doctor is exposed to in any given scenario and, therefore, tailor the way in which the IOC orders are sought accordingly. So, we do need to give some degree of assessment on the ground. But to illustrate the point that these orders are not made lightly, Members may be aware that it has been used twice in recent times – one against Dr Wee when there was a Court decision in relation to his conduct, and there was also a case involving Dr Ler Teck Siang who was involved in the leak of data from a HIV registry. So, these were the two recent cases, by way of examples, to assure Members that this is not going to be used at a very low threshold.
Dr Lim Wee Kiak and Mr Louis Ng asked about the composition of non-SMC members currently at the Complaints Panel, and the resourcing issues that we will have to address post-passing of this Bill. Let me just inform Members that, currently, there are 89 doctors who are not SMC members and there are 50 non-doctors on the Complaints Panel. The 50 non-doctors comprised 18 legal professionals and another 32 lay persons. That, in part, also answers Mr Leon Perera's point about the way in which we will engage patient advocacy groups.
Looking at these numbers, the representation by lay persons, or rather non-doctors, is not small and not insignificant. And the role they play directly in the process in the Complaints Committee, in fact, in several other committees that are set up in the SMC, that takes into account the non-medical, non-doctor input as well.
Moving forward, once the amendments are in force, the SMC intends to have minimally 120 doctors and 60 lay persons and legal professionals on the Complaints Panel. Obviously, we look at the volume of cases to determine whether or not that will be sufficient. But looking at the statistics, the numbers and what we forecast, these are the numbers that we intend to start with once the Bill is operationalised and then we can decide whether we want to move up thereafter.
Mr Louis Ng also asked about the IC. The IC will share the reasons, as I have outlined in my opening speech, for its decision, so that members of the public who have complained and the complaint is being dismissed by the IC will be aware not only of the decision but also of the reasons for the IC reaching that view. Why the IC? The reason for the IC is that it needs to act as a stronger filter. Today, yes, we have 6% to 7% of cases that are filtered away from that. But let me cite the Lim Lian Arn example to Members. In Lim Lian Arn, the Court of Three Judges felt that there was a miscarriage of justice and one of the factors they looked at was to analyse the complaint and they formed the view that even if the complaint was taken in its extreme, that means, you accept every fact set out by the complainant as correct and true, that still does not amount to professional misconduct.
And there was a very detailed analysis by the Chief Justice in that case. And those are precisely the type of cases that we want to be able to filter at the IC. The IC, together with legal resources, we feel will be better equipped to look at these cases, apply the law to these cases early and upfront, rather than, as in the case of Dr Lim's case, have the case travel through the system for a good four or five years, using up resources in that period of time, only to be thrown out at the hearing of final reckoning, at the last stage. So, that is what we want to do – to move the decision-making, move the resourcing upfront, and have that dealt with as early as we can.
Mr Yip Hon Weng and Mr Louis Ng asked for some timelines and also about some resourcing. How long does it take for the investigation to be concluded at present? It varies. But over the last five years, based on data, the average time that it takes to conclude cases at the CC is about 18 months. Some are a little bit longer. In fact, some take more time than this.
And then cases referred to the DT take an additional 23 months. So, two more years on top of this. We are trying to put everything into a system where, on the average, between 18 and 20-22 months, we are able to complete the entire process.
In terms of cases and backlog, the SMC has been working very hard to come up with a lot more resources and they have also used standing committees for the Complaints Committee and close to 90% of the stock of outstanding complaints as at September 2019 – that means all the complaints up to September 2019 – have been concluded by early September 2020. So, we have the remainder of the last quarter of 2019 cases standing, and then we are into 2020 cases.
Over the last two years or so, the SMC had worked very hard and managed to resolve many of these cases. As I have explained to members, this new regime will not be able to apply to existing cases. So, the existing cases still have to follow the current track and the current timelines. Cases filed once this Bill is in force will enjoy the new track.
Dr Tan Wu Meng, Mr Ang Wei Neng and Dr Lim Wee Kiak are all obviously very concerned about what Minister Gan might have to do to ask Deputy Prime Minister Heng, seated next to him now, for additional resources. I wanted to say that these are changes that we have made which we believe will enhance the system. You either spend on the system having a case travel through like I have explained in Dr Lim's case and incur a lot of resources and, at the same time, you do not really get any good outcomes as far as the doctor or the patient is concerned. Rather, we think resources are better spent putting upfront legal resources, mediation resources and a good filtering system. And, yes, that requires manpower and also resources.
Some Members are concerned whether we will have sufficient resources to support the new structure. I am happy to say that MOH has said that they will not pass on these costs to the patients and, as far as possible, not to the doctors. The reason for this is because the grants have been given to SMC to look at setting up these structures to look at redeploying what we have currently used, by way of resources, to deal with the cases which have taken four, five years or so to deal with but applying them upfront. So, we feel we can manage with the current resources. If not, we can top it up with some more, and I think Minister Gan will have to approach the Deputy Prime Minister for that.
But the idea is to be cost-neutral as far as possible because we believe that this is in a public interest. It is a system meant to safeguard patient welfare, public interest and public confidence in the system. That is why, like Dr Lim Wee Kiak had suggested, we also do not want to put a financial bar in front of every complainant before you can make a complaint to the SMC. That was something that was actually canvassed quite robustly at many of the town halls to put a fee upfront before a complainant can make a complaint. But we studied it and we decided, as did the work group, that we did not want, and it was against public interest, to put a financial bar to patients to file a complaint.
Instead, we decided that we will empower the CCs and the DTs to grant costs in the appropriate cases. My colleagues, who are lawyers in this House, will know that that is used very sparingly. The power does exist in the Legal Profession Act. It is used very sparingly and, really, as a measure of last resort to ensure that these frivolous vexatious claims do not continue.
Mr Leon Perera supported the Bill and said that it is in the right directions, which I appreciate, and also raised several suggestions for us to consider. I think he had about 10 or 12 suggestions. I cannot cover them all here in today's response. But I will respond to a few.
In terms of the time bar and the limitation period, why was there a difference? The reason is because when we have a complaint, as I have mentioned just now, about a doctor's conduct, this is an issue of public interest in itself because we are talking about upholding standards and confidence in the way in which doctors give treatment to patients. So, compared to a civil or commercial time bar where you are locked out from making a monetary claim, for example, or a claim for land, you are locked out after six years or such other period as the time limitation might prescribe. Those come on a very different footing from trying to look at complaints or entertain complaints outside of the time bar when you are talking about upholding public interest.
Second, in terms of the certified training, I think I have covered part of it in my response to Mr Singh's suggestion of Recommendation 3. But certainly, that will be taken up. We do want to enhance training. It is a very significant plank of what we have proposed here, as you have heard me saying. But that should also be taken in conjunction with the sentencing guidelines that have now been issued. We also want to remind Members that we have a legal unit that will support each of the committees across the spectrum of when they review the cases.
Mr Perera is right that there are already training programmes that are on-going now today. I am told that they have been fairly well attended until there was a break during the last few months because of COVID-19. But there has also been specific training not just for the members of the CC and the DT because they require more specialist training, but also encouraging doctors, as a whole, even if you are not involved in the CC or the DT, to have at least some basic knowledge of medico-legal principles. And I think that overall, with time, would help the appreciation of the standard of care, would help in appreciation of how doctors are to interact with their patients.
Mr Perera talked about whether we could recognise the support and remunerate persons who sit in in these Tribunals. Mr Perera may wish to know that, as of now, we already give an honorarium of $800 per day to a member of the DT. For members of the CC, there is also some amount but it is smaller, having regard to the fact that they play a lesser role in a sense that their time commitment is not as severe. But it is also very difficult, as I think Mr Perera also noted, to quantify the amount of remuneration to give. When you are designing a system that is meant to be a self-regulating system, then people within that system must step forward. I heard Dr Lim Wee Kiak say that we must encourage more members to come forward. And indeed, that is true. This system is really only sustainable if the best, the most experienced, those who can afford the time and even those who cannot afford the time, should step forward and serve in some capacity in the CCs, in the DTs, in the RCs. And it is not just because of the honorarium or the financial compensation.
On the SMC composition, I mentioned this at the outset, as it stands today, the number of persons nominated by the Minister has come down, and if you take into account the fact that the representation on the professional bodies, which are themselves elected by members of the medical profession – either the Academy of Medicine, College of Family Physicians Singapore or the SMA – then I think you will find that actually, after today's amendments, the cross representation and the spectrum of representation on the SMC of the medical fraternity is far broader and the numbers elected would outnumber the numbers appointed by the Minister.
Sir, I think I have covered, as far as I can, all the critical points. I know that I would have omitted some and I beg the Members' indulgence. We are prepared, after this Bill is passed, to take any of the further suggestions offline with the Members directly because the suggestions are good suggestions. And to borrow a phrase from my colleague, \"No one has a monopoly over good suggestions\". So, we welcome suggestions even after the Bill might be passed. Sir, with that, I beg to move.
Mr Speaker: I thought that was compassion. Any clarifications?
[(proc text) Question put, and agreed to. (proc text)]
[(proc text) Bill accordingly read a Second time and committed to a Committee of the whole House. (proc text)]
[(proc text) The House immediately resolved itself into a Committee on the Bill. – [Mr Edwin Tong Chun Fai]. (proc text)]
[(proc text) Bill considered in Committee; reported without amendment; read a Third time and passed. (proc text)]
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Medical Registration (Amendment) Bill","subTitle":null,"sectionType":"BP","content":"[(proc text) Order for Second Reading read. (proc text)]
Mr Speaker: Minister Edwin Tong.
The Minister for Culture, Community and Youth and Second Minister for Law (Mr Edwin Tong Chun Fai): Mr Speaker, Sir, on behalf of the Minister for Health, I beg to move, \"That the Bill be now read a Second time.\"
The contents of this Bill have been debated in Parliament earlier in conjunction with the Civil Law (Amendment) Act amendments. I beg to move, \"That the Bill be now read a Second time.\"
[(proc text) Question put, and agreed to. (proc text)]
[(proc text) Bill accordingly read a Second time and committed to a Committee of the whole House. (proc text)]
[(proc text) The House immediately resolved itself into a Committee on the Bill. – [Mr Edwin Tong Chun Fai]. (proc text)]
[(proc text) Bill considered in Committee; reported without amendment; read a Third time and passed. (proc text)]
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Exempted Business","subTitle":null,"sectionType":"OS","content":"Mr Speaker: Senior Minister of State Zaqy Mohamad.
The Deputy Leader of the House (Mr Zaqy Mohamad): Mr Speaker, on behalf of the Leader, I beg to move, \"That the proceedings on the business set down on the Order Paper for today be exempted at this day’s sitting from the provisions of Standing Order No 2.\"
[(proc text) Question put, and agreed to. (proc text)]
[(proc text) Resolved, \"That the proceedings on the business set down on the Order Paper for today be exempted at this day's sitting from the provisions of Standing Order No 2.\" – [Mr Zaqy Mohamad.] (proc text)]
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Housing and Development Board (Amendment) Bill","subTitle":null,"sectionType":"BP","content":"[(proc text) Order for Second Reading read. (proc text)]
The Minister for National Development (Mr Desmond Lee): Mr Speaker, Sir, I beg to move, \"That the Bill be now read a Second time.\"
The Bill seeks to amend the Housing and Development Act in four areas.
First, it will allow approved financial institutions to use their security interest in property loans involving HDB flats as security for liquidity from the Monetary Authority of Singapore or MAS.
Second, it will enable compulsory acquisition action to be taken, as a measure of last resort, against flat owners who deliberately make misleading or false statements, or misrepresent a material fact, when transferring a flat between related persons.
[Deputy Speaker (Ms Jessica Tan Soon Neo) in the Chair]
Third, it will standardise the forum in Court to which HDB applies to deposit compensation related to compulsory acquisition, or to deposit compensation when the flat is vested in HDB.
Fourth, it will enhance HDB's ability to manage its Board appointments.
Let me go through these areas in turn.
First, let me set out the proposal to allow approved financial institutions to use their security interests in residential property loans involving HDB flats as security to access liquidity from the MAS.
Like other central banks around the world, MAS lends to banks against good collateral, if the need arises, to tide them through short-term liquidity needs or times of financial market volatility. Timely and ample liquidity provision by MAS can pre-empt and mitigate liquidity strains in banks, reducing the likelihood of spill-overs to the broader economy.
On 28 September 2020, MAS launched a Singapore Dollar Term Facility to provide banks an additional channel to borrow Singapore dollar funds at longer tenors with more forms of collateral. MAS is introducing this Facility pre-emptively, in light of current economic headwinds, to provide greater certainty of access to central bank liquidity. This will help to contain any liquidity strains before they pose a serious challenge.
MAS intends to accept the security interests in residential property loans, for both private property and public housing, as security to enhance the banks' access to MAS' SGD lending facilities. While banks in Singapore are well capitalised and maintain healthy liquidity buffers, greater and more certain access to MAS liquidity will strengthen their resilience to any future financial market stresses. Strong and stable banks are in a better position to support the financing needs of individuals and businesses here in Singapore. The acceptance of security interests in residential property loans as security for central bank liquidity is an established practice among major central banks around the world.
Clause 4 of the Bill will therefore lift current prohibitions in section 51(1) of the Act in a limited way by allowing approved financial institutions to pledge their security interests in residential property loans involving HDB flats as security to MAS in exchange for liquidity.
Let me assure this House that HDB flat owners will not be adversely impacted in any way by this. In particular, this arrangement will neither affect flat owners' rights to their flats, nor result in any change to the terms and conditions of their housing loans. Over the period where the collateral is being pledged to MAS, HDB flat owners will continue to service their housing loans with the approved financial institution.
In the highly unlikely scenario where an approved financial institution defaults on its loan from MAS, MAS will take over the residential property loans and HDB flat owners will be asked to re-direct their loan repayments to another approved financial institution appointed by MAS. The terms and conditions of their housing loan will, for all purposes and intents, remain exactly the same.
Let me move on to the second batch of amendments in the Bill.
Currently, under the Housing and Development Act, HDB is empowered to compulsorily acquire flats if owners commit major infringements, such as unauthorised subletting. Compulsory acquisition is a decision that is not taken lightly and is generally invoked only as a last resort or for very egregious infringements. Unfortunately, such powers are necessary to allow HDB the ability to take commensurate action against the very small minority of flat owners who flout HDB's rules, and to safeguard our limited public housing supply for those who need it.
Today, the Act allows compulsory acquisition action to be taken against flat owners who deliberately make a misleading or false statement, or a misrepresentation of a material fact, in relation to their purchases of the flats.
Clause 6 of the Bill will extend these powers to instances where the flat or an interest in it has been acquired from a related person, or an interest in the flat has been transferred to a related person. This will enable HDB to undertake compulsory acquisition if flat owners had intentionally made misleading or false statements, or misrepresented material facts in the transfer of flat ownership.
The incidence of such cases is very low. Nevertheless, this will strengthen HDB's position to take compulsory acquisition action as a last resort should owners prove uncooperative and refuse to regularise the ownership of the flat.
The next amendment, set out in clause 5 of the Bill, is purely administrative.
Currently, when a flat owner passes away and there is no surviving co-owner, family members who are eligible may apply to take over the ownership of the flat. However, there are situations where there is no one to take over the flat. In such cases, HDB may step in and have the flat vested in HDB instead of leaving the flat vacant for a protracted period. HDB will compensate for this vesting. However, if there is no party to receive the compensation, or if there are disputes as to which parties it should be, HDB will apply to deposit the compensation with the Court where the compensation is held until there is a claim or the dispute is determined.
Clause 5 changes the judicial forum to which HDB applies to deposit compensation related to the vesting of a flat on the demise of the owner, from the High Court to the Registrar of the Supreme Court. This is to streamline the process for HDB and the Courts. There will not be any material change or impact on processes, other than a change in the judicial forum hearing HDB's applications for payments into Court.
Finally, and this is the fourth set of amendments, the Bill will make amendments to enhance HDB's ability to manage its Board Appointments.
Since HDB’s establishment in 1960, it has benefited from the strategic guidance of its Board in the performance of its statutory functions, and the development of plans and programmes. The diverse expertise of its Board members has also helped HDB to navigate challenges, and to develop as an organisation.
HDB sees the need for more diverse views, experience, and skillsets on its Board to guide its efforts in providing even better-quality homes and continuing to enhance the HDB living environment in a financially sustainable manner. These efforts will benefit from fresh insights, for example, in the areas of new technology that can help us develop greener, smarter, and more sustainable towns, and in the area of healthcare and ageing issues to guide our efforts to provide a quality living environment for an ageing population.
Clause 2 of the Bill therefore increases the maximum number of Board members to 15, up from 12 currently, to allow HDB more room to bring in additional expertise and new perspectives to complement the existing Board. The other Board-related amendments in clauses 2 and 3 are more administrative.
First, they clarify that the Deputy Chairman position is a discretionary one and will only be appointed by the Minister when required. Second, they will allow the Minister to temporarily appoint an acting Chairman, Deputy Chairman, or Member of the Board, in the event any of the individuals holding these positions is absent from duty or from Singapore. Third, the amendments will update the quorum for Board meetings to one-third of the total number of Board Members in office. Mdm Deputy Speaker, I beg to move.
[(proc text) Question proposed. (proc text)]
Mdm Deputy Speaker: Miss Cheryl Chan.
Miss Cheryl Chan Wei Ling (East Coast): Mdm Deputy Speaker, with COVID-19's business and individual relief soon expiring in the months ahead and the business climate still remaining sluggish, there is a likelihood that businesses and individuals will require more credit lines to tide over the crisis. For MAS to establish a new Singapore dollar Term Facility to provide liquidity to local banks in Singapore through inclusion of a wider range of collaterals, this would be a welcome move. Hopefully, it will provide another form of credit relief for businesses and individuals alike.
With regard to the amendments made to section 6, 51(C) and 56, there are four areas of potential concerns and clarifications, I wish to seek from the Minister.
First, the duration and effectiveness of this Facility.
Will this Facility be a temporary relief measure and if so, how long will this Facility last? On contrary, if the Facility will continue post-COVID as a permanent scheme, what are some of the benefits to the financial sector and will it be practiced in similar form as other jurisdictions, as the Minister mentioned earlier?\tGiven that the intent is to assist local businesses in obtaining greater liquidity, what financial controls on the Facility will be in place to ensure the extended liquidity will be flowed to local businesses instead of investments that are related to the banks' overseas portfolio?
Second, the notification of homeowners on the banks pledging of the properties to MAS for the Facility.
When the banks pledge the properties to MAS for loans, are the banks not required to inform the homeowners as part of the notification process even though it is an administrative procedure and I know it does not impact the existing service loan contract between the homeowner and the bank, but just as a notification process, is that still necessary? If homeowners are not informed, how would the following cases be handled?
One, I think Minister has already touched in his briefing just now. For example, if the property is bequeathed under the Will to the homeowner's next of kin. In the unfortunate event when the mortgage is still outstanding and the homeowner is demised, then the beneficiary is below 21 years of age and is not of working age to be able to continue servicing the home loan, what are the implications to the property and the beneficiary? I think the Minister touched upon how the property will not be compulsorily repossessed.
The second case I want to raise is there is an increasing trend of cross-marriages and in particular, across countries. So some of the homeowners have foreign spouses who are on LTVP or even LTVP+. Some of them we know they are unlikely to be offered Permanent Residency whether it is due to age or other reasons. If the homeowner has passed on or is incarcerated, how will HDB address the situations where the foreign spouse only has LTVP, so they cannot effectively takeover ownership of the home, or for a spouse who is a foreigner but the couple has Singapore-born children? So, from the perspective of MAS, can the property continue to be pledged as collateral given the change in ownership?
The third area, this is in respect to the amendment on the Board Appointments. While I agree for HDB to have direct management of the Board Appointments to better support their plans and also their programmes, so that they are better oversight on their Statutory Board performance, I would like to understand two areas.
One, what is the rationale to increase the number of Board Members instead of reviewing the role and the scope of the existing Board? Would this expertise not be available if the right composition of Board members were judiciously selected to have the right diversity and provide the missing areas of expertise?
The next is, before the decision to increase the number of board members, were other alternatives explored such as seeking external consultants and industry experts for advice on an ongoing basis rather than to formalise this expertise within the Board members?
And the final area, in response to the greater empowerment of HDB to compulsorily acquire a flat, under the fact that there is a false or misleading declaration, I would like to know, since Minister has said the chances of this misrepresentation or even false declaration is very low, then what is the rationale for including this in the amendment, in the terms of HDB flats and private properties, since it is going to be very low in this perspective? Are the current rules not sufficient to ensure that only eligible persons are able to purchase or retain the flats and properties?
Mdm Deputy Speaker, notwithstanding the clarifications I have raised, I support the Bill and the broad principles of the amendments made to address the immediate challenges the financial sector and the market needs.
Mdm Deputy Speaker : Mr Louis Chua.
Mr Chua Kheng Wee Louis (Sengkang): Mdm Deputy Speaker, all of us understand the importance of public housing and the role it has played, is playing and will continue to play in Singaporeans lives.
Today, more than 80% of Singapore's resident population resides in HDB flats, while homeownership rates among resident households for HDB dwellings is high at 92%. It is therefore of utmost importance that there is sound governance and proper oversight responsibility by the Board on matters relating to HDB, while also ensuring that public housing is not abused and remains affordable for those who need it the most. It is here that I would like to seek clarifications on two fronts, with regard to the proposed amendments to the Bill.
The first is the amendment to section 6 of the HDB Act. The amendment proposes to make the role of Deputy Chairman of the Board discretionary rather than mandatory. Based on my review of HDB's annual reports and the organisation structure of the Board enclosed within – the role of Deputy Chairman was not filled since Mr James Koh retired as Chairman on 30 September 2016 and was succeeded by Mr Bobby Chin who was the then Deputy Chairman.
I acknowledge, however, that from 1 October 2020 Prof Lily Kong will assume the role of Deputy Chairman for the new term of the HDB Board. The current Act seems to require the Deputy Chairman role to be filled. I would therefore like to clarify if any member of the Board has been serving as Deputy Chair from October 2016 to 30 September 2020. I would also like to clarify what the reason the role was made discretionary and the initial intended role of the Deputy Chairman on the Board. Who will be taking over that job scope should there be no Deputy Chairman appointed, once the amendments are passed? In the event that the Chairman is absent from duty, how would the Minister decide on the member of the Board to act temporarily as Chairman?
The second amendment I would like to seek clarification on the proposed amendment to section 56. The paragraph extends the list of possible reasons for the compulsory acquisition of a property if the owner has made a misleading or false statement in his application to the Board for his acquisition or transfer of interest of a flat from or to a related party respectively.
I would like to seek clarification on the motivations for the amendment to the subsection. What was the reasoning for the inclusion of this amendment, and did it come from an observed trend on specific events and fact patterns, which the HDB has discovered when it comes specifically to related person transactions? How many of such transactions took place and did the HDB suffer damages as a result of these transactions between related persons? As compulsory acquisition is a harsh measure, I believe it is imperative for the Government to clarify further the rationale for the change. This is especially so when clause 6 states that, \"Flat owners who make misrepresentations whether innocently or otherwise, will be liable to have their flats acquired.\"
Mdm Deputy Speaker, notwithstanding my clarifications on the amendments, I support the Housing and Development (Amendment) Bill.
Mr Louis Ng Kok Kwang (Nee Soon): Madam, this Bill makes two key changes. First, it enables banks to use HDB loans as collaterals to borrow from MAS. Second, it empowers the HDB to seize flats in certain cases where homeowners provide falsehoods to HDB.
I agree with these changes. They help banks release funds into a tight economy. They penalise the use of falsehoods by HDB applicants.
Sir, I have three clarifications to make. My first clarification is about HDB loans. The Bill allows banks to use HDB loans granted by them to obtain credit facilities and repurchase transactions from MAS. Previously they could not. This empowers MAS to inject more liquidity into our financial system. Indeed, MAS has recently created a new credit facility that allows certain banks to pledge home loans as collateral.
But there are risks. In this crisis economy, homeowners will increasingly feel the brunt of unemployment and salary cuts. More home loans will become delinquent or default. MND itself said in 2018 that prolonged unemployment and drops in household income are two main reasons why households fall into mortgage arrears. If households cannot repay their loans, banks will find it harder to repay MAS.
To clarify the significance of this amendment, I have two questions.
First, can Minister share data on what has been the default rate of HDB bank loans in the past five years? Second, what is HDB's forecast of the default rate of HDB bank loans in the next 24 months? I was initially going to ask if HDB will continue to suspend late payment charges on HDB mortgage arrears. I am glad the Minister has announced that given the current economic conditions, HDB will further extend this to 31 March 2021. This is indeed a much needed lifeline for many Singaporeans. Sir, ensuring that homeowners can repay their bank loans is in the interest of homeowners, banks and our financial system.
My second clarification relates to falsehoods, transfers and acquisitions. This Bill gives HDB new powers to compulsorily acquire flats in certain cases. In particular, HDB now has the power to do so in cases where applications for flat ownerships in an acquisition or transfer between relatives contained a false or misleading statement. I have two sets of questions related to this proposal.
One, in relation to both the existing section 56 and the new amendment, can Ministry clarify whether homeowners are allowed to amend the false or misleading statements in HDB applications they have submitted? If so, what are the channels for them to amend their statements? We must take a strong stance against the use of falsehoods in HDB applications. But where such falsehoods are assessed to be innocent or non-material, we should provide channels for voluntary correction.
Two, the amendment of section 56 introduces the terms \"transfer\" and \"acquisition\". There is no definition for either term in the Act for the purpose of section 56. Can Minister clarify what situations do \"transfer\" and \"acquisition\" refer to? In particular, does the definition of \"transfer\" in section 56 differ from its definition in section 49, which expressly states to cover only section 49? Section 56 has significant impact on lives, as it empowers HDB to compulsorily acquire flats. Clear definitions with examples, provided on Parliamentary record, will help avoid any doubt in its interpretation.
My final point is that we have not gone far enough in reviewing our HDB policies. The policy of not allowing the keeping of cats in HDB flats has to be reviewed and changed. I have spoken up about this for more than a decade now. I know this is not part of this Bill but I hope Minister will address this point.
Let me reiterate what I said in this House in March this year, \"HDB has stated that cats are generally difficult to contain within the flat. When allowed to roam indiscriminately, they tend to shed fur and defecate or urinate in public areas and also make caterwauling sounds, which can inconvenience your neighbours. It does not make sense that one is allowed to keep a dog and now a big dog, but not a cat, not even a little kitten. Dogs can also shed fur and defecate or urinate in public areas. What is more, they bark. HDB's concerns can be easily addressed. We can ensure that pet cats do not roam indiscriminately and are sterilised. Sterilised cats do not make caterwauling sounds. I have seen first-hand how all these simple measures can be taken and people can keep cats in their flats without affecting their neighbours.\"
In response to my question, MND said, \"When HDB receives a complaint, they go down and investigate. If the cat is not causing any disamenities, the resident will not be asked to remove the cat\". I appreciate this reply but my question then is, what is the point of having a rule that we do not enforce? So many people are already keeping cats in HDB flats. Many of us, as Members of Parliament, see this during our home visits and some of us even take photos with our HDB residents and their cats.
Sir, I sincerely hope that MND will amend the Housing and Development (Animals) Rules to reflect what we already accept in reality – that HDB residents are allowed to keep cats, which can be removed if they are found to cause disamenities in the community.
Sir, notwithstanding my clarifications, I stand in support of the Bill.
Ms Nadia Ahmad Samdin (Ang Mo Kio): Mdm Deputy Speaker, in the last year, Singaporean families have stayed at home through the pandemic and, thankfully, most of us have been able to keep ourselves safe from the COVID-19 virus. We have worked from home, studied from home and our homes have sheltered us.
For some 3.2 million Singaporeans like me, that home is an HDB flat. And for many Singaporeans who may face difficult times from the economic repercussions of this virus, holding on to our homes is one of our highest priorities. I support the HDB's efforts and measures to help Singaporeans during this period. For example, the suspension of late payment charges on HDB mortgage arrears till March 2021; and that households living in public rental flats will receive a 50% rental rebate between 1 October and 31 December 2020. These were welcome announcements.
I am certain that this Bill on the Housing and Development Act will be of interest to many people who will want to know if they and their homes will be affected. I also support the clear message from the Minister that the proposed amendments in this Bill will not impact HDB flat owners adversely. However, I would like to raise some points.
One of the amendments in this Bill aims to allow our domestic banks to use HDB mortgages as collateral for a grant of facility from MAS. Our domestic banks can borrow from MAS as a lender of last resort, or for precautionary liquidity. When they do so, these banks may have to offer some kind of assets as collateral or security for the loans. Through this amendment, MAS will be able to recognise HDB residential mortgages placed with these banks as collateral and these banks will then be able to obtain more liquidity from MAS.
With this, banks can then extend a greater supply of credit to Singaporeans and Singaporean businesses. This is in line with efforts by MAS. For example, the MAS Singapore Dollar Facility for ESG Loans provides a line of credit to our banks and finance companies at 0.1% interest per annum, to ensure vital credit for our SMEs during these difficult times.
Mdm Deputy Speaker, in that light, I support this amendment. However, I have some clarifications. It is critical for us to communicate to our fellow Singaporeans the impact of these changes, and make it clear if this amendment will affect HDB flat owners' rights. We want to prevent the proliferation of false narratives. We should also aim to provide clarity as to what would happen in the event that the collateral is enforced. I appreciate that this would be an unusual situation, but given that we are living in unprecedented times, I believe Singaporeans want to be prepared for any outcome.
First, in the event that MAS enforces on the HDB mortgages as collateral, will MAS, HDB or the bank provide prompt notice of the change to the affected HDB owner? What administrative steps will HDB owners need to take in such a scenario? They would likely have to change the bank they make their monthly mortgage payments to. Many of my residents are seniors, some of whom may not be technologically savvy or mobile, and unable to reproduce documents from a long time ago. What is the process and timeline for the appointment of a replacement bank and how will mortgage payments be managed in the meantime? What happens if some HDB owners accidentally continue to make mortgage payments to the former bank?
Second, when the HDB mortgage is administered by a replacement bank, will the commercial terms of the mortgage be kept the same vis-a-vis HDB owners? It is a fairly standard term in bank documentation that commercial banks may reserve the right to change the applicable interest rate without prior notice. Needless to say, an increase in interest rates on the loans may have a hard financial impact on homeowners.
Third, aside from the effect of this amendment on HDB owners, I wish to ask the Minister whether this intended use of HDB mortgages as collateral, especially given the financially troubled times ahead, may lead to an increased pressure on the banks to foreclose on HDB mortgages with outstanding arrears more quickly in order to balance their books. In other words, will Singaporeans who are unable to keep up with their loan installments be at greater risk of losing their homes?
Mdm Deputy Speaker, I believe Singaporeans will accept the risk of a potentially different holding bank for their HDB mortgages if they are well-informed of the change, if they are assured of the commercial terms of the loans that they had signed up to and if their concerns about any potential foreclosures are addressed.
I turn now to the second point I would like to make about this Bill – compulsory acquisition. This Bill also intends to add in a further ground for HDB to take compulsory acquisition, or CA action, of a HDB flat if the owner of that flat and I quote – \"... made a misleading statement in his application [to the HDB], or a misrepresentation of a material fact (whether innocently or otherwise)\" in relation to the acquisition of that flat or an interest in that flat, or in the transfer of an interest in that flat to a related person. I note that sections 56(1)(f) and (g), which are not amended, already allow the HDB to take CA action over a flat if an owner made a misleading statement or misrepresentation of a material fact relating to the purchase of that flat.
This amendment to introduce the new section 56(1)(ga) appears to extend the existing grounds in two ways. HDB can now take CA action against flat owners who had made a misleading statement or material misrepresentation. One, in the transfer of a flat, and not just a purchase; and in relation to an owner's acquisition of an interest in the flat or the transfer of an interest in the flat to a related person, including a spouse, brother, parent or a remoter lineal ancestor or issue.
I would like to make two points. I note that this CA action right is intended to apply even if the person who made that misleading statement or misrepresentation about their eligibility to own the flat, did so innocently. It seems a little harsh for HDB to take CA action over an innocent misrepresentation or misstatement, especially for eligibility factors which are straightforward or provable. What are some examples of the misleading statements or misrepresentations relating to eligibility which prompted this amendment and why is it that these factors cannot be independently verified?
The consequences of a CA action are understandably severe: (a) in accordance with HDB's compensation policy, owners of a flat subject to CA action will obtain compensation decided by the HDB; and (b) their future applications for a flat may be affected if they have used up their allocated number of HDB concessionary loans. What factors will be taken into consideration in determining the compensation in the event of an innocent misrepresentation?
Second, this amendment will apply section 56 to purchases or transfers – to acquisitions or transfers of interests in a flat in both a sole, or a multi-owner situation. Mdm Deputy Speaker, I wish to ask the Minister, where the entire flat is compulsorily acquired by the HDB due to the actions of one of its owners, how will HDB balance the rights of the other co-owners of that flat who may be innocent and unaware of the actions of the owner who had made the wrongful statements or representations? If the co-owners are not complicit and have done nothing wrong, it may come across as unfair to them to suffer the same severe consequences.
For example, will they be first given the opportunity to sell the flat on the open market? Or will these innocent co-owners be prejudiced by the compulsory acquisition in any future applications for another HDB flat? It would help if innocent co-owners are allowed another HDB concessionary loan if they had used up their entitled HDB concessionary loans for the previous flat which was subject to CA action. I believe some clarity on how innocent HDB owners will be treated will assure many of us.
In conclusion, Mdm Deputy Speaker, I appreciate the opportunity to share some of considerations and views which I felt are important to be raised. I wish to state my appreciation for the difficult task that the Minister and HDB has in protecting and ensuring a fair outcome for HDB owners while ensuring that access to our HDB flats is not abused and used only by eligible persons as intended. And I believe most Singaporeans do share that same appreciation. Notwithstanding the above clarifications, I conclude my speech in support of this Bill.
Mr Desmond Lee: Mdm Deputy Speaker, I would like to thank Members for their comments on the Bill. Allow me to address the issues raised.
Ms Cheryl Chan asked if the MAS Singapore Dollar Term Facility is a temporary or permanent facility and if MAS can direct the banks to on-lend the funds borrowed from MAS to local businesses instead of chanelling them to overseas investments.
Madam, the facility is a pre-emptive measure to strengthen the resilience of the banking sector, given the significant economic headwinds created by COVID-19. The facility will remain in place throughout the COVID-19 crisis. After the crisis is over, MAS will review if the facility needs to be retained.
The intent of the facility is not for the banks to directly on-lend the funds borrowed from MAS. Instead, the facility serves as a backstop that will provide banks with greater certainty of funding and provide the banks assurance and, in doing so, supports their lending to businesses and households during periods of heightened market uncertainty.
Ms Cheryl Chan also asked if HDB flat owners will be notified when banks pledge their HDB loans to MAS. Ms Nadia Samdin asked about the administrative implications on flat owners when MAS takes over the HDB loans and if the terms of HDB loans from banks will stay the same.
The borrower-lender relationship between the HDB flat owner and the bank, as set out in the terms and conditions of the housing loan, remains unchanged when the bank pledges the HDB loan to MAS. HDB flat owners continue to service their HDB loans with their respective banks and the bank still retains the legal title to the loan. There is, therefore, no change in the relationship between banks and the flat owners and, therefore, MAS will not require the bank to inform the HDB flat owners that their loans have been pledged to MAS as part of a portfolio of loans, both private and public, in return for this facility.
But in the highly unlikely scenario where a bank defaults on its loan from MAS, MAS will take ownership of the HDB loans and will appoint an agent bank to administer the loans on MAS' behalf. Under this scenario, HDB flat owners will be promptly notified to re-direct loan repayments to the agent bank. This is an administrative process and the terms and conditions of the HDB loans, including the interest rates charged, will not be affected in the process. Again, we emphasise that this is a very unlikely scenario, as banks in Singapore are well capitalised and maintain healthy liquidity buffers and this is, indeed, a pre-emptive measure.
Mr Louis Ng shared his concerns that increased default rates on home loans during periods of economic uncertainty may increase the likelihood of banks defaulting on their loans from MAS and asked about the current and projected default rate of bank loans on HDB flats. The current housing non-performing loan ratio remains low and stable at around 0.5%. The majority of borrowers are able to service their mortgages and should continue to avoid further build-up of debt. But, we will keep a close watch on the situation as the crisis unfolds.
As Mr Ng has pointed out, economic and employment conditions remain challenging for many households, and we can expect homeowners to face difficulties in the period ahead. For borrowers in financial difficulties, MAS has worked with financial institutions on further support measures that allow them more time to resume their monthly mortgage instalments. These measures, which were announced yesterday, will help ease individuals’ cashflow while gradually encouraging them to resume their home loan repayments in 2021. This complements HDB's own loan arrangements which were announced a couple of days before MAS.
Ms Nadia Samdin also asked if the use of HDB loans as security will increase the pressure on banks to foreclose loans with outstanding arrears. The MAS facility does not impact how banks manage their residential property loan portfolio. As banks now have access to an added layer of liquidity insurance provided by MAS, their ability to deal with liquidity stress should in fact be enhanced.
Finally, Miss Cheryl Chan asked how the proposal would interact with various scenarios relating to material changes in the ownership of the flat. In short, there is no impact on how such cases will be handled. The existing HDB policies will continue to apply. The banks will also continue to administer the loans based on their existing procedures.
I have sought to respond to Members’ queries regarding the amendments made to enable the MAS SGD Term Facility. If there are further technical queries relating to this or to the financial system, my colleague Minister Ong Ye Kung will be here to address them.
Next, let me address the points made regarding compulsory acquisition.
Ms Nadia Samdin asked if this would excessively penalise flat owners who may be innocent and unaware of the false statements or misrepresentation of facts. I would like to assure the Member that HDB will not exercise its powers to compulsorily acquire flats lightly, and will generally only contemplate such action as a last resort for egregious and severe cases, and where the flat owners refuse to regularise the ownership of the flat. Before initiating acquisition action, HDB will investigate each case thoroughly. Depending on the circumstances of each case, HDB may instead consider imposing a financial penalty or issue a warning. HDB will consider the interest of the parties involved, including any non-complicit owners and occupiers of the flat, and may allow the flat to be sold on the open market if there are extenuating circumstances.
The statutory appeal channel to the Minister under section 56 of the Act serves as yet an additional safeguard to the interests of potentially non-complicit owners.
Mr Louis Chua asked about the rationale for this amendment and, like Miss Cheryl Chan, also asked if there had been a significant rise in false statements or misrepresentations in the transfer of flats. I would like to clarify that this is not the case. By and large, HDB's existing process and system checks are able to reduce such occurrences. In fact, HDB had found around 10 such cases in the past three years. They principally revolve around false statements or misrepresentations about eligibility, about ownership of other properties, both locally and abroad and, of course, other statements that are material to the transfer or to purchase. This is thus a pre-emptive move to deter any such potential infringements in relation to the transfer of flat ownership.
Mr Louis Ng asked about avenues for owners to amend unintentional or non-material errors in their applications to HDB. I would like to assure the Member that we will apply this provision to those who intentionally make misleading statements or misrepresentations.
He asked also about the specific definitions of the terms “acquisition” and “transfer” in the amendment. The Member is right that the definition of the term \"transfer\" in section 49 applies expressly to that section only. Section 49 sets out the various transactions for which HDB may act for parties who do not engage their own solicitors. Such transactions include, among others, the purchase, sale, transfer of ownership interest, and surrender of HDB flats. The definition of \"transfer\" in section 49 is therefore purposefully broad, to cover the range of transactions where HDB can act for, some of which do not apply to the intended amendment in section 56.
For the purposes of section 56 amendment, we should take the ordinary meaning of the terms \"acquisition\" and \"transfer\". To explain, the term \"acquisition\" in this amendment refers to the obtaining of an interest in the ownership of the flat by an incoming owner. The term “transfer” here refers to an interest in the ownership of the flat being passed to an incoming owner. Let me use an example to illustrate. When a couple includes their child as a co-owner of a flat, the child acquires an interest in the flat, while the parents transfer an interest in the flat to the child.
Finally, Miss Cheryl Chan and Mr Louis Chua raised some queries with regard to the amendments relating to the HDB Board.
As I mentioned earlier, the HDB Board plays a strategic role in guiding the development of the Board. When appointing Board members, we seek a diverse representation of perspectives to cover the breadth of its work. In fact, with the current Board size, HDB has had to make trade-offs in selecting and bringing on expertise.
On the Member’s question as to whether HDB had considered enlisting the help of external consultants or industry experts instead, I would like to share that HDB does, indeed, engage such experts when dealing with specific projects or issues. For example, HDB has several advisory panels comprising industry experts to guide HDB in technical areas such as Architecture, Research, and Civil and Structural Engineering. Such panels are useful when HDB needs advice in more specific and technical areas. But they will not be able to replace the Board’s role in offering strategic guidance and contributing diverse viewpoints, including beyond their core areas of expertise, to guide HDB’s overall development.
With the expansion, HDB’s Board size will be comparable to that of other Statutory Boards such as the LTA, CPF Board and JTC Corporation.
Mr Louis Chua had asked about the appointment of a Deputy Chairman prior to the appointment of Dr Lily Kong as Deputy Chairman with effect October 2020. Prior to appointment, at the start of each term of HDB's Board, there would be appointed in HDB's Board a temporary chairman who would for all purposes and intents perform the role of a Deputy Chairman in managing the Board and holding Board meetings in the absence of the Chairman. This amendment brings the structure and composition of the HDB's Board in line with other Boards such as JTC, URA and LTA.
Finally, let me address an issue that is unrelated to the Bill but is very close to Mr Louis Ng's heart. This Bill relates to credit, compulsory acquisition, courts and candidates for the Board – four Cs – and that does not include the cats. Nevertheless, let me address Mr Louis Ng's point about the need to review HDB’s policy that disallows the keeping of cats in HDB flats.
Let me first declare that I am a cat lover and I have had four stray cats in the course of the last 15 years. HDB’s pet ownership policies seek to strike a balance between residents who are pet lovers and those who are not. We will continually review and I assure the Member that we will review and update our pet ownership policies to ensure that they are effective and balance the needs of different stakeholders. Mdm Deputy Speaker, I beg to move.
Mdm Deputy Speaker: Are there any clarifications? None.
[(proc text) Question put, and agreed to. (proc text)]
[(proc text) Bill accordingly read a Second time and committed to a Committee of the whole House. (proc text)]
[(proc text) The House immediately resolved itself into a Committee on the Bill. – [Mr Desmond Lee]. (proc text)]
[(proc text) Bill considered in Committee; reported without amendment; read a Third time and passed. (proc text)]
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[(proc text) Question proposed. (proc text)]
Ms Carrie Tan (Nee Soon): Mdm Deputy Speaker, I will first like to thank the Members for their patience. It has been a long day and I wish I could bring a song and dance item to break up the monotony of today's proceedings but that would not be allowed although I am sure it will be very welcome by Members of this House.
I would like to raise this Motion that “That this House recognises the importance of the Arts and to increase support for Performing Arts Workers and the Arts Industry.”
Mdm Deputy Speaker, the circuit breaker measures that were announced on 7 April sent our country into a tailspin. People were confined to their homes, separated from loved ones, deprived of their usual social activities and anxious about the future. After ensuring that we had enough food and essential items, our next instinct was to seek comfort in anything that could provide a semblance of normalcy, many of us turned to Netflix and YouTube, re-watched old films. We saw the videos on social media of people in other countries, singing, dancing, playing instruments and performing on their balconies to provide solace and companionship to their neighbours. I was touched by these videos. I am sure many in this House were too.
As the months dragged out, people sought ways to connect with others, to satisfy the need for human connection that we as human beings fundamentally need.
In our lowest moments, as the number of COVID-19 cases climbed higher, many of us felt powerless. The arts helped keep us sane, helped us process our confusion and grief and entertained us, lifting our spirits.
During the circuit breaker there was the poll in the newspapers reporting that Singaporeans thought artists had the most non-essential jobs. I was saddened to see that and felt it was unnecessary to include that poll of “non-essential jobs” at all. Perhaps the arts have grown so commonplace and ingrained in our lives that we started taking it for granted.
The arts have contributed not just in terms of providing comfort and strength during difficult times, but also to our economy. The Arts and Entertainment sector generated $6.6 billion in revenue earned in 2017 and provided jobs and livelihoods for 26,300 people in 2018.
There was a time when the arts held a great deal of importance to our society and our leaders. From former Acting Minister for Culture Mr Ong Teng Cheong who first recognised the importance of arts institutions in Singapore and who created what is now the National Arts Council, to former Minister of Information and the Arts, Mr George Yeo who aimed to turn Singapore into a culturally attractive global city through the Global City for the Arts project, we once saw the arts as a viable and important part of city-planning and development for Singapore.
However, it seems that the arts have fallen from their previous stature. Government funding for the sector has dropped almost 50% from $937 million in 2015 to $458 million in 2018. Artists today are struggling and many live hand-to-mouth.
This past month, I spoke with Edward, a 23-year-old Nee Soon South resident and professional actor, singer and dancer. Despite having a diploma in performance, he makes $10,000 a year, less than $1,000 a month, through his various freelance gigs. Edward worries about the future, specifically to what extent he will be able to support himself through his profession and whether he will ever be able to afford the expenses of starting a family.
When the circuit breaker measures were announced, all of the jobs Edward had signed on for evaporated, leaving him with very zero income. He is now returning to school to \"upskill\" and shared with me about his worries – whether there will be any opportunities left available for him in the arts sector when he re-enters the workforce in a few years.
Chronic income pressures on arts workers as well as other workers, come from a lack of regulations on a group of employees called \"permanent casuals\". They are among the 47% of freelancers that make up the arts and entertainment sector, higher than the 14% at our national level. Although permanent casuals might work full-time or part-time, they are paid hourly with no health or leave benefits. Such workers do not benefit from the Job Support Scheme or JSS because they are only paid for their time and therefore have no regular pay from their companies to begin with. They also do not qualify for the Self-employed Persons Relief Scheme because they typically often work exclusively for one company.
Outside of such workers, existing JSS measures provide only 10% of support to the arts and entertainment sector, even though this sector is still unable to return to its former operating capacity. From January 2021 onwards, JSS support will be reduced to 0%. There is a real risk that people like Edward may not have opportunities to return to, if or when the sector does recover.
Lack of stable income, heightened by COVID-19 restrictions, are forcing arts workers to seek other jobs. The arts and entertainment sector is incredibly diverse. It is not just made up of writers, actors, musicians and poets. It also includes lighting and sound technicians, school CCA teachers, museum operators, fashion designers, event photographers, and many more highly skilled people who produce and enable the productions that we consume. If we continue to do nothing more for them in terms of financial support during this time, they may be lost to other sectors, to the long-term detriment of our arts and entertainment industry.
An entire sector may be at risk of being wiped out. I was disappointed that in yesterday's Ministerial Statement by the Deputy Prime Minister, there was no mention of any extension of support to the arts sector workers.
To be fair to the Government, the $55 million Arts and Culture Resilience Package is certainly helpful, but it can be enhanced to make the support accessible for all arts workers, including permanent casuals.
The Digitalisation Fund specifically is also a good initiative in the right direction, but only currently available for productions rated G. Granted, NAC and IMDA may be approaching these funding criteria with consumer perspective and safety in mind, but I urge consideration on the limitations to creativity and marketability of our arts productions if only G-rated productions can receive funding. Parental controls on online media platforms exist for a reason, for parents to be involved and exercise the necessary control over children's media consumption. This should not be a responsibility that is shifted over to the state, with costs that the arts and entertainment sector ends up bearing, to the detriment of an industry's vibrancy and sustainability.
If we invest in its development and the development of those who are keen to have a career in the arts, it can provide financial upliftment to individuals and families. Take the story of another resident Yusri better known Shaggy in this industry. Despite being from a low-income and challenged family, he made a career and eventually a business out of being an arts technician and multimedia designer for stage productions. He saw the arts as a way out of poverty and it has, so far. His work in the arts provided him with a better life than he had when he was growing up. Yusri is quite established now in his livelihood after spending more than 10 years in the sector. He was also personally also highly resourceful in seeking out courses in business and marketing that could help his arts career.
Despite the progress thus far, Yusri sees such opportunities disappearing for those starting in the industry today like Edward.
Where in the past it was not necessary to have a degree to begin work in the arts and entertainment sector, it is now increasingly important, despite wages staying the same. He also shares the same anxieties about the future as Edward.
The arts and entertainment industry is one that has tremendous potential and unlimited in its \"export capacity\" – thanks to technology and the Internet. It would be a mistake for us to miss out on developing our arts and entertainment sector with a view towards its internationalisation. We can learn a lot from South Korea's example, whose arts and entertainment industry brought the country S$39.8 billion in 2018. Besides being now known globally, Korean entertainment has created subsequent demand worldwide for Korean-branded merchandise including cosmetics and food.
Even the example of a local food establishment cited by Deputy Prime Minister Heng yesterday during his speech – Seonggong, is also a Korean brand. This is the result of active and committed investment by the Korean government since the 1960s, in preserving traditional and modern culture, and actively promoting it internationally. Singapore can emulate Korea's example, and go even further, potentially increasing our soft power internationally as well.
I hope that the Government will consider investing more into the development of the arts. Create business mentorship and marketing training specifically for artists and entertainers so that they can acquire business literacy to make better livelihoods out of their talent and craft. The arts and entertainment sector can also benefit from professionalisation such as a wage framework guideline so that artists are not subject to the devaluation of their work and a race to the bottom to get jobs, which is happening often currently.
In our Future Economy deliberations, I sincerely hope the arts and entertainment sector will receive due consideration for its potential. When I was 16 years old, I told my parents I would like to study fashion design and become a fashion designer. They told me I would not be able to make a decent living out of it, and insisted I get a degree in NUS which I did. I am sad to observe that 20 years on, this still rings true.
The Singapore Tourism Board marketed us as a country where \"passion is made possible\". It was a wonderful campaign, but such efforts should go beyond being a short-term marketing campaign. We need broad and deep capacity-building, for the diverse talents and passion for our people to thrive.
To summarise, I have four specific proposals for the House to consider and to support.
In the immediate term, to increase and extend JSS support for arts workers, and income support to permanent casual workers who did not qualify for SIRS. Two, to broaden the eligibility criteria for the Digitalisation Fund beyond G-rated productions. Three, to develop a wage guideline framework for the arts sector, in consultation with the sector's workers. And lastly, to invest in capacity-building of the arts and entertainment sector through overseas exchanges, scholarships, as well as business and marketing training for arts and media students, artists and arts producers.
In the 1930s in America, Franklin Roosevelt's New Deal included a \"Federal One\" project. The federal government hired more than 10,000 artists to create works of art across the country, including murals, theatre, fine arts, music, writing, design, and so on. It was part of a plan to stimulate economic recovery during the Great Depression, where there was widespread poverty and high unemployment. This plan helped put artists back to work on lifting the spirits of a people, and inspiring them towards a more hopeful future amidst the economic turmoil of that time. We could take a leaf out of that book.
Art can be a great nation-building tool, forging common identity amongst the people amidst a crisis. And what do we envision when we say \"Singapore Together\"?
Singapore is not just a nation of engineers, scientists, technologists and doctors. Amongst us are playwrights, songwriters, painters, poets and storytellers. A truly inclusive economy and future is one that allows all diverse talent to thrive.
To borrow the words from a famous American actress Stella Adler, who founded the Stella Adler Conservatory of Theatre in 1949, and was also teacher to Steve McQueen and Robert DeNiro, \"When life beats down and crushes the soul, art reminds you that you have one.\"
Let us not allow our arts sector to languish any further.
Mdm Deputy Speaker: Minister of State Low Yen Ling.
The Minister of State for Culture, Community and Youth (Ms Low Yen Ling): Mdm Deputy Speaker, I thank Ms Carrie Tan for her passionate speech and for her four suggestions on increasing support for the arts.
Like Ms Carrie Tan, MCCY recognises that our arts and culture play a critical role in our efforts to foster a more caring people, cohesive society and nation. The arts play a key role in connecting different communities. The arts show the world who we are and what we stand for, as a people and as a nation. During these unprecedented times, the arts and culture sector is even more essential than ever, as a source of inspiration and hope for Singaporeans.
As Ms Carrie Tan noted, the Government has since the 1980s, initiated deep seated efforts to develop a vibrant and sustainable arts and culture sector. Wide-ranging in breadth and aims, the Masterplans from the 1980s to the 2000s, such as the report of the Advisory Council on Culture and the Arts or ACCA, and the Renaissance City Plans have built a foundation for the growth of Singapore's art and culture. Since 2012, our approach has been guided by the Arts and Culture Strategic Review or ACSR which seeks to bring arts and culture to everyone, everywhere, every day.
This blueprint to enhance our arts and culture has made steady progress. In the Committee of Supply debate last year, MCCY noted that several ACSR outcomes, such as the number of arts and heritage activities have been registering healthy increases. The diversity and the types of activities, as well as attendance, have grown as well.
Despite such progress, we cannot rest on our laurels. MCCY recognises the need to update our strategies and approaches, so that our arts and culture continue to strengthen Singapore's social fabric and unity. In 2018, these important aims were reflected in the inaugural Our SG Arts and Heritage Plans introduced after extensive engagement with stakeholders across the public, private and people sectors. These plans cover a span of five years until 2022, and comprehensively set out the strategies that will provide strong foundations on the continued growth of the arts and heritage sectors. These included the continued emphasis on nurturing arts excellence and focus on leveraging technology, that the Member spoke about as well. Out of the eight strategic priorities in OurSgArts Plan includes addressing the needs of arts freelancers.
To better support the development of our arts and culture, the Government has steadily and consistently increased funding for these sectors. Contrary to Ms Tan's suggestion that funding for the arts and heritage fell from 2015 to 2019, I would like to clarify that based on MCCY's annual Singapore Cultural Statistics report, funding for these sectors actually rose from about $300 million per year before 2013, to around $450 million per year from 2016 to 2018. In fact, funding was highest in 2014 and 2015 due to the enhanced programming for our SG50 celebrations, as well as major development projects like the revamp of the Asian Civilisations Museum and construction of the National Gallery Singapore.
I wish to also highlight to Ms Tan and Members that substantial funding was provided to the culture sector through the Government's provision of $350 million to-date for the Cultural Matching Fund or CMF to encourage cultural philanthropy. Rolled out in 2014, the CMF matches qualifying donations raised by the arts and heritage groups dollar-for-dollar. Between 2014 and 2018, the CMF has matched about $215 million worth of donations raised by the sector. This has helped over 100 arts and heritage groups double their donation income. The grant has enabled these arts and heritage groups to develop their capabilities – this topic is also one of the four recommendations that she has talked about – for the long-term sustainability of the organisations as well as support digital productions.
Mdm Deputy Speaker, with the pandemic, these steady efforts to grow the arts and culture sector are being disrupted like other affected industries hit by safe distancing measures and the halt of group events. The Government has, through its special budgets, released specific help and measures to boost incomes and livelihoods. Arts organisations and practitioners are able to tap on broad-based measures such as the Jobs Support Scheme or JSS, Self-Employed Persons Income Relief Scheme or SIRS, COVID-19 Support Grant or CSG and SEP Training Support Scheme for income support and skills training.
The Government recognises that the arts and culture sector, like the retail and food industries, has been significantly affected. Hence, the sector will continue to receive further Government support till March year. This is unlike what Ms Tan had suggested – that the arts and entertainment sector only receives 10% wage support under the JSS, with this dropping to 0% from January 2021. I would like to clarify that eligible organisations currently receive 50% wage support for 10 months under Tier 2 of the JSS, similar to the retail and food industries. These organisations will receive a rate of 30% for seven more months, with disbursements in March and June 2021. I hope Ms Tan will be happy to hear this information.
In addition to these measures, MCCY also announced a $55 million Arts and Culture Resilience Package or ACRP in April 2020. The ACRP provides additional support and opportunities for the arts and culture community while encouraging the development of longer term capabilities that will help the sector emerge stronger after COVID-19. By end August 2020, ACRP funding generated over 6,000 work and training opportunities for arts and culture practitioners and supported more than 900 digitalisation projects and programmes. As announced on 21 August this year, MCCY will be providing an additional operating grant under the ACRP to support arts and culture organisations as well as those in closely related sectors that Ms Tan talked about earlier and that are key to the arts and culture eco-system. I want to assure Ms Tan that we will announce additional details soon.
We understand that the pandemic has disrupted livelihoods and plans in the arts and culture sector. Arts workers, including freelancers, have been hard hit. I would like to thank Ms Tan for the initiatives she has suggested to better support these groups of valuable talents and workers. We recognise the diverse capabilities of our arts and culture freelancers and how they contribute richly to our arts and culture eco-system. It is important to provide them with ways and means to continue contributing in this sector. MCCY and NAC are working closely with partners to provide a range of support to boost the livelihoods and capabilities of freelancers.
Allow me, Mdm Deputy Speaker, to share several ways in which MCCY and NAC are ramping up assistance and opportunities for the arts and culture sector, including freelancers.
Firstly, we have the Capability Development Scheme for the Arts or CDSA. Capability development is also a topic that Ms Tan spoke passionately about in her speech earlier. Capability development has been and continues to be a long-standing priority for the sector. This grant helps arts and culture organisations and practitioners upskill and prepare for a post-COVID-19 recovery. So far, the CDSA has supported close to 600 training opportunities, of which around 300 were for freelancers. Those tapping on the CDSA are eligible for paid training allowance of $10 per hour. Many of the training programmes identified by the NAC are not only useful in raising the capabilities of arts freelancers across diverse domains, the programmes are also eligible under the SkillsFuture framework for costs to be defrayed.
Secondly, the Digital Presentation Grant for the Arts or DPG. This supports ground-up efforts by artists and arts groups to present their work in digital form. This not only generates work opportunities, it also builds industry capabilities in digital content production. She spoke passionately about K-pop and actually to a certain extent, I think it is also partly because of their ability to translate their art form into digital medium. The response to DPG has been positive. It has supported over 300 projects and provided around 4,500 work opportunities, of which about 1,100 were for freelancers.
Ms Carrie Tan had noted that the DPG only supported productions rated General. Mdm Deputy Speaker, allow me to explain the reasons for this. The DPG is created as a scheme during COVID-19 to support the efforts of artists and arts organisations wanting to present their work digitally or via a digital medium. Unlike live performances which are subject to classification ratings under IMDA, online content, like she mentioned earlier, is easily and generally available with no age segregation. This makes it prudent for the DPG to underwrite productions rated General. The DPG also serves to cater for inclusive access by all audiences, including young children. I think a lot of Members in the room are parents. We want to be there with our kids when they are consuming digital content but we cannot be certain that we will always be there guiding them when they are watching and consuming digital content.
Hence, the DPG has supported a large number of digital works suitable for the general public. That being said, I want to assure Ms Carrie Tan that productions with a higher than General rating are still being supported. Apart from the DPG, NAC has continued to provide funding for major companies, key arts groups and artists through NAC's regular grant schemes and commissions, which have been enhanced to include digital works and presentations. These could cover wide-ranging works, including those with a higher than General rating.
Thirdly, even though the arts and culture sector may be disrupted, practitioners in this sector continue to benefit from commissioned work and partnerships for key festivals and events like Silver Arts, Singapore Heritage Festival, Singapore Writers Festival and Singapore Art Week. By end August, Mdm Deputy Speaker, 72 commissions and partnerships were supported under the ACRP, providing over 950 work opportunities, most of which were for freelancers.
For example, NAC digitally adapted four performances for Silver Arts 2020. I think many of the Members in the Chamber, I think you have seen some of these productions. They have gone out to many of your elderly residents who usually will be out and about but they can now enjoy this programme in the safety of their homes.
These were new works by Toy Factory, Asian Cultural Symphonic Orchestra, Wadah Seni Entertainment and Ding Yi Music Company. Their productions anchored the digital festival in September 2020 – just last month – and encouraged many of our seniors to stay engaged creatively through performances and activities in the comfort and in the safety of their homes – in fact, through their mobile devices, at their fingertips, through their mobile devices, anytime, anywhere.
Another key project commissioned by the NAC was \"Streets of Hope\", which was an out-of-house and digital integrated campaign featuring original artworks at areas such as the civic district and presented digitally on the Gillman Barracks website and social media channels. This commissioned project benefited over 360 freelancers. I am happy to share with Ms Tan and the Members that it was well received online with an estimated 158,000 unique reach and 33,000 social media engagements.
Fourthly, Ms Tan raised the issue of \"permanent casuals\", or arts workers who may have neither benefited from JSS or SIRS. MCCY recognises that these workers have critical skills and are valuable members of the arts and culture sector. We have been working with our cultural institutions, including the Esplanade and Arts House Limited, to help workers engaged by these institutions apply for Government support schemes they are eligible for, including SIRS and also CSG. These institutions also provide the workers with information on job opportunities, including those under SGUnited Jobs initiative.
We know it is not easy and our arts and culture workers, especially the freelancers, need all the help they can get. I would like to highlight that freelancers can approach NAC's Arts Resource Hub or ARH for additional resources to help them continue their practice. The ARH, which was started in September 2019, has been engaging its stakeholders throughout this year to better understand their concerns during COVID-19. As a result of these engagements, ARH has expanded its range of talks and clinics to provide more targeted information and support for freelancers as suggested by Ms Tan. These include sessions on how to leverage digitalisation tools such as augmented and virtual reality, and copyrights and intellectual property in the digital realm. I am happy to share with Ms Tan and Members that the ARH has just reopened the co-working spaces at Goodman Arts Centre and Stamford Arts Centre today.
I wish to assure Ms Carrie Tan and the House that MCCY and NAC are fully and wholeheartedly committed to ensuring good work opportunities for our practitioners and freelancers. Our national cultural institutions have adopted the Tripartite Standard on Contracting with self-employed persons since 2018 and we encourage all other arts organisations to do so. In addition, NAC is working with partners from the arts community on initiatives to boost the industry, such as the one led by the artistic director of Drama Box, former Nominated Member of Parliament, Mr Kok Heng Leun, to look into best practices in the theatre scene. This effort will lead to recommendations on what constitutes good employment and fair work practices that can be adopted by both freelancers and companies.
Mdm Deputy Speaker: Minister of State.
Ms Low Yen Ling: Yes, Madam.
Mdm Deputy Speaker: Please finish your last point.
Ms Low Yen Ling: Thank you, Mdm Deputy Speaker. This is an important topic, please allow me two more minutes to wrap up.
Mdm Deputy Speaker: You have to wrap up in one minute.
Ms Low Yen Ling: Thank you, thank you, Madam. I will do so.
So, Madam, in conclusion, let us continue to work closely together. A healthy partnership between Government, private and people sectors can pull us through this crisis and ensure that our arts and culture eco-system emerge stronger from COVID-19.
I want to welcome and also urge Singaporeans to continue to support the talents and the productions and the programmes of our artists, which included the freelancers. As we do so, our demand creates work opportunities for this valuable sector and we also make the appreciation of arts and culture an integral part of our lives.
Mdm Deputy Speaker: Order. The time allowed for the proceedings has expired.
[(proc text) The Question having been proposed at 7.12 pm and the Debate having continued for half an hour, Mdm Deputy Speaker adjourned the House without Question put, pursuant to the Standing Order. (proc text)]
Adjourned accordingly at 7.43 pm.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":"Matter Raised On Adjournment Motion","questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Flexibility in Administering COVID-19 Relief Schemes for Residents in Landed Property and Those with Chronic Health Conditions","subTitle":null,"sectionType":"WANA","content":"22 Mr Yip Hon Weng asked the Deputy Prime Minister and Minister for Finance whether the Ministry can consider being more flexible in administering COVID-19 relief schemes for (i) those who stay in landed properties that they may not own and (ii) Merdeka and Pioneer Generation Singaporeans especially those with chronic health conditions.
Mr Heng Swee Keat: The COVID-19 relief schemes, such as the COVID-19 Support Grant and the SEP Income Relief Scheme (SIRS) are intended to provide support to those who have been adversely affected by the current economic uncertainty and have less means. To ensure that schemes prioritise those who are in greater need of support, the Government uses a range of eligibility criteria, including the Annual Value (AV) of one’s property of residence. The current AV threshold of $21,000 covers all HDB flats and a good number of lower-value private properties.
While there is no perfect way of assessing a person's financial situation, a person living in a high-value property with his family is in general more likely to be supported by family resources, even if the individual does not own the property. Nevertheless, we will consider appeals by those who face extenuating circumstances on a case-by-case basis.
To help Singaporeans cope with the impact of COVID-19, we have also provided broad-based help to families, including those who are living in larger property types. For example, the Solidarity Payment and Care and Support – Cash schemes did not have AV as a criterion. In addition, as suggested by the Member, the Care and Support -Cash scheme includes an additional payout for our seniors, including those of the Pioneer Generation (PG) and Merdeka Generation (MG).
PG and MG seniors also continue to receive additional lifelong healthcare benefits. These benefits include annual MediSave top-ups, special MediShield Life premium subsidies, and additional outpatient care subsidies. Together, they provide our PG and MG seniors a greater peace of mind over their healthcare costs.
Those who require further financial support may seek help through the MSF Social Service Offices (SSOs). MSF has also exercised more flexibility when considering ComCare applications during this period, to ensure affected Singaporeans and their families, can get help.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Help for Small F&B Outlets to Implement Safe Distancing Measures","subTitle":null,"sectionType":"WANA","content":"23 Mr Darryl David asked the Minister for Sustainability and the Environment what support is available for small and independent food and beverage outlets attempting to strictly enforce safe management measures but are also fearful about offending errant diners and worried about losing future business given that action will be taken against such businesses, even for first-time offenders.
Ms Grace Fu Hai Yien: With the commencement of Phase Two of Singapore’s reopening on 19 June 2020, many economic activities have resumed, including dine-in services at Food and Beverages (F&B) establishments. However, dining in F&B establishments involves considerable public health risks because it typically entails gathering in enclosed spaces, without masks on, and for a prolonged duration. Hence, we need to ensure that F&B establishments operate in a way that is safe for their customers and staff. Patrons should also cooperate by keeping to groups of no more than five, keep masks on unless when eating or drinking, and to maintain at least one metre safe distancing from other groups.
To help F&B establishments provide a safe environment, public agencies have also issued joint advisories on the measures specific to F&B establishments and to guide them on the steps they need to take to keep patrons and their staff safe. These include guidelines on crowd management, table and seating arrangement, contact tracing, health checks, cleanliness and hygiene practices. Our Safe Distancing Ambassadors and Enforcement Officers have also been advising the F&B establishments and the patrons on the application of Safe Management Measures (SMMs). It is encouraging to see that some F&B operators have proactively implemented additional measures on their own, such as having last orders for alcoholic drinks at 9.30pm, reminding patrons to finish their drinks before 10.30pm, and rolling down the shutter and switching off the lights at 10.30pm. We are heartened that the majority of F&B operators, including many small and independent operators, have properly implemented the SMMs.
However, a minority of the F&B operators have continued to breach SMMs, such as allowing the sale and consumption of alcohol after 10.30pm and allowing bookings and gatherings in groups of more than five. Several operators have even attempted to conceal their infringement by impeding our enforcement officers in their inspections or concealing their sale of alcohol. Over the past few weeks, agencies have stepped up enforcement checks on F&B establishments – out of 846 establishments inspected as at 5 October, 16 have been required to close for 10 days while another 46 have been issued fines for failing to observe SMMs.
Patrons also bear their share of the responsibility to achieve a safe environment in F&B establishments and most are cooperative. But some patrons refuse to comply with SMMs or cooperate with F&B operators. Such behavior not only endanger themselves but other patrons and staff of the F&B establishment. Agencies will not hesitate to take enforcement action against such irresponsible patrons who flout SMMs, endangering themselves and others. As part of the stepped up enforcement checks, fines were issued to 53 F&B patrons as at 5 October for failing to observe SMMs. In taking enforcement actions, agencies will also take into account whether the operator has taken effort to advise or deter the patron on non-compliance of SMMs.
We are at a critical stage in our fight against COVID-19. To ensure that our caseload remains low and effectively contain the spread of the virus, everyone must play their part and exercise social responsibility.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Disamenities and Inconveniences Caused by Placement of Safe Distancing Barricades at Public Places","subTitle":null,"sectionType":"WANA","content":"24 Mr Yip Hon Weng asked the Minister for Sustainability and the Environment (a) what is being done to alleviate the disamenities and inconveniences caused by the placement of safety distancing barricades and markers at public places; and (b) whether the responses pertaining to feedback from the public concerning safe distancing features are dealt with in a timely manner.
Ms Grace Fu Hai Yien: COVID-19 is a global pandemic of unprecedented scale and will remain with us for some time. We must therefore adapt and adjust the way we live, work and play to reduce the spread of the virus and keep ourselves and others around us safe.
During the Circuit Breaker period, the Government implemented stringent safe management and safe distancing measures, to curb disease transmission. The barricades and markers to restrict access to amenities such as public benches, fitness corners, sports stadiums were necessary to protect the well-being of our population.
We removed some of these barriers and markers as we gradually reopened our economy in Phase Two, to allow more businesses to operate. However, we must remain vigilant to keep the COVID-19 cases down. Every day, around 3,000 Safe Distancing Ambassadors and Enforcement Officers are deployed to educate the public and take enforcement action against egregious cases.
In crowded areas, control measures are still necessary to ensure safe distancing and prevent inter-mingling between groups to curb transmission. For instance, we have maintained, or even enhanced, access controls at some crowded hotspots like popular markets, shopping malls and beaches, in tandem with enhanced public education efforts. We work closely with the business operators in implementing these measures, and are grateful for their understanding as we strike a balance between protecting livelihoods and preventing community spread.
At the same time, we are mindful to minimise inconvenience to patrons and businesses from these safe distancing measures, such as longer waiting times and disruptions to businesses. Agencies are in constant discussion with stakeholders and re-calibrate our measures where the situation allows. For example, NEA had recently lifted the odd or even date entry restrictions at the four popular markets following feedback from stakeholders, and after assessing the crowd levels and the risks of transmission.
With the co-operation from business operators and the community, we have been able to manage the COVID-19 situation and keep community spread low. However, we cannot afford to be complacent. I urge everyone to continue to cooperate and play your part in adhering to safe management and safe distancing measures, so that we continue to keep community transmission under control.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Encouraging Singaporeans to Apply for Lasting Powers of Attorney","subTitle":null,"sectionType":"WANA","content":"25 Miss Cheng Li Hui asked the Minister for Social and Family Development (a) what is the number of Singaporeans who applied for Lasting Powers of Attorney (LPAs) since the two-year extension of application fee waiver in June 2018; (b) what is the total number of Singaporeans who have applied for LPAs; (c) how can Singaporeans be encouraged to apply for LPAs; and (d) whether there are schemes in place to assist those from lower income groups to get their LPAs done.
Mr Masagos Zulkifli B M M: The two-year waiver of the Lasting Power of Attorney (LPA) Form 1 application fee for Singapore Citizens was first introduced in September 2014 to encourage take-up of LPAs. It has been extended twice, in 2016 and 2018. The 2018 extension started on 1 September and ended on 31 August 2020, and in this period, about 42,000 Singaporeans registered LPAs. As at 31 August 2020, 88,300 Singaporeans have registered LPAs.
To encourage more Singaporeans to make an LPA, the fee waiver for LPA Form 1 has been further extended to 31 March 2021. Since 30 January 2020, the LPA Forms have also been revised to make the application process easier and more convenient. We have also worked to raise awareness in the community through outreach via Getai, radio advertising and community roadshows (before COVID-19). During the circuit breaker period, we conducted virtual talks to hospitals, participated in a virtual roadshow by the Council for Third Age, and are in talks with banks to conduct LPA webinars. We are also working with community partners to enhance the accessibility and convenience of citizens in making an LPA application.
We will do more to encourage the take-up of LPAs. As part of the overall digital transformation effort of the public service to better serve Singaporeans, we plan to enable LPAs to be made and registered electronically. A new electronic transaction system is expected in the latter half of 2021. Singaporeans will be able to make an LPA conveniently online or carry out transactions with the Office of the Public Guardian electronically and with greater ease.
For those who require some financial assistance to make an LPA, there are many not-for-profit organisations who offer LPA certificate issuing services at subsidised rates. These include Life Point, Potter's Place Community Services Society and Mount Alvernia Outreach Medical Clinic in Enabling Village.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Proposal for Extra Childcare Leave for Parents of Differently Abled Children","subTitle":null,"sectionType":"WANA","content":"26 Mr Louis Ng Kok Kwang asked the Prime Minister whether the Government will consider providing extra childcare leave for parents of differently abled children to attend developmental assessments, medical and therapy appointments.
Ms Indranee Rajah (for the Prime Minister): We recognise that caregiving can be challenging, especially for those who have to juggle between work and caregiving roles, some of whom may be parents of children with special needs. We have enhanced child care leave provisions progressively over the years – we increased child care leave provisions for parents with children aged below seven years old from two to six days per year, and extended two days of child care leave per year to parents with children aged seven to 12.
We have taken a practical approach to calibrating child care leave provisions. Any enhancements will need to balance the caregiving needs of parents with the manpower and operational needs of employers, to avoid inadvertently affecting parents’ employability.
Beyond legislated leave provisions, it is important for employers to provide a family-friendly work environment, to help parents manage their work and caregiving responsibilities. For example, employers could implement flexible work arrangements (FWAs), and allow parents of children with special needs to take a few hours off from work to bring their child for medical appointments or developmental assessments. The Tripartite Standards on FWAs and on Unpaid Leave for Unexpected Care Needs, introduced in 2017 and 2018 respectively, also encourage companies to provide additional support for employees’ personal or caregiving responsibilities.
The Government has steadily improved support for the child care needs of parents of children with special needs. Earlier this year, we enhanced subsidies for the Special Student Care Centre (SSCC) programme, which provides before-and-after school care service and supervision for Special Education (SPED) students. We also removed the age limit for children with special needs under the Grandparent Caregiver Relief scheme, from the Year of Assessment 2020. Working mothers who seek grandparents’ help to care for their children with special needs can now get the $3,000 tax relief, regardless of the child’s age.
Other support is available for caregivers of children with special needs. One example is the caregiver engagement and training provided by Early Intervention Programme for Infants and Children (EIPIC) centres, to equip caregivers with skills and knowledge to continue the support at home. SG Enable maintains The Enabling Guide and Carelender App to provide caregivers better access to information on resources available to support them, and provides the Caregivers Pod at the Enabling Village as a space for caregivers to find peer support, attend training sessions and organise sharing sessions among themselves.
We will continue to study how to better support working parents, including those with children with special needs.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Abuse of Jobs Support Scheme","subTitle":null,"sectionType":"WANA","content":"27 Mr Chua Kheng Wee Louis asked the Deputy Prime Minister and Minister for Finance of the employers who have received Jobs Support Scheme payouts (a) what is the number of firms that have conducted a self-review declaration; and (b) what is the number of cases of JSS abuse that have been detected and the range of penalties imposed.
Mr Heng Swee Keat: Since its introduction at the Unity Budget in February, the Jobs Support Scheme (JSS) has supported the wages of over two million local workers in 150,000 businesses. I am heartened that the majority of employers are using the JSS as intended, to retain and pay wages to their local workers.
However, we are aware that a small minority of employers have attempted to game, abuse or defraud the Government for JSS payouts that they are not eligible for. For instance, in order to increase their JSS payouts, some of these employers have made CPF contributions for non-genuine employees or have increased CPF contributions without any actual wage increase. To guard against such cases, the Inland Revenue Authority of Singapore (IRAS), which is the scheme administrator, has instituted a robust anti-gaming framework, leveraging data from various sources as well as information from whistleblowers.
Based on this framework, IRAS has identified 2,200 employers for further administrative review. Such employers had their July JSS payouts temporarily withheld and were required to provide documentations to verify the authenticity and accuracy of CPF contributions made. Once verified, the JSS will be paid out to them as soon as possible. We will continue to take this risk-based approach for future JSS payouts.
To date, IRAS has received documents from and completed the review of about half of the cases. Four employers have been referred to the Police for further investigations. Investigations are still ongoing.
We take a very serious view of employers who attempt to game, abuse or defraud the JSS. Employers who attempt to do so will be severely dealt with. Offenders can be charged under Section 420 of the Penal Code and may face up to 10 years of imprisonment and a fine.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Demand for HDB Flats by Flat Type","subTitle":"Impact on HDB's decision to build 4-room, 5-room and 3Gen Flats","sectionType":"WANA","content":"28 Mr Gan Thiam Poh asked the Minister for National Development in each year of the past five years for both mature and non-mature estates respectively (a) what is the number of HDB flats for each flat type built; (b) what is the average subscription rate for each flat type; and (c) whether HDB will consider increasing the supply of 4-room, 5-room and 3Gen flats to meet demand.
Mr Desmond Lee: From 2015 to 2019, HDB built 12,764 2-room flats and Studio Apartments (SAs), 12,150 3-room flats, 33,487 4-room flats, 17,330 5-room flats and 530 3-Gen flats in the non-mature estates. Over the same period, HDB built 3,294 2-room flats and SAs, 6,324 3-room, 13,887 4-room, 2,463 5-room and 112 3-Gen flats in the mature estates.
Between 2015 and 2019, the annual average Build-to-Order (BTO) application rates for 2-room Flexi, 3-room, 4-room and 5-room/3Gen flats in the non-mature estates ranged between 1.2-2.9 times, 2.0-2.6 times, 1.8-3.5 times and 2.4-4.0 times respectively. As for the mature estates, the annual average BTO application rates ranged between 1.0-3.1 times, 1.6-4.9 times, 3.1-11.0 times, and 2.8-14.4 times respectively.
In planning the BTO flat supply, HDB adopts a comprehensive approach, taking into consideration factors such as the prevailing economic and housing market situations, as well as long-term demographic and population trends. HDB also provides a range of flat types to meet different housing needs.
Between 2019 and 2020, the annual BTO flat supply increased from 14,600 units to about 16,700 units, to meet the overall demand for public housing. In particular, the annual supply of 4-room and bigger flats has increased by 42%, from about 7,900 units in 2019 to about 11,200 units in 2020.
HDB will continue to monitor the housing market closely, and calibrate the BTO supply and flat types offered in its sales exercises to meet the housing needs of the population.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Causes of Overcrowding in Some HDB Rental Flats","subTitle":null,"sectionType":"WANA","content":"29 Mr Murali Pillai asked the Minister for National Development whether a study can be commissioned to ascertain the causes of overcrowding amongst residents in some HDB public rental flats and identify solutions to address this problem.
Mr Desmond Lee: Less than 10% of rental households have more than four members. HDB has been looking into how we can help larger rental households. Larger households are generally those with more children, or with extended family members staying with them for mutual care and support.
Families that form two nuclei, such as grandparents staying with parents and children, can apply for two rental flats, and can ask for the flats to be in the same block. On a case-by-case basis, some larger families may be offered a 3-room rental flat, subject to vacancies.
We will continue to study and explore further options to help rental households of all sizes, in close partnership with MSF. For example, under ComLink, government agencies and community organisations work together to help rental households attain stability and social mobility. HDB has also set up the Home ownership Support Team to provide greater support to rental households who are ready to buy a flat, especially families with children. This includes advising them on their housing budget and options, the grants and schemes available, and guiding them through the flat-buying process.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Risk of Medication Errors Due to Similar Drug Packaging","subTitle":null,"sectionType":"WANA","content":"30 Dr Tan Wu Meng asked the Minister for Health whether the risk of medication errors is assessed in the procurement of medications in public care institutions such as (i) lookalike packaging where different drugs have similar containers or packages and (ii) changes in drug concentration of syrups that may confuse patients and care-givers especially when medications are administered in the home.
Mr Gan Kim Yong: The public health institutions (PHIs) and Agency for Logistics and Procurement Services (ALPS) are mindful of the risk of medication errors when medications that have similar appearing containers or packaging are dispensed or administered. Look-alike medications may lead to different drugs or different doses of drugs being administered to patients, with potentially severe consequences.
Special care is taken when there are changes to the brands or strengths and these may occur when new drugs (or new generic drugs) become available, or when alternative drugs are needed due to manufacturing or supply-chain disruptions.
A multi-pronged approach is adopted to mitigate medication errors and this starts with the procurement process whereby similar appearing containers or packaging of medications are evaluated and suppliers are approached when improvements are required for better differentiation from other products.
PHIs educate pharmacy staff, doctors and nurses dealing with such medications on the changes in appearance or dosage, and how to mitigate the risk for errors. Distinguishing symbols, colours or fonts are used when labelling the medications and the storage areas to highlight the differences in description of the medications.
When the medications are stored in the pharmacies and wards, different drugs with similar appearances are stored separately in different locations to reduce the risk of selecting the wrong drug. In the wards, a process of counter-checks has been introduced to verify that the correct medication has been selected during the preparation of the medications and during administration.
Finally, when dispensing the medications to patients, PHIs affix \"packaging or dose change\" stickers in various languages on the dispensing packs. Pharmacy staff also remind patients to pay attention to any changes to brands and/or strengths of products.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Reviewing Healthcare Services Support Schemes for Healthcare Inflation","subTitle":null,"sectionType":"WANA","content":"31 Mr Leon Perera asked the Minister for Health how often are subsidy levels for healthcare services support schemes like the Community Health Assist Scheme (CHAS) reviewed for healthcare inflation
Mr Gan Kim Yong: The Ministry of Health (MOH) regularly reviews our healthcare services support schemes based on a variety of factors, including healthcare inflation as well as household incomes, to ensure that healthcare remains affordable and accessible for all Singaporeans.
For example, CHAS was recently enhanced in November 2019 to provide subsidies for chronic disease management to all Singaporeans regardless of income. Other enhancements included the increase in the annual subsidy cap for complex chronic conditions for CHAS Blue and Orange cardholders, from $500 to $520 and $300 to $320 per year respectively, as well as the extension of subsidies for common illnesses to CHAS Orange cardholders. Merdeka Generation seniors are also entitled to special subsidies for medical and dental care at CHAS clinics.
MOH periodically updates the income criteria used to determine subsidy levels, to account for income growth and changes in healthcare expenditure over the years. In the latest review conducted in 2019, more than 365,000 Singapore Residents had benefited from higher subsidies resulting from the revised monthly per capita household income criteria for our means-tested healthcare schemes.
Such reviews form part of MOH's continual efforts to maintain healthcare affordability for our citizens, particularly those from the lower income groups, to ensure that no Singaporean will be denied appropriate healthcare because of inability to pay.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Number of Appeals Received from HDB Flat Owners for Waiver of Ethnic Integration Policy","subTitle":null,"sectionType":"WANA","content":"32 Mr Chong Kee Hiong asked the Minister for National Development (a) in each of the last three years, how many appeals for waiver of the Ethnic Integration Policy are received from HDB flat owners; (b) how many appeals are received from each ethnic group; (c) how many of the appeals are successful; (d) how many owners are granted time extension to sell their flats; and (e) how many of the flats remain unsold at the end of the time extension.
Mr Desmond Lee: In 2017, 2018, and 2019, there were a total of around 22,100, 23,100, and 23,700 HDB resale transactions registered, respectively. In each of the three respective years, HDB received about 530, 690, and 630 appeals from flat owners to waive the Ethnic Integration Policy (EIP). About 300 (16%) of these appeals were from Chinese flat owners, 460 (25%) were from Malay flat owners, and 1,080 (59%) were from Indian flat owners or flat owners from other ethnic groups. The percentage of appeals that were successful has increased from 8% in 2017, to 14% in 2018, and reached 18% in 2019.
As for time extensions granted to flat owners to sell their flats, from 2017 to 2019, HDB approved on average more than 900 such appeals per year. These time extensions were given for various reasons, not just the EIP. For example, flat owners may have requested a time extension because they faced medical difficulties, or unforeseen delays in renovations for their next flat. HDB is unable to provide a more detailed breakdown by the reasons given for the time extensions, as it does not track the appeals to this level of detail, and there could be multiple reasons given for any specific case.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Unsold Units in HDB's Sale of Balance Flats and Open Booking Exercises","subTitle":null,"sectionType":"WANA","content":"33 Mr Chong Kee Hiong asked the Minister for National Development in each of the last three years (a) how many (i) Sale of Balance flats (SBF) and (ii) open booking flats remained unsold for more than two years; (b) what are the main reasons for this; and (c) whether the Ministry will consider lifting the Ethnic Integration Policy criterion for such flats.
Mr Desmond Lee: As of 30 Sep 2020, only two flats that were previously offered through Sale of Balance Flats (SBF) exercises and open booking have remained unselected for more than two years, from the time they were first offered under an SBF exercise.
Flats may remain unselected for various reasons. Besides the Ethnic Integration Policy (EIP) limits, other reasons could include the personal preferences of applicants, the flats’ attributes like their location, layout or storey height, and the surrounding facilities and amenities.
There are currently no plans to lift the EIP limits for unselected flats, given the relatively small number of flats that have remained unselected, and the various reasons why this may be the case. The EIP remains important in ensuring that our HDB estates continue to reflect a diverse mix of ethnic groups, to promote racial harmony and strengthen social cohesion.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Facilitate Renewal of Foreign Manpower for Construction Sector Post-COVID-19","subTitle":"Shortening man-year entitlement to two years or less","sectionType":"WANA","content":"34 Miss Cheryl Chan Wei Ling asked the Minister for Manpower in view of COVID-19's impact on the construction sector, whether the man-year entitlement period can be shortened to two years or less for workers currently in Singapore so as to facilitate the renewal of workers when companies are unable to bring in new workers to continue their trade.
Mrs Josephine Teo: In the Construction and Process sectors, we encourage firms that wish to hire Work Permit holders from non-traditional source countries and China to do so up to their Man-Year Entitlements (MYE), so as to maintain manpower-lean operations. However, for firms that wish to hire additional workers beyond their MYE allocations, such workers should be experienced. This is why we require foreign workers to have at least three years of construction experience to qualify for MYE-waiver.
Nevertheless, we are cognisant of the impact of COVID-19 on the Construction sector, and are prepared to consider requests to renew the work passes of Work Permit holders with less than three years of construction experience under the MYE-waiver, on a case-by-case basis.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Help for Contractors Faced With Dormitory Constraints or Higher Temporary Living Quarter Costs","subTitle":null,"sectionType":"WANA","content":"35 Miss Cheryl Chan Wei Ling asked the Minister for Manpower in light of the limited number of dormitories and availability of temporary living quarters and the cost of living spaces for foreign workers doubling in cost, what has or can be done to assist the contractors during this period.
Mrs Josephine Teo: Since April this year, to lower the density in dormitories and risk of COVID-19 transmission, some dormitory residents have been moved out to Government temporary sites. More employers are also building new Construction Temporary Quarters (CTQs) and converting workplaces into Temporary Living Quarters (TLQs) to house their workers. This has led to a 30% reduction in the number of workers staying in current Purpose-Built Dormitories (PBDs) from 212,000 in April to 150,000 currently.
From end September, the Government has progressively stood up new Quick-Built Dormitories (QBDs). In total, the new QBDs, temporary dormitories fitted out by the Government and new CTQs built by contractors will provide around an additional 60,000 bed capacity. The additional capacity will help maintain a sufficient supply of beds in the market and moderate any increase in bed rental prices as a result of the reduction in density in the dormitories. Feedback from employers and dormitory operators have indicated that dormitory bed rental prices have generally remained stable since pre-COVID. Where employers have experienced significant increases in asking rents, they may wish to consider available alternatives in other dormitories.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Number of Accidents Caused by Leisure Riders Versus Delivery Riders","subTitle":"Follow-up after 2017 amendment to Active Mobility Act","sectionType":"WANA","content":"36 Ms Carrie Tan asked the Minister for Transport what is the number of accidents caused by leisure riders compared to the number of accidents caused by delivery riders on personal mobility devices since the 2017 revision of the Active Mobility Act.
Mr Ong Ye Kung: Between January 2017 and July 2020, there were about 490 reported accidents involving personal mobility devices (PMDs) on public paths. We do not track the breakdown of accidents across different types of PMD riders.
Notwithstanding, as delivery riders are heavier users of active mobility devices, we will require businesses to ensure that all active mobility device users engaged by them have appropriate third-party liability insurance coverage from December 2020 onwards. This will improve accident victims’ access to compensation, and protect riders from large claims.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Number of Domestic Abuse Cases Since Start of Circuit Breaker Period","subTitle":null,"sectionType":"WANA","content":"39 Ms He Ting Ru asked the Minister for Home Affairs (a) how many reports per month have been received by the police for domestic abuse cases since the start of the circuit breaker period; (b) how many of these reports have been investigated by the police; and (c) what percentage of such family violence cases subsequently resulted in charges being brought by the Attorney General's Chambers.
Mr K Shanmugam: Police have received an average of 415 family violence reports per month since April.
For all the reports, Police will assess the facts and circumstances of the case to determine if investigations should be initiated. Investigations were initiated in more than 40% of the cases.
About 3% of the cases investigated were prosecuted in court and about 12% were given a warning in lieu of prosecution. Family violence cases often have complex underlying issues and prosecution may not always be the optimal solution. In some cases, other avenues of assistance may be more appropriate. For example, Police may advise the victim to apply for a Protection Order, or refer the family to social service agencies for counselling and assistance.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Number of Infant and Childcare Places and Number of Citizens Born in Last Five Years","subTitle":"Broken down by URA planning areas","sectionType":"WANA","content":"40 Ms He Ting Ru asked the Minister for Social and Family Development (a) what is the number of infant and childcare places currently available in Singapore, broken down by URA planning areas; and (b) how many Singapore citizens were born in Singapore over the last five years, broken down by URA planning areas.
Mr Masagos Zulkifli B M M: To meet the preschool needs of young families, Early Childhood Development Agency (ECDA) regularly projects demand across regions in Singapore, taking into consideration factors such as population size, demographics and enrolment trends. Families’ decisions on where to live, which affect projections, can also change over time and need to be continually reviewed. ECDA then works closely with agencies such as HDB, to develop new preschools in tandem with new housing developments, and URA, to set aside space for preschools through the Government Land Sales programme.
Nationally, the supply of infant and childcare places has increased significantly by almost 50% since 2015 to 180,000 places, to meet rising demand. Of this, 10,200 are infant care and 169,800 are childcare places. Of the new preschool places added, many are in areas with more young families. For example, in the two newer planning areas, Punggol and Sengkang, there has been a 90% increase in the number of infant and childcare places since 2015.
Over the past five years, there was an average of about 33,000 Singaporean citizen births annually. Even if we assumed that every one of these 165,000 children born over the past five years attends a full-day preschool, there is sufficient capacity nationally to meet their needs. Surveys have shown that most parents still prefer for their infants to be cared for at home by family, rather than opt for infant care services. Nationally, about 73% of childcare places have been taken up by enrolled children. The enrolment rate for infant care places is lower at 66% of available supply. Even for the newer planning areas such as Punggol and Sengkang, the infant care enrolment rate is about 61%.
While the overall situation shows ample supply, there remain pockets with waitlists. This could be due to several factors. Examples include, location mismatches and parents increasingly wanting preschool places closer to their homes. While we are building new preschool places closer to families, it is not always possible for all families to have a preschool at the same block or within a few blocks of their homes, due to space constraints.
The Government remains committed to ensuring that every child who needs a preschool place will be able to have one. ECDA will develop another 20,000 new infant and childcare places by 2023, mainly in planning areas with upcoming HDB developments for new families.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Number of Persons in Different Age Groups Who Have Received Workfare Income Supplement Payouts","subTitle":null,"sectionType":"WANA","content":"41 Mr Gan Thiam Poh asked the Minister for Manpower (a) in the past three years, what is the annual number of persons who have received the Workfare Income Supplement (WIS), broken down by age groups of 35 to 40, 41 to 50, 51 to 60, and above 60; and (b) whether a review will be made to further raise the WIS amount to one-third of their monthly gross income.
Mrs Josephine Teo: The Workfare Income Supplement Scheme provides cash supplements and CPF top-ups that encourages eligible lower-income workers to work regularly and build up their CPF savings. Workfare boosts the incomes of these workers by up to 30 per cent. Payouts are generally higher for older workers. Persons with disabilities below age 35 can also receive Workfare.
From 2017 to 2019, an annual average of about 400,000 employees and self-employed persons received Workfare. About 45,000 were aged 35 to 44, 85,000 were aged 45 to 54, 70,000 were aged 55 to 59 and 195,000 were aged 60 and above. Another 3,000 persons with disabilities below age 35 received Workfare.
Workfare has been regularly reviewed since its launch in 2007. The qualifying income ceiling and payouts have been raised on four occasions. In fact, the maximum Workfare payout was just increased by up to 14 per cent starting from January this year. We will continue to review Workfare regularly to ensure the target groups are supported.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Legislation to Support Requests for Work-from-Home Arrangements","subTitle":null,"sectionType":"WANA","content":"42 Mr Louis Ng Kok Kwang asked the Minister for Manpower whether the Ministry will legislate the right for all employees to request flexible work arrangements and require employers who reject the request to provide a specific business-related reason.
Mrs Josephine Teo: The Ministry of Manpower (MOM) recognises the importance of flexible work arrangements (FWAs) in helping workers to better manage both their work and personal responsibilities. We have continuously reviewed and enhanced our efforts to support the provision of FWAs. This includes progressively implementing the recommendations of the Citizens' Panel on Work-Life Harmony that were submitted last year, such as growing a community of Work-Life Ambassadors and developing sector-specific implementation guides on FWAs.
Today, the vast majority of employees are benefitting from FWAs. In 2019, about 85% of employers offered some form of formal or ad-hoc FWAs.1 These numbers have increased during this COVID-19 period with employers being required to implement work-from-home and FWAs for safety of their workers. Post-Circuit Breaker, even as more workers are allowed to return to the workplace, the tripartite partners have called upon employers to not only stagger start times for their employees but also introduce flexible workplace hours as a norm.
MOM will monitor the effects of the higher use of FWAs, and study the best ways to entrench best practices after COVID-19. We will consider the experience of other jurisdictions and work with tripartite partners to ensure the interests of both employees and employers are considered. In the meantime, we urge employers to press on and continue to implement work arrangements that enable employees to maintain work-life harmony while continuing to meet business needs.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":["1 : Supplementary Survey on Quality Workplaces, Manpower Research and Statistics Department, MOM."],"footNoteQuestions":["42"],"questionNo":"42"},{"startPgNo":0,"endPgNo":0,"title":"Proposal for Guidelines on Euthanasia of Healthy Pets","subTitle":null,"sectionType":"WANA","content":"43 Mr Louis Ng Kok Kwang asked the Minister for National Development whether the Ministry will include in a set of guidelines on the euthanasia of healthy pets the requirement for pet owners to explore returning the animal to the person or organisation they adopted the animal from before proceeding with the euthanasia.
Mr Desmond Lee: NParks has established the multi-stakeholder Rehoming and Adoption Work Group (RAWG) to take a more holistic look into practices related to the rehoming and adoption of dogs.
The RAWG aims to clarify the responsibilities of the various stakeholders involved in the rehoming and adoption of dogs. This includes pet owners, as well as persons or organisations they adopted the animal from. The work group will consider views from different stakeholders to develop community-based standards and guidelines, including for the return of adopted dogs as suggested by the Member.
We look forward to working closely with the Member and other stakeholders in the RAWG.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Call to Re-instate Percentage Share of COEs for Motorcycles","subTitle":null,"sectionType":"WANA","content":"44 Mr Kwek Hian Chuan Henry asked the Minister for Transport whether LTA can increase and re-instate the percentage share of COEs for motorcycles back to its historical norm given that motorcycle COEs have been allocated to the Open COE category for the past few years which few motorcyclists utilised.
Mr Ong Ye Kung: Since May 2017, we have ceased the contribution of Category D Certificates of Entitlement (COEs) to Category E. This has stabilised the Category D market, and the total motorcycle population has largely remained unchanged over the last three years. As the Vehicle Growth Rate for motorcycles has been 0% since 2018, the Category D COE quota supply largely depends on the number of motorcycles deregistered in the preceding months.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Incentivising Public Transport Operators to Reduce Carbon Dioxide Emissions","subTitle":null,"sectionType":"WANA","content":"45 Mr Leon Perera asked the Minister for Transport whether there are currently sustainability clauses in the Ministry's contracts with public transport operators to incentivise them to reduce carbon dioxide emissions.
Mr Ong Ye Kung: Under our public transport service delivery structure, Government is the owner of key public transport infrastructure and operating assets, which includes public buses, trains, signalling systems and other operating assets. Hence, Government is in a position to advance sustainability goals directly.
For new public buses, LTA will purchase only cleaner energy vehicles to progressively replace the existing fleet. To date, LTA has deployed on a trial basis, 50 diesel hybrid buses and 15 electric buses, with a view to expanding such fleets. This is the first step in achieving our target of a 100% cleaner energy public bus fleet by 2040.
For rail, all new stations since 2014 are designed to minimise carbon dioxide emissions, and to meet Green Mark certification requirements. Our rail operators also comply with energy efficiency requirements under the Energy Conservation Act, which mandates energy efficiency requirements and energy management practices.
As public transport remains the most carbon-efficient mode of transport, we would like to encourage more people to adopt Walk-Cycle-Ride to meet their commuting needs. The peak-period Walk-Cycle-Ride mode share was 72% in 2019, and we aim to increase this to 90% by 2040.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Consumer Protection from Rogue Hair Salons Engaging in Pressure Sales Tactics","subTitle":null,"sectionType":"WANA","content":"46 Dr Tan Wu Meng asked the Minister for Trade and Industry what measures are being taken to safeguard consumers, especially the elderly, from rogue hair salons engaging in pressure sales tactics in our HDB heartlands.
Mr Chan Chun Sing: There are considerable measures to safeguard consumers from pressure sales tactics. Such unfair practices that exert undue pressure or influence on consumers to enter into transactions involving goods or services are prohibited under the Consumer Protection (Fair Trading) Act (CPFTA). Consumers can report these unethical practices to the Consumers Association of Singapore (CASE) and seek their advice and assistance in obtaining a redress from the suppliers.
Under the CPFTA, CASE may ask a supplier who has engaged in, or is engaging or likely to engage in an unfair practice, to enter into a Voluntary Compliance Agreement (VCA) and stop such actions. The supplier may also be required to compensate any consumer who has suffered loss or damage as a result of the unfair practice, as well as publicise the VCA.
In addition, the Competition and Consumer Commission of Singapore (CCCS), as the administering agency of the CPFTA, is armed with investigation and enforcement powers to file for a court injunction restraining a supplier that persists in unfair practices.
Apart from a consumer advisory on its website about how to shop wisely for beauty-related products and services, CASE also publicly lists the names of companies in this industry that use aggressive pressure sales tactics. In addition, CASE regularly holds awareness talks for senior citizens to educate them on their consumer rights and how not to fall for pressure sales tactics.
Furthermore, CASE works with industry associations to develop initiatives such the CASE Trust accreditation schemes for specific industries like the spa & wellness sector. To discourage heavy-handed sales tactics, the accreditation criteria for these industries include the need for sales staff to be trained in ethical sales practices.
The Government will continue to monitor developments in this area and work with CASE and CCCS to ensure that the interests of consumers, especially our seniors, are safeguarded.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Selective Weekend Entry Restrictions Imposed on Lucky Plaza and Peninsula Plaza","subTitle":null,"sectionType":"WANA","content":"47 Assoc Prof Jamus Jerome Lim asked the Minister for Trade and Industry (a) what are the motivations for selective weekend entry restrictions imposed on Lucky Plaza and Peninsula Plaza but not on other malls; (b) whether the restrictions are based on expected footfall; (c) what is the relative footfall for these two malls versus other nearby malls; and (d) whether the Government will consider either subsidising a partial rebate on rental costs for tenants in these two malls whose businesses have plunged, or closing the malls altogether and allowing tenants to make a case for a rebate from their landlords
Mr Chan Chun Sing: Prior to the entry restrictions, Lucky Plaza and Peninsula Plaza received close to 27,000 visitors and 9,400 visitors respectively1 a day on a weekend. The high and sustained visitorship led to long queues of shoppers waiting to enter the mall at different entrances for many hours. This in turn resulted in large crowds spilling over to the main thoroughfare and disrupted pedestrian flow. The situation at both malls led to considerable public feedback voicing concerns about crowding, as well as the danger of shoppers and establishments failing to keep safe distancing and safe management measures. This could affect visitors and risk a potential community spread of COVID-19.
Hence, there is a need for better crowd management at Lucky Plaza and Peninsula Plaza to ensure the safety of visitors and businesses during busy weekends. Enterprise Singapore and the Singapore Tourism Board worked with the management of these two malls to implement entry restrictions for public safety. We do not see such high and sustained congestion levels in other malls.
Since the implementation of entry restrictions in Lucky Plaza and Peninsula Plaza on 29 August, businesses in both malls are better able to ensure compliance with safe management measures. This has helped to address public concerns and minimise transmission risks, while keeping businesses open.
On the last question on Government assistance to businesses, both food services and retail businesses enjoy a higher level of support under the Job Support Scheme. The tenants in Lucky Plaza and Peninsula Plaza would have obtained rental reliefs in the form of cash grants and property tax rebates which property owners are required to fully pass on to lessees. Enterprise Singapore and the Singapore Tourism Board continue to work with the management of both malls to ensure a safe environment for visitors to the malls.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":["1 : Total number of visitors in the day (not unique visitors and including staff)."],"footNoteQuestions":["47"],"questionNo":"47"},{"startPgNo":0,"endPgNo":0,"title":"Transfer of SkillsFuture Credits between Family Members","subTitle":null,"sectionType":"WANA","content":"48 Mr Leon Perera asked the Minister for Education whether the Government will consider allowing family members to transfer their SkillsFuture Credits to one another so as to promote better utilisation of SkillsFuture credits by those who have greater training needs.
Mr Lawrence Wong: The SkillsFuture Credit seeks to empower every Singaporean to take charge of his or her own learning over the course of his or her life, even in the senior years. For this reason, we have designed the SkillsFuture Credit to be non-transferable.
We recognise the need in these times to provide greater support to Singaporeans for their training needs. The Government has therefore provided a $500 top-up to all Singaporeans aged 25 and above this year, as well as an additional $500 SkillsFuture Credit (Mid-Career Support) for Singaporeans aged 40 to 60. The SkillsFuture Credit helps to offset out-of-pocket course fees, which are already highly subsidised by the Government at up to 90%.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Second Environmental Impact Assessment on Bukit Batok Hillside Park Development Project","subTitle":null,"sectionType":"WANA","content":"49 Mr Dennis Tan Lip Fong asked the Minister for National Development whether a second environmental impact assessment on the Bukit Batok Hillside Park Development Project will be done to account for the feedback from environmental groups.
Mr Desmond Lee: An environmental impact assessment was conducted for the Bukit Batok Hillside Park area to guide the planning and development of the site. Members of the nature community were engaged in August 2019, and their feedback and suggestions were instrumental in shaping the findings and recommendations of the study. For instance, the study recommended retaining a natural stream that runs through the site as well as its catchment area, which nature groups supported. As a result, HDB will retain both the stream and its catchment area in future park development. To reflect this, the area has been rezoned from Residential use to Park use in the Master Plan. Significant plant species and mature trees will also be retained and incorporated into the future residential development.
The environmental study report was published for public feedback from 19 June to 16 July 2020. HDB, along with the environmental consultants and Technical Agencies, are currently studying the feedback received from members of the public and nature community before finalising the report. Rather than conducting a second environmental impact assessment, the finalised report will incorporate feedback from the public and nature groups. This report will be published on HDB’s website when ready, and will guide the plans and development of the site.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Take-up Rate of Lift Access Housing Grant","subTitle":null,"sectionType":"WANA","content":"50 Mr Liang Eng Hwa asked the Minister for National Development what has been the take-up rate of the Lift Access Housing Grant so far and whether there is a need to expand the scheme for residents in estates where the Lift Upgrading Programme is not feasible.
Mr Desmond Lee: The Lift Upgrading Programme (LUP) was launched in 2001 to provide direct lift access to flats and enhance convenience for residents, especially the elderly and less mobile. At the start of the programme, there were more than 5,300 HDB blocks without full direct lift access.
Over the years, HDB has adopted innovative technical solutions to provide such blocks with direct lift access. Through these efforts, the vast majority of the 5,300 blocks have since been able to benefit from LUP. Currently, there remain about 150 blocks where it is still not possible to implement LUP due to prohibitive costs, or existing technical constraints.
While we will continue to explore possible ways to bring direct lift access to these blocks, we know that some residents may urgently need direct lift access due to medical or mobility issues. In March this year, we therefore introduced the Lift access Housing Grant (LHG) of up to $30,000, to help those with medical or mobility issues buy a new or resale HDB flat with direct lift access.
As at August 2020, HDB has received 17 applications for the LHG and approved seven. The remaining 10 applications are being assessed.
We do not have plans to expand the LHG at this point in time. Nevertheless, we will continue to monitor the take up rate and review if enhancements are required.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Proposal for Public Defender Scheme for Vulnerable Persons","subTitle":null,"sectionType":"WANA","content":"51 Ms Carrie Tan asked the Minister for Law whether there can be a public defender scheme for vulnerable persons provided by the state for non-death penalty criminal cases.
Mr K Shanmugam: The agencies have considered the High Court judgment, and are conducting reviews. These reviews are still in progress.
I will address the question raised by the Member, after the reviews are completed. I expect to do so at the November sitting. As I have indicated, I will be making a Ministerial Statement.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Progress Made by Singapore Banks to Combat Money Laundering in Past 10 Years","subTitle":null,"sectionType":"WANA","content":"52 Ms Foo Mee Har asked the Minister for Home Affairs (a) what has been the progress made by Singapore banks in combating money laundering over the last 10 years; (b) what has been the effectiveness of suspicious transaction reports filed by Singapore's financial institutions in detecting illicit activities; and (c) how well does Singapore collaborate with overseas authorities to seize such funds and disrupt criminal activities.
Mr K Shanmugam: MAS shared in a written reply to Questions 101 and 102 appearing in the Order Paper for the sitting on 5 October 2020, on how banks in Singapore have improved their anti-money laundering (AML) controls over the years, under MAS’ close supervision.
Suspicious transactions reports (STRs) filed by Singapore’s financial institutions are an important part of these controls. The volume of STRs has increased significantly, from 12,000 in 2010 to 32,000 in 2019, a positive development. Of the STRs filed in 2019, 13% directly led to initiation of or supported investigations. In a recent case, Police successfully uncovered and prosecuted an insider fraud involving more than $1.9 million, pursuant to a STR filed by a bank.
Our law enforcement agencies have close working relationships with their foreign counterparts. We have collaborated in several complex transnational investigations to intercept criminal proceeds, disrupt the criminal syndicates and bring the criminals to justice.
In March 2020, the Police seized more than $6.4 million in a transnational money laundering case related to Covid-19 medical supplies, within one day of receiving the intelligence. In 2018, the Police returned more than $27 million in criminal proceeds to the Chinese authorities. These monies were linked to one of the biggest Ponzi schemes in China, which saw 1.15 million investors cheated out of $7 billion. These seizures were the result of Police’s money laundering investigations.
Since 2017, the Police have also conducted more than 10 joint operations with their overseas counterparts, in jurisdictions such as Malaysia, Hong Kong, Macau and China, to disrupt criminal syndicates conducting online scams targeting Singapore residents and laundering their ill-gotten gains out of Singapore. These operations resulted in the arrest of more than 120 syndicate members worldwide, with seven extradited to Singapore for criminal prosecution.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Proposal for Sheltered Walkway on Singapore Side of Johor-Woodlands Causeway","subTitle":null,"sectionType":"WANA","content":"53 Mr Ang Wei Neng asked the Minister for Transport whether Singapore has plans to build a sheltered walkway on the Singapore side of the Causeway in light of Malaysia's announcement to build a 1.2-km sheltered walkway on the Causeway between Johor and Woodlands.
Mr Ong Ye Kung: There is an existing pedestrian walkway on Singapore's side of the Causeway. This is currently sufficient to meet the needs of travellers.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Current Estimated Potential (CEP) within Civil Service","subTitle":null,"sectionType":"WA","content":"
1 Mr Louis Ng Kok Kwang asked the Prime Minister whether the Government intends to abolish the use of Current Estimated Potential (CEP) within the Civil Service.
Mr Chan Chun Sing (for the Prime Minister): The Civil Service adopts the concept of Currently Estimated Potential (CEP) as a proxy of an officer's potential. It is expressed in terms of the largest job responsibility level an officer is assessed to be capable of undertaking in his or her career in the Public Service. Today, it is used as a long-term talent development and succession planning tool for key leadership positions and a career management tool for progressing and developing officers.
Last year, the Civil Service embarked on a review of the CEP system, as part of a proactive review of its Human Resource (HR) systems and policies, to support Public Sector Transformation. We concluded that while CEP is still a useful tool to identify and develop officers with leadership potential, we need to adapt its application in a few ways.
First, we need to refresh what qualifies as having high CEP, or \"leadership potential\". The set of leadership competencies has been refreshed to be more holistic. For instance, leaders must have the cognitive ability but also be able to build systems for the future, lead people well and have a good sense of the ground. These qualities will be consistently observed through job rotations as well as through new channels such as 360 feedback.
Second, we will use CEP more lightly in our HR decisions. It is a means of identifying those with leadership potential for early development but will no longer be the single most important determinant of career development and progression. We will place greater weight on assessing officers’ demonstrated skills and competencies as part of performance management, progression, and talent identification and management.
Third, we will place more emphasis on helping individuals identify their potential and career goals within the short to medium term of three to five years, and work with them on achieving these goals. The Public Service has started to expand training, job rotations and career coaching as we expect that as our operating landscape changes, the CEP of our officers will keep changing. What is important is to create the best conditions, for our officers to discover their passion and talents and to maximise their full potential.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Relief Measures for Individual and SME Borrowers Whose Credit Ratings Are Affected by COVID-19 Pandemic","subTitle":null,"sectionType":"WA","content":"2 Mr Don Wee asked the Prime Minister whether MAS can provide guidance to (i) financial institutions not to let their individual and SME borrowers' dismal financial performance in 2020 affect their credit scoring and (ii) credit bureaus to rescind the adverse record of an individual borrower whose repayment ability has been affected by the COVID-19 pandemic.
[(proc text) Note: The Member has given notice of his declaration of interest as an employee of a Singaporean bank, although he is not involved in the credit approval process directly. (proc text)]
Mr Tharman Shanmugaratnam (for the Prime Minister): The COVID-19 pandemic has significantly disrupted incomes of many individual and business borrowers. The priority is to help them not to miss payments. That is why MAS has been working closely with the financial industry to implement relief measures since March 2020, to help borrowers defer and spread out their monthly repayments. Borrowers who take up the relief measures are able to avoid missing payments, and hence avoid hurting their credit standing.
MAS has also advised financial institutions (FIs) to look beyond the borrower’s short-term cash flow problems when assessing their credit standing. They should take into account any relief measure that the FI and borrower have agreed to, and the borrower’s ability to make full repayment based on the revised loan terms. This will help many borrowers avert a credit downgrade.
MAS therefore encourages borrowers who are concerned about any adverse credit records because they have missed payments as a result of COVID-19 to reach out to their lenders early to tap into the various relief schemes. MAS has recently announced a set of extended support measures to help borrowers on relief ease into making full repayments next year. If the borrowers can service their loans promptly under the revised terms, they will over time be able to restore their credit standing. Further, such loans would not be reported as restructured loans in their credit bureau records.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Help for Individuals Facing Property Loan, Credit and Insurance Premium Payment Problems from Continued Economic Uncertainties","subTitle":null,"sectionType":"WA","content":"3 Mr Chua Kheng Wee Louis asked the Prime Minister (a) what is the number of individuals who have applied for and received approval to (i) defer repayment of residential property loans (ii) lower interest on personal unsecured credit (iii) defer premium payments for life and health insurance and (iv) make flexible instalment plans for general insurance; and (b) whether MAS is considering extending (i) and (ii) beyond 31 December 2020.
4 Mr Murali Pillai asked the Prime Minister (a) to date, how many individuals have applied for the Special Financial Relief Programme (Unsecured); (b) how many individuals have been successfully subscribed into the Programme; (c) what are the main reasons for individuals not being able to participate in the Programme; (d) what is the average loan quantum of these individuals; (e) what is the average quantum that an individual saves as a result of converting his unsecured debt into this Programme; and (f) whether MAS can consider reducing the capped interest rate of 8% per annum, increasing the five-year loan tenor and extending the conversion period beyond December 2020 given the continued uncertainties Singapore's economy faces.
Mr Tharman Shanmugaratnam (for the Prime Minister): As of end-August 2020, financial institutions (FIs) had received 38,900 applications to defer property loan repayments. They had approved over 90% of these applications. More than 26,000 of the approved applications were for individuals seeking to defer their residential property loans. This amounted to almost $20 billion of deferments.
For personal unsecured credit, all eligible individuals can convert their outstanding balances from revolving unsecured credit facilities to term loans on a lower interest rate under the Special Financial Relief Programme (SFRP) (Unsecured). As of end-August 2020, the FIs granted more than 8,100 conversions. This amounted to more than $200 million of personal unsecured debt, or about $25,000 per individual on average.
For life and health insurance, the FIs received 32,700 applications for premium deferments, and about 90% of them were approved as of end-August 2020. This amounted to more than $66 million of premiums. Similarly, about 90% of more than 1,300 applications for flexible instalment plans have been approved.
The cost savings to borrowers who applied for SFRP (Unsecured) assistance will vary according to the situation of each borrower. They can be substantial. Take, for example, a borrower with outstanding unsecured credit card debt of $25,000, and is able to repay only the minimum credit card repayment of 3% outstanding every month, which works out to about $580 on average. By rolling over his credit card debt at a typical 26% per annum rate, at the end of five years he would have paid about $24,500 in interest cost and still have outstanding debt of about $14,500.
If he instead converts his outstanding credit card debt of $25,000 into a term loan under the SFRP (Unsecured), he will pay about $510 in monthly instalments and fully repay his debt by the end of five years, paying approximately $5,400 in total interest cost. The interest paid is hence 80% less than what he would have paid by rolling his credit card balance.
In designing SFRP (Unsecured), MAS and the industry took into account similar products in the market. These products are typically offered to customers with good payment records, and the range of interest rates is correspondingly competitive. The 8% cap on effective interest rate is already at the lower end of the range offered by banks. This relatively favourable rate is now being offered to borrowers under the SFRP (Unsecured) who are already past due on their payments. So, the terms are already very favourable.
While the current payment deferments on property loans have helped ease the cashflow pressures faced by borrowers, they come with higher overall debt. Where they are able to, borrowers would find it in their interests to resume making full loan repayments when the current relief measure expires.
Having said that, we recognise that some borrowers may continue to experience cashflow pressures into the beginning of 2021 due to impact of COVID-19. As such, MAS and the financial industry announced on 5 October 2020 an extension of support measures.
Under the extended support measures, property loan borrowers who face repayment difficulties can apply to make reduced instalment payments pegged at 60% of their original monthly instalment, which will cover interest and principal payments. For unsecured credit, the application period for borrowers to convert their outstanding balances from revolving unsecured credit facilities to term loans on a lower interest rate has been extended to 30 June 2021.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Statistics on National Service Deferment for Essential In-camp Training for March to August 2020","subTitle":null,"sectionType":"WA","content":"5 Mr Don Wee asked the Minister for Defence (a) what has been the percentage change in National Service deferment for essential in-camp training for March to August 2020 compared to the average over the last three years; (b) which category for deferment has seen the largest increase; (c) whether the Ministry will consider providing make-up pay to 'job seekers' who have turned to jobs in the gig economy instead of allowing these job seekers to defer; and (d) whether the Ministry can work with companies to permit such workers to maintain their incentive levels while they are serving in-camp training.
Dr Ng Eng Hen: From April to August 2020, all in-camp trainings (ICT) call-ups, except those for critical security operations or national COVID-19 efforts, were suspended due to the COVID-19 situation.
NSmen who hold jobs in the \"gig economy\" are eligible for Make-Up Pay similar to employed individuals in the formal economy. MINDEF does include their incentive quantums in the calculation of Make-Up Pay if the relevant supporting documents are submitted.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Statistics on Illegal Moneylending Activities between April and September 2020 and Plans to Increase Anti-unlicensed Moneylending Education and Enforcement Efforts","subTitle":null,"sectionType":"WA","content":"6 Mr Melvin Yong Yik Chye asked the Minister for Home Affairs (a) whether there has been an increase in illegal moneylending activities in the period of April to September 2020 compared to the same six-month period in 2019; (b) whether there is an increasing trend of young adults, aged between 16 and 21 getting involved in illegal loansharking and harassment activities; and (c) whether the Ministry has any plans to increase anti-unlicensed moneylending education and enforcement efforts given the current economic downturn.
Mr K Shanmugam: Between April and August 2020, 1,587 cases of Unlicensed Moneylending (UML) and UML-related harassment were reported. This was a 40% decrease from 2,642 cases reported during the same period in 2019. Data for September 2020 is not available yet.
Over the past five years, between 100 and 160 youths aged between 16 and 21 years old were arrested for UML offences every year. There was no clear trend of increase. More recently, between January and August 2020, 89 youths in this age range were arrested for UML offences, which was a 19% decrease from 110 in the same period in 2019.
The Police are stepping up efforts to counter these crimes, as the economic downturn may lead to more people seeking illegal loans. Between January and September 2020, Police conducted four major enforcement operations and arrested a total of 838 subjects who were believed to be involved in loan-sharking activities. The Police are also actively working and sharing information with various stakeholders, including foreign law enforcement agencies, to dismantle loan-shark syndicates that are operating outside Singapore.
On the public education front, Police launched the 4th Anti-UML campaign in January 2020, with the aim of increasing public awareness (i) not to borrow from unlicensed moneylenders or work for them; (ii) that there are social assistance and credit counselling agencies which provide help for UML cases; and (iii) that legal moneylenders are not allowed to advertise via SMS/WhatsApp, and hence the public should ignore, block and report UML advertisements received via SMS/WhatsApp.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Rationale for Imposing Cost to File a Claim before Community Disputes Resolution Tribunals","subTitle":null,"sectionType":"WA","content":"7 Mr Gerald Giam Yean Song asked the Minister for Law (a) what is the rationale for imposing a cost of $150 to file a claim before the Community Disputes Resolution Tribunals (CDRT); and (b) whether this fee can be waived for lower income residents in order to make the CDRT more accessible to residents with intractable neighbour disputes.
Mr K Shanmugam: In 2015, the Community Disputes Resolution Tribunals (CDRT) were established as specialised courts to deal with neighbour disputes with the intention that they be faster, less costly and less adversarial than traditional civil proceedings, so as to better preserve relationships between the neighbours.
Proceedings are therefore governed by simplified procedures and are judge-led. Lawyers are not involved, unless parties agree to legal representation and the CDRT judge permits it.
Consistent with this, the costs of proceedings before the CDRT are generally less than normal civil proceedings.
The filing fee was pegged at a level commensurate with the nature of the disputes, and lower than the filing fees for civil proceedings before the District Court and Magistrate's Court.
A successful CDRT applicant may claim the cost of filing his application from the respondent as a disbursement for his case. Additionally, an applicant who is able to show that he cannot afford to pay a filing fee may be granted a waiver, upon application. These are considered on a case-by-case basis.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Tracking Statistics and Data at Community Disputes Resolution Tribunals","subTitle":null,"sectionType":"WA","content":"8 Mr Gerald Giam Yean Song asked the Minister for Law whether the Community Disputes Resolution Tribunals (CDRT) will consider tracking (i) the number of neighbour disputes that had been previously mediated at the Community Mediation Centre (CMC) and (ii) data on the specific number of orders that relate to damages, injunctions, specific performances, or apologies.
Mr K Shanmugam: State Courts is able to provide the following statistics:
State Courts currently does not have readily available information on the number of CDRT cases that had previously been mediated at the Community Mediation Centre (\"CMC\") prior to filing at the CDRT. However, the CDRT requires all applicants to fill in a pre-filing assessment form, where applicants must state whether they had attended mediation with the respondents in the six months preceding the CDRT application.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Available COVID-19 Related Legislations Allowing Companies to Seek Recourse for Payments being Withheld","subTitle":null,"sectionType":"WA","content":"9 Miss Cheng Li Hui asked the Minister for Law in light of the current tough business environment, whether the COVID-19 related legislation provides for companies, especially SMEs, whose payments are withheld because of disagreement in interpretation of contract terms to seek recourse and, if so, what are these.
Mr K Shanmugam: Where there is a disagreement in the interpretation of contract terms, regardless of whether it leads to a withholding of payments or otherwise, it should be resolved in the usual way – through legal proceedings in the courts, or via any alternative dispute resolution mechanism agreed by the parties (such as arbitration or mediation).
The COVID-19 (Temporary Measures) Act 2020 (the Act) does not deal with disputes over the interpretation of contracts. Instead, the Act provides a suite of legal reliefs to help businesses and individuals whose contracts have been affected in unanticipated ways due to the extraordinary impact of the COVID-19 pandemic on all aspects of our daily life.
First, in April 2020, we introduced the Act to provide temporary relief to businesses and individuals who are unable to fulfil their contractual obligations under certain scheduled contracts due to COVID-19. It imposed a moratorium on the commencement or continuation of legal and enforcement proceedings where the breach of contract was materially caused by COVID-19.
Second, in June 2020, the Act was amended to create the rental relief framework for Small and Medium Enterprises, and specified Non-Profit Organisations, to support them in their recovery from the impact of the COVID-19 pandemic.
Third, also in June 2020, we amended the Act to include a new Part 8, which provide further targeted relief for specific sectors that have been affected by a delay or breach in a construction or supply contract.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Statistics on Cases Handled by Protection from Harassment Courts","subTitle":null,"sectionType":"WA","content":"10 Mr Leon Perera asked the Minister for Law (a) since the Protection from Harassment Act was amended in 2019, what is the number of cases handled by the Protection from Harassment Courts; (b) what is the breakdown between applications for protection orders and expedited protection orders and the outcomes for these applications; and (c) what is the average time between the filing of the application and the application being heard.
Mr K Shanmugam: On 7 May 2019, amendments to the Protection from Harassment Act were passed by Parliament. The amendments enhance the existing protections given to victims of harassment.
From 8 May 2019 to 31 August 2020, the breakdown of applications for Protection Orders (POs) and Expedited Protection Orders (EPOs) is as follows.
During this period, the average time for a PO application to be heard was 9 days from filing. The average time for an EPO application to be heard was 4 days from filing.
The amendments also provide for a new Protection from Harassment Courts (PHC), which will have oversight over all criminal and civil matters under POHA.
The preparations for the PHC are in an advanced stage. The procedural rules and subsidiary legislation required to support the creation of the PHC are being drafted, and arrangements involving a few agencies are being put in place. Changes to several online court filing systems, including the introduction of a dedicated POHA module, are also being implemented. The Ministry will make an announcement when the PHC is ready.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Data on Outpatient Visits for Systemic Lupus Erythematosus and Spondyloarthritis","subTitle":null,"sectionType":"WA","content":"11 Mr Louis Ng Kok Kwang asked the Minister for Health (a) for each year in the past five years, for systemic lupus erythematosus and spondyloarthritis respectively, what is (i) the average and median number of outpatient visits in public hospitals per unique patient and (ii) the average and median costs of each outpatient visit in public hospitals; and (b) whether the Ministry will start collecting this data if it is not available.
Mr Gan Kim Yong: Systemic Lupus Erythematosus (SLE) is a chronic multisystem autoimmune disease that has a wide range of clinical manifestations that can affect virtually any organ. Spondyloarthritis is the term for a group of diseases that causes inflammation in the spine and joints.
Data on the number of Specialist Outpatient Clinics (SOC) visits, bill sizes, and out-of-pocket expenses per SOC visit in the past five years, collected from the public health institutions (PHIs), is presented in the table below:
12 Miss Cheng Li Hui asked the Minister for Health (a) how did it occur that 41 cases were wrongly classified as confirmed COVID-19 infections; (b) what were the corrective and public health actions that had been taken in the management of these cases including follow-ups with the affected individuals; and (c) how can occurrences of such misclassification be prevented in the future.
Mr Gan Kim Yong: Of the 41 cases that were classified initially as confirmed COVID-19 cases, most were due to administrative errors such as wrongly recorded or duplicated entries by laboratories. Eight were subsequently reclassified as non-cases following laboratory investigations and clinicians’ assessment. Corrective action had been taken early in the management of all these cases to ensure that they were isolated appropriately from other COVID-19 patients. Following the re-classifications, the Ministry of Health (MOH) had also rescinded any active quarantine orders of their close contacts.
All clinical laboratories approved to provide COVID-19 testing are licensed and subject to compliance with the Private Hospitals and Medical Clinics (PHMC) Act. Licensees are required to ensure that they have the relevant resources, competencies and processes to conduct these tests in an accurate, safe and timely manner. Where the administrative errors arise from laboratory processes, the licensees are required to put in place corrective actions, which include additional counterchecks, re-training of staff and IT integration, to ensure that similar errors will not recur.
Testing errors may also arise due to technical limitations inherent in the sensitivity and specificity of diagnostic tests1. Some results may be affected by other infections present in the person. MOH works closely with laboratory and clinical experts to review cases with borderline results and conduct thorough investigations, including repeat testing and review of the relevant clinical history and epidemiology. Such cases may subsequently be re-classified as non-cases. As a precautionary measure, MOH will classify them initially as positive cases and commence public health measures such as contact tracing and placing close contacts under quarantine while investigations are ongoing for such cases. Collectively, these measures will help to reduce the incidents of errors in testing results while allowing public health actions to be taken early to prevent further transmission of infection.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":["1 : In medical diagnosis, test sensitivity is the ability of a test to correctly identify those with the disease (true positive rate), whereas test specificity is the ability of the test to correctly identify those without the disease (true negative rate)."],"footNoteQuestions":["12"],"questionNo":"12"},{"startPgNo":0,"endPgNo":0,"title":"Plans in Place to Deal with Potential New Wave of COVID-19 Infections","subTitle":null,"sectionType":"WA","content":"13 Mr Gerald Giam Yean Song asked the Minister for Health (a) whether there are plans for additional resources and hiring to be made available to the restructured hospitals to bolster capacity needed for potentially another wave of COVID-19 infections; (b) what are the current measures at hospitals to ensure that both frontline and laboratory staff do not get worn out; and (c) whether there will be a review to consider additional bonus payments for frontline officers in the public service.
Mr Gan Kim Yong: MOH had implemented a multi-pronged approach to mobilise resources to tackle the COVID-19 pandemic. First, we utilised existing surge capacity, especially in NCID, to support the increase in COVID-19 cases, and converted designated spaces in our public sector hospitals for isolation and ICU use.
Second, during the Circuit Breaker period, non-essential services were deferred to reduce transmission risks and to allow hospitals to release bed capacity and manpower to cater to the surge in COVID-19 patients.
Third, through collaborating with the private sector hospitals, and setting up Community Care Facilities (CCFs) and Community Recovery Facilities (CRFs) in partnership with various private sector providers, we were able to quickly expand our capacity to appropriately care for patients at various stages of their illness according to their care needs.
Lastly, to further supplement our manpower, we hired and trained additional temporary staff, including locums and volunteers through the SG Healthcare Corps. Our healthcare institutions are also ramping up hiring as well as partnering with the aviation sector to take on temporary redeployments into suitable care support and operational roles.
While we have stood down some of these measures with the situation under control, we have put in place measures to allow us to re-activate these plans to bolster our ability to respond swiftly and effectively to a second wave of infections, when it occurs.
Our public healthcare clusters have put in place various measures to reduce staff burnout, such as conducting regular reviews of the duty rosters to provide staff with sufficient rest breaks and rotating staff to different duties as needed. Our clusters also provide counselling services and helplines, supported by various psychological services and community providers, to support our staff and strengthen their mental and emotional resilience. We thank the community for sending welfare packs and gifts of appreciation to cheer on and encourage our staff. As the situation has since improved and remains stable for now, institutions have allowed staff to apply for local annual leave to take short breaks as needed.
Our healthcare workers and frontline staff played an important role in our battle against COVID-19. At the Budget Round-Up Speech 2020, DPM Heng announced that frontline public officers who are directly battling the crisis caused by the COVID-19 pandemic would be awarded a special bonus. This is intended to recognise the significant risks that they have shouldered in combatting COVID-19 throughout this year.
We are deeply appreciative of the efforts and hard work of all public officers, healthcare workers, and various other partners who have contributed to our collective COVID-19 fight. The Government will seek to recognise and appreciate their contributions through a range of monetary and non-monetary mechanisms, including the special bonus, at an appropriate time.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Claims Rejected under Integrated Shield Plan but Successfully Processed under MediShield Life Cover","subTitle":null,"sectionType":"WA","content":"14 Dr Tan Wu Meng asked the Minister for Health in the last one year (a) how many patients with an Integrated Shield Plan had their claims rejected by the insurer despite the claims being made for medically necessary treatments; (b) how many of these cases were later processed for the coverage component provided under MediShield Life (MSHL); and (c) what proportion of these MSHL requests were (i) patient-initiated and (ii) insurer-initiated.
Mr Gan Kim Yong: Over 90% of the claims processed by Integrated Shield Plans (IPs) insurers in 2019 were approved. The remaining rejected claims were mostly for treatments or medication not covered by the IPs, such as for pre-existing medical conditions excluded by the IP or for medication not approved by the Health Science Authority. We do not have data on the medical necessity of IPs' rejected claims.
As MediShield Life (MSHL) is an integral component of IPs, all IP claims will be processed by the Central Provident Fund Board for claims under the MSHL component regardless of the IP's decision on the claims.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Measures or Guidelines in Place to Protect Workers Vulnerable to COVID-19 Upon Returning to Regular Office-based Work","subTitle":null,"sectionType":"WA","content":"15 Assoc Prof Jamus Jerome Lim asked the Minister for Health what measures or guidelines are in place to protect COVID-19-vulnerable workers when there is a broader move to return to regular office-based work.
Mr Gan Kim Yong: Even whilst the local COVID-19 situation improves, the safe resumption of social and economic activities, including office-based work, continues to be premised on close adherence to the safe management measures in place, among other public health interventions.
Safe management measures like the wearing of masks, practising good personal hygiene, and observing safe distancing help to prevent the spread of COVID-19 within workplaces, as well as the community at large. Individuals who are unwell should also avoid going to work and seek medical attention promptly. These guidelines have been incorporated into the Ministry of Manpower’s requirements on ensuring safe workplaces.
In addition, the Ministry of Manpower's workplace requirements has also highlighted that companies should pay special attention to employees who are more vulnerable to poorer clinical outcomes in the event of a COVID-19 infection (i.e. persons aged 60 and above, and patients who are immunocompromised or have concurrent medical conditions). Where feasible, companies should enable vulnerable employees to work from home, or temporarily redeploy them to another role within the company which would allow them to work from home.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Measures to Restrict Young's Access to Harmful and Dangerous Content Available through Streaming Services","subTitle":null,"sectionType":"WA","content":"16 Mr Gerald Giam Yean Song asked the Minister for Communications and Information (a) how does the Ministry deal with content available through streaming services that deal with suicide, mental illness, and other sensitive topics; and (b) what measures are being taken to restrict access to material that may encourage harmful and dangerous behaviour among the young.
Mr S Iswaran: The Infocomm Media Development Authority (IMDA) administers the regulatory regime for broadcast media, including Over-The-Top (OTT) and Video-on-Demand (VOD) streaming services. OTT and VOD service providers are required to adhere to IMDA's Content Code for these services, including rating all content on their services and presenting the rating prominently such that consumers are aware of the programme's rating before deciding to view or purchase it. Under the Code, the programme’s theme and message are important considerations in its classification. Due to the potential impact on the young, programmes with mature themes such as suicide, depending on how it is depicted, are generally classified NC16, M18 or R21.
Service providers that offer content rated NC16 or higher must provide parental locks for such content. R21 content may only be offered if it is protected by a reliable age verification mechanism. All R21 content must be locked by default, and accessible only via an R21 Personal Identification Number (PIN). These measures ensure that content provided on streaming services protect the young from unsuitable content, while enabling adults to make informed viewing choices. Should IMDA receive feedback about content on streaming services, IMDA will review the content and, when necessary, engage service providers to rectify inappropriately-rated content.
More generally, IMDA also requires Internet Access Service Providers to offer Internet parental control services to its subscribers. Parents may subscribe to such services to manage their children’s access to websites and online services.
Given the dynamic and borderless nature of the Internet, it is not possible to block every website with undesirable content. Regulation alone is not enough. There must also be public awareness and understanding of potential dangers in the online space. That is why the Government and the Media Literacy Council (MLC) have been promoting safe and responsible online behaviour to create a better internet. For example, the MLC's 2020 Better Internet Campaign highlights the need to protect children from online harms and risks arising from the increased time spent online. The campaign also encourages online users to exercise judgment about the content that they come across online. We will continue to build on such efforts.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Final Cost of Revamp of National Archives Building and Amount of Budget Overrun","subTitle":null,"sectionType":"WA","content":"17 Mr Leon Perera asked the Minister for Communications and Information (a) what is the final cost of the revamp of the National Archives building; and (b) what is the budget overrun referred to in the Report of the Auditor-General for FY2019/20 and its amount.
Mr S Iswaran: Built in 1959, the National Archives of Singapore (NAS) building was gazetted for conservation in 2005. The revamp of the NAS building that started in 2017 is the first major one since NAS officially opened at its current site in 1998. The original budget was $37 million and included three categories of work: restoration and building construction works; digital infrastructure; and provision of equipment. The projected cost for the first category, i.e. restoration and building construction works, was $20.53 million. However, the final cost increased by $1.72 million to $22.25 million, after taking into account works to address unanticipated structural safety issues and site conditions. Despite the higher cost for restoration and building construction works, the National Library Board (NLB) kept within the overall budget of $37 million and did not require any additional funding for the project.
Notwithstanding this, NLB takes a serious view of the lapses identified by the AGO in its 2019/2020 financial year report. NLB has since completed its internal review of the lapses and has further tightened its procurement and contract management processes.
18 Mr Christopher de Souza asked the Minister for Sustainability and\tthe Environment whether research is being conducted to consider possible sustainable uses for incinerated ash and non-incinerable waste.
Ms Grace Fu Hai Yien: The National Environment Agency (NEA) has been studying different ways to convert incineration bottom ash (IBA) into construction material, which we call NEWSand. This involves treatment methods such as washing and chemical stabilisation, after the removal of metals from the IBA. NEA is planning field trials using NEWSand from treated IBA for road construction at Tanah Merah Coast Road.
NEA is also piloting the use of slagging gasification technology at the Nanyang Technological University (NTU) Waste-to-Energy Research Facility to directly convert municipal solid waste into glass-like slag, which can be used directly as NEWSand. For example, NEA has successfully used NEWSand from the slag to construct the concrete plaza in front of the Environment Building.
These efforts to create NEWSand, if successfully scaled up, will create a sustainable source of construction materials while helping to prolong the lifespan of Semakau Landfill.
NEA partners Institutes of Higher Learning, research institutes and the private sector to improve treatment methods for IBA, as well as develop new uses for incineration ash. For example, Republic Polytechnic is working on developing cost-effective techniques to treat and convert incineration ash into aggregates. NTU is also researching the use of incineration ash in automotive catalytic converters.
Non-incinerable waste (NIW), which includes industrial sludges and asbestos, makes up about 30% of waste sent to Semakau Landfill by weight. We are exploring new technologies to reduce NIW. For example, PUB is piloting a thermal hydrolysis process that reduces the amount of sludge from used water treatment. To spur further research, NEA launched a Request for Proposal (RFP) in March 2020 to call for research projects to recycle or reduce NIW. The RFP closed in July 2020, with 22 proposals received. These proposals are currently under evaluation.
My Ministry will continue to work closely with stakeholders to leverage science and technology to address incineration ash and NIW, supported by NEA’s $45 million Closing the Waste Loop R&D Initiative. This is part of our strategy to reduce the amount of waste sent to landfill by 30% by 2030 under the Zero Waste Masterplan.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Extension of Project Wolbachia to Sengkang and Rest of Singapore to Complement Existing Vector Control Strategies","subTitle":null,"sectionType":"WA","content":"19 Mr Chua Kheng Wee Louis asked the Minister for Sustainability and the Environment when will Project Wolbachia be extended to Sengkang town and the rest of Singapore to complement existing vector control strategies.
Ms Grace Fu Hai Yien: The National Environment Agency (NEA) commenced Project Wolbachia in 2016 through a phased approach to rigorously evaluate the technology in the field.
A key challenge is that Wolbachia technology is nascent and does not have an off-the-shelf commercial solution for big scale application. NEA and its collaborators are innovating engineering solutions to scale up production and release sustainably and cost-effectively. For example, the male-female pupae sorter, developed by NEA and its collaborator Orinno Technology Pte Ltd, can sort pupae 10 to 20 times faster than the previous model. It uses a specially designed sieve, lighting and water-flow control, to achieve high accuracy and high efficiency separation of male pupae, female pupae and larvae. The deployment of Wolbachia technology to additional towns is contingent on the success of these efforts.
As such, while the initial results of Project Wolbachia in the Yishun and Tampines study sites are promising, we will need to conduct further trials to determine the optimal method in releasing mosquitos to achieve effective suppression. This is so that the Wolbachia technology can be sustainably deployed on a larger scale in the future. Since May 2020, NEA has also tested a more targeted release strategy in dengue high-risk areas of selected neighbourhoods in Choa Chu Kang and Bukit Batok towns, to pre-emptively suppress high Aedes aegypti mosquito populations in these areas. These trials are part of NEA's efforts to explore alternative deployment strategies that are most suitable for the different urban landscapes in Singapore.
If the trials are successful, we will ramp up Project Wolbachia to cover the entire Tampines and Yishun towns by 2022, which is about 17% of all HDB estates and double the current area. We will start trials in landed housing estates. The selection of new areas for implementation will take into consideration the results of the trials in Tampines and Yishun towns, the mode of operations, NEA's assessment of long-term dengue risk profile and other environmental factors.
Mosquito suppression technology like the use of Wolbachia is not a silver bullet and it cannot replace the community's efforts to ensure good housekeeping, to keep our homes and estates free from mosquitoes breeding grounds. Comprehensive mosquito surveillance, source eradication of mosquito breeding, and comprehensive vector control efforts will continue to be Singapore's key strategies for dengue prevention and control.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Strategy to Attract International Pharmaceutical Companies to Locate Vaccine Manufacturing Plants in Singapore","subTitle":null,"sectionType":"WA","content":"20 Mr Melvin Yong Yik Chye asked the Minister for Trade and Industry (a) what is the Government's strategy to attract international pharmaceutical companies to locate their vaccine manufacturing plants in Singapore; and (b) whether the Government has plans to carve out a role for our small and medium enterprises to play a role in the local production of these vaccines.
Mr Chan Chun Sing: Singapore has a globally competitive pharmaceutical manufacturing sector. Many pharmaceutical companies, such as Pfizer, Sanofi and Amgen, invest here to leverage on our skilled talent, commitment to research and development, and excellent global connectivity.
Our ongoing efforts to focus on innovation has helped us to build up a base of local companies in the biomedical sciences industry. We have supported our local companies such as Tessa Therapeutics that specialises in cell therapy for cancer treatment and Advanced MedTech that is a pioneer in urology treatments, by partnering them with global companies, marketing their products and services to overseas customers in global markets, and facilitating efforts to conduct R&D, leverage technology and prototype new products.
This strategy of attracting global pharmaceutical companies to Singapore, and building up our local SMEs, is serving us well in our fight against COVID-19. To help vaccine developers ramp up production, we are in discussions with global pharmaceutical companies to manufacture COVID-19 vaccines out of Singapore. To ensure that Singapore has early and equitable access to vaccines, we are also participating in the COVID-19 Vaccines Global Access (COVAX) Facility with other like-minded countries. Locally, companies specialising in diagnostics such as Mirxes and Acumen Diagnostics are manufacturing diagnostic kits. Other local companies such as Proteona and Immunoscape are leveraging on their innovative R&D capabilities and sharing their insights on human immune response against the virus, with pharmaceutical companies and vaccine developers. Tychan, a local biotechnology startup is also developing a monoclonal antibody for the treatment of COVID-19.
We will continue to do what we must to maintain our innovation eco-system including attracting global companies to establish their manufacturing capabilities in Singapore, and supporting our local companies to pivot into new areas to capture emerging opportunities.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Eligibility Criteria for SGUnited Skills Programme and Extent of Ministry's Oversight over Private Training Providers","subTitle":null,"sectionType":"WA","content":"21 Mr Christopher de Souza asked the Minister for Education regarding the SGUnited Skills Programme (a) what are the eligibility criteria for the programme, (b) what is the extent of the Ministry's oversight over the private training providers; and (c) whether the Ministry will consider expanding the number of funded places\tshould the applicants be able to find self-sourced work attachments.
Mr Lawrence Wong: The SGUnited Skills programme comprises full-time training courses ranging from six to 12 months. Singapore Citizens and Singapore Permanent Residents are eligible for the programme, with the exception of fresh graduates, for whom the SGUnited Traineeships have been introduced.
Training providers appointed to deliver SGUnited Skills courses are governed through contractual arrangements with SkillsFuture Singapore (SSG) and are held to specified performance standards. They are selected based on their track record with SSG in delivering sector-specific training, and their capabilities in career advisory and employment assistance.
The Member asked if training places can be expanded if trainees were to self-source their own work attachments. But the issue is not just about finding work attachments. Training providers also need to ensure that the work attachments or industry projects are carefully curated and designed to be integrated with the training programme.
Under the SGUnited Skills Programme, our target is to provide 20,000 funded training places across a wide variety of courses. So far, we have rolled out 13,000 places and are on track to meet the target by December 2020. We are prepared to increase the funded training places, should there be additional demand.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Student's Access to Career Guidance in Schools","subTitle":null,"sectionType":"WA","content":"22 Mr Christopher de Souza asked the Minister for Education (a) whether access to career guidance is available in all polytechnics, institutes\tof technical education, junior colleges and secondary schools; and (b) if not, whether there will be plans to make such services available to all students.
Mr Lawrence Wong: Education and Career Guidance (ECG) is available to all students in Secondary Schools, Junior Colleges, Polytechnics and ITE. MOE’s approach to ECG is to progressively build on foundations provided in earlier education levels, to ensure that students receive relevant and timely support at each stage of their learning journey, including the transition to the workforce.
In MOE schools and at the Polytechnics and ITE, ECG is delivered through an ECG curriculum complemented with access to the MySkillsFuture portal, ECG experiences and ECG counselling services. All students are introduced to the MySkillsFuture portal which provides up-to-date education and career/industry information and tools to help students understand their own interests, values, abilities, and explore education and career choices. In addition, ECG experiences, such as education talks, fairs, visits to higher education institutions and industries, help students raise their awareness and guide their education and career planning. At the Polytechnics and ITE, the ECG curriculum and out-of-classroom activities, such as industry immersion programmes, learning journeys and career talks, help students make informed career decisions, and encourage them to embrace continual upgrading and lifelong learning even after they enter the workforce.
Students requiring more targeted ECG support can approach their teachers, academic staff and ECG Counsellors (ECGCs) in their educational institution for assistance and individual counselling. Through their Career Centres, the Polytechnics and ITE also offer additional career guidance services for their graduating students. This includes career preparatory services such as resume-writing and interview skills, and helping students match their strengths and interests to their career goals.
MOE will increase the number of ECGCs to support students in their learning journey and transition to the workforce. Junior Colleges will have an ECGC each, and Secondary Schools will have one ECGC supporting two schools – up from a ratio of one ECGC to four schools today. The enhanced ECGC resourcing will be implemented in phases, from January 2021.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Additional Primary School within New Brickland Constituency in View of Oversubscription during Primary 1 Admission Exercise","subTitle":null,"sectionType":"WA","content":"23 Mr Don Wee asked the Minister for Education as South View Primary School, Chua Chu Kang Primary School and Unity Primary School are oversubscribed by many times during the Phase 2C of the Primary 1 admission exercise, whether an additional primary school can be built within the new Brickland constituency, which is a BTO precinct with many young families, to cope with the increased demand for Primary 1 places.
Mr Lawrence Wong: MOE builds new primary schools based on localised demand projections and planned housing developments to ensure that there are sufficient school places for all Singaporean children in each residential area. However, individual primary schools in the same residential area could experience different levels of subscription for places based on many factors, including parental choice.
There are five primary schools within one kilometre and another nine primary schools within one to two kilometres of Brickland constituency. We are aware that there are several recently completed and upcoming housing developments in Brickland constituency and have made appropriate adjustments to the Primary 1 intake to cater to higher demand. Five out of the 14 schools had a total of about 430 remaining vacancies at the end of Phase 2C (Supplementary) in this year’s P1 Registration Exercise.
Although places in South View Primary School and Chua Chu Kang Primary School were taken up by the end of Phase 2C this year, nearby Teck Whye Primary School had 88 remaining vacancies at the end of Phase 2C (Supplementary). Unity Primary School did not ballot at Phase 2C and still had 57 remaining vacancies at the end of Phase 2C (Supplementary).
As the existing schools in the vicinity of Brickland constituency have sufficient places to serve residents, we have no plans to build a new primary school within the constituency. Nonetheless, MOE will continue to carefully review the demand and supply trends for the coming years and if necessary, adjust the intake for some schools in advance to meet projected demand.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Monitoring Word Problems in Primary School Mathematics and Its Impact on Examination and PSLE Results","subTitle":null,"sectionType":"WA","content":"24 Dr Tan Wu Meng asked the Minister for Education (a) what is the current pedagogical role of word problems in Primary school mathematics; (b) whether the linguistic complexity and reading ease of such word problems in examinations is monitored and, if so, by what metrics; and (c) whether the Ministry has studied the impact of English language fluency on students' Mathematics results in Primary school and the PSLE and, if so, what are the findings.
Mr Lawrence Wong: The relationship between English Language and mathematics competency is well established in research studies. Learning mathematics requires students to understand both the mathematical concepts and the language to express those concepts. Word problems can allow learning of mathematics to be meaningful by using real world context to help students see the relevance of mathematics. That is why word problems are widely used in mathematics education globally.
Nevertheless, we recognise that overly complex word problems can cause confusion among young learners, and be a barrier to learning mathematics. Hence MOE makes a conscious effort to ensure that the language used in the national and school-based mathematics examinations is appropriate and clear. MOE also provides guidelines and conduct workshops to help schools pitch their school-based examinations appropriately. This includes managing the difficulty level and using language and context at age-appropriate levels. Managing reading load, language demand and word counts are carefully observed as part of test and examination construction.
MOE will continue to guide schools in teaching and learning and ensure that mathematics word problems are appropriately pitched.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Repeated Oversubscription of Primary 1 Places in Some Estates during Phase 2C Distance-based Registration","subTitle":null,"sectionType":"WA","content":"25 Assoc Prof Jamus Jerome Lim asked the Minister for Education whether the distance-based criterion for registration of Primary 1 places should be revised in light of the repeated oversubscription within some estates during Phase 2C for Primary schools located within a kilometre from the applicants' residence.
Mr Lawrence Wong: Parents choose primary schools for their children based on a variety of considerations. These may include the convenience of having the younger sibling attend the same school as the older sibling, proximity to home, ties that the parents have with the school, including being alumni of the school, agreement with the school’s ethos and culture etc. Overall, the current Primary 1 (P1) Registration Framework tries to reflect these considerations, maintaining some balance between different groups of parents and their preferences through the different registration phases.
MOE regularly receives feedback on many different ways to adjust these priorities. Similar to what the Member is suggesting, some have asked for changes to the home-school distance balloting categories. Others have asked that we do away with priority arrangements in favour of pure distance-based priority to allow those who live near the school a much better chance of admission. On the other hand, there have also been calls for pure random balloting, due to concerns that a focus on distance could end up benefitting families with the financial means to move nearer to their choice schools.
There is no perfect system, but the current system seeks to strike a careful balance amongst different parental and community expectations, while respecting the history and legacy of many schools which started off as community initiatives.
As part of MOE's move to keep every school open to children who have no prior connections to the school, we have reserved 20 places each for Phase 2B and for Phase 2C since the 2014 P1 Registration Exercise. It ensures that there is open access to all primary schools, and also provides some assurance of places for those who live near the school. From time to time, we do review whether this is sufficient, as well as whether to simplify the P1 Registration Framework. We will keep in mind the suggestion from A/P Lim as well as from many others who have provided useful feedback and suggestions for future reviews of the P1 Registration Framework, taking into account the diverse perspectives and views.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Education and Housing Support Available to Young Men and Women out of Residential Boys' or Girls' Homes","subTitle":null,"sectionType":"WA","content":"26 Mr Christopher de Souza asked the Minister for Social and Family Development what support in terms of education and housing are available to young men and women who grow out of residential boys' or girls' homes.
Mr Masagos Zulkifli B M M: Children requiring care, protection or rehabilitation may stay in Licensed Residential Homes operated by social service agencies, or Youth Homes operated by MSF.
MSF places a strong emphasis on reintegrating these children with their families. During their stay in the residential facilities, there are programmes to restore the relationship between the parents and children. Residents are also encouraged to keep in contact through parent visits and leave schemes that allow them to return home.
Nonetheless, for some children or youths, it may not be conducive for them to return home to their families, despite the best efforts of all parties. MSF will support them in exploring kinship care arrangements to stay with relatives, where possible. Our Homes also prepare them for independent living by providing them guidance on key areas like education and employment, facilitating referrals to community agencies post-discharge, and connecting them to rental or hostel options. Residents of MSF’s Youth Homes are also provided post-care support up to a year to smoothen their transition and reintegration into the community.
During their stay, the children in Licensed Residential Homes continue attending school. Some residents of MSF's Youth Homes attend on-site lessons based on MOE syllabuses and taught by MOE-trained teachers. Due to the smaller class sizes, teachers at the Homes are also able to provide additional attention to residents who require more academic and pastoral attention. Residents who satisfy certain conditions may continue to attend their existing schools outside the Homes. Vocational studies are also available for older youth and school leavers. Depending on the age when the residents are discharged from the Homes, they may continue attending school, for example at Institutes of Higher Learning. The males may be enlisted for National Service. If the residents are ready to enter the workforce, the Homes will help to link them up with internships or job placements.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Protection Orders and Domestic Exclusion Orders Granted under Women's Charter since Start of Circuit Breaker Period","subTitle":null,"sectionType":"WA","content":"27 Ms He Ting Ru asked the Minister for Social and Family Development since the start of the circuit breaker period, how many protection orders and domestic exclusion orders under the Women's Charter have been granted each month.
Mr Masagos Zulkifli B M M: Persons experiencing family violence may apply to the Family Justice Courts (FJC) for a personal protection order (PPO) and/or a domestic exclusion order (DEO) under the Women’s Charter.
The monthly number of orders granted by the FJC is in the table below.
On average, FJC granted approximately 75 PPOs and seven DEOs per month since the start of the Circuit Breaker period. The monthly average from April to August is similar to the monthly average for the first three months of 2020.
28 Mr Murali Pillai asked the Minister for Transport when will the noise barriers along the MRT track plying through Bukit Batok MRT station be erected.
Mr Ong Ye Kung: The installation of noise barriers on the Bukit Batok MRT viaduct between Blk 298 Bukit Batok Street 22 and Bukit Batok MRT station is on track to be completed by 2Q 2021. LTA remains committed to mitigating the impact of noise for residents living nearby.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Barrier-free Covered Linkways to Ensure First and Last Mile Connectivity to Commmunity Clubs and Centres","subTitle":null,"sectionType":"WA","content":"29 Ms Hany Soh asked the Minister for Transport whether more barrier-free covered linkways will be built to ensure first and last mile connectivity from transportation nodes to all community clubs and centres in Singapore.
Mr Ong Ye Kung: LTA does build barrier-free covered linkways to link Community Clubs and Centres (CCs) to major transport nodes, provided the CCs are within a 400 metre radius of MRT stations or 200 metre radius of LRT stations and bus interchanges, and there are no site constraints. The CCs should also have covered linkways within their premises, connecting their building to their main gate. This is to ensure a continuous sheltered route. LTA will also take into consideration existing alternative sheltered paths to avoid duplication, so that the budget can be allocated to areas without such alternatives.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Requests and Appeals Received and Approved for Foreign Domestic Workers to Enter Singapore during Circuit Breaker Period","subTitle":null,"sectionType":"WA","content":"30 Mr Gan Thiam Poh asked the Minister for Manpower (a) how many requests and appeals have been received and approved for foreign domestic workers to be allowed entry into Singapore during the circuit breaker period to support residents' needs; and (b) what is the number of approvals by country.
Mrs Josephine Teo: Since the outbreak of COVID-19, many countries including Singapore have imposed travel restrictions and border controls. For work pass holders, entry approvals are limited to reduce the importation risk of COVID-19 cases and to protect public health.
During the circuit breaker period, the Ministry approved 630 requests for foreign domestic workers (FDWs) mainly from Indonesia, the Philippines and Myanmar to enter Singapore, out of about 4,100 entry approval applications and appeals received.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Building Homes with Home Gardening in Mind","subTitle":null,"sectionType":"WA","content":"31 Mr Christopher de Souza asked the Minister for National Development whether the Ministry will consider having homes built with home gardening in mind.
Mr Desmond Lee: NParks recently launched the Gardening with Edibles programme, which provided 400,000 free seed packets of edible plants for households to start home gardening. The programme also provides extensive online resources on how to garden at home with affordable tools that are widely available, such as pots of soil, fertiliser, and energy-efficient Light-Emitting Diode grow lights (if natural light is insufficient). NParks has received good feedback that many households have been successful at starting edible gardens in their homes.
People who wish to participate in larger-scale gardening near their homes can also start or join community gardens in their neighbourhood. Today, there are more than 1,500 community gardens across Singapore. NParks will continue to work together with Residents' Committees and Neighbourhood Committees to encourage the setting up of more community gardens.
In addition, individuals who wish to have dedicated plots for gardening can consider renting allotment garden plots from NParks. More than 1,000 garden plots have been made available in eleven parks across the island so far. NParks will progressively roll out more allotment garden plots, many of which will be in parks near residential areas.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"HDB Flats Rented out to Foreigners by Owners Who Rely on Rental Income for Retirement or Loan Servicing","subTitle":null,"sectionType":"WA","content":"32 Mr Gan Thiam Poh asked the Minister for National Development (a) what is the current number of HDB flats rented out to foreigners; and (b) how many HDB flats are currently rented out by owners who (i) rely on the rental income for retirement or (ii) have outstanding housing loans to service.
Mr Desmond Lee: Currently, about 58,900 HDB flats, or 6% of all HDB sold flats, are wholly rented out in the open market. Of these, about 52,200 are rented out to non-residents.
Among HDB flat owners who are currently renting out their flats, 20% have an outstanding HDB housing loan. As for the reasons for renting out their flat, 12% said that they needed the rental income to meet their retirement needs. Apart from seniors who are renting out their HDB flats to supplement their retirement income, flat owners may also rent out their flats for other reasons such as to live with their parents or children for mutual care and support.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Engineering Solutions to Improve Lift Access to Affected Units in Keat Hong","subTitle":null,"sectionType":"WA","content":"33 Mr Zhulkarnain Abdul Rahim asked the Minister for National Development given that piloted solutions like the pneumatic vacuum elevator and the vertical platform lift have been found to be unfeasible (a) whether HDB has further engineering solutions that can improve lift access to the affected units in Keat Hong; (b) what are the criteria used for lift installation under the Lift Upgrading Programme; and (c) whether the inability to provide lift access to affected HDB units can be a factor considered for Selective En bloc Redevelopment Scheme (SERS) of these HDB blocks.
Mr Desmond Lee: The Lift Upgrading Programme (LUP) was launched in 2001 to provide direct lift access to flats and enhance convenience for residents, especially the elderly and less mobile. At the start of the programme, there were more than 5,300 HDB blocks without full direct lift access.
Over the years, HDB has adopted innovative technical solutions to provide such blocks with direct lift access. Through these efforts, the vast majority of the 5,300 blocks have since benefited from the LUP. As the Government has the responsibility to ensure the prudent use of public funds, cost is a key criteria when deciding whether a block can be selected for the LUP. The other criteria is technical feasibility. Currently, there remain about 150 blocks, including those in Keat Hong, where it is still not possible to implement the LUP due to prohibitive costs or existing technical constraints.
While we will continue to explore possible ways to bring direct lift access to these blocks, we know that some residents may urgently need direct lift access due to medical or mobility issues. In March this year, we therefore introduced the Lift access Housing Grant (LHG) of up to $30,000, to help those with medical or mobility issues buy a new or resale HDB flat with direct lift access.
The Selective En bloc Redevelopment Scheme (SERS) is implemented on a highly selective basis. The identification of suitable sites for SERS involves a careful evaluation of various factors on a site-by-site basis, such as the redevelopment potential of the site, the availability of suitable replacement sites, and the Government’s financial resources. The inability to provide direct lift access to flats is not a consideration for SERS.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"More Legislative Power to Evict and Blacklist Disturbing Neighbours for Disputes that Cannot be Resolved","subTitle":null,"sectionType":"WA","content":"34 Mr Don Wee asked the Minister for National Development whether HDB will require more legislative power to evict and blacklist disturbing neighbours when the disputes cannot be resolved by the Community Disputes Resolution Tribunal, Community Mediation Centre and via a Magistrate's Complaint.
Mr Desmond Lee: Neighbourliness, mutual respect and consideration are important attributes required in dense, high-rise city living. When disputes occur, as they sometimes do, they are often best resolved by neighbours coming together to understand and try to resolve the cause of the friction and unhappiness between them.
Where neighbours are unable to resolve the dispute themselves, the Government has created avenues to help neighbours work out their disagreements. Under the inter-agency Community Dispute Management Framework (CDMF), most disputes between neighbours in HDB estates can be resolved amicably with some help from grassroots leaders and community partners. Additionally, the disputing parties can also seek mediation by trained, neutral mediators at the Community Mediation Centre, who can help parties reach mutually acceptable solutions. As a last resort in intractable cases where parties are unable to resolve their disputes through community facilitation or voluntary mediation, the aggrieved parties can file a case with the Community Disputes Resolution Tribunal (CDRT). Where criminal conduct is alleged, a Magistrate's Complaints can be made. Along the way, various government agencies can also render assistance depending on the nature of the disputes involved.
Despite these avenues, there continue to be difficult and intractable cases that remain unresolved. In some instances, there are neighbours who are so recalcitrant, that they are undeterred by court orders or criminal sanctions. Currently, HDB could potentially acquire HDB property from such owners under limited circumstances. However, this is a measure that has great impact on residents, and is not undertaken lightly. Eviction and blacklisting of such residents, and compulsory acquisition of their HDB flats, is not always the solution. The flat owners in question still require a roof over their heads and will need to find a home elsewhere, and if the underlying issues are not resolved, the problem will just be brought over to another community.
The Government will study how to better deal with these difficult cases as part of the ongoing review of the framework.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":null,"footNoteQuestions":null,"questionNo":null},{"startPgNo":0,"endPgNo":0,"title":"Households Requesting Rent and Arrears Assistance and Percentage Helped from January to July 2020","subTitle":null,"sectionType":"WA","content":"35 Ms He Ting Ru asked the Minister for National Development from January to July 2020 (a) how many of the 370 households who requested for rent assistance already had rent arrears; and (b) what percentage of those with and without arrears respectively received rent assistance.
Mr Desmond Lee: From January to July 2020, HDB received an average of 370 requests per month for rent assistance. Amongst them:
(a)\tAbout a quarter were from households with rent arrears at the time of request.
(b)\tFor both the households with rent arrears as well as those without, about two-thirds were assisted with their rent. The remaining households who did not receive rent assistance were assessed to be able to afford their existing rents, or did not follow up further after HDB contacted them about their initial request.
Beyond tenants who ask HDB for rent assistance, HDB will also assist tenants pro-actively. For example, if tenants are assessed for ComCare assistance and are found to need help with their rent, HDB will reduce their rents upon notification from the Social Service Office1. Those who cannot afford their rent even after reduction can have it covered by ComCare.
","clarificationText":null,"clarificationTitle":null,"clarificationSubTitle":null,"reportType":null,"questionCount":null,"footNotes":["1 : The lowest possible rents are $26-$33 for 1-room flats, and $44-$75 for 2-room flats, depending on location."],"footNoteQuestions":["35"],"questionNo":"35"}],"writtenAnswersVOList":[],"writtenAnsNAVOList":[],"annexureList":[],"vernacularList":[{"vernacularID":4061,"sittingDate":null,"vernacularTitle":"Vernacular Speech by Mr Ang Wei Neng","filePath":"d:/apps/reports/solr_files/20201006/vernacular-Ang Wei Neng MRA 6Oct2020-Chinese.pdf","fileName":"Ang Wei Neng MRA 6Oct2020-Chinese.pdf"}],"onlinePDFFileName":""}