Mr Govindasamy, Sir, I beg to move, "That the Bill be now read a Second time." The main object of the Bill is to update and amend the present Medical Registration Act (Chapter 218 of the 1970 Revised Edition) which is, in fact, the Medical Registration Ordinance enacted in 1907 and which was amended and re-enacted in 1953. The amendment to the Ordinance that was made in 1953 was primarily to make it mandatory for a medical graduate to obtain experience in a "resident medical capacity" in approved institutions before he could be fully registered. Thus our present law on medical registration can be said to be rather out of date and requires to be urgently up-dated in view of the major historical changes that have since taken place and the very changed circumstances that exist today. However, the amendments as proposed by the Bill do not change the basic structure of the present system of registration which is embodied in our present law. Essentially the system confers on a Medical Council, which is a body of nominated and elected medical practitioners, the function of advising on persons who may be registered as well as the converse of this, which is the power to remove a person's name from the register of medical practitioners. By operation of this latter function, the Medical Council exercises a disciplinary jurisdiction over the medical profession. The major amendments that have been proposed relate to the conditions under which persons may be registered for practice in Singapore and the method of registering such persons. Since it is the universal practice for each country to adopt its own conditions and methods of registration of its professional persons, it is only appropriate that we must make the necessary changes to our registration law in keeping with our independent status and national needs. Malaysia, which inherited a similar medical registration law as ourselves, has also recently amended its Medical Registration Act to meet its national needs. I shall deal with the proposed amendments under the various sub-headings as follows: (1) On registrable qualifications: As the law stands, persons who are entitled to be registered as medical practitioners fall into three categories, namely: (i) graduates of our local medical school; (ii) persons registrable by the General Medical Council (G.M.C.) of the United Kingdom; and (iii) persons with other medical qualifications registered by order of the Minister after he has consulted the Medical Council. Under the second category persons who are entitled to be registered are those who possess medical qualifications on the list of recognised qualifications adopted by the General Medical Council of the United Kingdom. The Bill now proposes to replace this G.M.C, list by our own local list of recognised qualifications which we have authority to vary from time to time. The list of recognised qualifications adopted by the G.M.C, of the United Kingdom are all from medical schools of the Commonwealth. Thus reliance on the G.M.C, list has restricted options of training of our medical students to Commonwealth medical schools. Additions and deletions to the list are not determined by the Medical Council of Singapore but by the General Medical Council of the United Kingdom. The basis on which qualifications are accepted and rejected by the G.M.C, of the U.K, is, on the face of it, determined by the standards of training in the medical schools. Thus a new medical school which on inspection by the G.M.C, of U.K, is found in the content of its course, training standards and examinations to be of acceptable standard is put on the list. Thus, for instance, an inspection team from the General Medical Council of the U.K. visited the Faculty of Medicine and teaching hospital in Kuala Lumpur before its degrees were recognised. Two drawbacks are inherent in this arrangement, and they are: (a) Medical schools which do not ask to be included in the list would obviously not ever be included in the list of recognised qualifications. Hence, there are very conspicuous omissions from the list. For example, the medical degrees conferred by McGill University, Montreal, Canada, were at one time on the recognised list. Apparently, because the University in Montreal did not agree to accept inspection by a team from the General Medical Council in the U.K., its qualifications were subsequently dropped. Thus, we get an anomalous position where one of the most prestigious of medical schools in the North American continent is no longer on the list of recognised qualifications accepted by the G.M.C. - and thus also accepted by us - whereas smaller and less prestigious medical schools in Canada, such as Saskatchewan, the Dalhousie University of Nova Scotia, are on the list. (b) There are no regular or periodic inspections. Inspections generally are made on invitation by the medical schools. Once a medical school is placed on the list, it is left on the list. It will remain on the list even though there is information that the standards have gone down, for it is usually not removed except after inspection. There may be several methods which might be adopted to meet these drawbacks to our present system of registration. One is not to have a list of recognised qualifications at all. In place of a list of recognised schools, registration may be done by examination. Thus, without exception, any person applying for registration will be required to sit and pass a registration examination. This is a system adopted in the United States of America. Other countries have adopted the other extreme, that is, they would accept any person who has a medical qualification and who could show evidence that he has been registered to practise in the country where he had obtained the qualification. This system is adopted by countries which do not have their own medical school. It would not obviously be acceptable in an independent and developed state with its own medical school such as ours. We have, however, chosen a compromise solution to this problem by proposing the adoption of our own list of recognised qualifications. This list which we propose to adopt is attached as a Schedule to the Bill. It is, in essence, the same list as the G.M.C, list but with certain additions and deletions. Opportunity has been taken to add on the list medical schools from outside the Commonwealth whose international reputation and prestige no one can gainsay. They include the medical schools of Columbia, Ann Arbor, Michigan, to cite .a few, from the United States, a German, a Dutch and a French medical school from Europe. From the Asian region, the schools included are the University of Philippines in Manila and the Medical School of Tokyo University. McGill Medical School in Canada has also been included. In completing our local list, omissions of a number of medical schools from the G.M.C, list have also been made. This has been done in the face of reports of malpractices regarding admissions of poor candidates, tampering of examination results and deteriorating standards in these schools which gave us little alternative but to drop them from the list of approved qualifications. These deletions were made also after consultation with the Public Service Commission which had made a special study of it. I would, however, like to point out here that by dropping them from the list of approved qualifications we are not in any way casting aspersions on the good name which some of these medical schools have acquired and their proud past records and on their graduates who might be eminent scientists and practitioners who can be found throughout the world. But in view of the reports referred to, we have no alternative but to play safe and make a general deletion of these schools from our list of recognised qualifications in the interest of protecting the present high standards of medical practice in Singapore. However, I wish to make it very clear here that the local list of recognised qualifications which we have proposed to adopt is in no way permanent nor is it exhaustive, since we are in no position at this stage to consider the inclusion of every single medical school in the world. Thus the amendments also provide that the list of recognised qualifications can be varied by additions or deletions made from time to time by the Minister after consulting the Medical Council. (2) On the registration of persons who do not possess recognised qualifications: Under the present law, the registration of persons who do not possess recognised qualifications may be made by order of the Minister after consulting the Medical Council. The Medical Council will advise the Minister on each application and the Minister may, on the basis of this advice, determine the order to be made in each case. Under the proposed amendment, this practice will in substance remain unchanged. However, regard has been taken of a deficiency in the existing provision in that the Medical Council, in advising the Minister on such applications, has to depend on the papers submitted to it. The Medical Council, therefore, has to make their recommendations based mainly on paper qualifications and hearsay evidence. This can sometimes make it very difficult for the Medical Council to arrive at a decision, because the Medical Council cannot possibly know the standards of each and every medical school in the world, and more particularly the competence of an individual applicant. To overcome this defect, the amendment proposed is to allow in those cases where the Medical Council is not able to determine on the standards of the qualifications submitted by the applicant and particularly if there are doubts regarding his competence, and, before it advises the Minister, to subject the applicant to a registration examination. The form of examination will be left to the Medical Council. This could be a full-fledged examination consisting of practical, written and oral parts. In some cases, however, it may be limited to an oral interview. This will allow the Medical Council to be more objective in determining the competence of the person applying for registration. (3) Temporary registration: The existing law for temporary registration only provides for persons who are engaged in research and training. In actual practice, it is given only for medical persons engaged by the University for research and teaching. There are, however, other categories of persons besides those engaged in the University who should also qualify for temporary registration. For example, they may be eminent specialists who are brought out not only to train or teach, but also to conduct special work amongst patients. There have been instances where eminent surgeons have been invited to treat special cases which the local surgeons felt could be best done by these eminent surgeons. A further category of persons who may require temporary registration are persons who are in Singapore working in the hospitals and medical institutions to obtain special experience or to fulfil their training requirements for higher qualifications. The proposed amendments will now provide for the temporary registration of these additional categories of persons afore-mentioned. (4) Conditions of registration: As is presently stipulated in the law, certain conditions may be imposed only in cases of persons who are registered by order of the Minister under section 9 (1) (c) of the Act. It is now proposed to allow for conditions to be imposed also when a person is to be registered temporarily. Under the Bill, it is also proposed to provide a general condition to apply to the registration of all persons. This is that the Medical Council must be satisfied that the applicant for registration is of "good fame and character" before he is registered. The interpretation of this phrase "of good fame and character" will, in practice, mean that the person is certified at the time of application to be of good character, and if he is registered in another country, he is still on that register, and that there are no proceedings pending or have been made against him for misconduct. This proposed provision is fairly commonly adopted in other countries and it is to safeguard against the occasional case where a person, who has been struck off the list of registered practitioners in one country, transfers his practice to another country. This, in fact, occurred on at least one occasion in Singapore. In this case, a practitioner was found guilty of misconduct in a state outside of Singapore and was struck off the register there, but was registered in Singapore even though it was known that he had been struck off from the register in that country. Nothing could be done since there were no provisions then to prevent his registration. It is, therefore, essential that this amendment be accepted. (5) Membership of the Medical Council of Singapore: As can be clearly seen, the Medical Council plays an important role in the registration of practitioners and it is the governing body on the conduct of the profession. The Medical Council in Singapore before its separation numbered 17, of which seven were from Malaysia. After separation under the constitutional changes embodied in the Republic of Singapore Independence Act, 1965, the Malaysian members on the Singapore Council ceased membership. Accordingly, the total membership of the Medical Council in Singapore has been reduced to 10. These are made up of the following: two officials, two nominees of the University Council, and six registered medical practitioners elected by the registered medical practitioners. The amendments proposed will make for an increase in the membership of the Medical Council to 13. The proposed increase is to be made up by the appointment of three registered medical practitioners by the Minister. This proposed modest increase will make the Council more workable and representative and, at the same time, more balanced. There will be two officials and three nominees, making a total of five appointed members against six elected medical practitioners with the two members appointed by the University Council holding the balance in the Council. (6) Housemanship: Members may be aware that a medical graduate cannot immediately practise medicine on graduation. Under the law, he has to serve for one year in a "resident medical capacity", which, di common parlance, is known as housemanship or internship. In reality, this is an extension of his medical training. It is an apprenticeship where a new graduate works under supervision and in approved hospitals or units. Housemanship became mandatory before a person can be registered to practise independently in 1953 when the Medical Registration Ordinance was amended and re-enacted. Under the present law the new graduate must undertake his practical training in one of two specialities, that is, in medicine and surgery, during the year of housemanship. Training in obstetrics and gynaecology may be counted as either medicine or surgery. Thus, within the one year of housemanship these medical graduates will do six months in a medical or a surgical type of posting. There is now, however, a growing range of specialities in the medical services. It is considered that some housemen could, with benefit, undertake some of the training in some of these special areas. The amendments proposed will allow for the postings of housemen to these other and never specialities which they now cannot undertake under the present law. This will allow for greater flexibility in the training of our housemen. (7) Annual retention fee: It is proposed in the amendments to introduce an annual retention fee for registration of medical practitioners. The amount will be determined by the Minister. However, it is envisaged that this fee will be a relatively nominal one and will be comparable to the fees paid by other professional persons who are registered in Singapore. Medical practitioners are the only professionals who up to date do not pay an annual retention or practising fee. This differs from every other registered professional persons in Singapore who have to pay an annual practising fee. Thus the architects, lawyers and engineers pay annual fees and so also do the pharmacists, dental surgeons, midwives and nurses, including assistant nurses. Among other things, the major reason for introducing the annual fee is that it will be a method by which an accurate and up-to-date record is kept of all medical practitioners. As it is, it is almost impossible to be sure of the reliability or accuracy of the Register. This is because once a person is registered, he does not feel obliged to inform the Registrar of any changes of his address of practice. Any changes at present may come about by chance or on the occasion when letters are returned undelivered to the Registrar. This is an unsatisfactory state of affairs. The annual retention fee will change all this. It will then be possible to keep an up-to-date record of every practitioner in Singapore. It is expected that there will be some rumblings about the imposition of this annual fee from the medical profession. One criticism is that we are taking away one of the last vestiges of privilege of medical practitioners. The annual retention fee has recently been imposed in the United Kingdom - not without controversy - to meet the expenses of the General Medical Council of the U.K., and more and more countries are adopting the same system. (8) Sir, I wish now to turn to penalties for misconduct. Under the present law, the Medical Council has recourse to only two methods of dealing with a practitioner when he is found guilty of misconduct. This is either (i) to let him off, or (ii) to remove him from the register of practitioners, in which case he will not be able to practise. It is felt that there may be certain intermediate misdemeanours where a less severe penalty than striking off the Register could be imposed. As it is, the Medical Council sometimes is not prepared to impose the maximum penalty of removal of the practitioner's name from the Register because the misconduct might not have been serious enough for them to do so. Yet to take no action would also be unjustified. For this reason, the amendments proposed would allow for the Medical Council to impose other penalties such as the issue of warnings or suspensions for a period of not less than three months and not more than one year in those cases where less severe penalties are considered appropriate. All the proposed amendments in the Bill have been referred to the Medical Council for their views and comments. They have agreed to some of the amendments, disagreed with a few and gave their views and comments on others. I have also received a delegation from the Medical Council to hear their views on some of the amendments. The amendments in the Bill before the House have been proposed after taking into account not only the interest of the medical profession but also that of the general public as well as that of our Republic. Sir, I beg to move.