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PERMISSION TO MEMBERS TO BE ABSENT Under the provisions of clause 2(d) of Article 46 of the Constitution of the Republic of Singapore, the following Members have been granted permission to be or to remain absent from sittings of Parliament (or any Committee of Parliament to which they have been appointed) for the periods stated: Name From (2005) To (2005) Dr Balaji Sadasivan 12 Mar 12 Mar 30 Mar 08 Apr 17 Apr 24 Apr Mr Hawazi Daipi 16 Mar 18 Mar 25 Mar 27 Mar Mr Ahmad Khalis Bin Abdul Ghani 18 Mar 20 Mar Mr Ang Mong Seng 18 Mar 24 Mar 11 Apr 14 Apr 25 Apr 30 Apr Dr Loo Choon Yong 20 Mar 29 Mar Dr Tony Tan Keng Yam 20 Mar 31 Mar 17 Apr 23 Apr Encik Yatiman Yusof 20 Mar 24 Mar 09 Apr 10 Apr Mr Zainul Abidin Rasheed 21 Mar 26 Mar 30 Mar 30 Mar 11 Apr 15 Apr Dr Ahmad Mohd Magad 22 Mar 24 Mar 26 Mar 05 Apr Column:7 Mr David T E Lim 22 Mar 22 Mar 30 Mar 02 Apr 07 Apr 10 Apr 14 Apr 23 Apr Miss Penny Low 22 Mar 26 Mar 30 Mar 09 Apr Mr Yeo Guat Kwang 22 Mar 25 Mar 01 Apr 04 Apr Mrs Yu-Foo Yee Shoon 22 Mar 26 Mar Assoc. Prof. Ong Soh Khim 23 Mar 23 Mar 30 Mar 30 Mar 06 Apr 06 Apr 28 Apr 28 Apr 04 May 06 May Mr Sin Boon Ann 24 Mar 25 Mar 30 Mar 03 Apr Mr Yeo Cheow Tong 24 Mar 27 Mar 28 Mar 01 Apr 17 Apr 22 Apr Ms Irene Ng Phek Hoong 26 Mar 06 Apr Assoc. Prof. Dr Yaacob Ibrahim 27 Mar 30 Mar Mr Lee Kuan Yew 28 Mar 01 Apr 20 Apr 23 Apr 25 Apr 28 Apr Mr George Yong-Boon Yeo 29 Mar 31 Mar 04 Apr 07 Apr 10 Apr 12 Apr 19 Apr 21 Apr 27 Apr 08 May Mr Lee Hsien Loong 29 Mar 31 Mar 22 Apr 23 Apr Dr Ong Chit Chung 29 Mar 01 Apr 04 Apr 06 Apr 20 Apr 21 Apr 03 May 03 May 06 Jun 10 Jun 13 Jun 15 Jun Mr Wee Siew Kim 30 Mar 31 Mar 02 Apr 05 Apr 19 Apr 28 Apr 20 Apr 21 Apr 02 May 08 May 18 May 28 May 19 May 22 May Mr Gan Kim Yong 01 Apr 04 Apr 07 Apr 12 Apr 14 Apr 14 Apr Column: 8 18 Apr 21 Apr 25 Apr 28 Apr Mr Lim Hng Kiang 01 Apr 05 Apr 10 Apr 11 Apr Mr Loh Meng See 01 Apr 03 Apr 05 Apr 10 Apr 13 Apr 17 Apr Mr Chew Heng Ching 02 Apr 06 Apr Encik Mohamad Maidin B P M 04 Apr 08 Apr Mr Ong Kian Min 04 Apr 06 Apr 11 Apr 13 Apr Mr Raymond Lim Siang Keat 04 Apr 07 Apr Mr Goh Chok Tong 05 Apr 06 Apr 09 Apr 13 Apr Mr Charles Chong 06 Apr 09 Apr 18 Apr 23 Apr Mdm Ho Geok Choo 06 Apr 09 Apr 16 Apr 17 Apr Mr S Iswaran 06 Apr 09 Apr 20 Apr 22 Apr 02 May 08 May Mr Leong Horn Kee 07 Apr 09 Apr 16 Apr 23 Apr Prof. S Jayakumar 07 Apr 09 Apr Mr Heng Chee How 08 Apr 14 Apr 25 Apr 28 Apr 01 May 05 May 30 May 06 Jun Mr Cedric Foo Chee Keng 10 Apr 24 Apr Mr R Ravindran 10 Apr 15 Apr Mr Khaw Boon Wan 11 Apr 15 Apr Assoc. Prof. Chin Tet Yung 12 Apr 15 Apr Ms Indranee Rajah 12 Apr 22 Apr Mdm Cynthia Phua 13 Apr 13 Apr 14 Apr 16 Apr Assoc. Prof. Koo Tsai Kee 13 Apr 15 Apr Mr Mah Bow Tan 13 Apr 15 Apr 21 Apr 24 Apr Mr Matthias Yao Chih 14 Apr 14 Apr Dr Michael Lim Chun Leng 16 Apr 18 Apr Mr K Shanmugam 18 Apr 22 Apr Mr Davinder Singh 19 Apr 21 Apr Dr John Chen Seow Phun 19 Apr 22 Apr Column: 9 Assoc. Prof. Low Seow Chay 19 Apr 22 Apr 09 May 28 May Mr Teo Yock Ngee 19 Apr 23 Apr Mr Zainudin Nordin 19 Apr 24 Apr Mr Abdullah Tarmugi 20 Apr 27 Apr Dr Chong Weng Chiew 21 Apr 22 Apr Dr Geh Min 25 Apr 04 May 29 May 15 Jun Mr Lim Swee Say 25 Apr 28 Apr Dr Lee Boon Yang 28 Apr 04 May Dr Ong Seh Hong 28 Apr 01 May Mr Seng Han Thong 11 May 15 May Mr Chan Soo Sen 24 May 31 May Assoc. Prof. Ho Peng Kee 22 Jun 26 Jun
PERMISSION TO MEMBERS TO BE ABSENT ABDULLAH TARMUGI Speaker Parliament of Singapore
ORAL ANSWERS TO QUESTIONS [Mr Speaker in the Chair]
ORAL ANSWERS TO QUESTIONS - PROPOSAL TO DEVELOP INTEGRATED RESORTS 1. Mdm Ho Geok Choo asked the Minister for Trade and Industry if he will update the House on the progress of the Government's review and deliberation of the various proposals received for the Integrated Resorts and the criteria and process in the selection of the proposal.
ORAL ANSWERS TO QUESTIONS - PROPOSAL TO DEVELOP INTEGRATED RESORTS 2. Assoc. Prof. Ong Soh Khim asked the Minister for Trade and Industry (a) whether Government tax revenue is the only economic factor in the assessment of the 19 Integrated Resort (IR) proposals that have been received; (b) what are the
ORAL ANSWERS TO QUESTIONS - PROPOSAL TO DEVELOP INTEGRATED RESORTS other quantitative factors in the assessment; (c) what are the qualitative factors, such as negative social effects, that will be considered in the assessment; and (d) how will the qualitative factors be quantified so that they can be evaluated on the same basis as the quantitative factors in the assessment of the 19 IR proposals.
ORAL ANSWERS TO QUESTIONS - PROPOSAL TO DEVELOP INTEGRATED RESORTS 3. Assoc. Prof. Ong Soh Khim asked the Minister for Trade and Industry, as much of the scenario planning on the development of an integrated resort and casino are theoretical, (a) will the Government consider a U-turn policy if the casino does not work out according to plan; (b) under what conditions will the Government consider a U-turn policy; (c) what are the contingency plans if the U-turn is initiated after the integrated resort and casino have been built; and (d) how will the Government remedy the situation if the outcome is disastrous.
ORAL ANSWERS TO QUESTIONS - PROPOSAL TO DEVELOP INTEGRATED RESORTS Question No. 1, Sir.
ORAL ANSWERS TO QUESTIONS - PROPOSAL TO DEVELOP INTEGRATED RESORTS Mr Speaker, Sir, can I have your permission to take Question Nos. 1 to 3 together as they relate to the same topic?
ORAL ANSWERS TO QUESTIONS - PROPOSAL TO DEVELOP INTEGRATED RESORTS Yes, you may.
ORAL ANSWERS TO QUESTIONS - PROPOSAL TO DEVELOP INTEGRATED RESORTS Sir, the Prime Minister will be making a Statement later on on the proposal to develop Integrated Resorts. I would like to urge Members to wait for the Statement. I think most of the queries will be addressed during the statement.
ORAL ANSWERS TO QUESTIONS - PROPOSAL TO DEVELOP INTEGRATED RESORTS 4. Assoc. Prof. Ong Soh Khim asked the Minister for Home Affairs with the development of the Integrated Resort and casino (a) whether there will be an
ORAL ANSWERS TO QUESTIONS - PROPOSAL TO DEVELOP INTEGRATED RESORTS increase in vice, illegal money-lending, money-laundering and drug activities; and if so, (b) what are the safeguards that will be put in place to prevent them.
ORAL ANSWERS TO QUESTIONS - PROPOSAL TO DEVELOP INTEGRATED RESORTS Sir, I think the Member must have heard the Minister for Trade and Industry. Similarly, the Minister for Home Affairs will be addressing these issues when Members debate the Ministerial Statement on the Integrated Resorts afterwards.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak 5. Mdm Halimah Yacob asked the Minister for Health what is the cause of the outbreak of the vancomycin-resistant enterococci (VRE) at the Singapore General Hospital and what measures have been put in place to prevent a future occurrence of such an outbreak.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak 6. Dr Amy Khor Lean Suan asked the Minister for Health (a) if he will provide an update of the vancomycin-resistant enterococci (VRE) outbreak at SGH; (b) what is the source or cause of this outbreak; (c) what are the risks of this outbreak spreading to other hospitals; and (d) what precautions have been or will be taken to reduce the risk of the development of VRE or other outbreaks within and across the different hospitals and possibly even the polyclinics.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak 7. Dr Tan Sze Wee asked the Minister for Health whether he will consider gazetting vancomycin-resistant enterococci (VRE) as a disease under the First, Second and/or Sixth Schedule of the Infectious Diseases Act.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak Mr Speaker, Sir, with your permission, can I take Question Nos. 5 to 7 together?
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak Yes, you may.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak Sir, several Members have asked about the VRE cases in the Singapore General Hospital. Let me assure Members that VRE is not like SARS.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak All perfectly healthy people have billions of bacteria in their large intestines. Enterococci are examples of such bacteria. Normal healthy people also carry bacteria in their nose, mouth and skin. These usually harmless bacteria may occasionally cause infections like pneumonia (lung infection) or septicemia (infection in the blood). Such patients are then treated with antibiotics. Enterococci used to be always sensitive to the antibiotic, Vancomycin. But bacteria mutate and can develop resistance to a specific antibiotic. When bacteria become resistant to an antibiotic, a different antibiotic has to be used to treat infections caused by the bacteria.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak The first antibiotic to be used in the world was penicillin. After many years of penicillin use, penicillin-resistant bacteria emerged. The same happened after years of use of Ampicillin and, more recently, Methicillin. Staphlycoccus aureaus - bacteria normally found on the skin which become resistant to methicillin is called MRSA. Not surprisingly, after many years of Vancomycin use, we now have enterococci bacteria that are resistant to Vancomycin - VRE.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak VRE was first reported in England in 1986, nearly 20 years ago, and hospital-acquired outbreaks have subsequently been reported in USA and Europe. In Singapore, fortunately, VRE is still rare, with only a handful of cases reported in recent years.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak Very few patients actually fall sick because of VRE. Those who do tend to be patients with low immunity because of multiple medical problems such as renal failure, diabetes and cancer. In these patients the VRE may infect sites such as a wound or urinary tract. The enterococci infection is then treated with an antibiotic other than Vancomycin. Mdm Halimah and Dr Amy Khor asked for the source of the VRE cases in SGH. It is still being investigated. We may never know for sure. The bacteria could be bacteria that mutated locally or it could be bacteria brought into Singapore by healthy carriers who carried the bacteria in their large intestines.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak The vast majority of patients with VRE are healthy carriers of the bacteria without any symptom. There are no effective treatments for healthy carriers since these bacteria are normal to the large intestines. Hospitals use many antibiotics within the hospital premises and the bacteria that survive and lurk in the hospital setting tend to be those that have antibiotic resistance. Outside of hospitals, the bacteria there tend to be the non-resistant type. So very often a VRE carrier in the hospital setting becomes VRE negative after being discharged. However, as this process may take some time, carriers can continue to shed VRE in their stools for many months. Hospitals have an interest to identify them early so that while in the hospital they can be isolated. This will reduce the risk of VRE spread.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak In the current episode, VRE was first identified by SGH on 9th March 2005 in a 75-year-old patient with multiple medical conditions. Through screening his close contacts, SGH identified five other patients with VRE. At that point, SGH decided to screen all its inpatients with a view to identify the carriers so that they can be properly isolated. In parallel, SGH staff were reminded to step up good infection control practices such as
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak Mass screening of all the inpatients in SGH has so far identified 93 patients with VRE. Of these, only three were found to be infected, with clinical symptoms. They were patients with multiple chronic medical conditions.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak To minimise the spread of VRE to other hospitals, we have also reminded them to step up infection control procedures. At the same time, SGH shares with the other hospitals the list of their recently discharged patients so that they can be isolated and screened for VRE if they are admitted there.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak So far, one such patient has been admitted to NUH. NUH has since identified another case of VRE in a foreign patient, but this patient was not related to the SGH cases.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak Mdm Halimah and Dr Amy Khor asked what precautions have been or will be taken to reduce the risk of future occurrences of VRE cases in hospitals. This is best done through a combination of measures. First, there must be a rational usage of Vancomycin. Second, there must be good surveillance for hospital-acquired infections. Third, there must be strict adherence to sound infection control principles such as prompt isolation of patients with infectious diseases, barrier nursing and hand washing.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak These are good hospital practices which all hospitals should adopt. Like penicillin resistant bacteria and MRSA, VRE may eventually become part of our bacterial landscape. If this happens, infections now treated with Vancomycin will have to be treated by other antibiotics. The greatest danger is bacteria that becomes resistant to multiple antibiotics. To minimise this risk,
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak Dr Tan asked whether VRE should be gazetted under the Infectious Diseases Act. We see no need as VRE is not a community-based infectious disease like tuberculosis or SARS. However, it poses a risk to immune-compromised patients in hospitals. We have therefore included VRE as a target in their infection control programmes.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak mandatory hand washing in between patients and stricter compliance of the 2-visitor rule in the hospital. antibiotics must not be used indiscriminately. Doctors should use antibiotics only when indicated and patients should complete their course of antibiotics when it is prescribed to them.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak Sir, the Minister did mention that VRE may become part of our eco-system. My question is whether there is a danger of VRE becoming entrenched in our hospitals, like the situation we see in some US hospitals and therefore becoming quite a menace.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak My second question is: is there a need for us to educate the doctors and the public on the use of antibiotics because that apparently seems to be the cause and the bacteria become more and more resistant to the use of antibiotics?
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak Sir, the answer to both queries is yes. In the US, UK and parts of Europe, VRE is now entrenched and the US' experience has been going on for about 20 years. We have been fairly lucky but I doubt that it has a lot to do with luck. It has to do with the practices. And careful usage of antibiotics and making sure that they are not used indiscriminately is one of the key measures besides the usual infection control procedures. We had SARS and that was a period when we reminded everybody about the importance of infection control.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak Now, we have the bird flu and VRE and potentially it could be a major risk for
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak us. I think it will be extremely difficult to eradicate VRE to make sure that it is not part and parcel of our eco-system because we are such an open economy. Just like the NUH case that I mentioned in my reply, it was a foreigner who came in for treatment. We look around the region and we know that antibiotic usage is almost rampant and that is a major risk.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak Sir, I would like to ask the Minister that if large hospitals like SGH are more susceptible to the spread of infectious diseases, not necessarily just the VRE, because of the volume of traffic, the number of patients and the sheer size of the hospital, are there any additional precautions that are necessary in addition to what has been listed.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak Sir, this is one hypothesis. It is not just the size of the hospital but it is also the range of specialties although the two tend to be linked. When you have a large hospital you will also have multiple disciplines, especially tertiary disciplines, with greater mixing of patients. One observation that some doctors made during the SARS period was why is it that SARS became such a problem in those major centres with modern hospitals whereas in the third world, in the villages, somehow it was not a problem. One hypothesis was that it was because of concentrating the multi-specialty patients together. Because of specialisation, the same patient is being handled by different departments and the patient has to go through several departments instead of just going to one place. Therefore, if there is a carrier of the bacteria, you expose the various patients in different parts of the hospital. I think it is a fairly reasonable hypothesis.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak Like all things, such as casinos, you open the window and all sorts of things will fly in. So we have to decide whether or not we want to shut the window and if we do so, of course, we will be secluded.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak But how do we stay secluded in a modern world?
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak Sir, the Minister has suggested that there are probably no grounds to consider VRE being gazetted as a disease under the Infectious Diseases Act. But I would like to clarify that it was reported in the papers that SGH had given the names of the patients tested positive for VRE to all hospitals. I agree that there are many good reasons for SGH to do so. However, I would like to know if consent from these patients has been expressly sought. If not, the privacy and confidentiality rights of these patients perhaps could have inadvertently been violated in the process. This is because VRE at present is not a disease on any Schedule of the Infectious Diseases Act and SGH may not be empowered ---
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak Dr Tan, no speeches. Please ask your question.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak I would like to ask, on the grounds of privacy and confidentiality, perhaps the Minister may want to consider gazetting VRE as one of the diseases under the Infectious Diseases Act.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak I honestly do not see a compelling need to do so because VRE is not like VD or HIV where there is a stigma associated with it. It is one of those "bad luck" illness, if you get it.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak Even with HIV, confidentiality is always preserved by hospital workers, in the sense that when we take a particular decision - in this case, circulate the list - it was purely on a need-to-know basis because, what is the alternative? The alternative is not to inform. Then we are exposing the patients, say, in the private hospitals to a potential spread. So, on this score, our conscience is quite clear, ie, there is nothing wrong in sharing the list for the greater good of society.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak May I ask the Minister whether there will be more liberal use of Vancomycin in SGH compared to other hospitals that caused the VRE outbreak in SGH? Has there been a review done on the prescription habits of doctors in SGH, especially on the prophylactic use of strong antibiotics? Should there be better guidelines on such prescription to prevent future recurrences?
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak Mr Speaker, Sir, I am not personally aware whether such studies were done. There may be. I would have to check. But it is traditionally very difficult to compare practices between two hospitals, unless they have identical patient profiles. SGH, being our major tertiary institution with multiple specialties, their patients' needs for vancomycin may be higher than the others, everything being equal. But what I can say safely is that we in Singapore, compared to many developed countries in terms of usage of antibiotics, are a lot more careful. And, as I said just now, it is not a result of good luck or whatever. Pricing has to do with it too. Vancomycin, for example, is a non-standard drug and, in countries where they subsidise until everything is free, the tendency to over-prescribe may be greater.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak May I ask the Minister whether in view of the fact that VRE infection is a hospital-acquired disease, affected patients will be given free follow-up treatment and are hospitals covered under insurance for such eventualities? May I also ask the Minister whether he really looks for the causative agent or the factor that caused the VRE outbreak so that other hospitals can learn from the mistake?
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak I think the reply to the second question is, yes, we are checking what actually caused this
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak As to her first question, hospital-acquired infections are now very much acknowledged as one of the complications of being hospitalised in a hospital, not just here but worldwide. Therefore, the practice worldwide, in fact, is not for hospitals to take responsibility for picking up the bills, for the simple reason that the cause of infection is very hard to establish. Is it the fault of the doctor, nurse or the patients themselves? So, instead, the global hospital practice is to look at what is the infection rate. Even in the best-run hospitals, it cannot be zero. It is almost impossible. Instead, what we do is that we benchmark ourselves against others to compare with our incidence rate. I look at those rates occasionally and, by and large, Singapore's situation is not bad. But I wanted to take the next step, which I think I have expressed before. I will be starting to publish some of our infection rates post-surgery, and we go by types of major surgeries, eg, hip replacement, what is the infection rate in Singapore among the various hospitals, and then we can benchmark against the other hospitals. And if we find that a particular hospital has an excessively high infection rate, then, as regulator, I think I would need to step in to perhaps, in extremis, even suspend the operation of that department until they clean up the operation.
ORAL ANSWERS TO QUESTIONS - VANCOMYCIN-RESISTANT ENTEROCOCCI - Outbreak cluster. As I said, although VRE is rare in Singapore, it does not mean we have none. All these years, looking at some of the data, each hospital may report one or two cases. It is a handful of cases. The trouble is, this phenomenon has been around for 20 years now and we are so well connected to the rest of the world, one, two or even a handful of cases a year should be considered as a fairly good outcome.
ORAL ANSWERS TO QUESTIONS - IMMUNO-COMPROMISED INPATIENTS - Measures to disperse among public hospitals asked the Minister for Health, in order to achieve better risk management against communicable disease outbreaks, will he consider having measures to 'disperse' the risk of large numbers of immuno-compromised inpatients, namely hematology, oncology and renal failure patients, from the Singapore General Hospital by increasing the availability of immuno-compromised clinical specialities in the other public sector hospitals.
ORAL ANSWERS TO QUESTIONS - IMMUNO-COMPROMISED INPATIENTS - Measures to disperse among public hospitals Dr Tan Sze Wee suggested that we disperse the immuno-compromised patients, such as hematology, oncology and renal failure patients, among the various public hospitals, instead of concentrating them in the Singapore General Hospital. This is to minimise the risk of a major communicable disease outbreak causing havoc among these patients.
ORAL ANSWERS TO QUESTIONS - IMMUNO-COMPROMISED INPATIENTS - Measures to disperse among public hospitals We do spread out such patients. In addition to SGH, these patients are treated in the National University Hospital, KK Hospital and Tan Tock Seng Hospital. However to distribute these tertiary specialties to all hospitals as a policy would not be practical. A tertiary specialty does require a critical mass of expertise, supported by a minimum volume of patient load. Otherwise, there will be wastages of duplication and inadequate opportunity for our clinicians to sharpen their skills.
ORAL ANSWERS TO QUESTIONS - IMMUNO-COMPROMISED INPATIENTS - Measures to disperse among public hospitals In any case, there is no excuse for poor standard of infection control practices. This is ultimately the most effective means to minimise such disease outbreak.
ORAL ANSWERS TO QUESTIONS - NEW PUBLIC SECTOR HOSPITALS - Limiting size of rooms asked the Minister for Health whether he will consider limiting the size of all rooms in new public hospitals to at most four beds per room, with an attached toilet and bathroom, as a means of achieving better prevention and control of the spread of communicable diseases in public hospitals.
ORAL ANSWERS TO QUESTIONS - NEW PUBLIC SECTOR HOSPITALS - Limiting size of rooms Dr Tan Sze Wee suggested that we limit the number of beds to four per room in our public hospitals in order to better control the spread of communicable diseases.
ORAL ANSWERS TO QUESTIONS - NEW PUBLIC SECTOR HOSPITALS - Limiting size of rooms While I appreciate his good intention, this would unfortunately mean that such hospitals would have to go without Class B2 and C wards. I know that Dr Tan is a strong supporter of means-testing and it is possible to have all patients in private wards but enjoying different subsidy level in accordance with their income. But this would require a much more intensive form of means-testing than what I have in mind and what Singaporeans, I think, are prepared to accept.
ORAL ANSWERS TO QUESTIONS - NEW PUBLIC SECTOR HOSPITALS - Limiting size of rooms The key point is whether good infection control can be achieved in an open ward. While large open wards pose a greater challenge, a high standard of infection control is still achievable if there is rigorous adherence to infection control practices and work processes, such as hand-washing, barrier nursing and prompt isolation of infectious patients.
ORAL ANSWERS TO QUESTIONS - NEW PUBLIC SECTOR HOSPITALS - Limiting size of rooms During the SARS crisis, Members may recall that Alexandra Hospital, with large open wards, remained SARS-free.
ORAL ANSWERS TO QUESTIONS - NEW PUBLIC SECTOR HOSPITALS - Limiting size of rooms Mr Speaker, Sir, I thank the Minister for his reply. I refer to the reply that was given to me for the written answer where out of the patients who had VRE in SGH, a significant proportion - in fact, more than 50% - were in B2 and C Class wards. I would
ORAL ANSWERS TO QUESTIONS - NEW PUBLIC SECTOR HOSPITALS - Limiting size of rooms like to suggest that perhaps the Minister consider, in the proposed new northern general hospital, that the wards as well as the bed sizes are so designed that it takes into account the fact that infectious diseases can be spread much more easily when patients are confined in the same space.
ORAL ANSWERS TO QUESTIONS - NEW PUBLIC SECTOR HOSPITALS - Limiting size of rooms I think, for new hospital design, our Class C wards are now much smaller. Alexandra Hospital, which I talked about just now, has as large as 40 beds. But those are I think Florence Nightingale days. Nowadays, if we keep it to 10, 15 and sufficiently "cubicalised", I think we can minimise the problem.
ORAL ANSWERS TO QUESTIONS - MEDISHIELD SCHEME asked the Minister for Health (a) how many Singaporeans have opted out of the MediShield scheme to date; (b) of these, how many are women; (c) what is the profile of these women in terms of their age, marital and employment status; (d) whether the Ministry will consider allowing those who have opted out of MediShield one last opportunity to opt in; and (e) if so, what conditions are likely to be imposed for the opt in.
ORAL ANSWERS TO QUESTIONS - MEDISHIELD SCHEME Dr Amy Khor asked me for some MediShield opt-out data. I have earlier clarified with her that she is actually interested in the number of Singaporeans who have completely opted out of catastrophic medical insurance, and not just MediShield. Besides MediShield, Singaporeans can choose from among 15 private catastrophic medical insurance plans.
ORAL ANSWERS TO QUESTIONS - MEDISHIELD SCHEME We encourage Singaporeans to subscribe to catastrophic medical insurance. Failure to do so may render one in financial difficulty in the event of a major illness resulting in a huge hospital bill. That is why we operate MediShield on an opt-out basis. Its auto-cover feature kicks
ORAL ANSWERS TO QUESTIONS - MEDISHIELD SCHEME At present, about 400,000 adult Singaporeans are not covered by any Medisave-approved catastrophic medical insurance. Of these, nearly 60% or 227,000 are women. Among these women, about 40% are above 60 years old. CPF does not have readily available information on their marital or employment status. Presumably, some opted out of MediShield after they stopped working. But the majority remain insured as they and their spouses see the benefits of continuing coverage.
ORAL ANSWERS TO QUESTIONS - MEDISHIELD SCHEME Singaporeans who have opted out have the opportunity to join MediShield anytime. However, to be fair to those who have stayed loyal to MediShield, CPF would have to subject these applicants to medical underwriting and, hence, medical examinations. Therefore, we strongly advise those who are uninsured to opt in while they are healthy, to avoid future regrets.
ORAL ANSWERS TO QUESTIONS - MEDISHIELD SCHEME in as soon as an individual starts working and contributing to the CPF, unless he or she opts out. Singaporeans appreciate the need for catastrophic medical insurance. Nine in ten working Singaporeans are insured under MediShield or its equivalent private insurance products.
ORAL ANSWERS TO QUESTIONS - MEDISHIELD SCHEME May I ask the Minister whether he would consider a component to encourage people to keep fit and healthy by having incentive premiums for MediShield, eg, annual discounted premiums for those who can maintain their weight or BMI and normal blood lipids and sugar?
ORAL ANSWERS TO QUESTIONS - MEDISHIELD SCHEME In principle, I like those features, because I am a great champion on healthy lifestyle. And if we can shape and influence behaviour that way, we should. The practical problem, of course, is how do we verify. Some of those data may be genetic. For example,
ORAL ANSWERS TO QUESTIONS - MEDISHIELD SCHEME I am genetically predisposed to high cholesterol. To say that just because of high cholesterol, you have a higher premium to pay, many Singaporeans may not find that acceptable. But if you say, "All right, if you do regular exercises, then I will give you a discount", how do you verify? Everybody would put up their hands and say, "I do regular exercise." But when you ask, "What exactly do you do?", you find that self-declaration is very difficult to verify. But I have been encouraging our private insurers to think deeply into this, because they have much more global experiences. Some of them are apparently thinking about incorporating some of these features and I am anxiously looking forward to their products.
ORAL ANSWERS TO QUESTIONS - MEDISHIELD SCHEME I would like to ask the Minister, given that 60% of the 400,000 women who have opted out or are not in MediShield or any other form of catastrophic insurance, whether MOH, say, through the Health Promotion Board, would undertake any programme to encourage the whole lot, but particularly the women, since due to longer life expectancy, to actually come into the MediShield programme.
ORAL ANSWERS TO QUESTIONS - MEDISHIELD SCHEME The short answer is, yes, because the more people are insured under any of these catastrophic plans, it is better, both for the individual as well as the society. The question is how to reach out, and we will do our best. It is always this half-empty half-full sort of phenomenon. We can certainly do better, and I intend to do more aggressively on this front. We are now trying to see where I can locate suitable points to remind.
ORAL ANSWERS TO QUESTIONS - MEDISHIELD SCHEME The younger people, it is easy because, upon registration of marriages, that gives me a useful milestone to remind the couples. But for the elderly, I probably have to work with the People's Association and the various community efforts to try to reach out to them.
ORAL ANSWERS TO QUESTIONS - RAJA IZZUWIN - Charge for parking offences The following Question stood in the name of Ms Indranee Rajah -
ORAL ANSWERS TO QUESTIONS - RAJA IZZUWIN - Charge for parking offences 11. To ask the Minister for Home Affairs, with reference to the case of Raja Izzuwin reported in the Straits Times on 30th March 2005, (a) why it is that the Police did not realise, prior to charging him with the parking offences committed by another person, that the I/C and residential particulars given by him were false, and (b) whether as a matter of general procedure the police checks the photos and thumbprints on the identity cards of suspects against the physical appearance and thumbprints of the suspects in custody.
ORAL ANSWERS TO QUESTIONS - RAJA IZZUWIN - Charge for parking offences Question No. 11.
ORAL ANSWERS TO QUESTIONS - RAJA IZZUWIN - Charge for parking offences Sir, let me assure Ms Indranee Rajah that Police has systems and procedures in place to verify the identities of persons who are taken into custody. These systems and procedures are constantly reviewed and fine-tuned. Indeed, an enhanced fingerprint identification system was introduced in 2002 to speed up the verification process.
ORAL ANSWERS TO QUESTIONS - RAJA IZZUWIN - Charge for parking offences Sir, in this case, the subject, Raja Izzuwin, gave the name and IC number of his friend when checked by Police officers, not realising that his friend was wanted by Police for failing to attend court for various parking offences. At the time of his arrest, he did not have any identification papers with him. Even when Raja Izzuwin discovered that his friend was wanted by the Police, he did not disclose his true identity to the Police. Neither did he do so to the Court when sentence was meted out.