Hansard, 2010-01-11

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 (2009/2010) To (2009/2010) Mdm Cynthia Phua 27 Nov 29 Nov 17 Dec 23 Dec Mr Liang Eng Hwa 27 Nov 06 Dec 10 Dec 13 Dec 12 Jan 15 Jan Dr Lim Wee Kiak 27 Nov 28 Nov 04 Dec 18 Dec Mr Tharman Shanmugaratnam 27 Nov 29 Nov 03 Dec 06 Dec 12 Dec 21 Dec Mr Zainul Abidin Rasheed 27 Nov 29 Nov 08 Dec 14 Dec 28 Dec 31 Dec 14 Jan 17 Jan Miss Penny Low 30 Nov 03 Dec Dr Vivian Balakrishnan 30 Nov 01 Dec 14 Dec 16 Dec 25 Dec 02 Jan 07 Jan 10 Jan Mr Charles Chong 01 Dec 03 Dec 13 Dec 23 Dec 29 Dec 31 Dec Ms Denise Phua Lay Peng 02 Dec 08 Dec Mdm Halimah Yacob 02 Dec 06 Dec 17 Dec 21 Dec Column: 1829 Mr Matthias Yao Chih 03 Dec 18 Dec Dr Muhammad Faishal Ibrahim 04 Dec 06 Dec 10 Dec 17 Dec 23 Dec 26 Dec 09 Jan 10 Jan Dr Ng Eng Hen 04 Dec 11 Dec Mr Wee Siew Kim 05 Dec 05 Dec 14 Dec 16 Dec 21 Dec 22 Dec 28 Dec 31 Dec 04 Jan 05 Jan 14 Jan 15 Jan 18 Jan 23 Jan 25 Jan 25 Jan 27 Jan 28 Jan 02 Feb 06 Feb Mr Baey Yam Keng 07 Dec 12 Dec 14 Dec 21 Dec 31 Dec 03 Jan Assoc. Prof. Koo Tsai Kee 08 Dec 08 Dec 21 Dec 26 Dec 17 Jan 20 Jan 25 Jan 29 Jan Mr Teo Ser Luck 09 Dec 12 Dec 15 Dec 17 Dec 22 Dec 04 Jan Dr Ahmad Mohd Magad 10 Dec 18 Dec 24 Dec 27 Dec 10 Jan 15 Jan Mdm Ho Geok Choo 10 Dec 19 Dec Mr Yeo Guat Kwang 10 Dec 15 Dec 17 Dec 21 Dec 14 Jan 18 Jan Ms Jessica Tan Soon Neo 11 Dec 13 Dec 26 Dec 01 Jan Dr Ong Seh Hong 12 Dec 18 Dec 09 Jan 10 Jan 30 Jan 02 Feb Assoc. Prof. Dr Yaacob Ibrahim 12 Dec 20 Dec 24 Dec 02 Jan Mr Ang Mong Seng 14 Dec 16 Dec 13 Jan 16 Jan Mr Lee Kuan Yew 14 Dec 17 Dec 11 Jan 11 Jan 18 Jan 24 Jan Mr Sin Boon Ann 14 Dec 20 Dec Ms Grace Fu Hai Yien 15 Dec 25 Dec Column: 1830 RAdm [NS] Lui Tuck Yew 15 Dec 25 Dec 16 Jan 17 Jan Prof. S Jayakumar 15 Dec 20 Dec Mr Lee Hsien Loong 17 Dec 31 Dec 12 Jan 15 Jan Mr Lee Yi Shyan 17 Dec 04 Jan 12 Jan 15 Jan Mr Michael Palmer 17 Dec 18 Dec Mr Abdullah Tarmugi 21 Dec 25 Dec Ms Ellen Lee 21 Dec 29 Dec 02 Feb 05 Feb Ms Irene Ng Phek Hoong 22 Dec 02 Jan Dr Mohamad Maliki Bin Osman 23 Dec 26 Dec Mr Sam Tan Chin Siong 23 Dec 28 Dec Mrs Yu-Foo Yee Shoon 23 Dec 01 Jan Assoc. Prof. Ho Peng Kee 25 Dec 01 Jan Mr Goh Chok Tong 26 Dec 29 Dec Mr Mah Bow Tan 03 Jan 13 Jan Mr Cedric Foo Chee Keng 05 Jan 07 Jan 12 Jan 15 Jan Ms Indranee Rajah 11 Jan 12 Jan Mr Chan Soo Sen 12 Jan 16 Jan Mr George Yong-Boon Yeo 12 Jan 14 Jan 24 Jan 31 Jan Mrs Lim Hwee Hua 12 Jan 15 Jan Mr Heng Chee How 17 Jan 24 Jan Mr Lim Swee Say 21 Jan 24 Jan Mr Zainudin Nordin 28 Jan 31 Jan Mr Teo Chee Hean 05 Feb 08 Feb Er Lee Bee Wah 13 Feb 16 Feb 13 Mar 16 Mar

ABDULLAH TARMUGI Speaker Parliament of Singapore

The following Bills were assented to by the President of the Republic of Singapore on the date stated:

14th December,2009 (1) Income Tax (Amendment) Bill (2) Singapore Armed Forces (Amendment) Bill

ABDULLAH TARMUGI Speaker Parliament of Singapore

The President has on 30th November, 2009 concurred with the following resolution on Government Securities, passed by Parliament on 23rd November, 2009:

"That Parliament, in accordance with Article 144(1)(a) of the Constitution of the Republic of Singapore and section 11(1) of the Government Securities Act (Chapter 121A of the 2002 Revised Edition), resolves that the Minister for Finance be authorised to borrow, by the issue of Government securities in Singapore under that Act, a further sum not exceeding Seventy Thousand Million Singapore Dollars (S$70,000,000,000), thereby in total a sum not exceeding Three Hundred and Twenty Thousand Million Singapore Dollars (S$320,000,000.000)."

___________________________

[Mr Speaker in the Chair]

Mdm Halimah Yacob asked the Minister for Trade and Industry (a) whether he will provide an update on

Singapore’s economic and employment outlook; (b) what are the factors that can derail growth in 2010, particularly with increasing protectionism in the aftermath of the global economic and financial meltdown; and (c) in what ways APEC can energise growth and development in the region.

Mr Speaker, Sir, my Ministry released the 2010 economic growth forecasts on 19 November 2009. We also released the advance GDP estimates for the fourth quarter of 2009 last week (4th January 2010). Based on the advance estimates, the Singapore economy contracted by 2.1% in 2009. This is in line with MTI’s forecast of a contraction of 2% to 2.5% for the year.

The global economy is turning around. This has contributed to the upturn in our economy in the second and third quarters of 2009. In the fourth quarter, our economy saw a moderate dip as compared to the preceding quarter, due to a pull-back in the manufacturing sector. This, however, does not imply a return to recessionary conditions. Instead, it largely reflects a moderation in the pace of recovery after the exceptionally strong expansion in the previous two quarters. Compared to the fourth quarter of 2008, the economy registered positive growth, at 3.5%, in the last quarter of 2009.

For 2010, my Ministry expects that the economy will grow by 3% to 5%. External demand will continue to grow, but at a sluggish pace. There will be some support from continued inventory restocking and a resumption in global trade. Domestically, the opening of new facilities for the chemicals and biomedical manufacturing clusters as well as the opening of the Integrated Resorts (IRs) will also provide a boost in 2010.

The recovery in 2010 is expected to be uneven. The risk of a return to

recession is low in the absence of further financial shocks. But growth momentum in the second half of 2010 may slow down as the effects of global fiscal stimulus measures and inventory restocking wane. In addition, weak household balance sheets and persistently high unemployment, especially in the US, will weigh down on consumer demand in our key export markets. Growth in 2010 may also be derailed if "creeping" trade protectionism becomes more prevalent and causes global trade flows to contract again. But the likelihood of this scenario is low. Thanks to the public commitments and exhortations by forums such as the G20 and APEC, protectionism has been largely kept in check. The threat today is lower than it was at the start of last year. At the recently concluded APEC Summit, economies around the table reaffirmed their commitment to keep markets open and refrain from raising new barriers to investment or to trade in goods and services. Everyone understands the dangers of protectionism at a time like this. Peer pressure through APEC and other forums should help to keep under control domestic pressures for protectionism.

Let me now turn to the outlook for the labour market. As we emerge from the recession, our labour market has stabilised. Overall employment expanded in the third quarter of 2009, a reversal from the preceding two quarters. Business and hiring sentiments have picked up in recent months with a greater proportion of companies expecting to increase their headcounts in the last quarter of 2009, compared to the earlier quarters.

The number of redundancies has also dropped significantly in the third quarter compared to the first two quarters of 2009. The unemployment rate however is likely to stay up for some time, as it typically lags economic recovery. More updated information will be available

when the Ministry of Manpower releases preliminary labour market statistics for the fourth quarter of 2009 at the end of this month. There are many jobs available for Singaporeans, at the rank-and-file and PMET (Professional, Managerial, Executive and Technician) level. These jobs can be found across a diverse span of industries such as pharmaceuticals, clean energy, retail, food and beverage, hospitality, healthcare, aerospace, IT and finance. The Integrated Resorts coming up this year will also be recruiting.

Let me now address the question of how APEC can help to spur growth and development in the region. As Chair of APEC last year, Singapore played a key role in practical initiatives to promote growth, boost trade, and reduce business costs. To improve the business environment in the Asia-Pacific, APEC economies agreed to make it 25% cheaper, faster, and easier to do business in the region by 2015, with an interim target of 5% improvement by 2011. APEC will focus their efforts on five priority areas identified by the business community, namely, Starting a Business, Getting Credit, Enforcing Contracts, Trading Across Borders and Dealing with Permits. The announced targets will translate into concrete gains for businesses. For example, it could cost on average up to US$450 less to import and export a container of goods in and out of APEC economies. The time taken to start a business within APEC economies could be reduced by one week on average. The Asia-Pacific is already one of the most economically open regions in the world. Gains will come not just from being more open, but being more connected. Hence the focus on improving supply chain connectivity. We started by identifying eight critical chokepoints impeding the smooth flow of goods, services and business travellers in the Asia-Pacific. We are now in the process of developing measures to address these chokepoints. These include enhancing customs clear

ance efficiency, improving coordination among border agencies, forging greater multi-modal transport linkages and developing common technical standards such as in logistics safety. These practical measures will help businesses in a tangible way, and thereby boost growth and development in the region over the medium term.

Mr Speaker, Sir, two follow up questions. I would like to ask the Minister what is the Ministry's assessment of the inflation rate for this year, bearing in mind there are concerns over the continued high prices of food stuffs and other essentials. And whether the Ministry's earlier assessment of the inflation rate still remains or will inflation be higher than that? The second question I would like to ask is what is the Ministry's assessment of the contribution to our GDP of the two Integrated Resorts?

Mr Speaker, Sir, our previous forecast that inflation will come in at between 2.5% and 3.5% this year, remains the same. On the contribution of the two IRs, they are only beginning their operations. We have to watch it carefully. When they submitted their proposals earlier, the estimate was that they would contribute between 0.5% and 1% of the GDP but this contribution would come about only when the two IRs are fully operational. So for this year, when they are only beginning operations, we can see that the contribution will be slower at the beginning.

The issue on everyone's mind is whether the recovery of the economy will be "W"-shaped or otherwise. I wonder if the Minister could provide some insight on this. Second question is, what is the Ministry's stand with regard to our own industries and their capability and capacity to withstand an increasingly global protectionistic environment?

I believe I mentioned in my speech at least on three occasions that a "W"-shaped or a double-dip recession is not likely. That is our assessment at this moment. Of course, if you followed the literature and analyses, there are some people out there who give higher probability to a double-dip recession, some giving as high as 30% or 40% probability. Our assessment is that it will not happen for us but we must expect a slower growth in the second half compared to the first half. On the performance of our industries – first of all, fortunately, the protectionist tendencies as mentioned, are lower today than at the depth of the recession in early 2009. So for that, we should be grateful. Secondly, many countries, together with the World Trade Organization (WTO) in Geneva have put a spotlight on this and are tracking this very, very stringently. Every trade measure that countries put up, WTO tracks this and broadcasts it so that everybody knows which countries are putting up additional barriers and which countries are opening up. There is a lot of peer pressure at the WTO and the APEC levels, and within the regional groupings. So I think the risk of very high levels of protectionism has receded more so now than in 2009.

asked the Minister for the Environment and Water Resources (a) what are the key achievements of the 2009 Copenhagen Climate Change Conference; (b) what are the implications for ASEAN and Singapore; and (c) whether there are plans to advance environment-friendly practices in Singapore.

Mr Speaker, Sir, the Copenhagen

Climate Change Conference was held from 7th to 18th December 2009. As is now well-known, it was not able to achieve the widely expected political framework agreement leading to a legally binding outcome in 2010. Instead, countries agreed to extend the mandate of the work into this year and present the outcome at the next Climate Change Conference in Mexico in December 2010. In addition, countries also "took note" of the significant political deal struck by a small group of Leaders on the last day of the Conference. As such, it has yet to be adopted as a formal agreement.

Sir, this political deal, called the Copenhagen Accord, outlines the key elements of long-term goals, mitigation, financing, adaptation and technology transfer, and calls for developed and developing countries to state their commitments and actions respectively in appendices. While the Accord itself is not perfect, it provides a step in the direction of arriving at a global legally binding framework agreement to address climate change. At the Conference, Singapore supported the Accord as a basis to move forward from Copenhagen.

It is premature to assess the implications of the outcome from the Copenhagen meetings, because quite frankly, there was no significant outcome or broad consensus on the key substantive issues. As such, countries will have to redouble their efforts in the coming months to try and overcome their differences in order to reach a global agreement this year. Notwithstanding this, Sir, climate change is a key issue for many ASEAN countries as we are collectively and individually vulnerable to the adverse impact of global warming. ASEAN leaders have recognised the importance of a legally binding international agreement to address climate change. This is reflected by the

participation of several ASEAN leaders in the Copenhagen Conference to show support for the global effort. In November 2007, ASEAN leaders had endorsed the ASEAN Declaration on Environmental Sustainability, committing to the goal of addressing climate change and preventing dangerous changes to the world’s climate system. ASEAN Environment Ministers have also endorsed the Terms of Reference of the ASEAN Climate Change Initiative and established an ASEAN Working Group on Climate Change, so as to enhance cooperation and collaboration between ASEAN countries on actions to address climate change.

As part of a global agreement, Singapore has committed to reduce its greenhouse gas emissions in 2020 by 16% from the Business-As-Usual (BAU) scenario. This commitment, Sir, is contingent on significant actions being taken by all countries and their implementation in good faith. While a legally binding agreement was not achieved in Copenhagen, Singapore will nevertheless commence to implement the mitigation and energy efficiency measures already announced under the Sustainable Singapore Blueprint in April 2009. These will amount to approximately a 7% to 11% reduction of emissions below BAU by 2020. These measures under the Blueprint form part of the 16% reduction below BAU. When a global agreement on climate change is reached, we will implement the additional measures to achieve the full 16% reduction below BAU in 2020.

Singapore has since independence taken several actions to develop in an environmentally sustainable manner, without which our island state would not have been liveable given our small size and high population density. These actions have gone hand-in-hand with our economic growth. The measures under the Sustainable Singapore Blueprint measures will continue in this vein and

enhance sustainable economic growth in Singapore, while promoting environmentally friendly practices such as increasing the public transport modal split and energy efficient Green Buildings.

I have three supplementary questions. First, with regard to our status as an island, I hope the Minister can give us an update on the data that his Ministry may have privy to about rising sea levels, and whether as Singaporeans living in this island-state, we should be concerned. Second, any initiatives to promote environmental sustainability will require lifestyle changes. Could the Minister please elaborate on any initiative that his Ministry might have in the pipeline to raise awareness for recycling and eco-friendly practices and change lifestyles of Singaporeans. My final supplementary question, Sir, from the limited research I have done, it seems like observers are very optimistic that we should be able to achieve the 16% target that he mentioned. Is there any secret plan to raise this a little higher?

Thank you very much for the three questions. As regards the first question on rising sea level, I cannot recall but I had reported in Parliament last year during the Budget debate of a preliminary study that we have done, based on the Fourth Assessment Report of the Intergovernmental Panel on Climate Change (IPCC). The data showed that, based on our current platform level, we are all right. But we are now going further in terms of the study. We have actually obtained more data to understand better its impact over the longer term. The study is subject to international peer review to ensure that there is enough rigour and robustness. So, I hope Prof. Straughan can wait. If we complete the study this year, we will announce to the public the response measures that we have in place to deal

with some of these challenges to our small island.

I just want to assure the public and Members of the House that our initial study showed that we should not be overly concerned about the rising sea level. But we will continue to update our study. The Fifth Assessment Report comes out in about four years' time and therefore we will update it and see what are the things that we need to do.

To her second question, part of my answer will be in the next answer to Nominated Member (NMP) Mrs Mildred Tan. But, briefly, there are already programmes in place, not only by NEA but other Government agencies, to ensure that Singaporeans transit to more environment-friendly lifestyle practices. She mentioned recycling. Member of Parliament, Dr Lim Wee Kiak, for example, had yesterday started a pilot scheme to increase the number of recycling bins within his constituency to encourage Singaporeans to recycle a bit more. Apart from that, the Ministry of Transport is looking into how they can encourage more Singaporeans to take public transport, and to facilitate this through greater rail connectivity with buses and other forms of public transport. These are the changes which are in place, taken by the Government across several agencies. I will elaborate on this later in my reply to NMP Mrs Mildred Tan.

The Member's final question is on the target of 16%. First of all, we must bear in mind that this figure that we have come up with is credible, based on the conditions in which we are subjected to. We do not have a lot of alternatives to energy sources. There is not enough wind in Singapore, nor solar power, and we do not have geothermal or hydro power. At the end of the day, whatever we do, we must do within the natural resources that we have. As I mentioned earlier, the additional measures that we have taken are on top of what has been mentioned at the

Sustainable Singapore Blueprint (SSB). The 16%, as the Member rightly pointed out, is doable; and it is credible. On top of that, we are not an Annex 1 country; and therefore, we have no historical responsibility, but we do this because we want to be a responsible member of the international community and contribute to the on-going efforts to reduce greenhouse gases. We will continue to monitor this. As Members know, technology will improve and over time, if there are other ways in which we can do things better to reduce our energy consumption and be more efficient, we will do that. So, at the moment, there is no secret, our target is 16%. But the agencies are monitoring this very closely, especially in terms of technology development.

We are investing in solar energy, even though we have pointed out that we may not have the ability to trap a lot of solar power. But, one day, if solar energy becomes at par with conventional energy, then we are ready to take on the opportunities. We will continue to invest and learn. And as we improve, we can do more, and we will certainly do so. But we must not forget that whatever we do, it must not be at the expense of our economic growth. Because, if we do not have the growth, we will not have the resources to do the things that we want to do. We have to calibrate and balance that properly.

Mdm Ho, last question.

I would like to ask the Minister two questions: one, what are the industries in Singapore that actually emit the most greenhouse gases and what steps are being taken to reduce these emissions? Related to this, of course, would be to what extent will the reduction of these emissions affect our economic growth? Second question: Indeed, if our coastal areas were to be

submerged, what is the time-frame if such a calamity should occur, and what steps are being taken to remedy this scenario?

Let me first answer the second question. Frankly, nobody knows and the timeline is very long. As I mentioned in my earlier response to the supplementary question, our initial study showed that we should not be concerned. But the various agencies are taking measures and studying this very carefully. For example, we know that there is some soil erosion on the East Coast and, I believe, URA, together with NParks, is working on how to strengthen this. But, at the end of the day, the most important thing is for us to continue to upgrade our understanding of the phenomenon. As more data and studies become available, I think it should put us in a better position. I would just like to assure the House that within the Government and within NEA, there is a unit that studies this very carefully across various agencies, so that we also build up our own capacity and our capability in terms of understanding the impact of climate change on Singapore.

To the Member's first question – which industries emit most of the greenhouse gases. We know that there is a large petrochemical sector in Singapore. But the most important thing is that we work with the industry very closely. At the end of the day, whatever that we do, as mentioned earlier, it must not impact our economic growth. So, the various agencies have been working together and ensuring that industries understand where we are coming from, so that whatever we do or whatever we want them to do, they do it in a manner which is to preserve jobs, preserve our economic growth, and switch over to more efficient technologies which are available in the market.

Sir, let me just give Members some examples. We have worked with some companies within the pharmaceutical

sectors where they have moved towards tri-generation where within their own premises they have generated electricity, water and steam for their own purposes. By doing so, they reap greater efficiency, and reduce our carbon footprint. So, these are the things in which we should do with the industries and find ways in which they can continue to do business in Singapore in a cost-effective manner, yet at the same time reduce the greenhouse gas emissions. As I mentioned earlier, this has to be balanced carefully. I want to assure the House that the various agencies are working very closely with the industries so that we can meet our 16% target, if there is a global agreement.

3. Mrs Mildred Tan asked the Minister for the Environment and Water Resources (a) if he will give an update on the $1 billion blueprint for Singapore's sustainable development that was unveiled in April 2009, in particular the incentives for greener options such as electric cars and solar energy; and (b) whether his Ministry has any future plans or undertaken any measures to stimulate green businesses in Singapore.

Sir, the Sustainable Singapore Blueprint is a comprehensive plan to improve resource efficiency, enhance our environment, develop capabilities and build an environmentally responsible community. We will adopt a multi-pronged approach to achieve these goals, including public education, incentives and legislation.

As a start, $1 billion has been set aside over five years to support the implementation of the plans in the blueprint. Since the launch of the blueprint in April last year, various incentive schemes and other investments

in sustainable development have been announced, including $100 million to improve the energy efficiency of our existing buildings, $43 million to implement cycling infrastructure in some HDB towns and $31 million to test-bed solar technology. There are also separately funded initiatives that contribute to sustainable development, such as the budget for the expansion of the rail network, park space and ABC Waters.

The Member asked about electric cars. A multi-agency taskforce, co-chaired by the Energy Market Authority (EMA) and the Land Transport Authority (LTA), is spearheading the test-bedding of electric vehicles in Singapore, with $20 million set aside to support infrastructure development and test-bedding activities. The taskforce is working with various automotive manufacturers and electric vehicle charging infrastructure providers on their plans to test their solutions in Singapore from 2010. This project will enable the taskforce to evaluate the scope for larger-scale adoption of electric vehicles in future.

Moving to solar, the cost of solar-generated electricity at the moment is still about twice that of grid electricity generated from fossil fuels. The technology is evolving and the price gap may narrow over time. Our approach is therefore to invest early in solar technology by test-bedding projects to prepare to use solar technology on a larger scale when the cost of solar energy falls closer to that of conventional energy. HDB is embarking on an island-wide test-bed to deploy solar technology within 30 public housing precincts by 2015.

Building new environmental and technological capabilities is one of the key strategies in the blueprint. This not only provides solutions to Singapore's sustainability challenges, but helps our companies to tap the economic opportunities from sustainable development.

The Government has further set aside $680 million to build new capabilities in Clean Energy and Water Technologies. This is on top of the $1 billion sustainable development budget, and supports research and test-bedding programmes as well as manpower development programmes. The Clean Energy and Water Technology sectors can potentially create an economic value-add of $3.4 billion and generate employment of 18,000 by 2015.

In addition, my Ministry has launched a $15 million Environment Technology Research Programme (ETRP) to build up technological competencies in waste management. The ETRP provides funding support for companies and researchers to develop, pilot and commercialise advanced technologies for waste management. The first round of applications ended on 31st August last year. Evaluations of the proposals are underway and we expect to award funding to a number of good proposals.

Various incentive schemes have also been implemented for the business sectors to improve resource efficiency. Examples include the Design for Efficiency (DfE) Scheme, which aims to encourage investors in new facilities to design their facilities to be as energy efficient as possible, and the Grant for Energy Efficient Technologies (GREET) which co-funds the cost of energy efficient equipment with owners and operators of industrial facilities.

The Sustainable Singapore Blueprint will evolve as we work towards our sustainable development goals which will be fine-tuned to take into account factors such as improvements in technology, changes in cost and, of course, public response.

Mr Speaker, I would like to thank the

Minister for his comprehensive reply. One quick supplementary question: does he feel that the budget that is being allocated is adequate?

Sir, we have to work within what we think is reasonable. The $1 million budget was actually a bottom-up process in which we discuss with the various agencies on what needs to be done. This, of course, has been approved by Cabinet, and we think this is sufficient for us to start with. It is a lot of money, but a lot of it will go into building up capabilities within the industry and the various sectors. I mentioned earlier the funding for the building sector, for example. It is a very huge sector for Singapore, especially the number of existing buildings. Based on the assessment by MND, the funding at the moment is adequate. But if we think more needs to be done, we probably have to go back and ask for approval. We will start with what we have and with the budget that we have, plus the additional funding that I mentioned earlier, we think we are able to implement this blueprint at this point in time to achieve the 7% to 11% reduction that I mentioned earlier.

Mr Speaker, Sir, I would like to ask the Minister if his Ministry or the Government, in general, has any plans to encourage or, if necessary, enforce some form of measures to get office building owners to increase the temperature of their office complexes. Because some of these offices are unbearably cold, and I cannot see why it has to be so. I am sure there can be a lot of savings of energy as a result of this. Are there any plans?

Sir, at the moment, what we have are guidelines for building owners to set their room temperatures between 22 and 24 degree centigrades. Of course, we should take the lead. For Government buildings, they should also be doing so. But having said that, the more

important thing for us now is to ensure that buildings themselves are efficient in the way they use energy. A lot of effort has gone into, for example, changing the chillers and coolers to more efficient ones which are available out there in the market.

Meanwhile, Sir, BCA and MND have already drawn up a building code for all new buildings. They will have to meet certain requirements. We are confident that when they meet these requirements with regard to energy and water efficiency, our carbon footprint will come down in terms of energy consumption. So, rather than stipulating it upfront, let us work with the industries on how best they can be more efficient in the way they manage the buildings. Whether or not we will come to that, I think this is something which we have to continue to evolve. We have studied the legislation of other countries, and we think it may not be necessary at this point in time. The more important thing is to try and level up the building sector as much as possible. Clearly, I think the public will also have a role to play. As building owners and people who use the building, they may want to impress

upon the building owners that these are the kinds of standards that we should live by. So, we will continue to educate the public, work with the building owners, impose new standards and I am confident that, over time, as I mentioned earlier, with all these programmes, we will be able to achieve the 7% to 11% that we announced in our blueprint.

Ms Irene Ng. Last question.

Sir, I am encouraged to hear that the Ministry is planning to build more infrastructure as part of its plans to promote environmentally friendly practices in Singapore. Can I ask the Minister whether there are any plans to work with

the relevant agencies to make sure that beyond the infrastructure, cycling is also a viable and safe mode of transport? If we want to promote cycling as a green mode of transport, it not only requires infrastructure but it also requires shower rooms in offices, education and enforcement to ensure that cyclists ride safely.

Sir, as mentioned in my earlier reply, the Ministry of Transport (MOT), together with HDB, has a programme to build up the cycling infrastructure. I do not have the details of it, to the extent, as mentioned by the Member, of shower facilities in some of the buildings. But, certainly, this is being tried out by MOT, together with the various local agencies, to ensure that if the infrastructure is built, the users are responsible and safety is ensured. As you know our roads are already crowded and if we were to build cycling paths within the main roads, there are concerns and issues which we should bear in mind. But, as I said earlier, this is something which MOT is studying very carefully. This is one of the plans in the Sustainable Singapore Blueprint. So we have to test it out and pilot it. But, to a large extent, if you ask me personally, it is about personal behaviour on how we work together as a community, ie, when we use the roads, we use it in a responsible manner.

4. Mr Christopher de Souza asked the Senior Minister in view of the past year's global financial crisis (a) whether the level of Government regulation of our financial market will increase; and (b) whether the Government’s regulatory philosophy of the market has shifted due to the lessons gleaned from the crisis and, if so, (i) how has it shifted; and (ii) what have been the lessons gleaned.

Mr Speaker, Sir, the general view that has emerged from the financial crisis is that following a period of deregulation of financial markets and fairly benign economic conditions in advanced economies in the US and Europe, there has been an over-reliance on markets to self-correct and on financial institutions to manage their own risks. As a consequence, a variety of risks were under-estimated and when these risks materialised and interacted in unexpected ways, many financial institutions came under stress and had to be bailed out by their governments.

Mr de Souza asked what lessons we have drawn from the crisis and whether our regulatory philosophy has shifted. I should first point out that Singapore is at a different starting point from the advanced economies. We have always maintained a robust regulatory framework and a rigorous supervisory approach which helped our financial system to remain resilient throughout the crisis. We also believe that a stable and dynamic financial system that serves the needs of the economy and the public cannot be built on regulation alone. Responsible and competent board and senior management who manage the risks of their financial institutions well are also critical. In addition, MAS also promotes transparency and market discipline in our financial system. This will improve the quality and comparability of financial information available to the public and investors.

In short, Singapore's regulatory philosophy is to maintain a sound regulatory framework but to complement this with board and senior management responsibility at the various financial institutions as well as disclosure and market discipline. We believe that this continues to be relevant and appropriate.

Nevertheless, while our local financial institutions have generally weathered the

financial crisis well, there is no room for complacency. International standard setters have been busy deliberating specific areas for strengthening regulation and board and senior management oversight, and MAS will continue to keep our regulations and industry abreast with global best practice. Let me explain more in greater detail what MAS is doing.

First, in the area of prudential regulation, MAS already requires our banks to meet minimum capital requirements which are higher than international standards as well as liquidity and provisioning requirements which were not widely adopted internationally prior to the crisis, but are now regarded as necessary and appropriate. In December 2009, the Basel Committee on Banking Supervision released a package of proposals to strengthen global capital and liquidity regulations for consultation. These are targeted for adoption internationally by end-2012. Our relatively conservative regulatory framework and the strong capital and liquidity positions of our financial institutions mean that we are well placed to meet these new stringent international regulatory standards. Over the next one to two years, as details of the international proposals are firmed up, we will consult widely with the public and the financial industry and ensure that we adopt the new international standards in ways that are appropriate to our context.

Second, the crisis has led regulators in many countries to re-examine aspects of their approach regarding the sale and marketing of structured products. In Singapore, MAS undertook a review of the regulatory regime governing the sale and marketing of unlisted investment products. In March last year, MAS published its policy consultation paper with proposals that covered issues such as promoting more effective disclosure, strengthening fair dealing in the sale and advisory process, introducing an enhanced regulatory regime for the sale of complex

investment products, and enhancing MAS' powers. In its review, MAS has been careful not to come up with overly prescriptive rules and the approach is intended to continue giving Singaporeans choices in their investment options.

MAS' regulation cannot replace the primary role of the board and senior management to ensure that the requisite controls and risk processes are implemented robustly throughout their organisation. MAS will be reviewing the Corporate Governance Regulations and Guidelines for locally incorporated banks and significant life insurance companies. These Guidelines were introduced in 2005 and were implemented in 2007. So it is time for review. The review will focus on the effectiveness of risk management at the board level, including the role played by the boards in safeguarding the safety and soundness of their institutions, managing market conduct risks and setting remuneration policies to manage these risks effectively.

Mr Speaker, Sir, in summary, MAS and all financial sector stakeholders have important roles to play in strengthening financial stability and market confidence in our financial system. Investors too have a responsibility to understand the products they invest in.

MAS will take a balanced and pragmatic approach in reviewing any regulatory changes, and will complement this with a focus on board and senior management effectiveness, including their role in safeguarding the safety and soundness of their institutions and in delivering fair dealing outcomes to their customers.

Just one supplementary question. Minister, last year, in an essay in the Straits Times, the Minister for Finance said that our key tasks in financial regulation must be to devise a new

framework that encourages innovation and an open global financial order while avoiding the build-up of systematic risks either nationally or globally. My question is, does the Government see more regulation going forward or is it the case that the Government sees the continued prompt and effective regulation when a crisis happens?

Mr Speaker, Sir, the gist of my answer was to reiterate that our overall regulatory posture has been proven to be appropriate. We started off more conservative than the other regulators and it turns out to be the right positioning. As a member of the international financial community, we have to recognise that the international rules will change over the next few months and years, and Singapore will have to position itself again within this new set of international regulations. There is a balance to be met in encouraging innovation, where innovation helps in the effectiveness and in reducing the cost of the financial system and, at the same time, not putting in place forces or measures which cause risk-taking to be taken to extremes. So there is a need for balance. But at the same time, we believe we are in a fairly good position to steer ourselves in this new environment.

I would like to ask the Minister to provide some insights on MAS' policy towards the relatively low interest rates offered by banks and whether this has an impact on the recent spree of property shopping by investors or buyers in Singapore in recent months.

The low interest rates experienced in Singapore is a reflection of the overall global conditions. With most central banks and governments putting in fiscal support policies and looser monetary policies in order to address the recession and to aid in the recovery, I think it is a well-known fact that the world right now is currently

facing fairly accommodative monetary conditions. I think that applies to us too. One consequence of this global liquidity is of course that the funds are looking for ways to be deployed, and assets in strong, regulated markets are very attractive. So it is not a secret that the property market and other asset markets in Singapore have more than its fair share of attracting such funds.

5. Mrs Josephine Teo asked the Minister for Education whether there are plans to nationalise early childhood education and to make pre-primary education compulsory for all.

Mr Speaker, Sir, we are committed to provide a high quality and appropriate pre-school education that is accessible to all Singaporeans. But we should avoid a system where pre-school education becomes extensions of our formal school systems. MOE therefore has no plans to nationalise early childhood education. There are valid educational reasons that support this approach.

The main focus in pre-school should primarily take into account the developmental needs of young children and provide age-appropriate programmes. Nationalising pre-schools to be part of the formal school system runs the risk of an over-emphasis on academic instruction and uniformity. It will increase pressure to accelerate pre-school children's numeracy and literacy skills at the expense of other developmental goals. This can be counter-productive, and dampen children's motivation and interest towards learning in the long run. Recently, a comprehensive review of primary school education undertaken by a group of researchers

from the Cambridge University advocated raising the formal schooling age in England which is now at age five, to six or seven years old. Their reason is that this is to provide pre-school children with more time to establish positive attitudes to learning, confidence and social skills, as well as basic language skills.

This is also why education experts recommend that pre-schools focus on teaching children social skills such as learning to work and relate with one another, expressing their thoughts and ideas and building confidence. These educational goals can be accomplished through a variety of ways. Indeed, a nationalised pre-school sector would tend towards conformity which is not ideal. It would deprive parents the ability to choose from a variety of early childhood care and education models and operators that best fit the needs of their child.

MOE therefore intends to continue the present approach where we set only broad parameters rather than overly prescriptive guidelines for kindergarten education. We do want to ensure a baseline of quality in pre-school education while still preserving the diversity of options and models offered by the community and private sector.

Consistent with this broad approach, we will continue to raise the quality of pre-school education by requiring higher teacher qualifications and providing resources and guidelines on best practices. But MOE will not prescribe what all pre-school must teach as we acknowledge that there is no universally accepted or codified model for kindergarten education.

Our approach is consistent with other top-performing educational systems elsewhere, which too avoid starting formal or national school systems too early. Let me give some examples. In Finland which is a very high primary

school education standard, children start formal education at age seven. Pre-school education is similarly not compulsory in Sweden. Closer home, from China to Hong Kong, Korea and Japan, pre-school education is neither compulsory nor organised as part of the formal school system.

However, we will ensure that pre-school remains accessible and affordable to all. In particular, children from lower-income households do receive targeted support through existing financial assistance schemes and community-based support from grassroots organisations, self-help groups and PCF kindergartens.

We have also increased pre-school participation by partnering community agencies to reach out children from lower income families. These efforts at first are led by the Senior Parliamentary Secretary, Mr Masagos. As a result of previous measures, we have reduced the percentage of children from lower and middle income households entering primary one without any pre-school education, from 5% in 2006 to about 2.4% in 2009. These outreach efforts will continue.

Thank you, Mr Speaker. I also thank the Minister for his comprehensive reply. Two supplementary questions from me. Minister said that the Ministry was committed to making early childhood education accessible and affordable for Singaporeans. Would the Minister agree that the fees that parents have to pay now to early childhood educators are far higher than what has to be paid for primary school education and whether pre-primary education could be made as affordable as primary school education?

The second question relates to the Minister's point about increasing teachers' qualification. Does the Ministry also have a plan to help in the continuing education,

training and career development for early childhood educators as a way of ensuring that in this sector, the quality of our teachers remains high and keeps up to the same standard that we have come to expect of our national school system?

Mr Speaker, Sir, let me first touch on ensuring affordability. Indeed that is our main focus to ensure that it continues to be affordable to lower income families and middle income households. MOE provides targeted support and these measures were started over the last few years. Let me provide some examples. We are providing annual recurrent grants to kindergartens that meet our criteria and over the years, it has gone up. It started at $17 million a year and by 2013 it will go up to about $62 million a year. These grants to individual kindergartens that can meet the criteria – which are basically mainly for lower and middle income families – will help raise teacher quality as well as ensure that the fees are affordable. But in direct response to fees affordability for lower income families, let me remind the House that we have the Kindergarten Financial Assistance Scheme (KiFAS) and this is specifically intended to help lower income families. It defrays up to nearly 100% of fees at eligible kindergartens. And indeed, for needy families which cannot afford the initial expenses, for example, the registration fees, the books and the uniforms, they can also apply for a start-up grant of about $200 per child per year, this is what MCYS provides. And I know that Members also know that over and above this, many of our grassroots organisations – CCCs or self-help groups and PCF kindergartens – supplement these Government subsidies.

As for teacher quality, that again indeed is a focus of our efforts but as I said in our reply, we are not prescriptive in what you teach, we just want to raise the quality of pre-school teachers and we are moving it in steps. One, at the

Government level – this is jointly steered by MOE and MCYS – which accredits diploma courses in order to improve the quality of training and trainers. We started the Pre-school Qualification Accreditation Committee in 2001. And in 2001, we set the minimum academic and professional qualifications to diploma requirement from January 2009. Over time, I see this increasing but we also have to pay to attract good teachers and I think that part of the grants, in a holistic manner, together with the raising of qualifications will attract better teachers into the pre-school sector.

Thank you, Minister, for the answers. The Minister mentioned just now that nationalising pre-school education creates an over-emphasis on academic teaching at the expense of developmental goals of our young children. He also cited the example of the findings of a Cambridge survey that state that entering formal school too early will result in over-emphasis on academics. My question relates to our country's definition of what education is. Is it too narrow to define education as purely academic? Why cannot subjects like social skills, daily learning skills, moral education, inculcating good habits and even working in teams or play skills be incorporated in our definition of education? And let this good education be available so that children of different backgrounds can have equal access to this kind of quality pre-school education in our country.

Indeed that is the approach. In other words, while we want to ensure that is accessible, we may not want to say that it is a uniformed programme. And I think there is richness in the diversity of providers. As in now, in the landscape, you have PCF kindergartens that provide a certain aspect.

You have also faith-based kindergartens that provide a certain aspect. Once you nationalise it, there is always the tendency to compare one kindergarten to the other, go to the extreme of asking us to rank kindergartens, and how they perform and to then compare what teachers are – that is the tendency. And I would say, especially so, for Asian cultures because if you look at landscape of Asian countries, it is hugely competitive.

In Hong Kong, they register their children when they are pregnant for kindergarten. There is this great drive to want to start ahead. So, I think our focus is, one, to raise the teacher quality. Where it comes to affordability, to help lower and middle income households and make sure that it is affordable and to set general guidelines, broad parameters in the desired outcomes of education so to avoid this issue of trying to make children ready. If you make it accessible to all and there are opportunities, we would have provided a service for our citizens and allow them to develop at their own pace.

Thank you, Mr Speaker. On the point of competition and ranking of kindergarten, is not this already taking place at the pre-school level where kindergartens are being compared and pressures are on teachers to perform; parents are lining up at the kindergartens to register their children so that they can get into better kindergartens? I am asking this in relation to the response by the Minister about the effects of nationalising pre-school education by the Ministry.

Sir, I apologise. Can the Member rephrase his question so that I understand what he is asking?

Rephrase but be brief, please.

The response by the Minister is that nationalising pre-schools will result in certain pressures on these schools to perform and the outcome essentially is that kindergartens will be under pressure to rank the teachers and their performance. My question is, is that not the case now in pre-schools where there is already competition to register children early in the better quality centres?

Sir, my primary response was not that. I do not want to reiterate my whole reply but my point was that pre-school education must provide age-appropriate programmes and should not be an extension of our formal school systems. And in formal systems, you indeed have, as what the Member says, the pressure for uniformity, for performance, for transparency. Pre-school education, as in many countries, is not formal for good educational reasons. It recognises that children should be allowed to develop and before school, they are still developing and that there is a richness from the diversity of programmes. There is no formally recognised universal programmes for pre-schools and this is the reason why educators have not pushed for this. I do not think that Singapore will be well-served if you push for formalised pre-school education.

Mr Sadasivan, last question.

A supplementary question to the Minister following up from the point raised about accessibility. I believe that a student who does not go through pre-school education would be somewhat disadvantaged when he goes into primary one. So, if the cost of sending the child to pre-school is prohibitive for the parents, is there a risk that lower income families might not send their children for pre-school education and as a result, the child would suffer? Hence, the argument is that it is very

important for us to make sure that access is universal. Can the Minister comment, please?

I agree with the Member that accessibility is important and that is why I gave figures for efforts to target the lower income households to ensure that these children do go to, if they want to, kindergartens and able to afford it. I gave some figures for certain programmes that we have started and we have reduced the percentage from lower income families who go to school without any pre-school, from about 5% to 2.5%. In other words, about over 97% of children do go to pre-school. And we have worked together with the grassroots organisations. The main reason for the remaining 2% is seldom financial. Many Members who have worked together at the constituency level with the RCs, we have given Members the names to go to households to knock on the doors, and Members know for themselves that the reason is not an issue of affordability. There are a variety of reasons that certain families do not put their children into pre-school education.

6. Mrs Josephine Teo asked the Minister for Education (a) if he will provide the reasons for the decline in the percentage of Secondary 4 Normal (Academic) students eligible for promotion to Secondary 5; and (b) what more can be done to help Normal Stream students advance to post-secondary education.

Sir, the Member made observations about the decline in the percentage of Secondary 4 Normal (Academic) students going to Secondary 5. I would like to say that that is not the most important parameter that MOE focuses on. But since she has asked the question, let me give figures for that first. Over the past 10 years, there has been a slight decline in the proportion of

Secondary 4 Normal (Academic) students progressing to the Secondary 5. Between 2000 and 2004, the proportion eligible to progress to Secondary 5 ranged between 78% and 80%. From 2005, it dropped slightly to between 75% and 77%. So there was a 2% to 3% drop. But there was a reason for it. It was due to earlier changes which allowed weaker students into the EM2 stream in primary schools. Remember we relaxed the criteria, which allowed some previously EM3 students to enter into EM2 and by 2005 onwards they would have reached Secondary 5 level and they have subsequently entered into the Normal (Academic) course. If you took out that group of students who, in the previous regime, would have not been able to take the Normal (Academic), in fact the proportion of those eligible to progress to Secondary 5 would have increased.

For the 2009 Secondary 4 cohort, about 74% were eligible to Secondary 5. I have given the figures because the Member has asked but I mentioned at the outset, that that is not the parameter or the most important outcome we focus on. More importantly, MOE tracks the proportion of students, not Secondary 4 to Secondary 5 but who enter post-secondary educational institutions such as the Institutes of Technical Education (ITEs), polytechnics or junior colleges because this is the more important determinant. These post-secondary qualifications provide students with good employability prospects, not the 'O' Levels. The labour market has changed and that is what we look for.

So, for example, if a student progresses to Secondary 5 but then does poorly at the 'O' Levels, such that he cannot qualify for a polytechnic or junior college education or even ITE, he may not have chosen the most appropriate pathway. For these students, a more

practical education at the ITE may have been more suited to their aptitude and provide them better employment prospects. For students whose chances of doing well enough at the 'O' Levels to qualify for polytechnics or junior colleges are low, opting for an ITE education after Secondary 4 may actually be a better choice than staying another year in Secondary 5 with the chances of doing well at the 'O' Levels very low.

And indeed, to better help such students choose their appropriate educational pathway, MOE introduced two changes in recent years which indeed meant that fewer students would progress to Secondary 5. We actually wanted fewer students to progress to Secondary 5. The first of these measures was the introduction in January 2008 which allowed a direct pathway to ITE's Higher NITEC courses after the 'N' Levels, to provide an alternative to progressing to Secondary 5. The first beneficiaries were in 2007 and under this option, students can start their Higher NITEC studies a year earlier instead of having to take their 'O' Levels first. And I will tell Members that the response has been encouraging.

More than 360 students enrolled in the course next year. They could have gone to Secondary Five, but they chose instead to go for this Higher NITEC course because we open it up, so that they can benefit from it, as they see the advantages.

The second measure we undertook was to revise the promotion criteria from Secondary Four Normal (Academic) to Secondary 5 in 2009 Secondary Four cohort. We wanted to ensure that those who did progress to Secondary Five would have a better chance, after taking their 'O' Levels, to enter polytechnics or junior colleges. And, indeed, we made it more stringent.

Our approach in providing different educational pathways for students with

different abilities and needs has worked well. When we look at the parameter and ask ourselves how many of the Primary 1 cohort finally get into ITE, JC or polytechnic, the answer is 93% now do – 30% in the junior colleges, 40% in the polytechnics, 20% in the ITE, and 3% to 4% in private education organisations. We will continue with our efforts to encourage as many students to further their studies in these Post Secondary Education Institutions (PSEIs) as possible.

7. Dr Muhammad Faishal Ibrahim asked the Minister for National Development (a) whether the current infrastructure and amenities are adequate to meet the needs of our increasing population; and (b) whether reviews are being conducted to assess the impact of the current population growth on our urban living environment.

8. Ms Jessica Tan Soon Neo asked the Minister for National Development in light of our increasing population and housing demand where more land parcels are released for housing developments, what are the considerations given to ensure adequacy of supporting infrastructure to mitigate overcrowding and congestion and in the provision of communal and open spaces, transport, traffic flow and services.

Mr Speaker, may I have your permission to take Question Nos. 7 and 8, please?

Yes.

Singapore has a forward-looking and comprehensive land

use planning system. Every 10 years, we review and formulate a Concept Plan to plan for and safeguard sufficient land to meet the future needs of our growing population and economy over a horizon of 40 to 50 years. This translates into the more detailed Master Plan that guides our land use over a horizon of 10 to 15 years.

One of our key objectives in land use planning is to ensure that we can set aside sufficient land to meet housing needs as well as to offer a range of housing options to cater to Singaporeans with different income levels.

As part of planning for a larger population, we will also provide land for sufficient supporting facilities and infrastructure such as healthcare facilities, schools, parks and transport infrastructure. For instance, we will create an additional 900 ha of parkland and triple our park connectors by 2020. Major improvements will also be made to our transportation network. LTA will build new lines and extensions such as the Circle Line, Downtown Line and Tuas Extension, amongst others, which will increase our rail network from 148 km to 278 km by 2020. We will also plan for higher density housing and commercial uses around these transport nodes to provide greater connectivity to our population.

We have embarked on the Concept Plan 2011 Review in July 2009, and as part of the review, we will consult the public and seek their feedback on how we can optimise the use of our limited land and make Singapore our best home. When completed, the 2011 Concept Plan will contain plans and strategies for Singapore's future development, and ensure that our future growth is economically, socially and environmentally sustainable.

Mr Speaker, I would like to ask two supplementary questions. One is with

regard to the upgrading of the existing infrastructure for increased capacity. As land parcels are being used for housing, can the Senior Minister of State share with us, in terms of the more mature estate, what is being done with regard to the upgrading of the existing road infrastructures for the increased density? And the second question is, what are the measures that are being taken to track conducive living environment with regard to the strain on the amenities, as there is increased density in these more mature estates?

With regard to the first question, what we have done is to make sure that additional infrastructure is set aside when we release parcels. In our planning system, we have taken into consideration the planned residential area. When new parcels of land are being released, sufficient infrastructure, including roads as well as recreational needs, have already been provided for in the area. That goes for new estates as well as mature estates.

On the second question, I think that is something for LTA to be concerned with to look at how traffic conditions are being affected by development. But our working relationship is such that this norm would be reviewed regularly, as what we are doing now in Concept Plan 2011. It is to review the planning norms with various Government agencies, so that new pattern, whether it is social pattern or vehicular pattern, can be taken into consideration in our planning horizons as well as planning parameters. So, in the case of mature towns, like Tampines, we have considered such additional requirements. And when we do release new plots of lands for development, we will again liaise with the relevant Government agencies to review the needs that will come along with such parcels.

Sir, I have two supplementary questions. I have met quite a number of residents who have shared with me their surprise on the increase in population and their concern about the adequacy of the infrastructure and amenities to meet the current needs. I have two questions for the Senior Minister of State. Firstly, I would like to know if there is evidence to show that due to the increase in the population, there are stress points with regard to the demand and the usage of our infrastructure and amenities, such as parks, shopping centres, carparks and other transportation modes, as well as in the housing market.

Secondly, in view of the increase in the population, I am just wondering whether the Ministry would consider bringing forward its plan to remake our heartland, particularly the HDB mature estates, with regard to the infrastructure as well as amenities, which I feel could be outdated at this point in time, to meet the current needs of the population.

Mr Speaker, I thank the Member for two very substantive supplementary questions, which probably warrant two separate Questions by themselves. But just to take the first question, I think in our planning for an increased population, we do as much as possible look into the needs as well. There is a reason for us planning very aggressively to expand our parks, for example, as well as park connectors, which have proven to be very popular with Singaporeans. In our plan up to 2020, we will be increasing our park connectors three folds from what we have today. Not many Singaporeans know that we actually have a 100 km of park connectors, which means you can already do two marathons over different routes in Singapore. And we intend to increase that three times to 300 km. Out of that, 150 will be a round-island route, which means that it will be connected. I think this is an

example of how creative use of land has served us very well. It started off by us looking at land reserve, such as reserve for canals that is not well utilised, how we can make good use of such land to create very beautiful environment for Singaporeans. Our plans to work with PUB's Active Beautiful and Clean Water, for example, will again create many beautiful recreational options for Singaporeans. When it comes to other infrastructures like shopping centres, residential buildings, that is already in the plan. We do have cases where short-term demands may not be easily matched. It is very hard to predict demand accurately, especially when you look at supply of commercial as well as residential buildings, there is always a lead time involved. We will do our best to try to reduce the volatility involved in the market. It is not possible to predict demand accurately, because we can never foresee conditions that may affect Singapore, such as the dip of demand in the last 18 months. In our planning horizon, we plan for a certain population. Our land sales system will allow us to respond to market quickly. We have two systems, whether it is a confirmed land sale or reserved land sale, that will actually allow property players to call for supply of land as they think the market will require.

On the second question about bringing forward the revitalisation or remaking of heartland, that is something that we have been doing all the time. For example, lift upgrading programme is one that we talked a lot about. That is our current focus, because we know that many Singaporeans are looking forward to that, with an ageing population, especially many elderly residents have been asking for lift access. So that is really our main focus at the moment. But we have been undertaking home improvement programme as well as neighbourhood renewal programme. That is to continuously remake and rejuvenate our

housing estates to make them more suitable for our current population.

9. Mr Christopher de Souza asked the Minister for Health (a) whether he will provide an update on the Ministry's efforts to clamp down on the online sales of illicit drugs; (b) whether there will be new measures introduced to reduce such transactions; and (c) whether buying of such drugs online is illegal.

10. Ms Ellen Lee asked the Minister for Health in view of the consumer advisory guide issued by the Health Sciences Advisory and besides partnering with the other worldwide national medicines regulators, police and/or customs, what is the intended strategy and action plan of his Ministry and other related agencies/bodies to mitigate against the onslaught of counterfeit and illegal drugs marketed and sold via the Internet.

Sir, may I take Question Nos. 9 and 10 together?

Yes

The sale of medicines through the Internet is a growing global problem. Enforcement agencies around the world cannot tackle this problem alone. As Internet sites are often located overseas outside the immediate control of national authorities, tackling this problem requires the active participation of the consuming public. Consumers need to be aware of the dangers and risks of online purchase of medicines, and should learn to make responsible choices. Their participation will significantly augment the trans-border coordination efforts of national regulatory and enforcement agencies. In Singapore, our control strategy comprises several elements. First, there

must be legislative clarity. We subject local Internet websites selling medicines and those who operate these sites to the same types of control as physical local 'brick-and-mortar' companies. Local websites are only allowed to offer over-the-counter health products that can be freely sold or supplied in general retail outlets. These are medicines or health products that do not require a pharmacist's advice or a doctor's prescription.

Second, the Health Sciences Authority (HSA) routinely monitors these sites to detect any illegal sale of medicines and will not hesitate to prosecute offenders. In 2009, 13 people were prosecuted or fined, and 14 issued warnings to remove or change their web postings. This is an increase over 2008 and is due to the intensified surveillance activities by HSA.

Third, we have active cross-border cooperation with our foreign counterparts. For example, if a fraudulent website originates from a foreign site, HSA will alert its overseas counterparts. Last month, HSA took part in an international effort by INTERPOL and WHO codenamed Operations Pangea II, where medicines regulatory authorities in 24 countries conducted a coordinated sweep of Internet sites selling dangerous and illegal medicines.

Fourth, HSA works closely with the Immigration and Checkpoints Authority to screen and stop contraband shipments of unregistered medicines entering Singapore, including those sent through parcel post. For medicines for personal use and for which there is valid documentation, up to three months of a person’s own consumption is allowed. Parcels with medicines containing controlled drugs without any supporting documentation are referred to the Central Narcotics Bureau (CNB) for further investigation. It is an offence for anyone to traffic, manu

facture, import, export, possess or consume any controlled drug, without authorisation. A person engaged in any unauthorised transaction of a controlled drug is committing an offence.

So far, the Internet purchase of medicines in Singapore remains under control. However, with increasing use of the Internet, there will inevitably be a rise in Internet purchases of medicines. We will continue to explore other measures to tackle illegal Internet sales of medicine. If necessary, we will not hesitate to raise the penalties on offenders selling adulterated and counterfeit medicines.

But ultimately, demand drives supply. Consumers must play their part in the fight against Internet sales of medicines. We will step up consumer awareness and education and remind Singaporeans that all medicines should be bought through legal channels and from trusted sources.

I would like to thank the Senior Parliamentary Secretary for his comprehensive reply. I have two questions. Firstly, does the HSA have the investigative enforcement and prosecutorial ability to carry out the regulatory framework that he mentioned? And, secondly, if it does not, would the Senior Parliamentary Secretary consider lending support from MHA in the investigative enforcement and prosecutorial work?

Yes, we are stepping up on our enforcement. We will always work with other agencies, like MHA, to make sure that we can screen, detect and take action against any offenders.

Sir, one supplementary question. The Senior Parliamentary Secretary said that the HSA is tracking or monitoring the sales of illegal drugs over the Internet. Would that necessarily mean that if any surfers were to come across such illegal trade, HSA

would necessarily be the authority to report this illegal trading too?

Yes, Sir, HSA is the right agency to report this kind of offences to, and so are the Police.

11. Mr Liang Eng Hwa asked the Minister for National Development (a) whether his Ministry will come up with more effective inter-agency measures to tackle the problem of high-rise littering in HDB estates; (b) whether there is the need to step up surveillance measures to identify serial high-rise litterbugs; and (c) how many serial high-rise litterbugs have been taken to task in the last three years.

Mr Speaker, Sir, HDB works closely with NEA and the town councils (TCs) to tackle the problem of high-rise littering in HDB estates on two fronts.

First, education. Last year, with the help of agencies such as NEA, SPF (the Singapore Police Force) and the Community Mediation Centre, HDB compiled a handbook on the "do's" and "don't's" of HDB living for all households. The handbook aims to remind residents against anti-social behaviour such as littering and disturbance to others. Recently, HDB and the TCs also embarked on a public education exercise against killer litter. This is in addition to NEA's ongoing effort to raise public awareness about the importance of keeping the living environment in HDB estates clean and litter-free.

Second, enforcement. To minimise the incidence of high-rise littering, NEA and TCs conduct joint surveillance operations

to catch high-rise litterbugs. In the past three years, NEA has taken 14 cases of high-rise littering to task through fines and/or corrective work orders. HDB has also served warning letters to 12 residents for the throwing of killer litter. Where warranted, HDB will undertake compulsory acquisition of a flat if a resident is convicted under the Penal Code for killer litter offences.

The high-rise littering incident in Sengkang last month resulting in a serious injury is a reminder to us that such irresponsible behaviour can have grave consequences. It is simply not possible for agencies to have 'eyes on the ground' round the clock. To combat high-rise littering effectively, it is critical that residents play an active part in the battle against litterbugs. First, do not be a litterbug. Second, spread the message to your family and those around you not to litter. Third, alert NEA and TCs if you are aware of litterbugs in your community.

We agree with the Member that we need to find more effective means to deal with the problem of high-rise littering and falling objects. HDB will work with other Government agencies and the TCs towards this end.

Sir, I would like to ask the Parliamentary Secretary whether he agrees with me that in the HDB estates' situation, it tends to be a small minority of culprits that is the root cause of this high-rise littering. Hence, would the Ministry, together with the other agencies, want to be more targeted, for example, have step-up surveillance measures on some of these possible repeat offenders, enforcement as well as counselling of these repeat offenders?

Sir, we agree that, often times, issues like these are actually affected by a small minority and we will continue to step up

surveillance methods. I think, more importantly, it is the cooperation between the residents and the agencies involved – NEA and town councils.

As mentioned earlier, we cannot have the "eyes on the ground" 24 hours but the system is one in which we rely on feedback as well as information given by the residents and the agencies will continue to do its surveillance and take action against those who are affected. When we take action against those who are affected, we give warning letters, we counsel them, and at the same time to make sure that they comply and if they do not comply, we take more severe action against them.

But having said that, we also think that it is important to do a broad sweep of public education campaigns to make sure that everybody is aware of the messaging that goes about, so that it is important for everyone to know their respective roles in the community. That it is also the responsibility of every resident to be aware of the issues of high-rise littering, especially killer litters.

Mr Speaker, Sir, I have a few supplementary questions. The Parliamentary Secretary has said that HDB has issued warning letters for only 12 cases. There is a report that says 4,650 in 2008. Who had actually issued the warning letters? And in 2009, what was the figure? Is there a disturbing trend in such high-rise littering by residents? If that is so, what is the land owner, ie, HDB, going to do? Because it only issued 12 letters of warning, as compared to –

Mdm Phua, we have only four minutes left. Make your question short, please.

The third question – can the design of such flats be further

improved? If high-rise planting is desired, then flats should be properly designed for high-rise planting. If not, can it be further improved to ensure that it is not dangerous for high-rise planting?

Sir, allow me to clarify. The 12 warning letters refer to warning letters to residents for throwing of killer litter whereas the figure of 4,000 that Mdm Phua mentioned refers to warning letters given out to residents who placed precarious objects that are potential killer litter. So these are two separate incidences. It is given out by HDB as well as town councils and today, we continue to do preventive efforts to make sure that residents are aware that it is wrong for them to even put out objects that are potential killer litter.

On the issue of the design of HDB blocks, we will continue to look at how else we can further improve on such situations. HDB estates have been around for many years and the blocks have been around for many years. I think the issue is really the extent to which residents are aware of their behaviours and the extent to which how dangerous these behaviours are to the residents. If we continue to educate them, telling them that what they are doing is really at the expense of other residents, they should be able to follow the regulations and stop themselves from behaving in such a manner, I think we should be able to have a safer environment for our HDB residents.

Miss Penny Low, last question.

Sir, two supplementary questions. One, I am aware from my block visits yesterday that Town Council, in working with the HDB, has started to issue a lot of letters of warning to residents for placing objects or undesired parcels precariously. This has caused a lot of unhappiness, mainly

because residents are not aware of the dangers associated with such behaviour. So may I ask the Parliamentary Secretary, in his reply earlier on, where he noted that there has to be a higher level of education, when will this be rolled out and can this be rolled out quickly so that the communication with the residents can be a lot smoother?

Second, on an associated litter issue, there has been a rise in unsolicited mails – mailers, pamphlets, leaflets distributed door-to-door by housing agents, locksmiths, and so on. This has caused two concerns. One is, of course the cost of cleaning up itself is tremendous and the residents are paying for that. Two, it has also become a signal of which unit is not occupied or that the occupants are temporarily away, and this has also caused quite a number of cases of burglary, even in my own area itself.

Miss Low, you only have four minutes left.

May I ask the Parliamentary Secretary whether there is going to be any step-up measure against unsolicited mailers?

Four minutes left, Dr Maliki.

Thank you, Mr Speaker. Sir, we have recently embarked on a public education campaign. Miss Low asked for the details of that campaign and how fast we can roll it out. On 17th December, we announced a public education campaign to raise the residents' awareness of a particular killer litter issue. We also worked with religious organisations, particularly three religious organisations. They issued statements on 17th December last year, to remind their devotees that it is not in line with their religious practices of compassion to place or hang religious items in precarious

manner. Killer litter posters were displayed on all notice boards in HDB estates and we issued advisory letters to all HDB households to reiterate the message against killer litter. Apart from issuing the warning letters, we also issued advisory letters. That has already been done. Advisory notes will be issued subsequently through newsletters of the different religious organisations. We are also in the process of producing the "do's" and "don'ts" of killer litter video which will be produced and screened at branch offices so that the residents are more aware of the dangers of killer litter.

On the issue of unwanted mailers, I think we have recognised that it is a problem in certain parts of Singapore and certain estates, particularly estates where your minimum occupation period has just been fulfilled and people want you to sell your flat. I think we will work together with the local organisations and the TCs to try to see whether we can actually address these issues locally.

Mr Low, a quick question. We have two minutes left.

There are some killer litters who are IMH patients. How does the HDB deal with them? And, secondly, under what circumstances will the HDB acquire the flat of those convicted of killer litter?

On the issue of mentally-ill patients, we recognise that it is a unique situation and I think most important is the role of the family to ensure that the mentally-ill patient is able to function effectively in the community. If the mentally-ill patient is not effectively ready to be in the community, then they should be in the Institute of Mental Health. Often times, the point is that the Institute of Mental Health thinks that they are ready because they are able to function in the community with medication. The issue is really the extent

to which they are able to comply with their medication regime. If we come across a situation like that, we probably seek the family member's cooperation in ensuring that this particular family member actually complies with his medical regime to make sure that he is still able to function in the community.

On the issue of how and when we actually compulsorily acquire the flat, it really depends first, as I mentioned earlier, on whether they have been convicted of the offence under the Penal Code and the severity of the offence. In 2005, we had actually compulsorily acquired a flat of a resident who actually had been convicted of such an offence.

3.00 pm

Order. End of Question time.

[Pursuant to Standing Order No. 22(3), Written Answers to Question Nos. 14, 18-19, 25, 27, 30, 32-33, 37-38, 46 and 49-50 on the Order Paper are reproduced in the Appendix*. Question Nos. 15-17, 20-24, 26, 28-29, 31, 34-36, 39-45, 47-48 and 51 have been postponed to the sitting of Parliament on 12th January 2010.]

*Cols. 1963-1980.

Order for Second Reading read.

Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

The Bill proposes three main changes to the Government Securities Act: First, expressly empowering the Monetary Authority of Singapore (MAS) to regulate

primary dealers; second, allowing early redemption of Singapore Government Securities (SGS); and third, allowing MAS to enter into securities lending arrangements using SGS.

Sir, let me explain the first amendment to empower MAS to regulate primary dealers. Primary dealers play an important role in providing liquidity, underwriting issuance and giving market feedback. In practice, MAS has been appointing primary dealers and issuing them directions in relation to their role as such. The amendment in clause 6 of the Bill proposes a new Part VIIA which sets out a regulatory framework for MAS’ appointment and regulation of primary dealers. Part VIIA will also allow MAS to issue directions to, revoke the appointment of, suspend and inspect the primary dealers.

The second amendment will allow Government to redeem SGS before maturity at market price. Currently when MAS conducts buy-back operations for illiquid issues to concentrate liquidity in key benchmark issues, the securities bought back are kept on MAS’ books until maturity. As premature redemption of these securities is currently not allowed, Government continues to pay interest on these securities to the MAS. The practice of early redemption is common among central banks and will provide more flexibility in the management of SGS. This amendment is provided for in clause 5 of the Bill.

The third amendment relates to the securities lending arrangements between MAS and the primary dealers. An efficient bond market relies on market-makers who are able to effectively price and deliver the bonds on-demand. To facilitate market-making, MAS currently operates a sale-and-repurchase or commonly referred to as a repo facility that lends SGS to primary dealers on an overnight basis when the SGS are not readily available from other sources. This provides the

primary dealers with greater confidence in delivering SGS to investors and enhances the overall liquidity, efficiency and robustness of the government securities market. This arrangement is formalised in clause 3 of the Bill.

The second and third amendments together will also enhance MAS’ existing repo facility. The amount of SGS which MAS can lend currently is limited to its own holdings. When demand for specific SGS exceeds MAS’ holdings, Government can issue new SGS to MAS to lend to primary dealers on an overnight basis. Government will then redeem the SGS the following day, to be allowed for under the proposed second amendment.

Other amendments in the Bill are administrative in nature.

Sir, I beg to move.

Question proposed.

3.02 pm

Mr Speaker, Sir, in the history of the Singapore Government, we have had the happy situation where we operate on a balanced budget and have not needed to borrow funds through the issuance of government bonds to finance expenditures. However, we must make plans to withstand another financial tsunami like the sub-prime crisis which rocked us in September 2008. Singapore may survive another round but at what expense, we do not know. To prepare for the odd chance that there is another financial tsunami, the Singapore Government would do well to fortify its financial arsenal, and the Government Securities (Amendment) Bill is indeed timely.

However, I would add a cautionary note in relation to the power of the Government to borrow money by issuing securities. A recent example is that of

Dubai, where its overleveraged Sovereign Wealth Fund was unable to meet its interest payments, resulting in a crisis for Dubai. Dubai was fortunate that its neighbour Abu Dhabi bailed it out; and this is a reminder for the rest of us that when we issue securities, we must be mindful to do so prudently and not over-reach ourselves. Singapore has come a long way in building up our capability as a sovereign debtor, and we must be careful not to mar this reputation by excessive borrowing.

The Bill provides MAS with the authority to appoint financial institutions as primary dealers of Government securities. Singapore Government Securities provide a sound investment opportunity with little or no risk of default, for both individual and institutional investors. To meet demand from investors, the appointment of primary dealers allows Government securities to be more easily distributed, and helps the Government reach a greater pool of counterparties. At the same time, it is much easier for the Government to deal with just a group of primary dealers, rather than having to deal with many different counterparties who hold Government securities in varying amounts.

Sir, the Government Securities (Amendment) Bill provides MAS with the regulatory powers to keep a check on the conduct of the primary dealers. For example under new section 29C, public and customer interests are given due importance. We do not want to have a situation where primary dealers, through manipulative machinations, pull the wool over the eyes of government securities investors. The painful Minibonds saga where huge amounts of money, especially of the old and ill-informed investors, who squirreled away their life savings, only to see it wiped away in one fell swoop, are invaluable lessons. And Mr Speaker Sir, these lessons are enough to last us a lifetime.

It is to be noted that new sections 29C and 29D together appear to impose quite a heavy obligation on primary dealers. If a primary dealer fails to observe directions issued by MAS under new section 29C, it may have its appointment as primary dealer cancelled. Can the Minister please provide examples of such directions that MAS may possibly issue, to give potential primary dealers a better idea of what they will be entering into?

Also, there are regulatory capital requirements for primary dealers in New York. Would there be similar regulatory capital requirements for primary dealers here in Singapore, and if yes, how much will this regulatory capital be?

With this, Sir, I support the Bill.

3.07 pm

Mr Speaker, Sir, first, I would like to thank Mdm Ho for her support of the Bill. Let me clarify some of the concerns that she has raised.

First, Mdm Ho has highlighted that although Government is currently able to finance its expenditures without borrowing, we should nonetheless be prepared for any unforeseen circumstances such as the recent financial tsunami. The prudent principle of not raising debt to fund Government's public expenditures has been enshrined in our Constitution. The issuance of the SGS is for the purpose of developing our domestic debt market. So the proceeds raised are invested together with the rest of our reserves. Despite the recent financial crisis, Singapore has actually maintained its AAA Sovereign rating and kept our debt servicing cost low and this has also indirectly benefited our local companies and businesses. But nonetheless, we will continue to ensure that the

Singapore Government spends within its means and continues to exercise discipline and prudence, and should another extraordinary financial tsunami hit us, our Constitution allows the Government to seek the President's approval to draw on our reserves, as was the case last year. But let me assure Mdm Ho that there are safeguards in place and the first of which is that the Government cannot borrow more than the limit that has been authorised by this Parliament which currently stands at $320 billion. The second is that the Reserves Protection Framework ensures that the proceeds raised are invested as part of our reserves and cannot be spent.

Mdm Ho also raised specific questions relating to the primary dealers. She commented that the Bill imposes quite a heavy obligation on the primary dealers. Let me clarify that the Bill merely formalises the existing arrangements for primary dealers and does not add to the obligations. The proposed legislation merely sets out a clearer legal and due process framework which will give greater certainty to all the stakeholders. That would include the Government, MAS, primary dealers and investors. As for examples of directions that the MAS has issued, they include the requirement for the primary dealers to fully underwrite the share of the SGS in an auction and the obligation to make two-way bids for SGS under all price conditions. Finally, she has a question about the capital requirements. I would like to clarify that only financial institutions incorporated in Singapore have to meet MAS' regulatory capital requirements.

Sir, I believe I have answered her questions.

Question put, and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

The House immediately resolved itself into a Committee on the Bill. – [Mrs Lim Hwee Hua].

Bill considered in Committee.

The citation year "2009" will be changed to "2010" as indicated in the Order Paper Supplement.

Clauses 1 to 8 inclusive ordered to stand part of the Bill.

Bill reported without amendment, read a Third time and passed.

Order for Second Reading read.

3.11 pm

Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

Sir, the Bill proposes two key amendments to the Statistics Act. The first set of amendments allow the Department of Statistics (DOS) and Research and Statistical Units (RSUs) which are gazetted under the Statistics Act to provide researchers access to anonymised microdata. The second set of amendments clarifies DOS’ legislative powers to obtain information from public sector agencies.

Providing anonymised microdata access

Today, DOS and the gazetted RSUs, collect, analyse and disseminate a wide range of socio-economic and demographic statistics. Under the existing Statistics Act, such statistics can only be provided in aggregated form.

However, to undertake more sophisticated analysis of behaviour across

different types of firms or households, researchers need access to microdata. Microdata refers to data on a person, household or establishment at an individual level. Many advanced National Statistical Offices (NSOs) like the US, the UK, Netherlands, Finland and Australia provide microdata in anonymised form, often masking the identity of the individual party by applying appropriate statistical techniques.

Microdata analysis will help us better understand the impact of public policies or external factors on firms and households with different characteristics. In countries where microdata are available, researchers have used it for a variety of valuable and useful research. For example, researchers used anonymised microdata from the Canadian Labour Force Survey of Statistics to investigate whether the government’s mandated maternity leave had any impact on the labour force behaviour of mothers. In Singapore’s case, income and expenditure microdata from the Household Expenditure Surveys could be used to study the consumption behaviour of different household types. Such studies will complement analyses based on aggregated data, and provide greater insights to aid policy formulation.

The proposed amendments will allow the Department of Statistics and gazetted RSUs to provide access to anonymised microdata for research purposes. We will however adopt a calibrated approach in opening up access to such data. To start off, only public agencies that require anonymised microdata for policy research will be allowed access to such data. These agencies can, on their own, engage consultants to undertake research using the anonymised microdata. To protect the confidentiality of individual data, all researchers, including consultants, will be subject to stringent security protocols. We will monitor this carefully. Access to a wider group, such as other research

institutions, will be considered at a later stage.

Protection of confidentiality

Mr Speaker, Sir, I will now elaborate on the various safeguards to protect the confidentiality of individual data. DOS will anonymise the microdata before access is provided. In instances where it may not be possible to completely mask the identity of the individual party, such as in the case of industries with only a small number of firms, then DOS will not provide access to this information.

To guard against any leaks, users will have to come to an on-site Data Lab at DOS or the gazetted RSUs to use the anonymised microdata. All data will be examined prior to removal from the Data Lab to ensure that only statistical tables and output without any anonymised microdata are taken out.

DOS will set up two committees to implement these changes. A Microdata Review Panel will look at the technical issues on anonymisation and subject matter sensitivities and will scrutinize each request for microdata. An additional Microdata Advisory Committee will advise the Microdata Review Panel on policy issues and processes relating to anonymised microdata access.

The proposed amendment will also increase the maximum fine for breaches of confidentiality, from $5,000 to $10,000, besides the existing provision for imprisonment for a term of up to 12 months. This serves as an additional deterrent to prevent abuse or misuse of anonymised microdata.

Obtaining information from public agencies

Mr Speaker, Sir, let me now turn to the second amendment and explain the

rationale to explicitly allow DOS to obtain information from public agencies. DOS was established to collect, compile, analyse and disseminate key official statistics. To minimise the burden on respondents, DOS has been using administrative data already collected by other agencies, instead of requesting the same information anew directly from members of the public or private establishments. This is a common practice among the many National Statistical Offices.

The proposed amendment makes it explicit that the Chief Statistician is allowed to obtain data from public agencies for statistical purposes. The data obtained will be protected under the provisions of the Statistics Act. This amendment will further strengthen DOS’ role as Singapore’s National Statistical Authority and will enhance DOS’ ability to provide more timely and relevant statistics to the Government and to members of the public.

As a safeguard, the Ministers responsible for the agencies that collect, or are in possession of the data will have the power to exempt sensitive information from being provided to the Chief Statistician.

Sir, I beg to move.

Question proposed.

3.18 pm

Mr Speaker, Sir, I welcome the Statistics (Amendment) Bill as it would give more teeth to the Department of Statistics, our national statistical authority.

Although statistics is a simplification of things in a real world, the process of gathering data is a tedious one. This Amendment Bill changes the law to allow the Department of Statistics and the

Research and Statistical Units to provide researchers access to anonymised microdata, when they previously only had access to data in aggregated form. The greater precision and detail of information provided will thus empower researchers in delving deeply into the significance and meaning of the data, and can only be beneficial to the policy formulation process.

This provision under section 3 of the Amendment Bill gives these units the authority to collect and analyse socio-economic and demographic statistics. This change is to be welcomed, and will hopefully be of great use in coming up with policies that cater to the needs and wants of our populace. Anecdotal evidence and expert opinions, together with a more detailed set of data and statistics, will go a long way towards identifying the source of the issues that we face, as well as pre-empt problems before they arise.

And now with the Integrated Resorts soon coming onstream, the data collected will be even more significant. However, there is the concern of accidentally revealing the identity or sensitive information about a particular respondent, with the provision of microdata relating to individuals. At the same time, it is important to ensure that the anonymisation process does not distort the data set, resulting in policies formulated based on mistaken information.

Sir, I am glad to note that there will be established a Microdata Review Panel to examine technical issues on anonymisation and subject matter sensitivities, as well as scrutinise each request for data. I would like to query if this Panel will effectively be making the decision as to whether to release the data, and who will be sitting on the Panel? Similarly, who will make up the Microdata Advisory Committee, which has the duty of advising the Review Panel on policy issues

and processes relating to anonymised microdata access?

Sir, at the same time, it is imperative that Singapore safeguards the data obtained and ensure that it does not fall into unauthorised hands. I would like to commend the Ministry for having proper safeguards in place to ensure confidentiality of information and the doubling of penalties for the breach of confidentiality is reassuring and helpful in safeguarding the status of Singapore as an international business hub.

With that, I support the Bill.

3.22 pm

Sir, there is a need to balance the public interest in gathering information and the right to individual privacy. Thus, I would like to ask whether the Bill will facilitate more data gathering, but makes compromises on information safeguards?

Specifically, the Bill has gotten rid of a safeguard which is present in the existing section 7(6) of the Act. Under the existing section 7, information that may have been provided under confidential circumstances to the Census Department, CPF Board, Comptroller of GST and Comptroller of Income Tax, had two layers of checks. The first check was that the Minister-in-charge of the department which gathered the data, has the power to put restrictions on what the statisticians can disclose after obtaining the information. There was an additional check under section 7(6) that no information furnished by them to the Chief Statistician or Director of any research unit, could be disclosed without the written permission of the agency itself.

Sir, the departments referred to in the current section 7(6), indeed collect sensitive tax information, personal

data and a person's employment details. They may also have gathered the data under obligations of secrecy. The importance of this additional safeguard on privacy by the agency itself was, in fact, highlighted in Parliament in 1990 and again, in 2004, when amendments to the Statistic Act were debated. It was stressed by two different Ministers that due to the sensitivity of those data, the approval of the agency itself, whether the CPF Board, Comptroller of GST or Comptroller of Income Tax, etc, should be obtained before statisticians release it. This is over and on top of the Ministers' right to restrict the disclosure of the information.

What this Amendment Bill appears to do is to repeal the third shadow altogether, which means that these five sensitive departments are now grouped together with the entire government machinery as public agencies. Under the new section 6, the Ministers-in-charge can exempt their agencies from disclosing certain information to their statisticians. However, the safeguard of requiring the five agencies to specifically give written approval before release of their data, has been removed. Instead, in the new section 7(3), it is the Chief Statistician or the Director of the research unit, who can imposed conditions on the use of the information supplied.

Is this change a compromise on the safeguards of the confidential data gathered? With due respect, the Chief Statistician or the Director of the research unit, may have no specialist-knowledge of the subject matter nor the public expectations at the time the data was gathered. I would like the Minister to clarify, why it was necessary to remove this additional check by the five departments which clearly gathers sensitive information?

3.25 pm

Thank you, Mr Speaker. This Bill gives the Chief Statistician a lot more authority to amass data collected through Government agencies.

The assumption is that relevant data will be used where appropriate to advice and inform policy. In principle, I agree with the amendments spelt out in this Bill for two main reasons. First, as research commissioned by Government agencies is done using public monies, there should be better consolidation of knowledge and information to avoid replication and inefficiency in research. And second, as we grow a keen appreciation of evidence-based research and acknowledge the relevance of data in informing policy, we should enable the Chief Statistician to facilitate the use of data to advance the important work of policy makers.

While I stand in support of this Bill, I have three comments. The first relates to the quality of data. As we move towards a culture that embraces quantitative research and the outcomes of surveys, we must reconcile the quality of data, especially those from survey research. For example, large scale survey projects that rely on quota sampling or convenient sampling like straw polls to obtain data are not able to generalise trends that are representative of community.

May I ask the Minister, what plans his Ministry has in place to ensure the quality of data before it is used to inform policy? For example, will research conducted by Government agencies be governed by instructions from institutional review boards?

My second concern relates to the implications of this Bill on ethical considerations in research. For example, a respondent agrees to participate in a research commissioned by a public

agency and is given the assurance that the data collected will only be used to advance appreciation of a specific set of social issues. Should this data be later used to reflect other concerns that were not spelt out in the original research agenda, this will compromise the issue of informed consent that in pivotal in any ethics consideration.

To overcome this possible ethical dilemma, may I suggest that data obtained from public agencies be used within the context of the original research objectives. Let me illustrate with an example. Health Promotion Board (HPB) commissions a research on teen smoking. So teenagers are encouraged to participate and HPB assures all respondents that the aim of the study is simply to appreciate the motivators that push a teen to take up smoking. But if the data is later used by law enforcement agencies to locate hot-spots where underaged smokers are likely to hang out, then that would be a serious breach of ethics. Subsequently, there will be a greater reluctance, if this should happen in a community to participate in research commissioned by public agencies.

My final point relates to growing a conducive culture for evidence-based research. If we are going to move towards a culture where we are going to use more data to advance policy and inform policy, then we have to ensure that there is good quality data that is amassed by researchers on the ground and this has a lot to do with cultivating a positive culture and appreciation for research by Singaporeans. For us to be able to leverage on the rich details present in the data that is collected through a professionally conducted research, we must nurture a community that is appreciative of this kind of social research. So it is critical that researchers in Singapore are able to establish a relationship with potential respondents that is based on trust and respect.

Currently, in most of the researches done, there is no direct feedback to respondents on the outcome of the studies that they participated and co-operated in. To overcome this, we should have better accountability to the public on how the statistics are used. One simple way is to achieve a meaningful connect between respondents and research outcome is the provision of an Executive Summary. So, maybe the Minister might want to consider making this mandatory in the research that is funded by Government agencies. If you have this kind of direct feedback to the public, then it will result, I am sure, in an increase in voluntary participation and it would invoke a more conducive research environment in Singapore.

Finally, this Bill supports the principle that data should be shared – between Government agencies and Chief Statistician. I would like to leverage on this, and propose that perhaps, a central repository of data be created where data sets derived from commissioned research can be shared, not just within the Government but with academics, students and interested members of the public. If we share non-sensitive data, it will result only in a win-win situation when you have many pairs of eyes scrutinizing the data set. Through this, we will only empower the community to rely on obtaining facts to inform opinion and decisions.

I would like to leverage on this, and propose that perhaps a central repository of data be created where data sets derived from commissioned research can be shared not just within the Government, but with academics, students and interested members of the public. If we share non-sensitive data, it will result only in a win-win situation when you have many pairs of eyes scrutinising the data set. Through this, we will empower the community to rely on obtaining facts to inform opinion and decision, and if

Singaporeans can reap direct benefits from research outcomes, they will also be more likely to contribute to research that is commissioned by the Government.

With this, I support the Bill.

Mr Speaker, Sir, first let me thank Mdm Ho and Prof. Straughan for their support of the Bill, and also to Ms Lim for raising some very important clarifications. Let me respond to the issues raised.

First, on the microdata review panel. This will be chaired by Chief Statistician and will include all the relevant members from the various agencies providing the source as well as the policy agencies. This panel will evolve, and depending on the requests put up to the mircodata review panel, we will have the composition of the relevant people to review the requests, and also to scrutinise the mircodata that will be released.

Ms Sylvia Lim asked whether by amending the Act, we have reduced the safeguards. The answer is "No". The amendment essentially formalises the current arrangement and, as I mentioned in my Second Reading speech, the Ministers who are responsible for the agencies that collect the data or that are in possession of the data, will have the power to exempt the sensitive information from being provided to the Chief Statistician. So the gatekeeper remains the agencies that collect the data, and the Ministers responsible for these agencies. So in the six agencies that she mentioned – CPF, IRAS, etc, – if the data is considered sensitive, the agencies and the Ministers can still exempt these data from being given to the Chief Statistician.

Sir, let me next answer the three comments raised by Prof. Straughan. First, on the quality of the data, I agree

with her that this is very important. I think the various statistical agencies are very concerned and they have international standards to abide by when they collect the statistics. Nevertheless, Statistics Department will review these quality guidelines and formalise this set of guidelines for the various RSUs. Second, on informed consent and ethical issues raised – again, because we are involving the agencies, both the policy agencies as well as the statistical agencies, in the microdata panel, if requests for such data compromises the informed consent or ethical issues, then the agencies involved in collecting the data, can veto and not release the information. So that is the check and balance.

Third point about how we can inculcate a conducive culture of evidence-based research – this is indeed our objective and we are taking these initial steps to release anonymised microdata in order to facilitate this culture of evidence-based research. But we do so in a careful calibrated manner. I think eventually we hope to have it extended to all important research agencies. For a start, we are extending this only to these agencies and the researchers appointed by these agencies. But once people gain confidence that even though we are releasing anonymised microdata, this is done very carefully and that confidentiality is safeguarded, then I think we can extend this to more researchers. I agree with her suggestion that there ought to be a good feedback mechanism, so that people feel that the data which they provided for various statistical purposes, are put to good use and that policies are increasingly based on proper research and proper evidence.

Question put, and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

The House immediately resolved itself into a Committee on the Bill. – [Mr Lim Hng Kiang].

Bill considered in Committee.

The citation year "2009" will be changed to "2010", as indicated in the Order Paper Supplement.

Clauses 1 to 14 inclusive ordered to stand part of the Bill.

Bill reported without amendment; read a Third time and passed.

Order for Second Reading read.

3.36 pm

Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

The Medical Registration Act (MRA) seeks to protect the health and safety of the public by creating mechanisms to ensure that medical practitioners are competent and fit to practise medicine. In this way, we uphold the standards of medical practice in Singapore, and so doing, maintain public confidence in the medical profession.

The MRA was last amended in 2003. Since then, new issues in professional conduct and standards have arisen due to changing demands and expectations of patients and the public. This Bill seeks Members' support for several amendments to the MRA. The amendments will address four key objectives:

To strengthen and streamline the Singapore Medical Council (SMC)'s existing disciplinary processes to cope with the

increase in the number and complexity of complaints and disciplinary proceedings;

To provide a wider range of orders and penalties which the SMC can impose, commensurate with the extent of a medical practitioner's wrongdoing and circumstances of the case;

To adopt a more nuanced approach to medical registration for both local and foreign-trained doctors; and

To set up a Register of Family Physicians.

Let me elaborate on each of these objectives and explain how the proposed amendments would achieve them.

SMC's disciplinary processes

First, we see a need to strengthen and streamline the SMC's disciplinary processes, to cope with the rising number and complexity of complaints against doctors. Singaporeans enjoy high standard of medical care and largely have high confidence in our doctors. Nevertheless, the number of complaints has gone up from 66 in 2003 to 96 in 2009. This is partly because the number of doctors has also increased substantially, from 6,292 in 2003 to more than 9,000 in 2009. This works out to about 11 complaints per 1,000 doctor per year, which is not alarming. However, SMC's capacity to cope with the rising number of complaints has remained the same during this period. The result is a growing delay by the SMC in processing the cases, especially if they are complex. Last year, as an example, a simple complaint took about three months to conclude, and one complex case actually took more than five years. As a result of long delay, there have been instances where the complainant who was dissatisfied with the outcome of the disciplinary process, was unable to initiate civil proceedings against the doctor. The complainant also has no recourse for

appeal against the Disciplinary Committee's decision under the current Act. This is unsatisfactory.

Clause 26 repeals and re-enacts Part VII of the Act relating to inquiry and disciplinary proceedings. The changes in Part VII seek to achieve more expeditious and equitable management of complaints. SMC's Complaints and Disciplinary Committee members are all volunteers. With the increasing number of complaints, the existing members have been heavily burdened with disciplinary inquiries which could last up to 10 days, and requiring at least six hours each day. The frequent and heavy commitment required makes it difficult at times to constitute the committees, thus delaying the proceedings. To improve the situation,

the new section 38 will raise the cap on the number of lay persons and registered doctors in the Complaints Panel from the current 80 to 150, almost doubled. Together with clause 4 which increases the number of Council members from the present 19 to 25 members, these changes will effectively increase the number of chairmen and committees that can be constituted to handle the larger number of complaints.

Further, the new section 40 will reduce the number of members of the Complaints Committees from the present four to three members, and all three members of the committee need to be present to constitute a quorum. With a smaller committee, this will make it easier and faster to coordinate members' schedules for meetings.

In addition, the new section 50 renames the Disciplinary Committees as Disciplinary Tribunals, a more appropriate term and changes the way they are constituted. With the amendments, the Disciplinary Tribunals will no longer

specifically require the chair and one member to be Council member as is the case today. The Disciplinary Tribunal's Chairman and members will be constituted from a panel of Chairmen appointed by the Minister, and the Complaints Panel respectively. It will also allow the SMC the option of appointing members with experience in legal matters, such as a senior legal officer, senior lawyer, former Supreme Court Judge or Judicial Commissioner, to be a member or the chair of a Disciplinary Tribunal. I will speak more on this amendment later, but briefly these changes expand the Council's capacity and capability to deal with the increasing number and complexity of disciplinary cases by widening the pool of members that can be appointed to the Disciplinary Tribunals.

The new section 42 and clause 28 will allow SMC's Complaints Committee to appoint and empower officers to investigate complaints against doctors. Currently, where information is received regarding a doctor's practice, such as errant prescribing of addictive drugs, there are no provisions for SMC to conduct a thorough investigation. A Complaints Committee can only rely on exculpatory statements and medical records submitted by the doctor and expert opinions. These may not fully reflect the facts or severity of the case. These amendments will empower the appointed investigators to seize evidence without notice to the doctor, and conduct a thorough investigation. In this way, the Complaints Committees will be better able to make informed and impartial decisions, resulting in complaints being processed more quickly and with fairer outcomes.

The new section 55 sets out the framework for the SMC or an aggrieved complainant to appeal to the High Court against the Disciplinary Tribunal's decisions. Currently, only the defendant doctor is allowed to appeal to the High Court on the decision of the Disciplinary

Committee. This is not necessarily fair to the public or the complainant. This section allows the SMC to appeal when the Council is not in agreement with its independent Tribunal's orders. The framework also allows the complainant an avenue to initiate an appeal through a review committee appointed by the Minister.

Expanding the range of orders

Second, we propose to expand the range of orders for SMC, its Complaints Committees, Disciplinary Tribunals and Health Committees so as to grant them more powers to be able to deal more effectively and appropriately with errant doctors.

The new section 37A provides for a doctor, who is aware of his performance difficulties to voluntarily request the SMC to remove his name from the register, suspend him, or impose conditions or restrictions to his practice. This enables SMC to resolve certain less serious health or performance issues with the mutual consent of the doctor instead of going through tedious, and formal disciplinary proceedings. However, this section will not apply if a complaint had been received against the doctor.

Currently, the Complaints Committees are only empowered to issue letters of advice or warnings where no further inquiry is necessary, or order an inquiry to be held by a disciplinary committee or a health committee. We propose to widen the range of orders available to the Complaints Committees so that less serious complaints can be concluded expeditiously without the heavy legal involvement and time required for Disciplinary Tribunals. When the Complaints Committee deems that no formal inquiry is necessary, the new section 49 will allow the Committee to:

order that the registered medical practitioner seek and undergo medical or

psychiatric treatment, or report on the status of his fitness to practise periodically to SMC;

order that the registered medical practitioner undergo further training, or seek and take advice in relation to the management of his practice;

refer complaints for external mediation to facilitate resolution amongst the parties concerned, for example, where miscommunication or compensation between the parties had been the key issue in the complaint; and

by agreement of the doctor, remove the name of a doctor from the register, suspend his practice for not more than three years, cancel or suspend his practising certificate, or impose restrictions and conditions on his practice.

These changes also allow the SMC to deal with correctable behaviours more constructively.

Under the current Medical Registration Act, the Disciplinary Committee can impose a financial penalty not exceeding $10,000 on a medical practitioner who is convicted. The next level of penalty is a suspension of between three months and three years. There is, therefore, a significant gap in the range of penalties in the current Act.

The new section 53 will allow the Tribunal to impose a fine of up to $100,000, thereby enabling the Tribunal to mete out a penalty that is appropriate to the severity of the case. This section will also allow the Disciplinary Tribunal to impose other orders, for example, changing his medical registration from one that is fully registered and unsupervised to one that is conditionally registered and supervised. The SMC, by so doing, can thus impose appropriate conditions or restrictions on the practitioner. The Disciplinary Tribunals will also be able to mete out the new range of orders

available to the Complaints Committee. All this enhances the powers of the Tribunal by expanding the array of possible orders.

Similarly, the new section 58 will enable the Health Committee to restrict a doctor's practice for a period exceeding the current three years where necessary. These changes, in conjunction with the expansion of orders available to the Complaints Committees, and Disciplinary Tribunals will allow appropriate rehabilitative or punitive actions to be taken that commensurate with the severity and circumstances of the cases.

A more nuanced medical registration

Third, we seek to enhance medical registration for both local and foreign-trained doctors. Mr Speaker, Sir, to cope with the rising demand for doctors in Singapore, we have increased the medical school intake at NUS, and started the NUS-Duke Graduate Medical School (GMS). However, this is still not enough to meet the rising healthcare needs of our larger population base, a significant segment of which is rapidly aging. We are actively recruiting competent foreign trained doctors and the enhanced registration framework will enable the SMC to cater to new issues that have arisen in view of these developments. Let me explain.

The new GMS with its different model of education will require a different mechanism for assessing its graduates for registration as opposed to the graduates from the NUS Yong Loo Lin School of Medicine. This is generally not provided for under the current MRA. Clause 10 enables the Medical Council to prescribe different requirements for the different degrees in medicine and surgery specified in the First Schedule. This will allow the

SMC to adopt requirements similar to the US system in assessing the NUS-Duke GMS graduates.

Over the years, we have also increased the number of overseas medical schools recognised in Singapore from 24 to 160, to facilitate the entry of foreign-trained doctors from good medical schools. There is a sizeable influx of foreign-trained doctors, both foreigners and Singaporeans who studied overseas, into our medical workforce. Last year, two out of three new medical registrations were foreign-trained. In other words, for every local graduate, there were two graduates from foreign medical schools. Aside from medical qualifications, we also need to monitor the performance of these doctors, making sure that they are up to our standards and adapt well to the local environment. The following changes will better enable the Medical Council to scrutinise and, if necessary, limit the practice and conduct of new doctors entering the healthcare system and to act to maintain standards:

The current Act only allows the SMC to consider reports from the supervisor in monitoring and assessing the conditional registrant. This is not always adequate for assessing competencies in areas such as communication and teamwork. Clause 11 improves the current supervisory framework by enabling the SMC to seek feedback and reports from other healthcare professionals other than the supervisor to provide a fuller assessment of the doctor's competence and ability to work in our local environment.

Clause 14 allows the SMC to cancel the provisional registration of a medical practitioner if he was found to be underperforming. Under the current Act, the SMC does not have such powers and is not able to stop a house officer from practising even when there are serious issues with his performance.

Currently, the SMC can refuse to register an applicant only if he was not qualified to be registered; was not of good reputation and character; or had his name removed from a register of medical practitioners in another country. For fresh foreign-trained medical graduates, neither of these reasons would apply. However, they may have health conditions, such as Hepatitis B, HIV or psychiatric disorders, which may render them to be unsuitable for practice in some areas. Clause 16 allows the Council to refuse to register persons who are found incompetent or is unfit to practise medicine due to a physical or mental condition, or fails to submit to a medical examination, or comply with any condition or restriction of any previous registration. This will enable the SMC to assess the applicants more thoroughly prior to registration and proactively deal with the registrant's condition.

Clause 22 allows the Specialists Accreditation Board to certify as specialists, persons who have the experience and meet the conditions for specialist registration even if they did not have recognised qualifications, and to define areas of sub-specialty. Clause 12 clarifies that conditions and restrictions can be imposed on a person's Specialist Registration. This will allow the SMC to register a foreign specialist, and limit the scope of his practice to only his field of specialisation or area of expertise where necessary. For example, hepatology is not defined as a specialty in Singapore. However, with the amendments, we can certify a hepatologist as a specialist in gastroenterology, which is a specialty here, but restrict his practice to hepatology. Hepatology is a sub-specialty of gastroenterology. I think it deals with liver diseases. This will help safeguard public interest and safety.

Registering family physicians

Fourth, we propose to set up a register of Family Physicians. With an

ageing population and the rising prevalence of complex chronic illnesses, there is a need to have more well-trained family physicians to serve the healthcare needs of Singaporeans in the community. Every Singaporean should have a trusted Family Physician. If you do not have one, better look for one now. The Family Physician will be a valued physician who will coordinate care for the patient and his family competently and cost effectively. Clause 23 of the Bill will establish the Family Physicians Accreditation Board to accredit such practitioners and clause 13 provides for the Registration of Family Physicians with the SMC. This Register will list the names of Family Physicians who have undergone a recognised formal training programme in family medicine. The new Board and Register will further enhance the level of healthcare in the community and raise the standard of family medicine practice in Singapore. If Singaporeans receive good and affordable healthcare in the community, they can avoid unnecessary visits to acute hospitals and therefore save money.

Miscellaneous amendments

Finally, we are taking the opportunity to introduce a number of miscellaneous amendments to enable the SMC to operate more effectively and efficiently. They include:

clause 5 which allows the SMC to provide administrative services to other bodies (whether corporate or unincorporate) responsible for the regulation of healthcare professionals;

clause 18 which removes the requirement for the SMC to publish a list of doctors in the Gazette, as such information is now already and regularly updated on the Council's Internet website; and

clause 31 which allows the SMC to compound offences in lieu of prosecution.

Consequential amendments will also be made to the following Acts:

section 12 of the Private Hospitals and Medical Clinics Act (PHMCA) to widen its powers of investigation, and section 13 to allow authorised officers to disclose information obtained under the Act, if such disclosure is under or for the purpose of administering and enforcing the Medicines Act or the Health Products Act; and

section 14C of the Dental Registration Act and section 18 of the Pharmacists Registration Act to empower the Singapore Dental Council and Singapore Pharmacy Council to impose conditions and restrictions on specialist registration for dentists and pharmacists respectively.

Public consultations

Mr Speaker, Sir, the Second Reading of this Bill today follows months of consultation that involved the general public, doctors and key professional groups. MOH had engaged the SMC and key leaders of various professional bodies, including the College of Family Physicians, Singapore Medical Association and the Academy of Medicine. I would like to thank all who have contributed their views to help shape the Bill.

One proposed amendment has been the subject of much debate from a segment of the medical fraternity. It is the provision to allow the SMC to appoint legal professionals either as chairman or as a member of a Disciplinary Tribunal. Let me explain why such a change is not only necessary but will also add value to the current system.

Disciplinary inquiries increasingly involve complex issues that are legally and procedurally challenging. In almost every inquiry, both the Council and the defendant are represented by legal teams. Thus, Disciplinary Committees always require the presence of a Legal Assessor to assist in the proceedings. For high profile cases, doctors have been known to engage top lawyers, including Senior Counsels. Disciplinary Committees are increasingly saddled with legal arguments, technicalities or materials that unnecessarily lengthen proceedings. Consequently, the legal costs of conducting inquiries have risen considerably.

Senior lawyers appointed by the Medical Council as Legal Assessors are, by law, limited in their ability to direct the course of proceedings at the inquiry, to assess the weight of evidence, or to participate in the final decision of the Disciplinary Committee. The quality and pace of proceedings can be significantly improved by appointing appropriate chairpersons or members who will be legally empowered to control the proceedings and rein in prosecution and defence counsels.

Sir, let me emphasise that the presence of legally-trained persons in the Tribunal is not intended to replace the medical profession's self-regulation. The reality is that the SMC can no longer hold any disciplinary inquiry without significant legal assistance and no inquiry can be conducted without legal inputs and extensive legal preparation and costs. No Disciplinary Committee wishes to risk submitting legal errors or judgements that can be subjected to challenges in a court of law. Even in the course of such extensive legal consultations, there have been cases in the past where the High Court had taken prosecuting lawyers or Disciplinary Committees to task for errors arising from failure to appreciate and comply with legal principles. Such situations may be reduced or avoided by

allowing senior legal professionals to sit in the Tribunals where it is deemed expedient by the SMC.

From the public consultations and discussions in the media and with the professional community, we believe that the changes will help to augment the processes and improve public confidence. As the provision was of great interest to the medical community, my Director of Medical Services (DMS) wrote to all the 8,000 registered doctors in Singapore, to explain fully the purpose of the provision and to seek their individual views. We assure our doctors that the decision to appoint a legal professional as chairman or a member of the Disciplinary Tribunal remains in the hands of the SMC – which is a body entirely made up of senior doctors. In any verdict passed, the influence of a legal professional will only come into being when the doctors on the Tribunal have different votes. Furthermore, only very senior and eminent legal professionals such as a former Supreme Court Judge or Judicial Commissioner, senior lawyers, or senior legal officers can be appointed to chair the Disciplinary Tribunal. After his explanation, the vast majority of the medical community have no objection to the provision.

Mr Speaker, Sir, the standard of clinical and ethical practice of our doctors in Singapore is high. I believe Singaporeans are proud of our healthcare services. In addition, a large number of international patients come here annually to seek treatment, which is further evidence of their trust in our medical services. Our job is to maintain the high standard that our patients expect and make sure that professional medical regulation keeps up with continuing changes in the environment.

I seek the Members' support for this Bill as we forge ahead in providing medical regulation that protects the interest of the general public and also the

reputation of our good medical professionals.

Sir, I beg to move.

Question proposed.

Order. I propose to take the break now. I suspend the Sitting and will take the Chair again at 4.25 pm.

Sitting accordingly suspended at 4.05 pm until 4.25 pm.

Sitting resumed at 4.25 pm

Debate resumed.

Mr Deputy Speaker, Sir, thank you for giving me this opportunity to speak on the Medical Registration (Amendment) Bill. First and foremost, I would like to declare my interest as a practising medical professional.

The Medical Registration Act (MRA) governs the registration of medical practitioners and regulates the conduct and ethics of doctors. It was last amended in 2003. It is therefore apt to amend the MRA to keep abreast the rapid changes in the medical profession.

There is a rising trend in the number of complaints and claims against medical practitioners. This rising trend is a reflection of two major contributing factors.

Firstly, the practice of medicine is becoming increasingly more sophisticated and complex. The advent of new medical technologies, surgical techniques, pharmaceuticals and emerging diseases has

resulted in more treatment options for many medical illnesses. Many diseases that may have been deemed untreatable in the past can now be treated, albeit with more new modalities that can carry with it potential adverse effects and inherent risks. In addition, with more doctors and more procedures being performed, many of which are technically more difficult, the number of complications will inevitably increase.

A good analogy that could be drawn is the rising number of road traffic accidents in recent years compared to 20 to 30 years ago where the number of road users and vehicles was much fewer. More cars, higher performance vehicles and higher speed limits on our highways all contribute to the rising trend. However, this does not mean that the drivers today are worse off in terms of their driving skills compared to those of yesteryears. Similarly, one should not conclude that doctors today are more reckless or less capable compared to the past.

Secondly, patients are also more educated and better informed these days. Many would have read all about their medical illnesses and treatment options through the Internet even before stepping into the consultation room. As a result, patients demand and expect more from their doctors and any deviation from the expected ideal can be perceived as unacceptable or worse – negligence. Gone are the days when doctors' words were taken as the "gospel truth" and their medical advice as "orders". Patients nowadays will demand the treatment they want to receive and would have no qualms questioning the doctors' treatment plans.

I believe, and I hope I am right, that we have not deteriorated to the extent of being highly litigious, whereby doctors

practise defensive medicine to protect their own interest rather than the interest of patients. Undoubtedly the cost of healthcare will escalate if we do go the way of the western countries. The practice of good medicine is a combination of both science and art. Doctors must exercise proper clinical acumen and professional judgment when treating patients as each patient is unique. There is no "one size fits all" in medicine. The doctor-patient relationship is also critical and proper communication and trusts are keys to minimising misunderstanding and unhappiness which can lead to potential legal actions.

Unfortunately and coincidentally, there have been a few high profile cases of medical negligence reported in the media of late. It has also been highlighted by the Minister that as a result of the limited capacity of SMC in processing complaint cases, certain complex cases actually took more than five years to conclude. As a consequence of this delay, complainants could be deprived of the option to initiate civil proceedings against the doctor. I am glad to know that one of the provisions of the amendment to the MRA is to address this shortcoming.

Sir, I would like to touch on three key areas in the Amendment Bill, namely, the Singapore Medical Council's disciplinary processes, the financial penalty and the new Family Physician register.

Under the current system, complaints of professional misconduct against any medical practitioners are handled by the Singapore Medical Council (SMC) which comprises entirely of medical doctors. When a complaint is lodged, the Chairman of the Complaints Panel will appoint a Complaints Committee comprising three doctors and a lay person, who will then be tasked to investigate the complaint and debate if a formal inquiry is necessary.

The Disciplinary Committee (which this Amendment Bill proposes to rename

"Tribunal"), comprises of three doctors (two of whom must be Council members), and a non-voting fourth lay person. The Disciplinary Committee must be chaired by a member of the Medical Council.

Clause 26 repeals and re-enacts Part VII of the Act, with the changes to facilitate a more expeditious management of complaints by the SMC. These changes include the new section 38 and section 40 which enlarges the pool of the Complaints Panel and decreases the number of members in the Complaints Committee respectively. However, one of my concerns would be the availability of training to ensure that the appointed members of the Complaints Panel will be equipped with the appropriate knowledge to act effectively in their various roles. I would therefore like to ask the Minister what sort of training do the Disciplinary Committee chairpersons and members receive currently and if this training would be refined further in light of the latest amendments.

Under the proposed amendments in the new section 50, the new Disciplinary Tribunal could be chaired by a senior doctor, or the Medical Council could exercise its discretion to appoint a senior lawyer, legal officer or retired judge for certain cases, in which case the Disciplinary Tribunal (DT) need not have lay person. This proposed change has led to a significant amount of unease and apprehension in the medical fraternity as the provision to allow the appointment of a lawyer to chair a medical Disciplinary Tribunal may send the wrong signal to the public that the medical profession lacks the integrity and ability to self-regulate.

As highlighted by the Singapore Medical Association President in the Straits Times Forum page on 24th June 2009, one of the main concerns of having a lawyer to chair the DT is that "it may bring about the legal-ethics convergence,

leading to a more legalistic SMC and a deterioration of ethics." The Minister has also mentioned in his speech that disciplinary inquiries increasingly involve complex issues that are legally and procedurally challenging and that in high profile cases, doctors have been known to engage top lawyers. However, the definition of "complex" is subjective and can be ambiguous.

There are possibly three sources of complexity in any disciplinary case – it can be scientifically complex, in which a doctor is better than a lawyer to chair the DT; or if it is ethically complex, then a doctor will be no worse than a lawyer or could even be more appropriate. In fact, a senior medical chairperson who has trodden the marathon of doctoring would have a deeper understanding of the nuances of a complex medical case in question. But if it is legally complex, then maybe such cases should be referred by SMC to the Courts, where it can be dealt with more fittingly.

Whilst appointing a lawyer in the DT can be argued to increase the transparency of the disciplinary processes, it may be perceived as SMC lacking the moral courage and legitimacy to discipline high profile complex cases. As it is, the Disciplinary Committees already have lawyers as legal assessors, and also lay people sitting in ensuring transparency, the SMC can have the option of appointing more than one lawyer to observe the proceedings. Getting a lawyer to chair the Disciplinary Tribunal can be counterproductive as it may give the negative impression that SMC is arrogating responsibility.

In a landmark case in which Singapore's ex-Chief Justice stated in his judgment:

"We often enough tell doctors not to play god; it seems only fair that, similarly, judges and lawyers should not play at being doctors. A judge, unschooled and unskilled in the art of

medicine, has no business adjudicating matters over which medical experts themselves cannot come to agreement."

I understand the intent of the new proposal is to ensure fair outcomes for the public, the complainant and the doctor, and engenders greater general public trust in the profession. The inclusion of non-medical practitioners such as senior lawyers as chairmen in such tribunals is not unusual. It is practised in New Zealand and Victoria in Australia, Canada and Britain. However, before we undertake to go in that direction, it is also important to understand the background and rationale for the inclusion in these countries.

In addition, the Law Society has decided to do away with appointing layman in their Disciplinary Tribunal (DT). If the Law Society is going in the opposite direction, how is it that the medical profession is regressing and arrogating responsibility?

The new section 55 dealing with Appeals against orders by the DT allows SMC or an aggrieved complainant to appeal to the High Court against the decisions of the DT. The current system only allows doctors unhappy with the disciplinary decision against them to appeal. This is reasonable as the complainant must be extended the same privilege that is accorded to the doctor who is being complained against. However, section 55(2) states that this appeal to the High Court will be conducted by the SMC on behalf of the complainant. If the DT was appointed by the SMC in the first instance, would not this be seen as a "double whammy" where the doctor is being persecuted twice by the SMC? Will it also lead to a situation where almost every dissatisfied complainant will, by default, file an appeal

without giving due consideration. I hope the Minister can elaborate on this.

Mr Deputy Speaker, Sir, most professions rightly cherish the concept and privilege of self-regulation. This ideal is upheld if those who err are made accountable in the requisite measure and the quickest time. The proposed amendment to the MRA might suggest to some that it is not possible to find respectable, impartial, effective and legally well-advised senior medical doctors to chair a SMC DT.

Sir, this debate is not about doctors protecting doctors. Neither is it about doctors refusing to countenance judicially controlled disciplining of the profession. It is about the principle and the spirit of self-regulation. The entire rationale of the existence of the SMC is to have a self-regulatory body, and that having non-doctors as the Chairman of the DT completely defeats this purpose. Hence, I hope that the Minister can clarify the impetus and rationale for this change.

The new section 53 allows the Disciplinary Tribunal to impose a fine of up to $100,000, which is a ten-fold increase from the previous amount of $10,000. Many medical practitioners have expressed that this steep increase is alarming. I hope the Minister can also elaborate on the reasons for the need to raise it by so much.

The proposal to set up a register of family physicians is indeed welcome as it serves to raise the overall standard of family medicine practice. Family physicians play an important role in the provision of healthcare to the general public. Family physicians deliver over 80% of the primary healthcare in Singapore and will play a pivotal function in the delivery of quality primary healthcare in the face of the changing landscape of a greying population.

The newly established Family Physicians Accreditation Board will determine the qualifications, experience and other conditions for registration as a family physician under this Act. However, will existing family physicians be automatically included in this register? Or do they have to go through an arduous accreditation process, over and above the experience they have accumulated over the years of practice? I hope the Minister can clarify this.

Mr Deputy Speaker, Sir, in moving the Amendment to the Medical Registration Act, it is important that the Ministry gives an unequivocal signal to the greater public that there is really nothing seriously wrong with the medical profession here in Singapore. This amendment comes amidst many adverse media reports of medical glitches and, instinctively, Singaporeans may have the wrong perception that the state of medical malpractice may have reached an epidemic level, warranting harsher measures to be introduced. In the practice of medicine, the patient's confidence and ultimate trust in the doctor is vital. Hence, if the integrity of the medical profession is placed in doubt, good medical services can never be delivered as doctors may put up a self-protective shield by practising defensive medicine.

On that note, I support the Bill.

4.39 pm

Mr Deputy Speaker, Sir, thank you for allowing me to join in this debate. Singapore's health system was ranked sixth best in the world by the World Health Organization in 2000. This is a remarkable testimony to our medical professionals. However, no health system is perfect, and we must constantly look for ways to improve. The Medical Registration (Amendment) Bill seeks to further strengthen our healthcare system, particularly in relation to medical practitioners.

One amendment has been hotly debated. This is the new section 50 that allows the SMC to appoint legal professionals either as chairman or member (with voting rights) of a Disciplinary Tribunal (DT). I understand that, initially, 96% of 800 doctors polled by the Singapore Medical Association (SMA) voiced their objections. In contrast, a smaller public survey conducted by the Health Ministry found that 59 out of 78 people are in favour of the change. A concern among doctors relates to the possibility that, as Chairman, the legal professional will have more influence over the conduct of the proceedings.

However, I understand that this concern has been dealt with in the Bill, under the new section 50. Where the Chairman is a medical practitioner, he will have a casting vote. Where the Chairman is not a medical practitioner, the issue will be decided by a majority of votes from the tribunal members who are medical practitioners. So it seems that that concern has been addressed. There is a perception among some members of the public that doctors side with fellow practitioners in disciplinary matters. Allowing a non-medical professional to chair certain disciplinary proceedings will help dispel this notion. The public would have greater trust in the medical profession if disciplinary proceedings are perceived to be fair and impartial.

Nonetheless, will the Minister be able to assure us that there will be measures in place to ensure that allowing lawyers on Disciplinary Tribunals will not result in the proceedings becoming overly legalistic, which may inadvertently shift the focus from what is medically professional or ethical to what is strictly legal. Therefore, will the Minister assure us that high medical professionalism will continue to be the guiding beacon for the Disciplinary Tribunals?

I understand that doctors may also object to a legal professional being appointed as a member or chairman of a DT on the grounds that the industry should be self-regulating. However, I believe that there is also a strong argument that the good of the patient and the public should also be a primary consideration. In cases where a legal professional can make valuable contribution as chair or member of a tribunal, he or she should be brought in. I would like to touch on a point that my hon. fellow Member raised. Dr Lam said that the Law Society had moved on by not including a lay person in the panel and why does the Singapore Medical Council regress by having a lawyer on board, which is in contrast to what the Law Society is doing? I would like to point out that lawyers often call on doctors as expert witnesses in court and they see that there is an importance for the synergy between legal understanding and jurisprudence and what goes on in an operation theatre or how a patient is treated. The lawyers themselves have realised the importance of that synergy and I think that can also be transposed into disciplinary proceedings tribunals.

Finally, I would like to state my support for the new approach to registration of doctors under clause 22. This would allow persons who have the experience and meet the conditions to be registered as specialists. This will help expand our pool of medical talent and benefit the community.

So, I join Dr Lam in supporting this Bill.

4.44 pm

Mr Deputy Speaker, Sir, I rise in support of the Medical Registration (Amendment) Bill. Under the amendments, the law is now very clear. Its aim is to protect the health

and safety of the public through mechanisms that ensure that doctors are competent, uphold the highest standards and maintain public confidence. As the practice of medicine becomes more complex, not only with the evolution of new diseases but also because of the rapid advancements in technology and the practice of medicine, the public needs a more effective protection regime. Although all doctors have vowed to uphold the Hippocratic Oath, the fact remains that increasingly medical services are also treated as commodities and, with some doctors, commercial decisions may override other considerations.

There is no doubt, Sir, that many in the medical profession uphold the highest standards of professionalism and have the patients’ interests at heart. Such doctors have nothing to fear with the changes as they are not likely to have the Act invoked against them. The changes are meant to check the small number of errant doctors who because of incompetence, neglect or crass commercialism, compromise their patients' interests. The changes will help to instil greater confidence and comfort among the public and is beneficial to the profession as a whole. We must never forget, Sir, that the doctor-patient relationship is very different from other transactions simply because patients rely very heavily on their doctors’ advice, judgment and expertise, more so than in any other profession and the damage is also greater as any neglect or misconduct results not just in financial loss but, more importantly, harm to the health and lives of patients.

Sir, some doctors are concerned that the amendments would go against the principle of self-regulation, since non-doctors will be allowed to sit in the Disciplinary Tribunals and also to chair the Disciplinary Tribunals. In my view, Sir, self-regulation cannot exist as an ideal in isolation of the basic purpose for which it was allowed in the first place, which is, to

protect and promote public interest. In other words, we cannot preserve self-regulation at all cost for the sake of self-regulation alone. If some tweaking is needed in the public interest, then it should be done.

Indeed, Sir, if self-regulation had worked so well, we may not need any law at all. But we all know that the reality is otherwise. In any event, the amendments had taken into account doctors’ concerns, as the appointment of any legally qualified person, whether as Chairman or a committee member, is at the discretion of the SMC. This, to me, Sir, is a major concession. We have to bear in mind that the appointment of non-doctors to head disciplinary committees is not new and is already found in other countries such as Britain, Australia and the US.

Sir, I agree with the Minister that the current situation is indeed unsatisfactory as there are long delays and this does not serve public interest when their claims cannot be pursued in the civil court because they have exceeded the limitation period. Hence, the various provisions aimed at expediting the disciplinary process are greatly welcomed. In cases where due to incompetence or neglect, a death or other serious mishap had occurred, the patient or aggrieved family members had already suffered a great deal and the interest of justice is certainly not served by delays which add to their anxiety, strain and loss.

Sir, whilst I applaud the Ministry for the progressive amendments designed to better protect public interest, I feel that there are several areas which were not addressed which could have helped us develop a more robust disciplinary regime.

One area that can be improved is the need for greater transparency in the SMC’s proceedings. As the disciplinary proceedings conducted by the SMC is behind closed doors, the public is not aware of the reasons or basis for the

SMC’s decisions. This is particularly important if their complaint is rejected and they are not told the reasons. It is in the interest of both the doctor and the patient to share the reasons so that there is no doubt or ambiguity that full consideration has been given to the complaint and all the pertinent factors. If a complaint is dismissed, for example, and reasons are given, then it would not lead to the kind of damaging speculation that we sometimes hear on whether the SMC is trying to protect its own kind.

Sir, making public the reasons for the disciplinary actions against professionals is not new. There are already precedents. Singapore’s Legal Profession Act requires a copy of the entire record of the proceedings of the Disciplinary Tribunal, including its findings and outcome, to be made public. This means that the reasons for disciplinary actions against lawyers are open to public scrutiny. In Britain, their Fitness to Practices Panel, the disciplinary arm of their General Medical Council, publishes its findings against doctors. If patient confidentiality is the concern, surely the SMC can find ways to address this, such as by keeping out sensitive patient information details.

The current SMC practice of publishing investigation outcomes only through press statements is very limited and does not give a clear picture of the reasons for the decisions taken. This is one area that I hope the Minister can review as justice must not only be done but must also be seen to be done.

Sir, the second concern that has widely surfaced is over the penalties imposed by the SMC. In the most recent case, a General Practitioner (GP) who pretended to be a plastic surgeon, not once but twice, was merely censured and fined $10,000. For his first offence, he was suspended for six months. In another case, a doctor who failed to conduct a Hepatitis B test on a patient before

starting him on cancer treatment, which is a routine test, thus causing the patient’s death, was merely suspended for three months. Coupled with the fact that detailed explanations are not given, the public is left with the impression that the penalties are not commensurate with the gravity of the offence. This concern could be addressed if there is a transparent set of guidelines on penalties and this will certainly instil greater public confidence. I urge the Minister to seriously consider providing a penalty guide for the various offences. The current practice of imposing penalties based on precedents can be arbitrary and is unsatisfactory. If it is not MOH issuing the guidelines, at least it is SMC that should consider issuing the guidelines.

The third area that we need to focus on is greater patient empowerment so that they could make more informed decisions when choosing doctors to treat them. Currently, other than medical qualifications and areas of specialties, patients may not know much about the doctor that they want to consult or are consulting. For instance, is there a list that a member of the public can refer to on doctors who have been subject to disciplinary action so that they can make informed decisions on whether or not to seek their services? Take the recent case of the GP who pretended to be a plastic surgeon – could this have been avoided if his patients were able to check on a list which indicates that he was disciplined before for the same offence? Also, now that the range of orders which the SMC can make has been expanded under sections 37A and 49, to include a doctor voluntarily removing his name or agreeing to the imposition of conditions or restrictions on his practice because of performance difficulties, how would the public know and is it not important for the public to know this? Or if a doctor has been subject to periodically report on the

status of his fitness to practise, should the public also not know about this?

Finally, as I understand it, most of the cases brought before the SMC are referred to it by the authorities, particularly the Ministry of Health, and not by private individuals or patients. Could the Minister confirm whether this is indeed true and what are the reasons for this? Could one reason be because the public is not aware of the complaint procedure or is the complaint procedure too difficult or has the public become frustrated because of the long delays in hearing their cases? Who in Singapore is responsible for educating patients on their rights to seek redress? How user-friendly is the current system? What about patients who are not well educated or cannot understand English well, what measures are in place to assist them as the process of filing a complaint can be quite daunting? Are we satisfied that the mere 96 complaints filed with the SMC in 2009 is an accurate reflection of the state of satisfaction with our doctors, considering that the number of doctors and patients have increased substantially? While we may not be thinking of a Charter of Rights for patients that exists in some countries and we may not even be ready for it, I think that there is a greater scope to educate patients on their rights, particularly their right to seek redress for the pain, suffering and loss caused to them due to incompetence, neglect or abuse. This is also another area which I hope the Ministry as well as the SMC can play a bigger role.

Sir, two other amendments which I strongly support are the establishment of the register of family physicians and the monitoring and supervision of foreign doctors practising here. There have been concerns expressed whether the Ministry has been too liberal in admitting foreign doctors and so these new amendments are helpful. But apart from the professional competence, there is also a need

to ensure the foreign doctors also understand the diversity in languages and cultures that are prevalent in Singapore and that they are able to communicate effectively with patients, particularly in the public hospitals, as this is important in ensuring effective treatments. I hope that the Ministry would also look at such softer skills in the training of our foreign doctors.

Finally, in conclusion, Sir, the amendments are indeed very progressive and will help to enhance public safety and confidence in our medical profession, and I think it would also help the doctors themselves.

I support the amendments, Sir.

Mr Deputy Speaker, I rise in support of the Medical Registration (Amendment) Bill and I thank the Minister for his elaborate explanation of the purpose of this Bill.

I feel that this Bill is timely. As I had shared previously, mental illness and impairment affect anyone regardless of race, profession or status and appear to be on the increase. Therefore, it is good to see this Bill introducing new changes to ensure that registered medical practitioners are competent and fit to practise medicine and also to uphold the high standards of practice and reinforce public confidence in the medical profession, not only locally but also internationally.

I am particularly drawn by the new section 37A which proposes to allow a practitioner who realises that his performance may be impaired for whatever reason so as to make him unfit to continue in practice to voluntarily apply to the SMC to remove his name from the register, or to suspend him or to impose conditions or restrictions to his practice. As this is a voluntary action, it does require the medical practitioner concerned to be honest and honourable and to

possess an extremely high level of moral courage and self-discipline to ensure that he puts the well-being of his patients in priority to his, that he will not jeopardise his patients’ life and well-being especially if he finds himself unable to treat his patients effectively due to his own physical or mental health or other hindrances. I sincerely believe that this provision seeks to provide the hallmark of a truly honourable physician. The courage to admit his inability to cure for whatever reason is heroic and commendable. In the interest of patients who have placed much trust in their doctors and physicians to save their lives, I hope to see this provision being widely practised for the benefit of not only the patients but also of the profession.

As a follow through of this, I would like to urge the Minister to consider allowing greater transparency to evolve and contemporaneously update the public in the MOH’s website the names of doctors censured or subject to disciplinary proceedings as well as those who are deemed unfit or have applied to limit their practice ambit due to physical or mental unfitness.

On a separate note, I would like to request the Minister to clarify my concerns on a recent article that I came across sometime in July last year. It was mentioned in the local newspapers that a survey was conducted in the wake of the conviction two years ago of a trainee doctor from the Tan Tock Seng Hospital who had tried to film a female colleague in the shower. Among the questions asked in the survey was whether he should be allowed to practise as a doctor. Fewer than half of the NUS-trained doctors said he should not be allowed to practise, compared to 71% of their foreign-trained counterparts. Furthermore, seven of the doctors trained locally found his actions pardonable. From the survey, it appeared that the Singapore-trained doctors were more unwilling to have their

colleagues disciplined or struck off the register even if they have a criminal record. Nor are they likely to tell on the colleagues who are tardy or abrasive. In short, they are said to be more lenient on colleagues who fall short on ethics compared to those who are trained in medical schools abroad.

In comparison, the survey pointed out that doctors trained in Australia, Canada, Malaysia, New Zealand and Britain were well taught, and I quote, "well taught and fully understood what constitutes 'medical professionalism'." It is sad to read that Singapore-trained doctors were thus said to lack professionalism and at times labelled as being tardy or abrasive when treating patients.

I would like to ask the Minister what are the current measures used in assessing the professional standards, ethics and service quality amongst our locally trained doctors. What have been done to place greater emphasis on training doctors on professionalism and communication? Moving forward, what is the system in place where newly trained doctors can receive ample learning opportunities especially in exemplifying professionalism, service and care?

Sir, with that, I support the Bill.

Thank you, Mr Deputy Speaker, for this opportunity to share my views on this important Bill.

This is a comprehensive Bill that covers a wide range of issues central to the professional management of medical services. Of key significance is the aim to foster greater public trust in the disciplinary process within the medical profession.

The main bulk of this very long Bill focuses specifically on this aspect. Details

on Disciplinary Proceedings, Health Committee Inquiries and Performance Assessments are spelt out in clause 26,

which spans from pages 16-52 and revamps the entire Part VII of the original Act. I applaud the Ministry of Health and the Medical Fraternity for amendments set out in this Bill.

In a climate where litigation is increasingly the first option for the aggrieved and where the increased incidence of medical malpractice lawsuits will result in escalating healthcare costs, a move to uphold high standards of professional conduct through enhanced self-regulation by the Medical Fraternity reflects social responsibility on the part of our physicians. As I stand in support of this Bill, I would like to seek the Minister’s elaboration of the some of the details involved. There are four aspects which I have queries on.

The first deals with transparency of the disciplinary review process and my concerns resonate with that expressed by Mdm Halimah. In his letter to the Medical Fraternity published in the SMA News (dated 13th July 2009), Director of Medical Services, Prof. K Satku wrote, and I quote:

"Self-regulation in a profession is intended primarily for the benefit of the public. In assessing whether the proposed amendment is appropriate, it is therefore pertinent to seriously consider if the proposed change ensures fair outcomes for the public, the complainant and the doctor, and engenders greater public trust in the profession."

For the lay community to appreciate and accept the internal review outcomes of the Complaints Committee and the Disciplinary Tribunal, we must first be able to follow the processes involved and observe the procedural steps which lead to the final outcomes. Sections 47 and 48

uphold the confidentiality of information obtained during the investigation. Sections 49 and 53 lay out the procedures to be taken at the completion of the investigation of the Complaints Committee and Disciplinary Tribunal, and detailed actions involving the medical practitioner in question. As the focus of the Bill is on self-policing, there is little attention paid to how information should be disseminated to the lay complainant.

While I applaud the inclusion of sections 49(11) and 55(2) which facilitate an appeals process for the complainant, I also note the feedback on this Bill from the Law Society of Singapore where Mr Kenneth Goh, Director of Representation and Law Reform, commented on the difficulties a complainant would face in filing an appeal. For the complainant to make an informed decision on whether or not he should exercise this option of appeal, he must first have access to the evidence on which the Disciplinary Tribunal’s decision was based. For the general public following the proceedings, it is equally important that there is sufficient information made available to allow for a fair assessment of how the judgment was influenced. Only when the processes invoked are understood and appreciated by the public, will self-regulation result in the promotion of trust in the medical profession.

May I ask the Minister to share with us the details on how information gathered during the investigation and the rationale for the outcomes arrived at, by the Complaints Committee and the Disciplinary Tribunal, will be shared with the complainant as well as the general public following the proceedings? Additionally, will there be mechanisms which will allow for queries or feedback on the proceedings by the lay community? I strongly believe that an informed lay community will be more likely to partner the medical profession in a constructive

manner that will promote a more efficient and effective healthcare delivery system.

My second query is on the nature of complaints which should be referred to the Medical Council for possible action by the Complaints Committee and Disciplinary Tribunal. Section 39(1)(a) to (d) outlines the complaints that can be considered. But the descriptives invoked are broad and vague. For example, section 39(1)(c) notes an eligible grouse as a "complaint that the professional services provided by a registered medical practitioner are not of the quality which is reasonable to expect of him".

Can the Minister elaborate on what "professional services" would cover? In many instances, expectations from patients may vary from the standard medical practice that is accepted by the medical profession. Whose expectations will be taken into consideration? With this broader definition of what is acceptable cause for raising concerns, does the Minister expect that the number of complaints should rise? And if so, will the Singapore Medical Council (SMC) be able to manage the increased caseload and revert on each case within a reasonable timeline? Relating to this is the statute of limitation for personal injuries, which currently stands at three years. As we expect most aggrieved complainants who are seeking redress to first lodge their complaints with the Medical Council, will the Singapore Medical Council (SMC) be able to complete its investigations within the three-year period, so that complainants who may wish to pursue a civil lawsuit can rely on the outcome of the Disciplinary Tribunal's decision to make an informed decision on what they should proceed with?

My third concern relates to the investigators that can be appointed by the Complaints Committee. On page 52 of the Bill, section 60A details how the investigator will be empowered to carry out his duties. The investigator, if you

read that section carefully, is a very powerful agent and he has fairly extensive authority. Can the Minister please comment on the qualifications investigators are expected to hold, given their significant role in the self-regulation process?

My fourth and final concern is on interim orders. Section 59B outlines the process which allows the immediate suspension of a physician if the Interim Orders Committee feels that it will benefit public interest. This is while investigations are still ongoing. While this may be reassuring to the public when it concerns a rogue doctor, may I ask the Minister what processes are in place to protect the innocent doctor?

My fellow Members had commented on the merits of publishing a list of errant doctors – I am not sure if I agree with this because in the spirit of encouraging self-discipline within the profession, I think that for a compassionate society, we should give doctors who have made serious errors or mistakes a chance to redeem themselves. So, therefore, publishing this list would pretty much limit their chances of redeeming that professional etiquette.

With these comments, I stand in support of the Bill.

5.08 pm

Mr Deputy Speaker, Sir, thank you for allowing me to join this debate.

I understand that it has been some years since the Medical Registration Act was last amended and since then, there have certainly been new developments in the medical profession and practice. I am in support of the Bill’s broad aims which take into account new needs and

developments in the sector, while maintaining the necessity of self-regulation by the medical profession and the importance of upholding the very highest standards of treatment, care and, last but not least, ethics.

The proposed amendments certainly appear to be aimed at developing more rigour in the Medical Council’s self-regulatory mechanisms and are also broadening aspects of the Council’s powers and scope to take into account the more complex issues in medical practice today. It also takes into account the increasing number of complaints and a better-read public with more access to information about medicine.

Among the changes, I welcome the formation of a Register of Family Physicians. This field of medicine which provides comprehensive health care for the person and the family covering the biological, clinical, and behavioural aspects of medicine for all ages, from children to the elderly, is likely to be more important for our society which is aging rapidly and where people are more susceptible to stress-related, mental as well as physical ailments at different stages of their lives. We have a College of Family Physicians founded in 1971 and a Register of Family Physicians recognises this branch of medicine and will encourage a high standard of practice.

When the proposed amendments to the Medical Registration Act were put out for public consultation in early 2009, there was understandably much interest and concern. Healthcare and housing issues probably draw the most emotional responses from Singaporeans as they affect all of us at some point in our lives. It is emotionally draining and heartbreaking to fall severely ill, or to care for a loved one who is sick, or to watch someone you love suffering. Added to this emotional aspect of the issue of regulating medical practice is the rising number of

complaints handled by the Singapore Medical Council (SMC) in the last three years. According to a New Paper report in 2009, there were 81 cases in 2006, 115 in 2007 and 138 in 2008. There has also been an increase in the number of claims for compensation being filed by patients against doctors. According to a Straits Times report, also last year, the claims rate is going up by about 10% a year.

Singaporeans are definitely becoming more demanding patients; they do not only desire the best clinical care, they also demand good service and customer care from doctors and hospitals. And this has put more pressure on the modern-day doctor. With many diseases and their treatments being complicated, there is always a risk of patients and doctors ending up in situations of misunderstanding.

There is also the growing practice of aesthetic medicine, where patient satisfaction is not based solely on the doctor prescribing the right treatment for a clinical condition. The recent tightening of rules for aesthetic medical practice is certainly welcome; however, people will always be enticed by promises of procedures that will enhance their physical appearance and, hence, the chances of things going wrong or the patient being unhappy with the results would be higher as more people go for such treatments. And the trend of more Singaporeans, especially younger Singaporeans going for aesthetic treatments, perhaps is worrying, but that is a debate for another time.

We cannot completely eradicate mistakes as no one is infallible. But we do not want to end up with a scenario where doctors are constantly on the defensive for fear of lawsuits. High-profile cases featured in the media where patients have successfully brought a complaint against doctors, may have dented the image of the medical profession somewhat. But

despite these cases, as a society, we must commit to the value of self-regulation in the medical profession, and empower the Medical Council with the means to uphold the highest standards of practice and ethics. In such a specialised field as medicine, it is impossible to expect the layman to make the right judgment call when it comes to questions of diagnosis and treatment. There is a history of practice and experience in the medical profession which doctors call on, not only in treating patients but also in hearing complaints brought against fellow members. A highly-ethical, socially responsible, self-regulatory body is crucial for the future of the medical profession and the quality of healthcare for all. To put the responsibility of monitoring and, if necessary, trial and punishment, at the hands of doctors while the public could sometimes question the transparency of the processes – it actually demands that doctors practise medicine with a commitment to proper treatment of patients, justice and concern for the community. Self-regulation asks that doctors demand the same kind of commitment from their peers and colleagues. And this commitment can only benefit society. For instance, let us not forget that doctors often waive or lower fees for patients who simply cannot afford proper medical treatment; on the other hand, a wrong diagnosis or mistake has an impact on the community as it undermines public confidence in the profession and system. But having said that, I am sure that no doctor is wilfully negligent.

In the spirit of encouraging the highest standards of self-regulation and evaluation by the profession, I applaud the provision for voluntary suspension or removal from the Register of Medical Practitioners, where a registered medical practitioner who feels he is unfit to practise by reason of a physical or mental condition, or due

to his inability to deliver medical services at the required standard, can actually apply for voluntary suspension, removal or other measures. I have two queries with respect to the provisions in the Bill on disciplinary proceedings. But before I ask for the clarification, I would like to also bring up some concerns with regard to the disciplinary hearings.

One of the public’s concerns is about doctors hearing complaints against their peers and the concerns about the transparency of these processes. The public is understandably concerned that doctors might want to protect and defend their own, and that therefore their complaints may not be given a fair hearing and that is an easy conclusion to jump to, given that the professional community is quite small and doctors are often acquainted with one another. However, we have to balance this concern against the need to have knowledgeable and experienced adjudicators who know how to examine and assess medical and scientific evidence.

One way to have a balance is to demand transparency and rigour in all inquiries, and I believe that even the existing Bill has provision for this: for instance, the requirement that non-medical practitioners are also appointed to the Disciplinary Tribunal and Complaint Committees. In the new Bill, the provision for aggrieved parties, whether the complaint or the person who is complained against, to appeal to the High Court is another safeguard, even though that might take another complicated legal route. The other concern from the medical fraternity as well as the public is the backlog of complaints. I understand that one of the reasons for the changes in disciplinary proceedings is to speed up the complaints process and facilitate them more efficiently. But I would like to ask for clarifications on a couple of points.

One of the changes is in section 39(3) where the Medical Council will no longer have to send to the Complaints Panel matters that are related to a complaint about professional services provided by a medical practitioner or to issues on the physical or mental fitness of a medical practitioner to practise. Instead, the Council can simply notify the medical practitioner involved and proceed to take action such as removing his name from the register or suspending him. This might be a response to the number of complaints that are related to such things like advertising by doctors, but this change might also backfire I feel, as the public may perceive it to be a less transparent way of dealing with complaints – even if the inquiry process is rigorous. Also in this section, the use of the term "professional services" is vague, and I wonder if it might be more fruitful to have a clearer definition and why the Ministry of Health has opted to use this term.

The proposed change that has drawn the most fire from the medical profession itself has already been mentioned by fellow Members, which is the provision for the appointment of a senior member of the legal profession to chair a Disciplinary Tribunal. I note that the proposed amendment, as it stands today in the new section 50, has been changed from the draft Bill initially presented for public consultation. In the Bill before us today, it is stated that a chairman who is not from the medical profession will not be allowed a casting vote; ultimately, it will still be medical practitioners making the ultimate judgment call. The concerns of the medical profession are valid and I believe it should not be dismissed out of hand. They have clearly stated their points of concern during the process of consultation and I do not need to rehash the same arguments. But just a couple of quick points. Most importantly, the medical profession is arguing a point of principle. They pointed out that having a

non-medical practitioner as Chair of a Disciplinary Tribunal defeats the purpose of the Singapore Medical Council being a self-regulatory body. They also noted that this is contrary to what is practised by other similar regulatory bodies in other professions such as the Law Society. And while acknowledging that some medical complaint cases involve some legal matters, and that doctors and complainants appear at disciplinary hearings with their own legal teams, the Singapore Medical Council also pointed out that a non-medically-trained person would not have the level of expertise to assess complex medical cases, especially those where even medical experts are divided in opinion.

Furthermore, the SMC already has legal counsel who I believe is present at the hearings and can advise on legal matters. In fact, with the legal ammunition that both doctors and complainants can bring to a tribunal hearing today, having a legal professional as Chair may not speed up the hearing and settlement process; it might be more drawn-out and more costly for all parties concerned. I hope that the Minister will address this concern.

Finally, I believe that despite new regulations, we are likely to see an increase in the number of complaints against doctors rather than a decrease. Singaporeans are more health conscious and seek more treatments today. We are also more aware of our rights as customers and, unfortunately, we can sometimes be a little too trigger-happy in hitting the complaint button. Having said that, patients are also entitled to be made aware of their options, should they wish to lodge a complaint. In the end, our public policy and legislation have to aim to maintain the medical profession’s high level of competence and strong ethical practices for it is that which sustains public confidence in the profession; and as I have already said, this is of

paramount importance in an ageing society where healthcare concerns will always be in the public spotlight. I welcome the Bill's expansion of the scope of the disciplinary measures and resolutions in cases of complaints, which allows the SMC to adopt a more calibrated approach that will enhance the rigour of its work. But, ultimately, legislation cannot be the only guarantee of good, proper medical practice; the medical profession has to continue to commit itself to the most exacting standards and be led by a core leadership with a deep understanding of medical ethics. I close by quoting from Dr T. Thirumoorthy’s letter published in the Singapore Medical Association's newsletter in June 2009: "Strong public policy and medical leadership that is prepared to establish and develop medical professionalism based on competence, ethics and altruism are still the best assurance to protect the interests of patients and doctors."

With that, I support the Bill.

Sir, it is indeed important for the public to have confidence in the standards and disciplinary processes of the medical profession. I wish to seek clarification on two points from the Minister. First, concerning Part VII on disciplinary proceedings; and second, the implications of the decision to recognise Duke NUS Graduate Medical School requirements on doctor training. Sir, the new Part VII makes some drastic changes to the disciplinary regime concerning doctors. Besides the Complaints Committee and the Disciplinary Tribunal, it introduces a intermediary core and investigator. Under the proposed section 42, any Complaints Committee who believes that a complaint against the doctor should be investigated further, must appoint an investigator to do so. Under section 44, it is the investigator who will now write to the doctor enclosing the complaint, and asking him if he has any written explanation to give.

Under section 48(2), the investigator must put up a final report to the Complaints Committee, which should include a recommendation on whether a formal enquiry by Disciplinary Tribunal should be convened. The investigator is thus earmarked for a very important and almost pivotal role in the disciplinary procedure at the complaint stage. He will be the one who interfaces with the doctor complained against, conducts the investigation and puts up the report on its findings to the Complaints Committee. He will also recommend to the Complaints Committee whether the doctor should face the second stage of appearing before the Disciplinary Tribunal, which decides whether the doctor should continue to practise. Given the importance of the task at hand, the investigator should be someone with suitable knowledge and experience to understand medical practice as well as patient interest. The proposed section 60(A) defines the investigator as being "a Member or employee of the Medical Council, any public officer or any person appointed by the Medical Council". Since the definition is very wide, it will be good for the Minister to elaborate on the likely persons to be called upon to fulfil this role. Will public officers from other Ministries, for example, become investigators? Will law enforcement investigators be called upon? Will the choice of investigator vary, depending on the nature of the complaint?

Second, Sir, the Bill proposes to recognise the degree conferred by Duke NUS Graduate Medical School as a Singapore degree. By doing so, I understand that Singapore would also be accepting the post qualification training requirements of Duke. While I note that Duke is well-known, there is local concern about its post qualifications training requirements, specifically the removal of the year of general housemanship and allowing graduates to choose their

specialisation immediately upon obtaining their medical degree. The one year of housemanship, with rotations among different fields of medicine, has been compulsory for medical graduates in Singapore for many years. Even for doctors who aspire to be specialists, housemanship was required to get an overview of the breadth of medical practice and knowledge of the realities of practising in the various fields. Patients here have had the assurance that their specialists generally have some clinical experience in other fields of medicine, which is useful in diagnosing health concerns which are often multifaceted. Will doing away with housemanship compromise on patient care by our specialists? How will fresh medical graduates be able to make an informed choice of specialisation if they had not had the taste of what each field involves? Will this chance lead to a drop in standards and in patients being short-changed?

Mr Deputy Speaker, Sir, thank you for allowing me to speak on this Bill. I rise in support of the amendments to this Bill.

I have three points to make regarding these amendments.

Firstly, the new section 38 – although the number of lay persons has been increased, the majority of the complaints panel will still be medical practitioners. Although I see the relevance of medical experience in assisting investigation and fact-finding in alleged offences by doctors, I question the need for doctors to retain a majority on the complaints panel. Although peer regulation remains an important tenet amongst professions, the credibility of the medical watchdog body may be increased if medical doctors do not form the majority of the complaints panel. I am not questioning the ability or integrity of medical practitioners to self-regulate; however I note that one of the

aims of these amendments is to increase the public confidence in the medical profession. For better or for worse, public confidence is often based on perception and it is my opinion that the perception of the neutrality and objectivity of the complaints panel would be increased if the majority of the medical complaints panel are not doctors. Moreover, the skills needed for investigation, fact-finding, adjudication and disciplinary judgment are quite separate from medical skills; a substantial number of years of medical experience may help in giving investigators background information of the alleged offences or in giving expert opinion, but are not directly applicable to legal fact-finding, adjudication and judgment which calls on a totally different set of skills and experience. I therefore urge the Minister to consider allowing non-medical practitioners, especially those with vast experience in disciplinary investigation and procedures, to form the majority of the complaints panel.

My second point is related to the first. I note that in section 50 (12), in the event of an equality of votes in the Disciplinary Tribunal, where the Chairman is a registered medical practitioner, the Chairman shall have a casting vote; or where the Chairman is not a registered medical practitioner, the question shall be determined by a majority of votes of the members of the Disciplinary Tribunal who are registered medical practitioners. If there is no such majority of votes, the question shall be resolved in favour of the registered medical practitioner under inquiry. For the same reasons I stated above, I wonder why this requirement is needed especially since I feel this will increase the chance that the public may perceive that medical practitioners are protecting their own. I would like to reiterate that although this may well not be reality, perception is important in the maintenance of public confidence, and unless there are overriding legal and technical reasons for doctors to maintain

their casting vote in the Disciplinary Tribunal, and I think there are not for the reasons I spelled out above, I urge the Minister to re-consider this subsection.

Finally, again in the interests of increasing public confidence, like my hon. colleague Mdm Halimah, I urge the Minister to consider making all proceedings and judgments fully transparent to the public. Closed-door adjudications may lead to less not more public confidence. Given the importance of the medical profession in society, it is my opinion that strengthening public confidence is of paramount importance. A complaints panel with a majority of non-medical practitioners, consisting of people with vast experience in procedural fact-finding, investigation and adjudication, as well as a process transparent to the public, will go a long way to ensure that members of the public will have full faith in all our doctors.

With that, Mr Deputy Speaker, Sir, I support the amendments to the Bill.

Mr Deputy Speaker, Sir, thank you very much for the opportunity to voice my opinion on this particular Bill. While I support the Minister's points on the Bill, I would like to voice some concerns mainly in two areas.

One of them is the proposed Residency Programme and the other one is the proposed Disciplinary Tribunal (DT) which has been debated so far in this House.

First, let me make some clarifications. My learned and hon. fellow Member of Parliament Mr Christopher de Souza brought up the point that sometimes a medical doctor may be invited by the legal fraternity to assist in legal proceedings. But that is as a medical expert. I have not heard of any medical doctors being requested by the legal professionals to help them in a disciplinary case against a lawyer within their own fraternity yet.

Second point I would like to highlight is that I disagree with our hon. Nominated Member of Parliament Mr Calvin Cheng who was pushing for the majority of the DT members to be non-doctors. That really goes against the spirit of self-regulation. At the end of the day, this is the Singapore Medical Council and I do fully support the concern that was brought up by the hon. Dr Lam Pin Min as well as some other Members that we have to protect self-regulation.

Let me just proceed with my speech on this particular debate. The training years of a doctor really constitute the most important part of their career. Essentially they lay the foundation for the grooming of an exemplary doctor so that he can be adequately equipped to go out and practise after having been exposed to good practices during this time. They are like your kindergarten and primary school years. In the UK-style residency programme or our training programme which has served Singapore very well in the past few decades, medical graduates rotate in different medical departments for a year in housemanship, after which they become medical officers for one to three years before deciding and being admitted into a three-year Basic Specialty Programme. We call it BST. And, subsequently, they have to go through another three years of Advanced Specialty Training before they are registered as a medical specialist by the Singapore Medical Council. This system gives our doctors a very good and wide exposure to different subspecialty as he gradually builds up a holistic knowledge and broad-based experience in medicine. And that is the reason why Singapore doctors are so well respected internationally. A doctor who seeks to become a specialist definitely must have holistic knowledge of various subspecialities as this will equip him as a specialist to be able to identify symptoms of ailments that may not be

related to his area of practice later on so that he can refer a patient in a timely manner to see another specialist. The entire process is long but is necessary. It takes about seven to 10 years. Under the new proposed US-style residency programme, it takes only five years to complete the training, during which the medical graduates spend the first year involved in clinical work and further education, and the next four years training in the subspecialty of their choice. When the duration is shortened, what is the impact on training as well as the knowledge imparted for this particular doctor? My personal view is that something has to give. I wonder if the Ministry has done any study on the implications of the reduction in the training period? And will our future medical specialists be less knowledgeable and less skilled than the medical specialists that we produce today under the current system?

Besides, you need to give young medical graduates adequate exposure by spending sufficient time in different subspecialties so that he can make up his mind on which area of medicine he wants to pursue for specialisation, and this is a lifelong commitment. This particular period is critical so that he can understand the subject, appreciate the implication before making an informed decision. While the shortened duration may benefit those who are already certain of the subspecialty they are interested in from the onset of the training, it is not so for most of them who have not yet decided immediately after graduation.

More than a reduction in duration, the proposed new residency programme is actually a complete overhaul of the existing system. With such short notice for the graduating batch of medical students, they may be forced to make some very rushed and uninformed decisions. As one medical student actually lamented in a blog that the sudden

announcement of this change has left him only one month to decide on the path he wished to take. Furthermore, as this is a new concept which affects an entire graduating batch of medical students, flaws in the new programme may result in trainees not performing up to standard. Will they then be expelled, or will they be given a second chance as the programme gets a review? More importantly, will mentors be able to cope with the changes and revise their training methods for this new programme adequately? These are really genuine concerns of doctors as well as medical students.

A doctor shoulders a very heavy responsibility. Will a shorter training duration now compromise the time needed for trainees to learn and excel in every area that is required in their career? How can they juggle between research, clinical practice as well as administration? We need to remember that doctors in Singapore actually see a much higher workload compared to those overseas. The US Society of Hospital Medicine at a recent meeting in Chicago in 2009 noted that the conventional wisdom holds that the optimal daily output for a doctor is 15 patients, but that varies from doctor to doctor. In Singapore, it is not uncommon for our doctors to see a much higher throughput, especially at Government clinics of up 80 to 100 patients a day. Hence all the more we need to ensure doctors are adequately exposed through the years of his training as the demand on them is much greater.

It also raised the question of the new batch of doctors be less rounded than their seniors who have additional years of rotation and hands-on experience before focusing on their eventual subspecialty. Given the complexity of medicine and the advent of new medical technology and advances in medical science, the longer the time a doctor spends in training, the better he is able to grasp and understand the practice of medicine. It is about life and death.

There is little room for trial and error. Even under the current regime, under our rigorous regime, we read of lapses on the part of doctors with the patients having to bear the consequences of their oversights. Are we able to continue to uphold our medical excellence that we have proudly and painstakingly built up over the years with the new programme?

Next, I will touch on the Disciplinary Tribunal (DT). I have some reservations with the proposal that a legally trained person should be appointed as a chairperson for the Tribunal although it is not always the case. The roles of the DT and the Courts of Law are entirely different. The DT actually is a platform to hear out complaints involving ethical issues and professional misconduct or mispractice. The DT presides and penalises doctors who misconduct themselves professionally in specialised area of their practice. Hence, who is better to lead the DT than someone who is trained in the practice, to be able to understand the thought processes and the judgments or decisions made by a trained medical professional?

The presence of a lawyer may bring about a technical convergence of the law and medical practice but it does not promote higher standards of medical ethics. In fact, in my view, moral ethics may perhaps be better advocated and better served by one who commands a very high degree of respect and trust from the public and the members of the medical profession, such as a Justice of Peace. Indeed, if there is a problem in terms of public perception that doctors may not be judging harshly on their peers who have come before the DT, then I think the presence of an eminent member of our community as the Chairman of the Tribunal, namely a Justice of Peace, more than a lawyer would actually add more weight to the proceedings. For more complex cases with legal implications,

there is already a provision for a legal assessor to be appointed to assist and advise the DT during such proceedings.

With that, I hope that the Minister would have time to elaborate on some of the points. I thank you for the opportunity to present my views on this Bill.

Mr Deputy Speaker, I would like to clarify one point. When Dr Lam said – I was out of the Chamber – but I was told that he had rebutted one of my points. I would like to clarify my position that I am not advocating that a medical doctor be now on a legal Disciplinary Tribunal although we hold medical doctors in very high regard, and I hope that there is a reciprocity between the two professions in that regard. What I was saying was that I think there is a great synergy between the legal fraternity calling doctors as medical experts in cases, and in fact the case that the hon. Dr Lam Pin Min cited was the case of Dr James Khoo against Gunapathy. That was a case in which medical experts were called by lawyers. So, it is really a point of synergy that section 50 of the new Medical Registration Act achieves between the legal profession as well as the medical profession which I think will only add to the disciplinary process and be a positive feature for doctors and patients.

Dr Lam, you were mentioned.

Thank you, Mr de Souza for that clarification. I would like to point out that in the current system there is already a provision for the legal assessor to be in the DT. But to allow a doctor to sit in a legal DT and to be the Chairman, I think it is a different story altogether. So, there is no comparison between the two although we understand

that doctors and lawyers can collaborate and work closely together for the benefit of the complainant.

I think it is quite clear now. Mr Ang Mong Seng.

5.40 pm

(In Mandarin): [For vernacular speech, please refer to Appendix A*. ] Mr Deputy Speaker, Sir, in order to improve the regulatory mechanism for doctors and to raise the standard of medical services, the Ministry of Health is once again seeking to amend the Medical Registration Act to provide medical protection to the public.

Over the last few months, the Ministry of Health has conducted extensive public consultation on the Bill involving doctors, lawyers, professionals, members of the public, grassroots organisations and various relevant agencies, and Minister Khaw Boon Wan himself has made very incisive observations on the responses by the doctors and the key professional groups on this Bill. Members who spoke on this debate today are mainly doctors, professionals or lawyers. As far as this Act is concerned, let me raise some of my views on this Bill in my capacity as a lay person, for the Minister's consideration.

First, set a time-frame for the Complaints Committee to complete the processing of complaint cases. The new section 38 will raise the cap on the number of registered doctors and lay persons in the Complaints Panel from the current 80 to 150 and the number of Council Members will also be increased from the present 19 to 25. This is to shorten the time taken to process the complaint cases, because at the moment some cases may take as long as five years to complete the whole process. I think increasing the number of members is a correct decision. With

increased manpower, cases can be dealt with more rapidly. But this Amendment Bill does not specify a timetable for the dealing of these cases. I would like to suggest that complaints received by the Ministry of Health be separated into two categories: the "core" and the "non-core" complaints. If it is a non-core complaint, the Medical Council must set up a committee to start proceedings within a month, and the whole case should be completed within three months. If the complaint is medical in nature and more complicated, then the Singapore Medical Council should set up a committee within a month and allow another month's "cooling period" to allow the parties to cool off and deal with the matter in a more peaceful and calm mindset. Case hearing should start on the third month and be completed within a year. If the committee needs more time to deal with the more complicated matters, they can apply to the Ministry of Health for an extension of time. In this manner, all the complaint cases can be dealt with within the prescribed timeframe to satisfy the needs of the complainants and also to enhance the image of the medical profession.

Secondly, improve the transparency of the Disciplinary Tribunal's proceedings. Some members of the public complained that the Disciplinary Committee's proceedings lack transparency. They said with all the committee members being doctors, they tend to be more tolerant of their fellow doctors for their mistakes or negligence. So, in order to improve the transparency of the proceedings, I would suggest that the complainants or members of their family be allowed to attend the proceedings, but they will not be allowed to interfere with the proceedings and they also must sign an agreement not to disclose details of the proceedings to outsiders. If they have any views, they can instruct their counsel to make the point. I think in this way, the complainants and their family members

would have a better understanding of what transpired at the tribunal. I hope that the Minister would consider this suggestion.

Thirdly, doctors with repeated offences. I would like to ask the Minister, over the last five years, how many doctors were complained against on the same issue, ie, the repeat offenders.

Fourthly, high-tech medical equipment. With modern advance technology readily available, I would like to ask the Minister whether there is any provision for technology to be deployed to prevent or detect any unintentional wrong-doings on the part of the surgeons. I remember there was a case where a surgeon left his scalpel inside the body of the patient after the operation. Could we consider using some sophisticated detector scanners, just like the metal detectors at the customs checkpoints, to scan the patient after each surgical operation? Should any substance that should not be left in the body of the patient be detected, it could be removed as soon as possible, thus improving the safety of the patient and reducing the chance of the doctor making a mistake.

I support this Medical Registration (Amendment) Bill.

*Cols. 1987-1990.

Mr Deputy Speaker, Sir, I thank Members who have spoken very passionately on this Bill – not always agreeing with one another – and generally in support of this Bill.

Let me address their comments and suggestions.

First, the proposal to allow senior lawyers to chair Disciplinary Tribunals. I am not surprised that this is one of the most heated issues this afternoon. Dr Lam noted that the practice was not unusual, having been done in Australia, Canada and elsewhere. However, he worried that

it might be perceived as, "SMC lacking the moral courage and legitimacy to discipline high profile complex cases". In any case, he commented that "the definition of complex is subjective and can be ambiguous". In contrast, he and Ms Audrey Wong noted the Law Society going in the opposite direction, doing away with the appointment of laypersons in the Disciplinary Committees. Dr Lam asked whether the amendment would mean "the medical profession is regressing and arrogating responsibility".

I do not know fully the circumstances that led to the amendment to the Legal Profession Act. But I recall the debate in this House which noted that formalised legal processes, like the legal disciplinary proceedings, would benefit from lawyers' participation. And the amendment to remove the layperson was to help speed up the proceedings. SMC's disciplinary proceedings are similarly formalised legal processes but currently without the advantage of having legal professionals on its Disciplinary Tribunal. Although there is a legal assessor present to assist the SMC's Disciplinary Committee, as noted by a number of Members, to address issues of law, the extent to which legal assessors can guide the proceedings is limited. During the public consultation on this amendment, one senior lawyer who has served many years as legal assessor for the SMC wrote in to express his observations that frequently the SMC's Disciplinary Committee wasted a lot of time on irrelevant matters but he was unable to intervene. I have his letter to the Ministry of Health here. I have not sought his permission to quote him – so I will not name him – but I would read an extract of what he said, because this is a real, personal experience of one who has helped out as legal assessor for many years. This is what he said:

"As a legal assessor, my role in the disciplinary proceedings is limited to advising

the Disciplinary Committee on questions of law arising in the course of the proceedings or informing the Disciplinary Committee of any irregularity in the conduct of the proceedings and advising the Disciplinary Committee when it appears to me that there is a possibility of a mistake of law being made. In that restricted role, I often felt inadequate and at times frustrated in being constrained from intervening when I noted counsel, either for the doctors concerned or for the SMC, spending a great deal of time in questioning witnesses on or dealing with irrelevant or peripheral matters arising. The doctors chairing the Disciplinary Committees were often too polite and indulgent to counsels and gave them a lot of leeway. Conducting hearings and dealing with contentious counsels, arguing with each other across the table and disputing on issues or points – sometimes serious and at other times frivolous – are not matters with which the doctors are familiar. It seems to me that if the proceedings were chaired by an experienced legally trained chairman, or if there were present such a person as a member, not as a legal assessor, the proceedings could and indeed would have progressed more expeditiously."

I spoke to the President and a couple of past presidents of the SMC, because when the reaction from a certain segment of the medical community emerged during the public consultation phase, I felt it necessary to get to the bottom of this, so I spent time with a few of these current and past presidents. All of them strongly recommended that we include this particular amendment. They have personal experience conducting the disciplinary proceedings and felt strongly that the presence of an experienced legal professional on the Disciplinary Tribunal will be a significant advantage. I note Mr de Souza's support for this amendment and also his very sound advice that SMC proceedings should not become overly legalistic, shifting the focus from what is medically professional and ethical to what is strictly legal. I agree with his call but the reality is that increasingly, senior

lawyers are being engaged in high-profile cases saddling disciplinary committees with legal arguments and technicalities, the relevance of which does require legal training to discern. And that is why the SMC President and past presidents have made such a strong recommendation to allow them the option to appoint senior lawyers to chair some Disciplinary Tribunals, where circumstances may demand it. This is not an indictment of the medical professional, rather it is a progressive development where the medical practitioners collaborate "synergistically" to use Mr de Souza's words, with the legal professionals to do their best, to manage efficiently both questions or fact of medical practice and questions of law. This will help the Disciplinary Tribunal to make fair judgments in complex cases.

Let me reiterate again that the SMC is not arrogating its responsibility. As noted by Mdm Halimah, "the amendments have taken into account doctors' concerns as their appointment of any legally qualified person, whether chairman or committee member is at the discretion of the SMC." The SMC will have the prerogative to include a senior lawyer to Disciplinary Tribunal, only when it deems appropriate. The Bills specify that there should be at least three voting members in a Tribunal, of which at least two, shall be medical practitioners and does not set an upper limit to the number of voting medical practitioners. The Medical Council may have two or more practitioners in addition to the legal professionals to constitute such Tribunals, so that when it comes to questions of facts pertaining to medical practice, the medical professionals' views will prevail. This amendment is to mitigate potential legal errors which may arise when dealing with complex issues of law which medical professionals are often either not familiar with or is aware of. After the Director of Medical Services has explained the background of this

amendment to the entire medical community, as I highlighted during my speech a couple of hours ago, the vast majority of the medical community had no further objections on this particular amendment.

And as noted by Mr de Souza and Ms Audrey Wong, we have made some amendments to the original draft Bill, which I put out for public consultation. The current Bill, which is in front of the House, contains amendments to the original because I take public consultations seriously. It is not just a show. When I consult, I am really keen to see what are the comments and if there are valid points, we will incorporate them. This is one example where, because of the strong views expressed by certain segments of the medical community, I decided to hold back the whole tabling of this Bill by two or three months to allow me to consult the various people and along the way, we amend the original draft Bill, which is the version that Members see today. I think and as noted by Mdm Halimah, we have made sufficient and relevant compromise to finding this trade-off between preserving the interest of the public as well as making sure that the self-regulation approach to medical professionalism that we have in the medical profession, is not compromised. And Members can notice that just on this point, in this House this afternoon, there are strong views, different views and I hope Members can accept that the compromise that I have struck, is a fair one.

Dr Lim Wee Kiak would like us to consider an alternative, which is to appoint a highly respected individual such as a Justice of the Peace, and not necessarily a legal professional to chair the Disciplinary Tribunal. Unfortunately, that cannot resolve the problem that we have identified, which is the legal complications which have been imposed on the Disciplinary Tribunal in dragging

out unnecessarily the whole entire proceedings. Of course, what is complex, I agree, is hard to codify or define, and that is why this is the question best left to the SMC. The SMC will have to consider each case differently and they are the ones who decide if this case is sufficiently complex in nature such that having a senior lawyer to chair will bring advantages to the proceedings.

Mr Calvin Cheng suggested that we should allow laypersons to form the majority of the Tribunals. But unfortunately, this will defeat the whole purpose as pointed out by Dr Lim Wee Kiak. This will undermine the whole approach of self-regulation that we wanted the medical profession to follow.

Dr Lam Pin Min also asked if the new provisions for SMC to lodge an appeal to the High Courts on behalf of a patient under section 55(2), constitutes a "double whammy" as this amounted to a doctor being prosecuted twice. This is not an issue unique to Singapore. In fact, there was a similar issue that was raised in the UK, where they have a Council for Healthcare Regulatory Excellence, which has the power to refer matters to the High Court that it considers to be "unduly lenient". Like the SMC, this UK Council can in effect, appeal on behalf of patients even where the doctor has been acquitted by the general medical council in UK. And when the issue was raised in the English Court of Appeal, the English Court accepted that this power creates an element of "double jeopardy", as they put it. But overall, they thought that such concerns were to take second place when this is necessary to protect the public. And in this instance, we have taken a similar approach in Singapore.

Second, Dr Lam asked if Disciplinary Committee members receive any form of training. Yes, they do. The SMC conducts

training sessions for all members of the Complaints Panel from which members of the Disciplinary Tribunals are drawn. The training sessions are conducted by SMC's lawyers and focus on legal issues, procedures and policies relating to the Medical Registration Act.

Third, Prof. Paulin Straughan noted that investigators appointed by the SMC are potentially powerful agents, as she put it, with fairly extensive authority. Ms Sylvia Lim also noted that the investigator holds an important and pivotal role in the disciplinary process. Both wanted to know the qualifications these investigators are expected to hold. Our plan is to recruit officers with at least 10 years of experience in the Police or related enforcement agencies. They will be very much like the officers in my Ministry's Enforcement Branch. We would like to assure this House that investigators will be provided with all the necessary training to equip them with the appropriate skills to carry out the duties of an SMC investigator.

Fourth, Prof. Paulin Straughan and Ms Audrey Wong commented on the time taken by the SMC to deal with each complaint. They are concerned about rising number of cases, resulting in delay and a backlog. I share similar concerns. In fact, one main objective of this Bill, as noted and welcomed by Mdm Halimah, is to help the SMC speed up the disciplinary processes.

Mr Ang Mong Seng offered some suggestions. He proposed that we categorise cases as core or non-core and set a time limit for each category. For instance, complicated cases should be concluded within a year and if more time is needed, a formal request for extension should be made. I agree that all complaints should be dealt with speedily. There are provisions to limit the time taken by the Complaints Committee and the Disciplinary Tribunals. The authority

to vary the time for the Complaints Committee and the Disciplinary Tribunal to complete the cases resides with the SMC. Prof. Straughan asked whether all complaints could be dealt with within the three-year limitation period so that complainants who may wish to pursue a civil lawsuit can rely on the outcome of the Disciplinary Tribunal to make an informed decision. SMC will make every effort to conclude the investigations of every complaint within a reasonable time. However, civil suits are best legally advised and considered independently from the Disciplinary Inquiry. Complainants who wish to commence civil proceedings should not wait for the outcome of SMC's investigation. If they intend to, they should instead file a civil suit within the limitation period to ensure that their right to sue is preserved. That said, SMC has assured me that most cases can be concluded within three years and, with the various amendments that I hope the House would pass this afternoon, we will now have greater ability to form Complaints Committee and Disciplinary Tribunals and get the proceedings off speedily.