Hansard, Tuesday, 15 January 2019

1 Ms Anthea Ong asked the Minister for Social and Family Development (a) in the last three years, how many foreign brides in transnational marriages are employed in Singapore; (b) how are their children supported in terms of integration; (c) how successful have the Marriage Preparation, Marriage Support, and Friendship Programmes been since they were introduced; (d) what has been the divorce rate of transnational marriages in the last three years; and (e) what support is given to divorced foreign spouses, especially those with no income.

2 Mr Mohamed Irshad asked the Minister for Social and Family Development what support is given to family units comprising a foreign spouse in terms of integrating and entrenching themselves in Singapore.

Mr Speaker, Sir, may I have your permission to take Question Nos 1 and 2 together, please.

Yes, please.

Thank you, Sir. Sir, we recognise that marriages between Singapore Citizens and Non-Residents may face unique circumstances, such as cross-cultural differences. Therefore, in 2014, the Ministry of Social and Family Development (MSF) introduced the Marriage Preparation Programme (MPP) and Marriage Support Programme (MSP) to help these transnational couples. These two programmes are designed to help transnational couples build a strong foundation for their marriage. The MPP focuses on key marital issues, such as roles and expectations, communications and conflict management, while the MSP follows up on the MPP post-marriage by helping Non-Resident spouses adapt to life in Singapore.

The programmes are well-received, with more than 98% of the MPP participants reporting that the programme has prepared them for marriage and that they could apply what they have learnt to their marriage. Similarly, more than 97% of the MSP participants said that the programme has helped Non-Resident spouses adjust to living in Singapore.

In 2015, we also introduced the Friendship Programme, where a trained volunteer is matched to a Non-Resident spouse to help him or her integrate into Singapore. More than 95% of the Non-Resident spouses who participated in the Friendship Programme reported that the programme has helped them adjust to living in Singapore.

To help Non-Resident spouses feel a sense of belonging in their community, the People’s Association (PA) also organises informal chit-chat sessions to bring transnational families, new immigrant families and their neighbours together. Between 2016 and 2018, PA organised 243 chit-chat sessions at Residents' Committees and Neighbourhood Committees, reaching out to about 15,600 residents.

Sir, most children from transnational families attend our local schools, just like other Singaporean children, and interact with students of different backgrounds in their classes and co-curricular activities. Through the Character and Citizenship Education curriculum in schools, children also learn about our society's norms and values. Being immersed in our local school environment is the best and most natural way to ensure that they are integrated, and children of transnational families do just as well in school as any other children.

In terms of employment, over the past three years, an average of 14,000 Non-Resident spouses holding Long Term Visit Passes (LTVP/LTVP+) were employed in Singapore each year with a Letter of Consent issued by the Ministry of Manpower (MOM). This figure includes Non-Resident grooms and brides married to either Singaporeans or Permanent Residents.

Sir, transnational marriages are as resilient as marriages between Singaporeans. The divorce rates for transnational marriages before the fifth and 10th year of their marriage anniversaries are comparable to those for Singaporean marriages from the same cohorts.

For Non-Resident spouses of Singaporeans whose marriages end in divorce, the Immigration and Checkpoints Authority (ICA) would generally facilitate their continued stay in Singapore through a renewable LTVP, as long as they have custody over young Singaporean children. This is to allow them to care for their Singaporean children here. They can seek support from community agencies for a range of financial assistance and social services, and approach Social Service Offices (SSOs) for an assessment of their needs. SSOs and our Family Service Centres will also provide help and socio-emotional support, if the need arises.

Ms Anthea Ong.

I thank the Minister of State for the clarification. What prompted me to ask the question was that one in three marriages in Singapore involves a Singaporean and a foreigner. We understand that a quarter of our babies born are born to a Singaporean and foreigner parent. In light of what the Minister of State has shared, does the Ministry have plans, be it in the long or short term, to introduce new policies or strengthen existing policies?

Sir, I thank the Member for a very useful question. Every child born in Singapore, whether to a Singaporean couple or to a Singaporean and a non-resident spouse, is a child of Singapore. So, we will do our best to help. I have mentioned that MSF has three programmes to help transnational couples, particularly the foreign spouse, to adapt to living in Singapore. We also have the Letter of Consent issued by MOM to help the foreign spouse find work and employment in Singapore. So, we do have a few programmes to help them, namely, the MPP, MSP and the Friendship Programme, all are designed to help foreign spouses to adapt to Singapore and eventually be integrated with our society.

Although I mentioned that these programmes have produced very positive results, we know that there is always room for improvement. My Ministry is in the midst of doing a review of the MPP and MSP to find out whether there are shortcomings in the programmes and, if there are, then we would want to strengthen them further. In the process, we will also explore whether there is a need to offer new programmes. If there is a need, we will seriously consider that.

3 Ms Tin Pei Ling asked the Minister for Health in light of the recent case of MediShield Life disbursing only $4.50 as payout for an eye operation (a) whether he can reiterate the role of MediShield Life in our public healthcare financing system; (b) how does the Ministry determine the claim limits and ensure that MediShield Life provides adequate coverage for Singaporeans; and (c) whether the Ministry will review MediShield Life's claim limits to address the gaps.

4 Mr Murali Pillai asked the Minister for Health how does the Ministry ensure that the pegging of hospital charges for complex medical procedures for the purpose of assessing MediShield Life coverage is made current so that subsidised patients who undergo complex medical procedures will continue to be protected against large hospital bills.

Mr Speaker, may I have your permission to take Question Nos 3 and 4 together?

Yes, please.

Mr Speaker, our public healthcare financing system comprises several components that work together to keep healthcare affordable for Singaporeans.

First, patients in public healthcare institutions enjoy subsidies of up to 80% of their bills. Second, we have introduced MediShield Life, a universal healthcare insurance which provides all Singaporeans lifelong protection against large hospital bills and selected costly outpatient treatments, regardless of age or health condition. Third, MediSave can be used for the balance of the bill and helps Singaporeans lower their out-of-pocket cash payments. Finally, MediFund and various forms of financial assistance at our public institutions provide discretionary, targeted assistance for those who have financial difficulties. Last year, MediFund provided about $150 million in assistance to patients who require additional help with their bills.

Taken together, this "S+3M" framework – the subsidy plus 3M – has worked well. It ensures that healthcare is affordable to Singaporeans, and no Singaporean is denied appropriate healthcare due to an inability to pay. To underscore this point, in our public hospitals, seven in 10 subsidised bills are fully paid without any cash outlay by the patient. In other words, 70% of all subsidised bills do not require any out-of-pocket cash payment by the patient at all. Of the remaining 30% of bills, one-third require payment of $100 or less in cash, and another one-third of that 30% is paid for using a cash outlay of between $100 and $500.

The enhanced MediShield Life was launched in 2015. This is a key component of our healthcare financing framework which provides universal and lifelong coverage, including for those with pre-existing illnesses. The Government provides premium subsidies to the lower- to middle-income to keep premiums affordable, and additional support to those who need more help with their premiums.

MediShield Life aims to strike a balance between keeping premiums affordable and ensuring adequate coverage of subsidised care. For this reason, MediShield Life has design features, such as claim limits, an annual deductible and co-insurance.

Coverage of claims and amount of payouts have improved since the introduction of the enhanced scheme. To provide members with a sense of the comparison, in 2017, 555,000 MediShield Life claims were approved and $845 million was paid out. This is up from 344,000 claims and $448 million in 2015 under the old MediShield. The average payout per claim was $1,520 in 2017, compared to $1,300 in 2015. For larger bills, the payout was correspondingly higher. For the largest 10% of subsidised hospitalisation bills, which was above $4,000 in 2017, the average payout per claim was $5,800. In comparison, MediShield paid out $4,000 on average for the largest 10% of subsidised bills in 2015.

As I had mentioned earlier, claim limits are one feature that helps MediShield Life strike a balance between keeping premiums affordable and also ensuring adequate coverage. MediShield Life claim limits and premiums were last revised in 2015 when the enhanced scheme was launched. At the time of launch, the claim limits were set to cover nine out of 10 subsidised bills. In addition, for larger bills within claim limits, the patient’s co-payment is reduced as the claimable amount goes up, dropping from 10% to 5%, and finally to 3%. So, for illustration, for claimable amounts above $10,000, the patient’s co-payment is 3%.

For bills that exceed the claim limit, patient’s co-payment will include the remaining bill not covered by MediShield Life. These bills tend to be for more complex cases or where patients received lower means-tested subsidies because of their higher income.

The latest available figures show that eight in 10 subsidised bills remain fully within the MediShield Life claim limits. This has come down from the limits set in 2015, caused in part by increased healthcare costs. We will review this and adjust the limits as necessary. However, even at present rates, in respect of the bills which fall outside the claim limits – in other words, outside of the eight out of 10 – about half exceed the claim limits by $230 or less.

The claim limits are necessary as they serve to keep premiums affordable. If we are to remove the claim limits altogether, there will be significant premium increases for all Singaporeans across the board, to the order of about 30% or more. Therefore, rather than impose this on all Singaporeans across the board, those who prefer to have higher coverage and are willing to pay higher premiums can consider private Integrated Shield Plans which can include "As-Charged" features that cover 100% of the bill. Conversely, where patients cannot afford the cash outlay, they can tap onto MediFund as I explained earlier, or on other financial assistance schemes.

In the recent case of Mr Seow Ban Yam, which Members raised, we understand that he had undergone a duct drainage procedure at the Singapore National Eye Centre (SNEC). The surgical procedure, which was performed by a senior consultant in an operation that took three hours, was complex, given his age. It is also not common for the procedure to be performed on both eyes at the same time. As an indication, this was only done for seven patients out of 42,000 procedures performed by SNEC that year. Mr Seow's bill was about $12,000 before subsidy. Of this amount, the Government subsidises approximately $7,500, leaving a balance of $4,500, or about $1,400 above the MediShield Life claim limit in this case.

Because the SNEC bill was significantly higher than the claim limit, the payout was comparatively small, after the yearly deductible of $3,000. However, the balance of Mr Seow's bill was thereafter fully covered by MediSave, which meant that Mr Seow did not have to pay any cash out of pocket for the procedures which he underwent. Nonetheless, we had asked SNEC to review their charges. Following the review, SNEC has decided to scale down its fees for this procedure and a number of other complex procedures with higher fees, and will do so from 1 March 2019.

MOH regularly reviews MediShield Life claim limits and benefits. For example, we recently extended coverage to Home Parenteral Nutrition and direct admissions from emergency departments of public hospitals to community hospitals.

Last year, we also started a review of claim limits, with a view to making the appropriate adjustments as may be necessary. This ongoing review requires a careful assessment of the appropriate claim limits and also the consequential impact it may have on premiums, to ensure that the coverage of MediShield Life remains broad-based and also sustainable. This review is also being done in the context of the commitment to keep premiums constant for five years after the scheme was introduced in 2015. We expect the latest review to be completed by end 2020, but if the review is completed ahead of time, we will, of course, announce the revisions earlier. Moving forward, MOH intends to conduct these reviews of claim limits more regularly, around once every three years.

Just as important as having a good healthcare financing framework is managing healthcare costs effectively, so that overall affordability can be maintained. We have to work hard on this and also explore various fronts on which this can be done.

The need to monitor and manage costs and charges in public healthcare is particularly important. The majority of Singaporeans utilise subsidised healthcare in our public healthcare institutions. Some examples of our efforts to keep costs sustainable are the use of group procurement to get better prices, tapping on technology to improve productivity and applying healthcare technology assessments to guide the appropriate use of services, devices and drugs. We have also introduced programmes and services to help Singaporeans receive care earlier or at more appropriate settings. For example, under the hospital to home programme, patients receive visits at home for a few months after hospital discharge to ensure that they recuperate well and do not get re-admitted to the hospital. Together, these initiatives help Singaporeans manage costs and moderate increases in healthcare bills. We will keep a close watch on public healthcare costs and redouble our efforts to keep healthcare costs sustainable and affordable for Singaporeans.

To sum up, we have a healthcare financing framework that has worked well in striving to keep healthcare affordable for Singaporeans. The healthcare financing framework is designed with several different but overlapping components to provide holistic support to meet Singaporeans' healthcare costs. MediShield Life is one key component that provides Singaporeans lifelong protection against large hospital bills and selected costly outpatient treatments. Its features are aimed at ensuring adequate coverage while keeping premiums affordable. We will continue to review, refine and strengthen MediShield Life and other components of our public healthcare financing system, and, just as importantly, manage our healthcare costs to ensure that public healthcare remains affordable for all Singaporeans.

Ms Tin Pei Ling.

I thank the Senior Minister of State for the very comprehensive answer. I have two supplementary questions. Firstly, for such an eye operation, which I would imagine is quite common for the elderly and with the ageing population, it will be imperative that we keep the cost affordable for them. So, since SNEC is reviewing its charges, will MOH also ensure other public hospitals or other healthcare institutions offering similar procedures also review their charges to make sure that they are on par and, therefore, ensure affordability for elderly citizens? That is the first question.

Secondly, I think Mr Seow's case has been quite unsettling for a lot of the elderly, given that it seems like a very reasonable procedure, common enough and yet the experience is that the payout is only $4.

50. Given the spirit of MediShield Life, such an example will not be very helpful in giving that sense of assurance in terms of healthcare affordability. While I am heartened that there is a review, I am wondering if the review can be brought forward, given that MediShield Life was launched quite a number of years ago. So, whether the review could be brought forward and, in terms of the review frequency, I understand that the Senior Minister of State is estimating around every three years. Would this be timely enough? Does this coincide with the general healthcare inflation pattern?

I thank the Member for the questions. Yes, we have to keep healthcare cost affordable. Members have heard me explain that that is our objective in designing the framework that we have. And in doing so, we try to strive to do that with two broad prongs. The first, obviously, is to look at the claims limit, which is the thrust of the Member's second question. And yes, we will review the claims limit and we will ensure that it is in tandem with the cost and ensure that the differential, as they move towards the inflationary cost for the healthcare sector, that it is kept in check and in tandem. Whether it is five years or three years, the objective is the same – to ensure that there is parity and that it rises in tandem, so we have decided to do it at three years. But, if necessary, we can always relook at the timescale as well.

The second prong is to deal with the charges side, because one has to look at the claim limits as one sector. The other one is, of course, the amount of cost that is charged at the healthcare institution. That will also be looked at to ensure that there is parity. And that is one key aspect of trying to bring down and maintain healthcare cost to keep it affordable. So, both will be looked at at the same time. In terms of timing, three years is what we aim for, both the reviews that we are doing now. And thereafter, we will see if that is in tandem with the trends and patterns in the healthcare industry. We will adjust as necessary.

Dr Lily Neo.

Mr Speaker, may I ask the Senior Minister of State how are deductibles derived at, and how do we make them more affordable? I am glad to hear that SNEC will look into the high cost of the eye duct operations. May I now ask whether MOH would also look at other departments, especially those with high charges on the conditions that require operations, in order to keep healthcare costs down? And how does MOH reassure Singaporeans that public healthcare costs, including the deductibles, are affordable to give them peace of mind?

Deductibles are necessary, because they are one component of ensuring that the premiums remain affordable. If there were no deductibles, or there are no other co-payment schemes, then one would imagine that the premiums would rise and we want to ensure that, for the broader base of Singaporeans, premiums remain at a scale which is affordable. So, deductibles are necessary for that reason.

In terms of how the deductibles are looked at, one has to consider it in the context of the kinds of treatments, the claims assessment, the actuarial assessments as well, and then when you look at that in contrast with the premiums that we want to maintain, the levels at which we want to fix the premiums, that is how the deductibles are looked at and determined.

In the context of assurance, as I have explained earlier, the healthcare financing framework is made up of not just MediShield Life. It is a combination of MediShield Life, together with MediSave and, if necessary, MediFund, along with the subsidies, all working in tandem and often overlapping with one another. Which is why, even in the context of Mr Seow's case, which Members have heard me explain, is not quite as common as one might imagine. Even in that situation, with the deductibles and with the co-payments after MediShield Life, the patient does not have to be out of pocket because of MediSave. So, one has to look at the entire framework working in tandem as being the framework that will sustain affordable healthcare in Singapore.

Mr Pritam Singh.

Mr Speaker, I would like to thank the Senior Minister of State for some of the statistics he gave. Mr Seow's case, of course, has started a whole enquiry into MediShield Life and how it works amongst many members of the public. I had a resident who has come to me, was hospitalised for two days for a minor stroke, out-of-pocket, including MediSave, from his own monies, it is about 25% of the bill. He sees a line item "MediShield Life" contributing zero dollars, that is, because it is within the deductible limit. So, my question really is about the review that MOH is undertaking – whether it is in line with the spirit of the MediShield Life Review Committee report, to have greater transparency on reserve requirements. Because that is where a large chunk of the public discussion is going to now – whether the amount of premiums collected is too high or is it just right? It is unclear to members of the public as to whether MediShield Life is over collecting premiums. Some clarity on that would be helpful, in line with the spirit of the MediShield Life Review Committee report.

Well, there are two different questions at play here in Mr Pritam Singh's questions. The first obviously deals with the review of the claims limit, and that is a product of working out where the claims limit lie in the context of how many bills MediShield Life is designed to cover and looking at the healthcare cost in tandem with that and to achieve the ratio that one seeks to. That is the review of the claims limit that I spoke about earlier.

What Mr Singh is separately asking about is the adequacy ratio. The adequacy ratio is something which is kept at a pace that ensures longer-term sustainability of the fund, longer-term ability to meet vicissitudes of life, and also to ensure that the MediShield Life scheme, on a longer-time basis, remains sustainable. That is something we constantly look at as well. But I want to emphasise that it is a separate issue from looking at the claims limit, which deals with the actual cost itself and how many bills are covered by MediShield Life.

Mr Murali Pillai.

Mr Speaker, Sir, I have two questions for the hon Senior Minister of State. The first question is in relation to claim limits for day surgeries. As the Senior Minister of State would know, with the advancement of technology, a number of procedures would entail patients to go through day surgeries instead of being warded in hospitals. This may result in cost-savings. Could these cost-savings be taken into account in setting the claim limit for complex procedures in day surgeries? That is the first question.

The second question is in relation to the information flow between the national health agencies setting their costs and MOH when assessing whether or not the claim limits would be sufficient and relevant. In the context of this case, for example, would ordinarily these healthcare agencies inform MOH, have that discussion on whether or not the price setting is appropriate before it is finalised?

There are several hundred thousand bills that are put out in our public healthcare institutions, so it is not possible to look at every bill that goes out and in discussion with the healthcare institution before that. There are basic guidelines and benchmarks, and that is something that we look at. It is, in fact, the subject of the review that we will do as well. And particularly in the context of this case, that is what SNEC has reviewed and will implement from 1 March. So, I assure the Member that we will constantly look at that and keep that within the range that fits in with the philosophy of MediShield Life.

On the question of day surgery, to some extent, shortening procedure timings or use of technology might save time and possibly expenses and money. That would be another feature that would be looked at in the context of setting the claims limit. As the Member knows, there are tables of charges for different procedures and these are regularly reviewed with a very broad spectrum of expertise. Certainly, the issue as to whether or not cost savings might be gained from day surgeries or shorter surgeries or procedures which may be truncated because of technology, all these would be taken into account as we review the amount of claim limits that we have.

Mr Leon Perera.

Mr Speaker, Sir, I thank the Senior Minister of State for his detailed answers. Just three supplementary questions. The Senior Minister of State alluded to the adequacy ratio. Can I ask if the Government consciously benchmarks the adequacy ratio of MediShield Life against other similar healthcare insurance schemes where the insurance is mandatory by legislation in other countries in the world? Is MediShield Life's adequacy ratio benchmarked to be similar or in the same range as the similar schemes worldwide?

The second question is in relation to – if I understand the Senior Minister of State correctly – the 10% or so bills which fall above the claim limit where the difference is more than $230. Would the Senior Minister of State be able to share with us any pertinent common characteristics in such bills? For example, are they usually for older patients, where procedures may necessarily be a bit more complex? That may be helpful for various stakeholders out there to know what are the common characteristics as we think about this problem.

And the third question is just a clarification. For patients whose bills go above the claim limit, are they, as matter of routine, informed by public healthcare staff that MediFund assistance that is means-tested, is available to them?

The adequacy ratio is not necessarily compulsorily or in a fix fashion benchmarked against other jurisdictions. But nonetheless, there are comparables that are looked at in determining and also assessing what the adequate ratio would be. But ultimately, we have to look at it in the context of our own domestic situation, our own claims pattern, the kind of procedures that we expect to see and also the healthcare trends that we expect in Singapore itself. And the ratio has to be determined based on those factors.

On the second question, the bills that fall outside the last 10%, as I explained in my speech earlier, they are largely made up of complex cases. I do not have the age breakdown for those cases. But, also, a sizeable component of those would be made up of patients who do not pass the means test for subsidies and that is why the amount outside of that would be larger.

Finally, the question of MediFund, at various stages in different hospitals, there will be counsellors, medical social workers as well who will be able to advise on the particular patient's case and the accessibility to MediFund based on the individual situation of that patient.

5 Ms Irene Quay Siew Ching asked the Minister for Health (a) what is the percentage of standard versus non-standard drugs prescribed for MediFund assistance patients in comparison to non-MediFund assistance patients in restructured hospitals; and (b) what is the governance in place to ensure appropriate prescribing of non-standard drugs for MediFund assistance patients.

Mr Speaker, doctors in our public healthcare institutions typically prescribe patients with standard drugs. Doctors may sometimes prescribe non-standard drugs in specific instances, for example, if the patient does not respond to treatment with standard drugs or cannot tolerate the effects of standard drugs commonly used for his or her condition.

We currently do not have ready data on the percentage of non-standard drugs prescribed for patients on MediFund assistance versus those who are not. Overall, however, 85% of drugs prescribed in public healthcare institutions are standard drugs. This has been consistent over the last five years. Available data from our public hospitals do not suggest that there is a systematic difference in the percentage of non-standard drugs prescribed amongst subsidised patients.

To guide appropriate utilisation of drugs, the Ministry of Health's (MOH's) Agency for Care Effectiveness (ACE) publishes guidelines on the appropriate use of selected standard drugs. To encourage the use of standard drugs, they are included on a Standard Drug List (SDL) as well as a Medication Assistance Fund (MAF) list where subsidies are provided and patients receiving the drug should meet predefined clinical criteria. Where clinically appropriate, drugs that are not on the lists may also be accorded financial assistance on a case-by-case basis. Internal hospital committees are charged to ensure that drugs funded under MAF follow the guidance. In addition, MediFund provides additional subsidies to those who are facing financial difficulties, including for non-standard drugs, to ensure that they are affordable.

MOH tracks drug utilisation in Public Healthcare Institutions (PHIs) to monitor compliance to ACE Guidelines. Each public healthcare institution also has governance in place to ensure appropriate drug utilisation. For example, Pharmacy and Therapeutic Committees evaluate drugs for inclusion in their hospital drug formulary and guide doctors on the drugs to use in the course of treating their patients.

MOH shares the Member's concern that patients should be prescribed the drugs that are appropriate for them. MOH will continue to remind our healthcare institutions to do so and also strengthen our governance processes where necessary.

6 Mr Leon Perera asked the Minister for Health (a) what measures are in place to promote the use of generic drugs in public healthcare institutions where they are assessed to be both cheaper and clinically equivalent to branded versions of the same drugs; (b) whether the Ministry tracks what proportion of the volume of all drugs prescribed are generics for those drugs where generic versions exist; and (c) if so, what is that figure in each of the last five years.

Mr Speaker, the Ministry of Health (MOH) works with doctors and pharmacists from public healthcare institutions (PHIs) to encourage the usage of suitable generic drugs. In 2017, to better guide institutions and doctors in the use of generic drugs, we introduced a basket of clinically and cost-effective generic drugs which can replace the more expensive branded equivalents.

MOH and the Health Sciences Authority (HSA) monitor new generic drugs that enter the local market and add them to the basket on a regular basis.

MOH and PHIs have also implemented other measures to drive use of generic drugs. These include automatic substitution at the point of drug ordering, requiring doctors to provide explanations on the usage of more expensive branded drugs where generics are available and monitor its usage.

The utilisation of the generic drugs in the basket has risen over the years. By volume, the usage of the generic drugs in the basket has increased from 87% in 2013 to 99% in 2017.

Mr Leon Perera.

Mr Speaker, Sir, I thank the Senior Minister of State for his reply. Just a few supplementary questions. Firstly, are there plans from the Government to monitor the extent to which, across the board, branded versus generic drugs are prescribed in healthcare institutions because, as I understand it, the cost differences can be really tremendous? For one active ingredient that I just checked at retail, the cost difference is actually a factor of seven times. So, it can make a huge impact on curbing a spiraling healthcare cost. That is the first question.

Secondly, at the retail level, of course, given the trend that many people are self-medicating, anecdotally, it has been observed that at our pharmacies, generic versions of drugs sometimes cannot be found so easily, they are not displayed so prominently or sometimes they are not available at all, compared to pharmacies in countries like the United States (US), for example, where generic versions are prominently displayed with huge cost advantages. Is that something that the Government is looking into?

Thirdly, again, anecdotally, there are cases that one hears about where in the private healthcare space, generic versions of drugs are sometimes prescribed at the same price as the branded version without the patient really being aware of it. Is this also something that the Government is looking at?

Lastly, is there a resource that patients can go to to access typical retail prices of branded versus generic drugs for common cases? Is this something that is available and, if not, can that be looked into as well?

I would like to thank Mr Leon Perera for those supplementary questions. In the PHIs, we do have a committee called the National Pharmacy and Therapeutics Committee that looks into the various kinds of drugs that can be included into this basket of generic drugs. We review them very regularly and these drugs are included because they have a high impact on the costs in terms of drug prescription. Basically, these drugs are usually assessed to have high spending and high utilisation in the PHIs.

With regard to the generic options at retail pharmacies, I think this will be up to the business model of the pharmacy in deciding whether it is better to bring in the generic options or the branded options. However, I have come across many private pharmacies that do carry generic options for patients' purchase.

For like-minded practitioners, such as private general practitioners or even intermediate long-term care providers who are mindful of drug cost, we are also trying to encourage them to have some form of collaboration in terms of group purchasing or group procurement. This will, hopefully, help reduce the cost of drugs in the private sector.

The Member also mentioned about whether we could encourage private healthcare providers, such as private hospitals or private clinics, to use more generic options, and also the amount of generic drugs versus branded drugs that are being charged. This is a business decision by the private hospitals and practitioners. As they have different operational expenses and considerations, it is difficult for MOH to dictate exactly how much or what kind of drugs they prescribe to their patients.

Mr Leon Perera.

I thank the Senior Minister of State for his very detailed answers. There was one question I asked: is there an online resource available for patients to check the price of generic versus clinically equivalent branded drugs, to educate patients so that they can perhaps demand for generic versions to lower the cost that they will need to bear? And if such online resources are not available, is this something the Government is looking into?

I thank the Member for the suggestion. I am not aware whether there is an online resource for that purpose. But I can check and update the Member.

7 Mr Ang Wei Neng asked the Minister for National Development (a) what is the number of HDB flat owners who gave up their new BTO flats in 2018, broken down by flat type; (b) what are the reasons for owners giving up their new BTO flats; and (c) whether their deposits are forfeited.

Mr Speaker, in 2018, about 900 Housing and Development Board (HDB) flat buyers cancelled their Build-To-Order (BTO) flat bookings, of which 25% were 2-room flexi or similar flats, 15% were 3-room flats, 38% were 4-room flats and 22% were 5-room flats.

The main reasons cited for cancelling the BTO flat bookings were either a change in housing plans, for instance, they wished to remain in their existing flat, or buy a resale flat, or a change in financial circumstances which affected the flat purchase.

Flat buyers who cancel their flat booking before signing the Agreement for Lease forfeit the booking fee, which ranges from $500 to $2,000, depending on flat type. If they cancel the flat booking after signing the Agreement for Lease, the forfeiture is 5% of the flat price. They would also need to wait a year before they may apply for another subsidised flat. These measures are in place to ensure that buyers are serious when they apply for a flat, and do not deprive others who are in urgent need of buying a flat. Nevertheless, where there are valid grounds, HDB has waived the forfeiture on a case-by-case basis.

Mr Ang Wei Neng.

I thank the Minister for the answers. I have three supplementary questions. Firstly, do we see a significant increase in the number of Singaporeans giving up BTO flats in 2018 compared to the past few years? And based on percentage, are there more second-timers that gave up BTO flats than the first-timers? Thirdly, are there plans to pick up the profile of Singaporeans who give up their BTO flats so that we can have a simple profile at the point of application and counsel them accordingly so as to minimise the chances of them giving up their BTO flats?

Mr Speaker, can I ask the Member to repeat the third question? I did not quite get the question.

For those who give up the BTO flats, do we have a profile of whether they are trying to sell the flat, they cannot sell, or for other reasons, so that we can identify this profile and, at the point of application, counsel them accordingly?

Mr Speaker, I thank the Member for these supplementary questions. We have not seen a spike in the numbers. Every year, there will be a few who come to HDB to cancel for the reasons that I have cited. There are some second-timers who would like to give up because, as the Member Mr Ang Wei Neng has cited, they find it difficult to sell their present flat and choose not to proceed with the purchase. But these are not that many because, very often, when they have these difficulties, our first recourse is to give them more time to sell the flat. And, very often, with more time, they are able to sell the flat and then move on to their next flat that they have purchased.

So, we continue to analyse each of these cases and, as I said earlier, we are flexible. If there are genuine reasons, if there are financial difficulties, we will have different ways of helping them.

Mr Lim Biow Chuan.

Mr Speaker, may I ask the Minister, when these flats are given up by the purchaser after they have signed the agreement, are these flats subsequently put up for sale under the Sale of Balance Flats (SBF)? Does HDB suffer losses when the flats are resold? The third question is: instead of forfeiting 5% of the purchase flat price, would HDB consider charging an appropriate administration fee, considering that HDB is not a commercial entity and, really, if there are no losses suffered by HDB, would there be a lighter penalty imposed? Otherwise, the flat buyers do suffer quite a heavy loss for losing 5% of the flat price and considering that he also has a one-year time bar imposed on him.

Mr Speaker, the flats are all put back to the Sale of Balance Flats. So, they are all eventually sold through the SBF exercise. As for why 5% and whether there are other mechanisms, at the end of the day, as I have said, we need a mechanism that ensures buyers consider very carefully the flat purchase. This is a major commitment; a major commitment for the flat buyer as a couple or as a single, and it is a major financial commitment as well. So, we want to have that in place to ensure that buyers take it very seriously and are also mindful that, when they make a flat purchase, it is a commitment on their part. If they were to apply and unwind it later, they are, in fact, depriving others who may want the flat more urgently.

So, it is not so much a loss on the Government but, in fact, they are depriving others of an opportunity to get a flat. So, we want that mechanism in place. But, as I have said, we do exercise flexibility and if there are individual cases that for some reason or another decide not to proceed with the application, they can put up the case and we will look at it on a case-by-case basis.

Ms Denise Phua.

Minister, I am speaking for the non-first-time home owners. How does the Ministry of National Development propose to help residents who, as home owners, have genuine difficulty in selling their homes because of the Ethnic Integration policy? For instance, in Little India, where flats are more popular with a certain ethnic group and it is really hard to sell to Chinese potential buyers, some of my residents really have genuine difficulty in selling their flats, yet have to commit to purchasing their BTO flats.

Mr Speaker, I have mentioned earlier our first way of addressing these appeals is to give them more time and, very often, we find that by giving more time to complete the transaction of the new flat and to sell the existing flat, they are able to proceed. But if even after more time is given, they are still unable to proceed and they wish to not proceed with the transaction of the new flat, they decide that it is better for them to just stay with their existing flat, they do not want to sell, then I suggest that they approach HDB and we will look at their particular case and, if indeed there are genuine difficulties with proceeding with the transaction, we will consider whether or not the forfeiture may be waived.

Mr Gan Thiam Poh.

Minister, what I want to raise is for joint applicants. What if something happens, say, if someone passes on or for whatever other reason, would HDB allow them to continue to purchase the flat, that is to say, as a result, they do not fulfil the conditions? And if they cannot, would a special waiver be given not to impose a penalty on them for such unfortunate cases?

Mr Speaker, in the event of a demise of an applicant, if the remaining applicant wishes to purchase the flat and is able to meet the eligibility conditions, certainly we will facilitate that transaction. And if in the event the eligibility conditions are not met and the applicant chooses not to proceed, we will certainly be prepared to consider waiver of the forfeiture.

8 Mr Muhamad Faisal Bin Abdul Manap asked the Minister for National Development what is the percentage of the land cost out of the actual cost price for a 3-room, 4-room, and 5-room type Build-To-Order (BTO) flat constructed in 2016 and 2017.

Mr Speaker, the cost of building Housing and Development Board (HDB) flats includes the cost of land, construction, consultancy fees, financing and other project-related costs. The proportion of land and construction cost for individual projects will vary from project to project, depending on specific site, design and market conditions, as well as other factors affecting land and construction cost. For projects that were awarded in 2016 and 2017, the land cost was about 60% of total development cost, and this percentage was about the same across 3-, 4- and 5-room flat types.

In general, HDB's total development cost cannot be fully covered from the sale price of the flats. This is because the pricing of new HDB flats is guided by our objective of keeping public housing affordable. That is why in the last three years, from financial year (FY) 2015 to FY2017, HDB incurred an average annual deficit of about $1.14 billion per year for its Home Ownership Programme.

Mr Leon Perera.

Just a point of clarification to the Minister. The Minister mentioned 60% is the average cost borne by HDB, on average, in 2016/2017. Just to confirm, for land cost, does that mean cost that is paid to the Singapore Land Authority by the HDB?

Mr Speaker, that is correct. We have a robust and transparent process for the purchase of land and also for construction. Essentially, HDB, as a developer, is treated like any other developer with regard to land sales. And as Mr Leon Perera and other Members would appreciate, land sales are governed under the Constitutional rules for the protection of Reserves. So, the sale of land is benchmarked at a price set by the Chief Valuer, and land proceeds go on to past Reserves and we use a share of that through the Net Investment Return contributions that come to the Budget every year.

On the construction side, HDB will put up a tender and the tender will set the basis for the construction cost.

9 Mr Dennis Tan Lip Fong asked the Minister for Defence whether steps have been taken or will be taken to prevent any further Malaysian Government vessels from entering the waters which Singapore has recently gazetted as part of her port limits on 6 December 2018 besides the existing Malaysian Government vessels which are currently within such waters.

Mr Speaker, in his Statement to Parliament yesterday, the Minister for Foreign Affairs comprehensively set out this Government’s position and that of the Malaysian agencies with regard to intrusions by Malaysian Government Vessels into Singapore Territorial Waters (Tuas). For short, I will say STW (Tuas). Despite our disagreements, both sides want to resolve differences through discussions and peaceful means. To this end, the two Foreign Ministers agreed at their meeting on 8 January this year, to set up a working group of their officials that will "discuss the legal and operational matters to de-escalate the situation in the waters off Tuas and will report within two months."

Against this context, Members – Mr Dennis Tan and Er Dr Lee Bee Wah, who has now converted her Parliamentary Question to Written Question – have asked how our security personnel will respond to intrusions into STW (Tuas). It is a matter of public record that Singapore has been exercising jurisdiction in STW (Tuas) without any protest from Malaysia until 25 October last year. Our Police Coast Guard, the Republic of Singapore Navy and the Maritime and Port Authority of Singapore will, therefore, continue to protect and assert our sovereignty over STW (Tuas) and the waters within Singapore Port limits.

Our security agencies carry out their operational duties with the utmost professionalism. While our security agencies do have the capability to compel the intruding Malaysian Government Vessels to leave, they have been ordered for now to exercise restraint and avoid escalating tensions with Malaysia, so as not to jeopardise the conditions necessary for constructive discussions and peaceful resolution of the dispute. Since 3 December, when intrusions by Malaysian Government Vessels began, our security personnel have repeatedly pressed these vessels to withdraw from STW (Tuas). We will continue to do so as their presence does not strengthen Malaysia’s legal claims in any way and, indeed, as we have said before, can result in mishaps or regrettable incidents.

Singapore has welcomed assurances by the Malaysian government that they would take measures to de-escalate the tensions in STW (Tuas). We hope that all Malaysian agencies will abide by this stated policy. Incidents, like the recent incursion by the Johor Menteri Besar, are provocative and escalatory, and contradict the officially stated policy of the Malaysian government. Tensions and real risks increased during this incident. Our security agencies had detected early the movement of the Menteri Besar’s entourage, which sharply increased the number of Malaysian Government Vessels in STW(Tuas) from two to five. Our Police Coast Guard and Republic of Singapore Navy vessels responded promptly to this provocation, as they had to. As a result, the total number of vessels in the area more than doubled. These provocations do nothing to help resolve disputes and, indeed, can precipitate incidents on the ground which will do lasting harm to bilateral ties.

10 Mr Leon Perera asked the Minister for Trade and Industry (a) to what extent the recent Causeway jams have impacted businesses in Singapore; and (b) what measures are in place to reduce the extent and impact of such jams in future.

Mr Speaker, Sir, the security and sustainability of supply chains are integral considerations for all of our businesses. To sustain business continuity, our economic agencies and businesses work closely together to diversify our supply chains where needed and possible, and anticipate and put in place measures to mitigate possible disruptions caused by natural disasters, seasonal factors or external circumstances. Such measures will include holding a certain amount of buffer stock for factors of production, and timing the deliveries to minimise delays by avoiding expected seasonal peak periods.

The Immigration and Checkpoints Authority (ICA) regularly releases notices to anticipate jams, for example, during the year-end school holidays and festive periods on the Causeway. Many of our companies will schedule deliveries to avoid peak periods and factor in additional travel time to buffer for any delays due to such seasonal factors or external circumstances.

If there are significant disruptions to supply chains over land route, businesses will also use alternative routes through air or sea freight, and/or reserve stocks for essential supplies. So, while the jams may affect the schedule or timeliness of deliveries, we have not received feedback that it constitutes a major source of business disruption for our companies recently.

We will continue to monitor the situation closely and work with our businesses to diversify and put in place anticipatory measures to ensure the security and sustainability of our supply chains, such that no one factor – be it natural disasters, seasonality or externally imposed actions – can cause a major disruption to our economy.

11 Mr Gan Thiam Poh asked the Minister for Home Affairs (a) what is the Ministry's stance on proceeds arising from the sale of drugs or related activities which are criminal offences in Singapore but not in other jurisdictions; and (b) whether existing laws are robust enough to deal with persons or entities in Singapore who have dealings with persons or entities in other jurisdictions who are involved in such activities and where these activities are not illegal.

Mr Speaker, Singapore takes a firm stance against money laundering. We recently strengthened our ability to take action against money launderers through the amendments to the Corruption, Drug Trafficking and Other Serious Crimes (Confiscation of Benefits) Act, passed in Parliament on 19 November 2018.

However, in order to prosecute a person who launders proceeds from the sale of drugs or other related activities in an overseas jurisdiction, those acts must be offences in that jurisdiction. This is in line with the international legal principle of dual-criminality.

Nevertheless, when we are aware of individuals who are involved in such dealings, we pay special attention to them when they come to Singapore.

Mr Gan Thiam Poh.

Sir, may I confirm that those persons who actually conduct such activities, which are deemed illegal here but are legal there, for them to launder their money over here, we cannot do anything against them?

Mr Speaker, what the Member said is not quite the case. Perhaps, I will take the opportunity to remind Members of the House on the set of legislative amendments that we made in November last year and how that has strengthened our position.

As I have explained in my earlier reply, Singapore needs to observe the principle of dual-criminality when dealing with money laundering offences linked to overseas crime. But this has never been the only challenge that prosecutors face. Previously, even after satisfying dual-criminality, prosecutors needed to obtain a certificate from the foreign government or a testimony from an expert in that foreign law to fulfil the burden of proof. This can be a very time-consuming process.

What we did with the recent legislative amendments is to reduce the burden on the prosecutors by allowing our Courts to decide on the basis of evidence presented by the prosecution that an offence has, indeed, been committed in the overseas jurisdiction. So, that requirement of dual-criminality must still be satisfied without having to rely on the foreign governments or experts.

Sir, this has helped to address the delays that we have encountered in obtaining the certificate in cases in which the foreign government may not act on our request expeditiously or, in some cases, may not be willing to issue it. With the amendments, we are, therefore, able to prosecute the moneylending offences more effectively.

But to the very specific question on what if you cannot establish dual criminality, as I had said in my earlier reply, if they have the intention to do money laundering and if they set foot in Singapore, we will pay special attention to these individuals and do what is necessary to bring them within the law.

Mr Gan Thiam Poh.

What I want to clarify is that lately, there are many countries that have legalised the sale of certain drugs which are considered illegal in Singapore. But in those countries, they have legalised these drugs. In other words, they allow retail of those drugs. But in Singapore, these are definitely prohibited; we will not allow them. So, for persons dealing in those drugs, I know they are not welcomed to Singapore, but they are okay in their country. In regard to that, the proceeds that are derived from sale in those countries, if they were brought to Singapore, how should we treat them?

Mr Speaker, to the Member's question, as I had explained earlier, the conditions of dual-criminality must be met in order for the money laundering offence to be established. But they may have other activities, and it is not for us to speculate on what other activities they may be engaged in. We pay attention to them and, if they have done something that is against the law in Singapore, then, we will take the necessary actions.

12 Er Dr Lee Bee Wah asked the Minister for Manpower (a) in the past three years, what is the percentage of successful appeals for earlier withdrawal of payouts by CPF members who had to retire early; (b) what are the main reasons for disallowing the appeals; and (c) whether the Ministry will consider another option for CPF Life payments that start payouts at the minimum retirement age.

Mr Speaker, on reaching the age of 55, all CPF members are eligible to make Central Provident Fund (CPF) withdrawals of up to $5,000, subject to available balances in the Ordinary and Special Accounts. Those with savings above the applicable Full Retirement Sum can withdraw all the monies above that amount. Those who own a property may also withdraw their savings above the Basic Retirement Sum using property charge or pledge.

Under the Medical Grounds Scheme, CPF members may apply to withdraw or start their payouts before the CPF Payout Eligibility Age of 65. The eligibility criteria include being permanently incapacitated, terminally ill, or having a severely impaired life expectancy due to illness. Such applications have to be accompanied by the relevant doctors’ certification. In the past three years, about 65% of applications under the Medical Grounds Scheme were successful. The remaining 35% were not successful because applicants did not meet the eligibility conditions. Unsuccessful applicants were referred to other avenues of help, such as Workforce Singapore (WSG) and the Social Service Offices.

In the last decade, the employment rate for residents aged between 60 and 64 has risen from 47.2% in 2008 to 60.4% in 2018. The unemployment rate for the same age group has remained consistently below 3% in the past five years.

A contributing factor is the introduction of re-employment legislation in 2012, which made it an obligation for employers to offer eligible employees continued employment after the age of 62, up to the age of 65. Re-employment has made it possible for many Singaporeans to work beyond the age of 62. Of those eligible for re-employment and who wished to continue working, over 98% were offered re-employment. In 2017, the re-employment age was raised further from 65 to 67.

In 2018, a Tripartite Workgroup on Older Workers was formed to review, among other things, the longer-term relevance of and the next moves on the retirement and re-employment ages. However, as the CPF Payout Eligibility Age was raised to 65 only in 2018, the Ministry of Manpower (MOM) does not have plans to lower it. The Medical Grounds Scheme will also continue to be available to eligible members who may need to withdraw or start their payouts earlier than age 65.

Er Dr Lee Bee Wah.

I have one supplementary question. I am not asking the Minister to lower the payout age to 62. The majority are okay with the payout age of 65. But from time to time, there are residents who approach me. They are retired at 62, there are no "medical grounds" justification, they are healthy. What they do not have is money. So, they are asking whether CPF Board will consider another option. For the majority, the payout age is 65, whereas some can get it earlier. They are prepared to get a lower sum but at the retirement age of 62.

Mr Speaker, I am glad to hear the Member's clarification on what she is asking. If I heard the Member correctly, it is to make the payout eligibility age lower for some people who want it, but maintain it at 65 for the rest. May I ask the Member whether she thinks that it is possible for us to do that – allow some people to have a lower age, and then require other people to stick to the payout eligibility age of 65? The option has to be made available to all?

[(proc text) The hon Member Er Dr Lee Bee Wah nodded in agreement. (proc text)]

I see. I think we have explained it before. If you make early withdrawal an option for all, then, in effect, it is really a reduction of the payout eligibility age. Today, the payout age can already be voluntarily deferred to 70 but the payout eligibility age remains at 65. That is the earliest that the person can withdraw.

So, the substance of the Member's request is really not an option but a reduction. I hope I have correctly understood the Member's suggestion.

Yes, it is true that, currently, for those who want to extend and withdraw their money later, it is available as an option. It is only for those who have money who can afford to opt to withdraw their CPF money at a later age. But there are some who do not have money and they would like to withdraw earlier. So, we can have: Option 1, withdraw at 62 years and at much lower sum; Option 2, the current one, where withdrawal of the money is at age 65; Option 3, withdrawal of the money at 70 years old.

Mr Speaker, I think we can establish that the substance of the Member's suggestion is to reduce the payout eligibility age. Here, some international benchmarking could be helpful. By international standards, setting the payout eligibility age at 65 is not unusual at all. Among the 35 Organisation for Economic Co-operation and Development (OECD) countries, well over half have pension withdrawal age at 65 or above. In fact, the highest today, as far as I know, is 67. In light of increasing longevity, people living longer and the likelihood of them working longer, some countries have already set in motion the raising of the pension withdrawal age. In the case of the Netherlands, for example, the pension withdrawal age will go up from 66 to 67 in the year 2021. In the case of Denmark, it will go up, if I recall correctly, from 65 to 67 in 2022. In the case of Germany, it will go up to 67 by 2031.

Against such a backdrop, we must really ask if it is wise to lower our own payout eligibility age for all. There will be no option, it will have to be for all, especially considering how we now have re-employment legislation that puts an obligation on the employers to offer work up to 67.

My sense is also consistent with what the Member said earlier that most workers understand this. They understand we are living longer. In the last few months since we started the tripartite workgroup on older workers, I have met many union leaders. At the National Trades Union Congress' (NTUC's) suggestion, we did this in clusters – aerospace, logistics, healthcare, financial services and even the public sector – a very diverse group of workers. We talked about many things. The CPF payout eligibility age did not come up very much at all. What has been said very clearly is that the workers want the opportunity to work longer. This is also consistent with the focus group discussions that we held with members of the public. They want to keep working and save more. I hear these workers and I understand them. I want to be able to help make it happen.

At the same time, the employers have also expressed their concerns to me. They have worries about their increased obligations and their considerations. I think we must not also dismiss lightly.

The main priority for now is to build a tripartite consensus on the way forward. And this tripartite consensus concerns the retirement age which is currently 62, the re-employment age up to 67 today. The new tripartite consensus is an important one and it is the topmost of my priority this year. In this process, we take reference from what we have always done in the past, which is that the workers express their views, the employers express their views, and we try to find a common ground for the best way forward. That is how we did it with the re-employment age of up to 65 and then, subsequently, to 67. If we can have a good new tripartite consensus on the retirement age and the re-employment age, it will point the way forward for all of us that is helpful. I ask for some time to get this done.

13 Assoc Prof Walter Theseira asked the Minister for Manpower (a) whether the Ministry will consider making public the data on complaints of unfair employment practices received by the Tripartite Alliance for Fair and Progressive Employment Practices (TAFEP) or the Ministry that identify the employer, specific complaint, and action taken; and (b) what considerations the Ministry has in publishing such data or keeping such data confidential.

Mr Speaker, the Tripartite Alliance for Fair and Progressive Employment Practices (TAFEP) already publishes aggregated statistics on complaints of unfair employment practices. TAFEP and the Ministry of Manpower (MOM) received 450 such complaints a year on average between 2015 and 2017. The vast majority of complaints are claims of unfair consideration for Singaporeans or age discrimination. In investigating these complaints, TAFEP would engage the employers involved, and employers are generally cooperative. Most of the complaints arise because employers do not have a proper system to address internal grievances or are insensitive to the different needs and conditions of employees. For the former, TAFEP would help employers improve their internal practices and processes. For the latter, our priority is to resolve such complaints amicably in a way that allows both the employers and the employees to move on from the incidents.

Some complaints result in sanctions. These involve employers who are not cooperative with TAFEP or who are found to adopt unfair employment practices. MOM takes enforcement actions against such employers, including curtailing their work pass privileges.

MOM and TAFEP will consider publicising cases in situations of public interest or where the conduct is egregious, as we have done so in the past. However, while naming all errant employers publicly would serve as a deterrent, there could be unintended consequences, such as indirectly identifying the affected employees and breaching their privacy.

To raise public awareness and prevent unfair employment practices, TAFEP develops case studies from actual cases and educates employers through focused channels, such as TAFEP's briefings and workshops, to share contextualised learnings from specific cases. Employers can better understand and appreciate the need to adopt fair employment practices through such in-depth discussions.

Assoc Prof Walter Theseira.

Mr Speaker, I thank the Minister of State for his response. I think the concern here among the public is whether there is effective action taken when they make a complaint on discrimination. Of course, I understand the Ministry and TAFEP are doing all they can on this matter. But I suppose when many employers are not named specifically, when only case studies are made, perhaps the most erroneous are named, then perhaps, there may be the perception amongst discriminated against parties that not much is being done by the Government on this front. So, I would appreciate if the Minister of State could reconsider this policy of not naming, in general, employers in cases.

I thank the Member for his supplementary question. One thing that I wish to assure the Member and Singaporeans in general about is that TAFEP will assess every complaint that comes in, especially those that are based on facts, and certainly, where you have a formal complaint where the employee also identifies himself, puts a specific complaint on the employer. We will listen to both sides, the employer as well as the employee. In fact, to assure Members that action has been taken, from 2013 to 2017, MOM investigated, and we took action against 521 companies for discriminatory employment practices. Among the 521 companies, 300 or 58% received warnings, and 221 or 42% had their work pass privileges curtailed.

So, to a certain sense, Members can see from the number of complaints and the number of companies that we have taken action against, it is quite substantive. So, to a certain sense, Members can see that there is action being taken. And certainly, we have to be fair to both employees and employers to make sure that the cases are dealt with fairly.

Mr Saktiandi Suppat.

Speaker. I would like to ask the Minister of State a follow-up question with regard to the first question. Since the inception of TAFEP, has the number of complaints, in terms of discriminatory practices or in addition to that, increased over time? Can the Minister of State share the general trend of the number of complaints since the inception of TAFEP?

The Member's question relates to publicity, so I do not have the statistics from the time TAFEP was conceived. But as stated in my earlier reply, there has been 450 complaints a year on average between 2015 and 2017. So, that is the number we got.

Mr Patrick Tay.

I thank the Minister of State. I just wanted to give a suggestion. As TAFEP flags out annually the kind of complaints it receives, is it possible to outline it? If the Minister of State cannot pinpoint a company and name a company, then perhaps the type of companies, that is, the sectors, the nature of the complaints, what kinds of discriminatory practices or unfair practices and as well as the size of the company.

I thank the Member for his question. Mr Speaker, as I had mentioned earlier, we do share with companies in general some of the cases and contextualise. And, in certain cases where the situation can be egregious, we actually name the companies. So, we are not shy from naming companies. But to name every single one, well, there are different considerations. One, there are different levels of egregiousness. Two, you may end up breaching the privacy of the employers, especially if it is just one targeted. So, we have to be quite careful about the kind of cases we put up. But generally, we do contextualise and put up case studies for other companies. But certainly, we will consider the Member's suggestion.

14 Assoc Prof Walter Theseira asked the Minister for Education (a) whether the Ministry has studied whether the larger endowment funds held by older autonomous universities (AUs) result in differences in student educational resources, expenditure, and opportunities across AUs; (b) whether the Ministry will consider measures to help newer AUs build their endowments to provide their students and faculty with comparable resources; and (c) whether the Ministry has any measures to ensure that differences in endowments do not unduly affect the quality of education and research across AUs.

Mr Speaker, our autonomous universities (AUs) raise donations to build up their endowment funds, which generate a steady stream of investment income to supplement annual Government funding, student fees and various grants to support university expenditures.

Since 1991, the Government has encouraged donations to tertiary education by providing 1:1 matching grant. This was raised to 1.5:1 in 2010 for AUs. For the newer institutions, for example, the Singapore University of Technology and Design (SUTD), Singapore Institute of Technology (SIT) and Singapore University of Social Sciences (SUSS), the Government further enhanced our support to them by granting them sizeable seed monies to start up their endowment fund, as well as more generous matching grants at 3:1.

The sizes of endowment funds across the AUs differ today. They depend on the ability of the AUs to raise donations, investment returns and, of course, how long the AU has been in existence.

Government funding continues to be the main source of funding for university education. Regardless of which AU they are enrolled in, Singaporean students receive a subsidy of around 75% of costs. There is also an array of funding initiatives from the Ministry of Education (MOE) and other Government agencies that AUs can tap on to support projects and research.

The Government will continue to support every AU, both financially and otherwise, to provide the best education experience for their students.

Assoc Prof Walter Theseira.

Mr Speaker, I thank the Senior Parliamentary Secretary for his response and, of course, also MOE for funding the newer AUs generously.

The National University of Singapore, I understand, has an endowment of about $4 billion and the Singapore University of Social Sciences of about $400 million. And these endowment funds may be used by the universities to support scholarships, professorships, teaching and research. So, while I do not begrudge the more established universities for their success at fundraising and using funds, I do wonder if the Ministry could monitor the use of endowment funds to contribute to teaching and research, and if it results in disproportionate access or quality, if the Ministry could use that as a consideration when granting operating funds to the universities.

Mr Speaker, I thank the Member for sharing his concern. Indeed, this is what we do. In fact, we not only engage the AUs at the staff level, even my own Minister visits all the different AUs regularly, especially the newer ones. And when we discuss, we discuss issues like these and we monitor them closely. At the end of the day, we also want to support them at the initial phase and we want to journey with them to ensure that it is about a long-term horizon. We want to develop universities that can last for many years. The National University of Singapore (NUS) has been in existence for 114 years. And we want our newer ones to be like NUS and beyond, so that we can give the best education experience for Singaporeans.

15 Dr Intan Azura Mokhtar asked the Minister for Education over the past five years (a) what is the annual number of cases related to mental health issues reported to the Ministry involving (i) primary school students, (ii) secondary school students and (iii) post-secondary students; (b) how many have been diagnosed through referrals made by mainstream schools or the Ministry; and (c) how many have made requests for special provisions for examinations or other assessment-related issues.

Speaker, mental health issues occur in a variety of forms and severity levels. Some students remain undiagnosed due to lack of awareness or prefer not to disclose their condition for various reasons. Further, as medical diagnoses are confidential, schools and institutions may not be kept informed of the outcome following a referral. It is, therefore, difficult to determine the precise number of students diagnosed with mental health issues.

Mental health issues are on the rise internationally. The World Health Organization projected that mental illness rates will continue to increase. Students are particularly vulnerable as they grapple with significant social, emotional and physical transitions in their growing up years. Having said that, most do not develop mental health issues but need support, especially from their families, for personal issues.

Schools and post-secondary institutions also provide support to students regardless of whether they have a specific diagnosis. Our teachers and lecturers are equipped to look out for students in distress, provide timely support, and refer them to school counsellors for additional support where necessary.

On the separate issue of Access Arrangements for examinations, over the last five years, the annual number of applications for Access Arrangements across the Primary School Leaving Examination (PSLE) and GCE-level examinations that have indicated conditions, such as anxiety and depression, is very small, at between 0.1% and 0.2% of the cohort.

We are monitoring the levels of stress and taking systematic steps to take care of students’ well-being and strengthen their resilience. We are also working closely with parents to raise awareness on mental health, so as to encourage early identification and increase help-seeking for their children.

Dr Intan Mokhtar.

Speaker, I thank the Senior Parliamentary Secretary for the answers. I have two supplementary questions. Can I check whether the Ministry makes provisions for extra time for students who are diagnosed with conditions, such as anxiety or depression, when they take their examinations, very much like that for students who are diagnosed with dyslexia, for example? The second question is whether the Ministry would also consider alternative assessments, such as regular assignments rather than a one-time pen and paper test or examination, for such students who are diagnosed with mental health issues.

Sir, I thank the Member for the questions. Indeed, we take on a case-by-case approach in the cases that we come across. We want to see how we can help the students as much as possible, and that is what we do for the Access Arrangements which I have shared earlier. It also includes working with professionals and specialists, and we take on the advice from the specialists on what would be the best approach to provide that educational experience to the children. So, we will take in the Member's feedback and, at the same time, we will continue to help as many people as possible.

Order. End of Question Time.

[Pursuant to Standing Order No 22(3), provided that Members had not asked for questions standing in their names to be postponed to a later Sitting day or withdrawn, written answers to questions not reached by the end of Question Time are reproduced in the Appendix.]

Mr Speaker, on 6 August last year, I informed this House that I had convened a Committee of Inquiry (COI) into the cyberattack on SingHealth's database system. The scale of the cyberattack was unprecedented. The personal particulars of about 1.5 million patients were illegally accessed and copied. It was malicious. Prime Minister Lee Hsien Loong's records were specifically and repeatedly targeted. And there were serious implications for public health and safety, as SingHealth's database system is part of our Critical Information Infrastructure (CII).

Therefore, I convened this COI because the Government wanted a robust and transparent inquiry that would get to the bottom of this cyberattack and, in particular, the COI was asked to, firstly, establish the events and contributing factors and evaluate the incident response by the Integrated Healthcare Information Systems Private Limited (IHiS) and SingHealth. And secondly, to recommend measures to safeguard public sector information technology (IT) systems that contain large databases of personal data against similar cyberattacks.

The Committee conducted a rigorous and comprehensive inquiry over five months. They examined testimonies from 37 witnesses, including local and foreign experts, as well as 26 written representations from members of the public, professional associations, organisations and companies. The COI conducted 22 days of hearings which were opened to the public except when there were implications for national security or patient confidentiality.

The COI submitted its classified report to me on 31 December 2018. The COI also released a public version of the report on 10 January 2019 which my Ministry has distributed to Members of this House. The public report contains all recommendations and material findings from the full COI report. It only excludes highly sensitive information heard by the COI in closed-door sessions.

Mr Speaker, with your permission, may I ask the Clerk to distribute the notes on the COI findings and recommendations?

Yes, please. [Handouts were distributed to hon Members.]

At this juncture, on behalf of the Government, I would like to place on record our deep gratitude to the Committee for its hard work in undertaking a robust and transparent inquiry. I would also like to thank the Attorney-General's Chambers, investigators from the Cyber Security Agency of Singapore (CSA) and the Criminal Investigation Department (CID), and the Ministry of Communications and Information (MCI) officers who supported the COI, witnesses who gave evidence, as well as organisations, professionals and members of the public who contributed their views and suggestions in the course of the Inquiry.

Let me now highlight the main findings of the COI.

The COI has been candid in its report, which establishes the sophisticated nature of the attacker, but also gives a detailed and stark account of shortcomings at the staff and systems level that contributed to the failure to prevent the attack or limit its impact.

Specifically, the COI found that while SingHealth fell victim to an Advanced Persistent Threat (APT) group, the success of the attacker in obtaining and exfiltrating the data was not inevitable. IHiS and SingHealth should have been better prepared and more robust in their actions. If they had done so, the cyberattack could have been limited or even stopped. I will now go into the findings.

First, the COI found significant shortcomings at the staff level. IHiS staff did not have adequate cybersecurity awareness, training and resources to appreciate the security implications of their observations and to respond effectively to the attack.

Also, certain IHiS staff holding key roles in IT security incident response and reporting failed to take appropriate or timely action, even when there were clear signs of an ongoing attack. However, and this is noteworthy, the COI also commended specific IHiS IT administrators who were vigilant, noticed the suspicious activities and took the initiative to follow up.

Second, the COI found a number of vulnerabilities, weaknesses and misconfigurations at the technical level in the SingHealth network and database system which allowed the attacker to obtain and exfiltrate the data. Many of these could have been remedied before the attack.

Third, the COI observed that although SingHealth was ultimately responsible, it had no management line of sight with regard to the assessment of the cybersecurity risks. SingHealth lacked the necessary expertise and resources and was wholly dependent on IHiS, even at the management level.

The COI, having heard evidence from CSA, also established that the cyberattack was the work of a skilled and sophisticated actor bearing the characteristics of an APT group. This finding was corroborated by international expert witnesses. An APT group is a class of cyberattackers, typically state-linked, who conduct extended cyber campaigns to steal information or disrupt operations. The COI found that the attacker was well-resourced and had used advanced techniques and tools to target the SingHealth patient database and illegally exfiltrate patient data. The attacker was persistent, evaded detection for a long time and even re-entered the network after being detected.

Appropriate action has been taken, and we know the identity of the attacker. But for national security reasons, I will not comment further.

The detailed evidence for all of the COI's findings are in the public report, but it does not include highly sensitive information – pertaining to SingHealth's network architecture, technical vulnerabilities exploited in the attack, and the identity of the attacker – which is only in the classified COI report.

Turning to the recommendations. The COI has made 16 recommendations to strengthen SingHealth's patient databases, as well as public sector IT systems which contain large databases of personal data. Seven are priority recommendations which should be implemented immediately, and nine are additional recommendations which are to be seriously considered. The recommendations fall into four broad categories – People, Process, Technology and Partnerships.

On People, the COI notes that frontend users are often the weakest link targeted by attackers, and that it is line staff who are often the first to notice a security incident and respond. Hence, the recommendations include enhancing cyber hygiene practices, building a culture of cybersecurity across the entire organisation, and ensuring that IT staff are well-trained and equipped to respond to cybersecurity incidents.

The COI also calls for strong institutional Processes. In incident response, for example, there should be clear plans and standard operating procedures (SOPs) and regular exercises with realistic scenarios to test their effectiveness. There should also be regular and comprehensive checks to identify vulnerabilities and high-risk areas, accompanied by audit and compliance checks, to ensure that the identified gaps have been plugged.

On Technology, the COI has proposed various measures to strengthen cybersecurity to better prevent, detect and respond to future attacks. These include stronger encryption for data, heightened monitoring of database activity, and an integrated system to aggregate and analyse threat information in real-time and rapidly isolate and contain the infected system.

The COI has highlighted the need to build up collective security over our systems, given that Singapore is highly connected and a high-value target. This can be achieved by strengthening Partnerships between the Government, industry and international partners, in areas, such as threat intelligence sharing.

The COI has emphasised that, ultimately, cybersecurity must be an integral part of a broader risk management framework and cannot be treated merely as a technical matter. Organisations need to strike a balance between security considerations, operational requirements and cost, and these tradeoffs and decisions must be made at the Board and Chief Executive Officer (CEO) level, and not just by the Chief Information Security Officer (CISO) and technical staff.

Mr Speaker, the Government accepts all of the COI's findings and recommendations. Cybersecurity is a critical enabler of our Smart Nation ambitions. We will, therefore, fully adopt the COI's recommendations and do our utmost to ensure that our IT and database systems are secure, and that personal data collected by Government systems is well-protected.

I will now elaborate on the Government’s efforts, ongoing and in response to the COI report, to strengthen cybersecurity at both the national level and across the public sector. Minister Gan Kim Yong will cover the public healthcare sector’s efforts.

The Government’s approach to cybersecurity is underpinned by two key principles that have also been highlighted by the COI.

First, we adopt a "defence-in-depth" strategy, with multiple layers of cyber defences to impede an attacker. These layers of defence cascade from the perimeter to within our systems, as we recognise that a sophisticated and determined attacker, given enough time and resources, may find a way through. This is why we also have capabilities in our layered defence that enable swift detection of a breach and a decisive response.

Second, we seek to enhance our system defences by strengthening our people, processes and technology. Our aim is not only to monitor and respond robustly to an incident, but also to ensure a quick recovery and resilience in our system.

The COI emphasised that the battle against today’s cyber threats must be based on networked defence across organisations and sectors. The COI also recognised the Government’s commitment to such collective security, by establishing CSA to coordinate our national cybersecurity efforts. CSA leads our national-level response to the cyber threat, including by reinforcing cybersecurity in all CII sectors.

Immediately after the cyberattack, and even as the COI proceedings were underway, CSA instructed all CII sectors to strengthen network security by taking additional prescribed measures, such as removing non-essential connections to unsecured external networks and implementing uni-directional gateways like data diodes to prevent data leakage.

CSA also accelerated the implementation of the Cybersecurity Act, which provides the legislative framework for the oversight and maintenance of national cybersecurity. The Act came into force on 31 August last year and CSA designated all CIIs by 31 December last year. All CII owners must now comply with their obligations under the Act. These include adhering to essential cybersecurity measures set by CSA through the Cybersecurity Code of Practice, reporting cyber incidents to CSA within prescribed timeframes, and conducting regular risk assessments and audits of their CIIs.

In addition, CSA also instructed all CII owners through their sector leads to conduct thorough internal reviews of their cybersecurity posture against the gaps identified during the COI hearings. These included reviews of their people, process and technology measures, such as mandating cybersecurity training and awareness programmes, establishing a robust patch management process and implementing access management solutions to manage privileged administrator accounts. CSA has directed CII owners to implement plans to close any identified gaps and report the results.

CSA will continue to actively work with the sector leads and CII owners to reinforce their cyber defences and cyber resilience and safeguard the cybersecurity of our systems and networks.

I now turn to the cybersecurity of public sector systems, which is a key enabler for our Smart Nation initiatives to improve public services for our citizens and businesses. The Smart Nation and Digital Government Group (SNDGG) had already started enhancing the cybersecurity of Government systems before the cyberattack.

Upon discovering the cyberattack, SNDGG paused the rollout of new Government systems from 20 July to 3 August 2018. During this pause, first, SNDGG checked and confirmed that other systems were not breached by the same attacker, whether through the IHiS system or via a separate breach. Second, SNDGG and CSA reviewed the Government’s cybersecurity posture, and introduced additional measures on critical Government systems to enable us to detect and respond more quickly to cybersecurity threats.

The findings and recommendations of the COI give added impetus to our efforts to continuously review and enhance the cybersecurity of Government systems. In particular, the findings reaffirmed the "defence-in-depth" approach that the public sector had adopted towards cybersecurity. The public sector will also continue to strengthen our defences on all fronts – people, process, technology and partnerships – as informed by the COI recommendations.

In terms of people and processes, SNDGG will strengthen existing processes to prevent lapses and heighten vigilance. The public sector will use technology even more to support its IT staff and automate cybersecurity tasks, such as patch management, so as to carry out these tasks more reliably. SNDGG will further tighten internal checks and enhance security audits, for example, by increasing their frequency. We will also instil a stronger cybersecurity culture across the Public Service. This will be done by conducting more exercises to sharpen our officers' readiness and train all public servants in cybersecurity. Above all, we expect our officers at all levels to be aware of their responsibilities, to be accountable for their actions, and to perform their duties to the best of their ability.

On the technical front, SNDGG will continue to shore up defences at the perimeter of Government systems, while introducing measures to better detect and respond to intrusions within our systems. Beyond the measures implemented during the pause in the rollout of new Government systems, such as monitoring critical Government databases, SNDGG is also looking into improving the architecture of Government systems to enable more extensive monitoring and detection of abnormal activities.

We also recognise that the Government cannot strengthen its cybersecurity alone. Therefore, the Government will enlist the expertise of the larger cybersecurity community, including ethical hackers, to help us surface and detect vulnerabilities in our information and communication technologies (ICT) systems. The Government Technology Agency (GovTech) and CSA have launched a Government Bug Bounty Programme, and have invited local and international white-hat hackers to search for and uncover vulnerabilities on five Internet-facing Government systems and websites. This will help us draw in a wide range of expertise to help identify cyber blind spots and benchmark our defences against skilled global hackers.

In terms of tracking the follow-up, CSA will oversee the follow-up on the COI's recommendations across all CII sectors, which includes the public sector. To do this, CSA will work through the sector leads of the 11 CII sectors who are responsible to monitor implementation for their respective sectors and to report progress to CSA as the national cybersecurity authority. SNDGG, as sector lead for the Government sector, will monitor implementation for Government systems. We will then track overall progress via regular updates at the relevant Ministerial committees.

The Personal Data Protection Commission (PDPC) has also completed its investigations of the data breach incident. Both IHiS and SingHealth have been found to be in breach of the Personal Data Protection Act. PDPC has imposed a total financial penalty of S$1 million, comprising S$750,000 and S$250,000 on IHiS and SingHealth respectively. These are the highest penalties meted out by PDPC to date.

The measures recommended by the COI will help us defend ourselves better against malicious cyber activities, including from international attackers. This was not the first instance where we were targeted and it will not be the last. Our networks are continually probed for weaknesses and regularly attacked.

A cyberattack of the scale and sophistication that was launched against SingHealth could also be mounted on any one of our major IT systems, threatening the safety and security of Singapore and Singaporeans, which are of paramount importance. Singapore is firmly committed to the establishment of a rules-based international order in cyberspace. We condemn all malicious cyber activity that seeks to undermine the integrity of the international political and economic system and violates the norms of behaviour in cyberspace as set out in the 2015 United Nations (UN) Group of Governmental Experts consensus report. This includes the cyber-enabled theft of sensitive data. Such activities can have a disruptive impact on Singapore and internationally in our highly interconnected world.

Singapore has consistently advocated that the international community come together to build consensus and develop a rules- and norms-based international order in cyberspace, a cyberspace that fosters trust and confidence, and one where its users can remain safe and secure. This is consistent with Singapore's fundamental stand that a rules-based multilateral system is indispensable to secure peace and stability in the international arena. To this end, Singapore has been actively hosting and supporting regional and international discussions and cybersecurity programmes aimed at building consensus on the rules of behaviour in cyberspace. Singapore stands ready to work with all parties toward closer international cooperation in the cyber and digital sphere.

Mr Speaker, Sir, to conclude, the Government takes very seriously its responsibility of ensuring the cybersecurity of our systems that are vital to the provision of essential services. The findings and recommendations of the COI into the SingHealth cyberattack have helped to sharpen our focus and given further impetus to our efforts to secure our systems and databases, especially against a sophisticated cyberattacker.

But there is no permanent fix nor absolute cybersecurity. It is a constant battle against cunning adversaries with advanced capabilities. And we cannot let incidents like this derail our Smart Nation initiatives that can enhance our economic competitiveness and deliver better public services for the benefit of our citizens.

We will do our utmost to strengthen Singapore's cyber defence capabilities and prevent cybersecurity breaches. However, if a breach occurs despite our best efforts, we must have the capability to detect it quickly and respond robustly to minimise the damage. Our people must stay resilient in the face of such a continuing threat while doing their part for our cyber defence. We will learn from this incident, emerge stronger and uphold the trust of Singaporeans.

The Minister of Health will be making a related Ministerial Statement. I will allow Members to raise points of clarification on both Statements after this Statement. Minister Gan Kim Yong.

Mr Speaker, Sir, thank you for allowing me to make this Statement on the COI into the cyberattack on SingHealth's IT system.

The healthcare system’s foremost priority is our patients' well-being. This encompasses not just safe and effective care, but also the protection of their personal data. We, the healthcare family, have a responsibility to our patients to ensure both these aspects.

The cyberattack on SingHealth's IT system has resulted in the data of a large number of patients being illegally accessed. Once again, I apologise to our patients on behalf of our healthcare family. We are deeply sorry.

Minister Iswaran has provided a summary of the COI’s findings and recommendations. I would like to thank the COI for its comprehensive work and detailed findings on the incident.

I agree with the COI that we were lacking in several areas.

Some of our IT personnel did not have sufficient levels of cybersecurity awareness, training and resources to respond to the attack. Certain staff with key roles in IT security incident response failed to take essential actions, resulting in missed opportunities to prevent the attack or minimise its impact.

There were vulnerabilities in our IT system that were exploited by the attacker. Examples include servers that were not adequately secured against unauthorised access, and weak passwords and administrator account controls.

There were gaps in the management of IT assets, compliance with security policies, as well as inadequate remediation of known system vulnerabilities.

The public healthcare family needs to do much better. I welcome the COI’s wide-ranging recommendations. These have been touched on by Minister Iswaran. So, I will not go through in detail.

I will instead focus on the healthcare family’s responses and follow-up actions. The COI findings and recommendations will play an important role in guiding our actions and our cybersecurity direction going forward.

Following the discovery of the cyberattack, IHiS implemented several measures to tighten cybersecurity. These included: (a) creating firewall rules to block further malicious callbacks to the suspected command and control servers; (b) reloading servers with clean images to eliminate any remaining presence of the attacker; (c) disabling the tool used by the attacker to enter the network; (d) implementing temporary Internet Surfing Separation (ISS) for the public healthcare sector; (e) accelerating the deployment of Client Advanced Threat Protection (ATP) to public healthcare servers and endpoint devices. ATP identifies threats based on the techniques used by more advanced threat actors and is better able to detect customised hacking tools designed to bypass conventional defences; and (f) IHiS has also improved its incident response processes and SOPs, with clearer channels of reporting and escalation criteria.

Subsequently, in November 2018, IHiS announced further measures which are being implemented progressively across public healthcare agencies. Let me highlight a few key ones.

Database Activity Monitoring (DAM) has been implemented for the SingHealth electronic medical record database. DAM provides more comprehensive alerts and blocks database queries from unauthorised sources. DAM will be extended to the electronic medical record databases of all the other healthcare clusters by mid-2019.

IHiS has strengthened the security of domain controllers, by limiting login access and requiring two-factor authentication for administrative access. This has been fully implemented.

In assessing and developing these measures, IHiS had benefited from the inputs and advice of CSA. I would like to record our thanks for CSA's support.

Parallel measures were also taken by SingHealth in patient engagement. SingHealth took steps to contact more than two million patients and successfully reached around 97% of them. These include all patients who visited SingHealth Specialist Outpatient Clinics and polyclinics from the start of 2015 to the attack, including those whose data were not accessed, in order to reassure them.

SingHealth has since also taken steps to improve the accuracy of patients’ contact information for better patient engagement. For example, it has identified patients without valid contact details so that staff can update the patients’ contact details at their next visit. Since November 2018, SingHealth has been sending short message service (SMS) to all patients on the day of their outpatient appointments to remind them to approach counter staff to update contact details if there are any changes.

SingHealth will be sharing their learning points with the other clusters and we will be making similar improvements across public healthcare institutions.

On our part, MOH has initiated independent security reviews on key public healthcare IT systems to identify vulnerabilities and recommend measures to address them. At a broader systemic level, MOH has appointed a Cybersecurity Advisory Committee (CAC) to conduct a horizontal review of the cybersecurity governance structures and processes across the public healthcare clusters and IHiS.

The Committee is chaired by Prof Tan Chorh Chuan and comprises industry experts. It is supported by independent consultants from KPMG. The Committee has just submitted an interim update to me on the findings and recommendations. We will be studying these closely and will start pursuing key interim proposals even as the Committee continues its work.

Beyond our own plans and efforts, the COI report has provided us valuable inputs and useful recommendations. We will follow up on them, but I will highlight our thinking and plans in response to some of the key recommendations.

First, enhancing governance and organisational structures. The COI has recommended that we enhance our security structure and readiness across IHiS and the public healthcare institutions.

We need to better organise and govern our cybersecurity oversight and efforts and give cybersecurity considerations more weight in decision-making. It is an important area that is also being reviewed by the CAC I mentioned earlier.

CAC has highlighted the need for clearer cybersecurity risk ownership and accountability between IHiS and the public healthcare clusters, underpinned by a strong relationship to avoid fragmenting our healthcare IT strategy. It also highlighted the need to elevate cybersecurity roles and functions to strengthen management oversight over cybersecurity, supported with the appropriate resources and expertise.

MOH agrees and we will implement the following organisational changes in line with these guiding principles.

At the Ministry, the MOH Chief Information Security Officer (CISO) is currently also the Director of Cyber Security Governance at IHiS. We will separate these roles. The MOH CISO will be supported by a dedicated office in MOH and report to the Permanent Secretary. The MOH CISO office will be the cybersecurity sector lead for the healthcare sector. It will coordinate efforts to protect the CII in the healthcare sector and ensure that the sector fulfils its regulatory obligations under the Cybersecurity Act. For its part, IHiS will have its own separate Director of Cyber Security Governance.

At the clusters, the cluster Group Chief Information Officer (GCIO) office will now be made fully accountable to the respective cluster management and Boards. The GCIO office will be adequately resourced to carry out its roles. The position of the Cluster Information Security Officer will be elevated to report directly to cluster management and be accountable to the IT and Risk Management Committees of the cluster Boards.

Together, these moves will strengthen oversight and minimise potential conflicts of interest between cybersecurity and operational demands.

Second, we will put in place a cybersecurity model with multiple lines of defence. The COI has recommended that the public healthcare sector review our cyber stack for adequacy in defending and responding to advanced threats and subject the systems to tighter control and monitoring. The CAC, too, has highlighted the need for a more robust "Three Lines of Defence" model.

We agree and we will establish a more robust "Three Lines of Defence" structure within public healthcare.

The first line comprises units and personnel who develop, deliver and operate the IT systems. This is the Delivery Group. We will strengthen the IT delivery group to better integrate cybersecurity into IT delivery initiatives, improve the management of network security, and increase emphasis on security architecture and monitoring.

The second line of defence comprises units and personnel who have the specific responsibility to oversee security strategy, risk management and compliance. We will strengthen and elevate this second line of defence by establishing a dedicated Cyber Defence Group in IHiS headed by a senior leader at or equivalent to the Deputy Chief Executive level. The strengthened group will have independent oversight of cybersecurity implementation, compliance and risk management, and will oversee incident reporting and management. This will ensure that cybersecurity is managed at the senior management level, and an appropriate balance is struck between service delivery and cybersecurity considerations.

The third line of defence comprises checks and assurances independent of IHiS and our healthcare clusters, and independent of the first two lines of defence. MOH Holdings Group Internal Audit will continue to play this role. We also intend to commission and tap on independent third parties where appropriate.

These changes will make our public healthcare system more resilient and robust against emerging and evolving cyber threats.

Third, we will improve our staff’s cybersecurity awareness and capacity. The COI has made several recommendations in this area. We agree that the "people" element is foundational and critical to our cyber defences. Every user needs to be trained and equipped to understand the important role that they play in cyber defence.

For example, to raise the competence of our security incident response personnel, IHiS will engage specialist providers to conduct realistic hands-on "Cyber Range" simulation training starting this year. This will augment the classroom discussion-style table-top exercises currently conducted for security incident response personnel.

We will also tap on the expertise of the wider cybersecurity community to test our systems. IHiS intends to learn from GovTech's bug bounty and vulnerability disclosure programmes and start similar efforts. This will be a further step to ensure that our systems are tested, our people are ready to deal with new challenges, and our processes are robust.

Next, we will pilot a tiered model of Internet access. In its report, the COI has recommended that an Internet access strategy which minimises exposure to external threats should be implemented.

Following the cyberattack, temporary ISS was implemented across our public healthcare sector. This was a necessary precaution as suspicious activity continued to be observed on the SingHealth systems, even after initial containment actions were taken. I had mentioned in my previous statement in this House that we would study the impact of ISS, determine whether ISS can be kept as a permanent measure and if long-term mitigation solutions can be developed to overcome the operational challenges arising from ISS.

While the implementation of ISS was necessary, it has, indeed, posed challenges in the provision of patient care in some areas, such as emergency care, decision support for prescriptions and treatments, access to patient education resources and booking of clinical appointments. ISS also caused delays to frontline patient management and backend administrative tasks. Research and education initiatives in the public healthcare institutions have also been impacted by ISS.

Let me give an example. ISS impacted the functionality of Internet-based video conferencing software used to conduct tele-consultation with the National Neuroscience Institute for suspected stroke patients. This software was used by some of our hospitals which do not have inhouse specialist neurology capabilities as timely diagnosis is critical for stroke cases. A dedicated leased line to support high resolution video conferencing had to be provided to overcome this challenge.

Where possible, we have put in place fixes and workarounds like this to reduce the impact to patients and healthcare staff. I thank them for their cooperation and understanding during this period of time.

While we can continue to operate on this current model of ISS, we have also been looking for longer-term solutions that are more efficient and sustainable. We also need a solution that will allow us to implement new models of care in the future, such as telemedicine, that leverage the Internet to improve patient care and services in the community.

This is why we have been experimenting with a "Virtual Browser" solution, even before the cyberattack. A "Virtual Browser" allows access to the Internet through strictly controlled and monitored client servers. Let me explain what a "Virtual Browser" means. If we imagine loading a webpage or downloading a file from the Internet to be like receiving a letter, the client server is like a decontamination room where the letter is opened and only a picture is taken and sent to the recipient. The recipient reads the letter only via the picture that was taken and does not touch the letter itself. This process makes things safer for the recipient as malicious material or hidden messages are left behind in the decontamination room. Although such a solution does not fully eliminate cybersecurity risks, it reduces the attack surface significantly, while minimising impact on service efficiency and patient care.

Our earlier trial conducted at the healthcare clusters has shown that a "Virtual Browser" is technically feasible. Our next step will be to run a pilot in an operational environment across different settings and healthcare roles, so as to assess its effectiveness in meeting both operational and cybersecurity needs.

If the Virtual Browser is found to be effective, we envisage putting in place a tiered model of Internet access among our healthcare staff in the longer term.

For some job roles, Internet access would not be required. For example, administrative staff handling certain backend tasks, may not need Internet access for their routine work, and these staff will not be provided Internet access.

For a number of job roles, Internet access is required but can be managed through the use of separate Internet and non-Internet facing devices. This would likely be the case for the majority. ISS will remain for this group and they will have access to the Internet via a separate device. We will further improve our current arrangements so as to make it more convenient for this group of users.

For some, access to the Internet and intranet systems on the same device is essential. This group could include clinicians who need to access the Internet for information from clinical reference databases and match them urgently against patients’ electronic medical records, such as information on new and complex drugs or obscure toxins. The Virtual Browser may be the best solution for this group.

The pilot will begin this quarter at the National University Health System (NUHS). Virtual Browsers will be deployed in selected job functions at selected departments and clinics. Some of the job roles participating in the pilot include frontline pharmacists and emergency department clinicians.

Apart from this small group of pilot Virtual Browser users, all other public healthcare staff will remain on ISS for now.

The conduct and evaluation of the pilot is expected to take about six months. We will work closely with CSA to assess the cybersecurity adequacy of the solution. We will also evaluate the effectiveness of the Virtual Browser. This will enable us to make a more considered decision on our Internet access model in public healthcare.

Earlier, I mentioned that we have also started independent security reviews of other key public healthcare IT systems. One such system being reviewed is the National Electronic Health Record (NEHR) system.

Over the past few months, NEHR has been undergoing a series of cybersecurity assessments conducted by CSA, GovTech and independent firm PricewaterhouseCoopers (PwC). These cover technical architecture design and existing cybersecurity measures. In addition, we are completing a series of penetration tests to uncover any security vulnerabilities against cyberattacks.

The NEHR system will be subject to further testing and reviews, including exercises to test its defences against targeted attacks, as well as business continuity and disaster recovery plans.

I had informed this House in August that we would be deferring plans for mandatory contribution of patient medical data to the NEHR. As NEHR is an important large-scale national system, we want to be fully assured that all the necessary safeguards are in place to handle the evolving cybersecurity threat landscape. We will, therefore, proceed with the introduction of the Healthcare Services Bill first, and continue to defer the NEHR mandatory contributions until we have completed these reviews.

Even as we conduct the reviews, IHiS will implement further enhancements to strengthen cybersecurity of the NEHR system. These include software and application upgrades, additional preventive and detection measures, and enhanced process and technical controls.

Mr Speaker, Sir, the COI has identified inadequacies in specific individuals employed by IHiS in preventing and responding to the cyberattack. The IHiS Board has appointed an independent human resource (HR) panel to examine the roles, responsibilities and actions of specific individuals involved and recommend the appropriate actions to be taken. The panel was chaired by an IHiS Board member and comprised two other members from the public and private sectors with relevant HR and IT expertise.

In assessing the appropriate HR actions, the panel considered whether the officers had acted in accordance with their job responsibilities. It also considered whether the officers’ action or inaction had contributed directly or indirectly to the outcome.

The panel has submitted its recommendations to the IHiS Board and the Board released its decision on this matter yesterday.

To recap, two IHiS staff – the Team Lead of the Citrix Team and the Security Incident Response Manager – were found to be negligent and non-compliant with orders.

While the Citrix Team Lead had the necessary technical competencies, his attitude and approach to management of the servers introduced unnecessary and significant risks to the system. He could have mitigated the impact of the attack if he had enforced proper compliance and exercised effective management of the servers.

The Security Incident Response Manager persistently held a mistaken understanding of what constituted a "security incident" and when a security incident should be reported. His passiveness even after repeated alerts by his staff resulted in missed opportunities which could have averted or mitigated the impact of the cyberattack.

Their behaviour had significant security implications and contributed to the unprecedented scale of the incident. The employment of the Citrix Team Lead and the Security Incident Response Manager has been terminated.

Financial penalties were imposed on the two middle management supervisors who are accountable as supervisors of the staff that were terminated.

A Cluster ISO was found to have a wrong understanding of what constituted a "security incident" and failed to comply with IHiS’ incident reporting procedures. The Board decided to demote the Cluster ISO and reassign him to another role.

Let me now come to the IHiS senior management team. As the senior management team, they hold collective leadership responsibility over the organisation and the incident. They know this. IHiS CEO wrote a letter to me in December. In his letter, he expressed disappointment that he and his IHiS colleagues were not able to prevent or respond better to the cyberattack. He apologised for the incident. He and members of his senior management team acknowledged their collective responsibility. The CEO expressed that he would accept whatever the IHiS Board may decide for him.

The IHiS Board has decided to impose a financial penalty, higher than that imposed on the middle management supervisors, on the CEO and four other members of the IHiS senior management team. They have all accepted the penalty.

I have emphasised to the IHIS CEO and his senior management team to learn from this episode and lead the organisation and its staff through the recovery and rebuilding. I expect them to do their utmost to remedy the shortcomings and help the public healthcare family emerge stronger, so as to win back public trust. MOH and the rest of the public healthcare family will render them our full support.

The COI did not identify lapses in specific individuals that are employed by SingHealth. However, SingHealth recognises its duty to its patients and its responsibility as the owner of the database system. The SingHealth senior leadership, including the Group CEO, has volunteered for a financial penalty which the Board has accepted.

Sir, beyond these disciplinary actions and penalties on specific individuals, penalties have also been imposed at the organisational level. Earlier, Minister Iswaran had shared that PDPC has completed its investigations into the incident. PDPC has decided to impose financial penalties on IHiS and SingHealth, which comes to $1 million in total. This is the highest penalty meted out by PDPC to date.

IHiS and SingHealth have accepted PDPC’s decision and penalties. This is the right response.

Mr Speaker, Sir, in the COI report, several IHiS officers were commended for their diligence in handling the incident beyond their job scope and responsibilities. They were proactive and demonstrated resourcefulness in managing the cyberattack.

The IHiS Board has presented Letters of Commendation to three IHiS staff from the Database Management Team, SCM Production Support Team and Security Management Team respectively. Each of them showed commitment to serve and had the persistence to get to the bottom of things. I am glad that their contributions have been recognised. I would also like to acknowledge members of our public healthcare family who have worked hard together to ensure patient care is not compromised by this incident.

At the same time, I thank Singaporeans for their patience and understanding on the inconveniences they may have encountered at our public healthcare institutions arising from the implementation of tighter cybersecurity measures.

Mr Speaker, Sir, I have sketched out the responses of the public healthcare family to the SingHealth data breach and the COI report. The public healthcare family will ensure that priority and attention are given to the implementation of COI’s recommendations as well as the cybersecurity initiatives that the public healthcare system has embarked on.

We are organising our efforts into six key workstreams spanning technical measures, cybersecurity policy, organisational structures, governance enhancements, management of CII and patient engagement.

Senior management and key personnel from MOH, IHiS and healthcare clusters will lead these efforts. They will report their progress regularly to the Healthcare IT Steering Committee chaired by my Permanent Secretary. The Steering Committee will oversee the implementation and closely monitor its progress. It will also tap on independent auditors to verify the completion of the follow-up actions.

Mr Speaker, Sir, this cyberattack has been a regrettable and painful incident for us and for the affected patients. We must learn from it. But we must not allow it to hold back our push towards using technology to provide better care for our patients. IT systems have improved the safety and effectiveness of patient care. It remains a key enabler we cannot do without for better delivery of healthcare to benefit Singaporeans.

Yet, we recognise that the cybersecurity landscape has shifted and the threat level has risen. So, the cybersecurity posture of the healthcare sector needs to be correspondingly raised. This will not be a one-off exercise as new and evolving threats will continue to target our systems. We must continually fortify our defences, and we need a strong team working together to achieve this.

Mr Speaker, Sir, to conclude, I would like to thank the COI once again for its work and the comprehensive findings and recommendations. We in the public healthcare family will take guidance from the COI report and strengthen our systems and capabilities. We must and we will emerge with stronger cyber defences. This will be the most fitting way to fulfil our responsibilities to our patients.

Mr Cedric Foo.

Speaker, Sir, I have a supplementary question for the Minister for Communications and Information. I recall that he talked about three parallel investigations: the COI, the PDPC as well as the Police. Any update on the last of these, whether there are any criminal findings?

Mr Speaker, the three streams of activity: one is the COI, the report of which has been furnished; second is the independent investigation by PDPC which took reference from some parts of the public COI report and is now concluded, and penalties have been meted out; and third is the investigation by CID which has been closed without any further action.

Mr Christopher de Souza.

I thank both Ministers for their thorough Statements. Recommendation 4 of the COI states "enhanced security checks must be performed, especially on CII systems." My question is, what is the accountability mechanism for this? Essentially, who will regulate cybersecurity officers to ensure such checks are up to a professional standard and performed regularly? Further, what is the professional standard we are pegging the expectation to and how regularly will security checks be undertaken?

Mr Speaker, I thank the Member for his question. The mechanisms and the framework for doing such an audit and compliance is actually set up under the Cybersecurity Act and CSA which has oversight of the overall national cybersecurity effort, in particular, the work that is being done by the CII owners in the 11 vertical sectors, who will be the ones that oversee the execution and compliance, if you will, of the processes that are needed to continually strengthen our cybersecurity system. And, in that regard, CSA issues various directives and advisories from time to time. There is a Code of Practice that CII owners are expected to adhere to. There are provisions for regular audits, minimally once in two years but, if not, can be more frequent, if mandatorily required by CSA. And also, the audit will be conducted by an auditor that must be approved by CSA.

So, we have the framework in place. As I pointed out, these have all been enabled with the legislation that came into force in August last year and, now, in having designated the CII, CSA is operationalising it and we have a mechanism to follow through on the broader imperatives that CSA has mapped out and also on the implementation of some of the COI recommendations.

Prof Lim Sun Sun.

Mr Speaker, I would like to thank the two Ministers for their illuminating Statements. On the issue of ISS, it is encouraging that we are exploring the Virtual Browser option. But at the same time, during the exercise of ISS, I wonder whether there were instances of healthcare workers using their personal devices and data plans to access the Internet for work purposes and whether such practices introduced security risks and if, in future, there will be safeguards to caution our healthcare workers against these kinds of actions?

Thank you very much. Indeed, some of the healthcare professionals have taken the initiatives to use their own personal devices to access Internet for work. Because their personal devices are not connected to the intranet, to our database system and, therefore, they are less risky from the systems point of view. Whereas our own internal intranet system – we have imposed ISS on our own internal system and, therefore, our internal system will have no access to the Internet for surfing purposes.

Ms Rahayu Mahzam.

Speaker, I have a question for the Minister for Communications and Information. I appreciate that the cybersecurity regime and ecosystem are a fairly relatively new frontier. I am just wondering, as part of our review and assessments, whether we look to the practices and systems in other countries and whether we benchmark ourselves against the technological capabilities as well as rigour and practices in those countries?

Mr Speaker, the answer is yes. Obviously, because it is a highly interconnected world that we live in, in a sense, while we do what we can in our own jurisdiction, we also have to take reference from what is happening elsewhere. Indeed, that is why cybersecurity agencies across the world formed these partnerships to share information and also to share best practices because the threat is an evolving one. I think that is the way we continue to ensure that we are plugged in. So, the short answer to the Member's question is yes, we do. But having said that, the onus is on us to ensure that we are up to the mark, and I would add that many countries look to Singapore for best practices.

Mr Vikram Nair.

I thank the Ministers for the comprehensive replies and the report which has been a very good learning experience for all of us. But the one elephant in the room, of course, is the decision that was made not to name the perpetrator. I have two questions related to this.

First of all, what actions, if any, can be taken against the perpetrators of such attacks? And if the answer to this is "none at the moment", can we change our domestic laws at least, so that if any of these perpetrators are within our jurisdiction, we can take action against them?

Mr Speaker, I thank the Member for his questions. If I may reiterate my earlier response: we know the identity of the perpetrator. We have taken appropriate action. But it is not in our interest to make a public attribution, and it is not because we lack the legislative capacity to do so, if indeed it is within our jurisdiction.

Dr Chia Shi-Lu.

I also want to echo my thanks to both Ministers and also to the COI for their work. Three questions to the Minister for Health. First, while we are trying to strengthen the systems, if we take a leaf from how we manage infectious diseases while we are trying to think of better treatments and so on, I think a key focus would be surveillance, that means detection and containment. So, there was some talk about the advanced threat protection and other systems to detect the systems and, as I know it, our healthcare system has hundreds of computer systems, not just in SingHealth but also the private sector. Could I just ask what is the extent to which these detection systems have been deployed through the national healthcare system, just to get an idea? Because there are other healthcare systems out there that could still be vulnerable and may not have these systems. I just want to have an idea about that.

Second, there was a point in the COI which merits study, which is the impact on patient care. Can I also find out what has been the work of MOH in looking at the impact that this cyberattack has had on patient care efficacy and efficiency?

Third, I am also concerned about the impact on the rollout of NEHR. It is something that is very useful. I think it is something that we should all have. It is for the future of Singapore's healthcare. So, in terms of the study on NEHR, could I get a sense of what sort of goals we are looking at in terms of the assessment of whether or not NEHR will be safe in terms of cybersecurity threats and so on, so that maybe we have an idea how long this may be delayed?

Sir, as I explained earlier in my speech, Advanced Threat Protection has been implemented in our healthcare system, generally. So, it is there to help us detect potential malicious activities. But for the private sector, it is something that we will have to work with them and see what would be applicable for them. But it is also important for us to always remember that whatever system we put in, there will always be the risk of exposure. The greatest risk for us is to assume that after putting in Advanced Threat Protection or ISS, we are quite safe and, therefore, we let our guard down. So, we always must remember "道高一尺，魔高一丈". That is, you must always be on alert and assume that we are being attacked all the time and be vigilant and get to know what is the latest development, what is the latest landscape, and continually upgrade ourselves to make sure that we are ready for them as best we can. So, this is a lesson we learnt from this incident.

Dr Chia Shi-Lu also asked about the impact due to this incident. Some patient care, some processes have been slowed down because of additional steps that they have to go through. But by and large, we have not compromised the quality of care. And particularly on patient safety, we have been quite conscious about this. I have always reminded our cluster leadership to make sure that despite all the additional cybersecurity measures, we cannot compromise our patient safety. So far, I think it has been going on all right.

On NEHR, I agree with Dr Chia Shi-Lu that we do not want to delay it unnecessarily. But given that it is a very large system and a very important national system, we want to be extra cautious to have it tested and tested again before we make it mandatory. We foresee that we will probably be able to complete our review within this year and then we can make a decision at the end of this year to see when we are ready to implement then because the process is still ongoing. This is an indicative timeline and we will probably give an update nearer the time.

Mr Murali Pillai.

Speaker, Sir, I have a question for the hon Minister for Health in relation to the relationship between IHiS and SingHealth and, for that matter, the other healthcare clusters.

I note that PDPC had fined SingHealth in its capacity as a data controller. But IHiS, which is owned by MOH Holdings (MOHH), is a nominated agency to deal with IT matters for all healthcare clusters. So, how would these two entities work to strike a balance between operational needs on the one hand and to maintain cybersecurity on the other hand? Do they work as equal partners, or would there be another arbiter to deal with any differences between these agencies?

Sir, I explained in my speech the significant reorganisation of IHiS, the cluster IT organisation, as well as MOH. Let me just quickly focus on the questions that the Member raised. Particularly within the cluster, currently, the GCIO is an IHiS staff and, therefore, there is a question: does he have sufficient resources, does he report to IHIS or does he report to the cluster? So, we have made it clear now that the GCIO in the clusters will report to the Board and the management of the cluster. So, he may be a secondee from IHiS, he may be a direct recruit, he may be someone that is loaned to the cluster, but his responsibility and accountability is towards the cluster. So, this provides the cluster some independence from IHiS as a system operator.

Particularly on security, the Cluster ISO now reports directly to the management, he does not report to the GCIO. So, security and operations now have separate reporting lines, and this provides significant independence between security considerations as well as operational requirements.

Within MOH, I mentioned that we are going to set up a separate Chief Information Security Officer (CISCO) which would report directly to the Permanent Secretary. And this will also be quite separate from IHiS' Cyber Defence Group.

So, I think the separation of roles among these few key functions will provide greater independence and check and balance between operational needs and cybersecurity needs.

Mr Png Eng Huat.

Speaker, this is for Minister Iswaran. The public version of the COI report is comprehensive on the technical facts of the cyberattack and also recommendations to prevent a repeat of such an incident. But it has fallen short on the damage control for the victims of the cyberattack. Imagine if someone were to receive an email/SMS and now, possibly, a hardcopy letter, purportedly from SingHealth or even CSA, stating his name, National Registration Identity Card (NRIC) number, date of birth, gender, race, to name some of the stolen data, and asking that unsuspecting person to call or to go online to verity some information because someone has given him wrong medication or some innocuous matter, life is going to be hell for this person if he were to make the first contact and fall victim to the scam.

So, my first question is, in the aftermath of the cyberattack, why did CSA say that there is no strong commercial value for such data when the danger for loss of privacy and financial for our victims of this cyberattack is clear and present?

To summarise, what is the Government going to do next to assure and alert this group of victims about such a danger? Because telling the victim to make a Police report is rather moot after they have suffered financial/privacy loss because it is very difficult to investigate cross-border cybercrimes.

Mr Speaker, I thank the Member for his questions. It is a reasonable concern. Let me start by saying that in the aftermath of the incident, we have been monitoring the Dark Web to see whether the data that had been exfiltrated has emerged in any form, and, to date, there has been no evidence of that.

Secondly, the kind of scenarios that the Member has highlighted about people being approached for personal data and so on and to verify, these actually have been occurring even before the cyberattack and they occur in different contexts. Because the way some of these scams, as the Member put it, are being perpetuated, is not just depending on this particular kind of incident. They are approaching it from different angles, using different resources at their disposal.

So, on the one hand, we are doing everything we can in taking it absolutely seriously that this has been an incident that we should not have allowed to happen. But it having happened, we want to contain it and ensure that every measure is put in place to protect the interests of the patients. So, if Members recall, SingHealth has made an extensive outreach to all the patients through SMSes and so on to inform them and also to advise them of the risks and what they need to do and why they can be assured in terms of the security of their data.

The second point I would make is, we have been emphasising, not just CSA, but the Government as a whole, whether it is this incident or any others, we have, each and every one of us, an obligation to exercise appropriate cyber hygiene habits. And that means if you have an unsolicited call seeking personal data, then our antenna should go up and we should be taking appropriate steps to ensure that this is a bona fide approach and not something that is a scam that is trying to take advantage of us.

So, first, and if I can summarise it, overall, the data, we are monitoring the situation. There is no evidence to date in terms of its use or emergence in the Dark Web.

Secondly, our agencies and, specifically, in this case, SingHealth, have reached out to all the patients to inform and advise and also, where they have had queries, they have been able to approach SingHealth.

Thirdly, we have, in general, an important and repeated advisory on appropriate cyber hygiene habits that should be undertaken by all of us.

Mr Patrick Tay.

I have two questions for the Minister for Health. Firstly, I wish to ask the Minister for Health if IHiS, which is a unionised company of the Healthcare Services Employees' Union, has notified and heard the union before taking action and meting out punishments to the affected employees because this is to be done regardless of whether they are or not union members.

Secondly, with regard to the financial penalty of $1 million imposed by PDPC on SingHealth and IHiS, I urge and appeal that the salaries and bonus of the workers in both organisations will not be affected as a result.

Sir, I do not know whether they have informed the union. I will inform the management. I agree with Mr Patrick Tay that it is a good practice whenever these incidents happen and we have to take disciplinary action, it is best to keep the unions informed. I do not know whether they are union members. And if they are, it would be useful for the management to keep them informed. And if they have not done so, it is still not too late. Better to do now than not to do so at all.

Secondly, the Member asked about the bonuses of IHiS staff and SingHealth staff. I think other than those I mentioned as part of the disciplinary action, the rest of the staff should not be affected. Should they continue to do well, they should continue to get what they deserve. And for those who have done well, their contributions will be recognised at the end of the year.

Dr Lily Neo.

Mr Speaker, Sir, I would like to declare that I am a medical practitioner. May I seek clarification from the Minister for Health on the implementation of the recommendations he mentioned earlier. Will MOH also assist private practitioners in coping with this cyberattack, especially those who are already embarking on NEHR? My concern is that cyberattacks on NEHR in the private sector may be linked to the public sector's. So, if there is a soft part in this area, will that affect the whole public sector in the end?

I would also like to echo Dr Chia Shi-Lu's question earlier whether the Minister will ensure that the NEHR is robust before it is widely implemented, to give confidence to patients and doctors.

Sir, I agree with Dr Lily Neo that it is important for us to ensure that NEHR is robust before we make it mandatory for data submission. Dr Lily Neo also mentioned how we can help private sector doctors, particularly if they are connected to NEHR. Indeed, we are aware that there is a risk, because we have many private operators which have to tap on to our NEHR in order to submit their data, and that is why we are taking additional precautions to test our NEHR cybersecurity and cyber defences to ensure that they are robust before we require everyone to submit.

At the same time, we will also be developing advisories to help advise our private practitioners how to strengthen their system, how to do audits on their system to ensure that their own systems are protected. We must remember that even without NEHR, many of our doctors have their own data system and keep their own patient records. Of course, these are limited to their own patients, not national data. Nevertheless, it is also important for our private doctors to ensure that the patient data that they collect and maintain are protected from potential cyberattacks.

In the past, our doctors may be using paper and pen, they have paper card records, it is less risky. But still, the sense of responsibility to safekeep these data is there among our medical practitioners. I think it is no different when it comes to electronic records. When doctors have their records kept in an electronic form, they should be quite mindful that they are also responsible to ensure that such electronic records within their own premises where they are kept, they also have to ensure that they are protected to a satisfactory extent.

So, we will help them. We will give them advice from time to time, especially arising from this incident. We will give them general advice on what they ought to do to ensure that their databases are protected.

Ms Irene Quay.

Sir, I thank both Ministers for their detailed Statements. While we understand that there are deficiencies and they will be implementing comprehensive recommendations, we must not forget that our IHiS staff have been working very hard and performing their best over the years as we move towards a Smart Nation. So, can I ask what are the resources – as we are piling them up with more recommendations and more work – as well as emotional support that we are rendering to these ground IHiS staff while they are going through this trying period, to boost their morale as we learn and move forward stronger together in this Smart Nation journey?

Thank you! I would like to thank the Member for her encouragement. Indeed, IHiS has been working very hard over the last few years in reorganising itself, strengthening its governance, as well as rolling out many major systems. But this is an important incident and it is a very critical and regrettable incident and, IHiS' staff morale has, indeed, taken a toll from this incident. We will continue to support them.

As I have mentioned in my speech, even as they go through the reorganisation, going through the repositioning, reprioritising, MOH and all our clusters will extend our full support for them and we want to encourage them to soldier on because there are still many important tasks ahead of us, and not the least, the implementation of the recommendations of the COI. On top of that, there are still many systems that they have to deliver and they have to deliver them with strong cybersecurity measures.

So, I would like to thank the Member for her encouragement, and will convey this to the IHiS team and to encourage them to press on with our task. Thank you.

Mr Cedric Foo.

Mr Speaker, Sir, I empathise with my colleague Mr Vikram Nair's view about the non-attribution of the identity of the perpetrator. It seems that the COI process has been very robust. It has been thorough, rigorous, public, transparent, and open. This will go some way to restore public confidence from the incident itself. However, even with recommendations on strengthening defences, the "vault", and many other areas, the person who actually "broke into the house" was not revealed. There seems to be a vacuum as far as the sense of justice is concerned. I am sure the Government's position was well-calibrated and considered, but perhaps the Minister can share more on the considerations of the Government for not revealing who the perpetrator is.

Mr Speaker, I think the Member's question, if I can put it in a broader context, is that, first, this incident has occurred. The basic question we have to ask ourselves is how do we ensure that Singaporeans continue to have trust and confidence in our public sector systems – IT systems and databases – because it is inevitable that when you have an incident like this, it will raise such qualms and questions. And I would say that in deriving a sense of confidence, our citizens should be looking at the totality of our response and not focus on one particular aspect of the response. Let me elaborate on what I mean.

Firstly, why do we collect data and have these IT systems? Because they enable all these services, conveniences that we take for granted, whether it is in our transportation system, our healthcare system, in our dealings with various other Government agencies. The fact that we can transact with ease and convenience is because it is enabled by data and the IT systems that we have. So, firstly, we are doing this because we want to serve the interests of our citizens.

The second point I would make is that, directly as a result of this, we should be looking at what has our response been, the Government's response to this. In that regard, I would highlight a few things. Firstly, we made the knowledge of the cyberattack public within days, if I recall correctly, 10 days after it was brought to the attention of CSA. I think it was 10 July that it was brought to the attention of CSA, and on 20 July, Minister Gan Kim Yong and I held a press conference and we announced it and shared it with members of the public. Why do we do that? Because we want to demonstrate that we are transparent and we want to ensure that all Singaporeans understand that we have nothing to hide here. We want to get to the bottom of it as much as Singaporeans do.

Thirdly, if Members look at our response thereafter, we appointed a COI. Why do we appoint a COI? Because the Government wants a robust and transparent investigation and inquiry into the matter, not because we want to lay fault – although if there are, those who have been negligent or egregious, then they have to be accountable – but also because we want to learn from this, understand what went wrong and rectify them. So, if Members look at the COI report, we have released all the recommendations and material findings in full in the public version. The only parts that have been held back are those that pertain to sensitive national security matters and also patient confidentiality. Everything else is out there – unvarnished, stark but very clear on what we need to get done. So, again, if Members contrast what we have done with the responses in other domains by different parties, I think we can hold ourselves up to the best practices and standards in terms of how we responded.

Finally, what are the actions we have taken? Apart from action against individuals, we have taken actions against the organisations and we have also undertaken a slew of activities and measures in order to further strengthen our cybersecurity system, some informed by the COI, others that our agencies have already been working on.

That is the totality of our response. And I do not think we should reduce whether we have confidence in the sense of justice to just one specific point, that there is no public attribution of the perpetrator. I can understand that Members have a desire, and on behalf of their constituents, to know this, but I think we have to exercise judgement as to what is in our national interests and whether a public attribution serves our best interests. And as I have said, we know who the perpetrator is and appropriate action has been taken.

Order. End of Ministerial Statements. Introduction of Government Bills. Senior Minister of State for the Environment and Water Resources.

[(proc text) "to establish the Singapore Food Agency, to repeal the Agri-Food and Veterinary Authority Act (Chapter 5 of the 2012 Revised Edition) and the Cattle Act (Chapter 34 of the 2002 Revised Edition), and to make consequential and related amendments to certain other Acts", (proc text)]

[(proc text) presented by the Senior Minister of State for the Environment and Water Resources (Dr Amy Khor Lean Suan); read the First time; to be read a Second time on the next available Sitting of Parliament, and to be printed. (proc text)]

[(proc text) "to amend the National Parks Board Act (Chapter 198A of the 2012 Revised Edition) and to make consequential amendments to certain other Acts", (proc text)]

[(proc text) presented by the Senior Parliamentary Secretary to the Minister for National Development (Ms Sun Xueling); read the First time; to be read a Second time on the next available Sitting of Parliament, and to be printed. (proc text)]

[(proc text) Order for Second Reading read. (proc text)]

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

Last year, there was a Parliamentary Motion filed by Mr Christopher de Souza. It was titled "Strengthening Singapore's Fight Against Drugs". A number of good observations were made. There were suggestions on how we can respond to challenges in the fight against drugs in the drug situation that we were and are facing. Several Members also made good suggestions on how we can improve our approach to rehabilitation, how we can involve families more in the rehabilitation process and how we can provide better support for abusers after they have been released.

Sir, there have been changes in the operating environment, with feedback from Members and stakeholders. We have looked at these carefully and we have been analysing the situation and also looking at the evidence that we have been collecting in our dealings with abusers both in the Drug Rehabilitation Centres (DRCs) and post-release. And the current amendments arise from that set of factors. So, these amendments to the Misuse of Drugs Act (MDA) have two primary focuses in broad categories.

First, we will enhance our anti-drug framework. They will make some additional actions offences; they will give some greater enforcement powers. The second part of it, they will give a much greater focus on rehabilitation and move away a little bit from the philosophy of long-term detentions.

Sir, if I can deal with the first point first, on the enhancement of the anti-drug framework and the increase in the enforcement powers. We will make some actions, including actions which we will categorise as contamination offences. There is a range of contaminative behaviours that may not meet the current definition of trafficking or abetment, but they contribute to the spread of drug abuse. And in that way, they harm others.

So, clause 3 introduces a new set of offences which targets acts of contamination. The proposed new section 11C will make it an offence if you introduce a person to a trafficker, and if you know or have reason to believe that the person intends to procure or consume drugs and the trafficker is likely to supply them. One example would be a student who offers to introduce friends to a trafficker to buy cannabis. The student himself does not take cannabis, did not take part in the transaction, but he facilitated his friend's drug consumption. We have to try and deter such conduct.

Section 11D(1) will make it an offence if you were to teach, instruct, provide instructions to another person, on the carrying out of drug activities. They could be activities like consumption, cultivation, manufacturing, trafficking, importing and exporting, knowing or having reason to believe that the person intends to carry out such drug activity.

Sections 11C and 11D(1) will have a mandatory minimum imprisonment sentence of two years for subsequent convictions and a maximum imprisonment of 10 years. There will be no mandatory minimum for the first conviction.

Now, supposing the perpetrator has no knowledge of the recipient's intent to commit a drug activity, nevertheless, the perpetrator has still caused harm. He has spread information on the carrying out of drug activities. So, clause 3 will have a section 11D(2), which will make it an offence to disseminate or publish information on the carrying out of any of the drug activities – those which I mentioned earlier.

So, this can cover a range of behaviour, from the irresponsible – like putting out or posting information on how to manufacture drugs, and if you were to put it up on social media where others can see it, to the downright malicious, like trying to teach and influence friends into taking drugs with one. We have to try and stop such behaviours.

Section 11D(2) will impose a maximum imprisonment of five years or a fine of up to $10,000 or both, for first-time convictions. If there are second or subsequent convictions, there will be a mandatory minimum sentence of one year.

When you criminalise with this framework, you need to provide a proper set of defences. Defences would include legitimate purposes, like administration of justice, science, medicine, education, art. So, if you did this for any purposes of any of those, then there could be exemptions. Subsidiary legislation will set out scope of authorised activities which will not be caught by the contamination offences I just spoke about, and clause 20 provides for that.

Clause 3 introduces new offences. This is aimed at better protecting our children. So, if you would look at section 11B – if an adult possesses illicit drug and then, knowingly or recklessly, leave it within the reach of a child, access of a child, that would be an offence.

If an adult permits a young person to consume drugs which are in the adult's possession, or does not take reasonable steps to prevent that from happening, that would also be an offence – the young person is under 21.

One example: in October 2016, or two years ago, we had two young children, aged two and four; they accidentally consumed their father’s drugs, fell unconscious and they were rushed to the Accidents and Emergency (A&E) department.

The new offences would carry imprisonment of up to 10 years for first-time convictions, and a mandatory minimum imprisonment of two years for subsequent convictions.

Moving on to a different point, we will also mandate that parents and guardians of young drug abusers where the young drug abusers are under the Central Narcotics Bureau's (CNB’s) supervision order, the parents/guardians must attend drug counselling. Clause 19 will provide for this.

At present, parents and guardians are required to attend counselling, but some parents persistently absent themselves. CNB will, even after the new legislation comes into force, understand their context, try and understand why they do not want to come, and will use these powers very sparingly. But as a last resort, if the parents and guardians refused to be involved in their children's counselling without reasonable excuse, then they can potentially be exposed to charges.

When there is a young drug abuser, the impact is on that person, and on the rest of the society. It cannot be just the State's responsibility. The parents must bear some responsibility, too, and they must come in and try and help. The State provides the counselling, so they should come in and take the counselling and see how they can help their children.

Next, we move to hair analysis and oral fluid testing. In 2012, we introduced hair analysis in the MDA as an alternative drug detection tool. Urine tests are able to detect only drugs that had been consumed within the week. Hair analysis goes further back; it can detect drugs which had been consumed earlier. Hair analysis now applies to the monitoring of those under supervision. The Health Sciences Authority (HSA), in its research and science, has enhanced the effectiveness and reliability of hair analysis. So, we will expand its use.

Clause 18 gives the Director of CNB the power to subject an abuser to rehabilitation and supervision based on the positive result of an hair analysis. So, if you are tested positive on hair analysis, you can be directed for rehabilitation and supervision orders. If a person fails to provide hair specimens, then he or she will face the same punishments and liabilities as a failure to provide urine specimens. So, these persons, if they intentionally refuse to provide the required specimens for testing with no reasonable excuse, then they can face charges.

We are also introducing the use of oral fluid, saliva, to test for drug abuse. This is clause 15 of the Bill with a new section 31B. So, enforcement officers can require a suspected abuser to provide oral fluids for the purpose of testing. The punishment can be a maximum of two years' imprisonment, a $5,000 fine, or both, if there is a failure to provide.

But the testing of oral fluids is for the purpose of immediate and effective and efficient screening of suspects, particularly in the context of a mass raid or large crowds. Officers can then prioritise individuals who require further hair or urine testing.

Oral fluid tests will be an efficient method of screening; they will not be used for prosecution or emplacement on rehabilitation or supervision. So, they are screening tests. We will continue to rely on urine or hair tests for the purposes of rehabilitation orders or supervision orders.

Those are the aspects in which the Act is proposed to be changed in terms of increasing the powers, enforcement powers, or adding in some new offences.

Now, let me move on to the rehabilitation aspect of the Bill. Drug abusers today, arrested for the first and second time, go through rehabilitation, which is mandatory, in DRCs. We call it DRC1 and DRC2, first time and second time.

It is done through orders made by the Director of the CNB under section 34 of the MDA. There is no criminal record for DRC1 and DRC2.

The Long-Term Imprisonment (LT) regime was introduced in 1998. That targeted hardcore abusers, who, at that time, formed three-quarters or more than three-quarters of the abusers who were being arrested. The purpose was to punish, but also to deter their drug use because everything else has been tried, but it was not possible to keep them away from drugs. They were getting into drugs, and they were contaminating others, and the problem was spreading. So, it was to protect the public from abusers who turned to crime to feed their drug habits as well.

So, third-time abusers face mandatory imprisonment of five to seven years, and three to six strokes of the cane. Fourth time and beyond: seven to 13 years in LT. In LT2, six to 12 strokes of the cane.

So, from the beginning of the LT regime, together with other efforts on the enforcement side as well as the rehabilitation side, the drug situation in Singapore has improved. The number of drug abusers arrested each year: in 1996, roughly, just under 6,000 to now, slightly over 3,000 in 2017. So, you can say, it is about halved, which is, as I have said in other fora, quite a remarkable record because all things are not equal. People's ability to afford drugs has increased, the amount of drugs being produced in the region and available internationally has increased, so, all things being equal, the number of arrests should have gone up, not gone down. So, it is a testament to the way CNB has worked. But it is not just CNB. The entire framework has worked to help our people keep off drugs. Education, prevention, a strong enforcement, an efficient CNB, an efficient legal framework – all have worked together. And the strong support that has been given, both in this House and outside, by the public, for the stand we have taken.

At the same time, over these years, Singapore Prison Service (SPS) and the Singapore Corporation of Rehabilitative Enterprises (SCORE) have stepped up support for abusers. They include high-intensity psychology-based programmes, especially for those with a higher risk of reoffending. They were also given skills training and work programmes. In 2014, we introduced the Mandatory Aftercare Scheme. So, we target the higher-risk offenders, and they will be given compulsory structured programmes even after they are released. After their release is when they are at the highest risk.

Throughout this period, the evidence that we have been collecting, we have been studying how to bring down recidivism down even further. Our assessment is that, for pure abusers, we can now afford to shift our balance quite decisively and focus more on rehabilitation as opposed to detention. We all know that long periods of detention can affect the abusers' employability after they are released. They are in for seven years, or 12 years or 13 years; when they come out, their ability to reintegrate back into society, their ability to hold down a job, there is a lesser ability.

So, really, the question is, how do you strike the balance? What is the risk of allowing them into the community without long-term detention versus the consequences of keeping them in long-term detention?

In 1998, we said, looking at the numbers and the way the problem was going, we have to go for long term, and one or two other number of significant factors then, too. Today, looking at the numbers and the profile of detainees, and looking at how we are managing, we think we can afford to take the risk and let them out from DRC into society faster, without going the long-term detention route.

The answer as to where you strike the balance depends on a variety of external factors. Our view is that the situation has now changed compared to 1998. So, SPS has been studying this. Our two-year recidivism rates for LT inmates are encouraging. The recidivism rate for the 2015 cohort is 27%. That is down from 35% for the 2008 release cohort. Significant. But, unfortunately, the five-year recidivism rate for LT inmates remains high at over 60%. What that means is that within five years of their release, six out of 10 of the LT inmates will be back in prison.

Addiction is a complex problem. Staying clean is ultimately dependent on a variety of factors, including the resolve of the abuser. But it is a difficult journey for the abusers. Often, they become estranged from their families, communities and the workplace. It is harder for them to reintegrate once released. A number get back into bad company, on drugs, and then they get re-arrested at various points; the cycle repeats itself over and over again.

So, we have decided, let us try and distinguish between those who only consume drugs – I call them the "pure" abusers – and those who also face charges for other offences, for example, trafficking, property offences, violent offences. So, if they have abused drugs and they have committed some of these other crimes, we put them in one category. We put those who only abused drugs in one category.

For the second group, those who consume drugs and commit other offences, they will continue to be charged for their drug-consumption offences as well as the other offences. If they are liable, they will be sentenced to LT.

For those who only abuse but do not have any other criminal offence, that means they only consume drugs and they admit to their drug abuse, then the general approach, regardless the number of times, would be that the Director of CNB will make the appropriate supervision or detention order, and channel them into the rehabilitation regime.

So, this group of abusers may also include those who have minor consumption-related offences like possession of drug-taking utensils or possession of small quantities of drugs. If the Attorney-General's Chambers (AGC) agrees with CNB that there is no need to charge the drug abusers for these minor offences, then these persons will also be channelled to the rehabilitation regime.

This will be conditional on the abusers admitting to their drug offences. If they deny their drug abuse despite the evidence, that means they have really not accepted the need for rehabilitation, they are likely to be charged in Court, if AGC concurs.

These changes, as Members will appreciate, are quite significant. Around 50% of LT-liable abusers could now be channelled to the rehabilitation regime. That means one out of every two for those who are going into LT could now go into a pure DRC regime.

And, really, to benefit as many persons as possible, CNB, with the concurrence of AGC, will generally not charge abusers who meet the criteria I have explained, from tomorrow, 16 January 2019, on the assumption that the Bill is passed today.

We also want drug abusers to come forward voluntarily for rehabilitation. So, moving forward, drug abusers who voluntarily submit themselves to CNB will be considered for a shorter detention in DRC. We will do a risk analysis but, based on that, they can and will be considered for shorter detention.

The abuser will still need to undergo operational and risk assessment before he or she can be considered for this. All abusers will be given two surrender opportunities in their lifetime. These are administrative under the MDA.

I will now highlight the key features of this enhanced rehabilitation regime. In general, first-time drug abusers assessed to be of low risk of further abuse, will be put on the Enhanced Direct Supervision Order (EDSO). That is a non-custodial supervision order with compulsory counselling. A case manager will provide dedicated support to these persons and their families.

Higher-risk first-time abusers, as well as repeat abusers, will undergo intensive, mandatory rehabilitation in the DRC, because that is a secure environment run by the Prisons. It maintains strict discipline. The interventions will be based on their assessed risk and needs of the abusers. These will include psychology-based correctional programmes. So, in order to correct it, you need to target the underlying attitudes and drug addiction issues. So, that is one: psychology-based correctional programmes.

Second, we will also run family programmes, so that, in a sense, they will be taught how to have better relationships with their loved ones. Because, by and large, a significant number would have very strained relationships.

We will also give them skills training and employment assistance. This is to improve their employability upon release.

Third-time and subsequent drug abusers, the Prisons will be introducing DRC3 and DRC4. The periods will be longer than DRC1 and DRC2. Clause 18 of the Bill increases the maximum period of detention for rehabilitation; to be increased from three years now to four years. That will apply to high-risk repeat drug abusers who are going to require a longer period of rehabilitation.

Those who are assessed to be ready to be discharged from DRC to move into Community-Based Programmes (CBP), they will be put into a halfway house, or a day release scheme from a community supervision centre. Or they could be allowed to go home with electronic tagging.

So, from DRC, released into CBP, where you could be leaving in the morning, going and doing your work, coming back at night, really to keep you in as safe an environment as possible. Last week, I just opened the first Prisons-run halfway house. There are other halfway houses, so we work with partners and we financially support them as well. They work quite well.

So, after CBP will be the supervision phase. During this phase, the abusers – ex-abusers, hopefully – will be required to report regularly to CNB for urine and hair testing.

Prisons, SCORE and CNB will also work with community partners. This is to try and help the abusers in areas, such as job training and support, casework, counselling and befriending.

We have been devoting a lot of resources to the post-release support and that is why we feel confident that we can move ahead with this.

The risk of recidivism is highest in the first two years. I have given Members the figures for five years. If they can be clean for five years, then the recidivism rates drop quite sharply, particularly for those who are able to keep a job.

The current supervision period is two years. So, I have decided that that should be increased. Clause 18 will increase the maximum supervision duration to five years. So, you are released but you are subject to supervision for five years, which, hopefully, will help in keeping you clean.

So, the changes, taken as a whole, mean that if you have abusers who only consume drugs and admit to their drug use, they will undergo shorter but more intensive rehabilitation in the DRC as opposed to LT. And then, they will be placed on CBP, and then they will report for a longer period of supervision of up to five years.

During the period of CBP and supervision, the abusers will be encouraged to hold a stable job, strengthen their relationship with their families and build better ties with the community.

So, really, the aim is successful reintegration back into society and to reduce reoffending. The journey is not an easy one for abusers. But we want to give them the best possible chance, and we want to motivate them to stay drug-free, and also put in the infrastructure like a longer period of supervision, which can help them in the long term.

Clauses 13 and 14 give the Director of CNB the power to require abusers who have completed their rehabilitation, supervision or imprisonment to still report to CNB for urine or hair tests when required. If the person fails to comply, then it is an offence, and the penalty could be an imprisonment or a fine, or both.

With the changes we implement, we obviously will track the recidivism rates very closely. If necessary, we will adjust our approach or change.

What are the consequences of this? A very substantial number, maybe up to one out of every two persons who are arrested, who would have gone to LT, could now go through this rehabilitation route that I have sketched out. Some will still be charged in Court. As I mentioned earlier, those who could be charged would likely be persons who face other criminal charges or deny their drug use.

Sentencing trend for first-time drug consumption is usually six to eight months. With one-third remission, the period in custody will come down to four to five months. That is shorter than detention in DRC. Those charged and punished with imprisonment should serve a sentence that is more reflective of the strong deterrent stance against drugs. They should not serve a period which is less than what a person in DRC would serve.

Clause 16 provides mandatory minimum sentence of one year for first-time conviction for drug consumption. Previously, there was no mandatory minimum. The mandatory minimum sentence will also apply for first-time conviction for failure to provide a urine specimen or hair specimen.

We have also reviewed the antecedents which count towards enhanced punishment for second-time abusers who are convicted in Court and LT.

For abusers convicted in Court, clauses 16 and 17, they will receive enhanced punishment or LT, whenever is applicable, if the current offence of which they are convicted is one of drug consumption, or failure to provide urine or hair specimen and their antecedents include any of the following: a previous conviction for drug consumption; a previous conviction for failure to provide urine or hair specimen; a previous admission into an approved institution for rehabilitation; and a previous conviction for drug consumption under the Singapore Armed Forces (SAF) Act.

I will now briefly summarise the other amendments, which are really of a more operational or technical nature. Clause 5 repeals and re-enacts section 13 to clarify that the punishment for abetting an MDA offence in Singapore from outside of Singapore carries the same punishment as the primary offence abetted.

Clauses 7 and 8 remove the powers of Vigilante Corps members for MDA offences, as they are no longer involved in drug operations. They also extend the powers of "Special Police Officers" to conduct search and arrest for MDA offences, they are often involved in ground patrols or operations which may entail the arrest of drug offenders. Special Police Officers will include full-time National Servicemen (NSFs) and operationally-ready (OR) National Servicemen during their periods of service.

Clause 2 sets out the different categories of transport devices to make clear the different types, including unmanned craft, that enforcement officers may seize in the course of investigations.

Clauses 6 and 8 define the related powers of search and seizure.

Clauses 9 and 11 set out the processes and requirements for forfeiture, return and disposal.

Clause 13 allows appointed SAF enforcement officers to collect urine specimens from persons subject to military law, if these persons are suspected abusers.

The current practice for suspected abusers is to be committed by Director CNB to a specified place for a maximum of seven days for medical examination or observation. Clause 18 codifies that. It also extends the initial period to which a person may be detained or rehabilitated and the period for which this may further be extended from the previous six months, now to 12 months. This is really to make it more streamlined, when now the detention order of every single abuser in our institutions needs to be extended every six months. But the total detention will not exceed four years, as I have stated earlier.

Finally, clause 20 provides the Minister with regulatory powers to provide for the supervision and aftercare of persons who have been convicted under the SAF Act for drug consumption or for failure to provide urine or hair specimens.

So, we intend for these groups, like all other groups, to undergo post-release supervision to encourage them to stay drug-free. Mr Speaker, I beg to move.

[(proc text) Question proposed. (proc text)]

Mr Christopher de Souza.

Sir, we have an exceptional anti-narcotics force in the form of CNB. CNB officers, working with the wider Home Team, risk life and limb to deter the trafficking and consumption of drugs in Singapore.

It is only right that anti-drug laws are amended and updated to give the team of officers the needed powers and tools to deter and fight against pro-drug activity in Singapore.

Therefore, significant amendments to the Misuse of Drugs Act being debated today are timely, useful and relevant.

Compared to many jurisdictions around the world, it can be said that Singapore does have the upper hand in the fight against drugs. But there is no reason why we should not continue making that upper hand more robust and stronger. We can do this by training our focus and resources on the threats at hand.

In 2017, four out of 10 total drug abusers were below 30 years old. Also, 40% of total drug abusers were new drug abusers. Of those, about two-thirds were below the age of 30. These are the kinds of proportions we have been looking at year on year since 2015. As the use of drugs leaves an indelible mark on the life of a person, the proportion of new drug abusers is particularly concerning.

What is also of concern is the increasing number of youths who take on a drug-tolerant attitude towards drugs. According to the National Council Against Drug Abuse’s Youth and Public Perception Survey, the proportion of youths aged 16 to 21 who agreed with statements, such as "I do not mind trying drugs when I am overseas" and "I would try taking drugs if it was not illegal" rose from 11% in 2013 to 16% in 2016.

This attitude towards drugs was more prevalent in older youth segments, that is, NSFs, university students and young working adults, than in younger youth groups, that is those from secondary school, junior college, polytechnic, Institutes of Technical Education (ITEs) and out-of-school youths. Over 33% of youths up to 30 years old misperceived cannabis as less harmful or non-addictive.

One suggestion I have, in addition to the amendments proposed today, is that we include clear and informative learning material in our Ministry of Education (MOE) Science syllabus, which should detail the host of ills and harmful effects of experimenting with drugs. Make it examinable material. We need to start young and reinforce it regularly by putting it in the primary and secondary school syllabus. For university students, students travelling to places where drugs are more accessible, pre-exchange briefings, for example, could be arranged to remind them that drugs are not just illegal but also harmful.

To supplement drug prevention education efforts, this Bill introduces new offences in new sections 11C and 11D to prohibit introducing a drug trafficker to another person or instructing a person to cultivate plants from which cannabis can be extracted, and manufacturing or consuming drugs.

Even as this offence provides tools to clamp down on contaminative actions and contain the spread of drug abuse, we cannot let this lull us into a sense of comfort. We still need to continue to be vigilant in equipping people with the skills to (a) find credible sources of information and (b) guard against the rhetoric used by the pro-drug camp.

There are also other offences introduced by this Bill that seek to limit exposure and contaminative acts. New section 11B introduces a new offence to protect our children against the harms of drug abuse. This is to be welcomed. In particular, it requires a person who possesses drugs or drug paraphernalia not to leave them lying around where a child may unknowingly take it. This is a crucial amendment. Why do I say this?

In April 2017, in Utah, a girl was born – born a drug addict. Her mother had used drugs heavily during her pregnancy. But lest we think that this can only happen in Utah, here are some stories from newspapers that let us catch a small glimpse of how children are impacted by their parent’s drug abuse in Singapore.

One, in February 2018, a one-year-old boy was rescued from suspected drug traffickers after his caregiver left him in their care. When his mother was found later, she was four months pregnant and had tested positive for drugs.

Two, in June 2018, a four-year-old girl was discovered with her mother – within reach of sachets of methamphetamine.

Three, in August 2018, a three-month-old girl was found in a unit with a suspected drug trafficker and drug abuser, with preliminary investigations showing that "ice" was abused during pregnancy and after the child was born.

These are real-life stories of how drugs ruin lives, including that of innocent children. Therefore, this new offence is important to protect children from harmful exposure to drugs. Singapore must continue to take a firm and tough stance against drugs and questionable pro-drug narratives.

While these amendments to the MDA will put another tool in the legal toolbox for grappling with contamination and exposure to drugs, I would suggest that the medium of the Internet should be given special consideration. This is because the Internet poses unique concerns. The Internet makes it easier to commit an offence and there is a greater potential for harm. This is especially true when it comes to buying drugs online where the convenience and relative ease of accessing the Dark Net in the "comfort of one’s own home" makes it little more than a click away.

Therefore, to counterbalance these factors which make drug trafficking over the Internet easier, lucrative and also more harmful, we should have targeted offences or aggravated offences if the medium of the Internet is used. Additionally, with the increase in online purchases, we need to make sure that our capacity to detect drugs in parcels will be able to match the volume being sent and received domestically and internationally.

Another suggestion is that the MDA give due consideration to the potential harmfulness of the drug when mixed or cocktailed with available consumables. We should not just be concerned about the weight of the illicit drug. This is because using such contaminants or mixers could make the cocktailed drug more addictive, more harmful.

Related to this issue, there is a rapid proliferation in number, type and availability of new psychoactive substances worldwide. We need to ensure that they are reclassified quickly into a First Schedule drug so that charges for trafficking, manufacture, import, export, possession or consumption can be made. Could the Minister consider this? This will help reduce the demand for and supply of such drugs, that is, through deterrence.

Besides preventing the spread of drug abuse and a drug-tolerant culture, it is important to step up rehabilitation efforts. I support these key and important steps of promoting rehabilitation of drug addicts.

This Bill seeks to support rehabilitation efforts in a few ways and build on the ongoing excellent work of the Prisons Officers, counselling staff and voluntary welfare organisations (VWOs) and non-governmental organisations (NGOs) who put in tireless efforts in the area of rehabilitation.

Firstly, clause 19 empowers the Director to require the parent or guardian of a supervisee under 21 to attend any counselling session. This is good in that it goes further to try to ensure that low-risk youths in the non-residential Youth Enhanced Supervision (YES) scheme are given the best shot at rehabilitation. This amendment also recognises the importance of the family in rehabilitation. Because the family can play an important role in providing not just practical support but also morale, encouragement and purpose in life, I hope that older drug abusers would also be given opportunities to engage their families, such as to help drug abusers reconcile with their families who could be their pillars of support upon release. Would the Ministry consider the possibility of having more open visits, such as that reported by The Straits Times during the Children's Day in 2017, for suitable cases, especially for inmates with young children?

Secondly, clause 18 increases the length of time for rehabilitation and supervision. Instead of six months, there will be a minimum of 12 months rehabilitation. The maximum duration has also been increased from three years to four years for rehabilitation and from two years to five years for supervision. This increases the amount of time that our captains of lives have to work with drug addicts to rehabilitate and decrease recidivism. This is excellent as there is greater support and accountability for a longer time during the integration phase.

With this longer supervision period, it is also important that supervision is not too disruptive so that the ex-offender's studies or employment will not be too affected. With the possibility of hair tests, how often does an ex-offender need to report for testing? For long-term resilience, could the Ministry consider providing some opportunities for physical activity or games so that former or recovering drug addicts can experience that there can be meaning to life and relief without drugs?

Besides increasing the time of the supervision order to decrease recidivism, would the Ministry consider giving a workbook for the ex-offenders to record and review what they have learnt in therapy sessions in relation to staying off drugs, for example, how they themselves can better cope with stress or how to replace drug cravings with sports? This would provide them with a resource that they can have on hand whenever they may need to refer to it so as to assist in quashing the urge to take drugs.

Also, because this Bill allows a supervision order to extend up to five years, it would be useful if the recidivism rate is tracked at the one-year, two-year, three-year, four-year and five-year marks. Would this be considered?

Currently, under section 34, the Director may require any person whom he reasonably suspects to be a drug addict to be medically examined or observed by a Government medical officer or medical practitioner. This Bill extends the power to committing the person to a place specified by the Director for up to seven days. Could the Minister please expand on the purpose behind this amendment and why seven days was chosen?

Thirdly, there seems to be greater differentiation between drug abusers as a result of this Bill's amendments. This is to be welcomed.

At paragraph 19 of the Ministry of Home Affairs' (MHA's) press release relating to this Bill, it reads, and I quote, "However, drug abusers who commit other criminal offences and harm society will continue to be dealt with very strictly. They will be charged in Court and be liable for imprisonment and caning, including LT." Is this differentiation between those who commit other offences and those who do not, the reason why clause 16 introduces a tiered minimum punishment for consumption and possession offences?

Let us be clear that these amendments do not mean that Singapore's stance against drugs has softened. We are still treating drug abuse as a clear menace which needs to be eradicated, not tolerated. In fact, if we look at the Bill closely, the changes are actually mixed in strategy but single in purpose. We want a drug-free Singapore. Clause 13 allows "random spot-checks" to ensure that ex-addicts stay off drugs while long-term imprisonment is still on the books. Clause 16 introduces minimum punishment for those charged and convicted for consumption or possession offences even though it is their first time.

So, what is clear is that while some amendments are rehabilitation-focused, the law does not hesitate to be harsh when it needs to be.

Sir, as we step up rehabilitation efforts, we cannot lose sight of the reason why Singapore is so hard on drugs in the first place – drug abuse itself is harmful. By consuming drugs, a drug user is harming himself or herself, his or her family, his or her community, and society. Even cannabis, which has been legalised in some countries, is harmful.

Even though patients try to minimise the consequences of cannabis, treatment providers say that many report feeling isolated, paranoid and are unable to effectively interact with the outside world, and experience psychosis and hallucinations.

In Colorado Springs, marijuana has even been called, and I quote, the "gateway drug to homicide" by a district attorney. In 2016, eight of 22 homicides had a "marijuana nexus." And I quote again, "In most cases, robbery of marijuana was a motive, or the victim was killed during a marijuana narcotics transaction." Homelessness had also increased by 50% since marijuana was legalised.

The impact is so great that there has been much local response to the harm marijuana is causing. Out of 64 counties in Colorado, 61% have prohibited or have a moratorium on recreational marijuana and, out of the 243 municipalities that have taken action on this issue, about 69% have prohibited it. In the Netherlands, the Hague has become the first Dutch city to outlaw smoking cannabis in and around its city centre, central railway station and major shopping areas.

So, why do we want a drug-free Singapore, not a drug reduced Singapore, not a drug tolerant Singapore, but a drug-free Singapore? Why? Because drugs are harmful. No insidious pro-drug camp should deter us from our view that drugs are, indeed, harmful – harmful to the abuser, their families, society and a country's human potential. Indeed, Minister Shanmugam has taken this clear line on the international stage and I support it.

Last year, Canada legalised recreational marijuana. I do not agree with questionable groups who push pro-drug rhetoric.

Singapore is on the right path in its tough stance against drugs. We must continually be on our guard, never taking a defeatist attitude. We have to look at threats beyond our shores in order to guard our shores.

Regionally, there has been a surge of synthetic drug manufacturing in the Golden Triangle, especially for methamphetamine. There has also been international concern that the drug gangs there will diversify into other kinds of synthetic drugs, such as ketamine and fentanyl, which are highly addictive, highly destructive.

Sir, in conclusion, our resolve to fight against drugs in Singapore will not be diluted. Rather, with legal amendments, such as these, the resolve is made even more steely. As this Bill adds steel to Singapore's determination to deter a potential drug menace, I support it.

Mr Pritam Singh.

Mr Speaker, the proposed amendments to the MDA represents an important philosophical shift to some aspects of the fight against drugs while reinforcing the uncompromising stance against drugs in Singapore.

Almost 20 years ago, the Ministry took a very specific approach towards hardcore addicts through the MDA, initiating long-term mandatory imprisonment and caning for hardcore drug addicts, a hardcore addict being warned, defined as having been caught more than twice for drug consumption.

Back then, the priority was not on framing drug addiction as a social issue afflicting drug addicts but a behaviour that has been criminalised. Addicts who consume drugs for the third time face up to seven years' imprisonment and six strokes of the cane, while addicts caught four times or more face up to 13 years' imprisonment and 12 strokes of the cane.

In introducing the long-term regime, the then Minister moving the amendments noted that the proportion of hardcore addicts amongst the total drug rehabilitation centre population has increased from 65% in 1994 to 71% in 1997.

In his Second Reading speech, the Minister also referred to hardcore addicts as "bad people" who are likely to become drug pushers and traffickers, too. The position revealed the state's philosophy that was focused on an uncompromising stance towards drug addicts, towards hardcore drug addicts, with rehabilitation openly seen as having its limits. In the words of the then Minister, I quote, "Sometimes, despite all the good heartedness, the love and the hard work put in by volunteers in halfway houses, some of these volunteers do feel disheartened that these addicts just do not have the discipline to take the treatment. But the Government will do what it can to help them, that is, both the recovering addicts as well as the halfway houses. In terms of financial support, I think if we can justify a case to ask for more money, we will look at it. But the Government does not just spend money, throwing good money after bad money to people who do not want to change."

One of the main amendments proposed today is to finetune the LT1 and LT2 regimes and circumstances where the drug addict does not have concurrent criminal charges. In parallel, the amendments raised the time an addict can spend in the DRC from three to four years, along with the longest supervisory window from two to five years to submit himself or herself at random to the authorities for urine tests or to provide a hair sample.

Speaker, I am supportive of the aforesaid changes and commend the significantly more enlightened attitude taken by policymakers to shift the focus on helping selected repeat drug offenders in a more purposeful and surgical manner through the calibration of the MDA rehabilitation regime. This is no mean feat, given the risks that some members of the public may erroneously construe this shift as a relaxation of attitude towards hardcore drug addiction.

However, I see it as an example of rational and sensible policymaking. In fact, this policy shift is significant, considering the LT regime was introduced a mere 20 years ago and to cover even more offenders when the Act was amended in 2006. Notwithstanding my support on these points, I have some clarifications I want to seek from the Minister.

The first clarification is a request for information. In 1998, the then Minister, in introducing the LT regime, shared that more than 73% of hardcore drug addicts have some form of a criminal record. I originally intended to ask how the percentages have changed over the years and what the figures were today and, with specific reference to the amendments, how many drug addicts imprisoned under the LT1 and LT2 regimes currently face concurrent criminal charges when they were originally sentenced to long-term detention.

But the Minister earlier shared that the figure was about 50% now. But the Minister also shared that, given easy access to funds and a general rise in access to drugs in the region, in view of these realities, and the latest statistics provided by the Minister in his Second Reading speech, would the Minister be able to share the family background and income levels of those with criminal charges and those without under the current LT1 and LT2 regimes?

Separately, to give the public a better sense of the rehabilitation task ahead, can the Minister share, out of the inmates committed to DRCs, how many are repeat offenders to date?

My second clarification, while the amendments do not foresee any increase in public expenditure, how much more support will be given to counsellors and the halfway house employees and volunteers, to help keep recidivism numbers low? The reality, when we speak of rehabilitation and the new calibrated approach, is that someone somewhere will be on the delivery end of the outcome sought – far fewer repeat drug addicts, compared to the current regime.

So, the proposed changes are likely to put an acute focus on the people behind rehabilitation as they endeavour to get drug addicts out of a dangerous situation for good. What sort of training and support will these individuals undergo so that they do not feel disheartened about addicts who do not respond well to treatment, such that they can continue plugging away at the hugely important task of rehabilitation? This is likely to become more significantly as a large part of rehabilitation involves reintegrating the addicts into the community and in gainful employment, something that may be even more challenging in this age of economic destruction. It is vital that maximum support is extended to the volunteers, workers and supporters throughout the drug rehabilitation chain, from DRC staff to uniformed officers, CNB officers and to families and parents that need help and assistance to, in turn, help their loved ones and individuals under their care to kick the habit for good.

Clause 3 of the Bill introduces a number of new laws that are far-reaching and reflective of the state's uncompromising and continued hard stance against drugs. Amongst other things, it criminalises the act of contamination which facilitates or promotes drug use, including actively introducing a drug trafficker to another person, knowing that the trafficker is likely to supply him with drugs. A person should also be guilty of a contamination offence if he teaches, instructs or provides information to another person on how to cultivate, manufacture, consume, traffic, import or export controlled drugs, such as cannabis, for example, knowing or having reason to believe that the other person intends to carry out these activities. It makes it an offence for an adult to leave drugs or drug utensils within easy access of a child, knowing that the child is likely to be in proximate range of a drug or drug utensils.

Mr Speaker, what is needed is for knowledge of these new laws to be widely disseminated within the community so that they help send a strong deterrent message. I would like to ask the Minister what measures would be taken to make these new laws well-known, particularly amongst foreigners, who may not be familiar with the minutiae of our various laws on drugs, and amongst high-risk individuals like former drug addicts.

Finally, I would suggest that more preventive education across platforms on these amendments as introduced in clause 3 would be particularly important because of the rising permissiveness and attitudes across the region on drug consumption and the general relaxation of the laws against drugs in the region. Mr Speaker, I support the amendments to the Act.

Order. I propose to take a break now. I suspend the Sitting. I will take the Chair at 4.20 pm. Order.

Sitting accordingly suspended

at 4.01 pm until 4.20 pm.

Sitting resumed at 4.20 pm

[Deputy Speaker (Mr Charles Chong) in the Chair]

MISUSE OF DRUGS (AMENDMENT) BILL

Er Dr Lee Bee Wah.

Mr Deputy Speaker, Sir, despite repeated efforts by law enforcement agencies, the problem of drug trafficking and drug abuse is still an issue in Singapore. A whole menu of drugs from cannabis, heroin, methamphetamine and others are commonly abused by teens and older persons, including women. In light of this, it is, indeed, timely to review the Act and implement much needed revisions to address the issue. In 2018, a number of large drug seizures, including one 8.8 kilogrammes (kg) of heroin, the largest heroin haul in three years, and a 5-kg haul of cannabis in June that year. Drug offenders nabbed by various CNB-led operations included Singaporeans and foreigners. The number of new drug abusers also remained high.

But what is even more worrying, however, is the increasingly liberal attitudes towards drug abuse among young people. A news report in 2017 revealed that, in line with rising trends of drug abuse among young people, more of them expressed that they are willing to experiment with drugs for a new experience. Among youths aged 13 to 21, 16% of those polled held such views, up from about 11% in 2013. Furthermore, one-third of the respondents had misconceptions about cannabis, believing it to have medicinal properties and overlooking its harmful side effects. This would not come as a surprise as more prolific use of social media means exposure to pop-media and a large population of youths in the West that normalises drug use. And, with more youngsters travelling, studying and working abroad where drugs are more accessible and even legal, certainly they would be able to find more opportunities to consume drugs.

The Bill seeks to criminalise acts of contamination, which include teaching and instructing others about drugs that could lead to the person carrying out drug-related crimes and usage, and introducing a drug trafficker to the person. I am happy to know that it is an offence for parents to consume drugs in the presence of their young children. In fact, I have seen young parents, both father and mother, go in and out of prison because of drug-related offences and that is why I brought up in this House recently, asking if there is any systematic ways of following up with those who have young children at home to make sure that their well-being is not compromised. Criminalising such acts of contamination is a form of deterrence that could save the lives of many young people who could potentially become drug offenders.

However, I am concerned about how this can be effectively enforced. We do not expect an offender to engage in a conversation, say, on how to use drugs, in an open setting. The conversation is likely to be held in private and would only come to light if there is a whistleblower. Perhaps, the only time this would come to light would be when the offence has been committed and the perpetrator squeals while under interrogation and there are records of text messages as evidence. Otherwise, I think it is difficult to enforce.

So, in the case of young children who do not know what their parents are doing but then they are exposed to drugs because their parents are drug abusers, so, I just wonder, in cases like these, how is this law going to take action?

Having said that, criminalising this act could serve as a deterrent to get people to think twice before intentionally influencing others to be involved with drugs. The question that arises then is: what is the definition of instruction? What if someone asks a question about manufacturing drugs and another person gives answers? Would that constitute an act of contamination? I am sure the authorities do not mean to restrict genuine public education to create awareness as a deterrent against drug abuse. But we must also be aware that those who are curious about drugs can turn to the Internet where there is an abundance of materials to get information. So, how will the Ministry address this?

I am pleased to note that the existing rehabilitation programmes will be improved. Drug addicts and offenders will certainly benefit from the increased counselling, supervision and longer detention.

However, do we have sufficient resources and skilled counsellors to execute these programmes? How many prison counsellors do we currently have versus the population of drug abusers? How many more will we need to meet the requirements of the amendments? Prison counselling is intensive work. So, I wonder if we have the relevant support networks for our prison counsellors. I know someone who does prison counselling work, and the nature of her job is such that she sometimes gets negatively affected, getting insomnia and even depressive feelings. I hope our prison counsellors and other professionals have a good care network as we have to ensure that their mental well-being is not being compromised in order for them to do their work well.

Additionally, what kind of benchmarks will be used to determine whether one is completely rehabilitated and ready to commit to a life that is completely drug-free and thus no longer requires supervision?

The Bill introduces some thoughtful new measures to enhance rehabilitation programmes and curb drug abuse through peer influence. But we have to get to the root of the problem. It is far more important to equip young people with the correct mindset and knowledge about drugs. It is far more impactful if they make the decision to say no to drugs, rather than for authority figures to make the decision for them. In Mandarin, please.

(In Mandarin): [Please refer to Vernacular Speech.] Surveys show that young Singaporeans are more and more liberal towards drugs, with 16% of them indicating that they are willing to try it out, while one-third of the respondents think that marijuana is harmless. As young people these days can easily access online information and more and more people are going overseas, they can easily be tempted by drugs. I believe this trend will become increasingly salient in the future.

Therefore, it is wise to amend the law to prohibit the act of introducing drugs to others. Although such behaviours are difficult to spot, having such laws would serve as a deterrent. At the same time, we should also pay attention to drug information that is originating from the Internet. Even without an introducer, someone who has his mind set on finding drug information will be able to find it on the net. The correct way is to equip the young people with sufficient information so that they can decide for themselves to stay away from drugs.

More counselling will help the drug addicts to kick the habit. However, do we have enough Prison counsellors, do we have enough support for the mental health of the counsellors themselves? Please clarify the above points. I support this Bill.

Ms Irene Quay.

Mr Deputy Speaker, Sir, I declare my interest as President of the Pharmaceutical Society of Singapore.

I salute our Government for maintaining strict control over the misuse of controlled drugs in Singapore, especially with the recent and timely amendments to the MDA to hold accountable any person knowingly or recklessly leaving controlled drugs exposed within a child's reach. We have seen many tragic stories of children ingesting such controlled drugs by accident which had resulted in overdose cases ending up in hospital emergency departments.

At my recent attendance at the World Pharmacy Congress in Glasgow, I learned from pharmacists practising in Africa, Canada, the United Kingdom (UK) and the United States (US) about the worldwide issues regarding drug abuse. The situation is currently out of control, resulting in countries no longer looking to curb the problem, but instead, resorting to setting up needle stations to try to, at the very least, prevent abusers from contracting the human immunodeficiency virus (HIV) or Hepatitis C infections. Such a defensive approach does not attack the root cause of the problem. The harm caused by the abuse of these substances on the abusers, their families and the society at large is devastating.

First and foremost, even though the situation is much more controlled in Singapore due to our strict laws regarding drug trafficking, I still have my reservations and concerns for potential abuse in prescribing of controlled drugs in Singapore.

According to the Singapore Medical Council (SMC) Annual Report from 2012-2017, there is an average of two to three cases of errant prescribers who were being censured, fined and suspended every year due to inappropriate prescribing or sale of hynoptics, codeine-containing preparations or controlled drugs. Could this be just the tip of the iceberg?

I quote Prof Tay Boon Keng, Emeritus Consultant and SMC Council member, who is also the Chairperson of the Ministry of Health (MOH) Opioid Guidance workgroup: "These past errant cases are all from the private health sector and tremendous expense was taken to take action (mostly legal) against these practitioners. In contrast, as prescriptions in public hospitals and polyclinics are limited by information technology (IT) system restriction and second layer of screening by pharmacists, this problem is almost non-existent."

Are there plans for MOH or MHA to consider dispensing separation for controlled drugs and other drugs of abuse, including hypnotics and codeine-containing preparations, to deconflict prescribing and dispensing of such drugs with potential for abuse?

Such a move will allow pharmacists to provide oversight of such prescriptions, evaluate for appropriateness of use and duration of treatment, as well as contribute to national aggregated information to flag out high-risk prescribers or patients. The dispensing separation will add additional barriers to access for addicts and, hence, reduce opportunities for abuse, prevent unintended addiction to a significant extent by the general public, and safeguard physicians from such malpractices.

Secondly, over the years, there has been an increase in the use of cannabis by drug abusers worldwide. Cannabis is now legalised for recreational use in Uruguay, Canada and eight other states in the US, while decriminalised in the Netherlands, Spain, Portugal, Jamaica, Slovenia and Columbia within recreational limits.

With such ease of access to such substances overseas, how can we heighten public awareness, especially for our children going abroad to study during their formative years, so that they are more prepared for the potential risks? Can we incorporate such awareness programmes with "rehabilitated ex-offenders sharing their experiences" into briefing sessions for students before they go abroad? Should we conduct more studies to find out the risk factors and reasons as to why these kids pick up such habits when they were away from home?

To add on, cannabis may be the active ingredient in many non-medicinal products presented in a myriad of formulations, such as cigarettes, vaporisers, herbs, lotions and oils. Some may mistakenly purchase these items innocuously, without knowing that the active ingredient is prohibited in Singapore. How can we ensure that the public is well informed of these risks when they travel overseas and avoid unknowingly bringing in these illegal products when they return home? Can we include a mandatory inflight education video/booklet for people departing and returning to Singapore?