CLOSING SPEECH FOR SECOND READING OF TRADITIONAL CHINESE MEDICINE PRACTITIONERS (AMENDMENT) BILL BY DR AMY KHOR, SENIOR MINISTER OF STATE, MINISTRY OF HEALTH, 11 FEBRUARY 2019
11 February 2019
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Mr Speaker, I thank Members for speaking in support of the Bill.
2. Assoc Prof Fatimah Lateef, Mr Gan Thiam Poh, Dr Chia Shi-Lu and Mr Louis Ng highlighted the increasing popularity of TCM and the growing number of registered TCMPs in Singapore, and hence the need for a robust regulatory and disciplinary framework and a code of conduct, etiquette and practice guidelines for TCMPs to provide greater assurance and confidence to the public.
3. Members also expressed support for the implementation of compulsory CPE to raise the standards of the profession.
4. Let me now respond to the queries and suggestions made by Members in respect of this Bill.
Compulsory CPE – Funding Support, Implementation Details, IT Enablers
5. Assoc Prof Fatimah asked if subsidies could be offered to TCMPs to defray the costs of attending CPE courses. As mentioned in my opening speech, individual TCMPs can already apply for the TCM Development Grant launched last year capped at $200 per year to help defray the cost of attending CPE courses. I am pleased to share that as at the end of last year, over 400 individual TCMPs have benefited from the Grant, with claims of more than $71,000 made.
6. This is in addition to the $90,000 granted to accredited TCM training providers for the organisation of TCM conferences and seminars. We will continue to monitor the utilisation of this Grant by individual TCMPs to defray the cost of attending CPE courses and make adjustments if necessary.
7. As Assoc Prof Fatimah rightly pointed out, TCMPs can also make claims under the SkillsFuture Funding for their courses. We will continue to encourage CPE course providers to get their courses accredited by SkillsFuture Singapore so that more TCMPs can benefit.
8. Assoc Prof Fatimah also asked whether there could be some flexibility given to the TCMPs during the first two years of implementation of compulsory CPE. We introduced voluntary CPE some five years ago and have also undertaken extensive consultations with the industry on the implementation of compulsory CPE. Hence, the TCMPs should be familiar with the CPE framework and guidelines on points accumulation.
9. Nonetheless, the accumulation of compulsory CPE points will take effect from 2020 after the Bill has been passed. For new registered TCMPs, they will be issued Practising Certificates (PCs) valid until June 2020 and will be required to accumulate 50 CPE points in order to renew their PCs in June 2022. They will start accumulating points after June 2020 and in June 2022, they will be required to have the requisite 50 CPE points for PC renewal.
10. Of the 2,800 existing TCMPs holding valid PCs, half of them will have their PCs expiring in June 2019 and the other half in June 2020. For those with PCs expiring in June 2019, their PCs will be renewed until June 2020. This exercise is to align the existing cohort so that the CPE requirement can start at the same time for all existing TCMPs. Between now till June 2020, the Board will engage the TCMPs and CPE course providers to update them on the revised CPE assessment framework. We strongly urge all TCMPs to actively participate in CPE and familiarise themselves with the online CPE system.
11. Dr Chia asked how TCMPs who are not currently in active practice will be impacted with the passing of this Bill. As the CPE requirement is uniformly applied to all TCMPs who wish to practice, those who do not currently hold a valid PC will have to fulfil the CPE points requirement before they can apply to resume their practice.
12. Dr Chia also asked how MOH will ensure the availability and quality of accredited CPE courses upon the implementation of compulsory CPE. On the availability of CPE courses, the Board has been engaging the course providers to organise more courses in anticipation of the implementation of compulsory CPE. To further ensure that there are adequate courses, the CPE course providers will be required to fulfil a minimum number of course-hours per year to maintain their accreditation status.
13. The Board has established guidelines for the accreditation of CPE providers and courses, such as the credentials of the speakers or instructors, to ensure they are of acceptable standard.
14. Assoc Prof Fatimah may be pleased to note that with the online CPE system, TCMPs may log on via the Board’s website to search for CPE activities they wish to attend and monitor their CPE points. The system will be enhanced to send reminders at appropriate junctures to TCMPs who are at risk of not satisfying their CPE points requirement to help them fulfil these requirements.
15. We note Mr Gan’s suggestion to integrate records of patients receiving treatment from both mainstream and TCM service providers for more coordinated management of care. However, as TCM is complementary to mainstream treatment and there are clinical and technical challenges that make it difficult to so integrate the records, we will continue to work with the TCM community in order to provide a holistic approach towards patient management through other avenues. For example, the TCM Development Grant supports the TCM service providers to strengthen their operating capabilities including the adoption of IT solutions and enhancement of clinic facilities for TCM clinics.
Disciplinary Framework
16. Assoc Prof Fatimah and Mr Gan asked for information on the number of complaints received, disciplinary action taken and the trend over the years. The number of complaints received by the Board each year since 2013 has remained relatively constant at less than 10 per year, with about half of these cases requiring disciplinary action against the TCMPs involved. The cases can be broadly categorised into professional misconduct, negligence, use of western medicines and criminal conviction. The actions the Board can take against a TCMP is dependent on the gravity of the matter the TCMP is guilty of and range from issuing a letter of advice, censure, or the suspension or cancellation of registration.
17. While the number of cases is relatively low, we need to continue to ensure that the disciplinary framework remains relevant and effective in safeguarding public interest and safety. This will be effected through the proposed three-pronged approach mentioned in my opening speech, namely to enhance the disciplinary framework to improve efficiency, increase maximum financial penalty to provide sufficient deterrence and enhance investigative powers.
18. The proposed increase in maximum financial penalty from $10,000 to $50,000 is to provide sufficient deterrence and punishment for misconduct so as to protect the safety and interests of the public. This quantum is similar to the maximum financial penalty applicable for dentists, pharmacists, and allied health professionals in the Dental Registration Act, Pharmacists Registration Act and Allied Health Professions Act but lower than the maximum penalty of $100,000 for doctors under the Medical Registration Act (MRA). We have on balance decided on the $50,000 maximum quantum as TCMPs provide direct outpatient care to patients, similar to the allied health professionals and dentists in general.
19. To Mr Ng’s query on whether the Board informs the complainant of the findings of the inquiry and if it communicates with former patients of the TCMP if the TCMP is found guilty of misconduct, the Board will promptly inform both the complainant and TCMP involved of the Board’s findings and decisions in writing once the inquiry process has been completed. Furthermore, upon the conclusion of the case, a press release will typically be issued and published on the Board’s website for public access.
20. I thank Dr Chia for his comments on having clear guidelines for the penalties to be meted out by the Board. The Board has already put in place a sentencing framework based on the degree of harm and culpability to assess the seriousness of the offence and to guide the appropriate sentencing. As deemed necessary, the Board will update the framework. In addition, the Board also engages the Academy of Chinese Medicine Singapore for expert advice on TCM professional matters.
Representation of the Board
21. Assoc Prof Fatimah and Dr Chia commented on the representation of the Board. We agree that the Board should consist of experienced and well-versed TCMPs who are conversant with various aspects of TCM practice. Hence, the current composition of the Board requires Board members who are TCMPs to have at least 10 years’ experience in the practice of TCM.
22. Taking into account feedback from the public consultation, the size of the Board will be increased from 9 to 11 so that more TCMPs can be included on the Board. We think this would suffice as since its inception, the Board has comprised the maximum number of members allowed under the Act.
23. Mr Ng sought clarifications on the differences in the use of term “mental or physical disability” in section 6 of the Act which sets out the criteria for disqualification of Board members and “mental or physical condition” in section 19 of the amended Act, which allows the Board to take certain action against the TCMP concerned. The amendment Bill revises the language in section 19(1)(k) from the term “disability” to “condition” so as to broaden the scope of mental and physical conditions that may render a TCMP unable to practice TCM safely. This will better safeguard patients’ interests as the TCMPs are directly responsible for the care of their patients. On the other hand, we recognise that a person may still be able to contribute effectively as a member of the Board even if he was afflicted by a mental or physical condition, like a mild stroke, that does not affect his daily activities and mental capacity. However, this same condition may affect a TCMP’s ability to provide safe and effective care.
24. The Inquiry Committee for conducting a health inquiry relating to a TCMP’s fitness to practice should consist of members who have the relevant expertise to inquire into the matter of which it is appointed, for example a member who is a medical practitioner in a relevant field.
Service Planning and Recognition of Medical Certificates
25. Mr Chen may also like to note that MOH regularly reviews the regulations and policies on TCM, taking into consideration the advancements in medical science and evolving standards of TCM. For example, based on latest literature on safety of use, MOH has lifted the ban of raw herbs containing berberine (黄连), to allow practitioners more options in the use of TCM in their practice and service to the public. Since 2005, acupuncture has also been allowed in our public hospitals. We are also happy to note that the research project, supported by the TCM Research Grant, on dry eye undertaken by the Singapore Eye Research Institute and Singapore Chung Hwa Medical Institution, has shown encouraging results. We hope that this will foster greater research collaborations between Western Medicine and TCM.
26. Assoc Prof Fatimah asked about the possible standardisation of charges for TCM services and recognition of Medical Certificates (MCs) issued by TCMPs. As TCM plays a complementary role to mainstream medicine in Singapore’s healthcare system, MOH will leave it to the employers and companies to decide if they wish to recognise the MCs issued by TCMPs. Assoc Prof Fatimah also pointed out that there is a range of charges for TCM services. This is due to a correspondingly diverse range of TCM practices and services offered, from charity TCM clinics operated by Voluntary Welfare Organisations to large industry players with chain clinics, catering to all segments of the population. Hence, the charges will continue to be left to market forces.
27. In response to Assoc Prof Fatimah’s request for clarification on the classes of registration, we would like to note that there are currently 2 classes of registration – practitioners registered as TCM Physicians are able to provide the full range of TCM practice, including acupuncture, while practitioners registered as acupuncturists can only practice acupuncture. To Mr Gan’s query on the accreditation of Tie Da” (跌打) practitioners, “Tie Da” is considered a form of traditional folk medicine passed down from master to apprentice and hence, Tie Da practitioners are not registered under the Act.
28. There is also no requirement for the registration of Chinese herbal dispensers, although herbal dispensers with the relevant qualifications can choose to be listed with the Board. There has been a decline in the use of Chinese herbs which are mainly available from Chinese medical halls, compared to the use of Chinese Proprietary Medicines (Chinese medicines in the prepared form), due to the latter’s convenience and ease of use.
29. Notwithstanding this, MOH supports the continuing education of herbal dispensers as part of the upskilling of the TCM industry. Herbal dispensers listed with the Board are also eligible for funding support provided under the Development Grant.
30. MOH will continue to support and promote the professionalism of TCM practitioners, and ensure consistency and the safety of TCM use.
Conclusion
31. Mr Speaker, Sir, a robust and efficient disciplinary framework and the upholding of practice standards are important for the safeguard of public safety as the TCM profession matures in Singapore.
32. We are indeed heartened by the support of the TCM community and the public during our consultation and engagement sessions, as well as the support of Members of this House.
Mr Speaker, I beg to move