ALLIED HEALTH PROFESSIONS BILL

ALLIED HEALTH PROFESSIONS BILL: Order for Second Reading read.

The Minister for Health (Mr Khaw Boon Wan): Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

The Allied Health Professions Bill establishes a regulatory body, the Allied Health Professions Council, to register and regulate the allied health professionals, and prohibits false representation of these professionals.

The Allied Health Professions comprise diverse groups of healthcare professionals providing a wide range of health services.

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They include radiographers, physiotherapists, occupational therapists, psychologists, speech therapists, and many others.

With a rapidly ageing population, demand for healthcare will rise as the sick elderly are more likely to present with many diseases and more complex conditions. We are reforming our healthcare system to cope with the challenges in two major areas. First, we are strengthening the community and step-down care sector so that patients can be treated there competently instead of in costly acute hospitals. Second, doctors will increasingly be assisted by multi-disciplinary healthcare teams with allied health professionals as key partners. Success of these reforms relies on well-trained allied health professionals.

These health professionals, with their specialised know-how, can contribute to better health outcomes and lower healthcare costs through effective rehabilitation, health promotion and prevention. For example, a physiotherapist is skilled in the physical rehabilitation of stroke patients or those who had undergone hip replacement, helping them to walk again. An occupational therapist is best placed to train the patient to perform self-care activities safely and independently, such as dressing himself, toileting and bathing. These rehabilitative activities are essential in helping the elderly regain an active and meaningful life.

For a long time, we have left the allied health professions to regulate themselves. This was somewhat adequate in the past as most of them worked in the public sector and the professional bodies had diligently taken on a voluntary regulatory role. However, as the demand for their services grows and as we try to build up the long-term care sector, the voluntary approach to regulation will become less effective. Voluntary self-regulation is also

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not the international norm. All developed countries have legislations to regulate their allied health professions and they have been doing so for years. Singapore is an outlier.

I signalled this intent to regulate the allied health professions in 2007 when I came to this House to move the Optometrists and Opticians Bill. The experience to regulate the optometrists and opticians has been positive. We are now better assured that these eye-care practitioners have the competencies to provide safe and effective eye-care services. Since then, the Optometrists and Opticians Board has registered more than 2,300 optometrists and opticians and will be implementing mandatory continuing professional education. This is a significant improvement from the past where untrained persons could easily set up shop and provide optometry services with sometimes questionable standards.

Our approach to regulation

The next major group are the therapy professions: physiotherapists, occupational therapists and speech therapists. MOH could establish another legislation to target this group but there are many more allied health professions, like the dietitians, radiographers and psychologists. Such a piecemeal approach will take a long time. Instead, we recommend the more efficient option of an umbrella legislation that will allow for the regulation of many allied health groups, with subsidiary legislations covering individual professions. The United Kingdom, New Zealand and Hong Kong have taken such an approach and this is the approach which is incorporated in this Bill. Let me now elaborate on the key features.

_Main features of Bill
_

Part I lays out the scope of application for the Bill where clause 4 clarifies that

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the Bill applies only to Allied Health Professions listed in the Second Schedule. As a start, only the occupational therapists, physiotherapists and speech therapists will be regulated. Clause 5 empowers the Minister for Health to amend the Schedule to regulate other allied health professions in future.

Part II of the Bill sets up the Allied Health Professions Council, provides for members of the Council to be appointed by the Minister for Health, and to include representatives from each of the regulated allied health professions. The Council's functions are set out in clause 7, and include registration, issuing of practising certificates, and setting of standards for training, conduct and practice.

There have been concerns raised regarding adequate representation of the different professions and the effectiveness of a single regulator regulating many different professions. Clause 12 empowers the Council to appoint committees and professional boards. These committees and professional boards play a key role in advising and making recommendations to the Council with regard to the standards and issues arising in particular professions, and will comprise mainly members of the specific professions. Coupled with a representative Council, such a structure would ensure that each profession is adequately represented and the unique issues faced by specific professions can be addressed. However, for operational efficiency, the Council is expected to maintain oversight and management of the committees and boards, complaints, investigations and disciplinary processes.

Part III of the Bill sets out the registration framework to recognise appropriately trained and qualified professionals for practice in Singapore,

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and empowers the Council to impose conditions and restrictions on registration, require mandatory continuing education, refuse registration, remove and restore names under specified circumstances. Clause 14 sets up the four registers, corresponding to the four types of registration and these are: Full, Restricted, Conditional, and Temporary registration.

Clauses 16 to 19 set out the general criteria, conditions and restrictions that may be imposed in the four registration categories. The tiered registration framework enables the Council flexibility to register individuals according to their training and practice experience, whilst providing safeguards to protect the public.

Let me now elaborate on the different tiers of registration. An allied health professional with full registration may practise generally and without supervision in the profession in which he is registered. There will be a list of approved qualifications. These qualifications will be determined by the Council and established for each regulated profession in the regulations. Anyone who holds an approved qualification or passes the local qualifying examination in a regulated profession would be eligible for full registration.

Clause 16 deals with full registration and requires an allied health professional to complete a period of supervised practice under conditional registration before being eligible for full registration. This allows the Council to make a more comprehensive assessment of the practitioner instead of relying only on his qualifications and credentials. Clause 16 also allows the Council to apply exceptions and give full registration directly to an individual who is clearly well-trained and competent. Where a person is not eligible for full registration, his application will be assessed for other registration categories.

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Clause 17 deals with restricted registration. A practitioner who does not have an approved qualification but has been practising in Singapore; or who may have a post-graduate qualification in specific area of professional practice but does not have an approved basic qualification, is among those who will be eligible for restricted registration. Like full registration, an allied health professional on restricted registration can practise independently. However, restrictions are imposed on his scope, place of practice, or employment because of his qualifications, practice experience, or health issues. Before an individual is granted restricted registration, his abilities may also have to be assessed through conditional registration.

Clause 18 deals with conditional registration. Conditional registration will generally be applied to all new registrants who have approved qualifications or have passed the local qualifying examinations. While under conditional registration, the practitioner will be supervised and subject to performance review. This enables the Council to make an assessment on the ability to practise safely and competently. The supervision requirement also ensures that new practitioners are adequately supported when they start working in Singapore.

Temporary registration is set out in clause 19 and applies to an allied health professional who is in Singapore for the purpose of teaching, research or postgraduate study; or deemed to have knowledge, experience and skill of value to Singapore to function in any healthcare capacity, including the provision of health services, but is not otherwise entitled to be registered. To safeguard the public, a practitioner on temporary registration will require supervision at all times, and additional conditions and restrictions may also be imposed.

Part IV of the Bill sets out the various offences and a penalty of a fine not

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exceeding $25,000 and/or prison term not exceeding six months for a first offence. This Part protects the public by prohibiting false representation of the regulated allied health professionals. There are inherent difficulties in regulating every aspect of practice in any profession as, naturally, overlaps occur in normal life and work. For example, both exercise trainers and physiotherapists prescribe exercises but for different purposes and to different types of clients.

However, we recognise that allied health professionals are trained and qualified to deal with healthcare and patients, and the expectation from the public is with regard to such expertise and its expected treatment outcomes. With a register of such professionals and laws against false representation, patients are assured that they are receiving treatment from bona fide practitioners.

Thus, clauses 29 and 30 make it an offence for a person who is not registered to imply that he is a qualified professional from the way he provides services, or use any title set out in the Second Schedule. Clauses 31 to 33 set out various offences to prohibit business owners and employers from making false claims that their employee is so qualified, and also holds the employee and his co-workers liable for such false claims.

Part V of the Bill deals with disciplinary proceedings before a Complaints Committee, Disciplinary Tribunal, Health Committee and interim orders committee inquiries. It provides for the Council to take action against the registered allied health professional on conduct and fitness to practise issues set out in clause 39, and also has in place appeals mechanisms for aggrieved parties. The clauses in this Part are substantially similar to the new Part VII of the Medical Registration Act.

To support professional self regulation, the Complaints Committee and Disciplinary

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Tribunal set out in clauses 40 and 50 will have a majority of members from the profession register index in the same profession as the person being complained against. As some of the smaller professions may not have members of sufficient experience and expertise, clause 50 also provides for the Minister to make exceptions to the Disciplinary Tribunal members' appointment where it is expedient to do so. Senior legal professionals may also be appointed to the Tribunal.

The Complaints Committee and Disciplinary Tribunal are empowered to make a wide range of orders to deal with matters. These include dismissing frivolous complaints; issuing letters of advice or warning; ordering the registered person to undergo treatment, or suspending his practice. These powers are set out in clauses 42, 49 and 53. In addition, the Disciplinary Tribunal is empowered to impose a penalty of up to $50,000 on a registrant.

Part VI provides for miscellaneous clauses to support the Council in meeting its mandate, such as setting out the powers of the investigators, appointment of legal and medical assessors and allowing for composition of offences.

Lastly, the First Schedule sets out the occupational groups defined as allied health professions, and the Second Schedule lists and describes the allied health professions to which the Bill applies to.

In preparing this Bill, the Ministry has consulted the public, allied health professionals and their associations as well as employers. There is strong support for the Bill. We will continue to consult them as we refine the implementation plans and subsidiary legislation that will follow.

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Mr Speaker, Sir, we need highly-skilled allied health professionals to beef up our healthcare teams so that Singaporeans can continue to enjoy a high level of health even as they grow old. Our allied health professionals have rendered a high level of care despite not being regulated. However, going forward, my Ministry believes that the allied health professionals can play an even larger and more effective role through statutory regulation as prescribed in this Bill. This will be good for the professions which have unanimously supported this Bill and this will be good for patients who can then be assured of competent and safe services. I seek the House's strong support for this Bill to ensure that the public continues to enjoy high standards of healthcare.

Sir, I beg to move.

Question proposed.

3.15 pm

Dr Lam Pin Min (Ang Mo Kio): Mr Speaker, Sir, I rise in support of the Allied Health Professions Bill.

This Bill is introduced at an appropriate time when the roles of allied health professionals become more important with the changing healthcare landscape in Singapore. The rapidly ageing population and the increased prevalence of chronic diseases will inevitably lead to an increase in demand for allied health services. This change will necessitate regulation of the industry to ensure a high standard of service delivery.

Allied health professionals are clinical healthcare professionals distinct from doctors, nurses and dentists. They work hand-in-hand with medical professionals by providing a range of diagnostic, technical, therapeutic and support services to patients. Singapore currently faces a shortage of allied health

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professionals. For example, there are currently about 800 physiotherapists in Singapore and this figure on a per population basis is way behind that of Hong Kong and Australia. In Hong Kong, the ratio is one per 30,000 whilst that of Australia is one to 10,000-12,000 population. The comparative ratio for Singapore is one per 50,000 based on a population of four million. There is, therefore, a need to train more and recruit more from overseas in order to meet the demand as the population ages.

The purpose of this Bill will serve to establish a legislative framework for regulating allied health professions for the protection of the general public. With the introduction of this Bill, the professional competency of allied health professionals will be strengthened and the public can be assured of a higher standard of care. It also provides a proper regime to handle complaints and disciplining errant practitioners.

The establishment of the Allied Health Professions Council as the regulatory body for the prescribed allied health professions will empower it to handle all matters, including registrations, training requirements and programmes, professional conduct and disciplinary proceedings of allied health professionals. The more structured registration process is important in accrediting allied health professionals. Due to the current shortage of allied health professionals, we will expect many to be recruited from overseas.

Allied health professions encompass a varied and diverse group of healthcare professionals. The current list in the First Schedule has included just 10 professions, namely, physiotherapist, occupational therapist, speech therapist, audiologist, clinical psychologist, radiographer, radiation therapist, podiatrist, prosthetist and dietician. The attempt to

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regulate a wide spectrum of healthcare professionals in a common Bill can be interpreted as one of convenience and can lead to many challenges, due to the diverse job descriptions and their individual peculiarities. The harmonisation of the registers of practitioners, complaints proceedings, composition of disciplinary tribunals and its various committees can be very complex. I applaud the Ministry for this concerted effort in drafting this umbrella legislation with subsidiary legislations covering the various professions. Though tedious, it is definitely a more efficient option than to take a piecemeal approach that can be very time consuming.

Whilst I welcome the introduction of this Bill, I would like to raise some concerns for the Minister’s consideration.

Besides the current list depicted in the first schedule, will the Minister consider regulating the chiropractors, homeopaths and the other allied health professions in the near future?

Clause 6 of the Bill spells out the composition of the Allied Health Professions Council. Will there be a minimum representation from the various allied health discipline and is there a maximum number of members in the Council?

Clause 15 provides that the Registrar may remove the name of a practitioner who has not renewed his practising certificate for a continuous period of not less than two years. For such practitioners whose registrations have lapsed and deregistered as a result for whatever the reasons may be, what is the mechanism for the reinstatement of the practising rights?

Clause 18 deals with the conditional registration of allied health professionals. Conditions are imposed on practitioners

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under this registration and this is often applicable to fresh graduates and returning overseas practitioners. Should these conditional registrants work under close supervision in a public institution where the working conditions usually provide a more comprehensive training and supervisory environment or can they be attached to private institutions where the workload and scope can be more restricted? Is there a maximum number of years or maximum number of renewals imposed on these conditional registrants? Practitioners who are placed under conditional registration for a prolonged period usually reflect the dubious competency of the allied health worker.

Clause 37 provides a voluntary insight mechanism for the registered allied health professional who believes that his fitness to practise is impaired by reason of his physical or mental condition; or the quality of his professional services does not commensurate with the minimum standard which is reasonable to expect of an allied health professional to voluntarily restrict, suspend or remove his practising rights. On the contrary, how would the Ministry of Health handle cases where the practitioners deliberately hide their physical, mental or professional incompetence and continue practising without informing the Council?

This Bill also provides for the Disciplinary Proceedings with clauses 43 and 44 allowing the Complaints Committee to refer parties involved in the complaints for mediation and appointing an investigator to investigate the case respectively. I would like to clarify with the Minister – how are the mediators and investigators selected and what are the necessary credentials for their appointment?

Will there also be guidelines on the advertisements of allied health practitioners, similar to that of the medical profession?

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Finally, I would also like the Minister to clarify the roles of the Performance Assessment Panel, Fitness Assessment Panel and the Health Committee as there is a tendency to misinterpret them as being synonymous.

Mr Speaker, Sir, the practice of medicine is always evolving and the various disciplines of allied health professions are no exceptions. Practitioners must continue to remain relevant and competent by upgrading their knowledge and skills. Just like the medical, dental, optometrist and opticianry professionals, a compulsory continual professional education programme will be necessary for all allied health practitioners. While establishing one can be achieved easily, the coordination of the various requirements can be challenging considering the diverse groups of allied health workers.

Mr Speaker, Sir, the proposed Bill will inevitably raise the standard and professionalism of allied health professionals. This mirrors very closely those of other healthcare professionals.

On that note, I support the Bill.

3.23 pm

Assoc. Prof. Fatimah Lateef (Marine Parade): Mr Speaker, Sir, this Bill is an important one and represents a milestone for allied health professionals. Accreditation is indeed the way forward. We cannot run away from surveillance of competence and practice performance. With the rising expectations from all sectors, maintaining good standing and standards of care is indeed crucial. This Bill will most certainly enhance the credibility of our allied health professionals, an increasingly important group of our multi-disciplinary healthcare teams.

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I have a few issues to raise. Firstly, in the initial stages, only occupational and speech therapists as well as physiotherapists will be regulated. What will be a timeframe for the rest of the allied health professionals to be regulated? I hope that this will not take too long. I also agree that, as this can be considered as an omnibus Bill covering so many professions in allied health, we may face many teething issues which require finetuning along the way; and thus a call for flexibility and adaptability on the part of those concerned. Lessons can be taken from the Opticians and Optometrists Bill which was introduced in 2007 and until today, there are still finetuning issues going on.

I support the various different categories of registrations stipulated. This is very much similar to that used by the medical professionals. When using this categorisation, it becomes important that we have:

(1) adequate supervision by trained supervisors;

(2) proper documentation of practices and maintaining of logs of certain skills; and

(3) a coordinated central secretariat to monitor and surveil accordingly. This would mean having enough manpower as the duties can be very labour intensive. This secretariat will have to network, coordinate and liaise very closely with the various institutions.

It is, thus, necessary to keep the registration framework simple and easy to execute and monitor.

With the passing of this Bill, Sir, it is inevitable that continuous learning and continuing education must become formalised. As in other professions, I feel that it must be linked to the renewal of practising certification. The Ministry will

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have to decide on the timeline for renewal, eg, yearly, two-yearly, three-yearly, and so on.

Sir, I support that the Allied Health Professions Council should have representatives from all different professions. But instead of having equal numbers from each profession, will it be possible to use a proportionate formula? For example, since we have more physiotherapists compared to, say, speech therapists, we should have more of the former represented on the Council, who will then work with the hierarchical committees and professional boards to be set up at different institutions and levels. This way, the model will be one of a "division of labour".

Sir, one of the areas which I feel should be given special attention to is the definition of "job scope", ie, what can and cannot be carried out by these professionals. This is important as there may arise frequent situations where there is a relatively blurred line between actions that can be carried out by, say, a physiotherapist versus an occupational therapist. In teaching institutions, for example, whereby there are clear distinct guidelines and definitions, usually there may not be any problems. However, in the private sector, this can sometimes be a bit more nebulous and for the more generic tasks, however, I agree that harmonisation of standards is, of course, acceptable.

Finally, Sir, will the Ministry of Health (MOH) consider licensing premises where allied health professional services are practised and offered? This can act as another level of checking mechanism besides just regulating the professionals themselves.

Mr Speaker, I am highly excited about this Bill and I am looking forward to its implementation. I feel it will enhance the

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performance of our allied health professionals – my partners in healthcare delivery.

3.27 pm

Mdm Cynthia Phua (Aljunied): Mr Speaker, Sir, I extend my compliments to the Minister for Health for his continuous effort to keep our medical professionals up to speed with the changing demands in our society. His latest is the Allied Health Professions Bill.

I am heartened to note that the Ministry is placing ample emphasis on identifying the qualifications and abilities of allied health practitioners. Allied health professionals are just as important to the nation’s health as doctors, for they are the ones who help patients get back to full health after a major treatment process. They also help ease the workload of doctors so that they can focus on the more critical issues in healthcare. Thus, allied professionals become more sought-after. It is, therefore, prudent that we ensure that the capability and qualifications of this group of people are up to the mark. I trust that the new measures announced in the Bill will help to address some patients' concerns. For far too long we have many who claim to be experts in dietary and would recommend all sorts of menu to maintain good health and to detoxify one’s body. So, too, we have some foot reflexologists who claim to be able to treat all kinds of ills, not to mention the tui na practitioners who sometimes claim to be able to cure most ailments.

With the new method of categorisation of allied health professionals, we are now able to clearly identify whether someone is fully qualified or partially qualified, which would undoubtedly be useful in employment and assigning duties. However, in the field of

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allied health, there are already many different specialties and sub-specialties. We need to be careful in not creating too many sub-specialties and complicate life for the patients. I think my parliamentary colleague has mentioned that we must be very clear about this sub-specialisation for our patients.

In addition, the Bill does not state how allied health professionals practising under the conditional registration category may qualify for full registration. Considering that the full registration category bears immense personal responsibility, it is important to make clear how applicants' abilities and knowledge will be assessed to gain access for an upgrade in registration.

I also note that professionals under the temporary registration category are likely to be teachers, researchers and postgraduates who will concentrate most of their work and research in medical education institutions and departments, while interning in hospitals and clinics. In this case, I wish to inquire whether it would be their school or the place of internship that will be responsible for reviewing their performance and supervision.

Lastly, I hope that the Allied Health Professions Council would not to be bogged down with all the nitty-gritty of registration and the various sub-committees or sub-specialisations but have the time to look at the distant horizon and draw up policies and guidelines to ensure that the community will enjoy the maximum benefit from the whole exercise of qualification and registration.

Sir, I support the Bill.

3.30 pm

Assoc. Prof. Paulin Tay Straughan: Mr Speaker, Sir, first, I would like to place on

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record my appreciation for the awesome work the Ministry of Health has done in meeting the healthcare needs of Singaporeans. I rise in strong support for this important Bill.

As our population ages and chronic ailments prevail, adequacy of healthcare provision and healthcare costs is of primary concern for all Singaporeans, particularly the older Singaporeans. Allied healthcare professionals are an indispensable and important group that supports the healthcare needs of Singapore. The Bill proposes setting up a single regulatory body – the Allied Health Professions Council – to oversee the conduct and the practice of allied healthcare professionals.

I have three short queries for the Minister. First, Sir, may I ask the Minister the timeframe his Ministry has in mind for the regulatory framework to be set up and operational to cover all the allied health professionals. Second, my concern relates to the diversity of the professions this proposed Council is tasked to represent and oversee. Can the Minister provide details on how the Council members will be elected and the relationship of the Council to the respective professional organisations? For example, will the Presidents of each of these professional organisations be invited to the membership of the Council?

Does the Minister see a parallel between this proposed Bill to regulate allied healthcare professionals and the regulation of Traditional Chinese Medicine (TCM)? If so, what is the learning point we can take from the regulation of TCM?

My final concern relates to cost. Sir, does the Minister anticipate that because of regulation, cost of seeking treatment from allied healthcare professionals will increase? Are there implications of regulation on reimbursements by insurance companies?

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3.33 pm

Ms Ellen Lee (Sembawang): Mr Speaker, Sir, the introduction of the Allied Health Professions Bill is indeed timely as we prepare for the imminent challenges of a fast growing healthcare industry in Singapore. Increasingly, allied health professionals will play a greater role as they are a key pillar in any healthcare institution working alongside doctors, nurses and other ancillary staff. It is foreseeable that the demand for their services will also rise across our private and public healthcare institutions.

With the registration of such professionals in the likes of nurses, pharmacists and doctors, there are inherent issues which need to be considered with the introduction of this Bill. From a public or the patient's perspective, it is essential that this group of healthcare professionals who have direct contact with patients and service users provide high quality care. Through this Bill, quality of care will be strengthened if comprehensive arrangements are put in place that require allied health professionals to meet lucid, minimum standards of practice, codes of conduct and pre-registration training before they can be registered and licensed. It will, therefore, be an important element of the new regulatory arrangements to establish clear criteria, in terms of qualifications or experience for admission to the register. There should also be clear procedures to manage those who fail in the registration and the readmission process. I believe quality of care will surely be strengthened if they are required to meet specified training and practice standards which extend to post-registration as well as strict continuing education and training requirements whether on an on-going basis or periodically.

By the same token, with this new Bill, allied health professionals can now be

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subjected to disciplinary proceedings if their actions or behaviour fall short of accepted standards. Unfortunately, from an allied healthcare professional's perspective, with a robust regulatory and licensing framework comes the need to safeguard themselves from discipline, litigation and malpractice issues just like doctors and lawyers. As such, there should be a need for such professionals to be covered by a compulsory professional indemnity insurance which must be low cost as many of these professionals, in particular the new hires, may find this insurance exceedingly onerous and costly. In particular, those operating on a freelance basis and not employed or attached to any major healthcare institution or establishment will also find this an added financial burden.

From these allied healthcare professionals' perspective, they would want to know if there are any safeguards to protect them in cases where trigger-happy patients lodge complaints which are frivolous. There is also a question of who can represent these allied health professionals if they are called before the regulator or disciplinary body to answer any complaint or charge. Although the Bill sets up a system to handle complaints, it should be a definitive and transparent system for complaints management and discipline so that the allied health professional, patient, regulator, the Ministry of Health and the public can withstand close scrutiny whilst at the same time uphold the profession, rule of law and natural justice.

Further, with the growth of new media and rampant use of the Internet, I am also keen to know how issues regarding the giving of advice on care or treatment by allied health professionals via the Internet will be dealt with as the level and quality of advice and care will differ and vary.

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I would also like to know why this Bill exempts chiropractors. The Chiropractic Association (Singapore) is a voluntary organisation and as such, membership is voluntary. It can self-regulate its members but if the rogues of the profession either terminate membership or are ineligible for membership as their business practices fall outside its standards, there is no way to rein them in.

The Bill delineates the scope of practice of scheduled professions and chiropractors feel that there is a lot of overlap between physiotherapists and them. While chiropractors say that they do not call themselves physiotherapists, they are understandably concerned that they do not lose the right to perform procedures that they have been duly qualified to perform in accredited courses due to their exclusion from the Bill. It would be good if the Minister could enlighten us.

On this note, Sir, I support the Bill.

Mr Speaker: Order. I propose to take the break now. I suspend the Sitting and will take the Chair again at 4.00 pm.

Sitting accordingly suspended

at 3.42 pm until 4.00 pm.

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Sitting resumed at 4.00 pm

[Mr Speaker in the Chair]:

ALLIED HEALTH PROFESSIONS BILL: **** Debate resumed.

Mr Khaw Boon Wan: Mr Speaker, Sir, I thank the five Members who have spoken on the Bill for their strong support. Let me address their various comments and valuable suggestions.

Dr Lam Pin Min noted that the Bill is quite different from the other health

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professional registration laws as the scope this time round is wide and varied. Assoc. Prof. Paulin Tay Straughan asked if we could draw useful lessons from the regulation of Traditional Chinese Medicine (TCM).

The registration laws for the different healthcare professions are generally similar as they all seek to protect the public from unqualified practitioners or those who are unethical. Not surprisingly, there are similarities in approach. When drafting this Bill, we have taken references from several countries, including Australia, Canada and New Zealand. The omnibus approach to this Bill, resulting in it being therefore wide and varied, is for a practical consideration as noted by several Members, including Dr Lam. But the strategic intent of raising professional standard, safeguarding consumer interest and promoting high ethical practices is similar to how we regulate doctors, dentists, pharmacists or TCM physicians.

However as the range is wide, adequate representation on the Council is therefore a valid concern. I have addressed this earlier in my second reading speech. Assoc. Prof. Fatimah Lateef suggested some sort of a proportionate representation of each profession on the Council. The Bill allows us to appoint more than one member of each profession on the Council. Where a profession has more than, say 500 registrants, I suppose we can appoint two Council members. But for now, we will start with one representative each, and see how it goes. The first Council will start off with the Director of Medical Services or his representative; the Director-General of Education or his representative; the Registrar; one physiotherapist, one occupational therapist, and one speech therapist. We will make sure all of them would have at least 10 years of practical experience. We will add new members as needed.

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Dr Lam Pin Min asked if we would put a cap on the size of the Council. We are thinking of keeping it to 25 members so that it does not become too big. Let me add that the Allied Health Professions Council is, first and foremost, a regulator. Its primary duty is to ensure the safety and welfare of the public. It is not set up to promote or advocate the different professions’ interest. In regulating these professions, the Council needs to ensure that the standards and regulatory policies are relevant to the different groups, and can effectively address any regulatory issues unique to the profession. The Council will have to consult extensively with the different professions and stakeholders as it further develops and implements the regulatory policies and standards. It will be supported by advisory committees and boards, comprising experienced practitioners from the professions. It should also learn from other allied health regulators overseas.

Assoc. Prof. Fatimah Lateef felt it is important to define clearly what each profession can and cannot do. We will define the knowledge, skills, and training required for each specific allied health profession. We will set standards on practice, conduct and ethics. But in defining what the professionals can or cannot do, we must be careful not to hinder other legitimate service providers from providing services which they are competent to do.

Ms Ellen Lee noted some overlap in the scope of practice between chiropractors and physiotherapists. She wondered if chiropractors would lose their right to practice what they are trained for. They will not. The Bill does not grant monopoly power to a particular profession. For example, both voice coaches and speech therapists provide voice training. If you are a teacher, and you want to control and project your voice better, a voice coach could well do

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the job. However, if you have just had a stroke and need help to regain your speech, you would need a speech therapist.

Even amongst the allied health professions, there are overlapping areas of practice, as noted by Ms Ellen Lee. For example, hand therapy may be carried out by both physiotherapists and occupational therapists; and difficulties in swallowing may be managed by both occupational therapists and speech therapists. As healthcare becomes increasingly team-based and integrated, it is more important that a profession is allowed to practice what they have been trained to do so long as they can demonstrate competence in doing so.

We do not want to reduce access to services, or choices for consumers because that will push up cost. However, it is important to help consumers make an informed choice. Therefore, we have to protect the titles and the practice of the profession under the title, and not the scope of practice. In so doing, when patients need an allied health professional’s expertise, the professional titles used will serve as a guide for them, as will the register of practitioners which will be readily accessible on the Internet.

Assoc. Prof. Fatimah Lateef, Mdm Cynthia Phua and Ms Ellen Lee commented on the registration framework. We have adopted a tiered registration framework as we have found it useful in regulating the other health professions. A tiered system allows practitioners of diverse background and training continued access to our system for the provision of care without compromising public safety.

Let me briefly explain how the registration framework will work. Full and conditional registration will apply to most

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practitioners. All practitioners who have approved qualifications or have passed the local qualifying examinations will be eligible for registration in either one of these two categories. For those who have been practising as an allied health professional in Singapore, they will be directly eligible for full registration. New graduates, or those who have little or no experience of practising in Singapore will first be conditionally registered and required to work under supervision. After completing their supervised practice period with no adverse performance reports, they will be able to convert to full registration.

Dr Lam asked if supervised practice during conditional registration can be done in private institutions. The answer is "yes". We will allow it, provided the private organisations have the capabilities and standards to supervise such professionals.

Among those who are currently practising in Singapore, there is a small number whose basic professional qualifications are not recognised. However, they have been serving patients for many years in their jobs. They should be allowed to continue in their practice, and serving the patient groups they are familiar with. Restricted registration will apply to this group of practitioners, where they will only be allowed to work with client groups they are familiar with, or only in specified employment or places of practice.

There will also be practitioners whose basic professional qualifications are not recognised, but have had good quality post-graduate training and practice experience in a particular area of the profession; or others who may have practised exclusively in a particular area of practice, such as sports physiotherapy, or paediatric occupational therapy, for a long period of time. Restricted registration may also be applicable to these individuals.

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Allied health professionals employed for the purpose of teaching, training or research, must also be registered. Competence and conduct issues remain relevant. When they are here for a short stint of a few weeks or months or do not have qualifications that are on the list of approved qualifications, temporary registration is needed. In areas of critical manpower shortages, temporary registration can also be applied as a stop-gap measure. Such a practitioner must work under supervision at all times. In this way, the tiered registration framework allows us flexibility to manage our manpower challenges and at the same time, protecting public safety and consumer interest.

Dr Lam asked about the process for renewal of registration for practitioners whose registration has lapsed. The practitioner can apply, or the Council can restore the name to a register on its own motion. The name will be restored to the same register if there is no reason not to do so. Otherwise, the Council can place the person on conditional or restricted registration as well. The details are in clauses 27, 56, and 59.

Dr Lam and Assoc. Prof. Fatimah Lateef asked if compulsory continuing professional education will be required. The Bill does provide for the Council to mandate continuing professional education to grant or renew practicing certificates. When implemented, this will better assure the public that registered professionals will be up-to-date in their knowledge and practice. As Ms Ellen Lee pointed out, this will strengthen the quality of care provided. The Council will consider this after completing the registration of existing practitioners. Given the wide range of the professions, the Council will set up committees to set the policies, standards and requirements for continuing professional education. The committees will comprise the relevant allied health professionals. Continuing professional

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education activities will be co-ordinated by the professional bodies, healthcare institutions, and other education providers as is the case with other healthcare professions.

Ms Ellen Lee asked if there were safeguards to protect registrants against frivolous complaints. These are provided for in the Bill. The complaint must be made in writing and supported by a statutory declaration. The professional will be given the opportunity to present his case. The Complaints Committee will review and investigate the complaints thoroughly, and only serious complaints will be directed for formal inquiries.

Ms Ellen Lee asked who could represent the allied health professional when he is called to answer a case against him. When the complaint is reviewed by the Complaints Committee, the allied health professional will not generally be required to appear before the Committee. Instead, he may be asked to provide a written exculpatory statement. It is only when the complaint is directed for further inquiry at the Disciplinary Tribunal or Health Committee, would his attendance at the proceedings be required. And at this stage, he can engage a legal counsel to represent him if he wants to. This follows the practice in other health professional regulatory Councils.

Dr Lam sought clarification on the different roles of the Performance Assessment Panel (PAP), Fitness Assessment Panel (FAP) and Interim Orders Committee (IOC). The Performance Assessment Panel will be appointed by the Complaints Committee if there is an issue of the quality of professional services provided by the professional. This is set out in clause 45. The FAP will be appointed where the professional’s fitness to practice is in doubt by reason of his physical or mental condition. This is in clause 46. The IOC will be invoked when

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immediate or urgent action is required for the protection of members of the public or it is otherwise in the public interest or in the interests of the allied health professional concerned. The IOC may order that his registration be suspended or be made subject to conditions or restrictions.

Dr Lam asked if there would be guidelines on advertisements of practitioners. We will set these guidelines in the ethical codes for the allied health professions, similar to the medical profession.

Assoc. Prof. Paulin Tay Straughan expressed concerns on the cost of regulation. Any regulation will come with a cost. The key is to minimise the cost of regulation. Indeed, one reason for taking an omnibus approach is to try to reduce the overhead cost, so that it will be minimised for the professions and the clients that they served. Our sense is that any cost impact will not be significant for as long as the market is sufficiently competitive. I think pricing is more of a function of how competitive the market is. This was our experience when we started regulating the optometrists and opticians. The Bill will not affect the choices available to consumers and patients regarding the type of services they seek.

Assoc. Prof. Paulin Tay Straughan wondered if regulation would impact reimbursement decisions by insurers. This is really something for the insurers to decide. Currently some insurance policies do reimburse for some allied health professional services. I suppose they will then price it into the premiums.

Ms Ellen Lee was concerned with the burden on the allied health professionals if they are subject to costly indemnity insurance. I agree with her that it will be

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prudent for practitioners to have arrangements either through their employers for some sort of indemnity, or if they are self-employed, to have their own indemnity insurance. In the public healthcare sector, we employ quite a large number of the professionals and, we have that kind of arrangement. In our experience the cost of such insurance, while market determined, is not too prohibitive.

Ms Ellen Lee asked how the quality of care provided over the Internet will be dealt with. This is an emerging issue and probably would be challenging as well. At the moment, for allied health services, by our observation, is not yet a significant issue. But I agree that the Internet will open up new possibilities and challenges.

Some of the other regulatory councils are currently looking into this issue, and it will be appropriate to develop this as a policy across all healthcare professionals.

Several Members asked about the implementation timeline. If the Bill is passed, we will set up the regulatory framework and get it operational for the three professions within a year.

We have, as you see in the First Schedule, listed 10 groups. I scanned the range of allied health professions regulated in other countries and by and large, these are the 10 professions which are being regulated in Australia, the United Kingdom and United States. We will start with the three therapy professions in the first phase and then this will be followed by another three professions: clinical psychologists, diagnostic radiographers and radiation therapists. These are the six professions which we already have local education and training programmes. For the rest of the professions we will bring on board as well. My own estimate is that we should be able to complete the registration of the 10 professions within the next term of Government.

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Ms Ellen Lee and Dr Lam asked if chiropractors would be included in this Bill. My Ministry is studying the regulation of chiropractors in some countries. Where they are regulated, they are regulated as “complementary and alternative health practitioners”. We are studying the need for such a piece of legislation and it is an assignment which probably will be in our work plan during the next few years.

Mr Speaker, Sir, the allied health professionals form an important pillar of our healthcare system. It is time for us to go beyond self-regulation. By setting and enforcing standards, the Bill will raise the quality of the allied health sector and, thus, serve the public better, and I seek the House full support of this Bill.

Question put, and agreed to.

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

The House immediately resolved itself into a Committee on the Bill. – [Mr Khaw Boon Wan].

Bill considered in Committee.

Mr Khaw Boon Wan:

The Chairman: The citation year "2010" will be changed to "2011", as indicated in the Order Paper Supplement.

Clauses 1 to 76 inclusive ordered to stand part of the Bill.

The First and Second Schedules ordered to stand part of the Bill.

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