TRADITIONAL CHINESE MEDICINE PRACTITIONERS BILL

Order for Second Reading read. 1.05 pm

The Parliamentary Secretary to the Minister for Health (Mr Chan Soo Sen): Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

Reasons for regulation of TCM practitioners

Sir, although Western medicine is the main form of healthcare in Singapore, Traditional Chinese Medicine (TCM) enjoys considerable popularity as a complementary form of healthcare. It has been estimated that about 45% of the population had ever consulted a TCM practitioner in the past. About 12% of the daily outpatient attendances opt to see TCM practitioners. Hence, TCM is a significant factor in the healthcare scene in Singapore.

There is a similar trend in developed countries. In the West, complementary medicine, including TCM, has a significant following. Some Western countries now allow insurance claims or reimbursement for acupuncture treatment. Acupuncture and therapeutic massage (or tui na) have been popular among patients suffering from painful conditions. There is also the popular belief that TCM is milder and has fewer side effects, thus making it a preferred modality amongst older persons. As the population in Singapore ages, it is likely that there would be an increased demand for TCM treatment.

The number of TCM practitioners in Singapore is also sizeable and it would probably increase in tandem with the demand for TCM treatment. A list published by the local TCM community in 1997 indicated that there were 1,807 TCM practitioners in Singapore. There is probably more now. The training and experience of TCM practitioners in Singapore vary. Some were self-taught. Some learned from peers or masters, while others graduated from TCM institutes.

In July 1994, the Ministry of Health appointed a Committee to look into the regulation of TCM. The Committee recommended a phased approach, (ie a step-by-step approach) to the regulation of TCM practitioners in order to safeguard patients' interest and safety, as well as to enhance the standard of training and professionalism of TCM practitioners in Singapore.

A phased approach is necessary, given the complexities of regulating TCM practitioners. Take the case of Hong Kong as an example. Although Article 138 of the Basic Law provided for the development of both Western and Chinese medicine, and there has been a Working Committee appointed since 1989 to promote, develop, and regulate TCM, the Chinese Medicine Ordinance was only enacted after 10 years in July 1999.

To facilitate the regulatory process in Singapore, the Ministry of Health first encouraged the eight main local TCM organisations to form the Singapore Traditional Chinese Medicine Organisations Coordinating Committee (STCMOCC) in 1996. The STCMOCC serves as the coordinating body amongst the mainstream TCM community. It also acts as a channel of communication between the mainstream TCM community and the Ministry of Health.

I must say that this arrangement has worked well. The formation of STCMOCC has led to the upgrading of the local TCM training course to a 6-year part-time diploma course in 1996. The STCMOCC has also worked out a listing of TCM practitioners in Singapore. That was how we knew that in 1997, there were 1,807 TCM practitioners in Singapore. In fact, this Bill was prepared with useful inputs from the STCMOCC. The Bill indeed has the support of the mainstream TCM community in Singapore.

Major provisions in the Bill

Mr Speaker, Sir, allow me now to present the main provisions of the Bill. This Bill is an enabling legislation to allow the Minister to declare any type of practice of TCM for registration if he is of the opinion that it is in the public interest for that type of practice to be regulated. In other words, the Minister will decide which form of TCM practice to be regulated at which point of time. It will not be that, with the promulgation of this Act, every form of TCM practice will be regulated. Clause 14(1) of the Bill states that the Minister can regulate by order published in the Gazette. This is in line with the phased approach the Ministry of Health has been adopting.

The Ministry of Health's intention is to start with regulating the acupuncturists, because acupuncture is an invasive procedure that carries risks of injury and infection. It is estimated that there are about 1,070 acupuncturists in Singapore. This will then be followed by the registration of TCM general practitioners in about 3 to 4 years' time, and the TCM herbal dispensers at a later date.

This Bill takes reference from the existing medical- and health-related legislation such as the Medical Registration Act, the Dentists Act as well as the Nurses and Midwives Act. All these Acts are essentially based on self-regulation. This Bill provides for the establishment of a Traditional Chinese Medicine Practitioners Board appointed by the Minister to register TCM practitioners, to accredit TCM training courses and institutions, as well as to regulate the professional conduct and ethics of TCM practitioners. The Board will consist of 5 to 9 members, comprising peers from the TCM community, members of the medical profession, as well as representatives from the Ministry of Health.

The Board can appoint Committees to which specific tasks are delegated. For example, the Board may appoint an Examinations Committee to set standards and to determine the content of the qualifying examinations for registration, as well as to oversee the organisation and conduct of the examinations. Also, the Board may appoint Investigation Committees to investigate complaints which may lead the Board to take disciplinary actions against practitioners.

The TCM Practitioners Board will have disciplinary powers to deal with any registered TCM practitioner found guilty of professional misconduct, professional negligence, or improper conduct, which renders him or her unfit to practise. The Board may -

(a) caution or censure the practitioner;

(b) impose a fine of not more than $10,000;

(c) impose conditions on the practitioner's registration for a period of no more than three years;

(d) suspend his or her registration for no more than three years; or

(e) cancel his or her registration.

Any practitioner who is aggrieved by the decision of the Board may appeal to the High Court within 30 days. A person whose registration has been cancelled can apply to the Board for restoration three years after the date of cancellation and not more than once in any period of 12 months. This is similar to the provisions made under the Medical Registration Act as well as the Dentists Act.

To deter unlawful practice of TCM, the Bill provides for the imposition of penalties similar to the provisions of the Dentists Act. The Courts may fine the offender not more than $25,000 or imprison him for a term not exceeding sixmonths or both. In the case of a second or subsequent offence, the penalty is increased to a fine of not more than $50,000 or imprisonment for a term not exceeding 12 months or both.

Any person who procures or attempts to procure registration by fraud shall be liable on conviction to a fine not exceeding $10,000 or to imprisonment for a term not exceeding two years or to both. This is similar to the provisions of the Medical Registration Act.

Implementation

Mr Speaker, Sir, the Ministry of Health's plan is to subject acupuncturists to registration by 1st January 2002. Details of the registration as well as the criteria for registration have been worked out with the STCMOCC, the coordinating committee that represents the mainstream TCM practitioners in Singapore. The criteria take into consideration both experience as well as qualifications. Those who do not have the necessary experience or qualifications may be required to pass a national examination called the Common Acupuncture Qualifying Examination (CAQE) before they become eligible for registration. The Ministry of Health and the STCMOCC have initiated the Acupuncture Upgrading Training Course (AUTC) in order to prepare acupuncturists for the CAQE. The course syllabus and course structure were formulated and developed by the STCMOCC as well as the Ministry of Health, with inputs from foreign TCM experts. The first four classes of AUTC had started since September this year. The response has been very good. We plan to conduct two or three CAQEs in the year 2001, so there should be sufficient time and opportunities for the acupuncturists to pass their examinations and to register by 1st January 2002.

When the TCM Practitioners Board is formed, it will take over these tasks from the Ministry of Health. The Ministry and the Board will maintain close contact with the STCMOCC to ensure that constructive proposals from the mainstream TCM community are taken into consideration. The registration of the acupuncturists will provide valuable experience to prepare us for the eventual registration of other TCM practitioners.

Sir, in conclusion, statutory regulation of TCM practice is necessary to safeguard patients' interest and safety. We have to ensure that TCM practitioners are properly trained and qualified before they are allowed to practise. There should also be a framework to raise the professional standard of TCM practitioners in Singapore. All these are provided for in this Bill. The mainstream TCM community, represented by STCMOCC, has played an active part in the preparation of this Bill. This Bill has their support.

Sir, I beg to move.

Question proposed.

Mr Ang Mong Seng: (In Mandarin): Mr Speaker, Sir, I fully support the Bill introduced by the Parliamentary Secretary on Traditional Chinese Medicine (TCM). With an aging population, more and more people are seeking medical attention, and most elderly people are more comfortable with TCM, including acupuncture.

The contents of the Bill cover mainly two areas - one, the setting up of a Traditional Chinese Medicine Practitioners Board, and the other, provisions for the conduct of examinations in TCM. On the establishment of the TCM Practitioners Board, I wish to raise five points which concern public interest:

Firstly, with the registration of TCM practitioners, will the medical certificates (MCs) issued by TCM practitioners enjoy the same status as the MCs issued by western-trained doctors, and be recognised by Government departments and employers in the private sector?

Secondly, will the receipts issued by TCM practitioners be accepted by employers for reimbursement of medical fees?

Thirdly, if a TCM practitioner is of the opinion that his patient is seriously ill and warrants immediate attention by doctors in the A&E unit of a Government or restructured hospital, will the referral letter by a TCM practitioner be accepted for the purpose?

Fourthly, currently, pharmacists in Singapore have to be registered and licensed in order to practise. Under this Bill, will the Chinese drugstores be required to apply for permits or licences to sell herbs or Chinese patent medicine?

Fifthly, will the Bill incorporate a set of code of conduct for the Chinese medicine practitioners to follow? At the same time, will the TCM practitioners be required to be properly attired when they are attending to their patients? I have occasions to visit TCM practitioners in Singapore, and I notice that they are usually not too particular about their attire. Some would wear an open-collar short-sleeve shirt, and some even wear the traditional Chinese pyjama pants when they see patients. The practice in China is quite different. All their physicians wear smart-looking white physician's coat whenever they are on duty, giving a very professional image.

When we look at western-trained doctors like Dr Tan Cheng Bock, he always wears a tie and he looks very handsome indeed. For the lady doctors, like Dr Lily Neo, she always pays great attention to her attire, and dressed beautifully. This reflects the professionalism in them. I hope that TCM practitioners in Singapore will also pay attention to their attire. Once this Bill is passed, I hope that our TCM practitioners will do their best to reinforce their professional image.

Mr Tay Beng Chuan: (In Mandarin): Mr Speaker, Sir, the Traditional Chinese Medicine (TCM) community in Singapore must be gratified and elated by the introduction of Traditional Chinese Medicine Practitioners Bill in Parliament today by Mr Chan Soo Sen, Parliamentary Secretary to the Minister for Health.

The Government is currently strongly advocating research and development on the life sciences with a view to developing this field into another pillar of our economy. Now, through legislation, the Government has included the practice of TCM in the scope of orthodox medical and healthcare industry in Singapore, thereby according the Chinese physicians and practitioners in the TCM industry their due legal status. This approach is certainly foresighted, appropriate, and wise.

Mr Speaker, Sir, the development of TCM is well established with a history of a few thousand years. The abundant knowledge of TCM is quite profound and extensive since it has taken generations to accumulate through continuous medical practice and combat against diseases. Yet, there is still room for the abundant knowledge on traditional herbal treatment and acupuncture to be further developed. As such, in addition to recognizing and regulating TCM through legislation, I would urge the Government to allocate adequate resources to train and recruit ample supply of outstanding TCM practitioners and researchers to study and develop TCM so as to make it a part of the development of the life sciences.

Mr Speaker, Sir, in view of the escalating cost of western medical treatment and medicines, TCM has been providing our people with an alternative way to seek cheaper and more convenient health care service. According to a relevant statistical report, out of three million Singaporeans, there have been more than a million visits to the various TCM hospitals and clinics every year. In addition, many people simply go directly to a TCM shop to purchase medicine over-the-counter and take it without any medical advice.

Statistics from 1999 showed that the Chung Hwa Free Clinic established by the Singapore Chinese Physicians' Association in 1952 sees an average of 900 patients per day. In other words, for more than four decades, it must have treated some eight million patients. The Singapore Thong Chai Medical Institution has been receiving an average of 700 patients daily since 1867. The Public Free Clinic was opened in 1974 and has about 400 patients every day. Moreover, many charities such as the Singapore Buddhist Free Clinic, the Singapore Buddhist Lodge, and the Kwan-In Welfare Society, Singapore, together receive more than 1,000 patients daily. As to the 1900-odd Singapore TCM practitioners, many of them see more than 100 patients each in their respective clinics each day.

Consequently, many people, especially those in the lower income group, are deeply concerned that the cost of TCM may be increased once it is regulated. I would suggest that the Government refrain from imposing excessive levies or unnecessary red-tapes when issuing practising certificates to the practitioners so as to avoid additional cost to them. Professional practitioners should also exercise self-discipline. Unreasonable charges may add on medical expenses of the ordinary citizens, bringing them extra burdens and compelling them to switch to western medicine or even self-medication to reduce their medical expenses. To TCM practitioners it would be more of a loss than a gain.

On the other hand, wholesalers and retailers of Chinese medicine also worry that once the law comes into force they may be obligated to hire registered TCM practitioners or pharmacists to be stationed at their shops to operate their business lawfully. Currently, most of the shops have the owners or the "old-hands" or supervisors to provide consultation and to help them dispense the correct herbs in their correct dosages as prescribed by the physicians elsewhere.

As a matter of fact, there is no so-called "controlled" or "non-controlled" drugs, as far as Chinese medicine in Singapore is concerned. However, the import and retail sales of Chinese herbs are subjected to strict control by the Ministry of Health. If any ingredient harmful to human health is detected, import of the medicine will be immediately banned and the medicine or herb will be prohibited from being sold in Singapore. In other words, all Chinese herbs presently sold are uncontrolled drugs which are safe for human consumption.

It is a common practice to see customers bringing their prescriptions to the TCM shop for the herbs to be dispensed. Selling the herbs and dispensing them according to the prescriptions produced by the customers are also the basic business and service available at all TCM shops.

Hence, if these shops would have to hire registered or certified practitioners to run the day-to-day business, life would be extremely difficult for the TCM shop-owners. The laws should be enforced only after all the conditions are met; otherwise, the business of the existing 1,000 or so TCM shops would be severely affected and the overall medical service, health care, and even the economy would suffer a negative chain impact.

If a TCM shop sells only patent and common over-the-counter medicines it should not come under the provisions of the Bill. This is the same as in the western medicine pharmacy where the presence of in-house pharmacists is not mandatory if no prescribed medications are sold in the shop. I believe that in order to enhance and control the quality of retail TCM shops we should consider the present practice of the TCM shops. Only if we take a pragmatic approach can our policy achieve the anticipated results. If in the future they are required to have registered practitioners in the shop, they should also be given ample time to train their staff. Also, for the best result, it is important to have the cooperation of the TCM community.

Mr Speaker, I support the Government's intention to establish a Traditional Chinese Medicine Practitioners Board to appraise the practitioners' qualifications and to issue certificates so as to ensure that the practitioners observe a high-level code of conduct, and to promote TCM education and training plans. From the national medical and healthcare standpoint, this Bill is rather critical as it has a profound impact on our TCM's survival and development. I would suggest that the Government invite TCM-related groups to sit on this Board to tap their expertise and experience. I believe with the cooperation of the Government and related industry, this innovative policy will achieve successful results. The development of our TCM will also attain remarkable results.

Mr. Speaker, Sir, I support the Bill.

Dr Tan Cheng Bock (Ayer Rajah): Mr Speaker, Sir, I support this Bill. As my name was mentioned, I thought I had better say a few words on this Bill too.

The Bill is welcome. As a Western-trained doctor, I still feel that we should register these practitioners. The main thing that we must consider is a good standard and training for all TCM practitioners. Medical students training to become doctors have to go through six years of rigorous training, including one year of medical housemanship before they can come out and practise. That is important because we are dealing with lives. For students who want to take up medicine, they have to achieve very good grades at 'O' and 'A' levels. So we are picking the top of the 'A' level cohort to become doctors. That should be so because the training to be a doctor is very tough and we are putting all these people out to treat patients eventually. Rightly so, we should maintain this very high standard in the medical schools. I am hoping that with the registration of TCM practitioners, all these TCM practitioners should also be trained very rigorously so that when they come out to practise they will also be of a very high standard.

If we expect the entry for Singaporeans to become TCM practitioners, let us say at 'O' level or just very poor 'A' level results, we might be getting poor quality graduates from the TCM school. It would be good to maintain a very high standard of entry for these Singaporeans who want to be TCM practitioners.

Mr Ang Mong Seng brought up the point whether, having registered the TCM practitioners, we would recognise them or not. It is a question of registration and recognition. If recognition is accorded to them, we must also be prepared to recognise the medical certificate. I am not sure what level of recognition he is talking about. Is it just recognition that they can practise or recognition at the same level as medical practitioners?

Mr Chan Soo Sen: Mr Speaker, Sir, I thank the three Members who have supported the Bill and offered constructive observations and suggestions. Since most of the discussions were in Mandarin, allow me also to answer the questions in Mandarin, if Dr Tan Cheng Bock does not mind.

(In Mandarin): Sir, I would like to thank Mr Tay Beng Chuan, Mr Ang Mong Seng and Dr Tan Cheng Bock for their very good and constructive suggestions. Let me take this opportunity to respond to the issues raised by them.

Mr Tay Beng Chuan said that when the Government registers the TCM practitioners, it should not impose excessive levies or red tapes to increase their costs, leading to higher fees for the patients. I can assure Mr Tay Beng Chuan that this is not the intention of the Government. I believe that the Chinese physicians will not and should not take the registration as an excuse to increase their fees either. I believe the fees would be a very small portion of their revenue.. The doctors, dentists and pharmacists also pay a one-time registration fee. The doctors and dentists pay $200 and the pharmacists pay $100. Every year, the doctors and the dentists pay a licence fee of $200, while the pharmacists pay $100. Assuming the licence and registration fees for TCM practitioners are similar, these are very nominal sums. They should not affect the consultation fees. I must emphasise that these were figures for illustration. The actual registration and licence fees would be determined by the TCM Practitioners Board after its establishment. I am sure that the Board will take into consideration the prevailing charges for the doctors, dentists and pharmacists.

I am sure TCM practitioners realise that their fees are determined by market forces. As Mr Tay Beng Chuan has mentioned, if the fees are too expensive, the patients may opt to see the western doctors instead. I am sure TCM practitioners will not kill the goose that lays the golden eggs by arbitrarily raising their fees. If there is a need, the Singapore Traditional Chinese Medicine Organisations Co-ordinating Committee (STCMOCC), the Committee representing mainstream TCM community could, like the Singapore Medical Association (SMA) for the doctors, provide fees guidelines for various treatments. If a patient feels that he has been over-charged, he can complain to the Traditional Chinese Medicine Practitioners Board, Consumers' Association of Singapore (CASE), or to the courts. These are channels through which they could seek redress.

Mr Tay Beng Chuan has also raised the issue concerning training of herbal dispensers working in TCM retail shops. The Government has no immediate plans to make it compulsory for TCM retail shops to engage a certain number of registered TCM practitioners or herbal dispensers. Even if we do so eventually, it would be done in stages.

However, it is true that the training standards of herbal dispensers working in TCM retail shops vary considerably. It is necessary to upgrade their training so that the TCM shops can serve their customers better. Ministry of Health had discussed this with the Singapore Traditional Chinese Medicine Organisations Committee (STOC) which represented the TCM traders and retail shops. We are very happy that STOC recognises this, and is planning for a training course for herbal dispensers. Ministry of Health will work with STOC to work out the course, and will help STOC to invite foreign TCM experts to appraise and evaluate the training courses. If all parties work together, we can start offering the herbal dispensers' training course in one or two years' time. This will make important contributions towards lifting the service standards of TCM retail shops in Singapore.

Mr Ang Mong Seng touched on the professional image and code of conduct for TCM practitioners. Dr Tan Cheng Bock also raised similar concerns. Under this Bill, the TCM Practitioners Board will consist of well-respected TCM practitioners as well as some western doctors. They will be in good positions to work out the code of conduct for the TCM practitioners. I hope the TCM Practitioners Board come out with some formal guidelines so that the registered TCM practitioners can refer to. I do not know whether they would go into details such as male practitioners to put on a tie and dressed up as handsomely as Dr Tan Cheng Bock, while the lady practitioners dress up as beautifully as Dr Lily Neo, as observed by Mr Ang Mong Seng. It is up to the Board to decide. However, the Board can supervise and take disciplinary actions against practitioners who conduct themselves unprofessionally.

Mr Ang Mong Seng and Dr Tan Cheng Bock both touched on the recognition of Medical Certificates (MCs) and receipts issued by TCM practitioners for the purpose of employee medical benefits. I feel that it is premature to talk about this matter at this point of time. Whether or not the employers will recognise the Medical Certificates issued by TCM practitioners and reimburse the cost of TCM treatment, will depend on whether the employers are satisfied that the Chinese physicians are of high professional standing, and whether the employers are comfortable with the authority and authenticity of these documents.

When the professional standard of our TCM practitioners has arrived, more and more employers will recognise their Medical Certificates. The Government cannot legislate to compel them to recognise these Medical Certificates. The decision should be taken by the employers. I feel that the most important task for the TCM community now is to upgrade their professional standard and image, not only to the satisfaction of the patients but also to the satisfaction of the employers. When this is achieved, the issue of MC and receipt recognition will resolve itself.

Mr Ang Mong Seng asked whether the Government and restructured hospitals would accept referrals by TCM practitioners for emergency treatment. I must say that this problem does not exist at all. If a patient is seriously ill, whether or not he has a referral letter by a western doctor or a Chinese physician, he would be attended to by the hospitals.

Mr Ang Mong Seng and Mr Tay Beng Chuan have also asked about licensing requirements to sell Chinese herbs. Regulating sales of Chinese medical products does not come under this Bill. This comes under the Medicines Act. Under the Medicines Act, TCM retail shops do not need a licence to sell approved TCM products. When Ministry of Health considers whether a certain TCM product is approved for sale in Singapore, we are concerned primarily with harmful or toxic ingredients, mixing of Chinese and Western medical ingredients, and excessive claims on the effect. There will be no change as this Bill has no impact on the existing regulations.

Finally, Dr Tan Cheng Bock asked about the admission criteria for candidates to be enrolled at training institutes for TCM practitioners. This has been set to be the same as entry requirement to Polytechnics. The institutions training these TCM practitioners are generally satisfied with the quality of candidates seeking admission to their institutes. The quality has been going up. Some trainees have university degrees. I have come across two doctors amongst the trainees. They felt learning about Traditional Chinese Medicine could help in their practice.

With the introduction of this Bill giving TCM more status, I feel that the quality of trainees going for TCM courses will get even better. But we cannot achieve everything all at once. The TCM training course duration has already been raised from five-year part-time to six-year part-time. One of the TCM organisations is introducing a three-year full-time course jointly with the Nanjing TCM University. These are all signs of progress. With this Bill, I feel that the progress will be even faster and TCM will have a better future in Singapore.

Dr Tan Cheng Bock: Mr Speaker, Sir, can I ask the Parliamentary Secretary to clarify a point?

He said that he would leave it to the employers to decide whether or not they recognise the TCM medical certificate. Can I ask whether the Government recognises the TCM medical certificate? The second point is that there must be a minimum standard of entry. At the moment, having heard what he said, it seems that you take in anyone who has some qualifications. But I feel that there must be a certain minimum standard.

Mr Chan Soo Sen: Mr Speaker, Sir, at the moment the Government does not recognise an MC issued by a TCM practitioner. I do not know when the Government as an employer will eventually recognise it. It all depends on how the TCM practitioners raise their professional standard sufficiently, to a level where we feel confident we can consider that particular question. The earlier the TCM community raise their standard, the earlier this question can be considered.

As to the question of minimum entry requirements for attending TCM courses, we now have TCM courses conducted by two of our biggest TCM organisations. One is in Chung Hwa Free Clinic and the other one is in the Public Free Clinic. After they have attended a six-year course, the trainees are awarded diplomas. Hence it is in order to peg the entry requirement to be similar to that of the polytechnics, which also offer diploma courses.

Dr S. Vasoo (Tanjong Pagar): Mr Speaker, Sir, the Parliamentary Secretary has been acupuncturing away his points. What I want to ask him is what measures are there in terms of monitoring abuses and poor standard of practice? What measures have been instituted or put in place? Because there are likely to be abuses and other related problems, how are these going to be dealt with in the interest of the public?

Mr Speaker: Dr Vasoo, you are not seeking clarification. You are asking totally new questions and you should have participated in the debate earlier on.

Dr Vasoo: No, I am asking him to clarify.

Mr Speaker: Mr Chan, would you like to respond quickly?

Mr Chan Soo Sen: Mr Speaker, Sir, I would say that this question probably would be answered by the TCM Practitioners' Board when it is set up. But at the moment, TCM practice is not regulated. So there is really no channel for this kind of reporting. But if people are injured because of unlawful medical treatment, under the current provisions the person who gave that treatment can be charged under the Medical Practitioners Act. This is the only recourse that they have now. When this Bill has been passed, when the TCM Practitioners' Board has been set up, there will be more recourse for reporting and investigating abuses.

Mr Sin Boon Ann (Tampines): Just a point of clarification. Going back to the earlier point made by the Parliamentary Secretary, my question is: how is the TCM institute able to draw capable people if the Government does not take the first step of recognising the qualifications by the institute?

Mr Chan Soo Sen: Mr Speaker, Sir, as I mentioned earlier, there is a big market out there for TCM treatment. There are people who just somehow prefer to see TCM practitioners for certain conditions. This is not confined only to the older people. For example, I know young people who injured themselves while playing golf telling me that they go for acupuncture. Also, because of the increasing popularity of TCM treatment even in western countries, some of our people are beginning to feel that TCM is a good alternative form of medicine. Just imagine there is no need to take medicine, just go for tui na and acupuncture. There are people who prefer that. So there is really a market for TCM treatment, notwithstanding the fact that their Medical Certificates are not recognised by the Government.

Mr Ang Mong Seng: (In Mandarin): Mr Speaker, Sir, first of all, I would like to thank the Parliamentary Secretary's positive replies to the points raised by us.

On the question of the Government's unwillingness to recognise the MCs and receipts issued by TCM practitioners, what if these receipts are accepted by the employers in the private sector for reimbursement of medical fees? What happens when they submit these receipts in their tax returns? Will there be any problem? On the other hand, if these MCs and receipts are not recognised, the practice and future of the TCM practitioners will be affected, and it will affect the patients too. People may not want to join the rank of the TCM practitioners.

I hope that the Government will seriously reconsider the issue.

Mr Chan Soo Sen: (In Mandarin): Mr Speaker, Sir, whether the employers recognise TCM MCs or whether patients want to see the TCM practitioners would depend very much on the practitioners themselves. If they continuously raise their standard of practice, the issue of recognition will be resolved as a matter of time. I understand the aspiration of the TCM practitioners that the Government and the employers will recognise their receipts and Medical Certificates. I would appeal to them to support this Bill, help Ministry of Health implement it well, and upgrade their professional standard and image. I believe the day will come.

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 Chan Soo Sen].

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