The Workers’ Party welcomes the broadening of the remit of the independent review committee to include review of MOH’s procedures and actions.
Drawing the right lessons from the outbreak of the Hepatitis C virus infections at the renal ward of the Singapore General Hospital (SGH) is critical for Singapore. It is tragic that four individuals may have lost their lives as a result of these infections in one of our leading healthcare institutions, and one more person may have died for reasons possibly related to the infections.
The outbreak and the government’s response to it have exposed potential gaps in our public health protection protocols. Aside from the risk to human life, the matter has considerable implications for Singapore’s status as an international business and tourism hub.
The work of the review committee is critical not just to rectify any lapses to prevent future recurrences, but to maintain and bolster public confidence in our healthcare system and review processes. To this end, not only must the review be rigorous, transparent, independent and fair in terms of its outcomes. It must also be seen to be so.
With these ends in mind, we call on the government to pursue the following actions in respect of the committee’s work.
- The government should explicitly task the committee to investigate the reasons for the extended delays between:
- The discovery of the cluster in April/May and the notification of MOH in late August.
- 3 September when MOH’s Director of Medical Services knew of the existence of the cluster of 22 infections, and 18 September when the Minister for Health was informed of the cluster.
- The terms of reference of the committee do not explicitly state that the committee is required to arrive at conclusions and recommendations about the timeliness of public alerts and preventive or containment measures. Given that the public was only informed about the cluster in October when the probable existence of this cluster was discovered in April/May, we repeat our call for the committee to review:
- If existing protocols about timeliness of public alerts and containment measures were adhered to in this instance; if so, how can these protocols be improved upon as they have been shown to be lacking; if protocols were not adhered to, why not; and what measures are recommended to strengthen adherence towards zero fault tolerance on such matters of life and death.
- If protocols do not exist, to recommend protocols that should be adhered to in future in respect of the maximum time frame for ascertainment of an infection cluster, for MOH notification, public notification and commencement of containment measures.
The Workers’ Party regrets the degree of delay between the discovery of a probable cluster of infections in April/May and the initiation of public notification and screening in October. We note that the Press Secretary to the Minister for Health stated, in a letter to The Straits Times Forum published on 20 October 2015:
“Medical professionals and public officers in MOH and SGH sought to perform their duties professionally and objectively. They acted in the interest of patient safety and to minimise risks to patients. Political calculations played no role in their consideration of the proper course of action. To suggest otherwise impugns the professional integrity of these public servants, who are unable to reply to defend themselves.”
We hold that a responsible and transparent government should explain in detail how the delays in public notification and screening from April/May to October represent actions that were taken in the best interests of patient safety and risk minimisation to patients.
Calls on the government to explain the delays in detail should not be met by calls to provide evidence of any inappropriate motivation.
Now that the review committee’s remit has been broadened to cover MOH’s workflow, we also call on the government to take action in regards to the committee’s composition and procedures in the following two regards:
- In the case of the Committee of Inquiry into the 15 and 17 Dec 2011 MRT breakdowns and the 8 Dec 2013 Little India Riots, the deliberations of the committee were made public so as to strengthen public confidence in the security and public transport systems respectively. In this case, we recommend that the deliberations of the committee likewise be made public. The Hepatitis C outbreak is at least as grave an incident as the MRT breakdowns and Little India riot, with serious implications for the public confidence of Singaporeans and foreign stake-holders in our vital national institutions. So as to facilitate this and in line with the norms established by the COIs relating to the MRT breakdowns and the Little India riots, we recommend that the current review committee be reconstituted as a Committee of Inquiry (COI) under the Inquiries Act.
- We note that the review committee is composed of currently serving clinicians in public healthcare institutions. Now that the committee’s remit has been broadened to include a review of MOH’s workflow, these individuals are effectively being asked to critique the actions of senior civil servants who oversee and administer government policy that affects their work as clinicians on a day-to-day basis. This would place members of the review committee in an awkward position. We suggest the inclusion of retired clinicians and healthcare administrators in the committee and the appointment of a retired healthcare administrator or clinician as co-chair. We further suggest that one of the committee’s members be a person qualified to be a Judge of the High Court, as required by the Inquiries Act should the committee be reconstituted as a COI. This would strengthen the ability of the committee to conduct a truly rigorous and, where necessary, critical review.
In this grave matter, the review committee bears a huge responsibility. We offer these suggestions so as to strengthen the review committee’s ability to do its job well and to be seen to be doing so.
NON-CONSTITUENCY MEMBER OF PARLIAMENT-ELECT
THE WORKERS’ PARTY
25 October 2015