Mental Capacity Bill
Mdm Deputy Speaker, I rise in support of the Mental Capacity Bill and thank the Minister for this significant legislation. If executed well, this new Bill will make a real positive difference to many lives.
I will speak on three key points: (1) responses to the Bill; (2) its positive features; and (3) provide three suggestions for implementation.
The response to the Bill is mixed. One, professionals, especially the social service, legal and healthcare sectors, generally welcome the new Bill as it provides a comprehensive framework that reforms and updates the current Mental Disorders and Treatment Act (MDTA). The current Act is limiting in its scope and does not allow persons to plan in advance for a time when they may lose their mental capacity. Two, parents of special needs or disabled children appreciate the new Bill and thank the Ministry for this. In a 2006 Parent Workgroup Report on enhancing the financial security of persons with special needs, close to 100 parents and disability experts were engaged. The families' key fears were grouped into two main areas, namely, (1) financial and (2) caregiving arrangements when they are unable or no longer around to look out for their special needs children. And, three, other Singaporeans who either do not have or do not want to rely on their children and wish to plan in advance for their old age, I believe, also embrace the new Bill.
However, for the man in the street, the content of the Bill does not appear to be their concern. At a recent dialogue with my residents and grassroots leaders, I learnt that there is even concern that planning too early will (1) disrupt harmony amongst their children, and (2) encourage the abdication of filial duties of adult children who are not "appointed" to make financial and personal welfare decisions when their elderly parents lose their capacity. Hence, for the typical Singaporeans, there is a need for the Ministry to educate them so they can make informed options, instead of relying on their potentially false confidence that things will fall into place when the time comes or as the Chinese call this attitude, "chuan dao qiao tou zi ran zhi", or as the song goes, "que sera sera, whatever will be will be".
As the new Bill is based on the British Mental Capacity Act passed in 2005 and came into force in 2007, Singapore is in a fortunate space to not have to reinvent the wheel. Positive new features were introduced in this new Bill. The Bill is comprehensive and protective of the person lacking capacity.
The new positive features of the Bill include the Lasting Power of Attorney that the Minister spoke about, a new regime for the appointment of a Deputy and even Successor Deputies for the person lacking mental capacity and the creation of the new Office of Public Guardian and Board of Visitors with accountabilities to safeguard the persons lacking capacity.
The new Bill is comprehensive and its authors took care to protect the person lacking capacity. Concerns raised in the UK experience were considered and, I believe, one of which was that lacking capacity need not be total and some people may lack capacity only in regard to some areas. For example, some people with disability may have no problems deciding what to eat and where to live but maybe unable to decide best on matters related to property and finance. Hence, the laudable provision of the Bill that persons participate as much as possible in any decisions made on their behalf.
To prevent abuse, limitations were also imposed on the powers of the Deputies and donees in matters such as the making of gifts, execution of wills, key decisions like sterilisation and the carrying out of life-sustaining medical treatment. These are good news and good features.
I want to move next to the point of similarities between the elderly and the disabled. In the same new Bill are provisions addressing what appear to be similar needs of the elderly and the "disabled". Both the elderly and the younger disabled at some time in their lives need someone to make decisions on their behalf and to look out for them and to look after them. The key difference is the time that it happens, the elderly are likely to take a longer time to reach the point of need but many elderly people do become less able and disabled at some stage. As the Minister had alluded to, we have nine people potentially in this House who could be afflicted with dementia. I believe that it is not just dementia we are talking about. Everyone in this House is potentially disabled.
And, indeed, the sooner we can see that some needs of the "disabled" and the "elderly" are not all that different, the sooner we can "mainstream" policies and services for the "disabled" in areas such as healthcare, employment, workfare, Medisave top-ups, MediShield, ElderShield scopes and coverages, tax reliefs for dependants, public transport and even housing.
Sir, it may be appropriate to even suggest that the Office eyeballing the needs of the elderly is also appointed to look into the needs of the younger disabled and identify common needs and strategies.
It has been said that behind every glamorous vision are a million plodding steps that need to be taken before the vision becomes a reality. Indeed, legislation alone is not sufficient and must be supported by practical guidelines and other initiatives to ensure that the Bill, if and when it is passed, does not become a white elephant.
The 2008-9 business plan of the UK Office of Public Guardian speaks of the reality of execution difficulties of the Mental Capacity Act, and I quote, "The implementation of the Mental Capacity Act 2005 in UK and the establishment of the Office of the Public Guardian is an ongoing challenge".
I therefore ask the Minister
to consider three suggestions to ensure that the Bill, when passed, will achieve its intended purposes. They relate to the need for:
(1) consultation in developing the Code of Practices;
(2) mass communication and education; and
(3) integration of other pieces in a master plan for the elderly and the disabled.
Madam, the Code of Practices is a critical document provided in the Bill to provide further guidelines and illustrations on implementation of the Act. In the UK, this document issued by the Ministry of Justice is 302 pages long. I am not certain that the Singapore equivalent needs to be that long. However, I believe that time and resources must be applied to ensure that there are careful consultations during the drafting of the Code of Practices. This is to ensure that it is localised to our Singapore conditions and understood by all stakeholders, not just attorneys and lawyers.
In addition, a loss of capacity can be caused by an array of conditions, such as psychiatric illness, dementia, Alzheimer's disease, brain injury, learning disability and other neuro-developmental problems. In drafting the Code of Practices, medical and disability experts, social workers and so forth must be included to provide expert inputs to assessments of capacity and for appropriate care plans for the persons affected. Crucial dialogues must be held.
Because the Bill provides for a framework that is flexible and intended to be so, to ensure that individuals can participate as much as possible and to cover a range of possible scenarios for decision making, there is a real need for clarity for the purpose of day-to-day implementation.
What do we mean, for example, by terms such as "all practicable steps" in clause 3, "best interest" in clause 6, "minimum level of restraint" in clause 8, "reasonable price" in clause 9, and "reasonable expenses" in clause 24? All these in practice need clarification and guidance for those implementing the Act.
A comment often overheard regarding the Bill is that whilst it is a very good idea in principle, how will the Bill or the Act later become public knowledge and be understood and applied? Out of the 10 professionals whom I have sent the proposed Bill to last week, only one lawyer could fully comprehend the terminology, proposed features and implications of the Bill.
I, therefore, propose the development of a Communication Matrix that lists target groups according to their income and language proficiencies; how and where these target groups receive information; and matching communication strategies so that many people who need to can easily access the information needed to plan for their own futures and know where to get help. Communication has to go beyond the usual brochures, media releases and cartoon illustrations.
The Ministry has been proactive in recent years to address the needs of the ageing population and those who are at risk, eg, the disabled and the lower-income group. Many of us in the sector are encouraged and grateful by initiatives, such as:
(1) Council for Third Age;
(2) Enabling Master Plan for the Disabled;
(3) Trust Company for the Disabled;
(4) Financial Literacy campaigns;
(5) ComCare Funds for the needy;
(6) Community Foundations; and several others.
The new Bill cannot operate in a silo if it is to make a difference. There is a need to integrate the many pieces of effort and provide a clearer roadmap for Singaporeans planning for their future. Take, for instance, the Bill presupposes that there are sufficient financial resources available for persons to plan the future. But findings of the October 2006 AXA survey of 10,000 Singaporeans showed that most people do not have sufficient to retire and, in fact, have a "worrying disconnect with reality", as far as the resources they have for retirement are concerned. This lack of preparedness is further compounded in families with disabled children and, worse, in lower-income families with severely disabled children. The current "que sera sera, whatever will be will be" attitude towards the future is a potential time-bomb for a rapidly ageing population.
Thus, I would like to urge the Ministry to take the lead to integrate the many piecemeal initiatives to help Singaporeans, especially those who are ageing and/or disabled, to be more prepared for their future.
Develop a more user-centric, not agency- or Ministry-centric, map of services for easier navigation, so that those who are more able can equip themselves to make more informed choices for themselves for their future. The same map can be used by the appropriate Helping Hands in society to identify, eyeball and support those who are at risk due to their lower income or education.
Let us also continue to learn from others who have walked the journey before us in the UK, Scotland, Germany, Japan and the United States. In the UK, for instance, the Office of Public Guardian has already been set up with its own business plans and Key Performance Indicators (KPIs). We can avoid any potential pitfalls while localising our practices to align with our own Singaporean culture and values. We can even contribute, as we learn, to a bank of best practices to carers and practitioners in the rest of the world.
In conclusion, I would like to again thank the Minister and his team for this significant legislation.
Mdm Deputy Speaker, I support the Bill.