Aline K. Wong
Singapore
“The ENABLE (Encouraging Achievement and Better Learning) programme gives additional support to those who are not achieving their potential. Our curriculum has given more emphasis to critical and creative thinking skills.”
“Can I just take one more second on the waiting list because Mr Ahmad Magad mentioned that the waiting list is long? There are 18 SPED schools now which cater to about 4,000 children. Of the 18 SPED schools, eight have waiting lists.”
“Sir, I am sure the Member in his meet-the-people sessions has also encountered cases where some families pleaded for priority to be admitted on grounds of, say, the child's sickness, or that the mother is working and is unable to bring the child to school, or that the grandparent cannot manage to take care of so many grandchildren.”
“I think he did not hear what I say. For both of these families, someone who lives within one kilometre or next door and someone who lives right on the border of this one kilometre, or of any delineation you choose to draw, my point is that for both of them, this is their nearest school.”
“Principals, as part of their duties, are always alert to what is happening in the school. They have also been given guidelines, in the Principals' Handbook, on discipline and the code of conduct which is expected of the teachers and staff members. But having said that, all these things are not foolproof.”
“It will continue to stagger the rental increase to market levels for assignment of tenancies, subletting cases and for tenants who are renewing their tenancies for the third time. Shop lessees can also apply to convert to shorter leases to reduce the cost of servicing their mortgage loans.”
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“So the extension of this scheme to ITE students is only for the full-time students. The value of the bursary is $300 for the pre-university level and $400 for ITE, which are higher than the rate for secondary schools because of the higher expenses of post-secondary students. The Edusave Merit Bursary for pre-university and ITE will be awarded at the end of 1996. Edusave grants are currently given to primary and secondary schools to enable them to purchase resources and introduce enrichment programmes to enhance the quality of teaching and learning. Primary and secondary schools currently receive an Edusave grant of $50 and $90 per pupil respectively. The Ministry has decided to give an Edusave grant to junior colleges and centralised institutes at the rate of $120 per pupil, and a grant to technical institutes at the rate of $100 per pupil. Independent schools, which at present do not receive the Edusave grant, will also be given the grant at the rate of $90 per pupil, similar to the Government and Government-aided secondary schools. The extension of Edusave grants to JCs, CIs, ITE and independent schools will be implemented in 1997. We estimate that a sum of about $1.8 million will be spent on the Edusave Merit Bursary Scheme for junior colleges, centralised institutes and ITE in 1996. The disbursement of Edusave grants to junior colleges, centralised institutes, ITE and independent schools in 1997 will require about $4.8 million which will be provided in next year's budget. There are currently 15 Government-supported special education (SPED) schools providing education to some 3,000 disabled children in Singapore. These SPED schools are run by voluntary welfare organisations.”
“Sir, a number of Members have asked whether Edusave can be extended to junior colleges, centralised institutes (CIs), Institute of Technical Education (ITE) as well as the special schools. The Edusave Scheme currently provides for contributions to Edusave accounts of pupils between ages 6 and 16 years as well as grants to all primary and secondary schools (except independent schools), scholarships for students in all secondary schools and Edusave Merit Bursaries for primary and secondary schools. So the Edusave Scheme has a number of attached programmes. The Edusave Merit Bursary Scheme was implemented last year to motivate pupils in primary and secondary schools who come from low and lower-middle income families to perform well academically. The value of the yearly awards is $150 for Primary 1-3, $200 for Primary 4-6 and $250 for Secondary 1-5. Last year, a total of about 47,000 primary and secondary pupils received the bursary amounting to about $9.5 million. These pupils are within the top 25% of each level and stream, with family income below $3,000 per month. The Ministry of Education has decided to extend the Edusave Merit Bursary Scheme to junior colleges and centralised institutes to give bright students from poorer families an incentive to perform well. The eligibility criteria would be similar to that in primary and secondary schools, that is, students within the top 25% of each level in each JC and CI whose family income is less than $3,000 per month. The scheme will also be extended to full-time students in the Institute of Technical Education who meet the same criteria. However, trainees in the Apprenticeship and Continuing Education and Training Programmes will not be eligible as most of them are working adults.”
“This is an overall subsidy, ie, an average of subsidy levels for a whole range of services.”
“I am not sure whether the charge varies with regard to the size of the hole. What I do know is that in the private sector, no matter how small the hole, they charge a certain price. For Mr Chiam's information, in our dental clinics, there is an overall subsidy level of 50%. For senior citizens and for students or young persons under 18 years old, it is half the price. So they pay 25% only.”
“At present, there are already two such dental clinics - one in Bukit Batok and the other in Geylang. By the end of 1996, we will open five more dental clinics in polyclinics. These are in Bedok, Jurong East, Tampines, Toa Payoh and Woodlands. For basic dental care, the charge is very reasonable and very affordable. If patients need specialist care, they will be referred to the National Dental Centre at subsidised rates, just like the way specialist outpatient clinics at restructured hospitals receive subsidised patients through the polyclinics.”
“I think a lot is attributed to the aging population today. As far as dental health is concerned, I would like to let Mr Chiam know that actually the dental health of Singaporeans is one of the best in the world, particularly among the younger population. The dentists use an index called the decayed, missing, filled teeth (DMFT) index to indicate the level of dental health among the population. Our index among the twelve year-olds is 1.0 which means that on average, only one tooth is either decayed, missing or filled. It is a very good indicator. We have provided a very good dental health service in the past, and we will continue to provide a very good one in future, particularly to the school children. But the responsibility to take care of one's teeth after one has left school must rest with the individual. Nevertheless, the Government still provides dental services to the adult population and, as Mr Chiam pointed out, there are community dental clinics. Yes, there are plans that we will be opening more. Later this year, the National Dental Centre is going to be operational. It is going to be a tertiary referral centre for dental care. This means it is a highly specialised inter-disciplinary dental centre. In this centre, only referrals or patients by appointments would be catered for. Referrals can come from the community dental clinics which are now operating in some of the polyclinics. 5.15 pm With the establishment of the National Dental Centre, the present community dental clinics at Pegu Road, the Institute of Dental Health and the Government Dental Clinic will be closed. However, we would be increasing the provision of community dental services in the polyclinics.”
“With the development of all those projects that I have just described, ie, 15 nursing homes and nine day rehabilitation centres, they would be able to take care of the projected increase in the needs of the elderly sick. Sir, Dr Wan raised the point about making the condition of C class wards more comfortable and amenable. I think he agrees with us that we have a very good hospital system where patients are free to choose the class of ward that they can afford to go to. Let me assure him that the charges for B2 and C class are highly affordable. But C class wards, as a matter of course, would be more spartan than B2, B1 or A. C class wards do not have airconditioning. They are open wards with more than 20 beds but they are in decent condition. So if a person without the financial means does not want to go to B2, C class is open to him. And the quality of medical care in C class wards is no different from that in B2 or, for that matter, in B1, although B1 patients can name their specialists. But those patients in B2 and C class wards are taken care of by a team of specialists. So the quality of care is good in our C and B2 class wards. I think we need to reassure our population from time to time that they need not worry. The Government has undertaken to give them good basic health care.”
“The Ministry of Health has committed as much as $126 million for 15 nursing home development projects and $3 million for nine day rehabilitation centres for the elderly sick for the period 1991 to 1998. When completed, these facilities will provide 1,800 beds and also 320 day places. Five of these 15 nursing homes and two of these nine day centres are already operating. Currently, there are 10 nursing homes and 7 day centres at various stages of development. The actual amount disbursed in 1995 for the building of these projects was $15.2 million. For FY96, $16.5 million has been budgeted. In addition, $10 million has been budgeted for recurrend funding. Dr Wong also asked whether all these health care facilities are available to the elderly sick. Access to specific facilities has to depend on the particular medical condition of the elderly sick. If they have dementia, then of course they will be considered for admission to the day care centres for dementia. If they need rehabilitation, they will be taken care of in the Senior Citizens Health Care Centres, and so on. The amount of fees payable by the elderly who use health care facilities run by the voluntary welfare organisations varies according to income. They charge according to the income of the patients. If they cannot afford, fees can be waived. On the average, the occupancy rate of nursing homes is about 90% and day care centres operate at full capacity. With the aging of our population, the demand for nursing home beds is expected to increase. By the year 2000, it is projected that about 6,000 nursing home beds would be required in Singapore.”
“Let us not talk about what we hear by way of rumours or assertions. But I just want to make the point that, in fact, we have taken very concrete steps to develop geriatric medicine. There are Departments of Geriatric Medicine in Alexandra Hospital, Tan Tock Seng Hospital as well as the new Changi Hospital. We are exploring all kinds of ways to develop this specialty, including post-basic training for the nurses in geriatric nursing. As I have just described, there is a whole range of health care services for the elderly that we are working out with the VWOs. In fact, our interest in providing for the care of the elderly is such that we are prepared to let them have a try at even traditional Chinese medicine. Members know that we have already got the Acupuncture Research Clinic at Ang Mo Kio Community Hospital. I am not saying that only elderly people can use the services at the Acupuncture Research Clinic. But we are looking into establishing a second Acupuncture Research Clinic at one of the other Government hospitals. Alexandra Hospital would be in a very good position to have the second clinic because it has a geriatric centre where it links up a lot of the community services. As I said, there is a Department of Geriatric Medicine there, as well as a day hospital for the elderly. We are looking into it. There is a great possibility that there will be a second Acupuncture Research Clinic at Alexandra Hospital. Dr Wong Kwei Cheong asked a series of rather specific questions. He asked how much money the Ministry of Health has spent to provide funding for the health care services for the elderly.”
“I hope Dr Michael Lim did not really mean it when he said that the hospitals should not just pay lip-service to the care of the elderly or to the development of geriatric medicine in our hospitals. We are very serious. In fact, we have developed this specialisation in a most systematic manner.”
“In other words, in this centre, you could have a facility for child care, another one for day care of the elderly, and in another space, you can have rehabilitative services. Thus, this kind of centre provides medical care as well as rehabilitative and social and recreational amenities. I understand that, some time back, the Ministry of Community Development was thinking about this concept but I am not quite sure what has happened to the idea. As far as the Ministry of Health is concerned, social or community services which have a rehabilitative or medical element would come under our charge. We formed a Department of Continuous Care in 1992 to coordinate the various agencies that provide health care to the elderly. The Department can discuss with Dr Tan if he has further concrete plans to build a new type of care centre for the elderly. I have visited such centres in Hong Kong. The interesting thing is that, in Hong Kong, health and welfare come under one department, the Department of Health and Social Welfare. So there is no need for them to bridge two Ministries. But I am sure things can be worked out because we are all within the same Government. As for the VWOs and Dr Tan's appeal for more subvention and support for them, as he knows, we are providing 50% of the recurrent cost right now. For hospice care, the Minister has just said that we are looking into whether we could consider a higher funding formula for them. These things can evolve. But the principle of sharing, the principle of the voluntary organisations raising their own share of funds is very important because of the idea of co-ownership, involvement and commitment.”
“In the Minister's opening reply to the first cut, he gave a very good overall view of the picture of our greying population and what this means, and what implications it has for our provision of health care services as well as for our health care costs. The approach we should adopt to take care of the health care needs of the elderly is that, as far as possible, they should be enabled to remain in the community. As far as possible, we should mobilise community resources which are right near to where they live to help take care of their health care needs. Only when they need acute care should they be hospitalised in our hospitals. If they need convalescence, then we build community hospitals for them. But the thrust of our provision for the health care needs of the elderly is community-based. Towards this end, we have a whole range of services like the senior citizens' health care centres as well as day rehabilitation centres which are run by the voluntary welfare organisations. We also provide home nursing care to the elderly sick. Some voluntary organisations are offering home-help services that include giving them some escort service if they need to, say, visit a doctor, and to help them do their laundry, deliver meals, and so on. 5.00 pm So our philosophy for taking care of the elderly is to enable them to stay where they live as far as possible. Therefore, we are building up a network of voluntary welfare organisations with which, I think, Dr Tan himself is very familiar. He talked about a new kind of model, not the stand-alone day care centre, or the stand-alone community centre. Some time back this kind of model was known as multi-service centre.”
“Sir, I will reply briefly to Mr Chiam See Tong first. It is a pity that he came in to the debate a bit too late because we were discussing health care financing policies and also the subsidies we have been giving out to our population. He made almost the same allegations that were made in the New Democrat, the newsletter that my Minister rebutted. We showed very clearly the difference in the average bill size between restructured hospitals and private hospitals. And he can see very clearly from the Tables that Government and restructured hospitals are not behaving like private hospitals nor are they making money. The amount of health subventions we give out each year is rising. So he cannot say that our restructured hospitals always watch the bottomline. They are not for-profit hospitals. Let me also tell him that the cost of land and buildings is not charged to the subsidised patients at all. The Government completely subsidises the cost of land and buildings for the subsidised patients. So there is no question that they are being charged like those in the private hospitals or that land and building costs add to the health care cost for subsidised patients. If he could take a look at the tables which have been distributed in the House, he should be convinced that the restructured hospitals are not charging the patients in the same way as the private hospitals. In fact, our charges are much lower and each year we give a lot of subvention to the restructured hospitals. Let me come to Dr Tan Cheng Bock's question on health services for the elderly.”
“It is not possible for hospitals to plan their bed complements exactly to fit people's demands. What we can make sure is that 65% of the overall hospital beds would be in B2 and C class wards and between C and B2, the cost difference is not much. As for commercial airlines, they have a very different rationale. They want to attract customer loyalty and so forth. Our restructured hospitals are not for profit.”
“Dr Tan talked about the case of a patient who needed hospitalisation and who wanted at first to be admitted to a C class but a bed was not available. The patient was asked whether he would be willing to go into a B2 ward. Sir, the patient is always given a choice. If there is no bed available in the C class, and if hospitalisation is not an emergency one, he can either reschedule his admission or he would be counselled to find, say, an available bed in the type of ward he wants in another restructured hospital. But if he does not want it, and he wants to take up the B2 bed straightaway, then he is counselled and told that if he goes into B2 he would pay B2 class bills. But during the period of hospitalisation, if a C class bed is available, he can go back to the C class ward. But he has to pay the first part of the bill at B2 rate because this is where he used the resources. For the second part of hospitalisation, when he is in C class ward, he will pay the C class rate. Dr Tan Cheng Bock: But it is not his choice that he wants to be upgraded to B2 class. That is his argument. He is upgraded to B2 because there is no bed in C class. Therefore, he has been upgraded to B2 class.”
“Within the Ministry of Health itself, we have already established a Traditional Chinese Medicine Unit which would serve to coordinate and supervise the implementation of the Committee's recommendations. We have also formed a Chinese Proprietary Medicine Listing Unit which will take on the task of listing the medicines, licensing the importers and exporters, the retailers, wholesalers and manufacturers. So things are progressing since we formed the Committee two years ago and since the Committee submitted its report in October last year. But I think we should not rush the process before the professional community is ready. We cannot force the integration of traditional Chinese medicine and western medicine by any artificial means. Perhaps Singapore would not be able to spearhead this kind of integration. Even in China, the practice of traditional Chinese medicine is not entirely integrated with western medicine. So I think we should play by ear. We should learn from other countries' examples and we use them to suit Singapore's context.”
“But we succeeded in getting them together to form a coordinating committee. The coordinating committee is at present looking at three main areas: First, to improve training - how to upgrade the present 5-year part-time training into a 6-year part-time diploma level training. Second, how to lift the status of existing practising Chinese physicians. Right now, we can only make guesstimates. We can have sample surveys. We do not really have an accurate picture of how many physicians that are out there, what kind of training and background they have and therefore what kind of upgrading the profession requires. So this coordinating committee is carrying out a survey of the members of their own organisations as well as reaching out to members of the public to find out whether those who are not members would want to come out and declare their background and interest. The third area is that they have established an Ethics Committee. They are looking into questions like professional ethics, charging, doctor/patient relationships and how to discipline errant members. Our approach is to let the profession regulate itself, raise its standard over the years and peg it at a certain level of some renowned overseas traditional Chinese medical training institutions. Our approach is that over the years they would upgrade their training, and also with the help of external or overseas experts, raise their level of knowledge. In the field of acupuncture, however, we have set ourselves a time frame, ie, within five years we will be registering acupuncturists and towards this end the associations are helping us at this moment to do some initial listing.”
“We intend traditional Chinese medicine to play a complementary role to Western medicine in Singapore. It is not to replace it. It is not even to act as an alternative form of medical treatment. We know that among the Asian populations, traditional medicine, be it the Chinese form, the Indian form or the Malay form, is very much part of their culture, very much part of the daily life, such as in food habits. So having cognisance of this fact and knowing from survey results that as much as 14% of our population see Chinese sinsehs in a year, we feel that traditional Chinese medicine has a role in our health care system. The question is: how do we help to raise the quality? A number of recommendations were made in the report. I must say that we cannot hurry the process too much in the implementation or hurry the process of eventual registration. The Committee recommended that there should be a phased approach, a first phase of self-regulation, followed by a phase of eventual registration. [Mr Deputy Speaker in the Chair] 4.29 pm Mr Chay Wai Chuen, who is not here, said that we must hurry. We must rush the process, the pace, of eventual registration. I do not think we can rush this. We really have to be quite careful about this. Because, first, we must build up the expertise within the Ministry. Secondly, the various schools and the various traditional Chinese medicine associations have to come together and try to raise the standard of their training and to raise the standard of their practice at the moment. The Ministry of Health has encouraged these organisations to come together to form a coordinating committee. Previously, they were acting very much on their own, with some rivalries among them. They were not even on talking terms.”
“Dr Tan Cheng Bock talked about the need for providing information for patients in order for them to choose the class of ward according to their means, and not be surprised in the end by a higher bill than they expected. The Ministry of Health is very well aware of this need. In fact, we have made financial counselling a mandatory process before admission. Before admission, a patient will be counselled as to the availability of different types of wards at different hospitals, and what is the likely bill size as well as the balance of their Medisave, how much can be paid out of Medisave and how much has to be topped up by cash. We are especially careful to tell patients that certain types of treatment, such as the one that he mentioned, are not covered by Medisave. So they have to be prepared to come out with cash. For that purpose, we give out some pamphlets to patients as well as use verbal counselling. In the implementation at the ground level, there may be slight lapses here and there, and this may lead to some disputes later. We can try to minimise this kind of incidents, but we are doing our best to do financial counselling for patients. Sir, since Dr Tan has raised the question of traditional Chinese Medicine (TCM) and the Minister did not have time to reply in the main cut, may I update Members of the House. Several Members have asked what has happened to the development of traditional Chinese medicine since the report of the Committee on Traditional Chinese Medicine came out in October last year. I think we have to be very clear about the role of traditional Chinese medicine in the context of Singapore. Dr Tan is right in pointing out that we should be concerned about standards.”
“More spending does not necessarily lead to better health results. In fact, even if we do nothing, the ageing of the population will help to boost the percentage of GDP we spend on health. One incentive that we are providing to the private sector to develop private hospitals is that the Government periodically sets aside land for sale. And it has identified parcels of land which are suitable for institutional use, including for hospitals. The private hospitals respond to market forces. Thus, beyond earmarking some land which is suitably located for such purposes, I do not think we need to do very much to give the private sector further incentives. Do we have enough medical specialists in Singapore to cater to the needs of Singaporeans? The answer is yes. At the moment, we have an adequate number of specialists to cater to the needs of Singaporeans. In fact, we have some spare capacity, as shown by the fact that in the private sector, some hospitals see 20-30% foreign patients. So we are able to cater to the needs of Singaporeans with some resources to cater to foreign patients. The priority of our health care policy and the priority in our training for health care manpower must be to provide for the needs of Singaporeans, ie, the local population first. I think that we must be very clear in our minds. Will the Singapore Government recognise doctors who obtain higher qualifications like the MRCP or FRCS in UK? Yes, the Singapore Medical Council recognises these qualifications. However, doctors with such qualifications will only be considered as specialists after they have undergone a specified period of advanced post-basic training in accredited institutions. This is because these qualifications are entry qualifications. They are not exit qualifications for specialists.”
“Dr Wong Kwei Cheong asked a series of specific questions. I would answer him point by point. He asked about our national health expenditure in FY93, FY94 and FY95. The figures were $2.9 billion in FY93, $3.3 billion in FY94 and $3.8 billion in FY95. As a percentage of GDP, our national health expenditure has stayed fairly constant at about 3% over the last five years. Let me hasten to add that the percentage of our health budget, as a percentage of GDP, is not a measure of the quality of the services that we offer. The average health care expenditure in the OECD countries may be around 7-8% of GDP. Hong Kong is 5.6% of GDP, Japan is 7% and the extreme case being America, about 14% of the GDP. But we know that in America, the key health indicators are not better than ours. In fact, they have higher infant mortality rates, higher maternal mortality rates and so on. So the precentage of GDP a country spends on health care does not indicate the quality nor the results of the health care services. We spend about 3% of GDP on health, but this is due to the fact that our population is still relatively young. And our GDP has grown. Our economy has shown very strong growth over the last decade or so. This may not remain the case in the years to come. As our economy matures, the rate of our growth will be slower. Also, as our population ages, the proportion we have to spend on health will definitely increase. According to a recent NUS projection, by the year 2030, we may very well spend 7% of our GDP on health. At the moment, we should still be very careful because these things will creep up on us and we really should be very cost conscious every step of our way. So we should not spend for the sake of increasing our percentage of GDP. This point is important.”
“As the Minister has just told the House, we are also taking an overall national view of our medical manpower resources. So the Ministry has set up a senior medical personnel board to oversee the implementation of managing the talents among doctors. The board looks into how doctors can be nurtured and groomed to their maximum potential for leadership positions in our national health system. And this includes not just the doctor resources in the public hospitals but also talent scouting from among the private hospitals. So we are taking an overall national view of our manpower resources. We are also emphasising research and development in a big way. In 1994, the National Medical Research Council was formed and was given the mandate to promote a research culture among our clinicians. It has been given quite a lot of funds to fund research projects which it coordinates as well as to fund research infrastructure. You can see that our approach to nurturing our medical personnel resources in the hospitals is multi-pronged. The emphasis is not just on salary revision. Dr Michael Lim talked about the restructured hospitals going into the primary health care sector. It is not entirely accurate to say so. I do not know whether he was referring to the two outpatient clinics at the Singapore General Hospital and Tan Tock Seng Hospital. These are actually clinics to cater for those patients who are non-emergency cases, who turn up at A&E departments and they clog up our A&E departments. These two clinics have been put in place in SGH and Tan Tock Seng Hospital. We are not really venturing into the primary health sector by going into the polyclinic kind of work. These are just measures to help out the A&E workload of the restructured hospitals.”
“Sir, I agree completely with the point raised by Dr Michael Lim about the importance of having doctors, nurses and paramedical staff whose interests are taken into consideration and accommodated in order to make our health care system into a high standard one. He talked about restructured hospitals, how we have upgraded the facilities, and so on. He placed emphasis on staff morale which is most important to make the system work. Otherwise, the equipment is really for nought. I agree with him, and since the Members who spoke on the first cut also talked about staff shortage in the restructured hospitals and what we are doing to stem the tide, as well as to raise staff morale, I would like to let Dr Lim know that we are aware of the situation. We have done periodical reviews of staff salaries and benefits for the staff. Revising the salary is not the only means to keep doctors, nurses or paramedical staff. Actually, our restructured hospitals have adopted a more staff focused kind of approach on personnel management. Dr Michael Lim said that there should be channels for staff feedback. In fact, this is institutionalised in all the restructured hospitals. They have channels to reflect their opinions. And if they resign from the hospital, they are invited to an exit interview, where they should be able to tell their superiors the reason for their leaving. The Ministry of Health and also the restructured hospitals place a great deal of emphasis on the development and training of the staff. And I think Dr Michael Lim is well aware of our hospital management development programme for post-graduate and continuous medical education for both doctors and nurses here and overseas.”
“As I said, the proportion of self-referrals is very small. If we were to do away with it, ie, by requiring all patients to have a referral before they can see a specialist in a restructured hospital, then we require altogether a very different system from what we have. We have to think about this proposal carefully and whether this constitutes another form of wastage of resources for the nation. To cut down costs, the patients themselves also have to be educated. They should not just go and see a specialist for a small thing. But may I suggest to the Member that this question is not really related to the main Question asked by Dr Vasoo. HDB SALES TRANSACTIONS (Handling by HDB appointed agents and private individuals) 2. Mr R. Sinnakaruppan asked the Minister for National Development (a) the rationale for allowing the Housing and Development Board sales transactions handled by appointed agents to be completed in 4 weeks while allowing those transacted by private individuals to take seven weeks and (b) what measures are in place to deal with those appointed agents who misrepresent to the Housing and Development Board on the purchase prices.”
“Yes, at the outpatient specialist clinics at the restructured hospitals, it is possible for patients to "walk in" to see a doctor, ie, they can make appointments by themselves to see a doctor. But generally, the bulk of the patients in the restructured hospitals come from referrals.”
“In the late 1980s and early 1990s, there was a consultancy fee scheme for doctors in the restructured hospitals. The idea was to encourage doctors to improve the quality of service to patients. After a couple of years, we found there were some weaknesses in the system and therefore some changes had been implemented to correct the weaknesses. One of the changes was to introduce the point system in remunerating doctors, so that the doctors earned points irrespective of whether they serviced private patients or subsidized patients. The recent feedback is that some doctors find this system not satisfactory either, because they feel that they are being timed and weighted for every single bit of work they do and they feel that their professionalism has been hindered. Now the hospitals are looking into reforming this system again. In reply to the Member, I must say that these changes have been found necessary. If she thinks that there have been too many revisions within a period of a few years, the people on the ground feel that some more changes are necessary because there are weaknesses in the existing system. But whatever system it is, there is always a certain degree of imperfection that we may have to live with.”
“I am not aware of any cases, but if the Member has any case to report, I would be pleased to look into it.”
“As I informed the Member in my general reply, there has been improvement in waiting time. But for specific information on the waiting time by the kind of service, I would appreciate it if he could file a Question and we will give him the detailed breakdown. But generally, between 1990 and 1995, all the hospitals have seen an improvement in waiting times. On the question of access to health care services for the poor, they have always had access to our public sector hospitals. As the Member is well aware, we subsidize B2 and C wards heavily. We have also introduced a new class of ward, B2+, in some hospitals and they are subsidized at 50%. Medifund has been introduced and the number of applicants has actually gone up and the proportion of cases which have been given financial assistance is still very high. I think some 99.6% have been given assistance. So restructuring does not and has not meant a decline in access to good health care at the public sector hospitals.”
“I think Members of the House should look at the promotion exercise in perspective. In the last two exercises, as I said, 19,000 teachers were involved, and 26% were promoted in the October exercise alone. And if they did not get promoted this time, they would again be considered next year. NORTH-EAST MRT LINE (Construction) 7. Mr Low Thia Khiang asked the Minister for Communications whether the Government has decided to proceed with the construction of the North-East MRT line forthwith.”
“I think all teachers know that they were being evaluated by the supervisors, who are the principals, the principals and the heads of department. The teachers would know that they were being evaluated according to their performance, including the length of service and so on. These criteria are commonly accepted. On the Member's question on whether the school informed each and every teacher of the position of their ranking, I do not know the exact answer.”
“I am not aware of such detailed guidelines. I think it was based on the general ranking of the teachers, taking into consideration all the criteria and not necessarily by departments.”
“I would not call it a quota system. As Members know, this exercise involved some 19,000 officers. All the officers in each school were ranked according to a list of criteria. You go down the list according to priority, but you must stop somewhere. There were a certain number of promotion places for each school according to the proportion of the teachers who were eligible for promotion in each school. There had to be a cut-off point for every school.”
“It does not work like this. Teachers can be promoted to GEO IA or IIA, whether or not they have already reached the maximum point on their existing scale. So the promotion can be a big jump for some teachers or it can be a smaller jump for others.”
“These promotion exercises, including the February exercise, pertain to promotion to the newly-created grades of GEO IA and IIA positions which did not exist before. So this involves salary increases as well as promotion in rank. What is the other question?”
“As I said, I cannot give a clear answer on this. But I can find out.”
“I cannot give an exact answer on this. But I can find out.”
“This is not the case. During the February exercise, about 830 teachers were also promoted.”
“This is correct because priority was given then to officers who are in leadership positions. The second exercise dealt mainly with the classroom teachers.”
“In February this year, about 2,500 were promoted. In October this year, about 5,000 were promoted.”
“As I have explained, I think the practice varies from school to school.”
“Sir, Mrs Yu-Foo Yee Shoon yesterday suggested - and I think Dr Vasoo alluded to it, so did Dr Wong - that my Ministry could perhaps look into the widening of the scope of the proposed tribunal in the Maintenance of Parents Bill to include providing conciliation and mediation to family members in family violence cases and to issue PPOs. Sir, my Ministry is in fact looking into the feasibility of such a widening of responsibility. We will certainly consider this to see how the concept can be developed further. Mr Speaker, Sir, undoubtedly there are some provisions in the Bill which have merit. And Dr Soin and the drafters of the Bill ought to be complimented for their effort. I am not averse to incorporating them as amendments to the Women's Charter. But I cannot, in all honesty, give my "assent" to the Second Reading of the Bill and I must say "no" to the Bill. But what I will offer, Sir, is to commit the proposed amendments to the Women's Charter to a Select Committee so that the Nominated Member and other Members of this House, as well as the public, can still propose inclusions to the amendments that would enable the piece of legislation to provide enhanced protection to victims of family violence. Let us work together to achieve our common objective.”
“Serious physical hurt or seizable offences will be punished under the Penal Code with or without the Bill and regardless of whether the Women's Charter is amended or not. Dr Soin said yesterday that the Domestic Violence Act of Malaysia which was very similar to the proposed amendments to the Women's Charter had its shortcomings. Her implication did not escape me, Sir. But the truth is something else. When the Secretary-General of the Malaysian Ministry responsible for the Act visited my Ministry earlier this year and when I met the Minister in Beijing at the 4th World Conference on Women, they told me that the Act was not yet implemented because of operational problems and because of differences in the State and Federal laws, not due to what the NMP implies. Dr Soin also implied yesterday that the amendments to the Women's Charter were modelled after the Malaysian Domestic Violence Act 1994 and implying that it had its shortcomings because of the reliance on the PPOs. Let me put the record straight. Earlier this year, Dr Soin submitted her Bill on family violence to CID. Except for the word "Singapore" which substituted the word "Malaysian", the Bill submitted was virtually a replica of the Malaysian Act. Of course, the Bill, as it now stands before the House, contains many modifications. When the Inter-Ministry Committee looked into the issue of family violence, it looked at not only the Malaysian but other Acts as well. In fact, there are many things we do not agree with in the Malaysian legislation. So let us not talk about who copies what and from where. It serves no purpose.”
“Perhaps it is because of this orientation that the authors fail to address the operational challenges and lack of community resources when they proposed mandatory counselling and police intervention the way they do. They expect and leave the rest of the community services to pick up the responsibilities after the law has shown its teeth. Sir, my Ministry and the Ministry of Home Affairs, on the other hand, are mindful of the reality - the resources available, the preparedness of police personnel and the values that our families hold. Hence, we opted for incremental changes in the law and building up community resources and police readiness at the same time to complement these changes. This is the rationale for the Ang Mo Kio project which we hope to develop and refine further. These are the premises for the proposed amendments to the Women's Charter. Sir, my Ministry's mission is to strengthen families to make them whole and to heal any rifts or concerns that may threaten the well-being of the family. It is therefore our conviction that every opportunity should be given to the family to heal and mend itself after a conflict. Disagreements, Sir, skirmishes and quarrels are part and parcel of family life. This is a reality we must accept. It is infinitely better for families to want to be counselled and to want to weather these storms rather than being reluctantly made to do so. Hence, the approach that we are taking in tackling the problem of family violence. It is more a total approach, combining the judicious involvement of the police, the professional counselling input of the service agencies and the natural inclination of most families to want to sort out their problems internally before seeking outside help.”
“If awareness is indeed an ingredient, then the rising number of reports made is testimony to people's acceptance of the PPO as a legal instrument to handle family violence. Sir, victims do not report or pursue their reports precisely because they do not want third party interference. There is a variety of reasons for not wanting this interference - from hoping that matters would clear up and followed by reconciliation; the sense of shame should others know of their disagreements, or wives saying "I still love him despite all this". Who are we, Sir, to butt in when we are unwanted and decide for them what should be done? Who are we to deny them their concerns and hopes, silly or senseless they may seem to us? Do we know better than them to decide what choice they should take in their relationships? Far better, Sir, for us to tell them of the choices and options available to them and to help them make the best of the route that they have chosen. I had had a discussion with the President of the Society Against Family Violence, that very body which works on the ground, quietly and committedly, to develop community resources to tackle the problem of family violence. They know the reality on the ground. They had no hand in drafting the Bill. They are concerned with the overly legalistic approach to solving the problem and the confrontational stance of this Bill. Indeed, Sir, the Bill is confrontational. It is more heavily weighed towards punishing the perpetrator. The offer of counselling to the abuser may appear to be conciliatory but, in my view, it is more a concession in lieu of prosecution, rather as an after-thought than a principal ingredient of the Bill.”
“It was made to appear that this is such a widespread and common face of family violence. It touches the emotions. It was designed to enrage us, to make us want to extract an eye for an eye against the perpetrator. Sir, without belittling the suffering of these victims and while this may be true in some cases, the reality in most cases is not as gruesome and the victims not as helpless as put. There is a wide range of abuse with various shades of gravity especially now that the definition of family violence has been widened. But the Bill treats them all equally as seizable offences. Most of the reported police cases, as mentioned by the Home Affairs Minister yesterday, merely want to place the offence on record and not to proceed beyond that. Some have already, as in the case of spousal violence, contemplated divorce. Sir, just as the Member could quote of specific cases where police intervention would be more desirable and effective, I and the Minister for Home Affairs can likewise cite other cases where intervention results in negative consequences. The story of Madam Ee Seng Mui quoted in yesterday's The New Paper is one such case. Anecdotal evidence such as these can only raise emotions and provide grist for arguments. The Member also quoted extensive statistics yesterday on the number of reported cases of family violence, concluding that the problem is growing worryingly. Sir, as a former statistician, I know how numbers can be crunched to spin a different tale from reality. The Member has not demonstrated conclusively that these numbers indicated an actual increase in incidence of family violence or merely an indication of growing awareness of and knowledge about family violence.”
“The emotional mechanics that come into play when people linked by blood or marriage inflict physical or psychological pain or damage to one another is extremely complex and sensitive. Family members will still have to contend with their relationship in the aftermath of that conflict. This has been alluded to by Dr Wong earlier too. Do they sever their relationship? Do they want to retain their relationship to the status quo ante? Or do they make adjustments just so they remain related, albeit on a different basis? Sir, these are decisions best left to the victims themselves. Strangers do not have to face these emotional challenges as the perpetrator caught and punished is neither a spouse nor a sibling or one's relatives, or even one's child. We therefore have to be extremely careful in our handling of and intervention in family violence. Making it mandatory for the police to intervene right from the start, to probe, to question, to record statements, to ascertain guilt and to put all these on police record (because that is what investigation means) could worsen an already brittle relationship between the parties involved, thus making it harder for them to reconcile and for the family to become whole again. The argument offered in support of the Bill is that victims are often helpless in the face of family violence and that unl ess the authoritative figure of the police intervenes, the victim can hope for no protection. Battered faces, lacerations on the body, even broken limbs; this is the picture of family violence portrayed every time the subject is raised in talks, forums and discussions. Indeed, Sir, these descriptions were mentioned several times yesterday in Dr Soin's speech and in even greater detail.”
“Evidence has to be gathered and witnesses have to be interviewed. This could mean going to the home where the violence took place to obtain evidence and talk to other family members involved. Contrary to what Dr Soin said yesterday, the police has no discretion at the scene, to offer counselling instead of prosecution. The police (Investigation Officer) will have to, after investigation, submit his investigation papers (IPs) to the Public Prosecutor and only he or an officer authorised by him, ie, the Public Prosecutor, can exercise that discretion. If the Family Violence Bill were to become law, Sir, family violence will not be "like any other offence". This is simply because unlike all current laws including the Penal Code, which give police discretion, whether to initiate investigation, the Family Violence Bill (Clause 13) "requires", I repeat, "requires" the police to investigate every case. Sir, I oppose the passage of the Bill, not for what it seeks to achieve, ie, to enhance protection of victims or potential victims of family violence, but for its approach and tone and for the fact that there is already existing legislation in the Women's Charter to address the same problem and which can be amended to enhance its effectiveness. The Bill proposes a more direct, mandatory and visible intervention by the police on reports of family violence. It obliges the police to investigate all reports of family violence and gives them the power of arrest without warrant regardless of the credibility of the report, the gravity of the offence and whether it is the first and only occurrence or a repeat offence. Sir, conflict among members of the same family is significantly different from those between strangers, neighbours or even friends.”
“Before I point out the critical differences, let me at the risk of repetition, state my premises yet again to put my stand in proper perspective: (1) That violence in the family should not be condoned and that society must find ways to protect victims and potential victims from the clutches of such violence. (2) That the proposed amendments to the Women's Charter should be seen in the context of the efforts of the police and the service agencies as piloted in the Ang Mo Kio project. Hence the police is involved, contrary to what the NMP would have the House to believe. The amendments should not be seen in vacuum because it has always been emphasised that family violence should be tackled through legislation as well as the police, service agencies and the community. (3) That family violence is a problem in our society (and indeed in virtually every society, as alluded to by Dr Aline Wong earlier) albeit not an endemic one here as the Member tried to demonstrate with her statistics yesterday. (4) That it is recognised that the existing legislation and supporting services are indeed inadequate, hence the work of the Inter-Ministry Committee and the proposed amendments to the Women's Charter. Yesterday, the Minister for Home Affairs elaborated on the differences in police approach in the Family Violence Bill and in the Women's Charter amendments. I checked again with the police and the legal authorities yesterday evening and this morning on the import and meaning of the provisions in the Family Violence Bill, especially clauses 13 and 14 as they pertain to police intervention. Clause 13(1) of the Family Violence Bill obliges the police to investigate every case reported. The purpose of a police investigation is to determine if an offence has been committed.”
“Amend the Charter, as the Minister has intended, and include the positive aspects of this Bill on family violence but as soon as possible, and before the proposal for a Family Law is studied thoroughly. I would like to remind the Minister that for a long time, women lawyers and organisations have pointed out the need to improve the present provisions for division of matrimonial assets, enforcement of maintenance orders and related matters. We women cannot wait any longer. 1.29 pm The Acting Minister for Community Development (Mr Abdullah Tarmugi): Mr Speaker, Sir, as I sat listening to the debate on this Bill yesterday, I would not blame anyone leaving this Chamber more confused about the differences between police intervention in this Bill and police involvement that complements the proposed amendments to the Women's Charter. Listening to the Nominated Member of Parliament elaborating on the role of the Police, it would appear that what the Bill provides for is similar to what the Ang Mo Kio project hopes to achieve. The Member spoke of police discretion, the benefits of counselling, keeping the family intact, and of healing, not destroying; the very same spirit, intent and philosophy of what MCD and MHA are in fact promoting. But the nub of the matter, Sir, is that there is a difference between the approach provided for in the Family Violence Bill and the MCD/MHA approach when it comes to police involvement. Sir, the difference is subtle, but it is fundamental enough to separate the Bill and the amendments to the Charter.”
“It is to the credit of Dr Soin and AWARE that much public discussion of this topic has been generated over the past few months. However, as I observe from the experience of some countries in the West, when the definition of domestic violence is too broad, you may cause the society to become more litigious. And when terms such as "child abuse", "spouse abuse", "psychological abuse", "hurt", "harassment", "marital rape" and so on become common coinage in the media, in people's conversations and in their subconsciousness, people's attitudes towards maintaining the family as a unit will also change. Where the law intervenes or is resorted to too readily, people will be less inclined to solve family problems through reconciliation or take moral responsibility for their own behaviour. In the long run, we may all be the losers. By comparison, the Women's Charter and other legislation are already in place. They can be reviewed to incorporate some of the positive features of the Bill. For Dr Soin's information, both Mrs Yu-Foo and myself have found that, at the grassroots, the women frankly do not mind one way or the other, so long as the Government is doing something to extend protection, so long as they know where help can be found when the need arises. I hope the Acting Minister for Community Development would not wait too long before the specific amendments to the Women's Charter are introduced in this House. Some lawyers have suggested that the Women's Charter should be thoroughly reviewed to make it into an all-embracing Family Law. I would recommend that we take one step at a time.”