Balaji Sadasivan
Singapore
“The issue is, of course, not good publicity for ASEAN. In fact, it is bad publicity for ASEAN. However, the fact that the ASEAN leaders have met and agreed to deal with the issue and ensure that we try and solve the problem at source, and the fact that ASEAN has tasked the Secretary-General to look into the issue and report to the various…”
“Thus far, the authorities here have not encountered any Rohingya refugees seeking to enter Singapore waters. Given our limited land and natural resources, Singapore is not in a position to accept persons seeking political asylum or refugee status. This has been our policy for decades.”
“I would like to conclude by noting that by resolving this dispute through third party adjudication, both countries have demonstrated our respect for international law and our commitment to settle disputes in an amicable manner.”
“Yes, we shall continue with those efforts. In fact, with the Youth Olympics and the F1, it is a great opportunity for all Singaporeans to think about their behaviour and whether they can improve it – whether they can be more polite and more gracious.”
“Sir, currently, the guideline for the Vasantham Channel is that a minimum of 75% of the programming must be in Tamil and 25% can be in other non-Tamil Indian languages. The number of hours is increasing, from 29 hours per week to 65 hours per week. But the guideline will still remain the same.”
“Sir, our branding is what we are and part of our branding is the law and order that we have and the safety that we have in our city and the fact that everybody has to comply with the law. This is part of our reputation and part of our branding, and it is not a bad part of our brand value.”
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“These staff will form the biosafety committee and they would then draw up all the protocols that are required for dealing with that specific agent and only when it is satisfactory will the Ministry of Health give them a permit. And to ensure that these protocols are satisfactory, we will have external auditors audit the protocols, and the external auditors that we will call to audit the protocols must be experts in that area. Since these are very specialised areas, it is not possible for the Ministry of Health to draw standard guidelines and have these guidelines apply for all laboratories. A less dangerous agent like the dengue virus may require a different set of rules. For example, with the dengue virus, we would not have the same public health danger of a community outbreak of dengue because of release of the virus. But with SARS, if one of the workers got infected with the SARS virus, you could have a risk of a community outbreak of SARS. So the protocols that are required for a laboratory that is going to deal with the SARS virus will have to be quite different from the protocol for a laboratory that is dealing with the dengue virus, and the protocol for the SARS virus will have to have detailed procedures on what to do if there was a lapse in biosafety. Hence, the importance and the need for biosafety committees. The Sixth Schedule stipulates that there has to be a biosafety co-ordinator who is trained to implement the necessary measures at the facility so as to ensure biosafety and biosecurity. In addition, the committee must consist of a person having expertise in microbiology and knowledge in the physical and biological sciences and laboratory practices, thus are relevant to the agent that has been dealt with in that laboratory.”
“Mr Deputy Speaker, Sir, I would first like to thank Mdm Halimah Yacob, Dr Lily Neo and Dr Chong Weng Chiew for their support of the Biological Agents and Toxins Bill. Sir, while the Biological Agents and Toxins Bill enhances biosecurity in Singapore, it also regulates activities that are important to ensure safe practices in the handling of highly infectious agents and toxins. My Ministry, on the recommendation of the National BioSafety Committee, which comprises members from key Ministries and agencies and members of the life sciences community, has adopted the latest WHO guidelines for laboratory biosafety and biosecurity. This set of international guidelines is not only comprehensive in addressing all aspects of biosafety and biosecurity but allows for flexibility to accommodate contemporary technologies and ever-changing approaches to achieving safety in the laboratory. This approach would ensure that there is a good balance between safety, security and cost. Mdm Halimah wondered if the Ministry should come up with standardised guidelines for all laboratories. We have not done this because the laboratories can be quite different and we need to individualise the biosafety and biosecurity controls. To begin with, most of the agents listed in the First Schedule, Second Schedule, and Third Schedule as well as the toxic agents in the Fifth Schedule are agents that are not present in Singapore and we do not have the capabilities of dealing with them. Suppose a laboratory were to ask for permission to do research with the SARS virus. Before the permit is given, the laboratory will have to ensure that the people that it has are not just ordinary experts in microbiology or in viruses, but staff who have the proven capability of doing research with the SARS virus.”
“They were briefed on the requirements of the proposed Bill, and in-depth discussions were held on the possible impact the provisions may have on their businesses and operations. The majority of the stakeholders agreed on the need for legislation to regulate the handling of biological agents and toxins. They were also assured that the Ministry would continue to engage them to allow for smooth implementation of the provisions of the Bill. Conclusion Mr Speaker, Sir, the provisions outlined in the proposed Biological Agents and Toxins Bill will establish a comprehensive legal framework to regulate the import and handling of high-risk biological agents and toxins to ensure complete coverage from acquisition to eventual disposal. It will enhance Singapore's international standing as a country with adequate infrastructure and systems in place to ensure the safety of workers in the biomedical industry. The proposed Bill will address pertinent issues related to laboratory safety and the risk of laboratory-acquired infections, and the security of biological agents and toxins that have potential to be used as agents of terror. Sir, I beg to move. Question proposed. 4.33 pm”
“In view of the possibility of serious outbreaks that could arise if one or more laboratory workers get infected, the Director is also empowered to subject any person who may have been exposed to the biological agent in the facility to medical examination, medical treatment and, where necessary, quarantine. Penalties The penalties proposed in the Bill vary according to the severity of the offences. It ranges from a fine not exceeding $5,000 and/or imprisonment for a term not exceeding six months for lapses in fulfilling requirements for importation of a biological agent to a fine of $1 million and/or life imprisonment for deliberate offences related to the non-peaceful use of gazetted biological agents and toxins. Exemptions The provisions of the Bill will not apply in the clinical care setting where laboratory testing of samples, that may contain the Scheduled biological agents, is carried out for diagnostic purposes or when carrying out an autopsy to determine the cause of death. The collection of environmental or food samples to determine the presence of biological agents or toxins will also be exempted from the provisions of the Bill. This is to ensure that diagnostic services and public health investigations can proceed as normal and not curtailed in any way. The use or possession of toxins in finished medicinal or cosmetic products, for example the use of botox by plastic surgeons and biohazard waste contractors who handle biological agents or toxins as part of the disposal process, is also exempted from the requirements of the Bill. Public consultation My Ministry has consulted widely with the stakeholders in the drafting of the Bill. We engaged key players in the biomedical industry and researchers in tertiary institutions in dialogue sessions.”
“The Bill stipulates that the operator need to obtain the advice of the biosafety committee with regard to safety measures that are required and to ensure that these measures are implemented by the biosafety coordinator before any activity is carried out at the facility. The operator is also required to ensure that the facility is properly maintained, staff are properly trained, risk assessments are carried out, safety measures are in place, proper inventory is kept and biological and toxin wastes are decontaminated before removal from the facility. Transport of biological agents and toxins The manner by which the more dangerous biological agents and toxins are transported within Singapore will also be regulated under this Bill. Vehicles used need to be affixed with biohazard labels. The Bill also requires drivers of these vehicles to be trained in the management of accidents involving biohazardous materials. This is in line with current practices involving transportation of other high-risk substances, such as toxic chemicals in Singapore. Packaging and labelling of the biological agents and toxins for transport will also be prescribed. Enforcement The Bill empowers the Director of Medical Services to investigate any lapses or suspected lapses in biosafety and to take necessary measures to rectify the situation. Where necessary, he can order the immediate cessation of any activities in the facility, destruction of the biological agents as well as the decontamination and closure of the facility. This is to ensure that timely action can be taken to minimise any threat to public health.”
“First, Second and Fifth Schedules The biological agents listed in the First and Second Schedules and the toxins in the Fifth Schedule are subjected to more stringent regulatory requirements as they have greater potential to cause serious disease. There are a total of 93 such biological agents and five such toxins. Of these, 37 biological agents and all the toxins are further identified to have specific bioterrorism risk. Facilities handling these biological agents need to be certified that they are able to meet the engineering and procedural controls to ensure safe-handling in the laboratories. This certification will be carried out annually by external certifiers that are approved by MOH. In addition, facilities handling toxins and biological agents with bioterrorism potential need to be gazetted as protected places under the Protected Areas and Protected Places Act. Third and Fourth Schedules The Third Schedule of the Bill comprises biological agents that are normally of low public health risk but require special attention when they are produced on a large scale. The Fourth Schedule covers the remaining infectious biological agents which are deemed to be of low public health concern as effective treatment and preventive measures are available. These biological agents are only subjected to importation control which is currently required under the Infectious Diseases Act. Duties and responsibilities of the operator The second part of the Bill defines the duties and responsibilities of the operator of a facility handling higher-risk biological agents and toxins and in the large-scale production of biological agents. The Bill requires the operator to appoint a biosafety committee and a biosafety coordinator.”
“A key component of this framework is the Biological Agents and Toxins Bill (BAT Bill). The new Bill was drafted to regulate biological agents and toxins that are of public health concern, some of which could pose threats to biosecurity. The requirements in the Bill are in line with what is practised in developed countries like the United States and the United Kingdom. Provisions of the BAT Bill Sir, I would now like to introduce the proposed BAT Bill. In general, the first part of the proposed Bill deals with the requirements to be fulfilled before a biological agent can be imported or used; the second part of the proposed Bill outlines the duties and responsibilities of the operator of laboratories and those involved in the transportation of biological agents and toxins; while the third part of the Bill spells out the enforcement powers of the Director of Medical Services. Control of biological agents and toxins The biological agents and toxins are divided into five Schedules according to their risk to individual and public health. The classification takes into consideration the ability to cause death and illness, the availability of preventive measures and medical treatment and the potential to be used as agents of bioterrorism. The operator of the facility would need to obtain relevant permits and approvals from the Director before an agent can be imported or used. Sir, although biosafety requirements may differ for different biological agents, there are a number of general provisions which apply across the board to all biological agents and toxins. These include the prohibition of the use of any biological agent or toxin for non-peaceful purpose and the transportation of any biological agent or toxin by postal mail or public transportation.”
“Mr Deputy Speaker, Sir, I beg to move, "That the Bill be now read a Second time." Background In 2001, shortly after the 9/11 attack there was an anthrax attack in the United States. As a result of the attack, thousands had to be treated for anthrax. Five people died as a result of the attack. Although the source of the anthrax spores is not known, it is clear that they came from a sophisticated laboratory. The anthrax attack showed that there is a need to have a framework to control biological and toxic agents. The public health dangers posed by infectious diseases like SARS, avian flu, and Nipah virus mean that there will be more laboratories doing research with such biological agents. When there are lapses in safety, workers in the laboratory can get infected. This happened in laboratories working with the SARS virus in China, Taiwan and Singapore. All three outbreaks were the result of lapses in laboratory practices. This highlights the importance of biosafety in our laboratories. High containment laboratories are designed for handling dangerous pathogens. They are a vital part of the arsenal against emerging infectious diseases, where we can perform diagnosis and undertake research before, during and after an outbreak. High containment laboratories are also needed to strengthen Singapore's position as the leading biomedical hub in the region. What we cannot afford are lapses in laboratory design and practices that could endanger the laboratory workers and public health. To this end, MOH has drawn up a comprehensive national biosafety framework to control the access to and usage of biological agents and toxins in high containment laboratories and to promote a safety culture in the industry.”
“The Sports School's students have also attained success at Asian and World age group levels, such as winning the Girls Under-15 Singles Title at the 2005 Asian Junior Table Tennis Championships. Nevertheless, I must stress that this is early in the game, and it will take some years for our youth to mature and reach their athletic peak. I would like to reassure Mr Chia and my Parliamentary colleagues that the Sports School has comprehensive Sports Science professionals to monitor the growth and development of our student sportsmen, and minimise their injuries. The majority of injuries surfacing in the Sports School are minor to moderate injuries like muscle strains and sprains. There have only been six cases of serious injuries to date, which we classify as those injuries requiring recovery periods of more than eight weeks. Three of these students have already recovered whilst three are in the final stages of rehabilitation. The severity and number of injuries experienced by the Sports School athletes are not higher than that of national athletes training under the National Sports Associations. Let me assure Members that the Sports School will continually monitor and enhance its injury prevention and treatment practices.”
“Internet gaming has both its good aspects and bad aspects. It is a form of pastime. It nurtures curiosity in the young and there are many life skills that can be learned playing these games. On the other hand, playing too much can lead to a lack of social life, social interaction, and could affect studies, these are concerns of parents. So we have been working with the parents' group, for example, the Parents Advisory Group for the Internet (PAGi) is cognisant of this. They support the Cyber Wellness Task Force's recommendation for the need for balance on the Internet and stress the importance of personal user responsibility for positive online gaming experience. So far, PAGi has not received any instance of complaint from parents against LAN shops. But we will be monitoring this. We think that what is required is a balance and, clearly, parents have a responsibility in monitoring the activities of their children. SINGAPORE SPORTS SCHOOL (Update) 12. Mr Steve Chia Kiah Hong asked the Minister for Community Development, Youth and Sports if he will provide an update on the success of the Singapore Sports School and whether many students have sustained serious injuries due to intensive training in the school. The Minister of State for Community Development, Youth and Sports (Mrs Yu-Foo Yee Shoon) (for the Minister for Community Development, Youth and Sports): The Singapore Sports School is into its second year of operations, and the progress to date has been encouraging. For instance, the school has five student athletes selected for the upcoming Southeast Asian Games in Manila. Nine national age group records in Track and Field and Swimming have been surpassed by our student athletes.”
“First of all, I like to make it very clear that when the patient's platelets are low, it means he is quite advanced in his dengue, and at that time, he does not have a Viremia and he is not infective to the mosquitoes. So using platelets to decide who is going to infect the mosquito will not be the right thing to do. What we have done is that we have formed the expert committee, and the expert committee has come up with recommendations, which are being sent out to all the GPs. Because when there is a new outbreak of dengue, particularly when the number of breeding sites comes down, it is quite natural that everyone has an explanation why there is an increase in dengue cases, and everyone has his own idea of how it should be dealt with. But we need some science in dealing with this problem. So we have got an expert committee and they have made the recommendation that, in the early phase of the dengue illness, the patients should cover themselves with insect repellent so that they would not be bitten by the mosquitoes. Likewise on the issue of when should a dengue patient be admitted to a hospital. The majority of patients can actually be treated as outpatients. So we need clinical criteria. The expert committee has met and drawn up the criteria. These criteria are based on advice from Centers for Disease Control and Prevention in Atlanta and World Health Organisation, and these scientifically-based criteria would be used by our hospitals. And I think these issues should be left to the expert committee and anyone who has suggestions can forward it to the expert committee.”
“So it is quite safe to go to nature parks, etc, where I know sometimes you have large mosquitoes flying around and they are the noisy variety. But those mosquitoes will not get infected with dengue. It is only the Aedes mosquito and, unfortunately, the Aedes mosquito stays in urban places, like your home or immediately outside your home or in buildings. That is why there is so much of emphasis about preventing the breeding of Aedes mosquitoes. If we can stop humans from infecting mosquitoes, we can reduce the incidence of dengue. This is because mosquitoes do not spread dengue from one mosquito to another. So the infected dengue mosquitoes will die, ie, their lifespan is about three weeks. But for each new generation of mosquitoes to spread dengue, they have to grow from larvae to become adults; they need to bite an infected human and fly around for about a week while the virus incubates in the mosquito and gets concentrated in its saliva and then, after that, bites another human being in order to spread the disease. And this particular mosquito, in order to get infected, must bite a human during that five days when he has virus in the bloodstream. So if we can have dengue patients or dengue suspects protect themselves from being bitten by the mosquito at home, because that is where most of the Aedes mosquitoes are going to be in urban areas, then we can stop mosquitoes from getting infected with dengue and stop the dengue-infected mosquitoes from infecting new persons. So we have sent that advisory out to all our general practitioners and hospitals for dengue suspects to use repellents. So my advice to all Singaporeans would be to follow that advice. The GP will advise the use of repellents and use it as instructed.”
“Mr Deputy Speaker, Sir, there are two points that Mr Leong brought up that I would just like to clarify. First, he has pointed out that the number of breeding sites has gone down, but the number of dengue cases has gone up and he suggested that it may be because the virus is much stronger and is a new mutant, or he suggested it could be that we are weaker, our immune status is lower, herd immunity is down. Actually, both are possibilities. So we really do not know why we are having this increase in dengue cases, and that is why we are having an expert committee to look at all these factors to see which one of these factors, or a combination of factors, has given rise to this increase in dengue cases. We are also doing some research studies, in terms of the sero status of patients and the general public to see if the changes in the immune status may be partly responsible for the increase in cases. As for the issue of whether people should self-quarantine themselves, there is no necessity for it. Because this is not an infection that spreads directly from one person to another. So any amount of human contact is safe because dengue does not move from one person to another person directly. Although you cannot infect another person, you can infect the mosquito, and that can only happen during a five-day window period at the start of your infection when there is virus in your blood. So we have asked our general practitioners to give advice on how to stop you from infecting the mosquitoes. As to whether you should stay at home or go out, actually if any other mosquito, other than the Aedes, bites you, that mosquito will not get infected with dengue.”
“Mdm Halimah Yacob asked the Minister for Manpower (a) what is the Ministry's assessment of the impact of the Retirement Age Act on the employment of older workers; (b) have there been any studies done to establish whether there is a positive or negative link between the extension of the legal retirement age and employers' recruitment and employment policies pertaining to older workers; (c) how many older workers have benefitted from the extension of the legal retirement age from 60 to 62; and (d) has the Ministry received any complaints of violations of the Retirement Age Act and how were these resolved.”
“First of all, I would like to explain that the reason why the percentage of time it has been closed has increased is due to the larger number of cases that the Emergency Department has been seeing because of dengue, and that certainly has a knock-on effect on all the hospitals which is why tackling the dengue outbreak is very, very important. But in the meantime, we have formed an expert committee to look at the problem of admission of dengue patients to all the hospitals as well as the Emergency Department to see if our resources could be used more efficiently so that the closure will be less frequent. With regard to the length of stay, it is more than just the age that differentiates the hospitals. The type of patients is also different. For example, Tan Tock Seng Hospital sees a disproportionate number of stroke patients for rehabilitation as opposed to rehabilitation for other causes, and hence there can be a disparity in the length of stay for rehabilitative patients. Specifically, for example, in NUH, rehabilitation medicine patients stay an average of seven days, whereas in Changi Hospital, it is 22 days, and Tan Tock Seng Hospital, it is 33 days, and a large part of this difference is because of the different types of patients. RETIREMENT AGE ACT (Impact on older workers) 11.”
“The Minister for Health had during an earlier session addressed this House on the issue of hospital capacity. The Ministry will continue to undertake immediate and longer-term measures, to ensure that there is adequate capacity in public hospitals and that no patient will be denied access to medical care.”
“However, the most critical cases are still admitted even if closure is declared. The declaration of "full house" at TTSH's Emergency Department is not something that is done lightly, since it has a knock-on effect on the operations of other hospitals. We will continue to closely monitor the situation across hospitals. Chickenpox and dengue fever In the past, chickenpox patients were typically admitted to the Communicable Disease Centre (CDC). If a patient's choice of ward class was unavailable at CDC, he would be warded at TTSH. The number of chickenpox cases admitted to TTSH and CDC in the first half of 2005 was about 100 cases a month, while there were about 50 cases a month in 2004. However, as chickenpox is a relatively mild disease that can be managed outside a hospital setting, TTSH and CDC have since July 2005 only admitted patients with chickenpox if there is a medical indication for hospitalisation. In August 2005, only eight such cases were admitted. Patients with chickenpox are no longer admitted for the purpose of isolation. My Ministry is monitoring the situation and has not detected any public health impact arising from the revised admissions policy. Minister Yaacob Ibrahim will be addressing this House on the national strategy for tackling dengue. So I will just respond to Dr Tan's specific question here. The number of hospitalisations for dengue fever has increased since May 2005, corresponding to the increase in the number of notifications of dengue fever. In May 2005, the utilisation of bed days for patients with dengue fever at public hospitals ranged from 0.8% at NUH to 2.7% at TTSH/CDC. By August 2005, dengue has taken up 6% of available bed days in TTSH/CDC, AH and CGH, and around 3% for NUH and SGH.”
“By discipline, the average lengths of stay for geriatric and rehabilitative medicine from January to June 2005 were 9.4 and 19.7 days respectively. The total number of patient admissions in acute care public hospitals increased slightly over five years, from 297,000 in 2000 to 303,590 in 2004. The figure from January to June 2005 was 150,290. The number of admissions varies depending on each hospital's capacity. For the first half of 2005, AH with the fewest beds had 10,530 admissions, while SGH with the most beds had 34,870 admissions. These statistics show the comparative situation in our hospitals. What is more important, however, is for each hospital to continue to ensure that their patients get appropriate medical treatment. If a patient needs to stay longer than the average length of stay in order to receive proper medical care, his doctor must ensure that he stays. While we monitor the length of stay in order to make hospital operations more efficient and more effective, we must also be careful not to make statistical data more important than the quality of care that patients receive. Closure of TTSH's Emergency Department The Emergency Department is one of several units in a hospital. The number of cases that can be treated by the Emergency Department varies, depending on the situation in the other units. For example, if there are a large number of dengue cases taking up many beds, then the Emergency Department's capacity to manage cases will be affected. Between January and August 2005, TTSH's Emergency Department was closed about 9% of the total operating time. In 2004, similar closures at TTSH comprised 1% of total operating time. During such times, ambulance cases are sent to the nearest hospital which can confirm it has available capacity.”
“Dr Tan Sze Wee asked a number of questions related to the bed situation in public hospitals, including admissions and length of stay, the closure of Tan Tock Seng Hospital's (TTSH) Emergency Department and the handling of chickenpox cases. Let me address these in turn. Hospital Admissions Although Singapore is a small city-state, there are demographic differences in the patients seen by the different public hospitals. Different hospitals see different types and ages of patients, have different medical departments, and treat different ratios of non-elective to elective cases. For example, in 2004, the median age of Tan Tock Seng Hospital's patients was 59 years, compared with 55 years in Singapore General Hospital (SGH), 52 years in Alexandra Hospital (AH) and 51 years in Changi General Hospital (CGH). The median age is 44 years for National University Hospital (NUH), partly due to its pediatric service. As another example, TTSH sees more rehabilitative medicine patients than other hospitals. In 2004, it treated 3,367 such patients, while CGH had the second highest volume of 510 such patients. The average length of stay in a hospital is therefore determined by a range of supply and demand factors, such as the demographics of the surrounding population, the conditions treated by the hospital, and the availability of step-down or alternative care services. Specifically, since 2000 when the average length of stay for public hospitals was 5.9 days, there has been a gradual decrease in this figure. The average length of stay in public hospitals for the period from January to June 2005, across all disciplines, was 5.6 days. NUH had the shortest average length of stay of 4.9 days, while TTSH had the longest length of 7.0 days.”
“It is very difficult to make comparisons across countries because there are various packages across countries. But if we look at prices internally within Singapore, we can see that the prices have come down as a result of competition. For example, SingTel's Classic Plan in 1997 cost $45 a month. An equal plan today in June 2005 costs $28. Likewise, MobileOne's Prime Plan, which was $40 in 1997, has come down to $28. So, while it is possible for us to compare prices of similar packages in Singapore, it is very hard to make comparisons across countries. MALAY LANGUAGE (Promotion as third language) 5. Mr Zainudin Nordin asked the Minister for Education (a) what is the progress of his Ministry's efforts to promote the Malay Language as a third language in schools; (b) what is the take-up rate and how many schools are providing these options; and (c) what resources are being allocated to ensure that we continue to have sufficient Singaporeans other than the Malays who are conversant in the Malay Language.”
“I do not have the data in terms of broadband penetration depending on income level, but we can check that up and provide that to the Member. Mdm Cynthia Phua: The Senior Minister of State has not answered the cost comparative with China, Korea and Malaysia. I would just like to have an indicative pricing as to our level of charges.”
“Sir, I believe Mdm Phua is concerned about international calls in the region. While local calls may be relatively cheap, the cost of international calls can vary. And this is because, particularly with roaming services, there are business arrangements made with companies that are outside our jurisdiction. To provide seamless connectivity when consumers roam between countries, there are commercial agreements in place between the local and the overseas operators. The cost structure for international roaming services therefore comprises several components. A mobile user would typically need to activate an international roaming service with his mobile service provider before he can make and receive calls while overseas. The activation of the roaming service may incur a one-time charge and subsequently there may be monthly subscription charges. In addition, there are also charges placed by the operator in a particular country that your call is going to. Those charges are not under our jurisdiction. So, while we are able to use market competition in Singapore to keep our charges down, it is not possible to determine what the charges in these countries will be. Hence, while businesses would like to have the charges as low as possible, we can only control using the market for the charges from the Singapore side.”
“This means that there were over 4 million subscribers in May 2005. Operators have also commercially launched 3G services since early 2005 at prices comparable to 2G (or GSM) services, opening up more service offerings to consumers. In conclusion, MICA and IDA will continue to promote competition in our broadband and mobile market for the benefit of consumers.”
“If successful, these trials will provide greater incentive for the operators to deploy these new technologies on a larger scale. I would like to assure this House that IDA will continue to seek strategic partners to deploy new technologies and business models to enable users in Singapore to enjoy competitive, pervasive and high-speed broadband access. Mdm Phua also asked about our mobile phone charges. Singapore's mobile market remains one of the most competitive markets in the region, with a large variety of price plans available for consumers to choose from, bundled with various attractive incentives such as free incoming calls and free IDD calls. For example, a typical non-free incoming GSM mobile phone package would cost consumers in Singapore approximately $28 per month which comes with additional bundled services such as free SMS, caller IDs and voicemail. I would like to point out that at this price range, our mobile services are not out of line with other regional markets. However it is not possible to make direct comparisons on account of the various packages and bundlings being offered by each and every operator. Our competitive mobile sector is largely due to the liberalisation of Singapore's telecommunications market. Prior to April 1997, Singapore had only one operator for mobile services. However, with the entry of M1 in April 1997 and StarHub Mobile in April 2000, consumers now not only have three operators to choose from, but also a large variety of service packages available to them. Competition has resulted in lower mobile prices and greater innovation in services as operators sought to differentiate themselves. As a result, mobile phone penetration in Singapore is one of the highest in the world at 95.5%.”
“Recent media reports had cited that the prices of local broadband access were kept high by the anti-competitive behaviour of incumbent operators controlling critical telecom infrastructure and thus hampering the entry of competitors into the market. The reports also suggested that such conduct had gone unchecked by the regulator. Such perceptions are unfounded. First, IDA has consistently worked to overcome the lack of effective competition in infrastructure by requiring SingTel and StarHub to offer wholesale broadband access to their respective networks. IDA has also mandated SingTel to offer its local leased circuits and unbundled local loops at regulated pricing. These measures are aimed at enabling Internet Service Providers (ISPs) not affiliated to these two companies to compete with them in the retail broadband services market without having to make heavy infrastructural investments. Second, to encourage greater competition, IDA is working closely with various industry players to offer alternative broadband access technologies, such as wireless broadband. In May 2005, IDA conducted an auction to allow industry players to bid for spectrum rights to provide wireless broadband access services in Singapore. IDA believes that the six operators that were awarded the spectrum rights will provide further competition in the broadband industry and open up more innovative and competitive broadband packages to consumers and businesses. In addition, IDA is also supporting technical trials in alternative broadband technologies that can lower deployment cost and increase access speed. These technology trials and pilot projects will help to iron out technical, operational and business issues.”
“The Senior Minister of State for Information, Communications and the Arts (Dr Balaji Sadasivan) (for the Minister for Information, Communications and the Arts): Mr Speaker, Sir, Mdm Phua asked if our charges for Internet broadband were more expensive compared to our neighbouring countries. The Internet broadband charges in Singapore are set by the market. Competition and technological advances have driven prices down and increased broadband subscription. Prior to 2000, majority of the consumers were on dial-up Internet access plans. Since 2000, consumers were able to subscribe to broadband services via cable modem or ADSL technologies. Higher access speeds are more common now and consumers can choose from broadband access of 256 kbps to as high as 25 Mbps. Residential broadband prices have declined by up to 70% for unlimited access plans since 2001. There are also low cost packages for novice users with low usage. Household broadband penetration has increased to 46.6% in May 2005, up from 33% in December 2003. Today we estimate that more than 40% of broadband subscribers in Singapore are on access speeds of at least 1.5 Mbps. While broadband prices have become more competitive and access speeds have increased, IDA recognises that Singapore still lags behind the leading regional economies of Korea, Japan and Hong Kong. However, in comparing broadband prices, we must be mindful that every country has different cost structures. On this aspect, I have explained in this House in September 2004 that underlying factors such as market size, usage profile, web surfing habit as well as competition from alternatives can have important impact on the price.”
“Mr Speaker, Sir, polio vaccination was introduced in Singapore in 1962. All new-borns have since been vaccinated against polio starting from three months of age, and given boosters when they are in Primary 1 and 6. We have thus maintained very high immunisation rates which confer 'herd' immunity in our population. Even if there is an infection from external sources, it will not spread. The last local case of polio was reported in 1978 and the last imported case in 1986. Our high standard of hygiene and modern system of sewage disposal also minimises the transmission of poliomyelitis through the faecal-oral route, which is the main cause of transmission in the community. There is thus very little risk of a polio outbreak in Singapore. Though we have already eradicated polio locally, we will continue to maintain a high degree of surveillance to check for imported polio cases. Despite the detection of isolated cases in Indonesia recently, WHO reports that polio is close to eradication. To give Members some idea of the perspective of risk today, say, opposed to 20 years ago, in 1988, there were 350,000 cases of polio in the world. Last year, there were only 1,266 cases. So, as far as the world is concerned, we are coming close to eradicating polio. And that is why when cases are reported in countries, they get a lot of publicity. INTERNET BROADBAND AND MOBILE TELEPHONES (Charges) 4. Mdm Cynthia Phua asked the Minister for Information, Communications and the Arts whether our charges for Internet broadband and mobile telephones are more expensive compared to our neighbouring countries.”
“When you are the first to try something, you may be the first to benefit from your initiative, but you may also be the first to suffer from the initiative. Because, as I have pointed out, as there is a high rate of false positives, you may end up treating many people for a disease that they do not have. Again, as I said, if you think that there is sufficient evidence, I would suggest that you marshall all the evidence, send it to our urologists who are the experts in this area and convince them to recommend to us that that is the right thing to do. POLIO INFECTION CASES (Spread from external sources) 3. Mr Leong Horn Kee asked the Minister for Health in view of the recent global increase of polio infection cases, what actions are being taken by his Ministry to guard against the spread of this disease in Singapore, especially against the spread from external sources.”
“Because, really, it is not something that we here are the experts who can evaluate and tell you, yes, you are right and our specialists are wrong. But if you have such evidence, please send it to the Academy.”
“Mr Speaker, Sir, therein lies the problem. If a person has PSA positive or slightly raised, then we have to decide whether the person has benign disease or malignant disease. So the person will then be subjected to a biopsy, because there is no point in doing a PSA if you are going to have a result and not do anything about it. The biopsy itself carries a certain amount of risk because it is an invasive procedure, and people have had complications from the biopsy. A biopsy samples only a small part of the prostate, and not the entire prostate. So if your biopsy is positive, you are going into one category. If your biopsy is negative, it does not mean that you may not have prostate cancer. Then you come to the question: if you did see so-called malignant cells in your biopsy, does this mean that this is going to be the type of prostate cancer that is going to matastise and reduce your life expectancy? Or is this going to be the changes that we see where it does look malignant but, clinically, its cause is benign and therefore your life expectancy is not going to be affected by it, and surgical intervention or treatment may actually do you more harm? So these are all the considerations in terms of treating prostate and these are all the problems with population-based screening. Prostate cancer is not unique to Singapore. There are many countries with a rate of prostate cancer that is much higher than Singapore. And the experts in these countries have looked at the data and none of them have advocated a nation-wide screening test. So, if there are individuals who strongly believe in it, the approach should be to garner the scientific evidence, submit it to the experts, and the experts are the chapter of urologists in the Academy of Medicine and let them evaluate.”
“Mr Speaker, Sir, we all want to save lives. So we are all on the same side. But the important thing is that whatever we do, there must be scientific evidence. And if you have scientific evidence that a population-based screening system reduces mortality, the right thing to do is to collect that scientific evidence and send it to the Academy of Medicine, the chapter of urologists, who are the experts in that field and if they advise us that we should consider it, we will.”
“Again, I would like to point out that the issue is not an issue of cost. The issue is: should screening be done on a normal population? The reason why it is not done is that large numbers of people, once they reach a certain age, will have cells in their prostate that one would consider prostate cancer. As a result, you may have a raised PSA. But it does not result in clinical disease and the life expectancy of these people is not reduced. So when you do screening, you may pick up people with essentially a benign disease. But because you have now diagnosed them as prostate cancer, you then subject them to treatment and the results of your treatment regime may be worse than if you had left them alone. That is why we should not proceed unless there are scientific studies to support it. If there is any physician who has scientific studies, the right thing to do would be to submit his or her scientific studies to the necessary experts and if the experts present to MOH a scientific case for doing that, then we will do it.”
“The answer to the first question is no. There are no studies that show that population-based screening for PSA improves the outcome. If anyone has such scientific studies, they can submit it to MOH. If there is no scientific evidence that the outcome will be improved, then it is not a question of whether it is $5 or whatever price the test may be. The problem with screening with PSA is that there is a high false positive rate. So while you may pick up more patients with so-called "prostate cancer", many of them will not have aggressive prostate cancer and as a result, there will be people who are treated aggressively for a disease when the disease itself may have a benign outcome. And, hence, we may do more harm than good by doing a population-based PSA screening regime. Because there are no scientific studies that support it, we have not proceeded with that.”
“Prostate cancer is the fifth most frequent cancer among Singapore men. Its incidence rate has increased from four per 100,000 population per year during the 1968 to 1972 period to the current incidence rate of 17. One key reason is that Singapore men are now living longer. Nevertheless, our rate is low compared to other developed countries. In 2003, prostate cancer accounted for less than 1% (0.8%) of all male deaths in Singapore. 94% of these deaths were in men above the age of 65. The treatment for prostate cancer has improved significantly over the years. A local study has shown that the five-year relative survival from prostate cancer has improved from 39% in the 1968 to 1972 period to 57% in the 1988 to 1992 period. Although it has been suggested that Prostate Specific Antigen (PSA) screening for prostate cancer can result in early diagnosis of the cancer, there is no conclusive scientific evidence that population-wide PSA screening can reduce prostate cancer mortality.”
“With regard to our hospitals, our hospitals are also improving their treatment as indicated by the drop in the mortality rates which I have just given her a little while earlier. Stroke is a burden on families, especially if they are left with disabilities. There are welfare workers and a whole lot of social support work that is provided for these patients. It is managed partly by my Ministry and also by MCYS. If the Member wants to know more details about this, she could table a Question at the next Parliament sitting because that is not in her Question. PROSTATE CANCER (Preventive measures) 2. Dr Lily Neo asked the Minister for Health, in view of the fact that prostate cancer is on the increase and 50% of deaths are due to late diagnosis, what is his Ministry's plan to prevent deaths due to prostate cancer.”
“Again, Dr Neo is correct. Educating our general practitioners and increasing their awareness is part of stroke prevention. That is why we have a lot of education programmes for our primary healthcare physicians with regard to stroke and other risk factors for cardiovascular disease. This is because most patients would see their general practitioners and primary healthcare physicians for management of minor diseases and for other reasons. These physicians are in the best position for primary and secondary healthcare. We think this has improved with new requirements for CME which came in several years ago so that now, our primary health physicians are also in tune with what the hospitals are doing and what the Ministry is doing in terms of bringing our stroke rates and cardiovascular disease rates down since the risk factors for both are quite similar.”
“I agree with Dr Neo that prevention is better than cure. In terms of managing stroke, we have a three-pronged approach. First, there is primary prevention. Primary prevention is mainly geared towards raising awareness and providing the skills and means for people to adopt a healthy lifestyle. Then, there is secondary prevention. This detects people who may have developed risk factors such as stroke and diabetes and manage these people so that their chance of developing a stroke would be less. For tertiary prevention, this is managing people when they come to the hospital with their TIA or minor stroke and managing them so that their outcomes are better. In terms of actual numbers, in the year 1998, we had about 7,350 stroke patients, giving us a rate of 332 per 100,000 persons and it has remained about the same level. The actual figure in 2004 was 7,345. But because our population has increased, the rate has actually come down to 211 per 100,000. Likewise, because of improvements in the tertiary care, the mortality rate has come down. In 1997, the mortality rate from stroke was about 38 per 100,000. Last year, it was 28 per 100,000. However, we should continue to work and see if we can bring these rates down further.”
“He should do what is reasonable and correct in the provision of care to the patient. The standard of care we expect is that set by his peers. So, there will always be some tension between the two - the doctor and the administrator. But this is a healthy tension, as long as both realise that the other is also working for the benefit of the patient.”
“We need to de-stigmatise testing and, at the same time, we must prevent discrimination against AIDS patients. A lot of education is going to be needed. And the Health Promotion Board in Singapore will be busy this year working on this. Those who test positive for HIV should be able to lead normal lives in society. MOH will consult with the public and stakeholders before proposing any legislative changes. Finally, there was some fear expressed by Dr Tan over the block budget system affecting clinical services. Minister Khaw has outlined to this House our approach towards block budgeting. There is no perfect health system. The health administrator has to work in a market-based system and is forced to be as efficient as he can. At the same time, the block budget ensures that the overall growth of the healthcare sector is moderated so that healthcare remains affordable. So, in answer to Dr Tan, the clusters will have to see what their block budget is and then determine what service they should expand. If they think polyclinic services should be expanded more because there is such an overwhelming demand, then that is what they should expand. If they think they should invest more in inpatient services, that is what they should do. I do not think we want to set a rigid guideline for what they should do over the next five years and then guarantee this House that that is what they are going to do and guarantee that the block budget should be used for that. As far as possible, we should let those on the ground decide how best to use the funds available and match what new services they are going to provide with what is needed by the people of Singapore. 1.15 pm For the doctor, he must do the best for his patients with the means available to him.”
“This increased the overall screening rate from 37% to 77%. As a result of screening, in the last two months, we have saved at least one child from getting infected. MOH is studying proposals to make testing of pregnant mothers compulsory so that we can achieve 100% screening. Sir, besides gays, the other major risk group are heterosexual men who have casual sex. In many cases, this puts the wife at risk. In countries where the AIDS epidemic is full-blown, the majority of AIDS patients are women. This is because it is easier for the infection to move from man to woman than from woman to man. Currently, 10% of AIDS patients in Singapore are women. If we do not act to protect women, many women will get infected and we will have a situation where women form the majority of AIDS patients. Do we want this to happen? There is a need to balance the right to confidentiality of the AIDS patient with the right to protect those at risk. The current legislation appears to be tilted in favour of the patient and exposes the spouse to the risk of catching AIDS. It also prevents the healthcare system from performing its public health duties. This is one reason why the AIDS epidemic is not coming under control. We need to treat AIDS like any other public health problem. We must give public health workers the tools needed to screen for the infection and contact-trace the infection. We need to protect the women of Singapore. There has been a reluctance to deal pro-actively with AIDS because of the fear that the AIDS patient will be discriminated. Hence, many measures were put in place which hindered efforts to diagnose HIV. But if the HIV patient is not diagnosed and even the person who is HIV-positive does not know he has HIV, how can we effectively stop the transmission of the disease?”
“In 2003, the number of new cases was 242. This means there was a year-on-year increase of 28%. Currently, 90% of these newly diagnosed patients are males, with one-third being gays. We had a low prevalence rate of HIV in the past, even in the gay community. We do not know the reasons for the sharp increase of HIV in the gay community. An epidemiologist has suggested that this may be linked to the annual predominantly gay party in Sentosa - the Nation Party - which allowed gays from high prevalence societies to fraternise with local gay men, seeding the infection in the local community. However, this is a hypothesis and more research needs to done by the experts. The reported new cases are only the tip of the iceberg. In total, we have more than 2,000 HIV/AIDS patients. But for every AIDS patient we have diagnosed, there are possibly two to four undiagnosed patients with HIV in Singapore. That means there could be anywhere between 4,000 and 8,000 undiagnosed HIV patients in Singapore. Last month, there was an alarming report from the US. The AIDS virus has mutated and the new virus is drug-resistant and kills quickly. Even those who are already HIV-positive can get infected by this strain. We therefore have to make testing simpler for people at risk. MOH is currently studying the introduction of over-the-counter HIV test kits. These test kits are easy to use because they test the saliva. Any member of the public should be able to do it themselves. This will allow those at risk to test themselves. If those with HIV are diagnosed early, they could receive treatment early and hence minimise the development of complications. They could also take precautions so that they do not spread the disease. Recently, we made testing of HIV in pregnant mothers an opt-out option.”
“The polyclinics will be piloting specialist Family Clinics to look after chronic diseases. They will start with clinics that will look after hypertension and diabetes. They will announce the details when they are ready to roll out the service. If the pilot is successful, then GPs can be brought into the system to provide holistic care. We will study how best to model this scheme, possibly similar to the PCPS scheme, as suggested by Dr Lily Neo. Similarly, we can study how VWOs can be involved in chronic care, as suggested by Dr Chong. Looking after the elderly requires a "many helping hands" approach. The grassroots can take the lead. And if any technical assistance is needed, my Ministry will help. I agree with Dr Chong that VWOs can play an important part in looking after the chronic sick. Like MOH, VWOs can employ competent doctors to provide primary health care. But there is a difference between MOH and a VWO. The great strength of the VWO is that it is a people-driven organisation, and that means it is an organisation with a heart that beats in tune with the community and that it is closer to the community. Dr Tan had asked about the adequacy of infectious disease manpower. There are 18 infectious disease specialists, of whom 15 are in the public sector. There are also over 70 trained public health specialists and there are about 10 trainees in each speciality. For the exact details on the numbers, we can send it to the Member. Is this enough? Having more specialists is always better but I think our numbers are adequate. In November, I had forecast that the rate of increase of AIDS was such that, in 2004, we will cross the 300 mark in terms of new cases diagnosed. The final tally is in. Sadly, the total number of new cases for 2004 was 311.”
“But it also means many will develop one of six chronic diseases in their lifetime, namely, hypertension, diabetes, heart disease, stroke, cancer or dementia. We must therefore be able to manage these diseases better and in a holistic manner. Unfortunately, many members of the public think that specialist care is better than the care of a GP or a polyclinic doctor. Perhaps, this is because of the word "specialist", which is derived from the word "special". So patients think they get ordinary care from a GP and special care from a specialist. This is not so. The "special" refers not to special care, but to a special part of your body. The part of your body considered special is not really special - it could be your liver, or your lung or your colon or skin. It is considered "special" by the doctor because that is the usual part of the body he treats. So depending on the number of parts your body is divided into, you will need that many specialists to look after you. A specialist is therefore a body-part expert and not a whole-body expert. I have said there are 35 specialties in Singapore. If we exclude pediatrics and obstetrics, which I presume a man will not need, a man may need 33 specialists for his care. So that is why many patients in our hospitals end up seeing multiple doctors which costs them a great deal. Even then, sometimes things are missed because there will be gaps between the body parts covered by the specialists looking after the patient. We need to educate the public that GPs, family physicians and polyclinic doctors are experts in looking after the whole body just as specialists are experts in looking after one part of the body. The chronic sick often have multiple problems and they need holistic care.”
“This gives patients choice and the competition between the two will lead to better service and lower costs. They have different manpower recruiting strategies and different plans for future expansion. The CEOs of the clusters, hospitals and polyclinics are on the ground and they are in the best position to make decisions. I believe MOH should not try and micromanage the polyclinics or hospitals. And we should not unnecessarily set restrictions on them on what they should do in 2007. I do not have a crystal ball to look into and say in 2007 what the situation will be and what decisions they should make. Mdm Halimah wanted to know what the doctor-patient ratio was. She was concerned about the number of doctors we have. In 2000, it was 1:720 population. It is now 1:650 population. So there has been an improvement. The second medical school will increase the supply of new doctors starting seven years from now. At the same time, we are going to need more doctors as our population ages. So looking ahead, I think supply will match demand, but even if the two did not match up exactly, any shortfalls or excesses will be evened out by the global market place in healthcare manpower. Mdm Halimah was also concerned about other health sciences professionals. I agree with her. We must support the training and development of other healthcare professionals like nurses and the allied healthcare workers. Dr Lily Neo highlighted the problems of chronic diseases in the elderly. Looking after the chronic diseases of the elderly will become the biggest sector in healthcare. With our high healthcare standards, Singaporeans can look forward to living into their 80s and 90s. This is good news.”
“Since the supply of neonatal specialists has increased greatly in relation to the number of deliveries, they have just set higher standards for themselves. 1.00 pm Mdm Cynthia Phua yesterday expressed concern about the high cost of drugs and diagnostic tests. The clusters buy in bulk and this has reduced the cost of medicines. With regard to radiological tests, there are many new diagnostic machines. In countries like the US, rules have been relaxed so that other specialists are allowed to own and operate these diagnostic machines. This is not yet the case in Singapore. Our regulations reduce the supply of specialists who are allowed to operate the machines to only radiologists. The cost of radiological investigations in Singapore is sometimes twice that of neighbouring countries. This is not a problem restricted to the private hospitals. The MRI and CT scan charges at our restructured hospitals may, in some cases, be higher than the private sector. Patients bear this cost. MOH will study how to safely deregulate and introduce more supply and more competition so that the unit cost for radiological tests is brought down. This will benefit patients. I have given these examples to show that market principles apply in healthcare and, at the same time, to show how supply can create its own demand. For the market to work, our hospitals must have autonomy in making decisions on how they employ their doctors and what services they wish to provide. So, in answer to Dr Tan on the differences between the clusters, there must be differences because NHG and Singhealth do not have identical practices. They have the autonomy to make their own management decisions and compete with each other.”
“Those on temporary registration who perform well should eventually be given full registration. In answer to his specific question on the number of temporarily-registered doctors, there are 219. They work in both clusters and about 30 of them are in the polyclinics. In looking at medical manpower, we need to also consider the distribution of doctors between the various specialties. Specialisation makes it difficult to redeploy medical manpower. The United States, which has a sophisticated training system, has 24 specialties and includes family medicine as one of the 24 specialties. Singapore has 35 specialties, and we exclude family medicine. Specialisation creates silos with walls that prevent the movement of work or doctors across specialties. Even within specialties, doctors sub-specialise further and are reluctant to be deployed elsewhere within the specialty. This can create a relative over-supply or under-supply within the specialty. For example, since the number of deliveries in our public hospitals has dropped from an annual peak of about 40,000 to less than 20,000, the number of neonatal beds should be halved. Instead, the neonatal specialists tell me the number of beds remains the same and that they are working at 110%. When there were 40,000 births, the neonatal specialists had the modest goal of reaching a standard equal to that in a good hospital in the UK or Australia. Now, they want to be one of the top three centres in the world. With more than enough skilled manpower, relative to deliveries, they can set themselves this goal. The neonatal specialists are a dedicated and hardworking group, and they may achieve their goal. I am proud of their work. But this is an example of supply-induced demand.”
“Our healthcare system works within this market. The global market helps us import doctors in the areas where there is a shortage and allows our doctors to work abroad if there is a temporary oversupply in any specific area. In the same way, there is a global market for nurses and the health sciences professionals like physiotherapists and radiotherapists. Our nurses are targeted by foreign recruiters. I am told that the recruiters hand out leaflets to nurses at the bus-stops and MRT stations serving the public hospitals. The existence of a global market means that we have to pay globally-competitive wages if we are to hold on to our healthcare workers. But it also means that we can meet shortfalls in our manpower requirements by recruiting foreign-trained workers. Of the 7,000 doctors registered by the SMC, about a fifth are foreign-trained. They have been a plus to our healthcare system. Let me give two examples of foreign-born foreign-trained doctors who have contributed to our healthcare system. Prof Abu Rauff and Dr K C Tan are foreign-born and did not graduate from the local university. Prof Rauff was Chief of Surgery at NUS and was teacher to many of the top surgeons in practice today. Dr K C Tan is, of course, Singapore's liver transplant surgeon who saved both Ms Andrea D'Cruz and Mr Suleiman when their livers failed. By welcoming talented foreign doctors, our healthcare system has been able to deliver better care to the public. There is no reason to discriminate against them. In answer to Dr Tan, there is no difference in the pay structure between foreign-trained and locally-trained doctors. The starting salary for medical officers is around $3,500 a month. Temporarily-registered doctors receive less because they have to be supervised.”
“Sir, I would like to thank the hon. Members, Mdm Halimah Yacob, Dr Tan Sze Wee, Dr Chong Weng Chiew and Dr Lily Neo for their comments. Mdm Halimah and Dr Tan asked about the medical manpower situation. Dr Tan made particular reference to the polyclinic. Sir, manpower planning in healthcare is not an exact science. As we recently announced, there will be a second medical school. This school will take 25 students in its first batch in 2007. They will be housemen in 2011, finish their advanced training around 2017, and become specialist consultants around 2020, ie, about 15 years from now. Likewise, the number of doctors and specialists we have today was influenced by the admission policies of the last 30 years. Fortunately, the number of doctors working here is not solely dependent on rigid manpower planning. This is because a significant number of Singaporeans study medicine abroad and a number of them return home to work. We also take in foreign doctors who have augmented our numbers. And we have Singaporean doctors who leave to work abroad in the US, UK and Hong Kong. They reduce the local supply but they are an asset to Singapore because they form a Singapore network around the world that we can tap into. Just as Singapore hospitals recruit foreign doctors, foreign countries try to recruit our doctors. Some time ago, there was a team from the UK which visited Singapore. It was led by a distinguished surgeon and they were trying to recruit surgeons for the NHS. Three years ago, two of my former neurosurgical trainees who became consultant neurosurgeons were offered salaries of US$500,000 each, tax-free, to work in an oil-rich country. They turned down the offer. Today, there is a global market for skilled medical manpower.”
“Sir, we give our award to the best local writer that we can find. This is to encourage our local writers and we must give recognition to our local writers as best as we can. It is not fair to compare this award with the award that you want to give to the whole region where you have overseas people competing in it. In which case, our authors may not have a chance to get recognition and may defeat the purpose. With regard to what we are doing to help the writers, we are doing more than just giving the grant of $325,000. We are trying to plug our writers into the global marketplace. So we have schemes to help our writers get into the regional and global markets. Among the schemes, our efforts include cultivating and engaging the overseas publishing houses so that they will be interested in publishing the works of our writers, exploring internships of Singaporean publishing professionals at international publishing houses for the purpose of understanding how these markets work. We are also reviewing our current grant schemes to enhance support in areas like translation, so as to make it more conducive for our publishers and writers to get their works translated so that the market for their works should be greater. We are working with our MOU partners to identify key festivals overseas so that their works can be showcased. Also, we are working with our MOU partners abroad to see if we can profile our writers abroad so that their market reach is greater. I think what we have to do is try to increase the market for our writers so that people will buy their books and, thus, the best support that they want and need.”
“Sir, I would like to correct Dr Ong. I said $325,000, and not $300,000. He has reduced it by $25,000. The grant was given as publishing grant, international touring grant, translation grant, writer in residence grant, overseas writing programme, Iowa writing fellowship programme and mentor access programme. I do not have the information, in terms of breakdown by language groups, but we can look at that and provide him the information. With regard to medals with prestige, I would like to point out that we give Cultural Medallions to writers, and about 14 writers have won the Cultural Medallions for their contributions. In terms of whether the award that he is talking is more prestigious, or whether the Cultural Medallion is more prestigious, that would be subjective. But really the recognition a writer gets depends on the quality of the work. No amount of medallion honours that we give can compensate for the quality of the work that he produces. And what MICA does is to give people the opportunities so that their works can be published and seen. And if the work is good, people will buy. But writers have to realise that, in a globalised world, they are competing in a globalised market, and competing in a global market is difficult.”