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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Every one of 434 lines we hold for Balaji Sadasivan, in date order, each linked to its source. Free to read, in full, without an account. Page 5 of 9.
“Sir, I said 100 metres, not 20 metres. Nevertheless, I would like to point out that safety depends on motorists too and at what speed they are driving. If you are on a German highway, you can drive at 140-180 km an hour, even at 200 km an hour. The stopping distance is much greater and the signs must be placed adequately early so that you are alerted about it. But if you are driving at 70 km per hour or 50 km per hour, depending on the restriction at that point, then our signs are adequate. So, if you find that it is not adequate, please check. Maybe you are travelling too fast! REVAMPING OF ONEMOTORING WEBSITE (Cost) 5. Mr Steve Chia Kiah Hong asked the Minister for Transport how the OneMotoring website could have cost $5 million for it to be revamped.”
“Sir, I would agree with the Member that we want to prevent accidents. So, if the Member had come across situations that he thought were unsafe and had called the LTA, we would have checked. Over the last six months, there has been no accident at any of the worksites. Of the 71 offences that were committed, because LTA audits the sites, they were all minor. Some offences were detected because members of the public called LTA, and LTA went down and noticed these minor infractions, fined the contractors, and the practices put right. As to whether the COP is adequate, from an individual point of view, it is very hard to say. I, for example, was driving to work today and because of this question, I looked at all the signs at a construction site at the AYE. There were 10 signs. Usually, I see the first sign and I assume that there are road works, and I do not see all the other nine signs, but there were nine signs. In addition to that, there was another sign that says "Road Works Over". And to keep you happy, there is one more sign which says, "Have a Good Day" with a smile. Whether this is excessive or not, I do not know. I am not a safety engineer. The safety engineers in LTA go around. They look at standards around the world and they try to put best practices in place. If anyone knows of better practices than what our safety engineers in LTA know, I am sure they will consider it.”
“As vehicles tend to be travelling at a higher speed on the highways, truck-mounted attenuators and orange cones also have to be provided just prior to the work zone, to help absorb the impact if vehicles should miss all the advance notices and still crash into the work site. Members may wish to note that the LTA reviews and updates the COP regularly by drawing on the experiences of developed countries in traffic control and safety practices. LTA also regularly educates the road users on these measures, to ensure that they are able to react appropriately when faced with the various traffic control measures. Failure to adhere to the COP renders errant contractors in violation of the Street Works Regulations and penalties in the form of a system of fines and demerit points will be meted out. In the last three months, 71 contractors had been fined for not complying with the COP. Though the COP is comprehensive, it is only as effective as the contractors and workers who implement it on the ground. To ensure proper implementation of the COP, LTA also conducts regular audits to identify sites with poor traffic control. Motorists can also play their part by calling LTA's hotline if they spot unsafe practices at road works so that these practices can be made right as soon as possible. Should Mr Chiam, or any Member of the House, come across such a situation, please call 1800-CALL LTA (1800-2255 582).”
“Sir, I fully agree with the Member that there is a need to give ample notice to traffic of road works. The Land Transport Authority (LTA) is empowered to control works on public streets through the Street Works Act (SWA) and Street Works (Works on Public Streets) Regulations. Under the Regulations, all utility agencies and contractors working on public streets are required to comply with the Code of Practice for Traffic Control at Work Zone (COP), which sets in place a set of comprehensive measures for those who work on public roads. The COP outlines clear standards and procedures and provides guidelines to utility agencies and contractors on the acceptable traffic control requirements needed to ensure the safety of the workers, motorists and pedestrians. LTA also chairs the monthly Road Opening Co-ordination Committee (ROCC) meeting with representatives from the National Parks Board, Traffic Police, HDB, JTC and the various utility agencies to emphasise the importance of road works traffic safety measures through the sharing of lessons learnt and good practices. Under the COP, agencies must erect or provide early warning notices to motorists approaching the work zone. In addition, the COP also requires lane changes to be demarcated with orange cones or water filled barriers, depending on the nature of the diversions or road openings. These are supplemented by advance warning signs, placed at least 20 metres from the work zone. On major highways, bright orange signs with alerts such as caution, arrows to show the diversion of the roads, works ahead, etc, are located at least 100 metres upstream, so that motorists would be aware of the situation and to exercise care and caution.”
“Sir, first of all, I would like to state that the principle of shared responsibility must be accepted, because security is everyone's responsibility. When you go to a hotel, the security guard in the hotel is paid for by the hotel. However, that does not mean that the police has no responsibility for looking after the security of the hotel district. For example, there are policemen walking round Orchard Road, and plainclothes policemen entering hotels. This cost is borne by the State. The security guards of the hotel are paid for by the hotel operator. The principle is shared responsibility. WORK ON PUBLIC ROADS (Adoption of greater safety measures) 4. Mr Chiam See Tong asked the Minister for Transport whether his Ministry will instruct those who work on public roads to adopt greater safety measures by making sure that ample notice is given to traffic of their presence on the road.”
“Conceptually, the security cost borne by airports and MRT stations and other transport systems should be the same. I would like to explain how the security costs are borne in the airports. It is borne partly by the State. On security patrols at the airports, for example, we see the policemen and the soldiers walking around, that is borne by the State. The guarding of critical installations like the VIP Complex, etc, is all borne by the State. Then, there is a terminal operator who pays for part of the security, for example, the security at the access control and pre-board screening. That is borne by the terminal operator. But users do pay for security at the airport. Passengers pay a fee of $21 for using the airport, of which $6 is a Passenger Security Service Charge. If we apply the principle of shared costs, and using the principle from the airport, we can see that for rail and road transport, both the operators, the Government and the commuter may have to pay for it. At this time, since the cost of providing the uniformed guards is a very small amount - it is less than 1% of the operating cost and less than one cent per journey - there is no need for any fare increase.”
“Sir, stroke is one of the three major causes of mortality in Singapore. It is also the biggest cause of disability in Singapore. It is a large part of our medical care and a large part of our healthcare subsidy, both to our acute hospitals and community hospitals. In fact, a large portion of the subsidy in the community hospitals is for stroke. With regard to an epidemiological study, there was an epidemiological study done in the 1990s on the breakdown of stroke in Singapore. Perhaps it is time to review that study to see whether a new one is needed.”
“Our subsidy scheme for home care services has benefited about 7,000 elderly who meet medical nursing and financial criteria for subsidised home medical and home nursing care. For 2003, over 53,000 home visits were provided by the VWOs, 10 home medical and 13 home nursing providers which altogether cost the Government $3.6 million in subsidies. The norm cost is $122 for home medical and $56 per home nursing visit. For the elderly to stay at home, care givers need to be trained to reduce burn out. Home carer training courses aim to equip home carers who may be family members or maids. Restructured hospitals, community hospitals, VWOs and private operators provide home carer training. Community Development Councils are also running a number of home carer training programmes in the community. The scope of training provided varies across organisations but, in general, it incorporates information on basic nursing care, activities of daily living, transferring techniques and personal hygiene. The Health Promotion Board also has a web page specifically designed to provide information on help for the elderly. A free video titled "Home Care for the Elderly" can be downloaded from the HPB website as well. We are also looking into improving the knowledge of home carers by providing them with easy access, eg, through the MOH website, to information on home carer training courses available in the community.”
“All our public hospitals have stroke units and multi-disciplinary stroke teams to provide integrated and holistic care to patients with acute stroke. Clinical care pathways and guidelines are in place to streamline the care of patients with stroke, from the Emergency Department till discharge. More than 95% of all stroke cases admitted to the hospitals would get a brain scan within 24 hours of admission. Most get it within one hour. As part of the clinical protocols in hospitals, rehabilitative care is initiated when the acute medical problems have been stabilised so as to improve outcomes. Patients who require more intensive rehabilitation are either referred to in-hospital rehabilitation departments, or to community hospitals. For those who will benefit from outpatient rehabilitation, they are discharged home with either a referral to community-based therapy centres and/or their care-givers are trained in simple rehabilitation techniques to assist the patient at home. The use of Medisave for outpatient brain scanning does not arise in acute stroke because acute stroke patients should go to the Emergency Department for appropriate treatment by a stroke team. Brain scans will be done as part of the inpatient evaluation and treatment plan. 3.45 pm The third issue that Dr Lily Neo brought up was on home care. The Ministry's philosophy on home care is to encourage the elderly to stay in the community for as long as possible and institutionalisation should only be a measure of last resort. As such, the Government has extended subsidy to financially deserving elderly who require home medical and home nursing visits. With subsidy, more severely disabled elderly can continue to stay in their own home with their families, thus avoiding the need to stay in an institution.”
“Sir, Dr Neo has brought up three issues. The first is related to fertility in women. I totally agree with her. My Ministry agrees with her that if mothers delay their pregnancies and have children in their old age, the risk to the children is much greater. The only solution to that is to encourage women to have children at a younger age, certainly below 35 years old. This is something the Health Promotion Board, as part of health education, needs to educate mothers on. This will be part of our contribution to the procreation policy of Singapore. She also asked about Medisave for in-vitro fertilisation. My Ministry would like to help couples who need assisted conception procedures to have children. A treatment cycle costs about $6,000-$8,000. The first cycle has the highest chance of success. With successive cycles, the chance of success decreases. Currently, couples can use their Medisave for assisted conception procedures up to a maximum of three treatment cycles. There is a need for a cap on the number of treatment cycles to prevent premature depletion of Medisave. The Ministry had, in June 2001, raised the withdrawal limit from $2,000 per treatment cycle to $4,000 per treatment cycle. This means that up to $12,000 from Medisave can be used for these procedures. This is a significant drain on Medisave resources of couples. I am concerned about the ability of these couples to pay for their medical care should they fall ill. The Ministry will consider reviewing the cap. And, when it reviews the cap, it will try and balance the competing needs - the need to preserve Medisave and the need to help procreation. The second issue Dr Lily Neo brought up was stroke.”
“The Health Manpower Development Programme has a Fellowship scheme, through which doctors are sent to eminent centres overseas for training, as well as the Visiting Experts scheme, where top foreign experts are invited to train local professionals. About 45 visiting experts are invited annually to train our health professionals in the various healthcare disciplines. The budget for the HMDP Fellowship and Visiting Experts programme is about $6.5 million per year. All of us want Singapore to enjoy the best healthcare in the least expensive way. We want excellent doctors, excellent nurses and excellent allied health professionals like therapists, radiographers, etc. We also want a logical well structured system that can draw out the best of what our healthcare professionals can offer. We want to remain healthy and not see health professionals if we can. But should we need to seek medical care, a family doctor should be our contact point with the healthcare system. We must encourage all Singaporeans to have a primary physician who can advise and guide them on healthcare matters. Healthcare is not just the concern of the Government and healthcare professionals. All Singaporeans have a part to play to ensure that the healthcare system continues to be both efficient as well as of high quality. And the first thing Singaporeans can do is to make sure that they have a family doctor.”
“For practising doctors and trainees, programmes on communication skills are organised by the Healthcare clusters, NUS and professional bodies like the Singapore Medical Association (SMA) and College of Family Physicians. Experienced GPs and family physicians are involved in such programmes. Nursing students in the Institute of Technical Education (ITE) and Nanyang Polytechnic (NYP) undergo course modules on communication skills which are also acquired in practice sessions and clinical postings. Good senior clinicians, both in medicine and nursing, serve as role models who teach our young doctors and nurses to understand the human condition and empathise with patients. Further Nursing Education, sponsorships and the nursing degree programme To upgrade the skills of nurses, the clusters have a sponsorship programme for Diploma training for nurses. Nurses who are working for VWOs under MOH funding can also apply for training sponsorship from MOH if the training is relevant. MOH provides funds under the HMDP for the upgrading of training of public sector healthcare nurses. This has resulted in an increasing number of nurses doing fellowships in well-known overseas centres - about 50 nurses in 2002 and 60 nurses in 2003. Under the Visiting Experts programme, nursing experts have been invited to teach nurses in specific nursing skills. The Ministry of Health, together with the Ministry of Education, is currently considering a degree course in Nursing at the proposed Outram Campus. The Health Manpower Development Programme The continuous training of health professionals is essential to provide high quality healthcare services.”
“30 pm Training of doctors in the Hospitals Are senior hospital doctors too preoccupied with daily workload that they have no time to teach the junior doctors? MOH had surveyed medical trainees in 2003 and it showed that over 70% of the trainees gave high ratings on the supervision received from their seniors. The survey showed that trainees have been given time for training and almost 90% of trainees indicated that they participated in various organised learning activities. The workload of the trainees was not onerous as more than 60% of the trainees saw fewer than 20 patients per day in the wards, while about 70% of doctors saw fewer than 60 patients per week at specialist outpatient clinics. We are assured that, on the whole, there is a satisfactory level of supervision and training for our trainee doctors in the hospitals. Communication skills training for doctors and nurses Communication skills are important, as pointed out by Ms Braema. The good practice of medicine requires good inter-personal skills. EQ is as important as IQ. Communication skills and the ability to empathise are skills needed for good medical practice. We can teach communication skills, but empathy must come from the heart. Medical students in Singapore undergo a communication skills programme to enable them to communicate effectively with patients and relatives. This comprises many hours of course work, lectures, role-playing and mentored interaction with patients. The programme, administered by the NUS Medical Faculty, together with the Faculty of Business Administration, supplements the students' practical exposure to communicating with patients during their 3-year clinical postings.”
“These include various types of ITE Skills Certificate in Healthcare, including outpatient, inpatient, homecare and clinic practice skills, which takes one year to complete as well as a similar Skills Redevelopment Programme which takes nine months to complete. ITE also runs short skills based programmes of three months for health service, housekeeping operations and patient service and a six-month course on rehabilitation therapy. Morale of doctors Dr Neo was concerned about the morale of doctors. We believe that the morale of our healthcare workers is good or even excellent. Our regular six-monthly survey of doctors indicated that over 90% of medical officers are satisfied with their work and postings. Doctors have traditionally worked long hours. During my years as a trainee, I routinely worked more than 100 hours a week for many years. Because this was a historical practice, it does not mean that we should carry on making our doctors work such long hours. All over the world, as has been pointed out by Dr Neo, in the US and Europe, steps are being taken to reduce the working hours of junior doctors. We too are gradually reducing their working hours. In terms of reduction of hours, in 2003, 18% of our junior doctors in public hospitals performed more than six night calls per month, compared to 26% in 2002. Our medical officers currently work an average of 60-65 hours per week. The clusters are also making efforts to ensure that junior doctors do not work more than 30 hours continuously. We cannot change the working hours dramatically overnight, because it will affect patient care. But as more young doctors graduate from our medical school, the working conditions of our young doctors will continue to improve over the next few years.”
“A multi-pronged approach is being taken to achieve this, including balanced work schedules, job redesign, improving career pathways, training and development programmes and review of nurses' salary to ensure competitiveness. In developing healthcare manpower, we have heard much about other professionals and retrenched workers who switched vocations to enter healthcare. The Strategic Manpower Conversion Programme (Healthcare) implemented by MOH and the Singapore Workforce Development Agency (WDA) is for mid-career workers who want to take up job opportunities in the healthcare sector. Under this programme, mid-career diploma courses have been launched to train registered nurses and diagnostic radiographers. The trainees are provided with full sponsorship and a training allowance. The first two batches of 109 trainees are undergoing the two-year accelerated diploma in nursing at Nanyang Polytechnic, and the third batch started in July this year - the target is 100 new trainees. Half of the trainees already have university degrees and the feedback on the programme has been positive. NTUC and the National Heart Centre have also launched the Skills Training and Employability Enhancement for Retrenched Workers (STEER) programme for training of Enrolled Nurses, Healthcare Assistants and Health Attendants. There are a total of 215 trainees for STEER, out of which 114 trainees have graduated from the Healthcare Assistant and Health Attendant programmes, and 101 trainees are currently undergoing the training for Enrolled Nurses, Healthcare Assistants and Health Attendants positions. There are also on-the-job programmes run by ITE together with participating healthcare employers.”
“Nurses For nurses, the intake of nursing students into the Institute of Technical Education (ITE) had increased from 146 in 2001 to 204 in 2002 and 238 in 2003. The number of new nursing students has to match the number of nursing instructors that can be recruited. Nanyang Polytechnic had also an increased intake of nursing students from 588 in 2001 to 707 in 2002 and 854 in 2003. More lecturers are being recruited by ITE. Nanyang Polytechnic is also actively recruiting clinical instructors. It has increased the number of lecturers and clinical instructors from 73 in 2001 to 87 in 2004. We are making progress, though there are no quick-fixes to the problem of training new nurses and doctors. The clusters continue to recruit foreign nurses to supplement locally trained nurses from Nanyang Polytechnic and the ITE. Measures will be implemented to reduce the attrition rate of foreign nurses and to encourage the better ones to commit to a long-term career with us. A new work pass, which will replace the existing Q2 pass, with effect from July 2004 will benefit many foreign nurses by allowing them to bring in their dependants. This may help to retain good nurses. MOH is also looking into reducing the waiting time for good foreign nurses to obtain permanent resident status. Vacancies for nurses in public sector institutions had been reduced from 4.1% in 2002 to 2.4% in 2003. The number of public sector nurses increased from 8,575 in 2002 to 9,065 nurses in 2003. The attrition rate of public sector nurses in 2003 was high - about 14%. The two healthcare clusters have targeted to reduce the attrition rate to 10% by 2005.”
“There are no quick-fix solutions, but we are working to enlarge our local base of professionals as well as drawing talent from overseas. Raising intake of students We have raised the annual intakes of students. For example, the intake of medical students in NUS has risen from 150 in 1996 to 230 in 2003. We have also lifted the quota on the number of female medical students, and to answer Dr Neo's question, in 2003, the intake of female medical students was 43%. We have also recognised more overseas medical schools - from 24 to 71 schools in 2003. For the past three years, an average of 100 doctors from recognised overseas medical schools were registered per year. The Singapore Medical Council has also allowed the clusters to employ doctors with non-registrable degrees under temporary registration, provided such doctors are very closely supervised. For the past three years, the total number of such doctors registered averaged 120 per year. We will continue to increase the supply of skilled healthcare manpower without compromising the standard of these personnel. The 13.9% vacancy in junior doctor positions in the last quarter of 2002 was reduced to 6.2% in the last quarter of 2003. To put in another way, the number of filled positions had risen from 1,470 to 1,656. For medical specialists, although there is a 40% specialist cap, we are still some way from reaching this as specialists presently only comprise 35% of all fully and conditionally registered doctors in Singapore. With the development of the regional medical hub, we will require more specialists to provide good quality care, both in the public and private sectors as well as to moderate healthcare cost increases. If there is a need, this cap will be removed.”
“HPB conducts public education programmes on stress management and managing depression for workers, students and the elderly. The Institute of Mental Health has plans to implement an Employee Assistance Programme to provide confidential counselling either through the telephone or in person for employees. With this programme, we hope tragedies like that mentioned by Mr Yeo would occur less frequently in future. Medical and healthcare manpower A number of questions were also raised on our medical and nursing manpower, the training of doctors, nurses, morale and communication skills of these healthcare workers. One key challenge is to safeguard our medical standards whilst we strive to achieve optimum numbers of skilled and competent healthcare professionals to meet the healthcare needs of Singaporeans, as well as to support our drive to become a regional medical hub. Healthcare manpower is highly skilled and takes many years to train, and you need the right mix of skilled manpower - doctors, nurses, pharmacists, therapists and health science professionals. All must move and work together for smooth progress. Protracted training required The protracted training required to develop these professionals poses a major challenge in managing manpower. It takes up to 12 years from entering as a medical student to becoming a medical specialist; and perhaps another 10-12 years to reach the pinnacle of excellence in a specialty. Three to four years are required to train entry-level practitioners for the various healthcare professionals like nurses and therapists. But it takes many more years of training and experience to produce highly skilled nursing professionals and therapists.”
“My Ministry intends to pilot an Aged Care Assessment Programme (ACAP) to promote right placement of care in hospitals, community hospitals, nursing homes, day rehabilitation facilities and the patients' own homes as appropriate. We will train health care professionals in the acute hospital to be familiar with the criteria for step down and rehabilitation services. Workplace health and mental wellness at work Prevention is better than cure and getting the public to lead a healthy lifestyle in a healthy environment will reduce the consumption of healthcare services as more people remain healthy. Two-thirds of Singaporeans work and spend a minimum of eight hours in the workplace daily. No company wants poor health amongst its employees. My Ministry is serious about healthy lifestyle amongst working Singaporeans. Workplace health programmes promote healthy lifestyle among employees, such as regular exercise, healthy eating, smoking cessation and mental wellness. To encourage workplace health, my Ministry gives a grant of up to $5,000 to companies to start workplace health promotion programmes. They can also apply to the Skills Development Fund for funding workplace health promotion training. We recognise that a collaborative approach from employer and employee is needed. Mr Yeo Guat Kwang has pointed out that NTUC is actively promoting this. The Health Promotion Board and NTUC will launch a pilot project to reward employees for participating in workplace health activities. Singapore National Employers' Federation (SNEF) is also HPB's key partner to promote healthy lifestyle in the workplace. Mr Yeo raised the issue of mental wellness of workers. Stress is a concern and mental wellness is important to work effectively.”
“15 pm Health Education Health education is important and besides using the various media, it is also conveyed through the polyclinics or by GPs, who can obtain free health education materials from the Health Promotion Board (HPB) either directly or through the Singapore Medical Association and the polyclinics. Doctors and patients can also download health education materials from HPB's website. Patient education tools have also been developed by HPB to help GPs provide education to patients with chronic conditions. The sick elderly and right placement of care Dr Chong brought up the issue of the right placement of patients so that they can get the appropriate care. Our elderly utilise more healthcare services because there are more health problems as a person grows older. There are challenges here - to deliver care at the right place at the right time. The community hospitals and nursing homes, whose focus is rehabilitation, provide lower cost and a more holistic care compared to acute hospitals. Elderly patients sent to the appropriate facility have better long term recovery. Wrong placement, on the other hand, results in unnecessary financial and social costs. A patient who should be rehabilitated in a community hospital but instead goes to a nursing home may not receive the optimum care to get back to their full rehabilitation potential. On the other hand, the patient who is better taken care of in the community hospital but stays in a more costly acute hospital may be consuming health resources to a greater degree than is needed. Lack of awareness of healthcare services must be tackled.”
“That is a 300% increase in the number of patients in one year, and we will continue to look at ways of increasing the scope of this programme. This programme is currently served by 570 GPs and 210 dental clinics. Night clinics were previously set up so that lower income Singaporeans could have the convenience of subsidised medical attention at night instead of having to wait until the following day. Seven night clinics have been set up so far. The polyclinics deploy their own doctors and also engage private GPs to provide the night clinic services. Each clinic employs an average of three doctors and sees about 57 patients a night. The cost per patient of providing polyclinic service at night is much higher than that during the day. So we will review these services to see if this is the most efficient way of providing primary healthcare. As suggested, perhaps GPs in the clinics may be a more efficient way of providing this care at night. The clusters have no plans to expand night clinic services. In the healthcare cluster, better vertical integration of hospital and primary care services has resulted in shared care programmes between hospitals, polyclinics and general practitioners. This enables the coordination and management of diseases across the spectrum of care from primary to secondary to tertiary care to achieve better outcomes. For example, the Singapore National Asthma Programme to manage severe asthmatics at both hospitals and clinics has helped reduce hospital admissions for asthma. 2.”
“GPs and polyclinic doctors are the key to solving the proper matching of health resources in our system to the health needs of the patient. My Ministry has, therefore, instituted measures and programmes to encourage Singaporeans to see their family physicians and general practitioners in the private and public sectors. Singaporeans must also play their part. Where a medical problem can be settled at GP clinics or polyclinics, it should be done so, and when the medical problem has to be referred, it should be directed to the right specialist. Such habits will reduce cost and build a long term doctor-patient relationship where there is commitment to care and trust between the patient and the primary care doctor. My Ministry has programmes to facilitate primary healthcare for special groups by improving accessibility of subsidised care. For example, there are many less well-off elderly who do not live near polyclinics. Getting to polyclinics can be inconvenient for them and for such elderly patients, the Ministry brings affordable healthcare closer to them through the Primary Care Partnership Scheme (PCPS), which was mentioned by Mr Gan. Under this scheme, my Ministry engages private general practitioners and dentists to provide common outpatient medical and dental treatment to needy elderly. These elderly pay polyclinic charges for such services. The number of elderly on the scheme has increased over the last one year, as a result of our outreach efforts, which include road shows at Senior Activity Centres and door-to-door promotion at 1- to 3-room HDB flats. More than 15,000 elderly are now on the scheme, compared to 5,000 elderly one year ago.”
“But if the patient says to the lung specialist, "This medicine is for my cough, but my nose is stuffy, do I have a sinus problem?", the lung specialist will refer him to the Ear, Nose and Throat doctor or ENT doctor. He goes to the ENT clinic, waits a little while more, then gets his sinus checked and will be given more medication. As the patient is about to leave the ENT clinic, if he says he feels bloated, then the ENT surgeon will refer him to a doctor looking after the digestive system. If he thinks the problem is at the upper end, the referral is to a gastrologist. If he thinks it is the lower end, the referral is to a colorectal doctor. If the ENT doctor is not sure, the patient gets referred to both. This is an example of expensive and inefficient delivery of healthcare. But if the patient had seen a GP, the GP would have treated all the complaints in one consultation. Many patients are seeing specialists when a primary physician can take care of the problem. This is why our specialist clinic attendance is growing at the rate of 6%. It is also driving the cost of healthcare upwards. This does not mean that patients do not need specialists. At times they do need to see a specialist, but the problem that the public sometimes faces is that they may not know when and which specialist to consult. If every family in Singapore had a family doctor, then by consulting the family doctor or GP, they would know when they need to see a specialist and when the family doctor can take care of their medical problem. The family doctor can serve as a friend and mentor to the patient and as a gatekeeper who directs traffic within our sophisticated healthcare system.”
“Sir, first, I would like to thank Dr Lily Neo, Ms Braema, Mdm Halimah on their questions on doctors, nurses and the supply of skilled healthcare manpower, Dr Michael Lim and Mr Gan on the question of primary healthcare, Mr Yeo on physical and mental health in the workplace, and Dr Chong on where patients should be appropriately treated. To begin, I want to point out that the healthcare system in Singapore is a good system, and has improved the health of Singaporeans. On average, our system has increased the life expectancy of Singaporeans by three months every year, over the last 20 years. The life expectancy was 73.3 years in 1984. Today, it is 78.9 years. We expect it to exceed 80 years by the end of the decade. Singaporeans enjoy a higher life expectancy than most people in the world. It is higher than even that of the US, the country that is the origin of most of the recent advances in medicine. If we are cutting corners, as suggested by Mr Low Thia Khiang, Singaporeans would not be living to such a ripe old age. Our challenge is to maintain this high quality system at an affordable cost. To do this, our healthcare delivery must be as efficient as possible. Healthcare is an expensive service. More than half the cost in healthcare service involves paying for the services of skilled people - doctors, nurses and other paramedical professionals. Our healthcare system can be more efficient if we use the services of healthcare professionals in an efficient and appropriate manner. For example, if a patient has caught the flu and has a cough, he could decide to see a lung specialist. He would make an appointment at the specialist clinic, wait a while and see the specialist. The specialist can treat the cough and prescribe a cough mixture.”
“We have briefed all the self-help groups on the programme, and provided opportunities for them to publicise their services, for example, at the Zonal Meetings that we have for the specialist teachers on the Learning Support Programme, our Learning Support Coordinators (LSCs). Several sessions have in fact been conducted by the self-help groups for the Learning Support Coordinators to raise awareness of what they each provide. These meetings have led to closer working relationships between the self-help groups and the Learning Support Coordinators, which we encourage. We in fact encourage the Learning Support Coordinators to refer families who they think are in some difficulty to the self-help groups and the Family Service Centres. These organisations can help to provide support and advice to the families, both in the interests of the Primary 1 child as well as younger siblings, if any. MOE will continue to engage the self-help groups and the community in reaching out to families of students who are underperforming.”
“I hope the grassroots leaders and the Member of Parliament have brought this up with the school and reached a consensus on the issue with the school principal and teachers and they could then bring the matter up with LTA. It would be easier for us to come up with a solution. LEARNING SUPPORT PROGRAMME FOR PRE-PRIMARY SCHOOL CHILDREN 15. Mdm Halimah Yacob asked the Acting Minister for Education (a) how many primary one school children have been placed on the Learning Support Programme this year; (b) what is their family profile; and (c) if these children have younger siblings will his Ministry consider working with self-help groups and other grassroots organisations to assist them before entering primary one. The Acting Minister for Education (Mr Tharman Shanmugaratnam): Mr Speaker, all Primary 1 pupils are screened at the start of the year to identify pupils who are weak in language and literacy skills for support in the Learning Support Programme (LSP). If we take last year, based on the screening test and recommendations from teachers, 9,586 Primary 1 pupils (that is about 20% of cohort) received additional support through the Learning Support Programme. Analysis of the family profiles of the Learning Support Programme pupils showed that 24% of them were from 1 to 3 room HDB flats, 45% from 4-room HDB flats, 24% from 5-room/HUDC/Executive flats; and 7% from private housing. 60% were from Chinese families; 28% from Malay families; 10% from Indian families and 2% from others. MOE recognises the merits of engaging the self-help groups (SHGs) and the community in complementing the Learning Support Programme in our schools.”
“Mr Speaker, I think she has asked that question before and I have said that school principals know best what is practical around their schools. Any request that they make, we will consider.”
“Mr Speaker, Sir, if the school requests that a "No Stopping" sign be placed in front of the school, so that no cars can stop in front of the school and children do not alight, that can be done. But we will do it if the school requests for it.”
“Sir, as I said, there are many factors that involve safety at schools with regard to students alighting from their cars. School principals are in the best position to know what is practical, what do parents want and what is needed for the school. LTA will consider all requests in changing the traffic around the schools as well as putting up signs to prevent cars from stopping if the principal, or the school, or MOE, requests for it.”
“Mr Speaker, Sir, the safety of students alighting in schools is paramount to LTA and LTA works with schools to try to ensure that we can make it as practicable and safe as possible. But there are several factors that determine safety, besides just slip roads, points where cars should stop and students should alight. As every school in Singapore is slightly different, in terms of its entrance, the kind of traffic around it, this solution has to be individualised to the school. Hence, where the school needs LTA to change the rules around the schools, LTA does so. Let me give you an example. At Anderson Primary School, there is a traffic crossing and there is a central railing. The children did not use the signalised crossing and they were bypassing the railing because it was not long enough. And when the school brought this up to LTA, LTA extended the railing so that the children had to use the crossing. In this way, LTA will work with schools to help schools ensure safety. So if any school were to request LTA to restrict part of the road so that cars do not stop there, LTA will put up signs, if it is possible, to ensure that no car stops there and that children do not alight. But we have to work with the principals of the schools so that we have a practical solution on safety in schools.”
“Mr Speaker, Sir, roads fronting schools should be clear of stationary vehicles to allow the main traffic to flow smoothly. This is especially so during peak hours. Students should alight and board within the school compound for their safety. However, we also acknowledge the schools' operational needs, and that some of the school compounds are not big enough to accommodate a large number of parents who drive their children to school. To provide a balance between these needs, LTA works closely with the schools and relevant agencies, such as Traffic Police, Neighbourhood Police and sometimes the grassroots organisation, to put in place effective traffic management schemes in the vicinity of schools. Adequate and appropriate warning signs are also installed to warn motorists of students using the roads. The proposal of a slip road for parents to drop off their kids is a good concept, especially along a busy road, but would require more land to be set aside. It would therefore not be practical or possible to do so for all schools. However, where there is land available either within the school or just outside it, LTA would work with the school to consider incorporating this facility.”
“We will consider and review the issue and we will work with MOE closely. BOARDING AND ALIGHTING OF SCHOOL CHILDREN FROM SCHOOL BUSES (Guideline) 14. Mdm Cynthia Phua asked the Minister for Transport (a) what is the LTA's guideline for boarding and alighting of children from school buses and private vehicles on the main road in front of schools; and (b) in order to avoid traffic congestion and provide some road safety for parents and children using roads fronting schools, whether the use of slip road, as adopted by the French school in Ang Mo Kio Avenue 3, can also be adopted by all schools.”
“Sir, if the school feels that it is now affordable, individual schools can impose a rule on the requirement. As for the exact date when this rule was implemented, I would take that information up - I do not have it with me now - and give it to the Member.”
“Seat belts are not compulsory, and we will be willing to review that.”
“The 30 students cut-off was determined because it was felt that below 30 students, the cost of an attendant would be prohibitive on the parents. However, where the school bus caters to kindergartens and childcare centres, we have imposed that restriction. If schools wish to impose that restriction for children above the age of 6, LTA does not object to it, and we are willing to review the rules again.”
“Mr Speaker, Sir, what I said was in the last three years, there was no fatality of school children travelling in school buses. We have allowed schools to determine whether additional safety measures are required. Schools will have to discuss with parents on what measures they want to take and the affordability issue before determining that.”
“Sir, I agree with Mdm Cynthia Phua that there is a difference between a 6-year old and a 12-year old. Where schools wish to impose such a segregation of children in school buses and when it is feasible to do so, LTA has no objection.”
“WRITTEN ANSWERS TO QUESTIONS FOR ORAL ANSWER NOT ANSWERED BY 3.00 PM INTERNET CHATROOMS 16. Mdm Halimah Yacob asked the Minister for Information, Communications and the Arts in view of Microsoft's recent decision to close its chatrooms worldwide, (a) what measures are in place to prevent Internet chatrooms from becoming a haven for sex predators; and (b) whether these measures are adequate given a number of reported cases in Singapore of men using the Internet to prey on young girls.”
“Let me explain how this arrangement came about. Our previous magnetic fare card system was managed by TransitLink, which is owned by the public transport operators. The ez-link card, on the other hand, is a new system that is relatively more complex. To ensure that ez-link took off, LTA, as the authority responsible for this function, decided to set up EZ Link Pte Ltd to facilitate the integration of the new ticketing system. As we are all aware, the system had its share of teething problems. However, over the months, LTA has worked hard to ensure that EZ Link Pte Ltd puts in every effort to resolve these problems in the most expeditious manner. I would like to assure Members that the current arrangement is a transitional one. Although LTA had to come in to start up the ez-link system, it has no interest in managing the ez-link business over the long term. LTA will divest the ez-link business eventually. In the interim period, the parent Ministry will monitor EZ Link's business activities closely to ensure that commuters' interests are protected. Let me conclude by reiterating that imposing card costs on commuters is the most fair and equitable option for commuters as a whole. Commuters in general should not be made to subsidise those who wish to have multiple cards through consequential fare increases. Let me also reassure Members that EZ Link will continue to work very hard to bring down the cost of ez-link cards, and to pass on such reductions back to the commuters. At a suitable time, LTA will divest EZ Link. In the meantime, my Ministry will monitor LTA and EZ Link to ensure that the interests of commuters are not compromised. ADJOURNMENT Resolved, "That Parliament do now adjourn." Adjourned accordingly at Half-past Six o'clock pm.”
“In addition, as non-transit applications become more successful and pervasive, the additional revenue will also go to help defray the cost of operating the ez-link system, including the cost of cards. Dr Wang has mentioned EZ Link's business with QB and Green Dot. I will not go into the details of these deals. But, essentially, EZ Link is trying to get additional revenue from the card through advertising and non-transit applications. Profits from these revenues will be passed on to the commuters and will help to bring the cost of the card down. While we commit to continue to find ways to lower card costs, I would like to add that we are taking all measures to minimise the impact of the new policy on existing cardholders. The existing $2 card deposit that commuters have paid will continue to be refundable. All these commuters will not be affected. They will not need to pay more to continue using their existing cards and will continue to pay the same fares. The Member has also mentioned about choices. His point is that commuters should not be made to pay the card costs since they have no choice and there is also no intrinsic value in the card that the commuter can benefit from. I would like to assure Members of this House that this is not the situation. In practice, commuters still have the choice of paying by cash. Indeed, some 300,000 cash payments still take place every day. But this is a small percentage of the total number of transport transactions daily. Commuters know that using the ez-link card will save them up to 17 cents on a bus trip, and up to 26 cents on a train ride. The Member has also questioned how the company, EZ Link Pte Ltd, came to be owned by the LTA. I agree with the Member that it is not ideal for the regulator to be in the business.”
“This will result in higher operating costs for the operators and will, in turn, translate to the need for higher fare increases in future. What this amounts to is that the commuters at large would be subsidising those who choose to hold multiple cards and those who lose their cards. This is no different from car insurance premiums being jacked up by those who chalk up excessive insurance claims. Or, two, we can charge the card cost to commuters. In this case, only commuters who are buying new cards would have to pay for the card cost. The advantage of this approach is that the cost of the cards will not be added to the cost of running the transport system. Hence, fares can be kept at the current levels or, when increases do occur, they will be less than what would have been the case if EZ Link had not charged for the cards. This is the real benefit of charging for the cards from this point onwards. Looking at the two options, it is evident that the option of charging card cost to commuters is the more equitable one. It is more equitable for those commuters who want to own additional cards or have lost their cards to pay for them. Those who are careful with their cards should not end up subsidising those who own multiple cards or who keep losing their cards. Having come to the decision to charge for cards, it is our responsibility to commuters to seek out lower card cost alternatives, and to pass on any such cost reductions directly to commuters. At the very least, we can expect the cost of cards, as with most technology products, to come down over time. We have already seen this happen, as the card cost has come down from $6 to $5 over the past year. I would like to assure Members that future reductions in card costs will similarly be passed on to commuters.”
“The final system chosen was based on proven technology that had at that time already been implemented in Hong Kong. Today, we can find similar systems being used in cities like Tokyo, Shenzhen and Delhi. Why did we need to impose a card cost? When the ez-link card was launched in April 2002, every Singaporean was given a chance to get a card free of charge, over a 9-month introductory period. As a result, 1.8 million of such cards were issued during this period and the great majority of adult commuters in Singapore would have got the card free. Commuters were also given the option to purchase subsequent cards with a $2 refundable deposit, even though the cost of each ez-link card then was $6. All these measures were intended to help commuters convert to the new ez-link system. We believed this gradual process of introducing the new fare system would have met the needs of all commuters well. We are now 19 months into the launch of the system. 5.3 million cards have since been sold. But the number of new cards being sold daily remained high, at over 3,000 a day. There is nothing wrong with commuters owning more than one card each. But there is no reason for subsidising these additional cards, especially when all commuters would have at least one, if not a few, cards each by now. Moreover, all MOE and ITE students will continue to receive their first cards free. Hence, going forward, we need to decide who should bear the cost of new cards. We have two options. One, we can charge the cost of new cards back to the transport system. As suggested by some writers, the card costs could be passed on to the public transport operators through higher ez-link transaction fees.”
“Mr Deputy Speaker, Sir, the Members have raised several points about the ez-link system. Their concerns have also been reflected in the Forum Page letters over the past week on the ez-link card cost. First, I would like to assure Members that the overriding consideration behind every public transport decision is to keep fares low, and to ensure an equitable charging system. As I can see it, the points raised by the Members centre around two main issues: First, commuters used to get the cards free. Now, they have to pay $5 for them. It is only natural that they ask why they now have to pay. Second, why is LTA in this business when it is also the regulator? Let me start by explaining why commuters have to pay $5. But before that, let me share with Members the history behind the introduction of the ez-link system, because this issue was also raised. Why did we have to replace the magnetic fare card system? We introduced the magnetic ticketing system in 1987, together with our MRT system. The magnetic ticketing system was subsequently extended to the buses, so that commuters would require only one card for all their transport needs. As we expanded our public transport network, the amount of information that we needed to store in the magnetic fare card increased, and the existing magnetic fare card system could no longer meet the needs of the expanding MRT system. LTA then decided to move to a new smart card system. The contactless smart card system was eventually chosen as the best option to meet our ticketing requirements, in terms of processing speed, reliability and performance, as well as its potential for non-transit application use. This decision was also endorsed by the National Information Technology Committee and the Electronic Payment Committee.”
“The Rome Convention covers piracy. Mr Chay is right in pointing out that the effectiveness of the Rome Convention would depend on the cooperation between countries that are parties to the Convention. If the offender is found in another country, we will not be able to prosecute him even though the law allows for this, unless the other country has signed the Convention. The fight against maritime terrorism and piracy ultimately requires a multi-lateral approach. Hence, we would like to see more countries in the region accede to the Rome Convention, as part of the multi-lateral cooperation to deal with the unlawful acts at sea. In acceding to the Rome Convention, the details of the Bill in Singapore are similar to other countries'. Hence, there is a clear distinction between reckless acts at sea and terrorism, and the Rome Convention does not cover reckless acts at sea. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill. - [Dr Balaji Sadasivan]. Bill considered in Committee; reported without amendment; read a Third time and passed. CONSUMER PROTECTION (FAIR TRADING) BILL Order for Second Reading read. 4.48 pm”
“Mr Speaker, Sir, I wish to thank the two Members for supporting the Bill. Mr Andy Gan has given examples of piracy and terrorism on the seas. Singapore takes a very serious view of maritime security. As part of our heightened vigilance against terrorist threats, we have intensified security measures for key areas in our port waters, including increased patrols by the Navy and Police Coast Guards. Singapore is also active in implementing the new maritime and port security measures adopted at the International Maritime Organisation which guard against threats to the security and safety of life at sea and disruptions to seaborne trade. The accession to the Rome Convention is part of Singapore's continuing contributions to the global fight against terrorism. We are not the first country to accede to the Convention. Mr Chay wanted to know how many countries have acceded to the Convention. 95 countries have done so. They include Asian countries, such as China, India and Japan. In Southeast Asia, we are the third country after Vietnam and Myanmar. Nevertheless, our ascension to the Convention now in this heightened security environment will increase safety in this region. It will enhance Singapore's ability to deal with and deter maritime security threats. Mr Chay also asked that the Maritime Offences Bill offer protection for passengers and crews of ships and the enforceability of its provisions. The provisions in the Bill reflect the requirements for countries that are parties to the Rome Convention. The Bill does not only protect ships and navigational equipment, it also covers acts of violence against passengers and crews, in conjunction with offences committed under the Bill. Both Mr Chay and Mr Andy Gan were concerned whether piracy was covered by this.”
“Clause 4 makes it an offence to intentionally destroy or damage a ship or commit on board an act of violence which is likely to endanger its safe navigation. Clause 5 makes it an offence to intentionally destroy, damage or interfere with the operation of any property used for providing navigation facilities, such as lighthouses and light beacons. Clause 6 makes it an offence to issue a threat to carry out an act referred to in clause 4 or 5, which might endanger the safe navigation of a ship. Clause 8 allows the master of a Singapore registered ship to deliver a person to the appropriate authority of another Rome Convention country, if he is of the opinion that the person has committed certain offences under the Bill. Mr Speaker, Sir, the importance for Singapore to be a Party to the Rome Convention is clear. Being a Party would demonstrate Singapore's firm commitment to deal with unlawful acts at sea, such as piracy and maritime terrorism. It also underlines Singapore's active involvement in the global fight against terrorism. In view of heightened security concerns over possible maritime terrorism and piracy attacks in the region, Singapore cannot afford to take maritime security for granted. Our intention to accede to the Rome Convention would not only strengthen our laws, but would also bring us to higher levels of international cooperation to combat maritime terrorism and piracy. Sir, I beg to move. Question proposed.”
“We have also strengthened coordination among the national maritime agencies to enable a more comprehensive and integrated approach to maritime security. Singapore was also the first Asian country to sign on to the Container Security Initiative which seeks to protect the sea container trade. On the international front, Singapore is supportive of the new maritime and port security measures adopted at the IMO, and the universal and effective implementation of these measures. Such measures are needed to guard against threats to the security and safety of life at sea and disruptions to seaborne trade. This is especially critical for international waterways such as the Straits of Malacca and Singapore, given their importance to international maritime trade. In this regard, the Bill before us to give effect to the Rome Convention forms part of Singapore's continuing contributions to the international maritime community's fight against terrorism. Main Features of the Bill Let me now touch on the main features of the Bill. A key aim of the Rome Convention is to eliminate safe havens for perpetrators of crimes at sea by requiring a member State to take action against any such perpetrator found in its territory by prosecuting or extraditing him, whether or not the act was committed within the State's territorial waters. As such, the acts described in clauses 3 to 7 of the Bill are offences under Singapore law regardless of the alleged offender's citizenship, the state in which the ship is registered and whether the offence is committed in Singapore or elsewhere. Singapore would establish jurisdiction over such offences. Let me elaborate on the various offences. Clause 3 makes it an offence for a person to hijack a ship.”
“Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time". Objective of Bill The Government intends to accede to the 1988 International Convention for the Suppression of Unlawful Acts against the Safety of Maritime Navigation, or the Rome Convention as it is commonly known. The proposed Maritime Offences Bill 2003 is to give effect to the provisions of the Rome Convention. Rationale Let me begin by providing a brief introduction to the Rome Convention. The Rome Convention was negotiated in the International Maritime Organisation (IMO) as its contribution to international efforts to fight terrorism aboard or against ships. It aims to eliminate safe havens for perpetrators of offences such as seizure of ships and acts of violence against persons on board ships that endanger navigational safety. It does so by requiring parties to take action against alleged offenders in their territories, even if the alleged offence is committed outside their territorial waters. As the Members of this House would know, the events of 11 September 2001 and reports of planned maritime terrorism by terrorist groups in the region have highlighted the vulnerabilities of the shipping and port sectors to terrorist attacks. This is compounded by the piracy problem in regional waters. Addressing the challenges of maritime security is of vital importance for the international community in a post-September 11 environment. As a maritime nation and a responsible member of the international maritime community, Singapore takes a very serious view on maritime security. As part of Singapore's heightened vigilance against all terrorist threats, we have intensified security measures for key areas in our port waters, including increased patrols by the Navy and Police Coast Guard.”
“I agree with the Member that cyclists are a risk group. Once upon a time, motorcyclists were a major risk group and the use of safety helmets has greatly reduced the number of deaths. We need to consider what else we can do to reduce the number of fatalities amongst cyclists.”
“If there is a Member of Parliament who requests for bicycle lanes in his constituency, we will study that.”