Chiam See Tong
Singapore
“Sir, Singapore's sovereign wealth fund companies, Temasek Holdings and GIC, returned 17% and 9.5% yearly respectively, using largely Singaporeans' CPF money. Why is CPF returning 2.5% on the Ordinary Account and 4% on the Special Account only?”
“Thank you, Sir, for allowing me to take part in this debate. Under Singapore law, single parents are treated as singles who are not eligible to purchase a Housing Board flat unless they are 35 years old and they are also given reduced children benefits like lesser maternity leave and no Baby Bonus.”
“Sir, the collection of revenue from ERP gantries is way above the total amount of revenue lost by the Government from the exemption of household TV and radio licences. I would urge the Government to review and reduce the charges at ERP gantries for vehicles entering the ERP zones.”
“Although the Government is pumping $120 million a year to support needy students in all levels through a slew of enhanced financial aid schemes, schools funds and bursaries, we should not forget to look into the plight of students who have been cheated by unscrupulous education centres by helping affected students to pay or re-finance the…”
“Thank you, Mr Chairman, for allowing me to join in the debate. I would like to touch on fairer distribution of treating scholars amongst schools. MOE should ensure fairer distribution of teaching scholarship holders after graduation from NIE to the various schools.”
“Children and adults with special needs deserve better protection. It will reduce the anxiety of both caregivers and patients with special needs, like the mentally-ill and autistic children. I urge the Government to issue special I-cards to these patients.”
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“But because of the need for so-called balanced distribution of talents, these students are thwarted in their aspiration and they have been given other courses such as engineering or courses in which they are not interested in. I feel that we should allow the market forces and the law of supply and demand to decide on this matter and the Government should not resort to arbitrary allocation of students to the various courses. On culture, the Government has not promulgated a clear-cut cultural policy. Is there such a clear-cut cultural policy? This is an issue, I believe many Singaporeans who are interested in culture, are con- cerned about. This year the Chinese, Malay and Indian communities have held their separate cultural months in Singapore. But there are some people, including the Senior Minister of State for Education, Dr Tay Eng Soon, who are of the view that such activities are not suitable, because they merely accentuate the racial differences of the communities. They felt that there should be one Singapore cultural festival to encompass the various racial cultures to replace such cultural months. Such views have led to heated debate. Many people are confused on this matter. What should we do? Is there a clear-cut Government policy on culture? Is the view put forward by Dr Tay his personal views or is it the view of the Government? All these doubts need to be cleared up. Although we do not have a Ministry of Culture, we must have a clear-cut cultural policy. Otherwise the various ethnic communities would have nothing to follow when they carry out their traditional cultural activities. There will be no clear guidelines for them to follow. Therefore, there is a need for a clear-cut cultural policy to guide our people in matters of culture. Where should we go?”
“Mother tongue education is still an issue that concerns the Chinese community. In March this year, the Minister for Education spoke in this House about the modifications of the word list for Chinese. This has given rise to concerns and worries of the Chinese community. They are worried that the reduction in the number of words or characters for Chinese will imply a reduction in the standard of Chinese. I hope the Government will alleviate such worries and doubts. Mr Speaker, Sir, in the Addendum to the Address, the Minister for Education also mentioned that language education is the core of education. Therefore, the language programme will be modified so that pupils will have a better grounding in English and mother tongue. I hope the Government will implement such a measure. The Minister also mentioned that more options will be given to the parents and pupils in education. In both secondary and primary schools, I hope the Ministry of Education will allow more schools to open CL1 classes for students who are interested in the subject. Such classes should not be confined only to the SAP primary or SAP secondary schools. In this way, schools would have more flexibility to provide such courses to Chinese students, so that both parents and pupils would have more convenience and more options when they decide on whether to take up Chinese as the first language. Mr Speaker, Sir, on the issue of tertiary education, the Nanyang Technological Institute will be upgraded to a university. This is good news. With another university, we will be able to meet the aspirations of more young people for tertiary education. However, I hope that the Government should also give more options and choices to the students. For examples, there are many students who like to study medicine.”
“Article 152 of the Constitution, inter alia, states quite clearly that the Government recognises the special position of the Malays, who are the indigenous people of Singapore, and that it shall, amongst other things, support the educational interest of the Malays. Free education to the Malays has been part of our life since the colonial time. The PAP Government took office in 1959 and later on we became independent in 1965. Throughout this period up to the present day, the Malays in Singapore have enjoyed free education up to tertiary levels. In other words, there is implementation of this part of our Constitution by the Government. And in accordance with the British constitutional law which we inherit, the carrying out of that part of the Constitution over time has made it become part of the Constitution by convention and practice. Therefore, it would appear that the Government's attempt to take away free education of the Malays is unconstitutional. It is a breach against well-established convention of the Constitution. I think this is the main complaint of the Malays - a deprivation of their established constitutional rights. Mr Goh Choon Kang (Braddell Heights)( In Mandarin): Mr Speaker, Sir, I support the Member for Tanglin's motion in thanking the President for delivering the Speech in the House. Today, I would like to make use of this opportunity to talk on the following issues, including education, culture, the poor families, and the participatory type of government. Let me touch on education first. The President in his Address pointed out that in the next few years the Government will continue to emphasise education by strengthening primary education and providing a more flexible education system with more options for the parents and pupils.”
“He shall be given veto powers on how our national savings to be spent and also powers to appoint key civil servants. As the President in his Address said: This is "a major modification to our constitution." This change in our Constitution will affect the very foundation of our present parliamentary democracy. The Elected President can overrule Parliament, the supreme body of our land which represents the will of the whole population of Singapore. In effect, the Elected President can go against the will of the people of Singapore. In plain language, he has dictatorial powers. The sad thing is that once he is put in power, the Elected President virtually cannot be removed. The Elected President has also powers to appoint key civil servants. These top key civil servants will naturally be beholden to the President. If the top key civil servants are loyal to the President, would it not be difficult for the Prime Minister, who is the Chief Executive of the land, to govern the country? These important questions must be answered. In view of the fact that the introduction of an Elected President is a major modification to our Constitution, it is only right that there should be a national referendum over it. The PAP does not really have the whole electorate with it on this issue. It must be remembered that nearly 40% of our voters cast their votes against the issue of the Elected President. As regards the issue of Malay rights to free tertiary education, my feedback is that the majority of Malays are unhappy with it. They view it as a constitutional issue and not as a removal of rights to hand out to them.”
“I have said that I would like to make Potong Pasir a model constituency. How can I do it if my hands are tied? Why is the Government so afraid of competition? The Government should stop putting obstacles in the way of the Opposition. Allow the Opposition access to information, allow the Opposition to take part in the national life of Singapore, allow the Opposition to debate over TV and radio on important national issues! The hon. Member for Fengshan said yesterday that the Government has done away with "wayang kulit" and "shadow boxing". I say this is not true. They have not been done away with. They are still very much intact. There cannot be participatory democracy if the Opposition does not play a major role in our national affairs. It must never be forgotten that the Opposition has about 40% of the total votes cast at the last general elections. The voice of the 40% of Singaporeans should not be silenced, should not be muted; it must he heard, otherwise all this so-called consultative style of the Government is nothing but a sham. The people of Singapore can very quickly see through the tricks of the Government, the stage-managed feedback sessions during the ministerial walkabout and on television. As long as the Opposition is not represented on these public programmes, the feedback cannot be complete, because 40% of Singaporeans are not represented. The format of the Select Committee to gather feedback should also be altered. The Opposition must always be included in public hearings and the final report should not just comprise the Chairman's report but also include dissenting views of the Opposition. Next, I come to the 35 billion dollar issue. I am referring to the Elected President.”
“When the Prime Minister was in London, he challenged the British journalist, who was a critic of his domestic policies, to interview him over British television, so as to give the Prime Minister a chance to rebut all the allegations made against him. But the said journalist refused to take up the offer. Similarly, I am now challenging the Government. I hope that the Government will not refuse this challenge. I am challenging the Government to come out openly and say that there is a place for the Opposition in Parliament in our Singapore way of life and allow the Opposition to legitimately compete with the PAP to do good for Singapore. At one time, the Government had even refused the Opposition to plant a single tree at Potong Pasir. I am glad to note that the Government has passed that infantile stage. At the last Tree Planting Day, I had helped to plant several fruit trees at Potong Pasir. Of course, there is still now the problem of the library. I am confident that the Government will sooner or later see its folly and allow the neighbourhood library to be set up at Potong Pasir. Then, of course, there is the community centre. The Opposition, after more than five years in office at that constituency, is still denied access to it. I have read in the newspapers that certain PAP constituencies have won certain awards. How can it be said that the Marine Parade Community Centre or the Braddell Heights Community Centre has won the best run Community Centre or that it has the best cultural programmes respectively, when the Opposition is not allowed to compete in those competitions? Is the PAP afraid that the Potong Pasir Community Centre under the charge of the Opposition will sweep all prizes and be known throughout Singapore as the best run Community Centre?”
“And although in their later years when their brains have fully developed, they are still unable to make a success of their lives. Therefore, a good enlightened education system is important, if we truly want to develop the talent of all Singaporeans to the fullest. Another area of complaint is the heavy workload imposed on our school children, especially those who are still in the primary schools. Parents have moaned that their children appear to have no time for anything else. At the primary level, children must be taught to enjoy schooling and enjoy learning. When too much work is given to young children, the majority of them may not be able to cope with it. Their interest in learning may be stifled for good. How then can we develop their talent to the fullest under such a warped education system? Now, about the library which I proposed to set up at Potong Pasir. If the Government is sincere in what it says and wants to help Singaporeans to improve themselves educationally, why then it refuses the people of Potong Pasir to set up a neighbourhood library? A library is a useful educational tool, especially one that is easily accessible to the people. The Government should discard its small-mindedness and allow the Opposition to initiate projects which are good for Singaporeans. I think this is an important issue. This is an appropriate time perhaps for the Government to recognise that the Opposition has a place in the political life of Singapore. The Opposition is a force for the good of Singapore. It provides a stimulus to the ruling Party. Open the doors to the Opposition, allow it to compete with the PAP to improve Singapore!”
“This is not because our pupils cannot cope with their mother tongue but because there is no effective teaching in an overcrowded classroom. If our class size is small, I am certain our pupils have no difficulty mastering the mother tongue as the teacher can give individual attention to the weaker students. When the class is large, it also inhibits the promotion of creativity in the pupils. Creativity can only come if there is an interaction between the teacher and the pupils. When the class enrolment is too large, it makes it impossible for an interaction between the students and the teachers. In Japan, Taiwan and South Korea, there is compulsory education there in varying number of years. In Singapore today, we still do not have compulsory education. Compulsory education is good. This is to ensure that no child misses out on his or her schooling. I would suggest that for a start the Government should immediately legislate to make compulsory education for every child for eight years from age six years and eventually to increase the period to 10 years. Our school children in their school career are taking more official examinations than their Japanese or European counterparts. Children should not be made to sit common examinations when they are still in their primary level because their brains have still not fully matured. The late developers will be penalised irreparably if they are made to sit qualifying examinations at that tender age and fail. Young children are very sensitive, and once they are branded failures, through no fault of theirs, that stigma may remain with them for the rest of their lives. Psychologically, some people may not be able to shake off the traumas of early failures.”
“Many Chinese who run their own businesses have only their holidays once a year during the Chinese New Year. These are the self-employed small businessmen and they do not have CPF to their credit. For them, they cannot afford to fall ill. Their children have problems too, as both parents are out working all day and no one to look after them when they return from school. The Government levy on foreign maids is exorbitant and these parents cannot afford to engage them. For the majority of Singaporeans, their lives have not improved since the last session of Parliament. The extra costs they have to pay are all Government initiated. Has our education system improved? I say it is still very unsatisfactory. It is flawed. My reasons for saying so are as follows: Firstly, our local schools, except the independent schools, are over-crowded. Secondly, there is no compulsory education. Thirdly, our schools are examination-orientated. Fourthly, our school curricula are too over-loaded. Fifthly, there is still streaming in Primary 3 and Primary 6 levels. These problems are not new. I have spoken about them at one time or other in public since 1984. Except for the independent schools, our school is not getting better. An enrolment of 40 pupils in the class is definitely too large. A teacher can never teach effectively in such a class size. The teacher will not be able to give individual attention to all pupils. In fact, it was reported that almost every child in Primary 6 has a private tutor to coach him or her outside school hours. This is an indictment on our school system. It is well known that the second language is a problem to many pupils. Why is this so?”
“Sir, I rise to support the motion in the name of the hon. Member for Tanglin to thank the President for his Speech made at the Opening of the Second Session of this Parliament. In the President's Address, it was stated that the Government's programme is to create a better life for all Singaporeans. This proclamation of intention is one thing but, in reality, is the Government creating a better life for all Singaporeans? I do not think so. Singaporeans have to pay more for new cars. New car prices have shot up by at least 30% or more, not from January 1989, but from January of this year. Tuition fees of independent schools have been increased by ten times; hospitals fees have been raised, as one hon. Member yesterday stated, to a level when it can bankrupt retirees who are unfortunate to fall sick and have been warded in hospitals. Rentals of both commercial as well as private properties have all gone up. This has created problems for our local businessmen. HDB commercial property rentals are also not cheap. They can never be cheap because of the tender system. Local Singaporeans have to work very hard to pay for their high rentals. I often hear local shopkeepers complain, "I am working only for the landlord." During my visits to the HDB flats, I noticed that many working couples do not come home until about 10.00 o'clock in the night. When I asked them for the reason, they say they are at their business. Long working hours appear to be the norm for many Singaporeans who run their own businesses. Are these people better off? The answer is obviously no. Most Singaporeans who run their own businesses have to work long hours from early morning to late at night, day-in and day-out, in order just to make a living.”
“I want the Member for Fengshan to explain. I really cannot see the point that he is trying to make.”
“May I have a clarification, Sir? Mr Speaker: Clarification is to clarify something in your speech which has been misunderstood. You have not made your speech.”
“Sir, may I seek a clarification from the Member for Fengshan? He says that other world leaders go abroad to plan a coup against their own successors ---”
“Mr Speaker, Sir, I have a clarification for the First Deputy Prime Minister. It would appear that there is an irreconcilable position. On the one hand, an NMP is said to be non-partisan and, on the other hand, he is allowed to be appointed as a Minister. Once he is appointed as a Minister and he gets into the government, how can he be non-partisan? It is not possible.”
“I thank the Leader of the House for his clarification in regard to the Report, ie, the Chairman's Report is presented to Parliament. Sir, the hon. Member should surely know that England has a constitution. But its constitution is unwritten. It is called an unwritten constitution based on its customs, its traditions and all the precedents that go before it. So it is wrong to say that England has got no constitution.”
“We are in fact not improving our parliamentary system as the Government tries to make it out to be. We are in fact making it less representative. So how can we say that we are improving it? In fact, we are removing the basic tenets to our democratic system. Sir, I can even say that we are taking the initial steps towards totalitarianism. Almost the whole world is marching towards more democracy. We are in fact moving away from it. Sir, I cannot support the Report although I am a Member of the Select Committee. I have not put my name to it. I have not initialled or signed it. Mr Speaker: I just want to make a point of clarification on what the Member for Potong Pasir has stated. During the debate on the Ministry of Health, it was not the time for each Member that was reduced. It was the time per topic that was reduced to four minutes. There is a lot of difference in both.”
“-- no need to get NMPs into Parliament. We do not need Cinderellas or ornaments in Parliament. That is what NMPs will eventually be. They will be out debated. Parliament is a place of work, of serious State business. Such serious State business is dealt in Parliament. And I say that only the committed, the people who brave the vicissitudes of the electoral pro- cess have a right to be in this House to transact such serious business. Sir, we must never make entry into this House an easy matter. Every Member in this Chamber has earned the right to be here, both morally and legally. Each Member must have a measure of support of the electorate. Without that support, the Member has no business to be here. Indeed, without the appropriate electoral support, an honourable Member will be thrown out at a general election or by-election. Sir, the whole concept of the NMP is constitutionally wrong. By constitution, I do not just mean our own Constitution. We should also take into account the constitution of England because our parliamentary system is derived from that country. Our present parliamentary system is a legacy of the British and we should take note of the constitutional struggle in England from early times until what it is today. It was a struggle between the King and the common people. The King, of course, was reluctant to divest his powers, whereas the common people wanted more powers for themselves. It was a long arduous struggle and finally of course the common people won. So the House of Commons is a fully representative institution. Sir, representation is the essence of parliamentary democracy. What we are doing is a retrogressive step. We are in fact going backwards. Instead of getting more representation, we are placing Members in this House by appointment.”
“Mr Speaker, Sir, the First Deputy Prime Minister has said that he will allow Parliament to decide for itself at every new session whether or not to have NMPs, and this is supported by the Member for Serangoon Gardens. But as pointed out by Dr Arthur Beng, this would be a fictitious choice. There is really no choice. You can see it today. When we have got a Constitutional amendment, the Whip can readily gather nearly all Members in this House. We have noticed that during the past two weeks, the House was barely filled up. But today, with the exercise of the Whip, we see nearly all seats are taken up. [Interruptions.] I am not controlled by the Whip. My point is that without the lifting of the Whip, there is really no choice. So the question is one of choice, whether the Members can freely vote to have or not to have NMPs at this new session. If we do not have that free choice, then this question of decision by the new Parliament really has got no effect at all. Sir, the important question now is: is there really a need to appoint more NMPs to improve the standard of debate in Parliament or to contribute to the proceedings in Parliament? I do not think so. There is no compelling reason at all. This is borne out by facts that during the Budget debates, it was demonstrated clearly that there was no need at all, because MPs in Parliament at the moment have risen to the occasion. All the main issues of each Ministry were thoroughly debated so much so there was insufficient time. The number of speakers was so many that during the debate on the allocations to the Ministry of Health, the time allowed for each speaker had to be slashed down from 10 minutes to four minutes. The debate in Parliament is of a high standard and there is really ---”
“I would like to ask the Minister of State whether the police has powers to tap the phone to investigate on illegal ---”
“Sir, I do not agree with the Minister of State. If he were to read the amendment carefully, it is not a question of whether it is a frivolous or non-frivolous tender. It is non-compliance. If a person who has misread the instructions carefully and non-compliance thereof, his deposit can be forfeited under the law. It says here, '... deposits for non-compliance with any conditions governing the submission of such applications;' Sir, the tender documents may contain a whole list of conditions and things that an applicant must do. And if he is not well versed in that and if he is not a dealer and he makes a tender for the first time, he is at risk. The deposit may be forfeited by the Government. It is not a question of frivolity but it is a question of non-compliance with any conditions governing the submission of such applications.”
“He has said that if there is anything unfair, Members could bring it up. And I am bringing up this point following what he has said.”
“Sir, I just want to clarify one point from the Minister of State.”
“Sir, I want to take up this point on what is fair and what is not fair.”
“Why are school leavers not opting for this noble profession?”
“Sir, I want to ask the Minister about the nurses. He says that there is an acute shortage of nurses in our hospitals. Nurses are the backbone of our hospital services. What is the Minister going to do to correct this shortage of nurses? Why is it that our school leavers are not so willing to enter this noble profession? Is it because the pay is not attractive enough or there is no good career path for them? Or is it because that while they are at work they are treated shabbily? There is no prestige in their work? Perhaps the Minister can tell this House what he is going to do to remedy the shortage of nurses in our hospitals.”
“For the first time in the restructured hospitals, we are now able to cost what is spent on patients in each area, whether they are subsidised or whether they are in the A and B1 wards, and therefore we can identify what it costs, what the patients are paying and how much we should be subventing the hospitals. She also asked that Medisave be safeguarded in order to avoid over-usage by the account holders. Sir, we have safeguards now, and that is, for patients in the restructured hospitals as well as private hospitals, there is a limit of $300 per day that they can utilise from their Medisave to pay for the ward charges and for the doctor's fees. Over and above that, they can claim a reimbursement from Medisave for the operations that have been carried out. This sets an effective quantum that can be utilized. The average length of stay for most patients varies from five to six days, resulting in a Medisave reimbursement for ward charges of $1,800 for A class patient. That is the amount that he can claim from Medisave, and he will have to pay the balance in cash. Similarly for operations, there is a limit. I think the limit is about $4,600 for the most complicated operation. Therefore, the safeguards are there and so far, they have been quite effective in ensuring that there is no over-usage by patients who go into the better class wards.”
“So we only pick those in Tables 5 to 7. Last year, out of the 114 operations carried out in SGH, 54% were on patients in the B2 class (subsidised patients). The figures show quite clearly that for the more complicated cases, B2 and C class patients are managed by the same specialists as those treating patients in the A and B1 wards. Members can therefore be assured that patients in B2 and C class wards are always given the level of medical care and attention appropriate to their condition. Sir, I now go to the specific points raised by each of the Members. The Member for Tampines GRC and GPC Chairman, Dr Aline Wong, raised quite a few points. She had asked about the development expenditure and recurrent subventions that have been granted to our restructured hospitals, namely, NUH and SGH, and she asked what these subventions are for. Sir, these subventions are only for service and for the equipment that are used in treating patients in the subsidised wards, namely, B2. The Ministry of Finance and the Ministry of Health have been very careful in vetting the requests put forward by the restructured hospitals to ensure that these subventions are spent in a proper manner, that is, they are spent in treating the lower-income group and not used for upgrading services for patients in the A or B1 wards, as Dr Aline Wong has feared. There is a clear distinction. And this is the advantage of having a commercial accounting system, a proper accounting system, in the hospitals.”
“Sir, we have built-in safeguards also to ensure that the specialists are not concentrating only on the patients in the A and B1 wards. Many Members have asked how we are doing that. We ensure that every specialist is spending seven out of the 11 sessions that he has each week on patients in the subsidised wards, and this means that two-thirds of each specialist's time is actually allocated to servicing subsidised patients, poor patients in B2 and C wards. And we monitor very closely for compliance, both at the hospital level as well as at the Ministry level. Let me give Members three examples to show that this system is working. All operations are listed into seven tables of operations, according to their degree of complexity. Table 7 lists all those operations which are the most complicated, and the simplest are in Table 1. Operations under Tables 5 to 7, being the most complicated, can only be performed by senior staff such as Senior Registrars and above. The three examples I will be quoting have been investigated and they show that these operations have all been carried out by such senior staff. The first example is coronary artery bypass. Last year, in SGH and NUH, there were 634 such operations under Tables 5 to 7. Of these operations, 232 or 37% were B2 or C class patients. So even though they were B2 and C class patients, they were still seen by this senior team of doctors. In Neurosurgery, Tan Tock Seng Hospital last year carried out 567 operations under this group of tables. Of these operations, 73% were on patients who were either in B2 or class C wards. So again, in this case, the majority were in the subsidised wards and they were also operated on by senior staff. Sir, in the area of paediatric surgery, there is a big range of such cases.”
“First, let me explain the structure of each medical or surgical department in a hospital, because I think it is necessary for Members to know this in order to understand why these fears are unfounded. Each unit or department comprises doctors who are non-specialists as well as doctors who are specialists, such as Senior Registrars and consultants, and the unit is then headed by a Senior Consultant. Every patient who is admitted into a B2 or C class ward becomes the responsibility of the consultant in charge of that ward. The consultant will then review the case and assign a doctor of a level appropriate to the medical condition of that patient. And not only that, he is also responsible for supervising and monitoring the management of that patient. If a patient has a specific condition which can be handled only by a consultant, he will then be managed by a consultant who is assigned by the consultant in charge or the Senior Consultant himself will handle the case personally. This ensures that the specialist resources of each department are optimally utilised for the benefit of every patient. Sir, as pointed out by Mr Peh Chin Hua, it is not possible for all patients to be allowed to choose their own specialists. This is because everyone will naturally in the course of his admission choose the most senior doctor. The result would only be a long queue for this limited number of doctors. The queue may stretch to months, maybe even years, in which case only those whose conditions are very minor can afford to wait, whilst those whose conditions are very serious will not be able to wait and will have to be treated by very junior people. This, I am sure, Members will agree, will be to the disadvantage of all patients.”
“Sir, this represents only 0.4% of all B2 and C class patients. So you can assume that less than 1% of patients in C class and B2 wards cannot even afford the low fees that are being charged. They apply for waivers and we have been very liberal in granting them waivers. Dr Wan Soon Bee has asked whether we have been too strict, and that is why the numbers are low. Sir, a total of 1,057 patients applied for waivers. This is for both outpatient and inpatient care in 1989 (April to December 1989). Out of that 1,057, only 15 were rejected. They were rejected because their family income was substantial enough for them to afford the small bills that they were facing, and we allow them in that case to pay by instalments, if need be. The number of rejected applications is extremely small - 1.5%. So it is not that we are not catching those people who need to be helped. The applications are there, and we have been very liberal in granting them waivers of fees. In terms of the Medisave accounts, for those patients in B2 and C class, whose Medisave accounts have been depleted, they can even apply to overdraw on their Medisave accounts. That means, Medisave will give them an overdraft which they can then repay through their monthly contributions. In 1989, only nine patients applied to overdraw on their Medisave accounts. Again, it shows that most Singaporeans have more than enough in their Medisave for B2 and C class bills. Sir, many MPs have raised their concerns that B2 and C class patients may not be able to get the appropriate level of care. This is because they fear that specialists will only look after the patients in the A and B1 class wards, as they can earn consultancy fees there. Whereas if they treat the C class patients, they do not earn consultancy fees.”
“For B2 patients, the average bill size is $410. However, it costs the Government $1,320 to care for each B2 patient. The subsidy is therefore $910 out of the total bill of $1,320. For C class, the patient bill size for 1989 was $205. This is about half the bill size of the B2 patients. However, the subsidy is $815, giving a subsidy rate of about 80%. So the services for our B2 and C class patients are heavily subsidized. The question is whether they are heavy enough and whether the C class bills and B2 bills are affordable. In term of the C class bill, if we look at the 75th percentile bill, the quantum is $220. That means 75% of all class C patients face a bill of less than $220. Is this figure affordable or not? Sir, for those with Medisave balances, for a worker with $600 income a month, or a family income level of $600 a month, this only represents six months of Medisave contributions. For those families without Medisave (self-employed or business proprietors), they only need to put aside $4 per month between the age of 20 and 50 years. This will ensure that they will have enough money to go into a C class ward at any time. For those who prefer a little bit more privacy and who get admitted into the B2 wards, the 75th percentile bill is about $480. This represents, for a patient with an income level of about $800 a month, Medisave contributions of 10 months. So 75% of all B2 class patients will be able to re-top up their Medisave accounts in less than 10 months. What about waivers and remissions? Patients who cannot afford such low bills can still apply for waivers and remissions. In 1989, the first nine months of our financial year 1989, which is April to December, the total number of bills waived was 564 for inpatients in our hospitals. This includes NUH and SGH.”
“All Singaporeans, rich and poor alike, have benefited from the progress made in our medical and health services. It is something which we can all be proud about. The figures show that although our overall expenditure on health care may be low in comparison with the developed countries, our people are able to enjoy a level of care that is at least equal, if not better, than that of the developed countries. They demonstrate that we are indeed getting good value for our money. Sir, many Members have asked about the level of subsidies and whether our hospital care and medical services are affordable. Sir, it is right that we show great concern for the poor. The Government does show great concern for the poor in making sure that our medical services are affordable. However, we also must ensure that the limited subsidies that we have are spent on the poor and not on those who prefer the highly personalised and comfort of the A and B1 classes. Sir, in terms of subsidies, Dr Ow Chin Hock had pointed out that subsidies had in fact increased over the years. He is right. Many MPs have questioned that and I would like to give Members some figures. In 1980, our subsidy per capita for health care was only $68 per year. In 1985, it was $114. Today, our subsidy is $134 per capita. In terms of B2 and C class patients, the subsidy has in fact doubled for B2, from $40 million in 1985 to $84 million last year. For C class, the subsidy has reduced in quantum and that is because of the dramatic decline in C class admission rates. But the level of subsidies for C class patients remains high at 80%. That means C class patients pay on the average only 20% of what it costs the Government to provide that service to them. Let me give Members some examples of the subsidies to the patients.”
“However, I have no doubt at all that if they had been given operational and management flexibility and autonomy, their results would have been even better. It is with this objective in mind that the Government has proceeded to restructure some of its hospitals and to allow them to operate autonomously. They will then be able to develop innovative, efficient, and cost effective systems and procedures, be able to develop more effective management systems in order to enhance the efficiency and productivity of their organisations. They will be able to be more responsive to patient's needs and therefore to provide a better level of service, and very importantly, they will be able to recruit, to motivate and to retain their staff with better personnel management policies. However, there have been fears that the poor will be adversely affected by the restructuring programme. Let me assure Members that the restructured hospitals, while they have operational and management autonomy, are still required to comply with the Government's policy of ensuring that the poor will always have access to proper medical care. Let me conclude by giving Members two key indicators of our overall state of health. In 1960, our infant mortality rate was 35 per 1,000 live births. Today, it is below 7 per 1,000, one of the lowest in the world. We rank on par with countries like Canada, Switzerland and are in fact ahead and better than many of the developed countries, such as USA and UK. Our life expectancy in 1960 was 63 years. Today, it is 74 years, an increase of 11 years. Again we compare very well against the developed countries whose life expectancy averages 74 to 75 years. Sir, these are remarkable achievements by any standard.”
“This will apply to all hospitals even after they are redeveloped in the next four to five years. Since the amount of money available to subsidize health care is limited, we should ensure that our subsidies are concentrated only on those who need to be assisted, ie, those patients in the B2 and C class wards. The subsidies on A and B1 wards will be reduced and eventually eliminated. It is only fair that those who prefer the privacy and comfort of these wards bear the full cost of the services that they use. Sir, as I have stated earlier, it is inevitable that hospital cost will continue to go up. The challenge is how to maintain a high standard of hospital service and at the same time keep future cost increases as low as possible. The answer, again as many MPs have pointed out, is to ensure that our hospitals are operated more efficiently and more cost effectively. Hospitals are large and complex organisations, each with between 2,000 and 4,000 employees. They operate a wide range of sophisticated equipment and offer a vast range of services. They serve thousands of patients daily, each with a different problem, each anxious for a quick service that is efficient and effective. And yet as Government hospitals, they are subjected to detailed centralised control by both the Ministries of Health and Finance. They have limited management and operational flexibility and are therefore not fully accountable for their operational results. It is therefore to the credit of the management and staff of the Government hospitals that despite such constraints they have managed to maintain such a high standard of care and to make such significant progress over the years.”
“We will therefore end up being short of nurses, therapists, counter clerks and other key staff. Standards of hospital service will go down and this will be to the detriment of all patients, especially poorer patients, who are unable to seek private sector treatment. Sir, previously the Government revised hospital fees across the board every four to five years. These infrequent increases meant that each adjustment had to be large and disturbing. From now on, Government and restructured hospitals will adjust fees more regularly in order to keep the increases smaller. They will also itemise more of the non-routine services and procedures so that only those who need these services will pay for them. This will be fairer to all patients. The Ministry of health has always heavily subsidized hospital treatment. It will continue to do so. The Government will maintain the amount of subsidy granted to Government and restructured hospitals as a percentage of our GDP. As salaries grow and medical costs increase, this subsidy will go up. However, the subsidy cannot be expected to cover the entire increase of hospital cost year after year. Hospitals will therefore have to raise fees periodically in order to recover costs and maintain their level of service. The majority of Singaporeans who are covered by Medisave will have no difficulty in paying their hospital bills. For the minority who cannot pay, the Government will continue to be very liberal in waiving their hospital bills. The Government is committed to ensuring that basic medical treatment will always remain affordable for all citizens. No Singaporeans will ever be deprived of hospital care purely because of lack of funds. The hospitals will always have adequate numbers of B2 and C class beds.”
“Our objective is to have a level of care in Government hospitals that all Singaporeans can be happy and confident about, especially when they fall ill and need to be hospitalised. This means ensuring that our hospitals are properly staffed and equipped and that the doctors and para-medical staff are properly trained and are keeping abreast of developments in medical science and technology. We must also be able to retain the better specialists as our hospitals also participate in the training of our future doctors and specialists. In this way, Singaporeans can be assured of a high standard of medical care. As pointed out by many MPs, unfortunately, hospitals are very expensive institutions to run. The cost of providing hospital services has been increasing rapidly in every country. Over the last few years health care cost has been increasing by about 13% annually in the USA, 16% in UK and 12% in Australia. In Singapore, Government health expenditure has been increasing at an average rate of about 12% a year over the last decade. At this rate, medical expenditures double every six years. It is inevitable that hospital costs will continue to increase. This is because hospitals are not only labour intensive, but they also require staff who are highly specialised and well trained. Manpower costs therefore make up 70% of hospital expenditures. With our tight labour market and strong competition from other employment sectors, salaries of hospital staff must inevitably increase. If hospitals do not or are unable to pay competitive salaries, they will not be able to retain their existing staff and, worse, will not be able to attract new job applicants. This is what has happened in our Government hospitals over the past five to 10 years.”
“My Ministry is committed to ensuring that Singaporeans will continue to have good and affordable medical care at both the primary and secondary levels. As pointed out by Dr Tan and several other MPs, the most cost effective way to treat illnesses is at the primary health level. In Singapore, we are fortunate that good primary health care is conveniently available from both the private and the public sectors. The private sector in fact plays a very important role providing about 70% of the primary health care in Singapore. As a reflection of my Ministry's strong emphasis on primary health care, it has since 1986 been upgrading its primary health facilities and services. The old, inefficient and poorly located clinics are being replaced by new generation polyclinics that offer families a one-stop medical centre for health and medical services. The new generation polyclinics provide, in addition to curative services, health education as well as inexpensive screening programmes for both young and old. We recognise that early identification of such diseases and disease conditions will mean shorter stays in hospital, as pointed out by Dr John Chen, and more importantly, a better chance of recovery. The new polyclinics will also be key centres for the provision of services to the elderly, such as rehabilitation and day care. The programme for the building of the 10 new polyclinics will be completed in 1994 at a total cost of $66 million. I think it is money well spent because by that time Singaporeans will then be served by a network of 16 modern polyclinics strategically located throughout the island providing an inexpensive and comprehensive range of services. We also need to provide for those whose medical conditions require them to be hospitalised.”
“The best way for an individual to reduce his expenditure on health care is to reduce his chances of falling ill. This is achieved through a programme of preventive health care and health education. Immunisation forms a vital component of our preventive health care programme. As Dr John Chen has pointed out, we have a high coverage rate and it is over 95%. And it has allowed us completely to wipe out such diseases as polio, diphtheria and tuberculosis amongst our young. But immunisation alone is not enough. Studies have shown that behaviour and lifestyles such as poor dietary habits, lack of exercise and high risk activities such as smoking can adversely affect a person's health. These are factors which only the individual himself can control. The health education programme is therefore aimed at making every Singaporean aware of the common health problems and how he or she can avoid them. Armed with the relevant knowledge and information, each person can then be responsible for his own good health. We believe that people are generally sensible and that provided they know how, they would take the necessary actions that will enable them to live a long and healthy life. This is well exemplified by the decline in the number of smokers which dropped from 23% of the population in 1977 to 13% today. My Ministry will continue its health education and preventive health programmes. We plan to spend about $190 million on such programmes over the next five years. This is a 64% increase over the $115 million spent during the previous five years. However, we recognise that it is not possible for us to totally eliminate diseases. Some people will still fall ill and will require varying degrees of medical care.”
“Surely there is some kind of arrangement which could be made for these Government servants to be seconded to SGH (Pte) Ltd. They can be working with SGH and still remain Government servants. Sir, this kind of staff problem will surely be repeated in other Government hospi- tals when they are privatised. Surely one of the principles adopted by the Government must be that those civil servants working in Government hospitals prior to privatisation cannot be put in a worse position when they are privatised. I am thinking particularly of the nurses. I think it is grossly unfair that so many of our nurses should suffer as a result of Government's privatisation programme. I hope the Minister will look into the plight of all those nurses. The Acting Minister for Health (Mr Yeo Cheow Tong): Mr Speaker, Sir, first, let me thank all my parliamentary colleagues for their views and suggestions. They have touched on many points and they have raised many questions in their very short allotted tune of four minutes. As the delivery of health care is a fairly broad subject, I would like to give Members a brief overview of my Ministry's programmes before replying to the specific points raised. Sir, good health is essential for a person's well being, as some of the MPs have pointed out. Likewise, our country's future depends on our having a nation of healthy Singaporeans. My Ministry's policies are therefore directed towards helping Singaporeans to remain healthy, and for those who fall ill, to help them to recover as quickly as possible. This is in line with the calls made by MPs this afternoon. With the health care cost rapidly increasing, the saying that prevention is better than cure gains greater weightage with each passing year.”
“Sir, basically I have two points to bring up. With the restructuring of Government hospitals, this basically means the privatisation of hospitals. Privatisation connotes that the purpose is to make money or to make a profit. Therefore, I have a plea to the Minister that the Government must never think that with privatisation it is given a licence to increase hospital charges as the free market dictates. It must always bear in mind the plight of the poor and the average worker. We know that 70% of Singapore workers earn less than $1,000 gross salary a month. So the majority of Singaporeans are still regarded as not rich. Therefore, the call for the retention of class C must be heeded by the Minister. I would really support the retention of Class C at SGH. Sir, basically, I think the Minister cannot say that the policy of the Government is to make hospital and medical services affordable. Because what is affordable and what is not affordable is very subjective. But basically the charges must be at a level which can be paid by our average worker. Sir, the other point is with regard to SGH. I was informed that last year when SGH was privatised, 40% of its experienced staff opted to remain as civil servants. As a result, they were all transferred out when SGH was privatised. If that was true, the SGH will be depleted of experienced staff and its standards will surely drop. I was also told that SGH (Pte) Ltd intends to recruit nurses from the Philippines and from Hong Kong. Why get these foreigners to work in SGH (Pte) Ltd when our own former staff of SGH would be willing to continue to work there? Why is the Government not willing to allow them to work in SGH (Pte) Ltd?”
“Sir, I do not understand what is the meaning of the Ministry's policy on sports excellence. To me, "excellence" means attainment and achievement of high standard. So where is our achievement? Up to date, we have not achieved anything internationally. So I think these words "sports excellence" should never be used at all.”
“Sir, as I sat there, I cannot help but want to ask the Minister what she really means by "sports excellence programme". It seems that the sports excellence programme is the focus of her Ministry. But I noted that in the last Commonwealth Games held in January in Auckland, Singapore failed to get even one medal, whereas Nauru, a small atoll in the Pacific, got a gold medal. How does she justify that we are having a sport excellence programme?”
“Sir, I just want to make one observation. Since the establishment of the Residents' Committees, I notice that the Government has not given permission for residents at the housing estates to set up their own Residents' Association. Perhaps the Minister could enlighten the House on this point. Before the Residents' Committees were set up, there were a few Residents' Associations established at Lorong 8, Toa Payoh. But subsequent to the establishment of the Residents' Committees, there were several blocks, especially point blocks, who have asked to set up Residents' Associations but permission was not granted. It is a sad thing, Sir. Because if Residents' Associations are allowed, they could not only bring the community spirit to their blocks but also they could arrange for security of their blocks.”
“Sir, if the Minister of State were to just pay a visit to the Toa Payoh branch library on a Saturday morning, she will see that school children are forming a queue right round the block. This is to show that there is an inadequate number of libraries. Unfortunately, I believe the schools do not open the school libraries to school children during weekends. So if the Minister of State would just bother to visit the Toa Payoh branch library one Saturday morning, I hope she will come back and tell this House whether there are enough libraries in Singapore.”
“Sir, I think the whole picture painted by the Senior Minister of State is not true. The MCD says that there are enough libraries for the whole of the Singapore population. But, Sir, this is not really accurate. This is not true. Because the Report of the Advisory Council on Culture and Arts states that, in fact, they will need at least four more libraries in new towns. They themselves think that it is not enough. Sir, the question of adequacy of libraries has to depend on the standards. One library to 200,000 population is definitely not serving the whole population.”
“One last word, Sir. But we need to get the clearance of the MCD. This is how the HDB works. The HDB has specifically written to us saying, "You go to the MCD and get their clearance. We will wall up the premises for you." That is the reason why we are approaching the MCD, otherwise we do not bother.”
“I would like to ask the Minister of State whether to establish a neighbourhood library is or is not a good thing.”
“An average HDB family does not earn his income, Sir. That is the reason why we want to have a library in HDB estates so that children between four and 10 years old can freely, in the safety of their estate, walk to the library instead of hazarding while catching a bus to the branch library. Sir, I do not have to repeat. I think it is important to have a library within walking distance of one's home. The other point is that we do not expect support from the MCD because we do not want funds from them. But we want their clearance because we want to be treated like all other PAP education centres. We want the HDB to wall up the premises for us and charge us the rate for their educational centres. That is what we want. So in that sense the Potong Pasir neighbourhood library will not be a private library. To a certain extent it must have Government support in helping us with a place and charging us rentals like all the other education centres. That is the reason why I bring this up and I shall be bringing it up again until we get a satisfactory answer.”
“Sir, I think the question is not 81 small libraries. The issue is accessibility of library reference books. I am sure hon. Members here, everyone of you here, in your own homes, have a good set of encyclopeadia reference books for your children to refer to. Why do you want to have it in your home? Because it is the most accessible. An hon. Member: Then pay for it!”
“As a result, we wrote to the Ministry of Community Development to get their support for these programmes. As regards the creche, I am happy to report that the MCD is willing to allow us to establish a creche there. But as regards the library, they are not that willing. Sir, I will read to you the reply of the MCD in regard to the library. First of all, they say that all branch libraries have already been provided for the whole population of Singapore. Then they hedged and they did not say whether they wanted to give clearance or not. We have to write to them again and this is their second letter: 'I would like to reiterate that the Government has already adequately provided for branch libraries to serve the whole Singapore population. Individuals and organisations, including Town Councils, which wish to set up their own libraries do not require my Ministry's approval.' So we wrote back to the HDB and say: 'On the one hand, you have asked us for support from the MCD and, on the other hand, the MCD says that if you want to set up own library you need not have the Ministry's approval.' So we are at a complete loss. I certainly do need the assistance of the Minister of State in this respect and I will be very happy if she could give a clear-cut answer and say "Yes, we will support your library". Then we will take off.”