Chong Weng Chiew
Singapore
“Due to the high fees currently, often a spouse, usually a woman, would have to quit her job to take care of such an elderly person. Considering that the median household income is about $4,000, the household income would be halved if she quits, thereby creating financial hardship and family stress.”
“Mobility is a big problem for them and many cannot afford to pay for unsubsidised home therapy sessions or domestic help and taxi fares to bring them for follow-up appointments. More often than not, they miss their follow-up therapy sessions and their conditions will start deteriorating from there.”
“With regard to my cut on genetic counselling, I would like to suggest that the Ministry work with the Registry of Marriages to encourage all couples registering for marriage to go for medical screening and genetic counselling. Potential couples have the right to know about each other's health status.”
“" Teens under the age of 18 have to get permission from their parents and many end up persuading their parents to donate too. Their contribution comes at a time when demand is growing due to the aging American population.”
“It has to be fair and preferably tiered to be as inclusive as possible. It should also be responsive and flexible, easy to administer and not require too much bureaucracy. This is a pretty tall order. Still, we have to find a way to align the disbursement of healthcare subsidies in all our public medical facilities.”
“Sir, in many countries, whistle-blowing has been a major source of discovery of many fraud cases. Could the public have a clearer understanding of the exact protocol and processes in which complaints can be made and also subsequently on what grounds would such complaints be further investigated, that is to say, what information the public…”
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“We need to do more than just encouraging the speaking of Mandarin in the school environment. At home, at work and at social gatherings, we need to create the environment conducive to the use of Mandarin. Only then can the standard of the language be enhanced, and Chinese can remain as a lively language. From the experience gathered over the years, I feel that there is still room for improvement as far as the environment for Mandarin-speaking is concerned. In a survey conducted by the Ministry of Education in May this year, there are more and more parents speaking to their children in languages other than Mandarin and now they use English to learn mathematics, science, history and geography and at their place of work, they also use English. No wonder the standard of Chinese has been dropping. The same applies to me. In my secondary school days, Chinese was my main language of communication. But when I went to the university and at work, I seldom used Chinese or Mandarin. In our daily lives, the ratio for our use of the four language skills, that is, listening, speaking, reading and writing, are of unequal proportions. Undeniably, many of our Singaporeans are using less and less Chinese and this is no good because it is only with more listening, more speaking, more reading and more writing that we can improve our standard of Chinese. There is no short cut to it. For my primary school and secondary school studies, I was in Catholic High School, where both Chinese and English were our first language. But among all the subjects, the one that I hated most was Chinese because I am not a language expert. Chinese was very difficult to learn and Chinese was consistently my worst subject.”
“Mr Speaker, Sir, the rapid development of Singapore has a lot to do with our choice of the working language. Using English as the working language for our Government agencies, enterprises and workforce has created a lot of investments and job opportunities for us. However, the ever-changing world has also brought new challenges to Singapore. The emergence of China has provided us with a lot of investment and enterprising opportunities. However, if we are unable to adapt to such changes, then the new environment would turn out to be a threat to us. There was a young man who was interviewed by Lianhe Zaobao, and he said that young people of Singapore are having a competitive edge over others in the international labour market because they are effectively bilingual. He felt that the level of our English is comparable to that in Europe and the United States and we are better than the young people in China, Hong Kong and Taiwan. We have some basic level of Chinese and for this, we are stronger than the American Chinese. But what I am worried is that this competitive edge may soon go off in 3-5 years' time. The reason is very simple. More and more Chinese people are actively learning English. They know very clearly the importance of being bilingual. So competition is inevitable. In order to survive, we have to raise our bilingual standard to maintain our competitive edge. Our only resource in Singapore is human resources. So we have to attract talents, retain them and even encourage our people to create (ie, to procreate) new talents and this is of top priority to the Government. If we want to maintain the standard of Chinese just by depending on the schools, I think it is not good enough and it is impossible.”
“The 14-day limit is reasonable because after this period, the cells start to differentiate into tissue and organ cells. Therefore, I do not object to permitting research on embryos less than 14 days old. Research on embryos is meant to benefit mankind and relieve suffering. Abhorrent acts such as cloning fetuses to extract organs or tissues, developing human embryos in non-human hosts and using non-human eggs to produce human embryos must be outlawed. Such attempts must be severely punished. I also support the ban on the export and import of any prohibited embryos and definitely the commercial trading of human eggs, sperm and embryos. The Bill has addressed all these concerns and has stated the appropriate penalties. I agree with the proposed jail term of a maximum of 10 years for rogue scientists and their accomplices. In my opinion, the Bill is balanced and forward-looking. It will benefit our patients, the medical and research communities and help keep Singapore at the cutting edge of scientific exploration. With that, I conclude my support for the Bill.”
“There is growing support for therapeutic cloning and I understand that no fewer than 40 Nobel laureates have warned that legislation to ban therapeutic cloning "would foreclose the legitimate use of nuclear transplantation and impede the progress against some of the most debilitating diseases known everto man". Nonetheless, the lives of human embryos are at stake here. They are used and destroyed in the interest of science for the benefit of third parties. It is so difficult to agree on when human life truly begins. Does it begin at conception, at 14 days or at birth? Some scientists and religious leaders do not consider very early embryos to be fully human as the cells have not formed a single, individualised entity. Hence, in their opinion, medical research utilising embryos is morally acceptable.My scientific mind agrees with this as well. But when we look at our own children, we know that, without a doubt, that their lives begin at conception. To reconcile all these conflicting theories, I have settled on this: early human embryos are intermediate beings. They are not fully human yet, but neither are they simply groups of cells that can be treated like any other tissue samples. They must be treated withdue respect and consideration they deserve. Let us look at comparative legislatures around the world regarding embryo status. In July, the European Court of Human Right ruled, and I quote from the July 9th issue of the Straits Times that, "... the issue of when the right to life begins was a question to be decided at the national level ... there was no consensus on the nature and ... status of the embryo and/orfoetus". Thus, we must set our very own guidelines. We must ensure that they are humane and, at the same time, as unambiguous as possible.”
“Mr Deputy Speaker, Sir, I rise in support of the Bill, and will keep my delivery short. Ever since the successful cloning of Dolly the sheep, there has been a general sense of unease towards this scientific development. Instinctively, many of us squirm and ask ourselves, if and when, wouldhumans be next. Then, religious and civic groups, and governments all over the world quickly got to work, to ban, with varying degrees, further research on human embryos. There are so many ethical, religious, medical and legal issues surrounding cloning. I welcome today's opportunity to share some of my personal views. The Bill will ban human or reproductive cloning while permitting research into therapeutic cloning. I think most people will not dispute the ban on human reproductive cloning. It is ethically and morally unacceptable to the general public. However, therapeutic cloning is much, much more controversial. It involves altering genes in embryos to create a new genetic makeup. Here, the Bill stipulates that the human embryos used must not be more than 14 days old. The debate is whether it is ethical to create life in order to destroy it later in the course of research. More than 50 countries, including the United States, have banned therapeutic cloning. However, some countries have changed their stance recently. In August, UK issued its first licence allowing scientists to use cloning techniques to create stem cells. In July, Japan has announced its intention to introduce similar legislation.The main reason for permitting therapeutic cloning is the promise it holds for medical cures. Therapeutic cloning offers hope to victims of heart diseases, diabetes, Alzheimer's, Parkinson's, spinal cord injury and many, many other debilitating diseases.”
“So, in the last quarter, we saw a 50% increase in steel prices. This means a 2.5% increase in total construction cost. So, for projects like that, both the agencies as well as the contractors might not need a price fluctuation clause. In any case, these sharp increases in prices of steel over the last few months were a normal thing because the events that took place in the last few months had caused this sudden increase. But in the last 10 years, basic material prices had actually fallen and many contractors in the years preceding the last six months were not in favour of price fluctuation clauses. They would rather have a lump sum tender because, in a price fluctuation clause tender, when prices go down, the agency reserves the right to claim back the savings. WORK ASSISTANCE PLAN AND HOME OWNERSHIP PLUS EDUCATION PROGRAMME 10. Dr Amy Khor Lean Suan asked the Minister for Community Development and Sports (a) how far have the Work Assistance Plan (WAP) and the Home Ownership Plus Education (HOPE) programme been working to fulfill their objectives; (b) what other measures, if any, will be put in place to help as many of the underclass as possible; and (c) how will the Government encourage community help groups to step in to care for the disadvantaged without creating a sense of dependency.”
“This could help to alleviate the financial risks of contractors in public sector projects. Building material prices are affected by various factors such as the global supply-demand imbalance and increases in raw material costs, freight charges, and export levies. These are largely beyond our control, as in the recent hike in steel price. BCA helps the construction industry by monitoring the prices of key building materials such as cement, bricks and steel, and providing regular information updates to the industry At the same time, contractors should diversify their supply sources for the key construction materials so that they would not be caught by any steep price increases from any single source. To this end, BCA will continue to help explore and facilitate alternative sources of materials supply for the construction industry. On Dr Teo's question on the actual construction cost increases in recent years, BCA's Tender Price Index showed that the increase was 2% from 2001 to 2002, and 6% from 2002 to 2003. Dr Teo Ho Pin: Sir, may I ask the Senior Parliamentary Secretary actually how many contracts were awarded with this fluctuating clause in the contract, and whether the inclusion of this fluctuating clause for materials will make it a fairer contract, in view of the very dynamic global conditions? Assoc. Prof. Koo Tsai Kee: Sir, some agencies do include this price fluctuating clause in their contracts. Not all agencies do that. There is a good reason. Because some contracts have long gestation duration and are heavily dependent on basic raw materials. If you have steel structures, then you might want to have a price fluctuating increase clause inside there. But for standard building, the cost of steel, for example, is only about 5% of the total construction cost.”
“The fact that there are different committee members managing different Town Councils, would the Ministry consider setting a guideline as to the standardisation of the collection of all these arrears for the different Town Councils? Assoc. Prof. Koo Tsai Kee: Sir, the Ministry keeps a watching brief on the Town Councils' operations but, ultimately, the Town Councils must be responsible for the operations of their own Town Councils. The Ministry of National Development looks at the arrears and flashes the warning sign to some Town Councils. It is up to the Town Councils to take enforcement actions. PUBLIC SECTOR CONTRACTS (Provision of fluctuating clause for building material prices) 9. Dr Teo Ho Pin asked the Minister for National Development (a) whether the public sector contracts will provide for a fluctuating clause for building material prices; (b) what measures are being taken to prevent the escalation of building material prices; and (c) how much has construction cost increased over the last 3 years (2001, 2002 and 2003). Assoc. Prof. Koo Tsai Kee (for the Minister for National Development): Sir, the Public Sector Conditions of Contract (PSSCOC) has an optional price fluctuation clause for building materials. Public sector agencies decide for themselves whether to adopt it, depending on the nature of their projects. The agencies are as concerned as contractors about the potential impact of increases in building material prices on their projects. A number of them, such as PUB, MOE, CAAS and LTA, have incorporated the price fluctuation clause for reinforced steel, for example, in some of their contracts. Others such as HDB and DSTA are considering doing the same for new contracts.”
“I beg leave to withdraw the amendment. Amendment, by leave, withdrawn. Quality of Tertiary Teaching”
“Sir, the Minister of State has not commented on Mr Ang Mong Seng's amendment on education for autistic students. Can he care to comment on that, please?”
“The four components are synergistic in action. Thus, I would like to remind the Ministry not to ignore totally the writing component of Chinese B. Nevertheless, I would like to praise our educators' flexibility in allowing Chinese B candidates to bring dictionaries into the examination halls with them since last year. This is a step in the right direction. It helps them to still try to express what they want to say when they have forgotten how to write. Lastly, I would like to urge the Ministry again to have more measures to ensure the confidence and the ability of these Chinese B students to handle and to improve on the language. The Chairman: Mr Ang Mong Seng. You have two cuts. Take them together.”
“Sir, I beg to move, That the sum to be allocated for Head K of the Main Estimates be reduced by $10 in respect of Code KC 1500. Sir, I am heartened to note that last year, only 2.6% of the 'O' level candidates took the Chinese B paper against the 10-20% projected by the Chinese Language Review Committee in 1999. This proves that the majority of our students are capable of handling the normal Chinese or Higher Chinese Language syllabuses. It bodes well for our future. Many parliamentary colleagues and I have acknowledged the growing role of Chinese in the new economy, similar to the role of English that has played in Singapore's development in the last 30 years. Therefore, it is clear that our students should be grounded in functional Chinese, at the very least, to prepare for the future. But are our 2.6% Chinese B takers ready for the future? They may be a minority, but I will feel better to know that they have sufficient competency to handle future working environments. Is Chinese B teaching then enough to handle practical day-to-day transactions? We should expect similar base standards of Chinese B as we did for our EL2 students in the past. I am from a Special Assistance Plan (SAP) school myself, with Chinese being my first language. Even with that, I find my command of the Chinese Language deficient in handling business matters with the Chinese in China. Thus, I worry even more for our Chinese Language B students. Secondly, one of the distinctive features of Chinese B is the greater emphasis on listening and speaking skills. As we know, listening, speaking, reading and writing, in Chinese, "ting xie duo ting" are the four wheels of a vehicle. Neglecting any one of these abilities would be tantamount to driving with a punctured wheel.”
“Sir, I declare my interest in the following cut. The Ministry introduced subsidies for home care providers two years ago. This is in recognition of the role home care plays in the healthcare system, and I was glad to hear the Minister reconfirming that point again just now. However, currently, the subsidies do not extend to home therapy providers. I hope the Ministry will reconsider this decision in view of our ageing population. Increasing numbers of elderly in Singapore will require physiotherapy. While there are currently day-care centres which provide physiotherapy, home therapy and day-care centres target at different groups of patients. Day-care centres request patients to be at their doorsteps. However, there is a large group of patients, especially those with severe strokes and who, as a result of which are bed-bound, are unable to go to day-care centres for rehabilitation. Thus, for such groups of patients, home therapy is the only option. Elderly poor patients who currently are unable to move to day-care centres, as a result, would be left stranded thoroughly without much of a subsidy and treatment. If the Ministry is able to fund home therapy services and with the convenient and regular but affordable treatment sessions, many current disabled home-bound elderly would be able to benefit from improvements in their health and quality of life. Thus, in conclusion, home care services, definitely including the therapy component, can contribute to a higher standard of health among our elderly patients. In the long run, this would help to bring down our healthcare costs. Hence, I hope the Minister could consider my request. Pro-family policies”
“Sir, under the present regulations, all facilities, including hospitals and nursing homes under the charge of the Ministry of Health, do not allow Chinese physicians to treat the patients there. Patients who require treatment with Chinese medicine would have to be moved to another room outside the hospital ward or nursing home before treatment could be administered. All Chinese medical treatment procedures, including acupuncture, are affected. This would not only cause inconvenience to the patients and medical and administrative staff but also marginalise the status of traditional Chinese medicine in our healthcare system in Singapore. In fact, the Ministry of Health recognises the role of traditional Chinese medicine in the medical scene in Singapore. The Ministry of Health itself has a department on traditional medicine and one on Chinese medicine. Over the years, the Ministry of Health has adopted positive actions to regulate and register the Chinese physicians, the Chinese medicine practitioners as well as the Chinese herbal and patent medicines. In order that we could further improve the use of Chinese medicine in Singapore, we should do something to satisfy the needs of our patients in Singapore who require Chinese medicine treatment. So, I would urge the Ministry of Health to allow the Chinese physicians to treat their patients in the hospital wards.”
“Many times, the doctors are not directly involved in the billing of the patients. As such, many of the junior doctors would not be aware of how much of the medicine, in terms of cost, they are prescribing. Definitely, we know that the latest and the most expensive medicines are not always the best nor the most appropriate. Hence, we should educate our doctors as far as possible, to avoid prescribing expensive medicine for patients, especially those which are beyond their ability to pay for them. Traditional and Complementary Medicine”
“Sir, for most illnesses, besides patented and generic medicine, there would usually be a number of alternative medications that a patient can take. Definitely, of course, he usually relies upon his doctor's prescription without much query. This could be good or bad, depending on how good or how bad the doctor is. Patients usually have no idea about the range and cost of the alternatives, or why one medication is prescribed over the other. It depends almost entirely upon the knowledge and diagnosis of the doctor. Some medications can be very expensive, and subsidised patients may find themselves struggling to afford them on a long-term basis even though the drugs could already be subsidised. The price difference between the prescribed drug and the next best alternative can be substantial. Sometimes, the effectiveness of one drug may be only marginally better than the alternative, although this may not be reflected in the price difference. The financial circumstances of the patient and his family should definitely be taken into consideration. To give an example, for gastric pain, the cheapest medicine that can cure it could be an antacid that costs only about five cents, while a new medicine being developed, eg, Omeprazole, can cost $2 per tablet. Therefore, I would like to suggest to the Ministry that they should ensure that doctors, particularly the junior doctors in acute hospitals, are aware of the cost of the medicine that they prescribe. This is particularly essential because, many times, junior doctors practising in hospital wards are not too aware of the cost of the medicine they prescribe, since the workflow of the hospital is such that they prescribe the medicine in the wards and the patients do not pay until they are discharged.”
“This would definitely translate into substantial savings for our entire healthcare system. Mental Wellness at Work”
“Sir, I am talking about patient siting. When I mention the words "patient siting", I am referring to where patients should be treated and admitted. Should it be in acute hospitals, community hospitals or nursing homes? Our current system of care placement and referral of our elderly patients can definitely be improved upon. With the implementation of Diagnosis Related Grouping (DRG) in acute hospitals some years ago, funding of the hospitals is based on a fixed budget per disease grouping. While it is an efficient system, it definitely places pressures on hospitals to discharge patients as quickly as possible to be cost-effective, as a result of which, elderly patients are most disadvantaged. Those who are not ready yet to go home are referred to step-down facilities. Particularly, these are patients with social problems. Sad to say, they would be transferred to the provider who accepts their cases fastest. This is far from ideal if we assess the long-term effects of indiscriminate discharging. For example, an elderly patient who may have rehabilitation enters a nursing home instead, rather than a community hospital, just because the nursing home has no waiting list and a community hospital has. Thus, may I propose to set up a neutral body comprising independent healthcare personnel, preferably employed by the Ministry of Health, to look into the assessment and the appropriate placements and discharges from hospitals. Finally, at the national level, we should definitely promote greater awareness of the various step-down care facilities and their functions. Singaporeans should realise that immobility need not be a natural progression in old age. In fact, in many cases, rehabilitation is the key.”
“Based on the following knowledge I have, I do know that staff in both clusters are rewarded bonuses based on the revenue and not on the level of service or efficiency. Last year, staff of the clusters were paid a group bonus, based on a group profit, on top of their basic pay package. So this motivates revenue-generating behaviour among the staff of the clusters. Thus, with this profit-oriented mentality, how can we ensure good competition to bring down healthcare cost? Things and circumstances, as I have mentioned, have changed and I do hope the Minister will review the situation and, hopefully, reshape our healthcare foundation by abolishing the two groups system in our healthcare system currently. Efficiency of Hospitals”
“Sir, years ago, one of the main objectives of setting up the two health clusters was to inject an element of healthy competition into our public health sector in order to spur us into achieving world-class excellence. It was an inspiring and exciting goal then. But since then, many unexpected changes have occurred. As a result, Singapore too, has been affected. The wind currents have changed and perhaps it is time for us to change our sails as well. A re-consideration of the role of the two health clusters and a restructure of our public health sector may be timely. What was appropriate earlier may not be suitable for our current situations as our priorities have changed. Right now, with a weaker economy and definitely an ageing population, we are more concerned with keeping healthcare cost down and ensuring the availability of solid basic healthcare to all Singaporeans. Therefore, the possible duplication of some resources as a result of the clustering has definitely become a concern. With that background, I have the following points and questions to raise. 12.30 pm Firstly, I read the National Healthcare Group Annual Report 2002-2003 and understand that the NHG employs about 1,600 staff in pure administration. Can I find out from the Minister the roles and duties of these 1,600 staff? I do not have the exact number for SingHealth, but I believe they would have a figure close to NHG. How much duplication of work is there actually? Secondly, we have a limited pool of medical personnel in Singapore and the clusters have to compete for talents in order to attract patients, driving up remuneration and adding to cost. Thirdly, the Acting Minister has said that there is always good and bad competition. But how can we differentiate one from the other?”
“Can I request the Minister to comment on the use of Medisave for home care?”
“However, if we are going to prevent catastrophic diseases through the provision of home care, should we not allow Medisave to be used for home care?”
“Sir, I would be talking about the usage of Medisave for home care. Singapore has a rapidly aging population and, as we all know, with fast rising healthcare cost. Domiciliary medical and nursing care which is commonly known as home care is one of the best ways to help curb costs. This is because home care allows patients to be discharged earlier and yet the medical team can provide monitoring as well as attending to these patients in the comfort of their homes. Also, many admissions to hospitals can be prevented and minimised with the provision of home care. I propose that the Minister reconsider the current position and allow Medisave to be used to pay for home care services. The reasons are compelling. Firstly, the trends in medical treatment are changing. Technology has made what was impossible previously accessible and convenient today. Secondly, due to the restriction of the use of Medisave, patients who could actually be treated at home currently choose more expensive treatment in hospitals. Why? Obviously, it is because they have limited cash savings and they could use Medisave in hospitals but not for home care currently. We have placed an additional burden on such elderly patients. And as custodians of their Medisave funds, it would be irresponsible for us to compel them to use them up more quickly than what is necessary. The Ministry has indicated that home care is the way to go for an aging population like ours. It is already funding operators of home care services currently. Thus, it is only logical that patients be allowed to use Medisave to pay for home care services. It was mentioned before that Medisave is for the use of catastrophic diseases.”
“Next, would the Ministry please also review the proposed income caps to qualify for the various subsidies? They should reflect our remuneration conditions more realistically. The proposed caps are too low, as what Dr Ong Seh Hong has mentioned earlier on, and currently resulting in about half of the current Singapore population not qualifying for some form of subsidies. Lastly, both acute care hospitals and step-down care facilities must use the same template for means testing if we do intend to extend means testing to acute hospitals. For example, we should not use household income to determine subsidies at acute hospitals but per capita income at step-down care facilities. A one system, two methods, would cause much confusion and chaos for all parties - the families, the acute hospitals, as well as the step-down care providers. My very last point is that, from what I read in the newspapers, there is a great amount of misunderstanding from the public about means testing. Many thought that if they do not qualify for any subsidies, they are unable to go to low-cost wards, like "C" class wards. I think the Ministry should embark on an exercise campaign to let the public know what means testing is all about.”
“Madam, I declare my interest as the CEO of Ang Mo Kio Hospital. The principle of means testing to allocate subsidies based on a patient's ability to pay is definitely a sound one, considering our limited resources in Singapore. Hence, I would urge the Ministry to consider implementing it in all public hospitals as soon as possible. I do understand that what I propose is a little bit different from some of the earlier speakers. The need to implement it as soon as possible is necessary because the longer we delay, the more difficult it would be to implement when the time comes. Definitely, we know that there are challenges in the implementation. I have close to about two years of experience in implementing means testing in community hospitals and nursing homes. The processes and tools involved can certainly be improved currently. There are messy and dodgy paperwork and there are long waits for family members to submit income documents, and as a result of which has led to delays. Therefore, I propose that the CPF Board and the Inland Revenue Authority, which currently are not involved, be involved so as to speed up the process. They could help to reduce administrative and manpower costs substantially. I would also like to propose, as what Dr Lily Neo has mentioned, to build more "C" class wards. "C" class wards 10 years ago and "C" class wards today are very different. The quality between subsidised wards and non-subsidised wards today is minimal. Thus, there is a good demand for subsidised wards, even from middle class and wealthy Singaporeans. Although they would not be entitled to subsidies once means testing is implemented, at least, they should still have the choice of lower cost wards.”
“Could the Minister give us an update on this issue? Bus Operators”
“It is generally agreed that competition, as Mr Chay has mentioned, however imperfect, serves to improve the level of services and level prices down for the benefit of the consumers. While the MRT and bus operators provide different forms of land transportation, they are actually quite similar, in terms of affordability and the degree of privacy. Thus, competition exists between MRT and bus operators for passengers. In a healthy competitive environment, the MRT operator should not be the owner of the buses which ply the same routes. For example, competition between MRT and buses along the NEL was reduced and, I quote from the Straits Times, "SBS slashed its network of bus routes to avoid cannibalisation of its train services." The resulting monopoly means that the consumers now have less choice and possibly less convenience and less comfort as they would have to vie for a place on the MRT, especially during peak hours. I hope the Ministry will review its policy regarding this aspect of public transportation. If we want less congestion, less cars on the roads, if we want to encourage more Singaporeans to take public transport, we must ensure affordability, speed, comfort and choice for different individual needs and preferences. Also, on another point which is on a lighter note, as we become a developed country, we should be looking and providing our country men more choices in life. We spend about 10% of our life travelling. We should try to enjoy our journeys to and from work as well. And the choice to travel by train or bus would really sometimes depend on the mood of the day. Let us give our Singaporeans more choices in life. Last, but not least, the Minister mentioned the potential merger of two MRT operators a couple of months ago.”
“Sir, currently, for overseas purchases using credit cards, the banks convert the foreign currency purchases into Singapore dollar at an exchange rate they decide and charge the Singapore dollar amount to the account holder. They are not obligated to disclose the basis of the selected exchange rate nor fees added by the bank, Visa or MasterCard. This violates the very principle of fair transaction. I am not against the charging of fees, but consumers have the right to know the basis of the calculation of the cost before, and definitely not after, the using of the credit cards. A Straits Times' reader last year compared this to "hopping into a cab and enquiring about the fare ... and being told that all charges vary daily and they cannot be disclosed to you until after you have arrived at your destination ... If cabbies cannot get away with such non-disclosure, why should banks be allowed to?" Visa International and MasterCard were taken to task over this in America, Canada, United Kingdom and Australia last year. In the US last year, a California judge had ordered Visa and MasterCard to refund US$800 million in fees charged to customers. He ruled that they should better disclose conversion fees in the future. As a leading financial centre, it behoves our financial institutions to be transparent and accountable in all their transactions. May I thus recommend that, in the interests of our reputation and to protect our consumers, the credit card issuers in Singapore be required to state clearly and unambiguously the basis of the selected exchange rates used and the details of any additional fees charged.”
“Our education policy and our teaching of Chinese language should also be improved to meet the changes and market demand of the international economy.”
“Therefore, I urge the Ministry of Education to change the streaming system so that every child would be able to decide on the pace at which he learns each subject, so as to avoid putting him into boxes marked "fast", "medium" or "slow" speed, just for administrative convenience. As it is said, we want quality and not quantity. So, in whatever we do, we will have to take this into consideration. Take the learning of Chinese. For example, I come from a Chinese school. But when I became a Member of Parliament, I discovered that my command of the Chinese language leaves much to be desired. Therefore, I engaged a teacher to help me improve my Chinese. Nowadays, a lot of Singaporeans have some basic knowledge of Chinese. But when they go to China, they discover that their command of Chinese is very limited. When they were talking business, I would say that they are no different from those who know no Chinese at all. I have also come across some businessmen who came from English schools who are now regretting that they did not spend more time learning their Chinese during their school days. Therefore, I urge our Government not to further lower our standard of Chinese. I fully agree with Prof. Koo Tsai Kee. We should encourage more Singaporeans to have a better command of Chinese. China's expanding market and rapid economic growth should be an impetus for the economic growth of Asia and even the whole world. So if we do not catch up, we would have lost our opportunity of being the bridge between the Chinese and English-speaking people, and this opportunity once lost would not come back. We have emerged from the ranks of a developing country and are attaining the status of a developed country.”
“Compared to Hong Kong, I think we lack flexibility and we do not have the urgent desire to succeed. The Hong Kong people of five years ago were entirely different from what they are today. Five years ago, the Hong Kong people may be arrogant and their standard of Mandarin was not very good. When we spoke Mandarin to them, they could only understand half of what we said. But, today, their service attitude is much improved, and they can speak Mandarin very eloquently. Let me now talk about our future generation and our education system. Let me share one story with you. A duck was showing off to the fish in the pond. He said, "I am the most talented among all the creatures. I can run, I can swim, I can fly. Don't you think I am very talented?" The fish smilingly replied, "Yes, you can run, you can swim, you can fly. You have this multi-talent which other animals do not have. But just think about it. When you run, you cannot run fast; and you cannot even catch up with the dogs and the cats. Talking about swimming, you cannot swim as far as I do. As for flying, you are the slowest and the lowest-flying among all the animals that fly. Do you still say you are the most talented?" From this story, we can see that specialty has a lot to do with excellent performance. In our society, we have cultivated many multi-talented people, but we should also cultivate some specialists. In order to face the challenges ahead of us, we have to restructure our education system. That is why I hope that the Ministry of Education will give our children more room to develop their talents and skills. I have no quarrel with the setting of basic grade requirement for the core subjects and I also support the bilingualism policy. But, as we all know, children learn at different paces.”
“Recently, I talked with some of my friends who are doing business in China. They told me that the various foreign government organisations doing business in China have very close relationship with their local businesses in their own homeland. USA, Japan and Taiwan are good examples. If one company wins a big contract, they will sub-contract to their own people, to their own businesses in their own land. In comparison, the relationship between GLCs and the SMEs needs to be improved. Our GLCs should also respond to the Government's call to lend a helping hand to our local SMEs. We should encourage our GLCs to have better rapport with the SMEs. They should lend a helping hand to the SMEs so that they could have the chance to show their strength. This would put them in a better position to venture overseas. The Government agencies should also conduct seminars to encourage Singapore business to work closely together and to avoid treating one another as competitors. It is said that at home, you depend on your parents, but outside you have to depend on friends. If we cannot help ourselves, then who is going to help us? Going overseas for our business, of course, will bring some pressure to our families. I think the Government should help to alleviate this burden. For example, we can build more Singapore international schools or also give some grants for our businessmen to defray some school fees for their children. Without their support, the people in the SMEs would not be able to maintain their very heavy cost of living in other countries, and many of them will sacrifice the opportunity to venture overseas. On the other hand, our local entrepreneurs should also improve the attitude in their work and service, and also their desire to upgrade themselves.”
“(In Mandarin): Mr Speaker, Sir, the economic prospect of Singapore this year has improved. We are all hoping that the economic recovery this time around could be sustained successfully. I firmly believe that with the concerted efforts between the people and the Government, we should be able to overcome the obstacles before us. The financial policies and the Budget announced by the Deputy Prime Minister are prudent and have far-reaching implications. This Budget is pro-business and it has also focused on helping the lower income families, eg, topping up of Medisave account for the senior citizens and more allocations for Medifund. I support this Budget. However, our Singapore people should learn to be more self-reliant and be less dependent on the Government. In fact, many Singaporeans are making efforts to improve themselves. They understand that ultimately, they will have to improve their skills so that they can get a good job and not wait for the Government's allowances to help them. I hope that the Government will set up more incentive schemes to encourage our people to upgrade themselves. As our market is limited, the entrepreneurs have to venture overseas. Only then can the companies have the opportunity to grow. Being unfamiliar with the new territories, the SMEs have to face a lot of obstacles. Our Government should continue to help them. Today, in the international market, the competition is very intense. The various governments, including the USA and Europe, are actively helping their local businesses to win over overseas markets and contracts. If our Government does not step up our efforts to support our local enterprises with more active and realistic actions, our engine of growth would have lost its momentum.”
“We must also pay attention to the welfare of potential donors. Factors such as undue influence and family pressure can affect a donor's judgement. Are there any follow-up medical and psychological checks conducted for donors? It would be useful for the Ministry to set up a database of all living donors and conduct a study tracking their health and subsequent attitude towards the procedure. The results of this study would be useful to assist us in refining our health policy in the future. With that, I would like to conclude my support for the Bill. EXEMPTED BUSINESS (Motion) Resolved, That the proceedings on the business set down on the Order Paper for today be exempted at this day's sitting from the provisions of Standing Order No. 1. - [Mr Mah Bow Tan]. HUMAN ORGAN TRANSPLANT (AMENDMENT) BILL Debate resumed.”
“Successful transplantation also depends on continued medical follow-up and the patients' compliance with the regimen of immunosuppressive drugs. The expense of these medications and treatments for resulting complications can be very high. I would like to ask the Minister how many patients have applied for financial assistance for such therapy, the quantum of assistance, if any, in the last three years and what financial assistance schemes are in place for this specific purpose. Next, I would like to touch on living donor organ transplants. Currently, for living related organ donation, genetic tests to prove the relationship between donors and recipients are not required in Singapore. However, it is required in the United Kingdom. Due to the potential for financial inducements in living organ transplants, I would like to recommend that the Ministry consider making genetic tests mandatory. For living unrelated organ donation, the Bill has provided for the appointment of a hospital's Transplant Ethics Committee to perform the evaluation. As we all know, transplantation brings money as well as prestige to the hospitals. Therefore, there is a risk, however minimal or minor it could be, that a hospital would be tempted to encourage potential recipients to recruit potential donors more aggressively or even be involved in the process itself. While the presence of a medical practitioner not employed or connected with the hospital and an independent lay person on the ethics committee can act as a safety check, it is definitely not foolproof. Different hospital evaluation criteria could emerge. Hence, I would like to suggest that clear, uniform and stringent regulations be laid out for all hospitals, both public and private.”
“The next point I would like to raise is that the Act has specified that it does not apply to donors below 21 and over 60 years of age. Should the Ministry also specify, or at least provide some guidelines for the age of the recipients, in order to ensure that breadwinners and parents with young children receive priority? The next point I am going to raise regards severe kidney disease as a real risk following transplantations. I came across an interesting publication in the New England Journal of Medicine in September last year. It concerns the largest study of non-kidney transplants ever conducted, that is to say, transplantation involving other organs, such as hearts and livers. It was stated that, after the operations, 16% of these patients suffered from severe chronic kidney disease. Subsequently, 33% of the group progressed to end-stage renal disease. The study involved 69,000 people in the United States who received transplants between 1990 and year 2000. Successful transplantation is defined by the long-term survival rates and improvement in the quality of life of patients. Hence, the study underscores the importance of counselling potential recipients on the significant long-term risks of kidney failure associated with transplantation, in addition to the opportunistic infections, cancer and bone diseases. In addition, the same study found that liver transplant recipients had a prevalence of Hepatitis C of 21%, with an associated excess risk of chronic renal failure. In view of this new information, I would like to know if there are regulations for hospitals to provide counselling to transplant recipients and requirement for them to update counselling materials and guidelines on a regular basis.”
“Arthur Caplan, an ethicist at the University of Pennsylvania, stated that the tissue was worth "more than diamonds, in some cases". The market for solid organs is more difficult to estimate because it is illegal in almost every country. However, international reports point to a dark and exploitative sector which is growing by leaps and bounds. What does all this mean to Singapore? Are Singaporeans immune to the lure of organs for sale? Not at all. Although we have no official statistics, for years we have heard occasional stories of sick Singaporeans going overseas for transplants. Often, the sources of the organs are suspect, with fatal consequences for the recipient due to organ mismatches and post-operative infections. Still, some continue to take the risk. They are afraid to join the ranks of those who have died while waiting or being forced to drop from the list while still being alive, because they become too ill to remain candidates for transplant. To address this shortage and keep organ trading at bay, the Ministry has chosen the opt-out system, which has proven worldwide to work better and effectively in increasing the number of organs compared to the opt-in system. However, with an expanding aging population, we must ask how Singapore is to cope with the never-ending needs for donors. More and more citizens will live longer, with the failure of perhaps one or two organs later in their lives. Transplants would then become more and more attractive as a means of postponing the inevitable. The scarcity could never be satisfied for underlying the demand is the natural human denial and refusal of death. The Ministry needs to work with the hospitals to educate Singaporeans at risk about the pitfalls of obtaining organs from doubtful and illegal sources.”
“Mr Speaker, Sir, I rise to support the Human Organ Transplant (Amendment) Bill. The support given by most respondents at the Bill's public consultation organised by the Ministry for the past year is clear evidence that there is good trust in our health system and our doctors. Singaporeans know that the precious gift of life from fellow citizens will not be abused for monetary gain nor will it compromise the provision of healthcare for potential donors. However, having said all this, I have the following points and questions to raise. The shortage of organs is not unique to Singapore. In a report "Human Organ and Tissue Transplantation" published by the World Health Organisation's Secretariat last year, it was noted that about 70,000 solid organs were transplanted annually worldwide. I quote, "The persistent and widening gap between patients' need for organs and the number available for transplantation" has become an international problem. The long waiting list has fuelled the growth of international black market in the trading of organs. Nancy Scheper-Hughes, a professor of anthropology at the University of California, has written extensively on human organ trade. In an article, "The Global Traffic in Human Organs", she wrote: "In general, the flow or organs follows the modern routes of capital: ... from Third to First World, from poor to rich ...". A 2002 Canadian Broadcasting Corporation programme named "Deadly Harvest - Parts for Sale" highlighted the rapidly growing tissue industry, estimated to be worth more than half a billion dollars. Apparently, a person who procures and sells human tissue could make anywhere from $80,000 to $200,000 per body.”
“Sir, if the aim of the ERS is to help cushion the impact of the GST hike, which is especially so for the low-income families, and with the understanding that many low-income families do have many other arrears, including utilities arrears, could the DPM reconsider the confiscation?”
“This flexibility allows us to better cater to some of our students' diverse abilities. We are already doing the same for Normal (Academic) students who have, from this year, been allowed to do two 'O' level subjects at Secondary 4.”
“In addition, Secondary 4 Normal (Technical) students may be promoted to the Secondary 5 Normal course if they obtain grade 1 in English and Mathematics as well as grade 3 or better in one other subject at the 'N' Level examinations at the end of Secondary 4. In the last five years, an average of 350 Normal (Technical) students, or about 4.9% of each Secondary 1 Normal (Technical) cohort, were transferred to the Normal (Academic) stream each year. Dr Amy Khor has asked if these criteria will be reviewed to allow more opportunities for Normal (Technical) students, who have the inclination and aptitude, to switch streams. The criteria for transfer seek to ensure that only academically-inclined students, who can benefit from an academic course, will qualify. We should not equate success for Normal (Technical) students with transferring to an academic stream. Progress up the path of technical education is an achievement no less valid than moving up the academic pathway. We will continue to encourage and help Normal (Technical) students, whose needs and abilities are best catered to by a technically-oriented education, to progress as far as possible in their studies, to post-secondary education in ITE and beyond. MOE is conducting a review on the Normal (Technical) curriculum, its delivery and its assessment system. The review will consider how we can better gear the Normal (Technical) programme for our technically-oriented students. To introduce greater flexibility within the Normal (Technical) course, we will also allow Normal (Technical) students with relatively strong abilities in certain subjects to proceed faster in those areas. They will be able to offer 1-2 Normal (Academic) subjects in areas in which they have particularly strong strengths.”
“On the second question, all FSCs impose a charge for counselling. It ranges from being free up to about $50 or so. If a particular constituent is referred to or goes to another FSC outside his boundary, he will also be charged. The charge has nothing to do with the fact that he is outside that boundary because all FSCs impose a small fee. But, Sir, any client who comes to the FSC and who cannot pay will not be turned away. That is the fundamental principle. If the hon. Member knows of any specific case that warrants my attention, I would be most happy to look into it. NORMAL (TECHNICAL) AND NORMAL (ACADEMIC) STREAMS (Criteria for transfer) 2. Dr Amy Khor Lean Suan asked the Acting Minister for Education (a) what are the criteria for Normal (Technical) students to be transferred to the Normal (Academic) stream and the levels at which such transfers can take place; (b) whether these criteria will be reviewed to allow more opportunities for Normal (Technical) students who have the inclination and aptitude to switch streams; and (c) what is the percentage and number of Normal (Technical) students who are transferred to the Normal (Academic) stream per year over the past five years. The Acting Minister for Education (Mr Tharman Shanmugaratnam): Mr Speaker, Sir, students from the Normal (Technical) course may be transferred to the Normal (Academic) course if they display the interest and aptitude for academic courses. Students need to attain an average score of 70% or higher for all subjects in the Normal (Technical) course to be eligible for the transfer. Most transfers take place at the end of Secondary 1 so that the students would have adequate time to adjust to an academic course and prepare for the 'N' Level examinations at Secondary 4.”
“Sir, I have two supplementary questions. The first question is currently, all the FSCs have the same funding, regardless of whether or not they provide counselling or crisis management services beyond office hours. So is there a necessity to review this funding mechansim? The second question is this. I am glad that the Minister mentioned that about two-thirds of the FSCs operate after office hours. But from what I know, a resident who is not being serviced by one FSC and he goes to another FSC for service, especially in the case of a crisis management, he is expected to pay a fee, and the fee can be as high as $70 per session. Is there a need to change this practice? Assoc. Prof. Dr Yaacob Ibrahim: Sir, all FSCs are given a budget based upon what is the projected workload that they would have to handle every year. We are reviewing the entire role of FSCs, with a view to strengthening some of the resources that may be needed. But the principle of whether we want to mandate all FSCs to open up beyond office hours is something that we have to consider very, very carefully. At the end of the day, we have to see whether or not there is a real need for all FSCs. At the moment, as I have mentioned, 23 FSCs are already open beyond office hours primarily because they want to service some of their clients whom they are familiar with, who are working and they come back in the evening. Therefore, they need to meet counsellors beyond office hours. Sir, at the moment, MCDS does not feel that there is a need for us to extend the operating hours of all FSCs beyond office hours. But whether we will increase the funding or not in response to what Prof. Ngiam has asked earlier, because of the additional work, we will study their needs carefully.”
“I would like to ask the Minister whether there is any consideration in the review to have all FSCs offer services after office hours, especially with regard to counselling services. Assoc. Prof. Dr Yaacob Ibrahim: Sir, at the moment, we do not see the need for all FSCs to operate beyond office hours. We have, as mentioned in my reply, 23 out of 36 FSCs operating beyond office hours and some of them do it on their own because they see the need to cater for clients who may need services in the night. We will ask our FSCs to put up information on the notice board to allow residents who need to get some help after the FSCs have closed for the day to turn to other appropriate agencies. At the moment, I cannot say confidently that all FSCs do have this information up on their notice board. We will ask all the FSCs to put up all the relevant information so that in case of an emergency, a family that turns up at a FSC which is closed, they can turn to other sources which are available within the community.”
“I fully agree with the fact that EIP is wonderful in promoting racial harmony. I do have an Indian resident who actually bought his flat in 1996 from a Chinese. However, when he wanted to sell his flat now, he could not do so because he was told that he could only sell it to a minority race. I would like to ask if it would be fair for a person from a minority group who bought his flat from a Chinese but is unable to sell it to a Chinese currently, as in the case of my Indian resident.”
“Sir, recently, I have seen a large number of bicycles equipped with self-installed motors travelling on the streets. Can I find out how aggressive is the authority clamping down on such activities? Do we see a need for stricter licensing requirements for such vehicles? I believe this is partly related to the Ministry of Transport. Assoc. Prof. Ho Peng Kee: Sir, this is under the Land Transport Authority. I think there is a categorisation where if it is above a certain capacity, then they will have to register. In terms of the details, the Member has to file a question with the Ministry of Transport.”
“Thus, a blank paper was submitted as the answers were illegible. Singaporeans should set aside part of their monthly salary as savings, and not depend solely on the CPF savings for their old age. I believe the package to buffer the impact of the CPF retuning exercise will be adequate to help our people deal with the changes. I hope that the Government will help the poorer Singaporeans, particularly in their housing, transportation and healthcare needs. I would like to take this opportunity to express my appreciation to Minister Khaw Boon Wan for his announced intention to cut healthcare costs in Singapore. I hope that other Ministries will also do their best to cut down the various charges to lighten the burden of the people in meeting the high cost of living. 6.15 pm”
“Any change to the contribution rate can only bring more procedural work to the employers. I would suggest that the CPF contribution rate should be maintained at a low but reasonable level, so that the employees will have enough savings to look after their retirement and healthcare needs in their old age. I also hope that the Government will encourage those companies which have done well to give more bonuses to their employees, through the grant of some tax incentives. The persuasive power of our leaders is not enough. To many companies, the appraisal of their shareholders on them is of paramount importance, and the remuneration of workers is secondary. To make sufficient provision for old age is the responsibility of the individuals rather than that of the Government. Although I understand that the Government wants to maintain relatively high CPF contribution rates to ensure that every citizen has enough savings for his old age, this has caused our labour cost system to be inflexible. Let me give you an illustration. A long time ago in ancient China, there was a rich merchant who made every effort to cultivate his son and prepared him thoroughly for the Imperial Examination. Unfortunately, when this son of his sat for the examination, he failed to make the grade. The rich merchant asked to see his son's answer sheet, and was shocked to find that there was no writing on the sheets, except for some watermarks. It happened that in the past the father would always grind the ink slab to make the ink for the son to write with his brush-pen. At the examination, the father was not there to grind the ink slab, so the boy did not know how to generate the ink from the ink slab, and he simply wetted his brush with water and wrote his essay.”
“Mr Deputy Speaker, Sir, I support the retuning of our CPF system. Although the medicine is bitter, it has to be swallowed. The proposed changes to the CPF may bring financial pressure to our people. But if we tighten our belts, this new system will help us to maintain our competitiveness, save jobs, and even create more job opportunities. Because of the high labour cost in Singapore, even higher than that in the United States and Australia, we must make quick adjustment to adapt to the investment changes in the international market. However, I hope that the Government will avoid making too many changes to the CPF system in future. Although flexibility in the CPF system will enable us to deal with the investment trend more nimbly, frequent changes to the CPF system will send unclear signals to the business community and the investors, making it difficult for them to make long-term plans. This would also cause confusion to the investors, and give them an unfavourable impression of Singapore. As a matter of fact, our CPF system has been subjected to many rounds of adjustments over the past few years. Ultimately, salaries and remuneration should be decided between the employers and employees. The CPF contribution rates do not make any distinction in the industries and companies. The performance of each industry, company and employee is not uniform. If you cut the contribution rate of employers, it will amount to a pay cut to the employees. This is unfair to the workers. Not many employers will tell the employees who have performed better that, "This time round, your CPF contribution rate is reduced, let the company pay you cash every month to compensate your losses." Whatever the CPF contribution rate may be, the employer has already provided for it in his budget.”
“I am sure the House would agree with me that, to date, the Government has done very well on this. PM, DPM and Minister Lim Hng Kiang have, time and time again, been emphasising about social responsibilities, and we all know that there are always some black sheep in the community who are socially irresponsible and selfish. Thus, in addition to the continuation of public education and the call for social responsibility, the amendment Bill would be necessary and definitely timely to safeguard the interests of socially responsible Singaporeans and definitely the general population at large. Let me end by saying this. Laws are necessary because of seeming disregard for public health, just like smoking, drunk driving, etc. And in a situation of an infectious disease like SARS, the effects carry even more profound and severe consequences. Laws are there to support and allow public health officials to act safely, to act as deterrent, to guide human behaviour and to spell out the gravity of the situation to the few who could not care less. Nevertheless, the public must still continue to be educated. Ignorance and fear would be more deadly than SARS itself. Ignorance would be overcome by public education. Fear would be minimised by the effort of the Ministry of Health, the healthcare workers and the Ministerial Committee's effort and, definitely, by the amendment Bill. Thus, I support the amendments.”