Dixie Tan
Singapore
“Although I did not enjoy it, it was good for me."? I think if you ask old soldiers, you will find many of them saying yes. And thirdly, from the point of view of the nation, is the nation better defended and more secure for having had those soldiers doing the training which they were required to do?”
“Indeed, the Minister for Homes Affairs has just today announced that he will be bringing in a Bill to provide for a strict divide between religion and politics.”
“In relation to the admission of husbands into Singapore, did the Minister not mention the question of work in regard to employment pass? Is there going to be this requirement?”
“If we perceive that there is a need, we should just carry on and start these departments in the university, however small the starting numbers of students. Then again, Sir, I have made this point before - I feel that each of our universities should be broad-based and should offer essential disciplines to be included in the subjects.”
“The reason is that I am worried that if we protect our population, our people, from all kinds of possible dangers and never expose them to any real dangers, they will not have the stimulus to grow and develop into political maturity. That, I think, will be a danger to us in the future.”
“Sir, is the Acting Minister aware that in cases where the stated reason for a nurse leaving the Government service is set down as poor working conditions, or poor self-image and such other non-monetary reasons, these reasons are blocked at the supervisor level and that the nurses are more or less impelled to state the reason as being mone…”
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“Care-giving in the family for people who might be very elderly, who might be convalescent, chronically ill, disabled, usually devolve on the women of the household. These women need help. They need respite care. They need counselling. They need encouragement and they need it in a readily accessible fashion, not in the HQ of the MCD. Then there are large numbers of children at risk, and this too has been touched upon. When I talk of children at risk, I mean children of women who are at work, particularly women from very poor households who do not work for the pleasure of it but in order to keep the family's body and soul together. Then there are families that are broken, families that are breaking, and families where their relationships are poor in some other way. This number of children will increase as more and more women go out to work. There is a need for good quality care and easily available care. Child care centres have been much talked about but I wish to add that children in school also need supervision and care during the hours when they are not at school until the hours when the adults are at home. If they are not cared for, then they roam about, as the Member for Telok Blangah has said, and they are at risk of becoming delinquents, low achievers, school dropouts and so forth. Whilst the Ministry of Home Affairs is doing a good job of rehabilitation of drug offenders and other youths that break the law, what we really want to see is prevention of the problem, and prevention is the responsibility of the Ministry of Community Development. Now I wish to enlarge on the proposal for neighbourhood counselling and care centres.”
“Sir, I wish to enlarge on the remarks made by the Member for Siglap and the Member for Bo Wen and others. To begin with, I wish to commend the Ministry of Community Development on the services that they do provide at present. I think these are not to be downgraded in any way. I think we need to commend them. But what I really wish to do is to call on the Minister to provide additional services in the form of branch services in all constituencies. The rationale for this is very simple. Services which are for the population at large can best be utilized and can give the best results only if they are readily available to the people. For instance, education, health and, more recently, even police services, are easily available to all our people wherever they may live. Why not community services, which are so very important in the lives of people? These are the kinds of services that I have in mind and much of these have been covered just this morning. Services for families at risk. You have heard that divorces are increasing from year to year. Pari passu with this increase in the number of divorces, there has been a decrease in the marriage rate, from 73 per 1,000 unmarried persons to 57 in 1986. The figure 73 was a little bit higher than average and this was in 1981. But there has been something like a 22% decrease in marriages and 27% increase in divorces. Clearly, the trend is towards fewer family units being formed and towards more family units being broken up. In fact, of the family units that are breaking but not yet made into the statistics, we do not know how many there are. Then there are families under stress, which has been mentioned.”
“Sir, is the Acting Minister aware that in cases where the stated reason for a nurse leaving the Government service is set down as poor working conditions, or poor self-image and such other non-monetary reasons, these reasons are blocked at the supervisor level and that the nurses are more or less impelled to state the reason as being monetary before their application can get passed?”
“Mr Deputy Speaker, Sir, I wish to support the intention of this Bill, which is to establish good standards of care for young children under the care of child care centres. Although it is my personal conviction that infants and young children thrive and develop best under the care of their own parents within the confines of their own homes, I do recognize that there is a trend for increasing demand for places in child care centres, and therefore it is timely that we ensure that standards of care are good when parents seek to place their children in these centres. Most of the points have been mentioned by other Members and I am sure that we all support this Bill. This Bill in effect gives the Minister wide ranging powers to draw up comprehensive regulations for the centres and powers to enforce them. Under clause 19 there is a long list of regulations setting out all the various aspects of the child care centres. May I suggest that an additional regulation be included which will address the question of minimum space allocation per child, and other factors of building construction such as ventilation and natural lighting. If I may digress just a little. I feel that child care centres are good to have but it may be that they are not the best thing for very young children. But it may be that in the future the need may arise when we ought to extend the scope of child care centres to include the care of children who are schooling, be they primary school or secondary school but, in particular, children of primary school age and children whose parents are both away from home, and who would return home after school to an empty house. However, this concept is not within the scope of this Bill.”
“Mr Deputy Speaker, Sir, may I make a comment on section 29(2) where the Board pays out monthly or other periodic loan instal- ments. There is no mention of the starting point where these payments will be taken up. I bring this point up because certification of incapacity often takes quite a while to be obtained, either because the attending doctor is not sure of the final degree of incapacity or because of just the slowness of the bureaucracy. A period of time may have elapsed, up to two or even three years, before there is actual certification. During this period the family of the member who is incapacitated would have to pay out the instalments. Is there any provision at present or in the future where a refund can be made where a case has been established that the member was actually incapacitated from a date previous to the certification of that incapacity?”
“Sir, would the Minister inform us whether he includes in his concern the quality of child care as given by parents themselves, and what is he doing to improve this nation-wide?”
“I should like to really try to place this concept that this is a surgical operation, and indeed it is, because it will be done by qualified surgeons who are experienced in the removal of organs and who are experts in the reparation of the surgical wound. One other matter. Kidney transplantation is not done for acute renal failure. It is done only for chronic renal failure. Acute renal failure is treated by other methods. Finally, I would wish to commend this Bill to all Members. 280 deaths from chronic renal failure in one year and so many from heart attacks and so many from accidents tend to leave us cold. These are just numbers. But anyone who has known a person suffering from chronic renal disease and who has known the suffering and the anguish of this person as well as the whole family concerned will no doubt support this Bill wholeheartedly. Sir, I wish to support this Bill.”
“Mr Speaker, Sir, first, I should like to commend the Minister and his officials for having gone to a lot of trouble to ascertain the views and the feelings of all segments of the population in the drawing up of this Bill, and taking all these views very seriously. I think most of the points that had been brought up by various peoples and by the various groups have been incorporated into this Bill. I support this Bill wholeheartedly and totally. I should like now to try and project a concept of the process of organ donation. Actually we should try to look at organ donation as a surgical procedure, much like operations that are being done every day in operation theatres in hospitals all over Singapore. Some people have expressed the fear that organ donation will leave a body that is hollowed out. This Bill specifically states that only kidneys are to be removed. The kidneys are two small organs located at the back of the abdomen, and surgery to remove these two kidneys will not leave any vacant space within the body. Then I have heard some people talk of mutilation of the body. There will not be any more mutilation of the body than the result of a surgical operation, namely, there will be one more line on the surface of the body that can be seen. In fact, victims of accidents, unfortunate enough to become organ donors, will be people who have suffered much more damage, damage enough for their brains to be dead, and the likelihood is that they will be far more mutilated on account of their accident than on account of their being organ donors.”
“Therefore, I would suggest that the Member for Anson owes a full apology to this House, to the people and especially to the Chief Justice; for the wrong that he has done to everybody, for the wilful way in which he has misled or tried to mislead at any rate the people. All this has caused a great wastage of time and effort and money if we start to count it. Surely, we have better things to do in this House than to waste a lot of time debating on empty, irrelevant, and things which are clearly proven to be untrue. How can we Members, honourable Members of this House, stand up and start saying things about the Police, the Judiciary, persons and institutions without any evidence beforehand? It really pains me, Mr Speaker, Sir, that such behaviour should be seen in this House. I would repeat my suggestion that the Member for Anson owes us and the people and particularly the Chief Justice, even Mr Michael Khoo, a full apology for dragging their names through the mud practically. With that, Sir, I beg to support the motion in the name of the Minister for Home Affairs. [Applause].”
“Mr Speaker, Sir, I do not think I want to attract any more boorish behaviour and make his reputation worse.”
“--- that a Member should so flagrantly abuse his privileges, especially when he has been elected in good faith by the people of Anson.”
“Mr Speaker, Sir, it saddens me that a Member of this House should behave in such a deplorable manner ---”
“On top of his other failings, Mr Speaker, Sir, I find him extremely rude, very boorish and absolutely without any sense of decency of behaviour. Some hon. Members: Hear, hear!”
“Mr Speaker, Sir, let me repeat. In my opinion, Members of this House have special privileges under protection and we have the media which bring our words into every home. Not only the words of Members on the Government side but also the words of the Opposition Members. However, this privilege, and this is what I really want to say, carries with it a duty and a responsibility to take care that whatever we say must be true and just and definitely must be defendable.”
“Thank you, Mr Speaker. Now we come to all this long business about the Judiciary. The Member says that his words do not amount to an accusation. I do not wish to go into words, regulations, Acts and sections but as a long suffering Backbencher having to listen to all his very long speeches, it was very clear to me about his meaning. His meaning was that the Chief Justice made a decision to move the Senior District Judge at the behest or under the influence of the Executive. That meaning came across to me extremely clearly. As for his intentions, I will not talk about that today. However, we all know that an independent Judiciary is basic to the structure of our nation. Therefore, if the work of the Senior District Judge can be influenced by the Executive, by non-legal considerations, it then follows that people will think that the independence of other Judges in the District Courts can similarly be influenced. And the Member for Anson himself mentioned this possibility. Therefore, I think this matter was taken up very rightfully and we have heard the evidence. We have seen his shifty behaviour in court. I beg your pardon. I withdraw that. We have seen his shifty behaviour at the Commission of Inquiry and we have seen his shifty behaviour in this House, right up to five minutes ago. He is shifty all the time apparently. Members of Parliament have special freedom of speech, special privileges under the protection of this House. And not only that, the media bring our words into every home.”
“--- how he brought up a fictitious case of wrongful detention by the Police. That is a very serious allegation. And yet it was without foundation altogether.”
“The Member for Anson has a long track record of throwing mud at innocent parties. But this matter is really getting too serious to be tolerated. Just yesterday ---”
“Mr Speaker, Sir, I really feel impelled to say a few words. Members of this House know that I am not in the habit of criticizing Members of the Opposition. It is my belief that every person is entitled to his or her opinion and opinions do differ in anything and everything. But making false and malicious accusations is another matter altogether. And we have heard too much of this in this House. The Member for Anson, of course ---”
“Then in the years to come, if our birth rate continues to fall, we may well need a Family Planning and Population Board to promote births in our population, to encourage people by various means to have more children instead of less children. For all these reasons I would ask the Minister to consider retention of this Board. It could be that the present infrastructure is not required and therefore it can be scaled down to whatever is necessary. The Board may be very small. It does not need, maybe, permanent staff or secretaries and so forth. Whatever is necessary can be retained and whatever is not necessary can be scrapped. But I would make a plea for this Board to be retained and for its functions to be varied according to the needs of our country.”
“Mr Speaker, Sir, can I add a few comments? I would support the Members for Bo Wen and Changkat in their remarks that the Act for the Board does not need to be repealed because family control and population control activities are now no longer needed on a big scale since the original objectives of the Board have been met. However, population control and family control does not merely mean family reduction and population reduction. It can mean other things. It can mean the mode of family control and contraception. For instance, the Board promoted oral contraceptives in a big way. At the same time, the Abortion Act was introduced. The Abortion Act has now run for about 14 years. The number of abortions has shown very sharp increases and many thinking people are very anxious about this problem. I think we need people, who have a long standing interest in the pattern of population and the way it is controlled, to monitor the numbers of abortions, the reasons for abortions and the implications on our nation - the social implications, for instance, how it will affect our thinking of life and death, and the implications of young people going for abortions rather than women in their 40s who were the original target for more abortions. These are matters of some national importance. Somebody need to look at them and who better than the Family Planning and Population Board. Then again, there are constantly new products in the market for contraception. We hear about injections, we hear about new hormones for both men and women. Here again, it will be good that we have a Board that can evaluate the efficacy, the dangers, the desirability to promote the uses of various oral contraceptives and other types of contraceptives for our population.”
“Mr Speaker, Sir, would the Minister of State tell us whether the recent publicity and efforts by the National Kidney Foundation to encourage people to support opting-out legislation for donor organ transplantation have been successful, and whether he feels that more cadaveric organ transplantations should be done in Singapore?”
“Sir, I shall continue with the remarks on organ transplantation. In 1985, 141 patients with chronic renal failure were presented for treatment at the Renal Unit of the Singapore General Hospital. This represents the demand for kidney transplant operations. On the supply side, in the same year, only eight kidney transplant operations were done. In 1984, 1,109 people died as a result of accidents. Of these, 45 of them were suitable potential organ donors. However, because they had not previously indicated their wish to be organ donors, 90 other people lost the chance for a new kidney and a new life, and if we include heart transplantation for which surgical expertise is also available in Singapore more people could have had a new life. Sir, I wish to urge the Minister to redress this situation by introducing some legislation. Legislation does not need to be compulsory. People who do not wish to donate their organs should they die in an accident can opt out of being organ donors and a register of such persons should be kept and be available at all times before organs are removed. Secondly, certification of brain death should be done by a panel of doctors who are not in any way connected with the transplantation programme. And finally, a lot of time and opportunity should be given to all sectors of the public to express their disapproval or their support or to bring up additional safeguards so that fair provisions be made for everybody's protection but at the same time allow our big problem of organ shortage to be met.”
“Many family members, such as wives who could work, have to give up their jobs so as to be able to help husbands to do their home dialysis or else to escort them to the dialysis centres. Every patient with chronic renal failure dreams of a new life with a new kidney. Kidney transplantation has been available in Singapore for many years. The techniques for the control of rejection of kidneys have also been available and are now so good that transplantation ---”
“Sir, by strange coincidence, the three of us, the Members for Toa Payoh, Jalan Kayu and myself have kidney disease on our minds. But let me give a few more figures. Every year about 200 people develop this very serious disease. Many of these people are young adults who may have recently started a career or recently started a family. The patients with this condition have three choices - death, dialysis, or kidney transplantation. Sadly, most of them die but certainly not from choice. Let me explain. In 1985, 141 patients with chronic renal failure sought treatment at the Renal Unit of the Singapore General Hospital. 107 or about three-quarters of them had to be turned away. Haemodialysis has been available in Singapore since 1968 and patients with non-functioning kidneys can be kept alive and actually fairly well if they are hooked up to dialysis machines for a five-hour treatment three times a week. At present, there are in the public sector some 30 machines providing service to 120 patients. A few of these patients have been stout-hearted and managed even to buy their own machines and have their dialysis at home. However, the costs are really formidable, as the Member for Toa Payoh has pointed out. Funding aside, patients with chronic renal failure on dialysis are literally tied to their machines for half a day, three times a week. The patients run the risk of contracting complications at each dialysis and run long-term complications, such as brittle bones. It is also a poor quality of life. Patients cannot find jobs because of having to take time off to go for dialysis. Nor is the patient alone in his suffering. Family members suffer along, emotionally as well as financially.”
“There are quite a number of such teachers, I believe, and the College of Physical Education is doing its job. But in art and music, at the moment there are only very few schools that provide art elective programmes and music elective programmes. Unfor- tunately, it does not seem feasible to introduce this very quickly because there is a bad shortage of teachers in these two areas. This brings me to tertiary education. I propose that funds from our development estimates be spent on a National College of the Arts to raise these areas of art to Diploma level. This college should also include an art gallery and also a theatre where students can exhibit their works of art and perform and get practise. If we start up such a college quickly, in a few years we will have product designers and graphic artists for our industry, we will have performers for our arts festival and, of course, we will have teacher material for our students both in primary and secondary schools. In conclusion, I wish to make a plea that we value our artistic people as much as we value our technical people because they complement each other to make a nation. We have to nurture the slow learners as well as the high flyers, and we have to nurture the high flyers who are both artistic high flyers as well as scientific high flyers. All citizens should be given a chance to achieve their maximum potential so that they can contribute to the nation in the best possible way. Sir, I support the motion.”
“Do they not also have a right to develop to their maximum potential? There is a great need for the Ministry of Education, and undoubtedly it is the responsibility of the Ministry of Education, to establish special classes for these children so that they too can have an education and training to equip them for jobs and to live independently like everyone else. Right now they are receiving an education in primary schools, but their education is not relevant and is not doing them very much good. Allowing them to grow up without a relevant education is both unproductive and very wasteful. So the National Productivity Board ought to jump on this wagon. Special education for ESN children is available right now. It is provided by welfare associations, but this is not the line to take. I believe very firmly that most of the ESN children right now are in primary schools where they are wasting their time. Therefore, I would plead with the Ministry of Education to develop this area of education. However, there is a problem with the number of trained teachers we have in various areas that I have mentioned. Well-trained teachers are necessary in subjects like music and special education and physical education, just as they are important in other subjects in schools. The College of Physical Education will in due course provide teachers in physical education but we have as yet no proper scheme for the training of the other two types of teachers, and I would again urge the Ministry of Education to develop the training of teachers in these two very important areas, ie, music and special education. Let us look briefly at secondary schools. I believe that every secondary school should provide the teaching of music and dance and physical education. Physical education is well under way.”
“Mr Speaker, Sir, in recent weeks many Ministers have spoken on the development of every individual to their maximum potential. In this context, I wish to draw attention to some areas of education that are in urgent need of development. I have in mind the $3 billion that has been mentioned as going to be made available for human resource development. Let us look at the primary schools first. Primary school education should be as broad as possible. There are good reasons for this. It allows a child to develop his whole self, to develop all areas of his brain -the dominant side as well as the non-dominant side. It also allows any special aptitude in a child to be picked up for further nurturing and development. The present unnatural method of examining only four subjects in primary schools, namely, English, Second Language, Mathematics and Science, causes undue focus and attention to be placed on these four subjects, to the detriment of the other subjects. If we must have examinations, and I suppose we must, then we should assess children in primary schools equally in all areas of study and development. This would include studies such as art, music, dance, and developments such as in physical education. This is especially important because we are streaming children at such a young age in Primary 3 and Primary 6. I wonder how many potential artists, musicians and perhaps even athletes have been lost to us because they failed their Mathematics at Primary Three, or perhaps because they were concentrating so hard on the four examination subjects that other areas failed to be developed and their potential failed to be picked up. Then what about educationally sub-normal children who comprise 2% of the primary school population?”
“This is the National University Hospital. I think the Hospital is quite ambitious and the motives are good. However, looking at it, I think this Hospital has its priorities wrong. A hospital which is charged with the duty of producing our generations of doctors should first and foremost concentrate on the teaching of undergraduates. Secondly, it should concentrate on research. Only finally should it concentrate on giving the kind of service that we expect to give for non-Singaporeans and for private patients. Therefore, where the National University Hospital is concerned, it is not a good model for us. If this model for private medical services should fail, let us not be discouraged. I would call on the private sector of medical specialists to reorganize themselves into efficient units to police themselves so that only the best people with good qualifications and experience will participate in these centres in order that we can achieve our objectives of consistently high medical care at affordable prices. I think in this way the medical services of Singapore can play a very significant part in the economy of our country. Mr Speaker, I have high hopes for medical service in this country. I have high hopes that we will give our own people very good medical care as has been done in the past. And over and above this, I have high hopes that we can and we will give very high quality medical care to people in the surrounding countries both for their benefit as well as for our benefit. 11.43 am”
“One needs to show proof that one is still qualified to be a specialist. Strangely enough, the best models for specialist care with which satisfy all these requirements: efficiency, good caring for patients and good salaries for the people who work there, are to be found in the developed countries where salaries are high, working hours are relatively short, and far away from many of the developing countries whose people go all the way, for instance, to certain clinics in the United States. How do they do it? I think if they can do it, we can also do it. But when I look at the models, and I will mention only the Mayo Clinic which, in my opinion, is a very good model to follow; first and last, they give high quality care to patients. Secondly, their charges are still affordable despite high salaries, short working hours and distance from many of their patients. First and foremost, they gave very consistently high quality care. Having done that for many years, they developed a surplus fund from which they were able to go into research and so on. The Mayo Clinic is in the forefront of research. But this did not come by chance or by happen-stance. They came because of the hard work put in by their doctors and by their administrators. The doctors do not bother about the charges, about the facilities, about anything except patient care. The administrators take care that their professionals work at optimal level and that all the supporting services that are required by these professionals are catered for. Now, in recent years, the Mayo Clinic has become so good in their research that they have gone into teaching of undergraduates and are recognized by many of the medical schools. In Singapore we have seen the emergence of a private hospital set up by the Government.”
“I was amused yesterday to hear about continuing education for people who had not achieved their PSLE. It is equally important for doctors who have achieved their MBBS and other specialist qualifications to also have continuing education. If we had a roll of specialists, we could actually incorporate these requirements for continuing education into a re-registration exercise so that registration is not a life-time thing but is perhaps a five-year thing.”
“Then there is duplication of equipment, which is a very expensive item and which needs to be replaced frequently if we are to keep up with advances in medicine. Re-duplication can be much reduced by a combination of professionals as well as laboratories and other services. In this way, with the pooling, the savings that accrue can partly be ploughed back into the service centre, into the medical centre, so that the centre can continually upgrade and be competitive. Secondly, I hark back to my previous remarks on high professional standards. I believe that we need to have some kind of definite recognition as to who is a specialist in Singapore. This is very important. When people come from elsewhere they have no way of distinguishing one person from another, both of whom may have equally long strings of incomprehensible letters after their name. At this moment, our basic qualification for doctors to practise is their bachelor's degree which they get after their undergraduate studies. We do not have a roll of specialists which says that so and so is now qualified in paper degree as well as in experience to be a reliable specialist in a particular field. I believe that this is the time for Government or else for Government to appoint a reliable body to create such a roll of specialists, so that people coming from broad, and indeed even our own patients, will be able to find their way to reliable specialists who can then give them a consistently high level of care. Some people become specialists because they have certain qualifications and certain experience. And having become a specialist or indeed even a family physician, there is no guarantee that they will keep up their standards. Medicine advances every year and there is a great need for continuing medical education.”
“If the public sector were to deteriorate in standard and numbers because they are non-competitive and because they are inefficient, then I think our country will be the worse for it in later years. Coming to the private sector, I think there is no need for the private sector to be afraid of competition from the government sector. The private sector has nothing to do but to provide a service. They have no encumbrances like bureaucracy, waiting for budgets, and things like that. All they have to do is to give good service. There is no good reason why they cannot compete effectively with the government sector even if the government sector were to offer services to private patients. As it is, the service in the private sector is already being extended to sizeable numbers of non-Singaporeans. However, all of us in the profession know that the clientele has declined in the last year or two, along with the decline in the economies of our neighbouring countries as well as along with the escalating charges that the patients have to pay. So, to the private sector, I would like to commend a reading of the Economic Report. The private sector must and should act to regain their competitive edge and I would like to propose a few methods for doing so. The private sector should reorganize itself into medical centres. What I mean by a medical centre is a cohesive group of a hospital or clinic together with a group of committed doctors so that the hospital and the doctors work as one unit. In this way there can be great savings in personnel, savings in floor areas and in equipment. A simple calculation will tell you that three surgeons sitting in three different offices would do better if they shared one office. This could be done if they were all part of the one organization.”
“Also, it is a terrible waste of medical study to put a medical specialist into a management position. Secondly, we need to promote the image of our many very excellent departments in the medical service. We have departments with very excellent equipment and very high level personnel who can work these equipment and provide services. I think it is high time that our medical services dropped their Cinderella image. Thirdly, many of our professionals are not working optimally. By this I mean that they are not getting enough secretarial help, nursing help and organizational help. I think it is a terrible waste to have a consultant write out his own report in long hand, putting a carbon paper underneath his report sheet in order that the carbon copy can be sent back to a referring doctor who has trouble reading the carbon copy. I think this is a waste of money and very inefficient. Finally, once we have reorganized and become more efficient, this surplus potential for service can easily be put to work in private wings which can be attached to our major government hospitals. These suggestions, if properly implemented, will increased efficiency in service to the benefit of our own citizens as well as to the benefit of other citizens who come from abroad. In case some people in the private sector say that government should not compete with the private sector, it is my belief that we do need a strong government sector in medicine because it is the government and university professionals who have responsibility for producing our future doctors, who have the responsibility for holding the standards and for leading the advancing edge in medicine.”
“So I thought over the various possibilities or the method for achieving this goal so that the medical service can become an important sector of our economy in the future. The public sector, and this includes Government as well as the National University of Singapore, has the primary function of serving our own population. We have a good record of high standard care for all of our population in the way of direct service care, in the way of training of doctors, nurses and other professionals and very important in playing a leading role in the profession so that we can keep up with all the continuing advances in medicine. I believe that with modest reinforcements in the way of support services and style and in the way of new radical thinking, the public service sector in medicine can be more efficient and can generate surplus in their services so that over and above serving our own population, there will be potential capability for serving non-Singaporeans as well. What are the proposals then that I would wish for the public sector? I think one of the most important areas is a change in management style. Our management style dates back to colonial days where a doctor came out from England usually, and was the Head of Department in control of a whole section, and therefore "everything" including management. However, I find it hard to believe that somebody who may have spent four years studying management and another four or five years working in management would not be better at managing than someone else who has studied five years in Medicine as an undergraduate and another four years in Medicine as a post-graduate and perhaps spent nine months studying hospital administration.”
“And these, by and large, boil down to specialist services, particularly in surgery but also in many of the sub specialities. So I think we need to focus on specialities, firstly. Secondly, our profession in the medical services must have a consistently high standard. It does not do to have eight good specialists and two very bad ones. What we need to achieve is an image that Singapore medical care equals good high quality medical care, in the same way that when we think of a Swiss watch, we think of a good watch. So I think standards are very important, particularly in the private sector. In the Government sector, there are systems for appraisal. There are certain standards and certain official recognition of expertise. But in the private sector where many of the doctors are self employed, there is no such uniform system. I will come back to this a little later on. Thirdly, and most importantly, charges must be affordable. We live in a region where per capita income is not very high. To be sure, this is a region of growth and of great potential. But right now, affordability is a very very important consideration when we are wanting to sell medical services to the surrounding region. I might add that charges do not include only medical charges, such as professional charges, hospital charges, laboratory and X-ray charges. They also include factors like hotel charges, restaurant charges, because relatives of patients have to stay in hotels, they have to eat in restaurants and they have to travel around by taxi. However, for today, I will not dwell on these non-medical aspects but confine my remarks to medical aspects.”
“Mr Speaker, Sir, I support the motion of thanks moved by the Member for Changkat for the President's Address. I am in broad agreement with the recommendations in the speech. But today I wish to focus on the role of the medical services in the context of economic recovery and economic growth in the future. I must declare that I have a vested interest in this area but the same interest allows me also a few special insights, I hope. Let us review first the status of medical care in Singapore. We have in Singapore doctors to the population ratio of about 1:1000. This compares very favourably with the 1:600 population in most developed countries. Among our doctors, one in three hold a specialist degree. Again, a very high and very respectable figure for specialization. Our medical school which is well recognized throughout the Commonwealth produces 200 graduates a year. We have a long tradition of training for nurses. We have had for the last two decades or more a good proportion of nurses who hold not only basic nursing qualifications but post-basic nursing expertise and certificates in many branches, such as intensive care nursing, paediatric nursing, psychiatric nursing and so on. We have hospitals which provide good care for patients, both in the public and the private sectors. With these good basic facilities, there is very high and good potential for growth so that over and above the needs of our own population, we can offer these services to non-Singaporeans. So let us think what will sell because that is what we wish to do, to sell our medical services. Services which are not available in other people's hometown or country will be the ones that people will come over here to look for.”
“Mr Speaker, Sir, may I speak now instead of at a subsequent subhead?”
“That is entirely correct and it is a sentiment which we would like every Singaporean to have. It is a pity that the Member was absent during the Committee of Supply. So it was not possible for us to have the benefit of his views and advice on how we can better improve our national defence preparedness, but I am sure there will be many opportunities for more positive contributions later on. Although the Opposition Member for Anson spoke up during the Committee of Supply on Defence matters, it is worthy to note that the fundamentals were unchallenged and were presumed to be correct, that we have to spend a reasonable sum, that we must be prepared, and that we must be ready even though we do not have any enemies today. This is a very significant development which should not pass unnoticed and which, in fact, should be applauded. Such progress cannot fail to have a good effect on the reservists' morale and performance in the SAF.”
“Sir, would the Minister of State agree that the speed of mobilization and the willingness of mobilization would depend a lot on public opinion and public support for this procedure? And what Mindef has done about it? BG Lee Hsien Loong: Mr Speaker, Sir, the Member for Ulu Pandan has brought up a very important point, and that is, how well the reservists respond, not only the speed of mobilization but how well they perform in general. It depends to a very great extent on how well we support them, how well the public supports them. As I informed the House last week, 96% of the public support the idea of national service, although some of them are still not very clear about the role of reservists as front-line fighting soldiers. But we have made progress and, in this process of making progress, opinion leaders have a critical role to play. And even when we talk about opinion leaders, we have taken steps forward. I refer to sentiments within this House concerning national service, concerning national security, concerning the defence of our Republic. If we make a comparison between the sentiments in this House now and the sentiments here perhaps about a year or two ago, significant progress has been made. This year, the Defence budget was discussed with nobody disagreeing with the fundamentals of defence. None of the PAP Members, of course, and none of the Opposition Members. It is an important step forward which we should note, with happiness and with further anticipation, that more progress will be made in time to come. The Member for Potong Pasir has said quite clearly in his first address here that he supports the idea of a strong defence within the limits of our affordability and, if need be, he will sacrifice himself for the defence of the nation.”
“Sir, I think the Minister of State has not quite understood me. What I meant was to involve all these various organizations that we already have within the community to take an interest in any of these homes that are located within their constituencies. If we have people more or less on the spot to visit them or take an interest in them regularly, we may be able to avoid the homes from running down, having low standards, and we would avoid the situation where we have to depend entirely on visits by officials of the Ministry. Officials of the Ministry may be busy with other duties and may not be able to visit very often. But people who actually live in the same community where the home is located should be able to do better than that. 4.00 pm”
“Whilst at this moment there may not be a big problem of the aged because our population is not so old as yet, there is right now quite a considerable problem of the aged sick. In other words, the aged people who have lived at home, who have fallen ill, say, of a stroke, and cannot be looked after at home, have great difficulty in finding a place where they can be looked after by competent staff. I personally know quite a few of these. They are not necessarily from poor families. They are not necessarily destitute at all. But there is not adequate provision in this area and a lot more needs to be done. On both the aged sick as well as the aged, and the homes in general which are run by the Social Welfare Department, I wonder if the Minister will think of involv- ing the community around that home as well as relatives of residents in the home. Of course, in homes that have destitute people only, there will be no relatives who are concerned. But in the home for the aged sick, for instance, there may be relatives, and the community in which this home is located could be interested in keeping an eye on how things are run. If we involve the people there, I think the monitoring of standards will be much better.”
“So I see no real good reason for insisting that students going into our National University should have a certain minimum qualification in second language at 'AO' level. That is the one that, I think, is not necessary. I think this may well bar many students who are eminently suitable for entry, but because they are not so good in the second language, they have trouble meeting this minimum requirement. It is all right to keep the second language even in pre-university education, but let us be clear that this is not for university entry but for improvement of social interaction later in life and also for cultural ballast. Therefore, I propose that this minimum requirement ought to be reconsidered with a view to dropping it, I thank you, Sir. 3.17 p.m.”
“I think now in Singapore all our people accept the fact that we need - to study English and our native language, and I think most of the students do not have much problem with the arrangement. But I see no reason why we must compel every last student to take the language of their ethnic group. The vast majority will do it anyway. But for the few per cent who do not want to do it, I see no reason why we cannot allow them to select one of the other Singaporean languages. I think this will have two good side effects. On the one hand, students whose home language does not coincide with their ethnic group would have less difficulties with second language in school if they were allowed a freer choice. Secondly, there are also students who have special aptitude for languages, and they may well elect to study their native language at home and to do another Singaporean language at school, which means that is their second language and thereby become proficient in three of our languages. Also on the subject of second language, we have in Singapore an entry requirement into the National University of Singapore which is a minimum standard at 'AO' level in second language. In my opinion, education in languages is part of general education and general education ends at 'O' level. This is the level to which we wish to educate the majority of our population. The purpose of pre-university education is to prepare students for entry into the university. Entry into university involves knowledge in the subjects of the chosen course of study and also a good command of the language of instruction which, in our case, is English.”
“What women are looking for is a fair deal, a willingness to take them back, a willingness to know that they are a little bit rusty and therefore they might need a little while to settle down. But I feel that once they come in, they would be good workers for another 30 years and the effort would be very profitable. Let me now touch very briefly on in-service training of teachers. The Institute of Education conducts numerous courses in the teaching of various subjects and I am sure the teachers do benefit from them. However, it is my observation that most of these courses are not intensive enough and not long enough for these teachers to obtain a certificate. In other words, it is not enough for them to be recognized as having special skills in certain areas. Therefore, when they get posted back to work, these special skills tend to get overlooked in the difficulties of job postings. I believe it is very difficult to draw up a time-table for teachers and so forth. Many of the teachers who have actually obtained some special skills do not get the opportunity to use them in their job assignments. Skills which are not put into practice soon get lost, and then the teachers would have wasted their time and the Institute its resources. I propose that the Institute of Education should introduce full-time in-service courses in the teaching of particular subjects and in special education so that the standard of teaching can be raised in a systematic manner. Now, I would like to say a few words regarding the second language in school. Here again, I must say that we have much to thank our leaders for introducing bilingualism into the schools.”
“Let the infants and young children stay at home with their mothers. I have to digress a little bit, Mr Speaker, because in order to encourage women to break their careers to stay at home for a few years, we have to take into consideration their fears that when they have stayed home for a few years, they may have trouble or difficulties returning to work. And these difficulties are quite well founded. So in order to have this good thing that we wish to promote - having mothers to attend to their young children - we must have easily available schemes for the retraining of women before they return to work, retraining so that they can regain skills which have gone rusty, and retraining so that they can feel confident enough to go back into the work force. I think these efforts are well worth the while because on the one hand, it is well worthwhile for a woman to stop earning a salary for a few years because the gain that we get from establishing a family on good solid ground is worth the while in the next generation. Furthermore, it is worthwhile for employers to bring these women back after they have been off work for a while. Because let us say a woman has her first baby at 23 years, second baby at 25 years and goes back to work at 30 years. With the retirement age now at 60, and maybe going on to 65, we have a woman here still with 30 years of service to give to the nation, 30 years of earnings to help the family. So I feel this is a worthwhile matter for the Government to consider, and perhaps Government as a major employer could take the lead to offer jobs for women in this situation. What women are looking for are not special privileges, special pay, and everything else special.”
“And the personality includes aspects such as learning ability, social behaviour, emotional toughness and many others besides which are the ingredients for success in education, not only in education but in all other areas of life. Therefore, I think the nurturing of the first few years of a child's life is extremely important to us as parents as well as to us as a nation. Although women now have education equal to the men, and girls do better than boys in school by and large, still, we have a need to make sure that we bring up the next generation as well as possible in order to give them every chance that they will need when they grow up. Actually, modern or otherwise, mothers of young children must think seriously about interrupting their work careers outside the home in order to devote themselves to their children during this very important phase of development. Singaporeans have so few children nowadays. Naturally the children are very precious and parents are anxious that they have every chance for success in life. Let us get our thinking straight. If we want them to succeed later on, we must give them this early foundation. If we want them to be filial to us later on, we must take the trouble to establish this parent-child bond in the family. And there is no shortcut to it. This brings me to the subject of child care centres. I am not against child care centres. I think we need to have them. But let us not forget the harm which we will do to our nation in the long term if we bring up a whole generation of infants and young children in these centres, however excellent they may be. Let us have the child care centres, but let us have them for the kindergarten age and the primary school age children, rather than for infants and young children.”
“Mr Speaker, Sir, I rise in support of the motion of the Member for Ayer Rajah in thanking the President for his Address. Sir, allow me to comment today on some aspects of education. In Singapore today, we have education easily available and of very good quality, equal to any in the world. That this happy state should have been achieved within a very short period of two or three decades is all the more remarkable and a testimony to the wisdom and the energy of our leaders during these years. However, we cannot rest on our laurels. We must press forward towards the goal for our people. And this is not a new goal, for let me read from the Constitution of the People's Action Party: 'To achieve their maximum potential through education and training so that there will be a place and role for every Singaporean whatever his contribution.' And so, Mr Speaker, Sir, the comments I have to offer today are offered in the spirit of striving harder towards the goal that our leaders have had for our nation all these years and which we must continue to have in front of us. Let me begin with the infants and young children because education begins from babyhood, not from kindergarten, not from going to school, but indeed from babyhood. During the first four or five years of life, children undergo very rapid growth, physically, mentally and emotionally. Also during these four to five years of life, they develop strong emotional bonds with their parents. Traditionally, these bonds begin between child and mother and later to go on to include the rest of the family. All these areas of growth and their nurturing are extremely important for the development of the whole personality.”