Halimah Yacob
Singapore
“Thank you. I think that is certainly a very good idea and that is what we want to do and wish to do, to have the integration of the facilities. As the Member said, it is to encourage inter-generational bonding and support. In fact, we have already started one in Mr Seah Kian Peng's constituency.”
“I thank the Senior Parliamentary Secretary for the clarification, and for his information, I have written twice to LTA. The answers have been negative. My question is, what is the alternative because the purpose of the overhead pedestrian bridge is for people to cross over but the elderly has difficulty crossing over?”
“Mr Speaker, Sir, I am really happy to hear about the immense investment in helping households cope with the rising cost of energy. There will continue to be households that, despite these assistance measures, will face difficulty in paying for their electricity bills.”
“Sir, I would like to ask the Minister: if the problem in Japan is not resolved within the next few months, what measures will be in place to assist sectors that are affected, notably, sectors like electronics?”
“Madam, I have two concise clarifications. My first concise clarification is to ask the Minister about the very low unemployment rate. Given this very low unemployment rate, does MOM have strategies in place to help people who want to find jobs, not just those who are already displaced but those who are currently employed?”
“Madam, on behalf of the House, I would like to thank the Minister, the Minister of State and the Senior Parliamentary Secretary for the very comprehensive and detailed responses given. This year, the Ministry of Manpower did not have the highest number of cuts. That honour went to the Ministry of National Development.”
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“These are enlightened employers, and by implementing such schemes they are also helping themselves because they are better able to retain skilled and talented women who would otherwise leave because of work life balance issues. But changing the mindset of employers is only one part of the equation. There is a need for us to change the mindset of the women themselves as well as their families. One Human Resource Director recounted to me her experience in trying to place a housewife who was looking for work. The morning after the job interview, she received an unannounced visit from the housewife's angry husband who warned her that under no circumstances, she was to employ his wife. This is not an isolated story as I have heard other instances before. I think families must discuss and think through some of these issues. There is no shame for the wife to work to help the family. It should not be seen as something undesirable or that the husband is irresponsible. Circumstances change and if there is a need for the wife to work, then she really needs the support of the whole family. We can go on asking for more help from the Government, in terms of childcare and other support, but what is equally important is the mindset of families towards working mothers. In November last year, with the CDCs, we launched the 30 Minutes to Work programme. The objective of this programme is to help place women in jobs near their homes. One successful example is Mdm Pang Kim Hong, a 40-year old housewife, who has two children and who left the workforce 13 years ago after she gave birth to her first child. She is now working in McDonalds, one of our partners, as a part-time crew.”
“This shows that age is not a barrier to acquiring new skills. Mdm Hamidah now has a good job paying her $1,400 a month. If we have many more workers with the same gung ho spirit as Mdm Hamidah, we will have no problems building a resilient community. UWEEI is now working with other electronic companies such as FCI, PAVC, Seagate and Cummins, to name a few. This year, NTUC, as a whole, will be assisting 20,000 workers through reskilling and job placements. This will be made much easier under the CET framework and I strongly support the top-ups to the Lifelong Learning Fund and the change to the SDF levy as well as subsidies for working adults to acquire part-time degrees at the three public universities and UniSIM. The second way in which NTUC is working on to help build greater resilience in our community is through the Back to Work Programme for Women. Under the Back to Work Programme, which we launched last year, NTUC aims to place 2,000 women back to work. In the face of rising costs and a widening income gap as well as greater job insecurity, as more people are now employed as contract or casual workers, women play an important role in helping to strengthen the family's finances and helping to build up the family's reserve that is so critical, particularly during rainy days. The WDA also supported our effort to help women get back to work through the $3 million Flexi-Works! fund. Companies can tap into this fund in order to redesign their work, such as developing part time and flexible work options. Indeed, a number of companies have already implemented flexible work options, such as KK Hospital and DBS Bank.”
“As the Executive Secretary of the United Workers of Electrical and Electronic Industry (UWEEI), my union works closely with companies to reskill workers who face the risk of retrenchment. Last year, for example, 1,500 electronic workers went through the Skills Retraining Programme (SRP). These workers continue to remain in their jobs but the SRP will help them to do the jobs when new technology comes into the factories. And up to January this year, we helped about 500 workers who were facing retrenchment to be reskilled and redeployed to other jobs. As you know, the electronics sector is a very volatile sector and, every year, we have the highest rate of retrenchments. We know that we cannot stop retrenchments but at least we could do something to assist the workers to move on to other jobs in the same or other companies, or even to other sectors. When ST Microelectronics, a wafer fabrication factory, decided to hive off their low value-added work to China, we worked with the company and WDA to reskill the workers so that the workers could move on to higher value-added jobs in the company. That particular exercise was particularly uplifting because workers not only kept their jobs, but most of those who were affected and retrained were workers above 50 years of age. One example of a worker that we had helped is Mdm Hamidah Sanwan. Mdm Hamidah's job became redundant when ST Microelectronics wanted to move out their operations. But there were many job opportunities in the front end. The union worked with the company to put her through a series of training and last August, she was placed to do the front end manufacturing at the company's wafer plant in Ang Mo Kio. Mdm Hamidah is more than 50 years old when she accepted the union's advice to go for reskilling.”
“Mr Speaker, Sir, when I listen to comments about this year's Budget, I am reminded very much by Jack Neo's popular movie "Money No Enough". Because no matter how much is handed out, it will never be enough as there will always be demands for more. Feedback from our union leaders, however, has generally been positive. As one of our union leaders, Mr Victor Pang, the General Secretary of the SATS Workers Union, sums up "the Budget is fair, as everyone got something". Mr Muthukumaraswamy, the General Secretary of our Amalgamated Union of Daily Rated Workers, wished for higher wages for his low-wage members but he felt that the Medisave and Medifund top-ups, in particular, are useful as he has a fair share of older workers in his union and is naturally concerned over the rising healthcare cost. Sir, most of the discussions on this year's Budget have touched on the Growth Dividends. But, to me, what is more important are the developmental aspects of this Budget, such as the investment in education and training, which I consider to be progressive and farsighted. I believe that the most important part of this Budget is the emphasis on building a resilient community. I would like to touch on three ways in which the NTUC is contributing towards building a resilient community and how this Budget would help us achieve this objective. The three areas are: (1) reskilling of low-wage workers; (2) Back to Work Programme for Women; and (3) re-employment of older workers. On reskilling of older workers, last year, NTUC assisted 15,044 workers to acquire better skills and to move on to better jobs. One good example is our effort to help workers in the electronics sector facing retrenchment to reskill and be redeployed to other areas of work, where there is a demand for workers.”
“Loopholes that plagued the old law resulting in abuses by employers and workers are addressed and cost increase remains manageable for employers. On this note, Sir, I support the Bill. 4.26 pm”
“I also support the various measures instituted to ensure greater efficiency in making applications and processing of claims and to enhance the various penalties to act as a deterrent to errant employers and to ensure greater compliance. Sir, to give us greater clarity on what would be the impact of this Bill, I would also like to request the Minister of State for the following information. Firstly, the number of employers who were prosecuted for failure to insure their workers under the Act in 2007 and the number of workers who were affected. Secondly, in such situations, where employers failed to insure and had no money to pay their injured workers or the dependants of the injured workers, how were the workers or their families being assisted? Thirdly, how many of the workers or their dependants who claimed for compensation due to injuries or death were Singaporeans and how many were foreigners? And, fourthly, Sir, how were injured foreign workers helped to proceed with their claims once they had returned to their own countries upon the expiry of their Work Permits? Sir, in conclusion, I strongly support these changes because the new framework will provide better protection and greater adequacy in compensation for our workers. However, there is a need to do more education and outreach programmes to make sure that our workers understand their rights, particularly, older and less educated workers. Having a good law is a progressive step but, for the implementation to be effective, workers need to be aware of their rights and where to get help. I urge the MOM to step up their education and awareness efforts and to reach out to more workers. On this note, Sir, I applaud the MOM for undertaking this comprehensive review. Workers now have better protection.”
“They do not know who their actual employers are. Often, workers of the principal employer are sub-contracted to many contractors who further sub-contract them. In many cases, the worker's primary contact point may be with the middleman who handles payment and assigns work. I observe that there are some changes in this Act to address this situation, and I hope that such changes would minimise the difficulty faced by some contract workers in holding someone accountable for the purpose of claiming compensation. Mr Speaker, Sir, I note that the new law provides for employers' liability for medical expenses to be limited up to a one-year time cap or a prescribed dollar per accident per employee of $25,000, whichever is reached earlier. This is an improvement over the existing provision, which is very restrictive, as it provides limits to claims under specific items, but, again, I would like to urge the Minister to review this quantum periodically as some occupational injuries may take a longer time to treat and follow-up treatments may continue for a long time. Also, with rising healthcare costs, there is a need for the MOM to regularly review this $25,000 cap so that it is fair and continues to be relevant to the needs of workers. Sir, I welcome the changes under section 14A as the present provision can cause hardship to workers, as it provides for payment only after a worker has filed his claim or only after his claim for compensation has been assessed. The new provision allows him to be paid according to the usual salary periods under his contract of employment.”
“For instance, why should the minimum amount be $47,000 for the death of a worker and not much more than that, or why should the maximum amount be $140,000? I believe there is a basis and criterion for that. I think it is important that this is also explained so that the public and the workers understand. The other area which I think is important, when it comes to this issue about quantum, is also to ensure that there is regularity in reviewing this quantum. The quantum was last reviewed in 1995, 13 years ago, which is a very long time. Workers should not be expected to wait for another 13 years before another review is done. Ministries should put in place a mechanism to automatically review the minimum/maximum quantums of compensation for death and permanent disability regularly, whether on an annual basis or at other reasonable, regular intervals. This is necessary to ensure that the quantums prescribed a realistic, relevant and fair to the needs of injured workers and their families. Sir, another problem which is frequently a cause of concern for workers is the computation of earnings. The amount of compensation that a worker receives depends on his salary. This poses a problem when employers under declare salaries in order to pay lower CPF contributions. In such a case, the compensation that the worker will get will be very low because his declared salary is low and it is difficult for the worker to prove otherwise. This is one area in the implementation of the Act that I believe has to be addressed so as not to undermine the protection accorded to our workers by this law, and I do hope that the MOM will pay attention to this. Another practical implementation problem is the contract workers because of the sub-contracting system.”
“Secondly, workers who do multiple jobs can claim for the total earnings from different employers, regardless of the kind of jobs they perform, whereas the existing law limits claims for multiple earnings only if a worker is employed in the same occupation. This will indeed be a booster particularly for our low-income workers who perform multiple jobs and are clearly a move in the right direction. The new definition of "workplace" is also comprehensive and would cover situations where workers are deployed to work in other premises outside the employer's factory or office and avoid the kind of ambiguities that existed in the existing law. Sir, our Seafarers' unions are also happy that section 2(4A) explicitly covers seamen, who will be covered for accidents occurring on board any Singapore ship, whether the ship is within or outside Singapore at the time of the accident, as the existing provision which covers accidents involving residents who work abroad lacks clarity as far as seamen are concerned. Mr Speaker, Sir, the second major area of change is in the quantum of compensation. I applaud the increase in the compensation quantum for death and permanent incapacity, another significant change in the new Bill. Workers will now be paid a minimum quantum of $47,000 for death, compared to $37,000 before and a maximum of $140,000, compared to $111,000 before. For permanent incapacity, workers will be paid a minimum of $60,000, compared to $47,000 before and a maximum of $180,000, compared to $147,000 before. Perhaps, I think, for greater clarity, it would be useful if the Minister of State could also explain what are the criteria and basis for setting the minimum and maximum benchmarks.”
“Although the Act now covers everyone, in practical terms, most of the claims will come from the manual workers who are currently already covered, regardless of the amount of salary that they earn. Also, under the proposed Bill, employers are given the flexibility not to take up compulsory insurance for employees who are newly covered under the Act. In my view, this is not the ideal arrangement as it would create two classes of employees, one covered under compulsory insurance and the other by self-insurance which is less impactful as the entire regime of this legislation is premised on compulsory insurance. Nevertheless, half a loaf or three quarters of a loaf, in this case, is still better than none as far as this issue is concerned. And if this will make it more palatable for employers from the cost perspective, then we are prepared to live with it. So, I hope that employers and the insurers will understand this trade-off and compromise that have been agreed upon and fully embrace the change. In fact, even without compulsory insurance, it will be in the employers' interest to insure their liability under this Act, as some are already doing, to minimise the cost to them in the event of an accident, as their liability under this Act remains even though they are not required to take up compulsory insurance. Sir, this Bill also provides better safeguards for low-income workers. First, our workers are no longer excluded from the ambit of the Act which is more realistic as people now work outside an employer's premises due to outsourcings.”
“This distinction sometimes gives rise to problems as to what kind of jobs can be described as manual or non-manual, particularly in today's context when the component of knowledge and skills in a job has increased. Also, since the purpose of this Act is to provide for a simple and fast process for injured employees or their dependants to claim, it does not make sense to continue to exclude a significant proportion of our workforce from the protection of this Act, and to leave them to make claims only through common law which is expensive, takes longer and where negligence or fault of the employer has to be proven before a worker will get any compensation. Such a route is also not in the employers' interest, as experience in other countries shows that expensive and protracted legal suits exact a toll not only on workers but also on employers whose business will also suffer. For non-manual workers earning more than $1,600, it is particularly painful because most of them do not earn enough to be able to maintain expensive legal suits for negligence against their employers, when there is no certainty even that they will succeed. Moreover, throughout the period of the suit, they may not have any income to support themselves and provide for their own medical care. So extending this scope is indeed a necessary change that will provide tangible protection to a wider group of people injured at the workplace, and this would certainly help to improve workplace harmony, productivity and efficiency. Sir, I understand that some employers are concerned that the new comprehensive coverage would result in an increase in cost. However, I think that the concern is probably overstated.”
“Mr Speaker, Sir, I rise in support of the Workmen's Compensation (Amendment) Bill. This Bill has made comprehensive and significant changes which will further strengthen protection for workers who die or are injured due to accidents at work, or because of occupational diseases contracted at work. One of the benchmarks of a progressive society is certainly the extent to which we are able to provide a safe working environment and adequate compensation for those who are injured or die at work. Workers deserve to be adequately compensated if they are injured or die at work so that they are able to provide for themselves during the period of their injury or, in the event of their death, their families will not face great hardship. If an adequate compensation system is not in place, there will be very few workers who will be prepared to work in risky places. As no matter how much precaution we take and despite the stricter regime under the Workplace Safety and Health Act, there will always be accidents and, therefore, adequate compensation is critical. It is important that this Act keeps pace with the latest developments and changes in the workplace. Workers welcome these changes and we feel that, perhaps, some of them are long overdue. One major area of change is in the scope of coverage. The most significant improvement is the removal of the distinction between manual and non- manual workers that existed in the existing Act under section 2 which defines the meaning of "workman". Under the old definition, there is no limit in the protection given to manual workers but non-manual workers have limited coverage, as only those earning $1,600 and below are protected under the Act.”
“I would like to thank the Minister for the explanation. Indeed, I think there are many schemes that are good such as the HOPE scheme which has helped 500 families so far. I would like to ask the Minister a follow-up question - whether the Ministry would look at reviewing existing guidelines in the provision of help scheme in two areas. The first area is whether the review could be done with regard to the salary capping which currently most of the financial schemes are pegged at $1,500. There are a lot of families now earning $1,600 or $1,700 who need help but they are not getting help because of this income limit. The second area I would like to ask the Minister is whether the Ministry will also provide greater flexibility because the current PA assistance is very stringent - it is long term. The other schemes are short term. But there are people who need something in between. Will the Ministry consider reviewing guidelines with regard to helping people who need in-between assistance, ie, medium-term assistance, and not short term or very long term?”
“Regarding the HOTA amendment, Malay/Muslim bodies and community leaders, together with our community, have shown maturity and an open mind that is exemplary, and it shows that we are capable and able to change on issues that are important for the benefit of not only our community, but for the benefit of all Singaporeans. I support this Amendment Bill. *Cols. 185-186. 4.39 pm”
“Seen in this light, the new measures introduced under this law will help to prevent abuses and exploitation of the vulnerable and needy in our society and instill integrity in our system. On this note, Sir, I support the Bill but please allow me to say a few words in Malay. (In Malay): [For vernacular speech, please refer to Appendix A*. ] Mr Speaker, Sir, I support the amendments that will be made to include Muslims under the Human Organ Transplant Act (HOTA). This is a progressive move and aims to save lives, something that is emphasised in Islam. Around 21% of 600 kidney patients who are waiting to get kidney transplants are Muslims. But only 2% are able to undergo transplant. This is because only someone who has included himself under HOTA will be given the same priority as other Singaporeans. Our efforts to encourage Muslims to include themselves voluntarily under HOTA have no effect at all, because until today, only 16,000 have pledged their kidneys. With this amendment, 300,000 Muslims will be included under HOTA. I applaud the efforts taken, before this amendment was made, to get the opinions and agreement of Muslims. Such efforts allow Muslims to express their feelings, look at other communities' experiences and get explanations on issues that concern them. In the end, there is a consensus that the benefits are much higher if Muslims are included under HOTA, rather than if they continue to be excluded. Our efforts to reach out to the community so that they further understand HOTA must be continued. And in this instance, the support of Muslim leaders and religious teachers is important. So far, the explanations given by MUIS, and the support of our religious teachers in providing explanations or assurances to our community, must be appreciated.”
“I would also like to quote from the decision of the Council of Islamic Fiqih Academy of the OIC (Organisation of Islamic Countries) which, in its 44th session in Jeddah in Saudi Arabia in 1988, ruled that "death" may take two forms: (a) when all functions of the brain come to a complete stop, and no medical cure can reverse the situation; and (b) when the heart and respiration come to a stop and no medical cure can reverse the situation. Despite the accepted legal definition of death as covering a situation where a person is brain dead, the case, which occurred last year involving the late Mr Sim Tee Hua, serves to remind us that despite the presence of HOTA, we need to continue to educate people about HOTA and issues such as when brain death takes place. Also, we have to continue to deal with individual cases at the hospital level very sensitively. It is, therefore, important that hospitals adopt protocols to equip doctors and other healthcare personnel with the appropriate knowledge, skill and sensitivity in dealing with the family members of the deceased, so as to minimise conflict. At the same time, it is equally important that family members respect the wishes of the organ donor who by not opting out clearly wanted his or her organs to be put to good use after death. Mr Speaker, Sir, the other aspect, which the Bill seeks to cover, is to vest the MOH with enforcement powers. This will enable the MOH to investigate any offence under the Act. This is an important amendment, as organ trading is believed to be on the increase. This prompted the World Health Assembly to urge governments to take measures to protect the poorest and most vulnerable groups from "transplant tourism". Organ trading is a scourge and should never be allowed to creep into our system.”
“The Fatwa issued by MUIS last year paved the way for Muslims to be included under HOTA. Under this Fatwa, there is presumed consent on the part of the waris. Saving the life of another human being is a philanthropic and unselfish act that is much encouraged by Islam. For those who have serious objections, they could, like other Singaporeans, opt out if they wish to. In the absence of any opting out by the person, then the family should respect the deceased person's wish to donate his organs after death. Despite the clear Fatwa and the pervasive practice in many Muslim countries, we cannot expect 100% support as there are bound to be some in the community who may continue to harbour some doubts. Hence, it is important that we continue to engage them. However, the response from the Muslim community, based on the feedback received arising from the extensive consultations that the Ministry of Health had with Malay/Muslim grassroots leaders and Malay/Muslim organisations, have been very positive. Malay/Muslim leaders strongly supported the move as they realise that not changing the status quo only means greater hardship and pain for those who are suffering from kidney failure. What is more important is that there is also overwhelming support from the Islamic religious leaders in Singapore. We thank them for their continued support and role in helping us to explain to the Muslim community which has helped to instill greater confidence in HOTA. Based on the feedback received, some had raised doubts over when death is deemed to have taken place. This is also, I think, an issue that was debated at the time when HOTA was introduced way back in 1987. It is internationally accepted by expert medical groups that death occurs when brain death takes place.”
“Mr Speaker, Sir, I rise in support of this Bill. This Bill makes a very important and significant change. After 21 years, Muslims will now be covered under HOTA. Instead of opting in, like other Singaporeans, we will now be automatically covered unless we decide to opt out. When HOTA was introduced in 1987, because of the situation that existed then, Muslims were excluded from the ambit of the Act. The situation today has changed. Our experience with a voluntary system of opting in has not worked. It is indeed a dismal failure. To date, Muslims make up 21% of the 600 patients in Singapore who are waiting for an organ transplant but account for only 2% of patients who actually receive an organ transplant. Only Muslims who have opted in have the same priority as other Singaporeans who have not opted out of HOTA. Hence, Muslim kidney patients have a much, much longer waiting time compared to other Singaporeans. Despite the larger percentage of Muslim patients waiting for a kidney, the number of Muslims who have pledged their kidneys is very small - only 16,000 have pledged their kidneys so far. The status quo is therefore untenable and has to change so that more lives could be saved. The change will result in a possible inclusion of 300,000 eligible adult Muslims in Singapore. Indeed, this is the raison d'etre why Islam allowed organ transplants in the first place. Muslims need not have any doubt or concerns over this issue. Organ transplants are already widely accepted and practised in the Muslim world. In Singapore, MUIS had long ago allowed Muslims to donate their organs. The only issue that remained was whether the support of the waris of the deceased is required before the organ transplant can take place.”
“We agree that there is a difference in healthcare services and dining in restaurants. So some amount of supervision or monitoring is necessary.”
“Sir, transparency in billing is obviously a progressive move. I would like to ask the Minister whether there is any mechanism within the Ministry of Health to monitor whether there are excessive charges being imposed, particularly among the private doctors, especially specialists, now that we do have shortages in specialists in certain areas. Is there any mechanism to monitor that, because I think we all agree that ---”
“Sir, I want to thank the Minister for his explanation. I look forward to the measures to be introduced in the Budget for the needy and retired Singaporeans, in particular, because they have a very fixed income and some may not have any income at all. I would like to ask the Minister to give us details about how much GST credits have the three-roomers and those in smaller flats enjoyed in order to help them offset the GST increase. I would also like to ask the Minister, when we have the Budget, whether he would review some of the criteria for social assistance to be provided because, in most cases, these are drawn at a certain income criterion that may be already outdated. Could the Ministry of Finance also look into that and make appropriate recommendations?”
“Including the overtime pay acts as a disincentive for workers to work overtime which is difficult to avoid in the current tight labour market where there is a shortage of workers but which means that quite a number of them will not qualify for the WIS. If the intention is really to encourage our low-income workers to work, then those who work harder doing overtime work or who work on their rest days or public holidays should not be penalised. I request the Minister to revisit this point and to consider the possibility of excluding overtime in determining the salary ceiling of $1,500 under the WIS. Second, Madam, as payment of the WIS now depends on regular contributions to CPF, it is important to ensure that employers pay their workers CPF. In this regard, the CPF Board should step up its enforcement efforts to ensure that low-income workers under contracts of service are paid CPF. Could the Minister enlighten this House on the kind of effective enforcement mechanism that is in place today to ensure that employers comply with their obligations to pay CPF? As the CPF contributions are already quite low for our low-income workers, there is no reason for employers not to pay their CPF contributions. Finally, Madam, the Workfare Bonus was introduced last year. Could the Minister enlighten this House how many people had claimed the Workfare Bonus and what measures will be taken to educate and inform low-wage workers that they can claim the WIS and how successful has this message been in reaching out to the low-wage workers, bearing in mind that the first instalment will be payable soon? On this note, Madam, I support the Bill. 6.12 pm”
“Mdm Deputy Speaker, I rise in support of this Bill. This Bill is a significant piece of legislation and the substance of it has already been very widely debated last month in this Parliament. For the first time in our history, we now have a long-term income supplement scheme to support low-wage workers, ie, the WIS. Stretched incomes, with income stagnation or decline for the bottom end of our wage earners, are not peculiar to Singapore. Globalisation and technological change have often been cited as the reasons for this income gap. While this is true, inequity can also be partly controlled through the right policies designed by Government, instead of leaving everything completely to the free market. The WIS is clearly one example of a proactive policy, which will benefit our low-income earners while not weakening self-reliance. Madam, there are three comments that I wish to make with regard to this Bill, specifically on the WIS scheme. First, currently, the WIS applies only to those who earn not more than $1,500. However, in computing this quantum, the current definition of salary under the Employment Act is used. Hence, instead of just using the basic pay as the basis for computation, overtime pay is included in the computation of the $1,500 salary ceiling. I would like to ask for this to be reviewed, as it is very common for low-wage workers to work overtime, which can on average come up to about 20% to 30% of the monthly wages. For example, in the security industry, it is common practice for workers to work fixed overtime of about four hours a day, which pushes their salary beyond $1,500. Without the overtime element, their basic pay will be less than $1,000 in most cases.”
“As this is something new, hospitals, clinics and laboratories should also have information leaflets on patient confidentiality and information disclosure and ensure that these have been read and understood by the patients. The UK's National Health Service has a comprehensive code of practice on patient confidentiality, which can be a source of reference for drawing up our own code and guideline. My final point is to seek clarification on clause 2 of the Bill on the definition of "healthcare institution". I notice that this whole Bill excludes the public sector healthcare institutions. I would like to ask the Minister whether there is any other law that covers patient confidentiality in public sector hospitals, polyclinics or laboratories. The Minister had mentioned that public sector institutions are already providing such information voluntarily but nothing was mentioned about what laws govern the use of "individually-identifiable" information for patients in the public sector. So the question is, what laws apply and how is patient confidentiality protected in the public sector, as the issues governing patient confidentiality apply equally to both the public and private hospitals and therefore there should be a common set of rules that applies to both. The Minister's clarification on this point would be most helpful. On this note, Sir, I support the Bill.”
“However, I feel that it should be made compulsory for all research applications to be referred to the National Research Advisory Committee to better protect patient confidentiality by ensuring that it is the whole committee, and not just the Registrar of the NRD, who will decide whether researchers will have access to patients' data and identity. Clause 12(5) in the current Bill leaves it to the Registrar to decide whether or not to refer an application by a researcher for the release of "individually-identifiable" information to the National Research Advisory Committee, which, in my view, is very weak, as it seems to give an inordinate amount of power to the Registrar. My third point is on clause 2 of the Bill, which defines the meaning of "requisite consent", for the purposes of section 11 or 12 of the Act. This is a very important part of the Bill but, unfortunately, it is rather scanty. I would like to urge the Ministry to draw up clear guidelines on how to secure consent from patients as, considering the gravity of the diseases covered under the Bill, patients may not always be in a clear frame of mind to make informed decisions without proper guidance. For example, the guidelines could provide that before patients' consent is obtained, they should be clearly informed that they have a choice on whether or not to disclose their personal information. The hospitals, clinics or laboratories should also make sure that patients understand the implications of their choice. For example, if they choose not to reveal the information to the doctors treating them, the lack of information may affect the effectiveness of their treatment. The hospitals, clinics or laboratories should also respect the rights of patients and facilitate them in exercising their right.”
“If so, this could cause embarrassment and discomfort to patients whose identities are made known to the public, especially if their consent is not even required under clause 10. Hence, disclosure of such "individually-identified" information to the public should not be allowed or, at most, allowed only in the most exceptional cases such as when we have a SARS-like situation. Again, on clause 10, I would like to suggest that the Minister consider making it compulsory for the consent of the patient to be obtained before any "individually-identifiable" information held by the NRD can be disclosed for the purposes of the national public health programmes. Clauses 11 and 12 already make it compulsory for such consent to be secured before "individually-identifiable" information is disclosed to a patient's doctor for his treatment or disclosed for research purposes. I do not see any reason why a similar requirement for consent cannot be imposed under clause 10 before the medical records of individuals with their identities revealed are made available for carrying out national public health programmes. Surely, under clause 11, it is necessary to get the consent of the patient before his record is revealed to his own doctor for medical treatment. I do not see why his consent is not required under clause 10 for national public health programmes. Sir, m y second point is with regard to the disclosure of "individually-identifiable" information for public health research. I understand that such information will be released for research purposes, only if the research will help to improve the quality of health services provided for patients suffering from any reportable diseases; or to support any national public health policy initiative or programme.”
“I have no major worries with regard to the use of anonymised information, as there are no serious confidentiality issues involved. My concern is more with the laxity allowed in the use of "individually-identifiable" information, where the identity of the individual can be readily discovered or ascertained from the information given. The use of "individually-identifiable" information is provided under clauses 10, 11 and 12 of the Bill. First, let me touch on clause 10. Under clause 10, the Registrar of the NRD may, with the approval of the Director of Medical Services, disclose "individually-identifiable" information to "any public officer or any other person" for the purpose of conducting national public health programmes concerning any reportable disease. I notice that unlike clauses 11 and 12, it is not necessary to get the consent of the patient before such information is released to the public officer or any person, which is a matter of concern. Could the Minister clarify, other than the public officer, who else can have access to the "individually-identifiable" information; in other words, who are covered under the ambit of "other person" stipulated under clause 10? I would like to suggest that to ensure greater transparency, the Ministry draws up a list of who will be included under the list of "other person", so that patients are clear as to the people who have access to their individual medical records. I would also like to seek a clarification whether, under clause 10, the identities of patients suffering from the reportable diseases can be made known to the public when the national public health programmes are conducted.”
“Mr Speaker, Sir, I rise in support of this Bill. I agree with the Minister that to develop rational healthcare policies requires accurate and timely information. This Bill seeks to do just that through the establishment of a National Registry of Diseases, which will help in gathering information in a systematic and continuous manner by requiring all reportable diseases to be registered. In this manner, the Registry will contribute towards the formulation of robust healthcare policies, promote research on major diseases as well as further enhance the delivery of medical treatment to patients. For these reasons, this Bill is timely and will help to develop and improve the quality of Singapore's healthcare services. However, Sir, I have one major concern as well as several clarifications to seek from the Minister. The Bill provides extensive powers for the Registrar of the National Registry of Diseases (NRD) to collect information and to have access to patients' data. Therefore, protecting patient confidentiality is very crucial to ensure credibility in the system and to win patients' trust. I note that the Minister has dwelt at length on this, citing a number of measures to protect patient confiden- tiality, including the imposition of jail terms and fines for those caught breaching it, which is necessary as we do not want to see a repeat of the Shovron case where there was a clear breach of patient confidentiality. I would like to ask the Minister to consider further tightening some of the provisions to ensure greater protection of patient confidentiality. The Bill provides for the use of anonymised information where the identity of the individual is concealed or protected.”
“Sir, two supplementary questions. Some economists have said that the CPI might still have understated the real inflationary pressures with the full effect yet to be filtered into consumer pricing. Another economist has also projected that inflation will hit 4% in the first half of next year. Can I have the Minister's comments on this, please? Second, if inflation continues to rise, will there be other measures that the Government will put in place to help the vulnerable people such as the low-income and the elderly to cope with the cost of living?”
“I just want to ask a supplementary question of the Senior Parliamentary Secretary. I am a little bit intrigued by the drawing of the correlation between the number of deaths and the proficiency in English. I wonder whether there has been any study done to show the correlation and therefore to justify the need for the foreign domestic workers to have English as a criterion.”
“Sir, I would like to ask the Minister a few supplementary questions. First, I would like to ask why are the numbers so small. 466 in 2007 and 336 in 2006 are indeed very small, compared to the large number of civil servants. The Civil Service is one of the largest employers in Singapore. My next question is, in view of this, whether the Ministry has done any study to determine what are the reasons and whether there is a need to review the scheme. Perhaps, the scheme is now no longer as relevant as it used to be. There is a need to review the scheme. My final question is: what more can be done by the Civil Service to encourage supervisors to make it easier for civil servants to make use of this scheme?”
“Mr Speaker, Sir, only 3,000 made use of the facility although there are 146,000 donors. So obviously, the publicity effort has not generated much outcome. I would like to urge the Ministry to consider other possibilities and options, so that the family members can really benefit from these new changes to the Act, and also the benefit of a higher return for their Retirement Account.”
“Sir, I would like to ask the Minister of State how many CPF members have topped up the Retirement Accounts of their family members.”
“Two supplementary questions, Sir. First, I would like to ask the Minister, of these 25,000 households, what percentage of the total number of 2- and 3-room flat owners does it constitute? Second, I am happy that the Minister is prepared to consider flexibility on a case-by-case basis. But, in a similar vein, I would like to ask the Minister whether he would also extend that same flexibility to first-time buyers of 4-room flats because the whole idea is actually to assist older Singaporeans to take care of their retirement needs and therefore we should extend it to the smaller flat owners. For the 4-room flat owners, older Singaporeans will fall in that category of those needing assistance for their retirement and income.”
“Today, we do not know how much of the bill that we are paying is for the doctor's consultation fee and how much of it is for the cost of the medicine. So, if all doctors start by giving a breakdown of their fees, that would be a positive first step, and I would like to urge our doctors to start doing so. Subsequently, we could make it easier for patients who want to separate prescribing from dispensing to do so, just like the Japanese system. In this manner, we would progressively move to a situation where patients are given an option to have the medicine dispensed either by the doctor or by a pharmacist. I do not know whether this is feasible at this point of time, but the key consideration for us should be what is in the best interest of the patient as we know that pharmacists play an important role in providing the checks and balances in drug administration so crucial to patients' safety. Currently, with doctors prescribing and dispensing medicines in the private sector, this element is not present. Mdm Deputy Speaker, I support the Bill. I think this is a progressive and good Bill. 5.42 pm”
“Currently, doctors both prescribe and dispense medicines. While it can be argued that this is convenient for the patient, as the least that a sick person wants to do is to go to another place to get his prescription, there is, however, a greater overriding consideration, and that is the patient's safety. The Minister has explained at great length about the important role that pharmacists perform - if I may quote the Minister again - "...in providing the checks and balances in the medication use process - from doctors' prescriptions to drug administration". In the hospitals and polyclinics, this is the practice where doctors and pharmacists work hand in hand in administering drugs to patients. But among the private sector GPs, this is not the case, and one has to ask whether, in the light of the current discussion in this House, this is in the best interest of patients. Quite a number of countries already separate dispensing from prescribing of medicines, including the US, UK and, in Asia, Korea and Taiwan. In Japan, this is not mandatory, but patients can ask for this separation of prescribing and dispensing, and it is estimated that about 50% of the patients have already done so, indicating that patients do want a second layer of review in the drug administered to them. At the same time, cost could also be another consideration for such patients. Mdm Deputy Speaker, I understand that in Singapore's context, this cannot be done overnight as we need to first educate the public who are not quite clear about the role of pharmacists and who have been so used to doctors doing both prescription and dispensation of medicines. Perhaps the first step that we can take is to encourage private practitioners to ensure transparency in their billings.”
“The Interim Register, which allows the Singapore Pharmacy Council to admit foreign pharmacists with equivalent or relevant qualifications, subject to conditions, would provide an additional pipeline of pharmacists and help to address the shortage that we are experiencing. I am sure that the same rigorous qualifications and standards required of local pharmacists would also be applied to these foreign pharmacists. Mdm Deputy Speaker, let me now touch on two further areas. There is a concern among Singaporeans on the increasing cost of medicines, whether medicines dispensed in the public sector or private sector hospitals and clinics. As a result, we see many Singaporeans flocking to Johor to purchase medicines, which is not without risk, as there is no certainty that they are not purchasing counterfeit drugs which could worsen their condition. I would therefore like to urge the Ministry to continue to monitor the price of medicines to ensure that they are affordable and accessible to Singaporeans. In this regard, I would also like to urge the Minister to review the list of standard medicines which are subsidised and which are prescribed in our public hospitals and polyclinics. There are quite a number of medicines prescribed to patients which are not subsidised although patients are told by their doctors that these medicines are necessary and critical to their needs. So I urge the Ministry to regularly review the list of standard medicines to bring it up to date to include new and necessary drugs and minimise hardship on the subsidised patients. Let me now come to my final point, Mdm Deputy Speaker, and that is the issue of whether we should consider separating the two acts of prescribing and dispensing of medicines.”
“But we need to do a lot more to highlight the existence of such a register so that it would be of greater use to the public. One problem is that, unlike doctors whose areas of specialisation, whether in paediatrics, oncology or gynaecology, can be easily identified by the public, it is a lot more difficult to know what the different areas of specialisation of the pharmacists are, especially those in the private sector. So, to make it easier for the public to access the services of such specialist pharmacists, I would like to suggest that the Ministry of Health come out with a list of specialist pharmacists, together with their area of specialties, which could be publicised and made accessible to the public. Mdm Deputy Speaker, I also strongly support the focus on continuing education, which is critical for patient safety as pharmacists work in so many different areas in both the public and private sectors and they too need to keep up with improvements in the standards of patient care. Continuing education will also further promote the specialisation of pharmacists in the different fields and ensure that only pharmacists who are adequately trained in the specific fields are allowed to administer drug therapy. For example, pharmacists who have not had the experience of handling patient care will now have to undergo a course before handling patients, and this will most certainly enhance patient safety. Another good move is the Interim Register as there is currently a shortage of pharmacists and the existing legislation is restrictive.”
“Mdm Deputy Speaker, I rise in support of this Bill. This is an important and timely Bill that will enhance the practice of pharmacy, upgrade the standard of professionalism of pharmacists and enhance patient safety. Pharmacists are an integral part of the healthcare system as they help in administering the drug therapy to patients. In many ways, they act as the safety net. Together with the doctors, they review the medications prescribed to the patients and ensure that they are adjusted to fit the needs of the particular patient, taking into account the health condition and other needs of the patient. As the Minister had described, they provide the "checks and balances in the medication use process - from doctors' prescriptions to drug administration." But for a long time, Mdm Deputy Speaker, they seem to be quite a neglected lot. Even the public is not quite sure what role the pharmacists perform in the whole health care system. In the hospitals, we are not aware of the important role that they play in drug therapy and, in the private retail pharmacies, their services are under-utilised. This Bill would therefore provide greater recognition to the work of pharmacists and it is a progressive step. So, Mdm Deputy Speaker, I support the Bill and, in particular, I support the creation of the Register of specialist pharmacists. Currently, there are already pharmacists who specialise in so many fields and the Specialists Register would give them due recognition. The Specialists Register is also good for the public, as we now have a register to refer to in the event we need the services of a pharmacist in a certain area of specialty. Some countries like the US and Canada already have such a register.”
“A point of clarification. The Minister misquoted me. I did not suggest the establishment of a Government-funded pension scheme. I work extensively in ILO, do a lot of extensive work, have had unionists sharing a lot of experiences, governments as well on the pension scheme, and I know what are the problems that these pension schemes are experiencing. So I did not, at any time, suggest the establishment of a Government-funded pension scheme. But the Minister quoted me correctly on the second point, and that is the social risk-pooling element, in the context of those without Minimum Sum or very little Minimum Sum to purchase the longevity insurance specifically in relation to women, because only 2.5 women out of 10 are working between the age of 60-64.”
“Sir, 15,800 CPF members do not have any Medisave balances at all. Is there a concern then on the part of the Ministry and what measures will be taken to assist them to build up their Medisave balances? Also, broadly, other than these 15,800, considering that we are having this debate today that we will be living beyond 85 years, are the general average Medisave balances of other CPF members sufficient? If not, what measures are being taken in order to increase the Medisave balances to prepare us for a much longer lifespan?”
“I would like to ask the Minister whether there is a medical protocol in private hospitals, public hospitals, polyclinics and the GP clinics as well, where there is a male patient diagnosed with HIV, there is a requirement also for the doctors to follow up with the spouse of the male patient, in order to ensure whether the spouse is infected or not and whether there is a need for further follow-up medical treatment for the spouse.”
“I would like to ask the Minister what other measures can be taken in order to deal with undiagnosed HIV cases. My second question is: is it possible or feasible to make HIV testing compulsory for male patients?”
“Ms Jessica Tan Soon Neo asked the Minister for the Environment and Water Resources (a) if more can be done to drive demand for alternative fuel/hybrid vehicles as the current difference in road tax for these vehicles is not enough to differentiate the cost involved in owning hybrid vehicles; and (b) if his Ministry will consider a lower Additional Registration Fee for hybrid vehicles to make the cost of acquiring such vehicles equal to, or lesser than, the cost of acquiring petrol/diesel-powered vehicles.”
“Sir, there is a shortage of trained counsellors. Therefore, I would like to ask the Minister what measures are being taken in order to increase the number of counsellors. Secondly, what other measures are being taken in order to help strengthen Muslim families? Assoc. Prof. Dr Yaacob Ibrahim: Sir, at the moment, given the case load, the number of counsellors that we have seems to be adequate, but not forgetting that we also work with partners outside the Syariah Court. We have 14 agencies and they have been very helpful to allow us to send some of the cases to them to be dealt with. There are, of course, other measures to strengthen Muslim marriages in Singapore. There is a whole host of programmes that we have started. With respect to, for example, minor couples, I think Mdm Halimah is aware that we have just started two centres to guide minor couples. Minor couples are defined as brides who are between the age of 18 and 20, because they are more vulnerable to divorces. At the same time, we have also started programmes through the VWOs, which are PPIS and AMP, to help couples who want to remarry again after they have divorced, to see how during the process of remarrying they can continue to strengthen their marriages. But, meanwhile, the key pillar in strengthening our Muslim marriages in Singapore is, of course, through marriage preparation courses that we have been conducting for many years. These courses are now being reviewed to ensure that they remain relevant. But after all that has been said and done, at the end of the day, it is up to the couples themselves to make their marriage work. We will provide the support possible within the framework of what is available in terms of resources within the community. FUEL/HYBRID VEHICLES 3.”
“Give CPF members a choice to have longer draw-down date in place of longevity insurance A final suggestion is to give CPF members a choice to opt for a longer draw-down period instead of purchasing the longevity insurance. Hence, instead of 85 years, CPF members can opt to stretch their Minimum Sum up to 90 years or 95 years, depending on their needs. This proposal is consistent with the objective of the longevity insurance and there is no reason why it cannot be considered. I think Dr Ng has also alluded to that in his Statement. I would appreciate the Minister's response and comments on the various points that I have raised. Let me conclude, Sir, by sharing with this House the conversation that I had with Irene who cleans our Parliament's toilets. Irene is a contract worker who earns $700 a month. The first question I asked her, being a trade unionist, is whether she is paid CPF. And Irene immediately retorted, "Of course." She said, "If not, if grow old, how?" Irene most aptly captured the heart of this debate and that is the question of "how". How are we to take care of our old age? How are we to live if our life extends beyond 85 years? We may not be able to answer the "how" questions completely and fully as no country has found a foolproof solution. But, at least, we have started to look at some ways how to do so as the status quo is neither a desirable nor a responsible approach. 5.55 pm”
“We should carefully study the proposal, give our feedback and make sure that the scheme really works for us. The feedback from our unionists is that this should not be a one-size-fits-all longevity insurance scheme as there should be choices given to CPF members. They suggest that the Government introduce a scheme akin to the MediShield and ElderShield schemes, which I think Minister Ng had also mentioned, by having a basic tier that covers everyone, but which provides only basic benefits so that the premiums could be kept as low as possible and the amount to be taken out from the Minimum Sum will not be too large. For those who want a bigger payment and for the money to be returned to their family if they die early, they could purchase an additional or enhanced tier and pay higher premiums from their Minimum Sum. CPF Board should administer the basic tier Our unionists also suggested that the CPF Board should administer the basic tier to benefit from economies of scale, lower administration costs and, more importantly, a higher rate of return. Currently, annuities are not popular because the average rate of return at about 2.3% is far too low and is worse than the Minimum Sum rate of 4%. Additional or enhanced tier can be provided by private insurers but limit amount that can be used from the Minimum Sum The additional or enhanced tier could be provided by private insurance companies but here, I would like to urge the Government to impose a limit on the amount of the Minimum Sum that can be withdrawn for the second tier as we also want to ensure that CPF members continue to have enough savings to live on between the age of 65 and 85 years.”
“The Government has explained that this longevity insurance is a form of risk-pooling. This is well and good but Singaporeans are asking why is it that they have to carry all the risks themselves. What is the Government's contribution to this risk-pooling? In other words, where is the social risk-pooling element? They feel that it would be more palatable if the Government could contribute something by injecting some funds into the pool. With the additional Government funding, many Singaporeans feel that the payout after 85 could be more meaningful and the premiums could be kept affordable. Singaporeans also feel that the Government should top up for those with no Minimum Sum or whose Minimum Sum is insufficient to pay for the longevity insurance, with housewives being a particular concern as there are many without the Minimum Sum and women, as we know, live longer. On this point, I note that the premium for women will be higher. As women have a lower Minimum Sum, this would cause hardship, and I would therefore like to urge the Government to impose a standard rate of premium, regardless of gender. Others have argued that the amount of $250 to $300 is too small and insignificant and will be completely eroded by inflation by the time we reach 85 years of age. So, they question the usefulness of the longevity insurance in providing for the financial needs of those who live beyond 85 years of age. I hope that these concerns would be fully addressed so as to generate greater confidence in the CPF reforms. Choices - basic tier for everyone In my view, although the longevity insurance is not the complete answer to retirement financing for those above 85 years, it is a good start and as Singaporeans, we should give more thought to it.”
“Public sector and GLCs should set the lead Finally, we would also urge the public sector and Government-linked companies to set the lead in the re-employment of older workers. Again, this is an issue of confidence as the private sector employers always pop this question when we ask them to re-employ older workers. If the public sector and the Government-linked companies do not set a good example, we have less moral authority to start pushing private sector employers to do so. We have heard Minister Teo explaining about the steps being taken by the public sector to promote re-employment of older workers and we certainly hope to see more Government-linked companies, especially the larger ones, announcing such initiatives before the legislation kicks in. Longevity insurance Sir, let me now touch on the longevity insurance. I have a few points to make. First, insurance represents a marked shift in our approach towards retirement financing. Since 1957, our policy has been that each Singaporean should work and save for his own retirement. But now, for the first time, we are told to do risk-pooling, where we contribute a portion of our savings to a pool and help to provide for other people's needs as well. This is not an easy change for many to digest, as one major problem is that many people still do not believe that they will live beyond 85. They worry that someone else will benefit at their expense. Worse still, some even feel that the longevity insurance will not benefit the poor and low-income as they believe that it is the rich that will live longer. Some people are also suspicious of the longevity insurance because they fear that the Government is transferring its responsibility of taking care of the poor and needy to Singaporeans.”
“Proposed re-employment law Sir, on the proposed re-employment law, our unionists welcome it but felt that five years is too long and have asked that the Minister consider legislating it much earlier, perhaps in three years' time instead, as after all, the proposed law is not an automatic extension of employment, but merely makes it compulsory for employers to re-offer employment which could be in different jobs and on different terms. Although there has been progress made in our re-employment efforts, there are still some employers who want to adopt a wait-and-see attitude basically to buy themselves some time. I feel that having this law in place before the later draw-down age takes effect in 2012 for those who are 57 now, would do a great deal in helping to generate greater confidence in the reforms. Ensure that legislation is enforceable and provide for dispute settlement mechanism Another concern raised by unionists is over the effectiveness of the proposed re-employment law. One feedback from our Japanese trade union colleagues about their re-employment law, which forms the basis for our current re-employment law, is that it lacks teeth and is not enforceable. We should avoid the same pitfalls and ensure that our re-employment legislation is enforceable against errant employers. Another concern that this proposed legislation should address is bogus or sham offers of re-employment. The legislation should provide for a mediation or dispute resolution mechanism for older workers to refer their grievances to if they are given terms of employment which are not genuine or the terms are so drastically reduced and are not commensurate with their contributions, qualifications or experience to make it impossible for the older worker to accept the offer of re-employment.”