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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“A follow-up question, Sir. I would like to ask the Minister of State what labour and employment issues will be covered by the Cooperation Agreement. How will workers in Singapore benefit and will the social partners be involved in this process of collaboration?”
“In our effort to promote resilience and independence on the part of underprivileged families and individuals, I would like to ask the Minister whether the Minister can work with the NEA and other agencies to allow such families, if they want to put up booths and sell some products in public places, some flexibility. Right now, it is extremely difficult for them to try and eke out a living in order to be self-sufficient. I have a resident who was fined $200 for selling something in a public place. But then he came to me and said, "But that is the way. I need the money for my family. I am a low-income worker." So I think we need some flexibility. We are concerned about certain things, eg, hygiene and messiness, but I think we should be able to live with some of these. So I hope the Minister will work with other agencies to help these individuals become more resilient and self-sufficient.”
“Sir, I would like to ask the Minister two questions. Firstly, is the sum of $1.2 million sufficient to assist the less fortunate families? Secondly, how many such families have been assisted under the MUIS fund? Assoc. Prof. Dr Yaacob Ibrahim: Sir, the $1.2 million is over and above what has already been spent. As mentioned in my speech, the money will be spent on new projects to be run by Malay/Muslim organisations that have shown some track record. Over the last two years, about 1,302 families received zakat monthly every year. But about 400 families have participated in this programme and 104 families have since successfully graduated from the EPS. What we do is that we mined the data from our zakat recipients, identified their families, and we put them onto these programmes so that we could then empower them and get them off the zakat altogether.”
“[For vernacular speech, please refer to Appendix A *.] Mr Chairman, we have heard from MOF and MOM that our economic progress will further improve and 450,000 jobs will be made available within this five-year period. Our society will have to be prepared to face a globalised future which is more competitive and makes use of the opportunities provided by the Government. Our society has made substantial progress in education and employment, but I am worried that there is still a section in our society who finds it hard to adapt themselves to the changes that we are experiencing and they will be left far behind. They also face social problems like divorce, drug abuse and dropouts from school. Many also do not have the skill to perform high-value jobs which pay better to provide for their families and, more often, they experience unemployment. The WIS scheme will help and motivate this group. At the same time, we have to give more focused and special attention in improving their standard of living. If not, I am afraid that there will be a group of underclass in the Malay-Muslim community who feel that they are being isolated and this will bring about other problems. Last year, MUIS announced that it will use the zakat monies to help these needy families to upgrade themselves. Can the Minister provide more information on what has been done in this effort? A special group which also requires a lot of attention is the single mother. Can the Minister also provide an explanation on the efforts that have been carried out to help them? How can we ensure that the vision of an inclusive society that has been drawn up for Singapore can be felt *Cols. 3639-3640. and will involve each and everyone in the society? Divorce Rate”
“Sir, the Senior Parliamentary Secretary clarified just now that there are existing safeguards to protect the maternity benefits of pregnant women in the event of retrenchment. But I would just like to say that in our law, when a pregnant woman is retrenched, her maternity benefits will not be protected. So I think for the woman to have access to that right, the law would have to be amended. I would like to ask the Ministry to consider amending the law to make it very clear that the maternity benefits of pregnant woman will be protected in the event of retrenchment. This is very fundamental in court because, otherwise, it would also act as a deterrent to women having more children and that would affect our population policy.”
“I have three clarifications to seek. First, I am happy to hear the programme - the Professionals Conversion Programme - being put in place to help the PMETs. I would like to ask the Minister when will the programme start, how much is being allocated, how many PMETs are intended to be assisted, and who will be eligible. My second question is on maternity leave. Could the Ministry consider providing better safeguards for maternity leave because, presently, the maternity benefit of women who are retrenched and who are pregnant is not protected? My third clarification, Sir, is on foreign domestic workers. Despite all the safeguards being put in place, foreign domestic workers continue to fall to their death, primarily because of two reasons: cleaning the windows and hanging out clothes to dry. Can the Ministry look into how to better safeguard them from falling from high places? Would the Ministry consider banning foreign domestic workers from doing such chores, since employers are not able to protect them?”
“I would like to ask the Minister to monitor the situation closely to ensure that cheaper 'S' Pass holders will not displace our university and polytechnic graduates. Can the Minister also give details on the number of 'S' Pass holders employed, and in which sectors? Column No : 3230 Column No : 3230 COMMITTEE OF SUPPLY REPORTING PROGRESS”
“Sir, I do not know whether my cut on the 'S' Passes is auspicious or inauspicious. But, indeed, I am taken by surprise by the Minister's announcement that the 'S' Passes will now be increased from 5% in 2004, just introduced 2 1/2 years ago, to 15%. I must say that the 'S' Passes have, to some extent, caused some concern among Singaporeans and will continue to cause more concerns now that it has been increased to 15%. Let me explain why. First, unlike the work permit holders, there are no restrictions on the source countries for 'S' Pass holders as employers can draw them from any part of the world. Second, unlike the 'P' Pass holders, that means, the Professional Pass holders, they are considered executives and are required to be paid higher. The minimum pay for a 'S' Pass holder is only $1,800. Hence, the 'S' Pass is a hybrid. It enjoys the best of both worlds. It is cheaper than the Professional Pass holders, in terms of salary, and it is very flexible, in terms of the source of countries, unlike the work permit holder. This makes them very attractive to employers, leading to the concern that they will displace our diploma and university graduates. Of particular concern would also be the PMETs who are already facing difficulties securing employment, especially the older ones. I think we heard from the hon. Members of this House before me about their concerns over PMETs and the Minister has already addressed some points. Although employment rate is high and unemployment rate is low, there are segments of our population who still find it difficult to find jobs. The rationale for our foreign worker policy, including the 'S' Pass, is to augment the local workforce and not to replace them.”
“Sir, I would like to thank the Minister and also the Minister of State for their very comprehensive replies. We have heard some policy changes and we also had an interesting debate. I beg leave to withdraw the amendment. Amendment, by leave, withdrawn. The sum of $2,058,203,710 for Head O ordered to stand part of the Main Estimates. The sum of $229,301,900 for Head O ordered to stand part of the Development Estimates. Column No : 3060 Head K - Ministry of Education”
“Sir, just a couple of clarifications. Whilst I agree with the Minister that in those cases of subsidised patients where they request for more expensive medicine or implants, then that should not attract subsidies, but in the majority of cases, these patients are not in a position to request for more expensive implants or medicine. In those cases where it is the doctor who prescribes that as part of the treatment procedure, would the Ministry then consider extending the same level of subsidy, rather than excluding them completely from the subsidy, because there are still some items which are completely excluded from subsidy and that is expensive and causes hardship? My second point is that the Minister said that what is important to the patient is, at the end of the day, the dollar quantum. I would like to ask whether the Ministry tracks, in terms of dollar quantum, whether there has been an increase. And if so, does the Ministry have a mechanism in place in the hospitals and other care providers to check why these increases are taking place? That leads me to the third question about wastage and duplication. I think there are two hospital clusters. The concern continues that there are duplication and wastage. Are there any initiatives in the Ministry to track to ensure that cost does not increase because of wastages and duplication between the two clusters?”
“Mr Speaker, I would like to ask the Minister of State how does the Government ensure that the Best Sourcing does not become cheap sourcing. Are the contracts awarded to the lowest tender or is it based on outcome? For instance, is there any auditing for the Ministries to determine whether CPF is paid and labour laws are complied for workers so that it is not cheap sourcing?”
“My third point is to seek clarification from the Minister on whether the level of subsidy for step-down care can be enhanced because currently there is a difference in the hospital subsidy and the step-down care subsidy. My final point is on ElderShield. Can the Minister consider relaxing the qualifying criteria so that more people can be covered under it? Because if you increase the period and also the amount, but if the qualifying criteria remain rigid, people will not be able to come under it.”
“Madam, I would like to seek clarification from the Minister on a couple of points and also to seek answers to a couple of points which I had raised but were not answered. First, on the question about affordability that I had raised and the point that the current subsidy does not cover all the items on the bill. In fact, some of the items that are excluded can actually be expensive items. Would the Ministry consider including all the items, so that when we talk about a subsidy of 80%, we are actually talking about the subsidy of the total bill and not only some of the items on the bill? Because the items that are not included are expensive, this can cause hardship to the subsidised patient if he has to pay. For example, I gave an example of a cancer patient that has to use the colostomy bag, and some of the medications are not subsidised for these patients, whether they are in "C" or "B2" class wards. My second point is on the SingaporeMedicine initiative. We are not at the stage yet where we are rapidly taking in foreign patients. Therefore, there is still scope for the public hospitals to think carefully on the structure that it has to put in place, to prevent possible conflict and also questions arising as to why are public resources being used for private patients. So, there is a clear need for there to be a better firewall to separate the two - service to public patients using public resources and private patients using completely private resources. I seek clarification on this point, ie, whether the Minister can think of this particular structure that I was talking about.”
“Many need temporary shelters but there is not enough of such facilities. Many cannot cope on their own and need support. Many parents with children suffering from mental illness worry in case they die and there is no one to take care of their children. Their problems require a multi-agency approach involving not just MOH but also MOM, MOE and MCYS, even maybe MHA, with very strong community support in order to put in place a more comprehensive framework to assist them, as well as an extensive public education programme to remove the stigma and prejudices that they have to endure and to help our population understand the critical importance of seeking treatment early. Could the Minister please give us an update on what is being done to improve our mental health programme and assist them?”
“Madam, could the Minister give an update on the Ministry's plans to upgrade Singapore’s mental health programme to make Singapore an emotionally resilient community? Recently, I met a man who was suffering from severe bipolar disorder. He has two young children and his wife is the main breadwinner as he is not able to hold down a job. He pointed out the many gaps in our current services for the mentally ill. The stigma and rejection is one thing, but he feels that even the standard of medical treatment needs improvement. At one public hospital, where he was treated, he was seen by a different doctor at every appointment, as he was a subsidised patient. He also feels that in that hospital, the very ill patients were mixed with the less ill patients. As a result, his condition did not improve. He has since changed hospitals and he feels better now. His own illness was left untreated although he was ill since he was a teenager and, as his family did not understand that the extreme mood swings were signs of mental illness, he got treatment only when he was in his 30s. When he was finally treated years later, his condition was actually quite bad. He now pours most of his energies into his art work but he finds it difficult to get a place to advertise his drawings for free. His family is suffering from financial difficulties as his wife does not earn enough to support the family and he worries about his children’s future. This man’s journey of anguish and pain is typical for sufferers of mental illness. They suffer many setbacks. Many find the cost of treatment a drain on their resources but, if they stop treatment, they will suffer a relapse, which worsens their condition. Many cannot hold proper jobs as the stigma against them is still very strong.”
“Could the Minister consider extending subsidies to the elderly sick who are taken care of at home to lessen the burden of families and reduce the overload on hospitals? Because there are some families who want to take out the elderly sick, but they do not have any subsidies for providing homecare services to their parents or elderly sick. Could the Minister also look into that? One final point is that I support the ElderShield changes. Could the Minister review the qualifying criteria, which I think are too stringent and many do not qualify? Focus on Patients”
“Mdm Deputy Speaker, for chronic illnesses to be managed effectively, we require a well-functioning and effective primary care system. This is one weakness in our healthcare system, as a result of which there is a high dependence on specialists pushing healthcare costs up. So there is a need to expedite the training of GPs as family physicians to take care of the chronically ill. Could I ask the Minister to give us an update on this and other measures to better manage chronic illnesses in Singapore? One major complaint of the elderly suffering from chronic illnesses is the poor integration of services from the hospital to step-down care, such as community hospital or nursing home, which are subject to means-testing and are under-funded as they enjoy lower subsidies. There are also insufficient homecare services for those suffering from chronic illnesses and there is no subsidy for such services which act as a deterrent for families to take care of the elderly sick at home. So, what more can be done to ensure better integration of services for the elderly sick suffering from chronic illnesses? Could the Minister consider extending the same level of subsidy to the step-down care services as the ones that are found in the hospital and do away with the requirement for means-testing for those moving from the hospitals to step-down care? Because once they are out of the hospitals, they go through any means-testing for step-down care and sometimes, they do not get subsidies as a result of that. As a result, patients do not want to move from the hospitals to the step-down care. Also, the level of subsidies are different compared to the hospitals and the step-down care.”
“I hope all the other hospitals would also emulate that programme. Finally, Sir, there is also a concern among the APNs that, while they are required to take over some of the tasks of doctors, they feel that they are not sufficiently protected, in terms of litigation or other actions taken against them. Apparently, doctors have better protection compared to them. So the APNs are concerned about that. They also would like to be given the chance to have more challenging tasks assigned to them in the hospitals. Could the Minister please look at these issues?”
“There is a shortage of doctors, nurses and allied professionals in the healthcare sector. The situation will get worse as demand goes up due to an ageing population and the decision to attract one million foreign patients. Could the Minister give an update on the manpower situation and what plans the Ministry has to address this problem, so as not to affect the standard of medical care in Singapore? What more can be done to increase the supply without compromising standards, as there are also some concerns over the recent liberalisation of the registration process for foreign doctors and the addition of new foreign medical schools on the list. Sir, while we are training more nurses in the polytechnics, retention is an issue as the attrition rate is high. After SARS, many were attracted to the nursing profession, which suddenly became glamorous, but reality sets in when they are posted to hospitals and find that the work is not suitable for them. So, there is a need to find a better fit. Recently, nurses' pay were raised and they also now have better career progression leading to the APNs, but for allied professionals, the situation does not seem to have improved as they feel that there is better recognition for them in the US and other developed countries where they are treated as professionals compared to Singapore. 4.15 pm Sir, as most of the nurses are women, could the hospitals consider providing more flexible work options so that they do not have to leave the service after having babies? The other option which the hospitals could also consider is re-employing people beyond the age of 62, ie, extending the re-employment. And I would like to commend SGH for their Silver Connect programme which is an excellent programme.”
“Sir, I would like to ask what steps will be taken to ensure that subsidised patients will not be affected by the push to attract more fee-paying and foreign patients into the public hospitals. What checks and balances are in place? Is there a need to adopt a more arms-length approach when public hospitals deal with private/foreign patients? Would it not be better for public hospitals that want to attract foreign patients to do so under a separate company, so that there is separate funding, accounting and full accountability to prevent concerns about conflict of interest from arising, as one of the complaints is that doctors in the public hospitals have the advantage of using the facilities funded by Government but yet do not face the risks undertaken by private hospitals. I think a more arms-length approach in wooing and treating foreign patients in the public hospitals is important. This will lead to better accountability in the use of public funds. It will also ensure that our public hospitals do not suffer from schizophrenia - a serious branding problem - unsure of how to project themselves and who they should serve, subsidised or richer foreign patients. Sir, I hope that the Minister would address some of the concerns and issues which I have raised. I must emphasise again that our public healthcare system is one of the better ones in the world and a lot of good changes have been made over the past few years, which I must credit the Ministry. But these two issues of affordability and the need to maintain and relook at structures and systems pertaining to the SingaporeMedicine and public/private hospitals are important issues of concern to Singaporeans.”
“However, there are concerns over how this will impact on subsidised patients when public hospitals too start chasing after foreign patients and treating them in the same hospitals as the subsidised patients. There are a number of issues here. Compared to other developed countries, the general sense is that there is no firewall when the doctors in public hospitals treat the private patients leading to concerns of conflict of interest. So such concerns already exist now, hence, the question is whether it will be exacerbated when public hospitals start marketing and intensifying efforts to woo foreign patients. 4.00 pm The question being asked is whether this will dilute the public hospitals’ core mission of providing affordable healthcare to Singaporeans. There are concerns that this will happen because, in the first place, foreign patients who come here do so because they want better and faster treatment and will have to be given priority in the use of scarce hospital resources, such as access to specialists or the use of medical technology, if we want to establish a reputation and continue attracting them. As it is, we are already suffering from a shortage of doctors, nurses and other allied professionals. The moral hazard becomes even more evident when the remuneration package of doctors is structured in a way which will incentivise them to treat more foreign or fee-paying patients. We need to address these concerns as it would appear that there is a policy shift in our public hospitals from one where its social mission is to provide good quality affordable healthcare to Singaporeans to one, which includes a commercial mission also, of providing excellent medical care to foreign patients.”
“The total project cost for the Computerised Physician Order Entry (CPOE) system and Inpatient Medication Records (IMR)Applications, for instance, for the two clusters alone is $41,905,000, which is a huge investment. But the question is: how has this helped to reduce wastage arising from duplication or multiple tests done on the same patient, and how has this helped in seamless care? Sir, what cost savings or greater productivity can the public expect from the $11.5 million investment in teleradiology - again not a small amount? Or what is being done by the two hospital clusters to synergise and leverage on economies of scale in purchasing or other areas so that the cost savings can then be passed on to patients? Why is there a need for each cluster to maintain duplicating areas of specialties, such as heart, cancer or eye, for instance? Or now that we are trying to right site the management of chronic illnesses to primary care physicians, is there a need for a hospital to maintain a Diabetes Centre, which contradicts this effort? Sir, what the public wants to see is greater accountability and transparency and concrete measures to address their concerns. I urge the Ministry to keep a close watch on affordability, as this is still a concern for Singaporeans. And I hope that the Minister can enlighten us on the issues that I have raised. Sir, I think the problem is also that the two healthcare clusters see themselves as competitors with their own priorities, rather than collaborators in delivering a very important public good, and that is in delivering an affordable and quality healthcare system. Next, SingaporeMedicine and Public Private Partnership. The decision to attract one million foreign patients by 2012 is a very bold plan, and the economic arguments are clear.”
“First, the subsidy should be based on the total bill and not only part of the bill. In other words, when the hospital says that it is subsidising 80% of the bill for the C class, then this should cover all the items in the bill and not only some of them. If the subsidy is not on the total bill and the patient has to pay the full cost of some items, then it actually means that the subsidy for the C class patient is less than 80%. This is very hard on low-income patients especially if the items excluded from the subsidy are expensive, and most who are on long-term care would have exhausted all their savings. Sir, I would also like to ask the Minister to consider publicising the exclusion list of drugs and medical implants or accessories that are not covered by the subsidy or MediShield, so that people know upfront what is the total cost of treatment to them, as many believe that everything on the bill will be subsidised and they do get a shock when they receive their bill. This exclusion list could be displayed on the Internet or other forms of communication. The Ministry could also track the total amount that the patient has to pay by treatment or procedures to determine affordability and if this keeps on increasing, then the hospitals should be asked to explain the reasons for the increase. The subsidy levels can be high but if the hospital charges keep going up, then it would still be expensive for the subsidised patient as the portion that he has to pay will be higher too. Sir, we must also ensure that public hospitals continuously look at ways to reduce wastage and unnecessary cost to the patient, and provide greater transparency.”
“Sir, I beg to move, That the total sum to be allocated for Head O of the Estimates be reduced by $100. Sir, much has been done to improve our healthcare system but affordability remains a concern. The recent DOS statistics show that people are spending more on healthcare, which had gone up by 8% in 2005. Out of a total healthcare expenditure of $5.9 billion last year, the Government's portion is only $1.7 billion, which means that people are bearing the bulk of the cost. This has been the trend in the past and is likely to continue. In this year's Budget, only $1.4 billion has been allocated as operating subvention to the restructured hospitals and institutions, polyclinics and VWOs to enable them to provide subsidised medical care. Yet, the MOH estimated in the Budget this year that the average bill size for subsidised patients will increase further at a rate not exceeding the health CPI, which is usually higher than the general inflation rate. So healthcare cost is going up faster than wages, particularly for those at the bottom 30th percentile whose wages have stagnated or declined. Sir, I would like to ask the Minister what more can be done to contain healthcare cost and ensure that healthcare remains affordable. Is the amount of Government subvention given to hospitals and other institutions for subsidised patients sufficient, considering that our population is ageing very rapidly and the significant increase in the number of those suffering from chronic illnesses? Sir, it is true that we have high levels of subsidy for the B2 and C classes, but using the subsidy level alone as a reference point to determine affordability is not sufficient. MOH should also look at two other factors.”
“And in the long term, it will help us because then, we will have a haze-free region.”
“The Minister has outlined various measures to cooperate on fighting the haze this year with Indonesia and other ASEAN countries. I would like to ask the Minister, in the light of the recent sand ban and other developments, how will that affect the efforts at cooperation to fight the haze. Assoc. Prof. Dr Yaacob Ibrahim: Sir, I like to echo the response of Minister George Yeo yesterday during the Foreign Affairs' COS. He said that we should look at these issues and how they affect our own interest. Whether the sand ban continues or not, the haze, if it happens in Indonesia, will affect Singapore and, therefore, we have an interest. Therefore, I see this as an important part of our effort to maintain the high air quality that we have here in Singapore. Notwithstanding whatever spats that we may have and in the interest of Singaporeans' health, we will continue to work with our Indonesian partners. But we are realistic, as I mentioned in my reply, that there must be political will on the part of the Indonesian government. Since the October meeting in Pekan Baru, a lot of things have happened and I am a bit more optimistic this time around that Indonesia is prepared to do its part. The fact that they are prepared to put their targets out publicly shows a certain amount of commitment. Will they achieve it? We do not know. We hope they will. We will continue to work with them. On Singapore's part, our role in Jambi will continue. The workshop will continue next week. We have informed the Indonesian Environment Minister. He has given his blessings. As I mentioned earlier, even the Governor is coming down next week because he wants to be hands-on on this. If we can put the measures in place to prevent land and forest fires, then perhaps other provinces may want to replicate.”
“Sir, the 19% of people re-employed in the civil service appears to be a very small number compared to the total number who retired last year. I would like to ask the Minister whether there is any target set in the civil service as to what is the percentage of people it wants to re-employ, taking into account the need to look at performance, skills, relevance, and requirements for the job. But, at the least, it would be useful for the civil servants to know that there is some target set for re-employment of older workers after the age of 62.”
“Sir, I would like, first of all, to thank the Minister for informing this House that there will be a revision of public sector pay and an announcement will be made in April. But I would like to seek a clarification from the Minister because he said that it would not be across the board. And he said that - if I catch him correctly - it would also depend on the market demand for that category of officers. But I would like to say that in the public sector, because of the nature of public service, there are segments of people who are doing jobs which you may not find comparable examples in the private sector. Therefore, I hope that in doing a review and being dictated by that parameter, that you would look at what are the categories of officers where there is a weak market demand, and the Minister would not overlook these categories and grades of officers as well. 1.45 pm”
“Sir, the Singapore public service is widely regarded as one of the most efficient and uncorrupt bureaucracies in the world. It is one of the key contributors to the success of Singapore since independence. The public service has improved in quality over the years in line with the general population and demand of the economy. As we move ahead, the public service will have to become even more innovative and market savvy to help us take advantage to deal with new opportunities and challenges in an extremely competitive environment. For this to happen, it is important to attract and retain the best talents in the civil service. Salary is certainly a key deciding factor that will determine whether or not the public service can attract good people. The last time that public service pay was adjusted was in 2000, in order to narrow the salary gap between the civil service and the private sector, and to curb the stampede of talent to the private sector. The labour market has been tight over the last few years, and this year will be no exception. With so many new programmes, including many more announced in this year's Budget, there is certainly a need to ensure that we continue to have the best people in our public service. I would like to ask the Prime Minister whether public sector pay is competitive and in line with the private sector. Will there be any revision of public sector pay to ensure that it can attract and retain the best people? When will such a revision be completed? And also, to ensure that the revision will cover all sectors, all grades and all categories of public servants, and not just the elite or the scholars.”
“Sir, population policies to improve our fertility rate have been in place since the 1980s. In 1987, the new population policy to promote procreation was launched with the slogan "Have three or more, if you can afford it". In 2000, supplementary procreation measures were introduced. And in 2004, a Ministerial Committee made many recommendations to arrest the falling fertility rate. The 2004 package of measures which cost $300 million a year provided for longer maternity leave, childcare leave, five-day work week, Wow! fund, HDB top-up grants, enhanced use of Medisave, enhanced Baby Bonus and a whole slew of tax benefits. However, the generous monetary incentives did not bring about a bonus of babies as expected, as our fertility rate did not improve much. This suggests that a more holistic approach is needed, including quality and accessible childcare, effective work-life balance and more support for young families; also, greater tolerance of pregnant mothers from employers is absolutely essential. I would like to ask the Prime Minister how successful were these measures to promote procreation, how much has been disbursed under the various schemes, and what more can be done? Does the failure in improving our fertility rate suggest a change in priorities in young couples? Does the fall in fertility rate reflect changes in social trends and individual attitudes which influence procreation behaviour? Do these trends indicate the need to look beyond money matters in tackling procreation issues? Is there a need for a more comprehensive approach beyond the current measures? Procreation Policies”
“[For vernacular speech, please refer to Appendix A *.] Sir, the Budget this year is a special one, not only does it fully focus on the problems of low-wage workers and help them through various measures such as the Workfare Income Supplement scheme because they have been acutely affected by globalisation causing their wages to decline, but, more importantly, the Budget urges Singaporeans to think globally. *Cols. 1769-1770. 6.50 pm”
“I hope that all Singaporeans will support this Budget, not just the dollars and cents but, more importantly, the principles behind it that we need to work together to grow Singapore and to help each and every Singaporean find a place in Singapore. Do I have time to make a Malay speech, Sir?”
“Hence, it is necessary that we consider increasing the payment and extending the coverage period. Sir, I would also like to urge the Ministry to look at ways of helping those who are not currently covered under the MediShield scheme to be so covered, in particular whether the Ministry of Health could consider introducing an opting-out scheme for MediShield for spouses who are not covered as well as children of those who are covered under the MediShield, ie, children of CPF contributors, because this is a major worry as the MediShield scheme is indeed a very important scheme and for major hospital bills, it is important that everyone is covered. So an opting-out scheme should be one consideration that I hope the Ministry would consider. Sir, I would also like to stress that although the WIS has become a permanent scheme, nevertheless, the best future for our low-income workers is for them to graduate out of the WIS and move into higher value-added and better-paying jobs. The WIS should act as a channel through which low-wage workers will get temporary relief until they move on to a better future. Indeed, I would be very sad if large numbers of our present cohort of low-wage workers continue to remain on the scheme, let us say, five years or 10 years from now. In conclusion, Sir, this is a Budget that I am happy to support. This Budget has given us a greater sense of confidence in our future. While this Budget cannot promise that there will be equality of outcomes for all Singaporeans, as that depends a great deal on individual motivation and effort as well, it is, nevertheless, trying to give more equal opportunities to those who strive hard and wish to succeed.”
“And I have another case where someone wrote to me and this person and two of her sisters are supporting her brother who has been hospitalised in IMH for 20 years and their Medisave account is dwindling very fast. But they are also not eligible for Medifund because they have savings available. So, Sir, it is such people at the margin who need help and I hope that the Government will review this and give greater flexibility so that people who really need it will not fall through the safety net. I support the senior citizens’ bonus for those above 55 years, with most of it going to the Medisave. It is a good idea as many senior citizens do not have enough in their Medisave accounts and their major worry is healthcare bills. Over the last few years, Sir, I must say that we have seen a lot of positive changes taking place in healthcare and this has tremendously benefited Singaporeans. The system is not perfect and further refinements are needed but, at least, the problems are being fixed. I welcome the most recent changes announced by Minister Khaw to increase the withdrawal limits and allow Medisave use for outpatient CT and MRI scans, if these form part of the treatment. The ElderShield scheme has also been reviewed and the Minister has announced that the coverage period will be extended to six years and the amount increased to $400. While I welcome these changes - certainly these are good improvements - I am also of the view that the Ministry should also consider reviewing the qualifying criteria for the scheme. I have received many feedback that the current criteria which require an elderly person to suffer from three disabilities, like not being able to bathe, not being able to walk or not being able to eat, are too onerous.”
“The Minister for Finance has said that an additional one billion dollars will be allocated over a period of five years from now to 2012. Currently, the percentage of public sector expenditure vis-a-vis private sector expenditure is declining, which means that individuals are paying more of their own healthcare costs. I was hoping that the Government would be even more generous in its budget allocation to health, considering that our population is ageing so rapidly and chronic illnesses have increased significantly. I do not expect us to reach the levels of the US where expenditure on health at 16% of the GDP is the highest among the developed countries but, in terms of results, it is not commensurate with the amount spent as 45 million Americans are uninsured. I was hoping for a more generous allocation although I must say that its increase in budget allocation is also a welcome increase. Sir, I welcome the topping up of the Medifund as the demand for assistance will continue to grow. In 2005, for instance, $39 million was disbursed, the largest sum that the fund has handed out since its establishment in 1993 and a significant 20.9% rise from the $32.3 million given out in 2004. And to its credit, in 2005, the fund only turned down 0.1% of the applications, mostly because the patients were deemed capable of paying their bills. However, I would like to urge the Government to make the Medifund more flexible so that people who earn more can still tap it if need be. I have a middle-income couple living in my constituency whose little boy suffers from leukaemia. The family does not qualify for Medifund but the family is already in debt from paying for the boy's treatment for leukaemia.”
“Companies should also put in place a system to monitor the performance of their contractors through regular auditing and through relevant clauses in the contracts to ensure that they pay their workers CPF and other benefits provided under the law. Lowering of the second tier foreign worker levy for manufacturing and services Sir, let me now come to the lowering of the second tier foreign worker levy for manufacturing and services. The second tier foreign worker levy for the manufacturing and services sectors has been reduced. While I understand the rationale for this, I would like to urge the Government to closely monitor the situation as such a move could make foreign workers even cheaper to employ. I urge the Government to review this foreign worker policy regularly so as to calibrate the supply with the demand, so that we do not end up with the displacement of Singaporeans. With the increase in the employer's CPF contribution rate, I hope that the reduction in the foreign worker levy will not make foreign workers more attractive than Singaporean workers. The mechanism employed to control the influx of foreign workers is through the quota and the levy. Last November, the Ministry had announced that the quota for foreign workers would be made more flexible. Hence, the only other control that exists is through the levy and if this is weakened, then we may end up making foreign workers so much more attractive than local workers, something that we must guard against. Increased healthcare expenditure Sir, let me now touch on healthcare expenditure. I welcome the increased budget allocation for healthcare but I wonder whether it is sufficient as our population is ageing very rapidly.”
“So I would like to ask MOM to enlighten this House on what measures will be taken to ensure that employers of contract and casual workers pay CPF, as otherwise the WIS will not achieve its objectives fully. Such workers are usually unlikely to complain against their own employers for fear of losing their jobs, as there is nothing to protect them against termination by errant employers. I have spoken to some of these workers. They showed me their payslips. It showed the salary and other components but no CPF, and I asked the workers, "Do you want us to take it up?" They said, "No, because if I were to lose my job, then it is going to be difficult for me to get another job and there is no protection against losing this job that I am having right now." So I would also like to urge the Ministry of Manpower to step up educational efforts so that contract and casual workers know what their rights are and would minimally contribute to Medisave themselves to qualify for the Workfare bonus. On cheap sourcing Mr Deputy Speaker, Sir, the problem of contract workers is complex and it is primarily caused by cheap sourcing. When companies go for the lowest tender, it affects the behaviour of the contractors who begin to tender lower and lower in order to secure the contracts. After tendering low, in order to survive, they cannot squeeze anything more from their rental of premises or from their equipment or chemicals. So they squeeze the workers and pay them very low pay with no benefits provided under the Employment Act and no CPF. This situation is not sustainable and I urge employers who outsource to behave responsibly and go for best sourcing instead of cheap sourcing, a constant refrain of the NTUC.”
“We use our CPF Medisave Account to pay for our medical bills and we use the CPF Special Account to provide for our retirement. Everything is linked to the CPF. So what will happen to those casual workers without CPF? How are they to buy a home, pay for their medical bills or plan for their retirement? Last year, 120,000 Singaporeans who claimed the Workfare bonus did not contribute to CPF. Is Mr Low suggesting, Sir, that we should increase this number because that is precisely what will happen if we do not have this WIS/Medisave/CPF linkage? The existing low wage workers who are contributing to Medisave will then decide that they want even more take home pay and opt out of the CPF. If this were to happen, I believe, having witnessed the hardship of the workers, it would be disastrous for us and social exclusion will become even worse in Singapore. So, Sir, this linkage is important but the Government needs to do a lot of outreach programmes at the community level to educate our casual workers on the importance and the benefits of contributing to the Medisave. Sir, I would also like to urge the Ministry of Manpower to step up efforts to enforce CPF payments among contract workers. In his reply to the question I filed in Parliament on CPF contributions for contract workers, the Minister for Manpower acknowledged that for contract workers, monitoring of CPF payments is more difficult. He further explained that the CPF Board regularly audits employers' CPF payments and wage records, especially if they belong to such high default industries such as cleaning contractors and security agencies. Sir, according to MOM, 12% of our workers work part-time or are in temporary employment. The potential for this problem to grow is there.”
“If we want the WIS to be effective as an instrument to supplement wages, the amount, in my view, has to be reviewed yearly to ensure its adequacy and to ensure that it keeps pace with inflation. I suggest that the Government review the scheme yearly instead of waiting for three years before doing so. Third, Mr Deputy Speaker, Sir, our unions have voiced the concern that the WIS may not reach the very group that we want to help, that is, the casual workers. Many casual workers are paid daily and they may not save enough at the end of the month to contribute to their Medisave, as they usually spend whatever they earn. But I want to make an important distinction here from the position taken by Mr Low Thia Khiang. The decision to link WIS to Medisave is a crucial and important one and, unlike Mr Low who thinks that this shows a lack of sincerity on the Government's part, I believe, to the contrary, that this shows how much concern the Government has for the plight of the low income and the casual workers. I work extensively on the ground among workers from all sectors - public, industrial and service - and I have seen the grave hardship that these workers without Medisave or CPF face. We spoke to many of them - in the cleaning industry, in the construction sector, in the other services sector - and their sense of insecurity and fear is real. Why are the casual workers so concerned about falling sick, retiring from work or, if they are sole breadwinners, they were to die leaving behind their dependants? The reason is very simple. In Singapore, housing, health and retirement are all tied to the CPF. We use our CPF Ordinary Account to purchase our homes.”
“Second, with these changes, in my view, there is now less scope for using CPF as a tool to adjust wage costs during bad times. Workers need to build up their CPF savings to meet long-term needs and this should not be subject to the vagaries of short-term adjustments to help companies manage their wage costs. In fact, for those earning less than $1,500, the CPF rate for employers has already been adjusted downwards. So there is little scope for further reduction during bad times without affecting workers' savings for retirement and medical. So employers need to really focus and make sure that the flexible wage system works to meet changes in their company's performance or in the economy. I hope that we do not hear calls for more cuts in the CPF during bad times. WIS Mr Deputy Speaker, Sir, our unionists also strongly support the Workfare Income Supplement (WIS) as a bold and innovative scheme to help the low-income level up, but without eroding their work ethics. It will make our job a lot easier when we encourage workers to work even in the low-wage sectors which up to now are still dominated by foreign workers. However, there are a couple of observations that I would like to make with regard to the WIS. First, the WIS is pegged to income and age levels but does not take into account the family size of the low-income worker. Hence, a low-income worker who is a bachelor receives the same amount as another low-income worker with a wife who is a housewife and has children to feed. I would like to ask the Government to consider whether it is possible to provide more to low-wage workers with families as they are in greater need of financial assistance. The second point is that the Government has said that the scheme will be reviewed only after three years.”
“On CPF Mr Deputy Speaker, Sir, unionists are very happy that the Government has accepted our suggestion to raise the CPF and to phase in the Medisave payment for the self-employed and casual workers. This shows that tripartism works and the Government values the inputs of the labour movement. Workers have sacrificed during bad times, so it is timely for the Government to raise the CPF when our economy is doing so well. And the Government has not forgotten the employers, who will be getting a 2% reduction in the corporate tax rate which is higher than the 1.5% increase in the CPF. So I am a bit surprised to hear that there are employers who are unhappy with the CPF increase. I hope that employers will see their workers as their stakeholders as no company can operate profitably unless their employees are properly motivated. Let me add that our workers see themselves as stakeholders and that is why they accept wage cuts when times are bad and expect to be amply rewarded when times are good. In fact, we received delegations overseas many times often and one of their comments is that they really do not understand how Singapore could quickly adjust its costs in bad times and get workers to accept a cut in the CPF rates. And they do not know how we could do it. But we could do it because, primarily, the labour movement has the trust of the workers and also because the Government also has the trust of the people and the Government delivers on its promises. Sir, there are other significant changes to the CPF in this year's Budget. First, the linkage between Workfare and CPF/Medisave has reinforced the basic role of the CPF to meet the retirement and healthcare needs of workers, something which has been weakened over the years.”
“Even as government extends a helping hand to the lower-income, it must manage new tensions that could emerge in terms of how the other segments of the population, specifically the middle-income, will view such initiatives. When I was in Germany a few years ago, I talked to members of think tanks about the pressures faced by Germany arising from rising pension costs. Many agreed that adjustments are needed but disagreed to the dismantling of the system. There is a higher degree of consensus on inter-generational cross-subsidisation to sustain the pension fund. Hence, even the young accept some of the burden of caring for the old in their midst as theirs is not a defined contribution but a defined benefits system which transfers the cost of paying for the pensions of the current old to the current young. In Singapore, I do not think we have such a high degree of consensus. Under the CPF system, each one must take care of himself and his future by contributing to his own fund and this is something which is deeply ingrained. Hence, it will take some time for us to accept the fact that there are Singaporeans who, no matter how hard they work, will not be able to earn enough to provide for current and future needs and, therefore, they need more help from the Government. So these are tensions which the Government must manage very carefully, but, as Singaporeans, we too have a role to play. At the end of the day, we should all view ourselves as Singaporeans. And if one segment of our population is left behind, over time, it will affect everyone. Let me now, Sir, come to some specific aspects of the Budget.”
“But globalisation will continue to exert downward pressure on the wages of the low-skilled workers and we have to guard against marginalising our low-wage earners. Unionists worldwide, Sir, remain concerned about globalisation and the divisions which it creates. They feel that the pressures of globalisation are being borne disproportionately by labour. According to a recent UN report, "stiff competition under increased globalisation has led to reduced job security, a reduction in job-related benefits and the diminished role for labour". It further added that worldwide unemployment has increased significantly since 1995 - despite robust economic growth averaging 3.8% annually in the last decade and at 16.5% increase in the number of people with jobs. This trend is supported by the International Labour Organisation (ILO) report on Global Employment Trends which highlighted that the boom in East Asia has widened the income gap. It noted that "inequality has arisen, not just in income levels, but also in schooling and access to basic services". In South East Asia and the Pacific, the unemployment rate stayed steady at 6.6% last year. However, the report said that 59.6% of the region's workers had family incomes of less than US$2 a day. Sir, in many countries, we see two races taking place: one to the top for the better endowed and the other to the bottom for the less fortunate. Is this a sustainable development? I do not think so. At some point, the tension and conflict that it will create will boil over and everyone will lose. So, we are doing the right thing by pursuing a different path - supporting globalisation strongly while ensuring that everyone gets a helping hand to move up. But, herein, lies the paradox.”
“Sir, I welcome the Government's decision to freeze all Government fees for a period of one year. However, I notice that hospital and polyclinic charges are excluded from the list and I hope that the Government could also assure Singaporeans that these charges will not be increased this year as some are concerned that this might happen. As healthcare is a necessity, I urge our public sector hospitals and polyclinics not to raise their fees this year. I would also like to urge hawkers and businesses not to take advantage of the GST as an excuse to increase their charges as I have received feedback that this is already happening. A grassroots leader told me that her daughter's tuition centre increased its fees, citing the GST increase as the reason. Perhaps, the Government could reactivate the Committee on Profiteering (CPI) which was previously established to look into complaints over profiteering. I am glad to note that our NTUC cooperatives are doing their part to help Singaporeans by absorbing the GST increase. NTUC Fairprice, NTUC Foodfare foodcourts, NTUC Childcare and NTUC Learning Hub will be absorbing $5.1 million in GST, and NTUC Fairprice will also provide $1 million worth of shopping vouchers for the needy to purchase essential items. I hope that more traders will emulate the example of these NTUC cooperatives and play their part to keep prices stable. Sir, listening to the Second Finance Minister unveil the Government's plans for the next few years, I think Singaporeans have every reason to be optimistic about this year's growth and our future. The job market continues to remain tight and based on feedback we received from our unionists, many companies are suffering from staff shortages.”
“Nevertheless, Sir, I think that there is no danger of Singapore over-spending as our past expenditure at about 15% of our GDP is the lowest in Asia compared to government spending elsewhere in the region, which ranges from about 18% of the GDP in the Philippines and Hong Kong to 20% of the GDP in Malaysia. Now that we are at the stage of our development where we have accumulated enough reserves, it is prudent to consider a higher social expenditure. Mr Deputy Speaker, Sir, we know that the 2% GST increase is certainly not a popular move and coming so soon after the 2004 increase was also unexpected. But many people agree that the generous offset package will help, particularly our low-income earners. There are also strong economic arguments for the need to broaden our tax base and shift more towards a consumption tax rather than through direct taxation alone. As Andy Mukherjee, a Bloomberg News columnist, argued, "Singapore is not a natural home for companies. It does not have deep consumer and labour markets or energy and mineral resources. It must compete based on the cost of doing business, a category in which the World Bank ranks it at the top of 175 economies. This advantage is not permanent." Hence, this decision to move towards a consumption tax is not a decision that was taken lightly and if in the long run, it would help to make our economy even more competitive and create more job opportunities, then it is in the best interest of Singaporeans. As one of our unionists said, for workers, the logic is quite simple. We must first have jobs before we can talk about consumption and paying a tax on our consumption. If there are no jobs, there is no consumption to talk of and there is no need to worry about GST.”
“Mr Deputy Speaker, Sir, our unionists have roundly applauded this year's Budget as generous, fair and humane - very pro-worker and far-sighted, balancing well both the economic and social needs of our society. The GST credits, CPF increase, the WIS and Senior Citizen's bonus are but some of the very substantial measures that the Government has introduced to help low-income workers affected by globalisation and all Singaporeans who are affected by the GST increase. Some of our unionists even described it as the best Budget that they have come across thus far - and we thought that maybe Christmas came early, and we had Christmas goodies - and have complimented the Government for coming up with such a Budget. But many also find the Budget confusing and not easy to understand and have asked that the Government do more to help communicate the message in simple terms to the population. Sir, this is also the first Budget in Singapore's history to provide for a wage supplement, something that was not considered feasible in the past, but which is now necessary because of drastically changed circumstances. Globalisation has seriously affected the wages of our low-skilled workers, so there is a need to mitigate this impact. But the Budget is not just about wealth redistribution, as it also addresses the need to invest in our future to make our economy more globally competitive and our city more vibrant and lively. Hence, there are many measures to bring Singapore to the next level so that we can become a "first-world nation", to quote MM Lee. While we welcome this generous Budget, there are also concerns whether it will be sustainable, as schemes like the WIS, once implemented, cannot be withdrawn so easily.”
“I would like to ask MOS, in line with the wish on the part of MOH to keep the elderly sick at home and in the community, are there plans on the part of MOH to intensify efforts to help caregivers take care of the elderly sick at home because the services and facilities currently available are extremely lacking?”
“What is equally important is the commitment on the part of those who manufacture, import or sell health products to act responsibly by maintaining the highest safety standards and by placing the public interest above profit making. I hope that businesses dealing with health products will uphold high ethical standards that go beyond the requirements of this Act as the potential for inflicting harm arising from dangerous, defective or tampered health products are really great. On that note, Mdm Deputy Speaker, I support this Bill. 4.00 pm”
“However, I think that one area, which the Ministry could consider with greater urgency, would be medicines as these contain potent substances that can cause great harm, if not effectively regulated. I know that there exist laws covering medicines, such as the Medicines Act, but the Health Products Bill provides a more comprehensive framework. So, I would like to know when the Ministry of Health intends to bring medicines under the ambit of this Act. Finally, Mdm Deputy Speaker, clause 61 of the Bill penalises agents and employees of health products companies that commit any violations. Clause 61 is very broad as it covers “an … employee of another person, or being otherwise subject to the supervision or instruction of another person for the purposes of any employment in the course of which the offence was committed, that person shall … be liable.” I am concerned about this clause because the ambit seems to be very wide. It seems to cover even a production operator working in a health products manufacturing company or a clerk doing documentation work, who knows nothing about what he is doing as he is merely a cog in the machine. If indeed this interpretation were correct, then it would impose very onerous obligations on employees, which is way beyond their capacity. I would appreciate it if the Minister could clarify on the scope of this clause. In conclusion, Mdm Deputy Speaker, this Bill is a forward-looking and progressive piece of legislation that is needed to raise the safety standards of health products manufactured, imported, exported or supplied in Singapore. However, having the law alone to regulate the market is not sufficient.”
“This is a win-win strategy, as the real objective of the Bill must be to ensure that businesses uphold high standards and with penalties kicking in only if there are violations. Hence, it is better to try and assist businesses to comply in the first place, rather than to rely on penalties alone to keep them in line. Mdm Deputy Speaker, since 2002, we have had a voluntary registration system in place for medical devices. I would like to ask the Minister to enlighten this House on the number of companies that had registered with the HSA voluntarily. I would also like to ask the Minister if he could provide this House with information on how many companies had been prosecuted for violations of the various legislation, such as the Medicines Act, the Poisons Act and the Sale of Drugs Act, and whether violations are increasing. Mdm Deputy Speaker, unlike the US Federal Food, Drug and Cosmetic Act, our Act does not cover food products. Increasingly, this can become an area of concern. One example is milk or food products for infants, which can make all kinds of claims that it is good for health. Or for that matter, dietary supplements used for convalescing patients or generally as a replacement in some cases for normal meals. I know the difficulty of trying to cover so many areas but, other than this reason, I would like to ask the Minister what is the rationale for excluding food products that are promoted as health-related products from the ambit of this Bill. Mdm Deputy Speaker, the Bill provides the Government with great flexibility to cover the other health products when the Ministry deems it appropriate by listing those products in the First Schedule.”