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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“Sir, I would like to ask the Minister: (1) What is the official epidemic level for the disease and have we reached it in Singapore? and (2) Have we done an analysis as to why we have a sudden spike of this disease, particularly the EV71 strain, and what measures are we taking to deal with it?”
“Mr Speaker, Sir, apart from labour cost, companies have also complained that other costs also affect their competitiveness, like rental of office spaces and factory spaces and also accommodation for foreign workers. Is the Ministry also looking into these areas to ensure that we continue to remain competitive and attractive to investments?”
“Sir, a follow-up question. Arising from Minister Mentor's recent comments on studying Sweden as a model for our marriage and procreation policies, there has been much discussion among Singaporeans on the issue. May I ask the Deputy Prime Minister whether the Government is indeed considering using Sweden as a model and, if so, whether the Swedish model can indeed be transplanted and applied in Singapore?”
“Sir, I have three supplementary questions for the Minister. I would like to welcome the two initiatives that the Minister has mentioned that will help to increase the number of donors available for transplants. (1) The Minister has not answered this question but I think it is still a pertinent one, especially since we still have the current legal framework in place – will the Ministry consider setting up an independent Ethics Committee to assess donations of kidneys by non-related donors and recipients? One of the difficulties is that of getting the hospital ethics committee to be able to effectively assess whether there is a genuine relationship, especially when we have non-related donors and recipients. (2) I think the premise of wanting to legalise organ-trading is that it would eliminate the black market, but as the Iranian situation shows us, even with a legal market, under-the-table arrangements and payments cannot be eliminated. It still prevails. How confident are we, even as we consider this as part of the debate and on-going discussion, that this area will be addressed? (3) Sir, may I ask the Minister whether we are focusing on the right issues? As we know, there is a huge number of Singaporeans suffering from diabetes and hypertension which are contributing factors to renal failure. Instead of just focusing on organ transplants, should we not be focusing more on prevention at the primary care level to prevent people from contracting these chronic diseases? And if indeed they have contracted them, should we not be spending more efforts in preventing their conditions from worsening, in other words, address the pipeline issue that contributes to the growing numbers of renal failure cases?”
“Third, Sir, I welcome the establishment of an expert committee, mentioned also in the Minister's written reply to my Oral Question yesterday, but I would appreciate a further elaboration from the Minister on the objective of this committee and when this committee will come up with its recommendations. Sir, infectious diseases have become a serious menace worldwide. As someone has observed, "the worst case scenario is the pandemic of a disease, such as influenza, which spreads rapidly and out of control, going from person to person and from country to country, with inadequate supplies of drugs or vaccines to deal with it, with a large number of deaths and a huge number of illnesses. And beyond the human cost, there are gigantic economic costs and disruptions". Sir, this Bill is aimed at dealing with such a tsunami, before it hits us. It is aimed at helping us to move quickly, have access to timely information and galvanise all available resources. It is also aimed at making sure that individual Singaporeans too take ownership and responsibility for containing the spread of infectious diseases. On this note, Sir, I support the Bill. 3.02 pm”
“Fourth, as the rate of voluntary testing is still very low in Singapore, could the Ministry invest more resources to set up anonymous testing sites to encourage people to get tested voluntarily and with full confidentiality? This is in line with the objective of this new law which is to push those in the high risk group to go for HIV testing to prove that he or she is HIV negative to exonerate himself or herself under the law. Fifth, could the Ministry indicate what are its plans and strategies to curb the rise of HIV/AIDS as the number of new cases reported last year has now almost doubled that in 2001 and it is cause for concern? Sir, I would also raise three other points and this is arising from the written reply given by the Minister in response to my Oral Question yesterday, and that is with regard to voluntary HIV testing by our doctors in the public hospitals. The Minister had said that the risk is only two to 24 per million of such an incident happening, that is a doctor who is HIV infected and, therefore, infecting the patients. I would like to ask the Ministry whether the Minister would agree that even if the risk is only two to 24 per million, it is still a risk. But doctors who have agreed to uphold the Hippocratic oath should not expose their patients to risk, how would the Ministry explain to a patient who contracts AIDS that he had contracted it from a doctor who has refused to undergo HIV testing? Second, would the Minister also agree that if doctors themselves are not prepared to subject themselves to HIV testing, then would it not make it even more difficult for the Ministry to persuade ordinary Singaporeans who seek treatment at public hospitals to agree to this testing, which is currently voluntarily done in hospitals such as CGH?”
“First, no one is going to admit to high-risk behaviour and it is not something that you can monitor. In the first place, what amounts to "reason to believe" or high risk behaviour? Does this include someone who has sex with multiple partners but who practises safe sex? Which husband would be prepared to reveal to his wife about his infidelities and risk breaking up his marriage? Would a spouse who is tested positive be prepared to complain against the husband and, therefore, exposing him to the risk of being jailed and bringing more misery to the family? There is also the question of proof. The law will kick in only if a person is tested as HIV positive and his or her partner is also tested positive, by which time it may be too late. There are no preventive elements under this law. Hence, Sir, I would like to ask the Ministry to consider the following to make the law more effective: First, if a patient is diagnosed to be HIV positive but does not complain about the partner, the Ministry should still investigate the case to establish whether the partner, if he or she is HIV positive and has informed the patient of the risk involved before sex, and take the offender to task. Second, since all newly diagnosed HIV cases are required to be reported to the Ministry, I suggest that the Ministry look into these cases to confirm whether the offence of failing to inform partners of the risk has been committed under the law. Third, could the Ministry also clarify if the victims are unable to provide details of their partner(s) for investigation, especially for those with multiple partners, how will the offenders be brought to justice? Also, how will the case proceed if the victims are unwilling to testify against their spouses or partners?”
“Again, I understand the objective for the amendment and I support efforts to curb the rise of HIV/AIDS infection in Singapore. The numbers have been increasing rapidly and there are now more than 3,000 HIV infected Singaporeans. At the same time, the rate of voluntary testing has not been fantastic. Only 13% of the HIV cases were detected through voluntary testing and 78% were detected when they were tested for HIV while receiving other medical care. Also, while two-thirds of those infected through sexual intercourse got it from heterosexual sex, just 3% of infected heterosexuals were found through voluntary screening. With such a dismal record of voluntary testing, MOH's concern of infections spreading through the reckless behaviour of high risk individuals is not without basis. However, we know that the heavy hand of the law alone is not sufficient to deal with this problem. Education and empowerment, particularly among women, are equally important. Women need to be taught that they have a right to safe sex, a healthy life and, most importantly, the right to say no. The new section 23, Sir, now provides that a person who has reason to believe that he has or has been exposed to a significant risk of contracting HIV/AIDS must take reasonable precautions to protect his sexual partner, even if he is ignorant of his HIV status, otherwise he must inform his partner of the risk of contracting HIV from him. The objective of this change is good as its intention is to curb irresponsible sexual behaviour. However, Sir, the implementation and enforcement of this law can present serious problems. This law will kick in only if there is a complaint from an aggrieved victim. This requirement practically means that the law may end up quite ineffective.”
“It is important, Sir, that with such extensive powers accorded to the Government agencies, Singaporeans are given a clear assurance that these powers will be invoked only in very grave situations where alternative arrangements are not workable. I would like the Ministry to explain further on the safeguards that are in place to protect Singaporeans from arbitrary use of such powers. I am not aware of any other country that has such laws and I do not recall the Minister mentioning that such powers exist elsewhere which, therefore, calls for greater caution before they are exercised here as we do not really know the impact. At the end of the day, Sir, we all understand that this is a matter of balance, the right of individuals and businesses to carry on with their tasks uninterrupted as against the interest and common good of the public, but we have to draw the line and how it is implemented are also important issues. Sir, I also think that it is important, even as we talk about information, resources and systems, that the Ministry focuses on adequate training for our healthcare professionals, whether in the public or private sectors, so that they are well equipped to deal with an emergency if one arises. We may have experience with SARS but we cannot take things for granted as at the end of the day, it is the people factor that makes the big difference. I would also like to urge the Ministry to engage the public, perhaps through the community engagement programme, so that Singaporeans are better prepared if there is an outbreak of infectious diseases. Sir, the other comments I have to make with regard to this Bill are in relation to the provisions on HIV/AIDS.”
“Mr Speaker, Sir, I rise in support of this Bill. I want to commend the Ministry of Health for its single-mindedness in dealing with the threat of infectious diseases. This Bill will put Singapore in a better position to deal with the spread of infectious diseases. According to the World Health Organisation, infectious diseases are spreading faster than ever before. In fact, there is a new one shaping up each year. The WHO wants countries to crank up their efforts to fight disease outbreaks and share data on viruses to help develop vaccines. Otherwise, it says that there could be devastating consequences for the global economy and for international security. In this context, Sir, we are indeed taking a step forward by passing this Bill which would provide us with additional ammunition in the fight against infectious diseases. We did a wonderful job in dealing with SARS and obviously the shortcomings that the Ministry of Health found in our legislation which constrained its efforts at that time have formed the basis for some of the current changes. However, while the objective is noble and clear the fact that the Bill gives pretty extensive powers to the Ministry of Health as part of the social distancing measures has raised some concerns. A case in point is the blanket prohibition of all or selected gatherings, meetings or public entertainment or closure of all or selected premises islandwide. As the Minister himself acknowledged, such a provision has serious implications as it will cause major disruptions to the businesses and the daily lives of Singaporeans, not to mention the curbing of certain civil liberties. There are also other examples, such as the power given to health officers to arrest a suspect without warrant for certain offences under the Act.”
“Sir, can I ask the Minister of State to also involve parents of children who are suffering from mental illness in the discussions as they are currently not included while those with other forms of disabilities are involved?”
“I would like to ask the Senior Minister of State whether it is true that it is difficult for a bankrupt to seek employment in the public sector. In addition, if a public sector employee becomes a bankrupt while he is in employment, he will also be subject to disciplinary action. If this is true, then would the public sector want to take the lead by removing these restrictions for bankrupts? Assoc. Prof. Ho Peng Kee: My understanding of the public sector is that there are currently civil servants who are bankrupts. Of course, this is a question where the details can only be provided by PMO. My understanding is that it depends on the circumstances under which they have become bankrupt. It is not automatic, therefore, that he is dismissed. So there is already some leeway because people can become bankrupt for a variety of reasons. Column No : 2640 EMPLOYMENT FOR UNDISCHARGED BANKRUPTS 6. Dr Lim Wee Kiak asked the Acting Minister for Manpower (a) how many undischarged bankrupts sought the Ministry’s assistance to seek employment in 2007; and (b) what was the success rate in assisting them to secure employment. The Acting Minister for Manpower (Mr Gan Kim Yong):Mr Speaker, Sir, in 2007, 40 unemployed persons disclosed that they were undischarged bankrupts when they sought employment assistance through the Distributed Careerlink Network (DCN). Twenty-five of them (or 62.5%) have been placed in jobs, mostly in the logistics and security sectors. Four of them are still being assisted by the centres, whilst the remaining 11 have either indicated that they no longer require assistance or could not be contacted.”
“Sir, I would like to ask the Minister why is the number of ElderShield recipients so low. Is this because the qualifying criteria are too stringent and, therefore, people cannot benefit? 3,100 out of 790,000 is a very small number. If the qualifying criteria are too stringent, would the Ministry be prepared to review it?”
“Sir, it is actually quite shocking to hear from the COI report that due to minor human errors and also small lapses a well-known terrorist like Mas Selamat could escape. But I think there is at the same time, a good thing coming out of this incident. The lesson learnt is that we just cannot be complacent. Whether it is security agencies or Singaporeans, we need to be vigilant all the time. I have three questions to ask the Deputy Prime Minister. First, I would like to ask about the behaviour of the Gurkha guard which seems to me a little bit puzzling. He did not seem to exercise initiative and had to wait for someone to instruct him. I hope this is not reflective of how all our Gurkha guards will behave in Singapore bearing in mind that they guard very critical areas of security here. My second question is with regard to investor confidence. Because Singapore has been very well-known and well regarded for security standards, how has this affected us, particularly in terms of investor confidence in us and our security capabilities? My third question is to ask DPM about what happened after the escape. Can the DPM please update us as to the efforts taken up to now, a lapse of almost two months, to track Mas Selamat?”
“Sir, I would like to ask the Minister whether MOH will now label procedures as high risk or low risk so that the public and patients are aware and know what to expect from high risk and low risk treatments which will help to enhance their safety. Second, I would like to seek a clarification on the status of high risk procedures between now and the time the regulations are implemented. Are these procedures now prohibited or illegal? The third question I would like to ask is whether the Ministry is concerned whether resources are efficiently allocated because if more and more doctors perform aesthetic medicine, if we have a major outbreak of infectious diseases, do we have enough doctors who are experienced in terms of clinical practice to deal with such outbreaks? This is a concern of Singaporeans. We have invested a lot in educating doctors and they are therefore rightly concerned over whether there will be enough experienced doctors to take care of patient needs when there is a major outbreak of infectious diseases or to support the chronic disease management programme.”
“Sir, if this practice of giving rebates to employers is not legal, I would like to ask what steps have MOM been taking in order to curb this practice. How many employers and employment agencies have to-date been prosecuted for violating this rule and what has MOM done for those foreign workers who are affected by this rebate scheme?”
“Clarification for the Minister of State. Last Saturday, I was travelling along the CTE for a duration of 10 minutes, and there were seven lorries carrying workers in their backs and significant numbers of them did not comply with regulations. Considering that thousands of lorries are carrying workers in their backs every day, how effective are the enforcement measures? Last year, two workers died and 184 were injured because of road accidents. I would like to ask the Minister of State whether more stringent measures will be enforced, including banning carriage of workers in backs of lorries if the situation does not improve, to provide better protection for foreign workers. Mrs Lim Hwee Hua: Sir, Mdm Halimah's concerns are valid which is why the Ministry of Manpower and the LTA would proceed with this Committee to look at the issues that are involved. Enforcement is certainly one key factor and that will be one of the points of focus as well.”
“(In Malay): [For vernacular speech, please refer to Appendix A *. ] Madam, according to the report card during Mendaki's 25th Anniversary, the percentage of Malays without secondary school qualifications and working in low-income jobs is still high. It is worrying because if we cannot help low-income families escape the vicious cycle of poverty, this problem will most likely spill over to their future generations. Poor families need various help because their problems are complex and many are also dysfunctional families. At the same time, it is important for us to ensure that any help given can increase their resilience and help them to be self-reliant. It will be a problem if our efforts instead make them continue to depend on assistance forever. We must also ensure that the programmes created are sustainable and coordinated, since some may not know where to get help, while others get help from multiple sources. With increasing cost of living and inflation, this group will be affected even more. In last year's COS debates, the Minister-in-charge of Muslim Affairs announced that MUIS will allocate more funds for programmes that will empower low-income families. What is the progress of these programmes? How many families have been helped? What are the new initiatives planned to help low-income families? *Cols. 2301-2302. Divorce amongst Malay-Muslim Teenagers/Minimum Marriage Age”
“Sir, I urge the MCYS to review its financial assistance scheme in two areas: first, the $1,500 income ceiling for social assistance is too low, and excludes needy families who need help. With rising costs of living and sandwiched between caring for their own children and elderly parents, they really struggle. Yes, exceptions can be made but this is case-by-case and lacks the certainty of knowing that you are eligible to get help in the first place. Therefore, I urge MCYS to raise the cap and to put in place a system to review the amount yearly. Second, the current scheme provides for long-term assistance through the PA, which is very stringent, as there are only 3,000 cases now. All the other schemes are short term and recipients have to re-apply every three months. This is onerous and cumbersome. I urge the MCYS to review this and provide for financial assistance of a much longer period, as some of the problems faced by families take a longer time to resolve. Housing Need”
“I just want to seek a clarification on the clarification that the Senior Parliamentary Secretary gave to me on the swindling of foreign workers by agents, where he said that some of these countries are outside MOM's purview. Could I ask the Ministry to be more proactive, such as working with ASEAN counterparts under the purview of ASEAN Charter, to ensure that the governments take more responsibility, especially when it comes to foreign workers coming from the sending ASEAN countries. We now have a Charter, and I expect the Charter to be more proactive as well. I want to seek a second clarification from the Minister. The labour market seems to be a lot more segmented because, last year, 237,000 jobs were created. Despite that, segments of the workforce – the women and older workers – find it difficult to get jobs. Apart from the measures already mentioned, does the Ministry envisage any other measures from the policy perspective to address this tricky problem, because it is a problem that is not going to go away? Even as more jobs are created, these two segments will continue to face obstacles.”
“Sir, the number of cases involving foreign workers being swindled by agents has increased. Are there any measures to help such abuses, which may require collaboration with the sending countries, because some of these problems have originated in the sending countries? Are there any measures to deal with that? My second clarification, Sir, is with regard to the issue of discrimination against women and contract workers. I would like to ask the MOM what is the progress and whether it is looking into reviewing the Employment Act with regard to two aspects. The first aspect is the better protection for retrenched pregnant women who currently are not entitled to maternity benefits when they are retrenched, although they are obviously pregnant even in their ninth month of pregnancy. The second aspect is whether MOM would review the Employment Act with regard to providing better protection for contract workers. Right now, although they are protected by the Employment Act, the employer can truncate the contract in such a way that they will start from zero base every time, which affects their ability to earn the entitlement under the Act, whether it is for leave, sick leave or annual leave.”
“Sir, the WIS is a good scheme, as it is aimed at motivating and incentivising our low-wage workers to strive hard and be self-reliant. However, for it to be a fair scheme, overtime should be excluded from the computation of the $1,500 income ceiling. Including overtime penalises low-wage workers who work hard, as the harder they work, the faster they will reach the income ceiling. This is unfair to them. It also runs counter to the stated objective of the scheme. Fixed overtime is commonplace in some sectors, such as the security sector, and other sectors starve for workers in a tight labour market. And overtime can constitute a significant portion of the wages, in some cases, even as high as 40% of the total wages. Indeed, if there are two workers working side by side in a company, and one has a good attitude and willingly agrees to do overtime every day, whereas the other is lazy and refuses to do so, then it is unfair that the one who refuses to do overtime will get the WIS, but not the hardworking worker. Therefore, I urge the Minister to consider excluding overtime in computing a $1,500 income ceiling.”
“Sir, I would like to ask the Minister for an update on the labour market outlook for this year. How many jobs will be created, in which sector, what kind of jobs, how many jobs will be created for Singaporeans and how many for foreigners? And what is the projected employment and unemployment rate? Could the Minister also give an assessment on the employment market for older workers and back-to-work women? Last year, the job market was very good with many jobs created. But even then, these two groups of workers have found it difficult to find jobs. This is the trend that MOM will have to observe very closely, as it indicates that even when job creation is strong, there will be groups who will struggle to find work. I would like to ask the Minister what more can be done to assist them. What is the impact of a flexible foreign worker policy on their employability? How has it affected employer's willingness to redesign jobs or change workplace practices to suit the needs of older workers and back-to-work women? Sir, I would also like to ask the Minister to give us an update on the situation of the S-Pass holders. The quota for the S-Pass has been increasing very significantly from 5% barely a few years ago to 25% today. Are there any safeguards to make sure that Singaporeans are not replaced by these younger, better educated S-Pass holders? If the labour market weakens this year, would our retrenched older PMETs be affected if they have to compete with these S-Pass holders? Is the scheme too attractive and flexible as S-Pass holders will only have to be paid $1,800 and there is no limit on the employment period? Employment Rate”
“Madam, we have had a very useful debate this afternoon and I am very glad that the Minister has agreed to consider some of the proposals made by Members of this House. In particular, I am very happy with the details on the means testing mentioned by the Minister on two counts, firstly, on the income cut-off point. Instead of the 50th percentile announced publicly, it is now the 60th percentile of salary level. And, secondly, between the 60th and the 80th percentiles, it is not going to be a steep incline but it is going to be incremental and gradual. These two amendments have been made as a result of extensive public consultation, which I am glad the Ministry has taken into account and also because of the feedback given by some of our MPs. I think this augurs well for our public consultation process and it is definitely a positive influence on public policy making. On that note, I wish to thank the Minister and the Minister of State. I beg leave to withdraw the amendment. Amendment, by leave, withdrawn. The sum of $2,415,776,200 for Head O ordered to stand part of the Main Estimates. The sum of $216,818,500 for Head O ordered to stand part of the Development Estimates. Head Z – Financial Transfers 5.45 pm”
“Mdm Chair, I have three questions to ask. Firstly, I would like to ask the Minister with regard to medical tourism and manpower development. Now that we are focused on attracting one million medical tourists by 2012, how will that impact on the Ministry's manpower situation, particularly since now we are already seeing quite a critical shortage in some areas like specialists, and so on? So is that in the Ministry's projection as well? Secondly, I would like to ask, now that we have got means testing in place, and it will be implemented in January 2009, whether the Ministry will be allocating more resources to the B2 and C class wards, particularly in reviewing some of the areas where currently subsidies are not given or lesser subsidies are given, for example, the list of standard and non-standard medicines. Some medicines are non-standard and prescribed by doctors because they are more effective, but they are still considered non-standard in the B2 or C class treatment. Thirdly, I would like to ask how much of the $88 million that has been given to help in developing mental resilience has gone into supporting community-based mental groups, that are helping to provide shelter and other forms of assistance to those suffering from mental illness. Finally, I would say that I am very happy with the Minister's announcement on means testing. It is really most welcomed and I think it would allay a great deal of the fears of Singaporeans.”
“Neighbours begin to complain. But when they speak to the son, he says, "I have to work. If I don't work, I stay at home to take care of my mother to make sure that she takes her medicine regularly. There will be two mental patients and not one." So I think that really points to the fact that we need a lot of support in the community for those suffering from mental illness. I would also like to urge for more support to be given to caregivers who suffer physically, emotionally and financially in taking care of their loved ones who are mentally ill. Preventive Healthcare”
“More specifically, I would like to suggest that the Ministry consider the following: (1) Extend MediShield to cover mental illness; (2) Develop more trained manpower such as psychiatrists, psychologists, counsellors and medical social workers, to deal with the increasing number of people suffering from mental illness; (3) Do more to educate and raise public awareness about mental illness, as a recent study found that one in three people believe that the mentally ill are dangerous and half the population thinks that the public should be protected; (4) Expand more community-based step-down care services for the mentally ill to help them re-integrate into society; and (5) Review the funding support given to VWOs who are running facilities or providing care and support for the mentally ill, such as the Action Group for Mental Illness and those providing residential care, such as the Singapore Association of Mental Health. In fact, according to some of these associations, there are now more numbers of people being picked up from the streets by the Police and being referred to them because as the population ages, those who are mentally ill are also ageing but, unfortunately, their caregivers are not in a position to take care of them, especially they themselves are growing much older. It is, of course, a tremendous strain for caregivers also, as they financially have to take care of the needs of the mentally ill. I have a resident in my area, for instance, who lives with his mother and only the two of them are living in the house. The son has to go to work and the mother has no one at home to take care of her. And the problem with people with mental illness is that when they feel a bit better, they do not take their medication, and that is when they start having problems.”
“Sir, one in six people here suffers from some form of mental illness and, based on trends in other developed countries, the numbers are set to go up especially dementia with an ageing population. Mental illness causes terrible anguish to the sufferers. It carries with it a terrible stigma, results in loss of economic independence and is a great burden to caregivers. The current approach adopted by our healthcare system in the treatment of mental illness is still very much focused on medication. There is also an over reliance on institutional care and insufficient attention given to community-based care, which can play an important role in the treatment and care of mental illness as it helps in the integration of the individual and is less expensive. Sir, I would like to ask the Minister for a review of the current framework and to put in place a more holistic and comprehensive healthcare framework for the treatment of mental illness. I would also like to ask for an update on the $88 million fund that was set up last year. Could the Minister enlighten this House on what was this fund utilised for and how has it benefited and helped to improve the lives of those suffering from mental illness?”
“Sir, with last year's increase of the ElderShield payment to $400, this scheme has now become more attractive. However, even with this increase, the cost of taking care of a highly dependent elderly family member is a huge financial drain on many families. This amount does not even meet the income per capita of $450 set by MCYS for eligibility to our financial assistance schemes. Unlike many developed countries, we do not have a scheme which covers the needs of the elderly sick from a common pool funded by tax, individuals and companies. Hence, the ElderShield scheme will increasingly become an important source of help for the elderly sick, complementing CPF LIFE. Although families wanting a higher payment can now opt for enhanced ElderShield, the premiums may not be affordable to many because the base is smaller compared to basic ElderShield. I urge the Ministry to consider increasing the basic ElderShield scheme, so that ElderShield will become a more effective financial scheme for our elderly sick. 4.15 pm”
“On average, a doctor in a big polyclinic sees about 62 patients per day, which is much higher than the average of 40 patients per day at a busy private GP clinic. From a national perspective, this mismatch in capacity and demand between polyclinics and GPs is an inefficient allocation of resources. I would like to ask the Ministry to consider allowing GPs to claim the same amount of subsidies for treating subsidised patients as that given to polyclinics, subject, of course, to conditions or protocols to prevent abuse.”
“Sir, currently, there are no subsidies for families who take care of their elderly sick at home. This is further exacerbated by the limited access to Medisave for home-based medical care. I urge the Ministry to rethink the current strategy as it seems to be designed at keeping the elderly in the hospital rather than at home, as it disincentivises those who opt for home-based care. Taking care of a sick elderly person is a serious physical, emotional and financial strain on families, particularly for those with limited resources. Small wonder then that we often hear that the elderly occupy a lot more of the subsidised hospital beds and also stay long, which is a cost to our society because hospital care is expensive. Although one may argue that the elderly stay longer in hospital because they are sicker, it could also be because families with little support at home drag their feet in bringing home their elderly relatives. I urge the Ministry to consider granting subsidies for home-based care of the elderly, so as to ease the burden of families and to help to keep more of the chronic sick at home. Extend Subsidies for Treatment at Private GP Clinics Sir, I now move on to my second cut. Judging from the long queues, polyclinics are finding it difficult to cope with the increasing number of patients. The problem will not go away even if we build more clinics and deploy more manpower. Conversely, an SMA survey shows that GPs now have fewer patients and face higher costs, forcing some GPs into aesthetic medicine resulting in 20 of them being scrutinised by the Ministry arising from complaints of botched cosmetic jobs. This is the kind of supply generated medical service that we can do without, as it causes health care expenditure to balloon.”
“Sir, the current state of step-down care services for the elderly is not satisfactory. As a result, many elderly continue to remain in hospitals although it may be cheaper for them to be taken care of at step-down care services such as the community hospitals or nursing homes. Some elderly prefer to stay in hospitals long after they have recovered because they can tap into their Medisave for in-patient stays. Home-care services for the elderly is lacking and, if available, is not affordable to many. There are also not enough people trained in geriatric care at all levels among healthcare providers. Another problem is that the services are rather piecemeal. Coordination between the hospitals and step-down care services can be improved. There is also some concern whether there is adequate number of places in nursing homes as the population is ageing rapidly but the number of places has not gone up as fast. I would like to ask the Ministry of Health to do a thorough review and enhance our step-down care services in Singapore to better provide for the needs of our ageing population. Health Issues and Ageing”
“Sir, currently, MediShield covers only up to the age of 85. I would like to ask the Ministry to consider increasing this age limit for MediShield coverage to be more aligned to CPF LIFE. In the debate on CPF LIFE, we have heard that Singaporeans are living longer and would therefore have to save more for retirement. But equally urgent is the need to make sure that we are adequately covered for our medical needs during our old age. A person could have a retirement income but that will do him little good if medical bills erode all his savings. This will surely happen if he does not have an insurance covering him beyond 85 years of age. It is clearly incongruent, in my view, for us to worry about someone's retirement income after the age of 85 but to be less concerned over whether or not he can afford to pay his bills after that age. In fact, a recent Ministry study shows that while Singaporeans are living longer, they will also spend the last eight years of their life in poor health. So, Sir, I urge the Ministry to remove the age cap of 85 years on MediShield. Manpower Numbers and Projection”
“Sir, the problem is not with means testing per se, but with the implementation. I urge the Minister to ensure that the implementation of means testing will be equitable, efficient and effective. Let me touch on three points. First, the cut in the subsidy levels for different categories of patient and ward classes should be fair and affordable. Here, I urge the Minister to err on the side of generosity when he decides on where to draw the line, to ensure that the majority continues to receive the same level of subsidies as they do today and will not be affected. Second, ensure that the entire process is seen to be fair and transparent. It should not discriminate against the disadvantaged and add to the financial burden of those in poor health. Rules should be flexible in marginal and exceptional cases. Third, the testing mechanism should be administratively simple and not time consuming and costly. But even as the Ministry of Health focuses on means testing for better cost recovery and allocation of scarce resources, I urge the Ministry to also look at other areas to control cost and ensure that healthcare remains affordable. I urge the Ministry to pay special attention to housewives as 200,000 of them are not covered under Medishield. In conclusion, Sir, I would like to ask the Minister to give us an update on means testing, particularly the details such as the income levels and levels of subsidy for the different categories of patients and ward charges. Also, could the Minister inform this House when will means testing be implemented?”
“One great lapse in planning is the absence of insurance coverage or insufficient coverage by many Singaporeans. 200,000 housewives, for instance, are not covered under MediShield and a significant number are under insured as far as MediShield is concerned. This is certainly one area that we need to pay greater attention to in the years ahead. I would like to ask the Minister what steps are being taken to control increases in medical costs. Efforts are being made to control demand for medical services through means testing and co-payments, for instance, and the supply of medical services, such as through the control of the number of doctors, but the public also need to know what is being done to control medical costs. For even if medical services are highly subsidised, if the portion that people have to pay keeps on increasing, the overall cost to them will continue to go up. Health Care Costs”
“The elderly will use between three to five times more healthcare services compared to the younger population and each episode amounts to about two times more than the average cost. In dealing with the elderly, the current focus of our healthcare system appears to be still on how to manage episodes of acute illness with intensive treatment. But this is not well suited to manage the medical problems of the elderly. The elderly need continuous low intensity medical or nursing care to manage their chronic illness and to enable them to live good quality lives even if they have age-related disability. New alternative types of cost-effective community-based long-term care, including hospice and home care, will have to be further integrated with health-care financing. I hope to hear the Minister’s response on this as well. Sir, Singaporeans are concerned about rising medical costs. Last year, medical inflation went up by 6.2%, almost three times the rate of the general inflation rate. Over the last two years, the average hospital bills have gone up by 10% to 30%, and it was the C class wards which had the highest percentage increase. Those who stayed in the C class wards now pay an average of $1,112, 30% more than the 2005 average of $858. Last year, a Tan Tock Seng Hospital survey among 200 patients with chronic conditions found that one in five among them failed to keep up with their medication because they cannot afford it. A 2007 of The New Paper poll among 125 people aged 18 to 65 years revealed that two-thirds worry about medical costs for serious illness or accidents. Sir, addressing these concerns of Singaporeans are important. Equally important is how to help Singaporeans better plan for and manage their own healthcare needs.”
“Sir, I beg to move, That the total sum to be allocated for Head O of the Estimates be reduced by $100. Sir, MOH’s mission is to provide good quality affordable healthcare to all Singaporeans. Indeed, over the last few years, we have seen significant improvements in our healthcare system, which have made our lives better even as we grapple with the issues of rising costs due to an ageing population, new medical technology and higher expectations. MOH should be commended for these changes. I am glad to note that the MOH’s budget for this year has increased by 19%. This is a good sign as our national healthcare expenditure of 4% is way below that of many developed countries and, with an ageing population, it will be difficult to maintain even the current level of healthcare service and quality without any increase in the budget. The burden cannot be completely shifted to individuals who are already contributing 41% to the total national healthcare expenditure. However, I would like to ask the Minister where these additional health dollars will be channelled to? What improvements and changes in healthcare can we expect with this increase? How will the increased budget improve the lives of patients in the polyclinics and hospitals? How would the quality of healthcare in Singapore improve? I would also like to ask the Minister, how have we prepared our healthcare system to meet the challenges of a rapidly ageing population and whether part of the increased budget will be used to further develop the infrastructure, systems and services for the elderly. This is a serious problem as our population aged 65 years and above will increase from 8% today to 18% by 2030.”
“Sir, only 10% or 25,000 of elderly households living in 2-room and 3-room sold flats qualify for the Lease Buy-Back Scheme. This number is small because only those who have taken one housing subsidy is eligible for the Lease Buy-Back Scheme. I would like to urge the Minister to review this restriction and allow all elderly 2-room and 3-room flat dwellers to benefit from the Lease Buy-Back Scheme, regardless of the number of subsidies that they have enjoyed. If the objective of the scheme is to help needy elderly Singaporeans unlock the value of their flat so that they can have a retirement income, then this should not be limited only to those who have enjoyed only one subsidy. Imagine a situation where there are two financially strapped elderly couples, both living in 3-room flats, but one couple can enjoy a retirement income under the Lease Buy-Back Scheme, but the other cannot do so because of the restriction, and both are equally needy. The other point I would like to ask the Minister is to do more to promote the scheme of elderly households as many are still ignorant of its benefits and some also worry that this scheme would deprive them of a home. So I urge the Ministry to step up efforts in its outreach and education.”
“The Chairman: Mr Chiam See Tong is not here. Mr Teo.”
“Sir, as the largest employer in Singapore, the personnel policies and practices of the public sector is closely observed by the private sector. Hence, it is important that the public sector takes the lead in re-employing older workers, particularly those above the age of 62 years. The Public Service Division has, in recent times, adopted various policies to promote the re-employment of older workers, and we also have a joint committee to promote the re-employment of older workers. I would like to ask the Minister to give us an update on the number of employees who have been re-employed after the age of 62 in the public sector. Could the Minister also update this House on the progress of the three pilot projects that have been implemented on re-employment of older workers and how the experience of these three pilot projects could be expanded to other areas? Sir, let me now move on to my next cut. Update on Work-Life Ambassador Scheme Sir, work-life balance has become a major issue among employees, particularly those with young children and sick elderly parents to take care of. Awareness on the importance of work-life balance is increasing among employers in the private sector. The public sector also has schemes to assist people with families, particularly those with young children, such as the part-time schemes and the flexi-work options. But, obviously, more could be done in the public sector as a high percentage of the employees are female. Last year, the Public Service Division announced that it will embark on the Family Ambassador programme. Could the Minister give an update to this House on the progress of this scheme? What does this scheme entail? How will the employees benefit and how many employees have actually benefited from this Family Ambassador programme?”
“One aspect that will be given specific attention is whether we can give a more effective and integrated support to assist the lower-income workers, so that they can escape the cycle of low-skilled jobs. Sir, the Malay community has made great strides in all aspects, and I am confident that, once again, we will be able to take advantage of the opportunities provided under this progressive Budget. I support this Budget. *Cols. 899-902. 2.40 pm”
“By possessing skills and a spirit of independence, they will be able to find better jobs if they are retrenched, and also reap higher value jobs provided by our economy. We must be open-minded and willing to improve ourselves all the time. We must also take advantage of all the opportunities provided by the CET network. The recently announced CET network is an effort that gives specific focus to help workers improve their skills and further their careers. Under CET, a greater allocation is being provided under the Budget this year. I also welcome a number of measures that were outlined under the Budget to assist workers, such as the top-up to the Lifelong Education Fund, and subsidies for those wishing to take part-time courses at the university level. For sure, Mr Speaker, Sir, employment is the best assurance to manage the problem of the cost of living and the widening income gap. Employment is also essential to enable us to save more money in our Minimum Sum, so that we can enjoy a lifelong monthly income after retirement. Here, I would like to suggest that the CPF Board carry out more efforts to explain and guide the people, because I feel that many are confused and wondering what are the options to be made under CPF LIFE. This confusion is not just confined to the ordinary people; even the professionals do not quite understand the CPF LIFE scheme. I was at a recent dialogue session that was attended by doctors and they, too, do not quite understand the CPF LIFE scheme. Sir, in the field of employment, we have worked hard to strengthen the Malay community through the employability network under the Community Leaders' Forum. This network will be further refined to be more effective in assisting them.”
“In conclusion, Sir, I support the Budget, which will help to strengthen our work ethics, develop a more resilient community, whilst maintaining Singapore's competitiveness. I urge every one to do our part to keep the Singapore dream alive. We must give those in the lower-income bracket hope for a better tomorrow. Through skills training, they should be able to earn more. Through good education, their children should be able to do even better than them. In this way, we will have many more examples of Mumtaz Mohamed Yusof, who was cited by Minister Tharman as a shining example of how a student from a low- income family could rise to the top of her cohort. Let me just say a few words in Malay, Sir. (In Malay): [For vernacular speech, please refer to Appendix A *. ] Mr Speaker, Sir, the Budget this year gives a lot of focus on the lower-income group because they suffer the most from the rising cost of living. Many will definitely feel relieved due to the assistance given through this year's Budget. But it is good if we can remind ourselves that whatever assistance given will, of course, be temporary in nature. No assistance can be given forever without bringing risks to the country and the individual. The country cannot afford to give continuous assistance for the long term, without affecting our ability to compete. The risk to the individual, if we are too dependent on assistance alone, is that it will weaken our desire to be independent and to work hard. So the best and most effective long-term strategy will be for us to determine that everyone is employed and possesses the skills needed by our economy, in order to face the challenges of globalisation or a changing economy.”
“We may not be able to do very much for the existing cohort nearing retirement, but we need to at least understand whether the policy of lowering the CPF contribution rate for low-income workers would further exacerbate the problem for new cohorts of low-income workers. I understand, Sir, that it is a perennial issue of balance, ie, between fulfilling today's needs and saving for tomorrow's. But it also shows that while a defined contribution retirement scheme has generally worked for us, moving ahead, there are difficulties with such a scheme because there is very little social risk pooling. I urge the Government to pay attention to the retirement needs of low-income workers as they are the ones that need a retirement income the most but, under the present policies, are the ones that are less likely to be able to save for their retirement. Sir, there are Singaporeans who wonder whether the Ministry of Finance could exercise some flexibility in determining the eligibility criteria for the Growth Dividends. Instead of looking at only the value of the property, could the Ministry also look at the total number of people living in the household, as two persons living in a three-room flat will get a higher dividend compared to 10 persons living in a five-room flat? After all, sometimes, people buy bigger flats out of necessity because they have big families. Finally, Sir, I understand the rationale for granting companies deduction if they top up the Minimum Sum accounts of their employees. However, at the same time, I am also concerned that companies may use this flexibility as a tax haven, particularly if the benefit is confined only to their very senior management. Hence, I hope the Minister can address this point as well in his response to this House.”
“Mdm Chua is 44 years old and is working as a cleaner earning $600 a month. Mdm Chua has two children in school, and her husband works as a dishwasher earning $1,500 a month. Both of them are also supporting her husband's retired father. Mdm Chua has only $700 in her CPF balance. With CPF LIFE, our social safety net has become stronger and tighter, but the low-income workers, like Mdm Chua, who are left out will not have an adequate retirement income and will not benefit from the additional 1% that the Government is contributing to the first $60,000 of our CPF savings. This group is not insignificant, as they constitute about 25% of active CPF members who will turn 55 in 2013. It should be a matter of concern for us if we have a social safety net that excludes 25% of the people, the very folks who need such protection the most. So I urge the CPF Board to continue to explore ways to be more inclusive in drawing up our social safety net so that all Singaporeans, particularly the low-income workers, will also be covered under our CPF LIFE. On a related point, Mr Speaker, Sir, last year, we reduced the employer and employee CPF contribution rates for older low-wage workers. The objective for doing so was to help such workers enjoy a higher take-home pay and to help reduce employers' cost of employing them. That policy somehow contradicts the CPF LIFE scheme, and so I would like to ask the Government for an assessment on how that policy would, in the long term, affect our low-income earners' ability to save up for CPF LIFE and prepare for their own retirement.”
“Mr Speaker, Sir, in line with this focus to empower Singaporeans to take greater control of their own personal development and upgrading, I would like to suggest that the Government consider the feasibility of giving every Singaporean an Individual Learning Account (ILA), which can be topped up every year if there are Budget surpluses. We are already doing this with the Edusave Accounts and now the Post Secondary Education Accounts. So why not make the signal even stronger and extend this support to Individual Learning Accounts for working adult Singaporeans. I know that there is a concern about such schemes because of the possibility of abuse and wastage as we can see in some countries. But there are also other countries, such as Denmark, which have successfully implemented it. Now that we are putting the CET framework in place with the focus on building world-class training providers, perhaps this is one idea that we can revisit with safeguards, if necessary. The ILA would send a very strong signal that Singaporeans should take ownership of their own learning and not leave it to the company, or the government, or the society. The ILA would also further strengthen the WDA's current worker-centric model of training compared to its past company-centric model. Mr Speaker, Sir, let me now turn to CPF LIFE. Our unions' feedback to CPF LIFE has been positive. Many feel that this would further strengthen our social safety net but they have also expressed concern over the plight of the many low-income workers and contract and casual workers who do not have the Minimum Sum of $40,000 to participate in the scheme. They are concerned that such workers will not have a sufficient retirement income. Let me quote to Members the case of Mdm Chua Ah Yan as an example.”
“It says neuroscientists have found that "many children growing up in very poor families with low social status experience unhealthy levels of stress hormones, which impair their neural development." The effect leads to impaired language and memory development of a child - and hence his ability to escape poverty. Mr Speaker, Sir, Mr Tharman was spot on when he said, and I quote him, “for Singaporeans to stay ahead, it must continue to be a place where Singaporeans can aspire, where there are opportunities to develop every skill and talent, and where everyone does his utmost to do better and surprise with his abilities." In other words, Singapore must continue to be a place where everyone can look forward to the future with hope, and everyone has the opportunity to fulfill his dreams, provided he is prepared to work hard. Our strong economic growth, sound tripartite relations, strong work ethics and tremendous focus on developing our people, stand us in good stead in addressing this challenge of a widening income gap. And I want to applaud the Government's farsightedness in introducing the Workfare Income Supplement (WIS). This has given greater motivation and meaning to work for our low-income workers. As our daily rated workers tell me, "What we want is not handouts but the dignity and satisfaction that a decent income gives to us from our own efforts.". Hence, the most important part of this Budget, in my view, is not the Growth Dividends but the investments that we are making in our people which are all aimed at empowering Singaporeans to take better control of their lives and to keep social mobility alive.”
“So, I urge the Government to continue to take steps to control and manage inflation. But, Mr Speaker, Sir, keeping our focus on building a resilient community is also critical in dealing with the challenge of a widening income gap, a more intractable issue staring at us. Since 2000, our Gini coefficient, a measure of the income inequality in our society, has been going up. A report released by the Department of Statistics recently showed that although, on average, wages in almost every income bracket have gone up, high income households have enjoyed bigger pay increases while the less well-off have seen more modest wage gains. The average monthly household income for the top 10% earners rose 10.5% to $20,240. For the bottom 10%, income from work increased just 3.9% to $1,210, or 1.9%, after inflation. Last year, our Gini coefficient was 0.485, which is higher than even the US Gini coefficient, but declined to 0.46 with the GST rebates, WIS and other assistance schemes, a ratio closer to the disparity level of five years ago. This widening income gap is a cause for concern, and I am glad that at least some of the measures in this year's Budget, just like last year's, are meant to address this issue. We know that the widening income gap is not peculiar to Singapore. A 12th November Newsweek article devoted much space to this issue under a big headline entitled "The Death of Social Mobility". A sub headline says, "In the Asian Tiger economies, the next generation will struggle to do as well as their parents did." A recent report of the New York Times under the headline "Poverty is Poison" highlights the perils of not addressing poverty.”
“Even as we discuss about the merits of CPF LIFE, we must not forget this very important aspect. Mr Speaker, Sir, the Budget covers two other important aspects; inflation and the widening income gap. Many Singaporeans have expressed concern about rising costs. Our lower income households, in particular, have been harder hit by rising food prices because such households usually spend proportionately more on food. Although we understand that some of the cost increases are inevitable because of imported inflation and the high oil prices, I agree with Mr Inderjit Singh that the Government needs to manage inflation, and help to control costs particularly those that are within its control. I remember that, in 1993, I was a member of the Cost Review Committee, which was tasked to look into the question of rising costs. A key recommendation of the Cost Review Committee was, and I quote, "that fee increases, where necessary, be carried out gradually and spread over several years. Fee increases by various Government departments should also be carefully coordinated to prevent the public from being hit with too many cost increases around the same time". This is a recommendation that is still relevant and useful and I urge all our public sector agencies to heed this advice, so as to avoid a sudden spike in cost increases, like the one we experienced over the last two years. For many years, Sir, we have been able to keep inflation at a very low level. I fear that if inflation continues at this rate, wage pushed inflationary pressures will mount. So far, we have been able to keep inflationary pressures out of our wages because people have been able to enjoy real wage increases due to the low inflation rate, and this has helped us to remain competitive.”
“Mdm Pang's example shows that having left the workforce for many years is no barrier to re-entering the workforce if they have the will and if we help them by providing them with the skills and through job placement services. This Back to Work Programme is all the more urgent now that we have CPF LIFE. I would like to join others in urging greater attention to be placed on this issue as women form quite a high percentage of those without the Minimum Sum of $40,000. A survey by the MCYS among 3,000 women shows that many do not have savings for their retirement. This year's Budget will make it a lot easier for husbands to top up the Minimum Sum Accounts of their homemaker wives. If they do so, their wives too will benefit from the Life Bonus. To help spread the message, the NTUC has launched an outreach programme called Women Interactive Series, or WISE. Under WISE, we aim to reach out to as many of our union members as possible to encourage them to top up their wives' Minimum Sum Accounts. I urge the Government to provide an attractive bonus to encourage and persuade husbands to top up the Minimum Sum Accounts of their wives. The third way, in which the NTUC is working on to help build a resilient community, is through our re-employment of older workers. As at January 2008, 385 unionised companies have committed to re-employ older workers above age 62. Currently, there are 3,650 retired workers being re-employed by 253 companies. For 2008, we aim to achieve a re-employment rate of 5,000 retired workers. This is an important pillar in building resilience as the Minimum Sum draw-down age has been raised to 65 years. If workers have no jobs after 62, it will be a real struggle for them to survive.”