Kanwaljit Soin
Singapore
“Mr Speaker, Sir, I would like to ask the Minister to give a response to an exclusion in clause 2 (b) which amends section 10 to deem any maintenance payment received by a parent or a child under a maintenance order not to be income subject to tax.”
“Clarification, Sir. I realise that. But I would like to know what is the policy, what is the thinking, that you can allow a parent who gets maintenance not to have to pay income tax. A parent is an adult. But you do not give the same privilege or right, I would say, to a wife who gets a maintenance ordered by the court.”
“My point is no income tax is charged for maintenance payments received by parents. That is what the Minister said about clause 2. But yet when wives receive maintenance from their husbands, those maintenance payments are subject to income tax. Why is there a discrepancy?”
“So I would like to ask what is the Minister's thinking. Why is it that the maintenance of a parent is not considered income, because it is for the subsistence of the parent, while the maintenance for a wife which is for her subsistence is considered as income?”
“If the letter of authority is not stampable, then this may become a recourse of getting around the stamp duty and income tax rules affecting sub-sales. Another issue to be considered is the timing of the payment of stamp duty. With the amendment, this has to be paid at the time of the signing of the sale and purchase agreement.”
“Would the Minister have, in hand, figures to show how many Singaporeans who go abroad to study medicine come back to do their housemanship in Singapore for the last three years? Dr Aline Wong: I do not have the figures on Singaporeans who come back to do housemanship for the last three years.”
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“Sir, would the Senior Parliamentary Secretary agree that privileges have to go with responsibilities? And if the man is the head of the household, then ultimately the man would have to bear responsibility even if the wife did not bring up the child well. Assoc. Prof. Ho Peng Kee: Under section 39, the court will look at the circumstances of the case. In fact, before the Juvenile Court makes a sentence, there is a pre-sentence report. The probation officer will interview the juvenile, the parents, members of the family, school teachers, peers and, if need be, a psychological assessment is taken. So all these facts are put before the court, which may sit with two assessors, which then decides, based on the criteria found in section 39, whether one parent or both parents have neglected to exercise due care over the child. If it is both parents, both will be fined. If it is one parent, the neglecting parent will be fined.”
“Sir, would the Senior Parliamentary Secretary agree that if the father has the privilege of getting medical benefits for the children as he is the head of the household, then he must also have the responsibility of bearing the burden that due care has not been exercised and the child has been neglected? Assoc. Prof. Ho Peng Kee: I think we should not mix the two issues. The father has the legal responsibility of maintaining and upkeeping the family, wife and children. But here we are talking about bringing up the children, looking after the children in terms of their behaviour. I think here both parents have a responsibility.”
“Sir, would the Minister of State agree that the open market value of the car goes up if the car comes with added features like airbags, etc? That is why car importers leave them out purposely so that the open market value is lower, so that the ARF and the taxes are less. Would the Minister of State therefore agree that by giving some tax concessions, this would be a positive way of encouraging the use of these safety features by the consumer?”
“Now that we are looking to increasing the retirement age to 67, a large portion of our working population is going to be elderly and will need transport. The Ministry of Communications, therefore, has to take responsibility for the transport needs of the aged and the disabled and plan an integrated transport system. The VWOs can give their support but they do not have the clout to influence transport operators to make their services available and accessible to the aged and the disabled. Only the Ministry of Communications can do this. Sir, I would like to urge the Minister to set up a high level committee from the involved sectors to look into the transport needs of the disabled and the aged and to formulate a national strategic plan for this sector of our society. By the year 2020, about 20% of our population would be more than the age of 60. So there is not much time left for us to start planning now.”
“I am speaking on Transportation of the Aged and the Disabled, Sir. During the discussion on the White Paper on "A World Class Land Transportation System", the Minister for Communications said, and I quote: `When designing public transport systems, thought has to be given to being as friendly to the aged, as it makes sense to do so. It has incorporated features like special flooring and special facilities at the various new stations, including vertical lifts to be incorporated in the Woodlands Station.' The Minister is to be commended for giving consideration to the commuting difficulties experienced by the disabled and our aged Singaporeans. However, I understand that modifications to the MRT stations are only being considered in the new MRT stations. What about existing MRT stations? How do we expect our aged and disabled to have seamless travel if their point of departure has facilities that are friendly to them but these are not present at the point of destination? Surely, we do not expect our old and disabled commuters to travel just from one new MRT station to another new MRT station. There are some transport services available for the aged and the disabled which are provided by voluntary welfare organisations. However, these services are inadequate, patchy and unsatisfactory although the voluntary welfare organisations are trying to do their best. Examples of the services provided include the "Dial a ride" service for the handicapped and there is also a "Dial a ride" service available for the elderly, but more or less limited for going to clinics and hospitals. A macro-survey done in 1985 by MCD revealed that one of the main reasons why more than half of the 4,000 disabled people interviewed were unable to work was because of commuting difficulties.”
“If not for this tip-off and the prompt action by MCD and the care and concern shown by his school, a young life could have gone astray and have been wasted. CID figures show that two-thirds of young offenders are 14-15 years old. An MCD study has found that half of the young offenders surveyed were premature school leavers. I would therefore like to urge the Minister to ask his Ministry to institute a system of keeping track of young school drop-outs after they leave school, so that we can bring them back to school in the shortest possible time. MOE could work with MCD on keeping track of these young drop-outs. I am sure that the Minister appreciates this problem, just as we appreciate his problem in dealing with the difficult issue of school drop-outs. But I am hoping that the Minister will be able to lead the way in solving this very thorny problem.”
“Sir, with your permission, I would like to refer to the concerns of my colleagues about heavy bags and physical development of a child. As an orthopaedic surgeon, I would like to assure them that there is no ill effect on the physical development or on the growth of the spine. In fact, it will end up making the students more robust if they carry heavy bags, and it will be good for their development. Sir, I would now like to go on to my cut which is on school drop-outs. I raised the subject of compulsory education and school drop-outs on more than one occasion, and I know that the Minister himself is concerned about school drop-outs, although he does not advocate compulsory education. In the 1993 Committee of Supply debate, the Minister spoke of two categories of drop-outs, the older ones and the younger ones. When referring to the young drop-outs, this is what he said: `... as soon as the students are found to be showing signs of dropping out, they will be counselled by their form teachers, and later on by their principals who will bring in their parents, and so on. This is an area where the Ministry is studying to see what further improvements can be made.' Recently, the case of a 13-year old, Chua Teck Huat, from Zhenghua Primary School, emerged as a heart-warming story. The boy was abandoned by his parents and dropped out at Primary One. Two years ago when he was 11 years old, MCD, acting on a tip-off, looked into the case and this resulted in the boy being admitted to Zhenghua Primary School, five years after being out of school. The boy did not even know the alphabet, but now he is in Primary Three and has become an achiever, and even received a book prize.”
“The Ministry of Education has announced an increased two-tier per capita funding for multiple disability and for single disability. This gesture of the Ministry is appreciated. But would the Minister please go all the way and take over completely the education cost of special education where it rightfully belongs. This move will free funds of the non-government sector to be used for other worthwhile community projects, for example, dysfunctional families, needy, elderly, and children and other disadvantaged sectors of society, instead of spending a lot of those funds from the community on the education of handicapped children. Would the Minister please consider this request favourably?”
“Sir, with your permission, I would first like to express thanks and appreciation to the Minister for his announcement of the career prospects for teachers and I am especially glad because the teaching profession is dominated by women. I would like to join Dr Ong Chit Chung in making a plea for special education or schools for the handicapped. The cost of running special education schools is currently being shared by the Ministry of Education and NCSS with other charitable organisations. Last year, I urged the Minister to consider taking full financial responsibility for special education during the Committee of Supply debate. Dr Aline Wong in her reply said, and I quote: `I think it should be a responsibility shared with the community. The financial cap that we have adopted is quite generous, up to four times the cost of educating primary school students in ordinary schools ...' With due respect to the Minister, I do not agree with the view and I am therefore bringing up the subject again. The cost of special education is made up of two components: (1) the education cost; and (2) the welfare cost. The VWOs who run the 14 or 15 special schools feel that the education cost of special schools should be borne by the Ministry of Education and this aspect of the special schools should be under the purview of the Ministry of Education, and I am in agreement with this view. The welfare cost of special education can be borne by the community and VWOs and thus the community will not be shirking its responsibility towards the disabled. If the education cost is borne by the Ministry of Education, the VWOs will then be happy to look after the welfare cost.”
“During this period, it is not necessary that the worker should be hospitalised, because this will bring up the medical cost unnecessarily. Therefore, some special provision has to be made for orthopaedic injuries as 14 days of non-hospitalisation sick leave is grossly inadequate. An amendment should be considered. Here, Sir, I would like to declare my interest as an orthopaedic surgeon in private practice.”
“Sir, my cut pertains to the guide for the assessment of traumatic injuries for workmen's compensation. This is a Ministry of Labour publication. The latest edition was published in October 1990 and this guide is used by doctors to assess the permanent incapacity of workers and to award them the percentage of disability. I would like to point out some shortcomings in this guide and suggest some changes. (1) The guide is not complete. For the upper and lower limbs, it only gives figures for incapacity for restricted movement of joints, for amputations and for shortening of lower limbs. There is no guide to the assessment of permanent damage to tendons and nerves. Nerve injuries can be very incapacitating and must be taken into consideration when calculating the percentage of permanent incapacity. (2) Some of the percentages allocated for incapacity are too high. To give one example, stiffness of the two joints of the thumb adds up to 26%, while amputation of the thumb at these two phalanges adds up to 30%. It is quite obvious that having a stiff thumb cannot be nearly as bad as having no thumb at all. I could give many other examples, but I think this will suffice to persuade us that a review of the guide is necessary. I hope that the Minister will initiate the review quickly. The Minister may also have to look at the Workmen's Compensation Act. Under the Third Schedule of this Act, a worker is entitled to be paid full earnings up to 14 days if not hospitalised and full earnings up to 60 days, if hospitalised. If the incapacity exceeds the above periods, the entitlement becomes two-thirds of the pay. In orthopaedic injuries where there are fractures of the upper and lower limbs, this usually necessitates that the worker be off work for about six weeks.”
“Non-compliance should entail a ban from hiring foreign workers for a certain period of time. Also, this scheme for a minimum wage for foreign workers could address a concern expressed by Mr Sinnakaruppan about the tendency of local employers to retrench local workers over foreign workers. Sir, could the Ministry also advise foreign workers to join a union? The union could then look after the foreign workers' welfare and bargain for reasonable wages. Finally, Sir, I would like to urge the Ministry of Labour to carry out a public education programme to advance the welfare of foreign workers. We should change the patronising attitude of some of our local employers who feel that they are doing the foreign workers a favour by giving them a job. Foreign labour should be perceived as an international shared human resource with benefits accruing to both the host country and the sending countries. Sir, we should therefore continue to look after the welfare of foreign workers and I welcome the Minister's view on this subject.”
“My amendment is on the welfare of foreign workers. Foreign workers have become a fact of life in Singapore and, as the Minister confirmed just now, they comprise 20% of our labour force. They do many of the jobs that are avoided by the local population. We must therefore acknowledge that the input of foreign labour is indispensable to our economy. As a nation and on an individual level, we have gone some distance in advancing the welfare of this sector of our society, but much still remains to be done. Wages of foreign workers cannot be left to market forces as there is a market failure. If it is just a question of supply and demand, then one could expect competitive wages for foreign workers as there is a limited supply and a much greater demand. However, this is not so, as employers have the upper hand in the continuation or the termination of the services of the foreign worker. Fear of repatriation affects their wage bargaining power, and as many of them have borrowed money to leave their home country, they have little choice but to work even when the wages offered are low. Thus, I would urge the Minister to look into the setting up of a minimum wage scheme for foreign workers. This proposal has already been adopted by the Indonesian and Malaysian governments to ensure that domestic maids from Indonesia are not exploited by either their employers or the employment agency. The Indonesian-Malaysian Agreement contains among other things the quantum of fees charged by the Indonesian employment agencies on the maids, maid's salaries and the responsibilities of employers and maids. Would the Minister please consider formulating a set of guidelines on the range of wages to be paid to foreign workers? Occasional checks can be carried out to ensure compliance by employers.”
“Sir, the Minister has overlooked two points about the family service centres, ie, the shortage of staff who could speak Malay and Tamil and the increased need for centres in areas where there are rental flats.”
“Also, Sir, the IMC report says that one of the features of multiple problem families is that they earn less than $1,500 per month and live in 1-room or 2-room rental flats. A 1992 HDB survey showed that rental flats are homes to 50,000 families, 20,000 of whom lived in 1-room flats. Does the Minister envisage that there should be a higher ratio of FSCs to population size in the areas where there are more rental flats and lower income families? If so, how are we going to realise this? I would welcome the Minister's insight into this issue. My last amendment, Sir, is on the referral of the unemployed. The Ministry of Labour's Employment Service Unit saw a big jump in the number of job seekers in 1995. At the end of December the number of job seekers was 1,345. There were 749 men and 596 women, and the increase came mainly from the women. While there were more job seekers last year, there were fewer job offers from companies. Most of the work sought and offered tended to be of the lower end, like cleaners, labourers and other blue-collar work. I would like to suggest to the Minister that his Ministry acquire this list from the Ministry of Labour. I see this as an entry point into probable dysfunctional families. With the available list, MCD could work with VWOs to help the unemployed and their families. I know of one private scheme whereby women are taught to make consumer items at home and are paid for this work quite well. MCD could refer the cases of the unemployed Singaporeans to the nearest FSC or VWOs that are willing to help in this area. By helping the unemployed adults quickly, I am sure we will be able to prevent families from getting into distress.”
“Thank you, Sir. My first cut is on family service centres (FSCs). There are now about 20 family service centres and most of them are located within major housing estates. These FSCs are a pivotal arm of our social services. However, we have a language problem that prevents full utilisation of these centres by the minority ethnic groups. Many centres cater to the Chinese speaking, but they find it difficult to staff the centre with people who can speak Malay or Tamil. Thus, the minority ethnic groups in many housing estates are unable to avail themselves of the services of the family service centres. There are two or three family service centres run by the self-help groups, but this is not enough as FSCs should play a central role at the neighbourhood level. In the IMC report, it states that: `The Committee notes that there is a need to employ more Malay and Tamil speaking Singaporeans to provide services to families from these ethnic groups. This is more cost effective than setting up centres specifically to meet their needs.' I realise that there is a problem of getting enough social workers who can communicate in Malay or Tamil. Would the Minister consider these suggestions to overcome this problem? (1) Social work students, who take up Malay or Tamil during their university years and reach an appropriate level, should have an extra language allowance added to their salary when they start work as social workers. (2) The MCD may have to pay the salary of interpreters who can be attached for half a day to each family service centre. 3.15 pm (3) More scholarships to be offered, both at diploma and degree level, to study social work, especially for students belonging to the minority ethnic communities.”
“At the present time, each working Singaporean contributes a small monthly sum which is disbursed to his or her assigned ethnic-based group. For Indians, the sum varies between $1 and $6, depending on the salary; for the Muslims, it is combined with the Mosque Building Fund and varies from $2 to $5; for the Chinese, the sum varies from 50 cents to $1. We could separate the Mosque Building Fund and then make working Singaporeans of the different communities pay similar amounts, according to their salaries, into a common fund. Then disbursements to the various self-help groups could be done from this common fund in proportion to the population ratio. On top of this, Sir, a Singapore citizen can be encouraged to contribute more to any or all of the self-help groups if he or she so desires. The common fund will result in a pooling of the goodwill of all working Singaporeans towards the less fortunate and disadvantaged Singaporeans of the various communities. This gesture will help to bond the various communities in Singapore and make the self-help groups more meaningful and relevant by doing away with the method of collecting and disbursing funds along the fault lines of ethnicity. We would then truly be a sharing and caring society.”
“(1) Corporations could be given tax incentives to encourage the hiring and creating of jobs for the spouses of the employees; (2) Arrangements could be made for the employees to fly back often to Singapore to keep in touch with their family; and (3) Singapore citizens working overseas should continue contributing to CPF. This is to ensure that there is enough CPF for a meaningful life-long financial plan for all the families, and that means Medisave and all the other benefits of the CPF plan. I realise that many of these policies are outside the purview of the MCD, but I urge the Minister to take ownership of this problem as he and his Ministry are cognisant of the problem of second families and are supportive of the family. To quote from the IMC Report: `MCD spearheads society's efforts to support the family. It should oversee all Government programmes and policies related to the family.' So I do hope that the Minister would take this under his purview. My next amendment is on Self-Help Groups. Although some Singaporeans, including myself, have reservations on forming self-help organisations along ethnic lines, these self-help organisations have become a fact of life in Singapore. The Prime Minister supports this approach of helping the various communities. However, with no disrespect meant at all to the Prime Minister's view, I would like to suggest an over-arching scheme of integration of the four self-help groups. I am aware that at the ground level, some programmes of the various groups are being jointly conducted but I feel that this is not enough. The area that could integrate all the groups is through the collection of funds for these groups.”
“The fund could be managed by NCSS to finance community projects over and beyond what the Community Chest is doing at the present and here I would like to declare my interest as a Board member of NCSS. The next amendment is on the Social Effects of Regionalisation. The push towards regionalisation spells the emergence of a new phenomenon - the setting up of second families by husbands who work overseas. While our economy and businessmen are beneficiaries of going regional, the inadvertent victims are some wives and children. The number of reported incidence of second families, as they are called, may seem to suggest that the problem is not significant. But if you rely on statistics alone, we may miss the boat in attending to this problem while it is still in its early stage. These cases usually begin inadvertently with the husband taking advantage of regional opportunities and going overseas to work. And there he develops a relationship with someone he works with or someone he sees often, and soon he has two families: one at home and the other one abroad. After that, some husbands cut off contact with their local families and also stop assuming financial responsibility for these local families. Some husbands go to the extent of withdrawing all their savings from the local joint account. There are also reports that some older men take out all their CPF savings and go abroad and start second families. We can wring our hands in despair and resignation and say that we cannot do much to curb this anti-social behaviour. This is not an issue of women's rights. It is an issue that impacts on the integrity of the family, social stability of our country, juvenile delinquency, etc. There are some measures that we can adopt to curb this problem. I will just mention three.”
“The total Government expenditure on community development is only 1.9% of the Government budget. This includes Government financial assistance to VWOs. I feel, Sir, that as a more advanced developing country, we ought to be allocating more money to community development, as this includes support for the family, the elderly and the disadvantaged. If we pay less attention to this aspect of our national development, then economic success alone cannot further the overall national interest. I also realise that if there is a worthwhile project, the Government will help to fund it partially in the framework of the Many Helping Hands philosophy. This is all very well but, in the real world, things do not always work out as planned. The Government provides VWOs 80% of capital cost and up to 50% of the recurrent cost to cater to the needs of the poor and the less advantaged sector of society. Unfortunately, Sir, this formula for sharing the financial burden is not always a viable option for VWOs and some worthwhile projects have not been undertaken or have not got off the ground by VWOs because of financial constraints. Local foundations, corporations, individuals and the Community Chest are all doing their bit but donor fatigue is becoming more prevalent. I would therefore urge the Minister to consider two suggestions: (1) To increase the share of Government financial assistance to VWOs so that the Government extends a bigger financial helping hand. This suggestion has also been made by Dr Vasoo. (2) To consider the setting up of a community endowment fund which can be built up over a few years with the contribution from each year's budget surplus.”
“Singapore has a very warm tropical climate. I think air-conditioning is very important for the mini indoor stadiums. After the upgrading, I am sure the mini indoor stadiums will be able to boost our sports activities. Since HDB flats are being upgraded, I think it is time for us to also upgrade these regional mini indoor stadiums.”
“(3) MCD can play an active role in ensuring that relevant VWOs, which provide training services to the disabled, follow up with the latter's vocational needs. And MCD can also educate other Ministries in dispelling the myths about the employment of disabled people which may be present. I would therefore like to urge the Minister to ensure that his Ministry look into these areas so that the disabled would be less advantaged and marginalised in terms of employment. Mr Choo Wee Khiang( In Mandarin): Sir, at the moment, besides the Singapore Indoor Stadium, we also have several regional mini indoor stadiums. Since the opening of the Singapore Indoor Stadium, many sports, cultural and entertainment activities have been carried out there. Spectators who attend these functions at this beautiful stadium find it comfortable and enjoyable. Apart from the contents of these programmes and activities, more importantly, the Indoor Stadium has very good, comprehensive and state-of-the-art facilities and equipment. But if we look at the regional mini indoor stadiums, I think they are a far cry from the Singapore Indoor Stadium. For example, the Toa Payoh Indoor Stadium has very limited and inadequate facilities and equipment. It does not even have good, decent chairs. The ventilation is poor, and it is not suitable, even unhealthy, for sports events to be held there. I hope that the Ministry of Community Development can upgrade these regional mini indoor stadiums, so that people of the various regions can go to their neighbourhood indoor stadiums, either to take part in or to watch the various activities. On the question of upgrading the mini indoor stadiums, of course, it should include improvements to the sound system, flooring, air-conditioning, lighting and so on.”
“Sir, my subject is on the employment of the disabled. From available statistics, it appears that there are only 283 disabled persons employed by the various Government institutions and statutory boards. This number, when taken as a percentage of total Government employees, is insignificant and falls far below ideal expectations. The question that comes to mind is: why is there such a low employment rate of disabled persons in the public sector? Should the Government not lead by example, by opening up employment opportunities to the disabled and removing as many obstacles as possible to gainful employment? Another issue in addressing the problem of unemployment of the disabled is the availability of data. Since the last survey on the employment of disabled persons was carried out in 1984, I understand there has been no similar compilation of data. I would like to suggest that the Ministry of Community Development takes on the major ownership of this challenge of addressing the needs and aspirations of the disabled for employment. And I would like to join my colleagues, Mr Choo and Mr Sinnakaruppan, in asking for the setting up of a high level committee. In particular, I would like to suggest a few areas that the Ministry can address: (1) Documentation of data of the disabled people - to establish a profile of the general situation of disabled people and assist them in meeting their needs. (2) Match-making role, ie, source employment opportunities and allocate jobs to the disabled by getting them in touch with their employers. This can be done in collaboration with VWOs who are already working in this area, eg, Bizlink.”
“And finally, I would like the Minister to consider the setting up of a central registry of child abuse in addition to mandatory reporting.”
“So the true incident rate is likely to be higher than what is officially reported. Would the Minister initiate a move to consider mandatory reporting of cases of child abuse and neglect handled by his Ministry, Ministry of Home Affairs, Ministry of Health and VWOs? The mandatory reporting should be done to the MCD who could then initiate investigations by social workers and the Child Welfare Section and take the necessary action. Here, it would be very relevant to quote the Minister himself before he assumed his Ministerial post and this is what he said in this House, in January 1993, during the Second Reading of the Children and Young Persons Bill, and I quote [Hansard, Vol. 60, col. 453]: `I would like to say a few words about mandatory reporting by medical practitioners to the Protector of Children of cases of possible physical or emotional injury of children under their medical examination. I can understand the difficulties of enforcing such a system - the need for it in the local context and the possibility of such a system discouraging parents or guardians from seeking treatment for abused children. But this could at least reveal more cases which would otherwise be lost or hidden. So I do hope that the Ministry of Community Development and the Ministry of Health would not drop this subject altogether for the earlier mentioned reasons, but would continue to monitor the situation to see whether such an option need to be implemented here in future.' If this view was held by the Minister three years ago, then I am sure that he will be supportive of the suggestion of mandatory reporting of child abuse and neglect brought to the attention of VWOs, his Ministry, Ministry of Health and Ministry of Home Affairs.”
“Some of the areas that require to be undertaken by the MCD in the case of before-and-after school care are: (1) to formulate basic rules and regulations on the setting up of before-and-after school care; (2) to define the roles and responsibilities of the providers of before-and-after school care and the minimum qualifications required of these providers; (3) to set a standarised curriculum to ensure minimum standards and consistency and uniformity in the delivery of the programme and this may have to be done in conjunction with the Ministry of Education; (4) to set guidelines on the fees chargeable and to ensure these fees remain affordable to children from lower income families - it might be necessary for the Government to give a subsidy to before-and-after school care just like it does for child care; and (5) to take on the role of a consultant to provide consultant expertise to service providers. In the matter of child care, as I have said, MCD is fulfilling these roles. Would the Minister consider the suggestion that his Ministry assume the same responsibilities in the case of before-and-after school care? This role of MCD is important as, besides physical custodial care, before-and-after school care will also impact on the child's moral and intellectual development. I would therefore urge the Minister to ensure that his Ministry take on a proactive and regulatory approach to the setting up and implementation of before-and-after school care facilities. My next cut, Sir, is on mandatory reporting of child abuse. Presently, there is no law requiring mandatory reporting of child abuse and neglect in Singapore. Data from a survey done in 1995 by the Children's Society indicate that there may be a high rate of under-reporting, perhaps as high as 80%.”
“Sir, my first cut is on before-and-after school care. The IMC report concluded that and I quote: `Children who are left to fend for themselves while their parents are at work are more likely to fall into bad company. The Committee proposes that before-and-after school care services be provided for these children and, where possible, they should be based in school and run by voluntary groups.' In another part of the report, the IMC states that before-and-after school care services should be kept affordable. It is to be commended that MCD is already putting this recommendation into practice and is offering VWOs 80% of development expenditure and 50% of running costs for developing and operating before-and-after school care. However, I feel that the Ministry must take on a much bigger role in before-and-after school care service besides the financing help. The Ministry is doing a good job in fulfilling this role in the provision of child care services.”
“The picture is more shocking when we take into consideration the report by the police recently that for 1995, 10% of the juveniles and the youths who were arrested are those between 7 and 15 years old and the female juveniles who had been arrested are also increasing. 12.45 pm Secondly, the report also shows that the crimes committed by them are becoming more serious. For instance, murder and rioting. As a small country with limited talent, we should be anxious about the long-term effect of these juvenile offenders because in future, they will become criminals. If we do not pay particular attention to this problem now, it will affect the future generation. The reasons why they are involved in crimes have been identified by the Inter-Ministry Committee on Dysfunctional Families, Drug Abuse and Juvenile Delinquency. Sir, what we have acknowledged in Singapore is that the community should nurture strong family values as a long-term and effective solution to handle this problem. To achieve this objective, a consolidated approach among the Government Ministries and agencies should be stepped up. In this respect, I would like to hear from the Minister what are the recommendations of the Inter-Ministry Committee that have been implemented and what further measures will be taken to reduce the number of offences.”
“Sir, the Inter-Ministry Committee under the chairmanship of the Minister came out with a commendable report. Would the Minister be good enough to tell the House: (1) What recommendations of this report have already been implemented or are in the process of being implemented; and (2) What are the plans for the other recommendations that have not begun the process of implementation. In particular, could the Minister please elaborate on these four issues: (i) In the IMC Report, the Committee suggests that MCD conducts studies to determine the profile of lower-income families in need of financial assistance. Has this study commenced? (ii) The Committee also recommends that a separate centre should be set up by MCD to rehabilitate young drug addicts who should be kept apart from older and more hardened drug addicts. What plans are under way for this? (iii) There is a recommendation to create a central database on young offenders to facilitate planning and research. Is the Ministry of Community Development or the Ministry of Home Affairs doing this? (iv) It is stated in the Report that MCD will conduct a major study into the state of the Singapore families soon and this study will look at both healthy families and those in distress. Has this study begun? Would the Minister please give us some assurance that all these recommendations are under way or soon will be? Mr Zulkifli bin Mohammed (Jalan Besar GRC)( In Malay): Sir, in the last few years, Singapore has seen a new unwelcome trend, ie, the number of juvenile offenders has increased. In 1990, the number was 1,005 but this has increased to 1,300 this year. Last year, it had jumped to 2,009. This is a great increase, almost 115% within a period of five years.”
“This number has been growing steadily with the GDP and in the last few years, it is about 0.7% of the GDP and that is because we have made very rapid economic growth. There is no doubt that this number would have to increase in the future as our economy slows down because we cannot reasonably expect our economy to grow at 8%, 9%, 10% every year when the population ages. But as I mentioned earlier, little changes we make now extrapolated 20, 30 years from now will have huge implications on our society. And I think we do well to be a little cautious and to be a little prudent in the way we try to be more generous in an unthinking way.”
“It is because we have a sense of shame that we do not freeload because we are afraid that when others find out, we lose face. If you can support yourself, or if your children can support you, you should not resort to Medifund. But if you are really a hard luck case, pride goes before a fall, you come before the Medifund Committee, they will give it to you. We will always have enough money to look after those who are genuinely in need. But however rich we are, we will never have enough money if everyone plays the system. And this is what has happened to America and Western Europe. In European countries, it is common for one in five in the population to be on disability allowances. You have a small problem, you declare yourself because there, these things are entitlements. And you are a fool, your friends will ridicule you, if you do not exploit the system because you have already paid taxes. In our case, there is a certain inhibition, there is a sense of reluctance and it is this which ensures that the money goes to the right people and that the truly needy are looked after. There are also comments by Dr Soin and others that the Government has in fact been spending less and this has caused private citizens to spend more. So figures from various books and reports have been cited. In fact, those numbers are not easy to understand because they are numbers on health care expenditure. Before we restructured, revenues which went back to the Finance Ministry were in separate accounts. After restructuring, we only pay through grant-in-aid, net. So, really, the number that we are looking at is net Government expenditure on public health in Singapore, and this number has not gone down at all.”
“I am not suggesting, Sir, that we open wide the gates of Medifund. But I am urging the Minister to institute education for medical personnel, so that they are more proactive towards the utilisation of Medifund so that fewer deserving people fall through the holes of the net. BG George Yong-Boon Yeo: Mr Harun Ghani asked whether we should not have an opting-out scheme for MediShield for children. We try not to do it unless it is necessary. We have conducted a publicity campaign last year to encourage parents to voluntarily enrol their children and we would like to try this out for another year before we decide. But I must admit that the results this last year have not been too encouraging. There is tremendous inertia on the part of parents and, maybe, sometimes an opting-out scheme may be the most practical. But we have not decided yet. We will decide next year. 4.00 pm Earlier, the point was raised as to whether we should not raise MediShield to age 75. In fact, a study had been conducted and we are likely to raise it to age 75 this year but the premiums would have to be higher of course. A rebate system is being worked out so that those who have enrolled early will get a rebate when they are older. This way the system works on the basis that you pay more when you are young and healthy in order to pay less when you are old. Beyond the age of 75, we are up on a steep curve in an actuarial sense and we need to study more and move cautiously. And there is always Medifund which is a comprehensive insurance of last resort. Dr Soin asked whether there is not too great a reluctance among Singaporeans to resort to Medifund. Let me, as a matter of principle, say that this reluctance is very important.”
“Sir, my cut is on Medifund. The function of Medifund is to provide the basic safety net for Singaporeans with ill health. But, unfortunately, in its implementation there are people who fall through the holes of this net. According to statistics, more than 98% or so of applications are approved by the Medifund Committee. And therefore the problem is not at this level. Rather the problem arises before that, before the applications reach the Medifund Committee. There is too efficient a screening procedure in place, unwritten, self-imposed screening. Some patients are ignorant. For others, the process of requesting is demeaning. They may be poor, but they have dignity. In some cases, the nurses and the doctors may not be alert to the patient's financial problems. Sometimes the medical social worker may conclude erroneously that the patient is not eligible for Medifund. Let me give you quickly one example, Sir. This is the case of a 13-year old girl with insulin-dependent diabetes. Father owns a hawker stall but is a compulsive gambler and owes the restructured hospital money for his daughter's previous admission. The mother brings in the daughter again for ketoacidosis, which is an emergency due to diabetes. She is unable to pay the bill. But the medical social worker thinks that the patient is not eligible for Medifund as the father owns a hawker stall. If on the next occasion the mother, because she has no money, is too afraid to bring the child to hospital to stabilise her diabetic condition, the child may die. The errant father also has not in the meantime subscribed to MediShield for the child. This is only one example but it illustrates that sometimes the staff working in hospitals may be taking too hesitant an approach towards Medifund applications.”
“And once the case is reported to MCD, the Ministry can then initiate investigation through its child welfare services. The Chairman: Order. You have exceeded the time. I propose to take the tea break now. Thereupon Mr Speaker left the Chair of the Committee and took the Chair of the House.”
“The rest have gone for dialysis irregularly because of financial difficulties although VWOs try to help them as best as they can. I have three suggestions for the Minister to help the Muslims out of this predicament. (1) To redouble efforts at public education to get Muslims to opt in. If some sort of an incentive could be given, the response could be better. (2) To change the Human Organ Transplant Act so that Muslims are included in the opt-out system. (3) To allow Muslims who are non-pledgers with kidney failure to be on the priority transplantation list. I urge the Minister to consider a humane approach to this problem so that the health of non-pledgers is not compromised. The next cut, Sir, is on mandatory reporting of child abuse by medical professionals. Statistics on child abuse resulting from violence in the home have been kept at public sector hospitals since the beginning of 1994 and the Ministry of Health has to be commended for initiating this. However, there are some cases of child abuse which result from violence not in the home for which statistics are not being kept. In any event, the cases of child abuse that are brought to the attention of doctors are treated. However, besides treating the patient, the medical profession is not able to ensure that further abuse is not inflicted on the child. If the Minister could consider instructing the medical profession to report these cases of child abuse, then effective intervention is possible. I would like the Minister to initiate mandatory reporting of all child abuse cases seen by the medical profession. The reporting can be done to the Ministry of Health which then can forward the names to the Ministry of Community Development.”
“Yes, Sir. I have only got two more cuts. The Human Organ Transplant Act (HOTA) was passed in 1987. The Muslims are excluded from this presumed consent law because of their religious beliefs. According to HOTA, priority for transplants will not be given to objectors (non-Muslims) and non-pledgers (Muslims). However, some Muslims are caught in a catch 22 situation. I will explain this. A usual human failing is to procrastinate for any opting-in system and many Muslims fall into this category. If these Muslim non-pledgers then develop kidney failure requiring dialysis, trouble begins. Muslims being non-pledgers are not put on the transplant priority list. As dialysis is a temporary treatment for patients awaiting transplants, subsidised dialysis transplant is only offered to those who are on the priority list for transplantation. The policy of not offering subsidised dialysis to non-pledgers is followed by the National Kidney Foundation and the self-dependency dialysis programme offered by the Ministry of Health. The consequences of long-term dialysis affect the health tremendously and make the Muslims poor candidates for subsequent transplantation when their turn eventually comes. Because when Muslims cannot get subsidised dialysis, they have to turn to the private clinic and, therefore, to save cost, they sometimes do not go as frequently as they should. Even if a Muslim decides to opt-in, he or she has to wait for two years before they are put on the priority list for transplantation. Sir, from what I understand, since the National Kidney Foundation has implemented this policy of not accepting non-pledgers in January 1994, more than 50 Muslim patients have been rejected. Some have died as they could not afford the dialysis treatment at the private centres.”
“For example, a diabetic ulcer not treated properly will end up as a leg amputation for the patient and this will affect not only his livelihood and daily life but will also affect the economic and social life of his family. Also, the total health expenditure of the nation goes up. Literally, in this case, a stitch in time saves nine. I am not discounting the role of the voluntary sector in the health services. But I think the right balance should be a bigger Government role and responsibility while tapping on the expertise and volunteering spirit of the voluntary welfare sector. The strategic national planning for various health programmes must be done by the Ministry of Health. Would the Minister please comment on this issue?”
“Should we not be forming an inter-disciplinary medical committee to work out appropriate performance targets for the medical industry? Would the Minister please give us his views on this important subject? My next cut, Sir, is on the divestment of health programmes. There has been a divestment of some health programmes by the Government. Health programmes have been relegated to the welfare category and are being funded to a large extent by the community. These are the Hospice Home Care Services, the Diabetic Society, the Home-Help Services and the Dementia Day Care Centres, to give some examples. The Home Nursing Foundation has become a voluntary organisation and runs, I think, the Senior Citizens' Health Care Centres. I am all in favour of the community doing its share of welfare work. But I feel that essential health programmes cannot be left mainly to the voluntary sector to manage and finance. Let us take the case of diabetics as an example. I think we have one of the highest rates of lower limb amputations found anywhere. One of the reasons for this is that diabetic ulcers are not managed properly. It is difficult for many elderly diabetic patients to go for dressings for their foot ulcers because these ulcers usually make them wheelchair bound temporarily. These patients need proper dressing and proper management of their diabetes. The Diabetic Society can only do that much as it is partly dependent on funds from the public. We have a lack of adequate services in at least two areas, home help for the elderly and care for the diabetics. I would urge the Government to take ownership of these important health programmes so that timely and good health care is provided. If we do not do this, then the consequences will be revisited on society.”
“I would like to express my concern to the Minister on the choice of performance targets in the field of health. The Budget book states that Tampines and Toa Payoh clinics will become autonomous agencies in FY96. The performance targets during peak hours are to attend to patients within 45 minutes for registration, within 16 minutes for consultation, etc. This sort of performance targets may be suitable for the hospitality industry or the Immigration Department but not for health care. Of course, patients should not be kept waiting inordinately long but what is important from the point of view of health is the quality of care given. 2.45 pm Sir, the performance targets should include matters like a thorough and complete medical examination and the satisfaction expressed by the patient. Instead we find that, in polyclinics, there are many patients and not enough doctors. In fact, during peak periods, a doctor in a polyclinic can see 100 patients in one day and this works out to about 4-5 minutes per patient assuming that everybody works non-stop. During a consultation with the doctor, a history has to be taken and then a physical examination which is followed by the ordering of tests, or the evaluation of tests. Then treatment has to be ordered and general advice given. Surely, this must entail time and care. Instead, we are leaving the management of physician activity in the hands of managers who measure productivity by the number of patients seen and the length of waiting time. The Joint Committee on Accreditation in hospitals in the USA will not certify doctors if more than two new and two follow- up cases are seen per session. What sort of norms and standards are we setting up?”
“Thank you. My first cut, Sir, is on health expenditure. I would like to read out the budget allocation for health: FY94, 1.18% of GDP; FY95, 1.15% of GDP; and FY96, 0.85% of GDP. Thus, for the last three years, the amount budgeted by the Government for health has been falling as a percentage of the GDP. It has fallen to below the 1% level to a mere 0.85%. Even if we add the sum for the Medical Endowment Fund, the figure is still below the 1% GDP level. Comparing FY95 to FY96, there is 0.19% less spending on health in absolute terms. Fortunately, however, although the amount spent by our Government on health is so low, the standard of basic health care available for most people is good. And it is to the credit of the Health Ministry that it can deliver so much for so little. However, it stands to reason that with an ageing population and with the Government spending less on health, there must be a greater financial burden on the people as our national health expenditure has not gone down. Furthermore, high-tech medicine and increasing health expectations should not logically lead to decreasing expenditure on health. If the Government therefore is spending less, then the people must be spending more. What is the reason for the Government limiting its health expenditure to below 1% of GDP? Is this figure going to be our medium term target? Should the Government not be increasing its share on health expenditure in tandem with GDP growth? Sir, are we putting the cart before the horse, so that we are deciding on the quantum of health financing first and then trying to fit in the country's health needs? Would the Minister please elaborate on the medium term policy of Government expenditure on health? My next cut, Sir, is on performance targets in the health industry.”
“Sir, would you like me to take all my cuts together?”
“However, Sir, I feel that these moves do not go far enough to integrate the public and private specialists. Would the Minister encourage a paradigm shift in the thinking of his Ministry on this public-private divide and instead allow much freer movement in both directions? We should in fact be viewing all the medical specialists in Singapore as one pool, so that it becomes possible to plan facilities and use skilled manpower much more efficiently, effectively and holistically. Singapore is a small country and such an integrated system is likely to lead to maximisation of potential in the medical arena. Would the Minister please give the House his view on the desirability and the practicability of such an integration?”
“Sir, I have put my cut under the heading "National Health Policy" and I would like to declare my interest as a medical specialist in the private sector. For many years now, Sir, hospital services and medical specialists in Singapore have been classified as private or public and have been subject to the problems and dilemmas of this public/private divide. The public area includes the restructured and Government hospitals and the specialists working therein, while the private sector includes the private hospitals and the private specialists who use these hospitals. Over the years, there has been a steady and sometimes furious haemorrhage of the public hospital specialists into the private sector resulting in some public hospital specialist departments being understaffed and losing their expertise. In response to this movement from the public to the private sector, the remuneration of specialists in the public sector has undergone numerous changes and yet the desired results have not been achieved. Whether acknowledged or not, Sir, the reason for the exit of specialists into the private sector has not only been an economic one, although money is often cited as one of the reasons. Other reasons include uncertain career paths, overwork and administrative hassle. Therefore, Sir, the private specialists' main preoccupation in life is not just to make money, as has been sometimes portrayed, but they are also caring doctors who can contribute to the public sector. There has been some attempt to encourage private specialists to work as part-time consultants in the public sector. 2.30 pm Another move to integrate the public and private sectors is in the setting up of centres like the Eye Centre, etc.”
“Sir, my cut is on an endowment fund for culture and the arts. The arts in Singapore are under-funded. This is a sad reality and to some extent, this reality is responsible for our society being less than gracious, as also stressed by Dr Koh Lip Lin. In recent years, the corporate world and the individuals have been more forthcoming with their financial support but the Government needs to give more than it does now. Only about 0.3% of the total Government expenditure is budgeted for the arts in Singapore. In Canada, besides the 2% of the Federal expenditure being budgeted for the arts, there is further provision at the provincial level. I would like the Minister to consider this suggestion. While Singapore is having good economic growth and there are ample budget surpluses, could the Minister persuade our gracious Minister for Finance to sequestrate a proportion of the budget surplus into an endowment fund for the arts. Over a few years, this fund will build up with contributions from the budget surpluses. The interest from the fund could then be used to finance new and worthwhile projects. The existence of such a fund would be very empowering for the arts community. The arts fund could be managed by the National Arts Council. This would provide an extra source of income every year on top of the Government grant to NAC which only amounts to about $16 million in FY96. The National Arts Council would thus have more flexibility and more money to carry out its mission of promoting arts development and to make the arts more accessible to Singaporeans.”
“Sir, would the Minister please give us his thoughts on the following: (1) It has been said that the change in digital communication is exponential. Small differences of yesterday can have sudden shocking consequences tomorrow. In view of this, should we be relying on methods, other than censorship, to maintain our culture which emphasises a strong sense of community? (2) Some people worry about the divide between the rich and the poor. But with digital communication, the divide is going to be generational. What can we do about this? (3) Some individuals have their own Web pages. Amongst other things, their content includes features like women in politics, effects of national policies, etc. How will these people be affected by the new rules and regulations? And here, Sir, I would like to declare my interest as one of those individuals with a Web page.”
“Mr Deputy Speaker, Sir, with your indulgence, rather than me rushing through the next four topics, maybe the Minister for Finance could take the remaining time to reply to the unanswered queries. It seems more productive that way.”
“I just want to ask about the after-care of prisoners, and not drug offenders. And I would like to know why the Ministry of Home Affairs is not taking a more pro-active approach because, as far as I know, there is only one voluntary welfare association called the Singapore After-Care Association which only gets token funding from the Government. So would the Ministry of Home Affairs please take a more leading role, otherwise we are going to have a very high rate of recidivism.”
“Sir, I think I will not have enough time, so I will not speak.”
“Sir, I beg leave to withdraw my amendment. Amendment, by leave, withdrawn. The sum of $46,269,930 for Head E ordered to stand part of the Main Estimates. The sum of $7,678,000 for Head E ordered to stand part of the Development Estimates. Head T -”
“I am not asking for a blanket non-disclosure of the identity of the accused, but only to give the court this discretion and it will be up to the court to apply it in certain selected cases.”