Khaw Boon Wan
Singapore
“Motor vehicle dealerships and showrooms have been closed since the start of the circuit breaker. As COE bidding is done mostly by the motor vehicle dealers on behalf of prospective owners, the Land Transport Authority (LTA) suspended COE bidding for the months of April and May.”
“Though stressed by the financial pain, they press on with the immediate priority of fighting the virus and supporting essential services. Post-pandemic, we will see how public transport evolves. Will demand for public transport services simply return to the pre-pandemic level?”
“Under our rail financing framework, the Government fully pays for the cost of building new rail lines. In other words, we do not recover the cost of building the Cross Island Line (CRL) from commuters through fares. The CRL project is being implemented and the final costs will depend on tender bids.”
“There are around 5,000 private bus operators with a combined fleet of 13,500 private buses. As we do not track the number of private bus trips and passengers, we do not have data on their carbon emissions.”
“There are nursing rooms at 50% of our bus interchanges. We will provide nursing rooms at all new bus interchanges and integrated transport hubs. For the MRT network, we will provide nursing rooms at all new interchange stations. We will also explore providing such facilities when MRT stations undergo upgrading.”
“Over the last three years, Singapore carriers have reported a total of 20 incidents of food allergies on board their flights. None required the use of epinephrine or emergency flight diversions.”
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“But whether it is too large depends on: (a) the size of the job; (b) on how the pay package is determined; (c) on whether the Board had a proper process such as a staff compensation committee and salary benchmarks; and (d) on the actualmeasured performance of the CEO. These are serious matters which an independent and competent Board should have properly established so that their decision could be defended in public. The review of the NKF will shed light on thissubject. Going forward, let me assure Mdm Ho Geok Choo that I have no doubts the new Board under Mr Gerard Ee has the expertise and the experience to help install a high-standard HR remuneration system for the new NKF. As for the interim CEO, I have said yesterday that our hospital would second a senior hospital administrator to the NKF. If the NKF Board approves the selection and the arrangement, the NKF would have to fully reimburse the hospital for the services of the seconded staff. Public hospitals have established policies of seconding staff and receiving seconded staff from other organisations. There are clear rules governing inter-agency reimbursement for seconded staff. We will follow the rules strictly. Fund-raising activities Dr Wang commented that the NKF appears to have gone overboard with its fund-raising activities. He felt that "Singaporeans are increasingly turned off" and he commented, and Prof. Ong Soh Khim too, that some of the NKF shows are "bordering on bad taste". Yesterday, we had some discussion with Prof. Ong on this issue of TV shows which she raised it again this morning.I am just the Minister for Health. Ministry of Health does not govern TV shows.”
“As I mentioned yesterday, all charities face this tension between protecting the privacy of their top executives and maintaining transparency with their donors. It is not an easy dilemma to resolve. I heard from Ms Irene Ng yesterdaythat this dilemma, of course,is alsofaced by otherinternational charities, like Oxfam.Somehow, according to Ms Irene Ng, they seem to have found some satisfactory ways to resolve the dilemma. She mentioned a particular US charity website which was able to release such sensitive information, not so much in terms of dollars and cents but at least as a percentage of something. I intend to study these various modelsto see if we can emulate it here. Ms Eunice Olsenasked for greater transparency along the same light, andwe intend to do so. And the message to the VWOsis - to voluntarily, as part of their clients' servicing, and the donors are their clients, be open with them. My own belief is that the more open you are with your donors, greater public trust isbound toyield greater support - cause and effect. The Buddhists would say yin guo (the cause andeffect). Dr Amy Khor proposed that all IPCs undertake independent audits and publish their annual reports and statements online. All IPCs are actually already required to provide their CFAs with annual independently-audited financial statements. We should certainly push the larger ones especiallyto publishaccounts online for greater transparency. Many Members spoke on the public disgust over Mr Durai’s $600,000 pay packet, especially the reported reluctance of the NKF to have this made public.$600,000 is certainly not a small sum.”
“But looking back at the sequence of events, I would be surprised if the Commissioner of Charities would havesat on his hands and let the crisis fester. Dr Khor asked if it was more effective to have a single body guiding all VWOs, instead of spreading the work among the various Central Fund Administrators (CFAs). She has a point, but there are arguments both ways. The CFA model was adopted to better spread out resources in assessing IPCs. Each of the 12 CFAs handles a number of IPCs, specific to that Ministry’s area of expertise. If all 1,700 charities, from temples to churches to nursing homes, were to be centrally managed by a single agency, I worry that the required Government machinery would be huge, cumbersome and unresponsive. On the other hand, there may be some gaps in regulating a complex institution like the NKF, as noted by quite a number of speakerstoday. Itis a company limited by guarantee,a charity andalsoan IPC - three in one. For instance, as noted by Prof. Ivan Png,the NKF also receives donations which are not tax-exempt andoutside IPCpurview, and therefore it is not under the purview of my Ministry as the overseeing CFA. A learning point here for Governmentis to have a more coherent approach to guiding the larger and more complex institutions, like the NKF. We will bear in mind the observations made by Prof. Ivan Png just now about ambiguous definitions of terms and the reporting format. Transparency and disclosure Mdm Halimah, Dr Wang Kai Yuen, Dr Amy Khor felt strongly that salaries of top executives should be disclosed as a mandatory requirement of all IPCs.This was in the original recommendations of the Council on Governance. But the Council discarded it, after extensive consultations with the IPCs.”
“Let us dive into the problems at the NKF first, grasp the full details, weigh the options and assess the implications, before we decide on the way forward. As I said yesterday, I see value in differential regulation, to apply different degrees of regulation and compliance to different charities.This is particularly so for quantitative controls like the expense ratio which many Members touched upon. Dr Wang Kai Yuen suggested a sliding scale for limiting expense ratios, ranging from, say, 15% for the large charities to 30% for the small ones. Dr Amy Khor suggested a tiered approach which sounds similar in concept. We would certainly have to give all these suggestions serious consideration. In any case, the recommendations of the Council on Governance of IPCs on a set of mandatory rules for all IPCs, which the Government had earlier accepted, will kick in by 1st January 2007. But we will see if we can advance this implementation deadline, as proposed by Mr Chew Heng Ching. But I myself will challenge the new NKF Board to achieve compliancewithin six months. Regulatory structure In terms of regulatory structure, Dr Amy Khor proposed a national watchdog to investigate and punish charities which flout the rules and abuse public trust. This is actually the purview of the Commissioner of Charities. The Charities Act gives him extensive power to investigate any abuses. He has power to remove trustees and de-register charities. Whether we need to strengthen his teeth, we can study. After we have completed the independent review on the NKF, we can ask the Commissioner to go for a dental appointment. Mdm Halimah wondered whether the Government would have intervened, if the previous NKF Board had not sought my involvement. This is now a hypothetical question.”
“But maybe the ego and arrogance went to the head, leading to poor judgement and insensitivity. I think there are lessons for all of us here. No matter how great our achievements are, we live for others. Look at the late Mr Hon Sui Sen. You could seeno ego in the man. He completely personified humility. Likewise, the late President Wee Kim Wee and hence the huge outpouring of emotions at his funeral. President S R Nathan is another such humble man who has done great for society, for Singapore, but remains exactly his past self. I am so glad he decided toseek a second term. I scanned through the local media today. I could not help noticing the different spin the Straits Times put to the MPs’ speeches yesterday, compared to all the other local media, like TODAY and Zaobao. Let us hope arrogance has not also gone to the head of the victor in the court case. Regulation of IPCs Coming back to the debate, not surprisingly, ensuring a robust regulatory framework for the IPCs was a central theme of Members’ speeches. Striking the right balance Many Members have noted the need for balance between regulation and flexibility. Mr Chew Heng Ching, Mr Gan Kim Yong and Dr Ong Seh Hong cautioned against knee-jerk reactions. They advised that we do not over-react and introduce new and tighter rules that may inadvertently cause more collective harm than good, particularly for smaller charities.On the other hand, Dr Wang Kai Yuen, Mdm Halimah, Dr Amy Khor and Mr Tan Soo Khoon argued for additional and tighter rules. They felt the existing regulatory regime would appear to be too loose for large charities, if episodes like the NKF could occur. As always, you know my preference, I think the best way forward isthe middle path. We should not rush or force an immediate solution.”
“Knowing the new Board members, I know they will get to the bottom of the issues. Precisely because of the high standing and reputations of the individuals serving on the Board, this House and the public can feel confident that their review will be full, thorough and that sound judgement will be applied. In the course of the review, if it is found that laws have been broken, the relevant authorities will certainly step in. I fully agree with Mr Tan Soo Khoon that any wrong-doers must face the law. If there has been any criminal act, the law will take its course. If there have been poor judgements, they will be acknowledged. If there are systemic flaws, they will be fixed. As I said before, I do not condone fraudulent practices. But we cannot conclude, a priori, that there were criminal acts on the basis of what has been published to date. We are a law-based society. Let us follow the due process, as advocated by Dr Warren Lee just now too. Let us also try to look at this issue from the perspective of Mr Durai’s family. His daughter emailed the Prime Minister. Let me quote a few lines from her email. She is a young student in JC but, I think,mature for her age. She wrote: "I was adversely affected by this fiasco". She went on to say: "Since I was young, my father had very little time to spend with us … I always asked myself why my father had no time for us. Were we less important to him than his patients? Was his work more important than us?"She went on to ask the Prime Minister: "After the review by the new Board, you will help him to restore his reputation and honour", if no wrong doings were found. From the media reports on the man, Mr Durai looks to me to be an arrogant man. His achievements are real and significant.”
“I knowfor a fact that many of the new Board Members are long time donors and regular supporters of not just the NKFbut alsoother charities. More importantly, the NKF donors are best served by knowing that the NKF would now have a strong Board which will make the right decisions,and often tough decisions. But I am not sure if it is a good idea to politicise the charities by inviting oppositionMembers on the Board, as suggested by Mr Chiam. Let us keep politics out of charities. Investigations into allegations All Members have called for a full and thorough investigation. As Dr Amy Khor put it, many questions remain unanswered and public unrest should be addressed. We certainly intend to do so. Dr Khor suggested that a committee of inquiry be convened to look into the matter. The Commissioner of Charities has the powers to initiate such investigations. But due process must be observed. The Commissioner must first establish clear evidence of wrongdoing, which includes getting the charity’s side of the story. At the end of the day, it is the substance of the investigations that matters, and not the form, whether it is called a commission of inquiry, an investigation or independent audit. We are all committed to finding answers to the many questions raised by Singaporeans and getting to the bottom of this matter. That is what counts. The new Board has appointed KPMG to do an independent review. Let us give them time to work on this thoroughly, away from the public glare and emotions, so that assessment can be made objectively and calmly. All the questions that I asked in my statement yesterday will be addressed. Their findings will be made public. The various Government agencies are comfortable at this point to have the new Board lead the investigation into past practices.”
“Helpfully, Mdm Halimah, Mdm Ho Geok Choo and many others have urged calm and patience, lest we all get lost in the woods. Mr Tan Soo Khoon wisely reminded Singaporeans not to direct their anger at the patients or the NKF staff. As Ms Irene Ng pointed out, coming together to express public outrage is one thing. But vandalising NKF buildings is unbecoming of a society which we want to belong to. I fully support these sentiments. Regaining public confidence All Members agreed that the best way for the NKF to regain public confidence is to pursue greater transparency and accountability. I am sure Mr Gerard Ee has taken this message back to his Board and they will do their best to bring this about. I note and am thankful for the ringing endorsement of the new Board of Directors. This is important, for they must be assured that they have the backing of the House and the public. At the same time, they would have noted the lofty expectations which they must meet. And I am optimistic that they can deliver. Given the professional competence of the NKF staff, the NKF could be a shining example of good governance, of transparency and accountability. This is my intent. Outside of Singapore, NKF already has a reputation as a pace-setter in kidney dialysis. In Singapore, I would like the NKF, as our largest charity,to now be the pace-setter of what good governance, transparency and accountability ought to be, for all charities and IPCs. As a refinement, Mr Tan Soo Khoon suggested that key donors, like the Foundations, ought to be represented in the NKF Board. Mdm Ho Geok Choo suggested that unions be represented on the Board. We will bear these suggestions in mind, when the final Board is constituted after the current priorities have been fully discharged.”
“Mr Speaker, Sir, I took this assignment on July 14th to shepherd the NKF through its crisis. I knew it would be a big challenge, but I had faith that the good sense and charitable nature of Singaporeans will prevail. Yesterday was daysix of my assignment. I heard the speeches by 13 Members of this House. Today I heard from another seven. I must confess that when I came to this House yesterday, I was not sure which views would prevail. Would they be negative and destructive: going for blood, witch-hunting, demolishing the NKF through speeches? Or would they be positive and constructive: taking the helicopter view, seeing the larger picture, rising above the fray, and shining the light forward? The 20 speeches cheered me up considerably. I was happy enough to go for a hair-cut last night! All noted the gravity of the situation. All conveyed in no uncertain terms the public anger over the revelations. But all noted the larger issues at stake. Although views on approaches to address these issues inevitably differed, by airing and debating these views openly in this House, we can then begin to find the answers and start the process to re-shaping the NKF and the charities landscape in Singapore. Future of the NKF We are all agreed that the good work done by the NKFmust continue. There are real patients out there and much of NKF’s activities genuinely save lives. Thankfully, nobody called for the NKF to be shut down. As Dr Wang Kai Yuen put it, the destruction of the NKF would be a "monumental loss to Singapore". All Members spoke on the charitable side of Singaporeans. Otherwise no amount of marketing skills and TV shows could deliver tens of millions of dollars, from all walks of life, to the NKF every year.”
“Meanwhile, Singaporeans with the passion, expertise and knowledge should continue to step forward and help our many charities. They can offer to serve on Boards to help improve governance, or serve as volunteers to help charities provide better services at lower cost. Indeed, many Singaporeans are making a difference to the community every day. Let us not allow one sad episode to discourage us from doing good. Instead, let us pick ourselves up and do even more to help our fellows in need. [Applause]. Mr Speaker, Sir, pursuant to Standing Order No. 44, I beg to move, That the Ministerial Statement on the National Kidney Foundation be considered by Parliament. Question proposed.”
“There is a dilemma here - if the charity declares every detail of its senior staff's remuneration, many capable people may not want to work there, but if it does not do so, donors may be unsatisfied, and may take their donations elsewhere. This is a real problem which many organisations face. There is no ideal solution to be found in governance rules or disclosure standards, though these are necessary. In the end, we must depend on putting people of integrity in charge, and earning the trust of the public that honourable men are doing their best for a good cause. Conclusion Mr Speaker, Sir, charity's work is never done. There will continue to be many needing help, and those who are more fortunate will always need to reach out to lend a helping hand. That is what being a society, and indeed, a nation, is all about. I am most heartened by the outpouring of constructive suggestions and offers to help. Over the last few days, I must have received so many emails from people volunteering to contribute their effort and time to improve the NKF. Such civic responsibility and social conscience of Singaporeans will certainly help to build a stronger volunteer and charity sector. I am confident that, together, we can turn this unhappy saga into a fruitful learning experience with a positive outcome. The cause for charity should not be diminished by this episode. If we learn the right lessons, and are skilful in managing the growth of our charities and IPCs, our charity landscape and our society will emerge stronger, to the benefit of all Singaporeans. While the process of change takes place, I appeal to Singaporeans to remain objective, patient and generous.”
“He even finds time to help me in my Moulmein Constituency as a grassroots leader. Volunteers like him, Gerard Ee and Jennie Chua spend much of their time, energy, expertise and resources contributing to charity work without any compensation. They teach us and spread the message of philanthropy. Singapore is a much stronger society because of such individuals. But I believe that our charity landscape can accommodate a diversity of models. There is nothing wrong with a large charity outfit run by professionals instead of volunteers, provided it is properly governed and managed. As one commentator pointed out, it is not wrong to combine "the passion of a social mission with an image of business-like discipline, innovation, and determination". We should not lose sight of the possibility that there can some day be a Singapore Oxfam or the equivalent of an International Red Cross but based in Singapore. Running such a large charity outfit will require full-time professionals. To recruit and retain such talent, the charity outfit has to pay a competitive wage. It is the responsibility of the Board to determine what this wage is and to defend their decision, if necessary. To avoid abuses and criticisms, the Board will need a robust human resource management system to design an appropriate compensation scheme, a sensible incentive bonus programme and proper checks-and-balances which ensure independence between the Board and the CEO. Unfortunately, the former NKF Board appears to have fallen short in this regard. It will also be necessary for such an outfit to be transparent in its disclosure, so that donors can be satisfied that their money is being put to good use.”
“But the gist is that Singapore's NKF seconded a few staff, paid for by Samoa, led by one Dr Prabhakar. He is a renal physician, and together with two other NKF staff, helped to supervise and run this centre. They were so pleased with this arrangement and the whole service that is being provided that the Prime Minister of Samoa has decided to bestow a High Chief title called muagututi�? to Dr Prabhakar. The award has already been given and the letter was to inform me that they have decided on this and partly also to thank me for the match-making role. Incidentally, Dr Prabhakar is my constituent in Moulmein. Just three days ago, on Sunday, when I was doing my house-to-house visit, the wife was there when I knocked at the unit. I cannot recognise her but she can recognise me. She said that her husband is right now in Samoa. We talked a little bit about NKF. So I have not neglected my constituency duties. Soon after the opening of the Samoan dialysis centre, the Fiji Health Minister visited me and I could guess what was the motive. He asked me to persuade the NKF to do the same thing in Fiji. Again, I set up a working lunch between him and Mr T T Durai. This was about two to three months ago. I understand that discussions with Fiji, as well as Seychelles, are now ongoing. We cannot and should not ignore, nor discount these visions and achievements. I know many find such developments jarring. They are used to the traditional model of charity. Yesterday, Dr Robert Loh wrote to the Straits Times to suggest that the NKF should return to this traditional model. Bob Loh is another person synonymous with charity and compassion. He is a former President of the National Council of Social Services. He personifies kindness and decency, a most wonderful man.”
“Indeed, the recent NKF shows on TV were not to raise funds for kidney dialysis, but for this new programme which is meant for cancer patients; and (d) The NKF also trains 500 clinical staff in Nephrology nursing under the NKF's Institute of Nursing, Education and Research, including continuing education in partnership with overseas universities. From a small local VWO, the NKF is today recognised as one of the leading dialysis providers in the world, with very good clinical results. The NKF has a vision to become a pace-setter on the international stage. It organises international medical conferences on nephrology and transplants, in conjunction with world-renowned nursing institutions. It has even exported its operating model to the South Pacific. Last year, the Samoa Health Minister visited Singapore because they had heard of the NKF. Kidney disease is a big problem in the Pacific Islands. Samoa had no local kidney dialysis facilities. Patients had to be sent to New Zealand. Therefore, very few received treatment, because dialysis means permanent residence in New Zealand. Very costly. I arranged a working lunch for the Samoa Health Minister and Mr T T Durai. This was last year. Within a few months, the NKF helped them set up the Samoan Kidney Dialysis Unit. When it was opened in Samoa in March this year, practically all the Health Ministers in the South Pacific attended the launch. It was a major event in the South Pacific. In fact, just an hour before coming to Parliament this morning, I happened to receive a letter from the Samoa Health Minister. I just received it although it was dated and sent quite sometime ago. I suppose postal service takes some time. Unfortunately, the font size is very small.”
“The Council's recommendations on differential regulation do not specifically recommend differential rates of the expense ratio. The current expense ratio requirement limits charities' fund-raising expenses to below 30% of funds raised. Some people think that large fund-raisers should be subjected to lower expense ratio. But it is not clear that there are economies of scale in fund-raising. In fact, each incremental dollar may take more effort to bring in. But we can certainly re-look this particular issue. I will definitely ask the new NKF Board, after they have settled down, to consider the expense ratio that they should be aiming for. But, frankly speaking, no expense ratio or disclosure requirement will be tight enough to catch a gold-plated tap. That is a matter of self-restraint and tone of the organisation and its leaders, which the charities themselves should set. Over the years, the NKF has grown into a large and complex charity. It has made many positive, innovative contributions to the Singapore community, not only in dialysis. Let me give you some examples. (a) The NKF conducts preventive health screening for up to a quarter million Singaporeans a year. It must be the largest health-screening service provider now. It operates three prevention centres and five mobile "prevention buses"; (b) The NKF Children's Medical Fund, set up in 2001, now supports six centres of excellence in local hospitals and institutions, provides support to children under seven clinical programmes, and provides help to other children's charities; (c) The NKF Cancer Fund, set up more recently, has begun to support some 140 cancer patients, because this is a very new programme for them.”
“We were all students once, and those of us with children will still be familiar with school flag sales, lucky draw coupons, and sponsored sports activities and challenges to support charities. It is important to have organisations continue to serve in this niche. In addition to delivering aid to the needy in specific areas, they also actively engage the community and the younger generation in community efforts. This is critical for sustainable people-sector renewal and community-building. At the same time, we must cater to other models of charity. We must be prepared to accept larger, more sophisticated organisations which want to and can mobilise the ground, garner support and donations, and systematically raise large amounts for charity. Unlike smaller groups, these charities can deliver higher levels of service to different corners of the island, employing professionals to ensure that beneficiaries get the care they need, and that the quality of medical care is continually improved. They have to plan for the long-term, so as not to worry excessively where their donations for the next month will come from. They have the focus and staying power to develop and grow programmes which take longer to yield results for their beneficiaries. We therefore need to work out a framework with sufficient regulatory controls on larger charities, and yet which does not stifle the small charities. There is a need for differential regulation, so that larger charities with large funds may have to follow some requirements from which small charities are exempt. Indeed, the Council on Governance of IPCs has included, in its May recommendations, the principle of subjecting bigger charities to higher standards, such as reporting standards.”
“Moving forward: balancing regulation and flexibility in a diverse landscape Notwithstanding the current regulatory framework, one may ask if we need more and tighter rules for charities and IPCs to prevent future mishaps. The answer is not straightforward. One key issue is finding the right balance between regulation and flexibility. This balance is not easy to strike. If rules and regulations are inadequate, the risk of abuse is high. Yet, if we go for a very stringent standard, and hard-wire onerous regulatory requirements into the system, we are likely to snuff out many charities and IPCs which focus on assisting specific groups of the needy, and which lack the resources for elaborate administrative overheads to fulfil regulatory requirements. The issue is further complicated by the diverse range of charities and IPCs in Singapore. There are nearly 1,800 charities and 900 IPCs. They represent a wide spectrum of organisations of different sizes and scales, with different philosophies, interests, target beneficiaries and programmes. They cover social services, education, health, self-help groups, sports, arts and culture, advancement of religion or the community. While some people may consider this an untidy situation, it collectively represents our ecosystem of people-sector organisations supporting the needy and other worthy causes across multiple niches. All play a part in inculcating the spirit of giving and helping others. Given this situation, it is not practical to adopt a one-size-fits-all framework in regulating charities and IPCs. We must leave room for smaller charities, which rely on a "traditional" or "cottage-industry" approach to do good work without too much fuss.”
“The Council was chaired by Ms Lim Soo Hoon, then-Permanent Secretary of the Ministry of Community Development, Youth and Sports. It comprised experts from the public, private and people sectors. After extensive consultations and deliberations, the Council published its recommendations in May this year. Most of their recommendations were accepted by the Government. In essence, the recommendations were to subject all IPCs to stricter mandatory requirements from 1st January 2007. These include: (a) Ensuring that information provided to donors, potential donors and the general public is not misrepresented; (b) Disclosing the intended use of funds when soliciting donations; and (c) Ensuring that funds and donations are used according to donors' intentions and the specific purpose communicated when soliciting for donations. The charities and IPCs need some time to comply with the new rules and best practices. Hence, the Council has set the deadline for mandatory compliance at 1st January 2007. I would, however, encourage them to adopt these guidelines and the best practices as soon as possible, ahead of 2007. For a professionally-run IPC like the NKF, they should be the first to achieve the higher standards and be the model for the other IPCs to emulate. I will ask the new Board to set this as part of their mission. Meanwhile, the public can and should play their part in encouraging their target charities to adopt these rules and best practices voluntarily. They should not feel that they must accept the charity's word when making donations. Vote with your donations. If the charity does not measure up to your expectations, donate to another cause instead.”
“Current approach towards governance of charities and IPCs Charities and IPCs are governed by two pieces of legislation, through which the Government sets the basic requirements for governance and transparency. The framework is basically sound, and the legislation has served us well. First, all charities are subject to the Charities Act. The Act promotes the effective use of charitable resources by encouraging the development of better administration, giving charity trustees information on any matter affecting the charity, and investigating and checking abuses. Under the Act, the Commissioner of Charities, who is concurrently the Commissioner of Inland Revenue, is vested with investigative and enforcement powers to regulate charities. As a charity, the NKF comes under the ambit of the Charities Act; and Second, charities which acquire IPC status are subject to the Income Tax Act. The Act requires IPCs to submit audited accounts and post financial information online. Under the Act, the Ministry of Finance appoints Ministries as Central Fund Administrators (CFAs) to assess and approve IPCs for tax-deductible donations. There are quite a number of CFAs, and my Ministry handles healthcare-related VWOs. As a CFA, my Ministry ensures that an IPC maintains proper donation and accounting records, and uses any tax-deductible donation within the Income Tax guidelines. The NKF's tax-deductible fund-raising activities are covered by its IPC status under the purview of my Ministry. The Government has been mindful to monitor developments and enhance the framework whenever necessary. Last year, the Government set up a Council on Governance of IPCs to review existing practices and to recommend enhancements to the standards of governance of IPCs.”
“Court disclosures suggest that the organisation's system of checks and balances was inadequate. Was this the case? If so, what safeguards should the Board put in place to prevent a recurrence? Fifth, the Board should review the NKF's communications with its donors. Are there misleading claims? Are there errors? If so, they should correct any misleading statements. Sixth, they should review the pricing and subsidy policies of the NKF's dialysis programmes to ensure that adequate assistance is provided to the intended recipients. Over the last few days, I have received several emails advising me that the NKF should provide dialysis services for free since it has such healthy reserves. This I must strongly advise against. It is one sure and quick way to kill the NKF. The NKF has been able to build a significant reserve precisely because it does not unconditionally give away free services. Patients are means-tested, and the level of subsidy varies according to the patients' ability to pay. One reason for such a stand is its belief that patients and their families should take co-responsibility for themselves. By making an effort to earn a living, the patients retain their self-esteem and live their lives more confidently. I fully endorse this philosophy, but the Board should review if the subsidy rules have been unduly stringent. Ensuring a robust regulatory framework A second component of restoring public confidence is putting in place a robust regulatory framework for charities and IPCs. Arising from the NKF incident, Singaporeans are asking if the Government had adequate safeguards against abuses and malpractices by charities and IPCs, and whether a tighter regulatory framework could have prevented the sad turn of events for the NKF.”
“Based on the Ministry of Health records, no major findings were raised, at least post-2001 when NKF's IPC came under the Ministry of Health. The new Board will no doubt want to discuss further with PriceWaterhouseCoopers, to get their insights on the NKF based on their past audit experience. Nevertheless, it would be helpful for the Board to commission a fresh, detailed review of financial controls within the organisation. They need to specifically ask the questions which Singaporeans have been asking: Have donations been wasted on inappropriate things? Were charitable funds used lavishly or improperly? Have there been lapses in judgment? Were any funds misappropriated? If so, could these lapses have been detected earlier? The new Board has moved very quickly and appointed KPMG to conduct this review. The Terms of Reference of the review are being discussed. I will advise the Board to make public the findings in due course. Third, the Board should review the adequacy of the reserves built up for dialysis patients. Is it three years, as presented by the NKF, or 30 years, as argued by the Singapore Press Holdings in the High Court? This will help the Board determine its immediate fund-raising needs. Meanwhile, I am glad that the NKF has taken my advice not to embark on new fund-raising activities until the Board has deliberated and determined what the funding needs of the NKF are. Fourth, they should review corporate governance. A Board of Directors has fiduciary responsibility for overall good governance. Did the NKF Board maintain sufficient independence from the management, to provide the necessary oversight and checks on management? How was CEO's compensation determined? What was the basis of his bonus payment?”
“I think the obvious competence of these Directors helped everyone feel comfortable. And Gerard Ee was, as usual, organised, confident and calm, calm without daily meditation. I am optimistic that the new leadership will enable the NKF to start afresh, on a sound footing. Their first task is to appoint a new CEO. Choosing a good CEO is the single most important responsibility of any Board of Directors. They will need to take their time on this assignment. Being new to NKF, they would first need to be clear of the organisation, its mission and objectives, before they can decide on the skill sets that a CEO needs. They should not rush through this. That said, there is much work to be done, with daily operations to run and reviews to address the various issues which have been raised. Hence, I suggested to the Board that, in the meantime, I ask a hospital cluster to second a senior hospital administrator to be the interim CEO. An experienced hospital administrator who is familiar with managing healthcare facilities will be most appropriate at this time of need. I have such a candidate in mind but the person has to be acceptable to the new Board. We hope to settle this and announce it within the next few days. Meanwhile, the Board has to identify and prioritise the many issues confronting the NKF. As I see it, six crucial areas require their early attention. First, is the continuation of patient care and the restoration of staff morale, which I touched on earlier. Second, they must fully address the public unease and disquiet over allegations of questionable practices and inappropriate spending of charity funds. Let me note here that the NKF's accounts have been audited by PriceWaterhouseCoopers (PWC) since 1999.”
“To regain public confidence, the Board needed Directors with high standing in their professions and in the community, with reputations for integrity and high ethical standards. Today, I am pleased to report that a new NKF Board of Directors has been appointed. In fact, they have already held their first Board Meeting. The new Board comprises: (a) Mr Gerard Ee, as Chairman; (b) Mr Koh Cher Siang, a retired Permanent Secretary and a former Commissioner of Charities, as Deputy Chairman; The other Board Members are: (a) Mr Gan Seow Aan, Executive Vice-President of Singapore Exchange Ltd; (b) Mr Philip Jeyaretnam, a Senior Counsel and current President of the Singapore Law Society; (c) Mr Ng Boon Yew, Chairman of Raffles Campus and a member of the Council that drew up the new Code of Governance of IPCs; (d) Mr Peter Seah, Member of the Temasek Advisory Board and Chairman of both SembCorp Industries and ST Engineering; (e) Mr Ernest Wong, Group CEO of MediaCorp. He is also a Director of the UOB Board and chairs Nanyang Technological University's Endowment Fund Investment Committee; and (f) Prof. Woo Keng Thye, Senior Consultant Nephrologist at Singapore General Hospital. These are competent and senior individuals, with vast experience and diverse skill sets, covering accounting, banking, business, corporate governance, legal and medical expertise. Together with Gerard Ee, they form a very strong Board with sound values and good community instincts. I know most of them personally, and I believe most are known to Members of this House too. They have good hearts and good heads. And this job requires a good balance of the heart and the head. I was not at their first Board Meeting, because I have no business to be there, but I was told that the mood was cheerful and determined.”
“They sought my help, presumably because patients' welfare was at stake, and their Institution of Public Character (IPC) status, which allows them to collect tax-exempt donations, was issued by my Ministry. I told them candidly that they had lost the public trust. The NKF was built up by public donations. Without public support, the NKF could not continue. For the NKF to survive, its top priority was to regain public confidence. They agreed with my assessment and asked me if I could help shepherd the NKF through this crisis. I told them bluntly that the status quo would not do. I added that a new Board and a new CEO would offer the best chance of winning back public confidence. They took in the message and offered to resign en-bloc to give me a free hand to reconstitute a new Board and to appoint a new CEO. That was how I got involved in this assignment. This was Friday, 14th July. In my view, the key to preserving public confidence and sustaining a vibrant voluntary sector is full accountability and transparency of all charities and IPCs. This should be achieved, first and foremost, through the efforts of the voluntary organisations themselves - their ethos, culture and policies - as determined by their Boards of Directors. This is why my first urgent task was to find a suitable Chairman for the NKF. After pondering a few possibilities, I approached Mr Gerard Ee. I am glad he is in the Chamber today. He is in the Public Gallery. I felt he was the best person to lead in this healing process. He is synonymous with charity and compassion, and is a well-known public figure. On 15th July, I got his agreement to chair the new Board. Gerard and I quickly got on to the next task of forming the rest of the Board.”
“The NKF runs 21 dialysis centres, serving 1,800 patients regularly. Professional standards and services must remain intact. Patients must continue to receive their medical treatments. They must continue to have access to their doctors and nurses, dialysis machines, medication and medical advice. Equally important, we must not forget the staff of the NKF: the doctors, nurses, administrative and support staff. Their morale has taken a beating. They are a dedicated group, serving a cause which they believe in. They need the assurance that their work is appreciated, and that they can carry on delivering patient care without distraction or worries about their future. Despite a difficult week, they have rallied together to ensure that the work still gets done. They need our moral support. Regaining public confidence But NKF must acknowledge that public confidence has been shattered. For the NKF to continue its work, it must address this comprehensively. Putting a new, strong Board in place The immediate task is to put in place a new, strong Board to stabilise the situation. A few people have questioned my involvement, and by extension, the Government's involvement in this matter. They are concerned about the Government's intervention in the affairs of a voluntary organisation. Mr Speaker, Sir, the NKF is indeed a private non-Governmental Voluntary Welfare Organisation (VWO). It was founded in 1969 and registered in 1984 under the Charities Act. It is not a Government-linked entity, nor is it run by the Government. It has its own governance framework to manage its organisational issues. However, as public pressure built up last week, the NKF Board of Directors and its CEO came to see me on Thursday, 14th July. They asked for advice on how to respond to the crisis.”
“Mr Speaker, Sir, the revelations in the High Court on 11th and 12th July by Mr T T Durai, then-CEO of the National Kidney Foundation (NKF), gripped the attention of Singaporeans and sparked widespread outrage. They eventually led to his resignation and the resignation of the entire Board of Directors. The intensity of the public reaction is understandable. Many Singaporeans have donated to the NKF with good intentions of supporting the less fortunate who suffer from kidney, cancer and other diseases. The donors are naturally upset by the disclosures which seemed to suggest overly-generous staff compensation, improper spending, weak Board governance and misleading statements on fund reserves. They feel misled, betrayed and deceived. While such emotions are understandable, we need, at the same time, to remain objective and not lose sight of the bigger picture. The NKF cause is a worthy one. There are real patients out there who have benefited from the work of the NKF and who continue to require care. I have visited the NKF dialysis centres before, and so have many Members of this House. We have spoken to the patients. They were sincerely grateful and happy with the work of the NKF in giving them a new lease of life. I believe that Singaporeans know this and support the NKF's fundamental cause. That is why the NKF enjoys such widespread support, with more than half a million Singaporeans making donations to the NKF last year. Continued patient care Therefore, while it is important that we look into the issues which the court case has thrown up, we must not allow them to distract attention from the NKF's patients in need. Our top priority must be to ensure that patient care and existing clinical services are not disrupted.”
“First, I must object to the statement that we only have one TV station. Several years ago, as a hobby, I chaired the Singapore Cable TV, and we brought in many channels that there are now so many channels at home that viewers can watch. As to what the visitors will feel, I think she has already heard the reply from the House. The second question as to what are the criteria by the Ministry of Home Affairs, can the Member please file a Question? Column No : 1025 2SG HU ENHUAI (Compensation to family and disciplinary action against personnel involved) 14. Prof. Ivan Png Paak Liang asked the Minister for Defence if he will brief the House on any compensation and disciplinary action taken in the August 2003 "Commando dunking" saga, specifically, (a) whether the family of Sergeant Hu En Huai has taken legal action and, if so, the outcome; (b) what compensation has been paid to the family of Sergeant Hu; and (c) what disciplinary action has been taken against the responsible military personnel who were not subject to criminal penalties and those who were subject to criminal penalties.”
“Mr Speaker, Sir, I would really prefer to defer such discussions to the next few hours when we will have plenty of time to discuss this particular issue. I also must get myself prepared for the 3 o'clock statement. Assoc. Prof. Ong Soh Khim: Sir, if I may, I have two supplementary questions related to the answers that the Minister has just given.”
“As to whether there are pressures on patients that they feel obliged to participate, I can only say categorically that it will be totally unethical. If a charity were to say, "Patient, if you don't appear, I will pull the plug on you.", I think that will be totally unethical and unacceptable. And if the patients, having seen themselves on TV after the event, discovered to their horror that they were being presented as such, they could always feedback to me or anybody, and I will take up the case on their behalf.”
“Sir, there was a time when I did not have to jot down points and I could still remember. But with passing years, I have to jot down points. Otherwise, I cannot remember when there are so many queries. First, too many shows. It is hard to judge whether it is too many, too few, once a month, once a week or whatever. The whole thing is self-regulated. If indeed, as Prof. Ong put it, Singaporeans got put off, then surely they would not be watching the shows. When they do not watch the shows, then you know that the shows may not be effective in raising funds. I think it is very difficult for civil servants to decide whether four is too many, three too little or what. Therefore, they have taken a stand whereby the charities make their own decisions because when they stage a show - I am not an expert in this area, but in the last few days I got to understand a little bit more about this subject - big costs are involved. It does not mean that they will always net it all and have revenue. And if they commit a lot of money and raise too little, they lose money. So, in that sense, it is self-regulated by Singaporeans themselves. At the end of the day, are the shows interesting enough for you to watch? I believe there are many who probably just watch without moving their mobiles. They just take it as an entertainment value. So, I have difficulty, honestly, stating what are the legitimate numbers above which you should not stage all those shows. But, as I stated in my reply, the Act requires that those who want to organise more than one per year, they have to seek permission. Under the Common Gaming Houses Act - I think it is under the Ministry of Home Affairs - each time, they will have to apply.”
“Second, if we look at the shows that had been carried out, like what the Minister said, there are guidelines to ensure that the shows are carried out in good taste and so forth. But if we look at it, there are top prizes of $500,000, condominiums and cars to be won. People at the coffee shops are saying that the odds are better than buying lottery. Again, are the regulations effective in this case? Should the gambling Act come in also? Third, the Minister said that some patients have voluntarily appeared in the shows for publicity. Sometimes what was told to the patients and what eventually was aired on national TV were different. Were these patients briefed in detail of what exactly would come out and how their story would be portrayed on national TV? Lastly, have these patients been psychologically threatened to come out and participate for the publicity of the charity shows? Otherwise, they would not receive subsidy from their respective charity bodies.”
“Viewers should carefully decide whether, and how, they wish to respond to these fund-raising methods. It is in this spirit that the Government has not imposed excessive regulations on large-scale fund-raising. In May 2004, the Council on Governance of Institutions of a Public Character (CGIPC) recommended a set of guidelines for compliance by VWOs by January 2007, as well as an additional set of best practices that VWOs should consider. I strongly encourage the VWOs to adopt the guidelines as soon as possible, ahead of the compliance timetable, as well as the best practices. These guidelines and best practices include recommendations on the conduct of charity shows, and advice to charities not to stir feelings of guilt in the public who may not wish to donate. Assoc. Prof. Ong Soh Khim (Nominated Member): Sir, I have four supplementary questions since both my questions were answered together. First, I did a count on the number of charity shows that we had in the past. The last show was the NKF Cancer Fund which was carried out in three parts which, effectively, were three charity shows. The coming President's Star Charity is going to be carried out in two parts, which means it is actually two shows. Earlier, in April, we had the NKF Charity Show for kidney dialysis patients. And now we are having the Singapore Cancer Charity Show and we are also going to have NKF Children Medical Fund Charity Show and another Heart Charity Show for the Singapore Heart Foundation. So, on the average, we are having about 10-12 charity shows a year, which is like one per month. In that sense, are the regulations effective in regulating the numbers and the quality of the shows? Are there also regulations to assess the requirements for a charity to put up a show?”
“Sir, I will focus narrowly on the specific queries. Because, separately, I will be discussing the broader issues with respect to charities arising from the NKF incident in my Ministerial Statement later on. Regulations on large-scale fundraising There are rules which guide the organisation of large-scale fund-raising activities. The Media Development Authority's (MDA) Free-to-Air Television Programme Code requires all TV programmes, including charity shows, to observe standards of good taste and decency. In addition, the Common Gaming Houses Act allows Institutions of a Public Character (IPCs) to conduct no more than one public lottery per year, via charity shows or otherwise. Those which wish to conduct more shows need to apply for waiver. Participation of beneficiaries I can appreciate that some beneficiaries may choose to play a part to help raise funds during charity TV shows. As long as such beneficiaries have voluntarily agreed to appear on such shows, we should respect their decision to do so. At the same time, charitable organisations must also respect the dignity of their beneficiaries. Cap on expenses On the use of fund-raising proceeds, IPCs, which are charitable organisations allowed to receive tax-deductible donations, are required under the Income Tax regulations to cap their fund-raising expenses at 30% of total donations received. This is described as the expense ratio. This is to keep administrative expenses within a reasonable limit. Role of Government VWOs should continually communicate to the public the causes for which the funds will be used. They should gauge the appropriateness and frequency of such fund-raising activities, bearing in mind donors' responses and potential donor fatigue.”
“Mr Speaker, Sir, with you permission, I would like to take Prof. Ong Soh Khim's Question Nos. 12 and 13 together on VWOs' fund-raising activities.”
“Ong Soh Khim asked the Minister for Health (a) whether there are any regulatory guidelines for Voluntary Welfare Organisations to carry out large-scale charity shows through the radio and TV media; (b) if there is a myriad of such large-scale charity shows leading to a donation fatigue syndrome in the general public; and (c) if there are any specific guidelines on (i) the methods of soliciting donation in these large-scale charity shows and (ii) controlling the strategies that these large-scale charity shows use to play on the sympathy, greed and fear of the general public towards certain illnesses to make them donate. 13. Assoc. Prof. Ong Soh Khim asked the Minister for Health whether the National Council of Social Service has (i) guidelines to prevent Voluntary Welfare Organisations (VWOs) from exploiting cancer and kidney disease patients by wheeling them out in public places and large-scale charity shows for publicity campaigns or "show-casing" them in their donation soliciting campaigns such as mailers; and (ii) guidelines, which VWOs have to adhere to on fund raising activities, that stipulate the percentages of the funds raised that shall go to beneficiaries and expenditures respectively.”
“Sir, generally, our hospitals take the following approach to recover outstanding hospital bills. Within 10 days after discharge, patients should receive their final hospital bills. Most patients would settle their bills upon receipt. If a patient has not responded after one month, the hospital will send a reminder. A second reminder, if necessary, will be sent during the following month. For a patient who expresses financial difficulty, the hospital would explore with him options for financial assistance where appropriate, or consider payment by instalments. For a small minority who do not respond after two reminders, the hospital would send a third reminder. If there is still no response, some hospitals may refer the case to a debt management agency to collect payment on their behalf. A debt collector is engaged by the hospital only after all internal collection efforts have been exhausted. Such agents are stringently selected and contractually bound to use legal and professional measures to collect debts. We do not use the agents engaged by ah longs. The hospitals regularly evaluate their debt collectors on their professionalism and performance. The experience so far has been productive. Column No : 1018 VOLUNTARY WELFARE ORGANISATIONS (Fund-raising activities) 12. Assoc. Prof.”
“Sir, in fact, the development in the last two years was a pleasant surprise to me. I grew up in the healthcare career. The problem is that there is always capacity in the training school but there are not enough young boys and young girls who want to opt for the nursing profession. But in the last 2-3 years, there was a significant change. I do not know what happened. It might be because of SARS or it might be because of better marketing, promotion and explanation on our part. But whatever the reason, the end result is that we now have a very happy situation where we exceed our projections. That is why I encouraged the polytechnics to expand their capacity as quickly as they can. And I hope the trend is a definitive one, and not just a fluke shot of 2-3 years. That is why we now have a second polytechnic also going into nursing, and we will quickly scale it up. But at the same time, I see no reason why we should not continue to take Chinese students who are interested every year - maybe 100-150 - to supplement our nursing pool in Singapore. Because if we look a little bit long term, the need for more nurses is there, with aging and so on. It is seen in every country. It is a global phenomenon. Nurses are really precious commodities and they are assets to the whole global labour market. And I think there is no such thing as over training of nurses. The more that we can take in, whether locally-trained or foreign-trained, the better all round. Column No : 1017 RECOVERY OF OUTSTANDING HOSPITAL BILLS 11. Mdm Ho Geok Choo asked the Minister for Health (a) how do hospitals recover outstanding bills from patients; and (b) what is the experience of the hospitals with regard to outsourcing of outstanding bill collection to debt collectors.”
“Sir, indeed, we do such studies. No doubt the number is small but if we can salvage each case, it is a contribution. These are people who initially thought that they were interested in nursing, but either during the course or upon graduation, the nursing career is not what they expected or anticipated. So they were having difficulty on the job. Some, unfortunately, then pursued this route to abscond. Maybe we have to go upstream to the selection process, which means more thorough interviews, assessment, maybe psychological testing. But we know that you cannot hope to do it so perfectly that we have zero attrition. Even in medical school intake, we have extensive studies and interviews lasting many days, and we know that there are still attritions. Except that in that instance, they are Singaporeans and they cannot run away and they are here. So there are no liquidated damages involved. From my point of view, over a 10-year period, 25 out of 1,500 is not a bad record but, of course, we should always still try very hard to bring it down to as low as possible.”
“Sir, the scholars who absconded were essentially nurses recruited from China under the Ministry's Scholarship Programme. We started this programme in 1994, to bring in selected Chinese students to be trained in Nanyang Polytechnic, largely as nurses. Upon graduation, they are bonded to work here, failing which they would have to pay liquidated damages. This has been a successful programme, benefiting both countries and the trainees. The vast majority of the scholars discharge their obligations and contribute to our healthcare services. Since 1994, we have recruited nearly 1,600 scholars. More than half have already completed their training, with the rest still in training. Currently, more than 700 scholars are serving their bonds in our hospitals. Unfortunately, a small minority, 25 nurses and one radiographer, chose to abscond without paying liquidated damages. My Ministry has a set of guidelines to help our hospitals deal with such default cases. This includes coordination with the relevant authorities to cancel their work permits and student passes, while taking steps to contact them and their guarantors. At the same time, all practical efforts to recover the liquidated damages will be taken, failing which, legal assistance may also be pursued.”
“It is so. I think the doctors convey that kind of information to the patients. In public hospitals, the bills are quite detailed and I insist on that because it should be properly itemised so that patients know what they are being charged for. That is why when patients are discharged from hospitals, and if they have stayed several days, the print-out of the bills can be quite long, because there are so many kinds of x-rays, laboratory tests and different kinds of drugs. Pertaining to drugs, something that I always push for is printing of the prescription so that the patients can take away a properly printed prescription, especially for patients whose drugs are not subsidised either because they are private patients or because the drugs are non-standard. Then, they have a choice. Do they want to buy from SGH because they happen to be a patient there or they may go to Guardian pharmacy or even to Johor Bahru if they think they can get it cheaper but of similar quality? This is the sort of thing that we ought to promote nation-wide, not just in public hospitals but also in the private GP clinics. So, as patients, Singaporeans should demand their GPs for a properly printed out prescription. Column No : 1008 CIGARETTE SMOKING BY WOMEN (Reasons) 7. Mdm Cynthia Phua asked the Minister for Health what are the main reasons why our women are taking up cigarette smoking.”
“Sir, I understand what Dr Tan has in mind. I think the fact of the matter is that, in most cases, the prices that we are able to get from vendors are probably among the lowest in Singapore. But that is pure economics, because we are the largest buyer of many of these products and, therefore, we enjoy a bulk discount. And the reason why the other healthcare providers, such as GPs or private doctors, would like to join in the scheme is because they are getting prices which are higher than the prices that we pay. But once you do that, then we will have one single buyer in Singapore, and I think vendors will take a different attitude. My priority is to the subsidised patients. So, I will work my best to try to get the lowest possible cost for the subsidised patients. If by extending my outreach and bringing in all the GPs under my web, I am quite sure the drug vendors will then take a very different attitude. So, when they compete in a tender today, they do take into account that 80% of my clientele are subsidised patients. But if they know that the tender price would now be enjoyed by patients in private clinics and GPs, I think they would price it differently, it cannot be less. Then, who would suffer? I think the subsidised patients in public hospitals would be worse off. So I am sorry.”
“Sir, I thank Dr Tan Sze Wee for his support of my Ministry's efforts in publishing hospital bill sizes for common illnesses. It has, indeed, led to a more competitive landscape. The primary objective is to give patients more information, so that they can make more informed choices as to where they could seek treatment. Dr Tan would like me to publish the prices charged by vendors to our hospitals. I am not keen, because these are micro-details which, I think, will clutter the information, causing confusion or distraction. In any case, the list prices of some proprietary prescription drugs are already in the public domain.”
“We are also building more de-contamination facilities so that healthcare workers can be protected when treating patients affected by chemical agents. As always, prevention is better than cure. That is why we are introducing measures to reduce the risk of an attack on Singapore. One such measure is in the control of hazardous substances. Administratively, we have tightened the control of access to dangerous biological agents. We now need the legal backing to such a measure. A Bill for this purpose is being drafted and I will introduce it to this House in a few months' time. But prevention is not the job of the Government alone. We can all play our part to be vigilant. And in the event of a bioterror attack, Singaporeans can also help to bring the transmission of the disease under control by consulting their doctors when they are unwell and isolating themselves if advised to do so. Formulating contingency plans and exercising them are important parts of our national preparedness to deal with terror attacks. We will continue to refine our plans and enhance our capabilities to deal with emerging threats as they are identified. WRITTEN ANSWERS TO QUESTIONS ILLEGAL PARKING 1. Assoc. Prof. Ong Soh Khim asked the Minister for Home Affairs (a) how long is the processing time for Traffic Police to respond to public feedback on persistent illegal parking on roads; (b) what are the steps taken by Traffic Police in response to such a feedback; and (c) what is the frequency of checks by Traffic Police on stretches of roads known to have frequent illegal parking incidences.”
“Hence, we need a range of contingency plans to meet the various types of attacks. We have, for example, a contingency plan to deal with a chemical attack which results in up to 1,000 casualties. For biological attacks, we have focused on a few bioterror agents such as anthrax and smallpox. As a general principle of contingency planning, we need to make sure that the necessary system, infrastructure, equipment, and skilled manpower are in place. There are no perfect or comprehensive contingency plans. We just have to regularly review and update them in the light of new knowledge and experiences. We have learnt much through dealing with SARS. First, we now have a quicker system to mount a coordinated response that involves many Government agencies, so that we can respond quickly to save lives and mitigate the impact to public health. Second, we have strengthened our infection control measures in the public hospitals. Third, we have enhanced our hospital infrastructure, with isolation rooms and fever screening areas to prevent cross infection. Fourth, we have acquired stronger capabilities in field epidemiology, infectious disease surveillance, contact tracing and quarantine which will all come in handy in any bioterror attack. Fifth, we have built up a stockpile of critical medical supplies including essential drugs, vaccines, antidotes and personal protective equipment. In addition, our public hospitals have expanded their contingency plans to deal with a sudden upsurge of patients in the wake of an attack. Current situation is much better than before, though not yet fully satisfactory. Our main limitations are in the capacity of the emergency departments and intensive care beds. We are expanding the physical capacity and training additional staff in these areas.”
“We have various contingency plans to deal with biological and chemical attacks. The nature of the plan will depend on the scale of attack and the type of biological or chemical agent used. The risk of such an attack on the civilian population is low but real. It has happened elsewhere before. In 1995, Aum Shinrikyo, a Japanese cult, carried out a chemical attack using Sarin gas on the Tokyo subway lines. The attack killed 12 and injured over 3,000 people, of which some 500 were hospitalised. More recently in 2001, a series of attacks through the use of anthrax-laced letters affected several locations in the US, including the Senate. This is a biological attack using a bacterium that causes anthrax. There were 22 victims, of which five died. It caused widespread anxiety among the population. Dealing with such attacks requires a total effort involving several Ministries as well as the private sector and Singaporeans at large. For the healthcare sector, biological and chemical attacks pose rather different challenges. Chemical agents such as nerve agents cause immediate injuries to those exposed. Survival is largely predicated on how quickly we can deliver treatment to the victims. If a large number of people are exposed, then there will be a large and sudden surge of victims needing immediate care in our hospitals. On the other hand, a biological attack will normally not yield immediate casualties. There would be an incubation period before the symptoms start to manifest and patients appear at the hospitals. Since many of the possible bioterror agents are transmissible from person to person, if we are not able to identify and isolate the victims, the public would continue to be at risk of contracting the disease, long after the perpetrator has left the scene.”
“The Standard Drug List (SDL) is drawn up by my Ministry, based on the recommendations of an expert committee called the Drug Advisory Committee. New drugs are regularly introduced into the market for the treatment of a wide variety of diseases. Hence, the Drug Advisory Committee reviews the SDL regularly, with inputs from our clinicians. The Committee takes into account five key factors: (a) Whether the medical conditions are common and important causes of morbidity and mortality in Singapore; (b) Whether the drugs are essential for the treatment of these medical conditions; (c) Whether the drugs offer a major improvement in terms of efficacy and effectiveness, as compared to existing standard drugs; (d) Whether there is sufficient long term safety data pertaining to the drugs; and (e) Whether there is sufficient evidence of the drugs' cost-benefits. In addition, my Ministry regularly compares our SDL with international formularies such as the WHO Essential Drug List, the Australia Pharmaceutical Benefit Scheme, and the US Kaiser Permanente Drug List. MASS BIOCHEMICAL ATTACK (Emergency preparedness contingency plans in hospitals) 27. Ms Indranee Rajah asked the Minister for Health what emergency preparedness contingency plans our hospitals have to deal with a mass biochemical attack and whether we have sufficient resources to deal with such a contingency.”
“The age cap for MediShield coverage is not a permanent age cap. As life expectancy goes up, it should move in tandem. The current age cap of 80 was set in 2001. I think it is time for another review. Now that the MediShield reform has been implemented, I have begun to look into this possible refinement. But I must confess that in the last three days, I have not been focusing on this subject. In this regard, the MediShield reform has already produced some early benefits. There are now four insurers offering catastrophic illness insurance coverage for Singaporeans above 80. It is likely that the current MediShield Plus tender may attract bids with an age cap higher than 80 years. If so, their bids will also help us in our study of where to re-set the age cap and the premiums for such an age band. 3.00 pm”
“In due course, Sir. MEDISHIELD COVERAGE (Age cap) 11. Dr Ong Seh Hong asked the Minister for Health whether his Ministry will consider further extending the age cap for MediShield coverage beyond 80 years or removing altogether the age cap for MediShield, to include more elderly Singaporeans under a broader based medical cover, particularly when this group will be most dependent on medical cover in their very old age.”
“Currently, Medisave accounts are subject to a Medisave Contribution Ceiling of $32,500. Once an account has reached this level, new contributions to Medisave will overflow to the member's Ordinary Account. This policy was introduced in 1986. It is to give Singaporeans greater flexibility in using their excess Medisave monies for other needs, once they have been deemed to have saved enough for their future hospitalisation expenses at class B2 level. Recently, we have received suggestions from some middle-income members to use their Medisave to help pay for the higher cost of hospitalisation in private hospitals and class A/B1 wards. The question is whether allowing this will undermine the adequacy of Medisave for future hospitalisation needs of Singaporeans. Perhaps we can allow this for those with healthy balances and active contributions. If we do, we may need to raise the Medisave Withdrawal Limits and the Medisave Contribution Ceiling for such members, as they are currently based on class B2 rates. My Ministry is studying the issue carefully and will also consult the public before making a decision on this.”
“Our hospitals do not routinely ask our patients for data on their income. I am therefore unable to supply the information as requested by Assoc. Prof. Ong. However, a study in 2002 found that, out of those patients who earned above $6,400 per month and hence belonged to the top 10th-percentile income group, 62% opted for Class A wards. Their hospital bills averaged about $4,000, including ward charges. The 2002 study did not collect information on the medical conditions of these patients. FUEL PRICE AND ALTERNATIVE FUEL SOURCE 25. Mr Steve Chia Kiah Hong asked the Minister for Trade and Industry, considering the rising price of crude oil, if Singapore has started exploring into alternative sources of fuel and, if so, what is our success thus far.”