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.”
The complete record
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“Sir, with your permission, I would like to take Question Nos.6 and 7together, as both are about medical insurance. Currently, Medisave can be used to buy a catastrophic medical insurance policy. There are 15 approved medical insurance policies for Singaporeans to choose from. Withdrawal from Medisave to pay for the insurance premium is limited to $660 per year per policyholder. This withdrawal limit is more thanenough for the basic insurance product such as MediShield. All the 15 insurance policies are competing insurance products; they are not complementary products. So buying one policy is enough. Paying for duplicated coverage brings no additional benefits. That said, my Ministry is reviewing our policy governing catastrophic medical insurance. The objective of our review is partly to address the concern raised by Dr Lily Neo on the affordability of hospitalisation costs. Although our work is not yet finished, we have drawn the following six conclusions. First, catastrophic medical insurance can play a useful role in helping to spread the financial risk of falling very sick and incurring a very large hospital bill. Very few Singaporeans get hospitalised; at any point in time, only 1 in 800 Singaporeans does. Moreover, not every hospitalisation results in a very large bill. Because of heavy Government subsidy, only a minority with a catastrophic illness will end up with a very large bill. If the vast majority of Singaporeans subscribe to a catastrophic medical insurance policy, then the insurance premiums needed to pay for these very large hospital bills can be quite affordable. The premiums will certainly be very much less than if the patient is to self-insure and pay through his personal savings.”
“During Financial Year 2003, 106,260 patients were hospitalised for more than three days in acute public hospitals: 50.2% were male and 49.8% female. During the same period, total subsidy for all inpatients in acute hospitals amounted to $538 million: $289 million for male and $249 million for female patients. The topthree illnesses and the associated bill sizes are tabulated below: Male Illness Class of Ward Median Bill Size 1. Accidents (including fractures and poisoning) Class A $2,030 Class B1 $1,605 Class B2 $646 Class C $421 2. Cancer Class A $5,498 Class B1 $3,804 Class B2 $1,165 Class C $837 3. Ischaemic Heart Disease Class A $3,833 Class B1 $2,888 Class B2 $1,148 Class C $827 Female Illness Class of Ward Median Bill Size 1. Accidents (including fractures and poisoning) Class A $1,622 Class B1 $1,357 Class B2 $679 Class C $506 2. Cancer Class A $4,386 Class B1 $3,855 Class B2 $1,103 Class C $793 3. Complications related to pregnancy Class A $1,223 Class B1 $913 Class B2 $328 Class C $307 DROPOUTS AFTER SECONDARY 2 AND 4 15. Ms Braema Mathiaparanam asked the Minister for Education in the last two years how many girls and boys dropped out of school after (i) Secondary 2 and (ii) Secondary 4 without completing the N or O-levels.”
“Ms Braema Mathiaparanam asked the Minister for Health in the last one year (a) how many men and women (by gender breakdown) were hospitalised for an illness lasting more than three days; (b) how much subsidies did men and women (by gender breakdown) receive from the Ministry for their treatment; and (c) what is the total bill size for the top three illnesses that men and women (by gender breakdown) suffered from.”
“The National Health Survey showed that the smoking prevalence among women aged 18-65 years increased from 3.1% in 1992 to 3.6% in 2001. The smoking prevalence among young women aged 18-24 years increased more rapidly, from 2.8% to 8.4% over the same period. There is no local study on why more Singaporean women are smoking today compared to previous years. Studies in other countries attributed the increasing trend in smoking among women to the aggressive advertising by tobacco companies which promote cigarettes to women using seductive images of vitality, slimness, modernity, emancipation, sophistication and sexual allure. In a study on smoking among the Singapore youths (2001), young women aged 19-24 years indicated that they smoke because of peer pressure, to relief stress, control their weight and improve their social image. A report published by the British Medical Association in 2004 on the impact of smoking on reproductive health showed conclusive evidence that female smokers are more likely to be infertile compared to non-smokers. It also reported that female smokers take longer to conceive and couples who smoke are less likely to respond to infertility treatment and the risks of miscarriage and stillbirth are higher in pregnant women who smoke. In view of the rising trend of young female smokers, the Health Promotion Board is now targeting its campaign to educate and encourage young females to stay smoke-free or quit the habit. ILLNESSES BY GENDER BREAKDOWN 14.”
“I will be reading the Human Cloning and Other Prohibited Practices Bill for the second time today. If approved by this House, it will prohibit all human reproductive cloning activities in Singapore. Outside of Singapore, any Singaporean who participates in such activities will be subject to the prevailing laws in those countries. The fact is that most countries, including Australia, Canada, France, Israel, Japan and the UK, have passed legislation banning human reproductive cloning. Theoretically, it may be possible to determine whether a baby has been cloned by subjecting it to DNA testing. One would need to demonstrate that the DNA profile of the baby in question is identical to the person who allegedly provided the genetic material to create the clone. However, in practice where the cloning took place overseas and made use of genetic material from an overseas source, it may not be possible to gather sufficient evidence to prove the case. That said, so far no one in the world has produced any evidence that he has successfully cloned a human baby. None of the reports on so-called human cloning have actually been verified by reputable authorities or supported by scientific data. I would like to advise Singaporeans not to be deceived by such claims in the media. WOMEN SMOKERS 13. Mdm Cynthia Phua asked the Minister for Health (a) if there are any studies done on why more women are taking up smoking in Singapore; (b) how will smoking affect female fertility; and (c) whether there is a trend among young mothers, who are smokers and who are addicted to tobacco, having problems conceiving children.”
“As Members can see, the medical safety net is well in place for those needy Singaporeans who, despite heavy Government subsidies, Medisave and MediShield, are still unable to afford their medical bill. BUDGET FOR MCYS 33. Dr Chong Weng Chiew asked the Prime Minister and Minister for Finance whether there will be a corresponding increase in the budget for the Ministry of Community Development, Youth and Sports, with its enlarged portfolio.”
“In the recent NKF Children Medical Fund Charity Show, the mother of a child patient with multiple illnesses spoke about her problems looking after the child. I sympathise with her and her family. As Dr Ong noted, she mentioned that she had already spent about $50,000 on her child's medical bills since birth. Dr Ong asked why the medical safety net was not there to help ease her financial difficulties. My Ministry has looked into this case. The child was born in a private hospital in 1998. After several months in a neonatal ward there, the child was transferred to the National University Hospital. She has been under the care of the NUH ever since. We have asked her mother about her medical expenses. She explained that the $50,000 expenses comprised: (a) $22,000 largely incurred in the private hospital and an initial stay at the NUH; and (b) $30,000 incurred in the NUH since 1999. The family sought the assistance of the NUH's Medical Social Worker (MSW) in late 1998 after they realised that they would have problem coping with the child's continuing medical care. After an investigation, the MSW was able to secure the approval of the Hospital Medifund Committee to help this family. This was in early 1999. To date, Medifund has paid $21,000 of the bills incurred by the patient, and has continued to help the family for the patient's medical treatment. The family's payment of the child's medical bills so far is therefore about $31,000 and not $50,000. The bulk of the expenses were incurred in the private hospital to which the family had owed some money. The mother has however clarified that, since the screening of the Charity Show, the private hospital has decided to waive the rest of the bill.”
“The ElderShield scheme was introduced onlytwo years ago. It provides older Singaporeans with basic financial protection against expenses required in the event of severe disabilities. Unlike MediShield, the ElderShield insurers, of which there are two, compete to provide an identical insurance product, with premiums and payouts which are identical and specified by the Government. The two insurers are appointed after an open competitive bidding process. Eligible CPF members are then randomly allocated to the insurers for coverage, unless they opt out of ElderShield. As a result, the profile of policyholders, in terms of age, gender or health risk, for each insurer is largely similar. The contract for the ElderShield insurers runs forfive years. Towards the end of the contract, in 2007, the Government will review the performance of the scheme as well as the insurers. That will be an appropriate time to assess the effectiveness of ElderShield and to see if we should make any refinement to it. At the moment, there are not enough claims data to allow for a meaningful evaluation of the scheme. MEDICAL SAFETY NET 28. Dr Ong Seh Hong asked the Minister for Health in view of a recent NKF Children Medical Fund Charity Show where a mother was shown to have incurred some $50,000 on medical expenses for her child, who suffered from multiple illnesses, why was the medical safety net not utilised to ease the financial burden of this family.”
“That was not quite what I said. What I meant was that the protection of data supplied by patent owner has nothing to do with safety of consumers. Patent rights and data protection rights are two different pieces of intellectual property rights. Most patent Acts allow for a period of 20 years' protection. If I invented something, over the 20-year patent period, nobody can infringe my patent. So this is one IP right. The second right is data protection which concerns the drug registration process. Having secured a patent, you still need what is called marketing approval for a product licence from the drug regulator of any country that you want to market to. And when you submit the application, you have to produce all the clinical trial results to show that the product is, firstly, safe; and, secondly, effective. So safety and efficacy data will have to be produced to the regulator. But having produced the data to the regulator, the regulator has a certain obligation, which is to make sure that the data are not openly disclosed, because otherwise trade secrets may be released to third parties who can then free ride on this. So, data protection is provided in that light. The data are derived from clinical trials on safety and efficacy. This amendment is about protecting these rights of the patent owner. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House. The House immediately resolved itself into a Committee on the Bill. - [Mr Khaw Boon Wan]. Bill considered in Committee; reported without amendment; read a Third time and passed. ADJOURNMENT”
“The Paxil case is quite different. It is not a case of IPR dispute. The legal proceeding is being processed. So we do not know what the outcome will be. But from press reports, the New York Attorney-General's point of view is that certain information has not been fully disclosed to the public, and therefore he is now taking up the case with the drug company.”
“On new section 16, Dr Neo felt that the licensee's request to revoke a product licence should be a written request. I agree. In fact, this is the intent. Any revocation of a product licence is a process not to be taken lightly. And any such request will need to be made formally in writing supported by appropriate documents. This is actually implied, as all official correspondences with the Health Sciences Authority have to be in writing. Finally, Dr Neo raised the question of additional data. Let me clarify that new section 19D covers all safety and efficacy data provided by the applicant regardless of whether it is data submitted at the point of application or additional data requested by HSA in order to approve the application. The current clause is therefore sufficient. But the obligation on protection of safety and efficacy data does not extend to additional data submitted after a product has been registered, as this was not included under our obligation for the bilateral FTA. When applying intellectual protection measures, it is necessary to balance the interest of the innovator companies with that of the companies producing generic medicines. I think we heard a fair bit of this question of balance about an hour ago when other Bills were being debated. Currently, there is no uniform international practice with regard to the protection of additional data submitted after the initial registration of a product. Dr Neo mentioned the Paxil case with Merck Sharp & Dohme. The two issues are quite separate. This protection of data is a concession given to a patent holder, so that if I am the patent owner, whatever safety efficacy data I supplied to the regulator, no third party can come in and free ride on my data. It has nothing to do with consumer safety.”
“But whether such a message will be effective, frankly speaking, I doubt it very much, because unlike cigarette packs, which are large enough to enclose lively pictures and pictorial messages, the wrapper is really too small to provide for any effective messages. Therefore, I think the most effective method of preventing these old problems from coming back is to continue to ban those chewing gums and only to make a small concession for those with therapeutic value. In any case, it will not be appropriate to use the Medicines Act to enforce environment-friendly messages. The Medicines Act can only enforce product labelling requirements which address health and safety concerns. As for the timing of this particular FTA obligation, the concession on chewing gum was implemented in January this year through a set of subsidiary legislation under the existing section 54 which is actually legally adequate. But just to avoid any doubt, the proposed section 54 (1A) will make it crystal clear that the existing powers under section 54 do apply to dental chewing gums. Let me now reply to the questions on the main amendments pertaining to greater IPR protection for patent holders. On the question of penalties, Dr Lily Neo felt that a fine of $5,000 seems rather low. The maximum penalty, as currently prescribed in the Medicines Act, is a fine of $5,000 or two years' imprisonment or both. For the current amendments, we have merely followed this prescription. But I take Dr Neo's comment that the existing penalty quantum seems low. We will review the penalties of all the offences as part of a larger review of the existing medicine legislation to bring them in line with other health and environmental protection laws in due course.”
“Madam, let me first thank Dr Lily Neo for her strong support of the Bill. She did raise a number of questions. Let me respond to them. First, chewing gum. We banned chewing gum in 1992 for very good reasons. Irresponsible disposal of the gum created an unnecessary problem for our cleaners and when it led to jamming of MRT train doors, it even posed a public safety risk for the passengers. We have now had 12 years of freedom from this sticky problem. We have no intention of welcoming them back. In fact, some foreign cities are seriously contemplating banning chewing gum as we have done. The concession we made on chewing gum for the bilateral FTA is therefore a very limited one. It certainly will not lead to a flooding of our market with the gums. First, what we have done is merely to create an exception for gums with therapeutic value. Their sale will then be subject to our health laws and regulation. In this way, we can expect a slight increase in consumption of gums but this will be for their therapeutic value and not for their recreational value. Second, the Environment Ministry and the Transport Ministry have, in parallel, introduced stiffer penalties for any indiscriminate disposal of used gum. This is to remind all that we have no intention to return to the bad, old sticky days. Dr Lily Neo suggested that we require gum manufacturers to print environment-friendly messages on the wrappers. I happen to have one here with me and it has a pictorial message on responsible gum disposal with a tagline "Keep your country clean".”
“For example, while almost all VWOs rely on Government subvention, the National Kidney Foundation has been able to raise its own funding to provide subsidy for most of its patients who require financial assistance. It taps on Government subsidy for only some of its patients. Dialysis patients managed in public hospitals generally have other illnesses and are more difficult to manage. Their Government subsidy will be about $1,200, $800 and $1,000 per month for haemodialysis, CAPD and APD respectively. There is also no means-testing in public hospitals at the moment. Government subvention for the dialysis centres amounted to about $4 million a year. The breakdown by service provider for FY2002/3 is as shown in Table 2: Table 2 Government Subvention by Service Provider: FY2002/3 Service Provider Subvention ($) Public hospitals: National Healthcare Group 253,776 SingHealth Group 2,091,096 VWOs: Kidney Dialysis Foundation 1,247,788 National Kidney Foundation 100,721 Others 315,860 MONEY IN CPF ACCOUNTS 3. Mr Steve Chia Kiah Hong asked the Acting Minister for Manpower (a) what is the total amount of (i) CPF money loaned to the Government over the last two years (2002 and 2003) and (ii) interest earned from such loans; and (b) how much interest was paid into each CPF member's Ordinary Account at the prevailing interest rate of 2.5%.”
“Between 1999 and 2003, the number of patients on kidney dialysis increased from 2,633 to 3,453. The breakdown by service provider is as shown below: Table 1 Number by Service Provider: 1999 & 2003 Dialysis Centre As at Dec 1999 As at Nov 2003 (a) Public Hospitals: National Healthcare Group 150 304 SingHealth Group 421 542 (b) VWOs (Voluntary Welfare Organisations): Kidney Dialysis Foundation 158 173 National Kidney Foundation 1414 1512 Others 25 109 (c) Private sector: Private hospitals/dialysis centres 465 813 Total 2633 3453 The total cost of treatment varies from patient to patient and will typically include some or all of the following items: cost of dialysis, medications, hospital outpatient consultation, hospital inpatient services for any complication arising from dialysis. The main cost is for dialysis. There are three types of dialysis: haemodialysis, CAPD (continuous ambulatory peritoneal dialysis) and APD (automated peritoneal dialysis). The cost differs among the service providers as it depends on the type of service and the level of care provided. Typically, the cost for haemodialysis ranges from about $1,300 to $2,700 per month. The cost for CAPD is around $1,200 per month, while APD will range from about $1,600 to $2,300 per month. Patients receiving dialysis at VWO dialysis centres are subsidised by the VWOs and/or the Ministry of Health. Generally, each patient on CAPD will receive a Government subsidy of $200 per month. For patients whose medical conditions require them to be on haemodialysis or APD, the Government subsidy is $600 per month. At the moment, the Government subsidy is provided without any means-testing. Individual VWO has its own pricing, means testing and subsidy policies.”
“Sir, as I have indicated earlier, all this is coordinated by the Ministry of Health. But because laboratories span over various Ministries - there are the Ministry of Education with its academic institutions, the Ministry of the Environment, etc, - the national biosafety committee will have representation from all. The national committee, since last year's incident, has administratively taken CDC's standards and/or WHO's standards as our standards. But I think we need to put legal backing to that, and that is what the current exercise is all about. To assure the Member, the system is in place but I want to do the last missing link, ie, to provide legal backing to it. UNEMPLOYED COMMUNITY LEADERS (Programmes to facilitate employability) The following Question stood in the name of Mdm Ho Geok Choo - 19. To ask the Minister for Community Development and Sports (a) how will community service be affected by the morale of community leaders who are above 40, who have lost their jobs and who have not been able to find employment easily; and (b) what programmes can the People's Association put in place to (i) facilitate the employability of these community leaders; and (ii) help retain their spirit of volunteerism and commitment.”
“Yes, indeed, we should. My Ministry, after last year's incident, has set up a national biosafety committee, chaired by the Director of Medical Services, Ministry of Health, including the relevant representations from the various agencies. They have formed three technical working committees. And one of the technical working committees is charged with the responsibility of drawing up a shortlist of those biological agents which have public health concern. Just for interest, of the other two working committees, one is looking at what ought to be our national biosafety standards and guidelines , taking into account international benchmark. And the third committee looks into training requirements, how to ensure that laboratory workers, especially our post-doc students who come in and out of the laboratories, are properly trained so as to avoid any future accident. The three working committees will soon submit their recommendations to my Ministry and together with this current work of drafting the legal framework, as well as the legislative changes, we will put them together and put up for public consultations. That will be done in a few weeks' time. We can then have a proper debate again in this House.”
“All of the approved laboratories were found to be in compliance with the required biosafety standards. The next audit will be done in six months' time. What I have outlined is the current system implemented after the laboratory acquired SARS-infection incident last year. To give legal backing to the system, my Ministry is in the midst of finalising the legal framework and drafting the legislative changes. They will be introduced in this House in a few months' time, after public consultations. The intent is to go beyond SARS virus to include any other infectious agent of public health concern.”
“Laboratories which intend to store or handle SARS Corona virus must get prior approval from the Ministry of Health. There is therefore a list of approved laboratories for the handling of SARS virus. The work carried out in these laboratories can be classified into three categories. First, research involving live SARS Corona virus. Live SARS viral stocks are highly infectious. Currently, only two designated Biosafety Level (BSL)-3 laboratories are allowed to store, handle or work on live SARS virus. At the moment, both laboratories are not conducting any research work on live SARS virus, although they do store these viral stocks. Second, diagnostic testing on clinical specimens. Specimens, such as respiratory aspirates and stools from patients suspected of having SARS, are potentially infectious. Such specimens can be processed and tested in BSL-2 diagnostic laboratories, although they have to be carried out using BSL-3 laboratory protocols. Currently only the diagnostic laboratories of three public hospitals are allowed to carry out such testing. Third, research using inactivated SARS materials. Having been inactivated, these materials are no longer infectious. A total of 14 laboratories in seven institutions have been approved under this category, but only 11 laboratories in five institutions are currently doing such research. There are international biosafety guidelines governing laboratory protocols, issued by the World Health Organisation and the US Centers for Disease Control and Prevention (CDC). The approved laboratories are required to comply with these standards strictly. To ensure compliance, the laboratories are audited regularly. In fact, one round of audit has just been carried out by the Ministry, jointly with a panel of appointed laboratory experts.”
“Of course, the HMDP programme is reviewed regularly. I do not have the data off the top of my head but, as far as we could, we always try to match supply with demand. As far as liver transplantation is concerned, as I said earlier, we do not have a shortage. But capability shortage there is, and we will try to fill the gap, as we do in this particular case. LABORATORIES HANDLING SARS CORONA VIRUS 18. Dr Lily Neo asked the Acting Minister for Health (a) how many of our laboratories are still handling the SARS Corona Virus; (b) whether these laboratories are adopting strict standards of biological safety; and (c) are they audited regularly for compliance with biological safety standards.”
“Does the Member mean whether there has been a reduction in postgraduate training in liver transplantation?”
“We have imposed this regulation because Singapore has a large population of 500,000 current work permit holders, and larger numbers who have worked here before. Our social system will be strained if these workers from many nationalities decide to marry and settle here. Foreign workers who choose to work here have understood this because this is an explicit condition and they have agreed to abide by this explicit condition. For the same reason, and to serve as an effective deterrent, an entry ban is imposed on those who contravene the stated work permit condition of marriage approval. My Ministry determines the period of entry ban based on the individual circumstances of each case.”
“As much as the researchers can secure. This comes under the Ministry of Trade and Industry, and A*STAR supports this. During the SARS crisis, they set aside a certain amount of their research money to support, not just SARS vaccine development but also SARS diagnostic kits. At the end of the day, coming up with a vaccine is an uphill task and requires huge resources. No single country can achieve it. It is now a global effort, a global network, everybody plays a part. So our local efforts ˆ’ NUS and A*STAR ˆ’ they work and collaborate with international partners, commercial as well as academic partners. Hopefully, they can succeed. EX-WORK PERMIT HOLDERS MARRYING SINGAPOREANS (Approval from Ministry of Manpower) 17. Dr Mohamad Maliki Bin Osman asked the Acting Minister for Manpower (a) what is the number of former work permit holders currently banned from entering Singapore for marrying Singaporeans without his Ministry's written approval and despite their marrying Singaporean spouses only after they have ceased to work in Singapore; (b) how long will the ban last before they can be allowed to re-enter Singapore; and (c) whether his Ministry will consider exempting Singaporeans from seeking written approval to marry ex-work permit holders who have ceased being a work permit holder for a certain period of time. The Acting Minister for Manpower (Dr Ng Eng Hen): Sir, it is a requirement for all work permit holders to seek approval before marrying a Singapore citizen or Permanent Resident, even after they have cancelled their work permits. The length of time an ex-work permit holder has stopped working in Singapore is also one of the factors considered for marriage approval.”
“Sir, the development of a vaccine against an infectious disease is a long and time-consuming process. There are three key stages. First, you need to develop an experimental vaccine which you can then test in animals for (a) safety, (b) ability to elicit a good immune response, and (c) effectiveness against infection and disease. Second, the experimental vaccine is then tested in humans as the response in humans and animals to the vaccine may be very different. Finally, the ability of the vaccine to protect people against disease can only be fully evaluated during an actual outbreak. The efforts to develop a SARS vaccine are underway in several countries including the United States of America, Canada, China and Singapore. None has gone beyond the first stage of animal testing. For instance, the US National Institutes of Health Vaccine Research Centre has reported last month that it had developed a DNA-based vaccine against SARS that appears to be effective in mice. But no human clinical trials have been conducted yet. Locally, the National University of Singapore and the Institute of Molecular and Cell Biology are working with other institutions to develop a SARS vaccine. The research is currently still at an early stage. In short, SARS vaccine research development efforts are still being actively pursued. The World Health Organisation has estimated that it would take another four to five years before a SARS vaccine can be commercially available.”
“As far as I could gather, she was not a patient of our public hospitals. DEVELOPMENT OF VACCINE FOR SARS 16. Dr Mohamad Maliki Bin Osman asked the Acting Minister for Health (a) what has been the progress in the research to develop a vaccine for SARS; and (b) have the efforts put in this research been as rigorous as when the issue of SARS was at its height last year.”
“Sir, it is always devastating for a patient when diagnosed with a serious illness like cancer. The medical team looking after the patient is the first line of support. This comprises the attending doctors, nurses and the nurse educators. They have a heavy responsibility. Besides rendering medical care, they also assist the patients and their families to cope emotionally and psychologically. If the medical team assesses that the patient needs special counselling, they will refer the patient to the medical social worker for the necessary emotional and psychological support. At the same time, the patient may also be introduced to community-based support groups. Often, the patient's family and care-givers are also involved. In some cases where the patient is excessively distressed, he will be referred to a psychiatrist.”
“Along the way, we will pass on best practices to all the other hospitals.”
“Unfortunately, despite repeated reminders, 61 applicants did not come forward for the appraisals, 37 did not come for their examinations and 27 did not enrol in the upgrading course. But they were really a tiny minority. 3.30 pm The common examination, from now on, will be conducted every year. So those who failed to be registered under the transitional arrangement can still enrol in either of the two local schools and be registered once they have passed the examination. Pro-family policies Finally, let me respond briefly to Mayor Yu-Foo Yee Shoon's various baby and family-friendly comments. Along the way, I will also address Mdm Halimah's comment this morning. As Members know, baby policies of all Ministries are under scrutiny. MOH will do its part in this review. I am quite sure Mr Lim Hng Kiang will leave no stones unturned; no diapers unchanged. But as a parent who knows how to change diapers, we also know not to change the diapers unless they are soiled. We will relook the pricing of IVF, but offhand, I think it is unsoiled. I will be very reluctant to start subsidising IVF. Why? Subsidy is a zero sum game. More subsidies for unborn babies mean fewer subsidies for the sick who are already born. But, of course, if there is extra subsidy coming from Mr Lim Hng Kiang's baby budget, then it is a different story. As for childbirth subsidy, Medisave has made childbirth expenditure very affordable. And that is the reason why more Singaporeans are born in the private hospitals now, than in public hospitals. Are hospitals family-friendly? I think they are. But, like all things, there is always room for improvement. With Dr Jennifer Lee, who champions family-friendly policies at the office, running KK, I know that KK could be a good benchmark.”
“The two local TCM training schools have recently upgraded their courses to six-year part time or three-year full-time diploma courses. This is accredited by the TCM Practitioners Board. One of the schools has also linked up with Nanjing TCM University to offer a Bachelor's Degree in TCM while the other offers a Masters degree in TCM, but jointly with Beijing TCM University. As for TCM herbal dispensers, my Ministry has worked with the traders community to conduct a four year part-time training course in TCM herbal dispensing. This course is also accredited by the TCM Practitioners Board. Dr Neo asked about the qualifying examinations for the practitioners. Any person who wishes to practise as a TCM physician now needs to pass the examinations. This was the decision taken many years ago, with ample notice to the TCM practitioners and with much preparation involving upgrading of TCM training at the schools. There are some TCM physicians who did not have the opportunity to receive formal training. The Ministry created a special transitional arrangement to grant them various exemptions based on their individual qualifications and experience. Only those - and that is a small minority - who did not have sufficient qualifications or prior experience, as assessed by TCM Practitioners Board, were required to enrol in the TCM upgrading training course and also to pass the common examinations. To give all applicants sufficient opportunities to upgrade themselves and to take various examinations, a total of three appraisals, two examinations and one upgrading training course were conducted over a period of two years, and a vast majority passed.”
“The major focus of regulation is to ensure safety of the TCM products, such as by checking whether there are contaminations of the herbs with heavy metals, and whether there are adulterations of Chinese proprietary medicines with Western pharmaceutical agents. However, regulators are unable to assess such products for efficacy as is done for Western pharmaceutical drugs. Therefore, consumers must not equate TCM with Western medicine. Consumers will have to be sensible and careful. At the same time, it is incumbent on TCM practitioners to regulate themselves, and to do so seriously, they must self-regulate and be prepared to turf out those who are sub-standard or not up to standard. And more importantly, they must continuously upgrade their standards of practice. Dr Chong and Mr Chay asked about the adoption of TCM treatments within our hospitals. Acupuncture, as I have said, is available at Ang Mo Kio Community Hospital and also in NUH, SGH and Tan Tock Seng Hospital for selected medical conditions. However, to make it clear to the patients that this treatment lies outside mainstream Western medicine, TCM therapy is provided in a clinic, separate from the Western clinics and hospital wards. I met the medical community recently and asked if we could now move beyond acupuncture to consider other forms of TCM therapies. They were unanimous in suggesting to me that the next modality after acupuncture could be "tui na". My Ministry has therefore formed an expert committee under Prof. Lee Tat Leang of NUH to look into this idea and if viable, to look into the operating details. Prof. Lee is both a professor of anaesthesia and a qualified acupuncturist. Mr Chay asked about the training of TCM practitioners.”
“Although TCM is increasingly subject to evidence-based tests in countries like China, where leading universities teach and conduct research in TCM, the level of rigour has not quite reached that required by Western medicine. The question to regulators is: should we accept lower standard of evidence for TCM or should we apply that evidence-based principle strictly? A strictly conservative approach will make it very difficult for the practice to continue, let alone grow. This will, as Mr Chay put it, deprive consumers of a service which has provided much relief and comfort to generations of Singaporeans, many of which are in his constituency. So in 1995, then Minister George Yeo appointed a TCM Committee, under Dr Aline Wong, to look into this subject. It recommended, and subsequently Ministry of Health agreed, a cautious step-by-step approach to TCM. That same year, 1995, MOH set up an Acupuncture Research Clinic in Ang Mo Kio Community Hospital which is still functioning. A year later, we started to upgrade the training of TCM practitioners. In 1999, we tightened the control of Chinese proprietary medicine. In 2001, we registered acupuncturists. Acupuncture is now a registered practice. Only in 2002, we began to register TCM physicians. I will continue this step-by-step approach. I will particularly want to learn from the experience of others. In fact, next week, I will be in Nanjing because we are launching the inaugural direct flight of SIA between Singapore and Nanjing. I will take that opportunity to visit the TCM University in Nanjing to discuss the development of TCM. But whatever we do, one thing is clear. This is an area where regulations inevitably will have to be light, for the simple reason that regulators do not know enough.”
“Of course, there is. Our data suggested that one in 10 outpatient attendances are served by TCM practitioners. Will the demand grow? TCM has been able to retain its market share over many years. In fact, this is not unique to Singapore. Recently, I read a British article which noted the growing popularity of TCM in the West. It made an interesting observation that the TCM clientele, at least in the West, were either the lower-educated or the highly-educated. The author did not explain why. There are many things about TCM which we have no answers to. That is why all healthcare regulators, whether it is the east or the west, find it very challenging to regulate TCM and other complementary medicine. The reason is the basis and approach of TCM and Western medicine are fundamentally different. Members would know Dr Hong Hai. He was an MP, western trained, English-educated engineer, with a PhD in Economics and a recent serious interest in TCM. He has just graduated from a local TCM school and he is now a fully qualified TCM practitioner. When I met him recently, he commented positively about my health. So I asked him to substantiate his observations. He explained his observations by noting the colour of my face, my complexion and such esoteric stuff. I was very happy with his conclusion - never mind if I could not fully understand his explanation. And therein lies the challenge of trying to regulate TCM, especially when we want to integrate it into mainstream Western medicine. In Western medicine, the operating principle is evidence-based medicine. If we say that a particular drug or a particular treatment works, it is backed by clinical trials, double-blinded randomised, and research findings which have been subject to international scrutiny.”
“But if they want to save money, then go for cheaper alternatives, which, as Dr Chong puts it, are as effective. Patients themselves play an important role and should understand that in most cases, the generic medication can do the same job as a branded drug. The Health Sciences Authority assesses generics for local registration to ensure that they are safe, efficacious and of good quality. My Ministry will step up public education to provide information on drugs to help Singaporeans make better choices. Home therapy services Dr Chong also asked my Ministry to consider subsidising the providers of home therapy. By home therapy, I presume it means sending a therapist to a patient's home to provide rehabilitation services. Whether we should subsidise such services will depend on the effectiveness of the service and, of course, the financial status of the patients. The problem is: home therapy is not cheap. We should not subsidise just because patients are poor, especially when there are cheaper alternatives in the community. We are already subsidising home medical and home nursing care. I will have to think many times to see whether we should make this further concession. For patients who need rehabilitation and therapy, there are many day rehabilitation centres providing such services. I do not know about Dr Chong's constitutency, but within Tanjong Pagar GRC, there are several. Many of them are located in HDB void decks and they are definitely very much cheaper than the home therapy. Traditional Chinese Medicine Let me now discuss the Traditional Chinese Medicine (TCM). I grew up with TCM. As a child, I probably took more Chinese medicine than Western drugs, and I do not think my experience is unique or unusual. Is there a role for TCM, even in modern Singapore?”
“Dr Chong Weng Chiew reminded our hospitals not to prescribe overly expensive medicine to subsidised patients especially chronic patients, as they may not be able to afford them after discharge. I appreciate his timely reminder. One practical way to help patients save money is to go for generic drugs and the savings can be considerable, as the example he gave just now, between $0.50 and $2. Use of generic drugs should be Standard Operating Procedure (SOP) in all our subsidised clinics and wards. It will help stretch the hospital's budget, patients' savings and Government subsidy - three-in-one. I therefore agree with him and also Dr Wang Kai Yuen, who mentioned this morning about the need for an open competitive market for drugs and to facilitate the entry of generic alternatives. About two-thirds of our 7,500 pharmaceutical products registered here in Singapore are generic drugs, from various sources, including India. We would, of course, continue to tap generic drugs where feasible. This morning I mentioned about DPM Lee reopening Ang Mo Kio Polyclinic and that he was shown the capabilities of IT in the NHG cluster. One of the applications pertains to this, which is, what we call, e-prescription. Instead of handwriting, which very few people can read, through the IT, the doctor can send out his prescription. And the power of IT is, with a computer screen, when the name of the drug is keyed in, alternatives are put up, including their pricing, so that doctors, whether it is the MO or the Senior Consultant, can, with a look, with the patient in front of him, decide what to prescribe. If the patient insists on branded products, we will tell him how much it will cost and we will prescribe accordingly.”
“Indeed, patient confidentiality is one key issue, and it has always been the issue, whether it is paper-based or IT-based. Today, it is not electronic medical records, it is paper medical records, but we also have to preserve patient confidentiality. In fact, with electronic medical records, it is easier to audit and manage. What is the concern? The concern is doctors or nurses may look into medical records of patients whom they have nothing to do with, somewhat being a "busybody". And you can be a busybody today. Doctors can walk into our medical records office and take out medical files. But, with IT, I can now track who are the busybodies, eg, someone who handles, say, 2,000 patients a month but has accessed 3,000 medical records. Something must be wrong, right? Then we can look into it. But whatever it is, the profession has to respect its promise to preserve patient confidentiality. And my intent is that it may be useful every year to remind all our healthcare workers about the need to preserve patient confidentiality. Doctors”
“So, I have resigned myself to the fact that clinic waiting is a phenomenon which is impossible to eliminate. But what one can do is try to reduce it. And this will require cooperation all round, from the patients especially. There are data to show that "no shows" - "no shows" means I have an appointment but I do not turn up - are, unfortunately, still very common. And the more "no shows" you have, in order to better utilise the resources, the more I have to overbook because, if I do not overbook and there is no show, then the doctor will be shaking legs. I can run a clinic with zero-waiting. But to run a clinic with zero-waiting means that I must have expensive resources waiting for business. And that is the model in the private hospitals. I charge high because my patients cannot afford to wait too long. But, yes, I see maybe 30 patients a month, instead of 30 patients a day, as in the public hospitals. The economics are completely different. So, if you want to keep healthcare costs low and as affordable as possible, I think we have no choice but to exercise our resources to the maximum, which means I have to work them at high occupancy level, whether it is wards or clinics and, unfortunately, as a result of that, I am afraid some waiting is inevitable. But, of course, the waiting cannot be because the doctors or nurses are having prolonged lunch or meetings and then not turning up at the appointed time.”
“There are two questions. One is on data to support why we say the medical standard in Singapore is not bad. However, I do not think this is the occasion, because I do not carry those data. One of these days, I will publish an occasional paper and the Member can see for himself. But, anecdotally, we all know who come here for treatment, like some of the VVIPs that we handle in Singapore. We know where the better healthcare standard is, Singapore vis-a-vis the others. As to waiting time, many years ago, when I started my career as a hospital CEO in 1984, young and naive, I told my management team at NUH - at that time, it included Dr Jennifer Lee - "Let us run a hospital with zero waiting time." As an engineer, I thought I could bring engineering practice into medicine, so that we can systematically manage the clinic, eg, a new case will require 30 minutes, repeat case maybe 15 or 20 minutes, and then we can schedule things, and so on. But I quickly discover that the reality outside is not like in textbooks. I remember one conversation I had with the former head of orthopaedic surgery. He had a busy practice, with many Indian ladies as his patients. He said: "You know, Khaw Boon Wan, when the Indian ladies come, especially those in sarees, they take more time to change". So, he said, "Please give me more time." But, more importantly, it is because illnesses differ. I think we have had that discussion not too long ago. Yes, we can schedule so many patients and so on, but once you have a complicated case, clinic management goes haywire. Should we, for the sake of efficiency, even though this patient may need one hour to look after, cut corners and just go for the scheduled 20 minutes so that everybody would not have to wait too long? We cannot.”
“Our immune system will take care of that. But if you are poor and you are very sick, where would you rather be within, let us say, a 7-hour flying radius of Singapore? I think it is Singapore. Yes, it is easy and politically sweet to promise a 30-baht medicine. But a 30-baht medicine is no use, if you need a bypass or you have serious cancer. I think we have a good system in Singapore. It does not happen by accident. It is an investment that we have done over many years, and my job is to continue to build on that.”
“In fact, I am trying to work with the Singapore National Eye Centre to see how we can try to meet these two contradictory goals of serving Singaporean needs and, at the same time, serving foreign patient needs. Hopefully, we can learn from that experience. Mayor Zainul Abidin and Dr Lily Neo talked about marketing Singapore and gave many useful suggestions. Mr Gan Kim Yong suggested that we should focus on niche specialties where we have a competitive edge and adopt a total approach in promoting them. Singapore Medicine has identified a few areas that we will intensively market, and these are likely to be specialties that have large patient populations in the region, and would include areas like opthalmology, cancer, heart, etc. Singapore Tourism Board is also in active dialogue with healthcare providers, travel agencies, hotels and other service providers to ensure that the diverse needs and requirements of our foreign patients are catered for. The issue of medical visas, I think raised by Mr Ahmad Khalis and Mr Gan Kim Yong, is also actively being reviewed. The objective is to make it easy for foreign patients to come here for treatment. Finally, let me respond to Mr Low Thia Khiang's point on medical standards. He reminded us that while we cut cost, let us not cut corners. I do not intend to do so. I think we would have failed in our duty, if medical standards deteriorate as a result of whatever objective that we may be at the same time tackling. The bottomline is this. In healthcare, if you are rich, regardless of what the healthcare system is, you are all right because you can fly to anywhere you want. If you are poor but not too sickly, also never mind, because whether your healthcare is good or bad, you will cure yourself anyway.”
“They will allow this for nine specialties, eg, general surgery, orthopaedics and so on, and they are actively looking into the other specialties, as there are significant differences in the training structure and duration. Fourth, we are getting our hospitals to redesign jobs and re-engineer their processes to make nursing a desirable profession again. This will improve the students' attitude towards nursing as a profession. Fifth, we are exploring setting up a local degree course in nursing in our university to provide the next generation of nursing leaders. Sixth, we are recruiting foreign nurses from countries like the Philippines and China. There is a global shortage of qualified nurses. Despite our efforts, the clusters still have 200 vacancies. We have to work harder on this front. Dr Lily Neo pointed out that, in order to sustain advantage in quality, we must always pay attention to medical training and, hopefully, the training of medical doctors as well as nurses can also be part of Singapore's intention to be an education hub. I totally agree with that. Hopefully, the Duke University partnership at the SGH Campus can help stimulate development along that line. I agree with Dr Gan See Khem that the public sector has a role to play in the regional medical hub. Let us work together. But we need to manage it properly because, by mandate, our public hospital workers must be to serve Singaporeans first, especially the bottom 50%. However, where the hospital has the capacity to do more, having acquired a regional reputation and strong finance, I think they should pro-actively pursue international patients on their own or jointly with private hospitals.”
“As is the case with other sectors of the economy, if we do not have a good handle over our cost-competitiveness, we can forget about trying to maximise our potential as a regional medical hub. An important part of our strategy is to recruit and train many more doctors and nurses. Matching supply of healthcare workers to demand is the key to ensuring that even as we become a regional medical hub, we do not inadvertently push up overall healthcare costs. If foreign patient load grows, without a corresponding increase in doctors and nurses, then healthcare cost is bound to rise. I therefore agree with Dr Wang Kai Yuen on the need to review our control of medical school enrolments and have more flexible market-based manpower policies. We certainly should not inadvertently protect a cartel. I am tackling this at various fronts. First, we have increased the NUS medical intake from 150 to 230. The next increase in intake will be when a new graduate medical school working with Duke University starts in the SGH Campus. Second, MOH has expanded the list of recognised foreign universities and medical schools to 71. I hope to do more. Third, we have allowed fast-track entry of foreign-trained specialists already registered in the UK and Australia. As a result, the number of foreign-trained specialists practising in Singapore has grown by an annual rate of 23% per year in recent years. Can we do more? I posed this question to the SMC recently: why can we not allow fast-track accreditation of all US-board certified specialists? They have reviewed, and they have just decided.”
“Also, it is how you cleverly leverage other people. Although we said only 90 million or 80-odd million dollars are for Health Promotion Board, this Government actually invests billions every year in health promotion. The entire budget of the Ministry of the Environment is for health promotion. You have clean water, you remove all the rats, as what Minister Lim Swee Say is trying to do, you are improving people's healthcare. You keep the air clean, you improve the healthcare for everybody. Likewise for Ministry of Education, the huge budget in the schools promoting healthy lifestyle, that is health promotion. We should also bear in mind that, in principle, while nobody can disagree with more preventive healthcare, it is also possible to go over-board. There is a recent rather controversial trend in the US where millions of people have been diagnosed with one or, often, several, what they call, "pre-disease", before disease, conditions. The controversial question is what to do with such pre-disease conditions? Preventive medicine is at its best, if pre-disease diagnosis leads to lifestyle changes: cut out salt, cut out sugar, cut down weight, exercise more. Preventive medicine is at its worst, if pre-disease diagnosis leads to over-treatment, over-medication: often expensive drugs paid for by insurers or the State. 1.30 pm But nothing is simpler than writing a prescription, and nothing is harder than achieving a change in behaviour. This is the challenge of managing preventive medicine. I am watching this US trend very closely. Let me now turn to Members' points about making Singapore a regional medical hub. Dr Lily Neo spoke about having competitive costs in order to attract foreign patients. I totally agree.”
“Unfortunately, many are still not aware of their risk factors. At the grassroots level, many of us are organising such mass screenings, as pointed out by Dr Neo just now. At the workplace, simple health screening for hypertension and diabetes can uncover hidden health problems. I really hope more companies can be enlightened to offer this for their employees. I am for more opportunistic screening. Let me explain. Every day, 1% of Singaporeans will visit some doctors, public, private, clinic, hospital, somewhere. So while the doctors attend to the patients' immediate needs, there is an opportunity for them to also screen the patients for the common risk factors, if this has not already been done recently, and then, more importantly, document the results in the patients' electronic medical record. In this way, we update the Singaporeans' electronic medical record regularly, making it a lifelong medical record, one for each Singaporean. This can potentially transform the whole practice of medicine in Singapore and bring the management of chronic diseases, such as diabetes and hypertension, to a higher plane. Through the proposed Jurong Health-connect, we hope to pilot some of these ideas. Dr Lily Neo also stressed the greater promotion of preventive healthcare. Yesterday, she pointed to the tiny budget of the Health Promotion Board, not so tiny, about $100 million, and supported a bigger budget for HPB. I must thank her. I always thank MPs who support bigger budget for the Ministry of Health. MOH has and will continue to support worthy initiatives, especially in the area of health promotion and preventive care. Effective programmes, by the way, need not always be costly. Much can be achieved if we have champions who are passionate and creative.”
“I have been in the Ministry of Health for nearly eight months now. I have never used the lifts. When I started, I would not bump into anybody at the staircase. Now, I do, and often. MOH, unlike my previous offices, does not have an office gym, because there is an excellent one in SGH campus. I use it regularly during lunch time. So compared to my previous office, it is a bit inconvenient because you have to change, expose yourself in shorts and drive there. But after a while, I realise that it actually serves an additional purpose. Hopefully, the taxi drivers and patients in the queue will be inspired to follow suit. Mr Ahmad Khalis asked if there were statistics to prove that healthy lifestyle did reduce sickness rate. There are plenty. They are all in the literature, you can find it on the Internet. But he is certainly correct to say that we need to design programmes that will cater specifically to segments of the population which are more prone to certain diseases. Dr Lily Neo spoke passionately about elderly healthcare. And she has done so often in this House and has made many good suggestions. We have to work together to get the elderly to stay physically, mentally and socially fit. Being old does not mean frail or disengaged from society. In fact, there are many elderly Singaporeans who remain active. I was at the 96th birthday party of Venerable Shi Chin Yam of Man Fut Tong recently. She is tireless raising funds for her inmates. At the party, she told us that she is launching a new project to build an orphanage. At the age of 96! Maintaining a healthy lifestyle from cradle to grave is the key. Managing and controlling the risk factors are important. The cost of screening these risk factors is inexpensive.”
“Mayor Teo Ho Pin is a champion of healthy lifestyle in his CDC. He started brisk walking clubs and he told me that he was pleased to note the steady increase in both the number of clubs and the number of participants. And occasionally, he told me he organised joint brisk walking among all the clubs and would be able to gather 10,000, 20,000 walkers in one session. Quite impressive! On the other hand, many are still not exercising regularly. Many are still over-weight. Many with hypertension and diabetes still do not know that they have such problems. So we are getting better, but we certainly can do more. Promotion requires a multi-pronged approach, as pointed out by Mr Ahmad Khalis. This is because young children, working adults, older individuals have different needs. To reach out, we need all the 3P sectors - the people, public, private - to work together. MOH is grateful to the Ministry of Education for its efforts in getting our kids to acquire a healthy attitude from young. We are also grateful to the Ministry of National Development for their many, many parks. I am especially pleased to read that NParks is expanding and will be adding more park connectors. And, of course, we also thank the Singapore Sports Council for their many sporting activities, including the Annual Singapore Marathon which several MPs and I took part recently, and we thoroughly enjoyed ourselves. At the workplace where more than half of the population spend a significant amount of their time, we have great opportunity to promote health. Where the company's CEO and management are personally committed, their company will tend to have the right environment for everyone to follow. And that is why it is so important for all of us in this House to set personal examples.”
“I read the Hansard recently and I recall there was at least one sitting during which Dr Lily Neo made several suggestions on how public and private sector healthcare services could be integrated to provide the elderly and the chronic sick with a better level of care. And this morning, she proposed more ideas on this issue, including having holistic treatment for the elderly and one-stop diagnostic centres. The question is how to convert intent into practical ideas which can be executed on the ground. But we know now who to call to help us in this project. So besides Dr Lily Neo, Dr Tan Cheng Bock will be invited to join the Fellowship of the Ring. And, perhaps, Dr Tan Cheng Bock shall be Gandalf, our wise counsellor. Mr Lim Boon Heng was persuaded by my plan and signed on to the Fellowship quite early on. He brought with him his full GRC backing on the ground. So Mdm Halimah is in the Ring too. We will work together to flesh out Jurong Health-connect and make it work for the residents there. As providers, we will put patients at the centre of our focus. But I hope Singaporeans, in turn, will put their health at the centre of their focus. They can do so by adopting a healthy lifestyle, but not merely chanting the mantra, but actually doing it. Mr Ahmad Khalis asked how Singaporeans' attitude towards healthy lifestyle has changed over the years. The cup is half-full and half-empty. On the one hand, many more Singaporeans have moved to the right side of the divide. The percentage of Singaporeans doing exercise regularly has gone up, from 14% in 1992, 10 years ago, to 20% now, ie, one in five. The percentage of Singaporean smokers has fallen from 18% to 14%. Tens of thousands of Singaproeans exercise in our public parks, especially during the weekends.”
“It is to pilot a new concept of care at our polyclinics with virtual links to day-care facilities, nursing homes and community hospitals, with close cooperation, weekly joint management meetings, single case files for each patient across the continuum of care. It will attempt what Dr Tan Cheng Bock outlined yesterday: "manage chronic diseases, like diabetes and hypertension in a proactive manner, but outside of hospitals", ie, a public and private partnership that not only treats the disease but also prompts the patients to manage their risk factors so as to avoid costly hospitalisation. This will enable us to serve patients better for both acute illnesses as well as chronic diseases. In America, it was reported that quite a large proportion of diagnosis and treatment traditionally carried out in a general hospital could in fact be done in a community setting. This is less traumatic for the patients, besides saving them money. Can the Jurong West Polyclinic be the nerve centre for this new concept of care? If so, it may have to be enhanced physically to provide a wider range of services. For the elderly requiring long-term care, there is the St. Luke's Community Hospital and several nursing homes and day rehabilitation centres run both privately and by VWOs. But the services are fragmented as they are all facility-centric. Can we bring all these services to a higher level by linking them up through IT and also link them up to NUH and AH so that the care of patients can be centrally coordinated, even as they progress through the various healthcare facilities? Is it worth doing?”
“They are still within acceptable limits but, at times, pressing the boundary. There are already a million Singaporeans living in the north and north-east. They can well justify a general hospital. So we shall site the rebuilt Alexandra Hospital in the north. My Ministry has been working informally with Assoc. Prof. Ho Peng Kee and we hope to settle the site for this proposed Northern General Hospital very soon. 1.15 pm Fourth example, integrated healthcare services in the West. I have been discussing with Minister Lim Boon Heng on existing healthcare services in Jurong. There are many players - a tertiary hospital in NUH, a community hospital, several nursing homes, and there is a new polyclinic coming up at Jurong West, and, of course, many GPs. So the residents are adequately served for the moment. There was a plan to build a new Jurong General Hospital. A site has been reserved. We could proceed with this plan. But I persuaded Minister Lim Boon Heng that it is better to postpone the plan for the time being. Let us focus instead on the software of delivering healthcare services to see if we can transform existing services to serve the Jurong residents better through greater use of IT, adoption of innovative ideas that link up the various players in a seamless manner. The idea is to put patients at the centre and with services reorganised around the patients. I think such a patient-centric, software-driven project in Jurong is much more meaningful than simply building another general hospital. We have tentatively codenamed this project: "Jurong health-connect".”
“I know this is a tall order, and I would be pleased if they can achieve half of what I have sketched to them. The hardware aspect is the easy part. We have done it many times before. But it is the software that will determine if they succeed or fail in this mission. The AH team is brainstorming these software issues, in collaboration with many partners, including Infocomm Development Authority (IDA). We will not know which ideas will work. But if you do not try, you never know. They will use the next couple of years to try them out at Alexandra Hospital. I will squeeze out some budget to support them in this. And for those ideas that work, we shall adopt them at the new hospital. I have asked them to consult widely, speak to the patients, ask their relatives, and certainly involve the stakeholders in the neighbourhood, the GPs, the polyclinics, the nursing homes, the MPs and the grassroots leaders. Whoever can bring value to the table, involve them. I have also told them to avoid building a huge hospital. Every city needs a couple of huge hospitals. We already have them - SGH, NUH and Tan Tock Seng Hospital. I suggest that they limit their new hospital to around 400 beds, big enough to accommodate a range of specialties, and yet small enough to be manageable and be patient-friendly. Hospital in the North Third example, the general hospital in the north. During the last general elections, DPM Dr Tony Tan promised a hospital in the north. In fact, he appointed Senior Minister of State Ho Peng Kee to head a committee to identify a site for the hospital. I am seeing through the commitment. Currently, we do not have any hospital in the north. All our hospitals are in the south. I have been studying the ambulance travelling time between Woodlands and our A&E departments.”
“It is already 65 years old. The buildings are old and sprawling. Patients have to walk long distances to get different treatment. Although the staff has done a wonderful job in sprucing up the place, it is becoming expensive to maintain. The question is, what kind of hospital should replace it? In the last 25 years, we have rebuilt all the public hospitals, except Alexandra. From Changi to Woodbridge, they have all been given a new lease of life. For the new hospital to replace AH, will it be more of the same? Members are aware of the transformation of our public libraries. From a boring depository of books, they have become "lifestyle destinations". Dr Tan Chin Nam told me that their approach was to treat every new library project as a prototype to test out new ideas, new innovations in library services. As a result, every new library is an enhancement over the previous one. I posed the challenge to the AH rebuilding team: do to your hospital as what Chin Nam did to public libraries. And I do not mean to turn hospitals into lifestyle destinations! Specifically, build a hospital where patients will be treated as you would wish for yourself or your loved ones. To meet this challenge, the hospital will have to be designed with patients unambiguously at the centre of the focus, with technology fully exploited for the benefit and convenience of patients. It will be a hospital where patients do not get lost or get pushed from pillar to post. It will be a hospital with minimal bureaucracy and paper work. It will be a hospital which is well linked to the polyclincs, GPs and nursing homes in the neighbourhood, and to which the patients can be transferred seamlessly and in a way that makes the most sense to them. It will be a hassle-free hospital.”