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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“For example, if an Ang Mo Kio polyclinic's patient was admitted to, say, NUH A&E Department, the NUH doctor would be able to check, real-time, online, the medical records of the patient in the other NHG institutions, even though it is the patient's first visit to NUH. This is the power of electronic medical records. Last week, the other cluster (SingHealth Cluster) also illustrated the capabilities of EMR to the public. The objective is identical, which is to exploit IT to benefit the patients. I am glad that for their pioneering efforts, SingHealth took one of the top five spots in the CIO Asia Awards. I am moving this initiative up to the next step. We are now working to link up the EMR of both clusters, so that a patient, once served by a member of a cluster, will enjoy the benefits of the EMR in subsequent visits to any member of the cluster. This has powerful applications. For example, patients would no longer need to re-register at counters, a tedious and time-consuming process. They can avoid being sent for repeat tests and x-rays, if these have been carried out recently by doctors in different institutions - I think a point made by Dr Lily Neo yesterday. A&E doctors can access the patient's medical record to look out for drug allergy, or other pertinent clinical information which may influence the treatment to be rendered. We are not there yet in linking up the EMRs of both clusters. But I am determined that the key pieces will be put in place within 12 months. It is complicated business, but it can be done. Rebuilding of Alexandra Hospital Second example, the rebuilding of Alexandra Hospital (AH). MOH made a commitment to rebuild Alexandra Hospital. I am seeing through this commitment. There are good reasons why Alexandra Hospital should be rebuilt.”
“That probably explains why I have less time to speak to the public, which is what Mdm Halimah urged me to do, which I will. My advice to both clusters is simple - put patients at the centre of their focus, not clusters, not hospitals, not doctors, but patients. At the same time, bear in mind the need to keep healthcare affordable, which means doing more with less but without compromising clinical quality. So to Mr Low Thia Khiang, let me assure him that, yes, we are cutting cost, but we will not cut corners. At the most fundamental level, these must be the key performance indicators which Mayor Zainul Abidin touched upon. Let me illustrate with some examples this patient-centric philosophy. Electronic medical record (EMR) First, sharing of electronic medical record (EMR). One in four of our patients needs to cross clusters. For example, a patient may begin with a consultation with a doctor at NUH. Subsequently, he may decide to seek another opinion from a doctor in SGH. If we focus on the clusters' benefits, we will probably make it inconvenient for the patients to cross the border. So, duplicate medical reports will have to be created and tests may have to be repeated at unnecessary cost. But if we focus on the patient's benefit, we will quickly realise that the correct decision is to facilitate the transfer and make it seamless. One cluster's gain is not another cluster's loss. It is not a zero-sum game. The patient's care is what counts. And this is the approach I take towards cluster competition and cluster cooperation. Two weeks ago when DPM Lee reopened Ang Mo Kio Polyclinic, he was shown how IT was being used to allow doctors in the National Health Group (NHG) Cluster to access medical records of the patients once they have had one encounter with the cluster.”
“Sir, several Members have asked if the corporate missions of our clusters are properly aligned with our objective of keeping healthcare affordable to all. For example, Mdm Ho Geok Choo asked what their mission is: Is it to get more patients? Dr Chong Weng Chiew and Dr Ong Seh Hong felt that if doctors and CEOs' income depended on patient volume, then they are bound to compete for more patients and revenue, pushing up healthcare cost. So I put these comments to the two clusters' CEOs. Dr Lim Suet Wun explained to me that pay and promotion would depend on a number of performance measures. Workload is not the only measure but it could not be ignored. Let me quote him: "Not to consider workload means that those who work hard and those who don't, are paid the same." In his cluster, as an example, his doctors are pushing projects which improve the care for asthma patients so as to reduce their admissions. Their diabetic foot care programme to prevent amputations is another example. As he put it, "less amputations hurt our bottom-line, but we enjoy doing it". Similarly, Prof. Tan Ser Kiat explained that his cluster doctors are also measured on a number of indicators. Revenue and patient load are not the only criteria. But, at the end of the day, it is values that count. If a doctor is solely interested in maximising his income, then I think the public healthcare sector is not the right place for him or her. We need to gather around us like-minded people who share a common objective to serve. We have to reward them adequately, and we will, but their passion must be towards their patients. Then they are qualified to join the Fellowship of the Ring. Our job is to expand that Fellowship. I, therefore, spend considerable time sharing my thoughts and values with the staff.”
“I do not want to prolong this agony other than saying this. Whatever we do, affordability of healthcare to all income groups, rich or poor - that is always an important operating principle in the Ministry of Health. Whatever we design, whatever fees we charge, it must be affordable. How we design means test so that even if we assess that you are clearly in the category who can well afford, the charges remain affordable. I do not think I will cut the division of lines so precise that if you miss by a dollar, you are in this or that category. We will go for simple classification. That will be the approach I will take to this exercise.”
“I thought I have answered that in my reply. The answer is no - it is a consistent reply of "no." Dr Tan Cheng Bock spoke about primary healthcare and said I must demonstrate words with dollars. Indeed, a huge amount of money is in primary healthcare, out of the $2 billion budget - I cannot remember the details - for the Ministry of Health, which is a big chunk. If we look at subsidies - I published an occasional paper a few weeks ago - this was a bit outdated, so the figures should be more by now. About two years back, generally, we subsidised more than $1 billion in healthcare, of which $100 million go to primary healthcare. There is an opportunity to discuss more about this very interesting topic of primary healthcare. Please hold your horses.”
“Sir, first of all, I thank Mr Steve Chia for clarifying that he has no problem principlely with means testing and that he was seeking details which, I am sure, we will have a few more months to discuss. Mr Low Thia Khiang also gave his explanation that he has no fundamental objection to the means test philosophy. In fact, he supported means test for polyclinics and nursing homes. But his worry is Class C ward. Because if you are wrongly means tested out or unfairly means tested out, then - to use his words - this last frontier of safety net will be taken away. I think I got him right now. At this stage, I am quite happy that if, on principles, we can agree on the whole conceptualisation of it, whereby if you are better off, you pay more than those who are less well-off, the rest are details. That is why I wanted the next few months to discuss those things. I do not think the last frontier is Class C subsidised ward. I think the last frontier, in the case of healthcare, has always been Medifund. Medifund is there to protect those who dropped through the safety net. So long as we have a good and sound Medifund in place, everybody can sleep tight. That is the reason why I persuaded DPM Lee and Minister for Finance to raise the Medifund allocation this year by another $100 million, to now make it $1 billion. But, never mind, let us hold the horses and await the details. We will have enough opportunities to discuss those details and then we can judge for ourselves whether they fulfill the various principles that I have outlined just now - simple, fair, etc. Mdm Halimah asked a question on Medisave and IVF. As there is a related question on this later on this afternoon, I will tackle that later. Dr Chong Weng Chiew asked about home care.”
“The guidelines provide schools with examples of programmes and strategies that they can adopt to manage discipline in their schools. They also advise schools on how they can work in partnership with parents, and obtain the assistance of external agencies, such as the VWOs, self-help groups and the Police. While the MOE guidelines help achieve a broad consistency of principles and approaches in managing discipline amongst our schools, each school has to decide on its own specific approaches. This will depend on the nature of its student body and the history of student discipline in the school. Schools also have to decide on the actions most appropriate in each situation, such as counselling the students involved, disciplining them within the school, referring them to other agencies for further counselling and help, or reporting the matter to the Police. In particular, a decision on whether to call in the Police has to be made by the principal, and that will depend on the severity of the offence, the scale of the problem, and the willingness of the students involved to cooperate. These are ground decisions that the principal is in the best position to make. Assoc. Prof. Ngiam Tee Liang (Nominated Member): Mr Speaker, Sir, the guidelines from the Ministry would probably set the broad parameters and depending on the experience of the principals (including new principals coming in), what additional guidance is given so that they have an idea of how to operationalise those guidelines? Otherwise, I think maybe it is a situation of not having opportunities to learn from each other and, although principals are trying their best, it could be a hit-and-miss affair.”
“The short answer is no. I think subvention has increased from $759 million in 1998 to $1.187 billion in 2002. This is the total quantum. As compared to volumes, I do not know. Healthcare is complicated because it is not just numbers. Every year, the case mix is different. Every patient is different. I witnessed my wife's three pregnancies and I was with her when the babies were delivered at the labour ward. Every delivery is different, although the same woman, the same husband. So let alone, illnesses. Yes, last year, we had 10,000 admissions; this year, 10,000 admissions, but if the case mix is different, the outcome and the resources needed would be different. STUDENTS FOUND WITH PORNOGRAPHIC VCDS 3. Mr Iswaran asked the Acting Minister for Education in light of the recent incident at Kent Ridge Secondary School, where students were found with pornographic VCDs and the incidents were reported to the Police, what guidelines on how to handle such incidents have been issued to schools by the Ministry. The Acting Minister for Education (Mr Tharman Shanmugaratnam): Mr Speaker, Sir, MOE has given schools broad guidelines on the approaches and actions they could adopt in managing student discipline. These guidelines set out the positive, proactive approach schools should adopt in handling discipline, as part of their broader efforts to help our young become responsible, thinking citizens. The guidelines recommend the development of a coherent, whole-school framework for managing discipline. This comprises measures ranging from the preventive to the corrective - in other words, from educating the students to counselling them and to taking disciplinary actions.”
“He said that we could store them in Johor Baru where land cost is low. So there are possibilities of that kind. I think we should let the players decide, they are paid to do so, to balance their accounts, provide the best possible service with the budget that they have, to stretch the budget as much as they can to produce the outcome that the society needs. Dr Lily Neo rose -”
“It is for the players to decide. It is not possible for the Ministry of Health, or Parliament, to micro-manage and decide, "Ok, you do this, you do that." The communist countries tried to do that and, of course, they discovered that they could not achieve the desired outcome through that way. What we can do is to make sure that at the macro level, we have the right parameters in place. What are those parameters? How much subvention am I prepared to give to the hospitals? What are those expectations about fee increases? And, of course, as shareholders of both clusters, our expectations are that they must balance their accounts. You cannot chalk up and build up losses perennially. That is why last year, I sat down with them and said that it was a bad time to raise fees, although I knew they were under a lot of pressure because they would otherwise be losing money. I said, "No. Learn to live within your means. Cut your costs." In any case, we are no longer providing them with very small sums. As you know, the Ministry of Health's budget is now more than $2 billion. I put out this paper last week where it showed a subsidy of more than $1 billion. This is not chicken-feed. So the question is, as a trustee of taxpayer's money, our job is to decide how best to stretch this budget. The way to do so is to make sure they spend their money properly and if they can collaborate to bring their costs down, do so. If they can outsource to private players in Singapore or even outside of Singapore, do so. The other day I met a pathologist from Tan Tock Seng and he was telling me that our storage cost for pathology samples cannot beat Johor Baru. I do not know exactly what he is talking about. But he seems to make sense.”
“Mr Speaker, Sir, in the same speech that I talked about a few minutes ago, I also covered this topic. I think I should send the speech to Dr Lily Neo. The competition for market share has to be taken in its right spirit. I advised the clusters that, stretching the argument, I would clap hands if their workload shrinks, but not if their workload expands. Of course, provided they achieve this not because of lousy service or unsafe standards when everybody runs away from them, like SARS. But, if despite giving good service and, let us say, all the parliamentarians help me out in promoting healthy lifestyles and after a while, illnesses drop, so that patient load comes down or if good economic management leads to strong growth, and more and more people can afford unsubsidised private hospitals and would rather not spend time waiting in the queue of public hospitals, and our market share shrinks, I clap hands. That is the spirit I bring to this whole issue about market share.”
“Mr Speaker, Sir, I recall making a fairly extensive speech last year about this whole topic. Obviously, the solution is not the extreme - either complete centralisation, going back to the good old days of the Ministry of Health when I started my career as a young officer, or to go all the way to compete and duplicate. Like all things, take the middle path and pick the best of both worlds. There are values in centralisation but there are also values in competition. My challenge to the clusters is: compete by all means but compete to produce more with less. But where it makes sense to collaborate, please do so. Recently, when SingHealth cluster started a public cord blood bank, I sat tight to see what was the reaction. Not bad. A few days later, I received an email from the other cluster saying that they would back this project, instead of duplicating a second cord blood bank.”
“From 1985 to end-2003, a total of 18 children have been reported to be HIV infected. Of these, four have died, three have full blown AIDS and 11 are asymptomatic carriers. In 2003, of the 242 new cases of AIDS in Singapore, only 1 case was a child. HIV/AIDS patients do get subsidised inpatient and outpatient care in our public hospitals and polyclinics. Children are innocent victims of AIDS. KKH has worked hard to ensure that these children get the best treatment. Singaporeans have been compassionate and have contributed generously to funds that help pay for such children's treatment. The KK Outreach to Kids fund helps pay for antiretroviral drugs when indicated, medications for HIV-related infections, laboratory tests and hospitalisation charges. This fund currently assists nine children. In addition, Action for AIDS, an NGO provides financial assistance to HIV infected patients - both adults and children. It has provided financial assistance for one child. There are adequate funding mechanisms and subsidy to help pay for treatment of AIDS, including anti-retroviral drugs, for children. CHILD-SEX OFFENCES COMMITTED BY SINGAPOREANS OVERSEAS 22. Ms Braema Mathiaparanam asked the Minister for Home Affairs (a) whether there is any provision in the law for Singaporeans who commit child-sex offences overseas to be brought home to face trial, and if there is none, (b) will his Ministry consider amending the law to allow for such extraterritorial jurisdiction as a deterrent to Singaporeans and as some form of protection to the children in the region.”
“We handled about 7,500 cases of hospitalisation due to stroke every year. About 30% of these cases ended up with some degree of residual disability. Our public hospitals have the capacity to do emergency CT scans for stroke 24 hours a day. More than 95% of all stroke cases admitted to these hospitals would get a brain scan within 24 hours of admission. Priority is given to patients with clinical conditions that warrant performance of an urgent CT scan. In 2003, 90% of stroke cases presenting at SGH and TTSH Emergency Department, had a scan done within the first two hours of the CT scan being ordered. This amounts to around 1,500 CT scans at SGH and 3,000 at TTSH. My Ministry has put in place a national stroke prevention and control plan to reduce stroke related premature death and disability. This plan comprises primary prevention through adoption of healthy lifestyles, early detection and management of risk factors, and integrated care. The Health Promotion Board and clusters run health education programmes to educate the public about the risk factors, and signs and symptoms of stroke. Persons with conditions that predispose to stroke like hypertension and diabetes are identified early through community screening programmes. Those who are found to have these medical conditions are referred to the polyclinics or their family physicians for treatment. All public hospitals have stroke units and/or multidisciplinary stroke teams to provide integrated and holistic care to patients with acute stroke. EXPRESSWAY MONITORING AND ADVISORY SYSTEM 20. Mr Steve Chia Kiah Hong asked the Minister for Transport (a) why is the Expressway Monitoring and Advisory System (EMAS) switched off; and (b) what is going to happen to the EMAS.”
“The House immediately resolved itself into a Committee on the Bill. - [Mr Khaw Boon Boon]. Bill considered in Committee. [Mdm Deputy Speaker in the Chair]”
“On finality, it is more than policy intent. I have checked with the Attorney-General's Chambers. They were quite clear that the various sections (9, 10 and 11), as currently drafted, make it clear that whatever information is in the objector register is the final position, irregardless of all the paper work that may have been changed over time. So it is more than policy intent. It is my policy intent, and it is already the legal position. I am not a lawyer. I stand advised by AG's Chambers. The second point is about mental disorder. Although I was long ago in the Ministry of Health, I could not quite recall this Mental Disorders and Treatment Act, what prompted the setting up of this committee of estate, what was the thinking behind that, which I could check. But whatever it is, the legal position is that committee has limited functions, and the functions are spelt out in the Mental Disorders and Treatment Act. And that function does not go into issues like giving consent on giving away the organs. So, it is completely and legally untenable to accept the Member's amendment. In any case, my position is, as a policy, leaving it to the parent and guardian for a decision like this is good enough. On the last point about a Singaporean who opts out of HOTA and opts in, and who will be such a person, I do not want to speculate on what is the reason why the person decides to opt in and opt out. But whatever it is, that is his or her personal choice. Again, as I said just now, I am a non-lawyer. I just assume that the latest decision should apply, if the two decisions were to contradict. But I could be wrong, I do not know. Question put, and agreed to. Bill accordingly read a Second time and committed to a Committee of the whole House.”
“Age is however a consideration as this is closely linked to medical suitability and outcome of the transplant. This set of selection criteria is formulated by Prof. Goh Lee Gan's Committee. It is made known to the transplant community. There is nothing secretive about it. Is it useful to publish it? I am not sure how useful it is to the layman. I myself have tried to decipher the various technical details. After spending some time on it, I found myself completely lost in the jungle of alphabets like HLA-A, HLA-B, HLA-DR, SGPT. I decided that I should stick to my core competence and not try to play doctor. Mdm Deputy Speaker, I think I have responded to all the comments made by the Members. I am sorry for taking a long time on this because I deliberately want to address all the points made by the Members on this very important topic. I am grateful for your patience, and I am grateful for the Members' strong support. Despite the sensitivity of the topic, Members have been able to give the Bill their support. Brain death and possible abuses were some of the important issues raised. These are legitimate concerns and we will ensure that when these policies are implemented, there will be continued emphasis on safeguards and strict ethical standards. As Dr Chong Weng Chiew puts it, the support shown by most Singaporeans for this Bill is evident - that they trust our healthcare system; they trust our doctors. This is a trust earned through the decades. We must not do anything to weaken or, worse, abuse that trust.”
“If the committee assesses that this does not amount to organ trading, then it can be allowed. Finally, let me respond to comments on how organs are allocated to those on the waiting list. Mdm Ho noted that in the US, elaborate contra-indications of who should get priority and who should not are developed and made public. We have a Committee headed by Prof. Goh Lee Gan to prioritise and make such decisions in a rational, scientific, equitable and unpoliticised manner. There are three main considerations. First, we want the best possible matching of tissue type to ensure the most optimal outcome. It would be a great pity if a transplanted organ ends up being rejected. So medical criteria, particularly tissue type compatibility, are important considerations. As a result, our transplant success rate is comparable, perhaps even better, to the best centres in the world. In Singapore, 90% of renal transplant patients have grafted kidneys that are still functioning after one year. 75% are still functioning after 10 years. Our 10-year graft survival results of 75% are significantly better than the US figure of 50%. Credit must be given to the Committee's careful patient selection. Second, HOTA non-objectors and Muslim pledgers should have priority over HOTA-objectors and Muslim non-pledgers. I think this is fair. This has been enshrined in HOTA since the very beginning. Third, those who have been on the waiting list longer will have priority over those with shorter waiting time. Socio-economic factors are not taken into consideration. We do not discriminate between rich or poor; politicians or non-politicians; skilled or unskilled; employed or unemployed; male or female.”
“In the United Kingdom and the United States, despite many years of promotion, they are equally short of organs. That is why more than 20 countries have enacted HOTA-like legislation. In the US, at least 13 states (including California and Texas) have begun to enact laws which provide for presumed consent, starting with cornea. But meanwhile, the gap between organ supply and demand continues to widen. So not surprisingly, we begin to read about radical ideas of paying for organs to save lives. Like Mdm Ho Geok Choo, I have read about the suggestion in Britain of creating "an ethical market in live donor organs and tissue". Maybe I am conservative, but I find "an ethical market for organs" a contradiction in terms. I read in the Boston Globe another article saying that altruism alone will not be enough to meet the need for organs. While the author was against trading of organs by live donors, it advocated the trading of organs from the dead. What do Members think? What do Singaporeans think? These are complex ethical issues which we may have to confront one of these days. Meanwhile, I belong to the old school which believes that all organ donations must be altruistic in nature. We will not allow any financial incentives to be given. However, I see nothing wrong in meaningful gestures to recognise generous acts of altruism. For example, some limited waivers of hospital charges are currently provided to the immediate family members. However, I would be reluctant to hard-wire these financial gestures into the Act, as it seems to be proposed by Mdm Ho. Mrs Lim asked if recipients would be allowed to reimburse lost earnings of donors. Such an intention should be made known and considered by the Transplant Ethics Committee.”
“Herein lies the difficulty. Her husband felt that she would not have consented, but her parents felt that she would. There were lengthy court proceedings over the years. The feeding tube was inserted, removed and then re-inserted as the court proceedings progressed. What a life! And what trauma it brings to the loved ones! In the hospital ICU, when a brain death occurs, we often face the anguish and moral dilemma of relatives. Many are not sure what their loved ones would have decided: would he or she have wanted to donate the organs to save lives or would they have preferred not to? If the person has clearly indicated his decision, either by actively opting in or by actively opting out, the relatives would be saved the anguish, especially at a time of sudden loss. Is it not better that we register this clear decision when we are able to, instead of leaving our loved ones to speculate? It will only take a few minutes. 50,000 Singaporeans have made this clear decision. Anecdotally, I know that several Members in this House have done so and pledged all their organs. Dr Neo asked if we have tried our best to get more to pledge. I am sure more can be done, and I will. But the global experience is not optimistic. There is an organ shortage everywhere, even in the most civic-minded society. HOTA is not a perfect solution but a practical approach to a real serious problem. It should not be a substitute for organ pledging, but both can co-exist. That is why we will continue to promote organ pledging. And we will work with all and sundry - religious bodies, professional and community organisations, and so on. As I said, we are not alone in having low organ pledge rates.”
“Mr Ang Mong Seng also asked why there were different age limits for different organs. No, there is no such difference. HOTA has one common age limit of 60 at the upper end, and is not organ specific. On the other hand, Mr Iswaran noted the different age thresholds for the young - 18 for opt in and 21 for opt out. This is true. I suppose the reason is that for HOTA, we have deliberately made it more restrictive and hence limit it to adults above 21. However, for opt in, where a conscious decision has to be taken, we have lowered the age threshold. Young people now mature quite fast. It is increasingly difficult to set a good age of consent. That is why for the live-donor portion of HOTA, we have decided not to hard-wire in the age threshold, but to allow the ethics committee to make a decision on a case-by-case basis. Some Members talked about our low organ pledging rate, and this is true. This is despite many years of work. I suppose part of the reason is that people do not want to talk about death, but death is one constant in life. We are not immortal. We all have to face death one day. I think it is far better that we prepare for death while we are still alert, rational and healthy, than to let our loved ones scramble in desperation at a time of sudden shock and grief. Members may remember the case of a woman in Florida last year who has been in a persistent vegetative state for more than 10 years. She is alive. She can breathe. However, she is unable to take in food or water on her own. But if she is fed through a tube, she will live; if not, she will die within a week or two. The doctors have to insert a tube into her stomach to feed her. Because this is an invasive procedure, consent is needed. Since she is in a vegetative state, someone has to act for her.”
“I also totally agree with Dr Lily Neo and Mr Ong Ah Heng that public education should stress the preventive aspects; in other words, to prevent the organ from failing by adopting a healthy lifestyle. Dr Lily Neo proposed two drafting amendments. First, she proposed that section 5(2)(f) be amended to provide for the consent of the committee of the estate to be obtained for the removal of an organ from a mentally disordered person who has died. This is an existing section. It was included in the original Act to exclude HOTA from persons of unsound mind, unless the parent or guardian has given consent. Dr Neo would like to empower the committee of the estate to provide consent for removal of organs under HOTA. A committee of the estate is appointed by a court under the Mental Disorders and Treatment Act for a particular purpose, and that purpose does not include medical decisions on treatment or related matters. So, I am afraid Dr Neo's proposed amendment is not doable. In any case, the current provision of leaving that decision to the parent or guardian, in my view, is sufficient. Second, Dr Neo suggested that HOTA be amended to state that the information recorded in the objector register shall be final and conclusive. This is indeed the policy intent. I have checked with the Attorney-General's Chambers and they confirmed that this is indeed the legal position of the current Act. Mr Ang Mong Seng asked if organ pledgers and non-HOTA objectors are subject to higher insurance premiums and whether they will lose the medical coverage. There is no basis for insurers to discriminate against organ pledgers and regard them as having higher health risks. Indeed, I am not aware of any insurance policy where insurance premiums are dependent on organ donation status.”
“Moreover, as pointed out by Dr Amy Khor, this should be a continuous sustained effort, as there would be new citizens, new PRs, and new Singaporeans who turn 21. Dr Khor made the helpful suggestion that we organise annual awareness activities to inform and educate Singaporeans on organ donation, on HOTA and organ pledging. This we will do. On Singaporeans turning 21, we do send out letters containing HOTA and opt out forms in four languages to every such individual. We batch this, not every day. We do it twice a year. My eldest daughter just turned 21 a few months ago. I notice that she did receive a parcel by registered mail. Recently, I did a welcome reception for new citizens and new PRs in my constituency. So, I did a casual check with them about HOTA and they do know about HOTA. In fact, at the reception itself, my grassroots leaders did some presentation to them about Town Council, community centres, how to join the activities, and HOTA was one of the topics in the presentation. But no amount of public education would reach every single Singaporean, but we should always do our best. Mr Gan is worried about the elderly who are illiterate. We will try to reach out to them too. Mr Ong Ah Heng called on older Singaporeans to change their mindset about organ transplantaion, brain death and so on. Actually, I think many senior citizens are supportive of HOTA and the amendments. But I agree that we have a duty to help educate the sceptics and provide them with the right information. Dr Ong Seh Hong asked if families of the dead would be able to perform the last rites before the organs are removed. Yes, they can.”
“I support Mdm Halimah's call for the Muslim scholars, MUIS, the Fatwa Committee and for international religious scholars to press on with these discussions to see how the constraint of section 5 can be overcome. My Ministry will provide the appropriate support. If they need me to speak in the mosques and so on, I will be most happy to do so. Let me now address some of the operational issues related to this Bill. Some Members commented about Singaporeans who may not want to donate all the four organs, maybe only one or two. Yes, the Bill allows for selective opting out. So you can say, "I opt out of cornea but I opt in for the rest." Mdm Cynthia Phua had two queries. One is when a person opts out of an organ but not the others, what about the penalty? The two-year penalty only applies to the specific organ which is being opted out, but not to the others. I think that is fair. She quoted a strange case of somebody who opted out of HOTA but opted in through the opt-in scheme. I do not know whether there are such persons. I am not a lawyer. I suppose when you have two different decisions which contradict, the most recent decision applies. Mr Gan Kim Yong asked how one could go about opting out. It is actually quite simple. These forms are available at hospitals, outpatient clinics, and they can also be downloaded from the Ministry of Health's website. Mr Gan Kim Yong, Mr Zainul and many others rightly pointed out that we should fully inform Singaporeans about HOTA and what they should do if they wish to opt out. After the Bill is passed, we will carry out a six-month public education campaign to inform everybody. We will be sending out information brochures to all households for this purpose. I take Mr Ong Ah Heng's point about printing brochures in four languages.”
“Fortunately, as pointed out by Mr Ahmad Khalis and Mr Zainul Abidin, MUIS has been regularly updating its interpretation, in the light of medical advances. I therefore share their hope that, in due course, there might be a fresh interpretation of how the consent of the waris could be expressed. Mr Ahmad Magad just now spoke about some possibility of an alternative process of giving consent. It sounds very complicated to me, but I think it is worth exploring to see how it can be done. The end objective is to see whether we could, as he put it, have an inclusive approach, so that the Muslim community could come under HOTA. Meanwhile, for as long as we cannot overcome the religious requirement, the Muslim community will have to make an extra effort. What are they? First, to prevent organ failure through healthy lifestyle and careful disease management. So, please join me in all my marathon runs. Second, to promote organ pledging. My Ministry will work with the Muslim community to encourage more to pledge to donate their organs. But, honestly speaking, we have already tried this for many years, with so little effect. So, I share Mr Zainul's pessimism. One solution is to encourage living donors, like in Norway. In this way, we can meet the waris and religious requirements. The regulation of living donor organ transplantation under HOTA will apply to Muslims. Another way, of course, is what Mr Ahmad Magad talked about just now - be creative to see how the process of waris' consent can be managed. But this is something for the Muslim community to think through and discuss.”
“The small number of kidneys donated by Muslims has put them at a natural disadvantage. First, because those who have not opted in get lower priority. Second, because the immunologic profile of Malays tends to differ from non-Malays. So it is more difficult for a Malay to obtain a kidney of the right match from a Chinese or Indian donor. Organ matching is affected by the genetic make-up of the person, in particular, the Human Leukocyte Antigen (HLA). The HLA type is related to the ethnic group of the person. So persons of the same ethnic group are more likely to have similar HLA type. Better HLA matching between a donor and a recipient will lead to better outcome for the recipient. And when organs are being allocated, this is a one key consideration. Organs are precious and we want the best possible matching. And with a small number of Malay kidneys available for allocation, it is not surprising that there are few Malay recipients. To compound the problem, Malays are at higher risks of developing kidney disease. Mdm Ho Geok Choo asked how many Malays are on the waiting list. 20% of the 700 patients on the waiting list are Malays, even though Malays make up only 14% of the total population. In other words, Malays are 50% more likely to develop end-stage renal disease than other races. For these patients with kidney failure, the suffering is real. As Mr Zainul Abidin told us just now, at the Meet-the-People sessions, we have all heard these heart-wrenching stories. Many have to endure years of kidney dialysis while waiting for a kidney. We should try to reduce this problem. Dr Lily Neo asked what could we do. Unfortunately, given the religious considerations, there is no easy solution.”
“Let me now discuss the Muslim issues. Muslims have not been able to benefit from HOTA as their religion requires them to also obtain the consent of their waris for organ donations. In other words, the consent of the donors alone is not sufficient. Hence, as pointed out by Mdm Halimah, section 5 of HOTA ended up excluding Muslims. But as pointed out by the Malay MPs, Islam does not prohibit organ donation. Indeed, MUIS has clarified that it supports organ donation to save lives. The Fatwa Committee has also ruled that kidney, liver, heart and cornea donation and transplantation are permissible. But as explained by Dr Maliki, to pledge their organs, Muslims will have to do so with their waris' consent through the existing opt-in Medical (Therapy, Education and Research) Act. The problem is that this opting-in approach has not been effective, not just with Singapore Muslims, but with any community in the world. And this is the reason why we and many other countries have enacted HOTA-like legislation. As noted by Mr Ahmad Khalis, only 15,000 Muslims have pledged their kidneys under MTERA. This is about 5% of the Muslim population. This is despite years of intensive efforts by community organisations such as the National Kidney Foundation and the Muslim Kidney Action Committee. The low pledge-in rate for organ donation is similar to the experience in other countries. Moreover, as Dr Lily Neo has observed, many Muslims sign up as donors only when they find out that they have failed kidneys. So, effectively, such donors do not really contribute to the pool. As a result, very few Muslims have actually donated their kidneys. Of the 70 potential Muslim donors who have been identified since 1988, consent for organ donation was given by the waris in only six cases.”
“Yes, I can give the assurance that quality will not be compromised. This is the starting point, that in this whole exercise, quality is paramount. But there are different practices. Medical practice is sometimes a bit of art and science, so it is not always clear which is the best regime. That is why I prefer a certain amount of diversity. Some hospitals have a longer length of stay because they think on a long-term basis, it serves the patients' interests better. Others think they can do with a shorter stay. We cannot be sure which is better until some time has passed. Like all things, let us have experiments and, along the way, hopefully, there will be some enlightenment. 3.00 pm”
“The Ministry collects data on the number of abortions among work permit holders, but it does not have detailed breakdown by category of worker. The available data from 1999 to 2002 are tabulated below: Abortions Among Work Permit Holders (1999-2002) Year Number As % of total no. of abortions 1999 1360 9.9% 2000 1408 10.3% 2001 1570 11.9% 2002 1420 11.1% PROFILE OF CENTRAL PROVIDENT FUND HOLDERS 5. Ms Braema Mathiaparanam asked the Acting Minister for Manpower if he will give a profile of active and non-active Central Provident Fund (CPF) holders in the last five years (1999, 2000, 2001, 2002 and 2003) by (i) age (ii) gender (iii) educational status (iv) industry-type and (v) amount held in the CPF.”
“To make it fun, we can have a monthly lucky draw of these namecards before they are discarded with prizes for the lucky winners. There are so many ways in which Singaporeans can get involved in fighting this battle. The fun part is not to trivialise the matter, but to help raise public awareness. For example, there can be a song or jingle competition on how to remind Singaporeans to take temperature twice a day, wash hands every other hour. Mr Speaker, this is a major crisis. We cannot duck it. But we should turn it into an opportunity to bond Singaporeans and to strengthen our spirit as one people. A few of our hospital workers have sacrificed their lives in this battle. A few are fighting for their lives. I saw them in the Tan Tock Seng Hospital's Intensive Care Unit. Many more are quietly but courageously fighting in the trenches, not knowing which patient will turn out to be SARS. As I walk the ground, talk to them, I know I am talking to true heroes and heroines. They are risking their lives every day, every hour, so that we can all be safe. The minimum we can do is not to hamper their work but to help them get on with their job. We are now many times better prepared than when we started 43 days ago. We know the enemy better, although still not fully. We are better equipped, better trained, better protected. Preliminary diagnostic kits have arrived, and we are perfecting them. So, even if the next few days may turn out to be worse than today, we know that we will win the battle sooner rather than later. Mr Speaker, I support the Bill.”
“His trolley was next to another patient who was also in a trolley, who subsequently turned out to be a SARS patient, although unknown at that time. But there was proper separation procedure and infection control. The husband never became infected. However, the lady visitor, despite constant advice and pleas by our A&E staff, insisted on hanging around in the observation ward for a good five hours, moving from trolley to trolley. She became infected by the SARS patient and is now in Tan Tock Seng Hospital. We have cut down visits to hospitals to one visitor per patient but, really, the hospitals would strongly prefer a "No Visitor" rule during this period, except for compassionate cases, like for children, and seriously ill patients. Toronto Hospital has already imposed such a rule. This will help minimise risk of inadvertent spread through hospital visitors, besides reducing the load on the hospital workers. On the ground, we will be flexible to address the emotional needs of some patients and their loved ones. We hope Singaporeans will support this no-visitor rule. Third, think out creative, practical ideas to help fight SARS. For example, I was most pleased to read about the taxi driver who prints his namecard and gives one to each passenger with a receipt. In this way, in the event that contact tracing has to be done, with him as a SARS suspect, his passengers will more likely be able to recall. Likewise, someone suggested that all counter staff in the shops, banks, supermarkets and hawker stalls place a bowl in which all their customers can throw in their namecards. Every day, the collections can be bagged and dated. In the event that contact tracing has to be done involving this particular outlet, the process can then be speeded up.”
“I do not think they are merely lucky. I think years of keeping high personal hygiene must have contributed to this state of affairs. So let us clean up our act in hospitals, homes, offices, hawker centres and everywhere. Second, support our hospital workers. They are working flat out for weeks now. As I walked the hospital floor, I can see fatigue in their faces. Many are now doing extended shifts - double shifts. I worry that some may break down. They need all the support and help that we can give. Many Singaporeans are indeed doing so. I see Milos, Ovaltines, essence of chickens, vitamin Cs being sent regularly to the wards, together with flowers, lovely poems and paintings - absolutely heartwarming. Believe me, if they are able to keep their body and soul together, despite having to live with the risk and punishing work pace, it is due to this wonderful moral support that they are getting from fellow Singaporeans. Unfortunately, a small number of Singaporeans remains determined to make our lives difficult. Some lie about their history, and some break home quarantine. This Bill will directly address these deliberate acts of dishonesty. However, there are also some Singaporeans who make our lives more difficult, perhaps without realising it. These are the visitors of patients to the hospitals, A&E Department and wards. Our staff are already busy, protecting themselves and their patients, besides rendering medical care. With visitors, they have the added responsibility to ensure their safety. This is not theoretical. There was a visitor who accompanied her husband to an A&E Department for treatment. The husband was in a trolley, closely monitored.”
“A new complication for us is that some patients with other illnesses have been infected. Because of their other illnesses, the SARS symptoms are often masked. This has made early detection very difficult. That is why we may still have the occasional break-out in our hospitals, despite the best of efforts. There is no shortcut to this problem, except to keep vigilant and to close in on the enemy as soon as its identity has been exposed. That is why we await so eagerly for a good reliable diagnostic kit. Without it, we are really fighting with a major handicap. Meanwhile, we should all be mentally prepared for new cases and some setbacks. But we should not allow such occasional eruptions to reduce us to frenzy and mass panic. To win this fight, we need cooperation from all Singaporeans. To stop the spread in the community, we need cooperation from the entire community, not 80-90% but 100% of cooperation. Just a few super-spreaders who are irresponsible and we will have a major setback. Singaporeans are not helpless in this fight. We should certainly not be mere frightened, passive spectators of this battle. We have much to do, and if we do it well, we can win this battle together, and decisively. What can you do? I suggest we focus on three areas. First, raise our personal and public hygiene to the Japanese standard. SARS appears to be spread by droplets. So regular wiping and cleaning would help. Everyone should stop irresponsible people from spitting in public, sneezing or coughing, without covering their face, or littering. Frown on them, stare at them, make sure they get the message. I cannot help noticing that Japan, despite very intensive business and people-to-people contact with China and Hong Kong, remains unaffected by SARS.”
“Together, these five components make up what I call the PDI strategy - Protect, Detect and Isolate. We are now putting it into practice in all our hospitals. With the virus now out of the bottle and in the international community, it is no longer possible to eradicate it soon. Hospitals will now have to live with SARS. Procedures and processes will have to be re-engineered to cope with this changed environment. Infection control will have to be taken a lot more seriously than in the good old pre-SARS days. What it also implies is that, going forward, we cannot hope for no more new cases of infection. Instead, it is more likely that we will have occasional cases of infection. Hopefully, we will be able to quickly detect and isolate them before they do extensive damage, but this is something for the future. Meanwhile, I am mentally prepared for the situation to get worse, before it gets better. This is because we do not yet fully know the enemy. How is it transmitted? How long does it survive outside the human body? It is tough fighting an invisible enemy. In the early days of the outbreak, many of our hospital workers were infected. This is because, for many decades now, modern hospitals do not have to deal with serious infectious diseases. As a result, we have relaxed on infection control standards, as it was unnecessary, and it would have been an over-kill. But after we have understood the enemy better, and put ourselves on high alert, in protective gear, the number of hospital workers becoming casualties has come down drastically. We are now busily strengthening all the hospitals, getting them up to shape. This will take some time as old habits do take time to change, but we are learning quickly day by day and getting into full swing.”
“We are working hard to maintain this state of affairs, while we continue to enhance infection control in the hospitals and achieve effective protection for our hospital workers, patients and visitors. This is the top priority of our SARS combat unit. It is to eliminate in-hospital infection. If we do our job well, we will be able to reduce the risk of hospital workers, patients or visitors becoming infected while they are in hospitals to the absolute minimum. And, with some luck, perhaps, even zero in some hospitals. How? We are focusing our efforts in five areas. First, equip our hospital workers, patients and visitors with proper protective gear, that means masks, 3Gs - gowns, goggles and gloves, and protective suits when doing procedures on patients like intubation or surgery. An unprotected or poorly protected worker handling a SARS patient is fighting a formidable enemy without weapon or shield. A few earlier cases of hospital workers being infected were due to inadequate protection. Second, train our hospital workers on infection control and proper use of protective gear, eg, an ill-fitted N95 mask that is not 100% sealed is no protection. Training and retraining now go on repeatedly. Third, ensure full compliance. A good infection control plan is only good if it is put into practice by all staff at all times. This calls for repeat reminders, frequent audits and peer pressure. Fourth, pick up early onset of symptoms. Without a reliable diagnostic kit, the next best thing is to measure temperature at frequent intervals. As soon as fever is detected in staff, patient or visitor, an alarm goes off and we spring into action. Finally, isolate immediately all those with SARS symptoms, with full protection and barrier nursing.”
“Thank you, Mr Speaker, for making this facility so that we can all join in the debate without causing any anxiety to our colleagues. Early this week, I had to visit Tan Tock Seng Hospital, Intensive Care Unit, where SARS patients were being cared for. I was properly protected - N95 mask, gown and gloves. I did not have to get near any patient. There was no risk of my being exposed and infected. But, purely to allay anxiety, I decided to suspend all my activities in my constituency, including my weekly meet-the-people session. The risk of my becoming infected and, in turn, passing it on to the residents in my constituency is practically nil, but I would rather not cause any anxiety on their part. For the same reason, I decided that I should stay away from Parliament during this period. I will resume community activities from 1st of May. In fact, my first public function will be the NTUC May Day Rally, even as I continue to visit the hospitals. But I will no longer need to go inside hotspots like Intensive Care Units. By the way, I continue to go home every day to play my role as a father and husband. I take comfort in the fact that no Tan Tock Seng Hospital worker has been infected for some time now, ever since we got to know this virus better, and instituted full infection control and protection for staff and visitors. Mr Speaker, this virus is dangerous, but actually not that scary. You can get infected only if you are near a SARS patient and unprotected. In Singapore, where we have so far managed to control its spread, the high-risk areas are mainly hospitals and the homes of SARS patients. Outside of these areas, the risk of getting infected is insignificant, although not zero.”
“I agree with Mr Tan Soo Khoon that it is logical to make the calling party pay for the call he or she initiates. It is like postal service. You pay for the stamp when you want to send a letter. If we were to start afresh and introduce mobile telephony today, then we would most likely have adopted the calling-party-pay system. But having gone for the mobile-party-pay system, we would now need to evaluate the cost of switching mid-stream versus the benefits of the switch. Switching is not cost free. But, first, let me explain why the regulator opted for the mobile-party-pay system.”
“By spelling out the ground rules for fair play, new entrants to the market will have a fair chance to establish themselves. This will, in turn, foster further investments in and development of the mass media market. Their success, in turn, will add to the range of quality media services available to Singaporeans, thus, giving them more choices. 3.45 pm”
“Sir, competition in the media industry in Singapore has to be limited because our market is such a small one. I remember talking about this last week when replying to Mr Steve Chia's question on a second pay TV. But, whether it is limited or otherwise, anti-competitive practices cannot be condoned. The Media Market Conduct Code sets out the ground rules for fair competition and fair market conduct. Some of the anti-competitive practices that we frown upon are spelt out in the Code, eg, the Code prohibits predatory pricing. If a dominant player, with deep pockets, deliberately prices itself, for example, advertisement rates below its marginal cost, with the view to make life difficult for a new player or small player, this is predatory pricing. Regulators will frown on such practices. The Code imposes special obligations on dominant players. The purpose is to prevent them from abusing their dominant position to stifle the development of new players. For example, mandatory bundling services are also frowned upon. If a dominant player, let us say, who owns several newspapers, insists that all advertisers must advertise in all its newspapers, he will find the regulator knocking at his door. The Code has comprehensive enforcement procedures to check on errant players. The regulator can either initiate enforcement actions or act upon complaints. There are prescribed procedures in the Code to investigate anti-competitive conduct. Enforcement measures will range from simple warnings, knocking at the knuckles to severe financial penalties of up to $1 million per contravention. In this way the Code serves the wider public interest by facilitating fair and effective competition in the mass media market.”
“I myself have watched it two and a half times. Once, in the cinema; once, on VCD. The third time was when it was screened on Channel 8. I only saw part of it, because when "lim-peh" became "ni-lau-pa", something was missing. "I Not Stupid" became kind of stupid, and I switched it off. There must be many like me in the Programme Advisory Committee who felt the same way. I am speculating, but I think this led to their call for some dialect programming on free-to-air TV. One way to resolve the contradiction in this instance is to screen "I Not Stupid" in its original form on Arts Central, but not on Channel 8 or Channel U. This way, we uphold our Speak Mandarin Campaign and still get to enjoy Jack Neo's masterpiece free-to-air. MITA will consider this and other programmes from time to time. But we must always bear in mind that in exercising such flexibility, we do not dilute or harm our efforts to promote Mandarin to our young.”
“So in my last 50 years, I found myself with competencies in different languages at different periods of my life. During my six years in primary school, I was fluent in Hokkien and Mandarin. During secondary school, I was strongest in English and Bahasa. I neglected my Mandarin somewhat. In university, I was most fluent in English and Fortran, a computer language. After graduation, I began to again spend time on Mandarin, but even then, it never quite reached the same competency as my English. My Hokkien and Bahasa are now probably at primary three level. My computer languages have become totally obsolete. So, we face a constant struggle with limited time and limited brain capacity. We only have 24 hours each day. If we spend more time on X, we have less time for Y. It is as simple as that. We all want to be good at X, Y and Z, but it is often just humanly not possible. That we have achieved some success in our Speak Mandarin Campaign is an outcome that is not irreversible. It was an uphill task, but we have managed to push that rock up the slope. Some of us can now take the hands off the rock and perhaps listen to shan ge in dialect. But if everyone does that, the rock will immediately roll down the slope. My advice to Chinese Singaporeans is san si - think thrice. Sir, this House has heard the debate of Mandarin versus dialect many times. The arguments are well known to all, including the members of the Programme Advisory Committee (PAC). These are rational establishment people. So why did they suddenly argue for a relaxation of our dialect policy? I was curious, so I sniffed around and I think I found out why. It is Jack Neo's "I Not Stupid". You see, "I Not Stupid" has been such a roaring success that Singaporeans want more of it.”
“That is why some dialect programmes are available on radio, on the arts channel and on cable TV. For instance, Arts Central occasionally carries dialect operas and art-house movies in dialect. FM 95.8 broadcasts dialect news daily, and dialect programmes are available on cable TV's TVBJ channel. We have, however, kept Channel 8 and Channel U free from dialect as these channels are watched by school children. We should not confuse them by, on the one hand, promoting Mandarin, and on the other hand, broadcasting dialect programmes on these channels. Let me share my personal experience. I grew up in a Hokkien-speaking family. My parents could only speak Hokkien, although they could read and write in Chinese. I then entered a Chinese kampong primary school and gradually picked up Mandarin, English and Bahasa. But even then, the school environment was largely Hokkien-speaking. I recall that we did not take languages too seriously, except to pass school examinations. At that time, we did not have compulsory PSLE examinations. Then I joined high school and because it took in students from all over, with varying language abilities, we were all put through an extra year, called "Remove" class, before we began formal secondary school education. "Remove" class was really an extra year for the students to brush up on their English as all other subjects, other than languages, were taught in English. Then I entered university in Australia and had to pick up more languages: computer languages - Fortran, Basic and Cobol. I do not belong to that small minority of people like Mr Seng Han Thong, or our colleagues in the interpretation booths, who can handle several languages competently with ease. I am just your ordinary fellow, with an average brain capacity.”
“For the new Asian Civilisation Museum at Empress Place, panel texts are in English. But we have gallery guides in brochures in Chinese, Malay and Tamil. This guideline also applies to our travelling exhibitions. The only exceptions are school exhibitions and temporary exhibitions of very short duration, where only the translation of the synopses in the official languages will be provided. In short, I agree with Dr Ong that we should be sensitive to the non-English speaking Singaporeans and cater to their needs as far as possible. At the end of the day, the purpose of a public exhibition is to reach out. It would be quite silly not to use the other languages, unless we are quite certain that the targeted audience is already comfortable with English. Finally, let me spend some time on this very important topic of dialect. I think Mdm Ho Geok Choo was a bit mistaken. She read in the newspapers the recommendations of the Programme Advisory Committee (PAC). MITA's policy is quite different. We have already announced it and replied to the newspaper. We stand firm on the current policy. I am glad that this particular MITA's policy, which we are standing firm, has the support of Mdm Ho. She understood the importance of Mandarin as a unifying language to bond the Chinese community. As she has pointed out, we should not inadvertently reverse the progress we have made in getting our people to use Mandarin, through a careless liberalisation of our dialect policy. We do not ban dialects. Where practical, we allow some dialect programming to service the needs of some older Singaporeans and the arts community. But when we make such concessions, we do it carefully to ensure that the concessions do not undermine our Speak Mandarin Campaign.”
“It focuses on the four performing arts: dance, music, theatre and film. 3.15 pm Singaporeans are responding to these niche libraries and niche services with great enthusiasm. They are saying that we are on the right track, and we will push on. Mr Zainudin hopes that we can make our new National Library an international icon of learning and knowledge. We will try, but within the sensible limits of budget. We do not have the huge budget of the British Library, but we will stretch what we have been given, to create something different and of value to Singaporeans. It is like our newly opened Asian Civilisation Museum at Empress Place. Our collections are modest, compared to what you can find in the museums in Delhi or Beijing. Ours is relatively small, in terms of quantity and perhaps even quality. However, through creative curatorship, I think we have created a product, quite world-class, and which we can all be proud of. This is the same approach we will be taking on the new National Library. So, stay tuned. Let me now touch on Dr Ong Seh Hong's cut on the greater use of official languages in public exhibitions. Let me state MITA's own guideline for our own museums first. Our museums provide all panel texts in English. But we do supplement with other languages, in two ways. First, we often provide panel texts in other languages, depending on the content, theme and target audience. Second, we have handouts and brochures in the relevant official languages for all our exhibitions. These handouts and brochures provide the synopses and explain the main themes of the exhibitions. For example, the current "Exhibition on 20th Century Chinese Paintings" in the Singapore Art Museum contains panel texts in both English and Chinese.”
“So, the next step is to have them to read more. I think they do. I do not think they visit our libraries merely to look at the decor or to drink cafe latte. One evidence is the sharp increase in book loans. The number of loans from the adult collections has more than doubled from six million in 1995 to 13 million this year. But this is a continuous effort and we have to be creative in the promotion efforts. So, last month we launched the Library Ambassador programme to promote reading and learning. We have personalities, such as our national bowler, Remy Ong, and Channel NewsAsia presenter Suzanne Ho as our Ambassadors. They fan across our 24 libraries to take part in activities, such as story-telling, meet-the-star sessions, Celebrate your Festival Series. As Mr Loh pointed out, just this week, we launched another programme, the Library@Office campaign to promote to office workers, professionals, executives and businessmen on our varied services, resources and extensive distribution channels. Mr Loh asked if all libraries should be general libraries or is it not better for some to specialise. He called it niche libraries. We agree with Mr Loh that not all libraries should be the same. Indeed, they are not. Wherever possible, we try to tailor the character of each library to reflect the targeted niche audience. In selected libraries, we set up special collections. For example, the Bedok Community Library has a Malay library service, and the Tampines Regional Library has a Chinese library service. I have just visited the newly upgraded Ang Mo Kio Community Library which is in my neighbourhood; a wonderful transformation. I notice it has an Indian library service there. And, of course, the library@esplanade is a great example of a niche library.”
“Sir, let me first reply to the cuts on public libraries. I agree with both Mr Loh Meng See and Mr Zainudin that public libraries have important roles to play. As Mr Zainudin put it, knowledge centres, to encourage reading and to promote continuous learning. That is why we were so concerned when visitorship to libraries declined and libraries were - this was some 11 years ago - at risk of becoming irrelevant. The then Minister for Information and the Arts, BG George Yeo, assembled a Library 2000 Taskforce to try to reverse the trend. I had the honour of being a member of that taskforce. As the Cantonese say: ngow mng yam tsui, dim gam ngow tou dai, ie, if the cow does not want to drink, there is no way you can get it to bend its head to the trough. If Singaporeans do not come to the libraries, then either we bring the libraries to the people, or we make the libraries compelling for them to want to visit. We decided to do both. As a result, we have been quite successful in reversing the trend. I thank both Mr Loh and Mr Zainudin for the compliments. Our libraries have now become so buzzy that I remember reading about some complaints against noise in the newspapers recently. Because libraries have been transformed, we now find visitors who had previously never stepped into any library. We can be proud of this transformation of our public libraries. The successful transformation of our libraries even became a Harvard case study. Some of the visitors that we now receive are fellow librarians from many other countries. They have read about our success, and they came here to see for themselves. What can libraries do to promote adult reading? Getting more adults to visit the library regularly and frequently is one important step. I think this we have largely succeeded.”
“And here, my worry goes beyond just the nuisance of spamming. In short, Sir, we cannot eradicate spamming, just as we cannot avoid catching the flu occasionally. But we can reduce the nuisance. And IDA will step up its public education programmes on how email users can better protect themselves against spams.”
“It can be a nuisance but overall the extent of spamming here is still relatively low. How do other countries respond to it? Is there any good model for us to follow? Unfortunately, the answer is no. Is legislation effective? The US experience is that anti-spam laws are not effective. The US has state laws against spamming, some dating back several years. But despite the law, successful suits against spammers are rare and the extent of spamming has not gone down. In fact, it has gone up. Australia too has concluded, after a study in August last year, that legislation alone will not be effective in curbing spams. One reason why spams are difficult to eradicate is that the majority of them originate from overseas. Anti-spam laws, even if enacted, do not have effective jurisdiction against spammers who are based overseas. We have just to adopt a practical approach, comprising (a) industry self-regulation; and (b) consumer education. This approach takes into account and balances the legitimate interests of businesses and consumers. Under this approach, our Internet Service Providers (ISPs) have all adopted best practices to counter spams originating from their subscribers. Each ISP has a policy of suspending the email account of its own customers. Users should also take some personal responsibility to safeguard their email information, just as we all do for our other personal particulars, such as telephone numbers and residential addresses. Some simple tips I would offer include the following: do not freely disclose your email address; only disclose your email address to organisations or websites that practise personal data protection principles; and of course, install anti-virus software. As a parent, I constantly remind my daughters about these tips.”
“E-mail spammers can be prosecuted if the e-mail spam is serious enough as to cause a degradation of the computer system and resulting in disruption of service. Victims can report to the Police who can pursue it under the Computer Misuse Act. Members may remember - I think it was two years ago - there was such a case when someone was prosecuted for bombarding HDB's computer department with something like 7,500 junk mails over a period of 21/2 hours. But the act of sending unsolicited email is itself not illegal. When used appropriately, it is a very legitimate form of marketing. The second aspect: is the unauthorised selling of email addresses illegal in Singapore? We do have sectoral legislation that contains provisions to protect an individual's personal information and that will include his or her email addresses. For example, under the Banking Act, banks are not allowed to sell the email addresses of their customers. Likewise, under the Private Hospitals and Medical Clinics Act, it would be illegal for hospitals and clinics to pass on the email addresses of their patients to a third party. However, if a company has collated email addresses from the Internet or from the Singapore Directory, repackage it and resell the information to interested marketers, the marketers are basically buying already public information, which they could otherwise obtain free of charge. Just last week, Minister David Lim received an unsolicited email from a company promoting a software package which it claims can, and I quote, "harvest hundreds of thousands of email addresses within seconds", and the word used is "harvest". And this is the type of spider which the industry talks about. Sir, email spamming is a global phenomenon. We are not alone.”
“Working through 28 training centres, the programme has so far benefited more than 113,000 people. About six in 10 Singaporeans are now IT literate. One significant achievement is this mindset change. There are many anecdotes of Singaporeans taking to the convenience of e-Government, SMEs leveraging on the Internet for their business, and housewives logging onto the Internet for information and leisure. Singaporeans do not resist IT for fear of layoffs or displacement. This is a big achievement that many other countries are still working on. Mr Loh Meng See talked about our telcos going regional and whether our FTAs will be one way to help them open up the market. Although our domestic telecoms market is still growing, our telcos know that they need to go regional to secure long-term double digit growth. The activities of SingTel and StarHub in the region and further afield have been well reported in the press. The opportunities are there. First, growing middle class will increase the market size. Second, as countries open up their regime and lift the domestic protection, there are new businesses for our players to participate. Our various FTAs certainly help to speed up the process, as we persuade our FTA partners to give us better market access. Mr Loh asked if the opportunities are more in applications development or infrastructure integration. I think it is both. But industry players will have to focus, as always, on their core competency and differentiate themselves from the competition. Let me now reply to Mr Steve Chia's cut on the subject of junk e-mails, commonly called e-mail spamming. There are really two parts to this issue. First, can we prosecute e-mail spammers? Yes, we can.”