Koh Lam Son
Singapore
“(7) To provide more theatrettes or curtains in the classrooms with the increased use of audio-visual equipment such as overhead projectors and slide projectors. These would help prevent unnecessary strain on the eyesight of the students.”
“Sir, this debate can go on, but I would withdraw my amendment. Amendment, by leave, withdrawn. The sum of $521,224,880 for Head P ordered to stand part of the Main Estimates. The sum of $466,063,100 for Head P ordered to stand part of the Development Estimates. Head R -”
“He should not, in my view, be a civil servant or ex-civil servant, but someone who has an understanding of the civil service, in tune with the hopes and expectations of the public and a grasp of the needs of the business community and financial institutions.”
“Sir, I believe that upgrading the facilities should be the first step, and a better way for the stallholders and for the community at large. 12.45 pm I also wish to state that complaints that customers are shortchanged with poor quality food and badly prepared food is a fact, but it is a separate issue.”
“No one else would do it for us. We have to do it all ourselves. So unless litterbugs clean up the act, we must make sure that they do not dirty our environment. I would like to ask the Minister whether he would consider increasing its own manpower to keep our city clean and green.”
“Mr Speaker, I do not think the Minister has answered the question whether unleaded petrol has any adverse effect on car engines. I believe that if unleaded petrol is of a certain grade - I think they use the term "RON" - if it is below 92, there can be an adverse effect on the valves of the engines.”
The complete record
Every one of 302 lines we hold for Koh Lam Son, in date order, each linked to its source. Free to read, in full, without an account. Page 4 of 7.
“Sir, is it not possible perhaps to wash these trucks before they leave for the road? Dr Ahmad Mattar: Mr Speaker, Sir, the trucks are washed before they leave the Environmental Health Offices and after they return. SINGAPORE RIVER (Measures to minimize pollution) 5. Dr Koh Lam Son asked the Minister for the Environment what problems are faced in minimizing pollution of the Singapore River and what measures are being taken to tackle the problems.”
“How many of these vagabonds are new cases and how many are repeat cases, ie, the people whom you cannot help and they go back into the streets? Is it true that if a vagrant is found to have a home address, the Ministry will then not give him or her any assistance?”
“Sir, may I ask the Minister whether it is a good idea perhaps to monitor those places which are habitually littered, and apply your enforcement actions, educational programme, just on those places. As an example, in the Telok Blangah Estate, we have one or two places, the rental blocks which are habitually littered. If the Ministry could put up more penalty signs, the anti-littering signs, monitor the situation and apply enforcement action there, I think perhaps we can clear up the problem.”
“Sir, under what circumstances, if any, will HDB evict a tenant who is in arrears of rent?”
“As the Minister is well aware, the Telok Blangah Estate is made up of mainly middle-income group and we can even afford to build a modern recreation club running on the lines of a country club. If the Minister is unable to say yes to this humble request of mine, may I suggest that he defer his decision to the Town Council in Telok Blangah, if a Town Council is to be formed in Telok Blangah. I suppose he is the best person to know this.”
“Sir, one of the common problems faced by old HDB estates is the shortage of space, as the Member for Bukit Merah has mentioned, and also the shortage of amenities. And so in the Telok Blangah estate, which was built about 10 years ago, in terms of amenities it is quite bare compared to the newer, modern HDB estates. We need very badly an open space for sports activities or open air recreation. It is true that there is a field in the neighbouring constituency of Radin Mas and I suppose our residents can take a 15 minute-walk to use the field. But as the Member for Radin Mas will testify, that field is very well utilized by the residents of his constituency. We have the extension of the Mount Faber into our constituency, but that is a bit too hilly for any sports activities to be organized there. Although we have three school fields, unfortunately, the school principals are very reluctant to open their doors to residents because of maintenance and repair problems they face. So we only have one piece of vacant land left in the Telok Blangah Estate. I think the Minister is well aware of it. I have made a similar request a year ago. This is a lovely piece of land, very open, very accessible to residents and the Minister has plans to build flats on this piece of land. And the last thing we need in Telok Blangah Estate is more flats. It is already very congested. So I would like to again request the Minister to defer his housing plan on this plot of land and perhaps lease it to us at a nominal fee so that we can develop it into a centre for sports activities like football, tennis and even build squash courts.”
“Sir, in terms of percentage of the total number of tenants in the rental flats what does this number represent? What are the reasons for the remaining tenants to continue to live in rental flats and not take advantage of the generous incentive schemes? How many does he think will come forward and how many will not come forward? Does he think that they do not come forward at all simply because they are poor and they will forever be poor and cannot afford? And if so, is it possible for us to achieve this 100% home ownership which we have visualized and hope to realize by the year 1999?”
“May I suggest to the Minister that when he comes across such a problem it may be too late for him to do anything about it.”
“Sir, would the Minister not think that since thousands of children are being looked after by foster mothers and baby-sitters while their mothers are out at work, it is important to study this problem, especially the emotional health of these children?”
“Sir, can I ask the Minister for the reasons for the decline in the number of cases, and whether there has been a sharper decline in the last one year since the call by the Government to produce more babies? Secondly, whether he would consider removing the incentive of one week's unrecorded leave for civil servants for sterilization.”
“Sir, in asking Question No. 5, I wish to declare my pecuniary interest. The Acting Minister for Health (Mr Yeo Cheow Tong): Mr Speaker, Sir, the number of male and female sterilizations has been declining over the past 10 years from 10,218 in 1976 to 4,768 cases in 1986. It declined by a further 23% in 1987 to 3,652 cases. In 1986, there were 4,504 female cases as compared to 3,524 cases in 1987. Similarly, the number of male cases declined from 264 cases in 1986 to 128 cases in 1987. In line with the New Population Policy, the incentives for sterilizations were revised in March 1987. Women with less than three children wishing to undergo sterilization are currently being counselled by their doctors in both the public and private sectors.”
“Sir, the Minister has said that the public toilets are now much cleaner. Can I ask him on what evidence does he base his judgment on?”
“First of all, I would like to see more modern amenities for the residents. There should be a modern recreational club with an Olympic-sized swimming pool, with modern facilities. There should be good quality schools, well-equipped library, well-run kindergartens and day-care centre. The CC must remain as the focus of cultural activities. High professional standards will be expected of teachers and organizers. I would like to see that the residents become closer together, knowing each other better, that there will be fewer strangers in the estate. I would like to see more people greeting each other in the streets, in the lifts, in the void decks. Community singing, folk dancing, will become a pastime. More residents will come forward to join the RCs and would want to serve the people to find satisfaction and fulfilment in community work. There will be more old people and I would like to see them enjoying good health, living independently and in dignity. Those who are sick and lonely will be well cared for by the families and the community. We may even have our own symphony orchestra and hold art exhibitions of works of our very own Telok Blangah artists. And, of course, we must have a well equipped and a well trained civil defence force. Sir, I would like to conclude by emphasizing again that before these goals can be achieved, every Singaporean must be made aware of and must be motivated to work towards these goals.”
“Sir, I do not believe that a Singapore culture will evolve. Singapore will always be unique in that the cultures of the people will be as diversified as the people are non homogeneous. This is neither unhealthy nor disuniting. Singaporeans should be proud and be appreciative of all the various cultures. To do this, again we must start in the schools. So in 1999 I would like to see more Singaporeans able to appreciate and to participate in the cultural activities, not only of their race but also of the other races. I would like to see Singaporeans able to explain with pride to visitors of Singapore the more popular cultural performances of all the various racial groups. Sir, how do we become a gracious people and live in a cultured society if our people cannot shake off their anti social habits? The discourteous behaviour of Singaporeans in shops, restaurants, Government departments and other places is still very obvious. Our annual courtesy campaign has yet to show any significant results. Littering, dirtying our public toilets and urinating in lifts are still very common problems. Can we get rid of all these problems by the year 1999? People are fined today for littering and spitting because they are uncivic. Is it possible that by 1999 people will become gracious enough for us to abolish all these Acts? I do have my doubts on this. I think the solution to this problem again lies in educating the young in schools. It is through our children that we can build our hopes and our vision of a cultured society. It is through our children that we can begin to influence the ungracious habits of some of the adults. What would I like to see in a housing estate like Telok Blangah in the year 1999? What would I like to see as a community living in excellence?”
“We can either hold a referendum or do what we have done through public discussions and feedback through the various channels. Hence, after a year-long discussion with the people, we are able to produce the Agenda for Action with the confidence that the people have participated in the drawing up of the Agenda for Action. As people become better educated, they do expect that this exercise of consultation and discussion with them be a permanent aspect of the style of implementation of Government policy, at least the major policy. This message to the Government is very clear and it serves well for the Government to take heed. The Government must always plan well ahead and time must be given to the people to thrash out major issues before they become policies. The Government should avoid taking a shortcut as a wrong policy may go down very badly with the people. On the other hand, the people must not expect the Government to be perfect and infallible. The Government is after all human. Sir, how do we bring the racial groups closer together? I believe after the national Agenda debate and the Herzog event, there is now more goodwill and more desire among the various races to want to come closer together. But old habits die hard and people are generally reluctant to start new habits. I believe that we should start new habits with the young and do it in the schools. The racial composition in every primary school must reflect that of the community. Children must be given basic lessons on all the cultures, customs and religions of the main races. In this way, they will grow up knowing what types of people their friends and neighbours are. They should also be encouraged to visit each other's homes and attend each other's festivities.”
“Mr Deputy Speaker, Sir, this Green Paper on the Agenda for Action has shown that Vision 1999 is not a political mirage. It is a clear set of goals which will lead our people into another golden era of peace, prosperity and great living. Notwithstanding the recent economic recession, the Government has pursued these goals by engaging the people in a year-long public discussion and education. However, I believe that Vision 1999 is even now still very misty or unheard of to many Singaporeans, especially the less educated. The Feedback Unit may bear me out on this. I therefore think that publicity campaigns and public discussions must go on until all Singaporeans are aware, convinced and motivated to work towards these goals. I suggest that this Green Paper be published in the four languages and distributed nation wide. I also suggest that this important document be used in all our secondary schools and tertiary institutions as a regular subject matter for discussion and education. Sir, during the two years of economic recession, our people were worried about retrenchment and had to contend with wage restraint and cut in CPF contributions. It was not easy then to understand and appreciate Vision 1999. Now that the recession is over, optimism and confidence have returned. But of course we must not forget the importance of good economic performance and that there will be no Vision 1999 if our economy does not perform. So the first and the most important step towards Vision 1999 is continued economic growth, continued industrial peace, increased productivity, a flexible wage restructure and our products and services must have that competitive edge in the international market. How do we arrive at a consensus with the people?”
“Can the letter from the Registrar of Marriages be in four languages too?”
“May I request that this form can be done in the four languages too.”
“Mr Speaker, Sir, I have asked this question because I believe there are genuine cases of people who are ignorant of this non-compliance between the two Ministries. The Minister has given us two sets of forms, one set is in four languages whereas the other set is only in one language. I am wondering whether this could be the cause of it. Because I have heard of cases where they are genuinely ignorant of the fact that the granting of permission to marriage does not automatically allow the foreigner to stay in Singapore.”
“Sir, may I ask the Senior Parliamentary Secretary how does the Ministry actually monitor the situation of the bus drivers supervising the alighting and boarding of the school children at the various pick-up points in streets and estates. How does his Ministry actually do it especially on rainy days because I believe that there are many instances where children are not actually supervised. The other question is whether the Ministry would consider further measures to upgrade school buses so that they are not only safe but also comfortable, perhaps to air-condition the school buses because many of these school children are very young and they have to travel long hours in the buses.”
“So far we have been able to work together with all communities, with all sectors of the community. This proposal is to guarantee Malay representation, the objective being to ensure that the interests of minority communities will be duly looked after by the Government. I think this proposal is one that is rarely implemented in other countries; and when the majority community, besides looking after national interests, consider the interests of the other communities as well. We have seen evidence of the advantages, of the sincerity of the Government in providing facilities for the benefit of our community, whether in terms of education, collection through CPF of contributions for the construction of mosques or other matters which involve the interests of our community in Singapore. Therefore, I wish once again to assure those who have lingering doubts about GRC but who still want multi- racialism. How should we effect it, if the GRC is unsatisfactory? What are the other, better alternatives? To me, in the absence of credible alternatives, I think this is the best and we should support it. 2.40 pm”
“We all know that the Government and the PAP have always been aware of the importance of this and several measures have been launched and policies enunciated to ensure that multi-racial politics exist in Singapore and that harmonious inter-racial relationship will always remain. Yesterday, the First Deputy Prime Minister explained in detail the Government's intention to ensure that Parliament will always have multi-racial representation. Whoever has any doubts about his explanation should read and examine in depth the real objectives that he has expounded. I think this is a good proposal and should be supported by all parties in the interest of our society, our nation, not only for the present but also for the future. Many arguments have been put forward yesterday and today and I do not wish to repeat them and bore Members by doing so. But I would like to seek clarification on, firstly, how the constituencies would be selected. Would the Government base its choice on existing constituencies where the Members of Parliament are from the minorities or take into consideration the distribution of residents after a resettlement, for instance, in the northern districts like Ang Mo Kio, Yishun and also districts in the West like Jurong, Jurong East, Jurong West and so on? This is necessary because some have raised questions and think that there will only be 13 GRCs in the existing constituencies with minority MPs. I think clarification is necessary so that all involved, particularly the voters, will understand and will be able to consider it and provide the necessary feedback to the relevant people before the implementation. I wish to call upon, in particular, the Malay community to support this proposal.”
“In this respect, may I ask the First Deputy Prime Minister what is the criteria for selecting GRCs, in particular GRCs with Malay candidates? Will this selection be reviewed if there is a shift in the population composition and, if so, the regularity of such a review? In conclusion, Mr Deputy Speaker, Sir, the Government and the PAP, by institutionalizing multi-racial harmony is taking only one step to guarantee such harmony is maintained. We must still continue with our existing policies and practices which also ensure and promote such harmony, eg, meritocracy as a pillar of our society, the promotion of the cultures and linguistic values of our racial and ethnic groups, the promotion and the encouragement of religious tolerance and the continuing policies of HDB and SAF to achieve racial integration in the housing estates and national servicemen respectively. In addition, we should continue to encourage open discussion of sensitive issues. This will serve to strengten rather than weaken our multi-racial harmony, promote racial integration and tolerance in schools and perhaps having exchange programmes amongst students of different ethnic groups during the school vacation. Finally, at grassroots level, we must promote activities that can achieve more racial integration. We should strive for multi-racial harmony, a very noble objective which we cannot afford to overlook or to be complacent about. Encik Abbas Abu Amin (Pasir Panjang)( In Malay): Mr Deputy Speaker, Sir, the Government has introduced the GRC concept to ensure multi-racialism in politics in Singapore.”
“I was interested to learn from several speakers yesterday that there are countries with already existing communal representation in Parliament or legislative assembly and yet affected by racial strife, eg, Cyprus, Sri Lanka and Fiji. This shows that you have to do very much more than just having minority representation in Parliament to bring about lasting racial harmony. Having representation in Parliament is only the first basic step but it must not stop there. In Singapore, our experience is different. We have multi-racial representation in Parliament for more than a quarter of a century and we do not have the legislative mechanism to ensure this. We were able to do this because the PAP has been a dominant party for more than a quarter of a century and because the PAP practises multi-racial policy. And today the PAP Government, through this Act, is enshrining in the Constitution what has been in practice for more than a quarter of a century. It is putting a basic step that should have been put in the first place much earlier on, perhaps after the racial riots in 1964. Sir, yesterday the Member for Potong Pasir stated that he is against the GRC because it will promote racialism and communalism. And he went on to say that although he felt the system did not disadvantage him, he would nonetheless totally reject it for the sake of nation- building and to prevent racialism. This is a serious statement indeed. But is he really sincere about it? If he is, then I would really like to know whether he would stand as a candidate for Potong Pasir in the next general elections if Potong Pasir is designated as a GRC. If he does, will he not, according to what he said yesterday, be promoting racialism?”
“Mr Deputy Speaker, Sir, I rise to support the Bill before us. Sir, the high level of inter-racial harmony which we enjoy in Singapore today is not due to chance or to an act of providence. I am sure we all remember the horrors that we went through during the racial violence in 1964 and remember the many innocent lives that were sacrificed. Since then, 24 years ago, the PAP Government has been resolute and very cautious not to let racial violence break out again. With multi-racial policy and practice, we have succeeded for 24 years. Can we succeed for another 24 years? The answer is yes we can, if we continue to vote for multi-racialism and we do not take multi-racial harmony for granted or slip into complacency. Sir, I regard inter-racial harmony as essentially a fragile balance of the positive and negative forces that exist in a multi-racial community. There is a threshold to this balance which can be triggered off when put to the test. Yesterday and this morning many speakers referred to several countries such as Sri Lanka, Fiji, Cyprus where we saw the consequences of such a test. Even in the country like the United States which has 200 years of nationhood, there is a threshold to their inter-racial relationship. This was triggered off in the 1960s by the civil rights activities resulting in racial clashes. In Singapore, President Herzog's visit was such a test of the fragility of our multi-racial harmony. We went through an open and soul-searching examination of the sensitive issues involving our Malay citizens. In summary, our threshold was high. We passed the test but at the same time it also revealed cracks, albeit hairline cracks in our racial harmony.”
“Sir, may I ask the Minister whether the response to the various incentive schemes so far gives him any confidence that in the longer term it will produce a significant change in the birth rate that we are hoping for?”
“Sir, would the Minister perhaps now consider doing the antibody test, since it is really part of the same test, as a service to blood donors?”
“Sir, what are the criteria for the eligibility of the Medical Fee Exemption Card?”
“May I seek a point of clarification? My point was that it would be best if you could counsel and persuade those who have opted out to withdraw their objection and to opt in.”
“Perhaps a trained person or trained persons should be present to explain the rules of the opt-out system and to stress on the opportunity that in their moment of grief there is also a gift of life to a dying person. I wish to seek clarification on clause 3(1) which empowers the Minister to prescribe the criteria for determining the irreversible cessation of all functions of the brain of a person. Does this mean that in case of doubt, the Minister will have the final say? I think this may not be wise because to put a decision on life and death upon the Minister will put a tremendous burden on him. This should be made by a team of medical experts. Finally, I refer to clause 12(1)(a) which gives priority to a person who has not opted out over one who has opted out in the selection of a proposed recipient. The Minister has said that, apart from medical criteria, the opt-out system will have priority on other criteria. But what about criteria such as the recipient's age, occupation, recipient's role in the family, role in the community? Will all this now not take precedence? As an example, will you select, say, a criminal who has not opted out or a social worker who has opted out?”
“Sir, I welcome the Third Reading of the Human Organ Transplant Bill after the Report on the Select Committee. Sir, this Bill must be regarded as a gift of life to Singaporeans who are dying from end stage renal failure. I am sure these Singaporeans will rejoice and I rejoice with them. In fact, all Singaporeans who do not opt out, and I believe they are the majority, should rejoice because this Bill gives them the assurance that should they be struck down by kidney disease they will have a much better chance of obtaining a donor's kidney than people living in other countries where such a legislation does not exist. The compassion to save lives is the motivation behind the Bill and I believe this far outweighs any protestation that the Bill to own one's body after death is now not automatic. You have to fill in a form to say that. With the opting-out system, we are in fact recognizing the feelings of more Singaporeans in supporting the Bill and we also end this costly and futile task of the National Kidney Foundation in recruiting people under the present system of opting-in. The Minister said just now that people who have opted out will not be coerced or counselled into opting in. Does that mean that the Ministry or the National Kidney Foundation will not persuade people who have opted out to withdraw? As this is a sensitive issue, I would also advise very cautious implementation of the Bill. First, there must be the widest possible publicity of the opt-out system. The benefits to relatives of donors must be highlighted and the joy of those whose lives have been saved be shown, in particular, the relatives of the deceased must be handled with tact and sensitivity. The Bill must not be seen to be forced down upon them at the moment of grief.”
“But Government regulations, no matter how strict, will not serve any useful purpose if they are not followed by vigorous implementation and enforcement. In this respect, I would like to say that it is my impression that the officers in the Ministry of Environment are committed and energetic in enforcing the regulations of the Ministry, and it is through their commitment and their dedication that we have a good, clean environment. However, nobody can deny that there is still room for improvement, evident by the many offenders that have been warned or prosecuted and many more who have got away time and again. I would like to suggest that the Minister consider introducing an incentive scheme to further motivate the officers. I would leave it to the Minister to consider the type of scheme that is more suitable for these officers. Finally, I must also point out that I have not so infrequently received complaints from stallholders and constituents that some officers in their eagerness to discharge their duties have appeared to be unreasonable and have been accused of abusing or misusing their power. As we are encouraging courtesy, we should not allow our civil servants to show discourtesy in discharging their duties, no matter how difficult they may be. Thank you.”
“Today, with the decline in housing construction, noise pollution is not so much of a problem. This new provision has come a little late. But, nonetheless, it is still appropriate for the Ministry to act now to control noise pollution. The Bill has not stated the criteria for noise tolerance level. I believe this would be followed up in the regulations. But I believe the criteria for noise tolerance level at construction sites should vary from location to location, depending on the type of buildings nearby, whether the building nearby is a school, a hospital or a residential estate. I would like to suggest that perhaps the Ministry should not be too strict on the criteria for noise emitted from construction sites, as such noise is usually of a short duration and also because it is very costly to employ anti-noise pollution equipment. For example, using the bore piling is very much more expensive than the traditional diesel piling. The Ministry has already set up rules restricting the time for noise-emitting activities from construction sites. This is one way of controlling noise. The Ministry should perhaps look further into restricting the time even more if noise pollution is still a problem, for example, during the period of school examinations when students are studying. The Ministry should perhaps also set up a consultancy service to advise contractors and other Ministries in planning their development projects. This will be much better than taking remedial action against offenders as remedial measures are likely to be more costly and less effective. Sir, there is no doubt the Environmental Public Health Bill is a tough piece of legislation to protect our environment.”
“We need to step up enforcement and to give publicity to the present anti-litter laws and general education of the public on the need for good habits in public places. Increasing the maximum penalty to $1,000 may have the initial psychological threat. But in the long run, it will have no greater effect than the $500 penalty. The truth is that litter-bugs get away. They do it because they know they will be able to get away with it. How often does one get fined for throwing litter? Perhaps once in a lifetime, and I think that is a very small risk for them to take. Also, as our society is now more mature, the educational approach of solving this littering problem is more acceptable to the people. Public signs should carry friendly advice rather than threat of punishment. So instead of "No Littering. Fine $500", I think we should say, "Thank you for keeping our parks clean" or "Thank you for not littering". It is just like the No Smoking Campaign. Before we used to say, "No Smoking", now we say, "Thank you for not smoking". So although littering is still a problem, it is not as serious, in my view, as the problem of spitting and urination in public places and the stench that is associated with our public toilets, which was hinted by the Member for Kaki Bukit. I think it is time for our Ministry to step up enforcement to further wipe out all these anti-social habits that belong to the colonial past of Singapore. Sir, clauses 47 and 48 refer to the control of the problem of noise pollution on construction sites. Singapore is small and densely populated. Any major construction will give rise to noise pollution. Over the years with major housing development, noise pollution was at its highest level and the people had no choice but to live with the noise.”
“Mr Deputy Speaker, Sir, I would like to say a few words on this Bill. First, I would like to reinforce the point brought up by the Member for Kaki Bukit on the increase in the maximum penalty for littering from $500 to $1,000. I think this is very stiff - $1,000 for littering one piece of paper on the road. But I was told by the officers at the Ministry during our meeting with them that this is only to act as a deterrent. The maximum penalty has never been implemented. The $500 has never been implemented too. But if you do not implement the maximum fine, how is it going to act as a deterrent? If people come to know that you do not, in fact, punish them with the $1,000 penalty, they will not respond to your heavier penalty. But why is there a need for greater deterrent? I feel that perhaps we are a bit over-concerned with the littering problem in Singapore. I do not think our problem is that serious. In fact, on my way to Parliament from Katong, I could not detect a piece of litter on the road. I think that shows how clean we are in Singapore. In fact, Singapore is cleaner than most other cities in the world and, as we all know, we have the reputation of being a Clean and a Green City. Our present anti-litter law is very tough and with the strict enforcement operations and public education, we have been able over the years to achieve a very high standard of public cleanliness. Today, littering is confined to only certain locations, certain spots along the East Coast Parkway. Even our HDB estates are very clean. It is only in isolated vacant turfed areas that we find litter. But on the whole, our estates are clean. But to tackle today's problem, we do not need to increase the maximum penalty.”
“Maternal and Child Health Service (18) That the sum to be allocated for Head P be reduced by $10 in respect of Subhead PE-03-1210 of the Main Estimates.”
“Financing of the National University Hospital (11) That the sum to be allocated for Head P be reduced by $10 in respect of Subhead PD-10 of the Main Estimates.”
“The reason is more of them have company benefits and that those patients in the lower class wards really have a higher utilization of Medisave. In terms of affordability, how do we assess affordability and ability to pay? I think one good measurement of affordability is the number of requests for waivers. If patients cannot afford, they do not pay up. Or knowing that there is a waiver system, they would come forward and inform the medical and social worker that they could not afford to pay up, and could we please help. We have been rather generous in that area, Sir. Let me give you some quick figures. Over the last five years, from 1982 to end of 1986, a total of 74,500 hospital bills were remitted and the amount remitted came to about $6.4 million. This represented about 2% of the total dollar amount of hospital bills raised. In terms of waivers, the waivers have been very small. But the important message behind this is that the low percentage of remission reflects that the hospital charges are within the means of most Singaporeans. The Chairman: Order. It is 5.15 pm. Guillotine time. Dr Aline Wong, please withdraw your amendment. No speeches.”
“Sir, I have not said that the quantum has not increased. In fact, in the earlier part of my speech I referred to the increase in the recurrent expenditure. What I am saying is that the share of the increase in the quantum has been reduced in terms of the contribution by the Government and the contribution by the users. The objective here is to reduce that share of the cost of health. That is the point I am making. I think it is quite right for the Ministry to aim to reduce this share of the increase in the quantum of subsidy and it appears to me that on the Table that was shown to us there was this objective to reduce the share on the side of the Government and to increase the share on the side of the users. Mr Yeo Cheow Tong: Mr Chairman, I am glad he has clarified his stand and that he realizes that in terms of actual quantum it has increased. Sir, in terms of whether the fee increases take into account the affordability versus usage of the services, I think the principle of paying for usage is a good principle and we should try to adhere to it. But whilst adhering to the principle of payment for usage, we should always make sure that, for the low income group who have limited affordability, their affordability is taken into consideration. So both are important. In terms of the use of Medisave as to whether because the Medisave usage on the hospital basis is 40%, as to why 40% of the C-class patients are not using Medisave, Sir, I do not have the actual details here. But I think the data that we have on hand do not really give a breakdown in the usage by classes. They give the total usage in terms of the entire A to C ward accommodation. Sir, the previous information I have seen suggest that for A class patients, in fact more of them are not using Medisave.”
“Mr Chairman, may I make a point of clarification?”
“The Minister has said more than once in this House and he has said it again today that no one will be deprived of hospital treatment because he cannot afford it. I commend the Minister for his compassion for the sick. However, I would like to know how the Ministry actually assesses whether a patient can or cannot afford to pay his fees. If he or she is on public assistance, then it is a clear-cut case. But there are numerous examples of people who are faced with temporary financial hardship, eg, those who are out of work and those whose relatives simply refuse to help out or unfilial children. Will assistance be given to this category? I would be interested to know the criteria as practised by the hospital social welfare department. Sir, since Medisave was touched on, I would like ---”
“However, the reduction in the level of subsidy must be implemented in a more equitable way. When we talk of subsidy, we should consider first on the basis of the affordability of the user, ie, the socio-economic status, before we consider the share of cost of the services rendered. A distinction must be drawn between the C class users and the higher class ward users. Those who choose to go to the higher class wards must be prepared to pay more. The A and B1 class rates should be compared with the private hospital charges. And there is no reason why the users should not be charged above cost if it is still cheaper than the private hospital charges. The C class ward users should be treated differently. There are people who cannot afford. This is the ward for the poor. They are dependent on heavy subsidy and any general increase in charges are likely to affect them most. Those who can afford and who want to make use of C class ward facilities because they are cheap should be discouraged to do so and I encourage the Ministry to formulate a means test to prevent this misuse. Sir, although the latest round of increase in fees is marginal, I am concerned with its effects on the poorer citizens, especially those who have no Medisave accounts. The increase is based more on the utilization of services rather than on affordability. The problem may arise, for example, if a senior citizen in a poor family falls ill and requires repeated hospital admission. I note that about 40% of hospital admissions do not make use of the Medisave account. I would like to know from the Minister what is the proportion of these non-Medisave users who are poor and have no Medisave account.”
“Mr Chairman, first, as a private medical specialist, I would like to declare my pecuniary interest. Sir, Singapore already has a high standard of health care and I like to congratulate the Minister and his Ministry for the good work done. Health care has always been costly and will be more costly in the future. And more and more is being spent every year to meet the escalating costs. I think it is right that if people want and expect a more sophisticated health care system, they should be prepared to share the responsibility of meeting the cost. Sir, I would like to know how important it is to the Minister that the subsidy level should fall every year. During a briefing by the Ministry officers, we were given a paper showing that the subsidy level has fallen year after year, from 1982 at 76% to 68% in 1986. For the two years, 1985 and 1986, there was, in fact, no revision of hospital charges. And the subsidy level was reduced because in 1985 there was increased demand for the use of higher class wards due to the availability of Medisave; in 1986 due to the cost-cutting measures introduced by the Government. In 1987, will there also be a reduction in the subsidy level? The Minister recently announced the revision of fees which will be effective on 1st April. The Ministry, according to the Budget, will spend $64.32 million more this year. Will this announced revision of charges and the continued demand for higher class wards be sufficient measures to produce a reduction in the subsidy level for FY 87? If not, will the Ministry introduce another revision of charges before the year is out? Sir, I am not against the reduction of subsidy level. In fact, I think it is necessary if we want a more efficient and sophisticated health care system.”
“Financing of the Sentosa Development Corporation (11) That the sum to be allocated for Head V be reduced by $10 in respect of Subhead VK-01 of the Development Estimates.”
“The senior citizen health centre, which is now being implemented by the Home Nursing Foundation, can be incorporated in the centre; so can the senior citizens' clubs for social and recreational functions. Voluntary helpers can be more easily recruited from among the residents to help out in these centres and voluntary social welfare organizations can also help out with financial and social support. And, Sir, with this centre acting as a headquarters, domiciliary services such as home-help, befriender scheme, can be more effectively organized. I hope the Minister will consider this suggestion.”
“They cannot cook their meals or do household chores and the biggest problem is immobility and loneliness. Left at home on their own most of the time, they lack both physical and mental stimulation. They soon become senile and infirm. Sir, the Committee on the Problems of the Aged has recommended the various services to reach out to the aged sick in the community and we have just heard from the Minister that some of these schemes have already been implemented. From what he has said, it does not sound that it has been successful. But I would just like to mention the schemes that have been recommended - domiciliary nursing services, home-help services, meal delivery services, day care centres, respite services and the befriender scheme. Sir, will the Ministry implement all these recommended schemes? How would the Ministry assess the need for these services? If the Committee on the Problems of the Aged had recommended them, is there not a feedback that such services are required? As all these services require both high cost and manpower, may I make a suggestion to the Minister - that these schemes be decentralized and coordination centres set up at the constituency or neighbourhood level. This coodination centre can also act as the senior citizen services centre. The centre should provide all the facilities needed for the social, recreational and health needs of the senior citizens. It can include a day care centre where both ambulant and non-ambulant or semi-ambulant aged sick can meet, exercise, have their mid-day meals and engage in a more meaningful day while their family members are out at work.”
“Mr Chairman, Sir, I would like to take this opportunity to focus attention on the problems of those disabled senior citizens who are unable to find admission into Government homes for the aged or for the aged sick and who cannot afford to go to the private nursing homes. What is, in fact, the number of such people in our community? I know that the problem is a growing one. Judging from the number of private nursing homes that have sprung up, perhaps this is not that small a number. Sir, in considering the problems of the disabled senior citizens living in their own homes, we can broadly classify them into two groups: those who are completely disabled, bedridden and incontinent of both bladder and bowel functions who need to be nursed round the clock. The burden on this family is tremendous. Fortunately, Singaporeans are still, by and large, filial to their elders and they accept it as their duty to look after their aged sick in their home. However, we cannot ignore the stress that the burden of an aged sick imposes on his or her family. Not too infrequently this has resulted in quarrels, friction and conflict in the family. In my view, the proper place for this group of aged sick is in the home for the aged sick and not in the homes of their children. So I hope the Minister will continue to do his best to try and alleviate this problem of the aged sick perhaps by creating more beds in the home for the aged sick or subsidizing beds in private nursing homes. The second group, which is the bigger one, are those who are semi-ambulant and frail, for example, old people who suffer from stroke, heart diseases or cancer. They can look after their basic needs but are unable to cope with an independent life.”
“Drug Enforcement and Rehabilitation (17) That the sum to be allocated for Head Q be reduced by $10 in respect of Subhead QG-00 of the Main Estimates.”
“Crime Control (5) That the sum to be allocated for Head Q be reduced by $10 in respect of Subhead QC-06-1210 of the Main Estimates.”
“Development of Refuse Disposal Sites (10) That the sum to be allocated for Head M be reduced by $10 in respect of Subhead MC-02-8101 of the Development Estimates.”