Koh Poh Koon
Singapore
“In 2025, for walk-in patients, the median and 95th percentile doctor consultation waiting times were eight minutes and 72 minutes respectively. However, the Ministry of Health (MOH) does not track waiting times by peak versus off-peak hours, but it is likely that 95th percentile waiting times happened during peak hours.”
“The offences and penalties for importing, supplying or abusing SPS products are similar to those in the MDA, to ensure similar level of deterrence. Mr Speaker, with your permission, may I ask the Clerks to distribute a handout that summarises the changes in legislative penalties for key offences.”
“So, if you are a Singaporean student, you will expect that there will be some subsidies to the fees. The third question on how can the public, who may want to seek psychological care, know who is legitimate.”
“Sir, I thank the Member for his question on audiologists. In general, a qualified audiologist in Singapore needs a higher level of certification because a diploma level may not be quite enough to perform the task. So, we will look and see whether there is a way to actually find an in-between.”
“We are starting with registration to give formal recognition to those who are practising in higher risk sub-sectors in psychology and making sure that the quality, the standards and the support is given to them to deliver the care that the clients and the patients need.”
“It takes a bit of, not just system change in the providers, in the doctors and the care teams, but also, a gradual shift in the mindset of our population as well. So, it is something that we have to continue to do. There is no magic bullet to this and it is not something we can achieve overnight. 12.15 pm”
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“We certainly recognise that seniors tend to have higher healthcare expenses, especially if they have chronic conditions. From the start of this year, we raised annual MediSave limits from $500 to $700 for patients with complex chronic conditions under the Chronic Disease Management Programme, or CDMP. The list of CDMP conditions will be reviewed regularly. To support elderly patients in seeking outpatient treatment, we also introduced Flexi-MediSave in 2015, and lowered the age eligibility from 65 to 60 in 2018, allowing more patients to benefit. From 1 June 2021, we will further raise the Flexi-MediSave annual limit from $200 to $300. We will continue to review the MediSave withdrawal limits regularly, to ensure that they remain relevant and adequate for Singaporeans. Beyond healthcare financing, as Dr Lim Wee Kiak has pointed out, we must also control upstream growth in medical costs to ensure affordability in the long run. First, we should tap on technology to deliver care more effectively while optimising our limited manpower resource. Since the circuit breaker period, polyclinics, SOCs and community nursing teams have used teleconsultation to reach their patients at home, allowing continued consultation and advice for these patients during the circuit breaker period. I understand from feedback that patients are comfortable with teleconsultation. Further, when ready, the National Central Fill Pharmacy will consolidate medications across multiple providers in a central location, enabling the delivery of medications directly to patient's homes, secured post boxes or other convenient locations. This will improve the access to pharmacy services, including for seniors with mobility needs, as Dr Tan Wu Meng mentioned, and support new care models, such as telemedicine.”
“First, MediShield Life covers Singaporeans for large hospitalisation bills and selected costly outpatient treatments. Following the recent MediShield Life 2020 review, various benefit changes have been made to ensure that the scheme continues to provide adequate and meaningful protection to Singaporeans. These include raising the policy year claim limit from $100,000 to $150,000. Premiums will also be adjusted to keep the scheme solvent and sustainable. The Government will provide up to $2.2 billion in premium subsidies and support over the next three years. Net premium increases for all Singapore citizens will be kept to no more than about 10% in the first year. Premium payment will also be deferred till the end 2021 for those who have insufficient MediSave balances and are unable to pay their premiums due to the economic impact from COVID-19. As noted by Mr Gerald Giam, the benefit changes and premium adjustments will take effect on or after 1 March 2021, which is the Monday that just passed. On premium pricing, I wish to assure Mr Gerald Giam that the pricing assumptions are assessed by independent actuarial experts. We are studying how technically complex actuarial reports can be shared in a meaningful way, and will provide an update when ready. Second, MediSave helps Singaporeans set aside some income towards their future healthcare needs, such as co-payments for large bills and for health insurance premiums. I would like to assure Dr Lim Wee Kiak that the MediSave contribution rates and Basic Healthcare Sum are reviewed regularly, in conjunction with other key healthcare financing levers, such as Government subsidies and MediShield Life. Ms Hazel Poa and Mr Gerald Giam asked how MediSave coverage can be expanded in the outpatient setting.”
“We will, therefore, enhance subsidies available in our community hospitals to support patients in utilising appropriate care, and facilitate the smooth flow of patients from acute hospitals to community hospitals. This allows acute hospital resources to be available for patients who require more intensive acute care. We will raise the maximum subsidy of community hospitals to 80%, aligned with that of acute inpatient care, and further increase the minimum subsidy from 20% to 30%. Together with increased MediShield Life claim limits for community hospitals sub-acute care from 1 March 2021, this should make community hospitals even more affordable, especially when compared to a prolonged acute hospital stay. Almost all, about 95% of all community hospitals patients will see an increase in subsidies. Mr Chairman, subsidies are the bedrock of our healthcare financing system. Healthcare costs will continue to rise in the years ahead, and Government spending on healthcare subsidies will commensurately increase even after all these changes. The changes outlined will make healthcare subsidies more progressive and help facilitate care at appropriate settings. We expect to implement these changes over the course of 2022. In addition to these changes, MOH will also review the financing landscape in the Long-Term Care, or LTC, sector. Last year, we launched CareShield Life and Medisave Care, improving affordability. However, as we uplift standards and draw in more Singaporeans to work in the LTC sector, cost pressures may potentially impact affordability. So, in anticipation of these challenges, we will once again review the financing situation for the LTC sector to see if further changes are needed. Next, I will speak on the enhancements to MediShield Life and MediSave.”
“Sir, having been in clinical practice for more than 20 years, I have also seen subsidised patients in the surgical SOCs who have, at times, preferred an A or B1 ward for specific procedures. Some preferred air-conditioning and others wanted more privacy in the private wards. But the cost of a potentially long tail of SOC consultations upon discharge worries them. For this reason, some patients have sometimes had to forgo their preference and request for a subsidised ward instead. These particular groups are those that Dr Tan Yia Swam shared earlier. With better targeted subsidies at the SOCs, we will now allow private patients in the Inpatient setting to opt for either subsidised or private SOC for their discharge follow up. If subsidised SOC is chosen, the patient will no longer be able to pick their specialist, as is the current practice. Overall, the SOC subsidy changes will affect about 30% of subsidised SOC patients, who are from higher PCHI households. Of these, seven in 10 will see an increase of less than $100 in total co-payment for their cumulative annual bills. This can be further offset by MediSave or MediShield Life, or for those who have private insurance coverage. For elderly patients, any increase in co-payment will also be partially offset by Pioneer Generation and Merdeka Generation subsidies. This brings me to community hospitals (CHs). Having worked in an acute surgical ward, I have occasionally encountered patients who have recovered significantly to be well enough for discharge to a community hospital for sub-acute or rehabilitative care, but who were reluctant to do so, due to the differences in the subsidy levels between acute and community hospitals.”
“This acute inpatient subsidy framework will also be applied to day surgeries which are currently subsidised at 65%. Effectively, this will increase subsidies for 70% of day surgery bills and encourage day surgeries instead of inpatient admissions when appropriate. Overall, with MediShield Life and MediSave, we expect that most patients will not see a change in out-of-pocket payments, or OOP payments, with about 30% seeing lower OOP and about 15% seeing higher OOP. Let me go to the SOC setting. While we raised SOC subsidies for the lower income up to 70% in 2014, higher income patients and median-income patients currently receive the same 50% subsidy support, despite both having quite different financial means. To bring about greater progressivity and allow resources to be better directed, MOH will introduce two new subsidy tiers in the SOC setting for patients with higher PCHI: (a) 40% for PCHI more than $3,300 and (b) 30% for PCHI more than $6,500. For a family of four, these PCHI levels correspond to household incomes of $13,200 and $26,000 respectively. Nonetheless, these higher income households may continue to tap on MediSave up to the applicable withdrawal limits to help pay for healthcare bills. With the introduction of the CHAS Green tier in 2019, higher PCHI patients with chronic conditions also have access to subsidised chronic care at CHAS GP clinics as an alternative. Complex chronic patients who are not suitable for management at primary care will also be able to utilise their MediSave through higher limits that are going to be introduced. I will speak more about this later.”
“We will, therefore, introduce a set of changes to the subsidy frameworks for inpatient care at the acute hospitals, specialist outpatient clinics (SOCs) and community hospitals. Let me go through each in turn. First, the acute hospitals. For inpatient admissions to acute hospitals, we currently use individual income as the basis for means-testing. I have seen in my clinical practice and also met people during my Meet-The-People sessions, how a sole breadwinner may earn a high individual income, but shoulders the full responsibility for his or her household needs alone. For such individuals, healthcare costs can become a significant strain, and I have great sympathy for them. Per Capita Household Income (PCHI), which is already widely used in our healthcare system, is, therefore, a better measure of means, as it also considers the amount of household support available, and the number of household members that this individual supports. MOH will thus align means-testing for inpatient admissions to acute hospitals from individual income to PCHI. Another observation over the years is that the physical differences between B2 and C wards are no longer so obvious, following infrastructural improvements to raise patient safety and infection control standards. However, we still have a legacy system of using choice of wards as a proxy of financial means to differentiate subsidy levels. Currently, B2 wards are subsidised at 50% to 65% and C-class wards at 65% to 80%. With better means-testing through PCHI, there is, therefore, less need to rely on ward choice. Therefore, we will unify B2 and C subsidies into a common framework, maintaining the same minimum and maximum range at 50% to 80%.”
“We will also train and equip GPs to care for persons with mental health needs. My colleague, Senior Minister of State Janil Puthucheary, will share more on this later. Second, strengthening regulatory frameworks, such as the Healthcare Services Act (HCSA) passed in January last year, will help us to better regulate newer, non-premises-based, models of care, such as telemedicine, through a services-based licensing framework. Fee benchmarks, an area which Dr Tan Yia Swam mentioned earlier, was introduced in 2018. This gave patients seeking care at private sector providers more confidence that charges are fair and reasonable. Early data showed that doctors have been taking reference from the benchmarks, with more than 80% of charges in 2019 within the upper limit of the benchmarks, and this is about 4% higher than in 2018. Therefore, together with the Fee Benchmarks Advisory Committee, we introduced new benchmarks for anaesthetist and inpatient attendance charges in December 2020 and will continue to review and develop new areas of fee benchmarking. I will now move on to our healthcare financing system which is anchored on Government subsidies and the 3Ms: MediShield Life, MediSave and MediFund. Today, the Government provides significant subsidies, covering up to 80% of treatment costs. In FY19, Government spending on healthcare subsidies amounted to approximately $5.7 billion, or about 60% of MOH's total operating budget that year. This is projected to grow to S$6.5 billion in FY20, an increase of 13.6%. As a society, we widely accept the need to be progressive and to target subsidies to those with greater needs. When formulating subsidy levels across the various healthcare settings, we should also encourage right-siting of care.”
“Over 970 private GP clinics serve as Public Health Preparedness Clinics (PHPCs), screening all patients with acute respiratory infections and conducted more than 250,000 swabs for early detection and containment of community COVID-19 cases. In the long-term care sector, private nursing homes receive funding to provide subsidised services. Both private and not-for-profit organisations also operate many Government-built nursing homes and eldercare centres, under a Build-Own-Lease arrangement. In the pandemic, they actively stepped up safe management measures and supported COVID-19 testing and vaccinations to keep our seniors safe. 4.15 pm To mount a strong pandemic response, MOH also tapped on expertise and resources from private laboratories for PCR testing capacity, vendors and distributors of medical supplies, cleaning companies that disinfected our medical facilities, and security companies, facility managers and transport companies that supported our quarantine and other operations. There are too many to list comprehensively, but each one helped make our robust national response to COVID-19 possible. On behalf of all Singaporeans, I thank our many private-sector partners for protecting Singaporeans from the scourge of COVID-19. I, therefore, agree with Ms Mariam Jaafar that the Government should continue to renew and deepen our partnership with private healthcare providers. First, we will uplift capabilities of our GPs through continuing professional education. For example, the Agency for Care Effectiveness (ACE)’s Clinical Update Service (CUES) assists GPs in navigating areas of uncertainty and challenges specific to their area of practice through personalised, evidence-based discussions.”
“Mr Chairman, even as we continue the fight against COVID-19, MOH’s key priority continues to be a healthcare system that provides good quality, affordable and sustainable healthcare for all Singaporeans. I will speak on how deepening our partnerships with the private sector, strengthening our healthcare financing system, driving greater value in healthcare delivery, and uplifting our healthcare workforce can help us to achieve these aims. Our strong partnerships with the private sector over the years have allowed us to mount a robust and coordinated national response to the COVID-19 pandemic. For example, we have partnered private hospitals to provide subsidised care to patients, such as Raffles Hospital for non-life-threatening emergency cases, an example referenced by Ms Mariam Jafaar, as well as Parkway Hospital, Mt Alvenia and Farrer Park Hospitals for other conditions, including dengue. At the peak of COVID-19, up to 400 beds across seven private hospitals were used to manage recovering COVID-19 patients. Private providers also supported our Community Care Facilities, clinics in worker dormitories, roving medical or swabbing teams, and many much more. Our partnerships with private GPs have also matured over the years. CHAS subsidies have expanded since 2012. Today, over two million Singaporeans can access subsidised primary care at CHAS GP clinics. In FY19 alone, we disbursed more than $180 million in CHAS subsidies. GP clinics in Primary Care Networks (PCNs) anchored care in the community, deriving economies of scale for ancillary services, and serving 130,000 patients with chronic conditions last year.”
“Indeed, Madam, this is what we have been trying to do in this House: to make sure that we take care of our most vulnerable. But I still do not understand. When we talk about sectoral wage floors, we are trying to make sure that the minimum wage floor by the sector is relevant to the particular industry, that job, and what the industry can bear, what the consumers are prepared to pay for the type of services so that that particular wage floor for the sector does not cause disemployment or unemployment in the sector. If the Member's position is that we should set the appropriate wage floor so that we do not create disincentive for employment, then surely it cannot be one single wage floor across all sectors, all job types that can be relevant and absorbed by all different types of services and service bias. I think this is why we propose that the advantage for PWM is that it is customised for a sector. It is a little bit more laborious maybe, but that makes sure that it is something the industry, businesses and consumers are prepared to bear. I said yesterday that we are looking at the option of pushing up for vocational PWM so that it actually involves different job types, especially those in the bottom 20% of income earners across multiple sectors. And that hopefully will address the larger swath of workers who are in the lower wage group. That is our strategy – we hope to cover as many of the low-hanging fruits and those who are in need, as the Member was pointing out. I hope by the end of this year, the tripartite work group will be able to come up with recommendations to push out occupational PWMs to cover the most vulnerable who are currently not covered by the mandatory PWM, sectorally.”
“Madam, I think the Member refers to the cleaning sector. I think that is probably not quite accurate because actually that is already a PWM sector, which is why you do not see an increase in disemployment, because there is a wage ladder together with skills ladder. And in his proposal now, he is talking about a sectorial wage floor, which in fact, is what sectoral PWM is all about. Are you still advocating for your universal minimum wage that WP wants? Or are you going with me now on my sectoral PWM with a minimum wage floor, sectorally? I am a little but confused there. Has the WP's position changed? But I think what the Member must also remember in my previous Parliamentary speech on this topic, is that the minimum wage floor in a PWM is not a standalone because there is a Government top-up with a Workfare Income Supplement that brings the salary way beyond $1,300. In fact, most of them will hit closer to $2,000 or $2,300. So, I think you need to take the whole context of what we have in place. Beyond the PWM, tThere is also the WIS component. And we have been talking about augmenting this yesterday in my speech. I hope the Member remembers my speech from yesterday.”
“The Labour Movement always keeps saying this: that in pushing for too high a minimum wage, a minimum wage can become no wage. And I think this is something that we ought to bear in mind – the cure we are proposing cannot be worse than the disease itself.”
“Mr Giam also talked about licensing requirement in diverse sectors at retail sector. I think that is a focus of the tripartite workgroup's discussion and we hope that we can land on something that can allow us to implement this, without the necessary agencies that may have a particular regulatory lever similar to other sectors that were implemented in the past. And hopefully, this can be a recommendation from the work group sometime in the later part of the year. Mr Giam also actually rehashed some of the points I already made yesterday about uplifting wages immediately using the Workfare Income Supplement. And in fact, I am glad he agreed with my suggestion to consider the wage credit scheme as a form of transitional support. So, I hope that when we do so, we will get more support; and in that sense, if there were any wage increase that translates to consumer costs increase, I hope the Workers' Party Members can also help to convince consumers that they have to do their part as well. What I do not understand is that in advocating for a sectoral wage floor across different sectors, how different is it from what we are already proposing for sectorial PWM, which starts with a sectoral wage floor anyway? And there is, in my mind, I thought there are some convergence there, in what he is suggesting and with what we are doing with the PWM sectorally. What the Member has not said, however, is how does what he proposed, whether it is a pervasive minimum wage can prevent disemployment? I have a great fear, that if we were to push pervasive minimum wage that is beyond what the industry can bear, my brothers and sisters will suffer from this employment and we will see more unemployment out there.”
“Mdm Deputy Speaker, thank you for obliging. The hon Member Mr Gerald Giam made a few references to my two speeches; one from last year and one yesterday about the PWM. So, I thought I am obliged to clarify some issues that he has brought up. The first thing he asked was why we push for a PWM in strata management as well as solar technology sector. I have great sympathy for my brothers and sisters working in the strata management sector. As I said yesterday my speech, this is an outsourced sector. Many of them have seen wage stagnation because as each contract is renewed, there is some resetting of their wages and there is no career progression, even though in terms of absolute pay, it may not be at the lowest bottom end of the bottom 20. I have great sympathy for them. I think the nature of the industry behoves us to think about a PWM model where they can see career and wage progression. So, that is the reason why we are pushing for that. And in essence from the first, when the Labour Movement first talk about PWM in 2012, actually the PWM construct, while is tightly linked to low wage workers, it was never construed as only for low-wage workers, because the whole idea of the four-wage ladders – wage tied to skills to productivity and career progression is applied to all jobs or job roles across the different parts of the industries. The reason why we started with the lowest sector is because they are the ones that need the most help. They are our brothers and sisters who need the greatest uplift to catch up the rest of society. But beyond the lower wage sector, we want the concept and the idea of a PWM to be pervasive across all job roles so that everyone in the job can see progression in their career and no wage stagnation.”
“Sir, as I have said earlier my speech, NTUC hopes that we can get traction within the next two to three years and, certainly, we want to uplift and close the wage gaps for the P20 and P50, hopefully within the next five to 10 years. And for different sectors, some may be more ready to implement earlier, some may take a little bit more time because either the wage structure or the skills framework needs to be more tightly stitched together. Also, for certain sectors, it could be the transitional period required because there could be contractual issues that we need to work with from the employers' side of the house. But, certainly, as I have mentioned in my speech earlier, for the six sectors, the majority of them, we hope to make some progress in the next two to three years.”
“Mr Deputy Speaker, I thank the Member for asking those clarifications. These are questions that we are also working out in the tripartite workgroup because each and every sector will require a discussion with the relevant stakeholders, both on the employers' side and the other agencies, to determine which particular job roles we want to include in the PWM. So, the numbers will not be something that we can tell offhand. There is a process to discuss, and also how, in the vocational type of PWM, we have yet to define what exactly are the vocations that we want to go into. It is not something that you can just say that we want to do so. But we need to get more data, working with the relevant stakeholders. So, give us some time. We will come back – I suppose at some point – to this House and, certainly, the tripartite workgroup will release a stronger recommendation with more details towards the end of the process.”
“The PWM implementation must move faster and wider in line with the aspirations of Singaporeans to build a more just, compassionate and inclusive society where we leave no one behind – every worker matters. Together with our Training and Transformation efforts via the CTC and OTR, NTUC wants to make "Every Worker a Better Worker", make "Every Job a Better Job" and to match every "Better Worker to the Better Job", so that we can make "Every Company a Better Company". Only then, can we emerge stronger with a better economy and secure three wins all round for our tripartite partners and make Singapore a "Better Singapore for every Singaporean". Sir, I support the Budget. [Applause.]”
“Importantly, this sector OTR provided further impetus for the implementation of a PWM for the Waste Management sector last month, uplifting wages of 3,000 local workers. Following the success of the sector OTR, NTUC T&T is engaging individual companies in WMRAS to form individual CTCs to develop their Company level OTR for customised action plans and deeper transformation of the companies. In the next two years, NTUC Training and Transformation Group will reach out to more TACs and business groups to pursue Sector OTRs, including sectors like Food Services and Retail where there is a growing consensus to implement PWMs. We look forward to working closely with the respective TACs to advance our mutual interest of Training Workers and Transforming Businesses. (In English): Sir, I will now conclude in English. Mr Deputy Speaker, Sir, a mandatory PWM or for that matter, a mandatory minimum wage will not guarantee employment for the unemployed because it is not a mandatory employment law that mandates employment. Upskilling and ensuring our workers have the skills relevant to industry needs is an important aspect of the PWM that ensures employability. The PWM is minimum wage plus, because to the Labour Movement, the minimum is just not good enough. Why stop only at the minimum? We want to see progression of wages over time through upskilling. A progressive wage is not about charity. A progressive wage is about recognising the dignity of our workers through their work. It is about paying a fair wage and ensuring that the wages of those in the bottom 20% keep pace with the rest of society.”
“Mr Deputy Speaker, Sir, I will now like to speak in Mandarin regarding NTUC's plans to actualise more pervasive business transformation to ensure workers and businesses are future-ready. (In Mandarin): [Please refer to Vernacular Speech.] The NTUC Training and Transformation Group (T&T) set up in September 2019 aims to address this need by supporting the formation of Company Training Committees (CTCs) between companies and the unions. NTUC partnered A*STAR in the utilisation of the Operations Technology Roadmap (OTR) which facilitates the companies' transformation process and develops mid- and long-term business strategies and workforce training plans. To date, more than 600 CTCs have been formed with over 100 companies having already embarked on the OTR. Approximately 25% of companies are SMEs. Last year, with many more companies seeing the need to transform and respond to the challenges and restrictions imposed by COVID-19, NTUC T&T developed a virtual/hybrid OTR in collaboration with A*STAR, leveraging on digital technology to assist companies in their transformation. Close to 60 companies undertook the OTR via a virtual or hybrid approach and we expect more to do so in the months ahead. Beyond engaging individual companies in CTC and OTR, NTUC T&T has embarked on Sector OTRs working in close collaboration with Trade Associations. An example of a sector OTR is with Waste Management sector between NTUC, the Building Construction and Timber Industries Employees' Union (BATU), the Waste Management & Recycling Association of Singapore (WMRAS) and the National Environment Agency (NEA). Seventeen companies in the Waste Management Sector came together and developed a sector OTR in October 2020.”
“NTUC will begin discussions with the relevant sector agencies on the key milestones for this year to implement a PWM in the sector, which could potentially benefit up to 3,000 workers. NTUC intends to submit our proposal to MOM by mid-2021. The sixth sector, Solar Technology. Following the launch of the industry-led Career Development Plan (CDP) for the Solar Technology sector in December 2020, NTUC has also started discussions with the relevant associations to develop this CDP further into a PWM. Again, while this is technically not a low-wage sector, we believe a wage-skills ladder linked to productivity and career progression will be useful for this growing sector. Let me talk about the fourth measure, which is a Vocational PWM to impact more job roles across multiple sectors. During my last Parliamentary speech on the topic of PWM in October 2020, I proposed that beyond a sectoral PWM approach, the tripartite partners should also look at a "vocational PWM" for lower wage occupations that cut across multiple sectors to improve their wage prospects. Expanding the PWM efforts beyond the confines of the sectoral boundaries will allow larger groups of workers such as clerks and logistics drivers to benefit from the PWM to uplift their wages. The skills framework for these vocations that has already been developed by the Tripartite partners together with SSG can form the basis for a "Vocational PWM" to be developed. This approach should also form a key outcome of the TWG-LWW discussions. One key tenet of the PWM is sustainability, ensuring that the higher wages are coupled with higher skills and productivity. Training of workers and transformation of business is key.”
“The implementation of PWM in this sector will hopefully attract more new entrants for a more fulfilling career. Hopefully, we will have many more superheroes, amongst us, waiting to rescue anyone who may be stuck. NTUC wants to speed up the implementation and expansion of PWM into six more sectors. Last year, NTUC mooted for PWM for the Waste Management sector. Since the formation of the Tripartite Workgroup for Lower-Wage Workers (TWG-LWW) in October 2020, the Tripartite Cluster for Waste Management has been formed in January this year, to develop and implement a PWM for this sector. NTUC has also been pushing for a PWM in the Food Services sector since 2018. In my recent engagement with business owners and members of the Restaurant Association of Singapore, many expressed support to raising the wages of the lower wage workers and are supportive of the PWM for this sector. We certainly hope to make progress in this aspect over the next two to three years. The tripartite partners also see the potential in the Retail Trade sector. PWMs in food service and retail sectors will benefit a potential pool of about 70,000 workers. NTUC hopes that the Tripartite Clusters for these two sectors – food services and retail trade sectors – will be set up soon, with recommendations released by this year and implemented within the next two to three years. The next sector, Strata Management. While most workers in this sector are technically not low-wage, a PWM for this sector can be an enabler for better progression and better work prospects for them. This is because their wages can remain quite stagnant due to the outsourcing nature of this industry. This could potentially benefit more than 5,000 workers in the strata management sector. Another sector, Pest Management.”
“Shortening the income assessment period for Workfare will ensure that we continue to support our low-wage workers in a timely manner, leaving no one behind. Thirdly, let me talk about expanding the coverage of PWM to more sectors. Sir, in 2018, the Government accepted the recommendations of the Lift and Escalator Sectoral Tripartite Committee to implement a PWM for this sector. My fellow Labour Member of Parliament, brother Melvin Yong, has been leading this effort since 2017. Following a three-year transition period, lift technicians will be the fourth group of workers to come under the mandatory PWM and enjoy higher salaries in 2022. Over 2,000 lift technicians in this sector will benefit from a more structured career progression and an uplift to their wages. I recall the story of brother Dickson Tong, my Union Leader in Metal Industries Workers' Union (MIWU). Brother Dickson is a senior lift technician with Hitachi Elevator Asia. He remembered being rather fearful after being stuck in a lift when he was just five years old. To his young mind, the lift technician who came to his rescue was like a superhero. Imagine in a dark lift and the door opens, this lift technician has a halo of light around him, coming from the outside. This has inspired him to join the lift maintenance sector. In the past 20 years, as a lift technician, he kept up with the technological advances in his area of work, ensuring that he had the skills to stay relevant. Now, with the recommendations of the Sectoral Tripartite Committee for Lift and Escalator sector, brother Dickson and other lift technicians can look forward to two career progression pathways: supervisory or specialist tracks, where skills are the benchmark for career progression with corresponding salary increases.”
“I thus urge the Government to provide transitional support to companies, especially to our SMEs, who commit to paying PWM wages, to allow such workers to benefit from PWMs earlier, rather than later. The Wage Credit Scheme has been extended in this Budget. I suggest the Government further consider repurposing the Wage Credit Scheme as a form of transitional wage support to help companies in new sectors implementing mandatory PWMs. Next, let me talk about enhancing Workfare Income Supplement. While awaiting the wider implementation of the PWM, I hope that Workfare Income Supplement (WIS) scheme can also be expanded to provide an immediate uplift. I hope the Government will consider removing the differentiation of the payout by age groups and base the WIS eligibility purely on income. For example, a worker aged 40, earning $1,500 a month gets an annual WIS payout of $1,704. Another worker, 10 years older, aged 50, earning the same salary of $1,500 a month, gets an annual WIS payout of $2,496, an additional $792 more than the worker who is 10 years younger. The 40-year old worker is more likely to have younger dependants and would certainly benefit from a higher WIS payout to supplement his take home pay. I hope that every worker, every low-wage worker with similar earnings gets an equal uplift regardless of their age, to further strengthen our social compact. In addition to the above recommendations, I call on the Government to shorten the income assessment period for WIS eligibility. Currently, the recipients must fulfil the WIS income ceiling criteria in the preceding 12 months before qualifying. This delays much needed support for lower wage workers.”
“67 or better, indicating that the P20 salary is at least two-thirds of the median income earners in these countries, suggesting a narrower wage gap. I can appreciate the different social economic situations and structures in different OECD countries that could account for these observed differences. But regardless of the reasons, NTUC hopes to see a greater range of salary increases for our lower wage workers over the next five to 10 years, so that cumulatively, our lower wage workers can close the wage gap with those earning median salaries in these sectors. Our sisters and brothers in the bottom 20%, should not become a social underclass. I hope MOM and the tripartite workgroup will study this possibility and work on a mechanism to uplift their wages. Third, repurpose the Wage Credit Scheme as transitional support for PWM implementation. Recognising that the current economic climate may be challenging for businesses and consumers to bear the costs of the faster rate of wage growth associated with PWM fully, NTUC calls on the Government to consider transitional support measures for companies coming on board the PWM to help with the increased wage costs. Many SME bosses I spoke to are concerned about the additional wage costs they must bear. Furthermore, it takes a longer time for outsourced sectors, like the Lift and Escalator maintenance to implement mandatory PWMs, because companies need time for current contracts to run out and renegotiate contract prices based on new wage costs with their clients. This means that workers would have to wait a longer period to get their salaries uplifted.”
“The Labour Movement first championed the PWM in 2012 to help all workers across different sectors achieve sustainable real wage increases in tandem with skills upgrading and increased productivity levels. Since then, through the combined efforts of the tripartite partners, 80,000 workers in the three mandatory PWM sectors of cleaning, security and landscaping have seen cumulative wage growth of around 30%, compared to 24% for workers at the 20th percentile of wages over the last five years. Lift and escalator workers will also soon enjoy mandated annual wage increases in 2022 in the fourth PWM that will become mandatory. I will share more on this later. Building on the impact brought about by these three mandatory PWMs, I suggest three further enhancements that tripartite partners can consider. First, include in-house cleaners and security officers in mandatory PWM. Currently, the mandatory PWMs for these sectors apply only to outsourced workers. Our sisters and brothers working as in-house cleaners and in-house security officers are not included in the PWMs. I propose that they should be included in the mandatory PWMs, so that those doing the same jobs should enjoy the same protection, progression and wages. This should be implemented as soon as possible because the framework and mechanisms are already there. Second, the wage gap between the P20 and the P50 must be narrowed so that the wage and social stratification will not be too stark and lead to social fragmentation. Today, the P20/P50 ratio is about 0.54, indicating that the P20 salary is only about half that of the median income earner. But 75% of OECD countries have a P20/P50 ratio of 0.”
“To do so, I suggest that a tripartite committee similar to the Committee Against GST Profiteering be formed. This tripartite set-up could investigate allegations of profiteering and ensure that any price increases flow into the hands of our lower wage workers. This reflects the desire of Singaporeans for a fairer and more inclusive society that cares about the dignity of those who are less privileged. Building an inclusive and compassionate society is also a key thrust of this year’s Budget. Indeed, Every worker matters and every bit of effort counts. Ensuring that those in the lower wage rungs get a fair wage must be a manifestation of a more inclusive society. There will always be a group at the lower end of the wage spectrum that we need to continually support. It is something that we will always have to keep working on. But starting at the "right" wage level is only the first step. If we just stop there, then we run the risk of wage and career stagnation over time. We must ensure that there is wage progression. We need to address the following four areas so that our sisters and brothers can start right and progress well in their careers. First, narrow the wage difference between the 20th percentile or P20 earners and the median income or the 50th percentile or P50 earners; second, enhance Workfare Income Supplement (WIS) to provide an immediate uplift; third, expand sectoral PWM faster to cover more sectors; fourth, implement "vocational" PWM to cover remaining lower wage workers in job roles that are distributed across multiple sectors. Let me elaborate on each of these four measures. First, on the narrowing of the wage gap between the P20 and P50, via the PWM.”
“I will then talk about how the efforts of NTUC’s Training and Transformation Group in Training of our workforce and Transformation of businesses via the CTCs and OTR has been useful in our collective efforts to emerge stronger. Mr Deputy Speaker, Sir, this COVID-19 pandemic has brought to the consciousness of Singaporeans the important roles that essential services workers perform in our daily lives. Nurses and healthcare workers are not low-wage workers but they are perhaps the most visible and recognisable of all the frontline workers performing essential roles during the COVID-19 crisis. As a doctor, as a political officeholder in MOH and as a unionist, I certainly welcome Deputy Prime Minister Heng's announcement in this Budget that the salary of nurses and support care staff will be enhanced. Unfortunately, many of our other essential workers have incomes at the bottom 20 percent of all wage earners. Singaporeans questioned the gap between their salaries and their contributions to society. Singapore National Employers Federation (SNEF) and industry associations that the NTUC have engaged with, agree that lower wage workers should be paid a fair wage. Consumers have also shared that they are willing to pay more, if lower wage workers can directly benefit though higher wages. At the height of the COVID-19 crisis in June 2020, a survey commissioned by The Sunday Times showed that eight in 10 Singaporeans are willing to pay up to 10% or 20% more for essential services, if the money goes to the workers. This mirrors two separate surveys commissioned by the NTUC in late 2020. While consumers are willing to pay more for Progressive Wage Model, or PWM wages, we too need to guard against companies profiteering from these efforts.”
“Labour Member of Parliament brother Mohd Fahmi Aliman, Nominated Member brother Abdul Samad and myself, we will share more about NTUC's aspirations and ideas to expand Progressive Wages and Practices to uplift our low-wage workers. With an eye to our ageing and shrinking workforce, NTUC Deputy Secretary-General brother Heng Chee How will share about what “Emerging Stronger Together” really means for senior workers. NTUC Assistant Secretary-General brother Patrick Tay will advocate for boosting the employment and employability of PMEs, especially those in their 40s to 60s. And NTUC Assistant Secretary-General brother Desmond Choo will call to strengthen the structure of the gig economy and support for young workers. [Deputy Speaker (Mr Christopher de Souza) in the Chair] Labour Member brother Seah Kian Peng will raise concerns on vulnerable citizens who fall through the cracks. A second key thrust of our speeches is on protecting jobs through this pandemic and beyond. I will share our plans for more pervasive business transformation to ensure workers and businesses are future-ready via the Company Training Committees (CTCs) and the Operations and Technology Roadmapping (OTR) process. NTUC Assistant Secretary-General brother Melvin Yong will offer insights on how we should respond to the Work-From-Anywhere and the Work-From-Home phenomena developing in our workforce. And brother Patrick Tay will also call to strengthen the Singaporean Core while Labour Member sister Yeo Wan Ling will advocate for better choices, potential and protection for women in the workplace. Let me begin with the most vulnerable and disadvantaged segment of our workforce – the Lower Wage Workers.”
“Scoot Staff Union together with another Union, the United Workers of Electronics & Electrical Industries (UWEEI) worked closely with NTUC's Job Security Council and our tripartite partners to match some 300 flight crew members from Scoot to jobs in the manufacturing sector. Both unions worked closely with the companies’ human resource team to coordinate virtual job interviews and continued to keep in touch with these cross-deployed crew members to support their adjustment in the new workplaces. With many workers' jobs at-risk, our unions' actions helped to secure secondment, contract or part-time positions into other sectors of need. NTUC was able to leverage on our strong labour-management relations and our network of partners to make a difference in a dire situation. I salute our workers for their fortitude and resilience and their adaptability; and of course, our unions who have worked hard to support them in this time of distress. This year, as we prepare to vaccinate our population and emerge stronger from this pandemic crisis, NTUC will continue to pay close attention to vulnerable worker groups who are more severely impacted by the COVID-19 pandemic and who may also face additional pressures in the new economy. For today’s Budget Debate, NTUC's Labour Members of Parliament will be advocating for the various vulnerable worker groups. This is in the DNA of the unions and also, in the DNA of the PAP Government. We will also lay out NTUC's proposals to better protect and empower these workers in order to strengthen Singapore's social compact.”
“Mr Speaker, Sir, the Labour Movement welcomes the Budget 2021 measures outlined by Deputy Prime Minister and Finance Minister Heng Swee Keat to help workers emerge stronger from this pandemic. The extension of Jobs Support Scheme (JSS) in sectors still facing headwinds and the Covid-19 Recovery Grant for severely impacted workers are welcomed by many of our sisters and brothers in the Labour Movement. The extension of SGUnited Jobs and Skills Package will continue to support the hiring of 200,000 locals this year and provide up to 35,000 traineeships and training positions. Together with the extension of the Wage Credit Scheme and the Capability Transfer Programme, these measures ensure that our workers have good jobs and job opportunities. Over the last one year, NTUC's key priority was on protecting our workers’ livelihoods. Through our NTUC Job Security Council and the Fair Retrenchment Framework, our unions have worked with management to cut costs and save jobs, as well as train and redeploy workers to sectors of need. Many of us in the House would know that the aviation sector has been severely impacted by the pandemic. At the height of the crisis, Scoot’s parent company, Singapore Airlines, had to cut 96% of its flight capacity. After Malaysia announced the Movement Control Order to control the spread of the COVID-19 virus in early March last year, many manufacturing companies had a manpower shortage as Malaysian workers who commute daily between Singapore and Malaysia were unable to come to Singapore for work. Many of my brothers and sisters in manufacturing sector had to pull extra shifts and put in extra hours in over time, just to keep up with the manpower shortage.”
“Sir, I thank the Member for his supplementary question. I think his starting point is that families want to be the first line of support and do their part to care more for the financial needs of those in the family who are suffering from cancer. I think that is quite admirable. But in trying to make sure there is a certain withdrawal limit for the use of the care-giver's MediSave funds to support the needs of a family member who is afflicted with cancer, we need to strike the balance between preserving enough MediSave funds for the care-giver as well, for his or her own longer term healthcare needs, while at the same time, trying to make sure that there is enough family support to care for the one who is suffering from cancer. I think what is important is that if the needs go beyond the current withdrawal limits, the family can approach the Medical Social Worker who will take a look on a case-by-case basis and see how we can mobilise MediFund, which would then remove the need to touch the MediSave of the care-giver, but yet, let the rest of the taxpayers also do their part to support the needs of this person who is suffering from cancer and who may have extra financial requirements.”
“Another grant – the Caregiver Training Grant – allows care-givers, including working care-givers, to attend approved courses to better care for their loved ones. Beyond healthcare-specific financial measures, care-givers can also qualify for tax reliefs if they meet the conditions under dependant related relief schemes. Families who need further help with care-giving expenses can approach the Agency for Integrated Care (AIC) or Medical Social Workers within healthcare institutions for assistance. We will continue to review and develop initiatives to strengthen support for care-givers.”
“Sir, the Government provides a range of financial support measures to help patients and their care-givers defray the cost of caring for cancer patients. We have financial support schemes to help keep cancer treatment expenses more affordable for patients and their care-givers. This includes means-tested subsidies of up to 70% at public Specialist Outpatient Clinics and up to 75% for subsidised medications. Eligible Singaporeans can also receive means-tested subsidies of up to 80% for long-term care services such as centre-based rehabilitation for cancer patients. Cancer patients can also tap on MediShield Life and MediSave to pay for both inpatient and outpatient cancer treatments. For patients who are diagnosed with terminal cancer and receiving end-of-life care, MediSave may be used to pay for home palliative care or day hospice care, and there is no withdrawal limit if the bill is paid using the patient’s own MediSave. In addition, patients with financial needs can apply for MediFund assistance, which helps to provide a safety net for those who are still unable to afford the bills. To allow families to stretch their combined savings to cover healthcare expenses, care-givers can also use their MediSave to pay for medical expenses incurred by their approved dependants. The Home Caregiving Grant (HCG) was introduced in October 2019 to provide a $200 monthly cash grant to eligible individuals, including cancer patients, with permanent moderate disability to defray the costs of long-term care-giving. It can be used flexibly for care-giving expenses, for example, to hire a foreign domestic worker, for the use of eldercare services, or for transport to medical appointments.”
“Together, these measures help reduce the risk of transmission from newly arrived migrant workers into our community. As an additional line of defence, to detect infections in the dormitories and high-risk workplaces early, workers in these settings such as those in the Aviation, Maritime and CMP sectors, are also required to undergo Rostered Routine Testing or RRT at least every 14 days. As the global situation evolves, the Multi-Ministry Task Force will continue to review our border control measures to strike a balance between public health considerations and the needs of our society and economy.”
“Sir, international connectivity is critical to our economy and survival. Singapore can ill afford to close ourselves off fully from the rest of the world. We need a continued inflow of migrant workers to support our key economic sectors, including construction workers to build our homes and critical infrastructure and foreign domestic workers (FDWs) to support the care-giving needs of our families. Many of such workers are from India and Indonesia. If we close our borders to them, many Singaporeans will not be getting the keys to their homes, many households will have their FDWs delayed and will need to find alternative care arrangements for their loved ones. Our economy will also slow down and the lives and livelihoods of many will be impacted. Some of the travellers are our citizens, permanent residents or their close relatives here to visit them. Therefore, we need to adopt a risk management approach to the inflow of these travellers, rather than to close the borders to them entirely. These migrant workers and visitors are subject to a set of stringent precautionary measures to keep the risk of COVID-19 transmission to our community as low as possible. These include pre-departure tests before they leave their country, on-arrival tests when they arrive in Singapore, and a 14-day Stay-Home Notice (SHN) at dedicated facilities, with another test before they complete their SHN and are allowed to leave the facility. As an additional precaution, all newly arrived Work Permit and S Pass workers in the Construction, Marine and Process (CMP) sectors are subject to an additional seven-day isolation and testing regime at a designated facility following their 14-day SHN.”
“Mr Speaker, less than 1% of our total arrivals since 1 April 2020 tested positive for COVID-19. Most of the arrivals during this period were from Malaysia, Mainland China, Indonesia and India. The proportion of imported cases out of the arrivals from each of these countries and regions was 0.04%, 0.01%, 1.6% and 3.7% respectively. From 1 January 2021 onwards, all Work Permit and S Pass holders are required to have medical insurance to pay for COVID-19 medical treatment and hospitalisation costs in Singapore, should the pass holder develop symptoms or test positive within the first 14 days of arrival into Singapore. As employers of Work Permit and S Pass holders are responsible for their medical treatment in Singapore, this requirement helps protect employers against medical expenses. From 1 February 2021 onwards, all short-term visitors applying to enter Singapore under the Air Travel Pass and Reciprocal Green Lanes have to purchase travel insurance for their COVID-19-related medical treatment and hospitalisation costs in Singapore. The travel insurance will help them pay for their costs of medical treatment in Singapore. The visitors can purchase the travel insurance from Singapore-based or overseas insurers. The Government will review whether to extend the insurance requirement to other travellers, taking into consideration the COVID-19 situations in their country of origin, as well as the availability of products in the insurance market.”
“Sir, I do not have specific details on this pertaining to the institutions but I would imagine that the generic provisions for workplace injuries and compensation would apply in this setting as well.”
“Sir, can I just clarify if the Member is asking about compensation by the hospitals or work injury compensation in general?”
“Sir, I agree with the Member that outsourced workers who share the same risks in very high-risk areas, for example, the COVID-19 ICUs or the COVID-19 wards, need to be appropriately recognised. And I am sure the healthcare institutions will look at ways to honour their hard work and sacrifices, and the risks that they take as well. We will give the healthcare institutions the latitude and the time to plan for appreciation in the various ways that they can to show solidarity with these workers who have also taken risks, just like any of our other healthcare workers in the frontline sector.”
“The Ministry certainly encourages the public healthcare institutions to continue looking into ways to show appreciation for the hard work of outsourced staff in many different ways.”
“Sir, as a doctor and a unionist, I want to thank all our frontline healthcare workers for their sacrifices and hard work during this COVID-19 crisis. About 10,000 staff, or about 13%, working in public healthcare institutions are hired by third party contractors. Some examples of outsourced workers include housekeeping staff, security guards, and staff doing landscaping, pest control and kitchen or food services. Of these outsourced staff, almost 70% of them are in roles which require them to be at the frontline or patient care areas, but less than 5% are involved in handling patient samples. In general, the third party contractors have been engaged by the public healthcare institutions under a contract for service arrangement for specific projects or services. They are engaged for a fee and take on the responsibility of hiring the staff required to meet the needs of these projects or services. Hence, the compensation and benefits of staff that they hire is determined and paid by these contract companies. Nevertheless, to ensure that the welfare of outsourced staff is taken care of during the COVID-19 outbreak, the public healthcare institutions have extended various initiatives to them. Outsourced staff who work in high-risk areas are trained in infection control measures and provided with full PPE, or Personal Protective Equipment, when discharging their duties. They are also included in the COVID-19 vaccination exercises for our healthcare workers. The public healthcare institutions appreciate the contribution of these outsourced workers in our battle against COVID-19 and many of these institutions have extended goodwill donations and care packs to their outsourced staff.”
“Sir, I think it is best we leave such a assessment and decision to the managing joint care team together with the patient. A panic attack or anxiety episode can occur with or without cancer, can occur with or without treatment. There can be a myriad of factors involved. But the joint care team will deal with the patients with compassion and find a way to help them overcome this current hurdle they are facing.”
“I do not have the exact numbers right now because it also depends on how many doses, how long the duration of treatment each patient got, and also different body size of patients may require different dosages to begin with. So, that is something that we cannot generalise; it is probably quite individual. That is why the dedicated care team from KTPH, especially the oncologists, will have to reach out to affected patients one by one and go through the conversation in a detailed manner.”
“Sir, the anxieties of patients are quite understandable, especially when they read about this in the news. I would want to give assurance and say that if you have not been contacted by your oncologist, it means you are okay. Those who are affected, as I said in my reply, 200 patients so far have been reclassified from HER2 positive to HER2 negative. In other words, these 200 patients from a poor prognosis tumour now has a better prognosis tumour, because HER2 positivity codes for a poorer prognosis to begin with. Therefore, it needs the managing oncologists to go on a one-to-one with any of these patients whose status have been reclassified, to do a detailed conversation on their own clinical prognosis, what is the stage of the tumour, what treatment has already been given in the past, what will be the on-going treatment needed. Not all patients, I must say, who have been tested HER2 positive be it now or previously, will go on to Herceptin treatment because it is a treatment decision that is guided by the needs of the patient, not just by the test alone. There are some patients for which the body may be too frail; even if you are HER2 positive, you may not receive Herceptin treatment. On the other hand, there are recurrent tumours where the oncologist feels that you have reached end of line, you will still require Herceptin treatment as a last resort, even though it may not be the first line in some other cases. The decision matrix is not a straightforward one. For patients who may be affected, it is best to seek your oncologist's advice. But if you have not been contacted specifically for this, it means that you are okay, your status remains as it was from the last conversation with your oncologist. The cost will vary from institution to institution.”
“I take that as a general question which in any form of medical diagnostics, if the clinician is unsure that a particular test alone cannot give you a high degree of probability of predicting a positive diagnosis or presence of an illness, then it behoves clinical judgement to call for a second test. But immunohistochemistry is a specific unique test. It does not necessarily mean that an alternative is available. Although in the literature, there are other alternative tests that could be done but we have to consider that against the time needed to do it because that could delay treatment, and also whether that brings on unnecessary costs. That, I think, we should leave it to the experts to come up with the process guidelines on what is a testing algorithm to decide for Herceptin-related treatment.”
“But to then say that this translates to a lifetime of compensation, I think that would be a little bit too far a thing to stretch because most of the complications, if any, or most of the side effects relating to the treatment, are transient – diarrhoea, a bit of fever, a bit of chills. They do not have long-term consequences, they are not long-lasting and we have to take that in the correct context of medical treatment. I hope that answers the Member's questions.”
“Sir, let me clarify the Member's misconception. When I said in my reply that KTPH is reviewing all the results from 2012, 2012 was taken at a point in which the test first started in KTPH. It does not mean that all the results going back to 2012 are erroneous. So, in that sense, KTPH is being prudent and careful, super kiasu, going back all the way to when the test first started. It may well be that the errors could have occurred in the last three months or six months. I think the key point usually is when the reagent has been changed. A different brand of reagent or a different provider of the reagent could usually be the starting point of why the protocol or the test conditions were no longer as optimal as they should be. But going back to 2012 when the test first started was really trying to be comprehensive and to be careful, to make sure that we do not miss anybody in the process. It does not mean that the test was erroneous from 2012. The results of the review are still on-going, so I do not want to prejudge the review process from the experts. Let us wait for the experts to look at all the results going back to 2012 and then decide at which point, what step of the process that could have been where the error occurred. When it comes to the question of whether you are going to get compensation, as I said earlier, any treatment cost due to the treatment arising from a positive HER2 results, in other words, usually treatment with Herceptin as the drug, the cost of the drug likely would be refunded. Any investigation or tests or treatment of any related complications as a result of, say, Herceptin, would also be refunded as well.”
“What we need to do, as in this instance, where the clinical practice within an institution does regular review of data accumulated over time; because to show that there is now an over-representation over time, you need to have accumulated enough caseload over a period of time, to show on a retrospective basis that after three years, five years, I accumulated 200 patients, 1,000 patients, and I aggregate the data and I realise, "Oops, it is actually more than 6%". Then, this is when it triggers a review. But when you first start the test, you only have one case, two cases, three cases, there is not enough to do statistical analysis to tell you whether you are above or below the 6% mark. So, I hope that gives a sense that it is not a complete failure of the system; it is inherent in the test and that is how a review process through a multi-disciplinary tumour board picks up any outlier conclusions to trigger a review.”
“Sir, I thank the Member for asking this question. It is going to be a little bit technical but let me attempt to explain this in a way that most people can understand. Inherent in any laboratory test, there is always a chance of false positivity, false negativity. That relates to the sensitivity and specificity of the test. In recent months, because of COVID-19, we have all been doing PCR testing, everybody is a little bit more attuned to the concept of why a certain test can give you a false positive and false negative result. Immunohistochemistry test actually is fairly notorious for having this kind of risk because, as I said, it is semi-quantitative, so the staining process is like mixing poster colours. If any part of the mixing process – the process of processing the specimen by putting stains, dyes and counter-stains – is not done optimally, the key word here is "optimal", you can perform all the steps but if the timing is a bit off, maybe the concentration is off by a little bit, the kind of picture that comes out on the slide that the pathologist gets to look at, will be quite different in terms of contrast and stain. If I may quote from a paper in Journal of Clinical Oncology published in 2015, a British medical journal, it gives a background that early studies using this technique to look at HER2 staining has shown high false positivity rate, as high as 19% – as high as 19% – in the early days when this test was started. Over the years, after 2007, when a stronger push by the professionals to put out guidelines, that false positivity rate has now dropped to about 6% or less, but it is still present; it is never going to be zero.”
“We will also use this chance to learn about some of the failures that may have happened in this multi-step process and help the laboratory to strengthen them for other immunohistochemistry tests as well.”