Lam Pin Min
Singapore
“Mr Speaker, on behalf of the Minister for Transport, I beg to move, "That the Bill be now read a Second Time". This Bill, together with the Active Mobility (Amendment No.”
“It is timely for us to put in place a regulatory framework to ensure that active mobility devices being brought into and used in Singapore are safe. This is a key step in helping us put in place a safe and sustainable active mobility landscape in Singapore. Mr Speaker, I beg to move. [(proc text) Question proposed. (proc text)] 1.55 pm”
“Clause 6 facilitates the transfer to and vesting in the financial security provider of a seafarer's rights against a shipowner as a result of any liability arising from the shipowner's obligation to repatriate the seafarer. For example, the liability to pay the seafarer's wages and entitlements.”
“Mr Speaker, to ensure a safe and high-quality blood supply for our patients in Singapore, pre-donation interviews are conducted to screen blood donors for risk factors and blood donations are also tested for blood-borne infections. However, infections can only be detected some time after the blood donors have been infected.”
“I thank the Member for that clarification. As far as I know, not all mental conditions will be excluded from blood donation. In fact, we have checked with HSA. There is a wide spectrum of mental illnesses – from very mild mental conditions to very severe conditions.”
“I think we must be cognisant that the reason why they are inmates is because of certain things that have happened, prior to that. That actually pre-disposes them to some high-risk behaviours.”
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“Moving forward, I think that it would be good if MDES could be extended to other professionals such as the Medical Officers in the SAF Medical Services as well, beyond the engineers and specialists in the Military Intelligence domain who are currently envisaged to come under this scheme. The job scope of the military doctors and the specialisation that is required of them is more akin to the Military Expert than the combat-trained officer. Does MINDEF have any plans to bring the medical officers under the MDES and why have they not been included from the outset? The objective and focus of the MDES on encouraging development of their specialisation will benefit the individual. I believe that the SAF will also stand to benefit from the better expertise that their doctors are able to provide. Mr Speaker, with that, I support the Bill.”
“Very often, even if they are able to find employment, they may have to accept a substantial pay cut. Will this situation be aggravated for MDES personnel who retire at the age of 60? They would have to compete harder with workers who already have experience and a track record in the private sector. What opportunities will be open for MDES personnel when they retire at age 60? How will the re-employment legislation and the guidelines on re-employment of older workers affect this group of servicemen? While it is a good thing that those under MDES are able to remain in service for a longer time, the flipside of the coin is that when they do retire at age 60, many would still be bearing the financial burden of putting their children through tertiary education and maybe even still paying off their mortgage and other loans. Is age 60 too late in the day for a second career? On a related issue, Sir, the original intention of the Savers and Premium Schemes for Officers and Warrant Officers respectively was to keep the SAF young and vibrant. MINDEF launched the Savers Scheme for the SAF regular officers more than a decade ago. It promised the SAF regulars a sum for their retirement upon completion of 23 years of active service with the SAF. During the introduction of this scheme, it was clearly stated that the objective was to keep the SAF young. Since the retirement age for the regulars has now been extended, can the Minister clarify if the Savers and Premium Schemes should continue to extend beyond the maturity and throughout this extended period?”
“The MDES will, in my view, serve to give due credit and recognition to this important group of professionally trained SAF regulars and clearly demarcate their roles within the SAF. I do however have a concern with the MDES parallel rank structure. Would the parallel rank structure result in the creation of a second class officer, a Warrant Officer within the service? While the amendments to the SAF Act expressly provide that the Military Expert of a certain rank is entitled to exercise the same powers as the Officer or Warrant Officer of the equivalent rank, the question is whether this is sufficient. Frontline combat-trained professionals or personnel are often perceived as being superior in some ways, more important to their counterparts who are support personnel and who may not be at the frontline of battle. MINDEF and the Armed Forces have worked hard to dispel this fallacy. By implementing the MDES rank regime, will MINDEF be creating the perception that MDES officers are somehow less important than their counterparts? If so, this may defeat the purpose of the MDES as an incentivised scheme for the Military Experts. Perhaps the Minister can share how MINDEF can avoid this perception, arising from inception, and how it intends to deal with it if it arises in the future. The other concern I have is with regard to retirement age. Under the MDES, Military Experts are able to stay in service until 60 years of age. Prior to the changes to the Officer's Scheme, Officers were expected to serve until the age of 45. When these officers retire at the age of 45, they are already at a borderline age where it may be a challenge for them to secure employment in the competitive private sector, given their advanced age and lack of relevant experience.”
“Mr Speaker, Sir, thank you for giving me this opportunity to speak on the Bill. In May this year, MINDEF announced the introduction of the new Military Domain Expert Scheme (MDES), which is scheduled to take effect from 1st April next year. To facilitate the implementation of the MDES, this Bill has been introduced to make the necessary amendments to the SAF Act. The MDES introduces a rank structure for Military Expert that is parallel to the existing Officer and Warrant Officer rank structure. The primary effect of the amendments proposed by the Bill is to bring the Military Experts appointed under MDES within the purview of the Act. The Military Expert will be entitled to exercise the same powers and will be subject to the same punishments for offences as his Officer or Warrant Officer counterparts. Indeed, the introduction of the MDES is a positive step towards refining the organisational structure of the SAF. From inception, the SAF has been made up of a myriad of professionals with a wide range of expertise. Being a small island country, the SAF recognises that technology is crucial for overcoming the limitations posed by Singapore's small population. Technology is without a doubt an important element in the SAF's transformation into a Third Generation fighting force. Research and experimentation to develop a technological age began as early as in the 70s. Today, MINDEF is one of the largest employers of engineers and scientists in Singapore. However, the existing scheme for Officers and Warrant Officers is tailored mainly for combat-trained soldiers and servicemen. While over the years, engineers and specialists in military intelligence have been accommodated within this rank structure, it may not have been an accurate reflection of their expertise and job scope.”
“There is another second part of my question which is about the general perception that maybe Singaporeans are just generally unsatisfied with the public transport system or the services that they provide to the public.”
“I would like to thank the Minister for her comprehensive reply. I have two supplementary questions for the Minister. Residents in new and developing estates often complain about inadequacy of public transport, especially bus services. When requests for more services were raised to the public transport operators, the answers that came back often blamed the lack of critical demand and the cost-effectiveness of adding more services. I see it as a chicken-and-egg phenomenon. With the lack of a good public transport network in new estates, residents are forced to turn to private vehicles. How will LTA taking over the central planning of bus routes be able to resolve this conundrum? Or is the poor utilisation rate a manifestation of the general public's dissatisfaction with our public transport system?”
“I have a supplementary question for the Minister. I have a resident who tried to make good use of the Fiance/Fiancee Scheme but, unfortunately, his marriage plans were three times unlucky. As a result, he suffered significant loss in the deposits. I believe there must be many such cases encountered by HDB. Will the Ministry actively consider refunding the deposits to such cases, at least for those who are assessed to be genuine?”
“I would like to ask the Minister, with the evolution of the H1N1-2009 pandemic, will there be a review of the screening and the surveillance strategy at checkpoints as well in the hospitals? Secondly, whether there are any plans to include vaccinations against the common bacteria that causes pneumonia which in a way resulted in the death of vulnerable patients who died from H1N1-2009-related infections?”
“I would like to ask the Minister in view of the current financial crisis and the ongoing H1N1 pandemic, will our target of one million medical tourists per year by 2012 still be achievable? Secondly, how many of our hospitals, both the restructured as well as the private hospitals, have been JCI accredited and if MOH has any intention for all our hospitals to attain JCI accreditations? Lastly, whether MOH has any statistics on the number of Singaporeans who sought medical treatments overseas because of the more competitive prices elsewhere?”
“The Director of Prisons, as I have said, has carried out a very careful review of the relevant officers who had come in contact with the inmate and he is satisfied that no officer has been professionally remiss. They did what they were supposed to do. But for reasons which, in fact, also came out in the court trial, one reason the inmate himself offered was that perhaps because he had a dark complexion, the injuries were not detected. The injuries remained undetected until finally, he disclosed them to the officers.”
“Sir, my question is that it is unimaginable that over eight days, the prison officers could not detect anything unusual about the abuse that this victim was subjected to. Surely there must be a way where prison officers can be trained to detect such abuses. I think we should not put most of the responsibility on the prison inmates themselves. Assoc. Prof. Ho Peng Kee: Sir, as I have said, there are operational procedures which at least try to ensure that the inmates are safe, but no system is foolproof. For example, I mentioned that there are muster checks three times daily. Body searches are also carried out on inmates. Cells also have the distress intercom that will enable any inmate who feels threatened or unsafe and who is beaten up to actually make a report. That is the key point. The key point is that we cannot think of every conceivable eventuality that may happen in prison. What Prisons must do is to provide a system which is generally safe and that is a point I want to reiterate. Our assault rates are low compared to many in the world and, indeed, many inmates come out from the prison gates rehabilitated. But there are also inmates, because of their own backgrounds, because of their own attitudes, may themselves engage in risky behaviour. If we follow the case in the papers closely, this inmate was like that, because he himself had been disciplined in prison before for assaulting other people. So, when it happened, if he had reported it early through any officer on the first day, or on the second day, this would not have happened. That is the point that is best reminding. Otherwise, we think that for eight or nine days they were unreported, why did it happen?”
“Sir, I would like to thank the Senior Minister of State for the very comprehensive answer and the reassurances. But I must admit that when I read the recent report, I was shocked to find that the victim was actually subjected to physical and sexual abuses over a period of eight days under the watchful eyes of the prison service in Changi. This only reminded me of the scenes in the Hong Kong blockbuster movie Prison on Fire –”
“I would like to ask the Minister this. Currently, the Medisave maximum allowable usage for acute hospitalisation is $450 for daily hospital charges. And for community hospitals, it is just $150 per day. This disparity may have encouraged patients to stay put in the acute hospitals rather than transfer to community hospitals. Will the Ministry review this criterion to encourage more elderly sick or those with chronic diseases to transfer to community hospitals instead?”
“Mr Speaker, I would like to thank the Ministry of Health for doing an excellent job in helping Singaporeans battle Influenza A (H1N1-2009) pandemic. I would like to ask the Minister one question which is, whether there are any clear and timely guidelines to the PPCs on when to offer Influenza A (H1N1-2009) testing. The reason I ask this is because there were reports in the papers that patients were turned away, treated symptomically and later found to have Influenza A (H1N1-2009) infection. There are down stream effects such as the duration of MCs to be given, whether the need for Tamiflu prophylaxis for the close contacts in the family as well as to prevent the further spread of the disease to the surrounding family members.”
“We debated about Eldershield in this House some years back. When the Eldershield scheme was launched in 2002, there were also heated public debates on the high premiums and low payouts. After five years of data collection, the scheme was revised according to the latest information available. According to analysts, theoretically, the odds in the equation for Eldershield claims are one in five for men and one in four for women. Therefore, if the incidence of birth defects is only 2%, bearing in mind this can range from very mild to very complicated conditions, would Infantshield not be possible without having to charge exorbitant premiums? Insurance is about giving people a peace of mind. Medical insurance is something that you buy hoping never have to use it. In a similar vein, medical insurance coverage for children with congenital diseases is to give would-be parents a peace of mind. I hope that the Ministry would seriously consider and study if this would be feasible. At the very least, we could start with baby steps of providing coverage for certain congenital diseases, and the extent of the coverage may then be progressively increased as our confidence and experience progress. Sir, the Ministry of Health's mission is to help Singaporeans live well, live long and with peace of mind. And also to promote preventive healthcare and champion an active, healthy lifestyle among Singaporeans. I fully endorse this philosophy and would like to thank the President once again for his visionary address to Parliament. On this note, I support the motion. 4.52 pm”
“Whilst keeping good health can be argued to be a personal responsibility, the Government could do more in the areas of prevention and early detection of chronic diseases and cancers. More public education, screening and prompt medical treatment can help minimise severe illnesses and medical complications. Can we even consider giving rebates on medical insurance premiums just like for motor insurances, if the policyholder maintains a healthy lifestyle and remains disease-free? I applaud the Ministry's commitment to tackle the "silver tsunami" by developing the 3E framework, namely, Eldersave, Eldershield and Elderfund, to help meet the needs of the ageing population. However, I would like to urge the Government to consider providing Infantshield, or medical insurance for unborn children who may be inflicted with congenital illnesses diagnosed at birth. Sir, I have come across cases whereby unborn babies have been diagnosed with congenital diseases that are medically viable should medical treatment be instituted. Parents in these cases are left in a dilemma of the prospect of being saddled with a lifetime of debts as a result of opting for medical intervention and the difficult decision of discontinuing the pregnancy. For every 1,000 births, up to 20 may have some birth defects with varying degree of complications, from cleft lip to heart or spinal cord defects. Whilst children with congenital anomalies can still join MediShield to cover medical treatment that is not related to their congenital conditions, currently insurers, including MediShield, do not cover treatment related to congenital conditions. The reason often cited was that existing policyholders will not welcome a higher increase in premiums to fund this additional liability. Insurance is about risk pooling.”
“7% felt that they could receive good medical treatment at restructured and private hospitals respectively. With regard to the cost of healthcare, 45.1% of respondents agreed or strongly agreed that healthcare was affordable, while 29.3% disagreed or strongly disagreed. Sub-group analysis by household income revealed that higher household income was positively associated with agreement that healthcare was affordable. This leaves us with more than half of the respondents, majority from the low- to middle-income houdeholds, who did not think healthcare was affordable in Singapore. These findings are worrying as healthcare by its nature is very emotive and the perceptions, rightly or wrongly, can result in unfounded anxieties and dissatisfaction amongst Singaporeans. Singapore's modest spending on healthcare, currently standing at about 4% of GDP, compares very favourably with other countries such as the United States (at about 16%) and the United Kingdom (at about 9%). With the rapidly ageing population in Singapore, it is inevitable that healthcare spending would have to be adjusted upwards. Keeping healthcare spending low, not in tandem with the increased needs of the population, will invariably result in the healthcare costs being passed to the general population. Having said that, we have to spend the health budget judiciously and in areas where we can reap most tangible benefits. The average lifespan of Singaporeans have risen, 81.8 years among women and 78 years in men. However, a study in 2007 showed that out of this lengthened lifespan, an average of eight years will be spent in poor health.”
“In addition, what is also severely lacking is the emphasis on social independence and improving the quality of lives of the handicapped and the sick and aged who want to contribute to the society and continue to stay in their own homes respectively. I hope MOH and MCYS can work together in the provision and research and development of assistive technology for the elderly and the handicapped. Many people are worried about the increasing cost of healthcare in Singapore. They are worried about the affordability of medical bills, in case they fall ill and need to be treated in the medical institutions. We hear of people being burdened with large hospital bills that can wipe away several years of savings. There is also a saying among the lower-income group that "it is better to die than to fall sick in Singapore". These Singaporeans are indeed apprehensive about the affordability of healthcare in Singapore. The Government has repeatedly given the assurance that no Singaporean will fall through the cracks. Strategies to make healthcare affordable for all include means testing and subsidy for healthcare services and the 3M framework, namely, Medisave, MediShield and Medifund. In a survey by Singapore Health Services in 2006 to study the public perception of healthcare in Singapore, the researchers sought to ascertain public perceptions of the Singapore healthcare system in general, paying special attention to issues related to cost and quality of primary healthcare vis-a-vis tertiary healthcare. The quality of healthcare was generally well regarded by respondents. 55.9% and 65.7% perceived that they could receive good medical treatment at polyclinics and private general practitioners respectively, while 65.5% and 46.”
“We should make use of this respite period to fine-tune our flu emergency preparedness plans and also to stock up our armamentarium of flu battle gear. The recent episode has highlighted the inadequacies of some of our primary healthcare practitioners in facing up to such an adversity. I hope the Ministry can look into this expeditiously. Being one of the fastest ageing populations in Asia, Singapore faces the continuous challenge of addressing the healthcare needs of the elderly. I have, on many occasions, raised this issue in this House. I am delighted that the Ministry of Health’s Addendum has highlighted many sweeping initiatives to enhance the capabilities and capacity of intermediate and long-term care services, including infrastructural, financial, manpower and professional developments. However, I would like to urge the Ministry to look into homecare and caregiver support as another priority area in managing the needs of the elderly sick. While building more nursing homes is important in addressing the current shortages, we do not want to send the wrong message to Singaporeans that sending our elderly parents to the nursing homes is the quick and easy solution to the care of the elderly. I am sure most elderly would want to grow old in the comfort of their homes, surrounded by the love and concerns of family members. Homecare service in Singapore is still grossly under-developed compared to many countries in the West and in Australia. The Government should look into this area of support, bearing in mind that 20% of Singaporeans will be above the age of 65 come 2030.”
“It is still evolving and its ultimate trajectory cannot be seen then when it first surfaced and not even now. Sir, we have been fortunate thus far with no confirmed case in Singapore. Would we continue to be so lucky? Being an aviation hub, we are very vulnerable to the import of infectious diseases. We must therefore be prepared to see our first case eventually. What is critical is for us to remain vigilant, exercise good personal hygiene and social responsibility. This will invariably help to prevent the rapid spread of the disease should the virus reach our shore. The Ministry’s measured response of progressively lowering the DORSCON level to yellow is appropriate as we are beginning to know more about this illusive enemy. As the Sun Tsu Art of War or 孫子兵法 (Sun Zi Bing Fa) strategies: 知彼知己，百战不殆 (Zhi bi zhi ji, Bai zhan bu dai); 不知彼而知己，一胜一负 (Bu zhi bi er zhi ji, Yi sheng yi fu) ； 不知彼，不知己，每战必殆 (Bu zhi bi, Bu zhi Ji, Mei zhan bi dai) 。 Translated to English, it means: "He who knows his enemies and himself, will fight without danger in battles. He who knows himself, but not his enemy, will have an even chance of victory. He who does not know himself nor his enemy, is bound to suffer defeat in all battles." We are still in a precarious position of not understanding our opponent fully. Scientists should step up their effort to unravel this virus and to produce effective vaccines against it. Meanwhile, we should not let our guard down.”
“During the Spanish flu pandemic in the early twentieth century (which also belonged to the H1N1 sub-type), the mortality rate of the disease was 2% to 5%, with the number of deaths estimated between 20 to 40 million worldwide. Not too long ago, SARS infected about 8,000 persons worldwide, between November 2002 and July 2003, with 774 reported deaths. This works out to a mortality rate of 9.6%. Till date, the Influenza A H1N1 has infected more than 11,000 involving 42 countries and 86 fatalities. The numbers are probably increasing as I speak. The mortality seems low. The rapid evolution of the Influenza A H1N1 epidemic has caught many experts and government agencies by surprise. While we can take comfort that the morbidity and mortality of this disease is low, what is it to stop this virus from mutating into a more virulent and dangerous strain in the very near future? The Ministry of Health has done an excellent job in handling the threat of H1N1. Our rapid and aggressive response was necessary initially when little was known about this mysterious disease that has infected many and claimed so many lives in Mexico, the epicentre of this outbreak. I have received feedback from fellow healthcare workers that perhaps the Ministry had over-reacted by implementing what perceived to be draconian measures then. But I beg to differ. Have we forgotten the painful lessons of the SARS episode just six years ago? Have we forgotten how the lives of many selfless healthcare workers were lost just because we were fighting an invisible enemy with inadequate personal protection? Do we need to see lives lost before stepping up our defences against the threat of H1N1 in Singapore? We are facing a new enemy, a new virus in the world.”
“Subsequent major terrorist attacks in London, Madrid and Bali served as constant reminders that any one country can fall victim to such fanatic ideologies should complacency set in and if we let our guards down. The escape of Mas Selamat was a costly lesson for our security forces and also served as a wake-up call to all Singaporeans that we should remain vigilant in order not to be outwitted by preying terrorists. Against this backdrop of a changing global financial environment and the constant threat of terrorism, I would like to focus my speech on three health-related issues that affect Singaporeans, namely, the emerging threats of infectious diseases, ageing issues and the perennial concerns of rising healthcare cost. With increased air travel and worldwide connectivity, the threat of infectious disease pandemic cannot be underestimated. Many people can potentially be exposed to an increasing array of infectious diseases, serving as effective vehicles for its spread. Air travel and globalisation have brought a whole new dimension to the epidemiology, surveillance, spread and control of infectious diseases. Just last year, the House debated on the Infectious Diseases (Amendment) Bill, which empowered the Minister for Health with more power to contain the outbreak of infectious diseases. We will never have imagined that this enhanced power can be exercised so soon, in the recent handling of the Influenza A H1N1 epidemic. Many experts have warned of the possibility of another influenza pandemic occurring. It is not about the certainty of it happening, but rather the question of when and how soon. Could this H1N1 scare be the one pandemic that the whole world has been anxiously waiting for?”
“Mr Deputy Speaker Sir, I rise in support to express my sincere thanks to the President for his Opening Address. Singapore is journeying into our 44th year of independence amidst a rapidly changing world. The world we all live in today is a very different world from the one we were so used to in the past. It is fraught with unexpected challenges, rapidly changing geo-political climate, fragile financial environment and constant threats of infectious diseases. While the fast changing world poses unprecedented challenges for Singapore, it also opens up an ocean of fresh opportunities. As this year’s national day slogan puts it: “Come together, reaching out, reaching up". To thrive in challenging times like these, Singaporeans need to stay united, move to where the action is and seize the golden opportunities and attain excellence. The effects of the financial armageddon is not fully manifested yet as most analysts believe the economic woes in the United States have hardly been cleaned up. The American consumer is still deep in debt, housing inventories continue to mount across the world and the recent green shoots are sprouting only because of massive government spending all around the world. Many developed countries are expected to run a fiscal deficit of close to 10% of GDP, on average, in 2009. It is cold comfort that this quarter the Singapore economy contracted by a smaller percentage of 14.6% as compared to the previous quarter. Even then, the GDP growth forecast by MTI will not be revised, remaining as minus 6% to minus 9% for year 2009. Amidst this economic uncertainty lies the unceasing threat of terrorism. The September 11 attack on mankind has transformed the world into one of constant fear and mindless loss of innocent lives.”
“The decision on the suitability and viability should lie on the transplant specialist, who should decide based on the medical history of the donor. The second initiative would be the setting up of a "live" donor registry where matching of a donor whose tissue is incompatible with the intended recipient with another pair in a similar situation. These paired matching donations would hopefully minimise the situation whereby altruistic donors are turned away because of incompatibility with the intended recipient and thus boost the number of altruistic "live" donations in Singapore. Sir, with the increasing prevalence of chronic systemic diseases such as hypertension and diabetes mellitus in Singapore, the number of patients suffering from organ failure is expected to increase further. Whilst the amended Bill will serve to increase the supply of both cadaveric organs and altruistic "live" organs, it is imperative to target the underlying factors contributing to the causation of organ failures. Continued health education and promotion of healthy lifestyles must be stepped up to keep Singaporeans in the pink of health. As the saying goes, "Prevention is better than cure". This would hopefully keep the number of organ failure patients in check. On that note, I support the Bill. ADJOURNMENT OF DEBATE Resolved, "That the debate be now adjourned." – [Mr Lim Swee Say].”
“After it was reported in some websites our intent to liberalise and sanction the reimbursement for organ donation, there have been several postings from India, Pakistan and Bali, asking for information on how they could donate their kidneys for a price. This is the image that we do not intend to portray to the rest of the world. I would like to seek clarification from the Minister if the reimbursement is restricted only to Singaporeans and how would foreign donors and recipients, ie, a foreign donor donating to another foreign recipient, be managed should the transplant procedure be performed in Singapore? Would the donor be reimbursed, and if so, who will pay for the amount reimbursed? Singapore's current opt-out system of cadaveric organ donation is one significant step in improving the supply of organs. In order to further tackle the shortages, immediate steps must be taken to improve on the current number of cadaveric and altruistic "live" organ donations. There are several limitations in the current HOTA and I am glad that the Ministry of Health will be introducing two new initiatives to boost the organ supply in Singapore. The current HOTA forbids the harvesting of organs in consented deceased above the age of 60. This has led to unnecessary wastage of potentially healthy organs. Many countries, including Spain which has one of the world's highest transplant rates, do not set such upper age limit. Lifting the arbitrary age limit of 60 for cadaveric organ donors would definitely increase the pool of potential cadaveric donors. There is currently no scientific basis to the viability of the donated organ based on its age.”
“In addition, sufficient safeguards must be put in place to ensure that there is no coercion or enticement into donating, and that the donor is adequately counselled on the decision. In Iran, the "sharing of organs", as they have coined it, is controlled by the Charity Association for the support of Kidney Patients (CASKP) and the Charity Foundation for Special Diseases (CFSD), with the support of the Iranian government. Whilst the current system in Iran may not be perfect, it is definitely worth a look and the important lessons learnt can be useful during the formulation of our system. The shortage of donor organs is a worldwide phenomenon. It is estimated that there are 40,000 patients waiting for a kidney in Western Europe, 6,000 in United Kingdom and about 70,000 in the United States. Against a backdrop of this critical shortage in supply of organs, the cost of organs in the black market has escalated significantly. The rising cost of human organs is driving syndicates to resort to even murder to harvest human organs. The organ transplant market has become so lucrative and is also the driving force behind the transplant tourism in certain countries. There is, therefore, an urgent need for Governments to take bold steps to regulate and prevent exploitation of the vulnerable. Sir, with the passing of this Bill, Singapore is likely to be one of the leaders in formulating reimbursement for "live" organ donation. It is, therefore, imperative for the Government to guard against, wittingly or not, from promoting transplant tourism.”
“Altruistic related "live" donation, however, is unlikely to experience significant decline as majority, if not all, of such donations were done out of love and care for the related recipients. And I sincerely believe no amount of monetary enticement will deter or change the minds of these altruistic donors in giving a new lease of life to their loved ones. The sole objective of reimbursement would be to compensate the donors for the sufferings and inconveniences experienced as a result of the organ donation. There is no doubt that the donor suffers the pain and discomfort of the surgical procedure and the recuperation period can last up to a few months. This period of downtime will render the donor economically inactive with consequential loss of potential income. This could only serve as a disincentive for a willing altruistic "live" donor to step forward. The all-important question of how this can be done fairly and ethically will warrant a comprehensive and robust study by all stakeholders. The amount to be reimbursed should ideally be fair, yet not large enough to become an inducement. The mode of reimbursement also needs to be worked out. There have been suggestions of paying a monthly allowance or setting up a fund for the donor's family. Others have also suggested putting the amount into a CPF account or using it to pay for the donor's medical insurance in the long term. One plausible proposal would be to have a neutral third party to administer the reimbursement for organ donation. This would prevent the direct negotiation between the donor and the recipient, which can sometimes make the whole process look so commercial.”
“On the contrary, proponents of legalising organ trading argue that if there were willing buyers and willing sellers, why not? If the availability of an organ could save a life, who are we to judge and nail the death sentence on the sick, when the transplant operation could well be the gift of a new life? However, the current state of affair is less than ideal. The current HOTA makes the payment of any kind illegal and this has inevitably pushed desperate patients into seeking quick and often reckless solutions from the black market. It will be naive of us to believe that all is well and that legalising organ trading will only result in the poor being exploited. The near-global ban on organ trading has forced the practice underground, with little control over the standard of medical care and the welfare of the poor organ sellers. The very fact that the black market exists to serve the high demand from patients all over the world already result in possible and unreported ignorant donors being exploited by the buyers and their middlemen, since there is currently no law to ensure a fair, un-coerced deal. Unfortunately, the terms "Organ Trading", "Organ Sale" or "Compensation" exuberate very negative connotations. A better and more appropriate term, as proposed by the Minister, after public consultation, will be "reimbursement". Many have argued that allowing reimbursement of organ donors will result in the significant shrinking of the number of altruistic "live" donations. Whilst the number of altruistic unrelated "live" donations may drop, the proportion of unrelated "live" donations is indeed minuscule in the first place.”
“Mr Deputy Speaker, Sir, I rise in support of the Human Organ Transplant amendment Bill. The organ trading debacle last year has raised many eyebrows and mixed reactions from Singaporeans. Organ trading or organ sale is a highly controversial subject, with Singaporeans clearly divided on the issue. The one good outcome that arose from the hype and debate of this issue last year was the enhanced awareness of the plights of many organ failure sufferers and the controversies related to illegal organ trading. Organ failure can affect any organ in the body, such the kidney, liver, heart, lungs and cornea. Organ failure can also affect anyone in Singapore. Whilst dialysis can help to prolong and sustain lives in patients with end-stage kidney failure, sufferers of liver, heart and lungs failure often die before a suitable cadaveric donor can be found. In Singapore, there are currently about 560 patients on the waiting list for a kidney transplant. The wait is long, averaging an arduous nine years, and often futile for many, dropping out of the list from either death or becoming too ill to eligible for one. The main controversy in organ trading stems around the ethical concerns, for fear that the poor and ignorant donors may be exploited by the rich recipients, and that those who can afford to pay will step out of the queue sooner to get a transplant. The opponents of organ trading frown upon the idea of even putting a price tag on any human organ. Some found the thought of selling one's organ demeaning and repulsive. They argued that organ trading can potentially divide people into "worthy patients" and "worthless sellers". Ethics aside, many religions also do not condone the sale of human organs.”
“Can I ask the Minister for a progress update on the corporatisation process? And whether there would be significant retrenchment as a result of the reorganisation? And if so, what measures are in place to help those affected?”
“Mr Chairman, Sir, air passenger traffic has seen a decline over the past few months. The economic downturn has put a spin on the number of people making air travel. The aviation industry is expected to remain challenging in the months ahead. The International Air Transport Association (IATA) has projected a 3% drop in global passenger traffic while cargo traffic is expected to drop 5%. The global financial crisis has also hit the cargo business especially hard. SIA Cargo had mothballed one freighter in the desert in the United States. And according to IATA, cargo traffic plummeted 22.6% in December 2008 and it is expected to get worse in the coming months and years. The dogfight for premier air hub status is a bruising one and the stakes are high. Changi Airport has had a good 27 years but it is up against some serious competitors such as China, India and the Middle Eastern countries. I would like to ask the Minister how long can Changi Airport retain its lead as a leading air hub in the region in the face of falling air passenger and cargo volume. What measures are in place to help Changi Airport maintain its status as an air hub? Civil Aviation Authority of Singapore which manages Changi Airport employs 1,700 public servants. By August 2009, CAAS will retain its regulatory functions, but the running of Changi Airport will go to a separate corporate entity. This entity will adopt private sector practices like setting competitive salaries to stay competitive and viable. Many successful airports around the world have gone corporate and in some cases are run by public-listed companies. The objectives of corporatising Changi Airport are to give it flexibility to respond to challenges, ability to attract and retain talents and pursue overseas ventures.”
“Mr Chairman, Sir, the vehicle population growth rate previously stood at 3% and this has been revised downwards to 1.5% from 2009 for the next three years. If the roads in Singapore also grow at the same pace, there will be no problem of severe traffic congestion. Unfortunately, in the last 10 years, our road system grew only at 1% per year, and it is expected to grow at half this pace in the next 10 to 15 years. This mis-match has contributed to the traffic congestion we see each day. Given that only 12% of Singapore's compact land is being used for the construction of roads, the possibility of building more roads to help ease the traffic congestion is not possible. Can I ask the Minister what is the long-term strategy in the management of road traffic congestion in Singapore, and whether other viable measures are being considered other than erecting more ERP gantries and raising ERP rates?”
“Mr Chairman, Sir, MOT's announcement of LTA's future role as a centralised bus planner is a welcomed move. There is no doubt that Singapore's land transport system is probably one of the best in the world. However, there is still room for improvement and, I believe, MOT will continue to strive for excellence and to make public transportation in Singapore a choice mode of travel. One of the problems faced by my residents is the lack of connectivity of the bus network. Although there is currently a LRT network serving the Senkang/Punggol area, residents staying far away from the LRT stations do not enjoy the convenience brought about by the system. In fact, the presence of the LRT has taken away previously existed bus services or even denied them the option of having additional bus services plying those so-called areas served by the LRT. Can I ask the Minister for an update on centralised bus planning? When will LTA take over this role? What is LTA's mandate and how Singaporeans will benefit from this initiative? Update on Central Bus Planning”
“Sir, the number of Singaporeans seeking social assistance during this economic downturn is expected to increase. Many Government agencies, such as MCYS, CDCs, WDA, the VWOs, GROs, FSCs, self-help groups and religious organisations have shown a caring and loving heart by extending assistance to Singaporeans in need. In fact, more and more schemes are being introduced by the different agencies, and the list just keeps increasing. This is indeed very heartwarming and reassuring. However, it is exactly this many-helping-hands approach that has resulted in duplication of resources and confusion on the ground. The needy looking for help in the social assistance circle is like walking into a rainforest full of trees without any compass or GPS to provide directions. Many needy residents, especially the old and illiterate, are not sure exactly who and where to turn to for help. At times, residents may turn up at a particular agency only to be told that they have come to the wrong place. I would like to suggest to the Minister that a central coordinating agency be set up to coordinate all initiatives offered by the various agencies, and to provide a no wrong door policy where Singaporeans can just turn up to seek any form of social assistance without being turned away. Just like in a tug of war scenario where all hands pull in one common direction to achieve victory, the many-helping-hands approach is only effective if there is one mind to control and coordinate the efforts of the different agencies. Coordinating Help for the Needy”
“The problem, I think, is well-defined, but the solution not so straightforward. Part of my motivation for supporting Medisave for outpatient mental illness is because I want to also, through this, build up a way of monitoring how GPs, psychiatrists handle their mentally ill patients. Just as the Medisave scheme for diabetes, I now have more than a year of data on how diabetic patients are being handled by their GPs: clinic by clinic. What is the number of cases they have? What is the blood-sugar level of the patients over time? Does it improve statistically for the whole group, does it stay the same, or does it worsen? One year is a little bit too short, but as we build up the data series over the years, we will get valuable information from the data. My intention is to publish it. Not to witch-hunt or to blame, but to let doctors learn from each other how they handle diabetes, for example, their performance level versus other GPs. And I am hoping that, in the case of mentally ill, likewise – depressions and schizophrenics – if we find that there are clinics which are able to handle their mentally ill patients better than others, then they may be able to share their experience, how they are more effective than other GPs, for example, in getting their patients to comply. So, along the way, I hope we all learn from it, and the industry improves and patient care improves as well.”
“I would like to seek Minister's clarification on the issue of mental health. We know that regular intake of medication is important in the treatment and control of symptoms of many psychiatric illnesses, such as schizophrenia and even depression. And we know that it generally is beneficial for the patients with mental illnesses to receive social rehabilitation in the community. I would like to ask how is the Ministry or IMH or the mental institutions going to monitor the recovery process of patients who are discharged from hospitals. Is there a system whereby this institution can actually track these patients, should they default follow-up? This is important because the omission of any medication and the necessary review by the professional can actually lead to other potential complications or even pose a threat to the safety of the patient and even the community at large. We have heard cases where patients were discharged, defaulted follow-up, omitted medication, failed to follow up until something big happens in the news. Mr Khaw Boon Wan: I thank Dr Lam for his comments. This is indeed a great challenge. Not just here, but all over the world for the mentally ill. How do you ensure compliance? Chronic diseases always have this problem. We all know the way to treat it is consistent lifelong low-tech treatment to avoid complications. The mentally ill presents another different aspect as, sometimes, the patients just deny that they have mental illness. At the MPS occasionally, we see these cases and some of them come to me and complain that the doctors insist they must eat this or eat that. So I learn from them how they tricked the doctors to think that they were taking the medication when they did not.”
“I would like to suggest the following to the Ministry: Consider setting up a one-stop caregiver resource centre to provide a range of supportive services, including information, educational programmes and emotional support for family caregivers. Formation of caregiver support groups to allow caregivers to ventilate, share and support one another. Formation of dedicated homecare medical teams to provide medical review services of stable patients at their homes so as to minimise the hassle of frequent travels to healthcare institutions, especially when most of them are non-ambulatory. And, lastly, consider the provision of monetary allowances for caregivers to compensate family caregivers for their unpaid effort and stress. This would definitely help alleviate the financial burdens faced by these families. Quality and Affordability of Healthcare”
“The medical fraternity is beginning to recognise the psychological and physiological changes experienced as a result of chronic stress due to on-going care giving activities. This condition has been coined "Caregiver Syndrome". Caregivers tend to be so immersed in their role that they neglect to take care of themselves. In addition, caregiving can result in new financial burdens, as many have to give up their careers to look after their loved ones. Many families with elderly sick or disabled family members would require special care and attention. Home-based care not only provides the ideal cost-effective long-term care of the elderly frail and disabled in the family, it also helps free up limited vacancies in rehabilitation centres, daycare centres and old folks homes for families who genuinely require such services. As the population greys, the infrastructural support such as nursing homes and step-down care facilities must grow in tandem. One complementary alternative would be to enhance the homecare support where the dependent elderly can receive optimal quality care and family love. Unfortunately, the structural support for caregivers in Singapore is insufficient, many a time, it is not available when it is needed most. Caregiver to the elderly dependent is like the conductor to an orchestra. In all cases, the caregiver is the elder dependent's link to the world of a completely independent life that he or she once had. The caregiver is just like any one of us, a human being, with physiological and emotional needs. Often times, caregivers start from the deep end of the water, not knowing what lies ahead and struggling to keep their heads afloat.”
“Madam, with Singapore's rapidly ageing demographic profile, the prevalence of dementing illnesses and physical disabilities will inevitably increase correspondingly. This phenomenon affects not only the individual but can also have devastating effects on the family. Former First Lady of the United States, Rosalynn Carter, once said, "There are only four kinds of people in the world – those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers." The family has traditionally been the main source of support for the elderly in Asia, and Singapore is no exception. Singapore is not a welfare state and individual responsibility is the mantra underlying most, if not all, policymaking decisions. There are obviously two choices when the family is encountered with caring for the elderly sick and disabled. They can either place them in the nursing institution or provide home-based care. Many elderly sick patients would definitely prefer to stay in the comfort of their homes. Home care, however, will not be possible without the dedicated participation of the caregiver, who is usually a family member most of the time. In Singapore, the Government has strongly upheld the belief that familial support of the elderly is ideal. However, are caregivers given the necessary support, both financially and emotionally by the Government? I think we are still far away from the ideal. Caregiving is a challenging task that can impact a caregiver physically and emotionally. The caregiver's role for a family with an elderly relative or persons with disability can be very demanding and could be a long-term or even lifelong responsibility.”
“In addition, current MediShield does not cover newborns for congenital illnesses diagnosed soon after birth. The cost of treating complex congenital illnesses can be expensive and financially draining for many families. I hope the Minister can consider the following – make MediShield coverage for housewives as an opt-out scheme, just like it has been facilitated for newborns and extending the MediShield coverage for congenital illnesses, to give parents a peace of mind that their newborns will still be covered by MediShield should they be born with any congenital diseases. Use of Medisave for Mental Illness”
“Madam, over the years, Medisave has been liberalised progressively for payment of medical-related insurance, outpatient treatment and investigations. An example will be the Chronic Diseases Management Programme (CDMP) where Medisave is allowed to be used for the cost of outpatient treatment, up to a cap of $300 per Medisave account per year. The diseases covered under the CDMP include hypertension, diabetes, hyperlipidemia and stroke when the programme first started, and has since been extended to include COPD and asthma. However, many Singaporeans visit their doctors for a myriad of medical problems, many of which are not included in the CDMP. I would like to urge the Minister to consider extending this coverage to all diseases, including mental illnesses, but still subject to similar restrictions of capping the maximum withdrawal to $300 per account per year. This would prevent premature depletion of the Medisave savings but, at the same time, help Singaporeans decrease the out-of-pocket expenditure for medical treatment, especially in challenging economic times like this. Medishield Coverage MediShield is an important component of our 3M healthcare framework. It is a low cost catastrophic illness insurance scheme introduced in 1990 and has benefitted countless Singaporeans. At present, MediShield covers almost four out of five Singaporeans and PRs. And since 1st December 2007, all newborns will be offered MediShield coverage on an opt-out basis. However, there are many housewives in Singapore who are not covered under MediShield or any form of integrated health plans. This is due to the fact that housewives do not contribute to Medisave and also possibly the inertia on the part of husbands to apply for coverage for the non-working spouses.”
“And I hope that with the concerted effort by everybody, including the various measures that have been implemented, the numbers will be arrested.”
“Mr Chairman, I would like to raise a point of clarification for the Senior Minister of State with regard to loansharking. It is heartening to know that MHA is sparing no effort in tackling the problem of loansharking. But the surge in the number of cases over the past few months is definitely not very assuring to the public. And I have come across more cases in my MPS about residents complaining about harassment by loansharks to the extent that some can even tell me that loansharks come at certain time and certain days. And whenever the residents report that to the Police at the police post, the answer they get is, "There is really nothing much we can do. This is under the jurisdiction of the CID". I think this is not very reassuring to the public. Whilst it is important to target the main syndicates, I think it is also important to nab the runners, so that they do not continue harassing the residents. Assoc. Prof. Ho Peng Kee: I agree with Dr Lam that that is not the line that the police officer in the station should give. A report has been made, I think the answer should be "Yes, we will look into it. We will work with the other police forces which, in this case, is CID". And they do it at different ends. CID tackles the syndicates but, on the ground, I think working with the residents and whatever leads that are available, the Police will also try to apprehend the runners. So, for example, I have mentioned the placement of CCTVs, because the Police cannot be on the ground all the time. So the judicious use of CCTVs, I think, can help in this process. The assurance I give, nevertheless, is that whatever leads that the Police has, it will pursue.”
“And, paradoxically, against our backdrop of an efficient and draconian law enforcement environment, illegal moneylending seems to be flourishing. I urge the Ministry to step up enforcement actions or even impose harsher punishments in order to curb and, hopefully, eradicate illegal moneylending activities in Singapore. Public – Private Cooperation in Criminal Investigations”
“Mr Chairman, there were a total of 4,755 loanshark harassment cases reported in 2007, down from the peak of 5,240 in 2006. This decline has been attributed to tougher measures undertaken by the authority to crack down on these unlicensed moneylending activities. Currently, the penalty is meted out to people involved in harassment activities related to illegal moneylending. It carries caning as well as a jail term. Yet, in spite of these seemingly tougher measures, public harassment by loansharks and their runners continue unabated. It is not uncommon within our constituency to witness explicit works of art, using red paint by runners or loansharks in their attempt to force debtors to pay up. Sometimes, harassment work carried out affects innocent victims who had just moved into the flat, which once belonged to a borrower. Affected residents often feel frustrated that nothing can be done soon enough to help resolve the harassment and embarrassment caused. In addition, many feel threatened and fear for the safety of their families. Very often, handphone contact numbers of loansharks are scribbled on the walls, and many of my affected residents actually did call up the numbers to explain the mistaken identities, but to no avail. Surely, the Police force will be able to work with the telco to track down the identities of moneylenders and to bring them to justice. The Police should also step up patrol in affected units, lay ambush or even set up CCTV outside corridors of involved households to deter such regular harassments. Unlicensed moneylending seems to be a lucrative business, in spite of the tough penalties imposed. Harassment by loansharks, therefore, is expected to increase in view of the credit crunch.”
“It is perhaps time for the Ministry to revisit the issue of dual citizenship. We should retain citizens by giving them compelling reasons to stay and not keep them by using artificial means. Offence of Nuisance and Proposed "Move On" Powers”
“Mr Chairman, dual citizenship is becoming more common in our increasingly interconnected globalised world. Many countries such as India, the Philippines and Mexico are now seeing the advantages of dual citizenship and are liberalising their citizenship laws. In fact, there are currently about 90 countries that officially permit or accept dual or multiple citizenship. Why would a person need or want to be a citizen of more than one country? In some cases, it may be simply a matter of cultural attachment. Some individuals who live in one country but were raised in another, may see dual citizenship as a way of connecting with their heritage. For others, dual citizenship may be a matter of convenience, making travel easier when the country places restrictions on visitors from certain countries. Dual citizenship also has advantages of broadening the country's economic base by promoting trade and investment between the dual citizen's two respective countries. There is no doubt that Singapore has benefited from its rich migrant society in terms of boosting its talent pool as well as contributing to the vibrant economy. Ironically, our strict non-dual citizenship policy is putting many foreigners in a conundrum as many enjoy working and staying in Singapore but cannot bear to abandon the land of their birth for sentimental reasons. The current policy risks losing these people whom the Government has tried so hard to retain, the very people with rich transnational experience and perspective. 5.30 pm In a similar situation, more and more Singaporeans, especially those working abroad, have grown to enjoy staying in a foreign country where they are working. They have to reluctantly renounce their Singapore citizenship.”
“In order to help, or rather, not make life more difficult for this vulnerable group, social assistance programmes should be non-discriminatory to benefit both single-parent and two-parent families in Singapore. Mr Speaker, Singapore is going through very challenging times ahead. The elderly, physically handicapped and the single-parent families have not been spared from the pains of the current economic crisis. As companies scale down on their hiring plans, disabled and elderly workers often find themselves on the losing end. The Government has and will always look after its citizens in good times and in bad. However, more could be done to alleviate the hardships faced by the vulnerable groups in the society. Let me end by quoting Hubert H Humphrey, ex-US President: "The moral test of government is how it treats - those who are in the dawn of life, the children; - those who are in the twilight of life, the aged; and - those in the shadows of life, the sick, the needy and the handicapped." And also allow me to add on to this evocative quote. Not forgetting: - those in the abyss of life, the mentally ill; and - those in the mirage of life, the single-parents. On that note, I support the Budget. Column No : 2027 Column No : 1892 TIME LIMIT FOR SPEECHES (Suspension of Standing Orders) 12.58 pm With the consent of Mr Speaker and the general assent of Members present, Question put and agreed to. Resolved, That the proceedings on the item under discussion be exempted from the provisions of Standing Order No. 48(8) in respect of the reply to be made by the Minister for Finance. – [Mr Mah Bow Tan]. Column No : 1892 Column No : 1892 ANNUAL BUDGET STATEMENT Debate resumed.”
“So in the face of the global financial turmoil, the issues they faced would be much tougher and more complex. When faced with financial challenges, these families have to compete with other vulnerable groups for means-tested social assistance. Even then, many assistance programmes have eligibility conditions that disqualify such families. In many aspects of public and discourse, single-parent families are viewed as undesirable alternative household entities to be frowned upon and thus excluded from some social services that are available to "normal" two-parent families. For example, public housing applicants in Singapore must be a proper "family nucleus", comprised of a married couple, in order to be eligible for a Government-subsidised apartment. This excludes unmarried single-parent families by default and has significantly disadvantaged such families in their attempts to apply for affordable subsidised public housing. Another example is the pro-natal Baby Bonus, a Government cash grant for newborns of married couples, for subsequent use towards childcare purposes. Disadvantages are also found in tax policies. For instance, tax relief granted to married parents to employ domestic maids is unavailable to single-parent households. Thus, instead of being helped, single-parent families are often discriminated or disadvantaged by our pro-family policies. Indeed, hardship cases involving single-parent families are not uncommon during our MPS. Many MPs would have seen such cases in their constituencies and can offer no long-term solution to their problems. If the Government fails to assist single parents, there would be potentially dire social consequences that would affect the opportunities for their children.”
“Our Government is worried that these not only undermine its "Asian values", and erode "the family foundation of nationhood" but also drain State resources. The single-parent has to serve a dual-parent role, making up for the deficit, both in physical as well as in the financial support. It is tough indeed to raise children and maintain a career at the same time for the single-parent family. This is especially so in Singapore, where many of our Government policies are staunchly pro-family in nature. I believe single parenting is not a choice many people would intentionally make but a consequence, many a time forced by circumstances and desperation. Contrary to what our pro-family policies serve to achieve, the number of these family structures is on the rise. Population census data shows the number of single-parent families increase from 13,000 to 18,000 households between 1990 and 2000. Single-parent households are generally at a higher risk of poverty than two-parent household. A survey of 20 countries confirms this belief even after factoring in social security benefits and direct taxation. This risk is higher in liberal welfare countries such as the UK, USA and Canada. Indeed, their experience demonstrates that poverty amongst single mothers is likely to be more persistent than the national average. Data for Singapore in 1990 illustrated that about half of single-parent households earn less than 50% of the national average monthly household income. *Cols. 2069-2070. (In English ): Sir, as a matter of fact, single-parent families are not specifically targeted by social assistance policies in Singapore. Even during the best of times, single parents face many difficulties – financially, socially and emotionally.”