Lily Neo
Singapore
“Thank you, Mr Speaker. May I ask Minister for Health on MOH's capacity in coping with serious cases of COVID-19 in terms of adequacy in respirators and in our ICU beds. Am I correct to say that already half of NCID's ICUs are taken up? What will happen when it reaches its full capacity?”
“But even so, with the right measures of social and medical assistance in place to assist them with their daily living, they can still age gracefully in the comfort of their own homes.”
“Thank you, Mr Chairman. Yes, I will keep it short. Minister earlier said that MSF will proactively reach out to families in HDB rental homes to assist them, to possibly buy their own HDB flats. Many of these families lamented that they cannot afford it. How does the Minister plan to do it?”
“Thank you, Mr Chairman. May I ask the Minister whether there is a possibility of more widespread community spread of COVID-19? And will MOH be able to cope with this? And whether does our Government have more specific measures in place to cope with this scenario?”
“Thank you, Mr Chairman. Earlier in my speech, I asked whether there are assessments by HDB for applicants of Joint Singles Scheme (JSS) to ensure that they are free from mental illnesses and medical conditions before compelling them to stay together.”
“Many of them have lived in rental housing for more than six years and some more than 10 years. Thus, there are signs of entrenchment. What are the schemes in place and the success rate of such schemes, to assist them in looking for better options in their housing needs and to help them get out of their predicaments?”
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“How is MediShield going to solve Singaporeans' concern on the basic issue of medical cost affordability? Sir, that is my worry. I would like to share with this House the various flaws of MediShield and how it has failed to serve Singaporeans' medical needs. MediShield is an opt-out scheme with many of those most vulnerable being left out. MediShield does not have good population coverage because it is available only to CPF account holders. Since only 59.6% of the labour force contributes to CPF, the other 40% of the labour force are not covered under MediShield. This does not take into account the proportion of the population not in the labour force. Of the three million CPF accounts, only 1.3 million are active. Sir, there are only 1.33 million MediShield and 0.3 million MediShield Plus accounts as of 31st March 2004. Apart from only covering catastrophic illnesses, MediShield imposes low annual and life-time limit coverage which defeats the purpose of giving assurance to Singaporeans on the affordability of their medical needs in the public hospitals. Basically,MediShield coverage provides for the bare minimum and, in some cases, only covers a fraction of the actual cost of treatment. MediShield pays $150 a day for hospitalisation. It has a maximum claim limit of $30,000 per policy year and $120,000 in a lifetime. If this cap is used up, either in the year or in the lifetime, the individual cannot claim any more. The Minister for Health earlier said that he would adjust the premium of MediShield and raise the annual and lifetime limit of MediShield. Sir, there are still other basic issues that are not addressed under MediShield such as the affordability of the majority of hospital bills and catastrophic hospital bills beyond the stipulated limits of coverage.”
“We definitely must avoid the pitfalls of failed medical insurance in other countries that lead to the moral hazards of excessive consumption of healthcare resources or the "buffet syndrome". Fear of over-consumption can be minimised by adopting best practices. MediShield pools risks minimally because it covers for catastrophic illnesses that constitute 5-10% of the hospital bills, while leaving a big gap of 90-95% of the rest of thehospital bills with no risk pooling. Sir, we need to close this loophole to ease the affordability of the majority of hospital bills, albeit with deductibles and co-payments in place.I favour solidarity principle reflecting objective securing universal coverage where risk-pooling is mandatory for at least basic public hospital bills. Risk-pooling for only basic public hospital bills without frills such asB and C class wards, will ensure affordable premiums for the majority. This will have the advantage of no Singaporean being left out, complete risk sharing across a nation with minimised variations in expected expenditure and avoiding inefficiencies and inequities associated with adverse selection such as cream-skimming and transaction costs. This will need good managerial control and coordination. Thenotion ofa compulsory risk-pool carries with it an implementation of a curtailment of individual choice as to the nature of the package of healthcare made available. Therefore, those who wish for the enhanced services should be allowed to secure a package of care in line with their preferences, for which they are willing to pay or supplement with privateinsurance, only after contributing to the mandatory basic pool. The Minister for Health earlier in this House mentioned that he will keep MediShield, albeit returning it to its original purpose.”
“The most important imperatives for risk-pooling are to establish appropriate and reliable systems of governance, to assure the collection and stewardship of finances and to ensure that providers are reimbursed appropriately. They imply the need for a long-term trust in the institutions of healthcare. I feel that, in Singapore, this role is best assumed by the Government especially for the mandatory national medical insurance. In Singapore, the bulk of healthcare financing comes directly from households in the form of eitheruser payments or out-of-pocket fees and Medisave. In fact, the National Healthcare Expenditure or NHE proportion is borne two-thirds by the people or the private share and only one-third by the Government. Here we have a system where minor and higher cost risks have been separated and financed through different mechanisms. Individual medical savings accounts (Medisave) provide inter-temporal spread for some ambulatory and hospital expenditures, while a national catastrophic illness insurance scheme (MediShield) is supposed to cover prolonged and expensive treatments. MediShield, however, has failed in its functions. I shall elaborate on this later. Medisave involves no direct risk-pooling and although MediShield does pool risks, the effect, Sir, is less than satisfactory. The trend should be towards larger risk-pools than exist at present. In addition, there is a complex system of co-payments and deductibles, which involve direct out-of-pocket private payments. We should preserve our policy on deductibles and co-payments to ensure individual's responsibility and accountability on the sensible consumption of our healthcare. This will emphasise the principle of individual responsibility for one's own healthcare needs.”
“Sir, may I beseech this House to look into healthcare financing in Singapore to ease the pain of healthcare expenses. [Mr Deputy Speaker (Mr Chew Heng Ching) in the Chair] I am sure many Members of this House agree with me that our present system of Medisave where we save and pay as we go financing for healthcare is becoming less adequate to serve our needs. An individual's expenditure on healthcare is, to a large extent, unknowable, both in magnitude and timing. It is, therefore, intrinsically difficult for an individual to make financial provision for episodes of sickness. Sir, healthcare affordability has been a major concern for many Singaporeans and their concerns will worsen with the expected escalating healthcare costs, in view of our ageing population and the rapid advances in medical technology. Our people would surely value arrangements that protect them from this uncertainty in expenditure. Thus, we need to make drastic changes here to ease the increasing burdens of the nation. Sir, "risk-pooling" in healthcare finance should be given a bigger role in Singapore. Risk-pooling in healthcare finance is a system whereby collected healthcare revenues are transferred to the purchasing organisations. Pooling ensures that the risk related to financing healthcare interventions is borne by all the members of the pool and not by each contributor individually. Its main purpose is to share the financial risks associated with healthcare interventions for which there is uncertain need. It implies redistributive functions - from the healthy to the sick and from the productive to the unproductive stage of the lifecycle.”
“Sir, I just want to register my point to say that I agree with the Minister. We must definitely avoid over-consumption. I will elaborate later in my speech in the adjournment motion, but I would just like to urge the Minister tointroduce an insurance scheme that will solve the affordability concerns of Singaporeans.”
“--- than save and pay as equal financing? Lastly, how does he reassure some Singaporeans who think that this MediShield revamping is another way of the Government taxing the people?”
“May I ask the Minister whether any insurance element introduced by his Ministry should have the three essential tenets of a viable insurance scheme: firstly, national coverage with no one being left out; secondly, long-term sustainability to give Singaporeans assurance on their long-term medical needs; and, thirdly, ensuring that this scheme will givepeace of mind to all Singaporeans on their medical needs in public hospitals, regardless of medical conditions, albeit with deductibles and co-payment in place. May I ask the Minister whether MediShield in fact has failed in these three tenets? May I ask the Minister whether it is correct that, firstly, MediShield isan opt-out scheme with many most vulnerable being left out? Secondly, it has an age limit which does not serve us well in view of our ageing population and longer life span of Singaporeans. And, thirdly, it also has low annual and lifetime limit which defeats the purpose of assurance on health cost affordablilty. The Minister earlier said that he will keep MediShield to cover catastrophic illnesses. But that only constitutes 5%-10% of the hospital bills. How does the Minister expect Singaporeans to pay the rest of the 90%-95% of the hospital bills? Did he notagree that risk-pooling is a better method ---”
“Mr Speaker, Sir, may I ask the Senior Minister of State, in view of the fact that measurable cardiovascular risk factors indices appear to have deteriorated in Singapore, whereas theepidemic of heart disease in England is heading downwards and the deaths from heart disease have fallen by a third, is there a need for us to re-examine and re-strategise our current practices in combatting cardiovascular diseases? Are we learning the experiences and best practices of other countries? Do we need to emphasise further on work health promotion and health screening to improve the health status of adult Singaporeans? Should there be more emphasison targeting high-risk groups? And, lastly, instead of just disseminating health messages, should we not now try to reinforce the benefits of healthy choices and better equip people with such choices?”
“I also welcome the harsh penalties of this Bill to ensure that research-friendly Singapore is not being taken advantage of by rogue scientists. Sir, in our present time when terrorists loom, we cannot be too complacent on any security issues. This Bill does not address bioterrorism. Sir, our scientists have cloned genes to target and destroy cancerous cells.In the same token, such research can also be manipulated to make bioweapons to kill healthy human cells. Such designer bioagents could be worse than any known disease. May I ask the Minister whether any precaution is taken in sensitive research areas? In Britain and the United States, some foreign nationals are either not permitted or vetted before they are allowed to do research in sensitive areas. What are the steps taken in Singapore to address bioterrorism and national security? Sir, I support the Bill.”
“More research should be channelled into this alternative source instead of encouraging the easier route in order not to inadvertently retard scientists' innovation on searching for non-controversial sources to get stem cells from diverse sources. I feel that there should be a need for a balanced approach on therapeutic cloning. Singapore is putting in place the funding, facilities and international links that offer one of the best environments in the world to do research, such as the $500 million Biopolis that features top-notch scientific equipment, resources and specialised research facilities and services. Many eminent scientists are drawn by Singapore's reputation as one of the most open-minded, research-friendly countries for biomedical work, and Singapore's determination to become a science hub. Singapore's biomedical science research has matured and is now ready to try to translate some of their locally acquired basic knowledge on cells into real cures and diagnostic tools. Therefore, there is a need for focused leadership to spearhead the potential of Singapore's biomedical science research to offer humankind the new frontier of cure for previously untreatable diseases. Sir, while we should pursue the promise of genetic cures for diseases, we should also act now to direct it towards morally acceptable ends. Sir, I welcome this Bill's aim of licensing of institutes doing embryonic stem cell research. May I ask the Minister whether there are already ethical and legal framework in place for embryonic stem cell research? May I also ask the Minister whether there is also a safeguard body in place that monitors subsequently and regularly on the progress of such research to ensure and prevent scientists deviating into unauthorised research?”
“Scientifically, not only do most attempts to clone mammals fail (only about one or two viable offspring for every 100 experiments), about 30% of clones born alive were affected with "large offspring syndrome" and other debilitating conditions. Several cloned animals have died prematurely from infections and other complications. The same problems would be expected in human cloning. In addition, scientists do not know how cloning could impact mental development. While factors, such as intellect and mood, may not be as important for a sheep or a cow, they are crucial for the development of healthy humans. The attempt to clone humans is therefore potentially dangerous and ethically irresponsible. Reproductive cloning is to create a baby that is identical to the parent whereas therapeutic cloning is to create tissue or cells that are genetically identical to those of a patient; so when they are implanted into a patient, they will not be rejected. This Bill allows human embryos to be cloned for research under special circumstances, placing Singapore in the camp of a minority that supports limited cloning, including Britain, Japan and China. Sir, therapeutic cloning is a thin wedge to reproductive cloning and I therefore urge the Minister to take the approach of strict scrutiny on the approval on embryonic stem cell research. A balanced approachis required but I favour more to err on the side of caution here to deter any misapplication of Singapore's open-minded stance on research. Singapore is considered one of the world's most research-friendly countries for biomedical work, particularly with regard to stem cells. Rather than depending on embryonic stem cells, many scientists believe stem cells taken from adults could be used.”
“Mr Deputy Speaker, Sir, I shall keep my speech short. Thank you for allowing me to participate in this debate. The antecedent to this Bill, Sir, is the historic paper of November 1998 by American and Israeli scientists, led by biologist James Thomson, that they had isolated and cultivated human embryonic stem cells. Stem cells are unprogrammed "master" cells, which can differentiate into other types of body cells, as needed, thus offering a revolutionary way to replace or repair diseased and damaged body tissues either from injury or disease. These cells are holding out hope for people suffering from Parkinson's disease or diabetes, as mentioned earlier, for example, or those crippled by spinal cord injuries. Stem cells can be taken from adults and discarded umbilical cords, but those from embryos are considered powerful and malleable because they have the potential to become any sort of cell or tissue. The contentious issue here is that the extraction of stem cells from human embryos violates the human rights of the embryos. The extraction of embryonic stem cellsis taken from blastocysts, which are the union of sperm and egg less than two weeks old, which, if transferred to a woman's uterus, might be able to grow into human beings. This Bill aims specifically at prohibiting human reproductive cloning or cloning to create human being. Sir, to clone a human being is to move from procreation to manufacture of human life. I support banning human cloning because I believe that human beings are special and truly sacred, and it is prudent to preserve the sanctity of human life.”
“Will he also extend subsidy to early and sustained rehabilitation of stroke patients in order to reduce disability? Am I correct to say that early brain scanning is essential for the outcome of stroke patients? Therefore, will he also extend subsidy to brain scanning at outpatient clinics in order for doctors to administer action soonest?”
“Sir, in view of the fact that stroke is the fourth leading cause of death in Singapore and stroke incidents have been on the increase with 7,500 cases of hospitalisation each year and about 33% of these cases end up with disability, will the Minister of State prioritise subsidising stroke patients further and soonest in our public hospitals?”
“May I ask the Minister what has happened to the plan of building a liquefied natural gas (LNG) terminal at Tuas which was announced in 1999? Have there been feasibility studies done for such LNG terminals since 1999? Will he now seriously consider building LNG terminals and storage of LNG in order to ensure the uninterrupted supply of natural gas in Singapore?”
“Clarification again, Madam. The Minister said earlier that this Bill does not require to have safeguards for the interest and safety of consumers. May I ask the Minister which regulations provide safeguards against the dumping of disputed drugs in our market?”
“Clarification, Madam. Does the Minister agree with me that the majority of the dental chewing gums do not have much therapeutic value? Therefore, will the Minister be more discerning in approving the licences of the many varieties of chewing gums in the market? Mr Khaw Boon Wan: In general, I can agree. The concession that we granted under the bilateral FTA requires chewing gums to be divided into two groups. The gum with therapeutic value has to be strictly controlled with prescription requirements. But in the process of bilateral negotiations, and because of lobbying by certain companies in the US, we made a concession for dental gums to be sold under the supervision of pharmacists. But we stood firm on our requirement that we are banning chewing gum and therefore it will not be possible for anybody to just walk into any pharmacy and purchase gum, such as an over-the-counter drug sale. And that is why we put in procedures which will make it more difficult to purchase such chewing gum, and that is why we require, for example, buyer's particulars to be taken down by the pharmacist. Occasionally, we do auditing to make sure that there is no excessive sale of this particular oral dental gum.”
“Madam, there is a need to address intentional selective disclosures to the detriment of consumers at any time. How does the Minister plan to ensure this? Do our regulations provide safeguards against the dumping of disputed drugs in our market, especially after they have been rejected by those countries with more stringent rules? Madam, this Bill should not be drafted only to comply with the commitments made under Article 16.8(1) of the USSFTA. It should be drafted, more importantly, to have the interests and the safety of the consumers in mind. The amendments to section 16 state that the licence can be revoked by way of a request to the licensing authority. I feel that to revoke the licence, it should be done by way of a written request. This is to prevent any dispute as to whether that request was made by the licensee. I hope the Minister can clarify the points raised.”
“How is the Minister going to address this potential environmental hazard by amending this Bill concerning chewing gum? May I ask the Minister why such chewing gums are already available in the market even before the implementation of this Bill? In order to prevent inconsiderate discarding of chewed gum, will the Minister require the manufacturers of gum for sale in our market to print environment-friendly messages on the wrappers to remind users on proper disposal of used gums? The penalty for offences under section 20(1), (2), (3) and (3A) is a fine of $5,000 and/or imprisonment of up to two years. Madam, this penalty is rather low for offences under section 20(3) and (3A). This may seem reasonable based on the maximum penalties allowable under the Medicines Act, but offenders under this section who may be caught under the Penal Code or other Acts, ought to have their penalty based on the more established Acts so that there can be consistency in the imposition of penalty for such similar category of offences. This Bill and the current Medicines Act, Madam, do not provide for situations where it calls for additional data to be given to the licensing authority even after granting of a product licence. Will the Minister consider inserting an additional new clause for such a requirement? Madam, situations may arise when such an action is necessary and I would like to cite, as an example, the case of New York State suing a drug giant recently over a drug called "Paxil". The civil lawsuit contends that the drug company engaged in persistent fraud by not telling physicians that studies showed that Paxil not only did not work in adolescents but may also be linked to cases of suicide.”
“Mdm Deputy Speaker, I support the Medicines (Amendment) Bill. This Bill seeks to amend the Medicines Act (Chapter 176) to implement certain obligations undertaken by Singapore under the United States-Singapore Free Trade Agreement conducted in 2003. Given Singapore's focus on being a medical and research and development hub, the safeguarding of rights on patented drugs, ie, the protection granted to an innovator to prevent others using copying or making the invention, would be highly desirable even if these were not a requirement under the United States-Singapore FTA. Research and development activities are laborious, time-consuming and expensive. Innovators should be encouraged and protected by our laws to safeguard their efforts. Moreover, advancement and new discovery would mean better drugs to comb the frontier of diseases. This will auger well for us in our endeavour to excel in research and development in the pharmaceutical field. This Bill thus will bolster Singapore's resolve to create a suitable environment for a medical and research and development hub. In point of fact, Madam, quite a number of pharmaceutical giants have set up their regional hubs in Singapore with research units, a moving factor for their doing so being the good regulatory environment apart from the high quality medical technology and the remarkable infrastructure. Clause 6 amends section 54 to allow chewing gum for sale to promote dental health or oral hygiene. May I ask the Minister whether this will result in proliferation of many varieties of chewing gum flooding the market? Madam, manufacturers may take advantage of this relaxation and vend them aggressively in a lucrative market of a previously-banned product.”
“Sir, could the Minister of State please answer my questions, especially on our appointments system, whether we allow matching of appointments with designated doctors, and whether public hospitals are still encouraging and remunerating doctors according to the number of patients they get to see?”
“Sir, supplementary questions on the subsequent follow-up of subsidised patients at specialist outpatient clinics at public hospitals. May I ask the Minister of State whether it is more time-consuming, laborious and pressing for a doctor to go through the case notes and learn everything about a new patient each time at specialist outpatient clinics with limited time of consultation and a long queue of patients waiting, and would such follow-up on the intention of previous doctors be less than satisfactory, especially if the writings of the notes have been less legible? Would it not be better for the same doctors to look after the same patients, for better patient care? Does the appointment system allow the matching of patients' appointments with designated doctors for continual care? Do our doctors in the public hospitals in the specialist outpatient clinics spend enough time with their patients? How many patients does each doctor see each time? And are public hospitals still encouraging and remunerating doctors according to the number of patients they see?”
“But that must be one of the options, that after you no longer need a big flat, you should have a means to downgrade to a smaller one, or to live with your children and make use of the money for your retirement needs. So, there are options available. It is best for the private sector to provide such financing. Yes, HDB will facilitate such schemes to the maximum extent possible. But it will not provide such schemes. HOUSING AND DEVELOPMENT BOARD FLATS (Relaxation of rules for purchase by single Singaporeans) 13. Mr Chiam See Tong asked the Minister for National Development whether the Housing and Development Board is willing to relax its rules and allow single Singaporeans who have attained the age of 30 years to purchase flats.”
“Sir, may I ask the Minister on the reasons why banks are not keen to offer reverse mortgages for HDB flats? Will it be that they may not want to own HDB properties in the event of defaults, especially for shorter remaining tenure? Would HDB not be in a better position to offer such reverse mortgages and whether the Minister would facilitate and step up such facility to the elderly? Mr Mah Bow Tan: Whether banks offer reverse mortgages or not, I think it is really a decision for the banks to take. They have their own policies on how much risk they want to take. They have a certain position that they are taking, in terms of the interest rates, and so on and so forth. I know for a fact that an insurance company, NTUC Income, does offer reverse mortgages. But I am told that it is currently not very popular with HDB lessees. One of the reasons is that the terms under which it is offered are not very attractive. And again, this is something that the company has to decide whether it is able to offer better terms so as to attract more people to come. This is not a decision for HDB to take. In fact, HDB has since last year stopped the issuing of mortgage loans for certain categories of people. So it is really not HDB's role to offer mortgage financing, or in this case reverse mortgage financing, to its lessees. I think its job should be to provide public housing, to frame policy on public housing, to provide loans for first timers and to make sure that first timer families are adequately provided. For the retirees, there are other provisions being made, including some of those that I mentioned earlier,eg, allowing lessees to sublet their flats totally. We can relax those conditions even further, if necessary.”
“Mr Speaker, Sir, may I ask the Minister whether I am correct to say that many elderly Singaporeans may be asset rich but cash poor. Few meet the CPF Minimum Sum for retirement, many have fewer children and the State provides very limited public assistance for retirees. Therefore, is it not time now to give more consideration and assistance to the elderly to cope with life after retirement? How does the Minister address this issue?”
“May I ask the Minister whether we have a national laboratory safety committee to monitor the biological safety standards of our laboratories? How does the Minister ensure that all laboratory staff receive adequate training in biological safety and that they adopt a culture of safety?”
“May I ask the Minister whether we should have a list of high-risk organisms that should be only handled by designated laboratories?”
“May I ask the Minister whether there has been a reduction in medical postgraduate training, such as HMDP? Has there been a recent review on postgraduate training? Should there be more emphasis and creation of opportunities for disciplines in shortage?”
“Mr Speaker, Sir, maybe I will refer the Minister to my source, ie, www.oanda.com. Sir, may I also ask the Minister how did our competitiveness fare vis-a-vis countries like China and India? Will the increase in the Singapore dollar value make our export dearer and will the currency fluctuation that we have experienced recently affect our competitiveness and thereby lead to further erosion of jobs to these countries?”
“Mr Speaker, Sir, the figure of 25% I quoted was the occurrence of fluctuations of different times since 1997. Sir, may I ask the Minister on the effect of the exchange rate fluctuations on the consumer price index and retail price index, and how have the exchange rate fluctuations impacted our trade relations with our major trading partners, such as the USA, Europe, ASEAN, China and India?”
“Ngiam Tee Liang (Nominated Member): Sir, the age band of 15 to 24 is quite a broad one and, if the figures were to show the number of young female working adults involved, it will probably constitute a larger proportion. If this were so, could the efforts that we are all doing not also be channelled into the workplace, and that a new public education programme in the workplaces be mounted with the cooperation of the employers, and to include suicide prevention as well? In this context, of course it is not just the females; it is also the male workers. So, too are the older workers and mothers under stress. We should not underestimate the importance of stress at the workplace and unrealistic expectations, as well as the uncertainties of the New Economy as contributory factors. Assoc. Prof. Dr Yaacob Ibrahim: Sir, I agree entirely with the Member that we should also look at workplaces. I do not have an immediate breakdown of the data as to whether there is a tilt towards working women or with females who are still studying. But I will take the Member's suggestion and work with the agencies as to whether we can work with the workplaces to spread the message of suicide prevention. UNIVERSITY ENROLMENT 2. Mr Steve Chia Kiah Hong asked the Acting Minister for Education (a) how will our university enrolment be increased by more than 15,000 students when our university cohort participation rate reaches 25% by 2010; (b) how many of the 15,000 students will be resident students, versus international students; and (c) whether tuition grants given to international students can be reduced so that more funds can be allocated to assist Singapore students going to university.”
“Sir, may I ask the Minister whether more efforts can be made to raise public awareness on suicidal tendencies, since about 80% of those who committed suicide have expressed their intentions to their family members and friends before their acts? The best preventive measure is to have family members and friends referring all potential cases for early treatment or help before it is too late. Therefore, how would the Minister facilitate this? Assoc. Prof. Dr Yaacob Ibrahim: Sir, I agree with the Member that the role of the immediate support system is important, ie, family members, friends, etc, who may know of colleagues who may have suicidal tendencies to step in to offer them help. In fact, we run a lot of public education programmes. For example, the Suicide Prevention Week run by SOS is meant to raise the awareness of the public not only about the causes but also the opportunities available. They can call the Family Service Centres. The numbers are readily available. I mentioned about Tinklefriend which is run by the Singapore Children's Society. The Samaritans of Singapore (SOS) runs a 24-hour crisis hotline. So, if anybody comes across a person, colleague or friend who may have such suicidal tendencies, he or she can call SOS and SOS can help the person with suicidal tendencies to deal with their problems. The Singapore Association of Mental Health also offers such services. The best avenue would always be to go down to the nearest Family Service Centre in the heartlands, because we have trained the frontline staff at the various agencies to deal with these problems so that they can assist the person in terms of walking him through to find a solution to his problem. Assoc. Prof.”
“Sir, could I have the Minister's comment on my question earlier on the training for women to re-enter employment after being away for a while looking after their families?”
“How would the Minister address this issue?”
“Sir, the 1990 Singapore Census showed that 40% of all married couples are dual-income earners. Many dual-income couples have difficulty in balancing work and family due to the lack of conducive working environment and this causes lower fertility. Working women find it stressful to juggle between inflexible work schedules and family, given that both roles are equally intensive and time-consuming. The recent study that polled 1,200 Singaporean women showed that they preferred to take on a full-time housewife's role or engage in part-time work, which suggests that they find the pull of home stronger than workplace. Almost four in 10 mothers polled preferred not to work at all, a third chose part-time work and only a quarter, the highly-educated women, wanted to continue working full-time. All these indicate that family-friendly work arrangements must have the top priority of attention to help the career-minded or working couples balance home and work commitments and stay in the workforce. The experience of family-friendly firms in the US showed that they reap productivity gains, better customer service, higher staff retention rates, reduction in recruitment and training costs and a drop in absenteeism. May I ask the Minister what steps are taken to promote family-friendly firms? Is the Minister satisfied with the results of his Ministry's efforts so far? What more can be done to improve the present situation? Will the Minister implement measures with impact, such as tangible incentives in terms of grants and tax relief for companies to adopt family-friendly policies for their employees? Complaints have also been heard that employers are not happy when their employees are expecting and taking time-off for antenatal check-ups and maternity leave.”
“Sir, in 2003, the female employees made up 44.7% of the total working population. The female labour force participation rate in 2003 was 53.9%, of which about 54% were married women, and about 40% of all married couples were dual-earners. Presently, there is a dearth of part-time work and flexibility in work arrangement, especially for professionals. Teleworking has not taken off. There is not enough assistance and training for women to re-enter employment after being away for a while, eg, after taking a few years off to look after the family, or taking a long maternity leave. What is the Ministry of Manpower doing to improve this situation? Could the Minister make substantial efforts to rectify this situation soonest possible? Working women find it demanding to try to balance between a full-time job and motherhood. This uneasy conscience is a phenomenon of modern parenting that makes having children daunting. There is a guilt in oursourcing caring of a child, especially with newborn babies. Post-delivery period is the crucial time for mother-baby bonding. It explains why an extended maternity and paternity leave, prevalent in Scandinavia, seems to improve their total fertility rates. In Singapore, the problem is compounded by the scarcity of infant-care facilities. Working women should be assured of their jobs after their maternity leave. Sir, labour force incentives are as important as monetary ones to help women to have children, without giving up or losing their jobs. Will the Minister ensure the assurance of jobs for our working women after childbirth? Flexible Work Arrangements”
“Parents can then be at ease to let their children develop their own unique potentials, some of which may not conform to the norm. Sir, schools should not be too fixated on accepting students with high grades, but should be more flexible and be open-minded in student admissions. I hope the Ministry of Education will continue reviewing and expanding favourable criteria for our school entry.”
“Sir, may I beseech MOE to strive for schools that are more family-friendly. In Singapore, 40% of all married couples are dual-earners. Many dual-income earners have difficulty in balancing work and family and find it stressful to juggle between inflexible work schedules and family, given that both roles are equally intensive and time-consuming. Many parents turn to private tuition to help their children cope better. It will be a good idea if our schools can provide tutorial classes after normal school hours, not giving the children extra work, but for helping them cope with their "homework" to free the children to spend quality time at home with their parents. Another way to help parents, especially working parents, is to organise the extra-curricular pursuits, like learning drama, piano and ballet and so on, collectively in the schools after normal classes. This will save parents from having to ferry their children to and from different places for these hobbies, and this will also help Singaporean parents save much time, effort and money. Let us make our schools more holistic and comprehensive in nature. The criteria for the ranking of schools need to be expanded to lessen the emphasis on academic achievements and grade scores. More weightage should be on other markers relevant to the present time. Thus, ranking should take attainments in developing the potentials of students in information technology, sports and the arts into consideration. Like my previous speakers, Mr Chew Heng Ching and Dr Amy Khor, I would like to ask whether MOE will start ranking of schools by bands rather than individually. Having flexibility in secondary school entry criteria, such as consideration for non-academic abilities, will lessen the stress for many students and parents.”
“Sir, may I beseech MOE to strive for a less stressful education for our children, especially at primary school level while developing a child's potential. The study on the Singapore Family by Dr Stella Quah of NUS revealed that the greatest worry for about 45% of families came from the problems associated with their children's education. Singaporean parents have also frequently mentioned children's education as the contributory factor in opting for smaller families. A study of pupils' stress in 1999 showed that pupils' stress, in terms of overload, had increased since 1990. Could MOE review and effect some changes to reduce this stress? Streaming at primary school level should be scrapped to reduce the stress for pupils and parents. This will also address the fact that there are late developers who may be disadvantaged from early streaming. Could our school principals monitor and ensure that teachers do not overload pupils with homework and tests? Could all teachers be equipped with more and better teaching resources to make education in schools interesting? How are schools progressing in parent-teacher rapport? Are all schools now promoting this rapport? Are schools considering all feedback and acting on them, especially on pupils' progress and family stress from education? Do our schools provide teacher-counsellors and professional counsellors for students, teachers and parents, if called for? Could MOE and schools promote and provide guidelines for better supportive parenting and discouraging parents from pushing their children to achieve beyond their abilities? Is there any effort by schools and teachers to identify students or families of students who are stressed? Sir, I hope that MOE can fine-tune our educational system for the better. Streaming”
“Sir, I am not quite satisfied with the answer. Anyway, I will discuss with him later on. I beg leave to withdraw the amendment. Amendment, by leave, withdrawn. The sum of $2,056,173,500 for Head O ordered to stand part of the Main Estimates. The sum of $1,725,017,350 for Head O ordered to stand part of the Development Estimates. Head K - Ministry of Education”
“Sir, the Minister of State addressed my earlier question on whether our healthcare system provides enough assistance to about 10,000 stroke patients each year. Does he foresee an increasing need for caring for more sick people with disabilities? And what is the action plan provided for this trend and whether will he agree on an epidemiological study on stroke with the purpose of improving the management and prevention of stroke?”
“Older people often have a variety of inter-related needs, including nutrition, nursing medication and mobility management. The training of caregivers of homecare is important for MOH to develop. And these caregivers can be the professional providers, family members and volunteers. There is a need to involve the communities to facilitate the elderly to stay in the communities and at their own homes for as long as possible by involving community help and community volunteers to deliver the services. Sir, apart from providing the combination of these services, MOH needs to look into the funding for such long-term healthcare to ensure that it is affordable, equitable to all generations, and sustainable over time.”
“Do we have enough therapists to provide for such care? Will the Minister enhance further on public education on stroke, especially on advice to seek early treatment and on preventive measures for strokes, maybe by the Health Promotion Board? Does the Minister foresee an increasing need for caring of more sick people with disability due to stroke and other causes in view of our fast ageing population? What action plan is the Minister taking to cope with this trend? Will the Minister also consider an epidemiological study on stroke with the purpose of improving the management of stroke patients and the prevention of stroke? Homecare Sir, the challenge for MOH on the care of the dependent elderly will be in assisting them to live in their own homes for as long as possible with appropriate support. We recognise that institutional care is costly and causes loss of independence. We also recognise that the family unit, with adequate support, is the principal way to provide care in the home environment rather than institutional care. Thus, we must accept that homecare will translate into convenience, lower costs and a happier populace. Such a priority for MOH, in the care of the elderly, will help our nation cushion the awesome effects of a fast ageing population. Careful proactive planning and action now will ensure a successful outcome in this area. Sir, the aim is to minimise hospital admissions and dependence on long-term care in institutional settings. Homecare with medical care, domiciliary services, daycare with rehabilitation facilities, occupational therapy services as well as equipment and adaptations at home should be made available. Homecare requires the services of personnel, transport and domestic support.”
“Therefore, I hope, as discussed earlier, that the Minister consider risk-pooling insurance schemes for medical expenses and maternity insurance from our Medisave to insure couples against complications of pregnancies and childbirths. Stroke Sir, stroke is the second leading cause of death worldwide, and it is the fourth leading cause of death in Singapore. Data from MOH shows a rise in the number of admissions to hospitals for cerebrovascular disorders, including stroke and transient ischaemic attacks, from 3,732 in 1986 to 10,250 in 2001. As some patients may prefer to remain at home rather than go to hospital, a notion that has to be corrected through public education, the actual numbers are probably higher. About 63% of all stroke survivors in Singapore are still moderately or severely disabled three months after the event. Sir, anti-platelet therapy and thrombolytic therapy improve outcome with fewer in-hospital deaths for cerebral infarcts when they are prescribed early; preferably within hours of onset. And, in Singapore, over 74% of stroke cases are due to cerebral infarctions that would benefit from such therapy. The diagnosis is possible and treatment can be started only following early brain scanning which, unfortunately, is expensive. Will the Minister facilitate these tests by allowing patients to use their Medisave to pay for them even as outpatients? Will the Minister help set up urgent protocols in our public hospitals to facilitate stroke patients to get early investigations and appropriate treatment as soon as possible? Since about 30% of stroke cases end up with long-term disability, does our healthcare system provide enough assistance in managing such patients, for example, in terms of rehabilitative and other supportive measures?”
“Sir, I beg to move, That the sum to be allocated for Head O of the Main Estimates be reduced by $10 in respect of Code OA 3600. Fertility Sir, one in five married couples finds it difficult to conceive. In view of our declining Total Fertility Rate, we should further help these couples who yearn to have children. The amount of Medisave withdrawal for each in-vitro fertilisation (IVF) programme should be increased. The Minister said earlier that he will do his part for the baby issue and, therefore, I hope that MOH will also consider subsidising other fertility procedures, like intra-uterine inseminations (IUI), to ease the burden for patients at all fertility clinics in the public hospitals, especially if he should get more funding from Minister Lim Hng Kiang. In Singapore, one in five women has kids when she is 35 years old or older. This figure far exceeds the developed world average. There is an increased risk of infertility with late pregnancy. Pregnancy in older women also carries increased risks for mums and babes. These include miscarriages, pregnancy complications and complicated deliveries. Would the Minister for Health help promote healthier pregnancies and prevent neonatal abnormalities by publicising and promoting the advantages of earlier childbearing? I feel that we need to better inform the public on the medical disadvantages of pregnancies in older women. MOH can disseminate this message through either the Health Promotion Board or in collaboration with other organisations. Grassroots organisations can be co-opted to hold talks and seminars on such topics in their constituencies. Sir, complicated deliveries for mother and premature babies can incur financial burdens to young couples.”
“Sir, I would like to thank the Ministers for their comprehensive replies, especially the Minister for Health, Acting or otherwise, for his clear replies. I would also like to wish him success in his endeavours on his priorities for MOH. I beg leave to withdraw my amendment. Amendment, by leave, withdrawn.”
“Sir, I would like to seek an update from MOH regarding the registration of Traditional and Complementary Medicine Physicians. May I ask for the number of those who took their TCM Qualifying Examinations, and the number of those who had succeeded and failed? May I ask the Minister whether considerations were given to those who did not make it in the examinations and thus causing them to lose their livelihood? Were they given chances to upgrade themselves to enable them to pass the subsequent examinations? Are the TCM Qualifying Examinations tailored to the various specialties of TCM? Is it better to examine them on the fields of their expertise? Since many have been in practice for many years, are considerations given to the patients under their care? Are we depriving the continuous care of their patients by not registering them? Is there assistance given to those who have failed the examinations repeatedly in terms of their livelihood?”
“There is a need to enhance and uplift the image of nursing to emphasise the noble nature of nursing. Nurses are an important and integral part of our healthcare system. The nursing profession should be given more recognition and its due importance. I hope that MOH can involve and rope in the nursing profession into planning and implementing any healthcare policies as well. Sir, there is an increasing need to have higher-trained nurses to perform more diverse duties. Within our fast-changing technological advancements in science and healthcare, we do require nurses to master complex information. To this end, will MOH give more upgrading grants for nurses to take up special diploma courses? Could we also have an undergraduate nursing programme for nurses? Presently, the shortage of nurses is being cushioned by foreign nurses. Many of them are doing good work and it is a pity that there are some acceptability hindrances by both patients and medical managements. Many foreign nurses do not have the sense of permanence here. Could we find novel ways to make their stay here more attractive, more alluring for them to stay here permanently? Workplace Health”
“Sir, we need to pay attention to the training of our junior doctors to ensure the competency of future generations of our healthcare providers as we talked about earlier. Only by continuing to invest heavily on our undergraduate and post-graduate medical education, I would like to emphasise again, that we can ensure our doctors' competency in the future. Thus, our investments on the Health Manpower Development Programme (HMDP) should be enhanced. May I ask the Minister what steps have been taken to ensure this? May I also ask him whether our hospital doctors are too preoccupied with daily routines that require them to manage maximal numbers of patients, as the Minister said earlier on maximising their time and effort, and leave the seniors with little or no time to teach the juniors who in turn have no time to be trained? Nurses There is a shortage of nurses in Singapore. May I ask what are the steps taken by MOH to address this perennial problem? What is the attrition rate of nurses and are there measures to try to reduce this attrition rate? It is necessary to review ways to make nursing more lucrative in terms of career development and monetary returns as well as family-friendly. Lately, there has been an increase in the number of admissions of students for nursing courses in ITE. But the increase has not been matched in terms of the training opportunity for clinical exposure due to various factors, one of the reasons being the shortage of clinical instructors. This may result in less-than-satisfactory trained nurses but, more importantly, the enthusiasm and morale of such young and aspiring nurses may be harmed even before they start on the job proper. I hope MOH will look into this issue urgently.”
“Sir, doctors in the public hospitals have complained of low morale due to various factors such as the uncertainty of their career paths and the frequent change of policies. May I request MOH to look into these issues and to engage the doctors more through better communication with them? Hospital staff have to be roped in for better planning and implementing of new policies. 1.45 pm May I ask MOH for an update on the problem of shortage of junior doctors in the public sector? Sir, the American Accreditation Council for Graduate Medical Education said that work-weeks of up to 120 hours were harmful to young doctors and could endanger patient care. In America, under the new rules, the normal resident work-week is limited to 80 hours. The standards also imposed mandatory rest periods of up to 10 hours between shifts, one day off a week, restrictions on moonlighting and close faculty supervision. Is there any plan to strive for such standards here? May I ask MOH not to subject our public doctors, especially junior doctors, to 30-hour shifts that may affect their concentration and standard of patient care? The Minister mentioned earlier that there will be an increase in the annual intake of medical students. May I ask him on this number, please? May I also ask for the percentage of female medical students admitted to the NUS medical faculty last year? Is MOH still practising recruiting junior doctors from our immediate neighbours whose medical schools we never recognised before? It has been the practice of MOH to limit the training of specialists to no more than 40% of each cohort. In view of our endeavour to become the medical hub of the region, will the Minister rescind this policy and increase the number of training posts for specialists in our public sector?”